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Notes on the history of Ayurveda – 2: Ideas of infection and contagion in the past

[In this series I attempt to inform readers of the excellent scholarship that exists on the history of Ayurveda, which is one among several of the premodern medical traditions of South Asia. See here for the previous article.]

The book ‘Contagion: Perspectives from Pre-modern Societies‘ (2000) is a great introduction to how people in the past thought about diseases which spread from one person to another, or rapidly within a community. It is difficult indeed to get into the shoes of people from around the turn of the millennium and imagine a world where the concept of germs in the air, water and surfaces was not a given. Historians have done a great job of detailing such past societies, and here we will take the help of two such scholars who have worked on the history of pre-modern South Asia: Rahul Peter Das and Kenneth Zysk.

The editors of the book, Lawrence I Conrad and Dominik Wujastyk, provide a helpful overview in their introduction:

That certain diseases are readily transmitted from an ill person to a healthy one is something that one might expect that all pre-modern societies would have noticed and explained in some way. As several papers in this volume show, the phenomenon of contagion was recognised by society at large, and was especially clear to pastoralists and those charged with the care of animals who did not need great epidemics to observe the spread of disease among their herds.. Both Chinese and Indian doctors posed the question of why many people should all fall prey to a single disease at a single time and place.

There are two chapters in this book which deal with India/South Asia. The one by Rahul Peter Das is titled Notions of “contagion” in classical Indian medical texts (Das is a professor at the Martin Luther University Halle-Wittenberg). His arguments are based on a detailed examination of four Sanskrit Ayurvedic texts: Ashtangahrudaya-samhita, Ashtanga-sangraha, Charaka-samhita, and Sushruta-samhita. As we saw in the earlier paragraph, it won’t be difficult to find references in the past to an understanding that ailments often spread from one person to another, and Das too finds several mentions of such a transference/transmission of diseases in Ayurvedic texts.

What is of interest to scholars, however, is not the presence of random references to disease transference, but a more systematic understanding of what these terms and concepts actually meant for people and societies in the past. Simply the existence of a similar word in a past vocabulary doesn’t mean that people in the past used the word to mean the same things as we do. For example, as Das mentions, the Sanskrit word ‘papa’ (पाप), which in the modern sense refers to ‘sin,’ had a more subdued meaning when it was used by Ayurvedic writers of the past: it simply denoted badness, or something harmful or unwanted. Similarly, the word ‘infection’ was present even in English writings from the 1500s, but it did not refer to microbial/germ infections then.

Through a study of references to transmission/transference of ailments in Sanskrit Ayurvedic texts, Das finds that when terms denoting what we today would call contagion – terms like sanchara, sankrama, etc. – were used by the Ayurvedic writers, they were referring to a number of ideas, and not a single concept of disease transmission through contact as we would today. There even was one passage which implied that perhaps all diseases are transferable. All of this indicates that what Ayurvedic practitioners conceptualized when they said a disease is ‘transferable’ from one person to another, was very different from what we mean today when discussing such an idea.

So what exactly was their understanding? In Das’s view, this can be explained by the general worldview of people living in those times: the magico-religious view. We saw in the last post that in pre-modern India/South Asia, rational explanations (as against magico-religious) of disease and ill health first developed in wandering groups of physicians who later systematized their knowledge in Buddhist monasteries in northern India. This knowledge then was co-opted and ‘Hinduized’ mainly during the Gupta period (around the 4th century CE) and gradually became the classical Sanskrit Ayurvedic texts we know of today. Thus, while rational thought is found aplenty in Ayurvedic texts, there is no sudden break from magico-religious thinking, and we see many such ideas in Sushruta- and Charaka-samhitas.

For example, historian Dominik Wujastyk shows in ‘The Roots of Ayurveda‘ that the Sushrutasamhita mentions three types of medical therapy: that which depends upon the sacred, that which depends upon reasoning, and that which triumphs through good character. “The one which depends on the sacred includes the use of mantras, herbs, jewels, good luck ceremonies, food offerings to the gods, presents to the gods, oblations, pledges, penances, fasts, benedictions, prostrations, and pilgrimage.”

Das finds that for the Ayurvedic writers, occurrence of disease frequently meant that supernatural powers were manifesting themselves in humans. These powers encompassed divine as well as demonic entities, and their actions were manifold. Words and deeds by humans could cause disturbances in the balance and the relative influence of these powers. Besides, disease was just one of the many ways in which the powers acted on humans (other ways could be something like falling off a cliff or drowning). As Das puts it, there was a “non-differentiation of diseases and other adverse things” in the worldview followed by the writers of these texts. Contrast that with people today for whom, for example, an attack by a shark on the beach does not share common, overlapping causes with the appearance of a rash on the face: in our worldview the causes of these events are completely differentiated.

It seems that what we [today] term “contagion” is in the ancient Indian context actually part of a complex of notions ultimately going back to the “magical mode of looking at the world”. Diseases are only one of the various means by which the powers that make up the world may manifest themselves in humans after they have overpowered or penetrated them. The modes of overpowering or penetration are various, and include physical contact either directly or indirectly, but also other means, such as looking or hearing… that all or almost all diseases pass from one person to another is quite consist­ent with this belief… Since not all powers are equally mighty, some diseases may be transmitted more than others.

Whenever we analyze the past, it is extremely important to first put aside our contemporary modes of thinking and assumed knowledge, and to appreciate the ideas and beliefs that might have been prevalent in the times we are analyzing. The texts that Das has analyzed belong mainly to the first millennium CE. People then indeed saw and realized that there are times when a disease occurs in one person, and then in another person who they interacted with, and then yet another. If people today came across such a disease, they would attribute it to microbial spread, whether through physical contact or through droplets or air. That is our worldview: we think of diseases as specific entities with specific causes and modes of spread (in this case, a microbial cause).

But for the people whose writings Das has analyzed here, diseases were not an exclusive entity. They were considered together with all kinds of adverse events that could affect an individual. And the causes of these adverse events were almost always what we today would call supernatural: being overpowered or penetrated by some kind of invisible power. This same kind of overpowering could cause, for example, epileptic fits in one person, blood-stained vomiting in another, and attack by a snake for a third one. Some adverse events, like diarrhea, would have been observed to spread from one person to the next. Such a spread would be caused, in their minds, by the transference of the harmful powers from one person to the next through the modes of touch or even just seeing or hearing. And “the best way to avoid not only disease, but any­ thing unpleasant, is to constantly guard against doing something which would bring about disharmony amongst the various mutually balanced powers.” That is, to avoid doing what were considered morally and ethically wrong things.

It is pertinent to note that while the cause of disease was thus attributed to such supernatural factors, the treatment for disease, as well as the prescriptions for avoiding ill health, frequently had a rational element to them. When we talk about Ayurveda today, it is this rationality in therapy that people emphasize more, while the supernatural aspects in the theories on disease etiology are almost always glossed over.

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