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

of the Sataponaka type all the small Vranas about the anus should be first incisioned and the principal sinus in the locality should not be looked after until these small ones had been healed up. The connected abscesses should be respectively incisioned on the external side, while the unconnected ones should not be opened at the same time in order that they may not run into one another and be thus converted into a wide-mouthed ulcer. The urine and the faecal matter are found in each case to flow out of the cavity of such a wide-mouthed ulcer ; and aching pains in the rectum and a rumbling sound in the abdomen, due to the action of the aggravated Vayu, are experienced. Such a case is enough to confound even a well-read and experienced physician. Hence the mouth of a fistula of the Sataponaka type should not be opened with a broad incision.

Forms of incision :-An experienced surgeon should know that the Langalaka, Ardha-Langalaka, Sarvatobhadraka and the Gotirthaka forms of incision should be the different shapes of incision, in a case of a many-mouthed S'ataponaka. An incision equal in its two sides is called the La^ngalaka (curvilineal), while the one with one arm longer than the other is named the Ardha-La^Dgalaka. An incision made in the region of the anus in the shaps of a cross (crucial) and a little removed from the raphe of the perineum, is called the Sarvatobhadraka by men conversant with the shapes of surgical incisions. An incision made by inserting the knife in one side is called the Gotirthaka (longitudinal). All exuding (bleeding) channels in the affected region should be cauterized with fire by the surgeon.

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A case of the ^itaponaka type occurring in a person of timid disposition or of delicate constitution, is extremely difficult to cure. Medicinal fomentations endowed with the virtue of arresting secretion and alleviating pain, should be quickly applied (to the seat of the disease). Fomentations with Kris'ara, or Payasa (porridge), made with the aforesaid Svedaniya (diaphoretic) drugs with a decoction of the drugs constituting the Vthddi group, Vriks/iddam and roots of the castor-plant mixed and boiled together with the flesh of the Lava, Vishkira (a kind of bird) and that of animals living in swampy or marshy land or aquatic in their habits or Gramya animals, and then kept in an oily pitcher and applied in the way of a Nddi-Sveda (fomentation through Nadi or pipe), should be at once applied to the seat of the ulcer. Sesamum, castor-seeds, linseed, Mds/ia-pu\se, barley, wheat, mustard-seeds, salts and the Amla-Varga (see Rasa Vijndniya chapter) should be boiled in a saucer and the affected part or ulcer should be fomented therewith. After being fomented, the patient should drink (a potion consisting of) Kiishtha, salts (the five officinal kinds of salts) Vachd, Hingu and Ajamoda taken in equal parts and mixed with (an adequate quantity of) clarified butter, grape-wine (Mdrdvika), Kanjika (Amla), Sura or Sauviraka.* Subsequent to that, the ulcer should be wetted with the Madhuka-o'\\ and the rectum should be washed with medicated oils which would alleviate pain due to the action of the deranged and aggravated Vdyu. The preceding medicinal remedies tend to bring about the outflow or evacuations of stool and urine through their natural channels or courses, and undoubtedly alleviate all acute and supervening distresses which specifically mark

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the progress of the disease. We have described the treatment of a case of fistula- in-ano of the Sataponaka (sieve) type ; now li>ten to me about the treatment of the Ushtragriva (camel's neck) type of the disease. 5.

* By the use of this potion the digestive power is increased.

Treatment of Ushtra-griva :— The ulcer

should first be searched with a probe or director and, after an operation, an alkali should be applied to it. To remove all sloughed off or sloughing flesh and membranes cauterization with fire is forbidden. [The fissures of pus vsinuses) and sloughed off flesh should be first drawn out]. A plaster of clarified butter and pasted sesamum should then be applied to it, and the ulcer duly bandaged. Clarified butter should be constantly applied over the bandage which should be removed on the third day. Cleansing or disinfecting (^S'odhana) measures should then be used by the surgeon, according to the Doshas involved in the ulcer, and the successive healing (Ropanaj measures resorted after its being properly purified (S'odhana). 6

Treatment of Parisrsivi :— in a case of the