Talk:Hospitals and Equipments of Ancient Times

Hospitals and Equipments

One of the greatest fictions of modern times is the belief that the institution of hospital is a gift of the modern civilization. This fiction is the result of gross ignorance of the history of ancient institutions and neglect of the study of Indo-Aryan culture. A researcher in the history of ancient institutions would soon find from the study of the historical reference sources. There are ample proofs of the existence and development of hospitals in the Puranas, medical works, inscriptions and foreign travelers memoirs.

As per Nandi Purana

In the Nandi Purana we find the following reference: Good health is the means of acquiring religious merit, wealth, pleasure and spiritual emancipation and hence the man who cures the sick and endows a hospital fully equipped with good medicaments, dressing material, learned physicians, servants and dwelling space gain the best results. The physician should be well versed in the science, experienced, familiar with the actions of drugs, expert in the knowledge of the color of the roots of herb and well acquainted with the proper season to cull them from the ground. He should be well versed in the qualities of the juices, their strength and actions of Sail rice, meat and medicaments, trained in compounding medicines, expert in intelligent penetration into the secret of a man's constitution, learned in the knowledge of body-elements, dietetics and pathology. He should be well versed in the understanding of the premonitory symptoms and in after-treatment, proficient in the knowledge of time and place, well read in the medical text books of Ayurveda in all the eight divisions and an expert in Posology are the furthermore qualities required for the same.

It further describes the merits accruing from establishing a hospital in the following verses: The pious man who makes such a hospital in which the services of a good physician of this nature are retained and thus establishes a charitable institution, in which the good physician cures every single patient of his maladies through the medicines, oleaginous remedies and compounds of the medicinal decoctions. It is believed that these merits follow even after the death taking him to Brahma's residence along with his seven generations of the ancestors. Any person that cures the sick by the use of roots or by massage and other methods, reaches these eternal realms mentioned above. He who cures the sick suffering from discordance of the three Dosas like the Vata, Pitta and Kapha by simple remedies goes to such blessed regions after death which are are secured by those who performed many religious sacrifices.

As per Skanda Purana

We find the similar references in Skandapurana. The philosophical merits assigned to the person building a good hospital, equipped with all the necessary elements beginning with eminent physicians, include attaining religious merits, wealth, pleasure and spiritual emancipation.

By curing learned man of his sickness such merit is acquired which is eternal and indestructible. Whatever merit can be obtained by supporting the ailing Brahmans, Ksatriyas, Vits and Sudras cannot be obtained by the performances of all the great Yajnas. As even the gods cannot reach the end of the firmament, likewise is there no end to the merit accruing from the gift of healing.

By this merit, it is believed that one attains liberation. Along with his twenty one generation of ancestors he stays in Siva's realm until the great destruction at the end of the cycle. Thereafter by the residual part of his merit and by his devoted service to Rudra, he acquires knowledge of truth.

Renouncing this world as a result of knowledge and dedicating herself to the worship of Siva and casting away this body sorrows, he reaches beyond the limits of sorrows. Being freed from all and becoming pure, all knowing and self-sufficient and absorbed in his own self, he is called the liberated one. Therefore for the sake of heaven as well as liberation, the sick should be well nursed and treated.

The great sages given to Yoga should be especially attended to even at the cost of one's life and riches. The wise must never cause annoyance to the weak patients but should be attended to like one's own preceptor. This is the path of virtue. He who knows himself to be well-circumstanced in life should relieve the sick by taking them under this care.

Religious Merits of Constructing Hospital

Construction of or an endowment for a hospital was considered to be an act of great merit as is evinced by the following quotations.

As per Viswamitra

Viswamitra says here: There does not exist a gift greater than the gift of health, hence one should attempt to give health to the ailing for the attainment of one's own welfare. One who gives to the patient medicine, wholesome articles, meals, oil massage and consolation is ever free from the clutches of any disease.

As per Samvarta

Samvarta says: One who gives medicine, oil and meals for the cure of the patient is himself ever free from any disease and is happy and long-lived.

As per Agastya

Agastya says: Those who give meals and medicine live happily and without disease. All the above three references are cited by Hemadri and they go to prove the early development of hospitals. The earliest medical and surgical works like Susruta abound in references to the hospitals.

As per Asoka

The edict No II of Asoka shows that charitable institutions were common during his reign. The edict runs as follows:

Everywhere in the kingdom of the king Piyadasi, beloved of the gods, and also of the nations who live in the frontiers such as the Cholas, the Pandyas, the realms of Satyaputra and Keralaputia, as far as Tambapani and in the kingdom of Antiochus, king of the Greeks and of the kings who are his neighbors, everywhere the king Piyadasi, beloved of the gods, has provided hospitals of two sorts: hospitals for men and hospitals for animals.

Wherever plants, roots and fruits useful either for men or for animals were wanted they have been imported and planted.

Foreign Travelers

Descriptions of Chinese travelers who toured India in the 5th and 7th centuries fully corroborate the fact of hospitals being an established institution in India of those days. Fa hien who was a contemporary of Chandragupta Vikramaditya describes the charitable dispensaries of Pataliputra.

The nobles and householders of this country have founded hospitals within the city to which the poor of all countries, the destitute, the cripple and the diseased may repair. They receive every kind of requisite help gratuitously. Physicians inspect their diseases and according to their cases order them food and drink and medicines or decoctions, everything in fact that may contribute to their ease. On being cured, they depart at their convenience.

Vincent smith remarks:

No such foundation was to be seen elsewhere in the world at this date, and its existence anticipating the deeds of modern Christian charity speaks well both for the character of the citizens who endowed it and for the genius of the great Asoka whose teaching bore such wholesome fruit many centuries after his decease. The earliest hospital in Europe, the Maison Dieu of Paris, is said to have been opened in the 7th century.

Donations by Sovereigns

Upatisso, Son of Buddha Das, built hospitals for cripples, for pregnant women and for the blind and diseased. Dhatushera built hospitals for cripples and sick. Buddha Das himself ordained a physician, for every ten villages on the high road and built assylums for the crippled, deformed and destitutes.

We learn from Huen Tsang's account that Siladitya II was inclined towards Buddhism and in all the high ways of the towns and villages throughout the country, he created hospitals, provided with food and drink and stationed there physicians with medicines for travelers and poor persons round about, to be given without any stint.

Speaking of the father of Bikkhu Srutavimsatikoli, Huen Tsang says, from his house to the snowy mountains, he had established a succession of rest-houses from which his servants continually went from one to the others. Whatever valuable medicines were wanted they communicated the same to each other in order and so procured them without loss of time, so rich was the family.

Ceylonese records furnish a lot of information in how the kings took up the erection and maintenance of hospitals as their chief duty. From Mahavansa we gather that in 437 B. C. King Pandukabhya constructed a residence for the Ajivakas, a hall for the worshipers of Brahma, of Siva as well as a hospital.

King named ParakkamaBahu built further a large hall that could contain many hundreds of sick persons and provided with all things, that were needful as stated underneath. To every sick person he allowed a male and a female servant that they might minister to him by day and by night and furnish him with the physic that was necessary and with diverse kinds of foods. He also built many store houses therein, filled with grain and other things needful for medicine. He also made the provision for the maintenance of wise and learned physicians who were versed in all knowledge and skilled in searching out the nature of disease.

And he took care to discern the different wants of the sick, and caused the physicians to minister to them, as seemed necessary both the day and night. And it was his custom, on the four sabbaths of every month, to cast off his king's robes and after that he had solemnly undertaken to observe the precepts, to purify himself and put him on a clean garment, and visit that hall together with his ministers. And being endowed with a heart full of kindness, he would look at the sick with an eye of pity, and being eminent in wisdom and skilled in the art of healing, he would call before him the physicians that were employed there and inquire fully of the manner of their treatment. And if so be that it happened that the treatment that they had pursued was wrong the king who was the best of teachers, would point out wherein they had erred, and giving reasons therefor would make clear to them the course that they should have pursued according to science. Also, to some sick persons he would give physic with his own hands. In this manner indeed this merciful king free from diseases would himself cure the sick of their diverse diseases from year to year.

Punyasalas

In the accounts there is a mention of charitable institutions called 'Punyasalas'. Formerly there were many charity houses for keeping the poor and the unfortunate. They provided medicines, food, clothing and necessities for the travelers for their comfort. Benevolent kings have founded a house of mercy with funds for procuring food and medicines, to bestow the charity on widows, bereaved persons, orphans and the destitute. A similar Punyasala or hospital was in K-ei-p-an-to.

Contribution to the Punyasalas

A king named Dappula III of 827 A.D. was a man of great compassion. He built a hospital for the city of Pullatthi and another at Pandaviya with a fruitful village attached thereto. He built hospitals for the blind and people to halt in diverse places.

A king named Kassappi. built a house for the sick on the western side of the city and gave alms of gruel and other victuals for the destitute. King Sena furnished all the hospitals with the medicines and beds. He even arranged for the rice to be given to the captives of the prison.

Hospitals in Chola Age

In one of the temple inscriptions of the Chola period, we find a detailed description of a hospital. Besides the several references to the hospitals in the Gupta period we get the following reference dating 600 years after the period. Veer Rajendra Deva of the Cholas issued a commandment in 1067 A D which is inscribed on the walls of the inner sanctuary of the temple of Venkateshwar at Tirumakudal in the district of Chingleput. He used to give all the expenses of the festivals of the deity along with school and hospital for the students.

The hospital was named Shree Veer Choleshwar Hospital. It contained 15 beds. There were physician, surgeon, two male and two female nurses, one servant, one gate-keeper, washerman and potter. Their salaries were also fixed. A person named Kodam Ramash- watham Bhattar was the physician. He was given his remuneration in kind. The remuneration was fixed for the surgeon, nurses and others. The male nurses duty was to bring herbs and firewood and to prepare medicines. The duty of female nurses was to administer the doses, feed the patients and do the necessary cooking. The washerman's duty was to wash the clothes of the patients and the potters duty was to prepare the necessary pottery for the hospital. The quantity of oil required to light the lamps at night was also fixed. Besides this set-up, there are instructions about special preparations also.

A later inscription dated 1262 A. D is found on stone-pillar of Malakapur in the Andhra country. It contains references to Kakatiya queen Rudramma and her father Ganapati's preceptor Vishweshwara's activities. This Vishweshwara was a Saivite preceptor of Gaud Desha and the inscription informs us that several villages to the south of the Krishna were donated to him by Kakatiya Ganapati and Rudramma. The income accrued from these villages was divided into three parts and Vishweshwara ear-marked one-third of it for maternity home, one-third for a hospital and the remaining for a school. It is not definitely known whether this maternity home and the hospital were built by Vishweshwara or his predecessors but they were linked with the local Siva temple.

Clothes

The patient should be always clean, with close-clipped finger nails. He should wear white raiment and should be devoted to the auspicious rites of Santi and Mangala and honoring the gods, the Brahmanas and the elders.  

Mental Hospitals

Mental hospital patients are feared by the means of snakes whose fangs have been removed or by trained Hons and elephants or by men dressed as bandits with weapons in their hands. The patient is scourged with light whips and left well-secured with ropes in solitary confinement. With the help of the drastic measures, the disorientated mind of the man is restored to normality. If the patient continues to behave in an irresponsible manner then he is tied with soft but strong bandages and put in a dark room free from metallic and wooden articles otherwise he would harm himself with these.

Military Hospitals

The Physician's fully equipped tent is in a big encampment just after the tent of the king. The persons afflicted with poison, darts and disease approach him there as it is very well differentiated by his flag. The physician who is an adept in his art and conversant with other sciences is honored by the king and experts.

Obstetrics Hospital

Architecture

Before the commencement of the ninth month, the physician should prepare a labor room on a site which is free from bones, sand and broken bits of earthen vessels. The soil of that place should be excellent with regards to color, taste and savor. The labor ward must be eight cubits long and four cubits broad and attractively built, with the entrance facing the east or the north. The brahmans who are the followers of Atharvaveda recommends the presence of wood of bael, false mangosteen, putramjiva, marking nut, three leaved caper or catechu.

The room should be well-built, well-plastered and well-furnished with doors and windows in accordance with the principles of architecture. there should be arrangements for a fire-place, water-storage, pounding, lavatory, bath-room and kitchen. The room elevation should make it comfortable in each and every season. It should be excellent, beautiful, well-lighted, sheltered from draught, well ventilated, strong, free from pests, animals, fanged creatures, mice and moths. It should be well-planned with regards to the places of water-storage, grinding, lavatory, bath and cooking. Moreover the rites connected with protecting the house from the influence of evil spirits. The house should be filled with clean and experienced physicians those attached to the family.

Obstetric Houses for Queens

The hospitals where princes and princess took birth should also have the following quality:

• High roofed and commodius
• Built in three concentric courts
• Furnished with narrow ventilator
• Thick walled
• Congenial in all weathers
• Well lighted
• Pleasing to the mind
• Noise proof
• Untenanted by women
• Equipped with all the requisite appurtenaces
• Expert physicians
• Medicines
• Brahmanas ready at call

Utility

The ward must be equipped with beds that are free from discomfort and well spread with a cloth and with its head towards the east and with instruments kept ready. It should be provided with beds, seats and spreads suited to each season. The surgical patient feels comfortable in his movements if the bed is well made and spread with a cloth. The gods have their dwelling in the east and hence his head should lie towards the east as a sign of obeisance. There the utmost care of the patient is taken under the care of attendants and the friends who are amiable and pleasant-spoken. The following articles should be kept there completely accessible:

• Ghee
• Honey
• Rock-salt
• Black and bid salts
• Embelia
• Costus
• Deodar
• Ginger
• Long pepper along with the roots
• Elephant pepper
• Indian penny wort
• Cardamoms
• Glory lily
• Sweet flag
• Piper chaba
• White-flowered lead-wort
• Asafetida
• Rape seed
• Garlic
• Clearing nut
• Kana
• Kanikaa
• Cadamba
• Linseed
• Balvaja
• Birch
• Black gram
• Maireya
• Sura wines
• Two grinding stones
• Two heavy pestles
• Two wooden mortars
• Untamed bull
• Two gold or silver cases for keeping sharp needles
• Sharp metallic instruments
• Two bed-steads made of bael wood
• Faggots of false mangosteens
• Zachum oil plauts for kindling fire

Obstetric Attendants

The female attendants should be numerous. They should be mother of children, sympathetic, constantly affectionate, agreeable behavior, resourceful, naturally kind-hearted, cheerful and tolerant of hardships. Their finger-nails should be clipped close. There should also be present Brahmanas who are knowers of the Atharvaveda. The patient should be attended by four women who are trustworthy, expert in obstetrics, well disposed, aged.

Other Significances

The building too was constructed under the supervision of expert structural engineers who were clever at the arrangement and division of apartments. Although the original conception of hospital construction was of an aristocratic type which was modified according to the present day needs. A striking feature in this picture of ancient hospital is the seasonal consideration. Arrangements were made so as to keep the rooms cool in summer and warm in the cold season. The methods employed then may seem crude to the world accustomed to air-conditioning, but they were the rudiments of ideal construction and the indigenous ways of achieving the desired result which astonish us. There were special places for the voidance of urine and feces and bathrooms were provided. The standard of cleanliness was very high.

In a ward built in this manner which is auspicious, clean and protected from the sun and the wind, one is free from diseases - psychic or somatic or diseases caused by external factors. The patient should be always clean, with close clipped finger nails, wearing white raiment and devoted to the auspicious rites of Santi and Mangala and to honoring the gods, the Brahmanas and elders. The hospitals were primarily meant for the diseased need not be reiterated, but some departments of the general hospitals or hospitals specializing in certain branches, like purgatorrams were frequented by healthy persons also thrice a year to undergo the course of purgative, revirilification and rejuvenation. Therein, in the retreat constructed, which is cleansed with the purification measures and on having regained the normal strength, the patient should undergo the vitalization procedure.

Surgical Hospitals

Architecture

One suffering from wounds should be first taken to the surgical ward and that ward should be built according to the rules of the architectural science. In a ward built according to the nomenclatures of architecture which is auspicious, clean and protected from the sun and the wind, one is free from diseases - psychic, somatic or diseases caused by external factors.

The expert architect should first design a good house which is strong and is warding off the wind except on one side, affording comfortable moving space, not surrounded by high places, not penetrable to smoke, heat, moisture, dust and to undesirable noise, contact, taste, sights and odor and is furnished with a water-storage room, pharmacy room, latrine, bath room and kitchen.

Apparatuses

The physician who is performing any surgical operations should be ready beforehand the following appurtenances viz, appliances, instruments, caustic alkalies, fire, probes, horns, leeches, sucking gourd, Jambavaustha, swabs, suturing thread, leaves, bandages, honey, ghee, fat, milk, oil, soothing lotions, ointment, paste, fan, cold and hot water, basin etc.

Attendants

The attendants or nurses who are affectionate, steadfast and strong are appointed. They even should be well-versed in singing, playing musical instruments, panegyrics, verses, stories, legends, modern history, mythology, quick in understanding, approved character, as well as who are versed in the knowledge of clime and season and who are the good members of society.

Other Significances

The fever-patient afflicted with a sensation of burning should lie down at ease in a specially constructed water-cooled chamber or an apartment cooled by frequent spraying of ice-cold water or cold sandal-water. Apartments have an arrangement for shower bath, cold underground chambers, pleasantly smelling woods cooled by moist breezes, use of vessels inlaid with azure and finally the pearls and precious stones made cool by putting cold water in them.

By the warmth of the bed and the blanket and the intensity of happiness and cheer due to the interior of the apartments, alcoholism of the Vata-type gets subdued effectively. The rumblings of thunder alleviate the effects of intoxication. Various devices of showering water and blowing breezes and the rooms equipped with cascades, should be devised by the physician for the cure of burning due to alcoholism. The body should be painted with perfumed cherry, cuscus grass, lodh, fragrant sticky mallow, fragrant poon, cinnamon leaves and nut-grass.

Room Decoration

The patient should stay keeping himself constantly vigilant, surrounded by men and in a house adorned with lamps, water pots, instruments (arms), flower garlands, loose flowers and roasted paddy and he should engage himself in listening to attractive, auspicious and cheering stories. Great care was taken in prescribing the diet. Weekly regimen containing the items of each meal was carefully prescribed. The convalescence stage was given great importance and the process of rehabilitation was carefully undergone. physicians, with a progressive spirit and selfless devotion to alleviating the miseries of the suffering mankind were engaged. The construction of a hospital was considered to be an act bestowing great merit on the donor. We find that some hospitals were so huge as to admit hundreds of patients.

The standard of medical attainment required in the doctors was very high and day and night attendance was provided for the patients. The standard of cleanliness was so high that even visitors were required to put on a clean garment while entering the hospital. Kings took great interest in the inspection of hospitals, and personal talk with the patients four times a month was a matter of his routine.

From Mahavansa we gather that villages were endowed for the maintenance and efficient running of the hospital and its staff. The hospitals were not only the refuge of the diseased alone. Pregnant women, blind, invalid and aged persons also were looked after in the hospitals.

The high degree of specialization in hospital work, the special features like refrigeration and other amenities of hospital life, the absence of caste distinction, the greater emphasis on prevention, the scrupulous and fastidious observance of cleanliness, the size of the institutions, the quality of the personnel employed, day and night attendance, efficient management and maintenance, all these really astonish us and make us think with admiration of those days when India gave the lead to the world in all those aspects of civilization which we are often erroneously led to ascribe to the West and to the modern age.

References

• The Caraka Samhita published by Shree Gulabkunverba Ayurvedic Society, Jamnagar, India