ACID INTOXICATION IN ASIATIC CHOLERA. 69 



minutes. In the stage of collapse, 4 liters of fluid were occasionally re- 

 quired for the first injection while in the stage of reaction 1 liter of 1.5 

 per cent sodium bicarbonate was sometimes sufficient. 



PEEPAEATION OF RINGEE-LOCKE AND OF THE ALKALINE SOLUTION. 



For the control series an isotonic Ringer-Locke solution was prepared ac- 

 cording to the formula : sodium chloride 0.9 per cent, potassium chloride 0.042 

 per cent, calcium chloride, crystallized, 0.024 per cent and sodium bicarbonate 0.03 

 per cent. 



The sodium bicarbonate was added to determine whether these salts in the 

 proportions in wliich they normally occur in the blood might not produce an effect 

 similar to that obtained with larger amoimts of the bicarbonate alone. 



A solution of the preceding formula can not be sterilized by heat without con- 

 version of the bicarbonate to the normal carbonate followed by subsequent 

 precipitation of the calcium. Consequently the first three salts were added and 

 the solution heated in the autoclave. The required amount of sodium bicarbonate 

 was added in solid form immediately before the injection of the solution. 



The formula was modified a-s follows for the alkaline injections during col- 

 lapse: Sodium chloride 0.4 per cent, potassium chloride 0.042 per cent and sodiiun 

 bicarbonate 0.5 per cent. The calcium was omitted on account of the insolubility 

 of its carbonate. When the 0.024 per cent of calcium chloride was added in 

 the presence of the 0.5 per cent of bicarbonate, a supersaturated solution oc- 

 casionally would be obtained which would remain clear for a short period, but 

 precipitation usually occurred after 20 to 30 minutes. An attempt was made 

 to prepare the solution of sodium bicarbonate with a minimal conversion to the 

 normal carbonate. The injection of sodium bicarbonate in aqueous solutions 

 entirely free from normal carbonate would appear to be impossible since even 

 at room temperature conversion to the normal carbonate takes place. Thus 

 McCoy(8) found that in tenth molecular aqueous solutions at 25° C, 2.68 per 

 cent of the bicarbonate immediately was converted to the normal carbonate and 

 that equilibrium was not established until only 40 per cent of the bicarbonate 

 remained unchanged. In stronger solutions the decomposition was much more 

 rapid, e. g., in three-tenths molecular solutions, 77 per cent, and in molecular 

 solutions, 86.2 per cent of the bicarbonate was decomposed at once. In view of 

 these changes, the 0.5 per cent of bicarbonate was added in solid form to the 

 sterilized solutions containing the sodium and potassium .salts and the injection 

 was made immediately without further heating of the solution. Samples of 

 freshly prepared sodium bicarbonate were selected which were shown to be sterile 

 when tested on ordinary culture media. 



The 1.5 per cent bicarbonate solutions for injection during the stage of I'eac- 

 tion were prepared without the addition of any other salt and were heated in 

 the autoclave at 3 kilograms pressure per square centimeter for forty-five minutes, 

 about 25 per cent of the bicarbonate being converted to the normal carbonate, 

 under these conditions. For the preparation of 0.5 per cent bicarbonate solu- 

 tions on a larger scale, it was found that an average decomposition of less than 

 3 per cent occurred when the solutions were heated in the autoclave in tightly 

 stoppered bottles at a pressure of 3 kilograms per square centimeter for forty-five 

 minutes, allowing the autoclave to cool to room temperature before opening to 

 the atmosphere. The amount of normal carbonate in the solutions after steriliza- 



N 

 tion was- determined by titration at 0°C., against hydrochloric acid in the 



