EDITORIAL. 145 



is almost certain, but I have seen one or two cases in which it did not 

 occur. In the provinces, in the midst of an outbreak any diarrhoea is 

 considered suspicious of cholera, and if that diarrhoea is followed by 

 cramps, we are apt to regard the case as one of cholera. 



Dr. v. L. Andrews, assistant. Biological Laboratory, Bureau of Science, 

 Asst. professor of patJiology and hacteriology : I am interested in Dr. 

 Eoger's remarks with reference to blood pressure. In the work at San 

 Lazaro Hospital I could distinguish, by the reaction of the patients to 

 the intravenous treatment with saline solution, two classes of cases. First, 

 those who would rally and not return to a condition of collapse; second, 

 those who would rally for a short time after each intravenous injection 

 of saline solution, but would in a little while sink into collapse again. In 

 the patients, comprising the second class of cases, there was no abate- 

 ment of the diarrhoea, and the water seemed to pass out through the 

 intestines as fast as it was injected into the veins; these patients did not 

 always manifest the severest symptoms at the beginning of the disease 

 nor were they always those to whom medical attendance came late in 

 its course. 



There seemed to be a point up to which the intravenous solution 

 might be given and the patient rally and remain in this condition, but 

 if one went beyond this point it would not be but a short time before 

 the diarrhoea would apparently be worse and the patient again sink into 

 collapse. 



In collapse, the organic constituents of the blood are concentrated, and 

 as the restoration of the normal ratio between the organic and fluid 

 parts of the blood is the thing to be desired, possibly the estimation of 

 the blood pressure by an instrument of precision instead of attempting 

 to estimate it by the sense of touch while feeling the pulse would greatly 

 aid one in determining the stopping point of the injection. 



With reference to Dr. Heiser's remarks that the virulence of an 

 epidemic always decreases toward its close I will state that the figures 

 of the present epidemic show a decrease of only 5 per cent between the 

 mortality of the first half and that of the last half of the epidemic. 

 I think that this difference can be attributed to improved facilities in 

 the discovery of the cases in the early stages of the malady, and their 

 prompt removal to the hospital rather than to a decrease in virulence 

 of the disease. 



Dr. Strong: In Dr. Andrews's paper I believe that all of the more 

 important points in reference to the treatment of the disease were referred 

 to. I might add a word in regard to the treatment of severe dyspnoea. 

 Dyspnoea occurs commonly in cholera as a symptom of collapse, and is 

 an evidence of failing circulation and disturbed cardiac action. Sudden 

 and severe dyspnoea may also occur apparently either from the develop- 

 ment of coagula in the right heart or to a spasm of the smaller pulmonary 

 arteries, in which case the vessels of the lungs are unable to transmit the 



