74 SELLARDS AND SHAKLEE. 



This group of patients showed definitely that the alkaline solutions 

 were effective in starting the excretion of urine in the stage of reaction, 

 whereas Einger's solution had practically no pemianent effect in severe 

 cases. 



The exact relation of acid intoxication and urgemia to each other is 

 rather difficult to determine; there is a little evidence which suggests that 

 an excess of acid leads to renal disturbance. Experimentally it has been 

 found that mineral acids such as hydrochloric, give rise to nephritis and 

 the acid intoxication accompanying a long-standing diabetes is associated 

 with renal lesions. Lastly, there are certain evidences of an acid intoxi- 

 cation during the course of an ordinary ureemia. If it could be shown 

 that the suppression of urine during the stage of reaction in cholera is due 

 to an excess of acid, then the diuretic action of the alkali could be con- 

 sidered as specific and it would seem difficult to replace it by any of the 

 ordinary diuretics. Early in the stage of collapse, when the anuria is due 

 to loss of fluid by rectum, there is no evidence to show that in severe cases 

 either the bicarbonate or the chloride solutions have any definite effect on 

 the kidney. Apparently, no detailed examination has been made in 

 regard to the action of diuretics in the stage of collapse, although free 

 elimination by the kidneys in this stage might be of value. 



The use of 0.5 per cent solutions of sodiiim bicarbonate during the stage 

 of collapse was satisfactory in this group of patients for the majority of 

 the cases. In two severe ones the response to the solution was very poor. 

 It seemed a little better to discontinue the 0.5 per cent bicarbonate solu- 

 tion and change to Einger's solution in those patients where a suitable 

 response was not obtained. However, such cases apparently belonged to 

 that group which fail to respond to any solution or any method of treat- 

 ment. There was no evidence of any harmful effect in the use of bicar- 

 bonate in this series nor of any increase in the death rate from collapse or 

 other causes. The early use of even relatively small amounts of bicar- 

 bonate appeared to lower the total amount which was needed to obtain 

 secretion of urine. The rather large quantities of 50, 80 and even 90 

 grams, which are occasionally necessary were thereby avoided in a con- 

 siderable proportion of cases. Excessively long periods of anuria did not 

 occur. Thus, in Table I it will be seen that no patient who recovered 

 showed complete suppression of urine for as long as forty-eight hours. 



The cases treated with bicarbonate often appeared to improve rapidly 

 and to recover more promptly than corresponding patients treated with 

 Einger's solution. However, this behavior was not constant. In one in- 

 stance two patients were admitted in complete collapse and apparently 

 were in almost duplicate conditions. The one receiving Einger's solution 

 recovered promptly, while the other responded very poorly to injections 



