UNSUNG SAVIOUR DILIP MAHALANABIS

TRIBUTE BY:

Prof. Kaushik Bose,

Head of Department, Department of Anthropology,

Vidyasagar University,

Midnapore – 721102, West Bengal, INDIA.

e-mail: kaushikbose@cantab.net

DILIP MAHALANABIS

(12th November 1934 – 16th October 2022).

Global data on diarrhoeal diseases suggest that it is the second leading cause of death in children under five years of age. Each year diarrhoea kills around 5,25 000 in this age group. Every year nearly 1.7 billion children suffer Diarrhoeal diseases. It is well established that individuals die of Diarrhoea because of dehydration and fluid loss. Immediate supplement of the fluids helps prevent diarrhoeal deaths. Earlier, intravenous therapy was the only method of ORT available to health professionals. Its use was restrictive. Experiments on animals established that glucose enhances absorption of water and sodium across the intestinal brush border membrane without causing any changes in the gut epithelium. This resulted in successful oral glucose saline therapy given to two cholera patients by Captain Philips of the US army in 1964. Thereafter, oral rehydration therapy was given to diarrhoeal patients. during the Bangladesh war (1971-72). A team working with Dr. Dilip Mahalanabis faced acute shortage of intravenous saline. It was then replaced by oral rehydration solution. The standard practise of it now is a proportionate solution of clean water, salt and sugar mixed in proportions of (six (6) level teaspoons of sugar, half level teaspoon (1/2) of Salt in one litre of clean drinking water). These ingredients are readily available in every household and could be given instantaneously to replenish fluid loss. The team had mixed glucose, salt, and baking soda. This simple innovation has over the years helped save millions of lives across the globe among the most impoverished populations. This tribute to his memory celebrates the life of an unassuming saviour of million lives whose contributions largely remained unsung in his own country.

Dr. Dilip Mahalanabis was born on November 12th,1934, in Kishoreganj District of Bengal in undivided Bengal during British rule. He obtained his M.B.B.S degree from Calcutta Medical College and specialised in paediatrics in 1958 and served there for a while as an intern. His intellect received recognition from the establishment NHS, UK and he was invited for further studies in London and Edinburgh. He obtained his FRCP degree from there. During his training in the UK, he became the first Indian to be appointed registrar of Queen Elizabeth hospital for Children. In 1960, he joined the John Hopkins University International Centre for Medical research and Training (JH-CMRT) in Kolkata. It was here that he started his initial research in Oral rehydration therapy for Cholera. His exemplary service as a medical professional reflects sincere commitment to Hippocrates oath that asks every physician to take a pledge “to prescribe only beneficial treatments, according to his abilities and judgement; to refrain from causing harm or hurt; and to live an exemplary personal and professional life”.

In the mid-1960s he did pioneering research on cholera and other diarrheal diseases at the John Hopkins International Centre for Medical Research and Training in Calcutta, India. During the Bangladesh war for independence he pioneered efforts by the John Hopkins Centre to save human lives. In 1971, Cholera outbreak occurred among the 350,000 Bangladesh refugees from East Bengal seeking shelter in camps there. They were seeking asylum in Bongaon and other areas in West Bengal. Providing intravenous fluid as rehydration to the patients became a huge challenge!

The team working with Dr. Dilip Mahalanabis made ready-to-use ORT sachets or ORS consisting of a mixture of table salt (four teaspoons), baking soda (three teaspoons) and commercial glucose (20 teaspoons) mixed in water. Mothers, relatives, friends, or anybody available in the camp were mobilised to give ORS to patients. The results of the ORS application were overwhelmingly reassuring. The death rate was 30%, when patients were being treated only with intravenous fluid therapy. But the moment oral therapy was introduced death rate dropped to 3.6% in just two weeks. This was historic success of a field experiment carried out to save human lives in a critical crisis.

Evidently, this was the first large scale use of ORS in a disaster situation. This unique intervention soon gained WHO’s recognition and was recommended for usage in most remote areas of the World. Aptly the Lancet called this as “potentially the most important medical advance” of the 20th century. This path breaking intervention of ORS for treating Cholera is said to have saved 40 million lives infected with this dreaded infection and changed the way this infection is being treated. To commemorate this ‘Elixir for life’, 29th July is observed as World ORS Day.

Phenomenal success of this intervention strategy for treating Cholera brought more responsibility to the young shoulders of Dr. Mahalanabis. From 1975 to 1979, he worked on cholera control for WHO in Afghanistan, Egypt, and Yemen. During the 1980s, he worked as a WHO consultant on research on the management of bacterial diseases. In the mid-1980s and early 1990s, he was a medical officer in the Diarrheal Disease Control Programme of the WHO. Later in the 1990s, he served as the Director of Clinical Research at the International Centre for Diarrhoeal Disease Research (ICDDR,B), Bangladesh from where he retired in 1995.

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

He was the Founder and Director, The Society for Applied Studies (SAS) which was established in 1990 in Kolkata with a vision of “Improved Health and Quality of Life” in India and other developing countries, especially for children and women. The SAS has now expanded and become the Centre for Health Research and Development, Society for Applied Studies (CHRD-SAS), New Delhi.

He was married to Jayanti Mahalanabis (now deceased), an eminent physicist. They had no children. In 2012 he was awarded a D.Sc. (h.c.) degree by Vidyasagar University, West Bengal, India, for his pioneering work on ORS. Subsequently, he received the same degree from Calcutta University.

However, it is surprising that someone who received such high acclaim globally did not get any government award from his own country. I was highly privileged and honoured to be associated with him for many years. I had co-supervised 2 Ph.D. theses with him at Vidyasagar University; one dealing with Risk factors for low birth weight among Bengalese (Samiran Bisai) and the other on Estimation of body composition of Indian infants (Bandana Sen). With him I have co-authored more than 10 research papers in peer reviewed international indexed journals of repute. Some of my important publications with him are Bisai et al. (2007; 2009; 2014) and Sen et al. (2009; 2010a, 2010b).

His generosity went beyond words. He donated his life’s saving of rupees one million to Institute of Child Health, Kolkata (ICH) from where he started his medical journey. On a personal note, he was a doctor who listened! Despite his reputation as a researcher of legendary stature, he was very polite, amicable and down to earth. He helped people whenever it was possible for him. He died on 16th October 2022 at the age of eighty-seven. It was a life lived in the service of humanity true to the spirit of Hippocratic ideals and values. An obituary published in the latest issue of the prestigious medical journal Lancet highlights the significance and importance of the pioneering contributions made by him.

May his soul rest in peace.

REFERENCES

Bisai, S., Mahalanabis, D., Sen, A., Bose, K. and Datta, N. Maternal early second trimester pregnancy weight in relation to birth outcome among Bengalee Hindus of Kolkata, India, Annals of Human Biology, 34:1, 91-101, 2007. DOI: 10.1080/03014460601080728.

Bisai, S., Datta, N., Bose, K., Mahalanabis, D. and Sen, A. Receiver Operating Characteristics (ROC) Curve Estimation of Low Birth Weight Based on Maternal Early Third Trimester Weight among Bengalee Women of Kolkata, India. Collegium Antropologicum,. 33 (3): 725–728, 2009.

Sen, B., Mahalanabis, D., Shaikh, S., Kurpad, A.V and Bose, K. Evaluation of equations for fat-free mass based on anthropometry in infants and young children in South Asia. British Journal of Nutrition, 101 (4): 551-7, 2009. DOI: 10.1017/S0007114508019867.

Sen, B., Bose, K., Shaikh, S. and Mahalanabis, D. Prediction Equations for Body-fat Percentage in Indian Infants and Young Children Using Skinfold Thickness and Mid-arm Circumference. Journal of Health and Population Nutrition, 28 (3): 221-229, 2010a.

Sen, B., Mahalanabis, D., Kurpad, A.V., Shaikh, S. and Bose, K. Total body water and fat-free mass: evaluation of equations based on bioelectrical impedance analysis in infants and young children in India. British Journal of Nutrition , 104 (2): 256 – 264, 2010b. DOI: https://doi.org/10.1017/S0007114510000498

Mahalanabis, D. A.B. Choudhuri, N.G. Bagchi, A.K. Bhattacharya, T.W. Simpson. 2012. Oral fluid therapy of Cholera among Bangladesh refugees. Public Health Classic. Volume:1Issue1. Pp 105-112.The John Hopkins University Centre for Medical Research and Training, Calcutta, India.

Bisai, S., Mahalanabis, D., Sen, A and Bose, K. Maternal Education, Reported Morbidity and Number of Siblings are Associated with Malnutrition among Lodha Preschool Children of Paschim Medinipur, West Bengal, India. International Journal of Paediatrics, 2 (4.2): 13-21, 2014. http://dx.doi.org/10.22038/ijp.2014.3363

Dilip Mahalanabis: Obituary. Lancet. (2022). DOI: https://doi.org/10.1016/S0140-6736(22)02367-4