Sellards had success in combating anuria, which is one of the most dangerous conditions encountered in cholera, and at the same time answered equally well with normal saline in relieving collapse, by giving 2% sodium bicarbonate injections. There is a marked acidosis in cholera and this form of treatment seems indicated. The objection to using sodium carbonate is that the salt has a lytic action on red cells in vitro and furthermore Sellards found that it tended to cause convulsions in one of his cholera cases. Sodium bicarbonate, even in 4 or 5% concentration, does not have any haemolysing effect on the red cells. Of course it is true that in sterilization the bicarbonate tends to be converted into carbonate but Sellards found that by sterilization in an autoclave connected with live steam, at 7 pounds pressure, this was minimized, only about 25% of the bicarbonate being converted into carbonate after 1 hour. If the temperature by rectum is about normal or slightly below, the temperature of the fluid should be 102° to 104°F. and one usually gives about 2 quarts. 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