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September 1999

A Commentary on the Use of Rational Oral Electrolyte Therapy

Author Affiliations

From the University of California, San Francisco; and Stanford University, Stanford, Calif.

Arch Pediatr Adolesc Med. 1999;153(9):910-912. doi:10.1001/archpedi.153.9.910

The following dissertation is derived partially from the literature, is partially a personal memoir, and contains a speculation. I try to answer the question of why oral glucose-electrolyte therapy was so long delayed as a part of the therapeutic armamentarium and why the present formulation of rehydration solutions has taken so long to gain acceptance in the United States. The story begins 268 years ago.

The recognition of dehydration as a physiologic disturbance affecting circulation could not have been understood until after Harvey's1 demonstration in 1628 that there was a closed circulation that could be adversely affected. It was 2 centuries later when cholera spread through Europe that William B. O'Shaughnessy, unable to obtain a medical license in London and therefore not allowed to practice medicine, worked in the laboratory doing quantitative analyses on samples of serum and stool water of cholera victims. The results led him to suggest that the replacement of salts and water might be therapeutic. The concept of physiologic therapy for dehydration was founded.2 O'Shaughnessy's experiments may have been influenced by hearing or knowing of William Stevens, who intuitively recommended and carried out saline replacement for patients with cholera, but whose work went unheeded. A practitioner in Leith, Thomas Latta, probably acquainted with O'Shaughnessy from O'Shaughnessy's days as a student in Edinburgh, Scotland, put into practice the theory limned in his brief letter to Lancet.3