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

linen on the two closed fists thus placed on the neck, the surgeon should ask another man from the back side of the patient to take hold of the two ends of the cloth with his left hand having the palm turned upward, and then ask him to tie up with his right hand the bandage round the part, neither too diffusely nor too tightly nor too loosely, so as to raise the vein and to press the bandage round the back for a good out-flow of blood. Then he (surgeon) should perform the operation in the desired spot, the patient having been previously asked to sit with his mouth full of air (i.e., he should confine his breathing till the surgical operation is completed). This proceeding should be adopted in opening any vein of the head, save those which are situated in the cavity of the mouth. 7.

In the case of opening a vein (Sira) in the leg, the affected leg should be placed on a level ground, while the other leg should be held in a somewhat contracted posture, at a little higher place. The aff"ected leg should be bound with a piece of linen below its knee-joint and pressed with the hands down to the ankle. A ligature of the above kind should then be tied four fingers above the region to be incised upon, after which the vein sh©uld be opened. 8.

In the case of opening a vein (Sira) in the arms, the patient should be caused to sit easily and fixedly with his two thumbs closed in his fists ',as above). A ligature ol the above-mentioned kind (rope etc.,) should be tied (four fingers above the part to be incised upon and the vein opened in the aforesaid manner. The knee-joint and the elbow should be held in a contracted or drawn up posture at the time of opening a vein in a case of Gridhrasi (Sciatica^ and Vis'vachi, respectively. The patient should hold his back raised

Chap. VIII.] SARIRA STIIANAM, 201

up and expanded and his head (and shoulders) bent down at the time of opening a vein in the back, shoulders and the Sroni (hips). He should hold his head thrust back and his chest and body expanded at the time of opening a vein in the chest or in the abdomen. 9-12.

He shall embrace his own body with his arms at the time of opening a vein in his sides. The penis should be drawn downward {i.e., in an flaccid state) on a similar occasion in that region. The tongue should be raised up to the roof of the mouth and its fore-part supported by the teeth at the time of opening a vein in its under-surface. The patient should be told to keep his mouth fully open at the tims of opening a vein in the gums or in the palate. Similarly a Surgeon should devise proper and adequate means for the purpose of raising up (distinct appearance of) a Sira (vein") and determine the nature of the banda^^'e to be used therein according to the exigencies {i.e., the health and the kind of diseases of the patient\ of each case, i Z-'^J.

An incision to the depth of a barley-corn should be made with a Vrihimukha instrument (Into a vein situated) in the muscular parts of the body, whereas the instrument should be thrust oily half that depth or to the depth of a VrUii seed in other places (Vrihi here signifies S'ukadhdtiya as well as Rakta-s'ili\ An incision over a bone should be made with the Kutharika (small surgical axe) to the half depth of a barle}-- corn. 18-19.

IVIcmorabIc Verses :— An opening should

be effected in such a day in the rain}' season as would be devoid of the rumblings of a thunder-cloud, during the cold {i.e., in the fourth) part of the day in summer, and at noon in the winter season (Hemanta). These are the only three times of opening a vein. A well

p. 26

203 THE SUSHRUTA SAMIIITA. [Chap. VI tr.

and successfully pierced vein bleeds in streams (almost simultaneously with the thrusting of the knife) and spontaneously stops after a Muhurta (a little while). The vitiated blood is seen first to flow out of an opened vein, like the drop of yellow pigment first coming out of a Kusunihha flower. Blood does not flow out from an incision made into a vein of an unconscious (Murchchhita), much frightened, or a thirsty patient. An incision of a vein without proper bandaging and raising up is attended with a similar result. 20-23.

A weak person, or one affected with the unusual derangement of the bodily Doshas etc., or one fainted (under operation), should not be subjected to a measure of continuous blood-letting at a time ; instead of that, the vein should be opened afresh in the same afternoon or on the following day, or on the third day (as the exigency requires). An intelligent surgeon should not allow the flow of blood to an excess but should stop the flow even with a remnant of the diseased blood in the system and administer soothing internal remedies (Sams'amana) for the purification of the diseased remnant. Bleeding to the quantity of a Prastha* measure should be deemed sufficient for a strong and adult patient, stuffed with a large quantity of the deranged Doshas (in the body). 24-26.