David Sachar Found that Glucose Sweetens the Recovery Process for Cholera Patients (from ScienceHeros.com)
Sachar, like many medical pioneers, was among the best and brightest of his generation. An honors graduate of Harvard Medical School, he could have simply turned to a lucrative private practice. But he felt the call of public service and joined a team of cholera researchers in Dacca, East Pakistan (Bangladesh) in 1965. The team was studying cholera’s interference with the body’s ability to transport sodium and water across the cells of the gut, resulting in potentially deadly dehydration. The insights gained through these studies led to the development of a new therapy known as Oral Rehydration Therapy (ORT). The only current available treatment to combat the dehydration resulting from cholera was IV therapy, a costly and highly technical protocol. ORT proposed to treat patients with a simple fluid mixture they would drink. Sachar played a key role in advancing the therapy. He developed a device to test a cholera patient’s ability to transport sodium, a key factor in the body’s ability to retain fluids. His work proved even a cholera patient’s body retains the ability to transport sodium, and that the process is enhanced by glucose. This foundational knowledge allowed for the insights that led to Oral Rehydration Therapy, a treatment protocol credited with saving over 50 million lives.
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 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 David Sachar, Norbert Hirschhorn, David Nalin, and Richard Cash. Sachar and Hirschhorn expanded upon the work previously completed by Robert Phillips. Though Phillips had come painfully close to coming up with 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 Sachar and Hirschhorn proved Phillip’s conclusions false, clearing away incorrect assumptions that allowed ORT to be born.
When Sachar arrived in Dacca, the clinical director of the project was wrestling with a complex issue. Though Phillips’ previous work had shown that a glucose mixture enhanced sodium absorption, he still held to the “poisoned sodium pump” hypothesis. This was the prevailing belief that cholera inhibits the mechanisms by which the body transports sodium and water across the cells of the gut and into the bloodstream. This results in the body’s inability to properly absorb water and other fluids, a critical factor in combating the severe dehydration caused by the diarrhea associated with cholera. It was a complex issue, which had been debated for many years, and Sachar was given the assignment to devise a means to test the hypothesis. He traveled to Copenhagen to consult with zoologist H. H. Ussing, who had been working on a similar issue. Dr. Ussing had developed a special device, the “Ussing Chamber,” to conduct in vitro experiments using frog skins. Sachar adapted the apparatus for his own purposes and returned to Dacca, where he completed the first definitive experiments to test sodium transport in humans. The results spoke volumes – the prevailing theories about sodium and cholera were wrong. The body actually retained the ability to transport sodium when afflicted by cholera, and the process was enhanced by glucose. Sachar’s work provided the base to move the ORT development process forward.
When the apparatus Sachar developed actually worked he and his colleagues were overjoyed, "...dancing around the test lab." But, the real significance of the moment escaped them. Their celebration was simply technical - the device functioned properly, allowing them to detail the sodium transport process. It was only later, in consultation with Hirschhorn, they realized the importance of what they'd found. Their tests disproved the "poisoned sodium pump" hypothesis once and for all, providing a clear direction for further research to follow.
The following are pictures of lab activities taken during David Sachar's days at the Cholera Research Lab in Dacca:
The following are pictures of lab activities taken during David Sachar's days at the Cholera Research Lab in Dacca:
