The Art and Science of Healing

The history of the prevention and treatment of disease, or in other words the science of healing, is a very exciting adventure, spanning almost the entire history of man, much of it unrecorded. It starts from primitive medicine and folklore, when it was considered more an art than a science, continues through the remarkable scientific breakthroughs of the nineteenth and twentieth centuries, to the hitech developments of today.

There is evidence to show that early Man did not regard death and disease as natural phenomena. Common maladies, such as colds or constipation, were accepted as normal and were cured by such herbal remedies as were available. These were not the only diseases. Serious and disabling diseases were considered to be of supernatural origin. They might be the result of a magic spell, visitation by a malevolent demon, or the work of an offended god who had either projected a dart, a stone, a worm into the body of the victim or had abstracted something, usually the soul of the patient. The treatment then applied was to lure the errant soul back to its proper habitat within the body or to extract the evil intruder, be it dart or demon, by counterspells, incantations, potions, suction, or other means.

It is clear that man was a fast learner. Soon he was discovering the science in Medicine. This becomes very clear when we study the history of Indian medicine. The earliest concepts of medicine in India are set out in the sacred writings called the Vedas, especially in the metrical passages of the Atharvaveda, which may possibly date as far back as the 2nd millennium BC. The system of medicine called Ayurveda was recorded by Dhanvantari who was deified as the god of medicine.

The period of Vedic medicine lasted until about 800 BC. The Vedas are rich in magical practices for the treatment of diseases and in charms for the expulsion of the demons traditionally supposed to cause diseases. The chief conditions mentioned are fever (takman), cough, consumption, diarrhea, dropsy, abscesses, seizures, tumours, and skin diseases (including leprosy). The herbs recommended for treatment are numerous.

The golden age of Indian medicine, from 800 BC until about AD 1000, was marked especially b y the production of the medical treatises known as the Caraka-samhita and Sushruta-samhita, attributed, respectively, to Caraka, a physician, and Shushruta, surgeon. Estimates place the Caraka-samhita in its present form as dating from the 1st century AD, although there were earlier versions. The Sushruta-samhita probably originated in the last centuries BC and had become fixed in its present form by the 7th century AD. Of somewhat lesser importance are the treatises attributed to Vagbhata. All later writings on Indian medicine are based on these works.

Not being allowed to cut the dead body, the Hindu's knowledge of anatomy was limited. But where there is a will there is a way. Some medicine men would keep the dead body in a basket and sunk in a river for seven days. Now the parts could be easily separated without cutting. Though the methods are crude, still it allowed the development of anatomy. The emphasis in Hindu anatomy was given first to the bones and then to the muscles, ligaments, and joints. The nerves, blood vessels, and internal organs were very imperfectly known.

The Hindus believed that the body contains three elementary substances, microcosmic representatives of the three divine universal forces, which they called spirit (air), phlegm, and bile. Health depends on the normal balance of these three elementary substances. The seven primary constituents of the body -- blood, flesh, fat, bone, marrow, chyle, and semen-- are produced by the action of the elementary substances. Semen was thought to be produced from all parts of the body and not from any individual part or organ.

Both Caraka and Shushruta state the existence of a large number of diseases, the latter believing there were as many as 1,120. Rough classifications of diseases are given. In all texts "fever," of which numerous types are described, is regarded as important. Phthisis (wasting disease, especially pulmonary tuberculosis) was apparently prevalent, and the Hindu physicians knew the symptoms of cases likely to terminate fatally. Small pox was common, and it is probable that smallpox inoculation was practiced.

Hindu physicians employed all five senses in diagnosis. Hearing was used to distinguish the nature of the breathing, alteration in voice, and the grinding sound produced by the rubbing together of broken ends of bones. They appear to have had a good clinical sense, and their discourses on prognosis contain acute references to symptoms that have grave import. Magical beliefs still persisted, however, until late in the classical period; thus, the prognosis could be affected by such fortuitous factors as the cleanliness of the messenger sent to fetch the physician, the nature of his conveyance, or the types of persons the physician met on his journey to the patient.

Dietetic treatment was important and preceded any medicinal treatment. Fats were much used, internally and externally. The most important methods of active treatment were referred to as the "five procedures": the administration of emetics, purgatives, water enemas, oil enemas, and sneezing powders. Inhalations were frequently administered, as were leeching, cupping, and bleeding.

The Indian materia medica was extensive and consisted mainly of vegetable drugs, all of which were from indigenous plants. Caraka knew 500 medicinal plants, and Sushruta knew 760. But animal remedies (such as the milk of various animals, bones, gallstones) and minerals (sulfur, arsenic, lead, copper sulfate, gold) were also employed. The physicians collected and prepared their own vegetable drugs. Among those that eventually appeared in Western pharmacopoeias were cardamom and cinnamom.

As a result of the strict religious beliefs of the Hindus, hygienic measures were important in treatment. Two meals a day were decreed, with indications of the nature of the diet, the amount of water to be drunk before and after the meal, and the use of condiments. Bathing and care of the skin were carefully prescribed, as were cleansing of the teeth with twigs from named trees, anointing of the body with oil, and the use of eyewashes.

In surgery, ancient Hindu medicine reached its zenith. Operations performed by Hindu surgeons included excision of tumours, incision and draining of abscesses, punctures to release fluid in the abdomen, extraction of foreign bodies, repair of anal fistulas, splinting of fractures, amputations, caesarean sections, and stitching of wounds.

A broad array of surgical instruments were used. According to Shushruta, the surgeon should be equipped with 20 sharp and 101 blunt instruments of various descriptions. The instruments were largely of steel. Alcohol seems to have been used as a narcotic during operations, and bleeding was stopped by hot oils and tar.

In two types of operations especially, the Hindus were outstanding. Stone in the bladder (vesical calculus) was common in ancient India, and the surgeons frequently removed the stones by lateral lithotomy. They also introduced plastic surgery. Amputation of the nose was one of the prescribed punishments for adultery, and repair was carried out by cutting from the patient's cheek or forehead a piece of tissue of the required size and shape and applying it to the stump of the nose. The results appear to have been tolerably satisfactory, and the modern operation is certainly derived indirectly from this ancient source. Hindu surgeons also operated on cataracts by couching, or displacing the lens to improve vision.

From being leaders in the art and science of healing, Indians now are pale imitators of the West. Let us hope that like our ancestors we too will blaze a trail of glory of which our sons and grandsons will be justifiably proud.