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Timestamp: 2019-04-20 17:03:06+00:00

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Abstract Objective: To chronicle the history of medicine and neurology in India with a focus on its establishment and evolution. Background: The history of neurology in India is divided into two periods: ancient and modern. The ancient period dates back to the mid‑second millennium Before Christ (B.C.) during the creation of the Ayurvedic Indian system of Medicine, which detailed descriptions of neurological disorders called Vata Vyadhi. The early 20th century witnessed the birth of modern Indian medicine with the onset of formal physician training at the nation's first allopathic medical colleges located in Madras (1835), Calcutta (1835) and Mumbai (1848). Prior to India’s independence from Britain in 1947, only 25 medical schools existed in the entire country. Today, there are over 355. In 1951, physicians across the field of neurology and neurosurgery united to create the Neurological Society of India (NSI). Four decades later in 1991, neurologists branched out to establish a separate organization called the Indian Academy of Neurology (IAN). Design/Methods: Information was gathered through literature review using PubMed, MD Consult, OVID, primary texts and research at various academic institutions in India. Results: Neurological disorders were first described in ancient India under Ayurveda. The transition to modern medicine occurred more recently through formal training at medical schools beginning in the 1930’s. Early pioneers and founders of the NSI (1951) include Dr. Jacob Chandy, Dr. B Ramamurthi, Dr. S. T. Narasimhan and Dr. Baldev Singh. Later, Dr. J. S. Chopra, a prominent neurologist and visionary, recognized the need for primary centers of collaboration and subsequently established the IAN (1991). The future of Neurology in India is growing rapidly. Currently, there are 1100 practicing neurologists and more than 150 post‑graduate trainees who join the ranks every year. As the number of neurologists rises across India, there is an increase in the amount of basic, clinical and epidemiological research being conducted across the country every day. Conclusions: The history of neurology in India roots back to its rich culture and tradition. Over time, there has been great structural and organizational evolution and the future of neurology in India appears to be bright. However, the number of neurologists and research in neurology needs to experience a significant growth in the future to ensure the best patient care.
Key Words Ayurveda, dementia, Epilepsy, history, stroke For correspondence: Dr. Shrikant Mishra, 16111 Plummer Street, North Hills, CA 91343, USA.
Figure 2: Charaka 500 B.C.
in Feet (Paada Suptata), Sciatica (Gridhrasi), Loss of movement in thighs (Urusthambha) and Lameness (Pangu) Paraplegia, Wasting of arms, Brachial plexopathy (Baahu soshana), Tinnitus (Asabdasravanam), Temporal Headache (Shankha Bhedascha), Frontal Headache (Lalata Bhedascha), Bell’s Palsy (Arditam), Monoplegia (Ekanga roga or vata), Quadreplegia/ Poly neuritis (Sarvangavata), Hemiplegia (Pakshavadha), Convulsions (Akshepaka vata), Syncope or Blackouts (Tamaha), Giddiness or Vertigo (Bhrama), Tremors (Vepathu), Hiccoughs (Hikka), Delirium (Atipralapa), Insomnia (Anidra), Instability of Mind (Anavasthita Chittam), Tetanus (Hanugrah) and Lathyrism (Kalay Khanj). For each category, a detailed clinical profile is presented and medical treatments are proposed.
scholars conducted the study on Ayurvedic drugs and further enriched the contents of Unani. Soon, Unani became popular nationwide between 12th and 17th centuries and maintained a strong hold even after the downfall of Mughal Empire. During the British rule, Unani medicine suffered a setback and its development was hampered due to withdrawal of governmental patronage. However, since Unani enjoyed faith among the masses it continued to be practiced. It was mainly the Sharifi Family in Delhi, the Azizi family in Lucknow and the Nizam of Hyderabad due to whose efforts Unani medicine survived during the British period. Today, Unani medicine is patronized by the government of India with the establishment of 43 Unani colleges and 22 research institutes nationwide. Ministry of health and family welfare, which monitors health services in India has two major divisions: Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy and Modern Medicine. With the advent of 17th century, the Portuguese, Dutch, French and British East India Company came to India as traders. Each brought their own doctors for their workers on ships and in factories. Towards the middle of 18th century, the British defeated other colonizers in a series of battles and emerged as a dominant European force in India. As a result of this, they started conquering territories and colonizing from local Indian rulers, established armies and eventually took over the entire governance including medical services in the Indian subcontinent.
Medicine in British India: (1858‑1947) Western Allopathic Medicine began in India when various acts such as the Quarantine Act (1825), Vaccination Act (1880), Birth and Death Registration Act (1896) and Epidemic Act (1897) were put in place. The British government established and organized Indian Medical Services to provide facilities for medical relief and the promotion of public health. The staff that occupied higher positions were recruited through examinations and trained in London. The first medical colleges were established to help prepare staff who filled lower positions, in 1835 in Calcutta and Madras and in 1843 in Bombay [Figures 7‑9]. Following the establishment of the first medical colleges, medical colleges were further established in Hyderabad (1846), Lahore (1860), Pune (1878) and Sindh (1881). Thereafter, in the early 1900s medical colleges were set up all over India to provide adequate training for upcoming medical professionals. Some of these colleges include: King George Medical College in Lucknow (1911), Medical College of Dhaka (1921) and the SMS Medical College Jaipur, India (1947). By the year 1946, there were 38 medical colleges with an estimate of 2,400 annual admissions in various parts of British India. In order to foresee medical education, the Medical Council of India was established in 1934. The Indian Medical Council was governed by the British Medical Council. British India saw great success, but India progressed at a rapid rate after gaining Independence.
performed by Lt. Col. Frederick Jasper Anderson in Madras. However, the neurologists/neurosurgeons at the time were not trained in India. Instead, they went abroad to acquire specialized training. Therefore, it was a tremendous achievement when India offered graduate training in Neurology starting in the last quarter of the 20th century.
Initially, the field of Neurosciences was dominated by neurosurgeons. The first Neurological training facility was established in 1948 when the Director of Christian Medical College, Vellore extended an invitation to Dr. Jacob Chandy to start the Department of Neurosurgery at the college. Following the establishment of the neurosurgery Department at the CMC, Vellore, numerous neuroscience departments were set up throughout the country. In 1950, Dr. B Ramamurthi initiated the second neurosurgery at Government General Hospital in Madras. This facility would later become to be known as the Institute of Neurology, Madras. In 1951, the third neurosurgery department was initiated at Seth GS Medical College, Mumbai. In 1962, a Department of Clinical Neurosciences was established at the Postgraduate Institute, Chandigarh. Later, a Department of Neurology was established at the Institute of Medical Science BHU in 1966 and Dr. BC Katiyar was appointed as the head of department. In addition, in 1974, All India Institute of Mental Health, which was started in 1954 as a mental hospital and asylum, was converted to an autonomous National Institute of Mental Health and Neurosciences. In 1976, the Sree Chitra Thirunal Institute of Medical Sciences and Technology added its neurological center of excellence. Furthermore, the Sanjay Gandhi Post Graduate Institute was established to focus on specialized education and research in various fields of medicine, which included neurology, in 1983. As a result of this progress in Neurology in India, there are currently over 1,100 qualified clinical neurologists working in the country. Also, there are about 59 MD programs instructing nearly 169 students annually and 39 DNB programs with 51 positions providing a form of postgraduate training in Neurology in a private practitioner based setting [Figures 10‑12]. The following table is a list of active Neurology Programs in India [Table 1] [Figures 13‑17].
number of medical colleges reached 81 with over 10,000 annual admissions. The Central Government of India took upon the executive responsibility of developing postgraduate medical education and promoting special studies and research in medicine. The University Grant Commission was established in 1956 and the Indian Council of Medical Research was started in 1949. Furthermore, the Central Government ministries like the Health ministry and Science and Technology ministry were responsible for the clinical, educational and research support. This allowed for the development of educational institutions that focused on Neurology.
History of Neurosciences in India Interestingly, the idea of establishment of neurosciences in India stemmed from the minds of clinicians in neurology. Hence, soon after the formation of the neurosurgery department at the CMC Vellore in 1949, the notion of setting up separate departments in basic neuroscience was conceptualized. The subsequent years saw the inception of Neurochemistry and Neurophysiology Departments at CMC Vellore followed by Neuropathology and Neurochemistry Departments at Madras Medical College. Over the years, various places across India saw similar development in the field of basic neurosciences. Later, NIMHANS Bangalore added a Department of Neuropharmacology in addition to the already existing Departments in Neurosciences. However, AIIMS New Delhi was the only institution with a strong foundation in Neuroanatomy, Neurophysiology and Neurochemistry prior to setting up Clinical Departments. Recognizing the need for a separate society for basic neurosciences, Professors K. P. Bhargava, B.
Research, Mumbai, Indian Institute of Science, Bangalore and the various research labs at the Council of Scientific and Industrial Research. In addition, there are several other notable institutions, organizations and neuroscientists that deserve a mention in this field.
Department of Neurosurgery in Madras and co‑founding of the NSI. Dr. Baldev Singh, who received his neurological training in Chicago, USA, was the first Neuroscience professor in India and he is referred as “Papa Neuron”. In addition, Dr. Singh was instrumental in the formation of NSI, led the Department of Neurology at All India Institute of Medical Sciences in 1965 and is regarded as the father of Indian neurology. Dr. Noshir Wadia received his neurological training from London and then went onto to create and led the Department of Neurology at Grant Medical College in the 1960s. Professor K. Jagannathan and Professor G. Arjundas were professors of Neurology and essential to the progress of Neurology in Madras. It was with contributions of these individuals that Neurology was able to flourish in India [Figures 18‑23]. As neurology started to grow in India, society’s specific to neurology began to form. Currently the two major societies are: NSI and Indian Academy of Neurology (IAN). NSI was the first organized society for Neurology in India and was founded in 1951 by Dr. Jacob Chandy, Dr. B. Ramamurthi, Dr. S. T. Narasimhan and Dr. Baldev Singh. Currently, the president of NSI is Dr. C. E. Deopujari. Sub‑sections of NSI include Neurology, Neuropathology and Neuroradiology.
accomplishments included seting up of Tumor and Stroke registries and traveling fellowships in early 1988. Despite the success of NSI as a pioneering representative society of neurosciences in India, it was still a society dominated by neurosurgeons. Therefore, the IAN was established in 1991 by Dr. Chopra. The first elections and complete staff constitution of IAN were completed by 1993. IAN also formed its own offical journal called the “Annals of IAN.” Intially when IAN was formed, there were 100 members; today, there are over 1,000 members [Figure 24].
Chitra Sarka, Dr. Radhakrishnan, C. G. S. Lyer, C. K. Job, K. V. Desikan, V. R. Khanolkar, D. K. Dastur, N. H. Antia, L. Mehta, S. S. Pandya, M. C. Vaidya, M. G. Deo, G. P. Talwar, Indra Nath, Tandon, Wadia, U. C. Chaturvedi, Asha Mathur, Kalyan Banerji and others have aided the field of Neuropathology. As for Neuropharmacology, Dr. R. N. Chopra, B. B. Bhatia, K. P. Bhargava, B. N. Dhawan, R. C. Srimal, R. B. Arora, N. K. Bhides, U. K. Seth, Nilima Kshirsagar, P. C. Dandiya, M. K. Menon Jaipur, C. Sarkar, D. K. Ganguly, P. S. R. K. Harnath, S. K. Bhattacharya, P. K. Das, S. K. Kulkarni, G. V. Satyawati and additional scientists have played a great role in its achievements. Scientists from IITY, Lucknow, NIMHANDS, Bangalore and NBRC, Manesar helped establish the field of neurotoxicology. It was with the help of the scientists and leaders mentioned above that the field of Neuroscience became a distinct discipline. Many others have followed in their footsteps to help establish the current state of Neuroscience in India.
increased from 8 in 2009 to 20 in 2012. The ISA is currently led by Dr. M. V. Padma Srivastava as the President and Dr. Vinit Suri as the Secretary. Epilepsy is yet another commonly encountered neurological disorder in India which deserves a special mention due to the social stigma attached to it. Epilepsy has a wide treatment gap with high discontinuation rates due to various myths and misconceptions associated with this disorder. Recent community‑based surveys have shown that epidemiological indices of epilepsy in India are comparable to those from developed countries, with a prevalence rate of ~5/1000 and incidence rate of ~50/100,000. The Indian Epilepsy Association was formed in 1972 as result of the combined efforts of Dr. Eddie Bharucha, Dr. Noshir Wadia and Dr. Anil Desai who was then a designated secretary of Epilepsy section within NSI (1968‑1969). The society rapidly gained importance and hosted the 18 th International Epilepsy Congress in India at New Delhi in 1989. The society which started with 16 chapters has around 27 chapters all over India today with a total membership of over 1597. It is currently led by Dr. V. V. Nadkarni as the President and Dr. M. M. Mehndiratta as the Secretary.
Neurophysiology and neurochemistry. More recently, Behavioral Neurology, Computational Neuroscience, System Neuroscience and Cognitive Sciences have been included. In a recent analysis of research output in neurosciences in India, it was found that India ranked 21 among the top 26 countries in neurosciences with an average citation of 4.21/paper. India was far behind China, Brazil and South Korea in terms of publication output, citation quality and share of international collaborative papers in neurosciences.  These statistics indicate the dire situation of neurosciences in India. In order to ensure growth in neurosciences, changes need to occur at the grass root level. The academic institutions should educate and encourage the graduates and postgraduates about various courses available in the field of neurosciences. The academic institutions should organize awareness programs and specialized training programs targeted towards young researchers. The development of infrastructure is critical in strengthening the research initiatives. The clinicians should be encouraged to participate in research projects and be aware of the latest developments in neuroscience. Substantial measures should be taken to improve collaboration among the researchers and clinicians of various academic institutions both national and international.
With the growth in aging population, the cases with dementias are growing to exponential levels. In India, according to 2001 census there were 77 million people above the age of 60 and it is estimated that by 2025 this number will increase to 177 million. Due to lack of accessibility, most of these dementias go unrecognized until later stages of the disease and the burden of care falls in the hands of the care givers. Alzheimer’s and Related Disorders Society of India is a non‑profit voluntary organization that is engaged in the care, support, training and research of dementia. It was established in 1992 due to the dedicated efforts of Dr. Jacob Roy and the organization has grown to embrace 14 chapters nationwide today.
There are several other disorders like Parkinson’s disease, Multiple sclerosis, neuromuscular disorders, neuroinfections and brain tumors which constitute the neurological maladies in India. The most important step in the management of these neurological disorders in India is the setting up of support groups and neurorehabilitative services. The Parkinson’s Disease and Movement Disorders Society of India, which was established in 2001 is a non‑profit organization, which aims toward successful coordination amongst various chapters and support groups. It is currently headed by Dr. BK Parekh as the President and Dr. B. S. Singhal as the Secretary. In addition, the Multiple Sclerosis Society of India, which was registered in 1985 as a voluntary, non‑profit organization aids in the welfare of patients affected with this disorder. The society is comprised of nine chapters nationwide with its head office located in Mumbai.
Many crucial changes need to take place in the field of neurology and neurosciences in India. The neurologists and the neuroscientists have to work in synergy to ensure advancement in this field. The country needs more neurologists to meet the high volume of patients and neuroscientists to discover groundbreaking remedies. Funding for the betterment of these two societies is quintessential in managing the growing burden of neurological disorders. It is only through these changes in India we can expect to see growth not only the field of medicine, but also in neurology.
The authors would like to thank Satish V. Khadilkar, MD, DM, Professor and Chair, Department of Neurology, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India. Ushakant Misra, MD, DM, FAMS, FASc, FRCP, Professor and Chair, Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
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