Sushruta Samhita is an excellent reference for anatomy and surgery and also deals with the concept of creation, Shristi Utpatti krama (theory of cosmic evolution). Sushruta Samhita explains that the union of sperm (Shukra) and ovum (Aartava) does not guarantee the creation of life, and that a superior agent in the form of soul (Atma) is also necessary. The physiological, pathological, and therapeutic aspects of Tridosha theory of Ayurveda is described along with the types of sleep (Nidra) and dreams (Swapna). The importance of time factor (kala), physiology of the human body (circulation of blood, formation of urine, etc.), pathology (description of various diseases, their causes, diagnosis, symptoms, treatment and diet), classification of diseases (Adhyatmika, Adhibhoutika and Adhidaivika vyadhis), toxicology, methodical surgeries (pre-operative- Purva-karma, operative- Pradhana karma, post-operative- Paschat karma measures) are documented in Sushruta Samhita. Before conducting the surgery on a human body, acharya Sushruta emphasises that the procedures be practiced on artificial objects like: excisions (Chedana) on fruits and vegetables, incisions (Bhedana) on urinary bladders and internal organs of dead animals, scraping (Lekhana) on animal skin covered with hairs, extraction (Aaharana) on pulp of the fruits, suturing (Sevana) on thick piece of cloth and bandaging (Bandhana) on full sized human figured made of clay.
Acharya Sushruta also explains the distinct types of surgical instruments (yantras and shastras), methods of sterilization, 8 types of surgical procedures (ashta vidha shastra karma), 60 types of management of wounds (Shashti upakrama). He also covers in in detail about the anatomy and location of veins and arteries (siras), nerves, soft tissues, etc (dhaminis), vital organs (marma). Special treatments like fire and alkali cauterization (agnikarma), blood-letting (rakta mokshana) and venesection (sira vyadha) are also explored along with grafting.
Sushruta Samhita insists on comprehensive and extensive learning of both theoretical and practical aspects of medical profession, especially surgical knowledge if one needs to provide service to the mankind in the form of a capable doctor. The Sarirasthana is made up of 10 chapters regarding the study of human anatomy in which it is mentioned that:
‘The different parts or members of the body as mentioned before including the skin, cannot be correctly described by one who is not well versed in anatomy. Hence, any one desirous of acquiring a thorough knowledge of anatomy should prepare a dead body and carefully, observe, by dissecting it, and examine its different parts.’
Due to the restrictions of the religious laws of that time, Acharya Sushruta had to develop methods that would allow him to work within the confinement of the law.
‘Therefore, for dissecting purposes, a cadaver should be selected which has all of whose parts of the body present, of a person who had not died due to poisoning, but not suffered from a chronic disease (before death), had not attained a 100 years of age and from which the faecal contents of the intestines have been removed. Such a cadaver, whose all parts are wrapped by any one of “munja” (bush or grass), bark, “kusa” and flax, etc. and kept inside a cage, should be put in a slowly flowing river and allowed to decompose in an unlighted area. After proper decomposition for seven nights, the cadaver should be removed (from the cage) and then dissected slowly by rubbing it with the brushes made out of any of usira (fragrant roots of plant), hair, bamboo or “balvaja” (coarse grass). In this way, as previously described, skin, etc. and all the internal and external parts with their subdivisions should be visually examined’
He considered the study of a dead human body essential for understanding the human anatomy. In Sushruta Samhita, the dissection of a dead body was initially conducted by Acharya Sushruta and was followed by his students as a tool to understand the anatomy. As mentioned in Sushruta Samhita, medical students should learn the art of dissection in the body of a puspaphala (a type of gourd), alavu (bottle-gourd) or ervaruka (cucumber) prior to dissecting a human body. Sushruta monitored the dissection and preservation of the dead body with ultimate precision because of which all the minute details of the cadavers were recorded. The documentation included the organs, tissues, blood vessels, nerves, bones and joints along with their structure, quantity, shape, size, capacity, location and dimensions. This information was considered to be mandatory to become a surgeon.
The beginning of plastic surgery
Modern-day reconstructive surgery or plastic surgery is the improvised version of the surgery conducted by acharya Sushruta for repairing the nose of a person cut for adultery during that time. This implies that Acharya Sushruta had a good knowledge of the human facial anatomy. The procedure he followed for the surgery was:
‘First the leaf of a creeper, long and broad enough to fully cover the whole of the severed or clipped part, should be gathered; and a patch of living flesh, equal in dimension to the receding leaf, should be sliced off [from down upward] from the region of the cheek and, after scarifying it with a knife, swiftly adhered to the severed nose. Then the cool-headed physician should steadily tie it up with a bandage decent to look at and perfectly suited to the end for which it has been employed. The physician should make sure that the adhesion of the severed parts has been fully affected and then insert two small pipes into the nostrils to facilitate respiration, and to prevent the adhered flesh from hanging down. After that, the adhered part should be dusted with [hemostatic] powders; and the nose should be enveloped in Karpasa cotton and several times sprinkled over with the refined oil of pure seasmum’.
Piercing of the earlobes and consequent enlargement of the hole was a ritual in ancient India to ward off evil. This practice led to tearing of the earlobes. Acharya Sushruta reconstructed the pedicle flap by grafting a piece of skin taken from the adjacent area and reattaching it without hampering the vascular supply.
‘A surgeon well versed in the knowledge of surgery should slice off a patch of living flesh from the cheek of a person so as to have on its ends attached to its former seat (cheek). Then the part, where the artificial ear lobe is to be made, should be slightly scarified (with a knife) and the living flesh, full of blood and sliced off as previously directed, should be adhered to it (so as to resemble a natural ear lobe in shape). The flap should then be covered with honey and butter and bandaged with cotton and linen and dusted with the power of baking clay.’ Again, such a procedure would necessitate a good working knowledge of human anatomy of the facial region including blood supply.’
Acharya Sushruta also treated cataract as he studied the eye and delineated the five anatomical divisions of the eye: eyelashes, eyelid, sclera, choroid and the pupil.
Author: Dr. Akhila K. Adisser
Note: The information and claims shared, opinions and views expressed, belong to the author.