Ancient Indian Plastic Surgery

Just as the Sun rises in the East, the science of plastic surgery first dawned on the ancient Indian civilization.
Sushruta operating on a burns victim
The first detailed description of plastic surgical procedures is found in the clinical text on Indian surgery, the 'Sushruta Samhita' (circa 600 B.C.). Atharva Veda, the root of Ayurveda , the classical text of Indian medical knowledge includes two seminal texts, Charaka Samhita on medicinal aspects and Sushruta Samhita which incorporates details of surgical tools and operative techniques. Sushruta wrote this treatise based on the lectures of his teacher, the famous surgeon king Devadas or Divadasa ('Reincarnation of Dhanwantari , the divine physician). He taught his pupils to try their knives first on natural as well as artificial objects resembling diseased parts of the body before undertaking the actual operations. It is interesting to note that modern surgery stresses so much upon simulations, models and cadaver training before actual performance to increase and improve patient safety. Sushruta stressed on both theoretical and practical training and had famously remarked once: "The physician who has only the book of knowledge (Sastras) but is unacquainted with the practical methods of treatment or who knows the practical details of the treatment but from self confidence, does not study the books, is unfit to practice his calling". Sushruta considered surgery to be the most important branch of all the healing arts, and had performed and described in details several complicated operations. This include operations for intestinal obstruction, hernia repairs, bladder stone, but more importantly several plastic surgical operations, including those for hairlip / cleft lip and rhinoplasty (nose reshaping) which are performed virtually unchanged even today from his descriptions about 3000 years ago! The prowess of his mind and skills were so amazingly high, and such were the dizzy heights that great minds in ancient India were able to reach and teach. 

In fourth century A.D. Vagabhat , an Indian physician recounted the plastic surgical procedures with more details than provided in Sushruta Samhita. In his book, 'Ashtanga Hridyans Samhita' he credits the techniques to Maharishi Atreya. It is interesting to find mention of plastic surgical procedures such as rhinoplasty, otoplasty, tissue grafting, organ transplants, transfer of embryo, cross-grafting of head and re-attachment of limbs etc. in these ancient Indian Medical Treatises and Puranic Literature. According to ancient scriptures, Sushruta, Atreya and Vagabhat are considered the Old Triad or "Vriddha Troyee" of Ancient Surgical Wisdom.

Jeevaka performing Neurosurgery
This golden era of Hindu Surgery began its gradual decline after the time of Buddha (562- 472 B.C.). This era was marked by the famous physician Jeevaka, who was declared by Buddha as the chief amongst his lay-followers and his own personal physician. Buddha enjoined upon monks to take exercise to protect health at the requisition of Jeevaka. It is interesting to note that Jeevaka is amongst the first known neurosurgeons in the world, and is said to have performed several surgical operations, including the famous brain surgery on King Bhoja. Still, Jeevaka is more famous for his supreme knowledge of medicine, especially on plant based 'Ayurveda' even till date. 

Nevertheless, Buddhist scripture Mahavagga Jataka enforced strict prohibition on surgeons and Manusmriti prescribed special rituals for purification of surgeons. Contemporary teaching at that time was basically medicinal i.e. Ayurveda, which forbade surgery, as contact with blood and pus was considered polluting. Hence, during this period, these great surgical skills were delegated to lower castes like 'Koomars' or potters who were known for their manual dexterity. They kept alive this valuable knowledge and passed it from father to son as a family secret. 

Royal College of Barber - Surgeons Estd. 1505

Burning of the Library of Alexandria in Christian Era
It is interesting to note that much later, the Western World also met with the same fate. During the middle ages, it was considered unholy by the Church to dissect cadavers or perform surgery, and all diseases were supposed to be cured by medicine alone. Christianity was extremely intolerant of any teaching that was counter to those of the Christian Church, including medicine, surgery and especially anatomy. The Church specifically banned the practice of anatomy and surgery and relegated the practice of surgery to the uneducated and lower class practitioners called the barber-surgeons, who were considered inferior to the physicians  and not allowed to enter through the main door of any house. The Royal College of Surgeons, the great institutions of learning modern surgery, started off as The Royal College of Barbers and Surgeons. The first was established in Edinburgh in 1505. The influence of the Church and the fact that the great library of Alexandria had been destroyed and its works burnt or lost, meant that the Western world would remain in the dark for centuries together. Great advances made in the Classical period would be stifled and no major advances would be made for years to come. Surgery was a craft which was ridiculed and relegated, until Renaissance happened and knowledge disseminated gradually to other parts of Europe from Italy. 

Isis, Egyptian Goddess of Healing
In fact, during the ancient times, India and Egypt are considered as the fountain-heads from which the stream of knowledge flowed to the middle east, eventually to reach Mediterranean civilization; the Greeks and the Romans. The ancient Indian medical knowledge was carried into Greece and Arabia by Buddhist Missionaries. 

The German, French and English surgeons were introduced to the older Indian method. During that period, certain German scholars who studied the original text in Sanskrit, British surgeons and French travelers, who saw for themselves the rhinoplasty operations performed in India, revealed the wonders and practical possibilities of this speciality to the Western world. It was, however, the discovery of anaesthesia (Morton, Long and Wells) and anti-sepsis (Lord Lister) which revolutionised the practice of surgery and made it painless and infection free.

Gaspare Tagliacozzi
The medical works of both Sushruta and Charaka, originally in Sanskrit, were translated into Arabic language during the Abbasid Caliphate in 750 AD. The Arabic translations made their way into Europe via intermediaries. In Italy, the Branca family of Sicily and Gaspare Tagliacozzi of Bologna became familiar with the techniques described by Sushruta.

Patient of Rhinoplasty, India 1794
British physicians traveled to India to see rhinoplasties being performed in the traditional methods. Reports on Indian rhinoplasty performed by a Kumhar Vaidya were published in the Gentleman's Magazine in 1794. Joseph Constantine Carpue spent 20 years in India studying local plastic surgery methods. Carpue was able to perform the first major surgery in the Western world by 1815.

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