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Cholera is a deadly disease that spread from the Ganges delta in India in the 1800s to the rest of the world. It's been responsible for seven pandemics (a worldwide epidemic), resulting in millions of deaths. One of the primary means by which it kills is dehydration, as a result of severe diarrhea and vomiting. In fact, cholera can take someone's life in as little as four hours following onset of symptoms. Undeveloped nations are particularly at risk, as lack of pure drinking water combined with inadequate sanitation facilities allows the disease to spread rapidly. Until the mid-1960s the only accepted treatment was intravenous therapy, a costly and highly technical method. Oral Rehydration Therapy (ORT) burst onto the scene as a lifesaving alternative thanks to the efforts of Norbert Hirschhorn, David Sachar, and others. Hirschhorn and Sachar expanded upon the work previously completed by Robert Phillips. Though Phillips had come painfully close to proving the effectiveness of ORT several years earlier, he became disillusioned when a clinical trial he directed resulted in the death of several patients. Ironically, it was under Phillip's directorship that Hirschhorn and Sachar completed their work on ORT. Their findings confirmed a simple mixture of water, glucose, and sodium given orally was effective in fighting cholera.
Hirschhorn's colleague David Sachar had devised an apparatus that allowed him to test the body's transport of sodium, a critical factor in fighting dehydration. This proved that even cholera patients retain the ability to transport sodium when afflicted by cholera, and the process was enhanced by glucose. Sachar was quite pleased - Hirschhorn was inspired. He immediately saw the link between this finding and the earlier work of his director, Robert Phillips. Hirschhorn was convinced this retained ability was the key to maintaining a positive hydration level - that cholera patients could indeed be given sufficient oral fluids to replace those they lost through diarrhea and vomiting. But, he faced a surprising hurdle. Both Phillips and Sachar resisted. Sachar felt it would be "premature" to conduct trials. Phillips, having conducted his own failed trial on ORT resulting in several patient deaths, was staunchly against the idea. But, Hirschhorn persisted and used the clinic's dwindling IV therapy supplies as leverage. In the end, he got approval and moved ahead. He tested ORT on six deathly ill cholera patients beginning in late 1966. Hirschhorn confirmed that cholera patients treated with ORT achieved a "net positive" hydration level, effectively absorbing more fluid than they eliminated. When he presented his findings in Dacca, one of the plantation doctors hailed ORT as being one of the most profound cholera treatment developments of the century. Hirschhorn's work laid the foundation for his successors in Dacca, David Nalin and Richard Cash, to make Oral Rehydration Therapy the standard means of treating cholera.
A visionary, a pragmatist - a poet... Hirschhorn is a unique combination of gifted scientist and accomplished poet. In addition to his medical background, Hirschhorn holds an MFA from Vermont College. He was nominated for a Pushcart Prize, and won the 1998 Chester H. Jones Foundation National Poetry Competition.
Dr. Hirschhorn is the co-founder of John Snow, Inc. – named after the 19th C epidemiologist who first identified the environmental cause of cholera in London. JSI continues in his tradition of putting data and research to direct use in helping communities around the world to improve health, education, and the environment.
Introduction by Tim Anderson
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Press release announcing Hirschhorn's winning the 2002 Pollin Prize:
Chapter in a book discussing Oral Rehydration Therapy and Hirschhorn:
Oral Rehydration Therapy and Hirschhorn
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