Dr E P Fritschi, ‘An Autobiographical Sketch’ (transcribed from an oral account) in S S Naik (ed) The Indian Leprologists Look Back. Bombay, 1990. pp. 49-54, posted online with revisions by E H Price, 31 August 2006.
Well. I am a bit of a mix-up. I was born in Mangalore, in what was then the South Kanara area of Madras State, of Swiss parents. My parents were called to India in 1920. Shortly after my birth - about 2 years after - we migrated to the Nilgiris. My father left his paid employment as an administrator in a Christian Mission and started off in private business in importing Swiss articles and exporting tea and so on.
In due course I went to school in the Weeks Memorial School and spent most of my schooling in that school. It was a strange school in that it was in the old colonial days and the curriculum was the prescribed curriculum for the Cambridge school certificate. Anything that we studied related to English conditions; the history, geography, everything. We didn’t learn any Indian history, nor did we learn any Indian geography and yet we were in the middle of India. So I was in India without knowing anything about India. From this situation having decided that I would like to do medicine I went to an Indian College. And for the first time I mixed with my peers who were Indians by blood and discovered a completely new India which I had never known before. During those years in the Madras Christian College, i.e. 1942-43, this Was the time of the Quit India Movement when the Independence Movement and struggle was at its height and I as a young Swiss teenager was exposed to this conflict between the British Government and Indian Independence struggle. From that time onwards I became - if I may dare to say so - something of a Gandhian. I took to spinning - I have always been interested in using my hands - and spun more yarn. In those days we had to give one anna’s worth of yarn for every rupee’s north of Khadi and continued this for the rest of my life. And when India got its independence I took Indian nationality. I learnt the needs of rural India, was exposed to the poverty, the inadequacy of medical services and so on. I had a background of interest in forestry and the choice that I made after my intermediate was between forestry and medicine. I suppose as an act of God I was selected in medicine - though I didn’t deserve it and would not have been able to get in if I had to face the competition young people have to face today. But having been selected in Madras Medical College I enjoyed my medical studies. I did very little study but enjoyed my time as a medical student.
Could you give us an idea of your Medical Studies?
Well now you know I have to be careful there. I took a long time to get through my pre-registration - 2 solid years for a 6 month course! This was because I was enjoying life so much and cut most of the classes and took part in all the dramatic items that were going. In every drama Fritschi was there on the stage, playing the fool or singing or something. So one could not say I was an ideal student. There were certain things that I was interested in but most of my studies I was not interested in. I never got any prize nor did I have any Ambition to get any prize. But I was interested in the practical aspects of study. And even in those early days I had some interest, some special interest in leprosy.
How did you enter the field of Leprosy?
My earliest recollection of leprosy - you must remember that in the Nilgiris there are no leprosy patients - so my earliest recollection was during an annual summer conference of the Christian Medical Association of India, held in Coonoor, when Dr. Cochrane, then quite a young man - this must have been in the early 40’s - was one of the chief speakers. And he spoke with his customary enthusiasm, inspiring challenge and interest on the subject of Leprosy. And from that time onwards I had some sort of a little bias about leprosy. And. then through my early college years this gradually began to consolidate particularly in the village clinics that we were running. In the Madras Christian College there was quite a rural service society and we had a clinic in a village near Pallavaram. That clinic started off as a general clinic but there were a number of Leprosy patients around that village and it began to develop into a proper leprosy clinic. And that fostered the interest. And, later when we needed the Finance, there was a lady who was the proprietress of the Chromepet Leather Industry. She offered to finance all the work that we did related to leprosy, but nothing that we did unrelated to leprosy. So the interest was there, and the finance was provided and I suppose that is how I first became really interested in leprosy.
What was your principal contribution to enhance the knowledge on the subject?
Well, I am something of an innovator. But I am not by any means what you could call a scientist. Its nice to be able to test something out, but I am not one of those people who can study abstruse subjects And my main contribution throughout my 30 odd years of service in leprosy has been in teaching techniques which have been devised and tested and on which a few papers have been written demonstrating the effectiveness of that particular technique and so on. And of course one of the important things is acting as a scaffolding from which more intellectually gifted persons than I could rise to new heights. In other words keeping the home fires burning while the brilliant ones made contributions to the subject: .... consolidation if you like.
Professional life as a Leprologist.
Well I started my professional life as a leprologist in Christian Medical College, Vellore working as the research assistant for Dr. Brand. And that is the area where I became most interested – the area of reconstructive surgery. I worked with and associated with him from about 1955-1958 both in CMC in Vellore as well as in Karigiri which had just started in 1955. Then I did post-graduate studies in England and Madras Medical College and that was what directed me into the areas of Surgery. So that rather than call myself a leprologist, I was more apt to call myself an orthopaedic surgeon working in leprosy.
Describe your participation of the changing patterns of leprosy-clinical, sociological, administrative and therapeutic aspects during your association with leprosy.
Well, when I came into leprosy there was almost nothing you could do except give injections which were of doubtful value and see the patients gradually getting from bad to worse. I think this is what attracted me into Dr. Brand’s area of work because there we made a definite attempt at preventing injury and at providing sociological rehabilitation for the patient. We established a little test-tube centre in which we tried out various methods of rehabilitation. Surgical reconstruction was part of the programme, and of course studying the effect of different procedures that we were doing. The changes that occurred during my career included the introduction of leprosy control in which I was not in any way directly involved. But, whereas when I started we had leprosy clinics - anybody who felt like taking treatment was welcome to take it from the clinics - the new emphasis was to go to the village, find new cases and follow them up and insist on their taking treatment. This is very definitely a new emphasis. Along with this emphasis came a lot of health education. We went through various phases and, the public I think is still confused. They are not quite sure whether leprosy is an infections disease or not. Because some slogans say, “Leprosy is the least infectious of all infectious diseases.” The public doesn’t understand the meaning of that. I must confess I don’t understand it myself. So we have allowed publicity to be coloured by emotion and in our anxiety to uproot stigma we may actually have created quite a lot of confusion.
What I mean is … we must emphasise that there is a very good prognosis in the treatment of early leprosy we must remember that our concept of leprosy and the concept of leprosy in the public is something quite different. Now suppose that you were to develop a little patch, or if somebody in your family develops a little patch on the skin, we could start you on treatment with absolute confidence that you will get a complete and permanent cure. This was not the case earlier on.
But it you tell a person, “Leprosy is curable in all stages’’- which is another famous slogan - what do we mean? If a person comes with advanced leprosy, with a collapsed nose, and no eyebrows, and can’t shut his eyes, and claw hands and holes in his feet, we can say we can cure him of leprosy, but he thinks you are talking nonsense, because his idea of leprosy is deformity. So our teaching of the public, our education of the public must be explanatory, so that the public knows what we are trying to talk about. I think this is the direction in which we have to go in the future.
Narrate any interesting or important incident connected with leprosy
Well I suppose hundreds….I recall working with Dr. Brand under many, many different circumstances. Going on out station clinics to Chingleput to Vadathorasalur operating under very strange conditions and sometimes under highly undesirable conditions where asepsis is not very good.
I remember working with Dr. Cochrane and Dr. Cochrane was not an easy man to work with. And in the later years of his life he was very, very exacting in his work methods. He himself slept only about 4 hours every day and he pretty well demanded that his assistants should be on the job all the time. Then I remember other personalities such as Dr. Ramanujam, Dr. Ekambaram - highly dedicated persons who have given their whole career to the service of leprosy.
Funny Episode….Many conferences which we attended together, all really difficult to remember individual incidents. But certainly it is true that anyone who works in leprosy meets interesting characters and goes all over the place and has interesting experiences.
Well, of course, eradication of leprosy is a slogan. It is quite definite that we are not going to eradicate leprosy within the next few years. Eradication implies that there is no further sign of leprosy, and that will depend on the last patient with deformity dying before we can say that. It also means that no case of leprosy should be contracted from now onwards because already there are less number of years before the year 2000 than the incubation period of leprosy.
But I see a big change in the pattern of leprosy, both qualitative as well as quantitative.
There are going to be areas where leprosy was highly endemic where it is obliterated completely - where there are no new cases. And there will probably be other cases where lots of other cases come out .... whatever it is, I think in the next generation, in the next half century, leprosy will be a common, mildly infectious disease in India.
Deformity has already disappeared to a very large extent and we do not see anything like the terrible ugly deformities that we used to see.
There was a time when we went to leprosy clinics where the whole atmosphere was smelling with the characteristic lepromatous odour - that’s gone. I don’t think I have smelt the lepromatous smell for years. It’s actually I believe, as we call it, the smell of lepromatous ulceration of the nose, which nowadays again you hardly ever see. So leprosy as we know it from beggars will disappear and hopefully leprosy will become taught in medical colleges so that the ordinary practitioner knows how to handle it. Now that there is the standard MDTs there is no reason at all why a general practitioner should not be able to treat leprosy patients, and I can see that this is going to increase…. But there will be scope for people who are specialising in leprosy just as there is still scope for people who are specialising in tuberculosis and diabetes mellitus, in all these various one disease entities. So the specialist will continue. The services will probably be more general and handled by the general practitioner, but leprosy will probably still be with us I am afraid until well into the 21 st century.
Hobbies unrelated to Leprosy.
I have too many hobbies, too many interests. My main interest is in the preservation of nature. As I said earlier, I was brought up in the Nilgiris and in those days there were areas near our home with beautiful primary tropical forests, and now it has all been cut down. The forests have been planted in eucalyptus or something and primary forest is now becoming increasingly rare. I myself remember seeing the shot body of a tiger when I was a teenaged boy. I was very thrilled about it then. But even then it looked a pathetic sight, lying on the ground in front of the tea factories. Now there are no tigers on the tops of the hills at all. There is still the tiger reserve lower down.
So the conservation of nature I think is the most important and the future of our country will to a large extent depend on the ability of looking after nature, rather than exploiting it, and seeing what we can get out of it. Closely allied to that is ecology in the form of agriculture which is environmentally protective. Nowadays we buy a plot of land on the side of a hill, where there is no stream and no visible water. We dig a well. The well is dug 40 feet deep. We can’t go anywhere, so we go 100 feet deep with a bore, and we start pumping water out of the bowels of the earth. And thereby we convert dry land - the kind of land God intended to be dry - into wet land. This is going against nature. Whereas we ought to use responsibly our water resources, we are exploiting our water resources.
Similarly fuel - the responsible use of fuel. We are going for all sorts of gadgets making use of electricity and what have you. We don’t ask ourselves the question, “where does the electricity come from?” We are not making use of probably the most important raw material in terms of energy in India, which is the sun! We talk a lot about solar energy now, but solar energy is so expensive in India that nobody can think about it. We talk about gobar gas, but very few people are using gobar gas.
We have exhibitions in agricultural shows and so on in which we advertise pesticides, but we don’t bother to find out what is the effect of the mass use of pesticides on the countryside. We kill the insects. The insects eat the pesticide, and the birds that eat the insects, die. Soon we will be left with a country with no insects and no birds and no worms and no life at all. I can see that India is progressing towards a desert unless something happens to change our outlook on life and make us realise that we are responsible before God to conserve the world that he created and not to exploit it for our own personal advancement.
The tape received on September 6, 1988.
Research Institute(s) associated with:
Christian Medical College and Hospital, Vellore, Vellore, Madras, India (currently Vellore, Tamil Nadu, India)
Schieffelin Leprosy Research and Training Centre, (currently Tamil Nadu, India)
“Values and Limitations of Surgery in Leprosy” Leprosy in India 48 (1976): 4-7.Reconstructive Surgery in Leprosy. Bristol: John Wright and Son, 1971.
|Karigiri (later Schieffelin Leprosy Research and Training Centre)||
Dr Ernest Fritschi was the first resident surgeon at Karigiri. He took over as Superintendent when Dr Gass left. Trained by Dr Brand in reconstructive surgery, Dr Fritschi, a creative surgeon, like his teacher, took on the responsibilities of leadership willingly. He loved his patients and they in turn loved him. He spent time with them, got to know them and understood each one's particular problems. In 1956, Karigiri was still a barren, brown desert. It was under Dr Fritschi that the greening of Karigiri and the ecology project started.
He was superintendent from 1956-1959 and again from 1974-1987. In 1974, Dr Fritschi returned to Karigiri with a special mandate from the missions to develop Karigiri into a training centre for those working in leprosy. …
Under his leadership, training courses in the different fields were systemized and organised into a syllabus, which was later recognised by the government. The training unit and hostels for trainees were built. Karigiri became an internationally acclaimed teaching and training centre for leprosy personnel all over the world.
Many additions to the old hospital were made during Dr Fritschi's tenure … the new physiotherapy block, the CBM ophthalmic ward, the trainees hostel, the training unit, the new guest house, the Lazarus ward, for private patients, two new houses for senior staff, the CBM medical ward, and the new operation theatre. MDT was introduced as the cure for leprosy, Karigiri video was launched, and roots for the Care after Cure Project were palnted.from A Place of Hope and Healing: The Karigiri Story Usha Jesudasan