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for the employment of additional staff where necessary. It was agreed that the
investigation would be conducted in rural areas only.
Thus 2,350 villages and hamlets with a total population of 3.30 millions were
included in the survey. Of these 627 villages had two or more outbreaks. The
number of cholera inoculations done was 1.18 millions.
In a field survey of this magnitude, the scrutiny of the particulars of nearly
35,000 cases in the village cholera registers among 1.18 million entries in the
inoculation registers and transforming of the relevant information to cards
necessitated the maintenance of very large staff. The work was subjected to checks
at every stage in order to maintain accuracy.
Statistical analysis revealed that the protection afforded by the vaccine was
significant. It was noted that the duration of immunity was about 6 months,
trailing for nearly a year. The immunity developed on the 5th or 6th day after
inoculation. The incidence of cholera in the uninoculated population was 10 times
greater than in the inoculated group. The mean duration of the epidemic in a
village was about 19 days, and the chances of occurrence of multiple outbreaks
decreased progressively as the proportion of persons inoculated in the first
outbreak increased.
These observations were certainly very optimistic. However, we had made one
mistake as subsequent experience had shown. In our analysis, we had taken the
whole population of the affected village as potentially at risk. This was not so.
We submitted in due course a comprehensive report to the Public Health
Commissioner in New Delhi. A few days later we received from him a most
disturbing communication. We were informed that the new Director of Public
Health, Dr Mathews, had intimated to him that the data on which our conclusions
were based, were unreliable, and that he would like opinion in the matter. Dr
Adiseshan had retired, and Dr Mathews had taken over. We knew that there was no
love lost between the two but did not realise that things would come to such a pass.
I wrote to the Public Health Commissioner that in the circumstances, it was
essential that our data should be verified by an independent observer by personal
visits to whatever areas he would like to visit where work was done. I, however,
made one request that whosoever was entrusted with the task should visit the
areas with his own independent staff and not accompanied either by any member
of the Public Health Department or from the King Institute.
Accordingly, the Public Health Commissioner requested Dr Chandrasekhar,
Professor of Statistics, at the All India Institute of Hygiene and Public Health,
Calcutta, to look into the matter. He reported to me later that it was not at all
difficult to verify the data, since apart from the name, age, sex and address of the
person inoculated recorded in the relevant register, the site of inoculation, i.e.,
whether on the right or the left arm, was also noted in the register. Indeed, we
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had given specific instruction for our own verification that sites should be chosen
indiscriminately. In his official report he stated that “the fact he found that such
omissions and inaccuracies as were detected were inconsequential”.
That was that. However, Prof. Chandrasekhar made one very valuable suggestion.
He suggested that data relating to hamlets or ‘Cherries’ which had suffered
more than one outbreak and where the population was living under very
unhygienic conditions and so were susceptible to infection, should be analysed
separately, since inoculations done in the first outbreak could be considered as
anticipatory with regard to the second outbreak. We suggested that he should do
that himself and publish the findings along with our paper. Dr Chandrasekhar’s
broad conclusions are recorded here :
In 61 out of 63 Cherries investigated, the cases of cholera in the second
and subsequent outbreaks occurred in the interval of one to five months after
inoculation. As such the assessment made here refers to all practical purposes
of the protection confirmed on the individual for a period of five months after
inoculation. The attack rate in the “not inoculated” population was found to be 2.4
times in the “inoculated group”.
Conditions created by the Second World War had posed many problems,
particularly in the manufacture of cholera vaccine. It was difficult to secure enough
supplies of agar for the purpose and demands for the vaccine were mounting
every day. Indeed, on one occasion, somebody from a village had notified Delhi
that the Institute was not supplying them vaccine which they would have liked
to use in anticipation of the epidemic. In reply I had stated, inter alia, that it was a
matter of congratulation if the Institute had created this consciousness amongst
the public for anticipatory inoculation. The section of the Institute manufacturing
the vaccine had to work continuously throughout the year, including Sundays and
other holidays. I must relate here an interesting episode. Just before the Diwali
holidays, the Head of the Section, Mr Balkrishnan, the Senior Technician, came to
see me along with a few of his colleagues.
“May we close the Section, Sir, for two days for the Diwali holidays?” he asked.
“I am sorry”, I said, “That you had to come with such a request. You have been
working almost throughout the year without respite. I should have thought myself
to give you a happy Diwali. Close the Section by all means and give me a fresh
schedule of manufacture”. As they were about to depart smiling, I added “Perhaps,
I was thinking of giving a good Diwali to the villagers”.
An hour later, Mr Balkrishnan returned and informed me that the Section had
decided to continue to work during the holidays!
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CHAPTER IX
EPIDEMIC OF CEREBROSPINAL MENINGITIS
(MADRAS)
One evening, in the first week of October 1938, we were dining at Hotel
Connemara in Madras. I do not remember now what the occasion was.
Sir Laxmanaswamy Mudaliar, the Superintendent of the Women and
Children Hospital, Egmore, and Lt. Col. C. Ganapathi, Director of Public Health,
were also present. During the course of our casual conversation at dinner, Sir
Laxmanaswamy exclaimed: “Well, Dr Pandit, there is apparently an epidemic of
cerebrospinal meningitis in the locality near my hospital; I am worried about the
possibility of the infection spreading especially to the children’s ward. Can you
do something about it?” I replied that I did not know that there was an epidemic.
I said I would ascertain the facts and let him know in due course. I went to the
laboratory that night to see if any specimens of cerebrospinal fluid had been
received for examination. I was surprised to find that eight such specimens had
been received and the medical officer on duty had already examined them and
reported them as positive for Meningococcus. To receive eight specimens on a
single day was, of course, unusual. I telephoned Col. Ganapathi the next morning
and requested him to arrange a meeting between us and the Health Officer
of Madras City, Dr Pillay. “The Health Officer does not come under me,” replied
Col. Ganapathi. I told him that it did not matter about these formalities now and
convinced him that there was need to take some kind of immediate action, of
course, in consultation with the Health Officer of the city. Accordingly, a meeting
was arranged at 10 AM that day.
By 2 O’clock that afternoon, two of our investigation units had already started
functioning: one was located at the Infectious Diseases Hospital, Tondiarpet, for
immediate diagnosis of infection, and the other to examine the contacts and
take such measures as were considered possible. We decided to survey the whole
locality. I also decided to invoke the provisions of the Epidemic Prevention Act and
take steps to isolate cases of fever in the Isolation Hospital itself. The idea was to
keep under observation the immediate contacts, to ascertain which of them would
develop the infection and treat them without any delay. Makeshift arrangements
had to be made at the hospital for the purpose.
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In addition, the inmates of all the households in the affected locality were
asked to gargle with permanganate solution, which was supplied by the unit.
This operation was, of course, supervised by a member of the staff of the unit. It
must be noted, of course, that examination of “carriers” in itself does not, or may
not, materially help in controlling or preventing the spread of the epidemic. It
did serve, however, to impress on the public the necessity for adopting measures
to disinfect the throat and nasopharynx. It is interesting to record that out of
50 contacts isolated, three were declared positive for infection, though only one
actually developed the disease. The unit was also asked to study all environmental
conditions in the locality, the effect of over-crowding and such other factors which
might have a bearing on the disease.
This was really an explosive outbreak resulting in 41 attacks and 22 deaths—
all within a period of a week. The study of the epidemic revealed some very
interesting features. How was the infection introduced into the locality? It would
appear that one Narayanaswami of Barumangalam village, North Arcot district,
came to Madras and resided with his relations in a locality in Egmore. He returned
to his village on the 1st of October, and died on the 3rd October after a short
illness. His relations from Madras went to the village to attend his funeral, and
returned on the 5th of October. One of the party took ill on the 6th of October
and died on the 7th . On the 8th two cases of fever occurred in the same house
which were admitted to the hospital and died. These were diagnosed as cases of
cerebrospinal meningitis. From this initial focus the epidemic spread rapidly to
other houses in the vicinity in this particularly congested area of Egmore. Thus, in
nine days, there were 41 attacks, which were confined mostly to six small streets
in the locality. All the attacks, excepting four, occurred in one community—the
Kammah community. The majority of cases were related to each other, and the
infection could readily be traced from one case to another. The infection spread
mostly by direct contact. Though the epidemic lasted for nine days, majority of
cases had occurred within the first four days! As usual the disease had greatest
incidence in early life. Incidence amongst women was somewhat higher when
compared with the incidence in similar outbreaks recorded in India. The study of
the infected households revealed that majority cases occurred in families living in
single room which was used both as a living room and kitchen. The influence of
over-crowding was thus apparent. It had been stated that in the vast majority of
instances only one case of cerebrospinal fever occurs in an invaded dwelling. The
present outbreak was uncommon, in that multiple invasions of households were
frequently noted. Thus, out of 23 households invaded, 16 had single cases and 7
had multiple cases. Four of these had four or more cases.
To my surprise the newspapers were full of reports about the severity of the
epidemic. Late in the afternoon on the fourth day of the epidemic, I received a
message from the Minister of Health, Dr Rajan, who asked me whether I had taken
any steps to arrest the outbreak. On being told what I was doing, he asked me to
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meet him at a suitable point in the affected locality and told me to request the
Director of Public Health also to be there. This was a bit embarrassing as I thought
he could have telephoned Col. Ganapathi himself directly. Accordingly, we met at
the specified point and went round the affected locality. He enquired about the
incidence of cases in different houses and the number of cases bacteriologically
positive and many other matters. Fortunately, I was able to give him all the
information asked for from our records. He then visited the Isolation Hospital and
saw the arrangements made both for isolation of the contacts as well as for the
diagnosis of the infection.
Following the newspaper reports there was a discussion in the local Legislative
Assembly. At the end of the discussion Dr Rajan made a statement that for the
timely action taken by Dr Pandit a serious situation would have developed. This
was also reported in the local newspapers— the Hindu and the Madras Mail. I
must confess I was really pleased with myself. However, a week later, I received
a letter from Sir John Russell, the Public Health Commissioner in New Delhi. He
must have seen the newspaper reports. The letter was very brief:
“My dear CG”, he wrote, “Do you believe you controlled the epidemic?”
To which I replied, also very briefly:
“Dear Sir John: I have made no such claim.”
When I look back on this episode, I cannot but remember with gratitude
the cooperation we always received from the people. Otherwise, who would have
subjected themselves to compulsory isolation in a hospital with all its attendant
inconveniences and that too on the mere suspicion of an infectious disease
because of high fever? Or was this because of their being of low socioeconomic
grade, perhaps not conscious of their rights and privileges but were always
law abiding? I do not know. But this was a factor whenever the Institute had to
undertake such investigations in those days!
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CHAPTER X
PLAYING WITH THE VIRUSES
After spending a year at the Johns Hopkins School of Public Health in
Baltimore, USA, as the Rockefeller Foundation Fellow in virology, I returned
to the King Institute in 1933. As I had indicated before, Dr R. Sanjiv Rao also
returned from the USA a year later after receiving the same type of training that I
had received. Thus we formed a team and during the next few years ‘played’ with
several virus problems that came our way. We did not have the advantage of tissue
culture techniques, nor did we have antibiotics to keep our systems sterile. We
worked with vaccinia and variola viruses and also with influenza and dengue fever
viruses. We debated on the virus aetiology of trachoma and sandfly fever. Virology
has made tremendous advances since the World War II, and our knowledge
concerning the above viral agents had undergone tremendous change. However,
what follows is only a brief resume of our work and would be at least of historical
interest! I myself am amused at what we did then!
I
Cultivation of vaccinia virus on the chorio-allantoic membrane of
the developing chick embryo
A report had appeared on the cultivation of vaccinia virus on the chorioallantoic
membrane of the developing chick embryo. I thought it worthwhile to ascertain if
the technique could be used for large scale manufacture of bacteria-free vaccinia
lymph for general use. The virus was cultivated not only on the chick membrane
but also in flask cultures with embryonic tissue. The virus went through many
serial passages. In their immunising power and in cross immunity experiments,
both the cultivated virus and the routine calf lymph behaved alike. The keeping
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qualities of the membrane lymph were rather poor and for human vaccination
in the field, it had to be transported in thermos flasks. The development of the
reaction in humans i.e., from macules to pustules, took a little longer in the case of
membrane lymph, i.e., at least twenty forms at each stage.
It was necessary, however, to determine the protection afforded by membrane
lymph against smallpox. It might be mentioned here that similar observations on
membrane lymph were being made in England also. The Ministry of Health in
England was, therefore, equally interested in the problem and suggested that we
should initiate observations to that effect in India. The request was communicated
to us through the Public Health Commissioner with the Government of India.
Accordingly, 26 villages within a range of 15 miles from the Institute were chosen
for the study. The general programme of work was drawn up in consultation with
both the authorities noted above. In each village, alternate individuals or children
were vaccinated with membrane lymph and calf lymph. It was found that the 748
cases of primary vaccination had a case success rate of 89.2% and success rate of
73.2% was obtained with membrane lymph and 99.1% and 97.6% respectively with
calf serum. The Deputy Chief Medical Officer, Ministry of Health, London, in a letter
to Major Gen. Sir John Megaw had mentioned that they had obtained 85% case
success rate with membrane lymph and 95% with calf lymph. We were, of course,
glad to note that our membrane lymph was as good as theirs!
In the fourth year of observation, there were small sporadic outbreaks of
smallpox in the district. However, in one of the experimental villages, Vellacheri,
near the Institute there was a severe outbreak with 64 attacks and 19 deaths. The
results were as follows:
• “In a group of sixty children previously vaccinated with membrane lymph
during the last five years, there was no attack of smallpox.
• In a similar group of 118 children vaccinated with calf lymph, there was
one attack and no death.
• In the unvaccinated group of 169 of all age groups, there were 19 attacks
and seven deaths.
• The remaining cases had occurred in the population previously vaccinated
with calf lymph before the commencement of the experiment”.
The sixty-four cases of smallpox had occurred in 36 households in the area,
amongst 203 inmates. It was noted that in eight cases previously vaccinated with
membrane lymph, there were no attacks. In 10 cases primarily vaccinated with calf
lymph, there was one attack and no death. In the age group of 0-5 years, there
were 8 unvaccinated children of whom seven got the infection and three died! It
was, therefore, concluded that within the period of observation of five years, no
noticeable difference was detected in the protection afforded against smallpox by
the two types of lymphs.
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II
Attempts at the production of an attenuated strain from the
variola virus
Following the observation of Col. King, the founder of the Institute, we had
successfully 'variolated' a calf and an attempt was being made to develop an
attenuated strain of variola virus analogous to vaccinia virus after passage through
monkeys.
The first monkey developed lesions all over its body. The material was passaged
through monkeys serially, and finally it was passed on to calves for over 40 serial
passages. This procedure was adopted in order to obviate any criticism like the one
made of Col. King's work to which reference has been made previously. This strain
of vaccinia virus, and the one currently in use for vaccine lymph production were
tested for their immunological properties. The agglutination tests revealed the
identity of the heat labile production of the two strains and complement binding
antigens were associated with the heat labile fractions of elementary bodies. Cross
precipitation and complement fixation tests revealed no difference between the
two strains. However, the new strain was not utilized for the routine production of
vaccine lymph.
I must mention here that I was informed later that our work could not be
confirmed by other workers. I was rather surprised to hear this. We had repeated
these experiments and had obtained four different strains using the same
procedures as before. Was our work vitiated because we were playing with vaccinia
virus all the time especially in our routine vaccine lymph production on calves and
there could have been accidental contamination with vaccinia virus at some stage
or other? I do not know!!
III
Study of response of chorio-allantoic membrane to inoculation
with various substances
It has been stated earlier that the only available method at the time to
cultivate the viruses in the Institute was the method of inoculation of the infective
material in the chorio-allantoic membrane of the developing chick embryos.
Interpretation of results presented many difficulties. It was, therefore, necessary to
study the effect of various substances when inoculated in chick membrane.
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The following substances were tried and the results obtained studied:
Kieselguhr, aluminium gel, Indian ink, olive oil, copper sulphate, glycerine,
starch, normal and febrile serum, milk, pepsin, and, of course, many organisms,
including B. proteus K.19.
It was found that aluminium gel and bacteria produced lesions on chick
membranes resembling those obtained with viruses studied.
IV
Virus aetiology of trachoma
At the suggestion of Lt. Col. Robert Wright, Superintendent, Ophthalmic
Hospital in Madras, it was decided to investigate the virus aetiology of trachoma.
It might be mentioned that the Indian Research Fund Association had sanctioned
specific funds for this purpose. It was originally believed that the disease was due
to filterable virus and the presence of Prowazaki Habbstadator bodies in smears
and sections of trachoma material supported this view. Later Noguchi isolated
B. granulosum from such material which he regarded as the causative agent in
trachoma. This view was disputed by other workers. Our attempts to isolate this
organism from typical cases of trachoma were also unsuccessful.
The material from early cases of trachoma was inoculated into the chorio-
allantoic membrane of the developing chick embryo and the usual types of
lesions, as seen associated with viruses, were obtained. The “virus” went through
several passages in eggs. Attempts to transmit the infection in a few blind human
volunteers were unsuccessful. The investigation was eventually dropped as we got
busy with the virus of Sandfly fever which was giving us interesting results.
V
Virus aetiology of sandfly fever
An investigation into the aetiology of Sandfly fever was undertaken because of
the interest of Lt. Col. H.E. Shortt, the Director of the Institute at the time, who had
some experience of Sandfly fever while serving in the Northwest Frontier. Samples
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of sera from acute and convalescent cases of Sandfly fever were obtained, and the
usual technique of inoculating in the chick embryo was followed. The following
observations were recorded:
• The virus went through 64 passages in eggs and 45 serial passages in
flask cultures.
• With the use of Elfords gradcol membranes, the size of the virus particles
was found to be 160 millimicrons.
• The virus was found to be circulating in the blood of patients, for 7 days.
• The neutralizing antibodies were demonstrable up to six months.
• The virus was found to be non-pathogenic to monkeys
• The virus was also isolated from the cerebrospinal fluid.
Since the virus was non-pathogenic to monkeys it was decided to try its effects
in human volunteers. These observations were made in the Central Research
Institute at Kasauli by Drs Anderson and R.O.A. Smith. Of the six volunteers to
whom it was given, three escaped infection, two developed a mild infection, while
one volunteer had a typical attack of Sandfly fever. Four of these volunteers showed
neutralizing antibodies 35 days after the infection.
The virus was sent to the Wellcome Research Institute in London for further
studies.
VI
Studies on the virus of influenza
Influenza virus A was obtained from USA for studies in the Institute, as
our initial attempts to cultivate it from local material were not successful. The
Government of India also suggested us that preliminary trials should be made for
the manufacture of the vaccine, if and when needed. The expenses for this purpose
were also to be met by the Government of India.
At this time full details of the techniques for the manufacture of the vaccine
adopted in USA were not available, except some essential details involved in the
process. Precipitation of the virus by freezing and thawing, and the technique
of erythrocyte absorption and elution method, were both studied. A suitable
technique of manufacture by the latter method was worked out after studying
the several factors, such as the age of the chick embryo, suitable concentration
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of erythrocytes for absorption, and the temperature and the time factors in the
absorption and elution of the virus. From the then published reports, it was noted
that the technique evolved was more or less in agreement with that followed
elsewhere.
The immunising value of the vaccine was tested in mice following the
technique suggested by the South African Institute for Medical Research, and
which was made available to us by the Public Health Commissioner with the
Government of India. The results obtained, however, were not comparable in that
the percentage mortality in control mice was not high enough, though they had
shown consolidation in lungs due to the action of the virus.
Obviously, there was the need to study the relative efficiency of several
methods of concentration of influenza virus in order to produce a potent vaccine.
Precipitation with protamine or calcium phosphate had been recommended by
various workers in USA and UK, as well as concentration with methyl alcohol at low
temperatures. These methods were tried in the laboratory, and it was noted that
calcium phosphate precipitation gave the best results.
It might be mentioned in passing that the Public Health Commissioner
with the Government of India was requested to issue a circular requesting the
medical and public health authorities to send to the Institute samples of sera from
suspected cases of influenza. No samples were, however, received!
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CHAPTER XI
THE DISCOVERY OF FLUOROSIS
As stated earlier, the Government had sanctioned two investigation units
to the Institute to enable it to investigate field outbreaks of infectious
diseases. By an administrative arrangement between the Director of the
Institute and the Director of Public Health, it was agreed that any officer of the
Public Health Department and of any status, could intimate to the Director of the
Institute the occurrence of any infectious disease within his jurisdiction, so that
immediate action could be taken by the Institute for its investigation. On receipt
of such ‘information’ the Institute had to decide whether or not any investigation
on the report was necessary.
Accordingly, when I was acting as the Director of the Institute, when Lt Col.
Shortt was away on leave in England, we received a telegram from the Health
Inspector of Podili town in the Nellore district, Andhra Pradesh, stating that there
was an “epidemic” of rheumatoid arthritis in the town which needed immediate
investigation!
I was rather surprised to receive this telegram. Obviously, there could not
have been an “epidemic” of the type he mentioned. However, I thought he must
have observed something which, in his opinion, needed some investigation. Since
there was no immediate hurry to send a team for the purpose, I decided to obtain
some more information from the local medical officer. I must say his reply was
casual. Obviously, he had observed nothing particularly unusual! Then I wrote to
the missionary medical doctor, Ongol, about 30 miles from Pondili to ascertain if
he could throw any light on the matter. He replied in detail. He had observed the
condition which was quite prevalent in the area. The affected persons had a stiff
gait and, in many cases, there was extreme rigidity. Indeed, some persons were so
stiff that they had to turn the whole body to look sideways for they could not move
their necks freely!
The condition was certainly interesting. My first reaction was that it was some
sort of a nutritional disorder and initially I was inclined to pass on the problem to the
Nutrition Research Laboratories at Conoor. However, I waited and that was just as well.
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We had then the “Journal Club” in the Institute. The journals used to be
received every week and they used to be distributed to staff members for review
at their meeting every Friday. I had allotted to myself among others, the Bulletin
of Hygiene which contained abstracts on many topics. As I was turning away the
first few pages of the particular issue of the week, and which dealt with abstracts
relating to fluorine, in which I was not particularly interested, I happened to notice
one small abstract of about ‘four or five lines of Rohm’s paper on symptoms of
chronic fluorine intoxication amongst cryolite workers in Norway. It was stated
that the affected workers were so stiff that they had to turn the whole body to look
sideways!
This information started a chain of thoughts. The concerned area in Andhra
Pradesh was a mica mining area, and mica contains fluorine. It was likely that
there was fluorine in water and the condition noted by the Health Inspector at
Podili and by the doctor at Ongol could be a manifestation of fluorine intoxication.
Accordingly, I immediately sent for Shri T.N.S. Raghavachari who was incharge
of the water analysis section, and asked him, if we had ‘ziriconium nitrate’ in stock
for testing fluorine in water. Fortunately, we had. A sample taker from the Institute
was sent to bring samples of water from wells in Podili town to ascertain their
fluoride content, if any. The only thing that remained to clinch the diagnosis was to
visit the area and see ‘branded’ teeth of children in the area.
However, before the samples arrived, Col. Shortt returned to the institute.
I acquainted him with the whole ‘episode’ and told him that I was awaiting the
results of water analysis before taking any further action in the matter.
Next I heard about this was that Col. Shortt was writing a paper about it.
Shri Raghavachari gave him the results of water analysis without informing me
and apparently without telling him what I had done before. However, I did not
say anything to him. A little later Col. Shortt sent for me and asked me if it was
true that I had asked for water analysis and other details from the area. When I
informed him again as to what had happened, he said that Col. McRobert, the
Professor of Medicine at the Madras Medical College told him about my role in
this whole affair. He said he would include me as one of the authors. A preliminary
communication appeared in the Indian Medical Gazette under the joint names
of Col. Shortt, myself and Shri Raghavachari! Visit to the affected area proved that
fluorides were responsible for the branding of teeth in children. It was, however,
necessary to prove that other symptoms observed in adults were also due to
fluoride in water. Accordingly, a few patients showing varying grades of rigidity
were brought to Madras and admitted to the general hospital for detailed study
under Lt. Col. McRobert, Professor of Medicine in the College. X-ray findings and
biochemical studies confirmed that the condition was skeletal fluorosis. Indeed,
the X-ray pictures were almost similar to those observed by Rohm amongst the
cryolite workers in Norway.
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Col. Shortt soon left on leave preparatory to retirement. Continuing the
investigation further, it was decided to survey the fluoride contents of water supplies
in the Province. It was noticed that the fluorine content of water supplies ranged
from nil to 2.5 ppm. Even in Andhra, in most areas it did not exceed that amount.
This finding raised one important question. Were these amounts responsible for
the clinical manifestation of the disease as noted in those areas? Even when the
fluoride content was as high as 7 ppm in some parts of the world, no skeleton
changes had been noted. Since extended investigations were necessary the Indian
Research Fund Association (the precursor of the ICMR) sanctioned a unit for the
purpose. The unit was stationed at Podili to make a survey and ascertain ancillary
causes if any, which were responsible for the skeletal manifestations of fluorosis in
the population.
The effort was not particularly rewarding. Men and women were almost
equally affected. So common was the condition that a young man would often tell
us that when he attained the age of 40, he would be as incapacitated as the ones
we saw with severe symptoms of fluorosis. It was apparently quite common to see
children complaining of vague pain in bones and joints enough to disturb them
in sleep. One finding, however, intrigued us. In spite of the rigidity of the pelvis,
women did not complain of any difficulty in parturition, and the deliveries were
reported to be normal.
However, we could not get any clue to explain the development of skeletal
changes with the comparatively low content of fluorides in water supplies. Then an
incident happened which threw some light on the problem. I used to visit the area
once every month to see the progress of the unit at Podili. On one such occasion
when we had arrived at the small rest-house in the town, we received the morning
post. The Institute had sent the results of examination of water samples in the
area. I asked Dr Subba Rao, the Health Officer of the district who had accompanied
me on this visit, to have a look at the figures. As he was doing it, he exclaimed, “Sir,
your laboratory has made a mistake. In the village of Darshivancha the fluoride
content is shown as 2 ppm. I think this must be a mistake. I have visited the village
and there are no cases of fluorosis, not even affectation of teeth”. I said that it was
unlikely that the laboratory would make a mistake. How far is the village? Could
we go there? The village was only three to four miles from the rest-house, and
we decided to walk to that place immediately. When we reached there, we were
surrounded by people as usual. It was obvious that their economic condition was
much better. The women were well dressed and some had even flowers in their
hair. This was certainly an unusual sight in a village so situated in the interior! We
started examining teeth of children. They did not show any changes. As we were
engaged in doing this, an old man enquired of us of what we were looking for.
When we told him as to what we were after, he said “No, no, you will not find it here.
You will see much of it in the Adi Dravida colony over there.” The Adi Dravidas were
living quite closely only about less than hundred yards away. When we visited the
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colony of about 100 people, we saw at least ten cases of skeletal fluorosis, including
one woman who was bed ridden. We had not seen such extreme manifestations
even in Podili.
Further enquiries revealed that the two groups had the same water supply,
viz., spring pits dug in the river. Preliminary enquiries revealed that they were
consuming the same food growing in the area. The caste Hindus of the village did
not consume milk but sold it for cash.
Here then, nature had made an experiment. Two communities, of course
of different socio-economic status, were living side by side, and their source of
drinking water and food supply was almost the same. Yet one community was
free and the other exhibited serious manifestation of the disease. It was obviously
necessary to study the reasons for this, if any. Accordingly, it was decided to move
the research unit from Podili to Darsivancha village for the purpose.
When we were discussing the problem at the Adi Dravida colony and
examining patients, a rather embarrassing incident happened. A peddler had
visited the village and had spread his wares on a sheet of cloth, mostly betelnut and
betelnut leaves. He was trading them for a measure of “Ragi”—a barter. In doing so
he used to receive the grain in his own bag but used to throw the leaves to them
from a distance for they were ‘untouchables’. But he did not mind, if they touched
him while receiving the grain! This rather enraged me. I scattered his wares! I do
not know what the people thought, but one of them said that the peddler used
to visit only occasionally, and they used to look forward to his visit for that was the
only luxury they could indulge in —an occasional supply of betelnut leaves!
I indeed felt sorry for what I had done whatever the provocation. I promised
them a regular weekly supply of betelnut leaves, as long as the investigation lasted,
and we received full cooperation from them in our investigations.
Incidentally, I may mention that Dr Ranjan, the Health Minister, visited the
area and at my suggestion gave special promotion to the Health Inspector for his
role in the discovery of this condition.
The unit worked in the area and among other things discovered that the
diet of the affected colony was very deficient in vitamin C intake. With this lead
investigations were undertaken in the Institute on the role of vitamin C in the
production of symptoms. The experiments were done in monkeys with adequate
controls. Sodium fluoride was administered to these—some receiving it along
with diet devoid of vitamin C. The monkeys were X-rayed periodically and within
a period of three months the monkeys showed typical X-ray changes—almost
identical with those seen in patients from Podili.
It was contemplated to make some observations in humans on the effect of
vitamin C administration and particularly amelioration of symptoms in children.
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However, the Second World War supervened and the whole coastal area was
full of military activity. No further work could be undertaken there. Later, at the
suggestion of Dr Wig, the Principal of the Amritsar Medical College, I gave a grant
for research to the Principal of the Patiala Medical College. It was an area where
symptoms of chronic fluorine intoxication were very common. He did very useful
work and received the Watumull Foundation award for it.
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CHAPTER XII
INTRODUCTION TO LEPROSY
I
It was sometime in early December in 1928. I was on my way to Calcutta to
attend the meeting of the Far Eastern Congress of Tropical Medicine and
Malariology. The train had halted at the Moghul Sarai station when a young
English couple got in our compartment. They were Doctor and Mrs. Cochrane
working in the Leprosy Mission at Purulia, Bihar. We saw quite a good deal of
each other during the Conference. However, we really came to know each other
when he came to Chingleput during the early thirtees, as the Head of the Leprosy
Mission Hospital there. We were frequent visitors to each other’s Institutions. I thus
got introduced to the problem of leprosy in the country. He was also a frequent
visitor to our household—indeed he was ‘Uncle Cochrane’ to my children when
we used to discuss not merely leprosy but many other matters including religion.
I remember one evening, when we were talking on religion after dinner, I asked
him: “What would Lord Jesus Christ like “Christian conduct” or “Christian Label?”
Unhesitatingly he replied, “Christian Label, of course”. Naturally he could not
separate the two. “Robert” I said, “let us go to bed!” and that was that.
Later he moved to Vellore as the Principal of the Women’s Medical College, as
it was then. When he knew that my daughter would not be able to get admission in
any of the two medical colleges in Madras, as she was a Brahmin, and there was a
quota for Brahmins even district-wise at the time, he sent me a telegram to say that
my daughter was admitted to the Medical College at Vellore! Later I was also made a
member of the College Council. Our association continued even after my migration
to Delhi. He was a member of the Leprosy Advisory Committee during the IRFA days
and also of the ICMR. I lost touch with him when he left India to take an appointment
as Secretary of the Leprosy Mission in England. How I valued his friendship!
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II
As stated earlier, I really got interested in the leprosy problem during my
frequent visits to the mission hospital in Chingleput, when Dr Cochrane used
to show me cases of leprosy in different stages of the disease. He used to keep
meticulously detailed records of the patients under treatment including detailed
notes of bacteriological findings. Listening to him, one day, I got an idea. I asked him
to give me the records of some of his cases to study them in detail. Later I told him
about my assessment of the progress the patients had made during treatment,
i.e., those who had made considerable improvement, those whose condition was
almost stationary, and others whose condition was obviously deteriorating. When
he asked me what criteria I had used to classify the cases thus, I told him about the
‘bacteriological indices’ I had roughly worked out from his own notes. Dr Cochrane
elaborated the idea further and adopted the procedure of taking smears from
sixteen different sites on the body for working out the indices. However, we did not
think of publishing a paper on these findings.
The problem of childhood leprosy always came up for discussion. So, when
Dr Cochrane received a sum of rupees sixteen thousand from a friend in England
for expanding the anti-leprosy work in any manner he liked, it was decided to
start a clinic specifically for children. After considerable discussion, the clinic was
established in Saidapet, very close to the King Institute, the facilities of which were
to be made available to the clinic as and when needed. I was also entrusted with
the money to spend as and when needed, since Dr Cochrane did not want to
handle it himself. The clinic is now being run by the Leprosy Research Institute at
Chingleput, as part of its activities.
Transference of infection to experimental animals has always posed a problem
in leprosy. Many attempts had been made in the past but none of them had stood
the test of time. Observations to be recorded here have also proved inconclusive.
They are reported here to make the account of my researches in the King Institute
complete, apart from any lead they might give for further work in that direction.
Our work was prompted by the observation of Adler who had reported
successful transmission of infection in hamsters after splenectomy. We felt that it
might be worthwhile to do the same in monkeys.
A nodule from a case of lepromatous leprosy was obtained and after removal
of the spleen it was fixed to the splenic stump. The same stitch which fixed the
nodule to the stump was used to close the peritoneum, thus bringing the nodule
in close proximity to the abdominal wall.
The results obtained in the first monkey we infected in this manner were very
interesting. After two months a small ulcer was noted at the site of the operation
wound. In the pus numerous acid fast bacilli were seen, as well as a few globi,
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large and small. When the monkey looked ill, it was sacrificed. Smears from the
abdominal wound showed clusters of acid fast bacilli in every field examined and
also many globi. Smears from the liver also showed acid fast bacilli in clusters and
globi. Smears from the kidney also showed acid fast bacilli. These results indicated
that there was multiplication of the organism in the monkey, as judged by the
organism content of the original implanted nodule which was very much less, i.e.,
only an occasional globus in twenty five fields or so.
While these experiments were in progress, we came across a reference to the
work of Collier, in Bangkok, who had reported transfer of infection to monkeys fed
on a diet containing “Colocasia antiquorum”. He had also reported that one of
the features of the infection was widespread erythematous rash in experimental
animals. In some of our monkeys erythematous rash was also observed. In view of
these findings, it was considered advisable to test Collier’s hypothesis also.
Number of monkeys were involved in these experiments. Attempts were made
to infect non-splenectomised monkeys. In some splenectomy was performed
soon after the nodule was introduced. In some monkeys, a nodule was introduced
again, i.e., after about two months, when there was the evidence that the first
nodule was absorbed. Such monkeys developed positive lepromin reaction later.
In spite of all these attempts, only in two monkeys results were obtained
somewhat similar to those observed in the first monkey referred to above, i.e., the
occurrence of acid fast bacilli here and there. Why we had some evidence of the
multiplication of the organism in one monkey alone, it is difficult to say. However,
looking back on these results and noting the more recent experiences with the
transference of other infections to new-born laboratory animals, or the very young
ones, it would appear that, perhaps, more consistent results would have been
obtained, if very young monkeys had been used in these attempts! I will not dilate
here further on this problem.
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CHAPTER XIII
YELLOW FEVER AND I
I
First yellow fever assignment
Ileft Shillong early in April 1940 to join my permanent appointment at the
King Institute at Guindy, Madras. I decided to stay, en route, in Calcutta and
spend a day with my old friend Shri J.V. Joshi who was then an officer of
the Reserve Bank of India. In the course of conversation during the night Bapu
(JVJ) suddenly exclaimed “Look, C.G., I see something in your horoscope which is
peculiar. Something is going to happen to you in the near future connected with
your profession but which you would not have expected; perhaps some kind of an
assignment which could be even hazardous”. He said that he could not elucidate
any further because he himself could not guess, however hard he had tried, the
nature of the assignment. I must confess, as indicated earlier, I had developed a
healthy respect for his predictions!
Soon after arrival in Madras I got the information that I was elected as the
President of the medical section of the Indian Science Congress to be held in
Baroda in 1941. When I informed Bapu about this, he immediately wrote to say that
the assignment did not fit in with his prediction as I could have expected that to
happen in any case. A few weeks later, Col. Shortt sent for me and told me that he
had a telephone message from Delhi to ask me whether I would ‘volunteer’ to go
to the United States of America to study the manufacture of yellow fever vaccine.
He explained that the Government of India had received some confidential
information from the United States that in the event of war in the Far East the
Japanese might resort to bacteriological warfare with yellow fever virus. Acting
on that information the Government of India felt that it was desirable to have
somebody trained in the technique of yellow fever vaccine manufacture should
such an emergency arise. I immediately replied that I was willing to volunteer. “I
hope you do realise”, said Col. Shortt, “what the conditions of travel are like and in
any case before you say Yes, I would like you to consult your wife”. I told him that it
was not necessary to do so. However, he insisted. My house was next door to the
Institute; I walked in and gave my wife the message. “Is it your duty to go?” she
asked. “Yes” I said. Without a moment’s hesitation she said that I should do my
duty and whether she liked it or not did not matter. We have to practice what we
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teach to our children, she added. Within a few minutes I acquainted Col. Shortt
of this and he seemed very agreeably surprised. A suitable reply was then sent to
Delhi.
Within a month I received a communication from the Government of India to
the effect that I should take leave for the duration of the assignment and since the
Rockefeller Foundation was going to meet all the expenses I would not be entitled
to any allowances.
I discussed the matter with Col. Shortt and told him that while I was not
interested in allowances I did not think that it was fair to ask anyone to go on
an assignment like this ‘on leave’ because an officer on leave has no status in
an emergency of the type we were facing. He asked me then to draft a suitable
reply to the Government of India. In the letter to the Government of India after
explaining all this I mentioned that if what I had suggested was not agreeable
to the Government of India, I would like them to know that I was prepared to go
to the US on the assignment without any conditions. When Col. Shortt asked me
why I had added the last sentence, I told him that I did not want to give them the
impression that I wanted to back out of the assignment if possible, particularly
because the war was then taking a serious turn for the allies. Incidentally I wrote to
my friend Bapu in Calcutta acquainting him with these developments and added
that since I had decided to accept the assignment, he need not give further advice
or “predictions” in the matter.
In due course I received orders to proceed to the USA. The Government
was ‘pleased’ to depute me ‘on duty but without allowances’. The nature of
the assignment will be clear from the following letter from the Public Health
Commissioner with the Government of India, dated 24th November 1941, which I
received just before embarkation in Bombay. It was addressed to me care of the
Port Health Officer, Bombay.
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DO No. 41-14/41-PH Office of Public Health
Commissioner with the
Government of India,
New Delhi,
24th November 1941.
My dear Pandit,
In continuation of my DO No. 41-14/41-PH of the 22nd November
1941, I enclose the following documents:
• a letter to the Commissioner of Immigration authorities,
New York, which you should deliver in person,
• a letter addressed to Mr John L. Mott, International House,
New York, which you should deliver in person,
• the monthly expense book mentioned in Dr Jacocks’ letter
to me of the 21st November, a copy of which has already
been sent to you.
I hope you will have a pleasant and successful trip.
The primary object, as you know, of your visit to the USA is the
study of the manufacture of yellow fever vaccine. In view of the
possibility of an influenza epidemic we are anxious that you should
also be acquainted with the latest methods which the Foundation
are using in the manufacture of influenza vaccine. I am sure that
the Foundation authorities will be glad to give you every facility for
studying each technique.
In his DO letter dated the 10th March 1941 to Dr Jacocks, Dr
Bauer stated: “The manufacture of yellow fever vaccine will, of
course, require special equipment as the virus is very labile, and in
order to render it in more stable from, it will have to be desiccated
in the frozen state. If a bacteriologist is sent here to learn the
technique, it would probably be advisable for him to purchase
desiccating equipment while here and learn how to use it. The
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apparatus we are using is not available commercially as it was built
in our own laboratories”. If, after discussion with the Foundation
authorities, you will be good enough to let us have details and the
estimated cost of the equipment to be purchased and brought by
you from America, we will obtain the sanction of the Government
of India to its purchase. You may, if necessary, let us know this
information by cable.
I wrote to you on 18th November asking for your views on the
manufacture of a vaccine against typhus, but there has not yet been
time to obtain your reply. If it is advisable for you to visit Casteneda
in Mexico, I will ask Dr Jacocks to be good enough to arrange for it
with the Foundation authorities.
Mr. J. Hennessy, who is the Principal Information Officer of
the Government of India and will now be on the staff of Sir Girija
Shankar Bajpai in Washington, will be on your ship. I was talking to
him today and I told him that I would tell you to look out for him and
introduce yourself to him. You will find him interesting company.
With best wishes,
Yours Sincerely,
Sd/- Col. Cotter
Dr C.G. Pandit,
C/O The Port Health Officer, Bombay.
I had thus to study the manufacture not only of yellow fever vaccine but also
of influenza and typhus vaccines!
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II
The Journey
I had to travel by ship since there was no air communication in those days
and my passage was booked by the American ship “President von Rooyen”. It was
her maiden voyage! The ship was spotlessly white. I boarded the ship on the 6th
December 1941. We sailed in the evening. The atmosphere was rather subdued;
most of the passengers had some kind of war assignment and ladies on board
were going ‘home’ as their husbands were away on war duty. Even so there was
some mirth and merriment during the night. Specially after dinner - what with
dances and movie and, of course drinking in the lounge. There was only one other
Indian on board, one Mr Lalwani, a student. We were sharing the cabin.
Next morning as I went to the dining saloon for breakfast, I found to my
surprise everybody gloomy, anxious and whispering to each other. On enquiry I was
told that America had entered the War. The Japanese had bombed Pearl Harbour.
It was the 7th December 1941. We were all excited. Naturally the atmosphere of
mirth and merriment disappeared, and all the passengers were actively discussing
among themselves what route the ship would now take: whether we would go as
previously scheduled through the Red Sea, Mediterranean and the north Atlantic
and so on. The Captain called all the passengers together and told us what had
happened and said that the ship would now go to the US via the Cape, i.e., via
Durban, Cape town and Trinidad. Since there was need to black out the ship the
Captain told us to take a pot of paint and brush and paint the ship black in any
manner we liked to do so. While the crew were engaged in painting the ship on
the outside, the passengers were assigned the task of painting the ship inside,
glass doors and windows, the port hole of the cabins and, of course, along the
gang ways. We literally played with the paint like children. There was no smoking
allowed on the deck but only in the blacked out smoking room of the ship.
We reached Durban after over 10 days of voyage. I wanted to know whether
there would be any orders for me from the Government of India in view of what
had happened. However, none were received. We proceeded to Cape Town. When
we arrived at the port in the evening, the city and the harbour were brilliantly lit.
The passengers were allowed to go ashore. We spent the next day in Cape Town
wandering along the streets and eating in restaurants. Mr Lalwani was with me
and we were moving together. In the evening we decided to go to a movie before
going back to the ship. When we asked for the tickets the girl at the counter asked
us if we were of the merchant marine. “No, was the movie meant only for merchant
marines?” I asked. She would not answer but apparently was hesitating to give
us the tickets. The Manager who was listening to the conversation said to the girl
at the counter “Give the gentlemen the tickets they want.” We ultimately found
ourselves occupying seats in the very last row in the balcony. It then dawned on us
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that though the balcony was comparatively empty we were given those seats just
to be sure that no one would notice our presence by turning their heads. The show
was interesting in many ways but in the news item there was a feature entitled:
“Exploits of our boys in the North”. This related to the doings of the Indian army
in the Egyptian desert and the audience vociferously cheered when the shots
were on. After the picture was over as we came down the stairs the Manager met
us again and asked us whether we had enjoyed the show. I enquired as to why
there was hesitation in giving us the tickets: “Was it due to the colour bar?” I asked.
“Unfortunately, Yes” he said, “because if anyone had noticed you, there would have
been questions even in Parliament.” He was extremely sorry but since we were
travelling during war time, he thought he could not refuse us the tickets. I told
him that I was rather surprised to find the audience clapping to the ‘exploits of our
boys in the North’, while there was hesitation to allow their own countrymen to see
what they were doing!
It was almost midnight by the time we reached the ship and in the lounge
many people were present and asked me how we had spent the day. I gave them
the account of what had happened at the theatre. One of the listeners was Mr.
Hennesey, the representative of the Government of India, to whom I had already
introduced myself. As was to be expected, the passengers both British and
American, were rather surprised at the treatment given to us. “Doc, this should not
have happened to you”, was their universal comment. Anyway, we retired to our
cabins in due course and in the morning after breakfast I found a different kind of
atmosphere. Our story had gone round and the Stewards and the Stewardesses,
all came to us and expressed their sympathies to us. During the morning session
for the soup at 11 O’clock when I wanted to fetch my cup, one of the stewards
approached me and said, “No Doc, stay where you are: I’ll bring you the soup”. I
received right royal treatment throughout the voyage thereafter.
It was two days after we left Cape Town. As I entered the dining hall for breakfast
I again found the atmosphere with general excitement. I was told that there was
an emergency of some kind. When I came to the deck the ship took a sudden turn
and I almost fell down. Just at that moment the bartender came running, opened
the bar and helped himself to a sizeable portion of whisky. On enquiry he just
blabbered that there were two submarines ahead and something like a man of war
behind us and we were apparently the target of both. We were ordered to wear our
life belts and we repaired to our respective positions near the life-boats. We could
only wait to see what would happen. We stood like this near our life-boats till about
1:30 pm when the all clear signal was given. We were moving in circles and zig zag
to avoid the subs and with our speed which I was told was about 20 knots, we could
successfully avoid the subs! We reached Trinidad a few days later where we had to
stay for two days. We did not see much activity at the Port and in due course sailed
through the North Atlantic and reached New York on the morning of February the
7th . It took us over one month to reach New York from Bombay.
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As soon as the ship berthed there was a crowd of reporters on board. News
of what had happened had gone round and they were busy interviewing the
passengers. When they approached Mr Hennessey, who was introduced to them
as the representative of the Government of India, he referred them to me. They
asked me many questions. They wanted to know particularly how come that I
undertook the journey at this juncture! My mission was confidential and I was
warned not to talk about it to any one and so I had to reply that when I sailed
from Bombay, America was not at war and that I had decided to go to USA for
postgraduate studies “Where do you intend to study, doctor?” they asked. I
thought it better not to tell all lies and replied, “Perhaps at the Rockefeller Institute
for Medical Research”, which incidentally was the place I was to work at. I never
thought about all this but on return to India I was told that Reuter had flashed a
message about the ship which I am reproducing below:
PASSENGERS HELP TO CAMOUFLAGE SHIP
Vessel's World Tour
Hoboken (New Jersey) January, 8
A sleek American ship, which was trapped in the Indian ocean on her
maiden voyage by the outbreak of war, has just returned to port carrying
65 passengers who pitched in—both men and women — slinging paint
brushes to help the crew paint her war-time gray.
Naval regulations prevented the captain detailing the homeward
course of the dangerous round-the- world trip, but he said he had received
navy orders from the moment of the Japanese attack on Honolulu to the
arrival at Hoboken. The ship was equipped for blackouts when she left New
York three and a half months ago. It took two days to camouflage her in
the rolling sea, with everybody helping cheerfully. Among the passengers
was Mr C. G. Pandit, an Indian doctor and scientist, who is joining the
Rockefeller Foundation as a bacteriologist.
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— Reuter. From 'The Hindu' Madras.
Why my name alone was mentioned, I do not know. As was to be
expected the news appeared in the local press in Madras, the Hindu of
10th February 1942. My office having read it, underlined the heading in red
and sent the paper to my wife to inform her that I had reached New York
safely! She thus knew about this before my cable from New York reached
her.
However, when I went to the Western Union office for sending a cable
about my safe arrival, the lady at the counter refused to take the message.
She asked me "How do I know that this is not a coded message?' I told
her that I wanted to send this message to my wife about my arrival in this
country. After a lot of discussion, she accepted the message but asked me
to add one word, "Love". The message then read: ARRIVED COMFORTABLY
LOVE! My wife later on asked me where was the necessity of this public
exhibition of love?
III
Assignment in New York
I was met by the representative of the Rockefeller Foundation when I
disembarked. He took me to my hotel, and I was briefed about the nature of my
assignment. Dr Hans who was then a member of the team of the Yellow Fever
vaccine manufacture subsequently made all the arrangements and since I
was going to stay for about three months at least in New York, he arranged my
accommodation in a hotel quite close to the RF Institute for Medical Research.
Next morning, I met Dr Goodner who was in charge of the yellow fever vaccine
manufacture and discussed with him my programme of work. I also met Dr Theiler,
the Nobel Laureate, and the discoverer of the vaccine. I was not permitted to visit
his laboratory as I was not yet protected against yellow fever. I received the vaccine
shot and started work.
It might be worthwhile to mention how yellow fever vaccine is made. Dr Theiler
was working with the yellow fever virus, isolated from a fatal case of the disease. He
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inoculated the virus into fertile eggs and was doing several passages in them. At
the 17th passage in his “D” series of experiments, he found that the virus had lost
the capacity to produce the disease, but nevertheless, was capable of producing
protective antibodies against the virus. Thus the “17-D virus” came to be used for
protection against yellow fever. Subsequently, when the experiment was repeated
anew in eggs, neither Dr Theiler nor other investigators could obtain the same
change as originally observed by Dr Theiler. The “I7-D” strain of the virus thus had
to be preserved very carefully for producing the vaccine for human immunisation.
In the preparation of the vaccine for use in humans, number of fertile eggs
are inoculated with the virus. The developing embryos which contain the virus
are removed and the material is further processed. Only living embryos are taken
and dead embryos are discarded, as the death might be due to contamination
with bacteria. The embryo material containing the virus is then dried under frozen
conditions to ensure that no loss in the virus content occurs during the process.
The suspension of the virus undergoes further tests for its purity and potency
before the vaccine is released for human use.
I had told Dr Goodner that I would like to acquaint myself with all the
techniques and procedures involved in the manufacture of the vaccine. Just on
the first day an amusing incident occurred. I went first to the section where
fertile eggs were received. I checked the consignment and placed the eggs in
the incubator. The room was in a mess with packing material. As I was sweeping
it, Dr Goodner came and asked me why I was doing it. I said that I wanted to
do everything myself and would omit no procedure however insignificant. He
smiled but was obviously pleased! That was a good beginning, for I was told and
discovered later, that he was a hard taskmaster—not easy to please! At the end of
my assignment the Rockefeller Foundation congratulated me on having got on
so well with Dr Goodner! We struck a good friendship and I had many encounters
with him in later years during my sojourn in the States, discussing among other
things cholera in which he had developed special interest!
The work in the laboratory was very exhausting. The laboratory was making
the vaccine, primarily for immunisation of the American army, and the demands
were excessive. When one morning I was examining the eggs to see if the embryos
were living or dead and took some time to do it, Goodner almost shouted “Hey,
you are withholding the traffic. It does not matter if one dead embryo gets in and
I have to discard the whole batch but get on with the work.” The manufacture was
organized on an assembly line technique and no unnecessary delay was permitted
to slow down the procedure.
In due course I worked with Dr Theiler on the yellow fever virus and discussed
with him the problems I would have to face in the manufacture of the vaccine
in India should it become necessary and especially in view of the paucity and
difficulty of getting the essential equipment for the purpose. We also did some
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comparative tests with yellow fever virus and the 17-D virus in the detection of
antibodies in human sera, just in case it was necessary to do so, since work with
yellow fever virus was prohibited in India for obvious reasons.
In the laboratory I met other workers engaged in the diverse fields of virus
research. My talk with Dr Smith, the entomologist, was most stimulating and
instructive. Here I must relate an interesting episode. Dr Hirst was then working on
the influenza virus. I had decided to spend some time with him, since manufacture
of influenza vaccine was one of my assignments. I was also doing some work
on the influenza virus in my Institute at Madras. On opening an infertile egg
inoculated with that virus Hirst showed me the agglutination of chick red cells—a
phenomenon which he was studying. I exclaimed I had also seen it. However,
following that observation, Hirst developed the technique, the haemagglutination
inhibition technique, which had to play an important role in the diagnosis of
viral infections. I felt, as many scientists have felt before, “Why the deuce didn’t I
foresee the importance of this!” But only the “prepared minds” can appreciate the
importance of such observations!
IV
Visit to Hamilton, Montana
An additional assignment given to me was the study of techniques of
manufacture of typhus vaccine. We had no idea then about the prevalence
of rickettsial diseases in the country, but epidemic typhus was a problem of
some importance specially to the army in the north-west. Life in New York was
becoming very dull, and I was therefore looking forward to this assignment in the
institute in Hamilton, Montana, where the Rockefeller Foundation had made all
the arrangements for my visit.
I arrived at Hamilton-a village of about 3,000 population- at about 6 O’clock in
the evening by bus from Massoula. I was received at the bus stand by Dr Cox who
was in charge of the manufacture of typhus vaccine. He took me to the local hotel
and asked me that after the evening meal I should see him in the laboratory to start
work. Accordingly, after dinner I went to the laboratory, discussed the problem of
typhus vaccine manufacture in some detail and returned to the hotel by midnight.
Early next morning as I was going to the laboratory most of the people on both
sides of the road greeted me with the words: “Good Morning, Doc.” I was rather
surprised that my arrival in the village was known so quickly. Of course, this sort
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of thing must happen in a village where many of the inhabitants were working in
the laboratory.
My stay in Hamilton was most enjoyable, apart from the interest in the
scientific work. I was overwhelmed with the hospitality, not only of the members
of the staff but also their wives. Indeed, one evening when I was invited for a cup of
tea by a member of the staff, his wife asked me whether I would talk to the officers’
wives. “Talk on what?” I asked. “We were discussing” she said, “some aspects of
religion; would you like to tell us something about the Hindu religion?” I assured
her that I had really no qualification to speak on that subject. “But you are a Hindu”
she said, “tell us something of what you believe and what you don’t”. In my weak
moments I agreed and talked on some aspects of Hindu religion. During my talk I
briefly referred to the teachings of the Geeta which was, I said, really a Bible of the
Hindus and since it was wartime, I drew their attention to the contextual setting of
the Geeta. It was preached on the battle-field, and I drew their attention to the last
verse- “Therefore rise, Arjuna, and fight”. I do not know but I felt they were amused
with what I had said, if not really interested.
A few days later my hostess again asked me whether I would give a talk on
any other subject some evening again. They won’t take ‘No’ for an answer and on
the appointed day I was surprised to find myself in the Village Hall where there was
a huge crowd of people not merely the members of the Wive’s Club. The subject of
my talk was “Life in an Indian Village.” Looking back, I am really ashamed to have
chosen this subject because my acquaintance with the village life at best could
be described as only casual. Nevertheless, they were interested judged by the
reaction on their faces as they listened to me. In describing the modes of transport,
I had referred to the Indian practice of palanquin used by the nobility. After the talk
they complimented me on my English vocabulary, because the word “Palanquin”
was almost new to them. Some of these episodes were published in the local
newspaper and when I reached New York subsequently, the representative of
the Rockefeller Foundation complimented me on what I had done. “Doc” said he,
‘”we were completely posted on your doings and we have in our files even the
newspaper cuttings”.
Manufacture of typhus vaccine, though a complicated procedure, was really
nothing extraordinary for one who had learned the technique of yellow fever
vaccine manufacture. One evening we were visiting the room where the infected
ticks were housed. As I entered the room, an officer shouted: “Stop dead, do not
proceed”! I was a bit surprised and he repeated’ the command again. I did stop.
The officer drew my attention to a broken jar containing infected ticks and some
of them were crawling on the floor! I then withdrew to the anteroom where two
members of the staff unclothed me and gave a thorough check up to see whether
any infected tick was harbouring on my legs and body. They did not find any and
even after such close scrutiny the officer declared that my chances of getting
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typhus were 50:50! I went back to the hotel, gave my suit for pressing and took
as hot a bath as I could bear to dislodge a tick if it should have been there. But
the remark that my chances of getting the disease were 50:50 haunted me till I
reached India!
As I said, life in Montana was most interesting. I felt that I was really meeting
real Americans! A New Yorker, in my opinion, did not represent the USA. One
evening as I entered the bar of the hotel for a glass of beer, a farmer walked in,
who did not know me, of course, and said to the bar attender “Miss, give Doc one”.
Immediately another farmer also walked in and repeated the same order. By the
time I was able to finish my own glass, four glasses of beer were arranged in a row
awaiting to be consumed. I really got worried and told the Miss that I was going to
order one all round for everyone, not to give me one. After the drinks were served,
I made my apology on the pretext that I had another urgent assignment to fulfil.
My work in Hamilton, Montana, being over I returned to New York.
V
Return journey
During the course of my stay in New York I had an occasion to call on Sir Girija
Shankar Bajpai, the then Representative of the Government of India in Washington.
During the course of my conversation, he had indicated that he would like me to
travel with him back to India because he was contemplating to return, as at the
time he was not in good health. While talking about Indian scientists in the States,
he made a suggestion that we should request Dr Subba Rao to return to India
and work there. Fortunately, I had occasion to meet him at one of the meetings of
the New York Academy of Sciences and when during the course of conversation
I appraised him of what Sir Girija Shankar had said, he told me that he regretted
very much but the offer was too late since he had already signed a contract with
the Lederle’s.
Incidentally he mentioned that he had played with the idea of returning to India
previously but could not see any possibility of getting a job even on Rs. 500/- p.m.!
Life in the laboratory was dull. I used to spend my time alternately with Dr
Theiler and Dr Hirst. I was anxiously awaiting the developments about my return
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to India. I had requested Sir Girija Shankar to arrange, if possible, my return by air
since there was a skeleton air service organized via New York and Lisbon. I must
confess I was really frightened of returning by the sea. Sir Girija Shankar informed
me that I need not be too optimistic as there were many high ranking officers
and generals who were waiting to go but could not, because of heavy booking
on the plane. A little later I was told that my passage was booked by a ship! I was,
therefore, surprised when one morning I received a telephone call from the First
Secretary, British Embassy in Washington, who wanted to know whether I could
leave New York the same day by the night plane to Miami en route to India. He
said that he could not disclose my actual route at that stage. If I would get into
the night plane I would be met at the Washington Airport by the officers of the
Embassy and after identification they would hand over to me my passport which
was with them and other official documents. However, he said that I would be
transported to Free Town, West Africa, in due course. He very much regretted that
the Embassy could not make any further arrangements about my travel to India.
He advised me to use my own wits and get myself transported from Free Town
to India by whatever route which seemed feasible to me. When I asked him as to
who would know me in Free Town, he said the Embassy would give me a letter of
introduction to the local authorities to render such advice and help to me as was
necessary. Free Town was a British territory.
As I had no funds with me for the travel, I went to the office of the Rockefeller
Foundation for their advice. Fortunately, the Foundation was able to secure for me
one seat on the plane leaving New York that night for Miami. When we discussed
the travel arrangements, I was given travelers cheques for $2,000 to meet the
travel expenses by whatever route I went. They also said that should I find myself
in Cairo and if more funds were needed, I could contact their office there for the
purpose. They were going to inform their office in Cairo accordingly.
After making the necessary preparations including purchase of two small
suitcases for travel by air and packing my belongings—books, clothes, etc.—in a
trunk to be dispatched by sea later, I boarded the plane at night. It was a Dakota.
Some of the passengers in the plane were apparently proceeding to different parts
abroad and just from their whispers I could gather an impression that from Miami
I would have to go to Trinidad. Of course, I had no official intimation to that effect.
I was met at the Washington airport by two officials of the British Embassy.
After identification, they gave me the travel documents along with a letter
of introduction to the authorities in Free Town and asked me to report to the
Embarkation Command at Miami port immediately on arrival. I reproduce here
the letter of introduction for use in Free Town.
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Indian Agency General
Washington, D.C.
TO WHOM IT MAY CONCERN
The bearer of this document Dr C.G. Pandit, Member of the
Medical Research Department of the Government of India, is
an official of the Government of India who have requested this
Agency to arrange for his urgent return to India as he is a specialist
on serums. His transportation to West Africa has been arranged
by the British Embassy and I am to request the good offices of any
of His Majesty’s representatives in Africa to whom he may apply
for assistance in expediting his return to India.
Sd/- M. Creagh Coen
ICS
22nd April, 1942.
On arrival at Miami the next morning I went to the embarkation command
as per instructions and enquired about my travel arrangements. The officer was
very apologetic and replied that he had no information whatsoever concerning
me. When I explained to him my plight and the conversation I had on telephone
with the British Embassy in Washington, he agreed to telephone Washington for
necessary instructions. It was a long wait. In the evening he informed me that he
had got the necessary permission to make travel arrangements for me and since
I was put to so much inconvenience already, he promised to put me on the first
plane leaving Miami the next morning. I boarded the plane; it was again a DC-3.
Unlike the plane from New York this had no seats but had only wooden benches
on either side. It did not matter because my immediate need was to return to India
anyhow.
We took off and as we were nearing Puerto Rico the engine developed
trouble and we had to force-land there. We were informed that repairs to the
plane would take some time and it would not be possible to resume the journey
till the next day. Arrangements were, therefore, made to put us in a local hotel
which was already crowded. This episode, however, altered the whole complexion
of things as would be seen later. At dinner that evening I met one of the fellow
passengers, Commander Leete and had very pleasant conversation with him on
my assignment to the USA and on various other matters. The next day when we
boarded the plane I asked him what I should do in Trinidad, especially regarding
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my stay. The only thing I knew was that I had to board a ship. Commander Leete
told me that he would take care of me and instructed me to follow him wherever
he went. I found myself in the officers’ mess where we had a good cup of tea and
was then taken to lodgings where other officers travelling in the plane were also
billeted. I attracted then, as well as later, considerable attention because I was the
only civilian and an Indian, travelling with a sports coat and trousers. Over drinks
that evening, Commander Leete warned me that I should be ready all the time to
board a bus which will take me to the harbour. No previous intimation would be
given since all arrangements for transport were of a confidential nature. Of course,
I was ready all the time and in due course I found myself aboard a ship. One of the
ship Stewards took me to the place allotted to me. To my surprise I found myself on
the top deck near a lifeboat and I was shown a hammock which I was to use for the
duration of the voyage. Another hammock next to mine alloted to a negro officer
who was travelling on some political assignment to Nigeria. Nobody met me that
evening and after dinner. Lying- in our hammocks, the negro officer and I talked
a great deal on many matters including the negro problem in the United States. I
really enjoyed talking to him.
The next morning, I met Commander Leete as he was passing by and when he
enquired as to how I was faring, I invited him to see where I was billeted. When he
saw the accommodation provided to me, he exclaimed “Doc, you can’t stay here;
let us go and see Capt. Hamilton”. I said I did not like to do that. But he insisted and
took me to see him. When I met the Captain, I immediately told him that I was not
complaining. “Well Sir,” said I, “I am quite happy as I am”. “There is nice company
on board, good food and a place where to rest and sleep comfortable, the lot of a
refugee could be worse”, I added that, since Singapore had just fallen. He seemed
pleased with my answer. “Well Doc”, said Capt. Hamilton. “I am very sorry. I got
your name the last and the accommodation had already been previously allotted,
there was no other place where I could put you. However, after we sail, I will see
what I can do for you”. I thanked him and left.
We lay in the harbour for three days. The decks were apparently cleared for
action for there was neither a bench nor a chair to sit. We squatted on the deck
with our lifebelts always near us. We were asked to have them always with us even
when we were sleeping at night. We saw ships coming into the harbour with
gushed wounds on their sides! We felt we were quite close to the war! In due
course we sailed at about eleven in the morning.
There were two ships that sailed that morning. One was ahead of us, and we
were next to leave the harbour. As soon as we left the harbour, Capt. Hamilton
came to me and said, “Well Doc, I have something for you, would you like to see?”
He took me to the --’C’ deck and showed me a room with a full-size bed, wash
basin, and a fan. “Doc, you can take this, if you want. This was reserved for a high-
ranking officer who did not turn up”. I looked at him and said, “Well Sir, I will take
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it, I believe in dying in comfort”! “What do you mean?” he asked. “Well, in my
present accommodation I am right on the top deck, by the side of a life-boat.
In an emergency if I were to be in this cabin on C desk, I would have to climb
three stairs possibly in the dark and fumble to reach the top deck”. He laughed.
He himself carried my suitcases and I was duly deposited in my new cabin. We
had hardly gone for two hours when suddenly there was some excitement. We
were informed that the ship ahead was torpedoed. We did not go to her rescue,
but we changed our course and sailed south towards South America and after
crossing the equator we found ourselves in Port Pernambuko where we stayed
for three days before proceeding again northwards to Free Town. We had crossed
the equator again and as an honour for having crossed the equator twice they
presented me with a Parchment stating the episode. Next day the ship’s doctor
saw me, took my personal history, examined me after completely stripping me
and since I was not immunized against tetanus gave me a shot of tetanus toxoid.
Life on board was very severe. The ship was carrying a regiment of Negro
soldiers. The ship’s officers had many problems in dealing with them.
Occasionally I could help them to settle their disputes. Water had to be
conserved and no fresh water was available for bath. Obviously, we could not bathe
in salt water. It was very warm during the journey as it was the month of April. One
has to realise how much a human being can stink! Water too was rationed, and
we could drink it only during meals. Coca Cola was available in small quantities on
payment. Because of my habit then of drinking water just before going to bed I
was permitted to smuggle a glass of water to my cabin after meals!
The journey was not without its anxious moments. Apart from routine alarm
signals I found one day the officers of the ship rather agitated and looking ahead
with their binoculars, whispering something to each other. No alarm was given
and when I enquired as to what was happening, they said they had spotted
something which looked like a whale! “What so far down south?” I exclaimed. “Yes
doctor, strange things can happen during war”. I wondered what it was! Could it
have been a submarine?
We arrived in Free Town in due course and an officer approached me and
asked me if I would like to celebrate the event. “Celebrate how?” I asked. “With
whisky, of course” he said. “But whisky was contraband on board”, said I. “Forget
about it, Doc; just join us”. I need not add that I was only too happy to oblige.
The next morning, I wanted to know what arrangements were there for
disembarkation. I was told that the Captain had put up a notice on board that
nobody was permitted to go ashore until further orders. I was rather perturbed
at this because according to the arrangements made I had to get off at Free
Town and make my own arrangements for the onward journey to India. I went
to Capt. Hamilton and explained to him the situation. After telling him what my
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instructions were, I showed him the letter of the British Embassy, requesting the
authorities in Free Town to provide me with all the facilities for the onward journey
to India. Capt. Hamilton read the letter, folded it carefully and put it back into my
pocket. “It might be useful, perhaps, some day”! he said. When I tried to argue
further he bluntly told me “Young man, no more discussions; no disembarkation
today’, That was that!
Later in the evening I was informed that there was a notice on the board
intimating that 14 passengers were to disembark the next morning. To my surprise
I was one of the 14. Commander Leete was to be in charge of the group. I was
very happy indeed with this development and went to Commander Leete the
next day to thank him for having included me in his group. “Well Doc”, he said,
“we disembark in the afternoon today. When ashore please ask no questions
and answer none. I would like you to follow me like a ‘dog follows his master’.
You understand that, don’t you?” I did not know what was in the offing but said, I
would certainly obey orders.
We got into a truck and a little later, Commander Leete got out and asked by
name seven of the fourteen to get out. I was one of the seven. The rest were carried
to another destination. I found that we were in the RAF Mess. When the officer
commanding received us, he was a bit surprised to see me in civilian clothes and
asked Commander Leete who I was. He said, what was to be his stock phrase later:
“This is Dr Pandit; I have orders to carry him to India”. I was rather surprised on
hearing this because I knew no such orders had been issued! I, however, kept
silent and asked no questions. The Commandant seemed very happy to see me.
After a few drinks we sat down to dinner, and I had the place of honour at the
table. After all was not I a British subject by birth! I acquainted the Commandant
with my mission. He was deeply interested, for Free Town was in the yellow fever
zone. After a pleasant evening we then repaired to our lodgings, Nigsen Huts,
in the same place where the previous seven were sent. On arrival we found the
seven almost in revolt. They, of course, knew where we had been. One of them
indignantly asked Commander Leete, “If you had invitation for only seven, why did
you choose these seven and not any one of us. Of course, we don’t mind the Doc.”
“You don’t mind the Doc?” said the Commander. “Don’t you know that according
to the Captain, Dr Pandit was the nicest man on board”. I could understand the
cause of this outburst. Unfortunately they were not able to get anything to eat and
they were naturally indignant at our having had such a good time.
I still did not know what was going to happen next, when early in the morning
the next day, a truck turned up and we were asked, all the 14 of us, to get in. We
found ourselves at the airport. Obviously, Commander Leete had arranged for my
transportation by air, and I guessed it would very probably be to Cairo. However,
the Captain of the aircraft, Captain Peterson, informed Commander Leete that
he could not take all the fourteen with him since he had a lot of freight to carry.
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There was again some kind of a dilemma. Commander Leete feigned he was
nonplussed, looked at me and said “Doc, how far have you to go?” I said, “Sir,
Karachi”. “Karachi, Karachi, a long way off, is it not? Doc, get in”. I was the first to
get in the plane. The same group that had dined at the officers’ mess at the Air
Force Station eventually got in and the remainder were asked to stay behind and
make their own arrangements the next day. On board Commander Leete said to
me, “I wanted to teach the blighters a lesson for the show they made last night.” In
due course we took off.
When we were airborne Capt. Peterson came to me. Commander Leete had
apparently told him about me. “Have you been in an aircraft before?” he asked.
I said, “Sir, just the previous month-from New York to Miami and to Trinidad”.
“Have you been inside the cockpit?” he asked. “Come along, let me show you.”
Once inside the cockpit, he said, “I understand, Doc, that you have to go to Karachi.
The reason why I called you here is not to show you the cockpit but to ask you in
confidence whether you would like to travel with me to Karachi since I am taking
this plane there.” I immediately replied that since the British Embassy had asked
me to make my own arrangements, I would be extremely happy to go with him as
far as Karachi. I was so happy that the problem of my transportation to India was
solved.
After about three hours of journey, we arrived at Accra where I was told we had to
stop for a couple of days. Again at the airport the British officer commanding asked
who the devil I was and Commander Leete gave him his stock reply. Fortunately,
I was asked no questions and, therefore, had to answer none. There were lots of
people waiting for transportation to Cairo. The stay in Accra was uneventful. I was
walking aimlessly in the bazaar and was trying to find out whether I could get the
glass of my watch replaced since it had broken accidentally the previous day. I
went into a Sindhi shop in the area. He was overjoyed to see one of his countryman,
volunteered to have the watch repaired at no cost, invited me to his home and
treated me to a sumptuous Indian meal!
Two days later we resumed our journey and went to Maiduguri. Maiduguri was
a station on the outskirts of the Sahara desert. The Americans were just setting up
a transit camp there. I saw lots of crates and equipment being unloaded from the
aircraft. We spent the afternoon and night in Maiduguri. We dined sumptuously
and every item on the menu was imported from the US. The only local product
was the Maiduguri chicken. Lodging arrangements were perfect and I slept that
night on a full -sized brass double bed which I had never done before or have done
ever since. I was wondering if the Americans wanted all these comforts even at
such an outlandish place as Maiduguri, how on earth, I thought, they would be
able to brave the exacting conditions of war!
Maiduguri was in the yellow fever belt. Both in Free Town, in Accra and in
Maiduguri I was never ask a question whether I was protected against yellow fever
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while the American army, of course, was. From Maiduguri we went to Khartoum.
In the evening we dined at a posh restaurant and proceeded next morning on
our onward journey to Cairo. I felt that at last I was in the midst of civilization even
though the atmosphere of war was prevalent everywhere. Here again I followed
Commander Leete as a ‘dog followed his master’ and found myself in Hotel
Heliopolis which was taken over by the Americans for their military personnel.
Commander Leete gave instructions to provide a room for me during my stay in
Cairo. After this I took leave of Commander Leete since he had another assignment.
The next morning Capt. Peterson approached me and with a long face told
me that in his opinion the aircraft was not in a fit condition to proceed further,
and would I mind if we stayed in Cairo much longer than previously thought of. I
was rather suspicious of the way he had said all this and asked him if the aircraft
was really unserviceable. He smiled. “Doc, you are returning home and we are
going away from home. You will understand”. I understood. These three days in
Cairo were really pleasant. I was taken to the Pyramids; I was not allowed to pay
entrance fees because Capt. Peterson explained to the authorities that, though
a civilian, I was on war duty. In due course we left Cairo but before we took off
the authorities had to be explained the reason for my being on board the same
way as Commander Leete had done before. Capt. Peterson had orders to carry
me to India. It was an American aircraft, and the British authorities could not do
anything. The aircraft was fully loaded with equipment and the onward journey
from Cairo was certainly not comfortable. We travelled via Libya, Baghdad, Basara
and Shahadra, stopping at each place for a day, and arrived in Karachi at about 3
PM one day!
I was happy to meet at the airport Major Jaffer who had worked with me at
Guindy as an Assistant Director in the Institute. We were very good friends. On
seeing me he hugged me and asked me what the devil I was doing and why I did
not inform the Government of India about my movements. I had to explain that
during the war time all communication with the outside world was prohibited.
Apparently, all airports wherever such aircrafts have a runway had instructions
from Delhi to look out for me. This was because the Rockefeller Foundation had
sent a telegram to Delhi that I had left New York by plane. Major Jaffer told me that
even the British Admirality were interested in my movements and wanted to know
where I was.
This was, however, not the end of my worries.
An hour later Capt. Peterson came to take his leave of me and asked me
whether I would like to go to Delhi with him since he was going there. I thanked
him profusely for what he had already done and told him that my plans were to go
to Bombay first and then to Madras, and then added mischievously, “Now, Captain,
I’d prefer to travel by an airconditioned coach, lie on the berth sleeping or reading;
order my tea and meals and pass the time, for the first time after two months, in
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some comfort.” “Well, that’s all right by me”, said Capt. Peterson and we parted.
During my subsequent journeys to the States, I always tried to get in touch with
Capt. Peterson but could never do so.
After the formalities at the airport were over, I went to Major Jaffer’s residence.
He asked me what further arrangements for travel I would like him to make,
since I was wanted in Delhi immediately. I told him that if I had known that I was
wanted in Delhi I would have gone by the same aircraft I had come! Since it was
too late to do anything now, I told him then what I had in view, “That is out of the
question” he said. “You simply cannot travel by train to Lahore and then to Delhi.
Don’t you know that there is at present a rebellion going on in Sindh — the Hur
rebellion? Train journey is extremely hazardous and if you are going to travel by an
airconditioned coach, forget about it because the rebels have that as their target.
A very high officer was killed the day previously”. He suggested that I should go by
air to Bombay and then to Delhi. I thought for a moment and told him that I will
stick to my original plan and requested him to book my seat by the airconditioned
coach by the Lahore mail leaving the next morning. In the evening I met at the
Club Mr. S.B. Junnarkar who was then the Principal of the Engineering College.
We were studying together in London during the 1920s and we were staying very
close to each other. I had not met him since and was extremely happy to talk of old
days with him. When he learned about my travel arrangements he again protested
and said that I should not risk travelling that way. I told him that having escaped
the Germans, if my own country men want to get at me, well one can’t help it. He
just shrugged his shoulders.
Next morning, I started by the Lahore mail in an airconditioned coupe. I
was very happy to see a co-passenger a Britisher and a Colonel in the army. His
trunk bore the information that he belonged to the Gurkha Regiment. To strike
acquaintance and to receive some information from him, I asked him “Have we
not met before?” This was, of course a sheer bluff. He asked “Where?” I said, in
Shillong, perhaps in 1935! I knew that Shillong was the Headquarters of the Gurkha
Regiment and sometime or the other he must have been there. Fortunately, he
replied that he was in Shillong in 1935 and that it was quite possible he must have
met me at the Pasteur Institute. The ice was broken and I made bold to ask him
whether he knew anything about the Hur rebellion. He smiled and said that he
was the officer entrusted to put it down! He then gave me all the details. He
unfolded a map which was studded with white, yellow and red dots indicating
the places where dacoities, derailments, etc. had taken place. He told me that
he was getting off at the next station round about 3pm and warned me to be
more careful thereafter because it was then that the train would pass through
the most dangerous territory. He advised me to take my suitcases from below the
berth and in case of trouble to hide underneath. The prospect was indeed grim.
At the next station he got off and another Indian railway officer got in. Both of us
wanted company and we were happy to find each other in the compartment. The
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train moved on and in a sort of forest area it stopped. By that time, I had seen the
damage done along the railway tract. I asked the officer whether he would like to
get down and see what was happening. “No Sir,” he exclaimed. “You know what
that means?” He was visibly shaken. Fortunately, after about half an hour or so the
train moved on. The cause, as we knew later, was not the rebel activity but some
engine trouble!!
We arrived at Bhagalpur in the evening which was a station outside the
dangerous zone. The railway officer was greatly relieved and invited me to share
the bottle of whisky with him which I readily did. The next morning, we arrived at
Lahore and I proceeded on my onward journey to Delhi. Incidentally near Karnal
there was such a severe dust storm that before we could close the windows dust
had entered the compartment and we could hardly see each other’s faces. I have
never experienced such a dust storm either before or after. I arrived in Delhi late in
the evening. What a relief it was to feel that my main mission was over!
The next morning, I wanted to see the Director-General, Indian Medical
Service, to report on what I had done. I was ushered in his office and there was
somebody sitting with him. I told him immediately that I wanted to report about
the yellow fever assignment. Immediately he said with slight agitation “Dr Pandit,
would you mind waiting outside for a while? I am a bit busy and would send for
you a little later”. I was really peeved at that because I had expected somewhat
warmer reception. I had hardly waited outside for 2 or 3 minutes when I was called
in again.
“My apologies to you CG; I had a visitor and when you mentioned yellow
fever, I had to ask you to wait outside till the visitor left. You know your mission
was confidential and we still do not like anybody to know anything about it. I am
sorry if I was a little rough. Now tell us what had happened.” I explained to him
briefly what I had done and told him that because of an emergency if I had to
make yellow fever vaccine, I would be prepared to do it, side-tracking a few steps.
I had discussed all this with Dr Theiler and others at the Rockefeller Institute. After
this I asked him, “Sir, how many Japanese prisoners of war have we now?” “Nine”
he answered “Can we get their blood samples? I would like to see if they have
yellow fever antibodies. Japan has no problem of yellow fever; their army may
not be fighting in yellow fever areas and, therefore, there was no need for them
to resort to yellow fever vaccination. If they had antibodies, we would have some
additional evidence in the matter. If they did not have, we need not take the risk
of bacteriological warfare with yellow fever seriously. They would not wage a war
unless their own armies were protected.” “Who would do the tests?” he asked. I
said, I could. “But you know, we do not have yellow fever virus in the country, and it
is not allowed to be imported even for experimental purposes”. “I can do the tests
with 17-D virus which was the virus used in the preparation of yellow fever vaccine,”
I replied. He thought for a while and said, “Even then I would advise you not to
126 My World of Preventive Medicine
Introduction to preventive medicine (1924-1948)
do the tests yourself because the information would leak out and there might
be scare”. Ultimately, we decided to send the sera, when received, to Entebbe,
Uganda, for further tests. In the meanwhile, the Director-General advised me to
proceed to Kasauli to discuss the whole question with Gen. Taylor, the Director of
the Central Research Institute and decide upon the future course of action. I was
also asked to explore the possibilities of getting any item or equipment needed for
making yellow fever vaccine from some of the workshops in the country, especially
the railway workshops.
I proceeded to Kasauli, discussed the arrangements with Gen. Taylor, visited
some railway workshops thereafter and returned to Madras to await further
developments. In due course the results of the tests were available. There were no
antibodies in the sera from the Japanese prisoners of war. The Government of India
immediately lost any further interest in the problem. Subsequently, however, I
advised that since the threat of yellow fever was always present, it would be a good
idea to have all the arrangements made for the preparation of the vaccine. The
Director-General agreed and in due course provided me with a special building
in the campus of the King Institute, Guindy, earmarked for the purpose of yellow
fever vaccine manufacture. However, before I could do anything in the matter, I
was asked to utilize the building for the manufacture of BCG vaccine to which the
Government of India was also committed.
Again, following my suggestion that attempts to manufacture the vaccine
should not be given up, it was decided to transfer that activity to the Central
Research Institute, Kasauli. The Institute now manufactures yellow fever vaccine
which is approved by the World Health Organization.
On return to Madras I met the representative of the Rockefeller Foundation. As
I had said earlier, I was provided with $2,000 for my journey from Miami onwards.
The fare up to Miami had been paid by the RF already. After deducting the
expenses up to Karachi and thereafter from Karachi to Delhi and Delhi to Kasauli
and back to Madras—all these were debited to the RF-I returned $1,800 to the
Foundation. The American army carried me free, and I fulfilled the expectations of
the British Embassy in Washington when they had advised me to make my travel
arrangements from Free Town onwards using my “wits”!
To conclude, after this experience I became the only yellow fever expert with
the Government of India even though till then I had not seen a single case of
yellow fever!
My World of Preventive Medicine 127
Introduction to preventive medicine (1924-1948)
VI
International sanitary regulations—India’s reservations
After I went to Delhi in 1948 as the Director of the Indian Council of Medical
Research, 1 had to deal with frequently on some aspect or the other of the yellow
fever vis-a-vis India. Though this narrative is written in a chronological order, I am
recording my further experiences here to maintain continuity.
Yellow fever is now prevalent in some parts of Africa, and in South America.
We have always been worried about its introduction into India through a
passenger who might arrive in the incubation period of the disease, or through the
importation of an infected mosquito from those regions. As a precaution against
such introduction of infection, an organization called “the Office Internationale
de Hygiene Publique” established after the first World War, and the World Health
Organization, its successor after the Second World War have made certain rules and
regulations called “International Sanitary Regulations” to prevent the introduction
of some communicable diseases from one country to another.
In India the problem vis-a-vis yellow fever, is of special importance. We have
the mosquito, in most parts of the country, which transmits the infection, and we
also have monkeys which are particularly susceptible to yellow fever.
lndeed, work on the yellow fever virus had been carried out on monkeys
obtained from India. In view of these considerations, India had not only accepted
the international sanitary regulations but insisted on having them made more
stringent to meet our own requirements. The additional safety measures are called
‘Reservations’ applicable to only those countries which insist on them.
According to these regulations, a traveler coming from a yellow fever area,
or passing through such an area, or who had boarded a plane coming from the
area has to have a ‘valid’ inoculation certificate with the yellow fever vaccine.
While the certificate becomes valid after 10 days after inoculation, India at that
time was insisting for a period of 12 days on technical grounds. In the absence
of such a certificate the passenger had to be quarantined in a mosquito-
proof accommodation for the period needed for the certificate to get ‘valid’.
Unfortunately, we had to rely entirely on the cooperation of travelers in maintaining
India’s freedom from yellow fever, knowing full well that in many instances, the
inoculation certificates can be “faked”. Since there was no other alternative, we
had given strict instructions to the staff at International Airports to enforce the
regulations strictly, indeed to the letter and not in spirit. If there was to be any
deviation, it was to be after consultation with the concerned authorities in New
Delhi. The staff at airports had no jurisdiction in the matter.
I was told of an episode. The daughter of Lord Wavel, the Viceroy of India,
travelled from London to Cairo, and boarded a plane there which had arrived
128 My World of Preventive Medicine
Introduction to preventive medicine (1924-1948)
from a yellow fever zone. At the Karachi airport, the officer on duty was a Sanitary
Inspector. He had the ‘audacity’ to tell her that since she did not have a “valid”
certificate she would have to be quarantined for a period necessary. She telephoned
to Lord Wavel who advised her to obey the regulations! I know, of course, that
many important dignitaries had undergone such quarantine most willingly!
I might as well relate another amusing story. I have already stated that during
my journey from Free Town to Karachi, nobody had asked me if I had a valid yellow
fever inoculation certificate, except in Karachi. During the Second World War many
high ranking American military officers used to land in Karachi after travelling
through the yellow fever zone in Africa and resume their journey across India to the
Burma Front. To quarantine them, which we did, was regarded as impeding the
war effort! I understood that after a lot of protracted correspondence, a meeting
was arranged in Simla to “sort out” matters. I was invited to attend to put forward
India’s point of view. Almost towards the end of our deliberations, the Chief of the
American delegation asked me:
“Well, Dr Pandit, what really are the chances of the infection being introduced
in India? One in billion?” “Sir” I replied, “would you kindly tell me, why I should take
that chance even though it is one in billion?”
“I am afraid, Dr Pandit, the only thing to do is to liquidate you!” he said smilingly.
“That would be of no consequence, Sir, for my views were in writing” I replied.
We repaired to lunch after this at Hotel Cecil. At lunch the officer whispered
to me: “Doc, you are damned right. Stick to your views”! I asked him then why he
did not support me at the open discussion to which he replied: “Doctor, that was
another matter”.
VII
Second, yellow fever assignment
In 1971 I was requested by the Maharashtra Government to deliver the first
Gharpure Memorial Oration. I chose as my subject “India and the Yellow Fever
Problem”. I took the opportunity of dealing with the subject comprehensively. It
is to be noted that, at the beginning of this century the then British Government
was seriously concerned about the grave health risks which the opening of the
Panama Canal exposed to the East. It is not generally known that the Government
of India had, as early as the second decade of the present century, a skeleton plan
My World of Preventive Medicine 129
Introduction to preventive medicine (1924-1948)
ready to deal with the situation should the disease appear in the Country! The
conditions in India are particularly favourable for the spread of the disease should
the virus of yellow fever be introduced into the country. We have the mosquito,
Aedes aegypti, which transmits the infection. We have the monkeys which are
particularly susceptible to the infection, viz. the rhesus monkeys. Indeed most
of the work on yellow fever virus had been carried out in laboratories abroad, on
rhesus monkeys imported from India; naturally the population is susceptible to
infection. Yet India has remained, so far, free from infection.
West Africa is the home of yellow fever. From there the infection spread to
America through the slave traffic. India did not have any sizable traffic by the sea
route from that region. On the other hand a few years ago when I visited Porbander
Port in the Gujarat State, I was told that there were over one thousand country
crafts licensed for trade with the East African ports. Surprisingly both the Gujarat
and Maharashtra Governments had no precise information on the routes which
these country crafts took to and from these regions. Fortunately the East African
region is comparatively free from yellow fever and the chances that the disease
might be conveyed by the sailing ships by that route are not very great.
In this connection I would like to relate an interesting finding. Most of the work
on yellow fever bad been done under the auspices of the Rockefeller Foundation.
It had undertaken immunity surveys in different countries to ascertain areas of
prevalence of antibodies to yellow fever virus. I had participated in such surveys.
Amongst the sera sent by me from localities round about my Institute in Guindy,
Madras, that from a class IV servant in the Institute showed the presence of
antibodies to yellow fever virus. He had never left his native village. How did he
develop these antibodies in his blood? However, in spite of such occasional findings
it is generally believed that the virus of yellow fever had not been introduced into
India.
However, we cannot afford to be complacent in the matter. Yellow fever has
appeared and then disappeared from certain regions in the world, and appeared
again in them. We had similar experience in India in 1963. Dengue fever and
chikungunya viruses produced epidemics of dengue fever with haemorrhagic
manifestations. The analogy is particularly interesting because of the involvement
of the same mosquito, the Aedes aegypti mosquito in them as well as in yellow
fever transmission.
Freedom of India from yellow fever has been the subject of much speculation
in the past. However, recent work on viruses transmitted by arthropods has
provided interesting evidence to explain the freedom of India, and indeed other
regions, from yellow fever. Of special significance to us are the so called group
B viruses, viz., the dengue, West Nile, Japanese encephalitis and Kyasanur forest
disease viruses which are present in India. These viruses show considerable
immunological overlap amongst themselves. In general terms it might be stated
130 My World of Preventive Medicine
Introduction to preventive medicine (1924-1948)
that infection with one virus first will modify the response of the other. Sequence
of infection is the determining factor. Thus these viruses provide the so called
ecological barrier to prevent the introduction of the yellow fever virus into India.
Even so, I had occasions to worry. I would like to relate an interesting episode.
At the annual meeting of the Indian Council of Medical Research in 1954 at
Nagpur, Dr Khanolkar confronted me with sections of liver from three patients
who had died with symptoms of fever and jaundice in the KEM Hopital in Bombay.
The sections showed typical pathology — diagnostic of yellow fever! Hence Dr
Khanolkar was worried and wanted my opinion. It must be remembered that
in countries where yellow fever had appeared after a lapse of many years, initial
diagnosis of an epidemic was often based on such autopsy findings. We were
faced with a dilemma. Should we or should we not officially declare these cases as
of yellow fever and face the consequences of such a decision? If these cases were
of yellow fever, we argued there would have been other cases as well—a beginning,
in fact, of an epidemic. Fortunately we had then amongst us Dr Harold Johnson of
the Rockefeller Foundation who had some experience in the matter. After a very
careful examination of a number of sections he felt we could exclude yellow fever.
I mention this for we may encounter similar situation again!
These and other matters I mentioned in my oration and finally I concluded
thus:
“Before I close, let me share with you another thought. Today, because of the
danger of dengue fever epidemics, we are advocating eradication of Aedes aegypti
mosquitoes from our midst. If we succeed, would we then lose the umbrella of
protection against yellow fever which we have today?
It might be argued that in that case the danger of the introduction of yellow
fever would also recede. It is, however, necessary to remember that we have also
A. albopictus and A. eittatus which are prevalent all over the country and can
transmit the infection. We had no occasion also, to examine the susceptibility of
other species of mosquitoes to yellow fever infection. Let us also not forget that
C. fatigans can also assume the role of a transmitter of infection even though it is
regarded as an inefficient vector. It is a well known epidemiological principle that,
under certain conditions, e.g., a high degree of viraemia in hosts, inefficiency in
transmission can be made up by its high density.”
“My friends, I have dared to share my thoughts with you today on a problem
which was always in my subconscious for many years. I have taken full advantage
of the privileges associated with the delivery of an oration and have dealt with it
philosophically. I have tried to be deliberately provocative to create an awareness
about it. We are now living in a shrinking world and what happens in our
backyard might be of frightful importance to many people in many lands. As one
distinguished public health philosopher said many years ago, “the price of health
is eternal vigilance!”
My World of Preventive Medicine 131
Introduction to preventive medicine (1924-1948)
The oration had its aftermath. In 1973 or thereabouts, the WHO and the ICMR
established a joint project in Delhi, known as the Genetic Control Unit, to deal with
the development of methods for the control of mosquitoes. The problem was of
importance in view of the emergence of malaria, exacerbation in the incidence of
filariasis, and the prevalence of haemorrhagic dengue fever in certain parts of the
country. The methods hitherto employed were found to be costly, cumbersome and
repetitive. At the same time the mosquitoes were getting resistant to conventional
insecticides in use. ‘The genetic control’ means the reduction or elimination
of methods and their replacement by a strain, genetically manipulated, which
cannot transmit the disease. Such mosquitoes, when released in an environment,
compete with local males to mate with local female mosquitoes, and thereby
sterilise them. Gradually the mosquito population dwindles because of the sterility
of the females.
While the objects of the unit were laudable, unfortunately the unit decided
to work with the Aedes aegypti mosquito which was involved in the transmission
of not only haemorrhagic dengue fever, but also of yellow fever. The activities
of the unit came under severe criticism in the press. Why did the unit not work
on mosquitoes responsible for the transmission of malaria or filariasis? Was the
unit really involved in developing methods for bacteriological warfare? In the
discussion in the press my views expressed in the oration were referred to. The
matter eventually came to the notice of the Public Accounts Committee in 1974. I
quote here the relevant extracts from the report of the Committee:
VIII
Aftermath of an Oration
In 1971 I was requested by the Maharashtra Government to deliver the first
Gharpure Memorial Oration. I chose as my subject “India and the Yellow Fever
Problem”. I took the opportunity of dealing with the subject comprehensively. It
is to be noted that, at the beginning of this century the then British Government
was seriously concerned about the grave health risks which the opening of the
Panama Canal exposed to the East. It is not generally known that the Government
of India had, as early as the second decade of the present century, a skeleton plan
ready to deal with the situation should the disease appear in the Country! The
conditions in India are particularly favourable for the spread of the disease should
the virus of yellow fever be introduced into the country. We have the mosquito,
Aedes aegypti, which transmits the infection. We have the monkeys which are
132 My World of Preventive Medicine
Introduction to preventive medicine (1924-1948)
particularly susceptible to the infection, viz. the rhesus monkeys. Indeed most
of the work on yellow fever virus had been carried out in laboratories abroad, on
rhesus monkeys imported from India; naturally the population is susceptible to
infection. Yet India has remained, so far, free from infection.
West Africa is the home of yellow fever. From there the infection spread to
America through the slave traffic. India did not have any sizable traffic by the sea
route from that region. On the other hand a few years ago when I visited Porbander
Port in the Gujarat State, I was told that there were over one thousand country
crafts licensed for trade with the East African ports. Surprisingly both the Gujarat
and Maharashtra Governments had no precise information on the routes which
these country crafts took to and from these regions. Fortunately the East African
region is comparatively free from yellow fever and the chances that the disease
might be conveyed by the sailing ships by that route are not very great.
In this connection I would like to relate an interesting finding. Most of the work
on yellow fever bad been done under the auspices of the Rockefeller Foundation.
It had undertaken immunity surveys in different countries to ascertain areas of
prevalence of antibodies to yellow fever virus. I had participated in such surveys.
Amongst the sera sent by me from localities round about my Institute in Guindy,
Madras, that from a class IV servant in the Institute showed the presence of
antibodies to yellow fever virus. He had never left his native village. How did he
develop these antibodies in his blood? However, in spite of such occasional findings
it is generally believed that the virus of yellow fever had not been introduced into
India.
However, we cannot afford to be complacent in the matter. Yellow fever has
appeared and then disappeared from certain regions in the world, and appeared
again in them. We had similar experience in India in 1963. Dengue fever and
chikungunya viruses produced epidemics of dengue fever with haemorrhagic
manifestations. The analogy is particularly interesting because of the involvement
of the same mosquito, the Aedes aegypti mosquito in them as well as in yellow
fever transmission.
Freedom of India from yellow fever has been the subject of much speculation
in the past. However, recent work on viruses transmitted by arthropods has
provided interesting evidence to explain the freedom of India, and indeed other
regions, from yellow fever. Of special significance to us are the so called group
B viruses, viz., the dengue, West Nile, Japanese encephalitis and Kyasanur forest
disease viruses which are present in India. These viruses show considerable
immunological overlap amongst themselves. In general terms it might be stated
that infection with one virus first will modify the response of the other. Sequence
of infection is the determining factor. Thus these viruses provide the so called
ecological barrier to prevent the introduction of the yellow fever virus into India.
My World of Preventive Medicine 133
Introduction to preventive medicine (1924-1948)
Even so, I had occasions to worry. I would like to relate an interesting episode.
At the annual meeting of the Indian Council of Medical Research in 1954 at
Nagpur, Dr Khanolkar confronted me with sections of liver from three patients
who had died with symptoms of fever and jaundice in the KEM Hopital in Bombay.
The sections showed typical pathology — diagnostic of yellow fever! Hence Dr
Khanolkar was worried and wanted my opinion. It must be remembered that
in countries where yellow fever had appeared after a lapse of many years, initial
diagnosis of an epidemic was often based on such autopsy findings. We were
faced with a dilemma. Should we or should we not officially declare these cases as
of yellow fever and face the consequences of such a decision? If these cases were
of yellow fever, we argued there would have been other cases as well—a beginning,
in fact, of an epidemic. Fortunately we had then amongst us Dr Harold Johnson of
the Rockefeller Foundation who had some experience in the matter. After a very
careful examination of a number of sections he felt we could exclude yellow fever.
I mention this for we may encounter similar situation again!
These and other matters I mentioned in my oration and finally I concluded
thus:
“Before I close, let me share with you another thought. Today, because of the
danger of dengue fever epidemics, we are advocating eradication of Aedes aegypti
mosquitoes from our midst. If we succeed, would we then lose the umbrella of
protection against yellow fever which we have today?
It might be argued that in that case the danger of the introduction of yellow
fever would also recede. It is, however, necessary to remember that we have also
A. albopictus and A. eittatus which are prevalent all over the country and can
transmit the infection. We had no occasion also, to examine the susceptibility of
other species of mosquitoes to yellow fever infection. Let us also not forget that
C. fatigans can also assume the role of a transmitter of infection even though it is
regarded as an inefficient vector. It is a well known epidemiological principle that,
under certain conditions, e.g., a high degree of viraemia in hosts, inefficiency in
transmission can be made up by its high density.”
“My friends, I have dared to share my thoughts with you today on a problem
which was always in my subconscious for many years. I have taken full advantage
of the privileges associated with the delivery of an oration and have dealt with it
philosophically. I have tried to be deliberately provocative to create an awareness
about it. We are now living in a shrinking world and what happens in our
backyard might be of frightful importance to many people in many lands. As one
distinguished public health philosopher said many years ago, “the price of health
is eternal vigilance!”
The oration had its aftermath. In 1973 or thereabouts, the WHO and the ICMR
established a joint project in Delhi, known as the Genetic Control Unit, to deal with
134 My World of Preventive Medicine
Introduction to preventive medicine (1924-1948)
the development of methods for the control of mosquitoes. The problem was of
importance in view of the emergence of malaria, exacerbation in the incidence of
filariasis, and the prevalence of haemorrhagic dengue fever in certain parts of the
country. The methods hitherto employed were found to be costly, cumbersome and
repetitive. At the same time the mosquitoes were getting resistant to conventional
insecticides in use. ‘The genetic control’ means the reduction or elimination
of methods and their replacement by a strain, genetically manipulated, which
cannot transmit the disease. Such mosquitoes, when released in an environment,
compete with local males to mate with local female mosquitoes, and thereby
sterilise them. Gradually the mosquito population dwindles because of the sterility
of the females.
While the objects of the unit were laudable, unfortunately the unit decided
to work with the Aedes aegypti mosquito which was involved in the transmission
of not only haemorrhagic dengue fever, but also of yellow fever. The activities
of the unit came under severe criticism in the press. Why did the unit not work
on mosquitoes responsible for the transmission of malaria or filariasis? Was the
unit really involved in developing methods for bacteriological warfare? In the
discussion in the press my views expressed in the oration were referred to. The
matter eventually came to the notice of the Public Accounts Committee in 1974. I
quote here the relevant extracts from the report of the Committee:
No. Para Ministry/ Conclusion/Recommendation Action
No. Deptt. taken
39 7.1.39 Ministry What causes even greater concern to the
of Committee, in regard to the experiments on
Health & Aedes aegypti, is the fact that the Ministry
FP of Health have shown utter disregard to the
(Deptt warnings of eminent authorities on yellow fever
of and on the dangers of eliminating dengue.
There is enough published evidence to show
Health) that dengue offers protection against the more
fatal yellow fever. In the first Gharpure Memorial
Oration held as early as May 1971, Dr C.G. Pandit
who is one of the foremost authorities on yellow
fever in the country, while discussing the causes
for the absence of yellow fever in India, had
raised the question whether we would lose the
‘umbrella of protection’ against yellow fever by
succeeding in eradicating dengue. Dr Pandit
had further stated that ‘previous exposure to
the dengue fever virus affords a varying degree
My World of Preventive Medicine 135
Introduction to preventive medicine (1924-1948)
of protection against Japanese B encephalitis,
Murray Valley encephalitis, St. Louis encephalitis
and probably against West Nile virus infections.’
Dr Pandit in other words, had warned that
eradication of Aedes aegypti might not
eradicate the vector of yellow fever but only
the beneficial dengue fever and once this
natural protection is lost, it is not unlikely that
other species of the Aedes family like Aedes
albopictus and Aedes vittatus might take up
the role of spreading the yellow fever virus. Dr
Pandit had also pointed out that, in the event
of eradication of Aedes aegypti even Culex
fatigans could assume the role of transmitter of
the infection.
40 7.1.40 Ministry The attention of the Committee has also been
of drawn by Shri Raghavan, Editor-in-Chief,
Health & Press Trust of India to even more authoritative
FP and important evidence on cross protection
offered by Dr Max Theiler, a Nobel laureate for
(Deptt his work on yellow fever, after exhaustive study
of in Carribbeans and Trinidad. According to Dr
Health) Theiler (Arthropod-borne viruses in vertebrates,
1973) there is experimental evidence to show
that dengue fever offers protection against
yellow fever. Dr Theiler observes: “The conclusion
is inevitable that all group B infections (dengue
belongs to group B) in man lead to the
development to a greater or lesser extent of
antibodies capable of neutralizing yellow fever”.
Dr Theiler further says: “It has been shown
conclusively that dengue immune sera have
the capacity of neutralizing yellow fever virus. It
has been shown that all human sera containing
group B antibodies from West Africa, Tanzania,
Malawi, Sudan, Egypt, India, Malaya and Hong
Kong are capable of neutralizing yellow fever
virus. It seems a general law that any group B
infection in man leads to the development of
antibodies capable of neutralizing yellow fever
virus.”
136 My World of Preventive Medicine
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