V.D. Selvaraj in Conversation with Dr M.S. Valiathan: History of Medical practices in India and the Study of Ancient Texts

V.D. Selvaraj in Conversation with Dr M.S. Valiathan: History of Medical practices in India and the Study of Ancient Texts

in Interview
Published on: 19 July 2021

V.D. Selvaraj

Currently the deputy editor of the reputed Malayalam magazine 'Kalakaumudi', Selvaraj has decades of experience in journalism. He has also brought out a book titled 'Gabriel Garcia Marquez Muthal Kelucharan Mahapathra Vare: Adoor Gopalakrishnan, M.A. Baby', which is a compilation of conversations between Adoor Gopalakrishnan and M. A. Baby.

Dr M.S. Valiathan in conversation with V.D. Selvaraj

Eminent cardiac surgeon, researcher, teacher, institution builder, Ayurveda scholar, Dr M. S. Valiathan has donned many hats in his fruitful life with aplomb. Born in the princely state of Travancore in 1934, Valiathan was one of the first-ever graduates from Thiruvananthapuram Medical College. He received his F.R.C.S. from Royal College of Surgeons, Edinburg in 1960. Valiathan specialized in cardiac surgery at John Hopkins and Georgetown University hospitals, U.S.A., returned to India and did brief stints at Safdarjung Hospital, Delhi and IIT, Madras. A new chapter opened up in his life when he took charge as the director of the newly founded Sree Chitra Thirunal Institute of Medical Sciences and Technology in Thiruvananthapuram.   

Under his able leadership, Sree Chitra soon became a leading medical and research institute in the country. He and his team pioneered biomedical research and developed prosthetic heart valves and blood bags for the first time in India. Valiathan has published several outstanding research papers in nationals and international journals. He was elected to many national and international medical academies, and was awarded the Hunterian Professorship of the Royal College of Surgeons of England. After his retirement from Sree Chitra in 1994, he became the first Vice-Chancellor of Manipal Academy of Higher Education.   

During his tenure at Sree Chitra itself, his mind had turned to our ancient medicinal practices and knowledge. After his retirement from Vice Chancellorship in 1999, he seriously began to pursue his interest in the history of Ayurveda. He was awarded a Senior Fellowship by the Homi Bhabha Council to pursue a study of Caraka, resulting in the publication of the book The Legacy of Caraka. Later, as a National Research Professor, he studied the other two greats of ancient Indian medicine—Sushruta and Vaghbata—and authored books on both of them.

M.S. Valiathan has been honoured with several prestigious national and international awards and honours for his contributions to medical sciences and technology. Valiathan has served on many national and international committees and councils pertaining to medicine, technology, science and technology. At 87, he resides in Manipal and actively pursues and supports medical research.        

V.D. Selvaraj: Dr Valiathan, could you talk about the medicinal practices prevalent during Carakas timeAlso, was learning medicine open to everyone irrespective of caste?

M.S. Valiathan: Caraka speaks in detail about medicinal practices and learning Āyurveda.  In his time, the Brāhmaṇas and Katriyas could learn Āyurveda.  But, according to him, if someone from other castes was smart enough and was interested, he could also be taught. About Suśruta Samhita, we have to remember that the Suśruta Samhita we read now was, in fact, redacted after the time of Caraka in the fourth century CE.  We dont really know about caste restrictions in the original text composed by Suśruta.

VDS: How many Suśrutas were there actually?

MSV: The person who wrote Suśruta Samhita was called Vṛdha Suśruta. He was the one who designed operations. He was also the one who led a students’ delegation to the court of the King of Kashi and appealed for permission to learn Āyurveda. The King asked,What do you want to learn?’ They replied, ‘We want to learn Śalya (Surgery)’. He said, ‘Very good, come’.

VDS: The oldest Suśruta…?

MSV: Yes, he was the original author of the Suśruta Samhita.  It was 800 years after him that Nāgārjunas redaction appeared.  In between many redactions might have happened. Nobody knows. In the Suśruta Samhita that we see today, many more restrictions are given. That is, if persons from castes other than Brāhmaṇas or Kṣatriyas come forward to study Āyurveda, they should not be taught mantras, even though there are not many mantras. These restrictions are not there in Caraka. Society became more and more restrictive. The operations done by Suśruta were no longer practised. Those who studied Āyurveda stopped doing surgery. So, by the fourth century, the decline had already set in.

VDS: This decline was mainly due to caste discrimination?

MSV: Yes.  Surgical practitioners were looked down upon.  Surgeons were not invited to ceremonies like Ṣrādhā or a wedding.  No one really knows how these things happened.

VDS: As a person who has studied and is still studying Indias culture and philosophy in great depth, how has the social discrimination based on caste regressed India? How much has it taken us backward?

MSV: It did us a lot of damage.   Let us, for example, look at the nasal repair operation that Suśruta developed. The British observers who witnessed the nasal repair in the 18th century noted that only the Kumbhar caste–potters–were doing the operation then. Dharampal showed me an original document containing the actual description of the operator as an illiterate person, who sat alone under a tree and did surgery skillfully.  But if any question was asked, he didnt know the answer.  Why are you making a flap like this?  Why have a pedicle? He had no answer and would only say, ‘My father taught me like this’.

VDS: What he does is plastic surgery.

MSV: Yes.  Whatever techniques he did, he did them perfectly.  The two British doctors who witnessed the operation in Pune published their observations in the Gentleman’s Magazine of London. Their questions to the practitioner received empty replies and he had no ideas about how the procedure could be possibly improved.  This was similar to the response of metalworkers who made India’s rustless steel which made the famous Mauryan column. When East India Company gained power in India, they sent a competent engineer and Fellow of the Royal Society–James Franklin–to investigate steel making by natives in Jabalpur of Madhya Pradesh. He produced a report of 40-50 pages, including diagrams. He saw a man sitting with an assistant breaking locally available iron ore with a hammer into small pieces and packing them in a smelter they made easily and skillfully. The ore-pellets were packed in layers alternately with layers of charcoal.  A hole in the smelter provided a connection to billows through a tube. At the top of the smelter there was another hole for scoria to exit. After the packing was lit and charcoal was burning, the scoria flowed out through the hole on the top and melted iron dropped to the bottom of the smelter. This was processed in a refinery they built easily and further heating was done with some plant leaves. Franklin got the finished steel examined by the British Mint in Nagpur who certified its quality as equal to Swedish steel.

VDS: The quality of steel is at par with Swedish steel?

MSV: Yes. But, the interesting thing is that when Franklin asked the steel maker any question such as “Wouldn’t it work better if the billows were connected at a different angle?’ He would not agree and always repeated that this was how he was taught by his father and he would never deviate. Franklin concluded: “It is clear to me that this man is thoroughly ignorant of the technology of steelmaking.  He doesnt understand anything. But the original design is a work of great intelligence”.  Whether it was steel making or repairing the nose by surgery, the connection between brain and hand was lost in the humble practitioners. They were independent of each other. Any improvement or refinement in practice could only be suggested by the brain, which was impossible in Pune or Jabalpur because social discrimination had denied access to education and social mobility to those who did manual work including surgeons.

VDSAll our knowledge ended there?

MSV: Yes, it was a huge setback. This is why P.C. Ray, one of the founders of modern science in India, said, ‘By doing this, Indias soil became morally unfit for the birth of a Newton (Isaac) or a Boyle (Robert) and her name was practically expunged from the history of natural sciences’.  It was harsh but true.

VDSAs a person who has studied the history and background of Āyurveda, what is the concept of life, according to those ancient Āyurvedic scholars? We generally say that Āyurveda encourages a strict diet and a vegetarian diet, and encourages a life with many restrictions.

MSV: That is not true. Caraka says there are three primary urges in life. One, a long life–jeevaiṣaṇa–to live long.  The Vedas sought the same. Jeevema Śaradassatam.  Two, vittaisṣaṇa or a desire for wealth. Nothing could be worse than living for a hundred years in poverty.  Caraka recommended occupations, farming etc., to make a living.  Third, he mentions, paralokaiṣaṇa or a good afterlife as he was concerned with the question, ‘Where do we go after death?’.  He however added that there are doubts regarding this question and entered into a long discussion on the proof for afterlife.

As far as food, vegetarian diet and restrictions are concerned, Āyurvedic views were quite rational. The human body is depleting all the time, and replenishment must be made by food. This is a biological necessity. But food should also be enjoyable. We don’t eat food like animals. Āyurveda decreed that food should be well cooked and served properly at proper times. Vāgbhaṭa describes how a dining table should be set, and how plates should be arranged. He describes how wine should be served. There is a common impression that Āyurveda forbids wine, but this is not true.  Vāgbhaṭa even favoured wine being served in attractive containers by good-looking girls. Āyurveda never considered enjoyment as sinful.  Renounce everything and retire to the forest was alien to Āyurveda.  But Āyurveda cautioned that enjoyment should have limits.  A moral code was always upheld.  The whole question of enjoyment, whether in food or sex, is circumscribed by ethics and a moral code.

VDS: Renouncing everything is not Āyurveda.

MSV: Yes. But enjoyment should be within limits. Codes relating to compassion, tolerance, and appropriateness were emphasised. There was no bar on enjoyment in regard to food or sex or games. 

After my Āyurvedic study phase, I became interested in Yoga Vāsiṣṭa. It is a classic in Vedantic literature but has a number of stories for children which illustrate profound concepts. Many stories are suitable to be retold. But they also convey a message for adults. This is similar to Alice in the Wonderland which was written by a mathematician. Children love them for the hilarious stories and adults cherish them for the hidden message. I even spoke to Joy on illustrating the stories as he had done a masterly job for my book in Āyurveda.  I got the four volumes of Yoga Vāsiṣhṭa, which is couched in great poetry. As I read the first two prakaraas,  I was confronted by a problem. Yoga Vāsiṣṭa’s message is uncompromising vedanta, perhaps even tougher than Śankaracharyas.  Here I was past 85 and had spent most of my life looking after sick people. When a blue child has seizures and is on the verge of death and parents are weeping, how could I believe or say that what I witnessed was unreal. Would I be sincere? Wasn’t it intellectually dishonest to claim that the condition of the child and parents was unreal. As this line of thought grew stronger, I stopped my study and donated my books to Chinmaya Vishwavidyapeeth in Kochi.

Vinoba Bhave is also harsh in saying that the human body is a burden, a stone, to be downgraded and discarded. I could not accept it because I believe the human body or an animal’s body for that matter is marvelous. Look at the way the eye or the heart or brain is constructed. Only God could design and construct them. When we make a substitute organ, they are hardly comparable to the original. Whatever the philosophers may claim, nature’s creations like a living body cannot be dismissed as a piece of dirt.

VDSAs someone who has studied the important texts of ancient India, you must have come across studies of soil, nature and humans of those times. The soil of ancient India, its description, or a disease prevalent then is maybe comparable with the soil or disease of today. How has Caraka described the soil of those days, its colour, or the ways of man?

MSVAbout soil, Caraka speaks only in a general way. He says that medicinal plants growing in the Himalayan country are potent and superior to those growing beyond the Vindhyas. India consisted of many Kingdoms in his days. In his Samhita, many chapters consist of discussions among participants who came from different kingdoms. The discussions resembled the international conferences of today. The country from which the speaker came is often mentioned and medicine prepared by a physician was named after him. The conferences were an effective way of advancing Āyurvedic medicine.

Another kind of discussion took place in gurukulas between the guru and his students. To give a flavour of these discussions, the guru in one instance advanced a proposition that chikitsa (patient’s treatment) has four elements. These are the patient, physician, attendant, and medicine. Each of these elements has four properties. The physician should, for example, have knowledge, skill etc. These are discussed in detail. If the four properties of each element, a total of sixteen, are present, the treatment will be successful.  When a discussion begins on this proposition, a student remarkedAcharya, in our experience, there are instances where treatment is successful even when the requirement of all the sixteen properties is not fulfilled. Also, there are instances where the patient dies when a total of sixteen properties are in place. The proposition may not always work’.  Here the student is contradicting the teacher.  Remember this was recorded 2000 years ago.  Today, a student wont dare to contradict a teacher. In Carakas time, an aspiring student would come to the teacher and tell him, ‘Acharya, I would like to study a particular text’.

VDS: The student suggests the text he wants to study?

MSV:Yes. Please note the student had the maturity and freedom to suggest his text for study. In those days, a text for study had prescribed requirements. This is similar to Mahakavyas having textual requirements. The acharya would examine the text chosen by the student and decide whether it is appropriate as a text for him or not.  It is important to note that the student chose the text in the first place. Not only that, he also had the freedom to look at the teacher’s qualifications. He was not looking for Ph.D., but whether the teacher was compassionate or not. If I made a mistake, would he be forgiving? Does he practise what he teaches? The student had the freedom to look into such qualities of guru or acharya before joining the gurukula. Caraka Samhita mentions these interesting aspects in the training of physicians. 

VDS: In ancient India, there were two great learning centers—Takṣaśila and Nalanda. A conversation is not possible without mentioning them. What was the importance of Takṣaśila? What kind of learning was there?

MSV: Takṣaśila was older than Nalanda, around 700 BCE. Some scholars suggest earlier dates and claim it is the oldest university in Asia. We dont know that but it was certainly older than Nalanda.  Āyurveda and philosophy were important subjects of study in Takṣaśila and they went together. Pāṇini was from Takṣaśila.  Takṣaśila was destroyed by invaders like Nalanda later.

VDS: Important people studied there, for example, Jīvaka, Buddhas physician. What is that story?

MSV: Jīvaka was Buddhas physician. There are many stories about him in the Jātakas.  An extraordinarily brilliant person, he became the physician of Lord Buddha and performed craniotomy in a merchant in Varanasi, removed worms and cured his illness which had been declared incurable.  Suśruta did not mention craniotomy in his Samhita.  This is the reason I believe that Suśruta lived before Jīvaka. If craniotomy had been in vogue, Suśruta would certainly have written about it in his description of surgical operations. The straightforward explanation for the significant omission is that craniotomy was developed later and probably by Jīvaka. There are medical historians of Europe who are reluctant to accept the authenticity of Suśruta’s operations and even of Suśruta! There is an element of condescension in the approach of many European orientalists to Indian scholarship. I once met a British scholar of Sanskrit who knew India and Indian manuscript studies well. He didn’t have a high opinion of India’s study of archives and went on to doubt how I could hope to study Caraka Samhita without a scholarship in Sanskrit. He had a point but I couldn’t let him get away with it. Caraka wrote in Sanskrit but he wrote about medicine, treatment of illness, complications etc.  How could a Sanskrit scholar hope to understand Caraka without knowledge of medicine?

Caraka, Suśruta and Vāgbhaṭa constitute Bṛhatrayī or the ‘Big three’ of Āyurveda. There are two texts–Aṣṭāṅgasaṅgraham and Aṣṭāṅgahṛdayam–attributed to Vāgbhaṭa. Aṣṭāṅgasaṅgraham is larger and not poetic in contrast to Aṣṭāṅgahṛdayam which revels in poetry.  There is an ongoing debate for 100 years whether they were written by one person or a father-son duo. Raghavan Thirumulpad was of the opinion that one person wrote both books. The author of Aṣṭāṅgahṛdayam says that he is saying nothing original but writing ‘neither too long nor too short’ to suit the times he lived in. He doesn’t deal with philosophical themes, the teaching of students or the environment but only with topics of interest to practicing physicians.  Aṣṭāṅgahṛdayam became immensely popular in Kerala where Caraka and Suśruta occupy a secondary position in Āyurvedic studies. In North India, the reverse is true.

VDS: When you talked about the history of Āyurveda you said that you are not interested in mathematics. But you actively researched on the history of mathematics in Kerala, and initiated the founding of the Kerala School of Mathematics. There is a lot of research in European universities on the ancient history of mathematics in Kerala.

MSV: What we know is this: Mathematics came to Kerala from the North and the Kerala school of mathematicians assimilated it and contributed to it.  Āyurveda too came from the North and we adopted it and added to it local procedures such as dhara and pizhichil.  We did not contribute to the conceptual or theoretical aspects of Āyurveda. We were not passive borrowers of knowledge. In mathematics, the significant start was Āryabhaṭa who lived in Bihar in the 4th century CE. Within 200 years of his death, his doctrines came under attack. Authorities like Brahmagupta repudiated his views.  The extraordinary thing was that 300-400 years later, Madhava in Kerala revived interest in Āryabhaṭa’s doctrines.

VDS: Which period was this?

MSV: Around 600 CE.  Professor Divakaran published a well-researched book The Mathematics of India recently. He was a professor at the Tata Institute of Fundamental Research (TIFR). His studies opened new grounds. Everyone thought that Madhava belongs to Irinjalakuda (Thrissur district). But Professor Divakaran produced convincing evidence that Madhava belonged to Kudallur Mana (mana means a Kerala Brāhmaṇa’s traditional residence) in Palakkad district. While we have no books written by Madhava, other eminent mathematicians such as Neelakanta Somayaji, and Parameswara quote from his writings. People at Kudallur Mana say that they had many manuscripts which they donated to the Manuscripts Library, Thiruvananthapuram. The Kerala School of Mathematics originated from Madhava. Parameswara was the next who invented Digganita. He was followed by Neelakanta Somayaji and Jyeṣṭa Deva who are internationally known.  Jyeṣṭa Deva invented calculus as indicated in his Yuktibhāṣa a hundred years before Newton. The University of Exeter in England set up a study center on Jyeṣṭa Deva.

My interest in the Kerala School is the fact that it produced several first-rate mathematicians with a keen and analytical mind. How did the school end abruptly? How did it flourish for over two hundred years in a village Thrikandiyoor? No one living in that area today knows about the great mathematical traditions of their habitat.  In fact, they were discovered by a British officer of the East India Company—Charles Whish who was serving in Kochi.  He got a few palm leaf manuscripts, got them translated and consulted Sir Francis Spring ICS in Chennai who was a mathematician by training.  Incidentally, he was the man who discovered Ramanujan. He discovered the importance of the manuscripts and advised Whish to report the findings to the Royal Society of London.

VDS: Our ancient manuscripts contain the culture and wisdom of ancient Kerala and India. Have there been attempts to preserve the old manuscripts? Many people say that our manuscripts were all whisked abroad, and so now we cant access the information contained in them. You must have inquired about it, havent you?

MSV: No, not in detail. Manuscripts are found in all parts of India. When Dr Sudha Gopalakrishnan established the National Manuscripts Mission, she identified and catalogued, I think, two million manuscripts in Sanskrit and regional languages and in all subjects including science and liberal arts.  Regional collections were large. For example, 100,000 in Odissa. 75,000 in Mysore, 50,000 in Thiruvananthapuram. Nowhere are they preserved well. For us, manuscripts are a low priority and they do not attract the attention of officials or ministers. It is true that many of our manuscripts were taken away to western countries during colonial rule. 

But Wujastyk who knows India well told me that Britain, France, United States, Germany, and Holland may have approximately a total of 70,000 manuscripts. They are catalogued, preserved and indexed. Any scholar who wants to do research can access their digitized texts easily. In contrast, we have two million manuscripts in India.Are you taking care of them?’, he asked.  The fact is we dont take care of them, nor do we let others study them!

What is lacking is not money or facilities but the spirit which drives humans to great deeds.