The Sushruta Samhita — trans. Bhishagratna

i8.

Parts to be guarded in Lithotomic

Operations: —The Mutra-vaha (urine-carry ingi and the S'ukra-vaha (semen-carrying) ducts or channels, the Mushka-srotas (cords of the testes), the Mutra-praseka

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[urinary) channels, the Sevani (the raphe of the perineum), the Yoni (uterus, vagina, etc.), the Guda (rectum j and the Vasti (bladder) should be carefully guarded at the time of performing a lithotomic operation. Death results in the event of the urine-carrying channels being in any way hurt during the operation owing to an accumulation of urine in the bladder. Similarly, any hurt or injury to the semen-carrying ducts at the time, results in death or in impotency of the patient ; a hurt to the cords of the testes begets an incapacity of fecundation ; a hurt to the urinary ducts leads to a frequent dribbling of urine ; while a hurt to the Yoni (uterus, vagina, etc.), or to the raphe of the perineum gives rise to extreme pain. The symptoms which characterise a hurt to the rectum or to the bladder have been described before. 19.

Memorable Verses:— The surgeon who is

not well cognisant of the nature and positions of the Marmas or vulnerable parts seated in the eight Srotas (ducts) of the body such as, the raphe of the perineum, the spermatic cords, the cords of the testes and the corresponding ones in females (Yoni), the anal region, the urinary ducts, the urine-carrying ducts, and the urinary bladder and is not practiced in the art of surgery brings about the death of many an innocent victim. 20.

Thus ends the seventh Chapter of the Chikitsita Sthanam in the
Sus'ruta Samhita which deals with the treatment of Urinary calculus.

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CHAPTER VIII.

Now we shall discourse on the medical treatment of
Fistula-in-ano, etc., (Bhagandara). r.

The disease admits of being divided into five different groups, of which the two, known as S'ambukavarta and S'alyaja (traumatic), should be regarded as incurable, and th^ rest as extremely difficult to cure. 2.

The General Treatment :— The eleven*

The disease admits of being divided into five different groups, of which the two, known as S'ambukavarta and S'alyaja (traumatic), should be regarded as incurable, and th^ rest as extremely difficult to cure. 2.

The General Treatment :— The eleven*

kinds of remedial measures commencing with Apatarpana up to purgatives (as described under the treatment of Dvi-vrana) should be employed as long as any fistular ulcer would remain in an insuppurated stage. The patient should be soothed by the application of medicated oil, etc., and his body should be fomented by immersing him in a receptacle of warm water, etc. as soon as suppuration would set in (and even after the ulcer had burst). Then having laid him on a bed and bound his hands and thighs with straps as described under the treatment of Haemorrhoid, the surgeon should examine closely as to where the mouth of the fistula is directed, outward or inward, and whether the ulcer itself is situated, upward or downward. Then the whole cavity or receptacle of pus (sinus) should be raised up and scraped out with an Eshani (indicator or probe). In a case of inter-mouthed fistula, the patient should be secured with straps (as before described) and asked to strain down. An incision should then be made by first directing the indicator when its mouth would become visible from the outside. Cauterization

* Apatarpana, Alepa, Parisheka, Abhyanga, Sveda, Vimldpana, Upandha, Pachana, Visrdvana, Sneha, and Vamana.

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Chap. VIII.] CHIKITSA STHANAM. 339

with fire or an alkali is a general remedial measure which may be resorted to in all the types of this disease. 3-4.

Specific IWeasurcs— IVI. Texts :- Incases

of the ^ataponaka type all the small Vranas about the anus should be first incisioned and the principal sinus in the locality should not be looked after until these small ones had been healed up. The connected abscesses should be respectively incisioned on the external side, while the unconnected ones should not be opened at the same time in order that they may not run into one another and be thus converted into a wide-mouthed ulcer. The urine and the faecal matter are found in each case to flow out of the cavity of such a wide-mouthed ulcer ; and aching pains in the rectum and a rumbling sound in the abdomen, due to the action of the aggravated Vdyu, are experienced. Such a case is enough to confound even a well-read and experienced physician. Hence the mouth of a fistula of the Sataponaka type should not be opened with a broad incision.

Such a case is enough to confound even a well-read and experienced physician. Hence the mouth of a fistula of the Sataponaka type should not be opened with a broad incision.

Forms of incision : — An experienced surgeon should know that the Ldngalaka, Ardha-Langalaka, Sarvatobhadraka and the Gotirthaka forms of incision should be the different shapes of incision, in a case of a many-mouthed S'ataponaka. An incision equal in its two sides is called the La(ugalaka (curvilineal), while the one with one arm longer than the other is named the Ardha-Laingalaka. An incision made in the region of the anus in the shape of a cross (crucial) and a little removed from the raphe of the perineum, is called the Sarvatobhadraka by men conversant with the shapes of surgical incisions. An incision made by inserting the knife in one side is called the Gotirthaka (longitudinal). All exuding (bleeding) channels in the affected region should be cauterized with fire by the surgeon.

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