The invention of IV fluid therapy

Thomas Latta first used IV saline in the 1832 cholera epidemic

IV infusions at Edinburgh Royal Infirmary in the 1970s

The second worldwide pandemic of cholera hit Scotland in 1832, travelling to Europe on ships from India, hence ‘Asian cholera’.  This was – and remains – a terrible illness with a high mortality without medical care.  Mortality is from fluid depletion.  It was still 20 years before John Snow proved beyond reasonable doubt that contaminated water was the cause, but therapies were also controversial.  Blood letting was a staple treatment. 
The disease spread rapidly and caused widespread alarm – riots were reported in Liverpool and the North East of England.  In part this seems to have been related to the mistrust of the medical profession engendered by the Burke and Hare case in Edinburgh – there was a fear that patients being taken away on carts might be killed for dissection. 

Dr WB O’Shaughnessy reported on the reduced amount of water in the blood of patients with cholera shortly before, and Latta took up the idea of replacing it directly after unimpressive results attempting rectal delivery of salt solution.  His  letter to the Lancet published June 2nd 1832 described injecting salty water into the basilic vein in increasingly large volumes in patients with terminal cholera, with remarkable results.

“She had apparently reached the last moments of her earthly existence … I feared that I should be unable to get my apparatus ready ere she expired.  … ounce after ounce was injected, but no visible change was produced.  Still persevering, I thought she began to breathe less laboriously, soon the sharpened features, and sunken eye and fallen jaw, pale and cold … began to glow with returning animation; the pulse, which had long ceased, returned to the wrist; at first small and quick, by degrees it became more and more distinct … and in the short space of half an hour, when six pints had been injected … her extremities were warm, and every feature bore the aspect of comfort and health.”   This patient died after her diarrhoea recurred. 

“At first there is but little felt by the patient, and symptoms continue unaltered, but … the improvement in the pulse and countenace is almost simultaneous, the cadaverous expression gradually gives place to appearances of returning animation, the livid hue disappears, the warmth of the body returns.”  The second patient he described survived after receiving 330 ounces (over 9 litres) of fluid in 12 hours; “and in forty-eight hours she smoked her pipe free from distemper”.

This was a revolutionary and heroic treatment and it proved predictably controversial.  The pages of the Lancet and London Medical Gazette of 1832 were filled with reports from both enthusiasts and sceptics. The short publication times and rapid dissemination of these new ideas and reports almost 200 years ago is sobering.  However after the epidemic subsided and ‘malignant cholera’ was no longer seen,  the treatment was not much used.  However by the early 1880s the advantages of saline versus glucose solutions for resuscitating dogs after haemorrhage were being demonstrated in Germany, and in 1882 the Lancet was reporting again on the use of saline to resuscitate patients, this time with haemorrhage.  By the end of the 1880s the treatment had finally established its place. 

Latta qualified in Edinburgh in 1819 and practised in Leith from 1822.  He didn’t live to learn of the overwhelming eventual success of his new therapy, dying of pulmonary TB only 18 months after his observations in cholera.

Whether saline remains the best fluid for resuscitation has recently being questioned – though it seems no worse, at least, than the colloid solutions that have had such a large place in recent decades.  This remains an evolving area.

Further info
Thomas Latta, 1832.  Documents communicated by the Central Board of Health, London, relative to the treatment of cholera by the copious injection of aqueous and saline fluids into the veins.  Lancet 18:274-80 (pdf)
N MacGillivray 2006, Dr Latta of Leith, J R Coll Physicians Edin 36:80-5 (pdf)
A Foex, 2003. How the cholera epidemic of 1831 resulted in a new technique for fluid resuscitation.  Emerg Med J 20:316-8 (Excellent account describing developments to 1900)
Barsoum N, C Kleeman, 2002.  Now and then, the history of parenteral fluid administration.  Am J Nephrol 22:284-9 (from the 3rd international IAHN meeting; paywall)
Latta used Read’s patent syringe (though this may describe a later version)
Wikipedia has another good account of Burke and Hare
Edinburgh Medical School’s short account of Thomas Latta
GA Venter’s account in Hektoen International (2015) gives a bit more information about his early life and work.
Modern guidelines for rehydration in cholera (CDC/WHO)
Another nice concise account online: The origin of intravenous fluids by Rebecca Kreston in Discover magazine (May 2016)


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