Chapter 8 - Treatment and the Status of the Patient

In ancient India the patronage to poets, Vaidyas and artists came from the aristocracy and hence the treatment prescribed in old medical works was mainly designed for the princes and aristocracy. It is but natural that the patronized class catered to the patrons’ tastes and status. The middle and the poor classes, however, were not neglected. The treatment prescribed for the aristocracy was modified according to the status of the patient. Moreover, it is in the fitness of things that the best possible treatment be described and modifications introduced according to the pecuniary condition of the patient. Thus although the whole chapter of Caraka Sutra XV is meant for the upper strata of society, we find that at the end of the chapter it is clearly stated that treatment should be modified according to circumstances.

[Carakasaṃhitā Sūtrasthāna 15.18-21, 23]

The aristocratic methods of treatment in various conditions especially in burning sensation in the body (dāha) out-do any of the luxurious way of treatment known to the modern world. Vivid descriptions of lavish dinner and drink parties are found in the Caraka-samhita. The dominance and patronage of the aristocracy resulted in innumerable pharmaceutical preparations, the great advancement of the culinary science, hundreds of varieties of wine, fragrant preparations, and milk and sugar preparations suited to the service of this class.

The love of art and display of riches permeated even medical practice and even the medical apparatuses used were ornamental

[Carakasaṃhitā Siddhisthāna 3.7, 9.51?, 8.34, 44]

Delicateness of constitution was considered to be a result or a characteristic of the aristocratic way of living and hence special preparations of medications were prescribed for this class, so that their delicate constitution may not suffer from strong and drastic drugs and procedures.

[Carakasaṃhitā Kalpasthāna 7.25, 27, 32]

The predominance of the rich was quite in consonance with the prevalent outlook of the people at the time. Wealth was considered one of the three great ambitions (eṣaṇā) of life. It stands next only to life (prāṇa) in order of importance. (Caraka Sutra XI.3)

[Carakasaṃhitā Sūtrasthāna 11.5]

The man devoid of money was considered miserable.

[Carakasaṃhitā Sūtrasthāna 11.5]

The dual strictness of the rules of the state and the society often made the practising Vaidya hesitate or even refuse to treat a poor patient, not because he lacked in the humane quality of compassion, but because the Vaidya was doubtful of his suceess in treating such a patient as the poor patient could not afford to have all the required articles of medication and also attendants (upakaraṇa). Failure to cure a patient would bring blame or discredit upon the Vaidya, and it is in order to save himself from such a fact that the poor man is included in the category of persons who are not to be taken up for treatment

[Carakasaṃhitā Vimānasthāna 3.45]

But this is only one side of the picture. In Sushruta Sutra 2.3, we find that it is enjoined upon the physician to treat such poor people at his own cost.

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“One should treat at his own cost as his kith and kin the following persons: the twice born, the preceptor, the pauper, the friend, the recluse, those who have sought his shelter, the virtuous, the orphan and the refugee. Thus does he earn credit.”

Thus in spite of the dominance of the aristocracy, the poor patients were not neglected and a sacrifice of great magnitude was expected of a physician. The Vaidya used to get enormous fees as is evident from Jivaka stories, and so he could afford to treat the poor at his own cost, as a compensatory measure for the royal fees he used to get from his rich patrons