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

402 THE 5USHRUTA SAMHITA. |[Chap. XIV.

of matter in the abdomen, in the event of the
patient being of a weak constitution. Hence it should
be gradually tapped at intervals of three, four, five, six,
eight, ten, twelve, or of even sixteen days. After the
complete outflow of the fluid, the abdomen should be
firmly tied with a piece of flannel, silk-cloth or
leather, inasmuch as this would prevent its flatulent
distention.

Diet;— For six months the patient should take
his food only with milk or with the soup (Rasa) of
Jdngala animals.

The diet* for the next three months should consist of
(meals taken with) milk diluted (and boiled) with an
equal quantity of water or with the soup of flesh of
animals of the Jdngala group seasoned with the juice
of acid fruits. During the next three months it .should
consist of light and wholesome meals. This rule
observed for a year brings about a cure. 22.

IVIemorable Verse :— Skilled physicians

should prescribe boiled milk and the soup of the flesh

* The use of water is forbidden during these nine months.

During ihe first six months, drinking, washing, etc., should be done with milk or the soup of Jangala animals. After this period, the said purposes should be served with half.diluled milk or meat-soup seasoned with the juice of acid fruiis. Water may be used during the period of the next three months. —Dallana.

Vagbhata following Charaka says: —

The patient should live only on milk for six months. After this period, he should live on porridge (Peya) boiled with milk ; and for the next three months he shoull live on boiled S'y^ma-rice with milk, or with the soup of meat seasoned with the juice or acid fruits and mixed with clarified butter and a small quantity of salt.

The water of tender and green cicoanuts is used in cases of Udara in place of pure drinking water with benefit. — Ed.

Chap. XIV.] CHlkltSA STHANAM. 403

of animals of the Jdngala group as food and drink

in all cases of Udara and use these as Asthapana measures and as purgatives as well. 23.

Thus ends the fourteenth Chapter in the Chikitsita Sth^nam of the Sus'rula Samhitd which deals with the treatment of Udara.

Now we shall discourse on the (surgical and medical)
treatment of the cases of difficult malpresentation of the
foetus and of difficult labour (Mudha-Garbha). i.

The extraction of a foetus, acting (^in the womb) as an obstructing Salya (foreign matter lodged in the body), is the most difficult of all surgical operations, inasmuch as actual contact or actual manipulation is the only means accessible to a surgeon in the region of the pelvic cavity, the spleen, the liver, the intestines and the uterus. All surgical acts in respect of the foetus or the enceinte, such as lifting up, drawing down, changing of postures (version), excision, incision, the cutting of limbs and section, pressure, the straightening and the perforat- ing of the abdomen, could not be done otherwise than by actual contact of the hand, which may sometimes prove fatal to the foetus or to the enciente. Hence the king should be first informed (as success in these cases is often uncertain) and all acts should be performed with the greatest care and coolness.

We have stated before that the foetus is generally presented in cases of difficult labour in eight different postures or forms. The obstruction of the child in the passage of parturition (Garbha-Sanga) may be effected in three different ways, owing to its head, shoulders or hips being presented in a wrong way and held fast in the passage. Every care should be taken and no pains spared to bring a child alive into the world, which is not already dead in the womb. The sacred verses (Mantras), possessing of the virtue of bringing out the foetus, should be recited in the hearing of the enciente in the case of a

dhap. XV.] CHlklTSA STHANAM. 4O5

failure in the first attempts at effecting parturition. The mantras are as follows. 2.

Metrical Texts :— ''O thou beautiful damsel,
may the divine ambrosia' and the Moon god with Chitra-
bhdnu and the celestial horse Uchchaih-Sravas take
their residence in thy room ; may this water-begotten
nectar, help thee, O lady, in swiftly casting off thy womb.
May the Sun, the Vdsavas and the Wind-god (Favana)
in the company of the saline Ocean give thee peace.
The incarcerated beasts have been freed from their
fastenings and binding chords. The Sun god has freed
his rays of light. Freed from all danger, come, O,
come, O child, and rest in peace in these precincts," 3.

Proper and useful medicinal remedies should also be employed for the delivery of the child.

Postures of the Foetus:— In the case of the

foetus being dead in the womb, the enciente should be
made to lie on her back with her thighs flexed down
and with a pillow of rags under her waist so as to keep
it a little elevated. Then the physician should lubri-
cate his (own) hand with a compound consisting of earth,
clarified butter and (the compressed juice of) S'allaki^
Dhanvana and S'dhnali and inserting it into the passage
of parturition (Yoni) should draw out the dead foetus
(downward with the hand). 4.

In the case of a leg-presentation (Sakthi), the foetus
should be drawn downward by pulling its legs. In case
where a single leg (Sakthi) is presented, the other leg of
the foetus should be expanded and then it should be
drawn downward.

In the case of the presentation of the buttccks(Sphik).
I breech presentation), the buttocks should be first pressed,
and lifted up and then the foetus should be drawn
downward by the legs. In the case of a longitudinal

406 THE SUSHRUTA SAMHITA, [Chap. XV,

presentation (the child coming stretched cross-wise) like a belt and arrested in the passage, its lower extremities should be pushed upward with the hand and the child should be drawn out with its upper part (viz., the head, etc.), thus pointed downward, and brought straight into the passage of parturition. In a case of the head being hung back a little on one side, the shoulder should be lifted up by pressing it (with the hand) after chafening it, so as to bring the head at the door of the passage and the child should be drawn straight downward. Similarly in the case of the presentation of the two arms, the shoulder should be lifted up by pressing it (with the hand) and, the head being brought back to the passage, the child should be drawn downward. The remaining two kinds of false presentation 'Mudha- garbha) previously described (in the eighth Chapter of the Niddna Sthana) should be considered as irreme- diable. The applications of instruments (Sastra) should be the last resort when such manipulatory measures would fail. 5.

IVletrfCal Text : —But even in such irremediable
(Asadhya) cases, surgical operations should not be made
if the foetus could be detected alive in the womb, as
such a course (as the cutting of the foetus, etc.) would
fatally end both as regards the child and its mother. 6.

Operations involving destruction of the Foetus— Craniotomy :- In cases where

there would be any necessity of using an instrument for
the purpose of delivery, the enciente should be en-
couraged (with hopes of life) before making the surgical
operation. The head or skull of the child in such
cases should be severed with the knife known as the
Mamlaldgra or the Anguli-^astra ; then having carefully
takdrt out the particles of the skull-bone (Kap^la),

Chap. XV.3 CHIKITSA STHANAM. 40/

the foetus should be drawn out by pulling it at its chest or at the shoulder with a Sanku (forceps). Where the head would not be punctured and smashed, the foetus should be drawn out by pulling it at the cheeks or the eye-sockets. The hands of the foetus should be severed from the body at the shoulders, when they (the shoulders) would be found to have been obstructed in the passage and then the foetus should be drawn out. The abdomen of a child, dead in the womb, should be pierced and the intestines drawn out, in event of the former being swollen into a flatulent (Vdta) distension like a leather bag vfor holding water), as such a procedure would remove the stiffness of its limbs, and then it should be drawn out. The bones of the thighs ( Jaghana-kapala) should be first cut out and removed, where the foetus would be found to have adhered fast to the passage with its thighs ijaghana). 7. lYIetrical Texts :— in short, that part of the body of the foetus should be severed and removed which (prevents its (foetus) withdrawal from the womb and the life of the mother should be saved at all hazards. The different types of false-presentations should be ascribed to the abnormal coursing of the deranged Vayu (in the uterus), and hence an intelligent physician should adopt, after careful considerations, proper remedies (for its pacification). An intelligent physician should not waste a single moment in drawing out the foetus, as soon as it would be found to be dead in the womb, since neglect in such cases leads to the instantaneous death of the mother, like an animal dying of suffocation. An erudite physician, well-versed in a'natomy, should use in such cases a MandaUgra instru- ment for the purpose of cutting out '.the foetus), since a sharpe-edged Vriddhi-patra may sometimes hurt the mother during the operation. 9-10.

408 THE SUSHRUTA SAMHITA. [Chap. XV.

A non-falling placenta (Aparai) should be extracted
in the way indicated before or the enciente should be
firmly pressed and the placenta extracted with the
hand. Her body should be constantly shaken or
her shoulders constantly rubbed at the time (of
extracting the placenta') after lubricating the passsage
of parturition with oil. i r .

After- measures :— Thus having extracted the Salya (foetus^, the body of the mother should b^ washed with warm water and anointed with oil, etc. Oil should also be copiously applied to the passage of parturition * as it would soften the Yoni and alleviate the pain therein. After that, powdered Pippali, Pippali-roots^ S'unthi, Eld^ Hingii^ Bhdrgi, Dipyaka, Vachd, Ativishd, t<dsnd and Chavya should be given in a Sneha (clarified butter, etc.), for the (proper) discharge (2>., purification) of the Uoshas (lotia) and for the alleviation of the pain. A plaster, or a decoction, or a pulverised compound of the said drugs without the addition of any Sneha (clarified butter, etc.) may also be given to her. As an alternative, the physician should ask the parturient woman to take S' dka-hdixV^ Hingu, Ativishd, Pdthd, Katu-rohini and Tejovati prepared and administered in the preceding manner. Then for three, five or seven days, Sneha (clarified butter, etc.) should again be given ; or the patient should be asked to take well prepared Asavas and Arishtas at night time. A decoction of the bark of S'irisha and Kakubha should be used for washing (Achamanaf) purposes and the other supervening distresses {i.e.^ complications) should be remedied with proper medicines.. 12- A.

* The oil should be introduced into the vaginal canal by means o. PicllUt i e.y cotton plugs soaked in oil, etc.

t This decoction should be specially used for 1 washing the uterus (Yoni).— Ed.

Chap. XV.] CHIKITSA STHANAM. .469

Diet and regimen of conduct :— The

mother should always be neat and clean and subjected
to a course of a small quantity of wholesome and
emollient diet and to daily anointments and foment-
ations ; and she should be advised to renounce all anger.
Milk cooked with the Viyu-subduing drugs should be
used for the first ten days. Meat-soup should then be
prescribed for another such period, after which a diet
should be prescribed according to the patient's health
and nature. This regimen should be observed for a
period of four months, after which, the patient would
be found to have regained her health, strength and
glow of complexion, without any complications, when the
medical treatment, etc , should be discontinued. 12-14.

The following Vald-Taila should be used for apply-
ing into the Yoni (Vagina, etc.), for anointing the body
and for drinking and eating purposes (i.e., along with
other food) as well as for Vasti-Karma, as the oil is
highly efficacious in curbing the action of the deranged
and aggravated bodily Va(yu. 15— A.

The ValSL Taila : -* An adequate quantity of
sesamum oil should be cooked with eight times as much
of the decoction of each of the following ; viz., Vald
roots, Dasa-mula and the three combined drugs of Yava^
Kola and Kulattha and with eight times as much of
milk and (one-fourth as much of) a paste (Kalka) com-
pound of the drugs included in the Madhura group as
well as with Saindhava-sdXt, Aguru, Sarja-rasa, Sarala-
Kdshtha^ Deva-ddru, Manjishthd, Chandana^ Kushthay