Talk:Nursing in Ancient Times

Foundation of Medicine

The quality of mercy is doubly blessed. It blesses the person who gives mercy and also the one on whom mercy is shown. Mercy is the younger sister of sympathy being born of the humane spirit. The objective search for the origin of medicine may lead us to Hippocrates or Atreya, but the subjective search for the origin of medicine leads us to the subtle spirit of mercy or sympathy. It is the main source of inspiration and the origin of the medical science.

Dr. Payne, the well-known American Historian has said, "The basis of medicine is sympathy and the desire to help others, and whatever is done with this end, is called medicine". Caraka and Susruta, the greatest medical works of ancient times, have an unequivocal term ascribed to the origin of medical science to this universal spirit of mercy and love.

Remarkably, the birth of the Buddha coincided with the height of the intellectual development of the country. The age between B. C. 600 to 200 A. D. was the time when scientific medicine evolved and took a definite shape. It was Buddha who extended the benefits of scientific medicine to humanity at large, motivated by the spirit of compassion. Later the spirit of Buddha was taken up by Christ Buddhism and Christianity. These are the two principal religions that turned prosaic scientific knowledge into one of practical utility and universal welfare by infusing in it the divine quality of compassion.

Composition of a Body

The human being is a conglomeration of varied factors such as body, mind, and spirit. The body is the material that is visible and can be examined. The mind can be inferred by its actions while the soul is yet in the field of speculation. The diverse natures of these component factors that constitute the whole human body have provided cause for contention between religions and philosophies, sciences and superstitions, priests and physicians.

Buddha's faith was propagated which gathered immense momentum in the course of time. Though there are scattered references to the art of nursing in the ancient literature, there was no definite systematic description of the practice of nursing before the period of Caraka and Susruta. By the time of Caraka, nursing was acknowledged as having great importance in treatment.

Rise of Medical Knowledge

The period of Asoka's reign which was pre-eminently Buddhistic was the golden period for medical progress. The hospital institutions were very well flourished in the 3rd century B.C. when Europe did not have any idea of it. The trunk roads were lined with medicinal trees rather than ordinary trees. Missionaries were sent to foreign countries to provide spiritual and medical aid. Buddhist monks were expert surgeons. Hence medical knowledge flourished in this period. The following extract from Kasyapa Samhita bears ample testimony to the advanced state of nursing during that period.

Significance of Female Nurses

Ayurveda gives nursing a significant place by making it one of the four legs on which therapeutics stands. The physician, the drugs, the attendant, and the patient constitute the four basic factors of the treatment. Possessed of the required qualities, they lead to the earliest cure of disease. Thus a nurse was considered to be important for the Vaidya, the medicine, and the patient.

A woman, who has a softer heart compared to males is more fit for this profession of nursing. It would be much more apt to replace the word sister applied to nurses in modern times with the far more significant word mother. The spirit of service along with the training in the art of nursing makes the woman the proper person for the administration of cure to the ailing patient. Caraka describes the qualities needed in a nurse to be full of knowledge of nursing, skill, affection for the patient, and cleanliness. These are the tetrad of desiderata in the attending person.

Basic Qualities Required for Being a Nurse

A nurse or medical attendant should be pure, clean, well-behaved, clever, skillful, and kind and should know how to cook hygienic and healthy food. A nurse should be clever in bathing or washing a patient, well conversant in rubbing or pressing the limbs, raising a patient, helping him to walk, well-skilled in making or cleaning beds, able to pound drugs, always ready, patient and skillful to wait upon one who is ailing and willing to follow physicians guidance. The qualities required in a female nurse are well enumerated in the following extract:

To become a good nurse, a woman must possess considerable intelligence, good education, a healthy physique, good manners, an even temper, a sympathetic temperament, and a deft hand. To these, she must add habits of observation, punctuality, obedience, cleanliness, a sense of proportion, and a capacity for and habit of accurate statement. Training can only strengthen these qualities and habits. It cannot produce them.

Specialization

Scientific progress always leads to specialization and we find the following classifications of work in nursing:

1. General nursing
2. Surgical nursing
3. Midwife
4. Wet-nurse
5. Masseuse
6. Miscellaneous

The details regarding the qualifications of nurses in each category give a clear concept of the standard of nursing in those days.

Qualities in General nurses

The physician, the drugs, the attendant, and the patient constitute the four basic factors of medical treatment. Knowledge of nursing, skill, affection for the patient and cleanliness, these four are the tetrad of desiderata in the attending person. Then the attendants who have, character, cleanliness, good conduct, affection, dexterity, and sympathy, who are well versed in nursing who are circumspect in all other work, who are skilled in the cooking of soups and rice, in giving baths and shampoo, in lifting or laying the patient in bed and administering medicines. They should not decline any kind of work assigned to them.

A nurse should be devoted to the patient, clean, clever, and intelligent. The qualifications of the nurse are an enlightened temperament, good health, ability, devotion to the master, knowledge of nursing skill, cleanliness, promptness in execution, all-round deftness, not wavering in mind, given to self-restraint, having control over the temper, etc. and having forbearance.

The attendant should be strong, upright, skillful, pleasant in speech, trustworthy, courageous, docile, attached to, and good at entertaining the patient with varied tales and wise in attendance. He or she must not be bound down by technicalities, must be trained in the preparation of medicines, and should be able to bear strain and respond to the moods of the patient.

Qualities in Surgical nurses

The surgical nurse is expected to be very prompt in the execution of the surgeon's instructions and tireless in her duties along with being affectionate and protective towards the patient's health and safety.

Qualities in a Midwife

The specific qualities of the midwife include good repute, maturity, experience in the birth process, handling many deliveries, maintaining good hygiene, and whose nails have been clipped closed. The woman in labor should lie in bed surrounded by female attendants, who are cheerful by temperament, who is not given to obstructive speech, and who are able to bear strain.

Qualities in a Wet-nurse

Wet nurse should young, submissive, free from disease, not deficient in any limb, not given to unwholesome pursuits, not ugly, not ill-disposed, native of the country, not mean-minded, not given to mean acts, well-born, affectionate towards children, who is a mother of male children, who is never heedless, not having bad company, skillful in attendance, clean and endowed with the excellence of knowledge in milk.

Masseuse

Warm massage soothes the body. Massage done by a well trained person cures kapha very quickly. This shows that massaging was often resorted to.

Miscellaneous attendants

Nurse attendants who are well-versed in singing, playing musical instruments, panegyrics, verses, stories, legends, modern history, mythology, who are quick in understanding, who are of approved character, who are versed in the knowledge of clime and season and who are good members of society are preferred apt for being an attendant. Affectionate and sympathetic friends before whom the patient feels free is perfect for being an attendant.

Jivaka, the physician to Buddha

There is an interesting story depicting to what noble heights the institution of nursing reached in the Buddhist period. It also depicts clearly how the public took undue advantage of it turning its very strength into its weakness.

The Medical treatment of the Buddha and his followers was entrusted by the generous king of Magadha, Seniya Bimbisara, to Jivaka Komarabhachcha, the Royal physician. Jivaka was an excellent young doctor, who had orders to wait upon the King, his Seraglio, and the fraternity of Bhikkhus with the Buddha at its head. He was a most distinguished medical authority of his times, well versed in both medicine and surgery. He was even called upon from distant places like Saketa, Benares, and Ujjeni.

Once there was an outbreak of the five diseases in Magadha. These diseases were leprosy boils, dry leprosy, consumption, and fits. The people suffering from them approached Jivaka to cure them of the diseases. But Jivaka denied it as he had the responsibility of treating the Magadha King Seniya Bimbisara, the royal seraglio, and the fraternity of Bhikkhus with the Buddha at their head. Those people thought that the precepts that these Sakyaputtiya Samanas kept and the life they lived were commodious. They had good meals and lay on the protected beds from the wind. Hence they took to the religious life among the Sakyaputtiya Samanas. Then the Bhikkhus nursed and Jivaka Komarabhachcha cured them. The demands of the sick made the Bhikkhus constantly beg for food for the sick, while Jivaka, having to treat so many sick Bhikkhus, neglected some of his duties to the king. This stratagem worked so well that persons similarly afflicted with one or other of those diseases began to offer themselves for monkhood, not for the sake of the religious life but simply to exploit the order, to get themselves nursed and cured, and then to return to the world. However, the entire corrupt practice was one day completely exposed when Jivaka, while on his rounds, encountered a former monk who had returned to ordinary life. After questioning him, Jivaka learned that many had joined the order simply to exploit the system for nursing and medical care. He reported this to the Buddha, who then declared that no one suffering from illness could be admitted into the order purely for treatment.

Summary

The institution of nursing was very highly developed and was well organized. This organized useful and benevolent institution changed in due course of time. Due to contact with the different parts of the world gave an impetus to its revival. An organized effort is needed to put this benevolent avocation on a high footing and thereby render medical aid and at the same time supply the means of livelihood to the helpless women and widows. We should develop a scientific spirit combined with an indigenous atmosphere and quality of compassion for the patients.

The nurses should also behave and mingle with the people, speaking the native language, knowing the needs of the people, and preparing and advising the diet suited to them and liked by the masses by becoming one with them. The institution revived on these lines will alleviate most of the sufferings of the masses and will bring happiness to the cheerless atmosphere of the sick-beds.

References

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