TOLERANCE FOR ALKALIES IN ASIATIC CHOLERA. 389 



with chloride and those with alkali, the most important difference is 

 the absence of uraemia in the bicarbonate series. As a rule, morphia failed 

 to quiet patients when the stage of uraemia had developed. However, 

 after the injection of alkali, the respiration improved and the restlessness 

 of the patients disappeared. Observation of the individual cases some- 

 times showed a sudden improvement following the injection of alkali. 

 The value of the injection of alkalies is seen most clearly in that class 

 of cases which have only mild symptoms of cholera, but which never- 

 theless develop a fatal uraemia. 



7. In the specific treatment of cholera, there are several distinct 

 pathologic conditions which are commonly present and, consequently, 

 no one treatment can meet them all. The treatment of the toxaemia, 

 which is the most important factor, is not under satisfactory control. 

 The effect of fluid on the relief of mechanical conditions in the stage 

 of collapse is well established. Symptoms of acid intoxication and the 

 development of uraemia during the stage of reaction did not occur 

 (except in one instance) in a group of fifty-five cases treated with 

 acetate or bicarbonate of sodium. 



GENERAL SU3I1L4RY. 



1. Examination of the urine in cholera showed an almost constant 

 increase in the excretion of ammonia. 



2. Cholera patients showed a definite tolerance to alkalies, a con- 

 siderable excess of sodium bicarbonate being required to render the 

 urine alkaline as compared with normal individuals. Within certain 

 limits, the administration of alkalies not only failed to render the 

 urine alkaline, but its acidity was even increased, as measured by 

 titration. Following the injection of alkalies, there was sometimes a 

 sudden and marked increase in the excretion of urea. 



.3. The early administration of alkalies practically eliminated death 

 from uraemia. 



The most important findings are the tolerance for alkalies and the 

 change in the course of the disease. This tolerance may be dependent 

 either upon the cholera infection, or upon the accompanying nephritis; 

 apparently it is related more closely to the uraemia than to the enteritis. 

 The condition will be of more general interest if it proves to be present 

 in uraemia from other causes than if it is specific for cholera. 



REFERENCES. 



(1) Rogees. Therap. Gaz. ( 1909), 33, 761. 



(2) Nichols and Andrews. This Journal, Sec. B (1909), 4, 81. 



(3) Czeeny. Arch. f. exper. Path. u. Pharm. (1894), 34, 268. 



(4) Cabot. Clinical Examinations of the Blood. New York, 4. ed., ( 1901), 226. 



(5) Cantani. Centralbl. f. d. med. Wiss. (1884), 22, 785. 



(6) v. Teeeat, Vas, and Gaba. Berl. klin. Wchnschr. (1893), 30, 309. 



