Eternal India Encyclopedia

Eternal India

encyclopedia

Ancient Concepts, Sciences & Systems

joining of the lips of wounds by causing them to be bitten by ants

and then cutting off the body of the ants, leaving behind the man-

dibles which would clamp the wound. The Arabs adopted this

method later.

Sushruta, author of the

Sushruta Samhita,

has been recognised

as the father of Indian surgery. Surgical science was called Sal-

yatantra (Salya-broken parts of an arrow and other sharp weapons;

tantra-

manoeuvre). The broken parts of an arrow or similar pointed

weapons used in warfare caused wounds requiring surgical treat-

ment.

Sushruta declares that anyone who wants to attain surgical

skill should study anatomy by dissecting dead bodies. He deals

with embryology and then anatomy of the human body which is an

extension of the embryo. He treats obstetrics and embryology

together. The growth of the embryo from month to month, the po-

sition of the foetus in the uterus, its passage during labour and the

possible complications and their management are dealt with in the

Sushruta Samhita.

DISSECTION

Sushruta describes in detail the dissection of the dead body for

the study of anatomy. The body of a person not very old and who

had not been suffering from a long-standing disease, should be

fitted in a case, wrapped in grass and kept immersed in running

water for decomposition for seven days. When it is soaked well for

seven days, it should be taken out and scrubbed slowly with a brush

made of hair, bamboo, bark etc and all the details of the external

body, limbs and the internal organs as have been described in the

text-book should be observed keenly with the eyes. The ancient

Indians were the first to understand the importance of the study of

human anatomy in the development of medical science and were ad-

vanced enough to make use of dead bodies to serve the needs of the

living.

Sushruta gives a list of blunt instruments for removal of foreign

bodies and for sucking the fluids and double armed axile instru-

ments with two moving limbs to hold and pull any object (forceps).

He describes blunt instruments for removal of foreign bodies from

various passages. Many types of probes, needles and spatulae are

described with their uses in different situations. Sharp instruments

for cutting, incising, puncturing and scraping are described in detail.

Fourteen types of bandaging covering all regions of the human body

are described along with different kinds of dressing material for use

during and after surgery.

The management of urinary stones is explained in detail. The

anatomy of the urinary bladder is described. The various kinds of

stones, symptoms, the method of extraction and operative compli-

cations are set out in detail.

The

Sushruta Samhita

contains a description of bladder surgery.

The surgeon rubs the second and third fingers of the left hand with

fat and makes sure that his nails are clipped. Then he introduces

these fingers into the patient's anus. He must thrust them vigor-

ously until he feels the stone in the bladder. Then he presses the

stone down against the rectum and with the knife in the right hand

cuts through to the stone. A forceps is then introduced through the

incision, the stone grasped and drawn out. The operation for re-

moving the stone from the bladder became known in Europe only

from the 14th century and it was for a long time traced to Greece and

Rome. Its origin in India is beyond doubt.

The most detailed exposition in the

Sushruta Samhita

is in

regard to rhinoplasty (surgery of the nose). The availability of so-

phisticated instruments now in use has not diminished the value of

the basic procedures of Sushruta which have almost become au-

thoritative dicta today.

Sushruta's most notable contribution is in plastic (reconstruc-

tive) surgery. He developed effective techniques for transplanting

skin flaps, which is still basic plastic surgical procedure the world

over today. The flap remained connected to the part of the body to

which it belonged until it had grown into the site of the transplant.

Detailed instructions were given in the

Sushruta Samhita

for the

restoration of a mutilated nose by plastic surgery. "When a man's

nose has been cut off (as punishment) or destroyed (by disease),

the surgeon takes the leaf of a plant which is the size of the de-

stroyed part. He places it on the patient's cheek and cuts out of his

cheek a piece of skin of the same size (but in such a manner that the

skin at one end remains attached to the cheek). Then he freshens

with his scalpel the edge of the stump of nose and wraps the piece

of skin from the cheek carefully all around it and sews it at the

edges. Then he places two thin pipes in the nostrils to facilitate

breathing and to prevent the sewn skin from collapsing. Thereafter

he strews powder of span wood, licorice root and barberry on it with

cotton. As soon as the skin has grown together with the nose, he

cuts through the connection with the cheek."

Sushruta must be acknowledged as a pioneer in anaesthesia

who saw the necessity of making the patient insensible to pain for

the successful conduct of the operation. He advocated the use of

wine to this end. The use of herbane (cannabia indicia) and Sam-

mohini and Sanjivani are reported at a later date. In the absence of

satisfactory anaesthesia, the importance of speed, presence of

mind, correct diagnosis and sharp instruments of good quality were

emphasised.

Sushruta has not overlooked even the treatment of the scar

after surgery. He has advocated the local application of ointments

to bring back the colour of the skin to normal and has described

measures to induce growth of hair or remove unwanted hair.

According to Sushruta a good surgeon is one who possesses

courage and presence of mind and a firm hand free from perspira-

tion. The patient has entrusted his life to the surgeon who should

honour this absolute surrender and treat the patient as his own. The

surgeon should gain the confidence of the patient with reassur-

ances. Rituals and worship performed before and after surgery

maintain the morale of both the patient and the surgeon.

After reaching such perfection, surgery was subsequently ne-

glected because of the taboo on contact with dead bodies which

discouraged dissection and the study of anatomy. The study of

medicine which did not involve the use of instruments or coming into

contact with pus and blood as surgery did advanced, while surgery

declined. It was kept alive for some time with the help of theoretical

knowledge but in the absence of practical skills developed by a

study of anatomy and dissection of corpses, it died out altogether.

The

Charaka Samhita

is the most authentic of all the extant

works on the Ayurvedic system of medicine. Charaka is derived

from the root "Char" meaning "to move about". Charaka propagated

his knowledge and moved from place to place giving relief to pa-

tients.

The

Charaka Samhita

consists of 120 chapters which are dis-

tributed in 8 sections covering : 1)

Sutrasthana

(general principles),