January 23, 2019 • 26 mins
Sushruta’s Compendium is one of the foundational texts of Ayurveda, India’s traditional system of medicine. He’s also known as the father of plastic surgery, and was writing about medicine and surgery at least 200 years before Hippocrates.
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Episode Transcript
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Speaker 1 (00:01):
Welcome to Stuff You Missed in History Class from how
Stuff Works dot com. Hello, and welcome to the podcast.
I'm Tracy V. Wilson and I'm Holly Fry. Over the
holidays this winter, I noticed a tweet from friend of
the podcast and past guest Mary robin at Call in
(00:25):
which she asked herself this question, I wonder if I
can reference plastic surgery in the nineteen sixties, how early
did it start World War One? Right? And then the
tweet goes on to express her total astonishment that it
was actually much much earlier than that. I was astonished
to learn that also, and I meant to make a
note of that as something to look into when I
(00:46):
got back into the office, but then, of course, with
it being the holidays, I forgot. Fortunately, though, Mary Robinett
dropped me a note with a name to look into,
and that was shrewd A. Sashuda wrote the s Schuda
Samita or Sashuta's Compendium, and that's one of the foundational
texts of ayur Veda, which is India's traditional system of medicine.
(01:09):
He is also known as the father of plastic surgery.
Sashuda lived at least twenty six hundred years ago, although
it might have been even longer, and that means that
he was writing about medicine and surgery at least two
hundred years before Hippocrates, who's the person who usually gets
the credit as being the father of medicine. So the
(01:31):
oldest medical texts we know about today are Egyptian papyrie
that date back to between two thousand and fifteen hundred
b C. But those texts are based on or copied from,
ones that are much older and have not survived until
modern times, at least not that we have ever discovered yet.
Perhaps it will be a future on Earth. But these
papyride document medical information that is at least five thousand
(01:54):
years old. One of these is the Edwin Smith Papyrus,
which is the oldest known surgical document in the world
and is named after the antiquities dealer who bought it
in eighteen sixty two. This papyrus was written sometime around
sixteen hundred BC, but it's like the others, believed to
be a copy of a work that was at least
a thousand years older. The Edwin Smith Papyrus includes forty
(02:17):
eight case studies of wounds and trauma and It details
the treatments for these that include things like suturing, setting
a broken nose, and preventing infections with honey. Given the
types of trauma that it discusses, it was probably written
for military use to deal with soldiers who had been
injured in battle. The oldest descriptions of medicine and surgery
(02:38):
in what's now India date to just after this, from
the Vedic period, which spanned from roughly fifteen hundred to
five hundred BC. This is when the Sanskrit scriptures and
hymns known as the vetas went from being passed down
orally to being written down. The word veta translates to knowledge,
and the vetas are the oldest sacred texts and Hinduism.
(03:00):
They're not really medical texts on their own, but they
do contain a lot of references to medicine and surgery
and pharmacology and physicians. This includes lists of thousands of
drugs and descriptions of midwiffery. The rig Veta also includes
descriptions of limb amputations during wartime and the use of
iron proscesses in place of the amputated limbs. The Shahruda
(03:24):
Samhita was written in the mental Late Vedic period or
possibly just after, so some time between one thousand and
six BC, but we don't have a whole lot of
detail about Shahreuda himself. Under the cultural and religious traditions
of the time, life was essentially an illusion, so documenting
the lives of common people was generally regarded as vanity,
(03:47):
and we don't even know his given name. Sashrewda is
an honorific roughly translating to famous or renowned or well heard.
There is a Sashruda mentioned in the Mahabharata, which is
one of ancient India's two major epics and also dates
back to the Vedic period and the Mahaparata. He's the
son of a sage named vis Vimitra. Among people who
(04:09):
believe in transmigration, vis Pamitra was an incarnation of Don Ventari,
who's an avatar of Vishnu and surgeon to the gods,
and that would make Sashruda a descendant of the god
of medicine. S Shruda may have been born in southeastern India,
but he worked and taught in northern India near the
Ganges River in what was then known as Kashi or Benares.
(04:30):
Today it's the city of Varanasi, and Varanasi is one
of Hinduism's seven Sacred cities. Although Saddharta Gautama or the
Buddha was born in Nepal, he began teaching in this
same region of what is now India, and this part
of India very important is also known as the birthplace
of ira Veda or the Vedic system of medicine. Going
(04:51):
back to our earlier discussion of the Vedas, ira Veda
translates to knowledge of life. Listeners may have heard of
ira Veda even if they've never been to India, because
it's experienced a resurgence as part of complimentary and alternative medicine.
It is really not possible for us to give a
thorough overview of ayur Veda in the context of this podcast.
Especially in the West, it is often distilled down to
(05:13):
the idea of using things like herbs and diet and
lifestyle to promote equilibrium among the three docias of vada
or air, pizza or fire, and kafa or water. These
three docias connect back to the Hindu idea of prana
meeting life force or breath, and sometimes this is all
compared to hippocrates idea of preserving the balance among the
(05:34):
four humors, and this is not entirely a new comparison.
When the Sashu Samsa was first translated into English in
the early twentieth century, the introduction contained this note quote
by a laments able oversight, the terms value, pitam, kafa,
and docia have been translated as wind, bile, flim and
(05:55):
humor in the first few chapters. I don't know why
that makes me laugh so hard. I guess part of
me is like, did you realize part way through the
chapters that you were doing it wrong and you couldn't
walk it back? Or questions for the ages. Although prana
and the three docias are part of the foundation of
ayur Veda, they really don't sum up the whole thing,
(06:16):
and even just that explanation of prana and the docias
is a very simplified one. Ayur Veda is a complex,
comprehensive and holistic medical system that incorporates a mind body connection,
a focus on proper diet and the protection of a
person's health, and it has three foundational texts. One is
Sa Shrewda's Compendium. Another is the Sharaka Samita or Sharaca's compendium,
(06:41):
and so Shrewda's compendium includes both medicine and surgery, while
Sharacas builds on earlier work by a stage named Atrea
and focuses only on medicine. Thanks to these compendia, Sashuda
is known as the father of ayer Vedic surgery and
Sharaca is known as the father of Iyervedic medicine. Sa
Shruda and Shara Taca are both believed to have been
(07:02):
individual people, but the their two compendia are more like
compilations of entire schools of medicine, really documenting and codifying
the whole theory and practice of these two schools, rather
than just one individual person's medical knowledge written down. The
third classic iur Vedic text is the Ashtanga Sagraha, which
(07:23):
was an attempt to combine and unify the teachings of
Sharaka and Sashruda. The Ashtanga tries to reconcile the places
where Sharaka and Sashreda disagree and resolve conflicts that had
grown out of those disparities over the centuries, and this
work dates back to the second century b C. Was
created by Vagbada the Elder. Of course, there are other
(07:44):
important texts as well, but together Sashuda, Sharaka and the
Baha the Elder are known as the Three Ancients, and
the three texts associated with them are known as the
Great Trilogy of Iurvedic Medicine or the Triad of the Ancients,
and a sent treas in which all of these works
were created is known as the Golden Age of ira Veta. Together,
(08:05):
these texts cover everything the general principles of medicine, anatomy
and physiology, pathology, diagnostics, therapeutics, and pharmacology, and they incorporate
eight branches of medicine typically described as general medicine, obstetrics
and gynecology, psychology, eyes, ears, nose and throat surgery, toxicology,
(08:27):
and reproductive and sexual health. All of this knowledge grew
out of medical traditions that had existed way before any
of these documents were written down. So these were traditions
that had either been passed down orally or written down
in texts that haven't survived. So as it's true and
the rest of the world, ira Veda grew out of
folk medical practices that were revised and formalized and systematized
(08:48):
through all of these and other texts, and we will
talk more about the Sashrewda Samita after a brief sponsor break.
In his compendium, the Shrewter writes that theory without practice
as like a bird with only one wing, and the
(09:09):
shrewdest of me to really reflects that belief. It is
a comprehensive text documenting both the theory and the practice
of ira Vedic medicine and surgery, including the origins of
ira Veda and guidance on how students should be inducted
into its study. Requirements for studying illur Veda were exact.
The cast system has started evolving by this point, and
(09:30):
medical students were expected to be of the highest or
twice born casts. They were also to be quote possessed
of a desire to learn, strength, energy of action, contentment, character,
self control, a good retentive memory, intellect, courage, purity of
mind and body, and a simple and clear comprehension command,
(09:50):
a clear insight into the things studied, and should be
found to have been further graced with the necessary qualifications
of thin lips, sin teeth, and thin tongue ung and
possessed of a straight nose, large, honest, intelligent eyes, with
a benign contour of the mouth, and a contented frame
of mind, being pleasant in his speech and dealings, and
(10:12):
usually painstaking in his efforts. A man possessed of contrary
attributes should not be admitted into the sacred precincts of medicine.
This text totals a hundred and eighty four chapters, documenting
more than a thousand medical conditions. Along with anatomy and physiology, pathology, diagnosis,
and treatment. It details diseases of the nervous system, including epilepsy, sciatica, torticolis,
(10:37):
and facial paralysis, along with other things like hemrhoids, urinary calculi, fistulis,
skin diseases, urinary tract diseases, scraw phula, and a whole
lot of eye diseases, including cataracts and descriptions for their
surgical removal. The Sashrewda Semita also details practical midwiffery, including
(10:58):
using forceps to ing difficult births, performing cesarean sections, and
removing fetuses that have died in the womb. It also
discusses embryology and fetal development, along with guidance about when
conception is most likely, and how to encourage conception of
a child of a particular sex. The text also includes
information about the circulatory system, including descriptions of the heart, hypertension,
(11:22):
and angina, which you may also say angina. It describes diabetes,
connecting it to frequent urination that passes large amounts of
sugar and is frequently associated with the patient's weight. There
are also pages and pages of treatments for fevers, diarrhea,
heart disease, tuberculosis, jaundice, fainting, alcoholism, vomiting, asthma, and worms.
(11:45):
Some of these treatments are more religious or spiritual, and
there are chapters on treating ailments brought on by demons
and superhuman influences, but many are also practical, and the
compendium includes a pharmacopeia of six hundred fifty drugs, including
nearly four hundred plants, substances, nearly sixty of animal origin,
and sixty four minerals. The Sashuda Semisa also describes how
(12:09):
to determine whether an illness is medical or surgical. S
Shrewda belief that surgery was critical to igraveda that it
was not something that should be reserved as a last resort.
And in some cases was the best and most efficient
way to bring relief to a patient. He describes three
hundred different surgical procedures divided up into eight categories, which
(12:30):
are incision, excision, scarification, puncturing, exploration, extraction, evacuation, and suturing.
The text also lists a hundred and thirty different surgical instruments,
most of them named for the birds and other animals
that they physically resemble. The techniques include using medicated wine
(12:50):
and cannabis is anesthesia, using the mandibles of black ants
to suit your wounds, applying leeches after surgery to prevent clotting,
and correctly dressing and bandaging surgical sites to prevent infections.
Is also a teaching book, and so Shrewda's students spent
six years studying before they could practice on their own,
(13:11):
and their surgical practice included really extensive use of what
you might describe as skills labs. Although some of their
practice used cadavers or animal carcasses, they also used a
lot of non animal substitutes for practice that include practicing
incisions on gourds and practicing probing using pieces of worm
(13:32):
eaten or rotten wood. They practiced bladder surgeries on animal
bladders or leather bags filled with water, and they practiced
vent as section using water lily stalks. Students also studied
anatomy through dissection, although due to cultural taboos, this wasn't
generally performed with knives, so Shrewda instead recommended submerging cadavers
(13:53):
in water and examining the layers of the body as
the tissues decomposed. So Shrewda supple mented the anatomical knowledge
from these cadaver studies with what he learned while performing surgery.
Sashuda's most famous surgical category, and the one that earned
him the name the Father of plastic surgery, was rhinoplastic.
In this period of Indian history, people lost their noses
(14:17):
for a lot of different reasons, including battlefield injuries in
late stage syphilis, but cutting off a person's nose was
also used as a punishment, especially in cases of adultery,
sex crimes, and witchcraft. Women were particularly affected by this,
since they were often punished for adultery regardless of whether
or not they were ultimately found guilty. We mentioned the
(14:39):
Mahabarata earlier. India's other major epic, the Romana, describes Prince
Lexhmana cutting off the nose of ladies surpanaka as punishment
and then arranging its reconstruction by royal physicians. Having one's
nose cut off was of course an embarrassing and disfiguring
form of punishment. It made it really obvious to everyone
(14:59):
that you had been and punished for a crime, or
at least suspected of one, in a very public way.
And this is also tied up in cultural ideas about
the face and the nose and what they expressed about
a person's worth and renown. I mean, we read that
whole thing earlier in which people who are going to
study Aurveda, we're supposed to have straight noses. So also
think about the whole concept of losing face. So there
(15:22):
was a lot of demand for a way to reconstruct
a person's nose after they had lost it. Sa Shrewda
documented a method of rhinoplasty that involved using a flap
of skin from the cheek, keeping a small attachment to
the cheek during healing. Here's how it is described in
the Sashrewda Samhita. First, the leaf of a creeper long
(15:43):
and broad enough to fully cover the whole of the
severed or clipped off part should be gathered, and a
patch of living flesh equal in dimension to the preceding
leaf should be sliced off from down upward from the
region off the cheek, and after scarifying it with a
knife swiftly adhering to the severed nose, then the cool
(16:04):
headed physicians 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 physicians should make
sure that the adhesion of the severed parts has been
fully affected, and then insert two small pipes into the
nostrils to facilitate respiration and to prevent the adhesion flesh
(16:25):
from hanging down. The Sashrewda Semita then describes dusting the
area with powders made from licorice, red sandal wood, and barberry,
and then wrapping it in cotton soaked with sesame oil.
It also describes what to do if the skin from
the cheek doesn't adhere properly to the nose, and how
to handle various other complications during the healing process, including
(16:47):
what to do if the reconstructed nose is not the
right length. After healing and this was not so shrewd
as only technique that would be described as plastic surgery.
As one example, he also wrote about using skin flaps
to read construct missing or damaged ear lobes. But this
method of rhinoplasty lasted for millennia after so Shrewda's death,
(17:07):
and it's why he's known as the father of plastic surgery.
We will talk about his legacy in the world of
plastic surgery after another quick sponsor break. The shrewdest method
of rhinoplasty continued to be practiced in India for centuries
(17:28):
after his death. But because this the Shrewdest Samza was
written in Sanskrit on things like birch, bark and palm leaves,
the knowledge of how to do it didn't really move
out of India and into the rest of the world
really quickly. It does appear that Indian physicians traveled to
other parts of the world, though for example, Alexander the
Great had Indian physicians at his court and also attempted
(17:51):
to conquer India. It is possible that Indian physicians influenced
the later work of people like Hippocrates and Galen. That's
the shrewd A Samita was also translated into Arabic. In
the eighth century, after the Arab conquest of the Indian
province of sind Europeans got their first glimpse of Indian
rhinoplasty during the Third Anglo Mysore War. A porter named
(18:14):
Kawasji was working for the British and he and four
others had been taken prisoner by Tippoo Sultan's soldiers. While imprisoned,
all five men had their noses and one hand cut off,
and they were eventually freed and later granted pensions by
the British East India Company. For the curious. Yes, that
is the same Tippoo Sultan whose rocket stash we talked
(18:34):
about in Unearthed earlier. A couple of weeks ago, about
a year later, a British officer was in a market
and met a merchant with a scar on his nose,
and the officer asked about that scar, and the merchant
said that he'd had his nose cut off as a
punishment for adultery. He said his nose had been repaired
by someone who did this procedure all the time, and
(18:55):
we don't know anything about the person who did this
reconstruction other than that he was scribed as a potter
or a brickmaker. When the officer came back with this story,
the British decided to pay for the five men to
have their noses reconstructed. And there might have been some
benevolence at work here, but it was almost certainly also
to demonstrate the British East India Company's generosity and to
(19:19):
reinforce the idea that Tipoo Sultan's army was using brutal
methods against the British too. British officers observed the procedure
at least once, and they documented what they saw. This
description of the procedure was printed in the Madras Gazette
in se quote, A thin plate is fitted to the
stump of the nose, who is to make a nose
(19:40):
of good appearance. Then it is flattened and laid on
the forehead. A line is drawn around the wax, which
is then of no further use, and the operator then
dissects off as much skin as it covered, leaving undivided
a small slip between the eyes. This slip preserves the
circulation to and union has taken place between the new
(20:02):
and old parts. The sick of tricks of the stump
of the nose is not paired off, and immediately behind
this raw parted through the skin, which passes round both
land goes along the upper lip. The skin is now
brought down from the forehead, and being twisted half round,
its edge is inserted into the incision. A little terra
(20:22):
japonica is softened with water and being spread on slips
of cloth. Five or six of these are placed over
each other to secure the joining. No other dressing, but
this cement is used for four days. It is then
removed and the cloths dipped in gee a kind of butter,
are applied. The connecting slip of skin is divided about
(20:44):
the twenty five days, when a little more dissection is
necessary to improve the appearance of the nose. For five
or six days after the operation, the patient is made
to lie on his back, and on the tenth day
bits of soft cloth are put into the nostrils to
key sufficiently open. This operation is always successful. The artificial
(21:05):
nose is secure and looks nearly as well as the
natural one. Nor is the scar visible on the forehead
very observable after a length of time. So there are
some tweaks, but this is really similar to the Stretta's
method of rhinoplastic from thousands of years before, except that
it uses a flap of skin from the forehead rather
than the cheek, And we don't really know how or
(21:27):
when surgeons in India made this shift from a cheek
flap to a forehead flap, and the centuries leading up
to the late eighteenth century, rhinoplasty had become a really
closely guarded family secret, being handed down orally rather than
written down. An account of this reconstruction, almost identical to
the one that I just read, ran in the Gentleman's
(21:47):
Magazine of London in October of sevent In the years
after that, British surgeon Joseph Constantine Carpew began trying the
same procedure. He actually carried out London's first rhinoplastic using
a forehead flap in eighteen sixteen. The word rhinoplastic first
appeared in writing in English in eight and plastic surgery
(22:09):
followed in eighteen thirty seven. That year, North America's first
forehead flap rhinoplasty was performed in Boston. The use of
a forehead flap to reconstruct a nose has continued to
be known as the Indian method, there is also an
Italian method, refined by gas Bar Tagli Kazzy in the
sixteenth century. The Italian method used a flap of skin
(22:32):
from the upper arm, requiring the patient to have their
arm bandaged up above their head for about twenty days
until their arms skin had attached from the nose and
could be detached from their arm. So you kind of
have your elbow out in the front of your head
like a big beak. Honestly, this seems very cumbersome and
inconvenient and uncomfortable to me, But that was the Italian
(22:56):
method of rhinoplasty. I wonder if the idea was that
there was some benefit to using that skin that facial
skin may not have offered. I mean, to me, and
I'm completely lay person, I have no knowledge, but to me,
going with the forehead skin, which on most people is
much thinner and has less subcutaneous fat versus cheek seems
like a weird transition. But but I don't know what
(23:18):
the requirements are. So if anyone out there is a
plastic surgeon, school me, because I want to know, they
may also have been wanting to avoid the potential of
having two scars on a person's face. But I did
not look into it in detail because the picture of
the person with their arm bandaged with their elbow like
a big old beak, It's just so comical that I
couldn't get past it. Kind of love it. Well, design
(23:40):
clothes just for that. It'll be great, uh. In the
late nineteenth century, the Seshruda Samita was also translated into Latin.
Between nineteen o seven and nineteen sixteen, it was translated
into English by coverage Kunja Labasha Gratna, who consolidated the
works original five volumes down to three and those are
all online at archive dot org. Can go read them
(24:02):
all yourself and see lots of diagrams of surgical instruments.
There are a lot of them. Do you have listener
mail to read yourself? My view? I have a quick
follow up to the ongoing saga of Charles Dickens Multiple Households.
This is from our Facebook from Kristen and Kristen says heyo.
I just listened to the first sojourn or Truth episode
(24:24):
and have an alternate answer to the listener mail question.
This past December, I read The Man Who Invented Christmas
by Leah Standford and learned that Dickens was constantly having
to send his parents money to keep them afloat due
to their terrible financial management. This could have been the
multiple households answer as well. Keep up the fantastic work ladies.
(24:47):
Thank you, Kristen. Apparently Charles Dickens was just paying for
a whole lot of people to keep their lives afloat
by busy guy. Fortunately, by that point he was making
more money than immediately after American tour that we talked
about back at Christmas time. So thank you for sending
us that note on Facebook. If you would like to
(25:08):
write to us about this or any other podcast, we
are at History podcast and how Stuff Works dot com,
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is missed in History dot com and find a searchable
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of all the episodes Holly and I have done together.
(25:29):
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(25:49):
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Welcome to Stuff You Missed in History Class from how
Stuff Works dot com. Hello, and welcome to the podcast.
I'm Tracy V. Wilson and I'm Holly Fry. Over the
holidays this winter, I noticed a tweet from friend of
the podcast and past guest Mary robin at Call in
(00:25):
which she asked herself this question, I wonder if I
can reference plastic surgery in the nineteen sixties, how early
did it start World War One? Right? And then the
tweet goes on to express her total astonishment that it
was actually much much earlier than that. I was astonished
to learn that also, and I meant to make a
note of that as something to look into when I
(00:46):
got back into the office, but then, of course, with
it being the holidays, I forgot. Fortunately, though, Mary Robinett
dropped me a note with a name to look into,
and that was shrewd A. Sashuda wrote the s Schuda
Samita or Sashuta's Compendium, and that's one of the foundational
texts of ayur Veda, which is India's traditional system of medicine.
(01:09):
He is also known as the father of plastic surgery.
Sashuda lived at least twenty six hundred years ago, although
it might have been even longer, and that means that
he was writing about medicine and surgery at least two
hundred years before Hippocrates, who's the person who usually gets
the credit as being the father of medicine. So the
(01:31):
oldest medical texts we know about today are Egyptian papyrie
that date back to between two thousand and fifteen hundred
b C. But those texts are based on or copied from,
ones that are much older and have not survived until
modern times, at least not that we have ever discovered yet.
Perhaps it will be a future on Earth. But these
papyride document medical information that is at least five thousand
(01:54):
years old. One of these is the Edwin Smith Papyrus,
which is the oldest known surgical document in the world
and is named after the antiquities dealer who bought it
in eighteen sixty two. This papyrus was written sometime around
sixteen hundred BC, but it's like the others, believed to
be a copy of a work that was at least
a thousand years older. The Edwin Smith Papyrus includes forty
(02:17):
eight case studies of wounds and trauma and It details
the treatments for these that include things like suturing, setting
a broken nose, and preventing infections with honey. Given the
types of trauma that it discusses, it was probably written
for military use to deal with soldiers who had been
injured in battle. The oldest descriptions of medicine and surgery
(02:38):
in what's now India date to just after this, from
the Vedic period, which spanned from roughly fifteen hundred to
five hundred BC. This is when the Sanskrit scriptures and
hymns known as the vetas went from being passed down
orally to being written down. The word veta translates to knowledge,
and the vetas are the oldest sacred texts and Hinduism.
(03:00):
They're not really medical texts on their own, but they
do contain a lot of references to medicine and surgery
and pharmacology and physicians. This includes lists of thousands of
drugs and descriptions of midwiffery. The rig Veta also includes
descriptions of limb amputations during wartime and the use of
iron proscesses in place of the amputated limbs. The Shahruda
(03:24):
Samhita was written in the mental Late Vedic period or
possibly just after, so some time between one thousand and
six BC, but we don't have a whole lot of
detail about Shahreuda himself. Under the cultural and religious traditions
of the time, life was essentially an illusion, so documenting
the lives of common people was generally regarded as vanity,
(03:47):
and we don't even know his given name. Sashrewda is
an honorific roughly translating to famous or renowned or well heard.
There is a Sashruda mentioned in the Mahabharata, which is
one of ancient India's two major epics and also dates
back to the Vedic period and the Mahaparata. He's the
son of a sage named vis Vimitra. Among people who
(04:09):
believe in transmigration, vis Pamitra was an incarnation of Don Ventari,
who's an avatar of Vishnu and surgeon to the gods,
and that would make Sashruda a descendant of the god
of medicine. S Shruda may have been born in southeastern India,
but he worked and taught in northern India near the
Ganges River in what was then known as Kashi or Benares.
(04:30):
Today it's the city of Varanasi, and Varanasi is one
of Hinduism's seven Sacred cities. Although Saddharta Gautama or the
Buddha was born in Nepal, he began teaching in this
same region of what is now India, and this part
of India very important is also known as the birthplace
of ira Veda or the Vedic system of medicine. Going
(04:51):
back to our earlier discussion of the Vedas, ira Veda
translates to knowledge of life. Listeners may have heard of
ira Veda even if they've never been to India, because
it's experienced a resurgence as part of complimentary and alternative medicine.
It is really not possible for us to give a
thorough overview of ayur Veda in the context of this podcast.
Especially in the West, it is often distilled down to
(05:13):
the idea of using things like herbs and diet and
lifestyle to promote equilibrium among the three docias of vada
or air, pizza or fire, and kafa or water. These
three docias connect back to the Hindu idea of prana
meeting life force or breath, and sometimes this is all
compared to hippocrates idea of preserving the balance among the
(05:34):
four humors, and this is not entirely a new comparison.
When the Sashu Samsa was first translated into English in
the early twentieth century, the introduction contained this note quote
by a laments able oversight, the terms value, pitam, kafa,
and docia have been translated as wind, bile, flim and
(05:55):
humor in the first few chapters. I don't know why
that makes me laugh so hard. I guess part of
me is like, did you realize part way through the
chapters that you were doing it wrong and you couldn't
walk it back? Or questions for the ages. Although prana
and the three docias are part of the foundation of
ayur Veda, they really don't sum up the whole thing,
(06:16):
and even just that explanation of prana and the docias
is a very simplified one. Ayur Veda is a complex,
comprehensive and holistic medical system that incorporates a mind body connection,
a focus on proper diet and the protection of a
person's health, and it has three foundational texts. One is
Sa Shrewda's Compendium. Another is the Sharaka Samita or Sharaca's compendium,
(06:41):
and so Shrewda's compendium includes both medicine and surgery, while
Sharacas builds on earlier work by a stage named Atrea
and focuses only on medicine. Thanks to these compendia, Sashuda
is known as the father of ayer Vedic surgery and
Sharaca is known as the father of Iyervedic medicine. Sa
Shruda and Shara Taca are both believed to have been
(07:02):
individual people, but the their two compendia are more like
compilations of entire schools of medicine, really documenting and codifying
the whole theory and practice of these two schools, rather
than just one individual person's medical knowledge written down. The
third classic iur Vedic text is the Ashtanga Sagraha, which
(07:23):
was an attempt to combine and unify the teachings of
Sharaka and Sashruda. The Ashtanga tries to reconcile the places
where Sharaka and Sashreda disagree and resolve conflicts that had
grown out of those disparities over the centuries, and this
work dates back to the second century b C. Was
created by Vagbada the Elder. Of course, there are other
(07:44):
important texts as well, but together Sashuda, Sharaka and the
Baha the Elder are known as the Three Ancients, and
the three texts associated with them are known as the
Great Trilogy of Iurvedic Medicine or the Triad of the Ancients,
and a sent treas in which all of these works
were created is known as the Golden Age of ira Veta. Together,
(08:05):
these texts cover everything the general principles of medicine, anatomy
and physiology, pathology, diagnostics, therapeutics, and pharmacology, and they incorporate
eight branches of medicine typically described as general medicine, obstetrics
and gynecology, psychology, eyes, ears, nose and throat surgery, toxicology,
(08:27):
and reproductive and sexual health. All of this knowledge grew
out of medical traditions that had existed way before any
of these documents were written down. So these were traditions
that had either been passed down orally or written down
in texts that haven't survived. So as it's true and
the rest of the world, ira Veda grew out of
folk medical practices that were revised and formalized and systematized
(08:48):
through all of these and other texts, and we will
talk more about the Sashrewda Samita after a brief sponsor break.
In his compendium, the Shrewter writes that theory without practice
as like a bird with only one wing, and the
(09:09):
shrewdest of me to really reflects that belief. It is
a comprehensive text documenting both the theory and the practice
of ira Vedic medicine and surgery, including the origins of
ira Veda and guidance on how students should be inducted
into its study. Requirements for studying illur Veda were exact.
The cast system has started evolving by this point, and
(09:30):
medical students were expected to be of the highest or
twice born casts. They were also to be quote possessed
of a desire to learn, strength, energy of action, contentment, character,
self control, a good retentive memory, intellect, courage, purity of
mind and body, and a simple and clear comprehension command,
(09:50):
a clear insight into the things studied, and should be
found to have been further graced with the necessary qualifications
of thin lips, sin teeth, and thin tongue ung and
possessed of a straight nose, large, honest, intelligent eyes, with
a benign contour of the mouth, and a contented frame
of mind, being pleasant in his speech and dealings, and
(10:12):
usually painstaking in his efforts. A man possessed of contrary
attributes should not be admitted into the sacred precincts of medicine.
This text totals a hundred and eighty four chapters, documenting
more than a thousand medical conditions. Along with anatomy and physiology, pathology, diagnosis,
and treatment. It details diseases of the nervous system, including epilepsy, sciatica, torticolis,
(10:37):
and facial paralysis, along with other things like hemrhoids, urinary calculi, fistulis,
skin diseases, urinary tract diseases, scraw phula, and a whole
lot of eye diseases, including cataracts and descriptions for their
surgical removal. The Sashrewda Semita also details practical midwiffery, including
(10:58):
using forceps to ing difficult births, performing cesarean sections, and
removing fetuses that have died in the womb. It also
discusses embryology and fetal development, along with guidance about when
conception is most likely, and how to encourage conception of
a child of a particular sex. The text also includes
information about the circulatory system, including descriptions of the heart, hypertension,
(11:22):
and angina, which you may also say angina. It describes diabetes,
connecting it to frequent urination that passes large amounts of
sugar and is frequently associated with the patient's weight. There
are also pages and pages of treatments for fevers, diarrhea,
heart disease, tuberculosis, jaundice, fainting, alcoholism, vomiting, asthma, and worms.
(11:45):
Some of these treatments are more religious or spiritual, and
there are chapters on treating ailments brought on by demons
and superhuman influences, but many are also practical, and the
compendium includes a pharmacopeia of six hundred fifty drugs, including
nearly four hundred plants, substances, nearly sixty of animal origin,
and sixty four minerals. The Sashuda Semisa also describes how
(12:09):
to determine whether an illness is medical or surgical. S
Shrewda belief that surgery was critical to igraveda that it
was not something that should be reserved as a last resort.
And in some cases was the best and most efficient
way to bring relief to a patient. He describes three
hundred different surgical procedures divided up into eight categories, which
(12:30):
are incision, excision, scarification, puncturing, exploration, extraction, evacuation, and suturing.
The text also lists a hundred and thirty different surgical instruments,
most of them named for the birds and other animals
that they physically resemble. The techniques include using medicated wine
(12:50):
and cannabis is anesthesia, using the mandibles of black ants
to suit your wounds, applying leeches after surgery to prevent clotting,
and correctly dressing and bandaging surgical sites to prevent infections.
Is also a teaching book, and so Shrewda's students spent
six years studying before they could practice on their own,
(13:11):
and their surgical practice included really extensive use of what
you might describe as skills labs. Although some of their
practice used cadavers or animal carcasses, they also used a
lot of non animal substitutes for practice that include practicing
incisions on gourds and practicing probing using pieces of worm
(13:32):
eaten or rotten wood. They practiced bladder surgeries on animal
bladders or leather bags filled with water, and they practiced
vent as section using water lily stalks. Students also studied
anatomy through dissection, although due to cultural taboos, this wasn't
generally performed with knives, so Shrewda instead recommended submerging cadavers
(13:53):
in water and examining the layers of the body as
the tissues decomposed. So Shrewda supple mented the anatomical knowledge
from these cadaver studies with what he learned while performing surgery.
Sashuda's most famous surgical category, and the one that earned
him the name the Father of plastic surgery, was rhinoplastic.
In this period of Indian history, people lost their noses
(14:17):
for a lot of different reasons, including battlefield injuries in
late stage syphilis, but cutting off a person's nose was
also used as a punishment, especially in cases of adultery,
sex crimes, and witchcraft. Women were particularly affected by this,
since they were often punished for adultery regardless of whether
or not they were ultimately found guilty. We mentioned the
(14:39):
Mahabarata earlier. India's other major epic, the Romana, describes Prince
Lexhmana cutting off the nose of ladies surpanaka as punishment
and then arranging its reconstruction by royal physicians. Having one's
nose cut off was of course an embarrassing and disfiguring
form of punishment. It made it really obvious to everyone
(14:59):
that you had been and punished for a crime, or
at least suspected of one, in a very public way.
And this is also tied up in cultural ideas about
the face and the nose and what they expressed about
a person's worth and renown. I mean, we read that
whole thing earlier in which people who are going to
study Aurveda, we're supposed to have straight noses. So also
think about the whole concept of losing face. So there
(15:22):
was a lot of demand for a way to reconstruct
a person's nose after they had lost it. Sa Shrewda
documented a method of rhinoplasty that involved using a flap
of skin from the cheek, keeping a small attachment to
the cheek during healing. Here's how it is described in
the Sashrewda Samhita. First, the leaf of a creeper long
(15:43):
and broad enough to fully cover the whole of the
severed or clipped off part should be gathered, and a
patch of living flesh equal in dimension to the preceding
leaf should be sliced off from down upward from the
region off the cheek, and after scarifying it with a
knife swiftly adhering to the severed nose, then the cool
(16:04):
headed physicians 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 physicians should make
sure that the adhesion of the severed parts has been
fully affected, and then insert two small pipes into the
nostrils to facilitate respiration and to prevent the adhesion flesh
(16:25):
from hanging down. The Sashrewda Semita then describes dusting the
area with powders made from licorice, red sandal wood, and barberry,
and then wrapping it in cotton soaked with sesame oil.
It also describes what to do if the skin from
the cheek doesn't adhere properly to the nose, and how
to handle various other complications during the healing process, including
(16:47):
what to do if the reconstructed nose is not the
right length. After healing and this was not so shrewd
as only technique that would be described as plastic surgery.
As one example, he also wrote about using skin flaps
to read construct missing or damaged ear lobes. But this
method of rhinoplasty lasted for millennia after so Shrewda's death,
(17:07):
and it's why he's known as the father of plastic surgery.
We will talk about his legacy in the world of
plastic surgery after another quick sponsor break. The shrewdest method
of rhinoplasty continued to be practiced in India for centuries
(17:28):
after his death. But because this the Shrewdest Samza was
written in Sanskrit on things like birch, bark and palm leaves,
the knowledge of how to do it didn't really move
out of India and into the rest of the world
really quickly. It does appear that Indian physicians traveled to
other parts of the world, though for example, Alexander the
Great had Indian physicians at his court and also attempted
(17:51):
to conquer India. It is possible that Indian physicians influenced
the later work of people like Hippocrates and Galen. That's
the shrewd A Samita was also translated into Arabic. In
the eighth century, after the Arab conquest of the Indian
province of sind Europeans got their first glimpse of Indian
rhinoplasty during the Third Anglo Mysore War. A porter named
(18:14):
Kawasji was working for the British and he and four
others had been taken prisoner by Tippoo Sultan's soldiers. While imprisoned,
all five men had their noses and one hand cut off,
and they were eventually freed and later granted pensions by
the British East India Company. For the curious. Yes, that
is the same Tippoo Sultan whose rocket stash we talked
(18:34):
about in Unearthed earlier. A couple of weeks ago, about
a year later, a British officer was in a market
and met a merchant with a scar on his nose,
and the officer asked about that scar, and the merchant
said that he'd had his nose cut off as a
punishment for adultery. He said his nose had been repaired
by someone who did this procedure all the time, and
(18:55):
we don't know anything about the person who did this
reconstruction other than that he was scribed as a potter
or a brickmaker. When the officer came back with this story,
the British decided to pay for the five men to
have their noses reconstructed. And there might have been some
benevolence at work here, but it was almost certainly also
to demonstrate the British East India Company's generosity and to
(19:19):
reinforce the idea that Tipoo Sultan's army was using brutal
methods against the British too. British officers observed the procedure
at least once, and they documented what they saw. This
description of the procedure was printed in the Madras Gazette
in se quote, A thin plate is fitted to the
stump of the nose, who is to make a nose
(19:40):
of good appearance. Then it is flattened and laid on
the forehead. A line is drawn around the wax, which
is then of no further use, and the operator then
dissects off as much skin as it covered, leaving undivided
a small slip between the eyes. This slip preserves the
circulation to and union has taken place between the new
(20:02):
and old parts. The sick of tricks of the stump
of the nose is not paired off, and immediately behind
this raw parted through the skin, which passes round both
land goes along the upper lip. The skin is now
brought down from the forehead, and being twisted half round,
its edge is inserted into the incision. A little terra
(20:22):
japonica is softened with water and being spread on slips
of cloth. Five or six of these are placed over
each other to secure the joining. No other dressing, but
this cement is used for four days. It is then
removed and the cloths dipped in gee a kind of butter,
are applied. The connecting slip of skin is divided about
(20:44):
the twenty five days, when a little more dissection is
necessary to improve the appearance of the nose. For five
or six days after the operation, the patient is made
to lie on his back, and on the tenth day
bits of soft cloth are put into the nostrils to
key sufficiently open. This operation is always successful. The artificial
(21:05):
nose is secure and looks nearly as well as the
natural one. Nor is the scar visible on the forehead
very observable after a length of time. So there are
some tweaks, but this is really similar to the Stretta's
method of rhinoplastic from thousands of years before, except that
it uses a flap of skin from the forehead rather
than the cheek, And we don't really know how or
(21:27):
when surgeons in India made this shift from a cheek
flap to a forehead flap, and the centuries leading up
to the late eighteenth century, rhinoplasty had become a really
closely guarded family secret, being handed down orally rather than
written down. An account of this reconstruction, almost identical to
the one that I just read, ran in the Gentleman's
(21:47):
Magazine of London in October of sevent In the years
after that, British surgeon Joseph Constantine Carpew began trying the
same procedure. He actually carried out London's first rhinoplastic using
a forehead flap in eighteen sixteen. The word rhinoplastic first
appeared in writing in English in eight and plastic surgery
(22:09):
followed in eighteen thirty seven. That year, North America's first
forehead flap rhinoplasty was performed in Boston. The use of
a forehead flap to reconstruct a nose has continued to
be known as the Indian method, there is also an
Italian method, refined by gas Bar Tagli Kazzy in the
sixteenth century. The Italian method used a flap of skin
(22:32):
from the upper arm, requiring the patient to have their
arm bandaged up above their head for about twenty days
until their arms skin had attached from the nose and
could be detached from their arm. So you kind of
have your elbow out in the front of your head
like a big beak. Honestly, this seems very cumbersome and
inconvenient and uncomfortable to me, But that was the Italian
(22:56):
method of rhinoplasty. I wonder if the idea was that
there was some benefit to using that skin that facial
skin may not have offered. I mean, to me, and
I'm completely lay person, I have no knowledge, but to me,
going with the forehead skin, which on most people is
much thinner and has less subcutaneous fat versus cheek seems
like a weird transition. But but I don't know what
(23:18):
the requirements are. So if anyone out there is a
plastic surgeon, school me, because I want to know, they
may also have been wanting to avoid the potential of
having two scars on a person's face. But I did
not look into it in detail because the picture of
the person with their arm bandaged with their elbow like
a big old beak, It's just so comical that I
couldn't get past it. Kind of love it. Well, design
(23:40):
clothes just for that. It'll be great, uh. In the
late nineteenth century, the Seshruda Samita was also translated into Latin.
Between nineteen o seven and nineteen sixteen, it was translated
into English by coverage Kunja Labasha Gratna, who consolidated the
works original five volumes down to three and those are
all online at archive dot org. Can go read them
(24:02):
all yourself and see lots of diagrams of surgical instruments.
There are a lot of them. Do you have listener
mail to read yourself? My view? I have a quick
follow up to the ongoing saga of Charles Dickens Multiple Households.
This is from our Facebook from Kristen and Kristen says heyo.
I just listened to the first sojourn or Truth episode
(24:24):
and have an alternate answer to the listener mail question.
This past December, I read The Man Who Invented Christmas
by Leah Standford and learned that Dickens was constantly having
to send his parents money to keep them afloat due
to their terrible financial management. This could have been the
multiple households answer as well. Keep up the fantastic work ladies.
(24:47):
Thank you, Kristen. Apparently Charles Dickens was just paying for
a whole lot of people to keep their lives afloat
by busy guy. Fortunately, by that point he was making
more money than immediately after American tour that we talked
about back at Christmas time. So thank you for sending
us that note on Facebook. If you would like to
(25:08):
write to us about this or any other podcast, we
are at History podcast and how Stuff Works dot com,
and then we're all over social media at miss in History.
That is where you'll find our Facebook and Twitter and
Instagram and Pinterest. You can come to our website that
is missed in History dot com and find a searchable
archive of all the episodes we've ever done show notes
of all the episodes Holly and I have done together.
(25:29):
The show notes for this episode will include links to
all of those historical documents that you can read detailing
the origins of Ira Veta. You can also find out
our website, a link to find out about our trip
to Paris that we're taking this June. And you can
also find and subscribe to our podcasts on Apple podcast,
the I Heart Radio app, and we're a else you
(25:49):
get your podcasts. For more on this and thousands of
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