This is a proposition to gain knowledge, and to understand Truth and Reality. Consciousness is awareness of one’s own state, condition, and fact of existence in a given environment. The Subject who exists because of the living functions of trillions cells has to be identified. The term ‘soul’ describes the functional unity of these trillions of living cells each of which is aware of its own existence in a given environment. My soul is the manifestation of trillions of units of awareness or consciousness of the individual living cells that comprise my human body. To exist in the natural world, my consciousness or awareness establishes what I describe as ‘God Connection’; the connection between the energy-seeker and the energy-provider. The biological function called Consciousness gives the ability to acquire energy from the given environment in which the living entity is present. To perform mental functions such as thinking, and having feelings, the human being has to maintain physical existence and sustain vital metabolic functions acquiring energy from external environment. The Theory of Total Consciousness must explore the total contents of conscious experience and determine its significance in relation to the act, state, or condition called Living.
Dr. R. Rudra Narasimham, B.Sc., M.B.B.S.,
M.B.B.S., Class of April, 1970.
- The Science of Consciousness (bhavanajagat.wordpress.com)
- Life and Death – a Changing World and Unchanging Reality (bhavanajagat.wordpress.com)
- Spirituality-the Confluence of Religion, Philosophy, and Science (bhavanajagat.wordpress.com)
- Spiritualism – the Biological Basis of Spirituality (bhavanajagat.com)
- Spiritualism – Spiritual Being and Self-realization (bhavanajagat.com)
- Spiritualism – the Cell Theory of Spirituality (bhavanajagat.com)
- Spiritualism – Self-realization and God-realization (bhavanajagat.com)
- Spiritualism – the Molecular Basis of Spirituality (bhavanajagat.com)
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- Spiritualism and Identity – the Conflict at Kurnool Medical College (bhavanajagat.com)
HYPOTHALAMUS,PITUITARY,AND ADRENAL GLANDS PLAY A CENTRAL ROLE IN STRESS RESPONSE.
THE AGE OF ‘STRESS’
We live in an age of “STRESS” and the Indian traditions refer to the present times as the age of “KALI YUGA”. The accelerated tempo of life brings forth stimuli of high velocity of action, magnitude, and impact that they stimulate a chain of psycho-physical reactions strong enough to cause manifest effects in the human body. A person experiences ‘strain’ when his life’s demands exceed his ability to meet those demands. Prolonged high intensity intellectual and emotional strain which involves fixation of motives to do hard work, achieve high standards, carryout a task against opposition, and aspiration for high professional, prestigious, economic and social career and status would produce ‘stress’. Stress is produced not so much by the efforts which have been rewarded by success but more often by the ones not ending in satisfactory achievement. The impact of modern living has a significant bearing on the genesis of stress-associated declines in health. Prolonged stress may result in increased levels of stress hormones such as cortisol, a decline in certain aspects of immune system which contributes to a decline in the immune system surveillance against viral infected and cancer cells, increases the rigidity of the vascular system which produces hypertension(high blood pressure), thickening of the coronary arteries that impacts cardiac health, aggravate breathing difficulties, disrupts gastrointestinal microbial balance, and a host of other problems. Depending upon the physical, psychological, and social environments under which the person has been brought up and is presently living; and depending upon the genetic and constitutional factors, stress affects a particular target organ or system. The problems associated with the use of alcohol, tobacco, and a variety of mind altering drugs and substances could be considered as an extension of a response to stressful stimuli and substance abuse further aggravates the ‘stress syndrome’.
THE BIOLOGICAL CONCEPT OF STRESS
The word ‘stress’ or ‘strain’ should be understood as a STIMULUS-RESPONSE-COMPLEX produced in an individual by hostile physical, psychological, or biological invasion. It also leads to the development of resistance to the stressful stimuli. Depending upon the nature of the hostile or invasive factor, the resistance produced may be physical, psychological,biological, or a combination of all. Thus ‘stress’ includes the chain of reactions which constitute the process of development of final resistance to extrinsic strains. Resistance produced may be general or specific. The reactions of stress may produce the ‘General Adaptation’ and ‘Specific Adaptation’ syndromes. Stress precedes and promotes all the resistance phenomena. Final resistance produced by any biological, physical, and psychological stress producing stimulus detremines the survival, or defeat/death of the man under the strain. Stress could be viewed as beneficial when it is produced in tolerable quantum and is spread over a tolerable period of time.
THE TYPES OF STRESS
The biological stress is caused by pathogenic organisms such as bacteria, viruses, parasites, animal bites and stings. Physical stress is caused by physical factors like heat, cold, burn, injury, radiation or privations. In modern times the most important stress producing cause is that of sleep deprivation. Our biological existence is synchronized with the cosmic event that causes alternating periods of light and darkness. A biological clock manages a variety of biological activities such as the production of stress hormones. Body needs periods of relaxation and should stay tuned with the 24 hour biological rhythm which is popularly known as the ‘circadian rhythm’. We very often disrupt the functioning of this biological rhythm to accomplish one task or the other. Many of us just stay awake for the sake of enjoyment of life. If not at work, or preparing for an examination, we stay awake in front of TV, listening to music, watching sports, playing games, drinking alcohol, partying with friends, and in a myriad of other ways which would provide a sense of EUPHORIA. While we are enjoying our time, the body still experiences STRESS and reacts to the stress of being in a wakeful stage when it should be resting without receiving any mentally exciting stimuli. Our desire to get away from the stress at work place or daily life, may actually enhance the effects of stress upon our body.The psychological stress is produced by an adverse situation, proximity of an aggressive or overwhelming personality, or an intellectual, emotional(such as anger or worry), or social challenge. We could therapeutically combat the stress due to biological agents and physical conditions. But the psychological stress is not amenable to an easy therapeutic approach. Stress as a disease producing factor very often refers to the psychological stress.
THE GENESIS OF STRESS
The part of the brain known as hypothalamus, and the organs of the endocrine system, particularly the pituitary and adrenal glands play an important part in the body’s adaptation to stress. The hormones such as epinephrine(ADRENALIN) and cortisol produced by the adrenal glands help to protect the body and raise its resistance against stress irrespective of the nature of the stimulus. After sudden exposure to stress stimulus, in times of anger, fright, fight, and flight, the initial ‘ALARM REACTION’ produces epinephrine that increases the heart rate and blood pressure. When the stress continues, the adrenals are again stimulated via the hypothalamus-pituitary axis and release hormones such as cortisol which is important for providing glucose, a source of energy for the body. If the stress further continues, body tends to develop resistance against prolonged stimuli. If the stress stimuli are very aggressive and are sustained over a very long period, the ‘General Adaptation’ mechanism of the body could fail, a ‘Stage of Exhaustion’ may follow and the individual could be overwhelmed. Pre-existent resistance against stress reduces the requirement of immediate response of an “ALARM REACTION”. Stress is reduced by pre-existing resistance. The defeat, imperfect production of resistance, or premature arrest of the process of its production gives rise to disease. Heredity, environment, physical and mental health, and social support detremine our ability to resist stress situations. The development of a well integrated personality to face life squarely determines the extent and quality of the resistance. By proper education and training, the threshold for physical and emotional stress could be increased.
RESISTANCE TO STRESS
A psychological stress stimulus may not cause a similar reaction in all individuals. All individuals have different capacities to perform and adapt when faced with stress. People will react differently depending upon the preformed resistance they have. Five different types of reactions are possible. 1. The stress stimulus acts like an inspiration and becomes a source of healthy pursuit. 2. The stimulus is accepted as a reasonable strain and the individual takes it up as a healthy challenge. 3. The situation appears to be overwhelming and the stimulus becomes either a source of depression, and breakdown or a source of ‘stress syndrome’. 4.It may cause anxiety and becomes a source of an anxiety state or neurosis. 5. The stimulus does not elicit any reaction at all as the individual is apathetic.
Depending upon their response or reaction to stress, we can distinguish five different categories of people.
GROUP I : Persons highly resistant to stress. They have superior preformed resistance and often display an ability to develop resistance within a short time of exposure to stress. They master the stressful event and overcome the stress triumphantly. They do not suffer from any negative consequences while they carry out the task even while under great stress. They have dominant will power and have a great power of endurance.
GROUP II :These persons have enough preformed resistance to overcome the stress partially. They do not show overt ‘stress syndrome’ but suffer to a lesser extent in their attempts to master the stressful situation and achieve success. The task does not suffer. Such persons are likely to suffer from precipitation of internal conditions such as hypertension, coronary artery disease if they have other predisposing risk factors.
GROUP III : These persons have very low preformed resistance. If a stressful situation continues such persons may develop resistance which carries them through for some time but sooner or later they succumb to the situation and show evident ‘stress syndrome’. The task may not always suffer but the individual suffers from physical manifestations of stress.
GROUP IV : These persons have no preformed resistance and their ability to create immediate resistance is low. These persons abandon the task and tend to get away from the stressful situation. The task suffers and the individual could be punished for failing to perform his task.
GROUP V : These persons are NON-RESISTANT to stress. They have no preformed resistance. They are not capable of favorably reacting to a stress producing situation at all. They succumb and become psychiatric casualties and cease to exist as an organized entity. Sometimes, they may not be able to maintain their biological existence.
Armed Forces consistently strive to select and recruit only RESISTANT personalities and weed out the vulnerable ones by careful monitoring of the health of the troops.Over fifteen years of military service, I had conducted several thousands of medical examinations to assess the physical and mental fitness of people and was actively involved in preserving their health and promoting the quality of their health.I had recruited several thousands of young people for service in the Indian Army and had also recommended the removal of people whom I had detected to be falling short of our expected standards of fitness. With proper nutrition, physical training, personal hygiene, clean habits, and immunization, without any doubt we could make people ‘resistant’ to a variety of biological, and physical stress stimuli. The stress imposed by psychological stimuli is also important and the RESISTANCE to such ‘stress’ could also be improved. Understanding the phenomenon of stress is important for our existence in the modern times. By improving ‘Stress Resistance’, we keep the men ready for a batlle at all times, maintain the level of Stress Resistance during the most stressful moments of the battle, and protect their well being after the stress of the battle is over. The psychological preparation for batlle includes an effort to increase the stress resistance level by proper motivational techniques used routinely in the medical fitness examinations of men. To sustain productivity in education, and at work, we need to lay emphasis on the concept of stress resistance.
Dr. R. Rudra Narasimham,
Kurnool Medical College, Kurnool, A.P., India.,
M.B.B.S., Class of April, 1970.
CREATIVE USES FOR SOUND ENERGY
The science of acoustics deals with the nature, properties, generation, propagation, and reception of sound waves. Sound is defined as a vibration, a mechanical disturbance from a state of equilibrium that propagates by wave motion through an elastic medium. In gases, and liquids, sound propagates as longitudinal, compression waves. In solids, sound propagates as transverse, shear waves. Sound waves behave in many ways as light waves do. Sound is a form of energy like light. Light is an electromagnetic wave. Unlike light, sound cannot exist in a vacuum. Acoustics is important in fields of speech and hearing, the production of music, in warfare, in research, in exploration, in medical diagnosis and therapy. Sonar is an acronym for sound navigation and ranging. Sonar is used in detection and location of submerged objects like submarines by using acoustical echo. Ultrasonics describe the study of all sound like waves whose frequency is above the range of normal human hearing. Ultrasound is widely used in industry and in medicine. Pulses of ultrasound could be used to shatter kidney stones and gall stones. Ultrasonic drills and saws are useful in surgery and dentistry. Ultrasonic transducers have come to be widely used in medical imaging and have become a common diagnostic tool in pregnancy and for screening medical conditions that affect children. The technique of studying heart motions by ultrasonic means is known as echocardiography. In modern life we use sound energy in several creative ways.
THE WORLD IS FULL OF SOUNDS
We encounter a great variety of sounds in our daily life. All natural phenomena such as thunder, rain, waterfall, surf, and gusts of wind generate their unique sounds which could be pleasing aswellas frightening. Across animal kingdom, sound is used for detecting danger, navigation, predation, communication, and also for relaxation. Animals possess special structures for production and reception of sounds. The sounds produced could be mechanical or vocal. The special vocal organs could also produce speech and song. Mammals can also produce sounds with parts of the body that are specialized for other purposes. We can produce sound by tapping the floor or by clapping the hands. Many animals are highly vocal and can produce species-specific sounds. By understanding the sound reception mechanisms used by animals, we can also protect ourselves. Snakes have no reception for sounds propagated through air as they do not have external ears. But they recognize the sound vibrations that are propagated through ground. Snakes often bite when they are stressed. During Operation Eagle 1971 in Chittagong Hill Tracts, the War of Bangladesh Liberation, I had allowed a large group of snakes to move under my legs by remaining still and not provoking them with any attempt to move. I had trained soldiers to protect themselves from snake bites. For example, we can easily alert others by shouting and announcing the presence of a snake while standing still and get help to avoid snake bite. Humans have developed Culture and technology such as radio, telephone, and music that allows them to generate, record, transmit, and broadcast sounds. We should further explore the potential uses for sound energy. In ancient India, thoughts were propagated from person to person using the ‘oral tradition’ which involves the use of sound energy as a tool of human communication.
THE BIOLOGICAL EFFECTS OF SOUND
A sudden, loud sound could disorient a person. High intensity sounds and exposure to noise could cause irritation, anxiety, fear, sleep deprivation, stress-reaction, and hearing loss. It could also cause permanent damage to the sense organs of hearing. High-order explosives produce a supersonic high pressure blast wave that could cause severe primary blast injuries in several organs like brain and lungs. Humans appreciate the value of sound as a tool for obtaining relaxation, rejuvenation of spirit and for mental amusement and entertainment. The soothing effects of sound can provide us mental comfort, help in the healing and recovery process. Indian traditions claim that sound could be used as a medicine and the sound could exert medicinal effects taking advantage of the mind-body connection. Sound undoubtedly can affect our physiological responses to stress. Sound could act like a stressor and as a stress reducer.
THE MYSTICAL EFFECTS OF SOUND
A ‘mantra’ can be defined as a sound, syllable, word, or group of words that are considered capable of creating transformation. The vocal sounds of the ‘mantra’ have inherent meaning independent of the understanding of the person uttering them. The incantor need not know the meaning of the words employed and it makes no difference to the mantric action. When we take prescribed medications, most of us do not understand the chemical formulas of the active ingredients and the pharmacological basis for their medicinal action. The vocal sounds of ‘mantra’ could still work even when we do not know the reason as to how it works. Many of the modern medications are derived from plants, herbs, and compounds that were traditionally used for curing illness. Indian tradition advocates the efficacy of vocal sounds in providing relief from physical problems that afflict us. In Bhagavad Gita, Chapter 7, verse 8, Lord Krishna states that He is the light of the sun and the moon, and that He is the sound in ether. Light energy, and sound energy are aspects of the various energy manifestations of an Eternal, Original,and Primeval Person described as ‘PURUSHA’, the LORD God Creator. Our earthly existence is made possible by our Cosmic Connection with the material energies that we exploit to sustain and support our living functions.. Sound is a unique natural phenomenon of our earthly existence and because of its uniqueness it could be described as a creative energy. In the entire universe that we know and have explored, planet Earth is the only place where sound is generated, sound is propagated, and sound is recognized by living entites with anatomical organs and structures that are designed for that purpose.
THE ATTRIBUTES OF ‘KALI YUGA’ – THE AGE OF STRESS :
The Sanskrit word ‘KALI’ means fermented or contaminated water. While fresh water contributes to good health, and vitality, polluted water would induce stress and strain and leads to illness that manifests as strife, discord, quarrel, or contention. One of the attributes of Kali Yuga is the importance attached to wealth acquisition. Money and acquisition of money have become significant “STRESSORS” in our lives. Money related problems are among top concerns playing a role in anxious or depressed moods. As avarice, greed, and wrath have become common, there is no contentment, nor discernment, and nor mental composure. As men are tormented by worries, the use of prescription drugs such as tranquilizers has become very common. Various methods have been developed to cope with psychogenic or internal stress including the use of psychotherapy. Unhealthy coping of stress is leading people to activities such as smoking, drinking, gambling, compulsive eating, and the use of mood altering drugs and chemical substances. Such unhealthy coping mechanisms to deal with stress can trigger more conflicts both at home and in the society.
AN ‘ELIXIR’ TO DESTROY THE POLLUTING EFFECTS OF STRESS
The creative power of sound could be used to counteract the contaminating influence of the age of KALI. The sixteen words of the HARE RAMA Mantra is first attested in the ‘Kali santaranopanisad'( KALI SANTARANA UPANISHAD) which is associated with the Krishna Yajur Veda. Creator Brahma had instructed sage Narada about the efficacy of this Mantra. The mere uttering of the words of HARI, RAMA, and KRISHNA is enough. A person does not require a Guru or a teacher to instruct the mantra. No fee is expected to obtain the knowledge of this mantra. A person is not expected to change his religion or observe any specific religious rituals as a part of using the mantra. There is no set time, or duration for repeating the words of the mantra. The words could be used individually or the precedence of the words could be rearranged. All the words are of a great potency.A person requires no previous qualification or training to use the mantra. There are no rites of initiation. It is unlike the practice of YOGA or MEDITATION. The person need not be in a temple or any other secluded place. The mantra could be used while fully engaged in the routine activities of life. The words could be repeated either out loud, softly to oneself, or internally within the mind. The mind hears the sounds of the words irrespective of the manner used to utter them. The Upanishad further states :
“Iti sodasakam namnam
Sarva- Vedesu drsyate.”
The sixteen words of ‘HARE RAMA MAHA MANTRA’ are especially meant for counteracting the polluting effects of the age of KALI. After searching through all the Vedic literature, one cannot find a better method.
I am not surprised to read about the mystical effects of sounds that could transform our lives and protect us from STRESS. I had personal experience of withstanding the physical stress imposed by sun’s scorching heat in the open deserts during military exercises. We had used nothing more than a little shade provided by thorny bushes or the camouflage net that we use to conceal our presence. The shade would at the most reduce the heat by a couple of degrees and yet the psychological relief it provides us so immense and it enables us to resist heat the entire day. I spent time in evaluating people and witness their ability to withstand a great variety of physical, chemical, biotic, and environmental stressors. The sixteen words of Hare Krishna Mantra have the potential to destroy the evil effects of stress by increasing our stress tolerance, by inducing stress resistance and protect our biological existence. Kindly review a related blog post about Stress.
Dr. R. Rudra Narasimham, B.Sc., M.B.B.S.,
Kurnool Medical College, Kurnool, Andhra Pradesh, India,
M.B.B.S., Class of April, 1970.
Indian Armed Forces train and conduct Military Exercises in Suratgarh region of Rajasthan with a sense of ‘excitement’ induced by the preparation to confront the enemy. The attack by an ‘invisible’ enemy is manifested by the medical symptom of mental excitement.
SURATGARH, RAJASTHAN – THE LAND OF RIG VEDA :
Suratgarh is in Sri Ganganagar District of Rajasthan. Around 3,000 B.C., Suratgarh is believed to be a lush green pasture land due to the presence of Sarasvati River which is repeatedly mentioned in Rig Veda and is described as “Ambi ta mey, Nadi ta mey, Devi ta mey, Sarasvati” meaning that River Sarasvati is Best Mother, Best River, and Best Goddess.
Fighting the Enemy – The Excitement at Suratgarh :
Suratgarh is of strategic importance. I had visited and camped in this area several times during the period from 1976 to 1978. It was not a picnic. My visits were mostly related to military training and exercises that would prepare me to fight the enemy in a battle. Battle preparation always induces a sense of excitement. Apart from the body, the mind would be put on an alert to accept the challenge and confront the enemy. I had never missed that feeling on any day that I had spent in Suratgarh. During 1977, I had camped at Suratgarh for three months where we had opened a ‘Desert Driving School’ to impart training to military drivers. The sandy desert terrain poses a challenge to the man aswell as the machine. The driving lessons were imparted by instructors from Army Service Corps which provides provisions(rations) and transportation in the conduct of military operations. We had established a very small camp in tents on the Suratgarh-Sri Ganganagar Road. I had set up a very modest Medical Inspection Room in a bunker to provide medical services to trainees at our School. I had posted a sign on the road near our School to encourage others to visit my Medical Inspection Room if they needed any help. I had always liked the idea of preparing for the battle. The success in actual war depends upon the skills a person acquires while training for the battle. I thought that it was important that I must learn to drive and operate all types of vehicles that Indian Army would use in the desert terrain. Like all other trainees at the School, I drove a 3- ton Lorry, the basic workhorse of Indian Army. I had successfully finished my training and was issued a Military Driver’s License. Apart from 3- ton Lorry, I also operated all other vehicles like Jeep, Jonga, and 1- ton trucks. The driving tracks included regular surface roads and plenty of cross-country driving over sand dunes and desert terrain. It was exciting to face the challenge and be prepared.
Fighting an Invisible Enemy – A Challenge to Human Existence :
Fighting a visible, external enemy is easier rather than fighting an ‘invisible’ enemy. The Rhabdovirus that causes the fatal disease of RABIES is one such invisible enemy. The virus has a characteristic ‘bullet’ shape. It is described as a neurotropic virus as it chiefly attacks the central nervous tissues and causes brain inflammation. While a person is alive, the infection is always diagnosed on clinical grounds.After death, the evidence for this infection is demonstrated by the presence of microscopic, the oxyphilic inclusion bodies called the ‘Negri Bodies’ found in the cytoplasm of the brain nerve cells. The disease once manifested, has no cure and the mortality is 100 percent. The disease was eradicated in Britain and Australia, but is still prevalent in India. Rabies is primarily a disease of a variety of animals( the Canidae tribe) and man is secondarily infected. In India, furious canine rabies causes most cases of the disease in man. The virus also attacks the salivary glands and the virus is present in the saliva of the infected animal. For man, the immediate source of infection is essentially the rabid domestic, street, or pet, dogs, and cats. The infection could also spread from wild animals like Jackals and Foxes. The virus is transmitted to man either by the bite of an infected animal or by contact through the mucous membranes or breaks in the skin such as cuts, abrasions, and open injuries that get licked by the animal.The virus cannot enter the body without some trauma to the skin or mucosa. However, the virus can gain entry if it contacts intact conjunctiva of the eyes. Transmission by ‘droplets’ has also been demonstrated. Once within the body, the virus travels using nervous tissues and attacks the brain. Depending upon the site of entry into the body, the disease can manifest itself in about 10 to 90 days.
HYDROPHOBIA – THE FEAR OF WATER : THE CHARACTERISTIC FEATURE OF RABIES :
During the very initial phase of infection which may last from 1 to 10 days, the disease is manifested as increasing restlessness, excitement, anxiety, and irritability. After the initial period of 1 to 10 days, the symptoms and signs of Hydrophobia appear in the man. This is a characteristic feature of the disease only in man and does not occur in dogs or other animals. The fearful manifestation of Hydrophobia includes violent contractions of the diaphragm and other respiratory muscles if the individual attempts to drink water. The muscles of throat go into spasm and the victim would be unable to drink water despite extreme thirst. The sight of water or even the sound of water may precipitate these very distressing spasms and attacks of panic.Man has no natural immunity against the infection. Anti-Rabic Vaccine treatment is useful during the incubation period. The Vaccine treatment has no value if the Rabies Virus reaches the brain. Once the symptoms of the infection appear, no treatment is possible. Rabies is prevalent in India, but the incidence is very low in the Indian Armed forces. We had 59 reported cases of Rabies from 1944 to 1964, about 3 cases per year. There have been cases of Rabies transmitted by corneal grafts taken from people who had died of undiagnosed Rabies.
THE INVISIBLE ENEMY’S ATTACK IN SURATGARH :
While I was attending to patients at my Medical Inspection Room at the Desert Driving School, a Non-Commissioned Officer(NCO) came to our Camp to seek my assistance. He belonged to the Corps of Electrical & Mechanical Engineers(EME). He being a member of the SIKH religious community could be immediately identified by the turban that he wore and his beard. He was well-groomed and was in proper military attire and had very good physical stature and appearance. His Unit had sent a small detachment to Suratgarh area in preparation for some training event. They were camping nearby. His Unit was not affiliated to the military formation which had set up the Driving School. During that time, Suratgarh had only a Primary Healthcare Clinic. I was the only Army Medical Officer providing services to military personnel stationed in that area. As he walked in, I could see that he was excited and I had immediately assured him that he should have no apprehension to seek my services and the Unit affiliations are of no consequence and he should totally feel free to discuss his medical problems with me. He had a very brief medical history. For some unknown reason, he was feeling restless, excited , and becoming anxious about his restlessness. He had no headache, no fever, and no other problems. He was apparently performing all his tasks very well and had no quarrels or arguments with his colleagues. I could easily see his attitude and military bearing. He was displaying a very disciplined behavior, a respectful attitude while coping with a serious and troubling condition. I could immediately rule out the possibility of overt or occult ‘Malingering’. He was a NCO who had spent some years in military service, he was very well-adjusted to his military life and had no particular problems with superiors or colleagues of his Unit. I spent time to fully medically examine him and evaluating his general condition and exploring the reasons for this sudden onset of mental restlessness in an adult who had no prior medical problems. He was not disgruntled, cynical or bitter. He was speaking and answering all of my questions in a very coherent manner. He was not expressing any bizarre ideas or thoughts. He was not hallucinating, not deluded or demented. His personal habits were good and he did not consume alcohol or any other mood altering drugs. He was not any medications. He was not experiencing a ‘STRESS’ disorder and appeared to be having good stress resistance. He had no pressing domestic concerns or problems. I could not discover any physical factors like Heat or infections like Malaria or metabolic disorders like diabetes which may explain his condition. Through careful interrogation, I could exclude Psychiatric illness or disorder. After spending some time, I could not still come to any conclusion and I was unwilling to send him away with some symptomatic treatment to relieve his anxiety.
MEDICAL COMFORTS AND MEDICAL DIAGNOSIS :
Unlike in civil medical practice, the army medical practice gives attention to the individual and not exclusively to the disease. At Medical Inspection Rooms, we very often provide ‘Medical Comforts’, to all people who visit us, as needed. The Medical Inspection Room is entitled to draw rations like sugar, tea leaves, and milk powder and very often we serve hot, and refreshing tea while people wait at the Clinic. Suratgarh is an extremely hot place. I was drawing blocks of ice to keep my Clinic cool as there was no electricity or air-conditioning. I was also serving chilled water to all visitors and consistently encouraged everyone to consume more fluids.
After my initial, inconclusive evaluation of my patient, I wanted to provide him some ‘Medical Comfort’ and offered to him a glass of chilled water as it was already very hot. He had declined my offer and showed no interest to drink water. He was not being rude or impolite. He was too excited and was not in a mood to relax. But, that very simple act of offering water as ‘Medical Comfort’ and his refusal made me to contemplate about his condition. It suddenly occurred to me that I could be dealing with a case of Rabies. He had no symptoms or signs that could be identified as ‘Hydrophobia’. He had no such concerns or problems at that time. However, I had decided to fully explore that possibility. I again started my interrogation to find out if he had any contact with any animal. He never had pet animals. He was never bitten by any animal. He was never licked by any animal. I carefully examined his skin and could not discover any cuts, abrasions, open wounds or healed injuries. His skin was intact and it would not be possible for Rabies Virus to enter his body through his unbroken skin. I had no other options left and I was not able to exclude the possibility of Rabies infection as the cause of his medical complaints of restlessness and anxiety. I had no choice other than acting upon my suspicion even though I had fully trusted his statements about never being licked or bitten by any animal.
THE ROAD JOURNEY FROM SURATGARH TO ABOHAR , PUNJAB:
I made a decision to medically evacuate my patient to a military medical facility located about 95 Kilometres away at ABOHAR, Punjab. We made no such prior plans to evacuate patients from the Desert Driving School to Abohar. I had to make that decision on my own keeping the best interests of my patient in my mind. I had also decided to transport the patient myself and to drive the 1 – ton truck ambulance.I wanted to assume the full responsibility for taking the vehicle to Abohar. As we were getting ready for this road journey, I checked and found that I had only 2 ampoules of Injection Chlorpromazine hydrochloride(LARGACTIL), a drug of choice to alleviate anxiety. It can tranquillize the patient without impairing his consciousness. Largactil has a marked sedating effect without causing stupor. However, I had only two ampoules in my Clinic. I quickly ran to Suratgarh Primary Healthcare Centre and met the doctor there to get some additional ampoules of Largactil. He had none in his dispensary. So, I prepared my patient for the road journey after administering the medicine that I had and none for the duration of the journey. The road was in a very bad shape with pot holes. My patient could not be fully sedated with the dose I had administered. While I was driving the ambulance, I had kept the partition glass window open to check on the patient. Two of my medical assistants were with the patient, and the ambulance driver was in the co-passenger seat in the front. The bumpy ride caused a bit of stress and my patient was constantly shouting from behind asking me to slow down and sometimes he was directing me to speed up. I was happy to hear his voice and finding that his condition was still stable without any worsening of symptoms. By the time we entered the Hospital at Abohar, it was already dark. I had contacted the Duty Medical Officer who had immediately sent word to the Hospital Surgeon to evaluate the patient. The Surgeon carefully examined him and there were no clinical grounds to diagnose Rabies at that hour. The possibility was there. In any case, the patient needed Hospital admission simply on account of his extremely excited condition. I gave the postal address of my Unit and obtained an assurance from the Surgeon that he would communicate to me the Medical Diagnosis of my patient. After that assurance, the patient was duly handed over, I left Abohar and returned to Suratgarh. A few days after this trip, my three months of stay at Suratgarh had concluded and I had returned to my Unit and had assumed the duties of Unit Adjutant. I had received that unfortunate Medical Diagnosis in the mail. The Surgeon wrote to me stating that the Medical Diagnosis of Rabies was confirmed after conducting an autopsy and the demonstration of ‘Negri Bodies’ in the brain nerve cells.
BHAJA GOVINDAM – PART- V :
The human body is very vulnerable and could be attacked in several manners. In this particular patient, the deadly virus might have gained its entry into his body through the conjunctiva of his eyes. The saliva, the droplets carrying the Virus from an infected animal like a Jackal or Fox could have entered his eyes while the animal was in his vicinity but escaped from being noticed by him. We camp outdoors and sometimes fail to notice an imminent threat. I would suggest to all of my readers to use protective goggles while camping outdoors and introduce its use on a regular basis while conducting military exercises and training in areas where infected animals could be present. After taking all these precautions, we still need the help, the help of our LORD, the help that a sweet name like GOVINDA could offer to protect and defend our human existence.
Bhaja Govindam, Bhaja Govindam,
Govindam Bhaja muudha matey,
Sampraapte 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.
A STORY FROM MILITARY HOSPITAL AMBALA, HARYANA STATE, INDIA :
I had served at the Military Hospital, Ambala from July 1970, to September 1971. I had served in the rank of Lieutenant during the period of my twelve months Hospital Internship Training. I had narrated an earlier experience at the same Military Hospital in my blog post titled ‘Defining Indian Identity-Listen to the Heart’. I want to recount some of my experiences to understand the nature of human condition and the challenges to human existence. The challenges are many and they are so vastly different. I am choosing to narrate the stories of those individuals whose life was cut short while they had no other health issues that could undermine their ability to live. Padma Sundarji, Lt.Col.D’ Souza, and the athlete at Army Ordnance Corps Centre, Secunderabad fought to defend their existence from the threats of Cancer. I had earlier described the nature of the Immune System that defends the human body from Cancer, infections, and foreign proteins. This is the story about a very young woman whose life was shortened in tragic circumstances and I want to stress the importance; the medical profession has a duty to avoid costly mistakes while delivering routine care.
When people walk into a government-run clinic or hospital, the usual impression is that a doctor would listen to the complaints in about a few minutes time, make a very quick evaluation, and send the patient away with a prescription. I had mentioned that in the Armed Forces, the Medical Officers would love to spend time medically examining people who have no apparent sickness as they lay emphasis upon diagnosing a person’s Good Health. I was introduced to aspects of Medical Practice in Army at Military Hospital, Ambala where I learned that writing a prescription should not be our first concern. Major. Mohan Pal Dhir, AMC, the Senior Surgical Specialist of the Hospital at that time of my service, had asked me to converse with my patients and try to know each one as an individual; as a person and not as a diseased entity. In India, we would still follow the cultural norms and do not intrude into personal lives unless the patient desires to discuss all the aspects of their medical history.
During 1971, I was in the Hospital Medical Inspection Room around 8.30 P.M. while my friend Lt. Mohan Lal Dubey, AMC was the Orderly Medical Officer;(Dr. M L Dubey is presently Professor, Department of Parasitology, Postgraduate Institute of Medical Education & Research, Chandigarh,India). A young woman about 17 years old accompanied by her father had walked into the Clinic. Her father had earlier served in the Indian Army. They were traveling in a bus and she was feeling unwell, and they had decided to discontinue their journey. The Military Hospital, Ambala is at a short distance from the Grand Trunk Road and the father knew the Hospital and thought that it would be better to have his daughter checked up before getting back to their village. She could not contribute any further information and did not suffer from any serious illness in her life. As she walked into the Clinic, I had noticed an expression of fear on her face, and it had alerted me that there would be some underlying problem. Surprisingly, we could not detect any reason( a medical condition ) to explain her feeling of being unwell. Her temperature, pulse, respiration, heart, lungs, and abdomen were all within normal expected limits. I did not want to suggest to this young woman that she was alright. I had kept talking to her and her father to arrive at some clues about this sudden sickness that she had experienced. While speaking to her and intently looking at her face, I had noticed with a sense of alarm, that her jaw muscle known as ‘masseters’ appeared to be a lit more ‘taut’. Masseters are the primary chewing muscles. They cover the sides of the jaw just behind the cheeks. These muscles help us to clench our jaws and to grind our teeth. The stiffening of these muscles forced me to think of the possibility of Tetanus infection. Her medical history did not reveal any possibility of contacting this terrifying disease. She had no injuries of any kind. Myself and my friend Dubey, checked her again and could not find any evidence of even a minor injury. Her throat, her teeth were normal. She was not hysterical. She was not exposed to drugs or poisons. She had no concerns or experiencing any difficulty about opening her mouth. There was no stiffness of the muscles that she could experience on her own. This stiffness of jaw muscles, this involvement of facial muscles is the basis for diagnosing the disease of Tetanus. We do not need any laboratory investigations. We need not see the Tetanus bacilli to clinically diagnose this condition. The bacilli live in the intestines of humans, cattle, horses, cats, and dogs without causing any disease. The spores of the Tetanus bacilli are widely distributed in nature, especially in top soil. The spores are very resistant to heat, and chemicals like lysol and can survive for years in the dust. But, the infection is caused only when the spores enter the body through any wound, particularly like a thorn prick, or a puncture wound caused by a nail, a splinter, or an agricultural implement. The bacilli are strict anaerobes, meaning that they cannot thrive in areas receiving free oxygen. The Tetanus bacilli germinate from its spores only where there is reduced oxygen supply. Generally, a patient would be having a dirty wound or injury. The disease manifests itself very quickly in about 2 days to 2 weeks after the spores germinated in the body tissues. The stiffness of the jaw muscles is called ‘Lock Jaw’ or ‘Trismus’. We could not conclude that she was a case of Tetanus. The sign of ‘Trismus’ was hanging in the air like a ‘SWORD’. We made a decision to admit her to the Family Ward with the Provisional Diagnosis of ? TRISMUS and initiated the prophylactic treatment against Tetanus as recommended in the Standard Text Books of Surgery. During 1970s, Indian Army Hospitals had no Tetanus Human Immunoglobulin, the antitoxin that is used in the United States to neutralize the neurotoxin produced by tetanus bacilli. We were then using Tetanus Anti-Serum that is procured from horses. This Serum could cause some serious side-effects, and very high doses are not recommended unless treating established Tetanus. She was given an initial dose of 5,000 International Units with due precautions. In India during 1970s, and prior to it, the children were not routinely immunized by ‘triple vaccine’ which is very effective against Tetanus infection. As a precaution, she was also started on Penicillin antibiotic and initiated immunization against tetanus with a dose of Tetanus Toxoid injection. I went away hoping that the stiffness of jaw muscles that I had discovered on my examination would go away and that she would be alright. Next day, when I had arrived at the Hospital at about 7.00 A.M., I came to know that the suspicion of Tetanus became stronger and the patient was transferred to the Intensive Care Room at the Acute Surgical Ward. They had treated her very vigorously and she had survived this terrifying ordeal of Tetanus for five days and had lost her battle. She had received medical attention as soon as she had become ill, and yet could not be saved. We had failed because we could not discover the seat of her infection. The tetanus bacilli after entering human body do not circulate in the blood. They remain stationary at a place where they thrive. The bacilli do not directly harm the body. It is the ‘tetanospasmin’, the neurotoxin that they excrete which circulates in the blood and reaches the neuron cells of the spinal cord that inflicts the damage. It is one of the deadliest poisons known. The poison is like the poison known as ‘STRYCHNINE’ which is used to kill rats. The poison specifically acts on the synthesis and release of ‘Acetylcholine’, a chemical that has a key role in the transmission of nerve impulses throughout the body. The stimulation, the accumulation of ‘acetylcholine’ results in rigidity of muscle groups of different voluntary muscles.This toxic rigidity of muscles gradually involves face, head, neck, trunk, extremities and the muscles of respiration. This rigidity of the body is punctuated by sudden tonic spasms, and convulsions. The patient would be exhausted and dies due to respiratory failure. Patients are nursed in dark, very quiet rooms, and are not disturbed and moved without reason. If the seat of infection is known, surgery is performed to completely clean the wound and remove all dead tissue where the Tetanus bacilli multiply. In this young woman, we could not detect the seat of infection while she was treated. After her death, the Hospital conducted an autopsy to discover the problem. The Hospital Pathologist, Major B K Sharma, AMC had later informed me that he had isolated the Clostridium.tetani bacilli from the lining of her uterus or womb. She had acquired a ‘Surgical Infection’ after undergoing a simple gynaecological surgical procedure commonly known as ‘CURETTAGE’ in which the lining membrane of the uterus is gently scraped and removed. The father and the patient did not reveal this information. A sense of modesty and Cultural sensitivity could have prevented them. The operation was done in a Clinic or Hospital and we could not obtain any details. The surgical instrument that was used in this procedure was contaminated with dust that had the Tetanus spores. The spores cannot be killed by autoclave or sterilizing the instruments at 121 degrees centigrade temperature. This apparently healthy young woman might have experienced a relatively harmless disorder of her menstrual function which would not truly require a surgical treatment. But, we have no treatment for a disease called ‘GREED’. A medical practitioner sometimes performs a surgical procedure to justify charging a patient a large amount in fees to fill up his/her pockets. In the autopsy examination, we could not find any reason as to why she was subjected to this Surgical Intervention which introduced this deadly infection into her body. She had no other complications from this surgical operation and she had no gynaecological problems and our careful examination did not indicate any problem. A
s a rule, doctors do not carry out a gynaecological pelvic examination in young patients and particularly when they are not married and have no symptoms and signs of a gynaecological disease. Even if we had known, we could not have done more to save her life. She was not evaluated by the Gynaecologist at the Military Hospital, Ambala. I would not think that a Gynaecologist would have done the operation of ‘CURETTAGE’ for a second time to get rid of Tetanus bacilli from the endometrial lining of her uterus. It could pose risks of its own. An emergency hysterectomy could be life saving as it would have eliminated the source of neurotoxin production and would have given us a chance to fully neutralize the circulating neurotoxin. Tragically, she got caught up in a situation with no further escape.
BHAJA GOVINDAM – PART IV :
We exist at the mercy of our LORD. It is not always easy to defend human existence. This tiny bacillus needs no oxygen for its survival. The antibiotics that we may use may not even reach it in enough concentration. The bacillus has a cell wall coated with sugar molecules which may even prevent the antibiotic from entering the cell. A person even with exceptionally strong and well-developed muscles cannot defend himself from this poison. Only timely immunization is the best way to protect a person. During 1970, a spent a month at the Kurnool General Hospital, Kurnool doing my Internship in Medical Ward III. As an Intern at the Medical Ward, I did a neurological examination of a young male patient with well-built body. He was admitted for Spasticity of his muscles of his limbs, and the trunk. He was rigid like a board but had not experienced any muscle spasms or convulsions. I had diagnosed him as a case of Tetanus and had him transferred to the Infectious Diseases Ward as per the Hospital Policy. These were the two instances when I had made the Clinical Diagnosis of Tetanus and they are important and live in my memory and constantly remind me to seek the protection which only the LORD could provide.
Bhaja Govindam, Bhaja Govindam,
Govindam Bhaja muudhamatey,
Sampraapte 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.
IRATE MOTHER SQUIRREL ATTACKED A VISITING TEACHER ON UNIVERSITY CAMPUS :
The Ann Arbor News has reported this story about a mother squirrel’s angry attack. A 52-year-old Detroit Public School teacher was with a group of students touring the University of Michigan campus in Ann Arbor on Thursday, April 23. She had spotted some baby squirrels that were outside of their nest. The teacher had tried to alert the mother squirrel that was at a distance about a baby squirrel that was left behind. The mother squirrel could instantly recognize that the teacher was giving unwanted attention to her baby. The mother squirrel was instinctively aroused, turned on the teacher. The teacher tried to run away from the angry mother squirrel. She slipped and fell on the ground and injured her ankle. Seizing the opportunity, the mother squirrel bit the teacher on her leg. The teacher managed to escape and went to the Hospital Emergency for treatment.
PARENTAL CARE IS AN INSTINCTIVE BEHAVIOR :
Parental care is an aspect of social behavior exhibited by all animals. This is a complex unlearned or innate behavior that is influenced by heredity(genetic basis) as well as by experience. The study of behavior provides valuable information about relationships among animals. No animal is ever completely isolated from some kind of environment. Animals exhibit social behaviors and form parental societies to care for their offspring. This parental care/maternal instinctive behavior is highly organized amongst mammals. The young are part of the mother while growing inside the mother and are nourished before birth by the ‘placenta’ of the mother. After birth, the young still seek nourishment from the mother and suck or lap milk produced by the mammary glands of the mother. This ensures that there is a strong family association between mother and the offspring.
BEHAVIOR AND CONSCIOUSNESS :
The mother squirrel while displaying its maternal instinctive behavior has demonstrated that it is a ‘CONSCIOUS’ entity. Consciousness is defined as the state of being ‘conscious’ which has two components. 1. Being ‘conscious’ means being aware or recognizing the fact of one’s own existence. 2. Being ‘conscious’ also means being aware of our natural environment and it represents the state of knowing what goes on around one. Being conscious gives us the ability to interact with our environment and display an appropriate behavior. In higher animals this consciousness or awareness is also characterized by the presence of mental activity which includes an awareness of our own thoughts and emotions. A living entity is always conscious of its own existence. A living entity always exists in a state of consciousness. We identify a person as ‘UNCONSCIOUS‘ if the person is not spontaneously interacting with his environment. There are several medical conditions that alter and affect our state of consciousness. Several drugs and intoxicants such as alcohol and poisonous agents like carbon monoxide, and carbon dioxide cause drowsiness, stupor, and various levels of semiconscious to deep unconsciousness. Consciousness is very important in evaluating people with head injuries and neurovascular accidents such as ‘stroke’. While a person is unconscious of his environment, he is still aware of his existence. This fact could be easily demonstrated by conducting tests. A living organism or a living cell responds when exposed to a stimulus. For example, an unconscious individual is evaluated by testing to see the response of the pupil of the eye which reacts by constriction of its size on exposure to a light beam.
CONSCIOUSNESS AND SURVIVAL :
An organism uses its awareness to survive in the environment. I could illustrate this by narrating my personal experience. While I was camping in the Himalayas, We were using the quarters left by the British while they ruled India. On a cold winter night, I was sleeping in a small room that was not heated, and the room had no fire-place or a chimney. However, I had used a coal burner to heat the room. The coal burns very slowly giving heat and it lasts for several hours and needs no attention. On that particular night, I did not recognize, the coal was of poor quality and it was not burning as expected and was giving away smoke. The door and the windows were shut, and the smoke started filling up the room. The smoke is lighter than the room air, and it slowly went up filling the room from top. While I was fully asleep in a dark room, unaware as to what was going on around me, I was suddenly alerted when I experienced ‘palpitation’, a consciousness of my heart’s rapid beating. I awoke, but still could not see the smoke in the dark room. I had evaluated my condition to understand my rapid heart rate. I was in good health and there was no reason to experience an increased heart rate. I had decided to investigate my problem and walked up to the door to turn the light switch on. The moment I had turned the light on, I could immediately see the smoke-filled room and the fresh, clear layer of room air was below my bed level. I immediately left the room to get fresh air from outside and saved my life. Many people are not that fortunate, and we read about entire families losing their lives while sleeping in rooms that are heated by improper burners. I was not conscious of what was going on around me while I was sleeping. However, my body was aware and conscious all the time. The chemical sensors in my body worked alright, they sent signals to my brain centers, which in turn sent signals to increase my heart rate to improve the oxygen delivery. It fortunately worked like an alarm for me. Very often, people become more drowsy, become fully unconscious, and lose life while asleep in smoke-filled rooms.
THE SQUIRREL IN THE STORY OF RAMAYANA :
Just like the mother squirrel in Ann Arbor which demonstrated its consciousness, in the epic poem of ‘RAMAYANA’, the awareness and the behavioral response of a squirrel is described. The story narrates the construction of what is popularly known as “SETHU” or a bridge across the sea from the southern shores of Indian peninsula to the island of LANKA. The squirrel was apparently conscious of its environment. It had observed the activities of thousands of monkeys throwing stones to build the ‘ADAM’S BRIDGE’, and recognized the presence of LORD Rama who had initiated the effort to build the bridge. The squirrel had volunteered to help and in its behavior it showed attributes of devoted service. The abilities of the squirrel are very small and yet it won the favor of the LORD and is blessed. The LORD is pleased with the squirrel’s conscious efforts to offer devoted service.
CONSCIOUSNESS AND ENERGY :
The living human entity or man is known as “NARA” in the Sanskrit language, and the superior energy is personified and is known by the name “NARAYANA”. The poem of ‘BHAGAVAD GITA'( The Divine Song) narrates the dialogue between ‘Nara’ known as prince ARJUNA and ‘Narayana’ known as LORD KRISHNA. The LORD describes the relationship between the human soul( ATMA) and the divine soul( PARAMATMA). In Chapter 7 which is called ‘PARAMAHAMSA VIJNANA YOGA'( The Knowledge of the Ultimate Truth), verse 5 describes the ‘energy’ relationships. The material nature which is composed of sky, earth, air , water, and fire are constituted of ‘inferior energy’ of the LORD. The superior energy of the LORD is manifested as the embodied soul of all living entities. This superior energy of the LORD which is in the living entities gives the ability to the living entities to exist in the world by exploiting the inferior material energy from nature.
THE ENERGY PROVIDER AND THE ENERGY SEEKER :
Humans like other living entities supports his existence by deriving energy from the environment. Living cells obtain nutrients such as sugars and use oxygen in their metabolism to generate energy to carry out their vital biological functions. The primary source of energy of all living entities on planet Earth is derived from Sun. The Sun provides energy by burning its hydrogen fuel. It is reasonable to assume that Sun has derived its energy from a higher source of energy or “Higher Power”. This is evidenced by the observation of stars in various stages of their natural cycles of birth , and death. We can observe the birth of stars, the stars that are existing for a long time, the dying stars, the spectacular supernovas, and the dead stars like the white dwarfs, and the brown dwarfs. Human consciousness brings us the awareness and sustains the connection between the energy provider and the energy seeker. We manifest our existence with this unique ability to gain energy from the environment. Just like the squirrel in the story of Ramayana, if we use our awareness, we will become ‘CONSCIOUS’ of LORD’s presence whose superior energy we manifest.
Please also view related blog post titled ‘I am consciousness, therefore I am’.
Dr. R. Rudra Narasimham, B.Sc., M.B.B.S.,
Kurnool Medical College, Kurnool, Andhra Pradesh, India,
M.B.B.S., Class of April, 1970.