N.K. Pattenshetty. 2001. Surgery in Ancient India:
Its Evolution and Progress. In History of Science, Philosophy and Culture
in Indian Civilization. Volume IV Part 2- Medicine and Life Sciences
in India. Edited by B.V. Subbarayappa. New Delhi: PHISPC. Centre
for Studies in Civilizations. Pp. 157-191.
Brief review by
Surgery in ancient India was highly
developed. Even up to the 18th century, before the British came,
plastic surgery was being practiced in India. Pattenshetty has given a detailed
account of the knowledge of surgery in ancient India in the essay quoted above.
The present paper Surgery in
Ancient India: Its Evolution and Progress, appearing in volume IV Part 2
named the Medicine and Life Sciences in India, has been contributed by
N. K. Pattenshetty who specialized in Clinical and Research Methodology. Pattenshetty
was engaged in Rural Medical Service in Karnataka and also taught Ayurveda at
degree and post-graduate levels.
In the very introduction Pattenshetty
tells us that Indian Surgery that forms one of the eight specialties of Ayurveda,
was known as Salya-tantra in ancient texts and that Salya-tantra
had along with the other seven specialties of Ayurveda had reached the
zenith of achievement at an early stage of Indian history. Out of the four Vedas,
the Rigveda, Yajurveda, Samveda and the Atharvaveda that are held
sacred by the Indians, Ayurveda is said to have its origin in the Atharvaveda
compiled sometime during 1000 BC, though Pattenshetty contemplates that knowledge
of surgery in India must have been known many centuries before the Christ. Susruta,
who authored the Susruta-tantra around 400 BC, is usually called
the Father of Indian Surgery. He was the son of Visvamitra and a disciple of
Kasiraja Divodasa Dhanvantari, a renowned surgeon simply known as Dhanvantari.
Susruta’s Susrutatantra is probably the earliest record on surgical
procedures. Until the time of Susruta there was no systematic record
of the treatment procedures, yet Pattenshetty believes that surgery as treatment
of wounds must have been known in India centuries even before him. The paper
tells us that Susruta systematized the scattered knowledge of the various
aspects of surgical techniques and also of allied subjects like obstetrics,
gynecology, pediatrics, geriatrics and ophthalmology, including a description
of anatomy, physiology and pharmacology thus making the Susruta-tantra
one of the most comprehensive compendia of his times. Pattenshetty tells us
that the Susruta-tantra is lost to posterity but its redacted version
by Nagarjuna (5th century AD) is now available by the name
Since the Susruta-Samhita
is the earliest extant record of surgical knowledge in India based on the Susruta-tantra,
Pattenshetty in this paper describes the contents of this Samhita. The
Samhita has been divided into six sthanas or six volumes, dealing
with different aspects of surgery. It is so comprehensive as to include the
fundamental concepts of surgery, knowledge about herbs and drugs, diagnostic
aspects of different diseases, physiological and embryological aspects, therapeutics,
poisons and science of nutrition. It is surprising to find extensive treatment
of subjects like Pediatrics, Ophthalmology, Geriatrics, reproduction and virility,
and social hygiene in this Samhita. It might make us wonder that in this
Samhita a whole volume is devoted to the study and treatment of ailments
through Psychotherapy as well, which has been accorded recognition and happens
to be a rapidly growing science in the modern world. Pattenshetty says that
in any case, going through the Susruta Samhita available now in its redacted
form, we can observe that every subject is classified and explained in a scientific
manner, in the form of groups and sub-groups, divisions and sub-divisions. He
further says, such classifications were possible because of wide practical experience,
close observation and logical interpretations.
Though Pattenshetty in his description
does not use the same pattern of division according to the volumes enumerated
in the Susruta Samhita, yet there is a certain similarity in the two.
The Samhita in its first
sthana or volume enumerates the fundamental concepts of Salya-tantra
or Surgery, which Pattenshetty has divided into eight sections:
1)Vrana and Vranasopha which this paper describes as Wounds
and Inflammation. After the identification of wounds and inflammation separately,
the Samhita describes sixty types of management ‘Sasti Upkrama’ of
these. The subject of inflammation, ulcer and wound, their process of repair
and management occupy relatively greater space in the Samhita.
2) Dagdha-Vranas or Burns and Scalds. Accidental burns are grouped
into four categories depending upon the tissues burnt, which are described as
partial epidermal first degree burns, dermo-epidermal second degree burns, whole
skin thickness third degree burns and fatty and muscle layer fourth, fifth and
sixth degree burns. It is recognized that special kinds of burns such as asphyxiation
by hot fumes, sun stroke, frost-bite and chilblain, burn by extremely hot objects
and burn by lightning required specialized treatment.
3) Sonita sthapanam or Haemostasis is bleeding wounds. The Samhita
divides the detailed procedures of controlling hemorrhage into four groups as
Sandhanam - approximation of wounds, Skandanam - use of coagulants,
Pacanam or cauterization by using caustic drugs and Dahanam- cauterization
by use of hot objects. Pattenshetty tells us that each one of the above measures
is more potent than the previous one and is indicated one after the other to
bring about homeostasis.
4)The next section in this first volume is devoted to Bhagna – fractures
and dislocations. Here Susruta necessarily had to describe the types of bones
found in the body. Pattenshetty says that today we are able to examine an injured
bone directly under radiological examination but in the absence of this Susruta
had evolved this useful and most logical method of determining the types of
fractures by inference. Susruta classified the skeletal injuries into two broad
groups (1) sandhi bhagna or dislocation of joints and (2) asthi bhanga
or fractures. Under this section Susruta also discusses the management of skeletal
injuries through traction, manipulation by pressure, by reduction or apposition
and immobilization. Mention of the management of compound fractures, physiotherapy
and use of splints is also found in this Samhita. Susruta had also identified
the barks and wood of various trees that were found to be useful to serve as
splints. Pattenshetty says that what Susruta suggested several centuries ago
with meager facilities of carrying out clinical investigations is so perfect
that there is hardly any room to permit any alteration at present. The principles
laid down by him indicate the height of development of Indian Surgery during
that remote period.
5)Karna-nasa-ostha Sandhanam or the Ear, Nose and Lip reconstructive
surgery. It is most surprising here to find the mention of Plastic Surgery by
Susruta who described fifteen varieties of repairing torn or defective earlobes.
Pattenshetty says Susruta may be called the father of Plastic Surgery. In addition,
Rhinoplasty or Nasa-Sandhanam and Ostha-Sandhanam or labioplasty
have also been elaborately described by Susruta which are his outstanding contributions.
Till the 19th century this branch of surgery had made little advance
anywhere in Western Countries.
6) Anusastra Karma or Para-Surgery. In para surgery as a specialty
Susruta has advocated the use of Ksara-medicinal caustics and agni-thermo
cauterization. Pattenshetty says there is no cure for these in modern surgery.
He says except for a few varieties of bhagandara-fistula in ano- and
arsus-haemorhoids where surgery was indicated a majority of these ano-rectal
conditions were subjected to para-surgery.
7)Rakta Visarvanam or Rakta Moksanam that is Blood letting.
Susruta seems to have been of the opinion that the onset of a number of diseases
could be prevented by following a proper method of blood letting. He advocated
five types of different methods to let out the vitiated blood. 1. Siravyadha-vene
puncture by certain surgical instruments, 2. Visana-by applying horn,
3. Tumbi-application of bitter gourd, 4. Jalauka- the application
of leeches, and 5. Pada or pracchana-incising by a surgical instrument.
In this section a detailed description of the surgical instruments and accessories
used for the surgical procedures described later in the paper is given, which
can make even the most distinguished of surgeon’s wonder at the ingenuity of
the ancient Indian surgeons. Pattenshetty also gives the diagrammatic representation
of these and also describes the medicaments and types of bandages utilized by
Here Pattenshetty does not use
the name Nidana Sthana for his next heading as accorded to the second
sthana by Susruta and Nagarjuna and names it as Diagnostic methods. The
second volume of the Susruta Samhita deals in the diagnostic methods
as well. Pattenshetty says that Susruta’s method of diagnosing a surgical or
medical disease though connected with the humoral theory in general was not
restricted to mere speculations. He has given explicit instructions regarding
the History-taking and the physical-examination patients. The physical examination
of a patient includes the use of all the five senses on the part of the physician
which is basically the same as the method used these days.
The third broad heading that Pattenshetty
uses is Surgical Training that is quite similar to the third volume - the Sarira
Sthana of the Samhita that deals in the anatomical, physiological
and embryological aspects including pre- and post-natal care of the mother and
child. It deals in knowing the body better and so perhaps rightly named by Pattenshetty
as Surgical Training. Pattenshetty tells us that Susruta happened to be the
first surgeon to evolve a sound method of training for his students in surgical
skills. He stressed the importance of observation and practical experience in
the art of surgery. Further, Pattenshetty says that Susruta might also have
been the first person to advocate dissection of the human body to gain first
hand knowledge of human anatomy. It has been perhaps rightly pointed out by
Pattenshetty that the historians of the western science attribute the evolution
of modern rational medicine to Hippocrates and marginalize the contributions
made by Susruta. Susruta has described the dissection of the human body and
given a vivid description of all the anatomical parts like skin, membranes,
groups of viscera, vital structural and functional components, arterioles, venules,
lymphs and nerves, muscles, ligaments, tendons, bones, joints and vital points,
metabolic byproducts, external orifices and respective passages, network of
plexuses etc. Pattenshetty says that before a student of surgery was granted
permission to practice on human beings he was required to attain a sufficient
amount of skill in various surgical procedures by constant practice on ingeniously
devised experimental models.
Finally, Pattenshetty exposes
the surgical procedure as practiced in the days of Susruta. We are told that
each surgical procedure was a phased programme- Trividha Karma of three
parts. The first was of the Pre-operative measures (Purva Karma), second
the Operative measures (Pradhan Karmas) and the third was of the Post-operative
measures- the Pascat Karma. Here Susruta in addition to emphasis upon
the surgical procedure describes certain procedures to bring the body to as
ideal a state of health as possible. These include restriction of diet, local
application of medicated pigments, local irrigation by liquids, softening by
anointing, sudation or fomentation, resolution, letting out blood, internal
administration of medicated oils, ghee etc, emesis, purgation and poultices
for preventing suppuration etc. Susruta insists that the patients who opt for
elective surgery the above procedures if adopted judiciously may curtail or
prevent the likely complications that may arise during or after the surgery.
As regards the preparation of the surgical instruments for operation they have
to be thoroughly cleaned, sterilized and kept ready for use. The operation is
to be conducted in a separate Agara-Operation Theatre, which should be
free from contamination, even by direct sunlight and air currents. Pattenshetty
says that the principle involved in administering a suitable anesthesia to a
patient in the pre-operative period is again Susruta’s contribution.
Under the operative measures Susruta
describes eight types of surgical procedures. They are Chedanam - Excision,
Bhedanam - Incision, Lekhanam - Scraping or curettage, Vyadhanam
- Puncturing, Visravanam - Drainage, Esanam - Probing, Aharanam
- Extraction by sharp hooks, and Sivanam - Suturing.
Postoperative measures as described
by Susruta include all the measures that should be taken up after the completion
of a surgical procedure till the patient is completely cured of the disease.
He insists that a careful and minute follow up regarding appropriate bandaging,
antiseptic fumigation, dietetics and rest, should be undertaken as post operative
measures. Further, Susruta also recognized that infection could spread from
person to person through close contact, sexual intercourse, inhalation, ingestion
and also by the use of infected objects. Hence, he advised that these should
be guarded against in the patient during the postoperative period of the patient.
Pattenshetty’s paper is an eye
opener for all, who influenced by heresy and the Eurocentric views as regards
the history of science and knowledge suspect the advances made by India in the
yore. Modern medical knowledge with its superior instruments could greatly benefit
from the simplicity of the inferences drawn and the procedures employed in the
medical knowledge contained in the Susruta Samhita. It is time that
the history of science and technology accorded due recognition to the knowledge
of the past, as its bases may be as good in reason, logic, objectivity and inference
as the modern Western knowledge.