My World of Preventive Medicine new size 21st Feb 2022 print

Emeritus Scientist (Delhi-Chandigarh-Los Angeles) (1965-1970)

was that in view of their status and position in the village, it would pay dividends if
they were involved in preventive work. What significance these recommendations
have vis-a-vis our concepts of basic health services, I leave you to judge. We may
raise our eyebrows and smile within ourselves. When we read about the recent
Chinese attempts at producing a “bare foot doctor”, stripped of its propagandist
approach, and its association with a particular political philosophy, the bare foot
doctor, to my way of thinking, is essentially a basic health worker of our concept,
with this difference that he is chosen from the village to work in that village. I am
sorry for this digression. Let me resume my thread.

The decision to establish primary health centres, one for each block, was
taken in formulating health schemes for the first five-year plan, and specific
targets were fixed for successive five-year plan periods. By the end of the second
plan, 2800 primary health centres were established. The situation was reviewed,
as stated earlier, by the Health Survey and Development Committee. It came
to the conclusion that the primary health programme, as had developed, had no
resemblance to that recommended initially, ‘because of lack of orientation of the
medical officers in public health matter, and because the district officers, in many
cases, were not quite clear about the concepts of an integrated health service’.
At such centres the doctor was busy looking after the sick, and preventive aspects
of work were completely neglected. The Bhore Committee had no doubts in their
mind as to what they were recommending They had stated that “each primary
unit doctor treating a typhoid patient should, in addition to the medical attention
he gives him, ensure that steps are taken to discover the source of infection to
prevent the spread of the disease in the community”. They had emphasised the
epidemiological approach to preventive medicine. In view of this, the Mudaliar
Committee had to recommend that opening of more primary health centres
on the existing pattern should be discontinued, even though the suggestion
might appear as a retrograde step. Again ten years have gone by since the above
assessment was made, but the situation today is, basically, the same as before! The
public health component of the integrated health service is just not there! –“The
physician of tomorrow”, said Dr Sigerist, “a scientist and a social worker, a friend
and a leader —he directs all his efforts towards prevention of disease, and becomes
a therapist when prevention has broken down”. Brave words indeed! I do not
know, however, when that tomorrow is going to dawn! We often take refuge in the
argument that doctors are unwilling to work in rural areas. It is not my intention
to deal with this problem at this stage. I understand from a recent document
produced by this Institute that “the present hospital and dispensary services in the
country are attending to only 15% of the total sickness in the community”. Assuming
for a moment that, by a miracle, we make the conditions of service worthwhile in
rural areas and make available the full complement of staff recommended, I still
wonder whether in view of the clinical load of the magnitude referred to above, the
doctors will have time to do the preventive work, or to put it rather bluntly, whether

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they would like to do it. The fact of the matter is that we have not made public
health work attractive. An unsuccessful heart transplant is big news, but the toils
of a poor health officer in fighting an epidemic and thus saving lives go unnoticed!

The scope and functions of public health service have been well defined. They
embrace all activities which will promote the physical and mental well-being of the
community. The development of social machinery for this purpose is its primary
task. Its programmes will depend on the stage development of the communities
due to economic, political and other considerations. The public health field is not
and cannot remain static and in this context, it is a speciality in its own right as any
other discipline in clinical sciences.

How do we produce such specialists to man our public health services? Let us
assess our needs. We needed technologists who are also able administrators, whose
responsibility is to enunciate the basic principles of a public health programme
depending on the scientific advances in that field and their applicability to the
current situations in the country. They, have to take the crucial decisions. Let us not
forget that a successful administrator has not only to take decisions, but get good
decisions. Then we need health officers who would be directly responsible for
translating in practice the actual programme in any area, taking into account the
local conditions in that area. They will need the help of experts in other ancillary
services, e.g., health education and social sciences. And lastly we want a large army
of adequately trained basic health workers who would be a link, as it were, between
the administration and the people and who would actually be responsible for
delivering the goods. The training of health personnel at all these levels is a task to
which we must pay special attention. Their training cannot be in any way different
from that of a clinician who attains eminence in his specialised field, beginning
first as an apprentice, working his way up by hard work, and what is important,
thereafter sticking to it. Does not the army build up its specialised services in this
way? I am amused at the suggestion that because of the difficulty of getting
doctors to work in rural areas, those who join government service should put in at
least two years service in rural areas. I hope the idea is not the same as trying to get
an attack of measles in childhood and forgetting about it in later years!

However, even this is not enough to make public health work attractive. Let us
trace the evolution of a doctor after his exit from the portals of an undergraduate
medical institution. Some will take to specialities in the clinical field. With the
explosion in medical knowledge during the last 50 years and the phenomenal
advances in clinical disciplines, the doctors today are being attracted more
and more to this field than to any other. Some more inclined towards scientific
pursuits, will perhaps choose a career in research in basic medical sciences. In
both the cases they want to emulate their teachers in this respect. Some will
decide to settle in private practice and the rest will choose, perhaps, a career in
public health. I do not have in mind those who may have a secret desire to migrate

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and eventually settle in other lands. What is very intriguing, however, is the fact
that while the foundation for their training was laid during their sojourn in the
hospital, thereafter they tend to follow their paths quite in isolation. Those who
work in well established institutions for teaching and research will seldom get any
opportunity to know what is happening in the community and those who work in
the communities will not be subjected to the stimulating atmosphere of a hospital
or an institution, where an attempt is always being made to expand the frontiers
of knowledge in every discipline of medical sciences. Indeed the profession in the
public health field is as isolated as their patients in an isolated hospital. We are
aware that early and adequate treatment of infectious diseases is one of the best
means of preventing them and thus lessening the burden of the load which the
society has to bear in terms of cost in this field. However, in reality what we have
done is to legally transfer the responsibility of such treatment to an agency whose
contact with the main hospital centre is conspicuous by its absence. What is the
role, may I ask, of the hospital in the changing needs of the society? Traditionally,
our hospitals are supposed to attend to the sick. Equally traditionally, the other
aspects of health are the concern of the public health departments. Apparently,
the twain shall never meet. Should not our hospitals assume a much more
dynamic role than what we are accustomed to see hitherto? Should not those
who work in different medical disciplines come together under one common roof
or at least in one campus and participate in the joint endeavour of promoting
community health? Should not our nursing services in the hospital devote some
time to train the patients, and through them, their relatives who visit them daily, to
adopt certain practices and procedures in their daily life, which will foster healthy
living, and contribute to the prevention of avoidable illness in the family? Should
not the long and weary hours of waiting in the out-patient departments of the
hospital be utilised for the same purpose through attempts at health education?
We have paid only lip service to the integrated approach towards curative and
preventive medicine in formulating our teaching programmes in our medical
colleges. Indeed the departments of preventive and social medicine are the least
developed in most of our teaching institutions. What I have in mind is that the
hospital is not necessarily the headquarters of those who are engaged in the
promotion of community health. If we can bring these two essential components
of our profession together under one common roof, perhaps we might provide
the basis for the intellectual inspiration not only to the students and staff working
in the hospitals but also to the members of the public health services who need
it even more. It is in this context that I attach the greatest importance to the one
recommendation of the Bhore Committee, to which I have made a reference,
namely, the role of the hospital as an integral part of the health centre and as
a focal point from which all preventive work should emanate into the homes of
people. We have learnt by experience that the only way to secure cooperation
of the people, either in our community health programmes or in field research,

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is through service to the sick. This is a challenge which our teaching institutions
must accept in the first instance and develop plans and procedures to bring this
about. Let the community feel that when they go to the hospital, they are not
merely going there for temporary relief from whatever they are suffering but they
are visiting it for getting guidance after their ailments are cured, for maintaining
themselves and their families in a state of positive health. The distinguished public
health philosopher and pioneer, Dr Joseph Mountain of USA said long long ago
thus: “We associate court house with justice, the school with education and
temple or church with religion, but medicine has no such physical symbol”. Let
our hospitals provide that physical symbol for health!

If we mean business, we must strive to bring about these changes deliberately.
If we succeed, we will have elevated public health work to that status which it never
had in the past. We will be able to attract men of calibre to man the public health
services, to provide them with opportunities to rise in that profession, and in due
course enable them to assume leadership. This is the way I would look at the future
of that service. But if we are unable to do so, because of lack of understanding or
apathy, I would be content to scrap the concept of an integrated public health
service, no doubt a counsel of despair, and revert to the status quo ante. At least,
as I have stated before, we were able to do some good then, and would struggle
to do the same in future.

Members of the faculty of this institution, I am deeply grateful to you for the
honour you have given me in asking to speak to you on the occasion of your
Annual Day. Your institution, within the short span of its existence, has already set
up an enviable record in the matter of training of officers of public health services
in the country and in the evaluation of some of our public health programmes
through operational research. I visualise the day when our public health services
will be manned with men with, vision, your function as a “staff college” will assume
different significance, and your institute will be able to concentrate on its equally
legitimate role as the planning and evaluation agency of the Ministry of Health!
Indeed, we await with interest the results of your researches on the working of the
primary health centres, and of integrated services in several states in the country. It
is for this reason that I have tried to share my thoughts with you regarding the past,
the present, and the future of our health services. I am conscious that I have not
dealt with the problems of the basic health worker without whose participation we
would be able to achieve very little. My preoccupation was with those fundamental
concepts in health, which were put forward by a committee two decades ago, and
which are in keeping with the most advanced thinking in that field in the world
even today. There is the danger that they might suffer because of neglect or by
attempts at premature implementation. Hence I would like to end as I began:
Please pause, ponder and then proceed.

Thank you!

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CHAPTER III

SOJOURN IN CALIFORNIA, USA

One day in Chandigarh in February 1969, I received a letter from Charles
E. Young, Chancellor of the University of California, Los Angeles, which I
reproduce below:

“Dear Dr Pandit

Each year the regents of the University of California make available
funds for the appointment of “Regents Lecturers”. These lecturers
are selected from men who have gained distinction in their chosen
profession, and who would be interested in spending a period of time in
a University atmosphere working with faculty and students.

Your name has been suggested by our School of Public Health as
a possible Lecturer during the 1969-70 academic year. I concur heartily
in the suggestion and take pleasure in inviting you to serve for a period
of nine weeks as a Regents Lecturer at UCLA. Professor Telford H. Work
of the division of Infectious and Tropical Diseases will be writing to you
soon to reinforce my invitation, to give you somewhat more details
about the nature of your activities while here, and to discuss a time for
the visit.

We would be honoured to have you with us next year and will be
looking forward to what we trust will be a favourable response from
you.”

In due course I heard from Dr Telford Work. I knew this invitation was entirely
“his doing!” I quote from his letter:

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“I requested this in the light of our previous attempts to bring you
to the United States to share your unique knowledge on communicable
diseases in India, with those of us who have special interest in tropical
medicine, infectious diseases, disease problems in India or a special
concern about one or another infectious disease that has occurred
or does occur in people like those you have been working with in the
Indian subcontinent.

You will remember that when I was at the National Communicable
Disease Centre, negotiations with the National Library of Medicine and
Dr David Spencer proceeded substantially towards having you come to
document your knowledge through a series of one hour presentations
on such topics as Small pox, Cholera, Malaria, Plague, Filariasis, Leprosy,
Tuberculosis, Virus diseases, Nutritional diseases and others that might
be of special concern. At that time we contemplated that these weekly
presentations might be put together in a volume titled something
like “Communicable Diseases in 20th Century India.”

As you may know, the University of California consists of nine
campuses. Several of these presentations might be made in the
biomedical facilities of other campuses at Berkeley, San Francisco
and Davis. In addition, we have expression of considerable interest in
having a special lecture at the University of Southern California.

We have talked about doing this on a number of occasions in the
past. With the wherewithal now in sight, I hope you share with me the
warm satisfaction that a long held desire is now possible to materialize.
I have been privileged to be at your feet many times over a long period
of time. The opportunity to have you teach in our newly developing
programme in infectious and tropical diseases at UCLA gives great
pleasure of anticipation not only personally, but for the students and
colleagues we are gathering around us here.”

Needless to say that I was overwhelmed with the affection, and sentiments
expressed by him. A few days later, I received another communication from him
that the American Society for Tropical Medicine and Hygiene had, at his suggestion,
elected me to give the year’s ‘Craig Memorial Oration’. The subject assigned to me
was “Communicable Diseases in Twentieth Century India.”

This was, indeed, a formidable assignment. Prior to my departure, I had tried
to collect the necessary information on subjects I was to talk about. Preparation of
slides took sometime. To add to my worries, there was illness in the family. I reached

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Los Angeles in October without adequate preparation for the task allotted to me.
I had to work hard in Los Angeles to prepare for the lectures. Fortunately, library
facilities there were excellent. I gave talks on Smallpox, Cholera, Plague, Leprosy,
and Filariasis. I was rather hesitant to talk on filariasis since the department was
actively engaged on research on that subject. I spoke from my notes since I had
not prepared written texts. The talks were well received, at least so I was told. The
audience, I felt, was adequate. However, frankly I must admit I did not think I did
full justice to the assignment.

The Craig memorial lecture in Washington, I thought went off well. On the
morning I was to deliver it, I received a phone call from Dr D. A. Sadun, who was
the President, to say that the talk was rather long. Dr Sadun was a member of
the Department of Medical Zoology, Walter Reed Army Institute of Research in
Washington. “Could you abridge it a little?” he asked. I said that I had timed it
for 40 minutes or so, as I was told. “I have to have time for your introduction,” he
replied. In the time at my disposal, I made a few changes. I reproduce here the text
of his “Introduction”.

Introduction of Dr C.G. Pandit as Charles Franklin Craig Lecturer
of 1969

Members and guests of the Society

Annually the Craig lecture series has provided the opportunity to bring before
this group a distinguished contributor to the field of tropical medicine. Through
this lecture the society has recognized the outstanding scientific accomplishments
of a renowned leader in tropical medicine who by presenting a review of relevant
knowledge will provide the high point of our scientific programme.

I am very glad indeed to announce that Dr Pandit will deliver the Craig lecture
this year. The title of his presentation “Communicable Diseases in Twentieth Century
India” is quite appropriate since he is the only man I know who has survived three
of the most dreaded infectious diseases on that subcontinent: plague, cholera
and typhoid fever. He survived the plague before the discovery of streptomycin,
recovered from typhoid before the development of chloramphenicol and lived
through a bout of cholera without the benefit of tetracycline or intravenous fluid.
It was this kind of toughness that enabled him to travel during World War II from
the United States to India via Africa through the hazards of riding the wrong trains
and taking boats about which few, if any, knew where, when or even whether they
were going to make port. A veritable Marco Polo adventure! His determination
enabled him to stick to his convictions during the difficult days of partition, and to
declare that his task was to help in building a public health service along modern
lines without meddling in politics.

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His indomitable strength, however, is tempered by an authentic gentleness
which enables him to provide a fatherly understanding of those who are in trouble
and to be always ready to listen to the problems of uninitiated investigators.
Although he is sympathetic and understanding, he does not hesitate to speak his
mind when confronted with sloppy work or confused thinking.

Born in Poona in 1894, Dr Pandit was already an “elder statesman” of tropical
medicine by the time many of us began working in this field. Under his guidance the
Virus Research Centre was started in India. As Director of the Indian Council of Medical
Research for many years he has an intimate knowledge of most of the medical
research conducted in that country and he has been exceptionally helpful to many
of our members in laying the groundwork for the cholera research programme.
His ability to understand and to accept new concepts of the pathophysiology and
treatment of infectious diseases is one of his most outstanding intellectual qualities.
He is one of those rare men endowed with the gift of perception of everyday life
through the multicoloured prisms of science and medicine, a keen-witted dreamer
who can transform a number of small observations that seemingly lack a common
link into an altogether harmonious mirror of reality as a whole. He has the ability
to pick out and stress the details which bring him in touch with the basic elements
of his country’s life. He is a scientist, an epidemiologist, a public health worker
and a man of refined human callings. Through his lectures and publications, he
managed to convey to a large and sophisticated group of foreign colleagues the
very essence of Indian life and progress. His published work is remarkable, since
he is ginned with an inborn grace of style and a rich literary outlook in which wide
experiences throughout the world and love for the country of his birth are blended
with an innate feeling for tradition and humor. A master of the art of gentle and
imaginative conversation, Dr Pandit gives rein to images, frequently seen with a
slightly ironic style which is a source of amusement and a very recognizable trait
as an author and as a speaker. Dr Pandit was only eight years old when, as he put
it, he had the honour to suffer from plague. He warns that “plague is not yet dead
and any complacency in its regard would be fraught with danger” and he states
that quarantine measures are necessary. Yet he recalls that to avoid being detained
when travelling by train from Bombay to Poona, if there were signs of fever his
mother would advise him to put his hand outside the carriage window so that it
would feel cool when the doctor examined him. Similarly, there is a detectable
smile when he recalls that he was vaccinated against smallpox from a cow which
was brought to the door of his family’s residence. As a human being he possesses
an unaffected and attaching charm. His conception of science is founded on
the scrupulously objective, correct and precise reporting of data, whereas his
discussions reflect the traits of a cultured Asian whose basic models are the great
classical works. Because of these attributes, Dr Pandit has gained a world-wide
reputation as a sincere, conscientious, imaginative and enthusiastic investigator as
well as an efficient and understanding administrator and distinguished lecturer.

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It is, therefore, with great pleasure and deep appreciation of the honour
conferred on me by our President when he asked me to serve as Chairman of the
Committee for the selection of the Craig lecturer for 1969, that I present to you Dr C.
G. Pandit who will speak on “Communicable Diseases in Twentieth Century India.”

This introduction was received with loud applause. Since I had to save time for
my presentation, I thanked him by saying, “Now I know what my obituary would
look like”. This too was received well.

After Washington, I went to Atlanta, at the invitation of Dr Seneer, the then
Director of the National Communicable Disease Centre. He had requested me to
give a talk on smallpox. Then I proceeded to Baltimore to meet my old colleagues.
As usual I had to give talk there also. I was invited by the Indian Student Community
at Yale. I could not do so as I had to return to Los Angeles to resume my duties. At
the end of my stay I had to address the students of the University of Los Angeles.
I chose as my subject: “The evolution of medical and other scientific research in
India and the problem of the brain drain”.

When the assignment in Los Angeles was over, I had to fulfil other duties in
San Francisco and Berkeley. This was part of my assignment as “Regents Lecturer”.

I enjoyed immensely my stay in Los Angeles. I had many informal talks with
Dr Work in the evenings at dinner. During the first three weeks I was billetted in a
place like a motel where I had a small kitchen attached to it. I wished I could cook,
for friends used to drop in at any time even late in the evenings. Later I moved to
a place quite close by within walking distance of the department. Many members
of the staff took me out either for lunch or dinner. Mrs Mathews, Secretary to Dr
Work, was most helpful. Apart from rendering technical assistance she took me
round the places of interest in Los Angeles, to the art exhibition in the city and
when I left, presented me with a brochure on ‘Family of man’ which-I still possess.
Her assistant always introduced herself as my ‘tobacco girl’ when she wanted me
to tell her what brand of cigarettes she should get for me! The lady-in-charge of
washing glassware invited me to tea. I was a member of the University club where
I met members of other faculties in the University. I particularly enjoyed talking to
Prof. Walpert, the author of Tilak and Gokhale. Dr Walpert had lived in Poona for
a couple of years to collect material for it. He knew Marathi well. I had known of
this book before and had attempted to get it but could not. We talked about this
book a great deal and I exchanged with him my anecdotes of Tilak and his times.
One day at lunch Dr Walpert asked me what I thought of Pandit Nehru’s Will! I
was surprised to learn that his class was about 500 (?) students or so. At one of his
lectures he told me he had `aired’ my views. When the time for departure came
near, I gave the faculty members a dinner. When I said goodbye to Prof. Walpert, he
presented me a copy of his book `Tilak and Gokhale’ with the following inscription:
“To Dr Pandit who knows it all”!

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I left Los Angeles with a heavy heart. A few days later, I received a letter from
Dr Work. He wrote:

“I have received many comments from people who had assumed you were
here permanently. When informed that you were here for fall quarter only, they
felt very fortunate to have heard you or met with you. This means that the goals
of the Regents in establishing such lecturerships were extremely well satisfied by
your presence and presentations here…Thank you for one of the most excellent
professional accomplishments of your career”.

On return to Chandigarh, I thought I would read the text of my talks in Los
Angeles. I found them really awful. They needed drastic revision. Before I could
attempt to do it, I got involved in the assessment of the National Filariasis
programme to which I have already referred. That took me nearly a year to finish it.

Time comes when one feels one has had enough. I then decided to retire to
settle down in Poona, the city of my birth. My colleagues in Chandigarh tried to
persuade me to stay. I thought it was better to go when the going was good. I had
left Poona in 1920 to go to England. I returned to the city in 1971, exactly fifty years
after!

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EPILOGUE

It is now twilight, ‘twilight of dusk and not of dawn’, as one distinguished
administrator put it in another context. Darkness will follow, when I do not know.
This is a period in one’s life when one invariably ruminates on the past, indeed
a favourite pastime of the old! What has one really achieved, or failed to achieve?
When one contemplates on the things one did, the picture often gets blurred. I am
reminded of what Alexander Solzhenitsyn, the Russian Nobel laureate, wrote in his
prose poem “Reflections”:

“On the surface of a swift flowing stream, the reflections of things near or far
are always indistinct; even if the water is clear and has no foam, reflections in the
constant stream of ripples, the restless kaleidoscope of water, are still uncertain,
vague, incomprehensible.

Only when the water has flowed down river after river and reaches a broad
calm estuary, or comes to rest in some backwater, or small still lake—only then can
we see in its mirror-like smoothness, every leaf of a tree on the bank, every wisp of
a cloud and the deep blue expanse of the sky.

It is the same with our lives. If so far we have been unable to see clearly or to
reflect the eternal lineaments of truth, is it not because we too are still moving
towards some end—because we are still alive?”

My father wanted me to be a practising doctor so that I would treat the poor
free. He was born in poverty and knew what illness meant. Could I have been a
successful medical practitioner? From the little experience I had of private practice,
I know I would have always been ill at ease, doubting whether I had done the right
thing with my patients. Yet I must confess, I had full admiration for clinical practice.
When I was working as an honorary consultant in the Postgraduate Institute at
Chandigarh, I could not but be impressed with what the staff was doing in clinical
fields—their joy in pulling a patient out of serious illness and their sorrow at what
was revealed at the autopsy table! To learn straightaway about your mistakes must
be more rewarding, I thought, than, as in the case of a scientist, to know about
them after publishing a paper in a scientific journal and reading criticism about it
months or even years later!

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As I have indicated in my “Early Years”, I became a research worker more
by accident than by design! I was, perhaps, a ‘good scientist’ by contemporary
standards. ‘Explosion’ in medical knowledge had not taken place, and ‘medical
research’ had not become as complicated an affair as it is today. Yet looking back
at my scientific pursuits, I am amused at the variety of problems I had to deal with.
I could not work in any one of them in depth so as to become an ‘authority’ in any
one of them.

Perhaps that was inevitable in the circumstances then prevailing. We had to
deal with problems as they arose, be it in the investigation of epidemics, or in the
manufacture of biologicals needed for their prevention. We did serve a purpose,
especially at a time when research institutes were being criticised, as in the Bhore
Committee, for wasting their time in the manufacture of sera and vaccines! We
were an ‘Institute of Preventive Medicine’.

When I retired from the ICMR, I was complimented for the steps I took for
the promotion of research in medical colleges. I have often wondered whether
I did really succeed in doing so! Many professors in several medical colleges, no
doubt, got grants-in-aid for research. Does a research project in any department
of a college create an ‘atmosphere, of research? The whole idea in promoting
research in our medical teaching institutions is to inculcate a spirit of enquiry
among the trainees. How much do we depend now on laboratory aids before
making a diagnosis and at what stage? What will happen when the whole process
of diagnosis and treatment is computerised?

When I look back on the recommendations we had made in our proposals
for promoting research in our ‘Second Five Year Plan’, I cannot help thinking
that the most important was the one related to the establishment of a ‘Research
Cadre’, initially to provide security of service to those who had proved their merit
while working on a year to year basis on an enquiry. It was our idea then to create
eventually an infrastructure suitable to deal with problems as they arose. We
had the fond hope that when members of the research cadre were ‘seeded’ in
the departments of universities, in our medical colleges, and also in our research
institutes, they would help to create an atmosphere of research in them. Above all,
it would have been one step towards national integration facilitating the migration
of scientists from one state to another.

One often makes mistakes of commissions and omissions. I wish I had done
something more in promoting research in Ayurveda, when I had the opportunity
to do so, in the institute at Jamnagar, which I had helped to establish. In addition
to promoting fundamental studies in that science, I wish I had suggested the
evaluation of Ayurvedic remedies in certain selected fields. That also would have
been a most suitable joint venture for the Ayurvedic and modern medical teams
working there. It might have had an impact on the future of that institute.

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Of course, I had my moments of pleasure once when I had demonstrated an
immunological phenomenon in filariasis, later known as ‘Pandit reaction’ to explain
the disappearance of microfilariae from cases of elephantiasis, and again when I
“discovered” the existence of “Fluorosis” in south India. The various “centres” which
I had established for research in communicable diseases have done remarkably
well and some of them have earned international recognition. Indeed, because
of their excellent performance, the authorities have seen it fit to ‘re-name’ them
as ‘National Institutes’ in their respective fields. In the ‘re-naming’ ceremony of
one such centre where I was present, I said, “It is seldom that one lives to see the
fruition of one’s efforts”.

But the greatest pleasure I had in my life, was the esteem and affection I
received from my friends both in India and abroad. I will not mention any names
lest I might omit to mention some. However, I would like to recall with pride one
occasion, when at a function organised to felicitate the 80th birthday anniversary
of Dr R. V. Rajan, the retired professor of venereology in the Madras Medical
College, he had suggested to the organising committee that I should be invited
from Poona to preside over the function in preference to a local dignitary! A
friend once said to me, “Pandit, how come you have no enemies?” I told him that
if he were to put it that way, I would not feel that I was a ‘normal human being.’ “I
may have had, perhaps, ‘covert’ enemies”, I replied.

I now lead a retired life in the city of my birth except my association with the
Haffkine Institute in Bombay, Gandhi Memorial Leprosy Foundation at Wardha, and
with the National Institute of Virology in Pune. One day in 1967 in New Delhi, a friend
(E.W.F.) came to see me. We talked of retirement. He left the following note with me.

Requirements for retirement

A job of work—but something you want to do,

A well grilled steak, and teeth to match, the kind that grew,

A glass of wine—perhaps a choice and may be two,

A good companion, well tried friend, who likes the things you like too,

And health, wealth enough to see you through,

A few regrets, the naughty things you did, more tantalising still, the ones you
did not do,

And then some credit, somewhere, to reflect upon

And then a quick release and dignified be gone!

I have come to the end of my tale! I take solace in the thought that in writing this
account of my professional life, I have kept the promise given to my father at his
death bed and that to the best of my ability, I did what I could.

My World of Preventive Medicine 349

Planning for the Future (1948-1965)

Felicitation event of Dr. C.G. Pandit by Prof. Ramalingaswamy and
Scientists of NIV

350 My World of Preventive Medicine

Planning for the Future (1948-1965)

Dr. K. M. Pavri, former Director NIV felicitating Dr. C.G. Pandit, 1987.

My World of Preventive Medicine 351

Planning for the Future (1948-1965)
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A HOMAGE TO DR C. G. PANDIT

Dr C.G. Pandit, the Founder-Director of Indian Council of Medical
Research (ICMR), passed away on July 10, 1991 at the ripe old age of 96
years. He has a long and memorable career with several cascading golden
epochs right to the very end of his life.

Born in 1895, Dr Chintaman Govind Pandit was brilliant at school
and college. He obtained a covetably high rank in the matriculation
examination. He joined in 1910, Elphinstone College, Poona, with a merit
scholarship. It is remarkable that Dr Pandit’s career is one of fulfillment of
the pardonable ambitions and expectations of his parents. The unerring
“astrological predictions” at crucial moments of his long and illustrious life
were correct on the dot as described by him in his eminently readable
autobiographical book “My World of Preventive Medicine” published by
the ICMR. Perhaps such a belief added to his quiet confidence as if he
knew that he was destined to have a long and illustrious innings.

Strangely enough, early in life, Dr Pandit was virtually a victim
of a number of tropical diseases. Thus, he had a brush with dreaded
epidemic diseases like cholera, plague and influenza, not to speak of
malaria, typhoid and possibly an episode of post-operative hepatitis. With
frequently reported deaths due to infectious diseases, his father groomed
his son so that there would be a “doctor at home”, little realizing that he
was destined to become a Doctor at large and India’s famous Microbe-
hunter. In the face of a possible personality clash, even after registering
for M.D. in Obstetrics & Gynaecology, he withdrew early after enrolment
in Grant Medical College, Bombay, and switched over to Pathology and
Bacteriology and for a while he worked in Poona as an Honorary Lecturer.
He soon proceeded to London on a Sir Mangaldas Nathu Bhai Scholarship
of the Bombay University. Following a subtle request to be permitted to
change the M.Sc. Registration to that of Ph.D., he became the first recipient
of the Ph.D. Degree in Bacteriology of the London University. In the course
of his stay, he also acquired the D.P.H. and D.T.M. qualifications. Armed
with such unassailable credentials, on his return to India, he strode like a
colossus. As a scientist with promise, he restrained his inner nationalistic
sentiments. Such a wise and pragmatic approach partly explains the
secret of his uninterrupted rapport with the British authorities and
particularly the imperial scientific elite of those days. Instead of the IMS, he
joined the Medical Research Department (M.R.D.) as one of the six small

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non-IMS contingent in the 30 man strong M.R.D. In those days, the variety
and magnitude of tropical diseases prevalent in different geo-climatic
conditions of the Indian sub-continent offered intellectual challenges of
the highest order.

Dr Pandit formally joined the King Institute, Guindy, Madras, in July
1924 and later he was the first Indian to adorn the chair of the Director of
this Institute. He learnt assiduously the science and art of manufacture
of vaccine lymph purely derived from a human strain of variola already
standardized in the Institute. As a bench worker, he did not stand on any
hierarchical formalities. He pays handsome compliments to his mentor
Khan Sahib Mohamed Gomar. His technical competence is exemplified
by his demonstration to an incognito judge in an investigation into the
spurious and exaggerated claims of a very high potency of antitetanus
serum. It illustrates the concern and conscience of a scientist in matters of
quality control of biologicals - a burning problem even today. For a short
period he concurrently acted as Professor of Bacteriology in the Madras
Medical College and among his famous students are the likes of Dr. K.N.
Rao, Col. R.D. Ayyar and Dr D.K. Viswanathan.

During his short stint as Director of the Pasteur Institute, Shillong, Dr
Pandit pursued his scientific enquiries on rabies, and the epidemiology of
cholera outbreaks in the Brahmaputra and Surma Valleys and verified the
role of Bacteriophages. In 1932-33, he was deputed to U.S.A. on a Rockefeller
Foundation Fellowship in Virology and worked with Dr Chambers. He
studied newer techniques such as tissue culture and micromanipulations.
His exposure to the working of the Marine Biological Laboratories,
Woodshole, Massachusetts had vivid applications in his future scientific
thinking. Enroute he spent some time in Strangeways Laboratories at
Cambridge and got introduced to Sir Mc Farlane Burnet, whom he met
for a longer period during his visit to Australia.

Dr Pandit’s expertise was much sought after not only by the Govt.
of Madras Presidency and the Central Government to understand the
outbreaks of epidemics and diseases. He was accorded the distinction
of participating in the Indian delegation to the Far Eastern Congress of
Tropical Medicine and Malariology held in China in 1934. The award of the
Minto gold Medal for distinguished work in Tropical Medicine in 1939 was
a high point in his career.

Yet another lifelong passion of Dr Pandit is traceable to his early
investigations in and around Madras on filariasis and elephantiasis. His

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pioneering work on “adhesion phenomenon” in filariasis was published in
the Indian Journal of Medical Research (IJMR) in 1929 and came to be known
as “Pandit’s Reaction.” With the growth of the science of immunology in the
growth of the science of immunology, the basis of his test was confirmed
35 years later by Japanese and U.S. scientists working in Calcutta. Similarly,
the systematic epidemiological studies on Plague, in which Dr Pandit was
involved in those years added substantially to our knowledge of its trail not
only along the cotton routes after the 1896 epidemic but the endemic foci in
places like Nilgiris due to the rat menace associated with potato cultivation.
A wealth of vector bionomics of different species of rat fleas in adjacent
areas was brought to light. Like-wise, at Guindy, Dr Pandit organized prompt
measures to unravel new and mysterious diseases of bacterial origin such
as meningoencephalitis, leprosy and tuberculosis.

With his training in Virology, Dr Pandit played a notable role in the
study of newer viral diseases like poliomyelitis, trachoma, sandfly fever etc.,
even later on. However, during the war years, Dr Pandit played a significant
(and at that time secret) role in preventing the imminent dangers of the
spread of yellow fever into the Indian subcontinent which had the full
complement of potential vectors and hosts which only needed a triggering
by the arrival of human beings harbouring the virus-troops or air passengers.
The perilous adventure is not without its high drama verging on science
fiction. Dr Pandit’s “My World of Preventive Medicine” vividly portrays the
excitement and fascination of a Microbe-hunter, in this episode.

It would not be out of place to record that the actual credit for the
discovery of endemic fluorosis due to the consumption of drinking
water with a high fluoride content should go to Dr Pandit. His article on
fluorosis was reprinted as an IJMR Classic [Pandit, C.G., Raghavachari,
T.N.S., Subba Rao, D. and Krishnamurti, V. Indian J Med Res 28 (October
1940) 533). Although the honour had been shared by many, his scientific
curiosity, serendipity and the Midas touch were largely responsible for the
recognition and characterisation of the malady, unrelated to any industrial
hazards and hitherto unrecognised by nutritionists.

The crowning glory of Dr Pandit’s pre-Independence career as a
working scientist was the conferment of OBE (the Order of the British
Empire) for his significant, substantial and sustained scientific contributions
which had a direct bearing on the health of the people. Equally prestigious
national honours like Padma Shri and Padma Bhushan in succession were
subsequently conferred on him by Independent India. He also was the
Fellow of the Indian National Science Academy, the National Academy of
Medical Sciences, and other scientific bodies.

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Yet another historical role played by Dr C.G. Pandit is related to the
establishment of the All India Institute of Medical Sciences. Stemming
from Lord Wavell’s idea of creating such an Institute as an appropriate War
Memorial, towards the end of the second world war. Dr Bennet Hance,
the Director General of Health Services, and Dr C. G. Pandit were asked to
visit and study the organisational pattern of some of the leading medical
institutions in the United Kingdom, United States and Canada. Together his
team went on an adventuresome journey round the Cape and examined,
at length, various alternatives and finally recommended that the proposed
Institute should be moulded on the pattern of the Johns Hopkins Medical
School with suitable modifications to fulfil the special needs of the country.

Soon after Independence, Dr Pandit was destined to play a much
greater role for medical research in India, by virtue of his rich experience
and knowledge. The Indian Research Fund Association (IRFA) with its hoary
tradition dating back to 1911, even preceding the establishment of the MRC,
was in need of a new leadership. He reached Delhi and assumed charge in
July, 1948 as Secretary of IRFA. He was already familiar with the functioning
of the IRFA as a member of its Scientific Advisory Board and Advisory
Committees. He was fully cognisant of the research scenario, the changing
fortunes viscicitudes and financial constraints of the IRFA accentuated by
the Inchcape Committee. With the moral support of Pandit Jawaharlal
Nehru, Dr Jeevraj Mehta and Rajkumari Amrit Kaur, he was not only able
to steer through the IRFA but refurbish it totally in 1949, under the new
banner of Indian Council of Medical Research (ICMR). He thus moulded
and reshaped medical research in the country. He embarked on a multi-
pronged approach to foster and generate a critical mass of research talent.
Top-most priority was given to the establishment of specialised institutions
for research, the Nutrition Research Laboratories (the present National
Institute of Nutrition at Hyderabad) at Coonoor as the flag-ship of ICMR.
Due to divergences of opinion on the establishment of a Central Medical
Research Institute, there was a progressive enlargement in the fleet of
discipline-oriented institutes, amongst which the Virus Research Centre,
Pune initially funded by Rockefeller Foundation was perhaps his most
cherished dream.

Concurrently, a large number of “Research Units” centred around
promising men of talent were set up. Thirdly, open-ended individual
research projects in medical colleges were also encouraged. Dr Pandit
was primarily responsible for exposing medical colleges to the new and
expanding opportunities of medical research by throwing open the

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deliberations of the Advisory Committees to the faculty in selected host
institutions. Many young and upcoming scientists were fired by the
excitement and prestige of the scientific meetings, popular lectures and
seminars. These were often organised by the ICMR along with the Annual
Meetings of the Indian Association of Pathologists and Microbiologists
of which Dr Pandit was a past President. At times, in such scientific
congregations, the alertness and quiet diplomacy of Dr Pandit saved
explosive situations. In his scientific parliamentarianism and in the
conduct of the ICMR affairs, he invariably applied the four-way test : the
scientific merits of any proposal, the interests of the medical research
community, the Government as represented by the Health Ministry and
the Parliament. The brave front he put up in 1959 against onslaughts on
the ICMR by interested parties supported by the bureaucracy is ample
testimony to his commitment to science. By his persuasive methods he
obtained the promise of the Rockefeller Foundation and other authorities
to build a permanent building for the ICMR Headquarters Office within
the precincts of the All India Institute of Medical Sciences in the Medical
Enclave at New Delhi.

Prior to his impending retirement he readily welcomed my suggestion
and volunteered assistance to undertake a critical in-house analysis of the
working of the ICMR during its uninterrupted post Independence era. It
is difficult to recall a parallel when a retiring chief, on the eve of his laying
down office, would place on the table a balance sheet of the organisation
and a SWOT Analysis. Indeed his public testament was the forerunner
of the First Review Committee of the ICMR, delineating structural,
organisational, functional and other improvements.

As an epilogue it must be added that as the best product of his age,
traditions and scientific temper, Dr Pandit was essentially a working
scientist, a “doubting Thomas” or a Martin Arrowsmith. Essentially, he was
a scientist-democrat and statesman who was not lured by opportunism
or self-aggrendisement. While such endearing catholicism and prudent
policies were admirable in themselves, they were not without their
disadvantages, one of them being that the growth of the ICMR lagged
behind as compared with many other sister agencies which were
established later.

Although retiring by nature, Dr Pandit was a very informed and
delightful conversationalist. His sense of subtle humour, peels of gurgling
laughter, simulated coughing befriended one and all, and kept at bay
even sharp critics, neophytes and prodigal sons of the soil who returned
to the country, scouting for scientific opportunities back home.

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Dr Pandit’s residence in the spacious (at No. 1, Safdarjang Lane, New
Delhi) quarters for nearly two decades was the hub of many a brain-
storming session where important national health issues were thrashed
out. He could truly be considered as the encyclopedic Samuel Johnson
of Medical Sciences in India. Dr and Mrs Pandit’s house was frequently
the meeting place of medical scientists and intellectuals (both Indian
and foreign). The pleasant evening at home and quasi-social parties
(always at his own expense) was indeed his unique style of generating
intellectual debates on the latest scientific advances as filarial infections
in crows or lizards at one end and national health policies such as BCG
vaccination, control of leprosy or the threat of Dengue and its biological
interfaces, at the other. Dr and Mrs Pandit represented the epitome of
Indian cultural traditions without any puritancial fads or obsessions. He
believed in modest, unostentatious good life and enjoyed minor pleasures
like tobacco in all forms and regaled his guests with sparkling liquid
refreshments, beverages and sumptuous dinners at the open-house
parties amidst his larger domestic and scientific retinue and admirers.
Although Mrs Pandit predeceased him by a few years, Mai - as she was
fondly called was the embodiment of domestic harmony and tranquility.
The Pandits were also fortunate that their four charming daughters were
married to equally enlightened service officers who attained the highest
echelons of civilian, diplomatic and service ranks.

By every reckoning, Dr C.G. Pandit would go down in the annals
of history of modern India as the “Bhishma Pitamaha”, who placed the
country on the global map of Medical Research.

Dr S. Sriramachari

INSA Senior Scientist &

Formerly Additional Director-General,

Indian Council of Medical Research,

New Delhi.

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