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

presentation (the child coming stretched cross-wise) like a belt and arrested in the passage, its lower extremities should be pushed upward with the hand and the child should be drawn out with its upper part {viz., the head, etc.), thus pointed downward, and brought straight into the passage of parturition. In a case of the head being hung back a little on one side, the shoulder should be lifted up by pressing it (with the hand) after chafening it, so as to bring the head at the door of the passage and the child should be drawn straight downward. Similarly in the case of the presentation of the two arms, the shoulder should be lifted up by pressing it (with the hand) and, the head being brought back to the passage, the child should be drawn downward. The remaining two kinds of false presentation Mudhagarbha) previously described (in the eighth Chapter of the Nidana Sthana) should be considered as irremediable. The applications of instruments (Sastra) should be the last resort when such manipulatory measures would fail. 5.

Metrical Text : —But even in such irremediable (Asddhya) cases, surgical operations should not be made if the foetus could be detected alive in the womb, as such a course (as the cutting of the foetus, etc.) would fatally end both as regards the child and its mother. 6.

Operations involving destruction of the Foetus— Craniotomy : -In cases where there would be any necessity of using an instrument for the purpose of delivery, the enciente should be encouraged (with hopes of life) before making the surgical operation. The head or skull of the child in such cases should be severed with the knife known as the Mandalagra or the Anguli-^astra ; then having carefully taken out the particles of the skull-bone (Kapala),

Chap. XV.] CHIKITSA STHANAM. 407

the foetus should be drawn out by pulling it at its chest or at the shoulder with a Sanku (forceps). Where the head would not be punctured and smashed, the fcetus should be drawn out by pulling it at the cheeks or the eye-sockets. The hands of the fcetus should be severed from the body at the shoulders, when they (the shoulders) would be found to have been obstructed in the passage and then the foetus should be drawn out. The abdomen of a child, dead in the womb, should be pierced and the intestines drawn out, in event of the former being swollen into a flatulent (Vata) distension like a leather bag ^for holding water), as such a procedure would remove the stiffness of its limbs^ and then it should be drawn out. The bones of the thighs (Jaghana-kapala) should be first cut out and removed, where the fcetus would be found to have adhered fast to the passage with its thighs (Jaghana). 7. Metrical Texts :— in short, that part of the body of the foetus should be severed and removed which Iprevents its (foetus) withdrawal from the womb and the life of the mother should be saved at all hazards. The different types of false-presentations should be ascribed to the abnormal coursing of the deranged Vayu (in the uterus), and hence an intelligent physician should adopt, after careful considerations, proper remedies (for its pacification). An intelligent physician should not waste a single moment in drawing out the foetus, as soon as it would be found to be dead in the womb, since neglect in such cases leads to the instantaneous death of the mother, like an animal dying of suffocation. An erudite physician, well-versed in anatomy, should use in such cases a Mandaljigra instrunjent for the purpose of cutting out (the foetus), since a sharpe-edged Vriddhi-patra may sometimes hurt the mother during the operation. 9-1Q.

p. 408

A non-falling placenta (Aparat' should be extracted in the way indicated before or the enciente should be firmly pressed and the placenta extracted with the hand. Her body should be constantly shaken or her shoulders constantly rubbid at the time (of extracting the placenta after lubricating the passsage of parturition with oil. ii.

After -measures :— Thus having extracted the Salya (foetus ', the body of the mother should b^ washed with warm water and anointed with oil, etc. Oil should also be copiously applied to the passage of parturition * as it would soften the Yoni and alleviate the pain therein. After that, powdered Pippali, Pippali-jvots, S'unthi, Eld, Hingii, Bhdrgi, Dipyaka, Vac/id, Ativishd, i^dsnd and Chavya should be given in a Sneha (clarified butter, etc.^ for the (proper) discharge {i.e., purification) of the Doshas (lotia) and for the alleviation of the pain. A plaster, or a decoction, or a pulverised compound of the said drugs without the addition of any Sneha ^clarified butter, etc.) may also be given to her. As an alternative, the physician should ask the parturient woman to take 5'«/^«-bark, Hingu, Ativishd, Pdt/id, Katu-rohini and Tejovati prepared and administered in the preceding manner. Then for three, five or seven days, Sneha (clarified butter, etc.) should again be given ; or the patient should be asked to take well prepared Asavas and Arishtas at night time. A decoction of the bark of S'irisJia and Kakubha should be used for washing (Achamanafi purposes and the other supervening distresses {i..e. complications) should be remedied with proper medicines. T2-A.

* The oil should be introduced into the va^^inal cinal by means jj . Pichu, i e-i cotton i)luc;i soaked in oil, etc.