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Dr Sambhu Nath De beat Europeans in stopping global Cholera Pandemic in British India

17 May, 2021 11:25:13
Dr Sambhu Nath De beat Europeans in stopping global Cholera Pandemic in British India

Pandemics are large-scale outbreaks of infectious disease that can greatly increase morbidity and mortality over a wide geographic area and cause significant economic, social, and political disruption. The ongoing COVID-19 global pandemic, reminds us of other deadly pandemics that have rocked the globe over centuries. Evidence suggests that the likelihood of pandemics has increased manifold over the past century because of increased global travel and integration, urbanization, changes in land use, and greater exploitation of the natural environment. Malaria, cholera, tuberculosis, leprosy, smallpox, influenza and others appeared during this period.

One such pandemic was cholera that first originated in India in 1817 and caused at least three major epidemics in Bengal during the 19th century, before spreading across the world and killing millions. Today, we know that cholera is a highly infectious disease caused by various strains of Vibrio cholerae bacterium. It was the work of a Bengali scientist Dr Sambhu Nath De, that radically altered our understanding of the pathogenesis of cholera and also played a pivotal role in discovering CTX. 

De was a brilliant student who completed his medical studies from Calcutta Medical College and Hospital in 1939 and started practicing but his heart was in the research lab. His mentor and father-in-law M.N. De was a renowned bacteriologist and he recommended young Sambhu Nath to Sir Roy Cameron, a famous pathologist. De joined the Cameron lab at the University College London as a PhD student in 1947.

German physician Dr Robert Koch was one of the founders of bacteriology. In August 1883, the German government sent a medical team led by Koch to Alexandria, Egypt, to investigate cholera epidemic there. He came to India and visited Calcutta as well to probe about cholera. Koch soon found that the intestinal mucosa of people who died of cholera always had bacterial infection, yet could not confirm whether the bacteria were the causative pathogens. Koch, who discovered several pathogens went off the mark this time and assumed that V. cholerae primarily attacked the circulatory system of the patient. 

Today, we know that cholera is a highly infectious disease caused by various strains of Vibrio cholerae bacterium. It was the work of a Bengali scientist Dr Sambhu Nath De, that radically altered our understanding of the pathogenesis of cholera and also played a pivotal role in discovering CTX.

Calcutta in 1894 during the Cholera epidemic

It was at this stage that Dr Sambhu Nath De played a crucial role. His brilliance lay in breaking free of Koch’s idea. He hypothesized that the cholera bacillus’s main target was the cells lining the small intestine. After conducting thorough research, Dr De came to the conclusion that V. cholerae releases the cholera toxin (CTX), which is a complex of six proteins into the small intestine. As soon as CTX enters the intestinal cells, it triggers a cascade of intracellular reactions. This results in the opening of floodgates causing sodium, potassium, bicarbonate ions and water to pour from these host cells into the intestinal lumen, causing intense diarrhoea and a rapid loss of water and electrolytes from the body. This discovery was a game-changer and it helped the scientific and medical fraternity to rein the deadly disease. 

De was a brilliant student who completed his medical studies from Calcutta Medical College and Hospital in 1939 and started practicing but his heart was in the research lab. His mentor and father-in-law M.N. De was a renowned bacteriologist and he recommended young Sambhu Nath to Sir Roy Cameron, a famous pathologist. De joined the Cameron lab at the University College London as a PhD student in 1947. While working for his thesis, De showed a keen interest in understanding the pathogenesis of cholera. 

He returned to Calcutta in 1949 and was appointed the Chair of Pathology at the N.R.S Medical College. He simultaneously worked at the Protein Lab at Basu Vignyan Mandir after hospital hours. His research on V. cholerae became his life’s sole mission. This was post-Partition Calcutta and the city was teeming with millions of refugees and hundreds were being struck down by cholera. 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 lessen the suffering of the hapless victims. De’s work was critical⁠—not just for the Indian subcontinent, but for the world at large.

In 1978, Dr De was invited to deliver a speech at the 43rd Nobel Symposium on Cholera and Related Diarrhoea where he expressed his frustration when he said, “I have been dead since the early 1960s. I have been exhumed by the Nobel Symposium Committee…

De’s seminal work not only strengthened our understanding of cholera and other diseases, but also provide the foundation for oral rehydration salts therapy (for cholera) that would go on to save millions of lives, particularly in developing economies. Meanwhile, Dr Koch, who discovered the anthrax disease cycle and the bacteria responsible for tuberculosis in 1876 received the Nobel Prize for Physiology or Medicine in 1905.  Nobel Laureate Professor Joshua Lederberg had nominated the Indian scientist multiple times for the Nobel Prize in Medicine but unfortunately, he never got the nod. 

In 1978, Dr De was invited to deliver a speech at the 43rd Nobel Symposium on Cholera and Related Diarrhoea where he expressed his frustration when he said,  “I have been dead since the early 1960s. I have been exhumed by the Nobel Symposium Committee… I discontinued my work on cholera enterotoxin as soon as I felt that with the limited resources and technology at my disposal, it would be impossible for me to pursue it further as I desired.” 

He passed away on 15 April 1985, at the age of 70 -- an unsung hero whom the country did not honour in his lifetime and chose to forget him so soon!

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