A Study of Buddhist Medicine and Surgery in Gandhara (Vol. XI)

This study approaches Buddhist Medicine and Surgery by comparing the medico-social events, the people who were involved in them and the tools they used; from mainly three civilisations of the contemporary period, the Greeks, Romans and Buddhists who prospered in Gandhara. The interactions of all three people for long periods in history are well documented; the study raises the obviously intriguing question of why in some areas they influenced each other markedly but not at all in others. No doubt it is the first study on the subject and a number of aspects brought up for discussion may be new and original altogether. This study might raise a few issues owing to looking at events from different perspectives because much of the history has no validity of its chronology and the mist of mythology is too thick. The narrative endeavours to engage support from reliable references and quotes from dependable sources.

Dr Nasim H. Naqvi, MBBS, DA, FECA, retired as Director of Anaesthesia and Intensive Care services from the National Health Service, U.K He has been interested in the history of medicine, and published many papers including a comprehensively illustrated history of blood pressure measurement. The evolution of medical instrumentation, the history of the pulse and medical manuscripts are his foremost interests from which he seeks his direction. He is an avid collector of medical antiques and visits museums all over the world looking for medical objects.

Gandhara was an ancient kingdom in the far northwest of South Asia; occupying the region that today lies across the borders of eastern Afghanistan and northern Pakistan. Its principal cultural centres were the cities of Puskalavati, Purusapura and Taksasila (modern Charsada, Peshawar and Taxila). The kingdom of Gandhara lasted from the early first millennium BCE to the early eleventh century - CE but was at its cultural peak under the Kusana dynasty of Buddhist kings who ruled from the first to the fifth centuries CE.

Gandhara was connected to the rest of the subcontinent by the famous ancient Northern Trunk Road (Sanskrit uttarapatha), which formed a southern spur of the Silk Route. It was connected to the eastern Mediterranean by the trade route through the Parthian kingdom from Antioch to Kandhar which is described in Greek sources of the first century BCE. At an early period of its history, Gandhara was politically part of the Achaemenid empire of Persia. Later, Taxila was captured by Alexander the Great, and his successors in the region created a unique blend of Greek and Asian art. After a period under the control of the Mauryan dynasty, Gandhara was in the third century BCE once again controlled and influenced by Greek culture through the Graeco-Bactrian rulers.

It has long been known that several ancient authors of ayurvedic treatises were residents of this complex, multicultural, vibrant region. The author Puskalavata, from a city of a similar name, is said to have written a treatise on surgery, now lost. The Gandharan physician Nagnajit sometimes thought to be of a royal line himself, is remembered as an expert in toxicology. The famous physician Jivaka, known from Buddhist sources, is said to have studied medicine at the university in Taxila, where some sources name his teacher Atreya, describing him as a surgeon. The Atreya Punarvasu, who taught medicine to Caraka and other founders of ayurveda, was probably different from Jivaka’s teacher but nevertheless is also sometimes described as teaching medicine in Gandhara on one occasion. Some ancient legends place Caraka himself at the court of the Gandharan king Kaniska.

It has long been recognised that one of the wonders of ancient Indian medicine was its sophistication and innovation in the field of surgery. A wide range of specialized surgical instruments is described in such detail in the Sanskrit texts that it has been possible for modern museums to create accurate reproductions of them for display. Until now, however, no original instruments have been known to have survived from antiquity. Dr Naqvi’s reexamination of the archaeological evidence from Gandhara, however, has now changed the picture, for it seems that we do indeed have ancient instruments that were simply not recognised as such by earlier generations of archaeological interpreters. Dr Naqvi offers a new interpretation of the archaeological evidence from Gandhara that sheds important new light on the history of ancient Indian surgery.

In short, Gandhara appears to have had a unique role in the medical history of South and Central Asia, specifically the earliest history of surgery. This role was not unconnected with the Buddhist culture of the region. But until now, no special study has been dedicated to this topic. We are therefore happy indeed to present Dr Naqvi’s new monograph in the series Indian Medical Tradition.

Why must I write this book? This question deserves a convincing answer and I had at least convinced myself before starting or even thinking about the title of the book. There are three good reasons why I wanted to put the facts on paper in respect of the study I had carried out regarding the practice of medicine and surgery by the Buddhists of Gandhara. Firstly, it is a subject no one has ever treated before; an obvious fact when one starts searching for relevant data in the literature on the history of medicine regarding the medical achievements of the Buddhists in Gandhara.

Secondly, because I did my schooling in the neighbourhood of Taxila I always wanted to find out more about its past and the social life of the people who built those monasteries, sculpted that art and made the objects that I saw displayed in the museum. During one of the many visits to the Taxila Museum, I saw a few artefacts that looked like surgical instruments. This led to a prolonged study of the history and archaeology of Gandhara in order to understand these objects and culminated in a publication in Medical History. From this, I always wanted to tell a comprehensive background story collaborating fully with the archaeological assessment of the surgical and medical artefacts unearthed by the archaeologists in the light of their expert appraisal.

Thirdly, being an anaesthetist (anaesthesiologist) for 40 odd years and watching surgical procedures closely I had observed the improvements in the outcome within my practising life were so visible, which I always attributed to unremitting advance and improvements of the available tools, a process that can be traced to the time of Celsus or even before, The evolutionary enhancements in instrumentation helped to improve the skills of both the surgeons and anaesthetists. A new blood pressure monitor or a modified surgical clamp, a hip implant made from a better metal or an inert plastic intraocular lens, all such new innovations consistently produced much better results than the previous versions. The opportunity of working in operating theatres, anaesthesia and intensive care surrounded by today’s rapidly changing technology was a great help and inspiration. My fascination for instrumentation made me an avid collector of medical antiques and induced a passionate interest in the evolution of surgical instruments. My curiosity about the surgical instruments discovered from the sites of Gandhara was a natural upshot of my hobby.

The excavated objects are silent witnesses, though they cannot speak but can make credible eyewitnesses if suitably analysed. The method employed in the study is a comparison with known instruments from the Greek and Roman periods. Such an approach is reflected in the selection of the pictures where an effort is made to highlight by comparison the fact that in general design, size, shape and function of most of the instruments, equipment and pharmaceutical-related objects excavated in Gandhara do bear a resemblance with the acknowledged Roman or Greek objects despite the fact that their design was independently evolved by the people living far away from each other. Such a comparative study is intended to bring about an interesting emphasis for the reader who can see the essential details in two different objects at a glance and then makes an unbiased opinion regarding the argument. In search of surgical instruments of the period I have visited most museums in Pakistan, including the National Museum at Delhi and in order to look at the real Roman and Greek surgical instruments I have also travelled to the National Archaeological Museum at Naples and the Museum at Epidaurus in Greece. While relevant information from some others such as the Museum of Calcutta, Madras Museum (still known by old names), and Allahabad Museum was obtained by correspondence.

The consequence of the study of surgical tools evidently ricochets onto the social history of the blacksmiths who made them, doctors or surgeons who used them and the patients who might have benefited or suffered from them. These are the reasons why I wanted to write this account in book form and I hope the readers may agree that at least I have tried to put most if not all relevant interesting facts together. This may not be a complete story but I have made a start to which more would surely be added by others in future. The process of finding the truth will continue. Now by assessing the contents of the book it is also up to the readers to judge whether the question that was posed in the first line has been justifiably answered.

I would also like to bring to the notice of the readers two aspects at this stage. The spellings of Arabic, Sanskrit and Chinese names and words are not standardised and various texts have used dissimilar spellings causing confusion and even difficulty for their readers. Here a simplified version of the spellings is chosen from previous publications and applied throughout the text, with the hope that the choice will be undemanding and the readers will not be burdened needlessly. The readers may find at times repetition of events, if an account is echoed it was only to keep the subject matter in context.

Finally, I would like to take the opportunity to thank the Directorate of the Archaeology and Museums Government of Pakistan for granting me permission to photograph the exhibits and the staff of Taxila Museum for the help they provided during the photography. Thanks are also due to Mr Saleh Muhammad Khan, the curator of the Peshawar Museum who was kind enough to allow me to photograph Kanishka’s Casket at the Peshawar Museum.

During ancient times, the territory of the present northern area of Pakistan and adjoining regions such as Afghanistan, and part of eastern Turkistan was known as Gandhara. It is also a fact of history that never at any point in the past any borders were recognised to make Gandhara a well-defined state with recognised borders. Even though the geography of the region contains the most natural borders in the form of the highest mountains in the World and the great rivers; this should have created lasting geographical boundaries. But the area always remained and still is the most porous, its inhabitants have always moved freely without any restrictions. From the second millennium BCE till the present this rugged region on both sides of some of the highest mountains in the World and their snow-covered peaks remained a melting pot where a number of diverse civilisations arrived from far away lands and left their marks which can be seen and felt even today. When it came under the Buddhist influence that lasted for many centuries it achieved a high point in learning both in arts and sciences. During this period Gandhara seems to be unique among the contemporary civilisations to independently develop its own medicine and more importantly practice surgery based on rational principles.

It is a fact of history and archaeological reality that the Buddhist Gandhara was the only place in the World outside the Roman Empire where high surgical skills were acquired and put into practice. The history of art, literature and various sciences taught in the universities of Gandhara has been well documented. However (the historiographers have not fully examined or talked about the available evidence that supports the advancement which was achieved in medicine particularly, the corroborated evidence regarding surgery despite unequivocal archaeological verification. In this study, an attempt is made to investigate the archaeological and historical evidence and evaluate how surgery and medicine developed, progressed and then declined in Gandhara. It is important to keep in mind that the history of medicine of any civilisation cannot be studied in isolation, since it is directly influenced by the ongoing social changes, cultural conflicts and upheavals and most importantly by the technological progress that the society can manage. Here we must also look at the technological progression of the people of Gandhara that enabled them to attain the advance in rational medicine and surgery during the Buddhist domination. In the chronology of events inclusion of the relevant social wax and wane and their consequences are not only inevitable but an overriding factor for better orientation of the course of history. Moreover, for the sake of continuity, a look into the past as far back as possible is also of paramount importance.

When we look at the evolution of health care in general terms, we notice that human skills evolved in a step-by-step manner over a long period during the evolution of the human race. We are told that the major changes which took place in the development of brain size and intelligence coincided with the ability of human beings to live together in social groups.’ Glancing through the evolution of medicine we are further informed by medical anthropologists that the newly socialised human beings as a matter of necessity started practising some rudimentary form of medicine and even surgery at quite an early stage. The medicine man seems to be present among the earliest settlements. The anthropologists have also made a case for caring among early societies from the discovery and study of toothless bones belonging to individuals who were incapable of biting or chewing and must have been provided suitably prepared food by others within the community. Such communal responsibilities and interdependence within the family unit offered the opportunities for man to learn how to protect the frail or weaker family members from many of the hazards faced by the primitive tribal communities. In the hostile surroundings, senior and wiser clan members assumed the guardianship of the needy by protecting and looking after the very young, very old and very weak, nursing and feeling the injured and those who were ill. According to Sir William Osler (1849-1919), ‘medicine arose out of the primal sympathy of a man with man, out of a desire to help those in sorrow, need and sicknesses’. In due course from the experience gained as a result of the primordial desire for caring emerged the early practice of medicine and surgery.