The list of the commonly employed hygienic measures is too long for reproduction in its entirety in this brief sketch, but an enumeration of some of the more important items may prove interesting. In estimating the value of these rules the reader should bear in mind that they were intended for people living in a hot climate. Daily bathing heads the list. Then follow: regulation of the bowels; rubbing the teeth with fresh twigs of certain trees which possess astringent properties, and also brushing them twice a day; rinsing the mouth with appropriate washes; rubbing the eyes with salves; anointing the body with perfumed oils; cutting the nails every five days, etc. Two meals a day were prescribed—the first one between nine in the morning and noon, and the second between seven and ten in the evening. “Only a moderate amount of water should be drunk during the meal; drinking water at the beginning of a meal delays digestion, while a copious draught at the end produces obesity. After the meal the mouth should be carefully cleansed and a short walk should be taken.” Among the more important articles of food the following deserve to be mentioned: rice, ripe fruit, the ordinary vegetables, ginger, garlic, salt, milk, oil, melted butter, honey and sugar cane. If meat is eaten, preference should be given to venison, wild fowl and the flesh of the buffalo. The meat of the pig, and beef, as well as fish, are less conducive to health. Gymnastic exercises in moderation are beneficial. Sleep should be indulged in during the day only after some specially severe exercise; at night it should not be extended beyond one hour before sunrise. Bathing immediately after eating is harmful, and it is not to be indulged in when one is affected with a cold, with a high fever, with diarrhoea, or with some disease of the eyes or ears. A hot bath or washing with warm water may be beneficial for the lower half of the body, but for the upper half it is harmful. Sea bathing and cold baths (preferably in the river Ganges) are beneficial. The clothing worn should be clean; soiled garments are likely to produce skin diseases. It is advisable to wear shoes, and an umbrella or a staff should be carried. The wearing of garlands, finery, and jewels increases the vital powers and keeps away evil spirits. The following are good measures to adopt for the preservation of health: an emetic once a week; a laxative once a month; and a bloodletting twice a year. All the measures enumerated above were subject to modification according to changes in the season, the locality, the weather, and various other circumstances.
In harmony with the extraordinary fruitfulness of the land the pharmacopoeia of India is very rich. It is a remarkable fact that not one of the numerous drugs mentioned in the official list is of European origin. The great majority of them belong to the vegetable kingdom; Caraka stating that he knew of 500 plants that possessed remedial virtues, while Súsruta placed the number at 760. Then, too, the list contains a goodly number of drugs which belong, some to the animal and others to the mineral kingdom. It appears that the physicians of India began using mineral substances, both externally and internally, at a very early period of their history. Among such substances the following may be mentioned: sulphate of copper, sulphate of iron, sulphate of lead, oxide of lead, sulphur, arsenic, borax, alum, potash, chloride of ammonium, gold, precious stones of different kinds, etc. The people of India were skilled in chemical and pharmaceutical work. The drugs were prepared by them in a great variety of ways—as, for instance, extracts of the juices of plants, infusions, decoctions, electuaries, mixtures, syrups, pills, pastes, powders, suppositories, collyria, salves, etc. Practicing physicians carried with them a sort of portable medicine chest, and they often collected, themselves, the medicinal plants which they required. Súsruta gives instructions as to the spots where certain plants are most likely to be found, and as to the seasons when they should be gathered. Charlatanry and mysticism often played a part in this business. Thus, it was maintained that drugs collected and prepared by persons other than physicians did not produce the desired effects. The fact that cosmetics (especially hair dyes), “elixirs of life,” aphrodisiacs, poisons and antidotes for poisons, occupy the most prominent place in the list of pharmaceutic preparations sold, casts a glaring ray of light, as Neuburger states, on the degree of culture among the people of ancient India.
The list of separate maladies recognized by the physicians of the latter country is inordinately long. There were 26 kinds of fevers, 13 species of swellings of the lower abdomen, 20 different diseases due to worms, 20 kinds of urinary diseases, 8 varieties of strangury, 5 kinds of jaundice, 5 varieties of cough or asthma, 18 kinds of “leprosy,” 6 kinds of abscesses, 76 different eye diseases, 28 affections of the ear, 65 disorders of the mouth, 31 nasal affections, 18 diseases of the throat, a large number of mental disorders, etc. It seems scarcely necessary to remark that these so-called diseases were in reality only groups of certain types of loosely related symptoms. The term “leprosy,” for example, included, besides the disease which modern physicians call by that name, a number of different affections of the skin. It is worth noting here that diabetes mellitus, which is one of the twenty different kinds of urinary diseases enumerated in the classified list mentioned above, was first described by the physicians of India, whose attention was directed to the disorder by observing that flies and other insects were attracted to the urine of these patients by reason of its sweetness. It is also an interesting fact that occasionally these physicians, who, beyond a doubt, were keen observers of symptoms, paid some attention to the anatomical features of the individual cases. Thus, it is stated that the particular form of swelling of the lower abdomen, to which they applied the name “splenic belly,” is dependent upon “an enlarged spleen which distends the left side, is as hard as a stone, and is arched like the back of a turtle”; whereas they spoke of “an enlargement of the liver” when very much the same conditions were observed on the right side of the abdomen. The accuracy of their clinical observations is particularly noticeable in their accounts of cases of consumption, apoplexy, epilepsy, hemicrania, tetanus, rheumatism, venereal diseases, some affections of the skin, and insanity. It was in their surgical technique, however, that the physicians of ancient India were distinguished above all their brethren of the neighboring oriental countries, and this superiority they maintained for a very long time. Among the operations which they performed the following may be mentioned: they removed tumors by excising them, they opened abscesses by the use of the knife, they employed scarifications (in inflammations of the throat) and made punctures (in hydrocele and ascites), they passed probes into fistulae, they extracted foreign bodies, and they employed needles armed with hairs taken from the horsed tail or with thread composed of flax or hemp. According to Súsruta their stock of instruments was composed of 101 blunt and 20 cutting instruments. Among those which were blunt there were forceps of different sizes and forms, hooks, tubes, probes or sounds, catheters, bougies, etc. They made use of the magnet for drawing out foreign bodies of iron, and they applied cups for therapeutic purposes. Their cutting instruments consisted of knives, bistouris, lancets, scissors, trochars, needles, etc. Steel was the metal of which they were made; for the people of India learned at a very early period how to make steel. In suitable cases cauterization, either with the actual cautery or with caustic potash, was a favorite method of treatment with the surgeons of ancient India. “Burning with the heated iron,” they taught, “is more effective than cauterization with potash, inasmuch as it permanently cures diseases which may not be cured by either drugs, surgical instruments, or chemical cauterizing agents.” In cases of enlargement of the spleen they plunged red-hot needles into the parenchyma of the organ, presumably through the skin and other overlying tissues. There were fourteen different kinds of surgical dressings; cotton, woolen, linen and silk being the materials used for bandages, and strips of bamboo or some other wood for splints. When the conditions permitted such a proceeding, it was customary to sew up wounds of the head, face and windpipe. Furthermore, it was the rule to perform all surgical operations at a time when the constellations were favorable. Religious ceremonies were performed both before the operation and after it was completed, and it was also considered necessary that the operator should face the west and the patient the east. Intoxication was employed as a means of securing narcosis. Owing to their scrupulous cleanliness and the minute attention which they paid to details, the surgeons of ancient India obtained for a long time a much higher degree of success than did the surgeons of other oriental nations. At the same time they were not lacking in that degree of boldness which enables an operator—in critical cases which probably without such prompt and radical action would terminate fatally—to save life. For example, they did not hesitate to open the abdominal cavity and to sew up a wound in the intestines; they cut for stone in the bladder, employing for this purpose the lateral method of operating; and they performed a great variety of plastic operations.
Some of their hygienic rules concerning pregnant and nursing women are eminently practical; others would hardly be approved by modern accoucheurs. Here are a few of these rules: During the period of a woman’s pregnancy close attention should be paid to her diet, and special care should be exercised by her to avoid excesses or errors of any kind. When the ninth month is reached she should take up her abode in the small cottage in which she is eventually to be confined—a building erected with special religious ceremonies and thoroughly fitted with everything that is likely to conduce to her comfort. At the time of the actual confinement she should have with her four female assistants, and all those measures, of either a religious or a practical character, which have in view the hastening of the birth of the infant, should be scrupulously carried out. If any delay in the delivery of the after-birth occurs, the removal of the mass may be promoted by the employment of well-directed pressure over the lower part of the abdomen, by shaking the body, and also, if necessary, by giving an emetic. The woman in childbed should not be allowed to get up before the tenth day after her confinement, and for a period of six weeks her diet should be most carefully watched. On the third day the child should be put to the mother’s breast; up to that time it should be given only honey and butter. If the mother, for any reason, is not able to suckle the infant, a wet-nurse should be employed for the purpose, but not until the physician shall have subjected her to a most thorough examination and shall have instructed her minutely in regard to her own diet. The subsequent care of the child was provided for in the most particular manner: It was restricted to a carefully planned diet; it was not allowed to sit or to lie except in certain prescribed positions; its times for sleeping were strictly ordered; it was permitted to amuse itself only in certain ways;—in brief, everything was done according to strict rules, even special precautions being taken to guard the child, during the first years of life, against dangerous demons. Weaning began after the sixth month, and for a certain length of time the child was fed largely on rice. In cases of difficult labor and in their gynaecological practice the physicians of ancient India did not manifest any special knowledge or skill.
One of the instructions given to young physicians in India when they were about to enter upon the practice of their profession, may be of interest to the reader. It is worded as follows: “Let thy hair and finger-nails be cut short, keep thy body clean, put on white garments, wear shoes on thy feet, and carry a staff or umbrella in thy hand. Thy demeanor should be humble, and thy heart pure and free from deceitfulness.” The following proverb, although it originated in India, is well worthy of acceptance in every part of the world: “When you are ill the physician will be to you a father; when you have recovered from your illness you will find him a friend; and when your health is fully re-established he will act as your protector.”
On a previous page the statement has been made that the science and art of medicine developed in ancient Greece quite independently of any influence that might have been exerted by the teachings of the physicians of India. This statement should be somewhat modified, for it is reasonable to suppose, although directly confirmatory evidence has not yet been discovered, that, through the channels of trade between the two countries, some knowledge of the doings of the physicians of India must have reached the ears of their Greek brethren. On the other hand, at a later period of history (after Alexander the Great had invaded India), the relations between the two countries became quite close and were kept up without a break for several hundred years. During the earlier part of this later period, as appears from the writings of Hippocrates, Dioscorides and Galen, various drugs and methods of treatment employed by the physicians of India were adopted by the practitioners of Greece.
Medicine of the Chinese and Japanese.—The isolation of China with respect to those countries which were within comparatively easy reach and in which there was a civilization that, already several thousand years before the Christian era, had attained a remarkable degree of development (India, Babylonia and Egypt, for example); her blind belief in authority; her unwillingness to tolerate any influences that seemed to emanate from foreigners; and her complete satisfaction with her own methods of doing things, with her own beliefs, and with her own natural and manufactured products,—these, it is generally believed, were the most important factors in keeping this remarkable nation in a state of immobility as regards at least some departments of human knowledge and accomplishment. This is particularly true in respect of the science and art of medicine. But China is at last waking up from this lethargic state. A wonderful change has come over her during the past twenty or thirty years, and she is now beginning to realize that, with her millions of population and wonderful natural resources, she has an important part to play in advancing the civilization of the world.
The preceding remarks must not be interpreted as signifying that, during the long ages of the past, China has not been developing and is not able at the present time to show a record of very creditable work accomplished in many departments of human activity. In her early history, many centuries ago, she accomplished great things, and all—so far as we now know—without aid from neighboring nations; but there came a time when all this creative activity ceased, and then, for long periods of years, she appeared to rest satisfied with the advances which she had already made, and to have no further ambition to add to the stock of her possessions.
Among the valuable things which should be credited to the Chinese are the following: the discovery of the compass (about 1100 B. C.), the making of porcelain, the invention of printing, the raising of silkworms, the manufacture of glass and of paper, the successful dyeing with purple, embroidering with gold, working in metals, the artistic cutting of precious stones, enameling, the making of “India ink,” etc. Furthermore, it is a fact most creditable to the Chinese that in no other country in the world have scholars been held in such high esteem, or assigned so high a rank, as they have been and still are in China.
Chinese medicine possesses a very rich literature. The first medical treatise, which deals with plants that possess medicinal virtues, is ascribed to the Emperor Schin-Nung, who flourished about 2800 B. C. This is the monarch who taught his people from which springs they should drink, and who tested all the plants of his vast empire with reference to their healing properties. According to the legend the wall of his stomach was so thin that he could look through it and see everything that was going on in the interior of that organ. In this way he was able to carry on a large series of experiments upon himself in regard to the action of different poisons and their antidotes. It is also related that medical knowledge was still further advanced by the yellow Emperor Hoang-Ti who lived about 2650 B. C., and who is credited by the Chinese with having invented arithmetic and music. The treatise called “Noi-King,” which deals with the subject of internal diseases and gives a systematic account of human anatomy, is also credited by the Chinese to this monarch; but Neuburger maintains that this book, which is still in common use in China, is of much more recent origin. There are several other medical treatises which deserve to be mentioned. Such, for example, are the following: the celebrated book on the pulse, written by Wang-Schu-Scho in the third century B. C.; two very important books written by Cho-Chiyu-Kei—one bearing the title “Schang-Han-Lun” (On Fevers) and the other that of “Kin-Kwéi” (Golden Casket);—the different treatises written by Tschang-Ki (tenth century A. D.) and published in the collection called “The Golden Mirror of the Forefathers in Medicine” (I-Tsung-Kin-Kien); and, finally, the very popular modern work (in forty volumes) entitled “The Trustworthy Guide in the Science and Art of Medicine” (“Ching-Che-Chun-Ching”). Of these forty volumes, seven are devoted to nosology, eight to pharmacy, five to pathology, six to surgery, and the remainder to children’s and women’s diseases.