Chapter 19 - Nursing

The quality of mercy is doubly blessed. It blesseth him that gives and him that receives Mercy is the younger sister of sympathy both being born of the humane spirit. The objective search for the origin of medicine may lead us to Hippocrates or Atreya, but the subjective search for the origin of medicine will always lead us to this subtle spirit of mercy or sympathy, the fountain source of inspiration and the origin of the medical science.

Dr. Payne, the well known American Historian has well said,

“The basis of medicine is sympathy and the desire to help others and whatever is done with this end, is called medicine”.

Caraka and Sushruta, the greatest medical works of India have in unequivocal terms ascribed the origin of medical science to this universal spirit of mercy and love (sarvabhūtānukampā).

The whole man is a conglomeration of such varied factors as body, mind and spirit. The first is material and absolutely visible aud examinable. The second can be inferred by its actions while the third is yet in the field of speculation. The diverse natures of these component factors that go to make the whole man has provided cause for contention between religions and philosophies, between sciences and superstitions, and priests and physicians

It is remarkable that birth of the Buddha coincided with the height of intellectual development of India. The age between B.C. 600 to 200 A.D. was the time when scientific medicine was evolved and took a definite shape. It was Buddha who extended the benefits of scientific medicine to humanity at large motivated by the spirit of compassion. The spirit of Buddha was, later on, taken up by Christ Buddhism and Christianity are the two principal religions which turned the prosaic scientific knowledge into one of practical utility and universal welfare by infusing in it the divine quality of compassion.

The ball which was set rolling by Buddha gathered immense momentum in course of time. Though there are scattered references to the art of nursing in ancient literature, no definitely systematic practice of nursing is described before the period of Caraka and Sushruta. By the time of Caraka, nursing had already become an acknowledged part of great importance in treatment.

Ayurveda gives nursing a significant place by making it one of the four legs on which therapeusis stands.

[Carakasaṃhitā Sūtrasthāna 9.3]

“The physician, the drugs, the attendant and the patient constitute the four basic factors of treatment. Possessed of required qualities, they lead to the earliest cure of disease”.

Thus a nurse was considered as important as the Vaidya, the medicine and the patient.

An orphan yearns for a mother and a child seeks solace and comfort in the gentle company of his mother A patient is very much like an orphan or a child and who else but a woman, who is ordained by nature for motherly functions and whose heart pulsates with motherly instinct radiating tenderness, mercy and love in all directions, can be more fitted for this profession of nursing? Where would the patient be if her motherly heart did not provide the necessary warmth, love, solace, and tenderness? It is these qualities of her heart that makes a female nurse far more useful than a male nurse. It would be much more apt to replace the word ‘sister’ applied to nurses in modern times by the far more significant word ‘mother’.

The spirit of service combined with the training in the art of nursing makes the woman the proper instrument for the administration of cure to the ailing patient.

Caraka describes the qualities needed in a nurse thus:—

[Carakasaṃhitā Sūtrasthāna 9.8]

“Knowledge of nursing, skill, affection for the master (patient) and cleanliness—these four are the tetrad of desiderata in the attending person.”

The period of Asoka’s reign which was pre-eminently Buddhistic was the golden period of medical progress in India. The institution of hospitals was a well-established fact in India in the 3rd century B.C. when Europe could not even dream of it. The trunk roads, instead of being lined with ordinary trees, were lined with trees useful for medical purposes. Missionaries were sent to foreign countries to provide spiritual and medical aid. Buddhist monks were expert surgeons. It is no wonder thus that the art of nursing attained a well-developed form during this period.

The following extract from Kashyapa Samhita (Kāśyapasaṃhitā), bears ample testimony to the advanced state of nursing during that period.

“After this should be secured a body of attendants of good behaviour, distinguished for purity and cleanliness of habits, possessed of cleverness and skill, endowed with kindness, competent to cook food and curries, clever in bathing or washing a patient, well conversant in rubbing or pressing the limbs, raising a patient or helping him to walk, well-skilled in making or cleaning beds, able to pound drugs, always ready, patient and skilful to wait upon one who is ailing and never unwilling to do what is commanded by the physician”.

The qualities required in a female nurse are well enumerated in the following extract

“To become a good nurse, a woman must possess considerable intelligence, good education, healthy physique, good manners, an even temper, a sympathetic temperament and deft [?? hands]?. To these she must add habits of observation, punctuality, obedience, cleanliness, a sense of proportion and a capacity for and habit of accurate statement. Training can only strengthen these qualities and habits. It cannot produce them.”

There is an interesting story depicting to what noble heights the institution of nursing reached in the Buddhist period. It also depicts clearly how the public took undue advantage of it turning its very strength into its weakness.

Jivaka, the Physician to the Buddha

The Medical treatment of the Buddha and his order of followers was entrusted by generous king of Magadha, Seniya Bimbisara, to Jivaka Komarabhachcha (Komarabhacca), the Royal physician, an excellent young doctor, who had orders to wait upon the King, his Seraglio and the fraternity of Bhikkhus with the Buddha at its head (Mahav. VIII. 1, 15-16). He was a most distinguished medical authority of his times, well versed in both medicine and surgery, and had calls from distant places like Saketa, Benares, and Ujjeni, always to treat diseases which baffled the skill of other medical practitioners. The free provision of such expert medical aid for the order was one of the temptations to the lay public to join it.

There is a story that on the outbreak in Magadha of the five diseases of leprosy boils, dry leprosy, consumption, and fits, the people suffering from them approached Jivaka and said,

“Pray, Doctor, cure us and all that we possess shall be yours and we will be your slaves”.

But the Doctor said.

“I have too many duties, Sirs, and am too occupied I have to treat the Magadha King Seniya Bimbisara and the royal seraglio, and the fraternity of Bhikkhus with the Buddha at their head I cannot cure you”.

Now those people thought:

“Indeed the precepts which these Shakyaputtiya Samanas keep and the life they live are commodious, they have good meals and lie down on beds protected from the wind. What if we were to embrace the religious life among the Sakyaputtiya Samanas, then the Bhikkhus will nurse us and Jivaka Komarabhachcha [Komarabhacca] will cure us.”

Thus these persons got themselves ordained by the unsuspecting Bhikkhus and then secured the Bhikkhus to nurse and the physician Jivaka to treat them. The demands of the sick made the Bhikkhus constantly beg for food for the sick, while Jivaka, having to treat so many sick Bhikkhus, neglected some of his duties to the king. This stratagem worked so well that persons similarly afflicted with one or other of those diseases began to offer themselves for monkhood, not for the sake of the religious life but simply to exploit the order, to get themselves nursed and cured and then to return to the world, for the entry into the order was as easy as exit therefrom. The entire corrupt practice was, however, one day completely exposed when Jivaka in the course of one of his medical rounds noticed a run-away renegade tramping the public roads and subjected him to a cross examination which revealed the whole truth. On Jivaka reporting the matter to the Buddha, he ruled that no person seeking the order in sickness should be admitted (Mahay; i, 39).

Specialization

Scientific progress always leads to specialization and we find the following classifications of nursing work.

1. General nursing
2. Surgical nursing
3. Midwife
4. Wet-nurse.
5. Masseuse.
6. Miscellaneous.

The details regarding the qualifications of nurses in each category give a clear concept of the standard of nursing in those days

1. Qualities in General nurses—

[Carakasaṃhitā Sūtrasthāna 9.3]

“The physician, the drugs, the attendant and the patient constitute the four basic factors of treatment”.

[Carakasaṃhitā Sūtrasthāna 9.4]

[Carakasaṃhitā Sūtrasthāna 15.7]

“Knowledge of nursing, skill, affection for the master (patient) and cleanliness, these four are the tetrad of desiderata in the attending person.”

“Then (the following accessories should be kept ready) the attendants who have, character, cleanliness, good conduct, affection, dexterity and sympathy, who are well verged in nursing who are circumspect in all work, who are skilled in the cooking of soups and rice, in giving baths and shampoo, in lifting or laying the patient in bed and in administering medicines and who are not disinclined to any kind of work”

[Aṣṭāṅgahṛdayasaṃhitā Sūtrasthāna 1.20]

“A nurse should be devoted to the patient, clean, clever (in all duties) and intelligent”.

[Bhelasaṃhitā Sūtrasthāna 1]

“The qualifications of the nurse are an enlightened temperament, good health, ability, devotion to the master, knowledge of nursing skill, cleanliness, promptness in execution, all-round deftness, not being given to disgust, possessing sous who are not low in nature or in number, not wavering in mind, given to self-restraint, having control over the temper etc., and having forbearance”.

“He should be strong, upright, skilful, pleasant in speech, trustworthy, courageous, not indocile, attached to and good at entertaining the patient with varied tales and wise in attendance. He must not be bound down by technicalities. He must be trained in the preparation of medicines and he must be able to bear strain and to respond to the moods of the patient”.

2. Qualities in Surgical nurses

[Suśrutasaṃhitā Sūtrasthāna 34. 24]

“That attendant is a proper support among the tetrad of supports of medicine, who is affectionate, free from disgust, strong, engaged in the protection of the patient, prompt in the execution of the physician’s instructions and is tireless in his duties.”

3. Qualities in a Midwife

[Carakasaṃhitā Śārīrasthāna 8.34]

“The female attendants should be many, who are mothers of many children, sympathetic, constantly affectionate, of agreeable behaviour, resourceful, naturally kind-hearted, cheerful and tolerant of hardships”

[Suśrutasaṃhitā Śārīrasthāna 10.8]

“There should be four female attendants who are of good reputation, fully grown in age who have given birth to many, children and whose nails have been clipped close”.

[Aṣṭāṅgasaṃgraha Ṭīkā Śā. 1.74]

“The woman in labour should lie in bed surrounded by female attendants, who have given birth to many children, who are cheerful by temperament, who are not given to obstructive speech and who are able to bear strain”.

4. Qualities in a Wet-nurse

[Carakasaṃhitā Śārīrasthāna 8.52]

“Bring a wet nurse who belongs to the same caste as the infant’s mother, who is in her youth, submissive, free from disease, not deficient in any limb, not given to unwholesome pursuits, not ugly, not ill-disposed, native of the country, not mean-minded, not given to mean acts, well-born, affectionate towards children, free from any disease, whose children have not died, who is a mother of male children, who has a large supply of milk, who is never heedless, not given to sleeping in beds soiled with excrement, not given to low company, skilful in attendance, clean, averse to unclean ways and endowed with the excellence of breasts and milk”.

[Suśrutasaṃhitā Śārīrasthāna 10.27]

“Then one should requisition for the enhancement of health and strength of the baby, a wet nurse of dark complexion, according to the required caste, one who is medium sized, middle aged, healthy, possessing good habits and steadiness of mind, who is free from sensuality, who is neither too thin nor too fat, whose breast-milk is clear, who has no pendulous lips and whose breasts are not too high nor too low, wbo has no bodily defects, who is not given to any evil addiction, who has a living child, whose lactation is abundant, who is affectionate and not given to any censurable practice, who is born of a good parentage and is endowed with many other good qualities A nurse of high breasts makes the child ugly in appearance. That possessing pendulous breasts, may sometimes, by choking the nostrils of the baby bring about its death”.

5. Masseuse

[Carakasaṃhitā Cikitsāsthāna 24.188]

“By soothing warm massage of the body by the well-trained hands of women, the alcoholism of the kapha type abates quickly”.

This shows that massaging was often resorted to.

6. Miscellaneous attendants

[Carakasaṃhitā Sūtrasthāna 15.7]

“Those who are well-versed in singing, playing of musical instruments, panegyrics, verses, stories, legends, modern history, mythology, who are quick in understanding, who are of approved character, who are versed in the knowledge of clime and season and who are good members of society”.

[Carakasaṃhitā Sūtrasthāna 151.7]

“Affectionate and sympathetic friends before whom the patient is free from shyness” [Suśrutasaṃhitā Sūtrasthāna 19.7-8]

“The surgical patient should lie at ease attended by sympathetic friends and who are endearing in speech Sympathetic and pleasant-speeched friends by their comforting words and speech quickly alleviate the suffering of wounds”.

Thus we see that the institution of nursing was very highly developed, and was well organised but in course of time, this organized useful and benevolent institution fell into decay together with other arts of this country. It was on the way to oblivion when contact with the West gave an impetus to its revival. Looking to the needs of the teeming millions of this country, an organized effort is needed to put this benevolent avocation on to a high footing and thereby render medical aid and at the same time supply the means of livelihood to the helpless women and widows of our laud. It is, however necessary, that instead of simply copying western modes of behaviour and manners only, we should develop its scientific spirit combined with indigenous atmosphere and quality of compassion for the ailing.

The nurses should so behave and mingle with the people, speaking the language of the place, knowing the needs of the people, preparing and advising the diet suited to and liked by the masses and by becoming one with them

The institution revived on these lines will no doubt alleviate most of the sufferings of masses and will bring sunshine and happiness to the cheerless atmosphere of the sick-beds.