Chapter 24 - The Vaidyas (physician)

It may be asserted with a fair degree of certainty that the institution of the Vaidya, the physician, is as eternal as medicine itself. It is not confined to a civilised state of society alone. Even when man was in the most primitive stages of his development, there must have been one or the other of his species that came to the rescue of his mate or offspring or members of the tribe or clan in an hour of pain and travail His remedies might have acquired any shape. from that of consoling sounds to herbs and incantations or coarse methods of medical and surgical manipulations

In India where history begins with the appearance on the scene of the Indo-Aryan clans, the institution of the physician is found to be well recognised and established ever since the days of the Rigveda. The Ashvins loom large in the Rigveda as the physicians of the gods and the divine institution may safely be taken to reflect its counter-part in mundane society, the mundane physicians in a context which denotes that the profession had not yet become hereditary but was open to any one to pursue:

[Ṛgveda 9.112.2]

“The bard I am. My dad is a leech, mummy lays corn upon the stones. Striving for wealth with varied plans we follow our desires like kine.”

We find again in the following verse the specific reference to the physician, the Bhisak, who is credited with the learning and the possession of disease remedies.

[Ṛgveda. 10.97.6]

[...]

“He who hath store of herbs at hand, like kings and a crowd of men, physician is that sages name, fiend-slayer, chaser of disease”

Even in that early age of civilised society, medicine had already become a complex science and art and presupposed certain degree of knowledge and intelligence that was possible for the highest stratum of society. Thus it was the Brahmana, the natural teacher and priest of the society that was also the physician. The sages held the Soma herb supreme among the plant kingdom and its juice opened their vision to immortal truth.

The verse in the Rigveda sings thus:

[Rigveda 10.97.22]

“With Soma as their sovereign Lord. The plants hold colloquy and say, O, King, we save from death the man Whose cure a Brahmin undertakes”.

The Atharvaveda is necessarily the source of the Ayurveda, for in it we find the preoccupation with the remedies for diseases, evil spirits and other ailments of man. There the physician is still the magic man priest and therapeutist rolled into one. But the various branches of medical aid have attained their distinctive ramifications. There is treatment by herbs, by organic body-juices, by incantations and we have surgical extractions and the countering of poisons

Again here is a physician assuring his patient that he will procure all the remedies that mortal physicians are aquainted with.

[Atharva. 8.7.26]

Already in the Vedic age, four different branches or techniques of treatment were well defined.

The Atharvani, the Angirasi, the Daivi and the Manusi are the four kinds corresponding to magical charms, body-juices or organo-therapy, the divine or psycho-therapy and lastly the human or drug therapy.

In the post-vedic period which is the golden age of Ayurveda, the position of the Vaidya was at the height of its glory. In the Caraka Samhita we have a complete picture of the physician, his equipment of learning and therapeutic accessories, his dress and manners, his Standard of ethics and his general position in society as guide and leader.

Dress

Like his modern counterpart, the ancient physician of India was conspicuous by his clean and well-washed clothes, his short-clipped hair and nails and his general demeanor of smartness and geniality.

Sushruta describes him thus:

[Suśrutasaṃhitā Sūtrasthāna 10.3]

“The medical graduate should enter into the medical profession resorting to the close clipping of his hair and nails, cleanliness, white raiment, holding of an umbrella and handstick, wearing of the shoes, and avoidance of gaudy clothes, and imbued with a spirit of helpfulness, brotherhood and sincerity towards all creatures”.

It is noteworthy that even in England for many centuries, the physician held a gold-tipped cane in his hand while visiting his patients.

Manners and Ethics

The physician was expected to be a paragon of gentlemanly qualities. He should not be given to braggartism. Even though possessed of learning and skill in his science, he should, not be loud in proclaiming it to the world.

Caraka lays down:—

[Carakasaṃhitā Vimānasthāna 8.13]

“Even though possessed of knowledge one should not boast and speak of it over much. For though a man be virtuous otherwise, boastfulness makes him hateful to people”.

His general attitude must be genial, gentle, modest and sincere. He was to harbour no ill will against any one and should look upon the destitute, the poor and the helpless as his own kith and km and be ready to offer help to such

His attitude to women was particularly aloof and detached. When he entered a patient’s house he was to keep his head bent and not be curious about the things and persons about him His mind must be devoted to the welfare of the patient alone. If he had to enter to treat a woman, he should never go unaccompanied, and he should neither laugh nor smile nor exchange irrelevant words with her No gifts offered by her in the absence of the husband are to be accepted. Even if he discovers her attachment to him and her amorous overtures, he should not respond Neither should he divulge them to others

The Kashyapa samhita is emphatic on the subject. It also describes the attitude he should have towards another physician that may happen to be interested in the patient.

[Kāśyapasaṃhitā Vimānasthāna 8]

“In the household of the patients, he should never engage himself in joke with women, even with female servants. He should not utter their names without prefixing terms of reverence, he should always speak giving the place of honor. He should not try to have any transaction with or great attachment to them. He should accept nothing from the woman without the knowledge of her husband. He should never enter without informing beforehand. He should neither talk nor sit with a woman in privacy. He should never look at her when she is uncovered or should not laugh at her. He should be indifferent towards her if she shows her love but should never bring it to light.

If any other physician comes in, he should forgive him and should win him over by friendly conversations. If he finds fault with him again and again, he should be challenged to debate and should be overpowered, from the very beginning, by the authority of other texts. He should not be given an opportunity to speak. If he begins to speak, one should bawl out ‘It is not so’. One should ridicule him and should catch hold of his faulty words and should involve him into difficulties. One should not treat him roughly losing control but should overpower him only by words of seeming praise”

Vagbhata sums up admirably the picture of a true Vaidya, his attitude and equipment in the following verses:

[Aṣṭāṅgasaṃgraha Sūtrasthāna 2.14-16]

“He who visits the patient only on invitation, well dressed and having perceived the good omens, who having entered reposes his mind on nothing else than the patient, who examines the patient and his malady in the light of the etiological factors, who never divulges any shameful features of the patient’s life and who knows the proper time and stage of treatment and uses it, he indeed is the true physician that achieves success in his treatment”

Professional Ethics

The medical profession was pursued as a means of living originally by the third class of Aryan society i.e. the Vaishyas. The Brahmana and the Ksatriya learnt the science, the former for researches in the higher spheres of the knowledge and for the relief of humanity purely as a mission of compassion, the latter for the advancement of the science and for the protection of oneself and his dependants from disease.

Yet all the four castes were entitled to study the science of Ayurveda for general enlightenment in the matter of purity, health, happiness and longevity.

[Kāśyapasaṃhitā Vimānasthāna 10]

“All may learn the science for the sake of a righteous and pure life.”

Though the professional Vaidya was making a living out of his profession and often fixed up the fees due to him in any particular undertaking, he yet had a code of ethics observe. He treated the poor and the destitute, the maimed and travellers and mendicants free of charge Bven in cases where there was no previous agreement as regards the fee, it was obligatory the part of the patient to pay up his fees and discharge debt to the physician. There was a widespread sentiment which obtains even today that among the debts that are particularly sinful if not paid, the physician’s debt is one

The ideal, a part from the exigencies of the physician's profession as regards fees, was always to keep in view the principle of compassion and service for the fellow-men and Caraka lays down the ideal m unrivalled grandeur in the following verses.

[Carakasaṃhitā Vimānasthāna 1/4.56-62]

The Vaidya besides these accomplishments was required also to be a good polemic. If he were to meet and be interrogated by a fellow of the profession on any point of theory and practice, he must be able to meet him in discussion and if the opponent persists in carping at him, he should deal with him severely and subdue him by reproaches and repulses in satirical terms.

The Vaidya was enjoined to seek the aid of other members of his class in diagnosis of different cases and in the determining of prescriptions and their pharmaceutical preparation. He must not quarrel with the fellows of his profession. A general spirit of geniality and kindliness and a supreme ambition to advance the welfare of the people were demanded of him.

Kashyapa says:—

[Kāśyapasaṃhitā Vimānasthāna 8.8]

Lastly we observe that the one great preoccupation of the ancient physician was to find out whether a particular case that came to him was curable or incurable A whole science of the signs and symptoms that prognosticated the favourable and the unfavourable trend of disease was laid out in order to enable physician to avoid the path to infamy and reproach by Handling cases that were incurable by any measure. Many factors must - have been behind such a drea of incurable cases. The fear of unpopularity and consequent fall in patronage was evidently one factor. But even more persuasive was perhaps the dread of state punishment or penalty if a physician was found to have been responsible for the death of a patient. A wise physician sometimes undertook treatment of even incurable cases only after declaring it to be such before the relatives of the patients and tried severe methods and measures with the permission of the relation and the state officials, in order to leave no stone unturned in saving the patient’s life, while absolving himself of the responsibility of his failure.

On this subject of prognostics, there is a striking resemblance in the spirit behind the growth of the science between the works of Indian writers like Caraka and the Greek author of Medicine, Hippocrates.

Hippocrates says thus in the book of Prognostics:

“It appears to me a most excellent thing for the physician to cultivate Prognosis, for by foreseeing and foretelling in the presence of the sick, the present, the past, and the future, and explaining the omissions which patients have been guilty of, he will be the more readily believed to be acquainted with the circumstances of the sick; so that men will have confidence to entrust themselves to such a physician. And he will manage the cure best who has foreseen what is to happen from the present state of matters. For it is impossible to make all the sick well; this, indeed, would have been better than to be able to foretell what is going to happen, but since men die, some even before calling the physician, from the violence of the disease, and some die immediately after calling him, having lived, perhaps only one day or a little longer, and before the physician could bring his art to counteract the disease; it therefore becomes necessary to know the nature of such affections, how far they are above the powers of the constitution, and, moreover, if there be anything divine in the diseases, and to learn a foreknowledge of this also. Thus a man will be the more esteemed to be a good physician, for he will be the better able to treat those aright who can be saved, from having long anticipated everything, and by seeing and announcing beforehand those who will live and those who will die, he will thus escape censure.”

“In as much as this work is entitled the Book of Prognostics; so it turns on the prescience that is to say, the fore-know ledge of the physician, which Hippocrates recommends to physicians for three reasons: first, for the confidence of mankind, which it will conciliate to the physician; then because it will free the practitioner from all blame, if he has announced beforehand the fatal result of diseases; and further, as being a very great instrument in effecting the cure.

But he who would wish to know properly beforehand those who will recover from a disease, and those who will die, and those in whom the disease will persevere for many days, and those in whom it will last for a few, should be able to comprehend and estimate the doctrine of all the signs, and weigh in his mind and compare together their strength. The Hippocratic foreknowledge rests not only on the observation of the signs, but also on the understanding of them.

First, to attract the confidence of one's patients; second, to free the physician from blame by enabling him to announce beforehand the issue of the disorder about which he is consulted, and third, to give him a decided advantage in conducting the treatment bypreparing him for remarkable changes in the diseases before they occur. And, in like manner, I may be allowed to remark the master of a ship who shows himself prepared for all changes of the weather will naturally attract the confidence of those entrusted to his charge, and whatever may be the result, he will be freed from blame if his ship should be damaged in a storm which he had previously predicted; and surely his knowledge of impending commotions in the sea and sky, will be of advantage to him by enabling him to make preparations for them”.

One can see from the Section of Prognostics (Indriya sthāna, Caraka) that dreams and sights and sounds, the complexion and voice and many other such traits show variations long before the attack of disease. And some of these symptoms appearing after the onset of disease prognosticate sure death or recovery. There is a great elment of mystical loreinm it. But there is much that may be verifiable by observation and experiment and that is a great aid to the physician who undertakes the treatment.

Adam, a recent writer, writing upon the subject makes the following observation:

“Looking then to the importance of general Prognostics, I have often wondered why this branch of Semeiology[?] is no longer cultivated, by the profession Did not the ancient physicians follow the best possible plan when they first described the general phenomena of diseased action and then applied them to particular cases? Surely they did right in first taking a comprehensive view of the whole subject described before attempting to examine the different parts of it in detail. This, in fact, constitutes the great superiority of the ancient savants over the modern, that the former possessed a much greater talent for apprehending general truths than the latter, who confine their attention to particular facts, and too much neglect the observation of general appearances. I trust no one will be offended if I venture to pronounce regarding the present condition of our professional literature, that (to borrow an illustration from the logic of Kant) it is altogether Cyclopic that is to say, it wants the eye of philosophy, for, although we have learned to examine particular objects with greater accuracy than our forefathers did, the sphere of our mental vision, so to speak, is more confined than theirs, and that cannot embrace the same enlarged views of general subjects. Surely then, we might gain a useful lesson by endeavouring to combine their more comprehensive views with our own more accurate and minute observation”.