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Vol. XXXII No. 1, April 16-30, 2022

Prof. Krishnamoorthy Srinivas – a look at his life and his work – I

Prof Krishnamoorthy Srinivas (1933-2017) was among the medical greats who made Chennai the medicare capital of India. An eminent neurologist, he brought to his practice an old world grace, charm and much empathy. Tusitala, Celebrating the Life and Work of Prof. Krishnamoorthy Srinivas, a tribute to him by way of a book was brought out last year. We remember this true friend of Madras Musings by publishing extracts from the book. Our thanks to his wife Padma for graciously giving us permission.

– The Editor

Dr. A. Lakshmanaswamy Mudaliar, the first postcolonial Vice ­Chancellor of the University, held uninterrupted office for 27 years, from 1942, and this era saw many of the best clinicians and academicians holding sway over the wards and classrooms of the institution. Srinivas’ mentors were renowned figures and highly accomplished in their respective fields; Doctors Cooper in Anatomy, Parvathi Devi in Physiology, Easwariah in harmacology, Govinda Reddy in Pathology, Dr. K.S. Sanjivi and Dr. Vaidyanatha Iyer in General Medicine, and U. Mohan Rao, R. Mahadevan and C.P. Viswanatha Menon in Surgery. Dr. R.V. Rajam was the Dean of MMC and ran the Department of Venereology, one of the earliest of its kind in a premier Government General hospital. Srinivas was to continue his association with Dr. K.S. Sanjivi and follow the ideology of his teacher in Community Medicine a little over a decade later.

Srinivas stayed in the Indian Officers Association Hostel during the preclinical years, a fairly comfortable single-room accommodation, vegetarian food and other young students for company. The location was central, on Royapettah High Road, with a direct tram service to Madras Medical College.

This mode of passenger transport had its old world charm, which Srinivas savoured. It went at a snail’s pace, 7 kmph, meandering on its tracks through the city’s arterial roads, with the odd car or bus chugging past. What was the need to hurry as long as one set out early enough, which Srinivas did always. The regular route through Mount Road to Ripon Building, a stone’s throw from MMC was Rs. 6 as season ticket for the whole month. Tram service also connected the Madras shipping docks to the interiors of the city and transported goods received by sea. During the clinical years Srinivas moved to the MMC hostel at Kilpauk, named Park Hostel. Staying there had the advantage of regular transport, as the MMC private bus service to and from the college was assured on a daily basis.

His period of training in ­Delhi with Col. R.D. Ayyar, Dr. M.S. Rao, his immediate boss and Dr. Khushwant Lal Wig had a profound effect in honing Srinivas’ clinical skills. A diagnostic dilemma in a patient would see him discussing medical findings of the case with his senior in the team Dr. Sikand or with his colleague Dr. K. P. Mathur. Prof. Srinivas would recollect how as Registrar, he had the opportunity to follow up on the daily injection routine for Prime Minister Jawaharlal Nehru. The PM would engage him in conversation to understand the thoughts, dreams and aspirations of a young Indian medico, why he chose to go abroad and would he return after the training period to serve his motherland, and so on.

Dr. Srinivas and Padma on their wedding day, in 1965.

Col. R.D. Ayyar and his wife settled in Kalakshetra Colony, Chennai, in their old age. Srinivas and his wife Padma would visit them to see to the welfare of the elderly couple. After Mrs. Ayyar’s demise, Prof. Srinivas took it upon himself to visit the retired Army doctor every month without fail. After the brief medical check up, they would share their views on several professional and worldly matters, and it would invariably end up discussing the dismal state of the present medical education in the country. The author remembers visiting the remarkable Dr. Ayyar several times as part of the home-based healthcare service offered by our department for the elderly and disabled.

One cannot do better to describe the lasting bond between the then young medical graduate, Srinivas (when he was mentored by Ayyar in Safdar Jung Hospital at the threshold of advancing his professional career through specialty training abroad) and the Colonel, than to present excerpts of Prof Srinivas’ tribute to his guru on his passing away at the age of 95 years.

“R.D. lyer passed his FRCS in London with flying colours and was directly recruited as a Captain Surgeon into the Indian Medical Service of the Armed Forces. Only the very best went there as surgeons and physicians. A long stint in the army, vast experience in surgery and his own brilliant surgical skills made him the personality he was.

The then Prime Minister, Jawaharlal Nehru, saw his extraordinary talent and brought him over to the civil side to be made the first Medical Superintendent and Chief Surgeon at the Safdarjung Hospital, New Delhi. With his enormous experience, especially as an administrator in the Army, he transformed these “barracks” into a modern well-equipped community general hospital in the heart of the capital. He recruited some of the best doctors of that generation. Adherence to the highest moral and ethical standards and a pair of superbly gifted hands made him the legend he was. The entire Nehru family, other political leaders, senior bureaucrats and various others became his patients.

In the final phase, the Government made him Director-General of Health Services. He played a crucial role in strengthening medical services, especially for government servants. He also expressed strong views on medical education, most of which went to the heart of the matter.

Ayyar’s greatest quality, however, was his caring attitude to the needy. No one was ever turned away from his door. The poor had direct access to him, and this was what made politicians think twice before going to him.

He has also left behind many first trainees like me, who have benefited enormously from his practical wisdom. We were personal witnesses in the 1950s to history in the making, through his politician patients whom he was able to influence through sheer integrity and professional distinction.”

Srinivas joined the Neurology Department of Government General Hospital, Madras, on 15 January, 1965, on the auspicious Pongal day. He was designated Honorary Assistant Physician and Honorary Asst. Professor of Neurology by Dr. B. Ramamurthi, Head of Department. Four decades down, on Prof. Srinivas’ 70” birthday celebration, Prof. Ramamurthi reminisced on his early impression of Srinivas as he joined the department. These are the excerpt from the message sent by him on the occasion: “He appeared a highly intelligent fellow, full of vigour and enthusiasm and with a desire to excel in Neurology. He had already acquired A class training in the UK and Canada and was considered outstanding. I would never have missed roping this young man into the department”. Dr. Ramamurthi confessed that to create the job of Asst. Clinical Professor, he had to overcome several roadblocks due to Government red tape. He goes on to say that Srinivas proved his worth through his noteworthy contribution to the department and in his professional competence, “From the beginning, what impressed us all both in the OP and in the ward rounds was the systematic manner in which Srinivas examined the patient, and the logical way he presented the case and explained the problem”.

When Dr. Krishnamoorthy Srinivas joined the Neurology department at the Government General Hospital (GH) in 1965, Dr. B. Ramamurthi and his top team of Neurosurgeons V. Balasubramaniam, S. Kalyanaraman and T.S. Kanaka supported by their senior Neurologist counterparts G. Arjundas and K. Jagannathan, became the earliest Indian team, in 1960. To perform stereotactic surgical procedures for various conditions, and at different brain locations, Leksell’s stereotactic machine was installed in 1962. The department soon claimed its place in the world map of stereotaxic surgery. In 15 years, more than 1,700 stereotactic operations had been conducted.

The clinical and academic work of the Neurology department at GH held Srinivas’s interest. He was pleased that he could apply his knowledge and the extensive and intensive training abroad to the advantage of healthcare for his patients. The patient flow was consistent and the workload was sometimes high, but the excellent ‘clinical material’ allowed for the high quality bedside Neurology clinics that he conducted for the MD students. He enjoyed the mutual sharing of knowledge between him and his colleagues, which he envisaged as steps in the direction of the advancement of Indian Neurology. He was called upon to do direct carotid puncture for angiography which he performed with precision and skill, a procedure which he had perfected under the keen supervision of Prof. Ambrose while in the UK. He reported the electroencephalograms of the department patients, as he was well trained in this field and was Fellow of the American EEG Society. There could be as many as 100 EEG records in a week to report.

Srinivas was quick to recognise that the epilepsies and headaches were similar to what he had treated in the West. However, recurrent seizures could often be traced to a clear history of non-compliance, the treatment gap often due to non-availability of free supply of anti-epileptic medication at the Government hospital pharmacy. The gap could also be due to sheer lack of awareness or neglect of instructions of a regular drug regimen. Malnutrition, socio-economic stressors and illiteracy, with lack of awareness were insurmountable barriers to the healthcare system for the lower economic group who attended the Government General Hospital. Degenerative diseases set in a decade earlier, there was a recognised Madras pattern of motor neurone disease (MND), which Jagannathan et al had placed at International Neurology meetings and was a recognised entity, a local geographic variant of MND. In all cases where there was a diagnostic dilemma, tuberculous infection as an underlying cause needed to be uppermost in the superspecialist’s differential diagnostic list in India! He knew that all that waddled was not Duchenne’s muscular dystrophy, and he offered his expertise in this area as he had undergone a year-long training with Dr. Walton at Newcastle in 1964 and again for a short spell in 1966.

The Anglophile in Srinivas had some difficulty initially to adjust to the Muniammas who retorted rudely to the legitimate, first medical history question “What brings you to the hospital?” or “What is your ailment?” with “Why would I come to you if I knew?” Since then he learnt to ask the same question in a more devious and acceptable manner, as history taking was of the essence in clinical neurological diagnosis. The Munusamis did not know their age and asked him to guess or offered a random figure ‘vechukko 50’ – keep it at fifty, which could miss the target figure by a good 10 years. Doctor shopping was the trend, injections were panacea and stigmas and social taboos were deeply ingrained in the minds of these patients of lower socio economic strata. To Srinivas, these were the earliest social revelations, which went hand in hand with the clinical challenges,

At GH, although overworked and understaffed, the doctors, nurses and allied staff were knowledgable, had efficient hands on training, and worked as a team. The sub-specialties like Neurochemistry (Prof. Valmikinathan), Neuropathology (Prof. Sarasabharathi), Clinical Neuropsychology (Virudhagirinathan) were all well represented, the clinical work being aided by good quality neurodiagnostics. The weekly grand rounds were a great success and provided valuable teaching-learning experiences. There was scope for clinical research and the team presented and published several important papers.

The referral system across departments was good, with prompt response and excellent collaborative effort in patient care. The most difficult diagnostic problems were solved, not in the wards or the labs, but by professors and their assistants discussing the intricacies of the case presentation, over crisp dosai and freshly filtered Madras coffee, in the old-fashioned GH canteens.

(To be concluded next fortnight)

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