100 ROGERS. 



many as 8,000,000 per cubic centimeter repeatedly having been found 

 by nie, the amount of serum whicli has been drained from the blood can 

 be estimated by a simple calculation. Working in this way I obtained 

 the following results in a successive series of cases treated by the method 

 described below. The average loss of serum in the most severe class of 

 cases, which comprised those which proved fatal in spite of intravenous 

 transfusion, amounted to no less than 64 per cent of the total. In the 

 cases requiring transfusion, but who recovered, the loss was 52 per cent. 

 In the mildest cases, who recovered without transfusion, it averaged only 

 35 per cent. There was thus a most definite relationship between the 

 loss of serum from the blood, with its corresponding concentration, and 

 the severity of the disease. If we take the blood as one-thirteenth of 

 the body weight, and the volume of serum of these Bengali patients as 

 55 per cent, then in the fatal cases no less than 42 of the total 66 ounces 

 of serum were on the average lost from the circulating blood alone, in 

 addition to the great drain from all the tissues of the body. Further, 

 in the second class of recoveries after transfusion, the loss averaged 34 

 ounces. Such great losses of fluid, accompanied by a corresponding 

 degree of concentration of the blood, must necessarily greatly embarrass 

 the circulation, evidence of which is so clearly seen in the cold and blue 

 extremities. In the severer cases the blood is so thick that it will not 

 run into the capillary tube of a hsemocrite without the aid of suction, 

 so that its passage through the minute vessels of the pulmonary and 

 systemic circulations must be very difficult. Moreover, as long as this 

 condition of the blood remains, and the exceedingly low blood pressure 

 of 50 millimeters and less exists in severe cholera, there is no possibility 

 of renal secretion, and on this the system is mainly dependent for the 

 removal of the toxins. All these observations point to the replacement of 

 the lost fluid as the primary consideration in the treatment of the 

 collapse stage of cholera. 



THE PROPORTION OF SALTS IN THE BLOOD IN CHOLERA. 



At first sight it might be expected that the loss of such large quantities 

 of fluid would be associated with an increase in the percentage of salts 

 in the circulating blood, and that this condition might act as a conserva- 

 tive process by producing osmotic currents carrying fluid into the blood 

 rather than from it. In this manner it would check the further escape 

 of the fluid through the bowel wall, a process which manifests itself 

 in the form of a M'atery diarrhcea and one which becomes much less 

 marked in the collapse stage. Further, intravenous transfusion of normal 

 saline fluids, such as have been used in the treatment of the disease 

 for the last eighty years, would reduce the excess of salines in the blood, 

 and again restore the draining of fluid through the intestines. It is 

 just this recurrence of the diarrhoea, commonly within a very few hours, 

 or even immediately after such injections, which has led to the generally 



