The power of radium

Franciszek Łukaszczyk and Tadeusz Koszarowski: the successors of Maria Skłodowska-Curie in Poland’s fight against cancer

The radium discovered by Maria Skłodowska-Curie soon began to be used to treat cancer. The development of Polish radiology, and later also oncology, was possible thanks to her students, the researchers and physicians, Franciszek Łukaszczyk and Tadeusz Koszarowski.

by Ewelina Szpak

At the beginning of the 20th century, tumors were recognized as a serious condition and one of the most common causes of death. This was probably a result of both the progress of civilization and an increase in detectability. Only in the United States at the beginning of the century, was cancer considered the 9th most common cause of death, and 20 years later had advanced to 6th place in the ranking. New discoveries in the field of physics and physicochemistry (including the discovery of “X rays”, which in honor of the discoverer were soon also referred to as Röntgen radiation, and then the phenomenon of radioactivity) proved to be applicable in the field of diagnostics and therapy, including oncological radiotherapy.

Maria Skłodowska-Curie (public domain)

In the early 20th century, still considered a mysterious disease, cancer was the cause of serious anxiety. It is significant that as part of the League of Nations created after the war, a special international Commission Against Cancer was established – the first institution of this type in history, which at the beginning of the 1930s already brought together 34 countries, including (from 1925) Poland. This meant that for the first time an “epidemic” was considered an endogenous disease that was not contagious and could not be eliminated with the help of even the most drastic measures in the field of social medicine. According to knowledge at the time, in the case of cancer, both pharmacological treatment, isolation and prevention were ineffective, surgical procedures were seen as the only option.

The achievements of Maria Skłodowska-Curie, her involvement in the research on cancer treatment and her innovative vision of interdisciplinary scientific work were equally important for creating a national cancer program in Poland. These naturally explain her scholar’s dream of establishing a Radium Institute in Poland modeled on a similar French institution.

In February 1906 before the First World War, on the initiative of Dr. Mikołaj Rejchman and Dr. Józef Jaworski, the Polish Committee for Combating Cancer was founded. After the war, in 1921, it was reactivated on a much greater scale. The wife of President Mościcki and the wife of Józef Piłsudski both became patrons of the Circle of Ladies created within the Committee (a precursor of the modern “amazon movement”) and thus engaged dozens of other women belonging to the then social elite. In 1923, the Committee appealed to Polish society requesting donations for a National Gift for Maria Skłodowska-Curie in the form of the construction of the Warsaw Radium Institute.

Radium Institute in Warsaw, 1930s (public domain)

Over just a short time, nearly PLN 2 millionwas collected, and two years later, on 7 June 1925, the foundation stone for the institute was laid. Thanks to the involvement of Polish women from the USA and Canada, it was possible to raise a half a million zlotys, a huge sum for the time. This allowed Maria Skłodowska-Curie, with the additional support of US philanthropists, to buy up to 1 gram of radium for the needs of the new Institute. In the same year, they began working on a Program Against Cancer.

The Radium Institute started its activity three years later in 1932, two years before Skłodowska’s death. Its first director was Franciszek Łukaszczyk – a pioneer of radiotherapy and Polish clinical oncology, a graduate of Kazimierz and Bronisława Dłuski, a student of Skłodowska-Curie and Claude Regaud, one of the pioneers of oncology and radiotherapy.

Professor Łukaszczyk was not only known for his knowledge, and outstanding organizational skills, but also for – as his student, Professor Tadeusz Koszarowski recalled – his “intolerance to empty talk (…) and a great sense of humor”. He was also known for his extraordinary courage, as he kept running the Institute also after the outbreak of the Second World War and during the German occupation. At the Institute, renamed the Municipal Anti-Cancer Hospital, Jews or members of the Polish underground were repeatedly hidden from Germans. An additional challenge, however, turned out to be the need to save  “Poland’s gram of radium” from Germans

Franciszek Łukaszczyk in 1936 (public domain)

The occupiers sought to seize the whole portion of the precious element. Therefore, Łukaszczyk and a group of his colleagues first concealed most of the smaller samples at the hospital, hiding smartly during investigations. Shortly before the outbreak of the Warsaw Uprising, Łukaszczyk also hid the radium which had previously been in the hospital safe. In its place fake samples of the element were placed, prepared in cooperation with the personnel. The Germans were fooled. It was these fake samples that were taken to Munich.

After the outbreak of the Warsaw Uprising, the hospital located in the Ochota district was destroyed and looted in the first days of August 1944, and the most sick patients were murdered. A few days later, Łukaszczyk risked his life, breaking through to the hospital, which had been looted by German marauders. He managed to extract all the radium from the safes, leave the district and transport the metal to his family estate in Poronin. He brought it without any protection. Exposure to strong radiation for several hours will lead to radiation sickness, from which the professor died several years after the war. However, with the support of Professor Józef Laskowski, they managed to re-launch the institute before the war.

It was a dramatic period. Polish oncologists were forced to cooperate with the Oncology Institute in Leningrad, so far unknown in Poland, to use treatment methods and surgical techniques recognized in the USSR, but rejected by a significant part of the Polish medical community. Polish doctors, however, tried to defend their autonomy. Tadeusz Koszarowski, then deputy director of the Institute and head of the Surgery Clinic and Department of Cancer Organization established from scratch, created a new definition of oncology – the “science of etiology, pathology, epidemiology, prevention and early detection of malignant tumors, combined with treatment of cancer patients, care for the terminally ill and the organization of the fight against cancer.” This approach still exists in international medical and research practice.

A Tchorek plaque commemorating the staff and patients murdered at the Radium Institute in August 1944 (photo: Jolanta Dyr; CC BY-SA 3.0)

In 1952, the Radium Institute was transformed into the Oncological Institute of Maria Skłodowska-Curie based in Warsaw, enriched by two branches: in Gliwice and Krakow. In the same year, cooperation between Polish and Soviet oncologists was officially declared – and the foundations of the post-war Program for Fighting Cancer in Poland for 1952-1975 were formulated. The program assumed the development of basic and clinical research, launching epidemiological research and cancer prevention program. The planned network of institutions referred to the program from the interwar period, in which it was assumed to create five oncological centers in the university cities of the Second Polish Republic.

In the new post-war project, due to the universal health service created in the People’s Republic of Poland, it was planned to create as many as 19 centers in each of the then regional cities. Like almost everything planned at that time, this network was to be created at an impossibly fast pace of 5-7 years, for which 32-year-old and extremely ambitious Koszarowski was responsible. His decision to implement an ambitious project meant that – as he wrote – “I was immediately hailed as a plug of the Ministry of Health, in the context of the whole political structure – with God knows what connections (…). I immediately became an enemy fought by almost all available methods, by people who were previously my friends and were kind to me only yesterday.”[1]

His report perfectly reflects the climate of distrust and suspicion of the 1950s, which accompanied involvement in activities supported by the then authorities. Nevertheless, it is worth emphasizing that after two years, Koszarowski regained trust and recognition thanks to reliable work. Łukaszczyk was one of the first to support him. Until the death of the latter, both doctors were sincere friends and cooperated. In 1956, despite the young age of Koszarowski, it was him whom the dying first director of the institute proposed as his successor. Until 1972, Koszarowski remained (at his own request) a deputy director, fully devoting himself to developing research and organizing the fight against cancer.

Maria Skłodowska-Curie in a mobile X-ray vehicle c. 1915 (public domain)

One of the achievements of Koszarowski which focused on the issue of epidemiology, was the Central Cancer Registry – one of the first registers of this type in the world. The project quickly gained recognition in world science and in the 1960s it was further developed in cooperation with the American Cancer Society. Its launch was an expression of the research of the team of Warsaw doctors predicting the dynamic pace of cancer development in Poland. And indeed: while initially incomplete data showed that in 1955, 29.5 thousand people suffered with malignant cancer in Poland (while 30.4 thousand died), 10 years later 58.2 thousand were ill (58.3 thousand died), while in 1975 there were 61.5 thousand patients (75.4 thousand deaths). According to forecasts made by the Institute team in the 1950s – by the 1990s, the number of cases was to reach 90,000 per year (in 1995 the actual number exceeded 100,000).[2]

Such a growth rate increased the fear of this illness in society, resulting in the lack of adequate knowledge and education on the one hand, on the other fostering the problem of the phenomenon of oncophobia described by sociologists, and the fact that it was treated as a taboo. From the perspective of physicians dealing with cancer treatment at the Radium Institute and its subordinate centers, the rapidly growing rate of people sick with cancer pointed to the need for a new, much larger center to fight cancer, allowing the collaboration of doctors representing various specialties under one roof and the use of all methods. Tadeusz Koszarowski presented the visionary project of such a “unified center” in 1966 during the 9th Congress of the International Anti-Cancer Union in Tokyo. The concept he proposed was recognized and to this day centers of this type are the most common model of the clinical center for the fight against cancer. In Poland, it was planned to implement the idea by building a new, large facility, today’s Ursynów Oncology Center in Warsaw.

The Franciszek Lukaszczyk Oncology Centre in Bydgoszcz (photo: Darpaw; CC BY-SA 3.0)

The visionary concept of the researcher had to collide with coarse realities. Despite widespread recognition in the international medical community, the idea of ​​a “unified center” had to wait for establishment for nearly a decade. This was, moreover, a consequence not so much of the country’s economic problems as the disagreement of a significant part of influential political activists with such a direction of Polish oncology development. Such a solution was also opposed by the adversary and direct superior of Koszarowski, an eminent radiologist – Władysław Jasiński, director of the Oncology Institute in 1961-1972.

The realization of Koszarowski’s dreams of a new center became possible only in the second half of the 1970s – that is after he took up the position of the director of the Oncology Institute (1972) and when he launched the next edition of the Cancer Program in Poland, this time for 1976-1990. It was also important that the Polish political system changed at the beginning of the 1970s, with the coming into power of the new First Secretary of the Communist Party, Edward Gierek. The effect of the third edition of the government’s cancer fight developed during his rule was a doubling of the number of beds in the hospital, upgraded equipment and a significantly increased number of specialists. All this contributed to raising the status of Polish oncology to the European level. At the end of the 70s, the Maria Skłodowska-Curie Institute even found its way onto the cover of the exclusive “Cancer Research” journal, recognizing the efforts of the Polish institution.

By the end of the 1980s, Polish oncology had created one of the first methodologies for the epidemiological study of cancer in Europe. A separate network of gradual oncological treatment was built, and large-scale cooperation was started with doctors of other specialties. All these achievements were so original and important that they were recognized as exemplary in the world, which was also confirmed by the WHO Office, which recognized Poland in 1979 as one of the benchmark countries for the system of organizing the fight against cancer in terms of the organization model.

Maria Sklodowska-Curie National Research Institute of Oncology (photo: Adrian Grycuk; CC BY-SA 3.0 pl)

As part of the Cancer Program, the construction of the aforementioned Ursynów Oncology Center was also initiated in 1975, which formally took place in 1975. The very construction of the Center reflected a number of mechanisms of the Communist reality. The choice of the main contractor turned out to be particularly troublesome: despite the favorable offer of the French company “Sodetec”, the party authorities decided to choose the newly created enterprise Budopol-Warsaw for this role. “It was – as Koszarowski recalled years later – an association gathering a group of professional directors, moving from position to position in the intervals between trips to foreign construction, organized on the basis of various connections. The enterprise grew at the expense of building the Oncology Center.”[3] As a result, the construction of the Maria Skłodowska-Curie Oncological Center was only fully accomplished in 1993. However, the time of the political transformation in the 1990s was not favorable to its efficient operation.

Although in the 1980s and 1990s, malignant cancer was already the third most common cause of deaths among Poles, the dynamics and scale of actions taken by Łukaszczyk’s students and the community centered around Koszarowski and outstanding surgeons, hematologists, radiologists, pathologists and other specialists from institutes in Krakow, Gliwice and other specialist centers, were rapidly . Another government program to fight cancer was only adopted in 2005 thanks to the involvement of oncologists themselves, supported by people of culture, science and politics. This almost 15-year break (since 1990) undoubtedly still backfires in the practical activities of this sector of Polish healthcare.

 

Author: Ewelina Szpak – Assistant Professor at the Tadeusz Manteuffel Institute of History, Polish Academy of Science, where she is currently working on a project entitled ‘A Socio-Cultural History of Cancer in Poland after 1945. Institutions. Places, People’. She studies biopolitics as well as social and cultural history of the Communist period in Poland.

Translation: Alicja Rose & Jessica Sirotin

 

Bibliography:

T. Koszarowski, Urywki wspomnień, Warszawa 2006.
W. Zatoński, Nowotwory złośliwe w Polsce, Warszawa 1994.
Patrice Pinell, The Fight against Cancer: France 1890-1940, Routledge 2002.
Z. Wronkowski, E. Towpik, Instytut Radowy im. Marii Skłodowskiej-Curie w Warszawie.
R. Furmna, Drogi do onkologii. Liderzy patrzą wstecz, Warszawa 2017.
T. Koszarowski, Dać świadectwo prawdzie, Warszawa 1998, pp. 1-46.
Rocznik Statystyczny Ochrony Zdrowia 1981, Warszawa 1982.
L. Tarłowska, E. Towpik, Instytut Radowy w Warszawie podczas okupacji i Powstania Warszawskiego, „Journal of Oncology” 2003, vol.53, No 1, pp. 74-86.
Z. Wronkowski, Skąd się wzięły Amazonki czyli o związkach Amazonek z Polskim Komitetem Zwalczania Raka, „Amazonki” 2013, No 23, p. 2.

 

[1] T. Koszarowski, Urywki wspomnień, Warszawa 2006, p. 164.

[2] In 2016, 164,000 suffered from cancer in Poland. 100,000 people died.

[3] Ibidem, p. 184.