Sushruta Samhita: Plastic Surgery From 1000 BC

An ancient Indian surgery manual from the first millennium B.C. introduced rhinoplasty to the world.

The hottest place to get a nose job in the first millennia B.C. was on the banks of the river Ganga. There, said to reside in the holy city of Varanasi was Sushruta – the father of Indian plastic surgery. With some wine to drug the patient, a leaf for scale and a sharp knife, you could get a new nose grafted from the skin of your cheek.

Nose jobs were not an undertaking of the vain – in those laws, the laws of Manu held that adulterers would have their noses cut off. Repairing this damage led to Sushruta developing many of the techniques used in rhinoplasty today, in his pinnacle work – the Sushruta Samhita, meaning ‘the compendium of one who has thoroughly learned through hearing.’

What gave Sushruta the necessary medical background? For one, ancient India already had repositories of medical knowledge – the Atharva Veda (3000-1000 B.C.) had descriptions of medical conditions, with 114 hymns devoted to healing methods.

The Charaka Samhita is the first ancient book on Indian medicine, written by Charaka of the University of Taxila between 1000 and 200 B.C., and is the oldest repository of Indian medical knowledge. Written like a medical textbook, it is divided into sections: General Principles, Pathology (Etiology), Specific Determination, 387 News, Notes and Queries Human Embodiment (Descriptive Anatomy), Sensorial Prognosis, Therapeutics, Pharmaceutics and Toxicology, and Success in Treatment.

 

The Sushruta Samhita is believed to have been written between 100-200 years after the Charaka, and where the Charaka is the foundation of Indian medicine, the Sushruta Samhita is its manual on surgery. It has 182 chapters, 1120 medical conditions, 300 surgical procedures and details of 650 drugs. Its depictions of surgical practices are not too out-of-place today, down to the naming of surgical instruments after the animals they resemble. It’s also considered the basis of Ayurveda today

Sushruta was part of a noble lineage of teacher-student. Dhanvantari is considered as an avatar of Vishnu – and is the physician of the gods. He is believed to have taught his discipline Devodasa, who in turn trained Sushruta. Continuing this practice, Sushruta taught surgery at the then-university of Benares.

Studying the human body was fraught with limitations. Hindu law prevented them from laying knife to a human body. To overcome this, Sushruta came up with an elaborate scheme of laying cadavers in a slowly-flowing river and allowing them to decompose for seven nights. Following this, course brushes would be rubbed across the body which would expose all the major organs and bones.

Students were made to practise surgery on fruits like gourds and cucumbers before being allowed to work on bodies. In those days, medical training was taken seriously – with a Vedic version of the Hippocrates oath being administered to would be practitioners. Mentioned in the Charaka, the Oath of Initiation calls for students to have an utmost devotion to their teachers, to live lives of celibacy (during their training) and to not go against the King in any manner.

There is no limit at all to the Science of Life, Medicine. So thou shouldst apply thyself to it with diligence. This is how thou shouldst act. Also thou shouldst learn the skill of practice from another without carping. The entire world is the teacher to the intelligent and the foe to the unintelligent.

An exhaustive list of all of Sushruta’s findings would excite a modern-day medical student – who would see terms like cauterizing, ophthalmic surgery (cataract removal), endoscopy and caesarean mentioned (in Sanskrit equivalent) therein. An interesting point of note is his categorization of thermogenic trauma – wounds caused by extreme heat or cold – as causing similar damage enough to be treated as one category. Modern science picked up on this only in 1950.

 

He also mentions diabetes, calling it Medumeha, and links it to obesity and a sedentary lifestyle. His recommendation? Exercise.

The rhinoplasty procedures invented by Sushruta were kept in practice in India for centuries. It was only in 1793 that two surgeons of the British East India company observed it in practice. Publishing the results in Madras Gazette. The idea of a man losing a nose only to get a new one grafted on must have been alien to readers, as a letter published in 1784 testifies:

Cowasjee, a Mahratta of the caste of the husbandmen, he was a bullock driver with the English Army in the war of 1792, and was made prisoner by Tipu Sultan, who cut off his nose and one of his hands. He joined the Bombay Army near Seringapatam. For about 1 year he remained without a nose, when he had a new one put on by a man of the Brickmaker (potter’s) caste near Poona.

By the 20th century, rhinoplasty had been disseminated to the world.

If there is any lesson we can take from the first millennia B.C., it’s that the culture of experimentation that Sushruta demonstrated is one that India needs to foster today. Good medical knowledge gleaned through rigour and experiment does not die out anytime soon.

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