THE ORIGINS OF

INTRAVENOUS
FLUIDS
GROUP MEMBERS
ESPESO, MARIEFLOR
GONZALES, ZACHARIAS III
GOPU, SRIHITHA ANUSHA
GUAMOS, ARIS
HERNANDEZ, HARVIE
KHAN, NIZAMUDDIN
KUMAR RATHORE, SUMIT
LABINI, PRECIOUS
LABORTE, IAN KEVIN
⦿ Flushing a vein with a liter of saline is standard
protocol in clinics and hospitals. To receive fluids
intravenously is an ubiquitous therapeutic, a common
tool to alleviate many conditions, so standard that
there are even businesses that offer an IV and a bag
of saline as a cure for the common hangover.
⦿ Intravenous fluid resuscitation relies on the principle
of replenishing our precious bodily fluids through
delivery directly into the blood vessels, but where
did this concept come from? How did a remedy that
breaches the skin and veins, violating the sanctity of
the human body to inject a liter of foreign substance
enter the medical armamentarium? It has its origins
in mankind’s quest to defeat a bacteria infamous for
causing such prolific diarrhea that it causes fatal
shock: cholera
AN 1828 ETCHING BY WILLIAM HEATH, "MONSTER SOUP COMMONLY CALLED THAMES
WATER." JUST A FEW YEARS BEFORE THE 1832 CHOLERA OUTBREAK, CONCERNS
ABOUT THE HYGIENE AND PURITY OF THE RIVER THAMES MOUNTED. REVEALING
THE IMPURITY OF LONDON DRINKING WATER. IMAGE: W. HEATH, 1828. SOURCE:
WELLCOME COLLECTION.
⦿ Cholera is “a disease that begins where other diseases end, with
death.”(1) It has swept the world seven times in massive pandemics
that have cost millions of lives. Infection with the bacterium Vibrio
cholerae is no simple intestinal tussle with a diarrheal bug. The
cholera toxin invokes a profound amount of fluid release from the gut,
with some patients producing a liter of watery stool per hour and
dying within hours of infection due to dehydration and hypovolemic
shock.
⦿ In 1831, a devastating strain of cholera blossomed along the Ganges
River delta in India and spread rapidly overland into China, Iran, and
Russia before being transported along the Ural Mountain trade routes
into Europe. In the British Isles, home to cargo ships returning from
hotspots such as the Baltic and Southeast Asia, over 23,000 people
perished of the new disease. European ships carried the disease across
the Atlantic, where it burned across Canada and the United States,
reaching the Pacific Coast as early as two years after the first
documented outbreaks in India. (2) It was an epidemic the likes of
which had not been seen since the bubonic plague, the bug inflicting
quick death and killing massive swaths of the population
⦿ A young Irish physician fresh out of medical school in late 1831,
William Brooke O’Shaughnessy was residing safely in Edinburgh, far
from the epicenter of the cholera epidemic. The 22-year-old was
intrigued by the nightmarish reports that reached him and was
confident that “the habits of practical chemistry which I have
occasionally pursued … might lead to the application of chemistry to
its cure.” (3) Seeking adventure and to make a name for himself, he
traveled to Sunderland in England to immerse himself in the
epidemiological fray.
AN 1832 ETCHING BY ROBERT CRUIKSHANK, "A CHOLERA PATIENT," DISPLAYING ASSORTED
REMEDIES AND THEIR ATTENDANT ANXIETIES. IV THERAPY IS EXCLUDED. IMAGE: ROBERT
CRUIKSHANK. SOURCE: WELLCOME COLLECTION. CLICK FOR SOURCE.
⦿ There he found an alarming scene and would later describe
the epidemic as “sudden, deadly, over-whelming, the living
death.” (4) Overcoming the clinical horrors and turning an
analytical eye towards the crisis, he noted that the victims
of cholera fared rather poorly with the treatments du
jour such as bloodletting, the application of leeches, and
the use of powerful cathartics and emetics such as mercury
chloride and castor oil to Drano-purge the intestines. Today
we can easily recognize that such treatments actually
worsened the loss of fluid volume and even hastened
death, contributing to cholera’s staggering mortality rate,
which ranged from 10 to 70% of those infected and rivaled
that of the bacteria Yersinia pestis during the Black Death.
(5)
⦿ Using his knowledge of chemistry, O’Shaughnessy examined
the blood and stool of his cholera patients, making crude
measurements of the electrolytes in both. Key to his work
was his observation that large amounts of water, sodium,
chloride, and bicarbonate had been leeched from the blood
and lost in the stool. Though his deductive mathematics
would no doubt be considered primitive today, their
simplicity finally and effectively illustrated an aspect of the
cholera’s pathology. He published his findings in The
Lancetand proposed a radically simple solution – replenish
exactly what was lost from the gut directly into the veins.
THE INDICATIONS OF CURE … ARE TWO IN NUMBER – VIZ. FIRST
TO RESTORE THE BLOOD TO ITS NATURAL SPECIFIC GRAVITY;
SECOND TO RESTORE ITS DEFICIENT SALINE MATTERS … THE
FIRST OF THESE CAN ONLY BE EFFECTED BY ABSORPTION, BY
IMBIBITION,OR BY THE INJECTION OF AQUEOUS FLUID INTO THE
VEINS. 
⦿ Dr. Thomas Latta, a fellow British physician,
was inspired by O’Shaughnessy’s logic. Less
than two months after The
Lancet publication, Latta performed the first
therapeutic intravenous resuscitation in May
of 1832 with infusions of a homemade
solution, a watery hypotonic mix of sodium,
chloride, and bicarbonate. By injecting what
he described as “copious volumes” of this
solution with the use of a syringe and silver
tube, he was able to revive eight of 25
patients that he infused. (7)(8) Latta would
describe the first instance of intravenous
fluid therapy:
⦿ Having inserted a tube into the basilic vein,
cautiously, anxiously, I watched the effect; ounce
after ounce was injected, but no visible change was
produced. Still persevering, I thought she began to
breath less laboriously; soon the sharpened features
and sunken eye and fallen jaw, pale and cold,
bearing the manifest impress of death’s signet,
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, fuller, slower and firmer, and in a
short space of half an hour, when six pints had been
injected, she expressed in a firm voice that she was
free from all uneasiness, actually became jocular,
and fancied all she needed was a little sleep; her
extremities were warm, and every feature bore the
aspect of comfort and health. (7)
⦿ Intravenous therapy was a radically progressive
treatment ahead of its time. While some clinicians
embraced it as a novel remedy – some even go so far
as declaring intravenous saline as a “miraculous and
supernatural agent” that would revive the living
dead – it was overwhelmingly denounced by the
medical profession who condemned the very thought
of invading the sanctity of the human body.(6)
Instead, with no small amount of irony, they would
continue with the leeches and ingested mercury,
flushing the intestinal tract and draining the blood
of their sunken eyed patients. As a result, the
ensuing six cholera pandemics of the nineteenth
century did not utilize O’Shaughnessy’s principle of
rehydration therapy.
A colored lithograph by from 1832 of a deceased cholera
victim. Note the blue complexion, sunken face, and
emaciated extremities. Source: Wellcome Collection. 
⦿ By our standards, it was almost the perfect
remedy. Though his intravenous fluid therapy
failed to gain widespread acceptance during his
lifetime, he would, in time, be vindicated as the
medical community grew to understand
that cholera could be treated without resorting to
antibiotics but through simple rehydration. Today
we treat cholera patients using the same concept
of rehydration to approximate fluid loss while also
replenishing electrolytes, although bypassing the
veins and simply drinking the solution. As one
physician writing on the history of cholera
treatments bemused, “the similarity between the
intravenous fluids recommended by O’Shaughnessy
in 1832 and those recommended by WHO for
treatment of cholera today are obvious.”(5)
⦿ His groundbreaking work in the effective
treatment of cholera aside, O’Shaughnessy is
responsible for establishing the principles of
IV therapy through his careful observation
and analysis of his patients’ bodily fluids and
his rational proposal of “physiologic
correctness.”(9) William Brooke
O’Shaughnessy, a toxicologist and chemist by
training, elegantly approached a medical
crisis with the poise and reason of a true
scientist, thus ushering in a new chapter of
medical history and leaving a profound mark
on the field that would save countless lives
to come.
REFERENCES
⦿ 1) RL Guerrant et al. (2003) Cholera, Diarrhea, and Oral Rehydration Therapy:
Triumph and Indictment. Clin Infect Dis. 37(3: 398-405
⦿ 2) CBC News (December 2, 2008) “Cholera’s seven pandemics” Canadian
Broadcasting Corporation. Accessed online May 27, 2016
at http://www.cbc.ca/news/technology/cholera-s-seven-pandemics-1.758504
⦿ 3) N MacGillivray (2015) Sir William Brooke O’Shaughnessy (1808–1889), MD, FRS,
LRCS Ed: Chemical pathologist, pharmacologist and pioneer in electric
telegraphy. J Med Biogr. [Epub ahead of print]
⦿ 4) TF Baskett (2002) William O’Shaughnessy, Thomas Latta and the origins of
intravenous saline. Resuscitation. 55(3): 231-4
⦿ 5) CCJ Carpenter (1992) The Treatment of Cholera: Clinical Science at the
Bedside. J Infect Dis. 166(1): 2-14
⦿ 6) JE Cosnett (1989) The origins of intravenous fluid
therapy. Lancet. 1(8641): 768-71
⦿ 7) WJ Daly and HL DuPont (2008) The Controversial and Short-Lived Early Use of
Rehydration Therapy for Cholera. Clin Infect Dis. 47(10): 1315-1319
⦿ 8) D Millam (1996) The History of Intravenous Therapy. J Intraven
Nurs. 19(1): 5-14
⦿ 9) R Zarychanski et al. (2009) Historical perspectives in critical care medicine:
blood transfusion, intravenous fluids, inotropes/vasopressors, and antibiotics. Crit
Care Clin. 25(1): 201-20