Owing to the collapse of the veins it is usually necessary to cut down on them instead of inserting the needle through the skin as for salvarsan injections. The same apparatus as for salvarsan injections is suitable but with a somewhat larger container as we give from 1 to 2 quarts of fluid. At least fifteen minutes should be taken up for the introduction of 1 quart of fluid.
To determine the necessity for intravenous infusion in cholera Rogers has recently recommended the employment of small bottles containing aqueous solution of glycerine with specific gravities varying from 1048 to 1070, increasing the specific gravity in each successive bottle by 2°.
Drops of blood from the cholera patient are deposited at the center of the surface of the fluid in the bottles from a capillary pipette. If the specific gravity of the blood is 1062 at least a liter of saline or sodium bicarbonate solution is needed. If 1066, at least 2 liters. Formerly he estimated the indications by blood pressure, considering a pressure of 80 in Europeans or of 70 in natives as indicating intravenous injections.
On the whole the reports from the use of anti-cholera sera are not very encouraging. Savas, however, was favorably impressed by such treatment during the Balkan war. It should be administered intravenously and early in the attack and given in doses of 50 cc. Of 61 severe cases, so treated, the mortality was 55.7%. Of 17 severe cases, not receiving serum treatment, all died.
Hot water bottles should be used to keep up the body heat. No food should be given during the first thirty-six hours but after that time we may give broths or albumin water.
CHAPTER XVI
MALTA FEVER
Definition and Synonyms
Definition.—Malta fever is a septicaemic condition due to the presence of the specific organism, Micrococcus melitensis, in the blood and various organs, especially spleen. It runs a protracted course, averaging three or four months, but is attended with very slight mortality (2%). Rare cases may run an acute course and show a high death rate. The fever course resembles that of a typhoid fever with two or more relapses, in that a step-like rise of fever for ten or twelve days is followed by a similar fall during the succeeding week or ten days, an afebrile interval of a few days then ensuing, to be followed by a second or third or even tenth febrile wave with the separating days of apyrexia. The course of the disease may last for a year or more attended with progressive anaemia and manifestations of neurasthenia. Very characteristic are sudden swellings of various joints which subside in a few hours to entirely disappear in a few days. Neuralgic manifestations, especially sciatica, are prominent features of the disease. It is chiefly spread by the milk of infected goats and can best be prevented by boiling such milk.
Synonyms.—Febris undulans (from the wave-like monthly accessions of fever). Mediterranean, Gibraltar or “Rock,” Neapolitan, Cyprus fever (from the geographical distribution). Febris sudoralis (from the night sweats). Mediterranean phthisis (from the bronchitis, anaemia and night sweats resembling phthisis). Melitensis septicaemia. Febris melitensis.