It has often been contended that the collapse of cholera cannot be the
mere result of the purging and vomiting, because, in some of the most
rapid and malignant cases, the amount of the stools and vomited fluid is
less than in milder and more protracted ones, or even in some cases in
which the patients recover. But, in the most rapid and malignant cases,
there is sufficient loss of aqueous fluid by the alimentary canal to
alter the blood into the thick tenacious state peculiar to this disease;
and the fact of more purging occurring in other cases which are more
protracted, only proves that, in these latter, absorption from the
stomach and intestines has not been altogether arrested, or that the
stools have been diluted with fluids drank by the patient. The loss of
fluid in every case of fully developed cholera must be sufficient to
cause the thickened state of the blood, which is the cause of the algide
symptoms; and the amount of malignancy of the case must depend chiefly
on the extent to which the function of absorption is impaired.
If absorption were altogether arrested in every case of cholera from the
beginning, the amount of discharge from the alimentary canal would not
equal that of a fatal hæmorrhage, for the thickened blood which remains
is certainly not able to maintain life so well as the same quantity of
healthy blood. Indeed, it is easy to calculate the amount of fluid
separated from the blood, by means of the analyses previously quoted,
and others which have been made of the cholera stools. In some analyses
of these evacuations made by Dr. Parkes,[4] the average composition in
1,000 parts was found to be 982.4 water and 17.6 solids; consequently,
the problem is merely to find how much of such a fluid requires to be
subtracted from blood consisting of water 785 and solids 215, in 1000
parts, in order to reduce it to blood consisting of water 733 and solids
267. The answer to this problem is that 208.5 parts would require to be
subtracted from 1000 parts of blood. M. Valentin has estimated the
average amount of blood in the human adult at thirty pounds; and,
therefore, the whole quantity of fluid that requires to be effused into
the stomach and bowels, in order to reduce the blood of a healthy adult
individual to the condition in which it is met with in the collapse of
cholera is, on the average, 100 ounces, or five imperial pints. This
calculation may be useful as indicating the amount of fluid which ought
not to be exceeded in the injection of the blood vessels.
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