Chapter 18 - Military Surgery

That the general art of surgery owes its origin and development to military surgery is popular knowledge. The Indian name for it is Shalya-Shastra (Śalyaśāstra) meaning the extraction of the spear head or arrow-head.

The word Dhanvantari, God of surgery, has the same significant derivation (dhanuḥ śalyaśāstraṃ, tasya antaṃ pāraṃ, iyarti gacchatīti).

The practitioners of the school of surgery are called Dhanvantariyas (Dhānvantarīyā):

[Carakasaṃhitā Cikitsāsthāna 5.44]

“Here begins the province of the surgeons, as regards its treatment; it is of such surgeons as have practical experience in the art of aspiration, punfication and healing of abscesses.”

Thus its military origin is evident in the very name of the art. The Aryans of ancient India were a heroic people given to the joy of war and military conquest. Their history and mythology is full of the echoes of battles and military victories over either the barbarian hordes of foreigners or aboriginals or the armies of rival tribes and neighbouring kings.

War was so common that military science had become one important branch of university education. Not only is there mention in the Vedas about persons approaching expert Gurus to learn this branch of knowledge, but even in later times we find Taxila having, 103 princes at a time as students in its military school.

Under these circumstances, it is nothing strange that at quite an early time in her history, India developed the great art of surgery. The palaces of all ancient kings were hot-beds of intrigues and conspiracies of potential rivals to the throne. Hence the fear of his food and drink being secretly poisoned was very great with every king. He therefore had a physician and surgeon all the time by his side in order to give himself the fullest protection from poison and disease. These duties became all the more important during war period. The Sushruta Samhita, the great treatise on surgery and medicine, devotes an entire chapter to this military surgery by name Yuktaseniya (Yuktasenīya).

Sushruta describes the duties of the military surgeon as under:—

[Suśrutasaṃhitā Sūtrasthāna A. 34.3, 4, 7]

“Here it is specified how a king should be protected by a physician when he is accompanied by the army and when he is intent upon vanquishing his enemies.

The enemies defile the road, the water, the shade, the food, the corn and the fuel. The physician should find that out and purify them.

The physician and the family priest both expert in toxicology and thaumaturgy should always diligently protect the king from the endogenous and exogenous diseases as well as from death”.

Thus the physician is warned to be on his guard against the kings food, drink, path etc being poisoned by the enemies and to purify these things from such contamination. He, along with the priest, was to protect the person of the king from the dangers of disease, injury, poison and evil charms.

The author further describes where the physician’s residence should be situated, what equipment he should have, what conditions he has to treat and how his abode can be distinguished. The organisation headed by the physician pitched its own separate tents near the royal tent and flew a special flag overhead to distinguish it.

[Suśrutasaṃhitā Sūtrasthāna A. 34.12-14]

“In a big encampment just after the tent of the king, the physician should be kept present, fully equipped.

The persons afflicted with poison, darts and disease approach him there without making a mistake—him who stays there being singled out by his flag, fame and name.

The physician who is an adept in his own art and is conversant with other sciences, being honoured by the king and experts, looks prominent like a flag”

Kautilya also refers to the duties of the military surgeon that has to treat and protect the infantry, horses and elephants from diseases, epidemics, food, troubles etc.:

[Kauṭilya Arthaśāstra 10.2]

“He should protect his army when it is suffering from a disease, pestilence or famine; when a great portion of its infantry, cavalry and elephants is 'diseased, when it is not sufficiently strong, or when it is in distress.”

He further describes how the king and his battling men must be enthused and supported and given first aid treatment from behind by surgeons equipped with instruments, apparatuses, antidotes, ointments and cloth and by women taking proper care in the service of food and drink.

[Kauṭilya Arthaśāstra 10.3]

“Physicians with surgical instruments, machines, remedial oils and cloth in their hands, and women with prepared food and beverage should stand behind, uttering encouraging words to fighting men.”

In addition to this he was expected to know the art of:

1. How to kill hunger.
2. How to increase the power of marching.
3. How to increase the power of eye sight.
4. How to disseminate various diseases in the enemy’s camp.
5. How to poison air, water and trees.

The detailed description of these and many other fair and foul means used in war is given in Kautilya. The physician was also made use of as a spy.

Kautilya ascribes still more devilish duties to the doctor than these. He was a creator of disease in the opposite army and curer of his own army—a devilish and divine personality combined.

[Kauṭilya Arthaśāstra 14.4]

“Having applied these remedies to secure the safety of himself and his army, a king should make use of poisonous smokes and other mixtures to vitiate water against his enemy”.

The Mahabharata, the greatest epic and war poem of the world, is full of references to the duties, work, the skill and greatness of the surgeons that attended on kings and armies. It describes in detail the various preparations to be made and precautions to be taken during the war time Ramayana is also a rich store of references on this subject. This is an unexplored field of research on the subject of war-injuries, medical organisation and ethics in war.

[Mahābhārata Śāntiparva A. Bhā. 69]

“A king when afflicted by the army of an enemy, should store up articles, viz., oil, fat, honey, ghee and medicines.

He should specially gather all medicines, roots, and the four kinds of healers viz, toxicologist, surgeon, physician and thaumaturgist”.

Ramayana references:

[Vālmīki Rāmāyaṇa Kiṃ. Sa. 37]

[Vālmīki Rāmāyaṇa Yuddha Kāṇḍa 69.18]

“The best among the monkeys, being fruit-eaters took with them these divine roots and fruits and the divine medicines”.

“Those monkeys having picked up all medicinal herbs, fruits and roots, made him keep them and spoke these words”.

“Those mighty demons who desired a fight, sallied out all the six of them having anointed their bodies with all the medicinal herbs and perfumes”.

Precautions in the military camp:

[Mahābhārata Śāntiparva 68.49]

“No fire, except the sacrificial one. should be lighted during the day. The fire should blaze well protected in the artificer’s chamber as well as the lying-in-chamber.

Having caused admittance in the house, the fire should be lighted inside”.

References regarding kinds of medicinal herbs specially used for war-wounds are found m Ramayana.

[Vālmīki Rāmāyaṇa Yuddha-kāṇḍa Sa. 74.33]

“They collected the divine medicinal herbs which may help the revival of consciousness, the extraction of arrows, the restoration of normal colour and the joining of bones.”

The medicinal herbs that helped extraction of arrows, and the healing of the wound, which gave the normal coloration to the scar and which helped the revival of consciousness are found to be collected and stored for war purposes

There were a number of operating surgeons in the military hospital with complete equipment.

[Mahābhārata Bhīṣmaparva A. 120.55]

“There waited upon him the physicians who were expert in the extraction of arrows, who were fully equipped and who were coached up well by the skilful (teachers)”.

Treatment in the military hospital was for three kinds of patients viz., (viṣa śalya-āmayārditā [?])

Those afflicted by—

1. Poison.
2. War injuries.
3. Ordinary diseases.

Princes and warriors were expected to possess sufficient knowledge of various branches related to military operation

[Vālmīki Rāmāyaṇa Sundarakāṇḍa 48.14]

“O subduer of enemies! proficiency in the various branches of science must essentially be had on the battlefield and then one should expect victory in the battle”.

War ethics of the ancient times were of very high order

[Mahābhārata Śāntiparva 95.12]

“Never a blow should be dealt to a man who is lifeless or childless”.

The chivalry of that age certainly did not neglect to include an organisation similar to our red-cross society, to extend surgical and medical relief to those injured in battle irrespective of the side to which the ailing belonged

[Mahābhārata Śāntiparva 95.13]

“That is a permanent observance that if a (wounded) opponent be in one’s own territory jor if he comes to one’s house, he should be treated; and when the wounds have fully healed up then only he should be allowed to go.”

[Mahābhārata Śāntiparva 26.8?]

“If a Brahmana, desiring peace on both sides, intervenes between the armies drawn close, then there should be no fight.”

In the same way, the physician may take the place of a Brahmana.

[Vālmīki Rāmāyaṇa Yuddhakāṇḍa 80.39]

“You should not kill an adversary who is not fighting, who has hidden himself, who has his hands folded, who has come for refuge, who is fleeing away or who is off his guard.”

The two anecdotes, one from Ramayaha and one from Mahabharata, given below will give the true conception of the clinical examination, the military surgeon was doing, and how the surgeons were called for surgical aid and the manner in which they behaved.

[... 23-29]

“Susena addressed this excellent speech consoling Rama who was speaking thus and whose sense-faculties were agitated owing to grief

Laksmana, the increaser of good luck, is definitely not dead; because his face is neither disfigured nor turned dark nor lustreless.

His face bears a lustrous and pleasing appearance. His palms are just like lotus-leaves and his eyes are brilliant.

O king! never can there be such an appearance of the dead. Those mortals alone, whose life-span is long, do bear such a face

This Laksmana, the increaser of prosperity, is not dead. Therefore O mighty hero! don’t plunge yourself into grief, O subduer of enemies, he does possess life.

O powerful warrior, this condition is declared by the heart which palpitates often and on, accompanied by respiration, while he is lying on the ground with his limbs loosened.”

[... 55-59]

The presence of great and skilled surgeons and physicians on the battlefield behind the lines is clear from the anecdote in the Mahabharata, wherein we find that a great number of surgeons skilled in operative measures and equipped with many kinds of instruments and apparatuses poured into the tent where the wounded general Bhisma lay.

They offered to treat him. But the heroic Bhisma turned to Duryodhana, the king, and said,

“Give generous and befitting presents of money to these good surgeons and pay them due honor and send them away. For to me in this condition no treatmen is welcome. The greatest boon for a Ksatriya is death on the battlefield and I covet it. I must be allowed to die with these arrows on which I lie like on a bed. With them let me be cremated.”

Listening to this heroic utterance, all applauded and the surgeons left him to his glorious end.