War Surgeons

It may be assumed that surgeons associated with military conflicts must have been occupied position of importance in the royal household though data regarding medical service at the battle-field is rather limited in our two medical sources. Warfare being a recurrent theme in ancient Indian politics, one can hardly imagine that the wounded got by without the services of physicians and surgeons. Caraka hardly makes any allusions to war time medical arrangements but Suśruta recognises the significant role the medical corps plays in ensuring the king’s victory. This is not unexpected as we have noted that the school of Dhanvantari trained surgeons in attending to traumatic injuries and wounds.

At the time of war, it is recommended that the physician outfitted with all the necessary equipment should set up his camp close to that of the king. Any person suffering from poisoning or injury from a foreign body or disease unhesitatingly resorts to a surgeon possessing name and fame which is as conspicuous as a glorified ensign.^[1] The royal physician sets up his tent with a flag next to that of the king so that it could be easily located minimising delay in bringing the wounded.^[2] Kauṭilya recommends the physicians with surgical instruments, apparatus, medicines, oils and bandages should be stationed at the rear of the army.^[3] The king is advised to accompany the physician on regular visits to the wounded, praising the bravest, lifting their spirits and thereby aiding their recovery.

Gabriel comments that nowhere in the ancient medical world is evidence of a medical military service so organized and so integrated into the military structure as the Indian medical military corps.^[4] Recognition of physicians and surgeons as non-combatants is another remarkable aspect of the medical corps, a development that came about much later in the West.^[5] The Epics shed some light on the medicine at the time of combat. Medical supplies were carried in to the battle field in war chariots according to the Epics. The army of Rāma was accompanied by Suṣena, physician and surgeon, who knew the medicinal properties of herbs like sanjīvakarni, viśalyakarni, etc., and he saved the lives of Rāma, Lakṣamaṇa and other warriors by such herbs.^[6]

The surgical school of Dhanvantari taught students about the five modes of entry of śalyas or foreign bodies into the human body, the consequent clinical features of embedded śalyas,^[7] the fifteen methods (invasive and non-invasive) of extracting them,^[8] the prognosis of wounds,^[9] treatment of wounds and inflammations with pastes and bandages,^[10] and how to take care of the wounded,^[11] all of which are extremely relevant for handling the war wounded.

It is therefore, not surprising when Suśruta comments that one who is medically equipped to deal with such knowledge of foreign bodies is the only one entitled to treat the king.^[12]

dvividhaṃ pañcagatimattvagādivraṇavastuṣū.
yo vetti viṣiṭaṃ śalyaṃ rājñaḥ kurtumarhati.

In fact, the battle wounds probably had no small contribution in the progress of the ancient Indian surgeon’s chirurgical skills. One gets the impression that a great deal of empirical clinical medicine in the Indian tradition stemmed from the military physicians” efforts to treat the myriad casualties that resulted from the almost endless wars.^[13] Descriptions of surgeries for the split ear lobule including cases where both flaps of the ear lobules are absent^[14] or the ear has been torn out of place,^[15] the amputated nose,^[16] abdominal perforation (pariśrāvyuodara)^[17], are clinical cases involving mutilations generally sustained in violent confrontations. The six kinds of recent traumatic wounds described by Suśruta are of grievous nature, which include extensive wounds with separation of body parts,^[18] injury to the body cavities with points of spear, lance, ṛṣṭī, sword, etc.,^[19] punctured wound caused by sharp pointed weapon,^[20] crushing of a part of the body and flattening of the bones,^[21] cut throat injury,^[22] complete limb dismemberment,^[23] puncture and avulsion of the eyeballs,^[24] and skull injury.^[25] Suśruta has also dealt with a range of abdominal injuries, the most severe being a situation where the abdomen is ripped open with ruptured (or non-ruptured) intestines.^[26] Hence, it can be said that the author was dealing with a wide range of belly wounds found only on the battlefield, and the description is far too accurate not to have been recorded by a physician who had direct experience with this type of wound-in short, a military surgeon.^[27]

Footnotes and references:

[1]:

Suśruta Saṃhitā Sūtrasthāna 34.12-14.

[2]:

R.A. Gabriel, Man and Wound in the Ancient World: A History of Military Medicine from Sumer to the Fall of Constantinople, Washington D.C., 2012, p.136.

[3]:

Arthaśāstra 10.3.47.

[4]:

R.A. Gabriel, Man and Wound in the Ancient World, p.136.

[5]:

R.A. Gabriel, Man and Wound in the Ancient World, p.136.

[6]:

U.P. Thapliyal, Military Organisation in the Ancient Period in S.N. Prasad (Ed.), Historical Perspectives of Warfare in India: Some Morale and Mat riel Determinants. History of Science Philosophy And Culture In Indian Civilization Series, Vol. X Part 3, New Delhi, 2010, p.93.

[7]:

Suśruta Saṃhitā Sūtrasthāna 26.

[8]:

Suśruta Saṃhitā Sūtrasthāna 27.

[9]:

Suśruta Saṃhitā Sūtrasthāna 28.

[10]:

Suśruta Saṃhitā Sūtrasthāna 18.

[11]:

Suśruta Saṃhitā Sūtrasthāna 19.

[12]:

Suśruta Saṃhitā Sūtrasthāna 26.23.

[13]:

R.A. Gabriel, Man and Wound in the Ancient World, p.136.

[14]:

Suśruta Saṃhitā Sūtrasthāna 16.10-14.

[15]:

Suśruta Saṃhitā Cikitsāsthāna 2.31.

[16]:

Suśruta Saṃhitā Sūtrasthāna 16.27.20/1-30.

[17]:

Suśruta Saṃhitā Cikitsāsthāna 14.17.

[18]:

Suśruta Saṃhitā Cikitsāsthāna 2.10/2-11/1.

[19]:

Suśruta Saṃhitā Cikitsāsthāna 2.11/2.

[20]:

Suśruta Saṃhitā Cikitsāsthāna 2.19/2.

[21]:

Suśruta Saṃhitā Cikitsāsthāna 2.21/2-22/1.

[22]:

Suśruta Saṃhitā Cikitsāsthāna 2.32.

[23]:

Suśruta Saṃhitā Cikitsāsthāna 2.37.

[24]:

Suśruta Saṃhitā Cikitsāsthāna 2.42.

[25]:

Suśruta Saṃhitā Cikitsāsthāna 2.69/2-70/1.

[26]:

Suśruta Saṃhitā Cikitsāsthāna 2.56-57.

[27]:

R.A. Gabriel, Man and Wound in the Ancient World, p. 137.