Ancient surgery
India
Varanasi on the banks of the Ganges is one of the holiest places in India. It is both the city of Buddha and a destination of pilgrimage for millions of Hindus who come to bathe in the holy river. It is also the home of Ayurveda, one of the oldest medical disciplines.
Ayurveda means ‘science of life’, and its approach to the body is philosophical and holistic. Among the greatest of its ancient writings is the Sushruta Samhita, which describes the tradition of surgery in Indian medicine.
Its author is believed to have been the scholar Sushruta, who lived over 3,000 years ago. Sushruta is said to have been given his knowledge by an incarnation of the god Vishnu. However, it is also suspected that he was simply reporting medical wisdom that had been passed down by word of mouth for centuries.
Illnesses and instruments
In the book’s 184 chapters, 1,120 conditions are listed, including injuries and illnesses relating to ageing and mental illness. For instance, there are accounts of 76 eye conditions, 51 of which were treated surgically. The book also describes 101 blunt and 20 sharp surgical instruments, many of which are surprisingly similar to instruments used today.
Other treatments are also discussed, comprising 700 healing plants, 57 preparations derived from animal sources and 64 preparations from minerals. One of the plants was used to produce suturing thread that had immunity-boosting properties. Others provided pain relief and still others were natural antiseptics.
Leeches
Sushruta also recommended using leeches to keep wounds free of blood clots. This has only recently been rediscovered and is now used, especially in plastic surgery, to help reduce congestion in tissues, especially in wounds and in flaps used for reconstructing body parts.
Sushruta’s general advice to physicians would certainly apply to doctors anywhere and in any age:
A physician who has set out on this path should have witnessed operations. He must be licensed by the king. He should be clean and keep his nails and hair short. He should be cheerful, well-spoken and honest.
The first nose jobs
The compendium goes on to describe some extraordinary surgical techniques, including a revolutionary nose reconstruction, or rhinoplasty. It was common practice in ancient India to punish criminals by amputating the nose. As a result, Ayurvedic surgeons had plenty of opportunities to practise this.
They would cut a leaf-shaped flap of skin from the forehead, making sure that the end nearest the bridge of the nose remained attached. The flap would be brought down over where the nose should be. Then it would be twisted skin-side-out and sewn into place. Finally, to keep the air passages open during healing, two polished wooden tubes would be inserted into the ‘nostrils’.
In a few weeks, when the graft had bonded and blood vessels had formed, connecting the graft to the person’s face, the place where the graft was still attached would be cut. The secret was to keep the blood flowing. The brilliance of Sushruta’s method was his understanding of the function of blood in the largest organ, the skin.
The Gentleman’s Magazine of Calcutta carried an etching of an Indian bullock driver who had had this operation as late as October 1794.
