Medicine in Antiquity Part 2

Prof (Col) Dr RN Basu • Therapeutics in • As per aurvedic therapeutic procedure there are five recorded procedures. These are: • Various kinds of massage • Anointment with oil, and • • Drugs came from well known plants • Example: • Senna was prepared from cassia and was used by vaidyas for two thousand years

2 • Surgery • and Sushruta achieved considerable success in surgery • Even transplant surgery was contemplated • Example: • Transplant of testes from ram was thought of as a cure of impotence • Ayurvedic treatise mentions about: • Caesarean section • Lithotomy • Couching the cataract • Tonsilectomy • Amputations, and • Plastic surgery

3 4 • These surgical traditions of Ayurveda posed considerable challenge to Western practices • In ancient , the aurvedic surgeons attained considerable success without undertaking any dissection of human body • Sushruta taught that the human body must be studied by direct observation • This essential knowledge was required for practicing and surgery • At that time, there was religious prohibition for dissecting human body • Sushruta’s innovative ways and methods could circumvent these barriers • The could study the minutest details of human body • Whether later physicians practiced Sushuta’s method was not known

5 • Ayurveda was equated with Hindu system of medicine • Apart from Hinduism’s influence on Ayurveda, it also came under Buddhist influence • There was no separate Buddhists’s system of medicine • They were using the Ayurvedic system of medicine to treat patients • Many Buddhists scholar enriched Ayurveda by their positive contribution • Among them name of Nagarjuna was prominent • He developed methods to purify many medicinal preparations to make them non-toxic • During Buddhist prominence, a famous university near Patna was set up. This was the Nalanda university • It was claimed that Nagarjuna was associated with Nalanda University

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A G N I V E S A • Unani medical system • Muslims made noteworthy contribution in the field of medicine • The Muslim rulers introduced unani system of medicine in India • The word unani is an Indian version of Greek medicine Ionia • Unani system was founded by • This system was based on humoral theory • According to humoral theory, there are four humours • These are: • Blood (dam or khun) • Phlegm (balgham) • Black bile (al-mira assawda) • Yellow bile (al-mira as-safra)

8 • According to Hippocrates system, health depended on balance between these humoral elements • Any change in the balance brings about changes in body and health • is a title by which unani physicians are known in India • There are two major categories of hakim • Some come from Arabian peninsula or Persia • They were employed by Indian Govt. on contract basis • Some of them settled down in India, rest returned to their country • Muslim rulers patronised the unani medical system in India

9 • Gradually became the main mode of treatment for the urban elite • established many hospitals, and other medical units • Emperor Akbar (1556-1606) was the pioneer in this regard to build hospitals in many parts of Delhi and Agra • Later Aurangzeb also had set up hospitals in many provinces and smaller towns • Ayurveda somewhat lost its prominence during this time because of lack of patronage from the rulers

10 • Ayurvedic texts were translated into Arabic by the physicians like and Razi Sempion. • Both of them quoted Indian Ayurvedic texts and established Islamic medicine "Unani System” • By the 13th,Century Unani system of medicine was firmly established mainly in Delhi, Aligarh, Lucknow and . • During Mughal period and subsequent years Ayurveda declined due to the lack of state support. • With the advent of the British in the 18th Century Ayurveda system was revived in India along with Western system of Medicine.

11 • • It is a traditional medical system in India • It is of Dravidian origin and its entire literature is in Tamil • Its origin is traced to Shaiva tradition • According to the tradition, Lord conveyed the knowledge of medicine to • Parvati was Lord Shiva’s wife • This knowledge was passed on to • Finally, the knowledge was given to • Siddhi mean that achievement of objective after long penance • Those who have attained Siddhi are Siddhas

https://www.infinityfoundation.com/mandala/t_es/t_es_tiwar_siddha.htm 12 • According to tradition there were 18 • They were: • Nandi, Agasthiyar, Thirumular, Punnakkeesar, Pulasthiyar, Poonaikannar, Idaikkadar, Bogar, Pulikai isar, Karuvurar, Konkanavar, Kalangi, Sattainathar, Azhuganni, Agappai, Pumbatti, Theraiyar and Kudhambai, but the Agasthiyar (Agastya) • Among them Agasthiyar was most prominent • He was the originator of Siddha medical system and also of • During the period of Ramayana, he settled down in • Origin of every tradition in South India is traced back to Agastya

https://www.infinityfoundation.com/mandala/t_es/t_es_tiwar_siddha.htm 13 • The basic concepts of the is the same as that of Ayurveda • Siddhars believed that a healthy soul can only be developed through a healthy body • Intense yogic practice was an important part of Siddha medicine • According to the Siddha medicine various physiological and psychological functions of the body are attributed to the combination of seven elements: • first is saram (plasma) responsible for growth, development and nourishment; • second is cheneer (blood) responsible for nourishing muscles, imparting colour and improving intellect;

14 • the third is ooun (muscle) responsible for shape of the body; • fourth is kollzuppu (fatty tissue) responsible for oil balance and lubricating joints; • fifth is enbu (bone) responsible for body structure and posture and movement; • sixth is moolai (nerve) responsible for strength; and • the last is sukila (semen) responsible for reproduction. • Siddha medicine also has similarity with Ayurveda • The physiological components of the human beings are classified as Vatha (air), Pitha (fire) and Kapha (earth and water).

15 • Western Medicine • Europeans introduced Western medicine in India • The Christian missionaries were very active in promoting the Western system • During the British colonial rule, for army’s interest, some Indians were given training in Western medicine • A Native was opened in 1822 in Kolkata • 20 students were admitted • A committee in 1833 found the condition of medical training was defective • Immediate closure of the school was recommended

16 • The committee also recommended formation of a Medical college for Indians with Western system of medical training • The medium of training recommended was English • On the recommendation of the Committee, a Government Order No.28 of 28th January 1835, Medical College of Bengal was established. • This day is still celebrated as the Foundation day of the Calcutta Medical College. • A small hospital consisting of 20 beds was established on 1st April 1838. In 1840 a large Hospital for women was founded with 100 beds to afford instruction in Midwifery

H Roy. with Special Reference to India. Available at http://www.histopathology-india.net/history_of_medicine.htm. Accessed 10 Oct 2018 17 MEDICAL COLLEGE BENGAL : Est 1835

18 • Women in Medicine • In the year 1847 Elizabeth Blackwell from U.S.A. became the first women to graduate from Geneva Institute. • "Women’s Medical College of Philadelphia“ was founded In 1850 • In UK Elizabeth Garatte in 1865, completed the course from Middlesex Hospital • But the Board of Management did not allow her to take the examination. • She obtained the Diploma of Society of Apothecaries in 1865 and opened an out-door dispensary named "Garatte Hospital“

http://www.histopathology- 19 india.net/history_of_medicine.htm. Accessed10 Oct 2018 • In 1870, Elizabeth Garatte obtained the M.D. degree of Paris. • In 1876, Sophia Jex Black received the degree from Edinburgh University, • It had to be withdrawn due to social disturbances. • Madras Medical College trained four women doctors fully trained according to the regulations, in 1878 • In Bengal, this question was first raised in the year 1876 and • Response was favorable from Lt. Governor Richard Temple, • It was not translated into action • In 1881, it was reconsidered and the Government took a liberal view • The matter was facilitated and even a scholarship of Rupees 20 was paid to every woman student of medical college

20 • In Bengal, Mrs. Kadambini Ganguly was the first native lady graduate of the Calcutta University in 1887. • Mrs. Ganguly went to England and became a Licentiate in Medicine and Surgery. • During the year 1925 to 1931 very few lady students were admitted to the Medical College. • For lady students, it was compulsory to stay in Swarnamoyee Hostel. • Most of the Hostel students were Anglo-Indians, Christians, Brahmos, Parsis and so on.

21 • Classical • Until recently, Western historians generally ignored China • Work of some scholars, however, placed the Asian science and medicine in its proper perspective • These works have helped in redefining the place of Asian contribution in medicine • Traditional Chinese and healing techniques have gained a significant place in Western world today • China has kept its alive in folk lores as well as in mature and respected forms

22 • Contd. • Since 1970’s, Chinese archaeologists discovered a golden past history • Ancient tombs contained magnificent wall paintings and manuscripts • These were written on bamboo or silk • China’s history was blurred in centuries of warfare and chaos • Emperor Shih Huang-ti wanted total reorganisation in order to eliminate all unacceptable historical traditions • He ordered destruction of all old manuscripts and much of historical traditions were lost • Before the unification done by Ch’in in 221 BCE very little survived

23 • Contd. • Huang Ti reigned for about 100 years • He was the last legendary emperor • He gave his people the wheel, the magnet, an astronomical observatory, the calendar, the art of pulse measurement, and the Huang-ti Nei Ching (The Inner Canon of Yellow Emperor) • The canon inspired and guided Chinese medical thought for over 2500 years • Like many ancient texts, the inner canon was also corrupted by addition, deletion and misprints • The existing text is very ancient and may be of the first century BCE

LN Magner. A history of medicine, 2nd Ed. Taylor & Francis, Bota Racon 24 • Contd. • Old texts that were buried with their owner during 2nd century BCE have been recently recovered in Mawangdui, Hunan in 1970s • These have provided new insights into Chinese medical thoughts • Therapeutics in older texts included medicinal drugs, exorcisms, magical and religious techniques and surgical operations • was the major therapeutic technique mentioned in the Inner Canon • This was not mentioned in the Mawangdui manuscripts • The conversation between Emperor Huang Ti and his health minister explores the medical philosophy based on the balance of yang and yin

LN Magner. A history of medicine, 2nd Ed. Taylor & Francis, Bota Racon 25 • Contd. • The terms yin and yang represent the pairs of opposits • These opposits represent the dualism of cosmos • Yin is characterised as • Female, dark, cold, soft, earth, night and empty • Yang is characterised as • Male, light, warm, firm, heaven. Day, full and so forth • Yang and yin are relational concepts • Their characteristics are exhibited in comparison to other entities and states

LN Magner. A history of medicine, 2nd Ed. Taylor & Francis, Bota Racon 26 • Contd. • Chinese medicine knew about the blood circulation long before Willium Harvey was credited with the discovery of circulation of blood • As per Cinese medical philosophy, disease is caused due to imbalance between yang and yin • As described in Inner Canon, the yin and yang and the five phases are closely related to the • Fve “firm organs” like heart, spleen, lungs, liver, kidney, and • Five “hollow organs” like gall bladder, bladder, stomach, large intestine and small intestine

27 • Acupuncture and • Acupuncture is about 2500 years old • In this, needles are inserted in some specific parts of the body • Moxibustion is a related technique • In this burning tinder made from the powdered leaves of Artemesia vulgaris (नागदोना, নাগদানা)is applied to specific parts of the body • This may be more ancient than the art of needling • Acupuncture has been accepted in the West but moxibustion has been ignored • It is claimed that moxibustion is not painful

28 • Food lore • In Chinese medicine properties of some food was used for treating diseases • Some beliefs were also associated with some food • Tea • Use of tea illustrates the overlap between food and drug • Use of tea as medicine is almost 6000 years old • Its food value is low but it contains many active alkaloids • Modern medicine is also now recognising the importance of food for causation and remediation of some diseases

29 • Surgery • It remained mostly outside the domain of Chinese medicine • This could be due to reluctance to mutilate the body • There was lac of dissection based anatomical knowledge • This hindered development of surgery • Forensic medicine however became quite sophisticated • The text “The Washing Away Wrong” is considered as the world’s first treatise on forensic medicine • Chinese scholars defend the lac of surgical practice by saying that preventive and therapeutic advancement made surgery unnecessary

30 • Contd. • Hua t’o was a famous Chinese surgeon • He invented anaesthetic drugs, medicinal bath, hydrotherapy and medical gymnastics • He was a master acupuncturist and a brilliant diagnostician • He could cure migraine with a single needle • He was executed by Emperor Ts’ao Ts’ao because Hua t’o prescribed trephining instead of acupuncture for his intractable headache • Thinking that it was a plot for his assassination

31 • Greek History of Medicine • Very little historical material is available to determine the early history of Greek medicine • As a result an impression has been gained that unlike Indian, Chinese and Egyptian medicine, emerged suddenly • Intellectual traditions established in ancient Greece provided the foundation of Western philosophy, science and medicine • The early history of Greece can be divided into two periods: • The Mycenaean – from 1500 BCE to the catastrophic fall of Mycenean civilization about 1100 BCE • Dark ages from about 1100 to 800 BCE

32 • Contd. • Greek medicine was portrayed by Homer in his epic poems Illiad and Odyssey • Greek medicine was an ancient and noble art • Apollo was the most powerful of the God physicians • Apollo could cause epidemic disease as a form of punishment or restore and heal the wounded • People worshiped Apollo in his famous temple of Apollo at Delphi • In Illiad the skilful was praised as a man more valuable than many others

33 • Contd. • Modern Western medicine traces its origins to the rational, scientific tradition associated with Hippocrates • Classical Greek physicians traced their art to Asclepius • Asclepius was the Greek God of medicine • Asclepius was the son of Apollo • The sons of Asclepius were also warriors and healers • Their special talents were futuristic

34 • Hippocrates and the Hippocratic Tradition • Hippocrates (ca. 460-360) has become synonymous with the phase “Father of Medicine” • Hippocratic tradition established medicine as an art and science • One of the most important and characteristics expressions of Hippocrates medicine is found in the text “On Ancient Medicine” • It maintains that nature itself has strong healing forces • The purpose of the physician was to cultivate techniques that would work in harmony with natural healing forces • This is to restore body to a harmonies balance

35 HIPOCRATES

36 1. LN Magner. A History of Medicine, 2nd Ed. Taylor & Francis, Boca Raton 2. MN Islam. Chinese and Indian Medicine Today. Springer, Zhuhai, China 3. P Distelzweig, B Goldberg, ER Ragland, Ed. Early Modern Medicine and Natural Philosophy. Springer, Notre Dame, USA 4. V Nutton. Ancient Medicine. Routledge, London 5. A Winterbottom, F Tesfaye, Ed. Histories of Medicine and Healing in the Indian Ocean World, Vol 2. Palgrave, Macmillan 6. B Debroy, D Debroy, The Rig Veda. Books for All, Delhi

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