Head and neck diseases in an ancient Indian surgical text (The Sushruta-samhita).

DESCRIPTIONS of diseases and methods for their treatment can be found in the earliest available texts of the inhabitants of the Indo-gangetic plain. The oldest, the Rig-Veda, deals with non-traumatic diseases treated mainly by magical rites (Pal and Chakravorty), the later Atharva-Veda concerns itself largely with medical matters though treatment methods are still more magical than rational. The golden age of Hindu medicine is still later in time and the Ayurveda (or Science of Life) is stated to derive from the Atharva-Veda. Of the three major postVedic texts the Sushruta-samhita deals most with surgical problems and the present discussion will be limited to material contained in the Sushruta-samhita. While the exact date of compilation of the Sushruta-samhita cannot be decided because of various reasons discussed elsewhere (Chakravorty, Jolly, Keswani, Winternitz), it is generally agreed that this was between the sixth and third century before Christ (Satyaprakash). A fresh examination of the original sanskrit text has been attempted and has been compared with various presently available recensions (Ambikadattashastri, Bhisagratna, Ghanekar, Sengupta, etc.). Most of the original text is presented here in free translation or pr6cis, keeping the sense of the original as close as possible to modern terminology. The Sushruta-samhita is divided into six major sections-the Sutrasthanam (Su),t Nidanasthanam (Ni), Sharerasthanam (Sh), Chikitsasthanam (Ci), Kalpasthanam (Ka) and the Uttaratantram (Ut). Each section is further subdivided into chapters or Adhyayas made up of a variable number of shlokas or statements in verse or prose. The Sutrasthanam defines the various subdivisions of Ayurveda as being eight in number. Two of these are Shalyatantra (approximately general surgery) and Shalakyatantra. The latter deals with the diseases of the parts of the body above the clavicles (Yatru), i.e., of the eyes, the ears, the nose, the oral cavity, etc. (Su/l/10). It also includes general measures in management-surgical, medical, dietetic, applications of eye drops, ear drops and medicated snuff, incantations, divination and prognostics. The general principles of surgery, operative methods, surgical instruments and postoperative care have been discussed elsewhere (Chakravorty, Satyaprakash) and will not be recapitulated. Information on the diagnosis and management of head and neck diseases is scattered throughout the entire text-the Uttaratantra concerns itself specially with these problems. In common with other postVedic texts, the Sushruta-samhita subscribes to the Tridosha or trihumoral theory of health and disease. Derangement of one or more of these three fundamental principles is believed to cause disease and therefore diagnosis and treatment are largely dependent upon the correct interpretation of the Dosha or Doshas at fault. In diseases caused by external agents or by trauma, the response to treatment and ultimate healing is thought to be conditioned by the constitutional characteristics of the patient (Bhisagratna, Ghanekar, Seal). This often causes prob-