NI FEATURE: BOOKS FROM MY SHELF--COMMENTARY
|Year : 2018 | Volume
| Issue : 4 | Page : 1213--1216
Jacob Chandy: Reminiscences and reflections. Memoirs.
Department of Neurosurgery, Jaslok Hospital, Mumbai, Maharashtra, India
Dr. Sunil Pandya
Department of Neurosurgery, Jaslok Hospital, Mumbai, Maharashtra
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Pandya S. Jacob Chandy: Reminiscences and reflections. Memoirs. Neurol India 2018;66:1213-1216
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Pandya S. Jacob Chandy: Reminiscences and reflections. Memoirs. Neurol India [serial online] 2018 [cited 2020 Aug 11 ];66:1213-1216
Available from: http://www.neurologyindia.com/text.asp?2018/66/4/1213/236990
Author : Jacob Chandy.
Book : Reminiscences and reflections Memoirs
Publishers : Kottayam: C. M. S. Press
Year of publication : 1988
Type : Paperback
Prof. Jacob Chandy Photo courtesy: Dr. Vedantam Rajshekhar
Dr. Chandy was an intensely religious person born into a Syrian Christian family and this shows in his memoirs as well. He was devoted to the healing ministry of the Indian churches and dedicated his life and work to the Christian Medical College (CMC) and Hospital in Vellore. An unfortunate byproduct of his religiosity is the left-handed compliment paid to some staff members at the CMC as being good even though they were not Christian. (See page 165 for an example).
Dr. Chandy's father was the presbyter (elder minister) of the Anglican church in Kuzhikala, a village 50 km. south-east of Kottayam. Dr. Chandy recalls the death of his mother from puerperal sepsis in their village when he was seven years old. Then, as when Dr. Chandy wrote his memoirs, there was little by way of medical care in and around that village. 'The tragic death of my mother was one of the factors that gave me the impetus to study medicine…'
The sudden death resulted in an upheaval in the matrilineal household. 'We did not have a home any more.' Eventually Dr. Chandy was moved to his uncle's home in Trivandrum. He recalled that the journey by boat took three days.
After completing his schooling, he joined the biology stream at the C. M. S. (Church Missionary Society) College in Kottayam, where his mother's eldest brother was Principal (the college was founded in 1817). It was at this stage that he decided to serve in a Christian missionary institution for the rest of his life.
The manner in which he secured admission to the Madras Medical College is described on pages 7 and 8. Commenting on his winning tactic, Dr. Chandy wrote, 'Even now I don't know whether my action was right or wrong.' The reader must decide for himself.
Dr. Chandy's initial acquaintance with the Missionary Medical School for Women in Vellore (later to become the Christian Medical College) was when serving as house surgeon to Dr. P. V. Cheriyan, the Ear Nose Throat Surgeon at the Madras Medical College. Dr. Chandy's cousins were training there to become nurses and told him about the institution where he was to eventually start neurosurgery in India. (Dr. Cheriyan – also spelt as Cherian – was an officer in the Indian Medical Service. Dr. Cheriyan went on to become the first Indian Superintendent of the Madras Medical College, Surgeon-General of Madras Presidency, Mayor of Madras and Governor of Bombay. His wife, Tara, was also elected Mayor of Madras.)
During his period of training in medicine, Dr. Chandy noted, 'There was no sensitivity to the tragedies of life… One of the greatest tragedies … (was) the complete indifference of the Government and of the people in authority to the living conditions of the people, their abject poverty, illiteracy and ill health.'
We learn that as a student and as a resident doctor, Dr. Chandy was a keen student of the Bible and 'never had any close friends'.
As he pondered over his career, his friend, Dr. P. V. Kurien, wrote from Arabia, asking him to join the American Oil Company Hospital there. Dr. Chandy did so but found work at this hospital unsatisfactory. He learnt of Dr. Paul Harrison, working at the Mission Hospital in Bahrain.
On termination of his contract at the oil company hospital, Dr. Chandy joined Dr. Harrison. It is of interest that the Reformed Church in America founded the Mission Hospital in Bahrain and the Christian Medical College and Hospital in Vellore, the former in 1913 and the latter in 1918.
Their patients were members of the Bedouin tribes. Dr. Chandy's account of how Dr. Harrison attended to the Bedouin chieftain who had killed his close friend, is to be found on pages 21-22 and is an object lesson on the precept 'Love your enemieAQs' (Bible, Book of Matthew 5:44).
Dr. Chandy highlighted another interesting aspect of life in Bahrain at the time. 'Almost every adult male in Bahrain had one or the other venereal diseases… it was a common belief that one only became a man when he was able to get a venereal disease' (Page 23). The following pages describe two interesting incidents, the first when he was called to see an ill woman from the tribe, and the second when he was asked to see the ruler of Qatar. I strongly recommend you read these, especially his quandary when the grateful ruler gifted Dr. Chandy twenty men and twenty women from his tribe who were to serve as his slaves for life.
Dr. Harrison told of his experiences as a house officer to Dr. Harvey Cushing. In return, Dr. Chandy spoke of his own sad experience of an 8-hour-long operation on a patient with a pituitary tumour by Colonel Pandala and Dr. Vishwanatha Menon at the Madras Medical College (see pages 22-23). 'It was obvious that they did not know anything about operating on the brain.'
Dr. Chandy's description of his arranged marriage to Thangam (page 27) is followed by this statement on which he does not elaborate: 'Arranged marriages have their benefits and advantages but also disadvantages.' On page 29 though is this paragraph: 'From the beginning, Thangam had to understand and reconcile herself to the fact that I had always been intensely involved in my vocation, dedicated to my work, with very little time available for her.' We learn of Mathew's birth by breech presentation on 29 December 1943 in Bahrain (Dr. Chandy spelt the name Mathew with a single 't'). An index of Dr. Chandy's deep affection for his wife is the fact that each important event during his stay in America and in Canada was followed by a telegram to her. Mathew was later to follow in his father's footsteps and gain independent renown.
Dr. Chandy writes about Dr. and Mrs. Harrison with intense warmth and affection. I cannot resist inserting this quotation from Dr. Harrison's writings found elsewhere which illustrated his qualities of mind and heart: 'The glory of medicine is not its scientific attainments, but, fundamentally, its outlook on all humanity as one family, with medicine as humanity's universal servant.'
Dr. Harrison was an innovative surgeon. An account by Lewis Scudder tells us that when work in the hospital was light, he would go to the slaughterhouse and buy a sheep's head on which he would practice operative techniques. This earned him the title 'the Butcher Doctor'. We also learn that he died in 1962 at the age of eighty years 'of complications resulting from medical experiments he had been administering on himself.'
Dr. Chandy, Thangam and Mathew (aged four months) returned to Kottayam via Bombay. Dr. Chandy then left for further training in America, as arranged by Dr. Harrison. Dr. Harrison had made arrangements for Dr. Chandy's stay and study in America.
All these months, Dr. Chandy had called Mathew 'Aziz' – a name that means powerful, respected, beloved.
The description of the journey to America by a ship via Australia and the order to sit with the blacks in the train to New York make interesting reading (the term 'blacks' is not used in a pejorative sense. It was in vogue then to describe what we now call the African American people).
During Dr. Chandy's early days in America, while he was studying for the Master's degree in Philadelphia, Dr. Harrison was already making arrangements for him to work at the CMC in Vellore. The manner in which Dr. Chandy was evaluated for his aptitude to carry out a research project in Philadelphia (page 36) speaks highly of the assessors there and of the very superficial and inadequate methods we use in India today.
At Dr. Harrison's suggestion, Dr. Chone Oliver, Secretary of the Christian Medical Association of India, then in America, came over to see Dr. Chandy in Philadelphia. She urged him to work in Vellore after his return to India. When Dr. Chandy unfolded his plans for training in neurosurgery, she recommended the Montreal Neurological Institute in preference to Dr. Francis Grant in Philadelphia (Dr. Grant had trained with Dr. Cushing).
Dr. Chandy moved to Montreal in October 1945 after completing his research project in Philadelphia and obtaining his Master's degree.
The two years in Montreal were productive and happy and are described on pages 39-43. You will find his descriptions of Drs. Penfield and Cone fascinating. Whilst he was there, he was visited by Dr. Robert Cochrane, Principal of the Christian Medical College, Vellore. This strengthened his decision to work there on his return to India.
At Dr. Penfield's suggestion, after he obtained his Fellowship of the American College of Surgeons and that of the International College of Surgeons, he moved with Dr. T. R. Rasmussen to Chicago to learn how a department of neurosurgery was set up.
Whilst in Chicago, the developing bonds with Vellore were strengthened when Dr. Liza Chacko, who taught anatomy at the upgraded Missionary Medical School for Women in Vellore, came to meet him and told him that there was no place in India where neurosurgery was being done. Another piece fell into place when the Dean of the Business Administration School offered to take up anyone willing to join Dr. Chandy in Vellore for training and Dr. Chandy was able to persuade Rev. Savarirayan to undertake this training. The die was finally cast when Sir A. Lakshmanaswamy Mudaliar, Dr. Chandy's teacher in midwifery and gynaecology at Madras Medical College, visited Chicago and spent time with him. Dr. Mudaliar was cheered by Dr. Chandy's intention to start neurosurgery in Vellore and volunteered to help him. Since Dr. Mudaliar was then Vice-Chancellor of Madras University, this was, indeed, a stroke of great good fortune. The stumbling block was the lack of funds to set up the department in Vellore.
Dr. Harrison once again stepped into the breech and handed him two cheques from well-wishers for US$ 8,000 and 5,000 respectively to purchase whatever he needed for establishing neurosurgery at Vellore. He urged Dr. Chandy to send a telegram: 'Joining Vellore. Bringing necessary equipment.'
In the third week of January 1949, Dr. Chandy left New York on a cargo ship travelling to Madras via Colombo. When he reached Kottayam, he saw Mathew, now aged five. 'Words are not enough to describe the intense joy I felt.' He then moved en famille to Vellore, where the other half of the house allotted to them on the college campus was occupied by Dr. Paul Brand. (Page 51) Dr. Chandy resumes the narrative on his family only on page 130. Dr. Chandy was operating on a patient with a brain tumour when Mathew's younger brother, Varghese, was born. Mathew's education at Bishop Cotton School, Bangalore and later at Loyola College and his admission to Christian Medical College, Vellore are described on page 132. Mathew obtained his M.S. degree in general surgery from the Madras Medical College. By the time he returned to his alma mater for pursuing M. Ch. in neurosurgery, Dr. Chandy had retired. Mathew worked under the guidance and supervision of Dr. Chandy's students – Dr. K. V. Mathai and Dr. Jacob Abraham. Mathew later spent a year in the Montreal Neurological Institute as the first Penfield fellow. In March 1952, when Thangam was expecting her third child, on the day of delivery, Dr. Chandy was once again performing a major neurosurgical operation when his daughter was born. Dr. Chandy's father baptized the girl.
Pages 49 – 78 describe the difficulties faced by the college and hospital during their early years and include short biographical sketches of the founder, Dr. Ida Sophia Scudder, Dr. Hilda Lazarus, the foundation of 'Friends of Vellore Board' abroad and Dr. Chandy's own early experiences. The difficulties faced by Dr. Chandy were also encountered by each of the other pioneers in Indian neurosurgery over the succeeding decade and more. Page 143 describes a surprising example of intransigent behaviour by the nursing superintendent of the hospital in 1949, who refused Dr. Chandy permission to teach a ward sister how to take blood pressure!
Some of the key persons who helped Dr. Ida Scudder develop the institutions in Vellore are described on pages 108-121. The incident that rendered Dr. Mary Verghese permanently paraplegic is described on page 114 and on page 171. Brief notes on some other staff members such as Dr. H. S. Bhat are to be found on pages 122-129 and on page 166.
The unfortunate fallout between Dr. Lazarus, then Director and Principal, and Dr. Chandy is explained on pages 68-69 and page 77. Thanks to the stand taken by Dr. Chandy, he was able to concentrate on neurosurgery and Dr. Reeve Betts was able to pursue thoracic surgery.
The well-known anecdote concerning Dr. P. Kutumbiah, Professor of Medicine, is to be found on pages 71-75. The identification of a brain tumour in a patient said to have meningo-vascular syphilis and its successful removal with full recovery of the patient went a long way in smoothening Dr. Chandy's task of building the department of neurosurgery. He met the need for information on the capabilities of the department by publishing papers in Indian medical journals.
We learn of Dr, Mary Thomas, the first house surgeon allotted to Dr. Chandy, who, Dr. Chandy concluded, 'was not a committed Christian' as she chose married life and left the institution.
Dr. Baldev Singh's entry into Vellore is described on page 86. 'Towards the end of January 1950, I had a letter from an Honorary Professor of Medicine of Amritsar Medical College, Dr. Baldev Singh, M.R.C.P….' Dr. Baldev Singh's resignation is described on page 97. The prelude to it is to be found on page 95. Dr. Baldev Singh then joined All India Institute of Medical Sciences in New Delhi as Professor of Neurology. A brief reference to his work and that of Dr. B. K. Bachhawat is found on page 103. More information on Dr. Bacchawat is available on pages 144-146.
Dr. B. Ramamurthi's development of the Department of Neurosurgery in the Madras Medical College in 1952 and the formation of the Neurological Society of India find brief mention on page 104.
Dr. Chandy's efforts at making the college and hospital Indian institutions, not subject to control from U.S.A. and U.K., speak highly of his concern for these institutions and their management. (See pages 91-101) Thanks to his efforts and the revision of the constitution of the institutions, Mr. Karunanidhi's efforts at liquidating them in 1970-73 came to naught.
Rajkumari Amrit Kaur, Union Health Minister, inaugurated the Neurology block of the Christian Medical College and Hospital in 1954. (Page 106)
Dr. Chandy had to travel 7 km. to reach the hospital. He had to return to the hospital each evening to check on the progress of his patients and this was inconvenient. He moved to a residence on the hospital campus in 1951. He retired as Principal in 1970.
When the Christian Medical College obtained recognition from the Madras University, there were 14 medical colleges in the country. Thanks to the help rendered by Sir A. Lakshmanaswamy Mudaliar, Dr. Chandy was able to obtain recognition not only for his institutions but for postgraduate courses in the various subjects as soon as the requisite conditions were met.,, In August 1956, Dr. Chandy met the Vice-Chancellor in his office and outlined a course leading to the M. Ch. in Neurosurgery. Dr. Mudaliar suggested that in contrast to examinations leading to the M.S. degree in surgery, the evaluation of candidates for this degree should include an actual operation performed by the candidate with his teacher as assistant. Safeguards for the patient were to be built into the procedure. It was only thus that competency in surgery could be ensured. In addition, he also approved M. Ch. examination in cardio-thoracic surgery and D. M. in neurology and in cardiology.
This system of getting an operation performed by the candidate as a part of the examination for getting the M. Ch. degree in Neurosurgery eventually became the standard all over India. In the late 1990s, the misguided policy of the then Vice-Chancellor, resulted in its abolition in Bombay, with a consequent fall in the standard of the qualification at this university. (For some other 'innovative' measures by this Vice-Chancellor, see http://www.rediff.com/news/2003/may/10dilip.htm).
Dr. Chandy's far-sightedness can be judged from the following example on pages 143-4. From the start, in 1949, he had envisaged a department of neurosciences in his institution in Vellore. To this end, he watched the first ten male students admitted to the college for training in medicine and followed their progress. He found Mr. K. V. Mathai (as he was then) quite a suitable candidate for induction into neurosurgery. 'He was an enthusiastic, mature science graduate… athletic, taking interest in all student activities… good in his studies…' Dr. Mathai became the first person to obtain the M. Ch. degree in neurosurgery in India.
For more details on the development of the departments of Neurosurgery and Neurology, see chapter 20 (pages 207-213)
Some information on Dr. R. N. Roy, who trained with Dr. Chandy for two-and-a-half years and was the first to obtain the M. S. (Neurosurgery) degree from Calcutta University have been provided on pages 146-147.
I recommend the account of the misdiagnosis that resulted in the death of Mr. Don Stephen Senanayake, the Prime Minister of Ceylon in 1952 (pages 153-154). Predictably, local and world press blanked out all information on the correct diagnosis made by Dr. Chandy. (See https://www.pressreader.com/sri-lanka/daily-mirror-sri-lanka/20160322/282561607295115 and https://trove.nla.gov.au/newspaper/article/18499768).
Other important patients are described on the succeeding pages. Dr. Chandy gave full credit for the recovery of the minister from Andhra Pradesh, who had met with a car accident in Chandigarh, to Dr. D. R. Gulati, who had already done whatever was needed for the patient. The relative of the Nehru family, who had met with a motor cycle accident, was fortunate that Dr. Chandy was then in Delhi. The surgeon looking after him 'did not know what to do'. Dr. Chandy diagnosed an extradural clot from the history of a lucid interval and operated successfully to save the boy's life. Dr. Rajendra Prasad, then President of India, had also sought Dr. Chandy's advice. As a token of gratitude, he invited Dr. and Mrs. Chandy to the Republic Day Parade in Delhi as his guests. Among the other guests were Queen Elizabeth and the Duke of Edinburgh! On a later occasion, President Radhakrishnan awarded Dr. Chandy the Padma Bhushan.
Dr. Chandy's recommendation to Dr. K. L. Wig, Director of the All India Institute of Medical Sciences, New Delhi, that a Department of Neurosurgery be set up there fell on deaf ears. Dr. Chandy kept repeating his offer of training someone to start the department. 'Years went by…' On one of his trips to Delhi to attend an official meeting, he learnt of the death following an automobile accident of the brother of Dr. Sushila Nayyar, Union Health Minister. Whilst offering his condolences, Dr. Chandy spoke of how her brother's death may have been prevented had there been a neurosurgeon in Delhi. Dr. Nayyar took up this suggestion in earnest and asked Dr. Chandy to recommend a person to be selected and appointed. Knowing of Dr. P. N. Tandon's return after training with Dr. Kristiansen and at Montreal, he was quick to suggest that Dr. Tandon be shifted from Lucknow, where he then worked, to the All India Institute of Medical Sciences. Later, Dr. Chandy's trainee – Dr. Ajit Banerji – was appointed as Dr. Tandon's assistant professor.
Dr. Chandy retired on 23 January 1970 on reaching the age of 60 years. He passed away on 23 June 2007.
I also recommend a study of the paper by Abraham et al. (2010) for details not available in Dr. Chandy's autobiography.
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|2||Nair K R. Organized neurosurgery: Additional facts. Neurol India 2017;65:443.|
|3||Rajshekhar V. History of neurosurgery at Christian Medical College, Vellore: A pioneer's tale. Neurol India 2016;64:297-310.|
|4||Singh M, Sawarkar D, Sharma BS. Neurosurgery at All India Institute of Medical Sciences, a center of excellence: A success story. Neurol India 2015;63:589-96.|
|5||Abraham Jacob, Mathai K V, Rajshekhar Vedantam, Narayan Raj K: Jacob Chandy: Pioneering Neurosurgeon of IndiaNeurosurgery 2010; 67:567-76.|