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

Upadrava : — The distressing supervening symp- toms which are found to attend a case of ulcer, are quite different from those of an ulcer-patient. Those which confine themselves solely to the ulcer are five in all — smell, colour, etc., and those which are exclusively mani- fest in the patient are fever, diarrhoea, hiccup, vomit- ing, fainting fits, aversion to food, cough, difficult breathing, indigestion and thirst. The medical treat- ment of ulcers though described in detail in the present chapter, will be further dealt with in the next chapter on Sadyo-Vrana. 118-120.

Thus ends the first Chapter of the Chikitsita-Sthanam in the Sus'ruta Samhita which deals with the treatment of the two kinds of ulcer.

CHAPTEK II.

Now we shall discourse on the medical treatment of recent or traumatic wounds or sores (SadyOVrana-

Chikitsa). i,

Metrical Texts; -The holy Dhanvantari, the
foremost of the pious and the greatest of all discoursers,
thus discoursed to his disciple Susruta, the son of
Visvdmitra. 2.

Different Shapes Of Sores :— I shall de- scribe the shapes of the various kinds of Vrana (sores or wounds) caused by weapons of variously shaped edges in the different parts of the human body. Traumatic ulcers have a variety of shapes. Some of these are elongated, others are rectangular, or triangular, or circular, while some are crescent shaped, or extended, or have a zigzag shape, and some are hollow in the middle like a saucer, and lastly some have she shapes of a barley corn (bulged out at the middle). An abscess or a swelling, due to the several Doshas and which spontaneouly bursts out, may assume any of the aforesaid forms, while the one effected by a surgeon's knife should never have a distorted or an improper shape. A surgeon thoroughly familiar with the shapes of ulcers is never puzzled at the sight of one of a terrible and distorted shape. 3 — 5.

Physicians of yore have grouped these variously
shaped traumatic ulcers under six broad sub-heads, such
as the Chhinna (cut), Bhinna (punctured or perforated),
Viddha (pierced), Kshata (contused), Pichchita (crushed),
and the Ghrishta (mangled or lacerated) according to
their common features and I shall describe their
symptoms. 6.

266 THK SUSHRUTA SAMIIITA. [Chap. II.

Their definitions:— A traumatic ulcer which is oblique or straight and elongated is called a Chhinna l^cut) ulcer, while a complete severance of a part or member of the body is also designated by that name, A perforation of any of the cavities or receptacles of the body by the tip of a Kunta, spear, Rishti, or a sword or by a horn, attended with a little discharge, constitutes what is called a Bhinna (punctured) wound or ulcer. The Amas'aya (stomachy the Pakv^saya (intestines), the Agnyasaya (gall-bladder ?\ the Mutras'aya (urinary bladder), the Raktasaya (receptacle of blood), the heart, the Unduka and the lungs constitute what is called the Koshtha (viscu>). A perforation (of the wall of any) of the As'ayas causes it to become filled with blood which is discharged through the urethra, the anus, the mouth or the nostrils and is attended with fever, thirst, fainting fits, dyspnoea, burning sensations, tympanites, suppression of stool, urine and flatus (Vata) with an aversion for food, perspiration, redness of the eyes, a bloody smell in the mouth, and feted one in the body and an aching pain in the heart and in the sides. 7 — 10.

Now hear me discourse on (their) detailed symptoms. A perforation of the wall of the Ama'saya (stomach) is marked by constant vomiting of blood, excessive tympanites and an excruciating pain. A perforation of the Pakva's'aya fills it with blood and is attended with extreme pain, a heaviness in the limbs, coldness of the sub-umbilical region, and bleeding through the (lower) ducts and orifices of the body. Even in the absence of any perforation, the Antras (intestines) are filled with blood through the small pores or apertures in their walls in the same manner as a pitcher with its mouth firmly covered may be filled through the pores (in its sides), and a sense of heaviness is also perceived in their inside, r i-i 3.

Chap. 110 CHIltlTSA STHANAM. '267

A wound or an ulcer caused by any sharp pointed Salya (shaft) in any part of the body other than the aforesaid As'ayas with or without that Salya being extri- cated is called a Viddha (pierced one). An ulcer which is neither a cut nor a perforation or puncture but partakes of the nature of both and is uneven is called a Kshata (wound). A part of the body with the local bone crushed between the folds of a door or by a blow be- comes extended and covered with blood and marrow and is called a Pichchita (thrashed) wound or ulcer. The skin of any part of the body suffering abrasion through friction or from any other such like causes and attended with heat and a secretion is called a Ghrisbta (mangled or lacerated) wound or ulcer. 14-17.

Their Treatment : —A part or member of the body any wise cut, perforated, pierced or wounded which is attended with excessive bleeding and with the local Vayu enraged or aggravated by the incidental bleeding, or haemorrhage will occasion excruciating pain. Potions of Sneha (oily or fatty liquids) and using the same as a washing (in a lukewarm state) should be advised in such cases. Preparation of Ves'avaras and other Krisaras largely mixed with oil or clarified butter should be used as poultices and fomentations with the Masha pulse, etc., and the use of oily ungents and emulsive Yastis (enematas)* prepared with decoctions of Vayu-subduing drugs should be applied. A crushed or thrashed wound or abrasion is not attended wi:h any excessive bleeding an absolute absence whereof, '^on the contrary) gives rise to an excessive burning sensation and suppuration in the affected part. Cold washes and cooling plasters should be used in these cases for the alleviation of the

* Snehapana is recommended when the ulcer is in a region above the umbilicus and Vasti-karma when the ulcer is in a subumbilical region.

268 THE SUSHRUTA SAMHITA. [Chap. IT,

burning and suppuration as well as for the cooling of
the (incarcerated) heat. What has been specifically
said of these six forms of ulcers, or wounds should be
understood to include the treatment of all kinds of trau-
matic wounds or ulcers as well. i8 — 20.

Treatment of cuts or incised wounds

&C : — Now we shall discourse on the medical treatment of Chhinna cuts. An open mouthed ulcer on the side of the head* should be duly sutured as described before and firmly bandaged. An ear severed or lopped off should be sutured in the proper way and position and oil should be poured into its cavity. A Chhinna cut on the Krikatika (lying on the posterior side of the junction of the neck and the head) and even if it allow the V^yu t (air) to escape through its cavity should be brought together and duly sutured and bandaged in a manner (so as not to leave any intervening space between\ The part thus adhesioned should be sprinkled with clarified butter prepared from goat's milk. The patient should be made to take his food lying on his back, properly secured or fastened with straps (so that he might not move his head and advised to perform all other physical acts such as, urination, defecation etc , in that position). 21-24

In the case of a lateral and wide-mouthed wound
(sword-cut, etc.) on the extremeties, the bone-joints
should be duly set and joined together as instructed
before and the wound should be sutured and speedily
bandaged in the manner of a Vellitaka bandage, or

* Several commentators explain those that are situated either on the head or on the sides.

t The dictum that a hurl on any of the wind-carrying sounding chan- nels is pronounced to be incurable, should not be supposed to hold good in the present case.

Chap. II.] CHIKITSA STHANAM. 269

with a piece of skin or hide in the Gophana or such other form as would seem proper and beneficial and oil should be poured over it. In the case of a wound on the back the patient should be laid on his back, while in the case of its occurring on the chest the patient should be laid on his face* 25-27.

In the case of a hand or a leg being carried away or
completely severed the wound should be cauterised with
the application of hot oil and bandaged in the manner
of a Kosha bandage and proper healing medicines
should be applied. An oil cooked with the eight drugs
Chandana, Padmaka, Rodhra, Utpala, Priyan^u, Haridrd,
Madhuka^ (Yasthimadhu) and milk, forms one of the
most efficacious healing (Ropana) agents A Kalka of
the thirteen drugs — Chandana, Karkatdkhya, the two
kinds of Sahd (Mugani and Mashani), Mdnsi, (D.R. —
Mashahva, Somahva), Amritd, Hatenu, Mrindla
Triphald^ Padmaka and Utpala should be cooked in
oil mixed with milk (four times that of oil) and the three
other kinds of oily matter (lard, marrow and clarified
butter) and this medicated oil should be used for
sprinkling over a wound of this type for the purpose of
healing (Ropana). 28.

IVIedical Treatment of Bhinna :—

Henceforth we shall deal with the medical treatment
of Bhinna (excised) wounds. A case of an excised eye
(Bhinna) should be given up as incurable. But in
the case where an eye (ball) instead of being completely
separated would be found to be dangling out (of its

* For the complete elimination of the deranged Dosha i.e,^ pus, eic , of the wound invloved in the case — Jejjata.

He who has got a wound on his back should be laid on his face and he who has got an ulcer on his breast should be laid on his back — Dififereut Reading Gayi.

2^0 THE SUSHRUTA SAMHITA. [Chap. It.

socket) the affected organ should be re-instated in its natural cavity in a manner so as not to disturb the connected Siras (nerve arrangements) and gently pressed with the palms of the hand by first putting a lotus leaf on its (eye) surface. After that the eye should be filled (^Tarpana) with the following (D.R, - Ajena in place of 'Anena' — i.e., prepared from goat's milk) medicated clarified butter, which should be as well used in the form of an errhine. The recipe is as follows : — Clarified butter prepared from goat's milk, Madhuka, Utpala, fivaka and Rishavaka taken in equal parts should be pasted together, and cooked with sixteen seers of cow's milk and four seers of clarified butter.* The use of the medicated Ghrita thus prepared should be regarded as commendable in all types of occular hurt or injury. 29.

In the case of a perforation of the abdomen marked
by the discharge of lumps or rope-like Varti (fat)
through the wound, the emitted or ejected fat-lump
should be dusted with the burnt ashes (D. R. -powders)
of astringent woods (such as Manu, Arjuna, etc.) and
black clay (pounded together). A ligature of thread
should then be bouid round the fat-lump and the fat-
lump cut off with a heated instrument. Honey should
then be applied and the wound (Vrana) should then
be duly bandaged. The patient should be caused
to drink clarified butter after the full digestion of his
injested food. Instead of this Ghrita, milk prepared

* Several authorities, however, say that equal parts of clarified butter prepared from goat's milk and from cow's milk should be taken and cooked with l6 seers of cow's milk and with the four drugs as a Kalka.

Bui Gayi recommends only four seers of clarified butler prepared from goat's milk cooked with 16 seers of cow's milk and the four drugs as a Kalka.

Chap. II.] CHIKITSA STHANAM . 27 1

medicinally with Yashtimadchi, Ldkshd and Gokshura^
mixed with (a proper quantity of) sugar and castor oil
(as Prakshepa)* is equally commendable for the alle-
viation of the pain and the burning sensation, (in the
wound or ulcer). The fat-lump (pariental fat) afore-
said causes a rumbling sound with pain in the abdomen
and may prove even fatal in the event of its being left
uncut. The medicated oil to be mentioned hereafter
in connection with Medaja-Granthi should be applied
in such cases. 30-32

Foreign bodies t^Salya) piercing into any of the Koshthas after having run through the (seven layers of; skin, whether passing through the veins, etc ^ (muscles, nerves, bones or joints or not, produces the distressing symptoms described before (Ch. III. — Sutra). The blood (of the affected chamber or receptacle) in such case lies incarcerated therein in the event of its failing to find an outlet and causes a paUor of the face and a coldness of the extremities and of the face in the patient. Respiration becomes cold, the eyes red-coloured, the bowels consti- pated and the abdomen distended. The manifestation of these symptoms indicates the incurable character of the disease. 33-34.