Home Medicine - Dasavala ( Hibiscus rosa-sinensis )

Dasavala ( Hibiscus rosa-sinensis )
    

    Shoe-flower, Chinese Rose (ENG)
    Jasund (HIN)
    Dasavala (KAN)
    Chemparuthi (MAL)
    Jaasvand (MAR)
    Japa, Japapuspa (SAN)
    Semparuthi (TAM)


It is a beautiful shrub that grows up to 3 m tall. Leaves are broadly egg-shaped and are toothed along margins. The plant bears long-stalked, large, showy, red or white flowers. The plant bears flowers almost through the year and is widely cultivated in gardens and households as an ornamental plant.
How to Grow: t is recommended to grow two plants - one each with red and white flowers - in home herbal garden. These can be planted either directly in the ground or in pots of size of 25 to 30 cms.

Care regime: When planted in ground, watering twice a week is adequate. However, plants in the pots require more frequent watering.


Parts Used: Flower petals

Collection :Fresh flowers can be collected in the morning by plucking.

Home Medicine - Basale ( Basella alba )

Basale ( Basella alba )
    

    Indian spinach (ENG)
    Poi, Lalbaclu (HIN)
    Basale (KAN)
    Basalaccira (MAL)
    Mayalu (MAR)
    Whamichi bhaji (MAR)
    Upodika, Potaki (SAN)
    Venpacalikkoti (TAM)


It is a delicate climber with shining purplish-red branches. Stem and leaves are fleshy. The plant bears small white or red flowers. The fruits are of the size of pea and turn white or black on ripening. Fleshy leaves are also used as vegetable.
 How to Grow: One or two plants of this important pot-herb are adequate per household from primary health care point of view. Being weak-stemmed, it needs to be provided support for climbing. It can be planted in the ground or in pots of the size 20-25 cm. It can also be planted in hanging baskets and its purplish dropping branches add a pleasant hue to the surroundings.

Care regime: This plant needs only little care for its maintenance. Watering two-three times a week is adequate for its optimum growth. Excessive watering may result in decay of this plant. The plant can sustain partial shade for a few days and needs to be periodically provided direct sunlight for its good growth.


Parts Used: Aerial parts

Collection :Use a sharp knife to cut the required quantity of aerial parts from a well established plant. New shoots keep on sprouting all through the year.

Home Medicine - Lolesara ( Aloe vera )

Lolesara ( Aloe vera )

• Indian Aloe (ENG)
• Lolesara (KAN)
• Kattarvazha (MAL)
• Korfad (MAR)
• Kumari (SAN)
• Soththu kathalai (TAM)

It is a cactus like plant having thick and fleshy leaves with spiny margins. Leaves contain a gel, which is bitter in taste. These are closely arranged near the plant base in whorls. Bright orange coloured tubular flowers appear in spikes during late winter on old plants.
 
How to Grow: 'Lolesara' has got beautiful shining green foliage and forms an attractive pot plant. For the purpose of use in primary health care, one plant in a pot size of 25 to 30 cms is sufficient per household. It can also be planted on the ground, where it grows up to a metre tall. It needs well-drained soil for optimum growth, therefore, pot mixture of soil: sand: manure (1:2:1) may be used for growing this plant

Care regime: It needs only occasional watering and can even thrive under moisture stress conditions. Excessive watering may result in decay of the plant. The plant likes direct sunlight.

Parts Used: Leaf-pulp

Collection :The plant becomes ready for yielding leaves from about three months after planting. Leaf collection can be started with the lower leaves that can be cut by a sharp knife from near the base.

Raja Yoga

Yoga is an Indian traditional system of personal healthcare practices.

The term Yoga has been derived from sanskrit and the word "Yuj", which literally means union. By Union is meant; focusing all the faculties together towards any activity. The practice of Yoga involves, the union between the body, the breath and the mind.

Patanjali in one of his sutras defines Yoga as 'Yogaha citta vritti nirodhaha', meaning ' Yoga is the ability to direct all the faculties of the mind towards one object and sustain that focus without distraction'.

In Yoga, all postures are derived from nature. For example the Mayurasana, a body posture that resembles and is derived from the peacock. It strengthens the hands, lower back, thighs, abdominal muscles and tones the digestive system. The Bhageerathasana is derived from a tree. It strengthens the legs and develops a sense of equilibrium and awareness of oneself in the standing posture. The Bhujangasana is derived from a cobra. It strengthens the lower back and opens the air sacs in the lungs.

What is Raja Yoga?

In the practice of "Raja Yoga", we identify "Yoga" with the breathing practices, body postures and meditative practices. Raja Yoga is also called as Astanga Yoga. It is often referred to as the 'King of Yoga' practices.

It involved 8 states - internal (Yama) and external (Niyama) disciplines, Body posturing (Asana) and breath regulation (Pranayama), the practice of attached detachment (Pratyahara), concentration (Dharana), de-concentration (Dhyana) and the blissful state (samadhi).

Kidney stone facts, Symptoms and treatment ?!

Different types of kidney stones occur in different parts of the world, and dietary factors probably play a part in determining the varying patterns. There are four major types of kidney stones. The most common type of stone contains calcium. A struvite stone may form after an infection in the urinary system. These stones contain the mineral magnesium and the waste product ammonia. A uric acid stone may form when there is too much acid in the urine. If you tend to form uric acid stones, you may need to cut back on the amount of meat you eat. Cystine stones are rare. Cystine is one of the building blocks that make up muscles, nerves, and other parts of the body. Cystine can build up in the urine to form a stone. The disease that causes cystine stones runs in families.
Kidney Stones Symptoms
Initially, a person who is suffering from kidney stones will not experience any serious symptoms of the disease. Kidney stone symptoms get serious as time passes and can turn disastrous if ignored for a longest duration. These stones are hard multitude of substances, which may include the foreign substances, as well as those from the body itself as dead tissues.
Until the size of these stones is small, they do not create any problems. However, if they grow in size and start block the passageway of the substances through the kidneys. Consequently kidney stones give rise to some problems, which may be either simple or they can be very severe too.
However, in the initial stages the kidney stones do not show any symptoms. On the other hand, the symptoms may be very modest or only one of them may occur. If just one of the kidney stones symptoms appears, the people do not take it too seriously. Some other reasons are accounted for it. However, when some of the other symptoms too, start appearance then the people get mindful of that something is wrong with them.
Due to the happening of the kidney stones, the patients feel pain in the abdomen. This is the most common kidney stones symptom. Generally, this pain begins from a mild one and it goes on increasing as the stone may grow in size.
The second symptom that the patient of kidney stone faces is the pain during urination or the menstruation. This happens if the stone blocks the flow of the urine form the kidney to the urinary tract. This hurting can be very serious depending on the blockage that the stone proves to be for the urine. Similar thing happens during the menstruation. If it becomes very painful then there is a need of medication.
In addition to the hurting during the urination, other problems with the urine also occur. One of them is the gain in the frequence of the urine and in addition to that, it becomes difficult to hold the urine. Most of the times, this occurs along with the hurting during the urination. Because of this, the problems of the patients increase.
Some people also experience coming out of blood with the urine. This happens due to the injury that the stone may cause to the nearby tissues. Sometimes due to the same reasons, some other secretions are also observed in the urine. This changes the color of the urine. Therefore, the change in the color of the urine is also a kidney stones symptom.
In addition to the problems with the urination, the other parts in the pelvic region i.e. the genital parts also experience pain.
The kidney stone also causes infections and inflammations in the surrounding region and thence these may lead to the other problems too. In such cases, the patient feels dull and unenergetic. He may develop nausea. This Sickness and vomiting without any, other reason is also a symptom of the kidney stones.
In addition to this, they patients sometimes experience fever and chills. During this fever the hurting in the bones and other parts of the body also occur. The bones of the back and abdominal parts are affected. Especially the back hurting is a severe happening during the kidney stones. This hurt may be modest in the beginning but in most of the cases, it becomes very high in the later stages.
Kidney stone facts

1.     A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract.
2.     Nephrolithiasis is the medical term for kidney stones.
3.     Symptoms of a kidney stone include flank pain (which can be quite severe) and blood in the urine .
4.     Kidney stones form when there is a decrease in urine volume and/or an excess of stone-forming substances in the urine.
5.     Dehydration is a major risk factor for kidney stone formation.
6.     People with certain medical conditions, such as gout, and those who take certain medications or supplements are at risk for kidney stones.
7.     Dietary and hereditary factors are also related to stone formation.
8.     Diagnosis of kidney stones is best accomplished using a CT scan.
9.     Most kidney stones will pass through the ureter to the bladder on their own with time.
10.     Treatment includes pain control medications and, in some cases, medications to facilitate the passage of urine.

If needed, lithotripsy or surgical techniques may be used for stones which do not pass through the ureter to the bladder on their own.
What is a kidney stone?
Kidney stones are made of salts and minerals in the urine that stick together, creating small “pebbles” formed within the kidney or urinary tract. They can be as small as grains of sand or as large as golf balls. Kidney stones are a common cause of blood in the urine and often severe pain in the abdomen, flank, or groin. One in every 20 people develops a kidney stone at some point in their life.
A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract. Kidney stones are a common cause of blood in the urine (hematuria) and often severe pain in the abdomen, flank, or groin. Kidney stones are sometimes called renal calculi.
The condition of having kidney stones is termed nephrolithiasis. Having stones at any location in the urinary tract is referred to as urolithiasis, and the term ureterolithiasis is used to refer to stones located in the ureters.
1. Calcium stones : These stones can be formed by excess salt in your diet that can arouse excretion of calcium in the urine and reduce in intake of salt can prevent formation of such stones. Many people came to know about their kidney stones until stones enters the ureter and cause severe pain. Nausea, vomiting and back and abdominal pain are the symptoms of kidney stones.
2. Uric acid stones : These stones can be formed from uric acid. Uric acid is a waste product of body and is excreted out of body through urine. In the beginning they come together in the urine and may get larger over time. High protein diet may also cause uric acid stones.
3. Struvite stones : These stones can be formed due to kidney or urinary tract infections. They are also called stag-horn stones because they are large and look like antlers on a deer.
4. Cysteine stones : These stones are likely to develop in people who have family history with and inherited condition that can lead to an excess of the cysteine chemical in the urine. These stones make up less than one percent of kidney stones.
Learn about additional risk factors you can control.
Weight gain can result in both insulin resistance and increased calcium in the urine, which can result in a greater risk for kidney stones. In one study, weight gain since early adulthood, a high body mass index (BMI), and a large waist size increased a person’s risk for kidney stones. People who are not very active may also have problems with kidney stones. Additionally, some medicines, such as acetazolamide (Diamox) or indinavir (Crixivan), can cause kidney stones to form.
What are risk factors you can control?
If you think that your diet may be a problem, schedule an appointment with a dietitian and review your food choices. Vitamins C and D can increase your risk of kidney stones when you take more than the daily recommendations. Levels of calcium in the diet may also affect your risk of kidney stones. Getting the recommended amounts of calcium combined with a low-sodium, low-protein diet may decrease your risk of kidney stones. Diets high in protein, sodium, and oxalate-rich foods, such as dark green vegetables, also increase your risk for developing kidney stones.
How can kidney stones be prevented?
The most common cause of kidney stones is not drinking enough water. Try to drink enough water to keep your urine clear (about eight to 10 glasses of water a day). Drinking grapefruit juice may increase your risk for developing kidney stones.
What is the treatment for stones that do not pass on their own?
For kidney stones that do not pass on their own, a procedure called lithotripsy is often used. In this procedure, shock waves are used to break up a large stone into smaller pieces that can then pass through the urinary system. Surgical techniques have also been developed to remove kidney stones. This may be done through a small incision in the skin (percutaneous nephrolithotomy) or through an instrument known as a ureteroscope that is passed through the urethra and bladder up into the ureter.
What is the treatment for kidney stones?
Most kidney stones eventually pass through the urinary tract on their own within 48 hours, with ample fluid intake. Pain medications can be prescribed for symptom relief. There are several factors which influence the ability to pass a stone. These include the size of the person, prior stone passage, prostate enlargement, pregnancy, and the size of the stone. A 4 mm stone has an 80% chance of passage, while a 5 mm stone has a 20% chance. Stones larger than 9-10 mm rarely pass on their own and usually require treatment.
How are kidney stones diagnosed?
The diagnosis of kidney stones is suspected by the typical pattern of symptoms when other possible causes of the abdominal or flank pain are excluded. Imaging tests are usually done to confirm the diagnosis. A helical CT scan without contrast material is the most common test to detect stones or obstruction within the urinary tract. In pregnant women or those who should avoid radiation exposure, an ultrasound examination may be done to help establish the diagnosis.
What are symptoms of kidney stones?
Kidney stones often cause no pain while they are in the kidneys, but they can cause sudden, severe pain as they travel from the kidneys to the bladder. Symptoms and signs include excruciating, cramping pain in the lower back and/or side, groin, or abdomen as well as blood in the urine. If infection is present in the urinary tract along with the stones, there may be fever and chills. A doctor should be called immediately.
Who is likely to develop a kidney stone?
For unknown reasons, the number of people in the United States with kidney stones has been increasing over the past 30 years. The prevalence of stone-forming disease rose from 3.8% in the late 1970s to 5.2% in the late 1980s and early 1990s. White Americans are more prone to develop kidney stones than African Americans, and they occur more frequently in men. The prevalence of kidney stones rises dramatically as men enter their 40s, and it continues to rise into their 70s. For women, the prevalence of kidney stones peaks in their 50s. Once a person gets more than one stone, others are more likely to develop.
What causes kidney stones?
Kidney stones form when a change occurs in the normal balance of water, salts, minerals, and other substances found in urine. Other chemical compounds that can form stones in the urinary tract include uric acid and the amino acid cystine. Dehydration through reduced fluid intake and strenuous exercise without adequate fluid replacement increase the risk of kidney stones. Some people are more likely to get kidney stones because of a medical condition or family history, as the tendency to form kidney stones may also be inherited. If other people in your family have had them, you may have them too.
Prevention of any more Kidney Stones
Kidney Stones can be prevented by drinking more water. Try to drink 12 full glasses of water a day. Drinking lots of water helps to flush away the substances that form stones in the kidneys. If you have a uric acid stone, eat less meat, because meat breaks down to make uric acid.
Can kidney stones damage the kidney?
Kidney stones can cause kidney damage. Whether there is damage and, if so, how much there is depends on the location of the stone in the urinary system. To avoid or minimize damage, it is important to eliminate stones that form and to prevent new ones from developing. therefore, your family doctor may refer you to a urologist, a doctor who specializes in urinary diseases.
What are the treatment choices?
Although kidney stones, espacially calcium stones, are very hard, most of the 20% to 30% that do not pass out of the body on their own can be eliminated without surgery. A process called lithotripsy(from the Greek word for ” stone cushing”) breaks into tiny fragments most stones that are less than three-quarters of an inch across.
Lithotripsy has been used in the U.S. since 1984. A urologist performs the treatment using a machine called a lithotripter. It is the most common method of treating stones in the US. There are different types of lithotripters, but all focus shock waves from outside the body on the kidney stone. Repeated shock waves cause the kidney stone to disintegrate into tiny particles. These particles pass easily out of the body in the urine
What are the advantages of Lithotripsy?
Lithotripsy offers many advantages over stone removal through surgery. Some of those advantages include:
1. Reduction in complications
2. Reduction in pain
3. Reduced recuperation time
4. Performed on outpatient basis 95% of the time
5. Able to resume normal activities much sooner
6. Reduced cost
7. No incision
Uteroscopic Stone Removal uses a small tool to remove stones stuck in the ureters.
Percutaneous Nephrolithotomy uses surgery to remove large stones from the kidneys.
Please discuss these options with your urologist to determine which is best for you.

Children born to overweight mothers ‘more likely to be fat’… but breastfeeding can offset the effect

Smoking during pregnancy also increases chances of child being obese.  Being heavy at birth and rapid weight gain are factors, say researchers.  A third of ten and 11-year-olds in the UK are overweight

Children born to overweight mothers face a higher risk of being fat themselves – but breastfeeding can help offset the effect, a study has shown.

Being overweight and smoking during pregnancy both increase the chances of a child being obese, along with being heavy at birth and rapid weight gain as a baby. But breastfeeding and the late introduction of solid foods can reduce a baby’s risk of becoming overweight by about 15 per cent, claim the researchers.

Big inheritance: Children born to overweight mothers face a higher risk of being fat themselves, according to a study which could help parents make healthier choices for their babies They say it should help new mothers make healthier choices for their babies. Stephen Weng, who undertook the study, led by Dr Sarah  Redsell, of Nottingham University’s School of Nursing, Midwifery and Physiotherapy, said complex influences affected child development, ranging from genetics  to parents’ lifestyle.

He added: ‘We can speculate about how breastfeeding  mitigates the risk of obesity in childhood – it could be mixed feeding, reduced calories from breastmilk, parental attitudes, or a combination of things. ‘The research shows that breastfeeding your baby compared with never breastfeeding does have a modest benefit.’ Link: Six out of seven studies looking at infant birth weight showed a correlation between babies who were heavy at birth and obesity in later childhood In the UK a quarter of children aged four to five and a third of ten and 11-year-olds are overweight. Evidence suggests that children who are overweight by five are more likely to become obese – so overweight it threatens their health – in adulthood. The findings come from a systematic review and analysis of data from 30 previous studies involving 200,000 people. The studies investigated factors affecting babies during their first 12 months and their potential link with childhood obesity.

The study, published in the journal Archives of Disease in Childhood, discovered that children who were breastfed and introduced to solid food later  had a slightly reduced chance of becoming overweight.

Children whose mothers were overweight before pregnancy were 1.37  times more likely to be overweight at the age of three; 4.25 times more likely to be overweight at seven; and 2.36 times more likely to be overweight between nine and 14 years.

Six out of seven studies looking at infant birth weight showed a significant link between babies who were heavy at birth and obesity in later childhood. Similarly, rapid weight gain in a baby’s first year often led to obesity, with one study showing those who gained the most weight were almost four times more likely to be overweight at four. Children who were breastfed – however briefly – were 15 per cent less likely to become overweight.

Statistics: In the UK a quarter of children aged four to five and a third of ten and 11-year-olds are overweight Giving solid foods early may be linked to later obesity, with one study showing formula-fed babies given solids before four months were six times more likely to be overweight aged three than those getting them for the first time between four and five months. Smoking during pregnancy alone increased the risk of children being overweight by 47.5 per cent. However, this may be because smoking is a good indicator of other social and lifestyle characteristics, said Dr Weng. He said the findings could be used to compile a ‘checklist’ for GPs and health visitors to help them spot infants most at risk of becoming obese later in life. Healthier? Breastfeeding and the late introduction of solid foods can reduce a baby’s risk of becoming overweight by about 15 per cent, researchers claim

Stomach ulcer

Helicobacter pylori:  The Helicobacter pylori bacterium (H. pylori) is the main cause of peptic ulcers. The discovery of this micro-organism in 1983 revolutionised many aspects of gastroenterology, including the treatment of stomach ulcers.

It is thought that about one in three people over the age of 40 years is infected with this strain of bacteria in Australia. The germs live in the lining of the stomach and the chemicals they produce cause irritation and inflammation. H. pylori directly causes one third of stomach ulcers and is a contributing factor in around three fifths of cases. Other disorders caused by this infection include inflammation of the stomach (gastritis) and dyspepsia (indigestion).

Researchers believe the germ could also play a contributing role in the development of stomach cancers. The infection is more common among poor or institutionalised people. The mode of transmission is so far unknown, but is thought to include sharing food or utensils, coming into contact with infected vomit, and sharing of water (such as well water) in undeveloped populations.

Ulcer bleeding: This is a serious complication of ulcer disease and is particularly deadly in the elderly or those with multiple medical problems. Bleeding from stomach ulcers is more common in people treated with blood thinning agents, such as warfarin, aspirin or clopidogrel (Plavix) and those people should also consider using regular anti-ulcer medication to prevent this complication.

Symptoms of a peptic ulcer can be  :
A history of heartburn, gastroesophageal reflux disease (GERD) and use of certain forms of medication can raise the suspicion for peptic ulcer. Medicines associated with peptic ulcer include NSAID (non-steroid anti-inflammatory drugs) that inhibit cyclooxygenase, and most glucocorticoids (e.g. dexamethasone and prednisolone).

In patients over 45 with more than two weeks of the above symptoms, the odds for peptic ulceration are high enough to warrant rapid investigation by esophagogastroduodenoscopy.

The timing of the symptoms in relation to the meal may differentiate between gastric and duodenal ulcers: A gastric ulcer would give epigastric pain during the meal, as gastric acid production is increased as food enters the stomach. Symptoms of duodenal ulcers would initially be relieved by a meal, as the pyloric sphincter closes to concentrate the stomach contents, therefore acid is not reaching the duodenum. Duodenal ulcer pain would manifest mostly 2–3 hours after the meal, when the stomach begins to release digested food and acid into the duodenum.

Also, the symptoms of peptic ulcers may vary with the location of the ulcer and the patient’s age. Furthermore, typical ulcers tend to heal and recur and as a result the pain may occur for few days and weeks and then wane or disappear.Usually, children and the elderly do not develop any symptoms unless complications have arisen.

Burning or gnawing feeling in the stomach area lasting between 30 minutes and 3 hours commonly accompanies ulcers. This pain can be misinterpreted as hunger, indigestion or heartburn. Pain is usually caused by the ulcer but it may be aggravated by the stomach acid when it comes into contact with the ulcerated area. The pain caused by peptic ulcers can be felt anywhere from the navel up to the sternum, it may last from few minutes to several hours and it may be worse when the stomach is empty. Also, sometimes the pain may flare at night and it can commonly be temporarily relieved by eating foods that buffer stomach acid or by taking anti-acid medication. However, peptic ulcer disease symptoms may be different for every sufferer.

A gastric ulcer develops once the formation of small erosions along the stomach lining form. Erosion is caused by the acidity of the stomach fluids, which contain hydrochloric acid and the enzyme pepsin (hence the name peptic ulcer). Usually, a thick mucosal layer protects the lining of the gastrointestinal (GI) tract. This layer is continually rebuilt as the acid continually destroys it. Overproduction of acid tips the equilibrium in favor of those forces favoring breakdown, and as the mucosa begins to degrade, erosion occurs and an ulcer begins to form. Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause or worsen this condition.

The mechanisms of erosion are still not fully understood, but somehow, Helicobacter pylori are able to survive stomach’s acidic environment and reproduce in its mucosa. This infection causes tissue damage and leads to ulcer formation.

If you think you might have an ulcer, it’s important to seek medical advice for diagnosis and treatment. If left untreated, an ulcer can further erode the mucosa until bleeding, obstruction, or perforation occurs. Follow-up is always recommended, as recurrence is likely if H. pylori is not completely eradicated. In some untreated cases, gastric ulcers have been shown to progress to malignancy, leading to a greater chance of developing stomach cancer.

A wide range of therapies exist to effectively treat symptoms and heal ulcers, so only in rare cases is surgery needed. So it’s important to realize that treatment failure does not necessarily mean that your case is untreatable. The main reason treatments fail is noncompliance (i.e., not sticking to the medical treatment your doctor has suggested). Risk factors like alcohol, caffeine, aspirin and other NSAIDs, (such as ibuprofen) and especially cigarettes have been shown to aggravate existing ulcers, so it’s important to follow your doctor’s advice regarding diet and lifestyle modifications.

Story: 1stnews9

Sushruta: The Grandfather of Surgery and father of plastic surgery

The roots of ancient Indian surgery go back to more than 4000 years ago. Sushruta, one of the earliest surgeons of recorded history (600 B.C.) is believed to be the first individual to describe Rhinoplasty. The detailed description of the Rhinoplasty operation by Sushruta is amazingly meticulous, comprehensive and relevant today.

The historical evidences suggest that plastic surgery originated in India more than two millennia ago and the oldest plastic surgery operation probably relate to nasal reconstruction. Sushruta,  an ancient Indian surgeon in 600 BC. is believed to be the first individual to describe Rhinoplasty.

Sushruta (also known as the “Father of Indian surgery”  and “Father of Indian plastic surgery)” authored famous ancient encyclopaedic treatise Sushruta Samhita’  (Sushruta’s compendium) and vividly described the technique of Rhinoplasty. ‘Sushruta Samhita’ is onsidered to be the most advanced compilation of surgical practices prevalent in India around two thousand millennia ago.

In‘Sushruta Samhita’, Sushruta emphasized all the basic principles of plastic surgery and vividly described numerous operations in  various fields of surgery with significant contributions to Plastic Surgery.

The notable contributions in Plastic Surgery are technique of pedicle flap, repair of ear lobe defects ,repair of traumatic and congenital clefts of the lip, classification of burns ,description of sharp (20 types) and blunt (101 types)instruments, practice of mock operations, cadveric dissection ,use of wine to dull the pain of surgical incisions, code of ethics; however the Rhinoplasty remains the greatest highlight of Sushruta’s surgery.

The nose in Indian society has remained a symbol of dignity and respect throughout antiquity. In ancient times, amputation of nose was frequently done as a punishment for criminals, war prisoners or people indulged in adultery. The practice of Rhinoplasty slowly started as a result of the need to reconstruct the external nose and later developed to the full fledged science.

Sushruta is considered as the innovator of the Rhinoplasty technique practised since 600 B.C.The detailed description of the Rhinoplasty operation in the Sushruta Samhita is amazingly precise and comprehensive.

The English translation of Sushruta’s original Sanskrit  description of the method is as follows : -

“The portion of the nose to be covered should be first measured with a leaf. Then a piece of skin of the required size should be dissected from the living skin of the cheek, and turned back to cover the nose, keeping a small pedicle attached to the cheek. The part of the nose to which the skin is to be attached should be made raw by cutting the nasal stump with a knife. The physician then should place the skin on the nose and stitch the two parts swiftly, keeping the skin properly elevated by inserting two tubes of eranda (the castor-oil plant) in the position of the nostrils, so that the new nose gets proper shape. The skin thus properly adjusted, it should then be sprinkled with a powder of liquorice, red sandal-wood and barberry plant. Finally, it should be covered with cotton, and clean sesame oil should be constantly applied. When the skin has united and granulated, if the nose is too short or too long, the middle of the flap should be divided and an endeavor made to enlarge or shorten it.”

The Sanskrit text of ‘Sushruta Samhita’ was later translated in Arabic by Ibn Abi Usaybia (1203-1269 AD). As the historical pages started opening up, the knowledge of Rhinoplasty spread from India to Arabia and Persia and from there to Egypt. However, it took centuries for the principles and the technique of Rhinoplasty to travel to Europe and other parts of the world. In the 15th century, Gaspare Tagliacozzi from Italy documented similar technique of nasal reconstruction. He successfully reconstructed the nose by using the skin of the upper arm. The principle of Italian procedure was precisely the same as of the pedicle flap which was described two millennia ahead by Sushruta. Ackernecht aptly observed “There is little doubt that plastic surgery in Europe which flourished in medieval Italy is a direct descendant of classical Indian surgery”.

The classical cheek flap Rhinoplasty of Sushruta was later modified by using a rotation flap from the adjacent forehead, The Traditional Indian Method of Rhinoplasty. This technique was kept a secret for centuries in India, and practiced by Marathas of Kumar near Poona, certain Nepali families and Kanghairas of Kangra (Himachal Pradesh) .

The resurgence of Indian method began in the 1700s when British surgeons working for the East India Company saw the work done by Indian surgeons. During Mysore War of 1792 between Tipu Sultan and the British. Cowasjee, a cart-driver with the British and four other native sepoys were captured by the Sultan’s soldiers. Their noses and a hand each were cut off by the Mysore army. After a year without a nose, he and four of his colleagues submitted themselves to treatment by a man who had a reputation for nose repairs. The operations were witnessed by Thomas Cruso and James Findlay ,surgeons at the British Residency in Poona. They appear to have prepared a description of what they saw and diagrams of the procedure. The technique used for Rhinoplasty was a modification of the ancient Rhinoplasty described by Sushruta. Sushruta’s version has the skin flap being taken from the cheek; Cowasjee’s was taken from the forehead. A photo feature on the sensational surgery was published in the Madras Gazette. Subsequently, the details and an engraving from the painting were reproduce The operation was described as follows: 

“A thin plate of wax is fitted to the stump of the nose so as to make a nose of good appearance; it is then flattened and laid on the forehead. A line is drawn around the wax, which is then of no further use, and the operator then dissects off as much skin as it had  covered, living undivided a small slip between the eyes. This slip preserves the blood circulation till a union has taken place between the new and the old parts. The cicatrix of the stump of the nose is next paired off, and immediately behind the new part, an incision is made through the skin which passes around both alae, and goes along the upper lip. The skin, now brought down from the forehead and being twisted half around, is inserted into this incision, so that a nose is formed with a double hold above and with its alae and septum below fixed in the incision. A little Terra Japonica (pale-catechu) is softened with water and being  spread on slips of cloth, five or six of these are placed over each other to secure the joining. No other  dressing but this cement is used for four days. It is then removed, and cloths dipped in ghee are applied. The connecting slip of skin is divided about the twentieth day, when a little more dissection is necessary to improve the appearance of the new nose. For five or six days after the operation, the patient is made to lie on his back, and on the tenth day, bits of soft cloth are put into the nostrils to keep them sufficiently open. This operation is always successful. The artificial nose is secured and looks nearly as well as the natural nose, nor is the scar on the forehead very observable after a length of time.”

This story encouraged Carpue, an English surgeon, to study the details and soon he recognized the immense potential of the operation. Carpue successfully performed the first Rhinoplasty operation (37  minutes) on October 23, 1814 followed by a second successful operation7. Subsequently, through the publication of these successful operations by Carpue in 1816, the use of Indian technique gained popularity amongst British and European surgeons. By 1897, at least 152 rhinoplasties had been performed in Europe.

One of the earliest European descriptions of Indian rhinoplasty is as follows :

The surgeons belonging to the country cut the skin of the forehead above the eyebrows, and made it fall down over the wounds on the nose. Then, giving a twist so that a live flesh might meet the other live surface, by healing applications, they fashioned for them other imperfect noses. There is left above, between the eyebrows, a small hole, caused by the twist given to the skin to bring the two live surfaces together. In a short time the wounds heal up, some obstacle being placed beneath to allow of respiration. I saw many persons with such noses, and they were not so disfigured as they would have been without any nose at all.” (Storia do Mogor 1653-1708 AD).

These Rhinoplasties were widely appreciated as the ‘Indian Nose’ and generated tremendous interest in the medical fraternity paving way for corrective Rhinoplasty in Europe , United states and other part of the world. Later, with the dissemination and refinement of the technique it became an established procedure worldwide. Though today the technique has received few modifications but the basic  principles laid down by Sushruta still remains true. Today, the world acknowledges India as the cradle of Rhinoplasty and the contemporary use of the “Indian flap” for nasal reconstruction testifies to its practicality and success for more than 2500 years.

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