Receiving fluids intravenously is now a common enough therapeutic tool. But the practice’s origin can be traced back to man’s effort to defeat the bacteria responsible for cholera.
Back in 1831, a particularly bad strain of cholera broke out from the banks of the Ganges in India and spread rapidly to Iran, Russia and China before making its way along the Ural Mountan trade routes to Europe. In the British Isles alone, more than 23,000 people died of the new disease.
European ships helped in the spread of the disease across the Atlantic, taking it to places like Canada and the United States, eventually having the disease in the Pacific Coast merely two years after the initial documented outbreaks in the subcontinent. The epidemic of this scale hasn’t been seen since the bubonic plague.
Seeking a solution, a young doctor sets out on an adventure
During this time, William Brooke O’Shaughnessy- a young Irish Physician was living in Edinburgh-quite far from the epidemic’s epicenter. Upon hearing the nightmarish reports about the epidemic, he became confident that he could come up with a solution with the application of practical chemistry. So, both to make a name for himself and seeking adventure, the doctor set out to Sunderland in England.
In the doctor’s own words the epidemic the way he saw it was “sudden, deadly, over-whelming, the living death.” He noted that treatments like bloodletting, applying leeches or using powerful cathartics and emetics like mercury chloride and castor oil to purge the patients’ intestines only made the suffering worse. In fact, such treatments only worsened the fluid loss and sometimes even hastened death.
O’Shaughnessy put his knowledge of chemistry to good use and examined the stool and blood of the cholera patients. He made crude measurements of the electrolytes in both the stool and blood. What became central to his work was the observation that huge volume of water, chloride, sodium and bicarbonate was leeched from blood and also lost via stool. Eventually he was able to illustrate a key factor about the cholera’s pathology.
His findings were published in ‘The Lancet’ in which he proposed the solution- to replenish what’s lost from the gut through the veins.
Another British physician, Dr.Thomas Latta got inspired by O’Shaughnessy’s idea. In less than two months since The Lancet publication, Latta did the very first therapeutic intravenous resuscitation. It was performed in May 1832. He used a homemade solution – a watery mix including chloride, sodium and bicarbonate.
Latta injected what he described as “copious volumes” of the solution using a syringe and silver tube. Of the 25 patients that he thus infused, eight were revived.
Condemned by the medical profession
It’s safe to say that intravenous therapy was way ahead of its time. Some clinicians accepted it as a new remedy but the medical profession largely denounced it, condemning the idea of invading the human body’s sanctity. In fact, they continued with the leeches, ingested mercury etc. for a long time yet. The consequence was that the six cholera pandemics which followed in the nineteenth century didn’t benefit from the rehydration therapy.
In time, O’Shaughnessy’s idea did find wider acceptance. In fact, cholera patients are treated today using the same idea of rehydration. Writing about the history of cholera treatments, a certain physician mused, “the similarity between the intravenous fluids recommended by O’Shaughnessy in 1832 and those recommended by WHO for treatment of cholera today are obvious.”
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