The Sushruta Samhita — trans. Bhishagratna

A Kapha-origined stone or gravel is white and glossy, attains to a large size, to that of a hen's egg, and has the colour of the Madhuka flower. This type is called S'leshmas'mari. 7.

The Pitta ja As'mari :— The Kapham charged (dried) with the deranged Pittam becomes hard (condensed) and large in the aforesaid way, and lying at the mouth of the bladder obstructs the passage of the urine. The bladder, on account of the flowing back of the obstructed urine into its cavity, seems as if it has been exposed to the heat of an adjacent fire, boiling with the energy of an alkaline solution. A kind of sucking, drawing and burning pain is experienced in the organ. This type of As'mari is further marked by symptoms which characterise Ushna-v^ta (stricture). The concretion is found to be of a reddish, yellowish

Chap. III.] NIDANA STHANAM. 2;

black colour like the stone of the Bhalldtaka fruit, or it is coloured like honey. This type is called Pittaja As'mari. 8.

The Vatas'mari :— The deranged Kapham (mucus) inordinately saturated with the bodily Vdyu, acquires hardness and gains in dimensions, and these lying at the mouth of the bladder obstructs the passage of the urine. The incarcerated fluid causes extreme pain in the organ. The patient constantly under severe pain gnashes his teeth or presses his umbilical region, or rubs his penis, or fingers his rectum (Pdyu) and loudly screams. A burning sensation is experienced in the penis, and urination, belching and defecation become difficult and painful.* The concretions in this type of As'mari are found to be of a dusky colour, rough, uneven in shape, hard, facetted and nodular like a Kadamva flower. This type is called Vdtas'mari. 9.

Infants are more susceptible to an attack of any of the three preceding types of As'mari, inasmuch as they are fond of day sleep or of food composed of both wholesome and unwholesome ingredients, and are in the habit of eating before the digestion of a previous meal, or of taking heavy, sweet, emollient and demulcent food. In children the bladder is of diminished size and poor in muscular structure. These facts contribute to the easy possibility of the organ being grappled (with a surgical instrument) and of the stone being extracted with the greatest ease in cases of infantile As'mari. 10.

These facts contribute to the easy possibility of the organ being grappled (with a surgical instrument) and of the stone being extracted with the greatest ease in cases of infantile As'mari. 10.

The ^UkraS'mari : — Sukras'maris or seminal concretions are usually formed in adults owing to the germination of semen in their organisms. A sudden or abrupt stoppage of a sexual act, or excessive coition tends to dislodge the semen from its natural receptacle

* Stool and urine can be voided only with the greatest straining.

2^ THE SUSHRUTA SAMHITA. [Chap. III.

in the body. The fluid thus dislodged, but not emitted, finds a wrong passage. The Vayu gathers up the fluid (semen), thus led astray, and deposits it (in a round or oval shape) at a place lying about the junction of the penis and the scrotum and dries up the humidity with which it is charged. The matter, thus formed, condensed, and hardened, is called the seminal stone (Sukrds'mari), which then obstructs the passage of the urine, giving rise to pain in the bladder, painful micturition, and swellino; of the scrotum. The stone vanishes under pressure in its seat^'. ii — -12.

Authoritative verses on the subject : —Concretions, sands and sediments found to be deposited in the urine in a case of Bhashma-meha are but the modifications, or attendant symptoms of a case of stone in the bladder (Asmari). The same group of symptoms and the same kind of pain are exhibited and experienced in a case of gravel {S'arkard) as in a case of stone (Asmari) in the bladder. The local Vayu coursing in its natural direction helps the discharge of calculi (Asmari) with the urine in the event of they being extremely attenuated in structure. Particles of a stone broken by the Vayu are called urinary calculi {S'arkard). A pain about the cardiac recfion, a sense of weakness and lassitude in the thiojhs, a griping pain in the regions of the spleen and liver (Kukshi-sula), a shivering sensation, thirst, hiccough or eructations, darkness or sallowness of complexion, weakness, emaciation with a non-relish for food and

* We can not but contemplate with admiration the fact that Sushruta was aware of the formation of seminal or spermatic concretions in the seminal vesicles through degenerative changes of spermatozoa and other secretions and their subsequent calcification as lately discovered by the savants of the "Wesi. — Translator

Chap. III.] NIDANA STIIANAM. 29

— Translator

Chap. III.] NIDANA STIIANAM. 29

impaired digestion are the symptoms which are manifest in a gravel-patient. A gravel {S'arkard) obstructed at the mouth of the urinary channel is detected by the following indications : — viz., weakness, lassitude, emaciation, cachectic condition of the body, pain over the hepatic region (Kukshi-s'ula), a non-relish for food, sallowness of complexion, hot and high coloured urine, thirst, pressing pain at the cardiac region and vomiting. 13.

The bladder is situated in the pelvic cavity, surrounded on its different sides by the back, loin (Kati), umbilicus, scrotum, rectum (Guda), groins and penis. This organ is provided with a single aperture or opening and lies with its mouth downward, covered with nets of nerves (Sira) and ligaments (Snayu), in the shape of a gourd. The organ is extremely thin in structure ; and thus situated within the pelvic cavity, it is connected, through its mouth or external orifice, with the rectum, the penis, and the testes. It is also known by the name of Maladhara (the receptacle of impure matter) and forms (one of) the primaiy seats of vital energy (Prana)*. The urinary ducts (ureters) pass close by the large intestines (Pakvas'aya) and constantly replenish the bladder and keep it moist with that waste product of the system in the same manner as rivers carry their contributions of water into the ocean. These passages or ducts (which are two) are found to take their origin from hundreds of branches (or mouths tubuli uriniferi), which are not visible to the naked eyes, on account of their extremely attenuated structures and carry, whether in a state of sleep or wakening, the urine from below the region of thep. 30 stomach-f- (Amasaya) into the bladder keeping it filled with this important fluid of the body, just as a newpitcher, immersed up to its neck in a vessel full of water, is filled by transudation through its lateral pores. 14.

* The text has Prdndyatanam^ which means that an injury to the urinary bladder may be attended with fatal result.