Two founders of Bombay Neurosciences: Professor Gajendra Sinh and Professor Noshir Hormusjee Wadia
Dr. Gajendra Sinh, F.R.C.S. (London) 1921-2013
Dr. Sinh was born on 18 August 1921 in Kathiwara, among the beautiful environs of the north-western Vindhyachal, 32 km. from Alirajpur. Kathiwara is almost equidistant from Godhra and Vadodara in Gujarat. Jhabua lies to its north-east.
Kathiwara was headed from the 1850s by a Rajput, Hindu family. Dr. Gajendra Sinh was born into this family.
His schooling was at Charterhouse in England. This eminent institution was founded in1611 by Thomas Sutton in London and was relocated in 1872 to Godalming in Surrey. It had, amongst its earlier students, John Wesley (founder of Methodism), Robert Baden-Powell (founder of the Boy Scouts), Gregory Bateson (anthropologist), Max Beerbohm (satirist), Robert Graves (poet) and Ralph Vaughan-Williams (composer). The school had its goals clearly laid out: 'Our priorities at Charterhouse are primarily academic, but that does not mean only achieving qualifications by passing examinations. We aim to stimulate independent enquiry and intellectual curiosity, to enrich spiritual awareness, to match physical fitness with love of the arts, and to promote individuality together with a sense of duty to friends and society.' Certainly, Charterhouse succeeded very well with this young student from Kathiwara.
The outbreak of World War 2 made Dr. Gajendra Sinh's return to India imperative.
His years at St. Xavier's College (1940-1942) must have enriched his understanding of science but were probably remembered more fondly by him for the opportunity to get to know the national table tennis champion, Meera Kudav, who ultimately agreed to be his wife.
He graduated in medicine from the Grant Medical College in 1947, having represented the college in cricket, hockey, football and athletics.
Dr. Gajendra Sinh obtained the Fellowship of the Royal Colleges of Surgeons in Edinburgh and England and trained to be a thoracic surgeon. On his return to India in 1955, his mentor and then Dean of the Grant Medical College, Dr. Shantilal J. Mehta, requested him to set up a department of neurosurgery. Dr. Mehta arranged for Dr. Gajendra Sinh to go to Vellore and work with Dr. Jacob Chandy from 1955-1957. This started a deep friendship with Dr. Chandy that ended only with Dr. Chandy's death in 2007.
Department of Neurosurgery, Sir J. J. Hospital
On his return from Vellore in 1958, Dr. Gajendra Sinh started the department of neurosurgery in the Yellappa Balaram Pavilion in the Sir David Sassoon Building. He was allotted just four beds in Dr. Shantilal Mehta's general surgical ward and was asked to operate in a general surgery theatre after the general surgeon had completed his list for the day. The radiology department was in the adjacent out-patient's building and taking patients to-and-fro for ventriculography and angiography was time-consuming and nerve-wracking. His experience mirrored that of Dr. Homi M. Dastur at Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital (KEM), an year earlier.
Among his initial registrars were Dr. Gongal (from Nepal) and the late Dr. V. I. Buch (subsequently a consultant plastic surgeon).
By the time I joined the neurosurgery department as registrar in 1963, it had moved to Ward 24 (for women and children) and 25 (for men) on the fourth floor of the 'new' J. J. Hospital building. The neurology wards (for 23 men and 24 women and children) were also on the fourth floor. Sister Biwalkar was in charge of the male neurosurgery ward. Strict with resident doctors, nurses and other staff, she was greatly concerned about the welfare of patients under her care. She kept herself well informed about the condition of each of her patients and would often guide us regarding their treatment.
Drs. Noshir H. Wadia and Bhim S. Singhal were the consultant neurologists. Dr. Vinodh Sarwal (later Dr. Karani)was their registrar. The neuroradiology department (where Dr. Jimmy N. Sidhva was helped by the radiology technicians, Mr. Saple and Miss Shah) was also housed here. The operation theatres designed by Dr. Gajendra Sinh (with Sister Gaikwad in charge) were on the fifth floor. Dr. Darab K. Dastur had his neuropathology department in the Postgraduate Research Laboratories within the campus but at some distance from the hospital.
The foundations for my abilities in the neurosciences – such as they are – were laid here. I owe whatever I know about neurosurgery to Dr. Gajendra Sinh and Dr. Vijay Dave at JJ and, later, Dr. Homi Dastur at KEM, as well as Professor Valentine Logue at Queen Square and Maida Vale in London, England.
Clinical neurology was learnt chiefly from Dr. Noshir Wadia, neuroradiology from Dr. Sidhva and neuropathology from Dr. Dastur – all willing teachers.
Dr. Vijay Dave had joined Dr. Gajendra Sinh as Assistant Professor and they complemented one another. Hailing from a princely family, Dr. Gajendra Sinh had royal tastes, a need for perfection and impatience with bureaucracy and officialdom. Dr. Dave was down-to-earth, patient, gentle and modest. He admired and respected Dr. Gajendra Sinh. Learning neurosurgery from them was a treat. Dr. Gajendra Sinh brought to us his British training in thoracic surgery and his training in neurosurgery under Dr. Jacob Chandy. Dr. Dave imparted to us all that he had learnt under Drs. Wilder Penfield, William Cone, Theodore Rasmussen, Arthur Elvidge, Herbert Jasper and others at the Montreal Neurological Institute.
Dr. Gajendra Sinh created a library in the department office in Ward 25 where he placed all his books on neurosurgery, issues of Journal of Neurosurgery and other relevant publications for his residents to use. I especially remember Dr. Percival Bailey's Intracranial tumors published by Charles C. Thomas. This book, by a person who, along with Harvey Cushing, had developed the prevalent classification of brain tumours, introduced me to the fascinating world of neoplasms.
Since the hospital did not have instruments needed for neurosurgery, Dr. Gajendra Sinh had purchased, from personal funds, sets needed for procedures such as drilling burr holes, performing a laminectomy and performing a craniotomy. These sets were deposited in the operation theatres for use by any member of his staff.
He also purchased and kept his Asahi Pentax Spotmatic camera in the department so that we could use it for photographing interesting patients, specimens and make slides for teaching. He gave us his Olivetti portable typewriter to prepare summaries on each patient for our departmental records.
He was strict about a number of matters: The care of patients, maintenance of records, discipline, courtesy to everyone in the department and respect towards our nurses. The suggestions of Sister Biwalkar and Sister Gaikwad were always gravely acknowledged and their suggestions for the improvement of the department implemented as soon as possible. He kept in touch with Sister Biwalkar after she retired and soon inducted her into Jaslok Hospital as the Matron. He later continued to provide help to both these admirable nurses right up to their deaths.
He replaced the lumpy cotton mattresses on all our beds in Wards 24 and 25 by foam rubber mattresses, using his own funds and those donated by well-wishers. This step greatly reduced the incidence of pressure ulcers in bed-ridden patients.
He set up a three-bed neurosurgery intensive care room near the entrance to Ward 25.
He published few papers but those that he did, continue to be read and quoted. In particular, I refer to his work on tuberculosis of the central nervous system and craniovertebral anomalies.
A personal note
Dr. Gajendra Sinh inspired me to become a neurosurgeon. As I entered the internship program at the Grant Medical College and Sir Jamsetjee Jejeebhoy Hospital (JJ) in 1960, I was torn between neurosurgery and cardiovascular surgery. With the audacity of the young, I approached Dr. Gajendra Sinh and explained my dilemma. He kindly invited me to accompany him on his rounds and watch him operate. He then took a most unusual step.
Knowing I was not interested in obstetrics and gynaecology, he approached Dr. C. G. Saraiya, (senior Professor of Obstetrics and Gynaecology, who celebrated his 100th birth anniversary on 22 October 2016), under whom I was to spend three months during the internship and requested a favour. 'Will you, please, allow Sunil Pandya to attend the neurosurgery department during this period?' With his usual mischievous smile, Dr. Saraiya asked, 'Gajji, are you sure he will not play hooky?' Dr. Gajendra Sinh guaranteed my attendance and I was hooked!
When he learnt that I aspired to a full-time appointment at K. E. M. Hospital, he offered advice based on his observation of the pomposity and arrogance displayed by some full-timers professors: 'Don't take yourself too seriously. Never imagine that you are the cat's whiskers.'
Amongst the honours received by Dr. Gajendra Sinh is that of being the President of the Neurological Society of India in 1975. He had served it well in the capacity of Secretary (1965-1975) and had organised the 3rd Asian and Oceanian Congress of Neurology in Bombay.
Philosophy and practice
Dr. Gajendra Sinh's outstanding qualities were integrity, sincerity, compassion and discipline. His loyalty to his alma mater; his teachers, especially Dr. Shantilal Mehta; and his colleagues, especially Drs. Noshir Wadia, B. N. Colabawala, J. C. N. Joshipura, Noshir Antia and Vijay Dave, was legendary.
If he had faults, he hid them successfully. He imparted to us his perennial philosophy. 'Fight for what is right.' and 'Never give in to the bureaucrats,' taught us to persevere in order to improve conditions for our patients and further develop the department.
It was a matter of satisfaction to him that whenever Dr. Noshir Antia, Professor of Plastic Surgery, went on leave, he left Dr. Gajendra Sinh as his locum tenens, 'Noshir realises that our surgery is as delicate as the operations he himself performs on nerves, faces and hands.'
Being a resident in his department meant a constant exposure to humour. Dr. Noshir Wadia was often teased for taking his responsibilities too seriously. Dr. Wadia's leg was also pulled for the little 'beetle' (Fiat) he used for a car whilst Dr. Gajendra Sinh gloried in his huge British limousine, and when Dr. Gajendra Sinh joined up with Dr. Sidhva, guffaws were the rule, each inspiring the other to greater humour.
Dr. Gajendra Sinh retired from his alma mater in 1977. At Dr. Shantilal Mehta's request, he started another department of neurosurgery at the new Jaslok Hospital in 1972. He continued to serve this hospital to his last day. As a final act of service to his teacher, he served as the chief trustee of the research fund set up by Dr. Mehta till it was wound up.
I admired his ability to remain young at heart and keep the interests of his patients above all else. Over the last decade of his life, he progressively divested himself of opportunities to operate on his patients. He preferred to hand them over to younger colleagues (many of them his own students) who, as he put it, 'will do a better job'.
Pneumonia, 'the old man's friend,' helped him lapse into a state of reduced consciousness and slip peacefully away in his sleep even as the Neurological Society of India held its annual meeting at the National Center for the Performing Arts in Mumbai.
Mr. Vijay Merchant, the great cricketer, was Dr. Gajendra Sinh's neighbour. Mr. Merchant cherished the motto 'Play the game.' Dr. Gajendra Sinh played an outstanding innings and did so with a straight bat. His final retirement to the pavilion on a high note was in the fullness of time and deserves applause.
Noshir Hormusjee Wadia M.D., F.R.C.P
(20 January 1925–10 April 2016)
Born to Hormusji and Dina Wadia in a modest, middle-income Parsi family in Surat, he was the fourth of five siblings. He studied at St. Xavier's School and College in Bombay, where he made life-long friends with Piroja Irani (later his own better half), Dr. Gajendra Sinh and Mira Kudav (later Mrs. Sinh).
Dr. Wadia completed his undergraduate and postgraduate medical education at the Grant Medical College and Sir Jamsetjee Jejeebhoy Hospital between 1943 and 1950. He described himself as a medical student of average-intellect who worked hard and spent long hours at study. Sports were more a diversion than a passion. He recalled Dr. Gajendra Sinh being the captain of his cricket team. He told us that he was drawn to neurology when he was a postgraduate student in Bombay. This blossomed as he underwent a three-month course at the National Hospital for Nervous Diseases at Queen Square just before he appeared for the examination for the membership of the Royal College of Physicians. He vividly remembered his first encounter with five teachers in the outpatient clinic at Queen Square – Drs. Elkington, Williams, Meadows, Brinton and McArdle. He was thrilled when he was awarded the Membership after his first attempt by a council headed by the President, Dr. Russell Brain in 1952.
Desirous of continuing his study in neurology, he sought a post at a teaching hospital in London but found, to his dismay, that not having done a house post in neurology in London, he could not be selected. When he applied for a house physician's post, he encountered what would later be known as a Catch-22 situation. He was overqualified for the house physician's post! Fortunately, just then a post for house physician in neurology in the department of neurosurgery was advertised in Newcastle General Hospital. Mr. George Rowbotham selected him for the post but cautioned him to forget his Membership and start as a junior resident. Thus, as Dr. Wadia later put it, started his sixty and more years journey in neurology.
At Mr. Rowbotham's urging, he applied for the Registrar's post at Maida Vale (part of the National Hospital for Nervous Diseases). Dr. Russell Brain interviewed him. Dr. Wadia attributes his selection to Dr. Brain's unit at Maida Vale as a consequence of Dr. Rowbotham's recommendation and his own expressed determination to return to India after completion of his training. Dr. Wadia worked, among others, with Dr. Douglas McAlpine, Dr. Russell Brain, Dr. Redvers Ironside, Dr. Paul Sandifer and Dr. Ronald Henson. He later worked with Drs. Brain and Henson at the London Hospital – the first Asian to be appointed as registrar on the staff of this hospital and a tutor at the attached medical school. It was at the London Hospital, at the urging of Dr. Ronald Henson, that Dr. Wadia and his neurosurgical colleague, Dr. R. H. Shepherd wrote that classic paper, Some Observations on Atypical features in Acoustic Neuroma, published in BRAIN (1956).
It was at Dr. Brain's instance, backed by Dr. McDonald Critchley's perception after a visit to India, that Dr. Wadia decided to practice neurology on his return even though there was no position in this speciality in any of the teaching hospitals in Bombay at that time.
On his return from England, he pondered joining the then fledgling All India Institute of Medical Sciences, New Delhi but his teacher, Dr. Shantilal J. Mehta, then at the head of his alma mater, convinced him that Bombay needed him and appointed him on the staff of the J.J. Hospital in 1957. Dr. Wadia's senior colleague, Dr. Menino DeSouza, befriended him. Dr. DeSouza's own interest in neurology had attracted referrals from other physicians in the hospital. These, he now referred to Dr. Wadia, giving him some of his own beds for in-patient treatment.
Blessed by teachers such as Dr. Minocher Mody in Bombay and Lord Brain in London, UK, Dr. Wadia developed into a skilled neurologist with elegant bedside manners. These were on display when he saw the poorest of patients at the J.J. Hospital and also when attending to the rich and powerful at his clinic at Ben Nevis and at the Breach Candy and Bombay Hospitals.
As Dr. Wadia's reputation in clinical neurology grew, so did the facilities offered to him by the J. J. Hospital. When the old, historic hospital building was pulled down and the new, towering (in relative terms) building was opened to patients, Dr. Wadia got a full-fledged male ward on its fourth floor. (Dr. Gajendra Sinh, his dear friend and neurosurgical colleague, was provided a similar ward on the same floor. They shared the female and children ward between them).
Over time, Drs. Wadia and Gajendra Sinh were able to attract Dr. J.N. Sidhva, Bombay's first neuro-radiologist, who returned to J.J. Hospital after training at the National Hospital for Nervous Diseases at Queen Square, London, UK. A little later, Dr. Darab Dastur moved into the Postgraduate Laboratories of the Grant Medical College with his Indian Council of Medical Research (ICMR) funded Department of Neuropathology. These four clinicians worked in harmony, which resulted in excellent patient care and clinical research (I have not erred in including Dr. Darab Dastur as a clinician. His fame rested as much on his clinical assessment of patients whose specimens he studied as on the pathological techniques used for further analysis).
Drs. Wadia and Gajendra Sinh were honorary professors and were expected to work in the hospital for four hours. The honorarium paid to them did not even cover their petrol bills for travel to and from J.J. Hospital. In fact, they were to be found in the hospital outpatient clinic, wards and laboratories (and, in Dr. Gajendra Sinh's case in the operation theatre) from 8 a.m. to 4 p.m. Their loyalty to the college and hospital was inspiring.
Dr. Wadia' s weekly clinics at the J.J. Hospital attracted students from all the medical colleges in the city and some seniors as well. Dr. S.D. Bhandarkar, already a teacher in medicine at the K.E.M. Hospital, attended these clinics regularly and later spoke fondly of Dr. Wadia's inimitable style of teaching. As a student, I recall being taught some unforgettable lessons. Let me give you two examples. Since attending Dr. Wadia' s clinics on the subjects, I have always examined the back in any patient with a non-healing ulcer in the foot to look for tell-tale signs of spina bifida; and, I have always asked patients undergoing caesarean sections or other operations in the lower half of the body about their undergoing the procedure under spinal anaesthesia. The latter lesson was brought home in a patient with non-tuberculous spinal leptomeningitis where this history was crucial in identifying the cause.
Dr. Wadia's researches are well known to all Indian neuroscientists. On his return from England, he soon realized that the prevalence of neurological diseases in India was very different from that in the United Kingdom. Excited by this discovery, he set about studying some of them in his usual, systematic manner, supplementing findings obtained in a detailed history and careful examination by relevant tests and, whereever possible, pathological studies in the live patient or at autopsy. Soon he was publishing papers in Brain, The Journal of Neurology, Neurosurgery and Psychiatry, Neurology Minneapolis and other reputed journals abroad and in Neurology India on neurological manifestations of manganese poisoning; the spectrum of craniovertebral anomalies; Wilson's disease; the clinical, radiological and pathological expressions of tuberculosis of the central nervous system; hereditary ataxias; Enterovirus 70 haemorrhagic conjunctivitis with neurological manifestations and other diseases of local and national importance.
Drs. Wadia, Gajendra Sinh and Darab Dastur ingrained into those of us fortunate enough to work with them the need for meticulous case notes on every patient seen by us (this was later reinforced in my case by the operation notes and case records of Dr. R. G. Ginde and Dr. Homi Dastur).
In 1961, returning to India from a meeting he attended as a founder member of the first Commission of Tropical Neurology of the World Federation of Neurology in Buenos Aires, his plane stopped over in Lisbon. India had just taken over the erstwhile Portuguese possessions in Goa. Dr. Wadia was arrested and jailed, perhaps as a prisoner of war! His release, three months later, followed intervention by the Papal Nuncio, Amnesty International, the International Red Cross, Dr. Dorothy Russell, Dr. Almeida Lima and Prime Minister Jawaharlal Nehru.
Dr. Wadia's retirement from J. J. Hospital did not mean resting on his laurels. He once again heeded his teacher's call, and in 1973, he joined Dr. Shantilal Mehta's Jaslok Hospital to set up a new department of neurology, this time with full-fledged sections on electrophysiology, neurochemistry, epilepsy, and movement disorders; and, with Dr. Anil Desai's help, diseases of the muscles.
Dr. Wadia was inspired to pass on lessons learnt by him over a lifetime. This resulted in Neurological practice: An Indian perspective. The second edition was brought out with the help of Dr. Satish Khadilkar, the current Professor of Neurology at the J.J. Hospital.
He received many honours in India and abroad and he specially cherished those from academic centres of excellence and the associations of neurologists in Britain, America and other countries.
Dr. Wadia derived immense pleasure from the successes of his many students. In turn, they honoured him and it was a treat to see the last great occasion a couple of years ago, when the anatomy lecture theatre of the Grant Medical College, packed with past students from all over the world, erupted in applause as Dr. Wadia approached the microphone. Dr. Wadia enthusiastically joined them as they chanted over and over again, 'Who are we? G.M.C.'
The obituary notice in The Times of India on Monday, 11 April 2016 was appropriately headed, 'Now I lay me down to rest.' A rest truly well deserved.