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),