EDITORIAL. 143 



canal and the further concentration of the blood. They thought perhaps 

 that a reabsorption of fluid nnight even take place from the intestine 

 and they were able to show in their animal experiments that such a 

 reabsorption did take place. Eumpf tried this method of treatment in 

 cholera, but did not obtain any more favorable results with it than with 

 that in which normal salt solution was employed. 



There is no doubt that the specific gravity of the blood is higher than 

 normal in the severe cases of Asiatic cholera, as has been shown by num- 

 erous careful examinations. This concentration of the blood is due to 

 the loss of water; the organic constituents are thereby increased. 



Biernacki showed that both the leucocytes and red blood corpuscles 

 were increased in number, owing to the loss of fluid from the blood; the 

 latter numbering from 6 to 8 million in severe cases. The salts of the 

 blood pass into the intestines together with the water. A number of 

 chemical analyses of the blood in cholera made by Schmidt showed a 

 moderate decrease in the sodium chloride and an increase in the potassium 

 salts in the concentrated blood. Schmidt's analyses were made in 1850 

 and no careful chemical study of the blood in cholera appears to have been 

 made since. Dr. Aron of our laboratory has recently begun some chemi- 

 cal analyses of this nature. I believe that the increase in the specific 

 gravity of the blood in cholera is due largely to the increase in the organic 

 constituents and is not affected much by the decrease in the amount of 

 salts. If it is advantageous to increase the amount of sodium chloride in 

 the blood in cholera cases beyond the normal, it would seem that theoret- 

 ically we have a basis for using the injections of hypertonic saline solution 

 as recommended by Major Rogers, however from the experiments of 

 Gartner and Beck we must bear in mind that possibly the toxic substances 

 in the intestine, the products of the cholera spirillum, may be more 

 rapidly absorbed at the same time the reabsorption of any water that may 

 be present takes place. 



During the recent epidemic in Manila, both hyper- and hypotonic injec- 

 tions of saline solution were employed in a small number of cases, but we 

 were unable to decide definitely in regard to their value. For the routine 

 method of treatment, saline solution of a specific gravity .085 was 

 employed. 



"We have also used the intraperitoneal injections, but could not convince 

 ourselves that they were as advantageous as the intravenous ones. Such 

 a canula as Major Rogers has suggested would certainly minimize the 

 danger of giving the intraperitoneal injections, and as he has remarked, 

 the intraperitoneal injections may be performed in a shorter time than 

 the intravenous ones. Ther-^fore, the former would be of advantage in 

 a large epidemic where the force of doctors and nurses was inadequate to 

 administer the intravenous injections. 

 84022 6 



