Sushruta:The Father of Surgery

Sushruta was a renowned surgeon of ancient India - 6th century BC. He lived , taught and practiced his art on the banks of the Ganga in the present day city of Varanasi. He was a direct disciple of Divodasa who was in turn a disciple of Dhanvantari. He wrote Sushruta Samhita where he described 101 blunt instruments and 20 sharp instruments, which "should have an edge so fine that it should divide the hairs on the skin.", 300 surgical procedures and classifies human surgery into 8 categories. Because of his contributions to the medical science and art of surgery he is also known by the title "Father of Surgery." His technique of forehead flap rhinoplasty, that he used to reconstruct noses that were amputated, 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. The Samhita was translated into Arabic before the end of the eighth century A.D. and was named Kitab-I-Susrud by Abillasiabil.
Sushruta was also the first surgeon to advocate the practice of operations on inanimate models like watermelons, clay plots etc. Sushruta was also a great teacher. He told his pupils that one could become a good physician only if one knew both theory and practice.
Sushruta wrote a complete volume of his experiences to ophthalmologic diseases. Susruta devotes 18 chapters to describing 76 different diseases of the eye of which 51 require operations. In the Uttar Tantrum, he wrote a elaborated classification of eye diseases complete with signs, symptoms, prognosis, and medical/surgical interventions. Susruta is said to be the first surgeon to have removed cataracts, described varieties of cataracts along with the method of couching.
According to Susruta, the eye is composed of five basic elements: the solid earth (Bhu) form muscles, heat (Agni) is in the blood that courses in its veins/arteries, air (Vayu) forms the black part (iris/pupil), the fluid element (Jala) forms the lucid part (vitreous), and the void ( Akasa) forms the lacrimal ducts/sacs for discharge of secretions. Anatomically, he outlines five subdivisions (Mandalas) of the eye: eyelashes (Pakshma-mandala) ; eyelid (Vartma-mandala) ; sclera/cornea (Sveta [or Sukla]-mandala) ; choroid (Krishna-mandala) ; and pupil (Drishti-mandala) , which "looks like a hole and is the size of a Lentil seed.

Medical treatment for these ocular conditions was formulated according to which component of the Dosha was predominantly abnormal. Matured clarified butter ( ghee ), breast milk, and Saindhava Salts were frequently used, in addition to plants and meats in the form of eyedrops (Aschyotanta, made by folding and squeezing materials through a piece of silk), salves (Anjana) , snuffs ( Nasya) , and fumigation ( Dhuma) . Additionally, linen-soaked bandages, venesections, soothing measures (Tarpana) , and emetics/purgatives were employed.

The following lines are direct translation from the original Sanskrit of what may be the first record of extracapsular extraction:"…The operation is auspiciously performed primarily in the warm season…Before the operation, the skin around the eye is washed with a pledget of cotton saturated with an oily medicinal followed by a heated bath. The patient is given a light diet. The room where operation is going to be performed is fumigated with vapours of white mustard, bodellium, nimva leaves, and the resinous gums of shala trees in order to rid the area of insects and to some extent disinfectant action. smoke of cannabis is used in addition to wine to sedate the patient. The patient sits on a high stool with the surgeon facing him. The hands are secured with proper fastenings. The patient is asked to look at his own nose while the surgeon rests his little finger on the (bony margin of the outer angle of the orbit), holding a Yava Vaktra Salaka between his thumb, index, and middle finger. The left eye should be pierced with the right hand, and vice versa. The eye is entered at the junction of the medial and lateral two-thirds of the outer portion of the sclera. If a sound is produced following the gushing of a watery fluid, the needle is in the correct place, but if the puncture is followed by bleeding, it means that it is misplaced. The eye is then sprinkled with breast milk. Care is taken to avoid blood vessels in the region. The tip is then made to incise the (anterior capsule) of the lens. With the needle in this position, the patient is asked to blow down the nostril, while closing the opposite nare. After this, lens material (Kapha) is seen coming alongside the needle. When the patient is able to perceive objects, the needle is removed… Postoperatively, indigenous roots, leaves, and ghee are applied with a lined bandage. Patient then lies flat and is asked not eructate, sneeze, cough or move. The eye is examined every fourth day for ten days. If the whitish material recurs, the same procedure is repeated…."

Bibliography:
Wikipedia, the free encyclopedia
Susruta of ancient India-VK Raju, Indian Journal of Ophthalmology
Sushruta – the Clinician – Teacher par Excellence by Girish Dwivedi and Shridhar Dwivedi
The Sushruta Samhita by Kaviraj Kunjalal Bhishagratna Cosmo Publications 1st ed