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An interpretation of ancient Hindu medicine

Chakraberty, Chandra

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medicine

medicine, ayurvedic

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AN INTERPRETATION __

ANCIENT HINDU MEDICINE

CHANDRA CHAKRABERTY

PUBLISHED BY

HAMCHANDRA CHAKRABERTY, M.A. 58, Cornwallis Street, Calcutta

' 1923.

PRINTED BX Prafulla Kumar Chatterjee

AT THE BENGAL PRINTERS LIMITED- 66, Maniktala Street, Calcutta,

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lTbrarv

736211-

UNIVERSITY0r[OS0i£r0_

TO SRIJUKTA LAKSHMIKANTA CHAKRABERTY

THIS BOOK 18 AFFECTIONATELY DEDICATED

< •

BY THE SAME AUTHOR

1. Food and Health

2. Principles of Education

3. Dyspepsia and Diabetes

4. A Comparative Hindu Materia Medica

5. A Study in Hindu Social Polity

6. Endocrin Glands

7. National Problems

8. Infant Feeding and Hygiene

TO BE HAD OF

LUZAC & Co. E. LE FRANCOIS

46, Great Russell Street, Librarie Medical et

London W. C. Scientifique,

9-10, Rue Casimir-Delavigno, Paris (Vie)

JOSFPH BAER & Co. Buchhandlung und Antifluariat, 6, Hochstrasse, "Fr^ikfurt a. M.

OTTO HARRASSOWITZ

Buchhandler und

Antiquar,

Leipzig.

THE ORIENTALIA. New York City.

CONTENTS.

Chapter I. — Anatomy

(a) Osteology

(b) Arthrology

(d) The Vascular System • II. — Thysiology

(a) Digestion

(b) Circulation

(a) Constitutional Pathogenesis

(b) Mechanical Pathogenesis

IV. — Diseases and their Diagnosis

V. — Diseases and their Clinical Studies

(a) Fevers

(b) Diarrhoea

(d) ^ Diseases of the Bladder (e)v^ Diseases of the Mouth

(f) Tumors

(g) Skin Disease ••• (h) Diseases of the Genital Organs

( ii )

VI. — Therapeutics... ••• -v 429'

VII. — Surgery ••• ••♦ «.. 491

VIII. — Dietetics ••• ••• < ... 536

IX. — Hygiene ••• ••• .•• 568-

< •

\ Foreword

I started this Book with the idea of making- it a comparative study of the ancient Hindu and Greek systems of Medicine in the light of niodem knowledge. But I soon realized that the Hindu students for whom this book is chiefly intended, would not be interested in the Greek Medicine, and as there are excellent translations of the works of Hippocrates,^!: I live confined myself to the in- terpretation of the Ancient Hindu Medicinealonu.

I was forced to the conclusion that the Ancient Greek Schools of Medicine were indebted to the Hindu Systems for the following reasons : — (1) Indigenous Indian drugs are found in the works of JlippoGrates as (a) Kardamomon from Sk. ^kardama* ( cardamon ) as an emmenagogue in

* I. E. Littre : Oevres Complete D' Hippocrate

( Text and translation ) 10 Vols. J. B. Bailier et Fils, Paris, 1'839-1861. I have used this edition for my reference.

2/ Robert Fuchs : Hippokrates Sammtliche Werke, 3 Vols. Miinchen, 1895-1900.

3. F. Adams : Genuine Works of Hippocrates ( partial ), Sydenham Society.

( iv )

Tol. VII. p 358 ; in dyspnea in Vol. VIII. p. 80 ; (b) Amomon from Sk. ^eW ( Elettaria cardamomum ) as an emmenagogue in Voi. VII. p. 358 ; (c) Feperi from Sk. 'pippaW ( Piper longum ) as an expectorant, mixed with honey- water in Vol. II. p. 464 ; in nasal catarrh in Vol. V. p. 183 ; in gingivitis in Vol. V. p. 244 ; as an errhine in Vol. V. p. 328 ; as a drink with honey, vinegar and water in Vol. VII. p. 150 ; with wine and oil in a pessary in Vol. VII. p. 364 ; in quartan fever in Vol. VIII. p. 654 ; Dia-trion piperidon, from Sk. trikatu,^ a preparation made from three species of ^Piper* (nigrum, longum and album ) ; (d) Kinnamomos from Sk. Hvak' (Cinnamomum zeylonacum) with myrrha, and safran in fumigation in Vol. VII. p. 372 ; simple fumigation in Vol. VIII. p. 364 ; (e) Akof'os from Sk. 'vacha' ( Acorus colamus ) with myrrha as antiseptic injection in Vol. VII, p. 368 ; made infusion with dry pomegranate skin in wine for astringent injection in Vol. VIII, p. 860 ; (f) Nardou from Sk. *jatmiiamsi^ . (Nardostachys Valeriana) as antiseptic fujriigation with cinnamon, myrrha and rose perfume in^VoI. VII. p. 372 ; as an astringent antiseptic wasti in lochia in Vol. VIII. p. 104 ; (g) Sesamon from Sk. Hila^ ( Sesamum indicum ) as a vulnerary in

( V )

empyema — suppurative abscess in Vol. II. p. 518 ; in the treatment of adiposis in Vol. VI. p, 76 ;. as a plaster in long-standing catarrh in Vol. V. p. 432 ; as' a fattening food in Vol. VI, p. 258. ;. as a nutritive food in Vol. VI. p. 544 ; as a substitute for cheese in Vol. VII. p. 78 ; in coughing of the children in Vol. VIII, 82 ; (h) Ziggiberis from Sk. ^rngavercC ( Zingiber officinale ) ; Kostos srom Sk. 'ktistha' ( Costus speciosus ) ; Sakcharon from Sk. ^sarkara^ ( Saccharum officinarum ) ; Pepereos riza from Sk. *pippali'muW ( radix Piper longum ) ; Kupeiros from Sk. 'mtistaka (Cyperus rotundus);' BdelUon from Sk. *guggnla' ( Aquilaria agallocha ) ; etc.

(2) Kumoral Fathology : In ^Feri Physios Atithropoy' ( On the Nature of Man ) Vol. VI, p. 32-69, Hippocrates advances arguments of supeiiorty of the principles of the four humors whose equilibrium in the body preserves the normal health and whose derangements are the etiological factors of disease, as the ^aima' (blood : Sk. 'rndhira '), 'phlegma' ( phlegm : Sk. ^slesmaf *chol(jn xanthen* ( yellow bile : Sk. 'pitta* ), and *choJ/n melainam' ( black bile : as a substitute for Sk. 'vayu' ), which he for the first time introduced into Greece over the ancient doctrine

{ vi )

of *}iof ( from fire ) *colfV ( from earth ), 'dry* ( from air ) and ^moisf ( from water ) qualities which were supposed to be the basic factors of healtli and disease, and whicli he also argues in his book 'Peri Archaies letriches' ( Ancient Medicine), Vol. I. pp. 570-637. In his 'Ferl Gones' ( Generation, 3 ), Vol. VII. p. 474, 'aima, chole, udor, phlegma* are mentioned as the four humors, using 'hile' without any qualifica- tion, and ill the place of one, 'udor'' ( Sk. ndaka = serous fluid ) is substituted, thus proving that the humoi-al question was still in transitional flux, and was not settled or fixed. In ^Peri Chymon'' ( Humors, 8, 14 ), Vol. V. p, 488, 496, seasonal changes are mentioned to cause the increase and the decrease of the humors, as the increase af the bile in the summer, and thus organisms are predisposed to certain diseases in particular seasons in which their controling humors are predominant, in a very strikingly similar language as described in Susruta (I. 6) on ^rtu-charyya''. In 'Pery Physios Anthropoy' (The Nature of Man, 7), Vol. VI. p. 46, it is argued that 'yhlegxtia' is dominant in the winter, for the reason that^m'an conforms to the laws of nature, and as every- thing is cold in the winter, and as pblegma is

( vii )

"the coldest of all the humors " in tactile sensation, it naturally therefore is in excess over ot^er humors ; in tlie spring, the blood is dominant, as the phlegma is still strong, owing to the plenty of rain and sap in the soil and plant, but it becomes desiccated by the warm sun ; in the summer, the blood is still strong, but the bile is formed by the strong sun, and the phlegma is in the minimum owing to the hot, desiccant sun ; in the autumn the blood is in the minimum, but the black bile is formed in abundance, as the season is dry and the nature tends to cool itself. In 'Peri Noyson to Tetarton' (The fourth Book of Maladies, 33), Vol. VII. p. 5i2, it is described how the humors are in excess or in deficiency : *'I shall describe now, how the bile, the blood, the "udrops* (serons fluid) and the phlegma are in excess or in deficiency ; it is through the food and the drink, in this way : the full stomach is the source of all things ; but when empty, it profits at the cost of the body which it disin- tegrates.'f, Moreover, there are other four sources from which each of the humors can come to the organs ; they come to the stomach, and when the stomach is empty, they go to the organs (superficial), but they come back, when.

( viii )

the stomach has something (ingesfca). The

source for the blood, is the heart, for the phleg-

ma — the brain, for the 'udrops' (serous /^fuid) —

the spleen, and for the bile, the part tlat is in

the liver (bile-duct)." And in the same book

(34 — 38), it is mentioned that as the plant can

select its food from the soil it needs, so each

humor can get its nourishment from all kinds of

food ; but phlegma is particularly increased by

the ingestion of cheese, acrid substance, or

phlegmatic food or drink ; the bile is increased.

by bitter food and drink, or bilious substance ;

^udrops' (serous fluid) is increased by the

water one drinks, and is pumped by the spleen

to itself and other parts of the body ; the blood

is increased by the bloody food one takes, and

which is attracted to all parts of the body, and

especially by the heart. As the disease is caused

by the excessive increment of one humor over

the rest, its cure lies in bringing out the coction

( paclicuia ) of the said humor, and cause its

evacuation and expulsion from the body ; ' the

crisis of a disease is the turning point .when the coction of the deransred humor bes^ins. aiid the coction produces the periods in fever ( Vol.\ I. p. 617 ; Vol. 11. p. 635 ; Vol. IV. p. 469 ; Vol. V. p, 485 ; Vol. VIII. p. 651 ).

(3) India is dii^ectly mentioned in association

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loitJi some of the drugs : (a) "Echochchous eclilep- santa oson treis mdichoy pharmachoij tou ton opbthalmovn, o chaleetaipeperijCliai tou stroggyloy, tna tauta leia tribein,cbai oinopalaio chliero dieis, balanionperi pteron ornitbos titlienai,chai odeprosa- gein."(Anotber : three decorticated grains, Indian drug wbicb is for tbe eyes and is called 'pepper', tbe round grain — tbese three are to be pounded and moistened with warmed old wine, it is to be pasted round a plum, and to be introduced thus ( as a pessary ). Gynaikeiioti JProton : ( Eemale Diseases, 81 ; Vol. VIII. p. 202 ). (b) "E ecblepsas chocbchous pentecbaidecha,esto de cbai indichoy poson" ( Or rather decorticate fifteen grains of Cnide, and add to it, tbe Indian preparation ; ibid 158 ; Vol. VIII. p. 336 ). (c) "Toyto to pharmachon odontas chathairei cbai euodeas .poieei chaleetai de indichoii pharmachon.'* ( This preparation cleanses the teeth, and imparts to them a fi.ne aroma ; it is called Indian prepara- tion ; ibid 185 ; Vol. VIII. p. 366 ). (d) *'Eteron prostheton ecblepsas chocbchous triechonta, to indichoth o'ohaleousinoi Persai peperi." (Another pessary .' thirty decorticated grains, and the Indian substance which the Persians call 'pepper'; ibid 205 ; Vol. VIII. p. 394 ).

(4) Indirect Inference : Urine of cow

( X )

{go-mutra) is recommended as a therapeutic agent in fistula, in Vol. VI. p, 453 ; as a disinfectant wash for the female genitals and in s^rility in Vol. VII. p. 365 ; in fumigation and lotion in female diseases in Vol. VIII. p. 211. Cow-dung ( go-maya ) is recommended with aromatic sub- stances as a fumigation in female diseases in Vol. VIII. p. 119. ; bovine desiccated bile (go-rochana) as a vulnerary preparation for wounds in Vol. VI. p. 415 ; in a purgative compound in Vol. VI. p. 419 ; in pessary with myrrh and honey in Vol. VIII. p. 59,157,203,395 ; as a laxative drink with wine in Vol. VII. p. 425. The cow being regarded as the sacred animal of the Hindus, it can be imagined that her excretory products may be used in India as therapeutic agents, but their use among the Greeks who had no such passions, indicates their foreign importation.

It may be said that all the writings that are now included in the Hippocratic Collection were not the genuine works of Hippocrates (460 — 377 B. C. ). That may be so. We are not concerned with that problem. It suffices for our purpose to know that the Hindu thoughts influenced deeply the Greek medical literature in the fifth and the fourth century B. C. We do not yet definitely know how the Medical science reached

( x! )

Hellas ; perhaps by the Persian intermediatories, or dir^tetly by the Hindu settlers in the Persian Empire. '\We know that in 606 B. C. the Median king Cyaxares conquered Assyria and annexed to it the territories up to the coasts in Asia Minor where there were many Hellenic settlers. Cyrus, ( 559 — 530 B. C. ) the great Persian nation-builder, defeats Astyages and conquers Media in 550 B, C, defeats Croesus, the Lydian king, and captures Sardis in 547 B. C, conquers Babylon and Greek cities of Asia Minor in 546—539 B. C. His son Cambyses ( 529— 522 B. C. ) conquers Egypt in 527 B. C, by defeating the Egyptian ruler Psammetichus III or better known as Amasis, under whom were numerous Ionian and Cartan mercenaries. The empire of Darius I ( 522 — 486 B. C. ) extends from Macedonia to the Indus, and from the Danube and the Black Sea to Nubia; while in 512 B. C. Darius invaded Scythia, to subdue the nomadic hordes, his general Megabazus reduced Thrace, and a few years later penetrated up to the river* ^ Peneus in Thessaly ; the lonians revolte/d against the Persian domination, and with the assistance of Athenians and Eretrians, burnt Sardis in 499 B. C, which led to the Persian invasion of Northern Greece in 492 B. C. under

( xii )

the generalship of Mardonius, and of Attica in 490 B. C, which ended with the defeat fl^f the Persians at the battle of Marathon on S/^t. 12 — 490 B. C.

Siddhartha Gautama ( the Buddha 563 — 483 JB. C. ) entered into ^niroana' in 483 B. C. after a strenuous life of may years' preaching. In Mahavagga (1. 6 ; 1. 8 ) a very old Buddhist work of the fifth century B. C, we find descrip- tion of advanced medical treatment.

But the Hindu influence over Greece even goes beyond that period. There is every reason to believe that the Dionysos orgies were the import- ed Soma-Siva cult from India. Dionysos is a Moon-god like Soma. He introduced wine-culture ( and civilization ) into Hellas. The bull, the goat and the serpent are sacred to him. And he is represented like Siva, as accompanied by a leopard, and in Alexandrian time,riding on' a tiger {l^tiC2/c. Brit. Vol. VIII. p. 287). The Orphic reli- gion seems to be no less indebted to the same source. Abstinence from meat, fish etc., from ani- mal sacrifices, the wearing of a special, garment, the practice of austere asceticism, belief i% the transmigration of soul, and the soul will attain perfection, passing through various beings, and when it attains it, it will be free from rebirth —

( xiii )

*the circle of generation' ( kyhlos geneseos ), as the I5y)dy is the bondage of the soul ( Ency Brit. Vol. XX. p, 328) — all these unmistakably indicate pre-Buddhistic Indian origin, whei^e these doc- trines have been indigenous, and are still believed by the multitude. Arthur Lille in his *Itama and Homer' argues that in the Ramay- ana, Homer found his theme for his great epics for the following reasons : (1) Like the two inseparable brotliers in the Ramayana, llama aTi'l Laksmana, in the story of Menelaus, thor<' are also two inseparable Greek brothers. (2) Rama and Laksmana liave been banislied by the conspiracies of a stepmother while the Greek brothers are banished from Argos by their usurping uncle Tliyestes. (3) Sita is born of a swan's e^^ ( Brahma's emblem ) in a furrow, Helen is also born from a swan's egg left by her mother, Leda, the swan, and Helen emerged from her egg in a 'yperwon' which means a furrow. (4) At tlie ^svaymvnra' Kama defeats all the competing princes, and Slta ohooses him as her husband, and in Greece, Men^laus is made to defeat all tiie competing prir/ces, and wins Helen, though neither a competing tournament for winning a bride, nor the choosing of a husband (svai/amvara) was

( xiv )

customary in Greece, and tbey were time- honored institutions in India. (5) "Whilst E^ma is away, Sita is carried away to Laiika/across the sea ; likewise Helen is carried away across the sea to Troy. (6) Vibbtsana from a high hill points out to Rama the principal warriors- of the forces of RiLvana ; Helen points out to Priam tiie chief Greek captains, after nine years of war and who came to rescue her. (7) The arrows of E,avana and the arrows of Hector come back to their hand after their flight. (8) As Hanuman with a mighty shout daunts the whole of the army of Ravana, so Achilles with a mighty shout daunts the whole of the Trojan army. (9) The heavens rain blood as an omen of the coming death of Ravana, and when the favorite son of Zeus, Sarpedon, is about to die, Zeus and Hera see a shower of blood falling on the battle-field. (10) The Hindu besiegers fare badly in the early encounters and Kama proposes to bring the army back to India ; the Greek besiegers fare badly as well and Agamemnon proposes to carry the army back to Greece. (11) In the Ramayana the !lft,aksVsas are depicted to be as big as mountains ; M^ rs,, when thrown down by angry Pallus who flings a rock at him. covers seven acres with his

( XV )

gigantic body. (12) In the Hindu epic, the gods aM the demons gather round to watch the crucial l)attles between the paramount chiefs E-ama and Ravana ; in the Iliad, the opposing gods also crowd round to watch the course of the battle, though the chiefs are not paramount, nor the encounter crucial. (13) Kuvera, the god of wealth, and ^iva, the god of death, throw dice ; in the Iliad, Jove suspends golden scales. (14) When Sita makes her determination to starve to death, Indra comes down and gives her the *amrta* — the immortal food ; when Achilles is of the same frame of mind, though he was not a Avronged party, Jove sends down Minerva with the ambrosia for him. (15) Vibhisana is the wisest denizen in Lanka ; Antenor has the same reputation in Troy. When Havana is about to kill Hanuman, the ambassador of Rama, Vibhisana remonstrates and saves his life ; when Menelaus and Odysseus came into Troy as ambassadors, they would have been killed, but for the intervention of Antenor. Vibhisana . advises Havana to give up Sita ; Antenc^ advises Paris to give up Helen. Vibhis'.Ana conspires against his country with the enemy, shows the enemies how to pass the sea, reveals the secrets of the ^chaitya^ of

( xvi )

Nikumbhila ;A.nteaor also plots secretly against his own country, and advises Ulysses t6 seize the Trojan Palladium, and make the 'wooden horse. Vibhisana, after the death of his brother and the capture of the city, becomes the crowned king of Lauka ; Antenor founded a new kingdom out of the ruins of the old. (l6) E/araa is loaned by the supreme god, his chariot with the celestial charioteer — Matali, and the terrible missile ^Brahmasiras' which alone can kill the ravish er of Sita, and the fiend of the gods. Achilles, the avenging hero, not the wronged husband, is given the coat of arms from the anvils of Vulcan, the chariot with the deathless steeds of Jove, and the charioteer Automedon who alone can drive such steeds, but he lacks the terrible * arrow of Fhiloctetes' which alone can kill the ravisher of Helen, and instead of killing the foe, he is himself killed by that foe. (17) Inconsistency and the lack of unity of the Homeric plot, and the invulnerable logic and conclusion of Valmiki's story : cattle- stealing and wife-stealing being ^ Mien the prevailing custom in Hellas, and Helen^being carried off by a fop, and not a fiend of the^gods, it could hot have precipitated a war between two peoples.

( xvii )

'JDhen the question arises as to the age of Sus'r^^ta and Charaka Sarnhitas, and that is very- hard to determine with any positive certainty. All that we know is that the great Buddhist scholar Nagarjjuna revised the old Sus'ruta, and added to it the supplementary section ( uttara- tantra ), IS agar jj una was a leading director -of Kaniska's Council that was held about 78 A. D.. He salutes Susruta in the beginning of the work ( Susniia I. I ) with Brahma, Prajapati, the Asvins, Indra, and Dhanvantari. It must have taken centuries to have made Susruta a mythical figure, and to be classified with the gods. Charaka Is mentioned in the Chinese Buddhist chronicles, as the family-physician of the Indo-Scythian king Kaniska ( about first century A. D. ), and who attended at a difficult child-birth of his wife. But Charaka is a family name, and there is an old Tedic Charaka school, known as Kapisthala Charaka (I. 1. 3). The internal evidence of both "the works indicates . that they were composed in pre-Buddhistic times, though there are numerous interpolations of a later ase. The ' Sutra-sthana* ( Section of General Principles ) and the metri- cal portions which are more or less explanatory, seem to be later additions. Not only do the prose versions resemble the Brahmanas in composition,

(• • • •

XVlll )

but all the gods also are post-Vedic, and the common use of meat, especially beef ( Charaka I. 2./<18 ; Susruta I. 46. 89 ), points out to apre-Buddhistic age. The osteological nomenclature used in Susruta is almost identical with that used in Atharva Veda (X. 2 ), and in the Satapatha Brahmana ( S. B. E. Vol. XLIV. p. 164 ). It is possible that the sage Yajnavalkya whose name is mentioned in the Brahmanas, and in association with the King Janaka, the reputed teacher of the 'Vajasaneyi Samhita* ( the White Yajur-Veda), and the Law-book is the same person, and he lived about sixth century B. C. And the King Janaka of Mithila might have been known as ^Kasi-raja* and Divodasa. It may be said that the Hindu medical science could not make such a rapid advancement from the primitive magic charms and sorceries of the Atharva-Veda period, which has been put at 1000 years B. C. It is true that the ^Ayu?'veda' (medical science) claims to be a branch of the Atharva-Veda, as the priest is the successor of the magician, and the medi- cine-man is a magician priest. But the Atharva Veda contains many of the oldest superstitions of the Indo-Dravidian masses, and they did 4iot become embodied in the E/g-Veda, simply because they represented the attitude of the masses rather

( xix )

=than that of the nobility. And whenP^ disease hoary with age, they became entitlee^^^^^^^^y

and became admitted in the sacred booP^" more

raka is older than the Susruta, for in ^ ^^ ^^^^ description, physiological explanatior^®^^^^^ classification of subject-matter, in the i ^^ ^^ language and in the therapeutic techniqW;^ ic represents a more ancient school. As there are many passages that are common,it seems that they were borrowed by the latter from the former.

In the following pages, I have tried to inter- pret and explain the Ancient Sindu Medicine principally based upon Charaka and Sus'ruta in modern medical terminology. Translation is an ungrateful task, especially of technical subjects, written nearly twenty-five centuries ago, their modes of expression being quite different from those of the present age. However, I have tried to be as careful and accurate as possible. The translation could be much improved bv transposition of words, or outstretching their meanings. I have preferred accuracy to dic- tion, ahfl I have often sacrificed, whenever it has ^ been necessary, a good literary form, to mai:e it as true to the original as possible and to reflect its meaning.

Yet it is very likely that some of my inter-

I ( XX )

pietations rray not find ready acceptance in inany ortlit^dox quarters. But sooner /it is- realized, ijj will be better for the communal * health, tlmt the ancient medical works can not S>':?rve us /to-day any other useful purpose than AtisuppKy rich materials for the cultural history ^r-liib race. Its. prolific vocabulary might be also profitably utilized to create a National School of Medicine, for continuity of historic consciousness activates and acts as a stimulus for progress. And it is well to know and remember that many of the medical books before they come from the press need revision to be up-to- date, and most of them, before thev are ten. years old, are almost antiquated. Bacteriology, micro-biology, chemistry, bio-chemistry, non- irritant antiseptics, prophylaxis, serum-therapy,, organ o-therapy, skiagrapy and the mechanical appliances have completely revolutionized dur- ing the last generation in method and technique ^the treatment and preventio7i of disease^'' which is the object of Medical Science {Susruta I. 1»

12 ). Our very great achievements, 'in the past, which we have every reason to be pi'oud of, instead of inspiring us with the greatest eifyrts to lead in arts and sciences, should not mortgage our future to the Dead Fast. For a race that does not take the utmost care and the most

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advanced methods for the prevention of disease and the preservation of health, can not effectively compete in the struggle for existence, with more forward races, and succeed in the survival of the fittest. Health is tlie foundation of all wealth and progress. We can not afford to cling to an empty shell, carry the dead weight of the past on our back, sacrificing our future, unless we want to be counted with the extinct races.

At the other extreme, there may be some who will contend that I have made a free ride on the wings of imagination, and there could not be such an advanced medical technique in the remote past. I want them to follow closely the original text. 1 suffer from no national hypnotism or megalomania. Exaggeration, on the other hand, I believe, is apt to lower the intrinsic value of a thing. Have I been sub- consciously influenced by the sense of the grandeur of the country, as an expression of suppressed or subdued patriotism ? I leave that for the readers to judge. I have always believed .that in ancientness — Egypt, in social polity T-China, in art — Greece, have nobler records of fundamental value than India can boast of. I admit, with all her faults, I love my country. I take pride and glory in

( xxii )

her past achievements. Tremors of her new awakening from the slumber of centurifis, have sent me joyous thrills, made me vil^rant with emotions and intoxicating dreams. And I live to see that she will contribute her share, worthy of her past, promising of a bright and brighter future, to the advancement of Human Civiliza- tion, and take her leading place in science and culture, and in the Council of Nations. But when studying history, intellect should not and does not need to be influenced by a gamut of sentiments and feelinsrs. and can be left free to exercise its supreme prerogative to judge facts as they are on their own merit. I have tried to keep that attitude of my mind — not to corrupt my intellect with emotions. In studying the medical historv of India one should not be misled

» 9

by the prevailing pathetic condition, — lack of hygiene, vicious dietary of the rich and the poor alike, ignorance and ineptitude of the medical practitioners, and the credulity of the public, for progress is not always steady and continuous. Except in the application of the mechanical ; developments and the appliances of machine power, modern nations have hardly made any further advancement in pure arts and literature than the Greeks. Medieval Europe, after the

( xxiii )

destruction of the Greek States and the downfall of the^Roman Empire, sank deeper in superstition and ignorance. In medical science the name of Galen ( Claudius Galenus 130 — 201 A. D. ) remained as the only supreme authority in Europe up to the seventeenth century, and in the Saracen empire up to the fourteenth century. The Arabs formed an eclectic school of medicine out of the synthesis of the Greek and the Hindu systems. In India medical science had its highest expression under the Buddhist rule when the relief of pain, human as well as animal, was regarded as a state religious duty, and hospitals were built in every important locality for men as well as animals. In the famous Buddhist universities of Taksasila and Nalanda, there were thousands of students from all parts of India and Outer-India who went there to study medicine alone. With the downfall of the Buddhist states, and the dispersion of the monks, whose principal duties were to administer to the sick, the acquired knowledge virtually disappear- ed from India, and healing became the profession of the mendicants by magic charms and incantations, or of the quacks, charlatans and barbers.

It is possible, however, that though I have

( xxiv )

been careful in the selection of the equivalent scientific terms for the Sanskrit, a few/ minor ones may need revision. I have labored under great disadvantages. Though New York Libra- ries are splendid institutions, and grant liberal privileges and easy access to the books, there are very few books on Indian Medicine, and I have not been able to avail myself of any book on the subject. Moreover it is very hard to write competently for one individual on all subjects dwelt on in Charaka and Susruta Sarah itas, and as they are the product of a medical assemblage — the collected wisdom of the sages that gathered together from all parts of India, as the drugs clearly indicate, and Agnivesa and Susruta might have simply acted as secretaries (Charaka 1. 1» 3), so their interpretation could be best done by a medical association with competent depaT'tmental heads on all subjects dealt with ;in those works. Mine has been simply a pioneer attempt, knowing not whether this task has been undertaken by any efficient Indian medical organization, and I, have had to work single-handed, without any advice from any source. This, I understand, can te no excuse or justification for any misleading statement or false conclusion, and I shall be

( XXV )

grateful to my readers to have them pointed, out. N

Eor transliteration, I have used the following method : —

3T=a ^=sk ^=d Jissm

3rr=aora^=:kh s = dh ?T=ry

5=1 *1 = g ^= n ?: s= r

t = i i*, or i 51 =r gh ^ = t S = 1

^=ru ;§:=n q=:th gs=v

3»=uorugs=ch ^=sd ^=s

I? =s e s ss chh ^=r dh ^ =s s

^=ai 3T=:j ^ = n H=ss

sftsrO 'Ksjh Tsrp ^=h

sftsau 3T=rn <T;=rph *=ip 3R[=r z=t ^=rb :=sh

5S= 1 S = th ^= bh

I regret very much that it will not be possi- ble for me to add an index to this book. This woris has already taken more than double of the time I anticipated it would require, and the pressure of other works does not permit

( xxvi )

me to devote more time to it. Under these cir- cumstances, I beg leave to bring to a conclusion the arduous task, I so light-heartedly undertook.

July 22—1922 364 West 120th Street, C. CHAKRABERTY

New York.

AN INTERPRETATION

ANCIENT HINDU MEDICINE.

ANATOMY.

The ancient Hindu physicians lacked pro- found and accurate anatomical knowledge. They have left more or less superficial, vague and imaginary description of the liuman anatomy, as found in their treatises, except in osteology. There is nothing astonishing in this. The Hindu medical science developed in the Buddhistic period for alleviation of physical sufferings. The Buddhists regarded all life as sacred. They naturally regarded with horror the idea of inflicting pain, and of depriving an animal of life for experimental medicine. In a tropical climate, as a hygienic measure, cremation of the dead has been ordained as a religious duty from misty antiquity. So there was no regular chance for human dissection and to acquire tlie exact

3 ANCIENT HINDU MEI'ICINE

knowledge of human anatomy. "Whatever tnow- ledge they acquired, they obtained it from personal observation and expSrience^ from caring for the wounded and disabled on the battle-tields, from a comparative study of the animal anatomy from the sacrificial animals in the pre-Buddhistic period. There is no record of the custom of human sacrifice, except the legend of Sunahsepa [Aitareya BraJimana, VII.3), as the act was repudiated by all presiding priests of the Kajastiya ceremony. If it was a mock-belief as a reminiscence of the remote past, it, however, clearly indicates that human sacrifice was no longer countenanced by the Vedic priesthood and was not practised in the post-Yedic Sutra period. Tlie students of siirgery were taught the technique of instrument- al operation on dead animals and vegetables, as water-melon, cucumber, pumpkin, gourds or skin-bags filled wdth water {Siimnita, I, 9. 2-5J. Under these circumstances, proficiency w^as not possible.

Neither in Greece Avas it better. In the time of Hippocrates, the anatomical kno.wledge was very defective and superfi.cial. No differentiation was yet made between the arteries and the Veins and both were called *phleps' — blood-vessels.

ANATOMY 3-

Howe^ver, this distinction was made by Polybus^ but on the whole his anatomical and physiological knowleclge was erroneous. But Aristotle (B. C. 385-322) by his comparative study of animals, laid the foundation of positive anatomy and physiology. In his ^Ilistory of Animals,' he devotes two-fifths of the work, the first four books, to the structural constitution of animals. He synthesizes all the knowledge of the time on the subject and corrects many inaccurate and misleading impressions of his predecessors. But he confuses, like Charaka and Susruta, bones- with cartilage and ligaments. He had vague ideas about nerves {neura) and identified them with the tendons, arising from the heart and he regarded the aorta as tiie nervous vein {neurocles- phleps). And the human anatomy was not studied with experimental observation and dissection before the famous Alexandrian schools attracted the best intellects of the age under the patronage of Ptolemy Soter {B. C.323-282), Erasistratus and Herophilus were both celebrated anatomists of antiquity. They acquired a to- lerably soulid knowledge of the organs and their Junctions, not only by animal but also by human dissection and experimentation. Erasis- tratus found out that the nerves originated from

4 ASCXESnr HINDU MEDIdNIE

the bTadn aad Heiophiliis distiiigtushed them' into those: of sKEisilioii and Tolantaxy motioii. Hero- philos also wrote a treadse on the liTer.^Trhich Galea has transaEuitled among his nmtmgs. Galen ilSO-200 JL J>,\ the reaUy accmate anatomist of ■antiquilhr, went to Alexandria to stndy medicine under the fomous analomisit Heradianus, and Claiiii:. > us of Pergamum c»n be called

th : - :v:ict medieal sdenoe by bis Tast

^r V research and hk accoiate

'w.„ _ . , - - . ; : j: < -1 :i - ii, :: i no wonder, for gen^a- f^^^-?. bis writings v ? held nncballenged -*ty both in E r ^ind Asia^ Tbe Arabic sc of medicine D^arded bim almost aa

.iwie.

. odotos {£. C, ^^4-4^7) mentions in lis L. > :y IL S5, that the Egyptian medical pro- f essioiA WHS Tenr advanced and learned, and it specialiaed in dilfiarent diseases. But tbere is laothiQg 1^ bnt a fragment of paipjros of the sixt^entb centoiy B^ C. to indicate the extent of the medicil knowledge of the ancient Egyptians. J^si llnis papyrus^ it is found that the heart, ves^elSfe liTer, spleeo, kidneys, metezs and bladder wexe Fdoosniaed and the blood T^sek came fitom the bexrt. Ibesr Tassels are d^^bed, some ^uriyiDg air, some mucus, while two to the

ANATOMY 5-

right ear are mentioned to cnrrv tlie breatli of

life iwd to the left ear, the hreath of deatli.. (Journal ofAnatomi/ and Physiology, vol. XXXIL P. 775). Even in tlie third millennium B. C. th& Babylooians possessed quite to a praise-worthy extent the knowledi^e of the liver which they regarded as the seat of life. The Chaldeans used the liver of the sacrificed sheep for the- divination of events. In tlie code of Hammurabi- about 1900 B. C. it seems that the Babvlonian medical art had already attained a marvellous^ efficiency, as the operation on the eye is men- tioned with bronze lancet as a regular profes- sional daily business. And a successful eye> operation is not possible without a thorough anatomical knowleds:e of its structure.

^ ANCIENT HINDU MEDICINE

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ANATOMY

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AKATOMY

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12 ANCIENT HINDU MEDICINE

"With teeth, sockets of teeth and nails, there are altogether 360 bones in the whole of t\if.(htim(m}' body. As the following : — sockets of teeth 32 ; nails 20 ; long bones of hand and feet 20 ; their bases 4 ; bones of fingers 60 ; heels 2 ; bases of the feet 2 ; wrist bones 4 ; ankle-bones 4 ; in the fore-arms 4 ; in the leg 4 ; knee-caps 2 ; elbow-pans 2 ; in the thighs 2 ; in the arms 2 ; collar bones 2 ; shoulder-blades 2 ; palate bones 2 ; the pelvic ring 2 ; ilium 1 ; sacrum 1 ; coccyx 1 ; back-bone 35 ; neck-bones 15 ; trachea

1 ; jaw bones 2 ; bases of the jaw bones 2 ;, parietal 2 ; malar 2 ; nasal bones 3 ; ribs ; 24 ; thoracic ribs 24 and sockets of the ribs 24 and altogether on the sides 72 bones ; temporal bones

2 ; frontal craniun 4 ; breast bones 17 ; altogether three hundred and sixty bones."Cha'raka IV.7.4.1

1. Charaka IV. 7. 4 cfif^ ^ferf^^lf'T aRTT'^T^t ^f ^5^^^^,^^'*. 1

^r<^qT?3r7rnjfT:, '^c^Mif^-^pf.^wt, =^^tk qifw^r^rl^, i5tf%^^- f^^^p^cf^ T?T%, i^^Tcrrm tTgr^'^w, i:i^^5n^i1% ^l^rat, f

ANATOMY 13

*• According to the medical men, there are 360 bones, but in surgery 300 bones are enumer- ated. Qf these 300 bones, in the branches, that is in both the arms and feet, there are 120 ; in the pelvic region, back and the breast, there are 120 ; and above the trunk 63 : altogether there are 300 bones in the human body.

"EoUowing are the 120 bones in the branch- es : — at every finger of the foot, there are 3 — so 15 ; the foot-support {77ietatarsus) ^ the ankle- bones and their base 10 ; heel 1 ; in the leg 2 ; in the knee-cap 1 ; in the thigh 1 ; so in one foot there are 30 bones : so in the other foot and arms.

"In the pelvis 5 as coccyx, ilium, pubis 4 and sacrum 1 ; ribs 32 one side and the same on the other ; back-bones 30 ; in the breast 8 ; shoulder-blades 2.

•'In tlie neck 9 ; in the wind-pipe 4 ; jaw- bones 2 ; teeth 32 ; in the nose 3 ; palate 1 ; malar temporal and ear bones 2 each ; in the cranium G." Susruta III. 5. 17-20. ''

Susruta III. 5. 17-'-^0 ^tf<!J ^R^1^p!?mcTTf^ t^^tTf^'Tf W^ff\ I

^■^ II ^^

^^jii% vTeff^ I , q:^%cK^^f^5fi^ ^ ^\m\^ II \^

14 ANCIENT HINDU MEDICINE

"The bones of the hand are 27 ; of th^ feet 4 ; of the neck ujd to the grand {bach-hone — shoulder blades) 7 ; pelvis 5 ; back-bon'es 20 ; the head with eyes 8 ; in total 91 with the nails 111. As to man, the hones we have ourselves learnt to know are : — the back-bones above collar-bones with the grand (shoulder-blades) 7 ; the back-bones as well as those of the sides {inbs 12 ; the back-bones that go farther the ribs in the pelvis 5.") Hippocrates : The Nature of Bones, I. {Peri osteon physios).

From the above comparative table, it is evident that the Hindu anatomists, especially the Susruta school, had a tolerably sound know- ledge of osteology. The discrepancies in the figures are due to the fact that the Hindus counted the processes, cartilaginous structures and the teeth as bones. But they classified the bones into five kinds according to their nature of constitution. {Susruta III. 5. SI). The nails — the epidermal formations were dismissed by Susruta as bones. If the teeth were counted in the skeleton, it is because the teeth are bone- like, hard and strong. Histology is '^a recent science and it could not be known in ancient times that tooth is a calcified papilla of the mucous membrane. If the cartilages, especially

ANATOMY 15

the V?ostal cartilages of the ribs have been counted as the bones, it is because in the embryo^aic state all the bones are in cartilagi- nous condition and in certain diseases, the costal cartilages become ossified. Sus'ruta counts 30 as the dorsal and the lumbar vertebrae, for the reasons that the spinal column really consists of 33 irregular bony segments of wliich the upper 24i are separated during life by discs of spinous cartilaginous articular processes, and are therefore called "true" or "movable" vertebrae, in distinction from the lower 9 whicli are called the "false" or **fixed" vertebrae, for they become consolidated into the sacrum and the coccyx. The Hindu anatomists counted the constituent bones of the sacrum and the coccyx as separate bones as well as the spinous processes, belonging to the vertebrae. While the modern anatomists designate as vertebra the upper 24 loose bones, consisting of the *C(}rvicar 7, 'dorsal' or 'tlioracic' the succeeding 12, and the 'lumbar' the lower 5. The Hindu anatomists enumerated the cervical vertibrae as the 'griya' or neck bones, adding also to it the hyoid bone. In the wind-pipe (kanthanal'i) tlie 'four cartilages — cuneiform, arytenoid, thyroid and cricoid, were counted as bones. The

16 ANCIENT HIKDU MEDICINE

breast-bone is given by Susruta to be 8, f/>r be iucludes among the breast-bones the 2 collar bones and as the sternum really consi'sts of three parts, the 'manubritim* which usually remains separate throughout life from the rest of the bone, the cartilaginous 'metasternum* and the *corpus sterni' or 'mesosternum' which is formed by the fusion in early life of four segments.

So if we try to identify the nomenclature and designation of the ancient Hindu and the modern systems of osteology, it becomes clear that the Hindus had acquired a sound knowledge of the human skeleton. And the term 'skeleton' [from the Gr. sheletos = dried) is applied to the parts which remain after the softer tissues of the body have been disintegrated or removed and includes not only the bones ,but also the cartilages and ligaments which bind them together ( Cunningham : Ancdomy, p. 67). In tliis generic sense the Hindus described their bony frame-work, but classified the bones into five kinds according to their composition as fiat (kapcUa)^ tooth (7'iichaka)^ tende^r (tmnma), strong {halaya] a,nd liollow (nala/ca) bones.

(3) "Tliese bones are of five kinds as thefo*ilow- ing: — 'flat' bones, 'tooth' bones, *tender' bones,

ANATOMY 17

J^strong' bones and 'hollow' bones. The bones of the kn^e, pelvis, shoulder, malar, palate and the head are flat bones. The teeth are ot' 'tooth' bones ; the nose, ear, neck and tlie eyesockets are of 'tender' bones. Those of the hand, foot, sides, back and breast are of 'strong' bones. The rest of the bones are 'hollow'." SusriUa III. 5. 21. ^

11. Arthiiology.

In Arthrology^ that is, in the description of the articulations or joints ( Sandhi ), Susruta shows also remarkable accuracy. "Joints are of two kinds — 'movable' {diarthroses) and un- movable (amphiarthroses.). In the four branch- es (hands and feet)^ in the jaw-bones and the loin, the joints are movable and the rest of the joints, the wise should regard as permanent (that is, of partial or incomplete movement).

"There are 200 joints in the body. Of them 68 are in the four extremities, 59 in the trunk and 83 above the shoulder (that is, in the neck and the head).

— » . ■■—■-- — — '

'B'^I^ II ^l Susruta III. 5, 21« 9

18 AKCIENT HINDU MEDICINE

"In every toe there are 3,except the grekt to© (correspondino;- to the thumb) which has two jo- ints, thus 14(4 X ?, + 2 = 14). The knee, ankle and hip has eacli a joint. So one foot has 17 joints ; the other foot likewise, as well as both the arms.

"In the pelvis 3 ; in the spinal column 24 ; in the sides {ribs) 54 ; in the breast 8 ; in the {vertehral-cervical) neck 8 ; in the trachea 3 ;. in the conjunction joints of the heart and lungs lS{hrdai/aklomanibacIdha); in the sockets of teeth 32 ; 1 in the thyroid cartilage {kakalaka) and one in the nose ; 2 bettveen the eye-sockets and the eye- balls {dvauvartmamandalau netrasrayaii). In the malar, temporal and the ears 6 ; in the jaw bones 2 ; on the top of tlie brows 2 ; in the craniun 5 and 1 in the forehead.

"These joints are of eight kinds as: — gynglym- oid (kora — a hinge joint), enarthrodial (tidukhala = mortar-like in shape ball-and-socket joint)^ enarthrodial {samudgarzcu^-\\\ni), costo-vertebral (|>ra^<2ra= raft-like), circular (mandala)^ sutural {ttmnasevan'l= ^^^\\ng) and ^^vci'^hy^io, {conch-shell like) joints. Intcrphalangeal {gynglymns-&{m^\Q hinge joints, surrounded by a capsule), radio- carpal {condyloid-ellypsoidal), the ankle-joint {gynghjmus), the knee-joint {c)ynglymus)y the elbow- joint {gynglymus) are all 'kora'\ the shoulder-joint

ANATOMY 19^

{enarth7'odial-ball-and-socket-joinf), the hip-joint, (enartlirodiar), teeth-sockets [sy fiarthrodial-imm ov~ able ?)^aYea,lViidukhala ; the sterno clavicular joint {diai'th'odial'fveely movable), sacro-iliac joint (Ji- arth7'odial)^sjm])hysis pubis {amphidiarthrodiul-^ a combined gliding and hinge joint), and lumbo- sacral joints {amphidiarthrodial) are ?i\\{sdmudga) \ cervical, dorsal and lumbar vertebral joints (limited amphidiarthrodial) are ^pratara' ; the tem- poral and the cranium joints (sutural) are tutma- sevanl ; trachea, heart, eye and lung-joints are mandala ; the ear and the nose joints (symphysic) are sankhavartta. According to the shape of the joints nomenclature has been fixed. Only the joints of the bones have been described. The joints of the muscles, nerves and arteries are countless". Susruta III. 5. 23-29^*

3a. 3nw^ ^^ ^R^r^ =C^T^^^ ^^^\ I

«yi<94ici1 II lai

20 ANCIENT HINDU MEDICINE

III. Myology

In myology, the muscular system, thougli Susruta at first appears to be fantastical and vague, yet by comparative study, it can be easily seen that notwitlistanding imperfection and clumsiness, there is some fundamental truth in the statement. Sasruta mentions 500 muscles {pesL) wliile Steadman's Medical Dictionary gives the names of 427 muscles. It is possible that Susruta duplicates many continuous muscles and omits many deep-underlyingmuscles, especially of the upper part of the body.

Muscles accoi'ding Muscles according to

to Susruta. Cunningham's

Anatomy.

I, The Lower Exremity Toe 3x5 = 15 3^

Pore foot 10 7

Ankle & Sole 10 9

Heel 10 2 tendons and

2 ligaments. f 25

Leg 20 12

Knee 5 3 tendons and -

4 ligaments. J

■ Leg and foot

ANATOMY

Thigh •

Thigh buttock

and

Groin "*

and 2 lio-a-

ments.

100

II. The Trunk of the Bodv

Pelvic region 3

Penis Spermatic cord 1

Testes 2

2 Ischio-coccygeus anp Levator Ani ; but the 'Levator ani' is divisible into 4 parts. 1 Erector 1~] Perineum 12 penis

1 Spermatic cord passing i throus'h 'cremaster*^

Bladder Stomach

2 6^

Breast

Abdomen

Navel

10. 6 1

•

Shoulder Back

. 7 16

Buttocks

2x^

1 1

Thorax "j 12

muscle.

Dartos muscle in

scrotum.

Compressor TJrethrae

!> Anterior muscles of 3 I the Trunk 19

-J

16 There are 16 super- ficial and and 15 deeper muscles in the back.

ANCIENT HINDU MEDICINE

Heart and Colon 2

3 myocardium and mas- culi papillares tunica muscularis (colon).

in. The Neck and the Head.

The back n

Jaws

Thyroid

Tongue

eck 4 2x4 = 8 1x2-2

5 3

Cheeks Nose

Front neck Eye

Forehead Palate

1x2-2

5 5/

Thyro-hyoid,Stylo-hyoid and Steruo-hyoid. or 8. The'extrinsic mus- cles' : genio-glossus,hyo- glossus, styloglossus and palato-glossus. The 'in- trinsic muscles' : supe- ^rior lingualis, inferior lingualis, transverse fi- bres andvertical fibres. The mouth 11 (eleven)

The top of the

he;)d 1

Ear 2

2-1-2=4 10

1x2 — 2 7 in the orbit and 4 in the eye-lids.

4 Eront- \ alis 1

2 Occipi- talis and

Trapezius2 ^

The scalp 6

Epicranial Aponeurosis

ANATOMY 23

)lY. The Female Reproil active Organs

Mammae 5x2 = 10 5 Pectoralis major, serra-

tus magnus, liga- ments of Cooper, apo- neurosis and recto abdominis muscles.

Vagina 2 + 2 = ^ 2 + 3 = 5 Tunica muscularis,

rugae vaginales, and (common bulbo caver- nesus, sphincter ani, extern eus levator ani and erector clitoridis ^ erector penis).

Uterus 3 3 Ligamentum latnmi

uteri (broad ligament), ligamentum teres

uteri (round ligament) and the muscular 'corpus uteri'.

Pallopian tube 3 3 Tunica muscularis,

ligamentum ovarium proprium and meso- varium.

"adhere are 500 muscles [pesl]. 400 of them are in the 4 extremities, 66 in the trunk, and 34 ^bove the shoulder (in the neck and the head).

24 ANCIENT HINDU MEDICINE

**Tlie toes { imdahgull ) of each foot have 15 muscles, having 3 muscles for each toe ;, 10 in the fore-foot {padagre) ; 10 in the heel {hurch- cJia) ; in the ankle and the sole (gulpha-talayoh) 10 ; between the ankle and the knee {gulpha- janvantare = Ieg) 20 ; 5 in th^ knee (janu) ; 20 in the thigh {uru) ; 10 in the groin (vanJcsana) : thus in one foot there are 100 muscles ; so in the other foot and the two arms.

*'In the j)elvis {payn) 3 ; in the penis {medhre)

1 ; in the spermatic cord {sevcm'i) 1 ; in the testes (vrsmi)' 2 ; in the buttocks (spJiicha) 5 each ; in the upper part over the bladder {vasti-sirasi) 2 ; 5 in the stomach (udara) ; in the navel {nabhi) 1 ; in the upper back {prsth- ordha) 5 longitudinal {muscles) on each side ; in the sides(of the spinal column =parsvci)Q ; 10 in the breast (Vaksa) ; in the shoulder (aJcsahamsa) 7 ;

2 in the heart and colon {hrdayamasaya) ; 6 in the spleen, liver and the lower intestine {yahft- pllha-imdul'a = abdomen).

*'In the back part of the neck {grlvct) 4 ; 8 in the jaws {hamt) ; in the thyroid .cartilage {kakalaJca) 2 ; in the palate {tahi) 2 ; in the tongue {jihva ) 1 ; in tlie cheeks 2 ; in the ^nose (ghona) 2 ; 2 in the eyes {netra)-^ in the front neck {gan a) 4 ; in the two ears {karna) 2 ; 4 in

ANVTOMT 25'

tlie forehead {lalata) , and 1 {one) on the top of the head {mrasi).

*'A woraan has 20 more muscles than man : 10 in the two mammse {sterna) at 5 each, which are developed in adolescence ; in the vagina {apatyapatha) 4. two in the entrance and two in the interior ; in the uterus {garhha-cchidrd) 3 and in the fallopian tuhes {sukrm'ttava-pravesa)^^ the muscles are 3.

"According to the position, the muscles are grouped together {oahula), isolated {pelava), thick {sthula)^ thin {stihsma), extensive {prthii)^ glohular {vrtta= tendon), short (/^r«s?;a), long- cylindrical {dlrgJia), hard {sthira), soft {mfdu), smooth {slahsm = nn^tYmted, that is primitive involuntary muscles), striated (lY^^'A-^sa-^oluntary muscles with transverse stripes), and they cover the joints, bones, arteries and nervous fibres according to their respective needs.

"The muscles that have been mentioned of men in their penis and testicles, cover in women their interior reproductive organs."

: Susrtffa til. 5. 37-45/

4. TT^ ^T^hjfiTf^ vr^f^ I cfT€t ^c^rft 5TcfT(% ^jw^ I ^"s ^s^^fe: i

26 ANCIENT HINDU MEDICINE

Tlie difference betu'een Sus'ruta's 500 muscles and Stedman's 427 muscles, which if counted separately like Susi'uta on both sides of the body Avould amount to nearly 800 muscles, can be easily accounted for by the fact that not only the modern classification and nomen- clature of tlie muscles are different from the

"^ ^T<«IIcft II ^c

^^T^i§sT Trrs\if{ xf,^^7^il^ f% cfi: ii ay^ ii

ANATOMY 27

vancicn't Hindu system, but Susruta did not include^the tendons {mamsa-rajj ii) and ligaments {s'imanta) in the muscular order. It is evident from close comparative study that the Susruta school ot anatomv had tolerablv sound know- ledi^e of the human muscular system for all practical purposes.

Sns'ruta mentions 14 joints of more than 2 bones {samghata) which are held together by a band or sheet of fibrous tissue, which he calls *siincmta that is ligament. He enumerated them in the following junctions : — "Three are in each foot at the ankle ( a joint of iihia^ flbida and astragalus, held together by, — anterior tvbio-jibular ligament^ posterior tihio-fihular lig., taXo-iihulare anterias, calcaneo-jibulare, talo- fihidare 'posterius and ligamentnm deltoidenm)^ at the knee (a joint of i\\Q femur, tibia, capped by the patella, lield together by ligamentum patellae, lig. Posticum JVinsloioii, lig. collater- ale tibiale, lig. collaterale jibulare and ligamenta eruciata genii), at the hip-join t (of ^\^ femur, ilium and pubi>s, held together by lig. Transversum ncetabuli, 'lig. iiio-femorale, lig. fuhofemorale^ lig. fischlo-capsulare, and lig. teres femoris) ; so in th(} arns at the wrist (a radiocarpal articulation between the radius and the

28 ANCIENT HIxSTDU MEDICINE

scapJwid^ semilunar and cuneiform hones; held toi^etlier by the external lateral ligament, internal lateral ligament, anterior and i^osterior ligaments), at the elbow ( a joint of Jaimerus, radius and ulna, held together by the ante7Hor and poste^nor ligaments, lig. collaterale ulnar and lig. collaterale radiale\_ and at the arm-pit (the slioulder-joint of tlie head of tlie humerus, glenoid fossa of scapula and the coracoid iwocess, held together by labrumglenoidale, capsula articularis and liga- mentum coraco-liumerale). Accoding to others, there are 18 (ligaments). The above-mentioned 14, one at the pelvis (sacro-iUac joint of sacrutn^ ilium and pubis, held together by lig. sacro-iliaC' um anterus, lig. saerb-iliacum postonis hreve^ lig. sacro-iliacum posterns longu^n, lig. ilio-lumhale, lig. sacro-tiiberosum . lig. sacro-spinosu7n, lig. pubicum posteri7is,an terius,superius and inferius^^^t the upper-breast (sterno-claviciilar \pm\. of the ster- num -da^di clavicles held together by Zi^. stei'no-clavi- C7flaris and lig. rhomholdale) and the lower-breast {steimo-costal ]Qmi^ of the sternum and the seven costal cartilages held together by lig.' costo-ster- nalium radiatum, ligg. sterno-costalia interarticu" laria) and at the neck (scapulo-clavicular joint held together by lig. coraco-claviculare, lig^

ANATOMY 29

^onoicleum and lig. trajoezoideum). Susruta III. 5. 15-1@=

It is very likely that Susruta by 'simanta* means only the synovial capsule and the mem- brane which are usually found at the joint of more than two bones and which he calls 'sam- ghdta\ By tlie general term 'saudhi' he has designated the articular joint and which he has enumerated as 210 and tlie fibrous band which binds the bones at the joints together (ligament) and the muscles to the bones {tendons,) whether it is ligamentous or tendonous, he calls by the common designation 'snayu*-'io bind' and which he describes to be nine hundred (///. 5. 30,) And the large and strong tough fibrous longi- tudinal bands and chords are called ^Jcandara\

^^Kan^aras are 16 : 4 in feet {tendo acMli^ in the leg and semimarbransus tendon in the thigh), 4 in the arms {supinator longus tendon in the forearm, and the semilunar or hiceptial fascia tendon in the arm,) 4* in the neck {sterno-oleido- mastoid tendon^ memhrana tectora^ memhrana atlanto-oecipitalis posterior^ lig .cruciatam atlantis

30 ANCIENTHINDUMEDCINE

with cms siiperius and infejnns), 4 in the spinal column (lig. lorigitucli'.iale anterms^ li(j. lonyitudinale posterms, Iki.flavum^ and lig. supraspinale). The terminals of the "kandaras of the hand and feet are in the nails ; tliose of the neck passing through the heart terminate in the sexual organ (medhra) and those of the spinal column passing through the pelvis terminate in. the pubis." Susruta III. 5. 10. '^

c ' . Ligameuts

Susruta nT ■,

lendoiia

1. The Extremities.

Toe 5x6-30 27 + 5 = 32 Palmar hand

lig collateralia and svno- vial membrane at each interphalangeal joint, 2 in each toe and 1 in the large toe(^ x 4 + i = 5)and 5 dorsal extensor tendons. 5 Four ligaments and one

svnovial membrane 5 Pive tendons. 28 18 intratarsal ligg. and 10 s. membrane.

Leff 30 28

-»

Thidi 40 34

Hip-joint 10 8 + 1 = 9 Knee-joint 10 7 + B = ]0 150x4 = 600

«»-■ . ■ — — — ■ ■ ■

ANATOMY

II.

The Trunk.

Loin

Back-bone

71 Lig.

interspinalia, lig. siipra-spinalia, lig. flava— vel subflava and synovial membrane for each of the 12 thora- cic and 5 lumbar verte- brae and 3 common lio^a- ments for all. Sides 60 72 Lig. capituli costae radia-

(24 ribs) turn, lig. capituli costae

interarticulare and syno- vial membrane for each of the 24i costo-vertebral articulations, SO 56 Lig. costo-sternalium radiatum, lig. costo- xiphoidea, lig, sterno- costal ia interarticularia and the posterior costo- ' sternal ligament for each

of the l4 ribs (7 pairs)

230

32 ANCIENT HINDU MEDICINE

(

III. The Neck and the Head. ^

Neck 36 52 4 Ligaments for ''each of

the 7 cervical vertehrae, sterno-clavicular 1 2 and acromo-clavicular liga- ments 12.

Head 3l< 31 Occipito-atloid joints 2

and each is provided with

70 8 ligaments, membrana

atlanto occipitalis anteri- or, membrana occipitalis posterior, membrana tectora, lig. cruciatum atlantis, lig. alaria, lig.

apicis dentis, capsular

Total 900" ligament and synovial

membrane ; atlo-axoid joints are three, eacli supplied with 5 liga- ments, lig. trans ver sum atlantis, capsular, anteri- or and posterior atlo- axoid ligaments and synovial membrane.

Susnita III, 5, 30— 32«

, ANATOMY 33

It will be noticed that there is a marked dis- crepancy between the two figures. And it may- be due to the different methods of calculation and classification, or it is possible that by 'snayu* Charaka and Sus'ruta meant something entirely different from the ligament and the tendon. The general tendency of the Sanskrit scholars is to regard ^snayiC as nerve. But this is contradicted by its etymological derivation from *sm' or *si\ to bind and the Susruta mentions 210 joints, but does not say anything anywhere else of the binding material that holds them together excepting of 14 *simanta^ at the junc- tion of more than two bones (samghata). He could not possibly omit to mention the binding material of the rest of the joints, when he has been minute in every other detail. And more- over the internal evidence tends to prove that he meant by ''snayu\ ligaments and tendons as he says : — *'Smi/tis are of four kinds — branching (pratmiavatt), globular (vrtta), extensive (prthti) and perforated (susira.) The 'snayns' in the four branches aijd joints are branching ; 'kandm^as' (the large snayus) are globular; the ^siiayus' of the anterixir parts of the stomach, intestine and the bladder are perforated ; the *snaytis' of the sides, breast, back-bone and the head are extensive.

34 ANCIENT HINDU MEDICINE

"As a boat of wooden planks well tied by many knots, can bear the weight of aninials and goods in water, so a man can carry weight as his joints are knotted together by *S7iayus\ The body does not suffer as much by the destruction of the bones, muscles or joints as by the destruction of ^snayus*. The physician that knows well the internal and superficial ^snayus' can only extract from the body, the deeply impregnated missiles", "Susmta III. 5. 34r36."'

"The flesh (of the body) being tied to the bones by vascular system and *snayt{s\ do not tear out and fall down". Susruta III. 5. 22. '

^T*Hi<*'iaiiii«%i wt ^ ^fro: ^^ I

HKW?TT *?%q,l ^m ^?TTt%cTT II

^:^% sif^Tsf^jR ^■[^ri\•. ^73m\ ^^', \ wT^fiT^fk'V^T vrR^r?T ^Tj\ II

w. ^ra : irf%3irfTrfcf ^raww^rKreM i

€ '^^' ai^JTm TfT^^tf^ tf%^ 11^^

8. iTt^psm fiT^^Tf^ famfk: ^igf^T^Hn I

ANATOMY 35

IV. — The Vascular System.

The vascula7^ system (^im = tubular vessel) is no less difficult, rather more so, as it defies all hu- man ingenuity to describe it in tabulated figures Eor the arteries bifurcate into branches and twigs, and spread out all over the body in infinite shape and size ; the veins commence at the ter« minations of the capillaries and as they converge towards the heart, they form larger and still larger vessels, uniting with one another until finally seven large trunks empty their contents into the auricles of the heart ; likewise the lym- phatic and the nervous networks. Hardly two vessels are of equal length, size, shape and di- mension in two different parts of the body. Therefore any comparison is necessarily to be more or less of guess-work. In the following table only the large and distinctive longitudinal vessels have been counted from the * Atlas of Applied Topographical Anatomy^ of Karl von Bardeleben and Heinrich Haeckel and the *Begional Ana- tomy* of George Mo Clellan. It seems that Sus'ruta includes'the nervous net-work in the vascular system which he divides into four classes, nervous ( Voita — air ), venous ( pittaAdWQ ), lymphatic ( /feapAct-phlegm ) and arterial ( raHavaha-sira- blood-carrying vessel ). The identification of the

36 ANCIENT HINDU MEDICINE (

^vata^ pitta, kapha and raktavaha sb^as* wu-h the ■nervous, venous, lymphatic and arterial systems is not far-feclied and fanciful. For Sus'ruta says : — "Tbe'yaifa'-carrying vessels are of tawny or light-golden-brown ( mnma) colour, and are tilled witli air; */)?'^/a '-carrying vessels are all warm and of blue {n'ila) colour ; 'kapha^ bearing vessels are cool and of white ( sveta ) colour ; the blood-carrying vessels are of red ( lohita ) colour and are neither warm nor cold." III. 7. 13*''.

"There are seven hundred tubular vessels : as gardens by water-conduits and fields by canals are irrigated and nourished, so by the irrigating and draining action of the 'siras* the body is nourished and sustained. As the midrib of a plant -leaf gives off laterally countless veins, so from the main (siras) small and smaller branches spread out." Susruta iii. 7, 2\

Sa. cT^re'nr ^m^i: ^^ ^^ fsro: i

ANATOMY

n:j ' — <

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'=4-1 .^ C3 +^ "H

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The Four

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58 ANCIENT HINDU MEDICINE ^

"The nervous {vdta), the venous ( jol/^« ), lymphatic (kapha) vessels are 175 each as well as the arterial (blood-carrying slras) passing the liver and the spleen. Thus seven hundred 'siras^ spread out all over the body. In one foot, there are 25 nerve-vessels ; likewise in the other foot and each of the arms. There are 3i nerve-vessels in the trunk of the body : in the pelvic region 8, in the sides 2 each, in the back 6, and in the breast 10, above the shoulder, there are 45 : in the neck 14, in the two ears 4, in the tongue 9 and both the eyes 8. Thus l75 nerve- vessels are described. And this description also corresponds to that of the venous, lymphatic and the arterial (blood-carrying) vessels, with this exception that instead of 8 nerve-vessels in the eyes and 4 in the ears, there are 10 (in the eyes) and 2 (in the ears) of the venous, lymphatic and blood-carrying (arterial) vessels." Susrttta III. 5. 7. 5-7 ^^

ANATOMY 39

Thut the heart was the centre of the circu- latory Jtystem, of the hlood, was well understood by Susnita (1. 14. 3-()) and according to Charaka it has 10 out-going {a?'ferlal) and in-coming {venous) trunk-vessels (1. 30. 1).

"Though chyle [rrtsa] circulates all through- out the body, its principal centre is tlie heart {hrdaya). That chyle in 24 tubular vessels, 10 upwards, 10 downwards and 4< sideways, enters into every part of the body, irrigates and main- tains its growth, vitalizes and supports life

Though chyle is aquatic in nature but in its passage through the liver and the spleen, it be- comes blood. Susruta 1. 14. 3-5.^^

^T^ %gqt: 1 ir^ctfr iT^^^sif^^ajct ^TcRlTTt fw^t siT^TfW IK

^^ i^ fwni: ^T^T^tf^ I f^^ci^ fqrT^^ %^?'5i, ^'n'qlf i

Tli, ?:^^T: *i*=<^I^ I ^^cTlf^ ^TT f3!TT3raTf*T ^raHTITf^ aTT^^ncnr^T ll-Q

^fiprgrT^ra^'n: m({4 w\TM%v^m^f?[ ^^% v(\T^m ?iFraf^

40 ANCIENT hin;du medicine

*'Iii the heart there are ten great out-going:

Ol|C-o

aTtn\

[mahamida] and in-coming [mahaphalalftu.h\xlar vesseles [dhamam].'' Charaka 1. 30. l^^''. The ten great vessels are the seven main trunk veins and three arteries as follows : (l) superior vena cava, [2] interior vena cava, [S] coronary sinus, [i-7] vena jiulmonalis ; [8] left pulmonary artery, [9] aorta, [10] right pulmonary artery.

"Below the heart, on the left side the liver and the lung, and on the right side, the spleen and the lung, are situated.'^ S^ismta III. 4. 30^-.

According to Charaka the skin consists of six strata (IV. 7. 2)^" hut Susruta more accurate- Iv describes them to be seven. III. 4. 3^*.

w^f^H ^^ip:iiTriT ^^^^rf% ^r^r^^riiTTf^ ^% q^ -^^ ^mv,

14. c?^ W'i'^lfFri^ TS*aiir<Uci4f<|{iR=gjfri5ra =fi^<^ ^^f^l^T: «Tf

ANATOMY 41

Siu'ruta Strata of the skin according to

Modern anatomy

Avbhasini f Stratum corneum

Lohita m^ I Stratum intermedium! Stratum

Sveta S I Stratum disjuuctum i lucidum

Tamra ^ •{ Stratum granulosum

Vedini ^

Rohini P^

Mamsadhara

Stratum mucosum Stratum germinativum Corium

Erom the foregoing comparative charts, it will be seen, that though tlie ancient Hindu anatomical school erred in some details, hut in fundamentals, their l^nowledge was remarkably accurate, minute and thorough, especially when we take into consideration the dim and distant age, in which these medical treatises were composed. The study of anatomy was regarded essential in the medical education and practice. Charaka says ; — '*In the medical science, know- ledge of anatomy is necessary ; one can only understand principles of hygiene, when be has

^sfV^T^ I <lffTfT 5WT^' f^f^'^e rT5|Tt^^g=ITTO5 ; ^T ^mt WT-

42 ANCIENT HINDU MEDICINE

studied Ijodily sciences ( anatomy and physio- logy ) IY.6.V'\ r

Susruta recommends dissection. He says S "The parts and the parcels (of the body) that have been mentioned up to the skin, can not at all he described without dissection. So if a surgeon wants to aquire positive (doubtless) knowledge, he should analyse thoroughly all the parts and organs of a body, after disinfecting it. Occular observation easily supplements studies and adds to knowledge. (The way a corpse should be taken for observation is described thus). The corpse should possess all the organs and not be deceased of any long illness or of poisoning, nor should it be of a man of a hundred years of age. The contents of its viscera (urine and feces) should be removed and it should be kept in a stream without current to rot. A plat- form should be made in the water to lay the corpse on it and cover the whole body with hay, grasses and leaves, so that fish can not eat it, and it is not put out of its place. In seven days, it will decompose sufficiently and then rub it irentlv from the skin to the interior with

ANATOMY 43

grass, ;iaiL' or bamboo-skin and observe minutely every Morgan and every part of the body. Smruta, III. 5. 49-50''.

In the Hippocratic collection of writings, though there is no systematic presentation of muscles, ligaments, blood-vessels and glands, yet their knowledge and position are clearly indi- cated in the books *^eri arthron' (articulations) *peri osteon physios' (the nature of bones), ^jperi adenon' (glands), *pe7'i sarkon" (flesh) and *mochaikos\ However their description is very vague and meagre, as being mentioned indirect- ly in connection with the treatment for dislo- cation and fracture of bones.

Galen was undoubtedly, par excellence, the greatest of ancient anatomists. The manner

^^fjf^T f^cT ^k^Jis^y^qtSTf^f^^JC II

^TiracT^ijwf' ^^ ^Hf^iT?7iia^.

44 ANCIENT HINDU MEDICINE

and methods of his narration, the style/i of his language, the accuracy of his descriptiorr, make the anatomical study, not only instructive, but captivating and refreshing. He divides his monumental work, *^The Utilities of the Muman Body'* which became the classic and the stand- ard authority in human anatomy in Europe and the Saracen empire for more than fourteen centuries, into 17 books or chapters as follows: — I. Hand ; II. Hand, fore-arm and the arm ; III. Abdomen ; IV. Alimentary organs and their auxiliaries ; Y. Alimentary organs and their auxiliaries ; VI. Respiratory organs ; VII. Vocal organs ; VIII. The head, brain and the senses ; IX. The cranium, the brain and the cranial nerves ; X. The eves and their auxiliar- ies ; XI. The face, especially the jaw-bones ;

XII. The neck and the rest of the spine ;

XIII. The pelvic structure ; XIV. Genital organs ; XV. Genital organs ; XVI. Nerves, arteries and veins ; XVII. Epilogue — Difference between function and utility. On every organ and every part of the body, Galen gives a comparative review of the similar structure of other animals and philosophic generalisations as to the origin and development of organs, which he ascribes to functional utility and

ANATOIY 45

adaptai\ioa as a means of self-preservation and reproduction and thereby anticipating Lamarck (17ti!l-1829) by nearly seventeen centuries. Below is given a short translation of his intro- ductory general remarks on the 'genital organs', as a sample, believing that it will interest more readers than any other part of the body.

*'Nature has three objects in view in the structural formation of the animal ; she has created them really, either for preservation of life as the brain, heart and the liver, or for the convenience of life as the eyes, ears, nose and hands, or for the perpetuation of the race as the external genital parts as the testicles and the matrix ; now we have previously demon- strated in detail, that any of the parts, either created for (preservation of) life, or for its embellishment, could not be better devised than what they are actually. It still remains for us to explain in, this book, the parts, destined for the perpetuation of race among us.

"First of all, nature would have desired, if it were possible, to create her work immortal. Nature not permitting it, she has invented the expedient she could to obtain immortality for it (her creation), as a clever founder of a city, who not only cares that his city is actually

46 ANCIENT HINDU MEDICINE

peopled, but takes all precautions tha^ it lasts for ever, at least as long as possible. However it does not appear tbat any city has been fortunate on that point, to have lasted so long that time has completely effaced the memory of its founder. But works of nature have lasted for thousands of years and shall live still, by the admirable means, she has invented to substitute always a new animal for a dead animal.

"What is then the means adopted among animals and man, so that no race perishes, on the contrary each race remains intact and immor- tal ? That is what I propose to explain in this book, in commencing with my exposition. Nature has given to all animals organs of conception and she has associated with those organs a special impulse of pleasure of generation and filled the soul with such an irrestable desire, quite un- explainable with their functional uses, that the animals erotically excited and impassioned, especially the adolescent, though deprived of reason and understanding, attend to the per- petuation of the race, as if they were completely reasonable. One should think that nature really knowing that the objects she has created, being^ not susceptible of perfect wisdom, has given the

ANATOMY 47

anim&ls, as a substitute for that wisdom, the allurement of intense pleasure, associated with the usage of those organs to assure the salvation and conservation of the race.

"It is just to admire, first, the ingenious device of nature and then the structure of the organs which naturally correspond for each animal to its bodily form. You would learn from us one day, concerning other animals when we fill the gap, left by Aristotle. Por the human species, all the world knows and understands, to what degree of utility, the external genitals by their convenient situation, their dimension, their figure and their entire conformation, have attained. When you will know the utility of each organ, profoundly hidden, organs which are revealed by dissection, you will admire, I am sure, the art that has created them.

"In fact, nature has placed the matrix beneath the stomach, the region she has recognized as the most favourable for copulation, reception of the sperm and especially for the growth of the embryo so ^hat the fetus can attain to a perfect state. You could not find, in fact, in any part of the animal, another region more suitable, for any of the purposes above-mentioned ; this is the best (place)for copulation, being fav removed

48' ANCIENT HINDU MEDCINE

from the facial organs ; most favourable for; the growth of the fetus, being capable of consider- able distension without difficulty and finally, the most convenient for the child-birth, as it is the easiest for the baby to slip off downwards to the inferior parts and the legs. In fact, the mouth of the matrix, which nature has formed as a passage for the entrance of the sperm and the departure of the embryo when it has reached its complete de- velopment, opens in the vagina. When the ani- mal has conceived, the mouth(of the matrix)closes so firmly, it will not permit the least thing either to escape or to penetrate ; during copulation, it dilates and extends in such a way that the «perm has an easy and large passage to the matrix."

II. PHYSIOLOGY

««

Anna^ (food) supplies the body with *dhatii* (elements) for its up-building and preservation." Siisi'uta 1. 14. 11 ^'. Food is converted in the alimentary tract into *ra8a' (chyle) by 'antaragni* (internal fire or combustion, that is oxidation). Oxidation takes place by the natural warmth of the 'pitta^ (bile = sanguinary principle) of the body. "As fire in a hearth converts rice and water of a cooking pot into food and foam, so the digestive-fire {pachatyagni) converts the ingested food and drink into chyle and 'mala' (excreta = feces and urine)." CharakaVl. 15. 6**. The bile-duct being situated above the alimen- tary receptacle, digestion is facilitated by the favourable situation as that of the sun and the moon. (The idea being that as cooking easily takes place when the cooking-pot is placed upon the fire and not below it or sideways, so the stomach being situated above the bile-duct, which was regarded as the fire-principle, easy

17. %l^ q-RTW +ird*HMMKI^I^Mdr'!icT: I

18. vri VS*\^W\'AM\m<^M^:f^r^'. I

50 ANCIENT HINDU MEDICINE

digestion was tlie natural consequence). Due to the rich aquatic content of the place, ingested food and drink are easily softened, favouring digestion. Susriita 1, 21. 16.*°

*'Now the question is whether the (digestive) fire is a different thing from 'pitta* (the bile) or the bile is the fire ? The answer is that due to its caloric quality, 'pitta* acts as fire in its action of cooking (pachatia) and oxidation (dahana) and therefore, the bile is called the 'internal fire* (oxidase). Siisruta 1, 21. 9 ■-'^.

"The chyle (rasa) though aquatic, becomes red during its passage through the liver and the spleen. In the radiant heat of the body, the qualified chyle becomes red, and is called the 'rakta* (blood)." Siisruta 1. 14. 5-6."-^

20. cT^ fg!=3M', f¥ ftm3Eff^^?^sftn, ^«Tr»1[%?T fq^i^^rni: ?f?T I "^#^^,— f ^ri rqTi«ifff^qfT^sfwm«i?f, Niyyc<4m ftrif

T^T^jftlf^ II <t

21. ^ Ts^\^ r^ vM-r^:"^ w^ xm^^f^ n

PHYSIOLOGY 61

"Chyle is transformed into blood, blood into flesh, flesh into fat, fat into bone, bone into marrow and marrow into semen." Susruta 1. 14. 10.^*

'*Because the chyle is transformed into *dhatu' (elements or bodily substances), and it constantly circulates in the body, it is called the Vasa'.

"This *rasa' remains in each ^dhdtu' 3500 moments (that is, the chyle is formed the same day, but it takes five days for the chyle to be transformed into blood and blood into flesh etc.) and thus in one month it is converted into the semen of man and 'di^ftava' (the rupture of the Graafian vesicles with the ripeness of the ova, or the menstrual blood which is associated with the occurrence) of woman." Susruta 1. 14. 11-12" \

Semen "circulates in every part of the body of all living beings ; as fat in the milk, sugar in the sugar-cane juice, so is the semen [suhra)

22. WT5^' fT^ Tig" Tt^T^^: ^mw^ I ^<i^^s% fWt ?T^T *rfr: ^mm ^pw^: iK°

23. cT^ T^ 5Tc^ ^^TgT^t;^^^si^ ^: iiU

52 ANCIENT HINDU MEDICINE

present in the human body." Susruto, III. 4. 20- 21-*. It is not manifest in the children for it is present in a small quantity as the sweet aroma and delicate fragrance of a flower is not per- ceived in a young bud before time develops and ripens it, though its presence can not be doubted in an elementary state. Susruta I. 14. 15'^*^.

**In the living body, there are as many cir- culations as are present in the body like the chyle and the blood etc, for in the living body without circulation, they can not be produced or reduced." C/im^aka III. 5. 1"^.

*'The centre of the vitalizing (prdnavaha) cir- culation is the heart and the great trunks {maha- srota) of arteries and veins). Charaka III. 5. 3^'.

5T^5 cT^r ^ ^^ ferr^fir^: w^\ 24(a). gqj fl H^gii^mt 1=^ ^ 3I^f«TfMlffI ^ ti TMl^?J^wn%,

^11% ai^: ar^: ^Rwrani^t^fifffi^f^ IK a. "^

25. ^T^w. g:^ ^ftf'T'^ >4H[^5im<dr«<5Ti t?^f«f^ ^cret ^nrrr-

?T^t^ I

PHYSIOLOGY 53

As the fibres of the water-lily and lotus stalks are naturally perforated, so in the tubular vessels, there are minute pores in the tubular vessels {dhamani) throuch -wliigh the 'rasa' circulates." Susruta IV. 9. 9.:,

I. Digestion.

From the above quotations, it can be seen that the ancient Hindu school of medicine grasped the essential fundamentals of digestion and circulation, though the intricate and complex process of their mechanism was not and could not be understood by them. Physiological chemistry is of but very recent development and growth. A few years ago, it was not even sus- pected that the digestion and absorption were due to the fermentative action of the glandular secretions. The digestive ferments or enzymes reduce the ingested food particles by cleavage into their elemental compounds by creating molecular instability through their electro- chemical action and in proportion as the food- stufPs are altered thus in the alimentary canal and transrQ;fmed from insoluble into soluble sub- stances, from such as are not diffusible into such

27. ^rar ^«T^ff: wrf^ 'jito f^ =^ i

54* ANCIENT HINDU MEDICINE

as are easily diffused, and they are absorbed by the epithelium of the gastro-intestinal mucous membrane and are synthetized into chyle during the passage through the restitutive secretion of the cells. The reaction of the enzymic activity upon the ingested food-particles, is the reduction and cleavage into their component elements, which is the same thing as oxidation. The Hindus understood that digestion was con- commitant with oxidation (anta7'agni), but did not know that the oxidation was caused by the digestive ferments.

*JRasa' has been translated as the chyle, for it is the most appropriate available term. But Vasa' is more than chyle. ^Rasd' is the whole of the soluble and diffusible solution of the digested food which being partially regenerated and synthetized during its passage through the mucous membrane by the anabolic restitutive secretions of the living cells, either enters into the lymph sinuses of the mucosa, or are absorbed by the solitary and agminated follicles and by the lymph-glands interposed along the lacteals or are taken up by the blood capillaries of the mucous coat, especially in the villi of the small intestine. Whether the 'msa' forced into the lymph torrent is carried along the thoracic duct

PHYSIOLOGY 55

•

which pours its contents (lymph and chyle) into the left subclavian vein or absorbed in the blood capillaries of the villi, travel by the venous portal system, it has to pass through the hepatic cells for further synthetic transformation, before it is driven to the heart for general circulation.

The blood is red in color, for it is caused by the mass of red-corpuscles (erythrocytes) held in suspension in the plasma. The blood is composed of a liquid part, the *plasma', in which float a vast number of microscopical bodies, the red corpuscles {erythrocytes), the white corpuscles {leucocytes) and the blood plates or platelets { hematohlast ). The red corpuscle has the shape of a biconcave disk with bevelled edges with a diameter of 0.0075 millimeter in man and for each cubic millimeter of blood, there are red corpuscles in man from 4 to 5 millions, in goat 9 to 10 millions, in sheep 13 to 14 millions, in birds 1 to 4 millions and in fish quarter million to two millions. The chief function of the red corpuscle is to carry oxygen, which it owes to its principal ingredient — haemoglobin and which possesses the special quality of chemically combining with oxygen and yielding up the same oxygen, whenever there is decrease in the con- centration of oxygen in the solvent. In perfor-

56 ANCIENT HINDU MEDICINE

mance of this important function, the red cor- puscles soon lose their vitality, deteriorate and are disintegrated in the liver. The liver elimi- nates the wastes and the pigments as an excretory product, which thus receives the golden brownish tinge. The bile is essentially the excretory product of the metabolic wastes which are formed in the hepatic cells as a result of their detoxi- cating and metabolic activities, but the bile has adapted in the economy of the system, to the functional utility of zymo-exciters, particularly of the lipolytic enzymes. The red corpuscles are newly formed again in the red bone marrow and the spleen, where special cells are provided for their reproduction. But it is probable that the spleen plays a more important role in the inte- gration and synthesis of the haemoglobin mole- cules, for iron is its important component element, having special chemical affinity for oxygen, and iron is principally metabolized in the spleen.

It is tlierefore a delightful surprise to read in Charaka and Susruta that they attributed to the liver and the spleen of transforming ^^asa* into blood, and heart was the centre and medium of the blood circulation to irrigate, feed, nourish and sustain tissues and life. Of course it was a fanciful speculation that the blood is trans-

PHYSIOLOGY 57

formed in five days into flesh and in a month into semen. But the blood supplies the nutrient materials for the cellular sustenance, growth and upbuilding. And it is a fact, though *spermin', the special substance of the semen, is found in concentrated form in the testes and prostate, it is found in a considerable quantity in the thymus, milt, ovaries and the blood and plays an im- portant role in the general oxidation of the tissues and in the metabolic reduction of the intermediate regressive albuminous substances as leucomines into harmless products as urea. ^<

'Rasa' contributes to health, pleasant countenance and nourishes the blood ; the blood contributes to . the brightness of the skin, nourishment of the flesh and keeps one alive ;, fat contributes to the adipose tissues, perspiration, hardihood and health of the bone ; the bone keeps the bodily frame and nourishes the bone- marrow ; the bone-marrow contributes to the pleasant countenance, adipose tissues, strength (of the body), increase of the semen and fills the bone ; the semen contributes to the personal bravery, • resistance to disease ( cJiyavana ),

* (A. Poehl : EinivirJcung des Spermins civfden Staffiimsatt. Ziiit. fur klin. Med.. 1894, p. 135)

58 ANCIENT HINDU MEDICINE

inclination to pleasure, physical strength and reproductive power. Susruta 1.15. 6 '.

**^i^lesma' (lymph) is produced in the intestine, sweet and cool ; from the sweetness, viscosity, and humidity from the digested food." Susruta

1. 21. l7»^

**'^lesma* is white (chyle in the lacteal, es- pecially after the heavy ingestien of fat), heavy and cool ; when it is unoxidized (avidagdha in the lacteal and in the thoracic duct, still in the condition of chyle), it is sweet, hut when oxi- dized, it is alkaline." Susruta I. 21. 19'**.

^lesma *'lubricates joints (snovia)^ is fattening, liealing, flesh-giving, causes growth, refreshing through moistening, strengthening, adds to the thickness of the subcutaneous fat, and thus 'slesma' doing five functions according to the position, benefits the body.'* Susruta I. 15. 5"^.

f^m^' '?^: H^^ I 'i^^ ^^ €■? ^ Tm^ ^*^M*ii\m ^Tttf?T i 29. 5RTWr?t ftrf^^^T^ ^iR f^c^ -m^ ^ I

20. $^T ^^ T5'. f'ng: ftrf^^; sitci q^ ^ I

PHYSIOLOGY 59

That by ^slesma* or 'kapha^^ lymph was under- stood, is proven by the fact that Susruta describes in tlie vascular system (III. 7. 1-13) the tubular lymph-vessels with arteries, veins and nerves and that his *5/^s»za' corresponds to the synovial lymph, is corroborated by this passage : — "As it works well, if oil or fat is applied to the axle of a carriage wheel, so the 'slesma* acts in the joints of the living beings." III. 4. 15' ^

IT. Circulation

The lymph is a colorless liquid found in the lymph vessels as well as the extravascular parts of the body, having almost the same constituents as the blood-plasma. The lymph is at least in part the mediator in the exchange of constituents between the blood and the tissues. Throughout the entire body, there is a rich supply of blood vessels penetrating every tissue with the excep- tion of the epidermis and epidermal structures as the nails and hair. In the ground-work of the tissue, there is space and this interstitial space is filled with lymph and thus all the tissue elements, in fact, may be regarded as being bathed

32. #f i«r?f ?jsrT era "^ ^TH ^^^ '

60 ANCIENT HINDU MEDICINE

in lymph. From this fluid the cell takes th& necessary nutrients dissolved in it, and into it the cell discharges its waste products. In the interstitial space, the lymph freely intercommuni- cates, finally connecting with a number of fine tubes — the lymphatics, through which excess of fluid, tissue wastes, pathogenic germs and their products are drained ofl^. The lymphatics like the blood-vessels freely anastomose, thus forming large trunks which finally empty their contents in the main venous trunks at both the junctions of the jugular and subclavian veins» In the course of the lymphatics, there are numerous adenoid structures (lymph-glands) which act as a filter as the fluid passes through them, retaining all the pathogenic germs, their deleterious products as well as various excretory products, which the lymph-glands either destroy or make them comparatively harmless.

The flow of the blood-plasma into interstitial space, where it is known as the lymph, is governed by the principles of pressure, filtration, diffusion, osmosis and the relative permeability of the capillary walls. The intracapillary pressure tends to filter the plasma through the endothelial cells composing the walls of the capillaries ; the force of diffusion arises from

PHYSIOLOGY 61

the inequality of the chemical composition of the blood-plasma and the interstitial fluid ; osmosis from different molecular concentration and relative permeability according to the regional capillary structure.

Though lymph lacks any central heart system as the blood vessels, the flow of its circulation is perhaps regulated by the relative pressure-level from the higher tensien in the capillaries to lower in the lymphatic space and in the minute vessels considerably much greater than in the larger ones as in the veins, and as this difference of pressure is the cause of the flow of venous blood from the capillaries to the heart. This flow may be accelerated by other factors. The lymphatics are provided with muscular wall of automati- cally oscillating tanus under the influence of special vascular nerves and as with each systolic efflux, there is an increased pressure of the arterial flow, muscular and nervous dilation which make the perivascular lymphatic valves act like tiny pumps, accentuating the momentum of the centripetal evacuation of the contents. Perhaps inspiration also exerts a sucking action by positively lowering the pressure at the sub- clavian vein in which the thoracic duct empties its contents.

62 ANCIENT HINDU MEDICINE

The lymph fluid is not uniform m composi- tion in every part of the body. The lymph originates from three sources : (a) by filtering from the blood through the capillary wall; (b) from exudation of the tissues with their anabolic and catabolic wastes ; (c) the digested nutrient solution which is absorbed by the lymphatic roots of the intestinal villi and which is known as the chyle.

The composition of the lymph, therefore, is variable. In the lacteals, the lymph mixed with the chyle has often after the ingestion of heavy fat and protein, a milky white appearance and contains a good deal of sugar. The lymph which flows from the fistula of the thoracic duct, is a watery, slightly opalescent fluid. In the capillary lymph-space and in the large serous cavities as the peritoneum, pleura, pericardium,^ tunica vaginalis of testicles, where there is always a sufiicient quantity of the lymph to keep the walls lubricated and moistened, it is a colorless liquid, almost like water, but decidedly alkaline.

The lymph does not coagulate as easily as the blood. But it contains fibronogen and in case there is any rupture of the lymphatic, it readily clots so that no serious damage be done

PHYSIOLOGY 68^

to the tissues. But unlike the blood, the lymph contains a very few corpuscles. Platelets and functions {thrombocytes) are always absent ; the red-corpuscles {erythrocytes) are met with on very rare occasions ; but the leucocytes — the wandering cells, are always found, though smaller in size and fewer in number. Perhaps the leucocyte through its ameboid movement traverses through the capillary membrane and enters into the lymph-stream and acts as useful scavenger and devourer of any pathogenic germ that might have gained access in the tissues ; or the leucocyte may be produced in the lympha- tic glands and enter into the arterial circulation when the lymph trunks empty their contents at the junctions of the jugular and subclavian veins and are carried to the heart. In the blood the leucocytes are seen larger and with developed phagocytic power for the reason that the blood contains opsonin and alexin which sensitize the pathogenic micro-organisms, thus facilitating phagocytosis. The destroyed germs are dissolved in the biood, increasing thus the protein content, which is a* nourishing food to the leucocytes.

So lymph glands not only filter and purify the lymph stream, they are ever watchful senti- nels to catch and retain any dangerous marauder

M ANCIENT HINDU MEDICINE

that may be in the lymph torrent^ but also are active synthetic laboratories for the origin and development of the leucocytes. In this vital work with the lymph-glands in the lympha- tics, all the lymphoid adenoid bodies as the spleen, bone-marrow and the thymus have their important share. In malarial fever, it is a well known fact that the spleen is enlarged. This only means that the spleen is hyperactive, destroying the minute protozoa that are attacking the red-blood corpuscles and producing an excess- ive number of leucocytes for the bodily defence. This also explains that with the ablation or total extirpation of the spleen, there is no serious consequence or there is any marked reduction of the leucocytes in the blood. The task of the spleen is supplemented and functioned by the bone-marrow and the numerous lymph-glands which are numerous and are scattered either single or in cluster all throughout the lympha- tics.

On the whole the flow of the lymph is very sluggish and much slower not only than the arterial, but also than the venous blood.

Susruta also mentions twenty-four 'dhamanV and passage of some other liquids in the body. But he does not confound 'dhamauV

PHYSIOLOGY 65

■

with 'slra* (vascular system) like Charaka (I. 30. 10). He says : "There are some who say that dhctmam and si'ota are not different from the sh'a (vascular system). But this is not just ; dkamam and srota are difPereiit from the *sira. For the characteristics of the ^srota' and ^dJiamam, differ from those of ^sira* How ? Eor the 'siras* have main central trunks and their action is also otherwise. In the medical science, they are mentioned separately. Only because they are situated close to each other,, they are minute and there is some similarity in their action, therefore in spite of their dissimilar activities, they are often confounded with each other. Smruta III. 9. 2^^.

''There are two vital streams — S7'0ta : their main bearers {mTdasthana) are the heart and chyle-carrying tubes (lacteals and thoracic duct);, if they are penetrated (by any wound), involun- tary cries, syncope, hallucination, illusion and trembling appear and death might even take

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66 ANCIENT HINDU MEDICINE

place. AUmeatary canals are two and their bearers are the intestine and the lacteals : if they are penetrated, pain, loss of appetite, vomit- ing, thirst, blindness or immediate death take place. Serous {udaka) tubes are two and their bearers are 'talu' (between the meningeal mem- branes surrounding the central nervous system) and the 'hloma' {plem^a) ; if they are penetrated, thirst and immediate death take place. Chyle- carrying tubes are two and their main bearers are the heart and the chyle-carrying vessels (the lacteals and the thoracic duct) ; if they are penetrated, there is edema or immediate death with symptoms the same as if the heart and the main arteries are wounded. The blood-vessels are two (the hepatic artery and the portal vein) and their main bearers are the liver and the spleen, and the blood-vessels ; if the sources of the two vessels (the liver and the spleen) are penetrated, there are paleness of the skin or jaundice, fever, burning sensation, bleeding and redness of the nose. Streams of circulating protein [mamsaoaha) are two and their main sources are ligaments, skin and the blood-vessels; if their main sources are penetrated, edema, emaciation, vascular obstruction and even death might take place. The urine-bearing tubes are

PHYSIOLOGY 67

two, the bladder and the penis ; if their main sources are penetrated, there are suppression of the urine in the bladdea.', anuria and paralysis (insensibility) of the penis. The feces-carrying tubes are two ; their sources are the intestine and the anus ; if they are penetrated, there are constipation, offensive odor, and the tying down of the entrails (ant?^a-ihe bowel). The seminal tubes are two : their sources are the mamma and the testicles ; if they are penetrated impo- tence, difficulty in seminal discharge take place. The ovarian {m-'ftava-vaha) tubes are two : their sources are the matrix and the ova-carrying tubes (the ovi-ducts — Fallopian tubes) ; if they are penetrated, sterility, pain in copulation and amenorrhea take place." Susruta III. 9. 12^*.

34. cfTf^T g ^TWt^^'^':^>'n^Ct^^H^^^^^^Tf^. ^f^wR Tj^^t ^.fH I ^i^Ejt M^iT ^^•. I cm irmw t, cT^'^ f ??i' ^^•

^5^ C crqt^^?n3!^S^Tff^^ V[?W. ; cTW f^^F^TTsf ^^rraw '^

■^^!^\ ; cT^ ^W^ ^^: iRiii^f Fii;^^ 'T'^a' cif^TTf^ ^ \ ^m^^ fy

68 ANCIEN^T HINDU MEDICINE

Here of course Susruta has used 'srota' in the generic sense of what are described in modern anatomy as tubes, ducts, canals and cavities.

III. — The Nervous System

*'The normal 'vai/?t' (nervous system) is the regulator of the physical mechanism. The nerves are of five kinds, 'Prana^ apana^ samana^ ndana and vymta* It carries out the physical attempts (muscular contractions), 'reveals the senses and is the carrier of the sense-perceptions as the impression, taste, smell, touch and hear- ing. It is the strengthener of the bodily ele- ments {dhatu) and the co-ordinator of the bodily organs. It activates speech, bases of sound and hearins? and is the main cause of the consciousness

^ ^, cT^t^^' ««ii1eai =^ ; fTW f^Fir^ ^^FRT'i 1%'mFrfTT flT^^: '^ ; cT^ far^^ WkcTT f^m fl^^ T^^^kIT "^ i ^^^ f, cTqt-

PHYSIOLOGY 69

of sound and touch. It is the source of pleasure and cheerfulness. It increases the digestive

fire and eliminates from the body all the waste- products." Clmrcika 1. 12. 7^".

"The *prana* nerves {cerehrosinncW) are locat- ed in the brain^ thorax, ears, tongue, face and nose. Spitting, sneezing, vomiting, respiration and digestion are the functions of the *prana- vayu'. ^Udana' nerves (cervical, thoracic and brachial plexus) are located in the umbilicus, thorax and in the neck ; speaking, exertions, heat, strength and complexion are its activities. *Samana* nerves {vasodilator) are located in the sudoriferous glands and ducts, and in the lymphatics ( animt. ) It beiug situated by the side of the digestive fire (bileduct ?), it increases digestive fire. 'VyamC (motor) nerves are spread over the entire body. Their conduction is very rapid. By ^vyZtna' nerves, walking, extension, movements of the hands and feet, contraction

70 ANCIENT HINDU MEDICINE

(of muscles), the twinkling of the eyes and other activities are accomplished. Apana (automatic or sympathetic) nerves are located in the testi- cles, bladder, reproductive organs, umbilicus (abdomen), knee, hip and the anus. The apana nerves residing in the bowels, cause the elimi- nation of semen, urine and feces and the expul- sion of the ova and the fetus." Chai^aka VI. 28. 4-9^ ^

"The brain is the centre of the senses." Susriita III. 3. 18 *'.

"The ten nerves {dhamam) of the upper.

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'^snqrtf^i*^ '^ f^Ti ^i^fwra % II

37. r3Kt^[^T^f fe^rr'UT^ i

PHYSIOLOGY 71

extremities, by activating sound, touch, impres- sions, taste, smell, respiration^ sighing, yawning, hunger, laughing, speech, and crying, maintain the body. •••Two (auditory) carry sound; two (optic) carry impressions ; two (lingual) carry taste and two (olfactory) carry smell. By two man speaks, by two makes (vocal) sound, by two he is asleep and by two he is awakened." Susruta III. 9. 4^^

'*Man sleeps when sense-organs cease to operate, being tired by the fatigue of the mind." CharaJca 1. 21. S5'\

"Memory is caused by the following eight causes : — Erom the cause of impressions, (their) similarities and dissimilarities, co-ordination of the mind, practice, consciousness, concentration (of attention), what is remembered from repeti-

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3y. g^ ^^T^ wt^ w^lm^: «R^Tf^m: i

72 ANCIENT HINDU MEDICINE

tion of sight, hearing or perception (as tasting or smelling ), is called the memory." Charaka IV. 1. 117-I18*\

"The side-way four ( cutaneous ) nerves, branching into hundreds and thousands, they have become countless. They open in the hair follicles by which they carry the sweat {sveda) and sebaceous secretion {rasa). By these secre- tions the internal and external body is moistened and refreshed... By them the pleasure and pain of touch are felt." Susruta III. 9. 8*\

l^^T^ifrTTSTt ^T^TfT ^»3f??^^^ Ill

ct't^f^fcRfsi" ^^ JIcH 5T y«1<l'lMT: II ^^ H^^T^M+Jci«^^^ ^WW'. I

^i^tfTw': ^m^ ^^'^'Tf'^^ =^ra^ II «iT«^mT: IF

• PHYSIOLOGY 73

"The waste-products {mala) of digested e«li-

ment, are the feces and the urine ,of lymph

mucous exudation, of blood, the bile, of flesh, as the wax in the ear-tube (sebaceous secretions), of fat the sweat, of bones the nails and hair, of bone-marrow wax in the eye-pits, and of the skin oil (sebaceous fatty secretion). SusrutalA^.b^O*"^.

Kapha ( lymph ), pitta ( bile = oxidation ) and ^ayu (air = nerves) maintain the body as the moon, the sun and the air vitalize the earth by their activities of humidity (of the moon), heat (of the sun) and the conduction of heat and cold ( by the air current). SiisnUa 1.21. 8^^,

The above quotations tend to prove that the ancient Hindu schools of medicine believed that the body was nourished by the lymph and the blood formed out of the chyle during its passage within the liver and the spleen, was the medium of circulation and the nerves acted as the conduc- tor of sense-perceptions of which the brain was the centre.

In the Hippocratic writings we find almost

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43. ft^JiT^Hf^^q : €t*T^|5rrr*i^ ^^^^\ i

74) ANCIENT HINDI! MEDICINE

similar views, though with less clearness and positive assertions. In 'peri physios mithropoy*' 4-5( = the nature of man), there are four ground principles — the hlood (aima), phlegm {phler/ma), yellow bile {cholen xanthen) and black bile {cholen melainan)^ which are described to be mixed and to circulate in the body. In the *peri noison to tefarton=t\ie fourth book of the Maladies 33), only bile is mentioned without any qualification and for the othes bile^ water {iidrops) is substituted. "The sources for the blood are the heart, for the phlegm the brain, for the water the spleen, for the bile a section of the liver.*' 33. They are introduced into the system with the ingested food and drink, containing these principles ( per^i noisoji IV. 35-38). Many glands {peri r^c?(?;^o^^ = glands 1-10) as the tonsil, mamma, lymphatic ganglions in the neck, arm-pit and groin as well as the brain, have been mentioned but not the pancreas, testicles or ovaries. The function of the glands is to absorb the superfluous liquid in the body and thus to preserve the bodily equilibrium. The largest and the most important gland par ^excellence was supposed to be the brain and its func- tion was to pump and distribute the liquid in all .parts of the body according to the organic needs.

PHYSIOLOGY 75

Galen distinguished between the arteries and the veins. According to him the blood was formed in the liver and it was sent to the heart for the distribution in all parts of the body after the YolsLtWized 'pnetima' (air = the spirit = the soul) has been separated. The 'pjieuma' mixed w^ith the air brought from the lungs, becomes the vital essence of life (animal spirit) and from th& brain, circulates to all parts of the body with the nerves. Before Galen it was believed that the vital spirit (pnettma = a,[r) circulated in the arteries, for arteries are always found empty after death.

According to Charaka (IV. 7. 8) there are eight handfuls {anjali) of blood and six of lymph in a normal healthy human body. (Because the body fluid constantly increases, or decreases, any calculation by the 'anjali* measure can be but conjectural). There are ten handfuls of water, according to each individual's own measure — the water that after absorption, becomes mixed with feces, urine, blood and other materials of the body ; which circulating in the system, nourishes the outer skin ; which entering into the abscess under the skin, is known as 'las'lkcl^; which being evaporated by the heat of the body, is eliminated as perspiration ; that water (udaJca = serovs fluid)

76 ANCIENT HINDU MEDICINE

is ten liaiidfuls. The material that is first formed out of the digested food and which is known as the chyle, is nine handfuls. The blood is ei^ht handful, feces seven, lymph six, bile five (or the venous blood), urine four, 'vasa'' (serum of the flesh) three, fat two, bone-marrow one, brain (or brain-serum) half handful, semen half handful and 'ojas' (prostate gland secretion) half handful." Char aha IV. 7. 10**.

According to Foster {Physiology^ p. 49), "the total quantity of blood in the human body is about one thirteenth of the body weight." Howell (Fhysiology, p. 458) says : "The ratio of weight of blood to weight of body is in the dog 7. 7 per cent ; rabbit and cat 5 p. c. ; birds 10 p c. ; in man we have upon record two determinations on guillotined criminals made by Bischoff, which

W^:, 'Rfe^^ ^tiWf%:, ■531^ flT^ IWP'I*, cTT^^ -«,1TWM'«

PHYSIOLOGY 77

gave 7. 7 and 7. 2 per cent. Haldane and Smith however have devised a modification of Grehant's caibon monoxide method, which they have applied to living men. The results of some 74 experiments gave them an average value of only 5 per cent per man. The distri- bution of this blood in the tissues of the body at any time has been estimated by Ranke from experiments on freshly killed rabbits, as follows : spleen, 0. 23 p. c. ; brain and cord, 1. 24 p. c.;. kidneys, 1. 63 p. C; skin, 2. 10 p. C; intestines, 6. 30 p.C; bones, 8. 24 p. c.;lieart, lungs and great blood-vessels, 22. 76 p. c; resting muscles, 29. 20 p. c. ; liver, 29. 30 p, c."

The blood circulates in the tubular closed vessels, for thereby the pressure is increased and the time for completing the circulation is reduced. "If we take 180 grams, as the quantity in man, ejected at each stroke at a pressure of 250 mm. of mercury, which is equivalent to 3. 21 meters of blood, this means that the left ventricle is capable at its systole of lifting 180 grams 3. 21 m. high, i. e. it does 578 gram- meters of wt)rk at each beat. Supposing the j heart to beat 72 times a minute, this would give for the day's work of the left ventricle nearly 60,000 kilogram meters. Calculating the work

'78 ANCIENT HINDU MEDICINE

of the right ventricle at one-fourth of the left, the work of the whole heart during the day would amount to 75,000 kilogram-meters." Poster's Tliysiologij, p. 218.

The blood is the medium through which every cell of the body is supplied with its nutritive needs. In blood circulate the synthetized ele- ments of the ingested food. In the capillaries, the blood-plasma filters through and fills the interstitial space, bathing every tissue in the lymph-fluid, from which the cells extract the nutritive materials they need for their sustenance and growth and to which they discharge tlieir waste products. Without blood-circulation there can be no supply of the lymph fluid for the pre- servation of the tissues. This is easily seen in the occlusion of the main artery of the extremity when putrefactive fermentation takes place of an animal tissue still attached to the body, known as tbuQ 'gangrene' with the production of gases as sulphuretted Iiydrogen and volatilized fat, which o"ives the bad odor and the iron-content of the hemoglobin is precipitated into sulphide of iron which imparts to the limb a range of colors com- mencing in green and terminating in black.

In addition to supply the nutritive fluid to the cells, the chief fimetion of the blood is to carry

PHYSIOLOGY 79

oxygen with hemoglobin, hormones and glandular secretions for tissue respiration, oxidation, and stimulation and in the intercellular oxidation, heat of the body is generated. When the oxygen of the blood is reduced and it comes back to the heart through the veins to be sent to the lungs, to be charged with oxygen, it is of purple color, but wlien it is loaded with oxYE^en. it is sparkle bright-red. The venous blood contains many waste products of the cells, dissolved in it as the amonium carbonate, urea, urates, xanthin bases, carbonic acid as carbonates, cholesterin and other substances.

Charaka and Susruta formed right conception of the function of the blood and the lymph in broad general outlines. Of course it was not possible for them to know their complex func- tional utilities in detail. Nor do we yet know. But they thought that the nexves were also tuberal vessels, through which flowed the vital force of life, something too fine for the eyes to see and which brought the sensory impressions to the ceiatral nervous system for co-ordination and carried* the motor impulses to the periphery.lt , was invisible but mighty like the air which brings heat and cold waves, storms and tempests {Charaka 1* 12. 6 ) or like blowing with bellows which in-

80 ANCIENT HINDU MEDICINE

tensifies the fire of the furnace and which it was compared to and identified with. But the exact nature of the nerve impulse and the mode of its conduction, is not yet completely understood. It is usually compared with the electric current. But the sensory and the motor nerves are differ- ent, the sensory fibres only bring impressions to the nerve-centre, while the motor only carry them from the centre to the periphery. Yet his- tological or chemical examination hardly reveals any structural differentiation. Moreover the propagation and the velocity of the nerve-force depends on the nature and locality of the nerve- fibre, the temperature and the pressure. The nerve- fibre is one of the units of a nerve-trunk : it is the axis-cylinder process of a neuron and is either medullated, that is, surrounded by a white sub- stance called myelin, or non-medullated ; either the medullated or the non-medullated may or may not be surrounded by the primitive sheath or neuri- lemma, so that there are four forms of nerve-fibres^ The neuron is the cell unit of the nerve-fibre and the neurons propagate their impulse by contact of the dendrites, the terminal arborization round the axon. The neurons also differ greatly in size, shape and internal structure and they are general- ly classified as the bipolar and multipolar cells.

PHYSIOLOGY ^ 8t

This structural variation explains the differ- -ence in speed of nerve impulstion. Helmholtz found that the motor nerve of a frog travels with the velocity of 28 to 30 meters per second and the researches of Piper indicated that the motor nerve of a man travels at the velocity of 117 to 125 meter per second. There does not seem to be ^ny structural difference between two afferent or efferent nerves, as for an example, between audi- tory and olfactory, and in their mode of conduc- tion and speed, and if they carry different impres- sions and impulses, it is because their terminal -endings have been developed to catch particular impressions and the lobe in the brain has been specialized as an economy to the system to receive, co-ordinate and react only to special impulses. It is just like two electric wires one of which has been connected to ring the bell and the other to make light.

By the specially adapted peculiar structure of the retina, the vibrations of light (color-images = rupa) can be focussed upon it, setting up nerve- impulses that are transmitted by the fibres of the optic nerve and optic track to the visual centre in the cortex in the brain, which is situated in the occipital lobes, for co-ordination, color-conscious- ness and response to the stimuli. Total blindness 6

82 ANCIENT HINDU MEDICINE

follows the removal of both occipital lobes. Bufc if only one lobe is ablated or injured, there is a partial blindness, affecting the symmetrical halves of both eyes known as 'hemipicC ; the right one influencing the two right halves of the eyes, and the left one, the two left halves of the retinas.

The outer ear is so .constituted that whert the vibrations of matter, the rapidly alternating variations of pressure, what is commonly known as the 'waves of sound', forced through the- accoustic apparatus, strike against the auditory e]>ithelium, richly supplied with the nerve-fibres^ of the cochlear branch, and the sensory impulse- thus generated is carried over the auditory nerve (eighth cranial nerve) and track to the^ auditory centre in the first convolution of the 'temporal auditory lobe,'; where auditory con- sciousness is developed.

The taste {rasa) nerve-fibres are distributed to parts of the buccal cavity and especially the tongue, of which the most sensitive parts are the tip, the borders, and the^ posterior portion of tha dorsum in the circum vallate papillae, Xhe anterior two-thirds of the tongue'are supplied with sensory fibres from the lingual nerve ( a branch of the fifth nerve) and the posterior third from the glossopharyngeal. The nerve track has not

PHYSIOLOGY 8S

yet been definitely known, but it is supposed to terminate in the hippocampal convolution^ posterior to the olfactory lobe. The gustatory sensation is possibly complex. There are but four fundamental taste sensations, —namely,, sweet, bitter, acid, and salty and the rest are but the combinations of these primary tastes, for the experience of which we are dependent on the terminal organs which are chiefly present in the fungiform and circumvallate papillae. And there are so many complex and multiple junctions between the fifth nerve, the seventh nerve and the glossopharyngyal nerve, by way of the Vidian nerve, petrosal nerves, tymphanie plexus, the otic and the splenopalatine ganglia, that it is hard to determine, how the taste sensation travels, but perhaps through the chorda tympani nerve.

In the 7iasal septum and a portion of the upper turbinate bone, the area corresponding to about 250 square millimeters in each nostril^ there is a profuse distribution of the fibres of the olfactory {gcmclha) nerve, in the shape of elongated, epithelial like cells, each of which bears on its end a tuft of six to eight hair-like processes. And there are tiny glands which keep the mucous always humid and moist.

83 ANCIENT HINDU iiEDICINB

Particles of odoriferous matters, carried in a gaseous medium, namely the air, to the olfactory epithelium, become dissolved in the thin layer of fluid that keeps the nasal membrance moist- ened and this peicoitues through and stimulat- es the nerve-endings. But if the membrane be too dry or the secretion be too abundant or altered in quality, the power of smelling is diminished and even may be wholly suspended. The olfactory nerve terminates in the cortex of the brain in the *cornu Ammonis and hippo- campus.' The animals with highly developed sense of smell possess a large ^limbic lobe.* Some of the substances retain their odoriferous quality even in minute dilution as camphor 1 : 400,000 ; musk 1 : 8,000,000 ; vanilin 1 : 10,000,000 parts.

The touch (sparsa) is a compound sensation of pressure, warmth, cold and pain, through ioar distinct kinds of nerve-fibres which are not only richly distributed over the general cutaneous surface, but also in the buccal and rectal membranes. But the alimentary mem- branes, or the superfacise in the interior of the body are supplied with nerve-fibres of pain and devoid of those of touch and temperature sensations. Application of cocaine on the eye

PHYSIOLOGY 85

or throat paralyzes the feeling of pain and pressure, but the sensations of heat and cold are not influenced, • which proves that their nerve- fibres are different and mediate through different channels. It has been clinically observed that the compression of the cords of the brachial plexus, resulted in the insensiblity of the arm to pressure and temperature, but not of pain. And it is supposed the nerve-endings of pain lie deeper than the tactile senses, which are- superficial ; the former mediating through the spinal cord and the latter through the posterior funiculi, together with some of the fibres of the muscle sense and they do not cross until after tliey reach the medulla and perhaps they are represented in the rolandic area.

The vocal sound or voice (ghosa) is distinct from speech, which is an articulate sound to express definite ideas. The apimals are endow- ed with vocal power, but not with speech. And there may be speech without voice as in whisper- ing and voice without speech as in singing a musical tone. The vocal organ, the larynx, resembles ^to a great extent the siren in the production of tone. The larynx is a framework of cartilages, connected with elastic ligaments, which are vocal cords, and it opens above into-

86 ANCIENT HINDU MEDICINE

the cavity of the pharynx and below into the trachea or windpipe. With respiration, the lung acts as bellows, pressing ti blast of air through the thin tube of the windpipe and the escaped air is modulated by the movable liga- ments into various tones. The voice has three characteristics, (1) 'loudness' which depends on the force of the expiratory blast; (2) * fitch' which depends on the rapidity of vibrations and (3) the 'quality* which depends on the capacity of the resonance chamber and the muscular strength and pliability of the laryngeal liga- ments (vocal cords). The alternate expansion and contraction of the ligaments and muscles of the larynx {glottis) are made by the bulbar and recurrent laryngeal nerves. If any of these nerves is destroyed, the rythmic widening and narrowing automatically cease and the glottis remains immobile and no voice (vocal sound) can be produced.

There are four speech (bhascl) centers^ situat- ed along the Sylvian fissure, in the left hemi- ■sphere for the right-handed and in the right hemisphere for left-handed individj.ials. The motor center for pronouncing and articulating words, occupies the foot of the third frontal convolution (left), immediately in front of the

* PHYSIOLOGY 87

centers of phonation, "utilized in speech. The destruction of this center produces motor aphasia (aphemia). In aphemia one is able to hear and to understand when spoken to, and is able to emit sound, to move the tongue and the lips, hut he has lost his vocabulary, in other words, the faculty to articulate words. But if the injury is not complete, that is, in partial aphemia, the patient can utter a few incoherent words and syllables according to the nature of the lesion. The center for auditory images, that is, for comprehending spoken words, occupies the posterior fourth of the first tempo- ral convolution (left). The destruction of this <;enter causes sensory aphasia (word-deafness). In sensory aphasia, one can hear the voice, as the faculty of hearing is not affected, but he can not understand the spoken words, and the words are to him mere sounds and do not express any idea. The center for visual graphic images, that is, for distinguishing written or printed words, occupies the left angular gyrus(posterior inferior ,part of the left parietal lobe). The destruction of this center causes alexia (word- blindness). In alexia, one can not read even his own writing, although his vision and intelli- gence are not affected and he can see the form

9 88 ANCIENT HINDU MEDICIEN

of the letters, but has lost the faculty of comprehending ideas, expressed through those words. The center for the faculty of writing, is situated at the foot of the second frontal convolution and the destruction of this center produces the inability to write {agraphia). In agraphia, one has lost his faculty of expressing his ideas in writing or any graphic form. Agraphia is usually associated in clinical experience with motor aphasia (aphemia).

Sleep {nidra) is evidenced by the cessation of sensory-motor reaction. Various hypotheses have been advanced to explain the causation of sleep. (1) Cerebral anemia was suggested by the old writers ; but it is rather the effect than- the cause of it. (2) Hyposecretion of the thyroid due to the inhibitive action of the accumulative waste products during waking hours and the hyper-secretion of the pituitary body ; but in myxedema, drowsiness is not constant, nor is there any proof that in hypnotic or epileptic somnolence, there is any increased secretion of hypophysis, or diminished secretion of the thyroids. (3) Osmotic theory of Devaux, which tries to explain sleep due to the increased viscocity of blood, through dehydration, is not bsustantiated by observation, as in privation of

PHYSIOLOGY 89

water — in thirst, the nervous system is rather irritated. (4) Chemico-toxic theory enjoys a hotter reputation. The accumulated tissue- waste products as lactic acid, cholesterine, leucomaine, exercise an inhibitory action on tho cerebral activity, either paralyzing the centre directly, through intoxication or indirectly by reflex vaso-constriction. (5) Accumulation of carbonic acid which has an extreme avidity for oxygen, reduces the minimum ratio of free oxygen, necessary for the central nervous activi- ties. (6) Consumption of the intramolecular oxygen causes cerebral asphyxia, which is expressed as sleep, as during the waking hours,, the brain cells use up their store of oxygen more rapidly than it can be replenished by absorption from blood ; the consequence is that for lack of respiration, the brain-cells can not react to th& sensory stimuli and gradually losing conscious- ness, store up sufficient oxygen through the- anabolic process to be awakened up again. (7) The neuron theory tries to explain sleep on the histological principle that the nerve track is not contiguous like the electric wire, but composed of the cell-units (neuron) which, transmit their impulse from one to the other by their contact through the interlacings of dendrid-

90 ANCIENT HINDU MEDICINE

ed and terminal arborizations, and when tliere is sufficient accumulation of fatigue products, the dendrides contract and retract, so that the nerve-path being broken and the brain being automatically relieved from sensory stimulation, sleep is mechanically produced. But it has not yet been proved that the dendride processes are contractile enough as to lose all connections with the neighborly cells. (8) A central nervous mechanism produces sleep, not* as a result of asphyxiation, toxins or neuro -toxins {Bouchard,)^ but to prevent them and to protect the brain- cells from the evil effect of their further accumulation, so that during enforced involun- tary rest, the obnoxious products can be elimina- ted and the brain-cells can be refreshed and revitalized through the anabolic process (the income of energy being more than its expendi- ture)— as an economic accommodation to self- preservation. If the sleep is deep, profound and undisturbed, it will take less time than other- wise to oxygenate, tonicize, recuperate and vitalize the brain-cells for the resumption of their activities of sensory-motor co-ordination and reaction.

B-unger and thirst {Jcsut-pipasa) sensations are mediated, probably through the nerve endings

PHYSIOLOGY 91

in the stomach and pharynx. Normal hunger is ^ known as the appetite and it is not yet definitely determined whether this impression is conveyed by sensory fibres, distributed to the mucous membrane of the stomach or of the muscular coat. When the stomach is empty, these peri- pheral nerve-endings are excited. That it has nothing to do with nutritive needs of the orga- nism, is evidenced by the fact that when water or indigestible substances are taken in to fill the stomach, the hunger sense is allayed. Prom this, it can be concluded that hunger is agastric sense. Of course, when there is a general tissue hunger for lack of nutrition, a general nervousness and discomfort are experienced, due to the resultant nervous excitation. The water needs of the body are experienced through the fibres of the glosso- pharyngeal nerve as an end organ of thirst, for we know, that if the pharynx is dried up either by salty or saccharine food, dried air or dust, at once there is a sensation of thirst, though there may be no bodily need for it and it can be ap- peased by removing the irritant substances and moistening, the spot. It is possible that when the tissues give up their storage of reserve- water to compensate the loss of the blood, it constantly incurs through respiration, perspiration and

92 ANCIENT HINDU MEDICINE

urination, there is a general call for supply of water, and it first expresses the demand through the excitahility of the glossopharyngeal nerve,, and if it is extreme through general nerve excita- tion and irritation, as in tissue hunger.

Sweat ( sveda ) is the secretion of the sudori- pareous glands, of which, there are nearly two- millions ( Krause ), distributed all over the cuta- neous surface, except the glans penis, prepauce and the deeper portion of the external auditory meatus. It is known that with vaso-dilation, their secretion is increased. But it can he also produced. independently, directly through the excitation of the nervous mechanism, as is seen in strong^ emotion, cold-sweat of phthisis and other diseases,, when the skin is in anemic state. The stimula- tion of the sciatic nerve in cat, has been demon- strated to produce profuse sweating on the hairless balls of the feet. But when an animal with sciatic nerve divided on one side, is made dyspenic^ no sweat appears on the hind limb of that side,, though there is abundance in the other, thus- clearly proving a central nervous mechanism, regulating sweat-glands as vaso-d.ilation. It seems that picrotoxin and strychnia induce sweating action by influencing the central nervous system while nicotin induces perspira-

PHYSIOLOGY

tion by acting both centrally and peripherally. As histologically and anatomically the nerve-fibers i)f the sweat glands and the vaso-constrictors resemble very closely, it is reasonable to presume, that like the latter, the central nervous regulator of the sweat glands is in the medulla.

Sebum {rasa) a semiliquid oily material, that

Is secreted by the sebaceous glands, distributed

all over the cutaneous surface, chiefly associated

with the hair follicle, but also without it as in

the glans penis, lips and the deeper portions of

the external auditory meatus, is meant possibly

to protect the skin from bacterial invasion, and

to prevent the hair from being brittle. Sebum

on exposure to air forms a waxy cheesy mass as

is seen in the comedones from the occlusion of

the ducts, or in the glans penis ( Smegma

preputti ) or in the auditory meatus (cerume?i =

ear-wax ) and it contains fats, soaps, cholesterin,

albuminous material ( casein like ), remnants of

epithelial cells and inorganic salts. As the

sebaceous secretive activites are associated with

vaso-dilation, it is presumed that their nervous

^nechanism is the same, although sebum by its

oil coating over the skin prevents the undue loss

of heat as well as prevents the undue absorption

of moisture. Vaso-dilation and vaso-constriction

94 ANCIENT HINDU MEDICINE

are regulated by the nerve-fibres belonging to the sympathetic or automatic nervous system.

Meat { iisma ) is produced as a reaction of the intracellular oxidation or vital process and absorbed in the blood, it is conveyed to every part of the body to preserve the temperature equilibrium of the hot-blooded animaL Eor heat is being constantly lost from the body through radiation (conduction), evaporation (perspiration from the skin), respiration ( vaporization of water through lungs ), and with urine and feces. If there is excess of heat, it is conducted to the periphery and is radiated with sweat by vaso- dilation. If on the other hand, the surrounding air is cold and the body needs to conserve its heat, there is vaso- constriction so that the escape of heat is reduced, as well as the production of heat is stimulated by increased oxidation. In cold- blooded creatures as fish, amphibia, reptiles or in the hibernating animals ( poikilothennos ), either the oxidizing process is not yet intense as in the former, or the heat-regulating mechanism is absent or poorly developed as in the latter, and the consequence is that their body tempera- ture fluctuates with that of the surroundings. While the hot blooded animal ( homoiotherinotis ) keeps relatively a constant temperature

' PHYSIOLOGY 95'

independent of the surroundings. There is every reason to believe that the heat-regulating mechanism ( tissue-oxidation for the prduction of heat, conservation of heat through vaso- constriction, and radiation of heat through vaso-dilation ) is controlled bj^ a nervous center, which perhaps is situated either in the pons or medulla.

III. PATHOLOGY

*' Whatever causes pain, is a disease (vt/adhi). Diseases are of four kinds : accidental or mechanical (agcmtti), physical {sarira ), mental (manasa)^ and natural (svdbhavika). Diseases caused by injuries are ^agantu' ; of alimentary origin and by the derangement of the nervous, venous, lymphatic and arterial systems, ^mr'ira^ ; through anger, sorrow, fedr, joyousness, sadness, jealousy, concentration of mind, misery, haughtiness, greed, envy, desires and longings, 'mdnasd' ; hunger, thirst, senility, sleep and death, are 'natural' diseases". Susrutal.l. 20*** .

"Again, the diseases originate from seven sources as follows: hereditary (adivala), maternal (janniavala), alimentrry (dosavala), mechanical (samghatavcda), physical ( kdlavala = seasonal ),

> PATHOLOGY 97

contagious {daivavala), and natural (svahhavavala) Susruta I, 24j. 4*'.

*'The diseases that are transmitted througli the lesion in the sperm or the ovum of the parents, are hereditary, as *ktistha' ( leprosy — there is every reason to belive that the syphilic eruption of the skin and ulceration were regarded as varieties of leprosy) and'am^' (hemorrhoids). The hereditary diseases are of two kinds and might come either from father or mother's side.

"The diseases that are produced through the improper regimen (cifpacA«r« = wrong food and injurious exercise ) of the mother ( during the intra-uterine life of the fetus) are called maternal as born — lame, blind, deaf, mute, ^minmina' (one who speaks with a hissing nasal accent, due to overgrowth of adenoid tissue in the rhino- pharynx) and the dwarf. These diseases ( acquired during the intra-uterine life ) are caused by either) mother's (defective) circulation {rasakrta) or miserable living.

"The diseases that are produced through impropeu food and living, or (reacting through

^iR't^MjTti sinict^H^Tii ^q^^rjfwm: b'^ct^^itiitit: ^^^^n^tii

98 ANCIENT HINDU MEDICINE

digestion) anxiety, are ^alimentary\ Alimentarj

diseases are of two kinds — gastric and intestinal occasioned by physical causes (as improper food and living) or mental causes (as anxiety, fear or nervous excitement).

"(The diseases occasioned by) the injuries struck with force on the weak, are *mechanicaV whether by instruments or by ferocious animals.

"The diseases that are producd by cold, heat, wind and rain, are ^physicaV , whether (they) are natural or unnatural.

*'The diseases that are produced by the tyranny of the gods (through thunder and lightning), through curses ( phobia ), sorceries of the Atharva-veda ( infectious diseases ), and through contagion ( syphilis ) are ddiva-vala (god-sent, i. e. beyond human control ). These diseases are of two kinds as occasioned by thunder-lightning or by demons ( infectious diseases as cholera or small-pox ). And again they are of two kinds — through accident ( as thunder-lightning ) or through contact ( as syphilis ).

"Hunger, thirst, senility ( old-age ), sleep and death etc. are natural diseases. They are of two kinds — timely or untimely. They can be cured

N PATHOLOGY 9&

■vyhen they are untimely ( i. e. if there is hunger, thirst or premature senility, when there is no reason for it, they are proper subjects for treat- ment ), but not so when they are timely."

Stisruta 1, 24, 5-7*'. "In addition to ( parasitic ) animalcules ( that cause disease), there are twenty kinds of microbes ( hrimi ) divided into four classes." Charaka III,

7. 6*^

**The origin of the microbes of the blood- vessels ( veins ), is like that of leprosy. Their

46. cT^if^^fwm t ipT^tf<Uci<^mHiii: irw^in'^cra: ; tsftr f^ff^: ^^csn^, H'T^ f^f^i: ^nt\x[ tpwt^ i '??i ^sfi^if^^: iia,

^*TT^^^WFf?T: =5rrf^WT5Wf^t^T?TiR^^: ; ^sft f^f^: <*i'Ji9ifiT '^rara-

100 ANCIENT HINDU MEDICINE

habitat is the hlood-vessels. They are very- minute, globular and without feet. Many of them are so minute that they are invisible." Charakalll. 7. 7*^

Pathology or the science of disease, has up to the last century, been rather vague owing to the complexity of reaction of the pathogenic agents upon the living matter. Bacteriology is entirely a modern science. A few years ago it was not even suspected that infectious diseases are due to the intervention of morbific microbic agents. Their very existence was not even known. Microscopy and chemical reagents have but recently revealed the most interesting teeming world of animalcules, which though invisible to the naked eye, are no less potent adversaries of the living beings, and there is a constant struggle between life and these invisible foes, to which it ultimately succumbs, and in spite of the relentless war of science for the last generation, it has not been able, but partially, to conquer and to control them. Even the diseases that we call organic, as tbe cardiac

48. aHHiiri^i'ii'*! lit: wm^ *iiitm'\M i ^srnff ?:s«iir?^ >nT^:

PATHOLOGY 10 1

affection, or metabolical as gout, may be the manifestations of the accumulated reactions of pathogenic germs, which have disappeard long ago, as pueumococci and gonococci respectively. This is clearly seen in tabes dorsalis, as a sequel of syphilis, after twenty or thirty years of infec- tion.

The ancient conception of disease was based more or less on humoral pathology, i. e. disease originated from the derangement of the humors and it was the function of the diet and medicine and proper living, to bring them back to their normalcy and equilibrium. According to the Hindu schools of medicine, there were three fun- damental humors {vayu^ pitta^ kapha), according to the Greek, four (blood, phlegm, bile and water by some, yellow and black biles by others) in the human body. ^VayiC is the active principle like the wind, which brings hot and cold M^aves ; *pitta^ is the heat principle like the sun ; and the *kapha^ is the cold principle like the moon, whose beams were reputed to exercise a very soothing and beneficial influence on plant life, in contradistinction of the sun's rays which were supposed to have a scorching effect, as it usually happens in an arid tropical climate. {Snsruta 1. 21. 8 ). As for the luxuriant vegetable life and

102 ANCIENT HINDU MEDICINE

growth, all these three elements in their right proportion are necessary, and excess of either, heat, cold or wind, is injurious to the plant, as in the animal kingdom.

However fanciful and grotesque this appears at the first glance to the moderner, it is not really so when it is seen with clear perspective and sharp analysis. It is true that concrete facts and statements appeal more to reason than vague generalization and abstract philosophy. But by close observation it will be easily observed that their *myu^ pitta, kapha' correspond, to what is expressed in vulgar terminology, as *nervous, sanguine and phlegmatic temperaments and which can be translated into medical nomencla- ture as ^hypermetabolism, normal metabolism and hypometabolism/ The following citations tend to lead to the aforesaid conclusion : —

*'Tlie bodily oxidation ( agni) is classified into four kinds according to its activities as follows : — hyper-( tlksna ), hypo-( manda ), normal (sama) and abnormal ( visama ). Of them ( one of ) hypermetabolism is able to bear all abuses ( i. e possesses a great resisting power against infection ) ; hypometabolism has its opposite qualities ; normal metabolism becomes ( easily ) upset by abuse, but without abuse, remains

PATHOLOGY 103

natural ; abnormal metabolism has the opposite >qi|alities of the normal,." Charaka III. 6. 6*'.

"These four kinds of oxidation pertain to man. Those who have vayu, pitta, kapha, in propotion ( equal ), enjoy normal oxidation. In the case of those who have predominance of vata ( nervous temperament ), oxidation beomes abnormal by association with vai/ti. In those who have predominance of pitta ( sanguine temperament ), oxidation becomes accentuated by its association (hyper-oxidation). In those who have predominance of * slesma' ( phlegmatic tempera- ment ), their oxidation becomes lowered by its association ( hypo-oxidation )." Charaka III. 6.

**The dominant qualities at the time of union of

twn vR'rij^: I ftHMT^pg f^Tiifk*?^ n^ftt^i^ ^Nut *{^^i^: i i^rami^ tiiT^jj^t "§r^rrfw% t^t »t^^^: i =^T^€"%fTr, ^^m-

104 ANCIENT HINDU MEDICINE '

the sperm with ovumj are inhorn (with the baby), as temperament {prakrti). Stisruta III. 4. 48 ^^

"The man of nervous ( vata ) temperament, is sleepless ( jagaruka ), sensitive to cold, ill- tempered, exclusive ( s^<?wa = thievish ), haughty, unmannerly («w^r?/« = un-arian), fond of music,, songs, dance and arts ( gandharvachitta ), whose hands and feet are long, whose beard, hair and nails are very dry, who is excitable (Jcrodhalu— angry) and strike people with hand and nails. That person is impatient, whose friendship is unstable, ( who is ) ungrateful, thin, violent, whose veins show out throughout his body, (who is) garrulous, who walks fast, is fond of walking and is fickle- minded." Stisnifa III 4. 59^".

"The man of sanguine temperament ( pitta ) perspires freely, smells come from his body (from volatile oil ), his body has the yellowish color

^FW, 8, V=^ I

ScHlfeiii'l^i'mr^clloHT fel^R l^fff ^'«rt^ W- II 'Q^fT^'f^^TT,-

^ PATHOLOGY 105

and is relaxed ; and his nails, eyes, forehead, tongue, cheeks, and palms of hands and soles of feet are copper-colored ( indications of good circulation of hlood ) ; he becomes repugnant when he gets wrinkled ( vali ), gray-haired ( palita ) and bald-headed ( hhcilitya ) : he is a voracious eater, sensitive to heat and he becomes easily angry and easily satisfied ; his strength and longevity are medium. A man of sangui- nary temperament is brainy {medhavi), clever and is an authoritative speaker ; in combat he is brave and irresistible." Snsriita III. 4. 61^^.

"The complexion of a man of phlegmatic (slesma) temperament, is like the grass, blue lotus blossom or wet ai^ista (soap-tree), sharpen- ed sword or the shaft of an arrow (i. e. fat and bright.) He is pleasant to look at, fond of eating sweet things (it is well-known that in myxedema or cretinism there is a great fondness

53. ^^ ^: TftdRir^^l^-^W'i<gl^^'1c1l^ra1^1^qTfil^TK?T^

106 ANCIENT HINDU MEDICINE '

for sugar and high tolerance for carbohydrates), obliging, lazy, patient, without desires, heavy, indifiPerent and thick-bodied." Siwmta III. 4. 65^*.

One can see here almost the true clinical picture of hyper-thyroidism in an advanced state, in the primary stage and hypo-thyroidism. Thyroid influences metabolism. With metabolsim is inter-locked the automatic bodily mechanism of self-defence against infection. It is well- known that our integuments and mucous mem- branes swarm with innumerable pathogenic germs which almost live a harmless, vegetative parasitic life, but if the organism is devitalized by overwork or malnutrition, if its immunizing resisting power is lowered, in other words, if its defensive mechanism has been weakened, then infection takes place. We inhale almost with every inspiration plenty of bacillus tuberculosis and they lodge in our nostrils and lungs, we harbour in our intestine enough of coli-group^ but they can not do any harm as long as our metabolic activities have not been . lowered

54. -^ ^^Tf^fe'siT^Tft^aK^TWTTm'^rrnFrw^*: ^^nr: fir^^nHt

PATHOLOGY 107

beyond the danger point. So far pathogenesis, vitality of the organism, is the important factor. This vitality classification, coefficient with metabolism and oxidation, is practically synony- mous with vayu ( = air) as a conductor of hot and cold waves, pitta{ = heat principle), kapha ( = cold principle)^ which we are justified to translate as the nervous (hypermetabolism), sanguine (normal metabolism) and phlegmatic (hypometa- bolism) temperaments, and on which the whole system of the Hindu medicine is based. If there are points in which the picture drawn by Charaka varies from modern clinical observation (as bad smell and premature senility in sanguine temperament, and strength in phlegmatic type), it should not be forgotten that, there have been evolutive changes with time both in the patho- genic agents and our system, from the time of the ancients and consequently reactions have been partially modified. Moreover, it is good to remember that for the age in which Charaka and Susruta lived, their studies strike our ad- miration'from the comparative historical point of v|ew, but for modern practical needs, they are nothing but crude and vague generalizations.

108 ANCIEKT HINDU MEDICINE '

I. Constitutional Pathogenesis

We can quite agree with Susruta (I. 120) that 'whatever causes pain, is a disease*. But the definition will be more logical and correct if we say, "Disease is the state of body and mind, produced in the organism, by a morbific agent and the organism reacting against it."

It is yet controversial whether infections are transmitted by heredity (adivala). According to Weissmon ( gemules of Darwin and plastidules of Haeckel are now practically discarded as bearers of heredity) the germplasm is a bridge between the past and the present, linking man to the first-developed unicellular existence. The germplasm or the germinative cell assures the continuity of life and progress. In the lowest step of the ladder in animal life, among protozoa, reproduction takes place by fission, budding or both combined when the mother cell, through excess of nutrition divides into two as a relief of cellular tension. With the growth of organic life and specialization of cells as an economy for functional utilities, special cells {garnets) have been developed for reproduction. In further evolution, gamets have been differen- tiated into female garnet {ovum) and male gamet

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(spermatozoon). Their amphimixis tends to <jause variation, while the germ plasm tries to conserve the type. Hence inspite of infinite Tariety, never two beings being the same, there is a fundamental unity of the species, as modifi- cations are very slow.

The germplasm — the bearer of heredity, is the "chromatin' substance of the reproductive cell- nucleus. The chromatin divides into chromosomes (idants) and when they break up again, the smaller units are called chromomeres {ids)and each chromomere or Hd* contains all the dynamic poten- tialities— generic, specific, individual, which under appropriate nutrition and temperature, forms the organism. , Each Hd' is surrounded by hypotheti- cal units, called the ^determinants^ and determin- ants by *hiphores' which are supposed to exercise the directing infiuence in the development of phylogenic evolutive transformations. Though immortality of the germ-plasm can be maintained without amphimixis, as in parthenogenetic eggs or by artificial parthogenesis in normal ova as de- monstrat^ed by J. Loeb, in higher plants and ani- mals however, sexual conjugation is the normal process. Conjugation or fertilization means the reducing division of the chromosomes and the restoration of the normal bulk in the fertilized

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ovum by equal contribution from both the parent cells. The stimulus which activates the fertiliza- tion is a chemotactic substance liberated by both the cells, but it seems that if the ovum is strong- er as in the final stage, there is a protoplasmic outgrowth towards the spermatozoon. The proto- plasm contains nutritive materials for the embryo.

Inheritance of heredity is complicated by two factors. Somatic characteristics are not transmit- ted— but only germinal. Yet the germinal mate- rials are influenced by somatic behaviour or f unc* tional uses. One might lose his limbs and his children would not be born without them. The Jews have been practising circumcision for the last four thousand years, yet the Jewish male ba- bies are born with prepuce. But according to the experiments of Brown Sequard, if the sciatic nerve of a guinea pig be cut, the animal becomes epi- leptic and if mated, brings forth offsprings that are epileptic, though the sciatic nerve is there and has not been severed, but its functional disturbance has been fixed by heredity.

Somatic cells undergo the evolutionary modi- fications of the functional exercise of an organ, by which its development is regulated. Th erf ore the hereditary transmissions are of two kinds, ger- minal and epigenetic, i. e, the germplasmic ma-

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terial becomes influenced and modified by the somatic behaviour, that is, by external conditions. And though the amphimixis takes place, the characteristics of both the parents are not equal- ly blend d in the offspring. It might receive the prepotent characteristics of one as in a cross be- tween a Negro with a White, pigment and hair etc., or the recessive charcteristics of the other. The sex of the offspring, according to some, depends on the maturity of the ovum, and if the fertilisa- tion takes place in the beginning, it is male and if at the terminating period of the catamenia, it is fema'e. If the twins are not of the same sex, it is because two ova have been fecundated at two different periods. Consanguineous marriages produce evil effects, for heredity fixes and accen- tuates the weak characteristics of both the parents. If a blind man marries a blind woman, there is a possibility that the offsprings of the mating would have defective eye-sight, if they are not born to- tally blind, but if a blind man marries a woman ■ with good eye-sight, the negative characteristic of one would be counterbalanced by the other and children born of that marriasre would not be affected probably in their eye-sight. Of course, the laws of heredity are not so simple. According to some biologists, one does not inherit more than

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50 p. c. from the parents, i. e. half from the father and the mother, each one of the parents cotributing about one-fourth, and each one of the grand-parents one-eighth and so on according to the geometric regressive proportion. But there may be also sudden reversion to the ancestral type and what is known as 'atavism.^ So no fixed rules of heredity can be determined. But it is cer- tain that the parents transmit to their offspring their psychic and bodily impressions. Eor germ- plasms must be certainly very sensitive to the somatic impressions and transformations.

We have no definite proof that the pathogenic germs are directly transmitted with the germ- plasms. Eor if really the ovum or the spermato- zoon be infected, then they would be incapable of fertilization, growth and development, lacking impulsive momentum, vitality and nutrition, necessary for amphimixis and embryonic forma- tion. The frequent abortion that takes pla,ce in the primary state of syphilis, is not probably due t@ the presence of treponema pallidum in the germplasras, but due to their low vitality and exhausted condition of nutrition or the inva- sion of the embryo by the pathogenic germs through the placenta. Of course, there are cases known in medical history where the

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offspring has been born with all the stigmata of syphilis, acquired from the father, while the mother has acquired immunity from its infection from the fetus through gradual elaboration of the antibodies, as a reaction of the organism. But it does not necessarily imply that the spermatozoon that fertilized the ovum and caused conception, had living syphilic germ in it, or it might have been simply saturated with attenuated syphilic virus — mild enough not to interfere with embryo- nic and fetal growth, yet a sufficient cause to bring forth immunizing reactions in the maternal or- ganism, witliout infecting her. In the matter of hereditary transmission of infectious diseases, the question is whether the germplasms can be car- riers of infective microbes ? In this the father is concerned only at the time of conception. Of course at the time of copulation and conception, the father's state of health and condition, are reflected in the offspring. If the father i& youthful, healthy and in happy mood, the offspring acquires a gay and cheerful disposition of mind. JX on the contrary, the father is aged, or suffers from* dyspepsia, malaria or liver troubles, which naturally create a melancholy frame of mind, the children inherit the appearance of pre- mature senility. The children of youthful parents

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usually inherit a mobile and agile nervous system, as in youth nerves are very sensitive and responsive to impressions. The children of goaty, tubercular or hemophiliac parentage aquire a diathetic predisposition to these diseases. In an arthritic family often are seen manifesta- tions in different members of the family of gout, €czema, nervous affections, hepatic and renal lithiasis, diabetes and Bright's disease. But there is no conclusive evidence that the germ- plasm is a carrier of infectious germ.

But the mother's influence is much more preponderant. The fetus lives and grows in the mother's womb as a parasite for eight to ten months. Por its nutrition it is dependent on the maternal circulatory system. Spermatozoon practically acts simply as a stimulant and gives the momentum to the ovum to start its anabolic evolutionary course. The child is really formed of the mother's nutrition. So her psychical and physical life vitally reflects in the formation and growth of the fetus, during the long period of gestation. If she has any infectious disease, it is very unusual, if she does not tr^ansmit it to the fetus through the placenta.

Nutritional (dosavala) disturbances are many and varied, and are known as metabolic

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diseases. Nutrition is the function of every living cell, consisting in the taking in and 'assimilation through fermentative changes, whereby tissue is nourished and built and energy is liberated : its successive stages are known as digestion, absorption, assimilation, disassimilation and excretion.

Anabolism is the assimilative synthetic process, while catabolism is the retrograde disassimilative metabolism. For both these functions a liquid medium is necessary in which the nutritive substances can be in a soluble state, so that by osmotic pressure, it can per- colate through the capillary wall and enter into interstitial space, from which the cells extract their food needs by endosmosis, and by exosmo- sis, throw out the metabolic v»^aste products formed in the organic synthesis into the lymph stream. If any of the waste products be allowed to accumulate, the organism would die out of auto-intoxication.

So nutrition comprises various functions. (1) Transmission and transformation of food in the alimentary canal by the digestive enzymes, from insoluble into soluble products so that they become dialyzable: starches are saccharified, albumines are peptonised and fats are partly emulsified

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and partly split up into fatty acids and glycerine. ,(2) Absorption of the digested soluble nutrients. (3) Detoxication, synthesis and fixation of the nutrients in the liver, especially the glucose, which is converted into glycogen. (4) Trans- portation of the nutrients with the blood-circula- tion to every tissue of the body for the food- supply of the cells, the extraction of the food- material from the plasma by the cells, and ejec- tion into it of the waste-production of catabolism. (5) Regressive metamorphosis and reduction of harmful disassimilative products into harmless substances, chiefly in the liver as the conversion of the nitrogenous end-products into urea. (6) Elimination of the metabolic wastes through the kidneys, lungs and the skin. It has been esti- mated that an adult voids daily 250 grams of iarbon and 18 grams of nitrogen. This must be replaced to preserve the equilibrium between the cncome and the expenditure of the bodily energy, or it will slowly starve to death.

Death takes place through starvation, when the body has lost nearly 45 per -cent of its weight. When food is withdrawn,^ the orga- inism performs its multifarious functional activi- ties, as the pulsation of the heart, • metabolism,, respiration, mainteaance of the body tempera-

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ture, muscular contraction and excretion of waste products, by consumption of the body fat and protein, sacrificing the less useful to the more useful in the economy. Death is postpon- ed if plenty of water is taken, for it maintains the integrity of the circulatory system and aids in the transportation of tlie metabolic wastes for expulsion from the body. Without suffici- ent consumption of water, the increased viscosity of blood and the retention of the toxic excretory substances hasten death. However, death through absolute starvation is very rare. But death through malnutrition — insufficiency or bad quality of food, especially during famine — is very common, indirectly or directly. Malnutrition weakens the vital resisting power of the organ- ism and clears the way for the invasion of epidemics, which is usually the case, or death is slowly preceded by gradual emaciation, anemia, dropsy, cardiac and cerebral disturbances, especi- ally delirium.

If the aliments are too abundant or of bad quality, the undigested food falls an easy prey to microbes that swarm in the alimentary canal, provoking fermentation and putrefaction, thus causing dyspepsia, lientery auto-intox icationn 41atation and catarrh of the digestive tube. In

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the children, it is manifest hj gradual emaciation, nervous irritability and erethema of the buttocks, vulva and thighs. But even if it be digested and absorbed, overnutrition is liable, with excess of carbohydrate consumption to engender glycosuria^ if it be coupled with hepatic and pancreatic in- sufficiency, with excess of protein consumption into peptonuria and albuminuria with heptal insufficiency under certain pathological condi- tions. The evil effects of over-nutrition did not escape Charaka. Eor he says : *'If any one accustomed to day-sleep and the comforts of bed ( i. e. does not take sufficient exercise ) indulsre in excess of oilv. sweet and slimv substances, new rice, new wine, meat, fish, milk, butter, and cakes, he becomes subject to many diseases. If he does not reduce ( the excessive consumption ) of restorative dishes, he will suffer from diabetes ( prameha = gljcosuvia, and albuminuria), cutaneous irritation ( katidu), pain {gouty), eczema ( hotha ), jaundice, fever^ leprosy, alimentary diseases, strangury ( mutra- krchchhi^a ), loss of appetite, lassitude ( tan- dra)^ impotence, emaciation, lethargy, heaviness of the body, burdening the circulatory system with waste products, dullness of sense-impressions, mental cloudiness, drowsiness ( p^amilaka )y

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edema ( sotha ), and other diseases." Charaka I. 23. l-5'\

II. Mechanical Pathogenesis.

Mechanical (adhibhautika) agents can be the means of causing bodily suffering and death in various ways under different circumstances. If a man falls from a tree, the in jury would depend on the pressure of contact, based on force ( weighty height of the position and the gravitation of the earth, as well as the nature of the ground). Even one can suffer fatal injury, especially to the ner- vous system, by the rapid vibration of air, as near the passage of a high-speed projectile, of which there have been numerous victims in the recent war and it is known as ^shell-shocks*. Whatever may be the injury, it is due to the conflict of power and resistance. When one falls from a tree, he is- the body in motion : when a sword or a bullet strikes him, he is the resistance. The injury on the wound depends on their mutual relation. One misrht strike another with a sword, lacking force without causing more than a bruise, but the same

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sword can cut him in twain, if struck with vigor. The nature of a wound depends on the instrument and the force with whichit is struck. With sharp- pointed intruments as the needle, pin, cannula of hypodermic syringe, sting of certain insects and scorpions, any wound is called the 'puncture^ and puDcture is usually harmless. Even the heart can be punctured without any serious consequen- ce Neither is tlie puncture of the nerve serious, unless the vital centres are penetrated which might cause sudden death. A bruise in the soft parts without a break in the skin is called *con' tused wound' which heals very quickly. A clean cut with a sharp instrument is called the '"incised wound' and though there is profuse bleeding as long as the incised parts are not tightened togeth- er, it heals rapidly usually without infection. Lacerated wounds are those which are inflicted with a blunt instrument or by biting of animals. They generally take a longer time to heal, as it is very hard to keep the torn out tissues in aseptic condition. The seriousness of a gun-shot wound depends on three factors, namely, the point of -entrance, the tract and the point of exit. When the bullet has lodged in the tissues of the body, the tract is known as 'blind'. The wound at the point of entrance is always smaller, due to the

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'Contractibility of the tissue than the aperture of the exit, as it is more subjected to pressure and distension and is consequently more or less lace- rated whether the tract of the bullet is direct or tortuous. When a buUiet lacks a great velocity, it slunts by, if it meets a bone and becomes tor- tuous, but if it be driven with a great force, it might drill clear through a bone or cause a frac- ture and impart to the fragments sufficient mo- mentum to act as glancing missiles and aggravate the lesion. The wounds caused by explosives are more serious, as aside from the mechanical effect, the tremendous sudden increase of press- ure and temperature, as well as the liberation of toxic gases cause a very severe nerve shock. In any gun-shot or explosive wound, it is the nerve- shock, that is the serious matter. Otherwise in a simple wound not affecting any vital part in the econom\, if there is no introduction of any septic matter, and bleeding can be arrested and suppuration prevented, there need not be any fatal consequence.

The physical {kala-vala) agents are many as heat, cold,* air-pressure, sudden seasonal changes, dazzling light, the sun (sun-stoke), sound and electricity. It seems that the human organism can stand cold much easier than heat. Of course

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with the rising temperature, metabolism is slovA ed up and the consequence is less oxidation,, ■which means in other words, less production of heat. And there is vaso-dilatation, and the blood rushing to the periphery loses part of its heat by radiation in the surrounding atmosphere, and with the evaporation of perspiration, there is not only further loss of heat, but also a noticeably cooling sensation. However, when the evaporation from the skin is not rapid as in humid heat, it is more unpleasant. The dog or the cat whose body is covered with hairy coating and can not perspire freely, put out their tongue, execute rapid respiratory movements and thus facilitate evaporation through their gustatory organ. But when due to excessive consumption of alcohol, the vaso-motor mechanism does not react, or due to burn, perspiration is interfered with, or in the close overheated chamber near a furnace or boiler, prostration comes with high fever, rapid pulse, stertorous respiration, hot and dry skin and delirium. Perhaps this symptoms-complex is due to the chemical change in tbe nerves, brought about by excessive heat and riot to the coagulation of myosin as it was supposed before. Exjposure to the strong sun for a long time, principally the unprotected head, affects the

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nervous mechanism directly, especially in one who has not been gradually accustomed to it, by the penetrating actinic rays, creating perhaps molecular changes in the nerve-cells. The pros- tration is extreme, rapid and sudden, but often the high temperature is missing, though in other ways, the symptoms are those of heat-stroke. Though cold can be better borne than heat, yet after heavy consumption of alcohol, which causes vaso-dilatation and consequently loss of heat, one can be easily frozen to death. The action of cold is intensified by humidity which absorbs a good deal of heat and wind which drives away the warm layer of air surrounding the body. Even a healthy person with prolonged exposure to cold and sudden fall of temperature, might get a frost-bite. The frost-bite is manifest in the first stage by erythema and rubefaction, in the second stage by ulceration and finally by eschars, entailing the loss of the organ. Even when it does not directly cause any lesion, in» directly in a weak, debilitated or undernour- ished organism, it causes the development of various germs as pneumococci ; or there is an irresistible tendency to sleep from which one, hardly wakes ; or the physical and mental apathy may be interrupted by cerebral derange-

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ment and delirium, and one dies of heart-failure. The influence of the variations of the atmos- pheric pressure is not very negligible. At the sea level, the air exerts a pressure of 1.03 kilogramme per square centimeter, that is, about 18,000 iiilogrammes for the human body. When a man makes an abrupt ascent to a high altitude in an aeroplane or makes a descent as a sea- diver, the sudden pressure variation is apt to cause various disturbances. At the sea level, at zero altitude, there is a barometric pressure of 76 centimeter of mercury ; in Cashmere at the altitude of 7,000 feet, 56 ; at Mt. Everest at the altitude of 29,000 feet, 24.8. If a deep-sea fish is brought to the surface, it bursts from the expansion of the gas contained in the fish, so a man by a sudden high ascent not only finds it hard to breathe owing to the rarefaction of the air and consequent diminution of oxygen, but also the intestinal gases expand and cause tympanites and the blood rushing towards the periphery provoke diverse disorders from the results of anemia of the internal organs. At the altitude of 2000 meters, the oxygen diminishes 13 per cent ; at 3000,21 per cent ; at 6500,43 per cent and at 8500,50 per cent. To counteract this influence, the aeronauts are supplied with

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oxygen tanks, and the deep sea divers with compressed air to two or three atmospheres. The benefit of a mountain resort is in the purity of air and its higher ozone content. But above 11,000 feet, one who is not accustomed to high- mountain climbing, mountaineering may provoke 'mountain sickness* with a symptom-complex of giddiness, nausea, dyspnea, headache, thirsty malaise and a slight rise of temperature, almost like the sea-sickness, and with weakness of heart may prove fatal. But when a deep-sea diver comes to the surface, he feels a buzzing sensa- tion in the ears, due to the difference of pressure between the two surfaces on the tympanum, and this difference may be sufficiently great to- cause rupture of the membrane, and there is a complaint of great fatigue and tendency to fainting. If the reduction of pressure is rapid,, there is hemorrhage from the nose, ears and lungs and on the skin in puntiform shape, which the divers designate as '^flea bites.'

Light is visible between 497,000,000,000 and 728,000,000,000 vibrations per second. Below or above this figure, there is no sensory impres- sion. Yet within this narrow limit of our visibi- lity, we can see that light plays an important part in stimulating our nervous system and

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general metabolism and killing many of the microbes exposed to it. It is well known how the sun light activates plant growth. Under its influence, carbonic acid — a waste product of the cellular metabolism, is made to unite with water — and thus reconstituting a hydrate of carbon — which is the principal mainstay of energizing food supply of human beings and herbivorous animals. And though light is used very effectively as a valuable therapeutic agent in dermatosis, a strong light might cause erythema and reflected light, either from sand as in the desert or snow, might provoke opthal- mia and blepharitis. The harmfnl effects of light can be avoided by using blue or black glasses over the eyes, and covering the body, especially the head with black or blue cloth through which the ultra-violet rays can not penetrate and to which the irritation is due.

Sound is only audible within the close range of 30 and 30,000 vibrations per second. Pro- longed harsh sounds may cause mechanical lesion, even perforation of the timpanum and reflexibly ne/vous irritation. The soothing and restorative effect of the mountains and country places is often in the freedom from noise. And music which is nothing but the harmyon of

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isound, is now well recognised as an important therapeutic agent for calming and soothing nervous irritation and in various other nervous derangements.

The nature of electricity is not fully under- stood. Life itself possibly is an electro-chemical reaction, brought about and maintained by the interchange of the intercellular fermentative activities. And the human body is a compli- cated electrical apparatus : the lungs are the battery and the nerves are the wires insulated with sheaths of modulated and lipoid coatings. If the nerve current propagates at the rate of 120 meters per second only, while electricity at 8000 miles, it is because the nerve is not a homogenous wire, but interrupted by thousands of sympathetic junctions. It is now recognised that the insignificant quantity of minerals in the diet plays a vital role in the economy. It is very likely that they are intimately connect- ed with the generation of electric current. And like vibrations of light and sound waves, the human organism can only adjust within a limited range. Beyond that, it provokes death by molecular change in the nervous system as in electricution. The alternative current of 200 voltage kills a dog within 30 seconds, 700

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a horse and about 2000 a human being. This also proves that the human body is a better electrical machinery, withstanding the shocks of 2000 voltage, while the horse though superior to man in body weight and muscular strength, succumbs to shocks of 700 voltage.

Infectious (daiva-vala) agents are of various kinds as a sporozoid in malaria (plasmodium malaria)^ a high fungus akin to streptothrix actinomyces in tuberculosis (bacillus tuberculosis) or a bacterium like gouococcus in gonorrhea, vlt seems that the pathogenic microbic agents are almost ubiquitous. They are in the soil, water and the air. They find themselves upon our skin from all sources. But they usually live there a harmless saprophytic life, as the horny epidermis underlined by a layer of fat offers resistance ta their penetration. With each inspiration count- less bacteria get admission in the respiratory passage, but tliey are retained by the hair in the nasal orifices and by the vibratile cilia of the mucous membrane. Those who penetrate farther, are either expelled with the mucous secretions, or by the germicidal mucus they are disinfected and pasted on the walls of the nasal orifices. The microorganism invade in large colonies the alimen tary canal with the ingestion of food and drink^

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but the hydrochloric acid content of the gastric juice possesses a considerable germicidal power. The intestine unquestionably is a fovorable placa for their growth, as sufficient humidity, warmth and nutrition from the residue of the food ara found ideally combined, ^d there is hardly any antiseptic secretion there to arrest their develop- ment. In the gastric cavity are found nearly 50,000 microbes, in the mouth of duodenum 30,000, in the cecum 25,000 and in the lower intestine about 100,000 per cubic millimeter. On the whole, on the same basis of computation there are about 412,000,000,000 microbes in the- whole of the alimentary canal and every day with the feces from 12 to 15 billions are evacuat- ed. That they do not increase usually more than that, is due to the fact that the fermenta- tive bacterial colony counteracts the luxuriant growth of the putrefying germs which cannot flourish in the acid medium and thus they preserve a mutual balance against each other so that they can not easily become obnoxious to the economv. But in case the vesretative microbic flo'ra become active and virulent, they reach the lymphatic glands and the liver, where- they are destroyed. Of course the toxins liberated by the pathogenic micro-organism

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can be absorbed, but they are more or less attenuated, modified and made innocuous in the hepatic cells and other mechanisms of the body. Though the vulva and vagina swarm with pathogenic germs, infection through the genito- urinary passages is very rare except in venereal diseases as gonorrhea, soft chancre and syphilis, where even an abrasion, wound or cut is neces- sary which generally takes place through the sexual congress by the sharp edges of the hair, so that the venereal disease-producing germs can find a safe lodging place to develop in vita- lity and virulence, as they are partly disinfected by the germicidal mucous secretion and washed away by the force of urination. When the morbific agents as streptococcus are introduced in the vaginal canal, they are all destroyed within forty-eight hours (Meuge) by the abun- dant vaginal secretions.

But even when the pathogenic germs force through and invade the economy, the body is not defenceless. When their morbific action is not very virulent, the leucocytes rush up to the locality and destroy them ; if complete destruction is not possible for the phagocytes, the lesion is circumscribed by the leucocytes and the exudation. However, if the morbific

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invading micro-organisms are very virulent, then of course the leucocytes are repelled by the negative chemotoxic action of their secretory toxins. And then they invade the economy by the lymphatic or venous path. For blood has a considerable germicidal power due to its opsonic content. But even in case the microbes enter by way of the stomach or the intestine and reach the portal vein, they have to pass through the formidable fortresses of the bodily defensive mechanism — the liver and the lungs which exercise a tremendous germicidal action, before they can enter into the left heai^t to be thrown into the general circulation. And whether the microbes enter into the circulatory system by the portal vein or penetrating through the capillaries, any way in blood they have but short-lived existence, for either they are destroy- ed or driven into the capillaries, within less than ten to fifteen minutes.

Life is indeed a continuous struggle with the micro-organisms to preserve its integrity. Even when there is a general invasion, the body does not give up the task of self-preservation hopelessly. The body enjoys more or less various immunities — racial, ancestral, seasonal, inocula- tionary, acquired and passive as a natural

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reaction of the organism to counteract the toxia products of the disease germs. We know that tlie Negro races possess a remarkable immunity against yellow fever while they are very suscept- ible to tetanus and tuberculosis. The Mongolian race is very predisposed to small-pox, but not to tuberculosis. It is well known that the offsprings of a gouty family are almost immune against tuberculosis. And syphilis runs in Europe a benign form, which when introduced among savages, rages like an epidemic and exterminates the population. Seasonal prefer- ence for diseases is also well marked as the typhoid and the gastro-intestinal diseases in the summer, malaria in the autumn, thoracic disorders in the winter and pneumonia in the spring. It is the Chinese who first noticed about four thousand years ago that certain diseases like the small-pox gave an immunity to its victim against its recurrence. On this principle, vaccination has driven away small- pox practically from all civilized countries. As a prophylaxis against infectious diseases, serum therapy is being built up on the sa'me basis, inoculating an animal with the virus and thus gradually attenuating the virus through a few successive animals, a serum can be obtained

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which contains enough of antibodies, but not strong enough to cause any malaise, in the human system. The inoculation of the attenu- ated serum is not only a prophylaxis against the disease, but even when the infection takes place, it stimulates the resisting power of the organism by its bacteriolytic {lysoyenic), agglu- tinative and opsonic action. Various sera have been made and tried as that of typhoid, pneumonia, cholera, but yet only the vaccine of small-pox has given completely satisfactory result. But undoutedly with the improvement of technique and with better knowledge of bio-chemistry and bacteriology, modified bacteri- al sera promise great results in therapeutics in no distant future.

134j ancient HINDU MEDICINE

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All infectious diseases are now ascribed to microbic agents and they have been all identified except in some eruptive fevers as the scarlatina, measles, small-pox, varcella {chicken pox) and ere long, it is expected they will be isolated. The parasytic diseases can be classified this way»

Diseases due to pyogenetic micrococci : — Suppuration, septicemia, erysipelas and gonorrhea.

Acute diseases due to specific bacilli : — Cholera, diphtheria, influenza, meningitis, plague, pneumonia, tetanus, typhoid, yellow-fever.

Chronic diseases due to tissue bacilli : — Glanders, leprosy, tuberculosis, mycetoma^ {Madura foot).

Diseases due to protozoa : — Dysentery, filaria- sis, kala-azar, malaria, sleeping sickness, syphilis.

But the same morbific agent may cause local or general pathogenesis as for example, when pyogenic streptococcus is inoculated subcutane- ously, only a local lesion — erysipelas is produced, but when it is injected into the veins, it causes general infection — septicema.

The microbes (Icrimi) in the feces originate in the same way as those in the lymphatics. Their habitat is the intestine. If some of them {krimi) travel towards the stomach, then in the breath and in the vomiting, there is bad odor. They

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are minute, globular ( micrococci ), white-com- piexioned, long (rod-like bacteria as that of the anthrax), and like the lamb-hair ( leptothrix )." CharakallL 7. 9''.

Detital caries : "In this disease the microbes {krimi)y orginating from corrupt blood, blacken, perforate and loosen the teeth." Susruta II. 16,

The disease-producing germs are introduced into the system either through the air as tuber- culosis, food and drink as in cholera, through soil as in tetanus, personal contact as in gonor- rhea, or through an intermediatory as in malaria {itnopheles). As long as the microbes remain in vegetative state, they simply live as parasites, but sparing the host and doing the least harm to the economy, as they take only the minimum food for their maintenance. It is only when the organism is devitalized due to over- work, fatigue.

PATHOLOGY 137

malnutrition, or undernutrition that they become virulent and by their toxic secretion cause func- tional disturbances and reactions.

Plies deposit microbes in the ulcer and when the ulcer is eaten up by those microbes, ( local ) edema is produced. Snsruta IV. 1. 103^«.

Chemical (Msa) agents are many, but they can be divided into two classes as endogenous and exogenous. The endogenous toxins are those that are produced autogenously in the cells as metabolic wastes or engendered by the microbes that live on tlie body as parasites. The exogen- ous toxins may be introduced with rotten, poison- ous, indigestive or disharmonious combination of food and drink, bites of venomous snakes and insects, occupations in lead, copper, corrosive chemicals, sulphur, arsenic, quick-silver mines or ovens, especially of coke-coals where in addition carbon monoxide may be absorbed.

"Toxins are of two kinds : stable (vegetable and metallic ) and mobile ( of animal origin ).

138 ANCIENT HINDU MEDICINE

Stable toxins are divided into ten classes and the-

mobile toxins into sixteen classes. Eoot, leaf, fruit, flower, skin, exudation, juice, extract, *dliatu^ {chemical principle or metal) and bulb are the sources of sthavara {stable) poisons.'* Susruta y. 2.2-3* ».

**iletention of feces and urine (through absorj)- tion of their poisonous contents), day-sleep, keep- ing vigil at night, drinking of liquor, exposure to cold and wind, sexual excess, exposure to foul odor, dust, smoke, wind and the sun, ingestion of ( excessive quantity of ) foods that are hard to digest, acid or vegetables (5^ ^^a= leaves of plants)^ drinking of very cold water, receiving a wound in the head, acidity due to indigestion, weeping, reten- tion of tear, cloudy weather, extreme depression, some misfortune to the country and untimely season, derange the nerve, venous and lympha- tic svstems and vitiate the blood of the brain and

f^k m wi H'^* '^\ '^'^ €K ^ '^ I

PATHOLOGY 130

thus cause headache with varied symptoms/' Charaha 1. 17. 4'^

"Foods that are turned into poison by (dishar- monious ) combination, are being mentioned '

Do not eat meat or fish with the grains of sprout- ing rice, fat, honey, milk, molasses or with bean ( masa-paseolus racUatus ). Do not take clarified butter, if it has been kept more than ten days in a brass vessel." Susruta 1. 20, 12-13 ^\

60. €^i^r^Tfi^T^¥Rm't siR'C'jn'^m, i

^^^FWl^^MTqil ai^SiT^f^^^ II

^mr^: ^^rRrf^ fai?:^^^ ^ri i cm: 'mm w^^ ^t f^r^i^^raiiT: ii

61. ^sj^rr^ '?'"4tJTT^f%fn1% ^wm: i ^ ^ r^^wR^^??'^'^-

faRTKI^ 1 ^^^ ^I^^I^T I ?^'§^T ^WTT I ^T?^^ ^^li ^^T '9¥

140 ANCIENT HINDU MEDICINE

"Poison is not the only toxin; unpurified copper ( that has not been incinerated and calcinated ) is a terrible poison." Rasendra-Sara- mragraha 1. 136^*.

*'Unpurified sulphur (that has not been incin- erated and calcinated) produces fever, eczema, delirium and bilious disorders." Rasendra-sai^a- samgraha 1. 50^^.

Purified mercury ( that has been incinerated and calcinated ) is like real ambrosia, but faulty ( i. e. incompletely purified or unpurified ) is harmful like venom.'* Rasendra-sara-samgraha 1. 7'^ '

^ai5cr^tig''fEict ^fq": I Ji-g =Cm'^w qi I ?m^i5Tqftq^% ^5-5<mRh-^% ^

63. -^i^r^i*?: IP^ g cTiq' li^' ^ fqTl^^ ^flf I

PATHOLOGY 141

Poisoning miglit also take place from the in- gestion of some fish-eggs at the breeding season, some fish and molluscs which live on putrefied matter, from the cooking earthen vessels that are varnished with substances containing lead, arsenic or Vermillion, foods that are colored and flavored with aniline products or jn-eserved with an excessive dose of salicylic acid.

All the snakes are not poisonous however, for though they are provided with a venom gland, all of them do not possess an excretory duct, so that the venom can not be poured out.

But all poisons do not act immediately on the organism. Some poisons especially the metallic ones as arsenic, mercury, lead, sulphur have cumulative effect. Though they may be taken in small doses, they may be accumulated in the liver and the osseous system and after months or even years, they might express in violent reac- tion of their cumulated effect. But in other poisons as that of morphine, alcohol and tobacco, the harmful reaction ceases more or less after a while when the organism aquires the habit of neutralising the noxious substances of those poi- sonings. Tobacco not only harms the organism by the partial absorption of nicotine, but also by the inhalation of carbonic acid, carbonic oxide.

142 ANCIENT HINDU MEDICINE

sulphuretted hydrogen, hydrocyanic acid and pyridic bases, which the tobacco smoking pro- duces.

According to Charaka (III. 6. 4), the diseases are innumerable, but Susruta (VI. 66. 6.) calcu- lates them as eleven hundred.

IV. DISEASES AND THEIR DIAGNOSIS.

"The physician in order to make a prognosis, must examine hj direct (p7'afi/aksa), indirect { amimana = inference ) and differential diagnosis, the color [ of the skin % lemon-yellow tint in pernicious anemia, waxy pallor in nephritis, bronzing in Addison's disease, greenish hue in chlorosis, blue skin ( cyanosis ) in conjenital heart disease, brownish-yellow coloration in jaundice, grayish tinge in the long-continued therapeutic ingestion of silver nitrate, yellow tint in cancer and a permanent pallor in malarial cachexia, tuberculosis, leucemia, syphilis, chronic mercurial, lead and arsenic poisoning ], voice [ whispering voice ( aplionia ), coarse or harsh quality of the voice that is generally known as ''lioarseness'' ( dijsplionia ) are due to the inflamma- tion of the larynx, or disease, or pressure upon the recurrent laryngeal nerve ; chronic aphonia ( hysterical aplionia is only temporary ) is said

PATHOLOGY 14.3

to be prodromal of leprosy and chronic hoarseness that of cancer ; deep, hoarse voice and brassy cough indicate interference with the superior laryngeal nerve and if there is aphonia without cough or dysphonea, it may be due to paralysis of all the laryngeal muscles ; a flat and toneless voice results form one-sided paralysis of a cord and a falsetto voice from paresis of the tensors of the cords ; the open nasal tone is indicative of the paralysis of the soft palate or destruction of the soft palate by ulceration, usually syphilitic or of congenital cleft of the palate, and the closed nasal voice is often suggestive of coryza, hay asthma, hypertrophic rhinitis, nasal polypus, postnasal adenoids, enlarged faucial tonsils, suppurative tonsilitis, acute pharyngitis and retropharyngeal abscess ; the varied forms of aphasia, motor ( apJwniia, agraphia ), sensory ( visual, auditory ), conduction, are the sympto- matic expressions of the focal cerebral lesion, occurring in the left hemisphere in the right handed and the right hemisphere in the left- handed, but might also occur in cerebral hemorrhage, thrombosis, embolism, abscess, tumor, gumma, depressed fracture of the skull and more rarely in hysteria, neurasthenia and immediately after epileptic convulsion ], odor

144 ANCIENT HINDU MEDICINE

[ an unpleasant odor of breath is usually present in the mouth of those whose teeth are not cleansed and food particles are allowed to accumulate on them and to cause decomposi- tion and fermentation ; a foul odor in stomati- tis and glossitis ; a stale and musty odor with the accumulation of sordes upon the teeth as in typhoid ; caries of the teeth, necrosis of the jaw, pharyngeal or tonsillar diphtheria, follicular tonsilitis and locunar concretions also produce bad odor ; bat the most fetid odor attends the mercurial and gangrenous stomatitis and less so scurvy ; in uridrosis occurring with diseases in which the action of the kidney has been impaired, the sweat has a urinous odor, and deposits white scales or crystals of urinary solids upon the skin ; there is volatile fatty emanation from the sebaceous secretion and mixed with perspiration, the odor varies in health and sickness, according to age and race : among the Negroes, it is the most pronounced and in the Mongolian race, it is the least ], taste [ a bitter taste is felt in jaundice ; a coppery taste in gastro-duodenal catarrh ( biliousness ) ; diversified taste sensations as sweetish, sour, foul are felt when the tongue is coated and furred from whatever cause ;

PATHOLOGY 145

abnormal taste with the long continued use of certain drugs as potassium bromide, iodide or tartar emetic ; perversions of taste in hysteria ; absence of taste ( ageusia ), if it is unilateral is indicative of the disease of the glosso-pharyngeal nerve, and if it is bilateral, of the diseases of the - nose as coryaa or polypus ; partial impairment of taste ( hemiageusia ) may be due to the facial paralysis, or due to local conditions of the mucous membrane of the tongue, involving the taste buds and end-organs of the gustatory fibers, as in thickly furred or coated tongue, or due to the irritating(as of piperine)or blunting(as of bromides) action of the drugs or condiments ), touch (sparsa) comprises tactile sense ( esthesic ), pain sense ( algesic ), temperature sense ( the?'mesthesic ), muscle sense ( myesthesic ) i the loss of tactile sensibility ( anesthesia ) is indicative of cerebral lesions ( causing hemiplegia ), hysteria, traumatic neuroses, diseases of the spinal cord, especially locomotor ataxia, neuritis and leprosy ; hemi- anesthesia, the loss of sensibility confined to one side of the body or to lower extremities or of unequal distribution, are mainly due to hysteria ; an excessive sensibility (hyperesthesia) is gener- ally met with in hysteria, chiefly in the hystero- genic zones, which are in the breasts and below 10

146 ANCIENT HINDTJ MEDICINE

them in the central part of the chest, in the pelvic region and the back ; in neurasthenia, there are localized hypersensitive tender spots- along the spine, scalp and the chest ; in meno- pause and gouty diathesis, there are also tender points on the scalp ; a general hypersensitiveness may be present in influenza, typhoid fever, and in alcoholic intoxication , disturbances in the heat and cold sensation {thermaesthesic) are due to syringomyelia and to a less extent to the lesions of the medulla and locomotor ataxia ; disturbances of the pain sensation — either hyper- — or hypo-sensibility are due to syringomyelia, Morvan's disease, hysteria and syphilic chord disease ; loss of muscular sensation is characteris- tic in locomotor ataxia, paramyoclonus multiplex^ myeletic disease, and the lesions in the medulla and the pons ; transference of sensation {alio- chiria) so that a touch, on one side of the bodv is felt on the other, is symptomatic of hysteria,, locomotor ataxia, disseminated sclerosis, myeletis;,, delayed conduction so that a tactile or pain sensation requires 5 seconds or more, instead of one-tenth of a second, is characteristic of locomo- tor ataxia and peripheral paresis), the eye (edema of the eye-lid, particularly the lower one, is. usually symptomatic of renal 'disease ; morning.

PATHOLOGY 1 47

puffiness "with bloated face is also seen after a night of debauchery or in cases of profound anemia, chlorosis or in neurotic adoloscents ; in erysipelas, glanders, severe coryza, hay fever^ measles, variola and occasionally in varcella, as. well as the prolonged use of arsenic and iodine^ may induce the swelling of the eye-lids ; ptosis — the dropping of the eye-lid — is either congenital or due to the paralysis of the third nerve ;. lagophthalmos — imperfect closure of the lids^ follows paralysis of the orbicularis muscle, either due to lesions of the portio dura of the facial nerve or leprosy ; blepharospasm — spasmodic closure of the lids is due to the reflex excitability of the fifth nerve in photophobia, in ocular disorders and is symptomatic of meningitis^ cerebral tumors, typhus, measles in certain, stages of their evolution and may be also present without actual inflammation of the membrane in hysteria and in chorea in children ; hordeolum — a sty or minute boil on the palpebral margin,, if small and single may be of local origin or indicative of the over-use of defective eves or- more frequently of digestive or genital disorders ;. blepharitis — inflammation of the margin of the lids which become thick, reddened and crusted with cheesy secretions, is indicative of scrofula or

148 ANCIENT HINDU MEDICINE

of minute ulceration, resulting from a previous oplithalmia or measles, anemia or in tuberculous diatliesis ; verruca — warts upon the eye-lids, are usually found in the old people, indicating the possibility of commencing epithelioma ; syphilic ulceration is generally deeply indurated and accompanies other stigmata of the tertiary stage ; a dusky color of the lids and under the eyes is «eea in women during menstruation, in menorrh- agia, long-continued leucorrhea and early in pregnancy : it may also accompany anemia, loss of sleep and in exhausting diseases ; dark circles round the eyes are symptomatic of the abuses of masturbation ; the yellow color of the sclera of the eye is symptomatic of jaundice ; bluish- white or pearly sclerotic is seen in anemia, pthisis and nephritis ; inflamed conjunctiva is usually caused by gonorrheal infection, though it may be present in lesser degree in diphtheria, measles, hay fever, coryza and influenza of the catarrhal type ; the eye may be dry and glazed in collapse or the typhoid status ; an increased secretion of the watery fluid of the eye {lachry' mation) accompanies conjunctivitis, irritation of any kind and in alcoholism : inflammation of the cornea (keratitis) is mainly of syphilic origin, while the ulceration of the cornea — a reddened.

PATHOLOGY 149

painful, photopliobic eye may be in relation- with exophtlialmic goitre ; protrusion of tlie- eye-ball (exophthalmos) is symptomatic of exoph- thalmic goitre and may be also present in lesser degree in spasmodic asthma or other conditions, attended by dyspnoea ; recession of the eye-ball or the sinking of the eye-ball into the orbit (enophthalmos)ma,j be provoked by any wasting disease as consumption, malaria, cancerous- cachexia, by absorbing the cushion of fat of the orbital cavity ; dimness of vision may be provoked by uremia, diabetes, excessive abuse of tobacco, hysteria and migrane ;, light appears yellowish in jaundice, and reddish after nervous irritation, fatigue and in wasting diseases), eai' (unusally promi- nent, long or misplaced ears with absence of helix, antihelix, or lobule, are degenerative stigmata ; tophi — small, hard, gritty accretions- of chalky masses of sodium urate, seen as- nodules in the external ear alons: the marc^in or in the depressions, is of gouty diathesis ; a very thin, waxy and bluish ear may indicate- general anemia or chlorosis; but a thickened and a deformed ear with the effusion of blood between the cartilages and the perichondrium (hematoma auris\ is a trophoneurosis of the general

150 ANCIENT HINDU MEDICINE

paralytic and the insane ; the flow of pus {otorrhea) from the meatus, which is very common among children and often associated with intense pain, due to inflammation of the tympanum (otitis media,) caused hy tonsilitis, influenza or measles, is usually without serious consequences, deafness is indicative of the disease of the tympanum, eustacian tuhe or the auditory nerve : it can be easily found out by placing a watch at a varying distance from the car and if its ticking sound is not audible by aerial conduction, and then if the same watch is placed upon the mastoid process and the sound becomes audible by bone conduction, then it clearly indicates that there is no nervous lesion and the deafness is due to local hindranc- es : the auditory nerve and its cortical center may be affected by syphilis, which is usually the case or by tuberculosis by injuring the nerve endings : quinine, salicylic acid or the salicylates may also provoke temporary deafness by causing labyrinthine hyperemia ; hypersen- sitiyeness of hearing (oxyacoia) and the buzzing, roaring, hissing sound {tinnitus auriiim)^ are due either to nervous irritability or to rhino- pharyngeal catarrh, with involvment of the eustacian tube or the middle ear), nose [a coarse

IBATHOLOGY 151

and broad nose is symptomatic of myxedema and cretanism ; a depressed and sunken nose is syphilitic unless there is traumatic fracture of the bone ; a pinched and distorted nose may "be due to obstruction of polypus, tumor or adenoid growth ; a chronic redness of the nose with dilated capillaries is indicative of alcoholism, otherwise of chronic digestive disorders or amenorrhea ; an intense pain in the nose is symptomatic of syphilic lesion and a burning pain, to catarrhal inflammations ; a sensation of dryness is felt in the preliminary stages of coryza ; sneezing — the spasmodic expiration, is due to the direct (presence of any foreign body or the inhalation of irritant substances as pep- per, snuff and in the early stage of coryza, mesales, pertussis, hay fever, asthma) or reflex {as in hysteria) irritation of the sensory nerves of the nose; nasal stenosis — difficulty of brea- thing through the nose, if acute, is symptomatic of an acute coryza, diphtheria, hay fever or prodromal of typhus fever, glanders and variola, and if chronic, it is either due to the obstruction to lymphoid growths as in children or to congeni- tal syphilis ; ulceration of the mucous mem- brane is usually a manifestation of tertiary syphilis or tuberculosis and might be followed

152 ANCIENT HINDU MEDICINE

"by necrosis and caries of the bones ; the ulcera- ted surfaces of syphilic origin is covered with a dry, greenish crust and the stench of the breath is sickening ; non-offensive, watery discharge from the nose marks tlie beginning of acute coryza, hay fever, pertussis, measles, typhus fever, catarrhal form of influenza and iodism ; offensive discharge accompanied with greenish -gray crusts and its foul odor impercep- tible to the subject, is symptomatic of syphilic necrosis or of atrophic rhinitis ; a discharge of blood from the nose (epistaxis) may have varied causes as alcoholism which renders the vessels to rupture, adenoid growths, ulceration in the nose, suppressed menstruation, chronic nephri- tis, cerebral thrombosis, and may be prodromal of typhoid or other eruptive fever infection ; loss of sense of smell (anosmia) may be due to local obstruction as polipi or adenoid growths, or chronic rhinitis and if it be only temporary, it may be of neurotic origin as hysteria or neurasthenia, and if it be permanent, the olfactory anesthesia may be caused by nasal necrosis of the bone, supporting the tract, or a tumor involving the nerve ; hypersensitiveness to smell {hypei'osmia)^ hallueinary smell {paros- mia) and an offensive smell (kahosmia)

PATHOLOGY 153

without any physical basis, are all of neurotic origin], tongue [the colour of the tongue, the only mucous membrane of the body, except the oral and the faucial, that is open to naked eye inspection, changes according to health, digestion and especially to tlie gastric condition to which it is closely related : it is pallid in anemia, bluish in cyanosis, reddish in gastric hyper-acidity, bright-red in the first stage of scarlet fever and in the inflammation of the tongue ( glossitis ), and greyish in nigrities ; a great enlargement of the tongue takes place in acromegaly and myxedema, but the tongue also swells considerably in variola, salivary calculus and in angina Ludovici ; the coating of the tongue consists of the accumulated epithelium, micro-organisms and food detritus : a thin -white coated tongue may be normal among the smokers or those who are accustomed to breathe through the mouth, but it usually accompanies mild gastro-intestinal disorder, nasopharyngeal catarrh or light fevers ; a flabby, swollen, indented tongue, covered with a yellow, pasty fur, is symptomatic of catarrhal gastritis, gastro-duode- nitis or febrile conditions ; a narrow tongue with a deep median fissure on each side of which there is a rough, thick, brownish fur, or if it be

3.54 ANCIENT HINDTJ MEDICINE

dry, red and glazed, is characteristic in typhoid status in its early and late stages ; a covered tongue with white fur through which project swollen and bright-red fungiform papilla, is indicative of measles and other eruptive fevers ; if one side of the tongue is higher than the other, this is due to the unilateral lingual paralysis and associated with hemiplegia ; if the tongue lies motionless in the floor of the mouth and the •subject is unable to protrude it and the functions of speech, mastication and deglutition are serious- ly impaired, it is due to' the total lingual paralysis, caused by thrombosis or sypbilic lesion], skin [ dryness of the skin {anidrosis) is observed in cholera, myxedema, diabetes, Bright's disease, dropsy and in the first stage of many acute diseases, attended by high fever ; moist skin and increased perspiration {hyperidrosis) occurs in typhoid fever, tuberculosis, trichinosis, tetanus and in rheumatism, but the rheumatic sweat is strong in odor and acid in reaction ; in many acute diseases ^critical sweats* suddenly break out with the fall of temperature as in pneumonia with the termination of paroxysm as in malaria, or the night sweats of tuberculosis and other wasting diseases ; partial or localized sweating is caused by the deranged innervation of the

PATHOLOGY 155

^aso-motor nerves and by the local vaso-motor paresis : this is particularly marked in rhachitis and in which disease, which usually occurs among children, the sweat is confined to the head and the patient rolls his head at night and the liair on the back of the head is rubbed off ; sweating of the hands and feet are seen in gener- vhI debility ; unilateral or one-sided sweating of the head and face may arise from destructive pressure on the sympathetic nerves, causing paralysis of the dilator fibers of the ciliospinal branches, as in thoracic aneurism, suppurative • parrotities, migrane, neuralgia ; unilateral sweating of the body (hemodrosis) occurs in liembplegia : eccymosis and petechiae — purple patches caused by extravasation of blood into the skin, appear in many diseases and drug poisonings as in acute yellow atrophy of the liver, pernicious anemia, in advanced stage of cancer of the liver and the stomach, cerebro- spinal meningitis (epidemic), cyanosis, diphtheria, jaundice (in severe forms), old age ( in the extre- meties ), poliosis rheumatica, pyemia, advanced cirrhosis ( hepatic or renal ), septicema, tuber- culosis (with extreme debility), typhoid fevers, ulcerative (malignant) endocarditis, yellow fever, and the rashes may be caused either by idiosyn-

156 ANCIENT HINDU MEDICINE

crasy or by poisoning with antipyrine, arnica, arsenic, atropine, belladonna, cannabis indica^ capsicum, chloral, copper, croton oil, digitalis, iodine, ergot, lead, mercury, morphine, opium, potassium iodide and bromide, quinine, salicylat- es, santonine, silver, sulphur, tar, tartar emetic ,. inflammatory eruption in cerebro-spinal fever, dengue, glanders (acute), erysipelas, syphilis ; exanthematous eruption in measles, rubella, scarlatina, varicella, variola ], mi/^c? (dullness of mind is seen in cerebral inflammations, scleroses of the brain, and in brain tumors), concentration of mind, pui^ity (hygienic conditions), disposition^ behavior^ memory [ memory is impaired (amnesia) in paralytic dementia, epilepsy, neurasthenia, the over-use of bromides and in old age], shape and general configuration of the body {aJcTti — tall, thin subjects with slender ribs, and a long narrow thorax are predisposed to tuberculosis of the lungs ; short, stout, thick-boned persons with florid face are predisposed with sumptuous living to obesity and gouty diathesis), tempera- 7nent ( irritability of temper is often associa- ted with gout, rheumatism, jaundice and neurasthenia ; change of temper is seen in pregnancy, typhoid fever, menopause and at the early stage of the exophthalmic goitre ; melan-

PATHOLOGY 157

choly mood is marked in hepatic lesions), perver- sions ( abnormalities of shape result from the following diseases as rachitis, acromegaly, my- xedema, pulmonary osteo-arthopathy, osteitis de- formans, osteomalcia), strength, endurance, in- telligence, cheerfulness, leanness ( as in consump- tion), obesity, lassitude^ beginning of the disease, acuteness (of the disease), lightness (of the disease) physical characteristics, dietary, habits^ quantity of food (that is consumed), the prevention of the disease ( prophylaxis ), the cure of the disease, the pi'eliminary symptoms of the disease, pain (pain is caused by the lesion of the peripheral, or the central nervous system, or indirectly by affecting the general economy; *acute pain'' is characteristic of acute inflammations of the serous and synovial membranes as in pleurisy or in joint inflammations ; *dull pain* is characteristic of the inflammation of the mucous membranes and the parenchymatous viscera ; *paroxysmaV or remit- ting pain^ is characteristic of neuralgias and colics; ^shifting pain' is charcteristic of rheumat- ism, hysteria, locomotor ataxia, trichinosis ; ^gnawing or boiling pain' is charcteristic in the diseases of the spinal column, thoracic and abdo- minal aneurism, periosteal inflammations, gastric carcinoma, and occasionally in gouty and lithemic

158 ANCIENT HINDU MEDICINE

lesions ; ^cramp' — the sudden painful spasm of certain muscles, aside from the occupation ••ramps, from the over-use of fingers as in writer's cramp, whether it is of the calf, toes or the abdo- men is usually characteristic of gastro-intestinal diseases and flatulence by causing an excessive tension to the muscular wall of the stomach and the intestine ; diffuse pain as in fever ; pain in the vertex — the crown of the head, is characteristic in neurasthenia, diseases of ovaries, uterus^ bladder, epilepsy, hysteria, anemia, chlorosis in the frontal and the temporal region of the^ head, in nephritis, uremia, eye strain, iritis, glau- coma, dyspepsia, constipation, syphilic nodes, lithemia, rheumatism of the scalp ; in the occipetal and cervical region : spinal irritation, diseases of the cervical vertebrae, dyspepsia, constipation, syphilis (very frequent), uterine lesions, eye strain, carous teeth, nephritis, uremia, cerebellar tumor, meningitis, adenoids of pharynx,, naso-pharyngeal diseases, middle ear diseases, rheumatism ; in the parietal region : dysmenorr- hea, diseases of ear and bone, cancer of tongue, hysteria, lithemia ; in the eye-balls : ophthalmo- plegia internaa inflammation of conjunctiva, iris, cornea, coryza, neuralgia of the fifth nerve, as- thenopia (eye strain) ; in the nose : acute rhinitis

PATHOLOGY 159

diphtheria, glanders, primary syphilis ; aural region : ottitis media, furuncle of meatus^ mas- toid abscess, polypus, carous teeth, alveolar ab- scess, cancer of tongue, aneurism of innominate dentition, temporo-maxillary rheumatism, syphi- litic or carous lesion of maxillary or temporal bones ; in the front neck : myalgia, cervical caries or abscess, sprains, inflamed lymph glands, aneu- rism of innominate ; nape of neck : rheumatism, neurasthenia, laryngitis, cerebrospinal meningitis^ tetanus, cervico-occipital neuralgia; throat: tonsi- litis, pharyngitis, scarlatina, diphtheria, cascinomaj^ laryngitis, irritant poisoning ; jaw : dental affec- tions, salivary calculus, neuralgia of maxillary- nerve, parotitis, actinomycosis ; shoulder : rheu- matism, synovitis, diaphragmatic pleurisy, dilated stomach or colon, duodenitis, colitis, neuritis, gallstone colic, hepatic diseases ; sternum : gas- tric diseases, bronchitis, epidemic influenza, tabes,, spinal apoplexy, angina pectoris, mediastinal ab- scess or tumor; breast : uterine and ovarian lesions, hysteria, menstruation and diseases of mamma -^ umbilicus : gallstone, hernia, carcinoma of omen- tum, tumor or ulcer of stomacli ; chest : pleurisy,^ acute pneumonia, pericarditis, phthisis, medias- tinal tumor; hysteria; flatulence, pericarditis ; right hypocondrium gall stones ( particularly )^.

160 ANCIENT HINDU xAIEDICINE

liepatic diseases; carcinoma of stomach, pancreas or duodenum ; movable kidney, uremia, pleurisy ; left hypochondrium ; gastritis, colitis, uremia, peritonitis, enlarged spleen ; precordia : functional disorders of heart, endocarditis, thrombosis of pulmonar artery, gout, hysteria, locomotor ataxia, angina pectoris, pyrosis ; Interscapular : flatulence, gastric in- flammation or ulcer, rheumatism ; lumbar : lumbago, fatigue, flatulence, appendicitis, hernia, dysmenorrhea, kidney lesions, prostatis ; epigas- trum : gastric lesions, appendicitis, gallstones, ulcer of duodenum^carcinoma of pancreas,cholera asiatica ; uremia, hepato-optosis, enteroptosis ; abdomen : gastralgia, especially hyper-acidity, arsenical, mercurial or lead poisoning, peritonitis, hernia, intestinal tuberculosis, flatulence, tabes, pancreatic lesions, leucemia, dysmenorrhea, diabetes ; right iliac : appendicitis, ovaritis, impactedcecum, colitis hernia, varicocele ; left iliac : colitis, impacted sigmod, hernia, ovaritis, varicocele; pubic region: cystitis, uterine or ovarian lesions, ectopic pregnancy, pyelitis, carcinoma of the bladder ; sacral region : uterine, ovarian, or testicular lesions, excessive venery, ulcer of rectum, sciatica; spine : iiysteria, neurastiienia, carcinoma of the liver.

PATHOLOGY 161

rachitis, scurvy, febrile affectations, spinal curvature, mediastinal tumor ; anterior thigh : ovarian or uterine diseases, pregnancy or displaced uterus, dysmenorrhea, renal colic, impacted feces ; posterior thigh : sciatica, locomotor ataxia, impacted feces ; leg : rheumatism, perios- titis, leucemia, locomotor ataxia, spinal meningi- tis ; calf : cramp due to nephritis, gout, diabetes, hysteria and over exertion ; heel : gout, neuras- thenia, ovarian lesion, achilodinia ; sole of foot : plantar neuralgia, disease of prostrate, erythro- imelalgia, ; in the articular joints : rheumatism, gonorrheal arthritis, synovitis, syphilis, tubercu- .losis, scurvy, neuralgia, pyemia, rachitis ; testicle : orchitis, or epididymitis ; penis and perinium : vesical calculus, or the passage of the uric acid crystals (gravel), inflammation or ulceration of the bladder, or irritation of the cal- culus in the ureter or urethra ; diffuse pain in the extremities : multiple neuritis, muscular rheuma- tism, spinal meningitis, influenza, rachitis, trichi- nosis), complaints^ gracefulness (of the body), com- jplexion (a dull, muddy complexion in hepatic lesion, constipation and digestive troubles), dreams (dream as a diagnostic aid has not yet been thoroughly evaluated, as the phenomenon of •dream is complex and it is hard to analyze it, 11

162 ANCIENT HINDU MEDICINE

but it is well kaown that nightmares are usually caused by indigestion, and it is probable tliat the dream images are formed by the digestive activity, action of the heart and the peripheral impressions or the indirect pressure of the full bladder or impacted feces during sleep, reacting on the central nervous system, awaking the memory centers which for lack of co-ordination, become distorted and fragmentary), messenger's countenance, disturbances on the road^ the condi- tions of the sick-room, medicines, the reactions of the medicines {[\\)on. the patient), and advice about the medical prescriptions'' Charaka

V. 1. 1«^

Predispositions (to diseases) are of six kinds : racial^ (Negroes are predisposed to tuberculosis, the Mongolian race to small-pox, Whites to yellow- fever, Jews to diabetes and insanity), ancestral ( congenital syphilis, arthritic diatliesis ), geo-

65. T% ^g "m ^ ^l^ ?wg ?q^^ "^Wi "^^ "^T^sra T^i^m "fm^m ^^^m Mm^ ^N^ jft^f^i^pirg ^rf^raiyif^^ n§ff?rg f^wm ^^^ f^\Wi %«?T =^ '^^'^^ ^^ #=?^ cT^ '^\v^^^ ^\<^^ ^rr^g ^^i-^k^ ftw^rar-

PATHOLOGY 163^

graphical (malaria localized in marshy places, where anopheles — a genus of mosquitos — an intermediatory of its infection can grow and thrive ), periodical ( epidemics — pneumonia is usually prevalent in the spring, influenza in the winter), according to age ( there are particular diseases of infancv. vouth, middle-aii^e and old- age) and individual (idiosyncrasy as susceptihility of certain persons to milk, oysters, strawberries etc. producing eczema, diarrhoea etc.) Charaka V. I. 3'«.

"So the respiration (the respiration rate of the ne«'born is 44? ; at five years, 26 ; in the adult, 16 to 20 ; in health it is faster standing than lying, during the day than at night, after meals than when fasting, in spring than ia autumn, and during exercise, emotional and mental excitement than when at rest ; and there is about four pulse beats for one respiration ; rapid respiration is observed in pulmonary lesions, in lobar pneumonia and also in fever^ especially in children by the indirect influence of the heated blood on the medulla ; slow respiration is observed in coma, collapse and poising with

164 ANCIENT HINDU MEDICINE

opium, chloral, chloroform or antimony ; jerking inspiration is indicative of asthma, hysteria, liyclrophohia ; jerking expiration in acute pleurisy and fractured rib ; stertorous respiration (snoring) is observed in apoplectic, uremic, diabetic coma, narcotic poisoning and paralysis of the soft palate, aside it is also observed in otherwise healthy individuals, especially children who have adenoids or enlarged tonsils and in grown-ups who are very tired and consequently there is muscular relaxation or are accustomed to mouth breathing, for the snoring sound arises from the vibration from the soft palate when breathing from the mouth and the nose at the same time ; stridulous or harsh respiration is due to some obstruction of the air passage through the larynx, caused through tumor, inflammation or any foreign body ; wavy or uneven respiration is symptomatic of pneumonia) ; neck ( a long, scrawny neck with projecting larynx is indicative of tuberculous diathesis and is usually correlated with the pthisinoid chest, while a short and thick neck with apoplectic predisposition ; rigidity of the neck, if chronic, may arise from the lesion of the, cervical vertebrae, caused by syphilic necrosis, arthritis or the affectation of the cervical muscles by rheumatism and if acute, through the inflam-

PATHOLOGY 1 65

mations of cervical glands, tumors or boils inter- fering with movements of the neck ; nodes upon the clavical bones, resembling the callus, but not caused by trauma, indicate tertiary sypbilie lesion ; but tumefaction above the clavicles- occur in amphysema and myxedema ; temporary swelling of the thyroid takes place during men- struation, or after sexual union, especially in women after first connubial embrace ; but a. chronic enlargement is generally symptomatic of exopthalmic goitre, but may be also due to adenoma, cancer, tuberculosis or gumma of the gland : an atrophied and depressed thyroid is observed in myxedema and cretinism ; ten- derness of the neck may be caused by the inflammation of the lymphatic glands of the region from any cause as cervico-occipital neuralgia, cervical myalgia or cervical caries),, teeth (a baby should have six teeth when one year old, twelve when a year and half old, sixteen when two years old, twenty when two and half years old ; milk teeth : 2 lower central incisors appear between six to nine months ; 4 upper incisors between eight to twelve months ; 2: lower lateral incisors and 4 anterior molars between twelve to fifteen months ; 4 canines between eighteen to twenty-four months ; four

166 ANCIENT HINDU MEDICINE

posterior molars between twenty-four to thirty anonths ; permanent teeth : 6 first molars appear between six and seven years ; 8 incisors between eight to nine years ; 8 bicus- pids ( 'premolars ) between 9 to 11 years ; 4 canines between II to 14 years ; 2 second molars between 12 to 15 years ; 4 third molars between 17 to 25 years ; premature eruption of teetli is indicative of congenital syphilis or tuber- cular diathesis while delayed dentition that of rachitis or cretinism ; if the permanent upper central incisors are dwarfed, narrowed, short, peg-like or somewhat rounded, tapering from gum to edge, with a single, shallow and discolor- ed notch in the edge, it is a sure sign of conge- nital sypliilis, especially if it be associated with keratitis and middle-ear disease ; dentated or furrowed teeth originate from malnutrition or an acute illness during infancy, sufficiently severe to interfere with the nutrition ; looseniog of the teeth in their sockets is associated with the ulcerated, spongy or bleeding gums and there- fore it can be ascribed to mercurial or gangren- ous stomatitis, pyorrhea alveolaris, scurvy or phosphorus poisoning ; a collection of sticky, dark-brown paste ( sordes ) upon the teeth, gums and the lips, sometimes stained with biood

PATHOLOGY 167

oozing from the gums, is very often present in typhoid and other low fevers ; gritting or grind- ing of the teeth among the children is usually associated with gastro-intestinal disorders ; erosion of the teeth takes place in gouty suhjects, with loss of polish of tlie labial surface, followed by ■grooves which extend into the gums, causing inflammation, necrosis, formation of calculi ( tartar ), loosening of the teeth and pyorrhea alveolaris ; early, excessive or rapid dental caries may be due to rachitis, but also takes place in pregnancy, diabetes or chronic phosphorus poisoning ; dyspepsia, chronic gastritis, constipa- tion, diarrhoea, persistent aural, nasal, opthalmic affections, nervous irritability, neuralgias or jnigraines may be easily caused by the carous teeth or pus sockets by the absorption of the toxin and the ingestion of microbes with the mastication of food ), liver and the spleen ( |;«ta= sides S the liver is the largest gland of the body and lies beneath the diaphragm in the right hypocondrium and the upper part of the epigestrurn, about the size of 3 by 5 inches and weiajhios: between two and half to three and half pounds ; enlargement of the liver which can be felt through palpation, occur in chronic malaria, hypertrophic cirrhosis, leucemia, hydatids, fatty

168 ANCIENT HINDU MEDICINE

infiltration, abscess, tumor, gummata or cancer ; progressive lessening ( atrophy ) of the liver takes place in cirrhosis ; displacement of the liver upward may be due to pressure from below by large abdominal tumors, meteorism or ascites, and by downward pressure on the diaphragm by emphysema, spasmodic asthma, large right pleural effusion, large intrathoracic tumor, a dilated heart or a pericardial effusion^; abnormal rough, hard and resistant surface is indicative of cirrhosis, carcinoma, amyloid or syphilic lesion : the spleen is of oval, flattened shape and lies in the left hypocondriac region between the stomach and the diaphragm, of almost the same size as the liver ; the rapid enlargement of the spleen takes place in any acute infection, as in typhoid, malaria and other fevers, tuberculosis,, small pox, diphtheria, pneumonia, cerebro-spinal meningitis, puemia or general scepticemia; chronic enlargement of the spleen occurs in pernicious malaria, in splenic anemia, hepatic cirrhosis ), eyes^ hairs, [ kesa = \oug hairs as of the head and the beard; /oma = small and fine hairs of the other parts of the body : the hair is luxuriant, bright, oily and wavy in hyper- secretion of thyroid as in Grave's, Basedow's diseases and the hair is dry, coarse, stiff and

PATHOLOGY 16^

sparse in hypo-secretion of tlie thyroid as in myxedema, cretinism ; early gray hair before- forty is usually associated with the premature arterial degeneration ( enderteritis ) but it is said that the sudden loss of pigmentation of the hair may take place at times under the influence of terrible fright, anxiety or deep emotion ; tendency to premature grayness of the hair may be hereditary ; circumscribed grey patches of hair may be due to trophic clianges^ brought about by the lesion of the fifth nerve and its branches ; undue and rapid loss of hair ( alopecia ) is indicative of syphilic lesion, but this must not be confounded with the excessive falling out of hair which takes place during convalescence from acute diseases, as typhoid, malaria, nor with that following an attack, of gout or erysipelas, for in syphilis the hair can be easily pulled in large masses without causing pain and the hair does not usually reappear ; in anemia, phthisis pulmonalis, myxedema, hydrocephalis, and the severe neuralgias of the fifth nerve, the hair is usually thinned ; premature loss of hair may be a hereditary family trait], abdomen [by in- vspection, palpation, percussion and auscultation, abdomen can be utilized of a great diagnostic^

170 ANCIENT HINDU MEDICINE

value : smooth, shining and stretched skin (in the abdomen) is observed in abdominal disten- sion ; whitish stricks or striae are indicative of previous long-continued distension as in ascites, fat or pregnancy, and in extreme case, the whitish stricks {Ihieae alhioantes) may be observed also on the buttocks and the upper portions of the thigh ; copper-colored, scaly, somewhat circular spots upon the abdomen are indicative of secondary syphilis, as well as the brownish or yellowish macular areas of cloasma, which may be also present ; enlarged glands in the groins -signify either venerial infection or bubonic plague and their retracted cicatrices of their past lesions ; enlarged superficial abdominal veins, radiating from the umbilicus, appear in portal obstruction, through hepatic cirrhosis or tumor, ascites of long duration or greatly dilated sto- mach ; the navel (umbilicus) ia deeply retracted in stout people ; if projecting it may be due to portal obstruction, pregnancy or hernia ; it is flattened or protruding in excessive ascites, or abdominal distentions ; fixation of the umbilicus is significant of hepatic malignant cancer ; the abdominal wall may be thick from the deposit of fat or edema and if it be thin with shrivelled skin, it may be due either to old age, wasting disease.

PATHOLOGY 171

repeated pregnancies or as a reaction of long- standing distension from ascites ; the abdomen may be distended by the accumulation of fat in the abdominal wall, or fluid in the perital cavity or gas ill the alimentary canal or the presence of a large tumor ; swelling in the gastric area may be due to tumor, abscess or cancer on the gastric wall, hepatic cancer or pancreatic cyst or scler- osis or tlie distension of the gall-bladder either with concretions or pus ; swelling in the hepatic area may be due to tumor, cancer, hypertrophic cirrhosis, hydatid cyst or passive congestion of the liver or sympathetically from the distended gall-bladder stuffed with concretions and pus ; -swelling in the splenic area may be due to mov- able or prolapsed spleen, perinephritic abscess, or congested movable kidney, or cancer of the stomacli ; the swelling of the appendical area is symptomatic of acute appendicitis ; swelling in tlie pelvic area may be due to distended bladder, or by the distended uterus by tumor or detained menstrual fluid {imperforate hymen) ; swelling in the sigmoid area may be due to the impaction of feces, tuberculous or cancerous peritonitis, ulcer of colon, ovarian tumor or cyst of broad ligament], nails (curving of the nails with clubbed fingers, occur only in chronic diseases as phthisis

172 ANCIENT HINDU MEDICINE

emphysema, aneurism or chronic cardiac diseases ; malforraaLion, frasjilitv. dryness or cracking of the nails may be due to injury, syphilis or due to trophic defects, resulting from nerve lesion, neuritis, syringomyelia or pul- monary osteo-arthopathy ; arrested gro\Yth of nails may be due to hemiplegia from cerebral apoplexy or acute infantile paralysis ; enlarge- ment of the nails with thickening and sometimes twisting occurs in the course of syphilis, sclero- dactyly and typhoid fevers ; the nails in some cases of Raynaud's disease, become dry, scaly and cracked or hypertrophied ; ecchymoses and ulcers at the bases of the nails may be due to chloral habit, but in a child {onychia) to syphi- lis or scrofulous diathesis ; white marks or transverse grooves on the surface of the nails may indicate, unless due to injury, the period of recovery from a recent acute illness ; the growth of the nail from the matrix to the end requires about six months and as the white marks develop at the root of the nail and with the growth of the nail, the transverse goooves also ascend higher and so a rough esti- mate can be made from their position of the time that has elapsed since the convalescence set in ; hard, brittle, and longitudinally striated

PATHOLOGY 173

nails are observed in gouty subjects), finger (distorted fingers are due to gout, arthritis defor- mans and less frequently to chronic rheumatism ; hard, white, glissening masses {tophi) may be present in the joints or along the tendons, on account of the accumulation of the sodium urate in gout and consequently in gout and rheuma- tism, the joints of the fingers are enlarged and painful , the tophi is more prominent on the dorsal surface of the joints and it sometimes breaks through the skin, so that the chalk-like concretion exudes ; knobby enlargements of the proximal ends of the terminal phalanges (end- joint arthritic nodes ) may be due either to gout or arthritis deformans and small crab-eye cysts may be formed over the nodes ; the tips of the fingers may be bulbous or club-shaped in chronic lung diseases as phthisis or chronic heart affection ; the claw hand occurs in consequence of atrophy and paralysis of the interossei and lumbrical muscles due to neuritis of the median and ulnar nerves ; the spade hand with large, coarse, thick fingers and broad nails is observed in myxedema, but in which only the soft parts are affected, while in acromegaly, the bones are enlarged ; the hand of the individual of a nervous temperament is firm, fine, delicate and

174 ANCIENT HINDU MEDICINE

dexterous ; of sanguine temperament, broad, heavy, strong and energetic ; of plilegmatic temperament soft and clammy ; coldness of the hands and feet, with or witliout tendency to sweating, if persisting for a long time, is due to neurasthenia, anemia, chronic digestive disorders^ gout, cardiac or pulmonary diseases, interfering: with the circulation) should be observed."

Charaka V. 3. 5'^

*'When he does that (vomits), the physician should examine the expectorated matter from the spittoon with attention." Charaka I. 15. 16® \

Urine was examined for its color, consistence, taste and smell, only in genito-urinary diseases. {Charahi II. 4 ; Susruta II. 6) but sputum, feces and semen as a vitality test and as a prognosis in diseases : "According to the sayings of the wise, his life is at an end, whose sputum, feces and semen sink, when thrown into water." Charaka V. 9. 14*". Susruta gives elaborate details of the prognostic symptoms : —

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PATHOLOGY 175*

"He whose complexion is changed into pale- brownisli (in Addison's disease), reddish (hypere- mia ; chlorosis rubra), yellowish (jaundice or icterus) or i)lue-purplish (cyanosis), he is near his death. He who suddenly loses his modesty, beautiful appearance, ability to hold himself upright and personal charms (in apoplexy, asudden loss of consciousness is followed by paralysis, due to cerebral hemorrhage or blocking of an artery of the brain by an embolus or thrombus), he can« be regarded as dead. Wliose loioer lip hangs down (the lips are loose and pendulous in diphtheretic- paralysis or chronic bulbar palsy), upper Up twitches up (twitching or trembling of the lips is index of general paralysis or bulbar palsy),or both the lips have the colour of ripe plums (the colour of the ripe plum is dark bluish, that is cyanotic : in diseases of the heart or the lungs, especially the chronic forms, owing to dyspnoea, the lips are open, dry and cyanosed), his life is hard to save. He whose teeth are reddish (stained with blood — sordes — in typhoid prostration),^ or pale brownish ( stained from the deposit of foul matter in jaundice on the tongue ), or like polished collyrium (dark black deposit is found on the tongue in Addison's disease or nigritis ),. or have fallen ( loosening of the teeth in their

176 ANCIENT HINDU MEDICINE

sockets may be due to pyorrhea alveolaris, scurvy, purpura hemorrhagia, and extensive and rapid dental caries is common in diabetes or rachitis ), can be regarded as dead. He whose tongue is black ( in Addison's disease or nigrites) paralyzed ( in basal meningitis, syphilic lesion, tumor or cerebral hemorrhage ), swollen ( glossitis may occur in various diseases as variola, erysipelas or sceptimia ), or dry and fissured ( in the typhoid status ), is near his death." Susnda I. 31. 2-6' ^

He whose hair looks oily (in hyperthyroidism), though not smeared with oil, does not live long.

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PATHOLOGY 177

and knowing this, the wise ( physician ) should give him up. CharaJca V, 8. 7^^

Susruta says^^, *'Nervous diseases, 'prameha^ ( diahetes and gonorrhea ), leprosy, hemorrhoids ( piles ), anal fistula, calculus, 'mudhagarhha* ( transverse or scapulo-posterior presentation of the fetus during hirth ) and ahdominal maladies — these eight are naturally hard to €ure ; but if these are also complicated with the developments of enervation, emaciation, dyspnea, thirst, ^sosa* (desiccation of the body or pulmonary consumption ), vomiting, fever, un- consciousness, diarrhea, hiccup and other compli- cations, then the wise physician, desirous of suc- cess, should not untertake their treatment. If

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^^^'Tkr f^^ii f»T^3rr ftrf^Ri^dr ii8 12

178 ANCIENT HINDU MEDICINE

in nervous diseases, there are complications of edema, insensibility to touch, paralysis of the hody, tremor, tumor and pain in the abdomen, the patient dies. If in urinary diseases these complications develop, and with the urine much substances ( albuminuria) are discharged and boils appear on the body, that patient dies. In leprosy, if the nodules ulcerate, eyes become red, the voice broken and the five kinds of treatment as vomiting and purgation do not succeed, the death of the patient is near. In hemorrhoids ( piles ), if there are complication of polydipsia, loss of appetite, pain, excessive

^1^ =^q?T«n^ fg^jKrisq^if^m 111°

PATHOLOGY 179^

bleeding, edema and diarrhoGa, the patient dies. The anal fistula throui^h which the intestinal seas. urine, feces, microbes and semen are discharfred is deadly. In the diseases of hard calculus {asmar'i)^ soft calculus {sarkcif^a) and gravel {sikata-iiric acid sands), if there appear edema in umbilical region, testicles, ischuria (retention of urine), and shoot- ing pain, the patient dies quickly. In the trans- verse presentation, if there is paralysis of the uterus, dull pain {mahkalla) and spasmic contrac- tion of the vagina, the gravida dies. In abdo- minal diseases, if there is deplegia, aversion for food, edema, diarrhea and inspite of purgation, the intestine remains inflated, then give up

180 ANCIENT HINDU MEDICINE

(treatment). In fevers, if the patient is delirious, unconscious, and is absolutely confined to bed, and while the outside of his body (skin) is cold and inside ( in the internal organs ) there is hyperaemia, then he dies. In fevers, if there is horripilation, eyes become red, there is an acute shooting pain in the heart, and respiration takes place only through the mouth, the patient is killed by the disease. And in fever, if the patient has hiccup, dyspnea, polydipsia, delirium and wandering eyes, he goes to the abode of death. In fever, if the patient has clouded vision, delirium, paroxysmal somnolence, hydre- mia (thinness of blood) and emaciation, the fever kills the patient. In diarrhea, if there are the complications of dyspnea, pain, polydipsia, ener- vation, emaciation and fever, the aged patient never lives, though an infant once in a while might survive. In phthisis, if the patient has glazed «yes, aversion for food, jerky respiration, and hyperalgia in seminal discharge ( in prostatic cal- culus), any of these complications is to be regard-

PATHOLOGY 181

ed critical. In abdominal tumor, if the patient has dyspnea, pain, polydipsia, anorexia, rupture of the tumor and enervation, death takes place. In a deep-seated abscess {vidradhi), if there is abdominal tumescence, anuria, vomiting, hiccup^ polydipsia, throbbing pain and dyspnea, he does not live. In icterus (jaundice), the patient dies if his teeth, nails and eyes turn yellowish, and he sees everything yellowish. In gastrorrhagia (hemorrhage from the stomach), if the patient repeatedly vomits blood, his eyes become reddish and he sees everything reddish, he perishes.'* Siisruta I. 33. 3-22.

Pains : "Boring ( todana = as caused by the penetration of sewing needle ), terebrant { vedana = to tear out ) lacerating ( tadana = concussion as a blow from a rod ), lancinating^ ( chhedana = cutting with a sharp instrument ), dilating ( ay a^m<xwa -radiating ), tensive ( man- thana=a>s fire is made by friction of two sticks), expulsive ( viksepana = to throw out ), sucking. ( chumuchumayana = as a magnet or mustard poultice draws by suction), hurning{ nirdahana =

182 ANCIENT HINDU MEDICINE

burning), grinding {avahhanjana = ^\x\.Yexizm^), Julguraat ( spohtana = bursting ), shooting (»irZ«rcK?za = penetrating), eoulsive ( utpatana = to pull up ), throbbing ( kampana = tremulous ), dully sharp ^ acute, itching, ir?Htant, premonitoi^y or after pain { vividha-sTda-vislesana = Ya.vio\x3 degrees of pain), shifting {vikirana = which, shifts from place to place as in hysteria ), C7'amp or spasmodic ( pUrana = which fills up ), pai^alyzing (stamhhana = which causes insensibility in the adjacent area), wtHnging {avaktiiichana = to press out ), foi^mication or itching {aiikiisika = sprouting, a sensation as of ants or similar ob- jects crawling over the body). By the derange- ment of nerves, these pains manifest in the *V7'anas* (abscess, tumor, pustule, boil, carcinoma, eczema, etc.) and if for any reason withot (appar- ent) cause, different kinds of pain appear, or in certain localities they appear repeatedly, they are to be ascribed to nervous origin.

Unilateral eruption (osa), cutaneous inflamma- tion (chosa), diffuse eruption {paridaha), oppress- ed feeling ( dhumai/ana = a,s in smoke suffoca- tion), the sensation as if burning coal were sprePod over the body with the increase of the subiective sensation of heat, and the similar sensation that is felt if a caustic were applied to

PATHOLOGY 183

^ wouud, — the pains experienced in these sensa- tions, are of * pitta' origin ; pains of the abscesses, /originating from the vitiation or poisoning of the blood, are the same.

Pruritus (X^«.^# = itching), lieaviness {gurutva = heaviness or Aveight is felt in the chest in hemoptysis, spasmodic asthma, chronic gastritis ; in the head in neurasthenia, hypocondrisis and is occasionally a premonitory symptom of apoplexy ; in the abdomen or pelvis, due to tumors in those regions ), somnolence ( sitjjtatva ), tumescence {upadelia), numbness {alpa-vedana = '^?ixi\dl anesthesia ), paresis ( siamhha ) and chilliness {saitya ) are of phlegmatic origin." Susruta I.

"The physician should examine first mtalitif ( c^yw = durability of life ) of the patient. Even, if there is ( good ) vitality (signs of long life, manifest in the physical organs ), malady

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18^ ANCIENT HINDU MEDICINE

{etiology and the natiu'e of the pathological mani- festation ), season ( of the year in its relation to the disease and its reaction against it), metabolism ( of the patient ; «5^;^^ = internal combustion, that is oxidation ), age^ pliysioal strength, nervous mtality^ predispositions^ characteristics ( of the patient ), remedies (available and their reaction against the disease ) and the region ( desa t marshy or dry, altitude, low or high land, plain or hilly, salubrity of the climate, prevalence of endemic diseases and of epidemics within the territory).

Signs of longevity : He enjoys long life, who lias large hands, feet, sides, back, nipple ( papilla mamma ), teeth ^ face, shoulder and forehead ; long phalanx, breath (or respiratory organ ), eyes and arms ; wide brows, precordial region {stanantara = t\\e space between the two nipples), and breast; short crus {jangha^the leg, especially the segment between the knee and the ankle), penis and neck ; deep breath ( or spiritual force ), voice and umbilicus ; the mamma not

liigh but firm ; fleshy, large and hairy ears ;

whose joints, veins ( vessels ) and tendons are hidden, all the bodily parts are healthy and strong, all the senses are steady, and the health lias persistently improved, that person will have

PATHOLOGY 185"

a long life. He who has never had any sickness from birth and whose body, intelligence and comprehension have progressively been deve- loped, will enjoy a long life. Snsruta I. 35.

"Life is (divided) into three periods : infancy,, middle-age and senility. Of them, childliood is up to fifteen years ( one minus sixteen ), divided ( further into three sub-divisions ) as sustaining on milk ( liquid nourishment ), milk mixed with other nourishing substances ( in liquid or semi- solid form as barley concoction ) and ( solid ) nourishment. A baby up to one year old sustains on milk, up to two years, milk mixed with other substances, and above two years on ( solid )

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186 ANCIEKT HINDU MEDICINE

food. From sixteen up to seventy years of age, is regarded as the middle-age : middle-age is composed of four periods as pubescence ( vrcldhi = growth ), adolescence ( yaucana = jo\ii\\ ), adultness ( sampurnata = coxn^lQiion of growth ), senescence ( M;^^ = declining period ) ; up to the age ©f twenty, is the period of growth, up to thirty — youth, up to forty full development or maturity, and from forty to seventy, it slowly and gradually declines. ( The skeleton reaches its limit very nearly at the same time as the whole frame reaches its maximum of height, the coalescence of various epiphyses being completed by about the twenty-fifth year. Similarly the mascular system in its increase tallies with the weight of the whole body. The brain, in spite of its increasing complexity of structure and function to wliich it continues to attain, even in middle life, early reaches its limit of bulk and weight. At about seven years of age it attains what may be considered as its first limit for though it may increase somewhat up to twenty, thirty, or even later years, its progress is more slow after, than before seven. The vascular and the diicestive orG:a7is as a whole mav continue to increase even to a very late period ( Foster's Physiology^ p. 1151). After seventy, elements

PATHOLOGY 187

( constituent ), sense, strength, courage and enthusiasm dailv fall off ; at this a^e, one becomes grey-haired and bald-lieaded and being subject to dyspnea, bronchitis and other complications, becomes incapacitated for all activities (as before) and becomes like a dilapidated cottage, exposed to the fury of rain, storm and tempests. This is called old age." Susrutal, 35. 26' '.

"Infancy is phlegmatic, youth sanguinary and old-age nervous." Susmta 1, 35. 27'^.

The following diseases may be congenital : malformations, syphilis, idiocy, hydrocephalus, hemophilia, infantile hemiplegia, osteomata, nevi, sclerema, pemphigus, dermatitis neonatorum, tetanus neonatorum, ichthyosis, acute fatty

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188 ANCIENT HINDU MEDICINE

degeneration, myotonia congenita, progressive muscular atrophy, icterus neonatorum, atelectasis, hemoglobinuria.

J3.ereditary diathesis : rheumatism, gout, hepatic disorders, renal disorders, renal calculus, respiratory lesions, diabetes, obesity, adiposis dolorosa, acne, eczema, leprosy, arthritis deformans, hernia, hereditary cerebellar ataxia, hemophilia, alcoholism, pseudo-hypertrophic paralysis, progressive muscular atrophy, cancer.

Diseases peculiar in infancy and childhood : cretinism, infantile paralysis, measles, roseola, scarlatina, cerebro-spinal meningitis, chorea, rachitis, hemophilia, infantile scurvy, hypertro- phic cirrhosis of the liver, diarrhoea, adenoids, bronchitis, broncho-pneumonia, spasmodic laryngitis, noma, endocarditis, primary renal sarcoma, eczema, pemphigus, seborrhea, ringworm, diphtheria, hydrocephalus, nodding spasm.

Tihberty and adolescence : acne, seborrhea, anemia, chlorosis, chloroma, myxedema, exoph- thalmic goitre, catalepsy, trance, myoma,myolema^. typhoids, meningitis, myocarditis, endocarditis, hysteria, cerebral embolism, epilepsy.

Uarly adult age: acute tuberculosis, pulmo- nary phthisis, gastralgia, gastric ulcer,syringomy-

PATHOLOGY 189

-elia, cerebral abscess, cerebral embolism, myoma, periodic paralysis.

Middle age : exophthalmic goitre, myxedema, diabetes, chronic nephritis, cysts of kidney, myo- cardial diseases, endocarditis, aneurism, leucemia, pernicious anemia, angina pectoris, ataxic para- plegia, dementia paralytica, paralysis agitans, intraspinal hemorrhage, myelitis, locomotor ataxia, psychosis polyneuritica, carcinoma, gout, cirrhosis of liver, gallstones, mollities ossium.

Old age : pruritus, ecthyma, gout, pephigus, epithelioma, carcinoma, gout, arteriosclerosis, cataract, gangrene,bronchitis,broncho -pneumonia, aneurism, prostatic disease, myocardial disease,, angina pectoris, cerebral apoplexy, paralysis agi- tans, melancholia.

Diseases special or predominant in females : chlorosis, osteomalcia, chorea, floating kidney, lupus erythematosus, gallstones, constipation, chorea, hysteria, neurasthenia, catalepsy, goitre, myxedema, adiposis dolorosa, gastralgia, anemia. In addition to the above-mentioned constitu- tional, metabolic or infectious diseases, there are of course countless other infectious diseases which' can attack all ages and can bring about by slow or rapid process the cessation of vital activities and their co-ordination of the organism.

190 ANCIENT HINDU MEDICINE

But though death is inevitable to multicellu- lar life, Ssuruta emphasizes that natural death through degeneration of senescence is a very rare phenomenon: "According to Atharva-veda scho- lars, deaths are of one hundred and one kinds, of which the natural death (through old age) is one while the rest one iiundred are accidental (inclu- ding infection)." Susruta I. 34. 5''. It is an undeniable fact, that protoplasm — the living substance, living a particulate life in unicellular existence and community life in mullicellular existence, under favorable conditions, has not necessarily any limitation of its life, and as every living organism, comes into existence as a protoplasm of a pre-existing living organism protoplasm is potentially immortal. Ptepro- duction among tho unicellular creatures is by fission, so in a sense they never die as long as proper conditions are maintained. But life can, also, be preserved under adverse circum- stances with arrested vitality as in hibernation of many animals in wiuter. Even suspended vitali- ty is not incompatible with life as many microb-

77. q^triT ^jr^sicirra^iii: w^^ I

PATHOLOGY 191

es, or their spores, can be completely desiccated and kept in that state for many years, and after that if they find a favorable medium, they show their full activities again ( anabiosis ). Grains which have been found in ancient Egyptian tombs which have been lying there in a desiccated state for more than one hundred ceturies, have been found to germinate. And many fish can be frozen with water and made an ice block and kept in that condition for any length of time and if it be thawed slowly, the fish can be revivified. Only when protoplasm is coagulated, it loses its vita- lity. Many trees are known, which according to reliable tradition, have lived more than a thou- sand years. Death comes to a tree by storm, light- ning, fungi and parasitic diseases, improper nu- trition from the soil either by the exhaustion or excess of some of the salts or the insoluble combina- tion of others, improper moisture or sunlight ; but these are all accidental and are avoidable. It is asserted that there are authenticated cases of men who have lived more than 152 years. Old age is certainly a disease, brought about by the dege- nerative changes, caused by microbic infection, absorption of their toxins and unhygienic living. But this will be in future more or less controllable with better knowledge of prophylaxis, dietary.

192 ANCIENT HINDU MEDICINE

rational living and hygiene. And very few people really die of senile degeneration. What actually happens is this : in the debilitated condition when the resisting power of the organism has been re- duced, some infection takes place. Preventive medicine in future will possibly eliminate many of the virulent infections, but it can not impl that death, will be preventible. Death is probab- ly nature's economy of life. It eliminates those who are no more capable of reproduction or can not contribute materially to the support and pro- vision of offspring, thus releasing the food-supply to the new-generation for growth, development and progress. Old age {senility) is the effect of the cumulative auto-intoxications. Organism in its very functioning — in the metabolic process, produces various toxic products, which, if not thoroughly eliminated, can accumulate in the or- ganism bringing about degenerative changes. According to Metchnikoff toxins are principally absorbed from the putrefactive products of thelarge intestine and to counteract the activities of the pro- teolytic bacilli, which can only thrive in alkaline reaction, he proposed the introduction into the large intestine of the most active lactic acid pro- ducing bacilli (bacillus Biilgaricus or maya fer- ment) in the form of soured and curdled milk.

PATHOLOGY 19S

It is true that the large intestine serves no vita!- function in the economy of life, and it has been simply developed in animals as an accommodation, so that animals are not compelled to slow the speed and wait for defecation, while running-. And animals with comparatively short intestine live relatively longer than the animals with larger intestine. And all the organs of the body do not equally show the signs of senile degeneracy. But the human body is a complex, intricate and deli- cate machinery. If any of the vital organs is seriously affected, it interferes with the integrity of the organism as all the organs are intimate- ly related and interdependent. A diseased organ like the heart or the kidney can not be replaced like a broken or worn-out part of an auto or aeroplane machinery. They can be only slowly and gradually improved by a regenerating^ process of relieving them of the burden and tension by proper dietary and rational living. But every disease leaves an indelible mark, every shock an impression and every healed wound a cicatrix. And the effect is cumulative. If all the infections could be controlled, still there would be old age and death brought about by the slow b. t (iimulative effect of the partial jetention i/ tlxe metabolic wastes, defective 13

194j ancient HINDU MEDICINE

liereditary inheritance, mental, emotional, and physical shocks and excitements.

Buff on calculated that the duration of life was six to seven times to that of growth, but Plourens estimated it about five times. As the epiphysis closes about twenty five in man, so it ■can be calculated that the longevity of man should average from 125 years upwards. This is certainly a respectable age compared to the pre- sent standard, though someof theanimals,lacking intelligence and control over the environment are reputed to live longer as some authenticated records show : salmon one hundred years ; in the case of a carp one hundred and fifty years ; pike two hundred years ; crocodile one hundred years ; tortoise two hundred years ; eagle one hundred years ; parrot eighty years ; swan eighty years; ducks and geese fifty years ; falcons one hundred years. In the records of zoological garden in confinement, the rhinoceros is known to have lived longer than thirty-seven years, and the average duration of the life of horses, asses and zebras from fifteen to thirty years, domestic cattle from twenty-five to thirty years, sheep, goats and antelopes from twelve to fifteen years, llama seventeen years, hippopot?^ 'iius thirty- seven years, domestic swine twenty years, ele-

PATHOLOGY • 195

f phants thirty to forty years, lions, tigers, bears about 25 years, domestic cats from twelve to twenty-three years, dogs from sixteen to eighteen, years, hares and rabbits about ten years, mice and rats from five to six years, bats about seven- teen j^ears, monkeys eight to thirty years ( Ency. Brit. Vol XVI. p. 975 ).

DISEASES AND THEIB CX.INZCAI. STUDIES.

*'Ailing ( vycidhi ), disease ( amaya ), sickness ( gada ), terror ( cttcmka ), consumption {yaksma) fever ( jvara ), indisposition ( vikdra ), and malady {roga) are synonyms. Miology (niddna), prodi'ome {purvarTipa), symptoms [linga)^ remedy ( npasaya ) and sequel ( samprdpti ) are the diagnostics of a disease. That *etiology^ means the causes of disease has heen previously mentioned. The premonitory symptoms that are observed before the development of a disease, ar termed as "iwodromes*. The symptom of a developed disease ( the disease might stay in a latent stat^^ and the incubation of many infections may last for many years in a resisting organism ) is called the *linga\ Characteristic {dkrti), indication {laksmcma)^ sign (cliihm), lineament (saonsthdna)^ trait {vyanjana)^ feature ( rlipa ) are synonymous terms with symptom ( llhga ). Remedy is called that combined 'action of medicine ( ausadha ), diet ( dhdra ) and hygienic living ( vihd?'a ), which cures the disease by counteracting either its-

DISEASES 197

causes or symptoms. Sequel ( samprapti ), out- come ( agath ) aud after-developmeuts ( jatl ) are syuonymous." Charaka IT. 1. 2"^

^'Fevers are being mentioned in the beginning of the book of pathology, for fever is tlie first expression of all physical diseases." Charaka

n. 1. 6^^

Feter ( pyrexia ) in which the normal tempe- rature is markedly exceeded for any length of time above about 37 degree Centigrade or 98. 6 degree Fahrenheilit, is caused by the disturbance of the heat-regulating mechanism. Whatever stimulates the thermogenetic centre or unduly constricts the vaso-dilators so that the excess of keat can not be dissipated, provokes fever. In sun-stroke, the peripheral nervous mechanism is

78. cm sufwT^ T^ ^m^ 5i=^r 5^t f^^i^t ^ ?«i«((y|Ti<*i, i

198 ANCIKNT HINDU MEDICINE

paralyzed and consequently the body temperai- ture is considerably raised. But when a toxin is introduced into the blood, the auto-defensive mechanism of the body — adrenals and thyroids — are stimulated and their oxidase-secretions are poured into the blood stream, the heat-generating centre is also excited by reflex and sympathetic stimulation, so that by the enhanced metabolism, the toxic products and their agents can be made comparatively harmless to the organism, if not destroyed. Adrenal secretion raises the blood pressure by constricting the vessels so that tlle^ toxins and their pathogenic agents are subjected forcibly to the immunizing action of the blood. Thyroid secretion dilates the blood vessels so that the attenuated toxins can be eliminated by sweat- ing to relieve the kidney of its heavy burden, if it has not been equal to the task imposed upon it. Eever is the i)hysiological expression of the severity of the struggle between the invading enemies and the host for self-defence, that is, the reaction that has been set up in the body to make innocuous the toxins and thehuicro-organisms^ that produce them. Eever is the index of the resisting power of the organism against the virulence of the infection. It is the nature's healing process, and indicates that the auto-

DISEASES 199

protective meclianism of the "body is active. Absence of fever in a toxemia of any kind proves the inability of the body to react, owing to defici- ent sensitiveness of opsonin of the blood and the immunizing glands, either inherited or acquired, or to the fact that the toxin is itself a very power- ful paralyzant or anesthetic of the sensory impres- sions. Hyperpyrexia ( fever above 105° E. ) on the other hand indicates the hyper-excitation of auto defensive mechanism and the consequent over-production of the immunizing principles, and if long continued, might lead to the proto- plasmic destruction of the red-corpuscles and the endothelial cells by hemolysis and autolysis. This excessive disintegration of the protoplasm is indicated bv the increased excretion of nitro- gen, sulphur and phosphorus and in extreme cases, acetone, aceto-acetic and E-oxybutyric acids with the urine. And this is attended with many functional derangements. The activity of the digestive glands is diminished, hence loss of appetite and inanition. On hepatic cells is imposed the heavy task of reducing excessive metabolic wastes, especially the vast number of red-corpuscles, and the consequence of the hepatic hyper-activity is the greatly increased production of the hepatic excretory product — the

200 ANCIENT HINDU MEDICINE

bile. And if it is contiaued lon2r, it causes ^bilious remittentfever or malarial liemoblogiuuric fever' {paittika jvara^ Susruta VI. 39. 12) in. which the urine is brownish yellow in color, containing a good deal of urobilin, less of urea, but more of ammonia, as the excessive quantity of sulphur and phosphorus — the disintegration- productions of abnormal destruction of red •corpuscles, become oxidized into sulphuric and phosphoric acids and readily combine with ammonia which otherwise would have been changed into urea. There is of course pronounced jaundice. The liver becomes fatigued and sluggish in its activity. Gradually com- mences the fatty and granular degeneration of its cells. The kidney also shows its terrible strain by fatty and fibrous infiltration, \

I, Fevers.

**Fever is caused by lesions of the body or the mind ; for fever otherwise can not be developed in a person without injury.'* Charaha VL 3. 10«\

DISEASES 201

"Excessive use or abuse of *snehadi'' [Sneha = unguents, svecla = sweating through Turkish bath or other sudoriferous means, vamana — xo- miting, virechaua =^ i^nrgaiion : absorption, re- tention (of any toxic matter) or exhaustion fever], traitmata {aJjhig/iata = shock or wound fever), development of disease {rogotthana= symp- tomatic fever as a reaction against the patho- genic germs and the toxins elaborated by them), tumesce}ice {p7Yqjaka = coct\on of tumefaction, that is inflammatory fever), fatigue {srama=fa,ti- gue fever), inamtion (/j.<?a?^flr= consumption, that is consumptive or famine fever), indigestioti (<(5/ir/za = dyspeptic fever), toxin {visa=ioxem\db) ruental derangement[satmyarttuparyc(ya = hysteri- cal fever), smell of poisouotis flowers {psadhl- puspa'ga}idha= coyzn, or hay fever), worry (so /jrt= depression fever), sudden seasonal changes {uaksat/'a-prap'idana = stellar vexations = spring or autumnal fever), hyimotism {ahhicharas- exor- cism : hypnotic fever), enervatio^i {ahhisapa = execration : nervous fever), desire ov passion (manas or y^(YWia = unreciprocated and ungratified sensual passion : erotic fever), hallucination -{bhWabhisankasiie'Ar of ghosts: hallucinary fever ), the unhygienic living of a woman that has miscarried or has given normal birth

202 ANCIENT HINDU MEDICINE

{puerperal fever^^ the establisliment of the secretion of milk following childbirth {stanyava- tarana=m.i\k fever) — these causing lesion of the nerve etc. produces /6'y^?" in human beings." Susruta VI. 39. 8.'^

"Excessive consumption of astringent, dry or cold food and drinks , excessive use of vomit- ing, purgation, sweating and snuffs ; and over- exercise, retention of feces and urine, fasting, traumata, venery, anxiety, sorrow, vigilance-^ excess of these things irritate the nerves." Oliaraha II. I. 8^".

"In the erotic fever, there is a good deal of contemplation (of the beloved object) and

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3!r?TrfT =^r^^^T^ f^qm 7fi(?Tr^q%<TTfT i ^'sfRcfT^ =1^ ^t ■^\^\ im % iic

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DISEASES 2 OS

sighing ; in the fever of sorrow, tears ; in the fever of fear, anxiety ; in the fever of anger, excitement ; in tlie hallucinary fever, delusion ; and in toxemia, unconsciousness, illusion, intoxi- cation and enervation." Chaixiha VI, III. 115.'^ *'In the gastro-intestinal fever, there are anorexia, indigestion, heaviness of the stomach, the irregularity of the heart ( beat ), semi-con- sciousness, lassitude, continued fever, unchange- ability of the lesion, nausea, salivation, lack of hunger, sliminess of the mouth, fatigue, somno- lence and heaviness of the body, polyuria, loose feces and enervation — these are the symptoms, in the gastro-intestinal fever." Charaha VI. III.

'204« ANCIENT HINDU MEDICINE

*' Lassitude, watery eyes, yawning', heaviness of the body, fatigue, inclination and disinclina- tion by turn for fire ( to sit by the fire side ), sun (sun-bath), breeze and water (bath), indiges- tion, foul taste in the mouth, gradual change of the (physical) strength, complexion and temper- ament— these are the prodromal symptoms of fever." ChamkaYl. 111. 25' ^

^'Excessive internal heat (hyperaemia), thirst, delirium, quick respiration, illusion, pain at the joints, cessation of the perspiration and consti- pation— these are the symptoms in hyperpyrexia (at the onset of malarial fever the blood is driven from the peripheral to the internal organs, where there is excessive congestion, and while the surface of the body shivers with chills, there is increased high temperature)." Charaka VI. III. 35^\

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DISEASES 205-

Thougli the principle of Hindu medicine is based basically on humoral pathology, it seems- Susruta formed a vague relationship of malaria with mosquito bites and swampy localities, where mosquitoes are developed. And it was ascribed to a particular kind of mosquito, and not to all classes of them.

"There are five types of mosquitoes {masaka belonging to the 'CiiUcidae* family, consisting nearly of one hundred genera' and eight hundred species), namely ^marine' (samiidr a =.co£ist?i\ mos- quitoes ), 'globular' {parimandala = ^i^\i\i2^^^ the mosquitoes belonging to the genus '"migarliininad which has strongly curbed proboscis), culex ele- phanti ( hastimasaka), 'dark' {ki^sna = taeniorhyn- chus) a,n.dL ^mountainous' {parvvatii/a = ano^hel&sy The biting of the * mountainous' mosquito (ano- pheles) produces an effect like that of deadly insects." Susruta V. 8. 18**^.

''If the part bitten by a spider becomes swoll- en, A7hite, black, red or bronzed (cyanotic or de- generative changes), and there are symptoms of

206 ANCIENT HINDU MEDICINE

fever, burning pain, dyspnea, hiccup and head- ache, the prognosis is usually bad." Charaha VI. 23. 45««.

"There is a kind of mountainous mosquito whose bite causes symptoms like the bite of deadly spiders {luta — aranea)"^*^.

According to medical experts, tQri\?in{trt'iya'ka) and quartan {oJiaturthaka) fevers ( of malarial origin ) are produced by nervousness ; while the valley or the marsli aupattjaha — at the foot-hill of the mountains, that is the swampy Tarai of the Himalayas where anopheles is found in large numbers and malaria is endemic ), and drink or intoxication ( madyasamudbhava — produced by wine ) fevers are ascribed to blood-pollution ( ^i^^«^-XT^a = corruption of the bilious principle, which is the blood ). Pneumonia {pralepalca) and

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DISEASES 207

influenza (vatavalasaJca) fevers are said to be of phlegmatic origin. Susruta VI. 39. 25^ ^

It has now been definitely proved that the mosquito of the genus of anopheles transmits the deadly malaria germ from man to man. It may be possible, however, that there are other carriers of malarial pathogenesis. And anopheles is not the only genus that is guilty. Yellow fever is trans- mitted by Stegmia calopus, dengue fever by Culex fatigans, tilaria bancrof ti by Culex fatigans. But all anopheles do not carry malarial protozoa. Anopheles has nearly one hundred species (Culex two hundred), of which only forty species have been proven experimentally to be the hosts in malaria and in India there are onlv ten of them as follows : Myzomyia culicfactes, Myzomyia lis- tonii, Myzomyia turkhundi, Pyretophorus jey- porensis, Myzorhynchus barbirostris, Myzorhyn- chus sinensis. Nyssorhynchus theobaldi, Nysso- rhynchus stephensii, Nyssorhynchus f uliginosus and Nyssorhynchus maculipalpis. According to Theo])ald none of the anoplielinae species

208 ANCIENT HINDU MEDICINE

of Eeltinella, Bironella, Aldrichia, Chagasia^ Chrystia, Kerteszia, Myzorhynchella and Lepho- scelomyia have been found to be the bearers of malarial germs.

But the protozoan parasites of the red blood- corpuscles that cause remittent or intermittent malarial fevers, (ire not the same, and they appear under four chief forms : tertian is caused by Plasmodium vivax, quartan fever by plasmodium malaria, estivo-autumnal fever or subtertiau malarial fever by plasmodium falciparum {laver- nia malaria^ plasmodium 'precox ), quotidian fever by plasmodium falciparum quotidianum.

These four kinds of blood-parasites produce different reactions in the organism according to

'p-

thsir characteristics. Plasmodium ^ ivax re quires forty-eight hours to complete the cycle of schizogony and sporulates principally in the spleen, liberating toxins which are hemolytic, pyrogenous and hemozoanous, and will provoke an attack of fever with single brood in the human host every forty-eight hours, that is on the third day and accordingly it is called 'tertian* {tvt'iyaka)^. and in the intervening period there is remission of fever. Plasmodium malaria needs seventy-two hours to complete its schizogon, and it principally sporulates in the peripheral blood, and the liber-

DISEASES 209

ated toxiti causes a severe constriction of cutane- ous vessels, thus provoking shivering chills on the surface and chattering teeth, though tlie temperature of the blood is rising rapidly, and driving the blood centripetally, causing congestion of the internal organs ; as it takes seventy-two hours for the cycle, that is, the fever appears every fourth day with a single brood of infection, it is called ''quartern'' {chatnrthakd). Laverania malaria is irregular in its sporulation and needs about from thirty-six to forty-eight hours for schizonomy, and as it sporulates in the red corpuscles of the blood, it causes an immense destruction of them, and as the pathogenic protozoon needs high temperature for its development, the fever takes place in the autumn, and is therefore called ^estivo-autumnaV (mradiija). This is the most malignant of malarial fevers, for it not only causes a heavy destruction of the red corpuscles of the blood, and it is calculated that there are nearly 25, 000, 000, 000, 000 red corpuscles in an adult human being, and it needs about 3, 000, 000, 000 of them to be affected to cause an acute fever, and if it be below 250, 000, 000, the malarial fever does not manifest and remains in a latent state ; but it can also provoke serious lesion in the brain, pancreas, liver, spleen. 14

210 ANCIENT HINDU MEDICINE

and othei' internal organs by forming thrombi through blocking the capillary passage by the accumulation of plasraodia, swollen endo- thelial cells laden with hemozoan and sporules. The bilious remittent fever ( bilious hemoglo- binuric or blackicater fever =pitta-jvm^a) is also caused bv it by the excessive destruction of erythrocytes which necessarily imposes a heavy labor on the liver, with the consequent production of excessive quantity of bile, vvhich produces jaundice of the tissues and also appears in the urine with other pigments ( hemozoan ) and the urine looks from brownish yellow to blackish in color. The quotidian ( anyedyusha ) fever may be produced by plasmodium falsi- parum quotidianum which takes twenty-four hours for schizogony, or by three broods of Plasmodium malaria, triple quartan fever, the parasites coming to maturity on three successive days ), two of plasmodium vivax { double tertian fever ), or two of laverania malaria {double estivo- mtfttmnal or double subtertiafi fever).

At the onset of malarial fever, all these types tend to be irregular, for the simple reason that the pathogenic sporozoa are of different n»es and inoculated at different times, and only as the disease proceeds, the fever becomes regular^

DISEASES 211

possibly because the parasites that can not conform to the age period of the majority in their schizogony, when the organism offers least resistance) overwhelmed by the combined attack of the parasites and tiio toxins liberated bv them becomes exterminated by the anti- toxins of the blood) produced as a reaction.

"The fever that lasts for seven, ten or twelve days without interruption, is called 'smitata' ( simple continued fever, produced by a bacillus, resembling coli communis, or the remittent fever produced by spirocheta carteri, known also as the relapsing fever or typhus recurrens) ; the fever that appears twice in day and night, is called \mtata* {doitle-quotidian or Kala acar, produced by a protozoan parasite Leishnmiia donovan\ and it grows in large numbers by fission, and i^ principally found in the liver, spleen, bone- marrow, ■ lymphatic glands and to a less extent^ in the pancreas, kidneys, suprarenals, lungs and testicles) ; the fever that appears on every third day, is called 'trtiyaha* {tertian) ; and which appears on every fourth day, is called tho *chaturthaka' {quartan):* Smritta VI. 89. 31"* .

212 ANCIENT HINDU MEDICINB

'*Tlie unhygienic living after the relief from (the primary onset of) the fever, aggravates the lesion, and owing to the low vitality (of the organism) deranges nerves and phlegma, and causes the development of double-quotidian {satata = kala-azar), quotidian {auyedyuska)^ ter- tian (trtlyaka)^ quartan (chaturthaka) and pneu- monic (^raZ5/?aA;a ) acute fevers." Susniia YI. 39. 22»\

*'Tremor, irregular onset of fever, congestion

of neck, face and lips, insomnia, suppression of

sneezing, desiccation of the body, pain especially

in the head and the heart, foul taste in the

mouth, constipation, flatulence (adhmana = swell-

ing) and yawning are the symptoms of 'vata'

( cerebro-spinal estivo-autumnal pernicious ) fever.

Onset of fever with rigor, diarrhoea, diminished

sleep, vomiting, tumescence of the neck, face,

lips and nose, sudoresis, delirium, bitter taste in

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DISEASES 213

the mouth, semi-consciousness, hyperpyrexia, intoxicated state, polydipsia, the yellowish tinge of the feces, urine and the eyes, and vertigo are the symptoms in 'pitta' fever {bilious remittent fever : known also as malarial heraoglobinuric or black water fever).

Heaviness of the body, chills, expectoration, horripilation, excessive sleep,sluggish circulation, mild onset of fever, salivation, sweet taste of the itioutli, low fever, vomiting, lassitude of the body^ indigestion, acute coryza (pr«/is^a?/a = profuse xticretion of the watery mucus from the nose), loss of appetite, and whiteness of the expectora- tion and the eyes are the symptoms of *slesma* (influenza) fever." Snsruta VI. 39. 11-13'' ^

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> «••» ..•/i*;'i|»»

214* ANCIENT HINDU MEDICINE

M'upiive Feve?'s : "Feverishness or cliilliness by turns ; pains in the bones, joints and tlie head (headache) ; watery, glazed or reddish, dilated or contracted eyes ; hissing sounds and pain in the ears ; neck as if covered with grains {siika =eruTpt\ve typhoid papules); somnolence; illusion ; delirium ; coughing ; dyspnea ; loss of* appetite (anorexia) ; delusion ; the tongue is rough and has the color of burnt coal (dry, brown, thickly coated, iissured and tremulous) ; inertia of the body ; nasal discharge mixed with blood (nose-bleed) ; bilious sputum (vomiting) ; agitation of the head; insomnia; angina pectoris ; scanty perspiration, urination and defecation ; the patient does not look emaciated ; sound in the neck (sonorous or sibilant rales indicating bronchitis) ; appearance of rose-red rxanthem {kotha) and rashes (mandala); ii\)\iixsm {mukatva) ; lesion in the circulatory system, heaviness of the epigastrium (flatulence) ; and the delay in the coction of the deranged humors (the long dura- tion of the disease and convalescence from it ) are the symptoms ef the typhoid fever." Charaka, VI. 3. 85".

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DISEASES 215

'* Altogether through (varied) lesion, there are thirteen kinds of typhoid fevers^ Charaha I. 17. W\

It is very probable that all the eruptive fevers have been classified by Charaka, as typhoid fevefs (smmipdta jvara)^ including in the category typhus, paratyphoid, cerebrospinal meningitis, measles, mumps, erysipelas, diph- theria, toxemia, septicemia, pneumonia,puerperal fever and small pox. Charaka and Susruta both mention smallpox as 'masTcrika.*

*'Due to lesion of the phlegma and the biles (circulatory blood), tiny rashes, anorexia, exuda- tive vesicles, called *romantV (varicellaa or chicken.

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94.. ^^"^ ft^ncM «RiMiciii^4it^^ 11

216 AXCIENT HINDU MEDICINE

pox) appear with fe^er, itching and polydipsia, Erom bile and phlegma (corruption of), the tumescence of the pustules that appear all over the body like lentils (ervum lens : ervum menus), is called the I'ariola or small pox ( masurika )."' Charaka VI, 12. 73' ^'\

"The painful, copper-colored, bronzed pustule that appears all over the body and within the mouth with burning fever, is called the variola ( masurika )." Suirnta II. 13. 30' ^

**'rhe typhoid fevers after passing through a crisis on the seventh, tenth or twelfth day, either become relieved or kill the patient." Susruta VI. 39. 18'^

As it was believed that disease was due to the derangement or the disharmonious combination of the humors of the body, the cure lay in their

w. ^^^5 iT^in^ ^^^v. fqTj^qfrH nf^T: i

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96. grm f^^t ffiK ^t ^T^sfq ^T I H^^'Ccrtt ijpr nfm <rrf^ ^f^ ^ u^c

DISEASES 217

proper combination by coction. Tlie internal^ Leat that was supposed to cause coction of tho- liumors and thus to preserve the balance of the liumors, requisite for normal health, was suppos- ed to be dissipated to the peripheral organs hy morbid agents and thus to produce fever. Cure from a disease only took place wdien the internal combustion ( metabolism or oxidation ) wa!§ normalized again. This was brought about by lnygienic living and dietary regulation. Medica- tion was but supplementary. It is well known, that quinine, the bitter alkaloid of the cinchona hark is a powerful remedy against the malarial Plasmodia. Though cinchona is a native of the South American Andes, it belongs to the llubiaceous family of which there are many members in India. Charaka in the treatment of malarial fever mentions a bitter ( tiktaka ) juice of leaves or bark, or concoction of a dry bark, but it is very hard now to identify what he meant by it :

*'In new fever, fasting, sweating, time, barley water and bitter extract (fiktako rasa) cause the coction of raw humors (that is, bring about the cure).

*''In the cerebro-spinal remittent fever and influenza, when the patient is thirsty, give him

218 ANCIENT HINDU MEDICINE

liot water to drink. In the bilious remittent fever, cook bitter (bark or root) in water and when it is cooled, give it to drink. Such a concoction is stimulating (d'ipana = digestive), oxidising {pacha im = which, causes coction of the humors), (febrifuge (jcaraghna ), blood-puri- fying (srotasam 6-6»f?/mwam = purifier of the streams, as the blood, lymph, urine), vitalizing {valya)^ appetizing (ritcJd-kara), sudorific {ghar- ma-kara) and is beneficial." Charaka VI. 3. 129.''

That this treatment was only meant for malarial fevers, is clearly indicated by the following passage : "At the onset of the (mala- rial) fever fasting is proper. But it should not be followed in consumptive, nervous, phobia, excitement, depression and fatigue fevers. By fasting pathogenic agents {dom) are destroyed a?id when metabolism is stimulated, the body

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DISIDASBS 219

becomes light and hunger appears. But fasting should not lower vitality (that is fasting for a longer period than is necessary is injurious), for recovery depends on the vitality of the patient, and the object of treatment is recovery." ChamkaW. 3. 128^'.

**In all kinds of fever, treat it by counter- acting the causative factors. In fatigue, consumption and wound (abhighata=\^o\mdiOY: traumatism) fevers, treat the original disease." Smruta YI. 39. 73 '\

*'As long as the fever patient does not regain his strength (i. e. does not completely recover), he should not indulge in shower-bath {pariseka), plunge-bath (avagaha), beverages, vomiting etc. {smmodhana)^ inunction, day-sleep, exposure to

«#^-^«i ^^ ^ ^ ^?5m^s^ I

220 ANCIENT HINDU MEDICINE

cold, exercise and sexual intercourse." Sasrutw VI. 39. 68 ^"^

"If a fever patient suffers from indigestion, old wine and barley broth is beneficial to him. If a fever patient suffers from coryza and anorexia (influenza), let him drink whey mixed with ^trikatu' (a mixture of mntM — ginger, 'mar'ioha black pepper, plppala — longpepper ; Gr. *dia trion piperidon' made of the same ingredients, piperis longura, piperis nigri, and zingiberis). In an exhaustive continuous fever, if the patient is ema- ciated, on tlie road to recovery, mentally depress- ed, in cerebro-spinal or bilious remittent fever, or if the pathogenesis is not well-marked, if the patient is desiccated, has polydipsia and burning sensation, drinking of milk will benefit him. But in new fever, milk should not de drunk, as it miglit even cause death:" Susruta VI. ^^9. 63^'''.

100. tjR^^NJir?!^ #?i^^ €^^5nfH "^ i

101. ^^' H^^ fn^^j^'^i^Mf^ci f%?f?^ I

IP DISEASES 221

'^In a long-standing continuous or remittent lever, if the patient becomes emaciated, he should be treated by light and easily-digestible food for his fever. Broth of a bean {mudga = phaseolus munffo), red lentil (masura = ervum hirsK- turn ), gram pea ( chanaka = cicer arietinum)^ plantain {musa paradisaica) , and dolichon biflorum. The fever patient that likes meat, can take the partridge {perdicum cheninensium), perdicum francolinorum, black antelope {anti- ,opariim nigrarum ), hystricum, small deer, hare {leporimi), black-tailed deer; golden-colored deer and antiloparum albarum. The crane (gruidce)^ heron (ardeidce), peacock {pavo), chicken (gallos doniesticos) and heath-cock {fefraoninnco), are hard to digest and very excitant ; for this reason they are not prescribed by many physicians. But when the fever patient is nervous, it can be given in a moderate quantity." Susruta VI. 39. 67'"^

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222 ANCIENT HINDU MEDICINE .^W^'

But Charaka only recommends uieir brotli and not their flesli : liowevrrr

can be a little acidulated with &m* "ti mixta re of pomegranate (punica irianatufn) to make it more palatable VI. 3. 165'" \

"Milk boiled together with ginger, raisins and dried dates, and mixed witli honey or sugar relieves thirst and fever. Or the milk might be diluted with water four-fold imd cooked to- gether; this is beneficial in old fever, and the drinking of hot milk is good in bilious remit-

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DISEASES 22S

tent fever. Milk is restorative in all consumptive fevers ; it always produces good result whether drunk hot or cold with whatever medicine prescribed for the particular fever." Chamka VI. 3. 196»«*.

"The embrace of maidens that are pretty and well-shaped, relieves the chilis of (malarial) fevers, by imparting the natural warmth of their body." Charaka VI. 8. 2081*^*.

"In old pneumonic or nervous fever, if the patient suffers from chills, heat should be ap- plied to warm him up, which is very beneficial

in such a case (drinking o\\ hot concoction,

liot wine, warm bath, hot salve and fomentations are recommended).... The body should be covered with warmed cotton or silken clothes. If the

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224* ANCIENT HINDU MEDICINE

patient feels fatigued anoint the body witli aloes {aqullaria agallocko ). And well- breasted, pretty and artful maidens in the first inflorescence of their youth, should massage :5ently his debilitated body. And the maidens with the face like the autumnal moon, eyes like the blue lotjis, long-curved tremulous brows, complexion like molten gold, bright-red lips (like the himha fruit = memordica monadelpha)^ narrow abdomen (slender waist) but. broad ex- pansive pelvic region, body anointed with delicate .fragrance {croco sativa and aquilaria agallocko), firm, round and elevated breasts, dressed in fine- smelling, washed and white loose dress, as a wild-creeper (entwines round a tree), should embrace him closely. But when the patient seems to be enlivened, then the maidens should be removed. When by the delightful contact of the maidens, the chills have disappeared, the patient should take pleasant and beneficial diet." Smruta VI. 39. 131^ "^

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=wi^§tJi =^T«?i=: ^-jsm^ f%^,??^ I

DISKASES •22&

Prophylaxis in malarial fever can be isuku* raed up in these words: (a) destruction of mosquitoes ; {h) the prevention of the entrance of the parasite into the human body; (<?) increas- ing resistance of the body against the parasite.

As the mosquitoes require shallow, stagnant water for breeding and development of their larvae, the first requisite for a determined fight against malaria, is the awakened public senti- ment against this pernicious and malignant

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226 ANCIENT HINDU MEDICINE

disease. Eor without communal co-operation, it can not be accomplished. There should be complete surface and subsoil drainage and the ground should, be so levelled by filling up the ditches and the natural depressions that there can not be any accumulation of water for the breeding of the mosquitoes. All the ponds, lakes, canals and water-ways should be deepened, and the water-plants that usually float on the surface as safe breeding place for mosquitoes, protecting the larvae from the fish must be regularly and systematically removed. Pish should be cultivated in every pond, lake or canal, especially the ^giradinus poeciloides^ which is a voracious feeder on eggs, larvae and pupae of mosquitoes. All trees on the bank of the water or near the dwelling house which takes away sunshine or interferes with free current of air, should be felled, for the mosquitoes need a dark place to hide in the day time. Laveran recommends the plantation of castor oil plants {Prophylaxie du paludism, p. 134), the odor of which he believes drives away mosquitoes. However the promise held by the Eucalyptus tree has been rather deceptive. Bats appear to be voracious feeders of mosquito larvae.

The next thing is to protect the inhabitants

DISEASES 227

tigainst the mosquito bites. Mosquitoes can fly- nearly a mile's distance from the breeding place, and many of them go out and bite only in the evening and at night. And it is the females that do the biting. The males live on vegetable and fruit juice. The life of a female mosquito is about a month. It bites any vertebrate it might come across in order to get blood which it needs as nourishment for its eggs. But it is only by biting a malarial patient, it can be infected with the malarial plasmodium, which it transmits to others when biting again. Therefore to prevent the spreading of malaria, it is necessary that the inhabitants be protected from mosquito bites, for in a malarial region, almost every one might har- bor malarial germ in the blood, though the disease is in a latent form and there is hardly any appar- ent symptom, excepting a little malaise and lassi- tude. The mosquito bite can be easily prevented by using mosquito wire netting in the windows, which does not prevent the circulation of air. Where it can not be done, mosquito-nets must be used in the bed. And if it is necessary to go out at night, one should take care to wrap the body- in clothes or smear the body witJi carbolated vaseline and to use a fine-gauze net round the lace and neck. . ^

228 ANCIENT HINDF MEDICINE

Quinine is the best prophylactic and curatire agent against malaria. In the endemic malarial region, it is a wise policy to take 2 to 4 grains of quinine daily, as a preventive medicine, which seems to be much more effective than larger do- ses at longer intervals. Chlorhydrate of quinine is preferable in an irritant stomach, or Sulphate of quinine can be given which is much cheaper^ During the acute stage of the malarial fever, it is better that quinine be administered in doses not smaller than one gram, nearly four hours before the expectation of the chills, as quinine takes nearly four hours to act, and ife should act energetically at the time of the sporulation — when the young broods are liber-- ated and w^hich provokes the chill, and the sporu- les then should be destroyed, for it is very doubt- ful how far the old garnets are affected by quinine. Quinine should be given every day, preferably by mouth and in powder form or in solution, and the bitter taste can be covered and neutralised by addition of syrup glycyrrhizae ( syrup of lico- I'ice) every day when the attack is expected, un- til the disease is broken, as it may be due to doilble infection by the tertian, estivo-autumnal and quartan parasites or to the treble infection of the quartan. And with the exception of rein-

DISEASES 229

fection, relapses can be usually prevented by giving quinine once a week for four weeks from iXie occurrence of tlie last cbill.

During tlie paroxysm, treatment needs simply iio be symptomatic : in chills hot drink, warm co- vers and hot fomentations can be applied to relieve the sliivering cold sensation, and during the suc- ceeding hot period cold application on the head to relieve headache and cold drink to relieve thirst. But the sweating period should not be shortened "by antipyretics as it might harm the organism by retaining the malarial toxins which perspiration tends to eliminate, and that is why the sweat of a malarial patient has a peculiar odor.

It goes without saying that nourishing food and hygienic living strengthens the resisting power of the organism against any infection,

II.- Diarrhoea.

"Excessive consumption of indigestible ( ali- 'fiientary diarrhoea provoked by the irritation of the intestinal mucosa through the indigestible residue ), fatty (fatty d. or d. adiposa, caused by the splitting of the fat into irritant fatty acids, or as in jaundice with the deficiency of the bile, by the evacuation of the undigested fatty sub-

230 ANCIENT HINDU MEDICINE

stances), drj-' (mechanical or serous d. caused by an augmentation of pressure within the alimen-- tary canal with exaggerated serous transudatioia into the intestine), hot {inflammatory d.), liquid {asthenic d. caused by the fermentation brought by the dilution of the digestive enzymes by an exceedingly large quantity of liquid), coarse {lin- terio d. in which the undigested or half-digested food particles are contained in the dicbarges ), ice-cold {congestive d. is induced by mechani- cally stimulating the peristalic contractions and possibly glandular secretions by a large quantity of cold water, thereby increasing the amount and fluidity of the intestinal contents, and by diluting the gastro-intestinal secretions which interfering with digestion, provokes fermentation ; the drinking of ice-cold v/ater and beverages cause loose movements for they mechanically bring about contraction of the superficial vessels of the mucosa, followed by reaction and congestion of the membrane, and if long continued to intesti- aal catarrh ), and improper foods [diarrhoea is provoked by all kinds of food poisoning, hroma- totoxismus either putrefactive, fermentative or infective with all toxemic symptoms : meat-poi- soning or kreototoxismus arises from decomposed meat ( proteus group alone or associated witlt

DISEASES 23t

colon bacilli), meat of diseased animals or infected animals ( as tuberculosis ) ; fish-poisoning or= ichthyotoxismus arises from eating fisli that is venomous, or only at the spawning season or' from feeding upon putrefactive substances or from its decomposed ptomaine poisoning as in' rotten egg ; milk-poisoning or galactotoxismus arises from taking contaminated or spoilt milk r milk may be contaminated from various sources as it is one of the best culture mediums of patho- sjenic germs, as from tuberculosis from a diseased animal, dust on the animal, filthv hand of tha milker, unclean receptacle, or, washed with polluted water, or from exposure when left uncovered for a considerable period, and milk usually contains myriads of bacteria, and in it are frequently observed colon bacilli and bacillus enteritidis, and to a lesser extent bacillus enteri- tidis sporogenes, staphilococci, paratyphoid and occasionally typhoid germs ; grain-poisoning or sitotoxismus arises from using spoilt, contaminated or sprouting grains, as pellagra in the use of diseased maize, or in the spoilt pea, paraplegia, or lathyrism ( lupinosis ) in the admixture of the grain with the seeds of the Hathyrus' ; it is well known that sprouting potatoes contain at the mouth of the sprouts or the greenish surface of

^2 ANCIENT HINDU MEDICINE

the skin exposed to the sun, a glycerid alkaloid-solanine, wliile many of the mushrooms contain another toxic alkaloid-rauscarin], mi- cooked food (uncooked food is not only hard to digest as cooking softens the tissues, but many <yf the vegetables and fruits might contain fungi, amoeba and the eggs of many intestinal worms which are thus introduced into the alimentary ■canal where they make their habitat, and pro- i?oke diarrhoea either by irritating the mucusa, or causing ulceration or impaction), disharmonious cmtibination of foods (as milk and acid, or sugar and acid which is apt to cause fermentation in a weak or debilitated stomach), repeated eating before the former meal has been digested {adhya- ^a»a=sd.ab ingluvie), miiv^estioxi {dyspeptic d.) excessive use or abuse of purgation, vomitinj^ and sweating (d. cathartica), poisoning (m. chronic mercurial poisoning perhaps due to the corro- ding action of its salts, there is an extensive ulceration of the alimentary canal, followed by fetid diarrha3a, anemia, foul breath, falling out of the hair, brittleness of the nails, salivation, stomatitis, buccal ulcers and entero- clitis '^ in acute or chronic arsenic poisoning, there is pronounced epigastric and abdo- minal pain, followed by vomiting and diarrhfjea

DISEASES 233

of rice water and often bloody and offensive stools, suppression of nrine or bloody urine, neuralg-ie pains and paralysis ; in lead poisoning, the gums have a bluish black tinge, progressive anemia., nutritive disturbance, constipation, but often alternating with diarrhoea), anxiety {emo- iional d.) depression (nervous or neu7'otic d:) polluted toater (water containing dysenteric germs or large amount of earthly alkali as magnesium or sodium, calcium or potassium car- bonates, dissolved from the soil) excessive drink- ing of spirituous liquor (in chronic alcoholism diarrhoea results from the thickened, inflamed, congested and often ulcerated intestinal mucosa, imperfect gastro-intestinal indigestion, inter- ference with colonic absorption, disturbance of the biles due to congestion and cirrhosis of the liver, and the effect of alcohol upon the local and cerebro-spinal nerve-centres controlling intes- tinal nutrition, secretion and motility, thus pro- voking diarrhoea alternating with constipation), mental derangement {neurogenic d.), sudden seasonal changes (thermic or summer d. of the hot season : it may be also induced by sun or heat stroke accompanied by enervation, dizziness, cramp, disturbed vision, dry skin, rectal and vesical irritability ; in exposure to

234 ANCIENT HINDU MEDICINE

cold and dampness, the surface of the body is suddenly chilled with the lowering of the surface temperature, which causes the contraction of the cutaneous blood-vessels, leading to congestion of the internal organs, chiefly the intestine and viscera, and reflexly irritating the motor and secretory nervous mechanism — thus leading to evacuations ; in sudden change of climate, diarrhoea may be, also, induced as hill or spruce d. ), excessive use of lavage ( ^nechanical d. \ obstructive ( due to carcinoma, tumor, calculi, fecal impaction or obstruction of the passage with the tapeworms as tenia solium which is intro- duced with incompletely cooked pork and might grotr from 6 to 12 feet, tenia saginata, from incom- pletely cooked beef varying in size from 10 to 25 feet, tenia lata from half- cooked fish varying in size from 5 to 25 feet, and tenia nana (dwarf tape) from one-fifth to one and one-fourth inches in length ; diarrhoea is provoked by them either because the formed feces can not pass through the obstructed passage and only watery liquid can ooze through, or due to irritation from the mucosa caused by them ), and by "krimis' [worms uncinariasis or hookworm, ascaris lumbricoides or round worms, oxyuris vermicularis or thread- worm, tricuris trichiura or whipworm, trematodes

DISEASES 235

or flukeworms and strongyloides intestinalis ; microbes : entaroebazer rhizapodes in amebic dysentery, flagellates ormastigophores in flagel- late dysentery, ciliates ( balandium coli, infuso- ria ) in ciliar dysentery, bacillus dysenterise in bacillary dysentery, spirillum cbolera asiatica in cholera, bacillus typhosus in typhoid fevers, gonococcus among the pedestrians with extensive lesion of the anal mucosa, plasmodium in bilious remittent fever ] these causes produce dirrhoea." Susriita VI. 40. 2^^*.

**Slow-moving (cya?;a = ascaris). agile {vijava = flagellates), creeping (^^^j^^/cr = trematodes or flukeworm), stealing (/^•ipy6»= uncinariasis or hookworm), knotted-feet (ffandi(,-pada = tenia), thread-like (chnru = oxyuris vermicularis or thread -worm) and two mouthed ((:/i;mw/(;^« = trichu- ris trichiura or whipworm) are the *krimV (para- sites) of the feces ; they are whitish and minute ; they move in the lower intestine and cause (bor-

107. 5^^f^^^^'i!r-5^^^nffi5^ci^: I

236 ANCIENT HINDU MEDICINE

I '

ing pain ; and among them there are some that have flagella puchcua as in flagellates) and they are Tjroad. These fecal 'h'imi' (worms and other microbic parasites) bring about colics, dyspepsia, jaundice, intestinal obstruction, weakness, over- flowing of the watery discharges, heart lesion and non-formation of the feces."

SmrutaYL 54.4'"'.

"The prodromes of diarrhoea are boring pains in the heart, umbilicus, coccygeal region, abdomen and the groin, lassitude of the body, flatulence, constipation, tympanites and indiges- tion." Susruta VI. 40. 4^ " \

* 'Abdominal pains, oliguria, sounds in the alimentary canal, prolapsus ani, lassitude of the

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t^^^p^^ H"^*: ^^^^ *f^^ 1% II

109. '^^fiTqR^5^f%eii'?-sii^rTOr?rf^9m^^: i

DISEASES 23'7

srroin, tln'gh and the knee and the evacuation of raucus-covered (saphena^' frothy) dark-brownish, hardened scybla in small quantities with gas — these are the symptoms of nervous ( dysenteric) diarrhoea.

"Dark-yellowish ( in biliary obstruction ), greenish (due to the presence of unchanged bili- verdin in the discharges as in acute enteritis), or reddish (tarry stools may be due to cancer or ulcer of the intestine or dysentery), unformed, serous (like the juice of pressed meat), foul-smell- ing and steamy discharges rush forth in bilious diarrhcEa (cholera asiatica) ; in this disease the patient becomes exhausted and becomes over- powered by polydipsia, vertigo and hyperemia of the internal organs. '

"Whitish (rice-water, or containing undigested fat) and pasty stool appears noiselessly, mixed with mucus in phlegmatic diarrhoea ; in this disease the patient suffers from collapse, somno- lence, lassitude and repeated evacuations ; and the patient becomes irritable and there is horripi- lation (contraction of the peripheral vessels).

**In the typhoid fevers, the above mentioned symptoms appear, but the color of the evacuation is varied and the patient suffers from polydipsia ; it is very, hard to cure and the prognosis is especi-

238 ANCIENT HINDU MEDICINE

ally unfavorable for the infants and for the aged." Susruta VI. 40. 5-8 » ^ \

"If in cholera asiatica (visuchtka) and tym- phenites {alasaka), the teeth (the gum), lips and nails become cyanotic, there is a comatose state, active vomiting, orbits of the eyes are sunk in the sockets, the voice becomes vreak and the

110. JCfjjfiw^: ^^^s^^

DISEASES 239

joints become relaxed, then the prognosis is very unfavorable." SusrutaNl. 56. 8^^^ .

**In acute diarrhoea, if the feces is formed or shows symptoms of being formed, and the vitali- ty of the patient is not very low, there has not been much emaciation of flesh nor blood much thinned, appetite and digestion have returned, then the patient can be cured with difficulty. But if the patient has the following symptoms, notwithstanding the above-mentioned presenta- tions, he is to be regarded as incurable. Incur- able symptoms are being mentioned : if the stool has the color of concoction (dark-brownish), redd- ish, like that of the spleen and fat ; or is (in con- sistency ) like water in which meat has been washed, curdled milk (semi-fluid), clarified but- ter, bone-marrow, oil, butter, milk, condensed milk, or deep bluish (with the development of indican in pronounced putrefaction ), reddish, lilackish ( in bilious remittent or black- water fever ), or transparent like water or the brownish-black color of the banana flowering- stem (clay or chocolate color stool appears in

111. W. ^ST^'^^'HeHi-rMy'^'^W^S*^'*''^^^^^' I

240 ANCIENT HINDU MEDICINE

absence in urohilin^ that is in the deficiency of the biliary secretion in the intestine ), very fatty, pale-greenish or dark-greenish ( due to unchanged biliverdin ), or multi-colored ^ or is turbid, lubricous or mixed with threadlike substance ( oxyiiHs vermiculaHs or thread- worms), mucus or like the ocellate spots on the tail-feather of a peacock (flakes) ; the odor is like that of a decomposed corpse (cadaverous), putrid, pyogenous or like raw fish (fishy) ; if the feces attracts quickly the flies, or various viscid sub- stances are observed in it (the stool may contain undigested food, blood, mucus, pus, membranes, fat ; calculi from the gall-bladder, intestines, sto- mach, salivary glands ; intestinal parasites, exfo- liated polypi and nerotic sloughs), or the dischai-ge contains very little feces (a normal stool should have hard but flexible consistency, golden-brown- ish in color, cylindrical in form, nearly an incli in diameter, three to four inches in length ; but if it is of small calibre, it is indicative of prolapr sus ani or an annular stricture of the rectum ;., ribbon-shaped or flattened stool of stricture or cancer of the rectum ; roundish masses of liard- ened feces {scyhala) may shoot out in dysentery or is indicative of the gastric ulcer, gastric dila- tation, cancer of the rectum or chronic coiistipa-

DISEASES 241

tion) or is free from it {serous) and the patient suffers from polydipsia, hyperemia of the intern- al colics or its insensibility to pain ; if there is anal fistula or ulceration, or hemorrhage of the pile or the pile does not go back to its own place, stricture of the anus, emaciation of the body, ■thinning of the blood (anemia due to the reduction of the red corpuscles), pain in the lumbar region, anorexia, morbid delirium and coma, or the diarrhoea suddenly ceases, that patient is to be regarded as incurable." Charaka VI. 19. 11^^-. "In the first stage sf diarrhcsa, fasting is bene- ficial. After fasting, for relief from diarrhoea barley water should be given with (astringent) concoction ( paohana ). If patient still suffers

112. M'%\ ^fWM aiW^fq^T q^nfT^=^'5?lt^5ftf%c[^ W^^-

242 ANCIENT HINDU MEDICINE

from colics and flatulence, give him an emetic with piper longum (which is carminative) and rock salt, dissolved in water. After vomiting light food can be given, barley water and piper longum. But if this does not relieve diarrhoea then everv mornin» a concoction of turmerics {curcuma longum) or sweet flag {acorum calamum) should be given to drink." Siisruta VI. 40.16^^^.

**In morbid diarrhoea (dysentery) and stran- gury, a (rectal) enema (»as(^i= clyster) of con- coction of liquorice root {glycyrrJiiza glabra) and blue lotus ( nyphaea cacriilea) mixed with milk, clarified butter and honey (for irrigation) should be given ; hemorrhagia proctica, aesus and fever are also relieved by this enema; If there is bloody stool an oily enema of soothing and honeyed herbs should be given daily either

DI3KASSS 24S

at day or at night. An oily enema relieves the nervous irritation where it is administered ; and if the nerves are subdued, ti»e dysentery is also cured/' Stisruta Y I. 4.0. 90'' \ . i

Ilectal irrigation uitli sootliing oil or steri- lizing: medical solution or their combined emul- sion is certainly one of the best means known to combat pernicious, ulcerated and resistant diarrhoea and is very effectively utilized in :ad- vanced modern treatment, Enemata serve to dislodge or to prevent fpcal impaction where ulcers have healed and a stenosis has formed in the lower bowel, and for evacuating gas, putre- fying matter, toxic discharges and other irritants within the rectum. Aq enema is generally givea in constipation. And in an enema the fluid administered has to be limited to two to three quarts or it might cause distension, pain, ptosis

111'. 5fr?ret ^(?§< ^ f«w^ v^^T^Hi

24t4i ANCIENT HINDU MEDICINE

or paresis of the intestine and in severe cases even the rupture of its membrane. While in irrigation, there is no limit to the quantity of fluid, for the solution is allowed to flow into and out of the gut through a double or return-flow tube (J,rrigator) or by making the fluid flow into the bowel by way of an artidcial opening (appendiceal or cecal) and making it flow out at the anus through a proctoscope or a pipe intro- duced for the purpose, thus escaping as fast as the solution enters into the bowel. Therefore irrigation serves by the soothing and antiseptic properties of its content to heal the local ulcerated lesions, prevent the formation of impacted fecal masses, to wash out the sores and to neutralize the toxins, to remove toxins, irrita- ting pus, blood, mucus, tissue debris and feces, to dislodge and wash away parasites, and to relieve enterospasm, colics and tenesmus. By vastl is meant to include the functions of an enema and irrigator according to the needs.

Improvement invariably follows daily irriga- tion of the intestine. But it is not so much due to the medicaments as to the dissolvent and cleansing quality of water and washing away the toxins, so that the organism does not suffer so ioauch from their absorption. IJniloubtedly

DISEAiJES 24-5

aniiseptic, deodorant, soothing and stimulating medicaments exert beneficial influence, especially in inflammatory, ulcerative and obstructive lesions of the intestine, but they are only of secondary value. The only thing that is important is to irrigate the intestine as often as possible with body temperature of the solution. Positive good result is obtained by daily irrigation with warm saline solution, camomile, flax-seed, oak-bark tea, pinas canadensis ( 1 p. c. ), borolyptol, potassium permanganate, glyco- thymolin or listerin (3 p. c. ), salicylic acid, alum, zinc sulphate or silver nitrate ( 1 p. c), boric acid or Carlsbad salt ( 2 p. c. ) or thymol ( I : 2000 ). In advanced cases of deq)-seated ulceration and erosions, it is better to use the above solutions a little stronger or ichtliyol or balsam of Peru ( 2 to 5 p. c. ), salicylate of soda ( 3 to 5 p. c, ) and bisulphateof quinine (1 :1000) especially in entamebic and bacillary dysentery^ Oils named according to the degree of tlieir proven usefulness, olive, sesame, sweet almond, cotton seed, liquid vaselin and neutralol, either alone or in emulsion with the above-mentioned medicaments, can be used witli marked residt.

Propyhlaxis : As water seems to be the principal source of infection of cholera asiatica.

-46 ANCIENT HINDU MEDICINE

typhoids and dysentery, and in water spirillum cholera asiatica, bacillus typhosus and pathoge- nic agents of dysentery ( entameha dysenteria^ hacillus dysenteria, halantidium coli ) can all live and thrive for a long time, it is essential that all drinking water must be thoroughly boiled and filtered. Milk also must be boiled before it is drunk, as it is often contaminated by water from suspicious sources. All dejecta from the victim of any of these diseases must be dis-in- f ect<3d with a five per cent solution of carbolic acid, one per cent of chloride of lime or one- fortieth per cent of corrosive sublimate, so that all the pathogenic microbes be destroyed and they can not enter into the soil, especially if it be saturated with moisture where they can multiply, and retain their vitality and virulence for j^ears. This also applies to urine and sputum. Nor should any vegetable or fruit be eaten raw or not tlioroughly cooked which might have grown on the soil or fallen upon it, where there is the least possibility that the soil has been fertilized by human feces. And all coarse vegetables and unripe fruits which might leave a good deal of irritant residue, should be avoided. It is true that these germs have been found living in harmless, inert vegetative state without

DISEASES 21-7

provoking any lesion in the gastro-intestiual tract where they have been harboured, and the predisposing cause of their development is the malnutrition, fatigue, over-work and exhaustion of the organism. Yet it must be admitted that it is very dangerous to sustain such potential enemies.

In the treatment of typhoid and cholerale diarrhosa, there Skve two fundamentally opposed theories. One is the destruction and removal of the vibrios and to neutralize the toxins by s, powerful antiseptic purgative like calomel ( 3 to 5 grains with 6 to 12 grains of sodium bicarbonate ) and after this initial dose to administer small doses ( one-tenth to one-twen- tieth grain ), every half or quarter hour until the symptoms improve or the patient passes into algide stage. Some strongly recommend the administration of castor oil ( half an ounce emulsified with chloroform ) before giving calomel. And to inject saline solution (1.25 per cent solution of salt, prepared by dissolv- ing 2 drachms of salt in one pint of water ) at blood temperature, ten to fifteen ounces every half an hour to counteract the circulatory disturbance through the evacuations.

The other theory is to spare the vitality of

248 ANCIENT HINDU MEDICINE

the patient wbicli is seriously dissipated by repeated evacuations, and for this purpose a strong astringent like tannic acid ( kino, cateclm^ rhatania are to be preferred to pure tannic acid ) should be introduced into the rectum one to two litters daily in one per cent solution at a little above the body temperature. This seems, to have shown good result. And if there are evidences of toxic accumulation and fecal reten- tion, calomel is to be given every two hours in doses of 0.03 to 0.05 gram. The patient must be confined to bed; The body should be kept warm by fomentation. To quench thirsty sterilized water should be given, preferably acidulated with the juice of pomegranate, but any other fruit juice or milk under no circum- stances. During convalescence pigeon, dove or chicken broth with rice, with aromatic but non-irritant spices is to be preferred, but all coarse and irritant food should be avoided.

In puerperal dlarrhcBa (sutika) which is usual- ly caused by the invasion of the blood by the streptococci, staphilococci, united with gono- cocci, coli bacilli and other micro-organisms through a wound of the uterus at child-birth or in miscarriage by careless, septic handling and spreading of the germs, treatment should be

DISEASES 24&-

more or less confined to increase t)ie resisting, power, bacteriolytic and agglutinative functions of the blood by dietary and hygienic regulations. The symptom-complex of septicemia (suHka) commences usually within a week after infection. At the onset there is chilliness with low and moderate fever, but which rises and tends to be- come of continued type with decided daily remission. If however pyogenic germs have also got admission into the blood, tlie fever sets in with rigor, there is high temperature with steep curve and daily remission with sweating, like malarial remittent fever. However, the fever runs an irregular course. But it may be complicated by previous or post malarial infec- tion. As compared with septicemia, pyemia exhibits recurring chills, deeply remitting fever and sweats, rapid wasting and moderate icterus ;.-. while in septicemia the chilliness is only felt at the onset of the fever which runs a mild conti- nuous type with no sweats and jaundice is much lighter. Headache, marked anorexia, nausea and diarrha3a are the usual symptoms of septicemia {satikd). The pulse is rapid, small and compressible. The spleen may be palpably swollen ; petechial spots are not uncommon ; rashes or herps might also appear. Slight toxemic jaundice is alsa

'250 ANCIENT HINDU MEDICINE

usually seen. The urine usually contains albumin, leucocytes, red-cells and tube casts. The leucocytes are increased and there is an immense destruction of the red-corpuscles of the blood, leading often to hemoglobinemia and liemoglobinuria. Loss of appetite is very pronounced and there is no desire to partake of any kind of food and there is a special disgust to meat. The stool is emptied with severe tenesmus and consists of mucus mixed with blood. Often the joints become painful and swollen, and the skin of those parts reddish. Respiration is rapid but there is no dyspnea. But there may be complications of broncliitis or pneumonia.

Prognosis is not very favorable except in cases where within 6 to 8 weeks the temperature, respiration and pulse slowly tend to be normal. The treatment should chiefly consist ef hygiene and dietary. The patient must be confined to bed. All movements should be restricted as much as possible, as movement tends to spread the in- fection. Even after convalescence has set in, the patient shall remain in bed, at least for four weeks and all physical motion and mental excitement should be forbidden. However it is Tery desirable that the room is airy, bright and ■cheerful, so that there is no oppressive dullness

DISEASES 251

and niouotony. Eood should be varied, easily digestible, appetizing and nutritious. However, all irritating spices must be avoided though aromatic and sweet-smelling substances can be added with advantage, with only exception to old wine which is very well tolerated in 'sutikd'. Meat broth of: pigeon, dove, chicken, tender goat or lamb ( from lamb, fat should be taken out ) is very useful in fighting this tragic malady which pitilessly transforms the long-dreamt happy motherhood into painful suffering and sad struggle for life. Lean, light fish can be given in any appetizing way, but fatty and heavy fish should be avoided.

Antistreptococcic serum which is calculated to destroy the bacteria either by producing agglutins or phagocytosis can be injected three times daily with promising result unless there is pyomia, in wliich case it is apt to do positive harm according to Menzer whose serum has good reputation for its efficacy. The inunction of unguentum is claimed by Crede'to be beneficial. But none of these preparations have given completely satisfactory results. They are more or less empirical. The antipyretics are recommend- ed by some.

But as fever is the expression of the bodily

252 ANCIENT HINDU MEDICINE

reaction against the toxic products of the in- vading micro-organisms, suppression of fever is- apt to do rather more harm than good unless absolutely necessary to reduce the temperature and relieve certain nervous symptoms. More- over all tlie antipyretics — antipyrin, phenacetin, acetanilid, malakin, kryofene, lactophenin and others are all coal-tar products. And the use of these drugs is followed by depression and some- times serious collapse. Therefore its repeated use in continued and prolonged fever might endanger the life of the patient by heart failure which is seriously damaged by this disease^ thougli the temperature of fever is thereby reduced. Quinine of course in non-malarial septicemia, is hardly of any value. Only it is. very us^'ful when 'suHka' is complicated by malarial iifection.

Frophylaxis in 'sutika' is the absolute aseptic handliiiu at every child-birth, for otherwise with le;js wound or abrasion of the female genital organs w'nicii is inevitable, circulatory system may be invaded by pathogenic micro-organism& through lymph channel or veins. All the instru- ments must be thoroughly sterilized, and sterilized irlove should be used. Genital organ also should be carefully examined before delivery

DISEASES 253

for any infections disease, especially gonorrhea. in case of gonorrhea all precautions must ho taken and the baby's eyes should he waslied with one to two per cent silver-nitrate solution, or better still — Argyrol in 1-50 to 1-20 solution to prevent the affection of the eyes with its virus {ophthalmia neonatorum).

III-Diahetes.

**The causes, lesions and the organs tliat are affected which provoke temporary (alimentary) diabetes are as follows : too often an excessive consumption of various kinds of new cereals, bean-broths (of new pisum sativum and phaseolus roxhurghi) seasoned with clarified batter, meat of animals and amphibious creatures, vegetable- leaves, sesame-seeds, rice or wheat cakes, rice- pudding, rice and lentil curry, pulf-corn, sugar- cane-juice, milk, fermenting milk, fluid-food, sweet-meats and the intemperate eating of other products which are phlegmatic (reduces meta- bolism), fattening and diuretic — they are etiologic factors of diabetes (that is, the excessive consump- tion of carbohydrates in various forms above the assimilative power of the organism). Excessive liquid phlegraa is the pathological production and abnormal accumulation of fat, flesh, per-

25J( ANCIENT HINDU MEDICINE

spiration, (production of) semen, blood, marrow,, lymph, chyle and lecithin (oja) are the predispos- ing causes ( become affected ) "C/iarctka II. 4,

There are various kinds of diabetes : "The urine is whitish, painless (micturition) and aquatic in ^udaka-meha' [diabetes Insipidfis, in which the quantity of urine is enormously increased ( 10 to 30 pints), it is light-pale in color and the specific gravity is low (1.002 to 1.007) ; the total urea output is slightly increased, but it does not contain albumin, sugar or casts ; only inosite ( muscle-sugar ) is met with on rare occasions. Except excessive thirst and loss of fluid, the patient otherwise might be in apparent good health. This disease is supposed to be of nervous origin] ; the urine is (sweetish) like the

DISEASES 255

sugar-cane juice in ^ikm-meha' ( diabetes mellitiis or glycosuria in which tlie urine contains one to ten per cent of glycose, is pale, acid and has a sweetish odor ; the quantity of urine is greatly increased (5 to 20 pints) and is usually of high specific gravity (1.030 to 1.045) ; urea is in- creased and in advar)C<^d stage of the disease acetone, diacetic and B-oxybutyric acid may be present. This disease is due to the lesion of the pancreas which seews to control the carbohybrate metabolism) ; the urine is like spirituous liquor in *siira-meha'' [acetonuria in which a large amount of acetone is excreted with the urine, indicating incomplete oxidation of albumiaes and fats, especially in absence of carbohydrate which is needed for their complete combustiono Acetonuria is met with in inanition, typhoid fever, pneumonia, acute miliary tuberculosis, acute rheumatic fever, cancerous cachexia intestinal auto-intoxication, septicemia and in diabetes, especially when sugar is completely withdrawn from diet fur some time or susrar metabolism is disturbed. Acetone is a colorless mobile liquid of pleasant odor, produced commer- cially by the destructive distillation of acetates (whence the name ^pyroacetic spirit')^ and of sugar, cellulose and varioub organic compounds.

256 ANCIENT HINDU MEDICINE

Acetone is the simplest representative of the aliphatic ketones and is known as '^demethyl- i'-etone\ It has some anesthetic quality and smells as etlier. Pure alcohol when ingested in excess or under certain pathological condition of the alimentary canal passes with the urine (A. E,onchese : L"* analyse desurins, p. 306) ; urination is painful and the urine contains sand-like minute but hard and angular crystals (uric acid sands) in 'slkata-meha' {[/ravel — very small concretions, usually of uric acid, calcium oxalate or phos- phates, are formed in the kidney and pass through ureter with the urine) ; repeated micturition of phlegmatic (colorless, jellylike) and viscous substance in mnairmeha^ [ fibrinuria in which a colorless sticky sediment {coagulum)^ or if much febrin is present, the conversion of the urine into a jellylike mass upon standing takes place. It is due to the presence of fibrinogen and a ferment capable of forming fibrin. It occurs in cases where the plasma of the blood enters some portion of the urinary tract, as in chyluria, crou- pous inflammation of the tract, villous growths in the bladder] ; the urine is clear and saline in 'lavanameha* ( chlorides are normally present 'in the urine and are daily excreted from 8 to 10 grams ; but a persistent increase of 15 to 30

DISEASES 257

grams occurs in the prodromal stage of general pa- resis and diabetes insipidus, during convalescence from lobar pneumonia and post convulsive stage of epilepsy) ; there is horripilation ( peripheral contraction) and the urine is whitish like thick rice-paste water {albuminuria occurs in acute nephritis, chronic parenchymatous nephritis and urethritis) ; the dispharge is turbid and thick in *sandra-meha^ {gleet in chronic urethritis causes a thin whitish discharge, but becomes, also, thick and yellowish under various causes. The origin of the discharge is the numerous mucous follicles, lining that portion of the urethra correspond- ing to the site of the chronic inflammation. When congested, granular or abraded patches exist, there is a constant hyper-secretiou of mucus or muco-pus with exfoliation of the epithelium upon the surface of the lesion. In this condi- tion tlie current of urine, as it passes over the diseased portion of the canal, rolls up into strings or threads the desquamated epithelium and muco-purulent deposit upon the surface and this appears in the urine as the delicate thready filament which is a familiar occurrence in chronic gonorrhea ) ; the discharge is like the semen, in 'sukra-meha^ ( spermatorrhea is indicative of self-abuse, excessive coitus, sexual neurasthenia

258 ANCIENT HIXDU MEDICINE

as cause or consequence, and prodrome of loco- motor ataxia. Sedentary habits, an habitually loaded rectum, asearides, and the too free use of condiments and liquors may be responsible for the slighter degree of the symptom. In a continent individual involuntary emissions during sleep, if occurring at intervals of 2 to 6 weeks, are quite normal. But if it be much more frequent and if the emissions occur without erection, unconsciously to the patient, in the day time or while straining at stool, their pathological character is marked. Sper- matozoa are found in the first urine passed after emission in men. • They occur also in some cases of injury or disease of the spinal cord. Occasionally a small amount of semen is expressed from the vesiculae seminales by the pressure of hard fecal masses, during severe expulsive efforts accompanying obstinate constipation. The persistent presence of sper- matozoa in the urine is symptomatic of sperma- torrhea ) ; scanty foamy urine in ^phenameha^ ( in renal congestion, the urine is scanty, acid, of high specific gravity and usually cloudy with urates ).

The urine is frothy, transparent and bluish { indiccmm'la in which indican is found in large

DISEASES 259

quantitj. When albuminous substances under- go ])acterial p'utrefaction in the intestine, or are rapi(31y decomposing in any part of the body, as in the putrid pus of septic peritonitis, or in empyema, indol is formed. When the indol is absorbed, it is oxidized, forming indoxyl, and the latter combines with, the preformed potassium sulphate to become the conjugate potassium indoxyl-sulphate, or as it is more commonly termed 'indican*. If indican which is itself colorless comes in contact with acids or oxidizing- agents, it is decomposed with the formation of indigo blue. An excessive formation of indican is indicative of abnormal intestinal putrefaction* As a rule, it is usually associated with hypo- chloro-hydria, as hydrochloric acid exerts restrain- ing influence on proteolytic bacteria. An excess of indican is found in gastric cnncer and perito- nitis ) 5 the micturition is painful and the urine has the color of turmeric (curcuma has yellowisli- brown color ) in ^haridra-meJia* {choluriain which the urine is yellowish-brown or greenish-yellow due to the presence of bilirubin in the urine. Ifc occurs in many diseases in which an excessive quantity of bile is excreted as bilious remittent fever and part of it appears unchanged in the urine ) ; sour odor and sourish taste in ^amla»

260 ANCIENT HINDU MEDICINE

meha' ( oxaluria in which there is a persistent excretion of oxalates. Normally oxalic acid is excreted daily from 0. 010 to 0. 020 gram ( one- sixth to one-third grain ), but exists in combina- tion as calcium oxalate, and is held in solution by the acid sodium phosphate of the urine, and when the latter is deficient, the oxalates ave precipitated. Oxalic acid is increased by certain foods, as cabbage, rhubarb, tomato, and to a lesser extent by asparagus, spinach, carrots, string beans and celery. Oxalic acid may also result from oxidation of uric acid or an incom] plete oxidation of carbohydrates, in which case the intermediate product is oxaluric acid. A persistent increase in the excretion of oxalates is usually associated with the disorders of the gastro-intestinal tract or neurasthenia ) ; the urine is like pressed alkaline water from ( laundry ) cloth, in smell, color, taste and touch in ^hsara-^nelicC ( phosphaturia in which a con- siderable amount of earthy phosphates mixed •with fixed alkali is excreted with the urine. It is found in dyspepsia and neurasthenia. Occa- sionally the fixed alkali and the earthly phos- phates deposit their sediments in the bladder, and the few whitish drops passed at the end of urination like semen, may be their symptomic

DISEASES 261

expression. The urine is decidedly alkaline. Normally phosphoric acid is daily excreted from 2 to 3 grams ( 30 to 45 grains ) in combination as alkaline and earthly phosphates, the alkaline salts predominating. It is derived from the food and partly from the decomposition of lecithin and nuclein. The excretion is greatly increased in leucemia, pernicious anemia, uervous dyspepsia and considerably diminished in intermittent malaria, pulmonary tuberculosis with high temperature, typhoid, nephritis, chronic rheumat- ism and yellow atrophy of the liver ) ; the urine is like the water of Indian madder {manjis- tlia=7mhia ynunjista, which has bright red color in ^manjistha-meha' ( hemoglobinuria in which tlie urine contains the blood- coloring matter 'hemoglobin' and its oxidation product *methemo- globin*. Hemoglobinuria occurs in cases where- tbere is such an extensive destruction of the erythrocytes that it exceeds the power of the hepatic activity to transform the whole of the liberated hemoglobin into bilirubin, and the excess escapes by way of the kidney with the urine. It is found in pernicious bilious remittent malarial fever, especially after excessive doses of quinine, syphilis, yellow fever and severe form of jaundice) 5 and the urine is like the blood in

262 ANCIENT HINDU MEDICINE

*sonitcMneha' {hematuria in which the red-corpus- cles of the blood appear in the urine. It occurs in cases where there is an acute congestion of the kidney and the number of erythrocytes indicates the severity of the lesion. Bloody urine may be voided in leucemia, hemophilia, purpura, and in renal cancer, tuberculosis, abscess and lithiasis).

The discharge is like clarified butter in *sarpi-meha' {pyuria in yxXnoXv the pus appears in the urine. It may be due to different causes, but often it is associated with the gonorrheal urethritis. The urine contaiuing tbe pus from any renal lesion is usually acid and from the bladder alkaline); the urine is fatty in 'vasa-meha* {lipuria in which the fat is present in the urine in such quantities as to enable its identification by the unaided eye. The fat may appear in the urine due to the ingestion of excessive amounts of fat (fat meat, or in cases of fracture involving the bone marrow and causino^ fat embolism, in long-continued suppurative processes, in the lipemia of diabetes mellitus, from the fatty degeneration of the renal epithelium in chronic nephritis, of pus cells, in pyonephrosis or neoplasm along the urinary tract, or in the fatty degeneration in phosphorus poisoning. If the urine is so crowded with minute fat globules as

DISEASES 263

to present a milky appearance to tlie naked eye, it is called 'chyhiria' or 'galactiiria\ Chyluria is usually due to parasitic origin, especially due to the presence of 'filaria, sanguinis hominis'}; the urine is in taste and color like honey-sugar {hsaiidra = fruit-sugar, that is levulose) in hsaudra- meha'' {levidosuria in T^'hich levulose appears in the u:ine. It seems that the pancreas does not re- gikte the metabolism of levulose, for when there is intolerance for dextrose as in glycosuria, a g3od deal of fruit sugar can he assimilated. Pro- lahly the liver synthetizes the fruit sugar and in tie severe hepatic lesion or in the presence of bxias in the blood which causes irritation to the nuscles, which possess a considerable power to uiiize sugars, levulose is abnormally excreted wth the urine, though its permeability through tb kidney is nearly four times less than that of mdtose); the urine flows like that of a mad ele- ph,nt in ^hasti meha' {polyuria or the diahetes inspidus in which 10 to 20 quarts of pale urine is eschar ged daily). Susruta 11. 6. lO*^*^.

f^^ «i^<5:?pi}* ^ti^l, ^"^^j fq^^g^' fq^^ft-, ^ift^' 5aT?* m^^% ^Rig^" ^^ft, '^w ^^^ ^st ^i^f( -^m ii^o

264 ANCIENT HINDU MEDICINE

*'Any one who repeatedly urinates ink-colored (blackish) warm urine, suffers from ^kala-meha' (cilkaptoniiria in which the urine darkens on standing, due to the presence of alkaptoa (glycosuric acid) or related oxyacids, or melanin from melanotic cancer; or in hemoglobinuria as in pernicious remittent bilious fever, duo to tte destruction of large amounts of erythrocytes, the blood-pigment may undergo change ai^d appear in the urine as brownish-black or blackish ^ and for this reason the fever is called ''blacU water-fever'):' Charaka II. 4. 17.'^'. j

"Prognosis: "If one has acquired diabet© mellitus {madhu-meha) by hereditary transmit sion, he is incurable. It is not only hereditar/' glycosuria that is incurable, but all hereditaA'

^■^ ^' wmf^Tir^^ ^^im: I ^fq':nwrsi ^f^^'^ft ^Rt;Wt- 117. iT€t^ »^5^^' ^t ^'^g'^ ^i^f?f I

DISEASES 265-

predispositions are hard to remedy." CharaJca YI. 6. 4P^».

*'As birds easily take shelter in low trees, so glycosuria rapidly attacks those who are addicted to gluttony, but averse to bathing and walking (physical exercise and exertion). Glycosuria proves fatal fot* one who lacks energy, is very fleshy, fat and extremely corpulent. He who eats only to cover his metabolic needs, recovers his health." CharaJca IT. 4. 32. ^^\

"If the diabetes lasts for a long time, then there are complications of polydipsia, fever, diarrhoea, hyperaemia, weakness, anorexia, indi- gestion and putrefying boils, abscesses and gangrenes." Charaka II. 4. 30'''".

lis. 5fTcT^^ 'I^Mt ^

^ =^f^ ^f%(T li^i^T f^^m 120. ^q^^^T^^irg iRtf%^ (f^T^^TTf^igi^rfft^^Kt^^r^i^:)

263 ANCIENT HINDU MEDICINE

*'If a diabetic has boils tlien an expert surgeon shall treat him by cleaning and restoring {cicatrizing) them by his instruments. Chai^aka VI. 6. 42^ ^\

JProphi/laxis: la diabetes mellitus, it is neces- sary to know whether the disease is acquired or inherited. In lesions affecting the pons medulla, cerebellum, liver, thyroid and especially the pancreas, diabetes may be provoked. But in other diseases which do not seriously damage the pancreas, as in syphilis, acute infection, trau- matic and surgical neurasthenia, physical and mental excesses, there usually exists a predis- po->ing cause. Tlie predisposing cause consists of metabolic deficiency of assimilating carbohy- drates. It might lie in some inherent weakness of the hepatic and principally the pancreatic cells or that of the organism to burn the carbohy- drates or that of the nervous mechanism control- ling the process. Susruta did not fail to distin- guish them. He says :

121. KOTi^'jit <^i: fq^^T «^"4twt:

DISEASES 267

**Dial)etes is either inherited or acquired (alimentary). Inherited diabetes is due to improper dietary. The hereditary diabetic is very lean, dry (skin), has weak appetite (anorexia)^ polydipsia and is very nervous ; the alimentary diabetic is fleshy, has voracious appetite {hulimid), adiposis and is addicted to sedentary habits (fond of bed, seat and sleep. The lean diabetic should be treated by dietetic regulation, and the fat diabetic by ^ a'pata^^'pana^ (exercise and fasting). Smruta IV. 11. 2'-".

Prophylaxis should begin with children, especially wlien children of hereditarily predis- posed parents are found with tendencies to neurosis, goat or obesity, , and tbey should not intermarry with families of the same diathesis, iior over-indulge in sugars or excess of carbohy- drates. Adults with hereditary tendencies should avoid taking sugar and should not exceed in the carbohydrate diet beyond the physiologic

fqqT^37 qf^€^^^Qi^ x^'m I ^^tii ^€t 'f^wt f^'Ei: si^re^^i^i'Jt: intern I cm s5i^^5^»T;jf?ig'^mfvr: f5Pi[fwf^f%?i^c[, ^j^ciq ^-

268 ANCIENT HINDU MEDICINE

and metabolic needs. Rather it would be wise to partly replace the carbohydrates with fat and protein. Tendency to obesity should be com- batted by regular exercise and frugal diet. When obesity has developed, it should be reduced by a slow process of moderate daily outdoor exercise and a slight undernutrition, especially in car- bohydrates and fat.

Treatment : Glycosuria can be successfully fought only by rational dietary. It is a safe policy in the beo-inning: of the treatment to eliminate all carbohydrates from the diet. It may be said against this, that the excretion of sugar in the urine is but a symptom of the lesion, and the elimination of the sugar can not remedy tli& cause of the lesion, and moreover even in a sugar- free diet, sugar is synthetically prepared and excreted out of the protein and fat molecules. This may be all true, but the clinical experience shows that in a sugar-free diet, the patient soon develops carbohydrate tolerance. And the presence of an excessive quantity of sugar in the circulation and tissues which can not be meta- bolized, causes various pathological changes and manifestations. Von Noorden finds the use of oatmeal gruel once a week proves very benefi- cial. But on the oatmeal day he forbids the

DISEASES 269

^se of any protein, even not egg or milk. Only a little butter is permitted. And the day be- fore the oatmeal diet, be gives only vegetables and fat. Levin e finds that potato is just as efiicacious as the oatmeal. Fruits containing minimum of glucose like the lemon and orange can be given, as there is certain tolerance for levulose. The alternating constipation and diarrhoea which is symptomatic of diabetes due to gastro-intestinal disorders, should be remedied by laxative and constipative food according to the needs. Strong purgatives should be avoided. If this is not sufficient, in constipation Carlsbad or Epsom salts can be given and in diarrhoea irrigation should be applied. Special attention should be given to the cleanliness of the skin, as many skin lesions are apt to take place in. glycosuria. Mild antiseptic neutral soaps, con- taining tar, boric acid or eucalyptus have proved beneficial. When an infective process has already begun, great care should be taken that the surrounding tissues or other parts do not 1 become infected and for local use, iodoform, iodol or aristol can be used with advantage.

Diabetes insipidus : The pathology of this tlisease is not yet well understood. It occurs in cases where tliere is lesion in the pons.

270 ANCIENT HINDU MEDICINE

medulla or tlie cerebellum. It may be caused by many diseases, but syphilis is the principal cause. And in that case its principal remedy is antisyphilic treatment.

IV. — Diseases of the Bladder.

'There are twelve kinds of lesions of the bladder as follows : — annular swelling {vata- kundalikd=peric2/stis ), hard globular tumor {mutrasthUd=»mt/oma)i swelling oi: the mouth of the bladder (vdtavasti=p7'0static hypertrophy)^ difficult and scanty repeated urination {mTttrat'ita = vesical tenesmus ), abdominal bladder ( mTdra^ j at har a = oveY'distensioii and hypertrophy of the bladder with contraction aiid obstruction of the cavity), obstruction to the passage of urine {mutrotsanga = urethritis), uremia (mutra^l-saya), fibroma {mutra-granthi), spermatorrhea iTrmtra- mkra)^ cystitis (usna-vdta) and gangrenous or suppurative cystitis {mutraiikasdda).

"If the urine is concentrated and is not eva- cuated (in time), the humor 'e;«y«^' becomes vitia- ted and it circulates at the mouth in circular form (that is causes annular infiammation). This causes much pain and there is repeated painful scanty micturition. This difficult disease

DISEASES 27 1

is known as *vata-hundaliJca {pericystitis, which implies iuflammation ot* tlie tunica advenitia of :}lie bladder. Inflammation of tlie bladder {cystitis) may be provoked by various causes as follows : («) Cystitis may occur during tlie course of many acute infectious diseases as acute arti- cular rheimiatism, typhoid fever, small-pox, measles, influenza, cholera, diphtheria. This complication may set in during the height of the disease, or may appear during convalescence. Toward its cause, a number of factors probably contribute. The chemical constituents of the urine are often profoundly altered : the urine is concentrated ; it contains abnormal substances of disturbed metabolism which are more or less irritant and moreover may contain the pathogenic germs of specific infections. The tissues of the bladder are deprived of proper nutrition and lack their full power of resistance, (b) In constitutional ■ diseases as gout and diabetes in which the urine is irritant, (c) In general septicemia as pyemia or internal suppuration of any organ in which the suppuration foci may be brought to the bladder, (d) Prom irritating food and drink as excessive consumption of strong and irritant pepper and alcoholic drinks, (e) Infections from the adjacent organs as the kidney and the

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urethra. Tlie bladder may be affected by the kidney either directly by the urine, or by the lymph channel or by contiguity of the tissues. Urethritis is a common cause of which gonorrhea is an important factor. In acute gonorrhea the passage of gonococci is favored through spincter vesicae in its ascent during vesical congestion under sexual excitement or under the stimulation of alcohol or irritating spicy food. Chronic prostatic hypertrophy is also often a causative factor of the congestion of the base of the bladder. The cystites are of two kinds — simple aseptic and septic. The simple aseptic inflammation may be provoked by the irritating substances in the urine, metabolic or ingested, by the disturbances in the function of micturition or by the disturbances in the circulation incident to vascular or nervous conditions. It is well known tliat ammonia, oxalates, urates and sugar, if they are concen- trated in the urine are active irritants of the bladder. And tlie primary role of the irritants can be ascribed to the uric acid sands and calculi. They by their mechanical irritation cause con- gestion and inflammation and if the patho- genic germs are present, ulcerous gangrenes. Disturbances in the functions of the urine

DISEASES 27$:^

cause more or less hyperemia and inflammation.. Over-distension of the bladder either voluntary or pathological, the too frequent and too forceful contractions in the act of urination bring about this condition. When the causes of the over- distension, retention and obstruction are organic^ septic infection takes place. Various micro- organisms have been found to be related with the suppurative process as the staphylococcus pyogenes aureus, albus and citreus which can decompose urea, streptococcus pyogenes, bacteri- um coli, proteus vulgaris (which possesses the power of decomposing urea with the production of ammoniacal reaction), gouococcus and tubercle bacillus.

*'Unusual frequency of micturition is present in all cases, except in the beginning and in mild cases when the urine remains acid. The causes of frequency are threefold. The reflex influences of an inflammation of the vesical mucous membrane are alone able to provoke frequent urination. In an analogous manner, the irritation of ammonia- cal urine and of precipitated salts effects contrac- tion of the organ. In cases of obstruction, the partial retention of the irritant urine powerfully excites the detrusors. Thus the condition of the frequent micturition is usually worse in the 18

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contracted bladder of prostatic obstruction. In calculous cystitis, violent movement usually aggravates the condition. Tenesmus is frequent- ly present. In some cases it becomes so ex- aggerated and remains almost constant, that the patient in order to get relief from the exasperat- ing pain, constantly attempts to urinate, to force a few drops, though the bladder may be almost empty).

'*'Vdyu' causes in the intermediate region of the lower intestine and the bladder, a hard, immovable and tough tumor. This causes the obstruction of the passage of the feces, urine and intestinal gas. This provokes tympanitis and pain. This (disease) is known as *vatastMla* {myoma is usually a hard interstitial tumor, producing a globular induration of the bladder wall. It is generally located at the orifice of the bladder, and it has been noted from the size of a cherry up to such dimension as fill half of the cavity. The tumor is divided into lobules bv connective tissue ; its main bulk is composed of unstriped muscle-cells, in some places arranged in fasciculi, in others irregularly grouped).

"In any one who retains urine, the 'vayu* of the bladder becomes vitiated and closes the mouth of

DISEASES 275

the bladder, and consequently the urine is obstructed. And this vitiated *vayiC remains in the bladder and the prostrate {kuksi= groin) as an oppressor (in intumescence). This disease is very hard to cure and it is called ^mta-vasti* (pbstrttotive hypertrophy of the prostate which may range in size from an orange to that of a cocoanut. The hypertrophy may be general, affecting the whole organ symmetrically or the enlargement is confined within the capsule of the gland and may extend a considerable distance, pushing the capsule and remain only connected with the prostate by a glandular and fibrous tissue. As the internal spincter may be considered as an integral part of the prostate, hence any alteration of the structure of the latter would be followed by the interference of the function of the former. In addition, as the prostate is limited in front and below by dense fascia, it tends to grow upward and backward as it hyper- trophies, elongating and narrowing or deflecting the urethra, according to whether the enlarge- ment is symmetrical or irregular, but always raising the vesical outlet to a higher level than normal. The urine therefore left after each micturition (residual urine) settles at the bottom, causing the formation of calculi by precipitation

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and sedimentation of the mineral constituents. And an early effect of the prostatic hypertrophy is congestion and later inflammation of that portion of the mucous memhrane of the bladder in contact with the tumor. The inflammation spreads in time, aggravated by the sluggish venous return. And as the passage of the urine is reduced, the bladder can only be incompletely evacuated and a small quantity at a time by slow dribbling from the distended bladder. And in this condition, the mucous membrane offers but slight resistance to microbic invasion).

"If for a long time the urine is retained, then when an attempt is made for its evacuation, there is no micturition, or it appears but slightly. If strained, the urine appears with slight pain and in small quantities. This disease is caused by the suppression of the urine, and is called 'mutrct' Ufa* {vesical tenesmus).

**If the urine is suppressed, it causes distension ; distension vitiates ^vai/u* and provokes painful tympanites. This is called 'mutra-jathara* and this disease contracts the do-wnward channel {hypertrophy of the bladder with contraction of the cavity and obstruction of the passage).

"In the disease in which the flow of the urine ::s interfered with either at the neck of the urethra

DISEASES 277

or near the glans penis, or under tenesmus bloody urine appears with pain, or without pain it dribbles little by little, this is known as ^mutrot- sang a' {urethritis). This disease is caused by a qualified (special) 'vayu\

'*In an emaciated and tired body, 'pitta' and ^myit absorb the urine. It causes hyperemia and pain. This disease is called 'mutraksaya^ (uremia) This is very troublesome. (Uremia occurs in the course of acute or chronic nephritis, puerperal eclampsia, some cases of obstructed renal calculus, and occasionally in patients with pronounced vascular changes. The symp- toms are general malaise, nausea, vomiting, insomnia, amaurosis, mania, delirium, dyspnea, increased arterial tension. In complete uremia, the patient lives about 10 to 12 days).

"The tiny, globular and firm tumor that is formed at the interior part of the neck of the bladder, is called 'mutra—granthi (^fibroma gene- rally occurs ia the adult and is usually located single upon the base and trigonum. The size is like that of a nut. It may be sessile or predi- culated, hard or soft. The surface is lobulated and covered with normal or inflamed mucous membrane, which may or not be firmly attached to the growth. On section tlie tumor is white

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and glistening, and there may be patches of myxomatous or areas of calcification). This tumor is painful, nonulcerative and narrows

Record · ID 637421
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