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COLUMNS
A LETTER FROM GRANDPA
India’s Sushrut was first surgeon of world
BY NIRANJAN SHAH
My dear Snehi and Sohan:
In last letter, we learnt about the science of surgery in India. India is the first country where surgery was developed in ancient period and is now being followed by modern surgeons. India had many surgeons even before Sushrut as described in Vedic literature, but Sushrut compiled the knowledge and teachings of his guru Divodas Dhanvan-tari, who was a king of Kashi in Sushrut-Samhita. Surgeons used to be associated with kings as mentioned in Riga Veda, Mahabharata and Arthashastra of Chanakya. Panini has mentioned both Charak and Sushrut. So Sushrut can be ascribed a period before Panini. British historians assign Panini 800 B.C., but latest researches show that he happened before 1600 B.C. or even 3000 B.C.
Sushrut encompasses surgery and other Ayurvedic faculties in Sushrut-Samhita. Sushrut details surgical procedures in other specialized branches such as obstetrics, orthopedics and ophthalmology also. For successful surgery, Sushrut induced anesthesia using intoxicants such as wine and henbane (Cannabis indica). A.O. Whipple writes in Story of Wound Healing: “Sushrut must be accepted as a pioneer in some form of anaesthesia.” The depth of his expositions in such a variety of faculties reflects his brilliance and versatility. He asserted that unless the surgeon possessed knowledge of the related branches, he does not attain proficiency in his own field.
Sushrut considered the knowledge of anatomy obligatory for a surgeon and taught dissection of cadavers. He also gives details of human embryology in Sharirsthan. Such detailed observation is today only possible using micros-copy, ultra-sonography and radiology. He mentions about fetus developing seven layers of skin, diseases by genetic inheritance, congenital de-fects acquired from parents, and other modern developments. In addition to general surgery, he deals with trauma and describes six varieties of accidental injuries encompassing almost all parts of body. Besides trauma involving general surgery, Sushrut gives as in-depth account and treatment of 12 varieties of fractures and six types of dislocations, which would confound orthopedic surgeons of today. He mentions principles of traction, manipulation, apposition and stabilization as well as post-operative physiotherapy.
Being a genius and perfectionist in all aspects of surgery, he even attached great importance to a seemingly insignificant factor such as scars after healing. He implored surgeons to achieve perfect healing, characterized by the absence of any elevation or indurations, swelling or mass, and the return of normal coloring. He went as far as prescribing ointments to achieve this, managing to change healed wounds from black to white and vice versa. He also prescribed measures to induce growth of lost hair and to remove unwanted hair. Such minute detailing reflects his deep insight, rendering him the first surgeon in the world history to practice a holistic approach in treating surgical patients. No single surgeon in the history of science has to his credit such masterly contributions in terms of basic classification, thoroughness of the management of disease and perfect understanding of the ideals to be achieved. To Sushrut, health was not only a state of physical well-being, but also mental, brought about and preserved by the maintenance of balanced humors, good nutrition, proper elimination of wastes and a pleasant, contended state of the body and mind.
He defined an ideal surgeon. Says: “He is a good surgeon, who possesses courage and presence of mind, a hand free from perspiration, tremorless grip of sharp and good instruments and who carries his operation to success and advantage of his patient, who has entrusted his life to his surgeon. The surgeon should respect this absolute surrender and treat his patient as his own son.” Sushrut’s excellence in surgery and original insights in all branches of medicines render him the most versatile genius in the history of medical science.
Sushrut grafted skin from the cheek. To aid healing, he prescribed the use of three herbs and cotton wool soaked with sesame seed oil in dressing the graft. After the graft healed, he advocated cutting off the tissue joined to the cheek. Regarding cosmetic surgery, Sushrut could also reconstruct ear lobs and enumerates 15 ways in which to repair them. Through the habit of stretching their earlobes, the Indians became masters in a branch of surgery that Europe ignored for another 2,000 years. Sushrut meticulously details the pre and postoperative procedures. After stitching, for example, he prescribed dressing the lobe by applying honey and ghee, then covering with cotton and gauze and finally binding with a thread, neither too tightly nor too loosely. Torn lips were also treated in a similar manner.
His contributions have withstood the test of more than 3,000 years. In the absence of sophisticated instruments available to us today, his profound observations then may be attributed to two factors: grace of a stalwart guru Dhanvantari and divine revelation through personal sadhana — meditation. These observations of an ancient rishi today continue to intrigue researchers at the Wellcome Institute of the History of Medicine in London and other similar institutions in Europe, the USA and India.
—Grandpa’s blessings
Niranjan Shah, a civil engineer from Baroda, who pioneered famous high-rise buildings in the city, is a broadcaster and a prolific writer. He will cover subjects like Indian culture, history, philosophy and literature, in his feature - “A Letter from Grandpa.” He has given several talks on All India Radio on these subjects. His interests also include production of plays and movies. He lives in Vestal, NY, and can be reached at nshah32@hotmail.com
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