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What greater or better gift can we offer the republic than to teach and instruct our youth? - Cicero
The internet is one of the few free public libraries that we still visit, but this time we decided to go behind the scenes and get the real story. It is our proud privilege to feature Prof. Inder Sen Jain in this edition of Tales of Yore, with excerpts of conversation with none other than the teacher of teachers, Prof. Amod Gupta, who joined Prof. Jain as a first-year resident in 1974 and remained a student, mentee, and a colleague till 30 June 1989, when he succeeded him to carry on his legacy. We were also joined by Dr. Sandeep Jain, for a more personal insight into the remarkable life of a legendary teacher, researcher, ophthalmologist and an unparalleled eye surgeon.
Prof. Jain was a highly distinguished and decorated student. He was the best graduate of King George Medical College, Lucknow from where he completed his undergraduate degree in 1952 [Fig. 1]. He received distinctions in Physiology, Ophthalmology, Pharmacology, and Medical Jurisprudence. He won the most coveted Hewett Gold Medal for the highest marks in the final professional exam, an award which had been won by the likes of Dr. A S Paintal (1948) and Dr. P N Tandon (1950) before him. He also received the Selby Gold Medal for being the best qualified in surgery, Anand Lal Gurtu Memorial Gold Medal for being first in final MBBS, Rai Bahadur Chaubey Shambhu Nath Misra Gold medal for highest marks in Ophthalmology and Bali Handoo Gold medal in Obstetrics and Gynecology. “He was the 37th recipient of the Hewett Gold Medal, but the first awardee to choose Ophthalmology as a specialty,” said Prof. Gupta. Dr. Jain went on to explain, “Dr. S P Gupta, the then Chief of Ophthalmology at King George Medical College coaxed him to join ophthalmology. However, he quit after a year! One of his seniors then encouraged him to then pursue DO and FRCS in London.” He went on to do a most prestigious DO (London) in 1954–55 and FRCS Edinburgh in 1957, during which he had a unique opportunity to work closely with and observe the legendary ophthalmologists of that era including Drs. Arnold Sorsby, Keith Lyle and Hyla Stallard. From 1954 to 1957, he worked in Moorefield Eye Hospital, London, Regional Eye Unit of Moorfields Eye Hospital at South and Middlesex Hospital, London, St Paul’s Eye Hospital, Liverpool, and the Ashford Hospital, Middlesex.[1]
Figure 1: Dr I S Jain, the best graduate of King George Medical College, Lucknow in 1952
On his return to India, he worked for a while in the then Irwin Hospital, New Delhi, and later joined an eye hospital in the village Asthal Bohr near Rohtak.[1] Dr. Tulsi Das, Director of Medical Education and Research in the Government of Punjab and the Chief Minister of Punjab visited the hospital in Asthal Bohr and at the end of the visit, approached Prof. Jain to join the newly minted institute in Chandigarh that was taking shape under the tutelage of Dr. Das. Prof. I S Jain was among the first flush of faculty members, most of whom returned to India with dreams in their eyes, to create a unique Post Graduate Institute of Medical Education and Research (PGIMER) in India that had been modelled on the Hammersmith Hospital of London. He joined as a Registrar on 1 December 1961 and, within five days, was selected as a lecturer by the Punjab Public Service Commission. “He was selected as an Assistant Professor in Dr. R. P. Centre for Ophthalmic Sciences in All India Institute of Ophthalmic Sciences. He respected and admired the work of Prof. L P Agarwal and remained a close associate. ‘We are both too independent to work together in the same Institute,’ he would say. And so, he chose to remain in PGI,” said Dr Jain. Prof. Jain went on to head the department of ophthalmology at PGI from 26 July 1969 to 30 June 1989 when he superannuated.
Prof. Jain was an internationally renowned figure, both for his surgical skills and his academic forte. Naturally, he made acquaintance with several leading ophthalmologists of that time. He first visited the United States in 1975 as a visiting professor at several institutes including the Wilmer Eye Institute where he met with not only the Chief, Dr. Ed Mauminee, but also a young Ron Michels, who was on the threshold of changing the world of retinal surgery through his innovations in pars plana vitreous surgery. “He was decades ahead of his time. He had the unique ability to look at the eye from the systemic point of view and not as an independent unit. One of his earliest works was establishing the relationship of atherosclerosis with black cataract. At Yale University Medical School, he shared his work on smoking as a major risk factor for the development of cataracts. To his horror, he found many of the residents and the staff smoking in the lecture hall, while he lectured on the cataractogenic effects of smoking. He felt let down when he was countered with a facile argument, ‘We all smoke, why don’t we have cataracts?’ He published his paper in the local PGI Bulletin, although it would be a few years before it was established that smoking indeed was a major risk factor for cataractogenesis,” recounted Prof. Gupta. This prompted Dr Edward Cotlier, a leading researcher in cataractogenesis to visit the PGI three years later, in the height of North Indian summer, to measure the temperature of the anterior chamber in rabbits for studying the possible effect of heat on cataractogenesis [Fig. 2]. At the Armed Forces Institute of Pathology, his meeting with Lorenz E Zimmerman led to a life-long collaboration in ocular pathology. He was the World Health Organization (WHO) advisor to the governments of Jordon and Iraq from 1985 to 1986. He visited Nagoya (Japan), Helsinki and Singapore from 1984 to 1988. Several renowned international researchers visited the eye department at PGI, including Dr. S Fyodrov from the USSR (March 1978), Dr. Carl Kupfer, the then director of NEI (January 1980) and Dr. S S Hayreh (April 1981), among many others [Fig. 3]. Prof. Gupta remembered the firm stance taken by Prof Jain: “Dr Fyodorov introduced a series of a few thousand sputnik anterior chamber intraocular implants and radial keratotomy to PGI and several other eye centres in India, with claims of no complications. Prof. Jain was against any such experimentation on the human eyes and his foresight was proven right once again.”
Figure 2: With Edward Cotlier, May or June 1978
Figure 3: With Dr. Fyodrov from the USSR, March 1978
A highly articulate speaker, keen observer and a meticulous surgeon, his observations made without the benefit of any of the modern-day technology have stood the test of time over the last five decades. Prof. Jain published more than 300 papers that were extensively cited in System of Ophthalmology by Sir Stewart Duke-Elder and the contemporary literature. Some of his seminal contributions included ocular changes in Takayasu’s disease, the protective effect of myopia of >5.00 D and high intraocular pressure on diabetic retinopathy, smoking as a risk factor for cataractogenesis, adverse effects of steroids on central serous chorioretinopathy, sympathetic ophthalmia simulating Vogt-Koyanagi-Harada disease, extracapsular surgery in Fuchs’ uveitis, ocular birth trauma and retinal hemorrhages in newborn babies.[1] He routinely presented cases and observations at the meetings of All India Ophthalmological Society, the proceedings of which, in the 1960s and 1970s were reaching the international libraries and, were being cited in publications. Prof. Jain was the President of the All India Ophthalmological Society in the year 1990.
“I consider his greatest contribution was creating a unique structured post-graduate teaching and training program in Ophthalmology when none existed in the country,” said Prof. Gupta. When everyone in the country saw patients in comprehensive outpatient clinics, he introduced the concept of rotating residents in the special clinics and laid the foundation of subspecialty training in Ophthalmology. It is to the great credit of his foresight that the structured program has remained unaltered at the PGI for the last 60 years. When hardly anyone talked of equitable health care, he taught lessons in equity by treating and operating on patients irrespective of their socioeconomic background, irrespective of whether he was operating in the institutional setting or at an eye camp. He taught residents to respect each eye. In the era when eye surgeons did sutureless cataract surgery (in a 12–15 mm incision!), he insisted on at least three preplaced sutures even in the eye camp surgeries. He led the team of ophthalmologists in carrying out eye surgeries through the conduct of several hundred hugely successful eye relief camps and introduced to the world a unique concept of the “Rural reintegration of the incurably blind”. “I have personally witnessed how he and his team of mobility instructors and trainers were worshipped by the village folk, as they trained several thousand incurably blind to become self-reliant, groom themselves, walk and travel on their own all with the help of a cane. It was magical how these hapless members of the society left to rot by the families were once again reintegrated into their rural environment as they now earned their livelihood through simple skill sets that they were taught,” recollected Prof. Gupta.
He was one of the most disciplined and punctual people, such that students could set their watch by his time of arrival, each morning at dot 8:00 AM. One of the sharpest clinicians of all times, he had exceptional observational skills. When nobody in India kept any notes, he made detailed notes in the patients’ hospital charts and, at the same time, maintained a notebook of the patients with unusual signs. Many of the professors who came as examiners were awestruck as he demonstrated to them on a slit lamp, the signs of Fuchs’ uveitis, herpetic dendritic keratitis and the like. “As an undergraduate student at Rohtak, my seniors often talked of him in whispers. So profound was his academic presence in the country that he was considered no less than the presiding deity of ophthalmology. All of us looked forward to his weekly clinical demonstrations on Wednesday at noon, where he taught us the fine nuances of the clinical signs. Looking back, I believe that this was how he had been trained in the United Kingdom (UK) by the masters themselves. Much later in life, I realized that for each of his demonstration classes, he prepared weeks and months in advance ensuring specific patients were present on a given day so that we could examine them while he supervised and discussed the fine nuances. Thanks to his training in the UK, each of us was expected to take an evening round of the hospital wards specifically looking for any patient admitted with eclampsia, hypertension, leukaemia, thyrotoxicosis, papilledema, a head injury, or any systemic diseases that may even remotely affect the eyes. [Fig. 4] On day one of my starting at the PGI, he glanced at me on the ward round, and asked, ‘Why are you not wearing the white coat? Show me your loupe and torch.’ Of course, I did not possess either of these. A lesson I would remember forever. He had exceptional skills in examining the retina with a 3-mirror Goldmann contact lens. Today, it may sound unbelievable, but I have assisted him in retinal surgeries that he performed having examined the patient with only a direct ophthalmoscope and making detailed diagrams.” A gentle smile appeared on Prof. Gupta’s face as he fondly reminisced about his days as a resident.
Figure 4: Outside the department for a farewell to the outgoing residents
Prof. Jain initiated, encouraged, and guided residents into research and writing papers, painstakingly correcting each paper himself. The most sacrosanct hour was the students’ grand rounds on Monday afternoon. He sat through each of the presentations made on an epidiascope, took copious notes and asked the most penetrating questions. “He was, in particular, critical of the wrong spellings and the pronunciations of which we were often found challenged especially saying the names of the French and the Spanish masters. It was the toughest hour of the week but then it prepared us battle-ready forever in our lives. It gave us so much confidence that none of us would ever come to grief in any meeting anywhere in the world,” said Prof. Gupta.
Prof. I S Jain left for his heavenly abode in the early hours of 29 December 2016, leaving behind a huge void in academia and an irreparable loss to the nation. News of his passing led to a wave of inconsolable grief among his students all over the world. Prof. Jain left behind a unique legacy of honesty, integrity, punctuality, equity and excellence in academia, traditions that continue in the present [Fig. 5].
Figure 5: A rare constellation in 2015; Dr Jain with the next four heads of the Centre. All of his students show continuity of values at the Advanced Eye Centre, PGI from 1961 to the present. From left, S S Pandav the current head, Sandeep Jain (son of Dr. Jain), Amod Gupta, I S Jain, M R Dogra and Jagat Ram
To me the sole hope of human salvation lies in teaching. - George Bernard Shaw
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