1908.] 



Composition of the Blood in Cholera. 



295 



such epidemic years as the present one, and the patients were frequently too 

 numerous to allow of as many being transfused as we should have liked. 

 Very favourable reports have also reached me from two other medical officers 

 who have tried hypertonic solutions in cholera. 



During the last few months I have made a number of observations on the 

 blood changes before and after transfusion in cholera, which appear to furnish 

 a rational basis for the regular use of large hypertonic transfusions in the 

 treatment of the disease, and propose to deal with them in the present 

 communication. The data have all been tabulated for convenience of 

 reference. 



The Relationship of the Amount of Fluid lost from the Blood in Cholera to the 

 Degree of Collapse and the Death-rate. 



As has been pointed out by Macnamara, Wall, and others, the amount of 

 the watery evacuations in cholera will not furnish accurate data for estimating 

 the degree to which the blood is drained of fluid, for the very rapid escape of 

 2 or 3 pints will have a far greater effect on the circulation than much 

 more considerable loss spread over a longer time. Thus, in the so-called 

 cholera sicca, in which death takes place without actual diarrhoea, the small 

 intestines always contain several pints of liquid, the rapid draining of which 

 from the blood has caused fatal circulatory failure. In order to ascertain the 

 real loss of fluid from the blood in cholera, and the effects of various quantities 

 of intravenous saline injections required to replace it, I have taken blood 

 immediately before and after transfusion, defibrinated it at once, and 

 measured the relative volumes of corpuscles and serum by centrifuging in 

 the hsemocrite. As the red corpuscles are not lost to the circulation, but 

 only the fluids of the blood, the reduction in the volume of serum can be 

 readily calculated, and the actual loss of fluid from the serum of the blood 

 estimated from the total volume of the blood in the body. According to 

 some observations on healthy Bengalis by Captain McCay, I.M.S., the average 

 proportions of corpuscles and serum respectively were 45 and 55 per cent.,, 

 showing a slightly smaller proportion of corpuscles than in Europeans. 

 Assuming that the red corpuscles are not lost from the circulation, the 

 diminution in the serum can be calculated by the following formula from the 

 hsemocrite figures. As the percentage volume of corpuscles found is to 

 the normal value (45 per cent.), so is the volume of serum found to X. For 

 example, if in a case of cholera the volume of corpuscles is 71 per cent, and 

 of serum 29 per cent., then as 



71 : 45 :: 29 : X, and X = 16. 



