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



frequency of reduction of the clotting power of the blood in cholera, I now 

 add 3 grains of calcium chloride to each pint of salt solution, and have seen 

 no hemorrhagic stools in the few cases since treated. 



Strength of the Hypertonic Solutions. 

 In a few cases, 1-65-per-cent. solution (2|- drachms to the pint) were used 

 with good results, but as the l - 3o per cent, has proved successful in so 

 many cases, and, moreover, suffices to raise the chlorides in the blood well 

 above the normal, it is recommended for routine use. The higher strength 

 may be reserved for second transfusions in very severe cases, or when the 

 lower strength has not increased the percentage of chlorides in the blood 

 to the desired point of 1 per cent, or over, and especially if watery diarrhoea 

 continues. We have never seen any harm from running these solutions 

 rapidly into a vein in cholera, 4 pints having frequently been administered 

 in 20 minutes. The specific gravity of the T35 solution is 1006, and of T65 is 

 1008, a knowledge of which allows the strength of the solution to be rapidly 

 verified. 



-Effects of Intravenous Saline Injections on the Blood-pressure. 

 The blood-pressures immediately before and after transfusions are shown 

 in columns 6 and 7 of the table. Nil means that there was absolutely 

 no pulse at the wrist, so it could not be recorded in the radial artery, which 

 was the site of the other observations. It usually required about three pints 

 to raise the blood-pressure to 100 mm., which is the normal for Hindus. 

 Experience showed that the best results were obtained by continuing the 

 injections until the pressure rose somewhat above that point, for which 

 purpose 4 pints were generally necessary, and allow some reserve. In 

 some of the worst cases it was impossible to get it above 80 mm., as in 

 numbers 1 and 2 in the table, for it remained at that point in spite of another 

 pint being run in. One instance was met with in which even 6^ pints failed 

 to raise the pressure above 65 mm. In such there appears to be some 

 vasomotor paralysis present, possibly due to absorption of albumoses through 

 the damaged intestinal mucous membrane. Adrenalin forces up the pressure 

 in them, but its effects are only very temporary, as I formerly found it to be in 

 the vasomotor paralysis of viperine snake poisons (4). The blood-pressure, then,, 

 is a valuable guide to the amount of saline solution to be run in, a pressure 

 slightly above the normal being aimed at ; but if 4 or more pints have been 

 given, and the last 20 ounces or so have produced no further improvement, 

 it is useless to continue it at that time. Fortunately a degree of vasomotor 

 paralysis which prevents the pressure being raised to 90 or 100 mm. in natives 

 of India is rare, as such have always terminated fatally in my experience. 



