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

* Several authorities hold that acts such as fasting, administration of purgatives, etc. should be included within the preliminary measures ; application of absorbent (Pachana) or healing medicinal agents, within the second or the principal measures ; and the administration of tonics or restoratives within the third or the after-measure group. Others, on the contrary, lay down that measures adopted for the absorption, lubrication (pacification by the application of oily substances) or elimination of the deranged bodily humours Ijy sweating should be grouped under the first subhead ( Purva-karma), the administration of active purgatives, emeticsr etc., under the second (Pradhana-karma) and the giving of rice meal, etc. to the patient under the (Paschat-karma) last ; while according to others the active medicinal agents employed to cope with the deranged humours in the incubative stage of a bodily disease till the appearance of its first characteristic symptoms, should be denominated as the Preliminary measure ; measures employed for the subjugation of a disease in its patent or fully developed stage as the Pradhana-karma, and measures employed to guard against the recrudescence of a disease and for the restoration of health in a patient is the sequel treatment or the Pasch^t-karma.

Chap.^ V. 1 SUTRASTHA'NAM. -^7

treats of surgical acts or operations, we shall discourse on them and their accessories at the outset.

Surgical acts or operations are divided into eight different kinds such as Incising (Chhedya), Excising (Bhedya), Scraping (Lekhj^as Puncturing (Vedhya), Searching or probing (Eshya), Extracting (Abarj'-a), Secreting fluids (Visravya) and Suturing (Seevya). A surgeon (Vaidya) called upon to perform any (of the eight preceding kinds) of operations, must first equip himself with such accessories as surgical appliances and instruments, alkali, fire, probe or director (Shalaka), horns, leeches, gourd (Alavu), Jamvavoushtha (a kind of pencil shaped rod made of slate with its top-end cut into the shape of a Jamboline fruit), cotton, lint, thread, leaves, tow(Patta), honey, clarified butter, lard, milk, oil, Tarpanara (powdered wheat soaked in water), decoctions Kashaya , medicated plasters, paste (Kalka), fan, cold water, hot water, and cauldrons, etc., and moreover he shall secure the services of devoted and strongnerved attendants.

Then under the auspices of blissful astral coi-Qbinations, etc., and having propitiated the Brahmanas and the physicians, with gifts of curd, sun-dried rice, cordials and gems, etc., and having made offerings to the gods and uttered benediction, etc., the surgeon should commence his work. The pa'dent should be given light food (before the act), and made to sit with

38 THE SUSHRUTA SAMHTTA'. [ Chap. V.

his face turned towards the east. His limbs should be carefully fastened (so as to guard against their least movement during the continuance of the operation). Then the surgeon, sitting with his face towards the west, and carefulh' avoiding the vital parts (Marmas), Veins, nerves (Snayus), joints, bones and arteries of the patient,should insert the knife into the affected part along tlie proper direction till the suppurated part would be reached and swiftly draw it out. In case of extended suppuration, the part opened (length of incision) should be made to measure two or three finger's widths in length. An incision (Vrana) which is wide, extended, equally and evenly divided, should be deemed the best.

Authoritative verses on the subject : — An incision which is wide, extended, well divided, does not involve any vital part, etc. of the patient, and is well-matured as regards time, is the best of its kind*. Courage, light handedness, non-shaking, non-sweating, sharp instruments, self confidence and self command are what should be possessed by a surgeon engaged in opening a boil or an abscess.

Two or three incisions should be made if a single opening does not seem large enough for the purpose.

* Certain commentators interpret the couplet as follows : A boil or an abscess which is wide, extended, well defined in its shape, equally suppurated in all its parts and does not involve any vital part of the body is the fittest thing for a surgeon's knife — Tr.

p. 39

Authoritative verse on the 'subject : — The knife (lancet) should be freely used wherever a fissure, sinus, or a cavity would appear in a boil, so as to ensure a complete flowing out of the pus accumulated in it.