The Sushruta Samhita — trans. Bhishagratna

XV.] CHlklTSA STHANAM. 4O5

failure in the first attempts at effecting parturition. The mantras are as follows. 2.

Metrical Texts :— ''O thou beautiful damsel, may the divine ambrosia' and the Moon god with Chitrabhdnu and the celestial horse Uchchaih-Sravas take their residence in thy room ; may this water-begotten nectar, help thee, O lady, in swiftly casting off thy womb. May the Sun, the Vdsavas and the Wind-god (Favana) in the company of the saline Ocean give thee peace. The incarcerated beasts have been freed from their fastenings and binding chords. The Sun god has freed his rays of light. Freed from all danger, come, O, come, O child, and rest in peace in these precincts," 3.

Proper and useful medicinal remedies should also be employed for the delivery of the child.

Postures of the Foetus:— In the case of the foetus being dead in the womb, the enciente should be made to lie on her back with her thighs flexed down and with a pillow of rags under her waist so as to keep it a little elevated. Then the physician should lubricate his (own) hand with a compound consisting of earth, clarified butter and (the compressed juice of) S'allaki^ Dhanvana and S'dhnali and inserting it into the passage of parturition (Yoni) should draw out the dead foetus (downward with the hand). 4.

In the case of a leg-presentation (Sakthi), the foetus should be drawn downward by pulling its legs. In case where a single leg (Sakthi) is presented, the other leg of the foetus should be expanded and then it should be drawn downward.

In the case of the presentation of the buttccks(Sphik). I breech presentation), the buttocks should be first pressed, and lifted up and then the foetus should be drawn downward by the legs. In the case of a longitudinal

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I breech presentation), the buttocks should be first pressed, and lifted up and then the foetus should be drawn downward by the legs. In the case of a longitudinalp. 406 presentation (the child coming stretched cross-wise) like a belt and arrested in the passage, its lower extremities should be pushed upward with the hand and the child should be drawn out with its upper part (viz., the head, etc.), thus pointed downward, and brought straight into the passage of parturition. In a case of the head being hung back a little on one side, the shoulder should be lifted up by pressing it (with the hand) after chafening it, so as to bring the head at the door of the passage and the child should be drawn straight downward. Similarly in the case of the presentation of the two arms, the shoulder should be lifted up by pressing it (with the hand) and, the head being brought back to the passage, the child should be drawn downward. The remaining two kinds of false presentation 'Mudhagarbha) previously described (in the eighth Chapter of the Niddna Sthana) should be considered as irremediable. The applications of instruments (Sastra) should be the last resort when such manipulatory measures would fail. 5.

IVletrfCal Text : —But even in such irremediable (Asadhya) cases, surgical operations should not be made if the foetus could be detected alive in the womb, as such a course (as the cutting of the foetus, etc.) would fatally end both as regards the child and its mother. 6.

Operations involving destruction of the Foetus— Craniotomy :- In cases where there would be any necessity of using an instrument for the purpose of delivery, the enciente should be encouraged (with hopes of life) before making the surgical operation. The head or skull of the child in such cases should be severed with the knife known as the Mamlaldgra or the Anguli-^astra ; then having carefully takdrt out the particles of the skull-bone (Kap^la),

Chap. XV.3 CHIKITSA STHANAM. 40/

The head or skull of the child in such cases should be severed with the knife known as the Mamlaldgra or the Anguli-^astra ; then having carefully takdrt out the particles of the skull-bone (Kap^la),

Chap. XV.3 CHIKITSA STHANAM. 40/

the foetus should be drawn out by pulling it at its chest or at the shoulder with a Sanku (forceps). Where the head would not be punctured and smashed, the foetus should be drawn out by pulling it at the cheeks or the eye-sockets. The hands of the foetus should be severed from the body at the shoulders, when they (the shoulders) would be found to have been obstructed in the passage and then the foetus should be drawn out. The abdomen of a child, dead in the womb, should be pierced and the intestines drawn out, in event of the former being swollen into a flatulent (Vdta) distension like a leather bag vfor holding water), as such a procedure would remove the stiffness of its limbs, and then it should be drawn out. The bones of the thighs ( Jaghana-kapala) should be first cut out and removed, where the foetus would be found to have adhered fast to the passage with its thighs ijaghana). 7. lYIetrical Texts :— in short, that part of the body of the foetus should be severed and removed which (prevents its (foetus) withdrawal from the womb and the life of the mother should be saved at all hazards. The different types of false-presentations should be ascribed to the abnormal coursing of the deranged Vayu (in the uterus), and hence an intelligent physician should adopt, after careful considerations, proper remedies (for its pacification). An intelligent physician should not waste a single moment in drawing out the foetus, as soon as it would be found to be dead in the womb, since neglect in such cases leads to the instantaneous death of the mother, like an animal dying of suffocation. An erudite physician, well-versed in a'natomy, should use in such cases a MandaUgra instrument for the purpose of cutting out '.the foetus), since a sharpe-edged Vriddhi-patra may sometimes hurt the mother during the operation. 9-10.

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