Robert Phillips
(July 16, 1906 - September 19, 1976)
Born in Cedar Lake, IA USA
Year of Discovery: 1968
Image Courtesy: Lasker Foundation

His Early Research Paved the Way for A Practical Treatment for Cholera

Phillips may have been doing what came naturally when he did his groundbreaking research. Both his father and his uncle were physicians. The two were partners in a medical practice, consisting of a clinic and a small hospital, which adjoined Phillips' boyhood home in Clear Lake, Iowa. Combining this rich medical tradition with a keen mind, Phillips was perfectly prepared to tackle the complexities of cholera. Phillips saw the futility of intravenous (IV) therapy. Though IV therapy was the only method available to rehydrate cholera patients, it was costly and required a clinical setting. Phillips' early experiments with Oral Rehydration Therapy (ORT) proved the ability of glucose to be absorbed within the gut of cholera patients - and, though he would minimize this detail in his reporting, to enhance sodium absorption. Glucose became a key component of ORT, and Phillips' early work set the stage for the full development of ORT as the simple, cost-effective, standard treatment of cholera worldwide.

Cholera is a deadly disease that spread from the Ganges delta in India in the 1800s to the rest of the world. It has been responsible for seven pandemics worldwide, 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 Robert Phillips, David Nalin, and Richard Cash. Phillips laid the foundation in clinical trials in the Philippines in the early 1960s. His work revealed the critical importance of glucose in the oral Rehydration process. Nalin and Cash expanded on these findings while working in Bangladesh (then East Pakistan) treating victims of a cholera outbreak. Though the conditions were not optimal, and they faced resistance from their colleagues, Nalin and Cash proved that intravenous therapy was unnecessary - the same results could be achieved through a simple solution administered by mouth. A mixture of clean water, salt and sugar became the low-tech solution to a global health crisis, and it is estimated ORT has saved over 50 million lives since.

Phillips first directly encountered cholera in 1947, while stationed in Egypt. An outbreak of cholera spread rapidly and 30,000 people were soon infected. Despite Phillips' coordination of a massive vaccine airlift form the United States the impact was devastating: 20,000 of those afflicted lost their lives. Phillips quickly established a small clinical trial, treating 40 of the sickest patients with IV therapy. Only three patients died, well below the rate of death in the general population. This further sparked Phillips' belief that cholera could be defeated, and he continued to intervene in cholera epidemics throughout the world. It was in 1961, while treating cholera patients in the Philippines, that Phillips came to realize a new treatment approach must be found. IV therapy was simply too expensive and required too much clinical support. So he and his colleagues began trials with ORT in early 1962. These studies established the critical importance of glucose in the treatment and laid the foundation for further development of ORT. Reflecting on the significance of their studies, Phillips predicted, "...one may be able to develop an oral treatment regimen which in the average case might completely eliminate the requirements for intravenous fluids."

Though Phillips was instrumental in establishing the foundation for ORT, his work was not without cost. In 1963 he continued his study of the importance of glucose being a primary component of the Rehydration therapy. But, convinced it was important to also show the simplicity of the protocol, Phillips insisted on conducting the research without laboratory support. This was a drastic departure for the normally precise scientist and the results were devastating - five of the 40 patients died of pulmonary edema (a buildup of fluids in the lungs), which led to congestive heart failure. The combination of the IV therapy, which they continued to use for safety, and the ORT appeared to have produced the fluid overload. Phillips was demoralized and came to seriously question the effectiveness of Oral Rehydration Therapy. In the ultimate irony, it was under Phillips' leadership, at the Pakistan-SEATO Cholera Research Laboratory (PS-CRL) in Dacca, that Nalin and Cash confirmed his earlier work. Though Phillips was still doubtful, and at times actually slowed their progress, Nalin and Cash finally provided the clinical proof necessary to validate Oral Rehydration Therapy. Phillips' long journey was over and the world had the treatment it needed to effectively combat cholera.

Introduction by Tim Anderson

Lives Saved:  Over 57,500,000


Snippets
In the Navy at the start of WWII Phillips developed methods to calculate various blood indices and to estimate intravascular fluid deficits on the basis of changes in the specific gravity of blood. The Phillips-Van Slyke test was adopted by the US and British armed services and proved invaluable in the field management of hemorrhage, burns, and shock during the war.

Few advances have so profoundly impacted public health as have those fostered by Phillips and his colleagues. Today, oral and intravenous fluid therapy for diarrhea and dehydration are part of everyday medical practice. Intravenous rehydration therapy has reduced the mortality rate associated with cholera accompanied by severe dehydration and shock to <1%, and it continues to be the mainstay of therapy for such patients.

                                                                                                                                                  Stephen J. Savarino


Key Contributors 
David Nalin
Richard Cash
Norbert Hirschhorn
Robert Phillips
David Sachar 


Links to More About the Scientist & the Science
A Legacy in 20th Century Medicine: Robert Phillips and the Taming of Cholera
https://academic.oup.com/cid/article/35/6/713/379600
 Magic Bullet: The History of Oral Rehydration Therapy, by Joshuan N. Ruxin
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1036912/pdf/medhist00037-0005.pdf