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



vitality of the tissues in cholera. I have recently had a simple cannula 

 •constructed with circular end sharpened like a cork borer, which can be safely 

 passed through the abdominal wall after incising the skin and fascia. By 

 this means saline fluid can be rapidly run directly into the abdominal cavity, 

 and it has been successfully used in a number of cholera cases in one of the 

 Calcutta hospitals. It can also be carried out in a much shorter time than 

 the more difficult operation of tying a cannula into the collapsed vein of a 

 cholera patient, but it takes several hours to be absorbed, so is less efficient 

 in urgent cases than the intravenous injections. The hypertonic solutions 

 have been found to give better results than normal saline by all methods of 

 administration. 



The Loss of Chlorides from the Blood in Relation to Hypertonic Transfusions. 



Edmund Parkes, in 1849, showed that the rice-water stools of cholera 

 contain very little albumen, but from \ to 1 per cent, of salts, so that for 

 every hundred ounces of fluid evacuations from the bowel nearly an ounce of 

 salt is lost from the blood and tissues. The main bulk of the salts consists 

 of chlorides, which may be taken as a guide to the amount in the blood at 

 any time. Some recent estimations made by me gave an average of - 53 per 

 cent, of chlorides in cholera stools. The vomited matter contains much less 

 salt than the bowel discharges, apparently owing to the gastric mucous 

 membrane being less involved in the disease processes than the intestinal. 

 Different observers have obtained very varying results as regards the 

 percentage of salts found in the blood in cholera, some maintaining that 

 they are higher, and others lower, than normal, but the observations on this 

 point in the very limited literature available in Calcutta were all made many 

 years ago. I have, therefore, estimated by the silver nitrate method the 

 amount of chlorides in the blood in a number of cases both before and after 

 transfusion with the l - 35-per-cent. sodium chloride solution. The results are 

 shown in columns 9 and 10 of the table. 



Taking first cases 1 — 7, which were fatal in the acute stage, we must bear 

 in mind that on the average two-thirds of the fluid had been lost from their 

 blood. If only the water had been removed without any saline constituents, 

 then the chlorides should have been present in three times the normal 

 amounts. The percentage of salts in the blood in Bengalis has been found by 

 Captain McCay to be somewhat higher than in Europeans, namely about 

 1 per cent., about 0'8 per cent, of which are chlorides. Yet in the fatal 

 cholera cases, in spite of the great concentration of the blood, the chlorides 

 were below the normal in four out of five, the single exception being a very 

 old man who died of heart failure. Eully two-thirds of the total chlorides of 



