International Leprosy Association -
History of Leprosy

International Leprosy Association -
History of Leprosy

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Dr Dharmendra

Status Medical Researcher
Country India

Notes

Dr Dharmendra was born in Pakistan in 1900. He was Director of Leprosy Control Work for the Government of India from its beginning until 1957. He was Director of the Central Leprosy Teaching and Training Institute at Chingleput, Madras, India, from 1957 and also editor of Leprosy in India at several periods.

He has a long career in leprosy research including early development of refined lepromin and chemical analysis of M. leprae. He is author of multiple papers on many aspects of leprosy understanding. He received the Damien-Dutton Award in 1970.

International Journal of Leprosy, Centennial Festskrift edition, Vol 41, No 2. 1973.

What follows is transcription of an interview given by Dr Dharmendra, ‘An Autobiographical Sketch’, from S S Naik (ed) The Indian Leprologists Look Back. Bombay, 1990. pp. 3-11 (with additional editing by Huw Price, 2006).

"— Dr Dharmendra you have spent most part of your life in the field of leprosy. Kindly give a brief account of your early life and childhood and the period of pre-medical education.

— Well I was educated in several schools, depending upon where my father was transferred to. Ultimately I passed my matriculation examination in the first division from Punjab University. After passing matriculation examination my aim was to become a Doctor. Therefore I just joined the intermediate science course in the Government College, Lahore. When the results came there were only few persons who were put in the first division and I was therefore very much sure that I would be taken in the King Edward Medical College, Lahore. However, during that year was a premium on the wards of those people who had taken part in the First World War. I was therefore disappointed and thinking what to do. I therefore joined the B.Sc. Hon. course in … Botany in the college. When I was in the second year of the Botany Hon. Course, the restriction or the premium on the wards … [for those who had taken part in the war] was no longer there. … I was so keen to join the medical college that I left my B.Sc.(Hon.) course in the second year and again applied for admission into the medical college. Because I was very high up in the list of merit, I was taken into the medical college this time.

When I was in the second year of the medical college, the non-cooperation movement was started and Mahatma Gandhi had given a call and I took part in the movement that was started after the tragedy of Jallianwala Baug, Amritsar. While there was good response from Arts and Science colleges, there was practically no response from the Medical college. From whole of the Medical college only two students left the college and I was one of them. This action of mine very much annoyed my father who was in Government service and he thought since only two students have left the medical college he might be picked up and some harm may be done to him and through him to the family. Well I could not remain unresponsive to this sentiment. But I didn’t want to go back to the college. However, I didn’t take any part in the political life of the country at that time. I left Lahore and went out somewhere just idling away my time. Next year when the enthusiasm had gone down and there was no insistence on students leaving the colleges, I again applied for the Medical college and since I was high up in the merit list, I was taken this time. Thus I lost two years of my life. First by joining the honours course in the Government College and then leaving the medical college on the call from Mahatma Gandhi. In due course, I passed the M.B.B.S. examination of the Punjab University.

Dr Dharmendra, how did you become interested in the field of leprosy?

— I got an opportunity of working in a laboratory in Delhi and Simla. I spent about too years in that laboratory, learning the laboratory techniques. But after two years I was fed up with the routine laboratory work and wanted to join some research institute. Fortunately there was an opportunity to join the School of Tropical Medicine, Calcutta, first on temporary basis and then on a permanent basis. First assignment given to me there was to work on the Zondek-Ascheim Test which was supposed to detect early pregnancy and to indicate the sex of the future child. This test was done on young white mice and urine of the pregnant woman was injected into the mice and after some time skin smear from the vagina were taken and the cells in the smear gave this indication. After confirming the findings of Zondek-Ascheim, I thought to try the test in young male mice. The urine of [a] pregnant woman was injected into the male mice and to my great joy I found that the testicles came down prematurely in the male mice. This very much heartened me and … gave me self confidence and the Director of STM, when he saw this report, was very much impressed and that impression lasted forever.

My second assignment was work on Asthma. I got a kit of the antigens from Parke Davis Company and prepared some antigens myself that from dust or in surrounding of the patients. But I found that there was sensitivity in very few patients of Asthma. Then I tried blood examination and including the Arneth Count. That proved that most of the patients of the Asthma in our country are not of a sensitive type but the result of chronic bronchitis. The treatment had to be different than in the sensitive cases. After this project I was put on pneumo[co]ccal typing from patients of Pneumonia. This work was successfully done but is now of no value. Because of the introduction of antibiotics the question of type sera did not remain any longer.

After having spent about two or three years in the investigation, the Nation’s spirit once again came back. I found that, in the field of leprosy, all the senior workers were the foreign workers (1935) and although I appreciated their … coming out such a long distance to India to do the work, I felt that there should be Indian workers of good calibre so that Indian officers could demonstrate their own ability. When I decided to join leprosy work, my family was against it. Because at that time, more than fifty years ago, stigma attached to the leprosy patients was also in some way attached to doctors who were doing leprosy work. As I said most of the senior persons were foreigners and I thought that some persons of good calibre of Indian origin should work in leprosy and show the ability of Indian workers. With my experience … [of] research work for the last two or three years I was conscious that I could certainly do some befitting research work in leprosy. When the occasion arose of joining leprosy [research], I at once jumped into that position. While at the School of Tropical Medicine Leprosy Department I did various kinds of work, clinical, laboratory, epidemiological. I wasted some time in trying to cultivate the organism of leprosy and then took immunology of leprosy. There is an immunological in vivo test called [the] lepromin test. It was first introduced into leprosy by [the] late Dr. Mitsuda of Japan. But nobody could find the active principle of the leprosy bacillus which caused this positive reaction. With [the] crude instrument[s] available at that time at that school in the department, I tried to find out the active principle and ultimately I succeeded. It was the lepromin moiety of the leprosy bacillus that caused the early and late lepromin reactions. This work was such an important work that my boss wanted that I should publish that jointly in the name of both of us. But I refused and I thought that the chief would be annoyed. On the other hand he got more friendly with me and he appreciated. Recently, Dr. Sengupta of JALMA (1982) Agra took up this study and confirm[ed] all my findings regarding proteins being the active principle of lepromin positivity. More recently about four decades after my discovery the IMMLEP project of WHO worked on this problem and came to the same conclusion that the active constituent of bacillus for lepromin positive reaction is protein. However, I am sorry to say that none of the IMMLEP workers referred to my work which I did in 1941 much earlier than the IMMLEP project. However, Dr. Jopling in his book has clearly stated that the lepromin work of IMMLEP is a continuation of Dr. Dharmendra’s work made possible by the huge number of leprosy bacilli that could be obtained from the artificially infected Armadillos.

Dr. Dharmendra, You had a long association with the School of Tropical Medicine, Calcutta. Please say something about your association particularly with Dr. Rogers and Dr. Muir.

I joined the leprosy department just after Muir left and Rogers had left much earlier. Although, I benefited by the literature that they had left. But I never met at that time … Dr. Muir or Dr. Rogers. Though later I had occasion to meet both of them, and Dr. Muir several times. The person in that School of Tropical Medicine who was very helpful, was Dr. S. N. Chatterjee, the assistant research worker who was a very good clinician and I benefited by his experience.

Please say something about the history of development of Dr. Dharmendra’s antigen.

As I have stated earlier I was interested in [the] lepromin test to find out the active principle, because protein solution could not be available and I did the test only on a project basis. I just tried to isolate the bacilli from the tissue by my own method called Chloroform Method. I isolated the bacilli, dried them in vacuum and prepared the vaccine in carbol saline. This vaccine, because of some personal reasons, was called Dharmendra’s antigen. But now it is normally referred as Dharmendra’s lepromin. I was standardising this lepromin by the weight of the dry power of the leprosy bacilli. But Dr. Sengupta found that to get constant results it is better to count the number of bacilli rather standardise the vaccine by the weight of the dry powder of the leprosy bacilli. I have gladly accepted this modification and I am grateful to Dr. Sengupta and his co-workers for this.

After your retirement from the Tropical School of Medicine, Dr. Dharmendra, you have spent number of years at Chingleput. Can you say something about your work at that place?

I was due to retire from the School of Tropical Medicine in 1955. But suddenly I got a note from Government of India extending my services for another 3 years. However, before I completed the 3 years, I was appointed the first Director of the National Leprosy Control Programme. I spent about two years on that work and visited the various centres throughout the country, the number of which was rather small at that time and what I found … [when] I checked … [was that there was] no uniform system of keeping records and sending out reports. So my next job was to prepare design forms for these purposes and with more experience gained these forms have now been changed to some extent. But suddenly after two years as Director of Leprosy Control I was called upon to go to Chingleput as first Director of Central Leprosy Teaching and Research Institute. Well, I agreed to go for three years but I had to spend about 13 years in Chingleput. After three years, when I wanted to leave Chingleput, just then [the] Health Minister asked me “If you leave the institute now at this stage, who will organise it and put it on a sound basis?” Well the Minister also requested my wife not to ask me to leave the job and go away. He even took a promise from my wife that she will not do so and that’s how I continued. I continued as a Director of the Institute from 1957 to 1966. During this period I was busy in administrative work but was still connected with the research work and I was head of the Clinical Division of Institute.

During this period I framed and executed the scheme prophylactic Dapsone in contacts of leprosy patients. Of course in this work I was joined by Dr. Noordeen, Dr. Ali, Dr. Ramanujam. We worked out a scheme whereby we spotted large number of contacts of lepromatous patients and divided them into two lots. One, the dapsone group and the other, the controls. At the end of the three years of the study we found that Dapsone gave about 52% of protection. But the protection was limited only to children up to ten or twelve years and if the children alone were to be taken like degree of protection would be much higher. This work was later continued after I left the institute by Dr. Noordeen and Dr. Wardekar was also trying the same thing and come to the same conclusion that prophylactic Dapsone does have protective value in contacts of lepromatous patients. After this method was tried in several places and all of them gave similar results, later instead of Dapsone the depot preparation acedapsone was prepared for depot action and injection of acedapsone would be given only about every 75 days. So that in the whole year we have to give about four or five injections. Although we have proved and others also have confirmed our work, this thing cannot be taken on a mass scale because of administrative difficulties. But this should be followed for the population which is most susceptible that is the home contacts of lepromatous patients.

Can you now Dr. Dharmendra, tell us something about the association with Indian Association of Leprologists?

I had been associated with the Indian Association of Leprologists since it was formed: as a matter of fact, I was one of the founder members when this Association was formed in Madras in 1954. Not being only a Member of the Association I was elected as President of the Association for four times. Every time [was] two years duration and ultimately I gave up the Presidentship in favour of Dr. Wardekar. After some time the Indian Association of Leprologists in consideration of my services to the Association made me the Hon. Member of the Association and I still enjoy that privilege till now.

You retired from Chingleput in 1967 and then you were Emeritus Scientist for two years. In 1970, you had moved down to Delhi after your complete retirement, Can you tell us something about your activities after your retirement?

After retiring from the Director’s post of CLTRI, I was taken as Emeritus Scientist by the ICMR and in that capacity I continued to be at Chingleput for up to the age of 70; that is the limit for Emeritus Scientist. Then I came to Delhi.

After your retirement can you tell something about your association with Leprosy in India?

I had been associated with Leprosy in India since very long time. While I was not the head of the department, Dr. Lowe was the Editor of this journal. But when he went on leave I used to edit it but in Dr. Lowe’s name. Later Dr. Lowe was shifted from leprosy department to the Professor of Tropical Medicine. Then I permanently took the Editorship of the Journal and continued it till 1957 and when I went to Chingleput I left the Journal with my successor at Calcutta. However, within two years the Journal, Leprosy in India went down to such a low place that I was again requested to take up the Editorship in Chingleput and as long as I was in Chingleput. From 1957 to 1970 I was editing this Journal. Again when I left Chingleput I left Leprosy in India there in to my successor. But within three years it went down so much that there were complaints from Indian Association of Leprologists and from others that something should be done to improve the Journal. The Director General of Health Services suggested that when I come to Delhi after my retirement I should be requested to take it again. I did not want to be tied up with Leprosy in India again and I told Hon. Secretary Col. Maitra “I am sorry, I cannot take it up for I will be busy with my book” which I was planning at that time. Ultimately when Col. Maitra said “Look Dharmendra, this is your child, and if you don’t take care of it now, it will die a premature death.” Then I could not resist any longer and I accepted for the third time to take up the Editorship of the Journal. Now in a way I am glad that did agree to take up the Journal because … I have raised it to the point of an International Journal and it is one of the topmost leprosy journal in [the] English language. Now we are publishing about 1400 copies of the Journal and I am really proud of it that I am able to take it up to this status.

Your work have been recognised by International authority and as far as I know you are the first Indian to win the Damian Dutton Award. How has your work been cited in your own country?

As far as my work is concerned it has been very well recognised in India by Indian workers and I am glad that all the Indian Leprosy workers have got great regard and love for me and I consider that very valuable. However, as far as [the] Government of India is concerned I do not think I have got the recognition that was due to me. Towards the end of my service I was given an award of “Padmashri”. I never knew that it was going to be given to me because the ordinary procedure is that they ask the recipient if he will accept the award. Now in most cases, leprologists have been honoured with “Padmabhushan” and if I had known that I was going to be given the “Padmashri” I would have certainly rejected it. So many friends wrote to me that we can’t congratulate you but instead of congratulating you, we see that it has been a great disfavour to you at the end of the service of about 50 years. Giving a reward of “Padmashri” is just like throwing away something on a person who deserves [a] much higher award. Well then when the ICMR started its scheme of giving awards to biomedical persons, during the first year itself I was selected for an award and my subject was fixed by the ICMR. I did my best to put my achievement in [a] good manner. But I was surprised to know that it was a meagre award. ICMR awards have been much higher value. But I don’t mind but I certainly feel that it was great injustice to me to give me the lowest award consisting of only mere Rs. 1,000/-.

Who were the personalities who have influenced you in your personal and professional life?

In my personal life during my school and college career, it was my elder brother who put me and kept me on the right path. Then when I graduated I owe gratitude to the doctor who gave me a chance to pick up the laboratory training. I went to the leprosy department of School of Tropical Medicine, Dr. Lowe the then Head of the Department was very nice and helpful to me except at the one incident which I have already quoted that I did not agree to publish his name on that paper which I published in 1941 regarding the protein fraction being constituent of the leprosy bacillus which is responsible for a positive early and late lepromin reaction.

When coming to Chingleput I found Dr. Ramanujam and Dr. Ramu very friendly and very helpful and even up to today I [have] got a great love for them. Then for the hard work that I was doing and for the time that I was spending on it, I could do it only with the co-operation of my wife. I didn’t spare very much time for her and I was so busy in so many projects that on every Sunday or holiday I would go as usual to the institute in the morning at 8.00 o’clock and we (myself and my wife) never had common breakfast because I had to go early. I took my breakfast in the office and she took it later. She has been co-operative and very helpful. Another person who was very faithful to me, very helpful to me was that when I went to the office on Holidays and Sundays etc. he very willingly and gracefully came with me to the office. He was very happy and I was also very happy, that was my personal assistant, Shri Venkateshan. Still up to now we are corresponding with each other. He always remarked “We can never have a Director again like you.” Of course, because of his sincerity and consciousness of duty I got him a good lift from the steno-typist to the Personal Assistant.

Recently International Leprosy Congress was held first time in India for which you are the Chairman, Can you tell as something about this International Leprosy Congress which you have in 1984?

The International Leprosy Association, besides getting out a quarterly Leprosy Journal known as International Journal of Leprosy, the Association holds a leprosy conference on every five years and there people get together, know each other, solve their difficulties and it is very sound influence and stimulation of work in the country where it is held. When I went to the Havana Congress in 1948, I had invited on behalf of India the next congress to be held in India. Central Council of the Association … very much liked the idea. But the next Congress was already fixed for Madrid in 1953. India’s invitation was accepted for holding the Congress in 1958. But somehow it so happened - the reasons into which I will not go here - that only three months before the congress was to be held, the Government of India withdrew its invitation. That embarrassed me very much and embarrassed the international Leprosy Association. Fortunately Japan (which also wanted to hold the Congress in 1958, but India was given preference) came to our help. Within two or three months they organised the Congress in a very good way and I had sent all the papers which I had collected as a Secretary of the Conference to Japan. Wish the help of those papers they could go ahead and hold the Conference on the day it was to be held in Delhi.

From that very date I was looking for the opportunity to invite the Congress to India again. But I kept silent for some time because I knew the mood of the International Leprosy Association about [the previous] invitation being withdrawn only few months before. So I just waited for a sufficient time and then began to move for Congress have to recall in Delhi in 1983. At my request to Secretary of Hind Kusht, Nivaran Sangh, wrote Government of India to invite the Conference. They agreed to hold the Congress. After all I went to Mexico Congress to invite the Congress to India for 1983. Actually accepting this they asked me [a] few questions. Whether this invitation is from [the] Government of India and whether it will not be withdrawn as it was done in 1958. They took my assurance that it is really the Government of India which have approved of it and they have just asked HKNS to organise the Conference and the second question I answered that I can assure you that there will not be the same experience which we had in 1958. It was very gratuitous of them that the Central Council of the General meeting of the members of Association, my request was unanimously accepted. Although there were some of the other countries that were in the field. But because so much work has been done on leprosy in India, they were very happy to accept our invitation. Specially because I had gone to Mexico Congress only for this purpose. My ambition was that the congress in India in Delhi should surpass all the previous congress, scientifically in providing amenities to delegates etc. and as soon as I came back we found we established a local organising committee for which the Minister of State for Health was the President. I was the working chairman and Dr. Thangaraj was elected, as Organising Secretary. With the spirit of … team work, we all worked together and ultimately the Congress was a big success in all aspects. We had 1400 delegates from all the different parts of the world. The congress was [a] very high standard and we looked after their hospitality and their transport from the Hotel to the Vidnyan Bhavan where the Congress was held and to the hotels. The cultural programme and reception which were given by a number of Embassies. After the congress was over and the delegates had gone back their countries, several letters of appreciation were received of the way in which the Congress was organised. The President of the International Leprosy Association in his letter said that everything was super.

How do you visualise the prospects of eradication of leprosy in our country?

The target for eradication of leprosy has been put by end of this century, i.e. in about another 16 years. Now I would be very happy if the target could be achieved. However, I am not optimistic about these when one sees the history of decline of leprosy in other countries. No doubt we are now in a better position with the MDT to tackle this problem. But mere MDT will not be able to eradicate the disease and in such a short time. The lesson that we have learned from eradication of leprosy in Norway is that with their small problem, they took 75 years to eradicate the disease. This was possible only because it is just really a social welfare country. Whenever anybody was isolated in hospitals, they were compensated for a loss of a person from the family if the family bread winner was isolated person. Now this thing can not be expected from India or other developing countries. Moreover it is not only the drug is needed, the raising of the socio-economic stains of the population is a very essential fact. Raising the socio-economic status will serve two purposes. Remove overcrowding in the houses so that if there is a case of leprosy, the chances of spread to others are not there if the patient is living in the separate room and not huddled together. The history of the decline of leprosy in Norway, which has been properly analysed because of the central registry of leprosy in Norway. All the cases had been entered and all their physiological conditions and habits of diet and this analysis has proved that lack of sufficient nutrition or malnutrition made the people more susceptible to leprosy. In the analysis they found out that there was less leprosy in the forms where the milk supply is sufficient, than in the forms where the milk supply was very low. This is quite good example of how … malnutrition causes leprosy. Then the sanitary conditions and sanitary habits of the individual have to be improved; eg. there is a habit of blowing the nose, spitting in the house here and there and in the public places, on the roads, streets etc. They indiscriminately blow their nose and spit. Now the leprosy bacillus is a very hardy bacillus and it remains viable for very long time in the dark and humid room or building. This habit of indiscriminately blowing the nose and spitting etc. has to be eradicated before leprosy is eradicated. To eradicate these habits of the leprosy patients it is essential that these habits has to be checked in the whole population. Otherwise we cannot expect the leprosy patients to follow certain lines which are followed by general population.

Have you any suggestions to make which will help for eradication of leprosy in our country?

As I have already stated, the financial position, the socio-economic condition of general population has to be raised for that there is no malnutrition. Second thing is that, unsanitary habits of spitting and blowing the nose indiscriminately. Third is that it is the accommodation in the houses should be such that there is no overcrowding and fourth the most important one is to arrange for short term isolation to avoid contact of infectious patients with healthy population.

It is no doubt that we are in a much better position now with MDT. But unless the necessary things which I have already indicated are not attended to, leprosy will remain with us for very long time till we are able to look to the various things which had been mentioned.

The last but not the least Dr. Dharmendra, what are your future plans?

Well, I am now of 84 years and my social plans are as long as I remain fit to do the work, I shall continue what I am doing now. * * *

Tape received on July 1984."

Research Institute(s) associated with:
Central Leprosy Teaching & Research Institute, Chingleput, Tamil Nadu, India

Publications

Notes on Leprosy. Two editions. The Ministry of Health, Government of India.
Leprosy, Vol 1. Kothari Medical Publishing House, 1978.
Leprosy, Vol 2. Samant and Company, 1985.

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