What’s Old Is New (and Sometimes Fake)

By Supriya Savkoor

It’s 3,000 years ago, and you decide you would like a new nose. Where would you go to get one? If you guessed the holy city of Benares in India, on the banks of the Ganges river, you'd be right. That's where the great sages prayed, and Hindus, Buddhists, and Jains pilgrimaged—and yes, sometimes got nose jobs.

It’s true. Back then, you could could have gotten a nose job or almost any other kind of cosmetic surgery in Benares (now called Varanasi), as well as had your hernia fixed, a caesarian, cataract replacement, prostrate removal, tonsillectomy, or a root canal.

That’s because Sushruta, often credited as the Father of Surgery and also the Father of Plastic Surgery, was from Varanasi, where he taught, practiced, and wrote a seminal series, the Sushruta Samhita, on the art and science of surgery sometime between 800 B.C and 300 B.C. With 184 whopping chapters, Suchruta’s compendium is exhaustive. He described more than 300 surgical procedures and 120 surgical instruments and classifies human surgery into eight categories. He detailed not only surgery but geriatrics, pediatrics, obstetrics, fetal development, psychiatry, and ear, nose, throat, and eye conditions. Overall, he classified some 1,120 illnesses and diseases, as well as 700 medicinal plants and 100 medicines prepared from both plant and animal extracts. And he explained how to examine, diagnose, treat, and give a prognosis on many illnesses and diseases.

In the surgery field alone, Sushruta created tools and techniques to make incisions, conduct probes and extractions, cauterize a wound, perform amputations, pull teeth, and drain fluids. He categorized in great detail the different ways bones dislocate and fracture and even how to measure and fit artificial limbs. He successfully used ant heads to stitch up intestines.The ants would bite into the wounds and act as clips, then Sushruta would twist their bodies off, leaving the heads intact to keep the wounds sealed. Bizarre, maybe, but it worked.

Perhaps most notably, he and his students reconstructed noses, genitalia, earlobes, and other body parts on victims who had these parts amputated as part of criminal or religious punishment. In particular, cutting off the nose was a common punishment for adultery in those days, so nose reconstruction was in high demand. Sushruta created a procedure known as forehead pedicle-flap rhinoplasty in which he used skin from the forehead to repair or replace skin from the nose. Plastic surgeons still use this method today.

Indian doctors and healers relied on Sushruta’s compendium for generations, but the earliest surviving manuscript, known as the Bower Manuscript, comes from the 4^th century A.D. In the 8^th century, the original Sanskrit text was translated to Arabic and traveled to Mesopotamia, Persia, and Egypt, and by the 15^th century, to Europe. Along the way, in Turkey, surgeons even used Sushruta's techniques to perform breast reductions. (Makes you wonder, who was getting breast reductions in the Middle Ages? The Real Housewives of Istanbul?)

A rendering of an apparently painless cataract removal from
an 8th century Arabic translation of the Sushruta Samhita. 

In the late 1700s, when the British annexed parts of India, physicians began studying Indian surgical methods, plastic surgery in particular. One of these doctors, Joseph Constantine Carpue, spent 20 years studying Indian rhinoplasty—nose jobs—and is credited with performing the first major rhinoplasty in the western world (in the UK) in 1815. The forehead pedicle-flap technique Sushruta invented is now known as the Carpue operation. (Insert your own sarcastic comment here.)

Doesn’t it give you a little chuckle that this holiest of places, from one of the world's oldest civilizations, is also the birthplace of plastic surgery? It does me.