Chapter 25 - The Vaidya and Society

It is a truism to state that the degree of honor accorded to the learned professions represents the degree of the refinement of the civilization of a people. Among the learned professions, that of the healer, the medical man stands supreme, being vital to the health, happiness and survival of the race. From the earliest history of man the healer has donned the robes variously of the priest, prophet and physician, as befitted the spirit and degree of refinement of the age. In the early dawn of human history when the eye of man beheld spirits, gods and demons who were credited with making trees, waters and rocks and hills their habitation and with powers for good or bad to exercise over man, religion and medicine were scarcely distinguishable from each other. Every ill-humor of the body or the mind was attributed to the evil influence of some invisible spirit, and exorcism or propitiatory rite was all the therapeusis demanded. The priest, naturally, was the right dispenser of healing and healing formed an integral part of the ritual of religious worship.

In the Rigveda, the earliest available records of civilized human life, the knowledge of healing, as a science comprising both religious and lay forms of therapeusis, had reached a high degree of progress. Besides, the healer and the healing science were already developed as an institution and the healer, the Bhishak or the physician was held in high honor among the gods as well as among men. The hierarchical order of the gods in the tradition of a race, represents the hierarchical order among its men. Already at that early period of human history the gods had their priests and their official physicians. The Ashwins were twins and expert in medicine and surgery. They healed and mended the injuries to the gods in their age-long conflict with the demons. There grew up in human society the counterparts of the divine healers and the sect called Atharvanas named after Atharvana, the seer and founder of the Atharvaveda, were popular as healers and exorcists in the Vedic and post-Vedic times.

The Ashwins though originally minor gods were later raised to the high status of the other gods and regarded worthy of being offered oblation in sacrifices by virtue of their proven powers in the healing art.

[Carakasaṃhitā Cikitsāsthāna 1-(4), 41-45]

“The Ashvins, who are the physicians of the gods are celebrated as the resuscitators of sacrifice, for it is they that reunited the severed head of sacrifice. It is these two, again, that successfully treated Pushan when his teeth had become loosened, Bhaga when he had lost his eyesight and Indra when his arm had become stiffened. These two, moreover, cured Soma the Moon-god of consumption and restored him to his happiness when he had fallen from his state of good health. When Cyavana, the son of Bhrigu, had become decrepit with loss of voice and body lustre, as the result of old age, but hankered still for sense pleasures, it is the Ashwin-pair that made him young again. On account of these and many other miracles of healing, these two, the greatest of physicians came to be regarded with honour by great personages such as Indra and others”.

The Caraka Samhita recites their wonderful feats and even above Dhanvantari known as the God of medicine, the Ashwin twins are the real gods and originators of the Science of Medicine. The high honor, accorded to them in the Vedas and the number of hymns composed and sung in their honor are indications of the noble status accorded in Vedic society to their mortal counterparts.

The period succeeding the Vedic one, retained its respect for the healer though by then already, impostors known by the name of Kuvaidyas or Kuhakas from which, the modern term “Quack” is derived had made their appearance in society and were increasing in their number. The Caraka Samhita which belongs to that period between the Vedas and the Smrti and Mahabharata devotes a lot of attention to drawing the distinction between the real physician and the pretentious quack. It accords the greatest Homage to the real one known as the bringer of life (prāṇabhisara[?]) and condemns. In elaborate manner the destroyers of life (prāṇahantāra) whose ways and manners are fully described in impressive words in a whole chapter (Carakasaṃhitā Sūtrasthāna 29).

That reflects the true conditions obtaining by then in society. By then, the profession of the healer must have become attractive, lucrative and enviable one of social distinction. Caraka offers sincere and respectful obeisance to the true physician, the bringer of life.

Having described the two kinds of medical practitioners—the true and the false, Caraka concludes thus:

[Carakasaṃhitā Sūtrasthāna 29.10-13]

“Those who, putting on the garbs of the physician, thus gull their patients, just as the bird-catchers in the forest (gull) the birds by camouflaging themselves in nets, such persons, outcastes from the science of healing, both theoretical and practical, of time and of measure, are to be shunned, for they are the messengers of death on earth. The discriminating patient should avoid these unlettered laureates, who put on the airs of physicians for the sake of a living; they are like serpents that have gorged on air. But salutations be constantly proffered to those others who are learned in the science, skilful, pure, expert in performance, practised of hand and self-controlled”.

The stress laid on the avoidance of the cases which showed symptoms of incurability indicates the dread of failure in treatments that the medical man entertained in that age. Loss of reputation, loss of monetary emoluments and worse results such as perhaps the censure and punishment by the State where death was recognised to be due to wrong methods of treatment, must have loomed large in the minds of medical practitioners. This gave rise to an elaborate science of diagnosis and investigation in the light of the patient’s dreams and premonitory symptoms and of the casual circumstances attending upon, surroundings of the patient, the messenger he sends to fetch the physician and such other conditions like omens on the physician’s path. This is elaborately described in the whole section devoted to it known as (indriyasthāna) ‘prognostics’. Throughout as well as at the outset of the treatise Caraka insists on avoiding the undertaking of cases showing symptoms of incurability. Such cases are known as ‘Pratyakhyeya’ (pratyākhyeya) those that deserve to be refused. Not that incurable cases were refused treatment absolutely, on the other hand we find the physician declaring the patient before his relatives to be incurable and with the permission of the state and his relations, heroic measures were resorted to, to alleviate the disease.

He mentions that declaring certain cases to be such yet the physician may undertake to treat them with view to alleviate the evil, so as perhaps to assuage the pain or prolong the life as long as possible.

[Carakasaṃhitā Cikitsāsthāna 18.141, 13.175-177]

“The patient suffering from cough born of consumption with all the symptoms of consumption fully developed and who is debilitated should be considered incurable but if the cough is of recent origin and the patient is strong the treatment should be undertaken despite declaring it to be of the incurable type”.

“When the abdominal disease due to the gathering of fluid has gone beyond the stage of treatment or if the humoral tri-discordance has not got subdued, the physician should summon the patient’s kinsmen, well-wishers, wives, Brahmins, state authorities, the caste and elders and speak to them about the precarious condition of the patient. If not treated, the patient s death is certain. But if treated by poison therapy he may have a chance to survive Having spoken thus and being permitted by the patient’s well-wishers to proceed, (he must administer poison......)”.

There is nothing more reasonable perhaps that even the modern counterpart of the old time Vaidya can do under such circumstances.

The Smriti and the Classical periods

Having witnessed the priest-prophet beginnings of the medical man and his later evolution in the post-Vedic or Samhita period into a fully established lay healer akin to the one of the modern times, we find a deterioration in his status consequent presumably upon a deterioration of his high ethical and intellectual standards set up in the hayday of Ayurveda. Particularly this applies to the art of surgery which dwindled into a handcraft unworthy of man of learning and of intellectual equipment. It is reasonable to conclude that medicine began to advance and gradually encroached upon the field that was formerly held by surgery so much so that most cases formerly regarded as amenable to surgical measures were claimed by the physician in his peculiar domain. There must have been a tendency to make as much of surgery as possible superfluous and the remaining inevitable measures of incision and excision of wounds and such other minor traumatic conditions, relegated to the simple craftsman such as the barber. Even in Europe until the eighteenth century, the barber surgeon was the prevailing institution. Even in the achievements of the modern medicine, this tendency is apparent More and more diseases such as syphilis and gonorrhea, surgical tuberculosis, and diphtheria have been taken out of the domain of surgery by the inventions of the sulpha group of drugs, radiology and other methods of therapeusis.

We find proof of this kind of transition where the Cikitsaka, the therapeutist, because of his handling impurities like the pus, flesh and blood was regarded as unworthy of attendance at religious sacrifices and ceremonial dinners.

Manu lays down:

[Manusmṛti A, 4.249]

“Those who earn their living by therapeutic service or from church property or meat dealing or by trade should be avoided in all religious as well as in obsequial ceremonies.”

Again he says:

“The food given by a therapeutist is just like pus, that by a harlot is like semen, that by a usurer is like fecal matter and that by a wine dealer is like refuse”

[Manusmṛti A. 4.249 (2)]

“The food offered by a therapeutist, an ungrateful person, a sculptor, a usurer, a eunach and by a harlot should not be accepted”.

It is evident that the medical profession during this period had fallen from its pristine glory and nobility. The reasons are obvious. The learning and the practical clinical training disappeared and it became a mere trade and craft descending from parent to offspring as was the case with other trades like smithy, carpentry and agriculture. In such circumstances, the love of knowledge, research and high ethical principles could scarcely be expected to prevail. The Bhisak so exalted in the Caraka and other samhitas becomes a mere Cikitsaka, a therapeutist. The tenets of non-infliction of pain must have discouraged surgical measures, dissection and other means involving the handling of flesh, blood and other unseemly things. They must have ultimately depended on a few time-honored herbal and mineral recipes incidentally opening up a field of research in metals. The great buddhist Nagarjuna was a veteran in the field of mercury preparations and an alchemist. But Ayurveda, as a science of life, with its vast list of animal products in its materia-medica and dialectics must have disappeared. The tenets of Vedic religion became more and more dogmatic and the observances of external purity and piety gained ascendancy over the liberalism of thought and spirit that obtained previously. As a sign of the general deterioration of thought and observance, the handling of bodily impurities of blood and flesh incidental to the practice of surgery was regarded as disreputable. The high purpose of surgical therapeusis was lost sight of and only the unseemliness of the method kept in view. This surely signifies a general decay in the cultural and scientific life of the race when mere forms were remembered and worshipped. The noble purpose of philosophy and science was clouded by the clamorous adoration of the external forms of religion and the catch-phrases of science substituted for its spirit and meaning. For, in no otherwise, can we understand the fall and neglect of such a branch of knowledge as Ayurveda, which men of the previous age had held to be supreme even above the other Vedas

This must have led Caraka whom we have placed somewhere in the second century B.C. when the Vedic religion and culture was reasserting itself to have rescued the disappearing science from oblivion and compiled his immortal Samhita to reinstate the great science of medicine in the national life. That is why in the classical period of India that is for the centuries from the second or first century B.C. despite the injunction of the Smritis, Vaidya reasserted his position of social importance in India. The references to the place of the Vaidya in the structure of the village and the towns, and the growing recognition of the significance of the medical science prove his reinstatement before Indian life was once again plunged into confusion and consequent dislocation by foreign invaders or conquerors namely the mohammedans.

The following few references culled from classical writers bear testimony to the above conclusion.

[... 3]

“All other arts and sciences are only for amusement. There is nothing worthwhile to be gained from them. But the sciences of healing, astrology and thaumaturgy are corroborated at every step.”

[... 6]

“O ye deluded philosophers! why do you still persist obstinately in the quest for unity? O ye, angular logicians! why do you still go about investigating with your noses in the dust? O ye theologians! why do you afflict the heart with scriptural recitations which pierce the ears like needles? Leave these varieties and seek refuge in medicine, the one perfect science for the sake of giving happiness to all life.”

It was a popular maxim that a physician was a necessary element in any complete civic unit.

[...]

“In a country where there is no man of wealth, no Brahmana well versed in the Vedas, no king no river and fifthly no physician, one should not live even for a day”.

Here below is the Caraka’s ideal of a physician—

[...]

“They are well-born, of wide learning, of wide practical experience, skilful, pure, practised of hand, self controlled, fully equipped wish all the appurtenances (of healing), in full possession of their faculties, conversant with the normal course of nature, able to take prompt and appropriate decisions these are to be known as the saviours of life and destroyers of diseases”.

The highest honor that a medical man aspired to was to become the kings physician.

The qualifications needed for such title were many and difficult Caraka lays down the qualifications thus:

[Carakasaṃhitā Cikitsāsthāna 6.19]

[Carakasaṃhitā Sūtrasthāna 9.19]

“The man who is aquainted with the characteristics of all diseases, versed in all therapeutic measures and conversant with the true properties of all drugs, is worthy of being made the custodian of the king’s life. He who possesses the fourfold knowledge of etiology, symptomatology, therapeutics and prophylaxis of diseases is the best of physicians and deserves to be honoured by the king. (He is fit for being the royal physician)”.

There can be no doubt that a true and learned physician must have earned the respect and patronage of society in all the ages past as he does at present and will continue to do for all time. He is the natural friend and guide of society and even the state has to consult him in conditions of grave dangers to racial survival arising from serious disease and lack of social hygienic and sanitary sense. He is the expert on health and his example and precept are valuable education to the society Medicine may be practised as a trade till some new social revolution takes place when all medical aid becomes an organ of the state, but a spirit of humanity and broad sympathy with the ailing fellowman will ennoble and endear even the practitioner who makes more than a living from his profession. But the stupendous fortunes to the making of which medicine is now an easy means must come to an end. It takes the soul out of the most humane of professions and makes it almost a censurable avocation. Under enlightened conditions of social life, the healer is bound to reclaim his leadership as in the primitive society. He was then the priest and magic man, later on the prophet and the miracle worker of health, the inspiritor of the individual as well as of society, a guide and leader into the higher realms of physical and psychic soundness and integrity. He guides and helps humanity across the rough seas of disease and decrepitude into the heaven of health and long life.

Let us repeat the noble lines from Vagbhata in praise of the supreme healer.

[Aṣṭāṅgahṛdayasaṃhitā Sūtrasthāna 1.1]

“Obeisance to that incomparable physician who destroyed the entire brood of psycho-somatic diseases such as passion and the like that perpetually afflict all embodied creatures and that give rise to the urge of desire, delusion and depression.”