An English Translation of the Sushruta Samhita, Vol. II — trans. Kaviraj Kunja Lal Bhishagratna (1911)

After that period, the body of the patient should be carefully fomented for ten successive days by applying any warm oleaginous substance or with any warm medicinal fluid (Drava-Sveda). As an alternative, the ulcer should be washed with the decoction of (the bark of) the Kshira-Vrikshas. A paste of Rodhra, Madhuka, Manjishtha and Prapaundarika (pounded together), should be applied then to the ulcer. A medicated oil or Ghrita cooked with turmeric and the preceding drugs should be applied to the ulcer. The accumulated blood in the affected part should be removed with the help of a Uttara-vasti (urethral Syringe). The ulcer should be cauterized with fire in the manner described before in the event of the urine not flowing through its natural passage after the lapse of seven days. After the urine takes its natural course, Uttara-vasti, Asthdpana and Anuvasana measures should be employed with the decoction of the drugs belonging to the Madhura- Varga.

A seminial stone or gravel (S'arkara) spontaneously brought down into the urinary passage should be removed through the same passage. The urethra should be cut open and the stone should be extracted with a hook (Vadis'a) or any other instrument in the case of its not being expelled out by the passage. The patient should refrain from sexual intercourse, riding on horse back or on the back of an elephant, swimming, climbing on trees and up mountains and partaking of indigestible substances for a year even after the healing of the ulcer. i8.

Parts to be guarded in Lithotomic

Operations; — The Mutra-vaha (urine-carry ingi and the S'ukravaha (semen-carrying) ducts or channels, the Mushka-srotas (cords of the testes), the Mutra-praseka

p. 337

(urinary) channels, the Sevani (the raphe of the perineum), the Yoni (uterus, vagina, etc.), the Guda (rectum j and the Vasti (bladder) should be carefully guarded at the time of performing a lithotomic operation. Death results in the event of the urine-carrying channels being in any way hurt during the operation owing to an accumulation of urine in the bladder. Similarly, any hurt or injury to the semen-carrying ducts at the time, results in death or in impotency of the patient ; a hurt to the cords of the testes begets an incapacity of fecundation ; a hurt to the urinary ducts leads to a frequent dribbling of urine ; while a hurt to the Yoni (uterus, vagina, etc.), or to the raphe of the perineum gives rise to extreme pain The symptoms which characterise a hurt to the rectum or to the bladder have been described before. 19.

IVIemorable Verses:— The surgeon who is

not well cognisant of the nature and positions of the Marmas or vulnerable parts seated in the eight Srotas (ducts) of the body such as, the raphe of the perineum, the spermatic cords, the cords of the testes and the corresponding ones in females (Yoni\ the anal region, the urinary ducts, the urine-carrying ducts, and the urinary bladder and is not practiced in the art of surgery brings about the death of many an innocent victim. 20.

Thus ends the seventh Chapter of the Chikitsita Sthanam in the Sus'ruta Samhita which deals with the treatment of Urinary calculus.

p. 43

CHAPTER VIII.

Now we shall discourse on the medical treatment of

Fistuia-in-ano, etc., (Bhag'andara). r.

The disease admits of being divided into five different groups, of which the two, known as S'ambukavarta and S'alyaja (traumatica, should be regarded as incurable, and th^ rest as extremely difficult to cure. 2.

The General Treatment :— The eleven*

kinds of remedial measures commencing with Apatarpana up to purgatives (as described under the treatment of Dvi-vrana) should be employed as long as any fistular ulcer would remain in an insuppurated stage The patient should b3 soothed by the application of medicated oil, etc., and his body should be fomented by immersing him in a receptacle of warm water, etc as soon as suppuration would set in (and even after the ulcer had burst). Then having laid him on a bed and bound his hands and thighs with straps as described under the treatment of Haemorrhoid, the surgeon should examine closely as to where the mouth of the fistula is directed, outward or inward, and whether the ulcer itself is situated, upward or downward. Then the whole cavity or receptacle of pus (sinus) should be raised up and scraped out with an Eshani (indicator or probe). In a case of inter-mouthed fistula, the patient should be secured with straps (as before described) and asked to strain down. An incision should then be made by first directing the indicator when its mouth would become visible from the outside. Cauterizationp. 339 with fire or an alkali is a general remedial measure which may be resorted to in all the types of this disease. 3-4,

* Apatarpana, Alepa, Parisheka, Abhyanga, Sveda, Vimlapana, Upandha, Pachana, Visrdvana, Sneha, and Vamana.

Specific IVIcasures— IVI. Texts: incases