1.

IMPFtESSIONS OF MEDICAL EDUCATION IH INDIA

Introductory Notes.

1.

      Except for the summary attached herewith I have nwnbeqed the

sections and paragraphs in the order of the importance of their contents,

and I have used the first sentence to state the essentials of each para-

graph.

will convey the substance of the report as a whole.

Rapid perusal, therefore, of the first sentences of each paragraph

2.

       The report consists of a brief preliminary summary, the body
of the report divided into Introductory Notes, Main Impressions,

Suggestions and Comments on the Context and Circumstances of medical

education in India.

not have time to read the rest ofthe report.

have arranged the major factors and aspects of medical education which

have impressed me.

The summary is intended for the use of those who do

Under Main Impressions I

I have divided the section marked Suggestions into two

p~rts: those that involve expenditure of money and those that do not.

The comments on the Context of Medicine should indicate to Indian readers

that I have been aware of some of the major factors affecting,  and at

times controlling, the scale or the rapidity of changes that need to be

made.

of the circumstances of the work for which doctors are being trained in India.

These comments will also serve to inform my colleagues in New York

3.

My purposes in writing this report are to comply with the

request of the Minister for Health for such a statement,  and to condense

for the use of my colle-gues in America a statement of impressions received
dur ng a visit to India dur.ng the autumn and winter of 1951/32.

intend the report to be critical in the unpleasant sense ofthat word.

would prefer the report to focus attention on the future and on the danger

of certain trends or tendencies, for I believe that there is a good deal
of truth in the aphorism "to forsee is to govern."

I do not

I

2.

Time is always important in a situation that is worsening and there are
several aspects of medical education in India that must be either mended

or ended,

as they are to remedying unsatisfactory affairs and acceptins innumerable

handicaps, are perhaps professionally prone to rnRking the best out of vhat
ie ~t hmd rather than spe&i:Ig: out !>lia;tly it: fevor of conditions they

repilire iv. order to do the beFt. job psscib'lo,

stet2 views that T know my Indian colle~yes! hold but which their positions

do not permit them to utter, or their yesent diecouragemat and apathy

prevent them from repeating.

it were to be taken RS unsympthetic censure or gratuitous fault-finding.

Brevity also invites mimnderstsndings but even with risks that cannot be

controlled this report is both candid and brief,

I think that laymen should remember that doctors,  accustomed

Aq ~n outside1 venture to

I should greatly rezret ny blunt candor if

3,

The report confines itself to inpressions received during

visits to medicel colleges,  schools anti some institutes in the following

plRces: Bombay, Poona, New Delhi, Agra, Lucknow, Calcutta, Vizagapatam,

Hyderabad, Banplore, Trivandrum, Mysore, Vellore and Kadras. ThRnke to

the hospiteble foresight of the Minister of Health, Tho Hon. Rajkumari

brit Knur, of Dr. Rnja, Dr. Pandit, the Director? of Medical Services in

the various ststes, and with the help of Drs, Watson and Anderson of the

Foundation's steff, the visits were without any exceptions well planned

and efficiently managed.

of hoepitality Mrs. Gregg and I feel.

I could not acknowledge adequately the debts

And I should add that I more than

appreciate the generosity of 8.11 the teachers and administrators in the

long list of institutions who allowed me to talk for an hour oC two with

them about their work, their interests md their needs. The visits in

India filled 94 days fill of p1er;sant and stimuleting work for which I

am gratefbl to all those who helped so effectively to make these visits

possible .

3.

MAIM IWRESSIONS.

I.

colleges are poor and becoming worse.

positive dam.

The prospects of hsving satisfactory teachers in the medical

The situation should cmme

1.  Salaries for teachers of all grades are far too small;  in no

colleges do salaries or dearness allowances reflect the 300 to

400 per eent increase in living.

clinicpl subjects deserve lorger ~alaries than clinicians on part

or full time.  To infer that because some profeasors have not yet

resigned they can be expected to continue is both unfair and

unwise. Even in ancient Greece it was observed that in civil life

only two groups of human beings can kill with impunity: judges and

doctors.

doctors it will deserve the charge of criminal negligence.

been shocked and depressed on learning the salaries given in Indian

medic81 colleges for honest, competent and sssentid services.

2.

Vacancies are numerous.

Commissions too frequently ignore profession91 And scientific

criteria.  Young doctors without interes f or aptitude for teaching

are posted as teachers in subjects that can only suffer from their

apathy.

ideals of Harley Street as Government service and so provided

competent clinicims to the upper brackets of British and Indian

society without giving Indims any idea of how to find and train

in India either comDetent clinicians or teachers of the medical

Services. All too few are those who how that beh'nd the mucb

Teachers on fill time in non-

If a government seriously underpays the teachers of its

I have

The quality of the teachers is on its way from bad to worse.

The methods of selection by Public Service

A serious defect of the I.Im;.S. was that it dis,uised the

4.

prized foreign degrees and diplomas stand a corps of full-time,  devoted

end decently paid non-clinicel teachers.  Without such teachers medical

education repidly deteriorates and advanced training becomes a mere

commercial investment.

of medical educetion in India sinks even the best Indian candidates for

foreign training will not be welcomed abroad as they have been in the past.

This possibility increases the argument for losing no time in improving

the quality of the oncoming generation of Indianteachers.

One f'urther warning must be noted: when the quality

3.

       The rule of retirement at the age of 55 with pensions thet

have lost two thrids of their earlier value is now dissuading young men

from choosing careers in teaching.

practice demmds no such heroic sacrifice.
ignore or over-ride the importance of recruiting enough devoted and well-

trained teachers for the future.

having ample time to regret their choice, for it will take a long time to

correct such inexcuseble improvidence.

As an obvious alternative private

Indian legislators can neglect,

But they do so im perfect certainty of

L-

    4. The present senior teachers, especially in the nonjclinical

subjects, work under a dangerous overload of teaching duties and service

demcinds.  The number of students is almost uniformly too large for effective

t-aching.

Demonstratorships are frequently vacant or held by young men whose hearts
are set upon private practice or f'oreiiy clinical degrees at the earliest

possible moment.

services in cliniccll potholoq and biochemistry would effect not only an

economy of academic brains but an iroprovement in the nulilber and reliability

of diagnostic services.

ignorant or insultingly cynical to expedt good research work of honest

Understudies or competent substitutes are ominously few.

Technicians to carry the burden of routine hospital

Under the present overload it is either extremely

teachers or to talk of creating more colleges or increasing the number of

$Btadhte.  Furthermore, the effort to induce foreign professors to accept

positions in Indian medical colleges where no time, technicians or devoted

recruits are available, becomes an effort fraught with dis-ppointment
because it avoids fzcing the f'undaroental issue...,..To import a foreign
professor is in large measure to invite him tq'race and solve defects which

now overwhelm admirable but discouraged Indim professors; namely, wniri-

terested demonstrators, insufficient technicians and the overwhelming

overloed of excessive teaching duties.

In Indie there is a general misunderstanding or underestimate of the value,

as well as the cost, of medic81 care, medical education and research, To
the familiar objection 'The Government cmnot afford to spend so much for
Dedical care" I would observe thwt the Government csnnot afford to spend

so little.

the world medical cnre is passing from being considered a privately pur-

chaseable service or a philanthropic boon, to being demanded as a civic

right.

medical attendants, in the position of a political issue of growing

importance. Witness Russia, China, the U.K. and the U.S.A.- all of these

countries where meeting the demsnds for private practitioners is changing

rapidly and profoundlv to meeting the need for medical care and public

health.

amounts to a curious lnck of political sazacity,

the importance of medical education

alone: the medical profession in India seems to me to ignore their own
eventual dependence upon popular and general understanding of the value

XI.

Medical service has advanced so remarke-bly that everywhere in

This fact puts medical care and medical education to produce

I submit that underestimeting the importslice of medical education

                      The blame for neglecting

cmnot be laid at the door of laymen

111.

6.

of medical care, educationand research. Medico1 educators in India neglect

most of their chances to explain the nature of medical science and ite

potentialities for every living Indien.

widely done, and more earnestly done, medical education in India will

languish for the lack of informed understanding.

implicstions for medical education of the increasing effectiveness of

medicpl science: together with foodd clothing and housing, medicine in its
broadest sense is coming to be one of the principcl means of keeping alive.
When this is realised no-one will say that a goverment wishing for political
stability will find the costs of effective medicccl education too great.

Until this is better done, more

We med to realise the

More attention should be ziven to the select Lon and trsin;ng of

the future doctors in India.

1.

Students should be selected in the light of the need for doctors

to be socidly useful rather than economicolly successful.  Since medical

educntion in India costs from three to twelve times the tuition paid,  the

state has tho obligption as well as the right to select students with more'

regard to their health, motivation, character and probable social usehlness
and somewhat less regard to their marks obtained in competitive examinations.

Only when students are fit to represent their communities will colnmunity

representation accomplish what is expected of it.

2.

More weight could well be given to the maturity and thoroughness

represented by the B.Sc. as a qualificrtion for entrance to medical collegee.
Since the teaching of English is byinning to decrease in the secondary
curricula+ I would expect the use of Zngliah in the medical colleges to
impose increasing difficulties in the path of students as young as 17 or 18.
I found no teechers in favour of discardin2 English as the medium of
medical instruction nor can I see any Rdvantages within the next quarter

7.

century in attempting to encourage or enforce the trensfer to Hindi,  Urdu

or any regionRl language as a means  of instruction.  A case could readily

be mde for adding sociology, statistics and psychology- to the traditional

chemistry, physics, biology and Englishrequired of the entrant to medical

co 11 ege .

3.

The ratio of students admitted to the number of full&ime teachers

and beds sn the teaching hospitals,  deserves more attenti0n.b so far as

pressures are ex#Aed to increase the numbers of students regardless of

this ratio, the results will be the mass production of sub-standard doctors

for India.

In the quality of - all the clinical histories I saw in the

hospitals, snd in the acknowledged excess of 'casuals"  or student failures

still retained by the colleges, and in the paucity of hospital beds for

teachins, and the double shift system there is mple renson for thi nking

that the students are being cheated of adequate instruction and control

sqecially in the light of their w+.rme :~otxt,h ra!.ntivq to the age of

medic91 studmts in rrrly ot'n.- ?miv?%tsrlefi. I am of' th- o?inion thit entrance

numbers of more than 100 per year

medical college I visited.

exceed %he tenchin? facilities of any

4.

To describe the medical course as oneof five year's duration

directa attention away from 9. more re?<listic fect.

and wasteful educational methods result in failiqy about (30 to 90% of the

The grossly compctitive

students at one point or another in their progrese t'nrou:l.,h the college.

A considerable proportion of the students are thus oblized to spend five
and a half to eizht years to entsr a profession thaineede no such additional

obstacle to supplylng India with more doctors.

8.

5.

The minimum age limit for entrance to medical college of l@

yenrs is less than I have met anmhere in he world.

to assum2 that the Indim students are intellectually mature three or four

Even if one is prepared

k

years earlier than elsewhere (and I am not sure that thifi can be assumed)

one can hardly doubt that even in India the younger the studeats the harder

it is to sdect, teach, house and supervise them, particularly in the

larger cities.

IV .

The curriculum for a field of knowledge changing as rapidly as is

medicine needs constant re- examination and re-ad justment .

1 . Too many students fRil in examinations. More weisht should be

at",sched to monthly tests or daily work.

The purpose of exmi<iations for

young stu6ents should be to weed out obvious incompetence. To expect a

boy or girl of 19 to show in three or four hours the results of two year's

work is psychologically unsound.

\ ;

-

It could fail to shock only those who

know little of education but by good fortune hRve survived so senseless an

ordeal.

The purpose of' medicEl educRtion is to produce good doctors,  not

passers of unreasonably difficult examinntions. I found it a sad paradox

to be told by several clinicians that the years the students learned the

most medicine were the yearewhen there :rare the fewest exminationa.

2.

In most colleges the teachers lay no emphasis on the fact that

they are prepring students to practice medicine in 1960, 1970 and l9GQ.. ...

not 1930 or 1940.

how to learn.

  More emphasis could go towards teachhg the students

medicine as it grows and changes, as it undoubtedly will.

c

In thia point too I must, say thit in my visits I mFssed ~n;y r?-asonable

awareness on the part of the te-chers of the imortmce of the fluture.

3.

We deceive ourselves by talking of a fiw year medical course.

Such

talk leads to overloadinz each subject with details (e.5, Anatomy) and

hurryinz the student into avoidin2 the responsibility of decidjns what

is irnFortant in his general perspective. Such talk also diverts attention

from the v?lue of a supervised internship,

I would stronsly support the

general adoption of the Pre-registration Clinical Assistantships and

further development of the housemmshipe a9 definltely preferfable to

diploma courses and ever more mugsing for exminntions.

gets far too much t'neory and far too little supervised experience.

Ths Indian student

5

4.

In the curriculsr of most colleges the followins chmges should

be made when satisfactory teachers can be found or trpined: Histology should
                                                 Lki?. -' 1
be tr-nsferred to the Anatomists thus providing the Psycholatqfsts with more

time for Biochemistry and Applied Humv Physiology.

r

More time should be

given to Medical Psycholo,q and Psychiatry.

More effort should be spent by

the clinicians in securiq post aortems: the present poor performance of

most hospitals in India in this direction comes from lack of energy and

skillful attention to the sentiments of the next of kin.

Teaching hospitols

should be judged by the percentage of their deaths whose certain cause is

proven by post mortem.

5.

The teaching of Public Health calle for radical revision,

mainly to come from the Director of Medical Services who should and could

benefit his nublic health service by organising it around the problem of

attracting and maintaining student interest in this important aspect of

medicine in India.

6.

I do not know enovgh about Ayurvedic and Unmi medicine to

make any useful comment.

ht it would seem to me that the extent to which

these systems are linked to politics and tradition suggests that the best

course to follow is to improve the education in modern medicine (especially

10 .

in the ethical and psycholocical training of the student) Rnd encourage

time and public education in health matters to clarify this issue.

Suppression of violent attack would be somewhat worse than a waste of time.

v. India needs medicel attendmts of severalkinds besides doctors.

If adequni-te numbers of nurses, technicians etc., were available the us13

fulness of doctors would be increased thrice to ten-fold.

1. Nurses to the number of 585000 would be needed if India were'

1

to match the U.K. in the ratio of trained nurses to the general papulation.

In the frce of such a vast deficiency the practical points of attack are

the training of teechers end supervisors of Nurses' Training Schools and

the payment of larger salaries to trained nurses in government employ.

Only so can new schools be erected md mointnined.

2.

The same measures apply to t'ne preparstion for incressing

the number of schools for the training of health visitors.

3.

      Employing quelified medical men to do technician$ work cannot

be defended on the grounds of economy since the time of a good tec'mician

costs less than that of a doctor, nor on the pounds of efficiency since

an experisnced technician does better work then En overloaded and inex-

perienced doctor (who knows Derfectly well thet his time is bein- wasted).

4.

The larger teaching hospitals deserve the services of full-time

hospital administrators.

must serve as head of the teaching hospital I must assume that many
important aspects of both posit;ons are either nezlected or left in the
hands of clerks who are not qu lified for such responsibilities.

When the dem or principal of a medical college

Research work in Indian medical colleges is all but crushed by

the teaching load, the saarcity of technicians, the claims of private

practice on part-time teachers, the lack of financial support, the rarity

11.

of dependable careers in research, the piovincialism of rival states,  and

the prestige of examinations diplomas and authoritarianism as contrasted

to and recogition of the spirit of enquiry.

1. Research on the dieeases of Indians, done by Indians in India,

offers far greater returns than research on the diseases of Indians done

in India by foreigners or research on the diseases of other natiomlities

done by Indiens abroad.

Indians in Indim medical colleges will interest and attrect cqpsble

students - and in their hands lies the mture of Indian research.

This is true bemuse research done here by

2.

Only when research opportunities are made available in Indian

medical colleges will teaching posts in India become attractive to *eachers

from other countries where research of the life of a teacher at every

stsge of his career.  It is somewhat Dore than rutile to send a young

Indian abroad to learn research methods and then discourage his chancee

of doing research when he returns.

3.

       Except for the provision of decent selaries no one rsform

would have a more salutary effect on the careers of teachers than the

certain prospect of being able to do first rate research work.

- VI1

Medical educytion suffers wi-en medical colleges are treated as

mere technic21 schools for the quickest end most "practical" prepnration

of addition91 practitioners. It ie not -ram the mere repetition 0-

clinic.1 observations already known that meZiciue has grown but from the

application of the new discoveries of mathemPtics, chemistry, physics,

biochemistry, biophysics, biology, psychology, sociology andother fields.

Ideally the medical college should be not merely affiliated with the

university but be far mo~ intimtely related to the resources and

academic standards of the university.

Vizagapatamthe nature of t'ne relntlonships between medical collqe and

J

It seemed to me that except at

12 o

university were depressingly formal, tenuous and unproductive.

Affiliation,

like matrimony, hps much to be said for it, but P good deal depends on the

mutuel understanding of what affiliation is for,  and on the character of

the contracting parties. In most countries medic41 educntion tends to

become is,-lated, self-regarding and st .=rile.

It needs contact with fields

that contribute to medicine. Academic control alone falls far short of

the ideal university connection.

SUGSESTIGKS.

A. Those which cost little or no money.

two

1.

The doctors in government service should he divided into cadres

teachers and all others.

This would substantiTlly Rid in clerifying the

importance of mFintRining an adequate supply of interested te-che -8,

2.

If the Principals 2nd Faculties of medical colleges are ziven a

larTer freedom end larger resnonsibility in choosing  k,eachers from a cadre

maintained as suggested above, the attention to teacher-quality would

probably increase.

3.

Less emphasis might well be .;iven to final examinations and

more emphqsis could wisely be placed on monthly tests.

present ferocious &dr rate I would suggest that firmness in dismissing a

In place of the

failure

student after three f'ailuree in ;my examination would be more efficient

as well as far more humane.

~%

The present Baxzmx? rate is inexcusably

unfair and indefensibly costly.

4,

The retirement age for progessors should be fixed at 60

instead of 55 md this chenge should be mde before additional losses

of experi.enced teachers are inflicted needlessly on an already depleted

professoriate.

'3.

5.

As n means of anticipatiQy the oncoming shortages af Rdequately

trsined professors the D.M.S.  et New Dslhi ehould preyOr3 a t

FJSP Sruu?g for esch tenchi?:: lrnnch of medecjns of e of the te-ckcr? il?

Tndion medics1 colleges, end tsx suppr"red resew& iristitutep. From euck
a t-bu!Ption it woiild be easy to see whot subjects (e.~., Pnyrhiatry,

Pharnecology etc .> can wiselynow receive prpferentiel conriderat on for

Coreiy fellawehips, and when a dearth or excess of teachers in any subject

msy be expected.

     6.

1:edecine should be increased and services of ten beds be cre-ted in general

hospitals for the use of such terchers in every Eedical colleze.

medicnl colleye in India have I seen everi F proximate justice done to thie

aspect of the care of human ileings.

The time yiven to tecachers of Pqrchiatry and/or Peychological

In no

7.

The tesch'ng of Histolog should be transferred from the

4epartments of Physiology to the Departments of Anatomy (3s the Cnlcutta
medic91 co13 ege) but without iiicreeHing the hours given t,o the teaching

in the departmmts of Anatomy. Thin would reduce the time availeble for

the unimportant details of gross anotomj snd Tive to the physiologists

more time for bio- physics, bio- chemistry find apylied human physiology

includ 'ng pereonal hygiene.

8.

The Indim Council on Medical EducRtion could prepare annually

a report to be rele sed to the newspspers, radio and other appropriate

medip for the puidance of prospective medicR1 students and their parents

on the entrance requirements, the current enrolment in medic-1 schools,

communal reprenentption, the nuwbera of 14.P.F S. degrees conferred, the

costs of medical educ-tion ificluding those borne by the State, the posts

currently open in teaching and ;overnroen-L service end the selaries offered,

tooether with such other inforwtlon FIS would better suide  studelit0 cox!-

templPting wreers in medicine.

Such frank and informtive amunl report 8

could influence favoursbly the recruitment to medicine in a very short

time and if accurately done could elso stimulate improvement in backward

states md indeed throughout all the colleges.

mortems secured as related to the tot 1 depths in every teaching hoEpital

should become a subject of' wide comparison since it is the best single

evidence of the efficiency of hospital teRching end scientific honesty.

I would think that the council has a morel obligation to deal with

prospective students and their prents in this open and explicit way.

The percentsge of post

9.

A service of about a dozen beds in the zene-a1 teRching

hospitals of each college should be Tiven to the professors of Pharmacology

for teaching practice1 therapeutics.

doctors in private practice or isolated government posts will  continue

For the next two decedes Indian

to be,dispensers to a degree that justifies more attentim to their

trai!iing ;n actus1 thera.peu.tics.

B. Those thRt will cost money.

1.

       By far the most important action imediotely and for the

future is to raise the salaries of all grndes of teechers.

Government is prepsr d to forbid the privete practice of medicine (as

the Communists did in Russie) y.u willhsve to face the fact that

practitioners can earn from two to thirty times as much as their tecchers,

md can continue to do so after the aee of 55.

teachers' salaries is now less than one third of whFt it was when the

present sc~le was fixed. A trivial increase that fails to interest the

younzer generation will :iicply be thro ing money away to no purpose

what Aver.  I believe that y :I face incrwsiq deteriorsltion of medical

educetion in India if you do not adopt a scale of sPla.riea at least as

high as:

UnlesR the

The buying power of

Brof essors

Non clinical full

time posts 2000 rising to

Clinical with restricted
practice in the Pay
Clinics 1800 rising to

Ass i s t ant

Lecturers

Professors &s Demonstrators

2500 1000 - 1,500 po - 800

2200 gOO - EO0 500 - 800

2.

      A large inckease in the number of teaching posts will be needed if

teachers are to have time for research, or if new colleges are planned for the

next two decades, or if any measure of selectivity or choice is to be used in

the nselectiona of teachers for poets soon to be vacated by retirements at 55.

But there cen be little sense in increasing the number of vacant posts at salar-

ies of no interest to anyone competent to teach.

3.

Technicians should be trained and employed in numbers sufficient to

e

allow all grades of teachers to teach.

ing courses for technicians.

courses instituted elsewhere.

owntechniciens if adequate salaries were provided to retain them.

At Calcutta and Vhllore are given train-

These courses could be helped and later similar

But in many cases professors would train their

4,

Plena for more medical colleges in India should be drawn up by the

Council, I would think, however, that the immediate difficulties of the

existing schools make f'urtheB raids on your teaching strength,  such as en All

India Institute, completely unwise until 1960.

and planning could wisely be done now.

a useful example of such foresight.

But more schools there will be

The Cormnittee for Upgrading serves as

5. The Council could sensibly counteract the tendency to provincial

jealousies and separation by fostering and supporting the expenses of meetings

comparable to the Pathologists' meeting at Eyderabad in November.

ment were given to the junior teachers to attend such meetings or,  better still,

to have one of their own, the future choices of professors would be improved

If encourage-

16 .

considerably.

Anything that aids comparison makes choice more satisfactory.

6.

Student Health Services and the pwsical examination of students

as part of the procedure for the selection of students deserve more attention

and support than I found in most of the medical colleges.

in a medical college some attention to the health, nutrition and physical

welfare of students, if only as an exmple set.

One might expect

7.

     The magazine of the Indian Medical Association "Your Health" could

be used as a meam of spreading information on medical education,  research and

public health.

paper editors, legislators, state government officials and members of the

profession would help produce better understanding of medical education than

now exists.

Aid in the form of 5000 paid subscriptions to be sent to news-

8.

If candidates who have passed pr+medical courses in sociology,

psychology and statistics were given explicit preference in admissions to

medical colleges, the students would be better prepared for the practice of

medicine than is now the case. It will take money, however, to assure a

desirable level of teaching in such courees.

9.

The Central Government could make a collection of the architects'

plans of all the Indian hospitals and colleges built since 194 and make these

plans available to all institutions now contemplating the construction of new

buildings.   It would goon become evident that the Central Govt. could employ

a Consultant in this connection on Hospital and Medical College construction.

This would give valuable and economical  service.

10. For certain fields in the medical curriculum foreign professors

might be engaged.  The main obstacles are the absence of junior Indian assist-

ants interested in the career of teaching and research,  the extreme overload of

teaching characteristic of Indian medical colleges, the lack of time, techniciam

and equipment for research, and the scarcity of foreign professors who would be

willing to leave home for extended periods of aewice, the delays attendant on

the ordering, shipment and payment of instruments, parte of instments and

consumable supplies that must be imported, and the tendency to relieve your-

selves of respomibilities by delegating them to foreign miracle men.

11.

      If soae explicit Percentage of e Sfate'a revenue could be fixed in
advmce over five yasr periods f~r asintainance (not na:r capital expend? tures)

the stud5.e~ preliminary to fixing t'nin exact percentage would show that medical

education is extremely expensive, but it is part of the cost of keeping alive.

No one of us can ascribe his good health to good luck:

thought and hard work that we drink safe water, eat eafe food, escape deadly

dieease and are cured by well trained surgeons and physicians.

begrudge expenditures so vitslly importmt?

it ie by money, fore-

Why do we

- THE CIRCUMSTANCES OR CONTEXT --I__ OF IEDICAL - EDUCATION IN INDIA.

1.

The population of India is about ~0,000,000.

There are about

9,000 doctors trained in modern medicine.

kinds t'nere may be rm one knoirls,  but I should be surprised if there was not one

for every 900 of the populntion - i.e. 400,000.

How many other "healeren of other

The population is 83 to 90% village.

Urbanism, at the expense of

village life and of a disastrously disorganized type, exiete in all of the larger

cities,

Indian society is in flux.

The population ia reported to heve increased 13.3'$ in the laet

decade, and there is no evidence that the rate of increase has slackened, The

arable 1md under cultivation has decreased.

Malnutrition md poverty are not only wideepreadj

they influence

public policy and the private conduct of every citizen.

Agricultural practices are primitive and wastef'ul.

They are ale0

traditionally and tenaciously followed.

protect the lives, destructive monkeys and 100,000,000 unproductive cattle exact

Religious belief 8 or superstitions that

18 .

additional losses upon the production of crops for hmm use.

2.

Communication of usef'ul knowledge and needed services in a country

where there are 16 main languages and 86198 200 dialects,  would encounter obvious

difficulties even if the literacy rate were high.
Travancore-Co&n is the only state where more than 25% of the population can

read and write.

change, tbe same cannot be said of religion,  if Zl'ne Partition of Pakistan and

Among the Indian States

Though caste plays a diminishing role as a barrier to inter-

.@U derived from religious differences

or communalism.

Roads that permit Dedical officers, nurses and patients to Dove from

village to village are so poor and so nearly impassable in wet weather that the

distribution of medical care becomes excessively hard.  To expect even salaried

doctors to live in isolated primitive villages shows either ignorance of village

life or ignorance of the criteria now used in the selection of medical students.

       Provincial rivalries, jealousies and isolation,though not easily

verifiable, can hardly escape the outsider's observation,  and it is idle to

suppose that mong the

of academic personnel that desemes to be considered easy or unimpeded.

medical colleges in India there is ae yet interchange

3.

The partition of Pakistan imposed immense expense to the govern-

ments involved. It furthermore caused an almost incalculable dislocation of

medical and academic personnel, especially in Pakistan,  and absorbed for relief

work large sums that might otherwise have been applied to education and medical

welfare work of a more lasting kind.

4,

       The heritage of the Past in India ie complicated indeed.

future of medicine in India I would think compassion and concern for the welfare

of the whole people as both the spiritual and the practical baeie for success.

The tradition of the 1.M.S. aems to me to have been tinctured with medical

colonialism, private practice, early retirement, and advanced degrees for a

privileged elite.

For the

These values are not what the Indian doctor needs. The

traditions of' family, csst

religiony and the glori

s of th

Past, i

19 o

late

and protect the individual Indian from the poverty, ignorance the population

pressure that surround him almost to suffocation.   Nor is it more of such

protecting isolation that will help the Indian doctor to work with others in

the service of' the whole people.   Nor is it my kind of conservatism except

the most carefilly conddered, that will survive the present political,  social

and economic strains.

and radical changes must be made - not merely planned end written up,  to be

ignored, postponed or debated.

Prompt and large assistance must be given and prompt