TOLERANCE FOR ALKALIES IN ASIATIC CHOLERA. 365 



In looking for evidences of acid intoxication attention was directed 

 especially to the examination of the urine 3 in regard to : ( 1 ) Acetone 

 and acetoacetic acid; (2) the ammonia coefficient; (3) tolerance of 

 the body to alkalies, i. e., the amount of alkali required by the body 

 to render the urine alkaline. 



Acetone and acetoacetic acid. — The urine was examined directly, with- 

 out distillation, for acetone using the iodoform test and the nitro-prussid 

 color reaction. Twenty individuals receiving treatment with sodium 

 chloride were examined. Specimens were obtained from both mild and 

 severe cases including urines voided in collapse, in uraemia and in con- 

 valescence. The reactions for acetoacetic acid were somewhat inconclusive. 

 With ferric chloride a definite Bordeaux red color was not obtained, but 

 in seven of the twenty cases a dark red and, in some instances, a slightly 

 brownish-red color was obtained. It is not unlikely that the urinary 

 pigments may have masked the violet shades which are obtained with 

 acetoacetic acid in aqueous solution. Furthermore, the red color faded 

 to a yellow on standing after a few hours; also when the urine was first 

 boiled, no color reaction was obtained. However, one would hesitate 

 to conclude definitely that acetoacetic acid was present, especially as 

 none of the specimens gave a definite reaction for acetone. The absence 

 of acetone seems a little unexpected when we consider that in cholera at 

 least three conditions are present which sometimes give rise to acetonuria, 

 namely, starvation, intestinal disorder, and uraemia. 



According to von Noorden (13) acetone and acetoacetic acid usually 

 appear in the urine on the first day of starvation in healthy individuals. 

 Ewing (14) has collected many instances of acetonuria in intestinal 

 disturbances which have been characterized especially as cyclic vomiting 

 and coma dyspepticum. In two cases of uraemia, Lorenz (15) found 

 acetone, acetoacetic acid and 8 oxybutyric acid. 



- More extensive observations might offer some explanation for the 

 failure of acetone to appear in the urine; perhaps a larger variety of 

 specimens from different stages of cholera might show that it is not 

 constantly absent. 



Ammonia coefficient. — Of course, the ammonia excreted in the urine 

 gives some information as to the amount of acids produced in the 

 body. V. Terray, Vas, and Gara (6) found a pronounced increase 

 in the excretion of ammonia during the stage of reaction and this 

 increase was both relative and absolute, the highest amount recorded 



s No examinations of the blood were attempted. Clinical determinations of 

 the carbon dioxide content of the blood are as yet unsatisfactory. Apparently 

 the normal alkalinity of the blood in cholera is definitely reduced (4). Cantani 

 (5) has even reported an acid reaction of the blood at the end of the life. 



