George A. Venters, PhD, MBChB, FFCM
Edinburgh, Scotland, UK (Winter 2015)
|An image of the apparatus Latta used during his procedures.|
In June 1832, the editor of the Lancet thanked Dr. Thomas Latta for “the intrepidity, scientific zeal and assiduity he has displayed.”1 This was in response to Dr. Latta’s letter reporting on his treatment by intravenous saline infusion of moribund patients in the final stages of cholera. He had brought the virtually dead back to life. The recovery of the patient seemed “more like the workings of a miraculous and supernatural agent than the effect of the interposition of medical science. The case thus alluded to is, we think, one of the most interesting recorded in the annals of our profession.”
A sense of excitement and hope filled the editorial – not just because of the scientific percipience which underlay the treatment nor the technical competence with which Dr. Latta carried it out, but for the courage he showed in undertaking it de novo. He was an extraordinary and admirable man. Below is his story as gleaned from the scant records we can find relating to him and his own writings.
Childhood and adolescence
Thomas was born in the last decade of the eighteenth century in Jessfield House in the fishing village of Newhaven.2 From his house he could look out over the Forth and run down the Whale Brae into the society of the fisherfolk who, of necessity, were hardy, indomitable, and self-reliant. We can presume that he spent the formative years of his childhood in Newhaven. His subsequent life showed that he shared the characteristics of the community he grew up in.
He was the fourth of five sons of Alexander Latta, a Leith merchant, who died in 1807. Alexander was an elder of the Kirkgate Church – a dissenting Presbyterian congregation – so births and deaths were not systematically recorded about the family. Consequently Thomas’s date of birth and that of his mother’s death are unknown, though she predeceased her husband.
After his father died, he lived with his elder brother – also Alexander and a medical student in Edinburgh at the time. When his brother set up in practice in Perth, Thomas moved with him. In 1815, when he himself became a medical student, he returned to Edinburgh. It is clear that his brother was both a friend and a mentor from the choice of career and the dedication written to his brother on Thomas’ MD thesis.
As a young man he was adventurous. As a medical student he had gone on an expedition in 1818 to Spitzbergen as surgeon companion to Captain William Scoresby, a contemporary Arctic explorer. Evidently he was considered competent enough to work as a doctor on his own before graduating in 1819. Certainly he was physically able, scientifically observant, curious and went on exploring and gathering specimens on the island. His experience there was put to good use, drawing on it both to illuminate aspects of his MD thesis “On Scurvy” and to demonstrate his capacity to draw his own conclusions. His recommendations on the treatment of scurvy show particular consideration for the welfare of seafarers.
Given his father’s dissenting Presbyterianism, the family Thomas was born into was unlikely to be averse to argument. And the intellectual climate of the times, the continuing afterglow of the Scottish Enlightenment, fostered reasoned scrutiny and analysis as way of life. This scientific approach can be seen from his reports of the cases he treated once cholera came to Leith. He had taken up practice there after he graduated.
Leith and Cholera
In the nineteenth century Leith was a prosperous busy seaport struggling fiercely for autonomy from the governance of the Edinburgh establishment. It had extensive, profitable trade with Northern Europe. Excise, imported goods, and manufacturing brought in considerable wealth of which Edinburgh appropriated the lion’s share. In 1820 it managed to obtain its independence. This allowed it to take steps to help deal with the epidemic cholera advancing inexorably from Asia.
Hamburg was the city from which it spread west from Europe. The restrictions in trade applied by Leith ensured that it did not enter via the port. However it spread north from Newcastle via Haddington and then through the East and Midlothian villages westward into Leith and Edinburgh.
Leith was well prepared.3 The interval between cholera arriving in western Europe and reaching Britain gave some breathing space. Public health measures were put in place to minimize its impact. The houses and living conditions of the poor were seen as the likely reservoirs of disease; thus, houses were cleansed and disinfected, food and bedding provided for the needy, and public middens and nuisances were moved away. Specific cholera hospitals were set up and the public persuaded to use them as the only places to nurse cholera cases. The local police were on hand to ensure that these measures worked.
Local doctors were organized to provide supervision and care in these hospitals. They worked one week in four on continuous call night and day. Thomas Latta was one of them. The reports of his cases show it was hard work. The first successfully treated case was admitted at 10:30 at night. He first saw her an hour later then worked on through the night resuscitating her. For another patient, his need to attend a confinement meant that he could not start treatment until 3:30 in the morning.
Confronted with the epidemic, Latta and his colleagues were trying to understand the nature of the disease and how it should be treated. They agreed that loss of water and salts was the major problem but could see that replacing them by drinking or enemas did not work for the worst afflicted. Their quest for more effective treatment meant that they kept continuously abreast of the latest information about cholera and the Lancet was the main source of this. It functioned virtually as a medical newspaper and provided the papers that illuminated a way ahead that Thomas Latta had the courage to take.
The leap into the light
Dr. William O’Shaughnessy4 reported in the Lancet in March 1832 on “Experiments on the Blood in Cholera” that people had lost a large proportion of their water and salts. He suggested that the intravenous injection of the normal salts of the blood might be beneficial. Latta had the skill and bravery to act on that suggestion for the first time – ever.
This was a scientifically reasoned and technically demanding exercise. It required basic surgical competence, practical skill in assembling the relevant apparatus and preparing the infused solution, and rigorous clinical observation during its infusion. Fundamental compassion also guided his decision. He wanted to help his patient and the treatment was a last resort. Time and again his pity and sympathy for his patients shines through in his reports.
The vigor of his writing vividly conveys the drama of the situation confronting him.5
She had apparently reached the last moments of her earthly existence, and now nothing could injure her – indeed so entirely was she reduced that I feared I should be unable to get my apparatus ready ere she expired. Having inserted a tube into the basilic vein, cautiously – anxiously, I watched the effect; ounce after ounce was injected, but no visible change was produced. Still persevering I thought she began to breathe less laboriously; soon the sharpened features and sunken eye and fallen jaw, pale and cold, bearing the manifest impress of death’s signet, began to glow with returning animation; the pulse which has long ceased returned to the wrist, at first small and quick, by degrees it became more and more distinct, fuller, slower and firmer, and in the short space of half an hour when six pints has been injected she expressed in a firm voice that she was free from all uneasiness…her features bore the aspect of comfort and health. This being my first case, I fancied my patient secure and from my great need of a little repose left her in charge of the hospital surgeon.
Though that first patient succumbed, the change wrought in her convinced him of the worth of his treatment. Subsequent cases recovered fully vindicating his efforts. His local colleagues followed his lead with similar success. One, Dr. Lewins, was sufficiently convinced of the major significance of this development as to recommend that Dr. Latta tell the Central Board of Health about it. The Board informed the Lancet and Thomas Wakley readily recognized the importance of these reports.
There was rapid general recognition that this was a substantial medical advance and others soon tried to introduce it with, however, variable results. The less successful maybe were less clinically able or assiduous and some introduced their own deleterious additions to the solutions infused. Selection of patients and timing of intervention was also crucial. In Latta’s hands it enabled recovery of a third of patients who formerly would have been mortally afflicted. Those who died either had demonstrably serious concurrent pathology (the doctors did their own post-mortems) or, as he said, were treated too late.
Like all fundamental innovations it had its detractors. It represented the brave new world of science supplanting medical mythologies, rooted in Galen’s teachings. Most doctors at that time were working within that antique intellectual framework. Changing their mindset was unlikely. Medicine has never been short of doctors with strong opinions and axes to grind. This sea change in practice impinged upon the kinds of certainties in which many had believed for centuries. Therefore they sought to discredit it.
Latta had the continuing support of local friends and colleagues, particularly Dr. Lewins, and was well able to defend himself but betrayal by his former collaborator, Dr. Thomas Craigie, hurt him deeply. This is evident from a letter he wrote in the Lancet in reply to objections to his treatment. Craigie had chosen to write in a local newspaper that he was the originator of intravenous infusion. Similarly an anonymous Edinburgh doctor had chosen to misrepresent his results in another paper implying that his success rate was no different from the generality.
Resorting to the uncritical popular press in such circumstances rather than respectable medical journals offended Latta’s sense of honorable professional conduct. It was an exercise in self-aggrandizement by Craigie, referred to by Latta as “Honest, honest Iago,” and cowardly malice by one of the scions of the Edinburgh Medical establishment. The probability is that his other traducer was James Gregory, a physician who held whimsically outdated ideas on the nature of cholera. He was seeking to ingratiate himself with conservative clinicians who would support his candidature for an upcoming chair in Medical Jurisprudence.6 He was successful.
By the time these local irritations surfaced, cholera was already on the wane. The need for this skilled and daring intervention was similarly diminishing. Dr. Latta’s time in the limelight was drawing to a close.
In just over a year after his introduction of his revolutionary treatment Thomas Latta was dead. He died on October 19, 1833 from consumption. Given the demands of his clinical work and the burden of disease among the people he cared for this was no surprise. Intravenous fluid replacement fell out of fashion for nearly fifty years. Medicine complacently turned its back on the door to enlightenment that Dr. Latta had thrown open by his brilliant example of the application of science to medicine. It was similarly careless of Thomas Latta himself. He did not receive the professional recognition that so major an advance deserved and died without any memorial other than the esteem of his friends and loyal colleagues like Dr. Lewins.
Fortunately there have been sporadic visitors to archives who bring his achievements back into the light. Even the briefest encounter with the bare bones of his story shows how meritorious he was.
Their papers and this essay perhaps may help resurrect interest in a young doctor who exemplified much of what is best in medicine.
My interest in Dr. Latta was sparked off by a description of his work in a history of Leith Hospital published in 1988 in Edinburgh called “A Beacon in our Town” by Christine Hoy. I drew on the excellent paper by Dr. A. H. B. Masson for much of the family history and was able to confirm and add to it from records held in the General Records Office, Scotland. A similarly illuminating paper by Dr. Neil MacGillivray was very informative on the contemporary local medical politics and much else besides.
- Anon, (1831-32), Editorial. Lancet II, 284.
- Masson, A H B (1971) Latta – Pioneer in Saline Infusion. Brit. J. Anaesth, 43, 681
- Christison, Robert (1832) Record of arrangements made by Edinburgh Board of Health, preparatory to the arrival of cholera in that city. Edinb. Med. Surg. J.,37, ccliv
- O’Shaughnessy, W B (1831-32). Proposal of a new method of treating the blue epidemic cholera by the injection of highly oxygenated salts into the venous system. Lancet, I, 366.
- Latta, T A 1831-32) Malignant cholers: documents communicated by the Central Board of Health, London, relative to the treatment of cholera by the copious injection of aqueous and saline fluids into the veins. Lancet, II, 274.
- MacGillivray, N (2006), Dr Latta of Leith: Pioneer in the treatment of cholera by saline intravenous infusion. J. R Coll Physicians Edinb., 36,80.
, PhD, MBChB, FFCM, is a retired Consultant in Public Health Medicine who worked in Lanarkshire Health Board from 1992 to 2003 and in Lothian Health Board from 1974-92. He had honorary Senior Lecturerships in Glasgow and Edinburgh Universities during these periods. He worked in mainly Public Health Medicine, as an Academic and Medical Practitioner at Health Board, and National levels. He attended Edinburgh University, receiving his MBChB in 1963, a Diploma in Animal Genetics in 1966, and a PhD in 1971. He became a member of the Faculty of Community Medicine in 1974 in London and has been a fellow since 1985.