V.D. Selvaraj in Conversation with Dr M.S. Valiathan : Pandemic, Medicine and Human Heart

V.D. Selvaraj in Conversation with Dr M.S. Valiathan : Pandemic, Medicine and Human Heart

in Interview
Published on: 19 July 2021

V.D. Selvaraj

Currently the deputy editor of a reputed Malayalam magazine 'Kalakaumudi', Selvaraj has decades of experience in journalism. He has also brought out a book titled 'Gabriel Garcia Marquez Muthal Kelucharan Mahapathra Vare: Adoor Gopalakrishnan, M.A. Baby', which is a compilation of conversations between Adoor Gopalakrishnan and M. A. Baby.

Dr M.S. Valiathan in conversation with V.D. Selvaraj

Eminent cardiac surgeon, researcher, teacher, institution builder, Ayurveda scholar, Dr M. S. Valiathan has donned many hats in his fruitful life with aplomb. Born in the princely state of Travancore in 1934, Valiathan was one of the first-ever graduates from Thiruvananthapuram Medical College. He received his F.R.C.S. from Royal College of Surgeons, Edinburg in 1960. Valiathan specialized in cardiac surgery at John Hopkins and Georgetown University hospitals, U.S.A., returned to India and did brief stints at Safdarjung Hospital, Delhi and IIT, Madras. A new chapter opened up in his life when he took charge as the director of the newly founded Sree Chitra Thirunal Institute of Medical Sciences and Technology in Thiruvananthapuram.  

Under his able leadership, Sree Chitra soon became a leading medical and research institute in the country. His team pioneered biomedical research and developed prosthetic heart valves and blood bags for the first time in India. Valiathan has published several outstanding research papers in nationals and international journals. He was elected to many national and international medical academies, and was awarded the Hunterian Professorship of the Royal College of Surgeons of England. After his retirement from Sree Chitra in 1994, he became the first Vice-Chancellor of Manipal Academy of Higher Education. 

During his tenure at Sree Chitra itself, his mind had turned to India's ancient medicinal practices and knowledge. After his retirement from Vice Chancellorship in 1999, he seriously began to pursue his interest in the history of Ayurveda. He was awarded a Senior Fellowship by the Homi Bhabha Council to pursue a study of Caraka, resulting in the publication of the book The Legacy of Caraka. Later, as a National Research Professor, he studied the other two greats of ancient Indian medicine—Sushruta and Vaghbata—and authored books on both of them.

M.S. Valiathan has been honoured with several prestigious national and international awards and honours for his contributions to medical sciences and technology. Valiathan has served on many national and international committees and councils pertaining to medicine, technology, science and technology. At 87, he resides in Manipal and actively pursues and supports medical research.

Following is the edited transcript of the video conversation (part 1) with Dr M.S. Valiathan conducted by V.D. Selvaraj in February 2021.         

V.D. Selvaraj: We are meeting in the most extraordinary times ever faced by mankind. We have followed all Covid protocols as we sit down for this conversation. Dr Valiathan, you have turned 87, and you surely must have faced times like these at some point in your lifetime. Because, indeed, 30s and 40s were the times of infectious diseases, and life expectancy in India then was 30 years or even less. Do you remember any period in your childhood when infectious diseases raised a scare? If so, how do you compare those times with the present?

M.S. Valiathan: Pandemics are not new.  Long before my childhood, in ancient India, conditions resembling epidemics had been witnessed though we have no evidence they spread beyond India.  Caraka has written in detail about the ‘destruction of habitat’ (janopadodwamsana).  Germ theory was not known until the 19th century, and Caraka lived 2000 years before viruses were discovered.  He describes unjust rulers levying big taxes to prosecute wars, shortage of food grains, starvation, bloodshed, famine, serious diseases killing whole populations, birds and animals and even gods forsaking the land.  He does also refer to what wise people should do in advance to mitigate the effects of the epidemic.

In my time in mid-twentieth century Kerala, the health conditions of people were better than those in many other native states or British Presidencies like Bengal.  From Bengal, there were many reports of cholera, which practically visited it every year. Mortality was high and 5,000 people dying in a week from cholera were common. It spread beyond Bengal and especially Puri on the east coast.

VDS: It spread through pilgrims? 

MSV: Yes. Also, the British used to send their army to Iran, so the infectious diseases found their way into Iran. The British had also sent Indian soldiers to China. Thus, the diseases spread through many routes. But in Travancore, where I lived, in my childhood, there was cholera, of course, but it was not as severe as in Calcutta. While there were deaths because of it, vaccination was practised.  I was vaccinated in primary school.

VDS: Were there instances of personal experiences in your family?

MSV: In my family, my two teenaged sisters died of typhoid fever. The most famous victim of typhoid fever in Mavelikkara where I was born and brought up was Kerala Panini A.R. Raja Raja Varma. He lived next door to our house. Typhoid fever was everywhere and every family would have encounters with this serious disease. It was unfortunate we had no effective treatment for typhoid fever in those far-off days in the first half of the 20th century.  If a doctor was called to see a patient, he could not wash his hands off because there was no effective treatment.  He had to do something and this included rubbing turpentine on the patient's distended belly, applying Mandel’s pigment to his throat and other measures which are no treatment at all.

VDS: The treatment sounds barbaric in today’s context.

MSV: Yes, it was. When I was studying in the medical college (Thiruvananthapuram), we went to the General Hospital for practice. There was no hospital at the medical college then. Two wards in the General Hospital were designated as fever wards. Mostly 50 per cent of the patients occupying the beds were typhoid patients. About 30 to 40 per cent of these patients would die. Medicine has advanced so much now, we have defeated such diseases. At that time a drug called Chloromycetine was used in the US in treating typhoid cases. But it was not available here.   

VDS: To understand a personality better, we need to know about his background, his hometown, family, parents, teachers, etc.  Could you talk about how your father influenced you?

MSV: I spent only three or four years closely with my father. Till I was eight years, I was more interested in playing with friends outdoors than spending time with my parents.  When I was eight, a tragedy hit our family and my two young sisters died of typhoid fever in a short span of three weeks. Only my parents and I were left in the house. I spent quality time with my father during my three years in 4th, 5th and 6th forms at the English High School, Mavelikkara. They correspond to the 8th, 9th and 10th standards of today. Afterward, I left for Thiruvananthapuram for my Intermediate.

My father was not a Sanskrit scholar, but he knew the language fairly well. That ran in the family. Everyone in his family knew Sanskrit and a bit of English. Those three years I spent closely with him gave me valuable experiences and unforgettable memories.

VDS: Did he stress on the learning of English?

MSV: Yes, he wanted me to learn to speak and write English well. To do that, he advised me to read (Joseph) Addison’s Spectator papers. Joseph Addison ran the paper Spectator in the eighteenth century. His articles appeared in it. My father said, ‘Addison’s style is very good. You should read his articles closely.’ The second book that he recommended was Oliver Goldsmith’s Vicar of Wakefield. Again, study the style. The third, the New Testament. ‘If you study these three texts well, you will achieve a good style of writing,’ is what he said. I remember it well. I came to read Addison’s papers after many years. His style didn’t appeal to me much. His style from the eighteenth century is not suitable now. Now we need a direct, simple style. There is a book by [Sir] Earnest Gowers titled Plain Words. Today, if you want to improve your style, you need to read not Addison’s papers but Earnest Gower’s Plain Words. Don’t use words unnecessarily. Use simple words. If simple sentences will suffice instead of complex sentences, that will do. Such an economy of expression that Ernest Gowers advocates are relevant for all times.

VDS: How did your mother influence you?

MSV: My mother was very religious. I have fairly good knowledge of our puranas, like the Ramayana, Mahabharata and Bhagavatha. It all began with my mother. She was very knowledgeable in the puranas. Several instances had occurred when I could gauge the depth of her knowledge. Once, I was reading A.R. Raja Raja Varma’s Bhashabhooshanam. It is about the rhetorical devices in poetry. The explanation of each device is supported by examples of beautiful, apt slokas. As I was reading, one sloka particularly struck me.

Mallanmaarkku idivaal, janathinu arachan, meenaanka nenaakshimar-

kkillathil sakhi vallavarku, ari khalarkka nandano nandanan;

kaalan kamsanu, dehikalkkiha  viraat, jnaanikku tatwam param

moolam vrishni kulathinennu karuti maalokara kkannane

Conspiring to trap and kill Krishna and Balarama, Kamsa invited them to the palace at Mathura. On their way, Kamsa positioned a rogue elephant, thugs, and other hurdles to harass and murder the boys. The above verse describes how the two boys appeared differently to the varied participants in Kamsa’s Court. It is a beautiful sloka, very pleasing to the ear. After I read it, I said to my mother, ‘Mother, how beautiful this sloka is!’ My mother replied, ‘My son, this is from Bhagavatha.’ I said, ‘No, this is from this book Bhashabhooshanam.’ My mother got up, returned carrying the Bhagavatha, and showed me a page. Read this. So, it was the same sloka albeit in Sanskrit. Kerala Panini had translated it for his book.

I had many such experiences with my mother. The many stories that she told me—that was a great education in itself. I learned a lot from both my parents. Also, I had very good teachers such as Kesavan Unnithan who taught Malayalam and Raja Raja Varma who taught us English. They were different from our regular teachers who taught to make students pass examinations. Unnithan sir used to recite good poems to us. They went beyond the syllabus and tried to inculcate a love of poetry in us.                                         

VDS: By 1951, you left Mavelikkara and came to Thiruvananthapuram to join the medical college. Was there any motivation for you to take up medicine for higher education?

MSV: No, there was none. There were very few options then. You could become a doctor, an engineer, a lawyer, or enter government services or opt to become a teacher. The options were limited then. Or else, you could leave Travancore and seek green pastures somewhere else. As for me, I was not interested in mathematics or technology. I was interested in literature. But there was no future in literature. You could become a teacher, that’s it. Nothing else. One of my family elders had studied medicine in his time.

VDS: Yes, Dr V. S. Valiathan studied medicine at the Edinburgh University.

MSV: Yes, also, there was another doctor—one of his nephews—in the family. For two or three generations, we had at least one doctor in each. So, I thought, I would pursue medicine. It was not a well-thought-out decision.

VDS: You belonged to the first batch of the Thiruvananthapuram Medical College.

MSV: Yes, I did. It was a huge boost for the state to have its own medical college. There were 60 seats in the first batch. The SAT (Sree Avittom Thirunal Hospital) was already functioning before the medical college was set up. About 160 acres of land was available around it at Ulloor. The decision was taken to establish a medical college on this campus. Dr C.O. Karunakaran was appointed as the special officer tasked with establishing the college. He was already past 60 years of age, but he used to work very hard. He would come in the morning in his Morris Minor car which he drove very fast, went back home for a lunch break, and returned post-lunch. He told us that he would take a one-hour nap immediately after his lunch, and afterward, as he drove back, he would consider it a new day—he had trained his mind to believe so. So effectively, he said, he would complete two days’ work in a day. That is a very significant statement.  

Dr C.O. Karunakaran was a good teacher too. He was the director [Superintendent] of the Public Health Laboratory. Teaching was not his main mandate, but he was an extraordinary teacher. He had taken classes for us in bacteriology and immunology, which have left an indelible impression on us. He would narrate interesting stories to make his class stimulating and unforgettable. The Sree Avittom Thirunal Hospital is popular today. Avittom Thirunal was the nephew of the then maharaja and was next in line to be the king. When he was eight or nine, he contracted kidney disease and died. In one of his classes, Dr Karunakaran told us the story about his illness. He was teaching us the importance of testing the pH level of a urine sample. When Avittom Thirunal was taken ill, the Surgeon General, Dr John, was called to the Kavadiyar Palace to treat him. So, John would come regularly to see the patient and test the urine. But he could find no trace of albumin in the urine sample. Still, the child exhibited typical signs of renal trouble. One day, John confided in Karunakaran that every time he tested the urine he could find no trace of albumin, but the patient was deteriorating. Karunakaran asked him, ‘Sir, did you acidify the urine before you tested it?’ I still remember none of us will ever forget what Dr Karunakaran said, ‘The surgeon general collapsed!’ He was a great teacher. Nobody would ever forget what he taught.

VDS: You must have had other teachers also like him.

MSV: I had two such great teachers. One was Dr Thangavelu who taught us pathology. He was a Tamil, and he came to teach us in 1953, when we were in our third year. He was an extraordinary teacher. One day he asked about pus in the class. The most basic lesson in pathology is about pus. Infection and pus were very common in those days. If you went to a ward in any hospital, there would be at least 10 patients with infections. Antibiotics were not common then. Professor asked us what the reaction of pus was. The students gave various answers. None of us knew actually. He listened to us patiently and then said, ‘You have told me all these. I know what you will do. You will go to the library, you will take the books and look at the references to see what the answer is. There is a better way to find the answer. That is when you go to the ward tomorrow, take a litmus paper with you. Everybody knows red and blue litmus papers. You go to the patient and check. If the blue becomes red, then you know it is acid. If the reverse happens, it is alkaline. Then you look at the pus report. What does it say? The name of some organism will be given there. You will learn that there is a connection between that organism and this reaction. You will find the answer yourself. That is the way to find the answer.’

This is a very profound way of teaching. Accurate observation and inference from it. To use your mind. When we do just textbook learning, we are not using our minds. But here you are using your mind. That is medical education.

Another great teacher was Dr Krishnan Thampi. He taught us community medicine. The state of Travancore sent him to John Hopkins (University) to study public health. I am not aware of any other state that had done such a thing at the time. The Travancore state sent two persons—one of them was my uncle—to Edinburgh (The University of Edinburgh) to study medicine. The fact that such a small state, in those days, sent two persons to Edinburgh to study medicine and another two persons to John Hopkins to study public health speaks volumes about its modern outlook. One of the latter was Dr Krishnan Thampi. He studied at John Hopkins, and upon his return, joined the Public Health Department of Travancore and later, our Medical College.

One thing I would like to say. When we were studying, the mental hospital at Oolanpara (a suburb of Thiruvananthapuram) was looked down upon. It was deprecatingly called a ‘lunatic asylum’. Nobody would go there. Even the doctors didn’t like to go there. When a patient was admitted, he would remain there for the rest of his life. No proper treatment was available. It was Dr Krishnan Thampi from whom we heard the term ‘mental health’ for the first time. Otherwise, everyone spoke about mental illnesses in very deprecating terms. The entire family of the patient would suffer. The new term brought about a change and a civilised way of looking at mental health and illness. Dr Thampi told us that in America too, it was like this in the nineteenth century. At the hospital, there would be about 2000 beds. When a patient was admitted there, he was finished, his life was over. He would not see the light of the day.

VDS: Somebody has written a book, right?

MSV: Yes. I am coming to that. Once a man who was suffering from some temporary mental disturbance was admitted in a mental hospital. He managed to get out. He remembered his life in the hospital very well, and he had good writing skills. He wrote a book on his experiences—A Mind That Found Itself. Only when people read it, they realised what a terrible thing it was to treat these patients like this. The book generated huge public awareness about the issue. Dr Thampi said that was how the mental hygiene movement in America started.

VDS: You started your life at Mavelikkara in 1934, and in 1957, you completed your medical education at Thiruvananthapuram Medical College. What made you want to study further and to take up cardiac surgery?

MSV: I had not thought of becoming a cardiac surgeon at that point in time. I wanted to become a surgeon, but there were no opportunities in Kerala to go for postgraduate training. Even the MBBS course had only just begun here. You had to go to Madras or Bombay for postgraduate training, but it was difficult to get seats there. So, the only option, if you wanted to become a surgeon, was to go for FRCS. FRCS is considered to be an important qualification even now. That was how I went to England in ‘57. In those days, if you decided to go to England, that would mean you might not return and opt to settle there. My family was worried. They were worried that I would marry a foreigner and settle down there. In fact, some even warned my mother that this might happen. So, yes, that was a big worry in those days.

VDS: Who inspired and helped you with your training in cardiac treatment and surgery?  

MSV: I did not get any training in cardiac surgery in England. That happened in the US. There, I worked with Dr John Gibbon, who developed the heart-lung machine. He took many years to develop it.

VDS: What does a heart-lung machine do?

MSV: In an open-heart operation, we have to open the heart and do the repair inside. This is impossible when the heart is full of blood. We cannot do that while the heart is functioning. When we conduct open-heart surgery, the heart and lungs of the patient are shut down and a machine will take over the functions of the heart and lungs.  These functions are pumping blood throughout the body and adding oxygen to blue blood which is deficient in oxygen. Open-heart surgery can be done only with a heart-lung machine. John Gibbon developed that machine. Because of it, millions of lives have been saved till now. I was with him for a year doing research. Still, I could meet and talk with him. I got to know how he lived, thought and worked. That was a big education in itself. I was really lucky in that sense. That was when I learned the concept of open-heart surgery. When I returned to India, I worked at Chandigarh. Open-heart surgery was not being done there at that time. My memories of associations with people like John Gibbon made me want to specialise in open-heart surgery. That was how I went back to the US for the second time.

VDS: Once you said that you had seen Leonardo da Vinci’s illustrations of heart for the first time when you were in England. They were made 400 years before William Harvey studied systemic circulation. 

MSV: Yes. I was always interested in medical history, how William Harvey discovered circulation, John Hunter’s discoveries and so on. I was always interested in the history of inventions and discoveries, to know how they did it and the thought processes that went into it. When I was studying anatomy in England, I saw da Vinci’s illustrations for the first time. That happened when I was attending the course at the Royal College. The originals are kept at Windsor Castle. Da Vinci himself had done dissections. Not only this, he had even sketched a lot of mechanical devices. Very accurate sketches! There are so many engineering drawings by da Vinci. He was a genius.

VDS: How detailed are his sketches of the human heart?  

MSV: It shows the four chambers, valves and interior of the heart. Very accurate. Here in ancient India, too, Caraka and Sushruta talked about the heart. But they don’t say anything about its interior. They say the heart is conical and there is blood inside. If there is any problem with it, the patient dies. This is all they say. But remember they lived a thousand years before da Vinci.

VDS: Da Vinci’s sketches would come as a surprise to today’s medical students.

MSV: Would today’s medical student even know about da Vinci? I doubt. Nobody is interested in medical history today. I would say it is rather unfortunate. It is their loss actually. There are students who study just to pass exams. They too become doctors. Then there are students who go beyond the syllabus. It is they who go on to make lasting contributions to medicine, through inventions or discoveries. Progress comes because of them, this 10 per cent. In Western countries too, the story is the same.

VDS: Now that we have talked about the human heart, I wanted to ask you one thing. We find heart problems are on the rise today, what do you need to do to keep your heart healthy?

MSV: The most important are two things. One is activity, exercise. Regular exercise. Second, habits. Abstain from smoking, alcohol and substance abuse, etc. Then, food. Don’t eat excessively. Keep your weight under control.  If you watch yourself, you can keep your heart healthy.