Norbert Hirschhorn

Norbert Hirschhorn (drawing by Natasha Gomperts , 2007, Wellcome Library London)

Norbert Hirschhorn (* 1938 in Vienna ) is an American doctor who, through his work in the field of Health Sciences (Public Health) became known. He is one of the developers of the so-called WHO drinking solution , which is used for severe diarrheal diseases .

Life

Hirschhorn's family had to flee to London in 1938 due to the threat of persecution of the Jews after the “Anschluss” of Austria , where he grew up during the war. The family later emigrated to the United States, where Hirschhorn attended the Bronx High School of Science and then Columbia University in New York City . He earned both a Bachelor of Arts (1958) and a doctorate (MD) in medicine (1962). He specialized in internal medicine and continued his clinical training at Boston City Hospital and Harvard Medical School (1962–1964, 1967–1968). Finally, he specialized in the field of public health .

From 1964 Hirschhorn worked in the American Public Health Service . He later lectured at various universities ( University of Minnesota , Yale University , American University of Beirut , Princeton University and others) and worked as a consultant for international organizations. One focus of his work was the effective treatment of infectious diarrheal diseases. Later he also dealt critically with the machinations of the tobacco industry .

In his private life, Hirschhorn works as a poet. In 1994 he earned a Masters in Fine Arts from Vermont College. He has published several volumes of poetry and anthologies and has also received literary prizes.

Hirschhorn lives in London and Beirut .

Working on cholera

From 1964 Hirschhorn worked scientifically on the treatment of cholera in Bangladesh (then East Pakistan ) . Cholera is a highly contagious disease that causes severe "rice water-like" diarrhea. These diarrhea can amount to many liters a day in terms of volume. Antibiotic therapies are often insufficient or ineffective on their own for these diarrheal diseases. The main task of the attending physician is to compensate for the strong loss of fluids and electrolytes ( sodium , potassium , calcium , chloride , ...) of the patient ( rehydration ). If this does not succeed, the patient often dies from multiple organ failure (insufficient organ blood flow) or from cardiac arrhythmias (balanced electrolytes are essential for cardiac function). The same applies to other severe diarrheal diseases. According to estimates by the World Health Organization (WHO), around 760,000 children around the world still die each year as a result of diarrheal diseases.

The fluid and electrolyte balance is usually achieved by administering intravenous infusions . In countries with a poorly developed public health system, this costly care can often not be guaranteed. Realistically, you have to rely heavily on oral fluid intake (fluid intake through drinking). The problem that had to be overcome is the fact that the bowel function is disturbed in diarrheal diseases, so that the bowel can only absorb insufficient fluid. The liquid given by drinking is lost with the diarrhea and does not get into the circulation.

Powder for the preparation of a WHO drink solution

Schematic representation of the sodium-glucose symport through the cell membrane from the intestine into the cell interior. The water molecules (H ₂ O) follow the sodium and the glucose.

In his clinical studies on the treatment of cholera, Hirschhorn was able to build on the work of his predecessors and colleagues, some of whom had shown in animal experiments that the addition of glucose ("dextrose", not table sugar = sucrose ) to an oral rehydration solution was decisive for the fluid absorption in the intestine can improve. Hirschhorn carried out a larger randomized clinical study on this for the first time . In this context, some of the cholera patients received the rehydration solution with glucose, another part received the rehydration solution without glucose, and a third part received no rehydration solution at all. All patients were treated with IV fluids when they needed them.

This study, published in the New England Journal of Medicine in 1968, impressively showed that the addition of glucose (or galactose , but not fructose ) to an oral hydration solution can significantly improve the effectiveness of an oral hydration therapy. This proved the effectiveness of an optimized oral rehydration therapy.

In the beginning there was great skepticism in the professional world about such a simple treatment for such a serious illness as cholera. For the first time on a large scale for use by Hirschhorn and colleagues (especially came Robert Allan Phillips ) developed oral rehydration in Bangladesh Liberation War in 1971 between India and Pakistan, caused the millions of refugees and was not thinking of a regular care in hospitals in the.

The underlying physiological principles were only clarified later. The glucose uptake in the intestinal epithelial cells takes place in the form of a so-called sodium-glucose symport , ie for the uptake of glucose (which is undisturbed in cholera), sodium is always also taken up into the cell. The water molecules passively follow the sodium and so there is a flow of fluids and electrolytes from the intestine into the circulation.

It is estimated that the so-called WHO drinking solution has saved the lives of around 50 million people since it was developed.

Honors

• 1993 American Health Hero (Honored by President Clinton)
• 1990 Charles A. Dana Foundation Award for Pioneering Achievement in Health
• 2002 Pollin Foundation Award in International Pediatric Research

Publications (selection)

• N. Hirschhorn, JL Kinzie, DB Sachar, RS Northrup, JO Taylor, SZ Ahmad, RA Phillips: Decrease in Net Stool Output in Cholera during Intestinal Perfusion with Glucose-Containing Solutions. In: N Engl J Med . 279 (4), 1968, pp. 176-181. doi: 10.1056 / NEJM196807252790402 . PMID 4968807 .
• N. Hirschhorn, RA Cash, WE Woodward, GH Spivey: Oral fluid therapy of Apache children with acute infectious diarrhoea. In: The Lancet . 2 (7766), 1972, pp. 15-18. PMID 4113619 .

Web links

• Lin Lin Ginzberg: The man who helped save 50 million lives. In: BBC News. August 3, 2014, accessed on August 3, 2014 (English, video interview with Norbert Hirschhorn). 
• Hirschhorn's "literary" private website

Individual evidence

1. ↑ N. Hirschhorn: Shameful science: four decades of the German tobacco industry's hidden research on smoking and health. In: Tob Control . 9 (2), 2000, pp. 242-248. PMID 10841866 . doi: 10.1136 / tc.9.2.242
2. ↑ Peony Moon: A contemporary poetry blog: Norbert Hirschhorn: Two Poems. Retrieved August 3, 2014 . 
3. ↑ Nobert Horschhorn Blog ( Memento from August 8, 2014 in the Internet Archive ) (English)
4. ↑ ^{a b c} Lin Lin Ginzberg: The man who helped save 50 million lives. In: BBC News. August 3, 2014, accessed on August 3, 2014 (English, video interview with Norbert Hirschhorn). 
5. ^ N. Hirschhorn, JL Kinzie, DB Sachar, RS Northrup, JO Taylor, SZ Ahmad, RA Phillips: Decrease in Net Stool Output in Cholera during Intestinal Perfusion with Glucose-Containing Solutions. In: The New England Journal of Medicine . 279 (4), 1968, pp. 176-181. doi: 10.1056 / NEJM196807252790402 . PMID 4968807 .
6. ^ Grants and Grant Outcomes. In: Health Affairs. 9, no. 4, 1990, pp. 197-207. doi: 10.1377 / hlthaff.9.4.197
7. ^ NewYork-Presbyterian Hospital Announces First Pollin Prize In Pediatric Research Recognizing Developers Of Revolutionary Oral Rehydration Therapy: “Most Important Medical Discovery of 20th Century” Saves Millions of Children's Lives Annually Worldwide. NewYork-Presbyterian Hospital, accessed August 3, 2014 .