ABSTRACT
In the normal person, absorption and secretion are balanced, but in the cholera patient, secretion in the small bowel is increased while absorption is diminished, to the extent that there can be a net secretion of up to 30 litres of fluid a day, the average being about 6. When cholera toxin is introduced, or produced, in the small intestine, it is rapidly and irreversibly bound to the epithelial cells, but there is a lag period of about 30 minutes before fluid begins to accumulate. Although the regime of isotonic intravenous rehydration has proved itself in the saving of countless lives since it was put on a sound basis by Phillips and his successors, it has in fact got limitations which make it hardly feasible in large-scale epidemics over wide and remote areas of underdeveloped countries. If the rehydration fluid could be administered by mouth rather than by vein, many of the problems of rehydration would be avoided.
