392 M'LAUGHLIN AND SELLARDS. 



tonicity, if it were sufficiently pronounced, might even result in absorp- 

 tion of fluid from the intestine. This, of course, would be accompanied 

 by the possibility of the absorption of bacterial products. However, 

 in practice, it is not supposed that the solutions employed are sufficiently 

 strong to cause any such harmful action. The effect of the isotonic 

 solution would fall between these two extremes, and presumably it 

 would not interfere with the natural processes of the body. The 

 essential question is whether one should attempt to maintain the cir- 

 culation with the use of as little fluid as practicable, checking the 

 diarrhoea if possible, or whether liberal amounts of fluid should be 

 used, allowing the diarrhoea to continue. In some respects the absolute 

 cessation of excretion by all channels is less desirable than a limited 

 amount of diarrhoea. 



Hypertonic salt solution has been in use for several years in the 

 treatment of the stage of collapse in cholera, but Eogers recently has 

 nsed it extensively and has reported very favorable results. He com- 

 pared the results obtained with hypertonic solution of 1.3 per cent 

 with those obtained with a hypotonic solution of 0.6 per cent. 



In the autumn of 1909 a small epidemic of cholera occurred in 

 Manila and at the request of Doctor Strong the effect of different 

 concentrations of salt solution for treatment were again studied. Two 

 solutions were tested, an isotonic one of 0.85 per cent and a hypertonic 

 of 1.3 per cent, The first 10 cases in each series were treated with a 

 Binger's solution which was prepared according to the following formula : 

 Sodium chloride, 0.8 per cent; potassium chloride, 0.04 per cent; and 

 calcium chloride, 0.025 per cent for the isotonic and for the hypertonic 

 solution, the sodium chloride was increased to 1.3 per cent, but the 

 calcium and potassium salts were not changed. For the remaining cases 

 sodium chloride only was used, in 0.85 per cent and 1.3 per cent solution. 



In comparing different concentrations it is important, of course, 

 to know the changes in the salt content of the blood. In the following 

 work it has been assumed that the loss of salts occurred somewhat 

 proportional to the loss of fluid and that the relative differences exist- 

 ing in the two salt solutions were not fundamentally altered after 

 injection. 



The cases were divided into two series as nearly comparable as pos- 

 sible. One of these series received isotonic and the other hypertonic salt 

 solution. As a routine, 2 liters of fluid were injected intravenously in 

 the course of one-half hour. The number and frequency of the injec- 

 tions was varied according to the individual case. In general, they 

 were repeated when the pulse became weak and rapid and when the 

 blood pressure registered between 50 and 70 millimeters of mercury. 



Measurements of the blood pressure were made on all cases. Kising 



