Baddha Gudodaram and Neuronal Development

Eric Lis

Some diseases are more complex than others. Heart attacks, for example, are reasonably simple: a clot or a piece of a plaque flowing through the circulatory system gets stuck in a small blood vessel feeding the heart muscle, cutting off the muscle’s oxygen supply, and the muscle dies, causing short term pain and longer term dysfunction. Some diseases are a lot more complex, such as leprosy, which has completely different presentations depending on whether the victim’s immune system is strong or weak. Our technology means that some diseases which would have been ineffably complex to our ancestors are relatively simple to us, as in the case of dementia, where CT scans allow us to see what areas of a brain are affected by disease and thereby not merely understand current symptoms, but also predict future ones. Many of our common and “simple” illnesses were totally incomprehensible to ancient healers who didn’t have the technologies, or indeed the language, to describe them. In spite of this, when you go looking in ancient medical texts, you do sometimes find surprisingly detailed understandings of diseases which would have been very difficult to comprehend.

Take, for example, Hirschsprung disease (also known as aganglionic colon or congenital megacolon), a genetic disorder near and dear to my heart because someone I’m very close to was born with it. Hirschsprung disease is, by modern conceptions, a fairly simple disorder. During fetal development, specialized nerve cells called ganglia fail to migrate through the growing gut, such that at birth the intestines don’t end up having all the nerves they’re supposed to. By default, the intestines lower down in the body are clenched tight to prevent things from passing through, so when these ganglia don’t develop, the body isn’t able to properly open them. If the disease is mild, the sufferer goes through life with chronic constipation. If the disease is severe, food can’t pass through the gut and the creature dies within a week or so of birth. The modern cure for this is surgery; the “aganglionic” gut is cut out and connected to healthy tissue downstream, resulting in a shorter but functional intestinal tract. Mechanically, this is fairly easy to wrap your head around, but what if you lived in a world where nobody had yet figured out nerves and ganglia were? How would an intelligent and observant scholar make sense of such a specific pathology being present in a newborn without having some understanding of how the body transmits signals along its length? To help put that in context, Hirschsprung disease is named after the Danish pediatrician who first brought it to public attention in the late 1800/early 1900’s, but it took another 50 years for someone to work out what caused it, and THAT was with the best medicine of their era (although obviously not of ours).

Despite Hirschsprung being credited, however, he wasn’t the first person to ever describe the disorder. Descriptions of what was almost certainly the same disorder predate Hirschsprung in the medical literature, and the earliest known Western recording of it probably goes back to the 1600’s. Long before that, however, Aurvedic medicine describes a disease known as Baddha Gudodaram which is probably Hirschsprung disease. Of course, describing is one thing, and understanding is quite another. How did Indian healers 500 years before the rise of the Roman Empire explain a disorder of neural cell migration and failure of gangliogenesis?

The Sushruta Samhita (literally “Sushruta’s Compedium”, Sushruta being one of the most important figures in Indian medicine), one of the seminal texts of Ayurvedic medicine, describes roughly a thousand diseases, hundreds of medicines, and numerous surgical procedures of varying levels of survivability. Primarily a surgical text, it describes caesarian section, hernia surgery, prostate removal, and even primitive prosthetics, but also discusses causes of chest pain, treatment of type II diabetes and obesity by diet modification, and approach to numerous infections. According to the secondary sources I read, there’s some pretty amazing stuff in the book, not the least of which is a technique of suturing closed wounds by holding the edges together, putting ants on the wound and letting them bite it closed, and then decapitating them so that their heads and pincers remain in place like staples. In any event, Ayurvedic medicine of this period understood the body as a balance of three forces: vayu, usually translated as gas, pitta, which was roughly analogous to what Europeans called black bile, and kapha, or mucus. Gas didn’t literally refer to gases, but to Ayurvedic healers was “that which spreads/moves,” and had a number of subtypes that modern scholars have suggested more or less approximate our understanding of the branches of the nervous system. The apana vayu was the gas that flowed within the muscle of the body’s digestive system, and imbalances of apana vayu led to pathology. Sushruta wrote that vayu was an invisible force which could be observed by its effect on the body and which moved along the body in predictable paths. On the one hand, that’s a pretty good description of the nervous system in a world without microscopes, but the same descriptions could also be used for much less scientific disciplines such as reiki, so we shouldn’t assume one way or another that it parallels anything referred to in modern books.

The Compendium describes Baddha Gudodaram, abdominal distension due to any sort of functional blockage of the lower gut. According to scholars more knowledgeable in Sanskrit than myself, Baddha Gudodaram seems to refer to the more chronic, survivable form of aganglionic colon as opposed to the form Hirschsprung himself described, which was deadly in infancy. The disease is suggested to be due to imbalances in both vayu and pitta. Is this a compelling explanation of the disorder? Perhaps it depends on how generous you’re feeling. The Compendium is essentially saying that Hirschsprung disease occurs when two out of three of the body’s main systems are messed up, which is hardly a specific explanation. On the other hand, the Compendium seems to implicate problems with the flow of vayu as being particularly causative, which may have been the closest that the language of the era could come to explaining an problem with the nervous system (and arguably comes a lot closer than most European sources did throughout history). It’s also interesting that the Compendium notes that the disease is incurable, meaning that it was understood that the problem couldn’t be fixed by moving around the body’s energy or opening a chakra or something; for all its imprecision, this was, at least, a basically non-magical explanation.

Should we be impressed by the wisdom of the Sushruta Samhita or not? I have mixed feelings, but I’m inclined to say that it was better than most things for its time. I don’t have the language to describe how a car transforms gasoline into forward momentum, and my attempts to do so, despite having a certain degree of intelligence, wouldn’t be as precise as the Compendium’s explanation of a much more difficult concept. In any event, it’s another example of what knowledge people had in the Ancient era, and equally importantly, how they understood and tried to expand upon what knowledge they had. 

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on August 16, 2015. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system