An English Translation of the Sushruta Samhita (Bhishagratna ed.)

Definition of Galaganda (Goitre;:— The

deranged and aggravated Vayu in combination with the
deranged and augmented Kapham and fat of the loca-
lity affects the two tendons of tne neck (Manyds) and
gradually gives rise to a swelling about that part of the
neck characterised by the specific symptoms of the
deranged Doshas (Vayu or Kapham) and principles in-
volved in the case. The swelling is called Galganda
(Goitre). 17.

Symptoms of the Dosha-orig-ined

Types : — The swelling or tumour in the Va^tajai goitre is characterised by a pricking pain (in its inside) marked by the appearance of blue or dark coloured veins Sira) on its surface. It assumes a vermilion or tawny brown hue. The goitre becomes united with the local fat in course of time, and gains in size, giving rise to a sense of burning in the throat, or is characterised by the absence of any pain at all. A Vataja goitre is rough to the touch, slow in its growth, and never or but rarely suppurates. A sense of dryness in the throat and the palate as well as a bad taste in the mouth likewise marks this type. The swelling in the Kaphaja Type assumes a large shape and becomes hard, firm, cold

78 THE SUSHRUTA SAMHITA. [Chap. XI.

and of the same colour (white). There is but slight pain
and the patient feels an irresistible inclination to scratch
the part. It is slow in its progress and suppuration is
rare and tardy. A sweet taste is felt in the mouth and
the throat and the palate seem as if smeared with a sort
of sticky mucous. 18-20.

Symptoms of the IVledaja Type:—

The swelling is glossy, soft (heavy — D.R) and pale-
coloured. It emits a fetid smell and is characterised by
excessive itching and an absence of pain. It is short at
its root and hangs down from the neck in the shape of a
pumpkin (Aldvu), gradually gaining its full rotundity at
the top. The size of the goitre is proportionate to the
growth or loss of flesh of the body. The face of the
patient looks as if it has been anointed with oil and a
peculiar rumbling sound is constantly heard in the
throat. 21.

Prognosis : - A case of goitre attended with
difficult respiration, a softening of the whole body,
weakness, a nonrelish for food, loss of voice as well as
the one which is more than of a year's standing should
be abandoned by the physician as incurable. 22.

Metrical Text: — A pendent swelling whether
large or small and occurring about the region of the
throat and resembling the scrotum in shape is called
a Gala-Ganda. 23.

Thus ends the eleventh Chapter of the Niddna Sthanam in the Susruta Samhita which treats of the Nidanam of Granlhi, Scrofula, «lc.

Chapter Xii

Now we shall discourse on the Nidanamof Vriddhi
(hydrocele, hernia, scrotal tumours etc), Upaclansa
(disease of the genital organ*, and Slipada (ele-
phantiasis), I .

Classes : -There are seven different types of
Vriddhi such as the Vataja, Pittaja, Kaphaja, Raktaja,
Medaja, Mutraja and the Antra-vriddhi. Of these both
the Mutraja-vriddhi (hydrocele or extravagation of the
urine), and Antra-vriddhi types, though owing their ori-
gin to the deranged condition of the bodily Vayu, have
been so named after the organic matters or anatomical
parts (urine, iliac colon etc.) involved in them. 2.

Definition and Premonitory symp-
toms : — Any of the deranged Doshas (Vayu, Pittam,
etc ) lying in the nether regions of the body may resort
to the spermatic cords (Dhamani) and give rise to a
swelling and inflammation of Phalacosha (scrotal sac)
which is called Vriddhi (scrotal tumour etc.). A pain
in the bladder, scrotum, penis and the waist (Kati)
incarceration of the Vayu and the swelling of the
scrotum, are the premonitory symptoms of the
disease. 3 — 4.

The Dosha-origined Types :— The type

in which the scrotum becomes distended with Vayu like an inflated air-drum, marked by roughness of (its surface) and the presence of a varied sort of Vataja pain (in its interior) without any apparent cause is called Vataja Vriddhi. The swollen scrotum, of the Pittaja Vriddhi, assumes the colour of a ripe

8o THE SUSHRUTA SAMHITA. [Chap. XII.

Audumvara fruit and is attended with fever, a burning sensation and heat in the affected part. It is of a marked rapid growth and speedy suppuration (of the scrotum). The swollen organ in the Kaphaja Vriddhi becomes hard and cold to the touch accompanied by- little pain, and itching (in the affected part . In the Raktaja type the swollen scrotum is covered over with black vesicles, all other symptoms of the type being identical with those of the Pittaja one. In the Medaja type the swollen scrotum looks like a ripe TMa fruit and becomes soft, glossy and slightly painful. The patient feels a constant inclination to scratch the part. The Mutraj a- vriddhi (hydrocele) owes its origin to a habit of voluntary retention of urine, its characteristic symptoms being softness and fluctuation on the surface of the swollen scrotum like a skin-bladder filled with water, painful urination, pain in the testes and swelling of the scrotum. 5.

Antra-vriddhi (Inguinal hernia) :— The local
Vayu enraged and unusually aggravated by lifting a
great load, wrestling with a stronger person, violent
physical strain or a fall from a tree and such like
physical labour doubles up a part of the small intestine
and presses it down into the inguinal regions lying
there strangulated in the form of a knot (Granthi)
which is known as Antra-vriddhi (inguinal hernia).
The part not properly attended to at the outset
descends into the scrotum which becomes ultimately
elongated and intensely swollen and looks like an
inflated air-bladder. It (hernia) ascends upwards under
pressure, making a peculiar sound, (gurgling) ; while let
free it comes down and again gives rise to the swelling
of the scrotum. This disease is called Antra-vriddhi
and is incurable. 6.

Chap. XII.] NIDANA STHANAM. 8l

TheUpadansam:— An inflammatory swelling of the genital, whether ulcerated or not is called TJpadansa*. The disease owes its origin to the action of the local Doshas, aggravated by promiscuous and excessive sexual intercourse, or by entire absti- nence in sexual matter ; or by visiting a woman, who had observed a vow of lifelong continence or one who has not long known a man, or one in her menses or one with an extremely narrow or spacious vulva, or with rough or harsh or large pubic hairs ; or by going unto a woman whose partturient canal is studded with hairs along its entire length ; or by visiting a woman not amorously disposed towards the visitor and vice versa ; or by know- ing a woman who washes her private parts with foul water or neglects the cleanliness of those parts, or suffers from any of the vaginal diseases, or one whose vagina is naturally foul ; or by going unto a woman in any of the natural fissures of her body other than the organ of copulation (Vi-yoni) ; or by pricking the genital with finger nails, or biting it with the teeth, or through poison- ous contact, or through practice of getting the (penis abnormally elongated by pricking the) bristles of a water parasite {Suka) into its body ; or by practising

* Upadans'a is not syphilis whole to whole. Certain types of Upadans'a such as the Raktaja and Sannipatika types which entail the destruction of the organs concerned exhibit certain symptoms which are common to syphilis as well. The secondary eruptions and tertiary symptoms of syphilis are not mentioned by ihe A'yurvedic Rishis who used to treat it only with vegetable medicines and this fact intimates the probability that the secondary and tertiary symptoms of syphilis might not arise by their efficient and able treatment from the very beginning, preventing the absorption of the poison into the system. The practice of ablution, so common among the Hindus, might be taken into consideration as one of the important preventive factors. Maharshi Cbaraka has comprised it within the chapter on 'Senile Impotency'.— Ed,

g2 THE SUSHRUTA SAMHITA. [Chap. XII.

masturbation, or any unnatural offence with female
quadrupeds ; or by washing the genitals with filthy or
poisonous water ; or through neglect to wash the parts
after coition, or voluntary suppression of a natural flow
of semen or urine or through any hurt or pressure
on the organ etc. The inflammation of the genital
thus engendered is called Upadans'a. The disease
admits of being divided into five distinct types, such
as, the Vitaja, Pittaja, Kaphaja, Tridoshaja and the
Raktaja. 7—8.

The symptoms of different Types:—

The roughness of the genitals, the bursting or cracking of the integuments of the penis and prepuce etc., numb- ness and swelling of the aff'ected part which is perceived rough to the touch and the presence of a varied sort of pain peculiar to the deranged Vayu are the characteristic indications of the Vattaja type. In the Pittaja type fever sets in (from the very beginning), the penis becomes swollen and assumes the colour of a ripe Indian fig (reddish-yellow), attended with a sort of intolerable burning sensation. The process of suppuration is rapid and a variety of pain peculiar to the deranged Pittam, (distinguishes it from the other forms of the disease). The penis becomes swollen, hard and glossy in the Kaphaja type marked by itching and a variety of pain characteristic of the deranged Kapham. In the blood-origined type (Raktaja) the organ bleeds heavily and is covered with the eruptions of large black vesicles. Fever, thirst, (Sosha), burning sensations and other characteristic symptoms of the deranged Pittam are also present. Palliation is all that can be occasionally effected in these cases. Symptoms specifically betraying to each of the Vataja, Pittaja and Kaphaja types concurrently manifest themselves in the Satnnipaitika type of Upa-

Chap. XII.] NIDANA STHANAM. 83

dansa. The organ cracks, the ulcers or cancers become
infested with parasites and death comes in to put a stop
to the suffering of its wretched victim. 9—13.

^lipadam (Elephantiasis) :- The disease in which
the deranged Vayu, Pittam and Kapham, taking a down-
ward course, are lodged in the thighs, knee-joints, legs
and the inguinal regions and spread to the feet in course
of time and gradually give rise to a swelling therein,
is called Siipadam. There are three types of Slipada
severally due to the actions of the deranged Vayu,
Pittam and Kapham. 14— 15.

The symptoms of the different

Types! — The swollen parts assume a black colour in the VsLfcaja type and are felt rough and uneven to the touch. A sort of spasmodic pain without any apparent reason is felt (at intervals in the seat of the disease), which largely begins to crack or burst. The Pittaja type is characterised by a little softness and yellowish hue (of the diseased localities) and often attended with fever, and a burning sensation. In the Kaphaja type the affected localities become white, glossy, slightly painful, heavy, contain large nodules (Granthis) and are studded over with crops of papillae. 16.

Prognosis : — A case of elephantiasis of a year's
growth as well as the one which is characterised by
excessive swelling (of the affected parts), exudation and
vegetation of knotty excrescences resembling the sum-
mits of an ant-hill should be given up as incur-
able. 17.

Memorable Verses : -A preponderance of

the deranged Kapham marks the three types of the
disease, in as much as, the heaviness and largeness (of
the swelling) can not be brought about by any other
factor than Kapham. The disease is peculiar to countries

84 THE SUSHRUTA SAMHITA. [Chap. XII.

in which large quantities of old rain-water remain
stagnant during the greater part (lit.- all seasons)
of the year making them damp and humid in all
seasons. 18-91

The disease is usually found to be confined to the legs
and hands of men but cases are on record in which it
has extended to the ear, nose, lips and the regions of the
eyes. (Penis — Mddhaba-Niddnam). 20.

Thus ends the twelfth Chapter of ihe Nidanasthanam in the Sus'ruta Samhifa which treats of the Nidanara of scrotal tumours, hernia, Upa- dans'am and elephantiasis.

CHAPTER Xm.

Now we shall discourse on the Nidanam of
Kshudrarog'am (diseases which are known by
the general name of minor ailments), i.

These diseases are generally divided into forty-
four distinct varieties or types such as : — Ajagallikji,
Yavaprakshya, Andhdlaji, Vivrit^, Kachchapika,
Valmika, Indravriddhd, Panasikd, Pashdna-garddabha,
Jala-garddabha, Kakshd, Vishphota, Agni-rohini,
Chippam, Kunakha, Anusaye, Viddrikd, Sarkard-
Arbudam, Pam^, Vicharchikd, Rakasa, Pddadarikd,
Kadara, Alasa, Indralupta, Darunaka, Arunshika,
Palitam, Mas'urika, Yauvana-pidaka, Padmini-kantaka,
Yatumani, Mas'aka, Charmakila,Tilakdlaka, Nyachchya,
Vyanga, Parivartiki, Avapatikd, Niruddha-prakas'a,
Niruddha-guda, Ahiputanam, Vrishana-kachchu, and
Guda-bhrans'a . * 2.

Metrical Texts : — The species of pimples or
eruptions which are shaped like the Mud^a pulse and
are glossy, knotty and painless is called Ajagallikai.
They are of the same colour (as the surrounding
skin) and their origin is usually ascribed to the action
of the deranged Kapham and Vayu. The disease is
peculiar to infants.f Ya^vaiprakshyai :— The eruptions