Gender in the Saṃhitās

We will now examine the intersection of gender and medicine in the Saṃhitās. One of the first questions that arises is what are the characteristics that differentiate the female from the male? We get an answer from Caraka’s compendium in this regard. These characteristic features which determine sex are either spiritual (i.e., those derived from the Soul) or material (bhautika, i.e., derived from the sperm and the ovum) in nature.

Sex difference in the foetus is caused by the dominance of one or the other of these factors:

1. weakness
2. timidity
3. lack of wisdom
4. ignorance
5. unsteadiness
6. heaviness of limbs
7. intolerance
8. slackness
9. softness
10. presence of the uterus and ovary.

These and other characteristics, according to Caraka, determine the female sex while the opposite traits determine the male sex; in a eunuch both these traits are equally present (napuṇsakakarāṇi).^[1] The first five features originate from the Soul and the rest from the mahābhūtas, viz., ākāśa, vāyu, agni, jala and pṛthvī. Those belonging to the latter category are caused by the dominance of the ovum.^[2] Therefore, negative characteristics are intrinsic to the female reproductive unit while the male is always associated with affirmative ones. It is worthwhile to note that not a single positive trait could be found in the female. A fourth gender is identified by Caraka as vārtā-one who has feminine characteristics in abundance yet is not completely female.^[3] Cakrapāṇidatta does not throw any light on the matter save that the word was used to connote a specific condition at the time when the original text of Caraka Saṃhitā was composed.^[4]

The discourse on the human anatomy, a very important part of the ancient medical texts, provides an insight into how the ancient Indian medical authorities viewed the female body. The discourse, particularly in the Caraka Saṃhitā, is centered on the male body.

This text, while referring to the ten resorts of life (daśa prāṇāyātanāni), includes the following:

1. the head
2. the throat
3. the heart
4. umbilicus
5. anus
6. bladder
7. ojas
8. semen
9. blood and
10. flesh.^[5]

While semen has been included, the menstrual fluid finds no place at all. Further, the foetus is described as the product of the nutrient fraction of śukra or semen.^[6] The explanation to this hypothesis rests on the premise that females are also endowed with śukra but their śukra is incapable of procreation.^[7] The special procreative ability of male seminal fluid or the inability of the female fluid is not explained.

In fact, the female procreative element is identified as śonita or blood by Caraka:

śukraśonitajīvasaṃyoge tu khalu kukṣigate garbhasaṃjñā.^[8]

The union of the sperm, the female procreative element and the Soul in the womb is designated as embryo.

The menstrual fluid is referred to by various terms for blood, viz., rakta,^[9] raja^[10] and asṛj.^[11] The term ārtava for menstrual fluid, which occurs in the Suśruta Saṃhitā^[12] is also used by Caraka.^[13] We again notice that in Caraka’s enumeration of the fifty-six sub-parts (pratyaṅgas) of the body, the phallus is mentioned but there is no reference to any organ of the female reproductive system.^[14] On the other hand, the female body is not completely absent in Suśruta’s discourse on the human anatomy. The enumeration of the seven dhātus or tissues that constitute the human body includes śukra or testicular secretion^[15] but its female counterpart is not mentioned along with it. Menstrual fluid or ārtava, is however, referred to as a separate category altogether and is mentioned after the enumeration of the three types of mala or excretory products.^[16] The parts of the human body are enumerated undoubtedly with reference to the male, but the female parts find mention only in anatomical dissimilarity: as for instance the length of the intestines in the female body is less than that of the males by half a vyāma;^[17] that the number of external orifices in the female are twelve as opposed to nine in the male;^[18] that the female pelvis is of the same dimensions as that of the male chest.^[19]

It appears, therefore, that anatomically the female body is practically absent in Caraka’s compendium but the school of surgery is at least cognizant of the non-uniformity of the male-female anatomy. One may conjecture that dissections carried on female corpses may have enabled these scholars to understand such dissimilitude. As commented by Rahul P. Das, the Caraka Saṃhitā is even more male-oriented than other medical texts and seems to have given little thought to the special characteristics of females.^[20] The female anatomy required surgical instruments with slight variations in specifications from those used in male patients. Thus, the instrument for the visualisation and treatment of piles in males, shaped like a cow’s udder, measures four fingers in length and five fingers in circumference, while for female it is six fingers in circumference and as long as the palm of the hand.^[21] The proximity of the uterus to the urinary bladder in the female necessitates that the incision in case of a procedure for removal of urinary stone should be directed in a manner to avoid injury.^[22]

Another aspect that merits a close look is the typological study of human personalities in our two texts. Suśruta classifies human constitution or prakṛti in three ways: on the basis of the predominating doṣa or doṣas (into seven types of doṣika), or the bhūtas (five kinds of pañcamahābhautika) or the mental faculty (sāttvika, rājasika and tāmasika). There are seven sāttvika kāya, six rājasa kāya and three tāmasa types, which are all explained from the male point of reference.^[23] Caraka’s categorisation is based on the three types of sattvas or mental faculty, sāttvika, rājasika and tāmasika, and is similar in its sub-classification with Suśruta’s. The masculine orientation is evident in the nomenclature itself.

The seven sub-types of sāttvika sattva are:^[24]

1. Brāhma: sharing the traits of Brahmā
2. Ārṣa: sharing the traits of ṛṣis
3. Aindra: sharing the traits of Indra
4. Yāmya: sharing the traits of Yama
5. Vāruṇa: sharing the traits of Varuna
6. Kauvera: sharing the traits of Kuvera
7. Gandharva: sharing the traits of Gandharva

Thus, it is difficult to see how female personalities could be based on attributes of male divinities. The rājasika sub-types are āsura, rākṣasa, paiśāca, sārpa, praita, and śakuna; two of the defining features of the paiśāca are fondness for women and liking for stay in lonely places.^[25] The tāmasika individual may be pāśava, matśya or vanaspatya depending on whether they exhibit attributes of an animal, a fish or plants.^[26] While several characteristics would be true of any gender, there is none which is specific to women. Suśruta considers it essential for the physician to be acquainted with the patient’s constitution for correct treatment^[27] which begs the question this was imperative in cases where female patients were concerned. The classification of the three basic types of human personalities and their sub-types also demonstrate a masculine orientation in both our texts.

It is noteworthy that female diseases are peripheral to the medical science of Āyurveda. References to variations in clinical conditions in the male and the female are few, the exceptions being difference in the origin and spread of swelling or śotha roga.^[28] One of gulma is known to occur only in women but its pathogenesis is again related to delivery or abortion.^[29] A branch of Āyurveda which has some bearing on female health is Kaumāra-bhṛtya or Paediatrics. Its primary concern, however, is the care of infants and children, treatment of diseases affecting breast milk of wet nurses as well as those caused by diseases caused by defective breast feeding and evil spirits.^[30] Diseases of the female genetalia,^[31] obstetrics and gynaecology, according to Hārita, are included in Kaumāra-bhṛtya.^[32] The separation of female diseases is as a distinct category is striking when we consider that male disorders find place within the discourse on general diseases. Suśruta’s chapter on the disease classification, vyādhisamuddeśīyamadhyāya, which catalogues disorders arising from the vitiation of the tissues (dhātu), the excretory products (mala) and the sensory organs (indriya) includes sterility, impotence, spermoliths, spermatorrhoea and other disorders of the semen (śukra)^[33] but ignores the related female syndromes.

The female disorders which have received the attention of the medical authorities are abnormal foetal presentations (mūḍhagarbha),^[34] and breast diseases specifically of the wet nurse in relation to vitiation of her breast milk and appearance of abscesses.^[35] In contrast, Suśruta’s compendium devotes a chapter to inguino-scrotal swellings (vṛddhi),^[36] genital inflammation (upadamśa)^[37] along with elephantiasis (ślīpada)^[38] wherein the treatment of venereal diseases only in the males has received the attention of the authors. The general line of treatment in the text for curable cases of venereal diseases is as follows: after giving oleation and sudation therapies to the patient, venepuncture of the dorsal vein of the penis should be done or leeches should be applied.^[39] Female venereal diseases are noticeably overlooked though genital maladies (yonidoṣa) in women are known for men are warned of visiting women suffering from such disorders;^[40] but silence about their treatment only serves to strengthen our view regarding the male-centric focus on the human body.

It is interesting to note that Āyurveda devotes a branch to issues of male fertility and virility. Vājīkaraṇa is concerned with oligospermia, qualitatively defective sperms, azoospermia, health of the sperm conducting channels, sperm vitality, spermatogenesis and also with methods to increase sexual pleasure.^[41] The concern with the female body of the ancient Indian medical authors is primarily from the perspective of procreation. As for gynaecological issues, the aetiology, the features, the diagnosis and general treatment of menstrual disorders has been discussed by Suśruta.^[42] A physician is however, advised to treat a case of asṛgdara, one such disorder, only if the patient is young, who takes all care of her health and who has minimal complications,^[43] thus indicating that the concern of the ancient Indian physician, at least gynaecologically, was with women of the child-bearing age. Fever arising during abnormal delivery or in the puerperal and lactation period is also referred to by Sūtrasthāna ruta.^[44] In the Uttara-Tantra section of Suśruta Saṃhitāas well as in Cikitsā-sthāna of Caraka Saṃhitā, twenty types of yonivyāpad or gynaecological disorders have been incorporated.^[45] The term yoni implies both the female sexual organ-the vulva (bhaga) as well as the uterus (garbhaśaya);^[46] and the gives bhaga as another name for yoni.^[47] The menstrual diseases discussed in the two texts such as udāvartā (dysmennorhoea), vandhyā (amenorrhoea), viplutā (vaginismus), pariplutā (dyspareunia), vātalā (dryness of the vagina), rudhirakṣarā (menorrhagia and metrorrhagia), pittalā (acute inflammation of the female genitalia), karṇinī (cervical growth),^[48] etc., need not necessarily be associated with the issue of pregnancy.

However, Agniveśa’s query to his preceptor provides the background in which the discussion on yonivyāpad is contextualized.

Agniveśa says:

“O Lord! Among human beings, women are the excellent raison de etre (lit. root) of progeny. It is the diseases of her genital organs which cause impediments in this regard (for the procreation of progeny). Therefore, I want you to explain the origin (aetiology), signs, symptoms as well as treatment of these disorders for the welfare of humanity.”^[49]

It is in response to this query that Caraka makes an exposition on the female diseases leaving us in no doubt that they have been included in the texts for the specific purpose of removing impediments to conception of the foetus. This raises the question whether women beyond the child-bearing age received medical intervention when they had to cope with gynaecological ailments. The Suśruta Saṃhitā does not mention the same context in the exposition on yonivyāpad but it is reasonable to assume that the same perspective is applicable here as well. This text, however, does make a differentiation between menstrual (śonita or asṛga) and vaginal (yoni) disorders in the Uttara-tantra, wherein it is said two kinds of medicated ghṛtas are described as being effective in both types of disorders.^[50]

The Dharmaśāstric emphasis on procreation needs to be underlined here. Fertility was one of the most essential qualifications for a wife in patriarchy. The barren wife was considered worthless.^[51] Manu lays down that women are created to be mothers, and men were created to be fathers;^[52] while Nārada goes further to say says that women have been created for the sake of procreation.^[53] This leaves very little scope of elderly women or young widows or even female ascetics of seeking medical help. As the primary concern of society at large and of Āyurveda is birth of a healthy child, there is an elucidation of the precautions to be exercised during menstruation as it is held that a woman’s conduct at this time has a direct bearing on the unborn offspring. Thus, she should avoid the following activities: conjugal union, sleeping during the day, applying collyrium, weeping, bathing smearing of creams and powders, massaging, paring of nails, running, laughing, talking loudly, loud noises, combing her hair, exposure to draughts and exertion. These acts are avoidable to prevent harm to the prospective child. Sleeping during the day makes the offspring suffer from sleepiness; collyrium causes blindness; weeping leads to visual disorders; bathing and oil massaging cause skin diseases; nail paring leads to deformed nails; running causes fickleness; loud laughter results in discoloured teeth, lips, palate or tongue; loud talking means a garrulous child; loud noise leads to deafness; hair combing leads to baldness and exposure to draughts and exertion can cause the birth of an insane child.^[54] The medical interest in gyneaecological issues, it thus appears, is more for ensuring female reproductive health and the birth of healthy progeny, specifically male progeny.

The preoccupation with the male offspring is evident in the texts. Caraka devotes a chapter to the procreation of excellent progeny (prajā).^[55] Cakrapāṇidatta holds that “prajā,” here implies both sons and daughters but admits that some scholars hold the view that the term stand for a male child only as the method of procreating a male child of excellent qualities by and large forms the subject matter of the chapter.^[56] The latter view is more tenable as Caraka, for example, gives the regimen to be followed by a woman desiring a son with a massive body, white complexioned with the strength of a lion, with vigour, purity and strong mind (bṛhantamvadātaṃ ṃ śuciṃ sattvasaṃpannaṃ putramiccheyamiti)^[57] followed by description of elaborate Vedic rites for the couple who desire such a son.^[58] Even the object of aphrodisiac treatment is to procreate sons.^[59]

There is also advice to fulfill desires for a son with particular physical features and desirable attributes; a woman may yearn for her offspring to be of bluish complexion, red eyes, elevated chest and long arms or a son of blackish complexion with black, soft and long hair, white eyes and teeth who would radiate brilliance and self control.^[60] Elaborate rituals for fulfilling such aspirations are restricted to dvijas alone; a śūdra woman is allowed to offer only obeisance to the gods, brāhmaṇas, preceptors, ascetics and siddhas without the fire rites.^[61] The text does not refer to desire for a daughter with particular attributes. There is another procedure prescribed by the Vedas for changing the sex of the foetus even before its manifestation. This is the puṃsavana therapy to ensure the birth of a male offspring which Caraka also recommends.^[62] Even the mantra to be uttered in the ear of the woman in parturition entreats the elements and the deities for the safe birth of a son like Kārtikeya without distress to the mother and baby as well as to ensure the protection of the new born.^[63] At the time of delivery, Caraka’s instructions are that the female attendants should say, “Thanks, you have delivered a son” (prajātā prajātā dhanyaṃ dhanyaṃ putram), which gives her relief and joy, and adds to her regaining vitality.^[64] This description itself is reflective of the innate longing for the birth of a male child deeply ingrained in the collective consciousness.

The naming ceremony which clearly refers to mother and son (sāputrā strī) gives instructions on how to select his name.^[65] In the absence of any directives on the selection of a girl’s name, one may only assume that it was not important enough to merit much attention. Further in the case of the wet nurse it is also desirable that she should have not only living children but that she should have sons as well.^[66]

Both the authorities have described the regimen to be followed for those desirous of begetting a healthy offspring, preferably a son. This regimen is partly therapeutic and partly ritualistic. According to Caraka, the couple should first purify their bodies with oleation and sudation therapies followed by elimination of the doṣas by emesis and purgation, restorative diet and administration of enema.^[67] That the birth of a healthy foetus and painless delivery are effected by a combination of several factors is recognized by Caraka. It is imperative that the sperms, the ovum and the uterus are in excellent form, the time of sexual union and delivery are favorable and the woman takes wholesome diet during the period of pregnancy.^[68] Even in a fertile woman conception can be delayed if there are deficiencies in the uterus, the sperms, the ovum, the mental condition, diet and regime; besides, union at an inappropriate time and weakness are also contributory factors.^[69] This is a significant statement of Caraka for the responsibility for conception and procreation of healthy baby is not pinned on the female alone. Dominance of the ovum during conception results in the procreation of a girl child while the reverse is true for the male.^[70] The procreation of a female child is attributed to dominance of the ovum during conception while a male child is conceived by dominance of the sperm (raktena kanyamdhikena putraṃ śukreṇa).^[71] The sex of the offspring is, thus, determined by physiological factors and not to any extraneous factor. The birth of twins, however, is attributed to actions during one’s previous life.^[72]

During the menstrual period, a woman is to stay in seclusion by sleeping on a kuśa mattress, taking food cooked in ghṛta on palms, earthen pots or on leaves and avoid her husband for three days^[73] and refrain from cleaning her body.^[74] The concept of impurity associated with menstruation noticed in the Dharmaśāstras which also describe similar though a more elaborate set of restrictions:

A menstruating woman remains impure for three days. She should not apply collyrium on her eyes or oil on her body, or bathe in water; she should sleep on the floor and not sleep during the day; she should not touch the fire, make a rope, brush her teeth, eat meat, or look at planets; she should not laugh or do any work; and she should not drink from a damaged cup, or from a copper vessel.^[75]

Manu enjoins that a brāhmaṇa should not have food touched by a menstruating woman^[76] nor converse with her.^[77] At the end of her menses, she takes a purificatory bath and puts on new clothes^[78] as bathing purifies a menstruating female at the end of her flow.^[79] Though the medical texts do not describe her as aśuci or impure unlike Vasiṣṭha (trirātraṃ rajasvalāśucirbhavati) in the above paragraph, the implication of regulations on normal activities for three days are the same.

Following the purificatory bath, a priest performs the necessary rituals for begetting a male child.^[80] Suśruta identifies the even numbered days in the fertile period (ṛtukāla) as the favorable days for conceiving a male child^[81] and odd numbered days for those desiring daughters.^[82] It is not clear whether the same regimen had to be observed as for a female child including the religious measures. This hypothesis is known to the law-givers as Manu says that sons are conceived on even nights and daughters on uneven ones; hence he ordains that a man who desires to have sons should approach his wife in due season on the even (nights).^[83] Medication of lakṣmaṇā, vaṭaśuṅga, sahadevā and viśvadevā is also prescribed for the woman who desires a son^[84] but none for the birth of a girl child. The medical Saṃhitās also reflect the deep societal craving for male children. The description of the features of a pregnant woman which can foretell the sex of the unborn child reveals another interesting fact. If she has a cheerful face among other characteristics (such as desire for masculine articles or if they appear in her dreams), then it signifies that she is carrying a male child. If otherwise, the foetus is female.^[85]

The medical authors emphasise that special care should be taken to satisfy the would-be mother’s desires. Fulfilling the desires of the dauṛdinī (the double-hearted or the pregnant) ensures a strong and long-lived child.^[86] Whatever she desires should be given to her by the physician to avoid harm to the foetus.^[87] The same is advised by Caraka as the proper maintenance and protection of the pregnant mother is as good as the maintenance or protection of the foetus itself.^[88] These longings foretell the nature of the unborn child. Thus desire to see the king foretells a moneyed and lucky son; craving for fine silk clothes or ornaments portends a handsome son fond of jewellery; and so on.^[89] It is noteworthy that all the desires have been interpreted with reference to a son, once again underlining the primacy of the male child in contemporary ancient society. The immense consideration paid to a woman during pregnancy is only reflective of the importance attached to her procreative role.

The regimen, diet and manner of living of a pregnant woman, particularly the avoidances, have been expounded at length by our medical authors. Considering that her physical and psychological conditions have bearing on the foetus, care has to be taken of her comfort and well being of the expectant mother. Cleanliness of her person and her environs is emphasised by Suśruta: she should wear white clothes, avoid touching dirty, deformed or maimed persons, stay away from foul odours as well as from food that is dry, stale, rotten or fermented. She should always be in a happy frame of mind, wear ornaments, make offerings for peace and good deeds, worship the deities, the as and the preceptor. Scenes and stories that disturb the mind, outings, a

vacant or a lonely house, a haunted tree, a cremation ground, the shade of a tree, feelings of anger and fear and fatigue are all avoidable for the pregnant woman. Occasional oil anointment and rubbing with powder, comfortable and well supported bed covered with soft clothes of a suitable height are to be provided to her. Her food should be palatable, liquid, sweet and demulcent mixed with appetizing drugs.^[90] Importance is given to the opinion of experienced women in the care of the expectant mother who may advise her to avoid such things which would be harmful.^[91]

The enciente is taken to a maternity home (sūtikāgāra) in the ninth month on an auspicious day. We understand that this house was built to caste specifications for Suśruta says that the sūtikāgāra should be built on white soil for a brāhmaṇa, red for a kṣatriya, yellow for a vaiśya and on black soil for a śūdra. The wood for construction and for the beds should similarly be made of bilva, nyagrodha, tinduka and bhallātaka according to the above order of the castes. The dimensions of the labour room are eight cubits long and four cubits wide (approx. 11ft. by 6ft.) with the door facing east or south. The walls had to be clean and well plastered, and the room provided with all the necessary equipment. It had to be protected from any evil by performance of religious rites.^[92] Though caste specifications are mentioned in the construction of maternity homes, there is no apparent class differentiation here. It is not clear if these homes were built by the concerned family or whether Suśruta is referring to institutions established at individual or state largesse. Caraka makes no reference to caste-specific maternity homes, rather mentions only one kind of construction presumably suitable for all.

The specifications of the construction are as follows: before the ninth month of her pregnancy, the maternity home should be constructed in a place cleared of bones, gravel and pieces of earthen vessels. The soil of the locality should have excellent colour, taste and smell. The doors should face towards the east. The wood of bilva (Aegle marmelos Corr.), tinduka (Diospyros peregrine Gurke), iṅgudī (Balanites aegyptica Delile), bhallātaka (Semecarpus anaerdium Linn.), vara a or khadira (Acacia catechu Willd.) should be used for constructing the home. Other measures prescribed by brāhmaṇas well versed in the Atharvaveda should be adopted.^[93] Among the types of timber mentioned by Suśruta, three are common with the exception of nyagrodha. We have reference to a prasūti-śālā in a thirteenth century Kākātiya land record from Malkapuram^[94] but no other details are available of the material of construction.

Women in our medical Saṃhitās appear as care givers rather than as therapeutic healers. Female attendants have an important role at the time of delivery and the post-operative or the recuperative stage. We have already noticed the desirable attributes medical attendants in chapter 3. It can only be expected that female attendants were required to attend to female patients though they are categorically mentioned at the time of child birth and neonatal care. Experience is particularly favoured in management of labour and child delivery, postpartum and neonatal care; therefore, the preference for midwives who have given birth to more than one child (bahuśaḥprajātā

on knowledge. Birth attendants are required to be multipara (bahuśaḥ prajātā), affectionate (sauhārdayuktāḥ), constantly attached to the lady (satatamanuraktāḥ), well mannered (pradakṣinācārāḥ), resourceful (pratipattikuśalāḥ), naturally disposed to love (prakṛtivatsalāḥ), free from grief (tyaktaviṣādāḥ), tolerant of hardship (kleśasahinyo) and agreeable (abhimatāḥ).^[95] Caste or family is not an important here. The exception, however, occurs in case of a wet nurse (dhātrī) who should be of the same caste (samānavarṇā) and neither should she have a husband of lower caste (na antyāvasāyinīm).^[96] Preference is also expressed for a woman born in the same locality (deśajātīyāma) in a respectable family (kule jātā).^[97]

Caraka also recommends the presence of old ladies along with brāhmaṇas well versed in the Atharvaveda at the maternity home (sūtikgārā) whose advice should be adhered to.^[98] We can assume that family members helped in the process. Bāṇa tells us that queen Yaśovati was always surrounded by friends, who never for an instant, left her side.^[99] In another of his works, Kādambarī, there is reference to a respectable old lady who occupied the space near the head of the bed while other senior ladies sang auspicious songs.^[100] As soon as the labour pain begins, the attendants are required to comfort and console the parturient,^[101] give her an oil massage,^[102] and guide her through the entire period of labour until safe delivery without harm to the baby and the mother^[103] and the mother is urged to obey their instructions (sāyathānirdeśaṃ kuruṣveti vaktavyā syāt).^[104] Removal of the placenta and postpartum care of the mother and the new born are also the responsibilities of these birth attendants.

These attendants along with friends of the lady have to be in constant attendance on her and the new born by keeping vigil and remaining awake for 10-12 days.^[105]

“The birth rite is the only wholly female rite where male presence is precluded. It is solemn, awesome, throbbing with tension because it solemnly empowers the female assistant and it is the only rite where a new life enters our world.”^[106]

There is no special term for such an attendant in our two medical treatises other than strī^[107] (woman) unlike the wet nurse who is designated dhātrī.^[108] The midwife, in all probability, is a woman of low caste. Curiously, the “midwife” is now known as “dāi’ which is term derived from “dhātrī”.^[109] Risley records in the late nineteenth century that the dāī is usually a Mahomedan or a Hindu of the Chamār caste. Among Hindus of all other castes there is a strong prejudice against cutting the navel cord, and a common term of abuse applied to a midwife is a narkātā or cord-cutter. The male relatives of these women are usually tailors or musicians; while in villages they often work as weavers, and sometimes sell betel-leaves.^[110] Dr. T.A. Wise noted that like the Purohit and barber, the Dāī is a privileged person, and has freedom of access to the female apartments at any hour.^[111] Risley comments that Chamain women “are the midwives of India” and are generally believed, though erroneously, to be skilled in all the mysteries of parturition.^[112] The wet nurse or dhātrī, on the other hand, is required to be of the same caste as the mother in puerperium, while caste affiliation is not a concern in the choice of the birth attendant.

In the selection of the wet nurse, several criteria have to be taken into account. She should be of the same caste, youthful, submissive, free from diseases, not deficient of limbs, not given to luxurious living, not ugly looking, not given to hateful disposition, born in the same locality, not mean minded, not given to mean acts, born in a respectable family, having affection for children, free from illness, having living children, having sons, having plenty of milk, careful, not given to sleeping over cloth soiled with excreta, not having a husband of lower caste, skilful in service, observing cleanliness, having aversion for dirty things, having the excellence of breasts and milk.^[113]

Other than pregnancy and childbirth, there are few instances of references to women’s disorders in the two medical texts. A variety of gulma or localized abdominal swelling in women arising from rakta vitiation is also known.^[114] Female patients are specifically mentioned in plastic surgery of the ear for the repair of the ear lobule or its reconstruction. As part of the pre-operative arrangements, the hair of the female or the male patient is required to be tied.^[115] From this specific mention, it appears that this was a common procedure among women. In the administration of drugs or surgical procedures, women are considered weak and delicate, and hence, placed in the same category as children, the elderly or the weak. Medicine taken alone or abhakta (i.e., without food) is inadmissible for a child, an old man a woman or to a person of weak constitution as it may produce great lassitude and loss of strength.^[116] Nothing is mentioned about female patients recovering in special wards. Male patients recuperating in the special ward are advised to keep away from female visitors with whom there is possibility of sexual relationship. Any interview, conversation and contact are absolutely forbidden for an audience with such ladies may lead occasionally to seminal discharge, which is harmful for the patient.^[117] The texts are silent about regulations to be followed in case the patient is female.

The rules of personal hygiene for maintenance of sound health and prevention of diseases, as described by Suśruta,^[118] are essentially prescribed for men though many of them would be applicable to women as well. The directives on apparel^[119] and physical relations^[120] have a purely male orientation. The same is true of the directives for dietetics and personal hygiene practice in Caraka’s treatise^[121] which do not address any specific feminine hygiene issues. It is interesting to note that neither Caraka nor Suśruta discuss the issue or need for contraception. This is a conspicuous omission when we consider that that the Kahun Medical Papyrus, the oldest surviving of the numerous ancient Egyptian documents, contains instructions on the preparations of contraceptives to be inserted into the vagina.^[122] There is overwhelming concern to masculinity, youthfulness and attractiveness, which find expression in the attention paid to aphrodisiac measures (vājikaraṇa) for the sexually weak male, treatment of male venereal diseases and guidelines for sexual activities. Suśruta’s exposition on the causes of male impotence^[123] and treatment thereof with various recipes^[124] testifies to our argument. Vājikaraṇa is exclusively a masculine affair; it is recommended for young men as well as the old, and is described as (very) beneficial for those who are desirous of sexual intercourse, who are hankering for the love of women, the emaciated, the impotent and those with poor semen. The absence of any aphrodisiac therapy for women is not surprising when we consider the portrayal of their innately lascivious nature in other texts. As Uma Chakravarti argues, reproductive power is the only one power that women still held in the new structure of relations in which they were subordinated, and one way of dealing with it was to simultaneously exaggerate and treat as terribly dangerous women’s innate nature. Their uncontrolled sexuality was perceived as posing a threat, and the narrative and normative literature of ancient India is full of references to the wickedness of women and their “insatiable” lust.^[125]

Other aspects of therapeutics such as pleasurable company of women as a therapeutic measure prescribed for the patient of fever with rigor^[126] or for uplifting his depressed and gloomy mood^[127] are not only class biased but admit of deep gender based stereotyping. Anointed with kuṅkuma and aguru, bejewelled, and dressed in fragrant, perfumed and fine clothes,^[128] these are evidently high-society ladies who attend on men of the upper classes. Apart from being young, experienced and beautiful (rūpasaṃpannā kuśalā navayauvanā)^[129], physically they are expected to conform to the perfect norms of feminine beauty.^[130] The patient of alcoholism, who is advised to bathe in ponds for relieving the burning sensation, is also prescribed the company of beautiful young women with lotus petal-like soft and cool hands, thighs, face and prominent breasts. They should be expert swimmers, sweet natured (madhurasvabhāvā) with the ability to entertain him by their artful enchanting conversation.^[131] The medical texts perpetuate the biologically engendered gender specific cultural roles.

Besides, the remarks on the women to avoid in physical relations are instructive. According to Sūtrasthāna ruta, sexual intercourse with a woman who is deformed (hīnāṅgī), unclean (malinā), spiteful (dveṣyā), unwilling (kāma) or sterile (bandhyāṃ) leads to destruction of semen and the intellect of the person.^[132] While cognizance of the woman’s consent in such matters is significant from the female perspective, avoidance of the deformed and the sterile, is a comment on the cultural perceptions of beauty and virility. A woman of an attractive age, beauty and other (good) qualities, who is of a similar temperament (as the man) and who belongs to a respectable family (vayorūpaguṇopetāṃ tulyaśīlāṃ kulānvitām) is commended by Suśruta.^[133] Similar is the opinion of Caraka: a beautiful and youthful woman, endowed with auspicious signs, amiable and skilled is the aphrodisiac par excellence.^[134] The gender bias in matters of age and sexuality is particularly evident here. It is this predominant concern with beauty that must have placed demands on physicians from a certain category of clients to create recipes for preserving their good looks and allure. Thus, Suśruta gives the formulation of lākṣādi ghṛta^[135] for kings, ladies as well as for similar (delicate) persons which is beneficial in cases of vyaṅga, advanced nīlikā, and eruptions on the face. It also helps to remove wrinkles, adds plumpness to the cheeks and imparts lotus-like beauty to the face.^[136] Both vyaṅga and nīlikā are skin problems: the former refers to black spots while nīlikā is identified as naevus^[137] (any congenital growth or pigmented blemish on the skin).

Deviations from the accepted sexual behaviour accompanied by or without morphological deformity in the reproductive organs have been referred to in both our medical texts.

Caraka notices eight kinds of sexual abnormalities (vikṛtiprakārāḥ)^[138]:

1. dviretas (hermaphroditism),
2. pavanendriyatva (aspermia),
3. saṃskāravāhī (anaphrodisia or the lack of sexual desire),
4. male sterility (naraṣāṇḍya)
5. female sterility (nāriṣāṇḍya),
6. vakri (hypospadias or congenital birth defect where the opening of the urethra is on the underside of the male organ),
7. irṣyābhirati (mixoscopia or voyeurism),
8. vātikaṣaṇḍaka (eviration or the loss of masculine qualities with the assumption of feminine characteristics).^[139]

The genesis of hermaphroditism is attributed to deficiencies in both the male and the female reproductive cells. Caraka says when that portion of the sperm and the ovum of parents that are responsible for the creation of genital cells of the foetus is vitiated, and both the sperm and the ovum undergo equal division, then the offspring becomes a hermaphrodite. Such an offspring will have the characteristic features of both the sexes.^[140] The other forms of sexual abnormalities are attributed to physiological deficiencies such as vāta disturbances in the foetus, congenital lack of strength, insufficiency of sperms and ova, weakness of sperms in the male partner and irregular posture of the female, etc., as well as to psychological problems like lack of passion or jealousy of the parents” cohabitation. But at the same time, it is stated that they are caused by the misdeeds in the previous life of the individual.^[141]

There is evidence of prejudicial attitude to women and individuals of the third gender in certain instances. A eunuch and a woman as messengers are regarded as reproachable.^[142] The physician is advised to look out for inauspicious features when he enters the patient’s house in various possessions such as the bed, the seat, the riding animal, etc. and in the patient’s wife as well. Inauspicious features in the wife indicate a fatal outcome for patient^[143] are identified as the superhuman cause of disease.^[144] On the way to the patient’s house, the sight of a poor person or one of low caste is undesirable.^[145] A person with shaven head is also not a good omen for the physician either at the time of departure on a visit or at his entry into the patient’s house.^[146] An unchaste woman (asati) who comes as a messenger is a bad omen and indicative of imminent death of the patient.^[147]

Therapeutics is entirely a male domain in the compendia of Caraka and Suśruta. Other than providing assistance during childbirth and peurperium, women are completely detached from the process of healing. However, the presence of folk healers, both male and female, cannot be precluded. At a much later period (during the nineteenth century) we get references to wandering healers belonging to the lower end of the social spectrum. Bediya women in Eastern Bengal move about with a bag, containing a variety of drugs, a cupping horn (siṅga) and a scarificator (nāran). They attract attention by bawling, “To tattoo, to cup and to extract worms from decayed teeth!” They also prescribe for female disorders.^[148] “Bediya” is the generic name of a number of vagrant gipsy-like groups, of whom it is difficult to say whether they can properly be described as castes. The women of one group, the Babajiya, Lava or Patwa, are described as skilful in the treatment of children’s diseases and the removal of nervous and rheumatic pains. Women of another Bediya group, consisting of Bāzigar, Kabutari, Bhanumati and Dorābāz, acrobats and conjurers, also dabble in medicine.^[149] Candāla women are known to cure goitre by tattooing,^[150] while Māl women, a Dravidian cultivating caste of Bengal, are employed for cupping, relieving abdominal pains by friction, and for treating uterine diseases.^[151] Another non-Aryan tribe, Gulgulia, who living off hunting, training monkeys, begging and pretty thieving, sell indigenous drugs as well.^[152] The existence of such itinerant folk healers is very much a possibility in the period of discussion, the object of much reproach in both the texts, as we have noticed in chapter 2. The poor may have approached these healers for medical intervention.

P.V. Sharma believes that there were two kinds of private practitioners (vaidyas): those who had enough property and other means of subsistence, practiced medicine on charitable basis and distributed free medicines; and another group took it as their profession and charged high fees and the price of medicines. The poor could not approach them.^[153] Ātreya also explains that Āyurveda is studied by brāhmaṇas for providing benefits to all creatures, by kṣatriyas for protection and by vaiśyas for earning a livelihood.^[154] That the poor could not afford expensive pills is known from I Tsing’s account.^[155] The nature of therapeutics expounded in the two compendia appears to be inclined to the needs of the upper stratum. This is not surprising keeping in consideration that the objective of both the preceptors, Ātreya and Dhanvantari, is to prepare their students for the responsibilities of the royal physician, whose qualifications are referred to time and again in the texts.

There are a few instances in the texts of an unfavourable view of individuals belonging to the lower end of the social stratum. Messengers, wearing old or dirty or torn clothes who call on the physician, are considered harbingers of misfortune for both the physician and the patient.^[156] The sight of a low caste or poor person by the physician on way to the patient’s house is also regarded as inauspicious.^[157] In the instructions to the gentlefolk on the general rules of hygiene and ethics, Suśruta says that one should not remain near the insane (unmatta), the fallen (patita), the mean (śūdra) and low grade people (nica).^[158] However, this may be taken as advice to avoid the companionship of individuals who are not of ideal conduct.

The question, therefore, arises whether such statements reflect the physician’s selective nature of dealing with patients. It seems unlikely that the downtrodden stratum was placed out of the purview of the āyurvedic medical practitioners. Besides, the low caste śūdras of good familial background are allowed by Dhanvantari to be initiated as students of medicine. Treatment methods in case of a disease like diabetes with urinary abnormalities (prameha), as we have seen above, are in consonance with the patient’s resources and the lifestyle. In prognosis and in treatment, the physician’s concern is with the patient’s physical and physiological variables such as age and body strength, pregnancy in women as also his or her social position which would determine the ability to undergo the effects of drugs or procedure. Barring the few instances cited above the medical texts do not generally manifest a negative perception of people at the lower end of the social ladder.

In fact, medical practitioners had to necessarily interact with members of all sections of society not only in the context of therapeutics but for gathering requisite materials for processing drugs. As we have noted in Chapter 2, cowherds, goatherds, forest dwellers and hunters are regarded as repositories of knowledge in plant drugs. The physicians and surgeons had to work in close tandem with attendants and midwives who in all probability may have been drawn from lower sections as they had to deal with polluting body fluids. Surgeons had to approach skilled blacksmiths for manufacture of surgical instruments. It has been remarked that this active cooperation between surgeons and blacksmiths is a reflection of the former’s positive attitude towards manual labour.^[159] We may add practice also necessitated cooperation with barbers (for removal of body hair) and potters (for shaping dummies required in experimental surgery). Surgery, in particular, developed “a crucial bond with manual work.”^[160]

Footnotes and references:

[1]:

Caraka Saṃhitā Śārīrasthāna 4.14.

[2]:

Commentary of Cakrapāṇidatta to Caraka Saṃhitā Śārīrasthāna 4.14.

[3]:

Caraka Saṃhitā Śārīrasthāna 4.30.

[4]:

Commentary of Cakrapāṇidatta to Caraka Saṃhitā Śārīrasthāna 4.30.

[5]:

Caraka Saṃhitā Śārīrasthāna 7.9.

[6]:

Caraka Saṃhitā Cikitsāsthāna 15.16.

[7]:

Commentary of Cakrapāṇidatta to Caraka Saṃhitā Cikitsāsthāna 15.16.

[8]:

Caraka Saṃhitā Śārīrasthāna 4.5; śonita also occurs in Caraka Saṃhitā Śārīrasthāna 4.7.

[9]:

Caraka Saṃhitā Śārīrasthāna 2.12: (raktena kanyāmadhikena putraṃ śukrena)

[10]:

Caraka Saṃhitā Cikitsāsthāna 23.233; Suśruta Saṃhitā Sūtrasthāna 14.6. (rajas)

[11]:

Caraka Saṃhitā Śārīrasthāna 2.6.

[12]:

Suśruta Saṃhitā Kalpasthāna 3.4.

[13]:

Caraka Saṃhitā Śārīrasthāna 2.14.

[14]:

Caraka Saṃhitā Śārīrasthāna 7.11.

[15]:

Suśruta Saṃhitā Sūtrasthāna 15.4.1.

[16]:

Suśruta Saṃhitā Sūtrasthāna 15.5.

[17]:

Suśruta Saṃhitā Śārīrasthāna 5.9.

[18]:

Suśruta Saṃhitā Śārīrasthāna 5.10. Ears, eyes, mouth, nostrils, anus and urethra are the nine external openings in the males while the three additional ones in the female are two located in the breasts and one for the flow of the menses.

[19]:

Suśruta Saṃhitā Sūtrasthāna 35.12.

[20]:

R.P. Das,. The Origin of the Life of a Human Being: Conception and the Female According to Ancient Indian Medical and Sexological Literature, Delhi, 2003, pp.55-56.

[21]:

Suśruta Saṃhitā Cikitsāsthāna 6.11.

[22]:

Suśruta Saṃhitā Cikitsāsthāna 7.33.

[23]:

Suśruta Saṃhitā Śārīrasthāna 4.72-98.

[24]:

Caraka Saṃhitā Śārīrasthāna 4.37.

[25]:

Caraka Saṃhitā Śārīrasthāna 4.38 (3).

[26]:

Caraka Saṃhitā Śārīrasthāna 4.39.

[27]:

Suśruta Saṃhitā Śārīrasthāna 4.98.

[28]:

Caraka Saṃhitā Sūtrasthāna 18.17.

[29]:

Suśruta Saṃhitā Uttaratantra 42.8.

[30]:

Suśruta Saṃhitā Sūtrasthāna 1.8(5).

[31]:

Suśruta Saṃhitā Sūtrasthāna 3.37.

[32]:

Suśruta Saṃhitā Sūtrasthāna p.19, fn.3(a).

[33]:

Suśruta Saṃhitā Sūtrasthāna 24.9.

[34]:

Suśruta Saṃhitā Cikitsāsthāna 15.

[35]:

Suśruta Saṃhitā Cikitsāsthāna 17.42-47.

[36]:

Suśruta Saṃhitā Cikitsāsthāna 19.3-24.

[37]:

Suśruta Saṃhitā Cikitsāsthāna 19.25-51.

[38]:

Suśruta Saṃhitā Cikitsāsthāna 19.52-69.

[39]:

Suśruta Saṃhitā Cikitsāsthāna 19.25.

[40]:

Suśruta Saṃhitā Cikitsāsthāna 24.115.

[41]:

Suśruta Saṃhitā Sūtrasthāna 1.8(8).

[42]:

Suśruta Saṃhitā Śārīrasthāna 2.5, 12/2-23.

[43]:

Suśruta Saṃhitā Śārīrasthāna 2.20/2, 21/1.

[44]:

Suśruta Saṃhitā Uttaratantra 39.22.

[45]:

Suśruta Saṃhitā Uttaratantra 38; Caraka Saṃhitā Cikitsāsthāna 30.

[46]:

Atrideva (Ed.), Suśruta Saṃhitā, translated into Hindi, Delhi, 2007 (Reprint), p.667.

[47]:

Amarakoṣa II.VI.II.27.

[48]:

Suśruta Saṃhitā Uttaratantra 38.6-7.

[49]:

Caraka Saṃhitā Cikitsāsthāna 5-6.

[50]:

Suśruta Saṃhitā Uttaratantra 58.57, 72.

[51]:

V. Chandra, Gender Relations in Early India, Jaipur, 2010, p.81.

[52]:

Manusmṛti IX.96.

[53]:

V.Chandra, Gender Relations in Early India, p.61.

[54]:

Suśruta Saṃhitā Śārīrasthāna 2.25.

[55]:

Caraka Saṃhitā Śārīrasthāna 8.

[56]:

Commentary to Caraka Saṃhitā Śārīrasthāna 8.3.

[57]:

Caraka Saṃhitā Śārīrasthāna 8.9.

[58]:

Caraka Saṃhitā Śārīrasthāna 8.12.

[59]:

Caraka Saṃhitā Cikitsāsthāna 2(1).4.

[60]:

Caraka Saṃhitā Śārīrasthāna 8.12.

[61]:

Caraka Saṃhitā Śārīrasthāna 8.13.

[62]:

Caraka Saṃhitā Śārīrasthāna 8.19.

[63]:

Caraka Saṃhitā Śārīrasthāna 8.39.

[64]:

Caraka Saṃhitā Śārīrasthāna 8.40.

[65]:

Caraka Saṃhitā Śārīrasthāna 8.50.

[66]:

Caraka Saṃhitā Śārīrasthāna 8.52.

[67]:

Caraka Saṃhitā Śārīrasthāna 8.4.

[68]:

Caraka Saṃhitā Śārīrasthāna 2.6.

[69]:

Caraka Saṃhitā Śārīrasthāna 2.7.

[70]:

Caraka Saṃhitā Śārīrasthāna 2.12.

[71]:

Caraka Saṃhitā Śārīrasthāna 2.12.

[72]:

Caraka Saṃhitā Śārīrasthāna 2.14.

[73]:

Suśruta Saṃhitā Śārīrasthāna 2.25.

[74]:

Caraka Saṃhitā Śārīrasthāna 8.5. According to the text, she should sleep on the floor.

[75]:

Vasiṣṭha Dharmasūtra 5.6-7. Olivelle, P., Dharmasūtras: The Law Codes of Āpastamba, Gautam, Baudhāyana and Vasiṣṭha, Delhi, 2003 (Reprint).

[76]:

Manusmṛti IV.211.

[77]:

Manusmṛti IV.57.

[78]:

Suśruta Saṃhitā Śārīrasthāna 2.25.

[79]:

Manusmṛti V.66.

[80]:

Suśruta Saṃhitā Śārīrasthāna 2.27.

[81]:

Suśruta Saṃhitā Śārīrasthāna 2.27-28.

[82]:

Suśruta Saṃhitā Śārīrasthāna 2.30; Caraka Saṃhitā Śārīrasthāna 8.5.

[83]:

Manusmṛti III.48.

[84]:

Suśruta Saṃhitā Śārīrasthāna 2.32.

[85]:

Suśruta Saṃhitā Śārīrasthāna 2.34.

[86]:

Suśruta Saṃhitā Śārīrasthāna 3.18.

[87]:

Suśruta Saṃhitā Śārīrasthāna 3.19.

[88]:

Caraka Saṃhitā Śārīrasthāna 4.15.

[89]:

Suśruta Saṃhitā Śārīrasthāna 3.22-27.

[90]:

Suśruta Saṃhitā Śārīrasthāna 10. 3.

[91]:

Caraka Saṃhitā Śārīrasthāna 4.18,

[92]:

Suśruta Saṃhitā Śārīrasthāna 10.5.

[93]:

Caraka Saṃhitā Śārīrasthāna 8.33.

[94]:

D.C. Sircar, Studies in the Religious Life of Ancient and Medieval India, Delhi, 1971, p. 158.

[95]:

Caraka Saṃhitā Śārīrasthāna 8.34.

[96]:

Caraka Saṃhitā Śārīrasthāna 8.52.

[97]:

Caraka Saṃhitā Śārīrasthāna 8.52.

[98]:

Caraka Saṃhitā Śārīrasthāna 8.34.

[99]:

Harṣacarita, p.109.

[100]:

P.V. Sharma, Indian Medicine in the Classical Age, Varanasi, 2000 (second edition), p. 92.

[101]:

Caraka Saṃhitā Śārīrasthāna 8.37.

[102]:

Caraka Saṃhitā Śārīrasthāna 8.38.

[103]:

Caraka Saṃhitā Śārīrasthāna 8.40.

[104]:

Caraka Saṃhitā Śārīrasthāna 8.40.

[105]:

Caraka Saṃhitā Śārīrasthāna 8.47.

[106]:

Sukumari Bhattacharji quoted in J. Chawla, Birth and Birth-Givers: The Power Behind the Shame, New Delhi, 2006, p.20.

[107]:

Caraka Saṃhitā Śārīrasthāna 8.34.

[108]:

Caraka Saṃhitā Śārīrasthāna 8.52.

[109]:

J. Chawla, Birth and Birth-Givers: The Power Behind the Shame, p.20.

[110]:

H.H.Risley, The Tribes and Castes of Bengal, Vol.1, Calcutta, 1981 (Reprint), p.210.

[111]:

H.H.Risley, The Tribes and Castes of Bengal, p.210.

[112]:

H.H.Risley, The Tribes and Castes of Bengal, p.181.

[113]:

Caraka Saṃhitā Śārīrasthāna 8.52.

[114]:

Suśruta Saṃhitā Uttaratantra 42.8/1.

[115]:

Suśruta Saṃhitā Sūtrasthāna 16.15.

[116]:

Suśruta Saṃhitā Uttaratantra 64.67.

[117]:

Suśruta Saṃhitā Sūtrasthāna 19.14-15.

[118]:

Suśruta Saṃhitā Cikitsāsthāna 24.4-110.

[119]:

Suśruta Saṃhitā Cikitsāsthāna 24.89.

[120]:

Suśruta Saṃhitā Cikitsāsthāna 24.103-132.

[121]:

Caraka Saṃhitā Sūtrasthāna 5-6.

[122]:

I. Hasan, et al., “History of Ancient Egyptian Obstetrics and Gynecology: A Review”, Journal of Microbiology and Biotechnology Research, 2011, 1 (1): 35-39. http://scholarsresearchlibrary.com/archive.html (Accessed on 22.9.2013).

[123]:

Suśruta Saṃhitā Cikitsāsthāna 26.9/3-15.

[124]:

Suśruta Saṃhitā Cikitsāsthāna 26.16-39.

[125]:

U. Chakravarti, Conceptualizing Brahmanical Patriarchy in Early India: Gender, Caste, Class and State, p.146.

[126]:

Suśruta Saṃhitā Uttaratantra 39.276.

[127]:

Suśruta Saṃhitā Uttaratantra 39.291.

[128]:

Suśruta Saṃhitā Uttaratantra 39.278.

[129]:

Suśruta Saṃhitā Uttaratantra 39.276.

[130]:

Suśruta Saṃhitā Uttaratantra 39.277-279.

[131]:

Suśruta Saṃhitā Uttaratantra 47.59-60.

[132]:

Suśruta Saṃhitā Cikitsāsthāna 24.124.

[133]:

Suśruta Saṃhitā Cikitsāsthāna 24.130/2.

[134]:

Caraka Saṃhitā Cikitsāsthāna 2(1).8.

[135]:

Suśruta Saṃhitā Cikitsāsthāna 25.38-40.

[136]:

Suśruta Saṃhitā Cikitsāsthāna 25.41.

[137]:

S. Kumar, et.al., Skin Care in Ayurveda: A Literary Review in International Research Journal of Pharmacy, 2013, 4(3). DOI: 10.7897/2230-8407.04301. Accessed at http://www.irjponline.com/admin/php/uploads/1657_pdf.pdf on 19.08.2013.

[138]:

Caraka Saṃhitā Śārīrasthāna 2.21.

[139]:

Caraka Saṃhitā Śārīrasthāna 2.17.

[140]:

Caraka Saṃhitā Śārīrasthāna 2.18/1.

[141]:

Caraka Saṃhitā Śārīrasthāna 2.21.

[142]:

Suśruta Saṃhitā Sūtrasthāna 28.6.

[143]:

Suśruta Saṃhitā Sūtrasthāna 32.6.

[144]:

Suśruta Saṃhitā Sūtrasthāna 6.19.

[145]:

Suśruta Saṃhitā Sūtrasthāna 28.40.

[146]:

Suśruta Saṃhitā Sūtrasthāna 28.

[147]:

Caraka Saṃhitā Indriyasthāna12.16.

[148]:

H.H. Risley, The Tribes and Castes of Bengal, Vol.1, p.291.

[149]:

H.H. Risley, The Tribes and Castes of Bengal, p.83.

[150]:

H.H. Risley, The Tribes and Castes of Bengal, p.292.

[151]:

H.H. Risley, The Tribes and Castes of Bengal, p.48.

[152]:

H.H. Risley, The Tribes and Castes of Bengal, p.301.

[153]:

P.V. Sharma, Indian Medicine in the Classical Age, p.9.

[154]:

C.S.Sūtrasthāna 30.29.

[155]:

P.V.Sharma, Indian Medicine in the Classical Age, p.15.

[156]:

Suśruta Saṃhitā Sūtrasthāna 29.8.

[157]:

Suśruta Saṃhitā Sūtrasthāna 29.40.

[158]:

Suśruta Saṃhitā Cikitsāsthāna 24.90.

[159]:

V.K. Thakur, “Surgery in Early India: A Note on the Development of Medical Science” in D. Kumar (Ed.), Disease and Medicine in India: A Historical Overview, New Delhi, 2001, p.19.

[160]:

V.K. Thakur, “Surgery in Early India”, p.19-20.