Why did you develop an interest in the history of medicine? Would you like to be considered a medical historian?

That’s a nice question. Yes, I trained under a polymath named Professor AM Selvaraj, who had a wide-ranging interest and could speak extemporaneously on any subject. He had a flair for history and would say, “If you know the history, you will not repeat the same mistakes and you will evolve into a better physician.” This applies to all branches and walks of life. From my formative years, I started to look at the bigger picture, and history seemed to be the foundation. You can refer to me as a medical historian, and I take it as a compliment. The highest chair in Australia,the James Stewart Chair of Medicine and Director of Research at The Royal Melbourne Hospital (RMH), is often held by a professor of medicine with an interest in history.

Please provide us with a brief history of the Department of Rheumatology, Madras Medical College.

The evolution of rheumatology services at the Government General Hospital began around April 7, 1971. One day, Prof. Thayumanaswamy, an orthopaedic surgeon, called upon Prof. A.M. Selvaraj, the-then professor of medicine, to examine a case of elbow arthritis. They met on the afternoon of April 7, 1971, a Wednesday, while Prof. A.M. Selvaraj was managing the renal care unit. This meeting marked the commencement of the renal and rheumatology services (R & R). On his birthday, April 10, he stated, “I am going to have a dedicated OP (outpatient) service for rheumatology every Wednesday.” Thus, it initially took place every other Wednesday, depending on the number of patients referred by the orthopaedic department and a few of the medical units, highlighting the humble beginnings under the leadership of Prof. A.M. Selvaraj. Later in 1971, the Director of Medical Education (DME) approved the establishment of a rheumatic care unit. The physiotherapy wing was established in 1973.

Consequently, the OP services began in 1972 and continued until 1974, during which Prof. K. Ramachandra took over as the department’s head. A full-fledged department, comprising two assistant professors, staff nurses, and one technician, was established by Prof. A. L. Annamalai, who succeeded Professor K. Ramachandra and served from 1974 to 1976. Subsequently, between 1976 and 1979, the department was headed by Prof. K. V. Thiruvengadam and the rheumatology department operated under the Department of Medicine.

A dedicated department of rheumatology was established in 1979, and Prof. A.N. Chandrasekaran was appointed as a reader. For a brief training, Prof. A. N. Chandrasekaran travelled to England, where he received training under Dr. Gabriel Panayi. He then returned to India, assuming the mantle from Professor Thiruvengadam and 30 beds were subsequently sanctioned for the Department of Rheumatology. Thus, it evolved into a full-fledged centre of excellence in rheumatology, dedicated to teaching, research, and patient care facilities and was the first of its kind in the entire nation. This was a significant milestone in the evolution of rheumatology in India. The immunology wing was established in 1982, offering a wide range of immunological investigations and supporting cadaveric renal and other transplant programs through tissue typing and cross-matching.

Then, in 1991, the D.M. Rheumatology Postdoctoral Degree course was started with the approval of two postgraduate seats. In 1992, the PhD program in rheumatology was started. In 1993, the Journal of the Indian Rheumatology Association was started with Prof. A. N. Chandrasekaran as its editor-in-chief. No words can describe the immense contributions Prof. A. N. Chandrasekaran has made to the field of rheumatology at both the state and national levels. He had an illustrious career throughout his life as a physician, rheumatologist, administrator, and teacher. Later, the department was headed by many dynamic professors and teachers. In 2010, the number of DM Rheumatology seats was increased to 4. Subsequently, the Department of Rheumatology was upgraded to an Institute of Rheumatology in July 2015, thanks to the efforts of the then departmental head Prof. S. Rajeswari.

The Department of Rheumatology was functioning in the library block until 2004. After 2004, it began operating on the 6^th floor of Tower Block I, with independent male and female wards located in rooms 166 and 161, respectively. “To achieve big, one has to dream big.” With the efforts of Prof. S. Rajeswari, a separate rheumatology block with eight floors was opened in 2021, featuring all the modern rheumatology and immunology facilities for comprehensive care under one roof.

How have things changed from when you entered the department as a resident to now when you are a faculty?

There is a significant difference between being a resident and entering the department as a faculty member, specifically as an associate professor. I have spent almost 18 to 20 years as a faculty member in the departments of nephrology and rheumatology. During this time, the number of postgraduate seats increased from 2 to 4 per year, and the department expanded into a large facility with an aging building. However, considerable scarcity persists despite an abundance of resources. The building is dated and the staff remains insufficient. There is a mismatch between demand and supply, but the friendly atmosphere and rigorous training have created a welcoming environment. For me, it is a time for giving back. As an alumnus of Madras Medical College with an MBBS, MD, and DM, I pause and reflect. It feels like I’m in the twilight of my life, wanting to give back to the department, the college, and the hospital that shaped me.

What has been the clinical and community impact of the department?

The Department of Rheumatology at Government Madras Medical College provides comprehensive and specialized care for autoimmune diseases, with over 84,000 annual outpatient visits and 2,300 inpatient admissions. Situated in an eight-floor dedicated building, it has 70 general beds, 10 ICU beds, an exclusive immunology laboratory that provides support for transplant services through HLA typing and cross-matching, and an in-house physiotherapy unit—delivering all services under one roof at no cost to patients across South India. The department conducts over 10,000 immunological investigations annually and has trained more than 92 DM postgraduates, many of whom now lead rheumatology services nationwide. Its free therapies, including biologics and strong outreach, make it a cornerstone of rheumatology care, education, and research.