INDIA
As with other Ancient civilisations, there is much controversy concerning the early dating of Indian
culture in general and the development of surgery in particular. In about 1500 bc, the Aryans invaded the Indian subcontinent from Central Asia and brought with them the Sanskrit language. The earliest writings on Indian medicine are to be found in the Vedas, the books of knowledge, which were believed to be of divine origin. Here we can read of sages who would carry bags of healing herbs and who would care for the injured, remove arrows and spears from the wounded, and who would employ a plant named after the god Soma, which would relieve pain. In addition, they would cauterise wounds and snake bites and might even have developed a catheter to relieve retention of urine and which would ‘open the flow of urine again like a dam before a lake’.
The earliest Indian surgical author was Susruta.
It will probably never be ascertained whether he
was an actual historical personage or a name to
which collected works of surgical literature are attributed. The time of his existence is also vague,
but it was some time after Christ. His works were translated into Arabic around ad 800 and are often
quoted in the writings of Rhazes.
Susruta stressed the following requirements for students who wished to study medicine and
surgery. They should be of tender years, born of a good family, possess the desire to learn, have
strength, energy of action, contentment, character,self-control, a good retentive memory, intellect,
courage, purity of mind and body, have clear comprehension,
command a clear insight into the things studied and should have thin lips, thin teeth
and thin tongue and be possessed of a straight nose, large, honest, intelligent eyes, with a benign contour of mouth and a contented frame of mind, be pleasant in speech and dealings and painstaking in
their efforts. Even today, it would be difficult to find medical students who are such paragons of virtue!
Today, much emphasis is placed on surgical training using models to improve technique. The
writings of Susruta include advice on how surgeons should practise the art of suturing on animal
skins or strips of cotton, improve their bandaging on life-sized dolls, practise surgical incisions on
watermelons or cucumbers, cauterise a piece of meat before trying this method on their patients
and practise the ligature of blood vessels and of bloodletting on lotus stems and the veins of dead
animals. A disciple was expected to study for a period of at least 6 years.
It is quite evident that Hindu surgery at this time had reached a high state of excellence. For example,
there is a detailed description of the operation for removal of a cataract, in which the opaque lens of
the eye is mobilised and then pushed downwards
into the lower part of the globe to allow restoration
of vision:
In the morning in a bright place, the temperature being moderate, let the
surgeon sit on a bench as high as his knee opposite the patient. The latter,
having washed and eaten and been tied,sits on the ground. After he has warmed
the patient’s eye with the breath of his mouth, rubbed it with his thumb
and detected the uncleanness which has formed in the pupil, he orders the
patient to look down at his nose. Then,while the patient’s head is held firmly,
he takes the lancet between his forefinger and middle finger and thumb and
introduces it into the eye towards the pupil, on the side, half a finger’s breadth
from the black of the eye (the pupil) and a quarter of a finger’s breadth from
the outer corner of the eye. He moves it back and forth and upwards. Let him
operate on the left eye with the right hand or on the right side with the left.
If he has probed correctly, there is a sound and a drop of water comes out
painlessly. Speaking words of courage to the patient, let him moisten the eye
with women’s milk, then scratch the pupil with the tip of a lancet without
hurting. If the patient can see objects, the doctor should draw the lancet out
slowly, lay cotton soaked in fat over the wound and let the patient lie still with
bandaged eyes
Susruta also describes what must have been
the earliest plastic surgical procedure, the restoration
of an amputated nose by means of a skin
graft turned down upon the forehead. Removal of
the nose was a punishment for adultery in those
days, so there was no shortage of patients for this
procedure. Interestingly, it evidently remained
in practice in India among itinerant surgeons for
hundreds of years. A newspaper account of this
in 1814 prompted Joseph Carpue of London to
perform a very similar operation, using the forehead
skin flap, with success in two army officers
(Figure 2.11).
The first patient had lost his nose from syphilis.
A forehead flap was fashioned and stitched around
the defect. The viability of the flap gave some initial
anxiety, but it fortunately recovered and the cosmetic
result was good. The second patient, another
officer, was a hero of the battle of Albuera, in the
Peninsular War in 1810. In saving the regimental
colours, the poor fellow lost an arm and sustained
five other wounds, one taking off part of the cheek
and the nose. Again, the operation was a success.
Carpue was born in 1764 in Hammersmith.
He was a catholic, who first considered entering
the Church, but instead studied at St George’s
Hospital under Sir Everard Home, becoming a
member of the Company of Surgeons in 1798. The
following year, he was appointed to the surgical
staff at the Duke of York’s Hospital, Chelsea. He
died in 1846.
As with other Ancient civilisations, there is much controversy concerning the early dating of Indian
culture in general and the development of surgery in particular. In about 1500 bc, the Aryans invaded the Indian subcontinent from Central Asia and brought with them the Sanskrit language. The earliest writings on Indian medicine are to be found in the Vedas, the books of knowledge, which were believed to be of divine origin. Here we can read of sages who would carry bags of healing herbs and who would care for the injured, remove arrows and spears from the wounded, and who would employ a plant named after the god Soma, which would relieve pain. In addition, they would cauterise wounds and snake bites and might even have developed a catheter to relieve retention of urine and which would ‘open the flow of urine again like a dam before a lake’.
The earliest Indian surgical author was Susruta.
It will probably never be ascertained whether he
was an actual historical personage or a name to
which collected works of surgical literature are attributed. The time of his existence is also vague,
but it was some time after Christ. His works were translated into Arabic around ad 800 and are often
quoted in the writings of Rhazes.
Susruta stressed the following requirements for students who wished to study medicine and
surgery. They should be of tender years, born of a good family, possess the desire to learn, have
strength, energy of action, contentment, character,self-control, a good retentive memory, intellect,
courage, purity of mind and body, have clear comprehension,
command a clear insight into the things studied and should have thin lips, thin teeth
and thin tongue and be possessed of a straight nose, large, honest, intelligent eyes, with a benign contour of mouth and a contented frame of mind, be pleasant in speech and dealings and painstaking in
their efforts. Even today, it would be difficult to find medical students who are such paragons of virtue!
Today, much emphasis is placed on surgical training using models to improve technique. The
writings of Susruta include advice on how surgeons should practise the art of suturing on animal
skins or strips of cotton, improve their bandaging on life-sized dolls, practise surgical incisions on
watermelons or cucumbers, cauterise a piece of meat before trying this method on their patients
and practise the ligature of blood vessels and of bloodletting on lotus stems and the veins of dead
animals. A disciple was expected to study for a period of at least 6 years.
It is quite evident that Hindu surgery at this time had reached a high state of excellence. For example,
there is a detailed description of the operation for removal of a cataract, in which the opaque lens of
the eye is mobilised and then pushed downwards
into the lower part of the globe to allow restoration
of vision:
In the morning in a bright place, the temperature being moderate, let the
surgeon sit on a bench as high as his knee opposite the patient. The latter,
having washed and eaten and been tied,sits on the ground. After he has warmed
the patient’s eye with the breath of his mouth, rubbed it with his thumb
and detected the uncleanness which has formed in the pupil, he orders the
patient to look down at his nose. Then,while the patient’s head is held firmly,
he takes the lancet between his forefinger and middle finger and thumb and
introduces it into the eye towards the pupil, on the side, half a finger’s breadth
from the black of the eye (the pupil) and a quarter of a finger’s breadth from
the outer corner of the eye. He moves it back and forth and upwards. Let him
operate on the left eye with the right hand or on the right side with the left.
If he has probed correctly, there is a sound and a drop of water comes out
painlessly. Speaking words of courage to the patient, let him moisten the eye
with women’s milk, then scratch the pupil with the tip of a lancet without
hurting. If the patient can see objects, the doctor should draw the lancet out
slowly, lay cotton soaked in fat over the wound and let the patient lie still with
bandaged eyes
Susruta also describes what must have been
the earliest plastic surgical procedure, the restoration
of an amputated nose by means of a skin
graft turned down upon the forehead. Removal of
the nose was a punishment for adultery in those
days, so there was no shortage of patients for this
procedure. Interestingly, it evidently remained
in practice in India among itinerant surgeons for
hundreds of years. A newspaper account of this
in 1814 prompted Joseph Carpue of London to
perform a very similar operation, using the forehead
skin flap, with success in two army officers
(Figure 2.11).
The first patient had lost his nose from syphilis.
A forehead flap was fashioned and stitched around
the defect. The viability of the flap gave some initial
anxiety, but it fortunately recovered and the cosmetic
result was good. The second patient, another
officer, was a hero of the battle of Albuera, in the
Peninsular War in 1810. In saving the regimental
colours, the poor fellow lost an arm and sustained
five other wounds, one taking off part of the cheek
and the nose. Again, the operation was a success.
Carpue was born in 1764 in Hammersmith.
He was a catholic, who first considered entering
the Church, but instead studied at St George’s
Hospital under Sir Everard Home, becoming a
member of the Company of Surgeons in 1798. The
following year, he was appointed to the surgical
staff at the Duke of York’s Hospital, Chelsea. He
died in 1846.
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