From classic texts to learned practice: Methodological remarks on the study of Indian medicine

$oc. Sci. & Med.. Vol. 12. pp. 97 to 103.

0037-7856/7~/PA01-0(~7502.00/0

© Pergamon Press Ltd. 1978. Printed in Great Britain.

FROM CLASSIC TEXTS TO LEARNED PRACTICE: METHODOLOGICAL REMARKS ON THE STUDY OF INDIAN MEDICINE FRANCIS ZIMMERMANN

Ecole des Hautes Etudes en Sciences Sociales, Paris Abstract--Assumptions about the continuity of medical traditions and the existence of medical systems are based upon ready-made realities. An alternative approach, exemplified in the works of Bachelard, Canguilhem, Foucault and others, focuses on historical discontinuities and the epistemological interpretation of texts to reveal processes of change in cultural paradigms. By decomposing traditions the stratification of levels of language can be examined. I illustrate this approach with material from my own study of medicine in the state of Kerala, India.

Tradition is not only a concept to be used when defining the subject-matter of a study as when we specify such and such medical traditions; there are methodological traditions as well. The present paper aims at introducing one of these methodological traditions which flows from the works of Gaston Bachelard (1884-1962). While I was perusing the programme of this session, I realized how deep was the difficulty in integrating my own references-current books on medical history in French--into the literature already cited by Professor Leslie. We are invited here to analyse the processes of change and continuity in medical systems; we are dealing with acculturation processes, and so on. Each of these phrases refers to a classical problem in American anthropology. When facing them, I do not feel at ease, I have the feeling of what may be called a kind of particularism, in the methods and training upon which I rely. To give an idea of my intellectual background, it may be worth while presenting a set of theoretical reflections which constitute the common heritage of Bachelard's students; they have given birth to a whole line of medical historians, whose books---excepting those by Michel Foucault--are still awaiting translation. These few remarks will be made from the background of a personal research carried out in Kerala (South India) among learned practitioners of classical Hindu medicine who belong to a particular subeaste 0f Brahmins whose name is a kind of pun or puzzle: A~avaidya-s, "physicians (devoted to) As.t (~tiga)", A.st.~oa "the Octopartite" being another name for the Ayurvedic system. They are Sanskrit experts, they refer daily to classic texts, and to the commentaries written by their fore-fathers. For centuries they have upheld the tradition of V~gbhat.a's A.stfitigahr.daya, "The heart of the Octopartite (system)", one of the classics (6th cent. A.D.) whose fame reached Tibet and Persia. Under the guidance of one of those learned practitioners, l am studying the successive stages of V~gbha.ta tradition in Kerala, through the series of mediaeval recensions and modern commentaries. More exactly, my purpose is to search for variants in medical practice, and to account for the appearance of pharmaceutical and therapeutical specialities. Let me cite a highly recommended diaphoretic massage with a decoction of Sida cordifolia: such

a process, unknown outside Kerala, is quite orthodox and flows logically from the classic texts, in spite of the fact that it is not specified except in modern Sanskrit tracts (from the 17th to 19th century). This study, which consists mainly in scrutinizing texts (family manuscripts, partly published), would merge into Sanskrit philology, but for the attempt to compare classic tenets with modern and local variants. It raises one or two questions to be looked into in the light of the methodological tradition already referred to, viz. the position of a particular doctrine within the whole set of medical institutions and prac tices, and also, the internal consistency of a classical tradition throughout time. Before we go any further, the theme: "Medical systems as cultural systems", needs a few words of explanation. System may be used with two different meanings. It may be used either to stress the mere interaction of facts in a given setting, or to designate the construction of a model. We must clear away this ambiguity. I. The phrase ("Medical systems") can be a mere empirical statement that would take for granted the orderliness of medical institutions and practices inside a given local or professional framework, as when I say for instance, the modernizing Medical system of Kerala to-day, or the Ayurvedic system of medicine, etc. Here the idea that there is a system is pure assumption: we organize the ethnographic data into framed wholes: in Kerala to-day, for instance, the whole historical network of social roles and medical beliefs. As for the Ayurvedic system, a profession among others, the body of physicians registered as practising in this system of medicine, their beliefs, practices and paraphernalia. Thus, in the first sense of the term, the definition of a medical system is purely concerned with facts. Geography, Law, etc. have traced out its boundaries. From this outlook, the stress is laid on the continuity of traditions. The Ayurvedic tradition consists at the outset of a series of canonical texts handed down through particular lines of Brahmin physicians; subsequently, it is professionalized and becomes an establishment, a medical system among others (Allopathic, Homoeopathic, etc.), integrated into the melting-pot of traditions, scholarly and popular, indigenous and foreign, which constitute 97

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the whole modernizing Medical system (a system of systems). Since a tradition is an observable unit of beliefs and practices, we are dividing the whole setting into various interacting traditions. We shall mention local, professional, sophisticated and popular systems of medicine, which are numberless but may be classified as variants of each other and reduced to a small set of generic types. But, even if the data be selected by an observer who does not pretend to itemize all varieties of cure, such entities as "the Medical system of Kerala to-day", or "the Ayurvedic system Of medicine", are ready-made units marked out by administrative, ecological or cultural boundaries. When choosing to study one of these units, or systems or traditions, we take for granted the ready-made groupings of facts, the usual splitting up of knowledge into various branches, so that for instance, in India, the greater sanskritic and scholarly tradition is separated from the little parochial and popular traditions. Here we meet with a distinction: great tradition vs little traditions, that stirred up a long-lasting controversy, when it was introduced into the field of Indian studies. The distinction between the two levels of Hinduism is obvious: the consistency of sanskritic Hinduism, which transcends provincial boundaries, contrasts with the various processes of modernization, professionalization, parochialization, and so on. The distinction is apparent in the material itself--literature vs custom; it is specified in the methodological approach--Sanskrit studies vs anthropological fieldwork. But it is nothing more than tracing over the usual boundaries between the various departments of knowledge. We must react against this kind of positivism, we must question these ready-made groupings or splittings. II. Then, we reach the second meaning of the phrase, namely, the construction of a model that would account for the consistency of one and the same network of conceptual relations all through the various traditions or systems it englobes. Suppose we adopt, as a working hypothesis, the idea that--to quote Louis Dumont and David P o c o c k [ l ] - - " t h e r e is some homogeneity between popular practice and literary disquisitions". If there is some homogeneity between the observable practices and local traditions in Kerala to-day, and the doctrines codified in Sanskrit texts, we shall be able to extend to the level of scholarly medicine a part of the conceptual relations discovered on the popular level. May I give an example to illuminate this argument? Some years ago, the Marma system of medicine acquired an official status in Kerala. One clause of the Kerala Medical Practitioners Bill, 1972 specified for the first time : "Indian medicine means the Ayurvedic medicine, the Siddha medicine, the Unani tibbi medicine and the Marma medicine." Roughly speaking, we may say that Marma medicine is simply bonesetting. But to understand the unusual promotion of bone-setting to the rank of a profession, one must remember the ancient martial and sporting traditions of the Nayars, a powerful caste of Kerala. Young Nayars were educated in fencing-schools named ka.lari-s (in the vernacular). The fencing-master--and that also is a caste tradition among Panikkars and Kurups--received from his father the secrets of bone-

setting and diaphoretic massages to give flexibility to the muscles and articulations. This traditional "friction, embrocation" (tirummal, in the vernacular) is frequently resorted to as a cure for scoliosis, and other maladies, even to-day. It must be compared to the diaphoretic massages of Ayurvedic medicine (those styled in Sanskrit: pin.d.asveda) prescribed, for example, in the case of rheumatic pains. For centuries, Kurup bone-setters have been the counterparts at the popular level of Brahmin physicians: both traditions of diaphoretic massages exemplify the same conceptual pattern of kinesiatrics, on two different levels of the caste system. Among the Nayars, and their servants who are fencing-masters and bone-setters at the same time, kinesiatrics related to the Art of fencing which leads naturally to a popular form of surgery. Among the Brahmins, kinesiatrics partakes of the Art of rejuvenation, and pi.nd.asveda massages constitute a local variant of the all-India practice of Ayurvedic medicine which repudiates any kind of surgery. The comparison between the two levels is significant indeed. This is one and the same cultural framework, within which the dominant tradition formulates in a more distinguished or prestigious way the same conceptions that we may discover in popular culture. Our object of study has to be constructed. The difficulty is that of evolving the structure in the interior of which the conceptual relations between several traditions are consistent. T H E UNDERLYING BASES OF KNOWLEDGE

In order to give a detailed account of these methodological views, may I draw upon Michel Foucault's book The Archaeology of Knowledge? Up to now, the history of ideas and the history of sciences have stressed continuity; historians have been searching for the intellectual filiations, the influence of forerunners, the continuity of traditions, the cumulative trends of routine thought; but, according to Foucault, "beneath the gross continuities of thought beneath the persistance of any genre, form, discipline, theoretical activity, from now on what we shall try to detect is the incidence of interruptions" [2, p. 10]. We shall look for the conceptual interruptions, breaks or thresholds--Bachelard said: "the epistemological breaks"--starting from which each new science has established itself by separating itself off from its ideological surroundings. From the first page of his book, Foucault refers to the school of historians clustered round the review Annales. (I shall cite one of them below.) Next, he mentions the achievements of his teacher Georges Canguilhem, a philosopher and the author of a book entitled The Formation of the Concept of Reflex in the 17th and 18th Centuries [3] which, in the opinion of French historians to-day, has become the archetype of a new medical history. Canguilhem demonstrates that the theory of reflex action originated among the Vitalists and not--as one would have thought-among the Mechanists. It could not arise within the intellectual field of Cartesian mechanist physiology; only a vitalist theory, which assimilates life with light, allows the idea of a reflex action to he conceived. Thus, the history of sciences becomes the history of the prerequisites, or the history of the conditions

Classic texts to learned practice

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required before any new concept can appear, before moment of its birth, a concept passes through a series any new problem can be formulated. The same kind of ideological displacements and transformations. Just of analysis is utilized in several books by Canguilbem, to cite one fascinating paper by Canguilhem [5]: the Foucault, Dagognet, etc. I may mention, by way of concept of milieu emigrates from Newtonian mechan example, Francois Dagoguet's The Catalogue of anics to Lamarckian biology through the translation Life [4], an inquiry into the botanical zoological and of Newton's term fluids into milieux by the French nosological literature of the 18th century, which exca- mechanists of the 18th century. The word is taken vates one of the underlying bases of this literature: over by Auguste Comte who defines it again from the new methods of recording, abbreviating and tabu- a mechanical, or better, functional point of view: the lating information. interactions between a live organism and the environLet me come back to the Archaeology where Fou- ment. (Says Comte: "In a given milieu, given the cault sums up the spirit of this school of historian- organ, find the function, and the reverse", Positive philosophers. "First", he says, "there is a negative task Philos., 40th lect.) Thus, by going back to Comte, and to be carried out: to get rid of a whole set of ideas further back to classic mechanics, we discover the which propagate the theme of Continuity .... Such is remote origins of a concept used in the behavioral the idea of tradition." [2, p. 31]. A particular domain sciences; we could not have made this discovery with) 0fknowledge, like Medicine, is a "cut-and:dried unit". out transcending the boundaries between various About such "doubtful units", Foucault asks "from domains of knowledge. The history of a concept is what background of discursive events they are to be not that of its perpetuation, but that of its dispersion, tingled out", and further, "whether these units may dissemination and disguises. not be surface reflections of more basic unThemes its" [2, p. 38]. The attempts to found the continuity of a given A common trend among historians is to hunt up tradition, or the homogeneity of a particular science, quotations from the forerunners of any significant on the persistence of its objects, style, concepts or theory: heliocentrists before Copernicus, evolutionists themes are as many failures. before Darwin, etc. But, in the Natural History of the 18th century, evolution is nothing more than the continuous unfolding of natural affinities and hierarThe object chies: From the 19th century onwards, the same Consider for instance the field of psychopathology. theme is connected with the analysis of functional inF0ucault himself, in his famous book on The History ofInsanity, demonstrated that insanity has no ontolo- teractions between the organism and the milieu. "One and the same theme", Foucault says, "but produced gical secret. The unity of statements and arguments by two different types of discourse", partaking of two which constitute the science of psychopathology canseparate fields of argument [2, p. 51]. not be founded on the existence of an object called I apologize for these references, at the same time insanity. Under the specious identity of names like elliptic and out of place. Out of place, since this paper neurosis, melancholy, etc., medical jurisprudence, reis supposed to deal with "medical systems"... But I ligious casuistry, toleration or measures of repression, should like to suggest that such systems do not exist etc., perpetually diversify the objects of pathology. except as surface reflections. Elliptical, since I can allude only briefly to certain books which follow the The style same methodological approach. I am trying to set Foucault once thought that the birth of Clinical forth those hypotheses I find useful in my own work, ' medicine--visual inspection, auscultation, palpa- and precisely, the four kinds of defective approach tion-at the beginning of the 19th century, could be Foucauh describes in the Archaeology make a suitsufficiently defined as the birth of a new style. "Medi- able starting-point. cine was no longer made of heterogeneous traditions, The attempt to focus the history of a particular observations and recipes, but of a collection of data knowledge on its object, style, concepts or themes, that implied one and the same view, the same segmen- ends in quite the opposite result: whenever we try tation of the perceptive field.., the same technique to analyse a tradition in terms of change and conof transcribing what is perceived into what is said tinuity, we come across fallacious connections that (same vocabulary, same set of metaphors)..." need to be broken up. But from these failures, we [2, p. 47]. The author now [2, p. 74n.] abandons the can draw new working hypotheses: idea of "medical perception" that predominated in his (1) The same name, e.g. "insanity" or, as we shall previous book The birth of the clinic. ~It appears that see, "surgery", which defines a cut-and-dried unit of language and perception, in other words, the style knowledge, represents quite different concepts in difof medical arguments, cannot be isolated from techferent social and historical contexts; niques (microscope...) and social surroundings (ad(2) Within a given corpus of texts that constitute ministrative regulations, patterns of medical educaa scientific tradition, different levels of language may ti0n..,). be distinguished; (3) Concepts are subjected to dispersion into various Concepts domains or levels (like the breaking up of light by Another way of unifying a given province of knowla prism--Bachelard's metaphor); edge would be to isolate the permanent and generic (4) Two different lines of discourse may develop one concepts, and to trace their continuous elaboration and the same theme; one and the same discourse may through iime. Alas, the history of concepts is not the combine two contradictory themes. history of progressive improvements. From the very Let us illustrate these arguments.

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FRANCIS KNOWLEDGE

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PRACTICE

While the classic texts boast an extensive knowledge of surgery and midwifery, together with a method of studying anatomy by inspection of decomposing corpses, both surgery and midwifery have completely dropped out of the modem practice of Ayurvedic medicine. The early British orientalists attributed this deterioration of a formerly flourishing science to the spread of ritualism and of the ideals of purity and non-violence. We do observe a slight degradation of the status of Brahmin physicians within the caste system: A~lavaidya-s in Kerala, for instance, are said to be Nambudiri Brahmins slightly degraded by the necessity of shedding blood they may be under, as surgeons. An exemplary case, since it involves two major problems: (I) the position of surgery within the Ayurvedic system, and (2) the status of the learned practitioner within the Brahminic society. We are confronted by two different conceptions of healing. First, in so far as it is defined in the classic Sanskrit treatises, healing is an operative art, which includes the rational observation of anatomical facts and the fulfilment of practical tasks. On the other hand, healing can be seen as expectant medicine which has taken on a ritualistic tinge. The prevalence of vegetable preparations, and the disappearance of all operative treatments, parallels the spread of vegetarianism and the triumph of the idea of non-violence. This opposition between operative and expectant medicine has been explained in terms of historical change, in which Hindu medicine undergoes a longterm process of ritualization. The conflict between two types of medicine is thus spread out thin over an infinitely long time: We can put this argument in diagrammatic form as follows:

from Classic age Sanskrit texts: OPERATIVE medicine i.e. surgery midwifery, etc.

Mediaeval and modern periods

to

Process of ritualization: EXPECTANT medicine and non-violence, vegetarianism, etc.

>

in order of time May I, nevertheless, suggest that such a retrospective view is most illusory? Not to speak of the lack of historical evidence, such an explanation does not come to the point, which is the internal strain of the classical doctrine. The classic texts in themselves exhibit the two opposite aspects or themes, since they develop both operative processes and expectant theories. Chapters on operative processes: surgery, midwifery, blood-letting, etc., are intermingled with chapters on expectant theories: the equilibrium of the humors, the healing power of time through the cycle of the seasons, etc. Furthermore, certain chapters describe the tasks of the physician attached to the person of the king--medicine is connected with political management and the art of war--while other chapters stress the Brahminic ideals of purity, compassion for

ZIMMERMANN

all living beings and non-violence. One and the same logical design applies to the methods and to the position of the physician: methods

Ib-P-Ei iV-EI

surgery etc. EXPECTANT the humoral theory, the seasons, etc.

position

i

b t

id-val-connec-tion o ? S, the physician with i I~the king, war and theft shedding of blood I. . . . . . . . . . . . .

I

Brahminic norms of purity and non-violence

The process of ritualization, if there indeed has been one, ends in the victory of the encompassing theme (Expectant medicine and the Brahminic ideals of purity and non-violence), while the encompassed (Surgery and the connection with kingly power) fades away. This is no conflict between the classic texts and the modem practice, but a conflict inherent in the classical doctrine itself. Eventually surgery disappears from modern practice, but the two dissociated themes still partake of the same structure. The polarity once inherent in the classic doctrine now expresses itself in the opposition between scholarly and popular practices: I already mentioned the polarity between the Brahmin physicians of Kerala and the Kurup bone-setters attached to the warlike Nayars. Thus, we concern ourselves with the discursive framework in the interior of which such polarities make sense. Leaving apart the operative processes, let us consider the prevalent theories: the equilibrium of the three humors (Wind, Bile, Phlegm), the five gross elements (water, earth, fire, air, ether), the dialectic of opposites (hot-cold, dry-wet...), etc. Facing these series of technical terms, what I am interested in is to reconstruct the architecture, the systematic arrangement of knowledge. In order to give an interpretation of these abstract generic terms, I may proceed from the metalan#uage to the language. The series of humors may be translated into the cycle of the seasons, or else, into the bipartition of man's environment. The seasons in South Asia are thr/~ in number: Summer, Rains, Winter. The rythm is quite different from that of the Mediterranean or far-eastern countries, but the Ayurvedic cycle of the seasons works in accordance with the realities of the Indian climate. The series Wind-Bile-Phlegm (metalanguage) is applied to the series Summer-Rains-Winter (langua#e): Wind accumulates in Summer, Bile in the Rains, and so on. Everywhere--from Greece to China--we meet with the humoral theory and the theory of an equilibrium in the relation between the patient and his environment. It is a truism to point out these similarities; to be fruitful, a comparison between different cultures should seek out differences. For example: four seasons in Greece, only three in India; the theory of the cyclic equilibrium of the

Classic texts to learned practice humors seems to be the same, but the actual partition of time is quite different. The Ayurvedic texts have evolved an original theory of climatic conditions, founded on the opposition between Dry lands and Marshy lands. The types of healthy constitutions, the vegetable and animal kingdoms, and finally, the entire territory of India, are divided into Jungle (l~hgala), i.e. Dry lands, and Marshy lands. (It is interesting to note that the original signification of the word Jungle in Hindu medicine is quite the reverse of modern English usage.) Given this ecological polarity, we may ascend to the more generic terms of Bile and Phlegm, fire and water, etc., or we may descend to concrete things: acacias and palm-trees, emaciation in Jungle and swellings in marshes, etc. The dialectic of Agni (the Sun, fire) and Soma (the Moon, water), found in the Vedas, prefigures the dialectic of Bile and Phlegm. According to the Ayurvedic texts, the Wind stays in an alternative position, associated now with Bile (Jungle) and now with Phlegm (Marshy lands). Thus the metaphysical opposition (Sun-Moon, fire-water, Bile-Phlegm) merges into ecological contrasts: the Indus plains acacias antelope phtisis

the Ganges plains palms, dipterocarps buffalo elephantiasis

The point I wish to make is that the more abstract theories, such as the humoral theory, are not to be understood without being referred to their practical foundations. Moreover, any comparison with the other domains of Indian culture must start from this attempt to break down the generic concepts into their practical elements. Thus, I may allude briefly to the fact that the concept of Jungle is placed at the confluence of Ayurveda (medicine) and Artha~Ftstra (the science of political management): same vocabulary, identical statements, one and the same discourse split into two different branches of knowledge.

lOt "

whole set of formulas exhausts the various possible deductions. Thinking consists of the juxtaposition of formulas, the grouping of which is a paradigm the sooth-teller learns to recite in order. The legal codes and the medical treatises are elaborated according to the same principles. They are collections of cases to be solved, systems of paradigms to be declined. We have to contrast this traditional form of argumentation with the modern one in which we are trained. Since we have fallen heirs to the Hellenic style of investigation and recording, we are used to one and the same kind of discourse: the Narrative, the linear, the sequential account of events and natural phenomena. Such achievements as the collection of papers on the various forms of rational argument displayed in the ancient art of Divination that includes the one by Jean Botttro, as well as the current sociological studies of Chinese thought inspired by Marcel Granet, are as many introductions to another style of discourse, viz. a kind of reticulated discourse which proceeds by the combination of stereotyped phrases. The Hindu medical treatises testify to the same kind of paradigmatic thought. Most of the medical Sanskrit texts are versified in a specific meter, each verse being composed of four octosyllabic quarters. This style of didactic composition is usually called "the k~rik-d style", since the k-drika-s or "mnemonic verses" characterize a particular type of scientific statement, to be distinguished from the s~tra-s or "aphorisms". Each one of the octosyllabic quarters of a verse consists of a stereotyped formula which is likely to recur periodically throughout the medical literature. The construction of such a verse can be put in algebraic form. Given a particular name--the suppositum it denotes can be a medicine, a disease, etc.--, such and such qualif3/ing words and phrases will be added. Let x, y, z... be the names and a, b, c... the qualifiers; we may compose and juxtapose octosyllabic units, no matter the number, on the lines followed in the subsequent examples:

"Coconut water is unctuous, THE LEVELS OF LANGUAGE

Let us turn now to the main aspect of the present research, that may be defined as an inquiry into the stylistics of knowledge. Here we come to the point where methodology yields precedence to the tasks of philology (to collate and translate the texts accurately). But we m u s t k e e p the objective in mind; an epistemolocdicalinterpretation of the texts in question. Such a combination of philological ability with an epistemological frame of mind has produced wellknown results in the study of myths. However, there are not many publications which follow the same approach while dealing with scientific texts. I may refer to a remarkable inquiry into the science of Divination, published by the assyriologist Jean Botttro in an exhaustive paper entitled "Symptoms, signs, graphic formulas in ancient Mesopotamia", [6] which provides a model for such a stylistic study. According to Botttro, in the ancient treatises of deductive prognosis, various series of physiognomic observations (protases) are listed, facing each of which are to be found the divinatory deductions (apodoses); all the possible cases to be solved are listed, so that the

X

.a

sweet, virilific, cold, light, b ¢ d _e subduing thirst, Bile, Wind, f g h etc." or:

"Intestinal stasis, abdominal distension, a b emaciation, excessive eructation, c d flabbiness of the thighs, (...) e shall be the premonitory symptoms in the development of piles." x

Each line represents an octosyllabic Sanskrit phrase. We can imagine the monotonous rythm of psalmody carried on through hundreds of verses. The above-mentioned A.st.avaidya physicians once used to learn the 120 chapters of the treatise of V~tgbhata by heart. At the age of 16, and for the term of one

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year, they were required to recite ten chapters every sunrise. In effect they were committing to memory the various declensions of symptoms, processes and recipes, by reciting them in definite order, each name (x, y, z...) calling forth a collection of qualifiers (a, b, c...) arrayed in a number of stereotyped phrases. We observe that most of the formulas are interchangeable with each other. Having mastered the network of relations between the technical terms, we are able to substitute synonymous phrases for each other. Thus we know that:

Incidentally we observe an interesting case of acculturation: the elaboration (in the 1920s) of a versified Sanskrit literature that embodies the rules of Western anatomy, including anatomical charts taken from English text-books and put in Sanskrit, The study of the diversity of styles, through the ancient and modern developments from the original classic texts, illuminates the processes of social change. I should like to mention another linguistic study currently in progress in France, of a comparable body of medical information, but along different methodological lines. Jean-Pierre Peter is working on the records collected, at the time of the French Revolution, in the course of an official "Inquiry about epidemics and climate" (from 1776 to 1792) supervised by the Soci6t6 Royale de M6decine [7]. Peter analyses the names of the diseases mentioned and tries to rationalize the diagnoses recorded in the various memoirs sent to Paris by country physicians, by means of statistical lexicography, He strives to identify the pathological realities denoted by such ancient terms as:

"having sweet taste" = "subduing Wind", and many other equivalents. Series of octosyllabic formulas, such as: "'sweet, virilific, cold, light" "unctuous, subduing Wind" "nourishing, provoking Phlegm" constitute paradigms, or systems of commutable elements. The point is to place the classical doctrine in one of its local settings, i.e. within the framework of Kerala culture. In the study of textural traditions, we must distinguish various styles employed by the different groups of authors. Among the Sanskrit texts proper, we must differentiate the microcosmic structure and formulaic style of the classical treatises from the slightly disconnected style of the commentaries, herbals and dictionaries, even though they imitate the ancient phraseology. Then, we must consider the transition from Sanskrit to the vernacular. Details would be out of place. I only wish to suggest a personal approach to scientific literature in a local setting, understood as a stratified whole to be decomposed into various levels of language. It may be convenient once again to put this argument in diagrammatic form, without pretending to give all the details. Certain terms, however, require some explanation. Ma~.iprav~!am "Pearl-and-coral" is a special idiom mixing Sanskrit (the coral) with Malayalam (the vernacular, the pearl). Ambalavasis are Brahmins situated on a slightly lower level in the caste system than the Nambudiri Brahmins whose disciples they may be. Ezhavas, a low caste of toddy-tapers, maintain a strong caste tradition of medical scholarship.

"pustule maligne" = carbuncle "'feu Saint-Antoine" -- ergotism "fi6vres vernales" = malaria

in order to utilize the diagnoses as reference material for the study of epidemics, the geography of malaria and other medical facts pertaining to ethno-history. Here we reach the limit the study of discourse may not overrun. Dealing with words, phrases and concepts, we are not able to decide the nature of facts... unless we become--like the above-mentioned author--ethnoseientists. To conclude, I have tried to show how I introduce into the study of Indian medicine the Bachelardian themes of discontinuity and of the systematic breakdown of concepts into various levels of language and practice. To put it another way, I have suggested that we concern ourselves with the underlying bases of knowledge, the historical breaks or cleavages from which a particular field of knowledge has emerged, and, to quote Michel Foucault, the "discursive formations" which lie beneath the apparent continuity of traditions. LITERATURE IN KERALA TYPES O F AYURVEDIC Classic texts Authors (V'~gbhata...) Styles the guardians I commentaries herbals, dictionaries of tradition:

Ast.avaidya-s

(Nambudiri Brahmins)

I

modern Sanskrit tracts texts in Manipravalam II Malayalam tracts

>

digests

the dilettantes: Ambalavasi Brahmins a lower caste on the way to

sanskritization: Ezhavas

(Hrdayapriya,

19th century)

attempts to assimilate Western medicine (P. S. Varier, 1920s) translation of classics into Malayalam (19th century): the stereotyped phraseology disappears

Classic texts to learned practice REFERENCES

I. Dumont L. and Pocock D. On the different aspects or levels in Hinduism. Contributions to Indian Sociology 3, 40, 1959. 2. Foucault M. L'Arch(ologie du Savoir. Gallimard, Paris, 1969. 3. Canguilhem G. La Formation du Concept de R~flexe aux X V I F et XVIII" Sibcles. PUF, Paris, 1955. 4. Dagognet F. Le Catalogue de la Vie. PUF, Paris, 1970.

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5. Canguilhem G. The concept of milieu, p. 129 ft. La Connaissance de la Vie (2nd edition). Vrin, Paris, 1965. 6. Bott6ro J. Sympt6mes, signes, 6critures en M6sopotamie ancienne. In Divination et Rationalitd (Edited by Vernant J. P.). Seuil, Paris, 1974. 7. Peter J.-P. Malades et maladies ~i la fin du XVIII ~ si6cle. Annales E.S.C. 4, 711, 1967. Reprinted in M~de° cins, Climat et ff~pid~'mies ~ la Fin du X VIII' Si~cle (Desaive J. P. et al.). Mouton, Paris/The Hague, 1972.