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The Classical Doctrine of Indian Medicine: Its Origins and its Greek Parallels c15: Appendix: Accadian, Greek and Indian Medical Prognostics

The Classical Doctrine of Indian Medicine: Its Origins and its Greek Parallels c15

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English

Appendix: Accadian, Greek and Indian Medical Prognostics

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¹ *JA*, Vol. CCXL, 1952, pp. 299-321.

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A RECENT publication of Mr. René Labat, *Traité akkadien de diangostics et pronostics médicaux*² has considerably enriched our knowledge of Mesopotamian medicine. It has a particular significance for the general history of science because of the light it throws on one of the oldest medical traditions and due to the point of comparison furnished by it, as regards other ancient medical traditions, which can be linked with it or which have at least been developed only a little later.

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² Académie internationale des sciences, Paris; E. J. Brill, Leiden, 1951, pp xlix and 247.

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The collection edited and translated by Mr. Labat had a large circulation in Mesopotamia; this is proved by the variety of the sources of fragments constituting the same. This fact alone shows that the work represents a tradition which was recognised everywhere and which was, consequently, quite old. The analogy with other technical collections has enabled Mr. Labat to accept as probable the fact that the composition of the work could possibly go back to the Hamurabbian period and more probably to the end of the Kassite era. But the majority of the tablets, which acquaint us with the manual, were written on the orders of Assurbanipal (668-627 B.C.), an older one going back to the reign of Mardukapaliddin of Babylonia (721-710 B.C.) and a more recent one being dated in the eleventh year of Artaxerxes, that is, in 453 (pages xiv, 212-213, tablet 35). Regardless, therefore, of the original antiquity of the manual, we have to deal with teachings which were in vigour in Mesopotamia from the VIIIth to Vth centuries B.C. This is the period of the beginning of Greek medicine and it is contemporary with that of the Vedic and Brahmanic elaboration of Indian doctrinal medicine. One could, therefore, ask oneself if there is any analogy between such Mesopotamian teaching and the two great medical traditions of antiquity, of which one was born in the East in India and the other in the West, in the basin of Eastern Mediterranean. Mr. Labat has himself looked for the analogies of the manual in Greek medicine and we are here going to look for the same in Indian medicine.

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But before presenting us with analogies with these two medical systems, the Mesopotamian shows up a striking difference. Whereas the former are characterised by an effort at constructing rational theories aiming at an explanation of physiological and pathological states, the Mesopotamian does not show itself under a theoretical form.. It does not, however, follow that it had never known any theory. The absence of theories in documents that have reached us could have been due to the extreme rarity of doctrinal works. Everywhere and in all the periods, the practical medical literature, the collections of usual data for diagnosis, prognostics and treatment are much more numerous and more widespread than dogmatic works; it is, therefore, the former that have more chances of being found when the tradition is dead and is revealed only by the chance-discovery in excavations. Whatever it be, in the particular case of Mesopotamian medicine, we know it only by the collections meant for the use of the practitioner and not for that of the theoretician.

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However, the practical teachings of Accad are methodically arranged; they show a great effort of regular observation and of rational classification and are well-suited for being compared with more elaborate teachings which have reached us more completely, i.e., those of Greece and India.

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The Accadian manual published by Mr. Labat consists of five parts. The first gives a series of prognostics drawn from signs observed by the exorcist when he goes to the house of the patient. It refers, therefore, as has been noted by Mr. Labat, more to divination concerning the patient than to medicine. The type of indications is as follows: "If, in the street, he (the exorcist) sees a potsherd planted (in the earth), anxiety will not approach that patient". Or "If he sees a table for offerings (?), the patient in question has been seized by some charm, he will remain ill and then die" (Table I, 2-3). In the latter case a diagnosis concerning the medical origin of the disease precedes the prognostics. This first part, designated according to its commencing words, *When the exorcist goes to the house of the patient*, also carries the enigmatic designation of *Sick Muscles*.

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The second part, *When thou approachest a patient*, after reminding the doctor of the necessity, for his personal safety, of performing a prophylactic charm prealably, enumerates the signs presented by the patient at the time of the doctor's approach and which reveal the origin of the disease, most often due to the "hand" of such and such a divinity, which has put itself over the sick person. For example: "If he is 'struck' in the cranium: the 'hand' of Papsukkal . . . If, being 'struck' in the cranium, his ears do not hear: the 'hand' of Istar' " (Table III, 9-10). The prognostic often follows or is given alone, without a prealable diagnosis.

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This part, written according to a prototype of Babylonia, is, properly speaking, an *aide-mémoire* of semiology, enumerating the symptoms, organwise, going from the head to the feet and indicating their significance. Most of the time, it is a case of isolated symptoms and its medical value is nil. It will be even difficult to believe that the Mesopotamian doctors could have preserved, for a long time, in their traditional lists of significative symptoms indications such as these: "If his nose is cold: he will die" (Table VI, 3) or: "If the tip of his nose is yellow, he will die" (ibid., 25). One should suppose that probably some complementary oral instruction existed or that the indications furnished by parallel manuals specified the conditions in which similar symptoms could become significant. Besides, these conditions are indicated in certain cases: they are constituted by the presence of other symptoms associated with the one referring to the part of the body in question, that is to say, in the existence of clinical entities or syndromes of recognised individuality. Here the manual does assume a really medical character distinguishing it from the collections of divination. For example, certain crises of convulsion are described in these terms: "If the neck of the patient continuously turns towards right, if his hands and his feet are clenched (?), if his eyes are closed and upturned, if slaver flows out of his mouth, if he snores: that is a crisis of high disease (*antasubbū*)" (Table X, 1). There are even indications of differential diagnosis, because the text immediately adds: "If, when seized by the crisis, he remains conscious: it is sure; if (on the contrary), at the time of the seizure by the crisis, he becomes unconscious: that is not sure”. This distinction, as has been ably noted by Mr. Labat, appears to refer to the differential diagnosis of epilepsy and other crises of convulsion, the loss of consciousness being characteristic in epilepsy. In any case, the still more characteristic symptom, regarding the absence of the memory of the epileptic accident, is not indicated and the given description nohow constitutes a complete and general *tableau* of the disease. Descriptions of this type prove that certain diseases were the object of efforts for nosological individualisation and not that these efforts had been in an advanced stage among the Mesopotamians as they had been a little later, among the Greeks and the Indians.

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In the third part, prognostics are drawn from the observations of symptoms during the first day of sickness and the moments when changes take place in the disease. Moreover, in this part the first efforts at drawing clinical pictures reputedly characteristic of the action of various gods or demons reappear. Diverse prognostics are added thereto in accordance with the psychical state of the subject and, eventually etiological indications also (for example, the fever due to dryness, Table XXIII, 29).

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The fourth part, extremely mutilated, depicts the multiple forms of the “malignant attack” (*misittu*), diseases provoked by various demons, the malignant transformation of certain diseases under a determined influence and the magical therapeutics meant to combat them. Lastly it indicates the prognostics resulting from the nature of the various hallucinations of the patient.

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The fifth part, which has reached us in an extremely incomplete state, deals with women and young children, specially with the prognostics concerning the sex of a child to be born and his chances of life. It also discusses the conditions of delivery and the sentiments to be shown in future by the child to his mother; this rather belongs to divination than medicine.

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Mr. Labat has then compared the Accadian and Greek prognostics, noting in the *Hippocratic Collection* as also in the Accadian literature, the existence of works specially dealing with prognostics, diagnosis being less mixed up with prognostics among the Greeks. Certain similarities of detail appear, but there are also big differences. Mr. Labat thinks that the personal action of Hippocrates has eliminated from Greek medicine, many teachings which could have borne the traces of Babylonian heritage (p. xlii). [This marked a great step forward.] One may also think that Greek medicine developed entirely out of the important influence of Babylonia. However, in the domain of the veterinary art, not turned upside down by the intervention of a Hippocrates, Mr. Labat notices closer concordances with the Accadian manual, specially in the listing of the enunciation of prognostics, although these latter were not gathered together in special manuals.

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It is certain that the chapters on prognostics in the Hippocratic Collection show certain gifts of clinicians which are entirely different from those seen in the Accadian manual. The impression that one is in the presence of the results of a personal medical experience and not that of a repertory of traditional data, is confirmed by the eventual reference to the cases of patients who are designated by name and are, in consequence, personally examined or whose observation has, at least, been personally known (Prorrhétique, I, 27, 32, 34, 72, 99, 104, 119). In any case, the personal twist thus given to the teaching of prognostics, does not efface the analogy of the general structure of certain Greek manuals with the Accadian text. This is how, as has been remarked by Mr. Labat (p. xxxviii), the Prénotions de Cos catalogue organwise the symptoms, having the value of prognostics, in a manner sufficiently similar to the second part of the Accadian manual.

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It could be claimed that this analogy does not have much interest, as any doctor desirous of enumerating symptoms could be tempted to do so organwise, beginning from the head. But precisely it is already remarkable that on both sides, in the Accadian medical literature and also in the Greek medical literature, similar enumerations have been constituted. The study of medical data put in such a form, does not form part of a method necessary for medical teaching wherever it be given and the instinct of the clinician not influenced by a mode of explanation which had been traditional before him, would make him understand his observations in a more natural manner, just as he may have gathered them; that is to say that he would describe the entire disease either in each particular patient or in a type summing up the common traits of similar morbid developments observed by him. The pre-determined way of listing the signs establishes a good relationship between the Accadian manual and the *Prénotions de Cos*.

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The examination of the *Prénotions de Cos* and of other Greek texts seems to be able to enlighten us even regarding this relationship as also concerning certain other peculiarities of the Accadian manual.

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After a list of symptoms, largely fatal and of signs showing themselves chiefly in fevers¹, the *Coan Prognoses* (beginning from 156), concern themselves with local physical signs approximately classified from the head downwards and in association with various other signs. Now certain groups of symptoms are found identically described, almost word by word, in the *Prorrhétique 1*, with additions in this latter text of a reference to a given patient.² One may *a priori* suppose either that the author of *Prorrhétique 1*, has borrowed elements from *Prénotions de Cos*, adding thereto the names of the patients where he remembered having seen these symptoms, or that the *Coan Prognoses* or some of them, have been gleaned from the collections of clinical notes like the *Prorrhétique 1*, with clinical references being suppressed, or that the two manuals have drawn from a common source. It is the second hypothesis which is confirmed. It is confirmed by the fact that one of the *Coan Prognoses* (543), coinciding with the propositions of *Prorrhétique 1* includes the reference to the patient, discussed by the corresponding proposition of *Prorrhétique 1* (119)³, whereas others do not include the same. It appears, therefore, that the editor of *Prénotions de Cos*, as we have them, has had recourse to *Prorrhétique 1*, but habitually leaving aside, except once, personal indications, and this helps us observe the compilatory process of the composition of the semiological collection of the *Coan Prognoses*. By a similar process particular or exceptional clinical observations could have easily found themselves arranged in pair with regular and frequent morbid facts, and one can understand that detached symptoms, and since then without significative values, be on the contrary presented as important signs, beside other really characteristic signs. A recapitulatory registration of clinical data had taken place with a view to a mode of traditional transmission which appears to be quite analogous to the Mesopotamian mode and which, while not naturally imposing itself, could very well have been inspired by the example of the former, extended up to the Persians and which the Oriental Greeks could not have ignored.

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¹ Littré (Vol. V, p. 588), has abusively entitled the series: “Des fievres considerées comme maladies générales.”

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² Pror. 27-Coa. 2 and 69; Pror. 32-Coa. 194; Pror. 34-Coa. 76; Pror. 99-Coa. 606; Pror. 104-Coa. 257; Pror. 119-Coa. 343 and 543.

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³ Save some orthographic variants the text, on both sides, is identical (cf., Littré, V, pp. 550 and 708) and denotes, following Littré’s translation: “In hysterical women, spasms without fever are easy, as among Dorcas”.

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The analogy of conditions in which certain propositions of the Accadian manual and certain *Coan Prognoses* are presented serves, in reality, to simultaneously help us seize a similitude of the compilation of this text and of *Prénotions de Cos* and explains to us the apparent futility of analogous propositions found on both the sides.

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We have taken note, a little earlier, of the Accadian preposition, "If his nose is cold, he will die", and supposed that such indications of prognostic could be held valid only after they had been completed by the knowledge of the conditions of their validity. Now we read in *Prénotions de Cos*: "Ears cold, transparent and contracted, fatal sign" (188) and exactly like the Accadian manual, here also nothing indicates in the context the clinical table under which this sign can have a value, which evidently it does not have it itself. But Littré in his translation refers to a passage of *Prognostics* (2, t. II, p. 115), which yields us the key to the enigma posed by the presence, among the *Coan Prognoses* of a proposition, which in itself is so insignificant and so false. This proposition detaches, simply for classifying it among the symptoms furnished by the ears, a sign, which in the *Prognostics*, is part of an entire clinical table whose significance is finely discussed over there. It refers to the examination of the face of the patient in serious diseases and not to that of the ears of no matter which subject, as one would have believed on reading only the *Coan Prognoses*. The comparison of the physiognomy of the patient is to be made with that of normal persons and chiefly with the physiognomy habitual to the patient himself. It is also specified that the patient will have to be asked if he had felt various types of fatigue or debilitating causes (prolonged awakening, strong diarrhoea, hunger). It is only when the possibility of these conditions, in themselves capable of producing alarming symptoms, is eliminated that one will relate the symptoms in question to the violence of the trouble and will hold them as really significant of a fatal prognostic. It is only then and when it is associated with the totality of other described signs, that the coldness and the contraction (?) of the ears can take on the value of a fatal sign.

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It can thus be seen that studied in isolation and not completed by data as that of Prognostics, Prénotions de Cos will lead to such gross errors in prognostics, under which no medical practice could survive. They suppose, therefore, and the persistent reputation of the Accadian tradition across entire Mesopotamia equally supposes the existence of a complement of teaching such as that of the Prognostics, preserved for us by the Hippocratic Collection, whereas the chance discovery of cuneiform tablets has not yielded us so far, for Mesopotamia, anything equivalent.

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It is also to be observed that the collections of the lists of symptoms which could not have, in themselves, sufficed as medical manuals, do not constitute a very natural mode for the fixation of the medical tradition and this can lead one to think that this mode having been habitual in Mesopotamia, it is by means of the Mesopotamian example that it got established among the Greeks, leading among them to compilations like Prénotions de Cos.

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We will see that closer analogies of the Accadian text with the aberrant parts of the Indian medical tradition equally lead us to think that the Mesopotamian mode of divinatory prognostication and of the presentation of signs could have been the example on the Eastern side.

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The art of diagnosis and of prognostic presents itself in India as a branch of the medical art, much less detached from others than in Mesopotamia. The medical diagnosis and prognostics constitute a part, as is normal in scientific medicine, of nosology and establish themselves in respect of each trouble described in its totality. It is only at a late date that special manuals of prognostic such as the Narapatijayacaryā, A.D. 1232, are met with.¹ But the big classical medical texts devote full chapters¹ to special collections of symptoms having the value of prognostics which remind us of the Accadian manual. As in the latter, which mentions twice more often the signs of the coming death than the favourable symptoms, Indian medicine is chiefly attached to the traits of incurability, the doctor being under the obligation of not taking up the useless treatment of the incurable², although according to Caraka, he must also refrain, on humanitarian grounds, from revealing too promptly the gravity of his prognostics (*Indr.*, XII, 61, 64).

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¹ cf., E.G. Kashikar, Indian Medicine by Dr. J. Jolly, translated from

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¹ German and supplemented with Notes, Poona, 1951, p. 207.

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² *Caraka-saṃhitā*, *Indriyasthāna*, XII Chapters; *Bhela-saṃhitā*, *Indriyasthāna*, XII Chapters; *Suśruta-saṃhitā*, *Sūtrasthāna*, XXIX-XXXIII; Vāgbhaṭa, *Aṣṭāṅga-saṃgraha*, *Śār.*, IX-XII.; *Aṣṭāṅgahṛdaya*, *Śār.* V-VI; *Kāśyapa-saṃhitā*, *Sūtr.*, XXVIII and *Indriyasthāna*; *Hārīta-saṃhitā*, 2, II, V and VIII-IX. cf., J. Filliozat, *Le Kumāratantra de Rāvaṇa*, Paris, 1937, p. 56, n.

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The external analogies in the methods of the explanation of this matter, common to Sanskrit texts and to the Accadian manual, are not rare. The headings are put at the end of chapters, the colophons resemble those of the Accadian manual. This first analogy, however, deserves to be noted only for the sake of memory, because this is the general usage in the entire Sanskrit literature. Another analogy is somewhat more remarkable as it refers to a usage, which is not equally widespread in India, though found in the Upaniṣads (*Kena*, *Īśa*), and which is nowise to be found in any Accadian text. This relates to the use of the first words of the text as its title.

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In the *Caraka-saṃhitā*, eight out of twelve chapters which constitute the section, *Indriyasthāna*, specially devoted to prognostic, have for titles words which begin them or a part of these words: CHAP. I, *varṇasvarīyam indriyam*, beginning: *iha khalu varṇaś ca svaraś ca* . . . II, *puṣpitakam indr.*, beginning: *puṣpam* . . . IV, *indriyānīkam indr.*, beginning: *indriyāṇi* . . . V, *pūrvarūpīyam indr.*, beginning: *pūrvarūpāṇi* . . . VI, *katamāni-śarīriyam indr.*, beginning: *katamāni śarīrāṇi* . . . VIII, *avākśīrsīyam indr.*, beginning: *avākśirā* . . . IX, *yasya-śyāvanimittīyam indr.*, beginning: *yasya śyāve* . . . XI, *anujyotīyam indr.*, beginning: *anujyotir* . . . XII, *gomayacūrṇīyam indr.*, beginning: *yasya gomayacūrṇābhyām*.

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The other chapters, without reproducing the initial words in their headings, draw them from the words of commencement. But the method is often employed, even in chapters belonging to other parts of the text, having no similarity with the Accadian collection.

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The accounts in Sanskrit frequently resemble the Accadian accounts in the formulae. For example, Caraka, *Indriyasthāna*, III, enumerates the symptoms of troublesome prognostic in phrases of the following type, which remind us of the Accadian method of presentation:

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“If the respiration is too long or brief”, one should know that “his vital breath will go away”.
“When palpated, if the two (lateral) cervical regions do not have the throbbing”, one should know that, “his vital breath will go away”.
“If his teeth are charged white, with gravel on them”, one should know, “that his vital breath will go away.”¹

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¹ *Indr.*, III, 8-10: *tasya ced ucchvāso ’tidīrgho hrasvo vā syāt|* *parāsuriti vidyāt||8||* *tasya cen manye parimṛśyamāne na spandeyātām|* *parāsuriti vidyāt||9||* *tasya ced dantāḥ parikīrṇāḥ śvetā jātaśarkarāḥ syuḥ|* *parāsuriti vidyāt||10||*

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But these are merely external analogies which, even when grouped, do not have any significance in themselves. Much more important are the concordances in the tenor of teaching, although they appear along with considerable differences. The most detailed explanation of special Indian prognostics is the one which covers the totality of the twelve chapters of the *Indriyasthāna* of Caraka-saṃhitā. Their brief analysis and that of similar principal texts will enable us to take up the comparison of their teaching with that of the Accadian text.

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The first chapter enumerates the signs to be considered in a patient or with reference to him to know the time left to him for living. The anomaly (*vikṛti*) of which he is the victim, is of three types: (1) *lakṣaṇa-nimitta*, “assigned by the types”, that is to say, signified and caused simultaneously² by the congenital structural types of the body; (2) *lakṣya-nimitta*, “assigned by the typifiable, that is to say, by the morbid manifestations, capable of being referred to nosological types, to individualised syndromes; (3) *nimittarūpa*, "conforming with the assigned ones", that is to say, with presages which occur and are thought to determine the consecutive trouble.¹ These are, then, more advanced theoretical views than those found in the manuals of the *Hippocratic Collection* concerning the prognostics as also in the Accadian manual. The chapter, thereafter, gives the unfavourable signs observable when the colour (of the skin, *varṇa*) and the voice (*svara*) of the patient are examined. That is the beginning of an explanation of objective symptoms which covers the two following chapters, while the fourth is devoted to a description of subjective symptoms.

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² Nimitta is both cause and sign. The chief sense is ‘sign’, ‘presage’, but in view of a reasoning current in medicine, both outside and in India, according to which *post hoc ergo propter hoc*, the preceding sign is easily taken as the determining cause; this gives the value of “cause” taken by the word.

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¹ The commentary of Cakrapāṇi explains that it "reproduces the significance of assigning (presage), which shows itself as engendering the effect or as taking note of the effect" (*nimittasya yo 'rthaḥ kāryajanana-rūpaḥ kāryabodhakarūpo vā tam anukaroti*). Cakrapāṇi, therefore, does not entirely accept the sophism *post hoc ergo propter hoc* and admits that the sign is not necessarily the cause, but can simply be an announcement (*Indr.*, I, 7).

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The second chapter describes the *ariṣṭas*, symptoms which appear to announce the death as flowers announce the fruit. These *ariṣṭas* are the odours spread by the patient and tastes of his secretions, these secretions not being tasted directly by the doctor, but he infers the savour thereof according to the behaviour of flies, leeches, etc., which suck it or which turn away from it.

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The third chapter concerns the information of prognostics furnished by palpating various parts of the body enumerated from the feet to the head (III, 5), the observable symptoms (III, 4) being: inertia (*stambha*) of the parts of the body, normally ever vibrant (*spandamāna*), the coldness of those which are normally hot, the stiffness (*dāruṇa*) of the supple, the rugosity of the smooth, the absence of the normally existing parts, such as the testicles, the relaxation, the rupture and the dislocation of the articulations, the diminution of flesh and blood, the (general?) stiffness (*dāruṇa*), the non-interruption of perspiration or its stoppage and all other abnormal symptoms. Thus are described the signs to be recognised by various sensorial faculties (*indriyas*, wherefrom the name of the section) of the doctor, those of sight, hearing, smell, taste and touch.

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The fourth chapter commences the examination of the manifestation of signs perceived by the sensorial faculties of the patient: vision, hearing, various sensorial errors regarding odours, tastes, hot and cold, etc. and various hallucinations.

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The fifth chapter studies the premonitory symptoms of death in diseases of various types, the objective ones observed by the doctor and the subjective ones reported by the patient. These latter consist chiefly of dreams, only a part thereof being considered as premonitory ones and a rational theory having been elaborated to explain, by means of the influence of the organic elements of trouble on the perceptions, the troubles of premonitory value of some of them.¹

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¹ cf, J. Filliozat, ‘Le sommeil et les rəves selon les médicins indiens et les physiologues grecs’, *Journal de psychologie*, 1947, pp. 326 ff., specially pp. 332-34.

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The sixth chapter describes the groups of the symptoms of incurability during diverse morbid conditions.

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The seventh chapter enumerates the forebodings of death, furnished by the anomalies of the shadow or the reflection of the body, as regards their state (*saṃsthāna*), their dimension (*pramāṇa*), their colour (*varṇa*) and their luminosity (*prabhā*). It adds diverse groups of the symptoms of the coming death.

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The eighth chapter continues the study of similar groups of symptoms to be specially noticed on the eyelashes, in the hair, on the tongue, in respiration and adds short clinical tables, such as the following, which remind one of exactly the tables of the Accadian manual.

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“Rubbing the knee against the knee, letting fall the feet after having raised them, the patient who often twists his face, does not live. Cutting the tips of his nails with teeth, cutting his hair with his nails, scratching the earth with a baton, he does not get rid of his disease.” ²

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² *Indr.*, VIII, 17-88:

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The ninth chapter takes up once again the signs of incurability in various sorts of diseases and other groups of symptoms, particularly in relation with the action of the bile (internal fire).

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The tenth chapter discusses the signs of imminent death

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*ghaṭṭayan jānunā jānu pādāv udyamya pātayan|*
*yo ’paśyati muhur vaktram āturo na sa jāvati|*
*dantais cchindan nakhāgrāṇi nakhais cchindañ cchiroruhān|*
*kāṣṭhen bhūmim vilikhan na rogāt parimucyate||*

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particularly those where the action of internal wind intervenes. The eleventh classifies the signs according to the time, at the end of which death will occur: a year, a month, a shorter period.

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Finally, the twelfth chapter, after certain indications of the same type as in the preceding one, studies the forebodings obtained by the doctor by observing the messenger come to fetch him for the patient or of the presages encountered by the doctor on the way to the patient's house and on entering that house. It terminates in a recapitulation of the entire *indriyasthāna* and in new indications concerning the necessity of hiding the fatal prognostic as also the favourable signs.

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The *Bhela-saṃhitā* which concurrently with the *Caraka-saṃhitā* presents teachings going back to the same master, Ātreya¹, enables us to go, in comparison with this *Caraka-saṃhitā*, to an older tradition, from which both of them are descended. What is common to both of them has every chance of belonging to an ancient source. Unfortunately the *Bhela-saṃhitā* has reached us only in a single mutilated manuscript.² But the *Indriyasthāna*, which corresponds to the section of the same name of the *Caraka-saṃhitā*, is sufficiently well-preserved. It has, like its pair, twelve chapters.

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¹ cf. supra., pp. 2, 196 and 207.

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² Other known manuscripts are mere copies of the former, whose edition has been given by Asutosh Mookerjee, *Cal. Univ., Journ. of the Dep. of Letters*, Vol. VI, Calcutta, 1921. In this edn., the *Indriyasthāna* runs from pp. 97 to 115. The editor (p. 97, n. 1) underlines that in this part there is closer conformity between the *Bhela-* and *Caraka-saṃhitā*.

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The first chapter, whose title has been lost along with the beginning, relates to the signs of the time left for living, one, two or four months and the signs announcing a short life or one more or less long, up to a hundred years. Only the first part has its analogous one in Caraka (C), in Chapter XI.

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The second chapter, *Svastyayana*, "favourable course", describes the symptoms of the coming return to health, as are found at the end of Chapter XII, but differently. The end is lost.

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The third chapter, the title and the beginning lost, indicates a series of symptoms of troublesome prognostics—certain sensorial hallucinations of the patient, certain fetid emanations, the considerable alterations of urine, etc. These symptoms, in effect, in most cases, in the actual state of therapeutics leave little hope (here are to be recognised notably the symptoms of grave diabetes).

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The fourth chapter, *Sadyomaraṇīya*, “concerning imminent death”, with its title identical with that of Chapter X, has the same contents in general in an editing greatly differing in details. It does not begin as Chapter X, with *sadyas*.

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The fifth chapter, *Yasyaśāvīya* (correct *Yasyaśyāvīya*), has an almost identical title with Chapter IX, and similarly starts with *Yasya śyāve*. It gives a teaching similar in its totality but altogether different in detail.

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The sixth chapter, *Pūrvarūpīyam*, “concerning the signs”, a title similar to that of Chapter V, is altogether different though devoted to the descriptions of the symptoms occurring in various diseases.

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The seventh chapter, *Indriyānika*, named after its first word, is identical word for word, except for numerous variants, with Chapter IV, similarly named and which contains only two additional *ślokas* (14 and 20).

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Chapter VIII, *Dūtādhyāya*, “chapter of the messenger”, corresponds to the part of Chapter XII, devoted to signs furnished by the observation of the messenger but completely differs in explanation.

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The ninth chapter, *Gomayacūrṇa*, has an almost identical title with Chapter XII, *Gomayacūrṇīya*, although it starts with *cūrṇam śirasi yasyaiva śuṣkagomayasannibham* . . . and not like Chapter XII with *yasya gomayacūrṇābham cūrṇam mūrdhani jāyate*. Its only *raison d'etre* consists in taking up the first words of the text as is done in Chapter XII; it follows that the editing of Caraka carrying *gomayacūrṇa* immediately after *yasya* is surely more faithful, at least here, to the original account, whose beginning is altered by the *Bhela-saṃhitā* while guarding the sense and keeping intact the old title which retains the traces of the first form of this account. After a common verse, with some variants, the two texts become divergent, that of Bhela merely describes various clinical tables of bad prognostic.

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The tenth chapter, *Chāyādhyāya* “chapter of the shadow”, is named after its first word *anuchāyā* . . . but only the first two verses refer to the shadow. The remainder describes the symptoms of incurability in the course of the diseases provoking haemorrhage (*raktapitta*), those of cough (*kāsa*) and those of dyspnoea (*śvāsa*) and other hopeless morbid tables.

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The eleventh chapter, entitled *Puṣpīya* corresponds in part with the second chapter of Caraka, called *Puṣpitaka* because it commences with *puṣpam*. But in Bhela, this chapter, which of course describes first of all the *puṣpita*, that is to say, the patient in whom appear the symptoms announcing some result as the flower announces the fruit, does not begin with *puṣpa*. It appears, therefore, that the ancient tradition referred to Ātreya agrees, in both Bhela and Caraka, in ascribing to Ātreya an account commencing with *puṣpa*, but that the text of Bhela has not preserved here as that of Caraka, the old beginning. After five verses devoted to *puṣpita* Bhela continues with an explanation of premonitory signs drawn from the dreams of the patient, identical with those found in the fifth chapter of Caraka but of a different tenor.

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Finally, the last chapter, *Avākśīrsīya*, is named after its beginning, similar to the eighth chapter, *Avākśīrsīya*, of Caraka and also discusses the same subject, particularly related to fatal symptoms seen in eyelashes, in hair, etc.

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The two *Indriyasthānas* relating the teaching of Ātreya, i.e., those of Bhela and Caraka, have, therefore, a common stock, with many similar details, but with different classifications and with internal changes in the contents of parts, which at first sight look similar. The spirit and the matter are the same but the latter has been kept similar only to enable one to admit that at the point of departure the tradition already had a definite formulation. This is not surprising. We do not know how the teaching received by Bhela has been transmitted, but we know that in relation to Ātreya, Caraka has come in only later. It is Agniveśa who might have received the teaching of Ātreya. Caraka intervened for revising the work of Agniveśa. Many of the divergences can be ascribed to him. However all should not be put to his account. We have seen that at least once he has been more faithful than Bhela in preserving the text which gave the title to a chapter. Moreover, he deals with subjects, which though missing in Bhela, must not be considered as new additions due to him. The investigation of the messenger is neglected by Bhela but is found in other words, in Suśruta¹, whose tradition parallel to that of Ātreya, is very close and in Hārīta¹, reputed to be a co-disciple of Bhela under Ātreya.

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¹ It is summarily recommended, *Sūtr.*, X, 4, without its name being given.

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¹ II, 8, *Hārīta-saṃhitā* actually known is, in any case, largely apocryphal, cf., *IA*, 1934, pp. 127 ff.

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In the *Suśruta-saṃhitā*, the third among the chief texts of Indian medicine, the teaching corresponding to the *Indriyasthānas* of Bhela and Caraka is incorporated in the *Sūtrasthāna* and is much better systematised. The five chapters XXIX-XXXIII, devoted to the same, respectively deal with the presages, subjective fatal symptoms, the "shadow" of the patient, other objective signs and particularly incurable diseases.

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The presages (Chap. XXIX) are drawn from the messenger, from encounters had while rendering oneself to the patient's house, while entering that house or they are drawn from the dreams of the patient or of those of his entourage. The subjective fatal symptoms (Chap. XXX) are the *ariṣṭas*, consisting of sensorial errors and of the hallucinations of the patient. The *chāyā* corresponds in general with what we call the good or bad "looks" (Chap. XXXI), but the chapter deals with it only at its beginning and discusses thereafter the signs drawn from the state of the tongue, of the nose, of the eyes, of hair, of eyebrows, of attitudes, of respiration, of various groups of symptoms shown in the course of certain affections, of the state of the mouth, etc. These are, then, mainly objective signs and their study continues in chapter XXXII. The next chapter enumerates the circumstances wherein appear the hopeless cases of patients who are victims of eight diseases particularly dangerous by their nature itself.

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As a whole, the doctrine is the same as that of Caraka and of Bhela. The account of Bhela looks less orderly and that of Suśruta as the best-arranged. It is also Suśruta who most often mixes up the enumerations of prognostic with general considerations regarding morbid causes. It seems that with him, traditional learning, in part divinatory and in part resulting from real medical experience, and which Bhela and Caraka have only half adapted in the theoretical medicine of scientific import, has tended to be integrated more closely into this medicine.

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In relation to these Indian documents, the Accadian but described in XI.

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manual appears as similar but typologically more archaic, less developed as regards the progress of empirical knowledge and of the collection of the facts of experience, for scientific knowledge and the comprehension of acquired experience. The theoretical Indian classifications of morbid manifestations and Indian attempts at a rational explanation of certain signs, viz., the production of dreams of bad augury by organic perturbations in the canals of the organ of thought, do not have any equivalent in the Accadian manual. But the rest of the teaching has, with this manual, both a general concordance and particular similarities.

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The general concordance is due to the principle itself of the grouping of symptoms having the value of prognostic in these lists, wherein they are detached from the concomitant signs, from the morbid atmosphere and from general conditions, which alone could give them fully significant value. The analogy between the Accadian manual and the special portions devoted to the same subject in the Indian manuals here is the same as is the case with this Accadian book and the Hippocratic manuals specialising like the former in the enunciation of prognostics, particularly the *Prénotions de Cos*.

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The incorporation among medical symptoms of purely divinatory signs, as those which consist of observations made by the doctor or the exorcist during his passage towards the patient's house, is the first particular analogy between the Accadian manual and our Indian teaching. It is striking for anyone who studies Indian medicine in its totality. Divination in India, at least in the scientific circles, about which we are informed by the principal Sanskrit texts, is in no way a dominant part of its preoccupations. In the *Caraka-saṃhitā* itself, a full chapter (*Sūtrasthāna*, XXIX)¹, which is devoted to the description of the qualities of a good doctor and which gives details of the activity of a quack, enumerates in great detail the knowledge which a doctor worthy of that name must have and it makes no reference to an interpretation of divinatory signs. The texts devoted to various manuals to *nidānas*, that is to say, to the conditions in which diseases appear and develop and which enumerate the symptoms of these diseases and discuss their prognostics, are essentially based on direct clinical observations and on the interpretations of these observations as a function of admitted pathological theories and not, or as a rare exception, on divinatory data. Such data, though present in special sections like the *Indriyasthānas* of Bhela and Caraka or in particular groups of chapters as in Suśruta, and there mixed, as in the Accadian manual, with the enumerations of clinical signs detached from general clinical tables and which are, most of the time, the signs of serious or fatal prognostics, such divinatory data generally remain in the margin of the chief teachings of Indian medicine, which is complete without the same. In short, Sanskrit accounts similar to that of the Accadian manual are admitted in all the principal medical texts of India, but they have therein a place entirely to themselves. They are added to these texts and are not intimately incorporated therein.

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¹ French translation by J. Filliozat in L. Renou, *Anthologie sanskrite*, Paris, 1947, pp. 394-97.

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Yet another trait which brings the accounts of Sanskrit medical texts near those of the Accadian manual, also separates them, though less completely, from the rest of the teachings of Indian medicine.

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The Indian medical texts are well acquainted with the phenomenon of demoniac possession, which gives rise to diseases. In these texts it is called *graha*, "seizure". A belief in such "seizure" belongs to universal folklore. It will therefore be in vain to observe that it is found several times in the Accadian manual, which frequently indicates that if the patient presents such and such a symptom or if such and such a foreboding takes place, then the "hand" of such and such a god "is on him", or that such and such a god or demon "has seized him or her". On the other hand, the data of Sanskrit texts, summarised by us, do not relate to the diagnosis of possession, but other parts of the main texts in Sanskrit give such diagnoses based on symptoms similar to those which establish demoniac possession in the eyes of the Accadian doctors, and these parts, as those which describe forebodings, also have a separate place in the teaching of classical Indian medicine. In fact they do not belong to the fundamental doctrines of the latter, which invoke only those causes of diseases that are purely natural, except in the case of infantile and psychic troubles. They derive their inspiration from another current of ideas, attested since the Veda, and which has imposed itself on Indian doctors, even though they had mainly sought to constitute a rational system of explaining the diseases. Their effort to bring the case of possession back to their ordinary natural explanations, while supposing that the demons are only one cause among others for disturbing the organic elements, appears only later.¹ Exactly like diagnosis by observing presages, the diagnosis of "seizure" by the demons or gods is not an integral and primitive part of the Indian medical system. They are admitted here and more largely than the divinatory prognoses, but they are not incorporated therein more intimately.

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¹ J. Filliozat, *Le Kumāratantra de Rāvaṇa*, op. cit., p. 63.

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Moreover, there are certain analogies of detail between Accadian and Indian diagnoses of demoniac "seizure" of children. These analogies are sufficiently close between the 40th tablet of the Accadian manual and texts like the *Kumāra-tantra*. On both sides, a certain number of described symptoms are the same; this can be sufficiently explained by the fact that it is a case of morbid phenomena actually observed among sick infants, but at the same time on both sides diagnosis often depends on the age, in days or in months, of the infant at the time of the attack and a "seizing female spirit" is denounced as being responsible for this trouble. On the Indian side, the mention of the "seizing female spirit" (*grāhi*) goes much higher than the medical texts which describe the symptoms of its presence; it is already found in the *Ṛgveda* (X, 161, 1).²

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² ibid., p. 79.

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Whatever be the resemblance of the Accadian manual with Indian medical data concerning possession as a cause of diseases, the idea of different types of possession shown by specific symptoms goes up much higher in India than the scientific medical texts. In the *Hippocratic Collection* the existence of similar ideas is shown by the very fact that the text *On the Sacred Diseases* gives its examples while rejecting them.³ But here the concordance between the Greek way of posing the diagnosis of possession with the Accadian and Indian ones remains very general. It is only the 40th tablet of the Accadian text which shows special similarities, with the post-Vedic texts regarding the diagnosis of possession of infants, which has been pointed out by us. These similarities, the only ones having the possibility of not being simply explained in terms of universal belief in demoniac seizures, are given on the Indian side by texts of the same stratum as provide the similarities in the domain of presages obtained on the path to the patient’s house or which details the mode of enumerating morbid phenomena having fatal prognostics, deliberately separated from complete clinical tables of which, in reality, they necessarily constitute a part.

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³ ed., Littré, Vol. VI, pp. 360-63; *Le Kumāratantra*, op. cit., p. 122.

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One may, therefore, ask oneself if the teaching of the Accadian manual could not have been known in India and have exercised some influence on the elaboration of Indian accounts on one side regarding certain diagnoses of possession and on the other and specially regarding a special tradition of prognostication in accord with divinatory and clinical signs racapitulat-ed apart from other morbid symptoms, as having a special prognostic value.

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In its origins the Accadian manual is very ancient, its eventual passage into India could, therefore, go back very high and one could be tempted to advance the hypothesis that it could be dated in the epoch in which there used to be communication between India and Mesopotamia, from the period of the Indus civilisation. However, the concordances with the Accadian manual are seen not only in the Vedic literature, not specially Vedic, it is true, but in much later Sanskrit texts, in most of the cases later than the Christian era in the form in which they have reached us; anterior only by a few centuries to the Christian era, if one is to go back to the common stock supposed by the accounts of Bhela, Caraka and Suśruta.

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Thus, on the Indian side, these concordances show themselves first of all in a period quite near that during which on their side the Hippocratic texts have concordances with Accadian prognostics and chiefly during that later period when the Greek manuals on the veterinary art in their turn present some. If the influence of the Mesopotamian tradition, and not chance, is the cause of all these concordances, then this influence must have been exercised in the East and West during the last period of its existence.

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Everything agrees in showing us precisely that it could have been most easily exercised during this epoch.

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First of all, we are sure that this system was current during the Achaemenid period and in their empire itself, as one of the tablets of the manual is dated in the eleventh year of Artaxerxes. It is also certain that parts of Greek and Indian lands, both under the Achaemenids, intercommunicated across this empire for the despatch of medicines and medical notions of India to Greek lands. This is all the more reason why the communications of both with Mesopotamia, situated in the middle of the distance separating the two, was easy.

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The passing of pepper, a product of South India, particularly of Malabar, in the hands of Greek doctors as an Indian medicine, is to be found in Hippocratic manuals, *On Woman's Diseases* and *On the Nature of Woman*.¹ The simultaneous passing of Indian medical teaching, on its side, is to be seen in the enunciation in the manual, *On Woman's Diseases*, of an Indian prescription on dentifrice alongwith a precept of alimentary hygiene.² These pieces of evidence, studied in relation with the facilities offered by the presence of Greek doctors in the Achaemenid court can explain, by means of the communication of doctrines creating at least some emulation, the concordances between Greek and Indian medicine during the Achaemenid period, i.e., before that of Alexander.³

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¹ supra., p. 252 ff.

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² ibid., p. 253.

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³ ibid., pp. 160 ff.

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In any case, the relations between Mesopotamian and Indian savants can be presumed to have existed by the mere fact that Persian administration employed in its satrapies and therefore in its satrapies of Gandhāra and Sindh, scribes of Babylonian culture writing in aramaic. Their reality is fully confirmed by the creation, in North-West India, of an aramaic transcription of the Indian language, a transcription made not in accordance with a summary notation of words following their consonantic frame-work, this being the principle of the Semitic alphabet, but in accordance with the learned phonological principles of Indian grammarians.⁴ We can even specifically state that probably these grammarians belonged to the school of Pāṇini. In fact this author whose date, unfortunately uncertain, seems to be in the fifth century B.C., belonged to Śalātura¹ in Gandhāra. He must have been, then, a subject of the Achaemenids, if he did live in the fifth century B.C., because the latter ruled over Gandhāra approximately from the middle of the sixth century, during the reign of Cyrus², up to the end of the fourth century B.C., at the time of the conquest of Alexander.

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⁴ *L'inde classique*, Vol. II, appendix on Palaeography.

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¹ This is what is corroborated independently in the seventh century by Hiuen-Tsang (S. Julien, *Mémoires Sur les contrées occidentales*, Vol. I, pp. 127 ff.) and by a copper inscription (M. Winternitz, *Geschichte der indischen litterature*, Vol. III, 1920, p. 384, no. 1) without counting Hemacandra who came later.

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