TOLERANCE FOR ALKALIES IN ASIATIC CHOLERA. 371 



treated with alkali. This diminution was often quite noticeable in 

 the amount of precipitate obtained on boiling the urine. It is possible, 

 where the albumen content is high, that considerable acid is bound as 

 acid albumen, but with the diminution in the amount of albumen, 

 less acid may be removed during precipitation and becomes available 

 for the neutralization of the alkali. 



The presence of alkali albumen in the urine would also be of con- 

 siderable importance on account of its acid properties. Several speci- 

 mens of urine were examined for alkali albumen in which the acidity, 

 after the injection of acetate or alkali, was equivalent to one-twentieth 

 of a normal solution or more. Eight samples were tested. In five, 

 no precipitate was obtained on careful neutralization, and in the remain- 

 ing three only a trace of turbidity appeared, which did not dissolve 

 in excess of alkali. On adding sodium chloride to saturation, three 

 specimens remained clear, four showed a faint trace of precipitate and 

 in one a moderately heavy precipitate appeared. These urines of course 

 contained more or less protein on account of the accompanying 

 nephritis. - This last specimen of urine, which precipitated with sodium 

 chloride, gave no precipitate when the acid solution was first heated 

 to boiling and the precipitated proteins removed by filtration. 



RELATION OF THE TOLERANCE FOR ALKALIES TO THE ENTERITIS AND 



TO UR.33JIA. 



It is of considerable interest to determine whether this tolerance 

 for alkalies depends upon the cholera infection itself or upon the 

 accompanying nephritis. It is important to note that the tolerance 

 apparently increases as the nephritis develops and persists after the 

 enteritis has subsided. In Table II, the only alkaline reactions which 

 were obtained occurred during collapse (cases numbers 16, 25, 26, 28, 

 and 39). Of the patients receiving alkali by mouth, one case (Table I, 

 number 1) was free from symptoms, and examination of the stool no 

 longer showed cholera vibrios to be present; nevertheless, there were 

 indications of a slight tolerance for alkali. A few preliminary tests were 

 sufficient to show at least that nephritis does not always cause a tolerance. 



Only four cases were tested, three of chronic and one of acute 

 nephritis. The three chronic cases were voiding freely and showed 

 no definite tolerance. One of these cases was given 4 grams and the 

 other two 8 grams each of sodium bicarbonate by mouth, in one dose, 

 and the urine promptly became alkaline in each instance. However, 

 the case of acute nephritis had developed partial suppression of urine 

 and was excreting about 375 cubic centimeters daily. Fairly definite 

 signs of tolerance were obtained. The ingestion of 32 grams of sodium 

 bicarbonate, in 8-gram doses every three hours, failed to render the 

 urine alkaline. On the day following the administration of alkali, 

 there was no increase in the amount of urine excreted, the twenty- 



