History India South Asia · History of Medicine · Medicine & Doctors

The time when we had medical colleges as well as medical schools – and the etiology of the MBBS degree

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 are adopting that phrase in informal conversations and discussions to describe what officially are still ‘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 explanation 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 feel duty-bound, as a history researcher, to inform them (and others) 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.

Sassoon Hospital, Pune, c 1870 [Royal Collection Trust]
The story of this asymmetry begins in 1835 when two new institutions of ‘Western’ 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 ‘Western’ medicine 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 three medical colleges came under the administration of these universities, and began granting two separate degrees: the licentiate and the doctorate. The Bachelor’s degree was added in the ensuing decades. Thus, by the turn of the century, the four Government medical colleges in British India (one was established at Lahore in 1860) granted degrees as shown in the excerpt here:

[Above excerpt is from the report ‘Progress of Education in India 1897-1902, volume 1.’ See full-text here.]

The Madras Bachelor’s degree was abbreviated as M.B. and C.M. while the other Bachelor’s simply as M.B. 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 was considered ‘lower’ than the Bachelor’s, which of course was less fancy than the doctorate.

These four medical colleges were not, however, the only allopathic medical education institutes in India in the early 1900s. 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, related 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 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 motive, as mentioned by historian David Arnold in Colonizing the Body

To summarize what we have seen until now: two different kinds of medical training institutes evolved in British India in the 1800s – medical colleges and medical schools – and only the colleges trained ‘doctors’ (there is little clarity on what degrees were offered by the private medical schools). There does not seem to be any predetermined, systematic intention of developing the institutes on these lines – the difference in nomenclature seems to be an organic evolution. Below is another excerpt from the 1897-1902 report, which concisely describes these developments:

The members of the Subordinate Civil Medical Service are divided into two main classes, a higher grade of Assistant Surgeons and a lower grade of Hospital Assistants. Speaking generally, the Civil Assistant Surgeons are trained in the medical colleges, and the Civil Hospital Assistants in the medical schools. Another function of the colleges and schools is to train subordinate medical officers, also styled Assistant Surgeons and Hospital Assistants, for the military service.

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 Univ 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. However, had the Bombay University followed the set routine, India’s future medical culture would surely have been less colorful, and a certain 2003 movie would have been titled a bland Munnabhai M.B. But the Bombay Univ broke new ground, and coined a totally new degree: the… drumroll… M.B.,B.S.!! (Note the comma.)

[Above extract is from the 1906 Bombay University Calendar. See full-text here.]

The M.B. was a familiar degree, and so was the B.S. (Bachelor of Surgery), especially in the U.K. So the Bombay Univ folks 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 (we’ll need more research to resolve this conundrum). To be sure, the neologism was not appreciated by everybody. Here is one senate member dissenting (in a clearly gendered language):

Thus, it seems that the contemporary nomenclature for medical degrees in India (the M.B.B.S. and the M.S. degrees) owes much to the 1906 Bombay University senate.

Coming back to the medical school medical college asymmetry, what happened after the universities abolished the licentiate is that the 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. So prior to 1910, we have a scenario wherein medical students, both LMS and MB, are trained in a single institution, the university-affiliated medical college; they share the same campus and learn from the same teachers even if there is a nominal difference in the ‘status’ of their degrees. They all carry the respectability of a major university degree when they graduate. A hierarchy does exist, but of a more subdued type. In fact since the Grant Medical College used to offer only the licentiate, it must be noted that almost all allopathic doctors in western India – including famous ones like Bhau Daji Lad – were licentiates.

However, post-1910, a vastly different scenario developed. LMS and MBBS students now received training in wholly different institutions, – the medical school and the medical college – and only the latter were considered university degree-holders. The LMS doctors had to go to the schools which, not long ago, actually used to train apothecaries and hospital assistants. (I have not looked into what happened to the training of these personnel after this development.) The status gap between the two degrees widened into a deep chasm, and the ‘lower grade’ 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 even 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 categories of the licentiates and the ‘graduates’. (For some more on this division, see here the EPW article by Meenakshi Gautham and KM Shyamprasad.)

In short, when independence loomed in the not-so-distant horizon, the licentiate doctors and their ‘medical schools’ had become 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 MCI proposed, in the early 1940s, that provincial governments should gradually abolish all medical schools and 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, was originally the Byramjee Jeejeebhoy Medical School, established around 1878. It became a college only in 1946.

Clearly, the new doctors of New India (like most rehashed things of recent years, even ‘New India’ is not a new phrase at all: it 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 Americanised English, the ‘school’ has stealthily and steadily staged a comeback.

What I narrated above is more like a bare-bones historical trajectory with little analysis. The analysis would include a far detailed, nuanced exploration of many of the questions that arise: Why did the universities abolish the licentiate, and were there any dissenters then? What was happening with the indigenous medical systems and traditions around this time? How did the British notions of racial superiority influence the development of medicine and public health (note the use of the term ‘subordinate’ medical service above)? What were the social backgrounds of the students at the medical schools as compared to the medical colleges, and how did the inherent Indian inequalities in the form of caste and class reflect here? How common was it for women to study medicine, and how easy or hard was it for them to enter medical college? If the leaders of the medical profession thought that abolishing the licentiate was necessary for erasing hierarchy among doctors, how do we then explain all the hierarchies and asymmetries that have developed in the post-independence period? Were there dissenters around 1947 who opposed the closing down of the medical schools? I am investigating and dealing with some of these questions, and many others, in my PhD dissertation, which looks at the evolution of the biomedical profession and its relationship with the public in the post-1947 period.

For more on the rise of ‘modern medicine’ in India, see my Wire article here.

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