Maharishi Shushruta

He is a legendry scholar of the Indian medical science and founding father of surgery. 2600 Yrs ago Maharishi Shushruta together
with his colleagues had conducted the variety of complex surgeries such as caesareans, artificial limbs, cataract, urinary stones,
fractures, and most specially the plastic surgery. A famous book (Shalya Tantra) has been described by the Shushruta about all the
surgical procedures. Shalya Tantra was later named as the Sushruta Samhita (have details about the ancient medical science of India,
well known as the Ayurveda). Maharishi Shushruta is the author of Sushruta Samhita in Sanskrit language and had described all the
amazing surgical procedures with the accuracy and curative efficacy. His great findings have become an essential component of the
Indian culture.

Maharishi Shushruta, a great sage, is commonly considered as the son of wise Visvamitra (According to the scholar’s, he was not the
Visvamitra of the Vedic period). The father of the Sushruta Samhita was the first person who had classified the surgical operations
and explained the plastic surgery as well as its tools in his book of 120 chapters in five parts. He had described around eight special
operations for surgery, such as the cutting, piercing, opening, scratching, inserting, and stitching. Maharishi Shushruta had worked as
both, the practitioner and the teacher of surgery. His contribution towards the Indian traditional medicine and the ancient cultural
heritage of India will always be a precious.

After his great writing, he had become very famed personality and his writing was first translated into the Arabic language (as a Kitab-
i-Susrud in the 8th cen CE). Consequently, it got translated into the Latin and English languages. Maharishi Shushruta had become a
worldwide legend and famous in many areas like doing surgery of the eye, amputations of the limbs and handling various
complications after childbirth. His redaction text, the Sushruta Samhita consists of 184 chapters and explanation of 1120 illnesses,
detail about 700 medicinal plants, a detailed study on Anatomy, 64 research from mineral sources and 57 research based on the
animal sources. Sushruta Samhita is the key reference book for all the ayurvedic surgeons.

The Sushruta samhita has two parts, first one is known as the Purva-tantra (have five sections) and the second one is known as the
Uttara-tantra. These two parts together cover all the other specialties such as the medicine, geriatrics, pediatrics, ear diseases,
diseases of the nose, throat, eye, aphrodisiacs, toxicology, and psychiatry. Hence, The Sushruta samhita is an encyclopaedia of the
medical learning for doctors with special importance on the Salya and Salakya. There are five books of the Purvatantra having 120
chapters are Sutra sthana, Sarira sthana, Nidana sthana, Chikitsa sthana and Kalpa sthana. The Agnivesatantra is commonly known
better as the Charaka Samhita. One of the five books, the Nidana-sthana provides the knowledge of aetiology to the medical
students.

Having knowledge about the aetiology, signs symptoms of various significant surgical diseases and their ailments, was not easy
before the Sushruta samhita. The following has been described in detail in the Sarira sthana, the rudiments of embryology as well as
the anatomy of the human body in conjunction with the instructions for venesection, essentials of obstetrics, positioning of the
patient according to each vein, safety of the vital structures and may more. The Chikitsa sthana contains the principles of managing
various surgical conditions including the obstetrical emergencies, geriatrics and aphrodisiacs.

The Kalpa sthana is generally known as the Visa tantra which describes the nature of poisons as well as the management. Hence, the
Purvatantra holds four branches of Ayurveda. And the Uttaratantra holds the other four specialties that are Salakya, Kayacikitsa,
Kaumarabhfefefrtya and Bhutavidya. The Uttaratantra is entirely known as the Aupadravika (have description of many complications
of surgical procedures like hiccough, fever, krmi-roga, pandu, dysentery, cough, kamala, etc. The Salakyatantra has description of the
various diseases of eye, ear, nose and head.

Maharishi Shushruta has described in his writings that the hemorrhage can be easily arrested by the apposition of cutting edges with
the stitches, through the cauterization with chemicals or heat and application of styptic decoction etc. According to the Shushruta,
the wound is an ultimate abrasion of the underlying pathological structure which starts with the inflammation. He says that the ulcer
is totally unclean in the first stage, so it is called as the dusta vrana. And by only suitable management it changes to a clean wound,
known as suddha vrana. The healing attempt is called as ruhyamana vrana and after complete healing it is known as the rudha vrana.

He was the pioneer of anesthesia and has promoted the proper use of wine with incense of cannabis for the anesthesia purpose. The
use of henbane and Sammohini and Sanjivani was started in the later period. He had explained the eight types of surgical procedures
such as the excision, incision, scraping, puncturing, probing, sravana, apposition, stitching. He had developed the variety of
experimental modules for practicing surgical procedures. Incision and excision can be practiced on the vegetables or on the leather
bags filled with mud of different densities. He had also classified the bones along with their reaction to injuries. He had described the
six types of dislocation of joints and twelve varieties of fractures of the shaft together with the principles of fracture treatment such
as traction, manipulation, appositions and stabilization.

Sushruta discussed the surgical conditions of ano-rectal region and provided all the methods of managing both haemorrhoids and
fistulae. Sushruta was well known about the urinary stones, varieties of stones, signs symptoms, method of removal, operational
complications as well as the anatomy of urinary bladder. Apart from all above, he had described the surgery of intestinal obstruction,
perforated intestines, abdomen accidental injuries which involves the protrusion of omentum. His main contribution was towards the
field of Plastic and Cataract surgery.

Plastic surgery

He had described all the basic principles of plastic surgery by offering a suitable physiotherapy before operation. The technique of
the release of skin in order to cover all the small defects, rotation of the flaps to heal the partial loss and the pedicle flaps to cover the
entire loss of skin from an area are well described by him. He has given various other methods together with the rotation graft,
sliding graft, pedicle graft, rhinoplasty, labioplasty in his Samahita.
Legacy

The Bower manuscript which was founded in a Buddhist monastery in Chinese mentions the name of Susrutha as one of the 10 sages
from Himalayas. It is reported that the first Indian rhinoplasty was performed by the local Vaidya of Koomhar caste using skin of the
forehead. It is considered that he was the descendants of Brahma’s son and he performed his rhinoplasty in front of two British
surgeons. Joseph Constantine Carpue was another who was able to perform the Indian rhinoplasty.
 Maharishi Sushruta
During the 6th century BCE, an Indian physician named Sushruta - widely regarded as the 'Father of Indian Medicine' and 'Father of Plastic Surgery' - wrote one of the world's
earliest works on medicine and surgery.

Sushruta lived in the ancient city of Kashi, now known as Varanasi or Banaras in the northern part of India.
Sushruta Samhita
Sushruta is known for his pioneering operations and techniques and for his influential treatise 'Sushruta Samhita' or Compendium of Sushruta, the main source of knowledge about
surgery in ancient India.
Written in Sanskrit, the Sushruta Samhita dates back to the times before Christ and is one of the earliest works in the field of medicine. It forms the foundations of the ancient
Hindu form of medicine known as Ayurveda and is highly regarded as one of the 'Great Trilogy of Ayurvedic Medicine.'
The Sushruta Samhita documented the etiology of more than 1,100 diseases, the use of hundreds of medicinal plants, and instructions for performing scores of surgical
procedures - including three types of skin grafts and reconstruction of the nose.
The influential nature of the Sushruta Samhita is supported not only by anatomical knowledge and surgical procedural descriptions contained within its pages but also by the
creative approaches that still hold true today.
Skin grafts entail transplanting pieces of skin from one part of the body to another. Today, surgeons use skin grafts to restore areas that have lost protective layers of tissue due to
trauma, infection, burns, as well as to restore areas where surgical intervention has created a loss of skin, as can happen with melanoma removal. Some grafts include blood vessels
and muscle, such as in reconstructive breast surgery.
ADVERTISEMENT

Origin of Rhinoplasty
Rhinoplasty, colloquially known as the 'nose job,' is a surgery performed to achieve two results:
 To improve the breathing function of the nose
 To improve the cosmetic look of the nose
Sushruta's treatise provides the first written record of a forehead flap rhinoplasty, a technique still used today to reconstruct a nose. He used a flap of skin from the forehead,
called a pedicle, to form a new nose.
The nose in Indian society has remained a symbol of dignity and respect throughout antiquity. In ancient times, amputation of the nose was frequently done as a punishment for
criminals, war prisoners or people indulged in adultery.
The practice of Rhinoplasty slowly started as a result of the need to reconstruct the external nose and later developed to full-fledged science.
The Sushruta Samhita is regarded as the earliest document to give a detailed account of rhinoplasty. (Image: ncsm.gov.in)
 Other contributions by Sushruta
1. Besides trauma involving general surgery, Sushruta gave an in-depth account of the treatment of 12 varieties of fracture and six types of dislocation. This continues to
spellbind orthopedic surgeons even today.
2. He mentioned the principles of traction, manipulation, apposition, stabilization, and postoperative physiotherapy.
3. Sushruta also prescribed measures to induce growth of lost hair and removal of unwanted hair.
4. He implored surgeons to achieve perfect healing which is characterized by the absence of any elevation, induration, swelling mass, and the return of normal coloring.
Plastic surgery in ancient India
Plastic surgery and dental surgery were practiced in India even in ancient times. Students were properly trained on models and were expected to study for at least six years before
starting their training. Before beginning the training, the students were required to take a solemn oath. Sushruta taught his surgical skills to his students on various experimental
models.
Incision on vegetables such as watermelon and cucumber, probing on worm-eaten woods are some instances of his experimental teachings. He was one of the first people in
human history to suggest that a student of surgery should learn about the human body and its organs by dissecting a dead body.
According to Sushruta, "Anyone, who wishes to acquire a thorough knowledge of anatomy, must prepare a dead body and carefully observe and examine all its parts."
The method of study was to submerge the body in water and allow it to decompose followed by an examination of the decomposing body at intervals to study structures, layer by
layer, as they got exposed following decomposition.
The most important point to note here is that the dissection was performed without a knife.
Golden age of surgery
Sushruta Samhita remained preserved for many centuries exclusively in the Sanskrit language. In the eighth century AD, Sushruta Samhita was translated into Arabic as 'Kitab
Shah Shun al -Hindi' and 'Kitab-I-Susurud.'
The first European translation of Sushruta Samhita was published by Hessler in Latin and in German by Muller in the early 19th century; the complete English literature was done
by Kaviraj Kunja Lal Bhishagratna in the three volumes in 1907 in Calcutta.
ADVERTISEMENT
Sushruta took surgery in medieval India to admirable heights and that era was later regarded as the 'Golden Age of Surgery' in ancient India. The genius of Sushruta prompted
eminent surgeon Allen Whipple to declare, "All in all, Sushruta must be considered the greatest surgeon of the pre-medieval period."