|HISTORY OF CANCER
|Year : 2019 | Volume
| Issue : 3 | Page : 282-284
The founding of the Tata Memorial Hospital, 1932-1941
Shirish N Kavadi
Independent Researcher, Visiting Faculty, Symbiosis School for Liberal Arts, Symbiosis International University, Pune, Maharashtra, India
|Date of Web Publication||19-Jul-2019|
Shirish N Kavadi
Independent Researcher, Visiting Faculty, Symbiosis School for Liberal Arts, Symbiosis International University, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
This article presents a brief account of the founding of the Tata Memorial Hospital. It draws upon archival material to show that this was not a mere philanthropic act but a scheme carefully thought-out by the Trustees of the Sir Dorabji Tata Trust. It discusses the major concerns of the Trustees as they deliberated upon establishing the Hospital.
Keywords: Cancer treatment, Dorabji Tata Trust, history of cancer, history of medicine, Tata Memorial Hospital
|How to cite this article:|
Kavadi SN. The founding of the Tata Memorial Hospital, 1932-1941. Indian J Cancer 2019;56:282-4
By the early 20th century cancer in India had begun to attract attention of medical personnel. The Imperial Cancer Research Fund initiated investigations into the volume and nature of cancer in India. In 1913, Col. Vaughan of the Indian Medical Service had introduced radium treatment for cancer in Ranchi. Radium was in use since the late 19th century but its efficacy came to be recognized only after the First World War. A proposal was made to set up a radium institute in 1920 and the Ranchi Radium Institute was inaugurated in 1922. The Chittaranjan Seva Sadan Maternity Hospital established in 1926 in Calcutta treated women cancer patients while the Bengal Cancer Institute and Hospital was established in 1936. Awareness about cancer was growing but knowledge was still limited. Research in cancer was still developing worldwide although it was virtually non-existent in India. Two developments in the 1930s saw a significant shift in the battle against cancer in India. In June 1931, Lady Meherbai Tata, the wife of Sir Dorabji died of leukemia. In April 1932, Dorabji endowed the Lady Tata Memorial Trust with a corpus of Rs 25 lakhs to support leukemia and cancer research. Around the same time Sir Fredrick Sykes, Governor of Bombay proposed that Dorabji set up a radium institute in the city of Bombay. Dorabji agreed to set up a radium wing in a Bombay hospital but died before the scheme could take any tangible shape. N. M. Muzumdar, the Secretary of the newly founded Sir Dorabji Tata Trust, urged the Trustees to pursue the incomplete radium institute scheme, an idea that was endorsed by the Advisory Committee of the Lady Tata Memorial Trust.
This article examines the deliberations among the Trustees that indicate that the founding of the Tata Memorial Hospital (TMH) was not a mere philanthropic act. Consummate planning by the Trustees was evident in the attention paid to the problem of cancer, its treatment, and research. The foresight and prudence of the Trustees contributed as much to the TMH attaining its present status as the role of the medical professionals associated with it. The questions that figured prominently in the discussions related to radium treatment, the viability of a cancer hospital, and recruitment of personnel. Costs too were deliberated upon but is not discussed here.
| » Planning the TMH|| |
The idea of a radium institute appeared restricted to the Trustees who suggested exploring a scheme that was comprehensive; offering treatment, undertake public education on cancer, research, and training of students to make it the first of its kind in the Asia region. With little knowledge about cancer and unfamiliar with running of hospitals, the Trustees were apprehensive about its feasibility. The Trustees suggested an enquiry into the scheme before making any commitment and investment. Muzumdar, who was asked to obtain the best professional advice in London and Paris, died before he could make any substantial progress.
Dr. Clifford Manshardt, an American missionary in Bombay who was advisor and later a Director of the Trust, was assigned the responsibility of preparing a preliminary report on the proposed radium institute and a scheme that could elicit public support. Manshardt directed enquiries to the leading cancer centres in the world and examined issues such as personnel, costs and cooperation with government or other public bodies. The issue of co-operation with government was settled right at the outset. Sorab Saklatvala and Nowraji Saklatvala were inclined to inviting government collaboration subject to the Trust retaining a dominant voice in the governing committee. However, J. R. D. Tata firmly resisted the idea arguing the scheme belonged to the Trust alone and that there was no need to seek cooperation from any government agency. It had to be run entirely as a 'Tata Show.' It was, however, agreed to seek assistance from abroad and appoint a trained and qualified Director from France or US for about three years to train local staff.
| » Invitation to John Spies|| |
In 1935, Dr John Spies, Head of the Cancer Service of the Peking Union Medical College, was approached by the Trustees to provide clarification and expert advice in the establishment of the Hospital. Lala writes, “He had the know-how. Tatas had the vision backed by resources.” Spies was among the first resident doctors at the New York Memorial Sloan-Kettering Cancer Center considered one of the foremost cancer centers in the world. The Trustees after a preliminary hearing on radium treatment asked Spies to survey and present a detailed report on cancer facilities in India and the scope and opportunities for a cancer hospital. Subsequent to the submission of the report they appointed Spies Director of the proposed hospital institute. Not all Trustees were enthusiastic about Spies. Homi Mody, for instance, opposed a long-term commitment to Spies and wanted his ideas for the hospital, even if approved by the Trustees to be examined by other consultants. The Trustees after an extensive discussion finalized his appointment but retaining control with veto power over decisions that Spies may take and which they may not approve of. Spies agreed to this stipulation. Assigned the responsibility of planning and giving the scheme a definite form they sent him to conduct a survey of cancer hospitals and research to Europe and the US. Spies spend nearly a year travelling abroad. Over the next 3 years, the Trustees deliberated on the reports Spies submitted and referred his plans to the Curie Radium Institute in Paris and the Memorial Hospital at New York.
| » Radium Treatment|| |
The TMH was conceptually based on radium treatment, but some of the Trustees had doubts about its efficacy. Mody, for instance, wanted to know about the cases of cancer in which radium treatment was effective, utility of radium, the advisability of getting radium, getting a radium expert who would work in conjunction with an existing hospital, and the significance of X-ray treatment which was gradually replacing radium treatment.,,
Spies assured the Trustees that the future of Radium treatment was promising for it had developed to a remarkable degree, with demonstrated efficacy in offering definite cures for certain kinds of cancers such as that of skin, mouth, lips, cheek, and uterus. In lip cancer treatment, 90% cases could be cured with no-recurring symptoms and Radium was indispensable for cancers of the mouth and uterus. For breast cancer, it was useful before operation. Radium treatment was commonly used at the Patna Cancer Institute. The use would really depend upon the kind of cancer cases received in the hospital while its efficacy in treatment depended a great deal on the training and experience of the personnel involved. Radium, X-rays and surgery were the three main weapons against cancer. X-ray treatment was an alternative only to a limited extent but had not displaced radium treatment.,
| » Educative Value|| |
Spies underlined the institute's educative value and its influence in developing a “cancer-cure sense” among the masses which could lead to use of the facilities and most importantly bring all cases to the hospital before they were far too advanced for successful treatment. With availability of patients, research workers could conduct research for both cure and prevention of the disease., This was a strong justification for its launching.
Citing world authorities he stated all evidence pointed towards the need for the establishment of a centralized cancer institute with all available methods of treatment. Spies did not favor working with other institutions. He felt that the TMH by showing interest in all the lines of work concerning cancer would have considerable influence over other institutions in the country. The TMH would be a parent centre from where collaborative effort could be undertaken even with institutes abroad thus giving India a place of its own among nations engaged in study of cancer cure and radium treatment. Spies offered a very hopeful picture where experience and demonstration could eventually lead to setting up of similar institutes. All this, however, required setting up a properly equipped institute with opportunities for work for which the scope for a radium treatment institute seemed limiting.
| » A Cancer Hospital|| |
Spies envisaged a full-fledged cancer hospital for the “idea of a radium institute or an additional wing to a Bombay hospital was too modest and would in the long run prove ineffective.” He noted: “The best interests of the cancer patient demand that all effective methods of treatment be made available at one place, so that judicious choice of a well-considered combination of methods may give to such a patient his best chance of a cure, or failing that, his best chance of life and the relief of pain.”
Homi Mody considered this too ambitious and wondered if there were enough cancer cases in the city of Bombay to warrant a large expenditure on establishing a cancer hospital. Did the city report that high number of cancer cases? While acknowledging that it was difficult to determine an accurate number since many were treated privately, some in public hospitals while still others probably did not seek or receive treatment Spies believed all cases in the city could fill a hospital of 500 beds. Enhancement of the radium institute reputation would increase the number of cases seeking institutional treatment. A modest beginning could be made with 50–60 beds which eventually could be expanded to 100–150 beds. The number of private, free, or partially free could be determined later. Setting up the hospital would encourage private patients for they tended to seek treatment in the early stage of the illness as against poor patients who did so in an advanced stage and therefore had few chances of recovery.,
Spies' survey had shown that in India most hospitals lacked the equipment and facilities to deal with cancer. All these indicated that there would be plenty of patients to warrant a first-rate cancer hospital. Medical professionals, cancer doctors, and different hospital heads and deans Spies had consulted in Bombay reiterated the need for cancer hospital; assured him there would be no lack of clinical material for a new cancer hospital in Bombay.,
The Annual Report on the Civil Hospitals and Dispensaries in the Bombay Presidency (1933) referred to patients with tumors and cancer treated, and also some 'unknown' cases which could be cancer related. There were patients who were not identified and those that went to private, municipal and missionary hospitals. Spies argued that the US had a minimum of 2,500 cases afflicted with cancer per million so Bombay could expect a minimum of 3,000 cases. The KEM hospital report for 1933–1934 had placed specific emphasis upon the need for greater facilities for the treatment of cancer and hoped that philanthropy would come forward to offer relief. There seemed no reason in the face of such overwhelming need and desire why Bombay could not have a separate cancer hospital. Spies emphasized that smaller cities than Bombay in America had cancer hospitals along with well-equipped general hospitals and special medical facilities. Tata and Nowroji supported Spies' ambitious plan. Nowroji concurred that a radium institute was too limited in scope and the need was for a comprehensive cancer institute and believed that the Trust could afford to support a cancer hospital observing, “The Trust had already the wherewithal and sinews with which to proceed.”
| » Personnel and Other Requirements|| |
The proposed service facilities would consist of an OPD to treat cancer of cheek, tongue, skin, and such other superficial problems; an X-ray department for diagnosis and treatment; a surgical department; personnel that included an internist, specialists; and a general surgeon. Spies suggested initiating training of personnel so staff appointments could be made at the earliest possible. Manshardt had similarly and suggested that the Trust award its foreign scholarships to train surgeons, radiologists, pathologists, dieticians, and nurses.,
Spies considered it essential to have certain trained personnel at the time of TMH's inauguration given the difficulty in securing staff with desirable qualifications. He, however, cautioned against sending persons, “abroad for training or maintaining others in India who would later have no connection with projects in which they are vitally interested.” He was also of the opinion that, “no good man would wait for long for a position, and hence, it was necessary that at least in two or three instances to place people on the pay roll considerably in advance of the opening of the hospital and to allow them to visit clinics and secure further training. In the long run it will be money well spent. Our personnel is all important.”
Spies gave priority to recruiting nurses who he said should be sent abroad for special training and could on return assume key positions in the hospital. When the TMH was inaugurated in 1941 the Trust had trained four young Indian doctors J.C. Paymaster, E.J. Borges, D.R. Meher-Homji, and D.J. Jussawalla. V.R. Khanolkar was appointed head of the Department of Pathology. The American doctors left when the US entered World War II. In September 1938, Spies resigned owing to differences with the Trustees over the delay and increasing costs.
| » Inaugural of the Institute|| |
The TMH was finally inaugurated on March 1, 1941. In his inaugural address, the Governor of Bombay, Sir Roger Lumley called it as “the first large contribution of India to the international fight against cancer” and stated that he was impressed with 'the greatness of the conception, and the care and the patience with which it has been worked out' and hoped the hospital would “become the spearhead of the attack on Cancer in this country, providing not only a centre where specialized treatment can be given, but also one from which the knowledge of new methods of treatment and diagnosis will go out to doctors and hospitals throughout the country.”
For Sir Sorab the TMH was “a labour of love” and “a temple of learning” where doctors and research students would work “to wrest from this dreaded scourge some of its terrible secrets.” Khanolkar described its establishment as follows:
“… a departure which takes into account the shortcomings of purely experimental institutions in other parts of the world. The Tata Memorial Hospital is particularly fortunate, inasmuch as the Trustees have been farsighted enough to organise a place where besides study, treatment and laboratory research would be intimately co-ordinated and the clinician will be a research worker, and a laboratory investigator will have an opportunity to extending the experience gained from the laboratory to the hospital patient. The institution is unique in its conception inasmuch as most of the clinicians and the whole of the laboratory staff will be devoting their whole time to the work at the institution.”
The Tata Trustees in establishing the TMH treaded cautiously. They sought expert advice and demonstrated comprehensive and conscientious planning that went beyond mere altruistic giving.
Financial support and sponsorship
This article draws upon a broader research project for which funding was received from the Sir Dorabji Tata Trust, Mumbai.
Conflicts of interest
There are no conflicts of interest.
| » References|| |
Vaughan JCS. The Radium Institute, Ranchi. A Report on the work from 1st
April 1925 to 31st
), Indian Medical Gazette January, 1926. pp. 29-30.
Lala RM. The Heartbeat of a Trust: Fifty Years of the Sir Dorabji Tata Trust. New Delhi: Tata-McGraw Hill Publishing Company Ltd; 1984.
Trustee Meeting, 29 September 1933, Sir Dorabji Tata Trust (DTT) Minute Files, 1932-1946, Box 358, Tata Central Archives (TCA), Pune.
Trustee Meeting, 4 September 1934, DTT, Box 358, TCA.
Trustee Meeting, 12 December 1934, DTT, Minute Files, 1932-1946, Box 358, TCA.
Trustee Meeting, 31 January 1935, DTT, Minute Files, 1932-1946, Box 358, TCA.
Trustee Meeting, 8 October 1935, DTT, Minute Files, 1932-1946, Box 358, TCA.
Trustee Meeting, 23 August 1935, DTT, Minute Files, 1932-1946, Box 358, TCA.
Supplementary Meeting, 20 September 1935, DTT, Minute Files, 1932-1946, Box 358, TCA.
Spies Report to the Trustees, 20 September 1935, DTT, Minute Files, 1932-1946, Box 358, TCA
Lala RM. The Creation of Wealth, The Tata Story. Bombay: IBH Publishers Pvt. Ltd; 1992.
Trustee Meeting, 6 July 1935, DTT Minute Files, 1932-1946, Box 358, TCA.
John Spies to the Trustees, 6 December 1935, DTT, Minute Files, 1932-1946, Box 358, TCA
Tata Memorial Hospital, 1941, DTT/DON/TMH/1, Folder 68.6, TCA.