Construction Of Medical Hegemony

Construction of Medical Hegemony: An Exploration into Colonial Encounters in Anatomical Knowledge in India

Jayanta Bhattacharya

How medicine has evolved since antiquity z Since antiquity the study and

practice of medicine hinges around a few ontological and epistemological questions. z (1) Ontological – what is health? What is disease and illness? 7/21/2009

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Contd. z (2) Epistemological – how to face disease

and illness? z (3) Epistemological – how to get over disease and illness? How to preserve health? z While addressing these issues questions of the human body, the environment in which human beings are enmeshed and the influence of cultural distinction come up. 7/21/2009

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Contd. z For the time being, putting aside all

other civilizations, we shall focus on two distinct paradigms of medicine and health – (a) Greco-RomanEuropean, and (b) Āyurvedic. z Both these paradigms/systems have differently dealt with the above mentioned questions. 7/21/2009

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Contd. z Modern European medicine is a

definite disjunction from the GrecoRoman lineage, occurring during the 16th-18th centuries. z Humoral theory of Greco-Roman medicine was replaced by pathological anatomy and organ localization of disease. 7/21/2009

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Contd. z In tandem, medicine made its journey from

Bedside medicine to Hospital medicine to Laboratory medicine (and, now, on to Techno-medicine). z Anatomical knowledge was the key transformatory factor. Symptoms to be verified by signs. Doctors were to extract signs from within the body. In stead of subjective symptoms truth had to come out of signs extracted by doctors. 7/21/2009

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Contd. z Vedic daiva-vyapāśraya-bhesaja  aja got

transformed into Āyurvedic yukti aja. Mode of vyapāśraya-bhesaja reasoning/understanding of disease metamorphosed - the causes of disease believed to being explained with tri-dosa  theory located inside the body. z But anatomical knowledge did not undergo any change at all in its transition from Vedic to Āyurvedic period. 7/21/2009

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Āyurveda: Expression of Indian Subjectivity z Āyurveda literally means – the knowledge

(veda) of the life span (āyus): it teaches how one may utilize the span of life apportioned by nature – traditionally taken to be a hundred years – fully and optimally. It also teaches how to behave in private as well as public life, even how to conduct one’s sexual activities. 7/21/2009

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Contd. z As such, āyurveda has to apply itself

mostly to medical matters, and thus it is justified to speak of it as ‘medicine’ provided one regards this term as an approximation and not as an exact equivalent of what one normally understands as medicine (Western medicine) today. 7/21/2009

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Contd. z Ethnographers argue that in stead of

conceiving the body as solid and bounded (as in biomedicine), Āyurveda conceives the body as fluid and penetrable, engaged in continuous interchange with the social and natural environment. z This particular characteristic perhaps forms the core of Āyurvedic/Indian subjectivity. 7/21/2009

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Body and Anatomical Knowledge in Āyurveda z

z

Scholars have found, “The interest of the Vedic Indians seems early to have been attracted to the consideration of questions connected with the anatomy of the body. [A. A. Macdonell and A. B. Keith, Vedic Index, Vol. II (London: John Murray, 1912), 358.] In a diachronic perspective, however, one may safely assume that quite a number of different body concepts were current at the time of the CS’s (Caraka-saṃhitā) composition.

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Contd. z

z

Śalya (surgery), according to Suśruta-samhita  hita), is declared to hold foremost place as it is preeminent on account of its quick action, owing to the use of sharp and blunt instruments (śastra, yantra), caustics (ksa  ra), and cautery (agni) – SS, 1.17-18. In Caraka-samhita hita (CS) – śārīram sarvathā sarvai sarvadā veda yo bhisak  ak / Ayurvedam sa kātsarnyena veda lokasukhapradam // (ŚārīraSthānam, 6.19)

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z [The physician who is always conversant

with the various aspects of the entire body, is the very person who is proficient in the āyurveda which can bring about happiness to the humankind.] z Two issues should be mentioned here. z (A) Suśruta’s marman-theory seems to be a synthesis of different and partly overlapping systematic and anatomical concepts, among which the theory of bodily constituents as the most comprehensive one became the model for marman-theory. 7/21/2009

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z (B) In Suśruta-samhit  hitā (SS) – pratyaksato  to

hi yadrs tam  anca  ca yad bhavet / tam śāstradrs t an samāsatastadubhayam bhūyo jnānavivardhnam // [The practical knowledge along with theoretical knowledge is very essential. Whatever is seen while doing practical study and going through Śāstra, adds the knowledge, when both are applied together.] (Śā, 5.48) z The place of Śāstra is too important where text becomes authority. For example, in CS, nānāryamāśrayet [Do not take recourse to anārya-s (non-Aryans). Su, 8.19] 7/21/2009

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z Moreover, it is also stressed that the vibhu

(ātman), being extremely subtle, cannot be perceived with (normal) eyes, but only by means of (the sight acquired through) spiritual knowledge (jnāna) and penace (tapas) – Sā, 5.50 [Meulenbeld, History of Indian Medical Literature, IA, 253] z It becomes evident that practical anatomical knowledge of the body is interpellated by (i) Śāstra, and (ii) spiritual knowledge. To add, since 600 AD onwards anatomical practices were in complete disuse. 7/21/2009

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Transformation of the body in European medicine z The fundamental change which European

medicine saw was symptoms (perceived within a two-dimensional body) to giving way to signs (conceived within the volume of the three-dimensional body). z Comparison between the following pictures only thirty years apart may help us to get at the issue. The 1513 Situs figure is from Peyligk’s Compendiosa capitis physici Declaratio, Leipzig. 7/21/2009

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Two-dimensional body of 1513 z

z

Five-lobed liver clutches at the stomach as if with fingers. Intestines are intertwined in an elegant knot. Traditional heartlung representation is so corrupt as to be virtually unidentifiable. Both are presented on a background of the stomach. Importantly, the localization of organs inside the body is twodimensional, all lying on the same plane. Courtesy: Leipzig: Melchior Lotter, 1499.

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Contd. z

z

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zodiac signs were also used for bodily organs. Johannes de Ketham’s Fasiculo de medicina (1493) is an example. The crab-shaped stomach lies just below throat. On the left side in Latin, “The Crab is the sign of June; avoid treating the stomach, the spleen, the lungs or the eyes.” Courtesy: National Library of Medicine, US – Historical Anatomies on the Web. 18

Three-dimensional body of 1543 z

This picture is from Andreas Vesalias’ De humani corporis fabrica libri septem (Basileae [Basel]: Ex officina Joannis Oporini, 1543), 268. Any one can

perceive the threedimensional nature of the body frame. All the lymphatic vessels are laid bare. Courtesy: National Library of Medicine, US – Historical Anatomies on the Web. 7/21/2009

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Bodily organs in Āyurveda z z

z

z

In SS (Sā, 5.11),– nakha (nails) are the terminal offshoots of the kandarā-s (tendon) of the hands and feet. Medhra (penis) is the  daya offshoot of kandarā-s which bind grivā (neck) and hrdaya (not heart, its position is indeterminate) together and run downwards. Bhāvaprakāśa differs with SS – here kandarā-s are big snāyu-s (?ligaments). While in Suśruta’s account simantas (?suture) are 14 in number, in Astā  ńgahrdaya  daya, Arunadatta and Bhoja they are 18 in number. These facts point to the contradictory and differing modes of counting organs. To add, Āyurveda does not have any single conception of the body, but a dominant one.

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Contd. z

z z

Problems arise in measurement of time, space and quantities too. Bodily constituents are measurable in ańjalis. Quantities mentioned are: ten ańjali of watery fluid (udaka), nine of rasa as a fluid resulting from the digestion of the food, eight of blood etc. According to Caraka – individual human height is 84 ańgula-s, while in Suśruta it is 120 ańgula-s. In Śārńgadhara-samhit  hitā –  amdr  drś yate rajah / jālāntaragate bhanau yat sūksam tasya trimś attamo bhāgah param  paramānuh  uh sa ucyate // (Pū, 1.15) [When the rays of sun enter through the window and the minute particles are observed thereby, the thirtieth part of that very particle may be called as an atom.]

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Contd. z In Caraka-samhit hitā, time (or, kāla) in relation

to disease-production, is described as of two types: nityaga and āvasthika. – Kālo hi nityagaścāvasthikaśca; tatrāvasthiko vikaramapeksate  ate, nityagastu rtus  tusātmyāpeksah ah // (Vi. 1.22.6) Nityaga is thought to be related with season and āvasthika is related with disease. In SS, time is perceived as both an end to life and actions going on. Quanta of time are aksnimes  nimesa  , kast ha ha, muhūrta etc.

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Contd. z

z

In Indian practice, burial of the children below the age of two years is customary. So, the scope of studying the human body was possibly limited to observing the children below two years of age (when all the bones not formed and the joints not fused properly) or the injured and wounded in wars. Taken together, these might have led to false counting of number of bones and joints. Also, in Hindu custom there remains the practice of collecting bones after cremation and immersing the body into river. Hence, osteological knowledge is well-founded but knowledge about the viscera below the diaphragm is ruefully deficient. Moreover, some vital organs like the brain and the heart are not explored and given attention at all.

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Contd. z

z

In actual practice there was most likely no real large-scale surgery. What was anatomically conceived was a body-frame (two-dimensional),  -s, dhātu-s not the real body, through which dosa and mala-s flow. The standing puzzle of Indian anatomy is the classification of śirā-s, dhamani-s and srota-s and oja. Knowledge of marman-s (lethal/vital points) – as discussed before (slide 13) – served as regional anatomy that contributed to the phenomenal excellence of Indian surgery despite their knowledge of anatomy being none too accurate or profound.

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Contd. z

z

In SS, Śā, 7.3 – sapta śiraśatāni bhavanti; yābhiridam śarīramarāma iva jalahārinī bhih kedāra iva ca kulyābhirupasnihyatehnugrhyate hyate  dibhirbiśesaih  aih / cākuńcanaprasāranā drumapatrasevanīnāmiva tāsām pratānāh, tasām nābhirmūlam, tataśca prasarantyurdhvarmastiryak ca // [There are 700 ducts. The body is irrigated by these, just like a garden by water channels, and a field by ditches…their ramifications are like veins on the leaf of a tree. Their root is the navel. From there they spread out upwards, downwards and horizontally.]

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Contd. z Dominik Wujastyk notes, “Suśrutasamhit  hitā

does not use a concept of fluid circulation, but rather works with a centripetal fluid distribution starting from the navel.” [“A Body Of

Knowledge: The Wellcome Ayurvedic Anatomical Man And His Sanskrit Context”, Asian Medicine: Tradition and Modernity 4(2008):211-248.]

z In Śārńgadhara-samhit  hitā (5.40-44) and

Suśruta-samhit  hitā (Śā, 7.3) we note that all the śira-s which are found in the human body are linked with nābhi (to note, not the Harverian heart) and there from they are spread all over the body.

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z

z

Whatever was the actual practice, we must not read back these texts with our present state of context-specific, ‘scientific’ notion of Harverian physiology or modern medical anatomy. Meulenbeld has discovered at least 8 different meanings of kloman, including the meaning of a small fleshy organ, the root of the channels carrying water. (The Mādhavanidāna, pp. 457-458) What these terms originally meant to our ancestors is but a conjecture. Following colonial epistemological encounters these terms were metonymically reconstituted to suit to the hegemonic paradigm of modern anatomy.

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z z

z

z

In Śārńgadhara-samhit  hitā –  apavanah sprist v ā nābhistha prānapavanah hrtkamal  tkamalāntaram / kanth  ād vahirviniryāti pātum visn  upad  upadāmrtam  tam // (Pū, 5.43-44) During nationalist revival, at least since 1885, visnupad  tam was translated to be oxygen. But upadāmrtam in a different translation, “The breath of life located in the navel, touches the inside of the lotus of the heart, and then exits from the throat to the outside to drink the nectar of the sky.” [Wujastyk, The Roots of Ayurveda, Penguin Books, 1998, 325.] Such was the trope of epistemological reconstitution of terms and, consequently, knowledge to make it consistent with positivist colonial scientific logic and reasoning.

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z

z

This is the first illustration employing Āyurvedic anatomical knowledge. With so many scribal errors, all the terms used here are from Bhāvaprakāśa. All the channels and viscera lying twodimensionally on a single plane. The volume of the body remains absent.

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z The previous picture is the illustration of the

Āyurvedic Man (now famous through Dominik Wujastyk). z Anatomical study of a man standing with Nepalese and Sanskrit texts showing the Ayurvedic understanding of the human anatomy. L0017592 Credit: Wellcome Library, London Pen and watercolour c. 18th Century. Iconographic Collections Library reference no.: Iconographic Collection 574912i. Courtesy: Wellcome Library, London.] 7/21/2009

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Pre- and Post-colonial Encounters z z

In Meulenbeld’s keen observations regarding Āyurveda – (1) Statements that appeared to jeopardize the tridosav  avāda caught the eye of the commentators and gave them much food for thought in their effort to avert any danger to the prevailing theory. The obvious meaning of some discordant utterances was twisted until concurring with

the system.

z

(2) Passages which were ambiguous and susceptible to various interpretations were made to conform. [contd.]

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Contd. z

z

And, more importantly, (3) a conspicuous aspect of the reasonings met with is the tendency to avoid the acceptance of any bodily constituent as a factor capable, independently of dosas, of initiating physiological and, more especially, of pathogenetic process. (Traditional South Asian Medicine 8(2008): 16-31) Following colonial encounter the Āyurvedics began to indicate physiological phenomena cartographically which was never present in centuries-old Āyurvedic practice.

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z The “modern” Āyurvedics began to copy

anatomical diagrams to be found in English handbooks, replacing the English captions with Sanskrit names. z The revival of Āyurveda thus led to the construction of a unitary and coherent model of Indian medicine, weaned from inconsistencies and untenable concepts. z The ancient terms for patho-physiological processes etc. were diligently re-interpreted to bring them in line with terms derived from Western medicine. 7/21/2009

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“Modern” Āyurvedic pictures following colonial encounter in anatomy

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z

z z

z

Picture on left is from Āyurveda Samgraha  graha, revised by Kaviraj D. N Sengupta and Kaviraj U. N Sengupta (Calcutta: C. K. Sen, 1902, 18.). Picture on right is from the same book, p. 88. In the first picture internal details of the brain, which was a completely unexplored area in classical Āyurveda, are illustrated. In the second one authors dare to give accurate details of the internal ear which is inconceivable in classical texts. In Āyurveda, position and function of hrdaya  daya (not the post-Harverian heart as discussed before) is undefined, more so of the brain, and better not to speak of the internal ear, inconceivable to the wildest guess of the ancient healers .

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Concluding Remarks z Construction of medical hegemony occurred

through multiple processes – very intricate, intersecting and insidious ones. Some of these processes can be understood, more are in need of better grasp. z Polysemous, context-sensitive speculative anatomo-patho-physiological and nosological terms of Āyurveda were metonymically reconstituted by circumscribed, context-neutral and universalized scientific terms. 7/21/2009

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z Mnemonic verses for organ description were

replaced by anatomical atlases and practical dissection. z Organ localization of disease gave birth to surgical excellence which, in the truest sense, resulted in marvelous “speedy efficacy” as avowed by Suśruta (Slide 12). z Consequently, prognosis-dependent slow Āyurvedic recovery turned out to be inefectual. 7/21/2009

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z

z

Emergence of secular social hierarchy in a positivist, utilitarian milieu generated (a) awe for new clock-time-based social system, (b) victory of scientific and technical education, and (c) a perpetual sense of “lack” with respect to the ladder of civilization. Reconstruction of time-space perception > individual patients (cases, not person per se) in hospital (not domestic) setting > production of clinical charts consistent with scientific temporal swings (not seasonal rhythms) occurring inside the body > postmortem dissection to clinch organ localization of disease.

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z

z

z

On their behalf, Āyurvedics were caught within a two-edged sword. On the one hand, Āyurveda was concerned more with prognosis which could be efficiently resolved by tri-dosa theory without having any knowledge of actual anatomy of internal organs. Anatomical knowledge and surgery were relegated to the lower castes of society. High caste Āyurvedic practitioners were content with philosophy, theory and herbo-chemical knowledge and practice of Āyurveda. On the other, if Āyurveda were to be established as a valid and eternally “modern” repository of knowledge of the body, health and healing, learning of modern anatomy became mandatory for the high caste Āyurvedics.

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z Printing

technology rendered manuscript culture of precolonial India marginal. “Mimicry” and “hybridiz-ation” of modern” Āyurveda. 7/21/2009

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Au Revoir 7/21/2009

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