Washington University Medical Center welcomes unusual patients for unconventional screening
October 24, 2014
Under the wraps: Modern medicine meets Egyptian mummies. Video by Clark Bowen and Tom Malkowicz/WUSTL Video Services. For photos of the mummies’ journey to and scanning at Washington University Medical Center, follow this link.
Under the wraps: Modern medicine meets Egyptian mummies. Video by Clark Bowen and Tom Malkowicz/WUSTL Video Services. For photos of the mummies’ journey to and scanning at Washington University Medical Center, follow this link.
Washington University School of Medicine recently teamed up with theSaint Louis Art Museum and the university’s Mildred Lane Kemper Art Museum to scan some very unusual patients: three Egyptian mummies.
The scanning took place Sunday, Oct. 12, at the Center for Advanced Medicine on the Medical Campus. The mummies, two of which are on long-term loan to the Saint Louis Art Museum from the Kemper Art Museum, were carefully transported across Forest Park and scanned one by one in a state-of-the-art computerized tomography (CT) scanner.
Among the early findings: One of the mummies already was known to have a brain, but scans revealed she also still has lungs. In many mummies, lungs typically were removed prior to burial.
The scientists — radiologists with the university’s Mallinckrodt Institute of Radiology — discovered that the same mummy also has an array of small objects around her head. It appears to be a headdress or embellished shroud, but other possibilities include packing material or debris.
The scientists were surprised to find that a second mummy appeared to be significantly shorter than his sarcophagus. Further scanning revealed that his head had been dislodged from his body, perhaps when grave robbers ransacked his tomb. They found an item on his chest that may have been a burial amulet missed by grave robbers. They hope to use the scanning data to reconstruct the item with a 3-D printer.
The researchers expect to have more detailed results ready to share in December.
Lisa Çakmak, PhD, assistant curator for ancient art at the Saint Louis Art Museum, initiated the project. The museum is preparing for an upcoming reinstallation of the mummies, and Çakmak thought scans might provide valuable information about the mummies and their societies that could be incorporated into the new exhibit.
The mummies’ burial containers and wrappings identify each by name. The Saint Louis Art Museum’s mummy is Amen-Nestawy-Nakht, a male; the Kemper Art Museum mummies are Pet-Menekh, also a male, and Henut-Wedjebu, a female.
Karen K. Butler, PhD, associate curator of the Kemper Art Museum, said Pet-Menekh and Henut-Wedjebu were donated to the university in 1896 by Charles Parsons, a St. Louis banker and prominent art collector. Working with a curator from the Egyptian Museum in Cairo, Parsons acquired them shortly after excavation through the Antiquities Service of Egypt.
“The mummies have been part of Washington University for more than 100 years,” Butler said. “Faculty from anthropology, classics, art history and archaeology all take students to see them. They are very much part of university life.”
Mummy history
Henut-Wedjebu, the oldest of the mummies, was discovered in a cave-like tomb near the ruins of the Egyptian city of Thebes. Her name means “singer of Amun and lady of the house,” and her elaborately gilded coffin, decorated with texts from the Book of the Dead, is one of only eight such objects to survive from the reign of Amenhotep III (1390-1353 B.C.).
Pet-Menekh — or “he whom the excellent one has given” — is thought to have been a priest of the god Chem during the Ptolemaic period (c. 300 B.C.). He died in his 30s or 40s, possibly of sudden trauma or acute disease. His coffin — likely found at the Necropolis of El-Hawawish in Akhmim — is richly decorated with hundreds of hieroglyphics as well as images of the goddesses Isis and Nut.
Amen-Nakht — or “Amun (Lord) of the Thrones of the Two Lands is Strong” — acquired by the Saint Louis Art Museum in 1980, was a priest of Amun during the 22nd Dynasty (945–712 B.C.). His coffin is thought to have been discovered in the Necropolis of Thebes. A painted cartonnage — a kind of funerary case made of linen and plaster — covers the body and illustrates the panoply of deities charged with escorting him into the afterlife.
This CT scan of Amen-Nestawy-Nakht shows that the mummy’s skeletal remains are significantly shorter than the sarcophagus. For more images from the CT scans and from the mummies’ journey to the medical center,follow this link.
Added Butler: “As a university museum, we’re always looking for new ways to understand and research our collection. This collaboration has allowed us to bring together two different aspects of the university community: art historical scholarship and scientific research. It’s really thrilling.”
Mummies present art experts and scientists with a formidable challenge: They are incredible time capsules from human societies that vanished thousands of years ago, but opening the capsules would desecrate human remains and possibly destroy unique cultural treasures.
Modern medical imaging techniques offer ways to peer into these time capsules without physically opening them. Scientists scanned Amen-Nestaway-Nakht two decades ago, but imaging technology has advanced significantly since then.
Çakmak, Butler and others approached Gil Jost, MD, then director of the Mallinckrodt Institute, about the possibility of getting the mummies scanned. Jost enlisted Sanjeev Bhalla, MD, professor of radiology and chief of cardiothoracic imaging, to lead the research team.
Other investigators for the project included Pamela Woodard, MD, professor of radiology and director of the Center for Clinical Imaging Research; Vincent Mellnick, MD, assistant professor of radiology; and Michelle Miller-Thomas, MD, assistant professor of radiology. The team represented expertise in imaging of the brain, abdomen and coronary arteries.
“This has been Dr. Jost’s specialty: bringing together the best technological resources and expertise necessary to do fascinating research, and then stepping away and letting them go to work,” said Bhalla. “His attitude always is, ‘Let’s make it happen.’”
The researchers and other medical center staff volunteered their time, and the School of Medicine and Barnes-Jewish Hospital donated time on the scanner and the computing resources necessary to process the results. The Saint Louis Art Museum paid for transporting the mummies.
How best to scan a mummy
The scientists considered scanning the mummies with a magnetic resonance imaging (MRI) unit, but it was impossible to guarantee that the mummies were free of any metals. Metal is prohibited in MRIs because the strong magnets in the scanners can damage the equipment and the subject being scanned. More importantly, though, mummies are free of water as a result of the mummification process, and the images created with MRI scanning are dependent on the water content of tissue.
The researchers instead brought the mummies to a powerful and recently installed computerized tomography (CT) scanner. The unit uses X-rays to virtually slice a solid object, producing detailed 3-D images of its interior.
“This new CT scanner has higher spatial resolution and quickly can assemble slices in a variety of ways, providing more medical details about the mummies,” Bhalla said.
In living patients, Bhalla and his colleagues often inject contrast agents that help make different types of cells and tissues stand out. This was not an option for the mummies, but researchers scanned them at two different energy levels to enhance details.
Among other goals, the researchers are analyzing the data for signs of artery hardening in the mummies. Indicators of heart disease have been detected in prior mummy scans, but it’s not clear yet if this is reflective of the elite lifestyle of anyone rich enough to be mummified or if heart disease was a common problem in ancient Egyptian society.
The researchers also will take a close look at the mummies’ teeth. The degree of wear on the teeth helps scientists more precisely estimate a mummy’s age at the time of death. They also will search for evidence of what caused the mummies’ deaths.
Logistically, the scans were complicated. The mummies had to be carefully removed from their display cases, packed and prepared for transport in custom-built boxes. The team took precise measurements to be sure each mummy would it into the scanner.
But Bhalla viewed another aspect of the scans as the greatest challenge of the project.
“It was very important for us to remember that these were human beings we were scanning,” he said. “We had to do the scanning in an atmosphere of spiritual and physical respect, and with the help of museum staff who acted as a kind of surrogate family for the mummies, we did that.”
Added Çakmak: “Mummification was a difficult and expensive process. It’s really very poignant. Each of these people was beloved by someone.”
ROBERT BOSTON
Curators and radiologists examine the mummy of Pet-Menekh on Sunday, Oct. 12, at Washington University Medical Center. From left are Lisa Çakmak, PhD, assistant curator of ancient art at Saint Louis Art Museum; Karen K. Butler, PhD, associate curator of Washington University’s Mildred Lane Kemper Art Museum; Sanjeev Bhalla, MD, professor of radiology and chief of cardiothoracic imaging at the School of Medicine; and Vincent Mellnick, MD, a Washington University radiologist. Pet-Menekh was scanned in a computerized tomography (CT) scanner at the medical center. For more photos, follow this link.
Under the wraps: Modern medicine meets Egyptian mummies
Mummies at the Medical Center
Photos: Ancient Egyptian mummies arrive on campus for state-of-the-art CT scans.
Washington University radiologists welcomed a trio of special guests to the Center for Advanced Medicine this month when three Egyptian mummies arrived for computerized tomography (CT) scans, also called CAT scans. Follow their journey below, or read more in the Record.
The mummy of Henut-Wedjebu was one of three taken to Washington University Medical Center to be examined in a CT scanner.
Henut-Wedjebu, the “mistress of the house and songstress of Amun,” was an upper-class woman who lived in the 14th century B.C. Lauded for its realism, her coffin is gilded in gold foil. Photo: Joe Angeles
Henut-Wedjebu’s mummy and that of Pet-Menekh belong to Washington University’s Mildred Lane Kemper Art Museum but are on long-term loan to the Saint Louis Art Museum. The third mummy scanned – that of Amen-Nestawy-Nakht, a male priest believed to have lived in the 9th or 10th century B.C. – is owned by the Saint Louis Art Museum. Lifting the lid of Henut-Wedjebu’s sarcophagus is John Woodworth of US Art. Jan Hessel of Kemper Art Museum is on the right. Photo: Joe Angeles
The mummies were prepared for transport at the Saint Louis Art Museum by a team of expert art handlers and museum staff. Clockwise from left are John Woodworth, art handler, US Art; Paul Haner, paintings conservator, Saint Louis Art Museum; Emilio Maldonado, art handler, US Art; Alice Boccia Paterakis, objects conservator; Ron Weaver, exhibition preparator, Kemper Art Museum; Jan Hessel, facilities manager and preparator, Kemper Art Museum; and Diane Mallow, assistant registrar, Saint Louis Art Museum.Photo: Joe Angeles
The Kemper Art Museum mummies were first X-rayed at the medical center in the 1960s. However, imaging technology has improved significantly, leading researchers to seek more detailed scans.
Pet-Menekh is thought to have been a priest who lived in the 4th or 3rd century B.C. His coffin is decorated with hundreds of hieroglyphics as well as images of the goddesses Isis and Nut. Photo: Robert Boston
Examining Pet-Menekh’s mummy, from left, are curators Lisa Çakmak, PhD, of Saint Louis Art Museum, Karen Butler, PhD, of Kemper Art Museum, and School of Medicine radiologists Sanjeev Bhalla, MD, and Vincent Mellnick, MD. Photo: Robert Boston
Today’s CT scans allow researchers detailed examination of the mummies in 3-D, without harming their remains.
CT scanners use special equipment that emits a narrow X-ray beam to obtain images from different angles around the body, generating 3-D images that can show the skeleton, tissues and organs. Photo of scan: Robert Boston
The computer adds color to the 3-D images to exaggerate differences in tissue. Photo of scan: Robert Boston
School of Medicine radiologists and museum staff hope the scans will teach them more about the mummies and the societies in which they lived.
Michelle Miller-Thomas, MD, assistant professor of radiology (seated), studies the CT scans as Lisa Çakmak, PhD, of Saint Louis Art Museum leans in for a closer look. Photo: Robert Boston
Each mummy’s sarcophagus was guided safely into the scanner, thanks to careful work by the art handlers and medical team.
Positioning Pet-Menekh’s mummy from the left are Ron Weaver, exhibition preparator at Kemper Art Museum; Diane Mallow, assistant registrar at Saint Louis Art Museum; John Woodruff, an art handler with US Art; and Jan Hessel, facilities manager and preparator for the Kemper Art Museum. Photo: Robert Boston
Jan Hessel (left) of Kemper Art Museum helps position Pet-Menekh’s mummy for a CT scan. Photo: Robert Boston
Staff from Kemper Art Museum, the Saint Louis Art Museum and US Art position Pet-Menekh’s mummy before it is examined. Photo: Robert Boston
More than 2,000 years after his body was wrapped in bandages, the mummy of Pet-Menekh is eased into a state-of-the-art CT scanner at Washington University Medical Center. Photo: Robert Boston
Researchers expect to share detailed results of the scans in December.
It was already known that Henut-Wedjbu was buried with her brain intact. Early findings of the scans show she still has her heart and lungs as well. In many mummies these organs were removed prior to burial. Image: Washington University
Radiologists also discovered that Henut-Wedjebu’s mummy has a collection of objects around her head. It appears to be a headdress or embellished shroud, but it could be packing material or debris. Image: Washington University
Images of the CT scans themselves may be incorporated into a reinstallation of the Egyptian mummies opening at Saint Louis Art Museum in 2016.Image: Washington University
Sushruta Samhita
From Wikipedia, the free encyclopedia
The Sushruta Samhita (सुश्रुतसंहिता) is an important Classical Sanskrit text on surgery. Written by, Sushruta, it is dated a period of 6th century BC.[1][2] [3][4][5]
It is one of three foundational texts of Ayurveda (Indian traditional medicine), alongside the Charaka Samhita and the medical portions of the Bower Manuscript.[6][7][8]
The Sushruta Samhita, in its extant form, in 184 chapters contains descriptions of 1,120 illnesses, 700 medicinal plants, 64 preparations from mineral sources and 57 preparations based on animal sources.[3] The text discusses surgical techniques of making incisions, probing, extraction of foreign bodies, alkali and thermal cauterization, tooth extraction, excisions, and trocars for draining abscess draining hydrocele and ascitic fluid, the removal of the prostate gland, urethral stricture dilatation, vesiculolithotomy, hernia surgery, caesarian section, management of haemorrhoids, fistulae, laparotomy and management of intestinal obstruction, perforated intestines, and accidental perforation of the abdomen with protrusion of omentum and the principles of fracture management, viz., traction, manipulation, appositions and stabilization including some measures of rehabilitation and fitting of prosthetics. It enumerates six types of dislocations, twelve varieties of fractures, and classification of the bones and their reaction to the injuries, and gives a classification of eye diseases including cataract surgery.
The text was translated to Arabic as Kitab-i-Susrud in the 8th century.
Contents
[hide]Contents[edit]
The Sushruta Samhita is divided into two parts, the 'Purva-tantra' and the 'Uttara-tantra'. Together, the Purva-tantra and Uttara-tantra (apart from Salyya and Salakya) describe the sciences and practices of medicine, pediatrics, geriatrics, diseases of the ear, nose, throat and eye,toxicology, aphrodisiacs and psychiatry.
- The Purva-tantra is dedicated to the four branches of Ayurveda. It is divided into five books and 120 chapters (It is noteworthy that theAgnivesa-tantra, better known as the Charaka Samhita and the Ashtanga Hridayam of Vagbhata, is also divided into 120 chapters). These five books are:
- The Sutra-sthana.
- The Nidana-sthana, dedicated to aetiology, the signs and symptoms of important surgical diseases and those ailments which have a bearing on surgery.
- The Sarira-sthana covers the rudiments of embryology and human anatomy, along with instructions for venesection, the positioning of the patient for each vein, and the protection of vital structures (marma). It also includes the essentials of obstetrics.
- The Kalpa-sthana is mainly Visa-tantra, dealing with the nature of poisons and their management.
- The Chikitsa-sthana describes the principles of management of surgical conditions, including obstetrical emergencies and chapters on geriatrics and aphrodisiacs.
- The Uttara-tantra contains the remaining four specialities, namely Salakya, Kaumarabhfefefrtya, Kayacikitsa and Bhutavidya. The entire Uttara-tantra has been called Aupadravika, since many of the complications of surgical procedures as well as fever, dysentery, cough, hiccough, krmi-roga, pandu, kamala, etc., are briefly described here. The Salakya-tantra portion of the Uttara-tantra describes various diseases of the eye, the ear, the nose and the head.
The Samhita is dedicated to other disciplines as well. Sushruta emphasizes that unless students possess enough knowledge of relevant sister branches of learning, they cannot attain proficiency in their own subject of study. The Samhita represents an encyclopedic approach to medical learning, with special emphasis on Salya and Salakya, and can be thought of as a comprehensive treatise on the entire medical discipline.
Surgical procedures described[edit]
Sushruta has pointed out that haemorrhage can be arrested by apposition of the cut edges with stitches, application of styptic decoctions, by cauterisation with chemicals or heat. That the progress of surgery and its development is closely associated with the great wars of the past is well known. The vrana or injury, says Sushruta, involves breakdown of body-components and may have one or more of the following seats for occurrence, viz., skin, flesh, blood-vessels, sinews, bones, joints, internal organs of chest and abdomen and vital structures. Classicallyvrana, the wound, is the ultimate explosion of the underlying pathological structure. It is, in Sushruta's words, the sixth stage of a continuous process, which starts with sotha (inflammation). Sushruta says that in the first stage, the ulcer is unclean and hence called a dusta-vrana. By proper management it becomes a clean wound, a suddha-vrana. Then there is an attempt at healing and is called ruhyamana-vrana and when the ulcer is completely healed, it is a rudha-vrana. Sushruta has advocated the use of wine with incense of cannabis for anaesthesia.[6]Although the use of henbane and of Sammohini and Sanjivani are reported at a later period, Sushruta was the pioneer of anaesthesia.
Sushruta describes eight types of surgical procedures: Excision (chedana) is a procedure whereby a part or whole of the limb is cut off from the parent. Incision (bhedana) is made to achieve effective drainage or exposure of underlying structures to let the content out. Scraping (lekhana) or scooping is carried out to remove a growth or flesh of an ulcer, tartar of teeth, etc. the veins, hydrocele and ascitic fluid in the abdomen are drained by puncturing with special instrument (vyadhana). The sinuses and cavities with foreign bodies are probed (esana) for establishing their size, site, number, shape, position, situation, etc. Sravana (blood-letting) is to be carried out in skin diseases, vidradhis, localised swelling, etc. in case of accidental injuries and in intentional incisions, the lips of the wound are apposed and united by stitching (svana).
To obtain proficiency and acquiring skill and speed in these different types of surgical manipulations, Sushruta had devised various experimental modules for trying each procedure. For example, incision and excision are to be practised on vegetables and leather bags filled with mud of different densities; scraping on hairy skin of animals; puncturing on the vein of dead animals and lotus stalks; probing on moth-eaten wood or bamboo; scarification on wooden planks smeared with beeswax, etc. On the subject of trauma, Sushruta speaks of six varieties of accidental injuries encompassing almost all parts of the body.
Sushruta also gives classification of the bones and their reaction to injuries. varieties of dislocation of joints (sandhimukta) and fractures of the shaft (kanda-bhagna) are given systematically. He classifies and gives the details of the six types of dislocations and twelve varieties of fractures. He gives the principles of fracture treatment, viz., traction, manipulation, appositions and stabilisation. Sushruta has described the entire orthopaedic surgery, including some measures of rehabilitation, in his work.
As war was a major cause of injury, the name Salya-tantra for this branch of medical learning is derived from Salya, the arrow of the enemy, which in fights used to be lodged in the body of the soldiers. He emphasises that removal of foreign bodies is fraught with certain complications if the seat of the Salya be a marma.
Sushruta also discusses certain surgical conditions of ano-rectal region, he has given all the methods of management of both haemorrhoids and fistulae. Different types of incision to remove the fistulous tract as langalaka, ardhalangalaka, sarvabhadra, candraadha (curved) andkharjurapatraka (serrated) are described for adoption according to the type of fistula.
Sushruta was well aware of the urinary stones, their varieties; the anatomy of urinary bladder along with its relations is well recorded in the chapter on urinary stones. Varieties of stones, their signs and symptoms, the method of extraction and operative complication are given in detail. Apart from the above, surgery of intestinal obstruction (baddha-gudodara), perforated intestines (chidrodara), accidental injuries to abdomen (assaya-bhinna) in which protrusion of omentum occurs are also described along with their management.
The samahita lays down the basic principles of plastic surgery by advocating a proper physiotherapy before the operation and describes various methods or different types of defects, viz.
- release of the skin for covering small defects,
- rotation of the flaps to make up for the partial loss and
- pedicle flaps for covering complete loss of skin from an area.
He has mentioned various methods including sliding graft, rotation graft and pedicle graft. Reconstruction of a nose (rhinoplasty) which has been cut-off, using a flap of skin from the cheek has been described. Labioplasty too has received attention in the samahita.
Authorship[edit]
Suśruta (Devanagari सुश्रुत, an adjective meaning "very famous"[9]) is the supposed author of the treatise. He is said to have been a physician originally of Kerala[10] active in Varanasi during the 6th century BC.[11] The earliest known mention of the name is from the Bower Manuscript (4th or 5th century), where Sushruta is listed as one of the ten sages residing in the Himalayas.[12][12] Later Ayurvedic texts present him as a fully mythologized figure, as a son of Vishvamitra or a descendant of Dhanvantari, the physician of the gods in Hindu mythology.[13]
Rao (2005) speculated that there may be an original "layer" to the text which might indeed date to the "elder Sushruta" (Vrddha Sushruta) which was redacted "by another Sushruta in the first century A.D.", with still later additions and redactions byNagarjuna leading to the extant text; a redaction by one Nagarjuna is explicitly mentioned by Dalhana, the author of the primary commentary on the Sushruta Samhita.[14]
Medieval and modern reception[edit]
Both the Sushruta and the Charaka Samhita were translated into Arabic during in the 8th century. The translator of the Sushruta Samhita was one Ibn Abillsaibial. The work was known as Kitab Shah Shun al-Hindi in Arabic, or alternatively as Kitab i-Susurud. The 9th-century Persian physician Rhazes was familiar with the text.[14]
In India, a major commentary on the text, known as Nibandha-samgraha, was written by Dalhana in ca. 1200 CE.
The Arabic translation was received in Europe by the end of the medieval period. In Renaissance Italy, the Branca family of Sicily andGasparo Tagliacozzi (Bologna) became familiar with the techniques mentioned in the Sushruta Samahita.[15]
The editio princeps of the text was prepared by Madhusudan Datta (Calcutta 1835). A partial English translation by U. C. Datta appeared in 1883. English translations of the full text were published by A. M. Kunte (Bombay 1876) and Kunja-lal Bhishagratna (1907-1911; reprinted 1963, 2006).[14] An English translation of both the Sushruta Samhita and Dalhana's commentary was published in three volumes by P. V. Sharma in 1999.[16]
See also[edit]
References[edit]
- ^ K. Mangathayaru. Pharmacognosy: An Indian perspective. Pearson Education India. p. 2.
- ^ Adam Hart-Davis. History: From the Dawn of Civilization to the Present Day. Penguin. p. 53.
- ^ a b Dwivedi & Dwivedi (2007)
- ^ Lock etc., page 420
- ^ "Sushruta: The first Plastic Surgeon in 600 B.C.". Internet Journal of Plastic Surgery 4 (2). ISSN 1528-8293.
- ^ a b Raju VK (2003). "Sushruta of ancient India". Retrieved 2007-05-24.
- ^ I M Ruthkow (1961). Great Ideas in the History of Surgery. Baltimore: The Williams & Wilkins Company. p. 57.
- ^ Loukas, M; Lanteri, A; Ferrauiola, J; Tubbs, R. S.; Maharaja, G; Shoja, M. M.; Yadav, A; Rao, V. C. (2010). "Anatomy in ancient India: A focus on the Susruta Samhita". Journal of Anatomy 217 (6): 646–50. doi:10.1111/j.1469-7580.2010.01294.x. PMC 3039177. PMID 20887391.
- ^ Monier-Williams, A Sanskrit Dictionary (1899).
- ^ Amaresh Datta, various. The Encyclopaedia Of Indian Literature (Volume One (A To Devo)). Sahitya academy. p. 311.
- ^ Singh, P.B.; Pravin S. Rana (2002). Banaras Region: A Spiritual and Cultural Guide. Varanasi: Indica Books. p. 31. ISBN 81-86569-24-3.[unreliable source?]
- ^ a b Kutumbian, pages XXXII-XXXIII
- ^ Monier-Williams, A Sanskrit Dictionary, s.v. "suśruta"
- ^ a b c Ramachandra S.K. Rao, Encyclopaedia of Indian Medicine: historical perspective, Volume 1, 2005, 94-98.
- ^ Lock etc., page 607
- ^ Susruta-Samhita: With English Translation of Text and Dalhana's Commentary Along with Critical Notes, 3 Vols. Vol. I: Sutrasthana, Vol. II: Kalpasthana and Uttaratantra, Vol. III: Nidana, Sarira and Cikitsasthana; Chowkhamba Visvabharati; Varanasi, India; 1999; First Edition; 1983 pages.
Bibliography[edit]
- Dr. Rudolf Hoernle. Medicine of India.
- D. P. Agrawal. Sushruta: The Great Surgeon of Yore.
- Chari PS. 'Sushruta and our heritage', Indian Journal of Plastic Surgery.
- Rana RE and Arora BS. 'History of Plastic Surgery in India', Journal of Postgraduate Medicine.
- Gunakar Muley. 'Plastic Surgery in Ancient India'.
- Aufderheide, A. C.; Rodriguez-Martin, C. & Langsjoen, O. (1998). The Cambridge Encyclopedia of Human Paleopathology. Cambridge University Press. ISBN 0-521-55203-6.
- Dwivedi, Girish & Dwivedi, Shridhar (2007). History of Medicine: Sushruta – the Clinician – Teacher par Excellence. National Informatics Centre (Government of India).[unreliable source?]
- Kearns, Susannah C.J. & Nash, June E. (2008). leprosy. Encyclopædia Britannica.
- Kutumbian, P. (2005). Ancient Indian Medicine. Orient Longman. ISBN 81-250-1521-3.
- Lock, Stephen etc. (2001). The Oxford Illustrated Companion to Medicine. USA: Oxford University Press. ISBN 0-19-262950-6.
- Susruta Samhita (English translation) http://chestofbooks.com/health/india/Sushruta-Samhita/index.html#.VFPYpDSUeSo
- Syncretism in the Susruta and Caraka Samhitas: http://www.carvaka4india.com/2011/11/syncretism-in-caraka-and-susruta.html