Kerala Sold Health Care to Corporates
With the handling of Covid-19 in a revolutionary manner, Kerala, a tiny state in South India is at the forefront of the struggle against the fight and has earned global attention. The Economist, where my son is a journalist, in an article remarked that if Vasco da Gama is to arrive in Kerala now, he will not seek the spices, instead he will crave human resources.
There is said to be a Kerala model, which economists like Amartya Sen have extolled in their writings, prompted by Dr K N Raj, who was Director, of the Centre for Development Studies, Trivandrum. The Kerala model is one in which a state invests a lot of public money in the fields of health and education to give it free for the people. The left in the state has always tried to take credit for the same; in fact, the left's role in all this is minuscule. So let us delve into the medical history of the state, which was built by human resources, not by the right or left.
When Padmanabhan Palpu, who belonged to the backward Ezhava caste was denied admission to the Travancore Medical College in 1878, he got admission to the Madras Medical College where Dr M C Koman was a Professor. Dr Koman, who again belonged to the backward Dheevara caste from Kannur, later became the Vice Principal there.
Koman's relative V V Janaki was the first gynaecologist in South India, in 1909.
Palpu, LMS, DPH (Cantab) FRIPH (London) ( 1863 – 1950) was a bacteriologist and is iconic in the annals of medical history of India due to his yeoman service during the plague in the erstwhile Mysore State. Palpu was posted as the first health officer during the plague outbreak. He played a key role in containing the spread in Bangalore. The Maharaja of Mysore later felicitated Palpu for arduous service to the state and he was instrumental in setting up the Victoria Hospital (Bangalore Medical College) in Bangalore.He met Vivekananda in Mysore. It was Vivekananda who told him to find a religious leader in Kerala for its renaissance, and we got Sree Narayana Guru. But Guru's biographer T Bhaskaran denies this.
Palpu's brother P Velayudhan was the first Ezhava graduate in Travancore. Palpu was the first LM & S in the state. Palpu passed Matriculation in 1883, a year after the graduation of his brother, and while a student of FA (intermediate) he wrote the entrance exam of the government medical school in 1884 and got the second rank. But he was denied admission by caste Hindus. Over age was given the reason-born in 1863, he was 24 at the time of passing the entrance exam. He reached Madras on 10 October 1885. With the help of his brother who was employed in Madras, he got admission to the course, Licentiate in Medicine and Surgery in the Madras Medical College. Palpu passed in 1889, but his application for a medical post in Travancore was rejected. He joined the Madras government service as vaccine superintendent on a monthly salary of Rs 70.
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| Dr M C Koman |
Sir MC Koman (1865 - 1925) Civil Surgeon at General Hospital Madras and also Associate Professor at Madras Medical College, submitted a Report on Investigation into Indigenous Drugs 1920, kept in the Asia Pacific section of British Archives. He is the only Knighted doctor from Southern India.
Ayurveda research
On 2 November 1915, A S Krishna Rao proposed a resolution in the Legislative Council of Madras Presidency, that the Madras government "direct a research and investigation of the Ayurvedic system of Medicine, to improve that system."It was passed in 1917, though in a much-revised form, "to direct a research and investigation of the pharmacological action of Indian drugs".The colonial rulers thereby expressed faith in the physical material of India, but not in the knowledge produced and recorded in, as Surgeon General G G Giffard put, it, "unintelligible" Sanskrit writings, a language of "priestly mysticism "and so clearly unsuited for scientific truths. Dr Koman was appointed as Chairman of the committee. The colonial plundering of native material with a rejection of indigenous forms of knowledge was manifested in many realms of activity, and medicine was no exception.
Koman submitted three reports, from 1918 to 1920. He considered a range of ingredients used for indigenous medicines and tested their effects on patients according to the standards of Western science. The Dravida Vaidya Mandal and the Madras Ayurveda Society protested and published a report which said, "the learned doctor had thoroughly failed to understand the indigenous systems and had grievously erred in many vital points."
Koman was initiated into the British Freemasons at the John Miller Lodge in Madras in the year 1898. He became District Grand Master of the District Grand Lodge at Madras in 1902, 1913 and 1914. He was the first Indian Worshipful Brother installed as Supreme ruler in Daman and Pythias Conclave (Primus in India) in 1910. invested with the Collar and Jewel of District Junior Grand Warden in 1918 honoured with Past Assistant Director of Ceremonies in 1923, and a Chair was created in Sir Koman's name at Madras Masonic Institution. He held a toast in a Cake and Wine dinner at the Banqueting Hall in honour of HE the Duke of Connaught in 1921. He was chosen Deputy Grand Master at the District Grand Lodge of Mark Master Masons in 1924. the third Indian to serve more than 25 years at John Miller Lodge. On the eve of the opening of Freemasons Hall at Madras in February 1925, Sir Koman's noble soul left its physical Tabernacle and flitted away into the land of peace.
Koman was initiated into the British Freemasons at the John Miller Lodge in Madras in the year 1898. He became District Grand Master of the District Grand Lodge at Madras in 1902, 1913 and 1914. He was the first Indian Worshipful Brother installed as Supreme ruler in Daman and Pythias Conclave (Primus in India) in 1910. invested with the Collar and Jewel of District Junior Grand Warden in 1918 honoured with Past Assistant Director of Ceremonies in 1923, and a Chair was created in Sir Koman's name at Madras Masonic Institution. He held a toast in a Cake and Wine dinner at the Banqueting Hall in honour of HE the Duke of Connaught in 1921. He was chosen Deputy Grand Master at the District Grand Lodge of Mark Master Masons in 1924. the third Indian to serve more than 25 years at John Miller Lodge. On the eve of the opening of Freemasons Hall at Madras in February 1925, Sir Koman's noble soul left its physical Tabernacle and flitted away into the land of peace.
Koman's relative V V Janaki was the first gynaecologist in South India, in 1909.
People like Koman could pursue medicine because people associated with the Thalassery British factory had established a hospital there in 1819. The hospital grew out of Oakes' work.
Rev Francis Spring, the Chaplain at Thalassery factory was part of the team that established the first school in Pallikkunnu, Thalassery on 25 June 1817, along with Parson John Laverock Oakes, Edbert (Canara), and Thomas Harvey Barber. The first schoolmaster was a Portuguese called John Baptist or Bapiste, a “native catechist,” who had four native assistants. Spring left for England in 1824. It was taken over by the CMS that year. In 1824, it contained 59 children of various castes and classes. Spring was able to take over control of the school to a greater extent in the years after 1820; it began to try to convert pupils to Christianity. John L. Oakes who was Master Attendant at Thalassery, died in about 1819, leaving 20,000 Rupees of his own fortune for the relief of the poor of Thalassery.
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| Dr Palpu |
Palpu's brother P Velayudhan was the first Ezhava graduate in Travancore. Palpu was the first LM & S in the state. Palpu passed Matriculation in 1883, a year after the graduation of his brother, and while a student of FA (intermediate) he wrote the entrance exam of the government medical school in 1884 and got the second rank. But he was denied admission by caste Hindus. Over age was given the reason-born in 1863, he was 24 at the time of passing the entrance exam. He reached Madras on 10 October 1885. With the help of his brother who was employed in Madras, he got admission to the course, Licentiate in Medicine and Surgery in the Madras Medical College. Palpu passed in 1889, but his application for a medical post in Travancore was rejected. He joined the Madras government service as vaccine superintendent on a monthly salary of Rs 70.
The government Medical school, started in 1884, where Palpu studied was the forerunner of the later medical college. In 1901 Dr. Percy Turner (Colonel Dayanesan) was appointed as the Physician of Catherine Booth Hospital, Nagercoil. He opened the first private Medical School in Travancore under the approval and funding of the Travancore Government. The medical school lasted only a few years from 1908-1914, but many officers graduated from it. They were Brigadier T. Chacko Joseph and Senior Majors S. Ghanaiah and J. Manuel who were in charge of the branch hospital.
Dr C. O. Karunakaran, a notable bacteriologist and microbiologist, again from the Ezhava community, was the founder of Government Medical College, Thiruvananthapuram. He was the first principal of the college and was also the Special Officer appointed to establish the first medical university in the erstwhile state of Travancore-Cochin. Born in 1892 at Mavelikkara, C.O. Karunakaran had his initial schooling at Mavelikkara Government High School. After the intermediate in Maharaja's College, Ernakulam he joined Madras Medical College for Bachelor of Medicine and Bachelor of Surgery.
Dr C. O. Karunakaran, a notable bacteriologist and microbiologist, again from the Ezhava community, was the founder of Government Medical College, Thiruvananthapuram. He was the first principal of the college and was also the Special Officer appointed to establish the first medical university in the erstwhile state of Travancore-Cochin. Born in 1892 at Mavelikkara, C.O. Karunakaran had his initial schooling at Mavelikkara Government High School. After the intermediate in Maharaja's College, Ernakulam he joined Madras Medical College for Bachelor of Medicine and Bachelor of Surgery.
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| C O Karunakaran |
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Following his study at Madras Medical College, he completed DTMH, DPH and DB from the University of Cambridge and the University of London. He worked for a short period as the Medical Officer of an estate and then as the Health Officer of Thiruvananthapuram. Later he took over as the Superintendent of the Public Health Laboratory near the Civil Hospital (present Trivandrum General Hospital) at Thiruvananthapuram. Sir C.P. Ramaswamy Aiyer realising his abilities, sent him to the United States of America for industrial training. When he returned he improvised the laboratory and in 1948, he was appointed as the Special Officer for establishing the first medical college in the state of Travancore-Cochin at Trivandrum. With his effort the plans for the construction of the Government Medical College, Thiruvananthapuram were finalised in a year and construction of the college was completed in just 16 months, once again proving the mettle of Sir CP.Family planning
The first call for family planning in India was by Dr. C.O. Karunakaran in his famous Karthikapally speech in 1925. He died on 30 November 1970. In his will, he had stated that no state honours or religious rituals be performed at his funeral. It also stated that the body should not be kept for more than six hours. He was the son of Alumoottil Padeetathil Ummini Kunju Channar and Kunjupennu Channati. His elder brother C.O. Madhavan was the Chief Secretary and Mayor of Thiruvananthapuram city. His younger brother Dr. C.O. Damodaran was the Commissioner of the Kerala Public Service Commission.
I have traced examples from the backward caste to prove the point that casteism was not rampant in the state factor which made progress easier. Hence Narayana Guru said, "It was the British who gave me sannyasa."
Medieval Kerala shows us that ‘practising hygiene’ was imposed as a responsibility and duty of different castes to have proper management of the caste hierarchy and gender-related functions. The pursuit of hygiene had been central to the community formation, purity of the self and community and integrity as well. Development of notions like ‘personal hygiene’, ‘domestic hygiene’, ‘social hygiene’, ‘ritual hygiene’, and ‘caste hygiene’ was maintained by rigid maintenance of the ritual, geographical, legal and actual boundaries in the name of “pulayappedi” and “parayappedi.” Through proper facilitation of ‘self’ and ‘other’ this practice was continued as late as the nineteenth century. Practices like constructing strange notions regarding the functioning of the female body, the biological change, the menstrual cycle and distancing it with ‘purity’, and so on were nurtured by different communities.
The first attempt to introduce modern medicine was made in Cochin in 1818 by a missionary, Rev J Dawson, who opened a dispensary in Mattancherry. It received a monthly grant from the government, but it was closed after a couple of years. In 1823, the Civil Surgeon of British Cochin was made ex officio Darbar physician, and a Dresser was attached to the jail at Ernakulam, while the Trichur jail was placed in the charge of the Dresser attached to the British Military detachment there. These three people began to show the advantages of modern medicine and surgery. In 1845, Dewan Sankara Warrier opened the first Government Hospital, the Charity Hospital in Ernakulam, which was developed into the present General Hospital. Just a year before the birth of Parikshit Thampuran, in 1875, a hospital was opened at Thrissur.
Kerala has a long history of organized health care. Before the advent of European medicine, families of practitioners of indigenous systems like Ayurveda handed their traditions from generation to generation. People were accustomed to approaching caregivers when they were sick, rather than turning to self-treatment. When the colonial powers established their presence in the region, they brought their medical system with them. In the 19th century, the princely rulers of the erstwhile states of Travancore and Cochin (which later were integrated into the state of Kerala along with the Malabar district of the Madras presidency in British India) took the initiative in making the Western system of care available to their subjects.
Vaccination was introduced in Travancore in 1811. This was the beginning of preventive medicine in the state. There was a lot of resistance from the public to the introduction of Western medicine. The royal family was prompted to act as a role model for popular acceptance. Upon the persuasion of the Resident, members of the royal family underwent smallpox vaccination in 1813, when Col John Munro was Resident and Queen Gowri Laksmi Bayi (1810-1815), mother of Swati Tirunal was Regent. Western medicine was introduced as a preventive care as vaccination against smallpox. Munro was, of course, interested in proselytisation. Maharani Ayilyam Thirunal Gouri Lakshmi Bayi was the Maharani of Travancore from 1810 till 1813 and Regent from 1813 till her death in 1815 for her son Swati Thirunal Rama Varma.
The widespread occurrence of smallpox and continuous pressure from Munro forced the Regent, who was rumoured to have an affair with Munro, to start a smallpox unit with a resident doctor. Munro reported to the Madras government:
"I wrote to her Highness earnestly requesting that she would allow herself to be vaccinated, and I sent a medical gentleman to Thiruvananthapuram to perform the operation. The Rani replied as she formerly had smallpox, it was unnecessary to vaccinate her; if however, I insisted upon her undergoing the operation, she would submit to it on my return to Thiruvananthapuram and in the meantime the doctor might vaccinate..."
In the beginning, only the members of the royal family and the Government officers received the benefits of this method of treatment. With the help of the Durbar physician Dr. Proven, the Maharani established a small section for vaccination in 1813, thus laying the foundation for preventive medicine in the State.
During the reign of the Rani, the attitude which prevailed in the royal family and among the public about socializing with foreigners changed. European doctors were allowed to treat women as members of the royal family. Dr. Proven was the first person appointed as the physician of the royal palace at Quilon (Kollam) and Dr. James Rose was appointed as the deputy physician at the palace. Rani Parvathi Bai (1814 – 1829), established a charity dispensary at Thycaud in 1816 where the jail convicts were treated first.
The charity dispensary started by Swati Thirunal in the palace continued to function under the name Elaya Raja’s Dispensary until the Fort Dispensary was established. Seven hospitals were opened in different parts of the State. The people thronged to these hospitals as they got free food and good treatment. The Medical Department which was thus started made rapid advances during the early years of the reign of Ayilyam Thirunal Maharaja (1860 – 1880). He laid the foundation stone for the civil hospital in 1864. This later developed into the present General Hospital. In the same year, the Palace Medical Officer was put in charge of the Medical Department. The civil hospital was under the direct supervision and control of the Durbar Physician, Dr. H.M. Ross.
"In 1846, a few months before Swati Thirunal's demise, it is known from several advertisements that appeared in London Times that Colin Peterson administered a drug marketed by Holloway on Swati Thirunal."
Holloway's ointment is known to have been created by Thomas Holloway, who termed it a 'cure anything' ointment and made him rich. It is also today known that Holloway's medicines contained aloe, myrrh and saffron, which are unlikely to cure anything in the modern view. However, the diseases claimed to be cured are pointers to the medical conditions of Swati Thirunal and require further research by medical practitioners.
Travancore society in the earlier periods was confronted with a lot of communicable diseases which shook the Travancore society and led to the increase of death rate. The year 1895 recorded the highest figure in the death rate being 19.52 per million. In 1896 and the following year the ratio fell to 15.01 and 15.72 respectively and 13.63 in 1898. After 1898 the figures began to improve on account of the unusually severe prevalence of cholera and smallpox.
A Medical school was also opened in 1869 in the capital to improve the education of the officers in the department. A new mofussil hospital was opened in Quilon (1870 – 71) with accommodation for patients. This hospital stood as the first mofussil hospital in the State. At first Deputy Surgeon of the Madras Presidency supervised the functioning of the hospitals in the State but later, the Durbar Physician was entrusted with that responsibility.
The earliest record of the ravages of cholera in Travancore was in 1869. The epidemic spread from the south along the main and diverging lines of communication to upwards of fifty miles north of Trivandrum causing very heavy mortality, especially among the aged and infirm and continued to prevail in the southern districts till the beginning of 1888 after which it died out. In1888. There was a terrible epidemic 6,587 cases were reported in the Taluks of Tovala, Agasteeswaram and Eraniel with 2, 101 authenticated deaths. Having at the beginning of the year prevailed in a sporadic form almost throughout the country, it laterally reached the fishing villages on the seacoast and assuming the character of an epidemic of a severe type affected the whole of the southern division causing great loss of life. After 1890 there had been a marked decline in death from this epidemic.
The infection of cholera represented by some specific morbid material is often brought into Travancore with the influx of pilgrims in connection with Saint Xavier's festival at Kottar and the Car Festival at Suchindram. At both these festive gatherings, the conditions of insanitation are crucially so pronounced as to render every facility for the growth, development and dissemination of the disease to all parts.
The year 1890 witnessed a serious epidemic costing 10,508 lives and affecting practically the whole state. The disease has continued ever since as a constant menace with alternating manifestations of mildness and virulence. In 1927 another furious outbreak over-ran South Travancore and also the Taluks of Trivandurm, Chirayinkizh and Shenkotta claiming altogether 10,727 victims.
A royal proclamation of 1879 by Ayilyam Thirunal made vaccination compulsory in Travancore for public servants, prisoners and students.
All heads of public departments were instructed to see that those under their care and control were vaccinated. Administrative reports indicate that public health authorities were also concerned about the spread of cholera during fairs and festivals, and initiated measures of containment.
During the short reign of Visakam Thirunal Maharaja (1884 – 1885), many statutory changes were introduced in the Medical Department and he established one medical centre for every 277 square miles in the State. There were thirty-one medical institutions in the State at the end of his reign. Maharaja Sree Moolam Thirunal (1885 – 1924) took several measures for the extension and improvement of the State Medical Department. He began a system of grant-in-aid to private medical institutions. During his rule, a nursing training school named the Victoria Jubilee Medical School began to function in Quilon which trained girls belonging to several castes. The Maharaja made arrangements at the Quilon hospital to train many more midwives and nurses. He contributed a sum of Rs. 50,000 to the training school. A fort dispensary was instituted by the Maharaja in 1886 – 1887 to treat the women living in proximity to the Maharaja’s palace who hesitated to go to the General Hospital. The Medical Department was strengthened by the appointment of three qualified officers, two of whom were licensed by the Madras University and one was an Apothecary of the Medical College. A small Maternity Hospital was opened as an annexe to the Zenana Mission Hospital in 1888 –1889. As the institution became popular and gained wide recognition, the maternity section was removed from the General Hospital and made into a separate institution.
In 1889, the Medical Department was reorganised and reformed at an additional annual cost of Rs 28,000 During this period of reorganization, a large number of compounders were employed to help the medical officers. A separate officer designated as the chemical examiner was appointed and the Durbar Physician was relieved from that work. A class for educating the compounders was opened in 1890. Though the course was abolished in 1893, all the hospitals were provided with compounders by this time. Accommodation for patients was provided in most of the mofussil dispensaries during 1893 – 1894 and a separate hospital for women and children was opened in the next year.
During the same period, the midwifery centre was shifted from the General Hospital to a new building near Trivandrum Museum and sub-assistant Surgeon Dr John Gomez was put in charge. In 1894 the Maharaja invited a lady doctor to take charge of the women and children’s hospital and recommended that a separate hospital managed by women staff should be established in Trivandrum for the benefit of women and children. In 1895 –1896, a separate Department was formed to control vaccination, collect vital statistics and provide proper sanitation in towns. A separate hospital for patients with incurable diseases was opened at Oolampara in 1896 and certain drugs like Quinin and Chlorodine were distributed to the public through the anchal (postal) office. Again in 1897 – 1898, a thorough re-shuffling was conducted by increasing the strength of the medical staff.
Sree Moolam Thirunal Maharaja decided to constitute the code of rules for the Medical Department. On the direction of the Maharaja, a Medical Code was prepared by the Durbar Physician and principal medical officer Dr. White in the year 1898. In 1906, the services of eight European Nursing Sisters were made available in the hospitals. Later on in 1908, the Victoria Jubilee Hospital was placed under the direct supervision of a female Assistant Surgeon. The Maharaja sanctioned an annual donation to several private medical institutions given the Golden Jubilee of Queen Victoria’s reign. Of these private medical institutes the Nagercoil Dispensary of the London Missionary Society, the Charity Hospital at Alapuzha, the Archbishop’s Hospital near Varapuzha, the Planter’s Hospital at Aryanad and the Local Fund Dispensary at Bodinaikkanur deserve special mention. At the close of 1915, the State maintained twenty-seven hospitals and twenty-six dispensaries.
The cholera epidemic of 1927 had proved the need for a more efficient public health organization to grapple with and control such emergent situations as efficiently and speedily as possible. The combating of cholera was one of the most prominent objects of the Public Health Department. The last epidemic of cholera occurred in 19358 causing altogether 11,792 attacks and 6,056 deaths. P Kumaran Nair the Medical officer of health was deputed for cholera special duty. The Public Health Laboratory supplied 7, 07, 875 c.cs.of cholera vaccine for carrying on a Mass Inoculation Campaign as a result of which the epidemic subsided within a shorter period, causing only a much lower incidence than in the case of the previous years.
In 1928, under the auspices of the Travancore government and with the help of the Rockefeller Foundation, parasite surveys were conducted in Travancore which led to measures to control hookworm and filariasis. A health unit incorporating many of the concepts of primary health care was also started in a rural area. The development of health services was not confined to the provision of preventive care – the general hospitals in Trivandrum and Cochin are more than 150 years old. Initiatives were also taken to get members of the respective states who were trained in Western medicine into key posts in the government service.
The appointment of Dr Mary Punnen Lukose (1886-1976) as the surgeon-general of Travancore in the early years of the 20th century is a case in point. A doctor trained in England, she was the first woman to be appointed surgeon-general in an Indian state, at a time when women doctors were still a rarity in Europe and America. Mary Poonen Lukose was an Indian gynaecologist, obstetrician and the first female Surgeon General in India. She was the founder of a Tuberculosis Sanatorium in Nagercoil and the X-Ray and Radium Institute, Thiruvananthapuram, served as the head of the Health Department in the Princely State of Travancore and was the first woman legislator of the state. Her father, T. E. Poonen, was a medical doctor, the first medical graduate in Travancore and the Royal Physician of Travancore state.
She had topped the matriculation examination. However, she was denied admission for science subjects at the Maharajas College, Thiruvananthapuram (present-day University College Thiruvananthapuram) for being a woman and had to pursue studies in history on which she graduated (BA) in 1909 as the only female student of the college and the first woman graduate of Madras University which Maharajas College was affiliated to. As Indian universities did not offer admission to women for medicine, she moved to London and secured an MBBS from London University, the first woman from what would later become Kerala to graduate in medicine. She continued in the UK to obtain MRCOG (gynaecology and obstetrics) from Rotunda Hospital, Dublin and underwent advanced training in paediatrics at the Great Ormond Street Hospital. Later she worked in various hospitals in the UK and simultaneously pursued music studies to pass the London Music Examination.
Mary returned to India in 1916, the year her father died] took up the post of an obstetrician at the Women and Children Hospital, Thycaud in Thiruvananthapuram and also worked as the superintendent of the hospital, replacing a westerner who had returned to her native place after marriage. During her tenure at Thycaud Hospital, she initiated a midwifery training program for the children of local midwives to win over their support and is known to have delivered her firstborn at the hospital. In 1922 she was nominated to the legislative assembly of Travancore, known as Sree Chitra State Council, thus becoming the first woman legislator in the state. Two years later, she was promoted to Acting Surgeon General of the state of Travancore, making her the first woman to be appointed as the surgeon general in India. She continued at the hospital till 1938 during which time she was nominated to the state assembly continuously till 1937. In 1938, she became the Surgeon General, in charge of 32 government hospitals, 40 government dispensaries and 20 private institutions. She is reported to have been the first woman to be appointed as the surgeon general in the world; the first woman surgeon general in the US was appointed only in 1990.
Somervell was born in Kendal, Westmorland, England to a well-off family which owned a shoe-manufacturing business founded by two SOMERVELL brothers in Kendal in 1845, that survives to this day, K Shoes. After completing his schooling, he studied at Gonville & Caius College, Cambridge where he developed his strong Christian faith and gained First Class Honours in the Natural Sciences Tripos. He then began training as a surgeon at University College Hospital; eventually graduating in 1921 after his training had been interrupted by the First World War. He married Margaret Hope Simpson (1899–1993), daughter of Sir James Hope Simpson, the general manager of the Bank of Liverpool.
Between 1915 and 1918 Somervell served in France with the Royal Army Medical Corps. He was commissioned as a lieutenant with the West Lancashire Casualty Clearing Station on 17 May 1915, having previously been a member of the University of London Officer Training Corps. He was Mentioned in Despatches, but the horrors of the war had a profound effect on him. During the Battle of the Somme in 1916 he was one of four surgeons working in a tent, while hundreds of wounded men lay dying on stretchers outside. On short breaks from surgery, he spoke with some of the dying men and noted that not one asked to be treated ahead of the others. The experience turned Somervell into a pacifist, a belief he continued to hold for the rest of his life. He relinquished his commission in 1921, by which time he held the rank of captain.
Somervell was invited to join the 1922 British Everest expedition. During the expedition, he formed a close friendship with George Mallory, and the two famously read Shakespeare to one another in their tent at night. With the expedition over, Somervell set out to see India, travelling from the far north to Cape Comorin. He was shocked by the poverty he saw and in particular the poor medical facilities. At the main hospital of the south Travancore medical mission in Neyyoor, he found a single surgeon struggling to cope with a long queue of waiting patients and immediately offered to assist. On his return to Britain, he abandoned his promising medical career and announced his intention to work in India permanently after his next attempt on Everest. Most of his famous paintings sold today are from his travels in various parts of India, even though most of his time was in Kerala where many landmarks to his name still remain.
Somervell worked as a surgeon with the London Missionary Society Boys Brigade Hospital (now known as LMS Boys Brigade Hospital ) at Kundara from 1923 to 1949. There was a separate operation theatre for him in that hospital. He had donated £1,000 to the hospital.
Somervell became an associate professor of surgery at Vellore Christian Medical College in 1949, a post he would hold until his retirement in 1961.
The malaria epidemic in South Travancore in 1934 was the first reported epidemic of malaria in the state on an extensive scale one that affected a far larger population than any other epidemic diseases. The foot of the hills from Bhutappandy to Thodupuzha forms a hyper-endemic belly of malaria and has been recognized as a centre of malarial infection for a long time. The malaria epidemic of 1935-36 was an extension of the disease in a virulent and epidemic form. The epidemic was most severe in certain provinces of Neyyattinkara and Nedumangad Taluks.
N Krishnan Tampi was appointed as the special medical officer in charge of malaria.11 Maharaja contributed rupees 1500 to the Malaria Relief Fund. Maharaja and Maharani visited the malaria-stricken areas and their words of sympathy and kindness to the patients and their gracious presence were a source of encouragement to the people and to the workers alike. Blood films from the patients were regularly taken for microscopical examinations. Mid-day meals to school children were given. The Managing Director of A.D. Cotton Mills Quilon offered 2000 yards of cloth for free distribution among the malaria-stricken people. The Salvation Army organized a party of officers and rendered much help in the malarial areas by collecting clothes, rice and other necessities for distribution among the patients. Sri Rama Krishna Mission and Veera Kerala Gymkhana rendered yeoman service for the control of malaria.
The development of health services was complemented by other parallel events: initiatives to provide safe drinking water (in the capital city of Trivandrum initially) and the provision of state-supported primary education, including education for women. Another important factor was the establishment of mission hospitals in remote areas under the auspices of Christian churches. Young girls from the Christian community in Kerala were keen to take up nursing as a career.
At the time of the formation of the present Kerala state on 1 November 1956, the foundation for a medical care system accessible to all citizens was already laid.
The left came to power in 1957, but November 27, 1951, was a very special day for a group of young men and women, who stood bursting with pride and excitement, when the then Prime Minister of the nation, Jawaharlal Nehru, lit the lamp, marking the formal opening of their alma mater and the first medical school in the State, Trivandrum Medical College. M. Balaraman Nair, a first-batch student, went on to become the first Professor, Principal and the first Director of Medical Education.
It was on August 1, 1951, that the first batch of 63 students joined TMC. The 1951 TMC batch includes several illustrious names like M.S. Valiathan, K.V. Krishnadas, P.P. Joseph, and P. Sukumaran, whose professional achievements and contributions to the health sector are well-known.
The history of Neurosurgery in this Institute is synonymous with the history of Neurosurgery in the state as this was the first medical college to start a Neurosurgery department within the state. The students after undergoing their rigorous training in the department, went on to establish advanced neurosurgical centres throughout Kerala and in several other parts of the country.
The period from state formation to the early 1980s was characterized by great growth and expansion of government health services. Figures show the annual compound growth rate of government health care expenditure for the period at 13.04% (at current prices, without deflation), outstripping both the annual compound growth rate of total government expenditure at 12.45% and the annual compound growth rate of the state domestic product at 9.81%.2 From 1961 to 1986, the state greatly expanded its governmhealth facilities. The number of beds and institutions increased sharply. The total number of beds in government hospitals in the western medical sector increased from around 13,000 in 1960–61 to 20, 000 in 1970–71 and 29 000 in 1980–81. By 1986, the total was 36,000. Estimates in 1996 put the number at 38,000. Private hospitals now surpass government facilities in the density of beds and employment of personnel. The number of beds in government institutions grew from around 36,000 to 38,000 in the 10 years from 1986 to 1996; in the same period, beds in private institutions grew from 49, 000 to 67, 500. This means the successive governments, including the left, torpedoed the Kerala model leaving the health sector at the mercy of the private sector.
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Reference:
1. Evolution of Modern Medicine in Kerala/Dr K Rajasekharan Nair
2. Historical Development of HealthCare in Kerala/Dr V Raman Kutty
3. Western Medicine Under State Patronage in Travancore: A Retrospect/Satheesh P
4.A Social History of India/S N Sadasivan
5. V.Nagam Aiya, The Travancore State Manual
6.T.K.Velupillai, The Travancore State Manual
7. Historicising "Tradition" in the Study of Religion/edited by Steven Engler, Gregory Price Grieve.
The first call for family planning in India was by Dr. C.O. Karunakaran in his famous Karthikapally speech in 1925. He died on 30 November 1970. In his will, he had stated that no state honours or religious rituals be performed at his funeral. It also stated that the body should not be kept for more than six hours. He was the son of Alumoottil Padeetathil Ummini Kunju Channar and Kunjupennu Channati. His elder brother C.O. Madhavan was the Chief Secretary and Mayor of Thiruvananthapuram city. His younger brother Dr. C.O. Damodaran was the Commissioner of the Kerala Public Service Commission.
I have traced examples from the backward caste to prove the point that casteism was not rampant in the state factor which made progress easier. Hence Narayana Guru said, "It was the British who gave me sannyasa."
Medieval Kerala shows us that ‘practising hygiene’ was imposed as a responsibility and duty of different castes to have proper management of the caste hierarchy and gender-related functions. The pursuit of hygiene had been central to the community formation, purity of the self and community and integrity as well. Development of notions like ‘personal hygiene’, ‘domestic hygiene’, ‘social hygiene’, ‘ritual hygiene’, and ‘caste hygiene’ was maintained by rigid maintenance of the ritual, geographical, legal and actual boundaries in the name of “pulayappedi” and “parayappedi.” Through proper facilitation of ‘self’ and ‘other’ this practice was continued as late as the nineteenth century. Practices like constructing strange notions regarding the functioning of the female body, the biological change, the menstrual cycle and distancing it with ‘purity’, and so on were nurtured by different communities.
Medieval Ayurvedic sources such as Chikitsa Manjari (Manipravala period)48 and Mahasaram (compiled in the 1820s) are compilations of ancient and medieval practices of hygiene and medicine. These texts give us valuable information about the actual Ayurvedic medical practices that prevailed in medieval Kerala. Chikitsa Manjari was originally a Manipravala text which is not available now, but the printed copy of the same is available with many medieval Ayurvedic families such as Mezhathur Vaidya Madom in Thrithala. Ashtanga Hridaya and Ashtanga Sangraha, written by Vagbhatantha (between A.D. seventh and ninth century)49 also give ideas of dosha-based actual practices that were very prominent in the medieval healing practices in Kerala.
The British occupied Malabar in 1792.
The British occupied Malabar in 1792.
Modern medicine in Kochi
Ernakulam General Hospital in the state of Kerala in India, was founded by the King of the Kochi princely state in 1848. The last King of Cochin was known as Parikshit Thampuran (1876-1964). Though his real name was Rama Varma (Kunjunni) Thampuran, he was known as Parikshit because of the travails he had to undergo before his birth. He went through the kind of experiments the Pandava king, Parikshit of Mahabharatha had to undergo before his birth.
Thampuran's mother, Amba/Manku Thampuran was not able to deliver the child even after two days after she started having labour pain. When the Ayurvedic medication by Thycaut Moos and Elamana Krishna Menon, was found fruitless, the family members decided to bring Dr D Gunther, Medical Officer, and father of Robert Gunther, from Ernakulam, and other doctors from the Cochin Fort, to do an operation. Dr Gunther said that they would be able to save either the mother or the child. The family began praying to the presiding deity, Sree Poornathrayeesa. Then, a Kshatriya lady (Nambishtathiri) servant in the Palace who was an expert in the ottamooli (treating with one wonder drug) treatment, came forward and said she would make a try. Dr Gunther grinned; he went to a room and sat there waiting for the tragic end.
The servant searched the Palace compound, made a juice with some medicinal plants, carried it on a wooden plank and entered the Queen's room. Within minutes, the cry of the newborn made the Palace jubilant-the mother had a sudden, easy delivery. Only Dr Gunther was unhappy. T M Chummar, who knew the King very well, records that, it was the famous Vaidya Madom Nambudiri, who experimented with a wonder drug, and it was before the arrival of the doctors.
Ernakulam General Hospital in the state of Kerala in India, was founded by the King of the Kochi princely state in 1848. The last King of Cochin was known as Parikshit Thampuran (1876-1964). Though his real name was Rama Varma (Kunjunni) Thampuran, he was known as Parikshit because of the travails he had to undergo before his birth. He went through the kind of experiments the Pandava king, Parikshit of Mahabharatha had to undergo before his birth.
Thampuran's mother, Amba/Manku Thampuran was not able to deliver the child even after two days after she started having labour pain. When the Ayurvedic medication by Thycaut Moos and Elamana Krishna Menon, was found fruitless, the family members decided to bring Dr D Gunther, Medical Officer, and father of Robert Gunther, from Ernakulam, and other doctors from the Cochin Fort, to do an operation. Dr Gunther said that they would be able to save either the mother or the child. The family began praying to the presiding deity, Sree Poornathrayeesa. Then, a Kshatriya lady (Nambishtathiri) servant in the Palace who was an expert in the ottamooli (treating with one wonder drug) treatment, came forward and said she would make a try. Dr Gunther grinned; he went to a room and sat there waiting for the tragic end.
The servant searched the Palace compound, made a juice with some medicinal plants, carried it on a wooden plank and entered the Queen's room. Within minutes, the cry of the newborn made the Palace jubilant-the mother had a sudden, easy delivery. Only Dr Gunther was unhappy. T M Chummar, who knew the King very well, records that, it was the famous Vaidya Madom Nambudiri, who experimented with a wonder drug, and it was before the arrival of the doctors.
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| Parikshit Thampuran with the Jews/Painting in Kochi Synagogue |
The first attempt to introduce modern medicine was made in Cochin in 1818 by a missionary, Rev J Dawson, who opened a dispensary in Mattancherry. It received a monthly grant from the government, but it was closed after a couple of years. In 1823, the Civil Surgeon of British Cochin was made ex officio Darbar physician, and a Dresser was attached to the jail at Ernakulam, while the Trichur jail was placed in the charge of the Dresser attached to the British Military detachment there. These three people began to show the advantages of modern medicine and surgery. In 1845, Dewan Sankara Warrier opened the first Government Hospital, the Charity Hospital in Ernakulam, which was developed into the present General Hospital. Just a year before the birth of Parikshit Thampuran, in 1875, a hospital was opened at Thrissur.
Kerala has a long history of organized health care. Before the advent of European medicine, families of practitioners of indigenous systems like Ayurveda handed their traditions from generation to generation. People were accustomed to approaching caregivers when they were sick, rather than turning to self-treatment. When the colonial powers established their presence in the region, they brought their medical system with them. In the 19th century, the princely rulers of the erstwhile states of Travancore and Cochin (which later were integrated into the state of Kerala along with the Malabar district of the Madras presidency in British India) took the initiative in making the Western system of care available to their subjects.
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| Gowri Laksmi Bayi |
The widespread occurrence of smallpox and continuous pressure from Munro forced the Regent, who was rumoured to have an affair with Munro, to start a smallpox unit with a resident doctor. Munro reported to the Madras government:
"I wrote to her Highness earnestly requesting that she would allow herself to be vaccinated, and I sent a medical gentleman to Thiruvananthapuram to perform the operation. The Rani replied as she formerly had smallpox, it was unnecessary to vaccinate her; if however, I insisted upon her undergoing the operation, she would submit to it on my return to Thiruvananthapuram and in the meantime the doctor might vaccinate..."
During the reign of the Rani, the attitude which prevailed in the royal family and among the public about socializing with foreigners changed. European doctors were allowed to treat women as members of the royal family. Dr. Proven was the first person appointed as the physician of the royal palace at Quilon (Kollam) and Dr. James Rose was appointed as the deputy physician at the palace. Rani Parvathi Bai (1814 – 1829), established a charity dispensary at Thycaud in 1816 where the jail convicts were treated first.
In Travancore
In 1818, two small dispensaries were opened, one in the palace and the other within the premises of the Nayar Brigade barracks. The Brigade hospital supervised by the Brigade commandant extended medical services to the military. A free dispensary was also opened under the supervision of the military medical officer at Quilon. Rama Varma Swati Thirunal Maharaja (1829 – 1847) established a charitable Hospital at Thykaud under the responsibility of the residency surgeon and provided free medical treatment to the people there.
Cholera started wreaking havoc in Bengal in 1819 and soon spread to Bombay and Bangalore. When it was felt that the disease would soon reach Travancore, the then ruler Regent Queen Maharani Gowri Parvathy Bayi (1815-1829) sought the help of the English East India Company to contain the scourge. Learning that foreign and allopathic doctors were at the forefront of the efforts to control cholera in big cities, she started plans to contain it. There were very few doctors trained in modern medicine in Travancore. Dr William Brown, Dr Gayle and Dr Muthuswamy are among them. Maharani decided to bring preventive English medicine from Madras and distribute it through traditional healers,vaidyans. On the 12th day of the month of Thulam in the Malayalam year 994 (1820), Dewan Janardanarayar Venkittayyar issued a proclamation stating that Allopathy doctors should train traditional healers.
Dr Brown, who was paid Rs 460 by the East India Company, was allotted another Rs 200 as salary to stay in Thiruvananthapuram. Those trained were appointed to the post of Medical pupil.
With the prince spending a large amount of time at his dispensary, people, especially those belonging to the Hindu community, preferred this institution to a government charity hospital.
Though upper-class Namboothiri Brahmins would not even touch English medicines under the idea that most of the liquid substance contained spirits, they began to take them freely from the prince's dispensary.
Brahmins, who visited Travancore as part of various religious ceremonies, spread the news of the medical knowledge of the prince and the virtues and effectiveness of European medicines in Malabar (north Kerala) and other neighbouring princely states.
The royal's dispensary was the only resort of outside-state Brahmins for medical aid while coming for Murajapam, an auspicious ritual conducted in Sree Padmanabha Swamy Temple here every six years.
Records also showed that Utram Thirnal successfully treated his brother and the then king Swati Thirunal, when he suffered from diarrhoea.
A three-month-long treatment under him also cured the chronic dyspepsia of a 'Gouda Brahmin Sastri,' who came here for Murajapam from Benaras.
The prince's laboratory had glass retorts, boilers, evaporating dishes, crucibles of different kinds, and many other things necessary for conducting chemical experiments.
There was also a powerful electric machine, a galvanic battery, an air pump, and an ice-making machine besides several kinds of optical instruments, such as stereoscopes of various sorts, telescopes of sizes and opera glasses.
In 1818, two small dispensaries were opened, one in the palace and the other within the premises of the Nayar Brigade barracks. The Brigade hospital supervised by the Brigade commandant extended medical services to the military. A free dispensary was also opened under the supervision of the military medical officer at Quilon. Rama Varma Swati Thirunal Maharaja (1829 – 1847) established a charitable Hospital at Thykaud under the responsibility of the residency surgeon and provided free medical treatment to the people there.
Cholera started wreaking havoc in Bengal in 1819 and soon spread to Bombay and Bangalore. When it was felt that the disease would soon reach Travancore, the then ruler Regent Queen Maharani Gowri Parvathy Bayi (1815-1829) sought the help of the English East India Company to contain the scourge. Learning that foreign and allopathic doctors were at the forefront of the efforts to control cholera in big cities, she started plans to contain it. There were very few doctors trained in modern medicine in Travancore. Dr William Brown, Dr Gayle and Dr Muthuswamy are among them. Maharani decided to bring preventive English medicine from Madras and distribute it through traditional healers,vaidyans. On the 12th day of the month of Thulam in the Malayalam year 994 (1820), Dewan Janardanarayar Venkittayyar issued a proclamation stating that Allopathy doctors should train traditional healers.
Dr Brown, who was paid Rs 460 by the East India Company, was allotted another Rs 200 as salary to stay in Thiruvananthapuram. Those trained were appointed to the post of Medical pupil.
Dr Brown was the son of a Danish missionary, Dr John. Dr Brown wrote a book, Propagation of Christianity Among the Heathens in 1814, proving modern medicine had a religious content.
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| Marthandavarma |
Uthram Thirunal Marthandavarma, who ruled Travancore from 1846 to 1860 had a great affinity for English medicine; he got a human skeleton carved out of ivory in 1853 to study anatomy and osteology. Social customs barred him from touching corpses and bones. Created by a craftsman, the skeleton is displayed now at the Natural History Museum on the Zoo campus. Travancore Dewan Peishcar, P Shangoonny Menon, in his History of Travancore from Earlier Times, has recorded that Marthandavarma had even run a private dispensary, where he treated people, carried out minor surgical operations, vaccinated his palace attendants with his own hands and distributed English medicines when he was Elaya Raja or heir apparent. He also set up a laboratory which had various apparatus and chemicals purchased from other parts of the globe His friendship with the Residency surgeon Dr Brown helped him study modern medicine. Even after Dr Brown left for England, Marthandavarma indulged in self-study by procuring and reading the works of eminent authors. He procured medicines from the Durbar physician's dispensary and used them for treating his own attendants and their families.
Though upper-class Namboothiri Brahmins would not even touch English medicines under the idea that most of the liquid substance contained spirits, they began to take them freely from the prince's dispensary.
Brahmins, who visited Travancore as part of various religious ceremonies, spread the news of the medical knowledge of the prince and the virtues and effectiveness of European medicines in Malabar (north Kerala) and other neighbouring princely states.
The royal's dispensary was the only resort of outside-state Brahmins for medical aid while coming for Murajapam, an auspicious ritual conducted in Sree Padmanabha Swamy Temple here every six years.
Records also showed that Utram Thirnal successfully treated his brother and the then king Swati Thirunal, when he suffered from diarrhoea.
A three-month-long treatment under him also cured the chronic dyspepsia of a 'Gouda Brahmin Sastri,' who came here for Murajapam from Benaras.
The prince's laboratory had glass retorts, boilers, evaporating dishes, crucibles of different kinds, and many other things necessary for conducting chemical experiments.
There was also a powerful electric machine, a galvanic battery, an air pump, and an ice-making machine besides several kinds of optical instruments, such as stereoscopes of various sorts, telescopes of sizes and opera glasses.
Cholera arrived in Travancore even as people were dying in the hilly areas of the north and south due to malaria and smallpox. The rulers of Travancore realised that the local treatment methods were ineffective against the combined threat posed by the three epidemics. As a result, hospitals offering free allopathy treatment (Dharmasupathri/charity hospital) were opened in various parts of the state. They included the Army hospital inside the Fort in the Malayalam era in 994 (1819 ) and the other hospitals in Kollam in 995 (1820), Thycaud in 1012 (1837), and Nagercoil in 1015 (1907).
Travancore King Swati Thirunal died on December 27, 1846. His condition began deteriorating on Christmas. He resorted to fasts and abstained from food. He denied audience to all including family members and personal physician Dr Colin Peterson.
Dr Achutsankar S Nair, a bioinformatics expert who sings Carnatic music brilliantly, and Catherine Logan have jointly published a paper, Colin Peterson and his Medical Report of Travancore (1842). Catherine is related to Peterson(1815-1863). We have seen Peterson was never allowed inside the Raja's chamber. In the paper, they said:
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| Swati Thirunal |
Dr Achutsankar S Nair, a bioinformatics expert who sings Carnatic music brilliantly, and Catherine Logan have jointly published a paper, Colin Peterson and his Medical Report of Travancore (1842). Catherine is related to Peterson(1815-1863). We have seen Peterson was never allowed inside the Raja's chamber. In the paper, they said:
"In 1846, a few months before Swati Thirunal's demise, it is known from several advertisements that appeared in London Times that Colin Peterson administered a drug marketed by Holloway on Swati Thirunal."
Holloway's ointment is known to have been created by Thomas Holloway, who termed it a 'cure anything' ointment and made him rich. It is also today known that Holloway's medicines contained aloe, myrrh and saffron, which are unlikely to cure anything in the modern view. However, the diseases claimed to be cured are pointers to the medical conditions of Swati Thirunal and require further research by medical practitioners.
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| Gowri Parvathy Bayi |
The earliest record of the ravages of cholera in Travancore was in 1869. The epidemic spread from the south along the main and diverging lines of communication to upwards of fifty miles north of Trivandrum causing very heavy mortality, especially among the aged and infirm and continued to prevail in the southern districts till the beginning of 1888 after which it died out. In1888. There was a terrible epidemic 6,587 cases were reported in the Taluks of Tovala, Agasteeswaram and Eraniel with 2, 101 authenticated deaths. Having at the beginning of the year prevailed in a sporadic form almost throughout the country, it laterally reached the fishing villages on the seacoast and assuming the character of an epidemic of a severe type affected the whole of the southern division causing great loss of life. After 1890 there had been a marked decline in death from this epidemic.
The infection of cholera represented by some specific morbid material is often brought into Travancore with the influx of pilgrims in connection with Saint Xavier's festival at Kottar and the Car Festival at Suchindram. At both these festive gatherings, the conditions of insanitation are crucially so pronounced as to render every facility for the growth, development and dissemination of the disease to all parts.
The year 1890 witnessed a serious epidemic costing 10,508 lives and affecting practically the whole state. The disease has continued ever since as a constant menace with alternating manifestations of mildness and virulence. In 1927 another furious outbreak over-ran South Travancore and also the Taluks of Trivandurm, Chirayinkizh and Shenkotta claiming altogether 10,727 victims.
A royal proclamation of 1879 by Ayilyam Thirunal made vaccination compulsory in Travancore for public servants, prisoners and students.
All heads of public departments were instructed to see that those under their care and control were vaccinated. Administrative reports indicate that public health authorities were also concerned about the spread of cholera during fairs and festivals, and initiated measures of containment.
During the same period, the midwifery centre was shifted from the General Hospital to a new building near Trivandrum Museum and sub-assistant Surgeon Dr John Gomez was put in charge. In 1894 the Maharaja invited a lady doctor to take charge of the women and children’s hospital and recommended that a separate hospital managed by women staff should be established in Trivandrum for the benefit of women and children. In 1895 –1896, a separate Department was formed to control vaccination, collect vital statistics and provide proper sanitation in towns. A separate hospital for patients with incurable diseases was opened at Oolampara in 1896 and certain drugs like Quinin and Chlorodine were distributed to the public through the anchal (postal) office. Again in 1897 – 1898, a thorough re-shuffling was conducted by increasing the strength of the medical staff.
Sree Moolam Thirunal Maharaja decided to constitute the code of rules for the Medical Department. On the direction of the Maharaja, a Medical Code was prepared by the Durbar Physician and principal medical officer Dr. White in the year 1898. In 1906, the services of eight European Nursing Sisters were made available in the hospitals. Later on in 1908, the Victoria Jubilee Hospital was placed under the direct supervision of a female Assistant Surgeon. The Maharaja sanctioned an annual donation to several private medical institutions given the Golden Jubilee of Queen Victoria’s reign. Of these private medical institutes the Nagercoil Dispensary of the London Missionary Society, the Charity Hospital at Alapuzha, the Archbishop’s Hospital near Varapuzha, the Planter’s Hospital at Aryanad and the Local Fund Dispensary at Bodinaikkanur deserve special mention. At the close of 1915, the State maintained twenty-seven hospitals and twenty-six dispensaries.
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| Sreemoolam Thirunal |
Spanish Flu in Travancore
The influenza epidemic of 1918-1919, better known as the Spanish flu of 1918, also almost spared Kerala. The census report of Travancore then is silent on the influenza deaths. But it took its toll in the neighbouring state of Madras. The 1921 census report of Travancore, South India, says:
“Influenza, to which about 6 million of people succumbed in places outside Travancore, affected the state only slightly and was not attended with high mortality”.
The report is silent on the death toll. The fever deaths during 1920-21 were 17, 377 and 15,210 in 1921-22. The duration of the pandemic was very long in Malabar. The mortality rate there was 10-20% per annum, per 1000 people.
The Tirunelveli district of Madras, adjoining Travancore was devastated. It, which had a population of 19 lakh in 1921, had 12,798 fever deaths, mainly due to the flu.
“Influenza, to which about 6 million of people succumbed in places outside Travancore, affected the state only slightly and was not attended with high mortality”.
The report is silent on the death toll. The fever deaths during 1920-21 were 17, 377 and 15,210 in 1921-22. The duration of the pandemic was very long in Malabar. The mortality rate there was 10-20% per annum, per 1000 people.
The Tirunelveli district of Madras, adjoining Travancore was devastated. It, which had a population of 19 lakh in 1921, had 12,798 fever deaths, mainly due to the flu.
The cholera epidemic of 1927 had proved the need for a more efficient public health organization to grapple with and control such emergent situations as efficiently and speedily as possible. The combating of cholera was one of the most prominent objects of the Public Health Department. The last epidemic of cholera occurred in 19358 causing altogether 11,792 attacks and 6,056 deaths. P Kumaran Nair the Medical officer of health was deputed for cholera special duty. The Public Health Laboratory supplied 7, 07, 875 c.cs.of cholera vaccine for carrying on a Mass Inoculation Campaign as a result of which the epidemic subsided within a shorter period, causing only a much lower incidence than in the case of the previous years.
In 1928, under the auspices of the Travancore government and with the help of the Rockefeller Foundation, parasite surveys were conducted in Travancore which led to measures to control hookworm and filariasis. A health unit incorporating many of the concepts of primary health care was also started in a rural area. The development of health services was not confined to the provision of preventive care – the general hospitals in Trivandrum and Cochin are more than 150 years old. Initiatives were also taken to get members of the respective states who were trained in Western medicine into key posts in the government service.
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| Mary Punnen Lukose |
She had topped the matriculation examination. However, she was denied admission for science subjects at the Maharajas College, Thiruvananthapuram (present-day University College Thiruvananthapuram) for being a woman and had to pursue studies in history on which she graduated (BA) in 1909 as the only female student of the college and the first woman graduate of Madras University which Maharajas College was affiliated to. As Indian universities did not offer admission to women for medicine, she moved to London and secured an MBBS from London University, the first woman from what would later become Kerala to graduate in medicine. She continued in the UK to obtain MRCOG (gynaecology and obstetrics) from Rotunda Hospital, Dublin and underwent advanced training in paediatrics at the Great Ormond Street Hospital. Later she worked in various hospitals in the UK and simultaneously pursued music studies to pass the London Music Examination.
Mary returned to India in 1916, the year her father died] took up the post of an obstetrician at the Women and Children Hospital, Thycaud in Thiruvananthapuram and also worked as the superintendent of the hospital, replacing a westerner who had returned to her native place after marriage. During her tenure at Thycaud Hospital, she initiated a midwifery training program for the children of local midwives to win over their support and is known to have delivered her firstborn at the hospital. In 1922 she was nominated to the legislative assembly of Travancore, known as Sree Chitra State Council, thus becoming the first woman legislator in the state. Two years later, she was promoted to Acting Surgeon General of the state of Travancore, making her the first woman to be appointed as the surgeon general in India. She continued at the hospital till 1938 during which time she was nominated to the state assembly continuously till 1937. In 1938, she became the Surgeon General, in charge of 32 government hospitals, 40 government dispensaries and 20 private institutions. She is reported to have been the first woman to be appointed as the surgeon general in the world; the first woman surgeon general in the US was appointed only in 1990.
The work of Dr Howard Somervell who came to Travancore after scaling the Everest, was remarkable. Theodore Howard Somervell OBE, FRCS (1890 1975) was an English surgeon, mountaineer, painter and missionary who was a member of two expeditions to Mount Everest in the 1920s, and then spent nearly 40 years working as a doctor in India. In 1924 he was awarded an Olympic Gold Medal by Pierre de Coubertin for his achievements in mountaineering (Alpinism).
Somervell was born in Kendal, Westmorland, England to a well-off family which owned a shoe-manufacturing business founded by two SOMERVELL brothers in Kendal in 1845, that survives to this day, K Shoes. After completing his schooling, he studied at Gonville & Caius College, Cambridge where he developed his strong Christian faith and gained First Class Honours in the Natural Sciences Tripos. He then began training as a surgeon at University College Hospital; eventually graduating in 1921 after his training had been interrupted by the First World War. He married Margaret Hope Simpson (1899–1993), daughter of Sir James Hope Simpson, the general manager of the Bank of Liverpool.
Between 1915 and 1918 Somervell served in France with the Royal Army Medical Corps. He was commissioned as a lieutenant with the West Lancashire Casualty Clearing Station on 17 May 1915, having previously been a member of the University of London Officer Training Corps. He was Mentioned in Despatches, but the horrors of the war had a profound effect on him. During the Battle of the Somme in 1916 he was one of four surgeons working in a tent, while hundreds of wounded men lay dying on stretchers outside. On short breaks from surgery, he spoke with some of the dying men and noted that not one asked to be treated ahead of the others. The experience turned Somervell into a pacifist, a belief he continued to hold for the rest of his life. He relinquished his commission in 1921, by which time he held the rank of captain.
Somervell was invited to join the 1922 British Everest expedition. During the expedition, he formed a close friendship with George Mallory, and the two famously read Shakespeare to one another in their tent at night. With the expedition over, Somervell set out to see India, travelling from the far north to Cape Comorin. He was shocked by the poverty he saw and in particular the poor medical facilities. At the main hospital of the south Travancore medical mission in Neyyoor, he found a single surgeon struggling to cope with a long queue of waiting patients and immediately offered to assist. On his return to Britain, he abandoned his promising medical career and announced his intention to work in India permanently after his next attempt on Everest. Most of his famous paintings sold today are from his travels in various parts of India, even though most of his time was in Kerala where many landmarks to his name still remain.
Somervell worked as a surgeon with the London Missionary Society Boys Brigade Hospital (now known as LMS Boys Brigade Hospital ) at Kundara from 1923 to 1949. There was a separate operation theatre for him in that hospital. He had donated £1,000 to the hospital.
Somervell became an associate professor of surgery at Vellore Christian Medical College in 1949, a post he would hold until his retirement in 1961.
There was an outbreak of smallpox at Alleppey, Poonthura and in the municipal town of Trivandrum in 1930. The Leper Asylum opened in 1896 and was shifted to Nooranad in August 1934. Lady Linlithgow’s visit to Travancore was taken advantage of for laying the foundation stone for TB hospital on 11 November 1939.
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| Somervell |
The malaria epidemic in South Travancore in 1934 was the first reported epidemic of malaria in the state on an extensive scale one that affected a far larger population than any other epidemic diseases. The foot of the hills from Bhutappandy to Thodupuzha forms a hyper-endemic belly of malaria and has been recognized as a centre of malarial infection for a long time. The malaria epidemic of 1935-36 was an extension of the disease in a virulent and epidemic form. The epidemic was most severe in certain provinces of Neyyattinkara and Nedumangad Taluks.
N Krishnan Tampi was appointed as the special medical officer in charge of malaria.11 Maharaja contributed rupees 1500 to the Malaria Relief Fund. Maharaja and Maharani visited the malaria-stricken areas and their words of sympathy and kindness to the patients and their gracious presence were a source of encouragement to the people and to the workers alike. Blood films from the patients were regularly taken for microscopical examinations. Mid-day meals to school children were given. The Managing Director of A.D. Cotton Mills Quilon offered 2000 yards of cloth for free distribution among the malaria-stricken people. The Salvation Army organized a party of officers and rendered much help in the malarial areas by collecting clothes, rice and other necessities for distribution among the patients. Sri Rama Krishna Mission and Veera Kerala Gymkhana rendered yeoman service for the control of malaria.
The development of health services was complemented by other parallel events: initiatives to provide safe drinking water (in the capital city of Trivandrum initially) and the provision of state-supported primary education, including education for women. Another important factor was the establishment of mission hospitals in remote areas under the auspices of Christian churches. Young girls from the Christian community in Kerala were keen to take up nursing as a career.
At the time of the formation of the present Kerala state on 1 November 1956, the foundation for a medical care system accessible to all citizens was already laid.
The left came to power in 1957, but November 27, 1951, was a very special day for a group of young men and women, who stood bursting with pride and excitement, when the then Prime Minister of the nation, Jawaharlal Nehru, lit the lamp, marking the formal opening of their alma mater and the first medical school in the State, Trivandrum Medical College. M. Balaraman Nair, a first-batch student, went on to become the first Professor, Principal and the first Director of Medical Education.
It was on August 1, 1951, that the first batch of 63 students joined TMC. The 1951 TMC batch includes several illustrious names like M.S. Valiathan, K.V. Krishnadas, P.P. Joseph, and P. Sukumaran, whose professional achievements and contributions to the health sector are well-known.
The history of Neurosurgery in this Institute is synonymous with the history of Neurosurgery in the state as this was the first medical college to start a Neurosurgery department within the state. The students after undergoing their rigorous training in the department, went on to establish advanced neurosurgical centres throughout Kerala and in several other parts of the country.
The period from state formation to the early 1980s was characterized by great growth and expansion of government health services. Figures show the annual compound growth rate of government health care expenditure for the period at 13.04% (at current prices, without deflation), outstripping both the annual compound growth rate of total government expenditure at 12.45% and the annual compound growth rate of the state domestic product at 9.81%.2 From 1961 to 1986, the state greatly expanded its governmhealth facilities. The number of beds and institutions increased sharply. The total number of beds in government hospitals in the western medical sector increased from around 13,000 in 1960–61 to 20, 000 in 1970–71 and 29 000 in 1980–81. By 1986, the total was 36,000. Estimates in 1996 put the number at 38,000. Private hospitals now surpass government facilities in the density of beds and employment of personnel. The number of beds in government institutions grew from around 36,000 to 38,000 in the 10 years from 1986 to 1996; in the same period, beds in private institutions grew from 49, 000 to 67, 500. This means the successive governments, including the left, torpedoed the Kerala model leaving the health sector at the mercy of the private sector.
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Reference:
1. Evolution of Modern Medicine in Kerala/Dr K Rajasekharan Nair
2. Historical Development of HealthCare in Kerala/Dr V Raman Kutty
3. Western Medicine Under State Patronage in Travancore: A Retrospect/Satheesh P
4.A Social History of India/S N Sadasivan
5. V.Nagam Aiya, The Travancore State Manual
6.T.K.Velupillai, The Travancore State Manual
7. Historicising "Tradition" in the Study of Religion/edited by Steven Engler, Gregory Price Grieve.
© Ramachandran
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