Richard A. Cash, who as a young public-health researcher in South Asia in the late 1960s showed that a simple cocktail of salt, sugar and clean water could check the ravages of cholera and other diarrhea-inducing diseases, an innovation that has saved an estimated 50 million lives, died on Oct. 22 at his home in Cambridge, Mass. He was 83.
His wife, Stella Dupuis, said the cause was brain cancer.
In the 1960s, diseases like cholera and dysentery killed some five million children worldwide per year, primarily through dehydration caused by diarrhea and vomiting. Patients could go “from a grape to a raisin” within hours, Dr. Cash often said.
It was widely understood that rehydration could save many of them, but that was easier said than done: intravenous drips, the standard method, required equipment, training and clinical settings that were often hard to come by in the impoverished communities where the diseases festered.
Dr. Cash, the son of a family doctor, arrived in East Pakistan, today Bangladesh, in 1967 as part of a project through the U.S. Public Health Service. There he worked with another young American doctor, David Nalin, to respond to a cholera outbreak outside the capital, Dhaka.
The two had already been researching a simple oral rehydration therapy and knew of other, previous efforts, all of which had failed. But they believed that the therapy held promise, especially in the face of mounting deaths.
They realized that a main problem was volume: Past efforts had resulted in too little or too much hydration. Dr. Cash and Dr. Nalin conceived a trial in which they carefully measured the amount of liquid lost and replaced it with the same amount, mixed with salt and sugar to facilitate absorption.
They divided 29 patients into three groups, with one group receiving an IV drip, another an oral treatment through a tube, and the third an oral treatment by drinking from a cup.
Other doctors and nurses found their experiment bizarre and tried to stop them. But Dr. Cash and Dr. Nalin persisted, splitting the work between them in two 12-hour shifts, to ensure the integrity of the trial.
The results were definitive: Only three of the tubed patients — and only two who drank the solution — needed additional IV treatment.
Their approach was put to the test in 1971, when Bangladesh’s war of independence drove tens of thousands of refugees into camps across the border in India. Cholera and other diseases soon spread rapidly.
An Indian pediatrician helping with the response, Dilip Mahalanabis, made oral rehydration a cornerstone of his strategy, with astounding success — proof for all the world that a simple solution could be brought to bear against one of the world’s greatest killers.
Dr. Cash and Dr. Nalin then worked with a local nonprofit, the Bangladesh Rehabilitation Assistance Committee (today known as BRAC), to teach Bangladeshi mothers how to administer the treatment at home. The organization even devised a song about it, with these lyrics:
Mix with much care,
Good water, a liter,
A pinch of salt with a fistful of gur [molasses],
Remove the menace for good
They ultimately trained some 12 million Bangladeshi parents. Diarrheal deaths plummeted. What began as a medical trial is, today, common knowledge in homes across that country, and the world.
“One could say, well, where did the folk wisdom for chicken soup and colds come from?” Dr. Cash said in a 2018 talk at the Council on Foreign Relations. “Probably a similar approach was used.”
The World Health Organization estimates that oral hydration therapy has saved more than 50 million lives, a majority of them children. In 1978, the British medical journal The Lancet called their innovation “potentially the most important medical advance this century.”
Richard Alan Cash was born on June 9, 1941, in Milwaukee, Wis., to Irving and Isabel (Cohen) Cash. His mother taught deaf children while his father practiced family medicine.
Richard graduated from the University of Wisconsin-Madison in 1963 and received his M.D. from New York University in 1966.
A pacifist, he joined the U.S. Public Health Service as an alternative to joining the war in Vietnam and soon found himself in South Asia.
In 1977, he joined the faculty at the Harvard School of Public Health (today the Harvard T.H. Chan School of Public Health) as a lecturer, a position he held at his death.
Along with his wife, Dr. Cash is survived by two stepsons, Alexander and Krister Weidenhielm; two sisters, Kathy and Ellen Cash; and four step-grandchildren.
Though his base of operations shifted to Harvard, Dr. Cash continued to spend as much time as he could in the field, including making annual trips to Bangladesh.
He continued to emphasize the importance of local, low-tech public-health efforts; especially in lesser-developed regions, he said, simple solutions are always better than big, complicated ones.
“We’re enamored by high technology,” he said at the Council on Foreign Relations. “And we’re not in love with low-tech. Low-tech is always seen in our eyes as second-class. Why would you do this, when you could do that? And I would argue just the opposite.”
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