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| Cholera: treatment and prevention | |
| During the 1830 epidemic,
Thomas Latta, a physician practicing in Scotland, treated 14 patients, who
were severely ill from cholera, with an intravenous salt solution. Eight
of these patients survived. This was the first record of administration
of an intravenous solution, other than blood, to a human. Latta made his
own needles of silver in his workshop, modified an enema syringe to administer
the fluids and prepared the solutions in his office. | |
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Latta based his treatment on a publication
by an Irish physician, William Brooke O’Shaughnessy, who had analysed
the blood and excreta from patients with cholera and found that the concentration
of minerals in the two solutions were similar and that there had been
a significant loss of water from the blood. He deduced from this data
that the cholera caused a loss of water and salt from the body and that
this was the major cause of death. He recommended the replacement of water
and salts as a therapy. However, as an Edinburgh graduate seeking to practice
in London, he could not get a license to do so and it was left to others
to test his idea in clinical practice. |
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Prior to the pioneering work of these men there had been no major advances in our understanding of the role of fluids and electrolytes in the body since the early 17th century. O’Shaunessy described what today we call dehydration - for the first time this was recognised as a physiological disturbance. Several other physicians reported
success with saline infusions during the 1830 epidemic, but when cholera
disappeared so did intravenous therapy and it was not used again until
another cholera outbreak in Naples in 1892. It was not until the early
20th century that this therapy became common place for the treatment of
dehydration. However, from the time of O’Shaunessy’s report, through experimental medicine, there were major advances in our understanding of the significance of fluid and electrolytes in normal physiology and pathophysiology. Here the work of Schmidt, Bernard, Van’t Hoff and Starling were major contributions. Experiments involving animals played an important role in these developments. The development of intravenous fuid therapy, which is critical in the treatment of shock and enables the successful performance of major surgery, started with the conceptual and therapeutic breakthrough made by O’Shaunessy and Latta. The sophistication with which we can now approach these problems is founded in the results of the experimental physiologists of the 19th century. |
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