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

Similarl}^ an abscess or an ulcer appearing in the nether region of the body and pointing upward, or the one appearing on the extremity of scalp (Romanta) or about the end of a finger-nail, or in an)" of the vulnerable parts of the body, as well as the one affecting either of the thigh bones (femurs), should be looked upon as equally hard to cure. Likewise an abscess or an ulcer affecting a bone of the pelvis 'Shronikanda- Acetabulum), as well as a fistulap. 222 in ano opening inward should be regarded as hard to cure.

Authoritative verse on the subject : — An ulcer (Vrana) appearing in a leper (Kushthi or in a person suffering from diabetes iMadhumeha , or from Shosha (lit : pulmonary- consumption) or from the effects of poison, as well as the one appearing in a pre-existing ulcer, should be looked upon as curable only with the greatest difficulty.

Ya'pya ulcers :--An ulcer incidental to, and affecting the seat of any of the following diseases, viz. Avap^thika ( paraphimosis , or Niruddha-Prakash (phimosis), or Sanniruddha-guda (constriction of the anus), or Jathara abdominal-dropsy), or Granthi (glandular inflammation), and characterised by the germination of parasites in its interior, as well as the one appearing in the cavity of the abdomen _, or affecting the mucous linings of the intestines, or brought about by the corrosi>'e secretions of a nasal catarrh (Pratishyaya), and infested with parasites, should be considered as onh- admitting of a palliative treatment. Similarly palliation is the only remedy in the case of an ulcer which appears in a patient suffering from any morbid secretion from the urethra (Prameha) or from any form of cutaneous affections, marked by worms in its inside.

Likewise a case of gravel Sharkara , or urinaryp. 223 calculi ■ Shikata ) in which the urine is found to be charged with concretions, or leaves a deposit of sandy sediment, can not be radicalh' cured by medicine alone. A case of V^ta-kundalika, Asthila, Upakusha, Kanthasaluka, Danta-sharkar^, Danta-veshta, ^'isarpa, Asthikshata, Uru-kshata, or Vrana-Granthi, may not perfectly yield to medicine alone. In an inflammation of the gums resulting from the use of poisonous twigs as brushes for teeth Xishkoshana) a temporary amelioration is all that can be expected from a good and efficient treatment.

IVIetrical texts :— In a patient neglecting a disease at its preliminary stage, (or otherwise not observing a strict regimen) even a curable malady ma}' speedily develop into one which admits only of palliative measures, while a disease of the last named type is soon transformed into an incurable one. An incurable disease under the circumstances speedily finds a fatal termination. A patient laid up with a disease, which only admits of a palliative treatment, lives so long as the course of the medical treatment is continued, and will die almost simultaneously with its discontinuance. Just as a prop or a pillar can prevent the collapse of a tumbling edifice, so palliative measures, judiciously^ applied by a skilful physician, may keep off the inevitable in a disease which knows no radical cure.

Incurable diseases :— Now we shall de224 '^^^ SUSHRUTA SAMHITA'. [Chap, xxili.

scribe the types of diseases which are usually held as incurable. An ulcer (\'rana) cropping up like a fleshy tumour, painful and containing pus in its inside, and which is characterised by a copious secretion, with its edges raised like those of the genital of a mare, should be understood as belonging to the incurable type. A condylomatous (papillomatous ) ulcer which is soft and raised like the horn of a cow, or the one which is moderately raised or elevated at its base, and secretes an exudation of vitiated blood, or a thin slimy secretion, should be likewise regarded as incurable. An ulcer with an embossed or heaved up centre, and one dipped or fissured at its extremity should be regarded as past all remedy. An ulcer covered over with shreds of ligaments, and looking as if studded with loose shreds of hemp, should be given up as incurable. Similarly, an ulcer due to the deranged condition of any of the fundamental humours, and secreting an exudation composed of coagulated blood, fat, marrow and brain-matter should be deemed incurable.

Likewise, an ulcer, in a weak and emaciated person, which is located within the cavity of the abdomen, (Koshtha: and which assumes either a black or yellowish colour, and exudes a secretion composed of urine, pus, blood and fecal matter, which finds its outlet both through the upward and downward fissures of the body (the mouth and the anus) making a rumbling, gurgling

Chap. XXIII. ] SUTKASTHANAM. 225