With NIMHANS celebrating 75 years this year, here’s a look at its inception.
The National Institute of Mental Health and Neuro Sciences (NIMHANS), located on the grounds of the erstwhile Mysore State Mental Hospital, was designed as the first modern, open mental hospital in the early 20th century.
The man behind this was Frank Noronha. The hospital’s origins, and its development in the context of the medical and social history of Bangalore (and India), thus offer a glimpse into the influences that shaped mental health services and education in India.
Frank (Francis Xavier) Noronha, born in 1878, to John Joseph and Seraphima Noronha. John Noronha had moved to Bangalore from Mangalore in 1855, and being fluent in both ‘English and Canarese’ was appointed as the ‘Head Moonshee’ under Capt. Francis Cunningham in March 1857. Francis Cunningham himself was a personal assistant to Sir Mark Cubbon, and an avid gardener, who played a role in creating the Lal Bagh Horticultural society to improve the vegetable, fruit and medical plants of the region. Gardens and spaces thus had an early influence on the Noronha’s, and one can only speculate that the name the young son of John Noronha was christened with also linked him to a love of gardens. Frank Noronha later He studied at the Madras Medical College, joined the Mysore Medical service, and also served in the Army. After the First World War, when efforts were made to improve the care of the mentally ill, Noronha became one of the first doctors to be formally trained in psychiatry at the new Institute of Psychiatry in London. This paved the way for the building and design of a new hospital complex, surrounded by landscaped gardens, which was different from the way asylums had been built in India. and it was this that prompted its evolution into a premier Institute.
The building, however, was a successor to a century of work and ideas. Dr Charles Irving Smith was born in Bangalore in 1809. After his education as a doctor in the U.K., he started his career in the same city in 1831 and began treating patients with ‘lunacy and mania’ at the Hospital for Soldiers, Peons and Paupers, which was established in the Bangalore Cantonment area as one of the first civic services provided under the rule of the East India Company. Based on his clinical work, and since he was also the personal physician to Sir Mark Cubbon, he was able to encourage him to establish a separate ward for the insane, and then gradually a separate building (part of the disused Jail) was added. By the 1850’s, a regular Asylum was in operation. Similar Asylums had been established all over India, some of the earliest in Calcutta and Madras in the 1790’s, where the East India Company had first established its presence. Dr. Smith also contributed immensely to the establishment and improvement of hospitals in Mysore, and later served as the Inspector-General of Hospitals for Madras and Rangoon.
By the time the first gazetteers of Mysore were written, and the first census undertaken in 1871, the Asylum was well established enough to figure in all the reports. It was mentioned that the Asylum had accommodation for 260 patients, at 50 superficial feet per person. The buildings were ‘simple but airy’, and the sanitation ensured by an adequate water supply and dry earth conservancy. Located in the building that now houses the headquarters of the State Bank of Mysore, it lay on the decline at the end of the Cubbon Park on the shores of the Dharmambudi tank, with an extensive garden of mango and other fruit trees. Fresh water and air, and sanitation were thus looked after, and the Asylum lay between the British zone and the old city Pettah. Doctors had to travel all the way on horse-back and requested relief that they be allowed to visit the Asylum once a day, instead of twice (2 miles each way, on horseback, twice a day being a bit of strain!). The Asylum proved quite popular, and by the 1870’s it was often noted that patients were brought in for ‘humane’ reasons (being paupers) rather than for medical ones. At time of crisis, e.g. during cholera and plague epidemics, the entire Asylum was moved to a healthy, hilly area of Basavangudi (now a crowded suburb). During the great famine of 1878, it was hinted that almost the only those mentally ill who survived were those in the Asylum, as those in the community starved to death in times of want. Dr. Oswald and Dr. Houston were among the early doctors, and Mr D’Cruz the Indian assistant who continued to serve here for many years into the 20th century.
Till the late 19th century, the Mysore Kingdom (which had become independent following the Rendition of 1881 and the Government having reverted to that of the Maharaja) was the only native kingdom that supported a lunatic asylum. It was thus identified as one of the regions of progressive governance, and its commitment to improving medical services was further strengthened by its support for many large hospitals in Bangalore and Mysore. Victoria Hospital was surrounded by a large garden of English design, while the gardens of Bowring and Lady Curzon were apparently modelled on gardens in Paris but, sadly, none of these now remain. A larger asylum was recommended as the population was likely to grow from the 150,000 that it was at that time! Some gradual improvements were made, but lack of staff and local cultural factors were quite cumbersome. By the end of the first world war (1920), a new building was thought essential, as according to Kantharaj Urs, the Dewan of Mysore “the present buildings consists of no more than a few stone mantaps, ill adapted for the purpose with no suitable accommodation for staff. There will have to be specialists in nervous diseases. For the treatment, a quiet healthy place away from the city is necessary… in the next year’s budget a plan may be prepared.”
Dr. F. Noronha was thus sent off to the U.K. in 1922 to train as a professional psychiatrist and also to manage the new asylum being planned. On passing his DPM exam, he became a member of the Royal College in 1924, where he was introduced by Sir Frederick Mott (a famous psychiatrist and geneticist). On his return, he improved the case notes and introduced a formal examination and files for every patient, and many other reforms (including the diet). Equally importantly, by this time, the financial burdens of the First World War were getting over, and the Kingdom finally had enough resources. The old campus on Avenue Road was sold off for a few lakhs, and the sprawling undulating hills that lay between Lal Bagh (where Francis Cunningham had worked a century before) and Basvangudi were chosen as a site for the new building. Though initially a site in Mysore (close to Huikal lake) had been mooted, Dr. Noronha was of the firm opinion that Bangalore was to be preferred as it was close to already established large medical facilities and “ which (while) being fairly away from the main centres of population will still be within easy reach of the principal medical institutions”. Mr Wilson, the Health Secretary, ensured that the asylum was separated from the larger tanks, and the city, of Bangalore by another garden (Wilson’s garden) and this area was reserved for the poorest and most marginalized (the Asylum, a TB Sanatorium, Juvenile reform homes and homes for the destitute were developed subsequently)
The second highest hillock in Bangalore (the highest having been developed as the Indian Institute of Science) was thus chosen. Sir Mirza Ismail was the Dewan by then and he shared a passion for gardens and well-designed public spaces with Dr. Noronha. Sir Mirza Ismail believed that well looked-after gardens and avenues cost little but yielded much “in the effect (they) had on peoples’ minds”. Many recall Sir Ismail riding up on horseback to review the progress of the building and the lawns.
Dr Noronha was also a very keen gardener, and many of the trees were chosen by him, in discussion with Gustav Krumbiegel, the eminent botanist from Germany, who designed the gardens at the Bangalore Palace at that time, and the Lal Bagh. More than 75 species of trees, both native and exotic, can be found in the campus of the Hospital. The plans of the garden were prepared in conjunction with those of the building, and Dewan Mirza Ismail was very proud of the fact that they had created parks in the Mental Hospital, which were often used as picnic-grounds for the citizens of Bangalore (and thus by association, the stigma and exclusion of mental illness was reduced).
The new building itself was loosely based on the plans of the Institute of Psychiatry building, then was housed at the Bethlem hospital site in Moorfields. It was constructed by the civil engineering firm, the Mysore Engineering Company (MEC), which was staffed entirely by Indian engineers and was responsible for many public works. It was considered essential that the spaces in an asylum provide an environment conducive for recovery, and this principle lay at the root of asylum design, where “where one could be both mad and safe”.
This careful consideration to a healing environment contrasted sharply with other asylums in India, which were often hand-me-downs from jails or barracks. This building, and the Hospital for Europeans and Indians in Ranchi, were the only two custom-built asylums in British India in the early 20th century, and were designed with the explicit purpose of providing a healing environment, and with all the necessary ‘modern’ attributes. The old asylum on Avenue Road was closed, and the staff and patients moved to this site in 1937.
Prof. E. Mapother, who headed the Institute of Psychiatry in London, while on a visit to India in 1937, was so impressed by the Mental Hospital in Bangalore that he strongly recommended it as the only one fit to impart post-graduate training and also because Bangalore was modern, cosmopolitan and free of communal or anti-Western feelings. His suggestions to the pre-Independence reform process were probably instrumental in the decisions made soon after, and the AIIMH was formally established in 1954 in association with the Mysore State Mental Hospital. Psychiatric services of Mysore, which began in the 1830s, thus, became part of the social life of Bangalore, and India. The Asylum has evolved into an Institute of some renown, and its services are used by more than 1000 persons every day. Almost 1000 psychiatrists, and several hundred other specialists have trained here and it has now become a hub for research into many aspects of the brain and mind.
Institutional histories are not merely an account of the brick and mortar, but also the ideas (and the trees) that are planted and nourished therein. The attention to the needs of the disadvantaged, provision of the best possible care for them, in the best possible environment, and concern for both the physical and mental spaces that surround those with mental illness, indicated a deep concern about the lives of the citizens.
The garden and the building are to be seen as a manifestation of this ideal, and perhaps deserve a heritage status. As we celebrate 75 years of the building, and its gardens, one would do well to remember those ambitions.
(Prof. Sanjeev Jain is Head of Department of Psychiatry, NIMHANS. Prof. Pratima Murthy heads the Centre for Addiction Medicine in the Dept. of Psychiatry, NIMHANS.)