SubodhMitra - The forgotten hero in the Indian Radiotherapy

This article aims at reminding us about the life and works of a pioneer Oncologist from India. Subodh Mitra, universally recognized and remembered as the first gynecological oncologist in India, was born on November 1896 at a town named Jessore of the undivided Bengal in a middle class family. He completed his medical Graduation in 1922 from the Calcutta Medical College. He received the M.D. degree of Berlin University in 1924. He was conferred the FRCS of Edinburgh (1924) and MRCOG of London (1925). After completion of his higher education and training abroad, Dr. Mitra joined the present day R.G.Kar Medical College and Hospital, Kolkata as an assistant superintendent and resident surgeon in 1926.[1] When Deshbandhu Chittarnajan Das died, he donated all his land and property for the purpose of building a hospital for the common people; specially the poor women. With the initiative of Mahatma Gandhi, Dr. BC Roy and the other luminaries of that time, a maternity hospital in the name of "Chittaranjan Sebasadan (CSS)" was started in 1926 at Kolkata. It was formally inaugurated by Gandhiji himself in 1927 and Subodh Mitra joined that hospital the same year.[1] Dr. Mitra was deeply moved by the pain and agony of the female patients and had the foresight to realize the need for a speciality hospital for the cause of treatment of the underprivileged women. Besides other maternity and gynecological services, he and his fellow doctors also started treating female genital cancers there. He also desired to establish this hospital as a comprehensive center for treatment, research and prevention of cancer. Dr. Mitra nurtured his project and continued saving Rs. 100/- per month from his salary with aim to contribute towards the funds of the existing Deshbandhu Trust. While the Tata Memorial Trust had already set up a Cancer Hospital in Mumbai, in accordance with, the wishes of Sir Dorabji Tata in 1941, Dr. Mitra succeeded to realize his dream in 1950.[1] Major scientific contributions of Dr. Mitra in Gynecology include the understanding of anemia and toxemia in pregnancy and cancer surgery.[1] The most important original contribution of Dr. Mitra recorded and recognized worldwide was his new technique of management of cancer of the uterine cervix.[12] At that time, Wertheim's Hysterctomy for cancer cervix yielded good results, but was an extensive surgical procedure with dissection of pelvic lymph nodes and its associated morbidity. Then there was the Schauta's vaginal hysterectomy which was easy but had the drawback of not doing pelvic lymph node dissection. Mitra combined the vaginal hysterectomy with in a two-stage operation, the first part being a radical vaginal hysterectomy and the second part (three weeks later), the extra peritoneal pelvic lymphadenectomy[3], thus decreasing morbidity of Wertheim's surgery (better resection of vaginal disease, less post-operative morbidity and suitable for obese and medically unfit patients). The new method was officially announced in the British, American and German Gynecology Congresses and demonstrated by the pioneer himself at Vienna in 1952 and at Berlin University in 1960.[12] As an worldwide recognition, his technique of operation has been embodied in a monograph ′′Mitra Operation for Cancer of the Cervix′′, and was published simultaneously in the USA. by Charles C. Thomas, in Canada by the Ryerson Press, Toronto and in London by Blackwell Scientific Publication Ltd. Oxford, England.[12] The above contributions of Professor Mitra as a Gynecological Oncosurgeon is well recognized. But he was more a comprehensive cancer physician than just a world famous oncosurgeon. He was also a Radiologist, Radiation Oncologist, Radiobiologist, Cancer Epidemiologist and one of the greatest visionaries of cancer that India has ever produced. Gandhiji in his letter to the frontier Gandhi says "Non-violence is like radium in its action. An infinitesimal quantity of it imbedded in a malignant growth, acts continuously, silently, and ceaselessly till it has transformed the whole mass of the diseased tissue into a healthy one."[4] It seems quite reasonable to justify that Gandhiji was imbibed by this nobility of radium from none other than Dr Mitra at CSS, both of whom were intricately associated with the development of that hospital where the first cancer treatment with radiotherapy in India was done. In his early life he was possibly interested in both surgery and radiotherapy. He used to practice radiotherapy in his Kolkata CSS hospital as back as 1927, treating gynecological cancers with a combination of teletherapy and brachytherapy.[5] He was the pioneer in India for using radium in the treatment of cancer. The deep X-ray machines were invented and used in Europe in the year 1920 and he managed to treat patients of carcinoma cervix by deep X-ray treatment at CSS almost at the same period. In his paper, he depicts the treatment procedure and results with discussions in a series of 360 patients. Deep X-rays of 180 KV were used from five different portals (Hypogastric, sacral two lateral and vulval) up to a full skin erythema dose each time. He used to deliver the brachytherapy dose to both vagina and the cervical canal by radium. For vagina he used customized vaginal mold (the Radium tubes covered by brass and rubber filters) for each patients separately depending on their vaginal contours,[5] to have an even dose distribution. In the cervical canal he used a special obturator having 0.5 mm brass filter. His study has a follow-up period of five years and besides he has also documented the overall survival acute toxicities of radiation treatment, symptomatic control and general condition of the patients during the follow up. About 90% of his patients had stoppage of bleeding after the first course of Radium therapy and for almost in all of them bleeding was controlled thereafter. He divided his patients into early, late and terminal groups. The cure rate at 5 years was 50% and 16.6% for the early and late cases, respectively. Even in the year 1932 being himself a Surgeon he was seen claiming in his article that Radiotherapy is more effective than surgery for the cure and treatment of even the early stage cervical cancers.[5] His other fields of cancer research included radiobiology and cancer epidemiology. He did studies on effects of radiation on the cancer cells of cervix at his cancer hospital and research institute.[6] He used to maintain a hospital based cancer registry at that time, and had published his data on cancer trends of India and survival[7] He was the founder secretary of the ′Indian association of radiology′[8] and one of the key members in formulating ′The Federation of Obstetric and Gynaecological Societies of India′.[9] Besides being a great doctor he was a great administrator, organizer and philanthropist. He was instrument in building up the second comprehensive Cancer hospital of India, attached with a research institute.[1] This era of evidence based cancer treatment was far seen about a century back by the noble man; hence, he went on documenting and publishing his works over the years. His ideas were to improve and develop own home grown techniques rather than imitating methods of other developed countries. At that time Dr. Mitra was widely known and recognized for his pioneering efforts among the world scientific community. Nobel Laureate Madame Irene Julio Curie came to Kolkata to inaugurate the cancer treatment centre, which he developed on 12 January 1950, on his request.[12] He was bestowed with many honorary degrees from across the world. He received the prestigious Honoris Causa Membership of the Society of Gynecology and Obstetrics of Italy in 1944 for his invaluable contribution to this field. Again in the same year he earned the Fellowship of the National Institute (FNI) in recognition of his contributions to Cancer Surgery, pregnancy related toxemia and anemia and fundamental researches in the field of cancer. Professor Mitra became the Fellow of the American College of Surgeons in 1949 and in 1960, the Academician of German Academy of Science.[12] Apart from discharging many other responsibilities in the field of medical education at that time, he also honoured the post of Vice-chancellor of the University of Calcutta in 1960. This great academician and teacher died outside the country at Vienna on the teacher's day that is 5 September 1961, while he was attending the third world conference of world gynecology.

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