1908.] 



Composition of the Blood in Cholera. 



299 



the blood must, therefore, have been lost. In case 5, with only 0'67 per cent, 

 of chlorides, the serum showed actual commencing haemolysis, which com- 

 pletely disappeared when they had been raised to 088 by hypertonic 

 transfusion, while similar results have been noted in a few other cases with 

 very low salt content. Column 10 shows that a material rise in the 

 percentage of chlorides in the blood was obtained by transfusion of 3 to 4 pints 

 of r35-per-eent. sodium chloride solution, but the average amount after it 

 was still only - 95 per cent. 



On turning to the recovering cases 8 to 24, we find the average percentage 

 of chlorides in the blood before transfusion was - 90, or considerably higher 

 than in the fatal series, and the same remark applies to the figures obtained 

 after transfusion, when the average was T07 per cent. Moreover, in cases 10 

 and 16, which showed a low amount of chlorides after the injection, the 

 disease was very severe, and in one a second transfusion was necessary to 

 save the patient. It will be observed that several of the cases, which 

 recovered after the injections, showed very low chlorides in the blood at the 

 first estimation, but when they were raised to about 1 per cent, or over by 

 the hypertonic solutions, the patients almost invariably did well as far as the 

 collapse stage of the disease was concerned, which is the most dangerous 

 period in cholera. 



Another striking feature was the far less tendency of the hypertonic 

 solutions to restart the copious rice-water stools, which so commonly renders 

 the use of normal salines of such very temporary value. It is not too much 

 to say that at the Medical College Hospital, where cholera patients are 

 usually brought in an advanced stage of collapse, the simple substitution of 

 2 drachms of salt to the pint instead of one, for transfusion, has so 

 revolutionised the treatment, that, whereas formerly it was considered a 

 matter for surprise when a severe case of cholera recovered, it is now a great 

 disappointment when such a case is lost in the collapse stage. 



The Coagulability of the Blood in Cholera. 



A few observations on the clotting power of the blood have been made by 

 Sir Almroth Wright's method. The results were very variable, the time 

 being normal in some, slightly reduced in most, and very markedly in a few. 

 It is noteworthy that in several of the worst cases, with a specially low 

 percentage of chlorides, blood taken in glass tubes remained quite uncoagu- 

 lated after several hours, and in one such case there were hsemorrhagic stools, 

 found post mortem to be dependent on extensive petechial haemorrhages in 

 the caecum. After transfusion with hypertonic solutions the blood in such 

 cases clotted firmly and gave a clear serum. In view, however, of the 



Y 2 



