The making of the Indian Medical Services THE Government of India asked C.M.G. Ogilvie of the ICS in 1934 to look into the reorganisation of the medical services. His report, as per the Defence Department Resolu-tion No. 205, dated March 25, 1937, when implemented resulted in a number of changes. The officer strength of the Royal Army Medical Corps (RAMC) in India was fixed at 268 and that of the Indian Medical Service (IMS) at 364. Of the latter, 144 were to be Indian officers, not more than 58 of them were to be on short service commission. On the civil side, 166 posts were reserved for the British and 54 for Indian officers of the IMS, of whom 97 British and 50 Indians constituted the war reserve. The remaining held the residuary posts. Of the 166 officers, 122 were employed in the provinces and 44 with the Central Government.

The second death anniversary of Dr P.N. Chhuttani falls tomorrow. He was President of the Tribune Trust from June 9, 1988, till he passed away on July 19, 1996. We are publishing this article by R.K. Malhotra in his memory on a subject which was dear to his heart.It highlights major events and decisions that have influenced the structure, administration and functioning of the Indian Medical Services, both in times of peace and war and also before and after Independence in 1947. Effects of the changeover from an imperial to a national government become perceptible in military and civil medical services to meet the changing needs of the country.Dr Chhuttani joined the Army (IMS) after doing M.D. from Panjab University, Lahore, in 1942. He served in the West Asian theatre of war during World War II. Later, he was conferred the rank of Hony. Brigadier for his pioneering contribution to the medical profession in India.

It was also decided that while the British officers would continue to be recruited by nomination, the Indians were to follow the route of selection for a short service commission of a five-year term after which they could apply for a permanent commission.
The promotion to the rank of Major was quickened by two years, but the basic pay was reduced by Rs 100-150. However, the overseas allowance payable to Europeans only was raised from Rs 150-300 to Rs 250-400 per month between the second and twelfth year of service. The IMS was given six more posts of Colonel, bringing the strength in the senior ranks on the military side to three Major-Generals, seven Colonels and six non-administrative Colonels. The civil branch included four Major-Generals, inclusive of Director-General, IMS, seven Colonels and five Lieutenant-Colonels. The three Major-Generals held the posts of Surgeons-General in Madras, Bombay and Bengal. Seven Colonels were posted as Inspectors-General of Civil Hospitals in the United Provinces, Punjab, Burma, Bihar, Central Provinces, Assam and North-Western Frontier Province.
The diseases endemic to India provided a rich field for research and the work of some of the IMS officers led to landmark discoveries. The foundational work of Surgeon-Major Dempster done in 1845 in relation to the spleen rate as a reliable guide to the incidence of malaria was carried forward with distinction by Sir Ronald Ross, who identified the mosquito as carrier of the malarial parasite in 1897-99. He was made a Nobel laureate in 1902 in recognition of his outstanding contribution. Sir Samuel Rickard Christophers, who directed the Central Malarial Bureau from 1919 to 1924, supplemented Ross’s work. Further work was done by John Alexander Sinton, when he was the Director of Malarial Survey of India from 1927-38. In 1948, Henry Edward Shortt demonstrated phases of malarial parasite which were hitherto unknown.
Sir William Boog Leishmann of the RAMC and Charles Donovan, Professor of Physiology, Madras identified the parasite of Kala-azar independent of each other, but simultaneously. Sir Leonard Rogers carried forward their work as also made a pioneering contribution in leprosy, bowel diseases and cholera. He also made his name with Sir J. Fayrer on poisonous snakes. Whereas Sir Ram Nath Chopra studied Indian drugs, the problems of nutrition were researched by Sir Robert Mac Carrison.
The Earl of Listowel, Secretary of State for India and Burma, paid rich tributes in the House of Lords in 1947 to the IMS officers who had made a singular contribution in medical education and research while at civilian posts. He said: “The Indian Medical Service, though its primary function has been the care of the civil and military services of the Crown in India, has also contributed substantially to the advance of medical science and has played a leading part in building up a modern system of applied medicine in India. Its research into the cause of malaria resulted in discoveries about the malarial mosquito. ... In the application of medicine it reduced the death rate from cholera in India by two-thirds and its mastery of the diagnosis of many tropical diseases has brought relief to thousands of victims. It was the pioneer, and for many years the only source of medical education, and the father of the three medical colleges, which were founded in British India in the nineteenth century. The result of the pioneer work done by the Indian Medical Service is that India now possesses a well-organised medical profession of more than 50,000 practitioners.” The three colleges he alluded to were founded at Calcutta, Madras and Bombay.
The IMS underwent the most exacting test of its capabilities when it served the armies in World War II. However, after the war the revolutionary changes brought about by the advent of Independence changed everything, including the medical services.
World War II, as expected, led to reorganisation of the IMS. Its strength before the war was 631 officers of whom 265 were in civil employ with 78 holding residuary posts. Another 300 officers were on the authorised strength of the army in India belonging to the Reserve of Officers (Medical). Members of the Indian Medical Department (IMD) in military employment consisted of 346 assistant surgeons of the British cadre and 578 sub-assistant surgeons of the Indian cadre. The number of the Indian Hospital Corps was 8645 with a reserve of 3522. Such a small strength was indeed insufficient to meet the Indian army’s requirements. To cap it, with severe losses in Burma and Malaya in 1942, and with an increased workload, the shortfall was so severe that the Medical Personnel Mission allowed the licentiates to join the IMD and the IMS on par with the graduates. This gave birth to the establishment of the Indian Army Medical Corps (IAMC) in April 1943, which remedied to a large extent the shortage of medical officers. The Indian Hospital Corps (IHC) was also merged with it. By the end of the war, it had a strength of 1,47,100.
The need for an unexpectedly expanded medical service led to an alarming situation as the war engines rolled on. It forced the powers that be to take a new took at the oft repeated question of whether the IMS should be basically a military or a civil service. However, the pressure of war resolved the problem, as the number of British doctors in India dwindled. Indian graduates and civil practitioners were given emergency commissions. As the shortage of British applicants restricted further recruitment to the British cadre of the IMD, members of the Indian cadre were duly recognised as a valuable adjunct to the hitherto exclusive service.
At a meeting of all administrative officers of the services held towards the end of 1945 in New Delhi, it was unanimously opined not to reopen recruitment for permanent commissions. By July, 1946 while there had been a relative increase in the number of temporary and emergency commissions, the total number of officers on the permanent cadre had fallen to 420 only. The other decision to permit all regular officers to proceed on leave pending their retirement in January 1947, hastened the inevitable end of the IMS. And, with the transfer of power on the partition of the country into the two nations of India and Pakistan, the IMS ceased to exist.
The incidental advantages both for the medical service and for India that flowed from the war were, indeed, unimaginably large. The six years of war enforced the change from a foreign medical service to an Indian one. It is, of course, debatable whether the successful bid for independence could have been achieved without further political strife, if there had been no World War II. As a consequence of the partition of the country in August 1947 the medical services of the armed forces were severely affected. Several wide-ranging administrative changes had to be undertaken in the wake of the division of assets between India and Pakistan.
The Army Medical Corps was soon involved in the process of modernising its facilities and updating its technology in keeping pace with the rapid strides being made in the medical sciences. The medical service, which was once merely an adjunct to the fighting troops, soon became an integral part of the armed forces. Its personnel mobilise themselves whenever the country is drawn into a conflict. The Army Medical Corps has also distinguished itself in many an assignment abroad at the behest of international agencies of the UNO. It has served in Korea, Vietnam, Laos, Gaza, Congo and some Middle East countries with credit.
After the British left, it was thought prudent to send medical officers abroad for training in specialised subjects with a view to building up a cadre of qualified doctors with postgraduate degrees. They, in turn, were expected to train younger doctors, particularly for large military hospitals. But to send them abroad was a drain on the country’s foreign reserves. In order to meet the situation, Dr B.C. Roy Committee recommended the establishment of the Armed Forces Medical College at Poona after combining various training centres already located there. The Army Medical Training Centre (AMTC) which was established in 1942 was to serve as a nucleus.
The Armed Forces Medical College was formally established as a postgraduate institution on May 1, 1948. It had the responsibility of training medical officers of the Army, Air Force and Navy with special emphasis on certain branches of medicine which were important to the armed forces in the times of peace and war. Continuing medical education was ensured by organising refresher courses, which kept medical officers updated with new techniques of treatment and provides facilities for the senior officers’ course previously held at Millbank in England.
The Armed Forces Medical College comprised three departments in addition to the headquarters wing. The Army School of Radiology and the Army Blood Transfusion Centre formed part of the clinical department. The Central Medical Research Organisation and the Central Military Pathology Laboratory constituted the pathology department. The Central Military Malaria Laboratory was merged with the Hygiene department. The post of Commandant of the new college was upgraded to that of the Brigadier, with three professors of medicine, surgery and pathology holding the rank of Colonel. The administrative control vested with the Director-General of Armed Forces Medical Services. An academic council was also formed to advise him on educational matters.