An English Translation of the Sushruta Samhita, Vol. I: Sutrasthanam — trans. Kaviraj Kunja Lal Bhishagratna (1907)

Secretions from ulcers :— Now we shall describe the characteristic secretions from all types of ulcers. Secretions from a contused or lacerated skin, as well as from an ulcer confined only to it), whether spontaneously bursting or surgically opened, are thin and watery in their consistency. They are characterised by a raw (fleshy) smell and a yellowish colour. An ulcer, affecting the flesh, exudes a slimy, thick and white secretion like clarified-butter. A copious quantity of blood flows out of a vein recently cut, while the incidental ulcer, in its suppurating stage, secretes a copious secretion, like water flowing out of a hydrant, which is moreover detached, thin, pendent (ropy), and slimy in its character and has a brown or frosty hue. An ulcer, confined only to a ligament, secretes a sort of cold and thick secretion, like expectorated mucous, though sometimes marked with streaks of blood.

A bone, mjured, tractured, or suddenly cracked by idiopathic causes (derangement of the bodily humours), loses its internal marrow and appears as if washed (loses its natural gloss\ It assumes the colour of an oyster shell, whereas the secretions from an ulcer, which is seated inp. 215 a bone, are cold and marked b}^ streaks of Mood and lumps of marrow. An ulcer, 'situated in an}' of the bonejoints, does not exude any secretion under pressure, but secretes a sort of slimy, pendent, frothy and bloodstreaked pus, when the affected limb or part is flexed, expanded, raised or lowered, as in running (moving about), sitting or standing erect, or at defecation.

An ulcer, seated in the abdominal cavity (Koshtha), exudes a secretion, which is mixed with urine, fecal matter, pus or blood, and a thin or watery (serous) fluid. The secretions from an ulcer, affecting any vital part of the body, need not be separately described, as such a part naturally involves the organic principles of skin, flesh, etc. ; and hence an ulcer, invading it, must necessarily exude a secretion, which is peculiar to any of the aforesaid bodily principles (skin, flesh, etc.) that has become affected.

The deranged V^yu makes the secretions from an ulcer, seated in an}^ of the seven abovesaid principles such as, the skin, flesh, veins, ligaments, bones, joints and the abdomen, respectively coarse, and rough to the touch, brown, grey, frosty, or white like the cream of curd, and coloured like the washings of an alkali, like that of meat or paddy husks. Similarly, the action of the deranged Pittam should be inferred from the secretions assuming the colours of a Gomedha (a species of bluish yellow agate;, or that of the urine of

2,6 THE SUSHRUTA SAMHITA'. [Chap. XXII.

a cow, or that of water saturated with the burnt ashes of conch-shells or that of Kashaya water or that of the wine known as the Madhvika or that of oil, according as the skin, flesh, etc. are respectiveh^ affected. The action of the deranged blood, in changing the nature of the secretions of ulcers in the seven abovesajd locations, is identical with that of the deranged Pittam with the exception, that the secretions are characterised by an extremel}'' fishy smell.

In an epidermic (confined onl}' to the epidermis of a part) or superficial ulcer the action of the deranged Kapham manifests itself by imparting a butter-like or a Kasisha (sulphate of iron) colour to the secretions. They have lard-like hue or a colour like that of rice paste, or that of water tinged with sesamum, or a colour like that of the internal juice or water of a cocoanut, or a colour like that of hog's lard, according as the flesh, a vein, a ligament, a bone or a joint is attacked. On the other hand, through the combined action of all the three deranged humours of the body (Sannipata), those secretions become coloured like the water tinged with the soakings of sesamum seeds, or the internal sap or water of a cocoanut, or the juice of the Ervaruka or the transparent surface layer of rice gruel, or the washings of the Aruka fruit, or the water tinged with the fruits of the Priy^ngu, or like the liver or the Mudga pulse.

p. 217

Authoritative verses on the subject : — An ulcer, situated in the cavity of the abdomen and secreting an exudation resembling paddy husks in colour, as well as one located in the viscera of blood (spleen or liver — Raktasha^'am) and exuding a secretion like alkaline water, should be deemed incurable. Similarh', an ulcer having its seat in the cavity of the stomach (Amashaya), or in the region of the Trika, (articulation of the clavicle with the intraclavicular notch) and exuding a thin, watery secretion, coloured like the washings of Kalaya pulse, should be regarded as belonging to the same type (incurable). A physician should only take in hand the treatment of an ulcer-patient after having examined the abovesaid nature of the discharges.