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

Chap. XIII.] NIDANA STHANAM. 93

tion. This dreadful disease is known as Niruddha-
gudam (stricture of the rectum) which is extremely
difficult to cure. Ahiputana : — A sort of itch-like
eruptions appearing about the anus of a child owing
to a deposit of urine, perspiration, feces etc conse-
quent on the neglect in cleansing that part. The
eruptions which are the effects of the deranged blood
and Kapham soon assume an Eczematous character
and exude a purulent discharge on account of constant
scratching. The Eczema (Vrana; soon spreads, and
coalesces and proves very obstinate in the end. The
disease is called Ahiputana. Vrishana-kachchu : — When
the filthy matter, deposited in the scrotal integuments
of a person who is negligent in washing the parts or
in the habit of taking daily ablutions, is moistend
by the local perspiration, it gives rise to an itching
sensation in the skin of the scrotum, which is speedily
turned into running Eczema by constant scratching
of the parts. The disease is called Vrishana-kachchu
and is due to the aggravated condition of the Kapham
and blood. Guda-Bhransa : — A prolapse or falling out
of the anus (due to the Vayu) in a weak and lean patient
through straining, urging or flow of stool as in dysentery
is called Guda-Bhransa or prolapsus ani. 42 — 45.

Thus ends the thirteenth Chapter of the Nidana Sthanam in the Sus'ruta Samhita which treats of the Nidanam of minor ailments.

CHAPTER XIV.

Now we shall discourse on the Nidanam of the disease known as SukadOSha. i.

Any of the eighteen different types of the disease may affect the genital (penis) of a man who foolishly resorts to the practice of getting it abnormally elongated and swollen by plastering it with Suka (a kind of irritating water insect) and not in the usual officinal way.

Classification : — Diseases, which result from
such malpractices, are knonwn as, — Sarshapika, Ashthi-
lika, Grathitam, Kumbhika, Alaji, Mriditam, Sammudha-
pidaka, Avamantha, Pushkarika, Spars'ahani, Uttama,
Satoponaka, Tvakapaka, Sonitarvudam, Mansarvudam,
Mansapaka, Vidradhi and Tilakalak. 2.

Metrical Texts :— The tiny herpetic eruptions
(Pidaka) which resemble the seeds of white mustard in
shape and size, (and are found to crop up on the male
organ of generation) on account of a deranged condition
of the blood and Kapham, as the result of an injudicious
application of Suka plasters are called Sarshapikai
by the wise. Eruptions of hard stone-like pimples,
(Pidaka) irregular at their sides or edges and which are
caused by the aggravation of the local Vayu by the use
of a plaster of the poisonous Suka, are called Ashthilika'.
The knotty Granthis (nodules) on the penis owing
to its being frequently stuffed with the bristles of a
Suka insect are called Grathitam. This type is caused
by the deranged action of the Kapham. A black wart
resembling the stone or seed of a jambolin fruit in
shape is called Kumbhikai. This type is due to the
deranged condition of the blood and Pittam. 3 — 5.

Chap. XIV.] NIJDANA STHANAM. 95

An Alaji (incidental to an injudicious application
of Suka on the penis) exhibits symptoms, which are
identical with those manifested by a case of Alaji
in Prameha (Ch. vi). A wart (papilloma) attended
with swelling of the part and caused by the aggravated
Vayu on the hard and inflamed penis causing pressure
(on the urethra) is called Mriditam. The pustule or
eruption appearing on the penis on account of its being
extremely pressed by the hand i^for the insertion of the
hairs of the Suka) in its dorsum is called Sammudha-
pidaka^. (It is the outcome of the aggravated Vayu*).
A large number of elongated pustules on the penis (in-
cidental to an application of Suka to the part) which
burst at the middle, causing pain and shivering, is called
Avamantha (epithelioma ^ 6 — 10.

The Pushkarika type of the disease is marked by the eruptions of small pimples around the principal one The type has its origin in the deranged condition of the blood and Pittam, and is so called from the part of the excrescenses being arranged in rings or circles like the petals of a lotus flower in shape. A complete anes- thesia (of the affected organ) owing to the vitiated blood by the injudicious application of a Suka is called Spars'a- haini. Pustules appearing on the penis through the vitiation of the local blood and Pittam by such con- stant applications are called Uttamsi. A suppuration of the prepuce under the circumstance is called Tvakapaikh. There is fever with a burning sensation in the affected organ. The disease is due to the vitiated condition of the blood and Pittam. 11-— 15.

The type of the disease in which the penis is marked
by the eruption of black vesicles and is covered over
with a large number of red pimples or pustules with

According to Dallana it is due to the action of Vayu and blood.

g6 THE SUSHRUTA SAMHITA. tChap. XIV.

an excruciating pain in the ulcerated region of the organ
IS called Sonitafcrvudam. The vegetation of a fleshy-
tumour on the penis (incidental to a blow on the organ
to alleviate the pain of inserting the hairs of the Suka
insect into its body), is called MsinsaLrvudam. A sup-
puration as well as sloughing of the penis attended with
different kinds of pain which severally mark the de-
ranged Vayu, Pittam and Kapham is called Ma'nsa-
paHia. This type is caused by the concerted action
of the deranged Vayu, Pittam and Kapham. 15-18.

The specific symptoms of a Tridoshaja Vidradhi
as described before (Chap.ix.) mark the one which affects
the penis (owing to an injudicious application of the
highly poisonous irritant Suka to the organs) The
disease is called Vidradhi. A process of general sup-
puration and sloughing of the organ marks the type
which is produced by the application of a black Suka or
one of a variegated coloured insect of the same species.
The type is called Tilakailaka, and should be regarded
as Tridoshaja one. 19-21.

ProgTIOSiS : — Of the above enumerated malig-
nant diseases of the penis, those known as Mansarvuda,
Mansapaka, Vidradhi and Tilakalak shoulda be deemed
as incurable. 22.

Thus ends the fourteenth Chapter of the Nidana Sthanam in the Sus'ruta Samhita which treats of Nidanam of different types of S'ukadohsa.

Now we shall discourse on the Nidanam of Bhagf-^ na.m (fractures and dislocations etc. of bones), i

Various kinds of fracture may be caused from a
variety of causes, such as by a fall, pressure, blow,
violent jerking or by the bites of ferocious beasts etc.
These cases may be grouped under the two main sub-
divisions such as. Sandhi-Muktam (dislocation) and
Ka^nda-Bhagnam (fracture of a kanda). 2.

Cases of Sandhi-muktam (dislocation) may be divided
into six different types, such as the Utplishtam, Visf-
lishtanty Vivartitam, Adhak-Kshiptam, Ati-kshiptam and
Tiryak-kshiptam. 3 .

General features of a dislocation :^

Incapability of extension, flexion, movement, circum-
duction and rotation (immobility, considered in respect
of the natural movements of the joint), of the dislocated
limb, which becomes extremely painful and cannot
bear the least touch. These are said to be the general
symptoms of a dislocation. 4.

Diagnostic symptoms of a disloca- tion : — 'In case of a friction of a joint by two articular extremeties (Utplishtam) a swelling is found to appear on either side of the articulation attended with a variety of pain at night. A little swelling accompanied by a constant pain and disordered function of the dislocated joint, marks the case of simple-looseness (Vislishtam) of the articulation ; while pain and unevenness of the joint owing to the displacement of the connected bones distinguish a case of Vivartitam (lateral displacement). An excruciating pain, and looseness of the dislocated

98 THE SUSHRUTA SAMHITA. [Chap. XV.

bone are the symptoms which characterise a case in
which a dislodged bone is seen to drop or hang down
from its joint (Adhah-kshiptam). In a case of abnor-
mal projection (Ati-kshiptam), the dislocated bone is
removed away from its joint which becomes extremely
painful. A case of oblique dislocation (Tiryak-kshiptam)
is marked by the projection or displacement of the
bone on one side accompanied by a sort of intolerable
pain. 5.

Different kinds of Ksinda Bhag-

nam : — Now we shall describe the Kanda-Bhagnam
(fracture etc.). Fractures may be divided into twelve
different kinds which are known as, Karkatakam, AsVa-
karnam,Churnitam,Pichchitam,Asthi-chchalitam,Kanda-
bhagnam, Majjagatam, Atipdtitam, Vakram, Chchinnam,
Pdtitam and Sphutitam. 6.

General symptoms of K^nda-bhag-

nam : — A violent swelling (about the seat of fracture) with throbbings or pulsations, abnormality in the position (of the fractured limb), which cannot bear the least touch, crepitus under pressure, a looseness or dropping of the limb, the presence of a variety of pain and a sense of discomfort in all positions are the indications which generally mark all kinds of fracture (Kanda-bhagnam). 7. Diagnostic symptoms:— The case where a fractured bone, pressed or bent down at its two articular extremities, bulges out at the middle so as to resemble the shape of a knot (Granthi), is called Karkatam. The case where the fractured bone projects upward like the ear of a horse is called AsVakamam. The fractured bone is found to be shattered into fragments in a case of the Churnitam or comminuted kind which can be detected both by palpation and crepitation. A smashed condition of the fractured bone marks a

Chap. XV.] NIDANA STHANAM. 99

case of the Pichcliitain kind which is often found to be marked by a great swelling. The case where the covering or skin of the bone (periosteum) is cast or splintered off is called the Asthi-chchallitam. The case where the completely broken or severed bones are found to project through the local skin, is called Katada- bhagnatn (compound). The case where a fragment of the fractured or broken bone is found to pierce into the bone and dig out the marrow, is called Majjsiaugatain, (Impacted fracture). The case where the fractured bone droops or hangs down is called Ati-paititani. The case where the unloosened bone (from its position) is bent down in the form of an arch is called Vakram The case where only one articular extremity of the bone is severed is called Chhinnaoi. The case where the bone is slightly fractured and pierced with a large number of holes, is called PaLtitam, an excruciating pain being the leading indication. The case where the bone largely cracked and swollen becomes painful as if stuffed with the bristles of a Suka insect is called Sphutitam (Green- stick fracture). Of the several kinds of fracture, cures are effected with extreme difficulty in a case of the Churnitam, Chhinnam, Ati-patitam or Majjanugatam kind. A case of displacement or laxation occurring in a child or in an old or weak patient or in one suffer- ing from asthma (Svasa) or from any cutaneous affec- tion (Kushtha) or Kshata-Kshina disease is difficult to cure. 8.

Memorable verses : —The following cases

are to bs given up as hopeless —z^/s. fracture of the
pelvic bone (or of bones that are of this description,
wherever they may be situated) ; dislocation of the
pelvic joints ; compound fracture of the thigh bone or
of the flat bones) ; fracture into small pieces of the

lOO THE SUSHRUTA SAMHITA. [Chap. XV.

frontal bone or its dislocation ; simple fracture of the
breast-bones, back-bone and temporal and cranial bones.
If the dislocations and fractures be improperly set
from the outset (Adito)* or if the union be anyhow
disturbed there is no hope for recovery. 9 — 11.

If fractures happen at any time of the first three
stages of adalt life which has been described before
(vide Sutrasthana Chap, XXXV.) and if they are set up
by an able surgeon they have a great chance of being
united. 12.

A bending of a gristle or cartilage (Taruna) is
called its fracture. A Nalaka (long bone) bone is
usually found to be severed. A Kapatla bone is found
to be cracked, while a Ruchakaf (tooth) is found to be
splintered off. 13.

* The word Adiio may be taicen into the sense of congenital mal- formation which is beyond remedy.

+ The presence of the particle 'cha' denotes Valya-asthi-

Thus ends the fifteenth Chapter of the Nidana Sthanam in the Sus'ruta amhit^ which treats of the Nidanam of dislocations and fractures.

Now we shall discourse on the Nidanam of
lYl Uk ha. Tog's. m (diseases which affect the cavity of
the mouth in general), i.

General Classifications:— Sixty five* dif- ferent forms of mouth disease are known in practice. They are found to attack seven different localities viz. the lips, the gums of the teeth, tongue, palate, throat and the entire cavity ; of these eight are peculiar to the lips ; fifteen, to the roots of the teeth; eight to the teeth; five to the tongue ; nine to the palate ; seventeen to the throat; and three to the entire cavity. 2 — 3.

Diseases of the lips :— The eight forms which
affect the lips, are either Vataja, Pittaja, Kaphaja, Sanni-
pdtika, Raktaja, M^ns'aja, Medaja or Abhighdtaja
(Traumatic). 4.

The Vsitaja Type:— The lips become dry,
rough, numbed, black, extremely painful and the affected
part seems as if it were smashed and pulled out or
cracked by the action of the aggravated Va(yu. In the
Pittaja type — the lips become blue or yellow-coloured
and studded with (a large number of small) mustard-
seed-like eruptions, which suppurate and exude a puru-
lent discharge attended with a burning sensation (in
the locality). In the Kaphaja type — the affected lips
are covered with small eruptions, which are of the same
colour as the surrounding part, and become slimy, heavy
or thick, cold and swollen. Pain is absent in this type
and the patient feels an irresistible inclination to scratch
the parts. In the Satnnipaitaja type, the lips change