There are so many traditional rehydration treatments for diarrhea, it is hard to imagine ORS was a scientific breakthrough. Nonetheless it was. This article suggests that the obstacles were as much social as technical and it gives a real world insight into the nature of the scientific process. I think many of our colleagues might be interested in this article I found describing the research process which ultimately produced ORS. It is a fascinating story.
Bruce
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Latta knew cholera patients’ blood lacked water and salt, so he’d tried pumping a briny solution into their intestines. It only made the vomiting and diarrhea worse. Undeterred, he decided to inject the solution directly into the veins of an elderly patient at Drummond-Street Hospital in Edinburgh. The woman was so ill Latta feared she’d die before he had a chance to piece together his syringe and tubing. He inserted a tube into a vein in the woman’s upper arm and slowly pumped the solution into her body. At first there was no response, but then the woman started to grow stronger. “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,” he wrote in the letter published in The Lancet. Six pints of fluid later, the woman declared in a firm voice that she was feeling fine and only needed a little sleep. The transformation astounded the young doctor: It had been like seeing a corpse reanimated right before his eyes.
The woman’s luck did not last long. Shortly after Latta left her bedside, she began to vomit and experience diarrhea again. Five and a half hours later she was dead. But the experiment was enough to convince Latta that the key to treating desperately ill cholera patients was to keep them hydrated long enough for the disease to run its course. He kept experimenting with his intravenous injections, later reporting that three out of nine gravely ill patients injected with his saline solution went on to recover. For a time, the pages of The Lancet buzzed with dispatches from other doctors reporting their own experiments with intravenous therapy.
This enthusiasm turned out to be short-lived. By the end of 1833, the cholera pandemic in Great Britain was waning and Latta was dead of tuberculosis. The brief vogue for saline injections died with him. Since most of the experiments had been reserved for the patients who were nearest to death, survival rates under intravenous therapy weren’t exactly encouraging. And without a knowledge of germ theory, doctors risked giving their patients septicemia every time they slid their tubing into a vein. When cholera returned in 1848, doctors in Latta’s old hospital on Drummond Street reached for their bloodletting scalpels. 7 It would be over a century before intravenous rehydration was established as the main treatment for severely dehydrated cholera patients.
The history of cholera treatment is full of these scientific cul-de-sacs: moments where a breakthrough therapy seemed inevitable but failed to materialize. Yet nearly 140 years after Latta’s experiments, work on the disease would lead to one of the 20th century’s most consequential medical discoveries: oral rehydration solution (ORS). This cheap, simple solution of sugar, salts, and water mixed in the right proportions and delivered orally has saved the lives of more than 70 million, mostly children, since its introduction in the 1970s. 8 It has helped slash the number of children under five dying of diarrhoeal diseases from around 4.8 million in 1980 to about 500,000 today. All of this from a drink that in its most basic form can be made by anyone with access to kitchen salt, sugar, and water. 9 But why did it take until 1968 to develop such a simple life-saving solution?
Salt, Sugar, Water, Zinc: How Scientists Learned to Treat the 20th Century’s Biggest Killer of Children
In June 1832, The Lancet published a remarkable letter written by a Scottish physician named Thomas Latta. Europe was in the grip of the second cholera pandemic — the first outbreak to reach Europe — and the medical journal’s pages were filled with speculation about how to treat the disease that seemed to kill half of all the people it infected. One surgeon wrote in to recommend a concoction of wine, vinegar, camphor, mustard, pepper, garlic, and crushed beetle to be rubbed into the patient’s feet and hands while they sweated under their bedclothes. Others suggested that laughing gas or bleeding might correct the tar-like blood that ran through victims’ veins — a consequence of the ceaseless diarrhea that dries out cholera victims until their organs are at the point of failure.Latta knew cholera patients’ blood lacked water and salt, so he’d tried pumping a briny solution into their intestines. It only made the vomiting and diarrhea worse. Undeterred, he decided to inject the solution directly into the veins of an elderly patient at Drummond-Street Hospital in Edinburgh. The woman was so ill Latta feared she’d die before he had a chance to piece together his syringe and tubing. He inserted a tube into a vein in the woman’s upper arm and slowly pumped the solution into her body. At first there was no response, but then the woman started to grow stronger. “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,” he wrote in the letter published in The Lancet. Six pints of fluid later, the woman declared in a firm voice that she was feeling fine and only needed a little sleep. The transformation astounded the young doctor: It had been like seeing a corpse reanimated right before his eyes.
The woman’s luck did not last long. Shortly after Latta left her bedside, she began to vomit and experience diarrhea again. Five and a half hours later she was dead. But the experiment was enough to convince Latta that the key to treating desperately ill cholera patients was to keep them hydrated long enough for the disease to run its course. He kept experimenting with his intravenous injections, later reporting that three out of nine gravely ill patients injected with his saline solution went on to recover. For a time, the pages of The Lancet buzzed with dispatches from other doctors reporting their own experiments with intravenous therapy.
This enthusiasm turned out to be short-lived. By the end of 1833, the cholera pandemic in Great Britain was waning and Latta was dead of tuberculosis. The brief vogue for saline injections died with him. Since most of the experiments had been reserved for the patients who were nearest to death, survival rates under intravenous therapy weren’t exactly encouraging. And without a knowledge of germ theory, doctors risked giving their patients septicemia every time they slid their tubing into a vein. When cholera returned in 1848, doctors in Latta’s old hospital on Drummond Street reached for their bloodletting scalpels. 7 It would be over a century before intravenous rehydration was established as the main treatment for severely dehydrated cholera patients.
The history of cholera treatment is full of these scientific cul-de-sacs: moments where a breakthrough therapy seemed inevitable but failed to materialize. Yet nearly 140 years after Latta’s experiments, work on the disease would lead to one of the 20th century’s most consequential medical discoveries: oral rehydration solution (ORS). This cheap, simple solution of sugar, salts, and water mixed in the right proportions and delivered orally has saved the lives of more than 70 million, mostly children, since its introduction in the 1970s. 8 It has helped slash the number of children under five dying of diarrhoeal diseases from around 4.8 million in 1980 to about 500,000 today. All of this from a drink that in its most basic form can be made by anyone with access to kitchen salt, sugar, and water. 9 But why did it take until 1968 to develop such a simple life-saving solution?
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