In a high-ceilinged but small room in the Campbell Medical College in Calcutta, a 47-year-old Bengali doctor made a discovery in 1920. His breakthrough saved many lives, not just in India but also in France, Greece, and China. It also earned him two Nobel Prize nominations, immortalising him across the world.
The discovery was Urea Stibamine and its creator was Dr Upendranath Brahmachari.
Unfortunately, the significance of Brahmachari’s discovery has faded over time just like his name. His contribution, though, was immense.
Urea Stibamine was used to treat kala-azar (black fever) with a 90 per cent success rate—a huge leap from a 90 per cent death rate. The disease was an epidemic, which had wiped out entire villages in Asia, Africa and Latin America in the late 19th and early 20th centuries.
The 1933 report by the Director of Public Health, Assam, recorded,
“Urea Stibamine was our main-stay in the Kala-azar treatment…since 1923…it is no exaggeration to say that approximately 3.25 lacs of valuable lives have been saved to the province.”
Brahmachari also set up Asia’s first blood bank in 1935 at the Calcutta School of Tropical Medicine in Calcutta (now Kolkata).
Also Read: Bengal’s Ram Brahma Sanyal was Indian zoo pioneer in 1800s. Wrote handbook on care, breeding
Finding the cure
Brahmachari had a stellar academic career. He graduated with honours in mathematics and chemistry in 1893, bagging the Thwaytes Medal in mathematics. After a master’s degree in chemistry from Presidency College, he changed track to join Calcutta Medical College where he topped both the medicine and surgery examinations, winning the Goodeve and MacLeod Medals respectively. An M.D. (1902) and a Ph.D. (1904) followed, both from the University of Calcutta. It was this unique blend of medicine and chemistry that enabled him to view the challenge of kala-azar from a different perspective.
After a four-year stint at Dhaka Medical School, he returned to Calcutta in 1905 to join Campbell Medical School (now Nil Ratan Sircar Medical College and Hospital). It was here that he began his relentless battle over the next two decades to find a safe and cost-effective cure for the dreaded black fever.
It is a disease that affects the liver, spleen and bone marrow. It causes fever and blackening of the skin (hence the name) and is fatal if left untreated. It is caused by a parasite that spreads through the infected bites of a sandfly. The first records of a kala-azar epidemic came from British doctors working in Assam in 1870. They were fighting a losing battle as the disease ravaged the Brahmaputra and Ganga plains. There were some reports of success in Brazil and Italy during 1913-1915 in treating the disease using tartrate emetic (potassium salt of antimonyl tartrate) intravenously. However, it had serious side effects.
Brahmachari tried substituting sodium salt with potassium salt and experimented with metallic antimony. The experiment gave better results but had other problems—these elements could not be procured easily or stored for long and were time-consuming to prepare and administer. There were other obstacles as well. Brahmachari worked in a small room at the Campbell Medical School, which did not have electricity and a proper water supply. The University of Calcutta provided him with research facilities at the newly-opened College of Science and Technology. However, CV Raman, the Palit Professor of Physics at the university, objected to the decision and asked for the room to be vacated for another professor who needed it to set up ex-ray spectroscopy.
Finally, in 1920, Brahmachari synthesised a new compound in the same small room—Urea Stibamine (the urea salt of p-stibanilic acid), which was successful against Kala-azar. We need to remember that this was long before the discovery of penicillin, the major Western breakthrough in the war against bacterial diseases.
The new compound brought down mortality rates to 10 per cent by 1925. It revolutionised treatment of the disease across the globe from China to France and Greece.
Brahmachari wrote later, “I recall with joy that memorable night in the Calcutta Campbell Hospital at Sealdah where after a very hard day’s work I found…that the results of my experiments were up to my expectations. But I did not know then that providence had put into my hands a wondrous thing and that this little thing would save the lives of millions of fellowmen. I shall never forget that room where Urea Stibamine was discovered. The room where I had to labour for months without a gas point or a water tap and where I had to remain contented with an old kerosene lamp for my work at night….To me, it will ever remain a place of pilgrimage where the first light of Urea Stibamine dawned upon my mind.”
Urea Stibamine was used successfully in the kala-azar epidemic which spread across eastern India 1922-28.
Colonel H.E. Shortt, the director of the Kala-azar Commission, stated in 1932, “We found Urea Stibamine an eminently safe and reliable drug and in seven years we treated some thousands of cases of Kala-azar and saw thousands more treated in treatment centre.” He added that a death rate of 90 per cent had been transformed into a cure rate of 90 per cent practically overnight. The drug began to be manufactured on a commercial scale in India and saved thousands of lives.
Had the medicine reached the market sooner, it would have saved the life of Sukumar Ray, an icon of modern Indian children’s literature and creator par excellence of nonsense verse in Bengali. He died of kala-azar on 10 September 1923. He was the father of Oscar-winning filmmaker and renowned author Satyajit Ray.
Prof Ashoka Jahnavi Prasad has contended that Brahmachari’s contribution to the medical field was even more noteworthy than that of Ronald Ross, who identified the malarial parasite, as the former’s work saved many more lives. He stressed that Brahmachari was the first to create a laboratory diagnostic test for kala-azar and while quinine-resistant strains of plasmodium (the malarial parasite) have emerged in plenty, Urea Stibamine continues to be effective against kala-azar.
Also Read: Girindrasekhar Bose—India’s first psychoanalyst was pen pals with Sigmund Freud
Recognition for his work
Brahmachari was nominated for the Nobel Prize in Medicine in 1929 and 1942 but unfortunately did not win. In 1929, Austrian neurologist Sigmund Freud and Russian physiologist Ivan Pavlov were in the running for the prize along with Brahmachari but it went to Dutch physician Christiaan Eijkman and English biochemist Frederick Gowland Hopkins for their work on vitamins. Brahmachari received five nominations in 1942 but no prize was awarded for medicine that year. Prasad argued that it was highly likely he lost out because of his ethnic origins.
Brahmachari’s work was not limited to kala-azar alone. He researched several other tropical diseases such as malaria, leprosy, filariasis as well as syphilis, influenza and diabetes. He was the first to discover the existence of quartan fever in Kolkata and Dhaka (A form of malaria where the fever recurs every 3-4 days and is transmitted by bites of infected female Anopheles mosquitoes). Despite his spectacular achievements he was not elected to prestigious scientific bodies such as the American Academy of Arts and Sciences or the Royal Society. In the case of the Royal Society, Prasad said that there was a racially motivated smear campaign against Brahmachari led by Leonard Rogers, a leading figure in Tropical Medicine in British India with the support of some Indian scientists.
These petty jealousies did not deter Brahmachari who saw his work as a form of service to the society and did not just seek to profit from it. He sold Urea Stibamine to the government at a cost price and gave it to countless hospitals across India for free. He donated generously to institutions such as the Indian Red Cross Society, the Blood Bank at Kolkata, the Jadavpur Tuberculosis Sanatorium, the Physiological Society of India, Calcutta Medical College, and the Indian Association for the Cultivation of Science, to name a few.
In his presidential address to the Asiatic Society of Bengal in 1930 Brahmachari said, “India, the seat of earliest civilization of man, is regaining the healthy state that she must have enjoyed in the days of old. Diseases which for many centuries were considered incurable and destroyed millions of human lives in India, are now losing their terrors.”
Today, kala-azar cases have drastically reduced in India, though it continues to be rampant in parts of Africa and South America. For that, we must thank the unflagging efforts of Brahmachari who made a revolutionary discovery with minimal resources at his command.
Dr Krishnokoli Hazra teaches History at the undergraduate level in Kolkata.