146 EDITORIAL. 



thickened blood. If the dyspnoea is due to the latter cause^ life may 

 sometimes be saved, provided immediate measures are instituted. Nitrate 

 of amyl should be administered at once with the object of overcoming 

 the spasm of the arteries and intravenous injection of saline solution 

 rapidly given at the same time, with a view of increasing the pressure 

 and of diluting the thickened blood. During the recent epidemic, two 

 cases of sudden dyspnoea and marked cyanosis were treated in this way, 

 in both of which the symptoms quickly disappeared and the cases even- 

 tually recovered. 



Dr. Paul C. Freer, Director of the Bureau of Science; professor of 

 chemistry and dean of the Philippine Medical School: The statements 

 of Dr. Eogers which are so well in conformity with those of many others, 

 that the severe symptoms of cholera are caused by losses of fluid from 

 the blood, brings us to the question as to how the action of the soluble 

 toxin is produced. We have discussed that question considerably in the 

 laboratory and I would like to hear from some of the biologists of what 

 they think about the subject. 



Dr. Oscar Teague, assistant. Biological Laboratory, Bureau of Science: 

 What I might say with regard to the cause of the diarrhoea in cholera 

 has only a theoretical interest and the experiments of Dr. Strong and 

 myself have developed as yet no new facts in this direction. 



It might be thought that since the cholera vibrio is one of the most 

 motile organisms with which we are acquainted and since it penetrates 

 the superficial layers of the inner lining of the intestine, the mechanical 

 stimulation of the nerve endings thus produced might set up an in- 

 creased peristalsis and resultant diarrhoea. But the consensus of opinion 

 is that the diarrhoea in cholera is due to a toxin, and in certain animals 

 a diarrhoea is produced when killed cultures of the cholera vibrios are 

 injected intravenously. Wliether the toxic substance concerned is a true 

 soluble toxin or an endotoxin, which is set free only after the death and 

 disintegration of the vibrios, is still undecided. It seems to me that 

 probably both the mechanical irritation of the motile vibrios and the 

 cholera toxin are factors in the causation of the diarrhoea. 



