Chapter 16 - Urban Medical Relief

India then, as now, was a land of villages. The vast bulk of the people have always lived in the country. The great changes in rulership, the palace revolutions and foreign domination have left the rural life of our country almost untouched. Every village has had its extent of land for tillage and pasturage, its temple for worship, its own priest and vaidya, its barber and dhobi all institutionalised on a lasting basis. Everything goes on today as it has gone on through the length of the ages.

The changes are in the town modes of life and all political and social upheavals have their source and their end in the life of the urban population. Every dynasty of kings took care to meet the changing needs of the urban life and so important an aspect as health and medical aid could not have been neglected.

Two Types of Institutions

1. State Service,
2. Private practice.

For this purpose two classes of medical practitioners came into existence. One class belonged to the state service and rendered medical help according to the rules and regulations of the State and with its authority too. The other class consisted of private practitioners who tried their best to help the people in a humanitarian spirit

For the institutions of state service the following references from Kautilya will shed much enlightenment on the subject.

Kautilya mentions the exact site where the state dispensary is to be established.

[Kauṭilya Arthaśāstra Pṛ. 55]

“To the north-west should lie shops and hospitals”.

He also states where the shrine dedicated to the Ashvinis along with that of other gods should be built.

[Kauṭilya Arthaśāstra Pṛ. 55]

“In the centre of the city, the aparatments of gods such as Aparajita Apratihata, Jayanta, Vaijayanta, Siva, Vaishravana, Ashvinas and the abode of Goddess Madira shall be situated.”

Also he mentions that a store of medicines adequate for the requirements of many years should be secured, and old stocks should be replenished by fresh ones.

[Kauṭilya Arthaśāstra]

“Medicinal articles shall also be stored in such quantities as can be used for years together without feeling any want.”

“Of such collection, old things Shall be replaced by new ones when received.”

In addition to the medical officers appointed by the State, there existed a larger class of physicians who did private practice.

That the medical profession was a popular one drawing a larger number of people to the trade is evident in as ancient a time as that of the Ramayana where we find it said that all the people of the town viz.,

[Rāmāyaṇa Ayodhyā-kaṇḍa 83.13-14]

“Grocers, jewellers, makers of rugs, keepers of hot water baths, medical practitioners, fumigators and wine sellers, all of whom accompained Bharata to meet Rama”.

The medical practitioners seem to have formed their own guilds just as other merchants, artisans and craftsmen did.

The medical profession must have been a lucrative one in those days so much so that it induced a lot of ambitious persons to parade as physicians and exploit the people. As we shall see the quacks abounded in every place and were known for their presumptuous manner and speech

Three kinds of practitioners were existant at that period as depicted by Caraka.

[Carakasaṃhitā Sūtrasthāna 11.50-52]

“Three kinds of medical practitioners are found in the world, firstly, the impostors in physician’s robes, secondly, the vain-glorious pretenders, and thirdly, those endowed with the true virtue of the healer.

Those who by parading their medical paraphernalia, books, models, smattering of medical texts and knowing looks acquire the title of physician, are the first kind, viz, the ignoramuses and impostors.

Those who by laying claim to association with persons of established wealth, fame, knowledge and success, while they themselves have none of these things, arrogate to themselves the designation of physicians, are vain-glorious pretenders”.

This shows the equipment a physician was having in his dispensary and the art he was making use of in his practice

Vatsayana makes interesting references to the dispensaries in the town that were the convenient trysting places for lovers.

[... 5.2.6]

“In the neighbourhood of the building of a friend, caste-fellow, high official or of a physician and on the occasions of marriage, sacrifice, festival, adversity and visit to the gardens etc., a woman tried to make her appearance.”

The equipment of the practitioner was as complete as the needs of the times demanded Caraka ascribed great importance to the completeness of equipment of a physician, for without it, successful treatment is not possible to achieve.

Before a physician takes up a patient for treatment, he is advised to keep ready all medication, apparatuses and instruments required for the procedure of treatment as well as for the emergency that may arise during the course of treatment

[Carakasaṃhitā Sūtrasthāna 15.3]

“The physician who wishes to administer the procedure of emesis or purgation to a person of kingly circumstance or a wealthy man, must keep ready before beginning his treatment, his full armamentarium. If the procedure proves quite successful, the equipment will be of use in after-treatment, and if the procedure goes wrong it will serve to help diagnosis and emergency treatment of complications arising during the course of treatment. The equipment should be kept because it is not easy to obtain immediately, even if the means to buy them be available, the stock of remedies needed in the event of an emergency development of the disease”.

Thus we see that even in that bygone age the medical profession was a popular one in the cities and towns and the best minds must have striven for high achievement in the profession and science. It is therefore that one should regard Ayurveda not as a mere dead letter come down to us only through mute books, but is a living and expanding art and science which dominated for thousands of years, but which has suffered neglect only for a few centuries recently. It is for the citizens of free India to pick up the thread and continue to progress into newer, realms of achievement and glory and to place it before the world in such a form as it may be of universal use and utility