Susruta Samhita: Ancient Indian Surgery (Set of 3 Volumes)

Book Specification

Book Description

About the Auhtor

Vaidyakirti (Honoris Causa, Sri Lanka) Born at Allahabad in 1932. Brilliant academic career with medical eduction at Lucknow, Edinburgh and Toronto. A widely travelled Paediatric Surgeon and Historian of Medicine, Rotarian Dr. Singhal was Professor & Head of the Paediatric Surgery Section and former Head of the Dept. of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi.

Prof. Singhal was a Fellow of the International Society of History of Medicine and was the President of the B.H.U. History of Medicine Society; he was also a Fellow/Member of many national/international academic bodies on Surgery/Paediatric Surgery/History of Medi- cine and was recognised as an authority on Ancient Indian Surgery. His monumetal ency- clopaedic Ayurvedic works on Sushruta Samhita and Madhava Nidana have already won national/international recognition are changing the History of Medicine and are stimulating research on Ayurveda all over the world. Prof. Singhal claimed Sushruta of India to be called the Father of Surgery” and frequently invited to give authentic talks on the subject in India and abroad.

Volume-1

PREFACE

It is a great pleasure to introduce the English translation of Susruca Samhita being brought out under the editorship of Dr. G. D. Singhal. Susrura Samhica is one of the important treatises of Ayurveda and has a lot of valuable information among others from the surgical point of view. A diligent search of this treatise reveals the presence of seeds of conceptual thoughts relating to many surgical aspects which are practised in current period,

Ayurveda has been handed over from generation to gencration almost in an uninterrupted continuity. In Susruta Samhita one finds a systematised approach and the deeper understanding of this is likely to open new vistas of thought and the present English version is aimed to apprise the modern worker the intti- cacies present in this great treatise.

The editorial board while translating has also presented a picture of gen- esis of cach concept and its place in the current surgical practice can be easily appreciated through this. This will enable the reader to know its impact on the art and practice of surgery today.

The entire work is divided into various sections almost faithfully based on the original text. The sections purport to highlight the surgical aspects practised in those days with their relevance to the present day surgical methods, manouvers and knowledge.

Susruta was considered a surgeon and he belonged to Dhanwanrari school of thought. The evolution of a medical system was invariably preceded by cura- tive spells and other religious and traditional folk customs. Medical and surgical procedures written at that remote period cannot ignore these fundamental traits. Following this a system of medical practice with considerable refinement emerg: d and it did not fully shelve the magic spells and traditions into oblivion in view of their hold on society and life.

The wars, in ancient days, to some extent contributed for the development and progress of different branthes of medical knowledge including surgery. War surgery developed in this way. References to Vedic surgery like uniting che head of the God of sacrifice to his decapitated body provides insight into the surgical acumen that existed then. War free period provided scope for leading a peaceful and stately life during which men travelled in chariots and other kinds of ve- hicles for enjoyment and as a luxury in a carefree mannet and got involved in road accidents. This provided scope for the development of the surgery of acci- dents and injuries. Midwifery also developed since the war surgery had litde place in peace time. Evolution and advances of surgery, or as a matter of fact of any branch of knowledge, is with reference to needs, circumstances and environ- ment in addition to other factors connected with life. Susrutarin surgery almost followed Vedic surgery. The credit of providing a systematised approach goes to Susruta since he was the earliest to make elaborate efforts to keep it on a sound footing so far as his age is concerned in practice and of imparting practical knowledge. Instrumentology also developed during his time since this has a greater potential for success in this field. The plastic surgery and rhino-plasty described by Suiruta have been acclaimed even today as the greatest of the sur- gical techniques and they may be treated as important landmarks in the field of surgery. Obviously by advancement of this and other techniques the country sowed sceds for the development of a high class surgical approach of sophis- ticated nature. India made original contribution to the corpus of surgical knowledge. Reference to cataract crouching, amputation of limbs, abdominal operations, setting of fractures and dislocations, treatment of hacmorrhoids and fistula, treating of hernia, etc. and the basic principles behind these numerous operations which were described by Suruta are as much valid today as it was then. Lithotomy and post-operative management of these cases are discussed in detail. A number of obstetrical manouvers and operative techniques have been elaborated. Ophthalmic surgery was practised in the days of Susruta. Practical training was considered essential and reference to methods to be adopted to provide effective practical knowledge in those days in surgical methods and techniques will be found to be interesting. Surgical incisions are practised on vegetables having different consistencies and textures; this provided a practical knowledge and experience regarding the force to be adopted, the extenvdepth to which the incisions were to be made in addition to making the surgical stu- dent steady. Another therapeutic measure mentioned was blood-letting.

With a view to provide the required knowledge. the treatise of Suiruta laid emphasis on a study of the anatomy and the dissection of cadavers. The work of Susruta dealt with cmbryology, biology. cosmogony, physiology, materia medica and therapeutics and a number of fields which have relevance to the study of Ayurveda. The medical aspect has also been mentioned by Susrura almost in the same manner though stress is laid on surgical aspects.

Susruta Samhita can be considered as an excellent surgical treatise which was much eulogised by a number of occidental and other experts.

With the availability of an English version with a detailed commentary and helpful notes, the treatise will benefit a wider circle of readers not only in India but also abroad with potentiality to contribute further in the art and practice of surgery. The planning of the work provides an advantage of a rapid reference to the subject/topic in which the reader is interested. The long felt need for such a work is expected to be solved by the series of volumes envisaged.

I have every confidence that this will prove to be a valuable addition to every medical institution whatever be the system it is handling. Research work- ers, scholars, teachers, surgical experts and scientists irrespective of the field of medicine to which they belong are sure to find the work useful and rewarding. The editorial board composed of experts of Ayurveda and allopathic system pro- vide an acceptable interpretation of the concepts and substance of Suruta Samhita. The much felt need for an English version of Sugruca Samhiea having interpretative and working information will be met with by this compendium.

Volume-2

PREFACE

India has a great and ancient cultural heritage. Medical treatment (Ayurveda) flourished here centuries ago when people in other parts of the world were not so advanced. There is no dearth of evidence to prove these state- ments as is shown by the Vedas, Puranas and other subsequent Indian publica- tions.

Ayurveda, the ancient Indian system of medicine, was practised about 1000 B.C. It is available today in three classical Samhitas or treatises, the Caraka, Susrura and Vagbhata (in addition to many other smalicr later publications). All were written in Sanskrit, the ages old Indian language comparable to the Greek or Latin of the Wester World. Caraka and Vagbhata books are mainly on medicine whereas Suiruta is chiefly a surgical treatise.

As all these classical creatises have so far been available in Sanskrit only, they have been comparatively less well known to the modern world, A great necessity was felt to bring out the proud possessions of ours accepted as invaluable national literary treasures using contemporary scientific and medical terminology in a language understandable easily in many other parts of the world. Susruta, the surgical treatise has been selected to be brought our firse.

A great necessity has been felt by the scientists of the modern world, doc- tors, surgeons, historians, research workers and the educated class of public in general to be able ca get to know Suruta-Samhitd in the language understand- able by them. English written in Roman script was selected as the language for translation as it is one of the international languages and myself and other authors and translators here have a working knowledge of it.

Other attempts at Translation and their Drawback The first accempt at cranslation of Suiruta-Samhitt was made in 1897 by Dr. A.ER. Hoernle, C.1.E. His preface is quoted verbatim below “The present translation of che Suruta-Samhit has been undertaken by me at the special request of the Council of the Asiatic Society of Bengal. The original translation made by Dr. Udoy Chand Dutt was stopped by the untimely death of the translator, after the publication of his second fasciculus. Its continuation by another translator proved so unsatisfactory that it had to be abandoned, after one more fasciculus. Dr. U. Ch. Durt’s translation, though a very fair performance, laboured under che disadvantage, owing to the translator’s want of knowledge of Sanskrit, of not being made dircctly from the original language. It also lacked elucidation from the works of commentators. Both points are remedied in the present translation, which accordingly has been com- menced de novo.” – Calcutta, 26th November, 1897 A.R.H.

The next attempr at translation only (without any comments etc.) of Suruta-Samhit3, was made by Kaviraja Kunj Lal Bhisagratna in 1907. He was a great Sanskrit scholar without modern medical or surgic +l background. Conse- quently, his book, though a brave and creditable attempt, could neither provide much help to the scientist, the research worker or the historian, nor could his interpretations be corrclated with modern medical terminology. Kaviraj Bhisagratnas translation, at places gives the impression of being explanatory rather than literal and of being somewhat biased.

Hoernle’s Translation was more accurate than that of Kunjlal or U.Ch. Dutrs bur the scientific comments were lacking and one could not find our the historical facts of importance or the problems on which scientists and research workers should concentrate. But whatever it is, he could bring out only one fasciculas of 98 pages of this much needed book.

The original has 186 chapters (1000 pages) in Sanskrit. Every verse or stanza in each chapter is numbered. Translation of each verse or stanza has now been done as accurately as possible. Each verse or a few verses together have been given followed immediately by their English syntex; each unit has been given a heading in modern terminology which is usually self-explanatory. Hence, foor- notes have been given sparsely and only if their necessity has been felt strongly.

In addition, the volume has an Introduction in the beginning which in- cludes a “four line gist” of each chapter contained in chat particular volume. Thus even a casual reader by reading the introduction would get to know the broad contents of the book. IF the gist of any chapter interests him he could read more about it in the “Summary” given at the beginning of the chapter con- cemed. If any point further arouses his curiosity, he could turn over to the verse or stanza concerned with the heading outlined for him alongwith the original Sanskrit and its literal (syntex) translation “ready on the plate” as it were. And the reader has not got to go further than turning to the end of the chapter to look for the research problems that he may be interested in. Importance of the Book.

It is believed that this book would be a fundamental contribution to the History of Medicine. Our entire concept of History of Medicine would need to be reoriented, e.g, classification of burns would begin by Susrura and nor Dupuytrens, lichotomy operations should mention Suiruta before Ambroise Pare, credit for describing signs of inflammation first should go to Susruta and nor to Celsus and a host of other things such as piles, fistula, skin diseases, cye diseases etc.

In addition, the research problems outlined in this book would interest the Pharmacology Deptt., Botany Depet., pharmaceutical drug companies, the surgeons and physicians, and the research workers in the experimental surgery and other sections.

Presentation of this terse, ancient Sanskrit medicinal classic in such a sci- entific yet easy and lucid way is something unique. If even one good drug is found such as that mentioned in S.S. 1. 14. which could be of value in haemostasis, e.g. after prostatectomy or a bleeding discase, or its counterpart, a drug which has anticoagulating properties of possible use in the prevention and cure of cerebral or coronary thrombosis, it would be a drug worth its price.

Translation has been checked many times by competent authorities. Sum- mary and research aspects, comments and references have been carefully writ- ten. Still it would be a great wonder if scope for improvement was not found. Many mistakes would certainly be pointed out by the learned readers which would be tried to be rectified in subsequent editions.

Book 3 on Diagnostic Considerations is being brought out first because of its greater practical utility. It is expected that the other books of the serics would be published in rapid succession.

Volume-3

PREFACE

Susruta Samhita is probably the carliest treatise which has deale with surgery as the foremost speciality of the medical science. In contrast, in the West it was considered an inferior calling relegated to barbers from the time of Hippocrates till the 19th century. This Samhitd is not only the most com- prehensive treatise on the ethical, philosophical and practical aspects of surgery, it has also given due importance to other specialities of the medical and related sciences! and in addition has made original contributions to Internal Medicine (Kaya-cikita) and Pharmacology (Dravyaguna) Evidently, the knowledge presented in a crystallized form in this treatise must have been based on a long period of earlier experience. It is generally accepted (Thorwald)? that Susruta’s lucid and systematic presentation of the conceptual and technical aspects of surgery, as well as the philosophy and ethics of medicine was quite advanced and may have relevance even today.

Surgical feats as replacement of the lost leg of Queen Vispala by an artificial iron leg and replacement or hetero-transplantation of the head and testicles by the divine win physicians Asvini Kumaras are mentioned in the Vedas, the ancientmost repository of human knowledge. It is only in Sugruta Samhita chat we find surgery systematized and presented in a scientific manner. It is specially significant because Susruta, the author of this Samhita and his preceptor Divodisa Dhanvantari lived carlier than Buddha (600 B. C.) as per opinion of the eastern as well as the western medical historians. Thus there is no doubt that this Samhita ancedates Hippocrates (300 B. C.) by several centuries.

The surgical practice of Susruca was of a high standard is evident by his insistence on the surgeon’s theoretical and practical expertise and ethical qualities, his precise, lucid and classified descriptions of the surgical procedures in general and of the individual surgical operations, his innovations in the use of various blunt and sharp instruments and his basic concepts in the total surgical management of patients. A few examples will amply testify to the above state- ments.

Surgical Armamentarium of Susruta

Status of surgery of any age can be best evaluated by the variety and quality of the surgeon’s armamentarium. Suruta has described 106 blunt! and 20 sharp? instruments which can be said to be the precursors of modern surgical instruments. In fact a number of them have similar names : as simhamukha yantna” (lion jaw forceps), mudrika iastra? (finger knife), etc. Fourteen differenc types of bandages fulfil all exigencies of bandaging. Varieties of needles (straight, curved, blunt and sharp), suture materials,” splints and fracture bed for immobilization of fractures at different sites, and parasurgical measures as cautery, etc. for bleeding are some other examples. Susruta may well be the first surgeon to have used endoscopes; he has described adi yantras (tubular inscru- ments) which were to be used for direct visual examination of the lesion (roga darianartham.” Specific measurements of some of these have also been given. e.g. of arioyantra”‘ and bhagandana yantra’? for visualizing piles and fistula. Ara dastra’ used for the diagnosis of suppuration may be said to be the fore-runner of biopsy needles. Similarly, mudrika iastra (Finger knife) was an ideal innovation for conducting blind surgical procedures like opening a retropharyngeal abscess or removal of a dead foetus per vaginum.”

Suruta further advised surgeons nor to be dogmatic but improvise instru- ments according to necessity, taking his descriptions as guidelines only.

Surgical Training

Susruta Samhita is the first ancient treatise which has advocated dissection of the human cadavers’ much against che prejudices which must have been prevalent in his times. Sugruta was the oldest teacher who insisted on dissection as an essential prerequisite for learning surgery. His method of dissection may not be considered ideal in the modern circumstances, bur the very fact that he insisted on dissection and direct observation of human organs in the remote past is very significant.

Besides, Susrutas ingenious experimental surgery (yogya)’ models for teaching various surgical procedures is unique in the history of surgery. His method of surgery was not of trial and error on human patients. His scudents besides undergoing rigorous clinical apprenticeship were required to be fully trained with the help of these experimental models. His experimental models are not only notable for their simplicity, but also for their similarity to the actual surgical procedures and thus Suruta is unique amongst the teachers of surgery of all times.

Surgical Concepts in Suiruta Samhita

Based on the accurate observation of facts Sustuta has scientifically classi- fied in a systematic manner a wealth of clinical material and the principles of management which are valid even today.

Classification of traumatic wounds, their prognostic evaluation and man- agement, insistence on primary suturing in clean wounds, avoidance of sepsis and excision of extruded omentum and careful suturing of intestinal perfora- tions in che management of perforating abdominal wounds, etc. are remarkable for their modern outlook. Similarly, classification of intestinal perforation in the management of perforating abdominal wounds, etc. are remarkable for their modern outlook?. Similarly, classification of skeletal injuries into dislocations and fractures, varieties of fractures such as green-stick, transverse, fissured, etc. according to the type of bones involved, principles of their management by reduction and immobilization and the criteria of an ideally healed fracture with no shortening, deformity or restriction of movement can be cited as other ex- amples. Further, he was the first to recognize the similar basic pathology of all thermogenic injuries – hot or cold; he coined the word dta-dagdha (cold burn), a term which has come in modern surgery only

Volume-4 PREFACE

Ayurveda is the Science of life. Ayurveda considers life as a combination of sattva (mind), arma (soul) and dartra (body). Thus life is an integrated psycho- somatic-spiritual entity. Ayurveda has twofold objectives, firstly to preserve the health of the healthy persons and secondly to cradicate the disease from the ailing. Through these objects Ayurveda longs for the ideal of aragya, which is considered to be the basis of the four-fold values of life, i.e. dharma, artha, kama and moka.

Thus Ayurveda is not only a system of Medicine, but is an unique discipline which deals very comprehensively with the human science and philosophy. Therefore while studying the Ayurvedic texts specially the classics, onc must keep in view this basic approach and should refrain from only gross physical understanding.

Susruta Samhita is one of the three major classical texts on Ayurveda, popu- larly known as Vehat-trayis, Suruta Samhita is considered a surgical text on Indian Medicine. Sugruta was a surgeon and he compiled his Samhita as a text book on Surgery. Susruta is therefore rightly being called by Dr. G. D. Singhal and his colleagues from Varanasi as the Father of Surgery. [tis true that to a large extent Susruta Samhita is a surgically oriented classic; however, it must be em- phasized that Sugruta Samhita is not only a text on ancient Indian Surgery but is a Samhit in che true sense of the word. It actually deals, in addition, with all other disciplines of Ayurvedic Science and Philosophy. !t provides equally rich material on Medicine as on Surgery. Considering it a surgical treatise only will be to undermine its significance and scope. As a matter of fact Suruta Samhiti is a classical text on Ayurveda as a whole with additional emphasis on anatomy and surgical and gynaecological practice.

The present volume would greatly support the above contention. This volume deals with such basic non surgical problems which are very fundamental to the practice of Ayurveda, i.e. the disciplines of Svastha-urtta, Rastyana, Bajtkarana, Parica-karma and allied Samiodhana measures. These considerations are of equal significance to a surgeon as well as to a physician.

Thus this volume deals with the Ayurvedic concepts of social and preven- tive medicine, personal hygiene, restorative and rejuvenative measures and purificatory therapy. In general this volume describes the fundamentals of pre- ventive medicine. In this context a number of such unique ideals are presented which may prove entirely new in todays perspective. Susrutas ideas of internal purification of the body as a preventive measure and as a preparatory procedure before specific medical or surgical intervention, the extent of complete mental and physical transformation through nesdyana therapy, etc. are some unique ideas which need scientific enquiry. The authors of this book suggest numerous problems on such ideas on which research should be carried out in the modern medical institutions for the benefit of the humanity.

It is a pleasure to nore that Dr. Singhal and his colleagues are working on Susruta Samhita and are tying to bring out the entire text in English in 12 volumes. An authentic English presentation of Sugruta Samhita has been a real need. The carlier English translation presented by Shri Kunja Lal has many falacies and it has been really criticised by many scholars. Ac this juncture this new series will be most welcome. The authors have done a very goed job in presenting an authentic, casy reading, English translation, comments, summa- ries for cach chapter and a list of probable research problems along with cross references.

This volume in particular is a highlight of the entire series, due to the fact that it deals with subjects of some interesting specialities of Ayurveda which are original to Ayurveda and whose significance and scope is increased in present times, namely Svasthaurtta, Rasdyana, Bajikarana and Paica-karma. These subjects are prescribed in undergraduate and postgraduate curricula of all Ayurvedic faculties and as such this particular volume should find a place as a text book for this purpose.

In short this work demands a change in the history of medicine of the world to enable Susruta of India to be recognised as the Father of Surgery, pre- sents the concepts of Ayurveda in a lucid way easily understandable by even a non-Ayurvedic person, provides numerous ideas for original research and stimu- lates all to use Ayurveda clinically; in addition it is full of excellent quotations with cross references.

The authors of this volume Dr. G.D. Singhal and Dr. RH. Singh are known to me for several years. They have done full justice to the job undertaken. Dr. Singhal is a renowned Paediatric surgeon and a teacher of modern medicine. He has widely travelled all over the world and is in touch with the current trends of international medicine and due to his interest in the History of Medicine he has developed an understanding of the historical perspectives of Medicine. The other author Dr. R. H. Singh is one of che brightest scholars of younger generation in Ayurveda. He is seriously engaged in research on Ayurveda and is a postgraduate teacher in Indian Medicine at Banaras Hindu University for several years. He has been specialising in specialities of Ayurveda such as Rasiyana therapy, Paiica-karma and Psychosomatic Medicine. Therefore he has a full authority to write such a volume. I congratulate the authors for having come out with such an authoritative volume on a subject of current interest in Ayurveda. They are privileged to have the support of many other scholars in the Editorial Board and I hope this work will go a long way in the revival of our great heritage, the Science of life, Ayurveda.

Volume-5 PREFACE

One of the objectives of Ayurveda as defined in Caraka Samhita is to describe materials, drugs and diets, etc., which are unwholesome for life or anta- gonistic to life processes. That is why onc of the sections (aaga) or branch of Ayurveda is Agada-Tantra or Visa- Tantra, All the Samhitds, to remain true to the object of expounding Ayurveda in toro-describe all the cight branches buc choose one branch as their main theme. Thus, Suruta Samhita, chough deals mainly with surgery, also deals with other branches in lesser details, Bur in the matter of description of poisons Acarya Susruta has shown such mastery and dealt with such specificity that he has devoted one full section of eight chapters for this particular branch which he has named as Kalpa-Schana. In this respect he excells over other ancient authors, In this section he has classified che poisons, described the modes of action of different types of poisons, dealt with the symp- tomatology and pathology and also given in detail the modes of treatment and the drugs used. He has even pointed to the examination of poisoned food and utensils, the culprits who try to poison the food and the post-mortem examina- tion of some internal organs. One simply wonders for the keen clinical observa- dons recorded.

Recent developments in biochemistry particularly in the field of synthetic medicines, has brought us to an era in which we are encountered with a flood of life saving chemo-therapeutic agents on the one hand and life destroying chemi- cal poisons of ever increasing intensity on the other. Humanity is passing through a situation which is reminiscen of the graphic mythological story of churning the ocean which was really started for bringing forth the ambrosia bur which incidentally brought forth virulent lethal poison Aalahala also life saving and life destroying agents are at all times simultaneously produced by the man himself.

The sources of poisons at present are not limited, as in the days of classics, to the two natural classes of animal (jaigama) or vegetable-cum-minerals (sthavara) i. c. IA: Prez or vo the extra class of poisons resulting from the incompatibilities produced by the combinations of some innocent substances like food or medicines but include the counteracting poisonous effects also as a result of the processing of a particular preparation i. . dara: and Fear: faraiht. Chemical poisons in the form of gas, spray or liquids or pills, powders and injections are a legion now a days and even latest b