Opinion
Book on Rabies for the public – by Prof. Nimal Senanayake
Reviewed by Prof. N.A. de S. Amaratunga PhD, DSc
Prof. Nimal Senanayake MD, PhD. DSc, FRCP, professor emeritus, eminent neurologist and creative writer and producer of drama and films, continuing his commitment to write in Sinhala on important health issues for public education, has published the 17th in the series and the chosen subject is the deadly Rabies of which the public awareness could be insufficient from the point of view of prevention and treatment to prevent death. Prevention of onset of the disease is not difficult if treatment is instituted soon after a dog bite or bite by other animals, like bats carrying the virus. Prof. Nimal Senanayake (NS) deals with these aspects adequately and in simple prose in his little book of 165 pages.
NS showing his proclivity to drama and suspense starts in dramatic fashion, bringing in bats rather than dogs to begin his story describing cases of rabies in Texas 1951, Florida 1953, and Pennsylvania 1953, all due to attacks from the sky, as it were, all bitten by flying bats coming down and biting without any provocation. All these bats were not blood sucking vampire bats but apparently harmless insectivora. NS’s intention clearly is not just drama but to draw the attention of the reader to the strong possibility of bats developing as vectors of deadly viruses as was the case with Corona and several other virus diseases which NS has written about. NS has mentioned that Rabies following bat bite had occurred in Sri Lanka, too.
NS then embarks upon a very interesting journey, through history, starting with Diana the Roman Goddess of Wilderness and the Hunt, and traces back the history of Rabies to 4000 years. He mentions great philosophers Democritus (500 BCE), and Aristotle (384 – 322 BCE) and the father of medicine Hippocrates, who had written about disease due to animal bites. Greek physician Galen (129 – 200 CE) had recorded the natural history of rabies and also treatment measures, including wound care, some of which are still valid. NS has commented on Arabian writings on rabies which is noteworthy as early development of medicine happened in the Arabian civilisation.
After history, NS switches over to his usual practice, adopted throughout this series,where he asks critical questions and gives lengthy explanations. These questions are those that may arise in the minds of science writers, students, patients and ordinary people. They are designed to bring out the most important information that these categories must know about rabies and also lively anecdotes. This is a very effective and efficient method of conveying the knowledge with brevity and clarity, that the author has developed with his vast experience of teaching and practice of medicine.
Beginning with the virology of rabies, with a description of the rabies virus, the author covers the entirety of all aspects of the disease. He connects up the physiology of the virus with the pathogenesis of the disease, how the virus enters the tissues of the human body, proliferates and then gains access to the nervous system through the peripheral nerves. What happens in the brain, when the virus reaches it and affects the brainstem, limbic system, etc., would be of particular interest to the medical students.
How the author looks at every aspect is exemplified when a question is asked whether the person who attends to the wounds of the patient could contract the infection and the explanation that follows showing how it could happen. Then the author explains why and how rabies is known as hydro-phobia, the horrendous result that ensues when the extremely thirsty patient attempts to take some water into the mouth and try to swallow it is the reason that causes severe fear of water in the mind of the patient. The physiological basis for this undue fear of water, according to the author, is ‘conditioned reflex’ and this is illustrated with the famous experiment by Pavlov and his dog. Similarly, the patient is horrified of the wind blowing against his body which, like water, causes severe shivering and muscle contraction. A comprehensive description of the possible animals that could be a vector for rabies is given and also how careful people should be about their pets and the danger of being suddenly attacked by these animals who may appear to be harmless, is vividly described.
Though these symptoms are seen in the advanced state, the early symptoms could be similar to those of common cold except that there could be radiating numbness at the site of the wound. The wrong beliefs that the patient may bark like a dog or even bite others have no basis and the origin of these beliefs is explained. But the caregivers must be careful not to get contaminated by salivary secretions of the patient, even on a minor wound or scratch on their skin.
The tragedy of the situation is that when the patient is not subject to severe muscle contraction and shivering he could be in his proper senses and he realises that he is facing a horrendous death. This state is really pathetic for everybody near and dear to the patient. Physio-pathological explanations of the often mysterious fearful clinical picture would be very useful to medical students. These fearful clinical features could be to some degree controlled with pain killers and sedatives. Apart from the nervous system other organs also may be invaded via the nerves and consequently heart failure and pneumonia could result. Merciful death would arrive with the patient going into coma due to the development of encephalitis which is not any different from other types of encephalitis.
After this comprehensive discussion on all the important aspects of rabies, the author talks about a rare type of rabies called paralytic rabies which is due to the spinal cord and the medulla oblongata being affected instead of the brain and brain stem. This condition is also known as the dumb or silent rabies as there is no violent spasms but a paralysis of limbs and other muscles. Yet slow death cannot be avoided. This type of rabies is more common with bat bites and there had been an outbreak of it of epidemic proportion in Trinidad in 1929 – 1931 period. Health authorities thought it was an outbreak of polio or botulism poisoning.
Author goes into details of diagnosis and draws our attention to the fact that the animal bite incident may even have been forgotten as onset of symptoms could be delayed. This makes diagnosis difficult and this is made worse by the fact that there may be several other conditions that may initially exhibit similar clinical features. NS with his usual thoroughness mentions that sometimes a person who has been bitten by a dog may undergo immense mental stress and go into hysteria which may simulate rabies!
NS gives a comprehensive description of tetanus which is one of the conditions that need to be differentiated in the diagnosis of rabies. Moreover tetanus could occur following bites by dogs and other animals who carry the bacterium that causes tetanus. In tetanus the bacteria do not travel upto the nervous system but the toxin it produces while proliferating in the depth of a wound could travel along nerves and effect the central nervous system. Spasms of muscles could result in a similar clinical picture to that of rabies though there are important differences that may help the doctor to suspect rabies. These differences are lucidly described by the author and illustrated with clear colour pictures which is a striking feature throughout the book which complements the text and adds value to the work. The fact that if adequate treatment is provided in good time tetanus could be fully cured which is not the case with rabies which needs to be nipped in the bud if it is to be cured is emphasized.
NS mentions botulinum toxin poisoning which is another condition that could mimic rabies. What is important to ordinary reader here is the fact that contaminated food, specially tinned fish that has gone bad could contain the toxin due to Clostridium botulinum contamination. NS does not forget to tell us how to detect the possibility of such contamination by an examination of the can of fish which would appear to be swollen and the fish would be blackish in colour. Other diseases that the author mentions, which may be clinically similar to rabies, are encephalitis caused by malaria, delirium tremens and poisoning by certain locally found wild fruits like “goda kaduru” and “attana” and also “ganja” which children may unknowingly consume.
Then the author deals with the tests that could be carried out to confirm the diagnosis particularly in the animal that had bitten the patient so that treatment could be started early to prevent death. He has a story to tell about the development of these tests and also the vaccines. He gives detailed account of how Frenchman Louis Pasteur succeeded in discovering anthrax causing bacteria in cattle and attempts at developing a vaccine against anthrax and also against rabies. Description of Pasteur’s attempt to experiment the rabies vaccine he had developed on a human being is full of drama and suspense. Scientific detail which could be boring is embellished with human drama which is a feature of NS’s writings that make them so readable. Author has written several pages on Louis Pasteur in order to emphasize the great importance of the ground breaking discoveries he had made which eventually helped mankind to combat many killer diseases caused by micro-organisms. The description of how Pasteur risks his life when he sucked into a tube saliva from a rabid dog is fascinating.
Next NS deals with the attempt at attenuation of the virus by Irish physician Sir David Semple (1856 – 1937) The attenuated virus could be used as the vaccine as it could initiate the development of immunity against the viral infection. Greater success was achieved by the efforts of Polish physician Hillary Koprowski (1960 -2013) and American bacteriologist Herald Cox (1907 – 1986) who used new methods to lessen the virulence of the virus. Methods of producing safe vaccines which may not have the complications of earlier varieties have taken vast strides with the development of DNA technology.
Finally, NS writes about prevention and treatment of rabies which is of vital importance as about 55000 die worldwide annually mainly due to ignorance, negligence and lack of facilities for vaccination. What should be done after being bitten by an animal which could be a vector of rabies are clearly described. The use of Rabies Immunoglobulin (RIG) and Anti-rabies Vaccine (ARV) and their mode of action is given in detail. This section is very important for the student as well as lay persons. The final chapter on animal management from the point of view of rabies prevention would be very useful for everybody, specially people who keep pets, animal lovers and animal farm keepers.
Prof. Senanayake has produced yet again a compact little book, full of knowledge important for everybody, written in beautiful Sinhala prose, like a story, simplifying complex matters and vividly emphasizing where emphasis is necessary. This excellent piece of work would be of use to ordinary people, medical students, postgraduates, animal farmers, and doctors who practice bread and butter medicine everywhere in the country.
by Ayampillai Dharmakulasingham,
(Retired Sri Lankan career diplomat)
The Communist Party of India won Legislative Assembly elections in the Indian states of West Bengal and Kerala, establishing their respective governments. Leftist parties were also influential in some other states, especially in Tamil Nadu, though they could not capture power there.
In Sri Lanka, JVP/NPP leader Anura Kumara Dissanayake’s rise to the presidency marks a new chapter in the country’s history. The upcoming general election, on 14 Nov. holds significant importance and has raised hopes that Sri Lanka is undergoing a transitional period for good. It may mark the first time a left-wing party comes to power in Sri Lanka. There are other factors that make the upcoming election important. Major political parties have become notorious for corruption, mismanagement of national resources, family dynasties, elitist politics, etc. Corruption has been widespread throughout government, accompanied by nepotism, lack of transparency, and mismanagement of public funds
It is indeed true that the JVP’s presence in the northern and eastern regions, is not as strong as in the south, such as Galle, Matara, Hambantota, Anuradhapura, Kurunegala, and other districts. However, Anura’s popularity has drawn attention in the north as well. For the first time, substantial support appears to be emerging for the JVP in the northern and district districts of Jaffna, Batticaloa, Ampara, and Trincomalee. However, every parliamentary election has been similarly heralded as “historic” by the press and media, though often without substance. The major parties – the United National Party, Sri Lanka Freedom Party, and Sri Lanka Podujana Peramuna – have ruled Sri Lanka repeatedly, with the media often playing a supportive role by portraying each election as historic, ultimately misleading the public.
Sri Lanka’s first left-wing political party, the Lanka Sama Samaja Party (LSSP), once had widespread support across the country and grew powerful enough to become a significant opposition force. The plantation population, in particular, supported both the LSSP and the Communist Party. The LSSP achieved major victories in parliamentary elections after the 1940s. In response, the first Prime Minister, D. S. Senanayake, revoked the citizenship of people of Indian origin, stripping them of their political rights. As a result, the LSSP lost a significant portion of its support base. When the citizenship rights of people of Indian origin were revoked, the prominent Tamil leader G. G. Ponnambalam served as a key Minister in the UNP Cabinet. Although he opposed the provisions of the Act within the Cabinet, Prime Minister D. S. Senanayake ultimately prevailed. Despite his opposition, Ponnambalam failed to take meaningful action to protect the political rights of the hill-country Tamil population. This perceived betrayal led S. J. V. Chelvanayakam to leave the Tamil Congress Party and establish the Federal Party.
In the northern and eastern regions, the parties and organizations that once formed the traditional alliances of the Tamil Alliance and other Tamil parties have fragmented. They are now contesting the general election as separate alliances. Like it or not, the Federal Party remains somewhat influential today, although its support base is not as strong as it once was
Tamil parties have often criticized and blamed the major national parties as being racist. Ironically, most Tamil political parties – such as Thamil Arasu Katchi, Tamil Congress, and the Tamil National Alliance – include “Tamil” in their names. In contrast, the Sri Lanka Freedom Party, United National Party, and Sri Lanka Podujana Peramuna do not reference any race in their names. Yet, Tamil parties have continued to win elections by appealing to Tamil-speaking people with claims that only the major parties are racist. Some insights into racism are important here. Muslim citizens representing major parties have been elected as members of Parliament in predominantly Sinhala areas. However, the stark reality is that the Muslim population in the North and East has been alienated by the Jaffna-centered major Tamil parties.
G. G. Ponnambalam, the leader of the Tamil Congress, advocated for 50/50 representation for the Sinhalese and other ethnic groups, despite the fact that Sinhalese people are the majority. This 50/50 representation demand is seen as an extremely racist slogan. In other words, he openly undermined the representation and political rights of the majority Sinhalese people. S. J. V. Chelvanayakam left the Tamil Congress and founded the Federal Party due to G. G. Ponnambalam’s perceived betrayal of the upcountry Tamils. However, Chelvanayakam’s own performance was not markedly better than that of Ponnambalam. Chelvanayakam’s own words deserve attention. In 1970, when the SLFP coalition swept the parliamentary elections, Chelvanayakam famously declared, “Only God should save the Tamils from now on.” It is essential to closely examine the underlying implications of this statement. The first implication is that the UNP government is preferable. The second is that Sirimao’s party will not benefit the Tamils. Notably, Chelvanayakam’s loyalty to the UNP correlates with the historical voting patterns of the Tamil (Jaffna) people, who have traditionally supported UNP candidates in all elections within the Colombo Municipal limits and the adjoining areas of Dehiwela and Ratmalana.
On 27 Oct., a book titled “Jaffna on Fire” (Tamil version) was launched in Jaffna. Original Sinhalese book was translated by well-known media personality and translator, Manoranchan, into Tamil. The author, Nandana Weerasekhara, presented evidence that the Jaffna Public Library, modern market, and other locations were set on fire during the presidency of J. R. Jayewardene, allegedly with his blessing. Another notable aspect is that Tamil leaders, both before and after this incident, provided full political support to the UNP.
President Dissanayake’s NPP is expected to win significantly in the upcoming general elections. This expectation arises from the fact that most Sri Lankans are seeking change. President Dissanayake has emphasised the need to elect representatives from the NPP in large numbers to cleanse the Parliament. It is understandable that the President requires a strong Parliament to effectively govern the country with new legislative measures. During a meeting in Kilinochchi on 04 Nov., Prime Minister Harini Amarasuriya captured the attention of the audience by stating that Parliament should be cleansed. She emphasised the importance of electing the right representatives in the upcoming general elections. The overwhelming response from the audience reaffirmed the prevailing mood of the country.
It was 1979. I had just married and was trying to manage my fledgling legal practice in Kurunegala when Franklyn Amerasinghe attracted me to the Employers Federation of Ceylon (EFC). I basically followed what he did 5yrs earlier; the exception being that when he left Kurunegala, he also left a lucrative Practice built by his late father. From then onwards, for the next 45 years he was my colleague, boss, friend and above all; professional and personal guide. I was indeed fortunate as a young professional in the EFC to have had S R de Silva, the doyen of Sri Lankan Industrial Relations and the late Franklyn as my bosses. I am ever grateful to them both for whatever I achieved professionally; ending my working career with the International Labour Organisation in which they served with distinction before me.
I will not dwell herein on the professional attributes and achievements of Franklyn. Neither can I do justice to that aspect in this short piece. Instead, I will attempt to capture what I knew of Franklyn the man. He was personally exposed to the vicissitudes of life in his youth and again thereafter when his loving wife Neelanthi passed away while their two daughters were still school going. These circumstances which would have drained a lesser mortal brought out the best in Franklyn’s innate strong character. Whilst being the devoted father to his young children and successfully managing his professional career, he was also the “go-to person” to so many in need of professional or personal help. With his children grown up and on their own feet, the demands on Franklyn’s time from others only increased. Regardless of social or official status, old or young, he gave wise counsel ungrudgingly and always found time for them. What fascinated me was his ability to make all those who knew him feel that there was a special place in his heart for each of them. They in turn considered him to be special.
Perhaps, it was this unique gift that enabled him to give inspirational leadership to those who worked with him. His faith in humanity was boundless. He genuinely believed that no person was useless. It was this faith that drew him to help the helpless. Few would know of all what he has done or the sacrifices he has made, to assist the less fortunate get on their feet, without breathing a word of what he had given or lost in the process. The “Diamond Trust” he initiated with the support of close friends and family in later years to facilitate learning for handicapped children was a dream come true for him. The Trust was his precious baby in the last days of his life. His wish to see the baby nurtured into adulthood is now in the able hands of his daughters and family. While he will be remembered for his philosophical strengths, he will also not be forgotten by those of us who knew him personally for his social camaraderie. A sportsman himself, he loved sports. So was it with music. His wit and humour was infectious. Many were the long hours he spent with family and friends signing old favourites around a Piano, late into the night at parties. This sense of camaraderie he shared with his office colleagues as well.
We who were at the EFC with him, will recall the family atmosphere he promoted among us. He was truly a man for all seasons. It was my privilege to have had known Franklyn. It will not be easy to fill the void he has left in my life and that of my family. The last audible words he said to me were “I will soon let you know what it is like on the other side” I know for certain that wherever he may be the grass there will be far greener than on this earth. To Michelle and Sharon, the loving daughters of a devoted Father, the tender care you showered on Dad, particularly in his final days was truly exemplary.
Gotabaya Dasanayaka
In Sri Lanka, established media channels, particularly television, play a crucial role in shaping public perception on various aspects of life, including both local and international politics. Social media, however, has also become a powerful force, frequently spreading biased or manipulated content that risks fragmenting communities and damaging the social fabric, especially during sensitive times such as general or presidential elections.
Sri Lanka’s media has long been aware of the full spectrum of public life in the country—the good, the bad, and the troubling. They understand that political corruption and malpractice have significantly contributed to social unrest, economic decline, and the deterioration of essential services like education, healthcare, and nutrition. This has prompted many citizens to emigrate, leading to a damaging “brain drain.”
Media outlets also recognise the challenges in electing better leaders. Entrenched politicians have erected legal and financial barriers to safeguard their positions, making it difficult for ordinary citizens to participate effectively in elections. Additionally, the high cost of media exposure during election seasons makes it nearly impossible for average citizens to run for office. While media organisations often use this period to maximise profits, it would be commendable if they could support underrepresented and less privileged candidates, contributing to the public good.
As we approach a pivotal general election, we urge these influential media institutions to uphold their social responsibility. Since media ultimately relies on public support, directly or indirectly, they have to prioritise the public interest. At this critical moment, we, as citizens, need to elect honourable, honest, and patriotic individuals who can act as “watchdogs” in Parliament and help guide our nation toward better governance. We respectfully request that significant media outlets dedicate at least a small amount of airtime to non-political candidates vying for a seat in Parliament. Providing even a few minutes of prime airtime for these candidates to present their mission and vision would be a meaningful gesture toward equal representation. This commitment to the nation’s well-being would be widely appreciated. After all, true equality—the very principle that media frequently champions for its own survival—is now an ideal that can extend to all.
Chula Goonasekera (admin@srilankaleads.com)
On behalf of the LEADS forum
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