Treatment of cholera--tradition and authority versus science, reason, and humanity.

Abstract

Focus is on the erratic nature of the evolution of therapy in the field of cholera. Cholera the most devastating of the diarrheal diseases was not known outside the Indian subcontinent until the early 19th century. Within a very few years after it spread an effective means of treating this disease based on sound physiological principles was developed and reported in respected medical journals. During the following 80 years in a series of 6 major pandemics this acute diarrheal illness exerted so great a human toll that it surpassed the bubonic plague as the greatest killer of all epidemic bacterial diseases. This occurred after an effective and simple form of treatment had been proposed tried and clearly described in the medical literature and it occurred because of the tremendous reluctance of tradition-bound pre-Flexnerian physicians to accept a new and simple concept in therapy. In 1830 Dr. Jaenichen infused saline intravenously in a cholera patient and the patient showed transient clinical improvement. The apparatus used was cumbersome but the process was basically sound and rational. The saline infused was not much different from that ideally required by the patient. This 1st use of intravenous replacement fluids in humans was roundly condemned at the time as being contrary to the laws of nature. At this time with the addition of the antimicrobial agents and oral electrolyte solutions adequate therapy should be available to all patients with this disease.