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

According to certain authorities, the deranged Pittam gets the preponderance over the local Vayu and Kapham, and transforms the blood into pus out of its own preponderant energy.

The incision or opening of a swelling in its inflammatory or unsuppurated (lit. immature, unripe) stage is attended with the destruction of the local flesh, ligament, bone, vein, or joint, and is usually followed by excessive haemorrhage. The incidental wound becomes extremely painful. Many distressing symptoms begin to manifest themselves in succession and cavities are formed inside the wound which may lapse into a case of Kshata-Vidradhi (a type of ulcerated abscess).

On the other hand, a fully suppurated swelling, left unopened for a long time out of fear or ignorance by the attending physician, is attended with symptoms which are fraught with dreadful consequences. The accumulated pus, unable to find an outlet, is infiltrated and attacks the deeper tissues of the affected part, and forms large cavities or sinuses in their inside, thus converting l6o THE SUSHRUTA SAMHITA. [Chap. XVII.

the disease into one of a difficult or incurable type.

Authoritative verses on the subject : — The physician (surgeon) who opens an unsuppurated or unripe swelling out of ignorance, as well as the man who neglects a fully suppurated one, should be looked upon as the vilest Chandala for his wrong or incorrect diagnosis. The patient should be provided with a meal before the surgical operation, or strong wine should be given him, if he is found to be addicted to the habit of taking any. The effect of a good meal under the circumstance will be to keep up the strength of the patient and to guard against his swooning during the operation, while the effect of wine will be to make him unconscious of the pain. The rule as regards the feeding and anaesthetising (wine giving) of the patient should be strictly adhered to, since the internal vital principle of a man is invigorated by the strength of his body which is the product of lymph-chyle, the essence of food, and the quintessence of the five material principles. A swelling, no matter whether limited or extensive, spontaneously runs on to suppuration, if not medicinally treated, or left to nature. The base of such a swelling goes on extending. It becomes unequally suppurated and reaches an unequal elevation, thus affecting the deeper tissues of the part and swiftly running into one of an incurable type. A swelHng, which does not yield to the application of medicated plasters

Chap. XVII. ] SUTRASTHANAM. l6l

or to corrective or blood-letting measures, speedily and uniformly suppurates, and • is marked by a small and restricted base and a circular or conical elevation. As a blazing fire fed by gusts of favourable wind soon consumes a withered forest, so the incarcerated pus, in the absence of any outlet, attacks and eats away the healthy flesh, veins and nerves of an organism.

Surgical acts in connection with an abscess (Shotha) may be divided into seven kinds such as i. mutilation (Vimlapanam) of the swelling by massage,

2. Avashechanam (bleeding or application of leeches)

3. Upanaham (poulticing) 4. Patanam (opening or incision; 5. Shodhanam (purification of the internal morbid matter of an incised boil with corrective medicines) 6. Ropanam (healing) and 7. Vaikritdpaham (restoring of the natural colour of the skin to the cicatrix).

Thus ends the .scvciUecnlh Chaplei of ihc Suiiaslhfinam in ttie Siisliiul;! Sanihit^ which lieals ofhuw to (hslinguisli Ijetween suppurating and noii-suppurating swelhngs.

p. 21

CHAPTER X V 1 1 1 .

Now we shall discourse on the Chapter which treats of dressings and bandages of ulcers (VranarlepanaVandha-Vidhi-madhyayam).

A medicinal plaster should be regarded as the general and most important remedy in all cases of (inflammatory) swelling. We shall presently discuss the nature of plasters to be used in each specific form of disease. A bandage plays a more important part (than a medicinal plaster) as regards its healing and curative efficacy, inasmuch as it materially contributes to the purification and healing of an ulcer and keeps the joints steady. A medicinal plaster should be applied from down upward or in a direction contrary- to that of the local hair (Pratiloma). It should never be applied (so as to run down with the local hair), since a plaster, applied as directed above, would firmly stick to the surface of the affected part, and naturally percolate through the follicles of the hair and the external orifices of the vehicles of perspiration (Sudoriferous ducts), thus permeating the organism with its own native potency and virtue.