Chapter 17 - The Royal Physician

It was natural that in a society patterned on the monarchical system of government, all the arts and sciences should centre round the person of the king and his patronage be the means and object, of all advancement in them. The poet, the artist, the scholar, the astrologer, the priest, the physician and the statesman were each of them attached to the king’s person and humored and helped him in his pleasures and pursuits and enriched his mental and physical equipment while they id turn received his admiration and encouragement and not seldom lavish patronage.

Nizami-i Arudi, a court poet of Samarkand in his persian book Chahar Maqala has well said that the four clashes of experts are indispensable in a properly constituted court, to wit secretaries of State, poet, astrologer and physician. While the poet and the others might be dispensed with, the physician and the statesman were indispensable for obvious reasons; that is maintaining order in the constitution of king’s body and the constitution of the Government respectively. Out of these two again the physician was of the greater importance to the king as the health, the basis of all happiness and activity can only be secured by the services of an able and trustworthy physician. Moreover, the king lived in perpetual fear of being poisoned, and his luxurious life made continual inroads on his health. He had therefore great need to entrust his everyday life to the regulation and supervision of the physician. The two aspects of medicine, namely the maintenance of health and long life as well as the combating of disease, found complete application, in the supervision of a king’s life by a physician

The post of Royal physician needed trustworthiness equally with the ability and hence the system of hereditary appointment might be prevalent as in the appointment of ministers.

We find in Harshacarita:

[Harṣacarita U. 5.11]

“Amongst those physicians, a boy physician named Rasayana, the descendant of Punarvasu, held his hereditary office in that royal family.”

The royal physician had to reside in the palace compound and be ever vigilant as he had to supervise every detail of the king’s daily life.

In the words of Vagbhata:

[Aṣṭāṅgahṛdayasaṃhitā 7.1.2]

“A king should make the physician reside near the royal palace, so that he may be ever vigilant everywhere. He shall protect the food and drink of the king, specially from poison. Acquisition and preservation to which are fettered religious merit etc., are dependent on him.”

In addition to the personal attendance on the king, he was responsible for the health of the queen and the prince. So he had free entrance to the harem.

That the physician had freedom of access even to the woman’s apartments where the virgins of the royal household lived is seen from a verse in the Naisadhiya-carita (Naiṣadhīyacarita) where it is said that there are only two that can enter with impunity the virgin’s apartments namely the prime minister and the physician who possesses all the learning of both Caraka and Sushruta.

[Naiṣadhīyacarita Sa. 8.116]

“In the same words replied to the king, both the prime minister and the physician by whose good offices the [bad elements—morbid humors] might not disturb the [inner apartments—internal organs] of the body of the princess. Listen, Your Majesty, I know completely by the [well-heard statement of the spy—authority of Suśruta and Caraka] that nothing except [Nala—Valerian] is able to relieve her affliction”.

He was expected to take extra care of the queen from the very day of the conception to see that the pregnancy period and intra-uterine growth of the fetus progressed satisfactorily.

[Kauṭilya Arthaśāstra 1.16]

“When she has conceived, the king shall observe the instruction of midwifery with regard to gestation and delivery.”

[Radhu—Raghuvaṃśa?. Sa. 3.12]

“Now, in due season, the development of the fetus having been effected by trustworthy physicians well-versed in the treatment of infants.” etc

A special physician was appointed to be in charge of the prince’s health, who had to stay with the prince; as Caraka says:—

[Carakasaṃhitā Śārīrasthāna 8]

“Fully accompanied by clean and aged physician and affectionate people.”

A special physician was appointed to superintend the kitchen; he was expected to possess special qualification as described in Sushruta.

[Suśrutasaṃhitā Kalpasthāna 1.8-11]

“The king should appoint a physician to supervise kitchen, who is of noble birth, religious-minded, affectionate, well-paid, of hereditary line, not greedy not a rogue, devoted, grateful, of pleasing appearance, devoid of auger, roughness, envy and deceit, possessed of sense-control, fortitude, cleanliness, character, compassion, intelligence, tirelessness and love, who is a well wisher, is clever, bold, skilful and devoid of lethargy. He should possess the above mentioned qualities and should have medicines always at hand”.

“There-he should appoint a superintendent who is for the most part possessed of qualities of a physician.”.... “The physician was skilled in the interpretation of internal sentiments by external gestures”

Thus he was skilled in the interpretations of gestures too.

Palace dispensary:

He has to keep the dispensary as well as the emergency requirement (first-aid) in the palace compound.

As Kautilya mentions:

[Kauṭilya Arthaśāstra 1.20]

“On one side in the rear of the harem, there shall be made for the residence of women, compartments provided not only with all kinds of medicines useful in midwifery and diseases, but also with well-known herbs and a water reservoir.”

In every building in the Royal court emergency medical aid was kept

[Kauṭilya Arthaśāstra 2.5]

“All these buildings shall be provided with halls, pits, waterwell, bath-room, remedies against fire and poison, with cats, mongooses and with necessary means to worship the guardian gods, appropriate to each.”

Royal hospital—

When the physician had to perform any procedure of Pancakarma or operative work he had to get his hospital fully equipped before-hand for the treatment as well as for any emergency which is likely to arise. The king received an aristocratic method of treatment.

[Carakasaṃhitā Sūtrasthāna 15]

“The physician who wishes to administer the procedure of emesis or purgation to a king or a person of kingly circumstance or a wealthy man must keep ready before beginning his treatment, his full armamentarium.”

“Only those who are kings or of kingly circumstance or men of abundant wealth can be given the purgation procedure, in this manner”.

Vaidya’s visiting time:

His time of daily visit to the king was very early in the morning

[Kauṭilya Arthaśāstra 1.16]

“And during the eighth division of the night, he shall see his physician, chief cook and astrologer”

Vaidya’s interview:

The physician was given preference in interviews.

[Kauṭilya Arthaśāstra 1.16]

“Having seated himself in the room where the sacred fire has been kept, he shall attend to the business of physicians and ascetics practising austerities, and that in company with his high priest and teacher and after preliminary salutation”.

Besides emergencies and important demands on his fund of wisdom, he had to be in constant vigilance regarding the purity of the food, drink and medicine served to the king, in which task he had to supervise both in the kitchen and at the service in the dining hall. He had first to taste the food himself and see it eaten by the cook and servants, and then let it be served to the king.

Kautilya says:

[Kauṭilya Arthaśāstra 21]

“Having taken out from the store-room of medicines that medicine the purity of which has been proved by experiment and having himself together with the decoctioner and the purveyor tasted it, the physician shall hand over the medicines to the king. The game rule shall apply to liquor and other beverages”

He had to supervise not only his food and drink and medicine but he had to supervise his bed-chambers too

[...]

“Protection of the king’s bed-stead by incantations”.

“The king’s bed stead should be well protected all round by muttering incantations for protection”.

Thus the royal physician was expected to look after the king in every detail of his life so as to maintain perfect health and longevity. He had to manage the luxurious methods of treatment in disease befitting the royal personage, he had to look after the queen, with special care during pregnancy, delivery and puerperium, he was responsible for the health of the prince and such other needs of the king and his family. Thus he was expected to be an expert in all the branches of medical science

All this goes to show how greatly were the medical man and profession in demand even in ancient times and particularly by the king who had regular establishment, dispensary, nurses and physician of his own. Such a royal physician was easily the prince of his profession and an acknowledged and respected leader in the realm.

It was therefore the ambition of those that took up the study and practice of medicine to be one day the king’s physician or honoured by the royal personage; as Sushruta says:—

[Suśrutasaṃhitā Sūtrasthāna 1.14]

“He who studies this science which is expounded by the self-existent Brahma and which is eternal and which is laid open by the Lord of Kashi, is, being of the merit of holy deeds, worshipped by the kings on earth and goes to heaven after death.”

But the selection of the Royal physician was based on such a high standard that only the best, wisest and ablest could hope to be chosen by the king (says Caraka). The Royal physician’s responsibility was very great.

In Vagbhata’s words:

[Rājasevāyā Kaṭhinatvam... 152-153]

“The attendance on a king is as dangerous as a sport with weapons, snakes and fire. It can only be discharged by modest persons through very great dexterity Having acquired unattainable sway and great honour from the king, one should remain vigilant so as to retain and enjoy them for a long time.”

Lastly this subject cannot be complete without quoting the verses of Vagbhata that describe the way in which the physician should conduct himself before his royal master; they are very interesting and betokens the wisdom of those times.

[...]

“If it is in the interest of some one else, he should see that time and place are propitious. At all times, the physicians speech should be consistent with the ends of righteousness and the king’s welfare. He should not proffer counsel unless solicited, for such gratuitous advice might easily be deemed a great presumption. He should never act in a way that is prejudicial to the king’s good, for, it would mean destroying his own support. The physician should see that what he says it palatable as well as wholesome. If he wishes to advise the king against an evil course, he should do so in strict privacy and in words that are noble and dignified. But even this he should do only when indifference on his part would be blameworthy. If such advice is met with a rebuff, the physician should hold his peace. Conversation that is distasteful to the king should not be persisted in. As between a man who is learned but a poor psychologist, and a man who is unlettered but is good at reading people’s minds, the former, even if he is in high favour, will soon slip into extreme disfavour and the latter from even extreme disfavour will rise into high favour.

In is only after acquainting the king that any measures, however slight, should be undertaken. As regards the treasury and the royal harem, the physicians visits to the places should never be uncalled for and when they take place, they should be as brief as possible.

He should show great satisfaction even at the bestowal of small rewards never betraying a haughty frame of mind.

While at court, he should avoid confidential conversations with any other than the king himself; he should also eschew gossipmongering, hostile disputation, imitating the king either in his sartorial habits or in his pleasures and recreations. But if the king himself has bestowed anything as a mark of favour, it should be worn for enhancing the royal pleasure, and while careful in being attentive before his royal master at all times, the physician should allow himself only a smile when the occasion demands loud laughter.

When a secret relating to some one else is being narrated, the physician should seem as though he were dumb, when a secret concerning himself is being divulged, he should put on the quadruple armour of deafness, fortitude, sweetness and perfect ease of manner.

He should not take excessive pains with the object of putting himself in a too highly exalted position, for it will be found that the joy of soaring high cannot compensate for the pain of the fall when it comes.”

Though closely associated with the royal person, the physician is not to strain that intimacy in any way nor press it to selfish advantage, for it is said that too great a liking or even dislike for a person from the king is fraught with danger. The physician should do nothing without having first apprised the king of it and taking his leave. He must show satisfaction with whatever he receives from the king as remuneration. He should not speak lies nor back-bite against others. He must be modest and not imitate the king in dress or manners. Where he might laugh he should only smile and thus conduct himself with great restraint. This is the way by which he may avoid coming to grief and remain happy and secure

Being such a royal physician, we may admit, demanded all the wisdom, caution and ability that the best of men are capable of.