376 SELLARDS. 



of loss of fluid may not differ markedly in cases which evidently may 

 have a widely different prognosis. Furthermore, cases which to all 

 appearances are very similar may behave rather differently under the 

 same treatment. 



Seven of these 1-1 cases died during collapse. This is not a pro- 

 portionately greater death rate from collapse than occured in the control 

 series treated with sodium chloride; yet observation of the individual 

 cases seemed to indicate that in some instances they responded less 

 promptly to the alkaline solution. 



The use of organic salts affords certain distinct theoretical advantages. 

 On injection, these neutral salts possess only the properties of salt action 

 and might be equally efficient with sodium chloride for the treatment 

 of collapse. However, subsequently after oxidation they would afford 

 the properties of an alkali and also of a diuretic. Furthermore, a salt 

 can be chosen which is chemically stable during sterilization, thereby 

 avoiding the formation of the hydroxide or normal carbonate such as 

 occurs in the sterilization of sodium bicarbonate. 



The group of cases recorded in Table VI was tested with sodium 

 acetate. The acetate was selected in preference to the citrate because of 

 the solubility of calcium acetate. Busquet and Paction (11) have 

 reported that the citrates, the normal carbonates and that group of salts 

 which precipitates calcium are more deleterious in their action on the 

 heart than those acids, the calcium derivatives of which are soluble. The 

 concentrations given in Table VI are calculated for the crystallized salt, 

 the 1.5 per cent solution representing approximately 0.9 per cent and 

 the 2 per cent solution 1.2 per cent of the anhydrous salt. 



The patient (number 32) who died in uraemia represented a type of 

 those cases which develop only a mild enteritis, but terminate in a 

 fatal uraemia. 



This patient, on admission, received 30 grams of sodium acetate 

 intravenously. The first laboratory examination did not show cholera 

 vibrios in the stool. The condition of the patient appeared altogether 

 favorable, but on the fifth day, slight symptoms of uraemia developed in 

 addition to the partial suppression of urine which had been present, and 

 a second examination of the stools showed the presence of cholera vibrios. 

 On the sixth day, 30 grams of sodium bicarbonate were injected intra- 

 venously. The secretion of the urine started promptly and in the 

 following fifteen hours 600 cubic centimeters were excreted, an amount 

 equal to the total volume for the five days previously. The urea content 

 was 7.8 grams as compared with 1.9 grams for the same volume of urine 

 excreted before the injection of alkali. 



In another instance the acetate was discontinued after the first injec- 

 tion. Symptoms of uraomia developed rather suddenly, and injection of 

 sodium bicarbonate was commenced on the third day. In the remaining 

 twelve days of life, a total of 180 grams of sodium bicarbonate was 



