Prince of ophthalmology
Here is a discovery that has to be made known to the ophthalmic community in India. Dr. S.S. BADRINATH, Dr. J. BISWAS and Dr. VASANTHI BADRINATH on Rajah Serfoji II, a royal prince and surgeon of Thanjavur who deserves a place in the world community of physicians.
A portrait of King Serfoji II ... pioneer.
THE magic of the cataract operation, has always been associated with ophthalmic giants Jacob de Wenzel, Jonathan Wathen, Antonio Scarpa and Karl Himly. The bravest of them, Dr. Jacques Daviel, took the medical world by storm when he presented his findings to the French Academy of Surgery in 1752.
The father of modern ophthalmic surgery, this French surgeon is believed to have heralded the concept of cataract treatment by removing the affected lens to restore sight. After that, eminent surgeons have created history with their innovative practices of painless operations that have resulted in the latest methods of anaesthetised cataract removal. Acclaimed as the pioneers of modern surgery, these European surgeons and physicians have practically obliterated others who were equally eminent but did not have access to international forums where their work also could have been presented and judged. Rajah Serfoji II (1777-1832), a deposed prince of the Maratha dynasty in the south city of Thanjavur in Tamil Nadu, was one such unknown pioneer.
A descendant of Chattrapathi Shivaji, and one-time ruler of the kingdom of Tanjore, this scion of a warrior dynasty became an ardent champion of the arts, education and healthcare. When the British forced him to give up his throne in 1799, Serfoji turned the crisis into an opportunity by seeking the privilege to manage temples and choultries in the kingdom. By promoting social, cultural and educational activities on an unparalleled scale, he accomplished much more than what he would ever have done with just a title.
Nucleus of medical care
The Dhanvanthri Mahal, a medical research centre dedicated to the research and practice of the alternate systems of medicine of Siddha, Unani and Ayurveda became the nucleus of medical care in the State. He dispensed medicine in the Aushadha Kothadi (pharmaceutical godown) and had scholars to document prevalent health disorders with these medical practices. The result was the scholarly treatise Sarabendra Vaidya Muraigal that dealt with, among other things, diseases of the eye.Rajah Serfoji was known to carry boxes of medicines and surgical appliances with him even when he went on pilgrimage to Kashi (Benares). He not only treated various diseases, but also practised surgery. The successful removal of the cataract by the couching method that he advocated and practised as early as in the 18th Century was perhaps as stunning an achievement as those of his British and European counterparts of that era. But, Rajah Serfoji II never stepped on the world stage. His little known achievements were confined to books and manuscripts and paintings, and now preserved by his descendants in the Saraswathi Mahal Library in Thanjavur.
In September 2003, a meeting between Dr. Badrinath and Babaji Rajah Bhonsle, current Prince of Thanjavur and sixth descendant of King Serfoji II, revealed the existence of 200-year-old manuscripts in the Saraswathi Mahal library containing records of the eye operations conducted by Prince Serfoji II. That was in early 19th century when photographic techniques had not yet evolved. But that did not deter Rajah Serfoji. He commissioned artists to draw pictures of the eyes of his patients with their defects. He filed these charts with details of their age, occupation, date of admission and discharge. The method of surgery and post-operative treatment with the names of prescribed medicines were also recorded. Babaji Rajah Bhonsle described at length the work done by his ancestor. We were delighted to hear about this treasure house and made plans to visit the library with a historian and a photographer.
We felt that not only should this important discovery be conveyed to the ophthalmic community in India but the royal surgeon of Thanjavur deserved a place in the world community of physicians and surgeons.
In March 2004, three of us accompanied by archaeologist Dr. R. Nagaswami and the photographer examined the records in the Saraswathi Mahal Library and the Dhanavanthri Mahal where the former prince conducted his operations. (The hospital is now a school run by St. Peter's Church.) It was a voyage of discovery. A medieval library serving as the nucleus of a range of activities in the fields of art, religion, history and literature. Along side was a wealth of material on judicial functions, social service and medicine. A scholar and visionary, Maharajah Serfoji may have belonged to a warrior race, but it must be remembered that this descendant of Shivaji came under the influence of a Danish priest, Father C.F.Schwartz, who not only taught him English and other European languages, but also kindled in his young pupil a yearning to learn and understand the thoughts of great philosophers. The collection and selection of the thousands of books in the library, with the Rajah's marginal comments, revealed his erudition and a wide range of interests.
There were many questions. How did Rajah Serfoji get into medicine in the first place? And why did he choose ophthalmology? We wondered if any British physicians/surgeons were involved. And what system of medicine did he follow? Could Father Schwartz have had anything to do with it? It was found from the Modi records that English ophthalmologist Dr. McBean was associated with the Eye Hospital of Dhanvantri Mahal. He was paid by the Company Rs. 4,000 towards his professional services.
Other questions will never be answered. The enigma of Serfoji's multifaceted career will always remain a mystery. The equipment and the instruments that he used were all confiscated and relegated to the dustbin of history. The hospital where he treated patients and performed operations is no more. Even the descendants of the patients have vanished.
Evidence of Serfoji's skills
The only evidence of Serfoji's amazing contribution to medicine lies in 50 charts and manuscripts. They contain handwritten case histories (38 of these written in English) of the patients operated by King Serfoji. Starting with the diagnosis of the disease, these records contain minute personal details of the patients. The medical team from Sankara Netralaya was astonished to find ophthalmic terminology like "cornea, conjunctiva, capsule of the lens and posterior chamber". In patients in the age group of five to 60 years, the most common condition was cataract and glaucoma. The status of their vision, and post-operative improvement were all carefully recorded. Medicines like silver nitrate, belladonna, chalk powder and peppermint water were used extensively. And, of course, there were leeches to reduce congestion and inflammation. Both Indian and European medicines were used. The significant part of these findings lies in some magnificent colour drawings of patients' eyes before and after surgery. At a time when scanning and imaging were unknown factors, this prince of medicine made use of his own techniques to treat and cure people free of cost.
Will the world of modern medicine understand or appreciate Serfoji's remarkable contribution to this field? With its own sophisticated and cutting edge techniques of surgery and disease treatment, will it have the patience to hear his story? The Mahratta prince may have lost a kingdom to the British. He may have lived and worked in anonymity.
A record of the treatment done at the time of King Serfoji (1777-1832).
He may have sought no recognition or won no awards, but if one can find the time and pause to consider the vast humanity of his labour, one will understand the magnitude of his achievement. This humanity can be found in the simplest of his actions. At the end of every cataract operation, a patient received a reward of two rupees from the royal surgeon for having given him the privilege of restoring one more person's vision!
The authors acknowledge the help of Senior Prince Babaji Rajah Bhonsle,
Mr. R. Perumal, Conservator, Saraswati Mahal Library, Dr. R. Nagasamy, Former Director of Archaeology for providing information and
Mrs Vatsala Vedantham for writing this article.
Dr. S.S. Badrinath is founder and Chairman of Sankara Nethralaya.
Dr. J. Biswas is Director, Ocular Pathology and Dr. Vasanthi Badrinath, Director, Laboratory Services in the same institution.
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