No. 1.
Sir,—I conceive it to be my duty to let you know, for the information of the Central Board of Health, that the great desideratum of restoring the natural current in the veins and arteries, of improving the colour of the blood, and recovering the functions of the lungs, in cholera asphyxia, may be accomplished by injecting a weak saline solution into the veins of the patient. To Dr. Thomas Latta, of this place, is due the merit of first having recourse to this practice. He has tried it in six cases, three of which I have seen, and assisted to treat. The most wonderful and satisfactory effect is the immediate consequence of the injection. To produce the effect referred to, a large quantity must be injected—from five to ten pounds in an adult—and repeated at longer or shorter intervals, as the state of the pulse, and other symptoms, may indicate. Whenever the pulse fails, more fluid ought to be thrown in, to produce an effect upon it, without regard to quantity. In one of the cases I have referred to, 120 ounces were injected at once, and repeated to the amount of 330 ounces in twelve hours. In another, 376 ounces were thrown into the veins between Sunday, at 11 o’clock, A. M., and this day (Tuesday) at 4 P. M.; that is, in the course of 53 hours, upwards of 31 pounds!
The solution that was used consisted of two drachms of muriate, and two scruples of carbonate, of soda, to sixty ounces of water. It was at the temperature of 108 or 110 degrees.
The apparatus employed in injecting was merely one of Reid’s common syringes, (the fluid being put into a vessel rather deep and narrow,) with a small pipe fitted, that it might easily be introduced into an incision in the veins of the usual size that is made in bleeding. It may, however, be well to keep in mind, that, in the event of the operation being frequently repeated, it may be adviseable to inject by different veins.
I forbear at present to enter further into the particulars; nor have we had sufficient experience to speak decisively on the subject. I may, however, mention, that the idea of having recourse to this remedy in cholera, occurred to Dr. Latta, from being convinced, (which I am also,) that the evacuations upwards and downwards are in reality the serum of the blood; that it is the duty of the physician to replace it, as speedily as possible, by injecting a fluid, as similar to the serum as can be formed artificially, directly into the veins, which has been done here with wonderful, and, so far as we can yet judge, excellent effect. An immediate return of the pulse, an improvement in the respiration and in the voice, an evolution of heat, an improvement in the appearance of the patient, with a feeling of comfort, are the immediate effects. The quantity necessary to be injected will probably be found to depend upon the quantity of serum lost—the object of the practice being to place the patient in nearly his ordinary state, as to the quantity of blood circulating in the vessels.—I have, &c.
(Signed)
ROBERT LEWINS, M. D.
To W. Maclean, Esq.
Secretary to the Central Board of Health.