366 



SELLARDS. 



being 6.5 grams in one day. In the examination of 28 eases we have 

 found, almost uniformly, an increase in the ammonia coefficient. There 

 were but 6 cases which at any time gave a coefficient of less than 

 5 per cent, and 3 of these were receiving alkali or acetate in relatively 

 large amounts. In some instances the increase was comparable only to 

 the values obtained in the acid intoxication occurring in diabetes: The 

 data are given in Table VIII. 



Tolerance for alkalies. — If, in cholera, there is an increased produc- 

 tion of ammonia for the neutralization of acids, then the administration 

 of alkalies might result, first, in a reduction of the ammonia coefficient, 

 or, second, the amount of alkali which is normally required to render 

 the urine alkaline might be increased. 



Preliminary experiments testing the ingestion of sodium bicarbonate 

 by mouth suggested a fairly definite increase in tolerance. The prin- 

 cipal source of error attending ingestion experiments would lie in the 

 possibility of a loss of alkali before assimilation. With the expectation 

 of at least partially avoiding such an error, the alkali was given in 

 relatively small quantities and repeated at frequent intervals until the 

 urine became alkaline. Patients were selected who were not in a stage 

 of active diarrhoea; also, only those cases were chosen which were voiding 

 rather freely in order that the results might not be complicated by 

 any marked disturbances in the secretion of urine. Because of these 

 restrictions none of the cases selected showed clinical signs suggesting 

 acid intoxication. In Table I those cases are excluded in which any 

 marked diarrhoea followed the use of the sodium bicarbonate. 



Table I. — Shoioing effect of ingestion of alkalies. 

 ONE GRAM SODIUM BICARBONATE EVERY TWO HOURS. 



Serial 

 number. 



Day of 

 disease. 



Condition of patient. 



Number 

 of stools. 



Total 

 amount 



of 

 alkali. 



Effect on reaction of 

 urine to litmus. 



Terraina- | 

 tion. 



1 



22 



15 



13 



5 

 3 



Recovered. One 

 week without symp- 

 toms. 



Convalescent (3 

 days). 



Convalescent (1 

 week) . 



Fair condition _ ._ _ 



Partial collapse 















1 

 2 

 



Grams. 



7 



7 



»4 



7 

 7 

 2 



Alkaline for 2 hours. 

 All specimens acid__ 



do :__ 



__do -- 



Recovery. | 



Do. 



Do. 

 Do. 



2 



3 ____ 



4 



5 ... 



do 



Neutral or alkaline 

 for 14 hours. 









