Hint: For dilute, dehydrating diarrhea, when drinking an oral rehydrating solution like Pedialyte, stay away from food or drink for at least an hour. (Don’t use Gatorade.)

When I was a freshman med student, a biochemistry professor who looked like the movie star Robert Wagner spent 10 years of his life proving that the water we drink isn’t merely passively absorbed. Salt and water are sometimes pushed into our body by a biochemical “pump” that is fueled by glucose. I took notes when the professor lectured and I passed the exam, but I didn’t understand why a person would spend years of his life learning how salt and water move across the small bowel membrane.

 
I later learned that when the cholera bacteria infect the small bowel, the organism forces a large amount of liquid to leak into the lumen of the intestines. Infected people develop watery diarrhea, don’t absorb much fluid, and often die of dehydration. Our lecturer, Robert Crane, showed that if a teaspoon of salt and two tablespoons of sugar are added to a liter of clean water, a biochemical reaction powers the liquid across the membrane of the small intestine, and people can be rehydrated. The World Health Organization distributes a version of Crane’s solution, and drugstores in the U.S. sell it as Pedialyte. The discovery of the sodium and sugar “co-transport” mechanism has saved more lives than most of the expensive medications advertised on television. 

Crane was born in New Jersey and wasn’t interested in science before he entered college. During the Second World War, he was a deck officer on a navy destroyer that “took a bomb” at the Battle of Leyte Gulf. His vessel was later part of the fleet of ships that carried Douglas MacArthur back to the Philippines in 1944. After the war, he earned a PhD in chemistry at Harvard, married a biochemist, and started working on his pump theory. In 1978, he was awarded the Nobel Prize. 
In the early 1800s people knew that some water made them ill and they “determined the quality of water based on its taste.”Children drank a brew made from boiled water and adults tended to imbibe ale. 

In 1854 an epidemic of diarrhea broke out in the Soho district of London. Many became dehydrated and over 600 people died. At the time, most households didn’t have piped-in water. People used communal pumps and stored their fecal matter in nearby cesspools. Sewage was dumped in the Thames, and the river smelled. A London physician named John Snow saw his patients suffering, mapped the location of the people who contracted the illness, and convinced town officials that the Broad Street pump was the source of the epidemic. They removed the pump handle and the diarrhea “almost immediately” trickled to a stop. 

 No one knows what caused the outbreak, but many suspect it was cholera. The lethal disease emerged from the Ganges Delta of India in the 1800s and caused a series of worldwide epidemics. Infected people developed severe diarrhea and became dehydrated. Many died. The disease was spread by ships trading goods in Thailand, China, and Japan. In 1831, a vessel whose sailors had the illness docked in the English town of Sunderland. After they disembarked, the infection spread through the U.K. and killed thousands. Later in the century the German researcher Robert Koch cultured and examined the stools of the people who had the infection and he identified the cause, a “bacillus that was bent like a comma.” 

In the late 1800s, people learned that waterborne outbreaks of typhoid fever, dysentery, and cholera were caused by bacteria and that chlorine killed the germs. The chemical is currently added to “over 98 percent of all U.S. municipal water,” and outbreaks of typhoid fever have been virtually eliminated. (Chlorine does not kill parasites like giardia and cryptosporidium.)


A substantial portion of the world’s population still lives in tightly packed dwellings and don’t have pipes that bring water in or fecal waste out. When people defecate outside (because the feces smell), their waste enters streams that flow into the rivers that are the source of drinking water. According to the CDC, one in nine childhood deaths worldwide are the result of diarrhea. The culprits responsible include bacteria like E. coli, salmonella, shigella, and cholera.

“Cholera remains a significant cause of illness and death in many African countries. In Southeast Asia and elsewhere, The World Health Organization estimates that officially reported cases of cholera represent only 5–10% of the actual number occurring annually worldwide and do not include an estimated 500,000–700,000 cases labeled as acute watery diarrhea.” 

In 1991, a massive hurricane blew across Hispaniola, the Caribbean island that is shared by the Dominican Republic and Haiti. At the time, Haitians hadn’t witnessed a case of cholera for more than a hundred years. The U.N. brought in relief workers from Bangladesh and they lived with the people. Seventy percent of the island’s households had either rudimentary toilets or none at all. A few months later, the water people drank contained the strain of cholera bacteria that was common in Bangladesh. Approximately 665,000 Haitians developed severe diarrhea and over 8,000 died. In 2006, fifteen years after the epidemic started, a nonprofit called SOIL started supplying compostable toilets and trying to help solve the island’s waste problem. 


 On the Mode of Communication of Cholera by John Snow, M.D.London: John Churchill, New Burlington Street, England, 1855

 “The son of a York farmer, John Snow moved to London where he studied medicine, and became a member of the Royal College of Surgeons ten years before “the first case of Asiatic cholera” came to “the great city.” The illness arrived in the body of a seaman who died a few hours after the illness “seized” him. The sailor had been working on a steamer where “the disease was prevailing.” Shortly after the man’s death his body was removed from the room he had been renting and another man moved in. Eight days later the newcomer developed severe diarrhea and fever—cholera”

 https://iubmb.onlinelibrary.wiley.com/doi/full/10.1002/iub.366 Cholera and Ganges delta https://www.passporthealthusa.com/2018/02/the-history-of-cholera-and-the-ganges-delta/ https://www.cdc.gov/cholera/index.html Cholera in Haiti https://www.nejm.org/doi/full/10.1056/nejmoa1012928 https://www.nejm.org/doi/full/10.1056/NEJMp1012997 

 Understanding Modern Health Care: The Wonders We Created and the Potholes We Dug. book by Steve Fredman | May 17, 2021

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