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[edit] Hakim

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A Mahomedan physican.

[edit] Notes

Muhammadan, or, as it is usually called, Yunani, or Greek, medicine has never flourished in Hindostan, as its study was neither fostered by State endowments nor patronized by royalty. For the last three centuries the most celebrated physicians in India have been Shiah graduates from the colleges of Shiraz, Samarkand, and Bukhara. During the reigns of Akbar, Ja-hangir, and Shah Jahan, the court physicians were Persian Shias, but Sunni doctors were favoured by the bigot Aurangzib.

1 From Sanskrit, Bheda, piercing.James Wise , ( 1883 ), Notes on the Races, Castes and Trades of Eastern Bengal , London , Her Majesty's printer Harrison and Sons.

After his death the Shias again predominated, holding all the official posts in the Empire; but to the Sunni physicians the credit is due of having written many of the most practical; as well as popular, medical works in the Persian language, while the salaried court doctors did little towards advancing their profession.

The Hakim of the Mughal period was not only a physician, learned in philosophy, metaphysics, and science generally, but a politician who was consulted in important affairs of State. As often happened, the Hakim, being the friend and confidant of the monarch, was permitted greater license of speech than other courtiers. When any difficulty with a neighbouring nation arose, and great tact and ability were required, the court physician was often sent as a special envoy to settle it. It was for the political part he played, and not for any professional services, that he retained his dignified position at the imperial court

A lower and less respected grade of physician was the Jarrah, or surgeon, whose skill, like that of the barber-surgeons of Europe, was limited to the opening of boils and abscesses, and rarely extended to the amputation of limbs, or to any major operation. The frequency of sword cuts, punctured and lacerated wounds, must, however, have accustomed him to treat such injuries.

The general practitioner, as we would style him, was the Tabib, whose daily life brought him in contact with all classes of society, and whose experience of diseases, of idiosyncracies, and of treatment, secured for him much popularity and respect.

The oculist (Kahhal) was occasionally met with, but his skill was uncertain, and his ignorance undeniable.

The lowest in rank, the Baitar, or veterinary surgeon, looked after the royal elephants and stud, but for these services he only received the pay of an Ahadi, or trooper.

Under the Muhammadan rulers, there being no medical schools, students were apprenticed to Hakims, who daily devoted a few hours, in the intervals of practice, to the instruction of their pupils. The size of the class varied according to the reputation of the master who endeavoured, for his own credit, to encourage the youths in their studies. He granted certificates of proficiency only to those considered worthy, otherwise he would have forfeited the right to what the Eastern nations set the highest value upon, the leaving a good name behind him.

In India, no official like the Hakim-bashi of Turkey conferred diplomas, so the medical profession was open to all; but the pupil of any famous doctor was sure of obtaining practice in cities where his master was known, and of at once gaining a position which less favoured rivals took years to reach.

The result of this system has been that many amateurs from reading medical works fancy themselves able to express an opinion on any subject connected with the structure and temperaments of the human body, or the properties of plants and qualities of articles of food. Problems which still puzzle wiser heads are solved by these pretenders to medical skill without hesitation, and to their own satisfaction. Where there was no encouragement held out for the advancement of learning, and where a widespread and remunerative system of quackery prevailed, a high standard of professional knowledge was not to be expected.

The Hakim practising in the towns of Bengal is generally familiar with the text-books of Yunani medicine, but very ignorant regarding the type of modern disease. When summoned to see a patient he never commits himself to any expression of opinion; but after feeling the pulse, noting its volume, tone, and rapidity, leaves with a few words of comfort and strict injunctions regarding diet and cooling drinks. After several visits, and not until the urine has been examined, and his text-books consulted, is his diagnosis formed.

This being done, he unpacks his stores and attacks the enemy with his most powerful drugs. Bleeding is gradually being laid aside; but in pleurisy venesection from the side affected is still recommended,1 and in the delirium of fever leeches or cupping glasses are applied. The particular vein to be opened often causes much anxiety, for it has been authoritatively laid down that certain veins are to be opened in special disorders. In leprosy and other blood diseases, the "haft-andam," or median vein, is the proper vessel to cut; in pneumonia and pleurisy, the "basalik;" and in delirium, the "qifal," or cephalic vein.

It is on the examination of the urine that the Hakim chiefly relies when forming his diagnosis. He has no urinometer and no reagents. The sample being poured into a thin glass bottle (qarura), he carefully determines its colour, surface (zubd), sediment (rusub), and density (qawani)

1 Early in the sixteenth century the medical schools of Europe were ranged in rival factions on the question which was the proper arm to bleed from in pleursy. Pierre Brissot, in 1502, taught that bleeding from the affected side, though commended by Rhasis, Avicenna, and Mesue, was contrary to the opinion of Hippocrates and Galen. He was opposed by Denys, a Portuguese physician, and the decision was left to the Academy of Salamanca. After much discussion the council gave the oracular reply that Brissot taught as Hippocrates and Galen had done.

This only added fuel to the fire. The adherents of Denys were dissatisfied, so the question was referred to the Emperor Charles V., it being urged that the teaching of Brissot was impious and pernicious, as detrimental to the body as the schism of Luther was to the soul. This memorable controversy was renewed at the death of Charles III. of Savoy, in 1553, who was attacked with pleurisy, bled according to Brissot's system, and died. The question was left unsettled by the Emperor; but the medical schools throughout Europe continued to squabble over the subject for several generations.

The anatomical knowledge possessed by the Hakims is quite rudimentary and very antiquated. The Muhammadan belief that a corpse feels pain when violence is inflicted has always prevented the study of human anatomy, while the resection of animals has been prosecuted with only partial success.

The tendons, nerves, and blood-vessels are only known to the modem Hakims by the indefinite term "Rag;" while the muscles, undistinguished the one from the other, are spoken of as "gosht," or flesh; and the intestines, with all the abdominal organs, as "Antri." According to Muhammadan anatomists, the human body is composed of seven elements, namely, chyle, blood, muscles, fat, bones, brain, marrow, and semen. The only textbook of anatomy is the Tasrihi Mancuri,1 of the fourteenth century, a most creditable work for that age, being illustrated with rough drawings of the arteries, veins, intestines, and skeleton.

The Hakims know little or nothing of physiology. The liver is still regarded, as it was by Europeans until the days of Harvey, as the root and fountain head of the venous system; while the spleen is held to be the organ where the blood is formed and purified. It was the Hindoo physicians who first taught that this was the function of the spleen, but the Yunani doctors advanced a step farther, by pointing out that when the spleen was inflamed, or congested, emaciation and bloodlessness ensued, for which the actual cautery was the proper remedial treatment.

Accordingly Hakims either cauterize, or apply blisters and issues in all cases of enlarged spleen. On the mysterious subject of impregnation, Hakims are content to follow the precept of the Koran,2 and to rest satisfied with a notion of the seventh century.

Pathology has not made any advance for many centuriees and all diseases are, as Avicenna wrote, due either to excess, deficiency, or faulty combination of one or more of the fundamental humours (mawadd) of the human body.

Although Yunani physicians have written much on hygiene, greater attention was always paid to fanciful descriptions of disease, and to Materia Medica. The careful accumulation and comparison of clinical observations were generally omitted, and every faculty was bent on discovering specifics, or a panacea for every ailment. Each physician boasts of having a secret nostrum, which is vaunted as an infallible remedy; but instead

1 The author is Mancur ibn Muhammad ibn Yusuf ibn llyas Heraati, who dedicated it to Pir Muhammad, grandson of Timur. The date of the work is A.H. 799 (1896).

2 Ch. xxiii. This text bears a most striking resemblance to that of Job x, 9-11, both being probably founded on ideas current among the Semitic races.

of having it tested by independent observations he only employs it as a valuable source of profit.

In their study of Nosology the Indian Hakims have devoted much labour to the varieties of type exhibited by disease, to the effects produced by peculiarities of temperament, climate, or age; but have entirely neglected the investigation of the exciting and predisposing causes of disease, as well as the laws regulating its origin and dissemination.

On the therapeutic treatment of disease Hakims entertain many fanciful ideas. According to them, all medicines possess one of the four following degrees of virtue:�

a. Those which do not manifest their usual effects in ordinary doses.

b. Such medicines as produce inconsiderable, though sensible, effects.

c. Those powerful drugs, which must be cautiously given, although certain in their action.

d. Poisons and other drugs which excite deleterious consequences.

Drugs, vegetables, and all articles of diet, they assert, have either sweet, bitter, acid, salt, pungent, or astringent ('afis) qualities, producing peculiar effects on the different humours; and are hot, cool, heavy, light, aphrodisiac, lithontriptic, demulcent, or emollient. Should the proper medicine not be procurable, its succedaneum (badal) may be prescribed, and if its action is thought to be too powerful, it may be lessened by a corrector (muclah) in the same may as the English apothecary combines sulphate of potash with scammony to counteract its irritating effects.

Cephalic (sa'ut) medicines are extensively used by Hakims in the treatment of common colds and headaches, it being the received opinion that there is direct communication between the nostrils and the brain. Equally absurd is the notion that the shape of a fruit often indicates its use as a medicine, and because the Mango bears a slight resemblance to a kidney, it is held to he useful in renal diseases.1 Indian Hakims have adopted many drugs of the Hindu pharmacopoeia, and make use of Yunani remedies in diseases for which they have been declared unfit by Arab and Persian physicians.

1 The superstition that the shape, or look, of a plant indicates its officinal use, is one of the very oldest known. Thus in Genesis it is mentioned that mandrakes promote conception, because its bifid roots bear a fancied resemblance to a man. So the modest little eyebright (Euphrasia officinalis) of English meadows got its reputation for curing ophthalmia, because its small white flower, with a dark dot in the centre, was fancied to be like an eye; and the Pulmonaria, or Lung-wort, was given to care coughs, because its spotted leaves resembled the human lungs.

In Bengal the following, being the most valued authorities, are the text-books given to students:�

Mizan-i-tibb, the first book given to the student, was published, A.H. 1125 (1713). Tibb-ul-akbar, with the date A.H. 1112 (1700). Qarabadin Qadiri, written A.H. 1126 (1714).

The author of these three works was Muhammad Akbar, Shah Arzani,1 a physician of the Delhi Court. The first treats of medicine generally; the second, a translation of an early Arabic work, the Sharh-al-asbab, of the causes, symptoms, and treatment of diseases; while the third is a work on Materia Medica.

Other standard works generally consulted are the Jami'ul-Jami',2 an encyclopedia of medicine, consisting of three sections:�

1. Makhzan-ul-adwiya, on Materia Medica, of the date A.H. 1187(1773). 2. Qardbadin Kabir. 3. 'Ilaj amrazi mukhtac aur ghair mukhtac., on the practice of medicine.

This great work is highly esteemed, and the Hakims boast that if it were preserved, and all other Yunani books of medicine destroyed, nothing of value would be lost. In compiling this encyclopedia, the author was assisted by his uncle, 'Ulwi Khan, the first physician of his age.3

The above mentioned text-books are ordinarily used by the Hakims of Dacca, and it is remarkable that they were all written by physicians settled at the Nawabi court of Murshidabad, the only place suited for study at the middle of the eighteenth century. Even at the present day the Qanun of Avicenna, or its abridgment, the Qanunchah, is read, and followed by many Hakims; but as their knowledge of Arabic is slight, Persian or Hindustani translations are usually preferred

Even in the brightest days of the Mughal rule implicit confidence was not placed in the skill of the court Hakims, and very rarely did any one occupy the position of the trusted family doctor. When European physicians appeared in India they were

1 His father was Haji Mir Muhammad Muqim, a Sunni by religion. Other well-known works by the son are Mufarrih ul-qulub, written in 1712, and Hadad-ul-amraz.

2 The author was Hakim Sayyid Muhammad Husain Khan, son of Hakim Muhammad Hadi 'Aqili-al-'Alawi, a Shiah from Shiraz. His elder brother was the famous Diwan of Bengal, Muhammad Reza Khan.

3 Sayyid Muhammad Hashim Shirazi was born A.D. 1669. When thirty years old he came to Delhi, and settled there. When Nadir Shah retired from Delhi in 1739, he carried off the Hakim with him, but in 1743 he returned. In 1747 he died. Shah 'Alam I conferred on him the title of Mu'tadil-ul-mulk, Ulwi Khan, and gave him land worth Rs. 3,000 a year.

consulted in urgent cases, and, not infrequently, occupied state appointments.

The first European physician resident at the Delhi court was a Frenchman, M. Bernard, a boon companion of the Emperor Jahangir, and who had the credit of being "an excellent physician and skilful surgeon." Bernier mentions1 that his pay was ten crowns a day, but this was greatly increased by his attendance on the high ladies of the Seraglio, and on the Omrahs, who seemed to vie with each other in making him the most liberal presents, not only because of the cures he effected, but on account of his influence at Court.

A few years later the Venetian Manouchi arrived at Delhi, where he remained forty-eight years (1649-1697). He was body physician to Dara Shikoh, eldest son of Shan Jahan, until his death in 1659. From 1659 to 1667 Francois Bernier was doctor to Aurangzib.

Tavernier met with European doctors practising in different parts of India. In 1652 he resided with Peter de Lan, a Dutchman from Batavia, who was attached to the court of Golcondah. He had attained that position through the stupidity of the native doctors. The King was ordered to be bled from the sublingual veins to cure a headache, but no one would undertake to do it. De Lan performed the simple operation, and was richly rewarded. In 1665 Tavernier reached Allahabad, where he found the governor in bad health, attended by ten Persian physicians, and "Claudius Maille of Bourges, who practises both Chyrurgery and physick both together."

In Bengal, Schouten states that the Mogols never send an army into the field without applying to the Company (Dutch) for surgeons "Qu'on y considere assez, et a qui les principaux Seigneurs se confient volontiers."2

The services of English physicians were also sought for, and appreciated. In 1636, when Jahanara, the second daughter of Shah Jahan, was severely burned in the Dakhin, a messenger was dispatched to Surat, and Gabriel Boughton, surgeon of the Company's ship "Hopewell" was sent, under whose skilful treatment the Princess was restored to health. In 1675 John Fryer attended the family of the Mughal general at Jeneah. The most important service, however, conferrred by an English doctor, was when William Hamilton3 cured the Emperor Farrukhsiyar, in 1715, of a carbuncle, and acquired for his country the settlement of Calcutta. In 1742 Mr. Forth, surgeon

1 Bernier, i, 309.

2 "Voyage de Wouter Schouten aux Indes Orientates," ii, 298.

4 Hamilton died of a putrid fever in 1717, and at the present day no memorial of his disinterestedness exists.

of the English factory, treated 'Ali Vardi Khan in his last illness; and in 1763, when the English were massacred at Raj-mahal, the only officer spared was Dr. Fullarton, who had been of great service to several Muhammadan chiefs.