Rhinoplasty and Congenital Megacolon By Acharya Sushrutha

By Dr Regina
In 1792 an Indian bullock cart driver named Cowasjee and four other Indian sepoys (Tilangas) who served the British were captured by Tipu Sultan’s soldiers at Srirangapatna. Their nose and a hand were cut off as a punishment for serving the enemy. They were sent back to the British Army where Cowasjee became a pensioner of the East India Company.
Read – Acharya Sushruta: Work, Samhita, Legacy, Amazing Facts

History

A few months later, a British commanding officer while interacting with an Indian merchant noticed an unusual scar on his forehead. On enquiring about it he came to know that the merchant had his nose cut off as a punishment for adultery. His severed nose was reconstructed by a Maratha surgeon belonging to the Kumhar caste (a caste historically associated with pottery). The commanding officer found the surgeon and asked him to reconstruct the nose of Cowasjee and the four sepoys.

In 1793, the surgeon performed the nose reconstruction procedure on Cowasjee near Pune, which was witnessed by two English doctors, Thomas Cruso and James Findlay at the Bombay Presidency. Ten months after the surgery, an artist James Wales painted a portrait of Cowasjee which showed his newly reconstructed nose and the remnant scar on his forehead. This procedure was first reported in The Madras Gazette dated August 4, 1794. This detailed procedure was also published in the Gentleman’s magazine, London in October 1794. The Europeans who had no interest in the Indian surgical procedures until then, were fascinated at the success of the surgery. Due to its uniqueness, this procedure came to be known as ‘the Indian method’.

This surgical method, which was kept as a secret and practised in India for centuries, is just one among the hundreds of procedures and techniques which has been explained systematically in the Indian classical text, Sushruta Samhita, written by Acharya Sushruta.
Read – Sushruta’s 8 Types Of Surgical Procedures – Astavidha Shastra Karma

Method of Nose reconstruction by Sushrutha

Sushruta Samhita Sutrasthana, Chapter 16, Verses 27-31 –

The leaf of a tree is cut in the shape of the nose. This piece of this leaf is placed on the patient’s cheek. The cheek muscle is cut to the same size and the flap is raised. This tissue is immediately placed on the mutilated nose. The nose should be scraped to cause bleeding before the tissue is placed over it. Proper bandaging is done while inserting two tubes (one for each nostril). Powders of Red Sandalwood, Licorice etc. is sprinkled over it. A cotton swab is placed and Sesame oil is sprinkled over it. The patient is subjected to internal oleation using ghee followed by therapeutic purgation according to the physician’s advice. Once the nose has healed, the excess tissue is cut off for shaping the nose. The same procedure was used for the reconstruction of mutilated lips, but without the insertion of tubes.

The technique performed on Cowasjee by the Maratha surgeon was a modified method of Sushrutha’s method of Rhinoplasty.
Read – Methods Of Surgical Training Elaborated In Ayurveda

Baddha gudodara

Dr. Harald Hirschsprung was the first paediatrician in Denmark. He was appointed as the chief physician in Queen Louise Children’s Hospital, Copenhagen when it opened in 1879.

Between 1880 and 1885, Dr. Hirschsprung noted some similarities between the clinical cases of two patients. The first infant had an absence of spontaneous bowel movements. Such a medical condition was not recorded anywhere previously. The second case also had a similar presentation. Enemas were given daily and laxatives were used as treatment. He continued to treat the patient without having enough knowledge about the condition. But the children didn’t survive. Autopsy was carried out which revealed that the rectum was narrowed, bowel loops had dilations and bowel walls were thickened.
Read – Rectal Prolapse – Causes, Treatment, Useful Herbs

Dr. Hirschsprung presented his findings in 1886 at the Berlin Conference of the German Society of Paediatrics. He has been acknowledged as the first person to write about this condition. Since then, the disease came to be known as ‘Hirschsprung’s disease’ or ‘congenital megacolon’.

Dr. Hirschsprung held this title until a paper was published in 2011, which stated that Acharya Sushruta had mentioned a similar condition called ‘Baddha gudodara’, many centuries ago in his book Sushruta Samhita.

‘Baddha’ means obstruction, ‘guda’ means rectum or anus and ‘udara’ means abdominal distension. Baddha gudodara is a condition mentioned in Sushruta Samhita Nidana sthana, chapter 7, verses 17-18. This condition occurs due to functional obstruction of the rectum due to accumulation of doshas, food, hair, stones etc. Fecal matter gets accumulated within the lumen of the intestine. This causes feces to be eliminated with great difficulty and in small quantities. The part of the abdomen between the heart and umbilicus becomes distended. The patient vomits materials with a fecal smell.
Read – Charaka Udara Roga Chikitsa – 13th Chapter

In Nidana Sthana, chapter 14, Sushruta mentions that this condition is incurable but has also mentioned a detailed palliative surgical procedure. Through an abdominal incision made below the umbilicus, four finger breadths left to the median hairline, four finger breadths of loops of the large intestine should be pulled out. The intestine is opened after careful examination, to remove any materials causing obstruction. The intestine is then bathed in ghee and honey, replaced back in its ideal site and the wound is closed by suturing.
Read – Guda Marma: Anatomical Location, Effect Of Injury

A brief comparison
Congenital megacolon according to modern medicineBaddhagudodara according to Sushruta
Caused by failed migration of colonial ganglion cells during gestationCaused by deraged Vayu, which can be understood as defective neuromuscular force or defective nerves
ConstipationPassing of stools with difficulty and in small quantities
Swelling of the abdomenDistension of abdomen, in the region between the heart and umbilicus
Vomiting a green or brown substanceVomitus with a fecal smell

From the above references, it can be concluded that ‘Baddhagudodara’ mentioned in the ancient text Sushruta Samhita closely resembles ‘Hirschsprung’s disease’ or ‘congenital megacolon’ described by Dr. Hirschsprung.
Read – Constipation Causes, Ayurvedic Treatment, Home Remedies

References

1. Jalaludheen, Syyed Mohammed. Outline of Salyatantra. Varanasi, Chaukhambha Sanksrit Sansthan, 2014.

2. Mukherjee, Nayana Sharma, et al. “A NOSE LOST AND HONOUR REGAINED: THE INDIAN METHOD OF RHINOPLASTY REVISITED.” Proceedings of the Indian History Congress, vol. 72, 2011, pp. 968–977., www.jstor.org/stable/44146788.

3. Roed-Petersen K, Erichsen G. The Danish pediatrician Harald Hirschsprung. Surg Gynecol Obstet. 1988 Feb;166(2):181-5. PMID: 3276016.

4. Frenckner B. Pionjär för pediatrisk forskning – omtyckt kliniker, mindre värderad föreläsare [The man behind the syndrome: Harald Hirshsprung. A pioneer in pediatric research – a popular clinician but less valued lecturer]. Lakartidningen. 1983 Nov 30;80(48):4664-5. Swedish. PMID: 6363841.

5. Raveenthiran V. Knowledge of ancient Hindu surgeons on Hirschsprung disease: evidence from Sushruta Samhita of circa 1200-600 BC. J Pediatr Surg. 2011 Nov;46(11):2204-8. doi: 10.1016/j.jpedsurg.2011.07.007. PMID: 22075360.

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