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Table of Contents    
NI FEATURE: CITADELS SCULPTING FUTURE - COMMENTARY
Year : 2018  |  Volume : 66  |  Issue : 3  |  Page : 807-814

Department of Neurosurgery, Madurai Medical College and the development of neurosurgery in South Tamil Nadu


1 Department of Neurosurgery, ABC Hospital, Tiruchirappalli, Tamil Nadu, India
2 Department of Neurosurgery, Madurai Medical College and Government Rajaji Hospital, Madurai, Tamil Nadu, India
3 Department of Neurosurgery, Devadoss Multispeciality Hospital, Madurai, Tamil Nadu, India

Date of Web Publication15-May-2018

Correspondence Address:
Dr. Natarajan Muthukumar
138, Anna Nagar, Madurai - 625 020, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.232298

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 » Abstract 


The development of neurosurgery in South Tamil Nadu can be traced to the Department of Neurosurgery, Madurai Medical College and Government Rajaji Hospital, Madurai, Tamil Nadu, India. The hospital was established in the year 1940 and Madurai Medical College was started in 1954. Prof. M. Natarajan founded this department in September, 1963. This department has a Neurosurgery Residency Program that is 50 years old. The establishment of this department and its growth to its present stature is documented here.


Keywords: Neurosurgery, Madurai Medical College, History of Neurosurgery, Tamil Nadu
Key Message: The history of the Department of Neurosurgery, Madurai Medical College and the noteworthy contributions of its faculty members that have helped the department in achieving national and international eminence is being traced. The well-trained students from this department have helped in establishing outstanding neurosurgical services not only in the state of Tamil Nadu but throughout India.


How to cite this article:
Thiruppathy S, Manimaran R, Niban GM, Muthukumar N. Department of Neurosurgery, Madurai Medical College and the development of neurosurgery in South Tamil Nadu. Neurol India 2018;66:807-14

How to cite this URL:
Thiruppathy S, Manimaran R, Niban GM, Muthukumar N. Department of Neurosurgery, Madurai Medical College and the development of neurosurgery in South Tamil Nadu. Neurol India [serial online] 2018 [cited 2018 May 20];66:807-14. Available from: http://www.neurologyindia.com/text.asp?2018/66/3/807/232298




“Lives of great men remind us, we can make our lives sublime, and, departing, leave behind us, footprints on the sands of time”

—Henry Wadsworth Longfellow

Citadels of learning are not just structures made of brick and mortar; they are eternal institutions that sculpt the future of humankind. The contributions of individuals who were responsible for building these academic citadels should be recorded for posterity so that they serve to inspire and guide the future generations. The citadel that shaped the course of neurosurgery in South Tamil Nadu is recorded here.


 » The City of Madurai Top


Madurai, located about 500 km south of Chennai, Tamil Nadu, is one of the few cities which has retained its name from time immemorial to the modern era. The recorded history of the city dates back to third century BC, being mentioned by Megasthenes, the Greek ambassador to India as Athens of the East and the City of Festivals. From time immemorial, the city has had a rich cultural and religious legacy. It was a highly sought-after religious destination and a center of learning for centuries. In the twentieth century, the tag line of the city became “the city that never sleeps.” Among the many historical events that changed the course of history of Tamil Nadu and the nation, the contribution of Madurai is profound. It was in Madurai, during one of his visits, the 'Father of the Nation', Mahatma Gandhi renounced the conventional attire and resorted to wearing only the loin cloth as he identified himself with the impoverished masses of his country. True to his historical transformation to the life of 'Mahatma', the blood-stained cloth that covered Mahatma's torso when he was assassinated is preserved in “Gandhi Museum,” which is right adjacent to the Madurai Medical College.


 » Government Rajaji Hospital Top


This hospital dates back to the British era, when on November 18, 1940, Sir Arthur Hope, the then Governor of Madras inaugurated what was then called as ”Erskine Hospital Madura” [Figure 1]. The name Government Erskine Hospital [Figure 2] was retained until the late 1970s, when it was renamed as “Government Rajaji Hospital” to honor Shri Rajagopalachariar [Figure 3] and [Figure 4]. On August 4, 1955, this institution was affiliated to Madurai Medical College. For several decades, this institution was the only major institution providing quality medical care to the entire population of the southern districts of Tamil Nadu.
Figure 1: Plaque in Government Rajaji Hospital commemorating the inauguration of the hospital by Sir Arthur Hope on November 18, 1940

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Figure 2: Outpatient block of Government Erskine (Rajaji) Hospital, Madurai taken on October 1958

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Figure 3: Government Rajaji Hospital main entrance in 2017

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Figure 4: Government Rajaji Hospital, Trauma Block, 2017

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 » Madurai Medical College Top


A long-cherished dream of having a medical college in Madurai was realized in 1954, thanks to the efforts of the then Chief Minister of Tamil Nadu, Thiru. K. Kamaraj. The college was officially inaugurated by the then Union Minister for Health, Rajkumari Amrit Kaur, on August 2, 1954 [Figure 5] at the old Taluk Building at the Fair Weather Road, Madurai [Figure 6].
Figure 5: Plaque in Madurai Medical College, Madurai commemorating the inauguration of the college on August 2, 1954

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Figure 6: Madurai Medical College in the year 1957

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The Special Officer Dr. K.P. Sarathy and the first Principal Dr. Tmt. Sarah. J. Sowri were responsible in no small measure for the rapid improvements of the college in a short span of time. The present buildings were occupied by the departments in 1958, till which time they were functioning in the semi-permanent buildings.

Fifty students who were admitted in the first batch were fondly referred to as the “FIRST FIFTY.” One among the “FIRST FIFTY” of Madurai Medical College was Prof. Setti S. Rengachary, well known for his textbook of Neurosurgery. Dr. S.S. Rengachary was also the “First Best Outgoing Student” of this college. The University of Madras, to which this institution was affiliated, accorded permanent recognition to this college in the year 1954. The first batch of students of this college graduated in 1960. Dr. C.K. Padmanabha Menon, an astute administrator and an illustrious teacher, took charge as the first Dean in 1963.

When the Madurai Kamaraj University (formerly known as Madurai University) was established, the Madurai Medical College was affiliated to it. Subsequently, when the Tamil Nadu Dr. M.G.R. Medical University was started in the mid-80s, like all other medical colleges in the state, Madurai Medical College also was affiliated to it.


 » Department of Neurosurgery, Madurai Medical College and Government Rajaji Hospital, Madurai Top


The founder of this department was Prof. M. Natarajan [Figure 7]. Prof. M. Natarajan had his school education in Kumbakonam in Thanjavur District of Tamil Nadu. He had his undergraduate medical education in Government Stanley Medical College, Madras. Following his graduation, he joined the State Government Medical Service. After having worked in places such as Coimbatore and Pudukottai, he moved to Madras (now known as Chennai) to undergo his Masters in General Surgery from Madras Medical College. He was then posted as an Assistant Surgeon in the Department of Neurosurgery, Madras Medical College, under the leadership of the legendary, Prof. B. Ramamurthi. His stint in this department and the attraction of the newly evolving specialty of neurosurgery drew him to get trained in the same. He was one of the first trainees of Prof. B. Ramamurthi. He then went to Newcastle-upon-Tyne under the Colombo plan to get further training in neurosurgery under Prof. Rowbotham. After returning from Britain, he once again joined the Neurosurgery Department at Madras Medical College. When the then Government of Madras (the state of Tamil Nadu was then called as Madras state) decided to start a Department of Neurosurgery and Neurology at Madurai Medical College, Madurai, Dr. M. Natarajan was chosen for this post.
Figure 7: Prof. M. Natarajan, Founder of the Department

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The Department of Neurosurgery and Neurology was officially started on September 9, 1963 at the Government Erskine Hospital, Madurai. Prof. M. Natarajan was the only neurosurgeon in Madurai for more than one and a half decades, attending to cases 24 × 7 throughout the year. When Dr. Natarajan started the department, he had to share the beds with his general surgery and general medical colleagues. He had to share the operation theatres with general surgeons. He was allotted a temporary structure constructed outside the general surgery postoperative ward consisting of two beds, which he had to use as his postoperative ward. Despite these difficult situations, he had the support of some senior colleagues, such as the legendary Dean of Madurai Medical College, Dr. C.K.P. Menon [Figure 8]. With consistency and hard work, he eventually got a separate neurosurgery and neurology ward. As there was no neurologist in Madurai, he had to double as the neurologist also. Eventually, he got a ward with 46 beds and three operation theatres every week. He also managed to get a neuroradiology department and an electroencephalography (EEG) room adjacent to the operation theatre. The investigative facilities that were available at that time were: air-myodil ventriculograms, direct puncture carotid angiograms, and myodil myelograms. With these facilities, the turnover of the department increased by leaps and bounds. He had only general surgeons to assist him. In the year 1968, he started one of the first neurosurgical residency courses in India and this course was affiliated to the then Madurai University. The first candidate was Dr. D. Balakrishnan. Prof. Natarajan observed the high incidence of head injury, and even in those days, developed the concept of having a separate head injury unit and relentlessly tried to get such a unit in Government Rajaji Hospital. In the year 1982, 4 years prior to his retirement, his dream came true when the Govenrment of Tamil Nadu sanctioned a separate head injury unit with 27 beds and this unit was equipped with a separate radiology unit, intensive care unit (ICU) as well as an operation theatre within the same complex. By the time of his retirement from State Government service in the year 1986, the Department of Neurosurgery had 46 elective beds, 27 head injury beds, a separate neuroradiology unit with a neuroradiologist, three neurosurgical units with three unit chiefs, eight assistant professors, and an intake of three neurosurgery residents every year. Dr. Natarajan's areas of interest in neurosurgery spanned a vast spectrum but his interests were in head injury, infections, and infestations of the nervous system and trigeminal neuralgia. During his time, open surgical rhizotomy of the trigeminal nerve was considered to be the standard treatment and he was very proficient in this procedure. His students still recall the speed with which he used to do the “Frazier's Procedure” and the posterior fossa rhizotomy for trigeminal neuralgia. For many years, Dr. Natarajan also served as the Neurology Consultant of hospital until Dr. K. Srinivasan, the eminent neurologist, joined the department in 1971. Dr. M. Natarajan was academically inclined, and despite a heavy work schedule that was so typical of the neurosurgeons of that era, he published regularly in national and international journals.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16] In 1983, the Department of Neurosurgery, Government Rajaji Hospital and Madurai Medical College, celebrated its 20th anniversary. He had invited his mentor, Dr. B. Ramamurthi to be the Chief Guest of the function [Figure 9] and [Figure 10]. In the same year, on the occasion of the 20th anniversary of the Department of Neurosurgery, the Annual Conference of the Neurological Society of India was conducted at Madurai [Figure 11]. In those days, when international travel was not as frequent and common as it is now, he had invited several foreign neurosurgical dignitaries to attend this meeting. These include the famous, Dr. Rassmussen under whom many first-generation neurosurgeons from India had trained. During his tenure, his department had a regular stream of foreign visitors, including the legendary Dr. Earl A. Walker who came to deliver lectures in the department. The photographs of those visiting dignitaries still adorn the walls of the department [Figure 12]. After his retirement, he was conferred the honor of the Emeritus Professor by the Tamil Nadu Dr. M.G.R. Medical University. After his retirement from government service in 1986 until the late 1990s, he used to regularly visit the department to take afternoon classes for neurosurgery residents.
Figure 8: Prof. M. Natarajan (seen on the left) with the then Dean, Madurai Medical College, Dr. C.K.P. Menon

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Figure 9: The mentor and the mentee: Prof. B. Ramamurthi with Prof. M. Natarajan

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Figure 10: Twentieth anniversary celebrations of the department with Prof. M. Natarajan addressing the gathering. Also seen in the photograph are from left to right: Prof. K. Srinivasan, Neurologist, Prof. G. Venkatasamy, Prof. of Ophthalmology and the Founder of Aravind Eye Hospitals, Prof. S.A. Kabir, Prof. of Anesthesia, Prof. B. Ramamurthi, Prof. Lalitha Kameswaran, Director of Medical Education, Tamil Nadu, Dr. Jacob, Dean

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Figure 11: Photograph taken on the occasion of the inaugural ceremony of the Annual Conference of the Neurological Society of India, December, 1983

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Figure 12: Prof. M. Natarajan with one of the visiting overseas dignitaries Mr. Cobb reading EEG

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The era after Prof. M. Natarajan

Following the retirement of Prof. Natarajan, Prof. R. Gajendran became the head of the department, with other unit chiefs being Prof. S. Athiappan and Prof. Mohan Sampathkumar. Prof. Gajendran was known to give a free hand to the younger neurosurgeons to hone their surgical skills and was affectionate toward the residents. Prof. Athiappan was known for his surgical skills and Prof. Mohan Sampathkumar for his clinical and surgical acumen. Following the retirement of Prof. Gajendran, Prof. K. Pushparaj took over as Head of the Department. He was a trained ENT surgeon who subsequently specialized in neurosurgery and brought his ENT skills to enhance the training of the juniors. Prof. G. Jawahar, one of the students of Prof. Natarajan, was professor in the department from 1997 till his untimely demise in May 2000. Prof. Jawahar had a keen interest in head injury research, which was exemplified by his publications.[17],[18],[19],[20],[21],[22] Following the retirement of Prof. Pushparaj in 2004, Prof. V. Inbasekaran took over the reins of the department. Prof. Inbasekaran was interested in infectious diseases of the nervous system and had several publications related to this area.[23],[24],[25],[26],[27],[28],[29] Prof. S. Manoharan followed Prof. Inbasekaran as the head in the year 2006 and remained so till his retirement in 2009. He was well known for his teaching skills, was very popular with the residents, and his neuroradiology classes were very famous among the residents of that time. He was also known to give a free hand to younger neurosurgeons to hone their surgical skills and he encouraged them to try newer surgical techniques. In 2009, Prof. D. Kailairajan took over as the Head of the Department. He was by then well known for his penchant for organizing spine conferences of which he held five in different locations in Tamil Nadu. He was instrumental in organizing the Annual Conference of the Neurological Society of India in Madurai in the year 2006. Following his retirement from government service, Prof. Ashok Kumar took over the reins of the department in 2009 and remained the Head till 2012. He was a soft spoken and unassuming person who was liked by all of his colleagues and subordinates. Prof. N. Muthukumar, the son of the founder, Prof. M. Natarajan, became the head of the department in 2012 and remained so until his superannuation in 2017. He had the privilege of conducting the 50th anniversary celebration of the department in the year 2013 [Figure 13]. He had the unique opportunity to be the Head of the Department on its 50th anniversary in the department founded by his father. He had a keen interest in academics and publications, as evidenced by his h index of 25 and the i10 index of 37. Some of his important publications are listed in the bibliography.[30],[31],[32],[33],[34],[35],[36],[37],[38],[39],[40],[41],[42],[43],[44],[45],[46],[47],[48],[49],[50],[51],[52],[53] Dr. M. Sundararajan was a professor in the department from 2012 till his retirement in 2013. He was trained and had spent the entire career in the same department. Dr. M. Jayabalachandran trained and served in the same department until his retirement in 2008. He endeared himself to his colleagues and students with his jovial attitude even in tense situations. The other eminent professors who spent variable periods in the department before they were transferred to other medical colleges in Tamil Nadu included: Prof. V. Sundar, Prof. V.G. Ramesh, (late) Prof. V.K. Rajagopal, Prof. B. Singaram, all of whom have a special affection for the department. Each member of the teaching faculty contributed in his own way to the academic and administrative activities of the department and they will always be remembered for their contributions in building this citadel [Table 1].
Figure 13: Photograph taken on the occasion of the 50th Anniversary celebrations of the department with the invited dignitaries, Prof. Hirotoshi Sano and Prof. Praveen Mummaneni

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Table 1: Heads of Department of Neurosurgery, Madurai Medical College and Government Rajaji Hospital, Madurai

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Academic activities of the department

The neurosurgeons who were trained in this department are listed chronologically in [Table 2]. One of the unique traditions of the department that has withstood the test of time is the teaching sessions that take place between 9 AM and 10 AM on Mondays, Wednesdays, and Fridays. This practice was started in the year 1968 by the founder, Dr. Natarajan, when the neurosurgery residency course was started and has been continuing without break for 50 years even now. During these teaching sessions, usually there will be a brief topic presentation for 15 minutes by one of the residents followed by case presentation by another resident. All the residents and faculty will be part of these sessions and will take active participation in the deliberations. This activity initiated by the founder is unique in another way, viz, even the junior most resident can clarify his/her doubts and can even contradict the faculty if he/she deems necessary, without any fear of retribution. These open discussions have often led to very interesting debates and sometimes stimulating new ideas in the minds of the participants. The senior author (NM) who was associated with this institution for 28 years as faculty has found this to be a two-way process where the teacher and the taught end up benefiting from the exchange. In addition to the above, monthly journal clubs and seminars have been conducted regularly where the residents and faculty participate. The founder of the department instilled the motto “publish or perish” in the minds of his students. The department staff and students have to their credit over 200 publications. In 1996, the students of Prof. M. Natarajan instituted an Oration in his name to honor their teacher. The first orators were: Prof. M. Sambasivan and Prof. B.S. Das.
Table 2: Neurosurgeons who qualified from the Department of Neurosurgery, Madurai Medical College, Madurai

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 » Conferences Conducted by the Department of Neurosurgery, Madurai Medical College Top


This department had the privilege of conducting two annual conferences of the Neurological Society of India: once in 1983, which was conducted under the leadership of Prof. M. Natarajan; and again, in 2006 under the guidance of Prof. D. Kailairajan. Dr. Kailairajan also conducted five consecutive spine conferences between 2001 and 2009. In 1993, under the leadership of Prof. R. Gajendran, the department conducted the 2nd National Neurotrauma conference in Madurai.

Madurai Neurosurgical Academy

In 2009, the faculty and students of the department felt that an alumni association should be started and it should be exclusively devoted to academic activities. With this in mind, Madurai Neurosurgical Academy was started in the year 2009. This Academy conducts “theme-based” meetings once in 2 years [Figure 14] and [Figure 15]. The meetings held so far and the faculty who had participated in these meetings are shown in [Table 3]. Apart from lectures from invited faculty, discussion of interesting cases by the delegates and faculty, every meeting has two orations: Prof. M. Natarajan Oration and the Madurai Neurosurgical Academy Oration, which are delivered by the invited faculty.
Figure 14: Photograph taken on the occasion of the inauguration of the Madurai Neurosurgical Academy in the year 2009

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Figure 15: Photograph taken on the occasion of the second meeting of the Madurai Neurosurgical Academy with the invited speaker Prof. L.N. Sekhar

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Table 3: Madurai Neurosurgical Academy Meetings

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Current status of the department

At present, the department has three units with Prof. R. Veerapandian as the Head and the other two Unit Chiefs being Prof. G. Rajasekaran and Prof. J. Srisaravanan. The department is composed of eight assistant professors and nine residents [Table 4]. At present, the department is fully equipped with two operating microscopes, an endoscope, neurosurgical drill systems, an ultrasonic suction aspirator, a stereotactic frame, as well as the intraoperative neuromonitoring equipment and neuronavigation. It has a bed strength of 56 in the elective neurosurgery section, and there is a separate trauma block where there is fully dedicated head injury unit with 58 beds, including a dedicated head injury intensive care unit (ICU) with 15 beds. The head injury unit is right adjacent to the computed tomography scan facility and a separate head injury operation theatre is located on the first floor of the facility. A new superspecialty block is being built with the state-of-the-art facilities right opposite the head injury unit, where the department's elective neurosurgery units will move shortly from the old premises.
Table 4: Faculty - Department of Neurosurgery, Madurai Medical College - 2018

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The Department of Neurosurgery, Madurai Medical College and Government Rajaji Hospital, Madurai will be remembered by generations of grateful patients, students, and staff of the department for shaping the course of neurosurgery in South Tamil Nadu. We are confident that future generations of neurosurgeons will take this department to greater heights and glory, thereby exemplifying the 2000-year-old Thirukkural couplet, the English translation of which is also given below:

thamin thammakkal arivudamai maanhilathu

manniyuriku ellam inidhu”

All living creatures on this earth will be benefitted when our offspring is more knowledgeable than us

–Thirukkural – couplet n: 68

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 » References Top

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[PUBMED]    
38.
Muthukumar N. The “human tail”: A rare cause of tethered cord: A case report. Spine (Phila Pa 1976) 2004;29:E476-8.  Back to cited text no. 38
    
39.
Muthukumar N. Ossification of the ligamentum flavum as a result of fluorosis causing myelopathy: Report of two cases. Neurosurgery 2005;56:E622.  Back to cited text no. 39
[PUBMED]    
40.
Thiruppathy SP, Muthukumar N. Mild head injury: Revisited. Acta Neurochir (Wien) 2004;146:1075-3.  Back to cited text no. 40
[PUBMED]    
41.
Muthukumar N, Swaminathan R, Venkatesh G, Bhanumathy SP. A morphometric analysis of the foramen magnum region as it relates to the transcondylar approach. Acta Neurochir 2005;147:889-95.  Back to cited text no. 41
[PUBMED]    
42.
Muthukumar N, Venkatesh G, Thiruppathy S. Arrested hydrocephalus and the presyrinx state. Case report. J Neurosurg 2005;103 (5 Suppl):466-70.  Back to cited text no. 42
    
43.
Muthukumar N. Terminal and non terminal myelocystoceles. J Neurosurg 2007;107 (2 Suppl):87-97.  Back to cited text no. 43
    
44.
Muthukumar N, Rossette D, Soundaram M, Senthilbabu S, Badrinarayanan T. Blindness following pituitary apoplexy: Timing of surgery and neuro-ophthalmic outcome. J Clin Neurosci 2008;15:873-9.  Back to cited text no. 44
[PUBMED]    
45.
Muthukumar N. Congenital spinal lipomatous malformations: Part 1 – Classification. Acta Neurochir (Wien) 2009;151:179-88.  Back to cited text no. 45
[PUBMED]    
46.
Muthukumar N. Congenital spinal lipomatous malformations: Part 2 – Clinical findings, operative findings and outcome. Acta Neurochir (Wien) 2009;151:189-97.  Back to cited text no. 46
[PUBMED]    
47.
Muthukumar N. Dural ossification in ossification of the ligamentum flavum. A preliminary report. Spine (Phila Pa 1976) 2009;34:2654-61.  Back to cited text no. 47
    
48.
Muthukumar N. Presyrinx state: An under-recognized entity? Acta Neurochir (Wien) 2010;152:1969-73.  Back to cited text no. 48
[PUBMED]    
49.
Muthukumar N. Surgical management of cervical spondylotic myelopathy. Neurol India 2012;60:201-9.  Back to cited text no. 49
  [Full text]  
50.
Muthukumar N. Transfacet screw fixation of the cervical spine- How I do it? Acta Neurochir (Wien) 2013;155:1235-9.  Back to cited text no. 50
[PUBMED]    
51.
Muthukumar N. Proatlas segmentation anomalies: Surgical management of five cases and review of the literature. J Pediatr Neurosci 2016;11:14.  Back to cited text no. 51
[PUBMED]  [Full text]  
52.
Muthukumar N. Multimodal intraoperative neuromonitoring during surgery for correction of spinal deformity: Standard of care or luxury? Neurol India 2017;65:80-2.  Back to cited text no. 52
[PUBMED]  [Full text]  
53.
Muthukumar N. Commentary: Neurocysticercosis: Evolution of our understanding. Neurol India 2017;65:885-7  Back to cited text no. 53
    


    Figures

  [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]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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Online since 20th March '04
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