§ LORD SYDENHAM had given Notice to ask the Secretary of State for India whether measures are in contemplation adequately to fulfil the medical requirements of the Indian Army, British residents, official and non-official, and the civil hospitals, and to secure the progress of medical science in all its branches throughout India; and to move for Papers. The noble Lord said: My Lords, I am very grateful to the noble and learned Earl for giving me this opportunity of raising this important question before the Recess. We have conferred immense benefits upon the peoples of India by the introduction of Western medicine and surgery. This most important part of our duty to the peoples of India may be said to have begun when Lord William Bentinck opened the Calcutta Medical College in 1835, but since then it has been vastly developed, and the Indian Medical Service grow in time to be one of the finest, perhaps even the finest public medical service ever created.
§ It has produced men who have won world-wide reputation, not only for research into the causes, the spread, and the prevention of diseases which afflict India, but also for the great work which they have done in educating the Indian students. And, while this service has always maintained a very high standard of health in the Indian Army, to which it specially ministers, its achievements on the civil side have been most remarkable in the interests of the Indian people. The hospital system which we introduced into India has been spread broadcast over that country, and has been imitated in many Native States. In my time it was receiving constant additions, and every effort was being made to bring Western medical science as closely as possible to the masses of India. I think that every Viceroy and every Governor did all in his power to assist those efforts, but all the work which had to be done was mainly due to the Indian Medical Service, which is in the strictest sense a key service, because it not only conserves the health of all the other British Services, but it supplies the directive force in all that may be called sanitation in India.
§ The Indian Medical Service is crumbling away, and it has been necessary lately 553 to send out medical officers on short contract, which is totally unsuitable to the conditions of India. It is essential that the medical officers of India should know the people, and know their languages, and should regard India as providing them with a career. This makeshift system cannot possibly answer. In recent years there have boon a great many inquiries into medical matters in India. The Royal Commission on the Public Services of 1912–15 in what was necessarily a belated Report, published, I think, in 1917, stated that the Indian Civil Medical Service was being economically and efficiently performed, which was undoubtedly true at that time. Then came the Verney Lovett Report of 1919, and that proposed a unified service to be called the Indian Medical Corps, the Indian Medical Service absorbing the R.A.M.C., and special provision being made for the civil duties. The Esher Committee of 1919–20 declared that the Verney Lovett plan was the only feasible scheme of unification, but it decided that the amalgamation of the I.M.S. and the R.A.M.C. was at present impracticable.
§ Then came the Lee Commission of last year, which proposed that the R.A.M.C. should absorb the I.M.S.—which, I believe, would give rise to a great many administrative difficulties—and that a civil branch should be created which would be 50 per cent. Indian-recruited. The Report alluded rather ominously to "the requirements of the Provinces for a separate medical service." Those words seem to show that there had been some political pressure brought to bear on the Commission, and I believe that our best medical graduates will never join a provincial medical service which would quickly become purely Indian, whatever proportion you arbitrarily fixed. Under the Act of 1919 all the Medical Services were made into a Transferred Subject and subsequently a boycott of the Indian Medical Service officers was set up. In many places they were boycotted as consultants and in other places attempts have been made to prevent patients from entering hospitals which are under their administration.
§ India has produced a limited number of medical men of marked ability, and the sub-assistant surgeons, a class which we have created, has done much useful 554 work, especially when under British supervision. But India has never shown the aptitude for Western medical science which has distinguished Japan. There are reasons why that should be so. The ways of the Western Medical Service there have not yet won the full confidence of the Indian people, or even of all the educated classes, although Mr. Gandhi, who is the greatest protagonist of Indian methods was not anxious to be operated upon by an Indian surgeon. Vaids and Hakims are still numerous and influential and they account annually for a considerable part of the mortality of the people in India. The Ayurvedic and Unani systems, which are not really systems, are now being subsidised from public funds in some places at the public expense, and this waste of public money is sure to be increased in the future. There can be no doubt that if the Indian Medical Service is not restored there will be a large reversion to indigenous methods which will have a disastrous effect upon the general health in India, and there will also be widespread corruption of the kind described in a letter to me from an Indian sufferer which I read to the House only the other day.
§ India cannot at present produce men capable of directing, teaching and developing an exotic system of medicine and surgery and, besides that, caste laws may and very often do interfere with the work of the Indian practitioner. Of the very large number of students we turn out annually from our medical schools a considerable proportion never make any attempt to practice, and many of them become politicians, while a few have specialised in bombs. So far as our fellow-countrymen, women and children in India are concerned, I am sure we all feel that it is the duty of the Government to provide them with medical assistance from men of their own race. The Lee Commission admits this and proposes to set up districts, each possessing a European officer whose journeys to patients, or the journeys of patients to him, may be defrayed in whole or in part at the public expense. If the districts are made small enough this plan might work, but already in some cases great hardship exists in the distance of British people from a doctor. To live in India a hundred miles from medical assistance adds terribly to the anxieties of our 555 married officials and tends to make service in India more and more undesirable.
§ I hope I have said enough to show the great importance of this Question in relation to the Indian peoples as well as to our own countrymen serving in India. I do not forget the work of the medical missions, of which I saw a great deal. They also are bringing Western science to the people of India and perhaps especially to the women of India who certainly are in dire need of it. The difficulties in finding a solution of many of the present problems are very great, in view of the hostility to British officials, to British methods and even to British science, which has been generated in recent years. I dislike and distrust centralisation, but I am convinced that the general direction of any Civil Medical Service in India, of medical education and of medical research must be retained in the hands of the Imperial Government. Failing this there will certainly be a general reaction and a fatal lowering of standards in the whole administration of the Medical Services throughout India. The effect of that, I am sure, would be a black calamity to the peoples of India, for whose welfare we still remain absolutely responsible.
§ I am sure that the noble and learned Earl realises the supreme importance of the Medical Services in India. But I do not think that any one who has not lived some years in India and closely studied the life of the people can quite understand what the decay of the Indian Medical Service must and will mean to them. I again appeal to the noble and learned Earl to think of the vital interests of at least 246 millions of simple, credulous people in British India who know nothing whatever about politics and do not in the least know what is now being said in their name by a small minority. I beg to put my Question and to move.
§ THE EARL OF BIRKENHEADMy Lords, the concluding sentence in the speech of the noble Lord seems to me to have very little relation to the interesting and largely uncontroversial observations which preceded it. It was really more appropriate to a debate which took place in your Lordships' House some few days ago. The Indian Medical Service and its organisation has always been a question 556 of extreme difficulty. It is at the same time, as the noble Lord has pointed out, a military and a civil medical service, and no one knows better than the noble Lord that the interests of the two branches have not always been the same. The reforms of 1919, as the noble Lord informed the House, introduced a further complication, and it should be made clear at the outset that the obligations are those that are laid on the Government by the Government of India Act and the statutory Rules which were made under it. The cardinal fact is that, generally speaking, the civil medical administration of India in the Provinces, including the administration of hospitals, public health and the provision for medical education, is a Provincial Transferred Subject; that is to say, the responsibility for it rests with Ministers and by a Rule under the Act the Secretary of State, one of my predecessors, has divested himself of the powers of superintendence and control which he formerly exercised in regard to it.
The Lee Commission, subject to the limitations I will presently mention, took the same line with the Indian Medical Service as with other All-India Services dealing with Transferred Subjects. It appeared to them to be the logical and the practical sequence of the reforms that, subject to the reservation of the rights of present members of the Service, the Provincial Governments should in future recruit and control the Services for whose work they were responsible to the Provincial Legislatures. Their view has been accepted in principle for the Indian Medical Service as for the other Services in question. In the case of the Indian Medical Service, however, the general principle is limited by two important considerations: First, the Civil Medical Service is the only source from which a medical reserve for the needs of the Army, and in particular its requirements in trained British medical men, can be easily obtained in emergency; secondly, I have decided to adopt the recommendations of the Lee Commission for the provision for European services of medical attendance by British medical men.
I will now deal with the various heads mentioned specifically by the noble Lord. In the light of what I have said it will be clear that the Secretary of State will no longer undertake be recruit officers for the medical administration of India 557 generally or, in particular, for civil hospitals as such. Nor can he assume responsibility for the medical care of British non-officials resident in India. But the Act left as "Central Subjects," for which the Government of India are responsible, a number of matters, for instance, central agencies for research and technical training and the promotion of special studies, and a reserved responsibility in regard to legislation for infectious diseases and the regulation of medical qualifications and standards. For these the Secretary of State remains responsible and he will continue to recruit officers to deal with them. He will also, of course, recruit for the civil medical needs of administrations that remain directly under the Government of India, and for the Political Department.
There remain for consideration the provisions to be made (1) for the Army, including its Medical Reserve, and (2) for medical attendance on the European Services as recommended by the Lee Commission. I have received the recommendations of the Government of India on these matters and their consideration is already well advanced in my office. I am not yet in a position to communicate my final decisions, but I may, perhaps, indicate the lines on which I think a solution of this difficult question will be found. The Lee Commission, with some hesitation, for they realised that military organisation lay outside their terms of reference, recommended that the military side of the Indian Medical Service should be absorbed in the Royal Army Medical Corps. The proposal has received very careful consideration from the Government of India and myself, and we have come to the conclusion that the solution proposed would raise many more difficulties on the military side than it would solve. We therefore think that the Indian Medical Service must be maintained. It would be essentially a Military Service, but its reserve would be secured by lending officers to the Civil Administration. A consideration of the numbers in question goes to show that the number of European officers in the reserve so lent would be sufficient to provide for the needs of the European Services on the lines of the scheme proposed by the Lee Commission. These officers would be stationed at the headquarters of groups of districts throughout India, and would be made available for the European Services 558 and their families. The officers required by the Government of India for the central medical subjects would also be obtained from the Military Indian Medical Service.
It is, of course, a matter of the first importance whether a service constituted on these lines will attract recruits of the right class. I am inclined to think that it will be essential, with this in view, to reserve for the portion of the Army Reserve lent to the civil side but not required directly for the medical care of the British Services, a number of civil appointments; for instance, research or professorial appointments. Such appointments have always been one of the attractions of the Indian Medical Service, and if the essential Army Reserve maintained in civil employment allows a margin, as it almost certainly will, it is clearly a gain not only from the point of view of recruiting inducements but a gain to Indian public health generally that they should be employed in the departments of research and teaching in which their predecessors have done so much for the welfare of India.
My statement on the matter is necessarily tentative, for the final conclusion can only be reached after a careful balancing of the various interests involved, and, in particular, the claims of the Local Governments to the control of the Provincial medical administration. But, as I have said, I am hopeful that a solution may be found on these lines, and that it will appeal to the medical profession. I am the more optimistic on the last point because, unlike certain other Services, the Indian Medical Service is at present obtaining recruits of a high standard from the medical profession in this country, notwithstanding the uncertainty of the position pending my decision. I need hardly give the noble Lord an assurance that I shall not fail carefully to read what he said as reported in the OFFICIAL REPORT, because it is a little difficult to gather precisely, in dealing with these somewhat technical matters, what is said at the moment. I will, however, carefully read what the noble Lord has said.
§ LORD SYDENHAMMy Lords, I beg to thank the noble and learned Earl, and to withdraw my Motion.
§ Motion, by leave, withdrawn.