|Year : 2019 | Volume
| Issue : 3 | Page : 285-286
The spread of radiology in India from 1941 to 1956
Robert D Smith
Department of Global Health and Social Medicine, King's College London, Strand, London, WC2R 1ES, United Kingdom
|Date of Web Publication||19-Jul-2019|
Robert D Smith
Department of Global Health and Social Medicine, King's College London, Strand, London, WC2R 1ES
Source of Support: None, Conflict of Interest: None
This commentary discusses how the reasoning behind the founding of Tata Memorial Hospital (TMH), India's first specialized cancer hospital, was influential in setting up a larger infrastructure of cancer care in India. I show how the arguments that led to the use of radium at TMH enabled the value that TMH placed upon radiology to permeate other institutions around India, ultimately establishing radium as an essential element of cancer care.
Keywords: Brachytherapy, history, history of cancer, history of medicine, radiology, radiotherapy, Tata Memorial Hospital
|How to cite this article:|
Smith RD. The spread of radiology in India from 1941 to 1956. Indian J Cancer 2019;56:285-6
| » Introduction|| |
This commentary reflects upon Kavadi's piece “The Founding of Tata Memorial Hospital, 1932-1941.” In this piece, Kavadi has been able to show that the decision to found Tata Memorial Hospital (TMH) was supported by evidence and was thought through by the Trustees of the Tata Trust, the founding body of TMH. This short commentary will discuss how the reasoning behind the founding of TMH was influential in setting up a larger infrastructure of cancer care throughout India, specifically with respect to radiology; in this commentary, the term radiology will be used to refer to its historical meaning of radiotherapy and brachytherapy, compared to its contemporary meaning often referring to diagnostics and imaging.
Kavadi has detailed arguments that were used to establish the validity of radium for the treatment of cancer when deciding to establish TMH. In this commentary, I will demonstrate how the arguments that led to the use of radium at TMH were also spread throughout other cancer hospitals in India. With investment from Tata, TMH radiologists became leaders responsible for validating the role of radium in the treatment of cancer in India.
| » The Founding of Radiotherapeutic Practice in India|| |
As mentioned by Kavadi, the Patna Institute, along with other institutes, would be among some of the first centers to administer radium for cancer treatment. Patna also served as a dispensary, allowing doctors in other institutes to purchase and administer radiotherapies. K. M. Rai, a doctor from the Barnard Institute of Radiology in Madras, would be among the first to use radium in practice. It was doctors like Rai that lead efforts to departmentalize radiology within their institutes, setting a precedent across India, and helping to emphasize the necessity of independent departments for radiology. The interest TMH later took up in the use of radium in the treatment of cancer further validated the establishment of independent departments for radiology.
| » The Founding of Radiotherapeutic Practice at TMH|| |
Retrospectively, it is now known that when TMH was established in 1941, the full harmful effects of radium were not known. Spies presented one of many views on the application of radium, often in conflict with his American colleagues. With support from Spies, brachytherapy and radiotherapy were made central to the approach of the treatment of cancer at TMH.
TMH had made substantial investments in radiology; when TMH opened, an entire basement floor was dedicated as a radon plant, a department of radiophysics was established, and TMH held 2000 mg of radium in solution. However, the results of radiotherapeutic treatment at TMH in its first two decades were not impressive. During this time, patients often presented to radiotherapists at stages too advanced for curative treatment. In a sample presented in 1945, out of 122 cases of cervical cancer, 2 patients reached 5-year survival.
| » Establishing Radiology as a Necessity in India|| |
As TMH developed their radiology program, this aligned with the interest of donors of other hospitals, namely, The Cancer Institute in Madras, as well as the few public cancer hospitals beginning to be established. During this time, the radiotherapeutic research that had been performed at TMH allowed it to establish radiotherapy and brachytherapy as not only a possible treatment, but an essential treatment for cancer in India. Further, the connections that the Tata Trust facilitated for TMH radiotherapists were fundamental to guiding the field of radiotherapeutic research in India.
The TMH's involvement in research began with Ramaiah Naidu, the founder of TMH's department of radiophysics, who held close collaborations with Homi Bhabha, Director of the Tata Institute of Fundamental Research. At this time, research for radiology was embedded within the field of nuclear research. As the department evolved at TMH, its second director, K. P. Mody, not only played a role in research but also played a role of therapeutic activism. He delivered a number of public addresses as well as frequently published in the Indian Journal of Radiology. In 1947, at The Second Indian Congress of Radiology, Mody articulated to radiologists the necessity of radium in the treatment of cancer. However, Mody was conscious of the limited role that radium could play in cancer during that time unless cancer prevention strategies were integrated into national strategies; specifically, Mody was an advocate for mobile X-ray units. Despite recommendations by the Health Survey and Development Committee in 1946 to build cancer facilities in all public hospitals, little government action had been taken. As a result, Mody turned to other areas of research within radiology. Mody believed that, without building capacity for prevention, the traditional practice of radiotherapy had “attained its maximum efficiency,” and encouraged further research into radioisotopes in collaboration with the Bhabha Atomic Research Centre, another Tata project.,
| » The Continued Spread of Indian Radiology|| |
With an infrastructure in place to discuss its necessity and its best means of practice, radiology was considered essential for an institute to be recognized as a comprehensive cancer centre. As a recently introduced treatment, sourcing radium for brachytherapy and purchasing the most recent radiotherapy technologies was not only challenging to find, but costly to purchase. However, successfully acquiring radiotherapeutic technologies brought fame to some institutes, namely, the Cancer Institute in Madras (WIA). In 1956, through a donation from the Atomic Energy of Canada Limited (AECL), WIA received the first cobalt machine in India; notably, at the time AECL's donation was in line with the interests of Canada's radiology program, which was aiming to increase its grip on international radiology markets. This provided WIA with attention from institutes across India, as well as the national government. Later, this fame would lead to collaboration with Homi Bhabha himself in an effort to build a cesium unit.
| » ”evidence-Based” Medicine|| |
When TMH was founded, radiology had demonstrated variable efficacy and was known to have serious side effects. However, Spies was able to convince the trustees that, for the cancers commonly seen in India, it would be a promising treatment. In light of these concerns, radiology was still evangelized throughout India, specifically through the seen importance of research, the advocacy of TMH doctors, and the donations to facilitate the use of radiotherapies. The evidence that was used to establish radiology at TMH would embed itself within a number of institutional structures used to facilitate the spread of radiology around all of India.
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Conflicts of interest
There are no conflicts of interest.
| » References|| |
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