Joseph R. Anticaglia, MD
Medical Advisory
I was having dinner in a restaurant when a man got up from the table gasping for air, couldn’t speak, and pointing to his mouth. In a blink of an eye, a woman ran to his table, got behind him, told him to “lean forward, open your mouth, and proceeded to perform the “Heimlick maneuver.” After the fourth attempt, out popped what appeared to be a chunk of beef from his mouth.
Cheers and applause erupted from the customers in the restaurant. Imagine the satisfaction, the euphoria, streaming through the woman’s body as well as the man’s gratitude for carrying out the maneuver, and potentially saving his life.
Now think about beyond one’s wildest dreams, a man and his colleagues who laid the groundwork that saved not one, not a thousand, but more than sixty (60) million lives worldwide because of his innovative, lifesaving, simple solution of sugar water with a pinch of salt!
Dr. Cash is renowned for his trailblazing work in developing ORT. It’s a type of fluid replacement therapy which treats dehydration due to diarrhea caused by diseases such as cholera, and dysentery. The treatment involves drinking a solution of water, sugar, and salt. Dr. Cash’s work, in collaboration with his colleagues, is a low cost, low-tech solution that has saved millions of lives across the globe.
A simplified formula of ORT—a half a liter of clean water, a fistful of sugar, and a pinch of salt has been taught to millions of mothers to treat children, and family with severe diarrhea at home. The impact of this recipe on public health has been astounding.
Cholera “is a bacterial disease spread through contaminated water and food” notes the CDC. It can cause voluminous diarrhea (many liters per day) resulting in the rapid development of severe dehydration and death if left untreated. “People living in places with unsafe drinking water, poor sanitation, and inadequate hygiene are at the highest risk of cholera.” The severe dehydration, Dr. Cash said, could turn a person “from a grape to a raison” in a matter of hours with dire consequences.
Dr. Cash grew up in Milwaukee ,WI, and earned a bachelor’s degree from the University of Wisconsin, Madison, WI. He received his medical degree in 1966 from New York University School of Medicine. His medical career took a dramatic turn shortly after his graduation from NYU.
Soom after graduating from medical school, Dr. Cash joined the National Institute of health. It came to Cash’s attention that twice a year, the Ganges Delta would swell, overrun its banks, and spread cholera, and other diarrheal diseases to the people of East Pakistan , now Bangladesh. It was a death sentence for those afflicted with cholera who could not reach a hospital, and receive intravenous fluids.
In 1967, the NIH assigned Dr. Cash to East Pakistan, to Dhaka, presently the capital of Bangladesh. Outside Dhaka, he worked with 26 year old American medical doctor, David Nalin, to respond to a cholera outbreak in that country. and joined the Pakistan Cholera Research Laboratory. Researchers knew that sugar water, and salt helped the intestines absorb water. but they didn’t know the ratio of water, to sugar to salt.
Dr.. Cash, together with Dr. Nalin and their colleagues, initiated a clinical trial to establish the optimal proportions of sugar, water and salt in the treatment of cholera , and other diarrheal diseases. They published their research in the medical journal Lancet in 1968 concerning the value of oral rehydration therapy (ORT). The findings allow mothers and others to administer lifesaving fluids to children and adults suffering from cholera without the need of intravenous fluids — a remarkable public health achievement of the 20th century
Dr. Cash’s work has had a profound, positive influence on global health. He began lecturing on this subject in 1977 at Harvard University’s School of Public Health, now called Harvard T. H. Chan School of Public Health. On numerous occasions he visited Bangladesh, and maintained close communications with medical leaders of that country.
He died on October 22, 2024 at the age of 83 at his home in Cambridge, Massachusetts. His pioneering basic research dealing with oral rehydration therapy can be administered by non-professional individuals in remote areas to treat diarrheal diseases. It has saved, and will continue to save countless lives.
UNICEF stated, “No other single medical breakthrough of the 20th century has had the potential to prevent so many deaths over such a short period of time and at so little cost.” The World Health Organization estimates ORT has saved over 60 million lives
