Chapter 23 - Fees, Presents and Remuneration to Medical Men

Although the ideal purpose of this noble art of healing was the philanthropic service to humanity, it was many a time practised for the sake of livelihood also.

Caraka lays down:

[Carakasaṃhitā Sūtrasthāna 30.29]

“This science is to be studied by the Brahmanas, the Ksatriyas and the Vaishyas. By the Brahmanas with a view to benefiting all creatures, by the Ksatriyas as subserving their role of protectors and by the Vaishyas as a means of livelihood, and in general, by all, with the object of attaining virtue, wealth and pleasure.”

Similarly Sushruta says:—

[Suśrutasaṃhitā Sūtrasthāna A. 9.19]

“This science of life is permanent and yielding merit, heaven, fame, longevity and livelihood.”

Although people practised medicine for livelihood, yet no mere commercial spirit was allowed to prevail in this noble art.

In this connection Caraka says that:—

[Carakasaṃhitā Cikitsāsthāna 1/4.59]

“Those who for the sake of a living, make merchandise of medicine, bargain for a dust-heap, letting go a heap of gold.”

Even to the practitioner who never wished to have any remuneration, this noble art was never fruitless

[...]

“Practice of medicine is never fruitless, it sometimes gives money, sometimes religious merit, sometimes renown, or sometimes the opportunity for study.”

That the art of medicine was practised for livelihood even in very olden times, can be seen from the following hymn of the Rigveda.

[Ṛgveda 9.112.2]

“I am a poet, my father is a physician and my mother pounds corn. Thus we follow different vocations with a desire for wealth like kine”

Then there was a golden period when all the Dvijas—Brahmanas, Ksatriyas and Vaishyas, practised this art with different motives. As long as mercy was the dominant ideal of civilization, the missionary spirit guided the profession Princes and ministers renounced their worldly power, wealth and position to serve humanity. A number of intellectuals devoted their whole lives to this humane work without any, expectation of remuneration Not only that but they travelled to foreign lands to relieve ailing humanity, and thus laid the foundation of missionary medical work. Such references of missionary Sadhus and Sanyasins are found from various books and in countries far beyond the limits of political India—in Ceylon, Siam, Burma, China, Bokhara, Persia, Arabia etc. Thus generally the Brahmanas practised this art with higher motives. Ksatriyas learnt and practised this art for the sake of self-protection just befitting their natural disposition and throughout the ancient era of our national life full of great battles, they evolved military surgery out of necessity and scientific curiosity. As time went on there was a great need for more and more physicians and the Vaisyas naturally came forward, thus fulfilling the double purpose of compassion and livelihood. As practitioners of the ancient art of healing, the physicians have been holding a very high position in the eye of society.

The above-mentioned facts go to show that the medical art was practised neither solely for money nor was always free of cost. The charging or otherwise of the fees depended upon the circumstances of the physician and the patient. The physician-patient relations engendered a dominant spirit of love and service on the part of the physician and the spirit of appreciation and liberality on the part of the patient.

This is proved by the following injunction of Ayurveda requiring every practitioner of medicine to give his treatment free as also his medicines free in the following circumstance.

[Suśrutasaṃhitā Sūtrasthāna 2.8?]

“The physician should treat with his own medicines and like one’s own relations the following persons. The Brahmana, the preceptor, the poor, the friend, the recluse, the sage and the helpless, whoever of them that approaches him for treatment. This tends to good consequence.”

Still the princes and princely persons and every man of means never failed to adequately appreciate the medical services. The problem of monetary remuneration varied according to the value attached to money in various civilizations of different periods and places

We read in the story of Jivaka that he received fees amounting to 16000 coins and presents from a patient which represents a sum far in excess of the fees received by the modern doctors. The man who received such a big fee from a wealthy man, treated other people without expecting any remuneration. Although the physician was expected not to bargain for his fees, it was made incumbent on the patients to discharge their obligation towards the physician.

[Carakasaṃhitā Cikitsāsthāna 1/4.55]

“Whoever, having been treated by a physician, does not recompense him, whether or not there be a previous understanding for remuneration, that man is beyond redemption.”

Caraka puts the position in strong terms that the fees may or may not have been fixed, but the patient must pay the due, as otherwise, he cannot absolve himself from the obligation of the physician

From the story of Jivaka we can gather that sometimes the physician treated a case with a contract to get the fees only if the case was cured Also there are instances where the fee is settled beforehand as well as when the fee is not settled at all.

If a quarrel arose in the matter of fee, the question was according to Kautilya referred to a committee of experts for final decision.

[Kauṭilya Arthaśāstra 3.13]

“That is the fee to be paid which is determined by the experts”.

Although the physician had his high ideal and noble code of morality, the society was never ungrateful and the men of means never failed to venerate the Vaidya by giving him remuneration in cash or kind. People like Bhisma honored the physicians wuo were called in to treat and gave them much wealth although their services were not actually accepted. The State maintained physicians, some as court physicians, some as village physicians, some as veterinary physicians, some as military physicians and some as travelling physicians. They were either paid in cash or were given a plot of land and allotted daily rations.

As the physician behaved so generously, society was not blind to the obligations of these incarnations of Ashvins.

[Carakasaṃhitā Cikitsāsthāna 1/4.50]

“What need, then, is there to say, that physicians can never be honoured too much by mere mortals who are subject to death!”

There was an unwritten tradition that after a victory on the battlefield, after recovery from a long or serious illness and after happy delivery, everyone whether a king or a commoner, expressed his thankfulness to the physicians by giving them presents and rewards.

In short, according to Caraka, this science of Ayurveda wag promulgated for acquiring religious merit as well as for the sake of wealth, and with spiritual release as its final goal