9. Surgery in Ayurveda

It is an established fact that Surgical Science is known as a distinct branch of Medicine in Ayurveda. The practical part of the subject of surgery is preceded by a few general remarks, in which, amidst many erroneous notions, we trace some justness of classification, and soundness of principle. "Living bodies are composed," it is said - svabhavamisvaram kalam yadrccham niyatim tatha | parinamam ca manyante prakrti prthudarsinah || tanmayanyeva bhutani tadgunanyeva cadiset | taisca tallaksanah krtsno bhutagramo vyajanyata || susrutasamhita - sa .1.11-12. "of the five elements, with action or life super added: they are produced from vapour, vegetation, incubation, and parturition, as insects, plants, birds, fishes, reptiles, and animals. Ayurveda considers vegetable bodies as endowed with life. Of animals, man is the chief, and in proportion to his complicated structure is liable to disease. The disorders of the human frame are of four kinds accidental, organic, intellectual, and natural. The injuries arising from external causes form the first class. The second comprehends the effects of the vitiated humours, or derangements of the blood, bile, wind, and phlegm. The third class is occasioned by the 87. Concise Oxford Dictionary, New Edition, p.140.

128 operation of the passions, or the effects on the constitution of rage, fear, sorrow, joy, and others; and the last is referable to the necessary and innate condition of our being, as thirst, hunger, sleep, old age, and decay. "The judicious alleviation of human infirmities, the means of which were compassionately revealed by the gods, can only be effected by the knowledge that is to be gained from both the study and practice. He who is only versed in books will be alarmed and confused, like a coward in the field of battle, when he is called upon to encounter active disease. He who rashly engages in practice, without previous conversancy with written science, will be entitled to no respect from mankind, and merits punishment from the king. Those men who, in ignorance of the structure of the human frame, venture to make it the subject of their experiments, are the losers of their species. He alone, who is endowed with both theory and experience, proceeds with safety and stability, like a chariot on two wheels." It is much to be regretted that these aphorisms have so little influence on Ayurveda practitioners. best authorities, of eight kinds The instrumental part of medical treatment was, according to the (Chedana), cutting or scission; (Lekhana), which means drawing (Eshya), probing, or sounding; (Bhedana), division or excision; lines. (Vyadhana), puncturing; (Sevana), or sewing; and the 3/4 (Aharya), extraction of solid bodies, (Visravana), extraction of fluids, including venesection; and mechanical means, by which these operations were performed, seem to have been sufficiently numerous. Of these, the principal are the following: (Yantras), properly machines, in the present case instruments; but to distinguish them from the next class, to which that title more particularly applies, we may call them implements; (Sastras), weapons, or instruments; &R (Kshara), alkaline solutions, or caustics; 37 (Agni), fire, the actual cautery; (Salaka), pins, or tents; 3/4 (Sringa), horns, the horns of animals open at the extremities, and as

129 well as (Alabu), or gourds, used as our cupping glasses; the removal of the atmospheric pressure through the first being effected by suction, and in the second by rarifying the air by the application of a lamp. The next subsidiary means are (Jalauka), or leeches. Besides these, we have thread, leaves, bandages, pledgets, heated metallic plates for erubescents, and a variety of astringent or emollient applications. The enumeration is tolerably full, and the details are curious, if not instructive. A few instruments, and some of neat and ingenious fabric, are in the hands of native operators, particularly those for depressing cataracts; but they are not very common. We can only therefore conjecture what the instruments might have been, by adding to the imperfect description given of them the purport of their names, and the objects to which they were applied. The Yantras, or implements, known to Susruta (I, Ch. 7) were one hundred and one, and were classed as Swastihas, Sandansas, Talayantras, Nadiyantras, Salakas and Upayantras. tatra, manah sarirabadhakarani salyani tesamaharanopayo yantrani || tani satprakaranih, tadyatha - svastikayantrani, samdamrayantrani, talayantrani, nadiyantrani, salakayantrani, upayantrani ceti || tatra caturvimsatih svastikayantrani, dve samdamsayantre, dve eva talayantre vimsatirnadyah astavimsatih salakah, pancavimsatirupayantrani || tani prayaso lauhani bhavanti, tatpratirupakani vatadalabhe| tatra, nanaprakara bhavanti, tatpratirupakani vatadalabhe | tatra, nanaprakaranam vyalanam mrgapaksinam mukhairmukhani yantranam ..... || susrutasamhita - sutrasthanam- 7.4-10. The Swastikas are twenty four in number - they are metallic, usually eighteen inches long, having heads or points fancifully shaped like the heads of animals, the beaks of birds, etc. They are secured with smal pins, and are curved or hooked at the points, and are used to extrac

130 splinters of bone or foreign bodies lodged in the bones. they were, therefore, pincers, nippers, or forceps. The Sandansas, which in usual import mean tongs, were of that description. There were in the time of Susruta but two sorts, one with and the other without a ligature or noose (Nigraha?) attached. They were smaller than the preceding, being sixteen inches in length; and were used to remove extraneous substances from the soft parts, as the flesh, skin, vessels. The work of Vagbhata adds another sort, only six inches long, which were employed preferably for the soft parts and for fleshy excrescences. The Talayantras must have been something of the same kind, only smaller, their length being but twelve inches. They were but two, and were employed to remove foreign matters lodged in the outer canals, as the ears. The Nadiyantras were, as the name implies, tubular instruments. There were twenty sorts, varying in size and shape according to their intended use. They were employed for removing extraneous bodies from deep seated canals, as the intestines, urethra. For examining affections of parts similarly removed from inspection; for the introduction of other instruments, so as to enable them to be applied; and for drawing off fluids by suction. The work of Vagbhata specifies the number of perforations in each of these tubes, as they varied in this respect as well as others: the descriptions are, however, very indistinct, and we can only conclude generally, that they bore an analogy to our catheters, syringes, etc. The Salakas were hollow round rods. They were of twenty-eight kinds, varying in size and shape, for extracting foreign matters, lodged in parts of difficult access; for cleansing or clearing internal canals, especially the urethra; for applying collyria, caustic solutions, and the actual cautery; and for eradicating nasal polypi, the complaint called Nakra so common and so troublesome in India, and to be alleviated by no other means than the forcible extraction of the irritating excrescence.

131 The Upayantras were, as their appellation signifies, merely accessory implements, such as twine, leather, bark, skin cloth. The first, best, and most important of all implements, however, is declared to be the hand. Sastras, the instruments, of which twenty different sorts are enumerated as under: vimsatih sastrani, tadyatha - mandalagra karapatra vrddhiprapatra nakhasastramudrikotpalapatra ..... || yada sunisitam sastram romacchedi susamsthitam | sugrhitam pramanena tada karmasu yojayet || susrutasamhita- sutrasthanam- 8.3-14. They were of metal, and always bright, handsome, polished, and sharp; sufficiently so indeed to divide a hair longitudinally. Vagbhata however, adds, they were in general not above six inches in length, and that the blade formed about a half or quarter of that length. - Thus the different kinds of scission, longitudinal, transverse, inverted, and circular, are directed to be practised on flowers, bulbs, and gourds. Incission on skins, or bladders, filled with paste and mire; scarification on the fresh hides of animals from which the hair has not been removed; - puncturing, or lancing, on the hollow stalks of plants, or the vessels of dead animals; extraction on the cavities of the same, or fruits with many large seeds, as the Jack and Bel; - sutures, on skin and leather, and ligatures and bandages on well-made models of the human limbs. The employment of leather, skin, and even of dead carcases, thus enjoined, proves an exemption from notions of impurity. Of course, their use implies the absence of any objections to the similar employment of human subjects. Although they are not specified, they may possibly be implied, in the general direction which Susruta gives, that the teacher shall seek to perfect his pupil by the application of all expedients which he may think calculated to effect his proficiency.