V.R. Khanolkar: Father of pathology and medical research in India

V.R. Khanolkar: Father of pathology and medical research in India

HISTORY OF PATHOLOGY V.R. Khanolkar: Father of Pathology and Medical Research in India Sanjay A. Pai, MD Vasant Ramji Khanolkar was the first patholo...

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HISTORY OF PATHOLOGY

V.R. Khanolkar: Father of Pathology and Medical Research in India Sanjay A. Pai, MD Vasant Ramji Khanolkar was the first pathologist in India. He made major contributions to the epidemiology and understanding of cancer, blood groups, and leprosy. He was the first to show the existence of dhoti cancers, and was among the earliest to demonstrate the carcinogenicity of tobacco and the use of needle aspiration cytology for the diagnosis of neoplasms. He was an acclaimed teacher and was on the boards of numerous international organizations. He was a bibliophile and his writings are Oslerian in style. He serves as a role model to the few in India who are aware of him. He deserves to be called the “Father of pathology and medical research in India.” Ann Diagn Pathol 6: 334-337, 2002. Copyright 2002, Elsevier Science (USA). All rights reserved. Index Words: Vasant Ramji Khanolkar, surgical pathology, epidemiology, medical research

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URGICAL pathologist, epidemiologist, research worker, and writer, V.R. Khanolkar deserves to be called the “Father of pathology and medical research in India” (Fig 1). Early Influences

under Sir William Bayliss and Prof AE Boycott as a research assistant. On his return to India in 1924, he joined Grant Medical College and the Sir J J Hospital as Professor of Pathology and Bacteriology. Two years later,

Vasant Ramji Khanolkar was born in a Maharashtrian family in Quetta. His father, Ramji Dhondji Khanolkar, was an army surgeon who, while passing through Quetta after a battle, was taken in by its beauty and decided to settle down there. As a boy, Vasant was undoubtedly influenced by his father and often accompanied him on his house calls. He spent a large part of his childhood reading Persian literature in his father’s library. Most of Khanolkar’s medical studies were completed in London, where he achieved his BSc, and later his MD (Pathology), in 1923 from the University College Hospital Medical School in London. Suffice it to say that he was the first candidate in 2 years to pass his MD from the University. He was a Graham Research Fellow from 1922 to 1924 and worked

From the Department of Pathology, Manipal Hospital, Bangalore, India. Address reprint requests to Sanjay A. Pai, MD, Department of Pathology, Manipal Hospital, Airport Road, Bangalore 560 017, India. Copyright 2002, Elsevier Science (USA). All rights reserved. 1092-9134/02/0605-0012$35.00/0 doi:10.1053/adpa.2002.35754

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Figure 1.

Vasant Ramji Khanolkar, MD (1895-1978)

Annals of Diagnostic Pathology, Vol 6, No 5 (October), 2002: pp 334-337

V.R. Khanolkar: Father of Pathology in India

he moved to the King Edward Memorial VII (KEM) Hospital to set up the department of pathology. KEM Hospital had just been set up by the Bombay Municipal Corporation to alleviate the suffering of the citizens. It was fitting then that Khanolkar, probably the first MD (Pathology) in India would be the Professor. He introduced tissue culture techniques in this hospital and later not only established the medical artists’ department, the central clinical laboratory, and the pathology museum, but also served as Dean from 1931 to 1933. His association with the hospital extended up to 1940, when he was approached with an offer to head a department in a new hospital. Based largely on a generous grant from the Sir Dorabji Tata Trust, a hospital “The Tata Memorial Hospital” was commissioned in 1936. It was the first specialist cancer hospital in India and even today is one of the largest such hospitals in Southeast Asia.1 Khanolkar was initially reluctant to leave the department that he had nurtured in KEM Hospital, but changed his mind on learning that his refusal would result in a foreigner being appointed. Being of an inquiring mind, he was interested in research and was largely responsible for the formation of the Indian Cancer Research Centre (later called the Cancer Research Institute) in 1953. He was Director of the Indian Cancer Research Centre from 1952 to 1963. Research It was at the Tata Memorial Hospital that Khanolkar carried out his major research. The complete pathologist, Khanolkar was interested not only in diagnostic surgical pathology but also in biophysics, biochemistry, basic research in cancer, blood groups, Rhesus factor, and erythroblastosis fetalis. Genetic variations, habits, and customs in carcinogenesis and submucous fibrosis were his other fields of interest. His contributions to cancer were tremendous. He studied the epidemiology of the disease and showed that, contrary to popular belief, cancer was not uncommon in India even in the 1940s.2 He was the first to show that a skin cancer could be caused by friction and irritation caused by the tight wearing of dhotis (an outer garment worn around the waist, common in India). He also showed that khaini, a mixture of dried tobacco leaf and lime, led to cancer of the lower lip, and confirmed the

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earlier finding that reverse smoking of chutta caused carcinoma of the palate.3 He, along with Sanghvi and Rao, was among the first to show the relationship between tobacco and carcinogenesis of the upper aerodigestive tract.4 With Sanghvi, he studied the distribution of Rh factor among Indians and later, erythroblastosis fetalis in Bombay.5,6 His epidemiologic observations have stood the test of time. He had shown that cancer of the lip was uncommon in India and that carcinoma of the base of the tongue was more common than oral tongue carcinoma, whereas the reverse was true in the West. This holds true even today.7,8 He documented the high incidence of breast cancer in Parsis.9 Khanolkar did extensive research in leprosy and was able to confirm the neural inception of leprosy; it was his team that isolated the Indian Cancer Research Centre bacillus in 1958 in the spinal ganglion cells of the human fetus.10 He also wrote the book “Perspectives in Pathology of Leprosy” as well as books on cancer for the general public. It is noteworthy that his scientific publications were in three languages – English, German, and French. His foresight is evident in the fact that he performed and published reports on the use of needle aspiration cytology of tumors in the 1940s. Further, he undertook research in contraception in an era when the concept of family planning was unknown. His interest in these various fields eventually led to the formation of the Blood Group Reference Centre (which later became the Institute of Immunohaematology), a Neuropathology unit (now based at Sir J. J. Hospital), and the Institute for Research in Reproduction, all in Bombay (now renamed Mumbai). Awards National and international recognition was a natural consequence of his devotion to science. Among the more prestigious memberships and fellowships were those of the New York Academy of Sciences, International Academy of Pathology, American Association for Cancer Research, and Royal Society of Medicine. He was elected President of the International Cancer Research Commission (later called the International Union against Cancer or UICC) from 1950 to 1954 and 1958 to 1962 and served on the World Health Organization Expert panels on Leprosy (1952 to

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Sanjay A. Pai

1957), Cancer (1955), Radiation Medicine (1957), and Medical Research (1959 to 1963). He founded The Teaching Pathologists Association (Bombay, 1935) and the Indian Association of Pathologists (now called The Indian Association of Pathologists and Microbiologists) in 1950. He was awarded the Padma Bhushan, one of the nations highest civilian honors, by the President of India in 1955. He was on the governing body of organizations, such as the Council of Scientific Research, Indian Council of Medical Research, and the Atomic Energy Commission. Khanolkar as Educator The crowning moment of his career as a teacher came in 1963 when the union government awarded him the first National Research Professorship in Medicine. Earlier, he had been the first teacher for MD (Pathology and Bacteriology) in Bombay University, and had served as the Vice-chancellor of the University (1960 to 1963). If a teachers’ legacy is determined by the brilliance of his students, Khanolkar falls into the highest category of teachers. His first student was R.G. Dhayagude, who later became the Dean of KEM Hospital. Darab Dastur, L.D. Sanghvi, H.M. Bhatia, C.G.S. Iyer, and Kamal Ranadive were among his students who won international acclaim. That Khanolkar had the rare ability of being able to inspire people and select the appropriate person for a job is evident when one realizes that Dr Sanghvi, a post-graduate in mathematics and statistics, had secured a job at an insurance company when his professor suggested to him that, with his inquiring bent of mind, he might be better suited to research than selling insurance! Sanghvi came into contact with Khanolkar and together they performed major epidemiologic research in blood groups in Indians. Sanghvi later completed his PhD under the renowned geneticists, Dunn and Dobzhansky. Further, Dastur, the well-known neuropathologist, was initially an internist who changed his career after hearing an inspiring talk by Khanolkar. Khanolkar’s administrative and organizational capabilities can be seen in the number of departments that he set up in various hospitals. Although he was a disciplinarian to the core, he commanded the loyalty of his staff. Khanolkar the Man Khanolkar, however, had an unhappy personal life. He lost 14 members of his family during the

earthquake in Quetta in 1935. Later, around 1950, his French wife migrated to France with their children. As a teacher he was said to be unimpressive in his lectures for undergraduates. However, he was a versatile man and his interests were not limited to medicine alone. At KEM Hospital, he was instrumental in the development of the gymkhana and in extracurricular activities. He was a polyglot and was fluent in English, French, German, Marathi, Pushtu, and Urdu. In fact, he was an examiner at the Osmania and Aligarh Universities where examination papers were written in Urdu. He was fond of hiking in the Khandala hills (ghats) and of reading. He was especially interested in the history of medicine and in the works of Sir William Osler. In fact, his nonmedical writings and lectures on advice to young doctors and scientists are strikingly Oslerian in their style.11-13 For example, consider the following passage: “the aim of a medical student is to become a good doctor and finally to help in implementing a health program which will benefit the mass of our people. Yours will be a glorious opportunity, because you will be called upon not only to make a living by your profession, but to occupy a place, probably an important place, in a great enterprise which none of your predecessors had ever dreamt of. . . The first thing that I had to learn as a student was that medicine could not be taught, but that it has to be learnt by one’s individual effort. . . You will notice much slackness and incompetence among your colleagues, you will see much pain and suffering in your patients. This should not allow callousness to replace the humane attitude in you, which should be the leading attribute of a ‘good physician.’ You should never allow indolence or indifference to creep in on you, at any stage of your development. Do not get into the habit of putting off today’s work to some other day, or passing it on to some other person. . . You will be told that yours is a noble profession, that life and death hang on your slightest movement. All this is moonshine and you will have plenty of time to discover the falsity of this and many other fables with which romantic people delude themselves and others. Our profession is like any other profession. It could be made noble if the men and women who practice it, accomplish their task with courage, fortitude and selflessness. If the work is carried out with selfishness and dishonesty it could be as mean a profession as the meanest of the lot.”12

V.R. Khanolkar: Father of Pathology in India

Although an introvert by nature, Khanolkar had his own circle of friends including Drs C.G. Pandit (ex-Director of the Indian Council of Medical Research) and B.B. Dixit (formerly the Director of the All India Institute of Medical Sciences), with whom he used to have long discussions on economics, sports, and politics. Like all Indians of that period, he followed the Indian freedom movement closely. World events after independence enthused him about world peace, social equality, and communism, and he even made an effort to learn Russian! Among his other interests were automobiles and tennis. He was also a connoisseur of French food and wines.

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who worked with him or are aware of the magnitude of his research, he serves as a source of inspiration. Wordsworth in“Character of the Happy Warrior” reminds one of Vasant Ramji Khanolkar – “Whose high endeavors are an inward light that makes the path before him always bright Who, with a natural instinct to discern What knowledge can perform, is diligent to learn“

Acknowledgments I am grateful to Drs S.N. Kothare, L.D. Sanghvi, and G.V. Talvalkar for helping with the preparation of this article.

Endpiece

References

It would naturally be expected that such a man would long be remembered by a grateful nation. Unfortunately, this is not so. Public memory is short and Indians in particular probably lack a sense of history. Khanolkar died on October 28, 1978 in KEM Hospital; the hospital that he had been associated with in its early days. He was senile and had dementia in his last few years, a fact that was made worse by the sheer brilliance of the earlier part of his life. To my knowledge, there is no oration or even a postage stamp in his honor. However, some years ago the crossroads (chowk) at the junction of KEM Hospital and Wadia Hospital, adjacent to the Tata Memorial Hospital, was named after him. This chowk lies on Dr Ernest Borges Road, the other great personality that Tata Memorial Hospital produced. The National Medical Journal of lndia and the Indian Journal of Medical Research reprinted his classic papers during and after the centenary of his birth. Cancer Research had a cover profile on him in their August 15, 1999 issue. (Coincidentally, August 15 is India’s independence day – Khanolkar would have approved !) To those

1. Pai S, Borges A: The Tata Memorial Centre. Natl Med J India 1995,8:43-45 2. Khanolkar VR: The susceptibility of Indians to cancer. Indian J Med Res 1945;33:299-314 3. Khanolkar VR, Suryabai B: Cancer in relation to usages: Three new types in India. Arch Pathol 1945;40:351-361 4. Sanghvi LD, Rao KCM, Khanolkar VR: Smoking and chewing of tobacco in relation to cancer of the upper aerodigestive tract. BMJ 1955;1:1111-1114 5. Khanolkar VR, Sanghvi LD: Distribution of Rh factor in Indians. Nature 1945;155:427 6. Sanghvi LD, Khanolkar VR: Erythblastosis foetalis in Bombay. Indian J Med Sci 1947;1:45-55 7. Khanolkar VR: Oral cancer in Bombay, India. A review of 1000 cases. Cancer Res 1944;4:313-319 8. Pai SA: Untitled article on the impact of Khanolkar on medicine in India and elsewhere. Natl Med J India 1996;9:150 9. Khanolkar VR: Breast cancer in Bombay. Acta Union Internationale Contre le Cancer Vol XVII, No 7, 1961 10. Bapat CV, Ranadive KJ, Khanolkar VR: In-vitro cultivation of an acid-fast mycobacterium isolated from human lepromatous leprosy. Indian J Path Bact 1958;1:156-159 11. Khanolkar VR: A doctor and his books. The Indian Physician 1946;5:101-109 12. Khanolkar VR: What shall we do? The Indian Physician 1946;5:165-172 13. Khanolkar VR: Science and the student. The Indian Physician 1945;4:80-89