THE ART OF DIAGNOSING GOOD HEALTH vs DIAGNOSING ILL-HEALTH


THIS PORTRAIT OF ADI SHANKARA DEPICTS HIM IN PERFECT, GOOD AND POSITIVE HEALTH.  

THE LEGEND ABOUT ‘BHAJA GOVINDAM’ : 

Adi Shankara, an Indian philosopher of 8th century CE, born in the southern Indian state of Kerala is well-known for his doctrine of Advaita Vedanta which he had established using Upanishads for reference. Shankara had established the ‘SMARTHA’ tradition to which I belong. He had recommended devotion to both Shiva and Vishnu and also the worship of other gods and goddesses. His poetic composition popularly known as ‘Bhaja Govindam’ deals with issues of human existence and the problem of death. Shankara had renounced the comforts associated with materialistic existence and had become a ‘Sanyasin’( Hindu ascetic) at a very young age and had walked across the length and breadth of India on foot. He had lived by accepting the offerings(‘biksha’) given by the community which often involved walking along the streets in places where he had lived. While he had lived in the city of Kashi also known as Benares or Varanasi, the legend claims that he had composed the twelve verses of Sanskrit poetry. He was accompanied by fourteen of his disciples who had also contributed a verse each and these songs are collectively known as ‘Bhaja Govindam’. The legend describes that Shankara had encountered a man teaching the rules of Sanskrit grammar to his students. In India, the teaching technique often involves learning by rote. A phrase is repeated several times to let the students put it into memory. As this Sanskrit Grammar teacher was repeating the phrase ‘Du krun kariney’, Shankara, a man of great spiritual insight, had instantly recognized that the Sanskrit teacher was actually facing the threat of death and the teacher himself was not aware of the threat to his physical existence. Shankara who had mastered Vedas and Upanishads was aware of the many sources both external and internal that endanger human physical existence. This particular ability of Shankara to diagnose the health of an individual interests me because of my educational experience and training in the ‘Art of Diagnosis’. Unfortunately, Shankara died at the very young age of 32. A mystery surrounds his death. The place of his death is disputed. He was always followed by his disciples. Some accounts claim that he had died in Kedarnath in the Himalayan mountains of Uttaranchal State. Others claim that he had died in the southern Indian city of Kanchi. What had contributed to his premature demise is not known. His portraits always depicted him in good and positive health. 

THE ART OF DIAGNOSING GOOD HEALTH : 

To diagnose ill-health is easy. The sick person may describe his ailments. In addition to a person’s subjective symptoms, ill-health shows objective manifestations. The art of clinical diagnosis in sickness and disease involves the use of signs and symptoms attributable to specific conditions that affect the state of health of an individual. However, the mere absence of ill-health does not necessarily mean that the person is positively healthy. Health, like beauty is often a matter of subjective impression. But, while beauty is in the eyes of the beholder, the diagnosis of perfect and positive health is a verdict rendered after a carefully executed medical examination. 

The important object of medical inspection and examination of Armed Forces personnel is to ensure that they are healthy and are able to perform the tasks assigned to them. As the medical officer providing medical cover to units in the Armed Forces of India and The Sultanate of Oman where I had served, I was responsible for assessment of health of all personnel under my care. To ensure that the troops are in good health, I was required to medically inspect all personnel under my care periodically and diagnose that they were in good health. Good health demands that a person should appear well nourished. In stature and build, a person should represent an average example of his race and class. The person should not present any evidence of emotional hyper-excitability. Temperamentally, the individual should exhibit reasonable aptitude and behavior consistent with the expectations of his occupation. Most importantly, the face of the person should reflect the bloom of vigorous health. A person in good health should appear cheerful and be full of vitality. The entire individual is carefully examined to assess the health status. I had acquired the practical skills of the ‘Art of Diagnosing Good Health’ by carefully carrying out regular, periodic health inspections of all men under my care. Armed Forces insists upon Medical Inspections for a variety of reasons and individuals who are subject to the Rules and Regulations that govern Service in Uniform cannot refuse the mandatory Medical Examinations. Medical Inspection of all the men including all food handlers of the Unit is done typically once every month. In addition, men newly posted to the Unit( New Arrivals), men before proceeding on and returning from Courses of Instruction/Leave of Absence/Temporary Duty, and after Hospital Discharge are Medically Inspected. Recruits posted to the Unit after completion of Recruit Training, and men joining their Units after serving abroad are subjected to Medical Inspections. Thorough, detailed and specific Medical Examinations of military personnel is required under the following conditions : 

1. All troops proceeding on ‘active service’ or troops proceeding overseas. 2. Individuals proceeding on permanent transfer to another Unit. 3. Men desirous of an extension of service or re-engagement. 4. Troops for transfer for the Reserve Duty. 5.Officers at the time of initiation of Annual Confidential Reports, entry to Staff College, any Course of Instruction, Fitness for Special Duty. 6. Men under arrest and undergoing sentence and before disciplinary action. 7. Men posted to serve at High Altitude. 8. Special examination at the outbreak of an infectious disease. Typically, I used to examine at least twenty known contacts of each case of Malaria or Viral Hepatitis. 

Medicine is not merely the Art of Diagnosing ill-health and it is equally the Art of Diagnosing Good and Positive Health. I had perfected this skill by meticulously repeating the task of conducting Medical Inspections thousands of times during the course of my service in the Armed Forces. This had also contributed to my ability to diagnose ill-health and in the next several posts I would narrate a few specific instances when I had diagnosed an impending outcome of death during my service and there are instances when I had diagnosed Good Health and made individuals to perform their assigned tasks and did not allow them to escape from the obligations of Military Duty. Sometimes, my acute power of observation was better than that of Physicians more qualified than me. During 1973, I was admitted to Military Hospital, ROORKEE for an intestinal infection. During my hospital stay as a patient,while I was standing in the lobby of the Officers’ Ward one particular evening, I had seen a young, male patient coming into the Ward after his admission. When I had looked at him from a distance, and the manner in which he was walking, particularly his gait and the position of his right hand over the right lower quadrant of his abdomen, I had suspected his medical problem. After he came into the Ward, from his facial appearance alone, I had recognized him as the younger brother of an Officer who was then serving with me in my Unit. Both of them belonged to the Corps of Engineers. I had introduced myself and he had confirmed his relationship to the Officer who was then serving at my Unit. I had asked him about his medical ailment. He was getting treatment from the Hospital Physician( Medical Specialist) over the last several days and was
already seen by the Physician twice in the Out-Patient Clinic and was not responding to the medicines that were prescribed. I had looked up at the Hospital Admission document. He was admitted to the Military Hospital with the provisional diagnosis of Fever Not Yet Diagnosed. I told him that Fever was not the real issue and that he was suffering on account of a common well-known surgical condition called Acute Appendicitis. I had confirmed this diagnosis by performing a simple test on this young Officer patient and told him that he would need immediate surgery and that his ‘APPENDIX’ should be removed without any delay. I proceeded to contact the Duty Medical Officer who had admitted and sent this individual to the Officers’ Ward. The Duty Officer had simply admitted this man based upon the written opinion given by the Physician. The Duty Medical Officer came over to the Officers’ Ward and he repeated the test I had performed earlier and the diagnosis was very clear. He immediately called the Duty Surgeon, who came over and repeated the test I had conducted and confirmed that Appendix should be removed. The appendix was removed and the Surgeon came back and told me that the appendix was highly inflamed and was at the risk of a RUPTURE which could pose a greater threat. While, Appendicitis is a common surgical emergency among young adults, Medical Specialists are not trained to treat this condition and sometimes they may fail to look for it. I was less qualified than the Medical Specialist but I had trained myself in the Art of Diagnosis which would be of use in diagnosis if not in delivering the special treatment a medical condition requires. Whatever may be the outcome, a Good Diagnosis is as relevant as a Good and proper Treatment. Roorkee was the hometown of this Officer patient. Later his father came to the Ward to meet me and was particularly excited with this chance coincidence ; I knew his first son and then I was in Roorkee at that precise moment and intervened as his second son was arriving at the Officers’ ward.
 

BHAJA GOVINDAM – PART-I : 

While the Art of Diagnosis interests me, I constantly remind myself that Good Health is due to the GRACE and MERCY of the LORD and Indians love to identify the LORD as GOVINDA. While we exist because of MERCY, when the existence is threatened, we have no choice other than remembering the LORD. 

Bhaja Govindam, Bhaja Govindam, 

Govindam Bhaja muudha matey, 

Sampraaptey Sannihitey kaaley, 

Nahi Nahi rakshati Du krun karaney. 

Dr. R. Rudra Narasimham,

Kurnool Medical College, Kurnool, A.P., India.,

M.B.B.S., Class of April, 1970.

 

NINE YEARS SERVICE MEDAL – A SALUTE TO THE LAW OF TEMPERANCE


John Milton (1608-1674). Milton wrote many of ...

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NINE YEARS LONG SERVICE MEDAL AWARDED BY INDIAN ARMY SYMBOLIZES GOOD CONDUCT AND TEMPERANCE

THE LAW OF TEMPERANCE  :

John Milton (1608 – 1674), in his greatest poetic achievement of ‘PARADISE LOST’ describes Man’s First Disobedience of God, and the loss thereupon of Paradise wherein Man was placed. Adam, the first Man who was created in God’s image and likeness brought Death into the World. God declares that Adam and Eve could no longer abide in ‘Garden of Eden‘, the Paradise. God sends Angel Michael with a Band of Cherubim to dispossess them. Michael reveals to Adam the ‘Law of Temperance’ which could help him to live for many long years. Angel Michael also comforted Adam by assuring him that if he observes the ‘Law of Temperance’, Death would be like the gentle act of gathering a ripe fruit when fully mature.

PARADISE LOST, BOOK XI ( 520-540)  :     

 

 

 

In John Milton's epic poem of Paradise Lost, angel Michael explained 'The Law of Temperance' to Adam, the first created man to face the threat of death.

 

I yield it just, said Adam, and submit.

But is there yet no other way, besides

These painful passages, how we may come

To Death, and mix with our connatural dust ?

There is, said Michael, if thou well observe

The rule of not too much, by temperance taught

In what thou eatst and drinkst, seeking from thence

Due nourishment, not gluttonous delight,

Till many years over thy head return:

So maist thou live, till like ripe Fruit thou drop

Into thy Mother lap, or be with ease

Gathered, not harshly pluckt, for Death mature:

THE NATURE OF TEMPERANCE  :

The essence of Temperance is choosing moderation and deliberately avoid excess. In Indian Culture, and Tradition, living in moderation and living in virtue are almost identical. Socrates suggests that one should “choose that which is orderly and sufficient and has a due provision for daily needs”. He compares the intemperate man “to a vessel full of holes, because it can never be satisfied”. Socrates describes the temperate man as able to satisfy his limited desires, whereas the intemperate man of boundless desire, can never pause in his search of pleasure. According to Freud, when “the ego learns that it must inevitably go without immediate satisfaction, postpone gratification, learn to endure a degree of pain, and altogether renounce certain sources of pleasure”, it “becomes ‘reasonable’, is no longer controlled by the pleasure-principle, but follows the reality-principle”, which seeks ” a delayed and diminished pleasure, one which is assured by its realization of fact, its relation to reality”.

TEMPERANCE AND COURAGE  :  

 

 

 

 

 

 

Saint Thomas Aquinas and 'The Law of Temperance'.

 

Thomas Aquinas has defined Temperance as “a disposition of the soul, moderating any passions or acts, so as to keep them within bounds. Temperate refers to a man who abstains from bodily pleasures and delights in this very fact. A man not only acts temperately, but is temperate in character, when his desires are themselves habitually moderated to be in accord with reason. A temperate man is not pained at the absence of pleasure or by his abstinence from it. Temperance contributes the virtue of Fortitude which strengthens men against “the enticement of pleasure” as well as against the fear of pain. A man who is able to stand firm against the onslaught of pleasures is more able to remain firm against the dangers of death. And so “Temperance can be said to be Brave”. The endurance of pain is central to the nature of Courage. Temperance and Courage are not distinct virtues as both are based upon an ability to stand firm against pain and danger.

NINE YEARS LONG SERVICE MEDAL – A SALUTE TO THE LAW OF TEMPERANCE  : 

During my service in the Indian Army Medical Corps, I learned the values of Temperance, Fortitude, Courage, and delaying gratification of desires, and avoid seeking physical comforts and pleasures.

 

During the first nine years of my Indian Army Service, apart from taking part in the War of Liberation of Bangladesh, I had participated in a variety of Army Operations that keep the men ready and prepared for a battle. Military Training and Service can be best described as habituation for a temperate character. The nature of Army Operations and Tactics always demand overcoming the onslaught of sense pleasures and voluntarily delaying the gratification of personal desires. A life style based upon physical ease and comfort, and indulgence in food and alcohol is not compatible with the Army way of life. The nature of Army Operations is influenced by terrain, climatic conditions, distances and the availability of transportation. There is no scope to cater for physical comfort, relaxation, and entertainment. The supply of rations and food provisions is limited because of the problems of their bulk and weight. Army Rules and the Code of Conduct would emphasize that men should honor their commitment to serve more than anything else. Such commitment to Serve with Honor would only be possible only when the man in uniform lives in accordance with the Law of Temperance.

Dr. R. Rudra Narasimham,

Kurnool Medical College, Kurnool, Andhra Pradesh, India,

M.B.B.S.,  Class  of  April,  1970.