Variations in Pressure and Composition of Blood in Cholera. 291 



vein leaves the cranial cavity through the foramen magnum. A very 

 characteristic feature of Sphenodon is the development of large transverse 

 sinuses resembling those of the crocodile, but these communicate with the 

 extracranial vascular system in quite a different manner from that described 

 by Eatbke in the latter animal. 



The Variations in the Pressure and Composition of the Blood in 

 Cholera ; and their Bearing on the Success of Hypertonic 

 Saline Transfusion in its Treatment. 



JBy Leonaed Rogers, M.D., F.R.C.P., F.R.C.S., I.M.S., Professor of Pathology, 



Calcutta. 



(Communicated by Sir T. Lauder Brunton, Bart., F.R.S. Received 

 December 4, 1908 — Read January 28, 1909.) 



During the quarter of a century which has elapsed since the discovery by 

 Prof. Koch of the comma bacillus of cholera, research work has been almost 

 ■confined to the bacteriology of the subject. Unfortunately, with the exception 

 ■of M. Haffkine's prophylactic inoculations, which are now very little used 

 ■even in India, this line of work has done little or nothing to help the 

 practitioner who is confronted with the treatment of this terrible disease. ISTo 

 powerful antitoxic serum of practical value has been produced, and even if 

 ;such should still be obtained, many patients come under treatment in such a 

 .state of collapse that no medicine can be absorbed, even if retained. 



The old controversy between the evacuant and conservative methods of 

 treatment has long since ended in the practically universal adoption of the 

 latter, although as late as 1866 Dr. George Johnson advocated castor oil, 

 denying that there was any relationship between the amount of fluid lost from 

 the body and the mortality, while he strenuously opposed the use of 

 intravenous saline injections to replace it. There is still much difference of 

 opinion about the latter treatment, for although all who have used transfusions 

 testify to the remarkable immediate improvement in the pulse and general 

 condition, yet this is commonly of such brief duration that many think it only 

 serves to needlessly prolong the agony of the patient, so that of recent years 

 it has been only exceptionally resorted to in India. 



For a long time I have been investigating the blood changes in cholera (1), in 

 the hope of finding some indication for a more rational and successful line of 



