David R. Nalin (born April 21, 1941) is an American
physiologist, and
Pollin Prize for Pediatric Research
The Pollin Prize for Pediatric Research was an annual award given to physicians who contributed important advances to the field of pediatrics, and was the only existing international pediatric award. The prize was created in 2002 by Irene and Abe ...
and
Prince Mahidol Award, a.k.a. Mahidol Medal winner. Nalin had the key insight that
oral rehydration therapy
Oral rehydration therapy (ORT) is a type of fluid replacement used to prevent and treat dehydration, especially due to diarrhea. It involves drinking water with modest amounts of sugar and salts, specifically sodium and potassium. Oral rehydrat ...
(ORT) would work if the volume of solution patients drank matched the volume of their fluid losses, and that this would drastically reduce or completely replace the only current treatment for cholera, intravenous therapy. Nalin led the trials that first demonstrated ORT works, both in cholera patients, and more significantly, also in other dehydrating diarrhea illnesses. Nalin's discoveries have been estimated to have saved over 50 million lives worldwide.
Discovery of Oral Rehydration Therapy
In the fall of 1968, Dr. David Nalin, at a young 26 years of age and having completed only his first year of medical residency, was working in
Dacca
Dhaka ( or ; bn, ঢাকা, Ḍhākā, ), formerly known as Dacca, is the capital and largest city of Bangladesh, as well as the world's largest Bengali-speaking city. It is the eighth largest and sixth most densely populated city ...
,
Bangladesh
Bangladesh (}, ), officially the People's Republic of Bangladesh, is a country in South Asia. It is the eighth-most populous country in the world, with a population exceeding 165 million people in an area of . Bangladesh is among the mos ...
at the
Pakistan-SEATO Cholera Research Lab when a cholera epidemic broke out near
Chittagong, along the eastern Burmese border. Until the discovery of ORT, the only efficient means of rehydrating a patient suffering from serious dehydration was to provide fluids intravenously. For the vast majority of people in the developing world, cholera or any severe diarrhea illness was too often a death sentence since people infected usually had no recourse due to the cost and inaccessibility of IV therapy.
Indian
Indian or Indians may refer to:
Peoples South Asia
* Indian people, people of Indian nationality, or people who have an Indian ancestor
** Non-resident Indian, a citizen of India who has temporarily emigrated to another country
* South Asia ...
scientist
A scientist is a person who conducts scientific research to advance knowledge in an area of the natural sciences.
In classical antiquity, there was no real ancient analog of a modern scientist. Instead, philosophers engaged in the philosoph ...
Hemendra Nath Chatterjee
Hemendra Nath Chatterjee was an Indian scientist from West Bengal, who gave a dilute salt and glucose solutions both rectally and orally to a small percentage of pre-selected mildly ill cholera patients. He did not measure intake and output and pr ...
first formulated and demonstrated the effectiveness of
Orally Rehydrated Saline (ORS) for
diarrhea
Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin w ...
management. His paper regarding this finding was published in ''Lancet'' of November 1953. In that paper he states that
Avomine
Promethazine is a first-generation antihistamine, antipsychotic, sedative, and antiemetic used to treat allergies, insomnia, and nausea. It may also help with some symptoms associated with the common cold and may also be used for sedating people ...
can stop
vomiting
Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose.
Vomiting can be the result of ailments like food poisoning, gastroenteri ...
during
cholera and then oral rehydration is possible. The formulation of the fluid replacement solution was 4 g of
sodium chloride, 25 g of
glucose
Glucose is a simple sugar with the molecular formula . Glucose is overall the most abundant monosaccharide, a subcategory of carbohydrates. Glucose is mainly made by plants and most algae during photosynthesis from water and carbon dioxide, using ...
and 1000 ml of
water
Water (chemical formula ) is an inorganic, transparent, tasteless, odorless, and nearly colorless chemical substance, which is the main constituent of Earth's hydrosphere and the fluids of all known living organisms (in which it acts as a ...
.
Adopting the research of
H. N. Chatterjee, Nalin realized that ORT treatment could completely replace IV treatment and could work for most diarrhea, not only that caused by cholera. Nalin and his colleague,
Richard A. Cash
Richard Alan Cash (born June 9, 1941) is an American global health researcher, public health physician, and internist. He is a Senior Lecturer in International Health at the Harvard T.H. Chan School of Public Health in Boston.
He is an alumnus ...
, working in an adverse research climate, working in a tent housing patient overflow, at a small missionary hospital carved out of the jungle, fought to perform scientific trials that would prove
Oral rehydration therapy
Oral rehydration therapy (ORT) is a type of fluid replacement used to prevent and treat dehydration, especially due to diarrhea. It involves drinking water with modest amounts of sugar and salts, specifically sodium and potassium. Oral rehydrati ...
would work.
UNICEF
UNICEF (), originally called the United Nations International Children's Emergency Fund in full, now officially United Nations Children's Fund, is an agency of the United Nations responsible for providing Humanitarianism, humanitarian and Devel ...
released a special report in 1987 regarding Oral Rehydration Therapy. It said “No other single medical breakthrough of the 20th century has had the potential to prevent so many deaths over such a short period of time and at so little cost”
ORT is extremely effective and can easily be applied at home rather than in a hospital, but the idea and formulation for this elegant solution was time consuming and challenging - the formula needed to contain not only water, not only salt and water, but water, salt and sugar in very specific ratios. This solution has saved millions of lives since its inception 40 years ago.
The English medical journal,
The Lancet
''The Lancet'' is a weekly peer-reviewed general medical journal and one of the oldest of its kind. It is also the world's highest-impact academic journal. It was founded in England in 1823.
The journal publishes original research articles, ...
, calls ORT “potentially the most important medical advance of this century."
[Editorial. “Water with sugar and salt”. Lancet 2, August 5, 1978, pp. 300–301. “The discovery that sodium transport and glucose transport are coupled in the small intestine, so that glucose accelerates absorption of solute and water, was potentially the most important medical advance this century.”] Since the adoption of this inexpensive and easily applied intervention, the worldwide mortality rate for children with acute infectious diarrhea has plummeted from 5 million to about 1.3 million deaths per year. Over fifty million lives have been saved in the past 40 years by the implementation of ORT.
Honors and recognition
Among many distinctions of his career, in November 2002 Nalin received the first ever Pollin Prize in Pediatric Research. This honor was shared with Dr
Norbert Hirshchhorn, Dr
Dilip Mahalanabis
Dilip Mahalanabis (12 November 1934 – 16 October 2022) was an Indian paediatrician known for pioneering the use of oral rehydration therapy to treat diarrhoeal diseases. Mahalanabis had begun researching oral rehydration therapy in 1966 as a r ...
, and Dr
Nathaniel Pierce. In January 2007 the
Mahidol Medal from His Royal Highness the King of Thailand was presented at a ceremony at the Chakri Throne Hall in Bangkok, in recognition of the discovery and implementation of Oral Rehydration Therapy.
Quotes about the Science and Scientist, David Nalin
“No other single medical breakthrough of the 20th century has had the potential to prevent so many deaths over such a short period of time and at so little cost” - UNICEF 1987
“Potentially the most important medical advance of this century." –
The Lancet
''The Lancet'' is a weekly peer-reviewed general medical journal and one of the oldest of its kind. It is also the world's highest-impact academic journal. It was founded in England in 1823.
The journal publishes original research articles, ...
“Which medicine has saved more lives than any other and can be made by anyone in their kitchen, back bedroom, shantytown hut or dwelling built of sticks – as long as they have access to clean water? The answer is: eight teaspoons of sugar, half a teaspoon of salt and one litre of water. Mix. Drink……It requires no specialized equipment; uses ingredients that are ubiquitous and have a long shelf life; has few side effects; and can be made up in any quantity – the prefect medicine.” - Jeremy Laurance, British Journalist
In October 2006, The Independent, A British newspaper, reported on the greatest achievements in medical science in 150 years. The second on their list was oral rehydration therapy (first was oral contraception).
The greatest eureka moments , The Independent
/ref>
Science of ORT
Many members of the research team responsible for the discovery of ORT had not yet completed their medical residencies. At the time there was a military draft in the U.S. and many medical students joined the U.S. Public Health Service, including the National Institutes of Health, Bethesda, MD, and the Centers for Disease Control's Epidemiological Intelligence Service, where some were shipped overseas to do research or offer medical care.
Every letter which went through the Bangladesh post office from 1993-1994 was stamped with a printed rhyme. Translated into English, it read (gur is a molasses):
Mix with much care,
Good water, a liter,
A pinch of salt with a fistful of gur,
Remove the menace for good.
Stomach acid provides a natural defense against cholera infestation. Researchers gave billions of bacteria to healthy individuals and none of them became ill, except when subjects were given an antacid. This decrease in stomach acid immediately made them susceptible to cholera.
If ORT were applied to all patients who needed it, some estimate an additional two million lives could be saved annually and global savings in healthcare from home use of ORT would reach $10–15 billion US each year.
500 million packs of the oral rehydration solution are used each year in more than 60 developing countries.
A person with cholera can lose up to 20 liters a day of water, 10-20% of their body weight, leading to death by dehydration.
Gatorade
Gatorade is an American brand of sports-themed beverage and food products, built around its signature line of sports drinks. Gatorade is currently manufactured by PepsiCo and is distributed in over 80 countries. The beverage was first develop ...
works based on the same physiological mechanisms as ORT, however, it is NOT a substitute for ORT in diarrhea cases because it is formulated for healthy athletes, chiefly to replace sweat loss, not for sick children or adults who have diarrhea, which is significantly different in composition, and which requires a different solution. In order to make it easier for busy Americans to take, Abbot Laboratories
Abbott Laboratories is an American multinational medical devices and health care company with headquarters in Abbott Park, Illinois, United States. The company was founded by Chicago physician Wallace Calvin Abbott in 1888 to formulate known d ...
created a ready mixed ORT drink for diarrhea, available in a bottle, called Pedialyte
Pedialyte is an oral electrolyte solution manufactured by Abbott Laboratories and marketed for use in children. It was invented by Dr. Gary Cohen of Swampscott, Massachusetts.
Description
Pedialyte is designed to promote rehydration and electr ...
.
Timeline
1941 - David Nalin born in New York City
New York, often called New York City or NYC, is the List of United States cities by population, most populous city in the United States. With a 2020 population of 8,804,190 distributed over , New York City is also the L ...
.
1957 - David Nalin graduated from the Bronx High School of Science.
1965 - David Nalin graduated from Albany Medical College
Albany Medical College (AMC) is a private medical school in Albany, New York. It was founded in 1839 by Alden March and James H. Armsby and is one of the oldest medical schools in the nation. The college is part of the Albany Medical Center, which ...
.
1967 - David Nalin arrived in Dhaka
Dhaka ( or ; bn, ঢাকা, Ḍhākā, ), formerly known as Dacca, is the capital and largest city of Bangladesh, as well as the world's largest Bengali-speaking city. It is the eighth largest and sixth most densely populated city ...
(the capital of East Pakistan
East Pakistan was a Pakistani province established in 1955 by the One Unit Scheme, One Unit Policy, renaming the province as such from East Bengal, which, in modern times, is split between India and Bangladesh. Its land borders were with India ...
, as Bangladesh
Bangladesh (}, ), officially the People's Republic of Bangladesh, is a country in South Asia. It is the eighth-most populous country in the world, with a population exceeding 165 million people in an area of . Bangladesh is among the mos ...
was known. before gaining independence) to do cholera research at the Pakistan-SEATO Cholera. Research Laboratory (CRL) as a research associate at the US National Institutes of Health
The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late ...
(NIH).
1967 - David Nalin discovers that oral therapy can work to rehydrate cholera patients. Collaborates with Richard A. Cash
Richard Alan Cash (born June 9, 1941) is an American global health researcher, public health physician, and internist. He is a Senior Lecturer in International Health at the Harvard T.H. Chan School of Public Health in Boston.
He is an alumnus ...
to develop trial protocol to confirm discovery success.
1973 - Dr Nalin established and served at the Johns Hopkins Center for Medical Research in Dhaka, Bangladesh.
1975 - the World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
(WHO) and the United Nations Children’s Fund (UNICEF) agreed to promote a single, orally administered solution of oral rehydration salts to prevent dehydration caused by diarrhea.
1979 - Dr. Nalin arrived in Lahore, Pakistan
Lahore ( ; pnb, ; ur, ) is the second most populous city in Pakistan after Karachi and 26th most populous city in the world, with a population of over 13 million. It is the capital of the province of Punjab where it is the largest city. ...
, to take charge of the malaria research centre, where he was later expelled by Pakistani authorities early in 1982 due to unfounded Soviet allegations that the research being conducted there was for the CIA
1983 to 2002 - Director of Clinical Research International, later Director of Vaccine Scientific Affairs at Merck’s Vaccine Division.
2002 - Dr. Nalin received the first ever Pollin Prize in Pediatric Research.
2007 - Dr. Nalin received the Mahidol Medal from His Royal Highness the King of Thailand
The monarchy of Thailand (whose monarch is referred to as the king of Thailand; th, พระมหากษัตริย์ไทย, or historically, king of Siam; th, พระมหากษัตริย์สยาม) refers to the c ...
, presented at a ceremony at the Chakri Throne Hall in Bangkok.
Books and publications
Dr. David Nalin has published over 120 peer-reviewed academic papers, spanning his work over 40 years. Some highlights include:
Oral maintenance therapy for cholera in adults. Nalin DR, Cash RA, Islam R, Molla M, Phillips RA. Lancet. 1968 Aug 17;2(7564):370-3.
This paper in The Lancet
''The Lancet'' is a weekly peer-reviewed general medical journal and one of the oldest of its kind. It is also the world's highest-impact academic journal. It was founded in England in 1823.
The journal publishes original research articles, ...
is the original report of Dr. Nalin and colleagues’ work with ORT.
Oral or nasogastric maintenance therapy in pediatric cholera patients. Nalin DR, Cash RA.
J Pediatr. 1971 Feb;78(2):355-8.
This paper describes the use of ORT in pediatric patients.
Worldwide experience with the CR326F-derived inactivated hepatitis A virus vaccine in pediatric and adult populations: an overview. Nalin DR, Kuter BJ, Brown L, Patterson C, Calandra GB, Werzberger A, Shouval D, Ellerbeck E, Block SL, Bishop R, et al.
J Hepatol. 1993;18 Suppl 2:S51-5.
This paper describes Dr. Nalin’s work with Hepatitis A vaccine.
Mumps, measles, and rubella vaccination and encephalitis. Nalin DR. BMJ. 1989 Nov 11;299(6709):1219.
Oral therapy for diarrheal diseases. Nalin DR. J Diarrhoeal Dis Res. 1987 Dec;5(4):283-92.
This paper provides an overview of how ORT can be used for dehydration resulting from diarrheal diseases, not only cholera.
Recognition and treatment of anthrax. Nalin DR. JAMA. 1999 Nov 3;282(17):1624-5.
Books published by the scientist
Displaying Many Faces: Art and Gandharan Identity Selections from the David R. Nalin Collection by Chandreyi Basu, David Robert Nalin January 2004
External links
ScienceHeroes.com
Dr. Nalin’s biography as the recipient of the Prince Mahidol award
Against the Odds – Making a difference in global health – A Simple Solution
References
{{DEFAULTSORT:Nalin, David
1941 births
Living people
American agnostics
American physiologists
Jewish scientists
American expatriates in Bangladesh
American expatriates in Pakistan