The following encounters cannot be supported by documented records. In the year 1964 retrievable medical record keeping did not exist in the hospital. These narratives are from my memories. The dates of occurrences may not be accurate. But the events are genuine.
Having nothing better to do, I used to follow around the hospital with Professor Raghavachary.
One early morning, during one of these rounds, a young ENT resident came running to me in the hospital. He wanted me to see a patient in their department. The story goes like this:
Professor Korean, the HOD of ENT department had a 17 year-old girl he had operated for otitis media. I even remember the side the left. Following surgery she began to complain of headache; started to vomit. She couldn’t eat, couldn’t keep any solid or liquid by mouth. She started to become unsteady on her feet. Unable to go to bath room. Finally she became bed bound. Professor Korean knew there was something wrong with the girl’s brain; possibly a brain abscess. In the early sixties diagnosis of brain abscess in a pa patient was like a death sentence. Almost 100% mortality. The case was hopeless. He declared to the retinue of assistants, residents and medical students that nothing could be done for the poor girl. At that moment, one of his assistants casually said that he heard a rumour that there is a neurosurgeon who came from Edinburgh working under Professor Raghavachary. Professor Kurian told his assistant casually,
“This girl is going to die any way. Why don’t you ask him to see her for an opinion.”
I was excited. The first official consultation for a neurosurgical opinion in the first Medical College Hospital in Kerala! I saw her immediately. The patient was an emaciated little girl, appeared to be too small for her age, confined to bed. I propped her up. She had truncal ataxia, head titubation, gross nystagmus and roaring papilledema. Diagnoses was easy: cerebellar abscess from the left ear infection with rapidly increasing ICP. The only treatment was immediate surgery to drain the abscess.
Here was the challenge.
In the early 60’s Neurosurgery was still in primitive stage even in Western countries with a horrible reputation! They all died! The treatment was worse than the disease! So went the legend. Diagnostic tests were limited; skull x-ray, myelogram, pneumoencephalogram, ventriculogram and EEG. Angiography was the latest advance. Professor Norman Dott of Edinburgh first used it to demonstrate a ruptured intra cranial berry aneurysm and operate to treat it by placing a ligature on the neck of the aneurysm through a craniotomy. I had the distinct honour of assisting him perform one of these operations in 1962 before his retirement. Even these tests, obsolete by current standards were not available in MCH.
I had to think fast; improvise. With the help of a few, curious general surgery residents and a very cooperative OT supervisor by the name Mariamma-I remember her face even now- I took the patient to OT; made a right frontal bur hole under local anaesthesia. Using a metal brain cannula ( I don’t know where I got it from) I punctured the ventricle. I hit the it at the first attempt (not because of my skill but due to the fact the ventricles were hugely dilated due to the blockage of CSF in the posterior fossa) I put 2 cc of Pantopaque, an oil based iodine x-ray contrast material, and took an x-ray of the skull; one view.
Voila, there it was! The fourth ventricle was distorted and shifted to the right by a huge mass in the left cerebellum; an abscess. I saw the patient at about noon. The diagnosis was confirmed by 2 pm. By that time all the major cases were over in the OT. All the anaesthesiologists had gone home for the day. Further details are vague. Under local anaesthesia I made a vertical scalp incision bout 2 inches long in the midline of the left occiput; made a 16 mm bur hole using the old fashioned perforator and Hudson Bur. I opened the dura and put a metal cannula at the centre of the bulging cerebellum. I hit the abscess cavity on the first attempt (again not because of my experience or skill but the abscess was so big no one could miss it). Out came about 30 cc of thick, purulent pus. The cerebellum became slack. I close the wound without a drain.
That is the first neurosurgical procedure done in Kerala as far as I can remember. It remains unchallenged even now unless some other medical historian tells me otherwise.
Next morning at 8 o’clock I came to see the girl. To my surprise, I found her sitting up in bed and eating breakfast! She went on to achieve full recovery and was home in a week; unusual for a brain abscess in those days. That little 17 year-old girl was lucky; during those days all brain abscess had grave prognosis even with surgical treatment.
The incident became the talk of the hospital, I became a hero! That didn’t last long. I will tell you about it later.