CHOLERA 



211 



Rogers gives some very interesting figures comparing the results 

 of the old methods with the new as follows : — 



Old System, 1895-1905 

 Age Cases Deaths Percent. 



52-8 



51-3 

 5&-5 

 637 

 69-4 



737 



Cases 



24 



121 

 197 

 134 



43 

 23 



New System, 1913-1915 



Deaths 



17 

 44 

 28 

 16 

 1 1 



The remaining mortality was due to collapse, uraemia, pneumonia, 

 heart failure and exhaustion, hyperpyrexia, septic complications. 



The total mortality is reduced by his treatment to 20 per cent, or 

 one-third of the former rate. 



Cox claims better results still as a result of using isotonic saline 

 instead of hypertonic saline. Cox, who has treated over 2,000 cases, 

 gives his figures as follows: — 



India China 



Collapse cases only 



Rogers, 1909-10 

 Number of cases, 103 

 Average amount transfused, 4^ pints 

 Mortality, 32 per cent. 



Cox, 1910 

 Number of cases, 666 

 Average amount transfused, 13 pints 

 Mortality, i8"8 per cent. 



In certain cases Cox gives hypertonic saline for the first eight pints 

 and then continues with the isotonic salines. 



Rogers denounces opium in any case. 



Cox has found it very useful in cases of collapse. 



Cox continues : An adequate reaction proportionate to the degree 

 of collapse must be looked for and assisted. This condition is never 

 attained until the infusion reaction rigor (which occurs approximately 

 when five pints have been infused) is w^ell passed. The continuance 

 of the saline infusion after the occurrence of the reaction rigor up to 

 8-10 pints will procure the following benefits : — 



(i) Dilution of the blood. 



(2) Elevation of the blood pressure, with re-establishment of sup- 

 pressed renal flow^ 



(3) Elimination of the endotoxins from the blood and later from the 

 stools, thus obviating the onset of the febrile reaction stage of 

 cholera, the remainder of the illness being usually apyrexial. 



No apprehension need be felt at a rise of temperature to 103° F. 

 during the infusion, in fact, this degree of temperature oscillation I 

 consider the most favourable for cessation of infusion of less than six 



