Dilip Mahalanabis. Image: Dhyeya IAS/YouTube, fair use
- A lot of what was written or shared about Dilip Mahalanabis, after his recent passing, contained toxic nationalism and incorrect – even blatantly false – information.
- Many tributes erased the long history of the development and advocacy of ORT, including the involvement of many researchers and institutions both Indian and international.
- Mahalanabis et al. undertook daring work in dire circumstances. “In order to treat … people with IV saline, you had to kneel down in their faeces and their vomit,” he recalled later.
- Propagating misinformation and false histories under the agenda of nationalism and even decolonisation is the worst way to go about learning about stalwarts like Mahalanabis.
Dr Dilip Mahalanabis, among the world’s foremost experts in oral rehydration therapy (ORT), passed away last month.
The news took me back to 2009, when I was an aspiring public health student with dreams of joining the WHO. I had come across an interview of Mahalanabis with another stalwart, Dhiman Barua, in the WHO’s Bulletin. There, he recounted his pioneering work in Bangaon, Bengal, in 1971, when he and his associates treated hundreds of cholera and diarrhoea patients with the then-new and experimental oral glucose-electrolyte solution.
As a young physician with a strong interest in public health, the work and experiences of Mahalanabis and Barua made a deep impression on me – and Mahalanbis’s death last month transported me to that fond academic memory.
But I was jerked back to the present when I read some of the tributes paid to Mahalanabis. Alongside several thoughtful commentaries, a lot of what was written or shared about him contained toxic nationalism and incorrect, even blatantly false, information.
I was also struck by how almost all the major media outlets simply rehashed the same few details of his life and work in their obituaries and offered little, if any, glimpses of Mahalanabis as a person. Many commentaries also proved unhelpful to gauge whether the authors were celebrating Mahalanabis the person or ORS the solution.
These articles are a good occasion to reflect on how we approach science and history, how we commemorate the dead, and how society and politics intersect with science.
Not the first
Many tributes needlessly and unfortunately erased the long history of the development and advocacy of ORT, including the involvement of many researchers and institutions both Indian and international. Firstpost gushed about how Mahalanabis “never patented his ORS solution” while a popular account on Twitter tweeted the blatant falsehood that he “invented the ORS sachet”.
Even an otherwise fine obituary in the Times of India said in the headline that he was “father of ORS”. Most mainstream platforms used the more ambiguous term “pioneered” instead of “invented” – but then failed to accurately portray and contextualise his work, with readers perhaps getting the impression that Mahalanabis was the sole, or at least the most deserving, “scientist who developed” ORT.
Mahalanabis was brilliant. And like every brilliant person, he stood on the shoulders of and rubbed shoulders with his brilliant peers. As my own memory of coming across Barua and Mahalanabis together indicated, ORT was a major innovation that was founded on the mammoth efforts of many others.
Barua himself passed away in 2020 and the few obituaries at the time describe him too as a “pioneer” of ORS. The original 1973 paper in which Mahalanabis laid out the details of the spectacular ORT work in Bangaon was written jointly with four others. In the first paragraphs of this article, the authors cited multiple instances of older research on which their work was based, and which preceded the steps taken in Bangaon.
In particular, Mahalanabis et al wrote that the “effectiveness of oral glucose-electrolyte solutions” had already been demonstrated in hospitalised patients, and that the ingredients and proportions in the solution they used were derived from previous findings. Clearly, ORS, or for that matter the “ORS sachet”, was not “invented” by Mahalanabis – nor was ORS “his”, or of any single researcher, to patent.
Also read: What We Lose When We Don’t Reframe the History of Science
‘Lone genius’
Far from being the product of the stereotypical ‘lone genius’ working away from the messiness of the real world, ORT was the product of multiple researchers and organisations sensitive to and toiling deep in the world’s diarrhoeal trenches.
In recent decades, historians and other scholars have worked to dispel the myth of the ‘lone genius’. Some of these efforts are also part of larger initiatives towards “decolonising” modern science and its narratives, with scholars showing that it’s incorrect to assume that only white European and American male researchers were responsible for the major scientific advancements in the modern era, and that we need to remember the invisibilisation of indigenous and ‘Global South’ communities in conventional histories of modern science.
Considering these developments in thinking about science, the extreme nationalistic content of some popular tributes paid to Mahalabanis last month was just jarring. The ignorance and erasure of the collective efforts of people across the globe in the development of ORT was striking.
While many elite, privileged-caste Indians have always mimicked the attitudes of their erstwhile colonisers and made preposterous claims that ancient Hindus made singular, single-handed contributions to global knowledge, the Mahalanabis commentaries showed how the Indian/Hindu exceptionalism bulldozer might not even spare recent history.
Mahalanabis’s work
One consequence of the misleading and confusing information about Mahalanabis in these tributes and obituaries was that people were left with little idea of what makes his work so important. A history of ORT, written three decades ago by Joshua Ruxin, provides useful context here.
By 1970, scientists had already demonstrated that ORT worked well in stable, hospital settings under expert supervision – but these studies couldn’t convince the mainstream medical and public health communities of the feasibility and effectiveness of large-scale ORT treatment.
Mahalanabis et al. undertook daring and innovative work in the dire, emergency circumstances of 1971 Bangaon. “In order to treat these people with IV saline, you literally had to kneel down in their faeces and their vomit,” Mahalanabis recalled in the 2009 interview. This is what helped ORT “really hit the map” since “it probably took that kind of a demonstration in a crisis to really document what could be done”.
Soon after, “ORT began demonstrating success after success as physicians experimented with it in different cases of diarrhoea and among patients of all ages”. In their own words, what Mahalanabis et al. did was provide “confirmation of the effectiveness” of ORS in a “field trial” where “extremely adverse logistic and administrative conditions prevailed”.
Also read: Pay Attention to What the Hands Do All Day
Another historical aspect that needs revisiting is the oft-repeated claim – which also appeared in the 2009 WHO Bulletin – that a 1978 editorial in The Lancet wrote that ORS was among the “most important medical advances” of the 20th century. The Lancet said nothing of the sort. What it did say was the following:
“The discovery that sodium transport and glucose transport are coupled in the small intestine, so that glucose accelerates absorption of solute and water, was potentially the most important medical advance this century.”
In other words, as Ruxin wrote, The Lancet was enamoured less by the practical, public health aspects of ORT and more by the theoretical, laboratory-based aspects of intestinal absorption, which are the physiological bases of ORT. This of course does not mean that ORT is insignificant: it absolutely is among the most revolutionary therapeutic innovations ever. But clearly The Lancet was doing something different than heaping praise on ORT.
Finally, despite the abundance of articles and tweets on Mahalanabis, one didn’t learn much about Mahalanabis as a person, even as a physician and scholar beyond his 1970s work on ORT. A few reporters were thoughtful and reached out to people who knew Mahalanabis personally, as of the Times of India and Financial Times. One learned that Mahalanabis was a great mentor and “delighted in developing the next generation in his field”.
I briefly spoke to Richard Cash, among the three ORT researchers who shared the 2006 Prince Mahidol Award with Mahalanabis. Cash emphasised that Mahalanabis’s deep and lasting commitment to child health in India was very admirable. It is worth noting that Mahalanabis and his wife also made a large donation to Kolkata’s Institute of Child Health in 2017.
If we are genuinely interested in learning about and celebrating stalwarts like Mahalanabis, propagating misinformation and false histories under the agenda of nationalism and even decolonisation is certainly the worst way to go about it.
Instead, how about we abandon exaggeration and sensationalism – and start being sensitive and sensible in both our celebrations of past and present Indians, and in the stories about us that we tell ourselves and to the world?
Kiran Kumbhar is a medical doctor and historian currently teaching and researching with the South Asian Studies Council at Yale University. He works primarily on the history of science and medicine in India, South Asian history and global health.