Dilip Mahalanabis, paediatrician, 1934-2022

When Dilip Mahalanabis died last month aged 87, it was scarcely remarked upon outside India. Yet the distinguished paediatrician deserved a less muted valediction.

His pioneering medical work among refugees fleeing war in the 1970s demonstrated that oral rehydration therapy — a simple solution of glucose, salts and water designed to replace vital fluids lost during bouts of infectious disease — could be successfully administered at scale, even during a desperate humanitarian crisis. The Lancet estimates this treatment has helped save 54 million lives over the past half century.

Mahalanabis was born in East Bengal, now Bangladesh, in 1934 and educated at a medical school in Kolkata. After a spell working for the NHS in London, he eventually returned to the city in 1966 to begin research into oral rehydration treatments at Kolkata’s Johns Hopkins University International Centre for Medical Research and Training. But in 1971, the Bangladesh war of independence broke out: thousands fled to refugee camps on the country’s border with India. Infectious disease spread rapidly in these close confines, and Mahalanabis decided to put his theory into practice.

In an interview published in a 2009 bulletin of the World Health Organization, he painted a graphic picture of the conditions he encountered while attempting to use traditional intravenous methods. “There were two rooms in the hospital in Bangaon that were filled with severely ill cholera patients lying on the floor. In order to treat these people with IV saline, you literally had to kneel down in their faeces and their vomit”.

Within 48 hours he realised he was fighting a losing battle “because there was not enough IV and only two members of my team were trained to give IV fluids”. 

He decided to deploy a simple, low-cost solution and to allow people without medical training, including family members, to administer it. “He told me that ‘necessity was the mother of innovation and the necessity was that people were dying in front of our eyes and we had to save them’,” said Raj Ghosh, an infectious disease specialist who for 25 years counted Mahalanabis as a mentor and friend.

The no-frills approach quickly proved highly effective. Ghosh recalled Mahalanabis telling him that a member of the army had asked about the length of time the oral solution should be administered for. “He told him they can keep on taking it as long as they are thirsty and when they are no longer thirsty that means they have become well and they can stop.” 

Mahalanbis did not discover ORT. Richard Cash, senior global health lecturer at Harvard’s TH Chan School of Public Health, played a key role in the first clinical trial of the treatment on severe diarrhoea patients during an epidemic in Dhaka in the 1960s. He noted: “It’s not simply the discovery of something, but the application of that technology that also needs to be recognised . . . And [Mahalanbis] had the foresight to say, ‘There’s no way we can handle this situation with the intravenous solution. So let’s do this. And let’s try it on a large scale.’”

Mahalanbis’s work in the camps, during a crisis, lacked the attributes of a scientifically robust trial. He initially struggled to have his findings published and encountered some scepticism from the medical establishment. But ultimately, his intervention helped spur the WHO’s adoption of the approach.

Mahalanabis went on to work as a medical officer in the WHO diarrheal disease control programme and served as the director of clinical research at the International Centre for Diarrhoeal Disease Research, Bangladesh.

He became a member of the Royal Swedish Academy of Sciences and a co-recipient of the Pollin Prize in Pediatric Research in 2002, as well as receiving the Prince Mahidol Prize which recognises exceptional contributions in public health, alongside Cash and another physiologist, David Nalin.

Yet Ghosh, who now works as a senior adviser to the Gates Foundation in India, says Mahalanabis remained a fundamentally modest man, always keen to promote others if there was a seminar to be led or an article to be penned. “He would say, ‘Others should do it,’” he recalled.

Mahalanabis delighted in developing the next generation in his field, and was as keen to receive knowledge as to transmit it, Ghosh said. “He was one of those persons who really connected very well with young researchers because he would speak to them as almost a peer.” 

Ghosh added: “I had many times told him he should write a memoir and he would laugh and say, ‘The time hasn’t come yet.’”