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|Year : 2018 | Volume
| Issue : 6 | Page : 1872-1876
IN MEMORIAM: Thanjavur Santhanakrishna Kanaka (31st March 1932 – 14th Nov 2018)
Apollo Telemedicine Networking Foundation, Apollo Hospitals, Chennai, Tamil Nadu, India
|Date of Web Publication||28-Nov-2018|
Dr. Krishnan Ganapathy
Apollo Telemedicine Networking Foundation, 21, Greames Lane Chennai - 600 086, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ganapathy K. IN MEMORIAM: Thanjavur Santhanakrishna Kanaka (31st March 1932 – 14th Nov 2018). Neurol India 2018;66:1872-6
| » Introduction|| |
Asia's first woman neurosurgeon, Prof. (Ms.) T S Kanaka [Figure 1] and [Figure 2] was indeed one of the strictest disciplinarians neurosurgery has ever seen. A ” loveable terror,” she superficially appeared to be stern and authoritative but that was a façade for perennial deep concern. Dr. Kanaka was one of eight children born to Santhanakrishna and Padmavathi in Madras. Her father was the Deputy Director of Public Instruction and the Principal of Madras Teachers College. Despite an urge to pursue spiritual studies in her early years, she went on to study medicine, completing MBBS in December 1954. Even as an MBBS student in the early fifties, she cultured gonococcus in 1952, was part of a group which worked on developing a vaccine for leprosy and was also in a study related to the biochemical parameters found in the cerebrospinal fluid in the local population. From 1956 to 1958, she struggled just to get an opportunity to scrub and be in the surgical team. She learnt her basic surgical skills from 1958 to 1960 under Prof. A. Venugopal, the eminent urologist. She obtained her MS (General Surgery) in March 1963. In those days, it was extremely unusual and difficult for a woman to become a surgeon. There was a bias and gender discrimination and Dr Kanaka apparently had to appear several times before the examiners realized that she was indeed serious. During the Indo- China war in 1962-63, she volunteered to help and was appointed as a Captain in the Army Medical Core [Figure 3] and [Figure 4].
|Figure 2: Dr. TS Kanaka posing for the photograph with her evergreen smile in place|
Click here to view
| » Neurosurgical Career|| |
She joined the Department of Neurosurgery, Madras Medical College and obtained the MS (Neurosurgery) degree in March 1968. She was the first woman in Asia to formally qualify as a neurosurgeon. Worldwide, there were not many women neurosurgeons even at that time. Early in her career, influenced by Dr V Balasubramaniam (VBS), Dr. S. Kalyanaraman (SKR) and Dr B Ramamurthi [Figure 5], she developed an interest in the then almost non-existing subspecialty of stereotactic surgery. Supported by her neurology counterparts, Drs. G. Arjundas and K. Jagannathan, she played a significant role in promoting stereotactic surgery. Following in the footsteps of Dr VBS and Dr SKR, she obtained a PhD in stereotactic surgery in 1972 (the title of her PhD thesis was: Evaluation of stereotactic surgery in the surgical management of cerebral palsy).
A large number of stereotactic procedures for involuntary movements, behavioral disorders, psychiatric disorders, epilepsy, and spasticity were performed, and many papers published [Figure 6] and presentations made. Madras became a center of international acclaim in stereotactic surgery. In 15 years, more than 1700 stereotactic operations were performed in Madras, and lesions were placed in almost every important part of the brain. Brain surgery for cerebral palsy was almost unheard of then. Undaunted, Dr. Kanaka started a Cerebral Palsy Clinic in the orthopedics department and had access to hundreds of patients. She sincerely believed that in the properly chosen case, if the correct target was chosen, a lesion in the brain would reduce spasticity. This was in the late sixties, seventies and eighties. 1975 marked the silver jubilee of the Madras Institute of Neurology (MIN) [Figure 7], and MIN was the Mecca of stereotaxy during the time when Dr Kanaka worked there. She was the first neurosurgeon in South Asia to introduce chronic electrode implantation in the brain [Figure 8] (as early as in 1975), decades before its clinical applications were introduced in the Western countries. Functional neurosurgeons in advanced countries would find it difficult to believe that chronic electrode implantation (exteriorized outside the occipital scalp) in the dentate nucleus was carried out in 1975 at the Madras Institute of Neurology using totally indigenous material.
The author recollects assisting Dr. Kanaka in the late seventies in various ablative and stimulation procedures using the Leksell's stereotatic apparatus. Following air studies, the Schaltenbrand Bailey's Atlas More Details was used for calculating target co-ordinates. This was the pre CT scan era. Anterior cingulum lesions successfully relieved obsessive compulsive neurosis and drug addiction. More than one hundred cases of drug addiction -- pethidine, morphine, alcohol and others (a nursing superintendent used to self-inject pethidine into his own jugular vein) -- were treated with stereotactic cingulumotomy lesions. Dr Kanaka was actively involved in this endeavour. A pioneer in promoting functional neurosurgery, Dr Kanaka always considered Prof V Balasubramaniam as her mentor and as a “wizard” in calculating stereotactic targets.
In 1973, she went to Japan. Over the next four decades, she travelled extensively all over the planet [Figure 9] and [Figure 10]. Her sojourn included a one-year Colombo Plan fellowship, working at Avery laboratories studying phrenic nerve stimulation, diaphragmatic pacing and other biomedical devices for pain management. She brought a transcutaneous stimulator and deep brain stimulation pro bono to Madras. Considering that this was in the mid-seventies, it indeed epitomized a phenomenal self- confidence and absolute passion in the area. A woman working in India presenting papers at World Congresses in stereoencephalography in the late seventies was indeed news. A brief fellowship at the University of California at Los Angeles (UCLA) was followed by guest lectures in several universities in the USA and Japan. She became a member of the International Brain Research Organization (IBRO). In 1988, she presented a paper in Australia on ‘Neuro-stimulation of the spinal cord for paraplegia’. Her visits all over Europe, New Foundland in Canada and Brazil are all the more remarkable as they took place in the eighties and nineties when women from India travelling overseas was certainly not the norm.
| » Resident Neurosurgeon|| |
Dr Kanaka literally lived in the institute. She would stay for several days in a week in her room, which was hardly 6ft by 8ft in the third floor of the Institute of Neurology. The postgraduates and assistants in her unit would have to present all newly admitted “cases” the same day. Often this presentation would extend to 9pm and even 10pm. She would make evening/night rounds accompanied by the duty resident/assistant professor. We had to give her updates of sick patients even at 5am. Though continuing this practice as a resident was difficult, it soon became a way of life for all of us. One day in the late eighties, she called me and said “Ganapathy – I know I have often been unreasonable, but none of you have complained or spoken back to me even though you are a senior assistant professor. Look at this boy – he is a house surgeon – he keeps me waiting for an hour and says he cannot come on a Sunday before 9am !!” She would always share not just the Tirupati prasadam but also the food she would eat. One day in 1983, she overheard me talking with a colleague about a Diploma in Higher Education (DHEd) programme which I was planning to join. She asked me to get her an application form also. I attended a few classes but was unable to spare the time and discontinued. Though 18 years senior to me, she persisted, passed the exam, and was very proud of that academic achievement.
| » Post Superannuation Career|| |
Unlike most of her contemporaries, Dr. Kanaka had never been interested in private practice. Following her superannuation from Government Service, she consulted at the Epidemiological Research Centre, Indian Council of Medical Research, Adyar Cancer Institute, Hindu Mission Hospital and the Tirupathi Tirumala Devasthanam Hospital. She worked with several organizations to provide healthcare to economically disadvantaged people. She used her savings to establish a Health Centre, named after her parents – the Sri Santhanakrishna Padmavathi Health Care and Research Foundation, offering free healthcare to the needy [Figure 11]. Implementing what she had learnt from Dr Ramamurthi, she maintained meticulous records of the hundreds of senior citizens who thronged her free clinic. Switching from functional stereotactic surgery to facilitating general geriatric care was indeed a major change. Senior citizens now benefited from her hard work, her attention to small details, the scientific rigor, the refusal to take “No” for an answer, which made her fight against all odds and gender discrimination of the twentieth century.
|Figure 11: Dr TS Kanaka at the Santhanakrishna Padmavathi Health Care and Research Foundation|
Click here to view
Not withstanding her frail health, she continued to be actively involved in her primary love, that is, functional neurosurgery. She continued to be a guide and supervisor for several PhD dissertations. A firm believer in “Make in India” movement, she did not lose a single opportunity in imploring local biomedical engineers to indigenize equipment for deep brain stimulation. In 1996, Kanaka became the Honorary President of the Asian Women's Neurosurgical Association. At that time, she was formally acknowledged as Asia's first woman neurosurgeon. In 2016, a group known as WINSI (Women in Neurosurgery in India) was formed [Figure 12]. Most of the 69 women neurosurgeons in the group conceded that they were inspired by Dr. T S Kanaka. In 2014, the Dandy Indian chapter honored her for being the first woman neurosurgeon [Figure 13].
Though single and a woman, she travelled widely. It was amazing to see her attending conferences all over the world. Until recently, she would attend most clinical meetings and academic programs. A year ago, I advised her not to travel alone to Bali for a conference and suggested that she give a talk through video conferencing. She came to my office and gave the talk. A few months ago, she sent me a 20-page article written for a journal and requested me to be a co-author and make it ‘presentable” [Figure 14].
Donating blood 139 times (mentioned in the Limca Book of Records), she was indeed an epitome of Social Service. She spent the last decade of her life influencing not only senior citizens but little children as well [Figure 15]. For the last 10 years, I have been receiving temple prasadam from her on our wedding aniversary. I understand that Dr. Kanaka used to perform an ‘archana’ (prayer) for many individuals as a part of her daily activities. Need one say more. Madam, it has been a privilege to have been your student and assistant. You will be a perennial source of inspiration. Au revoir – till we meet again.
I am thankful to Dr. Vincent Thamburaj for making available some photos and information included in this tribute.
| » References|| |
Ramesh VG, Bhanu K, Jothi R. The Madras Institute of Neurology, Madras Medical College, Chennai. Neurol India 2015;63:940-6.
] [Full text]
Kanaka T S. Back to the future: Glimpses into the past. Neurol India 2016;64:206-7.
] [Full text]
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15]