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

Metrical Texts :— A fracture or dislocation (Bhagna) occurring in a person of a Vatika tempera- ment, or of intemperate habits, or in one who is sparing in his diet, or is affected with such supervening disorders (as fever, tympanites, suppression of the stool and urine, &c.) is hard to cure.* A fracture-patient must forego the use of salt, acid, pungent and alkaline substances and must live a life of strictest continence, avoid expo- sure to the sun and forego physical exercises andparchi-. fying (devoid of oleaginous) articles of food. A diet consisting of boiled rice, meat-soup, milk, f clarified butter, soup of Satina pulse and all other nutritive and constructive food and drink, should be discriminately given to a fracture-patient. The barks of Udumbara, Madhuka, As'vattha, Palds'a, Kakuhha^ Bamboo^ Vata or Sdla trees should be used as splints (Kusa). Manji- shthd, Madhuka, red sandal wood and Sdli-ricQ mixed with S'ata-Dhauta clarified butter (i.e., clarified butter

* Jejjata does not read the first verse, but Gayi does.

t As a general rule, milk should not be prescribed to a patient suffering from an ulcer (Vrana) in general ; but a case of fracture forms an exception thereto. Some authorities hold that tepid milk may be given to a fracture-patient, if there be no ulcer (Vrana). Others, on the contrary, are of opinion that milk should not, in any case, be given to a fracturc'patient for fear of suppuration and the setting in of pus.

Others, however, take "Kshirasarpih" to be a compound word and explain the term to mean the clarified butter prepared from milk (as distinguished from that prepared from curd).

But experience tells us that in cases of excessive weakness or emacia- tion, milk may be given without any hesitation— Ed.

28o THE SUSHRUTA SAMHITA- [Chap. lit.

washed one hundred times in succession) should be used for plastering the fracture. 2-6.

Bandag'e : — Fractures should be (dressed and)
bandaged once a week in cold weather, on every fifth
day in temperate weather {i.e., in spring and autumn),
and on every fourth day in hot weather {t.e., in summer),
or the interval of the period for bandaging should be
determined by the intensity of the Doshas involved in
each individual case. An extremely loose bandage
prevents the firm adhesion of a fractured bone, a light
bandage gives rise to pain, swelling and suppuration
of the local skin, &c. Hence in cases of fractures,
experts prefer a bandage which is neither too tight nor
too loose. 7-Z,

Washings :— A cold decoction of the drugs of
the Nyagrodhddi group should be used in washing (the
affected part), whereas in the presence of (excessive)
pain, (the part) should be washed with milk boiled with
the drugs of the (minor) Pancha-mula, or simply with the
oil known as the Chakra-taila made lukewarm*. Cold (or
warm) lotions and medicinal plasters (Pradehas)ofDosha-
subduing drugs should be prescribed with due regard to
the nature of the season and the Doshas involved in
each case. 9-10.

A preparation of milk f from a cow, delivered for the
first time, boiled with the drugs of the Madhurddi group
and mixed with powdered shellac and clarified butter (as
an afterthrow) should be given (when cold) to a fracture-
patient as a beverage every morning. In a case of

* In winter and where the aching pain is present due to Vayu and Kapha.

t Consisting of the drugs of the Kakolyadi group weighing two Tolas, milk sixteen Tolas, water sixty-four Tolas, boiled together with the water entirely evaporated.

Ghap. III.] CHIKITSA STHANAM. 2^1

fracture attended with ulcer on the part, an astringent plaster plentifully mixed with honey and clarified butter should be applied ; and the rest (diet and regimen of conduct) should be as laid down in the case of a (simple) fracture. 11-12.

PrOgTIO^iS : -A case of fracture occurring in a
youth or a person with slightly deranged Doshas or in
winter, is held to b3 easily curable (with the help of the
aforesaid medicines and diet). A fractured bone in a
youth is joined by the aforesaid treatment in the course
of a month, in two months in the case of a middle-
aged man and in three months in one of old age. 13-14.

An elevated and fractured joint should be reduced by pressing it down, while one hanging down should be set by raising it up, by pulling it in the case of its being pushed aude, and by reinstating it in its upward (proper) position in the event of its being lowered down. An intelligent physician should set all dislocated (Bhagna) joints, whether fixed or movable, by the mode of reduction, known as Anchhana, Pidana, (pressure), Sankshepa and Vandhana (bandaging). 15-16.

Treatment :— A crushed or dislocated joint
should not be shaken (/.6'., should be kept at rest) and
cold lotions or washes and medicated plasters (Pradeha)
should be applied to the part. A joint is spontaneously
reset to its natural or normal state or position after the
correction of its deformity incidental to a blow or hurt
having been effected. The fractured or dislocated part
should be first covered with a piece of linen soaked in
clarified butter. Splint should then be placed over it
and the part properly bandaged. 17-19.

Treatment of fractures in particular

limbs : — Now we shall discourse on the measures to be adopted in fractures occurring in each particular

282 THE SUSHRUTA SAMHITA. [Chap. HI.

limb. In the case of a nail-joint, being in any way- crushed or swollen by the accumulation of the deranged blood (in the locality), the incarcerated blood should be first let out with the help of an awl (Ard) and the part should be plastered with a paste of S^li-rice. A finger or phalanx bone put out of joint or fractured should be first set in its natural position and bandaged with a piece of thin linen and should be then sprinkled over with clarified butter. In the case of a fracture in the foot the fractured part should be first lubricated with clarified butter, then duly splinted up, and bandaged with linen. Such a patient should forego all kinds of locomotion. In the case of a fracture of the knee-joint or thigh-bone the affected part should be lubricated with clarified butter and carefully pulled straight, after which it should be splinted with barks (of Nyagrodha, etc.) and band- aged with clean linen. In case of the fracture projecting out a thigh-bone should be reset with the help of a circular splint and bandaged. In the case of Sphutita (cracked) or Pichchita (bruised) thigh-bone, the part should be also bandaged in the aforesaid manner. 20-24. In a case of a fracture in the Kati (Ilium-bone), it should be reduced by the fractured bone being raised up or pressed down (as the case may be) and the patient should then be treated with Vasti (enematas of medicated oils or Ghritas*;. In the case of a fracture of one of the rib-bones (Parsaka), the patient should be lubri- cated with clarified butter. He should then be lifted up (in a standing posture) and the fractured rib (bone), whether left or right, should be relaxed by being rubbed with clarified butter. Strips of bamboo or pad

* In the Niddna-Sthana—Chap. XV., 9— it is stated that a case of fracture in the Kati should be given up (Varjjayet). Jejjata, however, explains "Varjjayel" as "hard to cure."

Chap. III.] CHIKITSA STHANAM. 283

(Kavalikaj should b3 placed over it and the patient
should be carefully laid in a tank or cauldron full of
oil with the bamboo splint duly tied up with straps
of hide. In the case of a dislocation of the Amsa-
Sandhi (shoulder-joint), the region of the Kaksha
(arm-pit) should be raised up with an iron-rod (Mushala)
and the wise physician should bandage the part, thus
reduced, in the shape of a Svastika (8-shaped) bandage.
A dislocated elbow-joint should be first rubbed with
the thumb, after which it should be pressed with a view
to set it in its right place by fixing and expanding the
same. After that the affected part should be sprinkled
over with any oleaginous substance. The same measures
should be adopted in the case of a dislocation of
the knee-joint (Janu-sandhi), the wrist-joint (Gulpha-
sandhi) and the ankle-joint (Mani-vandha). 25-29.

In the case of fractured bones in the palms of the
hands, the two palms* should be made even and opposed,
and then bandaged together and the affected parts should
be sprinkled with raw and unmedicated oil (Ama-taila).
The patient should be made later first to hold a ball of
cow-dung, then a ball of clay and then a piece of stone
in his palms and so on, with the progressive return of
strength (to the affected parts). In a case of a fracture of
the Akshaka, the affected part should be first fomented
and then reduced by raising it up with a Mushala
(iron-rod) in the arm-pit or by pressing it down (as the
case may be) and should be firmly bandaged. A case
of fractured arm-bone should be treated according
to the directions given in the case of a fractured
thigh-bone. 30-32.

* The text has ''Ubhe tale same kritvd.'' Jejjata explains "Ubhe tale" to mean "palms of the hands and soles of the feet j" Gaya Dasa explains it to mean "the palms of both the bands."

284 THE SUSHRUTA SAMHITA. [Chap. HE.

Iiith3cas3of a banding (twisting) or intussuscep- tion of the neck downward, the head should be lifted up by putting the fingers into the hollow (Avatu) above the nape of the neck and at the roots of the jaw-bones (Hanu;*. Then the part should be bandaged with a piece of linen after having evenly put the splint (Kusa round the neck). The patient should be caused to lie constantly on his back for a week. In a case of a dislocation of the joints of the jaw-bones (Hanu\ the jaw-bones should be foment- ed and duly set in their right position, bandaged in the manner of a Panchangi-vandha, and a Ghrita boiled and prepared with (the Kalka and a decoction of) the Madhura (Kdkolyadi) and Vdyu-subduing (Chavy^di) groups should be used as errhines by the patient. 33-3 ^ A tooth of a young person, not broken but loose, should be plastered with a cooling paste on its outside after having pressed out the accumulated blood at the root. The tooth should be sprinkled or washed with cold water and treated with drugs having Sandhdniya (adhesive) properties f The patient should be caused to drink milk with the help of a lotus stem. The loose tooth of an old man should be drawn. A nose sunk down or depressed (by a blow) should be raised up with the help of a rod or director, while it should be straightened in a case of simple bending. Then two tubes, open at both ends, should be inserted into the nostrils (to facilitate the process of breathing) and the organ should be bandaged and sprinkled with clarified butter. In the case of (the cartilage of) the ear being broken, the organ should be rubbed with

* According to Gayi, the lifting up of the head by putting fingers in ihe Avatu and in the Hanus should be made in cases of bending and intussusception of the neck respectively.

t Honey, clarified butter, and drugs of the Nyagrodhddi group.

Chap. III.] CHTKITSA STIIANAM, 285

clarified butter straightened, and evenly set in its
right position and bandaged. Measures and remedial
agents mentioned in connection with Sadyo-vrana,
should be likewise adopted and employed in the present
instance. 37.

In a case of a fracture of the bone of the forehead
unattended by any oozing out of brain matter, the
affected part should be simply rubbed with honey and
clarified butter and then duly bandaged. The patient
should take clarified butter for a week * 38.

Cooling plasters and washes should be applied to a part of the body, swollen but not in any way ulcerated on account of a fall or a blow. In the case of a fracture of the bone in the leg and in the thigh, the patient should be laid down on a plank or board and bound to five stakes or pegs in five different places for the purpose of preventing any movements of his limbs. The distribution of the (bindings) pegs in each case should be as follows. In the first case (fractured leg-bone), two on each side of the two thighs making four and one on the exterior side of the enguinal region of the affected side. In the second case (fracture of knee-joint) two on each side of the ankle-joints making four and one on the side of the sole of the affected leg. The same sort of bed and fastenings should be used in cases of fractures and dislocations of the pelvic-joint, the spinal colnma, the chest and the shouldersf. In cases of long-standing dislocations, the joint should be lubricated with oily or lardaceous applications, fomented and softened (with