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me most was that even on return to Delhi, I was not given any explanation of what
had happened and why!
I must confess that after this experience I lost all interest in the project. The
project terminated in 1955, five years after it was initiated! We received the final
report then—a report of five or six pages describing the work for over five years! The
report, too, was not discussed at the formal meeting of the Advisory Committee on
filariasis. It was stated in the report, as a final conclusion:
“The results of five years observation showed that the three methods of
control were effective in some measure or other. Each one of them had its own
drawbacks also. It seemed that a multiple approach using all the three methods
was essential for the control of filariasis.”
Five years of work was presented in a report of six printed pages.
Was five years of work with all the planning and financial outlay involved in
the project, necessary to arrive at that conclusion? However, I did not make public
the experience I had gone through. The report was not ‘formally’ considered either
by the concerned Advisory Committee or the Scientific Advisory Board, though it
was included in the official report of the Board.
Soon after, the Ministry of Health, with the help of the Malaria Institute of
India decided to “initiate a programme for the control of bancroftian filariasis in
the country”. I was not involved in its planning or its execution. The objectives of
the programme were:
• To carry out filariasis surveys in different States of the country where
the problem was known to exist in order to determine the extent of
prevalence, types of infection and their vectors;
• To undertake large scale pilot studies to evaluate the known methods of
filariasis control in selected areas in different States; and
• To train professional and ancillary personnel required for the programme.
I could not help feeling that the programme was also the reca of the work
intended to be accomplished in Orissa! The programme was launched
in 1955-56.
After the termination of the programme, the Director General of Health
Services requested the Indian Council of Medical Research to assess the results of
the programme. A Committee under my Chairmanship was appointed in 1960 with
Dr T.B. Patel, Dr N.V. Bhaduri as members and Dr S.P. Ramakrishnan, the Director of
the Malaria Institute of India as Member-Secretary. In the assessment it was noted
that the filariasis problem in the country was far greater than envisaged previously,
that over sixty million people were now residing in filarial zones as compared to
about 25 million estimated previously and that the disease was spreading from
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urban to rural areas. It was also found that mass administration of the drug had
limitations and that none of the synthetic insecticides was capable of significantly
intercepting filariasis transmission. In the assessment it was noted that the
drug produced severe reactions in some of the healthy carriers of infection. The
measure thus became unpopular. However, antilarval measures were found useful
and this formed the basis of work in subsequent years. In addition, the Assessment
Committee also recommended reorganization of filariasis units with provision of
adequate technical and ancillary staff and equipment.
The programme had been in operation for nearly a decade, when the Ministry
of Health decided to have its assessment. The Ministry suggested to the ICMR
in 1970 that a “One man Committee” should be appointed for the purpose and I
was entrusted with the task. I then got an opportunity to renew my acquaintance
with the filariasis problem in the country. The terms of reference were indeed very
comprehensive. They included the following:
• To suggest streamlining the research work and training load, as well
as the contents of the various programmes of such training, as done at
filaria centres; and
• To suggest an integrated coordinated research set up for the participating
States.
In the final assessment of antilarval operations in different States, it was
concluded that the measures adopted gave fairly good results in 33 per cent of
the units established and in the rest the results were either indifferent or poor.
It was also noted that about 136 million people were now living in filarial zones
as compared with 64 million noted previously. This was because more areas
were surveyed during the period. Of these over 12 million were found to harbour
microfilariae in their blood and nearly 8 million had signs and symptoms of the
disease.
Taking into account the experience gained during the previous assessment
and the current one I made some specific recommendations on the strategy to
be adopted in future in the control of filariasis There were not, of course, any new
methods of control which had come to light. It was a matter, therefore, of applying
known knowledge, taking into consideration several aspects peculiar to each area.
It is not my purpose here to describe them in detail. My report was published by
the ICMR in 1971 as their technical report No. 10.
Smallpox and cholera
In 1958 there was considerable rise in the incidence of smallpox and cholera in
the country. The Ministry of Health advised the States to form expert committees
in their respective areas in order to take timely measures to combat the diseases.
The Ministry also asked the ICMR to form a central committee to examine the
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situation in detail and to evolve a plan, in consultation with the State Committees,
for a concerted action against smallpox and cholera.
I was Chairman of Central Committee. The Central Committee met in due
course along with the representatives of States Committees to finalise their
recommendations.
The task was not difficult. In vaccine lymph we had a potent remedy for the
prevention of smallpox. It had stood the test of time though in the early thirtees of
this century, we had a few anti-vaccinationists in the country, fed by propaganda
in UK! Cholera vaccine, however, could not be considered an ideal vaccine. In our
studies in Madras province, we had expressed the view that it gave protection for
about six months and that the immunity conferred by it trailed for a few months
more. Controlled field trials conducted later by the WHO in Calcutta indicated that
the protection offered by cholera vaccine is even much less than noted previously.
Nevertheless, it was found that it had a definite place as a good public health
measure to fight cholera epidemics. It was, therefore, obvious that for ensuring
success in the control of smallpox and cholera, lacunae, if any, in the effective
utilization of the public health measures had to be dealt with. This view was
strengthened by the fact that if we were to take into consideration the number
of primary and revaccinations done against smallpox there should have been a
considerable decrease in the incidence of smallpox in the country.
The Central Committee accordingly studied the existing legal provisions in
different States in respect of registration of births and deaths, provision regarding
primary and, revaccination, legal provision in force to fight epidemics of smallpox
and cholera and such other matters. It was soon evident that practices varied in
different States and because of reorganisation of States on linguistic basis, even in
different parts of the same State.
Taking into consideration all the relevant information available, at the joint
meeting of the Central Committee and representatives of States’ Committees,
some general and some specific recommendations were made for the prevention
and control of smallpox and cholera epidemics. It is not necessary to list all these
here. We, however, pointed out the urgent need for:
• Promulgating a Central Infectious Disease Act more or less on the same
lines as the Central Food Adulteration Act to ensure uniform procedures
all over the country in respect of control of smallpox and cholera.
• One authority in each State should be entrusted with the task of
enforcement of the legal provisions.
• The role of the Panchayats in the early detection and notification of cases
of infectious diseases.
• Formation of anti-epidemic committees at the district level, and finally
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• The establishment of epidemiological units in each State for a
continuous study of smallpox and cholera, to study the probable source
of infection and to exercise such vigilance as is necessary to bring to light
shortcomings, if any, in the organisation of the campaign against those
and other communicable diseases.
This assignment, as the chairman of the Central Committee was to be,
personally, very interesting, and as it turned out to be, very rewarding. From
the data furnished by the Director General of Health Services, I could study the
behaviour of cholera epidemics in general and particularly the epidemics of
cholera in 1958. I could prepare series of maps indicating week by week spread
of cholera from the endemic areas in the country. The role of the endemic foci of
the disease in the deltas of the Ganges, the Mahanadi, the Godavari, the Krishna
and the Cauvery rivers in the spread of cholera in India could be very well brought
about. The findings were described in detail in the report we had submitted. I will
not detail them here.
On retirement from the ICMR I had opportunities to study the cholera problem
again as the ‘Emeritus Scientist’ of the Council of Scientific and Industrial Research.
Since it was, so far as I am concerned, a continuous study of the epidemiology of
cholera in India, I prefer to describe it later in that section of this narrative.
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CHAPTER XVI
MUDALIAR COMMITTEE AND FAMILY
PLANNING
In June 1959, the Government of India in the Ministry of Health appointed a
Committee under the Chairmanship of Dr Laxamanaswamy Mudaliar to
review the developments that had taken place since the publication of the
report of the Bhore Committee and make recommendations for formulating the
health programmes in the light of its assessment. I was appointed a member of that
Committee. Initially, Dr K.C.K.E. Raja was the Member-Secretary. The Committee
performed its task in the usual manner, i.e. by appointing its own subcommittees
entrusted to visit different centres in the country, issuing questionnaires to
scientists and relevant organisations and holding its own meetings at different
centres in the country. My own role was primarily in the spheres of communicable
diseases and medical research.
It is not my intention to summarise here their recommendations in any detail
except to say that the Committee was mostly in agreement with the views I had
expressed in the Memoranda submitted to them. My contributions were primarily
in the fields of smallpox, cholera, filariasis, leprosy, plague and to a limited extent
in tuberculosis and other infectious diseases. Indeed the Committee had quoted
extensively from the report of the Committee appointed by the Ministry, of which
I was the Chairman, to make specific recommendation for the eradication of
cholera and smallpox.
The Committee also made many important recommendations in the
administrative set up of both the Ministry of Health and the office of the Director-
General of Health Services, and after reviewing the recommendations of the Bhore
Committee, made a strong plea for the constitution of the All India Health Service.
I was, however, disappointed in one respect. The Bhore Committee had
strongly recommended ‘integration’ of health services. The ‘integration’ was
achieved at in toto in certain States and not in others. I suggested Dr Raja that the
Committee should assess the effect of this change in the two types of States and
ascertain to what extent the concept of integration had influenced the working of
the Health Ministries in the States which had adopted it.It was probably realised
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that the assessment of this nature would not be easy. Dr Raja informed me that for
some reason, Dr Laxamanaswamy Mudaliar was not in favour of the suggestion.
Some members of the Committee were not enthusiastic about the
recommendations dealing with the “Population problem”. The Committee had
stressed, no doubt rightly, on the need for enunciating studies on demographic
problems and for studying the long-term effects sterilisation, as well as on the
need for ensuring adequate supply of contraceptives, etc. Some of us felt that the
recommendations, while sound as far as they went, were not adequate to meet
the situation resulting from population explosion. Dr Raja had prepared a note for
the consideration of the Committee. Five members of the Committee including
myself agreement with the note, while the others, including the President were
not in favour of it. When we insisted that the note should go as our `dissenting
minute’, or something of that sort, Dr Laxamanaswamy agreed that he would
have no objection so it was included as the views of the concerned five members.
Accordingly, in the Chapter on “Population” the note was printed as “Note by five
members of the Committee”. This was agreed to. I would like to quote it here
in full in order that some day the suggestions made therein could be debated.
One is happy at the thought that some suggestions have now been accepted and
implemented.
Note by five members of the committee
The following note contains certain views and further suggestions in regard
to the implementation of the Family Planning Programme recorded by
1. Dr K. C. K. E. Raja
2. Dr C. O. Karunakaran
3. Dr C. G. Pandit
4. Lieut. Gen. B. M. Rao
5. Lieut. Gen. B. Choudhury
Certain suggestions for accelerating the rate of spread of family planning
A realization of the urgency and magnitude of the population problem is
evident from the provision of Rs 27 Crores for family planning during the Third
Plan period and the recommendation of this Committee for augmenting the
strength of the Ministry of Health to promote a more rapid implementation
of the family planning programme. If the growth in population does not show
any significant downward trend during the next five years the introduction of
appropriate legislative and administrative measures will have to be considered,
in order to ensure a definite fall in the birth rate of the country. The following
suggestions appear to deserve consideration in this connection. Some of them
may be considered to be controversial and doubts may be expressed about the
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feasibility of their implementation. However, the population problem is of such
paramount importance to the country today that a discussion of matters relevant
to a possible reduction of the rate of growth should be stimulated as widely as
possible. These suggestions are put forward for the purpose of promoting such
discussion:
(a) A graded scale of taxation from the fourth confinement onwards
The possibility of introducing a graded scale of taxation from the fourth
confinement onwards should be seriously considered. This measure can prove
to be deterrent in view of the fact that every one, rich or poor, would be anxious to
avoid the payment of such a tax. The tax will be relatively small at the lower ranges
of family income and it will rise progressively with increases in the resources
of individual families. It may be objected that those who contribute most to
population growth are the people at low levels of family income, that their ability
to pay the suggested tax, unless it be a token amount, is doubtful and that the
imposition of this penalty on childbirth may result in such an inroad into their
meagre incomes as to reduce further the existing low standards of life of such
families. There is considerable force in these arguments, nevertheless, it would
obviously be wrong not to explore all avenues of action likely to lead to a reduction
of the birth rate. Moreover, the enforcement of this measure may be worked out
in practice in such a manner as to make it more easily bearable by the people, for
example:
• A mother with two healthy children may be forewarned that she would
be offered sterilisation on the termination of her third childbirth and that,
apart from the operation being offered to her free of charge, she would
be given a prescribed amount as honorarium for the performance of
what is deemed to be a national service.
It is only in the case of a woman who refuses to take advantage of this offer
that taxation of the family will be enforced from the fourth pregnancy onwards.
• The tax may be made payable in easy monthly instalments; when its
payment has to be enforced in the case of poor families, a level of income
should be prescribed for the purpose.
Suggestions regarding the specific amount, to be levied as taxes at different
levels of family income are being purposely avoided; nor is the question considered
here as to whether those at the lowest level of income should be exempted from
taxation and, if so, what that level, .should be; these are matters requiring careful
consideration after taking into account a variety of related factors; further, decision
on them can profitably be postponed until the question of acceptance of taxation
on the lines suggested above is decided.
It is considered that, even if the whole community cannot be included within
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the range of action of the proposed tax, a good deal will have been gained if a large
section of the people can be brought within its scope. It is justifiable to assume
that contraceptive practice, even under favourable circumstances, would not
have extended to every section of the community in any country and that the rate
of spread would be slow. There is sufficient evidence to show that, in a country
like England with a definitely higher level of family income and a wider spread
of general education among the people than in India—these are factors which
actively help to promote family planning—birth control started among the higher
strata of the community and reached gradually down to the lower strata and that
the period over which this spread-of contraception took place might have been
about 75 years. Further, it is doubtful whether, in England or in any other country,
the lowest level among the special classes would have taken to contraception in an
effective manner; it is this class that includes, by and large, the mentally retarded
and those who are improvident and are incapable of exercising any reasonable
measure of self-control. The fact that, for obvious and uncontrollable reasons,
certain sections of the people cannot fall in line with a national programme of
family planning is never advanced as a reason for giving up community effort to
spread contraceptive practice. Similarly, a programme of taxation designed to
discourage excessive childbearing should not be commended because it may not
be possible to extend its operation to all sections of the community.
(b) Removal of disadvantages regarding income tax in respect of unmarried
persons
Under the income tax rules a married individual has certain advantages
in respect of income slabs below Rs. 5,000/- these concessions extending to all
persons whose annual incomes do not exceed Rs. 20,000/-. An unmarried person
gets exemption from income tax only on the first Rs 1,000/- and on the balance
of Rs. 4,000/- he has to pay 3 per cent. In the case of a married person, the first
Rs. 3000/-, Rs. 3,300/- and Rs. 3,600/- are exempt from taxation according as the
individual has no child, a single child or more than one child. Thus, in the case of a
married person the 3 per cent tax becomes levied only on Rs. 2,000/-, Rs. 1,700/- or
Rs. 1,400/- as the case may be in relation to the number of children. At the lower
income ranges there is, therefore, some discrimination against bachelors and
spinsters in respect of income tax. While we recognise that the concessions given
to married persons with children have justification, it is for consideration whether
bachelors and spinsters should be penalised by being made to pay higher rates
of income tax; in fact, by remaining single they are making a contribution to the
solution of the population problem. It may not be unreasonable to equate them
with married persons with no children and to give them the benefit of exemption
for the first slab of Rs. 3,000/- in their incomes.
The problem is not insignificant in character in so far as the concessions now
in force relate-to persons with incomes of Rs. 20,000/- or less per year. This figure
would include all individuals with incomes of Rs. 1,666.67 per month or less. With
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a per capita income in the country of about Rs. 300/- per annum, it is obvious
that a large percentage of the people would be able to avail themselves of these
concessions. Of them, the majority are bound to be in the smaller income group
with Rs. 5,000/- or less per year. The campaign for family planning must direct itself
to the large section of the people which may also include an appreciable proportion
of unmarried persons. In their case a removal of the present concessions on the
lines suggested above would help to make these single persons feel that they are
not being discriminated against. This may have some psychological effect in the
all-out campaign for population control.
(c) Withdrawal of maternity benefit in the case of those refusing to accept
family limitation
The grant of maternity benefit to women employees in the services of
government and local bodies and of private schools and other institutions
receiving grants from public funds should be limited to the first three pregnancies
of each such employee. A withdrawal of this benefit from subsequent periods of
pregnancy and confinement will undoubtedly have some value as a deterrent.
(d) Limitation of certain free services rendered by the State to children
Free education and other benefits conferred by the State on children may
be limited to three children in each family. Some discrimination will have to be
exercised, however, in examining each such free service before it is excluded; some
may have to be retained and extended to all in the interests of national efficiency,
e.g. free midday meals.
(e) Increasing participation by employees of governments, local bodies and
aided institutions in the spread of family planning
Government servants, including the medical and public health staff, and all
those who are employed by local bodies and aided institutions, including teachers,
should be encouraged to take an increasing part in spreading the contraceptive
movement. They harm a body of educated persons, whose sense of responsibility
towards their own families and towards the community should be higher than
that of an ordinary member of the general public. It is, therefore, their duty to
participate actively in an educational campaign for the spread of family planning.
(f) Abortion for socio-economic reasons
The offer of public medical facilities for abortion has been shown to be an
effective method for bringing down the birth rate significantly within a short time.
Japan used this method successfully to cut down its birth rate by one-half (from
about 34 per 1,000 population to 17) in the course of a few years. Yet it is significant
to note that the health hazards faced by women, particularly young women, even
when the operation is done repeatedly by qualified medical men, are so great
that Japan would like to replace abortion as quickly as possible by contraceptive
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practice.
It is equally pertinent to refer to the experience of the Soviet Union. In that
country, in the wake of the Revolution of 1917, abortion was legalised and widely
practised. About 1936, the Soviet Government put a ban on abortion and later,
in 1955, removed this ban. It is understood that this removal was based on the
experience that, by withdrawing legality, abortion was not stopped but that
the practice went underground. Absence of legal sanction led to the operation
being done, in many cases, by those not medically competent to do it and the
consequences on the health of the women who were concerned was far from
satisfactory. Nevertheless, although the ban on abortion was withdrawn in 1955,
it is understood that informed opinion in Russia is anxious to seek a regulation of
family growth by the spread of contraceptive practice and that intensive research
is in progress to facilitate an expansion of that practice.
In India such evidence as is available, shows that an appreciable number of
abortions is taking place every year. It is likely that most of them are done by persons
with no medical competence to perform abortion and in the circumstances these
abortions are likely to cause harm to the health of the patients. How to tackle the
problem is a difficult question to answer. Even with a wide expansion of health
services in the country, if legal status is conferred on abortion only in respect of
the operation performed for reasons of health, the problem of ensuring that the
vast majority of cases of abortion taking place in the country would be performed
under conditions of proper medical care would remain largely unsolved. Can
abortion be legalised in India for socio-economic reasons, as has been done in
some other countries? We are aware that there are weighty reasons against such
legislation including strong religious and social reactions of an adverse nature.
Nevertheless, we believe that we are right in holding that a good deal of abortion
does not take place in the country under conditions which are wholly undesirable.
The problem requires serious study and an unbiased approach towards its solution
by governments and the people. We do not propose to go further in expressing
our opinion on the subject.
On one point we are clear in our minds. We are not prepared at present to
recommend large-scale abortion as a legalised measure to combat successfully
the population problem of the country.
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CHAPTER XVII
I ATTEND THE MEETING OF THE AMERICAN
PUBLIC HEALTH ASSOCIATION
From the title of this Chapter, it would appear that I was going to record some
interesting information on public health and allied subjects which were
scheduled to be discussed at the meeting of the experts in Atlantic city. The
meetings, of course, were both interesting and instructive. However, looking back
on the number of trips I had made to USA, this particular one, I must confess,
was the most enjoyable one for the reasons which, would be apparent from what
follows!
This was a special meeting of the Public Health Association and Dr Leona
Baumgartner, Commissioner of Health, New York City, was elected the President
for the year. Dr Baumgartner was a frequent visitor to India and I had met her on
several occasions in New Delhi. We had developed a mutual regard for each other.
She knew that I was awarded the “Padma Shri” by the Government of India for
whatever reasons the Government knew best. However, when I was awarded the
`Padma Bhushan’, just before I was due to retire, she had written to me to enquire
what I had to do more than what I had done previously to deserve the second
honour! I had no suitable reply to give and had lift the matter at that.
At the suggestion of the President, I believe, the Association had decided
to invite a few scientists from abroad to attend the special session. Accordingly,
I received the invitation from Dr Baumgartner to attend the sessions in Atlantic
city and contribute a paper on `Haemorrhagic fevers of South East Asia.’ This was
for obvious reasons. The Virus Research Centre of the ICMR in Poona had just then
elucidated the virus aetiology of the Kyasanur forest disease in the Mysore State
which had indeed, attracted worldwide attention. Dr Baumgartner also invited me
to be her guest while in New York. I readily accepted both these invitations.
In due course, I arrived at the Kennedy airport in New York very early in
the morning. As soon as the plane came to halt an officer of the Public Health
Department boarded the plane and called me by name. I knew somebody would
receive me at the airport, but I did not expect that somebody would come to the
plane itself! I was amused with the thought that other passengers might consider
that I was wanted for some offence!
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I was whisked away through the customs. This was also a new experience!
Just as I was getting into the car, my escort asked me : “Well Doctor, I have a
message for you from Dr Baumgartner. She would be rather busy this morning
and would not be able to get home till in the afternoon”. When I said that it would
be alright, he said, “What would you like to do till then?” When I said that I had no
plans, he asked,
“Would you like to do some sight seeing, Doctor?” Apparently he must have
thought this was my first visit to New York. However, I replied that I did not mind
doing a little sightseeing.
“Where would you like to go?”
“I do not know”, said I, “As a matter of fact I had been to most places. Well, can
we go to Coney Island? I could not go there the last time I was here. Is it on the
way.” “It does not matter, Doctor, we have ample time at our disposal.”
So we were on our way to Coney Island! On the way, after a while, my escort
again asked me: “Doctor, you have had no breakfast. I know a very nice place
which is famous for its hot dogs. Shall we go there and have some?” I said I did not
mind. The hot dogs were really good and it was refreshing to have a cup of coffee
also. After a little stroll on the sands of Coney Island, I suggested that we resume
our journey.
Just as we were driving, this time the chauffeur asked me whether I would like
to see his house. It was on the way, he said. He also said that he was very proud
of it.
“I am building it myself, Doctor”, he said. After that I had no heart to disappoint
him and I had all the time at my disposal. At his house we were received by his
wife. It was really a cosy little place.
“Let us have some beer, Doctor, just to celebrate”. To that I could not have any
objection and I was really impressed by the warmth of his hospitality. A little later,
I said that I would like to resume our journey since I was a bit tired after a long and
tiresome journey.
We reached home when it was almost half past twelve. I wanted to say “Good
bye” to my escort as I got down from the car but he said that he would see me to
my room. It was on the first floor. As we ascended the staircase, I noticed a note
on one of the steps. It was from Dr Leona, asking me to come to the office of the
Rockefeller Foundation where I was expected for lunch!
This gave me really a shock. I knew that even though I were to leave
immediately I would be late for lunch. However, I had no choice.’ I shaved, changed
into a new suit and left for the Foundation’s office. Fortunaiely my escort who was
waiting for me drove me there.
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They were all waiting for me at the office. As soon as they saw me I could
notice a feeling of relief on their faces. Then Dr Baumgartner exclaimed:
“Dr Pandit, where had you been? I telephoned to the airport and was told
that the plane had arrived in time. I was also told that somebody had also received
you. You were also not at home. We thought you had met with an accident and
so had put the police on the job. There was also no report from them. What had
happened to you? Where had you been?”
I gave my apologies profusely and then explained the whole situation—quite
in detail. They were amused. One of them said “So you went to Coney Island
straight from the airport?”
Thus ended my first day in New York.
Dr Leona Baumgartner was a perfect host and so was her husband. He was
at the time participating in an experiment on ‘Diet and heart disease’. Number of
persons had volunteered in this study. They had to follow a strict dietatic regime
and if for any reason, they had to deviate from it they had to keep accurate records
of what they ate and why. This, of course, meant tremendous self-control on
everything you did!
In due course we left for Atlantic city for the meetings of the Public Health
Association.
I contributed a paper on Haemorrhagic diseases of South East Asia. It was,
I believe, well received; at least I thought so. I was also interviewed by the Press
which is, of course, usual on such occasions. Surprisingly, in the issue of the ‘Time’
magazine of the week my name was mentioned. I had not seen it while in the
States, but my attention was drawn to it on my return to New Delhi. Dr E.M. Holmes
who was working then in the All India Institute of Medical Sciences had written to
my wife about my “doings” in the USA. I quote from his letter:
“As you have probably heard Dr Pandit’s papers were very well recorded at
the meeting, and his remarks to the Press were quoted in the State Department
Bulletin ‘Wireless’. I have already sent a copy to his office, so that he will have it
on his return. He has also been given a very nice write up in the Time magazine,
November 2nd issue (1959) which appeared on page 48”.
“Already I am receiving letters from the States telling me what a grand job he
did in strengthening Indo-American relations among the medical profession. You
know how Sarah and I admire him so much”.
I am sorry I do not recollect today what I said to the Press.
Atlantic city was built, primarily for holding conventions, which to my mind
is a major industry in the USA! There were numerous Conference Halls and
Committee Rooms, not in one building as in `Vigyan Bhavan’ in New Delhi but
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in several others. It was a pleasant pastime walking from one set of buildings to
another. The town thrived on the visitors. In the evening in the bar, I met several
friends both those who had been to India and others. One of the guests at one of
these ‘extra curricular activity’ was Hubert Humphray, the famous Senator!
After the meetings, I was invited to visit the Johns Hopkins School of Public
Health, Baltimore by Dr Stebins, the Dean of the School. The School was then
considering the question of sending a team of American scientists to work in
India along with Indian scientists on problems of mutual interest. According to
Dr Stebins, the deficiencies of American Medical personnel in so called ‘Tropical
Medicine’ were vividly brought out during the Second World War. The proposed
arrangements would, to a great extent, remedy that situation. It was also suggested
that from amongst the Indian scientists who would be associated with the project,
some could be considered for further training in the USA.
My advice was sought on the location of the project in India. The idea of
having foreign teams working in our institutions had gained currency at the time.
I was told that Dr Laxamanaswamy was considering inviting a team from Canada
to work in Madras and a team from Edinburgh was to work in the Medical School
in Baroda. There was really nothing new in the proposal, so far as I was concerned.
After some discussion on the available sites for the location of the project I
expressed the view that from the point of view of the Johns Hopkins, School of
Public Health, Calcutta, would be an ideal place for the location of the project
particularly in association with the School of Tropical Medicine. The proximity of
the All-India School of Hygiene and Public Health there would be an additional
advantage. I, however, made it clear that the project must be cleared with the
Government of India, through the Ministry of Health, and that the ICMR would not
be involved in any way. The proposal eventually came through.
I may, as well, refer to the work, of this unit, at least, in the initial stages of
its work. The unit at the Tropical School had decide to, work on cholera. The
patients in the infectious diseases hospital in Calcutta were continuously under
investigation for twenty four hours. One team working for eight hours was entirely
composed of staff of the School of Tropical Medicine. I mention this to indicate how
the investigation was conducted jointly by both the American and School teams.
Whenever I visited Calcutta, I took the opportunity of acquainting myself with the
progress of these investigations. With the evidence the team had produced, they
could postulate that “no case of cholera need die if treated within twenty hours of
the onset of first symptoms!”
The impact of this activity was felt in the working of other departments of
the School also, as its Director, Dr R.N. Choudhury told me, “Example is better than
precept”. Indeed Dr Choudhury also told me that he had noticed similar reaction
when a foreign ‘scientist’ was working in the department of Pharmacology a few
years before. I wondered whether we must always have these outside stimuli to
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spur us into activity or to rouse us from the routine slumber so evident at other
times?
I learnt later that the whole project based on joint endeavour of the participants
got into bad repute for reasons I was not fully conversant!
While in Baltimore, I received a telegram from Dr Leona Baumgartner. It
informed me that tickets were booked for the play “My Fair Lady” and that I should
arrive in New York in time to attend it. This play was going on in New York for over
five years now and still there was a scramble for seats. Tickets had to be booked
well in advance, at least a few months ahead! Of course, I arrived in New York in
time to attend the play. Dr Baumgartner was however, busy that day and Mrs. Dick
Anderson accompanied me to the theatre. I was surprised to find our seats in the
fourth row! Needless to say, I enjoyed the play immensely. The cast was the original
one with Rex Harrison and others. We talked about it the next day at the breakfast
table especially about the musical numbers!
Couple of days later I left New York for New Delhi. My plane was scheduled
to take off at about 9 PM. As I was about to get into the car for the airport,
Dr Baumgartner while bidding goodbye, said,
“Dr Pandit, this time I am not going to take any risk. No journey to Coney
Island, if you please. The officer here will accompany you to the airport and he
has instructions to see that you are actually in the plane”.
I thanked her profusely for the good time I had. However, when I occupied
my seat in the plane, I found on my seat, the record of the music of ‘My Fair Lady’.
Whenever I play that record I am reminded of that trip. Thus ended what I had
always considered a most enjoyable trip to the USA!
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CHAPTER XVIII
ESTABLISHMENT OF THE INDIAN NATIONAL
ACADEMY OF MEDICAL SCIENCES
At the outset I must state that I had nothing to do with the formation of
the Indian Academy of Medical Sciences. I came to know about it when
Col. Sangham Lal walked into my office one morning and wanted my help
in selecting a few representatives of various disciplines in medical sciences who
could be considered suitable for nomination of founder fellows of the Academy. He
gave me a few details regarding the genesis of the Academy. It would appear that
the matter was under consideration for a long time, and a group in Bombay and
one in Delhi were vying with each other to take the first step for its registration.
The Delhi group succeeded in registering it first there and the Academy was a fait
accompli.
After some general discussion, and from the list of members of the ICMR
Advisory Committees, we were able to prepare a list of hundred medical men, both
scientists and professors working in medical colleges, who could be considered
suitable as “Founding Fellows” of the Academy.
I was told afterwards that Col. Amirchand was not in favour of having such a
large number of founder fellows and ultimately he resigned from the Academy. I
was asked to persuade him to change his mind. I did not succeed. Here I must pay
my tribute to Col. Amirchand. I had full admiration for his views, his integrity, and,
of course, for his professional ability. He was respected by all, his students as well
as his colleagues. It was after discussion with me that he agreed to donate enough
funds to the ICMR for the award of prizes to young research workers and a prize for
a senior research worker, i.e. one above forty years of age. Again, at my suggestion
he donated money to the library of the All India Institute of Medical Sciences.
Then came the day of the inauguration of the Academy. Dr V.R. Khanolkar was
to be its first President. Prime Minister Pandit Nehru had agreed to preside. Just
two days before meeting Col. SanghamLal came to see me. He looked very much
agitated.
He exclaimed that he had received no intimation from Dr Khanolkar whether
he was coming or not, and that he had also not sent a copy of his inaugural address.
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Col. Amir Chand 303
He graciously donated to the council sum of Rs. 50,000
in 1953 and named two Prizes ‘Basanti Devi Amir Chand
Prize’ & ‘Shakuntala Amir Chand Prize’My World of Preventive Medicine
Planning for the Future (1948-1965)
Since it was likely that he would not be coming, he requested me to come to his
rescue’ and agree to deliver the inaugural address! I was rather hesitant to agree
to his request. At the time the Advisory Committees of the Council were meeting
in New Delhi and I was busy attending these. I had no time to devote to any other
assignment and in any case the time was too short to do anything worthwhile!
Col. Sangham Lal, however, would not take `No’ for an answer and he left. I was
saddled with the responsibility of delivering the inaugural address!
Then an idea struck me. At the meeting of the Indian Association of
Pathologists in Mysore, I had decided to give my presidential address with the
caption, “No More Frontiers”. Dr Ramalingaswami who was working in the ICMR
then had helped me in preparing it. Indeed, it was greatly his effort. The address
was delivered but nobody could hear it as the microphone arrangements had
failed. It was also not published. I decided to utilize it, with suitable modifications
of course, in preparing my address to the Academy. I immediately telephoned to
Dr Ramalingaswami, who was then working in the All India Institute of Medical
Sciences. We discussed what modifications were necessary to present the views
suitable to the occasion. Dr Ramalingaswami did a marvellous job. I would like to
produce it here.
“Mr. Prime Minister, Ladies and Gentlemen,
In the unavoidable absence of the President of the Academy, Dr Khanolkar,
the task of delivering the Presidential Address at this inaugural function has
fallen upon my shoulders. While I deeply appreciate the honour that has been
bestowed upon me, I am equally conscious of my shortcomings. On this inaugural
day, are assembled here teachers of medicine, medical research workers, persons
concerned with the promotion of public health and workers derived from ancillary
medical disciplines. Each one of us represents one or the other of the innumerable
specialities into which medicine is being increasingly fragmented today. Some of
us are Physicians, some Surgeons, some Anatomists, Physiologists, Biochemists,
Pathologists, Microbiologists, Geneticists, Orthopaedists and so on. What is it
that binds us all together? The reason for the formation of this Academy, I should
like to think, is that there is an essential unity of purpose in all the work that we do.
It is this unity of purpose which is a reflection of the cohesiveness of medicine that
I want to discuss further on this occasion.
I would like to define our purpose as the acquisition of knowledge and its
application to human needs. Both these endeavours imply the inter-dependence
of the various specialities of medicine and public health, however separate and
compartmental they may look. We are interested not only in the divergent forces
at work in producing disease patterns but also in the beginnings and modes
of progression of such forces. In looking for origins of disease, we must project
our minds far beyond the confines of our hospitals and laboratories, out into the
community and even across the national boundaries into the world at large. We
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have to keep shifting our emphasis on diseases in line with the changes in the
morbidity patterns of the community. Again, in looking for early signs of disease,
we have to refine our methods of study and draw upon the techniques of physics,
chemistry, physiology and biology in an increasing measure. Medicine has
become increasingly dependent upon fundamental and basic sciences. In fact,
it is regarded today as the biggest parasite on branches of natural and biological
sciences outside medicine itself. The natural sciences, the social sciences and the
humanities have made and are continuing to make important contributions to the
progress of medicine. It is not simply enough to utilize the most recent advances in
physics and chemistry for the solution of medical problems. Biology and medicine
have a larger and wider pattern to interpret because living matter is so much more
complicated. We need ways of examining and marshalling the facts of biological
sciences and, in interpreting biological activity, we have to deal with the interaction
of the environment on the organism. We need to understand, as Lord Adrian has
said, “How society is organized and how to live together. We require a great deal
of observation and experiment in social sciences. In medicine, we are learning to
plan experiments so that the result is not too greatly changed by the presence of
the observer”. In brief, my thesis is that, for the progress of medicine and for its
application to human needs, which is the purpose of this Academy, there are no
more frontiers within and no more frontiers in between.
Medical science is a synthesis of all those disciplines that have as their ultimate
aim the health of man. A discovery in one field may spark a new pathway in another,
and equally the lagging behind of any one branch may affect the progress of the
other. It is, therefore, essential for the progress of medicine to break the traditional
divisions which have become a necessary evil in the course of the growth of medical
knowledge and to once again regroup the intellectual relationships of the various
specialities of medicine. This would in its wake bring about a free communication
of ideas and knowledge between the specialists in many branches of medicine.
The formation of this Academy represents to my, thinking, a recognition of, this
fundamental need of free and frequent intercommunication.
The fluidity of the frontiers of medicine is best illustrated by reference to an
event that occurs as a routine, say, in a department of pathology and bacteriology.
Having worked in such a department, I am sure you will understand my partiality
to this medical discipline. A specimen of brain tissue is received and sections show
evidence of damage to nerve cells, proliferation of glial tissue and perivascular
cuffing, features which point to a diagnosis of inflammation of the brain, what we
designate as encephalitis. In view of the symptoms noted by the clinician, virus
etiology is suspected and this is confirmed in due course. My contention is that
the work of the Pathologist does not stop with making this diagnosis, although
by doing so, he might have discharged his formal obligations to his institution.
He has to set his mind thinking on a journey that might take him far beyond the
confines of his laboratory, his community or even his country. He will first ask the
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question, what virus is responsible for the infection? Is the virus endemic there? If
so, how does it manage to survive? How did it reach the community, what factors
influenced its spread, and, if it proves to be one of the viruses transmitted by the
bite of an insect, then the whole chain of inter-related events has to be visualised in
a complicated cycle of man, insect and animal reservoir. In other words, in studying
that single section of brain tissue, the Pathologist comes face to face with clinical
medicine, with epidemiology and even with factors such as climate, geography,
rainfall, the type of afforestation in an area, the ecology of animals and birds and
so on. The community is a large laboratory where nature makes her experiment.
It is from where the patient comes and to where the patient returns, that is to say,
if he is lucky. A review of the present state of knowledge regarding virus diseases
transmitted by insects, particularly of knowledge recently gathered in this country
on the new virus disease in Mysore State, demonstrates clearly the rich harvest
medicine has reaped as a result of the ability of scientists and doctors looking,
beyond the confines of their disciplines and even national boundaries to work
together in a spirit of cooperation. The story of yellow fever is yet another example
wherein the elucidation of the whole disease and the success in delimiting it are
the results of a global effort and coordination.
I have so far indicated how pathology, microbiology, epidemiology and clinical
medicine are inseparable, even when you think of single disease entity. Similarly,
biochemistry today is profoundly influencing our concepts not only of disease,
but also of our understanding of the mechanisms underlying a variety of other
biological processes, inheritance, human behaviour and the like. Many of the
mental illness are being traced to hormonal and biochemical changes. Scientists
are now talking in terms of distorted thoughts being the result of distorted
molecules.
Going beyond the murals of a medical college I could take any traditional
discipline of a university, apparently unrelated to medicine to show how important
an association with such discipline is for the progress of medicine itself. For
example, studies in zoology have contributed to the understanding of a cell as
a unit and its functions. Studies on fruit flies elucidated the of chromosomes
in the transmission of genetic characters. Quest for medicinal plants led to the
development of botany as a science, while the studies on plant biology led to the
understanding of protoplasmic structure, metabolic processes, respiration and
enzyme action. I need hardly refer to the numerous drugs and potent therapeutic
agents like antibiotics which have come out as a result of a systematic study of
herbs, moulds and the like. Thus “botany, zoology and medicine exert a reciprocal
influence in our common search for the metabolic mechanisms, whether in plant
or animal tissues, that will explain the maintenance of the living state”. Physics and
chemistry have become an essential core of medicine and it is needless to dilate
on their role.
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I think I have said enough to indicate that the non-medical and basic science
departments of universities form, the advancing front of medicine. I would
very humbly suggest that there is a need for a careful evaluation of the type of
association that now exists between these disciplines in a medical college and
between the medical college and the university. It is obvious that there is need
for greater collaboration between the concerned disciplines and this is possible
through the sincere application of that greatest ideal and attribute of mankind,
namely, the ability to work together in a common endeavour.
While this is all true, there are other important factors which influence the
progress of medicine. They are the availability of men of genius and a proper
environment in which they can unfold their talent. Szent-Gyorgyi, the Nobel
Laureate, expressed it correctly when he said that human progress has been due
in the past to a large extent to the work of a relatively small number of creative
minds and it is likely that this will also be true in the future. It is perhaps true to
say that the fate of any nation depends on the extent to which it is able to produce
creative brains. Creative geniuses exist in all countries, and at all times, but many
of them, as he stated, are wasted. For the development of a genius a favourable
environment is necessary. Men of genius are not lacking in this country, but
I wonder whether we have the proper environment assured for them. All of us
are aware that many a young scientist leave our shores to seek a scientific career
elsewhere, not necessarily because of inadequate emoluments, but because of lack
of facilities, opportunities and a suitable intellectual atmosphere. The example of
late Yellapragada Subbarao, is an outstanding one. To be creative as we all know, a
scientist needs new conceptions, new tools, encouragement and a proper climate
for research. Few men can give their best, if they are set to work in an environment
which is either indifferent or discouraging to their efforts. It is, therefore, essential
that for the progress of knowledge and for the discovery of new facts all possible
handicaps are removed.
I would like to conclude this Address by reverting to the beginning of
this discussion, namely, the twin purposes of the Academy-the promotion of
knowledge and the application of knowledge to human needs. In fulfilling these
objectives, I have outlined the need for bringing about a greater collaboration
between universities, medical schools and research institutions, because teaching
and research cannot be separated from one another. I have also stressed the
importance of discovering men of genius, encouraging the creativity of individual
scientists and providing them with equipment and intellectual environment for
fruitful and productive activities. It is my hope that the formation of this Academy
will go a long way towards the fulfilment of these objectives. We have in a way the
great fortune of starting this Academy, unfettered by traditions, free to develop in
a climate where there is so much of constructive and nation building activity going
on all around us”.
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I was the recipient of many congratulations after the meeting and later in the
evening at the reception organised by the WHO.
This episode illustrates what one can achieve when one has dependable
colleagues to work with!
In due course I was elected the President of the Academy.
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CHAPTER XIX
CONCEPT OF AN INSTITUTE FOR MEDICAL
RESEARCH
Prior to retirement from the Council Dr Sushila Nayyar, then the Minister of
Health, had asked me to give her a note on the establishment of a research
institute under the auspices of the Council, for furtherance of medical
research in the country. I produce the note here in order to indicate the manner in
which my mind was working then. While my first task on assuming the directorship
of the Council was to promote research in medical colleges, I had felt that what
was done was only the first step in that direction. It is a truism that research has to
be built around men of proved merit and ability. The formation of a research cadre
was also a step in that direction. It is also equally necessary to provide them with
facilities and create a climate for research in which they can prosper. The scheme
outlined in the note was expected to achieve those objectives. Whether the views
expressed in the note in 1965 are valid today or not, I leave others to judge.
The Indian Council of Medical Research is endeavoring to stimulate medical
research in the country and particularly in the medical colleges by a variety of means.
Apart from giving grants-in-aid to approved scheme submitted by workers from
medical Institutions, the Council has helped in the furtherance of research through
the awards of fellowships of different categories, the creation of semi-permanent
“research units” around approved workers and, since recently, by advocating the
establishment of “research cells” in selected medical colleges. There is obviously a
need to assess these efforts critically, at all levels, and to formulate plans for future
development in terms of the experiences gained and the changing needs.
Bearing in mind some of the above considerations, the Council has prepared a
plan for the development of medical research during the ensuing Fourth Five Year
Plan. It is necessary, however, to look well ahead into the future and anticipate the
needs of medical research as well as that of medical research workers in the country
and to formulate long term plans in order to promote a balanced development of
research in all the fields of clinical and non-clinical medical sciences.
With these objectives in view, it is felt that the time is propitious for the Council
to reconsider its policies, especially with regard to the establishment of a Central
Medical Research Institute under its auspices.
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Genesis
The idea of establishing a research institute for carrying out fundamental
research in medical sciences under the aegis of the Council had been mooted
from time to time. In fact, during the year 1959 the subject was discussed in great
detail as to the desirability of establishment of such an Institute during the course
of Third Five Year Plan. While it was generally agreed that there was a need to
increase the tempo of medical research in the country, there were two major
schools of thought. One felt that the time was opportune for the establishment of
an institute for fundamental medical research at a central place, with a number of
subsidiary research cells located all over India in the universities, medical colleges,
research institutes and other institutions already devoted to fundamental work.
The other school of thought felt that the time was not ripe for the establishment of
such an institute due to the acute scarcity of trained leaders in the field of medical
research. This school of thought also felt that in view of the vast and comprehensive
nature of current medical research, it might not be feasible to cover it adequately
in any single institute. On the other hand, it was suggested that it would be
desirable to make substantial grants to the existing research workers and units,
operating in several medical colleges. It was pointed out that special emphasis
should be bestowed on the development of specialized “schools of thought” to
tackle specific problems in various branches of medical sciences.
The present situation
Unlike the problem facing the country about a decade ago, there is, at
present, a large body of Indian nationals highly trained in specialized techniques
in foreign laboratories, who do not find adequate openings for carrying out their
researches in India. As a consequence, an increasing proportion of Indian scientists
who go abroad for training, is lost to the country. From the impressions gained by
discussions with such workers, administrators and government agencies, it would
appear that several factors are responsible for this great waste of highly trained
man-power. There are not enough vacancies in the established institutes in the
country wherein the trained workers can be absorbed and fitted in accordance
with their specialized training to enable them to put to best use their rich
experience. Moreover, many of these workers are apprehensive that they may not
get adequate facilities for carrying out their work, if they were to join some state or
central institute. Thirdly, there are personal or interpersonal problems which seem
to dishearten the prospective returnees to accept suitable openings in India. Many
of these trained scientists who spend years of active work in foreign laboratories will
be of different ages. This creates embarrassing problems of absorbing them in the
existing institutes, especially of fitting them in the prevailing hierarchy of Directors,
Assistant Directors, Senior Research Officers, etc.
Some of the above problems have already received the attention of the
Government of India. In fact, the CSIR Pool for returning scientists was constituted
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to meet some of the above mentioned problems to cater to the needs of all types
of scientists including medical men. While the “Pool” seems to be satisfactory
to a great extent, there appear to be many practical difficulties in its -working,
vis-a-vis medical scientists. Quite often there are considerable difficulties in the
matter of obtaining suitable placements. Even after crossing these hurdles and
getting into a proper place, with adequate facilities to carry out their own work, the
sword of Democles in the form of a continued insecurity, and the need to search or
a more permanent assignment are potent psychological factors which deter the
returning scientists from settling down in the country. An analysis of the present-
day situation leaves no doubt that many of these problems must be tackled in such
a way that we can resurrect the large amount of technical man-power. It would
thus appear that the early hesitations about the dearth of trained workers for the
constitution of a Central Medical Research Institute no longer operate. So far, the
paucity of funds has been the second major reservation in going ahead with a big
central institute for medical research. Fortunately, the need and the urgency of
allocating more and more funds for research in science, including medicine, has
come to be felt, particularly in the wake of national emergency.
There is also a need to enlarge the scope of the proposed permanent research
cadre of the ICMR to attract an increasingly large number of medical research
workers who may like to work either in the permanent laboratories of the Council,
its research units, research cells, etc. or on terms comparable to corresponding
teaching and research jobs in the universities and medical colleges and the Council
of Scientific and Industrial Research. Only then, it will be possible to attract and retain
the potential workers for sufficiently long periods of time, for the pursuit of basic
problems, unhampered by the consideration of emoluments, security of service,
facilities for the conduct of research and opportunities to engage themselves in
undergraduate and post-graduate medical teaching.
It is to be appreciated that the problems of medical research workers in
different disciplines somewhat vary from that of research workers in other branches
of science, specially when it comes to satisfying the needs and requirements of
clinical workers, viz., access of hospital patients, etc. No policy and programme
for medical research will succeed unless opportunities are created for a large
number of clinical workers to engage themselves in original scientific research
without detriment to their other professional interests. In this connection, it is
worth mentioning that even in the West there is a radical change in the erstwhile
notions that clinical research should of necessity be carried out in large institutes,
like the NIH or MRC laboratories at Mill Hill. The swing of the pendulum is to the
other end, in that clinical (and even non-clinical) research can be conducted more
gainfully in smaller units attached to institutions with a not-too-heavy clinical
work or undergraduate teaching load. Such a programme would be somewhat
comparable to the MRC research units located in suitable teaching or technical
institutions, more or less on a permanent basis.
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Taking into account the scope and feasibility in the country for research, there
is an urgent need to increase the opportunities for carrying out fundamental
medical research. In this context it is worth recalling the sentiments expressed by
the Chairman in her inaugural address at the Annual Conference of the Council
this year. “While the idea of establishing Medical Research Institute has often
been mooted, we are crystallizing our own ideas on the scope and functions
of the organizational set up of this Institution. Based on the experience of the
more progressive laboratories in the world, which endeavour to attract and,
accommodate independent original thinkers, it is considered desirable to steer
clear of the principle of administrative hierarchy amongst scientific workers. The
new Institute of any concept is a loosely bound communion of small laboratories
to serve the need of working scientists. It would be something comparable to
a monastic order where enlightened souls will flock to ponder and ruminate on
nature’s truths. It is not my intention to give myself to academic speculations,
but to create an atmosphere favourable for the return and rehabilitation of the
increasingly large number of scientists who are forsaking Indian laboratories every
year in favour of comparatively more affluent circumstances elsewhere. It behaves
us to give serious thought to this perennial drain of highly specialized scientists.”
The basic concept of the proposed institute
Thus the time is considered to be opportune for re-examining the plans to
enlarge the facilities for medical research in the country, not in lieu of, but in addition
to what is already being done. The following tentative plan for the establishment
of a new institute for medical research is outlined to stimulate further discussions
and guidance by the Scientific Advisory Board and the Governing Body of the
Council. It is only meant to serve the purpose of a working hypothesis.
In keeping with the objectives and expectations of the proposed Institute, it
might be desirable to establish it on a flexible pattern of decentralization in all
its aspects without administrative hierarchy. Essentially the new institute should
consist of an agglomeration of small self-contained laboratories to meet the needs
of highly trained senior working scientists. It would thus be possible for such an
Institute to develop simultaneously on two main lines. Some of the laboratories
could be grouped together in one place or a “central institute” and its constituent
“research wings” located in as many medical colleges as possible. The subdivision
is purely arbitrary and every effort should be made to encourage interchange of
workers between the two main subdivisions of the Medical Research Institute. It
is even suggested that this to and fro exchange of workers might extend to the
existing ICMR research units and research cells, which may in course of time
become amalgamated with the corresponding “research wing” of the college.
Scope and functions of the new medical research institute
Decentralization of the proposed institute and the distribution of its
constituent units in an increasingly large number of medical colleges has many
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advantages. The diversified growth in a centrifugal and centripetal manner will
allow for a greater investment on men and equipment rather than on brick and
mortar.
A. Central research wing
The central group of laboratories of the Institute can concentrate on the selected
fields of basic medical sciences. While there will not be any watertight departments,
an attempt should be made to attract an increasingly large number of workers
in several disciplines which have not received sufficient attention in the country.
Thus, it may be desirable to impose certain restrictions on the excessive influx of
workers from any particular discipline who may happen to be numerically large. On
the contrary, an all-out effort should be made to attract people like biophysicists,
electron microscopists, specialists in tissue culture, bioengineering, etc.
It is anticipated that in the next few decades the greatest advances in the
field of medicine can be expected from newer disciplines and newer techniques
aimed at unravelling the secrets of molecular biology in health and disease. The
pace at which present-day biology is progressing, is bound to have its impact on
the promotion of health. It might be worthwhile for the Council to initiate greater
interest in these newer fields of medical research. It is well recognized that as far as
India is concerned, development on some of these lines has been very limited. In
the context of the present stage of knowledge and expanding frontiers in the field
of biology and biophysics, there is a need for tapping all our resources of trained
workers in these fields. While it is premature to envisage what type and what
number of scientists would be returning, it is considered that adequate provision
should be made to welcome at least 50 or 60 highly trained scientists to set up
their own small laboratories and work in the proposed central institute.
With regard to the location of the central research wing of the Institute, judging
from the past experience of many of the problems faced by the existing research
institutes it should neither be located in very crowded metropolitan cities and provincial
capitals with multifarious distractions, nor is it desirable to locate the Institute in some
isolated hill station where opportunities for the exchange of intellectual ideas are
very limited. Moreover, the latter creates problems of physical rehabilitation of the
scientists, such as living conditions, education of the children, etc.
Therefore, it is proposed that there is a need for re-thinking of this vital
question of a suitable location of the central research wing of the medical research
institute in the country. As a departure from the past, it is suggested that this
research institute should be located in a medium-sized town which can be either
a district or a taluk headquarters, and which is near to a university, undergraduate
or postgraduate teaching medical institution. Against the background of
developments in the country during the last two decades, it should not be difficult
to choose a suitable place on the above lines.
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B. Peripheral research wings
It is fully appreciated that the mere establishment of a Unitary Medical
Research Institute as outlined above may not satisfy all the requirements, nor
mop up all the available talent. Firstly, it will take sometime for such an institute
to get into full stride and cater to the needs of all the workers who await to be
absorbed in appropriate research openings. Secondly, there is an equally urgent
need to develop a number of peripheral centres of activity in the country within
the proximity of medical colleges.
As already pointed out these “peripheral research wings” of medical research
institute can concentrate on the several problems of clinical research and research
in social and preventive medicine. Such a development will have also salutory effect
upon the growth and research in a large number of medical colleges which alone
can solve the numerous problems facing the country. Therefore, it is suggested
that the main institute can extend its activities in a number of peripheral centres
in the country by having its peripheral research wings located in as many medical
colleges as possible. These research wings will be diminutive forms of the central
research wing. For the purpose of administrative convenience, the peripheral
research wings can be started initially in close proximity with the “research
units” and “research cells” of the Council, although this may not be obligatory.
Such a decentralization has many advantages. These future research wings will
act as buffers between medical colleges and ICMR research cadre, by offering
opportunities to scientists from any particular part of the country to look forward
to a peaceful atmosphere of work in one’s own place without going through the
routine hurdles of employment. The peripheral research wings will usually consist
of two or more experienced research workers who will work as members of the
permanent research-cadre of the ICMR with appropriate emoluments and with
all the necessary facilities for carrying out their work under conditions comparable
to those outlined in case of the central research wing of the Medical Research
Institute. They will be located in a near about medical college or institution which
will ensure a cooperative effort between them and medical colleges. For all other
purposes, the Council is to be responsible for the maintenance of these research
wings. The officers of the peripheral research wings will be directly under the
administrative jurisdiction of the Council. It will be incumbent on the host medical
institution to render all the necessary cooperation, especially for the conduct of
clinical investigations and also by providing physical accommodation.
In places where ICMR research units or research cells are already in existence, a
greater degree of administrative integration may be considered. As far as possible,
encouragement should be given for mutual exchange of personnel from the ICMR
research cells, research units and research wings on the one hand and the host
medical institution on the other. Depending upon the particular necessity of the
working scientists, he should be associated with the teaching programme of the
medical institution at the undergraduate and particularly at the postgraduate level.
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Although it is not possible to draw any hard and fast rules regarding the
number and location of the peripheral research wings, judged from the pattern of
research activity in the country, there is scope for establishing 10-12 research wings
during the next 10 years. Independent of the location or otherwise of a research
wing, individual research workers belonging to the ICMR research cadre and/or
the medical research institute, should be encouraged to explant themselves in any
medical college of their choice to carry out specific programme of work on the
analogy of the old medical research department. To ensure that they are readily
welcomed by the concerned department of the medical college, a generous grant
of six to seven thousand rupees per annum towards contingency expenses may
be provided for each worker. It would appear that quite often the lack of adequate
financial support to a pool officer and the consequent drain on departmental
resources tend to inhibit the scope for useful work. It has to be remebered that in
the long run undue polarization of research workers away from teaching medical
institutions is not desirable. In fact, there is a need for periodical review and re-
adjustment of conditions of service, so as to promote a dynamic equilibrium of
workers between the ICMR research cadre and the medical institutions in the
country and vice versa.
Organization of the proposed medical research institute
Obviously the central and peripheral wings of the proposed institute will
have to develop on a common pattern with regard to the service conditions of
research workers, their pay scales, opportunities for promotion, scope for carrying
out independent scientific work and freedom to migrate to teaching and research
assignments in medical colleges.
Recruitment
It might be desirable to constitute an elastic pay structure with two or three
main grades, depending on the age, qualifications, experience and promise
of original research. Contrary to the usual procedures for employment, the
onus of working out the pay at the time of the initial recruitment will be on the
investigator, which will be evaluated and ratified by a Committee of competent
scientists. Recruitment will be as far as possible, on the basis of the applicant’s
worth rather than finding an easily available man to fill a specific post. The
initial appointment shall be on a contract basis for a period of five years, when
his work will be evaluated for purposes of promotion in the same or to the next
higher grade for which the scientist might naturally aspire. There seems to be a
need to set up a permanent Board of Experts which meets annually to review the
records of all the new entrants and also ensures a quinquennial evaluation of all
the erstwhile workers who are eligible for review during the year. If at the end of
five years, a worker has not done the grade expected of him as an independent
worker, he can be transferred to one of the suitable ICMR research units, cells or
wings, where he will continue to work on the same scale but as a member of a
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larger team. Thus, while providing extra inducements for the growth of individual
initiative and enterprises, care is taken to see that the services of all those who are
adequately trained are not wasted and that they are tapped for appropriate team
investigations. It is suggested that in this institute there will be no administrative
hierarchy, no departments, no vacancies, and no waiting for promotions, except
periodical and generous re-appraisal of the needs of the working scientists. In line
with the current trend of thinking in India, it may be a good idea to incorporate a
continued escalator system of pay structure, ranging from Rs. 500/- to Rs. 2000/-.
In this connection, it is also worth considering the provision of a reasonable non-
practising allowance for medical scientists, so that they are attracted to a career
in research. This would be in keeping with the practice already followed in the
centrally administered teaching institutions and the central health services.
Staff pattern of laboratories
The central theme of this institute is to provide enough assistance to encourage
the working scientists, as opposed to the establishment of “scientific brigades”
under each chief. Therefore, it is proposed to provide each worker with a minimum
of essential technical assistance. Depending upon his eminence he may qualify to
be a recognised guide of a university and take one or two postgraduate students
who might qualify in time for higher degrees like the M.D. or Ph.D. In general,
unlike the case of other activities of the Council, the medical research institute
will be primarily concerned with active and original research by senior scientific
workers rather than in the turning out of a large number of postgraduate students.
Equipment and facilities
The research institute itself will be a sort of a communion of laboratories
serving the needs of the working scientists. As such it is envisaged that in the
initial stages efforts will be directed towards multicentric development to satisfy
the requirements and individual programmes of work. Based on mutual
discussions between the Council and the body of scientists both collectively
and individually, the requisite equipment and general laboratory facilities will be
provided for the corporate use of the participating scientist. Specialised equipment
needed by each worker will be obtained on the merits of each case, without
upsetting the overall economic considerations. Periodically at intervals of two or
three years provision will be made for regular care and maintenance of the old
equipment and the purchase of additional ones. In the event of a scientist quitting
the organization, attempt will be made to ensure the most rational use of the
equipment either in the central institute or in the constituent research wings or
research cells of the ICMR. If necessary, a competent and permanent body would
be set up to advise the Council regarding the re-allocation of the costly equipment
between the several functioning units of the Council including its permanent
institutions, research units and research cells. Though referred to in passing here,
this is a general problem facing the country which needs a bold and courageous
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re-appraisal if we are to put to use all the costly equipment available in the country,
a major part of which is perhaps locked up in the archives of its laboratories while
more needy scientists fondly yearn for fresh imports.
With regard to equipping the peripheral research wings, the same and
perhaps a more liberal policy has to be followed in each case, depending on the
particular needs of the workers of the Council and the availability or otherwise
of such equipment in the host medical colleges. It is assumed that the medical
colleges would fully cooperate in this connection. The Council would provide
all the reasonable equipment needed in the research wings. In this respect, the
financial support of the Council to the medical college should be treated on a
somewhat different footing than that of research units or research cells. However,
the equipment which will continue to be the property of the Council and used by
its permanent officers, can also be utilised by the regular members of the staff of
the college, depending upon the programme of the research institution.
Administration
Much could be said either way as to whether such an institute should have
a Director or not. For an institute of the type envisaged, viz. a conglomeration
of laboratories manned by senior individual workers, there is no particular need
of a central directing agency. Choosing a Director from amongst the scientists
working in existing institutions really amounts to robbing Peter to pay Paul. On the
other hand, beginning could perhaps be made with a competent administrative
officer who can either be a civilian administrator or retired scientist who does
not have any active research of his own. The duty of the administrative Director
or Officer is to ensure necessary coordination and cooperation between the
several laboratories, especially with regard to: (i) general laboratory facilities and
servicing, (ii) maintenance of the workshop, (iii) care and servicing Instruments,
and (iv) maintenance of a central animal house. He can also play a vital role as
a coordinating officer between the central institute and the research wings
and between each one of them and the ICMR. Later on should somebody from
amongst the working scientists emerge out as an acceptable leader, he can be
given extra allowances to discharge the duties mentioned above but there will be
no scale as earmarked for a Director.
With regard to the peripheral research wings, regional Directors are not
envisaged. The senior most officer acts as the liaison officer for both the central
institute and the Council.
All the constituent units of the medical research institute will be provided
with necessary administrative and secretarial staff for the benefit of the scientific
workers.
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Summary
Thus, it will be evident that there is a great scope and, need for harnessing the
large number of highly trained workers, both within, the country and outside India,
who are hesitating to return in the absence of reasonable conditions of service to
prosecute researches. While the Council has to continue its erstwhile research
programmes and policies, a time has come when it should seriously think of
establishing one or more research institutes in the country. Instead of developing
a limited number of research institutes, it is felt that there is a need for a new
pattern of thinking. To meet the specific needs and variety of interests of a large
number of workers, it would be appropriate to develop an Institute composed of
small laboratories aligned together, with a minimum of administrative hierarchy
and with full freedom for individual workers. Such a creation of laboratories can
be undertaken both in a central place as well as in a number of peripheral units
scattered in the country while both of them should constitute a part of the same
institute.
Certain details, the location, organization, function, scope of research institute
and its constituent wings have been presented to enable further discussion. There
is no doubt that the proposed institute of medical research will enlarge and expand
the existing activities of the Council. In due course when each medical college in
the country is provided with a research wing supported by the Council, the real
foundation for orderly progress of medical research in the country will be laid. It
will satisfy the varied needs of the promising or experienced scientist to solve their
own or local research problems in the basic medical sciences, clinical research or
social and preventive medicine. The medical research institute with its outposts
of peripheral research wings all over the country can act as a vital link and buffer
between the medical colleges and the specialized medical research institutions
in the country with regard to talent-scouting, recruitment and augmenting
the research potential of the country. Coupled with the creation of an enlarged
permanent research cadre, the establishment of a multifaceted medical research
institute would appear to be the logical culmination of the efforts of the Council
during the last 15 years.
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CHAPTER XX
I RETIRE FROM THE ICMR
Ihad a long innings in the ICMR and I thought of retiring, since it was better
to leave when the going was good than to leave it at a later date. As a matter
of fact, I had expressed my desire to leave on many occasions previously
but was persuaded rather to stay for one reason or another. When the question
of celebrating the golden jubilee of the IRFA-ICMR was mooted my term was
extended by one year. Later it was extended again for two years since the Ministry
felt that there was not, at the time, a suitable person to take over from me, even
though I had suggested the name of Col Ahuja, ex-director of the Central Research
Institute, Kasauli who was returning to India after relinquishing the office of the
Medical Adviser to the High Commissioner in London. This time, when I broached
the subject with the Health Minister, Dr Sushila Nayar, she tried again to persuade
me to stay. However, there is always the danger of continuing too long in one
assignment both from the point of view of oneself and from the point of view of
the organization. There is the danger of one losing one’s perspective. This time,
therefore, I had made up my mind to leave. After some discussion, it was agreed
that I should hand over to Rear Admiral Taneja, who was a pathologist and who
had held important positions in the Armed Forces Medical Services.
As a prelude to retirement I thought it advisable to prepare a document
reviewing the work of the Council in all its aspects, for I had decided to recommend
to the Governing Body the appointment of a reviewing committee to assess the
working of the Council during the past decade. I thought that such a document
would provide the background to the reviewing committee of the problems faced
in promoting research in medical colleges and research institutes, and the manner
in which they were dealt with.
It must be mentioned, however, that this was not the first time that such an
assessment was made. No organization can continue to function effectively unless
a periodic assessment is made of its working. This was done from time to time.
Previous assessments were mainly concerned with scientific achievements in
each field and to determine the need for continuing research in any specified field.
The Council’s fellowship programme was indeed assessed periodically with a view
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320 My World of Preventive Medicine
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Dr. C.G. Pandit with Dr. Sarvepalli Radhakrishnan, 1962
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to further its improvement. The scope of the present assessment was far more
comprehensive. I quote from the ‘Introduction’ to my report:
“It may be mentioned, however, that no specific attempts were made
towards a critical appraisal of the problems involved in the implementation of the
general policies of the Council, such as grants or financial assistance to individual
workers on a year to year basis, the pattern of the staff and technical personnel
employed year by year in individual enquiries as well as in the research units and
research institutes established by the Council. Obviously, such an analysis could
not have been done earlier. This is only possible after the lapse of a sufficiently
long period when some general trends are discernible. The broad trends. and
strains and stresses apparent in some aspects of Council’s working have only
begun to manifest themselves...”
Among the areas covered in the analysis were the following : main trends in
medical research under the Council, distribution of man-power, financing medical
research by the Council, analysis of research costs, supporting research in medical
colleges, and general trends in the annual grants, budget and expenditure with
special reference to total expenditure on research and various other matters. It was
rather interesting to note that yearly expenditure on the Headquarters office of the
Council always remained at a more or less constant level of 7 per cent of the total
grant received by the Council. Normal accepted limit is about 10 per cent. Again it
was also found that 4.3 per cent of funds were spent on related scientific activities
like reports and publications, library and stores, laboratory animals information
service, mimeographing and photocopy service, statistical service, etc. Thus the
balance, i.e. nearly 89 per cent of funds, was spent on research and development
activities proper, i.e. grants to ad hoc inquiries including pay and running expenses
of scientific workers.
The nature of the assessment made would be evident from the above. I would
like to quote again from our report:
“—Assessment of the working of the Council can be considered from two
aspects -assessment of scientific work done under the auspices of the Council
and appraisal of the policies of the Council in general for promotion of medical
research. Regarding the assessment of scientific effort, mention must be made
of Council’s policy of reviewing the results obtained by all projects which had
continued for a period of five years. Continuation or otherwise of the project
thereafter was determined solely after such an assessment. In addition, the.
Council has been taking stock of developments in particular fields periodically
by publishing special reports highlighting the results obtained... Apart from these
regular efforts, attempts were also made to take stock of the overall picture as
in the case of the seven yearly reviews brought out by the Council for the period
1950-57. Occasionally, however, as circumstances warranted it, even the policies of
the Council came up for general scrutiny and analysis. As the number of schemes
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progressed year after year, the Governing Body was appraised of the position and
suggestions were made as to the manner in which technical work conducted
under the auspices of the Council by individual workers could be further improved
bearing in mind the quality of work turned out”.
Finally, we stated in the report:
“The trends and portents of the present analysis might necessitate a
reconsideration in some respects, of the working of the Council in coming years.
Considerable progress had, no doubt, been made on many fronts. Commissioned
with the task of propagating medical research in the country, the Council often
faced with many practical difficulties. Many of these have been tided over, thanks
to the sympathetic understanding and whole-hearted cooperation extended by
members of the Scientific Advisory Board, the Governing Body, the Ministry of
Health, members of its several Advisory Committees, and above all the heroic
patience and sense of devotion of the investigators and employees of the Council.
It is hoped that the analysis of the working of the Council attempted in these
pages would help in a more objective recognition of the needs and the hurdles
confronting the growth of medical research in the country. In planning for the
enhancement of quantum and quality of medical research in the country there
is obviously a need to think afresh about the solution of some of the perennial
problems like:
(i) attracting and retaining promising research workers, (ii) creating a
corps of trained technical personnel who can take over an increasing burden of
experimental work, (iii) establishment of new research institutes and units, and (iv)
ways and means of spreading research activity in an increasingly large number
of medical colleges through the medium of research enquiries or the proposed
research cell, etc. Incidentally, it is felt that the experiences of the Council might
be useful in exploring the planning and financing of organised medical research
through College Research Committees and State Boards of Medical Research”.
The document comprising 150 pages was duly presented to the joint meeting
of the Governing Body and the Scientific Advisory Board which was specially called
by the Health Ministry to bid me goodbye. All the members of both the Bodies
were present. Indeed, I was surprised to see Maharaja of Parlakimedi attending
the meeting. He was a life member of the Governing Body since he had donated
one lakh of rupees to the IRFA for scholarships to those selected for work in the
field of nutrition. When I thanked him for his presence, he said “I have come here to
persuade you to stay and not retire!” Dr Sushila Nayar also informed the members
that she did not succeed in persuading me to stay. Needless to add that I was
really overwhelmed with the expression of these sentiments! Incidentally, I may
mention that when I presented the assessment report to the meeting, Dr Sushila
Nayar said to me:
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“Pandit, you could find time to study and write all this, I wonder how many of
us would find time to read it”.
I thought this was, indeed, a very significant comment! After the meeting,
there was tea at which the members congratulated me on the work done under
the Council. I did feel all were genuinely sorry that I was leaving.
A few days later, a formal function was arranged to bid me goodbye when
members of the medical profession working in the Institutes in the city were
invited. I was presented with the replica of the seal of the Council which I had
myself designed, as a memento of my association with the Council. I need hardly
mention, the function was arranged by the staff at the Headquarters in New Delhi.
When I had decided to retire, I had also sent a letter to all those who had
worked for the Council, scientists and others, thanking them for their cooperation
and requesting them to extend the same to my successor. It was really flattering
to note the replies I had received from most of them. All this may sound as self-
praise. But in what way I could record my appreciation for the support they had
given me at all times!
Finally in 1964 I was awarded the Padma Bhushan. I received the honour at
the hands of Dr Radhakrishnan, the President of India. In the citation it was stated,
among other things: “The outstanding work done by him in the field of medical
research has earned for India a place in the world map of Medical Research.”
I relinquished my office as the Director of the Council on the 1st August, 1964.
324 My World of Preventive Medicine
PART IV
EMERITUS SCIENTIST
(DELHI-CHANDIGARH-LOS ANGELES)
(1965-1970)
Emeritus Scientist (Delhi-Chandigarh-Los Angeles) (1965-1970)
CHAPTER 1
BACK TO CHOLERA RESEARCH
Just before I was due to retire Dr Sushila Nayar had suggested to the Council
of Scientific and Industrial Research, that I should be appointed National
Professor. The Minister-in-charge, I gathered, was rather hesitant, I did not
know why, and had asked many questions. When Dr Sushila Nayar told me about
this, I advised her not to press for my nomination as the National Professor, as I
felt that conferment of such an honour should not involve any- discussion, if
the person concerned was sufficiently known in scientific community. She
agreed. The Council, however, agreed to appoint me as their Emeritus Scientist
to work for a period of five years. In the meanwhile, Dr Nayar appointed me as
Honorary Adviser to the Ministry of Health. As it happened, I do not remember any
officer, either of the Ministry, or of the Directorate General of Health Services, ever
consulted me on any topic.
As Emeritus Scientist, I thought I should work in the National Institute of
Communicable Diseases. Dr S.P. Ramakrishnan welcomed the suggestion most
heartily. Initially I was toying with the idea of working in filariasis. However, just then,
an epidemic of cholera had broken out in the Gurgaon district of the Haryana State
and the Institute was requested to look into it. Since at that time the Institute had
not developed its own expertise, Dr Ramakrishnan requested me to take charge of
the investigation. I was back again at cholera research.
I
Before I describe the work done in connection with the Gurgaon epidemic,
I would like to refer to another facet of the cholera problem in India. In 1950, I
had to attend a meeting of the “Office Internationale d’Hygiene Publique”, an
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organisation established by the League of Nations after the First World War. This
was its last meeting for its functions were to be taken over by the World Health
Organization. At this meeting we were to take stock of the then existing situation
vis-a-vis some of the communicable diseases. In the discussion on cholera the role
of fish came up for consideration. Ultimately the following recommendation was
made:
“Following the Japanese work on infected fish and dissemination of cholera
through that source, and in view of the possibility that fish infected with cholera
vibrios could infect water supplies, further investigations on the role of fish and
other aquatic fauna and their potential danger in infecting water supplies should
be made”.
I decided to pursue this matter on return to India. Since I had no specific
knowledge about fish, I thought it advisable to consult Dr Hova, Director, Zoological
Survey of India in Calcutta. I explained to him the purpose of my visit, gave him
some general information of cholera and finally showed him a map indicating
the endemic areas of cholera worked out with certain criteria postulated by Dr
Swaroop. When Dr Hova looked at the map, he was excited and exclaimed that
it was also a map of Hilsa fisheries as worked by him. Indeed the two maps were
so alike that one could be superimposed on the other! We discussed the problem
in great detail. Dr Hova acquainted me with the whole life history of Hilsa fish
including their breeding and migrating habits. I gave such information as was
pertinent regarding cholera. Ultimately we decided to put down in writing all
that we had discussed, e.g. relationship between cholera endemicity and Hilsa
fisheries, between the seasonal variations of cholera and Hilsa fisheries, physical
factors affecting cholera epidemics and Hilsa fisheries, and many other relevant
matters. I presented a paper to the Association of Pathologists and published it in
the Indian Journal of Medical Sciences (Ref. Vol. 5, 1951).
However, I did not communicate it to the Cholera Advisory Committee of the
ICMR lest an enquiry is sanctioned because the proposal had emanated from me.
Also I had an uneasy feeling in my mind. Once you get an idea, you begin to put
in known facts with your hypothesis! Even so it does appear to me now that after
the discovery of Vibrio parahaemolyticus in the etiology of cholera a good deal of
attention has to be paid to the role of fish in its causation.
Our discussions, however, brought out an interesting feature of cholera
endemicity in India. All the important endemic areas of cholera in India are on
the East coast, i.e. the deltaic regions of the rivers, viz. the Ganges, the Mahanadi,
the Godavari, the Krishna and the Kauveri. However, the deltas of the Indus, the
Narmada and the Tapti rivers are free.
Why are the latter free? One seldom realises that the Bay of Bengal is a very
peculiar geographical area. The Irrawati from Burma also flows into the Bay of
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Bengal. Again waters flowing from Cherapunji in Assam, which has the highest
rainfall in the world, also goes into the Bay. This inflow of water from all sides
reduces the salinity of the water. It varies in different seasons from 20 to 30 while
the salinity near Ceylon is more or less constant at 36. The same figure holds good
for waters in the deltaic regions on the West coast. It should be noted that the
most suitable medium for the survival of cholera vibrios is so called “diluted sea
water”.
II
The study of the Gurgaon epidemic brought to light some interesting
features on the behaviour of cholera epidemics, Gurgaon town was first affected
and continued to report cases of cholera almost to the end of the epidemic.
In due course Rewari town down south was also affected. The two towns were
connected by rail and road transport. In my office in the Institute I had weekly
charts of the spread of the infection in the area. They showed the following peculiar
characteristics:
• In the first week only two or three villages were affected and the
surrounding villages were free of infection.
• In the second week, the villages affected in the first week, as well as the
surrounding villages remained free, but a few villages along the road
down or south reported the infection.
• The same observations were made in the third week, but the villages
which had remained free during the first two weeks continued to remain
free of infection.
• Ultimately Rewari town was affected and because of the cattle fair there
at the time, the infection spread radially from the town in all directions.
Even then the spread was only in one direction.
• The public health effort, such as it was, was concentrated only in the
affected villages.
It was thus apparent that the infection spread only in one direction, i.e. like
a wave! This was in spite of the fact that there was the usual road and rail traffic
between the two towns, and between the villages free and affected. There were
also no rivulets or streams to complicate the picture.
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In the first year, out of 400 villages in the area only 100 villages had reported the
incidence of cholera. However, what happened the next year was equally intriguing.
Gurgaon and Rewari towns were affected, but the area comprising four hundred
villages remained free, and the villages on the periphery of that area were affected.
What were the factors which had contributed towards that freedom?
Gurgaon district, however, was not an endemic area of cholera. I thought that
it would be interesting to study what happens in a known endemic area. At the time
Dr Rao, who had previously served as the Health Officer in West Godavari District,
was working in this Institute. From the data furnished by him, it was apparent that
the behaviour of cholera epidemic in that district had also shown some peculiar
characteristics. The villages affected during the first epidemic remained free of
infection during the epidemic in the following year. It was also noted that such a
freedom of a village also depended on the magnitude of the public health effort,
viz. cholera inoculations and the like, during the previous year. I felt at the time that
if such data were regularly collected, the health officer of the area would be in a
position to anticipate where cholera would strike next and when!
By the time the epidemic in Gurgaon district came to an end, Delhi started
reporting cases of cholera. This gave us an opportunity to study the problem
in some detail. It was apparent that cases of gastroenteritis were occurring
throughout the year. These cases were investigated bacteriologically. It was
intriguing to note that while clinically they looked like cases of cholera with
acute dehydration in some cases, cholera vibrios could only be isolated during
the period from mid-April to September, and that too not from all cases of
gastroenteritis. There was no relationship between the cases. How was the
infection introduced, and how did it spread? What was the etiological factor in
other cases from which the vibrios were not isolated. Of course, we did not know
then the role of Vibrio parahaemolyticus in the production of the disease. Again
the area affected was different from the area which had reported cases during the
previous year, though for all purposes they were contiguous. Meteorological data
supported the original observations of Russia and Sundarrajan about the influence
of temperature and humidity on cholera epidemics. Examination of water drawn
from hand pumps about 20 feet or so deep revealed the presence, in some cases, of
cholera vibrios. Did the meteorological factors mentioned above facilitate the
survival of the vibrios in the soil?
Finally I may state that we were equally busy in the laboratory.
I suggested to Dr S.C. Pal, Assistant Director-in-charge of the laboratory
to try and develop a suitable experimental model for the study of pathogenesis
of cholera. Of course a number of experimental models had been developed
previously, e.g. the infant rabbit model of Dutta and Habu, and the rabbit ileal loop
of Drs De and Chatterjee. However, they had their own limitations particularly with
regard to the easy availability and cost of the animals. We thought of using chicks
My World of Preventive Medicine 329
Emeritus Scientist (Delhi-Chandigarh-Los Angeles) (1965-1970)
for the purpose. The results were interesting. It was observed that either live
cultures of V. cholerae, or culture filtrates produced ballooning of the intestinal
segment. The results were more or less like those observed in ligated ileal loop, of
rabbits. It was felt that the chicken model would thus be as suitable as others, in
addition to being more economical. I presented the observations recorded above
in the Subba Rao Memorial Oration which I was asked to deliver by the Lederles.
I was also happy to participate in the training programmes organised by
the Institute from time to time. The two years I spent in the NICD were thus most
enjoyable and rewarding and when I decided to go to Chandigarh, the faculties of
the Institute gave me a hearty send off.
330 My World of Preventive Medicine
Emeritus Scientist (Delhi-Chandigarh-Los Angeles) (1965-1970)
CHAPTER II
CHANDIGARH —THE LAST ASSIGNMENT
When I was working thus in the NICD, and indeed even before my
retirement from the ICMR, my friends in the Postgraduate Institute
in Chandigarh had expressed the desire that I should work there for
some time and Drs Tulsidas, Santosh Singh Anand, P. N. Chuttani and Aikat were
rather insistent. Finally when I received a ‘formal’ communication from Dr Anand,
the then Director of the Institute, I readily agreed. The CSIR too had no objection
to my working there as Emeritus Scientist. The Institute allotted me a spacious
newly constructed House in Sector 24, the Institute’s doctors’ colony. I reported
first to Dr Anand and then went to call on the Health Secretary, who received me
very cordially, and when I asked her what my duties were, she said, “Dr Pandit, we
expect you to stay with us. You have no formal responsibilities. It is up to us to
make use of your experience.”
This, I thought, was the nicest assignment I ever had!
Being in the institute, one gets busy one way or another. My office was next
door to that of the Director, and over a morning cup of tea, we had discussions on
some aspect or the other on the institute’s working. I was also made a member
of the College Council and at its meeting I had a glimpse of the problem which
the Institute had to deal with. The Institute had a department of experimental
medicine. I was asked to review its working since its inception, i.e. for ten years
or so and make recommendations for its working in the future. The objectives for
which the department was constituted were many. These included:
• Training of postgraduates in research methodology, guiding them in the
preparation of a thesis,
• Providing laboratory and animal facilities to the clinical staff members for
their own research projects,
• Standardization of new techniques in animal experimentation,
• Routine parasitological diagnostic service for the Institute, and
• Special diagnostic tests for hospital patients.
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Emeritus Scientist (Delhi-Chandigarh-Los Angeles) (1965-1970)
Specific recommendations were made reviewing the activities in each field.
A suggestion was also made regarding the creation of a central instrument room
under the supervision of the staff of the department for the use of the department
as well as for other departments. In addition, it was also suggested that a special
research ward be created for the intensive investigation of any specific ailment.
The assignment gave me an insight into the working of the several departments
of the Institute.
There were other “duties” to perform. I was a member of the editorial board
of the bulletin of the Institute. This was a new venture of the Institute to facilitate
early publication of the work done by the staff. In addition, since I was credited
with having some experience as to how research projects should be submitted
to the Indian Council of Medical Research, I had frequently to give advice in the
matter! I thus fully enjoyed my role as Honorary Consultant without having any
responsibility whatsoever!
In 1970 the Ministry of Health, on the recommendation of Dr Raghavan,
the then Director of the NICD, appointed me as one man Committee to review
the work of the National Filariasis Control Programme during the years from 1961
to 1970. As the chairman of two previous Committees entrusted with the same
task, I was familiar with what steps had been taken to control filariasis during the
period of almost two decades. In the present assignment, I had to deal mainly
with antilarval measures adopted to control the infection. The results were rather
disappointing. Only in 33% of the units established in the country for antilarval
measures the results were ‘fairly good’ when judged by the downward trend on
such specific indices as vector density, infection and infectivity rates in mosquitoes
and microfilariaerates in children in the age group of 5-15 years!
After reviewing the whole problem, it was apparent that in the present state
of prevalence of filariasis in the country, the degree of unsanitary conditions that
exist in most areas, the structure of health services in different states, the load of
other urgent problems in the field of communicable diseases and the paucity of
funds, the ideal of eradication of filariasis which requires continuous effort over a
long period can only remain an ideal not to be reached in any foreseeable future.
In view of the above considerations, the only feasible method of control would be
to reduce the transmission of infection by methods currently available, and reduce
the risk of infection to as minimum a level as practicable.
In view of the considerations mentioned above it was recommended that
attempts should be made by each state to delimit the areas where the problem
is prevalent and make a list of those areas where preventive measures have to
be implemented. On the basis of evidence obtained through surveys, each state
should earmark areas for control in order of priority based on the nature and
extent of the problem. These areas would be: (a) large administrative units such
as municipal towns, semi-urban centres, and (b) purely rural areas with small
332 My World of Preventive Medicine
Emeritus Scientist (Delhi-Chandigarh-Los Angeles) (1965-1970)
population groups. This was suggested for the methodology of control to be
adopted in each of these areas will be different. It was emphasised that the correct
approach would be to deal with the problem on a regional basis, to deal with all the
foci, old and new, both urban and rural, through a method suitably evolved for the
purpose. Once the desired degree of control was achieved, it would be possible
to move the control teams to other areas for instituting similar measures in them.
In the report, specific suggestions were made to deal with the problem in the
three types of areas mentioned above. In addition, the role of filaria clinics was also
discussed.
It is not the purpose here to refer in detail the recommendations made to deal
with the problem of control of filariasis in the country. My report was published by
the ICMR as their Technical Report No. 10 in 1971. In the report I had also indicated
areas of research in this important field with special reference to research in the
immunology of filariasis and in operational research.
Though I was living in Chandigarh I had to go frequently to Delhi on one
assignment (or pretext?) or the other, especially to deliver lectures or orations,
viz. the Subba Rao Memorial Oration organised by the Lederle Laboratories, the
second Col. Amirchand Oration by the All India Institute of Medical Sciences, and
many others. When, however, the National Institute of Health Administration
and Education in New Delhi requested me to address them on their Annual Day
in 1969, I readily agreed. I chose as my subject “A look at the past and a glimpse
into the future” for the oration. I would like to reproduce it here for it has some
relevance to the time during which I had to play some role, however inadequate, in
the promotion of health in the country.
A look at the past and a glimpse into the future of health services in India
Many years ago, while travelling along a road in a south Indian city, I came
across a sign:
“STOP, LOOK AND GO”. I had passed by that sign many a time since, and
elsewhere in the country too, and I had always felt that its message had a much
wider significance than merely the prevention of an accident. There arises a time in
any human endeavour when it is necessary to pause and contemplate and assess
the fruits of its labours. About two decades ago we decided to travel along a road
chalked out for us by the Bhore Committee. Indeed we had broadly accepted the
recommendations of that committee almost without any reservations. We have to
satisfy ourselves that travelling along that road we will reach our goal ultimately.
Let us look at the milestones we have passed by since. We had embarked
on the gigantic task of eradicating malaria. We formulated plans for the control
of small pox, leprosy and filariasis. We took steps towards improving, within the
resources available, water supply and sanitation in urban and rural areas. The
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Emeritus Scientist (Delhi-Chandigarh-Los Angeles) (1965-1970)
planning for school health and nutrition also received attention and concurrently,
we have engaged ourselves on measures to tackle the problems associated with
population explosion. These attempts have been carried out with varying degrees
of intensity and success in different states in the country. We did pause once to
assess what we had done when the Health Survey and Development Committee,
popularly known as the Mudaliar Committee was appointed for the purpose in the
year 1959. While we have made admittedly much progress in the fields mentioned
above, the programmes have lacked that amount of dynamism which is essential to
fire the imagination of the people. The Bhore Committee had stated categorically
that “while purely official effort may, by itself, not prove entirely sterile, it cannot
possibly yield the results which we may reasonably hope to attain! without the
active, enthusiastic and enduring support of the people themselves”. At the same
time the basic and fundamental concepts enunciated by the Bhore Committee
have not received that attention which they deserved. It is my purpose today to
draw attention again to those concepts and examine the implications of some of
them, in the context of experience gained since they were formulated.
The Bhore Committee had made its recommendations in terms of conditions
then existing. They were planning, not for an independent India but for ensuring
post-war development of public health in the country. It must be remembered that
whatever plans emerged as a result of their deliberations, they could implement
them both at the Central and Provincial levels through the agency of the Indian
Medical Service since the key posts in all the provinces were manned by the
members of that service. Health was even then a state subject .
With the abolition of the Indian Medical Service, however, this unifying force
was lost. What was the state of public health and particularly of health services
at that time? It was estimated that nearly 3/4th of municipalities, i.e., urban
centres and more than half of the districts i.e., rural areas, had no qualified health
staff. The local bodies had the power to appoint and control their administrative
establishments including the health staff. Provincial Directors of Public Health
were in position, but they could give only advice to the local bodies and were not
in a position to ensure that such advice would be followed even when required in
public interest. The Civil Surgeon at the district headquarters hospital, busy as he
always was with clinical work, was also saddled with the responsibilities of public
health administration. It is needless to point out that ancillary health services were
equally ill-developed in most provinces in the country at the time.
However, there were a few notable exceptions to this general picture. Attempts
were made in U.P., Mysore and in the then composite province of Madras and
Andhra to put public health work on sound footing by organising a separate public
health service. The Rockefeller Foundation had played a notable part, through
training, in the organization of public health work in the Mysore State. The set up
created in Madras was due to the foresight of Sir John Russel who was then the
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Emeritus Scientist (Delhi-Chandigarh-Los Angeles) (1965-1970)
Director of Public Health of that Province and who later became the Public Health
Commissioner with the Government of India.
The basic features of the Madras Health Service were that all the health staff
working in municipalities of various denominations and in the districts, belonged
to the Provincial Public Health Service. Twenty-five per cent of the salary of such
officers working in municipalities was to be met by the local bodies, while the
rest was the responsibility of the Provincial Exchequer. This arrangement enabled
the health staff to discharge their functions according to the best of their abilities
without being influenced unduly by political and regional considerations. After
serving for a stipulated period in any area or a city, they were liable to be transferred
to other areas in order that they could widen their horizon of public health fields,
gain experience and develop competence. The leadership at the provincial capital
was provided by some of these officers who had gathered adequate experience
and who were found competent to deal with diverse situations. It was ensured that
an Assistant Director of Public Health working at the State level had jurisdiction
over all activities in one allotted area, as well as jurisdiction in one essential activity
in public health over the entire province. It was in this manner that the policies
enunciated in the diverse fields could be readily implemented.
Indeed when in 1939, a body corresponding to our present Health Council
met in Madras, all were unanimous in their opinion that the Madras pattern was
far in advance to that existing elsewhere in the country. As the Director of the
Institute of Preventive Medicine in that province, I recall with pride and gratitude
my association with that service, in the training of its officers, and in our joint
endeavour in the elucidation of many problems of water supply and sanitation,
and in the field of communicable diseases.
It is against this background that the Bhore Committee had to make its
recommendations. Let me draw attention to some which primarily deal with
policies in public health administration:
• In recommending the establishment of primary, secondary and district
health centres in their famous ‘three milli on plan’, it was stipulated that
the same doctor will combine in himself, curative and preventive health
functions.
• As a logical corollary to the above, the preventive and curative services
were to be integrated.
• The hospital, as an integral part of each of these health centres, is to be
regarded as the ‘focal point’, which is expected to play the dual role of
providing medical relief to the area served by it, as well as taking an active
part in the preventive campaigns against communicable diseases, e.g., work
in connection with maternity and child welfare, tuberculosis, and leprosy
etc., would be carried out into the homes of people from the hospital.
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Emeritus Scientist (Delhi-Chandigarh-Los Angeles) (1965-1970)
It has to be emphasised that the concept of the health centre, whether at the
primary, secondary or district levels was the same, though the staffing pattern, and
sphere of responsibility were to be different. At any rate, apart from the hospital
of varying bid strengths at different levels, it was envisaged that accommodation
would be provided for all categories of staff engaged in administrative, curative
and preventive health work.
Let me state here at the very outset, that since these recommendations were
based on ideological considerations, it was contemplated at the time to test their
feasibility by adopting them in the first instance in the Union Territory of Delhi.
It is interesting today to look at the terms of reference of that committee, the
committee was enjoined to make a broad survey which will give a general picture
of the present position and which will indicate, and place in proper perspective,
the causes of low level of health which will form the basis for suggesting future
developments. The committee was asked to plan boldly, avoiding on the one hand
extravagant programmes which are obviously incapable of fulfilment and on the
other, halting and inadequate schemes which would bring little return for the
expenditure involved. Apparently, the then Government of India had realised even
then that health was a commodity which could be purchased at a price!
The publication of the Committee’s report coincided almost with the
attainment of independence. The country then adopted the philosophy of
planning for a five yearly period. In the first five-year plan, special emphasis was
laid, among other things, on the ‘preventive health care of the rural population’. It
might be worthwhile here, to recall an episode which might interest you. Shri R.K.
Patil, then a member of the Planning Commission, called a meeting of a group,
to formulate plans to keep the agricultural population in a state of health, since
agriculture was to receive the highest priority in the first plan. One representative
of modern medicine and one each of the indigenous systems of medicine, i.e, the
Ayurveda, Unani, Homeopathy, Naturopathy (nature cure) etc., constituted the
Group. I was its Chairman. In his address to the group, Shri Patil emphasised that
since the matter was of extreme urgency, in making our recommendations, we
were to regard ourselves as on ‘war footing’. The group met for only one afternoon,
and produced an unanimous report! I do not think that this record has been
broken by any similar group since. The group recognised that different systems
of medicine had different approaches to the prevention of disease. It took note
of the fact that current activities of the public health departments in the country,
in that respect, were based on modern medicine, and since it was not desirable
to change horses in midstream when one was on war footing, those practices
and procedures should continue to be adopted for the time being. It was also
agreed that so far as treatment of the sick was concerned, the rural population
could resort to any system of medicine of its choice, and that the services of such
practitioners should be utilised in preventive work after suitable training. The idea
336 My World of Preventive Medicine
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