Dr A J Selvapandian, ‘An Autobiographical Sketch’, in S S Naik, The Indian Leprologists Look Back. Bombay, 1990, pp. 117-126.
I recall my early student days in my home town in Tuticorin in South India, the Pearl city of India.
My father, Dr. Amrose Jacob, was a very successful general practitioner who was the visiting doctor to the local leprosy hospital. At that time there was no full time leprologist or trained leprosy doctor, yet my father thought it important to give his service to this hospital. In the early 1940s I was introduced to one Dr. Vedopodekan who did voluntary leprosy work at Nazareth in Tirunelveli District. While he was working there as a missionary doctor, he took up the leprosy work there, since he found there was a great need in that place. He was one of the senior members of the Indian Association of Leprologists in those days. Dr. R. Vedmugdam was a great pioneer in leprosy work, at a time when there were no guidelines or directions. He undertook to go about treating these people at the roadside clinic.
Being a member of a large family, the eldest son, my father naturally wished that I should become a doctor, and therefore he would be telling me a lot of interesting clinical things, as he came across them in the Hospital. I did my high school at the Cald Well High School in Tuticorin. Then my Intermediate at St. Xavier’s College in Palayamkottai. At those times not being really interested in medical things, I was involved in activities of a general nature, social work and so forth. Then for my B.Sc. I went to the Madras Christian College Tambaram from 1941-43. During this time I came to know about a Leprosy Centre at Pamal visited by the student organisation on a voluntary basis which was visited by a doctor from the city of Madras. I did not have any active involvement or interest, except for the fact that students were doing this kind of work as part of the social work programme. In May 1942 I was caught up in the Quit India movement. I was arrested and imprisoned. At that time I was able to think about our land….our independence, future and of the needs of the millions,.... something in life. After the completion of the college studies, I was successful in getting admission of the MBBS course of the Government Stanley Medical College, Madras. This was something which was an answer to my prayers, so also my parents. In those days, of course, merit only counted, and I was very happy to be one of the 75 students of my class of 1943. With great pleasure I recall my classmates among so many. Dr Balu Sankaran was outstanding. He later on rose up to become the DGHS and WHO consultant and was a very leading figure in our country in the health programme. There were many others in my class who later on became eminent professors and teachers in the medical colleges.
As non-clinical undergraduate student, I was going through the studies. Things were made interesting when we came to the clinical years. We had some very outstanding teachers, both physicians and surgeons. I recall our posting in the leprosy wards in those days, which was part of the Skin Department posting. This was one of the most miserable wards in the whole hospital, and these patients with ulcers and deformities were given some kind of attention and care. There was a visiting doctor from Chingleput, once a week, who used to come and see these patients. I was not very much involved or actively interested, because there was no formal teaching given to the medical students at that time about leprosy. Perhaps we might have read about it in the textbooks for the sake of exams and nothing more. I would just like to know whether this state of affairs has changed in the past 3 or 4 decades in the medical colleges. The teaching and treatment of leprosy in medical institutions need much improvement.
While I was a student in Madras, I had the opportunity of visiting my uncle who had been treating leprosy patients with chaulmoogra oil injections and palliative treatment of that kind for those people who had been coming along with other general patients. What I observed was the absence of stigma by other patients about leprosy patients because they did not have much of deformity except for skin lesions. And on the part of the medical doctors also there was no difficulty about treating these patients. Actually the attitude of the doctors of those days had been to render real service, for a nominal fee, and give their best whatever they could to alleviate the sufferings of the patients. Those were the days when there were no antibiotics, no specific drugs against infectious diseases; the common ones being typhoid, malaria (for which quinine was there), and no antibiotics for any of the other illnesses. Of course, nobody had heard of any drugs against leprosy in those days.
The House Surgeoncy which I did at the Government Stanley Medical College was exciting….I was interested in general surgery. And when I had the opportunity to do the posting as a Senior House Surgeon at the Gynecology Obstetrics Department I took great interest in the subject because it was quite fascinating. Perhaps I did quite a few months more of training there because of the interest in the subject. The teachers were great men who really taught the subject well. But at that time, I was married in 1950, and my wife was the daughter of Dr. Vedapodekan about whom I talked earlier, who was my father’s great friend, and a pioneer leprosy doctor. He also happened to be a friend of Dr. Howard Sommerville, a great surgeon missionary who worked first in South Kerala at Neyoor, which is still a well known hospital. After completing the House Surgeoncy, he asked me to come and work with him. I was there for one year, very much involved, and immersed in surgical problems and surgical treatment of all kinds.
Then Dr. Sommerville was invited to take over as the head of the Department of Surgery at Vellore, CMC Hospital in 1951. So he suggested I find a home surgeonship at Vellore, to further my interest in surgery in an academic way. This was perhaps one of the best things that happened to me, even though in those days there was no paid post at the Vellore Hospital.... I was paid the paltry sum of Rs, 75/- p.m. as a Senior House Surgeon, after working as an Honorary position for 6 months, I was working in the General Surgery Department. At that time a young English doctor, Paul Wilson Brand, joined the Dept. of Surgery. He was an excellent teacher, a skilful surgeon. He was a General Surgeon with a special interest in Orthopaedic Surgery. So my exposure to his work and activities was a great inspiration indeed. In the later years I had taken up reconstructive surgery in leprosy as my hobby horse while I was doing full time Orthopaedic Surgery and head of the Dept. of Orthopaedics eventually.
Dr. Cochrane (who became the Principal of the Christian Medical College, Vellore) was visiting from Chingleput to give some advice about the clinical problems in leprosy. And the encounter and the meeting of the two minds, the 2 giants, as we used to say….Drs. Paul and Cochrane made it possible for Paul Brand to take [an] interest in devising reconstructive surgical procedures for deformities in the leprosy patients. The very many varieties of deformities….of the feet, of the hands and face baffled and puzzled everyone including Dr. Paul Brand at that time. But he was challenged, disturbed that someone should do something for these people. Therefore he took up the challenging work as his mission in life. Then the pioneering rehabilitation and reconstructive surgery for work of leprosy patients was … [started] in the early 50’s.
After my general surgery MS qualification in 1956, I had more responsibilities and I took over the orthopaedic department, which was then part of general surgery. At that time there was a ward for the leprosy patients who had been operated for deformities or being under observation. Such patients were in the Tata Memorial Ward which was donated by the Tata Memorial Foundation, the first ever in the medical world a leprosy ward in a general hospital in the proximity of general surgery wards. At that time this was possible because of the attitude of the doctors who were involved in the work on account of the dedication, and the missionary zeal. Of course the junior doctors and trainees at all levels were interested in the academic aspects as well as the humanitarian part of it.
I remember in those days when I used to be visiting the wards there was no objection on the part of the nurses, the paramedical personnel and the doctors who were posted there to have had any serious objection to work in these wards. The most gratifying thing was that the patients in the other wards had never looked at leprosy patients with any kind of different feeling except for them they are yet another patient in the ward. This was something which was wonderful and beautiful to see because the prejudice and attitude of mind is more in the educated people. I would say, among the doctors who do not really want to get involved in the leprosy work. This is a very sad thing to see even today.
In the early 50s in India there were a lot of things happening, not only in the medical field but also in general. As far as leprosy is concerned in 1950 the formation of the Indian Leprosy Association whose first President was Dr. Dharmendra. He was then at the School of Tropical Medicine, Calcutta. Then onwards, even though the All India Leprosy Workers’ Conference was the only conference which was conducted once in 2 years the IAL was also conducted alongside.
The subject of leprosy surgery and rehabilitation had been for the first time projected for the All India Leprosy Doctors in particular, during the Second Biennial Meeting of the Indian Association of Leprologists, Calcutta, 1955: Dr. Paul Brand presented for discussion the subject “Value of Surgical and Physiotherapy measures in Leprosy”. At the same time one Miss Ruth Thomas who was a physiotherapist working at Karigiri also was responsible as the main speaker to talk about the physiotherapy measures in leprosy.
At that time this had stimulated the interest of many people in the country as well as those outside, and this drew lots visitors who were regularly coming to see the actual methodology, the rehabilitation methods and the surgical procedures. At the same time a centre for rehabilitation of the leprosy patients was established. This was again an idea, an innovation which was the result of Dr. Paul Brand’s efforts. I could remember in those days the great pioneers in the leprosy field, Dr. Wardekar, Dr. Patwardhan, and so many others including Dr. Ramanujam who had shown so much of interest and who was responsible for the … much interest [shown] in the work. Those days when the procedures for reconstructive surgery were tried out and worked out the ideas were shared with people with identical interests and most of them were not from teaching institutions. Unfortunately the interest was confined to institutions which … [had] leprosy programmes in our country or outside. So much so, the development[s] regarding leprosy research, the bacteriology, the experimental work or even the clinical trials and field studies have been confined to leading leprosy institutions in our country. At first this was thought to be entirely the business of the leprosy doctors only. Therefore those who are in the Community Health Medicine or physicians or surgeons - even orthopaedic or plastic surgeons - have had no concern at all. This was not found to be strange at that time. Why, even these days our concern is how to integrate the important aspects of leprosy. Many aspects and problems, including epidemiology, immunology, bacteriology, the study of the various clinical diseases patterns, the mechanism of deformities and so forth, are subjects for study. So much so, the interest was mostly centred around institutions which happened to have, like our institution in Vellore, … active leprosy work … going on. Of course the important leprosy work was carried out at Karigiri, which was a sister institution of Vellore. I remember Dr Herbert Gass, Dermatologist, who took tremendous interest at that time. The development of occupational therapy [and] physiotherapy was due to the exchange of people from other countries who had applied their knowledge oriented to leprosy. And therefore we have at the present time as a result of many years of hard work and trial and error some kind of definitive treatment methods have been established.
The honest assessment of procedures, which were then tried out, and the defects rectified subsequently and modified in every aspect of surgery. This involved the reconstruction of the face, eyebrows, eyelids for lagophthalmos, foot drop correction and the multiple and various manifestations of problems in the hand. These had never been touched by anyone since it was said and declared, “What can one do for people with deformities due to leprosy who have got sensory loss as well?” The disorganisation and the destruction of the hands or the feet was almost invariably happening in these people. Therefore an honest study was made to find out the actual cause of trophic ulcers in the foot particularly and prevention of ulcer in the first instance or the recurrence of the ulcer subsequently, was the main burden studied by us and others who were involved. Therefore many experimental studies were done in the field and many modified footwear were used, and pressure studies were done on the feet. Such studies led us so the fact that the recurrence of ulcers is not due to leprosy but due to anaesthesia. In any other hospital where similar ulcer problems are seen these patients have anaesthesia due so the peripheral nerve damage or … causes other than leprosy, where [a] similar chain reaction has gone on. And therefore the necessity [is] to prevent the ulcer and treat the first ulcer more effectively, and subsequently to see that the patient also has the responsibility in identifying the pre-ulcer signs. Therefore [the patient has] to take measures himself or with the assistance of the doctors to whom he shows himself to prevent any further damage. Certainly [to] prevent the ulcer if possible. If the ulcer does develop, to treat it effectively. This knowledge I think was a great contribution. As we look at it from the outside it is so simple and so full of common sense; but it has been very difficult to practice. The patient was expected to know about this and therefore he must have health education. So the development of health education and the various methods have become essential. The whole Rehabilitation programme has become a very important branch, a special part of the leprosy reconstructive surgery programme.
This led us on to study further the involvement of the nerves in the early stages, and preventing further deterioration and the place of surgical decompression. Nowadays fortunately we have the very effective multidrugs and anti-inflammatory drugs. It was proved that a person who may have loss of sensation in the hands or feet could still be engaged in useful occupations with suitable preventive measures. This knowledge spread to many parts of the country and the rest of the world also. I must point out at this stage the 2 studies undertaken. Thanks to the help of the PL 480 funds which enabled us to conduct 2 major research projects. The first one was in 1961 “Investigation into the Methods of Rehabilitation of Persons Disabled by Leprosy”. What came out of this was something referred [to] by me earlier. These findings were very important. In 1968, another Project, in fact a continuation of the earlier project, was “The Development of Occupational Orientation in Reconstructive Surgery and. Rehabilitation of Leprosy Patients”. So numerous publications in the national and international journals followed, and I was responsible for the chapters in books related to leprosy surgery and all aspects of rehabilitation. I co-authored the book on Leprosy and a full length educational film on physiotherapy in leprosy was also produced. Thanks are due to the German Leprosy Relief Association, Wurzburg in Germany who have come out with assistance; and also the American Leprosy Mission, New York, USA, have generously helped to continue the good work which has been started. This enabled us to start very unique programme of a mobile surgical clinic. And its great contribution was to carry the benefits of reconstructive surgery and the knowledge by the team of experts to places outside Vellore and the other centres where many patients had been waiting for operations. This also enabled the young doctors in these centres to learn first-hand from the team of doctors who were making very regular visits to many centres in and around Tamil Nadu.
This has been a very special project in addition to many programmes of leprosy surgery and rehabilitation. The emphasis on leprosy made by us in the Department of Orthopaedics and the surgical aspects particularly helped in the integration with the general orthopaedic programme. This has enabled the undergraduates, postgraduates and other trainees also to be oriented to leprosy.
I was granted [a] one year WHO consultancy in 1979-1980 which was one of the most remarkable periods in my career. This helped me to visit 13 states in our country, to visit 82 medical colleges where I was able to lecture on the leprosy deform causes. I was able to demonstrate the various established methods of reconstructive surgery and also held discussions during seminars. The important thing was to demonstrate how leprosy work could be integrated in the teaching and treatment of orthopaedic as for any other disease in all hospitals, especially teaching hospitals. This of course had [a] good response with great enthusiasm and [was] welcomed by many. As a WHO Consultant in Nepal in 1981, I travelled widely in that country to advise the Government on organising reconstructive surgery and the rehabilitation programme in the hospitals there.
We have also conducted, at [the] CMC Hospital, Vellore, regular teaching programmes for undergraduates and postgraduates. A very important and useful leprosy physiotherapy training course was conducted, and also [an] orientation course was conducted in leprosy for medical officers. Thanks to the Hind Kushtha Nivaran Sangh which generously supported this programme.
I have had the opportunity to present numerous papers in national and international conferences. I was able to emphasise the importance of leprosy surgery.
My appointment as examiner for postgraduate orthopaedic university examinations in many universities gave me the opportunity of asking in the written as well as the clinical examinations about the orthopaedic problems related to the deformities in leprosy. This has enabled the undergraduates to know more about the various orthopaedic problems in leprosy. Therefore this was helpful to make people aware of the orthopaedic problems in leprosy which could be treated by the general surgeon, the orthopaedic surgeon or anybody for that matter who could be available.
In 1975 I was awarded the Sahu Gold Medal in recognition of 10 years of outstanding research work. I was also honoured with the BC Roy National Award in 1982 with the Citation as Eminent Medical Teacher and also many other honours for which I am very grateful indeed because the colleagues were generous in recognising the importance given to leprosy in my professional work and in whatever capacity I had the opportunity to serve as a teacher, as a research worker, as an examiner or even as a publisher of articles. After a period of time I was so much involved in leprosy and this has enabled me to conduct WHO Workshops at Vellore which were very popular, and again this was also held in other parts of the country and they [were] well attended. The participant[s] were surgeons of the speciality in the medical colleges, and other medical officers from the States of Orissa, Andhra Pradesh, Kerala. I want to recall the impact it has made on the people who had participated in such WHO Seminars.
Thanks to the advancement of effective drugs. Further strides were made following he possibility of producing leprosy in the foot pad of the mice and subsequently the armadillo. This is the great thing that has happened in the laboratory for the research workers to come out with potent drugs. For the first time we have an effective combination of drugs, the MDT which has now gripped the attention of the Government, the health workers and the doctors and physicians to treat effectively the multibacillary leprosy patients. This is one of our main concerns. Side by side the studies on immunology and. other aspects are also going on. The inevitable problems are also cropping up with regard to drug therapy when it is being indiscriminately and ineffectively administered without control, the development of drug resistant strains of organisms and those problems.
We are living in a golden era where the future of leprosy is very well secure. If one comes across a new case the chances of effecting a complete cure is there. So we have the satisfaction of seeing the light at the end of the tunnel of despair and. hopelessness at last.
The resurgence of enthusiasm and. the constructive programmes by the Central Government and the States and the untiring work and the leadership given by the voluntary organisations should fire the enthusiasm of people; the dedicated field workers, the doctors, the paramedical workers from different parts of the country, working in different parts of the world with the objective of eradicating leprosy by 2000 AD. Is it a pipe dream or is it a reality? Only time will tell us.
But at the same time we cannot bypass the numerous cured patients; those unfortunate ones who have developed deformities, some of them irreversible and permanent. They need to he taken care of as well, by rehabilitation, to be given a meaningful and useful life. Even these things have been made possible by the advances made on the prosthetic and orthodic [sic] appliances and the many privileges and consideration shown to handicapped people for employment. The increasing recognition that a deformity suffered by a leprosy patient is, after all, … secondary to the neuritis and which doesn’t evoke any special kind of prejudice. And these ideas are increasingly being accepted and we are very hopeful about the future.
We have a responsibility that the medical colleges should introduce in the curriculum the proper teaching of leprosy, all aspects of it like any other disease. But more importance to be given to this subject for the undergraduate students and maybe the orthopaedic and plastic surgeons should be involved in dealing with the problems caused by leprosy including eye problems for the eye surgeons and so on.
I was privileged and fortunate to spend about 2 weeks along with my team of physiotherapists, junior doctors for a session of surgery rehabilitation and assessment in Maharashtra State in Baba Amteji’s place which I will never forget. This was years ago when Baba was so much involved and was a tremendous source of inspiration inspite of his indifferent health at that time. It was a great joy to see what he was achieving in a very practical and humane way. No wonder since almost about 15-20 years since I had been there his untiring work, selfless service had earned national and international recognition. We are so proud of the worthy son of our land Baba Amteji and Mataji.
I also recall my units to many centres where I had the opportunity to learn so much. The one run by Professor Jagadisan who has fought a battle against leprosy is an outstanding one. He has won recognition for his unique achievements. He contributed much by his writings and his participation in important international and national meetings. I should also mention those people in voluntary organisations who have given such dedicated services like Hermann Kober regarding the GLRA’s involvement throughout the leprosy world. I was able to visit along with Hasselblad the President of ALM the Eastern African countries and also Nigeria for a 2 months period to introduce to them methods of surgery. Those visits looked enthusiastic response [sic]. The institutions where much help was not available … [benefited] by the help received and appreciated it. While I was in Northern Nigeria the innovations and adaptations made by … Pfaltzgraff an American surgeon were amazing and that too [with] very little help from outside. Now the whole thing has improved tremendously. So we all [experience] much better times these days as we are able to send surgeons to places where there may be need. But one thing where we are very fortunate is the decline in the various deformities one normally sees. This was observed even about 15 years ago the steady decline in the secondary deformities we normally see due to lepromatous leprosy, those offering the hands, and face, because of the control of the disease without allowing it to progress to damage further nerves. So one sees very rarely the complete facial paralysis, even lagophthalmos for that matter. And certainly not any ugly saddle-nose deformities. Many patients do not lose their extremities and digits as readily and as severely as they used to, thanks to the early control of disease. The severe non-healing ulcer problems are also on the decline. The demonstration of control studies in centres in different parts of the country is responsible … [for bringing] down the incidence of infection, the effective treatment of infectious cases; and again control of the disease in school children and the marked decline in the occurrence of plantar ulcers. And these are the things which are encouragement to us at this time as we pause and look ahead of us into the future.
This rambling random recording of my experience is an exercise which is new, and one is apt to forget to mention many things. But let me not forget what has been the source of progress, the knowledge, and this has been shared and passed on and kept updated by our organisation the Indian Association of Leprologists. I was privileged to be its past President when we had the annual meeting at Madras, and again all the previous meetings which I have attended. I was struck by the enthusiasm of the participants from the neighbouring countries and abroad. The scientists of eminence in addition to the eminent scientists from our own country contributed to the high quality of the discussions and the results of the findings have been of great importance. This is shared through the publications of the Journal which has been ably carried on faithfully by Dr. Dharmendra. May he live long with health and strength to continue this tremendous task. How many young doctors he has inspired and how many people have stood in awe and respect about his abilities and capabilities. We are very grateful indeed that we have a person of such remarkable eminence still guiding us.
And with that note let me conclude that we need men and women in the leprosy field both medical and paramedical, dedicated and inspired to stir the new generation to selfless service and to emphasize on research on all aspects of leprosy and to discover effective methods of treatment both medical surgical and rehabilitation. Thank you.
The tape received on March 23, 1989.