Military surgery (Salyatantra) was a highly developed skill in ancient India, according to P. V. Sharma’s History of Medicine in ancient India.
Many centuries ago, the great sage Sushruta wrote one of the definitive texts of Ayurveda, which came to be know as the Sushruta Samhita. In it Sushruta details a variety of surgical practices, which are comparable to modern practices. For example, below are the different successive steps mention in Sushruta for the treatment of wounds:
- Washing a wound with bactericidal herbal decoction
- Removing all foreign bodies from the wound
- Controlling blood haemorrhages
- Suturing the wound edges
- Applying healing herbal pastes
- Bandaging of the wound.
One ingenious surgical method, that sage Sushruta described, was the use of large ants in the healing of intestinal wounds. The jaws of the ants were used to uniting the two edges of the cut intestines. Sushruta’s method antedates by thousands of years the use of organic adhesives of the present day surgery.
In ancient India, battles between members of the warrior caste were common and were conducted in a ritualistic fashion. A surgeon always accompany the king to the battlefield and was responsible for protecting the king and his army from dangers. These the surgeon had to protect from or deal with:
- poisoned foods, drinks or other articles such as clothing
- detoxifying such materials and treating persons affected by poison
- medical and surgical treatment on the battlefield
- infective diseases spread within the army.
The speciality of the great Ayurvedic sage, Sushruta, was the treatment of wounds. He laid out six different kinds of wound classifications:
- Chinna: severance of a part or a whole limb
- Bhinna: wound puncturing of a hollow organ
- Viddha: wound puncturing of any structure other than a hollow organ
- Ksata: uneven or lacerated wounds
- Picchita: crushed wounds
- Ghrsta: superficial abrasion.
It’s interesting that Sushruta’s wound classification has not changed after many centuries, except for the addition of gunshot wounds.
Sushruta described twelve kinds of fractures (asthibhagna) and six types of dislocations (sandhimukti), along with their symptomatology and management including physiotherapy. Traction, manipulation, apposition and stabilisation were the four principles of fracture treatment. Other examples of his experiments in battlefield surgery are the treatment of head injury and prolapse of the testes.
One of the outstanding contributions of Sushruta was to reconstructive or plastic surgery. In great detail he describes the reconstruction of mutilated noses (rhinoplasty), earlobes (otoplasty) and lips (oroplasty) through the grafting of healthy skin.
Sushruta’s methods of rhinoplasty has stood the test of time and is even mentioned, in modern books on plastic surgery, as the Indian method. According to P. V. Sharma, despite the great advances of present-day reconstructive surgery, hardly any modification has been added that has not already been described by Sushruta.
Other Surgical Operations:
Sushruta used surgical treatments to help with a variety of ailments such as:
- Arsas: haemorrhoids
- Bhagandara: anal fistula
- Asmari: urinary calculi or stones
- Antravrddhi: hernia
- Baddhodara: intestinal obstructions
- Chidrodara: perforation of abdominal organs
- Gulma: abdominal tumors
- Granthi: benign tumors
- Arbuda: carcinoma
- Valmika: actinomycosis – a type of infectious bacterial disease
- Slipada: filariasis – parasitic disease caused by roundworms
- Mudha Garbha: obstructed labour
- Inflammatory and neoplastic diseases of the teeth, gums, palate, tongue and throat, diseases of eyes and ears etc.
The efficacy of some of Sushruta surgical methods have been recognised by modern surgeons and are becoming popular in western countries, e.g. his method of treating anal fistula by plugging it with a thread processed with vegetable alkalies (ksarasutra).
Sushruta’s knowledge of ulcers (vrana) and their treatment is quite detailed. He elaborates on the colour, smell, discharge, nature of pain and other signs and symptoms of different stages of ulcer:
- Dustavrana: the unclean ulcer
- Suddha Vrana: the clean ulcer
- Ruhyamana Vrana: the healing ulcer
- Rudha Vrana: the healed ulcer
He details good and bad medical prognostics and treatment. He describes objective criteria for determining a perfectly healed ulcer, such as the absence of hardness, swelling and pain, the return of normal colour and and normal skin levels.
It was once thought that surgery began to wane and then disappear in India due to the culture of non-violence promoted by the Jainas and Buddhists. Sharma shows this is not the case. He has found that Jain monks carried a medicine chest which contained surgical instruments. Buddhism also championed medical and surgical measures to lessen human suffering. Jivaka, a contemporary and a devotee of Lord Buddha, was an eminent surgeon who performed miraculous cures by his surgical skills. Akasagotta was another Buddhist surgeon of great repute.
Sharma, Priya Vrat. 1992. History of Medicine in India. New Delhi: Indian National Science Academy. Pp. 325-353.