The vast medical literature of ancient India remains, as yet, unexplored. Due to the limitations of language and the long history of India under constant invasions, the results of researches done by our ancient Rishis remain in a sad state of neglect.
Shalya, or Surgery, is one of the eight departments of Ayurveda. Shalya means broken arrow or a sharp part of a weapon and Tantra means maneuver. Shalya Tantra embraces all processes, aiming for the removal of factors responsible for producing pain or misery to the body or mind. In the work of Sushruta it occupies the first place. Medicine and Surgery, though part of the same science are treated as distinct branches.
Sushruta is the father of surgery. Sushruta is reverentially held in Hindu tradition to be a descendent of Dhanvantari, the God of medicine. Sushruta lived 2000 years ago in the ancient city of Kashi, now known as Varanasi or Banaras in the northern part of India. The definition of an ideal surgeon according to the great surgeon Sushruta is:
“A person who possesses courage and presence of mind, a hand free from perspiration, tremor-less grip of sharp and good instruments and who carries his operations to the success and advantage of his patient who has entrusted his life to the surgeon. The surgeon should respect this absolute surrender and treat his patient as his own son.”
Charaka, Atreya, Hartia, Agnivesha, and others are accepted as guides more in medicine than in surgery while Dhanvantari, Sushruta, Aupadhenava, Aurabhra, Paushkalavata, and others were surgeons rather than physicians, having written elaborate works on the art of healing by mechanical and instrumental means.
When a patient requires a surgical procedure, the physician says to his patients, “Atra Dhavantarinam adhikaras kriyavidhau”, meaning, “It is for the surgeon to take in hand this case.” There is no doubt that ancient surgery was lacking in comparison to modern science, but, that should in no way stop us from giving due acknowledgment to the ancients.
Surgical instruments used by the ancient Hindus are very small when compared with the armamentarium of a surgeon of the twenty-first century. The reason for this is that the instruments the ancient Hindus used were enough for their requirements because most of the diseases now dealt with by the surgeon were then cured medicinally. For example, an abscess was made to subside using certain kinds of plasters. Cases of urinary calculi were treated with antilithics and diuretics were administered so as to act as solvents for the stone. Surgery was the last resort and avoided unless extremely necessary.
Yet, the ancient Hindus’ earliest works mention no less than one hundred and twenty five surgical instruments for ophthalmic, obstetric, and other operations. They were experts in forming new ears and noses.
On this subject Dr Hirschberg of Berlin says, “The whole plastic surgery in Europe had taken its new flight when these cunning devices of Indian workmen became known to us. The transplanting of sensible skin flaps is also an entirely Indian method.” The same writer also gives credit to the Indians for discovering the art of cataract couching, “which was entirely unknown to the Greeks, the Egyptians, or any other nation.” The cataract operations are, it is said, performed by Indian practitioners with great success even to this day. The Hindus were also experts in performing amputations.
Another interesting case to look at is related to smallpox. Inoculation for smallpox seems to have been known to Hindus from a very early age.
Long before Edward Jenner was born, certain classes in India, especially cowherds, shepherds, and the like had been in the habit of collecting and preserving the dry scabs of pustules. They used to place a small amount of this on the forearm and puncture the skin with a needle. As a result of this inoculation, the classes are supposed to have enjoyed a certain amount of immunity from smallpox.
Sushruta classifies surgical procedure into the following classes:
Aharya – extracting solid bodies
Bhedya – excising
Chhedya – incision
Eshya – probing
Lekhya – scarifying
Sivya – suturing
Vedhya – puncturing
Visravaniya – evacuating fluids
Proper guidelines adopted for a successful surgical procedure were:
The surgeon, before commencing an operation, must equip himself with all the requisites, such as the instruments, salts, bandages, honey, oil, water, etc.
For successful surgery, Hindus induced anesthesia using intoxicants such as wine and henbane (Cannabis indica).
The surgeon should have practical experience of his art, and should have seen many surgical operations performed by others. He should be intelligent, steady, skillful, and should execute his work with a light hand.
The patient should be allowed to take light food before any operation is performed upon him. Intake of food should be avoided in case of abdominal operations.
After the operation is completed, Sesamum poultice should be applied on the wound and a cloth bandage be tied round it.
An incense should be kept burning in the operational room (often medicinal herbs like Neem).
The surgeon should not leave his patient without offering a prayer to the Gods for his speedy recovery.
The wound must be dressed at regular intervals until it is all healed up.
As stated in the blog earlier, there are in total one hundred and twenty-five surgical instruments mentioned for surgical procedures. These are grouped under two heads — Yantras (appliances) and Shastras (instruments).
There are in total 105 yantras, grouped into six categories as:
Svastikas – forceps and pincers, twenty-four in number
Sandashas – tongs, two types
Talas – two types
Nadis – tubular instruments like catheters, twenty varieties
Shalakas – bougies, thirty types
Upayantras – dressings like cloth, twine, etc., twenty-six in number
The last, but most indispensable implement in surgical operations is,
Hand, undisputedly the best surgical instrument.
On the other hand, Shastras (instruments) are twenty in number.
They are :
(1) Ardhadhara
(2) Atimukha
(3) Ara
(4) Badisha
(5) Dantashanku
(6) Eshani
(7) Karapatra
(8) Kartarika
(9) Kritharika
(10) Kijshapatra
(11) Mandalagra
(12) Mudrika
(13) Nakhashastra
(14) Shararimukha
(15) Sucm
(16) Trikurchaka
(17) Utpalapatraka
(18) VriddhiPatra
(19) Vrihimukha, and
(20) Vetaspatra.
In order to acquire precision in surgery, the preceptors made their pupils practise different operations on various objects. Incision, for instance, was practised on Pushpaphala (Cucurbita maxima), Alabu (Langenaria vulgaris), Kalinda (Citrullus vulgaris), Trapu (Cucumis pubescens), and other fruits; scarification on the fresh hides of animals on which the hair was allowed to remain; venesection was practised on the vessels of dead animals and on the stalks of the water lily; the art of probing and stuffing on bamboo, reed, cavities of wood and on dry Alabu extraction of solid bodies on Panasa (Artocarpus integrifolia), Bilva (Aegle Marmelos), Bimbi (Cephalandra indica), and on the teeth of dead animals. Ligaturing and bandaging were practised on dummies; application of caustics and the actual cautery on pieces of flesh and catheterization on an unbaked earthen vessel filled with water.
Sushruta took surgery in medieval India to admirable heights and is rightfully regarded as the Father of Surgery. Sushruta’s brilliance is astounding when it comes to surgical science. The lost art of Indian Medicine deserves investigation and preservation.
