Evidence Classic · Emergency and public health · Issue 00

Salt, sugar and a monsoon

In a refugee camp, a physician ran short of intravenous fluid. What his team measured next changed the treatment of diarrhoea everywhere.

Bongaon, West Bengal, India, 1971 · published 1973

During the 1971 war that led to the independence of Bangladesh, millions of people fled into India, and cholera followed them. At a treatment centre in the border town of Bongaon, Dilip Mahalanabis of the Johns Hopkins centre in Calcutta had far more patients than intravenous fluid.

Oral rehydration, a solution of salt and glucose in water, had worked in controlled research wards. It was not trusted outside them. With supplies running out, his team made it in bulk and gave it by mouth, with relatives helping patients drink.

They wrote down what happened. Of 3,703 patients treated at the centre, 3.6% died. In a demonstration unit that relied on oral fluid, the figure was 1% among 1,190 patients, in the conditions of a crowded emergency camp.

Because the results were recorded and published, they could not be dismissed as anecdote. Oral rehydration became standard treatment worldwide, and in 1978 The Lancet described it as potentially the most important medical advance of the century.

Evidence gathered in a crisis still counts, if someone writes it down.

Return to the issue