[This paper was published in Modern Indian History, vol. III – Festschrift to Prof. P. Chenna Reddy – (New Delhi, London: Blue Rose Publishers, 2023), pp. 188-211]
The practice of medicine of the ancients was an art, and not a science, and dignity it did not acquire until it was based on acquaintance with anatomy and physiology. – Joseph Leidy, 1858.[1]
Introduction
Knowledge of the body was no doubt a concern for the Āyurvedic authors. In the Caraka Samhitā –
śarīravicayah śarīropakārārthamisyate / jnātvā hi śarīratattvam śarīropakārakaresu bhāvesu jnānamutpadyate / tasmāt śarīravicayam praśamsanti kuśalāh // [Śā, 6.3] (Detailed knowledge of the human body is conducive to the well- being of the individual. The understanding of the factors that constitute the body provides knowledge regarding the factors which are responsible for its well-being. It is because of this that experts extol the knowledge of the details of the body.[2])
Perhaps the importance of acquiring anatomical knowledge cannot be better valued than the editorial of the New England Journal of Medicine. While “Looking Back on the Millennium in Medicine”, the editorial comments, “The emergence of a comprehensive understanding of the structure and function of the organ systems of the human body stands – without question – as one of the most influential advances of the past millennium…Considered together, the work of Vesalius and Harvey provided the intellectual underpinnings for many advances in human anatomy, physiology, clinical medicine, and surgery that followed during the remainder of the millennium.”[3] If society and science view medicine or art of healing in an all-encompassing way, the problems, and, more importantly, the solutions will be understood following this line of thinking. If, on the other hand, science and society view medicine as an industry and a market commodity, the problems and solutions will be understood as industrial and mercantile in nature. Because we are self-aware the study of the human has a unique place in establishing the image we have of ourselves; ultimately the prosaic descriptions of the bones, muscles, blood vessels and neural pathways are the context of our experience of life.[4]
While describing the history of anatomy and medicine, like other branches of knowledge, men need a theory, for the phenomena that come under observation are so numerous that in default of a theory they would elude our grasp. Medicine must be guided by a theory, for otherwise medical doctrine could not be handed on from the teacher to the pupil. Such was the opinion of Henry Sigerist.[5] John Abernethy, a very influential figure of eighteenthcentury and early nineteenth century anatomy and surgery in British medicine, wrote, “There was a time when medical men entertained so determined a dislike to the word theory, that they could scarcely tolerate the term.”[6] He goes further, “When also in the prosecution of our anatomical enquiries, we as it were analyze the body, or reduce it to its elementary parts;…we become lost in astonishment that such important ends can be effected by apparently such simple means.”[7] Interestingly, though talking about anatomical dissection at its perhaps most crude and experimental level he did not fail to take note of the Great Chain in Christian belief. He lets us know, “Mr. Hunter, who so patiently and accurately examined the different links of this great chain, which seems to connect even man with the common matter of the universe, was of this opinion.”[8]
All these historical facts (and many others not dealt with here owing to paucity of space) lead us to believe that though anatomical knowledge and surgical practices did make great advances in Europe, the impact was not much palpable in the theoretical world of the earlier “humoral” medicine. Moreover, until the advent of anesthesia and modern chemistry, medical and surgical therapeutics were not so superior to the motley Indian mode of healing – in both surgical and medical aspects. Temkin comments, “Medicine ran into the cul de sac of therapeutic nihilism, while surgery, with all its imperfections before 1846, could and did cure with some confidence.”[9] Moreover, “In turning to a localized pathology, medicine adopted a point of view prevalent among surgeons.”[10]
Earlier Understanding of Medical Scenario in India
At the time of colonial conquest of India in the mid-eighteenth century, the state of European medicine was not quite elegant or anything the British could boast. Let us examine one example. Jagat Set, one of those who wholeheartedly colluded with the British, was in trouble for his shoulder being “disjointed” and did not “get the use of my arm”.[11] The medicines sent for Set were some kind oil and “extract of horn and other medicines wrapt in paper for the cure of Juggut Seat’s arm dislocated by his foot slipping”.[12] A different experience of Honigberger, in the 1830s, can be cited here. He reported,
I introduced to our distinguished guests, Col. Wade and Dr. Murray, an Akalee or Nahung, whose nose, ears and hands had been cut off by order of Runjeet Sing (he had even deserved the gallows), and whose nose had been so well restored in the mountains that we were all surprised, and confessed it could not have been better done in Europe. As we know, from history, this operation was even in the remotest antiquity, practiced by the Hindoos; and they formed the nose out of the cuticle of the forehead, which proceeding is now, and always will be the same. [13]
Besides rhinoplasty, practiced among low caste people of India as a family craft for generations, the Indian way of cutting stone and couching cataract were also important indigenous surgeries, which the British came to learn. Moreover, during the initial days of colonization, Indian botanical, herbo-medical and chemical knowledge became a point of great curiosity and learning. However, with the passage of time, prevalent Indian medical and surgical practices at the time became an object of utter ridicule and an indicator of lower attainment in the rung of scale of civilization. Bayly succinctly points out, “When the British denounced Indian backwardness in theory, they meant their continued adherence to Aristotelian humoral notions which had only recently been abandoned in Europe. The insecurity of European knowledge was a potent element in their rages.”[14]
As modern medicine gradually consolidated its new epistemological and ontological characteristics, jettisoned from its humoral legacy, Āyurvedic nosology, pathology, disease prognosis – all taken together and premised on the theory of doṣa – were outright rejected. The continuing struggle between Āyurveda and modern medicine began to take place. In addition, it continues until today. In this article, our basic point of interest and focus is how the elemental tenets of Indian medicine – to speak of Āyurveda only, and not Unani or Siddha medicine – have been reconstituted. Moreover, it may be intriguing to know the mechanisms and motives behind them, following the introduction of European or modern medicine in India.
At least until the 1830s, there were rather two conflicting strands in European medicine. While symptomatology of the patient and six non-naturals of humoral theory guided the world of medicine, post-Vesalian anatomy and post-Harverian physiology built up the premise of surgical excellence and cures. One of the earliest medical treatises on India even discussed about ‘sol-lunar influence’ on fevers.[15] As a result, in the world of therapeutics, European medicine could not actually overcome indigenous therapeutics of India. Nevertheless, superior surgical dexterity was successful to produce awe for European medicine –
Hormasjee Bhicajee, a respectable native merchant and ship-builder, was induced to lay aside prejudice, and submit to the operation of lithotomy performed by Dr. Fogerty…The result of this and other operations has led us to the conclusion, that the natives of the country are daily becoming more and more alive to the benefit derived from the employment of European skill in the treatment of diseases.[16]
Contrarily, at least since 600 A.D., the study of anatomy and surgery had almost ceased to exist in India.[17] The scholastic practice of Ayurveda was solely confined to medicine, while surgical crafts were relegated to the hands of low-caste people. Zimmermann provides an example of virtual application of surgical knowledge by present day Ayurvedic practitioners. To the high-caste physicians who have access to Sanskrit knowledge the chapters on surgery and midwifery are a dead letter. Nevertheless, ‘the learned practitioners do read and recite these Sanskrit texts by heart so that apparently there will be no break.’[18] This example shows how the Indian system of medical knowledge differs from its European counterpart.
In addition to anatomical and surgical knowledge, two new investigative techniques like Auenbrugger’s percussion (1761) and Laennec’s mediate (distant or indirect) auscultation by stethoscope (1816), which was a shift from im-mediate or direct auscultation, gave birth to an altogether different mode of knowing. It yielded a new vision for the patient – doctor relationship, the doctor’s authority over the patient, a new knowledge of the bodily space, and organ localization of disease. A new norm and epistemological structure began to emerge. Interestingly, the new power of the physician was a source of apprehension as far back as 1826 (just ten years after the introduction of stethoscope). ‘It has been said that the use of stethoscope may be injurious, by leading the physician to know too much of the danger in a bad case…’[19]
Not only so, it could ‘make him despond and resign the patient to his fate too soon.’[20] Refuting these criticisms, Scudamore found ‘that by no other mode can we examine the interior of the chest, with equal accuracy.’[21] This new kind of medicine or, better to call hospital medicine, brought into practice by the British began to be engaged in serious epistemological encounters with indigenous healing practices, especially Ayurveda in our case. More importantly, the emergence of this new medicine operated institutionally as the continuum to produce doctors with entirely new medical philosophy. The new doctor neither fully belonged to medicine nor to surgery nor to obstetrics and so on. ‘The cognitive consequence of this union was a body of medical knowledge in which internal disease was newly conceived of from a surgical perspective.’[22] There was a differential in perception of European medicine between the native elites and population at large on the one hand, and ‘modern’ Ayurvedics and ‘traditional’ ones on the other. In their efforts to retain subjectivity, common people split up a space between practical therapeutics and ontology of health.[23] It was manifested in so many events like resistance against vaccination, plague riots etc.
There was doubtless the utter need of a constant supply of trained medical personnel for the British army. As there was a deficiency of European medical officers, native doctors became indispensably necessary to afford medical aid to the numerous detachments from corps in the extensive dominions of India. Moreover, it became ‘for the efficiency of the Bengal army, a point of vital importance to the state.’[24] British army had undergone so many casualties in the wars and mortality in ‘unhealthy’ climate of India. The mortality and morbidity of European troops in India – which numbered 24,500 in 1808, rising to 45,522 on the eve of the Rebellion in 1857 – was usually far higher than that of the sepoys of the Company’s regiments.[25] It would cost 100 ponds to train a soldier in British India.[26] Colonel Hodgson warned that in Bengal one year encounters as much risk of life as in three such battles in Waterloo.[27] It was welcome if a respectable body of Native physicians were created in India, ‘that might fill many subordinate offices, at a much more moderate charge, and render so large a body of European medical officers unnecessary.’[28] It was no wonder a commercial house like the East India Company would weigh the benefits of the Native Medical Institution or NMI (1822), the first institution in India for military medical training for the Indian population devoted to the production of subordinate Indian aides to the European surgeons, in pure economic terms.
From the phase of military medical training to the phase of medical education to produce primarily sub-assistant surgeons in India and, later, for the Indian Medical Service (IMS), there occurred the transition of medical practices to the era of hospital medicine in India, consistent with medical education and curricula pursued in the University College, London (UCL) and other provincial towns of England.[29]
At this juncture, it should be profitably mentioned that Āyurveda teaches “how one may utilise the span of life apportioned by nature – traditionally taken to be hundred years – fully and optimally.”[30] Āyurveda constitutes to an extent the Hindu subjectivity. One scholar also advises us against taking this term as an approximation and not as an equivalent of what one understands as medicine in the West. The Western medical tradition, now termed as modern medicine, may be viewed as a set of intellectual and material resources used to treat the ill, often in negotiation with patients, with the power of science within medicine, and the medical relationships developed beyond the nation, including the international frameworks and commerce.[31]
Caraka-Saṃhitā (or The Compendium of Caraka), one of the earliest medical texts of India, provides description of building a hospital, or “a kind of infirmary”[32]. Chapter fifteen (1.15.1-7) describes that “an expert in the science of building” should construct a worthy, strong and airy hospital, yet not exposed to the gust of wind. “It should be out of the path of smoke, sunlight, water, or dust, as well as unwanted noise, feelings, tastes, sights, and smells. It should have a water supply, pestle and mortar, lavatory, bathing area, and a kitchen.”[33] Animals like bustard-quails, grey partridges, hares, Indian antelope, black-tails, sheep, and nice, healthy milk cow with a live calf were also to be included in hospital. Moreover, there should remain provisions for a number of men who were “skilled in singing, making music, telling or reciting various kinds of stories in prose and verse (ullāpaka, śloka, gāthā, ākhyāyikā, itihāsa, purāṇa).”[34]
In an era of bio-medicalization as well as of techno-medicine, the hospital and the experience of the patient assume a figure completely different from the previous description and experience. An important textbook of internal medicine describes the hospital as “an intimidating environment for most individuals” where hospitalized patients find themselves surrounded by air jets, button, and glaring lights and “invaded by tubes and wires; and beset by the numerous members of the health care team – nurses, nurses’ aides, physicians’ assistants, social workers, technologists, physical therapists, medical students, house officers, attending and consulting physicians, and many others. … It is little wonder that patients may lose their sense of reality.”[35]
Evidently, in such a hospital patients almost cease to be persons, and the person of the patient gets reconstituted to be some conglomerations of pathology inside the body. “Removed from their normal surroundings they can be treated in ways that ignore those surroundings precisely because the physician is now focusing on disease entities.”[36] Risse comments, “As depicted by contemporary narratives, going to hospital resembles a journey to a foreign, exotic land, an often too common pilgrimage in which patients cross into a world of strange rites, miraculous interventions, and frequent death.”[37]
Let us have a closer look into the date of CS. Wujastyk places it between third or second centuries BC and the period of Gupta dynasty (320 – 420 AD). The latter date corresponds to the period when CS gets frequently quoted.[38] Meulenbeld on the other hand scrutinizes the philosophical material of CS. “The same material suggests that the author called Caraka cannot have lived later than about A.D. 150-200 and not much earlier than about 100 B.C.”[39]
In the narrative of CS, we find the patient in a milieu which actually does not dissociate him from his domestic setting; rather the hospital becomes an extension of home. “Beds and chairs should be provided with a (flower) vase and spittoon, bed well-equipped with carpet, bed sheet and pillow along with supporting pillows; and should be comfortable for attending to lying down …”[40] Needless to say, all these arrangements were meant for a king or wealthy persons of high social. In Meulenbeld’s expression, “Chapter fifteen … on the equipment of a physician, describes a kind of infirmary, with its personnel and equipment, suitable to the treatment of persons of high social status with full course of pañcakarman.”[41] Wujastyk cogently notes, “The poor are advised to follow the same evacuation treatment but with simpler equipment.”[42]
A few issues open up before us. First, the hospital described here does not seem to be a usual one – the receptacle of the sick. It is meant for wealthy people and for a particular medical purpose (pañcakarman). It does not seem to be equivalent to hospitals of the medieval period – East or West. Second, the evolution of the concept of pañcakarman itself is quite intriguing. Zimmermann finds that it might have been originally synonymous with śodhana, as both categories encompassed emetics, purgatives, drastic enemas, and errhines. “However, since bloodletting (the fifth of evacuant therapies) has fallen into disuse, it was removed from the set of Pañcakarman, and replaced by oily enemas.”[43] It is understandable that in the hospital of Caraka there was no surgical procedure, but only a medical one. Third, unlike three-dimensional modern medical body, in Caraka’s account, the body is assumed to be a two-dimensional frame through which doṣa-s, dhātu-s and mala-s (three morbific entities or humors), and saps flow.
Hospitals in Ancient and Medieval India
We would now make a brief journey through history of hospitals, as depicted in modern historiography. Through this journey, I believe, the shift from the hospital as described in the normative text of CS to hospitals as general charitable space for healing will be evident. “Medicine and healing were integral parts of Buddhist monasticism from its inception.”[44] Zysk contends that the much discussed second rock edict of Aśoka (reign: 269 BCE-232 BCE) “in no way proves that hospitals existed in India in the third century B.C., but suggests that the monk healers’ role of extending medical aid to the laity coincided with the spread of Buddhism during Aśoka’s reign.”[45] An inscription from Nagarjunikoṇḍa, dating from the third century C.E., suggests that a health house for the care of those suffering and recovering from fever was part of this famous Buddhist monastery.[46] Though there remains confusion regarding the exact meaning of fever. Zysk notes, “When Buddhism was submerged in India after 1200, these Hindu institutions seem to have assumed the responsibility for medical services previously provided by the Buddhist monasteries.”[47] A sixth century C.E. inscription from the Duḍḍavihāra in Gujarat states that the use of medicines and remedies was for all those who are sick, not only for the monks.[48]
In seventh-century India, there are oft-quoted records of Hiuen Tsiang or Xuanzang (A.D. 690). In his description, “in all the highways of the towns and villages throughout India he erected hospices, provided with food and drink, and stationed there physicians, with medicines for travellers and poor persons round about, to be given without any stint.”[49] He also mentions a puṇyaśālā or “a house of merit” or “houses of charity”. “The nobles and householders of this country have founded hospitals within the city, to which the poor of all countries, the destitute, cripples, and the diseased may repair. They receive every kind of requisite help gratuitously. Physicians inspect their diseases, and according to their cases order them food and drink, medicine or decoctions, everything in fact that may contribute to their ease.”[50] Unschuld adverts to the lack of normative structures that could have supported a specific social system “may have contributed to the ease with which Buddhist literature fused various secular and pre-Buddhist non-secular systems of Indian medicine into a conglomerate of differing concepts.”[51]
In Europe during the later Middle Ages, “hospital services remained largely traditional and thus custodial: religious ceremonies, rest, warmth, food, and perhaps some medications.”[52]
Comparable developments can be seen in the Indian subcontinent too. The provision of medical facilities was made in the Brahminical religious institutions of Northern India during the early medieval period. King Śrīcandra (c. 925-75 A.D.) of South-East Bengal provided two physicians, though, not for every hospital. It appears that the people “working in the temple of Brahman received their medical aid from these two physicians.”[53] By this shift in providing medical care, two counteracting issues seem to have arisen. First, medical personnel, very often despised by Brahminic culture, begin to be accepted in society. Second, through this adoption, the more secular nature of Buddhist medicine begins to crystallize into orthodox Branminic tradition.[54] Chakravarti and Ray note, “Prior to c. AD 500, most of our references to physicians and healing-houses are located within urban contexts. The physician appearing in a land grant record is often situated in a rural milieu.”[55]
Wujastyk has provided an insightful trajectory of hospitals in India, especially of Bengal and South India.[56] Wujastyk specifically aims at “to bring to the surface and organize important information about hospitals in peninsular South Asia.” Moreover, “We may never get the rich detail of patients’ experiences that fills the pages of Risse’s Mending Bodies, Saving Souls. But we do, at least in the case of Caraka’s Compendium, see into the mind of the physician when he planned his house of healing …”[57]
Wujastyk has also discussed about hospitals of Bengal and Kashmir of the twelfth century. Regarding King Vallāla’s (reign: 1160-1178 AD) hospital, he comments “The hospitals he was proposing to fund were to be substantial (“made of bricks”) and well-equipped and staffed. These institutions seem to be hospitals in a recognizable and formal sense, rather than mere dormitories or religious shelters.”[58] Here the primary shift has occurred from religious shrines to an abode of care and healing.
In his epigraphic studies on South India, Gurumurthy finds that a large number of inscriptions speak of the establishment of dispensaries called as ātulasālai or vaidyasālai in Sanskrit. “Most of them seem to have been manned by a local doctor of hereditary nature, for whose maintenance provision of tax-free land offered to the medical man is called in the records as vaidyakkāni or vaidyavṛtti, kāni or vṛtti meaning share of tax-free land.”[67]
An inscription of the king Vīrājendra, dated in his sixth year (A.D. 1069), is engraved on the east wall of the first prākāra (wall) of the Viṣṇu temple of Veṅkaṭeśa-Perumāl at Tirumukkūḍal in the Madhurantakam taluk (area) of the Chingleput district. The language characters of the inscription belong to the latter half of the eleventh century A.D. There were different types of allocations for maintaining different establishments. The last item of expenditure was for the maintenance of a hospital wherein were treated students living in the hostel, and temple servants that were sick.[68] A clear distinction between a physician (Savarṇan Kodaṇḍarāman Aśvatthāma-Bhaṭṭan) and a surgeon (Calliyakkiriyai Pannuvā) was apparent. The hospital had fifteen beds. Twenty different types of medicines were stored in the hospital. Some of the medicines were of animal origin, most were of vegetable origin. One item seems to be mineral in nature.[69] According to this epigraphic record, the physician in charge of the hospital was paid annually 90 kalam (old South Indian unit of measuring weight which varied from area to area) of paddy and 8 kāśu (equivalent to 30 grains) in addition to a grant of land. Contrarily, the surgeon of the hospital received 30 kalam of paddy. Two persons for fetching medicinal herbs were paid 60 kalam of paddy and 2 kāśu. A barber who performed minor operations in addition to his professional duties received 15 kalam of paddy.[70]
We must note, at least in this case, that the physician was the highest paid, while the surgeon received payment one-third that of the physician, and lower than persons fetching medicinal herbs and equal to that of barbers. If we remember the previous transformation of pañcakarman into an entirely medical practice, stripped out of its surgical content, inferior position of the surgeon in the eleventh century Brahminic temple makes sense to us. It indicates that there was a downhill journey of surgical knowledge and practice in the scholarly tradition of Indian medical practice. We should also remember the status of surgeons in medieval Europe. Moreover, there were provisions for preserving medicine throughout the year – “An amount of 40 kāśu (is provided) for purchasing … and for 1 padakku of bovine ghee required to be kept under the earth annually for Purāṇasarpi.”[71]
The thirteenth-century king Viśeśvara established a monastery. The third share endowed by him “was granted in favour of three different institutions which were a Prasūti-śālā, an Ārogya-śālā and a Vipra-satra. The reference to a Prasūti-śālā, i.e., maternity or lying-in hospital, in a record of the thirteenth century is very interesting.”[72]
The Srirangam inscription, dated Śaka 1415 (1493 A.D.), registers the gift of two veli land (old South Indian unit) made by Śrīnivāsa alias Śrīraṅgam Garuḍavāhana-bhaṭṭa who repaired and renovated the Ārogya-śālā or hospital.[73] An arogyasala or a healing-house explicitly figures in an inscription from Siyan (Birbhum, West Bengal), dated to the reign of the Pala ruler Nayapala (c. AD 1027-43). This inscription speaks of a large Śiva temple within the precincts of which stood this hospital. “Medical facilities were made available for both the religious community and the people in general; it has been argued that the inscription indicated that the physicians lived close to the sacred shrine.”[74]
As for Muslim hospitals during the Mughal period (1526-1857), Speziale comments, “The development of hospitals is among the contributions that Muslim culture brought to Indian society, where hospitals were not extremely common institutions at the time that Muslims arrived.”[75] Unlike numerous hospitals in the Christian world, as Speziale notes, hospitals in Muslim cities were not “founded or directed by religious in particular”.[76] For example, under Śīr Śāh Sūrī (r. 1540-1545), separate services for Hindus were introduced in caravansaries established along Indian roads and financed by the state.[77] Two Āyurvedic physicians, whose stipends were paid by the government, “worked at the dār al-śifa of the Śāh Wajīh al-Dīn (d. 1589) shrine in Ahmedabad.”[78] During the reign of Muhammad bin Tughluq (reign 1325-52), “there were around 70 hospitals in Delhi, while 1,200 hakims found employment through the state.”[79] From the book Sirat-e-Fiuz Shahi, it appears that Muhammad bin Tughluq “had established mobile as well as fixed hospitals and appointed competent physicians for each of them.”[80] “Many hospitals devoted to the service of the sick were established in the capital and the outlying cities during the reign of Aurangzeb.”[81] In Bengal, people came to Pandua from all over Hindustan to receive spiritual training under the sage Nur Qutb al-Alam. He maintained a college, hospital and a langar.[82] Ala al-Din Husayn Shah (1493-1519) made land grants to this college and hospital.
The Bahamani king Alā-ud-Dīn Shāh, the eldest son of Ahmed Shāh al-Walī, built a large hospital at Bidar of South India and endowed lands from the income of which medicine, food, and drink were provided for the sick. He also appointed physicians, both Hindu and Muslim, to treat the patients.[83] It is a sign of accommodating different systems of thought in the operation of the state. During the transition period from Buddhism to Brahminism, as we have seen, similar measures were adopted.
Mahomed Quli built a large hospital Dar-us-Shifa sometime around 1595, now used to accommodate the Hyderabad Municipality offices. The building is a square of 175×175 feet. The hospital was meant to serve the people. The medicines and food to the patients were given free. All the leading Hakeems of the Qutb Shahi period worked in this hospital.[84]
Transition Times: European Hospitals in India
Since most of Asia’s fundamental tools and mathematical conceptions were familiar to Europe before 1500, the Europeans of the sixteenth century and beyond concentrated upon products rather than devices or ideas.[85] 1735 in more than one ways is a watershed in the history of European scientific attitude. One was the publication of Carl Linnaeus’s Systema Naturae (The System of Nature). In this work, the Swedish naturalist laid out a classificatory designed to categorize all plant forms on the planet, known or unknown to Europeans. The other was the launching of Europe’s first major international scientific expedition, a joint effort intended to determine one and for all the exact shape of the earth.[86] In India, at this early colonial moment, the British grouped indigenous medicine with literature and the arts “considering it to be a part of local tradition distinct from universal science.”[87] It is consistent with the evolution of the concept and meaning of science in Europe. Science came into English in C14. It became more generally used, often interchangeably with art. “But from mC17 certain changes became evident. In particular there was the distinction from art.”[88] The practice of what we would now call experimental science, and indeed of what is now called, retrospectively, the scientific revolution, had been growing remarkably since mC17.[89] Calcutta Review commented, “the great mass of the Hindus are apparently now what the Europeans were three centuries before the Christian era.”[90] W. W. Bird somewhat jubilantly noted, “The Natives have an idea that we have gained everything by our superior knowledge … and they want to put themselves as much as they can upon an equality with us.”[91]
Francois Payrard, a seventeenth-century French traveller, found the Portuguese hospital (most likely dating from 1546) at Goa to be “finest in the world”. In his experience, “Nothing is done until the physician, surgeon, or apothecary has seen them and certifies that they are sick, and of what ailment, that so they be placed in the proper part of the building.”[92] In the hospital “the great care taken of the sick, and the supply of all comforts that can be wished for, whether in regard to doctors, drugs, and appliances for restoring health, the food is given to eat, or the spiritual consolation that is obtainable at any hour.”[93] The physician’s job was clearly defined, but not that of the surgeon. [94]
In India, Calcutta and Madras were the two cities where military establishments focused on hospital practice. There was visible drive for producing native doctors to reduce the burden of the Company’s exchequer.[95] As early as 1707, in Calcutta, hospitals were built “to keep the men in Health.”[96] One of the reports read, “Having abundance of our Soldiers and Seamen Yearly Sick and this year more particularly our Soldiers, and the Doctors representing to us, that for want of an Hospitall or Convenient Lodging for them is mostly the occasion of their Sickness, and Such a place as the Companys Charterparty Shipping to keep the men in health.”[97] By 1762 the East India Company’s Bengal army employed nineteen native doctors.[98] In January 1764, the Bengal Medical Service was founded. In Madras, similar developments took place. The surgeons were attempting to establish the city as an important site of medical research and treatment. “The hospital had in fact emerged as a valuable training ground for young medical professionals: by 1772, it was training Europeans, Eurasians, and Tamils in allopathic methods of diagnosis and treatment, and the preparation of medicines.”[99] The Madras system was actually lacking the orientation of simultaneous development of dexterity in both surgery and medicine, as demanded by the new medicine. It was content with producing dressers from the half-castes of the army. “But let not these be confounded with the native surgeons who were attached to our army” – was the cautionary note.[100]
In his important study, Harrison traces the dissection-based clinical practice in the East India Company’s medical service, which became one of the key factors in the development of hospital medicine in India. In his opinion, “developments within the armed forces prefigured those normally associated with the ‘birth’ of clinico-anatomical medicine at the Paris hospitals in the 1790s.”[101] He also notes that certain other features of “hospital medicine” are also evident in the Company’s service – “systematic bedside observation, the statistical analysis of cases, and the testing of what were presumed to be economical mass remedies.”[102] Focusing on a prerequisite of hospital medicine, he argues, “In Britain, the supply of bodies for dissection was still severely restricted, but there were no such constraints in the colonies, where cadavers were plentiful.”[103] As a result, practitioners working in the colonial hospitals were “able to compare post-mortem findings with the symptoms of disease in living patients, giving rise to a system of medicine not unlike that which later developed in revolutionary Paris.”[104] Along with this, there was the growing awareness that “men had economic value – and the articulation of this in systems of military accounting – provided a powerful stimulus to the improvement of medical provisions in foreign stations and other measures to conserve manpower.”[105] The hospitals of three presidencies – Calcutta, Madras, and Bombay – were “capable of providing the kind of environment that was conducive to medical innovation.”[106]
Indian Scenario: Prelude to Hospital Medicine
Since the 18th century, European hospitals became medicalized institutions. Risse argues, “In the controlled ward environments, substantial numbers of inmates, alive and dead, were selected for systematic study, classification, and dissection. Most remarkable were the implications of accurately mapping the sick body with the new techniques of physical examination.”[107] A newly conceptualized medicine started at death, when the bedside-practitioner gave up and the scientist-practitioner took over – and these were the same person.[108] Such was the situation in Europe, when hospital medicine came to reign in India.
E. E. Conwell, a staff surgeon of the East India Company, Madras, was possibly the first person to submit the cases he studied and his notes on the stethoscope to judgments of his colleagues in India in 1827. In his own words, “By submitting to the Profession generally, detailed statements of pulmonary diseases in India; I fulfil (sic) my promise to that effect, made at the request of my excellent and learned master M. Laennec, of Paris”[109] He had reported 25 autopsies in his book out of which 23 cases were native.
In the late eighteenth-century Madras hospital training, the use of stethoscope (invented by Laennec in 1816) was inconceivable. Following the foundation of the Native Medical Institution (NMI, 1822-1835) in 1822, in Calcutta, for the instruction of native students in European medicine through vernacular, this new diagnostic technique became popular among the Company’s surgeons and Indian doctors. As we shall shortly see, the NMI students had their hospital exposure and clinical rounds at the different hospitals and dispensaries in Calcutta. They even for the first time began to take case histories of individual patients. They used to see “bringing the ear close to the mouth or chest (auscultation) of the patient, or on applying the hand over the latter (palpation), as recommended for percussion.”[110] Adam noted, “The stethoscope, I have not had recourse to; but it is obviously an instrument well adapted to the diseases of the chest in children; and I have no doubt, if brought into more general use, it would found often materially to assist our diagnosis.”[111] So the stethoscope was an instrument in use in Calcutta.
John Gilchrist and others opined, “the Madras government had sent a particular class of individuals, the sons of soldiers – a sort of half-castes – to be educated at the hospitals as sub-assistant surgeons.”[112] He also argued, “As to the Madras establishment, and the way in which the pupils were there instructed, it had not the smallest analogy to the medical school for native doctors. Every regiment had three or four native doctors attached to it.”[113] Instead of Madras half-castes as dressers in a regiment, native doctors acted almost like a European doctor. “In May 1825, the Medical Board submitted a report, explaining the reasons why it appeared inadvisable to adopt the Madras system of employing as doctors those who served as dressers in the hospitals, and also explaining satisfactorily both to the Government and to the Court the superior usefulness and success of the school for native doctors, as it had been established, and was then conducted, in Calcutta.”[114]
For the purpose of acquiring practical knowledge of modern medicine like pharmacy, surgery, and physic, the pupils of NMI, which lasted for about 14 years, were attached to the Presidency General Hospital, the King’s Hospital, the Native Hospital, and the Dispensary. “Eight of the pupils who had been educated in this seminary were appointed native doctors, and sent with the troops serving in Arracan.”[115] It was widely accepted that “the British government could not have established an institution calculated to be of greater benefit … than the Native Medical Institution.”[116] Several of the students of NMI were employed “as Native Doctors to corps as well as in the two Dispensaries … for the purpose of affording relief to the Native Officers in Government, and to such of the Natives as have not means to otherwise procuring medical aid.”[117]
Though a new kind of secular medicine was in the making, it had to accommodate specific socio-economic, political and military exigencies of the colony, which threatened the secular matrix of modern medicine – “Hindoos and Mussulmans were equally eligible, if respectable; the sons of native doctors in the service to be preferred.”[118]
In 1825, during the prevalence of cholera in Calcutta, the pupils of this institution “were most usefully employed distributing medicines in different thanah, stations, and in affording to the wretched and numerous victims of the disease, every assistance in the power of European art to bestow.”[119] Besides ramifying the primordial tentacles of public health in India, the NMI did another important job for military service, which became more conspicuous after its abolition, “The body of servants was much needed, as the requisite supply of these subordinates has entirely ceased since the abolition of Dr. Tytler’s Native Medical School, and the demand for their services, in the Native Regiments especially, has become very urgent.”[120] Actually, the school was established “to afford the civil and military branches of the service a class of native doctors superior to those who were then employed.”[121] The differentiating feature between the NMI and the CMC was the practice of cadaveric dissection in the latter. Unlike Tytler’s NMI, in CMC “the subjects are taught practically, by the aid of the Dissecting Room, Laboratory, and Hospital.”[122] Besides this, the new techniques of investigations like thermometer and stethoscope and new modes of physical examination like inspection, palpation, percussion and auscultation, as discussed above, were introduced in these institutions.
Importantly, the brief phase of the NMI and medical classes at the Calcutta Sanskrit College can be regarded as the period of the gestation of hospital medicine. It was important in another aspect. “The pupils of the Native Medical Institution … keep a case-book of the symptoms and treatment of the sick on the establishment.”[123] This was for the first time in India that students were inducted in individual case-history taking, which was hitherto unknown to them. To note, the conceptual basis of the clinical case is the ordering of its facts by the agency of time. Its material dimension is the transcription of this evidence in written form, thereafter abstracted as a medical record of observed events. The introduction of time as ordering variable in the construction of clinical cases was completely new in Indian practice. Seasonal time began to transform into clinical time.
In 1826, Dr. John Tytler, then Superintendent of the NMI, began his lecture according to Western method at the Calcutta Sanskrit College on Medicine, and “Professors were appointed to teach Caraka, Suśruta, Bhāva Prakāśa, etc. Classes for the Āyurvedic students were opened in 1827.”[124] Tytler organized his classes around four major departments of medical science, viz Anatomy, Pharmacy, Medicine and Surgery.[125] A medical and an English class had been formed.
The report of 1828 stated that the progress of the students of the medical classes had been satisfactory “in the study of medicine and anatomy; and particularly that the students had learned to handle human bones without apparent repugnance, and had assisted in the dissection of other animals.”[126] They also “performed the dissection of the softer parts of animals”, and “opened little abscesses and dressing sores and cuts.”[127] Trevelyan wrote, “The systems of Galen and Hippocrates, and of the Shasters, with the addition of a few scraps of European medical science, was (sic) taught in classes … to the Arabic and Sanskrit colleges at Calcutta.”[128] Alavi notes that many times, passages from medical journals were read out to them. The native doctors “noted this medical knowledge with a piece of chalk on the floor, at the foot of the patient’s bed.”[129] Tytler’s anatomy classes at the Sanskrit College were a great success and “the governor general appreciated his efforts to initiate high-caste students towards knowing body anatomy and, in some cases, performing dissections on animals. He hoped that Tytler’s students would finalize their training in anatomy at the NMI of Surgeon Breton.”[130] Another example of this spirit was exhibited by Durshan Lall, a Hindu pupil of Tyler, who brought Tytler a skull picked up by his friend in the banks of the river.[131]
Tytler’s training of surgery in some way reminds us of the teachings of Suśruta where preliminary surgical practices were done on soft parts of dead animals or fruits and vegetables. Suśruta’s anatomy, learnt by the Ayurvedic students, was reconstituted into modern anatomical knowledge. Tytler had done translations of two chapters “of the First Part of the Soosroota.”[132] According to Sen, “This could probably be the earliest translation of part of the Suśruta Saṃhitā”.[133]
Earlier, in a letter of 18 August 1824 (signed by Harrington, Larkins, Martin, Sutherland, Shakespeare, Mackenzie, Wilson, Stirling and Bayley), it was observed, “In proposing the improvement of men’s minds, it is first necessary to secure their conviction that their improvement is desirable.” Apprehension was evident in the observation too, “both the learned and unlearned classes … generally speaking, they continue to hold European literature and science in very slight estimation.” To overcome this obstacle with any good effect it was stressed to qualify the same individuals highly in their own system “as well as ours, in order that they may be as competent to refute error as to impart truth, if we would wish them to exercise any influence upon the minds of their countrymen.” [134]
In Fisher’s memoir, “The report of 1829 states that 300 rupees per month had been assigned for the establishment of a hospital in the vicinity of the college.”[135] Though curricula were in accordance with Sanskrit medical works, a hospital of some kind was thought absolutely necessary for proper medical teaching. “There is now every reason that medical education in India will be improved in a very material degree by this institution.”[136] So, for “affording to the medical pupils ample opportunities of studying diseases in the living subject”, the hospital was established.[137] One graduate, N. K. Gupta, who had been trained as an apothecary, was apparently doing quite well in the position at the hospital. “Though no Hindu had yet performed a major operation, they regularly performed minor ones such as “opening little abscesses and dressing sores and cut”.”[138] Return of the Hospital attached to the Sanskrit College for the year 1832 shows that out 94 House Patients 84 were discharged and six died.[139] Mr. Wilson, who examined the medical class, was ecstatic about “the triumph gained over native prejudices is nowhere more remarkable than in this class”, where “not only are the bones of the human skeleton handled without reluctance, but in some instances dissections of the soft parts of animals performed by the students themselves.”[140] The great end was not to teach any religious learning but useful learning which was gestating the new epistemology of hospital medicine. The English class in the Sanskrit College was eventually abolished in 1835. Interestingly, “this decision was hailed by a section of conservative diehards.”[141] It is understandable that there occurred a change in sign system. The essence of the Sanskrit texts was metonymically reconstituted to suit the purpose of modern medicine. An insidious reconstruction of indigenous cognitive world began its full-fledged operation.
Hooper’s Anatomist’s Vademecum was translated into Sanskrit as Śārīra Vidyā (“Science of Things Relating to the Body”) by Madhusudan Gupta, for which he was paid a sum of 1000 rupees. “It was intended to convey to the medical pandits throughout India, who are an exclusive caste of hereditary monopolists in their profession, and all study their art in Sanskrit, a more correct notion of human Anatomy.”[142] Originally, the Śārīra Vidyā was destined to become a class-book in the medical branch of the Sanskrit College, “but that class had since been abolished, and the teaching of the medical art limited exclusively to English.”[143] The metonymic reconfiguration of indigenous anatomical knowledge into modern anatomical knowledge was set into action. “Once placed in a Sanskrit dress, the European system of anatomy would be accessible all over India for subsequent transfer into Hindi dialects of every province if requisite, and it was no trivial argument that the same work had been already printed in Arabic, and thus made available for the Musalman practitioners and for translation into Urdu when called for.”[144] Through this process Sanskrit terms lost their original polysemous nature, and were reconstituted as replica of modern scientific vocabulary.
Prior to the CMC, the NMI and medical classes at the Calcutta Sanskrit College and Madrasa were the conduits through which the new kind of anatomical knowledge could be taught to the students. Before reaching the goal of anatomical dissection preparatory psychological nurturing was done through introduction to zootomy of lower animals like goat and ship, and handing of bones and skeletons.
CMC: The Rise of Hospital Medicine in India
By an order of January 28 1835, the Medical College, Bengal was established. The original order had 34 clauses. Since its inception, under the guidance of Dr. M. J. Bramley, the first principal of CMC, there appears a visible trend in the activities of CMC to introduce basic sciences to its students. During the second year, 1836-37, courses taught at the college were – (a) Practice of Physic by Dr. Goodeve, (b) Elements of Surgery by Dr. Eggerton, (c) Chemistry and Pharmacy by Dr. W. B. O’Shaughnessy, and (d) Introduction to Botany by Dr. Wallich. The third year’s study (1837-38) comprised (a) Anatomy and Physiology by Dr. Gooedeve, (b) Demonstrations and Dissections by Dr. R. O’Shaughnessy, (c) Natural Philosophy and Steam Engine by Dr. W. B. O’Shaughnessy, (d) Structural Botany by Dr. Wallich, (e) Operative Surgery by Dr. Eggerton, (f) Materia Medica by Dr. W. B. O’Shaughnessy, (g) Practice of Physic by Dr. Gooedeve, (h) Elementary Surgery by Dr. Eggerton, and (i) clinical practice in a small hospital attached to the college.[145] Each candidate attended three courses of anatomy and physiology, two of actual dissection, three of chemistry, one of natural philosophy, two of materia medica, two of general and medical botany, two of practice of physic, two of the principles of and practice of surgery and one of operative surgery. In CMC, the most eminent medical officers in the Indian Medical Service were placed in the professors’ chairs. A library, dissecting rooms and a museum were established. “Efforts were made to procure every appliance necessary to place it on the same footing of efficiency as European colleges was (sic) furnished with a bountiful hand.”[146] The twelfth annual report CMC, for the session 1847-48, stated, “There is no institution, connected with the physical or material welfare of the people of this land, whose success we have viewed with more unfeigned satisfaction, than the Medical College of Bengal.”[147]
At its initial phase, CMC had created a space for the nurture of original, theoretical, and innovative scientific thinking. Unfortunately, it did not germinate. At a time when a chemical laboratory in an American medical school was rare, O’Shaughnessy started his chemistry and botany courses with lectures and “laboratory work was the equal of any in a European medical institution.”[148] Gorman notes, “Most importantly, the students were just as capable and enthusiastic about chemistry as they were about anatomy, and the testimony of outside examiners gives ample proof as to the rigor of the examinations.”[149] O’Shaughnessy proposed to construct, at CMC, a galvanic battery of one thousand cups, on Mullin’s principle “for the purpose of exhibiting the extraordinary experiments recently described by Mr. Crosse and others, and for carrying original researches in electro-magnetism and galvanism.”[150] He even undertook to conduct the “application of galvanism” in case of aneurism.[151] He was also a pioneer of intravenous fluid transfusion for cholera patients.[152] In Calcutta, Dr. Duncan Stewart half-heartedly tried it for cholera patients, but without any results.[153] Bramley’s premature death as well as O’Shaughnessy’s dissociation with CMC seems to put an end to such initiatives at CMC.
In 1839, 70 patients, both European and Indian, suffering from medical and surgical diseases were under treatment at CMC, and the outdoor dispensary attended to 200 patients daily. A few years later, Dr. Mackinnon commented, “Post Mortem examinations were performed by each of the students in my presence and they wrote descriptions of the result” in which “they all evinced practical knowledge … and an acquaintance with the healthy and morbid appearances of the different structures and organs.”[154]
This knowledge was well expressed in a case when “Ramnarain Doss, a student of the Medical College” saved the life of a native youth “who had, by fall, received a severe concussion of the brain.”[155] In 1845, CMC made a great advance, in remodeling its system of instruction “so as to bring it within the regulations of the Royal College of Surgeons in England, and of the Apothecaries Society of London” so that “the Institution may be duly registered and recognized’ in England.”[156]
Notably, within a few months of the discovery of chloroform in 1847 “ether and chloroform” were applied in surgery in CMC.[157] As a result, it was remarkable that among the prominent points of interest were “the extraordinary success among the graduates of the College in the performance of the formidable operation of lithotomy, and the valuable results which had followed the introduction of chloroform into the practice of surgery.”[158] The graduates coming out of CMC served four important purposes. First, it reduced economic expenditure of the Company as “appointing a Sub-Assistant Surgeon to each Native regiment will cost 1,02,000 Rupees a year, whilst their recommendation of a third Native Doctor, will only cost 25,500 Rupees a year.”[159] Second, specifically, their knowledge of stethoscope, microscope and pathological anatomy made them at par with European surgeons. Third, their example set the stage for a veritable flood of Indian students to England for study in all fields, a movement which continues to this day. “The British had invaded and conquered India politically and geographically, but now the Indians had done so in England academically.”[160] Fourth, it met the “wants of the whole northern India by supplying sub-assistant surgeons and native doctors for civil duties and by training medical subordinates for the army.”[161] W. H. Sykes provided reports of 94, 618 patients who were relieved in the Charitable Dispensaries of India in 1847.[162] All these facts make us believe that CMC and the extension of modern medicine and its ideology through dispensaries into all the corners of Indian society increasingly provided medical and surgical benefit to the people. Initial resistance to hospitalization gradually began to wane.
Mukharji deals with the question of dispensaries in the nineteenth and twentieth century. The government charitable dispensaries had been in existence since the eighteenth century, but their numbers grew rapidly in the nineteenth century. “By the end of the nineteenth century, Sir Henry Burdett described ‘the dispensary system’ as the truly original institutional innovation of British India. The increasing numbers of these dispensaries allowed a degree of autonomy to the Bengali Sub-Assistant Surgeons, who often held de facto charge of these dispensaries.”[163] The number of dispensaries increased from 6 in 1842 to 471 in 1917. In the 1840s, majority of the medical officers in Bengal were Indians. Some of them mixed some form of Āyurvedic with European medicine. In the 1870s, many sub-assistant surgeons were graduates from CMC, and of their apprentices became agents for the further dissemination of Anglo-Indian medicine.[164] The dispensary importantly served as a sort of hospital, basically differing in its character that the patient and his disease could not be put under surveillance in the dispensary.
The foundation of CMC and its subsequent developments became a tool for rewriting a new history of India too – “the seeds of knowledge we have thus sown fructify to a general and luxuriant harvest, that we shall have left a monument with which those of Ashoka, Chundra Goopta, or Shah Jehan, or any Indian potentate sink into insignificance; and their names will fall on men’s ear unheeded, while those of Auckland, as protector, and of Goodeve, Mouat, and others, as zealous promoter of scientific Native medical education shall remain embalmed in the memory of a grateful Indian posterity.”[165] In the ladder of civilization Calcutta came closer to London as hundreds of dead bodies “are daily dissected in London and Calcutta, and new discoveries are being made … bodies are dissected and practical anatomy taught to the pupils…’’[166] Through the production of generations of students and reaching out to population at large, CMC etched out its lasting, maybe indelible, existence on Indian society. But it did not arise out of historical developments in Indian society, it was rather implanted on India.
For 1835, Bayly provides “figures of about 1.5 physicians per hundred of the population in Jodhpur and one to every hundred people in Jaipur.”[167] In the following years, Āyurvedic and Unani practitioners faced unprecedented encroachment from modern medicine. Āyurvedics, on their behalf, were caught within a two-edged sword. On the one hand, they were traditionally more concerned with prognosis and they could do it well without anatomical knowledge. On the other, especially after the foundation of CMC, if Āyurveda was to be established as a valid and eternal modern repository of knowledge of the body and medicine, learning modern anatomy became mandatory. The traditional practice of Āyurvedics “was challenged with introduction of modern anatomy and medicine … Rather than raise the standards of Āyurvedic practice, these institutions (modern Āyurvedic institutions) reduced the Kavirāja to a simple medicine-man who lacked specialized knowledge of either Āyurveda or allopathy.”[168]
Wujastyk and Smith argue, “One step toward a modernized Ayurveda therefore was a break with the educational tradition of pupillage and a compensatory movement toward an expanded college system. This proved to be the only way to keep up with the growing number of graduates and license holders that the modern medical colleges were producing.”[169] Sivaramakrishnan emphasizes, “Ayurvedic learning was now rationalized as an indigenous, rational critical science that was ‘different’ owing to the Hindu religious intellectual tradition from which it originated.”[170] This ancient, intellectual past, and its sacred and scientific tradition of Āyurveda as Hindu science “therefore offered the possibility, in its revival, of addressing the claims of a Hindu Identity.”[171] Āyurvedics also felt the need to differentiate themselves from Unani practitioners. Banerjee sees these medical developments “coeval with those taking place in Britain at this time – the rejection of the humoral basis of medical practice that existed there and the triumph of clinical medicine.”[172] In her opinion, one of the implications of these processes leading to the marginalization of Āyurveda was “to explore some other space … and this proved to be the market.”[173] They became gradually engaged in a battle for market too.
Conclusion
Arnold observes, “Nor was India completely converted to allopathy. Even in the 1920s and 1930s there remained a far larger number of practitioners of the “traditional” systems of Indian medicine (principally Ayurveda and Unani) than of western medicine.”[174] Arnold further observes that the Bhore Committee in 1946 influentially endorsed the primacy of modern medicine within a system of de-facto pluralism. “The Bhore Committee presented a Beveridge-style blueprint that no colonial government of India would ever have put into practice. Its ambitious and idealistic public-health programme could only begin to be realised under an independent regime. Western medicine was never so powerful in India as when it shed its colonial identity.”[175] The arrival of hospital medicine and its successful functioning through hospitals and dispensaries generated the importance of clinical teaching, individual case history and pathological anatomy. In tandem, “no doubt influenced by European medicine have the Ayurvedics been concerned with indicating physiological phenomena cartographically … the appearance of treatises of anatomy written in Sanskrit and even in verse by eminent pundits.”[176] They copied the anatomical diagrams to be found in English hand-books, replacing the English captions with Sanskrit names.
Aspiring to talk in the language of modernity, in mimicry of English medical college and hospitals, Āyurvedic institutions began to emerge since the late nineteenth century. In these institutions, old humoral and macrocosmic-microcosmic understanding of the body had little role to play. It was reshaped in the fabric of modern medicine. Most eminent kabirajes (Āyurvedic practitioners) of Calcutta sent their sons to the CMC for anatomical learning, while they were studying Āyurveda.[177] In 1943, it was estimated that within a span of 25 years 4 big Āyurvedic college and hospitals were established in Bengal alone. At the same period, Dr. Popat Prabhuram and Vaidyaratna Gapalacharyulu established Āyurvedic colleges in Bombay and Madras respectively. In 1926, while proposing for a new “amalgamated” Āyurvedic college and hospital, Mukhopadhyaya noted, “No medical institution is complete without hospitals. A complete knowledge of disease can only be acquired in the wards of a hospital.”[178] Interestingly, two fundamental components of Āyurvedic learning – gurukul tradition and attending a patient at his domestic setting – were completely reconstituted in the aftermath of the new medicine. Āyurveda itself became “hospitalized”.
In May 1835 with their Urdu medical texts firmly in place, they “left the presidency in boats hired at their own expense under the acre of the native assistant teacher Shaikh Waris Ali and Hira Lall.” As the students of the NMI and its staffers dispersed into the qasbas and towns of the North India Country side, so did their new ideas and texts. In the period of high nationalism, such plural medical culture added fuel to the nationalist spirit.[179]
Old and wise Suśruta was all set to get admission into the new “constructive ingenuity” of the new Medical College. His anatomical tool transformed from grass and bamboo to scalpel. This Suśruta has been explored, assayed, assimilated, reified, and, finally, cast into the guise of post-renaissance, post-Vesalian and post-Harverian anatomy. Here remains no avagharṣaṇa (scraping away), only scalpel; no subjectivity, only objectified patient; no ailing person awaiting a healer, but diseased patient and a particular case who happens to be some conglomerations of anatomo-pathological and biochemical markers. Moreover, as noted by Carlyle[180], instead of “in kind” payment “Cash Payment” became the treibende Kraft. Hunterian “necessary inhumanity” became the clarion call of the day.
Dead teach the living!
And CMC played its historical role in the entire process. Hospitals, through their epistemological mutation and transformations, ushered in the era of hospital medicine in India, and marginalization of traditional medicine and the reconstiution of Indian subjectivity as well.
________________________
[1] Joseph Leidy, Lecture Introductory to the Course on Anatomy in the University of Pennsylvania for the Session 1858-59, Philadelphia, 1859, p. 7. (Quoted in Michael Sappol, A Traffic of Dead Bodies: Anatomy and Embodied Social Identity in Nineteenth-Century America, (Princeton and Oxford: Princeton University Press, 2002), 53.
[2] Agniveśa’s Caraka Samhitā (Text with English Translation & Critical Exposition Based on Cakrapāni Datta’s Āyurveda Dīpikā), Ram Karan Sharma and Bhagwan Dash (trns.), (Varanasi: Chaukhamba Sanskrit Series Office, 1977), 426. [Hereafter CS]
[3] Editorial, “Looking Back on the Millennium in Medicine”, New England Journal of Medicine, 342.1 (January 6, 2000:42-49.
[4] Gray’s Anatomy, 38th edn., Lawrence H. Bannister et al (ed.) (Edinburgh and London: Churchill Livingstone, 1995), 2 [Emphasis added]
[5] Henry E. Sigerist, The Great Doctors: A Biographical History of Medicine (New York, Doubleday, 1912), 15.
[6] John Abernethy, An Enquiry into the Probability and Rationality of Mr. Hunter’s Theory of Life; Being the Subject of the First Two Anatomical Lectures Delivered before the Royal College of Surgeons, of London (London: Longman, Hurst, Rees, 1814), 9. [Emphasis added]
[7] Ibid., 15.
[8] Ibid., 17.
[9] Oswei Temkin, “The Role of Surgery in the Rise of Modern Medical Thought”, in The Double Head of Janus and Other Essays in the History of Medicine (Baltimore, Maryland: Johns Hopkins University Press, 1977), 487-496.
[10] Ibid., 496.
[11] James Long, ed. Selections from Unpublished Records of Government for the Years 1748 to 1767 Inclusive, vol. I (Calcutta: Office of the Superintendent of Government Press, 1869), 243.
[12] Ibid.
[13] John Martin Honigberger, Thirty-Five Years in the East. Adventures, Discoveries, Experiments, and Historical Sketches, Relating to the Punjab and Cashmere; in Connection with Medicine, Botany, Pharmacy, &c. (London: H. Bailliere, 1852), 49-50.
[14] C. A. Bayly, Empire and Information: Intelligence gathering and social communication in India, 1780-1870 (New Delhi: Cambridge University Press, 2007), 281.
[15] Francis Balfour, A Collection of the Treatises on the Effects of Sol-Lunar Influence in Fevers; with an Improved Method of Curing Them (London: Cupar, 1815, 3rd edn).
[16] Asiatic Journal and Monthly Register (New Series) XXVII (November 1838): 162.
[17] Surendranath Dsagupta, A History of Indian Philosophy, Vol. II (Delhi: Motilal Banarsidass, 1991), 433.
[18] Zimmermann, The Conception of the Body in Ayurvedic Medicine, Ecole des Hautes Etudes en Sciences Sociales: http://philosophindia.fr/india/index.php?id=35 [ Accessed 6 August 2006]
[19] Charles Scudamore, Observations on Mr. Laennec’s Method of Forming a Diagnosis of the Diseases of the Chest by Means of the Stethoscope, and of Percussion; and upon Some Points of the French Practice of Medicine (London: Longman, Rees, Orme, Brown, and Green, 1826), 12.
[20] Ibid..
[21] Ibid, 14.
[22] Malcom Nicolson, ‘The Art of Diagnosis: Medicine and the Five Senses’ in W. F. Bynum and Roy Porter (eds.), Companion Encyclopedia of the History of Medicine, Vol. II (London, New York: Routledge, 1993), 816.
[23] Jayanta Bhattacharya, ‘The Body: Epistemological Encounters in Colonial India’ in Peter L. Twohig and Vera Kalitzkas (eds.), Making Sense of Health, Illness and Disease (Amsterdam, New York: Rodopi, 2004), 31-54.
[24] Asiatic Journal and Monthly Register, Vol. XXII (July-December 1826): 113.
[25] Mark Harrison, Climates and Constitutions: Health, Race, Environment and British Imperialism in India 1600-1850 (Delhi: Oxford University Press, 1999), p. 127.
[26] W. J. Moore, Health in the Tropics or Sanitary Art Applied to Europeans in India (London: John Churchill, 1862), 6.
[27] Jayanta Bhattacharya (2008), Encounters in Anatomical Knowledge: East and West, Indian Journal of History of Science 43(2): 163-209 (165).
[28] Oriental Herald and Journal of General Literature, Vol. X (July-September, 1826): 25.
[29] For a thorough understanding of these sea changes and the rise of hospital medicine in India see, Jayanta Bhattacharya, “The genesis of hospital medicine in India: The Calcutta Medical College (CMC) and the emergence of new medical cosmology”, Indian Economic and Social History Review 51.2 (2014): 231-264.
[30] Rahul P. Das, “The Development of Traditional South Asian Medicine against the Background of the ‘Magical’ Mode of Looking at the World”, Traditional South Asian Medicine 7 (2003): 29-54 (32).
[31] W. F. Bynum et al, The Western Medical Tradition 1800 to 2000 (New York: Cambridge University Press, 2006), 1.
[32] G. Jan Meulenbeld, A History of Indian Medical Literature (hereafter HIML), IA (Groningen: Egbert Forsten, 1999), 17.
[33] Dominik Wujastyk, The Roots of Ayurveda: Selections from Sanskrit Medical Writings (New Delhi: Penguin Books, 2003), 36.
[34] Meulenbeld, HIML, IB, 19.
[35] Harrison’s Principles of Internal Medicine, eds, Dan L. Longo et al, vol. I, 18th edn (New York, Chicago: McGraw Hill, 2012), 6.
[36] John Henderson, Pergerine Horden and Alessandro Pastore, ‘Introduction. The World of Hospital: Comparisons and Continuities’, in John Henderson, Peregerine Horden and Alessandro Pastore, eds, The Impact of Hospitals, 300–2000 (Oxford: Peter Lang Publishing Group, 2007), 18.
[37] Guenter B. Risse, Mending Bodies, Saving Souls: A History of Hospitals (New York, Oxford: Oxford University Press, 1999), 9.
[38] Wujastyk, Roots, 4.
[39] Meulenbeld, HIML, IA, 114. References to a king, certain types of officials, and of hospital, together with signs show that the central administration of the state was growing weak. It points to the fact that CS “belongs to the Mauryan empire or the period of Śuṅgas.” (Ibid. 112)
[40] CS, trans., P. V. Sharma, vol. I (Varanasi: Chaukhamba Orientalia, 2010), 105.
[41] HIML, IA, 17.
[42] Dominik Wujastyk, “The Nurses should be able to Sing and Play Instruments”: The Evidence for Early Hospitals in South Asia, accessed 12 June, 2012, http://univie.academia.edu/DominikWujastyk/Talks.
[43] Francis Zimmermann, “Terminological Problems in the Process of Editing and Translating Sanskrit Medical Texts”, in Approaches to Traditional Chinese Medical Literature, Paul U. Unschuld, ed., (Doerdrecht, Boston: Kluwer Academic Publishers, 1989), 141-151, 149.
[44] Kenneth G. Zysk, Asceticism and Healing in Ancient India: Medicine in the Buddhist Monastery (Delhi: Motilal Banarsidass, 2000), 44. Hereafter Motilal Banarsidass as MLBD.
[45] Ibid.
[46] Ibid.
[47] Ibid., 46.
[48] Ibid., 44.
[49] Si-Yu-Ki: Buddhist Records of the Western World, trans. Samuel Beal, vol. I (London: Trubner & Co., 1884), 214. The text may otherwise be read as “doctor’s medicines” or “physicians and medicines”. In Li Ronxi’s recent translation, The Great Tang Dynasty Record of the Western Regions (Berkeley: Numata Center for Buddhist Translation and Research, 1996) the description is somewhat different – “In this country there were formerly many alms houses to render help to the poor and needy, or give them free food and medicine, and provide travelers with meals so that they might dispel their fatigue.” (p. 113)
[50] Si-Yu-Ki, lvii.
[51] Paul U. Unschuld, Medicine in China: A History of Ideas (Berkeley, Los Angeles: University of California Press, 1985), 138.
[52] Ibid., 155.
[53] D. C. Sircar, Studies in the Religious Life of Ancient and Medieval India (Delhi: MLBD, 1971), 163.
[54] For transformation of the nature of medical profession, see, Debiprasad Chattoapadhyaya, Science and Society in Ancient India (Calcutta: Research India Publications, 1977).
[55] Ranabir Chakravarti and Krishnendu Ray, Healing and Healers Inscribed: Epigraphic Bearing on Healing-Houses in Early India (Kolkata: Institute of Development Studies Kolkata, 2011), 20.
[56] Wujastyk, “The Nurses”.
[57] Ibid., 29.
[58] Ibid., 26.
[59] P. V. Kane, History of Dharmaśāstra, vol. II, part II (Poona: Bhandarkar Oriental Research Institute, 1941), 885.
[60] Narayan Ganesh Chandavarkar, The Heart of Hinduism (Bombay, Calcutta: The “Times of India” Offices, 1912), 25.
[61] Girindranath Mukhopadhyaya, The Surgical Instruments of the Hindus, with A Comparative Study of the Surgical Instruments of the Greek, Roman, Arab and the Modern European Surgeons, vol. I (Calcutta: Calcutta University, 1913, 52-54.
[62] A. F. Rudolf Hoernle, Studies in the Medicine of Ancient India (New Delhi: Concept Publishing Company, 1994), 46, 197-200.
[63] Pratik Chakrabarti, “Science, nationalism, and colonial contestations: P. C. Ray and his Hindu Chemistry”, Indian Economic and Social History Review 37 (2000): 185-213 (212).
[64] Kane, Dharmaśāstra, vol. 5, pt. 1, 1st edn (Poona: Bhandarkar Oriental Research Institute, 1958), 104.
[65] R. C. Hazra, ‘The Nandi-Purāṇa’, Journal of Ganganath Jha Research Institute, 1944-45, 2, 305-320.
[66] Two things should be mentioned here. First, as pointed out by the reviewer, it is of little value to re-fight every historiographical battle of the early 20th-century. Second, in recent times, Ludo Rocher has dealt with these questions in an excellent and up-to-date study – The Purāṇas (Wiesbaden: Otto Harrassowitz, 1986).
[67] S. Gurumurthy, “Medical Science and Dispensaries in Ancient South India as Gleaned from Epigraphy”, Indian Journal of History of Science 5 (1970): 76-79, (77).
[68] K. V. Subrahmanya Ayaar, “The Tirumukkudal Inscription of Virarajendra”, Epigraphia Indica XXI (1931-32): 220-250.
[69] Ibid., 224.
[70] Ibid., 223-224.
[71] Ibid., 250.
[72] Sircar, Studies, 159.
[73] Ibid., 162.
[74] Chakravarti and Ray, Healing and Healers, 21.
[75] Fabrizio Speziale, “Introduction”, in Hospitals in Iran and India, 1500-1950s, Fabrizio Speziale, ed., (Leiden: Brill, 2012), 2.
[76] Ibid., 3.
[77] Ibid., 8.
[78] Ibid.
[79] Claudia Liebeskind, “Unani Medicine of the Subcontinent”, in Oriental Medicine: An Illustrated Guide the Asian Arts of Healing, Jan Van Alphen and Anthony Aris, eds, (Chicago, IL: Serindia Publications, 1995), 50.
[80] R. L. Verma, ‘The Growth of Greco-Arabian Medicine in Medieval India’, Indian Journal of History of Science, 1970, 5, 347-363, 351.
[81] Ibid., 359.
[82] A. K. M Yaqub Ali, Some Aspects of the Society and Culture of the Varendra, 1200-1576 A.D. (Rajshahi: Rajshahi Univesity, 1998), 180.
[83] Ghulam Yazdani, Bidar: Its History and Monuments (Oxford: Oxford University Press, 1944), 130.
[84] Varja Bolar, “The Role of Islam in Karnataka”, International Journal of Social Sciences and Humanity Studies 3 (2011): 489-498. Also see, D.V. Subba Reddy, “Dar-us-Shifa Built by Sultan Muhammad Quli: The First Unani Teaching Hospital in Deccan”, Indian Journal of History of Medicine II (1957): 102–105. For further information on hospitals during the Muslim period, see S. Ali Nadeem Rezavi, “Physicians as Professionals in Medieval India”, in Disease and Medicine in India: A Historical Overview, Deepak Kumar, ed., (Delhi: Tulika, 2001), 40-65; O. P. Jaggi, Medicine in India: Modern Period (Delhi: Oxford University Press, 2011), 70-85.
[85] Donald F. Lach, Asia in the Making of Europe, vol. I (Chicago: University of Chicago Press, 1994), 444.
[86] Mary Louise Pratt, Imperial Eyes: Travel Writing and Transculturation (London, New York: Routledge, 1992).
[87] Richard S. Weiss, Recipes for Immortality: Medicine, Religion, and Community in South India (Oxford: Oxford University Press, 2009), 22.
[88] Raymond Williams, Keywords: A vocabulary of culture and society (New York: Oxford University Press, 1983), 277.
[89] Ibid., 278.
[90] “Hindu Medicine and Medical Education”, Calcutta Review XLII (1866): 106-125, (111).
[91] Reports from Committees: Thirty-Two Volumes – East India. Lord’s Second Paper, Vol. XXXII (1852-52), 248.
[92] The Voyage of Francois Payrard, trans., Albert Gray, vol. II, pt. I (London: Hakluyt Society, 1888), 3.
[93] Ibid., 5.
[94] Ibid., 9.
[95] Jayanta Bhattacharya, “Encounter in Anatomical Knowledge: East and West”, Indian Journal of History of Science 43 (2008): 163-200.
[96] C. R. Wilson, ed., Old Fort William in Bengal, vol. I (London: John Murray, 1906), 68.
[97] Ibid.
[98] Charles Leslie, “The Professionalization of Ayurvedic and Unani Mediicne”, in Medical Professionals and the Organization of Knowledge, Eliot Freidson and Judith Lorber (eds), (New Brunswick, NJ: Transaction Publishers, 2009), 39-54.
[99] Pratik Chakrabarti, ‘”Neither of meate nor drinke, but what the Doctor alloweth”: Medicine amidst War and Commerce in Eighteenth-Century Madras’, Bulletin of the History of Medicine, 2006, 80, 1-38, 23-24.
[100] “Education of the Native Doctors”, Asiatic Journal and Monthly Register XXII (July 1826): 111-121, (121).
[101] Mark Harrison, “Disease and Medicine in the Armies of British India, 1750-1830: The Treatment of Fevers and the Emergence of Tropical Therapeutics”, in British Military and Naval Medicine, 1600-1830, Geoffrey L. Hudson, ed., (Amsterdam, New York: Rodopi, 2007), 87-120, (89).
[102] Ibid.
[103] Mark Harrison, Medicine in an Age of Commerce and Empire: Britain and Its Tropical Colonies 1660-1830 (Oxford: Oxford University Press, 2010), 4.
[104] Ibid.
[105] Ibid., 18.
[106] Ibid., 22.
[107] Risse, Mending Bodies, 330.
[108] Susan C. Lawrence, Charitable knowledge: hospital pupils and practitioners in eighteenth-century London (Cambridge: Cambridge University Press, 1996), 1.
[109] W. E. E. Conwell, Observations Chiefly on Pulmonary Disease in India and an Essay on the Use of Stethoscope (Malaca: Mission Press, 1829), v.
[110] J. Adam, “On the Epidemic Bronchitic Fever of Infants and Young Children, prevalent in Calcutta during the Rains, or Months of June, July, and August, of 1828”, Transactions of the Medical and Physical Society of Calcutta 4 (1828): 320-38, (324). [Emphasis added]
[111] Ibid., 324-325.
[112] “Education of the Native Doctors”, 121.
[113] Ibid., 121.
[114] Minutes of Evidence taken before the Select Committee on the Affairs of the East India Company; and also an Appendix and Index. I. Public (16 August 1832), 448.
[115] Ibid.
[116] “Liberality of the Indian Government towards the Native Medical Institution of Bengal”, Oriental Herald and Journal of General Literature X (July-September 1826): 17-25, (24).
[117] Quarterly Oriental Magazine VI (July-December 1826): cxv.
[118] Appendix to the Report from the Select Committee of the House of Commons on the Affairs of the East-India Company, 16 August 1832, and Minutes of Evidence. I. Public, 270.
[119] Ibid., 271.
[120] Report of General Committee of Public Instruction, for the Year 1839-40 (hereafter GCPI), 33.
[121] The Correspondence of Lord William Cavendish Bentinck, ed. C. H. Philip, vol. II (Oxford: Oxford University Press, 1977), 1399.
[122] Ibid., 34.
[123] Original Papers Illustrating the History of the Application of the Roman Alphabet to the Languages of India, ed., Monier Williams (London: Longman, Brown, Green, Longmans, and Roberts, 1859), 57.
[124] Girindranath Mukhopaddhyaya, History of Indian Medicine, vol. 2 (New Delhi: Oriental Books Reprint Corporations, 1974), 15.
[125] S. N. Sen, “The Pioneering Role of Calcutta in Scientific and Technical Education in India”, Indian Journal of History of Science 29 (1994): 41-47, (43).
[126] Minutes of Evidence, 1832, 436.
[127] David Kopf, British Orientalism and the Bengal Renaissance: The Dynamics of Indian Modernization 1773-1835 (Calcutta: Firma K. L. Mukhopaddhyay, 1969), 183-84.
[128] Charles E. Trevelyan, On Education of the People in India (London: Longman, Orme, Brown, Green, & Longmans, 1838), 27.
[129] Seema Alavi, Islam and Healing: Loss and Recovery of an Indo-Muslim Medical Tradition, 1600-1900 (New Delhi: permanent black, 2006), 71.
[130] Ibid., 147.
[131] S. N. Sen, Scientific and Technical Education in India, 1781-1900 (New Delhi: Indian National Science Academy, 1991), 142.
[132] Sen, Scientific and Technical Education, 160.
[133] Ibid., 160.
[134] Sixth Report from the Select Committee on Indian Territories; together with the Proceedings of the Committee, Minutes of Evidence an Appendix (8 August, 1853), 19.
[135] H. Sharp, Selections from Educational Records, Part I: 1781-1839 (Calcutta, 1920), 183.
[136] Letter, in Public Dept. to Bengal, 24 August 1831, Minutes of Evidence, 1832, 498.
[137] Ibid.
[138] Kopf, British Orientalism, 184.
[139] Sen, Scientific and Technical Education, 148.
[140] Minutes of Evidence, 1832, 494.
[141] A. F. Salahuddin Ahmed, Social Ideas and Social Change in Bengal, 1818-1835 (Leiden: Brill, 1967), 146.
[142] “Proceedings of the Asiatic Society”, Journal of the Asiatic Society 7 (1838): 663-669, (663).
[143] Ibid.
[144] Ibid., 664.
[145] Sen, Scientific and Technical Education, 223-24.
[146] John Clark Marshman, The History of India from the Earliest Period to the Close of the Lord Dalhousie’s Administration, vol. III (London: Longmans, Green, Readers & Dyer, 1869), 68.
[147] “Annual Report of the Medical College of Bengal. Twelfth year. Session 1846-47”, Calcutta Review 7 (January-June 1847): xliii-xlix, (xliii).
[148] Mel Gorman, “Introduction of Western Science into Colonial India: Role of the Calcutta Medical College”, Proceedings of the American Philosophical Society132 (, 1988): 276-298, (287).
[149] Ibid., 287.
[150] “Medical and Physical Society”, Journal of the Asiatic Society and Monthly Register 24-New Series (October 1837): 64.
[151] O’Bryen Bellingham, Observations on Aneurism, and Its Treatment by Compression (London: John Churchill, 1847), 101.
[152] W. B. O’Shaughnessy, “Proposal of a Kind of Treating the Blue Epidemic Cholera by the Injection of Highly-Oxygenated Salts into the Venous System”, Lancet 17 (1831): 366-371; “Report on the chemical pathology of the blood in cholera, published by authority of the Central Board of Health”, Lancet 17 (1832): 929-936.
[153] “Proceedings of a Meeting of the Medical and Physical Society of Calcutta, 2nd July”, Calcutta Monthly Journal (July-December 1836), 313-14.
[154] General Report on Public Instruction, 1852-1855 (1855), 96. Hereafter GRPI.
[155] Calcutta Monthly Journal 1839, LII, 171.
[156] “Annual Report of the Medical College of Bengal; Session, 1844-45”, Calcutta Review 3 (1845): xxxiii-xlvi, (xxxv).
[157] GRPI, 1847-48, Appendix E, No. VII, cli.
[158] GRPI, 1851, 122.
[159] GRPI, 1847-48, 90.
[160] Gorman, “Introduction of Western Science”, 290.
[161] Annual Report of the Administration of the Bengal Presidency for 1867-68, 121.
[162] W. H. Sykes, “Statistics of the Government Charitable Dispensaries of India, Chiefly in the Bengal and North-Western Provinces”, Journal of the Statistical Society of London 10 (1847): 1-37.
[163] Projit B. Mukharji, Nationalizing the Body: The Medical Market, Print and Daktari Medicine (London: Anthem Press, 2011), 80.
[164] Mukharji, “Structuring Plurality: Locality, Caste, Class and Ethnicity in Nineteenth-Century Bengali Dispensaries”, Health and History 9 (2007): 88-105.
[165] Sykes, “Government Charitable Dispensaries”, 23.
[166] GRPI, 1847-48, Appendix, i-cii (lxxviii).
[167] C. A. Bayly, Empire and Information: Intelligence gathering and social communications in India, 1780-1870 (New Delhi: Cambridge University Press, 2007), 267. Also see, A. H. E. Boileau, Personal Narrative of a Tour through the Western States of Rajwara, in 1835 (Calcutta: Baptist Mission Press, 1837), 233-237.
[168] Brahmnanda Gupta, ‘Indigenous Medicine in Nineteenth- and Twentieth-Century Bengal’, in Chares Leslie, ed., Asian Medical Systems: A Comparative Study (Delhi: MLBD, 1998), 368-378, 375-376.
[169] Frederick M. Smith and Dagmar Wujastyk, “Introduction”, Modern and Global Ayurveda: Pluralism and Paradigm, in Dagmar Wujastyk and Frederick M. Smith, eds, (Albany: SUNY Press, 2008), 7.
[170] Kavita Sivaramakrishnan, ‘Constructing Boundaries, Contesting Identities: The Politics of Ayurved in Punjab (1930-40)’, Studies in History, 2006, 22, 253-283, 260.
[171] Ibid., 261.
[172] Madhulika Banerjee, Power, Knowledge, Medicine: Ayurvedic Pharmaceuticals at Home and in the World (New Delhi: Orient BlackSwan, 2009), 43.
[173] Ibid., 44.
[174] Arnold, “The rise of western medicine in India”, Lancet 348 (1996): 1075-78, (1077).
[175] Ibid., 1078.
[176] Francis Zimmermann, The Jungle and the Aroma of Meats: An Ecological Theme in Hindu Medicine (Delhi: MLBD, 1999), 166.
[177] Gananath Sen, Āyurveda Paricay (Calcutta: VisvaBharati Granthalaya, 1943), 31-32.
[178] Mukhopadhyaya, History of Indian Medicine, vol. 2, 2nd edn. (Delhi: Oriental Books Reprints Corporations, 1974), 25.
[179] Alavi, Islam and Healing, 98-99.
[180] Thomas Carlyle, Chartism (London: James Fraser, 1840), 58.
This article is one of the best I ever read. In a stepwise manner Dr Jayanta discribed the evolution of medical education in India. It has historical value. Very few people know about Indian medical history. It also points out that first Hospital in India was established by the Buddhist though in primitive form. I may suggest Dr Jayanta to have it send to NMC, so that it is taught to medical students.
Darun lekha, lekhata pore Indiar Medical Education samparke anek kichhu jante parlam.