MILITARY SURGERY IN ANCIENT INDIA
In his History of Medicine PV Sharma informs us that military surgery (Salyatantra) was a highly developed skill in ancient India.
Sushruta used a variety of surgical practices which compare well even with the modern practices. Washing the wound with decoction of bactericidal drugs, removing all foreign bodies by appropriate method, controlling haemorrhage, suturing the edges of the wound, applying paste of healing drugs, and bandaging are the different successive steps in the treatment of wounds. An ingenious method used by Sushruta was to employ big ants for uniting two edges of the cut intestines by making the ants bite the edges and then cutting off their head when they were holding with their jaws. His method antedates the use of organic adhesives of the present day surgery.
As warfare was quite common, the surgeon had to accompany the king to the battle field and was responsible for protecting the king and his army from dangers, such as recognising poisoned foods, drinks and other articles of use, detoxifying such materials and treating persons affected by poison, providing medical and surgical treatment on the battlefield and many other allied duties.
The great surgeon of yore Sushruta specialized in the accidental wounds and their treatment. He classifies accidental wounds into six kinds: (1) wound causing severance of a part or a whole limb ( chinna ); (2) wound into a hollow viscus puncturing it ( bhinna ); (3) puncturing wound of any structure other than a hollow viscus (viddha); (4) uneven wound or lacerated wound ( ksata); (5) crushed wound (Picchita); and (6) superficial abrasion (ghrsta). It is a matter of pride to observe here that his classification has not changed even after many centuries except for inclusion of gunshot wounds.
Sushruta has described twelve kinds of fractures (asthibhagna) and six types of dislocations (sandhimukti), along with their symptomatology and management including physiotherapy. Traction, manipulation, apposition and stabilisation were the four principles of fracture treatment. Other examples of his experiments in surgery in the battlefield are the treatment of injury to the cranium and prolapse of the testes.
The most outstanding contribution of the great Sushruta was reconstructive/plastic surgery. He reconstructed mutilated noses (rhinoplasty), earlobes (otoplasty) and lips (oroplasty); grafting of the healthy skin from the cheek, rotation of the pedicle flap, its transfer to the nose, ear or lips and reconstruction resembling the normal shape have been described in great detail by Sushruta.
Sushruta's method of rhinoplasty has stood the test of time and finds mention as the Indian method in modern books on plastic surgery. Even with great advances in surgery in the present day hardly any modification has been added to the method described by Sushruta.
Other Surgical Operations:
Besides the above operations, Sushruta employed surgical treatment to a variety of ailments like haemorrhoids (arsas), fistula-in-anus (bhagandara), urinary calculi (asmari), hernia (antravrddhi), intestinal obstruction (baddhodara), perforation of abdominal viscera (chidrodara), abdominal tumors (gulma), benign tumors (granthi), carcinoma (arbuda), actinomycosis (valmika), filariasis (slipada), obstructed labour (mudha garbha), inflammatory and neoplastic diseases of the teeth, gums, palate, tongue and throat, diseases of eyes and ears etc.
Some of his surgical methods have been found very satisfactory by modern surgeons and are becoming popular in western countries, for example his method of treating rectal fistula by plugging it with a thread processed with vegetable alkalies (ksarasutra) .
Sushruta's knowledge about ulcers (vrana) and their treatment is quite elaborate. He describes in detail the colour, smell, discharge, nature of pain and other signs and symptoms of different stages of ulcers viz., the unclean (dustavrana), the clean ulcer (suddha vrana), the healing ulcer (ruhyamana vrana) and the healed ulcer (rudha vrana) and mentions good and bad prognostics and treatment in detail. He describes objective criteria of a perfectly healed ulcer such as absence of induration, swelling and pain, return of the normal colour and level of the skin at the site.
Sharma emphasises that the assumption that surgery waned and gradually disappeared due to the bias to non-violence of Jainas and Buddhists is not correct. On the contrary, Jaina monks carried with them a medicine chest which contained surgical instruments as well. Buddhism too championed the cause of ameliorating the human suffering through medical and surgical measures. Lord Buddha himself was called bhisak and salyabartha . Jivaka, the contemporary and devotee of Lord Buddha, was an eminent surgeon who performed miraculous cures by his surgical skills. Akasagotta was another surgeon of repute who specialised in anorectal surgery.
Sharma, Priya Vrat. 1992. History of Medicine in India. New Delhi: Indian National Science Academy. Pp. 325-353.