Raman C Mahabir Jochen Son Hing Alda L Tam and Alex D Vastardis

Modern surgical practices, especially those of plastic surgery, have their origins in ancient Indian civilization. While Greece influenced medicine in the West, Arabic medicine was the authority in Europe before the 17th century. Since the Ayur Veda literature was translated into Arabic and Persian by the 11th century, it is logical to assume that the practices developed in the Indus Valley went not only East, as far as Japan, but also West, to influence medicine today.

To see how these procedures spread, look to Indian history where civilization has existed for at least 5000 years. The preAryan culture flourished in the Indus Valley from 2500 to 1500 BC at which time an Aryan people invaded. The conquerors adopted the already advanced system of public sanitation and brought with them the foundation for the subsequent religious and cultural developments of India. Centuries later, the Aryan Hindu people migrated east to countries that are now part of Southeast Asia: Burma, Thailand, Cambodia, Laos, Vietnam, and Indonesia, taking their knowledge with them.

The Hindus recorded this knowledge, as well as religious cultures and practices, in a series of books collectively called the Veda. The Atharva Veda, acknowledged as the earliest record of medical subjects in India, is filled with charms, spells, and incantations meant to ward off evil spirits, diseases, and enemies. Unlike many of its contemporary societies, the Indian religion and mysticism did permit a system of secular medicine that engaged in sound, rational processes, although not completely free of magical associations. The Ayur Veda, which translates as "knowledge of life," developed from the Atharva Veda and aimed to improve and prolong life. Many of the practices outlined in the Ayur Veda are still used today in India along with the teachings ofWestern Medicine and ancient traditional Indian medications and remedies are the topic of considerable research to determine their value to modern scientific medicine.

An examination of the writings reveals that surgery in India developed independent of Greek influence and that surgery held a position of honor, making it the subject of careful study. One of the five works of the Ayur Veda, the Susruta-samhita (the collection of the physician Susruta), is of particular interest in the history of medicine for its devotion to the art of surgery.

Susruta, with his discourse on surgery, is one of the most famous physicians in Hindu medicine. While there is uncertainty surrounding the exact dates of his life, he is credited with making an unequivocal contribution to the practice of medicine in his own time, as well as shaping some of the surgical practices of modern medicine. Susruta collected and documented the experiences of older surgeons in order to describe and classify diseases and their management. Surgical procedures were classified into eight groups: incision, excision, scraping, puncturing, extraction, secreting fluid, suturing, and chemical surgery by means of alkali and cautery.

Operations for abscess drainage, amputations, cataract operations, tonsillectomy, neck tumor excision, lithotomy, obstetrical procedures, bowel obstructions, hemorrhoids, and anal fistulas were described in the Susruta-samhita long before they were ever adopted in Western medicine. A special chapter in the book is dedicated entirely to the pathology and treatment of fractures.

Perhaps the Hindu peoples' greatest contribution to medicine is their pioneering work in plastic surgery. Physical mutilation was a routine punishment for crime in Hindu society and, as a result, can be looked upon as a chief cause for the introduction of plastic surgery measures to repair the ear and nose. It is well documented that plastic surgery was practiced in India more than 2000 years ago. At that time, removal of the nose was the punishment for an adulterer. The art of rhinoplasty was practiced by many early Indian surgeons. Susrata on nasal reconstruction:

First the leaf of a creeper, long and broad enough to fully cover the whole of the severed ofclippedpart, should be gathered; and a patch ofliving flesh, equal in dimension to the receding leaf, should be sliced off [from down upward] from the region of the cheek and, after scarifying it with a knife, swiftly adhered to the severed nose. Then the cool-headed physician should steadily tie it up with a bandage decent to look at and perfectly suited to the end for which it has been employed. The physician should make sure that the adhesion of the severed parts has been fully effected and then insert two small pipes into the nostrils to facilitate respiration, and to prevent the adhesioned flesh from hanging down. After that, the adhesionedpart should be dusted with [hemostatic] powders; and the nose should be enveloped in Karpasa cotton and several times sprinkled over with the refined oil of pure seasmum.

Magical beliefs of the time held that piercing the ear lobe and enlarging the opening was a means of affording protection against misfortune. Ironically, this often led to rips through the lobe by a pulled earring. This provided a large volume of practice for the development of ear lobe reconstruction.

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