302 Variations in Pressure and Composition of Blood in Cholera. 



recovered from the collapse stage. On the fifth day both had passed little 

 or no urine and showed definite uraemic symptoms. The blood-pressure of 

 one was now only just 100 mm. and he died the following night of uraemia. 

 That of the other was 120 mm., and he began to pass urine that day, and 

 made a good recovery. Soon after another patient developed well-marked 

 uraemia, his respirations being over 40 per minute and very laboured, while 

 he was practically unconscious, and apparently in a hopeless state. As his 

 blood-pressure was found to be only just 100 mm., adrenalin and digitalis 

 were administered subcutaneously, and on the following morning his pressure 

 was 110 mm., he had recovered consciousness, was passing urine freely, and 

 got well from that time. Thus, the indications derived from the post-mortem 

 kidney perfusion experiments have been borne out in practice, and it is clear 

 that the blood-pressure is the most important factor to be attended to in the 

 treatment of the deficient renal secretion, which ensues in so many severe 

 cholera cases, after the danger of death from collapse has been averted by 

 saline transfusions. 



Conclusions. 



1. In cholera there is a very definite relationship between the amount of 

 fluid lost from the blood and the severity and mortality of the disease. 



2. This loss is usually so great as to indicate saline transfusions to restore 

 the circulation. 



3. Injections of normal salt solutions are commonly of only very temporary 

 benefit. 



4. Hypertonic salt solutions (1'35-per-cent. sodium chloride, or 2 drachms 

 to the pint) are much more effective, their use having reduced the mortality 

 by about one-half. 



5. A great loss of chlorides from the blood occurs in cholera, most marked 

 in the worst cases. If the percentage of chloride is considerably raised by 

 the intravenous injection of hypertonic salt solutions recovery usually 

 ensues. 



6. The development of uraemia in the reaction stage of cholera is 

 associated with a comparatively low blood-pressure, measures to raise which 

 are indicated for the prevention and treatment of this very serious 

 complication. 



KEFEKENCES. 



1. ' Lancet,' 1902, vol. 2. 



2. ' Indian Medical Gazette,' March, 1908. 



3. Ibid., May, 1908. 



4. 1 Phil. Trans.,' B, vol. 197 (1904). p. 1 23. 



