Legislation, activism and power play – Medical education policies in colonial and post-colonial India

ABSTRACT

Colonial medical education and public health policies emerged from an intriguing discourse of negotiation between the government and the people. These ‘structured conflicts’, rooted in the politics and the debates of the colonial institutions not only provided opportunities for creative thinking about public health but also for imposing constraints. The colonial and post-colonial India medical legislative debates revealing a new language of protest, assumed greater significance with the growing nationalist movement and the general (though variegated) intellectual polarisation – western and indigenous systems of medicine. Problematising the historiographic assertion of medical modernisation in colonial India to be a part of ‘civilising mission’, this paper argues that legislature emerged as a platform of activism and protest against the colonial and post-colonial State’s appropriation of modernity. While some members appealed for extending the benefit of ‘modern’ western medicine to the general Indian population, some debated in favour of introducing the indigenous medical systems to the terms of modern professionalisation. The post-colonial policies reveal the true significance of the legislative debates in reviving the position of indigenous systems of medicine in the context of professional modernity.

KEYWORDS:

• Legislature
• debates
• knowledge system
• medicine
• protest

Liberal legacies: Governance, health and modernity

Historians’ assertion of a universally valid bourgeoisie modernity justifying colonial presence has been severely criticised by post-colonial academia. As Sudipto Kaviraj has argued, modernity was neither a homogenous identity, nor does it ‘replicate western social forms in other parts of the world to produce a uniform modernity’. Critically analysing the role of orientalism (as a cognitively disciplined body of knowledge) in impacting the colonial policies, Kaviraj holds that such knowledge provoked the anxiety of the colonial rulers about the possible amenability of the colonial society to standard western ruling practices (Kaviraj, 2000). In the context of medicine, such anxieties caused much apprehension about the indigenous medical systems. Resultantly, the communal/religious association of Ayurveda and Unani debased them of their authentic, scientific and rational value and a departure from such ‘traditions’ were crucial to the modernising project (Deshpande, 2011, p. 1313). While for the colonial government, the usefulness of the traditional systems was limited to their pharmaceutical value (Banerjee, 2002), for the nationalist leaders, their revival became a means to perpetuate a communal, hegemonic caste/class ideology (Rai, 2019). With the admission of Indian elements in the Imperial legislature (later Central Legislative Assembly), debates on medicine negotiated an appropriation of the colonial modernisation agenda. The bills, debates and enactments revealed a reassertion of faith in British liberalism through a new language of activism to chart out a distinct path of modernity.

Nineteenth century was marked by its immense intellectual presence and as Kaviraj has pointed out, by twentieth century it led to the emergence of a western educated intellectual class that had acquired sufficient mastery of ‘what to take and what to reject of the proposals of Western modernity’ (Kaviraj, 2000, p. 147). Indian legislative representation since 1919 is marked as a political watershed in Indian nationalist movement – an important promise towards liberal constitutionalism, self-governance by diffusing British liberalism in India and reach out to the masses with the intended fruits of modernity. In the words of Madan Mohan Malviya: ‘There is much in the proposal that is liberal and that will mean a real and beneficial change in the right direction which we must welcome and be grateful for … ’ (Malviya, n.d., p. 19). Though the Congress, suffered an organisational rupture over constitutional ‘representation’, legislative members challenged the State’s authority in representing the concern of the colonial people (Chakraborty, 2009, p. 190). Thus, the Central Legislative Assembly emerged as one of the chief ‘paradigms of defense’ (Bala, 2012, p. xii) marking a distinct phase of governance. The debates in the legislature in the context of the Indian Medical Degrees Act and the Indian Medical Council Act, reveal a new language of protest against outright colonial imposition revealed the methods of reason employed to identify the forms of one’s own particular modernity (Chatterjee, 1993, p. 270).

In the following sections, this paper shall discuss how in the context of the Indian Medical Degrees Act (1916) and the Indian Medical Council Act (1933), the legislature emerged as a platform to deliberate on national as well as local medical concerns. It shall explore how the members protested un-modified western onslaught and how they incessantly emphasised professional modernisation of indigenous systems. In tune with the nationalist programme, continuous demands and protests were voiced in the legislature to modernise indigenous systems to serve public health.

Catchpenny degrees and ‘Charlatanism’: Need for imminent check

The registration of the western medical practitioners by the establishment of the Provincial Medical Councils in the 1910s and 1920s was an important step in institutional entrenchment of western medicine and marginalisation of indigenous practitioners, particularly the vernacular schools and colleges.¹ However, mushrooming of private medical institutions raised a flag of concern. Officially, the distinction was clear – the colleges (both private and government) provided doctorate and bachelor’s degree and the medical schools trained the Licentiates or Sub – Assistant Surgeons. According to the Indian Medical Review, 1937–1938, there were 18 government and 9 non-government schools in British India and around 6500 students were enrolled in these schools. Though many of these schools had begun as Ayurvedic and Unani teaching institutions, they had eventually abandoned them. These schools were under the administrative jurisdiction of the provincial governments or the local municipal bodies.²

While, in 1908, such institutions were warned and notified to get affiliated with one of the Universities and raise the standard of students, curriculum and infrastructure, they failed to take any initiative to that end. In America, The Flexner report (1910) had highlighted the menace created by the spurious ‘diploma mills’ and had recommended a ‘housecleaning’ by American Medical Association by improving their standard. Thus, on 22 September 1915, Pardey Lukis introduced the Indian Medical (Bogus Degrees) Bill to prevent any institution from granting diplomas in imitation of the degrees and diplomas of the affiliated medical institutions, thereby threatening the goodwill of the western medical practitioners. The bill passed as The Indian Medical Degrees Act, (Act VII of 1916), specified certain authorities to be entitled to issue any degree or diploma in western medicine or surgery. It also created the provision to penalise individuals falsely assuming any medical title which was granted either by the General Council of Medical Education of the UK or by authorities constituted under the Act.³ However, on the eve of WWI, finance remained a constraint and therefore these institutions were not summarily dismissed as they largely relieved the Government of any financial responsibility. The bill, while being discussed by the Indian Legislative Council, however, insisted on ‘affiliation’ as an essential clause to improve their standard at par with the government Colleges. Lukis, who was the Director-General of Indian Medical Service, expressed his views before the Council about this arrangement – ‘there is ample room for properly staffed and well-equipped un-official medical colleges and schools, which may be either affiliated to the University or run on the same lines as Government Medical School but entirely conducted by Indian Medical Men … ’⁴ The bill, maintaining the Imperial control over the medical education policy by the European medical officials (still a majority in the Senate and State Medical Boards) also ensured a direct control of the GMC, which in the face of Indian nationalist movement and WWI, was increasingly becoming apprehensive about the ‘standard’ of western medical education in the colonies.

The Bombay Government wholly supported the bill condemning this ‘category of practitioners’ to be ‘the dismissed ones’ lacking a proper training and constituting a great danger to the public. The imitative titles of their diplomas could be confusing and thus endanger public health at large. Maharaja Ranjit Sinha of Nashipur added that the purpose of the bill was defeated as there was no clause in the bill to prevent the practitioners with similar imitable diplomas and licenses from foreign private institutes. But importance of the bill remained on the acceptance of the ‘western’ medicine, though in a limited form as supported by the Indian members of the legislature. Surendranath Banerjee, representative of Bengal in the Imperial legislature, argued that the bill was much opposed to the prevalent public opinion as protest meetings against the bill were being conducted in different parts of the country. Banerjee argued that the doctor-patient ratio would increase unprecedentedly if the bill was passed, thereby forcing people to depend more on the quacks and endanger their health. With this enactment, a number of students from these institutions would be rendered ‘idle and discontented’ who had otherwise acquired the confidence of the public and served them for long.⁵ Appealing the Council to live up to its promised ‘deferential attitude towards the reasonable expression of Indian public opinion’, Banerjee pleaded for the withdrawal of the bill.

A resolution, reiterating the usefulness of these practitioners, urged the Governor General in Council to instruct the Local government to establish ‘vernacular private colleges’. It was proposed as a means to supplement the strength of the medical workers in India and serve the millions who could not afford the Government College graduates, especially in the rural areas. Surendranath Banerjee and Madan Mohan Malviya, objected to any restrictions on such medical practice. Banerjee argued ‘Some of the doctors might turn out to be eminent, medical practitioners, gifted with a genius for diagnosis, born physicians or born surgeons who might be able to do a good job … Let the public make their choice’.⁶ He added, ‘For when the law allows any quack to practice in towns, why should a trained man be disallowed by law to practice? I think it will go against the whole scheme’.⁷ With a word of caution about maintaining the ‘standard’ even with ‘external control and inspection’, official members like Sir Pardey Lukis and Sir Reginald Craddock acknowledged that the vernacular colleges, if built on private initiative and funding, could be an important measure to deal with the large population in rural areas. Passed with immediate effect, these vernacular colleges were also expected to provide recruits for sub-assistants in the IMS. However, the futility of the resolution was evident within a few years of its acceptance. While discussing the Budget (1919), it was stated that the resolution was never executed by the local governments and this failed to provide medical aid and relief particularly in the areas affected by the influenza epidemic of 1918–1919.⁸

In 1935, Major-General Cuthbert Sprawson, Director-General, IMS, reiterated the arguments on the basis of which the resolution on vernacular colleges was scrapped. In his words:

Experience seems to show that the average medical man, if not properly educated, when he is let loose on the world to practice his profession, himself tends to degenerate … it certainly seems better to have a few satisfactory schools rather than several inferior ones and that seems to be the generally accepted policy.⁹

By the time the Indian Medical Degrees bill was reintroduced after eliciting the opinion of the Select Committee and incorporating a few amendments, two of the four private colleges operating in Calcutta had already been closed and the other two had applied for the affiliation of the Calcutta University and the State Medical Faculty respectively. The college at Belgachhia, which was one of the oldest private colleges, also received an allocation of fund from the government to upgrade its infrastructure and ‘standard’ to produce duly qualified western medical practitioners. While the bill was treated detrimental to private initiatives in medical education, decision on curriculum and setting up of examining bodies by the Government could gravitate some funds from private sponsors and patrons and promote ‘an interest on the part of the non-official public in the amelioration of hospital conditions throughout the country.¹⁰ Even in research, private funding was wholly being solicited, particularly in the establishment of Tropical Medicine institute in Calcutta and Bombay as well as expansion of Central Research Institute in Kasauli.

Members like Vijiaraghavachariar, Malviya appealed for these institutes or even the affiliated universities to give ‘certificate’ (at least till the time the vernacular schools were established in accordance to the passed resolution) if anyone had attended some classes in these institutes. This, they argued, would have both long-term and short-term impact on the employment of medical aspirants. Such certificates, if provided, would also add to the medical workers with some knowledge to treat the poor people (who otherwise are deprived of any medical attention!). The amendment was rejected as it was feared that such certificates could further boost bogus claims to practice. The Central Government’s overhaul for maintaining standard continued with similar policies like doing away with the certificate course for the women medical workers, mandatory examination for the civil assistant surgeons for the military assistant surgeons and separate examination bodies being established for sub-assistant surgeons in Bombay, Calcutta and Madras.

The effect of the bill was much worse than apprehended. In 1917, there was a strong demand for opening a private school in Surma Valley, but after the bill was passed, Assam administration had refused to provide any funding for the recurring expenditure of the college.¹¹ On the other hand, the non – execution of the Resolution of 1916, failed to uplift public health in rural areas, especially during the influenza epidemic. Repeated appeals for a Medical faculty in the proposed Dacca University, eluded government support and it was not until the 1940s that a full-fledged medical college was established as a part of Dacca University.¹² Regular references were made in the debates about how the reduction in the number of medical students had affected public health especially when there was hardly any increase in the allotment of funds for medical relief and sanitation due to budget constraints in the war situation. In some industrial areas, the doctors in the mills were the only medical help available for the neighbourhood population while in most rural areas there was a complete lack of medical relief. Rather, the government officials like Major-General Edwards argued that the health of the population could be improved by imparting knowledge about the importance of public health to the masses. He argued that ‘such teaching would alone, without a single additional doctor or a single drug, save India hundreds and thousands of lives and millions of money every year’.¹³

The Indian Medical Council Act: Self-determinism or colonial control?

The Home Government had maintained its control and vigil on Indian medical education through the General Medical Council. The Council, since 1858, was instrumental in determining the minimum ‘standard’ of medical education that it thought was required for the maintenance of public health in England and played an important role in determining the medical education policy in India (especially due to its concern for the European population!) This received a further momentum in the early 1920s, when GMC threatened the termination of degrees from those institutions which failed to live up to their standard.

Referring to the lack of medical ‘standard’ in the matriculation level as well as in some of the Indian Colleges, particularly in medicine, surgery and midwifery, the Council passed a resolution in 1921 on conditional recognition of the Indian medical degrees for improving the teaching of surgery and midwifery. After 1919, there was also steady diminution in the number of European professors in the Medical Colleges, holding British qualification as they were no longer recruited exclusively from the IMS. Holding it crucial to the health of the European population in India, President of the GMC, MacAlister, remarked that ‘our primary interest is that recognised Indian medical degrees shall guarantee a standard of proficiency sufficient for practice in this country. It is this interest that we cannot forego, that alone justifies our intervention in the Indian Medical education’.¹⁴ Such a decision threatened the future of a number of Indian medical aspirants preventing them to appear for the Indian Medical Service examination or to qualify themselves for fellowship or membership of the Royal College of Surgeons and Physicians unless they had passed an examination from any medical institution of the United Kingdom.¹⁵ Thus came the resolution of the GMC.¹⁶ In 1921, as a temporary solution, Norman Walker was sent to report on the existing situation of the Indian universities, their curriculum and the infrastructure of the different departments, particularly on surgery and midwifery. Walker, on his return deputed Colonel R.A. Needham as ‘special inspector’, who, in 1923, reported on the inability of the Indian Universities in furnishing sufficient guarantee of the possession of the requisite knowledge and skill for the efficient practice of medicine, surgery, and midwifery in Great Britain. On his second visit in 1926–1927, Walker reported of the urgency of a coordinating authority in India ‘comparable to the GMC with which the Council could communicate’.

Appealing for appointing a committee, with representatives from GMC as well as from Indian Universities to ‘ bring the Indian institutions in all respects on a level with those of United Kingdom … ’,¹⁷ Col Gidney moved a resolution:

The ultimate goal that we aim at is swaraj. To attain this, we must prepare the ground so far as our medical needs are concerned … there is no national medical pride in our institutions, no unification of medical degrees and no one who is proud of his Indian M.D. or other degrees … It is for this reason, I regret that medicine and medical administration has been a transferred provincial subject … It should have been retained as an Imperial reserved subject, for we might then have got our own Indian General Medical Council.¹⁸

Gidney referred to Malviya’s words during his deliberation on Civil Medical Services: ‘medical science should become more nationalized … the advantages securing from a knowledge of medical science should be retained in India; they should be scattered more broadcast in the country and should go down to the people in a larger degree’.¹⁹ In fact, a number of members in the legislature maintained that the Walker Committee provided an opportune moment to inquire into the teaching of midwifery and rather associate with his investigation and overcome ‘the backwardness’ in this regard.

Though the decision of GMC received criticism from Indian medical professionals like Nil Ratan Sarkar and Bidhan Chandra Roy, both official and non-official members in the legislature acknowledged its importance as ‘progress’ in medical professional education in India. In the early 1930s, representatives of provinces and of universities concluded to set up in India a body which was primarily vested with three responsibilities: to coordinate the standards of medical education of graduates as well as formulate curriculum and supervise examinations, negotiate the recognition of British Indian Medical qualifications abroad and act as a medium of communication between British Indian Universities in order to ensure the attainment and the maintenance of a uniform standard of qualification. The result was the Indian Medical Council Act, 1933 and the establishment of the Indian Medical Council.²⁰ It was believed that once such an institution was established, recognition of the GMC would not be of much importance. However, it was argued that in the changing age of internationalism, ‘exclusivity, insularity and isolation’ could not be afforded. The Indian Medical Council Act introduced by Girija Shankar Bajpai received whole-hearted support in the legislature from all the quarters. In favour of a future of medical education in India to be based on the western medical system, even provincial legislatures unanimously favoured an apex body to regulate the standard of medical education in India.

In 1926, an amendment to the Indian Medical Degrees Act, was introduced to change the law so as to empower the local legislature to determine in whom and how this power to grant titles were to be vested.²¹ The amendment was rejected by reiterating the need for a central ‘control’ to rule out the frivolous awarding of degrees. Such amendment, it was feared, would prevent the maintenance of a standard in the medical profession. Dr. Amarnath Dutt, a western medical practitioner himself, argued that at the face of the growing population, its health problems and emergencies like the war situations, there must exist a uniform standard for the ‘western’ medical practitioners, which would be recognised throughout British India.²² Thus, it was in the context of the Indian Medical Degrees Act, 1916 and its proposed amendments that the idea for a Central Medical Council was generated and gradually it gained ground in the course of the next two decades. After the passing of the Indian Medical Council Act, the Provincial Medical Councils were concerned only with the ‘regulation and inspection of the examinations conducted by the various Provincial State Medical Faculties or Medical Examination Boards’ granting licenses, diplomas or certificates in respect of lower medical qualifications (Table A1).²³

Scientific basis of indigenous system vis – A vis western system

Studies on ‘colonial’ medicine, in the 1970s and 1980s, largely focused on the Eurocentric conduits through which the western medicine permeated into the indigenous society. Following Foucault, medicine has been analysed as a ‘tool’ of empire, with a vigilant gaze in bringing about intended subjectivity thereby reinforcing what Partho Chatterjee had termed as ‘rule of colonial difference’. To address what was ‘colonial’ about colonial medicine, categories of race, gender and class assumed increased importance. These studies focused on the colonial institutions as the bastions of active, exploitative colonial power that reflect the crucial agency of colonial governance. However, lately a growing body of work has been devoted to the interaction, appropriation and even manipulation and often resultant hybridity transpiring between the western and indigenous systems of medicine (Debroy & Attewell, 2018).

The establishment of western medicine was based largely on the debasement of the indigenous practices and on accusing the practitioners as ‘quacks’. The concern was reflected aptly in a paper by Gerald Giffard, a retired IMS officer read before the East India Association in 1924

 … In India, the existence of inferior and imperfectly trained practitioners (the sub assistant grade) is officially recognized and tolerated; there are thousands of medical men who although trained in Government medical colleges, have received so short and imperfect a medical education that they are not admitted to the British Register … ²⁴

Interestingly, the scope of both the bills discussed in the previous section was rigidly restricted to the western methods of allopathic medicine and surgery.²⁵ The official concerns were repeatedly spelt in terms of ‘quackery’ and unscientific indigenous practices that could negatively affect the health of the population, though often the efficacy and affordability of the indigenous systems were conspicuously accepted. In the words of Sir Pardey Lukis 1916:

I resent strongly that spirit of medical trade unionism which leads many modern doctors to stigmatise all vaids and hakims as ‘quacks’ and charlatans and I shall always be proud of the fact that I was privileged to have the friendship of two such learned men as the late Nawab Shafa- ud- dawla of Faizabad and Kaviraj Vijay Ratan Sen of Calcutta.²⁶

But the debates on the bills reflected larger issues on the indigenous systems of medicine. In the course of the debating different enactments, the Indian officials echoed the government concerns. However, legislature also emerged as the ‘site of protest’ whereby the Indian public health concerns were voiced by the provincial representatives in their non-official capacity. These non-official representatives were products of English education, mainly lawyers in profession and belonged to a ‘high caste gentry with some landed property’ (Ray, 1983). While on the one hand, the non-official concerns protested against the complete isolation of the Indian population from the benefits of the western medicine, they simultaneously pushed for recognition of the indigenous systems of medicine, both in terms of institutionalisation and professionalisation (Das, 2019).²⁷

Debating the 1916 Act, it was feared by the official representatives that the indigenous practitioners could get themselves enrolled to the non-official or private institutions and appropriate the diplomas to garner a good clientele. Babu Ladhu Sinha, IMS, a medical practitioner in Chapra, in his letter to the Civil Surgeon of Chapra, enlisted a number of quack practitioners – Homoeopath, Baidyas, Kabirajes, etc. in the provinces who could impose upon the public without possessing a medical diploma, degree or licence.²⁸ In 1924, F. M. Sethna was convicted and fined by the Magistrate when the registrar of Bombay Medical Council objected to the use of M.D before his degrees, F.Av.U, V.B. meaning Fellow of Ayurvedic University and Vaidya Bhushan. The appellant’s case that M.D. was used as a description in parenthesis was dismissed by the Magistrate.²⁹ The official resentment for the Indian traditional medical practices was evident in the words of Lukis

I maintain very strongly that it is not safe to permit any man to practise western medicine unless he comes up to this minimum standard, especially in these days when the medical man baa to deal with such important methods of treatment as that by Salvarsan, Tuberculin, intravenous injections of antimonial preparations, and all the various forms of vaccine and serum therapy as now practiced. I hold that if a man is unable to qualify up to the standard of a Hospital Assistant, he ought not to be permitted to practise western medicine, but should be content to confine himself to the simpler methods of treatment adopted by the vaids and hakims.³⁰

It is interesting to note that except for Vijiaraghavachariar, there was no discussion on Indian medical systems in the bills or in the resolution (1916). But in the following decades, the members of the Imperial legislature were keen to extend the modern medicine to the Indian population. Nationalist leaders like Surendranath Banerjee, was not only concerned about the career of students in western medicine, but persistently appealed for recognition of the indigenous systems of medicine and their professional upliftment. Both in the Imperial Council and in the Central Legislature, members of the zamindar group like Lala Sukhbir Sinha, Raja Manindra Chandra Nandi, Mir Asad Ali Khan, Khan Bahadur Ebrahim Harron Jaffer, argued for the opening up of colleges for indigenous medicines, supplementing western medicine and reaching out to the masses. They countered the official position, mainly on three points – that these systems were divorced from modern scientific basis because of Government’s negligence towards them; the Trade unionism’ of Government towards western medicine and drugs was mainly to cater to the imports business of the western chemists and lastly such matters of public health concern needed to receive much government fund allocation than other research items like roads and construction.³¹ Though the amendments were opposed to conferring any professional ‘status’ to the Indians who had been partially trained in western medicine, members like Vijiaraghavachariar suggested that instruction in English and lessons in anatomy, physiology and chemistry could be imparted in the Ayurvedic and Unani institutions to supplement the medical education of the indigenous doctors, rather than producing half – learned ones through the vernacular colleges.³² Hakim Ajmal Khan, who himself was part of the revivalist movement of traditional medicine, emphasised the importance of the indigenous systems of medicine both for its efficacy as well as for cheapness. However, he was much influenced by the western medical institutes that he visited in Europe in 1911 in preparing the blueprint of his Tibbiya College in Delhi.³³

Reacting to the Indian Medical (Bogus Degrees) bill (1915), the local Governments presented a statement concerning the status of indigenous systems of medicine. The indigenous systems of medicine, it was argued, ‘ignored the instruments of scientific investigation which made modern medicine and surgery possible’.³⁴ Any investment in such a system was regarded as a wastage of public money and only area which received attention was scientific investigation of the properties of indigenous drugs which could be utilised by the pharmacologists (of western medicine).³⁵ In 1922, a committee appointed by the Government on the request of the Madras legislature reported

 … If the Madras Government has the interest of the Indian people genuinely at heart, it will spend its energies in planting modern science in the country by the agency of scientists and teachers trained in western methods, instead of endeavoring to stimulate the belated indigenous systems into renewed activity.³⁶

Even in accepting the role of the indigenous practitioners in providing rural medical relief, James DoBoulay, argued that they were cheaper as the system was not based on ‘scientific theories’.³⁷ In 1920, a long discussion was carried on in the Legislature in the context of granting five lakhs of rupees to the Ayurvedic and Unani Tibbi College by referring to its contribution in serving the large number of population. While it was supported by members like Pandit Madan Mohan Malviya, Ebrahim Haroon Jaffer, Fazulbhoy Currimbhoy and others,³⁸ officials like Sir William Vincent opposed it openly. Funding for Unani-Tibbi institution, was refused because of Ajmal Khan’s association with the non-cooperation movement. Vincent remarked: ‘I am not to be blamed if the government does not offer to support with a grant of money an institution which is managed by persons who regard us as a Satanic Government’.³⁹ Resenting this official attitude, T. Rangachariar, during the Budget 1921, argued that ‘it is our duty to take advantage of the ancient systems of medicine and encourage them … at least now that we are in the majority in the Assembly, to give effect to our wishes in this matter’.⁴⁰ Though it did not garner much immediate attention, in 1926, a bill was introduced by Dr. Uma Rao⁴¹ in the Council to regulate the standard of qualification for the purpose of practice of indigenous systems of medicine. Following the British Medical Act of 1886 in principle, the bill sought to place the practitioners of the indigenous systems and those of the allopathic system on the same register. Rao argued that only this could ensure the availability of medical relief to all classes of people.⁴² However, the bill in the Council failed to gather support on the ground that it had infringed provincial autonomy.

In an amendment to the Workman’s Compensation Bill, nationalist leaders like T Rangachariar, Mr. Jamnadas Dwarkadas, Dr. Nand Lal, Chaudhury Shahabuddin and N. M. Joshi debated on the justification and scope of the terms ‘qualified medical practitioner’ in the context of the bill vehemently resisted the official opposition to include vaids and hakims within the scope of ‘qualified medical practitioners’. They argued that as large part of working population, if injured, consulted the indigenous practitioners as they could not afford the registered doctors. In favouring the amendment, Jamnadas Dwarkadas, representing Bombay, gave the example of Dr. Popat Prabhuram LMS who had been a medical practitioner of great repute. Dr. Prabhuram was disqualified by the Bombay Medical Council ‘on the ground that he was guilty of grave misconduct in as much as he used to take the assistance of Ayurvedic or Unani systems of medicine’.⁴³ The nationalist leaders like Chaudhury Shahabudin were trying to extend the benefits of modern western medicine to the labours argued that restricting the qualified medical practitioners only to the registered ones might also exclude those ‘eminent men who have not thought to get themselves registered’.⁴⁴ The motion was opposed by official members including Atul Chatterjee, Dr. Darcy Lindsay, Mr. C. A. Innes on the ground that certification of a registered doctor was necessary to ensure transparency and genuineness to the insurance companies.

However, in spite of their efforts to modernise and professionalise indigenous systems and extend the benefits of western medical knowledge to the indigenous population, there was hardly any coherent representation of the vaids and hakims. Focusing more on training and treatment through institutionalisation on colonial format, these debates were silent on any comment about the social status of the practitioners and the representation of their interest was never based on caste lines. The Council and the legislative members, mostly belonging to the upper-class gentry, displayed paternal concerns for the health of their people in the provinces, but it generally evaded the social and professional consideration of the practitioners. Interestingly, unlike the medical practitioners, in case of midwifery and nursing, often the debates referred to their lower social background, their filthy practices and how training/professionalisation was imminent for them to medicalise and modernise the process of child-birth!

Conclusion

1919 marked the initiation of a distinctive phase of a ‘self-regulating field of the social’ in colonial governmentality. According to Foucault, such governmentality, was instrumental behind the functioning of colonial institutions, ‘employing tactics rather than laws and even using laws themselves as tactics to arrange things in such a way that through a certain number of means such and such end may be achieved’ (Burchell et al., 1991, p. 95). Instituionalisation of western medical education was historically conditioned by the complexes of knowledge/power which shaped the colonial political rationalities (Scott, p. 193). In such rationalities, as Partha Chatterjee has identified, ‘race’ emerged as a specific colonial signifier of difference, asserting its superiority and reducing the colonised as the inferior and the ‘other’. The debates, in this context, help us to analyse the diverse ways through which such political rationalities got ‘inserted into subject – constituting practices’. (Scott, 1995, p. 198). Challenging the notion of a hegemonic, sovereign colonial state, the devolution of power and the constitutional reforms exemplified the layered power structure as well as the different political rationalities in the colonial governance. This ‘altered rationalities’ shaped the terrain on which the response of the colonised crystallised and reflected what Frederick Cooper and Ann Stoler have termed as the ‘tensions of Empire’ (Cooper & Stoler, 1997, p. xi). The resultant colonial anxieties, at the face of emergent nationalist movement, both inside and outside the legislature, provided the altered terrain where the modern colonial rulers rearranged the conditions (produce governing effects) ‘to oblige subjects to transform themselves in a certain, that is improving direction’ (Scott, op. cit., p. 201).

The native responses, by the 1930s and 1940s, were framed in the language of a modern state – insistence on ‘professionalisation of the indigenous system’, establishing it on a scientific basis and even condemning the ‘non-western practices as quackery’. This marked a parallel discourse with individuals linked to the indigenous medical systems actively participating in the nationalist project of reviving traditional medical practices. The growing tension and ambiguity were reflected clearly in the Bhore Committee Report (1946). For the members such as Fredereck James, Pandit L. K. Maitra, Dr. Vishwanath, Mr. P. N. Sapru and Khan Bahadur A. H. Butt stated that the ‘imperative need in India was the large scale production of trained medical personnel … including the adoption of a shorter licentiate course to increase both rapidly and substantially such personnel’.⁴⁵ Their views were outvoted by the majority who objected to the continuation of the licentiate service and sought to establish the point that resources needed to be focused on producing fully trained ‘basic’ doctors. The Bhore Committee, dismissive of the indigenous systems as ‘static in conception and practice and not keeping pace with the discoveries and researched of scientific workers the world over … ’ recommended that preventive western medicine had a big part to play in the future of medical organisation.⁴⁶ On the other hand, the Constituent Assembly elaborately debated on the possibility of retaining the professional indigenous colleges in India. Following the recommendations of the National Planning Committee, the All India Health Conference passed the following resolution:

 … adequate provision should be made in the Centre and the Province for research in and application of the scientific method of investigation of the indigenous systems of medicine like Ayurveda and Unani with reference to the maintenance of health and the prevention and cure of disease  …  for starting schools and colleges for diploma and degree courses in the indigenous systems of medicine and for post graduate courses in Indian medicine for graduates in western medicine. (Constituent Assembly Debate, 2 December 1947, p. 1110)

The vision for the post-colonial nation building included an ideological spectrum ranging from the Soviet model of development (Chakraborty, 2009), to the culture of science built up on new lines of modernity (Zachariah, 2001) The interventionist post-colonial state regarded health to be fundamental for the ‘progress’ of the newly decolonised nation. Thus indigenous medical systems, modernised through the syncretic practice of preventive and curative health care system, were provided a new lease of life. But the post-colonial policies framed in the newly constituted national legislature were based on new political rationalities which defined the political economy of health in India, characterised by widespread privatisation. It is important to note that though the revival of medical traditions and acceptance of medical plurality remained central to nationalist project, it eluded the gaze of the post-colonial nation-state, leading to the marginalisation of a large number of practitioners in professional categories. In the last seven decades, the initial focus on industrialisation followed by neo-liberal policies and the frantic pace of corporatisation resulted in a perceivable shift from the public welfarist approach towards a market-friendly approach, thereby divorcing the suffering – alleviation element from the health care systems. With the increasing inroad of global capitalist market, the divide between medical access and medical research has widened. It is time to revisit the past and strengthen the legislative machinery of the nation in addressing the global as well as local concerns of public health. This would undoubtedly challenge the imposition of health policies through the global syndicate of political players and rather create opportunities for decentralised policies, catering to the growing needs of the underprivileged sections of the society.

Acknowledgements

My sincere gratitude to the anonymous reviewers for their enriching comments.

Disclosure statement

I confirm that there is no conflict of financial or non-financial interest in the content of this article.

Notes

1 Bombay Medical Registration Act, 1912, Tamil Nadu Medical Registration Act, 1914, Bengal Medical Act, 1914, Punjab Medical Registration Act, 1916. According to these Acts, Councils were formed in the respective provinces which were needed to maintain a Register for the registration of the duly qualified medical practitioners (as were given in the schedule). But the problem was that according to these Acts, the Councils were given the power to sanction registration to persons on satisfaction that they possessed ‘the knowledge and skill requisite for the efficient practice of medicine’.

2 Indian Medical Review, 1936, p. 92.

3 Home Department, Medical Branch, Proceedings No. 51–57, Part A, April, 1917. Such authorization was given to the National Medical College, Calcutta, and later Boards were created in Bihar and Orissa and Burma for the purpose.

4 Ibid., p. 112.

5 Home Department, Medical Branch, Part B, 207–217, May, 1916.

6 Debates of Imperial Legislative Assembly, March 9, 1916, p. 293.

7 Ibid., p. 297.

8 The Indian Legislative Council, Vol. 57, March 6–10, 1919, p. 729.

9 Ibid., p. 94

10 Indian Medical Review, 1936, p. 92.

11 Abstract of the Proceedings of the Council of Governor General in India, March 7, 1917, p. 559.

12 LAD, March 21, 1921, p. 1410.

13 Proceedings of the Indian Legislative Council, March 10, 1919, p. 811.

14 General Medical Council and Indian Qualifications: Suggestions to the Government, TOI, August 2, 1929, p. 4.

15 LAD, September 28, 1921, p. 1167.

16 Indian Medical Degrees: The General Medical Council and Indian Qualifications, History of a Ten – Year Controversy, BMJ, Vol.1, No. 3610, March 15, 1930, pp. 508–511.

17 LAD, February 9, 1922, p. 2286.

18 Ibid., p. 2288.

19 Ibid., p.2292.

20 LAD, February 13, 1933, pp. 554–555.

21 The local governments had possessed such power before the Act of 1916 was passed. But the Act of 1916 had rendered this provision of the local Acts to be nugatory as it had prevented and penalized the holding out of any degrees by medical men which had not been granted by certain specific institutions.

22 LAD, February 4, 1926, p. 834.

23 Indian Medical Review, 1936, p. 165.

24 The Future of Medicine in India, BMJ, November 22, 1924, p. 966.

25 Home Department, Medical Branch, Proceedings No. 4, Part A, September, 1915.

26 Debates in the Council of States, February 16, 1921, p. 110.

27 For a Detailed analysis of indigenous, see, Shinjini Das, Vernacular Medicine in Colonial India: Family, Market and Homoeopathy, Cambridge University Press, 2019. Also, Madhuri Sharma, Indigenous and Western Medicine in Colonial India, Cambridge University Press, 2011 and Guy Attewell, Refiguring Unani Tibb: Plural Healing in Late Colonial India, Orient Blackswan, 2007 for the professional tension and anxieties within the indigenous system in their response to the western medicine and medical professionals.

28 Ibid.

29 Bogus Medical Degrees: Appeal dismissed the Medical Council’s Ban, TOI, November 20, 1924, p. 8.

30 Abstract of the Proceedings of the Council of the Governor General of India, February 15, 1916, p. 117.

31 Debates in the Council of States, February 16, 1921, p. 110.

32 Ibid., p. 295.

33 Home Department, Medical Branch, Part B, 207–217, May 1916.

34 Abstract of the Proceedings of the Council of Governor General of India, February 6, 1918, p. 457.

35 LAD, March 1, 1919, Appendix B, pp. 422–423.

36 Indigenous Systems of Medicine in India, BMJ, September 15, 1923, p. 479.

37 Abstract of the Proceedings of the Council of Governor General of India, February 6, 1918, p. 457.

38 LAD, March 10, 1920, pp. 1271–1276.

39 LAD, March 11, 1921, p. 977.

40 LAD, March 11, 1921, p. 976.

41 Rau was a member the Council of States, nominated from Madras. He was a medical practitioner and one of the co-founders of All India Medical Association. He was also the co-founder of a medical journal named Antiseptic.

42 LAD, March 2, 1926, p. 345.

43 LAD, February 3, 1923, p. 1877.

44 Ibid., p. 1879.

45 Ibid., p. 60.

46 Ibid., p. 78.

Appendix

Table A1. Status of medical facilities in British Indian provinces in 1938.

Province	Total No. of hospitals and dispensaries	Total No. of doctors registered	Population per Hospital/dispensaries
Madras	1134	6085	41,217
Bombay	429	6378	41,940
Bengal	1449	9019	34,585
United Province	597	3041	81,037
Punjab	896	4558	26,318
Central Province	343	NA	45,212
Bihar	528	3045	61,310
Assam	343	1166	25,138
Sind	108	NA	35,991
Orissa	164	NA	32,355
Delhi	24	NA	26,510
Northwest Frontier	114	NA	21,272
Baluchistan	41	NA	11,305
Ajmer Merwara	10	NA	56,029
Coorg	11	NA	14,848

Source: Compiled from Indian Medical Review 1938.