396 ARON. 



Two years ago, Kogers - stated that there is not only a great loss of 

 water in cholera, but, especially in severe cases, of the salts (chlorides) 

 in proportionally greater amounts than water, the blood becoming 

 hypotonic. Therefore, he suggested the injection of hypertonic " saline 

 solution and not of a normal solution such as is usually employed. In 

 recent papers 3 he describes very favorable results by this method of 

 treatment. As already mentioned, Eogers bases his treatment on the 

 fact that he found a diminution of the chlorides in the blood. The 

 accuracy of his chemical method of estimating the content of chlorides in 

 the blood or blood serum is open to criticism ; furthermore, his differences 

 depend upon results showing that the blood of the average healthy 

 Bengalese contains relatively more chlorides than that of Europeans. 



I have undertaken a number of further analyses because of the im- 

 portant bearing which the composition of the blood in cholera may have 

 upon the pathogenesis of the disease and its successful treatment, and I 

 began with a number of cholera patients who were brought to the San 

 Lazaro Hospital for Infectious Diseases. 



Blood samples were taken from a vein in the arm of the patient 

 before treatment had been instituted. It is often quite difficult and 

 sometimes impossible, especially in the stage of severe collapse, to 

 secure even a few drops of blood in this way. In addition to the 

 above, material was not abundant this year because the incidence of the 

 disease in the city of Manila was very small, only two or three cases 

 occurring per day, and a number of these were children. All the patients 

 from whom blood was taken showed the typical picture of cholera, and 

 the clinical diagnosis in each instance was verified at the biological 

 laboratory of the Bureau of Science by a bacteriologic examination of the 

 fa?ces. It seemed better, as was done by Rogers, to estimate the chlorides 

 as an index of the most important changes in the salt content of the 

 blood, rather than to determine the -total ash, because the latter course 

 never gives such exact results. 



Twenty or 30 cubic centimeters of the blood were poured into a glass-stoppered 

 weighing-bottle filled with a mixture of oxalate solution and a few drops of 

 formalin, the weight of these fluids having previously been determined. To be 

 used for the determination of the total solids, a second sample of 2 to 5 cubic 

 centimeters was at the same time put into a weighed, empty, glass-stoppered bottle. 

 The two were then sent to the laboratory as quickly as possible, again weighed, 

 and weighed portions of the samples taken for analysis. The content of chlorides 

 alone was determined in the first sample, and, as a rule, two parallel analyses 

 were made. 



It was my intention to make the first determinations according to Neuman's 

 method* which in former experiments has given very satisfactory results. 



'This Journal, Sec. B (1909), 4, 99. 



"Therap. Gaz. (1909), 33, 761. 



* Ztschr. physiol. Chem. (1903), 37, 115. 



