The Pioneering Human Dissection at Calcutta Medical College

In 1833, the British army were not satisfied with the services of Kolkata’s medical staff, who were trained in native medicine. A committee was formed by the then Governor General Lord William Bentinck in October 1833, which consisted of 6 members: viz., Dr John Grant, J.C.C. Sutherland, C.E. Trevelyan, Thomas Spence, Dr. M.J. Bramley and Ram Comul Sen, the only Indian member. This committee was to replace native medical institutions with scientific medical school, with English as the language of instruction, and the curriculum was fashioned at par with the European medical institutions . As a consequence, the Ayurvedic and Unani courses taught at the Sanskrit College and Native medical institution were abolished . The British replaced these native medical schools with a fully equipped Calcutta Medical College (CMC), to educate and train the natives in “the art of healing” in western medicine.

In the early 19th century, Western medical education was revolutionizing colonial India, but deep-rooted Hindu taboos against handling corpses posed a formidable barrier to anatomy training. On January 28, 1835, the then Governor-General William Bentinck passed a government order (G.O. No. 28, dt.28.1.1835) declaring the establishment of the first medical college in India, Medical College Bengal, which became affiliated with the University of London . The Calcutta Medical College (CMC), established in 1835 as Asia's first institution for modern medicine, became the epicenter of this transformation. Pandit Madhusudan Gupta, a brilliant Bengali Vaidya (Ayurvedic practitioner) from a high-caste family, emerged as the trailblazer who shattered these norms.

Historical Context and Preparation

Madhusudan Gupta (1800-1856) came from an aristocratic background. Madhusudan Gupta was descended from a Vaidya family in the Hooghly district village of Baidyabati, India. High in the feudal hierarchy were his ancestors. His grandfather served as the "family physician to the Nawabs of Hooghly, who were local rulers in the Bengal region during the Mughal period in India," while his great-grandfather bore the honorific "Bakshi." The honorific "Bakshi" was a title of respect traditionally conferred upon individuals who were responsible for overseeing financial or military affairs in feudal settings. Unlike his ancestors, Madhusudan showed no early interest in a formal education. It is stated that his father became enraged due to his dislike of studying and threatened to throw him out of the house. His father’s attitude made Madhusudan to move out

Gupta was a Sanskrit scholar fluent in multiple languages, including English. Recruited by British educators such as Henry Goodeve (Head of Anatomy) and Principal John T. Pearson, he bridged Ayurvedic traditions—drawing on Sushruta's ancient dissections—with Western empiricism..

The Landmark Event

The first recorded human dissection occurred on January 10, 1836 (some sources cite October 28), in CMC's anatomy hall. Assisted by students Rajkrishna Dey, Umacharan Sett, Dwarkanath Gupta, and Nabin Chandra Mitra—all Hindus—Gupta wielded the scalpel on an unclaimed body, likely from the poor. He held the knife with strong and steady hand, made a deep and long incision in the breast, and relieved the stress of the spectators and his guides . It was also revealed that Dwarkanath Tagore, successful entrepreneur and grandfather of Rabindranath Tagore, also helped smuggle the corpse in for dissection . Outside the hospital, a crowd had gathered to protest this unholy act, so the administration secured the gates and guarded them . Madhusudan Gupta was counselled, influenced, and guided to carry out dissection by British doctors Goodeve and Bremley, who were then Head of the Department of Anatomy and the Principal of Calcutta Medical College respectively. Scottish Philanthropist David Hare and educationist John Elliot Drinkwater Bethune also played an important part in convincing Gupta to break the social taboo and become the pioneer of the Western Medical system of medicine in India . Security was tight: on the fateful day, CMC gates were locked, guards posted, and crowds outside protested what they deemed sacrilege.

A 50-gun salute from Fort William reportedly celebrated the feat, symbolizing imperial endorsement. This act, nearly 3,000 years after Sushruta's era, marked Asia's inaugural modern cadaveric dissection.

Immediate Backlash and Gupta's Defense

Conservative society ostracized Gupta; orthodox Hindus viewed corpse-touching as polluting. Protests raged, with some labeling him an outcast. Undeterred, Gupta countered by citing ancient texts such as the Sushruta Samhita, thereby establishing dissection's Vedic precedent. His courage normalized the practice: dissections surged from 60 in 1837 to over 500 by 1844, totalling ~3,500 bodies in eight years.

Enduring Legacy

Following the first dissection, Gupta completed formal medical qualifications and received a medical degree, G.M.C.B. (Graduate of the Medical College of Bengal) on 26 November 1840. Gupta's dissection ignited practical anatomy education across India, fostering generations of surgeons and advancing public health. He later became CMC's Superintendent of the Military Class and a revered professor until his death in 1856. Dr. Gupta also conducted extensive studies on puberty, medical uses of leeches and high neonatal and maternal mortality in Indian women, fought vaccine hesitancy concerning smallpox, and advocated for proper sanitation to reduce diseases. He also wrote books like London Pharmacopoeia in Bengali, Shoreer-vidya, and also translated Shusruta Samhita, and Hooper‘s Anatomist Vademecum, etc. In 1834, Gupta was paid 1,000 rupees for translating Hooper's Anatomists’ Ved-mecum. It was completed under the title of Śärîravidyā ("Science of Things Relating to the Body") and was taken up for publication by the Asiatic Society, but was abandoned after page thirty-six, due to conflicting opinions on which language it was to be published in. It was following much discussion and the formation of a committee that it was ultimately published in Sanskrit rather than Hindi

Madhusudan Gupta developed diabetes mellitus and, following a dissection, contracted an infection which led to gangrene of his hands. He subsequently died of septicaemia on 15 November 1856. Today, his statue graces the college, commemorating the dawn of evidence-based medicine in the subcontinent. This event not only defied superstition but propelled India into the global scientific fold, echoing through medical curricula worldwide. Widely acknowledged as the "first dissector of British India", Gupta has been frequently credited with the launch of modern medicine in India and breaking religious taboos

T. W. Wilson, the then Principal of the Medical College, wrote in the obituary” To him a debt of gratitude is due by his countrymen. He was the pioneer who cleared a space in the jungle of prejudice, into which others have successfully pressed, and it is hoped that his countrymen appreciating his example will erect some monument to perpetuate the memory of the victory gained by Muddoosoodun Gooptu over public prejudice, and from which so many of his countrymen now reap the advantage”.

To keep the event in memory, Bethune commissioned S. C. Belnos to paint a portrait of Gupta, complete with a skull in his left hand, depicting his object of study and to be hung in the CMC

Madhusudhan Gupta

Oil painting by S.C. Belnos, wife of Jean Jacques Belnos, presented to Medical College by Drinkwater Bethune in 1850.

References

1. G D, Chandrupatla M, B H S. A Trailblazer in Anatomy: Madhusudan Gupta and the Historic First Dissection. Cureus. 2024 Oct 1;16(10):e70612. doi: 10.7759/cureus.70612. PMID: 39483588; PMCID: PMC11526181.
2. Uma SV, Rao CBR. First human dissector of colonial India. European Journal of Anatomy. 2024;28(5). doi:10.52083/COFW7942

Quiz time

Q- Who was the first to dissect the human body?
A – Andreas Vesalius

History of Surgery ASI team

Dr Kaushik Bhattacharya (Head of the team)
Dr Pratap Varute
Dr Patta Radhakrishna
Dr Surajit Bhattacharya
Dr Clement Rajan
Dr K Lakshman
Dr Mahesh Prabhu

The historical trajectory of Indian rhinoplasty is therefore not a tale of disappearance and rediscovery but rather one of continuity sometimes scholarly, sometimes artisanal, but rarely extinguished.

The Classical Origins: Sushruta and the Nasal Reconstruction

The earliest detailed description of rhinoplasty appears in the Sushruta Samhita, a surgical compendium generally dated between the first millennium BCE and the early centuries of the Common Era. Sushruta described a remarkably sophisticated method of reconstructing the amputated nose using a flap of skin raised from the cheek or forehead. The surgical steps are described with striking clarity: measurement of the nasal defect using a leaf template, elevation of a flap of appropriate dimensions, rotation and attachment to the nasal stump, and maintenance of the airway with tubular splints.

Sushruta’s account also emphasizes the importance of surgical instruments, wound care, and postoperative management. The text demonstrates a profound practical understanding of tissue viability and healing, even though it predates the knowledge of modern vascular anatomy his description remains one of the earliest examples of a pedicled flap in reconstructive surgery.

The cultural context of rhinoplasty in ancient India is equally important. Nasal amputation was a common judicial punishment for crimes such as adultery and theft. Consequently, the need for reconstructive surgery was not merely cosmetic but social and psychological. Restoring the nose restored honour and identity.

For several centuries after the composition of the Sushruta Samhita, Indian surgery flourished within the broader tradition of Ayurveda. However, by the early medieval period, the intellectual emphasis of medical scholarship had shifted increasingly toward pharmacology and internal medicine. Surgical practice gradually became marginalized within elite medical discourse.

The Migration of Surgical Knowledge

By the late medieval period, surgery in India appears to have moved largely out of the classical scholarly institutions and into hereditary craft communities. This phenomenon has been noted by several historians of medicine and was observed by European travellers as well. Certain surgical procedures—particularly those requiring manual dexterity rather than theoretical learning—were preserved through apprenticeship and family tradition.

Rhinoplasty became one of these craft procedures. The operation survived not in academic medical schools but among traditional practitioners who transmitted their knowledge from father to son. Although this shift represented a decline in formal surgical scholarship, it ensured the survival of specific operative techniques.

Thus, while classical Sanskrit texts faded from everyday medical practice, the practical surgical tradition itself persisted.

Niccolao Manucci and the Seventeenth-Century Observation

One of the earliest European eyewitness descriptions of Indian rhinoplasty comes from Niccolao Manucci (1638–1717), an Italian adventurer who spent much of his life in Mughal India. Manucci arrived in India as a young man in the service of Venetian traders and eventually became associated with the court of the Mughal emperor Aurangzeb. Over the course of several decades he travelled widely across northern India and compiled his experiences in a remarkable memoir known as Storia do Mogor.

Manucci’s narrative includes an account of nasal amputations carried out during military campaigns and the subsequent reconstruction performed by local surgeons. He described the method with surprising accuracy:

“The surgeons cut the skin of the forehead above the eyebrows and made it fall down over the wound on the nose… in a short time the wounds heal up… I saw many persons with such noses”.

This brief observation is historically significant for several reasons. First, it clearly identifies the forehead flap method, closely resembling the technique described by Sushruta many centuries earlier. Second, Manucci notes that he had seen many individuals who had undergone the procedure, implying that the operation was relatively common in the region. Finally, his account predates the famous Gentleman’s Magazine report by more than a century.

Manucci’s testimony demonstrates that rhinoplasty was not an isolated or rare procedure but part of a living surgical tradition in Mughal India. It also highlights the practical circumstances in which the operation was performed. Nasal amputation remained a form of punishment and humiliation in certain social contexts, creating a persistent demand for reconstruction.

European Travellers and the Craft of Indian Surgery

Manucci was not the only European observer to remark upon Indian surgical practices. Other travellers of the seventeenth century, including François Bernier and John Fryer, recorded aspects of indigenous medical practice during their time in India. Although their writings focused more on general medicine than surgery, they frequently commented on the empirical skill of Indian practitioners.

European observers were often puzzled by what they perceived as a contradiction: Indian surgeons demonstrated considerable technical ability despite lacking the anatomical training that had become central to European medicine after Vesalius. Operations such as rhinoplasty, lithotomy, and cataract couching were clearly being performed with competence, yet the practitioners belonged to artisan communities rather than scholarly institutions.

This situation illustrates a broader pattern in the history of surgery worldwide. Before the rise of modern academic medicine, surgical knowledge frequently survived in craft traditions—among barbers, bonesetters, and itinerant surgeons. India was no exception.

The Late Eighteenth Century: The Pune Rhinoplasty

The event that brought Indian rhinoplasty to the attention of European medicine occurred in western India toward the end of the eighteenth century. During the wars between the British and the Marathas, a Maratha cart driver named Cowasjee was captured and punished by nasal amputation. Several years later, a local practitioner reconstructed his nose using the traditional forehead flap technique.

Two British surgeons stationed in Pune, Thomas Cruso and James Findlay, witnessed the procedure and reported it in detail. Their description was published in 1794 in the Gentleman’s Magazine of London. The article included an illustration of the operation and described the technique step by step.

The publication created considerable excitement among European surgeons. Although reconstructive procedures had been attempted in Europe before, they were often unreliable and rarely successful. The Indian method, by contrast, appeared remarkably effective.

For European surgeons, this report represented a rediscovery of a lost art. For India, however, it was simply the continuation of a long-standing practice.

The Adoption of the Technique in Europe

The Gentleman’s Magazine report soon inspired several European surgeons to attempt the operation. Among them was Joseph Constantine Carpue, a London surgeon who undertook two rhinoplasty procedures using the Indian method in 1814.

Carpue carefully studied the original report and reconstructed the technique as faithfully as possible. His successful operations were published in 1816 in his monograph An Account of Two Successful Operations for Restoring a Lost Nose. The book included detailed illustrations and became widely known among European surgeons.

Carpue openly acknowledged the Indian origin of the procedure, referring to it as the “Indian method of rhinoplasty.” His work marked the beginning of modern plastic surgery in Europe and paved the way for further refinements by surgeons such as Dieffenbach in Germany.

Ironically, a surgical technique preserved for centuries in India through craft tradition now became celebrated within the emerging academic discipline of European surgery.

Rhinoplasty in Nineteenth-Century India

Despite the growing international recognition of the Indian method, the practice within India itself remained largely confined to traditional practitioners. Colonial medical institutions focused primarily on Western surgical techniques and often regarded indigenous practices with skepticism.

Nevertheless, the forehead flap rhinoplasty continued to be performed by hereditary surgeons in several regions of the subcontinent. One of the most notable practitioners of this tradition was Tribhovandas Motichand Shah of Junagadh in Gujarat.

Tribhovandas and the Living Tradition

Tribhovandas Motichand Shah (1849–1904) occupies an important place in the history of Indian rhinoplasty. Unlike many earlier practitioners whose work remained within local traditions, Tribhovandas documented his experience in writing. His observations were published in the Indian Medical Gazette in the late nineteenth century.

Tribhovandas described the rhinoplasty technique practiced in his community with remarkable clarity. The procedure closely resembled the classical method described by Sushruta and observed by Manucci centuries earlier. A flap was raised from the forehead, rotated downward to reconstruct the nasal defect, and supported with tubular splints to maintain the airway.

His report demonstrates that the technique had survived in essentially the same form for generations. It also illustrates the continuity between ancient surgical literature and the living traditions of Indian practitioners.

By the late nineteenth century, however, the balance of medical authority had shifted decisively toward Western institutional medicine. As hospitals and medical colleges expanded under colonial administration, indigenous surgical traditions gradually declined.

Yet the legacy of the Indian rhinoplasty remained embedded within global plastic surgery.

A Continuous Surgical Heritage

Viewed across the centuries, the history of Indian rhinoplasty reveals an extraordinary continuity of surgical knowledge.
 

• Sushruta provided the earliest detailed description of nasal reconstruction.
• Artisan surgeons preserved the technique during the medieval period.
• Niccolao Manucci recorded its practice in seventeenth-century Mughal India.
• The Pune rhinoplasty of 1794 introduced the method to Europe.
• Joseph Carpue established the operation within modern Western surgery.
• Tribhovandas demonstrated that the indigenous tradition continued well into the nineteenth century.

The story therefore challenges the simplistic notion that Indian surgery vanished after antiquity. Instead, it survived in unexpected places within craft communities, regional practices, and family lineages of surgeons who maintained their skills through generations.

For modern plastic surgeons, the forehead flap remains one of the most reliable techniques for nasal reconstruction. Its continued use in contemporary surgery stands as a testament to the ingenuity of the early Indian surgeons who first conceived it. More than two thousand years after Sushruta described the operation, the principles of the Indian rhinoplasty still guide reconstructive surgery around the world.

Summary:

By the seventeenth century, although classical surgical scholarship had declined, the practical art of rhinoplasty continued to survive in hereditary surgical communities. The Italian traveller Niccolao Manucci, who spent many years in Mughal India, recorded having seen numerous individuals whose noses had been reconstructed using a flap of skin taken from the forehead. More than a century later, British surgeons in Pune witnessed a similar operation performed on a Maratha cart driver named Cowasjee. Their report in the Gentleman’s Magazine in 1794 introduced the technique to European surgery, eventually inspiring Joseph Carpue’s celebrated operations in London. Yet the procedure never vanished from India itself. In the late nineteenth century, the surgeon Tribhovandas Motichand Shah documented the same method in the Indian Medical Gazette, demonstrating that the ancient surgical tradition described by Sushruta had survived in practice for nearly two thousand years.

References

Bhattacharya J. Indian medicine through travellers’ accounts with emphasis on anatomical knowledge: 17th–19th century. Indian Journal of History of Science. 2013.

Carpue JC. An Account of Two Successful Operations for Restoring a Lost Nose. London; 1816.

Findlay J, Cruso T. Account of a method of forming a new nose. Gentleman’s Magazine. 1794.

Manucci N. Storia do Mogor: Or Mogul India. Translated by William Irvine.

Mukhopadhyaya G. The Surgical Instruments of the Hindus. Calcutta; 1913.

Shah TM. Rhinoplasty in India. Indian Medical Gazette. 1889.

Sushruta. Sushruta Samhita. Various translations.
 

Quiz time

The punishment of nose amputation in ancient India contributed to the development of rhinoplasty. This punishment was commonly practiced for:

A. Theft
B. Adultery and crimes
C. Treason
D. Religious offenses

Answer: B. Adultery and crimes

The widely Known report in the gentleman’s Magazine of the Indian Rhinoplasty 1n 1794 .Two British surgeons stationed in Pune, Thomas Cruso and James Findlay, witnessed the procedure and reported it

Dr Tribhovandas Motichand Shah The Chief Medical officer of Junagadh Princely State Trained in Modern medicine In Grant Medical college Mumbai was an expert in performing the Indian Rhinoplasty in the 19th Century and he published his cases in the Bombay gazette this is his report of having performed 100 cases . the story goes that a dacoid kadu Makrani was famous in cutting noses of his victims and Tribhuvandas reconstructed them (kadu Kate naak ………..)

Painting of Sivaji Maharaj in the book Storia Do Mogar by Niccolo Manucci about Mughal India

History of Surgery ASI team

Dr Kaushik Bhattacharya (Head of the team)
Dr Pratap Varute
Dr Patta Radhakrishna
Dr Surajit Bhattacharya
Dr Clement Rajan
Dr K Lakshman
Dr Mahesh Prabhu

Acharya Vagbhata

When surgeons read the classical texts of Indian medicine, Sushruta naturally commands most of the attention. His operations are vivid, his instruments numerous, and his confidence unmistakable. Yet between the age of Sushruta and the later medieval period, surgical knowledge might easily have thinned out or fragmented. It is largely through Vagbhata that the surgical tradition was gathered, condensed, and transmitted forward.

Vagbhata probably lived around the 6th–7th century CE, was not primarily an operative innovator. His importance lies in preserving surgical principles and presenting them in a structured and teachable form. His two great works, the Aṣṭāṅgasaṅgraha (अष्टाङ्गसंग्रह) and the Aṣṭāṅgahṛdayasaṃhitā (अष्टाङ्गहृदयसंहिता) include substantial material on surgery (Śhalyatantra), wound care, fractures, cautery, and surgical instruments. Though briefer than Suśhruta’s descriptions, they show that a coherent surgical tradition was still alive in early medieval India. Modern philological research, however, argues that these two texts are unlikely to be the work of a single author. The relationship between the two treatises, as well as their authorship, remains a subject of ongoing scholarly debate and has not been conclusively resolved.

The title Aṣṭāṅga refers to the eight branches of medicine: internal medicine, surgery, diseases of the head and neck, pediatrics and obstetrics, toxicology, psychiatry, rejuvenation therapy, and reproductive health. This classification reflects an attempt to organize medical knowledge into a coherent system. For the modern reader, it suggests a curriculum rather than a manual, a structured approach to medical education.

The Concept of Shalya

The Sanskrit word śhalya refers to a sharp instrument (spear, javelin, arrow or a thorn) foreign body or anything that must be removed from the body. From this comes Śhalyatantra, the branch of medicine dealing with surgery. Vagbhata adopts this classical concept and describes a range of conditions requiring surgical intervention foreign bodies, abscesses, calculi, dead tissue, and traumatic wounds.

The surgeon’s role was therefore defined not only by cutting but by removal: removing pus, removing foreign material, removing devitalized tissue. The idea is strikingly close to what we would now call debridement.

Wound Care and Healing

One of Vagbhata’s most practical contributions lies in his descriptions of wounds (vrana). He classifies wounds by cause traumatic, surgical, and inflammatory and also by their condition. Clean wounds, contaminated wounds, and infected wounds are described in different terms, each with its own management.

The principles of treatment are logical and sequential. A wound must first be cleaned. Any foreign or dead material must be removed. Only then can healing proceed properly. Vagbhata repeatedly emphasizes that retained debris or devitalized tissue interferes with healing, a principle that remains fundamental in modern surgery.

Suppuration is described as a stage in the evolution of certain wounds. The surgeon is advised to recognize the signs of abscess formation swelling, pain, warmth, and fluctuation and to intervene when pus has formed. Premature incision is discouraged, but so is delay once suppuration is evident.

Drainage of abscesses is described in straightforward mechanical terms. The incision must be adequate, and the cavity must be allowed to empty fully. After drainage, dressings are applied to promote healing from within. The emphasis on adequate drainage reflects long practical experience with soft tissue infections.

Chronic wounds receive special attention. Vagbhat describes methods to stimulate healing in wounds that fail to close, including cleaning, scraping, and the application of medicinal substances. The idea that a wound might need to be “refreshed” before it can heal is familiar to any modern surgeon dealing with chronic ulcers.

Debridement

Although the modern term does not exist in the text, the concept of debridement is clearly present. Dead or unhealthy tissue is described as an obstacle to healing and must be removed. This may be done with cutting instruments or by other means. The wound is then treated so that healthy tissue can form.

This principle appears repeatedly in classical Indian surgery and remains one of its most enduring contributions.

Bandaging

Bandaging is discussed in considerable detail. Vagbhat describes a variety of bandage types, each suited to a different region of the body. The bandage must be firm enough to support the tissues but not so tight as to impair circulation.

Special bandaging techniques are described for the limbs, joints, and trunk. The importance of maintaining the correct position during healing is emphasized. The surgeon is advised to check bandages regularly and adjust them as needed.

The descriptions suggest a practical familiarity with postoperative care and the management of injuries.

Original lithographic print of the book Aṣṭāṅgahṛdayasaṃhitā written by Vagbhata printed in 1860s

Fractures and Dislocations

Fractures are described in terms of displacement and instability. The basic principles of treatment are recognizable: reduction, alignment, and immobilization.

The injured limb is first brought back into proper position. It is then supported with splints and bandages. Movement is restricted until healing has occurred. Vagbhata emphasizes that improper alignment leads to deformity and impaired function.

Dislocations are treated by manipulation followed by immobilization. Careful handling is advised, and excessive force is discouraged. The emphasis on gentle but effective reduction suggests a developed understanding of musculoskeletal injuries.

Surgical Instruments

Like Sushruta, Vagbhata describes a range of surgical instruments, though in less detail. These include cutting instruments, probes, forceps, and needles. Instruments are to be kept clean and in good condition.

The surgeon is expected to be familiar with the proper use of each instrument. Precision and control are emphasized over force.

Though the descriptions are brief, they reflect an established operative practice in which specialized tools were used for specific purposes.

Cautery

Cautery occupies an important place in Vagbhat’s surgical practice. Two forms are described: thermal cautery (agnikarma) and chemical cautery (kṣhārakarma) (akin to ksharasutra).

Thermal cautery is used to control bleeding, destroy diseased tissue, and treat certain growths. Chemical cautery uses caustic substances to achieve similar ends. Each method has specific indications, and improper use is warned against.

Cautery is presented not as a last resort but as a standard surgical tool. Its careful and controlled application suggests considerable experience.

Bloodletting

Bloodletting is described as a therapeutic procedure in selected conditions. Methods include venesection and the use of leeches. Though based on the humoral theories of the time, the techniques themselves required practical skill.

The descriptions include guidance on patient selection and technique, indicating that these procedures were performed with some regularity.

The Surgeon

Vagbhata’s description of the surgeon is worth noting. The surgeon must be steady-handed, observant, and disciplined. Cleanliness is emphasized, both in the person and in the instruments. The surgeon must understand the disease before attempting treatment.

Vagbhata’s Place in Surgical History

Vagbhata does not describe rhinoplasty with the detail found in Sushruta, nor does he present dramatic new operations. His importance lies elsewhere. He preserved the principles of surgery at a time when they might otherwise have faded.

Through his writings, the essential elements of surgical practice wound care, drainage, debridement, fracture management, and operative technique were organized into a coherent system and transmitted to later generations.

For modern surgeons, Vagbhata offers a glimpse of a tradition in transition. The bold experimental phase of early surgery had passed, but the craft itself remained alive. The operating surgeon was still present, treating wounds, draining abscesses, setting fractures, and managing injuries much as surgeons would for centuries afterward.

If Sushruta represents the birth of Indian surgery, Vagbhata represents its continuity.

From a historical perspective, Vagbhata represents a bridge between worlds. Behind him lie the great surgical traditions of ancient India. Ahead lies the long medieval period, during which medical knowledge was preserved in monasteries, courts, and teaching lineages. Without authors like Vagbhata, much of the earlier tradition might have been lost or scattered.

If Sushruta can be imagined as the master surgeon, then Vagbhata might be seen as the professor who ensured that the knowledge endured. His contribution was not dramatic, but it was essential. He gathered what was known, organized it, and presented it in a form that could be taught and remembered.

References

1. Vagbhata. Ashtanga Hridayam. Translated by K.R. Srikantha Murthy. Varanasi: Chaukhambha Krishnadas Academy.
2. Vagbhata. Ashtanga Sangraha. Translated by K.R. Srikantha Murthy. Varanasi: Chaukhambha Orientalia.
3. Meulenbeld GJ. A History of Indian Medical Literature. Groningen: Egbert Forsten; 1999.
4. Filliozat J. The Classical Doctrine of Indian Medicine. Delhi: Munshiram Manoharlal; 1964.
5. Wujastyk D. The Roots of Ayurveda. London: Penguin Classics; 2003.
6. Sharma PV. History of Medicine in India. New Delhi: Indian National Science Academy; 1992.
7. Menon, I (2010). "The Ashtavaidya physicians of Kerala: A tradition in transition". Journal of Ayurveda and Integrative Medicine.

Footnote

In addition to textual and scholarly study, Vagbhat is associated with a number of regional traditions in India, particularly in Kerala, where classical Ayurveda developed distinctive institutional lineages. These traditions form part of the cultural history of Ayurveda but are generally treated by historians as legendary or devotional accounts rather than established historical biography.

In Kerala, hereditary families of Ayurvedic physicians known as Ashtavaidyas (literally, “masters of the eight branches of Ayurveda”) preserved classical texts and clinical practices connected to the Aṣṭāṅga system described in Vagbhat’s works. Ethnographic and historical surveys of Kerala Ayurveda note that these families often traced their intellectual lineage to classical authors such as Vagbhat, Charaka, and Sushruta, though such links are understood as traditional affiliations rather than direct teacher–disciple relationships.

One such Ashtavaidya lineage is the Pulamanthole Mooss family of present-day Malappuram district, Kerala. Local family histories and community narratives maintained by the Pulamanthole Mooss tradition state that Vagbhat spent his final years in the Pulamanthole region and that a memorial site (samādhi) associated with him exists there. This association is referenced in institutional histories and regional cultural accounts but is not supported by epigraphic, archaeological, or contemporaneous textual evidence accepted by mainstream historians

The legacy of Vagbhata written by Dr. MS Valiathan

Digital Rare Book:
Astanga Hrdaya of Vagbhata (500-600 CE)

Quiz time

Which of Vagbhata’s texts is written mainly in concise poetic verses and became widely popular among physicians?

Answer – Ashtanga Hridaya

History of Surgery ASI team

Dr Kaushik Bhattacharya (Head of the team)
Dr Pratap Varute
Dr Patta Radhakrishna
Dr Surajit Bhattacharya
Dr Clement Rajan
Dr K Lakshman
Dr Mahesh Prabhu

King Bhoja

King Bhoja was a 11 century Parmar king who ruled in the area of present-day Madhya Pradesh. His ‘country’ extended from just east of Bhopal in the east to Sabarmati River in the west, and from Chittor in present day Rajasthan in the north to Konkan in the South.

Statue of King Bhoja in Bhopal

His life is chronicled in Bhoja Prabhanda authored by Ballaladeva in the 16th century. King Bhoja was a prolific writer with around 84 literary works attributed to him. The legends surrounding him match those surrounding King Vikramaditya. King Bhoja also fought many wars and was considered a hero by his citizens.

He was troubled by chronic headaches. Medications by his regular court doctors seemed to have no effect. Two Brahmins from Ujjain are credited with curing his headache through neurosurgery. They used anaesthesia, put him into a stupor, made trephinations in his skull and took out a tumour – and this cured him.

Trephination

Trephination or Trepanation involves making a ‘hole’ in the skull. These words are used interchangeably now. But the names are probably derived from the original names of the instruments used in the process.

The process involves scraping, cutting or drilling a hole in the skull. The process was practices as far back as the neolithic period. Trepanation has been documented in excavations of skulls from across the globe. The first ‘proper’ documentation was in mid 1800s from a skull excavated from Peru. Regularly shaped circular or rectangular holes suggest that it is man made. Scarring and ‘healing’ seen in the edges of these holes suggest that the holes were made in a live human and that he/she survived the procedure for a good length of time.

Different methods of trephining: (1) scraping; (2) grooving; (3) boring and cutting; (4) rectangular intersecting cuts. Reference: Gross CG. A Hole in the Head: More Tales in the History of Neuroscience. Cambridge (Massachusetts): MIT Press; 2009

In India, similar skulls with trepanations have been excavated from the Harappan sites (4500 years ago), Kashmir and Karnataka.

Trepanations were carried out for many indications including head trauma (to let the ‘bad blood’ out), headaches, epilepsy and psychiatric disturbances. That the patients survived the procedure has been mentioned. But there is no clear evidence about the patients getting better from the malady. But the fact that the procedure itself survived for such a long time suggests that it had some salutary effect.

A surgeon removing ‘the Stone of Madness’ by Trepanation; A 15th century Painting

Sushruta (600 BCE), the Father of Indian Surgery is credited with neurosurgical procedures in addition to the famous Rhinoplasty and several other surgical procedures. Sushruta designed and used more than 120 surgical instruments. He described methods of trepanation, extraction of foreign bodies, closure of wounds and application of dressings. Sushruta used some alcoholic potions as a form of anaesthesia.

Jivaka (5th Century BCE) is another well known physician of ancient India. His claim to fame was that he was the personal Physician of Gautama Buddha. Several neurosurgical procedures have been attributed to Jivaka as well.

Jivaka, Gautama Buddha’s physician
 

By the time of King Bhoja (11th Century), with 1500 years of experience, the science of neurosurgery had progressed. The improvement came in the form of anaesthesia. The Brahmin surgeons who operated on King Bhoja used a herbal mixture called Sammohini (probably a combination of cannabis and opium) to induce anaesthesia to the king. After the procedure, they used another herb called Sanjivini to wake him. Botanical equivalents of the herbs matching the descriptions have now been identified.

Thus, it can be seen that ancient Indian Surgeons were in the know of basic neurosurgical procedures. They had sophisticated anaesthetic protocols, designed and used proper instruments and clearly, the patients survived these procedures.

Bronze Age Harappan Trepanation skull (4300 years old)

Further reading:

https://journals.lww.com/armh/fulltext/2022/10010/history_of_trepanation_and_the_indian_connection.26.aspx

https://en.wikipedia.org/wiki/Bhoja

https://tamilandvedas.com/2015/06/17/brain-surgery-in-ancient-india-bhoja-and-indus-valley/
 

Quiz time

Who was the Father of Modern Neurosurgery in India?

Answer – Dr. B. Ramamurthi (who established the first neurosurgical department in Madras in 1950).

History of Surgery ASI team

Dr Kaushik Bhattacharya (Head of the team)
Dr Pratap Varute
Dr Patta Radhakrishna
Dr Surajit Bhattacharya
Dr Clement Rajan
Dr K Lakshman
Dr Mahesh Prabhu

Sushruta’s approach to anaesthesia, although not as advanced as modern techniques, was innovative. He used herbal anaesthetics such as opium (Ahiphena) and cannabis (Vijaya) to manage pain, employing methods such as inhalation, oral consumption, and topical application. Proper preparation and dosage were crucial, and Sushruta provided detailed guidelines for extracting and administering these herbal remedies. He also employed complementary techniques, such as distraction and positioning, to enhance patient comfort. Despite limitations such as variable efficacy and the short duration of these anaesthetics, Sushruta’s methods laid an early foundation for the pain management practices seen in modern surgery. His foundational Ayurvedic text outlines the use of Madyapanam (intoxicating drinks such as wine) combined with herbal medicines (sedatives), including Cannabis sativa (Bhang), Acorus calamus (Vacha), Nardostachysjatamansi (Jatamansi), Hyoscyamus niger (ParasikaYavani), and others to induce insensibility and pain relief. Sushruta’s pioneering approach to pain management not only enabled over 300 types of surgical operations—including rhinoplasty, cataract extraction, and intestinal repairs—but also introduced the first systematic preoperative, operative, and postoperative protocols emphasizing patient comfort, safety, and consent.

According to the Bhoja-Prabandha (a 17th-century collection of stories), the 11th-century Paramara king Raja Bhoja underwent a successful brain surgery to remove a tumor. Two surgeons from Ujjain reportedly used anesthetic powder (moha-churna) to make him unconscious, opened his skull, removed the growth, and used a revitalizing powder (sanjivani) to wake him. King Bhoja had incurable headaches. All the doctors in the town tried their hands and nothing worked. Having heard about the king’s health problems two Brahmin surgeons from Ujjain came to Dhara and told the king that they can cure him but it involved surgery in the skull. The king told them that he was ready to undergo any difficulty to get out of this torturous headache.

The surgeons brought with them a herb called Sammohini which will put any one in a coma stage like the Chloroform of modern operation theatres. The surgeons know how much of herb to give for certain number of hours. Nowadays the anaesthetists stand by the surgeons to increase the level of chloroform or reduce it. But in those days the surgeons themselves handled this. When the operation was over they administered an antidote herb called Sanjeevini (we have already heard about it in Valmiki Ramayana which cured Lakshmana from Indrajit’s biological warfare). King Bhoja also went through all the procedures, and the surgery was 100 percent successful. He came out of the surgery room as if he had just woken up. This is in Bhoja Prabandham, a Sanskrit book giving his life history.

The modern era of anaesthesia in India began when James Esdaile practiced mesmerism-assisted surgery in Hooghly. However, ether soon took precedence due to its reliability.

James Esdaile (1808–1859)

In 1839, Assistant Surgeon Dr. James Esdaile, in the East India Company’s service, arrived in Hooghly, a town 38 km upriver of Kolkata (Calcutta), to work at Hooghly Hospital. Originally from Scotland—and with a degree in medicine from Edinburgh—Esdaile was advised that a warmer climate would better suit his delicate lungs. In Bengal, Esdaile read about mesmerism, or animal magnetism. The practice, first popularized by Franz Mesmer in the late eighteenth century and only becoming popular in Britain in the nineteenth century, was said to have anesthetic properties and could treat psychoses (“nervous” patients).

Textbook on Mesmerism as an anaesthetic and Curative agent by James Esdaile 1852

As Esdaile described in his book, “Mesmerism in India, and Its Practical Application in Surgery and Medicine,” in April 1845, a local man named Madhab Kaura was sent to him from Hooghly jail for scrotal surgery. Witnessing the patient’s suffering during the procedure, Esdaile allegedly “turned to the native sub-assistant surgeon, an student of the medical college, and asked him if he had ever seen Mesmerism? He said that he had seen it tried at the medical college, but without effect.”

Esdaile admitted that he only knew about the practice from reading, but felt there was nothing to lose by trying it. Although the dulling of pain and loss of senses took longer than he had hoped, it reportedly worked. “I placed [the patient’s] knees between mine,” he reported, “and began to pass my hands slowly over his face, at the distance of one inch, and carried them down to the pit of his stomach. This was continued for half an hour…” Though the pain dulling and sensory loss took longer than expected, it seemed effective. Esdaile even went so far as to “apply” fire to the patient’s knee to test the strength of the trance-like state. The patient remained free of pain.

Esdaile performed seventy-two more operations that year, using mesmerism as an analgesia. A government-appointed committee—composed of colonial Bengal’s most distinguished people, including magistrates and the Inspector General of Hospitals—then allowed him to run an experimental mesmeric hospital, subject to scrutiny from medical officers.

Esdaile’s practice was widely popular with “the natives,” as he termed them, and caused much fanfare. As historian of psychiatry Waltraud Ernst reports, he performed fantastical feats such as excising a tumor “7 feet in circumference and 2 feet at the neck,” seemingly without the patient feeling pain. Historian Alan Gauld writes that Esdaile conducted hundreds of surgeries and reported a 5 percent mortality rate (other techniques had a 50 percent or higher mortality rate).

Filarial scrotum Surgery done in 3 minutes by Dr James Esdaile with Mesmerism anaesthesia

Hooghly Hospital came to be called jadoo hospital (the word for “magic” in many Indian languages), less because they believed Esdaile was casting spells and more because of his own use of the phrase belatee munter, “the European Charm,” when explaining mesmerism to Indian assistants.

Breast tumour of 10lbs weight removed by James Esdaile by Mesmerism

Despite the initial approval for Esdaile’s experiments by the review committee, mesmerism was widely viewed as a pseudoscience that was nothing but a spectacle for the elite of Europe. At his experimental hospital, Esdaile hired native assistants to perform the mesmerism in his stead (he said the practice tired him excessively). The mesmerizer would take the patients to a dark room and blow over their bodies until they achieved a sleep-like state. Esdaile would come and confirm if the mesmerism was complete. Mesmerism could take days, if not weeks. Once achieved, Esdaile would perform the surgery. The doctors inspecting Esdaile’s work noted that each mesmerizer had their own way of performing the entrancement. It was impossible to standardize . But this wasn’t the only problem. The association of mesmerism with magic was too close. And Esdaile wanted to distance himself from faith healing and present mesmerism as a science.

He did this in part by treating “non-natives,” i.e., Europeans, to legitimize his practice as science. But he also made his practice open to public opinion and reported the results of his experiments in the local newspapers, all to ensure that his work was seen as a science. When Esdaile cured severe epilepsy of the wife of Hooghly’s Deputy Magistrate, Iswar Ghosals, his fame knew no end. Soon, never-ending queues at the hospital became a regular feature with everyone wanting to be part of Dr. Esdaile’s “miracle”.

The government learned about Esdaile’s successes in Hooghly, and decided to give him one year to practice in a controlled environment in Calcutta, where medical observers could watch his operations and write an official report on whether mesmerism worked. The result of the report was mixed; the Governor-General Lord Dalhousie, while generally supportive, decided that it was not worth continuing a Mesmeric Hospital on the government dime.

This is where it gets really interesting. In response to Dalhousie’s decision, the group of locals listed in the second image sent a petition to keep the hospital open – and when that didn’t work, they raised funds through public subscription to create a Mesmeric Hospital for Esdaile! This hospital was located in Creek Row in Central Calcutta, and opened on September 1, 1848. Unfortunately, it did not last long, and Esdaile returned to England in 1851.

The ultimate cause of the demise of Calcutta’s mesmeric hospital was twofold. First, mainstream medicine decided that mesmerism was no more than parlour tricks. And second, the invention of anesthesia made a reliable, much cheaper alternative to mesmerism available – and the East India Company of course went with the cost-saving option.

Most of Esdaile’s patients were Indians, drawn from the general or convict populations. In Mesmerism in India, he described those he treated as coming from a “feeble-minded, ill-nourished race, remarkably deficient in nervous energy.” Eventually, Esdaile’s mesmerism hospital failed due to factors more practical than magical: economics and scientific discovery.

Soft tissue sarcoma surgery by Dr James Esdaile by Mesmerism

Whatever its efficacy, mesmerism was a costly practice. Ernst writes that Assistant Surgeon Dr. Frederic J. Mouat, already a critic of Esdaile, calculated the hospital would incur a significant additional expense of 750 rupees per month with its use, as one mesmerizer was needed for every four patients.

In addition, ether and chloroform were in use by the late 1840s, and they were cheaper, more efficient, and aligned with orthodox Western medical practices. Even Esdaile had to concede, albeit reluctantly, that they were better.

Esdaile was made Presidency Surgeon in 1848, but his mesmeric hospital lost favor. He returned to Scotland in 1851. Though it’s not certain that subtropical Bengal had helped his lungs, Gauld suggests that Esdaile moved once more, south to Sydenham (London), as the Scottish climate “proved too bracing for the weak lungs which had sent him to India in the first place.” He died there in 1859 at the age of fifty-one.

The final conclusion of Mesmerism for surgery, according to Esdaile was “ I beg, to state, for the satisfaction of those who have not yet a practical knowledge of the subject, that I have seen no bad consequences whatever arise from persons being operated on when in the mesmeric trance.

Cases have occurred in which no pain has been felt subsequent to the operation even; the wounds healing in a few days by the first intention; and in the rest, I have seen no indications of any injury being done to the constitution.

On the contrary, it appears to me to have been saved, and that less constitutional disturbance has followed than under ordinary circumstances.

There has not been a death among the cases operated on.”


Hooghly Imambara ( James Esdaile had a hospital in this complex)

Quiz time

Who was the anaesthesiologist for Mahatma Gandhi’s emergent appendicectomy?

Answer – Dr. Date

History of Surgery ASI team

Dr Kaushik Bhattacharya (Head of the team)
Dr Pratap Varute
Dr Patta Radhakrishna
Dr Surajit Bhattacharya
Dr Clement Rajan
Dr K Lakshman
Dr Mahesh Prabhu

Susruta was probably the first surgeon in the world to classify and describe, in detail, surgical instruments, their methods of manufacture, quality control, maintenance, and their specific uses in the diagnosis and treatment of diseases. He was also the first surgeon to describe endoscopes such as rectal, aural, nasal, and vaginal specula. First evidence of brain surgery in Bronze Age Harappa is reported by A. R. Sankhyan and G.R Shug in a scientific correspondence to Current Science. The communication states that it is the first report of its kind to unequivocally present a case of ancient brain surgical practice, known as trepanation, observed 4300 years ago in a Bronze Age Harappan skull. A decade ago, a Neolithic skull from Burzahoma in the Kashmir Valley was reported to have multiple trepanations, the first case from the Indian subcontinent. Trepanation, also called trephination or trephining, has been the oldest craniotomic surgical procedure practiced by mankind since the Stone Age, involving drilling or cutting through the skull vault of a living or recently deceased person.

Blunt Instruments invented by Sushruta.

Sharp Instruments invented by Sushruta

Aggalayya’s Stone Inscription is a stone inscription in Telugu-Kannada Script is incised on three sides of a stone pillar set up in the village named Saidapur village, Yadgirigutta mandal (Bhuvanagiri Taluk), Nalgonda District of Andhra Pradesh. This inscription, which portrays the practice of surgery by select vaidyas in the medieval period, it evidenced by the subjoined inscription, which alludes the greatness of a surgeon named Aggalayya who flourished under the patronage of the Chalukya King Jayasimha II (A.D. 1015-1042) The mention of Aggalayya in an inscription, as a surgeon-physician in this context, shows that the practice of surgery was not completely given up by medieval period. It provides a glimpse of how surgeons and physicians held a high status during the reign of the Chalukya King Jayasimha. Aggalayya taught surgery to students from across India and served under four dynasties, earning the title 'Samanta Raja.'

Figure 1 – Aggalayya’s Stone Inscription (1034 AD to 1074 AD )

While specific, individualized tools used by Aggalayya are not listed in the provided text, his era practiced Sastra-vaidya (surgery) based on the principles of Sushruta Samhita. Archaeological findings from similar periods in South India, specifically the Taxila Museum, provide examples of the types of instruments used at that time:

• Maṇḍalāgra: A disc-shaped blade instrument.
• Eśaṇī: Surgical probes.
• Sūcī: Needles with eyes for suturing.
• Saṁdaṁśayantra: Gripping instruments or forceps.
• Tālayantra: Spatula-type instruments with handles.

These instruments, including those for cutting, probing, and suturing, were used for various procedures, including vascular, rectal, and ophthalmic surgeries.

Figure 2- Surgical instruments in the Taxila Museum.

Indian Surgical Instruments (published in the Indian Medical Gazette in 1877 )

Among the pioneers who defended the scientific heritage of Ayurveda during the colonial era, Vaidyaraj Prabhuram Jivanram (1832–1902) stands as a monumental figure. A scholar of Vedanta, practicing Ayurvedic Vaidya, and realized yogi, he worked to rescue Indian medical knowledge from distortion at a time when European narratives often dismissed India’s surgical achievements.
One of his most remarkable contributions is the rare monograph “Forceps Used by the Ancients of India” (Bombay, 1892), edited with notes by his erudite son Vishwanath Prabhuram Vaidya. Printed in English, Sanskrit, and Gujarati, it is among the earliest scholarly attempts to document, analyze, and defend India’s ancient obstetric and surgical instruments as described in the Sushruta Samhita and related traditions. Today, copies survive only in a handful of repositories, including holdings in London—making it a treasure of Ayurvedic and world medical history. In this extraordinary monograph, Vaidya Prabhuram challenges the assumption that obstetric instruments were purely European inventions of the early modern period. He compares Sushruta’s Sandamsa (extractive tongs) and Anigraha, along with related techniques of rotation, traction, and controlled extraction, with their European counterparts—arguing that classical Indian obstetrics documented sophisticated tools and methods long before they were widely recognized in Europe.
He writes with clarity and conviction:

“The application of forceps in case of difficult labor, the different turning, flexing, and gliding movements, and other obstetric operations… were first systematically described by Sushruta long before fillets and forceps were dreamt of in Europe, and thousands of years before Christ.”
— Prabhuram Jivanram Vaidya, Forceps Used by the Ancients of India (1892)

The medical students in ancient India were trained to perform real surgery by observing mock surgeries on gourds, watermelons, and cucumbers. These resident students were from the Sushruta school (6th century BCE) and were known as Saushrutas. The students were trained in surgery for a minimum of 6 years, during which they were taught the principles of the “Susruta Samhita.”

The image is from a 15th-century copy of the “Sushruta Samhita” kept at the Odisha State Museum, Bhubaneswar.

Quiz time

What were surgical instruments broadly classified into by Sushruta?

Answer – Yantra (blunt) and Shastra (sharp)

History of Surgery ASI team

Dr Kaushik Bhattacharya (Head of the team)
Dr Pratap Varute
Dr Patta Radhakrishna
Dr Surajit Bhattacharya
Dr Clement Rajan
Dr K Lakshman
Dr Mahesh Prabhu

Farrukhsiyar ( 1683 –1719), was the tenth Mughal Emperor of India from 1713 to 1719.In 1717, Farrukhsiyar issued a farman (royal order) giving the British East India Company the right to reside and trade in the Mughal Empire. They were allowed to trade freely, except for a yearly payment of 3,000 rupees. This was because William Hamilton, a surgeon associated with the company cured Farrukhsiyar of a disease.

10th Mughal Emperor Farrukhsiyar ( 1683 –1719)

William Hamilton was a Scottish surgeon, associated with British East India Company (EIC), who travelled to India in the first half of the 18th century. He was a part of the delegation that went from Calcutta, the base of the company, to meet Mughal emperor Farrukhsiyar in his court in Delhi in 1715. The surgeon was called to treat a swelling in the groin of the Emperor Farrukhsiyar, which he treated successfully. In October 1715, the emperor again suffered from violent pain and feared it would be a fistula. Hamilton's treatment was again successful. As a result, in December 1715 Emperor Farrukhsiyar was finally able to perform the wedding of his beloved daughter with the daughter of the Rajah of Jodhpur, which had been delayed by his recurrent illness

The Surgeon Hamilton received the professional charges for his royal treatment to the Emperor on the eve of wedding as “an elephant, a horse, five thousand rupees in money, two diamond rings, a jewelled aigrette, a set of gold buttons, and models of all his instruments in gold."

But not deeming these sufficient, Farrukhsiyar asked Hamilton to name any reward “he wished for”. The good surgeon, however, proved to be an extremely unselfish man. He immediately asked the emperor to grant the British East India Company mission the objective with which they had arrived from distant Calcutta. The company's delegation was placed in high regard in the royal court of Farrukhsiyar. In April 1717, the emperor's farman (grant) was issued, meeting all the requests that the company had made in its petitions. Permission was granted to purchase 38 villages surrounding the three already held by the company (Sutanuti, Gobindapur and Kalikata, the predecessor of modern Calcutta). The company was also granted trading privileges in Bengal and further fortification of Calcutta.This grant was instrumental in the setting up of business and the colonisation of Bengal, later to be followed by the rest of India, by the East India Company.

After the grant, Farrukhsiyar expressed his wish to retain William Hamilton in Delhi as his personal surgeon, but Hamilton refused to stay. Hamilton promised to the emperor that after a visit to Europe he would return and join him as his personal surgeon.

Hamilton died in Calcutta on 4th December 1717. He was buried at the churchyard of St. John's Church, Calcutta. The inscription tells the story of his curing a "Malignant Distemper" of Farrukhsiyar.

Quiz time

In 1645, Jahanara Begum, the favourite daughter of Mughal Emperor Shah Jahan, was severely burnt when her clothing caught fire in an accident during a dance performance.Local healers had failed to cure her, and, at the advice of vizier Assad Khan, the Emperor requested an English surgeon to treat Jahanara. Who was the surgeon?

Answer – Gabriel Boughton

Inscription stone

St John’s Church, Kolkata

History of Surgery ASI team

Dr Kaushik Bhattacharya (Head of the team)
Dr Pratap Varute
Dr Patta Radhakrishna
Dr Surajit Bhattacharya
Dr Clement Rajan
Dr K Lakshman
Dr Mahesh Prabhu

Jivaka, also known as Jivaka Komarabhacca, is revered as one of the earliest and most accomplished surgeons and physicians of ancient India. Flourishing around the 5th century BCE, he is best remembered as the personal physician of Gautama Buddha and the royal doctor to King Bimbisara of Magadha. Though Jivaka was the official personal physician of the Buddha. There is a saying that the Buddha did not make him a monk; he accepted him as his lay disciple because the Buddha wanted him to remain free to tend to sick people. Jīvaka was born in Rajagraha to a courtesan named Shalavati. Deemed unwanted, he was abandoned shortly after birth. Prince Abhaya, son of King Bimbisara, found the infant alive and adopted him—hence the name Jīvaka (“the living one”) and the epithet Komārabhacca (“raised by a prince”)

Educated at the legendary medical university of Takshashila, Jivaka mastered surgery, internal medicine, and herbal pharmacology. Ancient Buddhist texts credit him with performing complex surgical procedures, including abdominal surgery, cranial interventions, wound management, and treatment of intestinal obstruction—remarkable feats for his era.

Surgery for fistula-in-ano was performed on King Bimbisara. This is the procedure that made him famous, as though the surgery for fistula-in-ano was practiced before, but caused a high degree of incontinence. King Bimbisara, a husband to several young wives, became a subject of ridicule because of staining of his underclothes with blood. No royal physician would dare suggest an invasive procedure. Jivaka approached the king with an instrument called “nakha sastra” which has often been wrongly translated as a fingernail, but the actual instrument is one finger in breadth and two to nine fingers in length with a cutting edge. It appears that Jivaka probably made an incision into the fistula, which subsequently healed. The king was pleased with his “grandson” and appointed Jivaka as the royal physician. This eventually led to Jivaka becoming the physician to the Buddha himself. As Jivaka had cured the old king of his ailment, he was again offered payment, which was declined. The king thereupon gifted Jivaka a Palace with a garden full of mango trees and other fruit trees, and a small village within the district. Jivaka was to later build a monastery in this garden for Buddhist monks.(Jivakambhavana)

Craniotomy (Susabadho) to remove what were probably parasites (“panaka”) or clots was one of Jivaka’s other famous operations, which is mentioned in almost all the texts. He performed this on a merchant who was suffering from intense chronic headaches. Jivaka operated on a youth whose intestines had gotten “entangled.” and diagnosed as volvulus. Jivaka did a laparotomy, derotated the intestines, and sutured them back in their proper position. There is a similar description for a strangulated hernia.

A splinter of rock was embedded in Buddha's foot after being hurled by his rival, Devadutta. It was extricated using a small knife “Khaja” by Jivaka. Surgery for hydrocele by Jivaka was called as ‘andavuddhi’. The surgery involved opening the covering of the testicles and removing a hard “bija.”

Jivaka had come across a wealthy merchant whose wife had been unwell for seven years. He had gone to the merchant's house and announced that he was a Vaidya who had come to treat the patient. The merchant's wife had inquired from her security guard about the nature of the Vaidya who had come, and was informed that he was quite young. She had been treated by the most reputed scholars of the city and was hesitant to trust the youthful stranger. However, Jivaka had endeavoured to win her trust and had informed her that he would not request any payment to begin with, but with confidence had told her that she might pay him whatever fee she thought fit, once she was completely cured. With this, the merchant's wife had agreed to be treated by him. As had been taught him during his training, he was said to have firstly applied the technique of “Ashtavida Pariksha" – the eightfold method of examination of a patient. (This constituted examination of the nadi, that is the pulse, the mala, which is the bowel movements and excreta, the mutra, which is the urine, jinva, the tongue, and rupa the patient's body,etc.) Eventually, Jivaka diagnosed that the lady primarily needed treatment for the recurrent headaches. He treated her for a sinus condition with a nasya – an extract of herbs with ghee, and after a while her condition improved. He continued with treatment that completely rid her of her seven-year-long ailments. She was reported to have paid him in 16,000. Kahapanas, silver coins, and so did her grandson and his wife; and her husband gave her in addition, even more coins, servants, a horse and a carriage. Now enriched as he was, Jivaka returned to Magadha to the palace of Prince Abhaya.

There is a similar story that happened in Northern India when Jivaka was summoned by one of the kings who ruled the northwestern part of India, Sibi. A blind Brahmin approached King Sibi and asked for eye donation. The Brahmin asked him because the king had already earned the reputation of a big philanthropist, donating anything you ask for. The king sent a word for Jivaka, and he came and removed both the eyes of the king and fixed them to the Brahmin. This is recorded in the Buddhist chronicles. This is probably the first instance of the organ donation in those days.

Beyond technical skill, Jivaka embodied ethical medical practice. He treated the poor without charge, emphasized compassion toward patients, and integrated moral responsibility into medical care. His approach aligns closely with modern principles of medical ethics, beneficence, and patient-centered care.

Jivaka is also regarded as a pioneer of traditional Indian medicine, influencing early Ayurveda and Buddhist medical traditions across Asia. In many Southeast Asian countries today, he is still venerated as the “Father of Medicine” and a patron saint of healers.

In essence, Jivaka represents the timeless ideal of the surgeon-scholar—scientifically skilled, ethically grounded, and deeply humane—a legacy that continues to inspire modern surgical practice.

The remains of Jivaka’s vihara in the city of Rajgir (Bihar) are still visited by hundreds of people from all over the world.Jīvaka thus occupies a foundational place in the history of Indian surgery—not merely as “the Buddha’s doctor,” but as the earliest historically contextualized exemplar of the Indian surgical tradition. Jivaca is considered as the father of traditional Thai Medicine.

Quiz time
What is one of the most famous surgical procedures Jivaka is credited with performing?

Answer: Surgery for fistula-in-ano on King Bimbisara.

Reference:
1. Zysk KG. Asceticism and Healing in Ancient India: Medicine in the Buddhist Monastery. Oxford: Oxford University Press; 1991.
2. Meulenbeld GJ. A History of Indian Medical Literature. Groningen: Egbert Forsten; 1999–2002.
3. Filliozat J. The Classical Doctrine of Indian Medicine: Its Origins and Its Greek Parallels. Delhi: Munshiram Manoharlal; 1964.
4. Wujastyk D. The Roots of Ayurveda. London: Penguin Classics; 2003.
5. Basham AL. The Wonder That Was India. London: Sidgwick & Jackson; 1954.
6. Bhishagratna KK, trans. The Sushruta Samhita. Varanasi: Chowkhamba; 1907.

History of Surgery ASI team

Dr Kaushik Bhattacharya (Head of the team)
Dr Pratap Varute
Dr Patta Radhakrishna
Dr Surajit Bhattacharya
Dr Clement Rajan
Dr K Lakshman
Dr Mahesh Prabhu

Sushruta defined surgical acumen as – “Surgery has the superior advantage of producing instantaneous effects by means of surgical instruments and appliances. Hence, it is the highest in value of all the medical tantras. It is eternal and a source of infinite piety, imports fame, and opens the gates of Heaven to its votaries. It prolongs the duration of human existence on earth and helps men in successfully fulfilling their missions and earning a decent competence in life.”

Sushruta defined surgical acumen as – “Surgery has the superior advantage of producing instantaneous effects by means of surgical instruments and appliances. Hence, it is the highest in value of all the medical tantras. It is eternal and a source of infinite piety, imports fame, and opens the gates of Heaven to its votaries. It prolongs the duration of human existence on earth and helps men in successfully fulfilling their missions and earning a decent competence in life.”

The first complete English translation – Kaviraj Kunja Lal Bhishagratna ,1907 Calcutta

Sushruta Samhita is a collection of surgical and allied knowledge, written in two parts, the Purva-tantra and Uttara-tantra. Purva-tantra has 120 chapters in five sections – Sutra-sthana, Sarira-sthana, Nidana-sthana, Chikitsa-sthana and Kalpa-sthana. The Chikitsa-sthana deals with surgical conditions including obstetrical emergencies, geriatrics and aphrodisiacs. The Kalpa sthana contains visha tantra which describes the nature of poisons and their management. Uttara-tantra covers Salakya, Kaya-chikitsa, Kaumarabhetya and Bhutavidya and Aupadravika, the description of many complications of surgical procedures like hiccough, fever, krmiroga, pandu, dysentery, cough, kamala, etc. The Salakyatantra has description of the various diseases of eye, ear, nose and head. The two parts together cover, apart from surgery, other specialities like medicine, paediatrics, geriatrics, diseases of the ear, nose, throat and eye, toxicology and psychiatry. The Sushruta Samhita describes over 300 surgical procedures and classifies human surgery under eight heads – Chedya (excision), Lekhya (scarification), Vedhya (puncturing), Esya (exploration), Ahrya (extraction), Vsraya (evacuation) and Sivya (Suturing). There are detailed descriptions on methods of haemostasis and leech therapy.

Like a true innovator. Sushruta designed his own instruments and did so by understanding his own needs as well as the utility of the beaks and claws and jaws of birds and animals, and naming his instruments after them. His Samdamsa yantras are the first forms of the modern surgeon's spring forceps and dissection and dressing forceps. In fact, his system of naming surgical tools after the animals or birds they resemble in shape, for example crocodile forceps, hawkbill forceps, is adopted even today. What is to be appreciated is not just the ingenuity of Sushruta but also the progress which research in metalurgy had made in India, way back in 600BC!

Instruments designed by Sushruta

The Sushruta Samhita thus is a comprehensive surgical textbook describing in detail general surgical techniques of making incisions, probing, extracting of foreign bodies, alkali and thermal cauterisation, tooth extraction, excision, the use of trocars to drain abscess, hydrocele and ascitic fluid, methods to stitch the intestines using ant-heads as stitching material, more complex procedures including removal of the prostate gland, urethral stricture dilatation, extraction of urinary bladder stone, hernia surgery, Caesarean section, management of hemorrhoids, fistulae, laparotomy and the management of intestinal obstruction, perforated intestine and accidental perforation of the abdomen with protrusion of omentum. Orthopaedic surgery, including management of dislocation of joints (sandhimukta) and fractures of the shaft (kanda-bhagna) bones and their reaction to the injuries, principles of fracture management, viz., traction, manipulation, appositions and stabilization including some measures of rehabilitation and fitting of prosthetics are all described. Ophthalmic surgery for various eye diseases, medical or surgical interventions including cataract surgery have also found a place in it. It also deals with dissection and the study of the anatomy of the human body, and even embryology and sequential development of the structures of the foetus!

Incision making, wound care and wound closure all find their due place in Sushruta Samhita. ‘Chedan Karma’ (Incision), according to Sushruta are mainly of three types – on head, eyelid, cheek, frontal region, lips, gums, axilla, hip joint – ‘Triyaka cheda’ means oblique incision, over upper and lower limb – ‘Chandramandal’ incision (Circular) and over anal region and penis incision should be ‘Ardhchandrakruti’ (Semicircular). He further went on to mention that if these rules of incision were not followed there were chances of injuring vital structures, delayed wound healing (Chirad Vranasanroho) and formation of keloid (Mamsakandi). Also while describing incision on breast abscess (StanaVidradhi) Sushruta has mentioned that incision should be taken such that it should avoid Papillary duct and areola otherwise there are chance of formation of sinus (Nandivrama).

While describing wound management (vrana-chikitsa) Sushruta has described sixty types of treatment (Shashthiupokrama). Interestingly, wound scrapping (lekhana) is mentioned as sixteenth upakrama. Thereafter before suturing wound should be thoroughly cleaned otherwise there will be chances of pus formation in wound. He mentioned that wounds with hard fatty mass should be scrapped. Scrapping should be such that edges of wound should be at equal level (Vartmanamtupramanenasamam). Thereafter before suturing wound should be thoroughly cleaned otherwise there will be chances of pus formation in wound. In Shashitiuparamas (Sixty methods) he described sixty types of treatments for different types of wounds and their treatments – Nirvapan, Vtkarika, Utsadan and Avasadan being a few treatments for large wound. The basic principles of wound care still remain the same even after so many years!

Sushruta has given detailed description of various techniques of wound closure. He mentioned four types of suturing – Vellitaka, Gofanika, Tunnasevani, Rujugranthi which should be used for different parts of body. He has also mentioned different types of needles to be used to different areas for wound closure. For areas which is less fatty in nature and over joints, round body two finger long needle (Vrultanguladwgyam) should be used while in areas with more fats – cutting body, three finger long triangular (Ayata tryangula tryastra) needle should be used and in areas where vital organs are nearby curved (Dhanurvakra) needle should be used.

His "paschat-karman" or post-operative schedule included the scar management protocols, rehabilitation and removal of complications. Fourteen types of bandaging capable of covering almost all the regions of the body and different methods of dressings with various medicaments are mentioned in Sushruta Samhita. Evidence points to a knowledge of Medhumeha (diabetes) and other co morbid conditions that can influence surgery!

Through all of Sushruta's flowery language, incantations and irrelevancies, there shines the unmistakable picture of a great surgeon. Undaunted by his failures, unimpressed by his successes, he sought the truth unceasingly and passed it on to those who followed. He attacked disease and deformity definitively, with reasoned and logical methods. When the path did not exist, he made one.’ – Dr Frank McDowell

Reference:
Bhattacharya S. Sushrutha – our proud heritage. Indian J Plast Surg. 2009
Jul;42(2):223-5. PMID: 20368862; PMCID: PMC2845369.

Quiz question

How was Venesection being taught at the time of Sushruta?

Answer

At the time of Sushruta (6th century BCE), venesection (Sira Vyadha), a critical method of bloodletting (Raktamokshana), was taught through a rigorous, practical, and simulation-based approach, emphasizing hands-on experience before practicing on patients. To teach the precise technique of venesection, students practiced on the stalks of water lilies (specifically Kamala and Kumuda). The soft, tubular structure of the lily stalks provided a realistic model for manipulating and puncturing veins without risk to a patient.

History of Surgery ASI team

Dr Kaushik Bhattacharya (Head of the team)
Dr Pratap Varute
Dr Patta Radhakrishna
Dr Surajit Bhattacharya
Dr Clement Rajan
Dr K Lakshman
Dr Mahesh Prabhu

The Department of Science & Technology (DST), under a programme called Science Heritage & Research Initiative (SHRI) has sanctioned a grant to a group of plastic surgeons, historians, Sancrit scholars and other affiliated domain expertd to dig into the history and gather some tangible evidence about the life and time of the great sage Sushruta. The fact that he was the ‘father of Plastic Surgery’ and his devised method of reconstructing a cut nose is still practiced today and the world calls it the ‘Indian Rhinoplasty’ is no longer debated. A statue of this great sage has found a proud place in the foyer of the Australian College of Surgeons in Melbourne and many medical institutions in India acknowledge his contribution by putting us his statues and paintings in their premises, a giant one in the garden of Amrita Institute of Medical Sciences in Cochin being the most eye catching.

Sushruta is believed to be the son of a sage Vishwamitra and disciple of guru Divodas or Dhanvantari, the King of Kashi. History dates him to 600 BC-1000BC in the Vedic times, placing him on the time line, a millennium before the Greek physician Hippocrates and two millennia before another Greek, Galen and Roman,Celsius! It is today hard to believe that even as way back as 600BC a man performed complex surgical procedures including reconstruction of the nose by cheek flap, repair of cut earlobe, piercing of earlobe, repair of cut lip and skin grafting with medieval instruments that he himself manufactured. Not only does it say volumes about the quality of medicine being practiced then but also about the quality of metallurgy and engineering which must have coexisted in order to make the variety of instruments which Sushruta had designed after watching closely the beaks of birds and paws and jaws of animals!

Sushruta is said to have compiled a monumental thesis in surgery, the ‘Sushruta Samhita’. It is the oldest known surgical text and it describes in exquisite detail the examination, diagnosis, treatment and prognosis of numerous ailments, as well as procedures of plastic surgery, including reconstructive surgery and rhinoplasty. Written in Sanskrit in the form of Shlokas, verses and incantations, gilded by the flowery language and metaphors characteristic to Sushruta, the Samhita was not an easy text to decipher. It is regarded to be a part of Atharva Veda and the access to the Vedic knowledge was restricted to select few scholars of the ancient times. Such social factors may have contributed to the lack of dissemination of this ancient knowledge in India leading ultimately to our dependence on the Western world for our surgical know-how. The ancient Indian medical practitioners were divided into two classes: the Salya-cikitsakas (surgeons) and the Kaya-cikitsakas (physicians) but for a surgeon the knowledge of both the fields was essential.

While we will talk about the Sushruta Samhita in great details in the next issue, it is pertinent to mention that in this unique document Sushruta has described Anatomy, Physilogy, Surgery, Orthopaedics, Obstetrices & Gynaecology, Embryology, Opgthalmology and Urology in great details. Sushruta did not limit his teachings to procedures; he also described surgical instruments, catheters, sounds and irrigating syringes. He gave details of their manufacture (including the metal to be used and the measurements) and maintenance (cleaning by caustics and alkalis).

Treatment was not confined to surgery alone but there are descriptions on comprehensive perioperative care. Sushruta remarks: "the patient who has been fed, does not faint, and he who is rendered intoxicated, does not feel the pain of the operation." There is evidence of usage of wine and cannabis incense for inducing anaesthesia before surgery. So Sushruta can be safely considered to be ‘the father of Anaesthesiology’ as well!

He made his disciples practice their surgical skills on various experimental models, like incising on watermelon, gourd, clay pots and reeds, probing on worm eaten wood, just like in present day simulation skills workshops. So, practicing ob Surgical Simulators, which the wortld is rediscoverig today, had its initiation in the hands of Sushruta. Sushruta insisted on a sound knowledge of anatomy (Sharirasthana) and embryology in surgical practise and studies were conducted on decomposing cadavers and dead foetuses towards this aim.

Fourteen types of bandaging capable of covering almost all the regions of the body were described for the practice of the student on dummies. The use of surgical devices such as tourniquets and setting plasters also find a mention. Some important procedures, which preceded actual surgery, such as cauterisation by Ksaras (alkaline substances) or Agni (fire – heat) and application of leeches were being practiced extensively by him.

Apart from his surgical prowess, Sushruta was also a staunch proponent of good ethics, attitude and communication skills in surgical aspirants. According to him, "He is a good surgeon, who possesses courage and presence of mind, a hand free from perspiration, tremor-less grip of sharp and good instruments and who carries his operations to success and the advantage of his patient who has entrusted his life to the surgeon. The surgeon should respect this absolute surrender and treat his patient as his own son." Sushruta laid down the pre requisites for a qualifying surgeon as”A physician who has set out on this path should have witnessed operations. He must be licensed by the king. He should be clean and keep his nails and hair short. He should be cheerful, well-spoken and honest". He warns that improper intervention with surgical manoeuvre due either to ignorance of the progress of the disease process, greed for money or lack of judgment, lead only to complications. With such high standards set by the master surgeon and teacher, this era was regarded as the golden age of surgery in ancient India.

Sushruta had realized the importance of balance in knowledge and skill. In the Samhita he mentions, "a physician, well-versed in the principles of science of medicine but incompetent in his art because of want of practice, as well as the physician, experienced in his art but short on the knowledge of Ayurveda, is like a one-winged bird that is incapable of soaring high in the sky".

Sushruta remains our proud heritage and Sushruta Samhita is a living testament to his outstanding brilliance and colossal contribution to the science and art of healing. It is a pity that despite knowing a fair bit about this sage, teacher and exponent of surgical practice, there are still gaps in our trail of knowledge which only tangible evidence would be able to fill. Let us try to fill these missing gaps. I also invite you to watch a movie which the Association of Plastic Surgeons of India produced on Sushruta:

https://www.youtube.com/watch?v=rCFtR92JS-c

Reference:
Bhattacharya S. Sushrutha – our proud heritage. Indian J Plast Surg. 2009
Jul;42(2):223-5. PMID: 20368862; PMCID: PMC2845369.

Quiz time

What was the modern upper GI endoscope known during the time of Sushruta ?

Ans Nadiyanta

History of Surgery ASI team

Dr Kaushik Bhattacharya (Head of the team)
Dr Pratap Varute
Dr Patta Radhakrishna
Dr Surajit Bhattacharya
Dr Clement Rajan
Dr K Lakshman
Dr Mahesh Prabhu