The genesis of hospital medicine in India: The Calcutta Medical College (CMC) and the emergence of a new medical epistemology

Opening the Space for Western Medicine—The Gestation of Hospital Medicine

Medicine, unlike other branches of the natural sciences, deals with living people; and the better understanding of disease demands the dissection of cadavers. In its transformation from the ‘art of healing’ to ‘biomedical cure’, western medicine had to incorporate advances in the basic sciences that were already current—and this transformation had an integral political dimension to it. Larwood for example has traced the establishment and consolidation of the British empire in India as coincident with the expanding interests and achievements in science in Europe. ³⁴ It is noteworthy therefore that British power ‘watched with peculiar anxiety the introduction into India of medical science in its European form, and its rise and progress as a plant from a foreign land, adopted and recognized by the natives’. ³⁵ In short, it had to go beyond the ‘enclavism’ of British hospital practice for this purpose in India. ³⁶

Favourable attitudes towards Western medical practice, I argue, was an outcome of general scientific education which began in India during the late eighteenth and early nineteenth century. The introduction of stethoscope was one of the most potent tools in this regard. Conwell, a staff surgeon of the East India Company, Madras, was possibly the first person to submit the cases he studied and his notes on the stethoscope in 1827. ³⁷ In similar ways (but in a slightly different context) the Serampore missionaries pioneered popularisation of general scientific education in the subcontinent. Sivasundaram, for example, exposes how the Serampore Mission of Bengal sought to bring indigenous traditions into a dialogue with European science, so that the former could give way to the latter. ³⁸

In his brilliant analysis, Raj depicts how Calcutta gradually became the capital city for a world of scientific knowledge construction. The British could not sustain control over the territory ‘by relying solely on the mere 1200 civil and military agents of the Company, who were, in addition, poorly trained for administrative tasks’, ³⁹ They were, therefore, always in need of people who could internalise Western science. In Raj’s argument, for the ‘construction of knowledge as such’ one should look ‘to the process rather than to the event’. ⁴⁰

Initially, the introduction of modern medical education in India had to overcome the impact of Ayurveda and Unani as well as the conventional repugnance of touching dead bodies instilled by social habits and custom. Curiously, even as late as the 1830s, Company surgeons seemed to be treated with low esteem in England: ‘the medical practitioner, in the service of our Honorable East India Company, is estimated somewhat under a butler in London! By the said Company a man is considered as far inferior to a horse—and consequently a surgeon is subordinate to a black-smith!’ ⁴¹ So, elevating the professional status of the Company surgeons in their homeland was strongly needed. In 1837, Goodeve felt, ‘Within the last twenty or fifteen years Anglo-Indian medicine has advanced with rapid stride’, and, accordingly, he believed, ‘[t]he immense improvements which have taken place in the medical sciences in Europe have doubtless contributed to this desirable end; for even…these distant regions…feel…the influence of scientific discoveries at home’. ⁴²

During the period under study, health treatment and other amenities for the common people of Bengal was in a nascent state of development. A ryot with a wife and two children seldom earned more than ‘five rupees a month, out of which he ha[d] to defray all expenses’. ⁴³ The common people of Bengal, it was reported, had to bear ‘the barbarous treatment of the Kobirajes’ and the half-educated quack—an Eastern type of Dr Sangrado who required a fee of ‘one rupee in many cases from the poor fellows’. ⁴⁴ In 1824, some people of Calcutta wrote to the editor of the Sangbad Coumudy (the Moon of Intelligence), ‘The people of this country have been relieved from a variety of diseases since it has been in the possession of the English nation.’ ⁴⁵ They wrote that the ten rupees which poor people earned every month was barely sufficient to sustain the family, and, consequently, ‘the populace have generally not the means of calling in a European doctor…whereby the poor might avail themselves of the medical treatment of European doctors’. ⁴⁶ They argued, ‘Were the Hindoo physicians to instruct their children in the knowledge of their own medical Shasters first, and then place them as practitioners under the superintendence of European physicians, it would prove infinitely advantageous to the Natives of the country.’ ⁴⁷

According to the reporting, this endeavour would benefit the society in four ways. First, pupils would be acquainted with both the English and Bengali mode of learning. Second, ‘by going to all places, and attending to poor as well as rich families, and to persons of every age and sex, he could render service to all’. Third, ‘he could go to such places as were inaccessible to European doctors’. Fourth, ‘this kind of medical knowledge, and the mode of treatment by passing from hand to hand, would be at length spread over the whole country’. ⁴⁸ The new medicine, heralding its universality with the words ‘[for] every age and sex’, also incorporated a kind of secular nature into it. Bearing only the faint trace of the gurukul system in which knowledge could be passed ‘from hand to hand’, the English mode of teaching had to be incorporated for better efficacy. It was in such an intellectual climate and bolstered by such favourable social attitudes (at least in a particular section of society) that the NMI struck its deep roots in Bengal.

Homasjee Bhicajee, a respectable native merchant and shipbuilder, ‘was induced to lay aside prejudice, and submit to the operation of lithotomy performed by Dr Fogerty’ and the result of that and other operations led to the conclusion, ‘that the natives of the country are daily becoming more and more alive to the benefit derived from the employment of European skill in the treatment of diseases’. ⁴⁹ More convincing was the cranial surgery done by ‘Ramnarain Doss, a student of the Medical College’ who treated a boy with ‘severe concussion of the brain’ and operated on the boy to restore him to consciousness, and ultimately to health. ⁵⁰ It was the ‘first triumph of the Medical College and must be gratifying to the Professors’. ⁵¹

The first Legislative enactment recognising the policy of education in colonial India was Act 53, George III, Cap. 153 of 1813. Cooke observed that owing perhaps to the unsettled state of Europe at the time, and ‘the breaking out afresh of the war with Bonaparte, with the consequent monetary disturbances in the English markets, no steps were taken to carry this resolution of the Government into effect…remained unfulfilled till the year 1823’. ⁵² The twin need for an educational economy as well as a cohort of trained ‘native doctors to supply vacancies in regiments’ ⁵³ was the principal motive behind educating ‘native doctors’ in India. In 1855, the Lancet reported, ‘It is little more than thirty years ago since the wants of the army caused the Medical Boards of Madras and Calcutta to commence instructing natives in some of the simple varieties of medical knowledge’, though these were ‘of the humblest possible description.’ ⁵⁴ The economic need of the state was explicitly stated: ‘Native surgeons, educated at the Company’s Medical College in Calcutta, could be easily procured, and would be glad to be employed, at from Rs 25 to Rs 50 per month, with rations and a free passage.’ ⁵⁵ For each English soldier, on the other hand, it would cost the state £100 to train him for duty. ⁵⁶

From 1819 new influences were at work at India House in London with the appointment of James Mill, the Utilitarian philosopher. ⁵⁷ During this time, there appeared strong voices against monopoly of the Company on the one hand, and ‘the singular monopoly of the College of Physicians in England’, ⁵⁸ on the other. Medicine and medical profession were even compared with ‘sum of good’ and ‘like commodities in commerce be limited only by demand’. ⁵⁹ All these factors intersected one another in many tangible and intangible ways in the shaping of the CMC. The earliest reference to ‘black doctors’ is possibly found in a return of the Company’s Bengal Army on 21 June 1762. There were 19 ‘black doctors’ among 8338 English soldiers, or about two per battalion of a thousand men. ⁶⁰ When the Company raised a standing army, native medical attendants were appointed to each crops and regiment. ⁶¹ Similar developments occurred in Madras and Bombay: those who were referred to as ‘Native Dressers’ in Madras corresponded to, it seems, the Black Doctors of Bengal. ⁶²

A Government Order (GO) of 15 June 1812 approved of a plan submitted by the Medical Board for training boys from the Upper and Lower Orphan Schools and from the Free School, as compounders and dressers, and ultimately as apothecaries and sub-assistant surgeon in Bengal. It was stated that twenty-four boys of fourteen or sixteen years of age were to be selected. They were to be posted as follows—ten at the General hospital at the Presidency, ten at the Garrison Hospital, Chunar and four at the General Dispensary. They were placed under the immediate charge of the Superintending Surgeon.

Such medical training was of a purely military nature, to serve only military purposes. Moreover, it was not an institutional training, but rather an individual tutoring under the superintending surgeon with the aim to produce compounders and dressers. It had no syllabus, no proper examination system or certification.

However one important change began to occur. As Seema Alavi has shown how, ‘[m]ost of this training took place not in a classroom but at the bedside of the patient. It was here that British doctors instructed native doctors on matters of medical practice’. ⁶⁴ Often passages from medical journals were read out to them: ‘The native doctor noted this medical knowledge with a piece of chalk on the floor, at the foot of the patient’s bed. Later they memorized it’. ⁶⁵

As I stated earlier, visual and verbal acculturations began to take shape, especially at the NMI. The superintendent of the NMI was to ‘direct the studies…to give demonstrations…to take every available means of imparting to them a practical acquaintance with diseases of most frequent occurrence in India, the remedies best suited to their cure, and the proper mode of applying those remedies’. ⁶⁶

From its inception (21 June 1822) to its abolition (1835), the NMI was a colonial institution serving colonial ends. Khaleeli notes, ‘The Indians were to watch and learn rather than contribute.’ ⁶⁷ M’Cosh specifically noted the duty of native doctors as ‘to…see that the prescriptions are taken, attend to the sick in the absence of the surgeon…and perform minor operations of surgery’. ⁶⁸ For the purpose of acquiring practical knowledge of pharmacy, surgery, and physic, the pupils of the NMI were attached to the Presidency General Hospital, the King’s Hospital, the Native Hospital and the Dispensary. ⁶⁹ The only practical information given on the subject was obtained from the dissection of lower animals and from the post mortem examination of persons dying in the General Hospital. ⁷⁰

The exposure to dead bodies began to erase the social taboo against touching the dead. Before the foundation of the CMC, students were exposed to the post-mortem examination and attended clinical classes at the General Hospital. This prepared the environs for exposing the new generations of pupils to visual and psychological acculturations with the new culture of medicine. When the cholera epidemic struck Calcutta in the 1820s, twenty of Breton’s (a superintendent at the NMI) ‘most experienced pupils’ were dispatched among the local population with the hope that a ‘decrease in the number of cases of cholera in the town will now admit of the aid’ of his students. ⁷¹ In a letter to Dr Breton, Radhakanta Deb wrote, ‘I shall introduce and recommend your advice and medicine, both here and in the interior; and the human lives which will thereby be saved.’ ⁷² Thus the background for the gestation of public health in India was prepared. Western education became successful in producing its agency through elite people like Radhakanta. Moreover, by suiting the desires of the government and the population at large, the NMI avoided ‘confrontation with the established medical men of pre-colonial India’. ⁷³

New experiments and trials in a hospital setting were also conducted, for example, by Dr Gilchrist,

…a quantity of finely powdered bark and cinnamon, with a due proportion of laudanum, into a bottle of Madeira wine, to shake the mixture well…to take a wine glassful of the medicine, to be repeated every half hour, until one of ourselves could attend in person. This experiment was tried with the utmost success… ⁷⁴

The year 1826 is significant because it is then that Dr Tytler commenced his lectures according to the Western method at the College on Medicine, and ‘Professors were appointed to teach Caraka, Suśruta, Bhāva Prakāśa, etc. Classes for the Āyurvedic students were opened in 1827’. ⁷⁵ Tytler organised his classes around four major departments of medical science, namely, Anatomy, Pharmacy, Medicine and Surgery. ⁷⁶ According to Tytler, it was ‘no small recommendation of Anatomy, that it has a most powerful influence in counteracting prejudices that arise from birth, or station, or cast, by demonstrating that, however mankind may differ in their externals, their internal organization is the same’. ⁷⁷ Anatomy, in this description, becomes the great social leveller—‘Before the knife of the anatomist every artificial distinction of society disappears; and if all the individuals of the human race be equal in grave, they are still more so on the dissecting table.’ ⁷⁸

To the beginners in the fourth class he taught anatomy in the following way—

After a preliminary lecture, I begin with the bones and commencing as usual with the head go regularly through the whole…on the bodies of sheep beginning with the Viscera and Thorax, then the Abdomen, the Pelvis and Brain and organs of sense…there are frequent opportunities of seeing these in Post Mortem examinations at the General Hospital. ⁷⁹

The gradual marginalisation of Indian medical texts were coterminous with the extension of western medical pedagogy in India. Although the original intention was to instruct boys in the Ayurvedic and Unani systems of medicine without excluding the European system, ‘the latter gradually and inevitably gained importance under European superintendence’. ⁸⁰ The process reached such a height that Durshun Lall, a Hindu pupil, brought Tytler a skull his friend had picked up in the banks of the river. ⁸¹

Opening up the cavity of an organism made pupils further aware of the depth and the third dimension of the body, as opposed to the received understanding of the two-dimensional idea of the body upheld by both Ayurvedic and Unani systems of medicine. Students would learn zootomy by dissecting goats and lambs. But, at the CMC, the subjects were taught practically ‘by the aid of the Dissecting Room, Laboratory, and Hospital’. ⁸² Additionally, new instruments of investigations like the thermometer and stethoscope and new modes of physical examination like inspection, palpation, percussion and auscultation were introduced. It is important to note, however, that the NMI did not have a proper institutional structure to incorporate the new medical education as yet, or in the offing.

Since its very beginning, the new medical training was secular in nature. A report from a Select Committee was to state: ‘Hindoos and Mussulmans were equally eligible, if respectable.’ ⁸³ Seema Alavi has further pointed out that ‘…any coolie attached to the army, once he became well versed in the Nagri script and qualified in basic hospital skills, could rise to become a native doctor’. ⁸⁴ For the first time in India, at the NMI, students were inducted into the procedures of individual case-history formulation. ‘The pupils,’ wrote Tytler, ‘keep a case-book of the symptoms and treatment of the sick on the establishment.’ ⁸⁵

Another dimension in the changes inaugurated by western medicine lay in the temporality of disease investigation and cure. The materiality of western medical practice lies in the transcription of evidence in written form which is thereafter abstracted as a medical record of observed events. ⁸⁶ The conceptual basis of the clinical case thus lies in the ordering of its facts by the agency of time. The introduction of time as an ordering variable in the construction of clinical cases was completely new in Indian practice; gradually the ‘seasonal time’ of indigenous Indian medical practice transformed into the clinical time of Western practice.

It became widely accepted that ‘the British government could not have established an institution calculated to be of greater benefit…than the Native Medical Institution [NMI]’. ⁸⁷ Macaulay’s efforts seemed only to add a snowballing effect to the process already started by the students of the NMI and Calcutta elites taken together. During the decade of its existence, the number of native doctors ‘which this institution furnished to the public service between 1825 to 1835…was 188’. ⁸⁸ Eight of the pupils ‘who had been educated in this seminary were appointed native doctors, and sent with the troops serving in Arracan’. ⁸⁹

My contention is that the brief phase of the NMI and the medical classes at the Calcutta Sanskrit College represents the period of gestation of hospital medicine in India. Medical classes at the Sanskrit College started in 1827. But the preparatory phase to introduce pupils to modern science—its technology and technique—had begun earlier. The report of 1828 stated that the progress of the students of the medical classes had been satisfactory ‘in the study of medicine and anatomy; and particularly that the students had learned to handle human bones without apparent repugnance, and had assisted in the dissection of other animals’. ⁹⁰ They also ‘performed the dissection of the softer parts of animals’, and opened ‘little abscesses and dressing sores and cuts’. ⁹¹ Moreover, at the Sanskrit College of Calcutta the number of pupils was then 176, and was rapidly increasing and of these only ninety-nine received allowances from the college. ⁹² This estimate makes it clear that seventy-seven students were without allowances and still pursuing their studies at their own expense—the lure of English medical education can be unmistakably discerned from these facts.

In Fisher’s memoir, ‘The report of 1829 states that 300 rupees per month had been assigned for the establishment of a hospital in the vicinity of the college’. ⁹³ Though curricula were in accordance with Sanskrit medical works, a hospital of some kind was thought absolutely necessary for proper medical teaching. As a letter written in 1831 conveys, ‘[t]here is now every reason that medical education in India will be improved in a very material degree by this institution’. ⁹⁴ It was thought that the institution would have the benefit of ‘affording to the medical pupils ample opportunities of studying diseases in the living subject’. ⁹⁵ One graduate, N.K. Gupta, who had been trained as an apothecary, was apparently doing quite well in the position at the hospital. ‘Though no Hindu had yet performed a major operation, they regularly performed minor ones such as “opening little abscesses and dressing sores and cuts”.’ ⁹⁶ In 1833, Dr J. Grant wrote to Major Troyer, the then secretary of the Sanskrit College,

The students of the Medical Class having attained a respectable knowledge of elementary Anatomy and Physiology as far as the means at our disposal permitted consistent with Native prejudices: The next point of importance was to give them some correct notions of European Medical and Surgical knowledge. ⁹⁷

In the same letter he made mention of ‘ninety-four House Patients (as stated earlier) and one hundred and fifty-eight out-patients. Of the Two Classes of Patients, the House ones sleep and dieted (sic) in the Hospital’. ⁹⁸ He also stated that the out-patients were ‘visited if unable to come at their own residence by the Apothecary, when practicable…’. ⁹⁹ The Asiatic Journal also published a similar report: ‘The poor afflicted and helpless sick are now admitted to this hospital, and are furnished with medicine, food and beds; and, in fact, they are attended better than they could be by their own families at home.’ ¹⁰⁰

I suggest that these were the first instances when Indian patients were dislocated from their domestic setting to the environs of the hospital. A new notion of treatment, which found its final shape in the CMC, began to emerge within social life. By this time, a shift in the vocabulary of medicinal pedagogy was effected and the word ‘education’ in lieu of the older ‘training’ gained currency. ¹⁰¹ Mr Wilson, who examined the medical class in 1830, ecstatically claimed, ‘the triumph gained over native prejudices is nowhere more remarkable than in this class’, where ‘not only are the bones of the human skeleton handled without reluctance, but in some instances dissections of the soft parts of animals performed by the students themselves’. ¹⁰²

Concurrently there was a more fundamental shift in the linguistic sign system which determined the development of medicine as an edifice of knowledge in the subcontinent. The essence of the Sanskrit texts was metonymically reconstituted to suit the purpose of modern medicine. As Vasudha Dalmia has shown, by 1827, within western Orientalism, there occurred a ‘radical shift from awe and a certain mystification of [the] wisdom of the East’ to a ‘marginalization of this knowledge and the degradation of the bearers of it to the position of native informants’. ¹⁰³ In the fundamental reconstruction of the indigenous cognitive world Dalmia shows that the pundits ‘had to deliver the raw material so to speak [and] the end products were to be finally manufactured by superior techniques developed in Europe’. ¹⁰⁴ Hooper’s Anatomist’s Vade mecum was translated into Sanskrit as Sarira Vidya by Madhusudan Gupta, for which he was paid a sum of ₹1000. ‘It was intended to convey to the medical pandits throughout India, who are an exclusive caste of hereditary monopolists in their profession, and all study their art in Sanskrit, a more correct notion of human Anatomy.’ ¹⁰⁵ Modern anatomical knowledge came in the guise of the indigenous one—‘Once placed in a Sanskrit dress, the European system of anatomy would be accessible all over India for subsequent transfer into Hindi dialects of every province if requisite…’. ¹⁰⁶ Interestingly, somewhat at the same time, Tytler translated two chapters of the ‘First of Sooshroota’ into English ¹⁰⁷ , while, in the Bombay School for Native Doctors ‘the Sooshroota Shereer’ was translated into Marathi. ¹⁰⁸

Unlike the NMI, the aim of the Sanskrit College was not the production of native doctors. Here students from higher castes of Bengali society were first exposed to general scientific training, and, then, gradually incorporated into the fold of Western medical education. The English and the medical classes at the Sanskrit College were eventually abolished in 1835 and the decision ‘was hailed by a section of conservative diehards’. ¹⁰⁹

Taking a cue from Gelfand, ¹¹⁰ I have shown that the CMC was not a sudden phenomenon exploding on the subcontinental scene in one clear move. This section has attempted to show that the new medical epistemology had its ‘gestation period’—a period exemplified by the work of the NMI. By virtue of their training in a medical institution (NMI), the students had the opportunity to be inducted into the basic sciences like rudimentary chemistry, material medica and pharmacopoeias along with their primary training in surgery. ¹¹¹ The NMI systematised medical instruction and laid out strict codes of medical apprenticeship and training. ¹¹² This pre-CMC training also foregrounded the absolute necessity of hospital of some kind for proper medical teaching. ¹¹³ All of this had simply inaugurated a predicament in which hospitals and medical pedagogy of an altogether new type became necessary. The ‘gestation period’ described in the section above, ushered in an era of hospital medicine and a new kind of medical cosmology and education in India.

CMC: The Beginning, Changes and Development

In 1828, Montgomery Martin laid the project and plan for a new medical college before Viceroy Lord Bentinck. The plan was rejected ‘at the time by the Supreme Government, lest Hindoo prejudices should be offended’. ¹¹⁴ It was the Act of 1833 in England that injected ‘fresh vigour into both the Home and Foreign divisions of [the] oriental administration…[and] medical and general education began to experience something like the attention it deserved’. ¹¹⁵

Bentinck had ‘indeed subscribed in 1826 for two shares in the newly founded University College, London—an institution under combined whig, Benthamite and Dissenting control, and a forward battalion in the “march of mind”…’. ¹¹⁶ Unlike Oxford and Cambridge, the students of UCL did not require subscription to the thirty-nine Articles of the Church of England. This new university tried in the 1830s to join the theoretical study of science to the practical work of the clinic, as was already underway in Germany. ¹¹⁷ UCL became a site at which the crucial issues of the ‘content of orthodox medical knowledge and of the locus of medical authority were contested and decided’. ¹¹⁸

All these happenings in England had their profound influence in shaping the mode of clinical training and curricula of the CMC. Percival Spear urges us to look to England rather than to India for the decisive changes in Indian educational policy. ‘The two sources of these ideas’, writes Spear, ‘were, briefly, Evangelical and the Utilitarian.’ ¹¹⁹ Interestingly, like UCL, when the Medical College Hospital was built in 1852–53 it was also built in Corinthian style. In 1834, Bentinck wrote to his friend Peter Aubre, ‘The mind of this country is receiving a new impulse and excitement, and we must keep pace with it. Three thousand boys are learning English at this moment in Calcutta and the same desire for knowledge is universally spreading.’ ¹²⁰ In an assured note, he continued, ‘My firm opinion on the contrary is that no dominion in the world is more secure against internal insurrection.’ ¹²¹ Against this changed scenario, the foundation of the CMC was firmly declared in a Government Order (G.O No. 28) of 28 January 1835. ¹²² Moreover, as the remarks of Goodeve would suggest to us, beyond this socio-political reason the vestiges of humoral theory had also been superseded by ‘rational medicine’ at the CMC. ¹²³

Before the issuance of the GO, a committee was formed in 1833 by Lord Bentinck to look into the state of medical education in the subcontinent. The Committee was to summarise the defects of the NMI. Some of the remarkable points brought forth were—(a) the absence of a proper qualifying standard of admission; (b) scantiness in the means of tuition; (c) the entire omission of practical human anatomy in the course of instruction; (d) the short duration of the period of study; and (e) the mode of conducting the final examination. ¹²⁴ On a closer look, one would realise that a paradigmatic shift from military medical ‘training’ to medical ‘education’ has taken place.

The following narrative will reveal the changing dynamics which led to the emergence and structuration of hospital medicine and medical education in India: ‘Efforts were made to procure every appliance necessary to place it on the same footing of efficiency as European colleges was (sic) furnished with a bountiful hand.’ ¹²⁵ The duration of education was fixed at four to six years. All foundation pupils were ‘required to learn the principles and practice of the medical sciences in strict accordance with the mode adopted in Europe’. ¹²⁶ The aspiring candidates for admission were to be ‘examined by the Education Committee and the Superintendent of the Institution’. ¹²⁷ Public service was to be supplied ‘with Native Doctors from the institution’. Definite provisions were mentioned to witness the practice of the General Hospital, the Native Hospital, the Honourable Company’s Dispensary, the Dispensaries for the poor, and the Eye Infirmary (thirty-first clause). Students, not the professors, passing out from this institution were allowed to enter into private practice (twenty-second clause).

Through the functions of the CMC, hospital medicine and the new medical education were merged together. All the foundation pupils received a stipend at the rate ₹7 (first class), ₹9 (second class) and ₹12 (third class). This was quite different from the circumstances of medical students in London: according to the 1834 Report on Medical Education, ‘about one third of the London medical students went to a private school…The core of the private school’s teaching, however, was anatomy’. ¹²⁸ They were never paid by the government. In regard to stipend, Trevelyan explained that the professional training at the CMC was carried so much beyond the period usually allotted to education in India, that ‘without this assistance, the poverty or indifference of the parents would often cause the studies of the young men, particularly when they come from a distance, to be brought to a premature close’. ¹²⁹ From his own experience, Dwarakanath Tagore wrote to Bramley, ‘no inducement to Native exertion is so strong as that of pecuniary reward…you will find difficulties disappear in proportion to the encouragement offered to the Students in this particular’. ¹³⁰ Another report of the same time gives us slightly different evidence regarding the effects of pecuniary encouragement to undertake medical education. This report informs us that, ‘[c]ertain students of the medical college have volunteered to attend the poor in cholera cases gratuitously. They were offered 30 Rs. per mensem for the duty, but refused it’. ¹³¹ By this time, the responsibility of medical education was transferred from the domain of the Medical Board (military character) to the Education Committee (general education). Unlike England then, the emergence of the CMC in the subcontinent can be traced to the point of departure where medical practice in India shifted from the dominion of the military to the civil domain.

The original staff of the CMC consisted of a superintendent, Assistant Surgeon M.J. Bramley, with Assistant Surgeon H.H. Goodeve as his only assistant. ‘By G.O. No. 10 of 5th August, 1835, Bramley’s official designation was changed from Supt. to Principal, that of Goodeve from Assistant to the Supt. to Professor of Medicine and Anatomy; while a Professor of Materia Medica and Chemistry was added to the staff, Assistant Surgeon W. B. O’Shaughnessy.’ ¹³² After Bramley’s death ‘the office of principal was abolished, a non-medical man being appointed instead as Secretary’. ¹³³ Hence, a clear division was made between areas of administrative and academic expertise.

The CMC introduced ‘the timid Hindoo youth to the use of scalpel, without offending the delicate nerves and still more delicate conscience too sensitively’. ¹³⁴ Webb, in his lecture before the students of CMC, reminded them that the college was no longer regarded as an experiment, but as an admirable, beneficent and established triumph, as ‘Graduates are being educated at the Medical College in a manner not inferior to some of the most celebrated schools of medicine in Europe.’ ¹³⁵ Once the ‘experimental’ phase of medical education was declared over, Webb emphasized the vast difference between the marvellous rapidity and success of lithotomy surgery in the hands of European professors and ‘the rude barbarism of SUSHRUTA’. ¹³⁶ Webb’s criticism of Indian surgical practice seems to come out of what Christopher Bayly refers to as the ‘insecurity of European knowledge’ which ‘was a potent element in their rages’. ¹³⁷

Initially, the CMC, often going against the prevailing educational trend of the time, had created a space for the generation of original, theoretical and insightful scientific thinking. Gorman noted that the students were just as capable and enthusiastic about chemistry as they were about anatomy. They came out successfully from the rigour of examination by outside examiners. ¹³⁸ A contemporary journal reported, ‘the chemical department has, within a twelve month [period], reached such a state of organization…with such eminent success, as to supersede the necessity of any other school of chemistry on the same scale in the colleges in and about Calcutta’. ¹³⁹ O’Shaughnessy proposed to construct, at the CMC, a galvanic battery of one thousand cups, on Mullin’s principle. ¹⁴⁰ He even undertook to conduct the ‘application of galvanism’ in case of aneurism. ¹⁴¹

O’Shaughnessy was an ardent and enthusiastic advocate of science as a means of bringing India into line with mainstream intellectual trends in Europe. In 1836, in his ‘Introductory Lecture’ to the students of the CMC, he made it clear that in every bazaar of India the raw material was to be found from which all the valuable remedies ‘from the use of which your countrymen are now debarred, can be prepared’. ¹⁴² O’Shaughnessy had counted the number of medicines then imported from Europe. It amounted to several hundred, all of which, except about eighty, might be prepared or grown in India. Moreover, ‘For these 80 many efficient substitutes exist in known indigenous productions.’ ¹⁴³

O’Shaughnessy was also a pioneer of intravenous fluid transfusion for cholera patients. ¹⁴⁴ In Calcutta, Dr Stewart half-heartedly tried it for cholera patients, but without any results. ¹⁴⁵ A committee was also formed ‘to experiment upon and report on the extent to which injections into the veins may be practiced with safety upon animals…’. ¹⁴⁶ O’Shaughnessy was selected as the secretary of the committee. It remains unknown how long this committee functioned. Later on, he diverted his attention to the use of Indian plants in the treatment of cholera.

The first annual report of the CMC was prepared by Bramley. But he could not present it himself due to his premature death at the age of thirty-six. Bramley’s first annual report contains some notable features. First, a considerable portion (first seventeen pages out of thirty-seven) is allocated for detailed discussion on the techniques to build up the physical and mental mould of his Indian students in conformity with Victorian England’s social aspirations. Second, only one paragraph is provided for Goodeve’s work, while a good portion of the report (five pages) speaks for O’Shaughnessy’s experimental endeavour. Third, Bramley provided a proposal to build a new hospital within the college campus and to unite it with the college. He specifically differentiated the new education at the CMC from the trends of instruction that had hitherto existed in India. The new educational curricula included ‘Lectures upon General and Practical Anatomy, Physiology, General and Practical Chemistry, Theory and Practice of Physic, Elements of Medical Botany and Materia Medica, Practical Pharmacy, together with hospital attendance’. ¹⁴⁷

Bramley’s plan was to establish a systematic mode of teaching, and as far as means and circumstances would permit to frame the general Instruction of the College on the mode of the English Medical Schools. ¹⁴⁸ The first course of lectures spanned from June 1835 to September 1835. During this period students were only instructed in surface anatomy of the large arteries, the principle muscles and nerves, etc. ¹⁴⁹ Gradually, a large portion of the class came to witness with considerable interest the examination of the bodies which had died in the hospitals they visited. ¹⁵⁰

It seemed that poor people ‘dying in the hospitals’ became virtually coterminous with becoming subjects for dissection—this trend would become a cause for some concern regarding the projected utility of the hospital. Concern was expressed, for example, in A.R. Jackson’s evidence before the Committee for Fever Hospital that

…if once the idea gets abroad into the minds of the Native population, that the Hospital is a part of the College establishment, and the source from whence subjects for dissection are to be supplied to it, its usefulness for the purposes of a General Hospital of relief to the sick Natives is at an end. ¹⁵¹

Bramley admitted that dissection is seldom approached by the uninitiated even in Europe. An English report noted the ‘natural feeling which leads men to treat with reverence the remains of the Dead … to regard with repugnance, and to persecute, Anatomy’. ¹⁵² In 1849, for example, two students of the CMC absconded out of ‘dread of the practical duties of [the] Dissecting Room, and their dislike of the Bengal climate’. ¹⁵³ Thus, the relentless and continuing efforts to indoctrinate native students into the ‘white coat’ ceremony of practical anatomical teaching, which had been continuing since the work of the NMI did not see immediate fruition.

The summer session of the CMC (April–September) was occupied primarily by lectures on basic sciences. The second regular anatomical course did not commence till October 1836. ¹⁵⁴ Throughout this period, examinations were held regularly ‘on each Sunday, and these were generally conducted in the presence of medical gentlemen’ who came on Bramley’s invitation. ¹⁵⁵ Bramley did not want to put the dissecting knife into the hands of the students until they had acquired some familiarity with the nature and situation of the parts and, also, ‘not until their moral training had been so ripened as to admit of the final’. ¹⁵⁶

According to Bramley, four of the most brilliant students, whose names were not disclosed for the fear of social repugnance, did the first dissection on 28 October 1836. Up to that period actual dissection had not been practiced by the class. ¹⁵⁷ He admitted, ‘the probable publicity of this document, forbids my making the disclosure’. ¹⁵⁸ Out of this practical dissection by Indians, the majority of the students could be ‘considered on a par with the pupils of the English schools of medicine, possessing the same, if not more abundant, opportunities for its acquisition, equal intelligence, zeal, and industry’. ¹⁵⁹ A few years later, Dr Goodeve reconfirmed that the most important blow which had yet been struck at the root of native prejudices and superstition was made possible by the establishment of the CMC, and the introduction of practical anatomy ‘as a part of the professional education of Brahmins and Rajpoots, who may now be seen dissecting with an avidity and industry which was little anticipated by those who know their strong religious prejudices upon this point twenty years since’. ¹⁶⁰ Lectures and instruction on the ‘Theory and Practice of Physics’ afforded the pupils an insight into pathology and explained to them the nature and cause of disease in general. ¹⁶¹ With the beginning of the new session, arrangements were made for the pupils’ attendance at the Native Hospital, the General Hospital, the Eye Infirmary, and the Kolingah Dispensary. ‘Most of them were anxious and ready to assist in the various minor operations, and some of them performed them with confidence and dexterity’. ¹⁶²

As the cornerstone of hospital medicine, hospital practice was academically necessary to make the students accustom to the disagreeable sights and impressions to be met with amongst the sick in the hospital. ¹⁶³ Visual and psychological acculturations, initiated at the NMI, were now carried on with a greater extent and momentum. Thus, although the NMI was abolished the process of acculturation continued with the CMC.

A new medical person was in the making. They were studying in a foreign language and, in the study of ‘Practical Pharmacy’, the pupils had to ‘prescribe in the language and signs of the British Pharmacopoeia’. ¹⁶⁴ In the classes on ‘Chemistry and Materia Medica’ delivered by O’Shaughnessy, ‘several of the young men…evinced a strong desire to become experimentalists themselves’ and ‘twenty of the most distinguished pupils were instructed in the manipulation of apparatus, preparation of reagents…and with the mode of preparation of many of the most useful mineral remedies’. ¹⁶⁵ Such a spirit of experimentation had been first kindled by the instruction in making new chemical substances by student of the NMI.

Bramley tried his best to adopt the system of concourse of chemistry, medicine and botany followed in ‘all the medical institutions of France, and where it ha[d] been adopted in England’ as the ‘leading principles of the College’. ¹⁶⁶ The laboratory contained an enormous electro-magnet, and pharmaceutical preparations illustrating English and Hindu drugs were also in the laboratory. ¹⁶⁷ Gorman notes, ‘[a]t a time when a chemical laboratory in an American medical school was rare, this course with lectures and laboratory work was the equal of any in a European medical institution’. ¹⁶⁸ Moreover, instead of giving a medal for brilliant results as was the conventional practice, there was also a proposal to give a microscope and several volumes of standard medical works to the students. ¹⁶⁹ Through such activities, students were supposed to be drawn more towards the science of medicine and not to its merely speculative domains. Goodeve and O’Shaughnessy proclaimed that as teachers ‘in a new and experimental institution’ they built their courses of study from the contents of British and foreign journals for this purpose. Of the seventeen medical journals they used, nine were French and eight British. ‘It must not be said of us in Europe, that expatriation has rendered us inefficient in the advancement of our profession.’ ¹⁷⁰ They strove to excite among the brethren of the fatherland some surprise to prove that ‘amidst the many impediments which beset’ them in India, they ‘still pursue the unabated zeal the various useful and ennobling branches’ of their ‘truly philanthropic art’. ¹⁷¹ Some of the more advanced students of the CMC, inspired by the spirit of O’Shaughnessy and Goodeve, formed the ‘Chemical Demonstration Society’ to perform and independently dabble in experiments. They performed all the experiments in illustration of their learning. ¹⁷² Bramley’s premature death as well as O’Shaughnessy’s early dissociation with the institution seems to have put an end to such initiatives.

In 1837, in his letter to Sutherland, Secretary of the GCPI, David Hare categorically emphasised clinical training in the hospital for better exposure to Indian diseases and not only European ones. ¹⁷³ Moreover, this new teaching was supposed to bridge the chasm between the ‘native hospital being exclusively intended for Surgical cases’ and ‘the General Hospital for instruction in all Medical diseases’. ¹⁷⁴ The century-long dichotomy between the physician and surgeon seemed to get resolved through the production of new graduates from the CMC—who were trained to become physicians and surgeons at the same time. In this way the CMC embodied one of the distinct hallmarks of hospital medicine.

In an earlier observation, Lord Bentinck had declared that ‘all the foundation pupils [should] be expected to practise human dissection and perform operations upon the dead body, or be discharged’. ¹⁷⁵ A few years later, Dr Mackinnon reported, ‘Post Mortem examinations were performed by each of the students in my presence and they wrote descriptions of the result’ in which ‘they all evinced practical knowledge…and an acquaintance with the healthy and morbid appearances of the different structures and organs’. ¹⁷⁶

In 1838, there were two divisions of classes—General Classes and Junior Classes. ¹⁷⁷ A secondary vernacular class, chiefly through O’Shaughnessy’s exertions, was opened in 1839. Here, ‘[t]he pupils were required to dissect, and were taught entirely on European principles and were employed, at the same time, on practical hospital duties’. ¹⁷⁸

In the 1844–45 session, the CMC made a great advance in remodelling its system of instruction to bring it up to the standard of the Royal College of Surgeons in England, and procure the recognition of the institution by that body so that ‘the Institution [would] be duly registered and recognized, and those of its pupils who may hereafter visit Europe for the purpose of graduating or obtaining the Diploma of Surgeon’. ¹⁷⁹ Following European Colleges, new regulations were made so that no single teacher would teach more than one subject and each subject would consist of not less than seventy lectures. It was also required that every student should, in addition, compound in the dispensaries of the Medical College under the superintendence of Mr Dally, the House Surgeon and Apothecary. ¹⁸⁰ The legacy of producing compounders and dressers, as was the case in Madras as well as in some modified ways at the NMI, were incorporated at an extended level in the CMC.

In eight years, from 1837 to 1844, nearly 3500 bodies were dissected. ¹⁸¹ This was an incredible figure! There seems to have been a never ending supply of unclaimed bodies of hapless poor Indian people. ‘Everyone knows that this city contains thousands of poor strangers, of all ranks, without wealth, connexion, or friends…some die on the road, and many perish for want of two pice worth of medicine.’ ¹⁸² Buckland noted that a large proportion of the corpses, instead of being burnt, were either thrown into the river, or consigned for dissection to the Medical College hospital, to be afterwards disposed off in the same way. ¹⁸³ This was possibly the reason why, unlike in England, there was no need for a replica of the 1832 Anatomy Act in colonial India. The body was colonised and cadavers were plentiful.

Along with the revision of the medical curriculum, the system of examination was modified so that it would be ‘more nearly assimilated to that which obtains [in] most European Universities.’ ¹⁸⁴ In addition to a written and a practical examination in the dissecting room, every final student was subjected to a special trial for twenty minutes at least. It was much more difficult than that for the Diploma of the Royal College of Physicians and ‘embraces everything required from a Graduate of the University of Edinburgh’. ¹⁸⁵ The method of giving marks to the candidates at the final examination began in the 1846–47 session. In awarding the number of marks, the written and practical examination was valued as equal—each at fifty marks apiece; so that the aggregate of both examinations would be calculated at one hundred for the highest number. ¹⁸⁶

Following changes in the 1844–45 session, the period of study in CMC was extended from four to five years for better clinical and surgical training. ¹⁸⁷ Moreover, the ‘establishment of the Fever Hospital’ was to ‘complete the amount of practical and clinical instruction furnished’ so as to ‘rank with any of the provincial schools of Great Britain, or the second class schools of medicine, in the centre of England, Scotland or Ireland!’ ¹⁸⁸

All these changes show the dynamic character of medical education in its initial years. Duncan Stewart, ‘in reply to the question of the relative advantages of Dispensary and Hospitals’, reveals his faith that an essential part of Medical education had to be conducted in the practical domain of the ‘Hospital, since there alone…can Clinical instruction be given with propriety’. ¹⁸⁹ To substantiate the importance of the hospital for a wholesome medical education, Martin pointed out that attendance on large bodies of sick ‘in their own houses would be obviously impracticable, even were it desirable’. ¹⁹⁰

With the passage of time, by 1841, the gender question regarding admissions to the CMC was resolved as well. ‘A large Female Hospital, intended to embrace the advantages of a Lying-in-Hospital with instruction in Midwifery’ was built and was ‘ready to receive patients’. ¹⁹¹ It could accommodate more than one hundred patients. In 1850, the policy was worked out ‘to encourage women to resort to the Institution for delivery’, and, for this purpose, it became necessary to hold out many little advantages to them (‘for the present at least’) ‘in the shape of clothes for themselves and their children when they depart, allowances for tobacco’. ¹⁹² Providing such ‘advantages’ might have arisen out of a threat from the indigenous practice of midwifery. Poor people were allured to institutional delivery, and this led to a gradual marginalisation of indigenous practice of midwifery. Madhusudan Gupta reveals that ‘[s]uch women so instructed and employed, would readily find employment at a moderate charge among Hindu women of all castes and ranks, at their own houses…’. ¹⁹³ Hence, the introduction of the new midwifery practice not only marginalised indigenous ones, but also created newer spaces of employment.

After nine years of successful experiments in 1844 the rules and regulations of the Bengal Medical College were codified. No stipendary student was permitted to present himself for final examination until he had completed five sessions of study in the College. ¹⁹⁴ They were also strictly required to perform the ‘duties of clinical clerk and dressers for not less than eighteen months, collectively’. ¹⁹⁵

After 1844, when the new medical education was free from its initial uncertainties, enrolment expanded: along with stipendiary students those who were referred to as ‘Free Students’ were allowed into the CMC. It was claimed that ‘[t]he number of students wishing to obtain a complete medical education at their own expense shall be unlimited’. ¹⁹⁶ Moreover, ‘Diplomas and certificates bestowed on the free students, shall be the same as those granted to Sub-Assistant Surgeons at the annual examination’. ¹⁹⁷ The Military Class was also brought under the regulations and placed under the control of Pundit Madhusudan Gupta. The internalisation of Western medicine advanced further with the replacement of European teachers by Indian ones in the Military Class. For example, the subject of anatomy and surgery was taught by the ‘Superintendent, and Practice of Medicine with Materia Medica by Baboo Shibchunder Kurmoker’. ¹⁹⁸

The secrecy with which the first dissection was carried out in 1836 was no longer necessary in 1844: ‘A certain number of the senior students shall, during each dissecting session…themselves dissect and become practically acquainted with the anatomy of the human body’. ¹⁹⁹ Additionally, there were ‘three cases for the teachers, second-hand capital cases for exhibiting all operations on the dead subject, a post mortem case…’. ²⁰⁰ Not only dissection, dressing, compounding and clinical training, the students were also taught ‘to read prescriptions and the instructions given by the Medical Officers, for the administration of medicines during their absence’. ²⁰¹ For the first time every dissecting student was to ‘deposit a sum of two rupees in the office of the College, to make good any loss or destruction, to which the instruments may be subjected, independent of fair wear and tear’. ²⁰²

The hospital attached to the Medical College was divided between the departments of surgery and medicine, holding in all 112 beds. The everyday functioning of this hospital was detailed meticulously and the ‘ritual’ of admission was described as follows: after admission into the hospital, patients would be ‘immediately seen by House-Surgeon…The disease shall be noted on a ticket with the diet, date of admission &c’. ²⁰³ A general register of all the cases admitted in hospital ‘shall be kept, and available for statistical purposes’. ²⁰⁴ As an outcome of these rituals and procedures the ‘person’ of the patient began to disappear and, in turn, began to be known as a number: ‘Enter and you will find East Indians and West Indians, Bengalees and Madrasees…they are of all classes; and (as all patients are distinguished not by name, but by numbers), were one to ask for “Now Number Sahib”…’. ²⁰⁵ The significant exception in the secular nature of the new medicine was determined by its colonial context where differences were often noted by caste and racial inscription. The daily charge for ‘the diet of each patient’, for example, was for ‘Europeans four annas, and for Natives one anna’. ²⁰⁶

In 1847, Balfour felt that perhaps one of the most striking features of the present history of India was the wonderful success with the opening of Dispensaries. ²⁰⁷ Dispensaries, in his view, were held by the great majority of the people with increasing favour. They were manned by graduate sub-assistant surgeons of the CMC. Thus, it was through the dispensary that a space for modern public health was opened up in a true sense. The success of these strategies was also dependent on the internalisation of certain rules of behaviour by the population at large. ‘Medicine thus acquired political status inasmuch as it gained a new relevance to the interests of the state’. ²⁰⁸ Sykes reported about 94,618 patients who were relieved in the Charitable Dispensaries of India in 1847. ²⁰⁹

Importantly, ether anaesthesia was administered on 22 March 1847, while chloroform was applied on 12 January 1848—within two months after its first introduction in London. ²¹⁰ Among the prominent points of interest referred to ‘were the extraordinary success of some of the graduates of the College in the performance of the formidable operation of lithotomy, and the valuable results which had followed the introduction of chloroform into the practice of surgery’. ²¹¹ Dr Jackson crushed large stones in the bladder by making the patient insensible to pain by chloroform. One hundred and thirty two operations were done in the Native Hospital during the years 1848 and 1849. ²¹² On 7 February 1849, J. Jackson of the CMC even corresponded with Simpson (the discoverer of chloroform) ‘describing the administration of chloroform in a case of severe pain’. ²¹³

Stewart also mentioned the successful introduction of new anaesthetic agents in his report. Chloroform was given in two obstetric cases of operative procedure with perfect safety and success in the presence of several of professors, and a number of the students of the CMC’. ²¹⁴ This report was sent for publication in the Register of Indian Medical Science.

The CMC, like its European equivalent, became a space for new scientific experiments. All these experiments were transmitted throughout India and, also Europe, through publications like the Transactions of the Medical and Physical Society of Calcutta, Quarterly Medical Journal and, later, the Indian Medical Gazette. Hospital medicine thus gained its universal character beyond its European origin to the extent that in some ways the peripheral location of the colony had a large role in influencing the development of the field in central metropolitan England.

Conclusion

The foundation of the CMC, as this article has argued, not only gave birth to hospital medicine and modern medical education in India, but it also influenced education in India in general terms. In 1845, four of the students of the CMC made their voyage to England and, supposedly, overcame ‘the dread of the sea, so firmly implanted in the mind of every Hindu’. ²¹⁵ They became the role model for future Indian scientists and students.

The CMC produced trained graduates who extended the applications of modern medicine and public health, as shown above, throughout India. Lord Hardinge was convinced of the impact of dispensaries and eulogised it ²¹⁶ as a way that would extend the benefits of modern medicine. In this way the CMC may have also played a role in the future of public health in India.

The birth of the CMC converged with the years in which the Anglicist– Orientalist debate would be resolved—from here on English would become the language of higher education. The CMC was also possibly the first Indian institution to work on the plan of ‘suitable [residential] accommodations’ within ‘the precincts of the College’. ²¹⁷ Residential education was considered one of the most essential and important features in the normal training of teachers in the schools of Germany, Holland, Switzerland and France. ²¹⁸ The CMC introduced this model to India. Native medical students were to be accommodated within the precincts of the college to make them immune from ‘every influence resulting from ignorance, superstition, the prejudices of caste, and similar means of weakening the effects of the intellectual and moral training he is undergoing in our schools and colleges’. ²¹⁹

The advocates of the new medical education saw themselves as the historical agents and visionaries for a new future of India. Sykes confidently proclaimed the successful colonization of the subcontinent via western medical pedagogy: ‘we shall have left a monument with which those of Ashoka, Chundra Goopta, or Shah Jehan, or any Indian potentate sink into insignificance’ and, at the same time, ‘those of Auckland, as protector, and of Goodeve, Mouat, and others, as zealous promoter of scientific Native medical education shall remain embalmed in the memory of a grateful Indian posterity’. ²²⁰ Notably, in this ‘new history’, pragmatic and successful people like Auckland, Goodeve and Mouat were mentioned to the occlusion of O’Shaughnessy, the person with an original inquisitive mind who was on advocate of the spirit of free thinking.

Despite the European intervention, Chuckerbutty likened these medical officers to ‘only bird[s] of passage’ and, as a result, they ‘could not, therefore, permanently improve the position and prospects of the profession out of the service’. ²²¹ In a move to replace these ‘birds of passage’, internalisation of modern medicine was of prime importance. Following the European method, he began his trials with ‘iodide of potassium’ at the CMC in the treatment of aneurism. ²²² It is important that Chuckerbutty preceded similar British trials in this regard. His trial was published in July 1862, while the British one was published in January 1863. ²²³ He strongly advocated for compulsory registration of medical graduates. This was to counter the presence of unqualified imposters: ‘[e]very druggist and chemist, every apothecary and quack, every sluggard, fool, and rogue, enjoys as yet full liberty to style himself a doctor and prescribe for the sick’. ²²⁴ In 1864, he enumerated 29 types of different medical practices prevalent in Calcutta alone. ²²⁵ If Chuckerbutty embodies the agency of modern medicine, Mahendralal Sarkar and Bholanath Bose represented two other distinctly visible trends. Sarkar, who was himself a graduate of the CMC, championed homeopathy of a distinctly ‘Indian’ kind. He was also the founder of the Indian Association for the Cultivation of Science (1876). Bose, I would propose, advocated for a hybrid of ‘allopathy’ and homeopathy. He wrote two books, A New System of Medicine and Principles of Rational Therapeutics. which the reviewer in The Philadelphia Medical Times described in the following manner: ‘[t]o those who view the present system of medicine as an inchoate mass of empiricism, and who are searching for something new and startling, we recommend the above works’. ²²⁶ Bose seems to have problematised the prevailing medical practice by emphasising the distinction between disease and sickness. ²²⁷ Notably, he used a unique term ‘kyaitis’—a hybridisation of the Sanskrit kaya, meaning body, and ‘itis’ from modern pathology, meaning inflammation. ²²⁸ Was he incorporating the concept of svasthya of Indian connotation?

As late as 1868, it was regretted that though under ‘British rule,…[native medical practitioners] have disappeared altogether from political life, and socially have little or no standing in European society’, and yet in native society, ‘all over the country, these men (Hakeems and Vaidyas) still hold their own, and are greatly respected’. ²²⁹ Possibly, out of desperation, Buckland wrote about the great difficulty to convince natives to take English medicines properly and regularly, and to submit themselves to reasonable treatment. He lamented, ‘how much of the effect is lost when medicine is given to a set of ignorant and doubting people in the villages’, who probably ‘do their best to destroy the valuable properties of the English drugs by combining with them (as they fancy) the prescriptions of the kabirajes or the wise and aged women of the village’. ²³⁰

We discern some epistemological fissures from inside as well as outside the modern medical cosmology in India. But modern medicine became the referent against which all other medical praxes could be measured. Alavi shows how, when the legitimating contexts of pre-colonial practitioners of Unani medicine were lost, Unani practitioners dispersed into qasbas and towns of the North Indian countryside, where their ideas, terms and culture contested colonial medical drives in the period of high nationalism. ²³¹ In an asymmetrically overdetermined space, a great part of Ayurvedics, endeavouring to be modern (navya-ayurveda), unscrupulously copied anatomical illustrations from English handbooks and replaced English terms with Sanskrit names. ²³² Finally, the core of Ayurveda was reconstituted. For all these historical phenomena, the CMC emerged as an event as well as a historical process.