BOOK REVIEW: CAPITALISM, DEMOCRACY AND MEDICINE
Mridula Ramanna
(Economic and Political Weekly, Vol XLVI No.31 July 30, 2011)
The Art and Science of Healing since Antiquity by Daya Ram Varma (USA: Xlibris Corporation), 2011; pp 413 (price not stated). [inserted: $23 paper back; $33 hard cover)
Writings on the history of medicine have included valuable contributions from social scientists and medical professionals, and attract a wide readership of both academics and general readers. The author of The Art and Science of Healing since Antiquity, Daya Ram Varma, studied medicine at Lucknow from 1950-55 and is professor emeritus, Department of Pharmacology and Therapeutics, at McGill University, Montreal, Canada. Written for a broad audience, the stated aim of the book is to address the questions of why there are so many schools (systems) of medicine and why they are likely to continue for long. The evolution of these schools is explored from the point of view of the prevalent sociopolitical context. Based on an impressive range of secondary sources, the book has 17 chapters and three appendices, including a review of the historiography of works in this field, a list of natural drugs currently used by modern medicine as therapy and the 1978 Alma Ata Declaration on Primary Health Care.
Do No Harm’
The chapter on “The Science and Art of Medicine” endorses the view that medicine includes a scientific aspect and an applied aspect in the form of therapeutics, which could be treated as the art of medicine. While great advances were made in medical science from Susruta and Hippocrates to the first quarter of the 20th century, Varma notes that there was minimal progress in therapy. The essence of medical science involved discovering the causes of diseases and how to treat them. But since science is not neutral, there could be both the “good and bad” use of medical science, for example, the use of ultrasound technology for sex detection. Even though the Hippocratic principle is “Do No Harm”, physicians can do harm since they too are subject to societal prejudices. Social, political and economic factors influenced advances in medical sciences, more so than in physical sciences, because medical needs are an integral part of society. The author contends that the replacement of the feudal mode of production by the capitalist mode of production was a major impetus in development of medicine. Commendably, Varma highlights the gender bias in medicine.
The commercialisation of medicine led to the creation of a market for the use of hormones by women, when no real need for them exists, and women’s bodies were subjected to medical interventions, as is evidenced by the numerous and increasing births by caesarean sections. The relative silence on the role of women is illustrated with various examples, like the contribution of Rosalind Franklin to the discovery of the double helical structure of DNA which was ignored. Varma credits the feminist movement with the posthumous recognition of her role. The other example of bias in medicine was the attribution of cholera in the early 19th century, to the poor of London or to the colonies, before the demonstration by John Snow that cholera was water borne.
Chapters four to 14 discuss different medical schools. The author suggests that witchcraft and magic were the forerunners of medicine and natural sciences, and that the earliest healers were probably women. The stages of medicine from the birth of humans to the beginning of “materialistic” medicine around 700 BC comprised phases, which are termed as “intuitive” medicine, “observational” medicine and “spiritual” medicine. It was after these stages that “materialistic” medicine began with the ayurveda and Chinese medicine systems and Hippocrates. Egyptian medicine, which was “empirical” medicine originated a thousand years before these schools. Despite the many gods and demon figures in Egyptian beliefs, the medical papyri bear evidence of physicians of different specialisations, veterinarians, dentists, surgeons, and various medicaments of animal and chemical origin. There are also gynaecological and surgical papyri. The weakness of Egyptian medicine was its silence on the theory of health and disease. Its advances were checked with the decline in central political authority and the many invasions that Egypt encountered.
Egyptian Medicine
The ayurveda and Chinese medicine systems are regarded as marking the transition to materialistic medicine. While not much is known of the medical system of the Indus Valley civilisation, ayurveda is associated with the Vedic age, reaching its peak during the Buddhist period. That is when, in Varma’s opinion, it made a dramatic shift towards materialistic medicine. Its significance was not in the correctness of its formulations or its pharmacopoeia but in the materialistic theoretical approach of the tridoshas. He further contends that the stagnation of ayurveda coincided with the decline of Buddhism and did not occur during the Moghul or British rule. Varma contests the view that ayurveda is the oldest medical science and points out that the Egyptian papyri are older than ayurvedic texts. The current popularity of ayurveda is attributed to the spiritual appeal, the natural therapeutic regimen with herbs, yoga and diet, its efficacy and its association with nationalism. The three main features of Chinese medicine are the following: (1) disease is internal to the yang-yin relationship and not due to external factors, (2) herbs are healing tools, and (3) acupuncture can produce healing and analgesic effects. The yang-yin is a universal philosophical approach and not limited to medicine, yang-yin can be distinguished but not separated, and can control and transform each other. The classification of diseases was based on an excess of yang or yin. Different diseases could have the same treatment and conversely the same disease could have different treatments, because it could affect different people differently. An important feature of medicine in China was the role of the State, which took over the healthcare system by opening hospitals and centres to train physicians.
Both the ayurveda and Chinese medicine systems have maintained their continuity.
Elevating Hippocrates to the position of the father of medicine, according to Varma, reflects a western bias in medical historiography. A comparison of ayurveda with Greek medicine shows the latter as more materialistic and divorced from religious overtones, which was a major development. Hippocrates’ theory of the four humours was a significant contribution, health being considered as a state of balance between them, with disease reflecting imbalance. Corpus Hippocraticum was based on close scrutiny of disease and on clinical observations. While most of what it contains was in the Charaka Samhita, 500 years earlier, the latter is not free from religiosity. Galenic medicine did much to advance the rich legacy of Hippocrates and emphasised philosophy and ethics. The period from Galen to the Renaissance is the phase when medical science regressed with the increasing control of the church and the emergence of feudalism. It was asserted that everything known was written in the holy books and men were to imbibe the truth as revealed by messengers of god. The Islamic medicine system, the Unani Tibb, is based on Galenic medicine. It not only popularised science by translating Greek texts into Arabic but also made original contributions in astronomy, mathematics, chemistry and medicine. The rapid increase in the number of followers of Islam and its spread in Persia, Mesopotamia and Egypt, which themselves had advanced civilisations and science, contributed to the expansion of Islamic medicine. It is popular today in many parts of the world.
Schools of Medicine
“The Age of the Witch Hunt” looks at the phenomenon of discovering witches and burning them alive and ascribes it to the culture generated by the emerging capitalism, slavery, the assertion of the power of the church and to gender biases. Other reasons postulated are the inexplicable illnesses of different types, locations in inaccessible geographical regions, the greed to confiscate property belonging to the so-called witches, conflict between different Christian denominations, and unexpected natural disasters. It was also used as a means to suppress rebellion. The author sees this tendency extended today to political dissent.
Surpassing all schools of medicine and second to modern medicine is homeopathy, which originated as a reaction to the sinister use of toxic doses of suspect drugs and bloodletting by followers of the Hippocratic medicine system. Homeopathy believes that disease and sickness are caused by disturbances in a hypothetical vital force and these disturbances manifest themselves in unique symptoms. This vital force reacts and adapts to internal and external causes, referred to as the law of susceptibility. Varma holds that the basic premise of homeopathy is wrong, but opines that it will survive until modern medicine convincingly demonstrates its superiority.
The comprehensive chapter on therapeutics is based on the premise that the history of medicine revolves around human efforts to eradicate a disease or at least to alleviate suffering and that drugs occupy a central position in this endeavour. The period preceding Hippocrates was the golden age of Therapeutics, when the Peruvian bark (source of quinine), poppy plant (source of morphine) and willow bark (source of salicin, the precursor of aspirin) were discovered. But from the Hippocratic era to the 20th century, Varma contends, all kinds of drugs were used, which did more harm than good, with the notable exceptions of the anti-smallpox vaccine and carbolic acid. With the advances in natural sciences and in chemistry and a better understanding of human physiology and pathology, a scientific approach to drug discovery began in the 20th century. The discovery of sulpha drugs and penicillin opened the way to treating infectious diseases, insulin enabled the treatment of constitutional diseases, some progress was made in the treatment of cancer and the contentious areas of gene therapy and stem cell research promised hope.
Unlike other schools of medicine modern medicine realised that the mysteries of health and disease are knowable, and that the gaps in its understanding of human physiology and pathology of diseases could be filled. It is neither allopathy, in that it is not based on administering massive doses of medicines, nor is it Hippocratic, in that it is not based on the four humours theory of diseases. Advances in all branches of science made it possible to solve problems, reject the older theories of diseases and identify specific causes of diseases, whether environmental, genetic or due to deficiencies of essential nutrients. The recognition of neuroplasticity, nerve regeneration, brain neurotransmitter and receptors, mechanism of different kinds of pain including phantom pain, electrophysiology of the heart, advances in immunology and public health measures has opened new approaches to therapeutics and prophylaxis. Surgery and dentistry can do marvels and prognosis is more accurate. While the achievements are monumental, challenges remain in the form of diseases like diabetes, hypertension, heart failure and Alzheimer’s disease. The author is optimistic that all diseases can be conquered. Much of the criticism of modern medicine is based on the role of medical professionals, not on the science, per se. Doctors are in no way different from other professionals. They have been both heroes and assassins, have placed obstacles to health reforms on the one hand, and on the other functioned as social workers. They face dilemmas in deciding whether to save or not to save the life of a terminally ill patient in agony. Varma opines that medical ethics is determined by the prevailing norms and civil laws of a given society and can differ widely.
Ushering in Capitalism
Joseph Needham posed the question why science grew in the west and not in China, India or the Islamic world. While supporting his supposition that it is due to differences in social structure and culture, the author suggests that the rivers Yangtse, Ganges and Nile did not allow for despondency in China, India and Egypt, respectively. Europe needed to dismantle feudalism and acquire colonies, and capitalism was ushered in. This together with democracy and the freedom to pursue research gave great impetus to science. In the concluding chapter, Varma answers the question as to why alternative systems of medicine continue to exist. This is neither due to the strength of these systems nor the weakness of modern medicine but due to the poor healthcare in most countries of the world. When universal healthcare becomes the norm, says Varma, the popularity of other schools of medicine would decline.
The premises in the book are clearly spelt out, the arguments cogently put across, the style is lucid, and examples from many situations familiar to the lay reader makes it a good buy. Careful editing could have avoided repetitions.
[Mridula Ramanna (mridularamanna@hotmail.com) is with the Department of History, SIES College, Mumbai.]
Top - Home