Of John (born in 1767; see Forbes 1813) no data on his ancestry has been uncovered, except that this father was " the renowned physician Michael Underwood, 1737-1820" (see Forbes 1813). For more on the father, see Wikipedia, Michael Underwood.
On Sarah nothing is known yet, except her name, taken from data in geneanet on their daughter in law Augusta Bella Charlotte Durand.

Children known are:
- John James, *1797 Fort St. George, Madras, East Indies (married 02/02/1824 in St. George's Church, Madras, to Augusta Bella Charlotte Durand), John James +15/03/1864 Tunbridge Wells, Kent, England.
- a son, *14/09/1798 (from Asiatic Annual Register, Vol.1, p.174; 1799); 
- Camilla Ann, * ca.1799 (married 1817 Robert Greig).
- Frederick Forbes, *1805 Madras, youngest son, studied at Christ Church Oxford, died there aged 23 (from The Asiatic Journal and Monthly Register for British India, 1828, p.285).

Fort St. George, Coromandel Coast, SE India; ca 1760. From Wikipedia.

- Elvina Rainer, *1806 Madras, +1854 (see main page).
- a "daughter" by "Lady of" J.Underwood *1808 (The Asiatic Annual Register, Vol. 10, p.301).

Note: in 1996 the city of Madras on the south-eastern coast of India was renamed Chennai.

John served with the East India Mercantile Marine as a ship's surgeon before joining the Madras Army where he also served as a surgeon (Forbes 1813).  Based in Fort St. George (Madras) in 1797, what appears to be their first child was born.

Madras, map of ca. 1800 (printed 1816) and of 1915; see location of Monegar Choultry.

In Madras on the SE coast of India, John must have seen the dismal state of medical services for the native population. This led him to put his efforts in improving their lot. He succeeded.

But first (from Padmanabhan 2018): "When Madras was stricken by one of its worst-ever famines in 1781, the city's first formal charity was set up by the Government and St Mary's Church. A Famine Relief Committee was established in 1782 and the Committee rented a house for poor feeding just beyond the north wall of George Town - in present day Royapuram that was all fields, vegetable gardens and fruit groves then. The house continued as a refuge for the poor and the sick even after conditions improved in 1784."
From StMC: "As part of relief operations, kanji (rice gruel) was served to people in a thotti (vessel) and so the name kanji thotti choultry. This rented house later became the Monegar Choultry¹, believed to be named after a village headman, a manugakkaran (monegar), who ran a gruel centre there for the destitute. Many years later, when Stanley Hospital came into being [1938] in the same campus, locals called it the kanji thotti hospital!"

From HfCP:  "Pobably, surgeon William Gordon, was the first one to suggest the establishment of a hospital for natives at Madras. He submitted his proposal in 1787, to the Council in this regard, but the Council was, initially, reluctant to accept his proposal."

John by now had left the military service and had become, in 1797, assistant surgeon of the Copmpany. The "Company" is, of course, the British East-India Company.

Further from HfCP:  A decade after the proposal of William Gordon, Assistant Surgeon John Underwood, in 1797, took the initiative for the hospital for natives. He offered to construct the building by himself,

Entrance gate of the Monegar Choultry compound. Image from MTCC (1939).

on the condition that the government would provide ground and pay the rental. The government nodded to the plans of John Underwood. The cost of the establishment was met by voluntary subscription and a surgeon, approved by the government, was to attend the institution.
In his letter to the Council, he proposed his plan for the hospital for native poor. He stated that: " I solicit your Lordship to be pleased to place this Institution upon a similar plan to the Lunatic Hospital, taking the building on a lease and granting such a monthly rent for the same and probable repairs as you may think reasonable and proper. I further solicit your Lordship to grant such an allowance to the Superintendant Surgeon as you may deem expedient for his personal attendance."
The management team included William Webb (Mayor of Madras, 1783-1784), Nathaniel Kindersley (a Madras Civil Servant), Charles Baker (a merchant?), Henry Sewell (a naval agent), and John de Fries (a merchant?), in addition to John Underwood (see Raman & Raman, 2019, Note 6).
Further from HfCP:  "The hospital was completed at Purasaiwalkam in 1799 at the cost of 9813 pagodas, as stated by John Underwood. The cost of the hospitalbuilding was higher than expected initially, and it rose because of the demand of Brahmins for a separate ward for themselves. The hospital consisted of two substantial blocks each of two wards, unfortunately, the medical establishment on western lines too, acknowledged the caste prejudices of Indian society, when one detracted ward was exclusively allotted to Brahmins. In 1808, Monegar Choultry was founded and it afforded shelter and food to the native poor. Apart from these medical institutions, there were private practitioners, mostly company's surgeon themselves, practicing in many parts of the Presidency. The surgeons, after having been discharged from the Company service for some reason, became private practitioners, settled in the Presidency temporarily or permanently."

A building of the Monegar Choultry that has sheltered and fed people since 1782. On the Monegar Choultry compound, John established the hospital. (Image from Padmanabhan 2018.)

And, following StMC:  "The sick were treated in three different establishments, a dispensary for out-patients, half a dozen sheds for in-patients and special wards for chronic cases. Within a month of formal establishment, the Infirmary had nearly 90 inpatients."

Most of the buildings of Monegar hospital have been demolished. The establishment has been replaced by a larger hospital. See also Wikipedia on Monegar Choultry.

In the years thereafter, several other medical institutions were established, in part upon the initiative of John. "Amalgamating it in 1809 with a younger Native Hospital in Purasawalkam, Monegar Choultry Hospital was developed by the Government to become the first organised hospital in North Madras for Indians" (see Muthiah 2016).

John's career followed the (perhaps) usual path for a succesful surgeon. Surgeon March 17, 1814; Superintendant or head surgeon: 1829; Member of medical Board 1836 (see Dodwell & Miles).

December 1837, Surgeon John Underwood, 3rd Member of the Medical Board was granted leave to proceed to the Cape of Good Hope on Sick Certificate (see Abhilke-Patal, 2012).

John, who was sick, had gone end of 1837 on his way from Madras via Cape of Good Hope to England. He died November 1839, aged 72, in the house of his daughter (the youngest??), Mrs. Col. Ormsby, at No. 6 Oriel Place, Cheltenham. England. The announcement in the "Asiatic Journal"² (Vol.40, p.195) says: Second Member of the madras medical Board, sincerely and deservedly regretted.

Sarah died early in 1858 in "St George In The East".

¹)  Choultry is a resting place, an inn or caravansary for travelers, pilgrims or visitors.
²)  "The Asiatic Journal and Monthly Register for British and foreign India, China, and Australasia".
References
- Abhilek-Patal (2012), from Abhilek-Patal (retrieved 20200712).
- Dodwell, E., Miles, J.S., Medical Officers of the East India Company's Service - 1764-1837, in "Alphabetical List of the Medical Officers of the Indian Army; With the Dates".
- Forbes,J., Oriental Memoirs - Selected and Abridged from a Series of Familiar Letters Written During Seventeen Years Residence in India London: White, Cochrane (T. Bensley, printer), 1813; summary abstract on Baumann rare books (retrieved 2020.08.11).
- MTCC = Madras Tercentenary Celebration Committe, (1939); The Madras Tercentenary Commemoration Volume.
- Muthiah, S., 2016, Madras miscellany: A well-kept old age home, on thehindu.com (retrieved 20200810).
- HfCP, no author known, year unknown, Hospitals for Civilian Purposes , in "3 Hospitals, Dispensaries and Medical Institutions in the Madras Presidency", on Shodh Ganga; a reservoir of Indian Theses (retrieved 20200810).
- Padmanabhan, G., 2018, Monegar Choultry: House of hope, on The Hindu (retrieved 20200812).
- Raman, R., & Raman, A., 2019, Women doctors and women’s hospitals in Madras with notes on the related influencing developments in India in the late 19th and early 20th centuries; Current Science, Vol.117, No. 7, p.1232 (2019).
- StMC, A Stroll Down The Memory Lane, on Stanley Medical College History (retrieved 20200712).

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