Latta's saline injections for cholera

On 23 May 1832 Thomas Latta, a physician in Leith, wrote to the Central Board of Health in London about a treatment for which, he said, he had no precedent. The Board forwarded his letter to The Lancet, which printed it on 2 June. The second cholera pandemic had reached Scotland, moving north from Newcastle. Leith had opened cholera hospitals, staffed by local doctors on call day and night one week in four. Latta, an Edinburgh graduate of 1819, was one of them.

The idea came from a review in The Lancet of William O'Shaughnessy's analyses, which showed that cholera drained the blood of water and salts. Latta first gave warm salt solutions by enema and by mouth. Neither gave lasting benefit, and he thought they made the vomiting and purging worse. He then turned to the veins, dissolving two to three drachms of muriate of soda (sodium chloride) and two scruples of subcarbonate of soda in six pints of water. He injected it at 112 degrees Fahrenheit with a Read's patent syringe fitted with a small silver tube.

The first patient was an elderly woman on whom every usual remedy had failed. Latta put a tube into her basilic vein and injected ounce after ounce with no visible effect. Then her breathing eased and her pulse came back at the wrist. After six pints, given over half an hour, she said she felt no discomfort. He left her with the hospital surgeon and went to rest. The vomiting and purging returned, and she died five and a half hours after he left.

He contrasted that death with a case given fluid freely. A woman of 50 whose pulse could not be felt even at the armpit received 120 ounces, relapsed within three hours, and was given 120 more. She took 330 ounces in twelve hours, and two days later she was smoking her pipe. Latta blamed his failures on injecting too little, on disease already present in the organs, and on starting too late. Robert Lewins wrote that six patients had been injected at the Drummond Street hospital in Edinburgh and three had recovered or were recovering.

Most patients relapsed after the first revival, and there was no method for measuring the fluid still being lost. Other doctors reported mixed results with their own solutions. Thomas Craigie, a former collaborator, claimed in a local newspaper that he had originated the treatment. Latta died of tuberculosis on 19 October 1833, and no portrait of him is known.