From civil hospital to public health lab: The erstwhile healthcare model of Kerala

At a time when people were afraid of accepting allopathic medicines, a young queen had started a vaccination wing in her princely state in the south of India during the early 19th century and insisted her royal family members get vaccinated first.

Rani Gauri Lakshmi Bai, the capable woman ruler who had administered the erstwhile princely state of Travancore from 1810-1814, persuaded her palace household to accept the jab for smallpox to remove the existing stigma attached with English medicines and thus to bring its benefits to the ordinary people.

Her sister and successor Rani Gauri Parvathi Bai carried forward the mission by establishing a charity dispensary for the treatment of commoners.

In the ensuing decades till the the country's independence, the princely state had opened a civil hospital, exclusive treatment centre for women and children, lunatic asylum, leprosy and ophthalmic hospitals, sanitation department, a public health lab and so on and manufactured vaccines for anti-rabies and smallpox.

At a time when the present "Kerala model" of public healthcare has been winning accolades worldwide, its roots and foundation can be traced back to the progressive and bold decisions taken by the royalty.

Not just in Travancore, the allopathic medicines and the concept of a well-defined public health system started gaining popularity in Cochin and British Malabar, the princely states which had later been amalgamated to form the state of Kerala post-independence, also during the period.

According to historical records, the first medical institution to be established in Travancore under the state was the 'Palace Dispensary' opened under the rule of Lakshmi Bai.

The first ever medical dispensary of Cochin was opened at Mattancherry in 1818 but the modern medical facilities in Malabar, which was under the direct rule of the British Collector, started only later, it said.

Travancore had 31 hospitals during the 1884-85 period, according to "Progress of Travancore" penned by poet and historian Ulloor S Parameswara Aiyer which was published by the state Department of Cultural Publications.

Veteran medical historian K Rajasekharan Nair said like other parts of India, traditional medical systems especially Ayurveda and indigenous healing practices were predominant in these princely states also till they came under the rule of the British East India Company.

"The arrival of Europeans and the influence of Christian missionaries, especially the London Missionary Society (LMS) helped modern medicines to gain acceptance among the royal family members here and thus among the common people in course of time," he told PTI.

The outbreak of "vasoori" (smallpox) had prompted the rulers of Travancore and Cochin to start a vaccination wing in their kingdoms during the early 19th century. "Actually, in Cochin, the vaccination was introduced by 1802 itself and six trained vaccinators were employed by the state since 1812.

But, it made no progress at all as the people were terrified by the vaccination," he said. Though Queen Lakshmi Bai of Travancore had launched the vaccination department with the support of the royal physician during early 19th century, it took over six decades for one of her successors to issue a royal proclamation (1877-78) making vaccination compulsory for public servants, students, patients, jail convicts and lawyers in the kingdom.

The 'charity dispensary' of Travancore, where prisoners were the first to be treated, had been upgraded as a lying-in-hospital in 1837 by versatile music-composer king Swathi Thirunal. King Uthram Thirunal, who had great interest in allopathy, even treated people by himself opening the “Elayaraja's Dispensary” at the Fort area, says the book "Evolution of Modern Medicines in Kerala" penned by Nair.

The Civil Hospital (present General Hospital here), which was opened in November 1865 by King Ayilyam Thirunal, can be considered as the first modern hospital in Kerala. After opening the hospital, designed by British civil engineer Barton, the king had said:

"My wish is to provide good healthcare facilities to people belonging to all sections. It is hence the obvious duty of the state to render its assistance in this direction." Though a maternity wing was also attached with this hospital since the beginning, caste Hindu women were reluctant to use that facility and an exclusive women's hospital started for them later by the Zenana Mission, an Anglican Missionary society, made a sea change in their attitude which prompted the royal rulers also to start a similar one.

Travancore royals also set up a temporary lunatic asylum in 1879 which was later shifted along with the leprosy hospital to Oolanpara, some kilometres away from the town. The reign of King Sri Moolam Thirunal, who had ruled the princely state from 1885-1924, was a flourishing period for modern medicine as several civil hospitals and advanced facilities came up during the time.

"The earliest private institution in Travancore was the one opened by the LMS at Neyoor (now in Tamil Nadu). The number of institutions receiving grant-in-aid from the government at the close of 1915-16 was 12," Ulloor said in his book.

Nair said: "Though Malabar was far behind Travancore and Cochin in terms of the implementation of the modern medical system in the early years, several landmark changes happened there later.

There was even a Medical School in Calicut which was started during the fag end of First World War." Travancore became the first princely state in India to abolish quackery through a royal decree in 1943 and the Journal of Indian Medical Association even wrote an editorial praising the government for its firm stand.

Travancore royal family member Aditya Varma said the last ruler of Travancore, Sri Chithira Thirunal was the one who had amalgamated the Sanitary Department with that of the Public Health. "Malaria had gripped the state as an epidemic in 1935. It was said that a statewide malaria and filariasis survey launched by the government helped to collect valuable data which played a vital role in drawing up a comprehensive plan to tackle that menace," Varma told PTI.

During the peak of the disease, king Chithira Thirunal and his mother even visited a treatment centre at Neyyattinkara and touched and interacted with them breaking the existing customs to give them solace and confidence, he said.

On the well-equipped Public Health Laboratory opened in the kingdom in 1937, he said besides the top-notch research facilities, it also provided remarkable services in the areas of diagnostic tests, examination of bacteria and culture, production of vaccines and anti-rabies treatment.

According to a government handbook published in 1958, there were 53 government hospitals and 198 dispensaries with a total bed strength of about 9340 in Kerala.