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Introduction to preventive medicine (1924-1948)

“Why” said he. “Just to acquaint myself, Sir, with the work the Institute was
doing”, I replied.

“I see, but the Institute closes at 4:30 PM”. “Yes, Sir, but there is no train then
which I could catch to go home. The train is only at 6:15 in the evening”.

“But there is a train at 4:30 PM”, “Yes, Sir, but that would mean leaving the
Institute before its closing time and I did not like to do so”.

He just looked at me, smiled a bit, and asked me to see him in his office the
next day, which I did. The interview the next day was most cordial. He informed
that I would be placed in charge of vaccine lymph manufacture and discussed with
me the problems associated with it. He referred to the need of preparing vaccine
lymph with as low a bacterial content as possible and mentioned the possibility
of immunising calves prior to their being vaccinated with vaccine lymph. The
interview ended. After a month later, he called me and asked whether I had given
some thought to his suggestion.

“I am sorry, Sir,” I replied, “prior immunisation of calves against staphylococcus
does not seem to have any effect”.

“What, you have tried to find out already?” “Yes, Sir” I said and gave him the
details. “Would you mind getting me the records?” I showed them.

“Would you mind if I copy some of these details?” I said I had no objection.
After this I was well rehabilitated with Col. Cunningham and he was extremely
cordial thereafter. He gave me some very interesting suggestions which I should
follow and ended by saying:

“In case there is any doubt, you should always consult Khan Sahib Mohamed
Oomar, your chief assistant. He knows more about vaccine lymph manufacture
than any of us and in case of any difference of opinion, remember he is always
right.” Finally, he said, “You know I am going on home leave for eight months. If
there is any question of your being confirmed in the department while I am away,
please do not hesitate to write to me”.

II
Learning the ‘art’ of vaccine lymph manufacture

Col. Cunningham was right. Though I was in charge of the section of
vaccine lymph manufacture, I knew next to nothing of the ‘art’ of vaccine lymph
manufacture (for at the time it was that and nothing else) and I had to rely heavily

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on the experience of Mohamed Oomar. He was trained by Col. W.G. King, who
had established the centre for the purpose somewhere in 1896-1897 at Guindy. I
have often wondered why he chose Guindy, a place so far away from Madras city.
Apparently, he chose the site for he was staying in the “Nawab Garden” close by
and probably for its proximity to St. Thomas Mount—a military cantonment. He
was regarded as the authority on lymph production at the time. During the course
of his work, he apparently succeeded in “variolating” a calf, i.e. producing vesicles
on the calf by using matter from a pistule from a patient suffering from smallpox.
From the calf he raised a stock of `vaccine lymph’ which he used in the routine
manufacture of lymph for human use. The authorities did not view this kindly. They
felt that such a lymph would be dangerous for human vaccination. Whether it
was for this reason, or something else, Col. King was transferred to Burma! In due
course the centre was expanded and a new building was built. At its opening
ceremony in 1905, Lord Ampthil, the then Governor of Madras Province, apparently
without consulting anybody and to render justice to Col. King, named it after him
as “The King Institute of Preventive Medicine”!

In the manufacture of vaccine lymph, the calves have to be inspected
periodically, and “lymph” is normally recovered 120 hours after vaccination, when
the ‘vesicles’ on the calf are just mature. However, Col. King always inspected
the calves every 3 to 4 hours, after 96 hours to note the maximum suitable
development, and the material was removed any time from 96 hours to 120 hours.
How to determine the degree of maturation? This was only a matter of experience
and Mohamed Oomar had it in abundance. I had to gather this knowledge myself
also by observation and it was in this regard that Oomar Sahab’s experience was
valuable. I soon realised, that in case of any difference of opinion amongst us,
it was better to trust to his judgment than mine! I am happy to record that our
section received due recognition, and we had the privilege of training officers
from different Provinces in India and also Burma in the technique of vaccine
lymph manufacture. In my lectures to the trainees, I did not miss the opportunity
of telling what trouble Dr Jenner himself had taken in sending his vaccine
lymph to India. This is, indeed, a fascinating story. He first attempted to send it
by the ship “Indiaman Queen”. A number of unvaccinated persons were placed
on board who were to be vaccinated periodically, so that when the ship reached
India, there would be a person on board with vaccine on his arm from which local
inhabitants could be vaccinated. Unfortunately, the ship foundered off the Cape of
Good Hope! He then attempted to send it via the land route, i.e., via Paris, Vienna,
Constantinople, Baghdad, Basra, and then to Bombay by the same procedure of
vaccinating people ‘en route’. From this lymph Anna Dusthal was the first Anglo-
Indian baby to be vaccinated in India. One might say that stock of lymph we used
then was derived from the material obtained from this child!

While talking to Mahamahopadhyaya Datto Waman Potdar, the celebrated
historian of Pune, he related the following story:

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“The Peshwa, in Pune, hearing of its success, requested an officer of the East
India Company to make arrangements for the vaccination of his army. The officer
got his transfer orders, his promotion cancelled and did the operations himself in
the interest of promoting good will with the Peshwa! I always ended my talk by
saying that since so much trouble had been undertaken to get “Jenner’s lymph” in
India, it was their responsibility to see that it was effectively utilised in protecting
our people”.

Khan Sahib Mohamed Oomar (he was awarded the title of Khan Sahib by the
Government in recognition of his services to the Institute) was a friend of the family
and my wife relied heavily on him in setting up of our household and in many day
to day problems associated with it. One day he came to me with a Chinese vase.
“Let it be here on this table in your drawing room. It will look nice”. It was a good
piece of antique. I only came to know its value much later. It is still with us. He
was also a good orator and spoke English fluently. Indeed, his services were often
utilized by the Muslim community, not only in Saidapet where he was staying but
by many in the city as well. I remember on one occasion he came to us and wanted
to borrow our chairs. “Why Khan Sahib, what is the occasion?” I asked. He said that
he was asked to arrange for a meeting of the community, at the Collector’s behest,
to draft a memorandum to be presented to the Simon Commission! When I raised
my brows, he only smiled.

His end, however, came suddenly in 1938. Col. Shortt, the then Director, was
returning from leave in England and I was supposed to receive him at the Central
Station early in the morning. Khan Sahib had expressed his desire to accompany
me to the station. However, as I was late, I went straight to the station, received Col.
Shortt and went back to Khan Sahib’s home to apologise to him. To my surprise
I found him lying on the floor and in intense pain in the chest. Obviously it was a
heart attack. I immediately fetched the doctor but in the evening he passed away.

Major Jafar was then working in the Institute as Assistant Director. We
decided to attend the funeral. However, I was given to understand that I wouldn’t
be admitted near the burial place. I then decided to walk behind the procession.
When we reached the place, the Imam enquired whether the Director of the
Institute was present for he will have the honour, he said, to put the first shovel of
earth in the grave! Thus, I could pay my last tribute to the Khan Sahib!

Khan Sahib was very popular with the staff of all grades. At the staff meeting
it was unanimously decided to raise a suitable memorial in his honour. I have a
recollection that we raised a sum of about Rs. Four thousand or so for the purpose.
What form should the memorial take? Many views were expressed—most of the
staff members suggesting the institution of an oration. I must confess I am allergic
to “orations”. The name after whom it is instituted is often forgotten and many
“orators” often do not pay any tribute to the person after whom it is named. I made
another proposal. Khan Sahib lived well but I do not know whether he lived beyond

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his means. I came to know that he had left nothing for his family. Two young sons
had to be educated, and the daughter married. I suggested that the fund should
be utilized to educate the sons primarily and for the marriage expenses - if needed
- secondarily. The proposal was accepted and implemented. We also erected a
brass tablet in the room where he worked to remember him always. I met one of
his sons later. They seemed to be well settled.

III
I fight for my rights

In the very first year at the Institute, there was an interesting episode. Some
members of the medical profession led by Dr M. Kesava Pai waited on the Surgeon
General protesting about my appointment as Assistant Director at the Institute.
Dr Pai was at one time working in the institute and had, I believe, officiated as its
Director for a very short period during a leave vacancy. Dr Pai was a friend of mine.
We were together in England. He assured me that he had nothing against me
but was fighting for a ‘principle’. The Surgeon General, of course, pointed out that
according to rules, the post was reserved for the Government of India officers. I was,
however, amused at the thought that the profession would not have protested at
all if an IMS Officer had been appointed instead. That had been the practice. I was
a non-IMS Officer!

Col. Cunningham went on leave and Dr D.A. Tarkhad was appointed as the
Director of the Institute. Before leaving, however, Col, Cunningham permitted Mr
Herbert Hawley to occupy the house “Nawab Garden”, then the official residence of
the Director. Dr Tarkhad continued to stay in the Assistant Director’s bungalow in
the Institute’s compound. Mr Hawley had been recently appointed as Government
Analyst with headquarters at the Institute. His immediate assignment was to work
out milk standards for the proposed food adulteration act of the Province. He was
located in the Institute for the needed laboratory facilities. I was thus deprived of
my official residence. With great difficulty I had rented a bungalow in Saidapet on
the Mount Road about three miles away from the Institute. It was good to look at,
but it had no sanitary facilities, and had no electricity. From the work point of view,
it was most inconvenient since there was no transport of any kind available there.
I used to go on a bicycle and I had to be in my section at 7 AM. I had explained
all this to Mr Hawley when I told him that I was thinking of making an official
representation in the matter as advised by Dr Tarkhad.

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My interview with the Surgeon General, Col. Simmons was “stormy”! He
asked me about my present accommodation. I gave him details explaining how
inconvenient it was from the work point of view to stay so far away. He replied
saying: “You want a change because you do not like where you are staying. You
Indians will always give the main reason last”. I replied that I believed that I was
entitled to the official residence, according to rules, and for the performance of my
duties and it was no concern of the Government where I stayed. I believe he was
annoyed at my reply and told me curtly that the interview was over. This was not,
however, the end of the matter.

In the meanwhile, I was appointed Professor of Bacteriology in the Madras
Medical College, in addition to my duties in the King Institute. These duties were
very taxing. It was necessary to study in the library as well, to prepare my lectures,
and living away from the Institute further aggravated the matter. I decided to try
again to get back my official residence when there happened to be a change in
the Directorship of the Institute, for Dr Tarkhad had retired and Lt. Col. H.H. King,
IMS, an officer of the Medical Research Department, had taken over. Col. King was
most sympathetic and after listening to me promised to look into the matter. A few
days later, he sent for me and told me that he had discussed the matter with Mr
Hawley and he had agreed that I could move into the house when he proceeded
“on home leave” to England in April. I readily agreed to this arrangement. In
April, however, the P.W.D. wanted to make some major repairs to the Director’s
bungalow. “Pandit”, said Col. King, “you have stayed away so long, would you
mind if you moved into the house a little later, i.e., till the repairs to my house are
completed?” I readily agreed. Unfortunately, the repairs took a long time to be
completed. In the meanwhile, I was deputed to go to Karnal to the Malaria Institute
of India, to take the course in malariology While there, I think it was in the middle
of September, that I received a communication from the Government of Madras
asking me to ‘vacate’ the house, as it was again being allotted to Mr Hawley! I sent
a copy of the letter to Col. King for his information.

On return to Madras from Karnal, I found that Col. King had issued orders
prohibiting Mr Hawley from occupying the house, since he was in correspondence
with the Government over the matter. When I asked him about it, he said: “Well
Pandit, I am sorry there is this delay in settling the question. Since the Surgeon
General wouldn’t agree, I have demanded an interview with the Governor. Pandit,
we have no business to be in India except on the ground of justice”. As I recollect,
the words were to this effect. This had its effects. One Thursday afternoon I
received orders that the official residence was allotted to me. Col. King sent for
me and asked me to move into the house the next day, i.e., Friday. I remember the
day, for Khan Sahib Mohamed Omar wanted me to move in too, because it was
Friday! As it happened, I had many guests staying with me at the time, because
of the meeting of the Indian Science Congress in Madras. All the same, I moved in
my official quarters along with my guests in spite of the inconvenience caused to

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them. When they knew the reason, they gave a helping hand to ease the burden
of moving!

How grateful I was to Col. King for this help! He was a religious man. One
afternoon, I remember, he asked me for a lift to and fro from his residence as his
car was in the workshop. I readily consented. As I was driving, he said “I am sorry
I am putting you to so much trouble. I am attending a religious meeting. Two
ex-army officers are addressing us. I do not know what you would be doing in the
meanwhile”.

“Cannot I attend the meeting?”

“Yes, of course, but we shall be praying.”

“Well, in that case, I shall also pray. In England I had attended a service once
and prayed along with the rest, in the Church of St. Albans”.

He said nothing. During the session I had to pray. At the end of the meeting,
the ex-army officer asked me:

“Do you get much Christian fellowship at Guindy?” I replied that “the only
Christian friend I have in Guindy is my Director, Col. King.” He looked at me and
asked whether or not I was a Christian. When I replied that I was a Hindu, he just
walked away!

Little episodes like these have their impact on human relationship. I got on
very well with Col. King.

In spite of all this, like all Englishmen at the time, Col. King could not tolerate
the sight of a Gandhi cap. Even so, I would like to relate an incident. When Gandhiji
was sentenced to nine months imprisonment, we were very sad. That evening, Dr
Nimbkar, who was a practising ophthalmologist, in the city came to see me. The
talk inevitably led to the topic of Gandhiji’s imprisonment. In the end we decided
to give up smoking till his release. What an impotent gesture, as I look back on it
today! However, when Col. King asked me the next day in the laboratory why I was
not smoking as usual, I told him. He looked at me and said “Pandit, I understand”,
and walked away.

Col. R. E. Shortt who succeeded Col. King as the Director of the Institute was,
in my opinion, one of the few scientists who did everything with his own hands.
Indeed, he did not like any laboratory attendant to meddle with anything. He used
to keep everything that required cleaning and washing in a sink. The attendant
was not permitted to touch or remove any bottle of a reagent on the table. His
table was always littered with bottles, and some of them even without labels. He
was fond of collecting prehistoric stone implements, from riverbanks. I had often
accompanied him on such trips.

After the Munich crisis, he was going on leave prior to retirement. In bidding
him goodbye at the station, I said, “By the look of things, I am afraid you would be

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recalled, and you will come to Guindy, and if you do, I will receive you in my new
car, and you will find your laboratory exactly as you have left it today”. I did exactly
as I had promised. I had kept his laboratory locked with all the bottles of reagents
lying about on the table!

I will always remember with gratitude help and guidance which I had received
both from Col. King and Col. Shortt.

IV
I become a Professor of Bacteriology in the

Madras Medical College

In 1926, the Government reorganised the teaching of pathology in the Madras
Medical College. It was decided to separate bacteriology from pathology and a
new Chair for Bacteriology was created. I was appointed the first Professor of
Bacteriology in June 1926—of course in addition to my duties in the Institute, with
an honorarium of Rs. 100/- per month! Twice a week I had to deliver lectures. On my
recommendation, Dr S. Ramakrishnan, then an Assistant Surgeon in the Institute,
was appointed full time Assistant Professor to look after the practical classes and
work in the Department.

The first day in the College was rather amusing. Along with me Col. Hesterlow,
the Assistant Director of Public Health, was appointed Professor of Hygiene. He was
to take the lecture first and I was to follow him. As soon as he returned from the
class after addressing the students, he met me and told me that the students were
rather rowdy and wanted to warn me about their behaviour. I took the hint. That
being my first encounter with the students, I told them, smiling, that I would like to
take the rollcall, not for knowing who were present or absent, but only to make their
acquaintance. They were, of course, free to attend the class if they felt interested. I
had no trouble thereafter. As was natural, I had recommended Hewlett’s Bacteriology
as the textbook. He had referred in the book to my research work in England. I was
told that this had enhanced my reputation! In any case, the students used to listen
to my talks “with pindrop silence”, as one student told me later!

Then there was an amusing incident. I had to take a written examination to
award a prize in Bacteriology. Two students qualified as they obtained identical
marks. One of them was a lady student. I decided to hold a ‘practical’ which was,
normally, not done. She mistook a spirochaete for microfilaria. She was disqualified.
I was told later that students expected the lady student to win the prize! Why? I
need not say!

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In addition to the 4th year students, I had to take classes for the B.S.Sc.
students (Bachelor of Sanitary Science) as well. Since Lt. Col. A.J.H. Russell, the
Director of Public Health of the Province was reorganizing the Public Health
Department, many students after their graduation from the College sought
admission to this course. As a matter of fact, all students of the first two batches
who qualified were absorbed in the Department as municipal or district health
officers. This was indeed most fortunate as these officers were of great help to me,
as my former students, in our epidemiological field investigations.

I found this part time arrangement most unsatisfactory and in due course
I suggested that it was essential for better teaching and for the development of
the department to have a fulltime professor. The recommendation was accepted.
However, I was rather surprised to receive a letter from Dr A. Lakshman Swami
Mudaliar, who was then the Personal Assistant to the Surgeon General, enquiring
whether I would accept that post ‘at my own terms’ as was mentioned in the letter.
I met him in his office and told him that I was not keen in leaving the Medical
Research Department. A few days later, I was sent for by Col. Hingston (IMS), the
Principal of the College. He wanted to know why I was not accepting the post. I
was rather surprised at his interest in the affair since he had hardly taken note of
me otherwise or in the meetings of the College Council.

My interview with him, however, was most cordial. When I told him of my
inability to accept the post, he informed me that the students who had waited on
deputation on him were most keen that I should accept the post. I did not know
that I was that popular with students! In my class in the first year was Dr K.N. Rao
who became later the Director General of Health Services in New Delhi and Dr
Ayyar who, after a career in the army, became the Chief of the Safdarjang Hospital
and a renowned surgeon in New Delhi. In the B.S.Sc. class was Dr Viswanathan, who
distinguished himself as the dynamic Director of Public Health of the Maharashtra
State and later in the WHO. I must, however, make it clear that I do not mean
to suggest that I was in any way responsible for their success! I relinquished my
duties as Professor of Bacteriology in June 1928.

V
I attend a course in malariology In Karnal

It was suggested that I should take this course as the Institute was always
involved in investigations of epidemics, which more often than not, at the time,
had turned out to be malaria epidemics.

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I arrived in Karnal almost at midnight. It was the field station of the Malaria
Institute of India. I was surprised to find Col. Sinton V.C., who ran the course, waiting
to receive me. In the room allotted to me, he personally saw to it that I was neatly
tucked up in bed with the mosquito net in position. He went through the whole
ritual of examining with the torch that no mosquito had got in! The malaria ritual
had begun! The class was composed of about forty officers, mostly of the IMS and
others deputed by the Health Departments of Provinces. Amongst my colleagues
in the class was Dr D. K. Viswanathan, who had been my student in the B.S.Sc. class.
The course consisted mostly of mosquito collections in different localities in and
around the city, their breeding and identification. In lectures, general principles of
malaria control were discussed including conduct of surveys of affected localities.
I used to take full notes of these lectures. Dr Viswanathan was rather amused at
this and said “Sir, why do you have to take notes? You had taught this to us in the
class in Madras”. I replied by saying that I was attending the course as a student!

There was hardly any social meeting or get together after the formal work of
the day was over. The IMS officers, both Indian and British, kept to themselves.
They had arrived in Karnal with their bearers who used to attend to them also
during meals. Of course, I had no bearer! Col. Sinton was a very hard task master.
Then came the final examination both written and oral. In the viva voce, he asked
me what I would do to the isolated community of about 500 people living under
certain malarious conditions. There was a drawing on the board showing a few
huts and a running stream close by. I replied that I would start treating the people
first and then was about to proceed to outline some antimalarial measures. He
was pleased and almost exclaimed: “You know, Pandit, you are the only one to
suggest treatment first!”

I was told that I stood first in the examination. I returned to Madras in
December 1928.

VI
Sojourn in Patna to learn the manufacture of cholera

bacteriophage

This was the time when there was considerable interest in the utility of
bacteriophage in the control of gastroenteritis epidemics, e.g. Dysentery and
cholera. Who had suggested this approach to the Government of India, I do not
know. We got the information in the Institute that Dr Asheshov, a pupil of Dr D.
Herth, was on a visit to India, on the invitation of the Government. It was to be one

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of his assignments to select a centre for the manufacture of bacteriophage in the
treatment of cholera. He was to visit the Institute for that purpose.

Col. King asked me to look after him. One evening I was asked to show
him the sights of Madras and then drop him at the Madras club. I told Col. King
that I would drop him outside the Club and I hoped that he would find his way in. “I
am sorry, Pandit, I understand”. We ‘natives’ were not allowed inside the premises
of the Club as it was reserved only for whites even though I had to visit the Club in
the morning, on many occasions, to look after their water supply installations!

Dr Asheshov finally chose Patna to establish his laboratory. When he was
well established there, it was arranged that I should work with him and learn his
techniques. I spent nearly two months with him in January and February 1931. He
kept his notes in Russian, but I kept notes of what I was doing. Though Asheshov
was a foreigner, he behaved in Patna as he was a Britisher! He spent his evenings
in the club where I was, of course, not admitted.

On return to Guindy, I started manufacturing cholera bacteriophage and
tried its usefulness in the treatment of cases of cholera. This was the beginning
of my association with bacteriophage which eventually involved me in interesting
developments which I shall narrate in due course.

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CHAPTER III

ROCKEFELLER FOUNDATION FELLOW IN VIROLOGY
(1932-1933)

In 1931, Dr Heisser of the Rockefeller Foundation had visited the Institute.
The Foundation, then, was awarding annually three fellowships to Indian
graduates working in Public Health fields for studies in the USA. I was selected
for such a fellowship for the study of virology. I was really excited at the prospect of
visiting USA. After the necessary formalities were over, including answering much
important questions as “Are you a bigamist?” or “Do you believe in the overthrow
of the United States government by violent means?” or “Are you a lunatic?”, or
something to that effect. I left Madras on the 3rd of January 1932 for Bombay
and sailed for London by the P&O Liner, S.S. Maloja, the very ship by which I had
returned from London. After a week’s stay there, and outfitting myself with two
new suits, I sailed for New York by the German ship, S.S. Bremen the largest ship,
I think, at the time, about 57,000 tons! Having travelled by the “S.S. Loyalty” about
5,000 tons, this was huge, with all the amenities of a ‘modern’ hotel though I did
not know of any ‘modern’ hotel then! The voyage was uneventful, though certainly
not very pleasant, what with cold, fog and storm, during only 4 days of voyage! I
would have had no vivid recollection of the journey but for a very long letter I wrote
to my brother in London. One young passenger complained that he had not seen
so many old people before. He asked me if I was in Dublin. I said, “Why should I
be in Dublin?” Another asked if I was in Guiana. I do not know even today how
Guianians look like, and so did not know why he mistook me for one. Socially, it
was not a bad voyage. In later years when I had to go abroad quite frequently’ I
always recollected travel by ship. In an aeroplane you do not have time to know
even your air hostess! We arrived in New York at 4 PM. A representative of the
Foundation received me and took me to Hotel New Yorker.

The next day my programme for studies was finalised. I was to work in the
Department of Virology with Prof. Hyde at the School of Hygiene and Public Health
of the Johns Hopkins University, Baltimore. I was told that was the only department
of virology at the time in USA! In addition, the Foundation agreed to my suggestion
that I should work with Dr Chambers, Professor at the New York University, New
York, for a month or so and study the techniques of micro-manipulation. I was told

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that Dr Chambers had agreed, rather reluctantly, for in his opinion, a month or so
was too short a period for the purpose. Finally, I was advised to read “Middle Town”
by Dr Robert and Helen Lynd (brother and sister) which described the life of the
American people - how they live, educate their children, spend their leisure and
such other matters. It was a sociological study of a town in mid-west, hence the
name. I enjoyed reading it and in later years always mentioned it while discussing
“Future Shock” or “Greening of America” which dealt with current problems of the
American people.

It is now amusing to recall the type of instruction we received in virology. Tissue
culture meant cultivation of a bit of heart muscle from a developing chick embryo.
It was very fascinating to observe the beating - like heartbeat-of a fragment of
chick heart. Occasionally, when everything was just right, one could observe the
beating of solitary muscle cell! I was lucky to get this in one of my preparations
and the whole class was asked to see it. Then there were a few experiments
with vaccinia virus. Prof. Hyde used to take lectures on different viral infections.
That was the type of “virology” we did. How different is the state of affairs today!
I have often reflected on those days when tremendous advances were made in
tissue culture techniques etc. But most significant advance in later years was the
availability of antibiotics for processing the biological material. One thing I learnt
then, i.e., self-help. There were no attendants to bring to you the rabbits and no one
to hold it when you did the inoculations! How different this was from the life in
my laboratory in Guindy! I could not then but remember what Dr S. Ramakrishnan
used to do. Spotlessly clad in China silk suit he used to sit at his working table and
an attendent or two used to pass to him from behind a platinum loop or a needle
and take it away from him the same way!

Life in the department was very pleasant. There was good comradeship. I
made particular friends with a few and one of them was Dr Cox who later joined
the Laboratories at Hamilton, Montana, and later still the Lederle Laboratories at
Pearl River. I remember, as we were leaving the laboratories after the day’s work
was over, he called me and asked me to be in the laboratory before 9 AM. “Why?”
I asked. “Don’t ask questions, just be there”. I obeyed. At 9 AM he and my other
friend brought 100 cc. of absolute alcohol, poured 30 cc in each of the three glasses,
added a dash of orange juice. We drank it all! However, we didn’t turn a hair and
did our day’s work as usual!

Just at this time Dr Cox got engaged and I decided to stand him a dinner, I
told him to choose the restaurant. “Shall we have beer?” he said. “Beer?” I asked,
for those were the days of prohibition. “I do not mind, but I would not like to go
to ‘speak easy’. However, there were the “joints” where liquor was easily available.
In the end we found ourselves in a restaurant and as we and others were drinking
beer, the policeman was walking to and fro outside!

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Talking about prohibition, I have another amusing incident. A resident in the
hospital with whom I got friendly, asked me to join him. “We are going to have
lunch with my uncle”, he said. The uncle was the president - or something like that
- of the University. “Come to my room in the hospital quarters in the morning and
then we will leave”. I agreed. When I went to his room he was lying on his bed as
nature had made him. “Get dressed”, I said, “and then we shall leave”. “Not till we
have something to drink”, he exclaimed. To my surprise he ordered the “Froze” by
telephone. As we were about to leave, he said “Eat this, my aunt does not like the
smell of liquor”.

In due course we had lunch with the President. At about 4 PM we decided to
leave. The President said, “Have a high ball before you leave”. Scotch was brought
in with three glasses. Before we could sip our drink, the aunt exclaimed, “Just let
me see” and took a sip out of her cousin’s drink. After we left, I told my friend that
his aunt was quite liberal in her outlook. “Yes” he said, “but that was entirely in your
honour!” I learnt later that the State of Maryland was not really for prohibition.

The staff of the department was equally friendly. I was a frequent visitor to
Prof. Hyde’s household - for picnics and the like. The tutor was equally friendly,
and we used to talk about American life etc., and discuss “Middle Town”. He had
just divorced his wife and was rather sad about it. “Well, Pandit, I had given her
everything she wanted. I gave her even a radio!”

After the studies at Johns Hopkins were over, I proceeded to Woodshole
(Massachussetts) to work with Dr Chambers at the Marine Biological Laboratory
there. Dr Chambers used to spend his vacation there along with his students.
Indeed, this was the practice followed by many professors at other Universities in
the USA. The laboratories were always open, and the students could work there
whenever they liked. If the weather was fine, they would be enjoying outdoor. If it
was wet, the students spent their time in the laboratories.

I arrived at Woodshole in the afternoon and went to the hotel where my
room was booked by the Foundation. However, the clerk at the reception desk
was rather hesitant to register me, when the manager who happened to spot me
asked the clerk to give me the room. When later in the afternoon I was resting
in the verandah, the manager approached me and profusely apologised for the
rude behaviour of the clerk. “What was the trouble” I asked. “He mistook you for
a mulatto or something” he said. “How did you know I was not one?” “I know you
were from India. I am English”. He had every reason to know an Indian!

Next morning I went to the laboratory to see Dr Chambers. I was told he
was not coming that day as he had been working the previous night. He was
expected late in the afternoon. I met him then and had general discussion on
the programme of my work. Next day, he showed me all the manipulations with
the micro-manipulator which bore his name as he had developed it. I practised

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the technique for a week when he told me that the best way to learn is to take
a research problem. He asked me to determine the pH of a sea-urchin’s egg by
injecting various dyes without in any way injuring the egg. After a little practice,
I succeeded. The observations were recorded in a paper of which I was the senior
author! He was obviously pleased with my work for later in New York the Foundation
congratulated me for having secured a fine report from Dr Chambers. Life in
Woodshole was most pleasant: what with outings in the neighbourhood with Dr
Chamber’s family and delightful evenings in their home when the weather was
rather uninviting. When I left, he gave me a 16 mm film describing the techniques
which I had exhibited many times in the Institute.

On returning to New York I stayed at the International House. That was a
most delightful experience when I could meet students of different nationalities. I
found the Chinese most open hearted and full of life. Koreans, on the other hand,
were very quiet. Korea was then under Japanese rule. They were afraid of talking,
I gathered, with other students. However, there was one rather painful experience.
One day flags of all nations were put up. I do not recollect the occasion now.
“Where is the flag of your country” my Chinese friend asked. I said “It is not here
today, it will be there some day”. He understood.

As I remember now, I was somewhat involved in many political discussions
on India. There was keen interest in the Indian problem in the United States and
one was struck with the genuine sympathy of the American people in that regard.
I met once Dr Sayyad Mohamed who was later ambassador to Egypt. He was
well conversant with what was happening in India. “Do you know the words of
Jana Gana Mana by Rabindranath Tagore?” I said I heard it sung at one of the
functions in Madras, but I do not recollect the words. Little did I know then that it
would be India’s National Anthem! There is another episode which I must relate.
In Baltimore a student asked me if what was written in Katherine Mayo’s “Mother
India” was true. I replied that, yes, some of it was true. “What, you think so?” “Yes” I
replied. “I would write the same way of America”. He understood and left.

The assignment in the USA being over, plans were made by the Foundation
for me to return to India. It was suggested I should spend a fortnight or so in the
Strangeways Laboratories at Cambridge, England, and work with Dr Honor Fell
and learn some tissue culture methods. It was also considered desirable to work
with Dr Elford and learn the making of celloidin membranes with different pore
sizes for filtration of biological fluids to remove bacterial contamination. This was
essential since at that time, antibiotics had not come into being. The membranes
could also be used for determining the size of various particles.

Accordingly, I sailed from New York by the S.S. Eropa, the sister ship of S.S.
Breman. Life on boat was most pleasant and the weather was fine. However, I was
not particularly excited specially with the arrangement on board since I had grown
fully accustomed to life in good hotels with modern amenities. The passengers

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on board were rather amused at my “English” accent. I was also amused at such
remarks for writing home on board the S.S. Breman. I had said that the process of
my “Americanization” had begun! I must confess, however, that I felt like arriving
home when I landed at Southampton!

The sojourn of two months in England was very interesting particularly at
Cambridge. Dr Fall was working at the time on the growth of embryonic chick
bones, femur, in tissue culture. In Dr Elford’s laboratory in the Medical Research
Institute at Hampstead, I made the acquaintance of Dr Burnet, later Sir Mc Farlane
Burnet, O.M.

Thus ended my fellowship programme and I resumed my duties at the King
Institute.

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CHAPTER IV

THE SHILLONG INTERLUDES

I

Soon after my return to Madras from the Rockefeller Foundation fellowship,
I received orders to proceed to Shillong to take up the appointment as the
Director of the Pasteur Institute and Medical Research Institute there. Col.
Morrison was the Director of the Institute, but he was to officiate as Surgeon
General, Assam, in a leave vacancy, and I was to take his place. Prior to departure
from Madras, Col. Morrison had intimated to me that he would be vacating the
Director’s bungalow and I could occupy it, that the house would be furnished and
that I should bring only the immediate necessities, including, however, carpets.
All the arrangements for the transport of my car and baggage were entrusted
to Messrs Thomas Cook and Sons, Madras. Their representative also met us in
Calcutta to make the necessary arrangements for the onward journey from
Sealdah (Calcutta) to Parbatpur and by meter gauge train to Amingaon. There we
had to cross the Brahmaputra by ferry to Pandu. From there it was just two hours
journey to Shillong.

The journey was long but did not prove tedious. It was certainly very pleasant
from Sealdah onwards. Col. Morrison received us at the taxi stand in Shillong,
and after lunch took us to our home. Later in the evening Col. Morrison drove us
to the residences of various Government officials, both British and Indian, to drop
our visiting cards in their ‘Not at Home’ boxes. We had thus ‘called on’ them. They
could then invite us to their homes whenever they wished! Invariably they did.
Soon after I was admitted as a member of the Shillong Club, but I had no voting
rights!

The next day there was a tea party at Dr Vardon’s house. He was the Assistant
Director in the Institute. One of the guests was Shri Barua, then the Health Minister
of Assam. He gave me a good look and exclaimed that he had expected to see an
old gentleman with a Poona turban! I said I was sorry if I had disappointed him! I
learnt afterwards that he had made all enquiries about me from Dr Heisser of the
Rockfeller Foundation who had visited the Institute previously.

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The next day, Col. Morrison gave me all the details about work in the Institute.
He was most interested in bacteriophage and believed that with its use in the field,
epidemics of cholera could be controlled effectively. He had organised distribution
of bacteriophage in the villages for immediate treatment of cases of cholera.
A stock of bacteriophage ampoules was kept with each village headman for
administration to the patients immediately on the appearance of first symptoms of
cholera. The stock, of course, was to be periodically replenished from the Institute.
Hence, he told me that my primary duty was to manufacture bacteriophage in
sufficiently large quantities. Indeed, I found that the Institute was mainly occupied
with this, in addition, of course, with the manufacture of cholera vaccine, though
on a small scale, and anti-rabies vaccine for the treatment of dog bite cases. In
view of my previous acquaintance with bacteriophage manufacture, I was fully
conversant with the technique, during my sojourn at Dr Asheshov’s laboratory in
Patna. Perhaps this was the reason why I was posted there. I was told that there
was a lot of discussion about my appointment. They never had an Indian as the
Director before. I realized that I was on ‘trial’!

On the 5th October 1933, Lord Willingdon, the Viceroy, visited the Institute.
This was my first experience of receiving a dignitary. The security officer saw me
couple of days before the visit to discuss the arrangements. He asked me whether
I was familiar with the staff. I replied that I was new to the Institute and did not
know any of them personally and certainly not their antecedents. In that case it
would be necessary, he said, to search them that morning before they entered
the laboratories. I agreed but said that the search would begin with me. I did
not want anybody to be exempted from the procedure. We adopted a simple
procedure. Laboratory overalls were freshly laundered and kept in one room. Only
bare minimum of staff was allotted to each room, the rest were made to assemble
at a suitable place in the Institute’s grounds, where they would get a good view
of the arrival and departure of the Viceroy. They were also instructed to cheer the
guest on both the occasions. Early in the morning the staff assembled, took of
their coats, and put on freshly laundered overalls. Thus, they could carry nothing
in the laboratories or conceal anything. These procedures were necessary since
there was the danger of some revolutionaries being about.

Then an amusing incident took place when I was about to introduce the staff.
They were asked to stand in a row, with Dr Rice and Dr Savage occupying the first
and second place. Dr Rice was a tall and hefty individual. Unfortunately, they both
exchanged places without my knowledge. Automatically, I introduced Savage as
Rice. I noted the mistake as I looked at them. There was no time to amend it
and Dr Rice in turn was introduced as Dr Savage. I thought it didn’t matter since,
I believed that Lord Willingdon wouldn’t know them anyway. The Viceroy had a
twinkle in his eye, as I did the introduction. Apparently, he knew Dr Rice personally
as I came to know later. That night during Dinner at the Government House, he
recalled the incident and complimented me for what I had done!

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As I said, I was mainly occupied with the manufacture of cholera bacteriophage.
The final product consisted of several types of phages isolated by the techniques of
Asheshov, labelled from type A to type M. New types could easily be developed by
subjecting a strain of V. cholerae resistant to all known types and then exposing it
again to the action of sewage. A new type thus could easily be developed. In the
manufacture, all the types were included in the ‘brew’.

The mornings used to be spent in attending to cases of dog bites. I must
confess I did not like the work at all. In frank cases of dog bites treatment could be
recommended according to rules, but in cases of licks how was one to decide the
possible risk of infection? Who can take the risk of advising that no treatment was
necessary! A wrong advice can take you to the law courts! We always played for
safety. How very unscientific all this seemed to me!

At this time Dr Sinton was working on the chemistry of cholera vibrios
and he had written to Col. Morrison for representative strains of cholera vibrios.
I suggested to Col. Morrison that we should send strains developed from single
cholera vibrio. I said I could do this with the help of a micro-manipulator which I
had, incidentally brought by me from the School of Tropical Medicine in Calcutta,
when I had visited it on my way to Shillong. It was lying in the stores unused.
Col. Morrison readily agreed and was really impressed when I showed him the
technique. However, when the news got round in Calcutta that I was helping Dr
Sinton thus, I got frantic messages to return the micro-manipulator to the Tropical
School since it was ‘urgently’ required there. I had to return it, of course, but found
it safely deposited in the stores later.

While we were thus busy with routine work, unfortunately, a severe epidemic
of cholera struck Assam. A batch of labourers from Mymansingh in Bengal sailed
up the Surma river as far as Lushai Hills to cut bamboos. There, one of them got
cholera. His body was thrown in the river and the rest in panic sailed down the
river to reach their destination. After a few hours journey, another developed
symptoms of cholera and died. At the bathing place near a village, they washed
their clothes and sailed. A woman of the village collected water for drinking from
the same place. The village was struck with cholera, and this was the beginning of
the epidemic, which was spread with great rapidity, first in villages along the river
and then into the interior.

Col. Morrison suggested that I should visit Silchar and look into the distribution
of bacteriophage. However, later he suggested that Dr Rice, who was doing
malaria work in the Institute should look into that question and I should organise
a laboratory in Silchar for the isolation of cholera vibrios from patients receiving
bacteriophage.

I arrived in Silchar in the evening and found the Circuit House crowded. The
office of the Public Health Department was also temporarily located there. I was
told that no room was available in the Circuit House. However, when I went round, I

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found a whole suite on the first floor vacant—a bedroom, bathroom, and a dressing
room. “Is this suite reserved?” I asked. It was not and after some hesitation, the
attendant said I could take it if I wanted it. One of the officers I knew asked me
to share his accommodation. I said I would prefer to be alone since the suite
was available. Next morning, I was asked if I had a comfortable night, and when I
replied that I had, they said nothing. Next evening, my stenographer joined me
and since there was not any accommodation available, I asked him to occupy the
dressing room in my suite. Late at night he shouted: “Sir, do you hear something?”

I replied that I did not hear anything, for I was really tired and wanted to sleep
and asked him to go to sleep. A few moments later he almost yelled “Sir, do you
hear something now?” By that time, I was fully awake and listened. There was
certainly some kind of a noise in the adjoining hall, noise of turning pages from
a book or something. When he shouted again asking me to listen, there was a
sound from the hall and we heard the words: “Gentlemen, am I disturbing you?”
Both of us were rather surprised to hear this, and we tiptoed to the hall. We found
an officer seated on the sofa looking into some files. The officer had arrived at
the Circuit House and not having any accommodation, had decided to rest in the
adjoining hall and was reading some official files.

The whole mystery was solved. Apparently, the room I was occupying was
regarded as haunted. It would appear that years ago an English officer had
committed suicide by shooting himself with a revolver and it was stated that blood
had trickled down in the room below! Since then his “Ghost” was in the habit of
visiting the premises periodically. Hence everybody was reluctant to occupy the
room, and hence the reluctance with which I was given the room. My stenographer
who knew the story was equally afraid to live there and when he heard the noise,
he was sure that the Ghost had visited the premises that night!

This was not the first time that I was living in a haunted house. Our house
in Saidapet had that reputation and “Nawab Gardens”, the official residence of
the Director of the King Institute, was also known to be haunted. It was near the
Guindy race course and a jockey who had died in an accident was credited with
visiting it “fully clad in dinner jacket”. Obviously all ghosts are not bad and some
of them can even provide amusement and an opportunity to tell ghost stories,
always an interesting subject of conversation at parties, specially when ladies are
present. I seldom missed an opportunity to entertain them!

I set up my laboratory in Silchar. Dr Rice in his daily visits to the field brought
samples of stools from patients both from those who had received the phage (and
these were few) and from others. It was agreed that after a week’s work I would
return to Shillong, and an Assistant Surgeon from the Institute would take charge
of it. I had left Shillong in a hurry without taking cholera inoculation. I expected to
return any day to Shillong. As it turned out, I had to be in Silchar for nearly a month!
I took food served steaming hot on the table and spent the evenings in the club. I
did not set a very good example for a public health official! I must confess, however,

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that I was not happy with the results of isolation of cholera vibrio from stools. I do
not know why. Perhaps, though I was the Director of the Institute, I had yet to
develop the competence of an experienced technician! Or was it because, as was
noted elsewhere, bacteriophage treated cases did not always give positive results?

However, as was to be expected, as the epidemic rose in intensity, the
demands for cholera vaccine rose enormously. The stock of cholera vaccine in
the Institute diminished rapidly and the manufacture did not keep pace with the
demand! At least I was informed that the Government was considering buying the
vaccine from the Bengal Immunity Company in Calcutta. I did not quite like the
idea. I did not like the impression to gain ground that the first Indian Director of
the Institute could not cope with the demand for the cholera vaccine! As my work
in Silchar was, in any case, ending I decided to return to Shillong to see what could
be done in the matter of vaccine supplies.

After consultation with my Assistant Director, Dr Vardon I decided to have
three shifts for increasing the manufacture. The first two shifts were to work
from morning till 7 PM each day and the third from 7 PM to midnight. I called for
volunteers for the third shift and offered to pay one rupee per day per person to
those who so volunteered. There was no question of “overtime” in those days. All
the members of the staff volunteered. It was, therefore, easy to arrange the shifts.
I put myself in charge of the 3rd shift, i.e., from 7 PM to midnight. All members of
the staff of the Institute were thus involved in the manufacture. At the end of 10
days, we had met all pending demands of the vaccine and had also a small surplus!

I must refer here to an amusing incident during this period. One evening the
Health Minister, Hon. Shri Barua had called us to dinner. I told him my inability to
accept the invitation because I was to be on duty at the Institute then. He did not
say much on the telephone, but came personally to the Institute at that time, as I
was told later, to verify that the Institute was really working till late at night. When
subsequently he congratulated me on the effort, I enquired, since I had incurred
some expenditure on shifts, especially the third shift, whether the Government
would reimburse me with the amount. He regretted that there was no provision in
the rules to do so. At any rate I was happy with the thought that as the first Indian
Director, I had not let the Institute down in an emergency. I must also state that
His Excellency the Governor also sent me a letter congratulating me for the work I
did during the epidemic. Thereafter, whatever proposals I had made regarding the
Institute, they were agreed to readily.

Soon after my term as “officiating” Director ended and I returned to Guindy,
though Col. Morrison did try to persuade me to continue to work in Shillong, if
need be, under the auspices of the IRFA.

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II

I had to go again to Shillong in 1935. Col. Morrison had retired and Col. L.A.P.
Anderson had taken his place. Col. Anderson had to officiate as Surgeon General
and this time the Government of Assam asked for my services to officiate as the
Director of the Pasteur Institute. I had no idea then that I would be called upon
to pass a judgment on the experiment initiated by Col. Morrison on the utility of
cholera bacteriophage in the control of cholera epidemics. From what has been
stated previously, it would be apparent that he was a firm believer on the utility
and efficacy of cholera bacteriophage in the control of cholera. His experiments
were undertaken on the belief that phage not only had some role in the treatment
of the disease, but had the additional advantage in reducing the infectivity of the
V. Cholerae. The modus operandi of the experiment was as follows.

Two districts were chosen for the study. One was the Nowgong district in
the Brahmaputra valley and the other, Habiganj district, in the Surma river valley.
The two districts differed somewhat in many of the epidemiological aspects of the
disease particularly in their proneness to epidemics, and the routes of infection. In
the two districts bacteriophage was distributed to each village in two cc ampoules
and the maintenance of adequate stock with the village headman was ensured.
It was the duty of the village headman to administer the phage to all suspected
cases of cholera.

I remember I had spent many anxious moments in analysing the data and
to come to any definite conclusion on the outcome of the interesting experiment.
The task was, however, made easy by the IRFA which had provided adequate
statistical assistance for the analysis of data collected. I would now quote a few
relevant extracts from the report which I had then submitted to the Scientific
Advisory Board of the Indian Research Fund Association.

It was noted that cholera vaccine had not been used in the two districts, in
Nowgong since 1929 and since 1932 in Habiganj. In judging the phage distribution
in these areas, the other districts in the province were taken as controls. These
were, however, not controls in the strict sense of the word, for during an epidemic
bacteriophage was being used widely by the Public Health authorities along with
preventive inoculation and other measures. One might suppose, however, that as
early cases of cholera were not being treated as cholera in those areas, the progress
of the epidemic would not be modified to any great extent. However, the use of
cholera vaccine along with bacteriophage there introduced another complication
from this point of view. In these circumstances, it was difficult to assess the value
of bacteriophage as the sole measure in the prevention and control of cholera in
the experimental areas.

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As regards the actual incidence of cholera in the two areas, the situations
were rather intriguing. Nowgong district almost escaped infection. The epidemic
had started in the Goalpara district on the Bengal border and spread westward
along the Brahmaputra River affecting Kamrup and Darang districts in succession.
In Nowgong only four villages were infected. Thus, for the 6th year in succession
Nowgong had remained free. Could this freedom from cholera be attributed to
bacteriophage? This could be suggested, but the proof was not convincing. There
were reasons to believe, if we were to take the behaviour of the epidemic in the
adjoining districts, that Nowgong district was not seriously threatened with an
epidemic. Again, in the four villages affected, most drastic action was taken to
prevent the spread of infection.

The epidemic in the Surma valley was a severe one. In the Habiganj district,
many villages had severe out-breaks. The data were collected from the following
aspects:

1. Total number of cases and percentage mortality in each of the sub-
divisions;

2. Number of villages affected in each division;
3. Number of villages which had only a sporadic outbreak;
4. Villages having five or more cases in each; and
5. Average duration of the epidemic.

The Habiganj Division did not compare very favourably with other divisions.

I had to conclude that the bacteriophage experiment as it was conducted did
not yield any conclusive evidence on its utility in the control of cholera epidemics.

The Scientific Advisory Board of the IRFA accepted these findings and with
this the bacteriophage era in the treatment of cholera also ended. In my view, it
was a sad end for otherwise a promising enquiry! Was this a wise decision? I do not
know. Much later, in 1950, or thereabout, I had to attend a meeting of the ‘Office
el Internationale de Hygiene Publique’ in Paris where we discussed this question
and where I voiced the feeling that perhaps the closure was premature. There
were, I thought, many lacunae in the experiment. To rely solely on the judgment
of the village headman whether bacteriophage should be administered or not
was certainly not an ideal procedure to adopt. Indeed, during the period of my
stay in Shillong I had occasion to study the epidemics, one in the Mondair village,
and the other in Manipur. In the first, in spite of bacteriophage administration the
epidemic ran its usual course with nearly 70% mortality. In Manipur, however, there
was some indication of it having some beneficial effects. Of course, in Manipur
I had three groups of cases to consider those receiving bacteriophage, those
receiving Ayurvedic treatment, and those who had received no treatment. I had
always felt that to compare the results obtained with specific treatment with

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those in the ‘no treatment group’ was not really a valid procedure, especially in a
disease like cholera where even a little attention to patient care might make all the
difference, and this aspect might be wanting in the group receiving no treatment.
Inclusion of a group receiving Ayurvedic treatment removed this bias in assessing
the results of treatment. It was thus possible to get real idea of the efficiency of
treatment, if any.

Rest of my work in the laboratory was concerned with the manufacture of
anti-rabies vaccine and treatment of cases of dog bites and treatment of cases
of rabies admitted to the hospital attached to the Institute. I have already stated
how dissatisfied I was with the way we gave advice regarding the necessity of
treatment or otherwise. Then an incident occurred which upset me considerably.

Once late in the evening as I was driving along the winding road to the
Institute, my headlights spotted a dog who then ran up the hill towards my
bungalow. On reaching home, I was told that our gardener was bitten by a rabid
dog and that he had gone to the laboratory to receive treatment. Apparently, the
Gurkha gardener and the dog had a fight! I found that he had over 30 wounds, big
and small. By the time I went to the laboratory, he had already received treatment.
However, I felt rather uneasy I gave him leave for a month and asked him not to
work in the garden and take complete rest. He, on the other hand, was insisting
on doing work. I refused.

Two months later, when I was having tea with Dr Verdon who was also
living in the campus, I was asked to go and see the gardener urgently. I had the
premonition of what was coming. The gardener was lying on his cot groaning.
When I gave him water to drink, he threw it out. He had rabies! I was told that he
was also getting violent and was abusing everybody. I knew he would refuse to go
to the hospital. I played a ruse on him. I got a stretcher and asked two attendants
to standby. I then gave orders to the Gurkha, like they do in the army, to get up and
lie on the stretcher. He instantly obeyed. He was tied to the stretcher and carried
to the hospital. He was never violent or abusive in my presence. When he saw Col.
Anderson (he was his gardener too) he even spat on him. He lived only for a week.
Knowing the end, how often I had wished that medical ethics had permitted me to
give him morphia and save his agony! I bore all the cost of his funeral.

In due course my sojourn in Shillong ended and I returned to Guindy by the
end of the year.

I had to go to Shillong again in 1940 under almost similar circumstances
as before. This visit was, however, of short duration. The Second World War had
just begun, one could hardly concentrate on work in the laboratory. News about
German advance came with rapidity which bewildered us. Speculation was rife as
to how long the war would last. In the circumstances, apart from routine work in
the laboratory, there was hardly any activity in the research field. Before I left, we

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heard the news of the fall of Paris. I returned to Madras towards the end of April to
resume my “normal” activities in the King Institute, Guindy.

How eventful were these three visits! Socially, we were always busy with
informal parties every now and then. We enjoyed even the frequent earthquakes!
And if a week passed without even a mild tremor, we talked about it. The social
life in the town was equally pleasant. We made many friends, but I must mention
one family to which we got very attached, that of Mr. S.P. Desai, ICS who was the
Health Secretary at the time. The friendship then formed persists even today. He
settled in Poona after retirement, and I came to settle in Poona much later in 1970!

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CHAPTER V

THE CHINESE EPISODE

The Far Eastern Congress of Tropical Medicine and Malariology was to be held
in Nanking, China, in the year 1933. I had attended previously the session
of this Congress in Calcutta and I knew the importance of it from the point
of view of not only meeting the people but also from the point of view of the
quality of discussions that were being held at the time. Apparently, the question of
sending an Indian delegation to this Congress was being considered and I came to
know that the Government of Madras was trying to depute one of its own officers.
I had not applied that I should be included in the delegation, but I came to know
that the Government of Madras was considering my name for the purpose. Just at
that time Col. Wright, Professor and then Principal of the Madras Medical College,
wrote to the Government that he should be sent as a member of the delegation.
The Government was apparently in a dilemma. When Col. Wright came to know
that I was also being considered for the purpose, he wrote to the Government of
Madras stating that in the event of the Government deciding to send only one
person, then it was Dr C.G. Pandit who should be included and that he was willing
to withdraw his request! The Government ultimately decided to include both of
us in the delegation.

We left Madras by train for Dhanuskodi and from there we reached
Colombo to take the ship to China. On board were Sir John Russell, Public Health
Commissioner, Government of India and the leader of the delegation, Col. and Mrs.
Wright, and one Dr Mrs. Pennel. Mrs. Pennel was a Parsee lady and was practising
in the Northwest Frontier. I had not met her before. As it happened, I did not
make her acquaintance on board as I did not know then that she was included in
the delegation. We reached Shanghai after a brief stay in Singapore, Pennang and
Hong Kong. In Hong Kong the Indian community met me on board and requested
me to stop over as their guest. I promised to do so on my return journey since our
stay in Hong Kong was very short.

On arrival at Shanghai there were a number of Chinese awaiting to receive
us. We had gathered on the top deck and were looking down from the railing
to see who had come. Dr Woo Lin Teh, the Secretary of the Congress, and one of

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the noted experts on plague, spotted me and asked me how many Indians were
there in the delegation. When I gave him the number, he said “No, I do not mean
the British members, I mean the Indian members of the delegation”. I was a bit
embarrassed to tell him that I was the only one. In due course he came on board
and invited us to a banquet in the evening and reminded me that Mrs Pandit was
also invited. I told him that I was alone and that my wife had not accompanied
me. He apparently did not understand and replied that he would not hear of any
excuses and that she must come. I thought there was no point in arguing.

Later in the day Col. Russell discovered that Mrs. Pennel was not invited. He
asked me whether I could speak to Dr Woo Lin Teh and get her an invitation.
When I told him he again blurted out, “Of course, I have been insisting on that and
the invitation is already sent. In due course we went to the banquet. Mrs. Pennel
accompanied us. A seat was, however, in the name of Mrs. Pandit. Apparently, Dr
Woo had mistaken the name of Mrs. Pennel for Mrs. Pandit. I explained to him the
situation when we reached the banquet hall. Incidentally this episode repeated
itself again when Mrs. Pennel exclaimed: “Dr Pandit, can I ever get rid of you?” I
said, “Madam, apparently not on this trip”.

The Conference in Nanking was well organized in sections. Dr Woo asked me
if I would agree to be the Chairman on the Session of Plague. I said that I should
consult Sir Russell in the matter. Sir Russell of course readily agreed. The Session
was rather slow to start with and when nobody was forthcoming to speak on the
Agenda item, I said that I was going to exercise my prerogative as a Chairman
and was going to ask Sir John Russell to open the discussion. Sir John gave me
a hard look and opened the discussion. As it turned out the Session gathered
momentum and we had a very interesting discussion on several aspects of plague.
At the end of the session, I received congratulations from all sides, both on the
manner in which I conducted the Session and on my own participation in it. I was
of course working on plague at that time in Madras. The session was over, and we
went to have lunch which was arranged by the Ministry of Communications. It
was not a big affair, and the guests were accommodated not on a long table but
on a number of small tables, four guests to a table and one local member of the
Committee to act as a host or hostess. We had a hostess to attend on us. Her duty
was to look after us in all ways. Just as the lunch started, we were served with a
glass of beer. I need hardly say that because of the encomium I had received at
the Session I was in a rather elated mood when Sir John Russell seated at a table
a little further away, got up and tried to convey some message to me which I did
not understand. He gave up and sat down. I consumed my glass of beer. During
lunch the ‘normal routine’ on such occasions followed. The Chinese rice wine was
served in very tiny cups. We had to gulp it down and show that they were empty.
It was the duty of the hostess to refill them. I had taken rice wine before at the
dinner in Shanghai and I had taken only a glass of beer. I did not know that this
combination was most potent. I was also not accustomed to drink them. Like me,

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Dr and Mrs. Dehangan, delegates from Indonesia who were at my table, had gone
through the same process, and apparently, they also did not know the effect of
the combination of beer and rice wine. By the time lunch ended we were not all
ourselves and, in the end, I was literally helped to get away from the chair to the car
to go to a Committee meeting where I was to preside. Dr Woo was the Secretary
and was to draft the Resolutions to be placed before the Conference. I asked him
“Have you drafted the resolutions?” “Yes Sir”, he said. “Read them one by one”. The
resolutions were read; there was no discussion. We all agreed. The meeting ended
in the record time of less than an hour. After the meeting I was helped to go to the
main lounge where I deposited myself on a chair and went to sleep.

The Chinese had organized hospitality on a very grand scale. A car was
placed at the disposal of four members and in charge again of a host or hostess.
The person detailed to look after our group was a lady technician working in the
Bacteriology Department of the Nanking University. At 5 O’clock that evening she
asked me whether I would like to go for a drive, and also informed me that Dr and
Mrs. Dehangan did not want to. I said I would like to go out for a drive and asked
her to fetch my hat. Apparently, she could not find it and reported so to me, adding
with a smile that it was only a hat that I had lost. I had not yet recovered from the
effects of what had happened at lunch and replied “Miss, having lost my hat, I
am afraid I am going to lose my head!” She blushed. We went for a drive. Again,
she asked me where I wanted to go. I said, “Just drive, anywhere”. We went in the
open country with hood of the car down and the draft in due course helped me to
regain normalcy. After that I scrupulously avoided, throughout the tour, both beer
and rice wine.

The next day there was a session on cholera and Sir John Russell presided. To
make amends for the previous day he called on me to open the discussion!

The Congress was a great success. The Chinese had organized lot of
entertainment in the evenings. One evening a male actor from Peking was to give
us a performance. He always acted the female roles. He was a handsome man and
was held in high esteem by the Chinese. Wherever he went, we were told, he always
drew large audiences. I was, of course, invited to see him acting. That afternoon the
lady technician looking after us came to me and said quite innocently, “Sir, you
have an invitation, both for you and Mrs. Pandit to attend the show. Could you take
me in place of Mrs. Pandit? I am most anxious to see him acting”. I said, “I regret
very much but it would not be right for her to impersonate as Mrs. Pandit”. Why
she blushed on this I did not understand but, nevertheless. I succeeded in getting
her an invitation for the show, all by herself.

After the Conference we were scheduled to go to Peking. We decided to travel
by a slow train in order to see as much of the countryside as possible. The lady
technician was on the platform to see us off. She looked so very sad and even
though requested she would not leave. Dr and Mrs. Pennel could not help asking

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me in Hindi: “Doctor Saheb, what is all behind this?” The journey to Peking was
uneventful. I had a coupe on the train and it was spotlessly clean, and a jug of
Chinese green tea was always ready for us to drink whenever we liked. The
countryside reminded me of what we always see in India, farmers working, early in
the morning and late in the evenings, in fields.

In Peking we stayed for nearly five days. I had an occasion to visit the Peking
Union Medical College which was established by the Rockefeller Foundation with
the explicit purpose of training teachers for China. Apparently, there was a plan to
establish many medical colleges in the country. Peking Union Medical College
was the last word in every detail. The faculty had an assignment to work for three
years when they would be replaced by a new set. I was told that the second set
was charged with the responsibility of assessing the working of the first team and
then to proceed accordingly. The Departments were lavishly equipped, and each
Department was almost independent of any other in equipment. Furniture was
the best and the buildings were of the Chinese imperial style with sloping roofs
with blue and yellow tiles. I spent three interesting days in the College listening to
the lectures and taking down notes on some of the items. I found that the ratio of
teachers to the student was 3:1 and only 25 students were admitted each year. The
Alumni of this institution, as I came to know later, did very wonderful work during
the Sino-Japanese war as well as in the Second Great War. In 1945 when penicillin
was first discovered, one of the students of the College succeeded in making it
under war conditions including the manufacture of glass vials. As I said before, I
had taken exhaustive notes of all that I saw without realising that they would be
useful some day! Dr John B. Grant was the Principal of the College then.

During our stay in Peking it was decided to pay a visit to the Great Wall of
China. We started on our journey by train one early morning. We carried our lunch
with us. Our carriage was attached to a goods train and the journey was slow. As I
got into the compartment, I started fumbling in my pockets for a box of matches
to light a cigarette. Apparently, I had forgotten to take one. A lady sitting right
opposite me, who was an American, lit my cigarette and I offered her one. We
went on talking on various matters and when it came to getting off from the train
and walk some distance to reach the Great Wall, this lady would not leave me. We
had our lunch together and throughout we were together walking and chatting
even on return journey! Mrs. Pennel again remarked in Hindi “Doctor, thus far
and no further please”. The visit to the Great Wall of China was, as most tourists
had found, most interesting. That such a structure could be built through human
effort was in itself such a great feat. No doubt, it is one of the nine wonders of the
world. We were told at that time that if there was a man on the moon, he would
not fail to notice this particular landmark. Looking back, I was rather disappointed
to find that our astronauts had not mentioned about it. We returned to Peking in
due course and after dressing for dinner, I went to the dining hall where the same
American girl met me. She told me that she was one of the actresses in Hollywood.

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After a while she exclaimed “Doc, this is a lousy place, no music, no dance. Let us
go to Hotel Peking for a dance. music and a meal”. I politely refused saying that,
while I liked music did not know dancing and that I was really looking forward
only to a light meal and being tired I wanted to go to bed early”. She was rather
disappointed. After some conversation she told me that she was leaving Peking
the next day. “Would you write to me on return to India?’ she asked. I promised
to do so. We exchanged addresses. When I reached India, I received a post card
with the legend “I have kept my promise. Will you keep yours?” My wife saw it and
asked me hundred questions as to what it meant. Whether she was happy with
the explanations I give, I do not know till this day.

In due course we went to Hangchow and then to Shanghai to take our ship
back to India. On Board we discussed what happened at the Conference and
elsewhere with Sir John and the episode of my getting drunk was referred to. Sir
John said, “C.G. this will also go in your confidentials”. “I hope along with the rest,
Sir” I replied.

We arrived back in Madras and resumed our normal life.

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CHAPTER VI

FILARIASIS-`THE CURSE OF ST. THOMAS’

Ihad lived in Madras for nearly twenty-five years, and quite close to the St.
Thomas’ mount, but I had never heard that filariasis, or rather elephantiasis
was known in the ancient times as ‘The Curse of St. Thomas’ till I came across
an article in the journal ‘Medical History’ by B.R. Lawrence (Ref. Vol. XIV, pp 352-363,
1970). The author quotes from many writers of the time about the legend. I give
here, some relevant extracts arranged to give a coherent picture.

St. Thomas was credited with performing many miracles for which he
received many favours from the Indian King. “Many Indians turned to Christian
faith and when the King of the Indians saw so great a change, he feared that if
he gave more opportunity the said Christians would multiply so much that they
would be able to rise and possess the country. And so, he began to persecute St.
Thomas, who withdrew himself to Cholmandal and then to a city which was called
Mylapur, where he received martyrdom. ... And one day as he wandered about, a
gentile hunter, with a bow saw many peacocks together upon the ground in that
mountain, and in the midst of these one very large and very handsome standing
upon a stone slab; this hunter shot at it and sent an arrow through his body, and
they rose up flying, and in the air, it turned into the body of man. And this hunter
stood looking until he saw the body of the said apostle fall...”

“The Christians appeared now to have accepted the sin as Linschotan also
suggested.”

“And as they say that the progeny of those that slew him, are accursed by
God, which is that” they are all borne with one of their legges and one foote from
the knee downwards as thick as elephant’s legge; the other legge and all their
members without any deformities being well proportioned, like to other men ...”

Lawrence’s article is interesting in many ways. Apart from giving some views,
as expressed by early writers on the doings of the apostle St. Thomas, and the
appearance and disappearance of the legend of the curse, the article contains very
interesting information on what the contemporary writers felt about filariasis in
the west coast of India and their views on the existence of the disease or otherwise

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on the eastern coast- the ‘Coromandal’ coast. Their observations on the whole
situation should be of interest to epidemiologists.

My own interest in filariasis is out of an incident. One fine morning as I
was coming out of my laboratory, I noticed a small boy carrying a garden lizard,
popularly known as ‘blood sucker’ (Calotes versicolor) in his hand. I asked him
to bring the specimen to me. I thought I would see what parasites it harboured.
On dissection I was surprised to find many worms in its peritoneal cavity. It was
a mass of them, and they looked like filarial worms. I asked our entomologist,
Shri. P.V. Sitarama Iyer to identify them. He reported in due course that they were
indeed filarial worms and belonged to a species hitherto undescribed. Because of
its anatomical characters and the place where it was first found, we named it as
Conispiculum glindiensis.

I then toyed with the idea whether the garden lizard could be used as an
experimental animal for the investigation of the filaria problem. With a view to
determine the mechanism of infection in them, it was decided to do a survey to
ascertain the degree of infection amongst them. The results were interesting. It
was noted that the infection was localised amongst the lizards (Calotes versicolor)
in an area, a mile along the Adyar River. It was totally absent in those caught
elsewhere. We succeeded in transmitting the infection to healthy lizards through
bite of infected Culex fatigans mosquitoes. The development of the parasite in the
mosquitoes followed the same pattern as seen in human bancroftian filariasis. It
was interesting to see the infective larvae migrating all over the mosquito tissues,
in the proboscis and in the tissues of legs and elsewhere.

We thus got interested in the problem of filariasis and decided to investigate
the conditions in the town of Saidapet which was just across the Adyar River and
quite close to the King Institute. This town had been surveyed previously and very
high microfilaria rates and elephantiasis rates had been recorded. The condition
had been noted there for a very long time, at least for hundred years. The rates were
based on the findings after examination of people who had been assembled for
the purpose. In order to assess the true picture, it was felt necessary to do a house
to house survey in certain representative areas of the town. The areas selected were
not only distributed in different parts of the town but also were representative of
different occupations of the people. It must be noted, however, that inmates of
all houses in these areas were examined for symptoms of filarial disease. This was
possible because adequate staff was made available for the purpose including the
inclusion of a lady doctor to examine the female population. We used to examine
the people and collect mosquitoes from each house in the morning and take the
blood of the people at night, since microfilaria appear in the blood only during
night. As was to be expected taking blood from children was not easy. The results
were interesting. The microfilaria rate in the population examined was 16.3% while
only 6.5% exhibited signs of clinical filariasis including elephantiasis. However, the

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microfilaria rate in children in the age group 0-5 years was 7.1%. The findings in
mosquitoes were very revealing. Out of nearly two thousand mosquitoes caught
in houses 34.6% were found infected, while 9.5% of them had infective larvae in
them, i.e. capable of transmitting the infection! While cases of filariasis were
noted in some households and not others, the distribution of mosquitoes, and of
infected mosquitoes as well, was remarkably uniform from house to house Special
investigation was undertaken to determine the source of infection in mosquitoes
since they can bite animals and birds which also harbour filarial infection. It was
found that the source of infection in mosquitoes caught in houses was human!

These results posed many problems. While seven per cent of the children
in the age group 0-5 years showed infection, the total microfilaria rate in the
community was only 16%. Infection was also not uniformly distributed even
though each house had a sizeable number of mosquitoes showing infection, there
were many households which did not have a single case of filariasis. How did they
escape the infection?

In order to investigate such problems, it was necessary to ensure a regular
supply of clinical material. It was, therefore, decided to start a filaria clinic in the
Institute to attract people suffering from the disease. It was obvious that those
suffering from the disease, such as cases of elephantiasis with varying degrees of
suffering, or recurrent attacks of lymphangitis with fever would attend the clinic.
However, it was just such cases that we wanted to study. We had, of course, no
specific treatment to offer. Injection of arsenic antimony etc. had limited value
and hetrazan had not been discovered. As stated earlier, we had isolated a strain
of streptococcus from elephantoid tissue from a case operated at the General
Hospital. We decided to use the vaccine prepared from this strain to treat the
cases attending the clinic. There was thus no dearth of clinical material for our
investigations! Incidentally, the vaccine treatment gave some interesting results.
Periodical attacks of fever in patients diminished considerably. However, the
dosage of the vaccine had to be regulated carefully to avoid local reaction.

The patients attending the clinic were bled to ascertain if there was
evidence of any immune response to filarial antigen which would account for the
disappearance of microfilaria in cases of elephantiasis. We, therefore, mixed the
sera from such cases with the whole blood from a case of filariasis, without of
course any symptom of even mild elephantiasis, containing both the microfilaria
and white blood corpuscles. It was fascinating to watch under the microscope
what was happening. A leucocyte would approach the microfilaria, and after many
apparently unsuccessful attempts, get itself attached to it firmly. The wriggling
movements of the micro-filaria would not dislodge it. Another leucocyte followed
and yet another. As the microfilaria got studded with such adhering leucocytes
its movements gradually ceased as more and more leucocytes got adhered to it.
Ultimately the parasites died within a period of eighteen to twenty hours! In the

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controls, the microfilaria could be observed healthy and wriggling even up to 72
hours, if not more. We labelled this phenomenon as the “adhesion phenomenon
in filariasis” demonstrating the presence of such antibodies in patients with
elephantiasis.

These observations were published in 1928 in the Indian Journal of Medical
Research. However, they remained unnoticed till some 35 years later a Japanese
scientist, a member of the Johns Hopkins team working in Calcutta confirmed it
and also showed that the phenomenon could be observed with infective larvae
also. We could not do so, for in our time, we did not have antibiotics to add to our
system to keep it sterile. Later the phenomenon we described came to be known
as ‘Pandit’s reaction’.

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CHAPTER VII

PLAGUE AND I

I

Imake no apologies for writing on plague though the disease has ceased to be
a major public health problem in the country. I have had the most intimate
association with plague. As stated earlier, I had suffered from it when I was
eight years old. Indeed, my childhood memories are of plague. I have seen the
ravages which it had wrought during its reign of terror of over twenty-five years. I
have witnessed the different phases of control measures which the authorities had
adopted from time to time in terms of knowledge then available, and above all, I had
the opportunities to work on some of the unsolved problems in the epidemiology
of plague. Plague had made history in many lands. It did make history in India!

It is commonly believed that plague appeared in India in 1896. It must be
stated, however, that there had been periodic epidemics of plague in this country
during the three centuries prior to that date, mostly in North India. There was
a focus of infection in the foot hills of the Himalayas, particularly in the district
of Garhwal. This focus, I believe, persists even today! From that region, infection
spread to other areas. Emperor Jahangir records the occurrence of an epidemic
in Agra in 1618. His story is most illuminating. He mentions the following episode :

“An infected rat was killed by a cat belonging to the daughter of the owner
of the house. The slave that removed the dead body of the rat was the first victim.
Ultimately all the members of the family succumbed to infection. During the last
three years the disease has caused many deaths during the winters. Hundred
deaths are reported every day. It is astonishing that during these three years,
though the disease was epidemic in Agra, Fatehpur Sikri was not affected!”

How severe was the infection can be noted from an account given by Col.
Harrison to the Indian Medical Congress in 1894. He wrote:

“Before my arrival in the village, I was informed that perhaps I would find some
abandoned children. The village was empty. I, however, found a girl of nine years,
Danuli by name, with her brother aged 5 years outside the village. Danuli, a girl
with brilliant eyes, was dressed in old jute. Her face was covered with an old bed
sheet. These children had lost their parents three months ago. They were left on

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their own resources. Thereafter, for nobody in the village wanted to be near them,
Danuli told her tale of woe, how during the last 8 weeks her father, her mother and
elder brother had died, how everybody had run away, how the house was burnt,
how her 7 year-old brother had died, and how his body was taken in the night by
jackals, how she defended her brother of 5 years, keeping him in a vessel with a
hole in it and how she, a girl of 9, prepared and boiled the rice for her younger
brother who always slept in her arms every night”!

I am sure such human tragedies could not have been infrequent in subsequent
years in other parts of the country.

When there were epidemics of plague periodically in Northern India, there
were epidemics in the Gujarat region also, particularly during the years from 1812 to
1821, and again in 1836 and 1837. It was interesting to note that people most affected
were Bohras dealing with cotton and others dealing with wool. The significance of
this observation will be referred to later. It must be stated, however, that apart
from the regions mentioned above, the rest of the country had remained free of
infection.

Then came the great plague epidemic of 1896. The infection was introduced
in Bombay by a ship coming from Hong Kong for the disease was prevalent in
China, at the time, particularly in the province of Yunan on the border between
China and Burma. In Bombay, the infection first occurred in Mandvi, an area quite
close to the port. The epidemic in Bombay was very severe indeed, over 200 deaths
being recorded every day.

From the initial focus the disease spread to many parts of the country with
amazing rapidity. By the end of 1898 plague had reached as far North as Hardwar
and as down South as Hyderabad. All the maritime ports of Saurashtra were
affected and very soon the infection had reached Lahore and to many parts of the
Punjab. It continued to advance in the South and it reached the Nilgiris in 1903. It
must be noted that the spread of plague was not necessarily by contiguity. From
the initial focus in Bombay, Karachi was affected first and the nearer ones later. The
important point to note is that the Eastern seaboard of the then Madras State and
Orissa remained free and continued to remain free to this day. This was, indeed,
the subject of our investigation at a later date!

The disease did attract the attention of the scientists from abroad and many
had arrived in the country to study it. There were at the time, i.e. around 1898 and
1899, an English Commission, a German commission and an Austrian commission
working on plague in India. These Commissions did not succeed materially in
adding much to our knowledge of plague. Some of the scientists had even refused
to admit the role of the rat in the propagation of plague.

There was, however, one exception. In 1897, there was working in Bombay
a Frenchman, Dr P.L. Simond. He had some knowledge about plague while he

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was working in a mission in Indo-China. He had pitched his tent on the Marine
Lines and worked there even during the fury of the monsoon. As a result of careful
observations and experiments he arrived at the following conclusions:

That plague was essentially a disease of rats; that the infection usually spread
from rat to man and less frequently from man to man; that plague could spread
through the medium of infected rats on ships; that those who handled the dead
rats almost always got the disease; and finally that the transmission of infection
from rats to human beings was by the bite of infected fleas.

As a result of his observations, Simond suggested many measures to fight
plague. Disinfection, he insisted, should be carried out in such a manner as to
destroy fleas. No dead rat should be handled unless boiling water was first poured
over it. Ships should be disinfected with Sulphur before they were allowed to leave
the port. It would appear that he had also advised the Bombay public health
authorities on the futility of some of the measures, particularly the disinfection of
drains, in the control of the infection. Dr Simond published his findings in 1898 in
the French scientific Journal “Annalesde Institute Pasteur”. It is also of interest to
note that the First Indian Plague Commission, appointed by the Government of
India did not agree with Simond’s views. However, Capt. Glen Liston who was a
member of the Second Plague Commission, confirmed the role of the fleas in the
transmission of plague! It must also be stated that Dr Haffkine, a Russian scientist,
working in Bombay at the time, had developed the vaccine for immunisation
against plague. Thus, it would not be an exaggeration to state that by 1898 we had
the essential knowledge to control plague!

It is, however, surprising to note that the authorities had not paid any attention
to these suggestions. If they had, the history of plague could have been modified
to some extent and much unnecessary expenditure and hardship could have been
avoided. It would be of interest to see what steps were actually taken to combat
the epidemics. The only methods that could be thought of were abandoning
the affected localities, segregation of patients and strict quarantine measures
to prevent the infected persons from going from one locality to another. These
measures were applied with all the rigour which the Government could command.
I remember the days when the whole of Bombay City used to be evacuated. Those
who could afford used to go outside the city even as far as Bassein but many used
to be evacuated to camps established on the beach along the present Charni Road
and Marine Lines areas. Indeed we, as youngsters, were always looking forward
to the plague season in order that we might go to the camps by the sea and play
about in the sands all day. The mounting death roll and the flames of burning
bodies shooting high over the boundary walls of the cremation grounds on the
other side of the railway track did not deter us. The sky used to be lit every night
and in that lurid light children of my age played on the sands! In later years, in 1918,

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Dr. P.L. Simond, Elucidated epidemiology of Plague

Dr. Waldemar Mordechai Wolff Haffkine, Originator of
Plague vaccine

Introduction to preventive medicine (1924-1948)

I witnessed once again the same phenomenon when there was a very high death
rate, and when the sky was lit up with the fire of funeral pyres, the killer this time
being influenza!

As regards quarantine, the measures adopted were very strict indeed. Every
person travelling by train, who had any temperature, was detained. I remember
travelling by train from Bombay to Poona, when I was taken down at Kalyan to be
examined for signs of fever. I clearly recall the advice of my mother, when the train
approached Kalyan, to put my head outside the carriage window, so that it would
feel cool when the doctor examined me!

Isolation was also strictly enforced in certain places, particularly in Poona city
where special makeshift plague hospitals were established. These arrangements
were under the direct control of Mr. Rand, the then Collector of Poona. This officer
was specially chosen because of his reputation in handling such measures with
the zeal of a fanatic. For searching out cases, military personnel were employed
and, naturally, in putting effectively such a programme into operation, the people
were put to considerable inconvenience. The bedding and household goods
were forcibly removed and, in many cases, burnt. Allegations were made that the
military personnel had behaved atrociously even towards women. I still remember
the terror stricken face of my mother when she shouted, as I was playing in the
courtyard of our house, “Get in quickly, the soldiers have come”! Concurrently
with such measures, the Government was trying to enforce the use of anti-plague
vaccine which had just then been developed in the Bombay Laboratory by Dr
Haffkine. The inoculation was made compulsory and apparently many facilities
regarding evacuation were denied to some who had refused to accept compulsory
inoculation. There was, at the time, considerable controversy about its efficacy in
the prevention of an attack of plague. Unfortunately, the measures adopted had
no effect on the spread of infection. The people clamoured for re-orientation of
Government policy. Public opinion in Poona rose to a high pitch and ultimately it
culminated in the assassination of Mr. Rand!

There is a lesson to be learnt from this tragic episode. If the authorities had
taken the people into confidence, explained to them why it was necessary to take
the steps that were being taken in terms of knowledge then available to bring the
epidemic under control, and thus secured their cooperation, Mr. Rand, who was
only doing his duty, need not have lost his life. In public health work, officers who
work with the zeal of fanatic will always be an asset!

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II

It has already been stated that plague had reached all parts of India by 1903
and the areas which remained free then continued to remain free even to this
day. The eastern seaboard along the Bay of Bengal was such an area. It was
decided to investigate the problem. In the meantime, knowledge about plague
had considerably increased, particularly the role of the rat fleas in the transmission
of the infection. Of the three types of fleas, the X. cheopis, X. brasilensis and X.
astia, the X. cheopis was the most efficient carrier and X. astia the least. With the
aid of a grant from the IRFA, a rat flea survey of the representative areas in the
then Madras Province, extending from Tuticorin in the South to Berhampur in the
North, was undertaken.

The findings were very interesting. Indeed, the survey of Madras city itself
brought out many interesting features. We first surveyed the two godowns on
the beach separated from each other only by a corrugated iron partition. One
godown stocked rice imported from Rangoon and the other was for groundnuts
for export to Burma. The first one showed the prevalence of over 90% X. cheopis,
while the other had only X. astia. Actually, X. cheopis had been introduced from
Burma. Normally, it would be reasonable to assume that, since the flea has to
leave the rat sometime or other for breeding purposes, its dispersal to other rats
would not be difficult. Therefore, the distribution of fleas localised in such small
isolated premises, warrants the assumption that the habits of rats are such as
to make them reluctant to leave their habitats, if they find the living conditions
entirely suitable.

Again, when we surveyed the two cotton mills in the city, we found the same
situation. In one mill, the Buckingham and Carnatic, X. cheopis was present to the
extent of over 90%, while the other, the Chooli mill, only a mile away from the
former, yielded only X. astia. Thus, the importance of cotton trade in the importation
of fleas came to light. Though both the mills were importing cotton from Hubli
and Dharwar in the then Bombay Presidency, the former was importing cotton
during the cold season and the latter in the hot season. These findings provided
a good lead as to where X. cheopis fleas could be found in other centres surveyed.
Sometimes a single house dealing in this trade was found to harbour X. cheopis
fleas, while the surrounding ones were free. Among other areas surveyed, the
Cheopis flea index was found to be very high in Berhampur in the North. Here we
also noted that the climatic conditions were more favourable for the persistence
of the flea. Thus, it was found that importation of X. cheopis was not widespread
throughout the Province. It would appear that not so much the actual temperature
but the duration of the summer season was the factor which limited its spread.

On the basis of evidence gathered during the survey, we concluded thus:

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“The explanation of the recent history of plague in India from 1896 onwards
and why this epidemic is different from the previously recorded ones which rapidly
died out, is that whereas previous epidemics occurred in the absence of Cheopis,
the 1896 infection occurred when Cheopis was fairly widespread throughout India
as a whole.

“We suggest that the dissemination of Cheopis occurred after the extension
of human intercourse and trade, particularly the cotton trade with Egypt following
the opening of the Suez Canal in 1896. Probably the process of Cheopis importation
began even before this. Thus, Choksy suggests that the actual infection was
imported into Gujarat from Egypt in 1815 with cotton and caused the epidemic of
that year. Whether this was so or not, it is apparent that the Bombay Presidency
was importing cotton at that time.

“Whereas all previous epidemics seem to have behaved like typical ‘astia
epidemics’ in being localised and in not carrying over from one year to another, the
epidemic since 1896, as we in India know to our cost, has behaved very differently”.

The study of plague in the Madras State brought into prominence the
existence of two endemic foci of the disease, one in the plains, the Kumbhum
valley in the Madura district; and the other in the Nilgiris.The situation in the
Kumbham valley was in one sense very peculiar. The valley 35 miles long and 20
miles broad at its maximum width is surrounded on all its sides by areas totally
free from plague, while in the valley itself, plague was endemic, cases occurring
in many villages throughout the year with minor exceptions. It was soon apparent
that climatologically the valley, unlike the rest of the province, was quite suitable
for the persistence of infection throughout the year. It was decided to study the
factors responsible for this state of affairs, and a grant from the Indian Research
Fund Association was obtained for the purpose. It was found that both the types of
fleas were present, of course X. cheopis predominating. The longevity of infected
fleas was five weeks after initial infection and starved fleas could also survive for
29 days at least. Control measures were then undertaken using cynogas for the
purpose with good results.

Similar studies were then carried out in the Nilgiris. Potato farming is
extensive in this region. Field rats abound in potato farms and the problem of
potato cultivation vis-a-vis plague had assumed importance. All varieties of fleas
capable of transmission of infection were found on rats and bandicoots in the area.

Finally, we investigated the utility of measures then adopted for the control of
plague. It was the common practice then, a legacy of bygone days, to disinfect grain
by exposing the gunny bags containing grain to bright sunlight. We demonstrated
that even if fleas were present in the grain, they could migrate quite inside the bag
to escape the temperature. The Government then stopped using this procedure.

With the termination of this experiment my association with plague ceased.

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CHAPTER VIII

CHOLERA—AS WE SAW IT THEN

I

I must state at the outset that what little I knew of cholera was based on the
work which we did during my sojourn in the King Institute in Madras, in
the Pasteur Institute and Medical Research Institute in Shillong, Assam, and

when I had the privilege of working as emeritus scientist in the National Institute of

Communicable Diseases in Delhi. I was thus exposed to the behaviour of cholera

epidemics in several areas in the country where cholera had posed a problem of

varying degrees of severity. I must make it clear, however, that what follows is not a

treatise on cholera dealing with all aspects of the problem but refers only to some

of its aspects in which I was directly involved.

Our interest in the cholera problem arose, initially, from the work of the
investigating units which had to deal with outbreaks of gastro-enteritis in
institutions, jails and in rural areas, particularly during the groundnut season.
All episodes of gastro-enteritis were, of course, not cholera. Our function was to
diagnose the infection and draw attention of the public health authorities to some
of the etiological factors we had discovered. After that it was the responsibility of
the public health department to take suitable action. However, it was not always
possible to determine the source of infection. Sometimes, however, we had some
interesting information. There was an outbreak of cholera in Samayapuram
Panchayat in Trichinopolly district in 1936. The officer-in-charge of our investigating
unit had reported as follows:

“Water from a borewell was stored in pots by a sanyasi. He gave it with his
benedictions to a number of devotees along with holy ashes. From the full and
authentic account and statistics collected, it was gathered that as many as 109
attacks and fifty-three deaths were directly traceable to the water cure rendered
by the ‘Swamiar’.”

I will now deal with several facets of the cholera problem we had dealt with.

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II
Cholera bacteriophage in the prevention and

treatment of cholera

During the early thirtees, we had some interest in the utility of cholera
bacteriophage in the prevention and treatment of cholera. As stated earlier, after
my return from Patna after spending a month with Dr Asheshov, I had started
manufacture of cholera and dysentery phages in the Institute. This was supplied
to the Infectious Disease Hospital in Madras and to the Public Health Department
for prophylactic purposes, particularly in jails. No largescale experiments were
undertaken since Col. Morrison had already initiated such studies in Assam
with the most elaborate arrangements for the distribution and storage of
bacteriophage at village levels. Nevertheless, a few observations were made with
the assistance of the Public Health Department on the use of bacteriophage in
the control of infections through fairs and festivals, especially in the Krishna and
Godavari districts, where cholera epidemics used to occur periodically. It might be
noted that in this region there were three large festivals, each attended by nearly
a million pilgrims. In the study of one such epidemic in the Godavari district the
following results were recorded.

As regards prophylaxis, among 7153 people of the nine villages where
phage was used, there were fifty-eight cases, while in 6444 people of six control
villages, 88 cases had been reported. It must be stated that cholera vaccine was
used in both the sets of villages. Cholera bacteriophage was also used for treatment
in a few villages. The results could be summarised as follows:

1. Before medical attention ... 40 cases 31 deaths 77%

2. Medically treated but not

inoculated and not phaged ... 68 and 35 51%

3. Medically treated, not

inoculated but phage-treated ... 77 and 16 21%

4. Medically treated and

inoculated but not phaged ... 44 and 7 16%

5. Medically treated and ... 19 and 2 11%
inoculated and phaged

Normally these observations would be considered as interesting. However, we
were debating then on their reliability, as we noted later that the Health Officer-
in-charge used phage even in control villages, after he was ‘convinced’ about its
utility! It was noted in the report we received that “we had similar ‘enthusiasm’
to contend with among health visitors also!” However, one positive finding was
recorded by the Institute’s bacteriological unit.

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While investigating the outbreak in Godavari district, it was noted that while
vibrios could be isolated from stools of untreated cholera cases, they could be
isolated rarely from the stools of those receiving the phage, though clinically they
were cases of cholera.

After these trials, the manufacture and issue of bacteriophage was suspended,
and the Institute was asked to participate in a coordinated programme of cholera
research under the aegis of the Indian Research Fund Association (IRFA). The
genesis of this programme, as recorded by Major-General Taylor*, the then Director
of the Central Research Institute, Kasauli, was as follows:

“In 1932, the question of taking up cholera research on a large scale in the
light of recent advances in bacteriological knowledge was under consideration,
and proposals had been put forward for the constitution of a Cholera Commission
with complete staff and organization for the purpose. The proposals had been
approved in principle by the Governing Body of the Indian Research Fund
Association, but it was not found possible to implement them in view of the
financial position at the time. This position was recognized by the Cholera Sub-
Committee at their meeting during the XIth Conference of Medical Research
Workers in December 1931. In view, however, of the international interest which
was taken in cholera at the time and representations which had been made
as to the desirability of India, with her special facilities, undertaking research
on the subject, the Sub-Committee recommended the formation of a special
Cholera Advisory Committee to coordinate research work on Cholera. Plans
were accordingly drawn up for the constitution of a series of enquiries which
would cover different aspects of the subject and would make use of the facilities
available in different areas”.

At this time, i.e., in 1934, Dr K. V. Venkatraman who was on the staff of the
Institute had returned from U. K. after working with Dr Gardner in Oxford, on the
serological classification of cholera vibrios. They had enunciated a definition of
what they called a “true cholera vibrio” with two sub-types: ‘Inaba’ and ‘Ogawa’
on the basis of serological tests. Indeed their definition of ‘true cholera vibrio’
was to hold sway for many years with profound influence on our concepts of the
epidemiology of the disease. We tended to ignore the role of other types of vibrios
in the etiology of ‘clinical’ cholera. Anyway, since Dr Venkatraman was interested
in the problem, it was decided to put him in-charge of the investigations into the
problem of cholera in the Madras Presidency with a grant-in-aid from the Indian
Research Fund Association.

I must pay here my tribute to Dr Venkatraman for the meticulous care with
which he carried out his investigations for the next five or six years, and particularly
to his critical ability in assessing the results of the enquiry. We had, indeed, very
frequent discussions on the results obtained in the field. His only ‘fault’, if I may so
put it, was his indifference to publish anything in scientific journals. He, however,

* “Cholera Research in India under the IRFA 1934-1940” Special Report No. 5, IRFA 1941.

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gave a very comprehensive account of the findings in the annual reports of the
Institute and I have drawn heavily on them in summarising the work here. The
work related, as I have said before, to many aspects of cholera but I have chosen a
few of them to record the findings.

(a) The distribution of the types of cholera vibrio in the Madras Presidency :

When the work started, our immediate concern was to determine the types
of cholera vibrios responsible for the outbreaks of cholera in the Province. Two
views were expressed at the time. In a conference of cholera research workers in
Calcutta in 1936, it was suggested that the Ogawa type of vibrio was, probably,
only a laboratory phase and the type produced only a mild infection. Of course,
it was soon proved that both the assumptions were wrong. Individuality of the
Ogawa type in the freshly isolated strains of cholera vibrios, as well as its role in the
production of severe type of cholera had to be accepted. However, the isolation of
the two types, Inaba and Ogawa, in different parts of the Province proved rather
intriguing. During the course of nearly two years, over a thousand vibrio strains
were isolated from epidemic areas in the Province. On the basis of distribution of
the two types, it seemed apparent that the northern districts, i.e., north of Madras
city (now Andhra Pradesh) the predominant type was Inaba, and in southern
districts (now Tamil Nadu) the Ogawa type. Madras city was the meeting point of
the two types of vibrios. In view of these findings, we reported in the annual report
of the Institute as follows:

“These observations show the presence of a large area in the Tamil districts,
where the Ogawa vibrio has been the prevalent type in successive waves of the
present epidemic while in the interval, an epidemic due to the other type, Inaba,
prevailed in the North. Similarly, the Inaba type has been prevalent in the north, i.e.
Telugu districts and has not been changed by the Ogawa epidemic in the south.
In the border areas, where the other type has been introduced, it does not tend to
persist except for a short period. The finding of the Ogawa type in a large area is
considered an observation of some importance. This type has not been reported
to any extent from other parts of India. This suggests that there exists another
endemic area in south Madras and field investigation relating to its persistence
could usefully be undertaken there.”

However, we spoke too soon! For during successive years the picture changed
completely. All the same, we were so impressed with our findings that in informal
discussions with the administrators across the dinner table in the Presidency Club,
we had suggested, in a lighter vein, that the boundaries between the future Tamil
and Telugu States, could and should be determined on the basis of their cholera
epidemiology!!

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III
Sulfa drugs in the treatment of cholera

With the availability of sulfa drugs, it was but natural that they should be
introduced in the treatment of cholera. Sir Ram Nath Chopra, the then Director of
the School of Tropical Medicine, Calcutta, had tried them in the Infectious Diseases
Hospital in Calcutta, apparently with good results. The Public Health Commissioner
with the Government of India requested us to undertake similar trials in Madras.
Accordingly, a Committee was formed consisting of the Commissioner of Madras
Corporation, the Health officer of Madras, Officer-in-Charge of the Infectious
Diseases Hospital, Dr Venkatraman and myself to organise and supervise the
work. Routine treatment of cholera consisted of administration of hypertonic
saline as and when needed and administration of antidiarrhoea mixture along
with potassium permanganate pills and atropine sulphate (gr 1-100) morning
and evening. The last two were omitted and substituted by sulpha-guanidine, 2.5
grams per dose every four hours, i.e., about 20 grams per day in the experimental
group. The total number of cases treated in both the groups was 670.

The results were not encouraging. The mortality rate in the control group
was 43.5% and in the sulpha group 36.3%. The results in bacteriologically positive
cases were 38.4% and 28.4% respectively. It must be noted, however, that in
the treatment of cases of dysentery immediate and striking improvement was
noticed with the administration of the drug. Why were the results obtained in
Madras different from those seen in Calcutta? Were they dealing, we thought,
with a much milder infection in the endemic region of lower Bengal than that
usually seen in the epidemic area of Madras Province? Or was it because there was
considerable delay in the admission of patients to the hospital after the onset of
the disease? The average delay in the admission of patients to the hospital after
the onset of symptoms was over fifteen hours. It might be mentioned in passing
that when the drug was administered under rural conditions, the results were
equally disappointing. It must be stated, however, that the dosage of the drug
administered was empirical.

It was then decided to try formol carbazol for the treatment of patients. The
drug was supplied by the Indian Research Fund Association. The general line of
treatment followed was the same as before except that saline administration was
controlled by noting the specific gravity of blood. Each case received 30 gms of the
drug, six grams were given on the first day and dose reduced thereafter. The results
again were not striking. However, it had definite effect on the excretion of V. Cholerae
by the patients. While the patients receiving the drug ceased to excrete the vibrios
by the 8th day, the control group continued to excrete them till the 18th day!

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Early Years (Bombay, Poona, London) (1894-1923)

Sir Ram Nath Chopra, initiated research in indigenous drugs

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IV
Persistence of infection in endemic areas

The problem of persistence of infection in endemic areas, particularly the
prevalence of the cholera vibrios during inter-epidemic period had received
considerable attention and extended observations were made in the Khulna district
of Bengal, with improved techniques of isolation of cholera vibrios developed at
the time. As reported by General Taylor, "In a period of over two years work, 'true
V. cholera' was not isolated except from the cholera case, direct contacts, and
from water in the immediate vicinity of the case." In view of these findings, it was
considered desirable to study the problem in another endemic area in the South,
i.e. the deltaic region of the river Cauveri. Thirty villages were chosen on the basis
of their previous cholera history. Elaborate arrangements were made for regular
collection of stool samples. Investigations lasted for nearly two years. Not a single
isolation of cholera vibrio was made during that period. Large volumes of water
were tested by appropriate methods. Agglutinable vibrio was isolated only once
from a pond which remained free thereafter. The area remained free from cholera.

The experience raised the question whether we had chosen the right area for
our investigations.

In further study of the problem, the monthly figures for cholera mortality
for several districts of Madras Province during the fifteen years from 1926 to 1940
were collected and studied, in collaboration with Dr K.C.K.E. Raja, with a view to
determine the real endemic status of the district. It might be stated that the same
type of investigation was made by Col. A.J.H. Russell for the years 1896-1924 for the
same area. As stated in the Annual Report of the Institute for 1941, the results of
analysis appear to corroborate the findings of Russell based on the figures for the
previous 30 years, that the frequency of cholera infection is more in the districts
of Tanjore, Trichinopoly and South Arcot than in other districts of the Province.
However, the continuity of infection is being maintained in Tanjore district, because
the seasonal incidence of the disease varies in the different parts of the district,
with the result that by the time cholera disappears in one area it starts in another.
This seems to be a spurious form of endemicity. The fact that three types of areas
have been brought together to form a single district is finally due to administrative
convenience. If, on the other hand, the deltaic areas of Tanjore, Trichinopoly and
South Arcot districts had constituted a single district, the recorded vital statistics
of this area would have shown that the incidence of cholera was mainly confined
to winter months. The area would not have been considered an endemic area.

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V
The role of the housefly in the transmission of cholera

In 1937, Dr M.B. Soparkar was posted to the Institute as supernumerary officer.
He was the most senior member of the Medical Research Department of the
Government of India and had worked in many places, e.g., in the Veterinary Research
Institute, Mukteshwar, and at the Bombay Bacteriological Laboratory,later named as
the Haffkine Institute. Indeed in 1919 when I was deputed to work in the Institute at
Bombay, I had to work mainly under Dr Soparkar. He was a meticulous worker. Indeed,
his work on schistosomiasis was well known at that time. His appointment therefore,
in the King Institute was a little embarrassing to me. We, however, were good friends
and during the period he was with us there were no embarrassing situations. After
general discussion, it was decided that he should work on the role of houseflies in the
transmission of cholera, as part of our work on the epidemiology of the disease.

Experiments were undertaken to determine the length of the time during
which the cholera vibrio remains viable in the body of the fly after its ingestion.
The experiments were carried out with laboratory bred flies.

They were dissected after two hours to nine days after the ingestion of the
feed. Vibrios could be detected only after two, five and eight hours after a single
feed. To determine what causes the death of the vibrio, it was thought desirable to
investigate if the gut of the fly had a destructive effect on the organisms. Results
showed that a mixture containing 0.25 cc of extract in tyrode solution and 2.5
million vibrios remained sterile. As was to be expected, the results depended on
the number of vibrios in the mixture. A mixture containing 50 million vibrios in 0.5
cc of the extract took 48 hours to become sterile.

Regarding the nature of the bactericidal principle, it was found that when
the extract was heated from 100°C to 115°C a thick precipitate of coagulated
material was thrown down leaving a clear supernatant fluid. Further tests showed
that it was not an enzyme. Further attempts at purification were made with
phosphotungstic acid. The clear fluid had the same bactericidal effect. It was
interesting to note that the extract had no effect on other organisms such as
B. typhosus, B. dysenterae, Esch. coli or Staphylococci. The extract thus had a
selective action on cholera vibrios.

Further work was not done since Dr Soparkar retired from service. Next year
while presenting the results to the Scientific Advisory Board of the IRFA. I had to
state that while the previous year’s finding that the extracts of houseflies contained
a principle of having a lethal action on cholera vibrios had been confirmed, it must
not be concluded that the results indicate any revision at present of the accepted
opinion on the role of houseflies in the transmission of cholera.

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VI
The efficacy of cholera vaccine in the prevention of

cholera epidemics

The protective value of cholera vaccine in controlling the cholera epidemics
had been accepted by almost all public health workers. While this was so, no
scientific evidence had been forthcoming as regards its efficacy, or the duration of
immunity conferred by it. In 1929 I had suggested to the Director of Public Health,
Madras, to provide some evidence in this regard, if that was possible. Statistics were
collected from the districts of West Godavari, Guntur, Chittoor and Chingleput. The
Director of Public Health had stated in his report as follows:

“Attacks and death rates per 10,000 of population were as follows: Uninoculated
had 116.0 attacks and 48.6 deaths. In the inoculated, these figures were 12.8 and
3.3 respectively. Population exposed to infection refers to the population of the
affected villages. It is seen that the amount of protection against cholera afforded
by the vaccine inoculation is very considerable reducing the total attacks by nearly
ten times. Also most of the deaths in the inoculated are found to occur before the
5th clay of inoculation, i.e., before the maximum protection had time to develop.
Had the third column in the table been described as attacks amongst the “un-
protected” as distinguished from the “inoculated” — the deaths within the first
five days after inoculation could reasonably be included amongst the unprotected,
as no claim is made that cholera vaccine gives full protection immediately
after inoculation, the figures would show that the vaccine gives almost perfect
immunity. While this is so, one must not lose sight of the fact that good sanitation
is the only weapon which will eventually help to stamp out this disease”.

Further opportunities to test the efficacy of cholera vaccine arose during one
of the most severe epidemics of cholera which occurred in the Province during
1942-43. This was one of the six yearly periodic waves of cholera in the Province.
The infection was introduced into Bellary and Kurnool districts through pilgrims
returning from Puri, and then the epidemic spread to the southern and south
eastern districts, ultimately reaching Mangalore on the West coast. The festival
centres in different districts helped in the spread of infection besides the periodic
migration of agricultural labour, e.g., groundnut pickers contributed to the spread
of infection. Indeed, one of the gangs was responsible for the spread of infection to
22 villages. There were about 300,000 cases of cholera and about 169,400 deaths
during the whole episode.

As soon as the nature of the epidemic was known, it was decided to ascertain
the efficiency of the vaccine in the prevention of the infection. Dr R. Adiseshan,
the Director of Public Health, agreed to make all the necessary arrangements
for keeping records, etc., by deploying the necessary public health staff’ for the
purpose. A grant from the Indian Research Fund Association was also obtained

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