The Transition – From the CMC to the Medical College and Hospitals (MCH)

It is pertinent to enquire about the status and achievements of the students of the CMC who made their first education sojourn from India to England. Dr. Goodeve sent details about those students’ advancements.1 From his report we come to know of their excellent distinctions achieved by them.2

Moreover, Bholanath was then “busily preparing for the final examination for the degree of M.B. at the London University in November, and he continues, in addition to his professional occupations, to pursue with great assiduity and advantage the study of Latin, a knowledge of this language being not only required in the examination in question, but much coveted by the young man himself.”3 Also, “Bholonath Bose and Gopal Chandra Seal on the first of this month, presented themselves for their first examination for the M.B. degree at the London University, for which they have been most assiduously preparing since my last report. The result of this examination has been very satisfactory. Both are placed in the first division.”4

Lord Brougham in his public address on the occasion of distributing the prizes at the University College on the 30^th April, 1847, observed that “the three Indian students have this year obtained nine honourable marks of distinction, independent of the Gold Medal gained by Bholanath Bose … but with two exceptions (British students) amongst more than two hundred pupils no one gained distinctions in so many departments of their professional studies”5. Mel Gorman rightly said, “The British had invaded and conquered India politically and geographically, but now the Indians had done so in England academically.”6

Further about their achievements, “Soorjee … will present himself for the first examination for the degree of M.B. in August … as well as for the Diploma of the College of Surgeons … In the vacation, after the examination for his degree, he proposes once more to accompany his friend, Dr. Grant, to the continent to pursue the study of Natural History in Germany.”7 Mr. Liton, the Deanof the Faculty of Medicine, University College, London, reported – “I have such pleasure in stating the conduct of and attention of Gopal Chandra Seal, Bholanath Bose, and Soojo G. Chuckerbutty have been very satisfactory during the last six months of their attendance on the classes of the College.”8

(Four Indian medical students in London. L to R – Bholanath Bose, Gopal Chunder Seal, Dwarkanath Bose, Soorjee Coomer Chuckerbutty – Wikimedia Commons)

Since passing the degree of M.B. examination from the University College, Bholanath was permitted to pass the higher degree of M.D. This favour was accorded to him by the Senate of the London University.9 Goodeve’s report said – “These young men are now Members of the Royal College of Surgeons of England, both Bachelors, and one of them Doctor of Medicine of the London University, the highest professional degree which can be procured in Europe. They have obtained these distinctions not by favour or indulgence, but by severe labor, and by submission to the rigid tests of proficiency … Soorjo Coomar Chuckerbutty … was placed in the first division, and subsequently obtained certificates of distinction in the examination for honors.”10 In his upcoming continental tour, Chuckerbutty was supposed to visit “in his route Berlin, Prague, Breslaw, Munich, Frankfort, Bonn, the Hague, Leyden, Amsterdam and more, with a purpose to visit museums in those places.11 Soorjo was about to embrace Christianity and was not prepared to return. His studies were until then were unfinished on account of his age. Moreover, he was completely European in his habits and ideas that “that he could be safely trusted to the exercise of his own discretion and self-management, during the remainder of his stay in Europe.”12

Revisiting the Impact and Significance of Hospital Medicine

Waddington characterizes an aspect of the impact of modern hospitals – “Equally important – and this is a point which has escaped the notice of medical historians – was the fact that it was within the hospital that new type of doctor-patient relationship emerged.”13

To remember that the Parisian hospitals developed in the first quarter of the 19^th century (unlike most of the English medical schools for anatomical teaching) were controlled by the government, which employed clinicians to attend patients and to teach, and, thus, “fostered the access of instructors and students to the bodies of living patients and their remains after death. By contrast, the London hospitals were private charitable institutions with lay boards of governors that vested medical control in a small number of socially elite physicians and surgeons.”14 Joan Lane reminds us that the changes in hospitals in the nineteenth century were in important areas like medical teaching, and the whole profession expanded as never before. The acute sick came to “outnumber the long-term chronic patients…the hospitals became more ‘medicalised’…”15

The French experience of the rise of hospital medicine heralded the closing hour of medical medievalism. It was no longer possible to practice without examination. “Surgeons, used to extirpating the lesions of the disease, and physicians, used to administering systemic medicaments, all suddenly now needed a blanket system that could unite heretofore disparate perspectives on the ‘seats and causes of disease’.”16

It is substantiated by the following observations – “The patients were poor, less articulate, less troublesome, and it was much easier to carry out research on them (especially statistically based research which required large numbers in one place – the hospital). Moreover, the advantage of the poor was that the large numbers of post-mortems that were carried out would elicit no complaints from influential families.17 All these observations are a definite pointer to a social condition where economic changes are going, forcing people to become penniless and uprooted.

By the 1780s, the patient’s narrative was no longer the focus of inquiry in the infirmary. Indeed, the patient himself was reduced to ‘a dull contented country lad’ with a bladder stone, or ‘Mary Townsend, aged thirty years, of a dark complexion, disagreeable Mulatto features and emaciated form’ who had supposedly ‘led a very dissipated life’. Neither person described thus would have been granted interpretative authority over their illness equal to that of the doctor. Their poverty and dependency was read from their physical features (notice how Mary Townsend’s ‘disagreeable’ features served to support the contention of dissipation) and made them unreliable witnesses.18

Hospital medicine is recent scholarships is an accepted paradigm, especially in Western scholarship, to differentiate the new medicine, intimately related to socio-economic changes during the late-eighteenth and early-nineteenth centuries in Europe. Following Ackerknecht, the three pillars of the new medicine (that is, hospital medicine) – physical examination, autopsy and statistics – as we have already discussed, could only be developed in the hospitals. Jacyna comments, “Ackerknecht offered a classification of the major stages in the history of Western medicine that proved to be remarkably influential.”19

It gained further momentum after the publication of Jewson’s now classic paper “The Disappearance of the Sick-man from Medical Cosmology, 1770–1870”.20 Jewson, among others, stressed on four specific issues—(a) medical cosmology characteristic of Western European societies during the period 1770–1870; (b) the universe of discourse of medical theory changing from that of integrated conception of the whole body to that of a network of bonds between microscopic particles; (c) social production of knowledge—raw material of production; and (d) a “collegiate” system of educational control emerging within the community of medical investigators. In his commentary on Jewson’s paper, Pickstone stressed that it may be profitable to think of a historical and analytical shift from a series-model of successive types of medicine (bedside to hospital to laboratory to, now, techno-medicine) to a model of co-existence and inter-penetration of types where novel forms co-exist with the old one in contested cumulations.21

Somewhat similar to the American scenario,22 anatomical or pathological signs became an expression of modernity. In India, during the mid-nineteenth century, British doctors derived their claims to scientific objectivity and authority largely from their studies of morbid anatomy and their attempts to relate the state of diseased internal organs examined after death to the symptoms manifested externally during life.23

To put it simply, the mode of production of medical knowledge began to change. Jewson has pointed to fact that perhaps the most striking feature of 18^th century pathology was the general lack agreement about the causes of illness and the effectiveness of therapies. Medical knowledge consisted of chaotic diversity of school of thought, each strenuously seeking ascendency over the others. Physicians, surgeons, and apothecaries each had distinctive patterns. Physicians were the most powerful, prestigious and wealthy of the three, and constituted a tiny elite among practitioners.24

In the first quarter of the 19^th century, all these distinctions and different modes of production of medical knowledge were effaced to produce the ‘new’ doctor who was physician, surgeon, and apothecary at the same time. We have already come to know of it in the evolving structure of medical teaching at the CMC. Now the primary site of production of medical knowledge was autopsy, almost always of the destitute and poor bodies, findings at laboratory, and pathological knowledge gained from the microscope.

The bedside in hospital itself becomes a site of data-collection. Application of measurement or numbers to medicine, as Trohler argues, may be seen under three broad headings – (a) “statistical quantification” or measurements made in relation to a single individual or place, (b) “medical statistics’ or measurements or numerical statements relating to small groups of individual, and (c) ‘vital statistics” or measurements or numerical statements relating to large groups of individuals or even to a population as a whole.25 ‘The body is sampled, invaded, measured and inspected, in order to yield images and information’ and it is “dispersed through multiple sites of investigation throughout this organizational complexities.”26

The medical encounter began to demand that patients reveal the secrets of their bodies, both by allowing physical examination and by giving their medical history under questioning by the doctor.

In Indian medical culture, revealing one’s body to the examination of an alien person was unprecedented. With this new vision of hospital medicine, there emerged an altogether novel thread, which bound culture, the hospital, society, and the notion of profession inextricably together. The body rather than the discursive patient was becoming the real object of medicine.

Pickstone tersely comments, “The hospitals of England experienced no revolutionary change, but here too the new attitudes took root.”27 He also notes that the health crisis of 1831-32 coincided with the political crisis over electoral reform.28 We shall shortly see that this was true for India, especially in the foundation of the CMC. Following Maulitz, “For the first time in modern Europe, there was a context, a set of structures and arrangements centered on the existence of a newly ecumenical faculty, within which a new theoretical canon could flourish. Under such circumstances, pathological anatomy could expand beyond a small elite and become a project, an enterprise with real practical and professional implications.”29

Somewhat similar changes were taking place in Bengal, and in India, during the first three decades of the 19^th century. But, unlike Europe, it was never like politically free and economically market-driven states of Europe. Rather the changes happening here were engrafted to a great extent. In the Indian context, four basic changes principally augured the beginning of the new medicine: (a) a conceptual change of the two-dimensional bodily image to the three-dimensional one; (b) the treatment of the patient in a hospital setting, not in his/her domestic environs; (c) touching and measuring the patient’s body with the stethoscope, thermometer or by other techniques; and (d) a transition to a new type of “modern” identity, that is, from the socially embedded individual to “case number” in a hospital.

In my analysis, the CMC represents an admixture of the secular and advanced methods of medical teaching adopted at the University College London (UCL) along with Parisian and German medical teaching to an extent, medical and surgical practices of the Company’s surgeons and the discriminatory nature of colonial practice on the one hand and; on the other, the transition from military medical training to modern medical education in India. Since the period of the foundation of the CMC, the structure of medical education in India, like European medical schools, acquired the ability to control “its own education and training followed by examination, certification and registration”.30 Though registration was a later development, graduates from the CMC initiated modern professionalism.

Reorganization of the CMC and the Persistence of ‘Miasma’

We have already seen in a detailed way how great curricular changes were made to operate in the CMC in concurrence with the University College, London and the Royal Society of Surgeons, England. Consequently, the CMC was recognized by these institutions of international repute. But disease perception was not at par with these superstructural changes, as we may call it.

It was observed that the only institutions existing in Calcutta and its vicinity, for the treatment of the diseases to which Natives, as well as Europeans, are subject, are the General Hospital, the Native Hospital, the Police Hospital, the Leper Asylum, the Male and Female Hospitals attached to the Medical College, and the Dispensaries, situated in various parts of the city and its suburbs. In none of these, however, is special provision made for the in-door treatment of Fevers of various kinds occurring among natives; and with the exception of the Police Hospital, cases of Smallpox and all contagious diseases are carefully excluded. More elaborately speaking –

The average amount of sickness existing in Calcutta at all times and from every cause, in a fixed and floating population, which has been estimated at 3,00,000 persons, is 18,000, and of these at least one-fifth, or about 3,000 persons die before the end of each year from acute attacks of Fever, or its numerous dangerous and fatal sequelae, without adequate shelter, clothing, food, or medicine of any description. Among the causes of this large amount of sickness, may be enumerated the improper unwholesome diet of the natives generally, their scanty clothing, exposure to the sudden alternations of climate incidental to the country, sleeping in damp, confined, ill-ventilated huts, for the most part without any other protection from immediate contact with the soil, than a bed of mats or leaves, and exposure to the noxious exhalations, surrounding them on every side from rank, decayed, luxuriant vegetation, putrefying animal matters, the poisonous, mephytic gases issuing from sewers, wells, cesspools, foul drains, and burial grounds, and the malaria and misamata ever present, and ever active in the work of destruction. The more dense and crowded the neighbourhood, and the more indigent its inhabitants – the greater is the intensity of disease, and the more fatal its results.31

Some important facts are observed in this part of the report – (1) from medical point of view ‘fever’ is a overarching category without its subsets, (2) about 3000 persons die each year, perhaps to provide plentiful dead bodies on the dissection table of the CMC, (3) the conspicuous mention of ‘miasmatic’ theory was still present, and (4) primary places of treatment of the population of Calcutta, both Europeans and Indians, were General Hospital, the Native Hospital, the Police Hospital, the Leper Asylum, the Male and Female Hospitals attached to the Medical College, and the Dispensaries. The trace of miasmatic theory denotes that even after the advanced teaching practices pursued in the College and acceptance of the ‘organ localization of disease’, both theories overlap each other. It was further reported in the report signifying that the CMC was at the time not capable enough to provide treatment a large section of Calcutta population –

It has been estimated upon accurate data and from the evidence of some of the most gifted members of the Medical Profession in India, that a small Hospital, containing only 200 beds, would be capable of receiving and discharging 600 patients labouring under acute forms of Fever every month, or 7,200 patients in the year. If the Hospital should contain 300 beds – and a smaller one would be quite inadequate to the demands for assistance – the number relieved in a month would be 900, or in a year 10,800, a small proportion of the sick, but “a large number of persons to be annually rescued from the certainty of death, and placed where each is within a reasonable hope of recovering, and where it is certain that the great majority will recover.”32

In the 1845-46 report new structure of classes and subjects taught are given below.33

In the report of 1845-46 session, to reiterate, it was reported – “Among the most gratifying, striking and important events of the session which has recently closed, has been the recognition of the Bengal Medical College by the Royal College of Surgeons of England, the University of London, and Worshipful Society of Apothecaries.”34 Moreover, this was “the first instance of any of the educational institution of British India being granted the privilege of preparing pupils for the academic and professional rewards of the corporate and chartered bodies of England.”35

Regarding achievements of the students of the CMC in England it was eloquently reported – “Bholanath Bose was third on the list (of botanical examination), in a class of more than seventy students. He only failed in obtaining the silver medal by two marks, his number being eighty-eight, and that of his successful rival ninety…”36 Further, “Gopal Chundra Seal, from the proficiency in practical anatomy, has been asked by Professor Quain to dissect the subjects for his lectures – a post of considerable honor in the anatomical class.”37 There was nothing much to say about Dwarakanth Bose. Sooraj Coomar accompanied Dr. Grant for continental tour for six weeks for further knowledge, as discussed before. He learned French during that time.38

Another part of this report reads – “Among the occurrences deemed worthy of notice and record was the volunteering of some of the senior native, Ceylon, and free Christian students to proceed on service to the army of Sutlej. Upon any terms and in capacity the Government might wish … to render themselves useful…”39 As I have often drawn attention to the colonial project of producing disciplined, docile and obedient ‘citizenry’ in the CMC, is quite visible regarding participation in military expedition to the Sutlej. To note, before their first sojourn to England, “An eligible opportunity of effecting as great and desirable a triumph, was unfortunately lost, during the China campaign, when three Sub-Assistant Surgeons volunteered to take charge of transport, filled with camp followers.”40

In 1844, the Rules and Regulations of the Medical College, Bengal, were first codified into a book. In 1849, it was further modified and set into practice. From this book we come to know about different kinds of examination in details. For the English Class, the examinations were of 3 kinds – (1) “General Examination to test progress”, (2) “Pass or Diploma Examination”, and (3) “Examination for Honors”. The general examination was for “students of the first, third, and fourth years, those of the second and fifth years being engaged in Pass or Diploma Examinations.” 41 Moreover, “In addition to the above, in the class of Anatomy, there shall be a practical Examination in the Dissecting Room which shall precede the Examinations in other subjects.”42 Again the examination “shall be partly written, and partly practical in the three subjects.”43 Regarding “Medical Hospital”, the hospital was divided between the professors of surgery and medicine. It consisted if three wards capable of accommodating 112 beds. Two were allotted for “native medical and surgical cases’ and the third one “for the European patients”.44 The professor of medicine “shall have at least six Clinical Clerks, four natives, and two European students. These shall be chosen from the rotation of the students. The appointment shall be held for two months by each, and during this period all the Native and European patients are to be divided as equally as possible among them.”45 “Dressers” in surgery department were equivalent to clinical clerks in medicine, assigned to different kinds of hospital job.

Finally, the circuit of ‘hospital medicine’ was completed.46

We can understand the model of the new French clinical medicine, later adopted in other countries including England, in this description. Another important issue was the transformation of a ‘social person’ to a ‘case number’ in hospital beds – without any identity of personhood. “Enter and you will find East Indians and West Indians, Bengalees and Madrasees, Armenians and Jews, Parsees and Burmese, and even John Chinamen! These creatures wear the same clothes; same beds and beddings as the Europeans; and as soon as they don the clothes they are ycelpt Sahibs! 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” – i.e., number nine gentlemen…”47

From the Rules 1849, we come learn that there are three divisions in the course of chemistry: (1) ‘Inorganic Chemistry’, (2) ‘The Imponderables’, and (3) ‘Organic Chemistry’. “The course of Chemistry shall consist of not less than seventy lectures. It denotes that chemistry was counted as a major subject. But, on deeper scrutiny, it reveals that under all the subheadings of chemistry – inorganic, the imponderables, and organic chemistry – not an iota of laboratory activities were included.48 More interestingly, when the 4 students of the CMC went to University College, London, they studied under Dr. Thomas who is regarded as the father of colloid chemistry. In the laboratory of the UCL, he did his pioneering work in dialysis and the diffusion of gases. But even studying in the UCL did not affect or influence any kind of fundamental laboratory researches in colonial setting.

This fact is further substantiated by a personal letter from Graham to S. G. Chuckerbutty.49

In the academic session 1846-47, a new ‘Ophthalmic Hospital’ was attached to the CMC. But “in which no practical means at present exist of teaching the pupils the nature and treatment of a class of diseases most abundant and destructive in all parts of India”.50 Besides this, attention was drawn to higher authorities by College Council – “In the first place there is no accommodation within the college compound for lodging any more pupils, and it has already been mentioned in the public reports of the Institution, and is coincided in both by the Medical Board and the College Council, that the students must at once be placed under the immediate personal supervision of the resident authorities, and be subjected to the strictest discipline.”51 It signifies that there was growing need of ‘residential education’ to keep students within the College compound under the gaze of resident authorities. Moreover, virtually though they were in general education, it seems that they are put under some revised military discipline suited to civilian purposes.

In his third report Dr. Williams of UCL  Bholanath Bose and Soorjo Coomar were  highly applauded – “In the competition at the close of the summer term the gold medal which is the first prize in the science class of Botany, was gained by Bholonath Bose, and the fifth certificate by Siirnj Coomar Chuckerbutty. In this class there was, as usual, much competition … Gopal is performing the duties of a Clinical Clerkship under me with great punctuality and intelligence, and already shews much knowledge of disease in the manner in which he reports the eases of the patients … Gopal Chudra Seal obtained high certificates in Practice of Medicine and in Physiology … Dwarakanth Bose obtained a certificate in Midwifery.”52 During the vacation Soorjee again accompanied his kind friend Professor Grant to the continent. They went on this occasion by way of Belgium up the Rhine to Mayene, and thence across through Frankfort and Leipzig to Berlin.

In August, 1846, Mr. H. Piddington, Coroner of Calcutta, proposed that two pupils of the Class of Medical Jurisprudence should attend the Police Surgeon in rotation, to assist him in making judicial post mortem examinations at the Medical College; and also that preparations taken from all medico-legal cases of interest, should be preserved for the Museum of the College. Mr. Piddington’s proposal was approved of, and the best thanks of the Council were returned to him, and to Mr. Maxton, the Police Surgeon, for their desire to advance the interests of the College. Many cases of high scientific interest occur, which will enable the pupils to acquire a valuable fund of experience in such matters, and teach them the proper manner of conducting judicial post mortem examinations in criminal cases.53

Moreover, the interaction between demography around the College and expansion of the College is contained in this report.

The position of the College itself, although centrical and per se well situated, is very ineligible for such an Institution, it being closely surrounded by densely peopled, dirty, ill-drained bazars in every direction, and the ground in its immediate vicinity being so expensive, (rupees 500 a cottah) as to render it difficult to extend the premises to the extent required by its increased and increasing growth and importance. There are nearly 125 students residing within the compound who have no place of recreation within the walls, or nearer than the maidan at the end of the Chowringhee road. A gymnasium, so essential for their health, and so useful in encouraging a manly and rational spirit of rivalry and enjoyment between all classes of students, was sanctioned by Government some time since, but the Council have been unable to find a local habitation for it.54

It was further mentioned – “As this is the only College in India where native students are subjected to the in-door training and discipline considered of so much importance in Europe, the Council are of opinion that its efficiency would be much increased by the means being afforded to the pupils of acquiring a taste for the moral and manly amusements of Europe, instead of the low vices and disreputable habits of the great bulk of the native community.”55 It seems that the College authorities were zealous to create an environment like a laboratory inside the College campus – ‘noise free’ as well as ‘pollutant free’, supposedly molded in ‘Indianized’ European manners and free from morally polluting native environment.

Everyone can find a purely racial tone in this description. Metcalf precisely explains – “The hierarchical ordering of societies on a ‘scale of civilization’ reflected not just the classifying enthusiasms of the Enlightenment, but was a way to reassure the British that they themselves occupied a secure position, as the arbiter of its values, on the topmost rung.”56 Metcalf further notes – “However India’s attraction made itself felt, the tensions it generated – between mastery and submission, denial and desire, an insistence upon difference and the perception of sameness – could not easily be reconciled.”57 Racial question even in a secular field like medicine was basically an irreconcilable issue, manifested time and again.

Below is a map around the CMC sometime in the late 1840s.

To keep the students in a ‘noise free’ as well as ‘pollutant free’ environment akin to laboratory was further elaborated,

The Native Medical Student in his own home, is exposed to every influence resulting from ignorance, superstition, the prejudices of caste, and similar means of weakening the effects of the intellectual and moral training which he is undergoing in our schools and colleges. His friends and relations are for the most part incapable of aiding or sympathizing with him in his scholastic pursuits, their conversation, manners, and morals are not such as are likely to improve or elevate him in the social scale, his books and studies are therefore laid aside until he can resume them under less unfavourable circumstance, and in the more congenial society of his fellow students.58

Hence it was emphasized,

The whole system of Education in India will necessarily be incomplete, until pupils are brought under the internal control and management considered so essential in Europe, to form the habits, improve the morals, and give a tone to the manners of youth at an age when impressions produce a lasting effect, and exert a beneficial or prejudicial influence upon the future career of the individual, in proportion to the good or evil training to which he may have been subjected. This is considered one of the most essential and important features in the normal training of teachers in the schools of Germany, Holland, Switzerland, France, and now, although to a more limited extent, of Great Britain.59

The British generally perceived their colonial subjects as childlike, needing guidance in their every step of how to behave properly. On a closer look, it appears that the issue of ‘pollution/dirt/excrement’ became a subject of crucial importance to differentiate between ‘civilized’ and ‘non-civilized’ population. From the experience of Philippines we come to know – “The ‘civilizing process’ in the Philippines depended on the medical production and filling of a closed, colonial space – the reproduction of “abstract space. Each society produces its own space. Abstract space … is the reductionist space of the grid and the map, hierarchical and segregated. It emphasizes the primacy of the visual”60. And, as a result, “The colonizing process must therefore be a “civilizing” process. Americans at all levels of colonial society (but especially women and public health officers) set out to train childlike Filipinos in the correct techniques of the body, “under the watchword of civilité,” rationalized as hygiene. The medical reformulation and reinforcement of the conventional sense of disgust permeated American social life in the Philippines.”61

Foucault explains, there are two series – “the body-organism-discipline-institutions series, and the population-biological processes-regulatory mechanisms-State. An organic institutional set, or the organo-discipline of the institution, if you like, and, on the other hand, a biological and Statist set, or bioregulation by the State.”62 Further, Foucault reminds us – “Medicine is a power-knowledge that can be applied to both the body and the population, both the organism and biological processes, and it will therefore have both disciplinary effects and regulatory effects.”63 So, keeping students of the College within the campus under constant surveillance was meant to “have both disciplinary effects and regulatory effects.”

In India’s context, Pande observes – “A general fear of contagion and corruption, of biological and moral degeneration, thus became materialized in the form of filth. Filth, as scholars have suggested, is essentially a term of condemnation, which instantly repudiates a threatening thing, person, or idea, by ascribing alterity to it. In the course of the nineteenth century, filth emerged as a powerful marker of national and racial distinctions … As imperial identity and the imperial vision became transformed over time, the city was imagined in new and different ways, and the city plans reflected new concepts of empire and selfhood.”64

Hence, as there were separate geographical spaces for the British (white town) and Indians within Calcutta itself, so there was an attempt to build a ‘microcosmic’ space in mimicry of the British space inside the campus of the CMC for Indian students. “As a ramification of the British rulers’ vision of India, the local people and the land are prepared to accept orders set by the colonial authority.”65

In his letter to the editor, Lancet, Goodeve wrote – “The successful result of the experiment upon the advantages of Indian civilization, of educating young Hindoos in England, must be gratifying in the extreme to all who are interested in the welfare of our possessions in the East. ”66 Further, “The most important blow which has yet been struck at the root of native prejudices and superstition, was accomplished by establishment of the Medical College of Calcutta, and the introduction of practical anatomy as a part of the professional education of Brahmins and Rajpoots … medical students alone were found sufficiently enlightened and enterprising to encounter the imaginary dangers of such an undertaking, and to brave the real hardships of permanently sacrificing in the cause all the social and domestic relations of life.”67

Truly speaking, tropical colonies became laboratories of modern governmentality.

Use of Ether and Chloroform at CMC

Importantly, ether anaesthesia was applied in CMC on 22 March, 1847 and chloroform anaesthesia in successful surgical procedures on 12 January, 1848 – just a few months after their discovery and application in US and England respectively.68 In Boston, ether was applied on 16 October, 1846 and chloroform was applied in London on 7 November, 1847 by James Young Simpson. More interestingly, professor of medicine J. Jackson wrote a letter to Simpson on February 7, 1849, describing “the administration of chloroform in a case of severe pain.” the administration of chloroform in a case of severe pain.”69

Duncan Stewart, professor of medicine of CMC of that period, wrote to the secretary of the College F. J. Mouat – “I must not omit to mention in this place the successful introduction into our practice of the new anaesthetic agents, ether and chloroform; the latter of which was employed in two cases of operative procedure with perfect safety and success in the presence of the professors, and a number of students. The details of these cases as being more suited to a professional journal than to this report, I have given for publication to Dr. Edlin in his Register of Indian Medical Science.”70

Some other issues of importance were also described in the report of 1847-48. During the initial period of expansion of dispensaries almost throughout India dispensaries were all manned by graduates of CMC – barring a few. The report sheds light on provincial detestations regarding a kind of ‘Bengali colonization’ of different parts of India,

The Council is fully aware that some of the Sub-Assistant Surgeons, natives of Bengal, have not proved quite so successful in the North West, as their contemporaries who are employed in their own province; but this result they submit is due to the peculiar genius, and strong local attachments of the Bengali – the growth of centuries – which can scarcely be overcome in the course of a few years, and for which no system of education, until it has acted upon several successive generations, can fairly be held accountable.71

It was further noted in the report – “Those who are aware of the strong feelings of contempt and dislike entertained for Bengal and its inhabitants, by most of the natives of other parts of Hindustan, will readily understand how very slowly confidence, always a plant of slow growth in novel circumstances, is likely to be generated in the skill and ability of the passed students of the College.”72

Way back in the late 1840s, about 200 years ago, there still existed “strong feelings of contempt and dislike entertained for Bengal and its inhabitants”, which even now very much visible. Thus digging into the history of CMC brings out different kinds of social, psychological, economic, and political, and, obviously, colonial academic history of India. It is quite a fascinating layered-history to traverse through.

The Question of Fever Hospital and MCH

In the report of 1847-48 the establishment of Fever Hospital (then it was termed thus) with all its costs and other details were discussed.73 It was further emphasized by the College Council that “The third and final report of the Fever Hospital Committee, with the detailed documents appended to it, exhibit in such strong and forcible terms the advantages that would result to the public generally from the building of the Fever Hospital in connection with the Medical College, in addition to its importance in regard to that Institution itself”.74

But, initially, there was also apprehension regarding the establishment of a Fever Hospital within the campus of the College itself. In his evidence before the First Committee Dr. A. R. Jackson stressed – “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.”75

Another interesting report can be cited here – “On the 5th December 1849, a letter was received from the Secretary Council of Education Calcutta, stating that the two youths, who had been studying at the Medical College, (as mentioned in last year’s printed Report), had absconded, and that every attempt at tracing them had proved unsuccessful. Dr. Mouat supposed that their dread of the practical duties of the Dissecting Room, and their dislike of the Bengal climate, had been the true reasons of their sudden departure.”76

Duncan Stewart, professor of midwifery of the College, while sending his “Report of the Obstetric practice of the Medical College, Female Hospital, from 1^st March 1847 to 1^st March 1848” to the College Secretary F. J. Mouat, noted –

it is within my knowledge that all of our college graduates, (six or more in number,) now settled and practicing in Calcutta, are habitually called to take charge of the women of the families they attend during their confinements, and that though not required to render manual assistance, except in cases of difficulty, they are always requested to undertake the medical management of every case, both during and after delivery; under this silent influence the old abominable practice of the Hindoos, that of shutting up the parturient females for 40 days in some filthy out-house, enveloped in the fumes of charcoal, and drenched with heating tisanes, is entirely abandoned by all the respectable Natives in Calcutta.77

Quite evident from this part of letter that (1) CMC graduates had done a kind of ‘social revolution’ by breaking the traditional unscientific mode of home delivery, (2) they had attained the authority to enter into the inside of the ‘andar mahal’ of orthodox Hindu families of higher echelons, (3) for the first time in the history Bengali social custom male doctors took charge of delivery, and, finally, (4) they were in control of “both during and after delivery; under this silent influence the old abominable practice of the Hindoos”. Gradually, social barriers began to be erased bit by bit, giving way to new ways of governmentality of the new state. Doctors, especially from the CMC, were faithful agents of this silent transformation.

GRPI 1848-49

In this session the foundation stone of the Medical College Hospital was laid in 1848.78

As Gopal Chandra Seal, Resident Surgeon of the Female and Lying-in Hospital, joined army for the Punjab campaign, he was replaced by the Goodeve Scholar Nobin Chandra Bose.79

Dissections: In November 1848 – l08, December – 129, January 1849 – 131, February – 112, March – 85. Total, 565

Number of bodies dissected, 220*,

Used for operations, 91,

Number bodies of which no use was made, in consequence of rapid putrefaction, 254.

Total … 565. 80

Footnote* mentioned – “In the last year’s report, the number of bodies dissected is stated to have been 500: that being the number actually brought to the College. It ought to have been explained, that the number made use of for operations, and those rejected on account of rapid decomposition lust year, should have been deducted from the total amount received, namely 500. The remainder would have given the correct number actually dissected.” It is quite painful to note that the number of bodies (254) of no use was greater than the number of bodies dissected (220) properly. Poor, destitute, hapless and helpless Indians were the source of abundant supply of bodies in excess of actual need. This is another layer of the history colonial medical education in India.

The report specifically mentioned – “The money for building this Hospital was raised partly by public Subscriptions through the Municipal and Fever Hospital Committee and the Council of Education, which produced Rupees 1,03,000. A further sum of Co.’s Rs.1,07,000 was contributed to this purpose, of which 50,000 was a munificent donation for the benefit of the City by Rajah Pertab Chunder Singh, and the remainder was the balance of a sum of money raised by Lottery for the improvement of Calcutta. Part of the ground on which it stands, of the value of Rs.12,000, was generously given by Baboo Mutty Lol Seal.”81 Moreover, many difficulties, connected with the purchase of the additional ground required, had also been overcome. In excavating the ground for the foundation, the greater part of the western end (possibly the site of the present B. C. Roy Annexe) was found to be the site of an old tank, from which a large quantity of loose rubbish had to be removed. In addition to this, the ground itself was so soft and yielding as to render piling, with a great amount of extra masonry, necessary.

Additionally, “It was also determined to name Wards after distinguished benefactors, and donors of sums of ten thousand rupees and upwards ; and, among the names suggested, were those of Sir John Grant, Mr. J. R. Martin, Pertab Chunder Singh, Suttochurn Ghosal, and Muttyloll Seal.”82 In this session, four students were also expelled from the College – “In July, it was ascertained that four of them were incompetent to follow out the course of instruction from defective education; they were accordingly removed from the Institution, and placed at the disposal of His Excellency the Commander-in-Chief.” 83

“In the class of Anatomy and Physiology 140 lectures have been given. In that division of the course which treats of General Anatomy, the tissues and structures which cannot be seen with the naked eye, were demonstrated by the aid of the microscope, and the whole course was illustrated by the use of diagrams.”84 This is the first time we find the mention of the use of the microscope for teaching purposes. Regarding “Midwifery Class and Lying-in Hospital” – “The deliveries are 4 more than in the last year’s report, and nearly double the number in the first two years after the establishment of the Institution in 1842.”85 59 deliveries were done of whom 55 recovered and 4 died. It was satisfactory to record “that none of the women, who throughout their whole labor were treated in the Hospital, suffered in any way during parturition. They were all delivered rapidly, without assistance, and speedily recovered, except the cases above mentioned, whose deaths are otherwise accounted for.”86

Furthermore,

Although anaesthetic agents were not employed in the natural cases generally, they were occasionally used with marked advantage, and all those cases which required manual assistance to promote delivery, were treated under their influence. Chloroform was the medicine used in every instance except one, in which Ether was given, because none of the former fluid was at hand. On all these occasions the patients were delivered without consciousness, and in none was the slightest bad symptom perceptible as the result of the hypnotic agent. On the contrary, the mortality in the cases operated upon under their influence was unusually and remarkably small.87

Though race became a question in some important issues, it must be stressed that caste, class or social status did not hold any importance in the class room of the College. The merit of the student was the only yardstick to assess. “Mere seniority will, in no instance, constitute in itself a claim to promotion, and it is distinctly to be understood that high attainments “whether the result of eminent talent or of laborious industry)” persevered in for a reasonable time, will give such claim at any time intermediate to the septennial periods”88

At the beginning of the report of 1849-50 session, it was mentioned – “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.”89

What was most intriguing part of the report that there was proposal under “Proposed Comparison of the proficiency of the Pupils of the Medical Schools of Bengal, Madras and Bombay”.90 Further, it was elaborated –

In April last, the Honorable President of the Council of Education suggested that it would be desirable to profit by Dr. Mouat’s s visit to Madras to attempt to institute a comparison of the proficiency of the medical students at the two Presidencies, by tests to be agreed on by him in conference with the medical authorities at Madras, subject to the approval of the Council. Mr. Bethune, at the same time, intimated his readiness to give two medals to be so competed for; a gold medal to the most proficient student of the two Presidencies, and a silver medal to the best student of the unsuccessful Presidency. The Council requested Dr. Mouat to endeavour to induce the medical authorities of Madras to concur in the proposed competition.

Upon his return from Madras, Dr. Mouat reported that he had visited the Madras Medical School, which he found in a much higher state of organization and efficiency than when lie reported upon it in 1845; that he had mentioned the proposal of the Honorable President to Professor Key and to the Honorable D. Eliott, and that it had been favorably received, although no plan of carrying it into effect had then been determined on.

The proposal of entering into the competition has been communicated to Dr. Morehead, the head of the Grant Medical College at Bombay, who also entertained it favorably, and stated his belief that the Institution over which he presided would shortly be prepared for it.91

So far historical records are concerned such a competition did not take place. Maybe, today’s ranking of the universities and colleges signifies in some ways traces of the proposed comparison between the three eminent medical colleges of the time.

Regarding Lying-in hospital Goodeve reported – “The native prejudices upon the subject of female treatment and the management of parturient women are yet very strong and deeply rooted. Amidst all these advantages and encouraging prospects however, the deficiency of funds forms a serious drawback to our prosperity. This want is now becoming so urgent that, unless some further pecuniary aid is obtained for the Institution, not only must all prospect of extending its utility be abandoned, but its present opportunities for relieving the number of patients who resort to it must be diminished, and consequently the invaluable instruction it affords to students must be curtailed even at present.”92 It means that the lying-in hospital was suffering paucity of financial constraints.

In this regard, Goodeve cited the example of the Madras Lying-in Hospital – “In proof of the insufficiency and smallness of the sum, in comparison with what is considered necessary in other institutions of the kind in India, I may state that, in the Madras Lying-in Hospital, the salary allowed to the matron alone is nearly as much as we receive for our whole outlay.”93 And, for this reason, he requested authorities to increase a “sum of not less than 50 rupees per month”

Moreover, “In the Madras Hospital, one hundred and sixteen obstetric patients were admitted in 1847, and one hundred and sixty-two in 1848; of the former, eighty-seven were natives, and of the latter, one hundred and thirty-one.” It shows that there was a significant trend among Indian women to be delivered in the hospital.

Keeping this in mind, 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”.84 Dr. Goodeve wrote, “The number of patients has continued to increase during the past year (there are at this moment twenty women awaiting their in the Wards, and I expect others daily), in yet larger proportion than formerly, and I have no doubt, if properly managed and supported, the already established utility of this Institution will rapidly advance in importance.”95 Providing such “advantages” might have arisen out of a threat from the indigenous practice of midwifery as we have just seen from the report.

Important academic developments during 1850-51 session were –

Hitherto the chairs of Materia Medica and Medical Jurisprudence had been held by the same officer, and the full course of lectures on Medical Jurisprudence had extended over two sessions, comprising about 35 lectures each. The Government, being desirous of rendering the College as complete as possible … the two chairs of Materia Medica and Medical Jurisprudence should be separated; and the former was attached permanently to the office of Deputy Apothecary, which it was considered would afford the Professor many facilities for efficiently discharging the duties of his chair. It was determined, at the same time, to institute a course of lectures on the latter science, which should exhibit the whole subject of Legal Medicine in a single session, as is the custom in Europe.96

For this purpose, “a room in the College was set apart for the use of the Professor of Medical Jurisprudence, to enable him, whenever practicable, to conduct the post mortem examination, which is required of him as Police Surgeon, in the presence of his class, and to demonstrate practically the methods of carrying on these investigations.”97 Also, a chair of Ophthalmic Medicine and Surgery was added to the courses of lectures.98

By this time, as mentioned above, the College of Madras had expressed itself ready to engage in the proposed competition; but it was found impossible to complete the necessary preliminary arrangements this year, and the contest has therefore been postponed for the present.99

There was also the report about the last student, of the four who went to England, returning to India – “Dr. Chuckerbutty studied for five years at University College, London, and obtained the degree of Doctor of Medicine in that University … Since his return Dr. Chuckerbutty has been employed in the Medical College Hospital as Assistant Physician, and has performed his duties in a highly creditable manner.”100

Notably, several of the students of the Hindustani Class “engaged in a riot with persons on the outside of the College walls, which led to the interference of the police, by whom ten of the pupils were seized and taken before the Magistrate, who punished all of them by fines. This matter was investigated by the Secretary of the College, and reported to the Council of Education. By the orders of the Council, six stipendiary students and four free students were dismissed from the school. Since this occurrence their behaviour has been good.”101

Such an unrest and lack obedience of ‘future citizenry’ was so stirring to the colonial authorities that the incident was reported in a medical journal of London too. The London journal reported under the title “Bengal Medical College” – “It appears necessary to enforce a strict discipline in the school, as towards the end of the session some the students were engaged in a riot with persons outside the College walls, which led to the interference of the police, whom ten of the pupils were seized and taken before the magistrate, who punished them all of them by fines.”102

In the report of 1851-52 session, we find three Indian representatives in College Council – Rasamay Dutta, Ramgopal Ghosh and Ashutosh Deb.103 Subjects taught were – (1) anatomy and physiology, (2) descriptive and surgical anatomy, (3) botany, (4) medicine, (5) surgery, (6) midwifery, (7) chemistry, (8) materia medica, (9) medical jurisprudence (toxicology), and (10) ophthalmic medicine and surgery.[104

It was noted – “In the examinations of some of the classes unfair practices were detected, which rendered it necessary to punish the offenders. The offence has heretofore been so rare in this College that no special provision regarding it is contained in the rules of the institution. The Council are of opinion that future offenders should be expelled.”105 116 ‘judicial post mortem examinations’ were conducted in that session.106 It was emphasized that – “On the important practical subjects of Medicine and Surgery, as shown both in the written theses and oral examinations, the candidates generally afforded very gratifying evidence of careful tuition and assiduous study, while the ease and dexterity displayed in the dissecting room bore satisfactory witness to the industry with which they had availed themselves of the opportunities, in this regard, enjoyed to a fuller extent by the students of this Medical School than by those, perhaps, of any other in the world.”107

Two important points are to be taken into account – (1) for the first time the term ‘written thesis’ has been used, might be as an impact of UCL, and (2) for dissecting opportunities CMC had more plentiful supplies of cadavers than any other medical schools of the world, as boasted in the report.

In the report of 1852-55, it was joyfully stated – “The most important event connected with the history of the Medical College during the past session, has been the opening of the large hospitals attached to it, for the reception of the sick.”108 Some of the benefits attributed to the newly opened Hospital were – (1) “means of diminishing the mortality of the city and of mitigating the sufferings of its pauper population” was the establishment of large ‘Central Hospital’, and (2) “the reception of cases of fever, small-pox, dysentery, cholera, and all such diseases” were actively in a state of intervention.109

About the Hospital it was reported – “That amount of space assigned to each patient in the wards of the new College Hospital, with the provision made for ventilation and a plentiful supply of water, will enable it in times of emergency and epidemic outbreaks of disease, to accommodate without injury, in the two upper floors, nearly 500 patients.”110 Again, “The European patients in the Medical College Hospital are all either paupers or seamen, and very many of them come for treatment in advanced and nearly hopeless stages of disease.”111

That CMCH was built at a much lower cost than famous London hospitals were frequently compared – “The entire cost maintaining the Calcutta Hospital is considerably less than that of any similar institutions of like extent, in England. King’s College Hospital, when it had only 101 beds, annual revenue of £4,000. The Middlesex Hospital with 300 beds, costs annually £8,000; Guy’s Hospital costs £21,000 annually … The gross annual sum expended in St. Thomas’s Hospital is £26,000. The entire annual cost of all departments of the Medical College at present is Company’s rupees 75,968-4-4”112. It was also mentioned that “The physicians and Surgeons of the London Institutions are chiefly paid from the students’ fees, while the whole expense of the School and Hospital in Calcutta is borne by the state.”113

With regard to cost of the MCH it was reported – “The entire cost maintaining the Calcutta Hospital is considerably less than that of any similar institutions of like extent, in England.”114 Possibly recurrent reference to presenting low cost of the MCH was primarily due to (1) there was strife between the EIC and the British Parliament, and (2) as the monopoly of trade of the EIC was already annulled before so there was an attempt to showcase ‘economy of education’ in India on behalf of the Company.

Regarding admission of Indian and European patients in the CMCH such was the figure – from 1841 to 1852, 11,540 European patients were admitted of whom died 1203 (about 10% of the admitted patients) and 10,337 were discharged; Indian patients admitted were 11,519 of whom 1,033 (<10% deaths) and discharged were 10,448. For European patients below is the table.115

About hospital space and accommodation of all groups of patients such was the report – “That amount of space assigned to each patient in the wards of the new College Hospital, with the provision made for ventilation and a plentiful supply of water, will enable it in times of emergency and epidemic outbreaks of disease, to accommodate without injury, in the two upper floors, nearly 500 patients.”116 Moreover, mortality rates among famous European hospitals and the CMCH were confidently compared.117

It was also strongly stated – “the above are sufficient to show that there is nothing in the site of Medical College Hospital to prove that it is an unfit or unhealthy receptacle for the sick. Indeed, it may be confidently predicted, that the increased space and improved ventilation of the New Hospital, will diminish both mortality and the average duration of treatment, as well as time of convalescence of the patients admitted to it.”

Benefits accrued from the Hospital were elaborated – “the spacious ne Hospital … now available for imparting efficient clinical instruction in the departments of Medicine, Surgery and Midwifery … by a more practical  system of examination than it has hitherto been possible to carry out. We would in fact suggest that the mode of testing the knowledge of the students, now understood to be in force at the University of London, should be also adopted at the College here, as it has already been to a certain extent and, it is believed, with great advantage, at Bombay.”118

In the report for the session 1855-56 it was reported that119

It was also emphasized – “Under the present system, the College does not supply half the number of Sub-Assistant Surgeons and Native Doctors for the public service” and “A large proportion of the students who enter the College from poverty chiefly, and other causes, cannot remain in it the five years required, to enable them to pass their final Examination, consequently the number of Graduates annually passed out of the College is very small.”120 Moreover, “some enter into private practice, some go to England to prosecute their studies still further … Two of this year’s Graduates proceed to England for this purpose.”121 Regarding education, it was reported – “it affords a first-rate school of Instruction to the students of all classes in the College … the study of theory and practice of their profession and by which they are enabled to complete successfully in Examination with Medical pupils educated at the best Schools in Europe.”122

Below is the building, wards and accommodation plan of the MCH.

For 1856-57 session, “The most important event of the past year, connected with the history of the Medical College, the effect of which has as yet to be developed, has been the establishment of the Calcutta University for the purpose of granting Honors and Degrees.”123

The College at this time contained ten chairs, viz, that of Anatomy, Physiology, Zoology, Chemistry, Botany, Materia Medica, Medical Jurisprudence, Midwifery, Surgery, Medicine and Ophthalmic Surgery, and an ample Museum which provided means for illustrating these sul4ecfs. It is recorded that, during the previous year, 900 bodies were utilised in the dissecting room for the purpose of studying practical Anatomy and Surgical Operations. In the Hospital, including the Ophthalmic Ward and Outdoor dispensaries, 700 sick could be daily seen, in every variety and stage of disease.124

The foundation of the Calcutta University in 1857 and the affiliation of the Medical College with it, in the same year, demanded a further modification of the education curriculum by requiring a course of practical Chemistry and additional clinical lectures. The University Entrance Examination was also made the portal of admission into the primary classes of the Medical College, and examinations to take place at the end of the third and fifth sessions, whenceforth the students, who used to obtain only one qualification, namely Graduate of the Medical College, were now required to obtain a licence in Medicine and Surgery from the University, which also offered the degrees of Bachelor and Doctor of Medicine.125

In 1860, a Code of Rules was drawn up for all classes of the Medical College with regard both to education and discipline, in accordance with the regulations of the University of Calcutta, under which the students were divided into four classes :—

Class I—The “Primary” and “Ceylon” classes, taking the full University Curriculum of 5 years, and three other classes each pursuing a three years’ course; Class II—The “Apprentice” Class; Class III—The “Hindoostanee” Class; and Class IV—The “Bengalee” Class.

The Primary and Ceylon Classes were eligible to sit for the Licence in Medicine and Surgery, the Bachelor of Medicine and the Doctorate of Medicine of the Calcutta University.126 Dr. Chandra Kumar De was the first M.D. and Dr. Mahendralal Sarkar was the second M.D. of the CMC/University.

“Chair of Dentistry” was established in 1861. In 1864-65,a professorship of hygiene was established. In 1871, a Resident Surgeon and Professor of Physiology and a Resident Physician and Professor of Pathology were also sanctioned. These appointments did material service to the college by adding to the number of minor Professorships and providing for the special teaching of Pathology.127 The graduates of the Medical College were, after this General Order (Order No. 370) was passed, known as “Sub-Assistant Surgeons”, the European and Anglo-Indian Military students received the designation of “Passed Hospital Apprentice” and the Indian Military students as “Hospital Assistants”. From 1874 onwards, the Graduates in the Provincial Medical Services have been designated “Assistant Surgeons”. The idea of training Indian women to become midwives, wives arose and in May, 1871. It was reported that ten had joined for training, four qualified and one had done very well.128

The question female medical education and female medical graduates from the CMC will dealt with separately.

______________

1. GRPI 1847-48, 81-87.
2. Ibid, 81.
3. Ibid, 82.
4. Ibid, 83.
5. Ibid, 81.
6. Mel Gorman, “Introduction of Western Science into Colonial India: Role of the Calcutta Medical College”, Proceedings of the American Philosophical Society, Sep., 1988, 132( 3): 276- 298. Quoted on p. 290.
7. GRPI 1847-48, 82.
8. Ibid.
9. Ibid, 83.
10. Ibid, 84.
11. Ibid, 84.
12. Ibid, 85.
13. Ivan Waddington, “The Role of the Hospital in the Development of Modern Medicine: A Sociological Analysis”, Sociology 1973, 7 (2): 211-214. [Italics added]
14. John Harley Warner, “Paradigm Lost or Paradise Declining? American Physicians and the ‘Dead End’ of the Paris Clinical School,” in Constructing Paris Medicine, ed., Caroline Hanaway and Ann La Berge (Amsterdam, Atlanta GA: Rodopi, 1999), 337-383. Quotation on p. 343.
15. Joan Lane, A Social History of Medicine: Health, healing and disease in England, 1750-1950 (London, New York: Routledge, 2001), 87.
16. Russel C. Maulitz, “The pathological tradition,” in Companion Encyclopedia of the History of Medicine, ed., W. F. Bynum and Roy Porter, vol. I (London: Routledge, 1993), 169-191. Quotation on p. 178.
17. Andrew Wear, “Introduction,” in Medicine in Society: Historical Essays, ed., Andrew Wear (Cambridge: Cambridge University Press, 1998), 1-13 (6). [Emphasis added]
18. Marry E. Fissel, “The disappearance of the patient’s narrative and the invention of hospital medicine,” in British Medicine in an Age of Reform, ed., Roger French and Andrew Wear (London, New York: Routledge, 1991), 92-109. Quotation on p. 99.
19. Stephen Jacyna, “Medicine in Transformation, 1800-1849,” in The Western Medical Tradition: 1800 to 2000, W. F. Bynum, Anne Hardy, Stephen Jacyna, Christopher Lawrence, E. M. (Tilli) Tansey (Cambridge, New York: Cambridge University Press, 2006), pp. 11-110 (53).
20. N. D. Jewson, “The Disappearance of the Sick-man from Medical Cosmology, 1770–1870,” International Journal of Epidemiology 38.3 (2009): 622-633. Reprinted from Sociology 10.2 (1976): 225-244.
21. John V. Pickstone, “Commentary: From history of medicine to general history of ‘working knowledge’,” International Journal of Epidemiology 38.3 (2009): 646-649.
22. Michael Sappol, A Traffic of Dead Bodies: Anatomy and Embodied Social Identity in Nineteenth-Century America (Princeton, Oxford: Princeton University Press, 2004).
23. Arnold, Colonizing the Body, 53.
24. N. D. Jewson, “Medical Knowledge and Patronage System in 18^th Century England”, Sociology 1974, 8 (3): 369-385. For effect Newtonian physics on medicine see, Anita Guerrini, “Archibald Pitcairne and Newtonian medicine”, Medical History 1987, 31 (1): 70-83.
25. Ulrich Trohler, Quantification in British Medicine and Surgery 1750-1830, with special reference to Its Introduction into Therapeutics (PhD Thesis, University College London, 1978), 41.
26. Paul Atkinson, Medical Talk and Medical Clinic (London, Thousand Oaks: Sage, 1995), 61.
27. John V. Pickstone, Medicine and Industrial Society: A history of hospital development in Manchester and its Region, 1752-1946 (Manchester: Manchester University Press, 1985), 48.
28. Ibid, 54.
29. Russel Charles Malitz. Morbid Appearances: The Anatomy of Pathology in the Early Nineteenth Century (Cambridge: Cambridge University Press, 1987), 4.
30. Irvine Loudon, “Medical Education and Medical Reform,” in The History of Medical Education in Britain, ed., Vivian Nutton and Roy Porter (Amsterdam, Atlanta GA: Rodopi, 1995), 229-249. Quotation on p.  233.
31. GRPI 1844-45, 134. [Italics added]
32. Ibid, 135.
33. GRPI 1845-46, 108.
34. GRPI 1845-46, 110.
35. Ibid.
36. Ibid, 111. Professor Lindley “regretting he had not another silver medal to give, presented him with a copy of his own admirable work as a testimony of approbation … Lord Auckland also on the same occasion presented the young man with a valuable book.”
37. Ibid.
38. Ibid, 112.
39. Ibid, 113.
40. Calcutta Review January-June 1845, V (III): xl.
41. Rules and Regulations of the Medical College, Bengal, 1849, 35.
42. Ibid, 36.
43. Ibid.
44. Rules 1844, 30. In 1849, this distinction was not mentioned.
45. Rules 1849, 40.
46. Ibid, 41.
47. Calcutta: A Hundred Years Ago, ed., Ranabir Ray Chowdhury (Calcutta: Nachiketa Publications Ltd., 1987), 4.
48. Rules 1849, 28.
49. S. G. Chuckerbutty, Popular Lectures on Subjects of Indian Interest (Calcutta: Thomas S. Smith, 1870), 202.
50. Annual Report of the Medical College, Bengal 1846-47 (hereafter ARMCB), 13.
51. Ibid, 12.
52. Ibid, 14-16.
53. ARMCB 1846-47, 20.
54. Ibid, 20-21.
55. Ibid, 21.
56. Thomas R. Metcalf, Ideologies of the Raj (Delhi: Cambridge University Press, 1998), 34.
57. Ibid, 167.
58. ARMCB 1846-47, 20.
59. Ibid.
60. Warwick Anderson, “Excremental Colonialism: Public Health and the Poetics of Pollution”, Critical Inquiry, 1995, 21 (3): 640-669. Quotation on p. 651.
61. Ibid, 648.
62. Michel Foucault, “Society Must Be Defended”: Lectures at the College De France, 1975-76 (New York: Picador, 2003), 250.
63. Ibid, 252.
64. Ishita Pande, Medicine, Race and Liberalism in British Bengal: Symptoms of empire (London, New York: Routledge, 2010), 101.
65. Senjuti Mallik, “Colonial Biopolitics and the Great Bengal Famine of 1943”, GeoJournal 2023, 88(3): 3205-3221.
66. H. H. Goodeve, “Hindoo Medical Students”, Lancet, vol.1 (1847): 189-190. Quotation on p. 189.
67. Ibid, 190.
68. S. Ahnantha Pillai, Understanding Anaesthesia (New Delhi: Jaypee Brothers Medical Publishers (P) Ltd., 2007), 13.
69. James Young Simpson Collection, GB779 RCSEd JYS 1-1882, RS RI; RS R2, Plans chest, letter no. 156.
70. GRPI, 1847-48, Appendix E. No. VII, cli.
71. GRPI 1847-48, 94.
72. Ibid, 94.
73. GRPI 1847-48, 103-104.
74. Ibid, 104.
75. Appendix C. Evidence taken by the First Sub-Committee upon the Fever Hospital and Municipal Improvements (Calcutta: Military Orphan Press, 1838), clvi.
76. Report of the General Report on Public Instruction in the North-Western Provinces for 1849-50, from 1^st May, 1849, to 30^th April, 1850, 24.
77. GRPI 1847-48, Appendix E. No. VII, p. cl.
78. GRPI 1848-49, 6.
79. Ibid, 2.
80. Ibid, 4.
81. ARMCB 1848-49, 7.
82. Ibid, 12.
83. Ibid, 14.
84. Ibid, 16.
85. Ibid, 19.
86. Ibid, 20.
87. Ibid, 20.
88. Ibid, 32.
89. ARMCB 1849-50, 4.
90. Ibid, 9.
91. Ibid, 9-10.
92. Ibid, 11.
93. Ibid, 12.
94. General Report on Public Instruction, From 1^st Oct. 1849 to 30^th Sept. 1850, 1851, 129. [Hereafter GRPI, 1851]
95. GRPI, 1851, 129.
96. ARMCB 1850-51, 6.
97. Ibid.
98. Ibid, 13.
99. Ibid, 7.
100. Ibid, 8.
101. Ibid, 10-11.
102. The Medical Times and Gazette: A Journal of Medical Science, Literature, Criticism, and News, New Series, vol. 5 (July 3 to December 25, 1852): 25.
103. ARMCB 1851-52, 1.
104. Ibid, 3.
105. Ibid, 5.
106. Ibid, 6.
107. Ibid, 8.
108. GRPI 1852-53 (30^th Sept. 1852, to 27^th Jan. 1855), 63. Hereafter GRPI 1852-55.
109. Ibid, 64.
110. GRPI 1852-55, 68.
111. Ibid.
112. Ibid, 71.
113. Ibid.
114. Ibid, 71.
115. Ibid, 68.
116. Ibid.
117. Ibid, 69.
118. Ibid, 80-81.
119. GRPI 1855-56, Appendix A, 126.
120. Ibid, 127.
121. Ibid.
122. Ibid, 129.
123. GRPI 1856-57, Appendix A, 199.
124. Centenary, 39.
125. Ibid.
126. Ibid, 41.
127. Ibid, 44-45.
128. Ibid, 46.