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Sushruta described many surgical operations like cataract, lithoromy, caesarian section, etc. and 121 surgical hernia, lithoromy, instruments, including lancets, sounds forceps, catheters, and rectal and vaginal speculums. Despite Brahmanical prohibitions he advocated the dissection of dead bodies as indispensable in the training of surgeons.35 He was the first to graft upon torn ear portions of skin taken from another part of the body; and from him and his Indian successor's rhinoplasty the surgical reconstruction of the nose-descended into modern medicine. 168

The ancient Indians, says F. H. Garrison, 'performed almost every major operation except legation of the arteries.' Limbs were amputated, abdominal sections were performed, fractures were set, hemorrhoids and fistulas were removed. 36 Susruta describes eight types of surgical procedures.³ Excision (cedana) is a procedure whereby a part or whole of the limb is cut off from the parent. Incision (bhedana) is made to achieve effective drainage or exposure of underlying structures to let the content out. Scraping (lekhana) or scooping is carried out to remove a growth or flesh of an ulcer, tartar of teeth, etc. the veins, hydrocele and ascetic fluid in the abdomen are drained by puncturing with special instrument (vyadhana). The sinuses and cavities with foreign bodies are probed (esana) for establishing their size, site, number, shape, position, situation, etc. Sravana (blood letting) is to be carried out in skin diseases, vidradhis, localized swelling, etc. in case of accidental injuries and in intentional incisions, the lips of the wound are apposed and united by stitching. (svana). 169

To obtain proficiency and acquire skill and speed in these different types of surgical manipulations, Sushruta devised various experimental modules for trying each procedure. For example, incision and excision are to be practiced on vegetables and leather bags filled with mud of different densities; scraping on hairy skin of animals; puncturing on the vein of dead animals and lotus stalks; probing on moth eaten wood or bamboo; scarification on wooden planks smeared with beeswax, etc. On the subject of trauma, Sushruta speaks of six varieties of accidental injuries encompassing almost all parts of the body. Susruta also gives classification of the bones and their reaction to injuries. varieties of dislocation of joints (sandhimukta) and fractures. of the shaft (kanda bhagna) are given systematically. He classifies and gives the details of the six types of dislocations and twelve varieties of fractures. He gives the principles of fracture treatment, viz., traction, manipulation, appositions and stabilization. Sushruta has described the entire orthopaedic surgery, including some measures of rehabilitation, in his work. As war was a major cause of injury, 37 the name salya tantra for this branch of medical learning is derived from salya, the arrow of the 170

enemy, which in fights used to be lodged in the body of the soldiers. He emphasizes that removal of foreign bodies is fraught with certain complications if the seat of the salya be a marma. Susruta also discusses certain surgical conditions of anorectal region, he has given all the methods of management of both haemorrhoids and fistulae. Different types of incision to remove the fistulous tract as langalaka, ardhalangalaka, sarvabhadra, candraadha (curved) and kharjurapatraka (serrated) are described for adoption. according to the type of fistula. 38 Sushruta was well aware of the urinary stones, their varieties; the anatomy of urinary bladder along with its relations is well recorded in the chapter on urinary stones. Varieties of stones, their signs and symptoms, the method of extraction and operative complication are given in detail. Apart from the above, surgery of intestinal obstruction (baddha-gudodara), perforated intestines (chidrodara), accidental injuries to abdomen (assaya-bhinna) in which protrusion of omentum occurs are also described along with their management.