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. He and 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 our 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 2) with Dr M.S. Valiathan conducted by V.D. Selvaraj in February 2021.
V.D. Selvaraj: 1964 was one of the most important years in your life. Your wedding with Ashima.
M.S. Valiathan: When I got an appointment in the Post Graduate Institute of Medical Education and Research, Chandigarh, I joined the faculty and met Ashima there. She was working in the dental department. A brilliant student from Amristar Dental College, her family was originally from Peshawar in Pakistan. She was born there. When Partition happened she was ﬁve years old. Her father was a judge. He had never gone south of Delhi and knew nothing of the world there. He had only heard of Madras and everything south of Delhi was Madras for him. Even in East Punjab, he knew little beyond Golden Temple in Amritsar. For the family, everything about Punjab was Lahore and the surrounding region.
VDS: Lahore in Western Punjab.
MSV: That was where they lived. Ashima’s father, Tek Chand Sethi, opted for Pakistan. When the Partition happened, the day before Radcliffe’s announcement came my father-in-law’s colleague, a Muslim, came to him and said, ‘Sethi Sa’ab, I can arrange a truck for you tonight. You must leave. Tomorrow I will not be able to do it. Because things are very bad.’ So he got the warning, and that night itself his family, wife and daughters, his only son was already employed in India, ﬂed and came to Gurdaspur. They stayed at a refugee camp there for three or four days. Then he got a posting. That was how they came. Ashima has only faint memories of it. But it was a very traumatic experience. I had talked with my father-in-law about it, but he was very philosophical. He had no bitterness in him.
VDS: You met her, and decided to marry her. Ashima herself has said it was like the North Pole meeting the South Pole. How did the wedding come about? Were there any mediators?
MSV: We were conservative people then. In those days there was no dating. It was unknown. You go to a restaurant and have a meal together, no such thing even in Chandigarh. I frequented the library, and she did too. We met and started talking in the library. I liked the way the talk was going. We didn’t talk about love. We talked mainly about history, books or whatever. I was nearing thirty, and I felt I should marry Ashima, I talked about it to no one. I went to my director, Dr Santhosh Singh Anand—he was a famous surgeon in Punjab—and said, ‘Sir, I wanted to talk to you about something personal.’ He stared at me and said, ‘Close the door, and tell me.’ I told him that I wanted to marry Ashima Sethi. Then he said, ‘My boy, does she want to marry you?’ I told him that I hadn't asked her, but I thought she would agree. He said, ‘I know the family. They are good people. I know Sethi Sa’ab. I will take you with me to Amritsar.’ He was a big man, intimidating. So, I said, ‘It will be better if you write a letter to her father, Judge Sethi Sahib. I will go and see them afterward.’ He wrote a letter to him, and I went to Amritsar to meet the family.
VDS: How did Pattom Thanu Pillai come to mediate for the wedding?
MSV: When I visited them, they were nice, but I understood their diffidence. Santhosh Singh Anand had written a superlative letter about me. But I was just a
fellow surgeon and a colleague. What Ashima’s family wanted to know was my family background. Where was my house? What was my family’s standing in
society? Santhosh Singh could not talk about those things. To write for me, it had to be someone who knew me and my background well and was well-known in Punjab. Finding someone like that was difficult. I thought Pattom Thanu Pillai would be the right person to write to. He knew me personally.
VDS: What was he doing then?
MSV: He had served as the Punjab governor. So, they knew him by name, had seen him on news and all. By then he had taken charge as the governor of Andhra Pradesh. So I wrote to him about my personal matter. He replied and said it was a good decision and that the North and South should come together. That was how our wedding happened. It has been 57 years since then.
VDS: 57 years! You started your career in Punjab, went to America, returned and taught at IIT Madras, and practised at the railway hospital (Southern Railway
Headquarters Hospital). Then, in 1974, you were invited to take charge as the Director of Sree Chitra Tirunal (Sree Chitra Tirunal Institute of Medical Science and
Technology). People only know that you took charge as the director. How did it come about?
MSV: It happened quite unexpectedly. I returned to India from the US in 1972. I was not looking to set up a private practice. Firstly, I wanted to do cardiac surgery.
Secondly, I wanted to develop the tools needed for cardiac surgery. We were importing essential tools like oxygenator, heart valve etc. We had to develop them here in India, technology is as good as those from abroad but less expensive. I wanted a suitable place to do my research too. For practice and research, you need a young student community of research fellows. Only then the atmosphere becomes right for breakthroughs. A good academic environment. I was searching for that. I tried at Safdarjung Hospital. But it didn’t work out. Then I joined Madras IIT. They had invited me as a visiting professor and also to practise at the railway hospital. I stayed there for a year. I realised that what I wanted would not happen there. In IITs, they would only teach. Madras IIT had a good aeronautical department. They taught the structure, electronics etc., of an aircraft. They would teach you all that. But you would not be able to build a model. It was a period of indecision, even confusion, whether to go into practice. I didn’t know what to do. I had turned forty by then. That was when Achuta Menon Government was in power in Kerala. That was also a historically important period for science in Kerala. The University College was established in Thiruvananthapuram in 1866 when Maharaja Ayilyam Tirunal was the king of Travancore. After the British East India Company came to Calcutta, institutions were set up— hospitals, medical colleges. The Presidency College also was started in 1856. Just 10 years later, University College appeared in Thiruvananthapuram. Like in Presidency College, British Professors came to teach here too. When you enter the University College, you see the paintings of Ross and Harvey.
VDS: The same Ross who taught C.V. Raman Pillai.
MSV: Yes, Ross was C.V. Raman Pillai’s teacher. They were all great teachers. They taught not just English but other subjects too, like physics. Since 1866 our people have studied there, passed tough exams, and have gone on to become teachers. That, too, of course, is a great service. They inculcated scientiﬁc temperament in their students. But none of these students opted for research. Whatever they studied in the classrooms did not trigger research or lead them to invent things beneficial to mankind. We don’t have that tradition here. But it was different in Calcutta. P.C. Ray is an example. He studied at Presidency College and passed the Masters examination in Science. He studied chemistry. He then built a business—Bengal Chemicals and Pharmaceuticals—for the people to avail of the beneﬁts of his research. But here we did not think on those lines. We don't have the tradition of serious research. A lot of other colleges were set up like the University College. But research, that didn’t happen. In my opinion, the ﬁrst steps towards establishing a tradition of research in Kerala were taken during the tenure of C. Achuta Menon. He set up the Department of Science and Technology in Kerala. The Central government did it ﬁrst. C. Subramaniam was the minister at the Centre and he said each state should have a Department of Science and Technology. Kerala was the ﬁrst state to establish the Department. We even drafted a policy statement regarding science and technology.
VDS: Kerala was the ﬁrst state to draw up a science and technology policy.
MSV: Yes, we were. Also, institutions like the Centre for Development Studies were established to address specific needs for development in science and technology. The Centre for Development Studies (CDS) was one of the first such institutes in India with Professor K.N. Raj at the helm.
VDS: The Kerala model (of development) evolved from their studies.
MSV: Yes. Though we had fewer resources, we made great achievements in the fields of education and health.
VDS: Did the model enable Kerala to be on par with developed countries in health and education?
MSV: Not on par, but close. The work on the Kerala model was done and published by CDS. Then K.P.P. Nambiar was called upon to revolutionise the field of electronics. In Kerala, we don’t have much land. Also, the population density is high. We don’t have much money to invest. We can’t set up big industries like steel. There is however no dearth of young, educated people. Electronics was the best ﬁeld to offer them jobs. That was why a central research laboratory was set up to develop electronic devices to suit various consumer needs. Also in every district, a manufacturing unit was established. 41 women’s cooperatives were set up. That was how KELTRON was established. Then Sree Chitra came. At that time, if patients needed heart or brain surgery they had to go out of the state. We didn’t have such facilities here. Specialised institutions were needed. Parallel to that, an environment conducive to research was also needed. So, each new institution under the Department of Science and Technology was built keeping in mind the state’s particular needs and requirements. Each of them had its own goals and guidelines for conducting research. Achuta Menon and his colleague P.K. Gopalakrishnan inspired these developments. They searched and identified suitable persons to lead these institutions. They were the two outstanding individuals who were responsible for this. They didn’t have any vested interest. They knew what they wanted and then identiﬁed the suitable person to head the project. When K.N. Raj resigned from Delhi University, he was called to lead CDS. Nambiar was brought here from Tata Electronics in Mumbai. Likewise others too. I was serving outside the state then. I, too, was called here. If it were not for these two persons, I would never have come to Kerala.
VDS: In ‘74, you came to Sree Chitra. It is not an easy task to lay the foundation for a serious and dedicated research centre. What I have heard is that you
encountered three or four failures when you tried to make the prosthetic heart valve. Could you recall those experiences?
MSV: The development of a heart valve is very complex. The reason is the valve should open and close one lakh times a day and in a year 365 lakh times. The artificial valve must do this flawlessly for ten years.
VDS: That is how many times the human heartbeats.
MSV: Yes. A prosthetic heart valve has to be durable for 10 years. That is the international standard. We have to adhere to that. The heart has to beat 365 million times a year and we have to demonstrate that our prosthetic valve could open and close the same number of times. At Sree Chitra, we didn’t have adequate test facilities. And to build those facilities was not possible either. We were a team of three. Bhuvaneshwar, one of my students at IIT, Madras, who was an engineer; Arthur Vijayan Lal, a veterinary surgeon; and myself. We three made up the team in the beginning. No one took what we were attempting seriously. Trivialising what we were attempting to do—that was what everyone did. In fact, this attitude is the greatest barrier to development in Kerala. Our mindset, ‘Oh, all this is impossible.’ ‘Only the whites can do this’. They will not admit it publicly, but deep inside this is what they believe. This is the greatest barrier. We have to get out of the shell and believe we can do the job. The first prototype valve we made broke down on our testing. As we had no test facilities, we approached the National Aeronautical Laboratory for testing. We also sought the help of Space Department institutions in Bangalore for solving engineering problems and the National Chemical Laboratory for plastic-related problems: when we needed to develop a sewing ring of polyester fabric we approached the South India Textile Research Institute (SITRA) in Coimbatore. We received goodwill and support everywhere. We were doing this not for proﬁt or fun but for need-based research. They didn’t even charge us. They did the tests and gave us the results. Actually, this heart valve is an all-India product. We were just the lead institution. Once the engineering tests were satisfactory, we had to test the valve in sheep. We had to buy the sheep from Tamil Nadu. Sheep of good size. We bought them from a farm in Coimbatore and brought them here. At least three sheep should survive for a minimum of three months following the valve implantation in their heart.
VDS: They had to survive with this valve for three months.
MSV: Yes. Then we had to do an autopsy and make sure the rest of the organs had no damage. Only after this was proved could we implant the valve in patients. Mistakes can happen at any stage—may be at the fabrication stage or at the testing stage. When it happened, we had to stop and start from the beginning. That was the difﬁculty. This continued for seven years which were dotted with three failures during tests.
VDS: Is the ﬁrst person in whom the valve was implanted still alive?
MSV: Yes, he is.
VDS: Tell us his story.
MSV: His name was Murali who is alive and well in his hometown Thrissur. Our valve passed all the tests successfully and we applied for permission to use the valve in a patient to the Institutional Ethics Committee (IEC) in 1990. Murali was thirty and a teacher. He had aortic valve disease which caused chest pain, shortness of breath and inability to teach. He needed a replacement of his aortic valve without delay. Our IEC under Justice Sukumaran’s chairmanship gave approval for the clinical trial of the Chitra valve in November 1990 in the hospital of the Chitra Institute. The trial of the initial 40 patients was to be done by me and a multi-center trial would be considered by IEC only after they were satisfied with the results of the initial trial at Chitra.
VDS: When you explained to Murali what you were attempting, what was his reaction?
MSV: He was not anxious about it. The operation was done on 6th December 1990. He did very well. He still calls me every year on December 6, inquiring after me! Not only the heart valve, we had another important medical device developed in Chitra at that time. Our ﬁrst technology transfer was the blood bag. When donors donate blood, it is collected in a plastic bag. That is very important. Because blood has many components like plasma, platelets, etc. If someone needs platelets transfusion, we don't need to give whole blood; but need to separate platelets from the blood, the plastic bags containing blood is spun in a refrigerated centrifuge at a particular speed. If you don’t have that facility, the blood will go to waste. So, we needed blood bags by millions but importing them was too expensive. If we have to have a transfusion service in India, we need to have blood bags. That was the ﬁrst technology transfer we carried out successfully. Currently, 40 million blood bags are produced by Terumo-Penpol and 30 million by Hindustan Lever Limited in Thiruvananthapuram every year and they supply the domestic market and export to 80 countries. The engineer who developed it, Dr SN Pal, and the engineers who developed the Chitra heart valve–Bhuvaneshwar, Ramani and Murali–were trained only in India. There was no support of any kind from foreign countries.
VDS: You were at the peak of research and development when you left Sree Chitra in the 90s.
MSV: I left Kerala in ‘94. I was sixty years old and my term at Sree Chitra had ended. At that time Manipal Academy of Higher Education (MAHE) was given recognition as a deemed university. Ramdas Pai was its Chairman. In November 1993, I was going to Delhi to attend a meeting. I met Ramdas Pai at the Bombay airport. I was catching a connecting ﬂight from Bombay. He asked me, ‘Doctor, are you leaving Sree Chitra?’ I said, ‘Yes, I am retiring. ‘Have you decided anything?’ he asked. I said, ‘No, I haven’t.’ During my twenty years at Sree Chitra, I had not taken a single day’s leave. I had administrative work, surgery, research, and I was part of government committees. I did not have a quiet life. I wanted to write some books. Write about what, I didn’t know. Just wanted a quiet life to write. That was all I wanted. Then he said Manipal was going to be a university. He was going to attend the decisive meeting in Delhi. ‘Why don’t you come as its VC? You can write your books too.’ Till then I had never thought of going to Manipal. Some people said the Manipal was a capitation fee college. I didn’t know anything about it. Anyway, that was how I came here. The VC’s term was for 5 years. I didn’t want any extension. In Malayalam, we have a saying: echu kettiyal muzhachirikkum. If work gets done, period. Move on to another. Then my old thought of writing books returned. After much deliberation, I ﬁnally decided to study Ayurveda and its history. Not to practise. While I was working at Sree Chitra, towards the end, a thought would often bother
me. Not so in the beginning. In my operating room, there would be about 10 people, including the patient, nurses and the doctors. A lot of instruments and equipment but only the persons were Indian. The rest, right from the theatre design, even the concept of doing open-heart surgery–during open-heart surgery, we stop the functioning of the heart, instead, a machine acts as the heart–this concept, instruments, medicines, everything came from abroad. I had often asked myself why was it like this? Hadn’t we done anything ourselves? Then, I realised this was true not just in cardiac surgery but in every speciality, whether it is neurosurgery or kidney treatment, everything in it came from abroad. India’s own contribution was zero. Then I remembered, (William) Shockley, a physicist who invented the transistor and got Nobel Prize had said only the whites could make revolutionary discoveries in science. No one else was capable of doing it. He was berated by many. But he never changed his opinion. I wondered whether there was any truth in what he said. The British ruled for over 200 years and they brought modern medicine to India. We had medical colleges, doctors and hospitals. But we ourselves had never invented or made anything here. This troubled me a lot. That was when I thought, our medicinal traditions are not just 200 years old, but much older than that. Treatment was in existence even during Buddha’s time. The term chikitsa is from Buddha’s period. They didn’t say Ayurveda. Ayurveda and many of its practices that we know now were however practised even then. Did our ancestors think or do something original in treating sick people? That was how I began to read old texts. After I finished my vice-chancellorship, my wish to write books gained momentum. As I said earlier, I wanted to know what the state of science and technology here was in the nineteenth century. There were reports on it written by British historians. I wanted to write on that as Dharampal did. He told me that many unstudied documents exist in the India Office Library, London.
VDS: He wrote Speaking Tree.
MSV: Beautiful Tree. Yes, he himself has written on several topics. He said to me that there are a lot more documents in London if I wanted to write. I was oscillating between this topic and Caraka. Around this time I visited the (Bharat) Kala Bhavan Museum and saw the painting of Caraka by(Nicholas) Roerich there. That was when I thought of M.T. Vasudevan Nair’s metaphor of 'Bhranthan Raghavan was looking for him when he was looking for Raghavan' as the birth of his story writing! When I was thinking of Caraka, Caraka himself was giving me a signal! That was when I decided to study and write on Caraka. Caraka’s treatise is not just about Ayurveda. Caraka was a great philosopher who was also a great physician. Take his observations on the school of philosophy called Sāṅkhya. Sāṅkhya is one of the oldest systems of philosophy. Even Bhagavad Gita mentions Sāṅkhya. An important doctrine in Sāṅkhya relates to parinama or evolution of the universe. Caraka was an originator of the doctrine which postulated 24 tatwas (a technical term indicating roughly stages). To start with, there was an indeterminate and indefinable existence called Avyakta. In infinite time, a perturbation occurred and awareness (Mahat or Buddhi) appeared; this was followed by the appearance of Ahaṅkāra or individuation when the collective became divided; next emerged five bhūtas—ether, air, fire, water and earth; the next to emerge from bhūtas were five senses and mind; the last to appear were the objects of five senses and mind, which are what the eye sees, the ear hears, tongue tastes, nose smells, skin feels and mind thinks. These objects constitute Samsara which, in infinite time, would dissolve into Avyakta and the parinama would begin all over again. This is of course different from Darwin’s evolution of species.
VDS: It is cyclical?
MSV: Yes. This is Caraka’s Mūla Sāṅkhya. You will notice the scheme doesn’t have a place for any external agent.
VDS: You mean God has no place?
MSV: Not just God, nothing external has a place. Bhagavat Gita, explicitly says that Purushothama exists above and beyond kshara and akshara (Kshara represents all creations that perish; akshara is that which doesn’t perish). In Iśwarakṛṣṇa’s Sāṅkyakārika, there are 25 tatwas, which gives a place to Iswara or Purushothama. This is Sāṅkhya distinct from Mūla Sāṅkhya. Caraka lived in the 1st Century CE and Iśwarakṛṣṇa lived one or two centuries later.
VDS: Original Sāṅkhya had no place for God; Iśwarakṛṣṇa’s Sāṅkhya reaffirmed it.
MSV: That is true. It is a fact that Mūla Sāṅkhya or Nirīśwara Sāṅkhya associated with Caraka and with 24 tatwas lost sway to Seśwara Sāṅkhya of Karika with 25 tatwas after one or two centuries of Caraka. The answer seems to be straightforward. When life is confronted by tragedies or existential threat, humanity turned to faith for solace and courage throughout history. As Mūla Sāṅkhya failed to offer a source of solace and support as we walk in the valley of the shadow of death, an affirmative doctrine of Seśwara Sāṅkhya brimming with hope won greater acceptance by posterity.