1 m 1 tniuerstty |£tbrarg 30114008107024 Glasgow University Library nsrlfwH 195 ^ 1 A 5%B 2002 — ALL ITEMS ARE ISSUED SUBJECT TO RECALL GUL 96.18 ,tore 1A0 Digitized by the Internet Archive in 2015 https://archive.org/details/b21468746 ore BIBLIOTHECA INDICA: A pOLLECTION OF pRIENTAL JAfoRKS PUBLISHED BY THE ASIATIC SOCIETY OF BENGAL. New Series, No. 911. THE SUCEUTA.SAMHITA OR THE HINDU SYSTEM OF MEDICINE ACCORDING TO SUgRUTA. TRANSLATED FROM THE ORIGINAL SANSKRIT BY Dr. A. E. R. HOERNLE, CLE. FASCICULUS I. If CALCUTTA : PRINTED AT THE BAPTIST MISSION PRESS, AND PUBLISHED BY THE ASIATIC SOCIETY, 57, PARK STREET, 1897. GLASGOW I UNIVERSITY I UBRAKY The present translation of the Sucruta Samhita has been undertaken by me at the special request of the Council of the Asiatic Society of Bengal. The original translation, made by Dr. Udoy Chand Dutt was stopped by the untimely death of the translator, after the publication of his second f.asciculus. Its continuation by another translator proved so unsatisfactory that it had to be abandoned, after one more fasciculus. Dr. U. Ch. Dutt's translation, though a very fair performance, laboured under the disadvantage, owing to the translator's want of knowledge of Sanskrit, of not being made directly from the original language. It was also lack- ing all elucidation from the works of commentators. Both points are remedied in the present translation, which accor dingly has been commenced de novo. R. H. Calcutta, 2Qth November, 1897. w TRANSLATION OF THE SUCRUTA. FIRST SECTION. ON GENERAL PRINCIPLES. (8 TJTRA-STHANAiLJ THE FIRST CHAPTER. On the Origin of Medical Science (dj/urveda) . (1) 1 Salutation to Brahma, Prajapati, the Acvin-pair, Balabhid, Dhanvantari, Sucruta, and the rest !2 In the following chapter I shall describe the origin of the Medical Science, even as the blessed Dhanvantari related it to Sucruta. [1] (2) Once Aupadhenava, Vaitarana, Aurabhra, Pauskalavata, Karavirya, Gopura-raksita, Sucruta, and the rest3 (thus) ad- dressed the blessed, immortal Divodasa, king of KacI, the 1 For the convenience of reference the translation has been divided into paragraphs. On the other hand, the numbers, in- serted in the text within angular brackets, indicate the paragraphs into which the Sanskrit original is traditionally divided. The two commentaries referred to in the annotations are cited thus : Bha. = Bhanumati, the commentary ( tilta) of Oakrapanidatta, and Nr. =Nibandha-samgraha, the commentary of Dallana Acarya. 2 By Prajapati is here meant Daksa, a son of Brahma, and father of Durga. His celebrated sacrifice is referred to - in § 7. BalabJiid or ' the Slayer of Bala ' is an epithet of Indra. See below, § 8. 8 There are seven pupils: and by " the rest " are meant such physicians as Bhoja and others. Others, however, take Gropura 1 2 SOTKA-STHA]STAM. [sec. I. Dhanvantari or ' Great Surgeon/41 as he sat in his hermitage surrounded by a number of Ri&his : " O Blessed One ! our hearts are pained to see around us human beings suffering from the painful attacks of bodily, mental, adventitious and natural dis- eases (see § 10), (and to observe) how, helpless in the midst of friends, they are consumed in fruitless endeavours (after cures) and loudly lament (their fate.) With a view to the relief of the diseases of those health-seeking people and with a view to the preservation of our own life, for the sake of doing good to' mankind, we have come here with a desire to hear (from you) a brief exposition of the Medical Science. That science is the basis of one's well-being both in this world and the next. There- fore we have approached you, Blessed One, as pupils." (3) To them replied the Blessed One : " You are welcome, my sons ; there can be no question about the fitness of any of you to receive instruction ! [2] (Listen) then ! What is called the Ayurveda (or Medical Science), is one of the minor portions of the Atharva-veda.6 Svayambhu or ' the Self- existent One' (i.e., Brahma, see §§ 8, 16), before even he created and Raksita to be the separate names of two men, thus making eight pupils, to whom, for " the rest," they add Nmii, Kaykayana, Gargya, and Galava, thus making a total of twelve pupils. So Ni., but Bha. only gives the first alternative. In the Bower Manuscript, Part I (verse 8), there is a list of ten Rishis, who applied to Kagiraja for instruction. But the only name common to both lists is Sugruta. Moreover in the Bower MS. Kaciraja is the proper name of the Rishi, while in Sucruta it is an epithet ('king of Kaci') of Divodasa, and the latter is identified with the mythical Dhanvantari (see note 4>). In the first chapter of the Caraka, another long but quite different list of 51 medical Rishis is given. 4 Dhanvantari is derived from dhanu, a synonym of Calya- gastra or ' surgery,' and antari or ' going across ' ; that is ' one who has mastered surgery.' So Nr. He is said to have been the physician, or rather the surgeon, of the Devas whose wounds he healed in their war with the Asuras. See § 8 and footnote 13. 6 The Atharva-veda consists of the following nine parts : the veda, vakya, itihasa, five puranas, and vaidyaka or ' medical science.' So Biia, CHAP. I.] THE ORIGIN OF MEDICAL SCIENCE. 6 men, composed it in a thousand chapters and a hundred thousand verses (qloka). Afterwards in consideration of the short life and small intelligence of men he re-cast it into eight divisions. These are (1) Qalya or major surgery, (2) Qalakya or mihor surgery, (3) Kaya-cikitsa or the treatment of the body, (4) Bhuta-vidya or the science of demoniacal possession, (5) Kaumara-bhrtya or the management of children, (6) Agada-tantra or the doctrine of antidotes, (7) Rasayana-tantra or the doctrine of alterative tonics, (8) Vajikarana-tantra or the doctrine of aphrodisiacs." [3] (4) The following is a brief account of each of these (eight) divisions : — The first called Qalya 6 treats of the extraction of extraneous substances (from the body), such as grass, wood, stones, sand, iron, earth, bones, hair, nails, pus, and (retained) secretions ; also the foetus within the womb. It teaches also the use of blunt and cutting instruments, caustics and the actual cautery, and the diagnosis of inflammatory swellings. [4] The second called Qaldlcya ? treats of those diseases and their cures which have their seat in the ears, eyes, mouth, nose, or any other part of the body situated above the collar-bone. [5] The third called Kaya-cikitsa 8 treats of those diseases and their cures which affect the whole body, such as fever, diarrhoea, haemorrhage, consumption, insanity, epilepsy, skin-diseases, morbid secretion of urine, and others. [6] 6 Calya, lit. means any pointed object. 7 Calakya, lit., surgery performed by means of a galaJca or ' pricker' or ' awl.' Calaka properly signifies the patala-vB'Uianl, i.e., ' the instrument for piercing the tunics of the eye.' Hence galakya or calaka-tantra properly means 'surgery of the eye' ; but it is here used in a wider sense. So Bha. 8 Kaya is said, by Bha. and JSTi., to be a synonym of aqni or ' digestion,' and for this Blioja is quoted as an authority. Hence kaya-cikitsa would lit. be 'treatment of the digestion.' Kaya, however, as Ni. adds, also means the ' body ' { hence kaya-cikitsa 4 SUTRA-STHANAM. [sec. I. The fourth called Bliuta-vidyd treats of the mental derange- ments due to being possessed by a Deva, or a Gandharva, or a Yaksa, or a Raksasa, or an ancestral spirit or a Picaca, or a Naga, and the like. It also teaches how to cure these gra/ias (or seizures) 9 by means of religious offerings and other conciliatory performances. [7] The fifth called Kaumdra-bJirtya treats of the management of infants, of the removal of defects in the milk of wet-nurses, and of the cure of diseases caused by bad milk or by demonia- cal seizure.9 [8] The sixth called Agada-tantra, or the doctrine of anti- dotes, treats of the diagnosis of the poisonous bite of snakes, insects, spiders, scorpions, mice, etc. It also teaches how to cure people suffering from any of these various poisons, or from poi- soning due to an (unsuitable) combination (of food). 10 [9] The seventh called Rasayana-tantra or the doctrine of altera- tive tonics, treats of those medicines which preserve youth, promote (length of) life, intelligence, and strength, and give power to resist diseases. [10] The eighth called Vajikarana-tantra 11 or the doctrine of aphrodisiacs, treats of remedies for the implenishing, restoring*, means ' the treatment of the body.' Practically there is no difference. 9 The number of these graha or seizures, is said to be eight. They are all due to various kinds of supernatural beings : viz., (1) deva or gods ('angels'); (2) asura or daitya or enemies of the devas (' devils ') ; (3) gandharva or heavenly minstrels ; (4) yaJcsa or guardians of hidden treasure; (5) ralisasa or monsters (such as the ten-headed Ravana) ; (6) pitri or spirits of departed ancestors; (7) pigaca or flesh-eating demons; (8) naga or beings in serpent form. There exists also another class of graha, viz., the bdla-graha or ' demoniacal seizures affecting children.' They will be found enumerated below in chapter 3, § 8. They belong to the fifth division or the haumara-bhrtya. 10 The combined materials, by themselves, may be innocuous. Thus Ni. instances tho combination of honey and clarified butter. 11 The term vajikarana is variously explained. Vaji means ' strong,' 1 impetuous ' ; hence vdji-Jcarana is a ' means of making CHAP. I.] THE ORIGIN OF MEDICAL SCIENCE. 5 revigorating and recreating respectively of scanty, diseased, dried up, or wasted semen. 12 It also teaches how sexual desire may be stimulated. [11] Such are the eight divisions of Medical Science. (5) " Now, whom (of you) shall I instruct, and in which of these subjects ? " They replied : " Teach all of us, Blessed One, beginning with the very first, the knowledge of Qalya or 'major surgery*. " He said : " Be it so ! " They again said : " Blessed One, seeing that we hold all the same opinion, Sucruta will put our questions to you, and while you are instructing him, we (others) will listen with attention." He replied : " Be it so ! " (6) ("Listen) then, Sucruta, my son! the object of the Ayur-vlda or 1 Medical Science'' is the restoration of those who are afflicted with diseases, and the preservation of the others in sound health. [12] Aynh means 'life' and veda means 'to know' or f to attain/ Hence tii/ur-veda is that science which is con- cerned with the nature of life and with the means of preserving it. On the first division of it I shall now instruct you in confor- mity with the sacred scriptures and with (the results of) obser- vation, inference and analogy. Listen attentively ! " [13] (7) This division takes the first place, because the first (application of the healing art) was on the occasion of the healing of the wounds inflicted (in the assault on the sacrifice) and of the restoration of the head of the sacrificial animal. 13 For (sexually) potent.' But vaji means also a ' horse ' ; hence vaji-Jcarana is a 'means of making one like ahorse' (in sexual potency). The latter is the usual traditional interpretation al- ready given by Caraka. Both the above interpretations are given by Bha. and Nt. The latter, however, adds a third, which makes vaji to be a synonym of guhra or ' semen ' ; hence vaji- Jcarana is a ' means of producing semen.' 13 ' Scanty semen ' refers to natural deficiency in youth under twenty-five, ' wasted semen ' to deficiency due to excesses in middle life, ' dried-up semen,' to deficiency due to old age. ' Diseased semen ' is due to diseases, and may occur at any age. So Bha and Ni. 13 The reference is to the celebrated sacrifice of Daksa. The commentaries (Bha., Nr.) take this passage to contain refer- 6 SUTRA-STHANAM. [SEC. I. it is related, that when Budra had cut off the head of the sacrifice, the Devas approaching the Acvin-pair said to them : " Blessed Ones, you twins are admittedly the most excellent amongst us. It is you who must restore the head of the sacri- fice." The twins replied : " So be it ! " Then for their sake the Devas gratified Indra with a share of the sacrifice ; and they restored the head of the sacrifice. [14] Moreover among the eight subjects treated of in medical science that (which concerns major surgery) is the foremost, on account of its doing its work quickly, because it must be done by the application of blunt instruments, sharp instruments, caustics, and actual cautery, and on account of its being equal (in value) to all (the other) ences to two distinct occurrences : (1) the great war of the Asuras with tlie Devas for the possession of heaven, (2) Daksa's sacri- fice. But the context, which enters .only into the details of the second ccurrence, renders this explanation improbable. The sacrifice of Daksa is related with some minor variations in the Mahabharata and other works. The main story is that Daksa invited all the gods with the exception of his son-in-law Civa or Budra, who, in revenge, violently interrupted the sacrifice. He created a monster Virabhadra, who decapitated yajna or 'the sacrificial animal' (a deer), and wounded and maimed most of the guests. Finally Civa was pacified by being given a share in the sacrifice, whereupon he restored all the injuries done in the en- counter. According to some accounts, Daksa himself was decapi- tated, and as his head had fallen into the sacrificial fire, it was replaced by Civa with a goat's head. All these accounts know nothing of any intervention of the Acvins as healers. This seems to be an imbellishment of the medical castras, according to whom the Acvins were induced to undertake the restoration by a share of the sacrifice being allowed to Indra, who was their pupil (see § 8). The introduction of Indra is hardly sufficiently accounted for: one would rather expect the Acvins themselves to be gratified with a share in the sacrifice : moreover, one would expect the twins as well as Indra (all being devas) to be among the original guests and participators. The version of the story in the Mahabharata seems to have more consistency, which, however, in stories of this kind is perhaps not to be expected. Or may it be suggested that Indra is an ancient misreading for Budra ? CHAP. I.] THE ORIGIN OF MEDICAL SCIENCE. 7 subjects (put together).14 Hence it is a means of attaining salvation, religious merit, heaven, fame, longevity, and a compe- tency. [15] (8) Brahma was the first to promulgate (the science o£ medicine) ; from him Prajapati (i.e., Daksa) learned it ; from him again the Acvin-pair ; from the Acvins Indra ; from Indra my- self; and my duty it is (now), for the good of mankind, to communicate it here (in this world) to all who desire (to receive) it. [16] On this point there is (the following verse) : — It was I, Dhanvantari, the primeval Deva,lB that removed decrepitude, disease, and death from the Immortals (i.e., the Devas) ; and now I have appeared on the earth, in order to teach here surgery as well as the other branches of medical science. [17] (9) In this science by that aggregate, the animated body composed of the five elements, 16 is understood the puruia or 'the 14 Commentaries : " unless surgical work is done quickly, the patient suffers injury." The translation, above given, gives two reasons for the excellence of surgery; the passage, however, (as the commentaries point out) may also imply three reasons: "on account (1) of its doing its works (viz., incisions, etc.) quickly, (2) of its employing instruments, etc., (3) of its being of equal value to the rest, because, as Bha. explains it enters into the subjects of all the rest. Both Bha. and JSTi. make mention of another recension of this passage, which simply reads adhika- kriya-karanat i.e., 'on account of its doing more work (than the rest),' instead of agu-kriya-karanad=yantra samanyac=ca. Both add that, even with this reading, the two clauses yantra-gastra- ksar-agni-pr/midhanat and sarva-tantra-samanyat must be under- stood as being implied, as giving the reasons for surgery doing more work than the rest. 15 The adi-deva or 'primeval devas' are Brahma, etc., as contrasted with the knrma-deva or ' those who owe their divinity to their extraordinary feats,' such as Indra and others, and with the praydjana-deva or ' those who owe their divinity to some ne- cessity ' such as Buddha, Skanda and others. So the Com- mentaries. 16 The five malui-bliiita or ' elements ' are : earth, water, fire, air, and akdga (or ether). 8 SfjTItA-STHANAM. [sec. Ii human being1.' It is ho (alone) to whom medical acts1? refer, (and) he (alone) is the subject (of my discourse). Why? Because the world consists of two classes of being's. For the world is divisible into these two, the sthdvara or 'those that cannot move' and the jaqgama or 'those that can move.'13 It may be added incidentally that (from the point of view of fitness for medicinal use) the world is also divisible into the two classes of the calorific and the f rigorific ; or, having regard to its great variety, it may be divided into five classes.19 [18] Now the (jarjgama, considered as) bJmta (i.e., from the point of view of bhiiti or ' the manner of their birth') are divisible into four classes, namely those respectively termed sveda-ja or ' produced from warm moisture ' anda-ja or ' produced from an egg,' udbhij-ja or ' produced from a split in the earth,' and jardyu-ja or ' pro- duced from the womb.' Among these the purusa or ' the human being' is the chief, because the others are intended for his service. Hence it is the purusa or ' the human being/ who forms the subject (of my discourse.)20 [19] (1 0 ) Any occurrence which causes him pain is termed a vyadhi or ' disease.' These (diseases) may be of four kinds : adventi- tious, bodily, mental, and natural. Of these the adventitious W Such as the administration of medicines, and the applica- tion of instruments, caustics, bougies, etc. (Commentaiues). 18 On the details of this classification, see below § 12. 19 According as one or the other of the five elements (see foot- note 16) predominates in their composition. 20 The argument runs continuously through paragraphs 18 and ]9 of the Sanskrit text. It is briefly this : the world is divisible into two classes, the stationary and locomotive. The latter class, which includes men, is subject to states of disease and health. Yet medical science concerns itself only with the human being. Why ? Because man is the chief, all other living beings being sub- servient to him. This is clearly explained in Bha. But Ni. does not seem to have grasped the argument quite accurately. In para- graph 18 it takes purusa to mean ' a sentient being,' including both men and pagu or 'animals,' while in paragraph 19 it takes purusa as restricted to the human being. CHAP. I.] THE OltlGIN OP MEDICAL SCIENCE. 9 are injuries caused by violent'contact.21 Bodily diseases are caused by any derangement22 of the air, or bile, or phlegm, or blood, or of all these (humours) combined, brought on by (irregularities in) food and drink. Mental diseases, showing themselves in the form of anger, grief, fear, joy, disappointment, envy, proneness to detraction, despondency, unfriendliness, lust, avarice, and such- like dispositions, are the result either of (violent) desire or (violent) aversion. Natural diseases consist in (a perversion of) the natural states of hunger, thirst, old age, death, and sleep. All these diseases have their seat in the body and in the mind.23 [20] (11) Depuratory and rectificatory remedies, observances regarding food, and corrective practices, proj)erly employed, are the means for checking diseases.811 [21] 7,1 Such as those produced by weapons, supernatural beings, poison, fire, wind, etc. (Commentaries). Agantu lit. means ' arriving,' ' adventitious,' therefore a ' disease coming from the outside,' i.e., 'caused by injurious contact with some external body.' 22 That is : derangement of the proper proportion of the humours, either through excess or deficiency. (Commentaries). 8S That is: either in the body (as fever), or in the mind (as wrath), or in both (as epilepsy). Besides, a disease affects the body first, and the mind afterwards, or vice versa. So the Com- mentaries. Si Depuratories are extex*nal or internal. The external are in- struments, caustics, plasters, etc. ; the internal are emetics, purga- tives, enemas, errhines, and blood-letting. Rectificatories also are either external or internal. The former are liniments, douches, baths, unguents, applications to the head, liquid and semi-liquid gargles, etc. The latter are digestives, attenuants, nutrients, tonics, aphrodisiacs, antitoxics, etc. Food is of four kinds (having regard to the mode of consumption) : what can be drunk, licked, swallowed, and masticated ; or of three kinds (from the point of view of its effect) : relieving deranged humours, curing diseases, and giving health and sustenance. Corrective practices have reference to the body or the voice or the mind. Bodily exercises are, according to Bha., walking, copulating, dancing, etc., according to Ni., fasts, abstinences, etc. Vocal exercises are reading, singing, rc- 2 10 SUTRA-STHANAM. [SEC. I. (12) Now food is the sustenance of living beings and (the source) of their strength, colour, and vital power. (In order to be such) it depends on the six tastes ; and these again exist in the material objects. But the material objects (also) serve as ds ad Id or ■ medicaments ' ; and the latter are of two kinds: st ha vara or ' stationary/ and jaygama or ' locomotive/ Of these the stationary ones are of four kinds ; namely, vanaspati or ' trees that bear fruit but have no flowers/ vrlc$a or ' trees that bear both fruit and flowers/ virudh or ' plants that grow in the form of a creeper or a shrub/ and osadhi or ' plants that die after maturing their fruit/26 [22] The jar/jama or 'locomotive be- ings ' are also divided into four classes : the jarayu-ja or ' those produced from the womb/ the anda-ja or ' those produced from an egg/ the svlda-ja or ' those produced from warm moisture/ and the udbhij-ja or 'those produced from a split (in the earth)/ Of these the womb-born are the domestic animals, men, beasts of prey, and others.25 The egg-born are the birds, all slow and quick-moving reptiles, and others. The moisture-born are the worms, insects, ants, and others. The earth-born are the cochineal insects, frogs, and others. As to the ' stationary beings ' (or plants), their bark, leaves flowers, fruit, roots, tubers, exudations, juice, etc., and as to the 'locomotive beings' (or animals), their skin, nails, hair, blood, etc., are the objects of use in medicine. [23J To the class of parthiva or ' minerals ' belong the following : hearsing, etc. Mental exercises are thinking, meditating, calcu- lating, etc. The term ' properly ' refers to considerations of locality, time, age, etc. So the commentaries. 26 Examples are : of vanaspati, the Plaksa and Udumbara (or Ficus Tjakela and glomerata), etc. ; of vrhsa, the mango, jamun (Eugenia Jamholana) and other trees; of virudh, the Vidari, (Ipomoea digitata), pepper, lovage, Calaparnl and Prgniparrti (Desmodium gangeticum and Draria lagopoides), etc. ; of osadhi, wheat and other cereals. (Commentai'ies). 26 The commentaries explain that the domestic animals are placed first, because from the point of view of medicinal subser- viency, which is here in question, they are the most important. CHAP. I.] THE ORIGIN OF MEDICAL SCIENCE. 11 gold, silver, gems, pearls, realgar, earth, potsherds, and others.27 i (13) With reference to time we have the following varieties : breezy weather, calm weather, sunshine, shade, moon-light, dark- ness, cold weather, hot weather, rainy weather, day and night, fortnight, month, season, half-year, and other divisions of time. These, by their very nature, exercise an augmenting, or deranging, or relieving, or repressing influence on the humours (and the consequent diseases) ; hence a knowledge of them is necessary. [24] On this ( subject ) there are the ( following ) verses : — With regard to the diseases of men the above-mentioned four-fold group28 of causes of derangement and relief has been laid down by the physicians. [25] Those diseases which are accidental are of two kinds : some affect the mind, others the body ; and their treatment is also of two kinds. [26.] For those which affect the body, the treatment is the same as for bodily diseases. In the case of those which affect the mind, sounds and the rest of the (five-fold) group (of sensations) 29 of an agreeable nature bring relief. [27] (14) Thus far these four terms have been expounded : purnsa or ' the human being/ vyddhi or f disease/ misadha or ' medica- 27 The commentators are much exercised to account for the reason why the partliiva or 'minerals ' are not included as a third class of osadhi or 'medicaments,' in spite of their being clearly intended to be a kind of medicaments. Nothing satisfactory is said by them. But Bha. cites Caraka as giving a threefold division of medicamentary objects, jaygama or ' animals,' udhhida or ' plauts ' and parthiva or ' minerals.' It almost looks as if in the original system of Sucruta, the minerals were not considered medicinal, but were only introduced afterwards. 28 Namely, stationary beings, locomotive beings, minerals, and time, according to the physician Jaijjhata ; or food, practices (see § 11), minerals, and time. Bha. adopts the former, Ni., the latter alternative. Neither seems quite satisfactory, though to me the former appears more consonant with Sucruta's text as it now stands. 29 The five sensations or sense-objects are : sound, touch, form, taste, and smell. 12 SUTRA-STHANA.M. [SEC. I. ment/ and kriya-kala or 1 time with reference to its suitability for treatment.' Here the term ' human being ' includes not only the whole of the materials which compose his body and which (as stated before in § 9) are themselves composed of the (five) ele- ments,30 but also the constituent parts of its major and minor limbs/1 such as the skin, flesh, blood-vessels, nerves, and so forth. The term ' disease ' includes not only diseases due to air, or bile, or phlegm, or the blood, or to any of these combined, but diseases of every description (inch adventitious) . By the term ' medicament ' must be understood material objects as well as their gtma or ' elementary properties/ rasa or ' tastes/ vlrya or ' sensific powers/ and vipaka or ' digestibility/32 The term ' treatment ' {kriya) is the general one for all medical operations, such as cutting, etc., and administering oils, etc.33 The term ' time ' (kala) refers to the variety of time (which may be suit- able) for any particular (medical) operation.341 [28] (15) Here comes in (the following verse) : — Herewith I have declared (to you) succinctly the germ or quintessence of the (whole) therapeutical science. I shall (now) give (you) a detailed exposition in one hundred and twenty chapters.. [29] 30 Here the clravya or ' materials ' are the seven dhatu or secondary elements : semen, blood, chyle, flesh, fat, marrow, and bones ; while the five bhuta (or mahabhuta) or primary ' elements ' are earth, fire, water, air and akaga. So the commentaries. Usually, however, the term dravija connotes the ' material objects,' as distri- butable among the five classes of bhuta; as in ch. 3, § 2 [40], ch. 4, § 2. 31 Major limbs, such as the head ; minor limbs, such as the chin. (Commentaries). 32 For an exposition of these four terms,, see below chapters 40 and 41. 33 Surgical operations, such as cutting, opening, scarifying, probing, extracting, bleeding, sewing. Again, oils, sudorifics, eme- tics, purgatives, enemas, fumigations, errhines, gargles, digestives, alteratives, and so forth. (Commentaries). 31 Thus, the forenoon is the time suitable for the administration of emetics, and the early morning for that of purgatives. So Nl. CHAP. II.] THE INITIATION OP A PUPIL. 13 These one hundred and twenty chapters will be (arranged) in five sections with reference to the subjects (taught in them) : the Sutra-sthdria or ' section on general principles ; ' the Niddna-st liana or ' section on pathology/ the Qarira-sthana or ' section on anatomy;' the Cihitsita-stlidna or ' section on therapeutics/ and the Kalpa-sthana or ' section on toxicology/ Afterwards I shall expound the remaining subjects in the Uttara- tantra or the ' supplementary treatise/ [30] (16.) Here comes in (the following verse) : — Whoever studies this (science), promulgated by Svayambhu (or Brahma) in primeval times, and made known (to the world) by the king of KacT (or Benares), that meritorious person is reverenced on earth by kings, and after death attains a position (in heaven) equal to that of Indra. [31] THE SECOND CHAPTER. On the Initiation op a Pupil. [1] (1) A physician may admit as a pupil anyone of the Brahman, Ksatriya, and Vaicya castes who is of (good) family,36 youthful, observant of caste-rules, persevering, clean (in body and mind), well-bred,36 modest, energetic, strong, attentive, contented, possessed of a good memory, intelligent, and resourceful. His tongue, lips, and teeth should be delicate. His mouth, eyes and nose should be straight. His disposition, speech, and deportment should be agreeable. And he should be able to bear pain. Any one with opposite qualities should not be admitted as a pupil. [2] (2) When a Brahman (physician) performs the initiation ceremony, (he should act in the following manner.)87 On an auspi- 35 So Ni., but Bha. interprets : ' one who belongs to a medical family.' Ni. also gives this as an alternative. 36 Acara appears to have been wanting in Bha.'s recension of Sucruta's text. It does not comment on it, and interprets glla as ' well-bred,' 37 I have adopted the reading upanayanlyas = tu brahmanah or 14 SUTRA-STHANAM. [sec. I. cious titJii or ' lunar day/ Jcarana or ' lunar half -day/ muhurta or '30th part of a lunar day' and nalcsatra or 'lunar asterism/ in an auspicious direction/8 on clean and even ground, a sacrificial spot, four cubits square, should be smeared with cowdung and spread with clarbha grass {Poa cynosuroides) . Then the gods should be honoured with flowers, fried rice, rice, and jewels, like- wise the (officiating) Brahmans, and the (witnessing) physicians. Then, having marked off (the sacrificial square) and besprink- led it (with water), (the officiant) should place the Brahman (pupil) on' his right, and kindling before himself a fire with the wood of Khadira (Acacia Catechu), Palaca (Butea frondosa), deodar and bel, smeared with curds, honey and clarified butter, or (with the wood) of the four trees with a milky sap, viz., the Nyagrodha (Ficas beugalensis), Udumbara (Ficus glo- merata), Acvattha (Ficus rcligiosa) and Madhuka (Bassia lati- folia),h% (smeared in the same way), he should offer on it oblations of clarified butter with a sacrificial ladle according to the Darvlhoma rite.40 Next with the mystical syllable and the great ' the initiating Brahman.' Here upanayaniyas has the active sense of upanetd. I follow hei'ein Bha. But Ni. adopts the reading vpanayainyam tu hralimanam or ' the Brahman (pupil) who is to be initiated.' But this reading does not well agree with the subsequent context hralimanam sthapayltva ' having placed the Brahman (pupil).' The case of the Brahman physician and the Brahman pupil is here only given as au exemplar of the initiation ceremony. The commentaries explain that they are only selected honoris causa, but that the same ceremonies take place in the case of Ksatriyas or Vaicyas ; only in the case of a pudra the ceremony is modified, as noted in § 3. They add, however, that of what- ever caste the medical teacher who ari-anges for the initiation may be, the initiation rites themselves must be performed by a Brahman. 68 I.e., towai*ds the East or North. (Commentaries ) 89 The members of this group of trees are variously enumerated. Some give the Plaksa (Ficus Tjakela) in the place of the Madhuka. Some give the number of the group as five. 40 The Darvlhoma rite is well-known as that of Brahmans who are chandovid or ' proficient in incantations.' So JSTi. OHAP. II.] THE INITIATION OF A PUPIL. 15 mystical words4,1 he should pronounce svd/td in the name of every deity and every Rishi, and cause the pupil to do the same. (3) A Brahman may give initiation to a pupil of three castes, a Rajanya (i.e., Ksatriya) to one of two castes/2 but a Vsd^ya, to one of the Vaicya caste only. Some say that a £iidra, if ne is of (good) family and (good) character, may also be admitted to instruction, but without the initiatory rites.4,3 [3] (4) Then leading the pupil three times round the fire 44 and invoking the fire as witness, he should thus address him : " It must be your inflexible rule to eschew lust, anger, avarice, pride, vanity, envy, rudeness, gossiping, lying, idleness, and every other reprehensible conduct, to keep short your nails and hair, to be clean in your person, to dress yourself in reddish-coloured cloth, and to endeavour to lead an upright, pure, and respectful life. You must be always ready to abide by my directions with regard to residing, going about, lying down, sitting down, eating, and studying, and you must always be intent on furthering my 4,1 The mystic syllable is om and the three great mystic words are bhur, bhuvah, svar. The formula runs as follows : Om bhuh svaha, Om bhuvah svaha, Om svah svaha, Om bhur bhuvah svah svaha. So Ni. 42 That is, to Brahmans, Ksatriyas, Vaicyas, and to Ksatriyas Vaicyas, respectively. 4,8 Paragraph 3 is clearly a later interpolation, as it interrupts the account of the initiatory ceremonies. According to Ni. it is rejected by the nibandhas or ' commentaries.' Bha., however, admits it, and argues strongly in favour of the fudras. The reason of the interpolation in this particular place clearly is to indicate that the preceding portion of the initiatory rites is omitted in the case of a f udra, while the subsequent portion (in § 4) is permitted. — According to Ki. there are two readings: either 0sampannam=anupanitam,i.e., ' he maybe admitted without any initiating rites ' ; or °sampannam mantra-varja'n-upanUam, i.e., ' he may be initiated, but without the mantra.' It is not clear which of the two was adopted by Bha. They are, however, practically equivalent. 4,41 In the form of pradaksina, i.e., from left to right, so that the right side is kept towards the fire. So Ni. 16 S UTlt A-STH AN AM . [SEC. I. pleasure and welfare. If you shall be wanting in all this, you will be a sinner, and your learning will be useless to you and fail to bring you fame. [4] On the other hand, if, while you are regular in the discharge of your duties, I should behave improperly towards you, I shall be committing sin, and my learn- ing will be useless to me." (5) To treat Brahmans, spiritual guides, paupers, friends, ascetics, neighbours, devotees, orphans and widows, and people who come from a distance, (gratuitously) with one's own medicines, as if they were one's own relations, is right. But hunters, fowlers, outcasts, and sinners should not be treated. By pursuing such a policy, one makes himself known as learned, and attains friends, fame, merit, wealth, and pleasure. [5] (6) Here come in (the following verses) : — On the eighth day of the dark half of the month, as well as on its two last days {i.e., the fourteenth and fifteenth) ; on the same days also of the light half of the month, as well as on the two twilights {i.e., dawn and dusk) of the day; when there is thunder and lightning at unusual times 46 ; when one's people or country or king are in dis- tress; [6] during the whole day on which one has been to a cemetery 4,6 ; during the time of a battle, or a festival,*''' 45 That is, when rain falls in any of the four months compris- ing the cold and dewy seasons (hemanta and gi^ira), i.e., from the middle of November to the middle of March ; or when thunder- storms occur in the morning or evening. (Commentaries.) 4,6 Adyatana is the period of a current day, reckoned either from dawn to dark or from midnight to midnight. This appears to me to be the only rational explanation of the compound word. Both Bha. and Ni. explain it thus : " on a cemetery or on a slaughter- ground of pack-animals " taking yana to mean hasty-adi or ' elephants, etc ,' and adyatana to mean badha-sthana or ' place of slaughtering.' I do not understand how the latter meaning for adyatana is arrived at. W Such as the festival of Qukra (or Venus) on the full-moon of the month Bhadrapada (August-September) ; the Kaumudi (or full-moon) festival in the month Avvina; the festival of 1/ CHAP. III.] THE CONTENTS OF THIS WORK. 17 or the appearance of a portent,*3 — (on any of these occasions) the student should never read ; nor should he do so at any other time when Brahmans do not study ; nor must he ever read when he is impure. [7] THE THIRD CHAPTER. On the Contents of this Work. [1] (1) It has been already stated (see § 15, p. 12) that the one hundred and twenty chapters (of this work) (will be distributed) in five sections. Of these the (first) section on General Principles will contain forty-six chapters : the (second) on Pathology, sixteen : the (third) on Anatomy, ten : the (fourth) on Thera- peutics, forty : the (fifth) on Toxicology, eight. Then will follow the supplementary part with sixty-six chapters. [2] (2) The following are the forty-six chapters of the Sutra- st/tdna or { Section on General Principles/ which is called so, because in it the whole of the subjects (of medical science) are presented in clear detail, proper arrangement, and orderly development. [11] i The origin of the medical science. ii The initiation of pupils. iii The exposition of the (contents of the several) chapters. iv The (importance of) understanding the (medical) terms. v Preliminary arrangements in surgical practice. vi Regimen (to be observed) in the various seasons. vii Description of blunt instruments. [3] viii Mode of applying cutting instruments. ix (Practical training in) the application of surgery. Kuvera (or the god of wealth) at the summer solstice ; the festival of Madana (or the god of love) on the thirteenth day of the light half of the month Caitra (March- April), and others. So Nr. 48 I.e., any extraordinary natural phenomenon indicative of evil, such as an earthquake or hurricane, a mirage or rainbow, or any wonderful change in a planet or star, (So Nl.) 3 SUTKA-STHANAM . [sec. x (Rules with regard to visiting) the sick-room. xi Preparation and use of caustics. xii Lecture on actual cautery. xiii Lecture on leeches. xiv Discourse on the blood. [4] xv Instruction with regard to the humours, con- stituent elements, excretions, etc., (of the body). xvi Piercing the (lobules of the) ear. xvii Diagnosis of immature and mature (inflamma- tions). xviii (Application of) liniments. xix (General rules of) treating inflamed parts. [5] xx Things salutary and in salutary. xxi Enquiry into (the origin of) inflammation. xxii Discharges from inflamed parts. xxiii Characteristics of curable and incurable (inflam- mations) . xxiv Classification of diseases. [6] xxv Definition of the various kinds of surgical operations. xxvi Diagnosis of the presence of a dead {i.e., foreign) substance (in the body). xxvii Extraction of foreign substances. xxviii Prognosis of inflammations. xxix Prognostication from the messenger, dreams, etc. [7] xxx Morbid changes (as premonitory signs of death) in the five senses. xxxi The same in the general appearance. xxxii The same in the constitution (of the body) . xxxiii Avoidance (of treating incurable diseases) . xxxiv Treatment of a king engaged in warfare. xxxv Treatment of the feeble. xxxvi Miscellaneous formulae (for external applica- tions to inflammations) . [8] xxxvii Different varieties of soil (with reference to the collection c f drugs) . CHAP. III.] THE CONTENTS OF THIS WORK. 19 xxxviii Classification of drugs. xxxix Drugs useful for depuration and rectification (of the humours). xl Exposition of the terms dravi/a or 'material 1 • i » 111 A A.Q object and the rest.*y xli Predominant characters ot drugs, [yj xlii Information on the (six) rasa or ' tastes.' xliii Preparation of emetics. xliv Preparation ot cathartics. xlv Various kinds of liquid substances. xlvi On food and drink. [10] (3) The following are the sixteen chapters of the Nidana- sthana or ' Section on Pathology/ which is so called on account of its describing the causes and symptoms (of diseases). [13] i Diseases of the nervous system, ii Hemorrhoids. iii Calculus in the bladder. iv Fistula-in-ano. v Skin-diseases. vi Morbid secretion of urine. vii Abdominal tumours. viii Complex labour. ix Deep-seated abscesses. x Malignant growths. [12] xi Glandular enlargements. xii Scrotal enlargements. xiii Fractures &0. xiv Sores on the penis caused by the gu&a or ' hairy caterpillar.5 xv Minor diseases, xyi Diseases of the mouth. 49 See footnote 30 on p. 12. " The rest " refers to the tastes, elementary properties, sensific powers, and digestibility, see chap. 4, §2. 60 Here the order of the chapters in the book itself differs. The fractures form the 15th chapter, while the penis-sores and the minor diseases form the 13th and 14th chapters respectively. 20 SUTRA-STHANAM. [SEC. I. (4) The following are the ten chapters of the Qarira-stMna or ' Section on Anatomy/ which was propounded by the Maharsi {i.e., Dhanvantari), in order to give to physicians and Yogis or ' wizards ' a knowledge of the (constitution of the human) body. [16] i Theory of the origin of living beings. ii Rectification of the semen and menses. iii Impregnation of the womb. iv Description of the foetus. v Description of the (human) body. [14] vi Exposition of the vital parts (of the body), vii Description of the vascular system. viii Venesection. ix Description of the ducts and nerves. x Description of pregnancy. [15] ( 5) The following are the forty chapters of the Cikitsa-stJiana or c Section on Therapeutics/ which is so called, because it treats of the amending or rectifying or curing or alleviating, as it may be variously termed, (of diseases). [25] i Treatment of the two kinds of inflamed sores. ii Treatment of recent inflamed sores. iii Treatment of fractures. iv Treatment of nervous diseases. v Treatment of major diseases of the nervous system. vi Treatment of hemorrhoids. vii Treatment of calculus. viii Treatment of fistula-in-ano. [17] ix Treatment of skin-diseases, x Treatment of major skin-diseases. xi Treatment of morbid secretion of urine. xii Treatment of eruptions on the skin (in the fore- going disease). xiii Treatment of diabetes. xiv Treatment of abdominal enlargements. [18] xv Treatment of complex labour. xvi Treatment of deep-seated abscesses. CHAP. III.] THE CONTENTS OF THIS WORK. 21 XVII xviii xix xx xxi xxii xxiii xxiv xxv xxvi xxvii xxviii xxix xxx xxxi xxxii xxxiii xxxiv xxxv xxxvi xxxvii xxxviii xxxix xl (6) The or ' Section treating) of sons. [27] Treatment of malignant ulcerations. Treatment of glandular enlargements. Treatment of scrotal enlargements and diseases of the penis. Treatment of minor diseases. [19] Treatment of sores on the penis produced by the guka or ' hairy caterpillar/ Treatment of diseases of the mouth. Prevention of inflammatory swellings. Prevention of diseases generally. Miscellaneous formulae. [20] Aphrodisiacs in cases of debility. Tonic treatment in every kind of ailment. Means of strengthening the memory and pro- longing life. (The Soma tonics for) the prevention of (all) natural diseases. [21] The tonic known by the name of ' pain-killer/ Use of medicated oils. Modes of sweating. Emetics and cathartics. [22] Treatment of disorders brought on by the misuse of the two preceding remedies. Classification of syringes, made of a nozzle and bladder, for clysters. Treatment of disorders caused by (the misuse of) such a syringe. The application of oily enemas by the urethra. [23] Enemas made with other liquids. Treatment of a patient weakened (by the use of the above-mentioned remedies). Various kinds of inhalations. [24] following are the eight chapters of the Kalpa-sthana on Toxicology/ which is so called because (of its the preparation and use of remedies against poi- n SUTRA-STHANAM. [sec. I. i The protection of food. ii Account of vegetable and mineral poisons. iii Animal poisons. iv Information on snake-bites. v Treatment of the latter. [26] vi Some dundubhi or < far-famed ' antidotes bK vii Antidotes against rat-bites. viii Antidotes against insect-bites. (7) Thus far altogether one hundred and twenty chapters have been described. Hence forward the TJttara-i antra, or the ' Supplementary Treatise ' will be spoken of, with its several (four) parts as hereafter named/52 [28] Its first chapter is concerned with the upadrava or ' troublesome diseases ' (of the eye) ; hence this (supplementary) treatise is also called the Aupadravika or ' Treatise on Troublesome Diseases/ [29] Next follow in order the (various) chapters which describe the diseases (of the eye) . i On troublesome eye-diseases generally. ii On diseases in the joinings of the eye. iii On diseases in the eyelids. iv On diseases in the sclerotica. v On diseases in the cornea. vi On diseases in the whole eyeball. vii On diseases in the lens. [30] viii Classification of the treatments (of eye-diseases) . ix Curing of ophthalmia caused by (deranged) air. x Cui'ing of ophthalmia caused by (deranged) bile. xi Curing of ophthalmia caused by (deranged) phlegm. xii Curing of ophthalmia caused by (deranged) blood. [31] xiii On scarification in eye-diseases. xiv On incision in eye-diseases. xv On excision in eye -diseases. 61 The order of these chapters in the book itself differs. There the dundubhi form the seventh, and the rat-bites the sixth chapter. 68 For these four parts, see below § 12. • CHAP. III.] THE CONTEXTS OF THIS WORK. 23 xvi On diseases of the eyelashes, xvii On diseases of the lens. xviii Description of external applications (to the eyes) . xix (Treatment of) injuries (to the eyes) caused by violent contact, xx Diseases of the ears. xxi Their treatment. [32] xxii Description of the diseases of the nose. xxiii Cure of these diseases. xxiv Cure of coryza. xxv Description of the diseases of the head. xxvi Treatment of these diseases. The preceding (twenty-six chapters) constitute the Q&ldhya- tantra or ' Treatise on Minor Surgery/ [33] (8) xxvii Description of the nine graha (or demoniacal possessions) . xxviii Treatment of the Skancla. xxix Treatment of the Apasmdra. xxx Treatment of the Qalcum. xxxi Treatment of the Revati. [34] xxxii Treatment of the PMand. xxxiii Treatment of the Andha-putand. xxxiv Treatment of the Mandika 63. xxxv Treatment of the QUa-putand. xxxvi Treatment of the Naigamesa. xxxvii Origin of these seizures. xxxviii (Cure of the) diseases of the womb. The preceding (twelve chapters) constitute the Kaumdra-tantra or ' Treatise on the Management of Children/ (and refer to the subjects) named in the Qarlra-sthdna or ' Section on Anatomy/ [35] (9) xxxix Cure of fever. xl Cure of diarrhoea, xli Cure of consumption. 68 In the book itself the chapter on Mandika is placed after that on Cita-putana. 24 SUTRA-STHANAM. [SEC. I. xlii IjITVP fir 5i.nn ATYiiTia.] fmnmivcj V^lllC \J L <X K)\.\.\J ill L 1 Idl LLllllU 111 D« xli.it I ,n VP At liPQ vf _rli coo ooa "vll V All V I ,11VP AT YY1 AVA1 A TiQ I AV xlv 1 ,11 VP AT li dPTYi Awn q cva V>* U-1 C LJX. JJ.oE7J4J.lJJ, 1 lx<*£* o. "vl VI AX V J. I .n VP at tqi n 1 1 n cp V^UIC KJl. Idlll LI 11 H . o xlvn t!iiVP nf fMPAiiAliam r^n*~l W 111 C/ UJ_ dilL-L/llUllbllJ . OU V 1 Will A 1 V 111 1,11 VP AT TV1 AVhl A T r»l VC T V MY I ,11 VP AT VATYlvfl Tl A* Lilt UX. V VXUl Llllg ■ 1 IJlTPP HT VllPPAIlO'Tl 11 1 ,11 VP AT 5S cfn m Q VUIC *JJL tlo I 1 Illicit lii 111 I n VP At aah rrn Vy 111 C Ul o liii Cure of aphonia. liv Cure of worms. lv Cure of retention of discharges. [37] lvi Cure of cholera. lvii Cure of anorexia. lviii Cure of dysuria. lxix Cure of strangury. The preceding (twenty-one chapters) constitute the remainder of the Kaga-cikitsd or ' Treatment of the Body / 64> [38] (10) lx Cure of diseases caused by superhuman agencies. Ixi Cure of epilepsy. lxii Cure of insanity. The preceding (three chapters) constitute the Blmta-vidyd or ' Science of Demoniacism/ [39] (11) lxiii Enumeration of the (combinations of) tastes, lxiv Hygienic rules. lxv Syntactical rules. lxvi Enumeration of the (combinations of) humours. The preceding (four chapters) must be understood to serve as embellishments of this treatise. 5i The commentary explains that the term 1 remainder ' indicates that other portions of the ' treatment of the body ' have already been given in the preceding part on galya or ' major surgery.' The reference here is clearly to the cikitsa-sthana or ' section on therapeutics.' CHAP. III.] THE CONTENTS OV THIS WORK. 26 (12) On account of its excellence the Maharsis have called this treatise the Uttara or ' superior one/ Its excellence lies in the fact of its comprising so many subjects. It is also called Uttara or ' supplemental * by reason of its position at the end. [41] The subjects comprised in it, are the following four : i Minor surgery, ii Management of infants, iii Medical treatment of the body, iv Science of demoniacism. [42] (13) The subjects of aphrodisiacs and alterative tonics are included in the Cikitsa-sthana or ' Section on Therapeutics.' 65 [42] The doctrine of poisons is given in the Kalpa-stMna or * Section on Toxicology/ Information about (the treatment of) foreign substances in the body will be found in every part (of this work). [43] (14) This work, then, with its above-named eight divisions, first made known by the Primordial Deva (i.e., Brahma), whoever will carefully study and use in his practice, he will become a saviour of life in this world. [44] Both are equally necessary : the study of this science as well as its practical application after study. A physician, who is proficient in both, will be honoured by his king. [45] (15) Here come in (the following verses) : — One who knows medical science only theoretically, but possesses no practical experience, looses his head in the presence of a patient, just as a coward does in the presence of a challenge to fight. [46] On the other hand, he who is well- versed in praxis, but from self-confidence is neglect- ful of (keeping up) the study of his science,66 does not obtain the esteem of good men, and deserves to be con- demned to death by the king. [47] Both these kinds of 66 Aphrodisiacs are treated of in the 26th, and alterative tonics in the 27th-30th chapters of that section. 56 I.e., One who, trusting entirely to his early acquisition of the science as a pupil, neglects to keep up his reading as a practitioner. (Commentaries.) 4 2G SUTRA-STAN AM. [sec. I. unqualified physicians are unfit to practice their calling ; for possessing only one-half of the knowledge of it, they ai-e like birds that possess only one wing. [48] Medicines, though they are like nectar, become like poison, light- ning, or other instruments of destruction, if they are administered by an ignorant practitioner." Therefore such should be avoided. [49] A physician who is unskilled in operations, such as excision and the like, or application of medicated oils and the like, merely kills people from avarice. It is the king's fault, if such bad physicians exist. [50] On the other hand, he who is proficient in ■ both (theory and practice) is fit to intelligently exercise his calling, just as a carriage with two wheels is fit to accomplish its work in the battle. [51] (16) Now, my son, listen attentively to my instruction, how this (medical science) is to be studied. After having performed the prescribed purifications, the pupil must present himself, dressed in his upper garment and with an undistracted mind, at the hour of instruction ; and the tutor should then teach him, according to his capacity, either a word, or a quarter-verse, or a f ull- verse 68 ; and the pupil must repeat these after him, again and again, in their proper order. In this manner the tutor should instruct each pupil separately ; and he should himself repeat the lesson after his pupil. The latter should read not too quickly, nor too slowly, nor with fear, nor with a nasal twang, but with distinct utterance of every syllable, and without distortion of any letter, not gesticulating with eye, eyebrows, lips and hands, but (reading) with a well-modulated voice, neither too high, nor too low. Nor should any one pass between tutor and pupil, while they are engaged in study. [52] (17) Here come in (the following verses) : — Purified, devoted to his tutor, alert, and eschewing laziness 6? The allusion is to the story of Garuda wlio stole the nectar and to whom it turned into poison. So Nr. 68 The text has floka, i.e., a verse of 32 syllables; and Bha. explains that if a medical work is written in prose, the direction refers to clauses of 8, 16, or 32 syllables respectively. CHAP. IV.] THE TERMINOLOGY OF MEDICAL SCIENCE. 27 and sleep, the pupil should study : in this wise he will attain complete mastery over medical science. [53] One who has completed his studies should then strive to attain clearness of speech, comprehension of the requirements of any case, confidence in himself, skill and practice in medical work, and success (in his profession). [54] THE FOURTH CHAPTER. The Importance of Understanding the Terminology of Medical Science. [1] (1) Learning by rote without understanding the meaning of what is learned is profitless labour like that of the ass carrying a load of sandalwood. [2] Here comes in (the following verse) : — As the ass that carries a load of sandalwood is conscious of the (weight of the) load, but not of the (fragrance of the) sandalwood, so those who learn numerous medical text-books, but remain fools with reference to their mean- ing are, ass-like, mere carriers of a load. [3] (2) Hence every word, quarter-verse, full-verse, and half- verse,BS singly, of these one hundred and twenty chapters59 must be again and again explained (to the pupil) and rehearsed (by the latter.) The reason is that it is a subtle matter to classify and discriminate the material objects, their tastes, elementary properties, sensific powers, and digestibility 82 ; the humours and constituent elements of the body, its secretions, viscera, vital parts, blood-vessels, ligaments and nerves,60 joints, bones, and 69 This shows very clearly that the Uttara Tantra is a later addition to the original work of Sucruta which only contained 120 chapters, up to the end of the Kalpa Sthana. 60 The term snayu includes both ligaments and nerves. The nerves are also included in the term dhamani, which comprises both ducts (or vasa) and nerves. The latter were not recognised as a distinct part of the body. 28 StjTRA-STHANAM. [sec. I. all the factors of pregnancy" ; also to extract foreign bodies, diagnose inflamed sores, and treat fractures ; also to prognose the curability or incurability of diseases. These and a thousand other such important matters which require to be thought over are apt to puzzle even men of clear and great intellect, how much more those of small intellect ? Hence it is very necessary that every word, quarter-verse, full-verse and half -verse should be over and over again explained (to the pupil) and rehearsed (by the latter). [4] (3) As subjects will be referred to in this (work) which belong to other sciences, and as it will be necessary (for the pupil) to know their meaning, he must obtain information on them from men learned in those sciences. The reason is that it is im- possible in (treating of) any one science to avoid referring to other sciences. [5] (4) Here come in (the following verses) : — Any one who knows no more than a single science, can have no thorough knowledge of that science. Hence a physician will not be proficient in his own science, unless he is versed also in many other sciences. [6] A physician who is not content with merely learning his science from the lips of his tutor, but familiarises himself with it by repeated study, he is a true physician; all others are swindlers. [7] The surgical treatises of Aupadhenava, Aurabhra, Sucruta, and Pauskalavati form the basis of all other treatises on the subject.6' Hence instruction should be given in those works. [8] 61 Such as semen, menstrual blood, etc. (Commentaries.) 68 According to Nl. the other treatises are those of Karavirya, Gopura-raksita, etc. But the commentary adds that, according to other commentators, mulani means only ' most important,' i.e., ' among the various surgical works those of Aupadhenava, etc., are the most important.' CHAP. V.] PRELIMINARIES FOR SURGERY. 29 THE FIFTH CHAPTER. Preliminary Arrangements for Surgical Operations. [1] (1) There are three stages in the treatment (of diseases) : the preliminary, the principal, and the after-treatment. These we shall describe separately in the case of each individual disease. In this work, surgery being the most important subject, I shall begin with describing the preliminaries for surgical operations and all the requisites for them. [2] (2) Of surgical operations there are eight kinds, namely, excision, incision, scarification, puncturing, probing, extraction, letting out pus, and stitching. (3) Now when a physician desires to perform any operation, he should first of all arrange in a handy place the following articles : blunt and cutting instruments, caustics and cautery, probes, a horn, leeches, a hollow bottle-gourd,63 a bougie,61 cotton, pieces of cloth, thread, leaves, bandages, honey, clarified butter, suet, milk, oil, refreshments and decoctions,66 liniments, pastes, a fan, cold and hot water, pans, and other useful things. (He should) also (provide himself with) trusty, steady, and strong assistants. [3] Then, on an auspicious tithi or ' lunar day/ karana or ' lunar half -day/ muhurtta or ' 30th part of a lunar day/ and naksatra or ' lunar asterism/ after having worshipped Agni {i.e., 63 This is the Alabu (Lagenaria vulgaris), the shell of which is hard and ligneous, and when dried is much used in the East as a vessel for holding fluids of all kinds ; also for making guitars and banjos. See Pharmacographia Indica, Vol. II, p. 67. 64 The text has jdmbav-austha, lit. ' having jambu-like lips.' Ni. explains that the bougie is made of a black stone the extremity of which is shaped like the fruit of the Jambu tree (the Jamun or Eugenia Jambolana). 66 The text has tarpana and kasaya. According to the com- mentaries, tarpana means gaktu (flour of any parched grain) or milk or other substance mixed with water and given to the patient if he becomes thirsty. Kasaya is explained as the decoction (to one-quarter or one-eighth) of medicinal plants. 80 SUTRA-STHANAM. [SEC. I. the god of fire), Brahmans, and (other) physicians with curds, whole (rice-) grains, food, drink, and jewels, offered oblations, and said words of lucky import and welcome, the patient, who must only have taken a light meal, should be set face to face with the physician and firmly secui'ed. The latter, (taking care to) avoid any vital part, bloodvessel, nerve and ligament,60 joint, bone, or duct,63 should introduce the instrument in the direction of the hairs of the skin, till pus appears, and then at once and quickly withdraw it. (4) In large abscesses the instrument may be inserted to the depth of two fingers' breadth. [4] The marks indicating an abscess to be ready for operation are, that it has a large base, rounded form, uniform maturation, and a favourable position. [5] Here come in (the following two verses) : — An abscess with a large base, a rounded form, well- matured, and unconnected with any important organ,66 and (in short) one which is operated on at the proper time, will readily heal by the operation. [6] It will heal, if it is operated on by a physician, who is fearless and quick, whose instrument is sharp, who does not perspire or tremble, and who does not err (in his diag- nosis.) w [7] If on the first incision68 the abscess is not emptied, it should 66 The term su-vibhakta is rather obscure, even in the com- mentaries. It seems to be here synonymous with sama in § 5 of the Sanskrit text, while in § 5 it seems to be synonymous with niragraya in § 6. 6? Or it may mean 'who does not faint (at the sight of blood).' So Ni. 68 The Sanskrit text has vrana, lit. ' wound,' hence ' incision.' This word is used, in medical works, with two different meanings. It may mean either simply ' a wound,' or it may be equivalent with gotha or ' inflammation,' ' an inflamed sore or swelling.' Thus Bha. says here : gotho 'pi vrana-hetutaya vrana ucyate, i.e., ' an inflamed swelling ' may also be called a vrana, when it is caused by a wound or sore. CHAP. V.] PRELIMINARIES FOR SURGERY. 31 be carefully explored, and other incisions should be made. [8] Here comes in (the following verse) : — In whatever direction (a physician) perceives a sinus, and wherever there is (still) a collection (of pus), there he should ' make an incision, lest any pus should re- main behind. [9] In the following places : eyebrows, cheeks, temple, forehead, eyelids, lips, gums, armpits, abdomen, and groin, a transverse incision is indicated. [10] A circular incision should be made on the palms and soles, and a semicircular, on the anus and penis. [11] Otherwise a bloodvessel or ligament or nerve may be divided, and thus excess of pain, and delay in the coalescing and granulating of the wound will be caused. In the case of complex labour, enlargements of the abdomen, hoemorrhoids, calculus, fistula-in-ano, and mouth-diseases,69 the operation should be performed (on the patient) in empty stomach. [12] (5) After the operation, the physician should revive the patient with cold water, and then press the wound all round with his fingers (to empty it thoroughly), smooth it down, wash it with an astringent decoction, wipe it with a piece of cloth, and insert into it a tent thickly smeared with a paste of sesamum- seed, honey and clarified butter, and impregnated with (depura- tory) drugs. Next he should cover it with a paste (of suitable drugs), place over this a thick pad,70 neither too wet nor too dry, tie (the whole) with a bandage, and fumigate it with pastils made of pain-killing drugs.71 He should also, for the patient's pro- tection from dangers, pronounce mantras or 'charms' against evil spirits. [13] 69 In the case of mouth-diseases the reason is that owing to the pressure of the operator's fingers, etc., or from disgust, the food is thrown up again, and the operation is interfered with. So Nr. Bha. only gives the latter alternative. 70 The pad may he made either of the crushed bark and leaves of the Palaga (Butea frondosci), Udumhara (Ficus glomerata) and other trees ; or of two or four folds of a soft piece of cloth ; or of powder of parched wheat mixed with clarified butter. So Nl,, but Bha. only gives the first method. 71 The object of fumigation is to ward off flies, etc. So Bha. 32 SUTRA-STHANAM. [sec. I. (14) Also the place should be fumigated 73 vvith pastils made of the powders of Indian bdellium, aloe-wood, resin of the Sal tree, (root of) Vacha (Acortis Calamus), and white mustard, mixed with salt and NTm-leaves, and done up with clarified butter. With the rest of the clarified butter (thus done up) the patient's vital parts (i.e., the heart, etc.) should be anointed. Then taking water from the drinking-water vessel, and sprinkling it (in the room), the physician should pronounce the subjoined protective incantation78. [14] (15) For the sake of warding off the malice of the Krtyas74 and Raksasas, I am performing this protective rite. May Brahma approve of it ! [15] Nagas, Picachas, Gandhar- vas, ancestral Ghosts, Yaksas, Raksasas:76 whoever of these may trouble you, may Brahma and the other gods always kill them ! [16] May the spirits that walk at night in the earth and sky, as well as those that dwell in the four quarters and in the habitations of men, and whom I now salute, protect you. [17] May the Munis (or sages) keep you and Brahma and the heavenly beings, and the Rajarsis (or royal sages) : also the mountains, and all rivers, and all seas ! [18] May Agni (or the god of fire) protect your tongue, and Vayu (or the god of wind) your respirations.76 May Soma (or the god of the For the purpose of deodorising the sick-room, as well as driving away blue-bottles and other flies which otherwise would breed maggots in the wound. So Ni. 73 The following incantation is in verse. 74 Krtya is a female Raksasa or fiend, raised by the evil machi- nations of an offended sorcerer. So Ni. 75 See ante, note 9. 76 The Hindus believe in five pranas or ' vital airs' : 1, prana whose functions are the respirations, also diglutination, and propulsion of the blood ; 2, vyana whose functions are all muscular and vascular movements ; 3, apana whose functions are every kind of secretion ; 4, udana whose function is the production of every kind of voice ; 5, samana whose function is the whole of the assimilative pi-ocess. CHAP. V.] PRELIMINARIES FOR SURGERY. 33 moon) protect your movements, and the clouds your secre- tary functions. [19] May the lightnings keep your vocal functions, and the thunders your assimilative functions, and Indra, the lord of power, your strength, and Manu n your two cervical tendons as well as your intelligence. [20] May the Gandharvas prosper your desires, and Indra keep your good qualities, and king Varuna your knowledge, and the ocean your navel. [21] May the sun keep your eyes, the quarters your ears, and the moon your thoughts. May the lunar asterisms ever keep your figure, and the nights your appearance. [22] May the waters promote the flow of your semen, and the medicinal herbs the growth of your hair. May the sky keep your canals, and the earth your body. [23] May Vaicnavara (or the god of wealth) keep your head, Visuu your energy, the best of men {i.e., Narayana) your manly vigour, Brahma your vitality, and the polar star your eyebrows. [24] May (all) these divinities, each with respect to his own part of your body, for ever keep you,- and may you attain long life. [25] May the blessed Brahma grant you welfare, and the Devas, as well as the sun and the moon, and both Narada and ParvataJ8 [26] May Ag'ni grant you welfare, and Vayu, and all the Devas that attend on Indra. May the protection granted by Pitamaha [i.e., Brahma) procure you welfare and long life. [27] May all calamities of the season be mitigated for you, and may you ever be free from distress. Svaha (or Amen). [28] By this vedic incantation, for the removal of all diseases caused by Krtya, your safety has now been secured by me. May you now attain long life! [29] 77 "Manu" here refers to Prajapati (so Ni.) or the primordial, ' man,' a son of Brahma, the demiurge of the world, and father of the human race. 78 Narada and Parvata are a pair of ancient, semi-mythical (devarsi) sages, descendants of Kanva, and authors of certain hymns in the Rgveda. They are said to act as 'messengers of the gods.' 5 34 SUTRA-STHANAM. [sec. i. (16) Then he should remove the patient, thus protected, into the house, and prescribe his regimen. Then on the third day, he should open the bandage and, after cleaning the sore, re-apply it. He should be careful not to change the dressing on the second day. [30] If the dressing* is changed on the second day, the sore will granulate and consanesce only with much delay, and will become very painful. Thenceforward,?9 he should give directions regarding astringents, liniments, bandages, diet and conduct, in accordance with the state of the humours, the (requirements of the) seasons and the strength (of the patient). Nor should he be in any hurry about causing an abscess to consanesce, if it still contain any pus ; for even a slight irre- gularity in the treatment will cause a gathering within, and the abscess will form anew. [31] Here come in (the following verses) : — Hence (the physician) should allow an abscess to consanesce only when it is entirely depurated within as well as without. Even during the process of consanescence (the patient) should abstain from indigestible food, violent exercise, and sexual intercourse, and (avoid excitements from) pleasure, anger, or fear, until the wound has firmly healed. [32] In the seasons of Hemanta (December- February), Vasanta (February- April) and Pravrs (June- August) the physician should, as a rule, change the bandage every third day, but every second day in Carad (October-December), Grlsma (April- June), and Varsa (August-October).80 [33] In diseases of very rapid pro- ?9 I.e., from the fourth day. So the commentaries. 80 The now current recension of the first half of this verse runs as follows : hematite cicire. c = aiva vasantB c=api moksayet, i.e., 1 in the seasons of Hemanta (November-January), picira (Janu- ary-March) and Vasanta (March-May) he should, as a rule, change the bandage (every third day).' There is, however, an- other recension, which runs as follows : hematite ca vasante ca pravrt- l-ale ca moksayet, i.e., ' in the seasons of Hemanta (Decembei-- February), Vasanta (February-April) and Pravrs (June-August) he should, as a rule, change the bandage (every third day).' This recension is mentioned by both Ni. and Bha., but both CHAP. V.] PRELIMINARIES FOR SURGERY. 35 gress, the physician need not observe these directions. In such a case, as with a house on fire, he must adopt swift remedial measures. [34] If, from the application of the reject it on account, as they say, of the heat which characterises the season of Pravrs or the early rains. They explain that the reason of the injunction to change the dressing on the third and the second days is that the seasons of Hemanta, Cicira and Vasanta are characterised by cold, while those of farad, Grlsma and Varsa are characterised by heat ; now in a cold season there is no fear of any rapid suppuration setting in, while in a hot season there is that fear ; hence arises the necessity of changing the bandage more frequently (i.e., every second day) in the latter seasons than (i.e., every third day) in the former. This reasoning I fully admit ; nevertheless I am disposed to believe that the rejected recension is the correct one, and accord- ingly I have ventured to adopt it in my translation. From the next chapter (the sixth) it will be seen that there are two divergent systems of arranging the seasons, which I may call the civil and the medical. The following table will render these two systems clear. I. The civil arrangement of the seasons. Season. Months. Months. (1) Cicira Magha-Phalguna 15th January-15th March (2) Vasanta Caitra-Vaicakha 15th Mareh-J5th May (3) Grlsma Jyestha-Asadha 15th May-15th July (4) Varsa Cravana-Bhadrapada 15th July-15th September (5) Qarad Acvina-Karttika loth September-15th Nov. (6) Hemanta Margaclrsa-Pausa 15th November-15th Jany. II. The medical arrangement of the seasons. (1) Vasanta Phalguna-Caitra 15th February-1 5th April (2) Grisma Vaicakha-Jyestha 15th April-15th June (3) Pravrs Asadha-Cravana 15th June-15th August (4) Varsa Bhadrapada-Acvina 15th August- J 5th October (5) Carad Karttika-Margaclrsa 15th Oct.-15th December (6) Hemanta Pausa-Magha 15th Dec.-15th February It will be noticed that in these two systems the seasons overlap one another, and that whiie'the civil "system omits the season of Pravrs, the medical omits the season of Ci^ira. 36 SUTRA-STHANAM. [SEC. I. instrument, the patient suffers severe pain, relief may be given him by the application to the part of tepid clarified butter mixed with liquorice. It will be also noticed that the recension which the commentaries reject follows the medical system, while the commentaries adopt the recension which follows the civil system. This can hardly be thought consistent. But further : Pravrs or the early rainy season, which the commentaries reject on account of its heat, is as a matter of fact (and as the experience of any one who has lived in India will bear out) a comparatively cool season ; any way, it is cooler than the admittedly hot seasons of Varsa (or later rains), parad and Grrisma, and also cooler than the Vasanta of the civil system, which the commentaries adopt; for that civil Vasanta runs from the 15th March to the 15th May, which includes the nearly hottest time in India. The recension which I have adopted is surely, in every way, the most consistent ; it gives the Hemanta and Vasanta of the medical system which include the coolest time of the year (15th Dec. to 15th April), it also gives the Pravrs which is the comparatively coolest time (15th June to 15th August) within the Indian hot period of the year (April to November). I suspect the only reason which originated the other recension, adopted by the commentaries, is an apparent incongruity ; viz., the interruption in the sequence of the seasons in the rejected recension, for here Pravrs comes between Grisma and Varsa. For this reason, apparently, the commonly received recension follows the civil system, and thus, by rejecting Pravrs and adopting ficira, establishes an un- interrupted sequence of seasons in its rule about changing of bandages. But thereby, as it appears to me, medical consis- tency is sacrificed. — The commentaries further explain that the expression ' as a rule ' (in Sanskrit caiva or capi) permits a relaxation of the rule in the case of sores characterised by deranged bile (paittika). These require dressing every second day, or even every day according to the seasons. » CHAP. VI.] REGIMEN FOR THE SEASONS. 37 THE SIXTH CHAPTER. Regimen to be observed in the different Seasons. [1] (1) Time, in truth, is the great Self -existent Being,81 without beginning, middle and end. From it depend the destruction and production of all material objects82 and the life and death of men. (Hence comes its name kala ' time ' ) ; for kala is either that which never ceases for the smallest kala, or ' moment ' ; or it is that which sarjkalai/ati or £ composes/ or which kdlayati or 'destroys' living beings.83 [2] (2) Time, considered as a year, is divided by the blessed Sun, through his own motion, in (periods called severally) aksi- nimesa, kdsthd, kald, muhurtta, aho-rdtra, jjaksa, mdsa, rtu, ai/ana, sathvatsara, and yuga. [3] Now a nimisa or ' wink of the eye ' is the time required to pronounce a short syllable. Fifteen nimesa make a kdsthd. Thirty kdsthd make a kald. Twenty kald plus one-tenth of a hold make a muhurtta.^ Thirty muhurtta make 81 The text has bhagavan Svayambhuh, which lit. means tbat time is identical with ' the Blessed Svayambhu. ' or Brahma. Svayambhu means ' self-existent.' 82 The text has rasa or ' taste ; ' but both commentaries explain that here, by that term, are signified the dravya or ' material objects,' as being the seats of the tastes. 83 'Composing' refers to the five elements which make up the body and into which it is separated when it dies (see Chap. I, § 9). Kdlayati is a denominative verb, formed from kala, which means not only time but also death. 84 Bha. here points out tbat the equation 20t1q lcala = l muhurtta agrees with the subsequent statement, in the 14th chapter on blood, that the rasa or ' chyle ' takes one month (or 30 days) to complete one circulation by staying 3015 kalas in each of the 6 elementary parts of the body. Accordingly it takes 5 days or 150 muhurttas for each elementary part ; hence 1 muhurtta is equal to ( Wo5 or) 20-ro kala. Bha. adds that this equation is founded on Aupa- dhenava's treatise, (see chap. I, § 2.) It further says that the statement of Bhoja and Bhalluki that a muhurtta is equal to only 20 kala, must be explained as a clerical error (lipi-dosa). ETi. only says that the equation of 20 kala=l muhurtta is refuted by the commentaries (nibandha). 38 SUTRA-STHANAM. [sec. I. an aho-ratra or ' the period (of a full day) comprising day and night/ Fifteen aho-ratra make a paksa or ' half-month ' ; this is of two kinds : the light and the dark.85 These two together make up a mdsa or ' month.' [4] Next the twelve months, beginning with Magha, make up six seasons, each consisting of two months. These are Qigira, Vasanta, Grisma, Varsd, Qarad, Illmanta. Of these f icira consists of the months Tapas and Tapasya ; Vasanta, of Madhu and Madkava; Grisma, of Quci and QuJcra ; Varsa, of Nabhas and Nabhasya ; Carad, of Isa and Urja ; and Hemanta, of Sahas and Sahasya.^ [5] The foregoing division is from the point of view of winter, summer and rains ; but from the function of the sun and moon as dividers of time, there result two Ay ana or ( paths ' : a southern and a northern. Of these, the southern (path) consists of (the seasons) Varsd or ' the rains/ Qarad or ' autumn/ and Hemanta or ' winter/ In these (months) the blessed Soma or ' the moon ' is very powerful, and the acid, saline and sweet tastes grow strong, and from month to month all living beings continue increasing in strength. The northern (path) consists of the months Qigira or ' early spring/ Vasanta or ' spring/ and Grisma or 1 summer/ In these the blessed Arlca or ' the sun ' is very powerful, and the bitter, astringent and acrid tastes grow strong, and from month to month all living beings continue decreasing in strength. [6] Here comes in (the following verse) : — The moon (lit. ' the cold-rayed one') moistens the earth ; and the sun (lit. ' the brilliant one ') dries it. The 85 Both commentaries observe that the position of the light before the dark half indicates that the author of the treatise followed the amavasija mode of reckoning. But Ni. adds that, according to another reading, the dark precedes the light half. 85 The more usual names of these months are : Magha and Phalguna; Gaitra and Vaigakha ; Jyestha and Asadha ; Craoana and Bhadrapada ; Agvina and Kdrttika ; Margacir&a and Pausa. See below, § 9. For the identifications of the seasons, see ante Chap. V, § 16, note 80. Magha runs from the middle of January to the middle of February. Similarly Phalguna is February-March, and so forth, Sahasya being December-January. CHAP. VI.] REGIMEN I'Olt THE SEASONS. 39 air, in conjunction with these two, maintains all living beings. [7] Again the two Ay ana or ' paths ' together make one year, and five of these (years) together make one Yuga or ' lustrum/ This whole series of divisions of time, from the nimesa or ' a wink ' to the yuga or ' lustrum/ as it is always going round like a revolving wheel, is called by some the Kdla-cakra or ( the wheel of time.' [8] (3) Now with reference to the growth, derangement and recti- fication of the humours, the seasons may be also arranged thus : 8? Varsd or ' the rains/ Qaracl or ' autumn/ Hemanta or ' winter/ Vasanta or ' spring/ Gnsma or 1 summer/ and Prdvrs or ' the early rains/ These seasons, beginning with the month Bhadrapada are also constituted of two months each, as follows : Varsa comprises the months Bhdclrapacla and Aqvayuja ; £arad, the months Kdrttika and Mdrgagirsa ; Hemanta, the months Pausd and Mdgha ; Vasanta, the months Phdlgnna and Caitra ; Grlsma, the months Vaigdkha and JyaistJia ; Pravrs, the months Asddha and Qrdvana. [9] (4) Now in the rainy season the annuals 88 are young and weak in their sensific powers, and the waters are muddy and mostly full of dirty matter 89 fallen (into them) from the earth . From the use of these acidity of the stomach 90 is produced in 87 This is, of course, the medical division of the year, con- trasted with the civil division previously explained. So, on the whole, both commentaries, though they give a more fanciful reason for pre-positing the civil year, because that year refers to the growth and strength of the rasa or ' tastes ' which are the causes of the humours. Bha. adds (only to refute it) that accord- ing to.Kacyapa the two systems of divisions are held to the north and south of the Ganges respectively, because there is more rain (hence two rainy seasons) in the South, while there is more cold (hence two springs) in the North. Nj. only mentions this theory, without naming its author, and says that Grayadasa refutes it. 83 Such as wheat, rice, chickpeas, etc. So Ni. The text has osadhi ; see chapter I, § 12. 89 Such as decayed leaves, dead and putrifying nimals. So Ni. ,0 Here as well as below, the expression used in the text is 40 SUTRA-STHANA5I. [SEC. I. men, whose digestion has become impaired through their air being deranged by cold, owing to their bodies being kept in a moist condition by living on ground saturated with the rains from the cloud-charged skies : and in consequence of the acidity of the stomach, they bring on an accumulation of bile. Then, in the autumn, when the sky clears up and the sloughs dry, the accumu- lated bile, diffused (through the body) by the rays of the sun, generates diseases which owe their origin to (deranged) bile. [10] In the winter, these same annuals, from the fulness of time, attain their full sensific powers, and the waters become clear. Thus they become emolient and heavy, and from their use dyspepsia90 is produced in men, whose bodies are affected by the frosts and (cold) winds due to the mildness of the sun's rays : and in consequence, through their emollient, cold, heavy and sticky qualities, they bring on an accumulation of phlegm. Then in the spring, when the accumulated phlegm is diffused (through the body) by the rays of the sun, it generates in men, now less affected (by the cold), diseases which arise from (deranged) phlegm. [11] In the summer, the same annuals become dry, sapless, and excessively light, and the waters likewise. From the use of them, through their dry, light, and sapless nature, they bring on an accumulation of air in men, whose bodies are dry from the heat of the sun. Then, in the early rains, when men's bodies are kept moist by (living on) ground saturated with water, the accumulated air, diffused (through their bodies) by the chilly winds, generates diseases due to the (deranged) air. Thus it has now been shown how the accumulation of the humours is the cause of their derangement. [12] (5) Now the depuration of the humours which have accumu- lated severally in the rains, winter and summer should, as a rule, only be undertaken after their derangement has come to a head the same : vidaha or vidagdha, which literally means ' burning ' or 'burned,' and figuratively, ' digested ' as well as ' badly digested,' ' turned sour,' etc. Bha. explains ifc as " sluggish digestion due to the production of acidity." Ni. explains it by amlapaka, lit. 'sour digestion'; and Dr. A. C. Dutt explaines it by dm-ajirna or 'imperfect digestion.' CHAP. VI.] REGIMEN FOE, THE SEASONS. ■41 in the autumn, spring, and early rains respectively.91 [13] This done, the rectification of diseases may be undertaken in ac- cordance with their respective nature ; that of diseases due to bile, in the winter ; that of diseases due to phlegm, in the summer ; and that of diseases due to air, in the autumn. In the fore- going remarks the way has been fully described in which the humours accumulate, become deranged, and are rectified. [14] With reference to these points, the forenoon may be said to be the analogue of the spring ; the noon, of the summer ; the afternoon, of the early rains ; the dusk, of the rains ; the mid- night, of the autumn ; and the dawn, of the winter. Hence with regard to the accumulation, derangement and rectification of the humours, the full period consisting of a day and night must be understood to be analogous to a year consisting of winter, sum- mer, and the rains. [15] (6) Further, when the seasons ai*e regular, the annuals as well as the water are also wholesome ; and their use gives to people longevity, strength, energy and vitality. On the other hand, irregularity in them is owing to fate. Cold, heat, wind and 91 Both commentaries explain that the phrase " as a rule " (Sanskrit ca) shows that the direction is a permissive one and does not apply to very acute diseases which require instant remedial measures. They add that the samgodhana or 1 depuration ' should be done, as a rule, after the lapse of the third month of the total period, i.e., in the second month of the respectively suitable season. Thus bile should be depurated in the month Margaciisa ; phlegm, in Caitra; and air, in Qravana. Bha. quotes from Bhattara Haric- candra the following rule • vars-adi-sancitan-ddsdn=tri-mas-antari- tan=har&t, i.e., 'the humours which have accumulated in the rains and other seasons may be removed after the lapse of three months.' The following table gives a summary : — Humour. Accumulation. Depuration. Rectification. Bile. Rains (4). Autumn (5), Winter (6). Margacirsa. Phlegm. Winter (6). Spring (I), Summer (2). Caitra. Air. Summer (2). Early rains (3), Rains (4). Cravana. The numbers refer to the medical system, see note 80. 6 42 SUTRA-STHANAM. [sec. r. rain, when they are irregular,92 cause the annuals and water to become unwholesome, and their use produces all sorts of diseases, or even deadly epidemics. Hence the use of wholesome annuals and water (is to be recommended). [16] Sometimes even with regular seasons, the people of a country suffer through some sorcery or some curse or the wrath of evil spirits or the wickedness of men. When wind carries into a country the exhalations of the flowers of poisonous animals, its people are attacked with cough, asthma, vomiting, nasal catarrh, headache, or fever, without any particular reference to the condition of their humours (at the time), but simply owing to the (noxious) influence of the planets or lunar asterisms or to an inauspicious sign in one's house, or wife, or bed, or seat, or conveyance, or beast of burden, or jewel, or gem, or any utensil. [17] In such a case the impending evil may be turned into good by leaving the place, or by (performing) propitiatory or expiatory rites, or by (using) amulets, incantations, burnt-offerings, dedications, donations, salutations, devotions, asceticism, observances, kindness, charities, receptions of mantras or ' charms ' and advice. Any of these means may be resorted to with reference to Devas (or 'gods'), or Brahmans, or Gurus (or 'spiritual guides'). [18] (7) In the following (verses) we will describe the characters of the seasons when they are regular : — [19] In Hemanta or ' winter ' a cold wind blows from the North, the atmosphere is charged with dust and smoke, the sun is obscured by mists, all pieces of water are covered with ice, [20] crows, rhinoceroses, buffaloes, rams and elephants are made bold, and Rodhra {Symplocos racemosa) , Prigaijgu [Arjlaia RoxbwgMana) and Punnaga (Ochrocarpus longifolius) bear flowers. [21] In Cigira or ' early spring,' the cold is intense, and the atmos- phere is full of rain and wind ; for the rest its character may be said to be the same as that of the winter. [22] On the Malaya mountains, marked by the red-stained soles of the wives of Siddhas and Vidyadharas,93 and scented 92 Either in amount or incidence. So Ni. ?s Two classes of supernatural beings, possessed of magical powers. CHAP. VI.] REGIMEN FOR THE SEASONS. through the womanly embrace of the sandal trees, [23] there blows, in Vasanta or ' spring/ a wind from the South which stimulates love, makes happy the lovers, and breaks down reserve between husband and wife. [24] In Vasanta or ' spring ' the sky is clear ; the groves are adorned with the flowers of the Kimcuka [Butea frondosa), Ambhoja {Nelumbium speciositm), Vakula (Mimusops Elengi), Cuta {Mangifera inclica), Acoka (Saraca indica) and other trees, [25] the delightful music is heard of the Indian cuckoo and of swarms of bees, the wind blows from the South, and the country is charmingly adorned with fresh green. [26] In Grlsma or 'summer'' the sun's rays are hot, the wind blows unpleasantly from the South-west, the earth is scorched, the rivers are low, the sky is, as it were, on fire, [27] the Cakravaka-pairs94, wander about, and the beasts of the forest are distracted for want of water, the shrubs, grasses and creepers wither, and the trees drop their leaves. [28] In Pravrs or {the early rains/ the sky is covered with clouds, brought by the west wind and discharging heavy showers of rain with tremendous thunder and lightning, [29] the earth is covered with beautifully green young grass, and is bright with the cochineal insert, and gay with (the flowers of) the Kadamba {Anthocephalus Cadamba), Nipa (a variety of Cadamba) , Kutaja {Holarrhena antidysente- rica), Sarja (SAorea robusta), and KetakT {Pandanus odora- tissimus). [30] In Varsa or 'the rains' the rivers are full of water and its banks (strewn) with uprooted trees, the reservoirs are radiant with full-blown white water- lilies and blue lotuses, [31] on the ground level land and holes cannot be distinguished, the fields are adorned with manifold crops, the rain falls without much thundering, and the sun is hidden by clouds in the sky. [32] In Carad 0r ' autumn ' the sun is ruddy and hot, the sky is clear and shows white clouds, the ponds are pretty 91 The Anas Casarca, commonly called the ruddy goose' or Brahmany duck. SUTRA-STHAXAM. [sec. I. with water-lilies and geese sporting among them, [33] the ground, according as it is depressed or raised or flat, forms ponds or dry land or is covered with trees, and is beautified with the flowering Vana {Barleria crisfala), Saptahva {Alstonia scholaris), Bandhuka {Pentapetes pJioenicea), Kaca [Saccharum spontanettm), and Asana (Terminalia tomentosa). [34] On the other hand, if there is any excess, or contrariety, or irregularity in the characters of the seasons, the humours of the body are deranged. [35] Phlegm should be depurated in the spring, bile in the autumn, and air in the rains, if it is desired to prevent the outbreak of any disease. [36] THE SEVENTH CHAPTER. Descriptiox of Bluxt Ixsteumexts. [1] (1) Of blunt instruments there are one hundred and one (varieties). Among these the hand must be accounted the foremost, for the reason that, without the hand, no instru- ment can be used, and that every surgical operations must be directed by it. [2] Foreign bodies are those that cause injury to the body and the mind : and the instruments are the means of removing them. They are of the following six kinds : cruciform instruments,96 pincer-like instruments, picklock-like instruments,96 tubular instruments, pricker-like instruments, and accessory in- struments. [3] 96 The text has svastika which is shaped like a Greek cross but with the ends of its arms bent rectangularly in the same direction. All instruments of this kind are made with two arms, moveable on a pin placed nearer to one end than the other, by which they are fastened, and on which they act crosswise like scissors. They as well as the sandamga or ' pincer-like ' instru- ments are merely different varieties of the forceps. 96 The text has tdla which means a lock and key. The ordinary Indian key is merely a picklock or hook. CHAP. VII.] BLUNT INSTRUMENTS. (2) Now there are twenty-four varieties of cruciform instru- ments, two pincer-like, also two picklock-like, twenty tubular, twenty-eight pricker-like, and twenty-five accessory. As a rule, they are made of iron, but sometimes, in default of it, of other suitable materials.9? The ends of these instruments generally resemble the faces of beasts or birds of prey. Hence they should be made so as to resemble them, following herein (the directions of medical) text-books, or (the verbal) instruction (of teachers), or (simply) imitating (other) instruments (of the same kind), and (withal) adapting them (to the requirements of each individual case). [4] They should be made just of the proper size, with their ends strong and polished ; 98 they should be also solid, well-shaped, and capable of a firm grasp. [5] (3) Now the cruciform instruments should be made of the length of eighteen fingers' breadth. Their ends should be shaped like the faces of the (following nine kinds of wild animals :) lion, tiger, wolf, hyena, bear, panther, cat, jackal, and deer, (and the following fifteen kinds of wild birds :) crow, heron, osprey, blue-jay, bhasa," hawk, owl, kite, vulture, falcon, Kraufica [Ardeajaculator), fork-tailed shrike, Anjali-karna,100 Ava- bhanjana,100 and Nandimukha (Turdus Ginginiauns), The (two) arms should be held together by a pin in the form of a Mas lira {Ervum lens), and their ends should be curved like an elephant driver's hook. These (instruments) are intended for the purpose of extracting foreign bodies (impacted) in bones. [6] (4) The pincer-like instruments are of two kinds : with or without arms.101 They have a length of sixteen fingers' breadth, 97 The Commentaries mention ivory, horn and wood. 9' According to others "their ends should be gross (like a heron's beak) or fine (like a lion's teeth) " as the particular opera- tion may require. So TSi. 99 A kind of vulture that frequents cowsheds. So Ni. 100 These two birds are of unknown identity, according to Nr. Bha. explains none of the animals or birds. 101 As the commentaries explain, the one with arms is like that used by barbers for depilating the nose, while the armless 46 SUTRA-STHANAM. [sec. r. and are intended for the purpose of extracting foreign bodies from the skin, muscles, veins, and nerves or tendons. [7J (5) The picklock-like instruments have a length of twelve fingers' breadth, and are shaped like the jaws of a fish.102 They are made either with one blade or two blades, and are intended for the purpose of extracting foreign bodies from the ears, nose, and outer canals. [8] (6) The tubular instruments are of various kinds and used for various purposes, and have a mouth either at one or at both ends. They are employed for the extraction of foreign bodies from the outer canals, for the inspection of (internal) diseases, for the suction (of fluids), and for the facilitation of (other) operations.103 In circumference and length they are adapted to the orifice of the outer canal or to whatever purpose may be in hand. The instruments (of this kind) are those used in the case of fistula- in-ano, haemorrhoids, tumours, abscesses, injections into the rectum and into the bladder, hydrocele, ascites, inhalations, stric- ture of the urethra and stricture of the rectum. Gourds and horns (used for capping) also belong to this class. All these instruments will be described in detail further on. [9] (7) The pricker-like instruments (or probes) also are of various kinds, used for various purposes, and are made of various diame- ters and lengths according to the purpose in hand. Some of one is like that used by goldsmiths. The latter is made of two blades, soldered together at one end ; while the former consists of two arms jointed crosswise on a pin. This, therefore, is really a variety of tlie svastika or ' cruciform ' instrument, and would seem to be classed here only because of its different function. 102 The picklock is a hook or metal blade curved rectangularly at one end. Two of these may be jointed at the other end ; the instrument then resembles the mouth of a certain fish. Ac- cording to the commentaries this fish is the Bhelunl or Bhetull or BhekatI, the tips of whose jaws are hooked. Both Bha. and Ni., however, give an alternative interpretation of the word tola which they seem to prefer. They make it to mean maisya-galka or matsya-cakra, i.e., ' the scale of a fish.' Bha. also gives the alternative reading tain ' palate ' for tdla. 108 Such as the scarification of piles. So the commentaries. CHAP. VII. J BLUNT INSTRUMENTS. 47 them have their ends shaped like earthworms, or the feathered part of an arrow, or the hood of a snake, or a fish hook, there being two varieties of each shape. These are intended respec- tively for the purpose of exploring, raising, transferring, and extracting.104' Two of 'them have their ends made of the shape and size of the half of a pea and slightly bent, and are used for the purpose of extracting foreign bodies from the outer canals. Six have their ends covered with cotton and are used for the purpose of wiping out (abscesses). Three have their ends shaped like spoons with a conical cavity, and are used for the purpose of applying caustic solutions, etc. Three others have their ends shaped like the fruit of the Jambu tree {Eugenia Jamtolana), and again three, like an elephant driver's goad. These six (varieties) are used for the purpose of applying the actual cautery. One variety, which is used for the purpose of removing a tumour from the (interior of the) nose, has its end made of the size of half the stone of the fruit of the jujube tree (Zizip/ms Jujuba), of a conical shape, and with sharp edges. One variety, which is used for the purpose of applying collyria (to the eyes), is made of the thickness of a Kalaya pea (or small Masiira or JErvum Lens) with both ends shaped like buds.105 One variety, which is used for the purpose of clearing the urethra, is made of the thickness of the upper part of the stalk of the flower of the MalatI (Jasminum grancliflomm) . [10] (8) The accessory instruments are (the following : — ) thread, twine,106 bandages, straps (or belts) of leather, bark (of trees),107 104 Thus, those shaped like earthworms are used for probing abscesses ; those like feathered arrows, for raising a spot in order, after incision, to remove a thorn from it (see infra, note 111) ; the hood-shaped ones, for transferring any material from one part to another within the flesh. So Bha. and Ni. 106 Nr. adds that in length it is of eight fingers' breadth. 106 The text has vcnika, which commonly means '.a braid of hair,' but the commentaries explain it to mean here guna-traya or ' twine made of three threads,' while raj'ju is said to mean ' thread.' Hair is mentioned further on. 07 The root-bark or the inner bark (bast) is apparently intended. Ni. says, it is used for bandaging fractures, and adds that it is SUTRA-STHANAM. [SEC. 1. (tendrils of) creepers, (pieces of) cloth, large round stones, a hammer,108 the palms of the hands, the soles of the feet, the fingers, tongue, teeth, nails, and mouth, hair, the ring of a horse's bridle, a branch (of a tree),109 spittle, fluxing 110 (the patient1), making (him) happy, a loadstone ; also caustics, fire, and medicines. [11] (9) With these instruments the whole body may be operated on, that is to say, any one of its limbs as well as its joints, viscera, veins and nerves, according as the case may require. [12] The operations (that may be performed) with them are of twenty (different) kinds : — Wrenching out, filling (the eyes or bladder etc. with oil), bandaging, raising (or smoothing),111 curling up, transferring, turning round, exposing (or opening out), pressing, clearing canals, p idling to and fro (or loosening a foreign body), pulling out, pulling up (into its right place), setting upright, bending down, contusing,112 stirring (with taken from such trees as the Palaca ( Buteafrondosa) and Udumbara (Ficus glomerata), both of which belong to the so-called panca- valkala set of five trees. See ante, note 70. 108 Used for the purpose of moving or loosening foreign bodies impacted in a bone. It may be made of wood or other materia!. So Ni. 109 Nt. explains that a bridle-ring and a branch are required for the extraction of foreign bodies. The branch apparently is put through the ring to afford a stronger pull. 110 I.e., causing discharges from the bowels, the stomach, or the eye in order to remove foreign bodies or impurities. 111 The text has vyuhana, i.e., ' arranging,' ' placing in proper position.' Both commentaries explain that it means urdhvl-kara- nam, chittva uttunditasya uddharan-artham, i.e , ' raising up for the purpose of removing a thorn after incising (the raised-up part).' They add, however, that others explain it by varaggena anusaranam, i.e., ' smoothing (lit. following up) with the handle (of the instru- ment, which has been used for the operation) ' ; that is, after an incision (e.g., after an abscess has been opened and emptied), the handle of the instrument is to be passed over the incised part in order to bring together the lips of the wound. 112 The text has bhanjana, lit. ' breaking' (the continuity of the CHAP. VII.] BLUNT INSTRUMENTS. a probe), sucking (with a horn or gourd) , exploring, splitting, straightening, washing, blowing (powders into the nose), rubbing out (from the eyes, etc.). [13] So much is certain that, considering the innumerable variety (in the circumstances of) foreign bodies, a sensible physician must be guided by his own intelligence in the choice of the precise mode of application of his instruments (in any given case) . [14] (10) Now there are twelve (kinds of) defects (that may occur) in an instrument. It may be too thick, or it may be made of impure metal, or it may be too long, or too short, or incapable of grasping, or grasping unevenly, or bent, or (of too) soft (material). Their ends may be too straight, or their pin or ends or edges may be too weak. [15] An instrument which is free from (all) these defects and which is eighteen inches long, — such an one a physician should consider the best and with it he should perform his operations. [16] (11) A foreign body which is visible, should be extracted with an instrument having the head of a lion or other (wild beast). If it is invisible, it should be extracted with an instrument having the head of a heron or other (wild bird). Moreover it should be extracted slowly and in accordance with (the dictates of) medical science or of one's reason. [17] Because it enters and turns with ease, and also grasps and extracts a foreign body with ease : for these reasons the heron-headed forceps is the best, and for the same reasons it can be applied, without any harm, to any part (of the body). [18] tissues). Bha. explains that it refers to $alya-karm-ader=mardana or ' the contusing of a part before it is surgically operated on,' or, as Hi. puts it, samantato mardana, i.e., ' contusing (a part) all round or all over.' But Hi. prefers its own alternative explana- tion that the term means girah-harn-ader=amardana or ' well rubbing the head, ears, etc' 7 50 StTT R A-STH A N A M . [sec. t. THE EIGHTH CHAPTER. On the Application of Cutting Instruments. [ 1] (1) There are twenty (varieties of cutting) instruments. They are as follows : 113 1, Mandul-agra or 'circular-headed/ [with a length of six arjffula or fingers' breadth. There are two sub-varieties, one with a circular edge, the other shaped like a razor] . 2, Kara-patrani or 'a saw/ [with a length of twelve fingers' breadth] . 3, Vrddhi-joatra or fa razor.' [The handle should have a length of five and a half fingers' breadth, and the blade, one and a half, the total instrument being seven fingers' breadth long. It has two subvarieties, one with a curved, the other with a resected point. The former is what is called a hsura or 'razor.'] 4, Nakha-gastra or ' nail-parer,' [with a blade two fingers' breadth long and one finger's breadth broad, the total length of the instrument being eight fingers' breadth.] 5, Mndrika, a cutting instrument of the size of the last phalanx of the index finger. 6, Utpala-patra, a cutting instrument resembling the petal of the blue lotus. 7, Ardha-dhara, or 'a single-edged' knife. [Its total length is eight fingers' breadth, and its blade measures two fingers' breadth in length, and at its broadest, one finger's breadth.] 8, Suci, or ' needle,' [of a length of two to three fingers' breadth.] 118 The information, enclosed within angular brackets in the following list, is extracted from the two commentaries and has been inserted in the text for the sake of convenience. See also below, § 5. 114 Literally : ' having a blade in the form of a hand,' the fingers representing the teeth of the saw. CHAP. VIII.] CUTTING INSTRUMENTS. 51 9, KiiQa-patra, an instrument shaped like the leaf of Ku9a grass (Eragrostis cynosuroides). [Its handle is three fingers' breadth long.] 10, Atl-muhha, an instrument shaped like the beak of the AtT bird [Turdus Ginginianus) . [Its blade is one, and its handle, seven fingers' breadth long.] 11, Qaran-mulcha, a kind of scissors resembling the face of the £arari bird.116 12, Antar-mnlcha,m a kind of scissors with semi-circular claws, the insides of which are filled up with straight, cutting blades. [Its length is eight fingers' breadth.] 13, Trikurcaha or fa three-edged ' instrument, a trocar. [The whole is eight, and the handle five fingers' breadth long ; the distance between the edges is that of a grain of rice.] 14, Kutlidrihd (lit., axe-shaped), an instrument like a gum-lancet. [Its handle has a length of seven and one- half, and its blade, of one-half fingers' breadth ; the latter has the shape of a cow's tooth.] 15, Vrihi-mulcha , or a trocar shaped like a grain of rice. [Its full size is six fingers' breadth, the handle being of two, and the blade of three fingers' breadth. Its head is shaped like a grain of rice with a very fine point.] 1 6, Ard or ' awl ' [resembling a shoemaker's awl ; sixteen fingers' breadth in total length, with a sharp end of the size of sesamum seed.] 17, Vltasa-patraka, an instrument shaped like the leaf of the rattan. [The blade is four fingers' breadth in length, one finger's breadth thick, and very sharp ; the handle is also four fingers' breadth long.] 18, Vadiga, an instrument shaped like a fish-hook. [Its total length is six fingers' breadth, its hook being one-half and its handle five and a half fingers' breadth.] 115 Ni. says that this is a bird with a long beak. There are two varieties of it : one with white shoulders, the other with a red head ; it is the former kind which is called Qarari or Carali. 116 Literally : ' having (blades) in the interior of the mouth.' SUTRA-STHANAM. [sec. r. 19, Danta-cayku or ' tooth-pick/ [It may be used for cleaning the teeth from tartar and broken bits. Its head is one-half finger's breadth long. It is quadrangular, and with a sharp edge ; and in the upper part of its handle it is like the vrikimnk7ia.~] 20, Esanl or 1 probe/ [2] (2) The mandalagra and karapatra are principally 117 vised for cutting through and scarifying ; the vrddhipatra, nalcha- Qastra, miulrika, utpalapatraka, and ardhadhdra, for cutting through and cutting into ; 118 the suci, kugapatra, dtimukha, qardrimukha, antarmnklia, and trikurcaka, for evacuating (abscesses, etc.) ; the Imtlidrihd, vrlhimukha, dra, and vetasapatra, for puncturing, also the suci ; the vadiqa^ and dantagarjhu for extracting ; the esanl, for probing and evacuating ; 120 and the different kinds of suci, for sewing. This enumerates the eight kinds of surgical operations for which castra or ' cutting instruments' are used. [3] 117 I.e., they may be used also for other suitable purposes, as indicated by the particle ca ' also.' So Ni. and Bha. 118 The text has chedana aud bhedana : the difference indicated is that of deep and superficial incision. The former means 'cutting through,' 'section,' and includes also the operations of dividing and excising. The latter means ' cutting into ' and includes both opening and incising. Vyadhana means ' puncturing ' and ' perforating.' 119 A vadica or ' fish-hook-shnped instrument ' is also mentioned among the yantra or ' blunt instruments' (see Chapter VII, § 7). The reason is obvious : it must be made either blunt or sharp according to the purpose for which it is intended. But both Bha. and Ni. explain that as a yantra or 'blunt instrument' it may be of any suitable size, while as a castra or ' cutting instru- ment ' it must be of the fixed size of six fingers' breadth, and have a sharp point. They add that for a similar reason also the esanl or ' probe ' is mentioned among both kinds of instruments. lao The text has anulomya by which, as the commentaries explain visruvana or 'evacuating' is intended, not 'serving as a guide' (as Dr. IT. C. Dutt translated), which is not any ' surgical opera- tion.' CHAP. VIII.] CUTTING INSTRUMENTS. 53 (3) We shall now briefly explain the mode of holding these instruments (when they are used) in any operation. The vrddhi- patra should be held at the junction of the blade and handle; in fact, all instruments used for an incision (should be held in this way). The vrddMjpatra and mandalagra, when used for scarifying, should be held with the hand a little raised : when used for evacuating (abscesses) they, and in fact all instruments, should be held by the forepart of the handle. In the case, how- ever, of children, of old or delicate or timid men, of women, and of kings and princes, an evacuation should be made with the trihurcaka. The vrlldmnhlia should be held with the thumb and forefinger, and with its handle covered within the palm. The katharika should be held in position with the left hand, and struck with the middle finger and thumb of the other hand held firmly together. The drd, Icarapatra and esani should be held at their extremities. The remaining instruments should be held according to the requirements of each case. [4] (4) As to the shapes of the instruments they are, in a general way, indicated by their names. (5) As to their dimensions, the length of the naMa-gastra or 'nailparer' and the esarri or 'probe' is eight fingers' breadth, that of the suci or 'needles' will be given (hereafter).121 The rest of the instruments are six fingers' breadth in length.122 [5] (6) The good points in an instrument are the following : it should have a well-made handle, it should be made of good iron, and it should have a fine edge, a pleasing shape, and a well finished end, and it should not be fearful to look at. The edge m I.e., in Chapter XXV, on the various kinds of surgical opera- tions. According to Nis. some insert here the following direction: " the mudrika is of the size of the last phalanx of the index finger ; the gararl-raukha has a length of eight fingers' breadth and is also called karttarl or ' scissor.' " 122 The text of this paragragh [5], as given in Jivananda's edition, is quite out of order. The true text, as shown by the commentaries and by the logical order of the subjects of the paragraphs, is given in the edition of Kaviraj Gaijgaprasad Sen, and is adopted in my translation. 54 SUTRA-STHANA.M. [SBC. I. of instruments, used in incising, should be of the fineness of a Masura (Ervum Lens) ; of those used in scarifying, of half a Masura ; of those used in puncturing and evacuating, of a hair ; and of those used in dividing, of half a hair.123 As to the vadiga or ' hook ' and the danta-gayku or ( toothpick/ the former should have a curved end and a fine point, while the latter should have an end shaped like the first leaf of barley. An esani or ' probe ' should, with regard to its end, be shaped either hire an earthworm, or like the previously mentioned instruments (i.e., the hook and toothpick). iZi On the other hand, the defects in an instrument are the following eight : if it is bent, or blunt, or jagged, or too thick or too thin, or too long, or too short. Hence instruments which are free from these defects should be used. The hara-patra or ' saw ' is the only exception ; for, being used for the purpose of cutting through bones, it must have a jagged edge. [6] (7) The tempering of these instruments may be done in three ways : by means of an alkaline solution, or of water, or of oil. Those tempered in an alkaline solution are used in excising arrows and foreign bodies, and in dividing bones : those tempered in water are used in excising or incising118 or cleaving muscles : those tempered in oil, are used in puncturing veins and dividing nerves or tendons. For sharpening these instruments a smooth bone of the colour of Masa (Phaseolus Roxburghii) should be used, and for preserving their edge, a case made of the wood of (^almali (Bombax malabaricum). [7] Here comes in (the following verse) : — When an instrument (has been selected) of a good make and with an edge so keen as to divide the hairs on the skin, and when it has been grasped at the proper place [see ante, § 3], only then it may be employed in any surgical operation. [8] 123 Nr. here points out, that the fineness of the edge will vary, according as the same instrument {e.g., a vrddhi-patra or ' knife ') is used for an incision or an excision. 12i This variety in shape of the probe is, as the commentaries explain, expressed in the text by the particle ca ' and,' which is omitted in Jivauanda's edition. CHAP. IX.] PRACTICAL TRAINING IN SURGERY. 55 1^8) Substitutes for cutting instruments are the following : bamboo, crystal, glass, ruby, leeehes, fire, caustic, the nails, leaves of G5jl {Elephcmtobtis scaler) or Cephalika, [Nyctanthes Arbor- tristis) or Caka (Tecto/ia grandis),m young shoots, hairs, and the fingers. [9] These substitutes may be used in the case of infants or of persons who are afraid of surgical instruments, or when such instruments are not available. The (first- named) four objects, bamboo, crystal, glass, and ruby, should be used for cutting through or cutting into118 some part. [10] The nails should be used, if those two operations as well as that of extraction can be done with them. The mode of using caustics, fire, and leeches will be explained subsequently. [11] If there is any form- ation of pus in the mouth or the eyelids, it may be evacuated with the leaves of G5ji or night-jasmin or teak. In default of probes hairs or the fingers or a young shoot will be found useful for exploring. [12] A wise physician will get all these instruments made of pure iron and with sharp edges, by a blacksmith who is skillful and experienced in his craft. [13] A physician who knows the use of cutting instruments always attains success; hence one should not fail to acquire experience in their handling. [11] THE NINTH CHAPTER. On Practical Training in Surgical Operations. [1] (1) Even when a pupil has learned the whole of the medical text books, he must still be made to acquire practical proficiency. He must be instructed practically how to perform surgical opera- 126 According to both commentaries Groji is either the same as Gr5jiliva (Elephantobus scaber) or Qakhotaka (Streblus asper). Cephalika is tbe 'night jasmine,' and Caka is the Teak tree. The leaves of all these are used as vulneraries in the form of an epithem. 56 SUTRA-STHANAM. [SEC. I. tions and how to apply oils and other (medicaments). However great his theoretical knowledge may be, unless he acquires also practical skill, he will never be a proficient in his surgical practice. [2] (£) Now every land of deep incision as well as the operations of excising and dividing may be shown (to the pupil) on pumpkin- gourds, bottle-gourds, water-melons, and various kinds of cucum- bers.126 The operation of superficial incision (or opening) may be shown on leather-bags, bladders and pouches, filled with slush : scarification, on stretched pieces of leather covered with hair : puncturing, on the veins of dead animals or on stalks of the water-lily : probing, on the apertures of worm-eaten wood, bamboo, reed, any tubular object, or dried bottle-gourds : extracting, on the pulp of the jack-fruit, the bel-fruit, or the Vimbl-fruit (Cejj/ialandra indica), or on the teeth of dead animals : evacua- ting (abscesses), on a lump of wax applied to a board of £almall wood (Bombax malabaricum) : sewing, on the ends of two thick pieces of cloth or of two pieces of soft leather : bandaging, on the various large and small limbs of a human figure made of cloth or clay, etc. : bandaging the root of the ear, on a piece of soft flesh or the stalk of a water-lily : applying the actual and virtual cautery, on pieces of soft flesh : introducing catheters, and compressing abscesses (formed) within the abdominal cavity, on the spout of an earthen vessel filled with water, or on the mouth of a bottle-gourd or similar objects. [3] Here come in (the following verses) : — An intelligent physician who acquires a practical know- ledge of surgery by operating on these and similar suitable objects, in the manner above explained, will never go wrong in any of his operations. [4] Hence, if he wishes to attain proficiency in the use of cutting instruments, and of the virtual or actual cautery, he should acquire a practical knowledge of the several operations by practi- sing them on those objects which have been above shown to be respectively suitable for them. [5] 126 The text mentions three kinds : Trapusa or Ctccnmis sativus, Ervaru or Cucumis utilissimus, and Karkaru or Cucumis Melo. CHAP. X.] VISITING THE SICKROOM. 57 THE TENTH CHAPTER. Directions for Visiting a Sickroom. (1) After having learned his text-book and understood its meaning, and after having seen operations performed and acquired practical skill in them himself, in short after having mastered the whole subject of medical science, (the candidate) should obtain the king's permission (to practise). Then, after having cut his nails and hair, bathed and dressed in clean clothes, taken an umbrella and a stick in his hand, and put on shoes, simple in attire and good at heart, with polite address and without ostentation, friendly inclined towards all creatures, and accompanied by a trusty attendant, he may now undertake to visit a sickroom. [2] (2) At a time when the messenger, the weather, the (behaviour of the) kites and other auguries w are favourable, he should go to visit the patient's house, and having entered it, he should view the patient, touch him, and question him. By these three modes of examination some say that most diseases can be diag- nosed. But this is not correct. There are six modes of diag- nosing diseases ; namely by the five senses, i.e., hearing, etc., and by questioning. [3] As symptoms discernible by the sense of hearing such as these may be mentioned : in diseases, charac- terised by a discharge from an abscess, air escapes with a noise, bringing out with it frothy blood. Symptoms discernible by the sense of touch are coolness or heat, smoothness or roughness, softness or hardness, and other tangible qualities (of the skin) in fever, consumption, and other (diseases). Symptoms discernible by the sense of sight are corpulence or emaciation, vitality, characteristic remarks, energy, change of colour, and so forth (of l27 The text has nimitta and maygala, two words of a very general character for ' omen ' or ' good omen.' The commentaries refer the former to metereological conditions, such as an agreeable breeze, and the latter to such objects, as the svastiJca or 'cross,' a vessel full of water, etc. 8 58 SUTKA-STHANAM. [sec. t. the patient). Symptoms discernible by the sense of taste ,2S are the various tastes noticeable in morbid secretions of urine and other diseases. Symptoms discernible by the sense of smell are the odours emanating from inflammatory or non-inflammatory states (appearing) on the approach of death or similar conditions. By questioning, (the physician) may ascertain the (patient's^ country,129 time/30 caste, habits and diet,131 the cause of his disease, the nature of his pain, his strength and appetite, the regularity or irregularity in his passing of wind, urine and fasces, the duration of his disease, and similar particulars. Seeing that there is a similarity between the (six) modes of examination and the (derangements of the three) humours, the physician is in a position to diagnose a disease from its symptoms corresponding (severally with the six modes of examination). 132 [4] Here come in (the following verses) : Diseases which are wrongly observed, and badly des- 123 Nr. explains that this does not i*efer to the sense of taste of the physician, but of bees, ants, and similar insects who are atti-acted by urine. (See note 133). 129 The country may be either jaggala ' wild,' or aniipa 'marshy, or of the ordinary kind. So Nl. 130 Time may be considered either from the permanent (nityaga) or accidental (avasthika) point of view. The former refers to the climatic conditions of the patient's country. The latter refers to the patient's age, or the circumstances of his disease, such as when his fever comes and goes, etc. So Nr. and Bha. 131 The text has satmya, lit. ' what is conducive to health ' or ' hygiene.' Under this head the commentaries explain that the physician should enquire into both the patient's habits and his diet. 132 This is a rather difficult clause. Bha. does not explain it at all, and it evidently did not exist in its recension of the text (see below, note 133). In my translation I have followed Ni.'s explanation. Nr. takes abman to mean dosa or 'the (three) humours,' which is an unusual meaning, but I know nothing better : atman often means garira 'body,' and this might be made, though not so well, to fit in with Ni.'s explanation. The argument of the clause is?as follows. There are six means of diagnosis : the five senses aud questioning. Similarly there are six kinds of syrup- CHAP. X.] VISITING THE SICKROOM. 59 cribed, and badly examined by touch, will confound the physician.185 [5] toms of the deranged humours, namely five sensible (audible, visible, tangible, tasteable and smellable symptoms), and one ascertainable by questioning. Morever these six kinds of symptoms vary accord- ing as tlie derangement is of bile or phlegm or air. Seeing that there exists this similarity between the two sets, the physician is thereby enabled to identify the symptoms of derangement of any of the three humours, and thus to identify the disease itself which is caused by the deranged humours. Thus, in the case of derangement of the bile, the sores due to it are known by touch, the yellowish colour due to it, by the eye, the sourish taste due to it, by taste, the pungent smell due to it, by the nose, the biting and burning sensations due to it, by questioning. And so forth, in the case of other deranged humours. 133 There is here a distinct trace of an older recension. This verse clearly refers to the same threefold means of diagnosis (sight, touch, questioning) which are mentioned above in §[3J, and there declared to be incorrecb. The latter part of §[3], and the whole of §[4], are an interpolation of a later revisor. The origi- nal recension evidently still existed in the time of the commentator Cakrapanidatta whose commentary, the Bhauumati, shows that he read the text as follows : §[3] prayaco veditavyah || §[5] bhavati c=atra | mithyd-drsfa vikava hi dur-dkhy&tas=tath=aiva ca I tatha duh-parimrstac=ca mohayey ug=cihitsiikam \\ 1 1| tasmat=pariksyah satatam bhisaja siddhim=icchata | yukty=aiva vyadhaynh sarve pra- mnnair-darqan-adibliih II 2 \\ His recension omitted the last two clauses of § [3] and the whole of § [4] . It added, on the other hand, one verse to §[5]. On this text, as he read it, Cakrapanidatta remai'ks that the word prayaco as well as the particle ca ' and,' appended to prcchet in the preceding clause, indicate that, besides the senses of sight and touch, also the senses of smelling and hearing as well as anumdna or ' inference ' are admissible as means of diagnosis. He explains that ■ inference ' is necessary, because the sense of taste cannot be exercised by the physician on the patient directly ; he must do it through the intermediacy of ants from whose attrac- tion by the urine he infers the presence of sugar in urinary diseases (see note 128). He then quotes Caraka as saying both that " there are three modes of examination, by sight, touch, and ■r 60 SUTRA-STHANAM. [sec. £. (3) Having thus fully examined a disease, the physician should undertake the cure of curable diseases, and the relief of the relievable ones, but the incurable ones he should not attend to ; also diseases which have existed for more than one year, he should avoid to treat. [6J But even curable diseases of the following persons are, as a rule, most difficult to treat ; namely : Brahmans learned in the Vedas, kings, women, children, old and timid persons, royal servants, gamblers, physically weak people, contemners of physicians, concealers of their diseases, poor, stingy, and irascible people, also people incapable of self-control, and such as have no natural protectors.134 The treatment of these a questioning," as well as that " there are two modes of examination, by observation (pratyaksa) and inference (anumana) ." The latter, he explains, means that observation refers to sight and touch, while inference refers to the other senses. Dallana Micra, in his com- mentary, the Nibandha Saqgraha, further states that the Pafiji- kara (i.e., Gayadasa) read the text exactly as Cakrapanidatta did, and declared that those who held " a sixfold mode of examination did not properly understand the text-book." The additional verse, which is above quoted from the original recension, may be thus translated : ' hence a physician who is desirous of success must alwa}'S examine every disease iu the light of the evidence afforded by sight, touch, and questioning, and not omit to use his reasoning powers.' The phrase yuktya Eva lit., ' even together with reasoning or inference' may be noted. It leaves sufficient room for any evidence afforded by smell, sound, and taste. The older recension appears to me to have for itself the preponderance of authority ; but as the newer recension only is now found in the printed texts, I have followed it in my translation. 18i The reasons why these persons are difficult to treat are thus given by N[. : the Brahmins on account of their predisposition to illness through the frequency of their ceremonial ablutions ; kings on account of their intolerance of a prescribed regimen, or their delicate constitution ; women, on account of their reluctance to disclose their diseases or to submit to enemas, etc. ; the young and aged, on account of their delicate constitution and conse- quent inability to bear surgical or medical applications ; the timid, on account of their reluctance to submit to medical treat- ment ; royal servants, on account of their not being master of CHAP. XI.] PREPARATION OF CAUSTICS. 61 physician should only undertake with great care : then he will secure for himself merit, wealth, pleasure, and fame. [7] Here comes in (the following verse) : A good physician will avoid to be alone, or sit close to, or to jest with women ; nor will he accept any present from them excepting only articles of food. [8] THE ELEVENTH CHAPTER. On the Preparation and Use of Caustics. [1] (1) Of all cutting instruments and their substitutes [see chap. 8, § 8] caustics (or vegetable alkalis) are the most important, because by means of them deep and superficial incisions [see note 118] and scarifications may be made, derangements of the three humours (air, bile, and phlegm) may be rectified, and some diseases can be treated with special advantage.136 [2] Ksdra or ' caustics/ are so called because they are a means of attenuating (ksarand) or destroying (ksanana) (deceased skin, muscles, etc.). On account of various kinds of medicinal plants entering into their composition they serve to rectify the three humours when deranged.156 On account of their white colour, their nature is lunar {i.e., cooling) ; but this fact, is by no means inconsistent their time ; gamblers, on account of their absorbing attachment ; the weak, for the same reason as the young and aged ; contemners of physicians, because they are too conceited to abide by the prescribed regimen ; concealers of their diseases, because they ■will not speak out; the poor, on account of their inablity to purchase medicines ; the stingy, because they grudge the cost of medicines ; the irascible, because their ebullitions of anger inten- sify their diseases ; the incapable of self-control, because of their indulgence in unwholesome things; those who have no natural protectors {i.e., widows and orphans), because they have no one to attend to them. 135 Ni. explains that this refers to the case of haemorrhage (rakta-pitta) and piles {nrqas). 136 N'l. adds that for the same reason they are also useful in the treatment of haemorrhage and piles. See preceding note. 62 SUTltA-STHANAM. [SEC. I. with their power of burning, maturing and tearing : '37 indeed, on account of the large number of heating medicaments (which enter into their composition) they are acrid, hot and pungent. Their (external) use promotes suppuration, corrosion, depuration, granulation,158 desiccation, haamostasis, and scarification. Their (internal) use cures worms, acidity, deranged phlegm, skin- diseases, poisonings, and obesity. An excessive use of them induces impotence. [3] (2) Potashes are of two sorts : for external application, and for internal administration. Their external use is indicated in the case of skin-diseases, keloid, ringworm, leucoderma, lepra, fistula-in-ano, tumours, unhealthy sores, sinuses, condyloma, black moles, chloasma, brown spots on the face, and warts ; also in the case of abscesses, worms and poisoning (both on the surface) ; also of the (following) seven diseases of the mouth : tumour under the tongue (or ranula), tumour on the tongue, inflammation of the gums, inflammation due to external injury, and three kinds of rohini or inflammation of the throat ; in these (seven) cases only, caustics should be applied as a substitute of cutting instruments.139 Their internal use is applicable in the case of chronic or slow poisoning, abdominal tumours, abdominal enlargements, cessation of digestion, indigestion, want of appetite, constipation, urinary deposits, calculus, deep-seated abscesses, (intestinal) worms, (internal) poisoning, and piles. [•!] Their (internal administration) is unsuitable in the case of persons who have a tendency to (internal) haemorrhage and bilious fever, of children, and old or weak people ; also in the case of persons suffering from giddiness, frenzy,14,0 fainting, amaurosis, or other 137 Ni. points out that intense cold (himani) has the same effect as great heat. J38 The commentaries say that some omit ropann or ' granula- tion,' because (they say) a healthy sore granulates by itself, and does not require any caustic to promote it ; a caustic may rather prove noxious. 139 The commentaries explain that there are five kinds of rolrim, but two of them are incurable. li0 Caused by poisoning, intoxication, derangement of the blood, or eating of (fresh) betel nuts : so Nr. On the poisonous proper- CHAP. XI.] PREPARATION OF CAUSTICS. 63 similar diseases. Caustics for internal use are prepared in the same way as those for external use, by burning and straining. The details (of the method of their administration) will be given elsewhere.141 [5] Caustics may be made of three strengths: weak, moderate, and strong. (3) He who wishes to prepare a caustic, should, on an auspici- ous day in the autumn, after purifying himself and fasting, (select) a lai-ge-sized, middle-aged, uninjured 112 Muskaka tree (Stereo- spennum, suaveolens) , bearing dark flowers 143 and growing on an auspicious spot 144 on a (lonely) mountain, and perform the aiMvasana or ' preliminary ceremony/ saying the following incantation 14,6 : — " Oh thou tree of fiery power ! thou of great power ! may thy power not be lost ! Oh thou auspicious one, stay ties of the Areca Catechu, see Pharmacographia Indica, Vol. Ill, p. 524. It is especially the fresh nut which causes intoxication, and the sensations of strangling and giddiness. 141 The commentaries refer to the chapter on gulma or abdomi- nal tumours, and subsequent chapters; i.e., to Part VI (Uttara- tantra), chapter 42 ff., where a number of formulae will be found, into the composition of which various kinds of caustics enter. The commentaries, however, add that, in the case of caustics for internal use, the second boiling is omitted, and the measures for their three strengths are one pala, three karsa (or three-quarter pala), and half a pala of alkaline ashes respectively. 142 By fire or insects : so the commentaries. 143 The Muskaka tree is also called Ghantdpatali or Qlianta- parali. It is probably a variety, with particularly dark-coloured flowers, of the Patali or Stereospermum suaveolens, which has dark, dull-crimson flowers, and a campanulate calyx, and is sacred to Durga. Bha. quotes from Vicvamitra the following verse : ' there are four varieties of Muskaka with white, dark (Jcala), red and yellow flowers, among them the dark-flowered one is considered the best.' 144 I.e., in which there are no holes (cvabhra) nor any burying place, etc. So Bha. 145 The adhivasiina is an oblation (bali-harman) accompanied with an incantation (mantra). According to the commentaries, Blioja 64 SUTRA-STHANAM. [sec. I. even here and accomplish my work ! When once my work is done, then thou mayest go to heaven ! " After which he should make an oblation with a thousand white flowers. At daybreak (of the next day), if he observe no change (in the tree) nor any marvel,1*6 he should proceed as follows.147 He should cut down suitable pieces (of the tree), and having gives the following directions and incantation: 'he should there, with his face to the east, offer an oblation, and then, on all four sides, with joined palms, devoted mind and pure body, addressing the tree, repeat (the following words) : " Whatever spirits may inhabit this tree, let them depart hence ; for to-morrow this tree is to be cut for a high object ! " ' 116 I.e., if no branches are broken or other damage done ; and no shower of blood (rudhira-varsa) has fallen. So the commen- taries. 147 In the above given translation I have adopted the older recension which, to judge from Cakrapanidatta's commentary, appears to have been contained in the copy of Sucruta which he annotated. As it is not to be found in any of the modern editions of Sucruta, I give it here, reconstructed from the commentaries. In the edition of Kaviraj Gan^aprasad Sen, an attempt to do so is made, but it is given in an imperfect form. It runs as follows : ... adhivasy-dbhimantnj-anena mantrena | agnivirya etc. up to gamisyati gveta-puspam sahasram juhuyat \\ prabhate vaikrtam= adbhutnm na pagyet tad=upahalpayel I khandagah prakalpy=dvapatya nirvatB dege citim hrtva tila-nalair-adipayet || etc. The later and ordinary recension is given in .Tivananda Vidja- sagara's and other editions. Its translation will run thus : and perform the adhivasana ceremony. On the following day he should cut down the tree with the following incantation : " Oh thou tree of fiery power " (etc., as above in the text) ; after which he should offer an oblation with a thousand white and a thousand red flowers. He should then cut the tree into suitable pieces' (etc., as above in the text). This later recension makes the whole tree, "a large-sized one," to be cut down, while the older recension only directs pieces of it to be lopped off. For the case in hand (merely preparing some alkaline ashes) the latter is obviously the more rational one; ac- cordingly I have preferred it. CHAP. XI.] PREPARATION OF CAUSTICS. 65 piled them for burning in a spot sheltered from wind,143 he should set fire to them with stalks of Sesame. When the fire has burned out, he should collect separately the ashes of t^e wood and the nodules of the ashes.149 [6] In the same way the fol- lowing trees may be burned, including their branches, leaves, fruit, and roots : 160 148 According to Ni., one recension of Sucruta interpolates here sndha-farkara$=ca praksipya, i.e., ' and having thrown in some limestone,' and afterwards substitutes kata-garkarag=c,a or ' excess of (lime-)stone' for bhasma-$arkarag=ea or ' nodules of ashes.' Bha. knows nothing of this recension : apparently in Cakrapanidatta's time it did not yet exist. In the modern editions of Jivananda, Avinaca Oandra Kaviratna, and Gangaprasad Sen, confusedly, the interpolation is adopted, but not "the substitution. Besides " excess of lime-stone " is a very forced interpretation of the word kata-garkara which is otherwise only known as a name of the Bonduc-nut ; see below §[9]. 149 The bhasma-parkara or ' nodules of ashes ' are thus ex- plained by Bha. from the Nighanta : " When during the burning of the (green) Muskaka wood, its sap exudes, it forms hard parti- cles with the ashes ; these particles are called ' nodules of ashes.' " According to the commentaries, these nodules are collected sepa- rately, in order to be used in a subsequent stage of the pre- paration of the alkaline lye. See below §[9]. 150 This does not mean (as it appears to have been misunder- stood by some) that the whole tree should be cut down and burnt, but that any part of it may be used ; the remark has evidently special reference to the case of climbing plants (such as the Kosataki) which would afford but little wood. The com- mentaries here speculate on the reason why the Muskaka is mentioned separately. They give two alternative explanations. (1) Either Muskaka by itself, or a mixture of all the others (Kutaja, etc.) together, may be used to prepare ashes. (2) All the plants (Muskaka as well as Kutaja, etc.), in combination, must be used, but in that case one-half of the ashes must be of Muskaka, while the other half should be of Kutaja etc. combined. Bha. seems to prefer the former, while Ni. adopts the latter alternative. 9 66 StJTRA-STHANAM. [SEC. I. Kutaj a H f)i flYT li P it n flit / ? it. il QPwf wi nrt ( Pnnooci r\o vit-N J J UVU/t 1 itC'iviA/ If- llu Civ tj ot-V i/l/Cl vLtl I V_/UXlCOOl Ucil IV N Palaca it/ vis ka/ if ly/OfJ/UOlAr ^iJaS tail \JL JL LulV J y Acvakarna RliOTPfi Tohn.sttn fSal frPfA Kj/Mt\si \j\a/ i lyij ivo I'Ui l CI x LI CC / * Paribhadraka 1 6 1 JbTiiih-Yni n tyiflion (floral trppl Vibhitaka TfiTfil/tfl/il/i ft hplp'Yi on (TSpIpvip rnvroVinlonl 1 Hl/V II/IA/U VIA/ L/OVC / VK/iAj ^A/C IC1 All \ I \J KJCuLCXiLL J y Aragbadha i /flSHi? fl til kfn In iTnmQ n T lannrn n m \ y^/vvooiVb J. i/Ovtl/VU/ ^XllLlldll Ua U LI 1. IIUI 1 1 I- Tilvaka SwTM-TiloPOSi TflPPMOSift Arka CoZotfoms oiaoMtp.a. Gia,aritiV> Swnllnwwnvt^ Snuhi ^Ejupliovhifi ncTtiJ^oJ/icb Apamarga Achuvfiyithes flsnpra (PnVfclv Pha-PP flowpiA U. .1 I lA/ll/V IVKj*3 LA/OJJO 1 I* ^ J. II^IVIV \^/ xlcXXl. LlKJ VVvJ. }y Patala St6V€0Sp6T7lUM SUClVBolcilSy Naktarnala t 071,(1 ftwt ff, filnhra ■M- \J 1 l/yj lAJ 11(1 \sl/ fj V IA/ \J 1 Hi y Vrsa Adhatoda Vasica (Malabar-nut tree), KadalT 31~usa pavadisiaca (plantain). Citraka Plumbago zeylanica, Putika Caesalpima Bonducella (Bonduc-nut), Indravrksa162 Wrightia tinctoria, Asphota163 Salvadora persica, Acvamaraka Nerium odorum (Oleander), Saptacchada Alstonia scholaris, Agnimantha Premna integrifolia, Gunja Aims precatorius ( Jequirity), Four varieties of Kosataki ibi Lujfa. [7] 161 According to the commentaries, this may also be the Deodar (Cedrus Deodara). 1BZ Dr. U. C. Dutfc identifies this with Terminalia Arjuna. But Ni says that it is a kind of Kutaja, of which there are two varieties : one with brownish flowers, the other with white flowers. Dr. Dymock's Pharmacographia Indica, Vol. II, p. 397, says that the Wrightia tinctoria is often confounded with and substituted for Holarrhena antidysenterica, but that it has " white jasmin-like flowers." 168 This is the identification given by Dr. U. C. Dutt. Ni., however, identifies it with Sariva ( Memidesmus indicus or Ichnocar- pus frutescens). Bha. does not explain it. Both Sariva are climb- ing plants. 161 According to the commentaries these are : 1, with large fruit, CHAP. XI.] PREPARATION OF CAUSTICS. 67 Next one drona of the ashes should be stirred into six dronas of water or of the prescribed kind of urine,165 then strained (through cloth) twenty-one times, and finally boiled slowly in a large pan, agitating it (all the time) with a ladle. When (the fluid) becomes clear, red-coloured, pungent, and soapy to the touch,166 it should be taken off (the fire), strained through a large piece of cloth, and placed once more on the fire, while the residium may be thrown away. Of the alkaline water, thus obtained, (eventually) either one kudava {i.e., 8 pala) or one kudava and a half {i.e., li pala) will have to be taken.16''' [8] In the meantime some Bonduc-nuts, nodules of the ashes [see note 149], bivalve-shells and conch-shells, after having been made red-hot in an iron vessel,168 should be thrown into the afore-mentioned (8 or 13 pala of) alkaline water, crushed to powder, and stirred into a paste. Then this paste should 2, with small fruit, 3, with yellow flowers, 4, with white flowers. They are all climbing plants or vines. 155 I.e., of a cow. The reference is to the 1st paragraph of the 7th chapter of the Kalpasthana (or 5th section) ; [see page 640, line 16, of Jlvananda's editjpn]. So Ni. But the reference in Bha. is to the division on urine in the 45th chapter of the Sutrasthana (or 1st section), where the urine of a number of other animals is also permitted ; [see paragraph 1 on page 191 of Jivananda's edition.] The latter reference is undoubtedly the correct one. 166 This stage is generally reached when the fluid is decocted to one-fourth, or according to others, to one-third of its original quantity. So the commentaries. See below note 159. 167 In the case of fluids the equation of the quantities is doubled. Thus for solids or dry substances one kudava is equal to 4 pala, while for fluids it is equal to 8 pala. See paragraph 8 in chapter 31 of the Cikitsastana (or 4th Section), page 538 of Jlvananda's^ edition. 168 Bha. says that an iron vessel is used either because of its hardness, or because the iron enhances the strength of the prepara- tion. The English word potash is said to be " derived from the circumstance that the water in which the ashes are washed is evaporated in iron pots." 68 SfrTRA-STHAN'AM. [sec. t. he superadded to that afore-mentioned decoction169 and (the whole) should be boiled under constant, attentive agitation 169 I read tSn=aiva prativapya, i.e., ' having superadded to that very (decoction).' The commonly printed recension reads ten— aiva dvi-drone ' sta-pala-sammitam cagkhanabhy-adinam pramonam prativapya, i.e., ' having superadded conch-shells etc. at the rate of 8 pala to that very decoction consisting of 2 dr5na.' Both readings are noted and commented on by Bba. and Ni. ; and Bha. seems to prefer the reading which I have adopted, and which is clearly, as I shall show, the older and better one. The directions given in the latter are as follows : Of wood-ashes one drona should be taken ; ashes being solid, a drona is equal to 256 pala. Of water (or optionally urine) 6 drona must be taken, i.e., six times he quantity of water, i.e., 1536 pala (not 3072 pala, as one might suppose, see note 157 ; the calculation of both commentaries is explicit on this point). The mixture of wood-ashes and water ( or urine) is to be reduced or thickened by decoction : no definite limit is stated ; this is left to the physician's discretion ; practically the required state of decoction is reached at one-third or one- fourth of the original quantity (see note 156). Of the decocted mixture either 8 pala or 12 pala (Jiere the mode of measuring liquids is adopted, see note 157) may be taken, again at discretion. The commentaries here expressly state that these quantities are mentioned to serve as a guide to the quantities of the extra- ingredients which have to be superadded. Of these extra-in- gredients there are four (bonduc-nut, etc). The quantities of these are once more left to the physician's discretion : as Bha., expressly states, more or less of them may be taken, only there should be sufficient to form a paste with 8 or 12 pala of the decoction ; thus the latter quantity is a sort of guide. Having prepared this paste of extra-ingredients (the technical term for which is prativapa), it should be thrown into the remainder of the decoction (i.e., into what remains after taking away 8 or 12 pala). The whole is now to be boiled until it reaches the proper state of consistency. Now in course of time, it became the accepted practice to decoct the original quantity of 6 drona or J 536 pala of water (or urine) to one-third, i.e., to 2 drona or 512 pala, and to let the ratio of the quantities of the extra-ingredient3 be 8 pala. The reason was this : taking 8 pala of each of the 4 extras, we CHAP. XI.] PREPARATION OP CAUSTICS. 69 (with a ladle). Great care must be taken, lest (the solution) becomes too thick or too thin. When it has reached the (proper stage of) boiling-, it should be removed (from the fire) to a sheltered place and deposited in an iron jar with its mouth well covered. This (process yields a caustic solution of) middling- strength. The same process, but without the addition of any superadded ingredients [i.e., without the paste of bonduc-nuts, etc.], gives a weak solution or (what is called) samvyuhima or ' a simple mixture/ [9] As extra-ingredients such of the following drugs as are available should be used : — Dant! Baliospermum axillare, DravantT 160 A kind of DantT, Citraka Plumbago zeylanica, Laggalaki Gloriosa superba (Superb Lily), Putlka-pravala161 Sprouts of Caesalpiuia Bonducella (Bonduc- nut tree), Talapatrl Curculigo orcliioides, Vida Vid-salt, black salt, Suvarcika Carbonate of Soda, obtain 32 pala, and these are the 16th part of 512 pala; a mixture in these proportions was supposed to give the best potash ; the 8th part was supposed to give a middling sort, and the 4th part, a weak sort of potash. When this had become the accepted practice, the text was altered and the above-mentioned passage was inter- polated. The commentaries, however, note that some decocted the original quantity to one-fourth, and others, even to one-sixteenth (or 1ft6 = 96 pala) ; again others made 8 pala to be the total quantity of the extra-ingredients, i.e., 2 pala of each of the four. All this shows that the original text was drawn so as to leave a wide discretion to the operator. 160 The identity of this plant is uncertain. The commentaries say that it is a kind of Danti, which Bha. describes as jivita-patra, or ' having living leaves (?) ' ; but Ni. adds that according to Bhadalaka it is the same as Samvarl. But the identity of the latter is also doubtful ; it may be Salvinia cucullata or Antheri- cum tuberosum. 161 Ni. says that according to some this is Chirivilva or Pongumia glabra. 71) SUTRA-STHANAM. [sec. I. Kanaka-ksiri 162 A kind of earth of gold colour, Hirjga Ferula alliacea (asafoetida), Vaca Acorns Calamus (Sweet Flag), Visa Aconitum ferox (Indian Aconite), A cakti (or half a pala) of each of these drugs, in fine powder, will make up the extra-ingredients. The caustic solution prepared with them, is the strongest and (is called) pdki/a or 'the boiled one/163 (4) In the administration of these (three kinds of caustics) account must be taken of the (nature of the) disease and the strength (of the patient) . If any caustic solution should loose its power, some fresh alkaline water may be added, by which its strength will be re-gained.161 [10] Here come in (the following two verses) : — A caustic should be neither too strong, nor too weak, nor too white ; it should be soft and soapy (to the touch) ; 162 The commentaries give the synonym kagkustha, which sug- gests the possibility of the proper reading being kanaka-ksara, as kanaka-ksirl is only known as the name of certain plants. On kaykustha, see Garbe's Indische Mineralieu, p. 69, No. 141, foot-note. 163 The text classifies caustics into (1) samuyuhima or ' weak,' which has no extra-ingredients (prativapa) ; (2) madhyama or ' middling ' which has the extra-ingredients consisting of paste of bonduc-nut, etc.; (3) pakya or ' boiled,' i.e., extra boiled with an additional set of extra-ingredients consisting of paste of Daritl, etc. Bha. quotes the following classification from Bhoja : " Caustics are divided into samvyuhima or 'weak' and pakya or 'boiled,' and the latter are again divided into sa-prativdpa or ' middling ' (lit., ' with an extra-ingredient ' ) and tiksna or 'strong.'" This is similar to the classification of Sucruta. But Bha. also refers to another system of preparation, according to which all three kinds of caustic solutions are made with extra-ingredients, and are dis- tinguished from each other only by the quantities of the latter, these being 4, 8, and 16 parts respectively for the weak, middling, and strong solutions. Compare note 159. 164 iphe commentaries explain that, after adding the fresh alka- line water, the mixture should be again boiled. A caustic may become ineffective either through lapse of time or through deficiency in ingredients. CHAP. XI.] PREPARATION OF CAUSTICS. 7L it should have only a gentle flow, 165 and (in its action) it should he beneficial and quick. These are declared to be its eight good qualities. [11] On the other hand, its bad qualities are said to consist in its being too weak, too cool,166 too hot, too strong, too soapy, too spreading, or too thick ; also in its being underboiled, or deficient in ingredients. [12] (5) Now when (the physician) goes to see a patient suffer- ing from a disease curable by a caustic application, he should select (for the operation) a spacious place protected from draughts and the sun, and the conditions previously explained.167 He should then, after having placed handy all his appliances, examine the patient's (diseased) part, rub it, scrape it, and scarify it, and then with a probe apply the caustic ; and having done so, he should wait for the space of time required to utter one hundred words.168 On the application of the caustic, the diseased part turns black, and this is the sign of its being (properly) burnt. When this occurs, (the application of) any acetic acid,169 mixed with clarified butter and honey, will give relief. [14] But if by reason of its being deeply imbedded, the burnt 166 So that, on application, it does not spread unduly. So the commentaries. 166 ISTi. explains gaitya by guklata, 'too white,' but I am not aware that gaitya or gita ever has that meaning. See, however, § 1 and verse [11]. 167 That is, he should select an auspicious moment of time, as explained in § 3 of the 5th chapter. So the commentaries. 168 I have adopted Dallana's recension of this passage, which is adopted in Garjgaprasad Sen's edition and runs as follows : galakaija Jcsaram pratisdrayed—dattvd vdk-gata-mutram—upekseta. Cakrapanidatta appears to have read chittva for dattva and to have omitted upekseta, while the current edition (of Jivananda and Avinaca Oandra) reads patayitva for pratisarayed=dattva. There is no practical difference in meaning. 169 According to the commentaries the reference here is to any of the artificially prepared acetic acids, such as the sour gruels fermented from rice or barley or pulses infused in water. On these see infra, chap. 45, §§ [44-47]. 72 SUTRA-STHANAM. [SEC. V part does not (easily) come off, an ointment should be freely applied to it, [15] consisting of a paste made of equal parts of the sediment of kdnjika or 'fermented rice-water/ sesamum-seeds, and liquorice. [16] The granulation of the wound may be promoted by a paste made of sesamum seeds, liquorice and a little clarified butter. But how can the fire-like alkaline caustic be neutra- lised by applying to it the (fermented rice-water with its) equally fire-like, hot, pungent, acid taste? [17] If this is your difficulty, my son, then listen to my explanation. Know that in a caustic all tastes are present except the acid. [18] 170 It has an acrid sub-taste, but its prevalent taste is saline ; when joined to an acid (substance), the caustic, with its pungent-saline taste, [19] turns very mild and relinquishes its pungent nature. Through its mildness its (burning) is neutralised, just as a fire, when drenched with water, (is extinguished). [20] 170 In the original this is a rather puzzling passage, and perhaps the reading is corrupt. In my translation I have adopted a sug- gestion of Dallana. Cakrapanidatta explains : " its prevalent taste is acrid, but it has a saline sub-taste." Dallana points out that this cannot be correct: because 1, people take saline things to neutralise acidity in their food ; 2, the caustics are treated in the division relating to saline things, but not in that relating to acrid things. A caustic, therefore, is in the main saline ; and when in § 1 of this chapter a caustic is said to be acrid, it is only said to be so because a caustic is prepared with agneya or ' heating ' medicaments. Hence Dallana proposes to construe anurasa with katuka, and bhuyistha with lavana. With the reading as it now stands, such a construction is impossible ; that can only be translated : ' it is acrid, but it has a prevalent saline sab-taste ' ; but a sub- taste can hardly be said to be the prevalent one. Diillana's contention, however, seems to me to be right ; it agrees with Caraka, who, as Cakrapanidatta points out, says katur=lavana- bhuyistkah (ksarah), i.e., 'a caustic is acrid, but in the main saline.' Perhaps the correct reading of the passage should be katukas=tatr=anuraso lavana-bhuyisthas=tatha (though being an unusual form of cloka). CHAP. XI.] PREPARATION OF CAUSTICS. 73 Now when the burning (of the afflicted part) is done properly, the disease (for which it was applied) is cured, the system is relieved, and the discharge ceases. When the burning is done insufficiently, there is shooting pain, itching, and insensi- bility, and the disease increases. When the burning is done to excess, there is burning pain, suppuration, redness, (increased) discharge, pain in the limbs, sense of weariness, thirst, and fainting, and even death may result. The wound, caused by the (insufficient or excessive) burn of a caustic, should be treated according to the (nature of the) deranged humour and of the disease. [21] (5) The following persons should not be treated with caustics : 171 weak people, children, old and timid people, those who suffer from general anasarca or (internal) haemorrhage [see ante § 2] , pregnant and menstruating women, people who are in an advanced stage of fever, who are weakened by phthisis, who are subject to fits of (morbid) thirst and fainting, or who are suffering from seminal exhaustion, or from the displacement downwards or upwards of the testicles or the uterus. [22] Caustics should not be applied to the vital parts, blood-vessels, nerves, joints, cartilages,173 sutures,'73 dkamam-vessels,1141 throat, navel, inside of the nails, penis, (excretory) canals, and parts thinly covered with flesh,176 nor to the eyes with the exception of the diseases of the eyelids. [23] But even in the case of diseases curable by (the application of) caustics, these afford no cure to a patient who is subject to fits of anasarca, violent 171 Either internally, or externally, or both, according to circum- stances. So the commentaries. 172 I.e., those of the nose, ear, nape, eye and forehead. So the commentaries. 178 Of these there are seven : five on the cranium, one on the tongue, and one on the perinseum. So the commentaries. 17i On these see below, chapter 9 of the Q&riva, Sthana or 3rd Seetion. There is nothing exactly equivalent to them in modern anatomy. See also ante, note 60. i76 Such as the knee, the upper surface of the foot, the forehead, etc. So the commentaries. 10 74 SUTRA-STHA.NAM. [SEC. I. pain in the bones, aversion to food, or pain in the heart and joints. [24] Here comes in (the following verse) : — In the same manner as poison, fire, sharp weapons, and lightning, caustics, if applied by a careless physician, cause death. When applied properly by a careful physi- cian, they quickly cure (many) serious diseases. THE TWELFTH CHAPTER. On the Mode oe Applying the Actual Cautery. [1] (1) With regard to surgical treatment, actual cautery is said to be superior to caustics,175 inasmuch as diseases treated with the actual cautery do not re-appear, and because it can cure diseases which are incurable by medicines, instruments, and caustics. [2] (2) The means for carrying out the actual cautery are the following : long pepper, goafs dung, orpiment, an arrow-head, or a wick ; also oval-headed probes, 177 made of iron or other metals ; further, honey, treacle, and the various kinds of oleaginous sub- stances.178 Of these, long pepper, goat's dung, orpiment, arrow- heads and wicks are used in the case of (diseases) affecting the skin ; probes made of iron or other metals (such as copper, silver, etc.) in the case of (diseases) affecting the muscles ; and honey, treacle, and oleaginous substances, in the case of (diseases) affect- ing the blood-vessels, nerves, joints and bones. [3] The actual cautery may be used in all seasons except the autumn and 176 The commentaries explain that though in chapter 11, § 1 caustics are said to be superior to all substitutes, including the actual cautery, there is no contradiction here. Each is superior from its own point of view : cautery with regard to effectiveness of treatment, caustics with regard to variety of application. 177 The text has jdmbausfha which is a probe with a head shaped like the oval fruit of the Jambu tree. So Bha. See also ante, chap. 7, § 7. 178 These are the following four : oil, clarified butter, fat, and marrow. CHAP. XII.] ACTUAL CAUTERY. 75 summer ; and even in these (it may be used) if a rapidly fatal disease cannot be cured without it, provided that suitable precautions 179 are taken. [4] In all diseases and in all seasons the actual cautery should be performed on a patient only after he has been kept on a mucilaginous diet, but in the case of complex labour, stone in the bladder, fistula-in-ano, piles, and diseases of the mouth, (it should be performed on him) on an empty stomach. [5] (4) Some say that there are (only) two kinds of cautery, namely that of the skin and that of the muscles ; but here (in this treatise) there is no prohibition against the cauterization of blood-vessels, nerves, joints and bones.180 [6] When the skin 179 The commentaries explain that this refers to cool cloths and diet, as suitable to those two hob months. 180 According to Bha. and Nr. the reference is to Kacyapa from whom they quote the following verse : " under no circumstances should the irritating part be surgically removed from blood- vessels, nerves, joints and bones, or the potential or actual cautery be applied to those parts." Kacyapa is one of the ancient Hindu physicians. He is quoted in the Bower Manuscript (see my edition, p. 170, verse 1020) and in the Astaijga Hrdaya (VI, 2, verse 43). A Kacyapa Samhita still exists and the above quotation is probably from that work. I have no means of verifying it. Ni. tries to reconcile the discrepancy by saying that Sucruta here only means to say that the cautery should be used to stop the flow of blood, when a blood-vessel or nerve, etc., is divided, but not, that it should be used to cure any disease of those parts ; for the latter object is practically included in the cauterization of the muscles, as a bye-product of it, according to the saying of Madacaunaka : " along with the cauterization of the muscles diseases seated in the blood-vessels, nerves, bones and joints are also relieved." This harmonization, however, seems untenable in view of Sucruta's direction in § [8], that cautery should be applied to the blood-vessels, nerves, joints and bones, as well as to the skin and muscles, in the case of a painful inflammation caused by the deranged air of the body. The reconciliation suggested by Bha. has more probability. It says : " the use of the negative phrase " cautery is not prohibited," instead of the positive " cautery 16 SUTEA-STHANAM. [SEC. I. is cauterized, the burning is attended with a (crackling) noise, bad smell, and contraction of the skin. When the muscles are cauterized, (the burnt part assumes) the colour of a grey pigeon, is slightly swollen and painful, and its Wound is dry and con- tracted. When blood-vessels and nerves are cauterized, the wound appears black and elevated, and the discharge is stopped. When joints and bones are cauterized, the burnt part becomes rough and red, and the wound is hard and solid. [7] In headache and ophthalmia the eyebrows, forehead, and temples should be cauterized. In diseases of the eyelids, the roots of the eyelashes should be cauterized, after protecting the eye with a piece of wetted cotton cloth.181 In very painful affections, caused by deranged air, of the skin, muscles, blood-vessels, nerves, joints, or bones, in sores forming hard and insensible protuberances, l8a in cystic tumours, piles, tumours, fistula-in-ano, enlarged lym- phatic glands, elephantiasis, condyloma, black moles, scrotal enlargements, and injuries to joints and blood-vessels the actual cautery should be applied. [8] (5) Now, there are (four) different ways of performing the is enjoined," shows that cautery is only intended to be used in the case of a rapidly fatal disease of the blood-vessels, etc." In any case, it may be noted that though Sucruta permits the use of the actual cautery, he prohibits the employment of the potential cautery, in the case of diseases of blood-vessels, nerves, etc. ; see § 5 of the 11th chapter. 181 The text has alaktaka, which Nr. explains simply by kavpata or ' piece of cotton cloth.' Dr. U. C. Dutt says it is " cotton coloured red with lac." 181 Dr. U. C. Dutt, in his translation takes this and the pre- ceding phrase to signify but one disorder: "when a painful inflammation is caused by deranged air on the skin, flesh, etc., and the inflamed part is hard, swollen and insensible." But a >: painful inflammation " could not at the same time be " in- sensible." Clearly two distinct disorders are referred to. This is also seen from Cakrapanidatta's remark that vrana is to be taken gamanya or ' in a general seuse,' and therefore not with any particular reference to deranged air. The latter term seems to indicate a different disorder s painful rheumatic affection. CHAP. XII.] ACTUAL CAUTERY. 77 actual cautery : namely, in circles, points, lines, and areas.'88 [9] Here comes in (the following verse) ; — When he has examined the place and form of the disease, as well as the vital parts and the strength or weakness of the patient, only then the physician should decide on carefully performing the actual cautery. flOj After the part is thoroughly cauterized, it should be dressed with honey and clarified butter. (6) Now the actual cautery may not be performed on the following persons : those who are of a bilious temperament, who are subject to internal haemorrhage or diarrhoea, and who have unextracted foreign substances in their body, weak people, children, old and timid people, also those who are suffering from numerous ulcerations,1841 and those who cannot be made to perspire.186 [11] (7) We shall now proceed to describe the symptoms of cauter- ization when improperly performed. Fire is made a means of cauterization by being introduced into some oleaginous or dry substance.186 But an oleaginous substance, if well heated by fire, will, by following the minute vessels of the body, penetrate into its skin and its other parts, and rapidly cauterize them. Hence in cauterization by an oleaginous substance there is a 183 To suit the differences in the shape of the diseased part, as the commentaries explain. I follow the reading given in Ganga- prasad Sen's edition, which is also that of Bha. and Ni. The latter, however, says that some add rog-akrtim-aveksya, i.e., ' with a view to the shape of the diseased part.' The reading of Vidya- sagara's edition rdg-adhisthana-bheddd=agnikarma caturdha bhidyate, i.e, ' on account of the difference in the seats of the diseases the actual cautery is divided in four kinds,' is clearly a redundant interpolation. 18i Text : aneka-vrana-pldita. Bha., however, reads aneka- vyadhi-pidita, i.e., ' who suffer from various diseases,' that is, such diseases as are unsuitable for treatment by cautery, lest they be increased. 186 E.g., those who suffer from morbid pallor, morbid micturi- tion, morbid thirst, haemorrhage, etc. So the commentaries. 186 I.e., by strongly heating wood, stones, metals, etc., or, on the other hand, clarified butter, oil, etc. 78 SUTRA-STHANAM. [SEC. I. greater amount of pain. [12] Now there are four grades of cauterization : scorching, deficient burning, proper burning, and over-burning. Scorching is that which merely results in a heavy discoloration (of the skin) . Deficient burning is that where severe blisters arise with a sensation of drying up and burning up, combined with redness, suppuration, and pains, and take a long time to heal. Proper burning is that in which the burn is not too deep, coloured (yellow) like the (ripe) fruit of the Palmyra palm (Borassus fabelUformis) , well-formed,187 and furnished with all the characters previously [see § 4] described. Over-burning is that in which the flesh is pendulous, the body languid, the blood-vessels, nerves, joints and bones excessively injured, and fits of fever, burning sensation, thirst and fainting supervene ; in which moreover the sore heals very slowly, and, even after hearing, has an unhealthy colour. All these four kinds of cauter- izations fulfill (for the plrysician) their own proper purpose.183 [13] Here come in (the following verses) : — Irritated by fire, the blood of living beings becomes greatly deranged ; and its derangement quickly communi- cates itself to their bile. [14] For these two (substances) are like one another in regard to their (hot) power, their (bitter) taste and their (character as) elements (of the body). Hence severe pains arise : burning comes as a natural result (of the fire) [15]; blisters quickly spring up; and fever and thirst supervene. (8) Now the treatment adapted to neutralise (the effects of) cauterisation is the following. [16] In the case of scorch- ing, heat should be applied, and heating medicines adminis- tered, for, when the body copiously perspires, the blood be- comes thin. [17] For cold water naturally thickens the blood. Hence heat gives relief, but never cold. [18] In the case of deficient burning, the physician should adopt both cold and hot treatments. Dressing with clarified butter and '87 Ie., neither too much raised, nor too much depressed. So the commentaries. m I.e., they show him both what he should do, and what he must avoid. So the commentaries. CHAP. XII.] ACTUAL CAUTERY. n sprinkling with cold water should be resorted to by him. [19] In the case of proper burning a dressing made of (equal parts of) bamboo-manna, (bark of) Plaksa {Fieus Tjahela), (red) sandal-wood, and Amrta {Tiuospora corcli- folid), and greased with clarified butter, should be applied. [20] Also a plaster, made of the pounded flesh of animals living in villages, marshes or water,139 may be applied. In fact, the treatment should be with enduringly heating medicines, the same as in the case of deep-seated abscesses caused by deranged bile. [21] In the case of over- burning all loose-hanging pieces of flesh should be removed, and a cooling treatment adopted by the physician ; after- wards a plaster made of the grains of £ali or ( cold- . season-rice/ [22] or of the bark of Tinduki {Biospyros Embryopteris) or other trees with an astringent bark, mixed with clarified butter, should be applied ; and the sore should be covered with leaves of Guduei {Tiuospora cordifolia) or of some water-plant. In fact, the physician should follow altogether the same treatment as in the case of erysipilas caused by deranged bile. [23] The following makes an excellent granulating agent for every kind of cauterized burns, namely a paste made of (equal parts of) wax, honey, (bark of) Lodhra [Symplocos racemosa), resin of Sarja (Shorea robusta), madder, (red) sandalwood, and (leaves and root) of Murva {Sanseviera zeylanica), powdered and boiled in clarified butter. [24] In cauterizations by (heated) oleaginous substances a dry method of treatment should preferentially be followed. (9) We shall now proceed to describe the symptoms of suffocation by smoke. [25] (The patient) breathes and sneezes hard,190 becomes distended with wind, and coughs ; his eyes become burning and red ; [26] his expirations are 189 Such as horses, etc., boars, buffaloes, etc. ; turtles, etc. So Ni. 190 The text has ksanti, which Ni. explains by Ivikkati or 1 he hiccoughs.' But the reference is to sneezing, as Dr. Dutt translates. 80 SDTRA-STHANAM. [SEC. I. mixed with smoke ; he can smell nothing else but smoke, nor can he recognize any tastes ; his hearing also is im- paired; [27] he is thirsty, hot and feverish; he sinks (under the treatment") and faints. Such is suffocation by smoke. Now hear its treatment. [28] The patient should be given clarified butter with the juice of sugarcane, or raisins with milk, or sugared water, or sweetened acid juices in order to cause him to vomit. [29] By vomiting the bowels are cleared, and the smell of the smoke disappears. By this treatment, the languor, sneezing, fever, [30] burning, fainting, thirst, flatulence, (difficulty of) breath- ing, and coughing are alleviated. The use of sweet, saline, acid and acrid gargles [31] restores the functions of the senses and revives (those of) the mind. Errhines, skilfully administered to the patient by the physician, [32] clear his sight and (relieve) his head and neck. A diet should be prescribed of articles which are not heating, easy of digestion, and oleaginous. [33] In cases of burns from hot winds or exposure to sun, a cooling treatment should always be adopted. Burns caused by exposure to icy cold or showery winds are alleviated by (the use of) heating and oleaginous substances. In the case, however, of a burn by lightening there is no chance of recovery.191 [34] 191 Tbe text has atitejas, lit. ' excessive burn,' which both Bha. and Ni. explain to refer to lightening. Bha, in its comment, however, adds that " if only slighty burnt by lightning (manag- dagdha), the patient may recover," and Ni. supports this comment. This clearly let to the textual addition of verse [35], which is given in Jivananda's edition, and runs as follows : " but if the patient survives after being struck by lightening, he should be treated with oleaginous applications, washes and poultices." In Dallana's time this addition already existed ; but he says: "the commentaries (nibandha) do not acknowledge it. Cakrapanidatta did not read it in his text ; and in Garjgaprasad Sen's edition it is omitted. Instead of the usual recension pta-vars-anilatr ' cold and showery winds,' I read, with Cakrapanidatta, hima-vars-anilair ' icy cold and showery winds.' Dallana who reads gita explains it by the popular saying : " that hima or icy-cold burns like heat." CHAT. XIII.] APPLICATION OF LEECHES. 81 THE THIRTEENTH CHAPTER. On the Application oe Leeches.192 (1) Leeches may be said to be the mildest of all means for extracting blood, well adapted for princes, rich persons, child- ren, old, timid and weak people, women, and delicate persons. [2] (2) Blood deranged by air, bile, or phlegm may be extracted by horns, leeches, and gourds respectively, or any kind of deranged blood (may be extracted) by any (of the three) ; but if blood is to be extracted profusely, the horn, leech and gourd should be employed (in the order mentioned).193 [3] Here come in (the following verses) : — The horns of cows are said to be heating, mild and unctuous ; 194 hence they are the proper (instrument) for extracting blood in diseases caused by deranged air. [4] Leeches are born in water, have a cold exterior and are mild j 195 hence they are proper (to be used) for extracting 198 The commentaries explain that this chapter really treats of the various 'accessory instruments' for extracting blood. Of these leeches are the mildest, then come horns and gourds, and finally scarification and venesection, the last two being not ' mild ' at all. 193 I have adopted the reading of the text of Dallana and Cakrapanidatta. It is also given in the edition of Garjgaprasad Sen. According to Dallana the concluding sentence was rejected by some commentators, including Jaijhata. It is also omitted in the editions of Jivananda and Avinaca Candra. On the other hand, Jivananda's edition interpolates, after the first sentence, the words " by reason of their unctuous, cooling, and dry natures," which Dallana says are rejected by all commentators, and they un- doubtedly seem to be superfluous, seeing that their purport is stated in the succeeding verses [4-6]. 191 Bha. reads plalcsnam ' smooth ' for usnaih ' heating.' 196 Text vari-sambhava ' born in water,' to distinguish them from trna-jalauka, lit., 'grass-leech,' i.e., a caterpillar. So Bha. Cit-adhivasa is explained by Ni. as gita-grhd or ' living in cold places,' but by Bha. as pta-sambaddha, which I have adopted. Madhura is explained by Bha. as ' mild in application.' 11 82 StjTRA-STHANAM. [sec. I. blood in diseases caused by deranged bile. [5] Gourds are said to be acrid, dry and pungent ; hence they are the proper (instruments) for extracting blood in diseases caused by deranged phlegm.196 [6] Now in cupping, the blood should be extracted by means of a horn to which a small bladder is tied as a cover, after sucking it ; 197 or by means of a gourd in the inside of which a burning wick is placed. [7] (3) The leeches are called jal-agiika because Jala or 'water' is their ayuli or 'food; ' and they are called jal-anlcasa because water is their okas or ' dwelling place.' They are of twelve kinds : six of these are poisonous and just as many are non-poisonous.193 The poisonous ones are (the following) ; Krsnd, Karvura, Alagardd, Indrdyudhd, Sdmudrikd and Gocandand. Among these the Krsnd or 'black one' is of the colour of (black) colly rium and has a broad head. The Karvara or ' variegated one ' is as 196 According to Garjgaprasad Sen, his Bombay copy adds here the following verse : alavv=astaggulam vidyat crggan=tu dvadaga- rjgulam, jalaulcd ca hared-raktam g'tta sarva-gatam nrnam it i.e., ' the gourd should be of the size of 8 arjgula, and the horn, of 12 ; the cold leech draws the blood of men from any part.' Dallana refers to this verse, though he does not quote it. But he quotes the following from an unnamed authority : ' the horn should be that of a white cow and should be of the size of seven arjgula, and shaped like the disk of the moon ; at the top there should be a hole of the size of a pea.' According to him, the gourd should measure 8 arjgula (6 inches) in circumference, and 4 arjgula (3 inches) in size. Cakrapanidatta's measures are: the horn should be 3 arjgula, and its hole should be of the size of the stalk of an oleander flower. His measure for the gourd is not fully given. 197 The sucking, of course, creates a vacuum in the horn ; so does the burning of the wick in the gourd. I read, with Bha. and Ni., vasti or ' bladder.' Another reading, also mentioned by Nl. and given in Jivananda's edition has vastra or ' piece of cloth.' 198 The commentaries state, that according to another text-book (tantra), not named by them, the poisonous leeches are of eight kinds. CHAP. XIII.] APPLICATION OK LEECHES. 83 long as an eel,199 and has an abdomen, in some places raised, in others depressed.200 The Alagarcla looks as if covered with hair, has large sides and a black mouth. The Indrdyudhd or ' rainbow ' is adorned with (longitudinal) lines on its back, of the colours of the rainbow. The Samudrika or ' the stamped one ' is of a slightly whitish-yellow colour and marked with flower- like spots of various forms. The Gocandand has a bifurcated tail resembling the scrotum of a bull, and a small mouth. If any person is bitten by these, their bite produces swelling and excessive itching of the part, and fainting, fever, heat, vomiting, delirium, and general collapse supervene. In such a case the 3Ia/idffadam or ' Great Antidote ' should be administered in the form of a potion or an ointment or an errhine or in any other form. The bite of an IndrdyudJid is incurable. So far the poisonous leeches and the treatment (of their bite) have been described. [8] Now the non-poisonous leeches are the following : Kapild, Piygald, Qarjku-imikJd, Micsikd, Pundarika-mukM, Sdvarikd. Among these the Kapild or ' the greenish one ' has its two sides of the colour of orpiment, and on its back it is smooth and of the colour of a (green) pea.202 The Piygald or ' tawny 199 The original has varmi-matsya or ' Varmi fish.' The Hindu medical dictionaries explain it as a "kind of river fish," and say that in the vernaculars it is called vani or vani or vain or van (Barjgall) and bambi or lam (Hindi). This is the name of the eel. The Petersburg Dictionary does not identify it. Ni says that it is "like a snake," but it adds that some identify it with the Rohita fish, which is a kind of carp. The comparison with an eel would indicate a rather long species of leech. 200 I.e., probably, as Dr. U. C. Dutt paraphrases it, " it has elevated stripes across its abdomen " ; but not, as Dr. Wise puts it in his Hindu System of Medicine, p. 177, that " it moves irre- gularly." 201 This antidote will be found described infra, in verses [59-61] of chapter V of the Kalpasthana Cor 5th Section). 802 Kapild is somewhat puzzling. It cannot have here the usual meaning of ' brown ' or ' tawny,' because the commentaries explain the following piygaltX by kapila. Of Mudga (I'haseolus 84 SftTRA-STHANAM. [SEC. I. one 'is of a reddish-brown colour and a round body aud moves quickly. The Q ayku-mnkhi is (bluish-red) of the colour of liver, sucks quickly, and has a long sharp mouth. The Mu&ika or 'rat-like one ' has the shape and colour of a rat's (tail)203 and is of a disagreeable smell. The Pundarika-rnukhl or ■ lotus-faced one ' is of the colour of a (green) pea,202 and has a mouth like the lotus. The Savarikti is slimy, (green-) coloured like a lotus-leaf, and eight arjgulas (or 6 inches) in length ; it is only fit for extracting* blood from animals. Such is the description of the non-poison- ous (leeches). The countries in which they occur are the Yavana, Pandya, Sahya, Pautana and others.20* The leeches found in these countries are large-bodied, and strong, suck (blood) quickly and eat much, and are specially free from poison. Those leeches which are produced in dirty water aud from the decomposition of poisonous fishes, insects, frogs, urine, and fceces are poisonous. Those which are produced in pure water and from the decomposi- tion of the various kinds of lotus, called Padma, TJtpala, Nalina, Kumuda, Smigandhika, Kuvalaya, Pundarika,im and of Qaivdla Mango) there are two kinds : green and yellow. Cakrapanidatta says that the harita-mudga or ' green pea ' is intended ; and harita is also a synonym of kapila. The latter is an undecided colour. 203 So Bha. : it is like the tail of a rat on account of its length. 804 According to Dallana, by Yauvana is meant the country of the Turuska {i.e., the trans-Indus country) ; by Pandya, the Dekkan or Southern India, by Sahya, the country about the Narbada or Central India, and by Pautana, the country about Mathura or Western India. Both Dallana and Cakrapanidatta state that some commentators reject this passage ; but in that case they would have to read, in the following sentence, tasu instead of tesu, in order to make it applicable to the feminine jalauka, 'a leech.' The neuter tesu refers to ksetrani and clearly presupposes the existence of the passage in question. 206 All these are different varieties of Nelumbium speciosum and Nymphaea lotus. According to Dallana, " Padma is whitish, and Pundartka, very white ; Nalina is reddish and Kuvalaya, red ; Utpala is bluish ; Saugandhika is very sweefc-scented and opens in moonlight ; Kumuda is the well-known vernacular Kuiya or Koi." The two last-mentioned are white varieties. CHAP. XIII.] APPLICATION OF LEECHES. 85 (Blyxa Octandra) are non-poisonous. [9] Here comes in (the following verse) : — These beneficial (leeches) have their habitat in meadows and fresh waters ; they do not live in confined places, nor do they lie in quagmires. [10] As to the means of securing them, they may be caught with (a piece of) wet leather, or with some other (suitable) article.206 They should then be kept in a new large earthen pot, filled with mud and water from a pond or lake. For food, they should be given of the green fungi growing on stagnant water, dried meat, and powdered tubers of aquatic plants ; and for bed- ding, grasses and leaves of water-plants. Every second or third day, fresh water and food should be given, and every week the earthen pot should be changed. [11] Here comes in (the following verse) : — Leeches the middle of which is thick, or which are ex- hausted, or are expanded, or which move slowly, or do not fix, or suck little, or which are poisonous, should not be selected (for use). [12] (4) When about to apply a leech to a person who has got a disease curable by them, the patient should be made to lie down, and the (affected) part, if free from ulcers,20? should be rubbed dry with powdered cowdung and earth. Then having taken hold of the leech, and irritated its body with (a mixture of) turmeric and mustard rubbed into a paste with water, it should be placed, for a little while, in a cup of water, till its dullness is seen to have passed off ; 203 and then it may be applied to the 206 E.g., a piece of freshly killed meat, or one's leg smeared with butter, or milk, etc. So the commentaries. 207 Because, otherwise, by ruhbing the ulcers the disease will be increased ; or else it sucks the ulcer, attracted by the wet and smell of the blood. So the commentaries. 208 The usual text has vigata-klama ' freed from dulness ' ; but Cakrapanidatta reads vigata-mala which he explains by apagata- vahya-mala, 'freed from external impurities.' Both readings make good sense. The leeches are smeared with the paste to excite them, and they are put in water to clean them again from the paste, before applying them. 86 SUTRA-STHANAM. [sec. r. diseased part, covering it with a fine white wet piece of cotton- cloth, but so as to leave its mouth free. If it does not fix quickly, a drop of milk or a drop of blood may be applied to, or a small incision may be made (in the deceased part). If even then it does not fix, another should be applied. When it fastens on (the part), a leech raises its shoulder and bends its head like a horse-shoe, then it may be known to be sucking ; and while it is thus sucking, it should be covered up with a wet cloth. If in the bitten part itching or pain is felt, it is a sign that the leech is drawing pure blood j and such a leech should be re- moved. If on account of its scenting the blood,209 it will not let go, it should be bestrewed with powdered rock-salt. When it now falls off, its body should be irritated with powdered rice and its mouth smeared with oil and salt ; then taking hold of it by its tail with two fingers of the left hand, its body should be slowly and gradually pressed with the thumb and index-finger of the right hand, (from the tail) towards the head, and thus it should be made to vomit, until it is thoroughly emptied. When it is thoroughly emptied and placed in a cup of water, it goes about in it in search of food. If it sinks (to the bottom) and does not move about, it is not quite emptied, and should again be made to vomit till it is thoroughly empty. A leech which has been insufficiently emptied, is attacked with an incurable disease called Indramada.™ A leech which has been completely emptied should be replaced, as before explained, (in the earthen vessel). According as the (quantity of) blood (drawn) is proper or improper, the leech-bites should either (in the former case) be rubbed with honey, or sprinkled with cold water and bandaged, or (in the latter case) the wound may be also poulticed with 209 The usual reading is gonita-gandhena ' by the smelling of blood,' but according to Dallana some substitute gmita-gardhena ' through greed for blood,' ou the ground that leeches have got no sense of smell. 210 According to the commentaries some reject this passage, on the ground that the nature of the Indramada disease is not explained in any medical text-book. Cakrapanidatta himself would seem to have been in favour of rejecting it. CHAP. XIV.] DESCRIPTION OF BLOOD. 87 cooling poultices made of astringent or sweet drugs mixed with clarified butter.211 [13] Here comes in (the following verse) : — Whoso knows (all about) the leeches, their habitat, the mode of catching them, their varieties, and the manner of keeping and applying them, he is able to overcome all diseases curable by them. [14] THE FOURTEENTH CHAPTER. Description of the Blood. [1] (1) Food, which is derived from the five (primary) elements, is of four kinds, and possesses six tastes, two or (according to others) eight sensific powers, and many other qualities,212 yields, if 211 This is the interpretation given by some commentators, according to Dallana and Cakrapanidatta. It is also adopted by Dr. U. 0. Dutt, though in a slightly and incorrectly modified form. It seems to me to be the only admissible one : two alternative blood- effusions are mentioned, and the treatment adapted to each. Dallana and Cakrapanidatta themselves, however, prefer another interpretation with a fourfold division. According to them ayoga is of three kinds : hina, ati and mithya. Rubbing with honey is intended for hlna-yoga or ' insufficient extraction,' sprink- ling with water and bandaging for atiyoga or ' excessive extrac- tion,' and dressing with poultices for mithya-yoga or ' imperfect extraction' {i.e., when impure blood is left in the wound). This interpretation, however, leaves no treatment indicated for yoga or ' proper extraction.' Hence those commentators add, out of their own head, that it should be treated by dhanta-ghrt-dbhyayga, i.e., ' dressing with well-washed clarified butter.' 212 On the five (primary) elements see notes 16 and 30. The four kinds of food are those which must be drunk (peya), licked ( lehya), swallowed (agita or bhojya), and masticated (bliaksya or khadita). On the tastes, sensific powers, and other qualities, see infra, chapters 40-42. By the other qualities are especially meant those of light (laghu) and heavy (guru) digestion; so Bha. Altogether twenty guna or ' qualities ' are counted. 88 SUTRA-STHANAM. [SEC. I. it is suitably taken and thoroughly digested, its clarified215 essence (as a fluid substance) of very great fineness, which is called rasa or ' chyle/ The seat (of this chyle) is the heart, which is purified thereby.814 Then proceeding from the heart, through the twenty- four clhamani- vessels, ten ascending, ten descending, and four trans- verse, it, day by day, satiates the whole body, increasing, main- taining, and strengthening it, by some mysterious manner of action.216 From the fact that it pervades the whole body it can be further inferred that its condition is liable to the ills of deficiency and excess.216 Seeing that this chyle pervades the 213 The term tejobhuta is explained in three different ways. Cakrapanidatta says it means ' pure ' (nirmala or pi-asanna ), and he quotes Caraka in support. But he allows the optional meaning ghrta-vad-utpanna ' produced like clarified butter from butter,' tejas being a synonym of ghrta. Dallana also allows the latter ; but he prefers the meaning vahni-sambhuta or ' produced by fire' (i.e., the digestive fire). 211 The heart is also said to be the seat of ojas or ' vital force.' Hence Dallana says that here by 1 heart' is to be understood not the heart itself but its region, while Cakrapanidatta says that the seat of blood is that portion of the heart which is not occupied by ojas as its seat. On ojas see the next chapter. I read, with Bha., yuch= chhuddham after sthanam. 215 The terms 'increasing,' 'maintaining' (dharayati or as some read jivayati), and 'strengthening' refer respectively to youth, middle age, and old age. So the commentaries. 216 I.e., rasa or ' chyle ' pervades the whole body, seeing that, being healthy (tejobhiita) itself, it keeps the body in a healthy state (Jejas), as explained in the preceding passage. But the body is not always healthy ; it is subject to diseases: hence it follows that the rasa itself must be subject to ills. This seems to me the correct con- struction of the passage, and its obvious meaning as intended by Sucruta. The commentators, however, give an entirely different construction and interpretation of it. They construe thus : tasya anusarato gatir=anumaiiad=upalaksitavya ksaya-vrddhi-vailcrtaih ; and interpret thus : ' The fact of the chyle pervading the body can be inferred from its ills of deficiency and excess (and the conse- quent diseases of the body).' But why should the latter be a CltAP. XIV.] DESCRIPTION OF BLOOD. m whole body, its limbs, humours, constituent parts,917 secretions, and receptacles,*18 the question arises,819 is this substance proof of the prevalence of the chyle throughout the body, any more or any better than the health of the body ? In fact this proof is already given by Sucruta in the preceding passage : it ia the health of the body which proves that the chyle which is also a liealthy substance pervades the body. But there remains a difficulty which Sucruta had clearly to answer. If the prevalence of the healthy chyle makes the body healthy, Iiow are the diseases of the body to be accounted for ? The answer is : that the chyle, though essentially a healthy substance, is subject to deficiency or excess. Moreover the very term upalaksitavya indicates that some additional mark of the chyle is referred to ; its health is pre- viously spoken of, now its drawbacks are noted. Dallana evidently felt this difficulty, for he suggests that ca ' and ' must be under- stood (drastavyd) with Jcsaya-vrddhi-vaikrtaih. But this would be not only a gratuitous addition, but the awkwardness of his con- struction of anumanat still remains. The diseases of the body con- sequent on the ills of the chyle are exemplified by Dallana thus : deficiency of chyle causes pains and palpitation of the heai-t, etc., excess of it, languor of the heart, etc.— It may be also noted, that ail modern editions read : ?ariram=anudhavatd or 'flowing through the body,' while both Dallana and Cakrapanidatta read fariram= anusarato. This is clearly the older reading which I have adopted. It may mean the same as anudhavato ' flowing ' or ' moving,' but not necessarily ; it may also simply mean ' pervading ' (as, as a matter of fact, it does mean in the immediately following passage), and in the original context of Sucruta, as I have adopted it from Cakrapanidatta, neither he nor Sucruta can have meant anything else by it. The whole context only further proves the well-known fact, that in Cakrapanidatta's time and before it the circulation of blood {i.e., chyle reddened) was not yet known. The substitution, in the context, of the explicit term anudhavato would seem to have been a resultant of the spread of that knowledge into India. 217 The dhaiu or 'constituent parts ' (or secondary elements) of the body are seven ; see below § [6], and ante, footnote 30. 218 On these parts of the body see the 5th chapter of the parira- 6th ana (or 3rd Section), also the next paragraph of the present chapter. Secretions include both excreta and secreta. 219 That question arises in this way : of the parts of the bodv 12 90 SUTRA-STHANAM. [sec. I. a cooling or a heating one. The answer is this : chyle is indeed an all-pervading substance,820 but from the fact of its being a lubricating, vitalizing, nourishing, and preserving agent, it may be concluded to be a cooling one. (2) Now this chyle, though originally a watery fluid, assumes a red colour by contact with (the bile situated in) the liver and spleen. [1] There are also (the following two verses) : — Now this watery fluid, which (in itself) is devoid of any colour, is reddened through the heating power (of the bile) present in the body of corporeal beings in a healthy state, and it is hence called rahta or ' blood ' (lit. the red substance). [2] From this same chyle also the so-called rajas or ' menstrual blood ' of women is derived ; this blood begins to appear at the age of twelve and comes to an end at the age of fifty.221 [3] That the menstrual blood, however, has the property of heat may be seen from the fact that the womb has both the properties of heat and cold.2'23 Other (medical) authorities add that the blood of living beings is (ultimately) composed of the five elements ; [4] for (they say) the smell of raw meat, liquidity, red colour, tendency to ooze, and lightness, which are the some are cold, as phlegm, others are hot, as bile ; but chyle pervades all : is it, then, cold or hot P So the commentaries. *20 I read only anusari with Ni. and Bha. The reading drav- ttnusari, lit. ' flowing pervader,' is an emendation due to the same cause as the reading anudhavato, see note 216. *21 For the third verse, Dallana mentions the following curious reading, unknown to Cakrapanidatta : rasad=eva rajas=strinam inasi mSisi try-aham dravet | tad=varsad=dvadagad=urdhvarib yavat=pan- casatam samah || i.e., ' from this same chyle flows the menstrual blood of women, month by month, for three days, beginning from the age of twelve up to that fifty years.' 222 The meaning is this : it is well-known that the womb, into which both the semen and the menstrual blood enter, possesses both the hot and cold properties. Now the semen is cold, and accounts for the cold property of the womb. It follows hence CHAP. XIV.] DESCRIPTION OF BLOOD. 91 five qualities of earth and the other (four elements respec- tively), are also observable in the blood. [5] (Further,) blood being produced from chyle, flesh is next produced from blood, fat from flesh, bones from fat, marrow from bones, and (lastly) semen from marrow. [6] Thus chyle, being itself the essence of food and drink, nour- ishes these (other six) dhdtu or ( constituent parts of the body/ 223 [7] (3) Now the root ras means ' to go ' ; and the dhdtu or ' constituent part ' rasa or 1 chyle ' is called so, because it moves continually. But it stays in each of the (other six) constituent parts (of the body) for the space of three thousand and fifteen kalu. Hence it takes the chyle one month to turn into semen, or, in the case of women, into menstrual blood.224 [9] Hereon comes in (the following verse) : — Hence the total period is stated, in this (i.e., the author's own) as well as in other text-books, to be eighteen thousand and ninety (18090) kala. [10] that the menstrual blood must be hot, in order to account for the hot quality of the womb. The ordinary blood is neither hot nor cold, for it is the joint product from the cold chyle and the heating bile, see §§ [1, 2]. So Cakrapanidatta ; but Dallana, who reads arthavam gdnitan=ca, i.e., 'the menstrual blood as well as the ordinary blood,' holds that both kinds of blood are hot, the heat of the ordinary blood being inevitably involved in that of the menstrual blood. 228 Jivananda's edition here inserts the following verse [8] : " hence one should remember that man is the product of chyle, and, as a prudent man, preserve the chyle by careful attention to food and drink and ways of living." Neither Dallana nor Cakrapanidatta had it in their copies of Sucruta. 221 See ante, footnote 84. The calculation, according to Bha, is as follows : 30 kastd make one kala; 'zO kala and 3 kastd (or 20 kala) make one muhurtta ; and 30 mahurtta make one' ahordtra or ' day of 24 hours.' Accordingly ( 20^ x 30 or) 603 kala make one day. Now chyle takes 5 days or (603 x 5 or) 3015 kala for each of its six successive transmutations (into blood, flesh, fat, bones, marrow, and semen or ova in the menstrual blood ) . Accord- SUTItA-STHANAM. [sec. I. This chyle pervades the whole body by a very subtle process, after the manner of the diffusion of sound, light and water. (4) Aphrodisiac medicines, when administered, act like (other) secretory agents,286 and cause, by dint of their own power and properties, the rapid secretion of semen. [11] Just as with regard to the bud of a flower one cannot say that there is any scent, nor that there is no scent ; yet, considering that the true state of things is not yet perceptible, (it must be so that) there is scent ; only, on account of its slightness, it cannot be per- ceived, but after a time, with the expansion of the petals and stamens, the scent is clearly perceived. Even so, with the advance of age, the semen of boys makes its appearance ; so do the lines of hair (on the body) and the other signs of puberty, as ingly it takes one mouth or (3015 X 6 or) 18090 kala (see § [10]) for the entire series of transmutations. One kala = 2 minutes and seconds ; accordingly 3015 Jcala = 5 days. Bha. mentions, however, also another theory. According to it, the period of transmutation varies : 6 days or 12 days or one month, according to the state of the digestion. Bha. further suggests : that this variation is intended to be expressed by the comparison of the process of transmutation to the diffusion of sound, light and water (see § [11]). These three things move with different degrees of velocity, and thus indicate three different degrees of rapidity of digestion. Light is most rapid and signifies tllcsna or ' brisk ' digestion; sound is less rapid and signifies madhya or 'middling ' digestion ; water is the slowest and signifies viand a or ' slow ' digestion. Nt. objects to this interpretation as untenable, saying that sound, light and water signify the transverse, up- ward and downward transmission of the chyle through the body. Neither interpretation, however, is probable ; the comparison with sound, light and water seems to me only intended to convey the same idea as the phrase ' by some mysterions manner of action ' in § 1, p. 88. — By arttava is here meant strlnam cukra or ' the semen of women,' i.e., ova as excreted with the menstrual blood. So the commentaries. 825 The original has virecana, which is the usual term for pur- gatives, but in giro-virecana the word is used in its more general sense of a secretory agent. CHAP. XIV.] DESCRIPTION OF BLOOD. 98 well as menstruation and the other mai-ks of womanhood ; and with the development of menstruation, an enlargement of the breasts, the womb, and the genitals takes place. Similarly, by reason of the body decaying through old age, chyle ceases to be a fostering agent for old people. (5) The above-mentioned [§ [6]] (seven) dhdtiiov ' constituent parts of the body' are called so because they make up the constitution of the body. Their growth and decay depends upon the blood. Hence we will now expound the subject of the blood. [12] When it is vitiated by air, blood is frothy, tawny, dark, thin, flows quickly and is indisposed to thicken.226 When it is vitiated by bile, it looks blue, yellow, green, and livid, smells like raw flesh, is not affected by ants and flies, and is indisposed to thicken. When it is vitiated by phlegm, it looks (pale) like a solution of red ochre, is oily, cool, thick, sticky, flows slowly and has the appearance of muscles. When it is vitiated by all three humours in combination, it has all the (above-mentioned) marks, and in addition it looks like kdnjikd or ' fermented rice- water ' and has a foul smell.287 When the blood is vitiated by any two humours at one time, it has the mixed characters (of blood deranged by those two humours).228 [13] When blood is in its natural (healthy) condition, it may be known from the fact of its showing the red 'colour of the cochineal insect, and of its being not thick nor in any way discoloured. 226 The original lias askandi, which Bha. explains by asamhata or ' not thickened,' and Ni. by styanatva-rahita or ' without thickness.' Dr. U. 0. Dutfc translates it " dries slowly," and Dr. Wise has " draws slowly," which practically express the idea. 227 Here Jivananda's edition inserts : " when the blood (of one part) is vitiated by the vitiated blood (of another part), it has the same marks as blood vitiated by bile and, in addition, is very black." Both Bha. and Ni. notice this reading, but do not approve it. 228 Jivananda's edition here inserts : " of -the blood of living beings we will speak elsewhere." Bha. knows nothing of this reading. Ni. notices it only to reject it. It does certainly seem to be out of place. 94 SUTRA-STHANAM. [sec. r. (6) Diseases which require blood-letting will be described elsewhere.289 Cases in which blood should not be extracted are swelling due to general anasarca or, in the case of a wasted male,880 to the eating of acids, and inflammatory swellings connected with morbid pallor, piles, abdominal enlargement, consumption, and pregnancy. [14] . (7) There are two modes of extracting blood by means of gastra or ( cutting instruments ' [see Chapter viii] : scarification and venesection. In making these, the instrument should be inserted with a quick movement and so as to avoid injuring any vital part, blood-vessel, nerve and joint, and the punctures (tbus made) should be straight downwards, not too close together, very fine, in a straight line, not too deep, nor too super- ficial.231 When the operation is badly done, or done on an inauspi- cious or on a cold and rainy day, on a patient whose perspiration is checked (by the chill) or who has not had his meal, the blood, by reason of being thick, does not come out freely or does not come out at all. [15] Here comes in (the following verse) : — In the case of persons who are suffering from intoxica- tion, fainting, or fatigue, or are troubled with retention of urine, faeces and wind, or are overcome with sleep, or are timid, the blood does not flow freely. [16] Vitiated blood, when it remains unextracted, causes itching, 229 I.e., in Chapter xxv, on the Eight Kinds of Surgical Opera- tions. So the commentaries. 280 The original has kstnasya, which might have a more general meaning ; but Ni. qualifies it with pumsah, ' of a male,' which seems to refer the word to ' wasted virility.' 231 These directions refer to both scarification and venesection ; so Bha. ; but Ni. appears to refer them only to scarification, and this view has been adopted by Dr. U. 0. Dutt. But Bha. is un- doubtedly correct. Bha. explains that blood-letting by means of anugastra or ' accessory cutting instruments ' having been des- cribed in chapter xiii, now blood-letting by gastra or ' cutting instruments' is described. It further refers to Chapter viii, § 3 with respect to the mode of holding the instrument (e.g., the kutharika). CHAP. XIV.] DESCRIPTION OF BLOOD. 96 swelling, redness, burning1, suppuration, and pain. On a hot day, when a patient perspires much, or if the puncturing is over- done by an ignorant operator, the flow of blood becomes exces- sive. From such a discharge severe pains in the head, dimness of sight, ophthalmia, cataract, wasting of tissues, convulsions, hemiplegia, paralysis of a single limb, morbid thirst, burning, hiccough, cough, asthma, ansemia, and even death ensue. [17] Here come in (the following verses) : — Hence the physician should not extract blood either on a cold or a very hot day, nor from a patient who is either chilled or very heated, and he should operate on him after having given him repeatedly some gruel .Ssa [18] When, after flowing (some time), the blood shows a proper red colour and stops of its own accord, then the physician may know that the blood is purified and that the bleeding has been properly done. [19] (Further) symptoms of a bleeding properly performed are (a feeling of) lightness, relief of pain, a check to the progress of the disease, and cheerfulness of mind. [20] Those who are in the habit of having their blood extracted periodically are never subject to skin-diseases, varicose enlargements, swellings, and (other) diseases due to (disordered) blood.233 [21] (8) If the blood does not flow freely, any three or four of the under-mentioned ingredients, or all of them together, just as they may be available, should be reduced to powder, worked up into a paste with mustard-oil and salt/34 and rubbed on the 283 This according to Mi., should be tila-yavagu or 'gruel made of sesamum seed;' or according to Bha., tila-tandula-yavagu or ' gruel of sesamum and rice.' But Mi. adds that according to others virala-drava is intended, which is a gruel of any grain made with clarified butter. According to the commentaries the patient should have two or three meals of gruel, before being bled. The object of this is to warm up his system and thus induce the flow of blood. 833 Such as deep-seated abscesses, ei'ysipilas, etc. So Mi. 83i Mi. reads here lavana-taila-pragadhair, i.e., ' made into a paste with salt and sesamum-oil.' The reading of Bha. is not apparent. 96 SUTHA-STHANAM. [SEC. I. scarified part, whereupon the blood will flow freely : — Ella Elettaria Cardamomum (cardamoms). Cita-civa Cinnamomum CampAora (camphor). Kustha Saussurea Lappa. Tagara Tabemcemontana coronaria. Patha (Roots of) Stephania hernandifolia. Bhadra-daru Cedrus Deodar a (deodar). Vidarjga Ewbelia Ribes (baberang). Citraka Plumbago zeylanica (plumbago-root). Tri-katuka The three acrids, ginger, long pepper and black pepper. Sgara-dhuma Soot. Haridra Curcuma longa (turmeric). Ark-arjkura Shoots of Calotropis gigantea. Naktamala- Seeds of Pongamia glabra. phala. (9) If the blood flows too freely powders of the under-men- tioned drugs should be sprinkled slowly over the scarified part and pressed into it with the point of a finger : — Rodkra Sgmplocos racemosa. Madhuka Ghjryrrhiza glabra (liquorice) . Priyarjgu Aglaia Roxburghiana. Pattanga Caesalpinia Sappan.™ Gairika Red ochre. Sarja-rasa * Resin of S/iorea robusta. Rasanjana Extract of Berberis asiatica. CalmalT-puspa Flowers of Bombax malabaricum. £ankha Conch-shell. £ukti Bivalve-shell. **6 Ni. describes this as rakta-candana or ' red sandal,' which would be Pterocnrpus santalinus. Bha. describes it as ku-candana or ' inferior sandal,' which is probably the Sappan-wood. This wood is whitish when freshly cut, but becomes red from exposure to air. It is by some Sanskrit writers included among the differ- ent kinds of sandal-wood, and is described as being of use to heal wounds and stop haemorrhage. See Pkannacographia Iudica, Vol. I, page 500. CHAP. XIV.] DESCRIPTION OP BLOOD. 97 Masa Phaseolus RoxhirgUi. Yava Barley. Godhuma . Wheat. Or powders of the following drugs may be taken : — Sala and Sarja Two varieties of Shorea rohnsta*1* Arjuna Terminalia Arjuna. Arimeda Acacia Farnestana, Mesacrrjga Gymmma sylvestre. Dhava Anogeissns latifoha.™ Dhanvana Grewia tilicefolia. Tvaea Cinnamon-bark. Or one may take for the purpose (the ashes) of burnt linen, or powders of cuttle-fish bone or of lac. This done, the wound should be firmly tied with (linen or woolen) bandages as prescribed [in Chapter xviii]. The patient should, then, be covered with cool clothes, given cooling food, and kept in a cool room; he should also be treated with cool douches and poultices. (Failing the above-described modes) the wound should be burned with caustics or with fire ; or the vein which gives off a too copious flow, should be divided at a place below the original incision238 (and then cauterised). (10) (After the operation) the patient should be given to drink a decoction of the Kakoll class of drugs [see Chapter xxxviii, §[31]], or a sweet mixture of sugar and honey. Or he should take the blood of an antelope, deer, ram, hare, buffalo or boar, mixed with milk or pulse-soup or meat-brothr and well greased (with clarified butter)". Any complications (that may arise from excessive loss of blood [see above § [17] ] must receive that 886 This is the explanation of Ni. The resin of those trees is •'■a name. They do not seem '"mm, lit." ' after vrak-krta- viously 98 SUTRA-STHANAM. [SEC. I. treatment which is suitable to the particular case. [-22] Here come in (the following verses) : — After any extraction of blood, owing to the loss in xhat constituent part (of the body), the patient's digestion becomes weakened, and his air becomes much derang. d. Hence he should be very carefully [23] kept on suc)i a diet as promotes the generation of blood, and which should consist of not- very-cooling, light, oleaginous artides, slightly acid or not acid at all. [24] . (11) There are four modes of arresting haemorrhage : contrac- tion (of the wound), thickening (of the blood), desicat- ing, and cauterising. [25] Astringent (decoctions'89) con- tract the wound ; great cold thickens the blood ; ashes [see § 9] dry up the wound ; and cautery causes the veins to shrink. [26] If the blood refuses to thicken (by the application of cold), astringents should be applied ; if these fail, ashes should be used. [27] By means of these three modes the physician should endeavour to the best of his power (to stop the bleeding) ; but if they all fail of success, cautery may be resorted to as an absolutely effective means. [28] If after bleeding any impure blood still remains (in the system), the disease will not increase much ; in such a case, (the physician) should rest content (with the ordinary modes of depura- tionsw) and not proceed to violent measures (of repeated bleedings). [29] (For) the blood is the root of the body, and it is the blood by which it is sustained. It should, therefore, be most carefully preserved ; for it is the basis of life. [30] If through the cold applications [see § 9 ] used to stop the bleeding, the air becomes deranged, and (in consequence) thfti -ifi*"^ -- ■ ' ' paint'ully swollen, it of tepid clarihV1 * *8« Ni. ins*' the so-cal1 • Pharr 24- ] GLASGOW UNIVERSITY > LIBRARY