382 SELLARDS. 



This group of cases showed that the injection of bicarbonate, in 

 sufficient quantity, was followed by an active secretion of urine. In one 

 case (number 56) excessive amounts were voided, more than 6 liters 

 being excreted in twenty-four hours. The urine secreted after the 

 injection of alkali differed in several respects from that obtained after 

 the injection of the chloride; after the use of the bicarbonate, both the 

 quantity of mine and also the urea content (see Table IX) rose 

 rapidly to normal. The acidity as determined by titration was some- 

 times increased. Not infrequently the amount of albumen diminished 

 rapidly and the urines became albumen free at an early period. 



One patient (number 50) in this series was of special interest. 



He was admitted after an illness of two and one-half days. The 

 symptoms of uraemia were fairly definite. The suppression of urine was 

 absolute. Eespiration was natural. The cheeks were flushed and the 

 mucous membranes were bright pink in color. The pulse was full and 

 bounding and the blood pressure measured 175 millimeters of mercury. 

 Thirty grains of sodium bicarbonate were injected intravenously. The 

 bright color of the mucous membranes persisted, but the tension of the 

 pulse diminished rapidly and, after an interval of ten hours, the blood 

 pressure had fallen to 135 millimeters. Sixteen hours after the injection, 

 the secretion of urine commenced. The amount was small at first but 

 steadily increased, and a prompt recovery followed. 



In another patient (number 48) the anuria persisted until the third 

 day. The secretion of urine finally commenced eighteen hours after a 

 subcutaneous injection 4 of 30 grams of sodium bicarbonate. The first 

 specimen of urine was entirely colorless and contained no trace of urea 

 or ammonium salts. However, there was considerable alkali present, 

 amounting to about one-fifth of a normal solution, which was present 

 both in the form of carbonate and bicarbonate. The second specimen, 

 a few hours later, contained a little pigment and a trace of urea, while 

 the third specimen was almost normal. 



In addition to following the reaction of the urine, estimations of the 

 ammonia coefficient 5 were made as a further aid in determining the 



' The danger of abscess formation and necrosis after the subcutaneous injection 

 of alkalies has been emphasized repeatedly, but this method may occasionally be 

 justifiable in the extreme conditions of cholera. In five instances where the 

 available number of superficial veins was limited, sodium bicarbonate was 

 injected subcutaneously in 1.5 per cent concentration. In no instance was there 

 any evidence of necrosis or abscess formation. Two of these cases were in an 

 extreme condition and it was expected that a second injection of alkali would 

 be required. A few hours after the injection, both patients complained of 

 muscular cramps throughout the body. The secretion of urine commenced without 

 further use of alkali. 



5 It gives me much pleasure to acknowledge the very helpful cooperation of 

 Mr. George F. Richmond, chief of the chemical laboratory, Bureau of Science. 

 These determinations were made under his direction, by Folin's (12) method. 



