Ayurveda Ayurveda (Devanagari: आयुर्वेद) or Ayurvedic medicine is an ancient system of health care that is native to the Indian subcontinent. It is presently in daily use by millions of people in India, Nepal, and Sri Lanka. The word "Ayurveda" is a tatpurusha compound of the word āyus meaning "life", "life principle", or "long life" and the word veda, which refers to a system of "knowledge". Thus "Ayurveda" roughly translates as the "knowledge of life", "knowledge of a long life" or even "science of life". According to Charaka Samhita, "life" itself is defined as the "combination of the body, sense organs, mind and soul, the factor responsible for preventing decay and death, which sustains the body over time, and guides the processes of rebirth" [1][2] According to this perspective, Ayurveda is concerned with measures to protect "ayus", which includes healthy living along with therapeutic measures that relate to physical, mental, social and spiritual harmony. Ayurveda is also one among the few traditional systems of medicine to contain a sophisticated system of surgery (which is referred to as "salya-chikitsa").
Contents
1 Overview 2 Eight Branches (Ashtanga) of Ayurveda 3 History 3.1 Ayurveda & Purana 3.2 Historical evidence 4 Development 4.1 Gurukul system of Ayurveda 5 Tridosha system 6 Ayurvedic tastes 7 Medications 8 Panchakarma and Ayurvedic massage 9 Current status 9.1 Ayurvedic institutions and practitioners 9.2 Practice in the West 10 Criticisms 10.1 Scientific studies and standards 10.2 Safety concerns 10.3 "Miracle Cures"
Overview
According to the Ayurvedavatarana (the "descent of Ayurveda"), the origin of Ayurveda is stated to be a divine revelation of the ancient Indian creator God Lord Brahma[3] as he awoke to recreate the universe. This knowledge was passed directly to Daksha Prajapati in the form of shloka sung by Lord Brahma.[4], and this was in turn passed down through a successive chain of deities to Lord Indra, the protector of dharma. According to this account, the first human exponent of Ayurveda was Bharadvaja, who learned it directly from Indra. Bharadvaja in turn taught Ayurveda to a group of assembled sages, who then passed down different aspects of this knowledge to their students. According to tradition, Ayurveda was first described in text form by Agnivesha, in his book the Agnivesh tantra. The book was later redacted by Charaka, and became known as the Charaka Samhitā.[5] Another early text of Ayurveda is the Sushruta Samhitā, which was compiled by Sushrut, the primary pupil of Dhanvantri, sometime around 1000 BCE. Sushrut is known as the Father of Surgery, and in the Sushrut Samhita, the teachings and surgical techniques of Dhanvantri are compiled and complemented with additional findings and observations of Sushrut regarding topics ranging from obstetrics and orthopedics to ophthalmology. Sushrut Samhita together with Charaka Samhitā, served as the textual material within the ancient Universities of Takshashila and Nalanda.[6] These texts are believed to have been written around the beginning of the Common Era, and are based on a holistic approach rooted in the philosophy of the Vedas and Vedic culture. Holism is central to ayurvedic philosophy and elements of holism is found in several aspects of ayurveda.[7]

Eight Branches (Ashtanga) of Ayurveda
Internal medicine - Kayachikitsa Surgery - Shalya Tantra Ears, eyes, nose and throat - Shalakya tantra Pediatrics - Kaumarabhritya Tantra Toxicology - Agada Tantra Purification of the genetic organs - Bajikarana (or Vajikarana) Tantra Health and Longevity - Rasayana Tantra Spiritual Healing/Psychiatry - Bhuta Vidya See also: The Eight Armed Ayurveda
History
There is a concept that has been passing down verbally from generation to generation in India about the origin of Ayurveda. Accordingly, the ancient "Rishis" or wise men of India gathered at the foot of the Himalayas. Their objective was to innovate together the secret of leading a healthy, long life. The final product of their effort came to be known as Ayurveda or the "science of life".
A statue of the Hindu God, Brahma. Hinduism believes in the divine origin of Ayurveda Dhanvantari, the God of Ayurveda Nagarjuna, a follower of Buddha, was a well known herbologist, known for inventing various new drugs for the treatment of ailmentsDocumented references to the precise timing of the origins of Ayurveda are not available. The age of Ayurveda has been established on the basis of correlating the evidence with other disciplines as well as circumstantial evidence. Ayurveda is said to have been first compiled as a text by Agnivesha, in his book Agnivesh tantra, which was written during Vedic times.[citation needed] The book was later revised by Charaka, and renamed to Charaka Samhitā (encyclopedia of the physician Charaka).[8] Other early texts of Ayurveda include the Charaka Samhitā and the Sushruta Samhitā[6] The system was orally transferred via the Gurukul system until a script came into existence.
The earliest scripts would have been written on perishable materials such as Taalpatra and Bhojapatra, which could not be readily preserved.[citation needed] The script was later written on stone and copper sheets.[citation needed] Verses dealing with Ayurveda are included in the Atharvaveda, which implies that some form of Ayurveda is as old as the Vedas.[citation needed] Ayurvedic practices have also evolved over time, and some practices may be considered innovations upon earlier Vedic practices, such as the advances made during the Buddhist period in India.[citation needed]
Hinduism attributes the genesis of Ayurveda to several theories in which the knowledge is believed to have been passed on from being to being, initially, through its realization by the divine sages, and gradually into the human sphere by a complex system of mnemonics. Details of Ayurvedic traditions vary between writers, as is expected when oral traditions are transcribed from multiple sources. The earliest authors of Ayurvedic manuscripts recorded divergent forms of the tradition.
Ayurveda & Purana
In Mahabharata it is stated that lord Krishna had a son Samb. He was suffering from leprosy. That's why Krishna called special Brahmin's of shakdvipa (believed that present Iran). They were sun worshipers and famous astronomer. They treated Samb and freed him from leprosy. Shakdvipiya brahmin originated from those shakdvipa origin brahmins and also called magi brahmin. Sakaldwipya are specialized in ayurveda (old indian method of treatment) and astronomy, astrology and Sakaldwipiya are sun worshiper so called Saura . The most detailed account of the origin of Śākadvīpīs or Bhojakas occurs in Bhavishya Purana (chapter 133)[9][10]Further they played a great role in ayrveda. The founder of modern Ayurveda Charaka was a Maga or Sakaldwipiya
Historical evidence
The history of indigenous Indian medical science is probably as old as the Indus Valley Civilisation dating back to 3000 BC. The meticulously planned cities of Harappa and Mohenjodaro are pointers not only to India’s rich cultural heritage but also to its advanced systems of hygiene and health care. The remains of deer antler and bitumen found in Harappa testify to the existence of a medical science. It was between 1200 and 700 BC, that the four sacred Vedas were composed. References to diseases, herbs and herbal cures can be seen in all the four Vedas especially in the Rig Veda.
The Atharva Veda has many hymns eulogizing herbs. Many plants were worshipped as deities and invoked by incantations. There were also many Mantras (invocations) to combat jaundice, consumption and hereditary diseases among others. The Atharvan hymns chanted for the cure of diseases were known as Bhaishajyams and those for attaining longevity and prosperity were called Ayushyams. These hymns, especially the Ayushyams are considered to be the foundation for advances in later medicine.
Development
Ayurvedic practice was flourishing during the time of Buddha (around 520 BC) , and in this period the Ayurvedic practitioners were commonly using Mercuric-sulphur combination based medicines.[11] In this period mercury, sulphur and other metals were used in conjunction with herbs to prepare the different medications.[citation needed] An important Ayurvedic practitioner of this period was Nagarjuna, a Buddhist herbologist, famous for inventing various new drugs for the treatment of ailments.[citation needed] Nagarjuna was accompanied by Surananda, Nagbodhi, Yashodhana, Nityanatha, Govinda, Anantdev, Vagbhatta etc. The knowledge of Ayurveda progressed a lot during this period, including development of newer and more effective medicines, and is therefore termed as the Golden Period of Ayurveda.[citation needed]
After emerging victorious at the Kalinga War, Emperor Ashoka (304 BC-232 BC) influenced by the Buddhist teachings, banned any bloodshed in his kingdom in 250 BC. Therefore many Ayurveda practitioners, who were practicing surgery along with medicine, left the surgical intervention and adopted totally new medicinal treatments. In this period, Ayurveda again evolved and flourished with the invention of new drugs, new methodology and new innovations. The practice of the accompanying surgery slowly died out during this period.[citation needed]
During the regime of Chandragupta Maurya (375-415 AD), Ayurveda was part of mainstream Indian medical techniques, and continued to be so until the colonisation by the British.
Chakrapani Dutta (DuttaSharma) was a Vaid Brahman of Bengal who wrote books on Ayurveda such as "Chakradutta" and others. Chakrapani Dutta was the Rajavaidya of Great King Laxman Sen {some says rajVaid of King Nayapala (1038 - 1055)}. It is believed by some practitioners that Chakradutta is the essence of Ayurveda.
Ayurveda has always been preserved by the people of India as a traditional "science of life", despite increasing adoption of European medical techniques during the time of British rule. For several decades the reputation and skills of the various Ayurvedic schools declined markedly as Western medicine and Western-style hospitals were built. However, beginning in the 1970s, a gradual recognition of the value of Ayurveda returned, and today Ayurvedic hospitals and practitioners are flourishing throughout all of India. As well, the production and marketing of Ayurvedic herbal medicines has dramatically increased, as well as scientific documentation of benefits[citation needed]. Today, Ayurvedic medicines are available throughout the world.
Gurukul system of Ayurveda
In the earlier days of its conception, the system of Ayurvedic medicine was orally transferred via the Gurukul system until a written script came into existence.
In this system, the Guru gave a solemn address where he directed the students to a life of chastity, honesty, and vegetarianism. The student was to strive with all his being to heal the sick. He was not to betray patients for his own advantage. He was required to dress modestly and avoid alcohol or drugs. He was to be collected and self-controlled, measured in speech at all times. He was to constantly improve his knowledge and technical skill. At the patient's home, he was to be courteous and modest, directing all attention to the patient's welfare. He was not to divulge any knowledge about the patient and his family. If the patient was incurable, he was to keep this to himself if it was likely to harm the patient or others.
The normal length of the student's training appears to have been seven years. Before graduation, the student was to pass a test. But the physician was to continue to learn through texts, direct observation (pratyaksha), and through inference (anumāna). In addition, the vaidyas attended meetings where knowledge was exchanged. The practitioners also gained knowledge of unusual remedies from laypeople who were outside the huffsteter community such as hillsmen, herdsmen, and forest-dwellers.
Tridosha system
The central concept of Ayurvedic medicine is the theory that health exists when there is a balance between three fundamental bodily humours or doshas called Vata, Pitta and Kapha.
Vata is the impulse principle necessary to mobilize the function of the nervous system Pitta is the energy principle which uses bile to direct digestion and hence metabolism into the venous system. Kapha is the body fluid principle which relates to mucous, lubrication and the carrier of nutrients into the arterial system. All Ayurvedic physicians believe that these ancient ideas, based in the knowledge discovered by the Rishis and Munis, exist in harmony with physical reality. These Ayurvedic concepts allow physicians to examine the homeostasis of the whole system. People may be of a predominant dosha or constitution, but all doshas have the basic elements within them.
The philosophy of Ayurveda
The emergence of different schools of Sanskrit philosophy like Nyaya, Vaisheshika, Sankhya, Yoga, Vedanta and Mimamsa was another landmark in the history of Indian medicine. The principles expounded in these philosophies facilitated the development within Ayurveda of its theory of humoral pathology which propounds that the human body is composed of Tridoshas, the three humors – Vata, Pitta and Kapha. When these are in equilibrium they are called the Tridhatus. The body in which these three humors are in a state of equilibrium enjoys perfect health; their disequilibrium causes ill health.
Disease management in Ayurveda
The principles of Ayurvedic pharmacology are fundamentally different from those of other systems of medicine, especially evidence-based medicine. Most Ayurvedic medicines are prepared from herbs.
Shamana and Shodhana are the two concepts of disease management in Ayurveda. Shamana means alleviation. Shamana methods mitigate the disease and its symptoms. Shodhana means elimination and Shodhana methods aim at the elimination of the basic cause of disease.
Ayurvedic tastes
Ayurveda holds that the tastes of foods or herbs have specific physiological effects. Those tastes that transform after digestion (Vipaka) are more powerful.
Sweet (Madhura) - Sweet foods nourish, cool, moisten, oil, and increase weight Sour (Amla) - Sour foods warm, oil, and increase weight Salty (Lavan) - Salty foods warm, dissolve, stimulate, soften, oil, and increase weight Bitter (Katu) - Bitter foods cool, dry, purify and decrease weight Pungent (Tikta) - Pungent foods warm, dry, stimulate, and decrease weight Astringent (Kasaya) - Astringent foods cool, dry, reduce stickiness.
Medications Ayurvedic practitioners believe that the tulsi (holy basil) plant has medicinal qualitiesAyurveda operates on the precept that various materials of vegetable, animal, and mineral origin have some medicinal value. The medicinal properties of these materials have been documented by the practitioners and have been used for centuries to cure illness and/or help maintain good health. Ayurvedic medicaments are made from herbs or mixtures of herbs, either alone or in combination with minerals, metals and other ingredients of animal origin. The metals, animals and minerals are purified by individual processes before being used for medicinal purposes.
Writers and compilers of Ayurvedic literature such as Charaka, Sushruta, Vagabhatta, Bhav Mishra, Shaligram and others have written about the qualities, characteristics and medicinal uses of the herbs, mineral, metals, chemicals, animal parts, cooked food articles, natural foods, fruits etc. Among them, the Bhav Prakash Nighantu, written by Bhav Mishra, is known for its detail .The composition of the Nighantu part (Ayurvedic Materia Medica) of the Bhav Prakash is part of the classical book. The details of the medicinal herbs are given according to the nature, effects, and curative properties as observed by the Ayurvedic practitioners.
Ayurvedic literature has been written by several authors in languages such as Sanskrit, Hindi, Kannada, Tamil, Telugu and more recently, in English.The Shaligram Nighantu was written in Sanskrit. The Banaushadhi Chandrodaya was written in Hindi.The Indian Materia Medica was written in English.
panchakarma and Ayurvedic massage
Panchakarma (the five actions or modalities) is a collection of purification techniques that Ayurveda prescribes for some diseases and for periodic cleansing. A course of Pancharkarma typically includes a short-term dietary prescription, massage, herbs, and may include purgatives, sweat baths, medicated enemas, and nasal cleansing.
Ayurvedic massage is a form of treatment for various age related and other common disorders. Some of the advantages which can be cited are pain relief, improved circulation, stress relief, better sleep, flexibility, athletic performance and emotional benefits[citation needed]. Massage therapy can soothe pain, relax stiff muscles, and reduce the swelling that accompanies arthritis[citation needed]. Advocates claim that, with ayurvedic massage, deep-seated toxins in the joints and tissues are loosened and released into the system for elimination through natural toxin-release processes.[12]. There are several different types of ayurvedic treatments such as panchakarma, marma massage and abhyangam.[13] Ayurvedic massage is especially developed in Sri Lanka and the Indian state of Kerala.
Current status
It has been suggested that Research and innovations in Ayurveda be merged into this article or section. (Discuss)
In the early 20th century, Ayurvedic physicians began to organize into professional associations and to promote their case for national recognition and funding.[citation needed] This began to become a reality after Indian independence in 1947.[citation needed]
Ayurveda is now a statutory, recognised medical system of health care like other medical systems existing in India. The Central Council of Indian Medicine {CCIM} governs and recommends policies for the research and development of the system. An Encyclopedia on Ayurveda - Ayushveda.com[2] has been developed to promote the knowledge of Ayurveda worldwide.
In India, practitioners in Ayurveda undergo 5 and 1/2 years of training including 1 year of internship in select Ayurveda Medical Schools wherein they earn the professional doctorate degree of Bachelor of Ayurvedic Medicine and Surgery[B.A.M.S.]. A Bachelor's degree with a major in Science [Physics, Chemistry, Biology] and a minor in Sanskrit is desirable for candidates interested in taking up the course.
Select institutions like the Banaras Hindu University, Varanasi, offer higher doctorates and postgraduate training such as MD [Ayurveda] which includes a 3 year residency and a dissertation similar to the MD/MS degrees in modern systems of medicine.
Ayurvedic institutions and practitioners
Ayurvedic practitioners have been appointed as Honorary Ayurvedic Physician to the President of India. Every year on the occasion of Dhanvantari jayanti, a prestigious Dhanvantari Award is conferred on a famous personality of Medical Sciences including Ayurveda. Traditionally Kerala has been the leading state in India that promoted Ayurveda as a medical system, because there existed about 18 families known as 'Ashtavaidyas' who practised ayurveda generation after generation. Even now a few number of these families exist (Pulamanthole Mooss, Thaikkattu mooss,Vayaskara Mooss, Alathur Nambi, Vaidyamadhom, etc.).They taught the ayurveda system of treatment to several people and it spread through them. It led to the establishment of Ayurveda colleges and also inspired research activities in Ayurveda. Now there are many Ayurvedic centers (known as Vaidya shalas) all over Kerala, and, of late, several Ayurveda colleges also have come up. One such dominant company is Kerala Ayurveda Limited founded on the banks of river Periyar at Aluva, Kochi, Kerala. Today Kerala Ayurveda Limited is a major force in health care, growing at a spectacular rate - with new clinics, new market strategies, new products, and new cures. Some of KAL's products are on the verge of being patented. KAL is truly on a mission to be the number one choice in Ayurveda globally.Besides Kerala, others also promoting Ayurveda are Gujarat, Maharastra, and Karnataka.
Practice in the West
As a result of regulations in medical practice in Europe and America, the most commonly practiced Ayurvedic treatments in the west are massage and dietary and herbal advice. Psychiatrist Frank John Ninivaggi, M. D. of Yale University School of Medicine has recently outlined the principles of Ayurveda, specifically for Western health practitioners.[14]
In the United States, the National Institute of Ayurvedic Medicine (established by Scott Gerson) is an example of a research institute that has carried out research into Ayurvedic practices.[15] Gerson has published part of his work on the antifungal activities of certain Ayurvedic plants in medical journals.[16]
Several Pharmaceutical companies and Academic Institutions in the west have come into conflict with Indian academic institutions and traditional Ayurvedic practitioners over the intellectual property rights of herbal products researched by the western agencies. The Ayurvedic practitioners have known about the efficacy of such products for centuries and so contend that they carry precedence with regards to patent rights on such products.
In December 1993, the University of Mississippi Medical Center had a patent issued to them by U.S patents and trademarks office on the use of turmeric (U.S. patent No. 5,401,504) for healing. The patent was contested by India's industrial research organization, Council for Scientific and Industrial Research (C.S.I.R), on the grounds that traditional Ayurvedic practitioners were already aware of the healing properties of the substance and have been for centuries, making this patent a case of bio-piracy.[17]
After a complex legal battle, the U.S. Patents and Trademarks Office ruled on August 14, 1997 that the patent was invalid because it was not a novel invention, giving the intellectual property rights to the principle back to the traditional practitioners of Ayurveda. R. A. Mashelkar, director-general of the CSIR, was satisfied with the result, saying:
"This success will enhance the confidence of the people and help remove fears about India's helplessness on preventing bio-piracy and appropriation of inventions based on traditional knowledge[17]"
The turmeric patent was just one of the hundreds that the several academic organizations and Pharmecutical companies in the west have claimed by ignoring Ayurvedic knowledge. Vandana Shiva, a global campaigner for a fair and honest Intellectual Property Rights system, says patents on herbal products derived from Neem, Amla, Jar Amla, Anar ("Pomegranate"), Salai, Dudhi ("Calabash"), Gulmendhi, Bagbherenda, Karela, Erand, Rangoon-kibel, Vilayetishisham and Chamkura also need to be revoked.[17]
Seven American and four Japanese firms have filed for grant of patents on formulations containing extracts of the herb Ashwagandha. Fruits, leaves and seeds of the Indian medicinal plant withania somnifera have been traditionally used for the Ayurvedic system as aphrodisiacs, diuretics and for treating memory loss. The Japanese patent applications are related to the use of the herb as a skin ointment and for promoting reproductive fertility. The U.S based company Natreon has also obtained a patent for an Ashwagandha extract. Another US establishment, the New England Deaconess Hospital, has taken a patent on an Ashwagandha formulation claimed to alleviate symptoms associated with arthritis. It is clear that the Ashwagandha plant is catching the attention of scientists and more patents related to Ashwagandha are being filed or granted by different patent offices since 1996.[18]
Ayurvedic wisdom originated in the main Vedas as a part of way of life - a spiritual connection with spirit and nature. This is most evident reading Atharva Veda. Ayurveda was used to remove obstacles on one’s path to Self-Realization. At some point the medical aspects began to take priority over the spiritual forms of healing (ie, focusing on lifestyle, dharma and moksha. Today, these spiritual aspects of Ayurveda have taken a back seat to the medical focus. As Ayurveda becomes a more commercially viable career, the spiritual aspects may continue to lose ground. Yet there are a growing number of practitioners who practice mainly these spiritual therapies and find better results than limiting their approach to the medical, physical realm.
Criticisms
Scientific studies and standards
Critics object to the lack of rigorous scientific studies and clinical trials of many ayurvedic products. The National Center for Complementary and Alternative Medicine states that "most clinical trials of Ayurvedic approaches have been small, had problems with research designs, lacked appropriate control groups, or had other issues that affected how meaningful the results were."[19]
In India, scientific research in Ayurveda is largely undertaken by the statutory body of the Central Government, the Central Council for Research in Ayurveda and Siddha (CCRAS), through a national network of research institutes.[20] A large number of non-governmental organisations are also conducting research work on different aspects of Ayurveda[21]. However, "even staunch advocates of Ayurveda like cardiologist Dr. M.S. Valiathan...admit that 'clinical studies that would satisfy the liberal criteria of WHO World Health Organisation have been alarmingly few from India, in spite of patients crowding in Ayurvedic hospitals"'.[19]
Safety concerns
There is evidence that using some ayurvedic medicine, especially those involving herbs, metals, minerals, or other materials involves potentially serious risks, including toxicity.
A research study published in the Journal of the American Medical Association[24] found significant levels of toxic heavy metals such as lead, mercury and arsenic in 20% of Ayurvedic preparations that were made in South Asia for sale in America. The Journal found that, if taken according to the manufacturers' instructions, this 20% of remedies "could result in heavy metal intakes above published regulatory standards"[24] Similar studies have been performed in India, and have confirmed these results. Cases of metal toxicity from use of ayurvedic medicines are well known.[25] Some practitioners claimed that "heavy metals are integral to some formulations and have been used for centuries. There is no point of doing trials as they have been used safely and have mention in our ancient texts."[25]
There is a technique of detoxification applied to heavy metals and toxic herbs called samskaras, which is similar to the Chinese pao zhi although the Ayurvedic technique is more complex and may involve prayers as well as physical pharmacy techniques.[26]
The described detoxification is a simple chemical process which involves four successive rounds of boiling the crude root in cow's urine (twice) and cow's milk (twice). This process is claimed to chemically modify both toxic and proposed therapeutic components of the root. It also extracts some of these compounds from the root into the boiling solvents, thereby decreasing their concentration in the final product.
Miracle Cures"
Most critics also question the safety of those Ayurvedic drugs that are said to provide "Miracle Cures" because "miracles" are more probably subject to theological rather than scientific inquiry.

Ayurveda- Definition
The word ayurveda has been coined by the conjunction of two Sanskrit words, "ayur" meaning life and "Veda" meaning knowledge. The word together means the knowledge of life. In ayurveda the process of ayur (life) is considered as a combined state of body (sharira), senses (indriya), psyche (mana) and soul (atma). Among these the visible body is made of panchamahabhoota and is called sthoola sharir whereas the sense, psyche and soul are invisible and thus are called sukshma sharir or linga sharir. Ayurveda not only consists of natural scientific methodology of medication but also provides the way of life. During the course of time Ayurveda, the way of life and its knowledge became the science of life, which has its root in ancient Vedic literature and encompasses our entire life, the body, mind and spirit. PunarjanmaIt is believed that death takes away the sukshma sharir to the heavenly abode leaving behind the sthoola sharir that decomposes back to its constituent elements, the panchamahabhoota. The sukshma sharir takes rebirth (punarjanma) until it attains moksha. The splitting of the sukshma sharir into indriya, mana and atma after it attains salvation (moksha) follows this life and death cycle. Indriya and mana that originate from the nature, surroundings (prakruti) remerge with the same whereas atma, the image of parmatama merges back into it. The other instance that is believed in, is the non- attainment of salvation (moksha) after death. This leads to the combining of the sukshma sharir i.e. the indriya, mana and atma with the new sthoola sharir at the time of shukra shonita sanyoga (fertilization) in the uterus. This combination of sukshma and sthoola sharir occurs in accordance with the karmafala that is to be enjoyed by the new sthoola sharir. The karma (deeds) of the previous sthoola sharir decide the karmafala of the new sthoola sharir. It doesn't always happen that the sukshma sharir combines with species of sthoola sharir same as itself. According to vedic science the sukshma sharir can combine with any of the species among the 8.4 million species that exists. Attainment of moksha is one of the chaturvidh purushartha. (four main objectives of life) and the process of splitting and combining of the sukshma sharir with the sthoola sharir continues till moksha is attained. Atma is comparable to god, the creator and is believed to be the almighty. Once the sukshma sharir and the sthoola sharir have atma attached to it, due to karmafalbandhan all its strength and might is lost and he has to lead this cyclical phase of life according to the karmafala. In ayurveda itself the Sanskrit word ayur has synonyms that possess the same meaning and value as life itself. Few synonyms are: DhariAs the physical properties of the body is sustained (dharna) during life. JeevitaAs the lively activities are carried out. NityagaAs the time of life is continuously spent. AnubandhaAs life is possible with the combination (bandhan) of the sukshma and the sthoola sharir. Charak Sootra 1/41In ayurveda ayu (life) can be classified as:
Sukha AyuThe ayu that leads a healthy life. Person has good health.
Dukkha AyuThe ayu that live a diseased life. The person suffers with some disease all his life.
Hita AyuThe ayu that lives life by serving the society.
Ahita AyuThe ayu that live life in destructive activities. Definition of AyurvedaAyurveda is the science of life that not only deals with Sukha Ayu, Dukkha Ayu, Hita Ayu, Ahita Ayu but also deals with the ways and means to achieve health the path that leads to disease.In all ayurveda deals with quantum of the Ayu, the life.

The writings that relate to Ashtang Ayurveda provide an introductory information of the eight branches of Ayurveda, namely: Surgery (Shalya), ENT with Ophthalmology (Shalakya), Medicine (Kaya), Bhoota, Gynac, Obstretics, Paediatrics (Kaumara), Medical jurisprudence and toxicology (Agada), Gerontology (Rasayan) and Science of Aphrodiasic (Vajikarana).. ShlokaShusrut Sutra 1/6 - 7 Pg. 30 (Ayurveda Hitopadesha) Ayurveda, Upaveda of Atharvaveda, written by Brahma is named as the Brahma Sanhita. It envelops in utself one million shlokas in form of rhymes written in one thousand chapters.Ayurveda was rewritten in the in eight parts popularly known as the ashtang ayurveda due to the decline in the intellectual level and life span of human beings. ShalyaShloka: Ref Shusrut Su. 7/4the word shalya refers to the things that cause discomfort to the body and the mind. Shalya is of two types, namely: shaarir (within the body) and agantuj (outisde the body). The shalya present inside the body is considered as the Shaarir Shalya.. Example: Unhealthy teeth, Hair, Nails, imbalanced doshas, dhatus and mala, abscess, tumor, fetus etc. Whereas agantuj are the shalya presen toutside the body. Example: Thorns, Stone pieces, iron pieces, dust particles, worry etc. Shalya tantra (Surgery): Shloka : Shusru. 1/8It deals with the means such as Yantra (Tools), Shastra (Instruments), Kshara (Alkalies) and Agni (Fire) to remove the shalya in the body by different methods. ShalakyaShloka: Ref Shusrut Su. 1/8It deals with the diseases related to Nose, Ear, Throat and Eyes. Inother words it deals with the disease of Urdhva Jatru region i.e diseases in the organs above the Clavicle (Jatru) and their treatment. Kaya Chikitsa (Medicine/ Therapeutics):Shloka : Shusrut Su. 1/8 it is the branch of Ayurved that deals with internal medicine. The treatment involved is called "Kayachikitsa", where Kaya means "Agni "and Chikitsa means "treatment". It is noteable that the entire Ayurvedic therapeutics is based on this concept of Agni. The concept of Kaya (Agni) is unique and is responsible for bio- transformation. As it is known that energy can neither be created nor it can be destroyed. In human body Kaya provides the necessary energy for all bodily activities. As energy can be changed from one form to another the living body derive energy from the food eaten and breathing air. Biological Kaya transforms this energy to the energy, which is utilized by our cells. In simple words, the vitamins, minerals, carbohydrates, fats etc. eaten are bio transformed by this Kaya to the bodily substances. As long as Kaya is proper all the activities in body are carried out smoothly. Any disturbance in Kaya causes imbalance in the homeostasis (equilibrium) and disturbs physiology which is nothing but the disease. In ayurveda therapeutics devotes to correction and maintenance of biological Kaya through the means of Mantra, Mani and Aushadhi. Keeping in mind all the benefits of ayurveda it must be kept in mind that anything and everything that is herbal can not naturally become Ayurvedic medicine, but only the therapy which considers the above mentioned concepts of Ayurved qualifies to be called as Ayurvedic medicine. Bhoota (Graha)it is the branch of Ayurveda that deals with diseases acquired or inherited from apparently unknown causes. In modern terminology it can be considered as idiopathic diseases in which the exact cause of disease is unknown. According to Ayurveda, diseases are caused by affliction due to Deva, Asura, Gandharva, Yaksha, Rakshasa, Pitara, Pishacha, Naga and other bad demons or evils. The exact patho- physiology of these disorders is to be extensively researched. Bala / Kaumara:it is the branch of ayurveda that deals with the diagnosis and treatment of diseases related to preconception, childbearing (Pregnancy), childbirth (delivery) and diseases of children (Pediatrics). Rasayana tantrIt is the branch of ayurveda that deals with various aspects of preventive health care. Without rasayana it is possible to gain neither oratory nor the desirable aura. It includes longevity, improved memory, health, youthfulness, glow, complexion, generosity, and strength of body and senses. Rasayana improves the metabolic activities and results in best possible bio- transformation leading to health. Vajikaranait is the branch of ayurveda that deals with the sexual aspects. It includes medications for diseases related with reproduction namely spermatogenesis, aphrodisiacs etc.
Prayojan (aims and objectives)
Shloka Charak Su 30/26the aims and objectives of Ayurveda, the science of life has been beautifully coined in the above shloka. To lead a good life health is priority. Through ayurvedic concepts it is necessary to maintain health and in case of a diseased state gaining back the normal health. Aims and objectives of ayurveda have been divided into two aspects namely:
Swasthasya Swathya Rakshanam (Preventive and Social medicine)
Aturasya Vikar Prashamanam (Therapeutics) These two aspects reflect the unique approach of ayurveda.Therapeutics is not strictly related to dravya chikitsa i.e. treatment with medicines but also to the form of bhava chikitsa i.e. treatment without medicines and in the form of achar rasayan (good conducts both personal as well as social). The two objectives though defined clearly in a concise statement, have been explained in great details in the scripturesThe four chatushtayas that form the basis of a good human life is a unique feature of ayurveda. Following of the chatushtayas it is not only necessary to maintain good health but also to treat a particular disease if inflicted from what so ever caused. Ayurveda has not restricted itself as the path, which treats diseases but being the science of life has covered all the aspects necessary to maintain health and to restore it when inflicted with a disease. Charak has specified in the following shloka chark sutrasthan 5/103 that ignorance is no excuse and we have to take pains to learn and to follow various rules and regulations to remain healthy. These rules and regulations are nothing but guidelines to remain fit, refrain from diseases and lead a healthy life. These guidelines have been mentioned under the topic of swasthavrutta. Despite of all the preventive measures if we suffer from a disease we should be able to known the probable causes of that disease and the probable fallacies on our part in following the rules and regulations put before us in the form of the first objective. Ignorance and fallacies lead to disease and it is here that the second objective of aaturasya vikara prashamana comes into picture

the origin of ayurveda, the word conjugated by "ayu" meaning life and "Veda" meaning knowledge can be traced back to the evolution of civilization. The Indian sages thousands of years ago enscripted their knowledge about life and the fundamentals of ayurveda in the oldest scriptures known to mankind, namely the Rig Veda, Yajur Veda, Athrva Veda and Sam Veda.Ayurved is regarded as the Upaveda or sub-scripture of the Yajurveda. This Veda contains abundance of information on how to keep oneself healthy and to combat diseases. Originated as a part of Vedic science, ayurveda is an integral spiritual science devised to give a comprehensive understanding of the entire universe, which it sees as working according to a single law. Ayurveda is the branch of Vedic science, which deals with physical body besides yoga, meditation, astrology, etc. Herbal medicine, dietetics, physiology, surgery, psychology, spirituality etc. are included in ayurveda under Ashtanga Ayurveda. From the ancient enlightened sages and period, Vedic culture ayurveda is the healing gift to mankind. It is believed that the astronomical records in ancient Vedic texts, the Vedic system, including ayurveda, was in practice even before 4000 BC. Hence it is evident that ayurveda was very mature and predominant in India thousands of years ago. Ayurvedic philosophy says that suffering is disease and contentment is good health and no human being is healthy if he does not posses a sound sharira (body), a sound mana (mind) and a sound atma (soul). Ayurveda advises for smallest things of personal hygiene and social conduct and describe the whole way of life, narrates how one should keep healthy. The sages of ayurveda emphasized on the importance of preventive medicine by developing individual's own immune system to fight against all possible infections. Ayurvedic healing has two levels:
One for the layman and self-care
Second for the healer and his practice. The first ones outlines many common and home remedies for different diseases and gives a general constitutional or life-style treatment for health enhancement and disease prevention. It is also believe that it is only when our life- style is out of harmony that more severe disease arise and more specialized and complicated health care becomes necessary. The second level provides some of this specialized ayurvedic medical knowledge and says that more is utilized by a health care professional. Most disease conditions involve physical and spiritual factors and require treatment on both levels. Ayurveda traditionally involves a holistic treatment of the entire human being and its full cosmic nature.According to the Upanishads, the main spiritual teachings of ancient India, disease is the highest form of asceticism (tapas), whereby the truth of life and the truth of one's own self can be revealed. Disease may be a sign of wrong action in life, but it can also be an indication that the soul is directing its energy within. Either way it requires a spiritual re-examination of our lives, particularly if the disease is severe. Hence, self-examination is the first step and fundamental basis of understanding and resolving any disease. Ayurvedic medicines consist of various natural herbs and minerals and are rapidly gaining acceptance all over the world. Ayurveda today is part of a new movement towards a global medicine that includes the best developments from all lands. Trisutra AyurvedaShloka: Cha. Su. 1/24According to Charaka entire Ayurveda is explained in three strings (Trisutra), namely hetusutra, lingasutra and aushadhisutra, which are extremely helpful in maintaining health and treating diseases. Hetusutra: It is the causative factor of disease. Lingasutra: These are the sign and symptoms developed due to the disease. Aushadhisutra: It is the means of treatment.

Medicinal valueIt is a blend of the leaves that is used to treat liver ailments including jaundice, ulcers, diarrhea and skin problems. The leaves are also used as a diuretic. For external purposes it is used as a fomentation for athlete's foot, sores, slow-healing wounds, and insect bites. Religious importanceIt is believed that Agrimony is used for protection form spells, to banish negative energies and spirits. It also reverses spells and reverts them back to the sender. If Agrimony is put under head a deep sleep is caused that continues until it is removed. HabitatMost of the United States and Southern Canada has tremendous growth of Agrimony, which is a perennial and reaches 2 to 3 feet tall. Complete sunshine and average soil is good for its growth. AlfalfaScientific name: Medicago sativaMedicinal valueIt is used for treating anemia, fatigue, kidneys, peptic ulcers, pituitary problems, and for building general health, retaining water in the body, relieving urinary and bowel problems. This herb is effective for the treatment of narcotic and alcohol addiction. Religious importanceIt is believed that if this herb is kept in a container and placed outside home it prevents the house from poverty and hunger. Scattering the ashes of burned alfalfa protects property. HabitatSunshine, regular watering are the necessary conditions for the growth of this 1 to 3 feet tall herb which is not picky about the soil and is cultivated in many parts of the world.. AllspiceScientific name: Pimenta dioicaMedicinal valueIt relieves toothache and is used as a mouth freshener for fresh breath. Religious importanceIt is believed that allspice enhances healing and is used to ask for money and good fortune it is used as a mixture. HabitatIt is derived form a tree that grows Central and South America and the Caribbean. Aloe VeraScientific name: Aloe vera, Aloe spp.Medicinal valueThe gel obtained from the inner part of the aloe leaf is used to treat burns, skin rashes, insect bites, healing wounds by drawing out infection, and preventing infection from starting and chafed nipples from breast-feeding. This gel can also be used internally to keep the bowels functioning smooth. It must be noticed that this medicine when taken internally causes intestinal cramping and there are other herbs that do this job better. This gel is best effective when used fresh rather than "stabilized" gels found in the stores. The fresh gel was used by Cleopatra to keep her skin soft and young. Religious importanceIt is believed that this plant if grown in the kitchen garden prevents burns and mishaps while cooking. It also prevents household accidents and safeguards against evils. It is reported that aloe was used to embalm the body of Christ. HabitatIt is bets to be grown inside home in pots. The climate of South, as in southern Texas or southern Florida is best for the growth of aloe outside. Aloe being a succulent needs water to keep the leaves fleshy and juicy. AmaranthScientific name: Amaranthus spp.Medicinal valueIt is best to treat stomach flu, diarrhea, and gastroenteritis. This herb is also helpful in stopping menstruation and for contraception. It reduces tissue swelling caused due to sprains and tick bites when applied externally. It is advisable not to be used by pregnant or lactating women. Religious importanceAmaranth is associated with immortality and is used to decorate god and goddesses. It is also used to repair broken heart. Woven into a wreath, it is said to render the wearer invisible. Also used in pagan burial ceremonies. HabitatThis 1 to 5 feet tall annual has to be sown inside soil to grow. It is generally not picky about soil type, and tolerates heat and drought well. AngelicaScientific name: Angelica archangelicaMedicinal valueIt is a herbal tea that is used to treat colic, gas, indigestion, hepatitis, and heartburn. It is also a remedy for afflictions of the respiratory system, liver problems and digestive difficulties. This herb also promotes circulation and energy in the body, often stimulates circulation in the pelvic region and also stimulates suppressed menstruation. It is advisable not to be used by pregnant women or diabetics. Religious importanceIf grown in garden it is believe this herb protects the garden and home. The leave is burnt to banish evil and root is used as protective amulet. It is also used to lengthen life and for protection against diseases and spirits. Adding it to a ritual bath will break spells and hexes. HabitatThis plant needs shade partially, rich and moist soil, wet bottomland, swamps and cool temperature grow. It grows to a 6 feet tall perennial. AniseScientific name: Pimpinellaa anisumMedicinal valueLike angelica this herb is good for the treatment of colic, gas, and indigestion. It is a trusted remedy for cough being the mildest of the herbs used for these purposes. Religious importanceIt is believed that if anise is blended with bay leaves it provide an excellent bath additive prior to ritual. Anise grown around the home keeps off evil and is it is placed in the sleeping pillow at night it chases away nightmares. Also in most parts of the world anise seed head is hanged on the bed pot to restore youth. HabitatIt prefers warm, sunny, rich sandy soil and well-drained areas. North America has an abundance of this annual plant with the height of 1-2 feet. It needs 120 days to produce fully ripened seed heads. AppleScientific name: Pyrus spp.Medicinal valueIt is used to treat constipation, lower cholesterol level, cures heart diseases and prevents infection if rubbed after crushing apple leaves on fresh wound. Religious importanceIt is used as a healing incense and an offering on samhain to the dead, since it is a symbol of immortality. Apple blossoms are used in love as well as gift for everlasting love. Apple wood is used to make magical wands. HabitatThe climatic conditions of North America are best suited for the growth of apple. A cool climate is just perfect for its growth. AstragalusScientific name: Astragalus membranaceousMedicinal valueThis herb strengthens metabolism and digestion, raises metabolism, aids in strengthening the immune system and is used in the healing of wounds and injuries. Apocynum (Black Indian Hemp)Scientific name: Apocynum cannabinum L. or A. androsaemifolium L.Medicinal valueIt is used to treat congestive heart failure as it contains cardio- active glycosides This herb doesn't have an edge over digitalis and hence is not advisable to be used by any human. HabitatThis perennial herb grows up to five feet tall in the climate of North America that is best suited for them. ArnicaScientific names: Arnica spp.Medicinal valueIf used externally this herb reduces inflammation and pain of bruises, aches, and sprains. While usage it must be kept in mind that internal application of this herb has a toxic effect on the heart and causes very high blood pressure. HabitatThe climate of meadows and mountainous regions of Europe and western North America is appropriate for the growth of this herb.

Medicinal valueIt is an astringent used to treat diarrhea and ease gum, mouth and throat irritation. A blend or tea of these leaves can be either drunk or used as a gargle or mouthwash. It is also an effective treatment for mucous membrane irritation and diarrhea but overdosing may cause excessive irritation of the stomach. HabitatIt is three feet in height and is widely cultivated in herb gardens and is native to the cleared meadows of Europe. BroomScienitfic name: Cytisus scoparius (L.) LinkMeidicnal value It has abundantly used as an alternative to marijuana, which has negative effects. It has an action of a diuretic but is not advisable to use it as a diuretic also. HabitatThe bets suited climate is of the Atlantic coast and the Pacific Northwest. BilberriesScientific name: Vaccinium myrtillus L. Medicinal valueIt is a food supplement and increases the visual acuity apart from preventing glaucoma, cataracts, and macular degeneration. HabitatThe herb height varies form six to twenty-four inches high, bear small, egg-shaped leaves with serrated margins and small, rosy flowers tinged with green. The hilly districts of Great Britain, northern Europe, and Asia have appropriate climate. Birch LeavesScintific names: Betula verrucosa Erh. or B. pubescens Erh.Medicinal valueThis herb is taken with a lot of water along. They act as a mild diuretic and are used for the treatment of kidney and urinary tract infections. HabitatThe colder parts of the Northern Hemisphere have plenty of growth of this herb. Also the Arctic and Alpine region have this herbs. BloodrootScientific name: Sanguinaria canadensis L. Medicinal valueIt is bets to use as a mouthwash as it helps reducing plaque cavities. HabitatEastern and Midwestern North America deciduous woodlands have this herb bloomed in spring season. BasilScientific name: Ocimum basilicumMedicinal valueThis herb is bets of the treatment of stomach cramps, vomiting, fevers, colds, flu, headaches, whooping cough, and menstrual pains. Furthermore, it reduces stomach acid and contributes to the cure of ulcers. To withdraw poison of insect bite from the body this herb is used externally. The herb is known for eliminating worms from the intestines and when applied in oil form to treat skin acne. Religious importanceIt is believed that basil is a protection against evil and negativity and helps in attracting and keeping love. Purification baths and in wealth and prosperity rituals basil is used. People believe that carrying a basil leaf in pocket brings wealth and if sprinkled over the spouse while sleeping, it removes infidelity from marriage. HabitatWell drained, rich soil and complete sun are the essentials for the growth of basil. Parts of North America have the perfect climate for this annual having a height of 2-3 feet. Pinch off the tips to promote bushiness and flower buds to maintain growth. BayberryScientific name: Myrica ceriferaMedicinal valueThis herb, strengthens blood vessels, increases circulation and also augments the vitality of the total body systems. Even vaginal infections can be cured by tea of Bayberry that stands good for gargle, sore throat and tonsillitis. Religious importanceIt is believe that oil of bayberry brings prosperity and luck. Bay LaurelScientific name: Laurus nobilisReligious importanceIt is believed that if this leaf is burned it will enhance psychic powers and produce visions. Moreover if worn in an amulet will provide protection from evil and negativity. People say that any wish written on bay leaf comes true.. BergamotScientific name: Monarda citriodoraMedicinal valueThis herb also known as Oswego tea and Bee Balm is good for the treatment of nausea, vomiting, cold and flu. If used in oil form is an effective treatment for acne, coughs, fevers, tension, stress, and depression. Religious importanceIt is believed that this herb is used in the rituals and spells for money and success. HabitatHaving all the characteristics of mint this herb of 2 feet tall height can be grown in pot or ground same way as mint and is a member of the mint family, so grow it as you would a mint. BistortScientific name: Polygonum bistortaMedicinal valueFor the treatment of diarrhea and dysentery the herb is boiled and drunk several times a day. It also acts as a dressing for cuts and wounds when mixed with echinacea, myrrh, and golden seal. Religious importanceIt is believed that an amulet fashioned of the root of Bistort is carried to fulfill the wish of conceiving. HabitatIt needs damp soil as of Europe. It is a perennial that reaches up to 30 inches tall. BlackberryScientific name: Rubus villosusMedicinal valueIt is an infusion of leaves that is good for the treatment of diarrhea and sore throat. It is often used as syrup prepared form the root. Religious importanceIt is believed that Blackberry leaves are used for money spells. HabitatFertile soil, full sun, no soggy soil and very good air circulation are the requirement for the growth of this plant. It is advisable not to grow this plant near other plants to avoid transferring diseases to the young vines. Black CohoshScientific name: Cimcifuga racemosaMedicinal valueFor the treatment of arthritis this herb is used a lot as it improves blood circulation. This herb is often used to cure delayed and painful menstruation besides being used as a conjunction with other herbs in treating menopause symptoms. It is advisable not to be used during pregnancy. Black Cohosh can be poisonous in large doses. Religious importanceIt is believed that if Black Cohosh leaves are laid around a room they drive away bugs and negativity. HabitatWindy Habitat, good soil, and partial shade is necessary for the growth of Black Cohosh. Georgia and Far West as Missouri areas are appropriate for the growth of this perennial, which reaches 3 - 8 feet tall. Blessed ThistleScientific name: Cnicus benedictusMedicinal valueIt is useful in strengthening heart and in all remedies for lung, kidney, and liver problems and also as a brain food for stimulating the memory. During menopause and for menstrual cramping and often for lactating women to stimulate blood flow to the mammary glands and increases the flow of milk, this herb is advised by ayurveda. HabitatAlong roadside or wasteland are the appropriate its growth. It is an annual and reaches to 2 feet tall. Blue CohoshScientific name: Caulophylum thalictroidesMedicinal valueTo regulate menstrual flow and suppressed menstruation this herb is used. This herb is also used to induce labor, also during childbirth to ease the pain and difficulty that accompany birthing, This herb should not be taken during pregnancy. HabitatMoist woodlands of southern Canada types are appropriate for its growth. The berry of this plant is poisonous and the plant itself can irritate the skin. The root is the part used in herbal medicine. BonesetScientific name: Eupatorium perfoliatumMedicinal valueThis herb is used for treating severe fevers, flu and catarrh conditions. Religious importanceIt is believed that an infusion sprinkled around the house drives away evil spirits and negativity. HabitatBoneset prefers damp to moist rich soils. It is a North American native perennial that reaches 2 to 4 feet high, and grows in partial sun. BorageScientific name: Borago officinalisMedicinal valueThis herb is used for treating bronchitis, rashes and to increase mother's milk. Religious importanceIt is believed that carrying fresh blossoms brings courage and its tea induces psychic powers. HabitatThe climate of Europe is perfect for its growth. This herb is an annual that grows in most soils, tolerates dry spells, and prefers full sun and reaching to 2 feet in height. BurdockScientific name: Arctium lappaMedicinal valueThis herb is used for the treatment of skin diseases, boils, fevers, inflammations, hepatitis, swollen glands, some cancers and fluid retention. It is an excellent blood purifier and its tea is used for indigestion. Helps clear persistent teenage acne if taken for three to four weeks. Religious importanceIt is believed that this herb is used for kicking off all sorts of negativity .

Medicinal valueThis herb is used for aiding digestion, promoting menses, increasing mother's milk and to add to cough remedies as an expectorant. Religious importanceIt is believed that caraway is used as an amulet for protection, it promotes memory and guards against apart promoting lust when baked into breads, cookies, or cakes. HabitatThe meadows, woods and rocky areas with rich soil are perfect for the growth of this plant. Areas of Europe, Asia, Africa and North America are appropriate regions for proper growth of this biennial that reaches 1 1/2 - 2 feet high. Cascara SagradaScientific name: Rhamnus purshiana Medicinal valueThis herb is used treating chronic constipation, stimulating digestive system and is safe as a laxative. It is used for treating intestinal gas, liver and gall bladder complaints and enlarged liver also. Religious importanceIt is believed that this herb if sprinkled around the home before going to court it helps to win the case and is also used in money spells and in repelling evil and hexes. HabitatCascara Sagrada is a tree that is native to the Pacific Northwest regions of North America. CatnipScientific name: Nepeta cataria Medicinal valueFor home remedies for colds, flu, fevers, upset stomach and insomnia, particularly good for children with upset stomachs in a very mild infusion this herb is a very effective medicine. Religious importanceIt is believed that the large leaves, well dried are used to mark pages in magical books. They are also used in conjunction with rose petals in love sachets to create a psychic bond between you and your cat. HabitatMoist soils like the one throughout North America is appropriate for the growth of this perennial reaching to 3 feet high. Cat's ClawScientific name: Uncaria tomentosa Medicinal valueThis herb is also known as una de gato and is used for the treatment of arthritis, gastritis, tumors, dysentery, female hormonal imbalances, viral infections. This herb should not be taken by those who have received an organ transplant or by pregnant or nursing women. CayenneScientific name: Capsicum spp. Medicinal valueFor herbal use, the peppers are usually ground into a powder and mixed with other powdered herbs in capsules. This herb is used for all sorts of arthritis and muscle aches and it also benefits heart and circulation when taken alone or added to other remedies. This herb normalizes blood pressure and is good for ulcer. It is used in antibiotic combinations, for menstrual cramps and as a part of treatment for depression. Religious importanceIt is believed that Cayenne pepper scattered around your house breaks bad spells. Adding it to love powders will ensure that your love will be spicy, and can inflame the loved one with passion. HabitatGood, rich soil, plenty of water and full sun are perfect for this herb's growth. The peppers are dried after ripening. CedarScientific name: Cedrus spp. Religious importanceIt is believed that this herb is used in rituals to attracts money and is also used in purification and healing. It is a symbol of power and longevity. If this herb is hung in home it protects against lightning. Juniper can be used in place of cedar. HabitatThroughout the world a variety of cedars grow and hence each variety has a typical type of climate that suits its growth. ChamomileScientific name: Matricaria chamomilla (German chamomile), Anthemus nobilis (Roman chamomile) Medicinal valueThis herb is used as tea for nerves and menstrual cramps. The tea is also useful for babies and small children with colds and stomach troubles. For inducing sleep in insomniac conditions and wash sore eyes and open sores this herb is advised. Religious importanceIt is believed that this herb attracts money and if added to incense produces relaxed state for better meditation. If it is added to a ritual bath it is said to attract love. HabitatChamomile is an annual that adapts to most soils, likes lots of water and full sun. It grows up to 20 inches tall. ChickweedScientific name: Stellaria media Medicinal valueThis herb is an excellent source of many B vitamins and various minerals and thus is used to treat bronchitis, pleurisy, coughs, colds and as a blood builder. Externally it is good for skin diseases, and the tea added to the bath is good for soothing skin irritations and rashes. Religious importanceIt is believed that if this herb is carried or used in spells it attracts love and maintains relationship. HabitatThis annual herb grows throughout temperate areas of North America and Europe as it prefers full sun, average to poor soils and infrequent watering. CinnamonScientific name: Cinnamomum zeylanicum Medicinal valueThis herb is used for acute symptoms, as this herb is a stimulant to other herbs and the body, enabling herbal remedies to work faster. It is a blood purifier and an prevents infections. . Religious importanceIt is believed that if this herb is burned in incense, cinnamon will promote high spirituality. It is also used to stimulate the passions of the male. Clover RedScientific name: Trifolium pratense Medicinal valueThis herb is used as a nerve tonic, as a sedative for exhaustion, to strengthen children with weak systems and is used with children for coughs, bronchitis, wheezing, as it is mild to their systems. In combination with other drugs it is used for the treatment of cancer and for skin eruptions (acne). Religious importanceIt is believed that this herb brings luck, prosperity and health. Carrying a three-leaf clover gives you protection and if worn over the right breast it will bring you success in all undertakings. HabitatClover being an excellent cover crop is planted in fallow areas and turned under in the fall, it makes an excellent fertilizer for poor soils. ClovesScientific name: Eugenia caryophyllata Medicinal valueThis herb stops toothache when it is applied directly to the cavity as oil. It is very useful with people who have cold extremities. Cloves promote sweating with fevers, colds, and flu and are often used in remedies for whooping cough. Cloves are also safe and effective for relieving vomiting during pregnancy. Religious importanceIt is believed that Clove worn in an amulet drives away negativity and hostility and stop gossip. It is often carried to stimulate the memory and can be added to attraction sachets. It is placed in sachets with mint and rose to chase away melancholy and to help one sleep soundly. ColtsfootScientific name: Tussilago farfara Medicinal valueThis herb is used to treat respiratory problems and acts as a soother for the stomach and intestines. A combination of horehound, ginger, licorice root and Coltsfoot soothes throat when used as a cough syrup. Religious importanceIt is believed that this herb is added to love sachets and is used in spells for peace and tranquility. HabitatThis herb prefers damp, clay soil along with partial sun. height ranging from 5 to 18 inches this herb is a perennial. ComfreyScientific name: Symphytum officinale Medicinal valueBesides being a healer for wounds, burn, sores and bruises when applied as an ointment Comfrey is an effective remedy for coughs, ulcers, healing broken bones, sprains and asthma. It must be kept in mind that large dosages can cause liver damage and if used externally it should be used as tea rather than capsules. Religious importanceIt is believed that Comfrey ensures safe travelling and if put in some luggage it prevents it from being stolen and brings good luck to the carrier. HabitatWell-drained soils and partial shade are the requirements of this 3 feet high perennial that has its growth from Canada to Georgia and Far West as Missouri, in the wild. CornflowerScientific name: Centaurea cyanus Medicinal valueThe juice of the stem of this herb treats wounds and cuts. Religious importanceIt is believed that Cornflower promotes and enhances psychic sight and normal sight as well. HabitatThis 2 feet tall, annual herb is adaptable to many types of soils and climatic conditions. Cramp BarkScientific name: Viburnum opulus Medicinal valueThis herb is mainly used for treating feminine problems like aiding menstrual cramps, after birth, preventing miscarriages and internal hemorrhages and is used as an uterine sedative also.

Medicinal value This herb regulates the female cycle of menstruation, stimulates sexual appetite and is good for urinary problems, nervousness and hypertension. Religious importance It is believed that the infusion of this herb incites lust and produces vision when burned. DandelionScientific name: Taraxum officinale Medicinal value This herb is good for proper functioning of liver as it clears obstructions (such as stones) and detoxifies poisons that gather in liver, spleen and gall bladder. This herb finds its utility in treating premenstrual syndrome, as a diuretic, to reduce cholesterol and uric acid and to clear skin eruptions when used both internally and externally. Religious importance It is believed that it is the sign of rain when a ripened dandelion falls. The seeds of this herb are also considered as carriers that carry thoughts to a loved one, near or far. Habitat Areas that are effected by chemicals like roadside are not appropriate for the growth of this herb. This herb can be grown in clean environment of personal yards and gardens. DillScientific name: Anethum graveolens Medicinal value Dill is an herb effective for the treatment of colic, gas, and indigestion. Religious importance It is believed that burned dried seeds of this herb protects home and a bath with one drop of this herb in water makes being loved irresistible and hence is used in love and protection sachets. Habitat The climate, frequent watering and well-drained soil of North America is perfect for the proper growth of this annual 2 - 3 feet tall herb.Dong QuaiScientific name: Angelica sinensis Medicinal value Being a uterine tonic and hormonal regulator this herb is an effective herb for female reproductive system. And is often used in premenstrual syndrome formulas as well as menopausal formulas. Dragon's BloodScientific name: Daemonorops draco Medicinal value This herb's resin has an external use as a healer and to stop bleeding apart from being used internally for chest pains, post-partum bleeding, internal traumas, and menstrual irregularities. Religious importance It is believed that this herb is used in love sachets and incenses to bring back love and increase the potency of other herbs.

Medicinal value This herb is used as a natural antibiotic and immune system stimulator, helping to build resistance to colds, flu and infections. It increases the production of white blood cells, and improves the lymph glands. The tea from this herb should be used in all infections and has been used in treating skin cancers and other cancers. Religious importance It is believed that Echinacea is used as an offering to the spirits or gods and goddesses to strengthen a spell or ritual. Habitat This herb for its growth prefers the prairies, open and dry places. It easily adapts to most soils and grows in full sun. The area of North America is perfect for the growth of this perennial that reaches to about 2 feet tall. Elder Scientific name: Sambucus nigra Medicinal value This herb is an internal cleanser when fighting flu and colds. Acne can also be treated with this herb when taken as a tea Elder flower oil is a remedy for chapped skin and is also used to cleanse the body, build the blood, treat inflammation, fever and soothe the respiratory system. Being an antiseptic it heals external wounds and is also used as an insect repellant. Fresh Elder's stem has cyanide and hence should not be used internally by pregnant or lactating women. Religious importance It is believed that if this herb is scattered in all wind directions it brings protection, can be used for magical wands for ritual. In Denmark, it is believed to be unlucky to have furniture made of elder wood. It is used at weddings to bring good luck to the newlyweds. Habitat With a height up to 30 feet, this shrub prefers moist areas throughout North America. Elecampane Scientific name: Inula helenium Medicinal value This herb is an effective remedy for treating intestinal worms, water retention and to lessen tooth decay and firm the gums. This herb can be externally used for washing wounds and itching rashes. It is burned to repel insects. Religious importance It is believed that this herb adds to love charms and amulets of all kinds. Habitat The mushy and damp soil of roadsides and pastures is appropriate for the growth of this perennial that grows 3 - 6 feet tall. Eucalyptus Scientific name: Eucalyptus globulus Medicinal value This herb has antiseptic values when used as an oil and is used to treat pyorrhea (gum disease) and prevent infections after burning. The oil and steam of leaves if breathed in will help clear the sinuses. When mixed with water or vegetable oils, it makes a good insect repellant. Religious importance It is believed that this herb has healing energies and a branch or wreath over the bed of a sick person helps spread the healing energies and its oil if added to healing baths, and for purification. Habitat Capable of reaching heights till 250 feet this is among one of the tallest trees of the world with the adaptability to several soil conditions this thrives only in areas where the average temperature remains above 60 degrees Evening Primrose Scientific name: Oenothera biennis Medicinal value This herb's oil stimulates to help with liver and spleen conditions. Even Multiple Sclerosis, low blood pressure, pain of angina can be cured by it besides being an element to slow the production of cholesterol. It is a valuable part of an herbal remedy for treating the symptoms of pre-menstrual syndrome (PMS) and menstrual cramping. Habitat The American variety found throughout North America prefers dry soils and full sun. It is a biennial, and grows 3 - 6 feet tall. Eyebright Scientific name: Euphrasia officinalis Medicinal value This herb stimulates the liver to remove toxins from the body and can be used externally and internally to treat eye infections and afflictions such as pink- eye. The herb strengthens the eye, and helps to repair damage. Religious importance It is believed that Eyebright is used to make a simple tea to rub on the eyelids to induce and enhance clairvoyant visions. Habitat Being adaptable to many types of soil Eyebright needs full sun for proper growth. It is a small annual that has a maximum height of 2 - 8 inches.

Medicinal value This herb is used sooths very delicate stomach and stimulates the reproductive organs in women and men. This herb is very important for use during menopause, due to its positive effects on uterine disorders, headaches and depression. Habitat False Unicorn grows primarily in very moist areas and partially shady areas of North America. FennelScientific name: Foeniculum vulgare Medicinal value This herb is used as a sedative for kids. It also improves digestion, cures cough and takes away appetite. It is used for cancer patients after radiation and chemotherapy treatments and enriches the flow of milk for lactating women. Religious importance It is believed that fennel is used for scenting soaps and perfumes to ward off negativity and evil. Habitat Dry, sunny climate and average poor soil is appropriate for the growth of this perennial that can reach 4 - 6 feet high. FenugreekScientific name: Trigonella foenum-graecum Medicinal value This herb is used to soften and expel mucous whereas its antiseptic properties kill infections in the lungs. It helps reducing fever when taken with lemon and honey and also nourishes the body during illness. It is used to relax the uterus and can be taken by pregnant women. Religious importance It is believed that this herb's seeds when added to mop water to clean house floors it brings money. Habitat Dry, moderately fertile soil and sunny location is all that is needed by this annual for a growth of 1 - 3 feet. FeverfewScientific name: Tanacetum parthenium Medicinal value This herb is used for the treatment of cold, fever, flu, digestive problem, to end migraines and other headaches. Religious importance It is believed that Feverfew is carried for protection against illnesses involving fever as well as for preventing accidents. Habitat This biennial or perennial herb for its growth of 2 1/2 feet requires all dry places, poor soil and full sunFlaxScientific name: Linum usitatissimum Medicinal value This herb is used for maintaining cardiovascular health, to help in menopause and as a mild laxative, apart from being used in seed form for the treatment of cancer. The oil helps slow the kidney disease that accompanies lupus. Religious importance It is believed that this herb is used for healing spells and rituals and to attract money and wealth. Habitat The climate of North America is perfect for the growth of Flax, an annual that grows to 3 feet high and is adaptable to many soils and conditions. FrankincenseScientific name: Boswellia carterii Medicinal value This herb relieves menstrual pains, rheumatic aches and pains. Externally it is used for liniments and for its antiseptic properties. Religious importance It is believed that if Frankincense is burned, it raises vibrations, purifies and exorcise to aid meditations and visions. The essential oil is used to anoint magical tools, altars, etc.

Medicinal value This herb is used to cure insomnia, prevent miscarriage, heart ailments, strengthening muscles, prevent arteriosclerosis, angina, poor heart action and for treating nervousness. Religious importance It is believed that the leaves are used to make protection sachets that if carried ensure good fishing. It is incorporated into spells and rituals for fertility and for protecting home from damaging storms. Habitat With a height reach of 40 feet this herb grows throughout North America and is tolerant to most soils but prefers alkaline, rich, moist loam. Hazel Scientific name: Coylus spp. Religious importance It is believed that the branches of this herb are used for divining and the wood makes wonderful wands. Hazelnuts if hung in the house bring luck and can be carried to cause fertility. Habitat For proper growth the Hazelnut trees should be planted in a well-drained, fertile, and slightly acid soil in any place with temperature below -10. Heather Scientific name: Calluna spp. Medicinal value This herb when made to tea suppresses cough and aids sleeplessness. Religious importance It is believed that heather if carried guards against rape and violent crime and if burned with fern it brings rain. Habitat This evergreen shrub with 1- 2 feet height prefers rocky or sandy soils and full sun for proper growth. Henbane Scientific name: Hyosycamus niger Medicinal value This herb is used to stop pain, lessens perspiration. As it is very toxic it is not advisable for use by pregnant women or weak children and must be taken in extremely small amounts for external use only and not on a regular basis. Religious importance It is believed that this herb if thrown into the water to bring rains. Habitat Due to the toxic nature it is not grown in home gardens but the climate and conditions throughout North America is perfect for its growth. Holly Scientific name: Ilex spp. Religious importance It is believed that holly is used as a protective plant and is used as decoration during the Yule season. It is said that if holly water is sprinkled on newborn babies it protects them. Habitat Sandy soil as well as acidic soil with full sun are just appropriate conditions for the growth of this 4 feet tall herb. Hops Scientific name: Humulus lupulus Medicinal value This herb is a sedative used for treating insomnia, coughs, bladder ailments, liver ailments and nervous tension. It is used in brewing beer and ales. Externally it is used to treat itching skin rashes and hives and it also removes poisons from the body. Religious importance It is believed that Hops is used in healing incenses and if included in sleep pillows it induces sleep and pleasant dreams. Habitat This herb is adaptable to many types of soil, prefers full sun and being a perennial has growth of 30 feet in height. Horehound Scientific name: Marrubium vulgare Medicinal value This herb is used as a home remedy for children's cough and as a tonic for the respiratory system and stomach. In large doses it acts as a laxative. Religious importance It is believed that this herb is used in incenses for protection and in exorcisms. Habitat Dry sandy soil and full sun and full sun is good for the growth of this perennial (except in very cold climates) that reaches to 3 feet tall and needs little water, tolerates poor soils and blooms during its second year. Horseradish Scientific name: Armoracia lapathifolia Medicinal value Herb oil is used to massage away muscular aches and help loosen chest congestion. It can be used to warm a cold body, and to clear up drippy sinuses. Religious importance It is believed that Horseradish is part of the Jewish Passover ritual and it repels evil around the home and property. Habitat By the second year this perennial plant grows to a height of 2- 3 feet throughout the world. Horsetail Scientific name: Equisetum arvense Medicinal value This herb is used for treating urinary tract infections, aid in coagulation, decrease bleeding, help broken bones heal faster, help brittle nails and hair and treatment for rheumatoid arthritis. When the plant boiled in water it makes an effective foot soak for tired feet and for the treatment of athlete's foot. It is advised to be not used by pregnant or nursing. Religious importance It is believed that whistles made from the stalks of Horsetail are used to call the spirits. Habitat Swamp and damp soils with full sun to partial shade are perfect for normal growth of this herb with a height of 1 - 2 feet. Hyssop Scientific name: Hysoppus officinalis Medicinal value This herb is used for treating lung ailments, aid in healing of wounds, soothe sore throats and inhibit the growth of the herpes simplex virus. Religious importance It is believed that Hyssop is used in purification baths and rituals and is used to cleanse persons and objects. Habitat This herb prefers dry conditions, tolerates most soils and full sun. It is a perennial shrubby plant growing to 3 feet tall and belongs to the mint family.

Medicinal value This herb is used to cure all kinds of chest ailments and nourish the weak, elderly and weak children. Habitat This herb prefers cold, humid mountain areas and wood lands and has a height of 4 inches. Ivy Scientific name: Hedera spp. Medicinal value This herb is used as an effective remedy for treating sores, ulcers and other skin eruptions externally. Religious importance It is believed that if Ivy is grown outside the home it acts as a guardian and protector and if worn by brides it brings luck to the marriage. Habitat This herb is found all throughout North America and can adapt to different types of soils.

Medicinal valueThis herb is used for treating insomnia, nervousness, relieving stress after injury, for pains associated with nerve and skin diseases. Large doses can create a toxic substance in the liver. Religious importanceIt is believed that the tea of kava kava is drunk to offer protection against evil and to invite good luck. HabitatThis plant is found in the South Pacific tropical islands and has a height of 8 to 20 feet.KelpScientific name: Fucus versiculosus Medicinal valueThis herb strengthens and promotes the glands, controls the thyroid and regulates metabolism. It is a terrific boost for pregnancy and good for child's development. HabitatBest found in stores as this is a sea weed that grows in the ocean.

Medicinal valueQueen Anne's Lace is used for treating gallstones, kidney stones, water retention, strains and sprains. It is also called Wild Carrot.HabitatQueen Anne's Lace is found throughout most of North America. It is a biennial that grows to 3 feet tall.

The Life of Ancient Egyptians
For Every Malady a Cure

Of all the branches of science pursued in ancient Egypt, none achieved such popularity as
medicine. Homer put it aptly in the Odyssey (IV, 229-232):
That fecund land brings forth abundant herbs, Some baneful, and some curative when duly mixed.
There, every man's a doctor; every man Knows better than all others how to treatAll manner of disease ...
There was even a degree of specialization quite remarkable for the time, if we are rightly
informed. Herodotus (II, 84) asserts that "The practice of medicine is so divided among them that
each physician treats one disease, and no more. There are plenty of physicians everywhere. Some
are eye-doctors, some deal with the head, others with the teeth or the belly, and some with
hidden maladies...'
The usual term for a doctor was sunu, written with an arrow-shaped symbol that, it had been
suggested, was an allusion to the use of arrowheads to lance abscesses. Some doctors belonged to
the priesthood, including priests of the goddess Sakhmet, patroness of diseases, remedies and
physicians, and of the lector-priests (khery-heb). Some again were counted among the scribes, as
shown in such titles as 'chief doctor and scribe of the word of god'. Many enjoyed ecclesiastical
as well as lay titles.
Like other professions doctors had their hierarchy. Besides ordinary doctors there were senior
doctors, inspectors, overseers and masters of physicians and the 'Chief of Physicians of the
South and the North', a kind of minister of health. Royal and palace doctors had their special
hierarchy and titles.
The Belgian scholar Frans Jonckheere counted 82 doctors known by name, many with titles
suggesting specialization in some defined area. Hermann Grapow, however, is probably right in
thinking of them as simply exemplifying the various skills which the doctor might possess.
Thus the 6th-dynasty court physician and high priest Pepyankh, known as Iry, was not only
'doctor to the king's belly' and 'shepherd of the king's anus', but also 'the king's eye-doctor'.
There has been much dispute recently as to whether dentistry ranked as a separate calling; there
are only five references to it in the Old Kingdom and another isolated one in the 2 6th dynasty.
Nor has it yet been settled whether any of the doctors known to us conducted research.
There were no female nurses to help the doctors, but we do know of male nurses, dressers,
masseurs and lay therapists. It would be wrong to see connections between the medical profession
and that of the embalmers, priests of the god Anubis. Contrary to older ideas that Egyptian
doctors took part in the preparation of mummies to improve their knowledge of anatomy, it must be
re-emphasized that most of their information came from ancient texts in which descriptions of the
internal organs were based on analogy with animal bodies.
The embalming procedure had nothing in common with medical autopsies. The physician learnt his
trade in the Houses of Life, notably at Per Bastet in the New Kingdom and at Abydos and Sais in
the Late Period. He was no doubt given some practical experience, but chiefly he had to study
what was already written. As the Ebers Papyrus says: 'His guide is Thoth, who lets the scrolls
speak for themselves, compiles treatises and expounds knowledge to the savants and doctors who
follow in his path.'
Diodorus too confirms this (I, 82, 3): '[They] administer their treatments in accordance with a
written law which was composed in ancient times by many famous physicians.' From his further
statement that 'on their military campaigns and on their journeys in the country they all receive
treatment free of charge', it appears that for some people, at least, there was a system of free
medical aid, such as we know existed also at Deir el-Medina. But on other occasions doctors
expected to be handsomely reimbursed, as we can tell from a scene in the I 8th-dynasty tomb of
the doctor Nebamun at Dra Abu el-Naga. There we see a patient, supported by his wife, (both
dressed in Syrian style), being handed some medicine by Nebamun's orderly.
Behind this group and on another register is a file of servants bringing the doctor his fee - a
copper ingot, a set of vessels (full, no doubt) and several little slave-girls.
The medical texts were not only the fount of professional knowledge but an insurance against
possible failure. Diodorus saw this clearly (I, 8 2): 'If they follow the rules of this law as
they read them in the sacred book and yet are unable to save their patient, they are absolved
from any charge; but if they go contrary to the law's prescriptions they must submit to a trial
withdeath as the penalty.'
Of the eight extant medical compendia the most important is the Ebers Papyrus, a collection of
about 700 prescriptions for treating internal diseases arranged according to the organ concerned.
This was built up between the 4th millennium BC and the New Kingdom through the continual
addition of fresh material. The Hearst Papyrus, by contrast, probably represents the memoranda of
a practicing doctor of the I 8th dynasty in which he had written out remedies from other works,
the Ebers Papyrus among them.
The Edwin Smith surgical papyrus shows a profound empirical knowledge of the different types of
injuries and how to treat them: this is a copy from the Second Intermediate Period of a work at
least 1000 years older. Other medical documents include the Great Berlin Papyrus, the London
Papyrus, Chester Beatty Papyrus NO.VI, Papyrus Ny Carlsberg NO.VIII and theKahun Papyrus, the last dealing with gynecology. These are largely copies of Old Kingdom
treatises made during the Middle and New Kingdoms.
Examination of both medical and non-medical documents has convinced many investigators that the
ancient Egyptians knew their anatomy in fair detail. In addition to externally visible features
there are many names of internal organs well known from butchery and cooking.
Notions of physiology and disease were all anchored in the concept of the heart as the center of
the organism. It was the site of the soul, the reasoning faculty, qualities of character, and
emotions. It was through the heart that god spoke, and the Egyptian received knowledge of god and
god's will. The heart was one's partner: it spoke to a person in his or her solitude.
It was at the same time the engine of all the bodily functions, not only of one cardinal
function, the circulation, as modern science revealed. From the heart proceeded channels (metu)
linking all parts of the body together.
These channels, the Egyptians believed, conveyed not only the blood, but also air (reaching the
heart from the nose, they thought), tears, saliva, mucus, sperm, urine, nutriment and feces, as
well as harmful substances (wehedu) conceived to be the agents of pain and illness. Not only
blood vessels were considered as metu, but also the respiratory tract, tear duct, ducts of
various glands, spermatic duct, the muscles, tendons and ligaments.
The female organs were likewise seen as tubes open into the internal cavity; the eye was supposed
to communicate with the car and the only purpose of the brain was to pass mucus to the nose,
with which it was also thought to be connected. The Egyptian idea of the human body, then. was as
a network of interconnecting channels and analogous to the branches of the Nile and the
artificial canals of their own country. It was soon realized that in some of the metu the heart
'spoke' and a doctor could 'measure the heart' from this beat. But he could only tell if the
heart was going faster or slower by comparing the patient's pulse with his own.
The concept of circulation was still beyond the Egyptians' knowledge, since they did not
distinguish between arteries and veins, nor appreciate that the blood returned to the heart. The
precondition of good health, they thought, was free flow through the metu: ailments arose when
they became blocked, just as with irrigation canals.
Thus if a woman was infertile this was because the sexual channel was closed, and constipation
or accumulation of the blood were likewise causes of disease. Harmful substances might find
their way into the metu through the natural orifices, mainly by the ingestion of bad food. But
they could also originate inside the gut, and doctors were therefore much exercised to ensure its
regular evacuation. Sometimes seeing worms in the stool, they deduced that these too might have
come into the body through the mouth and cause a disease.
With externally visible damage like wounds and fractures the causes were often obvious. But with
many internal ailments doctors were at a loss, so they imputed them to irrational influences,
usually gods - either hostile and malignant deities, or well-intentioned ones who sent down
plagues as a punishment for wrongdoing. Sickness might also be the work of evil demons, or of an
envious neighbor's evil eye.
It would far exceed the scope of this chapter even to enumerate the diseases of ancient Egyptians
that our researches have so far revealed. The evidence comes from several sources; from
identification of their names and from their description in the texts, from their characteristic
appearance in portrayals of the human body, from the study of pathological tissues in mummies
and, in the case of diseases of bones and teeth, from the examination of human skeletal remains
from burial sites. The study of all these sources constitutes the recently defined discipline of
paleopathology.
According to medical texts the ancient Egyptians recognized some 200 types Of sickness, though
there is no mention of diseases of the lungs, liver, gall-bladder, spleen, pancreas or kidneys -
the symptoms evidently eluded them. We can of course never be sure what any named disease refers
to unless its symptoms or recommended treatment are mentioned in the same context.
The descriptions of external lesions and in particular of wounds are fairly clear. A wound is
said to have a 'mouth' and 'lips' and may 'go as far as the bone'. It is usually accompanied by
bleeding, which in the case of severe injuries to the skull, may come from the nose and ears too.
The Ebers Papyrus (Case 8) mentions that a skull fracture hemorrhaging into the brain can cause
paralysis, on the same side of the body it says, not the opposite side - perhaps this was a
copyist's error.
The Smith Papyrus (Case 7) quotes a man with a gaping head-wound as showing the symptoms of
tetanus: 'His mouth is locked tight ... his brow is convulsively contorted and he has the
expression of a man crying.' The Egyptians distinguished simple fracture, sedj, where the bone is
broken in two, and complicated fractures, peshen, resulting in numerous fragments.
Conditions characterized by a bulging of the affected part were classified either as shefut,
commonly translated as 'swellings' but in view of some scholars references to a liquid content
possibly including abscesses too, or as henhenet and aat, thought
to denote tumors. The former were treated with dressings, the latter by excision. Most of the
ophthalmic and internal maladies mentioned in the texts are difficult to identify with certainty.
The only unambiguous ones are constipation, inflammation of the rectum, cystitis, and blood in
the urine, usually due (in Egypt) to bilharzia, equated by Ebbell and Jonckheere with the disease
aa.
We are on safer ground where we can find illustrations drawn by artists with a feeling for
characteristic changes of appearance. The Queen of Punt, familiar to us from a relief in the
temple of Hatshepsut at Deir el-Bahari, suffered from abnormal obesity, probably lipodystrophy.
The eunuchoid appearance of Akhenaten towards the end of his reign suggests Frohlich's syndrome
resulting from malfunction of the pituitary gland or of the mesencephalon, most probably due to a
tumor. There are many depictions of dwarfs, distinguishable from the ethnic pygmies of Africa by
their abnormal proportions.
One important achievement has been the examination of fragments of lung tissue overlooked by the
embalmers when they were removing the soft parts from inside the body. It has shown that Egyptian
lungs, like ours, contained coal dust in the lymphatic nodules (anthracosis), probably through
inhaling smoke from open fires. Hypertrophied connective tissue between the alveoli, and the
lymphatic vessels of other mummies proved to contain minute sharp-edged particles of silicates,
felspars and other granite minerals (silicosis).
In other cases lungs were found to be covered with dust of fine desert sand (pneumoconiosis).
Other mummies again showed changes characteristic of pneumonia, sometimes complicated by
pleuritis or pericarditis.
The Life of Ancient Egyptians
Bounty of the Black Earth
The Egyptian landscape is scenically among the most extraordinary in the world. A relatively
narrow strip of fertile valley spreads out into the Delta in the north, and to the south cuts
through the endless expanse of the Sahara.
Its fertility does not depend on the amount of rainfall, which suddenly decreased from the end of
the Neolithic wet phase in Upper Egypt and Nubia till it virtually came to a stop. Regular floods
bring about the Nile valley's annual miracle, when nature is reborn and the fields turn green and
then gradually golden with the harvest.
As early as the fifth millennium BC, the Egyptians realized the extraordinary fruitfulness of
their fields and the secret behind it - the deposits of black silt borne down by the river in
flood time. Hence they called the soil of the Nile valley 'black earth' (kemet), as distinct from
the 'red earth' (deshret) of the desert.
In their black land they felt content and safe. They were satisfied that a host of gods,
originally regional gods, kept guard over its fertility and that Khnum, the god of the First
Cataract, would ensure the punctual onset and adequate height of the flooding. The regular cycle
of natural events conferred a rhythm on their lives which was part of the maat, the eternal order
of things.
The red land, by contrast, was to be shunned as far as possible. From the western wilderness a
scorching, destructive wind, the khamsin as we now call it, would sometimes blow down on them.
Then, as now, it would raise clouds of fine sand and dust, blinding men and animals alike, and
sometimes drying out their fields.
No wonder they saw the desert as the domain of malignant forces disruptive of the established
order and personified in the Late Period by the baneful god Seth. It was of course the peasant
farmer whose links with the soil were strongest. He had learnt to cultivate it to perfection and
gradually extended the area of his fields to wherever the annual floods reached. He would clear a
course for as much water as he needed and steer the surplus back to its riverbed. In the passage
of time the size of his harvests and his herds grew to the point where, even in predynastic times
(4000--3000 BC), part of the population could turn to other employment.
This second social division of labor (following the first, that between men and women, which went
far back into prehistory) continued up to the threshold of the historic period. But even then the
majority of the population was still tied to agriculture and the rest of society lived on its
produce.
Egypt is the 'gift of the Nile' and her harvests depend on its floodwaters. These were the
fundamental pacemaker of the Egyptian farmer's life. It was the farmer, above all, who hadvested interest in the calendar, an invention which - thanks to the regularity of natural events
- this country was one of the earliest in the world to possess.
People knew from long experience that this was about the time for the level of the Nile to start
rising. Just before this, flocks of white ibises would have appeared on the fields as they
returned from the south. If they came late or not at all, farmers would see this as a bad omen
foreshadowing low floods and a poor harvest. So they regarded the wise bird that knew the secret
of this vital phenomenon as an embodiment of the learned god Thoth.
The Nile floods are in fact triggered by sudden monsoon downfalls on the Ethiopian plateau, the
source of the Blue Nile, and to a lesser extent by those around Lake Victoria and the Ruwenzori
mountains where the White Nile originates. Heavy rain and surging waters bring down the fertile
soil which the overflowing Nile then slowly deposits over the fields in its calm lower reaches.
Chemical analysis explains the fertility of the Nile mud, containing as it does all the important
ingredients which would otherwise have to be added to the soil by artificial manuring. Egyptian
farmers prayed to the hermaphrodite god of the Nile, Hapy - portrayed as a man with women's
breasts in symbolism of the apparently spontaneous fruitfulness of the river and its flood-plain
- to ensure that the yearly inundation were just right: not too deep, not too shallow.
If they were too shallow, the floods would not reach the thirsty fields, but if too much water
came rushing down it would sweep away the laboriously constructed dykes, tear up the fields, and
even threaten low-lying villages.
According to the theory accepted until quite recently, it was the very need for centrally-managed
canal construction and maintenance, and central allocation of water supplies, that played the
paramount role in bringing about the rise and continuance of the ancient Egyptian state. This
view ascribed the chief decision--making power to the king and his vizier, detailed supervision
of the work being entrusted to officials chosen from among the nobility and scribes.

It was even proposed by the Polish archaeologist Krzyzaniak that artificial irrigation started as
early as the second half of the Predynastic Period. As evidence that canals existed even before
the country was unified many writers have adduced the mace-head of King Scorpion, one of the last
rulers of a separate Upper Egypt, which may depict him officiating at the ceremonial opening of a
new canal.
Recently, however, the evidence for artificial irrigation has been analyzed independently by two
German archaeologists, Erika Endesfelder and Wolfgang Schenkel. The first-named has noted that
pyramid texts (the oldest being on walls of late 5 th-dynasty pyramids) do use the terms for
'canal', mer and henet, but only in the context of waterway traffic. Schenkel agrees that canals
existed in the Old Kingdom for traffic, and possibly also for the drainage of marshes.
Royal decrees of the 6th and gilt dynasties make no mention of labor squads being seconded for
the construction of irrigation canals, but simply make the distinction between two kinds of
fields: those that were flooded every year, and higher-lying ones that only came under water in
years of exceptionally high flood.
A part from reliefs showing gardeners watering vegetable patches as in the mastaba of Mereruka,
there are no scenes in Old Kingdom tombs of artificial field-irrigation or canal- and
dyke-building.
It appears indeed that no artificial irrigation was needed as a rule up until the end of the
Neolithic wet phase around 2350 BC. The Nile floods functioned quite regularly, supplemented by
occasional rain. It was only a series of low floods during the First Intermediate Period, when
rain ceased falling in Upper Egypt too, that famine occurred and radical measures were clearly
needed.
Water from this canal would have been distributed over the fields by the system of
basin-irrigation to be described later. It is under the Middle Kingdom that we first come across
terms for irrigation-- related works: a (canal), meryt (embankment), denyt (dyke) and others. In
contrast to the earlier notion that irrigation was a centralized affair, recent findings show
that it was promoted by local initiative which sometimes exacerbated parochial rivalry.
Canal-building, maintenance and water allocation were in fact managed by local consortia with no
one higher than a regional prince at the head. Nor do any later documents suggest the existence
of a central state institution dealing with these matters and we find no relevant titles in the
biographies of nobles or priests. On the contrary, every peasant had a share of responsibility
for water--management.
The Book of the Dead expressly makes it a great offence to obstruct another person in the use of
water or illegally to block his supply. If the central authorities concerned themselves over the
height of the Nile floods it was likely to be for fiscal reasons (since it was the basis of
harvest forecasting) or religious ones. But they were of course involved in any projects of
nation-wide importance.

Thus some investigators believe that a dam was built below Memphis soon after the town was
founded as the capital of a united Egypt. In the course of the 3rd and 4th dynasties the area of
land under cultivation grew through 'internal colonization', namely the draining of the Delta and
the utilization of land previously lying untitled.
In inter-flood periods water would flow out of this lake onto the surrounding fields through a
system of irrigation canals. The extension of cultivated ground in the Faiyum was completed under
the first Ptolemaic kings.
The development of an irrigation canal network made possible not only improved supplies of water
to fields that had enjoyed Nile flooding in earlier times but, more importantly, an increase in
the arable acreage in more remote and elevated areas. While under the Old Kingdom only natural
irrigation had existed, in the Middle Kingdom a distinction could be made between low-lying
fields flooded by nature and higher land watered artificially.
In the New Kingdom two further categories were recognized, of 'used' and 'fresh' fields.
Herodotus, who had personal knowledge of Egypt in the 5th century BC, evidently saw it during the
period of copious flooding. Hence his rosy view of the farmer's life there: 'Now, of course, they
reap the fruits of the earth with less effort than anywhere else in the world ... They do not
have to plough the furrow or dig the soil, they can dispense with the tiresome labor in the field
that other people must endure ... As soon as the river has risen of its own accord, watered the
arable land and receded again, each of them sows his own plot and drives pigs on to it to tread
the seed in. Then he awaits the harvest.

A textbook passage from a scribes' school, by contrast, paints the peasant's lot in much darker
colors - exaggerating perhaps by way of propaganda for the happy career of the scribe: 'When [the
farmer] returns to his fields he finds them in good condition. He spends eight hours plowing, and
the worms are already waiting. He cats half his crop himself, the rest is taken by the
hippopotamus. There are many mice in the fields, and locusts descend on them.
Even cattle devour his harvest and sparrows steal it. Then the scribe-officer arrives to count up
the harvest: he has bailiffs with him who wield sticks, and black men with palm-stalks. "Give us
the grain, " they say. "There is none." So they hold him by the legs and beat him, then tie him
up and throw him in the ditch. His wife is bound too, and his children, and their neighbors make
haste to abandon them so as to save their own grain.'
In tilling his land the peasant made do with a small range of simple tools, many of which are
used in almost identical form by the fellah of today. First and foremost was the indispensable
hoe for loosening the soil, its broad, thin sharp-edged blade of hard wood set at an acute angle
to the long wooden shaft to which it was bound with plant-fiber cord.
The oldest sign of its existence is a plough-shaped hieroglyph of the 2nd dynasty. The plough
consisted of a fairly long blade of hard wood fastened at its lower end to a pair of wooden
stilts slaved out toward their upper end, on which the plowman would lean to drive the blade into
the soil to the required depth and guide it along the furrow. A long pole extended from the lower
end of the stilts to the yoke over the necks of the draught animals.
For cutting the corn farmers originally used an almost straight or slightly curved wooden sickle
with a longitudinal groove in which a row of flint blades were set close together. These were
gradually superseded by copper and then, from the Middle Kingdom on, bronze sickles.
For wood-cutting, ground stone axes were used, the heads being tied to J-shaped handles. Other
agricultural implements included wooden shovels for tossing grain, wooden pitchforks for loading
the sheaves, wooden rakes for collecting the cut cars, plant-fiber nets and bags, leather or
canvas sacks for transporting both sheaves and grain, large wooden tubs for measuring grain and
cords for field-surveying.
The cereals the Egyptians cultivated were three kinds of wheat (einkorn, emmer and spelt) and
several of barley, notably the six-rowed variety. They devoted ample acreage to flax, their main
source of textile fiber. For a second crop, or in garden plots, a wide variety of vegetables were
grown, including onions, garlic, leek, Egyptian lettuce, radishes, cabbage, asparagus, cucumbers,
lentils, peas, beans and many spices. Valuable vegetable oils were extracted from sesame, flax
and castor-oil seeds. The floods meant a period of rest for the farmer, unless the pharaoh called
him up into army service or public works.
At the height of the floods, usually in mid-August, each farmer would row around his land closing
the vents in the surrounding dykes. Then when the Nile subsided the water would slowly run off,
deposit all the enriching mud it had brought with it and soak down deep into the soil. After
about a month-and-a-half he would come again to release the water, now turned brackish through
evaporation.

Once the water had completely seeped away and the ground was firm enough to walk over, the farmer
and his family would start hoeing it up again or deep--plowing it at intervals. Then it was ready
for sowing. The scribe in charge of the granaries would measure out the quantity of grain
allotted to each farmer and keep a written record. Then the vizier, through his officials and the
town and village headmen, would give the order for sowing to commence.
The ceremony symbolized at the same time the ritual burial of the god Osiris, who had died at the
hand of his brother Seth but came to life again thanks to his wife (and sister) Isis. Grain, the
symbol of Osiris' body, appears to have no life till it sprouts anew. Hence, in the harvest
festivals, the generous praise for Isis, to whom credit was due for the revival of the grain.
This popular belief was reflected in the little flat clay figures of the prostrate Osiris which
were 'sown'; the appearance of green corn was seen as an analogue to Osiris' resurrection.
So now the farmer could start sowing. With his grain in a leather bag slung across his left
shoulder, or in a basket held in his left hand, he would scatter it in wide swathes over the
prepared ground. Lest it stay on the surface to be pecked up by birds, he would invite a herdsman
to come onto the field with his flock of sheep or goats so that they could tread the grain in
with their hooves.
Sometimes the sun's heat had drawn off all the moisture before then. This was particularly liable
to happen on elevated sites beyond the flood's reach, or in years when the floods were poor
anyway. Unlike the Delta and central Egypt, where there would be an occasional brisk shower,
usually in November or December, the rest of the valley in Upper Egypt and Nubia had never
experienced a proper downfall since the Neolithic wet phase. So there was nothing for it but to
fetch additional water from the river or the irrigation canals.
The first mechanical device for conducting water to high-lying fields from the canals dates from
the Persian Period (after 525 BC). This was the tanbur or Archimedes' screw, a helix that could
be revolved inside a sloping cylinder. This provided a many times larger, faster and more
continuous flow of water, but as the corn between his fingertips and pronounces it ripe.
Harvest-time means mobilizing the village's entire labor force, women and children included.
From the New Kingdom onwards slaves and violators of royal decrees will have been roped in too,
and in an emergency even army units might be detailed to lend a hand.
The start of the harvest involved celebrations in honor of the fertility god Min. These were
opened by the king himself, who reaped the first ears of grain with a sickle. Diodorus tells us
that even in his day, the 1st century AD, peasants maintained the old tradition of setting up
stocks with the first corn harvested, beating their breasts and calling upon the goddess Isis.
Harvest scenes are depicted on the walls of many tombs, nowhere more fully than in the
15th-dynasty tomb of Menna at Sheikh Abd el-Quma. We shall now take these as a guide.
Before the sickles plunged into the standing corn the assessor-scribes led by the 'Overseer of
Fields' turned up to check the position of the boundary-stones and measure the size of the field
with a calibrated surveying cord. From these data they worked out the probable yield, which would
be compared with the actual yield after the threshing was done. This was clearly done to prevent
any part of the harvest being 'mislaid'.
The harvesters usually worked in a straight row, advancing steadily to the rhythm of one of the
songs documented for example in the tombs of Ty (5th dynasty) or Mereruka (6th dynasty) at
Saqqara. The song-leader was accompanied by a flautist and the harvesters probably chanted in
response. (We can hear Egyptian laborers singing today in the same fashion during the tedious
work of removing sand from archaeological sites.)
Grasping a bunch of stalks in his left hand the harvester would slice them through 9 at a level
just above his knees, then toss the cars aside to be picked up by the helpers. These would pile
the eared stalks alternately end to end, so that a compact sheaf forfned that required no binding
- the Ty relief shows this very clearly.
The sheaves were in turn loaded into nets or baskets to be taken on donkey back for threshing.
The threshing-floor was sometimes out on the field, sometimes next to the farmhouse. It was a
circular arena of trodden clay ringed with a low clay wall. The sheaves would be loosened, the
cars thrown on to the ground and cattle or donkeys driven into the enclosure to thresh out the
grain with their trampling, while the men stood outside in a circle urging the animals on with
cries or prodding them with sticks.
The grain released in this way was still mixed with chaff, straw and other impurities. Cleaning
was done on a breezy day on some well-swept piece of flat ground. It was usually a job for young
girls, who tossed the corn into the air with short-handled wooden shovels. The wind carried off
the lighter chaff and so on while the heavier grain fell back on the ground. This winnowing could
also be done by shaking the grain in sieves - usually a man's task. Once again the scribes now
came 3 on the scene to measure the volume of grain in standard wooden tubs. Finally it was sacked
up and carried, by manpower or donkey power, to the granaries.
The oldest type of granary, known from Archaic times, was a round-based cone with a domed top. It
was made of seasoned wood, often plaster-lined, or of mud bricks. The largest ones had steps
leading up to the filling hole, or else a ladder was laid against them.
All grain earmarked for the next sowing was stored in granaries of a different, trapezoidal shape
so that there was no danger of it being ground in error. Among Middle Kingdom models we find
another, four-cornered design of granary, standing in a row against one side of a house
courtyard. One such granary is shown with a flat roof and five filling-holes through which women
are pouring sacks of grain while a scribe, seated nearby, keeps a tally and a guard looks on,
stick in hand.
At times when central authority was weakening, especially after the Third Intermediate Period,
several royal or temple priests, army veterans and others were able to acquire land, initially to
cover their own needs for the rest of their lives. This land could however be passed on by
inheritance and in the course of time it came to be regarded as transferable and then as
saleable, the state no longer having enough authority to re-annex it to the state farming
enterprises.
The Egyptians had a high regard for flowers and trees and devoted great care to planting,
tending and protecting them. To sit in hot weather under the canopy of a tree was a favorite
recipe for relaxing body and mind.
It was popularly thought that trees were the abode of supernatural beings or much-loved gods. The
Books of the Dead linked this tree with the rising sun and with the sky goddess Nut, or at other
times with Isis or Hathor.
Even humble village houses had little gardens next to them. Where buildings were close together
the owners might have to be content with a few trees or flower-beds, or simply grow flowers and
small shrubs in clay pots or wooden troughs in the courtyard.
When the heavy trusses of golden fruit appeared among the crown of fronds, men would clamber up
the trunk with knives between their teeth to cut down the strings of dates. There is a painting
on the wall of Rekhmire's tomb that shows this being done. Here one man is shown plucking the
fruit with both hands and another is carrying it away in pans hung on a yoke. In the royal
gardens they even employed tame monkeys for this job.
An important oil-bearing tree was the baq, probably synonymous with the horseradish tree. Apart
from cultivated kinds, many valuable trees grew wild, including acacias, tamarisks, mimosas,
willows, palms and lemon trees. Most of the native broad-leaved trees yielded only inferior
timber that was too knotty, brittle or prone to split for use other than for stanchions,
roof-beams and some domestic furniture - chests and coffins.
When Egypt gained control of these lands in the early New Kingdom she developed tree-felling
there on such a scale that it helped to denude the entire coastal region.
Few gardens were without grapevines, which were also grown in separate vineyards. Many Old
Kingdom, and even more New Kingdom, tomb murals show bunches of grapes being gathered in baskets
and brought to the wine-press. This was a square vat lined with smooth mortar. The grapes were
thrown in and the juice trodden out by groups of barefoot men hanging on to ropes suspended from
a wooden frame so that they should not lose their balance and tumble into the pressings as they
inhaled the heavy vapor.
After this the must was filtered through cloth into fermentation vats and left for a time, heat
sometimes being applied to speed up the fermentation. Finally the mature wine was again filtered
through canvas and improved by the addition of spices or honey, then conveyed throughout the
country in wine amphorae whose frequent appearance in archaeological sites shows how popular the
drink was, especially from the New Kingdom on and even more so in Roman days. Masses of them were
found during the excavation of the Ramesseum storerooms, in the tombs of Theban dignitaries, at
Abydos, Tell el-Amarna and other places. Inscriptions on some amphorae give the vintage year,
type and quality of grape, locality and owner of the vineyard etc.
The ancient Egyptians were familiar with many wild shrubs and herbs and used them as drugs, for
making dyes and wickerwork - mats, baskets, bed matting, osier stands, sandals and so forth.
Many kinds of flowers were tied into bouquets for the living or the dead - cornflowers, poppies,
chrysanthemums, mandrakes, mallows, irises, larkspurs, jasmine, ivy and above all papyrus reeds
and lotus lilies.
The dense growths of papyrus and lotus in fens and marshes were a typical feature 113 of the
Egyptian landscape. Papyrus, particularly common in the Delta, became the heraldic plant of Lower
Egypt while the lotus, found all along the Nile, was the symbol of Upper Egypt. The close union
of the two parts of the country is proclaimed in reliefs round the plinths of colossal statues of
the king, which show the Nile god Hapy tying up bunches of papyrus and lotus together.
Papyrus thickets were also favorite hunting grounds. In the branches of the Nile in the Delta
maze little muddy islands developed which continually changed shape or shifted. In mythology the
papyrus came accordingly to symbolize the earth arising from the primeval ocean and hence, by a
shift of meaning, youth and happiness.
Amulets in the shape of papyrus bundles were popularly worn as a protection for the living, and
were credited with magic power to confer eternal youth and everlasting joy on the dead as well.
Papyrus bouquets stood for victory and for joy.
The Egyptians certainly appreciated the black earth that had yielded them so much benefit, and
they took care to husband it. New villages were most commonly sited on the very edge of the
fertile areas, where the desert sand began, or on flat islands of sand alluvium. In this way the
Egyptians minimized the encroachment of damp into their houses, while ensuring that not a scrap
of unable soil was wasted.
The Egyptian peasant's habit of working half-naked in the blazing sun, wearing only his short
kilt, shows how immune his skin had become to sunburn, and apparently they were not accustomed to
cover their heads to avert sunstroke. They stood up equally well to fierce winds, and were
resistant to common colds from the alternation of daytime and night-time temperatures. Their
diet, based on bread, green stuff and milk products, was balanced and biologically sound,
containing plenty of vitamins and minerals with little animal fat or harmful ingredients.
We know from their portraits that they enjoyed slender, wiry frames and athletic physique. A
peasant might also fall foul of one of the several kinds of scorpion that hid under the stones.
Their stings also have a neuro-toxic effect, like that of the cobra in the larger species, more
like a bee's in the smaller ones. Since neither preventive nor curative medicine of any value was
available, people resorted to charms, spells, magic knives and - in the Late and Graeco-Roman
Periods - to magic steles on which the god Horns is shown battling victoriously with snakes and
scorpions.
Perhaps this was why venomous snakes were sometimes embalmed as mummies. In truth most patients
could only hope to survive if the snake had already voided some of its poison in biting an
earlier victim.
Glass Making
There is still some doubt as to when and where glass was invented. The tradition passed on by
Pliny locates the event on the Phoenician coast, in modem Lebanon, where there later grew one of
the most important glass-making centers.
In Egypt, the first glass we know of, as a component of faience ware, dates from as far back as
the Neolithic Badarian culture at the turn of the 5th and 4th millennia BC. Glass is produced
from a mixture of silica-sand, lime and soda, colored with the copper ore malachite and fused at
a high temperature.
In the oldest Egyptian faience ware a skin of this substance was applied to a core made of
silica-sand and clay, or of the stone steatite. This was used at first only for beads, but later
on for amulets, shawabtis (the little figurines of the attendants of the deceased), other figures
and inlays (shapes inserted into the sides of vessels, wooden objects, or into plaster).
Particularly in the Middle and New Kingdoms a faience glaze was often applied to complete vessels
and statuettes.
Pure glass as a separate material came later, in predynastic times, in the form of translucent
beads. In the Old and Middle Kingdoms glass jewelry, amulets, little animal figures, mosaic
stones and similar things made their appearance.
Not till the reign of Tuthmosis I in the New Kingdom, however, is there any record of glass
vessels being made. The innovation was probably due to Egyptian expansion in the Middle East.
There Egyptian soldiers and administrators would have come across advanced centers ofglass manufacture and brought back local craftsmen, probably as slaves. This view is reinforced
by the fact that production of glass vessels started in Egypt as a royal monopoly serving the
court, top dignitaries and the high priesthood. Such 18th-dynasty workshops as have been
discovered were very close to royal palaces, such as that of Amenophis III at Malqata or
Akhenaten's residential quarter in Akhetaten. Further 19th-dynasty factories have been found at
Lisht, Menshiya and possibly Gurob.
Unlike those of other crafts, portrayals of glass production are conspicuously missing from
drawings and reliefs. (Alleged illustrations of glass-making that have been reproduced from time
to time are in fact metal foundries.) This was no doubt because of the royal monopoly. Since the
aristocracy owned no glass workshops, the subject did not feature in their tombs, and in New
Kingdom royal tombs non-religious scenes were very rare. The methods of glass manufacture would
thus have remained a mystery but for archaeological research and the extant glass vessels
themselves.
The glass factory found at Lisht yielded fragments of crucibles, conical clay stands for holding
the crucibles during fusing, pieces of slag from the ovens, samples of the pigments added to the
glass, little discs with well-worn edges used for finishing the surfaces, over too glass rods of
various colors, pieces of unfinished faience ware and nearly 200 sherds of glass vessels. There
are traces on the inside of some vessels of a clay-and-sand core, revealing the technology used.
Manufacture proceeded as follows. The raw glass was heated in pans up to 750'C and then again in
crucibles to as high as 1000C. A clay-and-sand core was made in the shape of the cavity of the
intended vessel, covered with cloth and stuck onto a metal rod. This was plunged into the molten
mass and given several quick twists to spread the glass evenly over it. (This did not always work
out, as we can see from the uneven thickness of some vessels.)
If decoration was required, one or more thin colored rods were wound spirally over the glass
while it was still soft. Before these rods hardened they were moved up and down with metal pins
to produce waves, garlands, arches and leaf or feather patterns. Sometimes a comb was drawn
across the rods, producing a series of vertical ribs. The whole job was then reheated and rolled
over a smooth stone block to produce an even surface. Finally, edge and foot could be pulled out
and handles fused on. Once the object was cold, the core had to be scraped out.
Ancient Egyptian glass was usually tinted with pigments added to the raw glass. A milky-white
color was produced with tin or lead oxide, yellow with antimony and lead, or ferrous compounds,
red or orange with oxides of copper, violet with manganese salts, greenish blue (in imitation of
the prized turquoise) with copper or iron compounds, dark blue (in imitation of lapis lazuli)
with cobalt com-pounds and black with a larger proportion of copper and manganese, or with ferric
compounds. The finished artifacts - little bottles, vases, goblets and bowls - were chiefly
destined to hold cosmetics and fragrant unguents in the boudoirs of queens and high-born ladies.
The decline of royal power after the end of the New Kingdom put a stop to glass production for a
time. Not till the Graeco-Roman Period did new Egyptian glass centers arise in the Hellenistic
cities of Alexandria and Naucratis. These enjoyed close links with centers in Asia Minor and
their extant Greek-style products show that they followed the international market of their day.
Around the beginning of the Christian era molded glass bowls appear, and another innovation was
millefiori glass made from variously colored glass rods fused together.
The revolutionary invention of glass-blowing took place, probably in Syria, during the 1st
century BC, though the technique did not reach Alexandria until the latter half of the following
century. As a rule clear glass was used, either of the natural greenish hue or with additives to
make it colorless. It was cut with a copper wheel and ground with emery powder. The new discovery
increased production many-fold and glass then ceased to be either a rarity or an upper-class
prerogative.
What the social status of glass-makers may have been we can only speculate. It was a highly
artistic craft and gifted individuals had a chance to become acknowledged masters. Though the
glass-factory employees appear originally to have been slaves, and for the most part foreigners,
skilful workers were probably freed at an early stage and imparted their secrets to Egyptian
colleagues among the royal artisans.
The work was doubtless strenuous and damaging to the health of its practitioners. The intense
heat produced by fusing glass on open fires could injure the body-fluid management; the cornea
and retina of the eye suffered from the glare, and skin burns were no rarity. Glass-blowing
exerted a back-pressure on the lungs that could lead to emphysema and circulatory trouble at an
early age, shortening a worker's life considerably.
While Beit El-Sennari was built in 1794 by Ibrahim Katkhuda El-Sennari, a Sudanese occultist, it
is famous for another reason. In 1798, Napoleon invaded Egypt bringing with him an army of
scientists, scholars and artists to establish a French culture base in Egypt. Soon, they began
their mission of making the first European study of Egypt which they published as Le description
de l'Egypte. Beit El Sennari was used to house many of the French artists and scholars at the
time. It became the center of the French study of Egypt, and therefore a very important monument
to early Egyptology.
The house was allowed to deteriorate until, in 1995, the first restoration of it was undertaken.
It had suffered much from neglect, air pollution and subterranean water damage. It was also
severely damaged during an earthquake in 1992. However, because of the efforts of the Egyptian
government with French assistance, it was faithfully restored and opened to the public in 2000,
though some restoration work continues.
Beit El Sennari is not well known by many tourists who visit Egypt. Situated on a small lane
named Haret Monge, just off of a downtown street called Khairat, there are very few tourism
attractions nearby. Perhaps the easiest way of reaching it is by using the metro to go to Sa'ed
Zaghloul Station.
This was exactly what I did. After leaving the metro I had to walk for about 15 minutes before
reaching the house. All the people I asked didn’t know Beit El Sennari or even Haret Monge
Street. I kept walking until I reached the Sayeda Zeinab Mosque and square. There, I found a very
old man sitting on a chair next to a shoe store, who knew Beit El Sennari
I walked in Haret Monge for a couple of minutes before I found myself next to a very beautiful
mashrabeya window to my right. I knew then that I had reached Beit El Sennari because there
aren’t any other older Islamic sites in the area. This mashrabeya screen looked older than many
of the other screens I have seen. Under this screen, there is the original door to the house but
it is closed these days. One must enter the house through a small door to the side of the
mashrabeya screen.
Upon making my way through this door, I found myself in an old garden that I found out later was
the main garden of the house. Here, I found many old palm trees, along with some construction
work, as the museum is still under restoration. I began looking around and found many brown
mashrabeya windows all around the house but I was lost as I didn’t know where to begin my
exploration.
Suddenly a cute girl appeared asking me what I wanted. I suppose, due to the small number of
tourists visiting this place, she didn’t understand that I just wanted to tour the house. I did
have to buy a ticket, which costs one pound for Egyptians and five for foreign tourists. Then she
showed me the way into the house.
Inside, what struck me first is that I was the only visitor. There wasn't another person in the
house, so I was free to roam about, unimpeded by any tourists. At first, I found myself in the
open air hall usually found in old Islamic houses and called a sahn. Typically, the rest of the
house surrounds this open courtyard, and it was used, particularly in the mornings, as a
reception place. The sahn of El Sennari House is very beautiful. There is a very old fountain in
the middle that seems very ancient.
The sahn is an excellent place to see most of the mashrabeya screens of the house, as they are
built to overlook the courtyard. These are some of the most beautiful ones I have seen in Cairo.
There are many mashrabeya screens all around the house and in a very good state. They are of the
finest variety, made of very small pieces of wood in tight patterns, and many have additional
arabesque carvings within the wood. To the left on the second floor, one's eyes are drawn to a
very attractive balcony with wood work all around it.
Under the balcony, there is a small display of pictures of the house as it appeared in the past.
It gives one an idea of just how effectively the restoration process improved the condition of
the house.
Afterwards, I entered a room near the main door of the house. This room has a hole in the ground
at the end of it, which I believe was a water well or a place to keep water because this area is
connected to all the other stores of the house. They used to transfer water all over the house
from this place.
From here, I found myself on the same balcony I had seen from the sahn. It is a big open air
space with the traditional Islamic decorated ceilings. Hanging from the ceiling are two charming
lanterns much like the famous fanoos of Ramadan. Strikingly, there are few objects such as
furniture within the house. Here, there was only a lonely wooden sofa where they used to sit in
the summer beside the wooden cupboards one would normally find in many Islamic houses.
The next chamber is the main salamlek, the guest room of the house. It is similar in its design
to the summer guest room in Beit El Suhaymi. It has a fountain and pillows to the right and left
of it to sit on. It's window is covered by the largest mashrabeya screen in the house. It is one
of those I spotted prior to entering the house and for those who love these screens, this one is
a masterpiece. I spent a few moments admiring the mashrabeya and then I was off to see the rest
of the house.
The bathroom was an interesting place. It has the same ceiling as in Beit El Suhaymi with the
colored glass all above you with the sun rays lighting the place through them. There is a second
bathroom, with rectangles cut into the ceiling and inset with small pieces of colored glass. It
was lovely, appearing almost like an electric lamp pasted to the ceiling. Like the rest of the
house, this bathroom was bare but for a big water container.
The next room was the main haremlek, a private room where the women of the house would have spent
much of their time. It had two mashrabeya screens to the left overlooking the sahn. To the right,
there are some wooden cupboards that were used by women to keep their precious items. Here, I
really began to notice the interesting doors of the house, which are made of old wood and
decorated beautifully in the Islamic style.
The third floor of the house wasn’t really interesting as it only had a few empty rooms and a
little open air hall in the middle. I soon found myself returning to the sahn, one of the most
pleasing areas of the house, to explore it a bit more. Here, I found what almost seemed like a
tunnel that leads to the old main door of the house.
I left the house feeling a bit empty, just as the house seems so empty of life, seeing very few
tourists and having so little content. It was not an unpleasant visit. I very much enjoyed the
mashrabeya screens and the old doors, but there is precious little else here. In the past, Beit
El Sennari hosted many works from different Egyptian artists. In 1917, a permanent exhibition
displaying Napoleon Bonaparte's personal collection was on display here, but that was removed in
1926. It also housed many other exhibits over the years.
And this is what this old, famous house is in need of today, along with some additional attention
to its garden. It needs some content, and specifically items to remind us of its real importance.
As both a historical house, and the center of work surrounding the scholars in the Napoleon
expedition, it deserves, and will probably someday receive, more attention. But probably only
then will it find an audience of tourists. Nevertheless, even today it does have its charm, but
only those very interested in such places will appreciate its appeal.
Ancient Indian thoughts, philosophy a developed with a rational synthesis an gathering into
itself new concepts. Spiritual was the foundation of India’s cultural histo spirituality, dharnza
(ethical conduct accordi state) was the most important concept of Indi Both are, unfortunately,
on the decline.
With the coming of the Europeans, and especially during the colonial rule, imitation of what the
rulers did and practised became more and more popular. But, there was also resistance to this
wholesale copying of the foreigners’ practices. ‘Reverence for the past is a national trait.
There is a certain doggedness of temperament, a stubborn loyalty to lose nothing in the long
march of the ages. When confronted with new culture or sudden extensions of knowledge, the Indian
does not yield to the temptations of the hour. but holds fast to his traditional faith, importing
as much as possible of the new into the old. Conservative liberalism is the secret of the success
of India’s culture and civilization(1).
The value systems in India have been influenced by all the religions, but mostly by Hinduism.,
the major religion (82.64% of the population), contributing to the philosophy and ethics of the
people of’ the country. The fundamental basis of ethics arises from the Hindu belief that we are
all part of the divine Yaranzatman; we have in each of us Atman, part of that Paramatman.
The ultimate aim is for our Atman to coalesce with Parmatman or Brahman to become one. According
to the Vedas (4000 RC to 1000 BC), the call to love your neighbour as yourself is ‘because thy
neighbour is in truth thy very self and what separates you from him is mere illusion (maya). ’
Closely allied to Hinduism are Jainism and Buddhism. These religions proclaim Ahimsa Paramo
Dharma. Most important of all our actions is alzinzsn, non- violence. Patanjali defined ahimsa
asSarvatha sarvada sarvabutananz anabhidroha(1) , a complete absence of ill- will to all beings.
Ayurveda is the ancient science of life. It lays down the principles of management in health and
disease and the code of conduct for the physician. Charaka has described the objective of
medicine as two fold; preservation of good health and combating disease. (2) Ayurveda emphasised
the need for healthy life- style; cleanliness and purity, good diet, proper behaviour, and mental
and physical discipline. Purity and cleanliness were to be observed in everything: jalasuddi
(pure water), aharasuddi (clean food), dehasuddi (clean body), manasuddi (pure mind) and
desasuddi (clean environment).
Ayurveda calls upon the physician to treat the patient as a whole: ‘Dividho jayate vyadih, Sariro
manasasthatha, Parasparanz tavorjanma, Nirdvadvam nopalahhyate.(Diseases occur both physically
and mentally and even though each part might be dominant, they cannot be compartmentalised).
Ayurveda treats man as a whole body, mind and what is beyond mind. The earliest protagonists of
Indian Medicine, such as Atreya, Kashyapa, Bhela, Charaka and Susruta have based their writings
on the foundations of spiritual philosophy and ethics. But the one teacher of Ayurveda who
established the science on the foundation of spirituality and ethics was Vagbhata, the author of
Astanga Hridaya(3) .Vagbhata says:Sukarthah sarvabutanam, Matah sarvah pravarthayah, Sukham ca na
vina dharmat, thasmad dharmaparo bhavet_( All activities of man are directed to the end of
attaining happiness, whereas happiness is never achieved without righteousness. It is the bounden
duty of man to be righteous in his action).
Charaka Samhita prescribes an elaborate code of conduct. The medical profession has to be
motivated by compassion for living beings (bhuta- daya)“. Charaka’s humanistic ideal becomes
evident in his advice to the physicians’. He who practices not for money nor for caprice but out
of compassion for living beings (bhuta- daya), is the best among all physicians. Hard is it to
find a conferor of religious blessings comparable to the physician who snaps the snares of death
for his patients. The physician who regards compassion for living beings as the highest religion
fulfils his mission (sidhartah) and obtains the highest happiness.
Informed consentThere is a general belief among the doctors in India that a conflicting situation that it is not
possible to get informed consent because of rampant illiteracy. They believe that the patients
are unable to make a reasoned choice because they cannot appreciate the intricacies of
alternative medical treatment, procedures or drug trials. Often a paternalistic view is taken:
‘The doctor knows best. ’
Dr. Srinivasamurthy and colleague8 at the National Institute of Mental Health and Neurosciences,
Bangalore, conducted a study into the relevance of obtaining informed consent. Almost all (99%)
of the subjects invited to participate in a drug trial gave a clear choice whether to participate
or not. Patient’s level of understanding and decision- making related to the amount and quality
of information provided. They did not correlate with social, economic, educational or other
background characteristics.
Charaka advises the physician to take into confidence the close relatives, the elders in the
community and even the State officials, before undertaking procedures which might end in death of
the patient. The physician is then to proceed with the treatment.Can the doctor withhold
treatment, if there is no informed consent? Can a man refrain from benefiting from medical
treatment and forfeit saving his life? Will the doctor be assisting suicide? On the contrary,
does not the patient have the right to control what shall be done to his/ her body?
What is the status of informed consent when a patient is admitted to the hospital in a critical
condition but in full possession of his/ her senses? Can the surgeon who diagnosed the condition
requiring immediate surgery refrain from operating on the sole ground that the patient had not
given his/ her consent for the operation? If the patient later dies, what is the liability of the
doctor?
An interesting case came up in the State of Kerala. A patient with acute abdominal pain was
admitted to a district hospital. He was examined by the surgeon, who diagnosed perforated
appendix with general peritonitis, which required an immediate operation. But the operation was
not performed by the surgeon and the patient died the next day. The relations filed a petition in
the court against the doctor personally and against the Kerala Government vicariously. The
doctor’s defence was that the operation was not performed as the patient did not consent to it.
The court rejected this plea and granted a decree against the doctor. The decision was confirmed
by the Kerala High court in the appeal preferred by the doctor. Two specialist surgeon who were
called as expert witnesses stated that they would have operated on the patient without the
explicit consent.
In contrast is the view that every human being has a right to determine what shall be done with
his or her own body. A surgeon who performs an operation without the patients consent commits an
assault for which he is liable? Indian physicians who are trained abroad or have imbibed this
principle find themselves in a conflicting situation.
What is the ancient teaching in such circumstances? Charaka advises the physician to take into
confidence the close relatives, the elders in the community and even the State officials, before
undertaking procedures which might end in death of the patient. The physician is then to proceed
with the treatment.
In India, great trust is reposed in the doctor, but more and more people are questioning the
practice. Trust based on ‘goodness’ of the doctor is slowly giving way to the concept that making
the decision is the right the patient.
AdvertisementThere are instances of unethical advertising by doctors. Such doctors are frowned upon by their
colleagues but little action follows. The Medical Council of India and the state medical councils
are to look into such matters but because of technical flaws, the doctor often escapes. Of late,
advertisements by hospitals and diagnostic centres are coming up in a big way proclaiming their
superiority over others.
Diagnostic aidsThere is a growing supermarket in diagnostic equipment. Sophisticated equipment is bought at
great expense of scarce foreign exchange. Most of the imaging equipment currently in use in the
various hospitals and diagnostic laboratories is in excess of the needs. Yet another problem with
the purchase of equipment from abroad has been the difficulty of servicing and maintenance.
Doctors trained abroad in the specialities ask for such equipment, but should these requests not
be tempered by the realities of the situation? Is it ethical for the doctor to order costly,
sophisticated equipment, which is not likely to function, utilising scarce foreign exchange? Is
it ethical for firms to supply these items without back- up service? This is a problem in most
third world countries. Thairu(6) suggests that an ethical code should be agreed on by both
(manufacturers and users) regarding the sale of equipment.
Drugs and pharmaceuticalsThere is a huge proliferation of drugs in the Indian market, with more than 60,000 formulations.
They are manufactured by large, medium, small and tiny factories - multinational and national.
There are many drugs in the Indian market which are banned in other countries. There are drugs
which were banned in India itself but continue to be marketed, after getting stay orders from the
courts. Legal proceedings take years. During this period, doctors continue to prescribe these
hazardous drugs, patients continue to take them and the firms continue to make huge profits.
Many of the drugs in the market are spurious or of substandard quality. It has been reported that
as a rule 20- 30 percent of the samples tested are substandard. Government agencies take a long
time to test the samples and to announce the details of the substandard drugs. Manufacturers are
expected to give the indications, contra- indications, side effects and adverse effects. They
often do so but in such a way that it will not attract attention; the greater the hazard, the
smaller the print.
One of the most distressing aspects of the present health situation in India is the habit of
doctors to over- prescribe or to prescribe glamorous and costly drugs with limited medical
potential. It is also unfortunate that the drug producers try to push doctors into using their
products by all means - fair or foul. These basic facts are more responsible for distortions in
drug production and consumption than anything else. If the medical profession could be made to be
more discriminating in its prescribing habits, there would be no market for irrational and
unnecessary drugs.
The drug firms do not generally follow the WHO ethical criteria for drug promotion. Gift giving,
almost universal, raises many ethical issues as in other countries(8 ) ; the effects are much
more pronounced in a poor country.
In the past, medicines were prepared under the personal supervision of the physician or by the
families of the patients. There were strict guidelines for the collection of herbs and other raw
materials and for the processes. Medicines thus prepared were reliable for quality and purity.
Right to healthEveryone has the right to a standard of living adequate for the health and well- being of himself
and of his family, including food, clothing, housing and medical care and necessary social
services - Article 25 of the Universal Declaration of Human Rights. If health is a fundamental
human right, it becomes the responsibility of the State to protect and promote the health of all
the people. There has to be an irreducible minimum of health care services to all. There is need
to close the gap between the ‘haves’ and ‘have nots’, achieve more equitable distribution of
health care resources and attain a level of health for all. The Alma- Ata Conference declared:
‘Governments have a responsibility for the health of the people, which can be fulfilled only by
adequate and equitably distributed health and social measures. ’
The right to health brings on the issue of distributive justice to make available an acceptable
and affordable care to all. One important aspect of such service is the provision of qualified
persons for providing health services where such services are not available at present. Can the
physician be compelled to provide service in villages where there are no doctors? The State and
the institutions generally subsidise medical education. Even if there is no subsidy, the doctor
has been provided an opportunity, not available to many. But opposing questions arise. The doctor
is not owned by the people or the institution. Can the doctor be deprived of the right to earn
legitimately as much as he or she can and where he or she can? Can a person be compelled to act
against his or her wish as long as no harm is done to the Society? The consensus is that the
doctor owes a duty to serve the people in the areas where they are needed but the medical
profession, in general, is not in favour of mandatory service. Health is included in the
Directive Principles of State policy, which is considered as the ‘conscience’ of the Indian
Constitution. Article 39 of the constitution directs the State to ensure health; article 47
requires the improvement of public health to be among the primary duties of the State. In
pursuance of these articles the Government had issued a number of policy statements and
programmes. The latest in the series is the National Health Policy (1982).
Health policyThe stated health policy of the Government of India has been frustrated by poor implementation.
The allocation of resources to the health sector has been very small. Often, the priorities are
assigned not on the needs of the people but on what is fashionable and on who has the maximum
political leverage. Very little allocation is made for control and treatment of infectious
diseases such as tuberculosis, malaria and kala- azar (especially prevalent in the villages of
Bihar, Orissa and West Bengal).
Questions arise: Who shall receive what health care? What resources can be allocated, how and to
whom? How do we set our priorities? What is an acceptable form of health care? Who should decide
on health policy?
Many issues are being debated currently. There is a demand for more equitable distribution of the
benefits of medical knowledge. Against it is the much more powerful force for the use of
sophisticated, spectacular and costly technology for the benefit of the few. Newer technology is
pushing skyhigh the expenses for diagnostic and therapeutic procedures. Patients are made to feel
that, unless they go through a whole array of expensive diagnostic procedures, a correct
diagnosis is not possible. There are wide networks of costly diagnostic laboratories, aided and
abetted by doctors who often get kickbacks.Patients are completely mystified by the advice they
get from their physicians. They shell out huge sums of money (relative to their earnings) which
they can ill afford. The onus for this unethical practice rests squarely on the medical
profession.
Does an individual have the right to buy expensive technology to the exclusion of others who
share the same resources? Is it right that the scarce resources of qualified and experienced
personnel, money (including foreign exchange) and materials be used for the benefit of a few
while the large majority of people are not able to get even simple primary health care services?
All religions advocate the care of the poor and needy. Christ declared: ‘When you have done this
to the least of my brothers, you have done it to me. ’ Gandhiji said: ‘I will give you a
talisman. Whenever you are in doubt or when the self becomes too much with you, apply the
following test: recall the face of the poorest and weakest man you have seen and ask yourself if
the step you contemplated is going to be of any use to him. Will he gain anything by it ?’ Kabir
said: ‘The valiant fighter is only he who fights for justice to the poor.’
The debate on distributive justice goes on. Shall the State purchase ten renal dialysis machines
(which will maintain the life of a few sick people) or employ fifty community health workers (to
help 50,000 people primary health centres have trained laboratory technicians who can spot the
malaria parasite? Shall the hospital buy one lithotripter or expand its programme for oral
rehydration for children affected with diarrhoea? The cake is small. How shall it be cut?
Has the medical profession any ethical responsibility in influencing the health policy? The
doctors in India are often passive spectators in the fight for social justice and against
discrimination in health care.
Educating the public on genetic engineeringWe must not imply tc the public that we are going to chase with the genome project, with somatic
DNA therapy, all the ills of man. It is surely ethically more acceptable, in both the developed
and the developing world, to tell the public that in the foreseeable future genetic engineering
will not provide practical and affordable solutions to these problems. Scientific responsibility
demands recognising this and not misleading the public with false promises and unattainable
hopes, as has happened in several biomedical projects of immense dimension during the past half-
century. There have been a number in my own field.
One has just been discussed at length in a recent book by Desowitz called The Malarial Capers,
which describes... the malaria ‘felons’. The story starts a century ago, with the catastrophic
prima donna- like contention for the Nobel Prize between Grassi in Italy and Ross in England. All
the chicanery that went on then in research reminds one of what the newspapers tell us today. The
story continues to 1991, with the molecular biologists promising much too much to the public and
Third World governments - that a practical subunit vaccine was just around the corner. One
billion dollars went into the project and we are still nowhere near. And none of the scientists
has loudly and clearly proclaimed that it ain’t going to happen soon and, it it ever does, it
will be for generals and armies and not for the general population in the Third World. No one has
dared to say this because it would interfere with the project and our careers.
D. Carleton Gadjusek
Gajdusek DC: Scientific responsibility. In: Fujiki N, Mater D (Eds.) Human genome research and
society. Proceedings of the Second International Bioethics Seminar. Eubios Ethics Institute,
Fukui, Japan. 1992. Pages 2052 10.

The Sukhadeo Thorat Committee, constituted to enquire into the alleged harassment of students
from the scheduled castes and tribes in the All India Institute of Medical Sciences, found
widespread evidence of such harassment (1). To make matters worse, the committee found that the
faculty, largely from the forward castes, were also involved in systematic denigration of
students from the scheduled castes and tribes. The complete report makes sad reading. The
harassment is in many ways: soon after new students join the college they are the target of
systematic verbal and, sometimes, physical attacks by higher caste students. They are frequently
told that they are inferior and do not deserve to be in the institute. They are given very little
space in sports and cultural activities. In the hostels, due to repeated harassment, these
students have been ghettoised into two floors. There is very little healthy social interaction
among students of higher castes and these students.
In the academic sphere they are the victims of scorn by the faculty. For example, the institute
has a system of continuous evaluation of the students and an end semester examination. There is a
widespread feeling among the students of the scheduled castes and tribes that they are
discriminated against in these evaluations. Systematic bias is also encountered in the junior and
senior residency posts and in recruitment to the faculty.
The basic proximate cause of this behaviour by the forward caste students appears to be that they
feel that the students from the scheduled castes and tribes have been given an unfair advantage
in selection to the course. They hold the view that the system of reservation or quotas is unfair
and results in the selection of inferior students. This feeling is shared by many of the faculty.
They feel that such students can never be good doctors. In short, casteism has a strong grip.
Competence, caring and equity in medical education
The assumption that reservation of seats for the less privileged castes would lead to a dilution
of standards has been disproved by the experience of Tamilnadu, where 68 per cent of seats in
medical courses are reserved for almost 40 years. Yet Tamilnadu has among the best health
indices. Medical care is not the only reason for this but surely does play some part. In the
curative sector, Chennai is a centre which draws patients from other states, notably from north
India.
The primary purpose of medical education is to train doctors to treat and prevent illness among
people. All over the world, competition to get into medical school is fierce and societies
everywhere try to select the best possible students. What are the desirable qualities that should
be looked for in students who will become doctors? To this apparently simple question there
appear to be no simple answers (2).The qualities that patients see as desirable in doctors are
humaneness, competence and accuracy, patients' involvement in decisions, and time for care (3,
4). In India, by and large, the only criterion used to select students is the marks scored in
examinations. Earlier attempts to use interviews as an additional tool failed because of
perceived widespread misuse by which the most influential candidate was selected, not the best
one. This gave rise to the idea that merit, defined as performance in examinations, was the only
fair criterion to apply. This has helped buttress the widespread notion among the forward castes
that all forms of quotas for castes which had been the victims of oppression were unfair as the
marks that they require to get into a medical college are lower than those required by student
from the forward castes. It is another matter that the influential ensured a loophole for
themselves by creating so-called self-financing colleges where those with money or influence
could qualify for a medical degree.
Marks in qualifying examinations are a good method of ensuring selection of capable medical
students who will make competent doctors. But they are not enough to ensure good doctors (5,6).
In many countries, for example Canada, France, Australia and South Africa, policy makers have
clearly stated that a secondary aim of medical education is to ensure equity and affirmative
action (7). These objectives are seen as desirable in themselves to build a healthy society.
Underprivileged people who enter the health sector not only ensure the economic security of their
own families but also make a favourable impact on their community (8). Schemes to ensure that
underprivileged sections of society will get adequate representation in medical school placement
are in place in most countries in the world. They all make provision for the fact that
disadvantaged sections of the student community will not score grades as high as the more
privileged will, even if they are equally intelligent (6). The concept that those who require
quotas are not as intelligent as those who do not shows an ignorance of the social determinants
of success in examinations. It ignores the effect of the advantages of class (and, in India,
caste), facilities and opportunity, all of which have been well-documented. (6). To understand
quotas as providing an unfair advantage is to be blind to the unfair disadvantages that certain
communities in India have been victims of. To understand quotas as opening the gateway to
training incompetent people ignores the basic fact that there is a minimum standard for
qualification.
At independence, a section of those who were instrumental in policy making, notably Dr. B R
Ambedkar, pointed out that certain sections of the populace were the victims of long-standing
oppression of the most demeaning kind and ensured that some provision was made for them to catch
up in the educational sphere and also in the struggle for jobs. Unfortunately, many influential
people in society, particularly the bureaucracy and politicians, have never really accepted this
view. In the 60 years since independence, many castes which were considered backward at
independence have been able to assert themselves through new political formations. However, the
dalits continue to remain marginalised.
Equity in service provision
There is clear evidence to show that doctors from less privileged backgrounds are more likely to
serve underserved populations (9, 10). In a society like ours, which remains primitive in many
ways, it is likely that the scheduled castes and tribes feel more comfortable seeking medical
advice from one of their own community. A time will come when caste has no relevance in India,
but the time is not yet.
Considering the dramatic maldistribution of doctors, with a majority being located in the cities,
a policy which will encourage provision of medical services to the poorly served is welcome.
The All India Institute of Medical Sciences and caste
The All India Institute of Medical Sciences was set up in 1956 with the intention of nurturing
excellence in all aspects of healthcare. It would seem to be obvious that this would include an
understanding of the causes of sickness and health that go far beyond the germ theory and into
the social and economic context of it. That this has not happened, and that in fact the institute
was the centre of activity against providing affirmative action for the less privileged, should
be a matter of great concern. The involvement of the faculty in the movement against quotas is
particularly disturbing. They are expected to be role models for students. If they perpetuate
ideas of caste superiority and the intrinsic unfairness of reservations, they do harm not only to
their students but to society as a whole. An American clinical teacher has said, “Ultimately
teaching is all about the learner, not the teacher. Thus effective clinical teachers aspire to a
sort of selflessness whose tangible expression is kindness to learners, especially when assessing
them (giving feedback).” (11) Doctors should have a broad view of the causes of ill-health.
Nothing in the present way that doctors are trained helps in this. The All India Institute of
Medical Sciences, instead of providing a lead in broadening the understanding of health and
disease and showing the way in producing good doctors, has become a centre of bigotry. The
ill-effects are felt all over the country. The time has come for a major shake-up in medical
education in general and in the Institute in particular.
The National Drug Policy (NDP), 1982, of Bangladesh was expected to make available essential,
good quality drugs at affordable prices. This article gives an overview of the situation today,
more than two decades after the Drugs (Control) Ordinance, 1982, was promulgated to implement the
NDP. While there have been some successes, many of the goals of this initiative are yet to be
achieved. Inadequate supply of essential drugs, substandard quality, uncontrolled drug prices and
inappropriate uses of drugs are major problems in Bangladesh.
Unethical drug promotion and marketing of substandard and unnecessary drugs in Bangladesh were
very common before 1982. Instead of producing essential drugs, most drug manufacturers
manufactured non-essentials such as vitamins, tonics, enzymes, gripe waters and cough mixtures.
To stop these practices, Bangladesh formulated a pioneering National Drug Policy (NDP) in 1982
(1). The Drugs (Control) Ordinance, 1982, was promulgated subsequently to implement the NDP (2).
The principal objectives of the NDP were to make available essential drugs; ensure good quality
drugs; control drug prices; ensure rational use of drugs; develop an effective drug monitoring
system; improve the standard of hospital and retail pharmacies; and ensure good manufacturing
practices (1, 2). Before the NDP, eight multinational companies (out of 166 licensed companies)
had about 75 to 80 per cent share of the drug market. Many of them abandoned their operations in
Bangladesh after the NDP. Today, local pharmaceutical companies dominate the drug market with a
share of more than 75 per cent (1). The NDP has had some success in regulating the drugs market
of Bangladesh, but many of the goals of this initiative are yet to be achieved.
Access to essential drugs
Although official documents indicate that 80 per cent of the population has access to affordable
essential drugs (3), there is plenty of evidence of a scarcity of essential drugs in government
healthcare facilities. One study conducted in four district hospitals and one medical college
hospital showed that only eight per cent of patients received the prescribed medicines from these
facilities (4) In another report, two major hospitals in the capital city of Dhaka were operating
without essential medicines for eight consecutive weeks (5). There are countless such incidents
relating to the supply of essential medicines in Bangladesh. In most such cases, government
officials and health professionals are responsible for the shortage as they often sell
government-supplied drugs to local drug stores instead of dispensing them to poor patients (6).
The government must be cognisant of this fact, but rarely takes any action.
Quality of available drugs
Of the 300 pharmaceutical companies in Bangladesh, only the 20 to 25 top ones produce drugs of
standard quality (6). Reports show that numerous small companies market substandard drugs in the
country (7). Fake or substandard medicines, including lifesaving ones, with an estimated worth of
US$ 150 million per year, are flooding the domestic market (8). In its annual testing in 2004,
the government laboratory detected 300 counterfeit or very poor quality drugs out of 5,000 drug
samples. A recent assay involving 15 brands of ciprofloxacin showed that 47 per cent of samples
contained less than the specified amounts of the active ingredient (6). Another report noted that
69 per cent of paracetamol tablets and 80 per cent of ampicillin capsules produced by small
companies were of substandard quality (9).
Good manufacturing practice (GMP) is a major criterion to maintain standard quality in drugs, and
it was one of the principal objectives of the NDP to ensure standard manufacturing practices for
drug manufacturers. But there are some 265 pharmaceutical companies in Bangladesh that do not
follow or comply with GMP (10). It is widely alleged that adulteration flourishes in the country
because of poor government vigilance and supervision over drug manufacturers and sellers.
Unfortunately, a section of corrupt physicians and government officials is involved in these
underhand dealings. The government states that it has limited manpower and facilities to cope
with the country's fast expanding pharmaceuticals sector (11). In fact, the regulatory authories
have given scant attention to quality matters in Bangladesh.
Lack of control over drug prices
In Bangladesh the maximum retail price (MRP) of every essential drug is fixed by the Directorate
of Drug Administration (DDA); for all other drugs the DDA endorses the companies' quoted prices
(2). Drug prices are quite high in Bangladesh in comparison to neighbouring countries. The drugs
control authority is apparently reluctant to negotiate with the companies to fix prices (12). The
regulatory authorities have virtually no control over drug prices in Bangladesh. Indiscriminate
pricing can be observed in all therapeutic classes of drugs. For example, prices of various
ciprofloxacin brands range from Taka (Tk) 5 to 14 (US$ 0.07 to 0.20) per unit (13). The price of
dexamethasone eyedrops extends from Tk 24 to 90 (US$ 0.34 to1.29) per 5ml, and diclofenac eye
drops are available at a price range from Tk 40 to 200 (US$ 0.57 to 2.86) per unit (6). These are
a few of the existing price discrepancies in the country.
Patterns of drug use
To ensure rational and appropriate use of drugs in Bangladesh was another prime concern of the
NDP. But there has been no drug use study in the country (14). Clinically inappropriate and
inefficient use of medicines is a serious problem. More than half the medicines in Bangladesh are
inappropriately prescribed, dispensed or sold (15). Despite legal prohibitions (1), numerous
drugs with similar or no significant benefits are available in the market. As a specific example,
there are seven members of the angiotensin-converting enzyme (ACE) inhibitors available in the
country. The efficacies and chemical structures of these molecules are more or less similar, but
their price vary significantly (13). The drug policy clearly prohibits the production of
multi-ingredient preparations of vitamins and minerals with the exception of B-complex vitamins
(1). But a mixture of 32 vitamins and minerals including selenium, vanadium, molybdenum, tin and
many other unnecessary ingredients has been marketed in the country for a few years, violating
the principles of the NDP. The need for these trace elements in Bangladesh is not established
whereas nutritional deficiencies are mainly related to vitamins A and B-complex, iron, calcium,
iodine and zinc (13). Irrational prescription and use of antibiotics are rampant throughout the
country, with an estimated half of all antibiotics being sold without prescriptions (16).
Self-medication is widespread, and all types of medicines can be purchased without a prescription
(17). There are about 30,000 illegal (6) and 80,000 unlicensed (8) drug stores operating in the
country. It is alleged that both legal and illegal drug dealers are engaged in selling fake,
smuggled and adulterated medicines in the country (6).
Conclusion
Inadequate supply of essential drugs, substandard quality, uncontrolled drug prices and
inappropriate uses of drugs are major problems in Bangladesh. The drugs control authorities
should be better equipped and more vigilant to cope with the situation. Health professionals and
drug manufacturers should be more committed in order to achieve the goals of the NDP.
Bioethics, which is the title of this national conference, is a term that implies far more than
medical ethics which dominates its sessions. What is bioethics? It is no more and no less than
the ethics of living or ethics of life, which evolved from non-life over millions of years.
Humans are a product of the evolutionary process like all other species, but they are unique
insofar as they not only participate in the evolutionary process but also command and determine
the future, as brought home so vividly by global warning. Nevertheless, as Professor Hubert Markl
remarked, there is a circular relationship between nature and humankind because human concepts
are nature's concepts. Human technological and economic inventiveness is no more than nature's
way of acting upon itself and shaping its own future. The outcome could be glorious success or
disastrous failure - in either case, nature acting through humankind bears partial responsibility
for the outcome. This is fundamentally an ethical question. Are we right, for example, to cause
the profoundest changes in biodiversity in all the 3 billion years of evolution by the mindless
destruction of all living species to accommodate 10 billion human beings and their domesticated
slave species of animals and plants? To make a sustainable future, we have an obligation to act
in accordance with the dictates of reason and moral norms, and remain responsible for what we do.
It is this undoubted fact of nature that makes us look for guidance to bioethics, without which
life would be replaced by fossils. I would, therefore, compliment the organisers for placing the
deliberations of this conference against the austere background of bioethics.
A missing domain
The programme of the conference is wide-ranging and covers practically all the vital and
contemporary issues relating to medical ethics in India. However it is silent on one issue of
great importance, which is ethics in the practice of ayurveda. An Indian traditional system of
medicine par excellence, ayurvedic practices were in vogue in Buddha's period when Takshasila was
already reputed as a major centre for the training of physicians. The term “ayurveda”
crystallised in the first century when the Charaka Samhita was written - a text that is taught
even today in ayurvedic colleges. India produces over 15,000 ayurvedic doctors every year from
over 200 colleges and, according to some estimates, 60 per cent of the countryside depends more
or less on ayurvedic practitioners for basic healthcare needs. To survive and flourish even after
2,000 years of varied fortunes, the traditional system must surely have intellectual and ethical
vitality, and its claim to consideration in a national discussion on bioethics would seem
self-evident. An effort is necessary - however difficult and time-consuming it may be - to
develop a unified ethical code that would apply to all forms of healing in India.
Ethics in ayurveda
In the three classic tests of Charaka, Sushruta and Vagbhata there are no separate sections on
ethics. But ethical concepts are ever-present and an ethical undercurrent runs through all the
texts. To distil the ethical content from these large texts is as difficult as extracting sugar
from a cup of sweetened milk. One can only attempt to present gleanings from here and there to
give a flavour of the ethical spirit which animates ayurveda.
Bioethics and ayurveda
On human beings as part of nature; their lives in harmony with nature; the kinship with all forms
of life and so on, ayurveda has plenty to say. Consider the panchabhuta doctrine, so central to
ayurveda: it says that the universe consists of five elements that are the stuff of the stars,
earth, oceans, all living beings and everything that exists. These are, of course, not the
elements of the periodic table, but substances that are perceived by the five senses of sight,
hearing, taste, smell and touch. The sensory experience constitutes the basis of physical reality
or nature - what is extrasensory may or may not exist, but that is not part of nature. According
to ayurveda what exists in the human body exists in nature and vice versa, and their
interpenetration and interaction are constant and continuous. The homology between the universal
macrocosm and human microcosm was carried to extraordinary lengths until humans were regarded as
cosmic resonators. Hurting nature was no different from harming oneself, and reverence for nature
was ingrained in the practice of medicine.
Health and disease
Ayurveda laid a great deal of stress on good health and its maintenance, even as it laid out its
elaborate encyclopaedia on diseases and their management. Health was regarded as a state of
equilibrium that was sustained by a number of component equilibria. These included the
equilibrium of the tissues of the body; of doshas or functional units; of fires that burn in the
tissues and bring about changes such as food into tissues; of the body and its surroundings, and
so on. The human body was designed to maintain this equilibrium, which was its natural state. Any
deviation into disequilibrium, which we call disease, was largely brought on by one's own
misdeeds, and it could be counted upon to resolve and return to equilibrium automatically. All
that the physician could do was to give a helping hand in the process. His task had less to do
with the removal of a cause, which was, according to ayurveda, not the primary objective of
treatment. Causes exist within the body and without, but they are not necessarily pathogenic.
They become pathogenic only when the equilibrium is breached by the imprudent conduct of the
individual. Nor is it possible to sanitise the body and environment of causes. Then why stress
upon a cause to the exclusion of other considerations? Thus argued the ayurvedic texts.
Patients
Patients were seen in their homes or in the residence of the physician. Diagnosis was regarded as
so important that an entire classical text - Madhava Nidana - was devoted to it. History was
taken with great care not only from the patient, but also from his family and messengers who
brought the summons. The illness of a person was, therefore, more than a matter between the
patient and the physician. Having made the diagnosis, the physician had to decide whether the
disease was treatable easily and curable; treatable with difficulty and palliative; or whether it
was incurable and untreatable. He was obliged to inform the patient and family about the
prognosis - especially the palliative and incurable types - before undertaking treatment. If a
hazardous procedure such as the surgical removal of a bladder stone through the perineum was to
be undertaken, the physician also had to obtain royal permission in advance. The Arthasastra of
the third century BC had even prescribed capital punishment for physicians who undertook major
procedures without prior permission that led to the death of the patient. The protocols for
treatment specified the best of procedures and formulations that were apparently costly, and the
physicians were exhorted to provide “no-frills” protocols for those who could not afford costly
treatment. There was no bar on accepting fee for service except from specified categories such as
the king, preceptor, Brahmins, the indigent, etc.
When necessary, patients were admitted to homes for treatment, which were described elaborately
by Charaka. These had a scenic location with plenty of flora and fauna, lakes with clear water,
rooms for the patient, physicians, attendants, kitchen, store, procedures, toilets, etc. The
homes also had in residence storytellers, singers, and friends and relatives of the patients. It
was obviously a friendly place. A physician was enjoined to look on the patient as his own so
that he would develop total trust in him and regard him as his “father and mother” even in
difficult circumstances.
The great emphasis laid on the signs and premonitions of impending death makes one wonder whether
there existed in the remote past a class of physicians who specialised in the care of the dying,
who were summoned when the treating physician felt that his role was over.
Training
Training of physicians took place in the gurukulas or in the universities such as Takshasila and
Nalanda. The qualifications for the teacher and student were stringent, and covered physical,
intellectual, professional, moral and social attainments and background. Students were preferred
from Brahmin, Kshatriya and Vaisya castes, but Shudras were also admitted if the candidates were
bright. On acceptance, the pupil had to take an oath administered by the preceptor in a sacred
ceremony attended by a learned assembly. The oath covered the student's conduct under all
circumstances; his duties to the teacher, patients, friends, relatives, etc; his attitude to
learning and practice of medicine; and his commitment to a virtuous life. The oath represents the
high point of medical ethics in ancient India.
Professional conduct
The ancient texts reserved the harsh language of condemnation for the impostors and quacks who
obviously existed even in those far-off days. Those who paraded their so-called skills and
knowledge; who lacked proper training in theory and practice; who blamed the patient and
relatives for setbacks; who fled if the patient developed dangerous complications; who made false
claims about their lineage and achievements - all these came in for severe condemnation. The
fraudulent physician was looked upon as a messenger of death. The noble physician who was
virtuous, an expert in theory and practice, compassionate to the core and a friend of all was
revered.
General conduct
The life pictured in the ayurvedic texts is that of a people who were happy and cheerful, and who
sought to live for a hundred years in good health and comfort. They celebrated life and enjoyed
themselves without worrying about metaphysical subtleties. These was little place for
self-torture or renunciation, while respect was always shown to the saints. There was a general
belief that diseases were caused by one's own imprudent conduct or the act of gods. Virtuous
conduct which stipulated the avoidance of the overuse, underuse and misuse of the 10 sense organs
- sensory and motor - was prized because it was the sovereign prophylaxis for all ailments, which
could even annul the effects of karma unless they were caused by enormously wicked actions.
Truthfulness, compassion and reverence to learning were held in the highest esteem.
Conclusion
An effort to raise ethical awareness in health care should not be an event, but a never-ending
process. The veneer of civilisation is thin and the atavistic tendencies of man for violence and
cruelty are ever ready to burst forth, as happened in Nazi Germany. The cases reported by Beecher
in the US reminded us that atavistic tendencies could reassert in more “civilised” ways under the
garb of science. What can one say about India where people live in fear of their kidneys being
stolen?
In strengthening our ethical convictions and practices, we are meeting our obligation to not only
the present but also to our past and the future.
Primum non nocere, the Hippocratic dictum, is perhaps the cardinal rule of medicine in general
and of medical ethics in particular. This principle has been honoured by most of its
practitioners in the long history of medicine. Thus, a book which provides a revisionist history
and bunks considerable amounts of accepted or known history needs to be noticed. Medicine has had
more error than it has done things right, says the author, David Wooton, Anniversary Professor of
History at the University of York, England.
Wooton does not write a conventional history. He chooses, instead, selected - but extremely
important - events in medicine to illustrate his theory. For instance, all medical students are
taught that James Lind was the physician who showed that scurvy could be prevented in sailors by
the regular intake of lime on long sea voyages. Likewise, Ignaz Semmelweis is given credit for
showing the aetiologic connection between puerperal fever and the lack of disinfection or washing
of hands by medical students and doctors who examined pregnant women after performing autopsies.
Wooten upsets the apple cart by stating that Lind had little to do with the treatment of scurvy;
our belief that he did so is purely a misinterpretation of known facts. He shows, also, that
Leewenhoek's microscopes and specimen preparations were far superior to what we've always
believed - that they were crude and incapable of yielding good information. Wooton shows that
there was a delay in microscopic pathology, a delay which is unforgivable and must have cost
numerous lives over the decades. In a similar vein, Wooton states that years took place between
the discovery of penicillin (long before Fleming rediscovered it) and the realisation of its
impact on therapeutics followed by its mass production and use. Indeed, many of our medical
heroes seem to have got it all wrong, in this book.
Because physicians refused to accept change and have an open approach to change until 1865, when
Lord Lister changed the course of medicine with his seminal introduction of antisepsis in surgery
, they have been unscientific, claims Wooton. And an unscientific physician is, it is obvious to
us, an unethical one.
And, yet, methinks the man doth protest too much. Is Wooton guilty of evaluating the events of
the past with today's knowledge? I suspect so. There is of course, much truth in what Wooton
states. But is it fair, for instance, to say that Semmelweis is given “more credit than he
deserves” only because “he did not recognise puerperal fever as an infectious disease or
recognise the role of germs”? Opportunities have been lost, mistakes have been made - but that is
what research and progress is all about. What he does not seem to realise is that there are very
few eureka moments in science. Change, when it does take place, is generally slow. This is
probably true not just for medicine, but for other fields as well. Further, making retrospective
diagnoses and offering armchair theories are among the easiest things on earth, be it in
radiology and pathology, history of medicine or in predicting the stock market. It is all too
obvious now that the earth revolves around the sun, but before Copernicus and Galileo changed
that belief, millions of people would have scoffed at the idea. Not for nothing is it said that
when a new idea is introduced it is initially scoffed at, then looked at with some interest and
then accepted as something that was obvious all along.
Wooton himself accepts that psychological and cultural factors worked (and work and will continue
working) against innovation. After all, medicine is a science which develops in a social context
and its history and interpretation cannot be studied in a vacuum.
It is also useful to keep in mind cases which were immediately accepted by medical science - the
use of thalidomide and of frontal lobotomy are only two examples of treatments which created much
misery before being discarded. More bad medicine, perhaps?
Although I do not accept Wooton's thesis - which has been warmly praised by some critics and
blasted with equal fervour by others - I recommend that you read the book. Much of his research
and interpretation is original and teaches that it is always sensible and often useful to
question established theories about known “facts”.
Government policy and medical practice
The character of the medical profession, the manner in which medicine is practised today and the
direction of healthcare are shaped by our environment with all its inequities of caste, class
and gender. This character, this manner and this direction are reinforced by the messages
conveyed in the medical education system, by the incentives of the new economic policies and by
the actions - or inaction - of regulatory authorities. Such an understanding is expressed in
various ways in this issue. An editorial writer comments on the Sukhdeo Thorat Committee report
documenting faculty inaction against caste-based harassment of students in the All India
Institute of Medical Sciences. That the caste and other inequities reinforced in medical school
are expressed in medical practice is illustrated in an interview with the director of a sperm
bank; parents demand - and doctors arrange - sperm of the desired caste and economic background.
The second editorial describes how the inequities in this environment are reinforced by the
government. As private medical care grows it seeks foreign markets; hence the policy to promote
"medical tourism" with tax breaks and other incentives - even as the vast majority of poor
Indians have no access to healthcare
Stem cell "therapy" is another example of an industry promoted by the government policy of
turning a blind eye to its unregulated proliferation. A commentary writer documents the
unjustified claims that prompt the desperate to spend their life savings in the hope of being
cured of a serious disease. Doctors undertake experiments with neither scientific basis nor
ethical clearance in the name of treatment. Regulatory authorities indicate their inability - or
unwillingness - to take action against unethical practices. Another commentary writer describing
his encounters with corruption in medical practice points out that corruption has infiltrated
the profession at every level, including those agencies meant to enforce ethical practice. Those
who benefit from the existing system - within medical practice and in society in general - have
every interest in maintaining the current state of affairs. More than 500 health professionals,
researchers, policy makers and students attended the Indian Journal of Medical Ethics Second
National Bioethics Conference in Bangalore. We carry a report on the conference and comments
from participants.
Medical ethics education in India
Medicine is one of the few professions that sets a code of behaviour for its practitioners. In
the past the relationship between the doctor and patient was paternalistic. Today this has
changed. Advancement of medical science and technology has made a tremendous impact on medical
practice. Rising costs of medical care and scarce resources pose dilemmas to the practitioner of
medicine.
Since the late 1950s there has been an explosion in the field of bioethics. Gone are the days
when problems were resolved by emulating seniors in the profession. Writing in The National
Medical Journal of India, Dr SK Pandya laments that today “unfortunately the number of role
models in the medical colleges is diminishing as unethical practices flourish and this adds to
the frustration of students for they see a divergence between what is preached and what is
practised” (1).
The Medical Council of India (MCI) regulations on undergraduate medical courses emphasise that
medical graduates become exemplary citizens by the observation of medical ethics, and
fulfilling social and professional obligations, so as to respond to national aspirations (2).
This is one of the objectives of medical education. Students need to develop a rational approach
to solve medical dilemmas that they will face in the future. Just as they learn various subjects
to tackle medical problems, they also need ethics to solve the moral quandaries that they are
likely to face in their practice in the future.
The application of the Consumer Protection Act to the medical profession has stimulated
professional bodies to consider medical ethics in their annual deliberations. Media reports of
patients faced with questions regarding transplants, medical negligence, end-of-life issues, etc
highlight the ethical dilemmas of the medical profession as well as those of the public. Reports
of misconduct in research, and the Indian Council of Medical Research (ICMR) guidelines on
clinical trials, have stimulated a keen interest in the study of ethics in the country.
Medical ethics teaching in India: the current scenario
The MCI curriculum does not have medical ethics as a separate subject in any of its courses. In
the curriculum of forensic medicine, the student is expected to “observe the principles of
medical ethics in the practice of his profession” (2). The St John's National Academy of Health
Sciences is one of the few medical colleges with ethics as a separate subject for training of
undergraduates (3). Many universities and medical colleges are making efforts to introduce it in
the curriculum. Since 2004 the ICMR has been conducting sensitisation workshops for students as
well faculty throughout the country. This has created a tremendous interest in medical ethics.
Therefore, we need to act now to fulfil aspirations.
A few law schools have started distance education courses in medical law and bioethics in the
country. These courses are more tuned to law than to ethics. Moreover all of these are
certificate or diploma courses. At present there is also a dearth of teachers and resources for
teaching medical ethics.
Challenges faced in teaching medical ethics
Course
1. At present the MCI curriculum does not have medical ethics as a subject. Only when it is made
a separate subject by the MCI will all the medical colleges and universities in the country
implement it. We need to lobby to implement it.
2. Medical ethics should be made a compulsory course with requisite attendance for the award of
medical degrees. Studies have shown that making ethics an optional course in medical colleges
does not serve its purpose (4).
3. Medical ethics need to be structured in such a way that the student is exposed through out the
medical training period.
4. Evaluation of the course should be left to the faculty teaching the course. Students should
have to be certified by the college, stating that they have successfully completed the course
with the requisite attendance. In my opinion, making medical ethics a university examination
subject adds to the burden of the student and reduces the classroom interactions.
Curriculum
A structured curriculum is necessary for the teaching of medical ethics. The St John's curriculum
has been modified by many universities. The ICMR is in the process of formulating a curriculum
for bioethics in the country. The MCI should develop its curriculum by adopting one of these
curricula. Care must be taken that it is not overloaded with legal issues.
Teachers
A handful of trained bioethics teachers (postgraduates) are available in the country, but only a
few of them work in medical colleges. There is a need to increase this pool. Many medical
teachers have diplomas in medical ethics. There is an acute shortage of trained medical ethics
faculty in the country. There is an urgent need to train staff if medical ethics is to be
introduced as a subject.
What can be done?
1. Organise advanced programmes urgently for teachers who have undergone diploma/certificate
courses in medical ethics.
2. Start master's degrees in medical ethics. Encourage more clinicians to become ethics teachers.
This will, hopefully, improve the standard of ethics practice and there will be better role
models for students to follow.
3. Redress the lack of faculties of law, philosophy and social sciences in medical universities
in the country. Faculty in these disciplines who are working in the regular universities must be
given a dual appointment in medical colleges and they should be actively involved in teaching.
4. Provide additional incentives for faculty who are involved in teaching ethics either in
monetary terms or in terms of career advancement.
5. Encourage medical universities to establish chairs and departments of medical ethics to
develop the subject in the country.
Resources for teaching ethics
There are few Indian textbooks on medical ethics. Most deal with the legal aspects of medicine
rather than ethical ones. Some books are even factually incorrect and misleading. There is a dire
need to have good textbooks on medical ethics in an Indian context.
There is a dearth of articles on medical ethics from the point of view of Indian philosophy.
Research has to be undertaken to identify and interpret Indian philosophy as it relates to
medical ethics.
Writing on ethics in the Indian context is negligible. General medical journals rarely carry
articles on medical ethics. Even if they are written, they deal more with malpractice and legal
issues rather than ethical thought.
Throughout the ethics discourse we need to remember that India is a secular and multicultural
society. Resource materials on medical ethics must incorporate this unique aspect.
Hope for ethics teaching
At present there is a tremendous interest in medical ethics in the country. Many universities are
actively working on developing an ethics curriculum. The ICMR is taking a lead to introduce a
certificate as well as a master's course in medical ethics. It is also in the process of
publishing a book on medical ethics. The response of the medical community to the first national
bioethics conference is another hopeful sign that medical ethics teaching will become important
in the near future. One hopes that the MCI will take the lead and make ethics a part of medical
education.
VIETNAMESE REVIVE ANCIENT MEDICAL ARTS
The Vietnamese, short of medicines, medical equipment and the money to buy them, are reviving and
encouraging the use of the country's ancient healing arts.
''We have 4,000 years of history and more than 1,000 years of written works of traditional
medical practice,'' said Dr. Tran Thuy, the deputy director of Hanoi's Institute of Traditional
Medicine.
''Acupuncture, massage, physical exercise and the use of plants and minerals are all part of
this,'' he added. ''With these, about 60 illnesses can be treated successfully, many in local
clinics.'' Dr. Thuy is an ear specialist with a modern medical training who moved into
traditional medicine out of a life-long interest Intellectual Vietnamese have made native
medicine into a science, but traditional medicine is not limited to government public health
services.
One of the most famous and popular men in Hanoi these days is a 75-year-old Buddhist private
practitioner of traditional medicine who goes by the professional name of Cuu The, ''the one who
saves lives.''
Cuu The holds office hours in a small shop in downtown Hanoi with posters on the walls and a
sidewalk sandwich board to advertise his specialties: liver ailments, rheumatism, asthma and a
host of sexual dysfunctions. His fee is measured in pennies, but his clientele is cosmopolitan.
Cuu The, a chain smoker who is almost toothless, chortles his way through a story about a Russian
who came to him for a cure for infertility. ''He was back this morning to thank me,'' Cuu The
said with a satisfied grin, looking at notes of the case he was recording in one of many school
exercise books.
The old practitioner, one of 18 members of the city's Traditional Medical Care Organization, most
of them private doctors, says that at the root of his success is his Sino-Vietnamese Buddhist
faith. ''If we were all Buddhists we would have peace in the world,'' he says. To that, he adds
yoga breathing techniques from South Asia. ''Good for headaches,'' he said. ''The air pushes out
the poisons.''
''The Buddha taught that on the globe there are rivers, and in the body there are also rivers,''
Cuu The explained. ''When there are no blocks in the earth's rivers, the water flows
continuously. When there are no blocks in the body, there is no disease.''
Cuu The also recommends relaxing massages, ''reasonable'' exercise and proper diet, based on
ancient Sinetic definitions of ''hot'' and ''cold'' foods (not related to temperature) for
traditionally understood ''imbalances'' in the body. Dried foods, he explained, strengthen the
body's ''positive'' aspects (the cause of headaches); water and wet foods, the ''negative.''
''A person will have good health when his body is balanced,'' he said. He also tells patients to
take a lot of vitamin C in the form of lemonade. Told he sounded like a California health-food
advocate, he laughed.
''Vitamin C is an old idea here -followed by papaya to keep the river flowing,'' he said.
''Thirty years ago I predicted foreigners would one day come to Vietnam to study our medicine.''
Cuu The dips frequently into herbal or other natural medicines, drawing on both Chinese and
Vietnamese prescriptions. ''But the basis is Vietnamese,'' he adds, echoing the official view
that Vietnam has nothing much to learn from China. ''Vietnamese medicine is better than Chinese
in both theory and practice,'' he said.
Cuu The said 95 percent of his prescription remedies were based on plant products easily found in
the countryside.
''Chinese medicine has about 1,000 natural materials,'' he said. ''We have 800. I know all of
these. Thirty of them cure difficult diseases.''
The Institute of Traditional Medicine also uses local vegetable, animal and mineral products.
Eucalyptus, mint, ginger and aromatic coleus are among the most widely used plants to treat
common illnesses, according to Dr. Thuy.
Dr. Thuy, whose institute conducts research and trains practitioners, said 23 common ailments
were now treated entirely at the local level by combinations of herbal remedies, massage,
physical exercise and simple acupuncture. More complex ''electro-acupuncture'' treatment cases
are referred to the four-year-old Central Hospital of Acupuncture, which adjoins the institute in
Hanoi.
Foreign medical experts who visit Vietnam as well as Vietnamese doctors say that the country's
most serious problems, especially among children, are intestinal diseases caused by universally
contaminated water and mosquito-borne illnesses, coupled with malnutrition that leads to easy
infection.
Dr. Thuy said 77.6 percent of common diarrhea cases and 86.35 percent of amoebic dysentery
attacks were now treated with traditional medicine. Respiratory ailments, allergies, fevers, back
pain and joint and muscle pains are also among what Dr. Thuy listed as diseases and symptoms that
are first treated without chemical or surgical cures.
''For economic reasons, our chemical industry has not developed yet,'' he said. ''By fully using
trees, the earth and other resources we can save foreign exchange. And there are no chemical side
effects on patients.''
At the Central Hospital of Acupuncture, where nearly 70 patients were sharing 50 beds and about
300 to 400 people crowded the corridors each day as out-patients, Dr. Mai Tue, the director of
specialty departments, showed a visitor people being treated for encephalitis, earache, back
pain, dizziness, loss of appetite, vision and hearing problems and paralysis.
The hospital also uses acupuncture as an analgesic in surgery for appendicitis, colosectomies and
hernias, among other procedures, Dr. Tue said. Two research projects are now under way in
cooperation with the Soviet Union, on optic nerve repair and the treatment of paralysis. The
hospital says it has had much success in both areas.
The hospital makes extensive use of a low-cost electro-acupuncture system its staff devised
themselves, Dr. Tue said. This involves attaching needles to a six-volt power source that
provides automatic vibration. Needles were earlier manipulated by hand.
''We can treat every disease or illness treated by modern medicine,'' Dr. Tue said. ''With our
economy facing so many difficulties, this is the most suitable way to deal with our health
problems.''