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Mysteries of Ancient Medicine - Season 1 Episode 8 - Barber Surgeons, Astrologist-Physicians, Ancient Indian Medicine
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00:03In an age when medicine is a blend of mystery and mayhem, a group of unlikely practitioners
00:10emerge.
00:11In popular culture, barber surgeons are often portrayed as bumbling, low-skilled practitioners.
00:17But in the medieval period, they were actually skilled tradesmen who operated at the crossroads
00:23of medicine and early surgery.
00:25In the shadowy realm of medieval medicine, astrologer physicians wield cosmic charts
00:32and celestial omens.
00:34When somebody's labeled an outsider, what it means is they're not following under the institutional
00:38expectations.
00:40A young surgeon's groundbreaking techniques will, centuries later, be recognized as the
00:46foundations of modern cosmetic surgery.
00:49Sushrita's technique for rhinoplasty is totally transformative.
01:17In the rolling hills of southern England lies the ancient Neolithic site of Avebury.
01:23known for its massive stone circles, Avebury has long captivated archaeologists and visitors
01:30alike.
01:31But in 1938, a startling discovery sheds new light on the site's more recent history.
01:39Avebury is a remarkable Neolithic site in southern England.
01:43This is one of the largest and most complex ancient sites in Europe.
01:50These sites include megalithic monuments like stone circles and chambered tombs that are built
01:57to reflect ideas about religion, ritual and social hierarchy.
02:03So as the centuries progress and Christianity becomes dominant in England, we could see that these sites
02:08go into severe disrepair, suggesting that they may have been attacked in some cases by Christians
02:14who probably didn't appreciate the presence of huge Neolithic monuments that date back to
02:19pagan times to remind them that there was a religion around a long time before Christianity was.
02:24In the 1930s, archaeologist Alexander Keeler takes a keen interest in the area and sets out on a mission
02:32to reconstruct and restore the site.
02:35While excavating a massive stone, he makes an astonishing finding.
02:40A skeleton, accompanied by a set of curious tools, a probe, scissors and a purse containing coins from the early
02:4914th century.
02:51What did these clues reveal about the identity of the remains?
02:57We think, potentially, that this body represents a barber surgeon.
03:02The tools of the trade being buried with the body lend quite a bit of credibility that that is the
03:07case.
03:08And if so, it's fascinating because we don't really have a whole lot of physical evidence
03:13about what the lives of barber surgeons were like in the Middle Ages.
03:17Usually, if you're finding tools with a person in their burial context,
03:21it's an indicator of their profession or their social status.
03:26But how was it in the Middle Ages that ordinary barbers evolved into skilled surgeons?
03:33The answer can be traced back to the monasteries of the early Middle Ages,
03:37where barbers are tasked to regularly cut the monk's hair in a high-maintenance cut known as the tonsure.
03:46Monks following a kind of communal rule, or what we might call a corporate style of monasticism in this period,
03:52lived a very regulated existence entirely devoted towards a certain lifestyle,
03:57which they believe is the way to get as close to God as possible.
04:00The monastic tonsure, as we see it in monks on the continent, is meant to imitate the crown of thorns
04:06of Christ.
04:07By the time we get to the High Middle Ages, we begin to see this differentiation within monasteries
04:13between monks who are usually from higher classes, who are educated, and people that are called lay monks.
04:19And lay brothers or lay monks are people that are there to do the general menial work of the monastery.
04:25The monastery's highly educated monks take on the duty of providing medical service to their communities.
04:32Some monastic rules have provisions which mean that certain monks would be dedicated to caring for the health of other
04:40monks in the monastery.
04:42There's certainly evidence also that people went to monasteries for medical care.
04:47The surgical tasks are passed along to the church's barbers due to their skill in handling sharp instruments.
04:55Such as blades, razors, and scissors.
04:58The types of surgeries that we would see in a monastic setting ranged from simple things like setting a broken
05:05bone,
05:06to stitching up a wound, to even things like amputations would have been done in the monastic setting.
05:13Yet even in the medical context, there exists a monastic hierarchy.
05:18There is a differentiation between the monks who would have been well-versed in medical theory,
05:23and the predominantly barber surgeons who might actually carry out an operation at the direction of the monk who is
05:30educated.
05:30They wouldn't want to get their hands dirty with the actual bloody work.
05:34The bloody work is, you know, akin to a chef saying,
05:38I don't really want to get involved in the dishwashing.
05:40I'm going to direct, you know, the recipe.
05:43However, in 1215, the Fourth Lateran Council, a significant Christian ecumenical council of the Catholic Church under Pope Innocent III,
05:54issues a litany of edicts and decrees that will change the course of medicine and surgery.
06:00The Fourth Lateran Council is a watershed moment during the Middle Ages for the role of the church in medieval
06:06society.
06:07But it also created a whole new set of rules for clergy.
06:10And one of those stipulations was to prohibit any clergy member from bloodshed.
06:16It meant that a monk or a canon could no longer, after the Fourth Lateran Council, actually do surgical procedures
06:23themselves.
06:24After the Fourth Lateran Council, and increasingly as we get into the later half of the Middle Ages,
06:30we begin to see barber surgeons as something truly separate from the church
06:34and something that really becomes a distinct profession.
06:39Access to medical procedures, once largely administered by the church,
06:43suddenly diminishes, prompting a shift toward more secular practices.
06:49Yet even beyond the confines of monasteries, where barbers had long been performing minor
06:54procedures for the sick, there remains a clear chasm between the physician and the surgeon.
07:01During the Middle Ages, the roles of physician and surgeon are separate.
07:04Physicians are mostly from the upper classes because they can afford an expensive private medical education,
07:09and they're learning medicine from books. They're thinking about the theory of medicine.
07:13Physicians are serving the wealthy. They're speaking Latin, they're highly educated, and they consider
07:19surgical techniques and procedures to be manual labor. They think it's actually beneath them.
07:24So physicians are not serving the common people.
07:26When we're looking at surgeons in the past, there is a very different connotation to the work that they do
07:33because it's so physical. It's not held with such a great esteem at that point.
07:41While physicians study the theory of healing, barber surgeons handle the external duties,
07:47most notably is the practice of bloodletting. The evolution of bloodletting starts in classical
07:54antiquity, approximately 460 BC, when Greek medical practitioner Hippocrates proposes the theory of the
08:02four humors. This theory proposes that the human body has four essential fluids, blood, phlegm, yellow bile,
08:11and black bile. An imbalance of these humors is believed to cause illness.
08:19Hippocrates continues to suggest that the properties of these humors correspond to each of the four seasons.
08:26Blood is hot and wet and predominates in spring. Yellow bile is considered hot and dry like summer.
08:36Black bile is cold and dry for autumn. And phlegm, cold and wet in winter.
08:44In response to this ideology, barber surgeons were helping to balance the humors out through making
08:50incisions to bloodlet, which is thought to be a way of purging the body from these imbalances.
08:57There are a number of ways that barber surgeons are undertaking bloodletting during the Middle Ages.
09:01The first is venesection, or cutting into a vein, usually in the elbow area. The second is cupping,
09:07where they would make some minor striations on the body and then put a hot cup over top of it
09:11to draw
09:12out the blood. And then the third, and my favorite, is leeches, which is just what it sounds like,
09:17putting a live leech onto the body. Over time, barber surgeons take on a key role in caring for
09:24everyday people. They learn their skills through hands-on work and apprenticeships,
09:30unlike the formal schooling of physicians. They handle an increasingly wide range of procedures,
09:37from setting broken bones to doing amputations.
09:43Their importance is officially recognized by royal decree when King Edward II of England grants guild
09:50status to barber surgeons. When we get to the point where we start to see regulations applied to
09:57barber surgeons and the introduction of guilds, there's an attempt to try to regulate what is
10:02otherwise a chaotic situation. There's no rules about who can be a barber surgeon, who can practice
10:07surgery. We could look at monks who are trained to do this type of surgery. We could look at
10:12battlefield medics, some with training, some without, some who have university education,
10:17some without, some who are doing their services out of the back alley, attached to a brothel,
10:22and some who are doing it in a very highly formalized religious setting, like in a hospital.
10:28Once we see the introduction of these guilds and regulations, it brings all of these different
10:33ways of being a barber surgeon into a profession with rules, a profession with guidelines,
10:38and this elevates the barber surgeon.
10:44Aspiring barber surgeons typically undergo a seven-year apprenticeship under a master,
10:50living and working in their household, where they receive hands-on training,
10:54starting with basic grooming tasks and working up to more complicated procedures,
10:59procedures like suturing and bloodletting. Even without formal training, they help many people
11:07at a time when trained doctors are rare and often unwilling to do surgery.
11:14But it isn't long until barber surgeons, with their unique blend of practical skill and adaptability,
11:21are poised to become indispensable frontline healers amidst a looming threat.
11:28In 1347, the Black Death sweeps across Europe like a merciless scythe, cutting down entire
11:35populations with breathtaking speed, and transforming vibrant cities into ghostly landscapes of death.
11:44The Black Death is a catastrophic pandemic that terrorizes Europe. Its progression is alarmingly fast.
11:52People often die just days after the first symptoms appear.
11:59As the barber surgeons get more involved and they're treating more people throughout the Black Death,
12:04they're acquiring more knowledge as to how to treat successfully and what innovative solutions they might have to come up
12:11with.
12:12The plague is characterized by swollen lymph nodes or buboes that turn black and burst, a symptom that
12:20some believe lies at the origin of its name, Black Death.
12:25There aren't many university trained doctors, and most work for the rich. As the plague spreads,
12:33many become overwhelmed with patients or die from the disease themselves.
12:40Barber surgeons emerge as one of the primary care-giver groups active during the plague years,
12:46and are in great need, often traveling from town to town to meet demand.
12:51During the Black Death, barber surgeons carry a variety of tools for both grooming and medical work.
13:00Their kits include razors, scissors and combs, along with surgical tools like lancets for bloodletting,
13:09pliers for pulling teeth and sores for amputations. They also carry bowls for collecting blood and urine,
13:16which they examine to help diagnose illness, even by taste.
13:22It also signals the beginning of a significant shift in healthcare.
13:27There is a move towards understanding sources of sanitation, or at least trying to understand
13:34how contamination of either food or water sources might lead to illness. There's a sense also of
13:39isolation and quarantine when communicative illnesses hit to make sure that something like this doesn't happen again.
13:47Amidst the devastation of the Black Death, barber surgeons emerge as vital figures,
13:54laying the groundwork for their future role in equally deadly circumstances.
13:59In 1337, war breaks out between England and France in what will become a century-long conflict.
14:09The Hundred Years' War is a transition period in medieval history. In many ways, it starts off as a medieval
14:14conflict with knights on horseback fighting in a traditional medieval fashion. By the end of the
14:19Hundred Years' War, we see battles being won with the introduction of gunpowder and cannons. The practical knowledge of a
14:27barber surgeon and the application of that knowledge is much more useful to soldiers than some university-trained
14:34doctor who was working under Galen's humoral theories. That's not going to pull an arrow out of someone's
14:41chest. That's not going to stitch up a wound from a sword. You need a barber surgeon for that.
14:48As warfare evolves, barber surgeons increasingly find themselves on the front lines, tasked with addressing
14:55the gruesome injuries inflicted by emerging weaponry, often without adequate resources.
15:03And the barber surgeon's services are in high demand by the military, where they need to adapt in real time
15:09to new challenges posed by artillery injuries.
15:15There's no anesthesia at this time, so treating wounds is extremely painful. Barber surgeons use
15:23cauterization, pressing hot metal or pouring boiling oil onto the wound to stop bleeding.
15:32It works, but it's agonizing. Patients often bite on wood or drink alcohol to cope with the pain.
15:42And it is in the field that an intrepid young French barber surgeon named Ambrose Paré revolutionizes the excruciating treatment.
15:52Ambrose Paré is a very interesting figure. He's someone that, again, comes from the army background rather than the learned
15:58professions.
15:59He also challenges many of the techniques that were inherited from the ancient world, such as the use of boiling
16:04oil.
16:05Ambrose Paré realized that the pouring of oil onto wounds wasn't actually helping. And so he came up with a
16:12new mixture that he applied to the wounds that he saw was more effective.
16:16That type of observation and application of new ideas is not something that we see commonly during the Middle Ages.
16:27Paré's findings are documented in his 1545 publication, The Method of Treating Wounds, made by arquebuses and other guns.
16:37Paré's techniques prioritized the goal of minimizing pain during treatment, an innovative concept for the time.
16:46Despite major contributions like these to medicine and surgical procedures, barber surgeons soon face a challenge unlike the dangers of
16:55a lethal bacteria or the battlefield.
17:00In 1743, King Louis XV of France enacts a law banning barber surgeons from performing surgeries.
17:08Two years later, England follows suit.
17:12At this point, we start to see barber surgeons losing their foothold as a profession because the medical professionals in
17:20Europe are trying to reclaim surgery as a technical skill.
17:25Despite barber surgeons' importance in society for centuries, it renders them almost obsolete.
17:33In France, Louis XV establishes five chairs of surgery at the medical college, which elevates the status of surgery as
17:42an academic discipline.
17:44In 1800, the divide is further solidified when England establishes their own institution, the Royal College of Surgeons, marking the
17:53end of barber surgeons.
17:58After his discovery of the skeleton at Avebury, archaeologist Alexander Keeler sends the suspected barber's remains to the Royal College
18:07of Surgeons for preservation.
18:10The bones seemed lost forever when World War II bombings destroyed the building.
18:15But decades later, in the 1990s, a local archaeologist finds the remains had quietly survived the war,
18:23tucked away in a storage room at the Natural History Museum.
18:28Today, the very stone that marked the ancient grave is now forever known as the barber stone.
18:35Barber surgeons historically filled the gap left by physicians, done all this hands-on work, and actually laid the groundwork
18:41for some of these modern surgical techniques.
18:43It's really important to remember the history of the real barber surgeons and all of the work they did to
18:48lay the infrastructure for public health that would follow them.
18:52The outbreak of the Black Death in the 1300s will not be the last time Europe must battle the deadly
18:58disease.
18:59Over the next several hundred years, it will besiege the continent, forcing the medical community to adapt and innovate.
19:10While barber surgeons prove their mettle and ingenuity as trial-by-fire surgical practitioners, others will seek to heal the
19:17sick through more unusual means.
19:23In Elizabethan England, astrology isn't just stargazing, it's central to medicine.
19:30Physicians look to the planets for guidance in diagnosing and curing disease, blurring the line between science and superstition.
19:39Treatments could be as strange as touching a dead man's hand, or strapping freshly killed pigeons to the feet.
19:45Remedies sought for everything from love-sickness to influenza.
19:52Cambridge University researchers uncovered thousands of such cases in the notes of Simon Forman, a self-taught doctor and astrologer.
20:03Simon Forman gains notoriety during the plague outbreaks of the 1590s.
20:08Like many of his time, he believes that the celestial movements can influence human health through hidden forces.
20:15He believes that astrology is the only true way to understand a patient's disease.
20:22But Forman's use of astrology medical practice isn't novel, and dates back to the time of antiquity.
20:28A millennia and a half before Forman produces his seminal works, Claudius Ptolemy is a prominent Greco-Roman polymath, who
20:38is referred to as the most famous of Greek astrologers.
20:43When we look to the writings of Ptolemy, he creates this philosophy, and that puts the earth at the center
20:50of the universe.
20:51It makes sense that we put the earth at the center of things because we don't have a construct for
20:56what exists outside of the world, and we see the sun, we see the moon, but we don't have the
21:02technological advancements yet to understand how we're positioned in relation to these celestial bodies.
21:08Ptolemy is informed by Aristotle's four elements, and he starts to link these two celestial bodies that will then be
21:16mapped onto health elements.
21:20Planetary positions and aspects are used to identify health problems, determine propitious times for treatments, and understand an individual's predisposition
21:29to certain diseases based on their natal chart.
21:34While he believes the heavens shape our health, he also values careful observation.
21:41He urges doctors and astrologers to gather facts and offer practical advice when advising and prescribing treatments for patients.
21:50This approach goes on to influence practitioners like Galen.
21:55Galen is a second century Greek physician, surgeon, and philosopher in ancient Rome.
22:02Galen served as a physician to gladiators, and later became the personal doctor to numerous Roman emperors.
22:10While Galen uses astrology, his approach is still empirical.
22:14He believes that the moon and other celestial bodies dictate how to treat fever-based illnesses.
22:21One example of how astrology might influence a physician's decision would be a doctor who's overseeing a patient who, for
22:29example, is sick with a fever.
22:30By consulting astrological charts, the physician might know what could be the critical days for that patient's health.
22:38And therefore, they might either delay or speed up treatment of certain medicines depending on the critical days.
22:47The concept of critical days becomes integral to medical practice during the Middle Ages, as Galen's writings are widely studied
22:55and revered by medieval scholars who use astrology as a principal diagnostic tool.
23:03One of the astrological tools that is heavily referenced by medical practitioners is the Zodiac Man.
23:11One way to think about the Zodiac Man is almost like a cheat sheet for a medieval or early modern
23:17physician.
23:18So if they're trying to decide what treatment to prescribe under given astrological conditions, they basically can consult the Zodiac
23:25Man and go,
23:26Aha! This is what we need to do.
23:29As the Middle Ages progress, medicine leans ever more on astrology, seeking meaning in an age of fear.
23:36In the late 1500s, a series of omens are unleashed, seemingly to herald a divine displeasure.
23:44It begins with a supernova eruption in 1572, which leaves a colossal mysterious light in the sky.
23:53And in 1588, the seas churn with the might of the Spanish Armada, a seemingly unstoppable threat to the country.
24:02But none match the return of the Black Plague in 1592, an event that propels astronomer physicians like Simon Foreman
24:10to fame.
24:11In the late 1500s, the Black Plague ravages London.
24:16Simon Foreman finds that he himself is infected with the disease.
24:20To heal himself, he mixes an elixir that he calls strong water.
24:25This is a distilled concoction that he makes after consulting the stars.
24:30After surviving his brush with death, he proceeds to treat others with this method.
24:34So this success seems to catapult Simon Foreman to new fame and people are seeking him out from all over
24:41England, all walks of life.
24:43And he's very good at using astrological discourse to bamboozle them.
24:48But certainly they're all impressed with his grasp of astrological phenomenon, how it affects humans on Earth.
24:55Simon Foreman is catapulted from relative obscurity to prominence by Londoners seeking medical aid, seeing over 2000 patients a year.
25:06His knowledge of astrology gives him a sense of mystical authority.
25:11Patients are drawn to him, not just for physical healing, but for cosmic insights into their problems.
25:20Simon Foreman keeps extensive notes on his patients.
25:24And when University of Cambridge researchers take on the Herculean task of transcribing thousands and thousands of pages of his
25:32handwritten notes that paint a picture of Elizabethan society.
25:38Elizabethan England was a time in which there were gradual preoccupation about sort of forces affecting either the state or
25:47indeed people.
25:49Simon Foreman is not just a doctor.
25:53His patients are coming to him with all sorts of needs.
25:56Everything ranging from a rash to needing marriage advice to decisions regarding finances or love.
26:03But with great success comes great enemies.
26:08Simon Foreman first runs afoul of the Royal College of Physicians when he is 27 and spends a year in
26:15prison.
26:18It's the first of many malpractice battles.
26:21Because of his lack of formal training, the college reputedly accuses Foreman of quackery and practicing medicine without a license,
26:29resulting in multiple fines and imprisonments.
26:38Despite these setbacks, Foreman continues to treat patients, defying the college's attempts to shut them down.
26:45He even expands his practice, taking on a new protege who expands on Foreman's methodology.
26:51And things get, well, weirder.
26:56We also have sources which tell us about a man named Richard Napier, who essentially was the apprentice of Simon
27:04Foreman.
27:04And from him, we get all sorts of treatments, some of which are far beyond anything we see Foreman prescribe.
27:15University of Cambridge researchers also transcribe Richard Napier's case books.
27:21Napier, an ordained clergyman, will end up in a lifelong partnership with Foreman.
27:26Neither of these men intend to keep their notes for posterity, yet they manage to survive.
27:33Six years of Foreman's notes are preserved, and the full run of Napier's from 1597 to his death in 1634.
27:45Around 65,000 individuals are covered in some 80,000 cases, amounting to one of the largest collections of private
27:54medical records in history.
27:57Napier's records provide the bulk of the collection and some of the more peculiar, if not outright bizarre, treatments.
28:06The strangest and most perplexing of remedies is the idea of using pigeon slippers.
28:12This involves slicing the body of a pigeon and applying it to the sole of the foot.
28:18What type of affliction could this treatment actually help?
28:22Where did this treatment originate?
28:25The use of birds in traditional medicine practices across different societies is fairly common.
28:32That being said, the use of pigeon slippers is a very unique approach to healthcare.
28:37There are certainly cases in which people are prescribing things like eating the liver of the dog that bit you,
28:43supplying ground up birds for cases of trauma, sheep bladders.
28:47The use of animal parts was certainly known for some of the more extreme treatments.
28:51But again, I think we have to understand this.
28:53This is a sort of a somewhat of a desperate search for a cure when other things have failed.
29:00Many of Napier's notes include blessings and prayers.
29:03But whether they are intended for any specific effect is unknown.
29:07A small number of entries reference charms and exorcisms, an area foreman did not wade in too deeply.
29:17As the 18th century dawns, a seismic shift occurs in the halls of medical academia.
29:26The emergence of new scientific paradigms, bolstered by mounting political and social pressures,
29:33spelled the end of astrology's long-standing place in formal university curriculum.
29:40The once revered discipline finds itself gradually but inexorably excluded from the realm of learned medical practice,
29:50marking a pivotal moment in the history of science and medicine.
29:57While some medieval physicians trained their eyes on the infinite expanse above,
30:02determining health by the movements of the stars centuries earlier,
30:06practitioners in India turned their attentions inward.
30:10They believed that true medical wisdom lay not in the skies above,
30:14but in the elemental forces existing both within and around us.
30:212,000 years ago, in the ancient city of Kashi, now Baranasi,
30:27Sashruta authored the Sashruta Samhita, a landmark medical text rivaling the works of Hippocrates.
30:36In 2007, Hamburg University researchers announced the discovery of a palm-leaf manuscript,
30:43possibly from 878 A.D.
30:46Though incomplete, its 152 folios preserve two-thirds of this foundational treatise,
30:53the Sashruta Samhita.
30:57The compendium, or Sashruta Samhita, is known for its detailed descriptions of these groundbreaking surgical procedures,
31:04especially rhinoplasty, and it really lays the foundations of what we would call plastic surgery today.
31:09Sashruta is referred to as the father of surgery, and he's really a groundbreaking figure in Indian medical care.
31:17Sashruta is born in the historical city of Kashi, around 600 BC, on the banks of the Ganges River,
31:24at a time when Indian medicine is passed down through the Guru Shishya Parampara, which translates into the teacher discipline
31:32tradition.
31:33Students reside with their gurus, teachers, and guru cools, learning both theoretical and practical aspects of medicine under close supervision.
31:47Having surgical information passed down orally can really be a strength because it means that in a time of unrest
31:53or war,
31:53the information is kept and continued to be taught.
31:56But this can also be a limitation because there's a lack of systemic recording, which means a lack of standardization.
32:02Medical education at the time is deeply rooted in the ancient tradition of Ayurveda.
32:10Ayurvedic medicine is an ancient holistic healing system originating in India.
32:15The term Ayurveda translates to the science of life or knowledge of life in Sanskrit.
32:23The approach is based on the belief that wellness stems from a balance between the mind, body, and spirit.
32:31Everyone has life forces called doshas, and everything in the universe is interconnected.
32:36So if there is an imbalance in one area, then illness and disease can occur.
32:42Central to the Ayurvedic practice is the concept of the three doshas, vata, pitta, and kappa.
32:52Vata is composed of air and ether and is characterized by qualities such as coldness, dryness, and lightness.
33:02Pitta, on the other hand, is primarily made up of fire and water elements, embodying qualities like heat, intensity, and
33:09fluidity.
33:13Kappa combines earth and water elements and is associated with stability, heaviness, and moisture.
33:22People experiencing an abundance of one dosha over the others experience imbalance.
33:30Through this holistic approach, it's likely that Sashruta is exposed to not only surgical procedures,
33:36but all aspects of medicine, such as pharmacology and natural remedies, which imbue his burgeoning practice.
33:45Pharmacology in ancient India, particularly within the Ayurvedic system, is quite sophisticated.
33:51The approach employs natural remedies from plants, minerals, and animal products.
33:57It classifies herbs based on their properties, as well as their actions and effects on the body.
34:02They consider factors such as taste, energy, and post-digestive effects.
34:10This classification allows practitioners to tailor treatments to individual patients by balancing those three doshas.
34:19The preparation techniques are pretty diverse.
34:21We see cold infusions, hot beverages, pressed juices, and a lot of really specific dietary practices.
34:27There's definitely an integration of spiritual practices into the herbal remedies as well.
34:31It's not only about eating the right things at the right time, there's also incantations and prayers that bring out
34:37the power of these foods.
34:38This approach treated the person as a whole. Body, mind, and spirit.
34:46Sushruta begins practicing as a physician and surgeon, as well as teaching at the Danvantari School of Medicine, an institution
34:55associated with Ayurvedic medicine.
34:58It's during this time he begins his writing of the Sushruta Samhita.
35:03He creates a systematic and holistic approach, which is important because it includes herbal anesthetics and post-operative care.
35:11Prior to Sushruta, ancient surgical practitioners were relying upon some herbal remedies and some really basic surgical tools.
35:18Surgical procedures at the time were really limited to just superficial wounds, things that could be stitched up and cauterized
35:24fairly simply.
35:25Ancient anesthetic methods were very different from what we use today.
35:30In India, substances like cannabis, incense, and wine were used to sedate patients.
35:37Drinking alcohol was one way to try to diminish pain before something painful like a surgery or an operation was
35:44going to happen.
35:44Drinking enough, you pass out. And if you pass out, then maybe if it's not too painful, you won't wake
35:49up.
35:50But you have to worry about what they'll do if they wake up and how much they'll move while you're
35:54trying to perform your surgery on them.
35:56If there aren't any other anesthetics that are known, then you're going to use what you have on hand.
36:00So whether it's cannabis, whether it's alcohol, these are the only choices you have because the third choice is just
36:06to bear it.
36:08Sushruta recognizes that the intimate understanding of the body's internal structure is crucial for successful surgical intervention.
36:20He stresses that surgeons must be uniquely familiar with the layout of muscles, veins, arteries, and organs, not just through
36:28theoretical study, but direct hands-on experience.
36:34And in order to do that, a thorough study of the human body is needed in the form of dissection.
36:44In ancient India, dissection of human cadavers is steeped in cultural and religious taboos, primarily rooted in beliefs.
36:53The human body is sacred, even in death.
36:57The shastras, which outline Hindu law, say that no body could be dissected or cut and that anybody over the
37:04age of two who dies needs to be cremated fully intact.
37:08Despite these religious and cultural constraints, Sushruta is really steadfast in his view that a surgeon must know anatomy and
37:15an anatomist must look at a body.
37:17So to kind of get around some of these limitations, he actually creates a way to dissect without actually cutting.
37:24He's able to get a cadaver, put it under water that is flowing freely, and eventually, through decomposition, the skin
37:32is sloughed away.
37:33He's able to actually see the layers below the surface.
37:37Sushruta is exacting in both the method and specifications of the body to be studied.
37:44Model cadavers must be under 100 years of age, free from a protracted disease, and not poisoned.
37:52After seven nights of decomposition, the body is meticulously cleaned and dissected.
37:59Sushruta can now see these anatomical structures.
38:02He's therefore able to teach them to his students and also to start to design surgical instruments.
38:07They come up with really inventive ways to practice surgical techniques when they're not able to practice on human cadavers.
38:13We see the use of practicing incisions on things like cucumbers and squashes.
38:18We see the flushing of fluids out of animal bladders, as well as practicing venesection on the stalks of water
38:25lilies.
38:26The breadth of this practice and teachings informs Sushruta to invent over 100 surgical instruments.
38:36These surgical instruments are crafted with an eye for sharpness and sterilization, which are actually really important tenets of surgical
38:43procedures today.
38:46But one of his most groundbreaking contributions to ancient surgery remains a key milestone in the history of plastic surgery,
38:54and one of today's most ubiquitous cosmetic procedures.
39:00In ancient India, the Hindu laws of Manu govern much of life.
39:07And the cutting off of noses is a common form of punishment, particularly for offenses such as adultery and other
39:14moral transgressions.
39:15This brutal practice, known as rhinotomy, is often performed publicly to shame and mark individuals.
39:28This is a brutal form of mutilation.
39:31So you can imagine this act of cutting off a woman's nose is severely painful, but it also marks her
39:38as a social outcast and strips her of dignity and respect within the community.
39:44You don't get an opportunity to explain.
39:47You cannot hide what's happened in the past.
39:49It also prevents you from changing.
39:51Is there value in everybody being given a second chance?
39:54Is there an opportunity for growth or change?
39:58But Sushruta sees an opportunity and radically changes the medical landscape with his technique for rhinoplasty,
40:05and subsequently birthing the practice of plastic surgery.
40:11Sushruta's technique for rhinoplasty is totally transformative, and it still recognizes one of his specialties.
40:19His revolutionary technique involved taking a flap of skin from the forehead or the cheek,
40:23but leaving it attached so the skin stayed alive and had enough blood flow.
40:27He reconstructed that into the new nasal structure and then sewed it all down and allowed it to take that
40:31new shape.
40:33And Sushruta will also carve a window to the world for those trapped in darkness.
40:40Prior to the development of surgical treatments for cataracts,
40:44people sought other remedies to try and break through the foggy cloud.
40:50One such remedy is to place a fully developed dead cobra in a jar of milk,
40:55along with four scorpions, and left to decay for 21 days.
41:03After this period, the milk is churned into butter,
41:06combined with chicken feces and applied to the eye in the hope of curing cataracts.
41:11Sushruta opts for a less putrid approach.
41:19Sushruta works with a technique called couching.
41:21He actually develops an instrument for this purpose.
41:23It's called a shalaka.
41:25And the shalaka is this fine rod that he uses to poke that cloudy lens to the back of the
41:29eye.
41:30His solution of pushing the lens to the back of the eye doesn't fully solve the problem.
41:36So you're not getting normal vision back, but it's better than looking through something that's opaque
41:42and you actually see nothing through that eye in the first place.
41:44It's better to see a fuzzy world than it is to see a dark one.
41:51The Sushruta Samhita is a comprehensive treatise that encompasses a wide range of medical knowledge
41:57and is arguably the oldest surgical textbook.
42:02Sushruta's name has been relatively less known,
42:05but more of a focus recently on Ayurvedic tradition and on holistic medicine in general
42:09has really brought him back into the spotlight.
42:13If you're only looking at Western medicine,
42:15you are missing out on so much of the story of human medical developments.
42:21By including the contributions of people like Sushruta,
42:24we gain the full view of the amount of knowledge and expertise that was distributed around the world.
42:34Standing at the crossroads of traditional and modern medicine,
42:38there's a resurgence of interest in ancient Indian practices.
42:43Ayurvedic principles of mind-body balance find new life in integrative medicine
42:47and in the operating theaters and research laboratories of today.
42:54From ancient Indian surgeries to the refined techniques of medieval barbers
42:59and the skyward explorations of medical astrologists,
43:04the study of well-being is as old as humanity itself.
43:08A quest that continues to light our way to the future of healing.
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