TOLERANCE FOR ALKALIES IN ASIATIC CHOLERA. 



367 



Table I. — Showing effect of ingestion of alkalies — Continued. 

 FOUR GRAMS SODIUM BICARBONATE EVERY TWO HOURS. 



Serial 

 numbers. 



dis a e y as e fiConditionof P atient - 

 i 



Number 

 of stools. 



Total 

 amount 



of 

 alkali. 



Effect on reaction of 

 urine to litmus. 



Termina- 

 tion. 





3 

 4 

 3 

 6 









Grams. 

 20 

 12 

 20 

 20 

 28 



All specimens acid__ 

 Neutral for 2 hours__ 

 All specimens acirL_ 

 do -_ 



Recovery. 



Do. 

 Death. 

 Recovery. 

 Death. 





In stage of reaction __ 1 

 Early uraemia 7 



6 



4 



10 



9 



Early urcemia 



3 



do 



EIGHT GRAMS SODIUM BICARBONATE EVERY TWO HOURS. 



7 



4 

 3 



Mild symptoms _ 

 Early uraemia. . 



1 

 2 

 







16 

 32 

 8 



8 





Recovery. 

 Death. 



8 



All specimens acid- 

 Neutral or alkaline 



for 7 hours. 

 Neutral or alkaline 



for 6 hours. 





Do 













a Bicarbonate discontinued on account of nausea. 



In order to eliminate some of the sources of error arising from the 

 ingestion- of alkalies, intravenous injection was also tested. In Table 

 I, one patient (Number 8), in addition to the alkali by mouth, received 

 intravenously 40 grants of sodium bicarbonate followed twelve hours 

 later by 10 grams of sodium carbonate, also injected intravenously; 

 the urine remained acid. Intravenous injections of sodium bicarbonate 

 were then taken up systematically. 



The majority of the patients were first tested immediately on admission, 

 while in collapse. As a routine, the bladder was emptied by catheter before each 

 injection of alkali. Because of the anuria of cholera there was, in some in- 

 stances, an unavoidably long interval between the injection of alkali and the 

 first secretion of urine; therefore, these intervals have been included with the 

 other data. The amounts of sodium bicarbonate are stated in terms of the original 

 amount present before sterilization. It is important to note that after sterili- 

 zation in the autoclave, approximately 0.2 per cent of normal sodium carbonate 

 was present in the solution, being derived from the conversion of the bicarbonate 

 into carbonate by heat. 



Precautions were taken not to overlook the excretion of unaltered 

 bicarbonate in the urine. When the reaction of the urine is acid it 

 is evident that there can be no bicarbonate present. In those instances 

 where a neutral reaction was obtained, the urine was tested both before 

 and after boiling to convert any alkali present into a form which would 

 react more readily with litmus. Onty the reaction of the first specimen 

 voided after injection is recorded in Table II, but observations were 

 made for at. least two days after the last injection. Where "no urine" is 

 recorded, this was determined in each instance by catheterization. 



