History of Science, Technology, Environment, and Medicine in India

Suvobrata Sarkar

• Publisher: Routledge India
• Year: 2021
• ISBN:
  9781000485004
• Edition: 1
• Topic: History
• Subtopic: Indian & South Asian History
• Index: History

This volume studies the concept and relevance of HISTEM (History of Science, Technology, Environment, and Medicine) in shaping the histories of colonial and postcolonial South Asia. Tracing its evolution from the establishment of the East India Company through to the early decades after the Independence of India, it highlights the ways in which the discipline has changed over the years and examines the various influences that have shaped it. Drawing on extensive case studies, the book offers valuable insights into diverse themes such as the East–West encounter, appropriation of new knowledge, science in translation and communication, electricity and urbanization, the colonial context of engineering education, science of hydrology, oil and imperialism, epidemic and empire, vernacular medicine, gender and medicine, as well as environment and sustainable development in the colonial and postcolonial milieu.

An indispensable text on South Asia's experience of modernity in the nineteenth and twentieth centuries, this book will be of interest to scholars and researchers of modern South Asian studies, modern Indian history, sociology, history of science, cultural studies, colonialism, as well as studies on Science, Technology, and Society (STS).

Section IV Medical encounters

12 When man meets medicine Some reflections on The Death of Ivan Ilyich and Āyurveda with its epistemological consequences

Jayanta Bhattacharya

DOI: 10.4324/9781003241980-17

Introduction: The case of Ivan Ilyich

In Tolstoy’s The Death of Ivan Ilyich (1886, translated by Louise and Aylmer Maude), the doctor seemed to imply “if only you put yourself in our hands we will arrange everything -- we know indubitably how it has to be done, always in the same way for everybody alike.” But he was obsessed with the question if his case was serious or not. The real question was to decide between a floating kidney, chronic catarrh, or appendicitis. We are faced with a number of problems related to medicine, health, body, and disease arising out of reading this classic. If Ivan Ilyich is eager to know of organ localization of his disease, the doctor appears to be omnipotent (and omniscient too) regarding medical decision. Ivan tried to “translate those complicated, obscure, scientific phrases into plain language.” The assured authority of the doctor was irrupted by a contradiction drawn from the examination of urine and the symptoms that showed themselves. Finally, “Reviewing the anatomical and physiological details of what in the doctor’s opinion was going on inside him”, Ivan understood it all. He began to think of the operation that had been suggested to him. To him, “It’s not a question of the appendix or kidney, but of life and …death.” The observable signs and the patient’s symptoms were increasingly matched to findings of pathological science, as in this case and, also, in tandem, with basic tenets of modern medicine. It may be profitable to take into account of German experience during the early nineteenth century. It shows how middle-class doctors imposed their bourgeois ideals of selfhood on suffering peasants. “The person contrasted radically from the self which physicians experienced and expected as a sign of health, namely a modern, secular, and individual self–unitary, self-bounded, internalized, responsible, and cut off from direct divine intervention.”¹

We, the readers of this story, become once again convinced of the fact that the body is a three-dimensional space inside which organize the disease. The person of the hapless, wretched, poor fellow Ivan Ilyich transforms into the pathology inside the body, with its temporal swings expressed in physiology. Ivan died with all his illness narrative in a domestic setting. He was living in the era of “The disappearance of the sick-man from medical cosmology, 1770–1870.”² He was solitary as well as alone. Seen from another perspective, he was not alone as well. American experiences of the mid-nineteenth century make us believe that people like Ivan Ilyich died at home in their beds. “As recently as 1945, most of deaths occurred in the home. By the 1980s, just 17 percent did.”³ Gwande trenchantly comments, “We did little better than Ivan Ilyich’s primitive nineteenth-century doctors – worse, actually, given the new forms of physical torture we’d inflicted on our patient. It is enough to make you wonder, who are the primitive ones.”⁴ Truly speaking, the doctors had a white coat on; they had a hospital gown – both uncertain about how to manage the terminal moments of one’s life. Hospitals were reserved for the indigent or those without friends or family and were sites of death rather than cure.⁵ Regarding formative years of medical education, as Gwande further brings to our notice, “They are spent in institutions – nursing homes and intensive care units – where regimented, anonymous routines cut us from all the things that matter to us in life.”⁶

Coming back to Ilyich, “He wept on account of his helplessness, his terrible loneliness, the cruelty of man, the cruelty of God, and the absence of God.” Ilyich seems to be sincerely in search for some metaphors which could fill in the vacuum of his excruciating pain and long drawn illness. Did he also think of a few moral and ethical questions which could redress his suffering? We are not sure.

At this point, to keep in mind, problems may arise when a metaphor expands in a sphere where it is not challenged or complemented by other equally powerful metaphors which are also expanding. In that case, the metaphor in question may go on expanding its application almost indefinitely. As a result of the declining vitality of religious metaphors in Western, or at least European, public discourse, metaphorical ideals such as “healthy behaviour” and “mental health”, propounded by doctors and others who are perceived to be “objective” and to have no ideological axe to grind, have expanded to fill the vacuum as it were. ⁷ Dostoevsky solemnly observed,

You see, gentlemen, reason is a good thing, that can’t be disputed, but reason is only reason and satisfies only man’s intellectual faculties, while volition is a manifestation of the whole life…life frequently turns out to be rubbishly, all the same it is life and not merely the extraction of a square root⁸

Since the era of “living anatomy” of Boerhaave by which he tried to unify anatomy and physiology, anatomy or, more precisely, pathological anatomy became the central question of medical metaphors.⁹ Simply put, death is a part of human experience, a necessary consequence of life that we all must face. Although death is a rite of passage in which we will all participate – as family members, providers, or eventually, patients – we understand little of what is valued at the end of life. For example, a search of the medical literature published in 1996 identifies 112 papers that contain the keyword “death”, a topic that directly affects everyone. In contrast, a similar search reveals more than 1,000 references pertaining to schizophrenia, a disorder with a population prevalence of about 1%.¹⁰ “The exile of the dead” began with the insinuation of commerce into the world of death. So, it is no wonder that atrocity stories are central to people’s talk about their encounter with the medical profession. In another poignant observation, “The white man’s image of death has spread with medical civilization and has been a major force in cultural colonization.”¹¹ Precisely, a novel image of death has emerged.

In Ilyich’s case, nay in the modern world too, the entire cosmos of everyday life seems to be completely filled with metaphors of fabricated “health and youth” of the commodity world or objective scientific metaphors which have destroyed traditional morality and the normal range of predictable moral expectations derived from religion or interpersonal subjective network and bondage. It could not easily confront the moral problems generated by these new social relationships. A vacuum was yet to be filled as perceived in Ilyich’s reflection on the absence of God. “To become a patient is to establish a healing relationship with another who articulates society’s willingness and capability to help.”¹²

We may try to understand how this relationship of health and its concept, unlike Euro-American paradigm of health–commodity–physician, are embodied in physician–healer–social assistance–neighbourliness–community paradigm in Indian medicine.¹³

Gadamer seems to make us aware that modern medicine is so geared to understanding disease and fighting illness that we seldom stop to think about our goal, namely, health. Health manifests itself, as Gadamer notes, by escaping our attention. Hence, the important task of thinking about health requires a patient and disciplined mind, sensitive to subtlety.¹⁴

At this juncture, it should be noted that in no other journal than the New England Journal of Medicine (NEJM), the way we see health and medicine in the twenty-first century has been critiqued in clear terms, “Faith in reductionism, which was infused into medicine in the 20^th century, has empowered medical research to pursue only isolated problems and to yield targeted, immediately deployable solutions.” In this conceptualization, what is missing is “whole-person approach focused on long-term functional status.”¹⁵ Another medical philosopher reminds us that within modern Western society, the highly individualistic culture and religious decline linked with medicine’s reluctance to relinquish an outmoded form of scientific rationalism can act as reductive influences, stifling conceptual development.¹⁶

Technology, medicine, and human body

Curiously enough, Ivan Ilyich is archetypal of the quasi-abstracted individual on the canvas of modern medicine, especially in the hospital setting:

The hospital is an intimidating environment for most individuals. Hospitalized patients find themselves surrounded by air jets, buttons, and glaring lights; invaded by tubes and wires; and beset by the numerous members of the health care team – nurses, nurses’ aides, physicians’ assistants, social workers, technologists, physical therapists, medical students, house officers, attending and consulting physicians, and many others…It is little wonder that patients may lose their sense of reality.¹⁷

Technologically, every time the stethoscope was (and is) applied to a patient, it reinforced the fact that “the patient possessed an analyzable body with discrete organs and tissues which might harbour a pathological lesion.”¹⁸

Physicians often become the only tenuous link between the patient and the outer world. To accomplish his humane task, the physician does need to incorporate the question of ethics in the realm of medicine and to build a strong personal relationship with the patient. Ruth Richardson reminds us,

The need for ethical awareness and ethical behaviour applies to all dimensions of medicine, not just the practice of clinical medicine. Pathology cannot hold itself somehow distinct from, or immune to, a movement that has been gathering pace since the Nuremberg Code.¹⁹

Seventeenth-century stalwarts of medicine, like Sydenham and Boerhaave, depended more on clinical history than on technology. Boerhaave instructed,

Everything pertaining to the case must be listed; nor that least thing neglected which a critical Reader might rightly seek to understand the malady…there must be arrangement according to the surging change of events, and each event must be recorded in its proper place.²⁰

Curiously, in 1829, the Lancet, expressed concern that the stethoscope could also lead to eavesdropping.

Auscultation Extraordinary.

Quoth Rodrick I’ll a place contrive

So dark and safe, no man alive

Shall to our private meetings grope

Egad, cries Johnny, that won’t do,

If there’s no crack to listen through

They’ll make reports by stethoscope.²¹

Technology is not only constitutive of the models of health and disease. It provides also for their metaphors. Furthermore, with the application of artificial organs such as pacemakers, cochlear implants and advanced limb prosthesis, technology becomes a part of humanity’s physical existence, that is, there is a fusion of human being and technology.²² Before the eighteenth century, medicine was based on the patient’s narrative of the symptoms. In addition to this subjective portrait of the illness, the physician observed the patient’s appearance and behaviour as well as any signs of disease. During the eighteenth and nineteenth centuries, medical instrumentation enabled and extended the physical examination of patients which made the physician less dependent on subjective narration.²³

Contrarily, if, rather than as a technological object, society and science view medicine or art of healing in an all-encompassing way, the problems, and, more importantly, the solutions will be understood following this line of thinking. The rise of pathological anatomy and Hospital medicine as the sheet anchor of modern medical knowledge²⁴ and, subsequently, surgical practice and technological innovations in Europe led to epistemological exclusion of mind and person from the purview of medicine.

In the era of Bedside medicine, cosmological analogies emphasized an image of the body “as a microcosm, a reality sui generis subject to its own peculiar laws of growth and decay, comparable to the macrocosm of the physical universe.”²⁵ This particular observation on macrocosm (and, microcosm) of pre-Hospital Medicine period somewhat pertains to Āyurvedic view of medicine of which we shall talk about later on. Notably, in pre-Hospital medicine era, during the medieval period, European medicine was also a logically closed construct. Disease was seen to pass through three stages – first, a rough stage, stadium cruditus; second, the increasing stage, stadium incrementi; third, a crisis leading to a decreasing stadium ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Contents
• List of contributors
• Foreword by Prakash Kumar
• Acknowledgements
• List of abbreviations
• Introduction
• Section I Science and society
• Section II Technology and culture
• Section III Environmental issues
• Section IV Medical encounters
• List of publications of Professor Deepak Kumar
• Select Bibliography
• Index