Decades before Sen’s birth, the creation of the Native Medical Institution (NMI) in 1822 marked the beginning of British influence over the medical education system in India, the effects of which reverberated throughout the 19^th century. For example, Sen’s final examinations to become a doctor took place at the Medical College conducted by European doctors (Sen 173). Notably, the NMI taught courses in Urdu and the curriculum included both Western and indigenous Indian medical practices. The Sen text illuminates how, though Indian and European doctors continued to work together, a clear hierarchy of European superiority was established with European doctors and nurses being paid significantly more (Sen 184).