FEATURE Ophthalmology in ancient india, Sushruta’s time and the modern era BY DHIREN BUJARBORUA hile reading an article Sushruta’s time has long been a encountered while doing the surgery. related to the history of controversial subject due to a lack of Several reasons, such as translation Indian ophthalmology, direct evidence [3]. The original copy of the original work by a non- W I came across this of Sushruta Samhita, the monumental medical Sanskrit scholar, difficulty in description of a surgical procedure: treatise on surgery written by interpreting Vedic Sanskrit and the “The doctor warmed the patient’s Sushruta, is not traceable. However, understanding of cataract at that time eye with the breath of his mouth. He a version of this textbook was might lead to this confusion. Recently rubbed the closed eye of the patient discovered in 1890 in Kuchar, Chinese there has been some debate whether with his thumb and then asked the Turkestan, and was named after the we should consider the operation patient to look at his knees. The man to whom it was sold, Hamilton done by Sushruta to be extracapsular patient’s head was held firmly. The Bower. The Bower manuscript is cataract extraction or couching [7,8]. doctor held the lancet between his currently housed in the Bodlean But in ancient times, cataractous fore-finger, middle-finger and thumb Library in Oxford [4]. Hoernle edited lenses were dislocated into the and introduced it into the patient’s and critically evaluated it and placed vitreous cavity rather than removed eye towards the pupil, in the strict sense. half a finger’s breadth Sushruta unknowingly from the black of the might have done some eye and a quarter of a partial extracapsular finger’s breadth from lens extraction in the outer corner of cases with mature or the eye. He moved the hypermature cataract lancet gracefully back while attempting and forth and upward. displacement of There was a small opaque lens from sound and a drop of the pupillary area water came out. The (couching). doctor spoke a few Nevertheless, it words to comfort the is really amazing to patient and moistened note that in the later the eye with milk. He part of the ‘Vedic Age’ scratched the pupil (3000 to 1000 BC), a ©Alokprasad at en.wikipedia with the tip of the surgeon dared to enter lancet, without hurting, the eye with a lancet and then drove the ‘slime’ towards the its origin around fifth century BC. As to remove the lens opacity. Couching nose. The patient got rid of the ‘slime’ Sushruta’s name was found in this became a very popular procedure for by drawing it into his nose. It was a document, it is presumed that he removal of blindness due to cataract. matter of joy for the patient that he must have existed in the fifth century The analogy of Buddha removing the could see objects through his operated BC or earlier [3]. Sushruta is the most screen of ignorance using a probe of eye and the doctor drew the lancet out celebrated physician and surgeon in wisdom to the surgeon who removes slowly. He then laid cotton soaked in India. Many of his contributions to cataract with a metallic probe is often fat on the wound and the patient lay medicine and surgery preceded similar found in Buddhist literature. Even still with the operated eye bandaged. discoveries in the western world [5]. a symbolic cataract operation was It was the patient’s left eye and the Sushruta practiced medicine nearly imitated at the time of initiation of doctor used his right hand for the 150 years before Hippocrates [6]. monks at that time [9]. operation.” The steps of the operation definitely It was quite natural that people at This is the description of an indicate that it was done for removal that period of time tried some non- operation that was performed by of the opacity of cataractous lens surgical measures to cure cataract Sushruta, India’s greatest surgeon of though there was some confusing before the development of the surgical the pre-medieval period [1,2]. interpretation of the findings remedy. In one such approach, a fully eye news | AUGUST/SEPTEMBER 2015 | VOL 22 NO 2 | www.eyenews.uk.com FEATURE developed dead cobra was put into a jar of milk along with four scorpions, and was kept aside to degenerate and decay in the milk for about a period of 21 days. After that the milk was churned into butter. This butter was fed to a cockerel. The faecal matter of this cockerel was applied to the eye with the hope of curing the eye of cataract [2]. Ancient knowledge The Vedas, the oldest sacred books of the Hindu religion are considered to be the first record of the ancient knowledge and civilisation of India, but also of the whole world. There are four Vedas, which were compiled in Sanskrit language between 3000 to1000 BC. Most of the early Vedic medicine was compiled in one of the four Vedas, known as Atharvaveda. Superstition Figure 1: The Sushruta Samhita or Sahottara-Tantra (A Treatise on Ayurvedic Medicine). Source: Los Angeles and magic is seen in Atharvaveda and County Museum of Art. the cures suggested are both magic spells and plant remedies [10]. The running to 1700 pages in its English surgical procedures in his Samhita [11]. ancient Indian system of medicine translation [13]. As a textbook, it is He was the first surgeon to systemise and surgery is commonly known unrivalled in respect of composite surgery by dividing it into separate as Ayurveda (science of life). This teaching on the subject, as it included fields. He is known as the originator was given the status of ‘Upa Veda’ information about all allied branches of plastic surgery, cataract operation, (supplementary subject of Veda) or of medical learning required by a laparotomy and vesical lithotomy [3]. fifth Veda in the next stage of growth. surgeon [11]. The original Sushruta He was aware of angina and the ill Among the available literatures three Samhita was revised by Nagarjuna in effects of obesity. He also knew about ‘Samhitas’ (compendiums) – Sushruta, the second century AD. Nagarjuna was diabetes and was aware of the benefits Charaka and Astanga Hridaya are a great Buddhist teacher. The Samhita of physical exercise in controlling this currently the chief source of knowledge was again re-edited by Chakrapani disease. Tipton [17] rightly observed of Ayurveda [11]. In fact, the first in the 11th century [6]. The Samhita that Sushruta’s concepts pertaining rational approach to medical science contains 184 chapters and description to the health benefits of exercise were is seen in the composition of Sushruta of 1120 illnesses, 700 medicinal plants, “remarkably modern.” He is credited and Charaka Samhita in the pre- a detailed study of anatomy, 64 with performing cosmetic surgery and Buddhist period [10]. preparations from mineral sources and especially rhinoplasty using forehead The oldest treatise dealing with 57 preparations from animal sources. skin to reconstruct noses which were surgery is the Sushruta Samhita. Sushruta devoted 18 chapters to usually amputated as a punishment for Sushruta was possibly born in the describing 76 eye diseases, of which 51 crimes in his era [1,6]. This rhinoplasty seventh century BC. He practiced required surgical treatment. Sushruta operation eventually changed the and taught the art of surgery at the Samhita was written in the aphorism course of plastic surgery in Europe. University of Benares in the ancient form and the techniques described in it Indian ophthalmic tradition started city of the same name, located on the are eminently in line with the technical much earlier than Sushruta’s time. bank of the river Ganges that flows abilities of the times [11,14]. Indeed, India had a long tradition through the northern part of India Sushruta was one of the first in the of ophthalmic study and practice [3,12]. The followers of Sushruta were world to study the human anatomy starting from the legendary King Nimi called Saushrutas. The new student with the aid of a preserved dead body. of Videha (located in what is now was expected to study for at least six He was the first person who established the eastern Terai-Madhesh region years. Before starting his training he the technique of preservation of dead of Nepal and the northern Indian had to take a solemn oath, which can bodies [1,15]. Sushruta had devised state of Bihar). This great king was be compared to that of Hippocrates various experimental models for trying considered to be the founder of the [12]. Sushruta had superb observational surgical procedures for the students science of ophthalmology in India. It power and a sharp analytical mind. before trying their hands on actual was Nimi who first gave instructions for Sushruta Samhita established him patients [16]. operation on a cataract. The knowledge as the ‘Father of Indian Surgery’ or Sushruta described surgery under of ophthalmology, as well as other rather ‘Father of surgery in the world’ eight heads – excision (Chedya), aspects of medical science, was passed [3,11,13,14]. The Sushruta Samhita was scarification (Lekhya), puncturing through king Nimi to Sushruta and a textbook of surgery in those days (Vedhya), exploration (Esya), extraction Nagarjuna of second to fourth century and was studied by the students of (Ahrya), evacuation (Vsraya) and AD, Vagbhaa of sixth century AD and so medicine more than 2000 years ago. suturing (Sivya) [1]. He described over on up to pre-modern times [9]. The text of the Samhita was quite long, 120 surgical instruments and 300 The procedure of the cataract eye news | AUGUST/SEPTEMBER 2015 | VOL 22 NO 2 | www.eyenews.uk.com FEATURE surgery described in Sushruta Samhita System also became popular in Europe the healthcare of their own people into might have been transmitted to the and helped to form the foundation of the hands of Ayurvedic physicians and west by Greek travellers from India and the European tradition of medicine [6].