Why India, Among the Largest Exporters of Doctors in the World, Does Not Have “Medical Schools”
But has “medical colleges” instead
During my almost six years at Pune’s Byramjee Jeejeebhoy Medical College, from where I graduated a decade ago, I never used the phrase “medical school.” I also don’t remember anyone else using that term to describe any of India’s four hundred or so medical colleges. Recent years, however, tell a different story. Folks at a website titled The Indian Medical Student seems to consistently use the term “medical school” for our medical colleges. More and more of us in India are adopting that phrase in informal conversations and discussions to describe what officially are “colleges.”
An important reason for this, many say, is the growing dominance of American cultural motifs in India aided by the expansion of access to the Internet (which of course is heavily dominated by all things American). This Scroll piece has some useful explanations of the phenomenon.
Whatever be the reasons for why Indian MBBS students and doctors are now preferring to call their training institutes schools instead of colleges, I believe they should at least know that there is a very specific history to the terms medical school and medical college in our country. While we are using them interchangeably today, a century ago our MBBS ancestors would most probably have looked at such equivalence with contempt and scorn.
The origins of medical schools and colleges
The story of this asymmetry begins in 1835 when two new institutions of biomedical (modern medical) education began in India. One, in Calcutta, got named as a medical college; the other, in Madras, was named as a medical school. During this time in Britain, medical education institutes were generally known as medical schools (although there were some medical colleges too, like the London Hospital Medical College). So it is not clear what motivated the respective British officials at Calcutta and Madras to name their institutions in those ways. But importantly for us, the next medical institute was also named a college, — the 1845 Grant Medical College of Bombay — and in 1850 the medical school at Madras was renamed as the Madras Medical College. In other words, “medical college” became the default term for major biomedical training institutions in India.
In 1857, in the midst of bloody battles of the revolt in the East India Company army, the first three universities in British India were established at Calcutta, Madras, and Bombay. The above-mentioned medical colleges came under the administration of these universities and began granting two separate degrees: the licentiate and the doctorate. The Bachelor’s degree (later became MBBS) was added in the ensuing decades. Thus, by the turn of the nineteenth century, the four Government medical colleges in British India (one was established at Lahore in 1860) granted degrees as shown in the excerpt here:
The Madras Bachelor’s degree was abbreviated as M.B. and C.M. while Calcutta and Lahore simply called it M.B. Bombay was not granting Bachelor’s degrees yet. Apart from the above, the universities also granted a doctorate, fashioned as M.D. It is important to note that there was a hierarchy in the degrees. The licentiate (most often fashioned as L.M.S.) was considered “lower” than the Bachelor’s, which was less fancy than the doctorate.
These four medical colleges were not, however, the only biomedical education institutes in India. Apart from these colleges, there were — you guessed it right — the medical schools! So if the university-affiliated medical colleges were already training doctors, who did the medical schools train? That would be other healthcare personnel: apothecaries, compounders, dressers, hospital assistants, etc. Some of these schools offered courses not in English but in the vernacular languages, and the duration of the courses was less than of those in the colleges. The above-mentioned 1897–1902 Progress of Education report lists eleven government medical schools: those at Madras, Poona, Ahmedabad, Hyderabad, Calcutta, Patna, Dacca, Cuttack, Agra, Lahore, and Dibrugarh. The medical schools, unaffiliated to the universities, were almost entirely in the domain of the provincial governments. There were also some private medical schools, most of them in Calcutta. (Not surprisingly, most private schools were notorious for lax standards and for their profit-over-all-else approach, as briefly discussed by historian David Arnold in Colonizing the Body.)
To summarize what we have read until now: two different kinds of biomedical training institutes evolved in British India in the late 1800s — medical colleges and medical schools — and only the colleges trained “doctors”. There does not seem to be any predetermined, systematic intention of developing the institutes on these nominal lines: the difference in nomenclature seems to be an organic evolution.
The rise of the MBBS degree
In the first decade of the 1900s, another important development occurred: the universities decided to do away with their licentiate programs. The medical colleges thus no longer granted the LMS degrees. We saw above that among the universities, Bombay University used to grant only licentiates: so with the abolition of the licentiate, they needed to start a new degree. Since they anyway hadn’t been offering the M.B. like their peers, they could simply have adopted that degree and nomenclature. But the Bombay University broke new ground and introduced a totally new nomenclature: the M.B., B.S. (note the comma).
The M.B. was a familiar degree, and so was the B.S. (Bachelor of Surgery), especially in the U.K. So the Bombay University officials seem to have amalgamated these two Bachelor’s degrees to create this neologism. It is not clear, however, if they were inspired by any other place which also granted the MBBS around this time. To be sure, the neologism was not appreciated by everybody. Here is one senate member dissenting:
Thus, it seems that the present-day nomenclature for medical degrees in India (the M.B.B.S. and the M.S. degrees) owes much to the 1906 Bombay University senate.
The triumph of the “medical college”
Coming back to the medical school-medical college asymmetry. Prior to the 1910s, we had a state of affairs in which all medical students, both LMS and MB, were trained in a single institution: the university-affiliated medical college. They shared the same campus and learned from the same teachers even if there was a minor difference in the “status” of their degrees. They all carried the respectability of a major university degree when they graduated. A hierarchy did exist, but of subdued type.
However, post-1910s, a vastly different scenario developed. After the universities abolished the licentiate, this “lower” LMS degree shifted to many of the medical schools which previously used to train, as we saw above, the non-doctor healthcare personnel like apothecaries, hospital assistants, etc. So MBBS and LMS students now received training in wholly different institutions — the medical college and the medical school— and only the former were university degree-holders. The LMS doctors had to go to the schools which, not long ago, used to train apothecaries and hospital assistants. (I have not looked into what happened to the training of these personnel after this development.) The earlier subdued status gap between the two degrees widened into a deep chasm, and LMS education came to be scorned as one of “inferior quality”.
Later, when the All-India Medical Council (the latter-day MCI) was established in the 1930s, licentiate degree-holders were excluded from the proposed All-India Medical Register (but they continued to be listed in the provincial registers). To be sure, the licentiates were still considered doctors, but the Indian medical profession was now divided into these two large, unequal, often bitterly opposed groups of the licentiates and the “graduates”. (For some more on this division, see here.)
In short, when independence loomed for India on the not-so-distant horizon, the licentiate doctors and their “medical schools” had become a sort of unwanted baggage for the larger medical profession in India. Most elite doctors were advocating for what they termed a “uniform standard of education” for the whole country — that all doctors should have a single basic degree and that there should be no hierarchy therein.
The Medical Council of India (MCI) proposed, in the early 1940s, that provincial governments should gradually discontinue all medical schools or convert them into medical colleges. The 1946 Bhore Committee report also recommended the same. Thus, for example, the Byramjee Jeejeebhoy Medical College where I studied medicine in the late 2000s, was originally the Byramjee Jeejeebhoy Medical School, established around 1878. It became a college only in 1946.
Clearly, the new doctors of New India (this phrase was widely used in the 1940s-60s) were determined to erase all traces of the purportedly inferior “medical schools” from the country. It is a fascinating turn of history that in recent years, largely under the influence of Americanized English, the “school” has stealthily and steadily staged a comeback.
