TREATMENT OF CHOLERA. 105 



There is, then, a very definite relationship between a continued low 

 blood pressure and the supervention of uraemia after recovery from 

 the acute stage of cholera, which affords most valuable indications for 

 treatment of this justly dreaded complication. Uraemia is most frequent 

 in two classes of cases, first in very acute ones admitted early in the 

 disease, and second, in mild ones admitted more than 48 hours after 

 its onset, whose treatment has been consequently neglected, and in which 

 a low blood pressure has persisted for a long period of time. 



CONCLUSIONS. 



1. The severity of the cholera attack is in proportion to the loss of 

 fluid and salts from the blood, which, in all but mild cases of the disease, 

 it is desirable to replace. 



2. This can best be done by the intravenous injection of about four 

 pints of hypertonic salt solution, two drachms of sodium chloride to the 

 pint, (1.35 per cent) being a suitable strength. The use of this sohition 

 has reduced the mortality during 1908 in the Calcutta Medical College 

 Hospital by nearly one-half. 



3. When time does not suffice and the staff of assistants is not suf- 

 ficiently large for the regular administration of intravenous injections, 

 the salt solution may be given intraperitoneally with great advantage 

 by the simple method described above. 



4. Post-choleraic uraemia is associated with deficient blood pressure, 

 and should be treated by methods which raise the tension in the arterial 

 system. 



(For the discussion of this paper before the Philippine Islands Medical 

 Association see p. 141.) 



