198 "^he Philippine Journal of Science 1917 



less and fail to urinate can be made to do so in a short time. 

 Therefore the absence of urine in the early stage of cholera must 

 be a mechanical process resulting from the fluid portion of 

 the blood becoming decreased, and hence the remaining blood, 

 of higher specific gravity and decreased volume, is unable to 

 circulate through the secreting tubules of the kidneys, resulting 

 in the cessation of urinary secretion. Then the same principle 

 must apply to the arterial system of the uterus. If this failure 

 of the circulation lasts sufficiently long, the foetus must surely 

 die, because the mother's blood fails to nourish it and to carry 

 off the waste products, thus allowing the toxins to accumulate 

 in it. Also the failure of the mother to eliminate properly 

 results in the damming up of her own toxins to the detriment 

 of the foetus. 



These factors alone are sufficient reasons for the subsequent 

 death of the foetus and for the high percentage of abortions as 

 seen in group III. But then, what justifiable reasons can be 

 given for the cases comprising group I, which cases never became 

 pulseless and did urinate on admission, showing 48 per cent 

 abortions in contrast with group III, which cases did not urinate 

 on admission and gave 52 per cent abortions, a difference of 

 only 4 per cent. Then if the cessation of urination in the early 

 stage does not cause abortion, and as the period of the fever 

 before abortion occurs is so short, it does not seem possible for 

 the same factor which causes the abortions in the other fevers 

 to be responsible. Sellards(l7) has proved the presence of an 

 acidosis in cholera, and Rogers (13) states that this acidosis is an 

 important factor in causing postcholeraic uraemia. Davis (3) 

 says that the placenta is affected and that the foetal movements 

 are unusually violent during the first stage, and my own observa- 

 tions agree with this statement. Schutz(i6) found that cholera 

 shows a marked tendency to affect the nonpregnant uterus, par- 

 ticularly in the first stage, producing a metrorrhagia in one third 

 of the cases, but that the Graafian follicles shoAV no signs of a 

 hemorrhagic condition, thus dispelling the idea that this metrorr- 

 hagia may be a menstruation. This condition was not often 

 noticed in the present series of cases, but the necropsy reports of 

 the nonpregnant cases, many of which were not admitted to the 

 hospital and were untreated by intravenous injections,, showed 

 that hemorrhage in the uterine cavity, hemorrhagic endometritis, 

 and congestion of the serosa of the uterus, ovaries, and fallopian 

 tubes were not uncommon. Slavjansky(l5) has described a 

 hemorrhagic endometritis in one third of his nonpregnant cases. 



