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Remembering Sambhu Nath De, the Medical Man for the Blue Death

#mustread" data-image-description="<blockquote id="yui_3_7_2_1_1364715489059_5699"> <div id="yui_3_7_2_1_1364715489059_5698"> <div id="yui_3_7_2_1_1364715489059_5702"> <div dir="ltr" id="yui_3_7_2_1_1364715489059_5701"> <div id="yui_3_7_2_1_1364715489059_5700"> <div><img alt="" src="" /></div> <div></div> <div id="yui_3_7_2_1_1364715489059_5704">38 year old Comrade <a class="zem_slink" title="Shalini Kumar" href="" target="_blank" rel="wikipedia">Shalini</a> passed away on 29th March. She battled with courage till her last breath. For those not aware, Comrade Shalini was the chairperson of the Jan Chetna Trust along with being an executive member of the Rahul Foundation.  Please go her blog to know more about her and what a gusty and determined person she was.  The blog has material in english and hindi. <a href="" target="_blank" rel="nofollow"></a></div> <div id="yui_3_7_2_1_1364715489059_5706"></div> <div id="yui_3_7_2_1_1364715489059_5708">The <a class="zem_slink" title="English language" href="" target="_blank" rel="wikipedia">English translation</a> of a very powerful poem written by her on 31st January, 2013 in <a class="zem_slink" title="Hindi" href="" target="_blank" rel="wikipedia">Hindi</a> called “<a class="zem_slink" title="My Last" href="" target="_blank" rel="wikipedia">My Last</a> Wish : A Revolutionary’s Will” is being pasted below.</div> </div> </div> </div> </div> </blockquote> <h3></h3> <div id="post-body-8999356892483275348"> <div dir="ltr"> <div></div> <div>Communists fight every battle with all their might.</div> <div>I know – <a class="zem_slink" title="Metastasis" href="" target="_blank" rel="wikipedia">metastatic cancer</a> is a deadly disease<br /> So I am fighting it with all my willpower.<br /> I want to live my life to the fullest and I do believe<br /> That my will to live will defeat even <a class="zem_slink" title="Death" href="" target="_blank" rel="wikipedia">death</a><br /> And even if it does not happen<br /> I will prove in any case that<br /> True revolutionaries neither give up in the face of hard times<br /> Nor surrender before death like a coward.I believe in my determination and combativeness<br /> And I know that I have to win this battle and<br /> Return to the front, to hold which till my last breath<br /> Is a commitment made to my soul.<br /> So, there is every possibility that this last wish of mine,<br /> This ideological testament of mine<br /> Might become meaningless tomorrow,<br /> But even after fighting valiantly till the last breath,<br /> <a class="zem_slink" title="Bullying" href="" target="_blank" rel="wikipedia">Like</a> a true communist,<br /> If I have to fall,<br /> I want to leave this letter of my last wish<br /> For my <a class="zem_slink" title="Comrade" href="" target="_blank" rel="wikipedia">comrades</a> and friends.I know I have to defeat cancer.<br /> I have the love and pain of my comrades with me.<br /> I have to get back to rejoin the ongoing war against capital<br /> On my front, for the sake of coming generations.<br /> But if this is not going to be possible,<br /> My comrades will ensure that<br /> My body is untouched by the dirty hands of those<br /> Who threw dirt on our red flag<br /> Who vilified and slandered against our experiments<br /> Built through hard work and sacrifices of numerous comrades,<br /> Who defamed ‘Janchetna’ and our publications<br /> By saying these are profit-churning enterprises, even though they know the truth.<br /> The vermin must not be allowed to come near my body<br /> Who indulged in the filthiest mudslinging against us and tried their best to spread<br /> Poisonous fumes of suspicion and distrust among communist ranks<br /> To cover up their own degeneration.<br /> These deserters who fled to hide in their dens in the hard times<br /> Shamelessly talk of principles.<br /> Some are degenerate opportunists who still run political shops<br /> To satisfy their egos and make a living.<br /> This abominable gang has even used death and disease of comrades<br /> As a political weapon to target us.<br /> Even my filthy rich father is a part of this gang<br /> Who blinded by his class arrogance and vested interests<br /> Has tried everything possible to damage our work,<br /> He has his own class commitments<br /> And he will never change.<br /> Comrades! You all must ensure<br /> These people must never come close<br /> To my body even after I am gone,<br /> This is my last wish.</p> <p>Comrades! I am not a daughter of working people.<br /> I was born in a family of<br /> Usurers, traders, landlords, parasitic moneybags.<br /> As I gradually imbibed the spirit of <a class="zem_slink" title="Communism" href="" target="_blank" rel="wikipedia">communism</a>,<br /> I tried to think of myself as a daughter of <a title="Working class" href="" target="_blank" rel="wikipedia">working class</a>,<br /> And tried to work like a labourer on the revolutionary front.<br /> I don’t know how much I have been able to pay back the people’s debt,<br /> How much sins of my ancestors I have been able to wash away –<br /> This will be judged by the coming generations.<br /> I can only assure that<br /> I have never thought of going back home,<br /> I was never attracted by the idea of settling in a cosy nest,<br /> And back away from the storms.<br /> Like a normal communist<br /> I too have had natural human weaknesses,<br /> And even some class weaknesses inherited from my background.<br /> I do not claim that I was never touched by pessimism,<br /> Or I never had any grievance with my comrades,<br /> But I can assure that I have always got satisfaction and happiness<br /> In my efforts to become a better communist,<br /> I love my comrades more than anything in the world<br /> And trust them wholeheartedly<br /> And I still love life with all my heart<br /> And I want to live as much as I can.</p> <p>That’s why, I believe that victory will be mine<br /> The cancer is bound to be decimated against my communist resolve<br /> In this fight against death.<br /> But I am ready like a true communist<br /> To face every adversity<br /> And that’s why I am writing down my heartiest wish<br /> That if I lose out in the battle of life<br /> My body must be wrapped in our cherished red flag<br /> And then it must be donated to a government hospital or medical institute<br /> For the purpose of scientific research or to donate organs to poor and needy patients.<br /> I will legally assign the responsibility for this to two of my comrades.<br /> If this is not possible for any reason<br /> My body should be taken to an electric crematorium<br /> On the shoulders of my comrades<br /> And my last rites must be performed without any religious rituals<br /> With raised fists and the International being played.<br /> It must also be ensured<br /> That none of the degenerate renegades must be allowed to join<br /> They must not be allowed to come near my body.<br /> I know, those who say even today<br /> That I have been “brainwashed” (which is the biggest abuse for me),<br /> Will not refrain from using my death for their dirty politics,<br /> Thus, it is necessary<br /> That I write down my wish in clear terms.</p> <p>Comrades! I do not await death<br /> But to get back to my work.<br /> Cancer can be defeated by<br /> Positive attitude and firm resolve<br /> And all possible treatments are going on.<br /> But still if I am unable to return to my front,<br /> There is nothing to worry,<br /> I will remain present in your thoughts and determinations.<br /> I know, you will turn grief into strength<br /> To make up for my loss.<br /> You can turn one into a hundred.<br /> We have to save the children! Save the dreams!!<br /> We have to wake up forgotten ideas,<br /> And explore new thoughts!<br /> We have to recruit new soldiers<br /> And make the people realise once again<br /> That they are the makers of history.<br /> I may or may not be with you,<br /> But this fight will go on, till victory comes.<br /> The caravan will keep on going, until it reaches our destination.</p> <div><b>– 31/1/2013</b></div> <div></div> <div>An inspirational poem  for shalini</div> <div></div> <div> <h3><a href="">शालिनी से</a></h3> <div></div> <div id="post-body-6399335238767149682"> <div dir="ltr"> <div><a href=""><img alt="" src="" border="0" /></a></div> <p>हम लड़े हैं साथी<br /> उदास मौसम के खि़लाफ़<br /> हम लड़े हैं साथी<br /> एक नयी राह बनाते हुए, प्रतिकूल हवाओं<br /> के ख़ि‍लाफ़<br /> हम लड़े हैं साथी<br /> उखड़े तम्‍बुओं वालों की घिनौनी तोहमतों के ख़ि‍लाफ़<br /> हम लड़े हैं साथी,<br /> मौत पर राजनीति करने वाले<br /> गिद्धों के ख़ि‍लाफ़<br /> हम लड़े हैं साथी<br /> उल्‍टे पैर घर लौटती दुनियादारी के ख़ि‍लाफ़<br /> सीलन भरे अँधेरे के ख़ि‍लाफ़,<br /> वैचारिक प्रदूषण और दि‍खावटी प्रतिबद्धता के ख़ि‍लाफ़।<br /> और अब, हम लड़ेंगे साथी<br /> मौत की चुनौती के ख़ि‍लाफ़,<br /> षड्यंत्ररत मृतात्‍माओं के ख़ि‍लाफ़।<br /> हम लड़ेंगे<br /> कि ज़ि‍न्‍दगी ठहरी नहीं रहेगी।<br /> हम लड़ेंगे<br /> कि अभी बहुत सारे मोर्चे खुले हुए हैं<br /> जूझने और जीतने को।<br /> हम लड़ेंगे<br /> पीड़ा और यंत्रणा के ख़ि‍लाफ़<br /> हम लड़ेंगे<br /> सच्‍चे ज़ि‍न्‍दा लोगों की तरह<br /> क्‍योंकि उम्‍मीद एक ज़ि‍न्‍दा शब्‍द है।</p> <div>                               <b>– कविता कृष्‍णपल्‍लवी</b></div> </div> </div> </div> </div> </div> </div> <h6 class="zemanta-related-title" style="font-size:1em;">Related articles</h6> <ul class="zemanta-article-ul"> <li class="zemanta-article-ul-li"><a href="" target="_blank">Young revolutionary and cultural organiser Shalini passes away #RIP</a> (</li> <li class="zemanta-article-ul-li"><a href="" target="_blank">25th Anniversary of Paash – A Punjabi Poet who died for opposing Fanaticism #mustshare</a> (</li> <li class="zemanta-article-ul-li"><a href="" target="_blank">#RIP – Comrade V. B. Cherian, President of the NTUI Kerala State Council</a> (</li> <li class="zemanta-article-ul-li"><a href="" target="_blank">An appeal to friends and comrades to save the life of a revolutionary #mustshare</a> (</li> </ul> <p>&nbsp;</p> " data-medium-file="" data-large-file="" class="size-full wp-image-15926" src="" alt="Scanning electron image of Vibrio cholerae. Credit: Wikimedia Commons" width="800" height="625" />

Ask someone what Black Death is and the prompt answer will be “the plague”. But, ask what Blue Death is and even some biologists might falter. The answer is cholera, historically known as Asiatic cholera. A highly infectious disease, cholera likely originated in India and caused at least three major epidemics in Bengal during the 19th century, before spreading across the world and killing millions. The terror of the scourge ensured that Oladevi (or Olabibi), the ‘anti-cholera goddess’, was devoutly worshiped by all Bengalis. John Snow’s 1855 discovery that the causative agent got transmitted via contaminated water revolutionised the field of epidemiology and public healthcare. A few decades later, Robert Koch, the iconic bacteriologist, conclusively identified the pathogenic bacteria: Vibrio cholerae.

Today, there has been a sea-change in our understanding of how the pathogen causes the disease. It is common knowledge that the actual mischief-maker is the cholera toxin (CTX), a complex of six proteins released by V. cholerae into the small intestine. When CTX enters the intestinal cells, it triggers a cascade of intracellular reactions. The final result is the opening of floodgates such that sodium, potassium, bicarbonate ions and water pour from these host cells into the intestinal lumen, causing intense diarrhoea (the faeces is typically rice-water-like in appearance) and a rapid loss of water and electrolytes from the body. Yet, Sambhu Nath De, the Indian scientist whose discoveries radically altered our understanding of the pathogenesis of cholera and also played a pivotal role in discovering CTX, is all but forgotten, even in his own country. On his birth centenary, it is worth honouring him by recalling his scientific genius.

The rice-water like appearance of the faeces of a cholera victim. Credit: Wikimedia Commons

Early years

De’s life exemplifies the ability of champions to overcome all obstacles. He was born in an impoverished family in a village close to the French colony of Chandannagar in Bengal in February 1915. A considerate uncle and a benevolent neighbour paid for his education till De won a scholarship to the Calcutta Medical College. He started a medical practice in 1939 but his heart was in the research laboratory. De’s mentor and father-in-law M.N. De was a renowned bacteriologist. Convinced that his jamai was destined to be a top-notch scientist, M.N. De recommended him to Sir Roy Cameron, a famous pathologist, and De joined the Cameron lab at the University College London as a PhD student in 1947. After an initial bout of struggle and depression, De’s research found its tracks and Cameron noted, “… he has regained confidence. He is doing excellent work.”

However, apart from his own thesis, De developed an intense interest in understanding the pathogenesis of cholera. By the time he returned to Calcutta in 1949 and was appointed the Chair of Pathology at the N.R.S Medical College, it was evident that research on V. cholerae would be his life’s mission. It was also a time when post-Partition Calcutta was overflowing with refugees and hundreds were being struck down by the Blue Plague. The N.R.S Hospital catered to most of the city’s cholera patients and provided De with the impetus to understand the pathogen, in a bid to ameliorate the suffering of his fellow-citizens.

Koch’s mistake

But unknown to all scientists in the 1950s, the major hurdle was a wrong scientific assumption. Several decades prior, Robert Koch – credited with discovering several pathogens – had concluded that V. cholerae primarily attacked the circulatory system of the patient, a rare case where Koch was off the mark. Yet, just as Ptolemy’s geocentric model had prevented most astronomers from thinking radically for more than a millennium, so influential had Koch’s ideas been on bacteriology that scientists had continued to study cholera by injecting the bacteria into the blood but never into the intestine.

The result was that, even after various bacterial preparations had been tested on different animals, the symptoms of cholera had never been replicated in the laboratory. And in absence of an animal model that could be studied in the lab, scientists were effectively groping in the dark.

De’s brilliance lay in breaking free of Koch’s idea. He hypothesised that the cholera bacillus’s main target was the cells lining the small intestine. To demonstrate this, he anaesthetised rabbits and introduced V. cholerae into the intestinal lumen. The rabbits did not suffer from diarrhoea but died a few days later. The autopsy, however, showed something remarkable. Usually, herbivorous rodents like rabbits have a large caecum – the pouch-like beginning of the large intestine that is directly connected to the small intestine and helps in digesting plant matter. In De’s own words, “… we found that the huge caecum of these rodents, which normally contain pasty semisolid material, was full of semiliquid faecal matter from which V. cholerae could be recovered…” De correctly concluded that the infection had initially caused fluid to flood the small intestine, but subsequently it had accumulated “in the caecal backwater’’.

The loop idea

In the following experiment, De tied two silk ligatures on either side of a four-inch segment of the small intestine, isolating this part from the rest of the gut. Then, he introduced the bacteria only into this segment. The next day’s autopsy heralded a scientific breakthrough: the isolated segment was swollen and distended with rice-water fluid, reminiscent of the faeces of cholera victims. The rest of the intestine – where no bacteria had reached – was in a collapsed state.

Sambhu Nath De. Credit: Wikimedia Commons

To quote De himself, “This represents cholera localised to a small segment of the intestine” and proved that the bacteria changes the permeability of the intestinal cells, resulting in an explosive secretion of fluids. The discovery, published in 1953 in an article titled ‘An experimental study of the mechanism of action of V. cholerae on the intestinal mucous membrane’, is considered a landmark publication. More importantly, it would pave the way for introduction of the oral rehydration solution (ORS), a simple, home-made therapy that has saved millions in India, Bangladesh and Africa.

Within the next few years, using the same ileal-loop technique, De demonstrated that several patients had been infected by strains of Escherichia coli, which induced similar intestinal secretions, another milestoneHe received accolades for his work in the UK, much to the delight of his mentors.

Another seminal discovery was in the offing: the discovery of CTX. Today, it is recognised that a bacterial toxin can be either secreted by the pathogen (an exotoxin) or be an integral part of the bacterial cell itself (an endotoxin). The question was if the elusive CTX was an exotoxin or an endotoxin. No one knew but most believed it was the latter. Again, De’s experiments would cause a paradigm shift in scientific understanding. By 1957, De was labouring to identify the CTX so that it could be converted into a toxoid for use in vaccines. Since the medical college had no infrastructure for such a venture, he worked at the Bose Institute, Calcutta.

A premature close

Supremely passionate about science, he used to start experiments in the evenings after hospital duty and refused rest even on Sundays. The efforts bore fruit. De noticed that if V. cholerae was grown in a liquid medium and then the cells were removed, the cell-free filtrate could still induce cholera in the intestine. After having painstakingly repeated the experiments, De was convinced that CTX was not an endotoxin but an exotoxin that the bacteria released into the medium. When the CTX exotoxin reached the intestinal cells, it induced diarrhoea, the classic symptom of cholera. The findings were published in the journal Nature in 1959.

Unfortunately, although De was eager to identify the CTX molecule, the lack of modern equipment in India meant his work came to a screeching halt. As research surged ahead in the rest of the world, he felt disheartened at the lack of progress and recognition. He retired from the hospital, in 1973, and also from the laboratory. In 1978, however, he was invited by the Nobel Foundation to be a guest-speaker at a special symposium and received rich praise.

Science had been De’s only passion. He had never cultivated close relations with the establishment as such. Hence, as P. Balaram, one of India’s leading scientists and editor of the journal Current Science, noted in a special issue dedicated to ‘S.N. De and the cholera enterotoxin’ (1990), “… De died in 1985 unhonoured and unsung in India’s scientific circles. That De received no major award in India during his lifetime and that our academies did not see it fit to elect him to their Fellowship, must rank as one of the most glaring omissions of our time.” Indians lament that scientists such as J.C. Bose, Meghnad Saha and S.N. Bose never received a Nobel Prize. But they have at least won the adulation of the common Indian. In contrast – and what is perhaps more tragic – is that De’s heroic tale of intellectual brilliance and perseverance has remained unknown to the layperson. Yet it is certainly one of the most inspirational in the annals of modern science and Indian researchers would do well to emulate him.

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