from prehistoric times to latest developments

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"Surgery is the first and the highest division of the healing art, pure in itself, perpetual in its applicability, a working product of heaven and sure of fame on earth" - Sushruta (400 B.C.)

MYTHOLOGY AND ANCIENT TIMES ( Click below to see appropriate section )

HINDU EGYPTIAN GRECO-ROMAN CHINESE PERSIAN

 

HINDU MYTHOLOGY

Ancient Indian medicine, in fact Hindu medicine, since Hinduism was the only religion existing those days in India, goes back to 6000 years B.C. or more.

According to Hindu mythology, the creator of the Universe, Lord Brahma, was the first teacher to make a compilation of Ayurvedic texts which he later abridged into eight parts , with medicine (Kayachiktsaya) and surgery (Shalya tantra) as the main subjects. It is believed that Brahma propagated this knowledge through Daksha Prajapati who in turn taught this science to the Aswini Kumars ( the twin sons of the Sun God ). The Aswinis imparted the science to Indra. Upto this time, the knowledge of Ayurveda was known only to celestial personalities. It is believed that it was Lord Indra who passed on this knowledge of Ayurveda, the "science of life", to sages and rishis ( mortals ) , the first pupil being Bharadwaja. He, in turn, taught this subject to others including Atreya. He, it is believed, lived in the period 700 - 600 B.C. and became a renowned teacher at Taxila.

History by definition is a record of events and / or of personalities of respective periods usually in a chronological order. This definition cannot be applied strictly to the history of medicine because of certain shortcomings such as the non-availability of written scripts over a period of several centuries. This lacuna is more acutely felt when it concerns ancient Indian (Hindu) medicine. It is believed that in India, the first known writing was recorded in Bramhi script in the third century B.C. For centuries in India, knowledge was propagated by word of mouth from Guru [ teacher ] to Chela [ student ] and this situation persisted till the arrival of the Aryans. Information on Egyptian, Babylonian and Greek civilizations has been derived by deciphering hieratic, hieroglyphic and cuneiform writings available through archaeological excavations.The excavations of Mohenjo-Daro and Harappa have thrown light on community living and sanitary conditions in ancient Indian civilizations, which even by current standards were commendable. In fact, our present water carriage system of drainage is an improved version of the same. The chief sources of information of ancient Hindu culture and medicine are the four Vedas amongst which the Rig Veda was the earliest and the Atharva Veda, the last. The Atharva Veda, believed to have been composed some time in 1200 B.C.is the most important source of information on ancient Hindu medicine. All four Vedas are in the form of shlokas (hymns), verses, incantations and rites, used on appropriate occasions to propitiate the respective deity, depending upon the need of the afflicted.

Lord Vishnu is also believed to have been associated with ancient medicine. It is said that several sages approached the Lord and begged of Him to help them save humanity from diseases and suffering. In response to their plight and prayers, he ordered the churning of the ocean of milk with the aid of " vasukis " and " asuras ". Dhanvantari then came out of the ocean with the pot of " amrita " in his hands. (There is a sculpture of Dhanvantari in the Somanathpur temple in Karnataka). According to another version, Lord Indra favoured and blessed him with knowledge in Ayurvedic medicine. Dhanvantari, in years to come, became a renowned teacher in the art of surgery and taught this subject to his disciples at Varanasi (Kashi). He was considered the "Patron Saint of Surgery" and later elevated to divinity of classical medical wisdom. He lived some time in the 6th century B.C.

Atreya (700 - 600 B.C.) was an eminent sage and a pupil of Bharadwaja at Taxilla (Taksasila) situated on the banks of the river Sutlej now in Pakistan. He taught medicine and ushered in the age of scientific medicine through his astute observations of symptoms, disease and their correlation. He is rightly known as the "Hippocrates of Ancient Indian Medicine" as well as the "Father of Indian Medicine". Charak was one of his students. Like Atreya, Dhanvantari (600 - 500 B.C.) at Banaras (Varnasi), became a renowned teacher of surgery and later came to be known as the "Patron Saint of Surgery".

Father of Indian Surgery

Sushruta, one of his disciples attained great proficiency in surgery, lived some time in 400 B.C. His famous writings known as "Sushruta Samhita" are devoted essentially to surgery. But that was not all: he also wrote on medicine, pathology, anatomy, midwifery, ophthalmology, biology and hygiene. From the available records, it is evident that major abdominal operations were also carried out. Vesical calculi, even those days, were common and hence the operation for the removal of vesical calculi was well described in Sushruta Samhita. Surgical procedures for anal fistula, fractures, extraction of foetus in abnormal presentation, amputation, excision of tumours, repair of hernia and couching of cataract were also known. Rhinoplasty was commonly performed for restoration of severed or cut noses as punishment for certain offences such as adultery. He carried out plastic surgery, giving his patients a new nose or a new ear by the process of skin grafting. Dr.Hirschberg of Berlin pays his tribute to ancient Indian surgery by writing "The whole plastic surgery in Europe took a new flight when these cunning devices of Indian workmen became known to us". Sushruta described many sharp surgical instruments emphasizing the need to get them made of "pure, strong and sharp iron". Several types of knives and needles have been described depending upon their use and tissues concerned. He taught his pupils how to make incisions on the abdomen by using a pumpkin for demonstration purposes. It is believed that the following ingenious method for suturing the severed ends of intestine was employed. The cut ends of the intestine were apposed to each other and big black ants, collected specifically for this purpose were made to bite the apposed ends and their heads severed when their pincers had closed. Thus the pincers remained 'in situ' due to rigor mortis retaining the cut ends of the intestine in apposition for some time. The heads and the pincers of the ants being organic matter got digested in due course of time, not unlike the catgut of the present day surgery. His works were translated into Arabic by the 8th century A.D. and called " Kitab-i- Susrud ". There is adequate evidence that in ancient India, anatomical study of the human body was carried out. To quote the appropriate translation, "Any one, who wishes to acquire a thorough knowledge of anatomy, must prepare a dead body and carefully observe and examine all its parts". The method of study was to submerge the body in water and allow it to decompose: an examination of the decomposing body was carried out at intervals to study structures, layer by layer, as they got exposed following decomposition.

Charak, the great Hindu physician lived some time around 320 B.C., There is a lot of uncertainly regarding his parentage, his place of abode and whether Charak was his personal name, the name of the school he belonged to, or a title he assumed for himself, or which was conferred upon him. His teachings are complied into what is known as "Charak Samhita" which forms along with the "Sushruta Samhita " some of the classics of ancient Indian medicine. Referring to ancient Indian medicine, Castiglioni writes "....we must admit that Indian medicine, and especially its surgery, had a development in ancient times that was most probably quite independent of Greek medicine ".

Vagbhata I was another important personality of the time. He probably lived around 200 B.C.. His chief work was "Astanga Samgraha" ,a comprehensive treatise on medicine, therapautics, hygiene, anatomy, surgery and other allied subjects. Vaghabhata II wrote extensively on medicine which is known as " Astanga Hridaya Samhita". A lot of matter in this work appears to be , more of less, a reproduction of Charak's and Sushruta's teachnings. Madhavacharya dealt with methods of diagnosis of diseases. His compilation is known as "Rugvinischaya" and it also includes pathology - "Nidana". Nagarjun was a renowned alchemist and is very rightly known as the "Father of Indian chemistry". He lived some time during the period 100 B.C. - 100 A.D.

In ancient India , advances in surgery took place through wars and battle wounds. Aryans used their knowledge of herbal, mineral and other drugs effectively besides their surgical skill. It is believed that Visapala, a woman related to Raja Chola, accompanied him into the battle field and lost a leg. The Vedic surgeons Aswinis fitted her with an artificial leg. Also described in Rig Veda asthe legend has it, that Raja Bhoja's (980 A.D.) skull was trephined to relieve him of his severe headache and to remove the malignant portion of the brain. After the surgical procedure, the Raja was cured of the pain..

Ancient Indian medicine can conveniently be classified into three broad groups :

a) the Pre-Vedic period ( from 6000 B.C. upto the Aryan invasion of India ,about 1500 B.C.,),

(b) the Vedic period ( 4000 B.C.- 700 B.C. ), and

(c) the Post -Vedic period ( 800 B.C. - 200 A.D. ).

It must be noted that these dates are not authentic but derived from archaeological findings and other available data. Diseases during the Pre-vedic period were attributed to supernatural powers, magic, etc; hence the treatment consisted of prayers, to appease the supernatural powers, and religious rites, talismans, amulets etc. to counter evil magic.

The four Vedas were written during the Vedic period and of these, the Rig Veda, the oldest, was written some time in 4000 B.C. This scripture contains, besides spiritual and philosophical thoughts, some minor contributions to medicine. Atharva Veda which was written some time around 700 B.C. covers essentially medicine - the origin of Ayurveda. Diseases were, as in the earlier period, attributed to evil spirits, magic and the wrath of God. The treatment consisted of prayers and religious rites for appeasement, with addition of medicines of herbal and animal origin.

During the Post-Vedic period (800 B.C. - 200 A.D.) medicine assumed a more rational approach under the great gurus Atreya, Dhanvantari, Sushruta and Charak .

 

EGYPTIAN MYTHOLOGY

Like ancient Indian medicine, ancient Egyptian medicine dates back to 3000 B.C. and even earlier. During those days, Egyptians attributed diseases to the displeasure of various Gods, the Sun, the Moon and their effects on the human body. Imhotep who lived some time in 2980 B.C. was a renowned architect, astronomer and later a physician. He is in fact, the first physician mentioned in history.

Isis (1500 B.C.) was considered the "Divinity of Medicine" and was a renowned teacher of surgical skill. Horus was the son of Isis and had lost his sight in childhood. Isis prayed to Thoth and her prayers were answered with the restoration of the eyesight of Horus. Since then Horus has been worshipped as the "God of Medicine" and the eye of Horus, has become a symbol of protection of health.

The significance of the symbol Rx dates back to 3000 B.C. It was also supposed to have arisen from the eye of Horus. It was a symbol of durability, strength and beneficence of the medical profession and the Egyptian druggist, and is hence conventionally written at the beginning of all medical prescriptions.

The Egyptian practice of embalming or mummifying the body contributed to a certain extent, to the knowledge of anatomy, surgery and bandaging. The Edwin Smith Papyrus is a surgical treatise probably written some time between 3000-2500 B.C., It is, surprisingly, the most important and complete treatise on Surgery in ancient Egypt. It dealt essentially with traumatic surgery. The most important surgical instrument of that time was the knife made of stone. By 1600 B.C., it was made of bronze and iron.

The Ebers Papyrus of Egyptian medicine dates back to 1500 B.C. Its surgical section dealt with treatment of Carbuncles, Cutaneous tumours, Hernia, Hydrocele etc. Cautery was also used for checking excessive bleeding during operations

GRECO-ROMAN

Greco-Roman medicine borrowed a lot from the Egyptian medicine. Egyptian medical men were invited by Greeks to practice medicine in their countries and were highly respected.

Apollo was considered the earliest Greek God of medicine. Apollo was born in Delos and brought up in Delphi. Here, as the legend goes, the infant Apollo slew a python or a monster that had plagued the site. Following this, Delphi became a sacred place in Greece, where oracles occured ; (oracle : divine advice / solution to problems including those of health and sickness). Apollo is similar to the Egyptian Horus. Apollo was supposed to be the son of Vulcan. Amongst the Greek Gods, Zeus was considered even higher than Apollo. Apollo taught the healing art to Chiron, the gifted Centaur , who is sometimes regarded as the God of Surgery. He taught the art of healing to Achilles, Aesculapius (Asklepius) and Jason.

In ancient Greek medicine, reference is made to surgeons in one of the Homeric poems written some time 1000 B.C. Therein, it is stated "One surgeon was worth an army of men" recognizing the value of a surgeon during frequent wars that raged those days. It was also believed that Hippocrates found in surgery, rational methods of treating certain diseases.

Pythagoras (570-489 B.C.) was a mathematician and a physicist ; Although known to all as the discoverer of the theorem in geometry which goes by his name, he was also known for his profound influence on medicine. According to him, diseases were due to disturbances of four humours: (1) Black bile was cold and dry. (2) Yellow bile was hot and dry, (3) Phlegm was cold and moist and (4) Blood was hot and moist. There is a similarity between Pythagoras' concept of diseases and the Ayurvedic concept enunciated al teast two centuries earlier.

Hippocrates (460 - 370 B.C.) was an astute Greek physician who was born on the island of Cos, but probably practised on Rhodes. He was the first to maintain records of his patients complaints and his own observations. With this began the study of symptoms and signs and their correlation. With the use of several such records it was possible to diagnose similar conditions in other patients. Among his contributions to medicine are the descriptions of the face in the terminal stages of life [ Hippocratic facies ] . It was Hippocrates who enunciated the physician 's oath , now known as the "Hippocratic Oath".The following is an abstract from the famous Hippocratic oath.

" I swear by Apollo, the healer, invoking all the Gods and Goddesses to be my witnesses, that I will fulfil this Oath and this written convenant to the best of my ability and judgment. I will look upon him who shall have taught me this art even as one of my own parents. I will impart this art by precept, by lecture and by every mode of teaching. The regime I adopt shall be for the benefit of the patient according to my ability and judgement, and not for their hurt or for any wrong. In my attendance on the sick or even part therefrom, whatsoever things I see or hear, concerning the life of men, which ought not to be spoken abroad, I will keep silence thereon, counting such things to be as sacred secrets".

His aphorisms are also famous, some of which state :

"Life is short and the art long; opportunity is fleeting, experience fallacious, judgement is difficult."

"In every disease, it is a good sign when the patient's intellect is sound and he enjoys his food; the opposite is a bad sign."

" In winter occur pleurisy, pneumonia, colds, sore throat, headache, dizziness, apoplexy."

It was Hippocrates who gave a humane and philosophical face to medicine. He is rightly considered the " Father of medicine ".

Claudius Galen of Pergamon (130-200 ) at the young age of twenty one, went to Smyrna in Asia Minor to study anatomy. Later he proceeded to Alexandria where he had an opportunity to examine a human skeleton. He also undertook long journeys to Asia Minor in search of new drugs. He was an anatomist, a physiologist, a pharmacologist and a physician. Since dissection of human beings was not allowed during his times, Galen dissected pigs , dogs and Barbary apes and extrapolated his findings onto man. In retrospect, it appears that this dogmatic attitude coupled with the fact that his disciples blindly followed him was responsible for stagnation in medical learning and progress, for over a thousand years. Galen was also a good diagnostician and had a good knowledge of the anatomy of the brain as well as of the bones, joints and muscles. He showed that the arteries contained blood and not air and studied the function of the spinal cord by injuring it at various levels. In his writings- he wrote about 500 books ! - he often acknowledged his indebtedness to Hippocrates. He was the physician to the great philosopher-emperor, Marcus Aurelius.

 

CHINESE MYTHOLOGY

The primitive Chinese attributed diseases to demons; each disease was due to a particular demon. Hence the treatment was in the hands of priests and sorcerers, who employed divination, incantation and magic including the use of special herbs.

Shen Nung (2838 - 2698 B.C.) was the legendary " Father of Chinese medicine" . The Chinese medical classic, "Canon of Medicine", is supposed to have been written by Huang Ti, the Yellow Emperor (2698 - 2598 B.C.). It consisted of two parts: the second part was a treatise on Acupuncture. However, prohibition of dissection of the human body due to religious beliefs, retarded the progress of medical science in China. The dissection of the human body was later permitted by the presidential mandate of November 1913.

In Ancient China, surgery was practised in a very limited manner. Hua T'o (190 A.D.) has been quoted in ancient Chinese medical scripts as the leading surgeon. In order to produce eunuchs for the Imperial Court, castration with amputation of the penis was performed prior to 1000 B.C. Chinese surgery apparently made no progress after the advent of the Tang dynasty (619-907 A.D.) due to strong prejudices.

In Chinese medicine the "pulse" is given a lot of importance and is taken on both , the right and the left hand, at sunrise or otherwise. There are 52 types of pulse classified in Chinese medicine. Chinese therapeutics consists of (a) acupuncture, (b) moxa or moxibustion : Moxibustion is like cauterization but more painful as a counter irritant. (c) massage.

Besides these, a rich materia medica essentially of herbal origin exists. There is also a mention of substances derived from sheep's thyroid for treatment of goitre and cretinism and the use of sheep liver for disorders of the blood.

Lin Tan (600 B.C) was also known as Lao Tzu: according to him, health depended upon the interplay of two cosmic forces, - "Yin" and "Yang", - the negative and the positive force. " Yin", the female force was associated with evil and its dominance resulted in disease. "Yang", the male force had an opposite and favourable effect in man. The body was composed of five elements (wood, fire, earth, metal and water), which were kept in balance by " Yin" and "Yang". Their disturbance resulted in ill-health.

Three famous Chinese physicians of antiquity are :

1) Ts'Kung ( circa 180 B.C.)

(2) Chang Chungchin ( c 168 A.D), also known as"Hippocrates of China" and

(3) Hua T'o ( c 190 A.D.), a Surgeon. Hua T'o employed anaesthetics (probably Cannabis indica), for his surgical treatment.

Hospitals or hospital-like institutions existed in China since 1000 B.C. With the spread of Buddhism many more hospitals were established till 827 A.D. However, in 845 A.D. under the order of Emperor We Chung, many Buddhist temples were demolished and with these, the so called hospitals for the sick and the infirm.

PERSIAN

Learned men of Indian and Greek medicine were invited by Persian Kings, and were retained in their courts with due recognition of their knowledge and contribution to medicine. Jirjis lived some time in the 8th century and was a Persian physician of repute from Jundi Shapur. He was invited by the Caliph-Al-Mansur to Baghbad in 765 A.D., to take charge of the hospital. He came from a family of physicians of six generations.Baghdad was then the medical centre and intellectual capital of Islam under the patronage of a broad minded Caliph, Harun- al -Harun (763- 809) and later his son Al Mamun (786-833). During this period, in Persia, organized examinations were conducted and a diploma in Medicine was awarded.

The Arab invasion of Persia took place in 636 with the subsequent capture of Jundi Shapur. Arabic Medicine emerged as an off shoot of alchemy and chemistry. The use of senna, camphor, sandalwood etc. was borrowed from ancient Indian medicine - substantive evidence of the Ayurvedic influence. The Greco- Arabic Medicine was and is even today known as Unani Medicine. Among the well known personalities associated with this system of medicine were Rhazes, Avicenna and Albucasis.

Rhazes (Abu Bakar Muhammed Ibn Zakariya Al Raz (841-926 ) was born in Teheran. He wrote books on medicine and surgery : his original observations were on small-pox, measles, stones in the bladder and kidney and what is, at present, known as "hay-fever". He differentiated small-pox from measles and also described the recurrent laryngeal nerve and the guinea worm. He had varied interests [ including philosophy ] apart from medicine. His fame as a physician spread far and wide. His encyclopaedia " Kitab-al -hawi " was a source of reference for therapeutics for three centutries. The ruler of Ravy conferred on him the position of the head of the hospital in Baghdad.

Avicenna (980 -1037 ) also known as Ibn Sina ( Abn -Ali- Al - Hussain ) was another important personality of Persian medicine. His observations on respiration and pulse could well be considered as pointers to modern concepts on respiratory and cardiovascular physiology respectively. He wrote several books, including his famous compilation "Qanum" on various aspects of medicine.

It is believed that with the invasion of India by Alexander, the Great, in 327 B.C., Unani medicine was introduced into this country, and it flourished under the tutelage of the Moghul Kings. Hakim Ali Gilani was a protagonist of Unani medicine during the reign of Emperor Akbar. The first Unani Medicine school was founded by Haziqul Mulk Hakeem Abdul Majeed Khan in Delhi in the year 1893.

 

REFERENCES:

Kothare, SN, Pai, SA : An Introduction to the history of Medicine

Bhatia, Maj. Gen. S.L. Medical sciences in ancient India, 1972.

Bhatia, Maj. Gen. S.L. History of medicine with special reference to the orient: published by management commitee, Dr B.C.Roy Award Fund, Office of Medical Council of India, New Delhi- 110 002, 1977.

Encyclopedia Britannica Inc, Publisher William Benton, Chicago, Illinois, London,

Manila, Vol. 2, 1969.

Mettler, Cecilia. C. : A History of Medicine, The Blackstone Company, Philadelphia, Toronto. 1947

Vakil, R.J. Romance of Healing and other Essays - Our Medical Heritage, Asia Publishing House, Bombay, calcutta, New Delhi, Madras, London, New York, 1961.

Wong, K. Chimin, and Lien-Teh, Wu: The History of Chinese Medicine, Tientsin Press, Tientsin, China, 1932.

Bettman, O.L.: Pictorial History of Medicine, Charles C. Thomas, Springfield, Illinois, U.S.A., 1956

Leonardo, R.A.: History of Gynaecology, Richard A. Froben Press, New York, 1944

The Charaka Samhita, Edited and published by Shree Gulab Kunverba Ayurvedic Society, Jamnagar, 1949.

The Sushruta Samhita, Edited and published by Kaviraj Kunja Lal Bhishagranta, No.10, Kashi Ghose's Lane, Culcutta, 1907

Thapar, Romila : A history of India , Penguin Books, 1966

 

History of surgery can be divided into three eras ( click on the following for further reading):

Ancient

Middle

Modern

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