COMPOSITION OF THE BLOOD IN ASIATIC CHOLERA. 401 



does not prove that the blood has become hypotonic. The quantity of 

 salts is often reduced in relation to the amount of total solids, but 

 this calculation is apt to convey a wrong idea with regard to the tonicity 

 of the fluid. The quantity of the salts should be compared in relation 

 to the quantity of water and then it should be determined whether 

 the loss in salts is proportional to the loss, in water, or greater or less. 

 If we do this, we will see that in the samples obtained during the first 

 three days of the disease we can scarcely speak of a greater loss in 

 the salts than would correspond to that of water. Of course, in the 

 later stage of the disease, in Schmidt's analyses as well as in my own, 

 the water content of the blood is almost normal, while that of salts, 

 estimated as chlorides, is below that point. At this time, which corre- 

 sponds to that of the urasmic stage of the disease, we really would 

 have a hypotonic blood. It is worth noting that Eumpf 8 and Dennstedt 

 also found a very great decrease in salts with but slight decrease in 

 water in the blood of a man dying of nephritis (in urasmia). 



The composition of the blood obtained at autopsy is exactly the 

 same as that in the stage of collapse, during which all of these persons 

 died. The water in almost all of these instances is decreased to 72 

 per cent. I found in this blood a marked decrease in the content of 

 sodium, and a slight increase in that of potassium and of phosphorus. 

 The results agree with those of the more extended analyses of Schmidt. 

 This increase in potassium is readily explained if we consider that 

 cholera blood contains a higher percentage of red blood cells than is 

 normal. Schmidt pays special attention to the increase in phosphorus. 

 "While I found the same, I do not consider it at all remarkable, for 

 the rise in the percentage of red blood cells and protein probably 

 accounts for the higher phosphorus content of the blood. 



The analyses of the sera also show a decrease of water and chlorides 

 in cholera as compared with normal serum. The loss of the blood 

 in water, as shown by these analyses as well as by those of Schmidt, 

 is partly due to the loss of the serum in water, but the latter must also 

 leave the red blood cells. The reduction of chlorides and water shown 

 by the analyses of the serum confirms the observation made on samples 

 of the entire blood. 



SUMMARY. 



In the stage of collapse in cholera a loss of water in the blood is 

 regularly encountered, accompanied by a corresponding loss of chlorides 

 (salts). This water loss is constantly high in the blood of persons 

 who have died of cholera. In the later stages of the disease, the 

 blood again shows an almost normal content of water, but the salts 

 are not replaced to the normal amount. Therefore, the blood at this 

 stage has a diminished salt content and is hypotonic. 



8 Miinchener med. Wchnsohr. (1905), 52, 393. 



