Leonard Rogers KCSI FRCP FRS (1868–1962) and the founding of the Calcutta School of Tropical Medicine

G.C Cook

Abstract

Sir Leonard Rogers made enormous research contributions to ‘medicine in the tropics’, especially in Bengal where the spectrum of disease was already well delineated. He also did much to enhance the formal discipline of tropical medicine. But perhaps his most lasting memorial lies in the Calcutta School of Tropical Medicine—that occupied a decade of politicking and stress—which survives to this day and is a timely reminder of a past era in India. It is not widely appreciated, however, that the original impetus for this institution came not from Rogers but from a young medical practitioner, Alfred McCabe-Dallas, attached to an Assam tea plantation.

Introduction

Sir Leonard Rogers KCSI CIE MD LID FRCP FRCS FRS (1868–1962) (figure 1) was one of the most significant pioneers of tropical medicine. Most of his research was conducted in eastern India, to which he went in 1893, at the age of 31 years. His expressed intention was to devote himself ‘to research in tropical diseases’, a task that he accomplished over the following 14 years. The disease spectrum in Bengal had already been delineated in the early nineteenth century by William Twining (1790–1835) among others, but the causes of the various entities were still not understood.1 His important book, Fevers in the tropics,2 was published in 1908. While on leave in England that year, he was offered the Chair of Tropical Medicine at the Royal Army Medical College; however, he chose to return to India and continue research, much of which focused on cholera and amoebic dysentery. It was during these years that he was also the major figure behind the foundation of the Calcutta School of Tropical Medicine, which caused him a decade of problems—mostly related to fund-raising. However, a young doctor, McCabe-Dallas, working in Assam was responsible for the original idea for this project, a fact that most previous authors have either ignored or understated.

Figure 1

Sir Leonard Rogers (1868–1962). (Photograph by J. Russell & Sons; reproduced courtesy of the Wellcome Library, London.)

Biographical notes

Rogers was born at Helston, Cornwall, and educated at Tavistock Grammar School, Plymouth College, and St Mary's Hospital, London.3–9 He joined the Indian Medical Service (IMS) in 1893, primarily as a pathologist. He initially investigated kala-azar (visceral leishmaniasis) in Assam,10 where this disease was epidemic, and came to the conclusion that it was a form of chronic malaria. In 1900 Rogers was appointed Professor of Pathology in Calcutta (Kalikata); here he worked on Entamoeba histolytica, which he correctly associated with both dysentery and hepatic ‘abscess’; he pioneered treatment with emetine for this infection.3 He also used antimony in kala-azar, with moderate success. In cholera, which was endemic in India, he researched the best composition of fluid for intravenous rehydration.11 Rogers also assessed the value of sodium gynocardate (a component of chaulmoogra oil) in the treatment of leprosy.3 Other contributions were research on snake venoms, and on trypanosomiasis in horses.3 Above all, he took a great interest in the epidemiology of all of the major infections in India.12

Following retirement from the IMS in 1920 (still only 52 years old), Rogers was appointed medical adviser to the Secretary of State for India in London. He was also elected extra physician to the Hospital for Tropical Diseases, which was then situated at Endsleigh Gardens, London WC1, and in addition was a lecturer at the London School of Tropical Medicine. Rogers also devoted much time to raising money (he was now an experienced fund-raiser) for the British Empire Leprosy Relief Association. Rogers was knighted in 1914, and elected to the Fellowship of the Royal Society in 1916. During the period 1933–35 he was President of the Royal Society of Tropical Medicine and Hygiene (figure 1).12 At the Royal College of Physicians he gave the Milroy (1907) and Croonian (1924) lectures, and received the Moxon medal in 1924.

Rogers's principal hobbies were walking and cycling. Much of his life is encapsulated in his autobiography, Happy toil: fifty-five years of tropical medicine, which was not published until 1950.3

The Calcutta School of Tropical Medicine

A new initiative

On 10 March 1910, Dr Alfred McCabe-Dallas13 DTM (Liverpool), an Assam tea-plantation medical practitioner, wrote to the Editor of The Englishman, a daily Calcutta newspaper. This letter, which was published the following day,14 called for a Tropical School (figure 2), which would be of benefit to Assam and Eastern Bengal and also the ‘whole of India’. It should, he felt, be situated in Assam, which ‘could be easily approached from all parts [of India] by railway’. It was, he wrote, ‘an undoubted fact that a large percentage of mortality in India generally, and Assam [where the disease spectrum was already well known] especially, is a preventable one …’. He continued, ‘It seems an anomaly for medical men to have to go to London or Liverpool to study tropical disease (“[where the] clinical material is dependent on the shipping from the East, Africa, and the West Indies”), but there is no other option under present circumstances.’

Figure 2

The School of Tropical Medicine and Hygiene Institute, Calcutta.36 (Reproduced courtesy of the Wellcome Library, London.)

He then emphasized that in those two English schools it was the laboratory (rather than clinical) work that was of paramount importance. ‘Australia, Germany, and the Grand Canary islands have [he wrote] already got their tropical schools, and New Orleans is to have one shortly.’ Staffing of his proposed School could be ‘safely left in the hands of … Rogers [see above], and Christophers15 [and] Stephens16 of Liverpool.’

The Indian Government, he claimed, contributed nothing to the two [English] schools and he implied that they would also be unlikely to make a pecuniary contribution to his envisaged school; instead ‘Princes, native noblemen, rich zemindars [sic], and wealthy merchants’ were more likely to finance an ‘Indian tropical school’, which could grant diplomas as was apparently done at ‘the Liverpool and Cambridge Universities’, and also accept ‘a thesis in tropical medicine for their M.D Degree’.

Rogers accepts the challenge

This letter from McCabe-Dallas prompted Rogers to write an editorial for The Englishman, which was published on 21 March 1910.17 In it he proved far more supportive than McCabe-Dallas of the Indian Government, and gave them ‘credit … for what they [had] done to facilitate and assist the researches of recent workers’. He also maintained that McCabe-Dallas had ‘overlooked the fact that in the Medical College, Calcutta [there already existed] laboratories that are the admiration of visitors from every part of the world …’. Important research had also been done in Bombay, Madras and Kasauli; the problem was that at all of these locations the laboratory was far distant from the hospital. He agreed that ‘there is [an] urgent need for a fully equipped and fully recognized School of Tropical Medicine for India’, but he felt that ‘It should be located in a hospital in one of the great centres so that investigators should be in intimate touch with patients’. He (naturally) favoured Calcutta where, he felt, ‘All that is required is a small extension of staff and a small extension of laboratory accommodation …’. The trained doctor, he also considered, should be able to diagnose and manage not only the local diseases, but ‘foreign’ tropical conditions such as African trypanosomiasis. He concluded the editorial, ‘We are confident that the Government of India will take the matter up in earnest and will carry out the minor alterations and additions necessary to convert the [Calcutta] Medical College into a first class school for research and post-graduate study in tropical medicine.’

By 1910, the London and Liverpool Schools of Tropical Medicine had been in existence for a little more than a decade, and similar institutions were springing up in all those countries with colonial interests. In Calcutta (which was, between 1772 and 1912, the administrative capital of India), there was a large number of medically qualified Indians and expatriates who were not part of the IMS; therefore a government-funded school would, in Rogers's estimation, make good sense.

Although Rogers acknowledged the primary impetus to his project in his autobiography, he avoided mention of McCabe-Dallas by name: ‘… in March 1910, I read a letter in a Calcutta paper, from an Assam plantation doctor, advising the formation of a research institute in that province to investigate diseases affecting the tea-garden labour forces’.3 This editorial was followed by one in the British Medical Journal18 in April 1910, which he also wrote anonymously, and which gave further credence to the idea; Calcutta, he contended, already had almost 1200 beds and the Medical College Hospital (MCH) there possessed ‘the premier hospital and medical school in the East’. The suggestion for a tropical school principally to carry out research into local diseases, as put forward by a ‘planter's doctor in Assam’ (see above) was to be welcomed, for the MCH already possessed ‘suitable laboratory accommodation’. He called on the ‘Government of India to found an efficient school of tropical medicine’; this would be a valuable addition to the ‘English schools of tropical medicine [which] have done invaluable pioneer[ing] work, and are essential for the training of those about to enter on their labours in hot countries.’

And he was rightly of the opinion that neither of the English schools at the Albert Dock Hospital19 and Liverpool20 had anything like the concentration of ‘tropical’ cases21 as did Calcutta.

Funding of any project is at present full of problems, but the difficulty experienced by Rogers in obtaining financial backing for what one would consider was a major priority for the Raj (namely the elucidation of the causes and satisfactory treatment of the multiplicity of disease entities in Bengal that afflicted the ‘coolies’ and the expatriates alike) now seems impossible to comprehend.

Frustrated attempts

King Edward VII (1841–1910) died on 6 May 1910. Rogers immediately made a proposal that a School of Tropical Medicine in Calcutta, together with a sanatorium, would constitute an appropriate memorial; this idea was received enthusiastically by the Medical Section of the Asiatic Society of Bengal. Although the idea was also warmly welcomed by Sir Pardey Lukis (1857–1918),22 then Director General of the IMS and based at Simla, the Lieutenant Governor (Sir Edward Baker)23 apparently favoured a non-medical proposal (which was in fact rejected, largely because it failed to find favour with the public, as likewise was Rogers's renewed attempt).3,24

The Government of India felt that rather than launching into a major scheme (which would be very costly), they should begin on a small scale; the professors of medicine and pathology at the MCH should, they considered, institute a six-month course for a Diploma in Tropical Medicine. In January 1911, Lukis told Rogers, the principal of the Medical College, and also the Professor of Biology that there was a possibility that the Government of India might make a grant of 3 lakhs (£21 300) (which in the event did not materialize) for the project. The three of them formed a planning committee, but their proposal for a 260-foot frontage was rejected by the government of Bengal; they would not sanction a site more than 100 feet long.3

Further progress had to await until late 1912, when Lukis persuaded the Government of India to make a grant of 5 lakhs (£37 500) on condition that the Government of Bengal supported Rogers's major scheme (that is, a 260-foot frontage), which they agreed in principle to do. The site was cleared and Rogers launched an appeal for 8 lakhs (£59 000) in September 1913. The Bengal Government architect, H. A. Crouch,25 had already drawn up plans. There was then a substantial obstruction to the progress of Rogers's scheme in that an ‘Improvement Trust’ decided that in order to widen the main road through Calcutta they required a portion of the land that Rogers had earmarked for the laboratory. Nevertheless, building of the laboratories began in January 1914, and on 24 February Lord Carmichael,26 the Governor of Bengal, laid the foundation stone. But more ‘political’ problems with the ‘Improvement Trust’ were to ensue and in this Rogers was supported by Edwards (head of the Bengal medical department)27 and Duke (the Indian Civil Service Member of Council in charge of the Medical Department);28 Crouch had subsequently to redesign the laboratory building.

The next problem involved staffing, and Rogers's request for six professors was backed by Lukis, but unfortunately for him not by the Government of Bengal.

The staffing dispute

In April 1914 the issue of staffing of Rogers's School of Tropical Medicine came to the fore. The Government of India were not prepared to pay for staff, in addition to their capital contributions to the building, and the Bengal Government also felt unable to finance them. The Englishman on 4 April contained an anonymous article with a somewhat controversial heading (figure 3).29 ‘The Government [of India]’, it claimed, ‘leans to the opinion that the College should be staffed largely, if not exclusively, by the IMS [already in post]’ instead of Rogers's plan, which was to ‘appoint research officers from amongst men of note and established reputation in the world of medicine’. This might therefore mean, the article continued, that Rogers's intention to establish a School of Tropical Medicine in Calcutta might have to be abandoned for he would not approve of anything but the best! In fact Rogers wished to appoint the most suitable individuals worldwide to the proposed new full-time chairs. This scenario was all the more disappointing because a mere two months previously the Foundation Stone had been laid by the Governor of Bengal (see above).

Figure 3

Heading of an anonymous article in the Calcutta daily newspaper.29

Three days later, The Englishman published a ‘[Bengal] Government Communiqué’ totally denying the accuracy of the article of 4 April; any delay in the opening of the school would not be the result of a staffing crisis but, it claimed, was owing to the fact that ‘in one part of the site of the proposed school considerable difficulties have had to be overcome in obtaining a safe foundation’.30 Perhaps not surprisingly, this gave rise to a leading article on the same day (7 April).31 In this, the Government ‘communiqué’ was designated ‘one of the most misleading official documents that any provincial Government has yet had the audacity to publish’. The article referred to a speech by Colonel Harris at the Foundation stone ceremony (see above) in which he stated that ‘a whole time staff of not less than six Professors will be required …’. Part at least of the problem, the article claimed, was that Calcutta had recently ceased to be the ‘Imperial Capital’ and the Government of India was putting more planning and finance into Bombay, where it had already sanctioned a new School of Tropical Medicine. Therefore, the Government of India ‘is attempting to throw the financial responsibility it morally owes to the Calcutta School …’. People in Bengal, it seems, had supported Rogers's proposed school financially; The Englishman felt that ‘The Government must do its duty too and help towards the complete realisation of the scheme it had originally in view’. Rogers himself therefore had (with the Bengal Government's blessing) to launch another Public Appeal for funds (in the event, highly successful), and he therefore became Honorary Secretary of The School of Tropical Medicine Endowment Fund.

The Carmichael Hospital

Although the Surgeon-General and the Government of Bengal approved the idea of a Hospital for Tropical Diseases, finance was still not forthcoming from official sources and Rogers's Endowment Fund had to raise 2½ lakhs of rupees. Several major contributions were received, and the Calcutta millionaire Sir David Yule32 proved extremely helpful. Carmichael laid the foundation stone of the new hospital (figure 4), which was named after him, on 24 February 1916; that is, two years after that of the laboratories.

Figure 4

The Carmichael Hospital for Tropical Diseases, Calcutta.37 (Reproduced courtesy of the Wellcome Library, London.)

An Institute of Hygiene

Both Rogers and the Bengal Government decided that the new Calcutta school should teach hygiene (public health), in addition to tropical medicine. Again, Lukis was an influential supporter. In the event, it was decided to initiate an Institute of Hygiene to mark the retirement of Carmichael from the Governorship of Bengal; he was succeeded by Lord Ronaldshay (later the Marquis of Zetland). However, this scheme had to be abandoned, largely as a result of the onset of the Great War (1914–18). After a long struggle to raise funds (in which the new Governor proved helpful) and to remove the police morgue from the site, the Hygiene extension was at last begun, but not until mid-1918.

Completion at last

Figure 5 shows the completed school (left) and Carmichael Hospital soon after they were built. The whole project had been completed in 1920;33 Rogers, who had fought so hard and long to see the project completed, and whose health by this time had deteriorated, was soon to set sail for England, and he did not return to Calcutta.

Figure 5

The School and Hospital, Calcutta.38 (Reproduced courtesy of the Wellcome Library, London.)

However, research was now well established into many of the local diseases of Bengal—including kala-azar, malaria, dysentery, leprosy, hookworm disease and diabetes.3 Subsequent annual reports indicate the valuable results provided by these varied research projects.34,35

Power has concluded that despite Rogers's invaluable researches into many of the diseases of Bengal, ‘the Calcutta school [which was in fact the ‘brain-child’ of McCabe-Dallas, remains] the most tangible legacy of his career’.33 However, had it not been for the initiative of the young plantation practitioner, and the editorial staff of The Englishman, this project might never have got underway. This once again emphasizes that the catalytic input of a young, and relatively unknown, worker is easily obscured by a more senior and well-established figure.

    Notes

    1. Alfred McCabe-Dallas studied medicine at Guy's Hospital, graduating (LSA Lond.) in 1900. He then served as an Assistant Medical Officer at the Boro’ Asylum, Portsmouth. He was a Civil Surgeon to the South Africa Field Force from 1901 to 1902. McCabe-Dallas took the DTM diploma at the Liverpool School of Tropical Medicine before proceeding to Assam. See also Medical directory (J. & A. Churchill, London, 1920), p. 839.

    2. Sir (Samuel) Rickard Christophers FRS (1873–1978) was an eminent protozoologist and specialist in tropical medicine. He was educated at University College, Liverpool, and proceeded to South America and India (where he served in the research branch of the Indian Medical Service). He was subsequently made Professor of Malarial Studies at the London School of Hygiene and Tropical Medicine. See also C. Garnham, ‘Christophers, Sir (Samuel) Rickard (1873–1978)’, in Oxford Dictionary of National Biography, vol. 11 (ed. H. C. G. Matthew and B. Harrison) (Oxford University Press, 2004), pp. 559–560.

    3. John William Watson Stephens FRS (1865–1946) was an eminent parasitologist and tropical diseases expert. He received his training at Gonville and Caius College, Cambridge, and St Bartholomew's Hospital, London. After service in India and British Central Africa, he spent most of his career at the Liverpool School of Tropical Medicine where he became Walter Myers Professor of Tropical Medicine. See also W. F. Bynum, ‘Stephens, John William Watson (1865–1946)’, in Oxford Dictionary of National Biography, vol. 52 (ed. H. C. G. Matthew and B. Harrison) (Oxford University Press, 2004), pp. 476–477.

    4. Sir Charles Pardey Lukis KCSI FRCS (1857–1918) received his medical education at St Bartholomew's Hospital, London. He entered the Bengal Army as a surgeon on 31 March 1880. Lukis became Civil Surgeon in Simla in 1899, and Hon. Surgeon to the Viceroy in 1905. He was also appointed Professor of Materia Medica at the Calcutta Medical College, and in 1905 Professor of Medicine and Principal of the College and first Physician of the hospital attached to the college. He was ultimately promoted to the rank of Lieutenant-General on 22 September 1916. See also Anonymous, ‘Lukis, Sir Charles Pardey’, Plarr's Lives i, 741–742 (1930); Who was Who, 1916–1928 (A. & C. Black, London, 1947), p. 651.

    5. Sir Edward Norman Baker KCSI (1857–1913) was Lieutenant-Governor of Bengal from 1908 until 1911 and an ordinary member of the Council of India from 1905. He had been a member of the Bengal Legislative Council from 1900 until 1902, and financial secretary to the Government of India from 1902 to 1905. See also Who was Who, 1897–1916 (A. & C. Black, London, 1935), p. 35.

    6. Henry Arthur Crouch CIE FRIBA (1870–1955) received his early education at Brisbane Grammar School. After several architectural successes in England, he became Consulting Architect to the Government of Bengal (1909–35), and Consulting Architect to the Government of India, during which he designed the School of Tropical Medicine and Hospital for Tropical Diseases, Calcutta. He also designed numerous other buildings in India. See also Who was Who, 1951–1960 (A. & C. Black, London, 1961), pp. 262–263.

    7. Baron Carmichael of Skirling (1859–1926) was born in Scotland; his father was a tenth baronet. He was educated at St John's College, Cambridge. Carmichael was appointed in May 1911 to the Governorship of Madras, but in the following April he was appointed first Governor of the newly reconstituted state of Bengal. From his early days he had a great interest in art. See also K. Prior, ‘Carmichael, Thomas David Gibson, Baron Carmichael (1859–1926)’, in Oxford Dictionary of National Biography (ed. H. C. G. Matthew and B. Harrison), vol. 10 (Oxford University Press, 2004), pp. 179–180.

    8. Maj.-Gen. Sir William Rice Edwards KCB KCIE FRCSE (1862–1923) was educated at Magdelan College School Oxford, Clifton College and the (Royal) London Hospital. After junior appointments at his teaching hospital, he entered the Indian Medical Service (IMS) in 1886. After service in South Africa (with Lord Roberts), he held several administrative posts in India before becoming Director-General of the IMS (1918–22). From 1915 to 1918 he had been a member of the Bengal Legislative Assembly, the Government of India (1918–20) and the Council of State for India (1920–22). See also Who was Who, 1916–28 (A. & C. Black, London, 1947), p. 322.

    9. Sir William Duke (1863–1924) was born in Scotland, and after joining the Indian Civil Service was posted to Bengal. In 1909 he became Chief Secretary for Bengal, and was ultimately in charge of the Medical Department. See also P. G. Robb, ‘Duke, Sir (Frederick) William (1863–1924)’, in Oxford Dictionary of National Biography (ed. H. C. G. Matthew and B. Harrison), vol. 17 (Oxford University Press, 2004), pp. 164–165.

    10. Sir David Yule Bt (1858–1928) was Director of the Midland Bank, the Mercantile Bank of India, Vickers Ltd and the Royal Exchange Assurance. He was described as a ‘shy and reclusive man’. In 1875, he went with his uncle to Calcutta to manage the Bengal Cotton Mills. See also Anonymous, Sir David Yule. A great east India merchant. The Times, 4 July, p. 21 (1928); Who was Who, 1916–1928 (A. & C. Black, London, 1947), p. 1158; I. F. Russell, ‘Yule family’, in Oxford Dictionary of National Biography (ed. H. C. G. Matthew and B. Harrison), vol. 60 (Oxford University Press, 2004), pp. 973–974.

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