Oral Rehydration Therapy

This article records tradition as it has been passed down and reported. Its sources are not yet part of the atlas's verified catalogue.

For most of medical history, severe diarrheal disease killed by dehydration, and the only real treatment was an intravenous line, a resource few of the world's poorest patients could reach in time. That changed in the hospital wards of Dacca, in what is now Bangladesh, where physicians Richard Cash and David Nalin ran the trials that, in the late 1960s, proved a patient could be rehydrated by mouth instead of by needle: a carefully measured solution of glucose and salt, drunk rather than infused, could maintain a cholera patient's fluid balance as effectively as an intravenous line, at a fraction of the cost and without the trained staff a drip requires.

The British medical journal The Lancet has since called the discovery the most important medical advance of the twentieth century, and in 1978 the World Health Organization created its own diarrheal disease control program to carry the treatment to the clinics and camps that needed it most. The claim has aged well: researchers estimate that oral rehydration therapy has saved something like seventy million lives since its introduction in the late 1970s, at a cost, in lower-income countries, of around fifty cents a treatment course. Few medical advances in history have done as much good for as little money.

This article records tradition as it has been passed down and reported. Its sources are not yet part of the atlas's verified catalogue.

The clinical trials that proved oral rehydration therapy worked were run in a hospital, with trained staff and measured doses. Its most dramatic proof came somewhere far rougher: a refugee camp during the 1971 Bangladesh Liberation War, where physician Dilip Mahalanabis found himself overseeing a cholera outbreak with far more patients than his intravenous supplies could possibly treat.

Mahalanabis made a decision that had no real precedent at that scale: he had his staff hand out pre-measured packets of salt and sugar, to be mixed with water and drunk rather than infused, to patients and their families directly, effectively turning every patient's relative into part of the treatment team. The camp's cholera case-fatality rate, which had been running at roughly 30 percent under conventional care, fell to below 4 percent. It was an improvised, wartime answer to a hospital-trial question, and it is the moment the treatment's champions point to when they call it the discovery that proved itself in the worst possible conditions rather than only the best ones. This atlas describes the history of the treatment and is not medical advice.