292 Prof. L. Rogers. Variations in Pressure and [Dec. 4, 



treatment, than the mere administration of more or less useful drugs, into a 

 gastro-intestinal tract, which is too congested to retain any appreciable powers 

 of absorption. The great loss of fluid from the blood was shown by marked 

 increase of the number of red corpuscles per cubic millimetre, which 

 sometimes rose from 5,000,000 to over 8,000,000, while, like others, I found 

 leucocytosis to be constantly present, and when of a marked degree to be of 

 bad prognostic value. Differential counts showed a great decrease of the 

 lymphocytes, corresponding with their accumulation in the lymphoid tissue of 

 the alimentary tract, while the large mononuclears were markedly increased, 

 both relatively and absolutely, this change being in proportion to the 

 mortality, indicating its probable relationship to some specific toxin of the 

 disease. These changes were often of great value in the difficult diagnosis of 

 cholera from ptomaine poisoning, as I have not found them in the latter 

 affection. 



More recently I have studied the blood-pressure in cholera as an indication 

 for the necessity of transfusion and the quantities to be injected. My first 

 experiments in this line were carried out in conjunction with Captain 

 J. W. D. Megaw, I.M.S. (2), who was in charge of the cholera patients at the 

 Calcutta Medical College, normal saline solution (1 drachm to the pint) 

 being used in accordance with the general custom. The patients were nearly 

 all natives of India, whose normal blood-pressure averages only about 

 100 mm., being thus considerably lower than that of Europeans. In cholera, 

 the pressure was rarely over 50 mm. on the admission of the patients, while 

 in many it was too low to be estimated in the radial artery, owing to absence 

 of any pulse at the wrist. We found that 1 pint of saline solution injected 

 into a vein usually had very little effect in raising it, but a second pint 

 generally increased it to 90 mm. or more. The immediate effects of this 

 treatment were little short of marvellous. The terrible restlessness and 

 cramps disappeared, and the worn out patient often fell asleep before its 

 completion. The pulse was fully restored, and the blueness and coldness 

 were replaced by the normal pink hue of the lips and nails and warmth of the 

 extremities. A few improved steadily from that time, but only too frequently 

 within 2 to 12 hours the copious rice water stools and vomiting recurred, and 

 the patient relapsed into as bad a condition as before, with complete loss of 

 the improvement in the blood-pressure. Eepeated transfusions usually failed 

 to save such patients, and although the mortality did show some reduction 

 during the year Captain Megaw continued them, yet the disappointments 

 were so many that the method soon came to be adopted only in a few 

 desperate cases, and was eventually almost entirely abandoned once more, as- 

 it had been by so many earlier enthusiasts. 



