• cholera
• fluid resuscitation
• epidemic

Cholera was a much feared disease as it spread across Europe in 1829–1830. The Lancet on the 19 November 1831 charted its progress and even published a fold out map of Europe to allow its readers to monitor its approach.¹ The epidemic reached Sunderland in October 1831.

On the 3 December 1831 a Dr W B O’Shaughnessy delivered a lecture to the Westminster Medical Society on the “Blue epidemic cholera”, as it was then known. As there was still no known “remote” cause of the disease, he considered it legitimate to look at the effects of the disease and to treat these instead. He had observed that, “universal stagnation of the venous system, and rapid cessation of the arterialisation of the blood, are the earliest, as well as the most characteristic effects.”² He then posed the question, “What is the best mode by which this artificial arterialisation can be effected ..?” At the time most physicians favoured venesection. Others, “Recommend the inhalation of oxygen gas, or of a mixture of oxygen and atmospheric air, or of the protoxide of azote, ... “laughing gas”...”²

He went on, “Now it might rationally be imagined that the success or failure of these methods should afford us a touchstone of some authority, in deciding on the rationality of the principles on which they are practised ...”² and concluded that there was some evidence in favour of venesection, if done in time and no other problems were encountered. He found no evidence in favour of oxygenation and conceded that venesection might also fail. In vitro physiology studies had shown that venous blood could be arterialised by agitation in atmospheric air, or contact with highly oxygenised solids or fluids. This led him to suggest the idea of intravenous injection of nitrate or …