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Indian Medicine (Medicin), translated by C. G. Kashikar c9: II. Physicians and Therapy

Indian Medicine (Medicin), translated by C. G. Kashikar c9

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II. Physicians and Therapy

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§ 18. Training of Physicians¹ :— In the choice of a teacher the future physician should be cautious and should approach a person who is experienced both in theory and practice, is clever and blameless, has got control over his hand, has the necessary means and materials (of relief) and possesses friendly behaviour. Similarly a teacher should accept as a pupil only a young man from good family, especially from a family of physicians, intelligent, courageous and devoted to his teacher and one who has a good memory and other qualities. The beginning of instruction is preceded by a consecration ceremony (Upanayana). The instruction is not to be imparted on pretty numerous holidays and on unlucky natural events and occasions of impurity etc. He has to show particular respect and strict obedience to the teacher These and similar directions remind us of the statements of Dharmaśāstra about the conduct of the Brahmacārin² and are copied from them (Car. 3. 8. 1-5; Su. 1. 2; AS. 1. 2).

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It is also not immaterial as to which text-book (śāstra) the pupil chooses, since many text-books are current among the physicians. Only such text-book is suited for study as is tested, recognised, easily understood, properly arranged and complete (Car 3. 8. 3). The study consists of learning by heart when the pupil reads the sūtras serially, utters them loudly and often repeats them (Car 3.8.6). It is, however, not sufficient simply to learn them by heart. The teacher should explain every word of the text and the pupil should repeat the explanations. Memory without knowledge would be useless, just like a donkey carrying sandalwood; it only feels the load, without being delighted by its fragrance (Su 1. 4. 3-4). Along with learning and teaching Caraka also speaks of discussions with specialists in different branches. They consist partly of peaceful conversations and partly of disputations, and advance the knowledge, insight, elocution and reputation. Suśruta stresses the necessity of practical training, for even a very learned physician would be incapable of practice without practical training. At the same time, on account of his surgical point of view, he emphasises methodical instruction in surgical operations. So one should demonstrate to the pupil the process of deep cuts, sections and cross-sections on various kinds of gourds and cucumbers, watermelons, superficial parts of filled leather-bags, bladders (of animals) and pockets, the process of curetting on stretched and hairy animal-hides, the process of opening on the blood-vessels of dead animals, or a lotus-stalk, the process of probing on openings of a worm-eaten wood, bamboo, reed, objects like reed in general or dried large bottle-like gourds, the process of removing on the flesh of certain fruits or on the teeth of dead animals, the process of squeezing on a board smeared with wax, the process of suturing on the ends of two pieces of thick linen or soft leather, the process of bandaging on the limbs of a doll made of stuff or other material, the process of cauterizing and branding on tender flesh etc. (Su 1. 9).

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(1) Cf. Roth, *Indische Medicin : Caraka*, ZDMG 26, 441-52; Puschmann, *Geschichte des medicinischen Unterrichts* (Leipzig 1889) 6-15. (2) Cf. Hillebrandt, *Grundr.* 3, 2, § 24-35.

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§ 19. Position and Practice of Physicians :—After termination of his studies and his practical training, the future physician should secure permission of the king for the practice of medical profession (Su. 1. 10. 3). This permission of the king is necessary because otherwise the quacks would force their existence in his kingdom and might prove a public calamity (Dallana). Caraka speaks very strongly of such cheats who wander about in the streets boasting in the garb of physicians. As soon as they hear of a patient, they hurry and praise loudly their medical capacities so that they reach his ears. They try to win over the friends of the patient by all sorts of attention and emphasize that they would be satisfied with small remunerations. When they treat a patient and are not able to allay his pains, they assert that the patient does not get the necessary remedies, he disobeys the directions given and that he cannot control his desire. When the case is hopeless they run away. They try to praise their cleverness before uneducated people, and by doing so they only betray their ignorance. They avoid the assemblies of educated people, just as a traveller avoids a dangerous forest. Nobody knows their teacher, pupil or fellow-pupil (Car. 1. 29. 9)¹. Such quacks are particularly responsible for the bad reputation of physicians, as a result of which it was laid down in Dharmaśāstra not to accept charity from a physician (*cikitsaka*)². Yet the Ambaṣṭhas whose business is healing art, hold a tolerably high position in the succession of castes, because paternally they are descended from Brahmans⁵. Even the modern Vaidyas in Bengal, of whom about one third practise medicine even to the present day, enjoy high regard. In the middle age the famous Sena dynasty descended from them⁶. The highest aim for a physician seems to be to treat a king and become the physician of the king. It was the duty of such court-physicians to protect the king from poisoning and to inspect the royal cooking for this purpose (cf. § 95). This also explains why Cakradatta, the famous medical author, was the son of the head-cook of a Bengali king⁷. In war also the physician should protect the king, particularly from poisoning, should purify the wells, food etc. poisoned by the enemy and should stay closely by the side of the king, treat poisonings, wounds and diseases occurring in his army (Su. 1.34). In fact Alexander the Great gathered the most expert Indian physicians in his pavilion in order to cure serpent-bites and also other ailments (Arrian, *Ind.* p. 15). Jivaka Komārabhacca, a contemporary of Buddha, received very high honorarium for his wonderful cures⁸. A physician mentioned in the Rgveda desires to receive "horses, cattle and clothing" by means of his healing herbs⁹. The physician should give his medicines gratis to a Brahman, a spiritual teacher, poor, friend, an ascetic and the like. On the contrary, he should not treat the hunters, fowlers, outcastes and sinners. By such procedure he obtains friends, fame, merit, wealth and satisfaction (Su 1. 2. 8). Regarding the outward appearance of the physician Su 1. 10. 3 says he should keep his nails and hair short, should bathe and wear a white dress, should wear an umbrella, a stick and shoes. He should be modestly dressed, of friendly speech, accompanied by a dependable servant and should thus go for practice. According to Car 1.8.18-28 he should direct his attention towards the curing of the patient and should not cause an injury to him even though his own life were at stake, should not think even once of the wife or property of anybody. He should avoid drunkenness, sin and bad company. He should not disclose events in the home of the patient, he should also not utter a word even if he felt the vicinity of death, lest it might do harm to the patient or to others. According to Su 1. 25. 44 the physician should treat the patient as his own son. On the hospitals see § 22.

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⁵ Cf. Roth, l.c. 452; Avinash Chandra Kaviratna's trans. pp. 408ff.

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⁶ Manu 4. 212; Visnu 51. 10.

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⁷ Manu 10. 8, 47

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⁸ Cf. Risley, *The tribes and castes of Bengal* (Calcutta 1892), 1. 47.

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⁹ (5) ZDMG 53, 379. Cf. § 4. (6) SBE 17, pp 173 ff.; Puschmann l. c. 14. (7) RV 10. 97.; Roth ZDMG 25, 646; Zimmer, *Altindisches Leben*, p. 398.

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§ 20. Diagnosis :— The physician should go to the house of the patient at favourable signs, enter the house and observe, palpate and question him (Su. 1. 10. 4; AHr. 1. 1. 21). All five senses must be set to work at the medical examination. Thus in an abscess he should feel with the ear the bustling overflow of the air with frothy blood, the sounds in the entrails, the crack of the joint, changes in the voice etc.; with the eye the decrease and increase of body, colour, form and extent of the same, vitality etc.; with the taste the various tastes of urine in diabetes and other ailments, the bad taste in the body by the creeping of lice on the same, and the sweet taste by the creeping of ants etc.; with the touch, cold or heat, smoothness or roughness, softness or hardness and other qualities of skin in fever, jaundice and other diseases; with the smell, the smell coming out of the body especially at the approach of death. By questioning the patient one knows his native place (or home), his condition, caste, mode of living and diet, the origin of his disease, pains, vitality, appetite, the appearance or non-appearance of flatus, urine or stools, the duration of his disease etc. Much can be decided simply by inference (anumāna) (Su. 1. 10. 5 f.; Car 3.4).

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Later works contain particulars of the medical examination. Thus according to Bhāv 1. 2. 162 f. the eyes are to be examined for their colour (red, yellow, white, brown etc.), further whether lustreless, sunken, watery etc., in order to know as to which of the three doṣas is affected. Similarly a rough and cracked tongue shows the derangement of wind (vāyu), a red or blackish the derangement of bile (pitta), a covered, moisty and white tongue shows the derangement of phlegm (kapha). The urine becomes whitish by vāyu, red and blue by pitta, only red by blood, white and frothy by kapha. The pulse-examination (nāḍī parīkṣā) is fully described. On this subject there exist special works under the title Nāḍīparīkṣā, Nāḍīprakāśa, Nāḍīvijñāna and the like. According to one¹ of these works, the pulse of left side in the case of women and that of right side in the case of men is to be examined, as a rule, only on the wrist; yet the pulse also in foot, neck and nose is at times examined. The physician feels the pulse by pressing the three middle fingers of his right hand. By vāyu the pulse goes like a serpent or a leech, by pitta it goes like a crow, quail or a frog, by kapha it goes like a swan, peacock, pigeons of different kinds or a cock. The condition is affected by the three Doṣas and is incurable if the pulse is sometimes slow, sometimes weak and sometimes exciting, sometimes stopped, sometimes completely lost or scarcely felt, continuously abandons its natural place and then appears again. In diarrhoea the pulse is cool and slow. In cholera it is sometimes not traceable, sometimes it remains in its place. In disease of the worms (in intestines) the pulse is slow and weak, many times irregular or weak. In jaundice it is faint or excited as if it would spring out. In hemorrhage it is weak, stiff and soft. In consumption it shows the most varied movements. In internal wounds of the breast the pulse springs high and is quick, in consumption it is quite feeble, in cough it is shaky etc. Even at present the kaviraja in Bengal considers the pulse-examination as particularly important and capability to decide the nature of an ailment from the pulse is attributed to many physicians*.The pulse-feeling perhaps originated among the Arabians or Persians.

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¹ [Footnote text missing from page]

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∗ (1) Nari-vijnana or An Exposition of the pulse by Kaviraja Dhurmo Dass Sen Gupta, Calcutta 1893. (2) Risley, The tribes and Castes of Bengal, 1. 364.

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§ 21. Prognosis :— More particular value is attached to the prognosis, for the clever physician should not treat an incurable patient. Therefore, in the description of diseases the unfavourable symptoms and signs of death are usually enumerated, and the bad omens as well as favourable signs are also discussed.

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First of all is considered the messenger (dūta) who is sent for the physician, his appearance, caste, clothing, speech, as well as the appearance and behaviour of the physician when he is called. Thus it is unfavourable if the messenger belongs to a caste higher than that of the patient, if he is an eunuch, or a woman or is himself ill, sad, frightful, frightened, or comes running, or holds a weapon or a stick in hand, wears a garment which is worn out or torn or unclean or wet or wears only a single garment, if he is clean shaven or rides on an ass, camel or buffalo etc. Ominous is also the arriving of the messenger at a certain time, like midnight, midday, twilight, moon-eclipse etc., further if he meets on the way certain animals or birds or a corpse, a blind man or an enemy, if he had to face a hot and strong-smelling head-wind etc. The messenger must also not come to the physician when he is sleeping, lies undressed on the ground, is anointed, bears loose hair, perspires or offers sacrifice to Gods or fathers etc. It is, on the other hand, favourable if the messenger is white-clothed, clean, with delightful appearance, is of the caste of the patient, sits in a cart pulled by oxen etc. (Su 1.29; AS 3.12; AHr 2.6)

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The consideration of omens is extended also to the time of departure and arrival of the physician, and his reaching the patient. The dreams of the patient are also important. Thus one who dreams that he has drunk liquor in company with dead spirits and is attacked by a hound, will soon die of fever. It is also a bad omen if he dreams that a black woman with red clothes laughs at him and dances and binds him with torn hair, and moves to the southern direction, or that dead spirits and mendicants embrace him, or that he drinks honey or oil or falls in a swamp, or being naked, carries a red wreath on his head, or that he is devoured by a fish, or tumbles down from a mountain peak or is carried away by a current etc. (l. c.)

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Other Aristas (bad omens) depend upon abnormal changes in the physical or mental condition of the patient. Thus if he feels to be hearing a noise or confounds various noises with each other, if he gets irritated at the voice of a friend and rejoices at the voice of an enemy, feels the cold as hot and hot as cold, feels burning heat in chilblain, does not feel a blow or even the cutting of a limb, believes to have seen stars and moon by day and the sun at night, if his eyes are remarkably restless or motionless, if brown, red, blue or yellow shadows follow him, if his teeth have become brown or have suddenly fallen out, if the tongue is white or brown, dry, heavy, benumbed, covered or rough, the mouth smells badly, the limbs become suddenly heavy or remarkably light, if the veins stand pre-eminent on the forehead not present previously, the sneezing, cough etc. sound differently from the usual, strong perspiration occurs without occasion, the patient does not have any sleep or sleeps continuously, his feet and hands are cold, the breathing is difficult etc. (Car 5.1.ff; Su. 1 30-32; AS 3.9.f.; AHr 3.5). The Aristas are not the same in all cases; they change according to the nature of disease. Thus the fever proves fatal if it is severe, deep-seated and continuous, is accompanied by delirium, giddiness, difficult breathing, swelling and indigestion, if the patient is strong but can speak only with difficulty, has red eyes and pain in the chest, is vexed by dry cough in the forenoon or afternoon, if he has lost his strength and flesh, and has phlegmatic cough (AS, AHr), further if he has become senseless and falls down unconscious, if he shivers with cold while he feels hot within, rolls the eyes etc. ( Su ). Consumption is fatal if there is pain in the sides, constipation, vomiting of blood and pain in the shoulders. Diabetes is fatal if the usual complications are present, if the urine-secretion is excessive and dangerous ulcers are caused. Hemorrhoids lead to death if the hands, feet, navel, buttocks testicles and the mouth are swollen, there is pain in the chest, sides and limbs, the anus is inflamed, the secretion of blood is excessive and there is thirst, loss of appetite, colic and fever. The stone brings quick death if the testicles are swollen, the urine is retained and there is acute pain ( Car 5.9; Su 1.33; AS 3.11; AHr 3.5 ). Further Aristas will be dealt with at the individual diseases.

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Before commencing the treament (karman, kriyā) of a patient, the physician must find out his vitality which is known from certain signs on the body, such as large dimensions of hands, feet, sides, back, nipples, teeth, face, shoulders, forehead etc. He should treat such patients ( Su 1.35 ).

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§ 22. Healing Substances :— Physical ailments, says Caraka 1. 1. 58, are cured by medicine ( auṣadha ). Already in the Vedic medicine, the healing plants play a great role along with magic incantations. In the Bower MS very many medicaments, mostly vegetables, are mentioned. According to Viṣṇu 92. 17 it is meritorious to give free medicine. By the hospital for men and animals ( cikitsā, ārogya-śālā ) which are mentioned in Aśoka's inscriptions and Purāṇas and elsewhere, one understands by analogy to the modern davākhānās, institutions for distribution of medicinal remedies.

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According to AS 1.12 medicines are of two kinds : ( 1 ) those giving strength and ( 2 ) those removing disease. The former are elixirs ( rasāyana ) and aphrodisiacs ( vājīkaraṇa ); the latter appease the disease or prevent its recurrence, and consist partly of mineral, vegetable and animal stuffs, partly of fastings, smearings, incantations and other procedures. According to Caraka, there are animal, vegetable and mineral medicinal stuffs. Of the animal stuffs he mentions honey, milk, excretas, fat, marrow, flesh, faeces, urine, skin, sperm, bones, sinews, horns, claws, hair and the gallstone of the cattle; of the minerals he mentions gold, the five metals (silver, copper, lead, zinc and iron ), sand, lime, realgar, jewels, salt, red ochre and antimony. The plants are divided into four kinds : trees bearing fruit, trees having blossom and bearing fruit, plants living for one year and creepers and bushes (elrudh). Their roots, bark, solid interior, gum, stalk, juice, twigs, potash, milk, fruit, blossom, ash, oil, thorns, leaves, bud-covers, clods and shoots are used. Further Caraka specifies 16 plants among medicinal stuffs the roots of which are used, 19 the fruits of which are used, 3 the juice of which is used and 3 the bark of which is used; four kinds of fat (*sneha*) namely ghee, oil, fat and marrow; five kinds of salt namely *sauvarcala*-a blackish salt being the precipitate of a solution of the usnal salt in a solution of rocksalt, *saindhava*-rock-salt from the Indus region, *Vida*- black salt, a decoction of usual salt with an addition of myrobalans and Soda¹, *sāmudra*- sea-salt, *audbhida*- desert salt; eight kinds of urine, namely of sheep, goat, cow, buffalo, elephant, camel, horse and ass; eight kinds of milk, namely of sheep, goat, cow, buffalo, camel, elephant, horse and woman.

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According to Su 1.37 one must examine the ground while collecting the medicinal plants, whether it contains holes, pyrites, stones, anthills, desert-salt etc., whether it is soft, black, white or red etc. According to the condition the ground has the qualities of the five elements; thus one should take, e. g. purgative from the ground in which earth and water prevail, emetic from the ground in which fire, air and wind prevail. One should learn to know the medicinal plants from cowherds, ascetics, hunters and other people living in forests. One should take the animal substances like blood, hair, nails, milk, urine and faeces from grown up animals after their digestion. The hut (*bhesajāgāra*) for preserving the plants should be erected on a clean place. Further (1. 38) he mentions over 700 plants divided into 37 Ganas according to the diseases for which they are to be applied, and gives them names according to the first plant of every group, as e. g. *arkādigana* from Arka (*Calotropis gigantea*). This classification is crossed by another grouping (1.39) according to the effect of the medicine as emetic, purgative, errhine or pacifying remedy. Car 1.1-4 divides the remedies from similar points of view; particularly he mentions in 1.4 fifty groups of decoctions (*kaṣāya*) namely those which prolong life, make the body fat, make it thin, cause secretions, contract (the fractures), raise appetite, give strength, improve the complexion, cure hoarseness, stimulate the voice, remove oversaturation, hemorrhoids, skin-diseases, itch, maggots and poisoning, beget mother's milk or purify it, create or purify the sperm, are remedies for fattening, perspiring, vomitting and purgation, remedy for ordinary and for oily enemata, errhine remedy, remedy for retching, thirst, hiccup, diarrhoea, for change of colour of the faeces, for increasing the urine and for changing its colour, remedy for cough, asthma, tumour, fever, fatigue, feeling of heat or cold, nettle-rash, arthritis, colic, bleeding, pain, unconsciousness, barrenness and decrepitness. Each of these 50 groups covers 10 plants, so that 500 vegetable medicines are mentioned in them. The most exhaustive collections of medicines inclusive of the eatables and drinks with the exact information of their qualities and effects are contained in the medical glossaries. See § 11.

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¹ Cf. Buhler, ZDMG 37, 98 ff.; Hemadri 1.894 ff., Puschmann l.c. 14 f.

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² Watt, Economic Products of India, 6, 2, 415.

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§ 23. Properties of Medicines :— A number of general qualities and effects are attributed to the medicines as well as to the articles along with their specific effects in individual diseases. The six kinds of rasa— taste, are of special importance. They are : sweet, sour, salt, pungent, bitter and astringent. 1. The sweet causes stickiness in the mouth, increases the phlegm, chyle, blood, flesh etc., appeases thirst and hunger, delights and pleases, and causes many ailments like cough, asthma, flatulence, maggots, goiter, elephantiasis etc. when taken excessively. 2. The sour causes sensitiveness of the teeth, salivation and appetite, helps digestion, is mostly agreeable, but causes pus formation in wounds and ulcers and on account of the heat-producing nature of sour substances causes burning in throat, chest and heart if used in excess. 3. The salt purifies and stimulates digestion, but causes itch, tumour and other ailments if taken in excess. 4. The pungent provokes appetite and digestion, lessens the corpulence but its excessive use leads to nervous pain in hands and feet etc. 5. The bitter acts favourably on appetite and digestion, but causes convulsions, headache and the like by excessive use. 6. The astringent cures and purifies wounds, but causes convulsions cramps and the like by excessive use. All important medicines and articles of food are put by Su 1.42 in one of these six groups. In medical glossaries also the taste of every stuff is given.

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When the stuffs come in contact with the digestion-fire in the stomach, they are changed by digestion (vipāka), whereby sweet and salt things become sweet, sour things become more sour, and pungent, bitter and astringent things become pungent ( AS 1.1; AHr 1.9). Many controversies still exist on this subject; the taste may indeed generally be considered as a product of digestion (Su 1.40 ).

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Every medicine further possesses its own power (*virya*) : hot or cold. This is the usual doctrine, yet Su I. c. mentions a different theory according to which there are eight kinds of virya : hot, cold, oily or softening, dry or desicative, clear or purifying, slippery, mild and pungent.

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All the stuffs have the properties (*guna*) of the elements of which they are composed. Thus the purgatives have prominently the properties of earth and water; they are, therefore, heavy and move downwards (Su 1.41).

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§ 24. Curing Methods :— The most important curing methods are collected together under the name *pañcakarman*, namely vomiting (*vamana*), purgative (*virecana*), enemeta (*basti*), oily enemeta (*sneha*) and nasal therapy (*nasya*). The most usual vomiting remedy (*vamana*) is Madana (*Randia dumetorum*), a small sweet fruit like a small apple¹. As a support to the action of vomiting, the patient puts a castor-stalk in his throat, while an attendant holds him by his head and sides. The physician must examine the vomit. Emetic is indicated in phlegmatic diseases, poisoning, fever, consumption, diseases of female breast, diarrhoea, diabetes, flatulence, cholera, indigestion, dyspepsia, nausea, erysipelas, leprosy, asthma, cough, elephantiasis, heart-disease, excessive fatness, madness, epilepsy, rheumatism, ozena, swollen tonsils and other diseases. Among the *virecanas* the foremost are *trivrt* (*Ipomea Turpetum*), the most popular remedy of this kind among the Hindus even to the present day, and *eranda-taila* among the oils². Purgative is prescribed in fever, poisoning, loss of appetite, hemorrhoids, swelling of the body and of the spleen, abscess, leprosy, fistula of the anus, female diseases, erysipelas, cholera, wind-dropsy, diabetes, strangury, wounds, burns, opthalmia, cataract or glaucoma, heat in the head and other parts of body, hemorrhage, jaundice, colic and other diseases (Car 1.15 f.; Su 4.33 f.; AS 1.27; AHr 1.18; Vr 73 f.). An enemeta is called *basti*, *bastikarman*. The enema-pot should be made of the bladder of cattle, buffalo, boar, goat or sheep or eventually of leather or of thin but closely woven cloth; the tube (netra) should be made of gold, silver, copper, iron, brass, ivory, horn, reed etc., ending to a point like cow's tail, 12 fingers long for a patient of 25 years and thick as a thumb at the beginning. Bastis are prescribed in fever, diarrhoea, glaucoma, cataract, headache, opthalmia, convulsions, hemiplegia, flatulence, calculi (śarkarā), colic, swelling of testicles, constipation, strangury, stone, dystocia and many other diseases. They make an impotent potent, a thin man fat, a fat man thin, remove wrinkles and grey hair. Distinction is made between a cleaning enemeta (nirūha, nairūhika) and oily enemeta (snaihika, anuvāsana). Oily enemeta should be resorted to when the passages in the body are purified by nirūha. The recipes for enemeta are of many kinds. Accidents (vyāpad) in enemeta appear to have frequently occurred, since Suśruta counts 76 of them. In the first place he mentions wounds and pains in the anus. Injections in the urinary passages, also in vagina in the case of women, are called uttarabasti (Car 8.10-12; Su 4.35-38; AS 1.28; 5.4-6; AHr 1. 19, 5.4.f.; Vr 15 f.). Snuffs or nasal remedies (nasya) are then mentioned, whereby a medicine or an oil mixed with medicine is put into the nose (nāsikā, Su 4.40). Like enemeta, the Nasyas are divided into two classes, namely the purifying, purging the head (sirovirecana) and oily or strength-giving (snehana, bṛmhana). Further the dropping of pungent juice is called avapīḍa, the introduction of powder in the nostrils through a reed is called pradhamana, the pulling up of oils in the nose by drops without swallowing them down is called pratimarśa. The nose-remedies are suited particularly for diseases of head and throat (Su 4.40; AS 1.29; AHr 1.20; Vr 78).

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In the application of pañcakarman, sneha and sveda precede and they play a great role. Among the animal fats, ghee is the best and among vegetable fats, sesame oil is the best. One can eat the fat or oil either unmixed or with various additions like salt, flesh-broth, flesh, milk, whey, pap and others, or turn them into embrocations, plasters, enemeta, eye-ointments, spraying in the nose and ears and the like. In internal use, the full dose (uttamā mātrā) is to be taken by strong patients with good digestion and in swelling of the body, serpent-bite, erysipelas, madness, strangury, constipation; the medium dose in tumour, small blister, itch, leprosy and other skin-diseases, and by those who eat moderately and who are not very strong and are not constipated; small dose is to be taken by the aged or the children or by persons who are infirm or who have already taken a purgative or have weak digestion or are suffering for a long time from fever, diarrhoea or cough. Car 1.14 distinguishes 13 kinds of *sveda*: 1. *saṅkara-sveda*, fomenting with objects like cowdung, sand etc. made hot in cloth and placing them on the suffering part of the body. 2. *prastarasveda*, sweating by a bed of straw on which the objects are put loosely in a cloth. 3. *nāḍīsveda*, the steam-bath through a reed, one end of which is applied to the body while the other sticks to the boiling pot. 4. *pariṣeka*, bathing with warmed medicinal stuffs. 5. *avagāha*, bath in a cask with warm water and medicines. 6. *jentākasveda*, sweating in a sweating room which is made hot through an oven with many holes. 7. *aśmaghanasveda*, sweating by lying on a hot stone. 8. *karṣūsveda*, filling a ditch beneath the bed of the patient with fire. 9. *kuṭīsveda*, sweating by lying on a bed in a compact hut. 10. *bhūsveda*, lying on level ground, in other respects like 7. 11. *kumbhīsveda*, burying a pot filled with medicines below the bed of the patient and adding heated iron balls or pieces of stone. 12. *kūpasveda*, filling a wide ditch with dung which is kindled and on which the bed of the patient is placed when there is no smoke. 13. *holākasveda*, the bed is placed on a heap of burnt dung.

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Sveda is prescribed for rheum, cough, hiccup, asthma, pain in ears, throat and head, hoarseness, pain in the neck, apoplexy, constipation, urinary troubles and many other diseases (Car 1.13 f.; Su 4.31 f.; AS 1.25 f.; AHr 1.16 f.; Vr 71 f.)

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By *dhūma* or *dhūmapāna*, fumigations in the nose or mouth are to be understood. According to Caraka the medicines to be used are powdered and kneaded into a ball which is fixed to the end of a reed-stalk. When the ball is dry, the stalk is pulled out, the tube thus formed is put in a pipe of metal, wood or ivory; it is then kindled and the other end of the reed is put into the nose or mouth. According to Suśruta, there are five kinds of dhūma. AHr prescribes dhūma for headache and throatache and such other diseases; according to Car, Su, AS, it is prescribed also for sleeping sickness, exhaustion, green sickness, poisoning, bleeding, mania etc. (Car 1.5.24 f.; Su 4.40; AS 1.30; AHr 1.21; Vr 77). Local application of smoke through pipe in ulcers, skin diseases etc. is called *dhūpana*.

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Fluids for *kavalagraha* and *gandūṣadhāraṇa* (mouth-rinsing and gargling) are prescribed particularly for the diseases of mouth and teeth. The fluid is to be retained in the mouth until tears come out of the eyes and drops begin to fall down from the nose; then a new portion of the fluid is to be taken (Su 4.40; AS 1.31; AHr 1.22; Vr 78).

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For the ailments of the eye, instilling of drops (*āścyotana*) is prescribed in the first place, since it removes redness, lachrymation, pain, pus-formation and other affections of the eye. The eye-ointment (*añjana*), particularly made of Antimonium, is frequently spoken of, which is put into the eye with a probe (*śalākā*) (AS 1.32; AHr 1.23). Face-applications are called *mukhapralepa*, application is *pralepa* in general, softening poultice is called *pradeha*, suppository is called *varti*, *phalavarti*, ointment is *lepa*, *abhyaṅga*, *anulepana*³. Elixirs (*rasāyana*) form an important class of medicines to be taken internally. They are considered as the seventh subject of medicine; and it is said in many recipes that one could obtain a hundred years' life by their use. On Burns and Cauteries see § 29.

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(1) Dutt, Materia Medica 177. (2) l. c. 202, 231; (3) cf. l. c. 17 ff.

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§ 25. Form and Quantity of Medicine :— We can get an idea of the mixtures used by Indian physicians about 1600 years ago through the recipes that are prescribed in the Bower MS. Most of these consist of a considerable number of various ingredients and are adorned with sonorous titles like "Citron pills of Dioskuroi" (*aśvinīmātulṅgaguṭikā*), the ambrosia of ghee (*amṛtaprāsam nāma ghṛtam*), ghee containing ten medicines (*daśāṅgam nāma ghṛtam*), an oil for removing wrinkles and grey hair (*valipalitanāśanam tailam*) and the like. Many of these names as well as the recipes themselves are repeated in later medical literature.

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In the preparation of medicines too, only a little change has occurred in course of centuries. Mention may be made here of some chief forms¹ all of which are found in the Bower MS: *Ghṛta*, medicinal stuffs are cooked with an addition of water, milk and the like; mostly for internal use. *Taila*, similar decoctions in oil; mostly for internal application. *Kaṣāya*, *kvātha*, decoction, particularly of 4 to 16 parts of water with one part of medicine; the mixture is boiled until one fourth remains.

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*Vaṭikā, guṭikā*, pills and balls. *Modaka*, sweet uncooked pills. *Puṭapāka*, roasted vegetable medicines. The stuffs are turned into a ball which is enveloped in leaves, strung together and is covered with a layer of mud, whereupon the whole is roasted, then the shell is broken and the roasted medicine is given either as pill or powder, or its extract as juice with honey. *Cūrṇa*, powder, is pounded in a mortar and is strained through a piece of cloth. *Kalka*, paste of a plant bruised on a stone. *Svarasa*, natural juice which is produced in a mortar by pounding fresh plants. *Leha, lehya, avalehya*, licking substance consisting of thick extracts from plants with addition of sugar. *Yavāgū*, meal-sauce with an addition of medicinal stuff. *Ariṣṭa, āsava*, a fermented drink of honey, syrup and water with various medicinal stuffs. A variety of this is *cūrṇāriṣṭa*, which is mixed with a powder. *Kañjika*, fermented rice-gruel. *Kañjikaguḍa, kañjikalavaṇa*, mixtures with syrup and salt respectively. As for the doses in which particular medicines are mixed and the mixtures are administered, much has been borrowed by the medical works from the recipes of the Bower MS. The apothecary weights correspond in general with those mentioned in Smṛtis. The most important small weight is *guñja*-the seed corn of *Abrus precatorius*, corresponding the modern *ratti* of the apothecaries and jewellers. However, there are wide local differences¹ regarding particulars. Children are to be given smaller doses.

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(1) Cf. Dutt, *Mat. Med.* 9-16. (2) Bower MS p. 13, 78, notes; Colebrooke, *Essays* 2, 528 ff.; Buhler, remarks on Manu 8.134; Dutt, *Le.* 7-9.151; Sachau, *Alberuni's India* 1.162 f.

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§ 26. Mercury and Opium.—In order to go into the details of the application and history of particular medical substances a history of Indian botany, minerology, pharmacy and chemistry is required to be written, for which there is want of space here. Reference may be made to the rich material in Watt's *Economic Products of India*, Hoernle's Bower MS, Garbe's *Indische Mineralien* and other works quoted in § 17. In general, the use of minerals as medicines appears to have increased continually. The mercury (*pārada*) particularly attained the fame of a universal remedy which was used externally, especially for syphilis in later period, as well as internally. An entire class of literature was created on *rasa* (§ 3) in which other metals and minerals such as sulphur, gold etc. are also dealt with. Mercury is, therefore, called *rasendra, rasarāja, rasanātha*, the

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king of metals. In *Rājanighaṇṭu* 33 different names are given to it¹. Among the ascetics also the use of a mercury-preparation (*rasapāna*) for prolonging life was common, and even the philosophy developed (in 14th century A. D. at the latest) a mercury system (*raseśvara-darśana*)². Mercury does not occur in the Bower MS; in Su, AS, AHr it is mentioned as Rasendra, Pārada only in a few places. Whether Caraka knew it, is doubtful³. At any rate the purification (*śodhana*) by heating and the consequent immersion in certain fluids and the "killing" (*māraṇa*) i. e. the calcination or powdering of mercury and other metallic processes which make it fit for pharmaceutical application, are not mentioned in these old works.

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Watt⁴ leaves the question open whether the Indians knew the medicinal effects of mercury before or after the Arabs. Since, however, the calcination of mercury is traced only to Mahommedan epoch, it may be believed that it originated from the Arabic alchemy in which mercury plays such a great role. The Indian physicians also received from the Arabians the opium which began to be cultivated in India since the 16th century A. D. and was formerly being imported from Arabia⁵. The designation of opium as *ahiphena* "Serpent-foam" is evidently only a popular etymological transformation of the old *aphena, afim, afin, afuka* and these expressions go back to one of the Arabic transformations (usually *afyun*) of the Greek *ὄπιον* and they come only in later works like Madanavinoda, Rajanighaṇṭu, Śārṅgadhara, Rasendrasārasaṅgraha and Yogaratnākara, while Caraka, Suśruta, AS, AHr do not know them. A constipating and narcotic effect (*grāhin, mohakṛt*) is attributed to it, therefore it is particularly prescribed for diarrhoea⁶ (*Atisāra, Grahaṇī*).

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(1) Garbe, *Die indische Mineralien*, 60. (2) Cowell and Gough, *Sarvadarśanasaṅgraha*, 137-44. (3) Cf. ZDMG 54, 263, Dutt, *Materia Medica* XII, 22 ff. (4) *Economic Products of India*, 5, 234. (5) l. c. 6, 24. (6) Cf. Dutt, *Mat. Med.* III ff.

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§ 27. Surgical Operations¹ :- The major surgery (*śalya*) deals with the extraction of foreign matters from the body (§ 81), the blunt and sharp instruments, cauteries and brandings and Vraṇa (wounds in the widest sense, see § 78). The surgery of the eye, ear, nose and throat (*śālākya*) covers all ailments of the head, and especially deals with eye-diseases (§ 82). Each of these two sciences

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forms one of the eight subjects of medicine (Āyurveda) and Suśruta places it at the head of the same. He particularly points out the special importance of Śalya (Su 1.1.3 ff.). The more important operations like laparatomy, stone, cataract etc. shall be described later on while dealing with the diseases concerned. Here, therefore, only certain general observations may be made.

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The surgical operations are divided into eight parts: excision, incision, scarification, puncturing, probing, extraction, drainage and suturing. The surgeon must, therefore, keep ready the following: blunt and sharp instruments, cauteries and fire, probes (salākā), a horn (for cupping), leech, a hollow calabash, probe for cauterization, cotton, cloth, thread, leaves, bandage, honey, ghee, fat, milk, oil, refreshing substances, boiled medicines, ointments, paste, fan, cold and hot water and pans. Sympathetic and strong assistants should also stand by his side. The operation should take place on a lucky constellation, accompanied by a religious ceremony and followed by a lengthy prayer by the surgeon. The patient who should have taken only a little food before the operation, is seated in front of the surgeon and is fast bound. In ulcers or wounds the instrument should be introduced with the precaution of avoiding dangerous places (marman), veins, bones and the like, until the pus is visible, and then should be quickly withdrawn. If necessary, counter-incision should be taken. The cut may be oblique, round or hemispherical according to the part of the body. The patient should not eat anything before the operation of dystocy, ascitis, hemorrhoids, fistula of the anus and mouth-diseases. After the operation the surgeon should refresh him with cold water, should drain out the wound with fingers on all sides, compress it, wash it out with medicines, cleanse it with cloth, should thereupon spread a layer of thick paste of sesame mixed with honey and butter, besmeared and soaked with medicines, upon which again another layer of paste comes, on it a compress, whereupon the whole should be tied fast with a piece of cloth. Fumigations and incantations then follow. After three days the bandage should be renewed. The healing process should not be precipitated so long as the pus is present. The patient must keep diet (Su 1.5). According to AS 1.38; AHr 1.29 the patient should be given to eat what he wishes and wine to drink before the operation, so that he may not faint and may not feel the knife.

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Of the eight above-mentioned operations, the excision is prescribed in fistula of the anus, unripe growths caused by Kapha, dark moles, edges of the wounds, tumours, hemorrhoids and similar growths (*carmakīla*), foreign matters in the bones or in flesh, hairy moles, fleshy growths (in the palate), swollen tonsils, rotten ulcers on the penis (*śatapoṇaka*), a red tumour on the palate (*adhruṣa*), abscesses on penis, flesh-tumour (in vagina?), tumour on wisdom-tooth. Incisions are suited to deep going abscesses, growths, erysipelas, swelling of testicles, abscess on testicles or axillary cavity, carbuncles created by diabetes, tumour (*śopha*), diseases of the mammary glands, pustule on penis, cysts on eyelids, ulcers on the foot, fistula, throat-inflammation (*vṛnda* and *ekavṛnda*), the ulcer of the penis (*puṣparikā* and *alajī*), most of the "minor diseases" (§ 67), tumours (*puṭpala*) on palate and teeth, abscess on the tonsils, hard tumour in the throat and septic tumour or tumour originated from fat. The bladder is, on the contrary, to be opened only in stone. The four curable kinds of Rohiṇī (throat inflammation), leucoderma (*kilāsa*), a tumour on gums originated from fat, growths, abscesses, tumours on tongue, hemorrhoids, circular spots, growth of flesh and increase of flesh should be curetted. The different veins, hydrocele and dropsy are to be punctured and tapped. Fistula, wounds containing foreign matter and irregular wounds should be probed. The three kinds of sand, or gravel, tartar on the teeth, stone, foreign matter, dead foetus and the faeces accumulated in the anus should be extracted. Abscesses with the exception of the most difficult form, lepary skin-diseases (*mahākuṣṭha*), local swellings, abscesses on ear-lap, elephantiasis, blood-poisoning, tumours, erysipelas, teeth-tumours and many other swellings and skin pustules should be drained. Tumours originated from fat should be sutured after they are cut and cleansed; so also wounds and injuries on movable joints. The threads for suturing should consist of flax or hemp and other vegetable fibres or of sinew or hair of the tail of beasts. The needle should be 2 to 3 fingers long according to the part of body, and straight, round or three-edged or curved. The parts sutured together should be covered with cotton or linen; curing powder should be cast upon them and then they should be bandaged (Su 1.25).

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On the 14 bandages in Suśruta see § 78. According to AS, AHr there are 15 kinds of bandages named after their form. On the buttocks (*bandha*), axillary cavity, sides, upper part of thigh and on the head a tight bandage should be tied; on the arms and legs, face, ears, neck, penis, scrotum, back, sides, belly and the breast a medium tight bandage should be tied; on the eyes and on joints a loose bandage should be tied. Bandages should not be used in the case of lepary skin-diseases, wounds caused by burning, diabetic-carbuncles, wounds caused by cauterization or by poison and similar cases ( AS 1.38; AHr 1.29, cf. Su 1.18 ).

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(1) Cf. Trendelenburg, De vet. Indorum chirurgia. Berlin dissertation, 1866. Haser, Ubersicht der Chirurgie 3-5 (Breslau 1879).

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§ 28. Surgical Instruments :—Descriptions of surgical instruments really agreeing in essentials are made only in Su ( 1.7 f. ), AS ( 1.34 ), AHr ( 1.25 f. )¹. Of the two kinds of instruments, namely the blunt ( yantra ) and the sharp ones ( sastra ), the former are divided into six kinds with 101 instruments in all. According to Su, the hand is the most important of all yantras, for without it no operation can be made². The main function of the yantra is extraction of foreign matter ( salya ) from the body, yet AS and AHr assert that yantras also serve to protect healthy limbs in difficult operations with knife, fire, cauteries, e. g. in diseases like hemorrhoids and fistula; they also assert that Basti, cupping horns, hollow calabash and other implements should be counted as yantras. 1. Svastikayantra " cross-shaped instrument " ( pair of tongs ) should, as a rule, be made of iron, 18 fingers long, the ends of the heads like beasts of prey and birds of prey, the arms of the pair held together by a pin the head of which is as big as a lentil and therefore bent where it is to be held. According to Susruta there are 24 Svastikayantras, 9 appearing at the end like the heads of lion, tiger, wolf and other beasts of prey and 15 appearing like the heads of crow, heron, vulture, falcon and other birds of prey. AS and AHr give no definite number.

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They serve to extract foreign matters from the bones, and really the 9 yantras bearing the heads of beasts of prey extract such foreign matters as are prominent and are easily sizable. The best pair of tongs applicable to all parts is that of heron's head. 2. Samdamsa ( pair of tongs ) of two kinds, with or without arms, 16 fingers long, to extract Salya from the skin, flesh, veins or sinews. AS, AHr mention two more Samdamsas : (1) a smaller kind, 6 fingers long, to extract hair in the nose or on the eyelids, irregular flesh on the wounds and the like and (2) mucundi provided with a ring on the grip which serves to extract remnants of cut-off Pterygium or to remove irregular flesh in deep abscesses. 3. Tāla, spoon, 12 fingers long, resembling the mouth of a big fish. There are two kinds : a single spoon and a double spoon. They serve to extract foreign matter from the ears, nose or fistula. 4. Nāḍī-yantra "Reeds", 20 kinds, with an aperture on one end or on both the ends, of different length and strength, according to the organ in which it is inserted, serving to extract foreign matters from the canals, (e. g. from the ear) for diagnosis (e. g. of diseases of throat), for sucking (e. g. poison), for the facilitation of operations (e. g. for washing out wounds ) or for introducing medicinal stuffs.

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These reeds are applied in fistula of the anus, hemorrhoids, tumour, ulcer, enemata, injection in the urinary passage, hydrocele, dropsy, inhalation, stricture of the urinary passage and the anus. The calabashes and horns for cupping also belong to this. AS and AHr describe some of these Nāḍīyantras in detail, thus a 10 fingers long and 5 fingers broad reed for the examination of a śalya stuck to the throat, a short but thick reed for examining, cauterizing and operating in the case of piles, a 16 fingers long reed for the examination of female genitals etc. 5. Śalākāyantra "instruments of the kind of awl" are 28 in number. Out of these, seven have earthworm-like points for probing, two have ends like an arrowshaft for shaking, two have ends like a serpent-hood for pushing, two have hooklike points for extracting, two have a little bent ends, of the form of a half lentil for extracting śalya from external organs, six have turbanlike points, surrounded with cotton for wiping off (pus, blood, cauteries etc.), three have spoonlike points for introducing cauterizing material, three have heads like Jambu fruit for cauteries and brandings, one with a point like a half fruit-kernel for extracting or branding a tumour in the nose. There are three more Śalākāyantras for branding and one for introducing eye-ointment and for cleansing the urinary canal.

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AS and AHr mention a foetus-hook (garbhaśaṅku) for extracting a dead foetus, a hooklike instrument like serpent's hood for extracting stone in the bladder, an instrument with a point like an arrowshaft for extracting bad teeth, an ear-spoon etc. and six other instruments. The 25 anuyantras "secondary yantras", i. e. helping implements are a magnet (for extracting foreign matter), a horse-bridle ring, branch of a tree (for similar purpose), thread, cloth-pieces and bandage, a hammer (for loosening foreign matter), cautery, fire and medicines, the hand and foot-palms, tongue, teeth, nails and the mouth, time, digestion, cheering and the like.

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The knives or sharp instruments (*sastra*) which an expert smith should prepare from iron are divided, according to Suśruta, into 20 kinds : 1. *maṇḍalāgra*, with rounded point, according to Dallana either round or formed like a razor, 6 fingers long and, according to Suśruta, applicable for scarification and excision in diseases of eyelids. 2. *karapatra*, saw, according to AS, AHr, 10 fingers long and 2 fingers broad, finely teethed, serving to cut the bone. According to Suśruta, 1 and 2 serve for excision and scarification. 3. *vṛddhipatra*, sharp or blunt, according as it is used for a superficial or deep tumour, serving for deep or superficial excision (AS, AHr). 4. *nakhaśastra*, with straight or crooked blade for extracting thorns and other small foreign matters and for cutting or cleaving the nails (AS, AHr). 5. *mudrikā*, ring, a small knife for operation of the throat (AS, AHr). 6. *utpalapatra*, resembling a blooming leaf of blue lotus. 7. *ardhadhāra*, one-edged or *adhyardhadhāra*, one and half-edged (AS, AHr). According to AS, AHr, 6th has a long and 7th has a short point; according to Suśruta, 3-7 serve for deep and superficial excisions. 8. *Sūcī*, needle, for sewing, of 3 kinds, according as it is used for fleshy parts, for bones, joints and the like or for the dangerous places in intestines or anus (AS, AHr). 9. *kuśapatra*, bearing the form of a Kuśa-blade, according to AS, AHr, two hands long. 10. *āṭīmukha*, " Āṭī-beak " i. e. formed like the beak of *Turdus ginginianus*, also two hands long (AS). 11. *śarārimukha*, " Heron-beak " according to Dallana, a kind of scissors, according to AHr, a trocar. 12. *antarmukha* " with point in the middle", according to AS, AHr, sickle-shaped, 1½ fingers long, according to Suśruta (Hoernle) a pair of crooked scissors with straight part in the middle. 13. *trikūrcaka*, trocar. 8-13 serve, according to Suśruta, for cleansing abscesses. 14. *kuthārikā*, an axe with a ½ finger broad blade of the form of a cow-teeth. 15. *vrīhimukha*, " rice-corn-headed", the blade 1½ hands long, a pointed instrument for tapping fluid in dropsy, abscess and the like and for bleeding purposes (AS, AHr). 16. *ārā*, awl, four-cornered but furnished with a round point serving for boring through the ear-lap and for the examination of tumour (AS, AHr). 17. *vetasapatra*, i. e. cane-formed, edged and serving for boring through or puncturing (*vyadhana*), which, according to Suśruta, is the purpose of 14-17 in general. 18. *baḍiśa*, " Fish-hook ", with crooked point, for catching swollen tonsils, pterygium and the like (AS, AHr). 19. *dantaśaṅku* (*dantalekhana*) toothpicker, four-angled, serves for removing tartar. 20. *eṣaṇī*, "probe" of two kinds, viz. with earthwormlike point for probing of wounds or needlelike and furnished with a caustic thread for tearing fistula. In AS, AHr, there are 26 *śastras* among which, besides the above, there are a pair of scissors (*kartarī*) for cutting sinews, thread, hair and the like, an edged instrument (*śalākā*) of copper with a point like a grain of corn to prick the cataract, a reed-stick (*khaja*) with 8 points for effecting bleeding of the nose etc. According to Suśruta most of the *śastras* are 6 fingers long. The edges should be so sharp that one could cut the hair on body. The vicarious instruments (*anúśastra*) are leech, cautery and fire, glass, rock-crystal, ruby, adular, cutting bark, hair, finger or fresh shoots for probing, the nail for extracting or cutting, and the like.

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