Dilip Mahalanabis
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Dilip Mahalanabis (12 November 1934 – 16 October 2022) was an Indian
paediatrician Pediatrics ( also spelled ''paediatrics'' or ''pædiatrics'') is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until the ...
known for pioneering the use of
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 ...
to treat
diarrhoeal diseases 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 wi ...
. Mahalanabis had begun researching oral rehydration therapy in 1966 as a research investigator for the
Johns Hopkins University Johns Hopkins University (Johns Hopkins, Hopkins, or JHU) is a private research university in Baltimore, Maryland. Founded in 1876, Johns Hopkins is the oldest research university in the United States and in the western hemisphere. It consi ...
International Center for Medical Research and Training in
Calcutta Kolkata (, or , ; also known as Calcutta , List of renamed places in India#West Bengal, the official name until 2001) is the Capital city, capital of the Indian States and union territories of India, state of West Bengal, on the eastern ba ...
,
India India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the so ...
. During the Bangladeshi war for independence, he led the effort by the Johns Hopkins Center that demonstrated the dramatic life-saving effectiveness of oral rehydration therapy when cholera broke out in 1971 among refugees from East Bengal (now
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 ...
) who had sought asylum in
West Bengal West Bengal (, Bengali: ''Poshchim Bongo'', , abbr. WB) is a state in the eastern portion of India. It is situated along the Bay of Bengal, along with a population of over 91 million inhabitants within an area of . West Bengal is the fou ...
. The simple, inexpensive Oral Rehydration Solution (ORS) gained acceptance, and was later hailed as one of the most important medical advances of the 20th century. From 1975 to 1979, Mahalanabis worked in cholera control for 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 ...
(WHO) in
Afghanistan Afghanistan, officially the Islamic Emirate of Afghanistan,; prs, امارت اسلامی افغانستان is a landlocked country located at the crossroads of Central Asia and South Asia. Referred to as the Heart of Asia, it is bordere ...
,
Egypt Egypt ( ar, مصر , ), officially the Arab Republic of Egypt, is a transcontinental country spanning the northeast corner of Africa and southwest corner of Asia via a land bridge formed by the Sinai Peninsula. It is bordered by the Medit ...
and
Yemen Yemen (; ar, ٱلْيَمَن, al-Yaman), officially the Republic of Yemen,, ) is a country in Western Asia. It is situated on the southern end of the Arabian Peninsula, and borders Saudi Arabia to the Saudi Arabia–Yemen border, north and ...
. During the 1980s, he worked as a WHO consultant on research on the management of
bacterial diseases Pathogenic bacteria are bacteria that can cause disease. This article focuses on the bacteria that are pathogenic to humans. Most species of bacteria are harmless and are often beneficial but others can cause infectious diseases. The number of t ...
. In 1983, Mahalanabis was made a member of the WHO’s Diarrhoeal Diseases Control Programme. He remained in that role for over five years. He was also associated with
Kolkata Kolkata (, or , ; also known as Calcutta , the official name until 2001) is the capital of the Indian state of West Bengal, on the eastern bank of the Hooghly River west of the border with Bangladesh. It is the primary business, comme ...
's National Institute of Cholera and Enteric Diseases (NICED) and the
Institute of Child Health The UCL Great Ormond Street Institute of Child Health (ICH) is an academic department of the Faculty of Population Health Sciences of University College London (UCL) and is located in London, United Kingdom. It was founded in 1946 and together ...
.


Early life and education

Dilip Mahalanabis was born on November 12 1934 in
Kishoreganj district Kishoreganj ( bn, কিশোরগঞ্জ) is a district in Dhaka Division, Bangladesh. Earlier it was a Mohkuma (মহকুমা) under the Mymensingh district. It was taken 2495.07 sq. km of land from Mymensingh district to form pres ...
of Bengal Province of British India. He graduated from the
Calcutta Medical College Calcutta Medical College, officially Medical College and Hospital, Kolkata, is a public medical school and hospital in Kolkata, West Bengal, India. It is the oldest existing hospital in Asia. The institute was established on 28 January 1835 ...
as a paediatrician in 1958 after working there as an intern. The establishment of the
NHS The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
in UK provided him an opportunity to pursue medicine in the UK, he obtained degrees from London and Edinburgh.


Career

While he was in the UK he became the first Indian to be selected as the registrar for the
Queen Elizabeth Hospital for Children The Queen Elizabeth Hospital for Children was based in Bethnal Green in the London Borough of Tower Hamlets, London. In 1996, the hospital became part of The Royal Hospitals NHS Trust, later renamed Barts and The London NHS Trust. In 1998, the ...
. In the 1960s he joined the Johns Hopkins University International Centre for Medical Research and Training (JH-CMRT) in Kolkata, where he began his research into oral rehydration therapy.


Bangladeshi Refugee Camps and pioneering of Oral Rehydration Therapy

The outbreak of the Bangladesh war of independence led to a massive refugee crisis with most of the refugees ending up in India. Cholera quickly became a major cause of death among the starving and exhausted refugees with a
case fatality rate In epidemiology, case fatality rate (CFR) – or sometimes more accurately case-fatality risk – is the proportion of people diagnosed with a certain disease, who end up dying of it. Unlike a disease's mortality rate, the CFR does not take int ...
(CFR) of 30%, to help the government and non-governmental organisations deal with this situation, JH-CMRT sent its professional and paramedical personnel to the refugee camps. Dr. Mahalanabis and his team worked along the border of India and
East Pakistan East Pakistan was a Pakistani province established in 1955 by the 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 and Myanmar, wi ...
, with their treatment center being located in
Bongaon Bangaon is a city and a municipality in North 24 Parganas district in the state of West Bengal, India. It is the headquarters of the Bangaon subdivision. Geography Location Bangaon is located at . It has an average elevation of 7 m ...
. 16 beds available to them in two cottages which served as cholera wards were completely insufficient to serve the 350,000 refugees living in the vicinity of the town, cholera wards quickly ran out of space with even floors being completely occupied by sick patients, this necessitated the setting up of a large separate tent with 100 cots. They also suffered from a shortage of intravenous fluids and had no way of obtaining them in the required quantities and trained personnel to administer them. Based on research available at the time, Mahalanabis and his team were confident that oral rehydration alone would be enough to prevent fatal dehydration in the early stages, with intravenous fluid being required only for severe cases after the onset of hypovolemic shock and severe
acidosis Acidosis is a process causing increased acidity in the blood and other body tissues (i.e., an increase in hydrogen ion concentration). If not further qualified, it usually refers to acidity of the blood plasma. The term ''acidemia'' describes ...
. He used an oral rehydration solution (ORS) using locally available ingredients and with minimum number of ingredients consisting of 22g
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, u ...
, 3.5g sodium chloride, 2.5g sodium hydrogencarbonate per litre of water. The glucose was prepared by JH-CMRT and the ingredients were weighed and packed in sealed and labeled polyethylene bags. This powdered mixture was added to drums containing potable water and given to patients in cups. Due to local sourcing of all the materials, the cost was just 11 paise (1.5 cents) per litre of the solution. The family members of the patients were instructed to provide the patients with the ORS due to the simplicity of the therapy. Potassium was also orally administered for children, and coconut water was provided whenever possible due to its high potassium content along with a small dose of
tetracycline Tetracycline, sold under various brand names, is an oral antibiotic in the tetracyclines family of medications, used to treat a number of infections, including acne, cholera, brucellosis, plague, malaria, and syphilis. Common side effects in ...
for both adults and children. During a 8 week period in which he and his team administered this therapy to 3700 patients, only 135 cases were fatal translating to a CFR of 3.6% which was a massive decrease from 30% fatality observed earlier, in the separate tent the CFR was even lower at 1%, however the conditions were so poor that half the patients died before any oral rehydration therapy could be even administered. During this time Dr. Dhiman Barua who was the head of the Bacterial Diseases unit of the
WHO Who or WHO may refer to: * Who (pronoun), an interrogative or relative pronoun * Who?, one of the Five Ws in journalism * World Health Organization Arts and entertainment Fictional characters * Who, a creature in the Dr. Seuss book '' Horton He ...
visited the camp managed by Mahalanabis, and began boldly promoting the treatment in the WHO and
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 humanitarian and developmental aid to ...
. Despite this Mahalanabis's treatment was met with skepticism from the scientific community with many journals refusing to publish his original paper, it would take 7 more years for oral rehydration therapy to be accepted as a good treatment for dehydration from diarrhea and other diseases. He never patented his ORS formula.


Later career

He worked in the cholera control unit of the WHO from 1975-79, serving in Afghanistan, Egypt, and Yemen. He worked as a consultant on bacterial diseases for the WHO during the 1980s. In the mid-1980s and early 1990s, he was a medical officer in the Diarrheal Disease Control Programme of the WHO. In 1990 he was appointed as a clinical research officer at the International Centre for Diarrhoeal Disease Research (ICDDR,B), Bangladesh. Later going on to become the Director of Clinical Research there. In 2004, he and Dr. Nathaniel Pierce were working on an improved version of the ORS which would be more effective at preventing dehydration from all forms diarrhoea and confer addition benefits like reduced stool output.


Awards and Honours

In 1994, Mahalanabis was elected a foreign member of the Royal Swedish Academy of Sciences. In 2002 Dr. Mahalanabis, Dr. Nathaniel Pierce, Dr. David Nalin and Dr. Norbert Hirschhorn, were awarded the first Pollin Prize in Pediatric Research for their contributions to the discovery and implementation of oral rehydration therapy. In 2006 Dr. Mahalanabis, Dr.
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 ...
and Dr. David Nalin were awarded the Prince Mahidol Prize, also for their role in the development and application of oral rehydration therapy.


Personal life and death

Mahalanabis was married to Jayanti Mahalanabis. He died at a private hospital in
West Bengal West Bengal (, Bengali: ''Poshchim Bongo'', , abbr. WB) is a state in the eastern portion of India. It is situated along the Bay of Bengal, along with a population of over 91 million inhabitants within an area of . West Bengal is the fou ...
,
Kolkata Kolkata (, or , ; also known as Calcutta , the official name until 2001) is the capital of the Indian state of West Bengal, on the eastern bank of the Hooghly River west of the border with Bangladesh. It is the primary business, comme ...
on 16 October 2022, at the age of 87. He was suffering from lung infection and other old age related ailments.


Awards

* Pollin Prize (2002) *
Prince Mahidol Award The Prince Mahidol Award ( th, รางวัลสมเด็จเจ้าฟ้ามหิดล) is an annual award for outstanding achievements in medicine and public health worldwide. The award is given by the Prince Mahidol Award Found ...
(2006)


References


Further reading


Randomized, double-blind, placebo-controlled clinical trial of the efficacy of treatment with zinc or vitamin A in infants and young children with severe acute lower respiratory infection


* ttp://jn.nutrition.org/cgi/content/abstract/127/8/1451 Long-Term Oral Supplementation with Iron Is Not Harmful for Young Children in a Poor Community of Bangladesh
A Randomized, Placebo-Controlled Trial of the Bivalent Killed, Whole-Cell, Oral Cholera Vaccine in Adults and Children in a Cholera Endemic Area in Kolkata, India
{{DEFAULTSORT:Mahalanabis, Dilip 1934 births 2022 deaths Bengali scientists Members of the Royal Swedish Academy of Sciences Bangladesh Liberation War Medical doctors from West Bengal People from Kishoreganj District