Book Review – The Surgical Instruments of the Hindus

August 11, 2013

The Surgical Instruments of the Hindus by Girindranath Mukhopadhyaya, BA,MD


ASI website has many rare books in digitized form. I read a book titled ‘The Surgical Instruments of the Hindus’ by on Dr.Girindranath Mukhopadhyaya. This book was published in 1913 by Calcutta University.

This very well written book covers Surgery in the Ancient India. The author compares the surgical knowledge of Indians with Greeks and Romans as well.

According the the author the level of surgery practised was very high in Ancient India especially during pre-buddhist era. Even cranial surgery and some form of anaesthetic inhalation were practised with success. The decline started after dissection of human bodies were given up, the priests started curing diseases by spells,charms, text and drugs. Also the fear of surgical knife in the minds and excessive reliance on cautery by the surgeons at the time resulted in decline. Another reason according to the author is the high regard to for writings of the sages and earliest works on medicine became standard works and held sacred. Yet another and probably most potent cause is the rapid spread of Buddhism in India. Please read the book to know how the author explains this particular fact. The steady decline in the support of the government is another cause.

The treatment of subject is very methodical and exhausitve. First chapter tells about the sources of information about the ancient surgical knowledge- Caraka, Susruta and others. The second chapter talks about hospitals and dispensaries – their location, the instrumentation etc. Chapter III talks about materials of instruments- iron and steel, copper ,tin,gold,sliver etc. The chapter IV talks about the surgical instruments, their numbers and classification. Chapter V talks about blunt instruments while VI chapter talks about sharp instruments. Chapter VII deals with Accessory sharp instruments. Chapter VII deals with Hygienic appliances and hospital requisites.

The part II has illustrations of the instruments Ancient Indian, Greek and modern (by 1910 standard).

I recommend this book to anybody who is interested in history especially medical history. It is about a century since publication of this book.  Considering the knowledge acquired in the last 100 years about India’s past by means of archaeology, history and others I think it is worth another research similar to what this author has done. 

Few of the interesting/highlights I noticed are summarised below. Texts given in bold  are from this book.

Chapter -I Sources of history

  1. Atharva Veda – Vedic period, being last among the four vedas

  2. Caraka Samhita by Caraka – Brahamanas, upanishadic period

  3. Susruta Samhita by Susruta– datable between 1000bce to 600bce

  4. Astanga Samgraha by Vagbhata -I – Around dawn of CE

  5. Astanga Hrdaya Samhita by Vagbhata -II – May be around 6th Century CE

    Apart from the above the author uses many other sources like Rigveda, some treatise on veterinary treatments etc.,

Chapter II – Hospitals and Dispensaries

  1. Caraka mentions the suitable place for building hospital and dispensaries. He also mentions about staff their nature etc. A detailed list of articles required is also mentioned – including bed-pan.

  2. Susruta gives a list of appliances required like blunt instruments, cautery, cold and hot water, cotton etc.

  3. Separate lying-in-room for pregnant women

  4. Separate child’s room – which has some toys also

  5. An isolation room for patients who have undergone surgery

  6. Hospitals and dispenaries along highways were built

  7. Orphanage with food and medicine to bereaved, widows etc.

  8. Following quote from Smith’s Early History of India about hospitals in India is worth noting

    “No such foundation was to be seen elsewhere in the world at this date; and its existence, anticipating the deeds of modern Christian charity, speaks well both for the character of the citizens who endowed it, and for the genius of the great Asoka whose teaching still bore such wholesome fruit many centuries after his decease. The earliest hospital in Europe the Maison Dieu of Paris is said to have been opened in the 7th centuries”

  9. Animal hospitals known as pinjrapoles were common. In one such hospital in Surat in 1772 had horses, mules sheep, monkeys, pigeons and curiously an aged tortoise which is 75 years old. An extraordinary ward for rats, mic, bugs and other noxious vermins.

  10. Wine was the main Anesthetic used.

  11. There is a mention of cranial surgery with anesthetics in 927.A.D

Chapter III – Materials of Instruments

  1. Iron and steel, copper,gold, silver, ivory, horn, wood were main material.

  2. The edges of instruments varied according to usage – upto half a hair

  3. Susruta describes 24 kinds of operations using blunt instruments, 8 kinds using cutting instruments called sastras.

  4. Instrument cases were used.

Chapter IV – The Number of Surgical Instruments

  1. Classification according Susruta

    1. Blunt instruments

    2. Sharp Instruments or sastras

  2. The instruments are further classified

  3. Susruta emumerates about 101 blunt (yantra) instruments and about 20 sharp (sastras) instruments

  4. Some interesting cruciform instruments are Simhamuka, Vyaghramukha forceps

Chapter V – Description of Blunt Instruments

  1. This chapter describes the blunt instruments like forceps in detail. Blunt instruments were called svastika

  2. There were tubular instruments for examination and treatment. They were called Nadi Yantra

  3. Some of them are Kanthasalyavalokini or throat speculum, instrument for piles

  4. Description of many surgical procedures are given. One such description from Susruta is

    “Susruta describes the extraction of a foreign body, made of lac from the throat of a patient by the following device. A heated iron probe or sound should be introduced into the throat of a patient through a tube of copper and made to touch the bit of shellac. The foreign substance would begin to dissolve or soften and so will adhere to the probe. The rod is then to be cooled by sprinkling water through the tube and the foreign body then should be drawn out steadily with it.”

    See tube-inside-tube may be precursor to modern endoscopy.

    Treatment of fracture of nasal bone

    “ To treat a case of fracture of the nasal bones, Susruta recommends two straight tubes open at both ends to be introduced into the nasal cavities after putting the fractured ends in position, either lowering or elevating the raised or depressed end by a rod as required. Then bandages are to be applied. The tubes serve as splints to support the broken ends in position, while through their orifices the patient may br breathe without inconvenience.”

  5. The description of Joni-vraneksana or Vaginal speculum is astounding.

    “ Vagbhata describes it to be a tubular instrument, sixteen anguli long, and six anguli in circumference. It consists of four blades, attached at their bases to a ring. The tube tapers gradually, the end is free and looks like the bud of lotus. To the four blades are soldered four rods in such a way that on pressing their free ends, which pass out of the ring, by the surgeons’s hands, the tapering end of the tube would gape widely. The surgeon by regulating the pressure of his hand, may open or close the speculum to any desired extent.

  6. The Atharvaveda Samhita has a reference to catheter.

    “In the Atharvaveda Samhita, however, we find a hymn unmistakably alluding to the use of catheter in ancient times.

    Against obstruction of urine with a rod.

    “This hymn is intended to be used in a rite for regulating the flow of urine. The reed implies some primitive for of fistual urinaria, thevastiyatra vastiyantra(one of the nadiyantrani) of late physicians- who however do not appear to have made frequent uses of it.”

  7. Tubular instrument for Cupping were in practice. Cow’s horn is common for this.

  8. Gourd after drying was used as cupping instrument.

  9. Brass pots were used as cupping instrument. Here is a nice description

    “ Caraka says:- After the abdominal tumor has been relaxed or softened a little by fomentation and oleaginous application, it is to be covered by a piece of cloth. Then inside a small ghati, a fire is to be lit by burning kusa and other forms of grasses; the pot is then to be inverted and pressed over the part covered by cloth. By this way the tumor would be drawn upwards i.e be made prominent. The ghati is then to be taken away and after removing the cloth and examining the extend of the tumor it is to be incised. The different shapes of the incisions are called vimarga, ajapada and adarsa. After incision, the tumor is to be pressed and rubbed with fingers. But the intestines and the heart must not be touched:”

  10. Surgical treatment for stones seems to be problem both in the east and west. Hippocratic oath says ‘I will not cut persons laboring under the stone, but will have this to be done by men who are practitioners of this art” . Similarly Susruta says “ Even experienced and able surgeons fail to attain success by operation for the stone. So the surgical treatment is the worst of all treatment here. But if you do not operate, the patient will die; and it is doubtful whether he will live after the operation; so give him the chance of operation in God’s name”

  11. The upayantra or Accessor instruments were threads, bandages, sutures etc.

  12. Fourteen varieties of bandages were mentioned by Susruta

  13. Caraka mentions use of abdominal binder for the recently delivered woman to prevent derangement of air by its expansion in her abdomen.

  14. Horse hair was an important Suture material. Fine thread, fibres of the bark of asmantaka, threads made of hemp or flax and many others were also used.

  15. The Mouth parts of the ants as clasps to close incisions on the intestines was mentioned by Susruta.

  16. Susruta mentions four sorts of sutures – winding, sling, continued and interrupted.

  17. Cauteries were common and considered ultimate by Susruta and others.

Chapter VI – The Sastra or the sharp instruments

  1. Round headed knife is mentioned. Saw was also used.

  2. Many other varieties of knife seem to be common

  3. Three varieties of needles for suturing are mentioned.

  4. Kusapatra is a form of knife resembling in shape the leaf of a kusa grass(Poa cynosuroides). Here is one description of its use

    “Cakradatta uses kusapatra as a bleeding lancet and says Out of the twelve vessels that lie on the sides and underneath the tongue, select the two large bluish vessels on either sides of the tongue, raise them up by vadisa or hook and puncture them by the kusapatra knife and then, after bleeding, apply a paste of treacle and ginger to the wound. In the Yogaratnarkara, the author adivises us to adopt this method of bleeding, in the treatment of tumors in the neck.”

  5. Many varieties of scissors like Sararimukha,antarmukha.

  6. Trikurccaka is an instrument consisting of three needles fixed on round wooden handle. It is used for evacuating abscesses and for draining blood from the nasal polypus.

  7. Axe like instrument called kutharika was used for puncturing vessels.

  8. Sharp Hooks called Vadisa were used for extraction of foreign bodies like stone from the urethra.

  9. Susruta advises students to practise tooth extraction on the fruits of panas, vimbi, vilva and on the teeth of dead animals.

  10. The operation of couching for cataract was practised. The operation is described minuetely by Susruta

    “ Susruta says: Now we shall describe the treatment of cataract caused by phlegm. If inside the crystalline lens, anything is seen like a half-moon-shaped drop of water or pearl, hard irregular or thin, striated or shinning, painful or red, caused by the deranged humours, the oleaginous applications and fomentations are to be tried first at a time when it is neither hot nor cold; then he(patient) is to be ligatured after having him seated conveniently, and should be directed to look towards his own nose. The intelligent(surgeon), then separating the white part from the black part and the external canthus of the eye after opening it, avoiding the vascular network, and leaving the parts above and below intact, is to pass a yavamukhi salaka ( or sharp needle having its end resembling a wheat) through a natural opening on the side, steadily holding the rod with the thumb, index and middle fingers. If the operation be required on the right eye, the left hand and if on the left eye, the right hand of the surgeon should use the needle in puncturing. A successful puncture is known by the escape of a drop of fluid and an audible sound. The experienced surgeon is to sprinkle woman’s milk just after puncture, and keeping the needle there, whether the deranged humour be movable or not, should apply fomentations externally by means of oily remedies for the deranged air. The crystalline lens is next to be scarified by the sharp end of the needle. Then keeping the needle fixed in the side of the eye, the patient should be directed to sniff so as to destroy the phlegm of the lens. The proper scarification will be indicated when the lens appears brilliant as the sun uncovered by clouds. The the vision being clear, the needle in the side of the eye, is to be removed and the eye is to be well soaked with ghee(melted butter) and bandaged properly.”

  11. Practical training in surgical operation was an important aspect Sustrua lays emphasis on.

    “However learned he may be in books, he cannot be fit for surgical practice, unless he has acquired the practical training. Therefore the preceptor should show his pupils the methods of operations, of incision, excision and division, upwards and downwards on the pumpkin, bottle-gourds, water-melons, and the three varieties of cucumbers- Trapusa(cucumis sativus), Ervaruka(Cuumis Uitillissimus) and Karkaruka(cucumis Melo). The operation of puncturing or tapping may be demonstrated on leather bags, bladders and pouches, filled with slush, scarifications on stretched pieces of leather covered with hair; opening on the veins of dead animals or on stalks of water-lily; probing on worm-eaten wood, bamboo,reed, tube or dried bottle-gourd ….”

Chapter-VII Anusara or the accessory sharp instruments

This chapter describes substitutes for cutting instruments like bamboo, crystal,glass,ruby, leeches, fire,caustics, nails etc.

  1. Dissection of human body for anatomical studies was not common in ancient world is the common belief. However Sustrua talks about dissection.

    “Thus a body should be secured which is complete in all the parts and which is a person who was not more than 100 years old, nor who died from the effects of poison or of a chronic disease. Having cleared the intestines of any faecal matter, the body should be well wrapped either in Munja (Saccharam Munja) or grass, or barks of trees or hemp etc., put inside a cage which should be firmly fastened, in a solitary spot, in calm river and thus allowed to decompose. After seven nights, having taken out the thoroughly decomposed body, it should be slowly rubbed with a brush made either of Usira(Andropagon Muricatus) or hair or bamboo, or barks of trees, examining at the same time with the eyes, every division and sub-division of the body, external or internal, beginning with the skin, as delineated in the sastras.”

  2. There is no indication of practice of animal dissection. Greeks did not practise dissection of human body.

  3. Leeches were used for extracting blood.

Chapter VIII – Hygienic Appliances and hospital requisites.

Common hygienic appliances were tooth brush, tooth pick, tongue cleaners, razors,comb.

  1. Tooth brush: Branches of trees as tooth-brush was common usage.

  2. Bedpans and urinals were in use

  3. Pus basins made of metals were used for holding discharges after operations.

Chapter IX – The Conclusion

In this author summarizes and gives the contribution of the ancient Indian surgeons to the medical knowledge. Hoernle says “Its extent and accuracy are surprising when we allow for their early age- probably the sixth century before Christ – and their peculiar methods of definition.”

According to the author there is a treatise on the treatment of plants and trees.

Finally the author concludes

“Thus we see that it can safely be affirmed that the medical science of Europe has been, both directly and indirectly, influenced by the Hindu System of Medicine.

Part -II of the Book.

This part contains illustrations and some actual pictures which were dealt in Part-I. The author has painstakingly given drawings Indian, Greek and modern wherever possible.