Sushruta

By

Tamarapu Sampath Kumaran

 About the Author:

Mr T Sampath Kumaran is a freelance writer. He regularly contributes articles on

Management, Business, Ancient Temples and Temple Architecture to many
leading Dailies and Magazines. His articles for the young is very popular in “The
Young World section” of THE HINDU.
His books on Science and Technology, has received good response from the
readers.
He was associated in the production of two Documentary films on Nava Tirupathi
Temples, and Tirukkurungudi Temple in Tamilnadu.

Acknowledgement: Google for the pictures and several authors, references from
Professors of West Virginia University, about Sushruta.
In the Sushruta school, the first person to expound Ayurvedic knowledge was
Dhanvantari, who then taught it to Divodasa, in turn to Sushruta.

The indigenous system of medicine in India. Ayurveda literally means 'the science
of living' (longevity). Ayu means life and Veda means knowledge. The origins of
this system of medicine are lost in the hoary past, and the body of knowledge that
comes under the heading Ayurveda constitutes ideas about diseases, diagnosis and
cure, which have been accumulated over the ages past.

The feature that distinguishes this system of medicines from other systems like
Allopathy and Homeopathy is that it is solely based on herbs and herbal
compounds. This it shares with the ideas on this area in tribal societies. But what
makes Ayurveda, a scientific art of healing is its disassociation from the magical
aspect which tribal forms of healing normally have. Hence the practitioner of
Ayurveda could never degenerate to the level of a shaman or witch-doctor. Hocus
pocus and voodoo which are still widely prevalent in rural India could not become
a part of Ayurveda as it always retained a physical link between the disease and its
cure.

According to Charaka, a noted practitioner of Ayurveda in ancient India: "A

physician who fails to enter the body of a patient with the lamp of knowledge and
understanding can never treat diseases. He should first study all the factors,
including environment, which influence a patient's disease, and then prescribe
treatment. It is more important to prevent the occurrence of disease than to seek a
cure".

Sushruta is considered the "Father of Plastic Surgery." He lived in India sometime

between 1000 and 800 BC and is responsible for the advancement of medicine in
ancient India. His teaching of anatomy, pathophysiology, and therapeutic strategies
were of unparalleled luminosity, especially considering his time in the historical
record. He is notably famous for nasal reconstruction, which can be traced
throughout the literature from his depiction within the Vedic period of Hindu
medicine
Sushruta, asserts that a physician should invest effort to prevent diseases as much
as curative remedial procedures. An important means for prevention, states
Sushruta, is physical exercise and hygienic practices. The text adds that excessive
strenuous exercise can be injurious and make one more susceptible to diseases,
cautioning against such excess. Regular moderate exercise, suggests Sushruta,
improves resistance to disease and physical decay. Sushruta has written Shlokas
on prevention of diseases.

The influential nature of the Sushruta Samhita, the compendium documenting

Sushruta's theories about medicine, is supported not only by anatomical knowledge
and surgical procedural descriptions contained within its pages, but by the creative
approaches that still hold true today.

The Sushruta-samhita also provides

details on toxicology, pediatrics, pharmacology and other branches of the
traditional system of Indian medicine known as Ayurveda.

The book Sushruta Samhita, in which he describes over 120 surgical instruments,
300 surgical procedures and classifies human surgery in 8 categories .

For Sushruta, the concept of shalya tantra (surgical science) was all-
encompassing. Examples of some of his groundbreaking operations include
rhinoplasty (the repairing or remaking of a nose), removal of a dead fetus, and
lithotomy (surgical incision into hollow organs such as the urinary bladder to
remove stones, or calculi). He also developed many unique and practical
techniques to dissect the human body and study its structure.

He is credited with performing cosmetic surgery and especially with using

forehead skin to reconstruct noses which were amputated by the rulers as a
punishment for crimes in his era.
Sushruta was the first to perform cataract surgery by couching. Many
ophthalmologists, especially those familiar with the history of medicine in India,
give credit to Sushruta.

Sushruta advocated for learning medicine in part by dissecting the human body,
and that he developed and described several surgical tools while teaching that the
human hand was the foremost surgical instrument.

A graphic description of the procedures followed is given hereunder:

The practice of surgery was already long established in India by the time of
Sushruta but in a less-advanced form than what he practiced. He significantly
developed different surgical techniques (such as using the head of an ant to sew
sutures) and, most notably, invented the practice of cosmetic surgery. His specialty
was rhinoplasty, the reconstruction of the nose, and his book instructs others on
exactly how a surgeon should proceed:

The portion of the nose to be covered should be first measured with a leaf. Then a
piece of skin of the required size should be dissected from the living skin of the
cheek and turned back to cover the nose keeping a small pedicle attached to the
cheek. The part of the nose to which the skin is to be attached should be made raw
by cutting the nasal stump with a knife. The physician then should place the skin
on the nose and stitch the two parts swiftly, keeping the skin properly elevated by
inserting two tubes of eranda (the castor-oil plant) in the position of the nostrils so
that the new nose gets proper shape. The skin thus properly adjusted, it should then
be sprinkled with a powder of liquor ice, red sandal-wood, and barberry plant.
Finally, it should be covered with cotton and clean sesame oil should be constantly
applied. When the skin has united and granulated, if the nose is too short or too
long, the middle of the flap should be divided, and an endeavor made to enlarge or
shorten it.

Wine was used as an anesthetic and patients were encouraged to drink heavily
before a procedure. When the patient was drunk to a point of insensibility, he or
she was tied to a low-lying wooden table to prevent movement and the operation
would begin with the surgeon sitting on a stool and tools on a nearby table. The use
of wine led to the development of an anesthetic involving both alcohol and
cannabis incense to either induce sleep or dull the senses to a stupor during
procedures such as rhinoplasty.
 In the cataract surgery, the doctor
warmed the patient's eye with the breath ~ of his mouth. He rubbed the closed eye
of the patient with his thumb and then asked the patient to look at his knees.
The patient's head was held firmly. The doctor held the lancet between his fore-
finger, middle-finger and thumb and introduced it into the patient's eye towards the
pupil, half a finger's breadth from the black of the eye and a quarter of a finger's
breadth from the outer corner of the eye. He moved the lancet gracefully back and
forth and upward. There was a small sound and a drop of water came out.
The doctor spoke a few words to comfort the patient and moistened the eye with
milk. He scratched the pupil with the tip or the lancet, without hurting, and then
drove the 'slime' towards the nose. The patient got rid of the 'slime' by drawing it
into his nose. It was a matter of joy for the patient that they could see objects
through his operated eye and the doctor drew the lancet out slowly. He then laid
cotton soaked in fat on the wound and the patient lay still with the operated eye
bandaged.

Sushruta attracted several disciples who were known as Saushrutas and were
required to study for six years before they even began hands-on training in surgery.
They began their studies by taking an oath to devote themselves to healing and to
do no harm to others. After the students had been accepted by Sushruta, he would
instruct them in surgical procedures by having them practice cutting on vegetables
or dead animals to perfect the length and depth of an incision. Once students had
proven themselves capable with vegetation, animal corpses, or with soft or rotting
wood – and had carefully observed actual procedures on patients – they were then
allowed to perform their own surgeries.

These students were trained by their master in every aspect of the medical arts,
including anatomy. Since there was no prohibition on dissection of corpses,
physicians could work on the dead to better understand how to help the living.
Sushruta suggests placing the corpse in a cage (to protect it from animals) and
immersing it in cold water, such as a running river or stream, and then checking on
its decomposition to study the layers of the skin, musculature, and finally the
arrangement of the internal organs and skeleton. As the body decomposed and
became soft, the physician could learn a great deal about how each aspect
functioned and how one could help a patient live a healthier life.

Sushruta recognized that optimal health could only be achieved through a harmony
of the mind and body. This state could be maintained through proper nutrition,
exercise, and rational, uplifting thought. In certain cases, however, when the
patient’s imbalance was severe, surgery was considered the best course. To
Sushruta, in fact, surgery was the highest good in medicine because it could
produce the most positive results more quickly than other methods of treatment.

Sushruta’s holistic view of healing, with an emphasis on the whole patient and not
just on the symptoms presented, should be familiar to anyone in the modern day.
Physicians today work up a medical history of a patient based on questions asked,
research possible genetic causes for a problem, and prescribe treatments ranging
from medical to surgical to so-called “alternative” practices. Further, a physician’s
bedside manner in the modern day is considered important in establishing trust and
encouraging the success of treatment. These practices and policies are considered
innovations when compared with those as recent as the mid-20th century CE, but
Sushruta had already implemented them over 2,000 years ago.