Chapter IX - Practical surgical instructions

Now we shall discuss the Chapter which treats of practical instructions in surgical operations (Yogya-Sutra).

The preceptor should see his disciple attends the practice of surgery even if he has already thoroughly mastered the several branches of the science of Medicine, or has perused it in its entirety. In all acts connected with surgical operations of incision, etc. and injection of oil, etc. the pupil should be fully instructed as regards the channels along or into which the operations or applications are to be made (Karma-patha). A pupil, otherwise well read, but uninitiated into the practice (of medicine or surgery) is not competent (to take in hand the medical or Surgical treatment of a disease). The art of making specific forms of incision should be taught by making cuts in the body of a Pushpaphala (a kind of gourd), Alavu, watermelon, cucumber, or Ervaruka. The art of making cuts either in the upward or downward direction should be similarly taught. The art of making excisions should be practically demonstrated by making openings in the body of a full water-bag, or in the bladder of a dead animal, or in the side of a leather pouch full of slime or water. The art of scraping should be instructed on a piece of skin on which the hair has been allowed to remain. The art of venesection (Vedhya) should be taught on the vein of a dead animal, or with the help of a lotus stem. The art of probing and stuffing should be taught on worm (Ghuna) eaten wood, or on the reed of a bamboo, or on the mouth of a dried Alavu (gourd). The art of extracting should be taught by withdrawing seeds from the kernel of a Vimbi, Vilva or Jack fruit, as well as by extracting teeth from the jaws of a dead animal. The act of secreting or evacuating should be taught on the surface of a Shalmali plank covered over with a coat of bee’s wax, and suturing on pieces of cloth, skin or hide. Similarly the art of bandaging or ligaturing should be practically learned by tying bandages round the specific limbs and members of a full-sized doll made of stuffed linen. The art of tying up a Kama-sandhi (severed ear-lobe) should be practically demonstrated on a soft severed muscle or on flesh, or with the stem of a lotus lily. The art of cauterising, or applying alkaline preparations (caustics) should be demonstrated on a piece of soft flesh; and lastly the art of inserting syringes and injecting enemas into the region of the bladder or into an ulcerated channel, should be taught (by asking the pupil) to insert a tube into a lateral fissure of a pitcher, full of water, or into the mouth of a gourd (Alavu).

Authoritative verses on the subject:—

An intelligent physician who has tried his prentice hand in surgery (on such articles of experiment as, gourds, etc., or has learnt the art with the help of things as stated above) or has been instructed in the art of cauterisation or blistering (application of alkali) by experimenting on things which are most akin, or similar to the parts or members of the human body they are usually applied to, will never lose his presence of mind in his professional practice.

Thus ends the ninth chapter of the Sutrasthana in the Sushruta Samhita which treats of Instructions in Surgical operations.