68 SELLARDS AND SHAKLEE. 



However, during the stage of collapse when man}' liters of fluid are 

 being lost by rectum no measures whatever have been effectual in pro- 

 ducing excretion of urine. It is also a fact that the use of alkali 

 during collapse has given no definite indication that it possesses any 

 advantage over a neutral solution. Indeed the higher concentrations 

 of 1 and 2 per cent can only be used for the first injection in carefully 

 selected cases. 



The following patients were treated with alkali Avith the object of 

 determining the maximum concentration of sodium bicarbonate which 

 • could be used during collapse as a routine for all cases. Although a 

 previous series showed that a fatal uraemia did not develop after large 

 amounts of alkali, yet it is important to know definitely whether there 

 is any increase in the number of deaths from other causes, that is, 

 to know that patients who would have died in ui-semia were not merely 

 dying in collapse under alkaline treatment before the uraemic stage 

 was reached. The possibility also has been suggested that uraemia 

 causes only an apparent increase in the mortality, namely, that those 

 cases which die in uraemia would terminate fatally from other causes 

 if the course of the disease were not shortened by uraemia. 



The patients available for this investigation were received at the hos- 

 pital in the majority of instances rather early in the course of the disease 

 only about one-half being in complete collapse. Several conditions indi- 

 cate that the epidemic was at least moderately severe. During the period 

 of investigation there were sixty-five deaths among untreated cases re- 

 maining in their homes, although the number of recoveries under such 

 conditions is not available. There were a few individuals who died imme- 

 diately on arrival at the hospital, or at the commencement of the first 

 intravenous injection; two patients were received in an almost moribund 

 condition and others repeatedly went into collapse, notwithstanding the 

 frequent injection of salt solution. The disease in all instances was diag- 

 nosed bacteriologically by the staff of the Bureau of Science, the cholera 

 vibrio being isolated in pure culture from the faeces and identified by ag- 

 glutination reactions. Only uncomplicated cases showing typical clinical 

 symptoms were selected; those presenting serious complications in addi- 

 tion to the cholera infection were not included. Thus, one case, admitted 

 in pregnancy at full term, is omitted from the series, as well as another 

 in which there was extensive tuberculosis. On admission to the hospital, 

 the patients were divided into two groups of which one received the ordi- 

 nary saline treatment and the other a solution containing 0.5 per cent of 

 sodium bicarbonate. In the stage of reaction, the concentration of the 

 bicarbonate was increased to 1.5 per cent in those cases in which suppres- 

 sion of urine persisted. As a routine the solutions were injected intra- 

 venously in 2-liter quantities, during the course of fifteen to thirty 



