The hesitant growth of surgery in Bengal

The hesitant growth of surgery in Bengal RELIGIOUS and social practices are responsible for a tradition of prejudice in India against human dissection, which has resulted in surgery being generally ignored in indigenous medical systems such as ayurveda and unam. Poonam Bala sets 1836 in her book, Imperialism and Medicine in Bengal, published by Sage, New Delhi, as the turning point in Indian attitudes to dissection.

"Four Indian youth," Bala recounts, "were bold enough to discountenance the prejudice, volunteered to take to dissecting human corpses and, in the presence of all the professors of the colf;ge and of other pupils, demonstrated with accuracy and nicety, several important parts of the body."

In time, Bala continues, "the four students were among the 11 who passed the first examination (held on 30 October, 1838) and were the first Indian physicians appointed b@ the government as sub-assistant surgeons to hospitals at Dacca, Marshidabad, Patna and Chittagong, at a monthly salary of Rs 100.
Changing relationship Bala's review of the impact of British policies from 1800 to 1947 on the medical profession in Bengal portrays the colonial period as a recent stage in the history of the growth of medical knowledge in India. She contends that with the advent of British rule in Bengal, the traditional relationship between ayurvedic and the unani practitioners and their royal patrons began to change.

In the 19th century, Western medical science was advancing rapidly and becoming increasingly professional. Attempts to impose a similar pattern on indigenous medical systems slowly transformed co-existence to a conflict of interests. By the end of the century, advances in Western medicine had undermined and erodocNthe similarities in approach and practice that earlier made extensive cooperation at least a possibility.

The Western system sought supremacy by trying to root itself in the emergent English-speaking elite - the bhodralok. But, this effort did not succeed completely because of the inherent social and religious differences between the two cultures. Thus, despite official policies favouring British medical practices, they could not over- whelra the support amidst the indigenous population for their traditional medical practitioners.

Traditional medicine Indian medicine can be traced to at least 3000 BC, but Bala notes that in the Vedic (1500 BQ and Post-Vedic (600 BQ periods, medicine was marked by the dominance of Brahmans, who appropriated and codified medical knowledge without generating it. This, says Bala, "led to an apparently rigid and an underdeveloping system of medical knowledge in India."

In the code of Marm, contact with dea&bodies was taboo and necessitated ritual purification. Although the Brahman medical practitioners codified and appropriated medical knowledge, they had a strong distaste for surgical practices which manifested itself in the medical system that has come to be known as ayurveda, which reflected a transition in therapeutics from association with religion and magic to rational and scientific methods of treatment. Its richness may be judged from the extensive knowledge of medicine contained in the chief medical texts of ancient India, the Caroko Samhita (on a detailed classification and nomenclature of diseases), the Susruta Somhita (on surgery) and the Astanga Samagraha (a medical manual incorporating the first two). Collectively, these treatises are known as Vrddhatrayi, or the three elder ones. Diagnosis in ayurveda is based on the three dashes (elementary forms of nature, humours) - vota (air), pitha (bile) and kapho (phlegm). It involves bhumi-pariksa (examination) of the place, meaning the patient's social environment, food habits, mode of living and other general conditions that can affect health. The Susruta Samhita emphasises the importance of direct sense-percaption for diagnostic purposes, and, as this necessitates corroboration by direct observation of the human anatomy, dissection became essential.

The extensive materia medica of ayurvedic physicians included drugs derived from indigenous plants. And, despite religious interdictions imposed on study of the human anatomy, ayurvedic surgery was advanced, espe&41ly in rhinoplasty (of the nose) and lateral lithotomy (for removal of stones). However, as the new methodology of medical science involved violating the ban on contact with dead bodies, physicians came under strong condemnation from the *Brahmans, who expressed their hostility in later Vedic annals such as the Yajurveda and the Brahmanas. Their contempt of physicians was extended to the legal codes of Apastamba, Gautama and Vasistha, and Mann, in which doctors were.considered "so impure that their very presence pollutes a place, that food offered by them is too filthy to be accepted and that even the food offered to them turns into something vile".

Challengers emerge
By the sixth century, however, Brahmanical orthodoxy was challenged by Buddhism and Jainism, both religions according high regard for medical knowledge and physicians and, as a result, medical training and research flourished. Physicians were patronised by rulers and soon became preoccupied with writing medical commentaries. Ayurvedic exponents became famous not for medical research but for their compilations. Muslim invaders in the medieval period introduced the unani (Greco Arab) system of medicine to India, based on the medical concepts of ancient Egypt and Greece and enriched by the Arabs with the best in their contemporary medical systems of Persia, China and other southern Asian regions. Medieval Indian rulers actively encouraged physicians and provided them suitable facilities, Mughal emperors Akbar and Shah Jahan drew on the imperial treasury to establish hospitals throughout their realm.

The advent of British rule in India shifted the focus of medical policy and indigenous medical systems lost official patronage, though until about the 1860s there was a period of peaceful co-existence during which the Native Medical Institute (NMI), the Calcutta Sanskrit College and the Calcutta Madrasa (school) were established and offered instruction based on indigenous and translated Western texts. Dissection at these institutions was carried out on animals and not on humans. But the increasing profess i onali sation of medicine and standardisation of dr4s in Britain led to Goverrior-Goneral William Bentinck abolishing the NMI in imposed on study 1835 and discontinuing medical classes at the Calcutta Sanskrit College and the Calcutta Madrasa. Instead, the Calcutta Medical College (CMC) was opened in 1835, offering instruction and training in Western medicine.

The medium of instruction at CMC was to be English because "a knowledge of the English language we consider a rhinoplasty and sine qua non, because that lan guage (has) obvious advantages over Oriental languages ......"

Despite this, interest was maintained in indigenous drugs, as they were cheaper and more easily available. In 1837, William O'Shaughnessy compiled the Bengal Pharmacopoeia, a compendium of the medical plants of Bengal and their properties and uses. Country medicines, such as kala dana and kut keliju, were used extensively, along with opium-based drugs during the devastating cholera epi- demic of 1839-40.

Major assault
If the first attack on indigenous medicine is identified as making English the medium of instruction, the second major assault was the attempt to enact registration acts in each province "...so that no doctor of indigenous medicine could be legally recognised to give testimony in legal disputes, to certify illness for workers, or to perform any other legally required function". A third attack used the recognition of medical schools and colleges to downgrade institutions involved in indigenous medical systems. But the growth of the nationalist movement in the 20th century, pressured the government to support indigenous medical systems and provisional committees were appointed to look into indigenous systems. In 1931, a General Council and State Faculty of Ayurvedic Medicine was established in Bengal with powers to regulate ayurvedic teaching standards and award certificates or diplomas. Nevertheless, the gap between Western and indigenous medical systems widened, leading to such measures as excluding indigenous medical practitioners from the Medical Council of India, which was formed in 1936.

Bala's work indicates, the development of medicine in Bengal during colonial rule cannot be seen purely as a struggle between different systems. Inslead, it consists of periods of competition and then of accommodation, a pr6cess that continues even today.

The author is already planning a new book on the people's response to structural transformations in Indian medicine. Hopefully, she will get out of the elitist mould of secondary sources and archival documents and study "subaltern material" that can be found in many tols (indigenous schools) in Bengal. Mofussil newspapers and magazines are other sources that could be tapped. She should also consider the acceptance of homeopathy locally, especially as in rural Bengal it is as popular as indigenous herbal remedies.