The Honorable Rajkumari Amrit Kaur
Minister of Health
New Delhi
Dear Rajkumariji:--
Doctor Raja suggested on January 28 that you might like to have a confidential memorandum on the reservations I expressed to him regarding the All India Institute project.  I did not put these into my report giving my impressions of medical education in India since no suggestion had been made that I do so nor did I have better than newspaper information until I saw you that this aspect of the suggestions in the Bhou Report was assured of realization.
On reflecting upon the simplest form in which to present my opinions it seems to me that they can best be offered under these headings: (A) the reservations I have regarding the All Indian Institute as a primary claim on the Central Government; (B) the arguments against proceeding with such a project before 1960; and (C) provisions and precautions that might well be taken to minimize the disadvantages mentioned in (A) and (B).  I venture to add these considerations (C) because I would be glad to be of any possible help in alleviating the consequences of a course I would prefer to avoid.  To some extent the points in (A) and (B) overlap--at least reasons against undertaking the plan
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of an All India Institute at any time would obviously be in operation if the project is to be initiated and pushed in the near future.
A.  I question the wisdom of creating such an Institute in Delhi for the following reasons:
1.  In no capital cities in any country that I have seen does an institution controlled and supported by the national government escape the distractions of politics, the temptations of power, and the jealousies of provincial institutions.  The influence of Johns Hopkins derived from the similarity of its status to that of other medical colleges: it never had the inimitable status of support from the Federal Government.  If it had, emulation would have given way to jealousy, and its example would have lost its force.
2.  Leadership cannot ignore the sentiments of potential followers.  The primary function of the Central Government is to aid its constituent states rather than stimulate them: otherwise the so called stimulus is likely to be resented.
3.  If the Institute is to include a college of Medicine as well as a place for training research men and teachers the size of the total budget will make the provincial colleges averse to trying to imitate it--the full cost will be too discouraging, and those who will stop to break it down into its component parts too few.
B.  The effort to create an All India Institute before 1960 presents additional objections:
1. Why another child where the existing children are starving, or,
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why create another medical college when the existing colleges are so anemic and precarious?  You can staff an All India Institute only with men taken from existing colleges.
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Outline of Report on All India Institute
Reasons for
1.  Example it would set of how a medical college should be organized and maintained.  This example is needed by the State Govts. who need both the stimulus and the example that would be given.
2.  A place is needed where recruits to the ranks of teacher and investigator can be trained as teachers and investigators before or after training abroad
3.  It is important to have such an institution in the Federal Capital in order to ensure through contact and familiarity that the Central Govt authorities directly or remotely responsible shall be familiar with the needs and potentialities of such an institution.  Furthermore it could not be placed in any of the States without creating jealousies and intransigent non-cooperation as the result of such jealousies.
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Reasons against creating an All India Instit. immediately i.e. before 1960.  The views of the Bhou report have been ignored until it is now too late.
1.  It could only be staffed by men taken from the existing medical institutions in the various states.  How can one expect that colleges that have lost their best men to an All India Institute will feel friendly enough to urge their best brilliant juniors also to leave to attend the All India Institute?
2.  The present resources (in able men) of the present medical colleges are too few to stand further depletion from Central Govt.
3.  If you strengthen the existing leaders all over India with funds that will provide assistants, technicians, space, instruments, salaries, and time to do research work and advanced teaching you would set an example more stimulating and to a larger number, of young men than creating a single institute in Delhi.
4.  Until salaries for all ranks in the medical colleges are raised there will be so few recruits to teaching and research in the medical sciences that the expense of establishing an all India Institute for the advanced training of teachers would be unjustified.  Time will pass before the increase of salaries in any serious proportion in 24 State schools can be effected.
5.  No effective leader for such an enterprise has been mentioned and a very great deal of the success of such an enterprise depends upon him.  As long as the present 55 year retirement rule continues to be in force the selection of such a person becomes more diffic.
6.  Political and financial uncertainties of the next 5 years.  The present indifference to and ignorance of the value of high quality
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of medical education made me unable to assure an enthusiastic understanding on the part of future Central Govt officers.
Reasons against an All India Instit at any time in Delhi
1.  Confusion of purpose: is it another medical college?  If so why start another when so many existing ones are languishing and for reasons that the Central Govt could reverse at less cost that that of creating a new one.  Why another child when the existing children are starving?
2.  Isn't it better to aid the states than to shame them?
3.  In no world capitals I know does higher education escape the distractions of politics, the temptations of power, and the jealousies and at times the despair of provincial institutions.
4.  Having the teachers in Delhi calls for buildings that should be begun now at an excessive cost.
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C  Since you are committed to a course I think unwise I can only offer comment that lies more of warning than of recommendation:
1.  Get the 55 rule abrogated so that you can take the best men from the State medical schools at 55 and thus avoid the adieu of stealing their best men.  This will secure experienced teachers but very few of them will be in their productive years as research men.  They will also be hard to handle.
2.  Offer posts to young men who have returned (or will return) from foreign fellowships to posts where their research interests are entirely ignored.  Of course I think Central Govt would be wiser to help these young men where they are in the State Universities but you do not apparently agree.  You must back the young men with opportunities to do research unless the Institute is going to be just another teaching institution.
3.  Get a direction for this enterprise who commands your full confidence and give him liberty as well as responsibility.  It will take him ten years to produce results enough to be evidence of his success or failure.
4.  Get some land where the staff can live together or near enough to each other to make possible a corporate spirit and some measure of comfort.
5.  Divide your staff appointments into these categories A) Permanent, B) 5 year renewable only once for 5 years C One year appointment renewable yearly for five years.  Thus C appointees at the end of five years will either leave or be taken on as B appointments and B appointees after 10 years will either leave or be given permanence.  The Director will need a strong Board to make this system work.