Glory of Bharath  »  Scientists of Bharath - Part Seven
Acharya Sushruta

Sushruta was an ancient Indian surgeon (datable to between the 6th century BCE and about the 4th century CE) and is the author of the book Sushruta Samhita, in which he describes over 120 surgical instruments, 300 surgical procedures and classifies human surgery in 8 categories. He lived, taught and practiced his art on the banks of the Ganges in the area that corresponds to the present day city of Benares. In the Sushruta school, the first person to expound ?yurvedic knowledge was Dhanvantari who then taught it to Divodasa who, in turn, taught it to Sushruta, Aupadhenava, Aurabhra, Paushakal?vata, Gopurarakshita, and Bhoja.

Because of his seminal and numerous contributions to the science and art of surgery he is also known by the title "Father of Surgery." Much of what is known about this inventive surgeon is contained in a series of volumes he authored, which are collectively known as the Sushruta Samhita. The "Samhita" has writings that date as late as 600 AD, and some scholars believe that there were contributions and additions to his teachings from generations of his students and disciples. Sushruta is also the father of Plastic Surgery and Cosmetic Surgery since his technique of forehead flap Rhinoplasty (repairing the disfigured nose with a flap of skin from the forehead),that he used to reconstruct noses that were amputated as a punishment for crimes, is practiced almost unchanged in technique to this day. The Sushruta Samhita contains the first known description of several operations, including the uniting of bowel, the removal of the prostate gland, the removal of cataract lenses and the draining of abscesses. Sushruta was also the first surgeon to advocate the practice of operations on inanimate objects such as watermelons, clay plots and reeds; thus predating the modern practice of the surgical workshop by hundreds of years.

Sushruta Samhita
is a Sanskrit redaction text on all of the major concepts of ayurvedic medicine with innovative chapters on surgery, attributed to Sushruta. Cataract surgery was performed by Sushruta before 800 BC. The preserved text dates to the 3rd or 4th century AD. The Sushruta Samhita contains 184 chapters and description of 1120 illnesses, 700 medicinal plants, a detailed study on Anatomy, 64 preparations from mineral sources and 57 preparations based on animal sources. Detailed practical guidance for water purification is given in the famous treatise of Indian physician, Sushruta. Sushruta disclosed that muddy water could be purified with herbs and naturally occurring substances; Nirmali seeds, roots of Kamal (lotus/water lily), rhizomes of algae and three stones, Gomed (garnet) Moti (pearl) Sphatik (quartz crystal) were used. He recommended the disinfection of contaminated water by exposing it to the sun or immersing red hot iron or hot sand in it.

The Sushruta samhita is in two parts, the Purva-tantra in five sections and the Uttara-tantra. Those two parts together encompass, apart from Salya and Salakya, the other specialities like medicine, pediatrics, geriatrics, diseases of the ear, nose, throat and eye, toxicology, aphrodisiacs and psychiatry. Thus the whole Samhita, devoted as it is to the science of surgery, does not fail to include the salient portions of other disciplines too.

In fact, Sushruta emphasizes in his text that unless one possesses enough knowledge of relevant sister branches of learning, one cannot attain proficiency in one's own subject of study. The Samhita is thus an encyclopedia of medical learning with special emphasis on Salya and Salakya. The Sutra-sthana, Nidana-sthana, Sarira-sthana, Kalpa-sthana and Chikitsa-sthana are the five books of the Purvatantra containing one hundred and twenty chapters.

Incidentally, the Agnivesatantra known better as the Charaka Samhita and the Ashtanga Hridayam of Vagbhata also contain one hundred and twenty chapters in all. The Nidana-sthana gives the student the knowledge of etiology, signs and symptoms of important surgical diseases and those ailments, which have a bearing on surgery. The rudiments of embryology and the anatomy of the human body along with instructions for venesection (cutting of veins), the positioning of the patient for each vein, and protection of vital structures (marma) are dealt with in the Sarira-sthana. This also includes the essentials of obstetrics.

Principles of management of surgical conditions including obstetrical emergencies are contained in the Chikitsa-sthana, which also includes a few chapters on geriatrics and aphrodisiacs. The Kalpa-sthana is mainly Visa-tantra, dealing with the nature of poisons and their management. Thus the Purva-tantra embraces four branches of Ayurveda. The Uttara-tantra contains the remaining four specialties, namely surgery, ENT, ophthalmology, pediatrics, psychiatry. The entire Uttara-tantra has been called Aupadravika since many of the complications of surgical procedures as well as fever, dysentery, cough, hiccough, krmi-roga, pandu, kamala, etc., are briefly described here. The Salakya-tantra portion of the Uttara-tantra contains various diseases of the eye, the ear, the nose and the head. Thus the whole Samhita is a comprehensive treatise on the entire medical discipline.

On the whole, the entire Samhita is a complete work on medicine with special attention to Salya and Salakya tantras. The succinct and serious style and overall superiority of the Sushruta samhita led to the extinction of other treatises which preceded this compilation or were contemporary. As a text-book, it is unrivalled in respect of composite teaching of the subject of surgery with reference to all allied branches of medical learning required by a surgeon. It is a forerunner of Vagbhata's Astanga-sangraha.

Sushruta has pointed out that hemorrhage can be arrested by apposition of the cut edges with stitches, application of styptic decoctions, by cauterization with chemicals or heat. That the progress of surgery and its development is closely associated with the great wars of the past is well known. The vrana or injury, says Sushruta, involves breakdown of body-components and may have one or more of the following seats for occurrence, viz., skin, flesh, blood-vessels, sinews, bones, joints, internal organs of chest and abdomen and vital structures. Classically vrana, the wound, is the ultimate explosion of the underlying pathological structure. It is, in Sushruta's words, the sixth stage of a continuous process, which starts with sotha (inflammation). Sushruta says that in the first stage, the ulcer is unclean and hence called a dusta-vrana. By proper management it becomes a clean wound, a suddha-vrana. Then there is an attempt at healing and is called ruhyamana-vrana and when the ulcer is completely healed, it is a rudha-vrana. Sushruta has advocated the use of wine with incense of cannabis for anaesthesia. Although the use of henbane and of Sammohini and Sanjivani are reported at a later period, Sushruta was the pioneer of anaesthesia.

Sushruta describes eight types of surgical procedures: Excision (chedana) is a procedure whereby a part or whole of the limb is cut off from the parent. Incision (bhedana) is made to achieve effective drainage or exposure of underlying structures to let the content out. Scraping (lekhana) or scooping is carried out to remove a growth or flesh of an ulcer, tartar of teeth, etc. the veins, hydrocele and ascitic fluid in the abdomen are drained by puncturing with special instrument (vyadhana). The sinuses and cavities with foreign bodies are probed (esana) for establishing their size, site, number, shape, position, situation, etc. Sravana (blood-letting) is to be carried out in skin diseases, vidradhis, localized swelling, etc. in case of accidental injuries and in intentional incisions, the lips of the wound are apposed and united by stitching (svana).

To obtain proficiency and acquiring skill and speed in these different types of surgical manipulations, Sushruta had devised various experimental modules for trying each procedure. For example, incision and excision are to be practiced on vegetables and leather bags filled with mud of different densities; scraping on hairy skin of animals; puncturing on the vein of dead animals and lotus stalks; probing on moth-eaten wood or bamboo; scarification on wooden planks smeared with beeswax, etc. On the subject of trauma, Sushruta speaks of six varieties of accidental injuries encompassing almost all parts of the body.

Sushruta also gives classification of the bones and their reaction to injuries. varieties of dislocation of joints (sandhimukta) and fractures of the shaft (kanda-bhagna) are given systematically. He classifies and gives the details of the six types of dislocations and twelve varieties of fractures. He gives the principles of fracture treatment, viz., traction, manipulation, appositions and stabilization. Sushruta has described the entire orthopedic surgery, including some measures of rehabilitation, in his work.

As war was a major cause of injury, the name Salya-tantra for this branch of medical learning is derived from Salya, the arrow of the enemy, which in fights used to be lodged in the body of the soldiers. He emphasizes that removal of foreign bodies is fraught with certain complications if the seat of the Salya be a marma. Sushruta also discusses certain surgical conditions of ano-rectal region, he has given all the methods of management of both haemorrhoids and fistulae. Different types of incision to remove the fistulous tract as langalaka, ardhalangalaka, sarvabhadra, candraadha (curved) and kharjurapatraka (serrated) are described for adoption according to the type of fistula.

Sushruta was well aware of the urinary stones, their varieties; the anatomy of urinary bladder along with its relations is well recorded in the chapter on urinary stones. Varieties of stones, their signs and symptoms, the method of extraction and operative complication are given in detail. Apart from the above, surgery of intestinal obstruction (baddha-gudodara), perforated intestines (chidrodara), accidental injuries to abdomen (assaya-bhinna) in which protrusion of omentum occurs are also described along with their management.

Though the contributions of Sushruta are mainly in the field of Plastic and Cataract surgery, a number of his other contributions to medicine are listed below:

Plastic Surgery
Sushruta lays down the basic principles of plastic surgery by advocating a proper physiotherapy before the operation and describes various methods or different types of defects, viz., (1) release of the skin for covering small defects, (2) rotation of the flaps to make up for the partial loss and (3) pedicle flaps for covering complete loss of skin from an area. He has mentioned various methods including sliding graft, rotation graft and pedicle graft. Nasal repair or rhinoplasty has been described in greater detail, which to this day has stood the test of time and is mentioned as the Indian method of rhinoplasty in the books of plastic surgery. Lastly, labioplasty too has received his attention. In short, all the principles of plastic surgery, viz., accuracy, precision, economy, haemostasis and perfection find an important place in Sushruta's writings on this subject.

- October 11
- December 09

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