How Different Or Relevant Is Ancient Indian Rhinoplasty (in Sushruta Samhita) To Modern-day Surgery?

Sushruta Samhita , originally written by Acharya Sushruta. It is a Sanskrit text written about ayurvedic medicine and surgery. Sushruta Samhita was written on palm leaves which are cooked and dried for the ink to stick. The oldest text of Sushruta Samhita is in Kaiser Library, Nepal (Kengo Harimoto, 2011). My artifact is from the online collection of the Los Angeles County Museum of Art (LACMA). It is not the original text as the original text has not survived to the modern-day. My artefact is dated at 12th-13th century. The exact time when the original manuscri pt was written is unknown, however, estimates range from 1000 BCE to 500 CE. Tipton, a famous historian, states that the comparison of the Sushruta Samhita text with Hindu Vedic hymns such as Atharvaveda traces the first Sushruta Samhita to about 1 BCE (Tipton, 2008). Ancient physicians from more than 2000 years back talking about Plastic surgery surprised me and I was intrigued to know more about Sushruta, who is an Indian surgeon this allowed me to delve deeper into my Indian culture and history. Sushruta is most famous for describing Rhinoplasty and this earned him the title, "the Father of Plastic Surgery". Rhinoplasty is a surgery that changes the appearance of the nose.

In its current form, Sushruta Samhita is divided into 186 chapters, and it describes 1120 illnesses and preparations from 700 medicinal plants. I could directly connect with this artifact as my Indian grandparents liked to use home remedies from plant products, for example, using turmeric for wound healing and Triphala for headaches. I know in India, alternate medicines such as Ayurveda, Siddha, Yoga, Unani are prevalent as they are thought to have fewer side effects compared to modern medicine. Even whilst doing Rhinoplasty surgeries, Sushruta describes that Karpasa cotton is used to envelop the nose after surgery and refined oil is sprinkled over instead of dressings (Sushruta Samhita, n.d.). Sushruta only suggests patients drink clarified butter after surgery for digestion this is mostly not given in modern medicine.

Rhinoplasty in today`s modern medicine has both cosmetic and medical reasons, for example, changing the shape of the nose, injury to the nose, improve breathing (Rhinoplasty, 2021). The reasons for cosmetic surgery can be complex, however, the most common reason for people having Rhinoplasty in the UK is to improve breathing and to treat sleep apnea. However, most people who had Rhinoplasty in Ancient India were so-called `criminals` who had their nose amputated as a result of criminal/ military punishment.

Even though Rhinoplasty was well-liked in Colonial India, it took much time to reach the west due to translation. It was only when Indian Rhinoplasty had been published in the Gentleman s Magazine of London, Rhinoplasty brought in a lot of notice. On 23rd October, the first successful Rhinoplasty was performed by Carpue, a British surgeon. (Eagle, 2016) This surgery lasted 37 minutes. This is shorter the modern-day Rhinoplasty performed which takes around 1 to 3 hours. I was shocked to know that modern Rhinoplasty takes longer. However, this might be due to increased time taken in Anaesthesia and determining doses. Alternatively, it might be due to the increased complexity of surgeries done compared to historic India.

Erwin Ackerknecht was the first to notice that plastic surgery practiced in Europe could be a direct descendent from Sushruta Samhita. This shows that Sushruta Samhita still holds its relevance to modern day surgery. Free-graft rhinoplasty is described in detail in chapter 6 of Sushruta Samhita and is sometimes also known as the Indian flap (Saraf, 2007).

In contrast, many surgeons might believe that Sushruta Samhita can t really be used as a guide in modern Rhinoplasty. This is because Rhinoplasty detailed by Sushruta uses cheek-flap using whilst modern rhinoplasty uses the skin from the forehead. Thus, modern methods used have evolved from ancient Indian medicine. The main reason why flesh from forehead is used is because the forehead flap provides a large amount to tissue and a sturdy bone. (Correa, 2013)

Also, I wasn t surprised to know there was a difference in the use of medical instruments. For example, during general surgery, the patient would-be put-on intubation for normal breathing as the patient cannot breathe if put on general anesthesia. However, in the times when Sushruta practiced, he just put 2 hollow pipes through the nostrils. Tools used by Sushruta were primitive, but I was amazed to find out that he made use of the basic tools of that time to provide the best patient care possible.

Another difference in the instruments used was that Sushruta used suture materials from bark, tendon, silk, and hear. He made use of ant heads to hold the skin together when stitching and substituted what we know as anesthesia with wine. This is different from what I observed in my work experience where sutures and tools used such as forceps, needle holders were sterilised ularly. However, there were also many similarities in the endoscopes and forceps used which can be seen in the images below.

Moreover, measurements of how much flesh must be cut off were done using a leaf as explained in the Sushruta Samhita. However, now we use vascular measuring caliper which is of much greater accuracy than using a leaf. It also greatly reduces mistakes and is more likely to result in a cleaner finish.

Additionally, the `Sushruta Samhita` used wine with the incense of cannabis for anesthesia. Some people might believe that this is an outdated procedure. However, I think this set the basis for pain relief which moved away from the earlier practices of surgery. I believe that pain relief is highly important whilst providing holistic care and improves patient satisfaction and compliance. This is like the now modern practices where pain relief is given high importance. I noticed this with chemotherapy patients where there is a shift to patient-centred care from historic doctor-centred care where patients don t feel involved. Many healthcare professionals were involved in the MDT meetings such as nurses, pharmacists, doctors, biomedical scientists, caterers, dieticians, and so on. This was different from the time when Sushruta did surgery where he and his students were the only people involved in the care of the patient and management after surgery (Sushruta Samhita, n.d.).

In conclusion, we can see that modern day surgery is evolving with increasing accuracy and precision in surgery performed. This is coupled with surgery becoming safer with increased number of patients being involved in their care. This trend could also be seen in Sushruta Samhita which moved away from pre-historic practices beforehand. Thus, I believe that despite the differences between the Rhinoplasty described in Sushruta Samhita and that of modern surgery, I believe that a lot of skills and qualities are still relevant to this day, especially that of pain relief and the importance of delivering holistic care to a patient. However, many people might argue that Sushruta Samhita is outdated as modern medicine is now more dependent on technology such as 3D printing and Robotic surgery. Nevertheless, I think that reading Sushruta Samhita allows us to see how surgery and medicine has evolved and teaches us important lessons on how improvements can be made in medical ethics and practices. Many doctors who practice ayurveda might agree that Sushruta Samhita is still relevant till date as it talks about plant remedies which is still thought to be effective, and pain free compared to modern medicine. Therefore, I still believe that whilst the procedure of surgery might be different, the skills and values of doctors can still be relevant when used alongside advancing technology.