374 SELLARDS. 



In the treatment of acid intoxication there are, apparently, two objects 

 to be accomplished, namely, (1) the neutralization of acid, and, (2) 

 the removal of carbon dioxide. Three groups of chemicals may be 

 considered for this purpose: The normal carbonates and hydroxides, 

 the bicarbonates, and certain neutral salts of the organic acids. 



Of the first group, normal sodium carbonate is most commonly em- 

 ployed and, of course, without preliminary alteration combines with 

 carbon dioxide and neutralizes acid. The bicarbonates, being saturated 

 with carbon dioxide, can only neutralize acids, while the organic salts, 

 such as the acetates and citrates, can do neither. However, both the 

 organic salts and the bicarbonates are converted in the body, in part 

 at least, to the carbonate. The ultimate decision as to the most suitable 

 form of chemical to be employed may be found to vary according to the 

 stage of the disease in which its administration is commenced. We 

 have tried normal sodium carbonate, sodium bicarbonate, and sodium 

 acetate from the three groups just mentioned. Normal sodium car- 

 bonate, in relatively small quantities, has long been recommended for 

 use in cholera, but no reports have been found as to the effect of this 

 treatment. Apparently the largest amount which has been used is 

 that recommended by Manson,(10) who suggests a concentration of 

 60 grains to the quart, injecting about 2 to 3 quarts of fluid, making 

 a maximum of about 12 grams of sodium carbonate. This solution is 

 apparently intended to be used for the treatment of collapse. 



EFFECTS OF ALKALIES IN ASIATIC CHOLERA. 



In testing the normal carbonate, a slightly stronger solution than 

 that used by Manson was prepared, namely, 0.5 per cent each of sodium 

 chloride and sodium carbonate, and used in two cases in extremis. 

 Following the usual routine, 2 liters of fluid were employed and in 

 each instance death occurred five hours after the injection. 



The first case was one which had been in uraemia for three days. The 

 injection was followed, after about four hours, by slight convulsions, but it is 

 impossible to say whether or not they were caused by the alkali. The urine 

 did not become alkaline. The second case was in total collapse and did not 

 respond to the injection. No urine was secreted. There was a slight muscular 

 rigidity which lasted a few minutes. The suppression of urine could hardly 

 have been responsible for this rigidity, since the total duration of illness was less 

 than one day. No changes in the erythrocytes occurred in either case. 



Because of the apparent tendency to cause convulsions, the normal 

 carbonate was discarded and a small group of cases was tested, using 

 sodium bicarbonate in varying amounts and concentrations, but always 

 commencing the injections during the stage of collapse. In the majority 

 of cases, two liters of fluid have been given at each injection. Three 

 concentrations of sodium bicarbonate were employed, namely, 1, 1.5, 

 and 2 per cent. One-half per cent of sodium chloride was added to 



