Ancient India

We have always been fond of legends and the field of medicine has its share of these handed down over generations. The vedas and the upanishads embodied information from the hoary past. The veda attributed to Atharvan contained the wisdom that led to the science of medicine.

Lacking the means to record these indelibly, the ancients resorted to memorizing them and transmitting them through disciples and students, enabling them to develop shruti through such means as vakya patha, pada patha, krama patha, jana patha and ghana patha. These techniques led to the titles of individuals according to the number of vedas mastered by them, i.e. those who mastered one veda—vedis, two—dwivedis, three—trivedis and, four—chaturvedis.

At least two millennia ago, the art and science of medicine were said to have been transmitted by the gods to such masters as the Asvini twins, Bharadwaja, Atreya, Agnivesha, Çaraka, Susruta, Jivaka and others. Countless generations were nurtured on accounts of the origins and achievements of these justly famed persons even as they studied their teachings embodied in the canonical works termed samhitas. Best known of the latter are those produced by the schools of Çaraka and Susruta. We are fortunate in being able to study these in Sanskrit and in English translations.

We owe much of our current knowledge on ancient Indian medicine to scholars who delved into palm-leaf manuscripts and texts preserved in repositories by individuals such as Pipallada—also known as Paippalâda. (The earlier name stems from his association with the pipal tree under which he was placed by his mother as she took samadhi.) The Kashmiri version of the Paippalâda recension of the Atharva Veda is preserved in the library of the University of Tubingen, where it can be studied even today.

Colonial India

While the medical curriculum in each of the pioneering medical colleges (Calcutta, Madras and Bombay) contained no specific allocation of time for the study of the history of medicine, the British professors did make passing references to western medical pioneers. The medical history of India was by and large ignored.

It was left to European and American scholars such as F. Max Mueller, Heinrich Zimmer, Thomas A. Wise, A.F. Rudolf Hoernle, G. Jan Meulenbeld, Douglas Guthrie, Henry Sigerist, Charles Singer and, more recently Julius Jolly, J. Filliozat, Kenneth Zysk, David Arnold, Dominik Wujastyk and others to give prominence to the history of Indian medicine. They highlighted the contributions by Indian authors—hitherto generally neglected.

Along with the other reforms recommended by the committee headed by Sir Joseph Bhore was that for fostering the study of the history of medicine. This followed the co-option of Dr Henry Sigerist as a member of the Bhore Committee.

Indian expertise in the subject appears to date from the work of such scholars as Dr Heerajee Eduljee (Bombay), Dr Girindranath Mukopadhyaya (Calcutta), Dr Bhagvat Sinhjee (Gondal), Dr D.V. Subba Reddy (Hyderabad), Dr S. Parvathi Devi (Madurai), Dr Pranjivanlal Mehta (Jamnagar), Dr P. Kutumbiah (Madras and Vellore), Major General Sohan Lal Bhatia (Bombay, Delhi, Bangalore), Dr Nandkumar H. Keswani (Bombay, Delhi and USA), Dr Rustom Jal Vakil (Bombay), Dr A. Neelameghan (Madras), Hakim Abdul Hameed (Delhi), Dr O.P. Jaggi (Delhi), Dr M.S. Valiathan and Dr Farokh Udwadia (Bombay).

Departments and institutes

Dr Subba Reddy founded the Department of the History of Medicine in Andhra Medical College in Vishakapatanam in 1956. When he moved to Osmania Medical College in April 1957, the department moved with him and was upgraded to the Indian Institute of History of Medicine. It remains active but is now focused on Indian forms of medicine such as Ayurveda, Unani and Siddha.

Attempts to set up an Institute of the History of Medicine in Bombay in 1949 and in Delhi in 1953 failed.

When Dr N.H. Keswani was appointed Professor Anatomy to the All India Institute of Medical Sciences in New Delhi at its inception in 1956, he soon setup a division of the history of medicine and ensured that his title was Professor of Anatomy and History of Medicine. He had proudly shown me the section of the history of medicine on the ground floor of the main building of the institute. There is no trace of this section now.

The Hamdard Foundation established the Institute of History of Medicine and Medical Research in Tughlaqabad, New Delhi in 1970. It has focused on Unani.

Journals

Dr Subba Reddy founded the Indian Journal of History of Medicine in 1956. Dr Parvathi Devi succeeded him as its editor. Dr Subba Reddy also founded the Bulletin of the Institute of History of Medicine in 1963. Hakim Abdul Hameed founded Studies in History of Medicine in 1977.

These journals reached their acme while these pioneers were at the helm. Internet searches for recent issues of these journals yield no results.

The National Medical Journal of India continues to do what it can to enthuse you and other readers into studying our past. It has been publishing essays in series entitled Classics in Indian Medicine, Indian Medical Colleges and Eminent Indians in Medicine.

Each instalment of Classics in Indian Medicine provides a brief biography of the author, reproduces the landmark paper by him and adds expert comments on work on the subject since that paper was published. Volume 1, No. 2 featured Dr U.N. Brahmachari’s essay published in 1922, entitled ‘Chemotherapy of antimonial compounds in kala-azar infection’. Papers by Drs Ronald Ross, W.J. Elmslie, Ernest F. Neve, A.S. Paintal, Rustom Jal Vakil, Shambhu Nath De, D.N. Chatterjee, V.N. Shirodkar, V.R. Khanolkar, Bimal K. Bacchawat, N.H. Wadia and others can be found in this section.

The obituary column enshrines biographical notes, anecdotes and summaries of achievements by many of our eminent physicians.

In the immediate past, the Journal has added another series on the history of pioneering medical journals. Thus far, those in Britain, Scotland and America have been reviewed. The stories of the development of medical journals in India, Ireland and France are in the pipeline.

The only other systematic series advancing our knowledge of our past was to be found in Housecalls published by Dr Reddy’s Laboratories and edited by Ms Ratna Rao Shekhar. It featured essays on ancient Indian medicine by Dr B.S. Mehta. It also published historical essays on our medical colleges and their hospitals. A third series recorded interviews with eminent Indian physicians. This journal has shut down.

Stray papers on the history of medicine in India do appear in various Indian journals from time to time. Those in Current Science (Bengaluru) and Indian Journal of the History of Science (New Delhi) attract attention.

What are the advantages of studying the history of medicine?

The works of Jurgen Thorwald (The century of the surgeon, The triumph of surgery, The patients, and The dismissal: The last days of Ferdinand, Sauerbruch) illustrate events in surgery. Books such as Samuel Johnson in the medical world: The doctor and the patient will enthuse those with dual interest in the history of medicine and that of literature. It is not difficult to find similar books combining interests in medicine and music, for example.

Medical history also incorporates a fair share of humour. A much-neglected, noteworthy exponent in this field was François Rabelias (?1483–1553). I bring him to your notice as his humour ranged from the sophisticated to the bawdy. Students of pathology have chuckled and marvelled while studying the works of William St Clair Symmers (Curiosa and Exotica). More recently, we have the likes of Richard Gordon (The alarming history of medicine: Amusing anecdotes from Hippocrates to heart transplants), Adam Kay (Kay’s marvellous medicine: A gross and gruesome history of the human body) and Samuel Shem (The house of God). Those wishing to delve and imbibe knowledge and burst into laughter at intervals would do well to study Mould’s medical anecdotes. A venerable publication of the same kind is John Timbs’ Doctors and patients or anecdotes of the medical world and curiosities of medicine published in 1876 and reissued in 2018. Here is an anecdote of the legendary British anatomist and surgeon, John Hunter from this book: He once was to perform a serious operation on a tradesman’s wife; the fee agreed upon was twenty guineas. He heard no more of the case for two months, at the end of which time he was called upon to perform it. In the course of his attendance he found out that the cause of the delay had been the difficulty under which the patient’s husband had laboured to raise the money; and that they were worthy people, who had been unfortunate, and were by no means able to support the expense of such an affliction. ‘I sent back to the husband nineteen guineas, and kept the twentieth,’ said he, ‘that they might not be hurt with an idea of too great an obligation. It somewhat more than paid me for the expense I had been at in the business.’ He held the operative part of surgery in the lowest estimation. ‘To perform an operation,’ said he, ‘is to mutilate the patient whom we are unable to cure; it should therefore be considered as an acknowledgment of the imperfection of our art.’

We are fortunate in being able to read autobiographies by such Indians as Drs C.G. Pandit, B. Ramamurthi, Jacob Chandy and, more recently, Dr Prakash Tandon. I am sure there are others that I am not aware of. These accounts enable us to learn of the problems these pioneers faced when they started in India and describe how they overcame them. They serve to inspire us.

Creativity in this field

For those fortunate enough to be blessed with the urge to add to existing stores of knowledge and endowed with boundless energy, the history of medicine offers unending opportunities.

Let me give you just one example.

Hugh L’Etang, the then editor of The Practitioner (England), published two books that soon stirred extensive interest. Entitled The pathology of leadership (1970) and Ailing leaders in power 1914–1994 (1995), they analysed the effects of illnesses in leaders in Britain, America, the Middle East, the Pacific and Asia. Case histories were appended. They emphasized the risks of having ailing individuals in positions of enormous power. Preventive measures—then deemed radical by many—were advocated.

Winston Churchill’s physician, Lord Moran, published medical details of his distinguished patient.1 President John F. Kennedy had his endocrine and autoimmune abnormalities, injury to the back and other abnormalities of health analysed.2 More recently, we have essays discussing the illnesses of German Chancellors Willy Brandt, Helmut Schmidt, Helmut Kohl and Angela Merkel.3 Gandhiji’s illnesses were described in a special issue of the Indian Journal of Medical Research.4

We have no such studies on Indian leaders in power. The field is ripe for study. There must be the literary equivalents of gold mines in the Nehru Memorial Museum and Library, The National Archives, the archives of the various states and those housing the papers and other memorabilia of all our leaders.

Present state

If you discuss the history of medicine in India with students in most of our medical colleges you will either encounter puzzled faces or, at best, references to Çaraka and Susruta.

As examiner for the degree of MCh in neurosurgery I carried out an experiment. At the end of the viva voce in the practical test, I informed each candidate that the question I was about to ask had no bearing on their examination results. I asked the candidate to give me a brief history of the department in which he had trained. Few could even name the founder of the department let alone describe his contributions to neurosurgery.

The only books on the history of medicine in India known to some students are those by Dr Kenneth Zysk or Dr Dominik Wujastyk. A few may recall Dr Valiathan’s recent works on Çaraka and Susruta and Dr Farokh Udwadia’s volumes. Most are unaware of Dr D.V. Subba Reddy, Dr Parvathi Devi, Major General S.L. Bhatia, Dr P. Kutumbiah, author of Ancient Indian medicine or others of this meritorious band who have contributed in their own ways.

Kavitha Rao makes a poignant statement in the introduction to her book entitled Lady doctors: ‘Little is known of these unsung women...They do not appear in our textbooks or museums, and have been largely left out of Indian history. A crater on Venus is named after Anandibai, but not a single road or school in India. Anandibai and Rukhmabai have had biographies written about them in Marathi; Rukhmabai was the subject of a 2017 film by Anant Mahadevan and, in 2019, Sameer Vidwans directed a Marathi film about Anandibai. Nevertheless, these women are hardly household names across India, in the way that Sarojini Naidu or Rani Lakshmibai of Jhansi are.’ (See ‘Suggested reading’ at the end of this editorial for the full reference to her book.)

It is a sad commentary that while we see a proliferation of institutes and medical colleges, we see no sustained effort at promoting the study and analysis of past giants in medicine in particular and science in general in our country.

Can anything be done to revive pride in our medical history?

Is our lack of interest in the history of medicine related to our general apathy towards history? Analysts suggest that the struggle to make ends meet and ensure two meals a day for every family member make concern about history a luxury for the vast majority of our countrymen. Surely, this is not true in the field of medicine!

Perhaps in a manner similar to that used by experts teaching children to swim, we should throw our students into the stream of the history of medicine. After the first few dips, the student will savour the narratives, drama, heroism and courage of our pioneers. They will learn of triumphs and tragedies and marvel at what it took to advance medicine from what it was in prehistoric times to its present state.

We need a renewed emphasis in all our medical colleges and institutes on enthralment in the humanities. This is best done by example. If our teachers and professors study the various components of this group of disciplines—the history of medicine, ethics, philosophy, art, literature…and incorporate them subtly and blatantly in their teaching in wards, seminar halls, lecture theatres and operating rooms, seeds can be sown in the impressionable minds of students and residents.

We see an encouraging trend in the annual conferences of some of our medical societies and associations in the form of sessions devoted to medical history and to ethics.

Dr Farokh Udwadia (Mumbai) continues his one-man mission and even during the lockdowns necessitated by the Covid-19 epidemic, continued to record on YouTube a series of talks on the history of various aspects of the history of medicine. His brother, Dr Tehemton Udwadia, is currently attempting to record the history of surgery at his alma mater—the King Edward VII Memorial Hospital.

St John’s Medical College, Bengaluru has shown that it is possible to develop and sustain a world-class museum and library on the history of medicine. We hope that many other institutions will use this model. We shall be able to hold our heads high when we see the sustained development of departments, museums and institutes devoted to the humanities, hold conferences and seminars on selected topics and publish journals, papers, books and YouTube recordings on subjects related to the history of medicine.