06 - SUSRUTA – SURGEON OF OLD INDIA
That ancient land, India, nurtured man to its breast early in the dawn of civilization. The dry sands of Sind, now in West Pakistan, have revealed to archeologist’s remains of civilizations going back 5000 to 6000 years, and perhaps further- peoples whose well-constructed cities included houses with adjoining bathrooms and wells, and elaborate public drainage systems. Some scholars believe that it was these early people, whose civilization dates from a period contemporary with the early Egyptians and Babylonians that were conquered by Aryans during their invasion from the north, about 1600 B.C. From them, the Aryans learned many civilized ways, and from this amalgamation developed the Aryan Hindu people. The conquering Aryans brought with them a group of dialects belonging to the Indo-European linguistic family; one of these dialects, to which the name Sanskrit was later applied, came to be the polished instrument of literary composition and the vehicle of Hindu civilization through the ages.
The oldest and most sacred book of the Hindus are collectively called the Veda, a word literally signifying knowledge; but in view of the fact that religious knowledge was considered knowledge par excellence, the word Veda should be taken in this specialized sense. The oldest and foremost portion of the Veda is the Rig Veda, consisting of hymns of praise to the various deities of the large Hindu pantheon. There are also some very remarkable hymns of a philosophical and speculative character. The most recent of these collections, and the last to attain canonicity, the Atharva Veda, for the most part consists of various charms and spells designed to ward off the effects of diseases and the incursions of enemies. The Atharva Veda is the earliest document in India in which there may be found allusions to medical subjects, although they are of a somewhat primitive character, and largely permeated by magic and sorcery.
In the course of the centuries, the Hindus greatly improved upon and supplemented the primitive beliefs about medicine in the Atharva Veda, and came to apply to the art of healing the same subtlety of intellect and penetrating study that characterize the many other technical branches of Indian learning. The body of literature that gradually grew up on the subject of medicine is called the Ayur Veda- literally, the “knowledge of life.” The most important medical manuals grouped under the generic name Ayur Veda are: the Charakasamhita or “Compendium of Charaka, “and the Susruta-samhita or Collection of Susruta.”
Among the many distinguished names in Hindu medicine, that of Susruta stands out in particular. Unfortunately, the dates of Susruta’s lifetime, like those of so many other figures in India’s long history, are not definitely assignable. From mention of his name by the famous Arab physician, Rhazes, as well as from accounts of the Chinese Buddhist pilgrim, 1-tsing, and his inclusion among medical authorities mentioned in the famous Bower manuscript (about 350 A.D.) found in Chinese Turkistan in 1890, there can be no doubt that Susruta flourished prior to the fourth century A.D. Certainly this is the very latest period that can be assigned to him. However, several writers have placed him at a much earlier date- sometimes as early as 400 B.C. There is no agreement on this point.
Susruta’s fame rests for the most part on the famous compilation known in Sanskrit as the Susruta- samhita, or, “The Collection of Susruta.” Though this work is mainly devoted to surgery, it also includes medicine, pathology, anatomy, midwifery, biology, ophthalmology, hygiene, and not a little psychology and understanding of what would today be called the “bedside manner.” Susruta attempted to arrange systematically experiences of older surgeons, and to collect scattered facts about medicine into a workable series of lectures or manuscripts.
The accuracy of Susruta’s descriptions and classification of diseases is really remarkable. Much of his great compendium has a modern feeling about it. Of course, the original autographic manuscript of the Susruta-samhita has not survived. Extant only are copies of copies and revisions of revisions, so that the original work for Susruta has been much obscured by centuries of emendation, supplementation, and various kinds of alteration. However, from beneath the layers of all the incrustations of later men’s ideas the original luster of Susruta still shines forth.
Susruta begins his Samhita with an allegorical description of the beginning of medical teaching, but he quickly gets into some very practical suggestions about how a medial student should be selected, how he should be initiated, and the oath he should take (which is strikingly like the Oath of Hippocrates). He also sets forth quite plainly the qualifications of a physician about to enter practice- rules of personal and of professional conduct singularly parallel to those of today. Susruta also urged upon his students continual practice, and outlined many ways for them to perfect their skills before using instruments on patients.
In Hindu society, as in many contemporary ancient societies, punishment of wrongdoers frequently took the form of physical mutilation. Cutting off the nose was the usual punishment for adultery. Such judicial demolitions may perhaps be looked upon as the chief cause for the introduction of plastic surgical measures for repairing disfigured ears or noses, Susruta describes otoplasty in detail: “A surgeon well-versed in the knowledge of surgery should slice off a patch of living flesh from the cheek of a person so as to have one of its ends attached to its former seat [cheek]. Then the part, where the artificial ear lobe is to be made, should be slightly scarified [with a knife] and the living flesh, full of blood and sliced off as previously directed, should be adhesioned to it [so as to resemble a natural ear lobe in shape]…” He then directs that the part shall be anointed with honey and clarified butter, and covered with a cotton and linen bandage, tied neither too loose nor too tight, and dusted with powders of baked clay. He gives full directions for postoperative care, and for shaping the new lobe.
Disease was defined by Susruta as follows; Man is the receptacle of any particular disease, and that which proves a source of torment or pain to him is denominated as a disease. There are four types disease such as, traumatic or of extraneous origin, bodily, mental, and natural.”
Disease could be explained equally well as consequence of sin committed in a former existence (Hindus believe in transmigration of the soul), or derangement of humors. The body was alleged to consist of seven elements- chyle, blood, flesh, fat, bone, marrow, and semen, and each of these is transferred into the following after five days.
As has3 been observed by Keith, “The striking similarity in many points between the Greek and Indian medical systems has long been well known. We find in both such things as the doctrine of humors, whose derangement explains disease, the three stages of fevers, and other disorders which correspond to the Greek.”
While omens, good and bad, were considered important by Hindu Physicians, Sustuta gives extensive directions concerning diagnosis. Questioning of the patient, and examining him with all five senses, was directed. Pulse was studied. Tasting of urine to determine presence of diabetes by the sweetness of the liquid was practiced by Hindu physicians a thousand years before Europeans became aware of this method.
Hindu physicians were good observers, too. They determined constitution by comparing body proportions; and arrived at prognoses not only from omens but from the patient’s features. The description of a dying patient clutching at his bedclothes in the Susruta-samhita is very similar to the classic description, in Hippocrates’ Prognostic. His writings include also excellent descriptions of pulmonary tuberculosis; skin disease, including leprosy; diabetes and urinary diseases; ascites, with reference to liver cirrhosis; and fevers. Hindu doctors were familiar with epilepsy and with other convulsive disorders; with tetanus; hemiplegia; elephantiasis; abscesses; osteomyelitis; and with puerperal fever. They knew scrofula and goiter; and they described venereal diseases. In fact, Susruta mentions no less than 1120 diseases.
Therapy among the Hindus always included prayers and incantations. They used “cleaning” procedures, such as cathartics, emetics, and venesection; but were well aware of dangers involved therein. Diet, too, was considered important. In fact, Susruta seems to have been close to modern nutritional concepts, for he stated that; “Plants should be regarded as partaking of the virtues of the ground they grow upon.”
Drugs derived from plant, animal, and mineral kingdoms were employed extensively. Susruta mentions no less than 760 vegetable drugs; Charaka, some 500. Hindus also had extensive knowledge of poisons, and were specialists in treatment for snake bites.
In the medical texts of the Hindus, there is no mention of a general anesthetic, from which it may be inferred that none was known in ancient days. Susruta, however, distinctly directs that “wine should be used before operation to produce insensibility to the pain of the operation.’ The Hindus also inhaled the fumes of burning Indian hemp (cannabis) as an anesthetic at a period of great antiquity.
Susruta gives a good description of hay fever in this sentence: “Sometimes the pollens of poisonous flowers or grasses, wafted by the winds, invade a town or village, and produce a sort of epidemic cough, asthma, catarrh, or fever, irrespective of all constitutional peculiarities or deranged bodily humors agitated thereby.”
In his foreword to Kashikar’s English translation of Dr.Julius Jolly’s INdische Medicine, J. Filliozat says: “Indian Medicine has played in Asia the same role as the Greek Medicine in the west, for it has spread in Indo-China, Indonesia, Tibet, Central Asia, and as far as Japan, exactly as the Greek Medicine has done in Europe and the Arab countries… The importance of Indian medicine has done in Europe and already been realized by the Greeks of Alexander [331 B.C.].” Yet, through its continuous connection with theology, Hindu medicine tended to remain static. As a whole, Greek medicine had greater influence on the world, because Greeks developed medicine through a completely secular approach to growing science.
In conclusion, it may be noted that the Samhitas of Charaka and Susruta were translated into Persian and Arabic about 800 A.D., and since Arabic medicine became the chief authority for European medicine down to the seventeenth century. Indian ideas undoubtedly have indirectly entered modern Western medicine. Certain it is, in any case, that British physicians learned the art of rhinoplasty form Indian surgeons in the days of East India Company.
Susruta, famed Hindu surgeon, is depicted in the home of a noble of ancient India, about to begin an otoplastic operation. The patient, drugged with wine, is steadied by friends and relatives as the great surgeon sets about fashioning an artificial ear lobe. He will use a section of flesh to be cut from the patient’s cheek; it will be attached to the stump of the mutilated organ, treated with homeostatic powders, and bandaged. Details of this procedure, and of Susruta’s surgical instruments, are to be found in the Susruta-samhita, ancient Indian text on surgery.