This paper focuses on the Madras Presidency of British-ruled India and highlights the ideological background behind the introduction of modern medicine, particularly through modern medical education starting with the Madras Medical College. It goes beyond the technicalities of the founding of the college to look at the underlying rationale and the preceding debates to explicate the ways in which medical ideas and values were moulded, imparted and contested through the agency of an educational institution. The paper traces the roots back to the early 17th century when the British started having mental impact on India through their medical knowledge and skills. Madras was the first presidency to have a hospital established in India in the year 1664. The hospital had served as the nodal centre for all other branches and for the future medical developments in the Presidency. Along with the discharge of medical duties came the need for more local training. The various incremental efforts converged into a momentous one in 1835 when the foundations were made for a fully-fledged medical institution run on western lines. This marked a decisive moment in the encounter of medical traditions as it simultaneously subsumed much of the intellectual contestations of the preceding two centuries and queered the pitch for more. The paper explores the attempts at hegemony, accommodation and flexibility around the establishment of the college, its course curriculum, its admission patterns and in the opportunities it threw open for Indians. It also highlights elements of indigenous responses related to the introduction of anatomy, physiology and midwifery, and to procurement of cadavers. It also analyses the multiple intellectual roles of native practitioners of modern medicine who were carriers of British medical ‘ideas and items’, and the practitioners of indigenous medical systems who were at times contesting and at other times seeking legitimacy under the new intellectual order. The paper aims to capture the results of the curious indigenous reaction against western hegemony by taking the story up to the year1924, which saw the establishment of a School of Indian Medicine