Charaka Samhita and Sushruta Samhita
by Nayana Sharma | 2015 | 139,725 words
This page relates ‘Infirmaries and Hospitals in ancient India’ of the study on the Charaka Samhita and the Sushruta Samhita, both important and authentic Sanskrit texts belonging to Ayurveda: the ancient Indian science of medicine and nature. The text anaylsis its medical and social aspects, and various topics such as diseases and health-care, the physician, their training and specialisation, interaction with society, educational training, etc.
Infirmaries and Hospitals in ancient India
In the context of the therapeutic process we need to look at the health care institution which is an important requirement of this process. Evidence from our two medical texts on the nature and set up of institutions providing medical care and surgical treatment is far from substantial. With regard to treatment of internal disorders, there is hardly any reference to patients being admitted to health care institutions. A designated space for the performance of surgical procedures does not feature in the list of prerequisites for surgery, though for surgical patients, Sūtrasthāna ruta gives specifications of the post-operative chamber āgā ) for recuperation. It is required to be located at a good site and provided with all the necessary equipment.[1]
It is in the context of the requirements of conducting procedures like emesis, purgation, etc. that we get the description of an infirmary. It is referred to as any other structure and not by any specific term by Caraka. An appropriate location, a strong structure, proper ventilation and adequate space for movement are its essential characteristics. A water reservoir is an essentiality.[2] It is required to be well provided with various categories of attendants, and varied kinds of apparatus-utensils, mortars, drugs and animals,[3] which we will discuss below.
For evidence on infirmaries, we need to turn to other literary sources and epigraphs for they often developed in association with Buddhist and Brahmanical institutions. The role of Buddhist monasticism in the development of the infirmary is significant. We have noticed that medicine was included among the four essential items permissible to monks and nuns. At the outset, ailing monks were attended to by their fellow inmates or nursed by lay devotees. There is the well known example of the renowned physician Jīvaka providing free medical services to the Buddha and the Saṃgha. Besides, he donated his mango grove, Jīvakārāma, at Rājagṛha to the monastic community.[4] Gradually, from the mid-third century B.C.E., the monks extended their healing activities to the population at large.[5] State establishments providing medical facilities to humans and animals are known from Aśokan epigraphs: the second rock edict of at Girnar and a minor inscription from Erragudi.[6] Reddy, however, points to the existence of hospitals before the time of A oka on the evidence of the Arthaśāstra.[7] Zysk does not subscribe to the view that hospitals existed in India in the third century B.C.E.; rather the Girnar edict suggests that the healing activities of the monk, that were being extended to the laity, coincided with the spread of Buddhism in the time of the Mauryan ruler.[8] Inscriptions from a later period provide more firm evidence for infirmaries. An inscription from Nāgārjunikoṇḍā of the third century C.E. bears reference to a house within the Buddhist monastery for the patients recuperating from fever. The inscription is fragmented but the relevant portion reads: [śo]bhane vihāramukkhye vigatajvarālaye (“in the splendid chief monastic house, [in] the abode of feverless”).[9] Fever, here, could imply any febrile condition or mental distress[10] or any other illness for that matter as the term jvara is synonymous with disease in the medical compendia.
A sealing discovered from the site of Kumrahār that reads, śrī ārogyavihāre bhikṣusaṃghasya (“in the auspicious health house of the monastic community”), points to an infirmary attached to the monastery at Pāṭaliputra. The probable structure of the ārogyavihāra, dating from around 300 to 400 C.E., consists of four rooms with walls of fire-baked bricks and a floor of concrete.[11] It is interesting to note that the cells are placed are in such a manner that they do not face each other, possibly to prevent spread of infection, maintain silence[12] and provide some privacy to patients. Two potsherds found from the same debris bear respectively the inscriptions (ā)rogyavihāre (“in the health house”) and (dha)nvantareḥ (“of Dhanvantari”). It is suggested that the latter may have been the title of the presiding physician of the infirmary who practiced medicine according to the surgical tradition of Dhanvantari.[13] However, there is no reference to ārogyaśālā in any other inscription found in the excavation from Kumrahar.[14]
Further evidence comes from the fifth century account of the Chinese Buddhist traveler, Fa-hsien, who confirms the existence of charitable institutions established by heads of vaiśya families at Pāṭaliputra. They were open to the poor, the destitute and the diseased where they were examined by physicians and provided with food, medicines and decoctions or any other kind of help. They departed upon recovery[15] indicating that these were in the nature of residential in-patient centres. Further evidence for infirmaries attached to Buddhist monasteries comes from a sixth-century C.E. inscription from Duḍḍavihāra in Gujarat and another dated 604 C.E. from Lele near Kathmandu.[16] The former states that medicines and remedies were meant not only for the monks but for the use of all sick persons. The Nepal inscription mentions the royal donation of land for a ārogyaśāla.
Provision for medical facilities in Brahmanical temples is known from the Sanjeli Copper Plate inscription of Mahārāja Bhūta,[17] the Bhāgalpur Plates of Nārāyaṇapāla[18] and the Siyan Inscription of Nayapāla (c.1027-1043 C.E.).[19] We get reference to a hospital within the precincts of a Śiva temple that served the religious community and the general population from the last mentioned inscription. Rest-houses with food, drink and medicine for the sick and the needy associated with the Sun temple in Multan is known from the accounts of another Buddhist pilgrim, Hsuang-tsang.[20] The Malkapūram stone pillar inscription, dated 1261-1262 C.E., speaks of a maternity house (prasūtiśālā) and an ārogyaśāla.[21]
Two inscriptions from South India are especially significant in this context: the Tirumukkūḍal Inscription of Vīrarājendra (1069 C.E.)[22] and the Srirangam inscription of Garuḍavāhana Bhaṭṭa (Śaka 1415)[23] engraved on a shrine of Dhanvantari within in the precincts the Raṅganātha temple at Śrīraṅgam. The former, in particular, provides details of the hospital management including the remuneration structure of the hospital staff, mode of payment and the overhead costs, which is not available elsewhere.
The āturaśālā or hospital was meant exclusively for the teachers and students of the residential school attached to the temple of Venkaṭeśa Perumāl as also for all categories of service providers to the temple. The staff of the fifteen-bedded hospital comprised a vaidya, a surgeon, nurses, barbers and herb collectors. The nurses attended to the patients and administered medicines. The barber served the hospitalized patients, teachers and students. The staff in-charge of collecting the herbs was also given the task of collecting fuel and preparing medicines.[24] The details of hospital management have been tabulated in the appendix to this chapter.
Footnotes and references:
[1]:
Suśruta Saṃhitā Sūtrasthāna 19.3.
[2]:
Caraka Saṃhitā Sūtrasthāna 15.6.
[4]:
K.G. Zysk, Asceticism and healing in Ancient India: Medicine in the Buddhist Monastery, Delhi, 2000, p.43.
[5]:
K.G. Zysk, Asceticism and healing in Ancient India: Medicine in the Buddhist Monastery, p.44.
[6]:
[7]:
D.V.S. Reddy, Glimpses of Health and Medicine in the Mauryan Empire, Hyderabad, 1966, p.5.
[8]:
K.G. Zysk, Asceticism and healing in Ancient India: Medicine in the Buddhist Monastery, p.44.
[9]:
K.G. Zysk, Asceticism and healing in Ancient India, pp.44-45.
[10]:
K.G. Zysk, Asceticism and healing in Ancient India, p.45.
[11]:
K.G. Zysk, Asceticism and healing in Ancient India, p.45.
[12]:
S. Basu Majumdar, “Medical Practitioners, Medicines and Medical Institutions in Epigraphs” in S. Basu Majumdar and N. Sharma Mukherjee, Essays on History of Medicine, p.23.
[13]:
K.G.Zysk, Asceticism and healing in Ancient India, p.45.
[14]:
S. Basu Majumdar, “Medical Practitioners, Medicines and Medical Institutions in Epigraphs”, pp. 23-24.
[15]:
K.G.Zysk, Asceticism and healing in Ancient India, p.45.
[16]:
K.G.Zysk, Asceticism and healing in Ancient India, 44-45.
[17]:
S. Basu Majumdar, “Medical Practitioners, Medicines and Medical Institutions in Epigraphs”, p. 21.
[18]:
S. Basu Majumdar, “Medical Practitioners, Medicines and Medical Institutions in Epigraphs”, p.20.
[19]:
R. Chakravarti and K. Ray, “Healing and healers inscribed: Epigraphic bearing on Healing Houses in Early India, Institute of Development Studies, Kolkata, 2011, p. 21-22.
[20]:
P.V. Sharma, Indian Medicine in the Classical Age, p. 13.
[21]:
K.G.Zysk, Asceticism and healing in Ancient India, p.45.
[22]:
Ayyar, K.V.Subramanya, “The Tirumukkuḍal inscription of Vīrarājendra’, Epigraphia Indica, Vol XXI, pp. 220-250.
[23]:
S. Basu Majumdar, “Medical Practitioners, Medicines and Medical Institutions in Epigraphs”, p.28.
[24]:
S. Basu Majumdar, “Medical Practitioners, Medicines and Medical Institutions in Epigraphs”, pp. 24-26.