|HISTORY OF CANCER
|Year : 2019 | Volume
| Issue : 4 | Page : 364-367
V. R. Khanolkar and the Indian Cancer Research Centre, 1952–1962
Shirish N Kavadi
Independent Researcher, Visiting Faculty, Symbiosis School for Liberal Arts, Symbiosis International University, Pune, Maharashtra, India
|Date of Web Publication||11-Oct-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 note presents a brief account of the ideas and efforts of V.R. Khanolkar in the period 1952–1962 to develop the Indian Cancer Research Centre into a “center of excellence”. Khanolkar, who is recognized as a pioneer in cancer research in India, focused on developing multidisciplinary medical research and mentored and trained young medical researchers. He sought and received aid from the Rockefeller Foundation, which was keen to support him in this task.
Keywords: Cancer Research Institute, history of cancer, history of medicine, Tata Memorial Centre, Tata Memorial Hospital
|How to cite this article:|
Kavadi SN. V. R. Khanolkar and the Indian Cancer Research Centre, 1952–1962. Indian J Cancer 2019;56:364-7
Research was planned at the Tata Memorial Hospital (TMH) from the time the scheme was conceived and deliberated upon by the Sir Dorabji Tata Trust. The Pathology Laboratory at TMH was the centre of this research. V. R Khanolkar, Professor of Pathology at the Seth GS Medical College in Bombay, was invited to head the Laboratory and direct research. After independence this Laboratory was upgraded to a post-graduate department and eventually transformed into the Indian Cancer Research Centre (ICRC). Khanolkar was known to have vast knowledge of an array of disciplines and his interests varied, covering fields such as leprosy, reproductive physiology, blood groups, and medical education. He established a reputation as a brilliant pathologist and epidemiologist. His colleagues and fellow scientists recognized him as a man of foresight and imagination; full of productive and practical ideas and immense clarity in thought. This article examines in the context of Khanolkar's varied interests, considerable knowledge, and passion for research his ideas and efforts to develop the ICRC into a “center of excellence” through multidisciplinary medical research and training young medical researchers to address some of the basic problems associated with cancer. He is known to have inspired and mentored several young researchers who went on to win eminence in their respective fields of research.
Khanolkar at the Tata Memorial Hospital
Khanolkar began his career at the government run Grant Medical College in Bombay but later switched to the Seth Gordhandas Sunderdas Medical College founded by Indian nationalists in 1926 and which was fully staffed by qualified Indian doctors. As Professor of Pathology, he distinguished himself with his innovative teaching methods. Extant literature on the history of medicine in colonial India has highlighted the colonial government's neglect of medical research in medical colleges., Khanolkar, as Jivraj Mehta points out, made special efforts to promote medical research in the Seth Gordhandas Medical College., When the Tata Trust offered him the Directorship of the TMH's Pathology Laboratory, he accepted it as it seemed a challenge to Indian science and his refusal could mean the appointment of a foreign scientist.
Khanolkar pioneered cancer research in India. Writing about the status of cancer research in India, Khanolkar noted that while lay people lacked awareness about cancer it did not appear to occupy an important place in the minds of medical profession. Among the reasons he cited was that cancer research had, in his own words, no glamour attached to it. Interest in cancer research was lacking among both medical professionals and workers in basic sciences, such as Biology, Physics, and Chemistry. Yet, it was the study of cancer that offered a wide scope for researchers in these basic sciences. From 1941 to 1951, Khanolkar focused on biochemical, cytological, genetic, histological, and statistical aspects of cancer. He conducted research with clinical material from the hospital and field investigations in various places in India that showed that contrary to general impressions the incidence of cancer in India was not much lower than the United Kingdom or United States. He considered statistical investigation of cancer morbidity and mortality and incidence of different types of cancers in patients as an important approach to understanding cancer and its treatment. This was especially so since, Khanolkar argued, most doctors were obsessed with finding cure not realizing that while not all cures were known, it was possible to know about the treatment of different types of cancer, and a cure by following certain rigid standards could be demonstrated in a large number of cases. He also stressed that mere efficient treatment was not adequate. Having a system of records and follow-up was important to make useful contribution to knowledge relating to cancer.
Khanolkar made several important contributions to knowledge about the incidence of cancer in relation to its usage. The habits and usages of Indian people appeared to cause cancer at certain sites of the human body. In order to understand these causal factors, he made intensive surveys of the habits, customs, and usages in different regions of the country. He was one of the first to recognize chewing tobacco and betel nut as a possible causal agent of oral cancer.
Founding of the Indian Cancer Research Center
It was always Khanolkar's idea in his own words, “that the Department of Pathology, Tata Memorial Hospital, with which I was closely associated since its inception, should form the nucleus for the establishment of the Centre for advanced basic research on cancer.” A composite of developments conflated in the founding of the (ICRC). One of the earliest steps undertaken by the Indian Council of Medical Research (ICMR) was the promotion of research units at existing medical institutes to strengthen their research capacities. The unit consisted of a team of investigators led by a reputed scientist of proven ability and supported by adequate funds and facilities over a reasonable period of time for investigation into problem of own interest. The idea was to assure security and continuity in research. As a member of an ICMR committee, Khanolkar was instrumental in formulating the government's policy that recommended upgrading of research facilities in various medical colleges and institutions. Khanolkar's own research received recognition from Rajkumari Amrit Kaur, the first Union Health Minister of independent India, and support from the Director General of Health Services K.C.K.E Raja and Dr. C.G. Pandit, the Secretary of the ICMR. In 1950, a Government of India Committee recommended upgrading the Pathology Laboratory at TMH into a postgraduate department. In 1951, the Tata Trust informed the Government of India of their wish to gift the TMH to the nation while simultaneously (1952) proposing a separate building for a cancer research laboratory adjacent to the TMH for which Khanolkar requested building funds from the ICMR. A committee constituted to review the work of Khanolkar's unit at TMH recommended the setting up of a national laboratory for cancer research. The ICRC was inaugurated in December 1952, and in October 1953, the Government of India entered into agreement with the Tata Trust for establishing an All India Centre for postgraduate teaching and for research in cancer and allied subjects. After prolonged negotiations in which the main point of contention was autonomy of the institute, separate Governing Boards were constituted for the TMH and for the ICRC. In 1957, the TMH was officially handed over to the Government of India.
The Rockefeller Foundation (RF) whose policy was to support “the already good to become even better” and of “making the peaks higher” enthusiastically aided Khanolkar. Doris Zallen referring to the RF's approach observes how its, “officers continually trolled the scientific community throughout the world as they sought out the most eminent laboratories or promising scientists to support, to fulfill the foundation's function of “making the peaks higher.” Although ICRC was not the largest medical research center in India, it was considered “probably the best” and the young staff “first class.” The RF favored individuals who had attained a certain distinction. The RF officials noted high leadership qualities in Khanolkar; with an excellent grasp of the scientific situation in medicine; sound judgment; a sympathetic interest in the work of his staff; who tried hard to give opportunities to the younger members of his staff that made for high staff morale; and attracted research fellows from abroad to the center. The RF's initial support consisted of fellowships to young Indian medical scientists from the ICRC to train in universities and institutes in the United States; support to set up research units; and providing funds for equipment and chemicals for laboratories.
Khanolkar on medical research
Khanolkar believed that it was important to bridge the gap in scientific advancement between the West and India; reduce the country's dependence on the West; and, for Indians to address the medical problems of India themselves. For encouraging medical research and training of research personnel, he stated that the “greatest need is to augment the number of well trained medical practitioners.” The common practice in India was to send most of the best students for postgraduate training to the West, which was traditionally considered “to lead the world in the sphere of scientific medicine.” This dependence upon the West, while natural, it was essential for India to “evolve a method of educating more than occasional students from our own people in post-graduate studies to a level such that they can command the respect of medical scientists from anywhere in the world.” This Khanolkar argued could only be done when those returning from abroad were able “to exploit the techniques and ideas that they had acquired … to medical problems peculiar to or dominant in the tropics and the East.” Only then would “they be able to stand on their own feet” and attract young researchers to work with them in India and “not be forever turning for help and inspiration to the West.” The only way to achieve this objective was “to encourage and support financially enough research of this nature” to attract a few of the top young researchers trained abroad “so that they can make their mark in the research field.” This, he said, “may start a chain reaction which will ultimately allow us from the East to pursue a mutually advantageous and interdependent existence in the medical sciences.”
He mentored and groomed young talent; emphasized opportunities for young medical professionals and scientists for a career in research and the need to foster an atmosphere of enquiry in medical schools. Khanolkar noted a tendency among scientific workers to confine their activities to their own disciplines and cited the cases of biological and biomedical sciences and their efforts to form their own associations. He deplored such exclusiveness and the prejudice and rivalry that often impede collaboration among medical scientists. He emphasized collaboration among scientists from different disciplines as essential for advancement of research and cross-fertilization of ideas. According to him, an ideal research worker should be able to work in a team. With regard to addressing the problem of cancer in particular, he believed that multidisciplinary approach was a necessity. This required persons from different specializations to work in concert and as a team with respect for each other's work. In the ICRC, Khanolkar made purposeful and intentional efforts to bring researchers from different disciplines to work in close association.
Khanolkar encouraged his young staff to apply for fellowships for training at American and European universities and on their return offered them suitable positions and facilities at the ICRC. Those who received these fellowships were Kamal Ranadive, who studied tissue culture techniques; C.G.S. Iyer studied neuropathology at the Harvard Neurological Unit, and K.S. Korgaonkar, who was trained in physics, studied biophysics at University of Colorado and received training in biology at Harvard University, University of Michigan, and the Sloan-Kettering Institute. Darab K. Dastur was given a travel grant to train at the National Institutes of Health, Bethesda, in brain metabolism. L.D. Sanghvi trained in mathematics and statistics received a WHO fellowship to spend a year in the Department of Zoology, Columbia University. With the training and exposure to advanced medical knowledge and practice that each of them received Khanolkar encouraged them to develop their own research programs at the ICRC.
Research at ICRC
ICRC was primarily established to conduct cancer research, but Khanolkar, who was aware that research in the basic sciences, leprosy, and physiology of reproduction were interlinked to cancer research, undertook to promote research in these areas as well. As a Graham Research Scholar at the University College Hospital, London, he had received valuable research experience in basic sciences along with medical research. Moreover, in developing programs in these disciplines, he was attempting to encourage the study of problems that were specific to India, His vision was broad and not restricted to doing research at ICRC but included creating a research culture in India. Cancer research focused on experimental and clinical studies with special attention on the different aspects of its causation, mode of occurrence, and biological behavior within the host system and therapy. Techniques from the disciplines of Biology, Biochemistry, and Biophysics were used to investigate malignancy in all its multiple manifestations. Biological research was conducted both on laboratory animals and cells in tissue culture.
Khanolkar expanded the program to develop more than 10 different departments, namely, biochemistry, enzymology, pathology, neurochemistry, endocrinology, electron microscopy, microbiology, leprosy, nutrition, physiology of reproduction, radiation biology, biophysics, and applied biology. The Biochemistry Department was one of the first departments to be established at the ICRC, whereas another new discipline of Applied Biology was introduced at the Centre and Bombay University. He managed to get the RF to support the programs in tissue culture, neurology, biophysics, and genetics; offer fellowships and travel grants made training abroad of personnel in new and modern techniques associated with each of these areas; and give grants-in-aid to purchase equipment for the laboratories.
Ranadive was entrusted with the task of organizing the Tissue Culture Section. She subsequently was responsible for the creation of three new divisions, such as carcinogenesis, cell biology, and immunology at ICRC. Her work on animal models for understanding pathophysiology of cancer assumed great significance for research on leukemia, breast cancer, and cancer of esophagus. She was among the first to identify the correlation between cancer susceptibility and interaction between hormones and tumor virus, whereas her research on leprosy bacteria led to the preparation of a leprosy vaccine. She would later be awarded one of the India's highest civilian awards, the Padmabhushan.
Khanolkar had initiated research in leprosy in the TMH laboratories for he believed that “Leprosy was an important disease in relation to the solution of fundamental neurological problems quite apart from its intrinsic interest.” In a letter to R.K. Anderson, Khanolkar noted that India lacked a first-rate center for fundamental neurological research. Any appropriation of financial aid from the RF would help in developing a neurological institute. The Neuropathology Unit, the only one of its kind in India, was established in January 1948 at TMH under the auspices of the ICMR. Iyer was given responsibility for developing the unit which would also serve as a reference laboratory. In the early 1950s, it was planned to expand its scope to cover the general discipline of neurology. RF assistance was sought to fund the purchase of scientific equipment and supplies.
Genetics and Human Variation Unit
Sanghvi was put in charge of the Department of Genetics with additional responsibility to develop the Human Variation Unit, which was essentially a program in genetics that had its origins in the work on human blood groups that was initiated at the laboratories of the TMH in 1944. The Unit was formed in January 1953 with support from the RF and the Tata Trust. Human genetics was a field in which the RF had a special interest. Research into genetics covered serologic studies of different blood groups and its association with cancer. The research threw remarkable light on the genetic issues pertaining to castes – endogamous groups unique to India. As an RF official observed, it offered “almost unlimited material for studies of hereditary defects and diseases” and was seen as contributing to the “world pool of knowledge.” Demographic surveys of different castes and tribes were conducted through the 1950s and 1960s. The development of genetics was also considered essential to medical education in India.
The Biophysics Department was created at the very inception of the ICRC and was introduced as a new discipline in the Bombay University curriculum for M. Sc and PhD levels as well. Till then, the discipline had been neglected in Indian universities and research centers. Khanolkar set up and guided the development of the Biophysics Department in the Institute. Indian scientists, the RF noted, had made substantial contributions in mathematics and physics but had tended to neglect biology. The growing field of biophysics furnished a natural meeting place between India's established scientific traditions in the physical sciences and the increasingly important field of modern biology.
Khanolkar had the ICRC affiliated to the Bombay, Poona, and Kerala Universities as a postgraduate department. Young researchers worked at the ICRC for their master and doctoral degrees in the medical sciences. By the time he retired as Director of ICRC in 1963, Khanolkar had developed and established its reputation as a major cancer research center in the country. Given his varied interests and involvements beyond cancer, he was instrumental in the establishment of the Institute for Research in Reproduction and had a role in planning the All India Institute of Medical Sciences, New Delhi; the Bhabha Atomic Research Centre and also the Post-Graduate Institute for Medical Research in Chandigarh. Khanolkar's legacy is not important only for the contribution that he made on the national and international level in cancer research but also for the institutes he was responsible for setting up and developing but most significantly training a generation of young medical researchers who individually contributed to both cancer and medical research and thus to the task of nation-building.
Financial support and sponsorship
The article draws upon material collected for a broader research project for which funding was received from the Sir Dorabji Tata Trust, Mumbai and a Research Fellowship in the History of Medical Research from the Rockefeller Archive Center, New York.
Conflicts of interest
There are no conflicts of interest.
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