English
cirrhosis or tumor, ascites of long duration or greatly dilated sto¬ mach ; the navel (umbilicus) is deeply retracted |j in stout people ; if projecting it may be due to portal obstruction, pregnancy or hernia; it is t flattened or protruding in excessive ascites, or j abdominal distentions ; fixation of the umbilicus is significant of hepatic malignant cancer ; the abdominal wall may be thick from the deposit of fat or edema and if it be thin with shrivelled skin, it may be due either to old age, wasting disease, , PATHOLOGY 171 repeated pregnancies or as a reaction of long¬ standing distension from ascites ; the abdomen may be distended by the accumulation of fat in the abdominal wall, or fluid in the perital cavity or gas ill the alimentary canal or the presence of a large tumor ; swelling in the gastric area may be due to tumor, abscess or cancer on the gastric wall, hepatic cancer or pancreatic cyst or scler¬ osis or the distension of the gall-bladder either with concretions or pus ; swelling in the hepatic area may be due to tumor, cancer, hypertrophic cirrhosis, hydatid cyst or passive congestion of the liver or sympathetically from the distended gall-bladder stuffed with concretions and pus ; •swelling in the splenic area may be due to mov¬ able or prolapsed spleen, perinephritic abscess, or congested movable kidney, or cancer of the stomach ; the swelling of the appendical area is symptomatic of acute appendicitis ; swelling in the pelvic area may be due to distended bladder, or by the distended uterus by tumor or detained menstimal fluid {imperforate hymen ); swelling in the sigmoid area may be due to the impaction of feces, tuberculous or cancerous peritonitis, ulcer of colon, ovarian tumor or cyst of broad ligament], nails (curving of the nails with clubbed fingers, occur only in chronic diseases as phthisis 172 ANCIENT HINDU MEDICINE emphysema, aneurism or chronic cardiac diseases; malformation, fragility, dryness or cracking of the nails may be due to injury, syphilis or due to trophic defects, resulting froms nerve lesion, neuritis, syringomyelia or pul¬ monary osteo-arthopathy; arrested growth of nails may be due to hemiplegia from cerebral apoplexy or acute infantile paralysis ; enlarge¬ ment of the nails with thickening and sometimes twisting occurs in the course of syphilis, sclero- dactyly and typhoid fevers ; the nails in some cases of Raynaud’s disease, become dry, scaly and cracked or hypertrophied ; ecchymoses and ulcers at the bases of the nails may be due to- chloral habit, but in a child {onychia) to syphi¬ lis or scrofulous diathesis; white marks or transverse grooves on the surface of the nails- may indicate, unless due to injury, the period of recovery from a recent acute illness the growth of the nail from the matrix to the end requires about six months and as the- white marks develop at the root of the nail and with the growth of the nail, the transverse goooves also ascend higher and so a rough esti¬ mate can be made from their position of the time that has elapsed since the convalescence set in; hard, brittle, and longitudinally striated PATHOLOGY 173 nails are observed in gouty subjects), finger (distorted fingers are due to gout, arthritis defor¬ mans and less frequently to chronic rheumatism; hard, white, glissening masses {tophi) may be present in the joints or along the tendons, on account of the accumulation of the sodium urate in gout and consequently in gout and rheuma¬ tism, the joints of the fingers are enlarged and painful , the tophi is more prominent on the dorsal surface of the joints and it sometimes breaks through the skin, so that the chalk-like concretion exudes ; knobby enlargements of the proximal ends of the terminal phalanges (end- joint arthritic nodes ) may be due either to gout or arthritis deformans and small crab-eye cysts may be formed over the nodes ; the tips of the fingers may be bulbous or club-shaped in chronic lung diseases as phthisis or chronic heart affection ; the claw hand occurs in consequence of atrophy and paralysis of the interossei and lumbrical muscles due to neuritis of the median and ulnar nerves ; the spade hand with large, coarse, thick fingers and broad nails is observed in myxedema, but in which only the soft parts are affected, while in acromegaly, the bones are enlarged; the hand of the individual of a nervous temperament is firm, fine, delicate and 174 ANCIENT HINDU MEDICINE dexterous ; of sanguine temperament, broad, heavy, strong and energetic; of phlegmatic temperament soft and clammy ; coldness of the hands and feet, with or without tendency to sweating, if persisting for a long time, is due to neurasthenia, anemia, chronic digestive disoi*ders, gout, cardiac or pulmonary diseases, interfering with the circulation) should be observed.” Charaka V. 3. 5^^. “When he does that (vomits), the physician should examine the expectorated matter from the spittoon with attention.” Charaka I. 15. 16®*. Urine was examined for its color, consistence, taste and smell, only in genito-urinary diseases- {Charaka II. 4 5 Sus7'uta II. 6 ) but sputum, feces and semen as a vitality test and as a prognosis in diseases : “According to the sayings of the wise, his life is at an end, whose sputum, feces and semen sink, when thrown into water.” Charaka V. 9. 14*'’. Sus'ruta gives elaborate details of the prognostic symptoms :— 68. cf I 11 69. Tpsffa 1 PATHOLOGY 175 ‘ “He whose complexion is changed into pale- brownish (in Addison’s disease), reddish (hypere¬ mia 5 chlorosis rubra), yellowish (jaundice or icterus) or l)lue-purplisli (cyanosis), he is near his death. He who suddenly loses his modesty, beautiful appearance, ability to hold himself upright and personal charms (in apoplexy, asudden loss of consciousness is followed by paralysis, due to cerebral hemorrhage or blocking of an artery of the brain by an embolus or thrombus), he can. be regiirded as dead. Whose loioer lip hangs down (the lips are loose and pendulous in diphtheretic* paralysis or chronic bulbar palsy), upper lip twitches up (twitching or trembling of the lips is index of general paralysis or bulbar palsy),or both the lips have the colour of ripe plums (the colour of the ripe plum is dark bluish, that is cyanotic : in diseases of the heart or the lungs, especially the chronic forms, owing to dyspnoea, the lips are open, dry and cyanosed), his life is hard to save. He whose teeth are reddish (stained with blood— sordes —in typhoid prostration), or pale brownish ( stained from the deposit of foul matter in jaundice on the tongue ), or like polished collyrium (dark black deposit is found on the tongue in Addison’s disease or nigritis ),. or have fallen ( loosening of the teeth in their 176 ANCIENT HINDU MEDICINE sockets may be due to pyorrhea alveolaris, scurvy, purpura hemorrhagia, and extensive and rapid dental caries is common in diabetes or rachitis ), can be regarded as dead. He whose tongue is black ( in Addison’s disease or nigrites) paralyzed (in basal meningitis, syphilic lesion, tumor or cerebral hemorrhage), swollen (glossitis may occur in various diseases as variola, erysipelas or sceptimia), or dry and fissured (in the typhoid status), is near his death.” Susnita I. 31. 2-6^®. He whose hair looks oily (in hyperthyroidism), though not smeared with oil, does not live long. 70. SJTT^ ^ ( ?niTT ^ f^r ^ TO 11 PATHOLOGY 177 and knowing this, the wise ( physician ) should give him up. Char aha V. 8. 7^*. Susruta says^^. ‘‘Nervous diseases, 'prameha' ( diabetes and gonorrhea ), leprosy, hemorrhoids (piles), anal fistula, calculus, 'nmihagarhluC (transverse or scapulo-posterior presentation of the fetus during birth) and abdominal maladies—these eight are naturally hard to cure; but if these are also complicated with the developments of enervation, emaciation, dyspnea, thirst, ‘sosa’ (desiccation of the body or pulmonary consumption ), vomiting, fever, un¬ consciousness, diarrhea, hiccup and other compli¬ cations, then the wise physician, desirous of suc¬ cess, should not untertake their treatment. If 71. 72. ii^ fvi5iT 118 ^ vrv ^T'flurf^qlfVcm i VTctssjTflilf^' JTIS#T 118, jn?' '5Pf( H fT,': II 12 178 ANCIENT HINDU MEDICINE in nervous diseases, there are complications of edema, insensibility to touch, paralysis of the body, tremor, tumor and pain in the abdomen, the patient dies. If in urinary diseases these complications develop, and with the urine much substances ( albuminuria) are discharged and boils appear on the body, that patient dies. In leprosy, if the nodules ulcerate, eyes become red, the voice broken and the five kinds of. treatment as vomiting and purgation do not succeed, the death of the patient is near. In hemorrhoids ( piles ), if there are complication of polydipsia, loss of appetite, pain, excessive irs' It'S 11= ftfiTOi; I vnKUTT ^ IK 5iw€tqq5:ra^i feq’ 553W qsftfRigTHiqsRT: iiu qi^vr^raRf q-5^1qiifhgiTqlf%cn}; i fw^Rtsiq qr i PATHOLOGY 179 bleeding, edema and diarrhoea, the patient dies. The anal fistula through which the intestinal gas, urine, feces, microbes and semen are discharged is deadly. In the diseases of hard calculus (asmcm)^ soft calculus {sarhara') and gravel (si^a^a-uric acid sands), if there appear edema in umbilical region, testicles, ischuria (retention of urine), and shoot¬ ing pain, the patient dies quickly. In the trans¬ verse presentation, if there is paralysis of the uterus, dull pain (makkalla) and spasmic contrac¬ tion of the vagina, the gravida dies.