Dr Barnard – The X-Ray man at Madras

Perhaps Dr. Christian Barnard’s blazing trail with his work on open heart surgery during the late 60’s eclipsed the valuable contributions of another, the Captain Thomas William Barnard, O.B.E., F.H.A., F.R.P.S., M.S.R. who refined X-Ray techniques some three decades earlier, during his tenure at Madras. That he made a world standard institution of it at Madras would not be known to many and so I thought it a good idea to share some of TWB’s experiences and his charming insights with you all.

Prof Arcot Gajaraj wrote - Captain Barnard belonged to the category of great men who had a modest beginning, but by dint of hard work, perseverance and foresight brought laurels not only on themselves but also made valuable contributions to the welfare of mankind. He was not a product of any medical school and began his life as an ordinary X-ray operator hardly 10 years after the very discovery of X-rays. What is even more astounding, as our esteemed Madras Chronicler S. Muthiah explained, is the fact that Radiology came to Madras in 1900, when the General Hospital got an X-ray unit a mere five years after Wilhelm Roentgen’s discovery and before such facilities, it is claimed, were established in much of Europe and the rest of the world. As time went by and the first world war wrought tribulations on much of the western world, this invention was to bring about rapid developments in correct diagnosis of diseases, orthopedic issues and go on to impact medical sciences immensely. Let’s now trace the voyage of both man and equipment, their chance meeting at Bombay and see how it impacted the history of Indian medicine.

But before we get to Barnard and his X-ray work, we should hasten to find out how the first X-ray unit reached Madras so early. It appears to have been installed during the days when senior surgeon and Professor Lt Col John Maitland served at the GH. We are given to understand that it was a primitive unit, run from a small set of accumulators. The radiologist who handled the equipment did not quite remain upto date with technology and was not well regarded, so avenues for private investment were opened and Dr. P. Rama Rao filled the void and set up his own X-Ray institute at Kilpauk. One could conclude that Rama Rao and the unit at the GH, managed various patients of the Madras presidency, with Rao sharing a larger percentage of the clientele. As the anxiety of the Asst Surgeon General Dr Govindarajalu Naidu peaked with this deplorable state of affairs, he started a search for a qualified and experienced radiographer.

GH Madras

Captain Barnard’s entry into this dangerous field was deliberate. Why dangerous, you who have been under an X-ray machine so many times, would ask! In those days, the apparatus to produce these all seeing rays was quite crude compared with that now used. It consisted of induction coils with various types of interrupters and many gadgets and devices and well, the naked X-Ray Tube had to be kept cool by various means. Earlier machines were single phase self-rectified x-ray machines with air-cooled rectified valves, cones and cylinders. The tables were mechanically or manually operated with crude spot film devices, etc. There was but little protection against Radiation and Electrical dangers and the risks "X-Ray Operators" (as the staff were named in those days) were called upon to incur were many. Most of the early operators lost limbs and developed dermatitis and other related injuries.

T. W. Barnard joined the staff of the X-ray department of the London Hospital, Whitechapel in 1908. One aspect he picked up quite early was that even with poor equipment, one could obtain good results by dint of hard work. Quoting TWB from his memoirs “Although I used a 'naked' X-Ray Tubes with no protective shield, I escaped serious injury apart from damaged finger nails, as I took precautions ignored by my Seniors, the most important being to keep a safe distance from the X-Ray Tube when it was in action; I attribute the fact that I am alive today being due to my use of a length of insulated flex by means of which I switched the Tube mounted on my Ward apparatus "on and of' from a distance of about 10 feet”! Now you should also note that it was not a quick flash like you see today, but the patient was subjected to prolonged exposure for over 15 minutes to get a good image, so it was indeed a lot of radiation!

The equipment at Mudros

When the WW1 started in 1914, there was a great demand for X-ray operators and initially TWB was not allowed to go to the war fronts but had to stay on at the ‘London’ hospital. It was in 1916 that he was deputed to the Cumbala hospital in Bombay. Reaching there he found no X ray unit to work with but just a leaky room filled with a number of packing cases.How those cases reached there is another interesting story, which I pieced together from diverse sources. If you recall, one of the fiercest losing conflicts fought by the British was with Mustafa Kemal’s Turkish army at Gallipoli, one which left so many Australians, Brits and Indians dead. There had been virtually no x-ray service in the Dardanelles, and its lack was keenly felt. 1 ASH at Mudros was the only medical facility on the Island of Lemnos which possessed an x-ray machine, and this had to serve one Indian and three British hospitals as well as meet its own needs. When the British retreated finally, this X-Ray unit which had provided yeoman service to these soldiers, was packed up (hurriedly) and sent off to Bombay.

A friendly electrician and the ‘mad sahib’ TWB decided to install and commission this condemned system from Gallipoli, it use having been served at the war front. As the story goes, when powered up, the top of the gas tube promptly blew up due to moisture ingress. After scouring the Bombay bazaars for repair material, the duo patched it all up and after finding a willing patient, powered the system again only to see sparks flying all around the bewildered and terrified patient, who promptly fled.

It was from these humble beginnings in Bombay that TWB learnt so many important lessons such as cooling the film bed which usually could not withstand the X-Ray heat or earthing the system (an invention wholly his, but something he never bothered to patent) to drain leakage currents. After moving to a hospital at Colaba and authoring a few papers, he found himself appointed as ‘Radiologist to the Government of Madras’. Barnard was enthusiastic because, as he stated - Madras has always had a good reputation for its Medical facilities and its high standard of Medical Education (I must add, my late father Dr Viswanatha Menon was a Stanley Medical College Alumni from the 50’s and would have warmed up to this statement!). By then, there was another X-Ray unit in Tanjore and a second private clinic in Madras. Would you believe that the prime mover of the generator powering the Tanjore unit was run by a bullock trotting around?

Anyway, Dr TWB quickly got the new department (not the bullock) into a gallop and he was to remain there until 1941 as Chief Officer of Radiology Services with supervision of all X-ray services covering an area three times that of England and a population of 50 million. During that period Captain Barnard opened some twenty new X-ray departments in the state and developed the services in the Madras General Hospital and Medical College as a major teaching center for South India. T. W.B. then established the Madras Government Institute of Radiology, which to his surprise was named after him on the day of the official opening in March 1934 as the Barnard Institute of Radiology.  The center had a primary GE supplied Victor XP4 X-ray unit and a secondary screener unit and it became a major center in South India with the initial cost of this section contributed by Dewan Bahadur M. R. Subbiah Chettiar.

Barnard, who continued on as Director of the Institute till 1940, used the 400KV X-ray unit installed in 1934 for the first time in India on his wife’s hand, just as Roentgen had done the first X-ray ever on his wife’s hand!

H Miller explains in his obituary of Capt Barnard - There was nothing like it in India or in South East Asia, and not much like it in the USA or Great Britain at that time. It was a two storey building around a courtyard where playing fountains formed part of the air-conditioning plant of the X-ray diagnostic department. Its therapy unit housed a 400 kV apparatus, three 200 kV units, two superficial and two contact sets. It had a radium department including a radon plant for supplying radon for up-country hospitals. It had a physics department and laboratory, a physiotherapy department and a clinical photography unit. With its protected walls of locally made brick loaded with barium it had a layout so far in advance of its time that for a generation it remained the outstanding radiological center of South East Asia. The equipment has been kept up up-to-date by adding new units such as the Convergent Beam, Pendulum and another type of moving beam Therapy apparatus - long before important centers in England received such Units.

Captain Barnard ‘Cappy’ remained with the Institute until he left India in 1940 and under his guidance a number of courses for the Diploma of Medical Radiology and for Certified Radiological Assistants were instituted with Captain Barnard serving as the President of the Board of Examiners for both diplomas. Though he had no basic medical qualifications, he was instrumental in initiating several research programs, in collaboration with medical colleagues, such as estimating the age with radio-graphic examination of epiphysis and the study of endemic fluorosis poisoning.

Captain Barnard's had varied interests, he was associated with the Madras Boy Scouts Association and was a keen collector of art objects. But of course, his case files present the more interesting insight to his life and times. As an invention which could see though body tissues, it found instant acceptance with the London police who with Barnard’s help collared a thief who had swallowed gold sovereigns, he later used the same method to catch a Madras thief who had snatched a girl’s chain and swallowed it. Other instances involved the seizing of stolen jewels secreted inside cheek cavities of a woman member of a gang of robbers, a few involving gemology and identification of gemstones, uncovering the sleazy tricks of some charlatans, catching smugglers, determining the age of certain persons (process called epiphysis),  and so on.

Captain Barnard finally called it a day in 1940 and moved back to England. Tracing his later days, H Miller continues - In November 1942 Captain Barnard took charge of a tiny office in the Sheffield Royal Infirmary as Secretary of the Sheffield National Centre for Radiotherapy. From that time until he retired in 1964 his influence on the development of radiotherapy services in Sheffield was immense.

He worked with upcoming technologies such as megavoltage therapy, isotope facilities and started a new radiotherapy hospital. In 1946 T.W.B. began negotiations with MIT about building a 2 MV Van de Graf generator for Sheffield, the first commercial installation of such an equipment. Age never mattered for when he started all this in Sheffield, he was 58!

He passed away in 1978, aged a ripe 93 years old.

Life has come a long way, nobody bats an eyelid thinking about the radiographer o radiologist. But I am sure many are aware that global radiology requirements these days are mostly outsourced to and handled from India, something Barnard can be proud about. The concept has even got a new name, tele-radiology, though it relates not to the X-ray work, but studying the pictures and sending the diagnosis back taking advantage of time differences and having a report ready by the start of the next working day.

But you may wonder how I stumbled into researching Capt Barnard’s life in Madras. Well as it happened, some months ago, my good friend Nick Balmer from the UK sent me a link from the British Library suggesting that it could present an interesting challenge. The archives department was trying to unearth the story behind a letter received by Capt Barnard in June 1923, a letter sent by 4 girls from a small village near Trichur in Kerala, requesting monetary help. I tried as hard as I could to find some information, but only succeeded in figuring out that the girls belonged to St Mary’s school in Chenagloor. Did Capt Barnard visit that area with a mobile Xray or something or did he just pass by the Trichur area and the school? He must have visited Malabar just after he got to India, so was it a pleasure trip, a vacation or on an X-Ray camp??I could find no details at all, but the fact that he did many such camps. S Muthiah put out a clarion call in his ‘postman knocked’, but I doubt if anybody answered. If I do hear something, I will update this page.

The letter reads:

Jesus Mercy.

The good God rewardeth even a cup of Cold Water given in His name to one of His little ones.

O.J. Annie, Mary, Catherine and Elizabeth. Poor Students. Chemgaloor, Pudukad Post, Malabar

Most Honred Sir,

We, four poor student girls (Mary and Catherine are orphans) most respectfully and humbly beg to state that we are in great difficulties and distress. We are badly in need of food and Clothes. We are promoted to our new class. We have not got new books. We most humbly pray you will be kind enough to send us some help. We pray you will not refuse our humble prayer. Thanking you in anticipation, we beg to remain

Yours most obedient and humble servants.

O.J. Anne and others

22.6.1923

One thing is clear, Capt Barnard made an impression on those little girls at Trichur as you can make out from the picture attached. OJ Annie, Catherine, Mary and Elizabeth remain ghosts from the past. I don’t know if they received the food, books and clothes they requested, but I believe they did since Capt Barnard treasured this letter and stored it in his collection till he died. The letter itself is remarkable and bordered with all the used stamps the girls could find, of Cochin Raja’s, Travancore,

On that note, I will conclude, happy that I chose to spend some time researching yet another luminary, about whom you would otherwise never hear of…

References

Obituary - Captain T. W. Barnard, 0.8.E. 1885-1978 London - Madras – Sheffield, H Miller - The British journal of radiology, Vol 51, # 611, Nov 1978

Obituary – Capt TW Barnard – Prof A Gajaraj, Indian journal of Radiology, vol 32, issue 4-5, 1978

X rays – Personal Recollections, Capt TW Barnard, Journal of Medical Physics / Association of Medical Physicists of India. 1995, vol 20, issue 3

Hindu Articles – The radiologist from Chipstead S Muthiah, April 4, 2010

British library request - Karen Stapley, Curator, India Office Records

Note: The title states Dr Barnard. He was not a doctor licensed with a medical degree, but was virtually considered one by dint of his meritorious service and the knowledge he possessed about his own field.

pics - Capt TWB - courtesy - Journal of Medical Physics, X-ray unit - I I and P magazine