THE DANGERS OF SALINE INJECTIONS
Authors: E. C. Hort, W. J. Penfold
Journal: BMJ (1911)

THE DANGERS OF SALINE INJECTIONS.[ I Tu BAvJOUA 589 C'linical Si!ifls and Sym)pto)iis.-He is mich emaciated anid very pale.The abdoomen is slightly distended, At the ininer half of the left costal margin a lhard mass can be felt projecting (lownwards for a couple of inches.It is dull oIn light percussion.It is separated from the spleen, which is not enlarged, by a belt of resoinaince.It is continuotus with the liver dullness.The liver (loes niot extend below the costal margini.The Blood.The leucocyte clhart of this case shows a very sinlilar variation to that of the Hodgkin's disease.There is a marked daily rise and fall in the number of leueocytes.The variation on the average amounts to fromii 5,000 to 40.000 leuicocytes per cubic millimetre of blood, an eight- fold increase.The leucocytes reach their height about midday, and are lowest about midniglht.The total muononuclear percentage, howvever, unlik-e tllat of Case i (Hodgkin), remains at about normal level, and thiere seems to be a tendency for the mononuclear per- centage to fall with the leucocyte rise.The temperatutre of this ease has so far remained normal, and during the period of observation the patient remained in bed.FnurUer Observations on the Blood.Red Cells, 3,200,000 per cubic millimetrC.-Theyslhowe(d some poikilocytosis and basophilia.Occasional nucleated red cells annd occasional microcytes were found.Haemuo- globin 30 per cent.Leucocytes.-The eosinophiles were sliglhtly increased, sometimes as many as 8 per cent.Occasional myelocytes were seen, and there was an occasional increase of large mononuelear leucocytes.This case, in my opinion, also suggests the possibility of the presence of a protozoal parasite having a definite period of development.Again referring to Cabot (1904), I find that the leucocyte counts in cancer of any part of the body are very variable, from-n 3,000 per c.lnin. to conisiderably over 100,000 per c.mmll. of blood.Isolated counts, however, seem only to have been iaile, usually niot more than once daily, so that I aDl led to believe that the variations recorded dependedl chiefly upon the fact that the blood was taken at different periods of the leucocytic cycle, the cycle ha'ving been nissed owing to the infrequency of the counts.It is stated also that a digestion leucocytosis is seldom found in cancer of the stomach, so that the daily variation' revealed in this case can hardly be attributed to a digestion lencocytosis, in which the leucocytes seldonm increase to even twofold their number.It appears also that considerable variationis in the character of leucocytes are found in canicer cases.It is stated bv Cabot that Taylor, Osler and MeCrac have found an increase of the large mononuclear leucocytes in some cases amounting to 26 per cent.I think that these facts are also significant, as in mialarial fever, in which there is a marked leuicocytic cycle, marked variationis also take place in the relative variety of leucocytes, and there is a marked increase in the lnumlber of large m-iononuclears.Controls A, B, and C.-Tlhe letucocytes in tllese colntrols slhowed no abnormality in variety or numbers.;Control A was a healthy female, aged 26; controls B and C were lhealthy males, both 27 years of 'age.From this papIer it w-ill appear that repeated daily couniting of leucocytes is lilkely to give a valuable methocl of diagniosis in var:'e.a3dliseases.N.B.-None of tIme above cases, nor the controls, lhad aniy hiistory of malarial fever, neither had they any septic comiiplications.Before concluding I would beg. to tlianik Dr. Macalister anid Dr. Lloyd Roberts for their kindness in giving m7ne full scope in the examination of the blood of their patients.