In contrast to India, surgery generally remained outside the domain of China’s scholarly, elite medicine. Presumably, reluctance to mutilate the body and the lack of dissection-based anatomy inhibited the dev- elopment of surgery in China, but such obstacles are not necessarily insurmountable. Indeed, forensic medicine reached a high level of sophistication in China, as indicated by a text known as The Washing Away of Wrongs (1247), which is considered the world’s ﬁrst treatise on forensic medicine.
When confronted with their apparent failure to establish a respected surgical tradition, Chinese scholars contended that the efﬁ- cacy of their preventive and therapeutic medicine obviated the need for surgical interventions. Nevertheless, Chinese history provides accounts of physicians who performed miraculous operations. Inter- actions between China and India during the transmission of Buddhism may have inspired such stories, although they did not lead to the inte- gration of surgery into classical Chinese medical traditions.
The most famous Chinese surgeon, Hua T’o (ca. 145–208), was credited with the invention of anesthetic drugs, medicinal baths, hydrotherapy, and medical gymnastics. Master of acupuncture and a brilliant diagnostician, Hua T’o could reputedly cure migraine head- aches with one acupuncture needle. One of his most unusual cases involved a patient suffering from a painful tumor between the eyes. When Hua T’o skillfully opened the tumor, a canary ﬂew out and the patient was completely cured. Although canary-ﬁlled tumors may be a rarity in medical practice, headaches and chronic pains are not, and Hua T’o usually cured such disorders with acupuncture. Unfortunately, when consulted by the Emperor Ts’ao Ts’ao, the surgeon recommended trepanation as a treatment for his intractable headaches. Suspecting that such drastic surgery might be part of an assassination plot, Ts’ao Ts’ao ordered Hua T’o’s execution. Unable to smuggle his writings out of prison, Hua T’o took the secrets of his great discoveries with him. The lost secrets of Hua T’o supposedly included ointments that prevented and cured infection as well as miraculous anesthetics.
According to tradition, of all the operations invented by Hua T’o, the only one to survive and enjoy considerable usage was his technique for castration. This operation provided the eunuchs employed as civil servants and palace attendants. Descriptions of castration as practiced in 1929 note that despite the crudeness of the operation most patients healed in about a hundred days, although about two percent died as the result of hemorrhage or infection.