Bombay University was the first to fashion its basic medical courses as MBBS.

The famous medical course of “M.B.B.S.” was introduced as a university degree in India around 1906. Bombay University was the first to fashion its basic medical courses as MBBS, and the history of how this came about is a fascinating story both of curricular developments in the field of modern “allopathic” medical education, and of the uniquely Indian clash between two different types of medical training institutes: the medical school and the medical college.

Formal modern medical education began in India in 1835 with two new institutions. One, in Calcutta, got named as a medical college (“Medical College, Calcutta”); the other, in Madras, was named as a medical school. It is not clear what motivated the respective British officials at Calcutta and Madras to name their institutions in those particular ways. But importantly for our story, the next two medical institutes were called colleges: the 1845 Grant Medical College of Bombay and the 1860 Lahore Medical College . The medical school at Madras itself was renamed as the Madras Medical College around this time. In other words, “medical college” became the default term for major modern medical training institutions in the Indian subcontinent.

For some time, these medical colleges awarded various diplomas and certificates to graduating students, with little standardisation in the titles of these diplomas and degrees. But after they came under the administration of the Central universities which were established in 1857, the colleges began granting standardised certifications, most commonly the Licentiate in Medicine and Surgery (LMS), Bachelor’s degrees in Medicine and Surgery, and the doctorate degree. At the turn of the century, the four government medical colleges in British India were granting degrees as follows:
The Madras Bachelor’s degree was abbreviated as “M.B. and C.M.”, while Calcutta and Lahore simply called it “M.B.” Bombay was not granting Bachelor’s degrees yet. In addition to these, the colleges also granted a doctorate, fashioned as “M.D.” It is important to note that there was a hierarchy in the courses. The L.M.S. was generally considered “lower” than the Bachelor’s, which was of course “lower” than the doctorate.

These four medical colleges were not, however, the only modern medical education institutes in India in the 19th and early 20th centuries. Apart from the medical colleges there were , well, the medical schools. So if the colleges were already training doctors, who received training in medical schools? That would be other healthcare personnel: apothecaries, compounders, dressers, hospital assistants, etc. Some of the schools offered courses not in English but in the vernacular languages, and the duration of the courses was less than in the colleges.

The 1897–1902 Progress of Education report lists 11 government medical schools: those at Madras, Poona, Ahmedabad, Hyderabad, Calcutta, Patna, Dacca, Cuttack, Agra, Lahore and Dibrugarh. The medical schools, unaffiliated to the Central government-managed universities, were almost entirely in the domain of the provincial governments. There were also some private schools, most of them in Calcutta.

Then in the inaugural decade of the 1900s, an important development occurred which led first to the introduction of the MBBS course, and over time to the withdrawal of the LMS (or licentiate) degree and the eventual closing down of medical schools across India. This development was the decision by the colonial government to phase out the LMS courses from its universities. It meant that university medical colleges would no longer grant the LMS degree. As seen above, Bombay University was only granting LMS degrees around this time, apart from doctorates (and no Bachelor’s degrees). After this decision, it now needed to introduce a new Bachelor’s programme. Considering that other universities had already been granting Bachelor’s degrees styled as “M.B.” or “M.B. and C.M.”, Bombay University could simply have adopted one of these nomenclatures. But it decided to inaugurate a totally new name: the M.B., B.S. (note the comma).

The M.B. was a familiar degree, and so was the B.S. (Bachelor of Surgery), especially in the U.K. So Bombay University officials seem to have amalgamated these two Bachelor’s degrees to create this neologism. It is not clear if any other institution anywhere in the world granted an “MBBS” around this time, but we can say with certainty that it is the Bombay University that inaugurated the MBBS degree in South Asia, with the final decision being made in a December 1905 Senate meeting.

To be sure, the neologism was not appreciated by everybody. Here is one senate member (Arthur Powell) dissenting: “I am of opinion that the University should not father such a hybrid title. M.B. stands, I believe, for Medicinae Baccalaureus, B.S. for Bachelor of Surgery. I do not think a learned body should be sponsor for such an Anglo-Latin mixture. If satisfactory initials cannot be decided on, let the University confer the degrees of “Bachelor in Medicine” and “Bachelor in Surgery” and leave any abbreviation or mutilation to the public.” Nevertheless, the MBBS was here to stay.

As for the LMS course: it did not exactly disappear even though the universities jettisoned it. With no home in the Central government-controlled colleges, the LMS course was shifted to the provincial government-controlled medical schools which previously used to train, as we saw above, non-doctor healthcare personnel like apothecaries and “hospital assistants”. This was, however, bound to deepen the existing asymmetries between LMS and the Bachelor’s degree. Prior to these changes, both Licentiate and Bachelor’s medical students received training in the same institution, i.e., the university-affiliated medical college. They generally shared the same campus and learned from the same teachers, and enjoyed the respectability of a major university degree. A hierarchy was there, but in a more subdued form.

However, in the early 1900s, a vastly different scenario developed. LMS and Bachelor’s (including MBBS) students now received training in wholly different institutions  – respectively the provincial medical schools and the university medical colleges . Only the Bachelor’s degrees (and higher) now boasted of the coveted university stamp. The status gap between the two degrees widened into a deep chasm, and LMS education came to be scorned publicly, often by LMS graduates themselves, as being of an “inferior quality”. When the All-India Medical Council (the latter-day Medical Council of India, or MCI) was established in the 1930s, licentiate degree-holders were excluded from the proposed All-India Medical Register. To be sure, the licentiates were still considered doctors, but the medical profession was now divided into these two large, unequal, at times bitterly opposed groups of licentiates and “graduates”.

So in the 1940s, when independence loomed for India on the not-so-distant horizon, the licentiate doctors and their “medical schools” had become a sort of unwanted baggage for the larger medical profession. Most elite doctors (both licentiates and graduates) were advocating for what they termed a “uniform standard of education” for the whole country  – that all doctors should have a single basic degree and that there should be no hierarchy therein. The MCI proposed, in the early 1940s, that provincial governments should gradually either discontinue medical schools or convert them into medical colleges. The 1946 Bhore Committee report also recommended the same. For example, the Byramjee Jeejeebhoy (B.J.) Medical College, where I studied medicine in the late 2000s, was originally the Byramjee Jeejeebhoy Medical School, established around 1878. It became a college only in 1946.

Clearly, in the late 1940s, the new doctors of New India (this phrase was widely used during this time) were determined to erase all traces of the purportedly inferior “medical schools” from the country. They turned out to be highly successful in this endeavour, despite significant opposition. It is a fascinating turn of history that in recent years, largely under the influence of Americanised English, the “medical school” has stealthily and steadily staged a comeback in India.

Kiran Kumbhar is a historian, teacher and former physician, currently affiliated with the University of Pennsylvania.

In his column ‘Past Forward’, Kumbhar provides us with a rear-view mirror that ensures we drive straight ahead.
Dr. Yatendra Kumar Pathak