Dr Sankaran Govindan and his compounder Padmanabhan Pillai travelled across Kadakkal, in what is now Kollam district in Kerala, to cure the tropical bacterial infection, yaws

Two men were on a mission in a bullockcart. Covering the hilly terrain was not easy in the mid-1930s when roads were few. Moving from village to village and walking through paddy fields and slush in the rural area of Kadakkal, now in Kollam district, nearly 50 km from Thiruvananthapuram, Kerala, were Dr Sankaran Govindan and his compounder Padmanabhan Pillai. Over three years they injected more than 12,500 patients with medicine, to cure them of the tropical bacterial infection yaws that was mutilating and crippling people.

As doctors and health workers battle COVID-19 the world over, Dr G Krishnakumar rewinds to an era when his father worked hard to cure the people of Kadakkal from yaws, an infection affecting the skin, bones, and joints, that was endemic in the hilly areas of the princely state of esrtwhile Travancore, on India’s south-west coast.

A patient of Dr Govindan’s in Kadakkal. (left) Before treatment and (right) after the treatment | Photo Credit: Special arrangement

Dr Govindan, then a young doctor in his thirties who’d graduated from Madras Medical College, took up his first posting as medical officer in 1935-36 at a government dispensary in Kadakkal. His father Shangu Vaidyan was the Kottaram Vaidyan (palace physician) and he sent his son for higher education to what was then Madras.

Allopathy was still an unknown system of treatment in rural Kadakkal, but the young doctor’s work, attitude, and sincerity gradually brought him patients. In the predominantly agrarian area, inhabited by marginal farmers and tribes people in the hills, Dr Govindan noticed a lesion that occurred in many people of different age groups, especially among those who lived in close quarters. He identified it as yaws that is closely related to the bacterium that causes syphilis, though it is not transmitted through sexual intercourse. It spreads through direct contact with infected wounds, instead.

What causes Yaws Yaws is a disease caused by Treponema pallidum subsp. pertenue, a bacteria closely related to Treponema pallidum, which causes syphilis. The bacteria is transmitted by direct contact, acquired during childhood and can cause severe late manifestations years after initial infection.

“My father began documenting the illness and its treatment in an album-cum-journal that he meticulously maintained in 1936,” Dr Krishnakumar says, gently turning the pages of two albums, crumbling with age, and speaking of an era before the arrival of antibiotics, when doctors and compounders worked hand in hand to make medicines.

A jotting in the journal, supplemented with photographs, explains his findings and the progression of the disease. He noted that the primary lesion often occurs at the site of an existing ulcer or bruise, does not respond to any local treatment, and persists for years. Children were susceptible to yaws, perhaps because of their tender skin and poor health.

Kadakkal Government dispensary in the thirties where Dr Sankaran Govindan was appointed as medical officer | Photo Credit: special arrangement

Dr Govindan found that healthy children with primary or secondary manifestations were able to withstand the disease but at any point of time when their immunity was compromised, they would fall prey to it. “The secondary manifestations sometimes appear after a period of years…. The ulcerating condition is more prolonged and extremely destructive. It makes the patient a cripple. …Bow legs are one of the characteristic features of Yaws,” he wrote.

In those days yaws was considered incurable. Dr Govindan found that Neo-Salvarsan, a drug made in Germany was found to be effective in curing the disease. But he understood that this would be too costly to treat a large group of people, especially those he treated, who were mostly underprivileged.

“That is when he read about an alternative treatment for yaws and found out that compounds of bismuth had been used in the treatment of syphilis since 1921. Immediately, he contacted his friend Narayanan Potti, then head of the department of chemistry at University College in the Thiruvananthapura,” says Dr Krishnakumar.

Professor Potti managed to synthesise and purify the sodium bismuth salt of tartaric acid for him in quantities sufficient for mass use. He called it Bisota. Dr Govindan and his assistants travelled from village to village injected one dose into each of those afflicted by yaws. As a result of their tireless work, yaws was eradicated from Kadakkal and the surrounding areas, says a historical article published in The Journal of the Association of Physicians India that Dr Krishnakumar wrote.

The nameplate of the new medical officer with the year given according to the Malayalam calendar | Photo Credit: special arrangement

“My father had told me about this when I was a child. Now, these albums are all that remains of that momentous journey. Once the Trivandrum Medical College came up in Thiruvananthpuram, he was appointed in the department of surgery. After his retirement in 1962 as Professor of surgery in Kozhikode Medical College, he established Govidan’s Hospital in 1966,” says Krishnakumar.

He adds that as long as his father was practising, patients used to come from Kadakkal for treatment. Today, Kadakkal is a town and not many remember the work of its first doctor.