Monday, September 11, 2017

IMS Study Group Report

Report of the Study Group constituted by President MCI on Indian Medical Services (Part 1)

The President Medical Council of India (MCI) constituted the present Study Group to make appropriate recommendations in regard to the need, relevance, scope and modality of initiative Indian Medical Services in the interest of generating necessary administrative cadre to effectively administer health care services in a cogent, credible and a meaningful way, thereby sub serving the larger public interest in the National cause.

Accordingly the study group met and deliberated the said issue in all its aspects and taking stock of the relevant literature on the said subject has formulated its observations and recommendations thereon.

Historical perspective  

The Indian Medical Service owes its origin to the East India Company formed by the British. It was on December 31, 1600 when Queen Elizabeth granted a charter to the Association of Merchant Adventures of London to trade with the East, which gave birth to the East India Company. As a matter of fact the establishment of the company was a result of a huge struggle amongst the nation for the control of lucrative spice trade, in which to begin with the Venetians, then the Portuguese, the Spaniards, the Dutch, the French and finally the British came to be drawn into the treasure hunt.

For the said trade, the First Fleet of the East India Company under the command of Captain James Lancaster, in December, 1600 sailed out. Each of the four ships in the fleet carried ‘Surgeons’ and a ‘barber’. They came to be designated as ‘Ship Surgeons’. This was also the voyage which resulted in experiment on lemon juice as a cure for scurvy.

With the establishment of trading posts around India, more surgeons and physicians found employment not only with Europeans but also in the service of wealthy natives. These men of medicine included Nicholas Manucci, a Venetian born in 1639, who served Dara Shikoh before studying medicine in Lahore where he served Shaha Alam from 1678 to 82. An Armenian named Sikandar Baigh served as Surgeon to Suleman Shikoh, son of Dara Shikoh and there are records of several Dutch and French physicians in courts across India.

Surgeons were also availed for diplomatic missions to various course and they were found to be very effective. Operationally speaking the Indian Medical Service (IMS) was a military medical service in British India, which also was attributed some civilian functions. It had served during the two world wars and remained in existence until the independence of India in 1947. Many of its officers who were born British, and Indian served in civilian hospitals as well.

The East India Company in 1614 introduced a hierarchy in their establishment with the appointment of a Surgeon General. The first to be appointed to the said post was John Woodall. However, he was accused of financial embezzlement in respect of pay from apprentices as a result of which he was retrenched in 1642.

There are many anecdotes of which one of the important depiction is of Gabriel Boughton who is reported to have saved Shahjahan’s daughter Princes Jahanara from injuries due to burns. In reward he was given Duty Free Trading Rights and it is said that it was the very document, which was availed by the East India Company to procure Rights for itself from the ruler in Surat. 

Historically speaking the first sign of organization came into being with the establishment of the Bengal Medical Service on October20, 1763, with fixed grades, rules for promotion and services. On the similar lines, Madras Medical Services and Bombay Medical Services came to be established in 1764. It was due to increased military actions that compelled the separation of ‘Military Surgeons’ from the ‘Civil Surgeons’.

As a matter of rule, each non-native military regiment had a surgeon, as a result of which the strength of the medical service grew. A census record of 1854 reveals that the Bengal Medical Service had a strength of 382 while Madras Medical Service had 217 people and Bombay Medical Service had a strength of 181. The medical services of these three Presidencies were united into a single Indian Medical Service after 1857, which was in vogue till 1947.

The personnel under the medical services contributed to the foundation of other departments as well under the organization of the Govt. Dr William O’Shaughnessy, while serving as Professor of Chemistry at Calcutta conducted the first experiment for the introduction of electric telegraph in India and was designated as Director General of Telegraphs in 1852. In 1861, Dr James Rankin was appointed as Director General of Post Offices in India. Dr John Royale represented the East India Company as a Reporter on their economic products as the great exhibition of 1851 and the first four appointments of Conservator of Forest were also filled by the Medical Officers under the medical services of the presidencies.

In 1858, when the Crown took over the Government of India, and in the context of several epoch making developments that were occurring in the art of medicine the Indian medical service entered upon a new phase of the history. The General Hospitals were built in the presidency towns and several smaller hospitals and the dispensaries came to be established in the Districts. In 1835, a medical college was founded at Calcutta and another one at Madras. A decade later another medical college was instituted at Bombay. From 1853 onwards, several medical schools were laid out which mandated the services of the medical officers working under the presidential medical services to be availed for teaching at the initiated medical schools till they had trained graduates to succeed them.

The Indian Medical Service always primarily remained a military service so as to provide medical officers for duty with the Indian Army in the time of War. During the 1914-1918 First World War the service was represented in France, Palestine, Asia Minor, Persia, China, East and West Africa. 92 Retired officers rejoined for duty and well over 1000 temporary commissions came to be granted. Likewise during the Second World War well over 1000 filled medical units were mobilized over and above, the hospital accommodation for 11000 officers and 1.50 lakhs other ranks arranged for in India. In the course of all these members of the Indian Medical Service earned ‘Victoria Cross’ for five times. And one of the recipient of the same Dr John Alexander Sinton was later conferred the fellowship of Royal Society in his researches for the problems of Malaria.

It is a matter of record that in the legislative council in Delhi in 1918 a motion was brought forward by an Indian Member of the council to disband the Indian medical services primarily on the ground that India was a poor country and could not afford to maintain such a service.  The defense that was put forth by the then Surgeon General Dr. Edwards gives a significant insight into the utility of the Indian Medical Service at that point of time. The text of the defence put across by him is as under:

“I need not dwell, on the fact that this resolution is tantamount to the abolition of the distinguished service to which I have the honour to belong, but before proceedings with my reply I wish to say few words concerning the work which has been done by this service in recent year and which is still being done, for I do not think that this council is fully aware of the extraordinary value of the Indian Medical Service not only to India but to the world at large. This service has worked out the life history of the malarial parasite, a discovery which has revolutionized our ideas concerning malaria and which, among other things, has enabled the Panama Canal to be successfully built. It has reduced the mortality of cholera by 2/3rd and shorn amoebic dysentery of most of its terrors. It has worked out the method of transmission of bubonic plague, work which points the way to the ultimate eradication of that disease. Enlarge prostate, that terrible and fatal concomitant of old age, can now be overcome, thanks to the member of Indian Medical Service, while in the domain of eye surgery more specifically with regard to cataract and glaucoma the work of the service is recognized throughout the scientific world.

The resolution so moved did not succeed and the Indian Medical Service continued for nearly three decades thereafter with significant work and contribution in research and the unending problems of public health resulting in several achievements as a result of which it stands the scrutiny at the bar of history. Great names attached with it are Ronald Ross, Leonard Rogers, Rickard Christophers, Robert McCarrison, Henry Shortt and many others.

In the year 1943, the Government of India, decided for a review of the whole medical position and also to seek suggestions for future improvements. In fact it was aimed that evolving a model like that of National Health Service, however, the disease burden that was observed was too huge. It was stated in the report that in India that nearly 10 crore suffer every year from malaria. Each year 5 lakh deaths from tuberculosis and a further 25 lakh active cases required treatment, cholera, small pox and plague add to the said disease burden. The other diseases of topic namely leprosy, filarial, hookworm, guinea-worm saddle the country with innumerable chronic sufferers. To combat adequately, this magnitude of disease burden and many other problems involved and to provide a comprehensive health service for whole of the population would require a staff of 2.5 lakh doctors, 7.50 lakh nurses along with a great army of associate medical workers. The Indian Medical Service which served India, so well almost for last 300 years definitely had prepared a way for the same, but when power was transferred in 1947, the Indian Medical Services stood abolished.

The foundation of the service

The Bengal Medical Service was founded by orders passed dated October 20, 1763, whereby the individual medical officers then serving in the Bengal Presidency were, with effect from January 1, 1764 combined into a regular medical establishment with fixed grades and definite rules for promotion from grade to grade. The Madras and Bombay medical services appeared to have come into existence at about the same time as the Bengal Service.

A list of Bengal Medical Service in 1774, preserved in the Calcutta record office gives a strength of total 69 viz. 18 surgeons, including the Surgeon General and Surgeons Majors, 7 Subordinate Surgeons and 44 Assistant Surgeons.

A list compiled by Surgeon General Denial Campbell in 1777 comprises 64 names that include 22 Surgeons and 42 Assistant Surgeons. Another list compiled for the Governor General Warren Hastings in 1777 gives 27 Surgeons and 45 Assistant Surgeons totalling to 72. Of these, 11 surgeons and 13 Civil Assistant Surgeons are shown in the civil employment as against 15 surgeons and 32 Assistant Surgeons on Military Duty, while one man noted as dead is not shown under either head. 

The First Maratha War occurred in 1780-81, the Second Mysore War in 1781, with Campaign against the Raja of Banaras was undertaken in the same year. Five battalions under Col PD Pearse marched from Bengal to Madras towards the end of 1780. Six battalions with artillery and cavalierly were detached to Bombay from 1778 to 1784. All these troops required extra medical officers, and vacancies caused in this campaigns required to be filled up. To indent on the court of Directors at home for more medical officers was of little use, as new men from home even if recruited in sufficient numbers could not arrive for more than a year after the requisition for their services was sent home. The Indian govt. accordingly appointed a large number of men, recruited locally to the Bengal medical service. They were obtained chiefly from two sources. Firstly the surgeons of the India men trading between England and India and secondly subalterns or free adventurous who had some medical training in some cases had practiced medicine at Home, before coming to India.

Rules regarding medical personnel in military employment holding collateral civil charges and vice versa were laid down in Bengal Gazette of 12th March, 1836. Practically the same rules continued to be in force till 1947, when the services were disbanded. No officer civil or military was at liberty to decline such collateral charges.

In the early settlement of the East India Company in India the question of rank was not of much importance. The President or Agent stood first next to the President came the members of his council. The governing body consisted of four members. The Agent, the Accountant, the Store Keeper, the Purser Marine, fifth rank was the Secretary. The surgeon was sixth after the Secretary, they came the Steward and after him the General Body of Merchants, Writers, and Apprentices. The writers as the name employees were the clerks. But from this small body of commercial servants has developed the finest Governing Body in the World, the Indian Civil Service.

As such, the chronology of events in a sequential manner brings out as to how the Indian Medical Service came to be created by the East India Company to begin with and then how it came to be structured in a definitive manner with stipulated rules and regulations in respect of ‘Rank, Pay, Leave, Duties and Responsibilities’ and other cogent official matters.

Taking into consideration the successes and effectiveness that got accrued to the said service during a period spanning nearly three centuries, it can be safely deduced that it needs to be revived afresh by suitable incorporations therein in terms of the contemporary and long term perceived requirements.

(To be contd)

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