On the quarter-millennial anniversary of the Madras General Hospital

-- by Ramya Raman, Anantanarayanan Raman

The English-East India Company (EEIC) established the Bengal Medical Service in Calcutta (presently Kolkata) in 1763. Similar services were established by the EEIC in Bombay (presently Mumbai) and Madras (presently Chennai) shortly after. By 1775, a Medical Board in Calcutta and Hospital Boards in Madras and Bombay started administering hospitals. Surgeons holding British medical licences, either a Licentiate of the Royal College of Physicians (LRCP) or a Licentiate of the Royal College of Surgeons (LRCS), were recruited by the EEIC. Those recruited personnel were to obligatorily serve the military for the first two years of recruitment before being permitted to enter civil-medical service.The Indian Medical Service (IMS), and the Subordinate Medical Service (SMS) were established in 1760–1780. Most of the SMS personnel were Indians, who worked as either ‘Dressers’ or ‘Apothecaries. Until 1679, ‘barber’ surgeons were employed by the EEIC, who ‘treated’ the sick practising external medicine such as phlebotomy, dressing of wounds and ulcers, treating skin diseases, hernias and contusions. Better medical knowledge established in the mid and late-19th century Europe influenced the administration of the Madras Presidency to consider western science-based medical care in public health management. Training of professionals in treating diseases by applying principles and practice of western medical science grew rapidly. However, with the rise of nationalism, potential merits of alternative medical practices – Ayurvéda and Unani – were also gaining relevance in Madras.

Charles Grant’s (1792– 1797) public document written to the Court of Directors of EEIC in London stimulated the British administrators of India to allocate £100,000 to strengthen science in India, which, fortuitously, included provision of better medical facilities. The result of this stimulus package was that an Indian doctor in the rank of havildar (≈Sergeant) was appointed in every military station, including Madras.

What is popularly known as the General Hospital of Madras – renamed as the Rajiv Gandhi Government General Hospital in 2011 – is the first formally established western science-based hospital facility in India. However, it began as a military hospital (MH) in 1664. In 1772-1773, on relocating to where it presently exists, it was named the ‘General Hospital’ (GH). We chronicle key details of the Military Hospital (1664-1772) and its transformation into the GH (1772-date). In 2022, the GH is completing 250 years of service to the people.

Edward Winter, the 8th Political Agent in Madras, established the western science-based MH, to treat the sick and wounded British soldiers in a building used by Andrew Cogan in 1664. John Clarke was appointed as the first surgeon. In the next two decades this facility moved around within Fort St George. Because this last-used building became inadequate to accommodate lying-in-patients, a double-storied structure close to St. Mary’s Church within the Fort was identified in 1689, and the MH moved into this building. Several new British personnel referred as ‘Factors’ or ‘Servants’ arrived from Britain in Madras. Factors meant traders, business people who were interested in procuring cotton fabrics; their trade establishment was collectively referred as the Factory. Eventually this building was changed as the quarters (the ‘College’) for them. The sick were moved to a hired house in James Street (James Street, which then existed in the Fort, does not exist presently) to build a new hospital. In 1684, Elihu Yale (1649–1721) took over as the President (≈Governor) at the Fort. His Council of Directors acquired the James Street facility and rebuilt it as a larger facility, which existed close to the northern end of the barracks within the Fort. Located in James Street, this hospital was constructed in Tuscan style at a cost of 2500 pagodas. The EEIC at that time minted ‘Three Swamy’ pagoda gold coins.The Government Museum of Chennai’s website provides details of the Three Swamy pagoda coins.

Views of the Madras General Hospital, early 1900s. (source: Nicholas Senn, 23 pp. 198 and 199)

Funds towards this building were generated mostly as public subscription from among the British families living within the Fort. Nathaniel Higginson (1652–1698), President (1692– 1698), William Fraser, a member of the Council, and the Corporation of Madras, Captain James Bett, initially Second Commander of the Garrison, later Captain of the Guard, have signed a notice: tis agreed and order’d that it be bought of the Parish for their account, and that a new hospital be built with the money at a more convenient place near the river side. And Mr. Higginson, Mr. Fraser, Capt. Bett and the Church wardens do make a due survey and value of the said hospitall building; and that it be paid for accordingly; and that the Church wardens &c. do begin with all expedition the new hospitall by the river.

This hospital facility was run by the Anglican Clergy, which maintained St. Mary’s Church within the Fort precinct. The Clergy received a sum of 50 pagodas annually towards maintenance from the Government at Fort St George. John Heathfield, recalled from civil service, was installed as the Head Surgeon in 1687. He died the following year. Samuel Browne, a locally available ship surgeon, was summoned to fill the vacancy created by Heathfield’s death, since the chosen surgeon Edward Bulkley (also spelt as ‘Bulkeley’) from London could not arrive in Madras in time. Further to his role as a surgeon, Browne was avidly searching for local plants for their medicinal value. He collected plants and made notes on their medical relevance further to other traditional uses. In 1698, the Church administration challenged the Government that the hospital serviced only EEIC soldiers and sailors. Thomas Pitt (President at the Fort, 1698–1709), successor of Nathaniel Higginson, responded to the challenge. Pitt ordered that this facility was to open its doors to civilians. This order changed the complexion of health management in Madras town and the Presidency, and it prevailed so, for the next 200-odd years. Between 1651 and 1809, 29 Principal Medical Officers (PMOs) led Madras’s Medical Department, including Edward Bulkley in the 18th Century. Bulkley arrived in 1692. Bulkley’s appointment strikes as a major event in the pages of medical history of Madras. The EEIC, highly impressed by his all-round skills in being a clever surgeon and a smart physician, directed him to superintend the Military Hospital.

A medical forensic ­examination

Samuel Browne continued as a second surgeon (precise designation not traceable) after Edward Bulkley’s arrival. James Wheeler, a member of the Council at the Fort and the Chief Justice, was sick on 28 August 1693. He died at 11 a.m. the same day. Samuel Browne on Wheeler’s death sent a signed note (reproduced below) to Nathaniel Higginson, the Chief Agent:

Honourable Sir

I have murdered Mr Wheeler, by giving him arsenic. Please to execute Justice on me the malefactor I deserve. Your Honour’s unfortunate obedient Servant

– Samuel Browne

The circumstances leading to Wheeler’s death were that Browne’s servant ground the medication that Browne ‘prescribed’ for Wheeler, without cleaning the mortar, which was used previously for grinding arsenic. This resulted in the death of Wheeler. Nathaniel Higginson asked Edward Bulkley to conduct an autopsy of the dead Wheeler. Bulkley did the autopsy later on the same day.

The post-mortem examination report was:

According to your (sic. the Worshipful Council) orders. I did on Monday, the 28th instant in the afternoon open the dead body of Mr. James Wheeler about five hours after his death, and upon viewing the viscera and bowels, found them not much affected from their natural temper and colour. The parts that seemed to suffer most were the stomach and intestines, which were a little inflamed, and almost wholly bared and stripped of the mucous and slimy covering which those parts are commonly invested. The lungs were a little inflamed. The blood that I gathered out of several vessels all appeared blacker than usual. But the suddenness of his death, and the severe symptom he laboured under before he died, were greater arguments of poison received than anything I could trace out by dissection.

– Edward Bulkley

Bulkley’s conclusion was that little could be gleaned from what he saw during the examination, although the symptoms presented towards poisoning. No chemical verifications were carried out. Samuel Browne was later acquitted by the Grand Jury, who brought in the bill ignoramus (no details are available as to how Browne’s servant was treated in this criminal case).

(To be concluded next fortnight)

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