Indore, India (Winter 2016)
Through all of Sushruta’s flowery language, incantations and irrelevancies, there shines the unmistakable picture of a great surgeon.
Undaunted by his failures, unimpressed by his successes, he sought the truth unceasingly and passed it on to those who followed.
He attacked disease and deformity definitively, with reasoned and logical methods
– Frank McDowell In “The source book of plastic surgery”, 1
Sushruta, Surgeon of Old India
Sushruta, one of the founding fathers of surgery and plastic surgery, lived in India sometime between 600 to 1000 B.C. His Sushruta Samhita (Sushruta’s compendium), one of the most outstanding treatises in Indian medical literature, describes the ancient tradition of surgery in India. He lived, taught, and practiced in what presently corresponds to the city of Varanasi (Kashi, Benares), and is remembered especially for his innovative method of rhinoplasty.2,3,4,5
Sushruta also commented on diabetes, referring to it as madhumeha;6 and is mentioned in ancient birch bark medical treatise Bower Manuscript discovered in Kuchar (present day China), dated around AD 450, and preserved in Bodleian Library in Oxford.4 He wrote that “any one wishing to acquire a thorough knowledge of anatomy, must prepare a dead body and carefully observe and examine all its parts”. As he wrote in Sanskrit, his text was only slowly disseminated to the west and other parts of the world. Around AD 360-350 the Buddhist scholar Vasubandhu revised and rewrote the original text in simplified language
Sushruta Samhita was translated into Arabic as Kitab-Shaw Shoon-a-Hindi and Kitab-i-Susrud in the eighth century A.D on orders of the Caliph Mansur (A.D.753 -774). The first European translations were published by Hessler into Latin and by Muller into German in the early 19th century. The first complete English translation was done by Kaviraj Kunja Lal Bhishagratna in three volumes in 1907 at Calcutta.7.
Sushruta developed surgical techniques for reconstructing noses, earlobes and genitalia, many amputated as religious, criminal, or military punishment. He developed the forehead flap rhinoplasty procedure that remains contemporary plastic surgical practice; also the otoplastic technique for reconstructing an earlobe with skin from the cheek. In Sushruta Samhita he describes the free-graft rhinoplasty as follows:
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 the castor-oil plant in the position of the nostrils, so that the new nose has proper shape. The skin thus properly adjusted, it should then be sprinkled with a powder of liquorice, red sandal-wood, and barberry plant. Finally, it should be covered with cotton, and clean sesame oil should be continually 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 endeavour made to enlarge or shorten it. (Sushruta Samhita 1.16)
The famous Indian Rhinoplasty (reproduced in the October 1794 issue of the Gentleman’s Magazine of London) is a modification of the ancient Rhinoplasty described by Sushruta in 600 B.C. Even today pedicle forehead flap is referred to as the Indian flap.
Regarding anesthesia Sushruta wrote “Wine should be used before operation to produce insensibility to pain. The patient who has been fed, does not faint, and he who is rendered intoxicated, does not feel the pain of the operation.”
Sushruta is considered to be the first surgeon to have removed cataracts, describing varieties of cataracts along with the depression method of couching by the anterior root. A.O. Whipple in his The Story of Wound Healing Repair wrote “All in all Sushruta must be considered the greatest surgeon of the pre medieval period.”8And in his short history of medicine Ackernecht aptly observed ”There is little doubt that plastic surgery in Europe which flourished in medieval Italy is a direct descendant of classical Indian surgery.”9
- Frank McDowell. The Source Book of Plastic Surgery. Baltimore; Williams and Wilkins Company: 1977:5-85.
- Eisenberg I. A history of rhinoplasty. South Afr Med J 1982; 82: 286-92
- Wise TA. Commentary on the Hindu system of medicine. Thacker: Calcutta; 1845:1.
- Hoernle AF. Studies in the medicine of ancient India. Clarendon Press: Oxford; 1907:109.
- Johnston-Saint P. An outline of the history of medicine in India. Indian Med Rec 1929; 49:289.
- Krall LP, Levine R, Barnett D. The history of diabetes. In: Kahn CR, Weir GC, editors Joslin’s Diabetes Mellitus; 13th edn. Philadelphia: Lea and Feibiger; 1994: pp 1-2.Sushruta Samhita. English translation by Kaviraj Kunja Lal Bhishagratna, Calcutta, 1907, Chapter 16, 152-154.
- Whipple AO. The Story of Wound Healing Repair . Springfield, Illinois: Charles C Thomas, 1963. p 18.
- Ackernecht EH. A short history of medicine. Johns Hopkins University Press: 1982:41.
DR. SATISH SAROSHE obtained his M.B.B.S, M.D with specialization in community medicine and is Assistant Professor in the Department of Community Medicine M.G.M Medical College Indore, a government medical college affiliated with the Devi Ahilya University Indore. He is Sentinel Surveillance monitor for Government of India National AIDS Control Program, and is associated with UNICEF, UNFPA WHO through various public health projects. His interest is epidemiology and biostatistics.
Highlighted in Frontispiece Winter 2016 – Volume 8, Issue 1