Chapter 21 - Hospitals and Equipment

One of the greatest fictions of modern times is the belief that the institution of hospital is a gift of the modern civilization. This fiction is the result of gross ignorance of the history of ancient Indian institutions and neglect of the study of Indo-Aryan culture. A researcher in the history of ancient Indian institutions would, soon after he has waded through the darkness of historical material resulting from the depredations of foreign invaders, find that institutions of hospitals had a very early development in India. We have ample proofs of the existence and development of hospitals in the Puranas, medical works, inscriptions and foreign travellers’ memoirs.

In Nandi Purana we find the following reference:

[...]

“Good health is means of acquiring religious merit, wealth, pleasure and spiritual emancipation, and so the man who bestows cure on the sick as also he who endows a hospital fully equipped with good medicaments, dressing material, learned physicians, servants and dwelling space, gam these results. The physician should be well-versed in the science, experienced, familiar with the actions of drugs, expert in the knowledge of the colour of the roots of herb and well-acquainted with the proper season in which to cull them from the ground, well versed in the qualities of the juices, (their strength and actions), of Shali rice, meat and medicaments, trained in compounding medicines, expert in intelligent penetration into the secret of a mans constitution, learned in the knowledge of body-elements, dietetics and pathology, free from indolence, well versed in the understanding of the premonitory symptoms and in after-treatment, proficient in the knowledge of time and place, well read in the medical text books of Ayurveda in all its eight divisions and an expert in Posology”.

The same Purana further describes the merits accruing from establishing a hospital in the following verses:

[...]

“The pious man who erects such a hospital in which the services of a good physician of this nature are retained, and thus establishes charitable institution, in which the good physician cures even a single patient of his maladies by means of medicines, oleaginous remedies and compounds of medicinal decoctions, goes after death to Brahma’s residence taking with him seven generations of the ancestors. If the rich and the poor were to get treatment in proportion to the riches they possess and can spend, where would the poor man get a hospital and a young physician to cure his diseases Any man that cures the sick by the use of roots or by massage and other methods also, reaches these eternal realms mentioned above. He who cures the sick suffering from discordance of the three Doshas or Vata, Pitta, and Kapha, by simple remedies, he too goes to such bleesed regions (after death) as are secured by those who performed many religious sacrifices.” (yajñas).

Again in the Skandapurana (Skandapurāṇa) we find similar references.

[...]

“Hear, what amount of religious merit accrues to a man who erects a hospital equipped with all the necessary elements begining with eminent physicians. As good health is the means of attaining religious merit, wealth, pleasure and spiritual emancipation, therefore, does one, by giving health, gives all these four blessings.

By curing learned man of his sicknes such merit is acquired as is eternal and indestructible. He too who cures a sick man who is reposeful and absorbed in meditation and in the worship of Shiva, attains virtue equal to that which results from all kinds of alms-giving Brahma, Visnu, all the minor gods, diseases, relatives and kings, all these are obstacles to Yoga and are thus diseases, but not to the Yogi. Whatever merit can be obtained by the great, by supporting the ailing Brahmans (priest), Ksatriyas (warriors) and Vits (cultivators) and Shudras (servants) cannot be obtained by the performances of all the great Yajnas (religious sacrifices) As even the gods cannot reach the end of the firmament, likewise is there no end to the merit accruing from the gift of healing By this merit, the man reaching the realm of Shiva enjoys himself by soaring in celestial cars and attaining all his desires Along with twenty-one generations of his ancestors and surrounded by his servants, he stays in Shiva’s realm until the great destruction at the end of the cycle Thereafter by the residual part of his merit, and by his devoted service to Rudra, he acquires knowledge of truth

Renouncing this world as a result of knowledge, and dedicating himself to the worship of Shiva and casting away this body sorrows like a straw, he reaches beyond the limits of sorrows. Being freed from all and becoming pure, all knowing and self-sufficient and absorbed in his own self, he is called the liberated one. Therefore for the sake of heaven as well as liberation, the sick should be well nursed and treated. The great sages given to Yoga should be especially attended to even at th cost of one’s life and riches. The wise must never cause annoyance to the weak patients but should be attended to like one’s own preceptor. That is the path of virtue. He who knows himself to be well-circumstanced in life should relieve the sick by taking them under bis care, and thus reach the other bank of this ocean of life.”

Construction of or an endowment for a hospital was considered to be an act of great merit as is evinced by the following quotations.

[...]

Vishvamitra says here—

“There does not exist a gift greater than the gift of health, hence one should attempt to give health to the ailing for the attainment of one’s own welfare One who gives to the patient medicine, wholesome articles, meals, oil massage and consolation is ever free from the clutches of any disease”.

Samvarta says—

“One who gives medicine, oil and meals for the cure of the patient is himself ever free from any disease and is happy and long-lived”.

Agastya says—

“Those who give meals and medicine live happily and without disease”.

All the above three references are cited by Hemadri and they go to prove the early development of hospitals in India, at a time when the West could not even dream of them

The earliest medical and surgical works like Sushruta abound in references to, hospitals, usually known as (puṇyaśālā, ārogyaśālā, vraṇāgāra[?]) etc.

The edict No II of Ashoka shows that charitable institutions were common in India during his reign.

The edict runs as follows:

“Everywhere in the kingdom of the king Piyadasi, beloved of the gods, and also of the nations who live in the frontiers such as the Cholas, the Pandyas, the realms of Satyaputra and Keralaputra, as far as Tambapani and in the kingdom of Antiochus, king of the Greeks and of the kings who are his neighbours, everywhere the king Piyadasi, beloved of the gods, has provided hospitals of two sorts: hospitals for men and hospitals for animals.

Wherever plants useful either for men or for animals were wanting they have been imported and planted. Wherever roots and fruits were wanting they have been imported and planted. And long public roads have been dug for the use of animals and men.”

Descriptions of Chinese travellers who toured India in the 5th and 7th centuries fully corroborate the fact of hospitals being an established institution in India of those days

Fa hien (405-11-A D) who was a contemporary of Chandragupta Vikramaditya describes the charitable dispensaries of Pataliputra thus,

“The nobles and householders of this country have founded hospitals within the city to which the poor of all countries, the destitute, the cripple and the diseased may repair. They receive every kind of requisite help gratuitously. Physicians inspect their diseases, and according to their cases order them food and drink and medicines, or decoctions, everything in fact that may contribute to their ease. When cured, they depart at their convenience”.

Vincent smith remarks:—

“No such foundation was to be seen elsewhere in the world at this date, and its existence anticipating the deeds of modern Christian charity speaks well both for the character of the citizens who endowed it and for the genius of the great Asoka whose teaching bore such wholesome fruit many centuries after his decease. The earliest hospital in Europe, the Maison Dieu of Pans, is said to have been opened in the 7th century”.

Upatisso, Son of Buddha Das, built hospitals for cripples, for pregnant women and for the blind and diseased. Dhatushera built hospitals for cripples and sick. Buddha Das himself ordained a physician, for every ten villages on the high road, and built asylums for the crippled, deformed and destitutes.

We learn from Huen Tsang’s account (610-650 A. D) that Shiladitya II was inclined towards Buddhism and in all the high ways of the towns and villages throughou India, he created hospitals, provided with food and drink, and stationed there physicians with medicines for travellers and poor persons round about, to be given without any stint.

Speaking of the father of Bhikkhu Srutavimsatikoli, Huen Tsang says:

“From his house to the snowy mountains, he had established a succession of rest-houses from which his servants continually went from one to the others Whatever valuable medicines were wanted they communicated the same to each other in order, and so procured them without loss of time, so rich was the family”.

In his account there is mention of charitable institutions called “Punyashalas” as common in India.

“There were formerly in this country (Tsch-Kia-Takka) many houses of charity (goodness or happiness, Punyaśālās) for keeping the poor and the unfortunate. They provided for them medicines and food and clothing and necessaries so that travellers were never badly off”

Again he says,

“Benevolent kings have founded here (Mo-ti-pil-lo or Matipura) a ‘house of merit’ (Punyaśālā). This foundation is endowed with funds for procuring choice food and medicines, to bestow the charity on widows and bereaved persons, on orphans and the destitute”.

A similar Punyashala or hospital was in K-ei-p-an-to (Kannandha). While describing Multan he says,

“They have founded a house of mercy t happiness ), in which they provide food and drink an medicines for the poor and sick, affording succour and sustenance”.

Of Shiladitya he says,

“Every year is assembled the Shramanas from a countries and on the third and seventh days he bestowed on them in charity four things of alms viz, food, drink, medicine and clothing”.

Ceylonese records furnish a lot of information in how the kings took up the erection and maintenance of hospitals as their chief duty From Mahavamsha we gather that in 437 B.C. King Pandukabhya constructed a residence for the Ajivakas, a hall for the worshippers of Brahma, (another for those) of Shiva as well as a hospital.

“Duttha Gamani feeling his earthly journey ending (161 B.C.) asked that records of his reign be read to him and among the last words the dying king heard was, ‘I have daily maintained at eighteen different places, hospitals provided with suitable diet and medicines prepared by physicians for the infirm.” (Robinson’s History of Ceylon)

We quote below a few references from the Mahavamsha part II by L.C. Wijesinha Mudaliyar P 57 chapter XLIX. (King’s name Dappula III 827 A D.)

“And being a man of great compassion he built a hospital for the city of Pullatthi and another at Pandaviya with a fruitful village attached thereto. He built hospitals for the halt and the blind in diverse places”

P. 67 chapter L. King’s name Kassappi (929 AD). “He built a house for the sick on the western side of the city and gave alms of gruel and other victuals for the destitute”

P 86 chapter LIV Name of the king, Sena (955 A D.) “He furnished all the hospitals also with medicines and beds and caused rice to be given daily to the captives that were in prison”

P 194-195 Chapter LXXIII King’s name, Parakkama Babu (1164 A.D.) “And this ruler of men built further a large hall that could contain many hundreds of sick persons and provided with all things, that were needful as stated underneath. To every sick person he allowed a male and a female servant that they might minister to him by day and by night and furnish him with the physic that was necessary and with diverse kinds of foods. And many store-houses also did he build therein, filled with grain and other things, and with all things that were needful for medicine and he also made provision for the maintenance of wise and learned physicians who were versed in all knowledge and skilled in searching out the nature of disease. And he took care.to discern the different wants of the sick, and caused the physicians to minister to them, as seemed necessary both by. day and night. And it was his custom, on the four sabbaths (Uposatha days) of every mouth, to cast off his king’s robes and after that he had solemnly undertaken to observe the precepts, to purify himself and put him on a clean garment, and visit that hall together with his ministers. And being endowed with a heart full of kindness, he would look at the sick with an eye of pity, and being eminent in wisdom and skilled in the art of healing, he would call before him the physicians that were employed there and inquire fully of the manner of their treatment. And if so be that it happened that the treatment that they had pursued was wrong the king who was the best of teachers, would point out wherein they had erred, and giving reasons therefor would make clear to them the course that they should have pursued according to science Also, to some sick persons he would give physic with' his own hands. In this manner indeed this merciful king free from diseases would himself cure the sick of their diverse diseases from year to year”

In one of the temple inscriptions of the Chola period, we find a detailed description of a hospital. Besides the several references to hospitals in the Gupta period we get the following reference dating 600 years after the period Veer Rajendra Deva of the Cholas issued a commandment in 1067 A.D. which is inscribed on the walls of the inner sanctuary of the temple of Venkateshwar at Tirumakudal in the district of Chingleput. It provided for the expenses of the festivals of the diety [deity?] and together with it a school and a hospital for the students. The hospital is described as under. It was named Shree Veer Choleshwar Hospital containings [containing?] 15 beds. There were a physician, a surgeon, two male and two female nurses, one servant, one gate-keeper, a washerman and a potter. Their salaries were also fixed. One Kodani Ramashwatham Bhattar was engaged as the physician and he was given his remuneration in kind (a certain amount of corn). Next in order the remuneration in kind was fixed for the surgeon, nurses and others. The male nurses’ duty was to bring herbs, and firewood and to prepare medicines. The duty of female nurses was to administer the doses, feed the patients and do the necessary cooking. The washerman’s duty was to wash the clothes of the patients and the potters duty was to prepare the necessary pottery for the hospital. The quantity of oil required to light the lamps at night was also fixed. Besides this set-up, there are instructions about special preparations also.

A later inscription dated 1262 A. D is found on stone-pillar of Malakapur in the Andhra country. It contains references to Kakatiya queen Rudramma and to her father Ganapati’s preceptor Vishveshvara’s activities. This Vishweshwara was a Shaivite preceptor of Gaud Desha and the inscription informs us that several villages to the south of the Krishna were donated to him by Kakatiya Ganapati and Rudramma. The income accruing from these villages was divided into three parts and Vishveshvara ear-marked one-third of it for maternity home, one-third for a hospital and the remaining for a school. It is not definitely known whether this maternity home and the hospital were built by Vishveshvara or his predecessors bat they were linked with the local Shiva temple.

Now we shall quote a few verse from the earliest medical treatises of specialized hospitals and their management

Surgical Hospitals

[Suśrutasaṃhitā Sūtrasthāna 19.3-4]

“One suffering from wounds should be first taken to the surgical ward, and that ward should be built according to the rules of the architectural science. In a ward built thuswise, which is auspicious, clean and protected from the sun and the wind one is free from diseases—psychic or somatic or diseases caused by external factors”.

[...]

“The physician desiring to perform any of the surgical measures should keep in readiness beforehand the following appurtenances viz., appliances, instruments, caustic alkalies, fire, probes, horns, leeches, sucking gourd, Jambavaushtha, swabs, suturing thread, leaves, bandages, honey, ghee, fat, milk, oil, soothing lotions, ointment, paste, fan, cold and hot water, basin etc., and attendants who are affectionate, steadfast and strong”.

[Carakasaṃhitā Sūtrasthāna 15.6]

“Here, therefore, we shall instruct in brief concerning several accessories. It is thus. The expert architect should first design a good house which is strong and is warding off the wind except on one side, affording comfortable moving space, not surrounded by high places, not penetrable to smoke, heat, moisture, dust and to undesirable noise, contact, taste, sights and odour and is furnished with a water-storage room, pharmacy room, latrine, bath room and kitchen”.

[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 Cikitsāsthāna 3.261]

“The fever-patient afflicted with a sensation of burning should lie down at ease in a specially constructed water-cooled chamber or an apartment cooled by frequent spraying of ice-cold water or cold sandal-water”.

[Carakasaṃhitā Cikitsāsthāna 4.103]

“Apartments with arrangement for shower bath, cold underground chambers, resort to pleasant woods cooled by moist breezes, the application of vessels inlaid with azure, pearls and precious stones made cool by putting cold water in them”.

[Carakasaṃhitā Cikitsāsthāna 24.135]

“By the warmth of the bed and the cover and the warmth of happiness and cheer of the interior apartments, alcoholism of the Vata-type gets subdued effectively”.

[Carakasaṃhitā Cikitsāsthāna 24.158-159]

“The rumblings of thunder alleviate the effects of intoxication Various devices of showering water and blowing breezes, and rooms equipped with cascades, should be devised by the physician for the cure of burning due to alcoholism (The body should be painted) with perfumed cherry, cuscus grass, lodh, fragrant sticky mallow, fragrant poon, cinnamon leaves and nut-grass”.

Military Hospitals

[Suśrutasaṃhitā Sūtrasthāna 34.12-14]

“In a big encampment just after the tent of the king, the physician should be kept present, fully equipped.

The persons afflicted with poison, darts and disease approach him there without making a mistake—him who stays there being singled out by his flag, fame and name.

The physician who is an adept in his own art and is conversant with other sciences, being honored by the king and experts, looks prominent like a flag.”

Mental Hospitals

[Carakasaṃhitā Cikitsāsthāna 9.83]

“Thus he may also be terrorised by means of snakes whose fangs have been removed, or by trained lions and elephants or by men dressed as bandits or foe-men with weapons in their hands”.

[Carakasaṃhitā Cikitsāsthāna 9.81]

“Or having scourged him with light whips, he may be left well secured with ropes in solitary confinement. From such drastic measures, the disorientated mind of the man is restored to normality”

[Carakasaṃhitā Cikitsāsthāna 9.30]

“If the patient continues to behave in an irresponsible manner then he should be made soft by soft but strong bandages and put in a dark room free from metallic and wooden articles (lest he should harm himself with these).

Obstetric Hospitals

[Carakasaṃhitā Śārīrasthāna 8.33]

“Before the commencement of the ninth month, the physician should get erected a lying-in room on a site free from bones, sands and broken bits of earthen vessels, in a soil which is excellent with regard to color, taste and savour, facing east or north, with the wood of bael, false mangosteen, putramjiva, marking nut, three leaved caper and catechu or with any other wood which the brahmans who are knowers of the Atharvaveda recommend. This should be well-built, well-plastered and well-furnished with doors and windows and in accordance with the principles of architecture, there should be arrangements for a fire-place, water-storage, pounding, lavatory, bath-room and kitchen, and it should be comfortable in that particular season”.

[Carakasaṃhitā Śārīrasthāna 8.34]

“The following articles should be kept there ready to hand—ghee, honey, rock-salt, sanchal black and bid salts, embelia, costus, deodar, ginger, long pepper, the roots of long pepper, the elephant pepper, Indian penny wort, cardamoms, glory lily, sweet flag, piper chaba, white-flowered lead-wort, asafetida [asafoetida], rape seed, garlic, clearing nut, kana, kanika, cadamba, linseed, balvaja, birch, black gram and maireya and sura wines. Similarly, two grinding stones, two heavy pestles, two wooden mortars, an untamed bull two gold or silver cases for keeping sharp needles, sharp metallic instruments, two bed-steads made of bael wood and faggots of false mangosteens and zachum oil plants, for kindling fire. The female attendants should be numerous, being mothers of many children, sympathetic, constantly affectionate, of agreeable behaviour, resourceful, naturally kind-hearted, cheerful and tolerant of hardships. There should also be present Brahmanas who are knowers of the Atharvaveda. Whatever else is thought to be necessary should be kept, also whatever else the Brahmanas and old dames advise, should be carried out”.

[Bhāvaprakāśa 2]

“The labour ward must be eight cubits long and four cubits broad and attractively built, with the entrance facing the east or the north. The patient should be attended by four women who are trustworthy, expert in obstetrics, well disposed, aged and who have clipped their finger-nails close”.

[Carakasaṃhitā Śārīrasthāna 8.51]

“We shall now describe the procedure with regard to the construction of the nursery. A skilful architect should build and furnish the nursery. It should be excellent, beautiful, well-lighted, sheltered from draught, admitting of air from only one direction, strong, free from such pests as marauding beasts, animals, fanged creatures, mice and moths, well-planned as regards the places of water-storage, grinding, lavatory, bath and cooking, comfortable during all seasons, and provided with beds, seats and spreads suited to each season. Moreover the rites connected with protecting the house from the influence of evil spirits as also those with propitiatory, auspicious, sacrificial and penitential offerings should be performed and the house should be filled with clean and experienced physicians and with those attached to the family. Thus has been described the procedure with regard to the construction of the nursery”.

Besides these we have descriptions about purgatonums or recreating homes where the quinary purificatory procedures (pañcakarmavidhi) viz., (vamana, virevana) etc, were undergone.

Then there were (svedanagṛha) or sudatoriums and also health-homes:

[Carakasaṃhitā Cikitsāsthāna 1, 1/17-20]

“We shall set down the procedure regarding the immure meat therapy. In an area resided in by princes, physicians, the twice-born communities, saintly men and men of virtuous deeds, free from alarm, salubrious, close to a city, where the necessary appurtenances may be had, one should, having selected a good site, cause a retreat to be built with its face towards either the east or the north. It should be of the following description—high roofed and commodius; built in three concentric courts, furnished with narrow ventilator; thick walled; congenial in all weathers; well lighted; pleasing to the mind; proof against noises and other disturbing agents, untenanted by women, equipped with all the requisite appurtenaces [appurtenances?], and having physicians, medicines and Brahmanas ready at call”.

From the descriptions given above, it becomes evident that particular care was taken in selecting the site for hospitals, a site which gave protection from excessive wind, irritating noise, and dust, and uncomfortable light. Even the modern hospitals have something to learn from this ancient institution especially with regard to precaution against irritating sounds.

The building too was constructed under the supervision of expert structural engineers (vāstuvidyā-viśārada—vāstuvidyāviśāradāḥ) who were clever at the arrangement and division of apartments (sthānavibhāga-vida).

Although the original conception of hospital construction was of an aristocratic type, it was modified according to needs.

A striking feature in this picture of ancient hospitals is the seasonal consideration. Arrangements were made so as to keep the rooms cool in summer and warm in the cold season. The methods employed then may seem crude to the world accustomed to air-conditioning, but they were the rudiments of ideal construction and the indigenous ways of achieving the desired result, astonish us. There were special places for the voidance of urine and feces and bathrooms were provided.

The standard of cleanliness achieved was very high:

[Suśrutasaṃhitā Sūtrasthāna 19.4, 23]

“In a ward built thuswise, which is auspicious, clean and protected from the sun and the wind, one is free from diseases—psychic or somatic or diseases caused by external factors.

The patient should be always clean, with close clipped finger nails, wearing white raiment and devoted to the auspicious rites of Shanti and Mangala and to honoring the gods, the Brahmanas and elders”.

The hospitals were well equipped with various devices and instruments. A list of some of these Yantras is given below.

 

That the hospitals were primarily meant for the diseased need not be reiterated, but some departments of the general hospitals or hospitals specializing in certain branches, like purgatoriums were frequented by healthy persons also thrice a year to undergo the course of purgative, revirilification and rejuvenation.

[Suśrutasaṃhitā Sūtrasthāna 1.24]

“Therein (in the retreat constructed) being cleansed with the purificatory measures and on having regained his happiness and normal strength, he should undergo the vitalization procedure. We shall first describe the cleansing procedure”

A few quotations will throw an interesting side-light on the beds, its accessories, cleanliness and decorations of the rooms.

[Suśrutasaṃhitā Sūtrasthāna 19.5-7]

“The ward must be equipped with beds that are free from discomfort and well spread with a cloth and with its head towards the east, and with instruments kept ready. *** The surgical patient feels comfortable in his movements if the bed is well made and spread with a cloth. The gods have their dwelling in the east and hence his head should lie towards the east as a sign of obeisance. *** There he should lie freely attended by friends who are amiable and pleasant-spoken”.

Clothes etc.

[Suśrutasaṃhitā Sūtrasthāna 19.23]

“The patient should be always clean, with close-clipped finger nails, wearing white raiment and devoted to the auspicious rites of Santi and Mangala, and to honoring the gods, the Brahmanas and the elders”.

Room Decoration

[Suśrutasaṃhitā Sūtrasthāna 19.25]

“The patient should stay keeping himself constantly vigilant, surrounded by men and in a house adorned with lamps, water pots, instruments (arms), flower garlands, loose flowers and roasted paddy and he should engage himself in listening to attractive, auspicious and cheering stories.”

Great care was taken in prescribing the diet. Weekly regimen containing the items of each meal was carefully prescribed.

The convalescence stage was given great importance and the process of or rehabilitation was carefully undergone:

[Carakasaṃhitā Siddhisthāna 12.3-9]

“When after being duly purified by the procedures of emesis etc., patient is in a debilitated condition, emaciated, weakened in his digestive power, has his joints loosened, is purged of the morbid accumulations of flatus, urine, mucus and bile, the stomach and the intestines have become contracted, the body has become vacuous and accordingly unable to bear any farther strain, he should be protected by the physician from all kinds of risk, just as a tender egg is protected or a vessel brimful of oil, or the kine by the cowherd armed with staff.

The physician who is conversant with the order and sequence of therapeutic procedures, should put the patient on a liquid diet beginning with thin gruel and leading upto meat-juices for the purpose of re-stimulating his gastric fire.

To this end, he should prescribe the use first of unctuous, acid, sweet and pleasant articles, then of articles of acid and salt tastes, and later, of sweet and bitter tastes, and last of all articles of astringent and pungent tastes. In this manner by the use of two antagonistic tastes at a time, and by the alternate use of unctuous and dry articles, the physician should restore the patient to his normal health.

When the patient is able to tolerate all the tastes, when there is no retention of excretory matter, when the zest for life has returned, the sense-organs have regained their firmness, when strength has returned and the mind is fully composed, it should be known that he is restored to normality”.

In the last of the above-quoted verses the attainment of the ‘normal’ is defined. A patient could be discharged only when he was completely rehabilitated and attained the normal condition.

The procedure of discharging a patient as given in Caraka is very interesting:

[Carakasaṃhitā Sūtrasthāna 15.17]

“On finding that he has regained his vitality, complexion and cheerfulness of mind, and after he has slept happily, digested his food well, taken a full bath and painted the body with sandal, has put on garlands and untorn clothes and has adorned himself with befitting ornaments, he should be shown round to his kinsmen after being presented to his friends. Thenceforward, he should be left to resume his normal activities”.

From what has been cited above we find that there were certain salient features in the institution which conferred individuality on it and which may well be copied by our modern institutions We find that Psychic therapy was offered to the patient and health preservation was given equal importance with disease-curing. As a matter of fact Ayurveda has always laid more stress on prevention than cure and accordingly prophylactic and preventive hospital work was more emphasised. Friends and other people relieved the patient of the tedium of hospital life by lively conversation and story-telling. Absolute cleanliness was observed and caste distinction so far as hospital treatment was concerned was an unknown thing Any one from a Brahmana to a Sudra was admitted without distinction or favouritism. The hospitals were primarily run for the benefit of the poor people who could not afford the luxury of a private physician or the sometimes costly treatment. The hospitals were fully equipped with all the known appurtenances and apparatuses and young physicians, with a progressive spirit and selfless devotion to alleviating the miseries of the suffering mankind were engaged.

The construction of a hospital was considered to be an act bestowing great merit on the donor. We find that some hospitals were so huge as to admit hundreds of patients

The standard of medical attainment required in the doctors was very high and day and night attendance was provided for the patients

The standard of cleanliness was so high that even visitors were required to put on a clean garment while entering the hospital Kings took great interest in the inspection of hospitals, and personal talk with the patients four times a month was a matter of his routine

From Mahavamsha we gather that villages were endowed for the maintenance and efficient running of the hospital and its staff. The hospitals were not only the refuge of the diseased alone. Pregnant women, blind, invalid and aged persons also were looked after in the hospitals

The high degree of specialization in hospital work, the special features like refrigeration and other amenities of hospital life, the absence of caste distinction, the greater emphasis on prevention, the scrupulous and fastidious observance of cleanliness, the size of the institutions, the quality of the personnel employed, day and night attendance, efficient managemant [management?] and maintenance, all these really astonish us aud make us think with admiration of those days when India gave the lead to the world in all those aspects of civilization which we are often erroneously led to ascribe to the West and to the modern age