1908.] Composition of the Blood in Cholera. 297 



specific gravity of the blood by the chloroform and benzene method, or more 

 conveniently in a hot climate by Lloyd Jones' plan of using a series of small 

 bottles containing solutions of glycerine in water of different specific 

 gravities, into several of which a drop of blood can be placed until the one 

 in which it neither sinks nor rises is found. I have made a number of 

 observations in this manner, and find that in bad cases of cholera the specific 

 gravity usually rises over 1070, while in those which did not require 

 transfusion it only reached up to about 1065, so that a clinically valuable, 

 approximate estimation of the concentration of the blood in cholera can thus; 

 be very rapidly obtained at the bedside. Moreover, this test can be repeated 

 during transfusion so as to ascertain when the blood has been diluted down 

 to its normal point, or better, a little below it, and the quantity of fluid 

 injected can be so regulated. 



The Quantity of Fluid required to replace the Loss in Cholera. 



Columns 1 and 5 in the table show the percentage volume of serum in the 

 blood before and after intravenous transfusion with 1*35 sodium chloride 

 solution in the quantities indicated in column 4. The usual amount was 

 4 pints, and in several successful cases this quantity was repeated a second 

 time. These are larger amounts than are usually recommended for intra- 

 venous use in cholera, but have given very good results. Moreover, column 5 

 of the table shows that they did not increase the volume of serum very 

 materially above the normal level of 55 per cent., while any excess will pass 

 rapidly into the greatly drained tissues, and some allowance must be made 

 for further losses through the bowel before the disease completely subsides. 

 In several cases the blood was found to have again become so concentrated 

 by the following day as to necessitate a second injection, with ultimate 

 recovery, so that the amounts used were certainly not excessive. At the 

 same time there must be a limit to the quantities that can be rapidly 

 administered intravenously at one time, and the fact that in several cases the 

 volume of serum was raised to between 65 and 70 per cent, appears to 

 indicate that 4 pints is sufficient in most cases. In the very exceptional 

 concentration of the blood in case 5, however, even this amount failed to 

 increase the serum even to the normal point, the specific gravity after the 

 injection being also 1064, or considerably above the normal, and the patient 

 ultimately died. 



In the less severe types much fluid can be got into the system by rectal 

 injections, which are of great value. Subcutaneous injections are often used, 

 but act much more slowly than intravenous ones in raising the blood- 

 pressure, and are very liable to be followed by abscess in the low state of 



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