Gandhi and the Development of Public Health Infrastructure in Interwar Bombay

INTRODUCTION
From the beginning of the 20th century, nationalism emerged as a force in India, and the political landscape witnessed an increasing struggle for political power (Chakrabarti 2009). In the field of medicine and allied research, while the Montagu-Chelmsford reforms, on the one hand, resulted in the decentralisation of power, on the other, they also provided for further colonial domination. The Indian Medical Service, for example, continued to remain under the purview of the central government (Arnold 1994). This resulted in a growing discontent among the Indian medical professionals about the nature of the Indian Medical Service, something that was also visible in the city of Bombay (Rast Goftar 1914). 
Since the beginning of British rule in India, the field of medical practice and research had been dominated by the British officers who were the elite members of the Indian Medical Service (Kesari 1914). By contrast, Indian medical men were only appointed to subordinate non-clinical positions (Sanj Vartaman 1914), deliberately being kept away from the positions of power and authority. In 1913, the native population accounted for only 5% of the Indian Medical Service (Jeffery 1979). From the beginning of the 20thcentury, the domination of the British officers was contested by the rise of nationalism in the Indian subcontinent (Chakrabarti 2009). The Indian medical men began to demand equal opportunities based on merit in the Indian Medical Services (Kaiser-i-Hind 1914). Another important peculiar feature of the Indian Medical Services was the process of recruitment. The entrance exams were conducted only in England, and the training was provided entirely at British universities, making it difficult for the Indians to enter the colonial service (Sanj Vartaman 1914). Similarly, the colonial government ensured that the Indian university curriculum courses in health and medicine and research in the allied fields all remained elementary by contrast (Chakrabarti 2009).
The growing ‘nationalism in its attempts to create its own identities and spaces had challenged some of the established norms of medical tradition that the British had so carefully established in India, a process that endangered political, physical, moral, and institutional encroachment’ (Chakrabarti 2009). Since the late 19th century, the Indian medical men began to formally protest against these set procedures of the colonial authorities. The Bombay Medical Union, the earliest society of Indian medical professionals, in partnership with the Indian National Congress (INC), began demanding an end to the monopoly of the Indian Medical Services. In 1913, the Bombay Medical Union sent its representation to the Royal Commission on the Public Services in India, demanding equal status, privileges, and emoluments for the independent medical men, especially those in higher grades (Chakrabarti 2009). 
Furthermore, the arrival of M K Gandhi on the national front and his political ideology of ‘satyagraha’ and ‘swadeshi’ had a significant impact on the minds of the native population (Bandyopadhyaya 2004). Soon after World War I ended, the colonial government passed the Rowlatt Act, 1919. A series of events following the passing of the Rowlatt Act resulted in the launch of the Non-Cooperation Movement from Bombay in 1921(Bandyopadhyaya 2004). Some of the common forms of protests used by natives included the boycott of government medical institutions and British medical equipment, an emphasis on the indigenous systems of medicine, and so on. In the following section, I argue that during the interwar period, the contemporary political environment and the arrival of Gandhi significantly affected the public health infrastructure policies in Bombay city.
THE NON-COOPERATION MOVEMENT 
The Non-Cooperation Movement was the first of the three mass movements initiated by Gandhi (Bandyopadhyaya 2004). One of the important aspects of the movement was the refusal to engage with the institutions set up by the British and instead opt for ones run by native organisations. The idea of the Non-Cooperation Movement appealed to the members of the Grant Medical College (GMC) in Bombay, and they decided to boycott the British government by leaving the GMC and instead moving to medical colleges run by the natives. Many members of staff and students at the GMC began shifting to the National Medical College near Victoria Gardens. Famous medical practitioners from the GMC held evening classes for medical students(https://tnmcnair.edu.in/). This initiative was taken to prove that the Indians could build and maintain medical institutions without the British government's support. 
The political ideas of Gandhi also seem to have a profound impact on the decisions taken by the donors and the managing committee of the King Edward Memorial Hospital and Seth Gordhandas Sunderdas (henceforth GS) Medical College, which was established immediately after the end of the Non-Cooperation Movement in 1926 (http://www.tnmcnair.com/home/about.html#.Wfy2902ZOUl ). Though the hospital was built through a public-private partnership, the equipment committee consisting of Rustom Cooper, P T Patel, and Colonel Hamilton urged the BMC to boycott the use of British goods while purchasing scientific apparatus and medical instruments for the hospital (Pandya 1988). As far as the management of KEM Hospital was concerned, Pherozshah Mehta, Jehangir Cursetji and other donors insisted that the professors and teachers employed should all be qualified Indians who were not working for the government (Pandya 1988). The BMC passed a resolution stating that ‘the medical staff employed in the King Edward VII Memorial Hospital should consist of properly qualified independent Indian gentlemen not in actual Government Service’(Keswani 1951). It was a significant step considering that it provided employment opportunities for qualified Indian teachers and doctors’ when they were denied attachments at the Grant Medical College of J J Hospital in Byculla, which was the only medical school in the city at that point (Times of India 2016).
As far as the organisation of the hospital and the medical school was concerned, the BMC decided to approach the Bombay Medical Union for a detailed scheme instead of consulting a colonial institution. Jivraj Mehta, who had just returned from London after obtaining a medical degree, was approached by the union, and he accepted the proposal (Pandya 1988). He suggested a radical departure from the traditional design of teaching hospitals in India. Before the opening of KEM Hospital, most hospitals had isolated blocks that housed separate medical departments (Keswani 1951). Instead of following this set style, Mehta proposed that the entire medical college be housed in one large building and the hospital (including the outpatient block) in a separate building (Keswani 1951). In the opinion of Mehta, this would facilitate coordination between the various departments. The Seth GS Medical College and KEM Hospital were the first multistoreyed institutions of their kind and also the first Indian hospital housing the outpatient department within the main hospital building (Pandya 1988). 
During the non-cooperation phase, nationalist leaders felt that Bombay should have a medical college that was established only with the help of locally generated funds, without any help from the colonial government. This medical college was to serve the Indian medical students who were denied admission to the Grant Medical College. Through the donations received from the Tilak Swaraj Funds, the National Medical College was established in September 1921 at the Victoria Cross Lane in Byculla. It was at the National Medical College that the medical students received clinical instruction and were trained not only to provide medical relief to the patients at the hospital but also encouraged to serve the local community. Ayurveda, an indigenous system of medicine, was taught at this institution because the managing committee of the hospital took great pride in the heritage of the Indian subcontinent (http://www.tnmcnair.com/home/about.html#.Wfy2902ZOUl ).
The administrators of the National Medical College wanted to set up a People's Free Hospital so that the students could receive their clinical instruction at the same. However, they faced a paucity of funds and ruled out approaching the colonial government for help. During their search for local support to fund their efforts, A L Nair, who was the proprietor of Powell and Co, dealing with medical supplies and equipment, extended financial aid (http://www.tnmcnair.com/home/about.html#.Wfy2902ZOUl ). He donated two acres of land for the hospital campus and helped to set up a well-equipped hospital in 1925, which was then named after his mother, Bai Yamunabai Laxman Nair (Times of India 1929). The hospitals had 55 beds, including a separate maternity wards (Ramanna 2012). Apart from Nair, social reformers M R Jayakar, Kaikobad C Dinshaw, Rajabali V Patel, and K Natarajan, editor of the Indian Social Reformer, were on the board of trustees (http://www.tnmcnair.com/home/about.html#.Wfy2902ZOUl). The medical men working with these two institutions performed their duties in an honorary capacity and at considerable self-sacrifice, considering that neither of these institutions were recipients of government aid (Times of India 1929). 
W S Carter, from the Rockefeller Foundation, visited India in 1926-27. In his report, Carter critically commented on the National Medical College and declared it to be the 'weakest' in the country (Maharashtra State Archives GDC 1914). He noted that because the college was closely associated with the nationalist movement, it was not recognised by the government. Carter found the medical education imparted to the students was of low standard and therefore he declared Nair’s move to place his hospital at the disposal of National Medical College, to be a case of ‘misplaced philanthropy’ (Maharashtra State Archives GDC 1914). Carter was of the opinion that the "Indianization of most of the government and medical schools, brought about because of the pressure of the national movement, had contributed greatly to superficiality and mediocrity" (Ramanna: 3). There is, however, an evident bias reflected in Carter’s assessment of the National Medical College. Soon after its establishment, the institution began to provide medical relief to the native population. In 1926, a final-year student from the National Medical College stood first among the successful medical students of the Presidency (Times of India 1929). This proved that the native medical professionals were capable of effectively managing the medical care facilities and efficiently imparting knowledge of medicine to the students. 
    In 1929, the hospital management undertook the extension of the Bai Yamunabai L Nair hospital (Times of India 1929). The committee felt this was necessary due to the overwhelming number of cases seeking medical relief at the institution. The hospital was located in a thickly populated locality, and due to the charitable nature of the institution, it had become extremely popular. Dr Nair once again came forward and made a generous contribution towards the extension programme. He agreed to bear the expenses of the extension, exclusive of the equipment. Venkatrao, a member of the hospital's executive committee, urged the masses to come forward and contribute towards the programme. He firmly believed that the work of medical relief and medical education was difficult without the support of the native population (Times of India 1929). The people of Bombay supported the cause and contributed generously towards the extension program (Times of India 1946). 
THE CIVIL DISOBEDIENCE MOVEMENT 
Gandhi initiated the Civil Disobedience Movement in 1930 (Bandyopadhyaya 2004). The movement can be defined as a “public, non-violent and conscientious breach of law undertaken with the aim of bringing about a change in laws or government policies” (Vijayalakshmi 2012). Bombay ‘was in the vanguard throughout the course of the movement (Maharashtra State Gazetteer). Bombay witnessed mass participation in a wide range of protests such as strikes, temple entry movements, breaking of the Salt Law, demonstrations, hartals and picketing in front of liquor shops. During the movement, violent confrontations between the native population and the imperial forces resulted in a high number of casualties among the native population (Times of India 1930). On 17 April 1930, the police force entered Hurkisondas Nurrotumdas Hospital, and lathi-charged the fleeing men (Vijayalakshmi 2012). Fredrick Sykes, the governor of Bombay, believed that civil disobedience had acquired a powerful thrust in Bombay city and 'could not be dealt with under the ordinary laws' (Maharashtra State Gazetteer). The colonial state on the other hand made no arrangements to provide medical relief to the wounded. There was palpable callousness on the part of the government in this matter (Times of India 1930). 
The Indian National Congress and various organisations attached to the party opened up improvised hospitals to treat patients. For example, the Congress Free Hospital was set up on 25 May 1930 and the Times of India called it as the ‘by-product of the satyagraha campaign in the city’ (Times of India 1930). Various sections of the society came forward to support the working of the Congress Free Hospital. Similar to the system existing at the National Medical College and Nair Hospital, the medical staff voluntarily agreed to work at the Congress Free Hospital and did not receive payment of any kind. The medical staff looked at it as a kind of service to the nation. The hospital was stocked with medical equipment and food items such as grains and milk, medicines, etc, all of which came as gifts from philanthropic traders. Not only did the Barbers’ Association in  Bombay make a donation towards the hospital fund, but they also offered their voluntary service. Other residents in the city, such as washermen and taxi drivers in Bombay city, also helped the patients free of charge (Times of India 1930). Thus, the participation of the medical professionals in the non-cooperation and civil disobedience movements displayed a twofold agenda. Firstly, service towards the nation, and secondly, as a platform to express their professional capabilities in a biased colonial set-up.
CONCLUSION
Thus, one can conclude that nationalist ideas strongly affected the health policy-making process. Inequalities existing in the Indian Medical Service were pointed out and openly criticised. The Indian National Congress began to take up various issues related to the medical profession and made it a part of their agenda. Furthermore, the emergence of Gandhi as a leader of the masses and the ideas of ‘non-violence’, 'boycott' and 'swadeshi' found firm roots even in the field of public health. The native population not only boycotted the Indian Medical Services and set up local medical schools and hospitals, which were staffed entirely by Indians, but also replaced medical equipment from Britain with locally manufactured ones. The nationalist movement had a tangible impact on Bombay's development and management of public health infrastructure.