Childs Nerv Syst DOI 10.1007/s00381-015-2634-5

INVITED PAPER

Sanat Bhagwati (1928–2013): a tribute Chandrashekhar Eknath Deopujari

Received: 9 January 2015 / Accepted: 3 February 2015 # Springer-Verlag Berlin Heidelberg 2015

Sanat Bhagwati was born on December 17, 1928 in Ahmedabad in pre independence India. He was to spend most of his life in the western Indian coastal city of Mumbai (Fig. 1). Sanat was born into an illustrious family. His father Natwarlal, a lawyer, was an activist in the Indian freedom movement and worked through peaceful resistance towards the Indian independence from the British Empire. He then served as a judge of the Supreme Court of India and as the Vice Chancellor of the very prestigious Benares Hindu University. Sanat had a happy, mildly privileged childhood in Mumbai. His parents had engaged the services of a private music teacher for him, but to their dismay, Sanat did not seem to have an ear for music! When he was 11, a favorite uncle died suddenly of complications from appendicitis. His death was a psychological blow but helped crystallize young Sanat’s decision to become a doctor and save lives. Sanat Bhagwati completed his medical graduation (MBBS) and basic surgery training (MS) from the Seth Gordhandas Sunderdas (GS) Medical College and the King Edward Memorial Hospital (KEM) in Mumbai. Here, he came in contact with and was influenced by the work of Dr. Ram Ginde, the pioneer neurosurgeon of western India. Ginde motivated him to take up Neurosurgery as his specialty (Figs. 2 and 3). There was no formal neurosurgical training in Mumbai at the time. On the advice of his senior colleague, Homi Dastur, Sanat proceeded for his neurosurgical training under the guidance of Sir Wylie McKissock at the Atkinson Morley

C. E. Deopujari (*) Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India e-mail: [email protected]

Hospital in London. There he had opportunity to work with visiting surgeon Kenneth Till, the leader in Pediatric Neurosurgery in UK at the time. Sanat then received a fellowship in pediatric neurosurgery at the Children’s Memorial Hospital, Chicago, in the year 1961 and first half of 1962 with Dr. Luis Amador as the Chief of the Service. There he worked with and developed friendship with David McLone and Anthony Raimondi. During this fellowship, he also developed a thick friendship with Dr. Harvey White, Professor of Radiology and used his expertise of doing studies of pneumoencephalography (PEG) and ventriculography which was a significant advance at the time in the neuroradiological investigations at the Children’s Memorial Hospital. He also spent his spare time working in Percival Bailey’s pathology laboratory. After his training in London and Chicago, having a patriotic zeal and wanting to improve neurosurgical services back home, he returned to Mumbai in July 1962. He joined the Grant Medical College and Sir Jamshedji Jijibhoy (JJ) Hospital, a state government-run hospital with Professor Ginde and continued to serve there till his retirement as the Head of the Department in 1986 (Fig. 4). His mentor, Dr. Ginde, also encouraged him to join the Bombay Hospital, a charitable private medical institute as it was the practice norm at the time. He continued to work at the Bombay Hospital till 2012 when he retired due to ill health as the Director and Emeritus Professor (Fig. 5). In February 1963, Dr. Bhagwati married Rashmi Daftary, a practicing architect and interior designer. She has also been interested in the restoration of heritage structures and is a jewelry designer. They have two daughters. Ketaki, the elder daughter is an economist and works with the World Bank in Washington. Niyati, the younger daughter, has followed Dr. Bhagwati’s footsteps to be a medical doctor and is a clinical hematologist in New York (Fig. 6).

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Fig. 1 Prof. Sanat N. Bhagwati (December 17, 1928–December 14, 2013)

Sanat Bhagwati’s older brother, Praful, went on to become the Chief Justice of the Supreme Court of India and has been instrumental in the introduction of judicial activism and accountability for both elected and appointed high officials of the state. Sanat’s younger brother, Jagdish, was also drawn to international activities, emigrating from India to accept the Chair in Economics at the Columbia University in New York.

Fig. 2 Medical graduation

Fig. 3 Dr. Ram Ginde

Dr. Bhagwati was among the first neurosurgeons to prove the efficacy of ventriculo-atrial and ventriculoperitoneal shunting in patients with tubercular meningitis and hydrocephalus. He went on to emphasize the success of conservative treatment of ‘tuberculomas’ with anti-TB drugs and that surgery should be reserved when the diagnosis is in doubt or when the lesions cause lifethreatening rise in intracranial pressure or lead to blindness [1–10]. In the J.J. Hospital, he arranged many academic activities including visits by renowned neurosurgeons like Pia, Groto, M. Samii, J. Hardy, W. Sweet, R. Sengupta, and Picard for educational courses. He also worked with Drs. Darab Dastur (Neuropathologist) and P.M. Udani (Pediatrician) on neurotuberculosis and performed brain biopsies on cases of tubercular encephalopathy to understand etiopathology which has become a definitive work [9]. He carried out a large postmortem study of the circle of Willis in over a thousand cadavers at the J.J. Group of Hospitals to determine the incidence of cerebral aneurysms in the Indian population. At the time, it was believed that the incidence of aneurysmal rupture in the country was lower than in other parts of the world [11, 12]. Dr. Bhagwati was also the first to establish stereotactic surgery in the western part of India in late 1962 and performed over 300 thalamotomies for Parkinson’s disease and amygdalotomies for behavior disturbances. He did this body of work with an indigenously modified stereotactic frame,

Childs Nerv Syst Fig. 4 With the colleagues and staff of J.J. Hospital, Dept. of Neurosurgery (1989)

which seven other centers in the country used to perform stereotactic surgery later. He was one of the main pillars in the organization of the World Congress held in India in 1989. He used this opportunity also to invite the 17th Annual Meeting of the ISPN in Mumbai just after the Congress which was an unqualified success. This proved to be a great impetus for the pediatric neurosurgery movement in India and was a catalyst in the formation of a group of neurosurgeons interested in pediatric neurosurgery. What followed was the formation of the Indian Society for Pediatric Neurosurgery the following year with Dr. Bhagwati as its Founder President. Pediatric Neurosurgery was the first subspecialty neurosurgical society in the country. He started pediatric neurosurgery courses by the International Society for Pediatric Neurosurgery which have been regularly held since 1992 and have been a rich source of learning and training programs

Fig. 5 With consultants and residents at the Bombay Hospital, Neurosurgery Dept. (2010)

in pediatric neurosurgery (Fig. 7). The International Society for Pediatric Neurosurgery (ISPN) was like a family to him, and he was nominated the President of the International Society for Pediatric Neurosurgery in 1995 (Figs. 8, 9a–c). The organized pediatric neurosurgery subspecialty was soon followed by the Neurotrauma, Skull Base and the Stereotactic and Functional Societies. Sanat has held many positions at the various societies and contributed immensely in the foundation and growth of these societies and furthering their role in the medical field. To name a few, he was elected as the President of Neurological Society of India (NSI), the Indian national organization for neurosurgeons (1988–1989) (Fig. 10). He was also the founder president of the Skull Base Surgery Society of India, president of the Indian Stereotactic and Functional Neurosurgery Society, and the honorary president of Asian Australasian Association of Neurosurgical Society in 2007.

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Fig. 8 President, ISPN 1995–1996

Fig. 6 With wife Rashmi (extreme (R) and daughters Ketaki (extreme (L) and Niyati (R)

He had the vision to institute the Ginde Oration in 1992 with the help of the Bombay Hospital Trust wherein masters of various fields of neurosurgery from all over the world were invited to give scientific talks and to demonstrate the nuances of their surgical techniques in live surgical or cadaveric workshops. This has become an annual event and is a very important component in the national neurosurgical calendar. This provided an opportunity for Indian neurosurgeons to rub shoulders with the doyens in this field and to learn from them (Fig. 11). In spite of having a flourishing practice, he was extremely interested in academic activities. His motto was “Work is

Fig. 7 Beginning of Pediatric Neurosurgery courses in India

worship.” He liked to keep himself updated and adopt newer techniques and technologies. He treated a large number of patients for free at the Bombay Hospital and helped relieve the financial burden of poor patients (Fig. 12). Although a strict disciplinarian, he was a father figure to all his residents and stood by them in their hour of need. He inspired them to become good doctors and above all better human beings. His honesty and integrity may have cost him many friends but won him admirers. He regularly sent his students abroad and to other centers in the country for further training. His passion for academic neurosurgery was evident in his numerous publications, textbook chapters, and platform presentations. Though his academic areas of interest were varied, special mention must be made of TB meningitis, cranial and spinal dysraphism, congenital craniovertebral junction anomalies, neurooncology, pediatric

Childs Nerv Syst Fig. 9 a–c ISPN

(a) ISPN Family Sanat with Harold Hoffman, Osamu Sato and Fredd Epstein

(b) Rashmi and Sanat with his Predecessor

(c) Sanat with Tai-Tong Wong, Hal Rekate,

David McLone & his wife

Rashmi (seated) Kiyoshi Sato, Anthony Raimondi, & Shizuo

meningiomas, medulloblastomas, and craniopharyrngioma [13–23]. Dr. Bhagwati has been directly responsible for training over 50 students in Neurosurgery, who are respected neurosurgeons in their own rights. It is no surprise then that six out of the nine neurosurgeons currently working at the Bombay Hospital have either been his students or have worked with him. He has been a great teacher, mentor, and guide. His legacy will remain in the form of the three institutes he

Fig. 10 President, Neurological Society of India (NSI) 1988–1989

developed for neurosurgery training in Mumbai and helped three others in Ahmedabad and Rajkot, his work ethic and enthusiasm, for having trained over 50 neurosurgeons, encouraging and helping many young neurosurgeons to train in India and abroad, for having pioneered CME programs in India, having encouraged multidisciplinary surgical work with craniofacial and

Fig. 11 Ginde Oration of Bombay Hospital in 2008 with M.G. Yasargil

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Fig. 12 Dr. Bhagwati with patients and relatives

ENT colleagues, and helping in the development of organized neurosurgery in India. May his soul rest in peace.

References 1. Bhagwati SN (1971) Ventriculo atrial shunt in tuberculous meningitis with hydrocephalus. J Neurosurg 35(3):309–313 2. Bhagwati SN (1986) Management of tuberculoma in the brain stem and the thalamus. In: Samii M (ed) Surgery in and around the brain stem and the third ventricle. Springer, Berlin, pp 410–415 3. Bhagwati SN (1986) Intracranial tuberculoma. Neurol India 34:161– 163 4. Bhagwati SN, George K (1986) Use of intrathecal hyaluronidase in the management of tuberculous meningitis with hydrocephalus. Childs Nerv Syst 2(1):20–25 5. Bhagwati SN, Parulekar G (1984) Management of TBM hydrocephalus. Role Shunt Surg NIMHANS J 2(1):55–58 6. Bhagwati SN, Parulekar G (1986) Management of intracranial tuberculoma in children. Childs Nerv Syst 2(1):32–4

7. Bhagwati SN, Singhal BS (1970) Raised intracranial pressure as a mode of presentation in tuberculous meningitis. Neurol India 18:116 8. Bhagwati SN, Singhal BS (1974) Ventriculo atrial shunt in the treatment of tuberculous meningitis—WHO monograph on tuberculosis of the nervous system 9. Dastur DK, Udani PM (1966) The pathology and pathogenesis of tuberculous encephalopathy. Acta Neuropathol 6(4):311–26 10. Singhal BS, Bhagwati SN, Syed AH, Laud GW (1975) Raised intracranial pressure in tuberculous meningitis. Neurol India 23(1):32–39 11. Bhagwati SN (1998) Incidence of subarachnoid hemorrhage from aneurysmal rupture in India. Neurol Med Chir (Tokyo) 38(Suppl): 128–30 12. Bhagwati SN, Deshpande HG (1993) Study of Circle of Willis in 1021 Consecutive autopsies: incidence of aneurysms, anatomical variations and atherosclerosis. Ann Acad Med Singapore 22(3 Suppl):443–446 13. Bhagwati SN (1989) Treatment of Glioma with intratumoral instillation of autologous lymphocytes. Childs Nerv Syst 5(1):38–40 14. Bhagwati SN (1990) Congenital atlantoaxial dislocation. A study of 99 cases. Neurol India 38:317–24 15. Bhagwati SN (1995) The treatment of hydrocephalus—a brief guide to shunt selection—comment. Surg Neurol 43(4):320–320 16. Bhagwati SN (1997) Ethics, morality and practice of medicine in ancient India. Childs Nerv Syst 13(8–9):428–434 17. Bhagwati SN (1999) Dermal sinus. In: Choux M, Di Rocco C, Hockley A, Walker M (eds) Pediatric neurosurgery. Churchill Livingstone, New York, p 442 18. Bhagwati SN, Deopujari CE, Parulekar GD (1990) Lamina terminalis approach for retrochiasmal craniopharyngiomas. Childs Nerv Syst 6(8):425–429 19. Bhagwati SN, Deopujari CE, Parulekar GD (1998) Trauma in atlanto axial dislocation. Child’s Nerv Syst 14(12):719–721 20. Bhagwati SN, Mahapatra AK (1999) Encephalocele and anomalies of the scalp. In: Choux M, Di Rocco C, Hockley A, Walker M (eds) Pediatric neurosurgery. Churchill Livingstone, London, pp 101–119 21. Mehta N, Bhagwati SN, Parulekar G (2009) Meningiomas in children: a study of 18 cases. J Pediatr Neurosci 4(2):61–65 22. Sankhla S, Nadkarni JS, Bhagwati SN (1995) Adoptive immunotherapy using lymphokin—activated killer (LAK) cells and interleukin-2 for recurrent primary brain tumors. J Neuro Oncol 27(2):133–140 23. Shah AB, Muzumdar GA, Chitale AR, Bhagwati SN (1998) Squash preparation and frozen section in intraoperative diagnosis of central nervous system tumors. Acta Cytol 42(5):1149–1154

Sanat Bhagwati (1928-2013): a tribute.

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