Henry Ford said ‘History is bunk’. Francis Bacon said ‘histories make men wise’. Whatever one feels it is an undisputed fact that all the knowledge that we have today is the result of achievements and failures of great men recorded in the past. If you look into the evolution of the orthopaedics you can see that a few fundamental truths are enunciate at the earliest recorded time. Then the pattern of developments is mostly one of lapses of memory, rediscovery of forgotten knowledge and fresh application. History often serves as a deterent to fraudulent claims by persons for a new discovery, which perhaps was already known for many years and forgotten. In the following pages I intent to cover this history under the following headings.
General practitioners and Orthopaedics
General Surgeons and Orthopaedics Practice
Orthopaedics becoming a specialty
Early Orthopaedic Surgeons
Formation of Kerala Orthopaedic Association
Activities of the KOA through the years
Since the time of Susruta in India , around 400 BC, bone setting is well known treatment for fractures and massage and manipulation of joints for the relief of pain. The text book of surgery known as ‘Susruta Samhitha describes very vividly many of these treatments. Several translations of this book exists today. Kerala was depending on bone setters or so called marmanees( marma Chikilsa specialist) for trauma cases from time immemorial till the middle of the 20 th century. Bone setters apparently acquired their skill from their fore fathers and it is considered to be of Ayurvedic origin. In the initial stages of development, these techniques lacked any scientific basis and involved application of various oils, different types of massages, manipulations, splinting etc. Apparently they were able to cure a good number of cases affected with a variety of ailments. At the same time there were also some disasters which perhaps were considered as acceptable complications in those days. Inexperience and improper application of these techniques probably lead to too many disasters and the system ultimately went into disrepute for quite some time.
In recent times some of the children and grand children of these bone setters have joined Ayurvedic colleges, becoming qualified Ayurvedic physicians. Some of them were specialized in the treatment of musculoskeletal diseases and injuries. As years went by several changes occurred in their approach and line of treatment. The diagnosis of fractures by the appearance and feel is replaced by X-ray and the bamboo sticks and cloth impregnated with egg white or corn paste by plaster of Paris. Probably the most important advancement as one Ayurvedic physician ( Marmanee) has stated ‘ Ayurvedic medicine cannot have immediate effect and the patient could develop serious or fatal complications if some cases especially major trauma, compound fractures and acute infections were treated’. More over treatment of non-union , mal-union and infected fractures are now a days seldom entertained by them and and are often referred to an orthopaedic surgeon. As I am aware of only few such awakened Ayurvedic Centers now exist in Kerala. However one must not forget that even today the initial treatment of bone and joint injury from a qualified doctor of modern medicine is obtained only in about 25% in our state. Scarcity of qualified doctors, especially in the villages and the rising cost of orthopaedic treatment may be the reasons for this trend.
General practitioners and orthopaedic practice.
The practitioners of modern medicine in Kerala probably arrived in late eighteen hundreds(1800 s) or early nineteen hundreds(1900s). They were all trained in other states since Kerala did not have a medical college until 1951. They were mostly licensed medical practitioners and were authorized to treat every disease and injuries. After a certain period in their practice some of them started concentrating on their favorite branch. Some turned to medicine while others on surgery. The so called surgeons besides operating on various parts of the body, also managed musculoskeletal diseases and injuries.
Dr.M.A. Urumese, M.B.B.S, , a well known surgeon of Cochin belongs to the above mentioned category of medical practitioners. He took M.B.B S from Madras medical college and after serving in the Royal army during the 2nd world war joined cochin state health service some where around 1945. I knew him well for he treated me (Dr Poulose Chaco) for a broken clavicle and metacarpal when I was 10 years old. Much later I had the opportunity to remove some of the implants he had put in to treat fractures many years previously. Apparently these were done very skillfully at a time when internal fixation of fractures were relatively unknown. No doubt he was a great surgeon and attracted many patients not only from Kerala, but from other states also.
General surgeons and orthopaedic practice
In late twenties and early thirties qualified general surgeons trained in England with FRCS came on the scene. About the same time a few physicians with MRCP also arrived thereby making surgery and medicine two separate entities in the hands of two separate specialists. Most of them initially practiced in the health service and a few of them later joined Trivandrum medical college, the first medical college to start in the year 1951. Some of the most notable surgeons during that period were Dr.Kesavan Nair, Dr.Raghavachari and Dr.Kanakasabesan. Dr Kanakasabesan`s main interest was in orthopaedics and he was considered as an excellent teacher. All the above surgeons were teachers in the dept. of surgery at one time or other and was engaged in teaching undergraduates. The modalities of the treatment they adopted were extremely conservative . Fractures were mostly treated by bed rest , prolonged immobilization in plaster casts,and traction, and chronic musculoskeletal pain with manipulation, heat and massage. Open surgery was rarely performed for the treatment of fractures . It was mostly performed for compound fractures and for amputations.
Orthopaedic Surgery becoming a specialty
Till the second quarter of this century orthopaedic surgery was an unknown specialty in the country. It was in the year 1928 the first department of orthopaedic Surgery in the country was started by Dr.M.G Kini at Madras Medical College. The second place to start this specialty was King George Medical College Lucknow, in the year 1930 by Dr.B.N Sinha. Soon it was started in other medical colleges in major cities like Calcutta, Bombay, Delhi. In 1951 , Trivandrum Medical college was started by the untiring efforts of Dr.C.O. Karunakaran. Dr.R.Kesavan Nair FRCS who was then the chief surgeon at General Hospital , Trivandrum was appointed as Prof. Of Surgery. Dr.Kesavan Nair was the first teacher in orthopaedics for the 1st batch of students at the medical college. He was considered as the best surgeon during that time.
Recognizing the importance of the new specialty of orthopaedic surgery the then Govt. of Travancore sent Dr.K.I George from the health service Dept. to U.K on deputation for higher training. He first got training in U.K and took Fellowship. Then he went to USA and had practical training in the subject. After acquiring requisite training he joined in the Dept. of Surgery at the medical college in 1956 as Asst Prof. of Surgery ( Orthopaedics)He later become professor and founder of Orthopaedic surgery in Kerala.
As stated earlier the first unit of orthopaedics was started in 1956 at Trivandrum medical college with Prof. K.I George as the Head. On the health service side the first unit was started at Kottayam district hospital in th year 1961 as Dr.Mathew George as the Head. In 1962 another unit was started at Calicut medical college by Dr.P.K Surendran. Although there were orthopaedic units in medical colleges for a decade ,only clinical service and undergraduate teaching were being carried out. By the untiring efforts of Prof. K.I George the first PG course (Diploma) in orthopaedics was started at Trivandrum Medical College in 1963. The degree Course(M.S) started in the following year. Dr.P.K Surendran is mainly responsible for starting the second PG course in Calicut medical college in the year 1975. Trivandrum and Calicut are the two medical colleges where postgraduate teaching is available at the present.
Early orthopaedic Surgeons
Formation of Kerala Orthopaedic Association
The idea of forming KOA was first mooted by Prof. K.I.George as early as Dec. 1967 when a seminar on Rehabilitation and research activities was conducted at Trivandrum Medical College. The then secretary of IOA attended this meeting and in his presence preliminary steps to form the association were taken. But somehow things did not turn out as planned and the cruel fate snatched away the life of Prof.K.I.George in 1970. Even though orthopaedic units in Medical Colleges and in Health services started functioning in the late sixties. It was only after two decades Kerala Orthopaedic Association was formed.
Dr.P.A Alexander an assistant Professor at Kottayam Medical College was mainly responsible for the revival of the idea of formation of the KOA in the year 1981 Dr.P.A Alexander , a very dynamic personality organized a preliminary meeting involving most of the senior members of the profession from all over the state. This meeting was conducted at the Rotary Hall , Kottayam on 26th April 1981.. 65 Members attended the meeting. Dr. P. K. Surendran occupied the chair. There was an active discussion by Dr. T. C. Joseph, Dr. N. Mohandas, Dr. P. Bhaskaran Nair, Dr. K. Venugopalan Nair, Dr. Jacob Zacharia, Dr. P. K. Namboodiri, Dr. M. K. Viswanathan, Dr. Paulose Chacko Dr. Rajaram, Dr.P.A.Alexander and others. Dr. P. A. Alexander moved the resolution. The first team of office bearers were President Dr. P. K.Surendran, Vice Presidents Dr. K. Venugopalan Nair & Dr. T. C. Joseph, Secretary-cum-Treasurer Dr. P. A. Alexander, Joint Secretaries Dr. N. Mohandas and Jacob Zachariah Executive committee members Dr.P. V. P.Nair, Dr. P. K. Namboodiri,Dr. P. Bhaskaran Nair and Dr.K. A. Balachandran. The next executive committee was convened on 12-07-1981 at Cosmopolitan Club Calicut. The inaugural conference was conducted at Chalissery Hall Trichur on 30-08-1981.
The Inaugural meeting was organized by Dr.Balachandran and it was held on 31st Aug. 1981 at the Chalisseri Hall,Trichur. Prof.M Natarajan of the Madras Medical College was the chief guest. He inaugurated the conference and donated Rs.500/- for the newly formed association. At this meeting it was decided to hold the first annual conference in Ernakulam at Lisie Hospital. Dr.Jacob Zackariah, then Head of the Dept. of Orthopaedics at Lisie hospital organized the conference and it was held in March 1982. At this meeting Dr.Venugopalan Nair was elected as the president and Dr.P.A Alexander as the Secretary.
The first annual general body meeting was conducted on 13-03-1982 at Lissie Hospital Cochin. 57 Members attended the first General Body Meeting. The first annual conference also was conducted there by the organizing team headed by Dr. Jacob ZachariahDr. M. Natarajan spoke at the meeting. The executive committee on 14-03-1982 at Lissie Hospital accepted in principle the suggestion to have an oration in the name of Dr. K. I. George. The Dr. P. K. Surendran Award was instituted following the executive committee meeting on 12-02-1983 at Muscot Hotel Trivandrum. The K. I. George Oration Committee was constituted with Dr. Cherian Thomas and Dr. K. S. Pillai, Dr. P. A. Alexandar and Dr. K. Neelakanta Pillai. Discussions for a journal was started by Dr. P. K. Namboodiri on 13-02-1983. Dr. Willson Ipe was the organising secretary of the second annual conference, Dr. N. Mohan Das of the third annual conference and Dr. C. V. Prathapan of the fourth annual conference. Dr. Willson Iype took over as Secretary cum treasurer on 19-02-1984. Efforts for the Journal was continued by Dr. M.K. Viswanathan at Calicut & Quilon. The first journal was presented by 1985and the second journal was also printed overcoming the scarsity of articles and financial constraines. Dr. Varghese Mathai Travelling fellowship was instituted on 16-02-1986 by Dr. Alexander Mathew. Dr.P.V.Padmmanabhan Nair took over a secretary and treasurer on 26-04-1987. Dr. Varghese Chacko gave the inaugural K. I. George memorial oration during the conference at Hotel Casino Trichur in 1989. KOA was registered following the efforts of the secretary Dr. Lazar Chandy in 1992 and during the tenure of Prof.N.J.Mani as president.The basic and advanced CME s and CMEs for nurses were also instituted. The KOA house was purchased in 1997 and Dr. A. A. John with the support of all members was instrumental in the endeavour. The KOA bagged the A. K. Gupta Trophy for the best state chapter of the Indian Orthopeadic Associaton in 2000, 2001, 2002 and 2003 when Dr. Sherry Isaac and Dr. Tigi Thomas Jacob as Secretaries and Dr.A.A.John, Dr.SunnyP.C, Dr.Wilson Iype and Dr.P.S John as presidents. The hatric was unprecedented in the history of Indian orthopaedic association and the magnificence continued by making it four in a row. The KOA was made an affiliated state chapter of IOA in 2002. The best poster award was instituted in 2002 at Kottayam. The protocols of KOA were also passed during the Kottayam conference. The first web site was made in 2000 and the official website and the IT committee in 2004. The PA Alexander CME was instituted in 1-3-1991and the PAAlexander life time achievement award in 2004 along with the meritorious awards and honorary fellows of KOA.
PROF K. I. GEORGE
Hailing from an aristocratic christian family of Kottarakkara born to the high school head master Mr.K.I.Idiculla, Prof.K.I.George did his primary medical education at Meeraj Medical School and later his condensed MBBS from Bombay. He took FRCS and FRFPS from UK and after a short stint in USA returned and joined as Assistant Professor in Surgery in Medical College Trivandrum. In 1956 he was instrumental in founding the first orthopaedic unit in our state. He struggled hard to establish a separate entity of orthopaedics but had to wait 12 years to become a professor. Single handedly and enthusiasically this great teacher would cast his spell on students with his beautyful black board diagrams, artistic surgery with deft movement of his fingersand his exciting classes. Through his students we will remember the loving heart, commanding eyes, hitler moustache and the mischievous smile which rarely surfaced. We pay him rich tribute by instituting the Prof. K.I.George Memorial Oration. The first given in 1989 by the only national president from Kerala Prof. Verghese Chacko. The cruel hands of fate took this legendary lone ranger early leaving a big void in the orthopaedic scenario in 1971.
PROF. P. K. SURENDRAN (1923-1990)
Took his MBBS from Culcutta, MS Ortho from King George Medical College, Lucknow under the lion himself Prof.B.N.Sinha. Founded the Dept of orthopaedics in 1963 where he was the first Director and Professor. He introduced hemiarthroplasty way back in 1973 and started the PG course in Calicut. An excellant teacher he inspired a generation of students. This punctual and principled selfdeciplined man was the President of IMA and Rotary Trichur and always maintained his professional honesty. He retired from service in 1978 and we honour him by instituting the Prof. P.K.Surendran memorial gold medal. He left to heavenly abode following an MI in 1990
PROF. P. A. ALEXANDER (1939-1989)
Prof. P.A . Alexander born on 30th Aug 1937, did his MBBS in Trivandrum Medical College, graduated in 1962. He jointed as tutor in Medical College, Kottayam in 1964, took his M.S in Orthopaedics from GSVM, Kanpur in 1968. Within the shortest possible time he became the director and Prof. in Orthopaedics, the chair he occupied till he expired on 10th March 1989. The man who was responsible for starting the post graduate course in orthopaedics in Kottayam, Medical College was one of the very early members of the IOA and IMA. He was the main driving force behind the inception of KOA. Founder Secretary cum Treasurer of KOA, State President of IMA, General Secretary and Vice-President of KGMCTA, Members of the board of studies in medicine in Calicut and M. G. University, Officer in-charge of the ICMR project was some of the responsibilities that he took. This eminent and dedicated teacher and excellent surgeon possed an in-depth knowledge of orthopaedics. The association pays respect by instituting Dr. P.A. Alexander CME’s and the Dr. P. A. Alexan der Life Time Achievement Award in 2004.