India’s initiation into western medicine

The bright spots for medicine during colonial times were the initiation of public health measures, vaccination, and the elevation of tropical diseases to a special area of study. Dr Anshu,Department of Pathology, Mahatma Gandhi Institute of Medical Sciences, Wardha and Dr Avinash Supe, Dean, Seth GS Medical College and KEM Hospital, Mumbai opine The history of cross-cultural exchanges between the people of India and their colonial rulers provides a  fascinating insight into how these encounters shaped medicine and medical education in India. Given the  backdrop of colonialism and hegemony, the confluence of the East and the West was turbulent. It nevertheless transformed and shaped both systems of medicine. In the 16th century, it was the Portuguese who first introduced Western medicine into India. In 1600, the medical officers who arrived along with the East India Company's first fleet of ships also brought Western medicine to India. Initially, medical departments, with surgeons, were set up to provide medical relief to the troops and employees of the East India Company. In 1775, hospital boards which comprised the Surgeon General and Physician General were formed. These were essentially constituted by the staff of the Commander-in-Chief of the British Indian Army in each  presidency. Medical departments were set up in Bengal, Madras, and Bombay presidencies in 1785, and these  looked after both military personnel and British civilians. The Mutiny of 1857 led to the dissolution of the East India Company and the British government was established in India. Several organised services such as the Indian Medical Service, the Central and Provincial Medical Services, and the Subordinate Medical Services were initiated to provide medical services and improve public health. A public health commissioner and a statistical officer were also appointed to the Government of India. In 1869, the medical departments in the three presidencies were amalgamated into the Indian Medical  Service. A competitive examination was conducted in London to recruit people into the Indian Medical Service. The   European officers of the Indian Medical Service headed the military and civil medical operations in the three presidencies. However, they needed trained assistants and supporting staff such as apothecaries, compounders, and dressers in their work. Appointing European doctors had large financial implications. This prompted the  British government to look toward establishing a system of medical education in India to recruit local staff. In 1822, the Native Medical Institution was established in Calcutta to provide medical training to Indians. Around  20 young Indian students were instructed in the vernacular medium. European texts in anatomy, medicine, and surgery were translated into the local languages for the benefit of students. Though dissection was not performed, clinical experience in different hospitals and dispensaries was mandatory. John Tyler, an orientalist,  was the first superintendent of the Native Medical Institution. Parallel instruction was given in both Western and indigenous medical systems. In 1826, classes on Unani medicine were held at the Calcutta madrasa, while the Sanskrit college conducted classes in ayurvedic medicine. Successful native  graduates were absorbed into government jobs. In 1826, to offer Indians the opportunity to learn and practice Western medicine, an Indian medical school was started in Southern Bombay with surgeon John McLennan as the superintendent. This school, however, did not run beyond six years. In the 1830s, the anglicists managed to overturn several cultural educational policies started by the  vernacularists and orientalists. Charles Trevelyan, an ardent Westernizer, chastised the British policy of educating Europeans in the languages and cultures of the East and recommended that “the Asiatics ought to be educated in the sciences of the West. In 1833, Lord William Bentinck appointed a committee to look into the state of medical education in Bengal and the teaching of indigenous systems of medicine. In 1834, the report, submitted by the Committee led by Dr John Grant, criticised the medical training and assessment conducted by the Native Medical Institution. The absence of instruction in practical anatomy was also censured. The report recommended that the state  should find a medical college for the “education of natives.” The various branches of medical science should be taught to students, as in Europe. The trainees should be able to read and write in English, Bengali, and Hindustani, and must be proficient in arithmetic. In February 1835, Thomas Macaulay composed a powerful  minute recommending that the government withhold further grants to institutions, “conferring instruction in the  native languages.” The termination of official patronage to indigenous systems of medicine sealed the fate of the students of the two leading oriental institutions in Calcutta. The Native Medical Institution was abolished. The classes held at the madrasa and the Sanskrit College were discontinued in 1835. In their place, a new medical college was established to train Indian students “in strict accordance with the mode adopted in Europe through the medium of the English language.” Calcutta Medical College was established in 1835 and it ushered in a new beginning to medical education in India. Youths between 14 and 20 years of age were trained in the principles and practices of medical science using methods of the West. Around 49 students were selected, some through a preliminary examination. They were to be trained for a period not less than four years and not more than six years, after which they had to appear in a final examination. Successful candidates were given certificates allowing them to practice surgery and medicine. They were called “native doctors,” and allowed to enter public service with initial pay of Rs 30 a month. In Bombay, Sir Robert Grant became the Governor and was deeply moved by the vast number of Indians who died due to lack of proper medical care. He envisaged the idea of training Indians in Western medicine and as he tried to expedite his agenda for a more systematically planned medical college, he met with strong opposition. To  quell this opposition and also to encourage a spirit of scientific inquiry, the Medical and Physical Society of Bombay was formed in 1835. This group led by Dr Charles Morehead studied the reasons which led to the abolishment of the previous medical school. In 1837, the Society concluded that the establishment of a medical  school was necessary “for the education of the Indians of the presidency in Medical Science to the extent of qualifying Indians to become useful and safe practitioners of medicine.” Dr Charles Morehead wrote that in gifting medical science to the people of India, there was a scope “not merely for the operations of successful imitation but also the adaptations of original genius.” The college was not designed in imitation of the Medical College in Calcutta which intended to produce government servants. The college in Bombay was designed to produce independent medical practitioners from the natives of India. In March 1838, a generous grant by philanthropist Sir Jamsetjee Jeejebhoy made way for building a new general hospital. The East India Company endorsed the proposal to set up a medical college on July 18, 1838. However, Sir Grant succumbed to illness nine days before this news arrived. The new medical college was named after Grant as a tribute to him. The foundation stone of the Grant Medical College was laid in Bombay in March 1843 to “impart the benefits of medical instruction to the Natives of Western India through a systematic system.” The general hospital which was opened in 1845 is now known as the Sir JJ Hospital. The first-batch students who entered Grant Medical College were between the ages of 16 and 20 years. They were selected on set standards of vernacular language, arithmetic, and English. Two levels of instruction were offered. Indians could undertake a course to qualify as doctors as assistant surgeons or they could undertake shorter courses to allow them to practice as medical subordinates (sub-assistant surgeons, hospital assistants, and sanitary inspectors) for British government services. A medical school was established in Madras in 1835 to “afford better means of instruction in Medicine and Surgery to the Indo-British and native youths, entering the medical branch of the service in the presidency.” Different courses were conducted for the medical apprentices of the apothecary branch and for pupils of the native branch of the military sub-medical department to be appointed as dressers later. The two-year course consisted of Anatomy, Materia Medica, Medicine, and Surgery. Later, Midwifery, Physiology, Ophthalmology, and Chemistry were added, and the course was extended to three years. Eventually, medical colleges were started in other provinces too, to produce a cadre of doctors who could be recruited into the Subordinate Medical Services. In 1840, the Portuguese started the Medicine and Pharmacy Licenciates, now known as Goa Medical College. University-affiliated medical education became the norm in the 1850s, after the opening of the first three Indian universities in Madras, Bombay, and Calcutta. Madras Medical College was the first in India to open its doors to women students in 1875. Even so, in 1877, among the 8000 medical practitioners, only 450 were trained in Western medicine. The rest were practitioners of indigenous systems of medicine. While nationalism provided fertile soil for the revival of Ayurveda and other indigenous branches of medicine, the demand for swaraj or home rule entailed that India needed to be projected as a progressive, modern, and scientific nation. Therefore, the revivalist efforts during this period placed importance on establishing the scientific and progressive credentials of Ayurveda. A proliferation of books on Ayurveda in English, Sanskrit, and vernacular languages “tried to transform the hitherto relatively inaccessible knowledge into social knowledge as well as a shared system of knowledge among the practitioners.” Ayurvedic practitioners organised themselves and founded the All India Ayurvedic Congress. The themes central to the discourses at these conferences were British orientalism, the synthesis of medical systems, and the institutionalisation of Ayurveda. MM Gananath Sen, an ayurvedic practitioner from Bengal, founded a college for  the study of Ayurveda and a pharmaceutical concern for manufacturing ayurvedic medicine. Several such efforts were made to resurrect Ayurveda in the wave of patriotism. The bright spots for medicine during colonial times were the initiation of public health measures, vaccination, and the elevation of tropical diseases to a special area of study. The state  took responsibility for sanitation and hygiene. Collection of vital statistics was initiated. Many epidemiological and research studies were conducted on cholera, plague, malaria, tuberculosis and leprosy.