The first forty years of the twentieth century have seen greater
advances in the science and art of surgery than the whole of preceding time.
But, as the field of surgical endeavour has widened, new problems have arisen.
Operations are now carried out upon patients so reduced by their disease that
formerly interference would not have even have been considered. The outcome of
such enterprises depends upon meticulous care in the pre and post-operative
treatment, not the least important aspect of which is the maintenance of normal
water and electrolyte metabolism. In this connection it is interesting to recall
that as long ago as 1831 Dr. W. B. O'Shaughnessy of Newcastle upon Tyne recognised
the essentials of water and electrolyte depletion and also outlined treatment.
In a brief letter to the London Medical Gazette he summarised the changes which
occur in the blood of patients suffering from cholera. He stated that:
1. "The blood drawn in the worse cases of cholera is unchanged in its
anatomical or globular structure."
2. It has lost a large proportion of its water, 1000 parts of cholera
serum having but the average of 850 parts of water."
3. "It has lost also a great proportion of its neutral saline ingredients."
4. "Of the free alkali contained in healthy serum, not a particle is
present in some cholera cases, and barely a trace in others."
5. "Urea exists in the cases where suppression of urina has been a marked
6. "All the salts deficient in the blood, especially the alkali or carbonate
of soda, are present in large quantities in the peculiar white dejected matters."
From the early papers and the very numerous investigations which
have since been carried out, it has become obvious that loss of water and sodium
chloride from the body so alters "the innumerable and interrelated chemical
reactions that together accomplish what we call metabolism that life itself
may thereby be seriously endangered. Therefore rational fluid therapy must be
directed not to restoring the normal body content of any particular component
of the body fluids (which indeed is separately impossible), but to the restoration
and maintenance of the normal volume, composition, and distribution of the body
fluids as a whole, so that metabolism may proceed under the most favourable of
circumstances. It is the purpose of this paper to discuss the metabolism of the
body fluids, the practical applications of fluid therapy in surgical patients,
and to make some contribution to our knowledge of the therapeutics of sodium