Should circulate

That is the Rajiv Gandhi Government General Hospital (RGGGH), across the road from the Chennai Central station. It has been providing medical care from this space since the late eighteenth century, when John Sullivan, a writer at Fort St George, won the tender for constructing a hospital capable of receiving and accommodating "500 men and 30 officers". 

One of the facilities we take for granted in hospitals now is a blood bank. But that part of the medical profession is very recent. It was only in 1937 that Bernard Fantus of the Cook County Hospital in Chicago began refrigerating donors' blood, naming it a 'Blood Bank'. Following upon the work of Dr. Charles Drew, who oversaw the large-scale shipment of blood plasma to UK in the 1940s, the nature of blood banking changed. 

Today, large blood banks are commonplace in many hospitals. The RGGGH in Chennai has the largest one in the state. It is one of the nearly 3,000 blood banks across the country, most (~75%) of which are public / not-for-profit operations. Despite their best efforts, they are not able to meet the demand for blood. Projected at 14.6 million blood units for this year, demand outstrips supply by over 1 million units. On this day - the World Blood Donor day - go over to register as a donor here and make sure you do your bit to reduce that shortage!

Chinese dentistry

Walking along Evening Bazaar Road, you might not be taken aback at this sign. After all, Madras has always attracted visitors and quite a few of them have made this city their own. But now you start looking at these signs more closely. You find that Thou and Jennifer are not the only Sens in the game; Christopher is a short distance away. More competition comes in the form of Dr. Peter Chen, whose name when written in Tamizh, is the same as 'Sen'. There is also Dr.Hubert Gerard Hu's Chin Shyn Dental Clinic, with a board dating its origins back to 1933, beating out Drs. Sen & Sen, who started off more than a decade later. But Dr. Thousen's trump card is that he has certification from Beijing, which probably makes him a more authentic Chinese than the others. 

And that is how it should be. Dr.Shieh Thousen will turn 74 this year, and he is the senior-most of the eight Chinese-origin dentists in the area, all of them tracing their roots back to Hubei province, but having grown up in Madras. Dr. Shieh Thousen and his brother (also a dentist, also on the same road) fled Hubei with their father Dr. Say Maw Seng and a few others, fearing communist persecution in pre-WWII China. They landed in Madras via Burma and gravitated towards George Town. Although they weren't registered as dentists then, their treatment worked well for both the locals as well as those passing by. They settled down and grew roots. Dr. Shieh Thousen and his brother went to school, and dental college, in Madras. Their children have also followed that route; Doveton Corrie, Don Bosco, Saveetha, Meenakshi Ammal are the names dropped. 

The fourth generation is now in the business; but then, many of the original families have already moved out of Chennai, both within India and outside, to USA, Australia, Canada or the UK. Others have become 'more integrated', marrying locally and becoming fans of SuperStar or SPB, celebrating Deepavali with gusto. But they apparently still gather together for the Chinese New Year, even if none of them has any memory of celebrating it in Hubei! 

Road to gate

James Lawder came to India as an Assistant Surgeon with the Madras Medical Service in July 1822. By then, he had been in service for a while and had seen action in the Peninsular War. He had also completed a stint in the USA; but it was in Madras that he spent the majority of his career. In 1835, Lawder was made a full surgeon. His most significant contribution seems to have been his views on the treatment of leprosy and the management of patients afflicted with the disease.

For some reason, James Lawder was sure that leprosy was a hereditary disease and that it was contagious. For this reason, he pitched strongly for expanding the Madras Leper Hospital and making a few changes in the facility. In 1839, the government of Madras made a grant of Rs.2,000/- to the MLH and Lawder used the funds to build high - over 3m - walls around the MLH, but also between the eleven wards of the MLH. He also favoured restraining the patients, so as to not have them spread the disease. With such facilities, the MLH seems to have been more of a prison than a hospital.

James Lawder married in Madras, and had a family here. Being a senior medical officer, he would have bought himself a garden house in Purasaiwalkam, accessed from the Poonamallee High Road. In those days, houses were few and road names non-existent. The path to Lawder's Gate became a road in itself. Even though the house and its memories have long gone - Lawder went back to England and died there in 1860 - the place still remembers the surgeon in the name of a street!

Old buildings

The tiled roofs and the quiet yard seems to indicate some stately house. But the arrow signs seem out of place in a house. They direct 2-wheelers and cars to their parking spots. And they also tell us this is not a residence, but a place where a lot of visitors come in. Not all of them would be willing visitors - this is the front yard of the CSI Kalyani Hospital on Radhakrishnan Salai. 

The Kalyani Hospital was built on land donated by Dewan Bahadur Narayanaiyar Subramaniyam, an advocated who converted to Christianity after his retirement. He bequeathed his lands on Radhakrishnan Salai to the Church of South India (CSI). He had but one request, that a hospital be built there, and named after his mother, Kalyani. And so on March 1, 1909, the Kalyani Hospital was opened by Lady White, with 24 beds.

Over the last 105 years, the hospital has grown to over 200 beds, but it continues to stay true to its mission of providing quality healthcare to the less affluent members of society. And in the process it has become one of the enduring landmarks on Radhakrishnan Salai!

Special medicine

Another view of the super-multi-speciality hospital - the building which was originally supposed to be the new home of the Tamil Nadu state assembly. 

Would have expected to see more crowds. Is it because people don't get sick enough to go to hospital on a Sunday morning? 

Lease of life

The media have been all agog over a heart transplant operation performed in this hospital a couple of days ago. While the coordination between the hospitals involved and the Chennai City Traffic Police was indeed commendable, not much attention has yet been given to the framework that enabled it to come about. In the 20 years since the Transplantation of Human Organs (THO) Act, 1994 was passed, Tamil Nadu has led the country by many a mile in reaping the benefits of this Act. In 2012, over 40% of the donors (and the harvested organs) were from Tamil Nadu, giving it a donation rate of 1.15/million population (Punjab with 0.43 and Kerala with 0.36 were the nearest)

Chennai, of course, has been in the vanguard of this movement. In 1999, five hospitals in the city came together to create the Indian Network for Organ Sharing, under the MOHAN Foundation. The experience with this project was encouraging and the state government came into it in 2008, setting a clear process to support such sharing - the Cadaver Transplant Programme, which has become the point of reference for other states to implement similar programmes. 

Fortis Malar, pictured here, was where the transplant was carried out on Monday evening. But there are other hospitals, both private and government-run, that have carried out similar procedures as a matter of routine. The newsworthiness of Monday's transplant was the traffic management, to ensure that the heart was moved here from the donor hospital in double-quick time. But let us also take a moment to cheer the progress achieved in making such transplants routine!

Dispensing health

This is the building where, in 1905, V. Krishnaswami Iyer founded the Venkataramana Ayurveda Dispensary. The name was probably a part-tribute to his father, Venkatarama Iyer, who was a munsif in the Thanjavur district. Krishnaswami grew up there and it was only after he completed his schooling that he came to Madras. He studied at Presidency College (where, unable to follow the British accent of his lecturers, he found it far more entertaining to spend his time on the Marina) and then at the Madras Law College. 

Though he seems to have been academically rather average, he used his keen intelligence and quick wit to build a reputation as a lawyer. He earned quite well, too and was a benefactor to several institutions in the city, even setting up a few himself.

The Ayurveda Dispensary - which was also to serve as a teaching institution - was one of the beneficiaries of Krishnaswami Iyer's generosity. He set aside this building and then endowed the institution with a corpus of Rs.20,000. The dispensary continues to occupy the same space. Some parts of the dispensary / college are elsewhere, but close by. For Krishnaswami Iyer, this was one of the many things that he picked up, did something about and moved on!

Not all there

The entrance to the in-patients sections of the Institute of Mental Health (IMH) at Kilpauk is rather forbidding, being flanked by two rather high walls and guarded by a gate with spikes sticking out on the top. In contrast, the out-patient services wing seems to almost invite you inside. The gates are wide open, the walls are just about waist-high and there are no security guards or "Visiting Hours" boards up there. 

The out-patient block is relatively new, having come up in 1971. But the IMH itself is over 200 years old, by the official reckoning. IMH's website traces its beginning to an asylum that was caring for 20 patients sometime in 1794. Situated in Purasawakkam, it was under the charge of the East India Company and the asylum was placed under the charge of Valentine Connolly, the company surgeon. As with many other such 'charges' handed over to officers of the East India Company, this was another way to make money. Connolly, when the time came for him to move to England, sold the practice, buildings and all (even though they were not his, but merely leased for 20 years) to Maurice Fitzgerald. Dr. Fitzgerald, in his turn, made money by selling the asylum to Dr. J. Dalton. Dr. Dalton went about enhancing the value of his purchase. He rebuilt some of the premises and expanded them to accommodate over 50 patients. But he probably got too greedy, for when he was looking to flog the place - which, by then, had come to be known as "Dalton's Mad Hospital" - the government medical board took it over. But it continued to be run more as private enterprise than as a state service, until 1860s. 

In 1867, the Madras Presidency sanctioned construction of the Madras Lunatic Asylum. The site identified was Locock's Garden, in what is Kilpauk today. Construction took four years and on May 15, 1871, the Madras Lunatic Asylum started functioning in its new premises, with 145 patients. Since then, it has grown - and assumed various names, in keeping with the sensibilities of the periods - to its current position as a medical institute of significance. Attached to the Madras Medical College, the IMH offers Post-Graduate courses in Psychiatry, and cares for about 1800 patients, making it the second largest such facility in the country. There was a time, in the 1980s, when "Kilpauk case" referred to the target's feeble mind; I haven't heard the phrase for a long while!

Another blue board

White-on-blue boards held their own for a long time, through generations. Almost every business had similar boards, with the differences being only in the font of the letters. And then they suddenly disappeared from the scene; so now, every blue board with white lettering seems to be something of an antique.

This one is not all that old, however. The Madras Kidney Trust was founded in 1990 by Prof. M.S. Amaresan, with the aim of providing affordable medical care for renal conditions. With such an aim, the Trust will certainly need to economize in all areas. However, I don't think it extends to this board. There is a larger and more modern sign above this, with more up-to-date information, including the city's name as well as a phone number that is at least 8-digits.

I can only imagine there is some nostalgic - or superstitious - attachment to this board for it to be retained for so long. From being a ubiquitous signage, it is nice to see this being unique enough to catch the eye these days!

Green hospital

No, it is not a comment on their environmental credentials, but merely about the colour scheme of this building. Situated inside Fort St George, this serves as the Ex Military Hospital as well as the Section Hospital. The building was probably not built to serve as a hospital (does that remind of you of another such?), but has been taken over to serve as one. 

The first hospital in Fort St George was set up in 1664, thanks to two gentlemen (they must have been Company doctors) William Gyford and Jeremy Sambrooke petitioning the governor Sir Edward Winter, saying, "...we have thought it very Convenient that they might have an house on purpose for them, and people appointed to looke after them and to see that nothing comes in to them, neither of meate nor drinke, but what the Doctor alloweth", the 'they' referring to English soldiers coming to Fort St George. Sir Edward agreed with them, and the hospital was established on November 16, 1664. 

That hospital appears to have moved around inside the fort for a while, sometimes being commandeered for use as barracks, before being ordered out of the fort, into Peddanaickanpet, in 1752. That hospital grew into something else. Much later, after independence, the Indian Army took over parts of Fort St George. And they went ahead and took over this building for its current purpose. Wonder if the ex-servicemen coming here would heed the exhortation of "neither meate nor drinke"!

Multipurpose building

It was intended to be the integrated complex housing the state's legislative assembly, the secretariat and maybe some government department offices as well. But with petty rivalries overtaking any kind of reasonable thinking, the entire building has been 're-purposed' to be inaugurated as a multi-super-speciality hospital.

As somebody mentioned, the architect must have been a super-duper thinker. It doesn't matter what you want to use it for, the building will be able to accommodate it!

Hospital annexe

The Kasturba Gandhi Hospital in Triplicane has been serving the women of Chennai for well over a century. Though the hospital was initially established somewhere in Nungambakkam or Egmore, it moved to its current location at Triplicane very early on and has been functioning from there all this while.

The picture shows the out-patient department, across the road from the main hospital buildings. These must also be the same vintage as the hospital itself, judging by the nature of the building and the materials. The difference is that the OP department is a single storey-ed structure while the main hospital is housed in much taller buildings.

Unlike the namesake railway station, whose name has been effectively converted into a mockery ("Kasturibai") of the original, the hospital is still sticking to the Kasturba spelling, at least in the English signboard. The Tamizh version has gone out tentatively, claiming it to be the Kasturiba hospital!

Eye temple

What does it take to become an 'institution'? A sense of purpose, for starters. And the stick-to-it-iveness to ensure that the zeal does not falter. For Sankara Nethralaya, the first was clear: to bring world class eye care to India. Since 1978, they have been doing just that, and along the way, they have been bestowed with several awards: 'Best Eye Hospital in India', 'Business Superbrand', 'Social Enterprise of the Year', 'Best Managed Charitable Organization' are some of them. 

Is there a contradiction? A 'business superbrand' from a 'charitable organization'? The efficiency with which Sankara Nethralaya is run is vastly different from the majority of charity organizations. True, they are backed by some of the biggest names in India, but that backing has been hard earned and well deserved. Sankara Nethralaya sees about 500,000 patients every year and performs about 40,000 surgeries. Patients come from all over India, as well as from neighbouring countries. In fact, this hospital has had to set up an exclusive, dedicated information centre at the Chennai Central Railway Station, because there are quite a number of people who just get on to a train and come to Chennai, knowing that the Nethralaya would not turn them away merely because they did not think about making an appointment. 

Over the years, the charitable organization has also become reputed for its academic excellence, offering Fellowship programmes in a few opthalmic super-specializations. It has also expanded beyond this campus in Chennai. Apart from a couple of other satellite centres in Chennai, Sankara Nethralaya is now present in Bengaluru, Kolkata, Rameswaram and Tirupathi. The CU Shah Eye Bank, set up in 1979, is a pioneer in driving eye donations across the country (here's the link, if you wish to sign up!). With so much happening at this institution, it truly lives up to its 'Nethralaya' - 'Temple of the Eye' - name!

Lying, waiting

In 1834, the Asiatic Journal reported that, "the cause for extra subscriptions to the Monegar Choultry no longer exists, the poor creatures having been all forwarded to their native places....on the 31st of August, only 1,079 distressed objects remained...". It is hard to imagine that the 'objects' being talked about were actually people; people who had to be sheltered at the Monegar Choultry to help them tide over the famine of 1833-34 that killed nearly 200,000  across Guntur, Nellore, Masulipatnam and Madras. There is nothing to show how many were saved by the kindness of Monegar Choultry, which was arguably the first public charity of the city of Madras.

The Choultry was set up in response to an earlier, even more miserable famine: that of 1781-84, which probably left upwards of a million dead. (One report says 10 million, but that seems too fantastic a figure). The Famine Relief Committee rented a building just outside the North Wall of the city - maybe by design, to keep the destitute outside the city walls, or maybe it was just the only one available - to serve as the soup kitchen of its time. Or maybe it was because there was a village headman - a manaiyakkaran - running a kanji centre nearby; people would know where to go to be cared for. So manaiyakkaran became 'Monegar' and the Choultry grew famous under that name. So famous that, despite being renamed as the 'Raja of Venkatagiri's Choultry', the old name continues to be displayed and referred to all around. 

This building is the oldest - but certainly not from 230 years ago - survivor of the Choultry's history. An even earlier practice, that continues still, is that an inmate's relatives (who probably cared little for him/her during the lifetime) have no claim to the body after his/her death. The cadaver is automatically sent across to the nearby Stanley Medical College's anatomy department. The destitute, in death, trying to ease the burden of the living!

General well-being

The Government General Hospital at Chennai is one of the oldest institutions in the city - and quite likely the oldest functioning hospital in the country. It started off as a small hospital to treat the soldiers of the British East India Company who were routinely falling prey to various tropical maladies. It was Sir Edward Winter, during his first stint as the Agent of Fort St. George, who inaugurated this hospital on November 16, 1664.

It wasn't much of a hospital, initially. being based out of one of the houses in the Fort. And for a few years, it moved around inside the Fort itself, before the general congestion of the Fort and the 'Town' area forced it to look outside. It was only in 1762 that a new site was identified, a little away from the Fort, on the road to Poonamallee. 

None of the buildings from that time was preserved when these new buildings came up in the early 2000s. All the old buildings were taken down and these two blocks replaced them. Supposedly, a couple of plaques from those buildings are preserved somewhere inside this campus - but discovering them may be more difficult than the task Charles Donovan faced in discovering the kala-azar agent in 1903. Even the plaque commemorating that discovery, one of the high points of the hospital's history is also missing!

Birthplace of 'Ob-Gyn'

INTACH's guide on Madras' architecture says the buildings are "Laid out in the shape of the female pelvis". Several sorties overhead on Google Maps does not show me any resemblance - no wonder I did not become an architect. There is however another story, of one of the early chiefs describing the building's layout in anatomical terms. Those flights of fancy are understandable, for the Government Hospital for Women and Children, (at first known as Lying-in Hospital) was the first specialised maternity hospital in India (and probably in Asia) and its early superintendents were doubtless eager to link that speciality with everything in sight.

Today, the hospital clocks around 18,000 births every year, but in its first year, it barely reached the three-figure mark. That was in 1844, when the hospital was situated nearer the River Cooum than it currently is. It was only in 1882 that the present buildings were occupied - thanks to the efforts of Sir Arthur Mudge Branfoot, KCIE, who was then a Surgeon of the Madras Medical Service. In 1921, the teaching block came up, named after Maj. Gen. G.G. Giffard, who had presided over the hospital's expansion between 1905 and 1917.

The hospital was also the birthplace of the Obstetric and Gynaecological Society of Southern India - and, in 1936 played host to the first ever national Ob-Gyn Congress, held at the Museum Theatre, just next door. With such an impressive heritage, it should be no surprise that the hospital boasts of a 120% bed-occupancy rate even today!

To treat them all

It is hard to believe that a major reason for relocating the military hospital of Fort St George to this site in 1772 was because it had, all around it, open spaces and was therefore considered to be much healthier than its previous location in (today's) Armenian Street. The decision to move was made in 1762, but it took another decade to be operationalized. John Sullivan, a young 'writer' won the tender for constructing the hospital buildings with a quote of 42,000 pagodas, which was almost 10% less than Col. Patrick Ross' outlay of 46,500 pagodas. It appears that the original specification of 1762, to build a hospital capable of receiving and accommodating "500 men and 30 officers" remained unchanged; the construction, though was reportedly designed so as to carry a second storey, when required.

The expansion does not seem to have been required until 1859. By then, the hospital had become truly 'general', with native civilians being admitted for treatment since 1842. (The military handed it over to pure civilian control in 1899). More additions were made through the last quarter of the 19th century; and then, between 1928 and 1938, a complete remodelling and much re-construction was done. With so much of chopping and changing, it is likely that none of the original buildings were still around when the most recent re-construction was done in 2002. That effort tore down all the hospital buildings and replaced them with these twin blocks - glass and concrete, but with the porticos shaped like those of Chola palaces.

While the open spaces around it have long since disappeared, the Government General Hospital's location is still convenient for travellers coming in - in these days of A(H1N1) threat, it may be reassuring to find this, the first hospital of India, waiting at the gates of the Chennai Central!

Flying doctor

Unlike Dr. Guruswamy Mudaliar, his contemporary, Dr. Sarukkai Rangachari often treated his patients for free. In fact, there are stories about how he gave a poor fisherwoman Rs.100 to take care of herself and her newborn child, and also how he once gave a boy a coin a day when he was down with typhoid. (That boy went on to become a famous neurosurgeon, incidentally). That kind of generosity coupled with 'rare medical skill and boundless humanity' made sure his clinic 'Kingston', on Poonamallee High Road was always full of patients. He would start his day at 4 am, performing varied surgeries until 11 am, followed by the in- and out-patient clinics, after which he would make house calls. Often, his lunch was had in his car, a luxury he defended by saying that he practically lived in the vehicle, and so allowed himself the privilege of making it a nice home.

One of his students, Lt Col Dr C.R. Krishnaswami, recalls that Dr. Rangachari was blessed with a wonderful constitution, that "from 1906, when he started, till his death in 1934, it was continuous, strenuous work of up to 18 hours a day for Dr. S. Rangachari." That constitution could not, however, stand up to the rigours he placed upon it during the typhoid breakout of 1934. Fighting hard against the sweep of the epidemic, Dr. Rangachari pushed himself to even longer hours, reaching out to more patients than anyone else thought possible. And so, when the disease struck the doctor, he succumbed to it, passing away at the height of his powers and popularity. The public of Madras subscribed to a statue in honour of this surgeon, which was unveiled by Lord Erskine, Governor of Madras, in 1939. That statue still stands near the exit gate of the General Hospital, shaded by a cupola, a couple of hundred meters away from that of Dr. Guruswamy Mudaliar.

There was another significant difference between the two contemporaries; where Dr. Guruswamy was frugal, Dr. Rangachari was outwardly lavish - apart from using a Rolls Royce to travel within the city, he had his own private aircraft (in the early 1920s) to make house calls in cities other than Madras!

Curable!

Though I am be ready to bet on it (yet), this building marks the location where the Cancer Institute (WIA) began service from. The font used to write its name gives away its age, even if the building construction itself could be anytime between 1950 and 1970. Other sources tell us that it is true, the Cancer Institue was established in 1954 in a small hut and it moved into this building in 1955. It is probably the only institute that the WIA (Women's Indian Associaiton) manages; a wise move to not take up any other cause. Considering that the Cancer Institute screens over 125,000 persons every year, the WIA will have its hands full managing the processes and the standard of care provided by the CI (WIA).

Today this is not the only building; in a long stretch which seems to be the backbone of Gandhi Nagar in Adyar there are at least 3 other buildings of the Institute. The fifth one, which was inaugurated in 1977, is on Sardar Patel Road itself, a little way away from this 9-acre campus. When it was inaugurated, this institute was the second dedicated centre in India for treating cancer - the first was the ICRC at the Tata Memorial Hospital in Mumbai - but it has been a pioneer in many other ways. The Institute has played a key role in securing several changes to help treatment and prevention of cancer - duty exemptions, travel concessions, recognition of Oncology as a specialty and many other far-reaching initiatives. Most of all, according to this article in The Lancet, the Institute has built capacity for cancer control in the country.

And for all that, the Institute is run on the lines of a not-for-profit; of the 423 beds it has, almost 300 are free; even among 'outpatients', almost two-thirds of them are treated for free. Such dedication has been instrumental in the survival rate among cancer patients going up!