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December 1992

Rumination on the History of Recognition of Dehydration

Am J Dis Child. 1992;146(12):1425. doi:10.1001/archpedi.1992.02160240035015

The opportunity for unreviewed publication leads me to ruminate a bit on history important to medicine as a whole and to pediatrics in particular. I refer to a seminal event in medical history: the recognition of dehydration as an important disturbance, and the prescription of fluid therapy as a corrective. Not only is it good to be reminded of these events, but I believe that there is a mystery hidden in the account as we know it, about which I wish to speculate.

First is the story as we know it, from James Gamble's paper in 19531 and other medical historians.2-3 W. B. O'Shaughnessy, then working in London, in December 1831 published in the Lancet the results of clinical analyses of serum and stool water from patients with cholera, a disease seen in epidemic form that year for the first time in the British Isles.4 He noted that the water content of the serum was sharply reduced and that the two fluids had similar concentrations of inorganic ions. He then hypothesized that replacing the water and salts would lead to recovery from a disease in which the mortality rate was fearful (probably 25% to 50% among London's poor).

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