Oral rehydration therapy (ORT) is a simple and powerful remedy that saves millions of children from diarrhoeal deaths every year. Improvising a simple oral remedy for diarrhoea was a Third World priority because the West, with good sanitation and ready access to intravenous (IV) fluids, rarely encountered diarrhoeal deaths. The scientific evidence in support of ORT began with researchers demonstrating the ‘cotransport phenomenon’, in which glucose was shown to enhance sodium absorption by specific transporter proteins. The ensuing clinical trials with ORT solutions of varying concentrations of sugar and salt, produced inconsistent and sometimes dangerous results. Early success came with the crucial 1968 Chittagong trials, when cholera patients in shock were treated intra-gastrically with ORT solutions. Subsequent field trials confirmed that ORT saves lives, even without IV fluids. Yet, translating ORT to the community remained problematic, until the Bangladesh liberation war (1971–72) when Dilip Mahalanabis (Infectious Diseases Hospital, Kolkata) conducted the game-changing field trial in squalid refugee camps under extreme conditions. With neither doctors nor nursing support, family members administered ORT to dying patients. This pragmatic and frugal remedy went on to become the flagship public health programme under UNICEF and WHO. Though under-implemented to this day, ORT remains the greatest contribution from the Indian subcontinent towards achieving Sustainable Development Goals. ORT teaches many lessons: the delays in translating research to therapy, lure of gadgetry smothering frugal innovation, need for institutional endorsement from the West, in addition to the general indifference towards public health priorities.
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