Sushruta: ‘The Father of Surgery’ :: 300 different types Operations, and 125 Surgical Instruments

2600 years ago he and health scientists of his time conducted complicated surgeries like cesareans, cataract, artificial limbs, fractures, urinary stones and even plastic surgery and brain surgery. Usage of anesthesia was well known in ancient India. Over 125 surgical equipment were used. Deep knowledge of anatomy, etiology, embryology, digestion, metabolism, genetics and immunity is also found in many texts.

Sushruta (also spelt Susruta or Sushrutha) (c. 6th century BC) was a surgeon who lived in ancient India and is the author of the book Sushruta Samhita, in which he describes over 120 surgical instruments, 300 surgical procedures and classifies human surgery in 8 categories. He lived and taught and practiced his art on the banks of the Ganges in the area that corresponds to the present day city of Varanasi in North India.

In the Sushruta school, the first person to expound Āyurvedic knowledge was Dhanvantari who then taught it to Divodasa who, in turn, taught it to Sushruta, Aupadhenava, Aurabhra, Paushakalāvata, Gopurarakshita, and Bhoja.

Because of his seminal and numerous contributions to the science and art of surgery he is also known by the title “Father of Surgery.” Much of what is known about this inventive surgeon is contained in a series of volumes he authored, which are collectively known as the Susrutha Samhita. The “Samhita” has some writings that date as late as the 1st century, and some scholars believe that there were contributions and additions to his teachings from generations of his students and disciples. Susrutha is also the father of Plastic Surgery and Cosmetic Surgery since his technique of forehead flap rhinoplasty (repairing the disfigured nose with a flap of skin from the forehead),that he used to reconstruct noses that were amputated as a punishment for crimes, is practiced almost unchanged in technique to this day. The Susrutha Samhita contains the first known description of several operations, including the uniting of bowel, the removal of the prostate gland, the removal of cataract lenses and the draining of abscesses. Susrutha was also the first surgeon to advocate the practice of operations on inanimate objects such as watermelons, clay plots and reeds; thus predating the modern practice of the surgical workshop by half a millenium.

The Sushruta Samhita is one of two early texts that form the cornerstone of the Indian medical tradition of Ayurveda (Ayurveda means science of life). The other treatise is called the Charaka Samhita. Samhita is Sanskrit for compendium, and Sushruta and Charaka are proper names. So thetitles translate as “Sushruta’s Compendium” and “Charaka’s Compendium.” Likethe Charaka Samhita, the Sushruta Samhita made revisions and alterations to an earlier text on which it is based, in this case, the writingsof Divodasa Dhanvantari, the author’s teacher. The author, Sushruta, is identified as the son of the Vedic sage Visvamitra. The text is long, running over 1,700 pages in English translation. The exact date of its composition is unknown, but is generally thought to be around 100 A.D.

Like the Charaka Samhita, the Sushruta Samhita refers to the eight branches of Ayurvedic medicine. Sushruta is organized similarly toCharaka, but in addition to emphasizing therapeutics, it also discusses surgery, which Charaka barely mentions. The text is divided into six sections and 184 chapters. In another major departure from Charaka,Sushruta describes the need for and way to conduct dissections on human cadavers to gain knowledge of anatomy. Students might practice on natural and artificial objects, for example, vegetables and leather bags full of water. Quartered sacrifical animals were used to study different kinds of anatomy.

Sushruta details about 650 drugs of animal, plant, and mineral origin.In addition, it describes more than 300 kinds of operations that call for 42different surgical processes and 121 different types of instruments. Other chapters in Sushruta make clear the high value put on the well-being ofchildren, and on that of expectant mothers. Sushruta’s coverage of toxicology (the study of poisons) is more extensive than that in Charaka, and goes into great detail regarding symptoms, first-aid measures, and long-term treatment, as well as classification of poisons and methods of poisoning.

In keeping with the Ayurvedic philosophy of preserving life and preventing the infirmity of old age, Sushruta extols the benefits of clean living,pure thinking, good habits and regular exercise, and special diets and drug preparations. A plant called soma that is described in the early texts but hasnever been clearly identified was recommended as a treatment for rejuvenating body and mind. Sushruta explains the need of all living creatures tosleep and to dream as a function of two principles of the mind that give glimpses of previous existences or warn of future ill health. When both principles are weakened, coma results.

Sushruta explains the origins of disease as imbalances of vital humorsthat occur either individually or in combination, and that originate from within the body or outside of it, or for no known reason. It discusses the useof surgical devices such as tourniquets and setting plasters, and surgical tools and procedures. Operations are described for amputations, hemorrhoids, hernia repair, eye surgery, and Cesarean section. An operation using skin flaps, for example, to repair a nose, was also described in Sushruta. The procedure was observed in India by a British surgeon in 1793 and published inLondon the following year, thus changing the course of plastic surgery in Europe.

 Sushruta also admits members of the lowest of the four classes. However, such persons would be excluded from special ceremonies accorded to students of more respectable parentage. Sushruta describesthe day-to-day life of the physician in ancient India, who made the rounds ofpatients’ residences and also maintained a consulting room in his own home,complete with a storeroom of drugs and equipment. Although doctors could command a good living, they might also treat learned brahmins–priests–and the poor for free. Sushruta describes the ideal qualities of a nurse, and suggests that doctors may have been required to have licenses.

The drugs described in Sushruta include 395 plant substances, 57 substances of animal origin, and 64 mineral substances, metals, and so on. Many ofthe complicated procedures for dissolving, macerating, extracting, and combusting a variety of solid, squashy, and liquid substances remain part of modern Ayurvedic pharmacological practice.

The conquest by Arabs of the Indian province of Sind (now a part of Pakistan)in the eighth century unleashed a scholarly exchange of scientific ideas. The Sushruta samhita was translated into Arabic and later into Persian.These translations, as well as those of Charaka, helped to spread thescience of Ayurveda far beyond India.

Surgery: 300 different types Operations, and 125 Surgical Instruments::

The ancient Indians were also the first to perform amputation, cesarean surgery and cranial surgery. Sushruta as early as 600 BC used cheek skin to perform plastic surgery to restore and reshape human nose, ears, and lips with incredible results. In his treatise, Shushruta Samhita, he classified surgery into eight types:

aaharya (extracting solid bodies),
bhedya (excision),
eshya (probing),
lekhya (sarification),
vedhya (puncturing),
visravya (extracting fluids), and
sivya (suturing).

Shushruta describes the details of more than 300 operations such as extracting solid bodies, excision, incision, probing, puncturing, evacuating fluids and suturing. Ancient Indians were also the first to perform amputations, caesarean and cranall surgeries with 42 surgical processes. He worked with 125 kinds of surgical instruments including scalpels, lancets, needles, catheters, etc. Sushruta even devised non-invasive surgical treatments with the aid of light rays and heat. Sushrata & his team conducted complicated surgeries like cataract, artificial limbs, cesareans, fractures, urinary stones and also plastic surgery and brain surgeries.

Chanakya's Arthashãstra describes post-mortems, and Bhoja Prabandha describes brain surgery, successfully performed in 927 AD by two surgeons on King Bhoja to remove a growth from his brain. Usage of anesthesia was well known in ancient India medicine. Detailed knowledge of anatomy, embryology, digestion, metabolism, physiology, etiology, genetics and immunity is also found in many ancient Indian texts.