Theyyam: When Gods Descend on earth

India has many rich religious traditions during which the Gods are supposed to come down to the earth and express themselves through some persons. Examples of similar traditions can be found in different parts of India.

This post focuses on one such tradition called Theyyam, which is celebrated in northern Kerala in south India.

Gods Speaking Through Humans

Hindus believe that the Divine is present in each living being as universal consciousness. At the same time, they have a pantheon of a huge number of Gods and Goddesses, one for each of life’s different forms. The Gods, animals and plants are all inter-linked through the sacred stories and myths.

The religious ceremonies in which Gods speak through humans has 2 main functions – (i) as a part of celebration of specific religious and social events; and, (ii) to answer questions and to give blessings to people.

 

All over India, especially in small towns and villages, there are persons who are known in the communities as “carriers of God”, who can go into a trance, and invoke a God spirit to come and speak through them. In north India this process is called “Devi ka aana” (arrival of the Goddess). Usually they do it by sitting down in meditation with their eyes closed and then go into trance. The arrival of the God in their bodies is marked by signs like convulsive shaking while their voices turn rough. After that others can ask questions or ask for blessings and make an offering. This role can be played by both men and women.

In many parts of India, there are also elaborate make-up, costumes and rituals linked with this tradition. For example, in North Dinajpur district of West Bengal, persons manifesting the Gods wear colourful wooden masks during the sowing of fields – this tradition is known as Gomira. In East Burdwan district of West Bengal, the men invoking the Gods, paint their bodies with blue colour and transform into Shiva – this tradition is known as Shiva Gajan. Satyajit Ray's film Devi can be seen as one representation and exploration of similar ideas.

While God-manifestation roles are mostly enacted only by men, usually they are about Goddesses, the different forms of Shakti. In some places, persons of other religions, especially Muslims & Christians, are given specific roles to play during these ceremonies image below with Muslim characters in a Theyyam), which could be linked with specific historical events and indicate processes of religious inclusion.

Theyyam Tradition in North Kerala

The word “Theyyam” probably comes from “Devam” (God). This religious tradition is common in villages of northern Kerala, especially around the district of Kannur and surrounding areas of Kerala and Karnataka. Between October to March, every village holds one annual Theyyam at the village temple. In each temple, there can be different Gods/Theyyams, depending upon the presiding deity and his consorts. Bhagwati is one of the principle deities of the Theyyam.

The persons playing Theyyams usually belong to specific lower castes in villages. The responsibility belongs to specific families and is hereditary, so that male children watch and learn from their fathers and uncles putting on the make-up, making specific ritualistic dance movements and conducting specific rituals in the temple. For the duration of the Theyyam, persons of all castes, bow in front of Theyyams.

The ceremonies continue day and night for 3-4 days and are usually carried out in the open courtyards around the temple. During the celebration, sometimes there can be an occasional animal sacrifice, especially a hen. After their rituals and dances, each Theyyam receives devotees who pay obeisance, and ask questions or their blessings.

Visiting Theyyam ceremonies

I had seen a few Theyyam dancers in a cultural festival in Guwahati some years ago and had been struck by their elaborate make-up and costumes. Then, a few years ago, in a museum near Fort Kochi, I had seen the masks showing specific make-up face-patterns for different Theyyams, which had greatly intrigued me.

It is easier to see Theyyam performances as part of cultural shows, but I was interested in seeing them as a part of a living religious tradition of a village.

In February 2018, during a visit in Kerala, I had gone to Kunnur, where I had hired a local Theyyam guide. You can find online the calendar of Theyyam celebrations in different villages. However, more specific information is available only in Malayalam. Finding and reaching specific villages where the celebrations are being held is not very easy unless you know the local areas. Thus, a local guide can make things easier.

With my guide Chandran, I had visited Theyyam ceremonies in 2 different villages and seen different Theyyams, each with their special make-up and costume. As you can see from the pictures, both were colourful ceremonies filled with beautiful rituals, dances and faithful. Even elderly persons touched their feet and asked for their blessings.

 

 

In my opinion, they are not just a rich and colourful tradition, they are an expression of people’s faith. I found the ceremonies emotionally moving. Unfortunately, with changing times, some young persons feel that these are just old superstitions and are dismissive towards them. Though the Government is supporting some of the families engaged in Theyyam by making them a part of cultural festivals, I feel that to see them as part of people’s living traditions and faith, is a completely different experience.

Conclusions

In one of the villages I visited, I watched a young man patiently lying on the ground for a couple of hours, while the make-up of God Narsimha was being put on his face. While he was getting ready, his uncle, Mr. Narayan, who was one of the drummers and had come home from Delhi, especially for this ceremony, had explained to me the significance of different steps of his preparation.

The most beautiful moment for me had come when after getting ready, the young man had moved away from the group and walked up to a small hill (image above). There he had bent down to touch the ground and then stood there with his eyes closed in a silent prayer. When he had opened his eyes and turned towards people, there was a subtle difference in him – he had transformed into Theyyam. Moving with a feline grace, he had walked to the courtyard of the temple, a God descended on earth.

That transformation had touched me deeply. Gods and humans, together and separate, are bound together in the sacred stories of human imagination - Theyyam is an illustration of this bond.

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Note: Post originally written in 2018, updated in 2023

Reforming Hindu Traditions

In 2018, I had spent a few days in Rishikesh where a chance meeting with a young Swami ji (ascetic) had led to some interesting discussions about how to bring reforms in Hinduism.

In terms of discussions around Hinduism, it is strange how a new aggressive narrative of Hinduism is being pushed in some traditional and social media (especially in English). Hinduism (along with Buddhism and Jainism) is predominently seen as a religion of peace which accepts people of different religions and creeds, as shown by the millennium-long Indian traditions of accepting people persecuted in their own lands including Parsi, Jews, Armenians, etc. International image of Hinduism is also associated with spirituality and Mahatma Gandhi including elements such as Yoga, meditation, non-violence and vegetarianism. However today, there are many persons in India and outside, who talk of Hinduism exclusively in terms of hate, violence and discrimination.

This post is about a discussion with a Swami ji from Rishikesh about how to reform Hinduism, it does not go into the new narratives being built around it.

Rishikesh

Rishikesh is the last mountain town where the river Ganges passes before reaching the plains in Haridwar. I had been to Rishikesh a few times as a child. My most memorable visit was in early 1968 with my maternal uncle. At that time, the Beatles had just visited the ashram of the Guru Mahesh Yogi and this had brought international spotlight on this obscure town. Last year when I went to Rishikesh, I had vague memories of those old journeys. I went to look for the old ashram of Mahesh Yogi but it was closed and covered with overgrown vegetation. This part of Rishikesh has now many new ashrams and there is a new huge white statue of Shiva built in the middle of the river.

As the river Ganges comes down, the old town of Rishikesh is located along its left bank, near the area of Triveni Ghat. All the new ashrams and yoga centres of Rishikesh are located to the north of the old town, along the opposite side of the river.

I was staying near Triveni Ghat and spent a great deal of time sitting along the river bank, with my feet in the ice-cold river waters, talking to old men and women who had come here on pilgrimage from different parts of India. Every afternoon, underneath the trees of Triveni Ghat, persons gathered in small groups and discussed. These discussions were usually very down-to-earth and mixed an earthy humour and occasional obscenity with the spirituality.

Meeting the Swami

The Swami ji was much younger to me, probably around 40 years and was clean shaven. He wore the saffron cloth of renunciation and seemed well educated. I met him near Bharat temple, which is one of the oldest and most beautiful temples in Rishikesh. He was from West Bengal and I talked to him about my experience of living in Assam. I was curious to ask him what had brought him to the path of renunciation, but felt a bit embarassed, it seemed like a very personal question to ask to an occasional acquaintance.

We started talking about Upanishads and I explained to him my fascination with Katho-Upanishad, which tells the story of Nachiketa's visit to Yama, the God of death and their discussions about the meanings of life and death. He was very knowledgable and recited different shlokas from that book, explaining his understanding of it.

Then he asked me if I had been to the Ganga-aarti? During this aarti a group of young Brahmins do a choreographed dancing prayer holding metal lamp-stands full of burning lamps, which has a great visual impact. I explained to him that for me, the teachings of Upanishads held the real meaning of Hinduism and I did not have much faith in rituals like aarti. I had found aesthetic pleasure in the choreography of the burning lamps and prayers sung by the faithful, but not any spiritual connection to it.

 

My comments about the aarti provoked a discussion during which Swami ji explained to me his understanding of Hinduism. He said, Hinduism is like Ganges, a river made of a lot of different streams. There is the Spiritual stream of Hinduism with an abstract view of God, and this stream finds a value in the sacred books of Veda and Upanishad. There are many other streams. Like the Vaishnav stream of belief which is practiced in Assam by the followers of Shrimanta Shankar Dev, which focuses on Bhagwat Puran and does not have any idols. However, according to him the biggest stream of Hinduism is that of simple persons who believe in the different Gods, in the different avatars of Vishnu and in the stories of Ramayan and Mahabharat. For them, the stories of Ram, Krishen and Shiva are the bedrock of their faith, these are felt as true in a material sense.

Swami ji felt that many of the present problems of Hinduism were caused by the disconnect between persons believing in different streams of the religion. According to him, most of the highly educated Hindus among the thinkers, writers, academics and other influential groups are like me, who appreciate the higher teachings of Gita, Veda and Upanishad but do not have the simple faith of common persons in their Gods.

"Persons like you, they dominate the society and what they say is taken up by TV and newspapers. You do not believe in Gods and Goddesses but you give your advice on what should be done about Hinduism. How to celebrate our festivals, where to make our temple, how big should be the statue, how to reform our traditions, you know everything and you want to take all the decisions for all the Hindus. The simple people for whom Ram, Sita, Krishna and Shiva are real, their opinions are considered as inferior and unimportant. This is creating problems in our society because they are the majority but they do not have a voice and people like you are a minority but you have a big influence", he said.

My point was that if a festival like Diwali creates pollution because of crackers or if we use Plaster of Paris statues covered with chemical paints at Ganesh Chaturthi and Durga Puja and after the festivals, throw them into rivers & create pollution, then something has to be done. Why can't we find another way to celebrate these festivals without feeling that others are persecuting us? Our religions need to change with the changed reality of the world.

He said that reforms in Hinduism must come from within, they can't be imposed by others. According to him we need persons like Mahatma Gandhi, or a Guru who understand the bigger picture and who share the faith of common Hindu - they can bring a change from the grassroots.

Conclusions

The words of that Swami ji have remained with me and I have reflected on them. I can see that I have a certain intellectual way of being a Hindu, I do not really believe in temple-rituals or Gods. I like visiting temples, just like I like visiting churches, museums and art exhibitions, for an aesthetic pleasure.

There is a lot about Hinduism in India, as it is lived by millions of persons, which I don't really understand - from Kanwariyas who walk for hundreds of kilometres to collect water from Ganges for their temples, to the pilgrims who spend weeks on the road for festivals like Ambubashi or Kumbha Mela - I understand all of it in an intellectual way but I can't understand the simple faith which moves these people.

The question is how can we promote a grass-root change in them? According to the Swami, the reformist movement has to come from them, and from their gurus and other persons in whom they have faith. These can't be forced by laws. In a way I understand this point, I had written about it in relation to the Sabarimala judgement.

But I am not convinced about the role of persons like me, who believe in Hindu spirituality but do not have the simple faith in rituals and prayers, do we have any role in promoting reforms related to that way of faith in following Hinduism? What do you think? Please do share your point of view in the comments below.

(Originally written in 2019 and updated in 2023)

*****

My Spiritual Journeys

I grew up in a non-religious family. However, I have always been interested in spirituality. This post is about the meaning of spirituality for me and some of my more significant spiritual experiences.

By "spirituality" I mean the ideas about the nature of soul, consciousness and reality. For me, spiritual experiences are usually related to reading, meditating, listening to music, watching stars and being in nature. They induce in me feelings of being connected with others and with the universe, as well as, feelings of peace and joy.

The Spiritual Gurus

The Indic traditions place a lot of emphasis on the role of a Guru, a spiritual teacher. For me, my spiritual teachers are the books and my favourite spiritual readings are the Upanishads of Hinduism.

It was in 1968, when I had first met Mahesh Yogi, during the days when the Beatles were visiting him. Suddenly he had become The Guru for the world's famous. I had liked his smile and his explanations about transcendental meditation.

During the 1970s-80s, I had become very interested in reading the books of Acharya Rajneesh (Osho). 

Finally, during the early 2000s, I had visited the ashram of Sree Sree Ravishanker near Bangalore and then in 2015, I had gone to listen to him when he had visited Guwahati.

However, so far I have had no desire to follow any Guru. Perhaps, it means that I don't need a Guru, or, may be it means that I am not yet ready for a Guru.

Instead, about 40 years ago, I was fortunate to meet Don Silvio Favrin, a Catholic priest from Castel Franco V. in the north-east of Italy. He died earlier this year (April 2022). He was a friend for me, and at the same time, he was a great spiritual being - some of our conversations had a deep influence on me. He had the capacity to share the most profound ideas in simple words, often tinged with irony along with an ability to laugh at himself.

Unexpected Spiritual Interactions

Many of my memorable spiritual interactions with people have been unexpected. For example, during 2014-16, while I lived in Guwahati, I had a couple of spiritual experiences.

The Sadhu in the Forest: The first encounter was in the forest behind the Bashishtha temple, where I had come across a Sadhu, who had built his home beneath a rocky overhang. He told me about his wanderings across India. I asked him why he had chosen that particular place to set up his home and he started talking about the subtle energy that comes out of the earth and how he felt that energy in that rock.

"Put your hand in this place", he pointed to the rock, "then close your eyes and try to feel the energy." I tried but did not feel anything. So, he said that I needed to quieten my mind, then may be I will be able to feel that energy.

He was a simple person but listening to him talk about the universe and our connection with nature was a wonderful experience.

Ambubashi in Kamakhaya: Another intense spiritual experience for me was during the Ambubashi festival at the Kamakhya temple. Kamakhya is a Shaktipeeth, it celebrates the feminine principle of the nature and the Ambubashi festival celebrates the metaphysical mentruation of the mother-godess.

In a courtyard on the hill near the temple, I came across a group of Baul singers. Some of them were smoking cannabis. Others were dancing and singing Baul songs. At a certain point, a thin old man stood up, his eyes closed in an ecstatic trance, a box in the right hand and a bottle of talcum powder in the other, and he started dancing. It was one of the most amazing and emotionally touching spiritual experience that I have ever had.

The Mendicant in Orchha: I was staying with a family in a village just outside Orchha in Madhya Pradesh. A local NGO had organised my stay. One morning, I was walking towards Sundar Mahal, the dargah of a Sufi saint called Sundar Shah, when I met a poor mendicant, who was sitting on the ground.

I stopped to talk to him. He had left home due to some mistreatment by his daughter-in-law and had decided to wander around and to live on charity. We talked about his preivious life, his home and children, and his present life as a wandering mendicant. I felt very sorry about his plight that in his old age, instead of sitting and resting, he was forced to go around, ask for alms and never be sure if he will find a place to rest for the night.

"So, what do you wish for, what do you want now?", I asked him. He smiled and shook his head, "Nothing, I have found everything I need", he answered.

To remember that meeting and his words, can still make me emotional. As you can see, what I think of as "spiritual" experiences can be very different things.

The Spiritual Places & Broken Statues

I have been to a lot of pilgrimage places of different religions in different countries. I am not religious and I do not go anywhere to pray. However, I like to visit the religious places in search of spiritual experiences.

In India, I have travelled widely, from the Vivekanand rock in Kanyakumari to the Kumbh mela in Prayagraj. There have been many beautiful moments and it is always fulfilling to see the beauty in temples, mosques and churches.

Yet, when I think of my unforgettable spiritual moments, they are usually not associated with any of these places. However, I love the Hindu idea of creating statues out of mud for specific festivals and at the end, immerging those statues in the sea or a rivers. The divinity is thus an expression of nature, which goes back to nature. I love the sight of old broken statues left near the rivers.

While travelling in Assam, it was common to find statues of Durga, Kali and Saraswati left near the rivers and invariably, I used to stop to look at them.

One evening, I was walking along the Kolong river in Nagaon and I came across an old broken statue of Saraswati lit by the rays of the setting sun. For a moment, I felt as if the Goddess was speaking to me. That experience was so powerful that for about another 10 minutes or so, as I walked, it seemed as if everything was lit by an internal light.

Music and Spiritual Experiences

One of the most profound spiritual experiences which I can remember was in Mandya in Karnataka, when I was staying with some Catholic nuns in a convent. One early morning, I listened to them gently singing hymns in a small chapel. The rise and fall of their voices was like the tide of an ocean, washing over me like waves, a truly wonderful spiritual experience.

Once, I was visiting a project in West Bank in Palestine and I was staying with some friends. I usually wake up early in the morning. I remember waking up in his guest room, listening to the sound of azaan coming from different mosques. They were not synchronous, the timber of their voices were different and together it created a wonderful spiritual experience.

Another occasion when music touched me deeply was in Bologna in Italy during a dance recital. Alessandra Pizza, the Bharatnatyam teacher, was singing a Ganapati prayer accompanied by the rhythmic beating of a gong on a wooden block. We were sitting in a gallery, under a high dome so that her voice had a little echo. It was so amazing that it brought tears to my eyes.

I also love listening to the singing of Gurubani in the Sikh gurudwaras. Often the Raagi (singers) in the gurudwaras are trained classical singers and their prayers have simple and yet profound words, that I find very moving.

As an adolescent and young man, some of my musical-spiritual experiences were listening to famous classical singers like Bhimsen Joshi, Pandit Jasraj, Kumar Gandharv and Kishori Amonkar. For example, even today listening to "Ud jayega hans akela" (The swan alone will fly away) by Kumar Gandharv can touch me deep inside.

Finally, some years ago, during a music concert in Bologna (Italy), Ms. Ashwini Bhide Deshpande sang my favourite bhajan "Ganpati Vighnaharan Gajanan" on my request. The acoustics of that place were wonderful and I felt surrounded by her voice. Just thinking about that experience makes me feel a great joy.

In the End

Writing this blogpost has been a wonderful experience. I wrote it originally for my Italian blog and then decided to translate parts of that into English. When I had started writing it, I had a completely different idea in my mind. However, as I started writing, a lot of forgotten memories came up in my mind and this post has gone in an unexpected direction.

Re-reading it, I can see that it is very much linked with India and Hinduism, which is natural since I grew up surrounded by these ideas. A person growing up in another culture and other religious traditions would have other kinds of spiritual experiences.

I hope that reading it would make you think about the meaning of spirituality for you and remind you of your own spiritual experiences.

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Importance of Alternative Medicine

Over the past couple of years, ever since we have broadband internet with unlimited use, I often watch some YouTube video channels including lessons on cooking and about the use of specific software. I also like some channels on politics, health related issues, Indian classical music and dances.

One of health related channels which I often watch is Medlife Crisis by Dr Rohin Francis from UK. Recently, I came across one of his older videos, which was about "alternative medicine". In this video he had explained about the importance of evidence-based medicine and how this scientific approach ensures that we can truly understand the efficacy of treatments and make rational choices about medicines. The other aspect of his intervention was that alternative medicine lacks this evidence-based approach and thus for him it was mostly hogwash.

In his intro on this channel he also says that "There's a lot of bad science on YouTube, especially medicine, with quacks and clowns peddling garbage", which probably also refers to alternative medicine, apart from other conspiracy theorists and No-Vax groups. The image below shows a person receiving a traditional treatment in Mongolia.

In another tiny video titled "How does Homeopathy work?", he has a short no-nonsense answer to this question - "It doesn't".

Rohin Francis is not the only one who speaks out against wasting money on alternative medicine. Some of my other doctor friends have been very active against quacks and untrained persons masquerading as doctors in India. Some doctors on Twitter regularly rant against homeopathy and alternative medicine practitioners.

I understand from where all these persons are coming from. However, I do not agree with them that alternative medicine is all about non-evidence based quackery. In this post I want to share some personal experiences and some opinions regarding the role of alternative medicine in today's world.

Disclaimer: Quacks & Clowns Peddling Garbage

I know that there are persons who claim to have miracle-powers and who can cure all kinds of conditions. They prey on people when they are most vulnerable and psychologically fragile and they do it to earn money and gain power. Some of these frauds may be mentally ill and may actually believe in their supernatural powers. This post is not about justifying any of them. They do need care and treatment for their delusions and if needed, deserve law-suits and prisons.

I also do not wish to say that alternative medicine can cure everything such as conditions like high blood pressure or diabetes or cancer. People who give up their blood pressure or diabetes medicines because of their beliefs in alternative medicine, often end up with irreversible body damage to their vital organs like kidneys or eyes. Conventional (western) medicine is a better choice for most such persons.

Origins of Alternative Medicine

For thousands of years, ancient humans have tried looking for treatments for common health conditions. They did it mainly by looking for plant-based treatments. The plant-based medicines they identified, did not have the backing of double-blind studies on random samples of carefully chosen groups, but to call those "non-evidence based" would be a bit of stretch. Many of our common modern medicines from Aspirin to Quinine and Artemisia come from those traditional experiences. Guys looking for the next blockbuster drugs have often stolen the knowledge of plants and herbs from traditional healers. Scientists carry out experiments with synthetic derivatives based on those same plants and herbs and then do scientific trials to show their effectiveness. Many of them call as quacks the traditional healers in villages who are using those same herbs, simply because they base their knowledge on the oral transmission of experiences and tradional learning.

In countries like India, China and Mongolia, people practicing traditional medicine, study in their medical collages just like students studying modern medicine. For example, in Ayurvedic medical collages in India (I have visited 2 of them), students study for their medical degree for 6 years and their curriculum includes all the subjects such as anatomy, physiology, pathology and pharmacology, taught in conventional medical colleges.

However, a part of their studies is based on beliefs which modern science does not accept. For example - the Chinese beliefs about meridians running through the body with the energy points and the balancing of Yin and Yang forces; or the Indian beliefs about the three body humours (vayu, kaffa and pitta); or the homeopathy belief about using "like to counter like" and the power of dilutions of medicines. These beliefs do not fit with the understanding of modern science, because they do not follow the logical-thinking paradigm but follow some other esoteric or intuitive paradigms.

Shaping of Our Beliefs - Personal Experiences

Our beliefs are predominantly shaped by our own life experiences. Scientists say that our experiences are anecdotal evidence and are unreliable and usually biased. So we should only believe in what scientists and experts tell us. However, from personal experience I know that if I have experienced something, I may accept scientific opinions but I will also find a way to keep my own opinion based on my experience, even when the two are contradictory. This seems to be a common human trait.

Let me share a few experiences regarding alternative medicine, which have shaped my ideas on this theme.

My first experience with alternative medicine was with homeopathy in 1980s, when I was a community doctor. I had developed a strong pain in my left shoulder and had difficulty in lifting that arm. For many days I had taken anti-inflammatory and pain-killer medicines. In those days my paternal aunt had high blood pressure and I often visited her house for her check-ups. My aunt's husband, my uncle, had retired and taken up homeopathy as a hobby. He gave free homeopathic medicine to anyone who came to him. During one visit, after checking my aunt's blood pressure, I told my uncle about my shoulder pain and that I was tired of taking pain-killers as they were giving me gastric problems. He asked me numerous questions about the pain and then gave me a small dose of small sweet-tasting pills. He also wrapped in an old newspaper, two more doses of those pills and told me to take them after some hours. In less than 15 minutes after the first dose, my shoulder pain had disappeared and I had no difficulty in raising my arm. It was like a miracle and it changed completely how I felt about homeopathy.

My second experience of alternative medicine was more recent. In 2015, while living in Guwahati in India, I developed a severe knee pain. It became so bad that it curtailed my walking. I stopped going out for walks and took frequent anti-inflammatory and pain-killing tablets. In 2016, back in Italy, I went to an orthopaedic specialist for a few visits. A scan of my knees showed myxoid degeneration of Cruciate ligaments. I was given Hyaluronic acid injections in my knees, wore knee supports and took pain-killers. But nothing seemed to help me. After a few visits, the orthopaedic specialist told me that I had to learn to live with the pain as I was too young for knee replacement surgery. I was also told to reduce weight and do physiotherapy. I shared my scan results with an orthopaedist friend in USA and even his opinion was the same. Talking about it with a Catholic priest, who had become my friend in Guwahati, he suggested that I should try Ayruvedic treatment in a hospital in Kerala.

In January 2017, I went to the Ayurvedic hospital suggested by my friend for a one week of treatment. The treatment consisted of daily massages with oils containing different herbs. After a week's treatment, I was advised to rest for a few days. After that one week of treatment, my knees improved greatly and I could again walk without pain. I went back to that hospital for a week in 2018 and 2019. However, in 2020 and 2021, because of Covid-19, I have not been able to go there and lately, I have again started to have some knee-pain after walking for a few kilometres, though the situation is yet not as bad as it was in 2015. I am hoping to go back for this treatment later in 2022. The image below from 2019 shows Dr Vijayan, the chief Ayurvedic doctor of this hospital, together with his 3 students from the Ayurvedic Medical College who were doing internship with him.

A couple of years ago, I had talked to an orthopaedist friend to explain what had happened, to try to understand why I had responded to the Ayurvedic treatment. His answer was that it was possibly a placebo effect. According to him, another possibility was that the effect of medicines taken in Italy had arrived after a few months.

Perhaps it was indeed a placebo effect, but I would like to know why I didn't have this placebo effect after treatment in Italy and after the injections in my knees? Are traditional treatments likely to induce more placebo effects? If yes, why?

Finally, a friend from Mongolia told me about her experience with traditional Mongolian traditional medicine. We are working together for a project and communicate frequently. Last week she told me that her mother was very unwell due to Biliary colic caused by stones in her gall-bladder. Her mother is quite old and she was in a great deal of pain. However my friend was hesitating to take her to hospital due to Covid-19 fears, so she was visited at home by a doctor and was given pain-killers. He had suggested that if the pain would not pass, they might need to do surgery for removing the gall stones. After 3 days of injections, her conditions had continued to be serious, so the family invited a traditional healer to visit her. The traditional doctor visited her and wrote some herbal medicines. Due to Covid-19 restrictions, it was not easy to buy the traditional medicines but somehow they managed. That night, after taking the herbal medicine her mother slept well after many days of pain. The morning after, it was the day of Lunar new year, she woke up completely pain free - she got up from bed as if she had not been seriously ill till the previous evening. My friend who had been so worried was overjoyed. She said that it was like a miracle. Once again, I am sure that if we ask, most doctors in the hospital will explain it as placebo effect or some kind of psychological effect.

These are all anecdotal stories without any scientific value, they do not prove anything. But if any of these had happened to you, will you be able to forget them? Such experiences illustrate why so many persons, especially in traditional and rural societies, continue to go to traditional healers even when experts tell us that there is no proof regarding their usefulness.

For persons like me, strongly anchored in the Western Medical Paradigm, alternative medicine may not be the first line of treatment for any problem, but I will seek it if modern medicine are not able to resolve my health condition.

A Role for Traditional Medicine

Even for persons who feel that alternative medicine is not effective or is illogical, I feel that in today's world there are some functions for which it can be very suitable. For example, think of illnesses like flu and viral fevers. Doctors say that these should be given only some symptomatic treatment and not treated with antibiotics because they are not useful. Still a large number of people take antibiotics for such conditions. I think that taking alternative medicines for such illnesses is a good strategy to discourage the antibiotic abuse.

There are so many chronic non-infective conditions accompanied by pain, like the ones I had in my knees or in my shoulder, where long-term treatment with conventional medicines can have many side-effects. So if persons can feel better with alternative medicines, why not encourage them to try?

When modern medicines can do little because we have not found treatments for some conditions, I feel that people should be given the option of trying alternative medicines. The image below shows a modern pharmacy plant for making Ayurvedic medicines based on herbs and oils in India.

I know the situation in India - alternative medicine is usually cheaper and is much more accessible to persons. Unless it is a life-threatening condition, often alternative medicine can provide psychological support and even serve as placebo and reduce suffering. In many villages, traditional medicine is all they have because modern medicine is costlier and located far away.

I feel that demonising alternative medicine as fraud and quackery and to think of people preferring it as gullible or stupid, is not the right approach towards it.

(An earlier version of this post was first published on my blog in 2021)

Bonsai & the Life in the Plants

Last month I visited a Bonsai exhibition at the Jaquard gardens of Schio. The sight of tiny plants looking like a miniature version of full-grown trees reminded me of a nature-visit in Bologna some years ago. This post is about two different ways of thinking about the life-forces in the plants. At the same time, it is also a reflection about the relationship between humans and nature.

Indian Ideas About Nature

Let me start briefly with some of my ideas about nature, which are influenced by my growing up in India. Hinduism is full of Gods and Goddesses, each of whom is linked with an animal and a plant species. There are many mythological stories that teach one to respect all the beings as a part of the respect for the sacred.

There are different stories linked with plants in the Hindu mythology. Like the story of the sacred Tulsi plant (Indian Basil), which represents a pious prostitute. Thus, people believe that this plant should not be kept inside the house, but must be planted in the courtyard where the families can pray to it at dawn and sunset by lighting a lamp near it. The 1960's Hindi film Parakh had one of my all time favourite songs, Mere Man ke diye (The lamp of my heart), in which Sadhana lights a lamp and prays to Tulsi plant. According to Ayurveda, Tulsi is an important medicinal plant. Such myths and sacred stories, are ways to remind the communities about the importance of different species of plants and animals, and to safeguard the biodiversity.

I remember my grand-mother once telling me to not to pluck the leaves of a plant at night because "the plant was sleeping". I think that such a way of thinking illustrates the popular understandings of life in the plants among Indians. While in the cities, people have a more transactional ideas about nature (for example, that it is good for breathing and well-being, it is relaxing and stress-busting), in the smaller towns and villages of India, I feel that there is still a lot of respect and traditional knowledge about these ancient understandings of nature.

Bonsai Plants

Literally the term Bonsai means "planted in a vase". The aim of growing a Bonsai is to create a realistic representation of nature through a miniature tree.

An exhibition of Bonsai plants was held at the beautiful 19th century Jaquard garden in the centre of Schio. It is a small garden but is very beautiful, with an old theatre and a green-house. The exhibition presented the plants grown by the Bonsai students of Schio under their teacher Dr. Ennio Santacatterina.

I spoke to Ennio to understand about Bonsai. He explained that he had discovered his passion for Bonsai after his retirement. His school is a part of the Bonsai Art School and its classes are held in a local plant shop called Garden Schio.

Ennio sees Bonsai as a part of the Zen traditions from Japan, in which it is fundamental to understand kamae, the basic and essential nature and characteristics of each plant. He cites the Bonsai guru Aba Kurakichi and says, "We must conserve all the specificities of the nature of each plant because Bonsai is a life-art." This means that each plant will develop according to its own characteristics and the Bonsai-maker must know how to enhance its individuality and highlight its beauty by selecting the appropriate style, branches and spaces.

I think that it means that a Bonsai is not created but rather it is nurtured, grown and gently guided. It is an exercise in mindfulness, in which the Bonsai-maker searches for a connection with the plant through silence and meditation, to understand its nature and develops a vision of how it should grow. Then, with patience and mindfulness, the maker helps the plant to achieve that vision.

Free-Growing Nature

While Bonsai speaks the language of Zen, meditation and mindfulness for creating a connection with plants, it seems as if the plant is moulded into an idealised vision of how it should look. It reminded me of another encounter about plants - in 2011, I had an opportunity to meet Mr. Marco Colombari, a gardener and plant-lover from Bologna, who had some very radical ideas about the plants.

Marco had guided us in the discovery of a forest, talking to us about how to observe and "see" the plants. A century ago, this forest was an "aviculture centre", an area for developing and growing different species of birds. Then it had become a hunting laboratory and a honeybee cultivation centre. In the 1980s, surrounded by multi-story apartment buildings, this area was supposed to be used for building more condominiums. However, the local residents had started a campaign to save it as a natural area. It is now managed by an association called Oasi dei Saperi (The Knowledge Oasis), which promotes it as a site for the conservation of biodiversity. It is known as the Forest of St. Anna and is located in the Corticella area of Bologna.

Marco's point was that every plant is a living being and has its own characteristics. He felt that people decide about planting trees and plants without really thinking about those natural characteristics. Thus, every time we cut the branches of a tree for making it fit into our urban landscaping, it is like closing an animal or a bird inside a cage. In the forest, he had shown us parts of the trees where the branches had been cut, making us look at the seeping liquids from the cut surfaces and drawing parallels with injured animals.

Besides the natural forest, St. Anna Forest also has some other areas including a botanical garden for growing medicinal herbs, a small pond which was used in the past for jute production and a group of ash trees with old artificial nests which were used for keeping birds when it was an aviculture centre.

Some Reflections

Listening to Marco had a very strong impact on me. Reflecting on his words and coupled with the philosophy in the Indian sacred books of Upanishads, I feel that it is the same life-force flowing inside the trees and plants which flows in every living being.

How do I reconcile this understanding with our daily business of living? There is a proverb in Hindi which says "If the horse becomes the friend of the grass, what would it eat?" I think that this proverb sums up the basic dilemma of our life - the impossibility of avoiding violence, if we wish to live.

Thus, I think that all life in the world is inter-connected and there is no way we can avoid eating other life forms, till the time comes for us to die when we return back to the earth, turn into our basic elements and become a part of the never-ending cycle of life, death and decay. To me it means respecting nature and all forms of life, which I translate as avoiding giving unnecessary suffering to my fellow creatures. Thus, I feel that individuals can decide if they wish to eat meat or they prefer to be vegetarian or vegan - it is a matter of choice linked with personal convictions.

However, I think that keeping animals to be used for their meat (chicken, ducks, sheep and cows) in narrow spaces, which do not allow them to move, and making them eat food laced with hormones and antibiotics so that they can fatten quickly, or hurting them unnecessarily, are wrong.

It means being kind to the animals and birds that we keep as pets. It means, taking care of the nature so that our biodiversity is maintained and strengthened. It means that if we have a zoo or a circus, we shall ensure dignified spaces for keeping the animals and treat them with care. I think that zoos and wild-life parks can play an important role in saving species close to extinction and in teaching young people about the importance of safeguarding nature and biodiversity.

Some people would completely separate humans from other animals because they see all human-animal interactions as basically evil and unwelcome for the animals. They are against keeping pet animals, they don't like zoos, they do not want any experiments involving animals - I feel that it is an extreme view and does not help the animals or the nature.

I hope that science and technology would soon progress so that one day we can have all kinds of food, including meat and fish, grown in cell-cultures. In the meantime, I would like more humane conditions for the animals we keep for meat.

Conclusions

Coming back to the plants, does making the plants grow as miniaturised Bonsai trees means that the plants are being forced into unnecessary suffering? Probably Marco Colombari would say yes. I don't think so. I feel that Bonsai practice, by helping us to seek a connection with the plants through mindfulness and meditation, is another path to recognising the importance of nature.

The evolution has made different life-forms co-dependent on each other. We have biomes inside each of us, made of billions of bacteria and viruses - every time we are ill and take medicines, we are killing millions of them. Life, death and decay are a part of a never-ending cycle going around us all the time and there is no way we can say that we don't want to be a part of this cycle.

This reflection about the life in the plants, makes me think of Shiva, the Hindu God who controls the never-ending cycles of creation and destruction in the universe. I think that Shiva is a metaphor of the life and death which connects together all the organic and inorganic matter of the universe. It is the life-force moving the particles composing the atoms, which combine to make the molecules of different elements, the building-bricks of everything in the universe. Life and death are illusions, because those atoms and the forces moving their particles, they do not die and will continue to combine and create new forms all the time.

***

Merry Christmas Or Seasons' Greetings?

A few days ago, one morning I read two articles which made me reflect on the two different ways in which multi-cultural and multi-religious societies can look at inter-faith dialogue, respect and harmony.

In this post, I am going to talk about these 2 different ways of looking at religious differences and what we need to do for living with a diversity of beliefs.
The Two Articles

Let me start with the 2 articles which had stimulated this reflection. The first was an article in a recent issue of Readers' Digest magazine. Actually it was not an article but a snippet under the heading "Your True Stories". I am transcribing that snippet here:

Last December, a young lady ringing up my purchases greeted me with an enthusiastic Merry Christmas!” I was not offended, but I am a Muslim, and at the time I was wearing a beautiful headscarf in a manner identifying my spiritual convictions. I responded, “Happy birthday!” At first, she was taken aback, but then she nodded and laughed good-naturedly, acknowledging my point. I smiled back at her and said, “Merry Christmas to you.”

The second was an editorial in the Indian newspaper Hindustan Times, written by Mr. Rajmohan Gandhi, the grandson of Mahatma Gandhi, under the title "In Memory of Frontier Gandhi, a Plea for Justice for Faisal Khan". It mentioned the story of Khan Abdul Gaffar from Peshawar, now in Pakistan, and his organisation called Khudai Khidmatgar, which worked for promoting Hindu and Muslim unity. Khan Abdul Gaffar was also known as Frontier Gandhi and I have memories of meeting him as a child in Delhi in early 1960s at the home of Dr. Ram Manohar Lohia, the charismatic leader of the India's Socialist Party. This article is about a person from Delhi, Mr. Faisal Khan, who has an organisation in India inspired from the ideals of Frontier Gandhi. It described Faisal with the following words:

Faisal Khan has striven without pause for two goals — communal harmony and relief for the neediest. He is also a wonderful singer of the Tulsi Ramayan. Hindus of all types, from venerated guru to college students, have been charmed by his rendering of the Ramayan’s verses. Keen, as part of his efforts towards harmony, to identify with the traditions of his Hindu friends, Khan, along with associates, recently performed the much-valued Braj Parikrama. On the last day of this 84-km yatra, they went to Mathura’s Nand Baba Mandir, where they were courteously received by the priest.
Reading these 2 articles, made me reflect about the two approaches to inter-faith harmony.

Multicultural Approach to Inter-faith Harmony

I think that first article represents the multi-cultural approach to inter-faith harmony, which arose in UK or perhaps in Western Europe. Now this approach seems to be common in the West (Europe, USA and Australia). It is slowly making inroads even in countries like India, at least among some academic and activist groups. It asks individuals to respect the diversity of religions of others, by not offending them by involving them in things related to other religions. Thus, if we are Christians, it says that we should not have overt signs celebrating Christmas or Easter in public spaces and schools. If we have to greet people we do not know, we should use generic terms like "seasons' greetings" and to not "merry Christmas", for not offending non-Christians. People who believe in this approach, talk of tolerance and respect for other religions.

If we believe in this approach to inter-religious relations for harmony, then if we are Muslims, we won't make Eid or Ramazan greetings to the non-Muslims and if we are Hindus, we would greet only other Hindus on our festivals.

Indian Approach to Inter-faith Harmony

When I grew up in India, our approach to diversity of religions was different. While in school, we had holidays for the festivals of all the religions. Since early childhood, I was used to meeting persons of different religions among neighbours, friends and in public spaces.

Over the years, we lived in different houses, where we had as neighbours families of different religions. Even at home, among the socialist friends of my father who visited us included persons of different religions. During our travels, I had stayed at the homes of family friends of different religions.

When I think of those years, it is remarkable that I can't remember ever thinking about the diversity of religions of all those encounters in India. I had been familiar with news of riots and religious riots, but somehow they had no real bearing with my relationships with persons of different religions. My first actual encounter with the underlining of and impact of diversity of religions happened in Italy, when a high school student asked me if I believed in Madonna. I had told him that I was a Hindu. He did not know any Hindu but he knew about protestants and that question was his way of reassuring himself that I did not deny the sacredness of Madonna. When I told him that I respected Madonna, he was reassured.

The basic understanding governing the multi-religious relationships in the India of my childhood was that all religions are about the one and the same God. Therefore, festivals of all the religions belonged to everyone. Having school holidays for all those festivals reinforced that feeling. So it meant, waking up at early morning to go out and stand on the side of the street to wait for Prabhat Pheri of the Sikh when they celebrated their Gurupurab. It meant wishing everyone Eid Mubarak and eating the sweet sewaiyan, that our neighbour Irene brought to our home. It meant going with my Catholic friend to the midnight mass in the Cathedral on the Christmas eve. It meant going into Buddhist temple to pray to Buddha. And, it meant, saying Happy Diwali to everyone and offering them sweets to celebrate the Hindu festivals.

In that India of my childhood, the idea of "tolerance" in reference to other religions, would have been kind of insulting, because we were expected to share the joy and sacredness of each religion and not just "tolerate" them

Which Approach Do You Prefer?

I think that with some exceptions, increasingly the modern world is going towards less orthodox religious beliefs. A large number of my friends and members of my extended family in India, do pray in temples and homes, but they are equally respectful of other religions. There are four inter-religious couples among my cousins' families. My own family is also inter-religious. With time, I expect that religious diversity in our family is only going to increase. This means that we shall have more occasions for celebrating festivals and also picking and choosing some aspects of ideas and practices of other religions in our daily lives. This seems to be in line with the ideas of inter-religious harmony with which I had grown up in India.

It is true however, that even in India, I feel that compared to my childhood, today many groups of persons are more polarised in terms of religions. Though a lot of persons continue to value respecting and sharing among persons of different religions, those with polarised thinking speak louder and dominate many forums. Fortunately, India continues to have a lot of mixed religious spaces formed by inter-mixing of persons of different religions.

I think that the ideas of multi-culturalism approach to inter-religious relations in Europe and America, which are focused on "not offending those of other religions", are a result of increased encounters after the second world war and due to a globalised world, between the more secularised and less religious populations in the West with more conservative minorities, often immigrants, who feel that they need to hold on to their specific identities, for not getting lost in their new lands. Thus, I feel that it is an expression of cultural anxiety.

In many ways, these inter-cultural encounters are also shaped by identity politics and ways of reading all relationships in terms of dominance and oppression. Perhaps historians can tell us from the experiences of the past, how such encounters between people of different cultures can evolve and resolve?

Which of these two approaches to inter-religious harmony do you prefer?

Conclusions

From the way I talk about the Indian way of looking at the diversity of religions, it must be obvious that I prefer this approach to inter-faith harmony. At the same time, after my travels across different countries and encounters with a diversity of religions and cultures, I must acknowledge that many persons feel threatened or at least uncomfortable if they have to accept close contact with other religions. I try to respect their diffidence, though I must confess that I can't really understand their anxieties.

I also try that I continue to deal with persons of different religions in my way. I go rarely to the mass in a church, but when I do, I am happy to bow my head and pray. I am not very religious, and while visiting temples, churches, gurudwaras and sufi dargahs, I try to feel the sacredness of their ambience and prayers. I also wish Eid Mubarak or Merry Christmas or Happy Deewali or Happy Navroz, to all my friends at the festival times without worrying if they are Hindu, Muslim, Jew, Christian or Sikh. However, if I know that a person does not appreciate receiving greetings for festivals of other religions, I try to be respectful of their choice.

I know that we live in polarised times. For whatever reasons, some people have become more aware of religious differences and at least some of them, do not wish to celebrate the festivals of others or to visit the others' prayer places. At the same time, I often find many persons who think about different religions like me, they are happy to listen to religious ideas of others and do not get offended by religious differences.

Personally, while each one of us is secure in his or her own religion, I would prefer a world of acceptance, respect and joy towards all religions. I know that it is an utopia, but I like utopias.

A final note about Mr. Faisal Khan mentioned above: I have read that Mr. Khan was arrested on 2nd November 2020 for offering namaz in the courtyard of a Hindu temple in India, though it was the temple priest who had suggested to Mr. Khan to pray there. I think that a Muslim singing Ramcharit Manas and praying in a Hindu temple can happen only in India because of this approach to inter-religious harmony that I am talking about. It is an embodiment of the Indic thinking which sees different religions as paths to the same God.

I hope and pray that better sense will prevail and Mr. Faisal Khan can be released.

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From Butchers to Surgeons

Recently I read Dr. Lindsey Fitzharris' 2017 book called "The Butchering Art". It is not a book for the faint-hearted. In this book, she describes the way surgery was done in England till late 19th century and how two discoveries - anaesthesia and antisepsis, revolutionised it. Before those discoveries, surgery was the domain of butchers.

Reading this book raised a question in my mind about surgery in ancient India. More than two thousand years ago, ancient Ayurvedic surgeons were doing different surgeries including full-thickness skin grafts and plastic surgery operations such as rhinoplasty. I have already written a blog post about it. The question in my mind was, how did ancient Indian surgeons resolve the problems of anaesthesia and prevention of bacterial infections during their surgery?

This post is about the Fitzharris' book, as well as, about ideas of anaesthesia and asepsis from the ancient Indian text of Sushrut Samhita.

The Butchering Art

Fitzharris has a vivid way of writing. She brings alive the old and forgotten world of surgery, before the discovery of anaesthesia. Her writing is so graphic, that at times it made me feel a bit queasy. Her book starts on a December day of 1846 and describes one of the first surgeries done under the effect of Ether anaesthesia at the London University College hospital. The surgeon was Robert Liston and on that day, as usual the operation room was full of spectators, who had paid a ticket to watch the show.

It was a time when surgery was reserved for desperate and life-saving situations. Surgeons operated on conscious persons, who had to be held on their place by a group of strongmen. The lucky ones lost consciousness and were thus spared the pain of their bodies being opened and their bones being sawed off. The most important quality of surgeons was their speed in finishing the operation.

In the middle of the room was a wooden table stained with the telltale signs of past butcheries. Underneath it, the floor was strewn with sawdust to soak up the blood that would shortly issue from the severed limb. On most days, the screams of those struggling under the knife mingled discordantly with everyday noises drifting in from the street below: children laughing, people chatting, carriages rumbling by. ...At six feet two, Liston was eight inches taller than the average British male. He had built his reputation on brute force and speed at a time when both were crucial to the survival of the patient. Those who came to witness an operation might miss it if they looked away even for a moment. It was said of Liston by his colleagues that when he amputated, “the gleam of his knife was followed so instantaneously by the sound of sawing as to make the two actions appear almost simultaneous.” His left arm was reportedly so strong that he could use it as a tourniquet, while he wielded the knife in his right hand. This was a feat that required immense strength and dexterity, given that patients often struggled against the fear and agony of the surgeon’s assault. Liston could remove a leg in less than thirty seconds, and in order to keep both hands free, he often clasped the bloody knife between his teeth while working.

It was also the time when people had no understanding about bacteria and infections. If the patients did not get the infection from the dirty hands, blood-soaked aprons and instruments of the surgeons working in crowded halls where people were sneezing, coughing and talking, they got it from others who were admitted in the crowded hospitals. Mortality due to post-operative infections was very high.

In the 1840s, operative surgery was a filthy business fraught with hidden dangers. It was to be avoided at all costs. Due to the risks, many surgeons refused to operate altogether, choosing instead to limit their scope to the treatment of external ailments like skin conditions and superficial wounds. ... The surgeon, wearing a blood-encrusted apron, rarely washed his hands or his instruments and carried with him into the theatre the unmistakable smell of rotting flesh, which those in the profession cheerfully referred to as “good old hospital stink.” ...At a time when surgeons believed pus was a natural part of the healing process rather than a sinister sign of sepsis, most deaths were due to postoperative infections. Operating theatres were gateways to death. It was safer to have an operation at home than in a hospital, where mortality rates were three to five times higher than they were in domestic settings.

The book starts with discovery of anaesthesia and then quickly moves to its main subject - the ideas of antisepsis and their impact. It tells the story of Joseph Lister and his ideas about prevention of infections during surgery. During 1850s, Louis Pasteur in Paris had come up with the theory of invisible germs which were responsible for souring milk and fermenting grape-juice for making wine. In 1862 he boiled milk, which prevented souring of milk and proved his theory. Lister, who was passionate about microscopes, heard about Pasteur's work and felt that similar microscopic germs were responsible for causing infections in patients during surgery. In 1865 he developed his antiseptic solution based on carbolic acid, and showed that it was possible to reduce the post-operative mortality due to infections.

The book starts with discovery of anaesthesia and then quickly moves to its main subject - the ideas  of antisepsis and their impact. It tells the story of Joseph Lister and his ideas about prevention of infections during surgery. During 1850s, Louis Pasteur in Paris had come up with the theory of invisible germs which were responsible for souring milk and fermenting grape-juice for making wine. In 1862 he boiled milk, which prevented souring of milk and proved his theory. Lister, who was passionate about microscopes, heard about Pasteur's work and felt that similar microscopic germs were responsible for causing infections in patients during surgery. In 1865 he developed his antiseptic solution based on carbolic acid, and showed that it was possible to reduce the post-operative mortality due to infections.

The book is a fascinating read. Even if Lister proved the importance of antisepsis in preventing infections, for a long time, surgeons were sceptical about his ideas. Lister was helped by others who helped in spreading his ideas. He had inspired the maker of Listerine , which is now known as a mouth-wash but was initially developed as a disinfectant in operation theatres and used for cleaning wounds. He had also inspired Robert Wood Johnson , who had started Johnson & Johnson company to make sterilised dressings and sutures. It was not until 1877, when Armour Hansen saw the leprosy bacillus under a microscope, identified it as the cause of leprosy and firmly established the germs theory of infections.

Surgery in Ancient India

Sushruta is considered as the father of shalya-chikitsa (surgery) in Ayurveda. Various modern text books on surgery and plastic- surgery acknowledge that some of the techniques described in his treatise "Sushruta Samhita", such as that of full-thickness skin graft and rhinoplasty, have inspired them and are still used. When I read the Fitzharris' book, I wondered how did the ancient Indians develop those surgical skills without modern anaesthesia and antisepsis? To make a full-thickness skin graft or to do rhinoplasty, the surgeons need patients who are calm and can lie still for some time. It was not a work that a person with brute force could do by cutting away a part of the body while others held the patient. Such delicate surgeries would have been wasted if there were post-operative infections. So how did ancient Indian surgeons such as Sushruta do those surgeries?

I searched on internet and found an English translation of the first volume of Sushruta Samhita - it was translated from Sanskrit by an Ayurvedic doctor called Kaviraj Kunjalal Bhishagratna in 1907. In the introduction to the volume, he explained that this was not the original text of Samhita written by Sushruta, rather it was a commented version written by a person called Nagarjuna and was probably written around 3rd or 4th century BCE.

I found some answers regarding the questions of anaesthesia and use of anti-sepsis in surgery in the introduction of this text:

Verses about medicine, hygiene and surgery lie scattered through out the four Vedas. ... There were 5 groups [of healers] - Rogaharas (physicians), Shalyaharas (surgeons), Vishaharas (poison curers), Krityaharas (demon doctors) and Bhisag-Atharvans (magic doctors). (p. 13)[Sushruta] first classified all surgical operations into different kinds ... Aharya (extraction of solid bodies), Bhedya (excising), Chhedya (incising), Eshya (probing), Sivya (suturing), Vedhya (punturing), and Visravanya (evacuating liquids). ... Sushruta enjoins the sick room to be fumigated with the vapours of white mustard, bdellium, nimva leaves and resinous gums of Shala trees, which foreshadows the antiseptic (bacilli) theory of modern times. (p. 16)Amputations were freely made and medicated wines were given to patients as anaesthetics. ... In those old days, perhaps there were no hospitals to huddle patients together in the same room and thereby to create artificially septicemic poisons which are now so common and so fatal in the lying-in rooms. A newly built lying-in room in an open space filled with the rays of the sun and the heat of burning fire, and for each individual case the recommendation of a fresh bamboo chip for the section of the [umblical] cord are suggestions the value of which, the west has yet to learn from the east. (p. 19-20)

This brief description shows that in many ways, Ayurvedic surgeons had found solutions to the problems of sepsis and anaesthesia, which had plagued the surgeons in the UK till 19th century. Use of fumigation, sun light, keeping persons separated, using a new and clean cutting instrument, are all ideas that are known to promote antisepsis. Use of medicated wines for anaesthesia needs to be understood better to see which kind of medications were used. My knowledge of Sanskrit is limited but probably there would be more detailed information in the texts of Sushruta Samhita, which can give us more precise answers.

Those understandings of ancient healers like Sushruta were probably based on centuries of observations and experiments, though they had no real understanding of different kinds of bacteria and infectious agents as there were no microscopes to directly observe the micro-organisms. As the quote about different kinds of healers shows, the world of ancient healers was also a world of magic and demons, and thus it is likely that many of the old ideas would be expressed in "unscientific" terms.

Challenges of Understanding Ancient Wisdom

I think that at least some of such ancient understandings were common heritage of humanity and not just limited to India. In large parts of the world such ancient knowledge has been lost because many of the old traditions, along with old gods and their myths were discarded, before they could be codified, written down and preserved for posterity. It is easy to discredit ancient experiential knowledge because it is expressed in unscientific terms and is associated with old myths and ideas of supernatural. In India, in spite of invasions and mixing of cultures, fortunately there has been a civilisational continuity and thus the traditional knowledge in the old texts has been kept alive, and even today Ayurveda is a living tradition, followed by millions of persons.

Unfortunately, there is a tendency in India to diminish the importance of Ayurveda and its knowledge, as explained so eloquently in a recent article by Madhulika Banerjee, where she has written:

... my research has shown me several other worlds of Ayurveda — the world of the practising Ayurvedic doctor, the teachers in the scores of colleges and universities of Ayurveda and researchers in different institutes. These worlds are much bigger and deeper, beyond that of Patanjali, Dabur and Himalaya. That world is vibrant, has integrity and it is important that it be known, respected and valued. ... Under the influence of colonialism, we tethered the language, the institutions and the systems of Ayurvedic knowledge production to the margins of our learning and education. We closed many doors and windows of scientific practices within and around traditional medical systems. But in a trick of inversion, we say they do not follow the language and methodology of science.Despite Ayurvedic knowledge being rooted in a different philosophy, teachers have found ways of keeping up the process of adapting learning from the texts to contemporary education, fitting into modern classifications of anatomy, physiology and higher specialisations at a deeper level. They have both adapted to and adopted new knowledge, widening their horizons unhesitatingly, true to their tradition. Yet they have to face unhappy students, struggling with low self-esteem, under immense pressure to compromise their knowledge.... When two knowledge traditions have two completely different perspectives on body and disease, then why compete on the medicine and cure? And when parameters of treatment and expected outcomes are of different kinds, then how can the protocols of biomedicine be used for evaluating Ayurvedic medicines? Why can Ayurvedic manufacturing not focus on creating a different world of diagnosis, treatment and cure in keeping with its perspective, expanding the range of choices patients have?
I feel that the last part of Banerjee's quote above is fundamental - the value of the knowledge in Ayurveda can not be and should not be limited to evaluations by "scientists", it also needs to be understood and judged according to its own perspectives. For example, words like dosha, pitta, kapha and vayu, which are fundamental to ideas of Ayurveda, represent complex ideas that can not be translated into illness, bile, mucous and air and then laughed at, because they do not fit our understandings as modern doctors.

As explained in my blog-post on Ganesha story and ancient Ayurvedic techniques of plastic surgery operations on the nose (rhinoplasty), these were copied by British surgeons from India fairly recently (during the last part of 18th century). Yet, that does not stop "modern" doctors from calling Ayurveda as "alternative" medicine or worse, implying that these are inferior knowledge systems, if not outright quackery.

Conclusions

Linda Fitzharris' book on the old surgical art of butchering provides a glimpse into that time when getting a tooth extraction or having an abscess incised could lead to sepsis and death. It was also a time of unimaginable pain as persons were immobilised while the surgeons amputated their limbs or did similar operations. Discovery of anaesthetics and an understanding of spread of infections has led to the world today, where we have advances like laproscopic surgery, laser surgery and robots which can do delicate operations.

Forty years ago, when I had studied medicine, I had learned how to use ether anaesthesia for work in rural hospitals which did not have access to a Boyle's machine for anaesthesia. It was still the same technology which Fitzharris has described in her book as taking place in 1846. I don't know if anywhere anyone still uses that primitive approach to anaesthesia! So in way, I could directly identify with that world and feel the horrors of having brutal surgeries without anaesthesia.

It was also enlightening to read the book about Sushruta's techniques of surgery more than 2,500 years ago and appreciate how he and other ancient healers in India had developed an understanding about both anaesthesia and asepsis and were able to conduct and develop complex surgical techniques and to find that some of these techniques were copied in the west fairly recently (in 18th century).

I don't think that Ayurveda and ancient texts like Sushruta Samhita would all make sense according to the modern scientific understandings. They are texts of their times and they would have their parts of myths, stories and fantasies, interspersed with real experiential knowledge. As my brief exposition above shows, they did develop understandings which the modern medicine has developed only relatively recently. They do merit respectful analysis, even when we can't understand their meanings.

End-Note: The images used with this post are from the old anatomy theatre of Bologna in Italy and from an Ayurvedic college in Kerala, India.

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