English
These tubules are thousands in number and be¬ cause of their minuteness, they are invisible. Awake or asleep they trickle down by osmosis {nisyanda) and fill up the bladder, as a new earthen pot (porous) is filled up by the surroun¬ ding water, if pressed down into it up to its neck.” Susruta II. 3. 13-14’®®. “Calculus is bard to cure and is dangerous. 128 . sRiu Rl'iidl i srau "s'ii w g ftraRRT i a'€ltirtsf^: ^rr^i’ rnq_Jtiacu ii ^tl^'diPmi'iit g 'a I 5EraiT u a^t ii u 294 ANCIENT HINDU MEDICINE When it is young (tender), it may be controllable by medicines, but ■when it is mature (hard), it has to be extracted by operation. “In the preliminary stage of lithiasis oleaginous potions are beneficial and remove the cause of its formation, A decoction of Plectran- thus scutellaroides, Aeschynomene grandiflora, Pothus officinalis, Oxalis, Asparagus racemosus, Placourtia cataphracta, Solanum jacquini, Flacourtia sapida, Columba domestica, Solanum melongena, Barleria caerulia, Pentaptera arjuna, i ii fecwipftvf: I ^ wft 11 *raTW. jii<tiiiiciiyTifl* *j^ II l9iiat<l<wi?cts I aiwcf: A 9 t^nzpC’T ii ^ ytr. i ^ ^rar ftfe ii DISEASES 295 Andropon muricatus, Trapa bisponosa, Hedysa- rum gangeticum, Bballuca, Capparis trifoliata, Tectonae grandis fructus, Hordeum bexastichon, Dolichos biflorus, Zizyphus jujuba and Strychni potatorum fructus,seasoned with clarified butter, and sprinkled with alkaline earth, if drunk in proper doses, causes fracture of the calculi. And in addition, in this’treatment alkalies, barley- water, soup, astringents and milk should be drunk for the amelioration of ‘vata\ SuSruta IV. 7, = ^ 129. i cret ^H I qpnnwft cRn I swraft II 5 STRial’ II jfw; ^^rifn wra ’ffsnfir i inf ? a ficW, II ftinfiT ftinfi g i Tl3i*iiPi ^ qi<t*(iai*t ii i 296 ANCIENT HINDU MEDICINE Spontaneous fracture of stone has been observed by many in the bladder {Ord, Deboiit d' JSstrees, Femoick^ Martin, etc),either by radical cleavage from the centre to the periphery or by splitting in concentric laminae. It has been demonstrated that spheres of carbonate of lime, which had formed in solutions of gum, split radially and disintegrate, if placed in a solution y of different specific gravity. It is possible that in a similar way, the urinary calculi split and disintegrate under the influence of varying, specific gravities and reactions of the urine, which causes molecular tension and cleavage, and consequently spontaneous cure takes place at some famous springs (as Carlsbad or Contrexe- ville) which enjoy special reputation for this curative property. Uric acid or oxalate of lime h calculi can be formed only in strongly acid urine while in the alkaline urine phosphates of ammonia and magnesia are precipitated. There¬ fore if in the uric acid or oxalate of lime calculus, the urine can be made and kept alka¬ line for some time, it is likely to create molecular instability of the calculi and split them into frag¬ ments, gravel or brick dust. And vice versa in phoshate calculi. Carbonate of potash, ace¬ tate of potash, piperine, common and lithia DISEASES 297 salts are also reputed to exercise a solvent ac¬ tion upon uric acid crystals in the urine. “If emulsion, alkalies ( carbonate of potash astringent infusion, milk and bougie do not relieve the calculi, then operation is the only remedy. Susruta IV. 7. 11*^“. ‘‘Place the patient upon the lap af a strong, man (to hold in position) seated on a knee-high table. The patient with courage and deter¬ mination stretches his upper part on his back and his pelvis raised by a cushion underneath it; the legs are to be flexed (to about a right angle with the table) and supported by a man (on each side), or held in position by a cloth crutch. Then the umbilical region should be massaged and pressed with unguents by hands as long as the calculus does not come below the umbilicus. Next after manicuring, and lubricating the fingers with oil, the fore and the middle-fingers of the left hand should be introduced in the rectum towards the raphe scroti. VThen the calculus has been found, it should be carefully forced down between the 130. '5^; ^ i 298 ANCIENT HINDU MEDICINE middle of pubis and the urethra, and placed in an even, mediura-^ized and polished staff, and pressed so hard that the calculus appears like a tumor.•••Incision should be made about third of an inch to the left of the raphe scroti ( and an inch and half from the anus ) of the size of the calculus. According to some (autho¬ rities ), if it facilitates the operation, incision can also he made at the right side. But care should be taken that the calculus be not broken ( into fragments ) by the instruments or pulve¬ rized, for if even a minute fragment remains ( in the bladder ), the calculus 'grows ( round it as nucleus ). Therefore for extracting cal¬ culi, use forceps with curved blades ( serrated and concave in the inner side ). “In woman, the uterus is situated by the bladder, therefore do not make long incision, nor deep incision, as it might wound the sphincters ( mutt'a-sram ). If the incision is made at the proper place ( by distending the bladder upward and forcing the calculus down¬ ward ), it might also result in the incontinence of urine in man by severing the sphincters ( by the lateral perineal incision ). Without litho¬ tomy, there cannot be any break in the blad¬ der, but if it does (in rupture by over-disten- DISEASES 299 sion), the patient dies. If however in the extraction of the calculus, the bladder is penetrated, the patient might survive, for the medicines that are used for the healing of the incision wound, can be also applied for the cicatrization of the other wound. And the penetration of the bladder ( sphincters ? ) is not in violation of the ( medical ) code. Moreover, the urine causes the formation of the calculus, and the little incontinence of the urine can not do much harm, and though the barley- , water is diuretic, it is found beneficial (in lithi- asis). After the extraction of the calculus, the patient should be given hot sitz bath ( hip bath ), for in hot water, the bladder can not be fi.lled with blood. But if it takes place, the bladder shall be irrigated with astringent effusion of Ficus glomaratm.” IV. 7. 13-15*®*. “Prostatolith or phosphatic crystals ( prosta- 13!. citft aa; awirj feaia- TTO fit 1 tm: ^’fpa’s aroint# afe' am aaj‘ aafit i 300 ANCIENT HINDU MEDICINE tic calculi are of two kinds—those formed in the kidney or bladder and lodging in the prostatjc sinus, and those which originate in the gland itself), if they are dislodged from their own cavities and are locked up in the passage through the urethra, they should be extracted (by forceps) through the urethral passage. If it can not be done then an incision should be made in the urethra ( median perineal urethrotomy ) and the calculus extracted by hook-forcep. And though the wound is cicatrized for a year, sexual intercourse, riding horses and elephants, tree- ^ ftw g i ftin hi?''?’ i A ' ^ fvrft ^ ^ ti DISEASES 301 climbing, mountaineering, charioteering and swimming shoiild not be indulged in ; heavy indigestible food should also be avoided. Make incision so that the prostate, vesicula seminalis, vas deferens, ureter, raphe scroti, vagina, rectum or the bladder are not hurt. If the prostates are severed, death takes place by the accumulation of urine in the bladder (the passage for the discharge of the urine into the ure¬ thra being blocked by tbe tumorous or hypertro¬ phic growth of the prostate ); by the severance of the vesicula seminalis, death or eunuchism takes place ; by the severance of vas deferens, impotence; by the severance of the ureter, dispersion of the urine (to the contiguous tissues by percolation) ; wound in the raphe scroti causes intense pain ; and if the bladder and the rectum are wounded, all the symptoms due to their penetration, mentioned before, appear. Smnita IV. 7. 19-20*®*. Modern lithotomi hardly differ^ much from that of the Susruta school, especially when lateral 132- n' ®“si‘ m I 73ivrr: i i t 302 ANCIENT HINDU MEDICINE incision is made, except that before operation, the bladder is drained off and distended by hot' boracic lotion, and kept ia that condition during operation by plugging the spigot of the silver catheter by which the injection has been intro¬ duced. But generally now-a-days supra-pubie operation is preferred, but below the peritoneum, as higher up serous membrane is met. After the bleeding has stopped, the wound is closed by sutures. However, litholapaxy seems to be the favorite means adopted for the removal of vesical calcu¬ lus. And when the urethra is not roomy enough to admit an instrument of adequate calibre, or the stone is very large or hard (oxalate of lime- calculus), and if under these circumstances, litho¬ lapaxy can not be practised, lithotomy is adopted for the removal of the stone. Lithotrity consists of crushing the stone within the notched and fenestrated inside surface of very hard steel ■o >D DISEASES 303 blades under a severe and continuous pressure into a very fine powder, and the removal of the detritus by flushing out through a full-sized hollow metal catheter and an India-rubber wash bottle. V. Diseases of the mouth, "There are sixty-five diseases of the mouth. The centers of their origin are seven, namely,, lips, gum, tooth, tongue, palate, throat and the buccal cavity. Of these the lips have eight kinds of diseases, gum fifteen, teeth eight, tongue five, palate nine, throat seventeen, and the buccal cavity three”. Susnita II. 16. 2-3'®*.