Chapter 12 - Examination, Registration and Convocation

Entrance examination

In order to maintain a lofty standard of intellectual studies pursued in the ancient universities, there was maintained an institute of Dvara-Panditas (dvārapaṇḍita) or entrance-pandits who guarded the holy portals of the temple of learning against the intrusion of mediocre talents. These Dvara-pandits were each expert in the various subjects taught at the university. They conducted an entrance examination of the aspirants for higher studies. They were very strict in their tests. Hardly 20 to 30 % of the students succeeded in getting admission. They took scrupulous care not to make admission cheap. They were the standard bearers of the prestige and scholarship of the university. Thus the doors of the university were zealously guarded by experts who were always ready with the most difficult questions at the entrance test in order to find out the competence of the candidates seeking admissions.

Examination in General

The knowledge imparted was both theoretical and practical and the students were required to pass stiff tests in both. There is the story of Jivaka which gives us an inkling into the method of practical examination adopted in ancient days

Practical Examination

According to the Tibeten tales, Atreya said to his pupils,

“Go to the pine hill and fetch from it that which is no remedy.”

The pupils went there and each of them brought back that which he thought was no remedy. But Jivaka reflected that there was scarcely anything which is not a remedy for some or other ailment, so he brought with him only a knot from a reed and a piece of stone. He also took with him a pot which a shepherd girl whom he had cured, had given him.

When they all returned to Atreya, each of them showed what he had brought with him Atreya said,

“Oh sons of Brahmans, this one is of use in such and such an illness and the others in other illnesses”

When Jivaka was asked what he had brought, he said,

“Oh, teacher, all things are remedies. There exists nothing which is not a remedy However, I have brought a knot of a reed and a piece of stone and a leavening pot”

“Of what use are these things?”

“If a man is stung by a scorpion, he can be fumigated with the reed knot and healed with leavening pot and with the piece of stone can a pot of curdled milk be broken at harvest time”.

The truth of this story is confirmed when we refer to Caraka Samhita. It is said in the 12th passage of the 26th chapter of Sutrasthana:

“In the light of this knowledge there is in the world no substance that may not be used as medicine in this or that manner for this or that purpose”.

Theoretical Examination

For the theoretical test they employed what is known as the “Salaka Pariksa” This was the method adopted at the final examination in Mithila which reflourished during the thirteenth century. (Mithilā was the capital of Videha, the ancient seat of learning). The test was conducted as under. The page of the manuscript was picked up by a probe at random and the student was asked to explain the matter contained. This test was equally difficult as the admission test of Nalanda and Vikramashila controlled and conducted by the Dvara Pandits. This Shalaka test was a test of the students knowledge in theory.

The final examination was equally difficult. This method of test was also employed for a foreigner coming here for practice. It was the practitioner’s test. Any practitioner desirons of getting registration and the right to practise in this country, had to pass this examination before he was permitted by the State to practise.

[Carakasaṃhitā Sūtrasthāna 30.3?]

“Now a physician should be examined by another physician on eight topics viz, the system and its interpretation, the main sections of the system and their interpretation, the chapters (in each section) and their interpretation, and the questions and their interpretation, and thus being examined, he should give hie answers, leaving out nothing, by verbatim quotations, by explanations of the quotations and by further elucidations of difficult parts of the explanations.”

[Carakasaṃhitā Sūtrasthāna 30.16-19]

“The question arises—How is the system and the rest expounded verbatim, or with comment or with detailed elucidation?

To this the answer is—When a system promulgated by a seer is recited in its entirety and in the order of its (original) enunciation, then it is said to be delivered verbatim.

When, having penetrated into the truth of its meaning by means of the understanding (a system) is propounded in words that are elaborate or succint (as the occasion may demand) by the method of proposition, reason, analogy, application and conclusion, and in a manner that is intelligible and appealing to the three types of studentmind, then it constitutes an exposition (of the system) with comment.

When the difficult passages occurring in the treatise are elucidated by further glosses, then the exposition is called a detailed elucidation”.

This could discriminate real scholars from quacks.

[Carakasaṃhitā Cikitsāsthāna 4.52-53]

“On the completion of his studies, the physician is said to be ‘reborn’ and acquires the title of ‘physician’. For no one is a physician by right of birth.

On the completion of his studies, the spirit of revelation or of inspiration of the truth descends into the student. It is by reason of this initiation then, that a physician is called a ‘Dvija’ or a twice-born one”.

Registration

A graduate in medicine had to obtain king’s permission to embark on his professional career. It was the duty of the state to protect its people not only from external invaders and depredators but even from the robbers and bandits within as well as those other robbers, bandits and cheats that might rob people of their money and even life in the guise of a friend, adviser and healer. It was to prevent the ravages of the internal enemies that registration of responsible professions such as the lawyer’s and the doctor’s has come into being. This obtained even in ancient India where the State took proper care to eliminate by strict methods the charlatan and the ignorant but ambitious crook, from endangering the welfare of the people. The men that had studied the science well, had acquired proper skill in the practice and had passed all theoretical and practical examinations could set up practice only after obtaining the permission of the king or the state.

Such a registered practitioner, who received the approval of the state, entered “Visikha” (viśikhā) meaning the cessation of the student life (when he had to keep the tuft) and the actual entrance into professional life.

[Suśrutasaṃhitā Sūtrasthāna 10.3]

“Having studied the science, having fully grasped the meaning, having acquired practical skill and having performed operations on dummies, with ability to teach the science and with king’s permission, a physician should enter into his profession”.

The need for such testing and previous approval of a physician before setting up his practice is explained by pointing out the duty of the king to protect his people from the harm that might otherwise befall them at the hands of false men who easily put on the airs and apparel of the real physician.

The existence of such bogus men was considered a blot on the king and the state:

[Carakasaṃhitā Sūtrasthāna 28.8]

“Opposed to this are the votaries of diseases and the destroyers of life. These charlatans in the robes of doctors, thorns in the flesh of the whole world, with talents similar to those of mimes and mountebanks, move about in the land through the want of vigilance on the part of rulers.”

[Suśrutasaṃhitā Sūtrasthāna 3.52]

“A quack; ignorant of the procedures of oleation and other therapies and of the operative measures of incision, etc., will through greed destroy the lives of the people as a result of the king’s connivance or inattention to such false physicians”.

Thus it would appear that in ancient India utmost care was taken to safeguard the welfare of the people from the unauthorized and ignorant exploiters in the name of medical men. They took care to maintain a high standard in the profession by the tests to which the applicants to the profession had to submit. In the case of foreigners, they had to pass the same rigorous examination as the final examination before having the permission to practise ether by the royal physician or by a council of physicians.

Shukracarya lays down positively that without the permission of the king no physician should be allowed to treat.

[Śukranīti 1-3, 4]

Even the veterinary surgeon had to appear before the king for registration and then be allowed to practice.

The Convocation or Samavartana Ceremony

The convocation ceremony was a solemn, grave and elab orate occasion. The oath was administered to the students which contained very practical hints to the students who were on the threshold of a new life and were just to embark on the medical career.

This convocation ceremony was the remainder of the vow which he had taken at the initiation ceremony. It was called the Samavartana (samārvatana) ceremony, meaning thereby the returning to home of the student after finishing the course at the teachers residence.

[Carakasaṃhitā Vimānasthāna 8.13-14]

“Acting at my behest, thou shalt conduct thyself for the achievement of the teacher’s purposes alone to the best of thy abilities.

If thou desirest success, wealth and fame as a physician and heaven after death, thou shalt pray for the welfare of all creatures beginning with the cows and Brahmanas.

Day and nighty however thou mayest be engaged, thou shalt endeavour for the relief of the patient with all thy heart and soul Thou shalt not desert or injure thy patient even for the sake of thy life or thy living. Thou shalt not commit adultery even in thought. Even so, thou shalt not covet others possessions Thou shalt be modest in thy attire and appearance Thou shouldst not be a drunkard or a sinful man nor shouldst thou associate with the abettors of crimes Thou shouldst speak words that are gentle, pure and righteous, pleasing, worthy, true, wholesome and moderate. Thy behaviour must be in consideration of time and place and heedful of past experience Thou shalt act always with a view to the acquisition of knowledge and the fullness of equipment.

No persons, who are hated of the king or who are haters of the king or who are hated of the public or who are haters of the public shall receive treatment. Similarly those that are of very unnatural, wicked and miserable character and conduct, those who have not vindicated their honour and those that are on the point of death and similarly women who are unattended by their husbands or guardians shall not receive treatment.

No offering of meat by a woman without the behest of her husband or guardian shall be accepted by thee. While entering the patient’s house thou shalt be accompanied by a man who is known to the patient and who has his permission to enter, and thou shalt be well clad and bent of head, self-possessed, and conduct thyself after repeated consideration Thou shalt thus properly make thy entry. Having entered, thy speech, mind, intellect and senses shall be entirely devoted to no other thought than that of being helpful to the patient and of things concerning him only. The peculiar customs of the patient’s household shall not be made public. Even knowing that the patient’s span of life has come to its close, it shall not be mentioned by thee there where if,so done it would cause shock to the patient or to others.

Though possessed of knowledge one should not boast very much of one’s knowledge. Most people are offended by the boastfulness of even those who are otherwise good and authoritative.

There is no limit at all to the ‘Science of life.’ So thou shouldst apply thyself to it with diligence. This is how thou shouldst act. Again thou shouldst learn the skill of practice from another without carping. The entire world is the teacher to the intelligent and the foe to the unintelligent. Hence knowing this well, thou shouldst listen and act according to the words of instruction of even an unfriendly person, when they are worthy and such as bring fame to you and long life, and are capable of giving you strength and prosperity.”

[Suśrutasaṃhitā Sūtrasthāna 2.8]

“The twice-born, the preceptor, the poor, the good and the destitute—these thou shalt treat, when they come to thee, like thy own kith and kin and relieve their ailments with thy medications. Thus behaving, good will befall thee. Thus thy learning will attain popularity and will gain for thee friends, fame, righteousness, wealth and fulfilment”.

[Kāśyapasaṃhitā Vimānasthāna 8.8-9]

“Having finished his studies and permitted to leave the school, he should go about wearing white garment with clipped hair, with undeluded mind and with his eyes looking straight before him. He must be genial and take the initiative in a conversation. He must never resort to the patient’s house uninvited. Having entered he must scrutinize the prognostic omens. He should not turn his gaze on anything else in the house but the patient. He should not indulge in exchanging smiles with the women or the female servants of the patient’s household. He should not call the women by their names unprefixed with honorific terms but accost them in respectful terms. He must not develop a relation of intimacy or love with them. He must accept from them no gift without the knowledge of their husbands. He should not make his entry without announcing himself. He should neither stay nor talk with a woman in secrecy. He must not behold a woman when she is scantily clad or not smile at her. He should show indifference to a woman who makes amorous overtures to him and should not divulge the fact. He should not broadcast the secrets or the shortcomings of the patient’s household. He should withold from the patient the untoward prognostic signs that he may have perceived. He should continually offer consolation to the patient. He must not undertake to treat one who is on the verge of death, or one who is incurable or one who has not the means of treatment. He should not administer the medicine in the wrong order nor should he delegate the responsibility to another. He should make an altogether novel combination and administer it. He must be versed in the knowledge of characteristics of constitution, drugs, disease and age. He should always be equipped with the store of fumigating drugs, eye-salves and other medicines. He should not incur the hostility of other members of his profession. In cooperation with them he should prepare the medications. He should be given to speech that is bold, unambiguous, prompt, vivid, charming, gentle, persuasive, comprehensive, non-contradictory and righteous. For indeed, the physician who desires the well-being of people enjoys happiness in this world as well as in the other.

If he is attacked in debate by another physician he must be able to take his stand against him. The opponent should be persuaded by gentle words. If he persists in repeatedly attacking him, he should be overpowered by hostile methods of debate and by abundance of textual authorities. The opponent should be allowed no scope of speech. If yet he persists in speech, he should be told ‘not so, not so’. He should be scoffed and his grammatical errors exposed and he should be dragged into discussion of very difficult passages, but forgetting oneself one should never indulge in harsh language. One should condemn an opponent with words of seeming praise”.

From the above oaths we learn that the following points were stressed upon. The graduate could not return to his place without the express permission of the preceptor. He must complete the course of theoretical text and must fully understand the interpretation of the same. He must have witnessed the performance of actual operations himself. He must be neat and clean in appearance. He must put on white clothes, carry on umbrella and stick and must put on shoes. His dress must not be foppish. His mind must be pure and good. His speech should not be violent. He must not practise any deceit. He must have a brotherly feeling towards all creatures. He must possess sufficient assistants and equipments. He is advised as to how he should proceed to the patient’s place, what he should do there, how he should examine the patient, what kind of cases he should accept for treatment, what are the most difficult cases for cure and lastly, but not of the least importance is the injunction given to avoid intimate association with women His relations with other physicians are emphasised upon and consultations with other physicians in difficult cases are strongly recommended. These oaths formed the basis of the ethics of the physician, and a physician having all these qualities, could run a successful medical career.