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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