English
These ethyl ester deidvatives have be(m in use at the United States Public Health Service leprosy investigation station at Kali hi in the Hawaiian Islands only for three years with a very limi¬ ted supply of the oil, and within this short period 140 lepers* have been paroled and return ed to their families, the disease apparently arrested, if not totally cured. From the joint report of .1. T. Mc.Donald of the leprosy inves¬ tigation, and A. L. Dean, President of the University of Hawaii, the following conclusion may be summarized ; (1) The intramuscular 378 ANCIENT HINDU MEDICINE injectioD oE the ethyl esters of the fatty acids of the chaulmooi^i’a oil usually leads to rapid improvement in the clinical symptoms of leprosy. In many cases the lesions disappear, except for scars and permanent injuries, and the leprosy bacillus can no longer be demonstrated. (2) ' When combined with iodine, the fatty acids of chaulmoogra oil and their esters give good ' result, but there is no adequate experimental proof that it causes any increase in the effect¬ iveness of the materials used. (3) Although conclusive evidence is not at hand, it is probable that the oral administration of chaulmoogra oil derivatives is of minor importance compared with the injections. (4) In treating leprosy, it is important to make use of all auxiliary agencies to build up and maintain bodily vigor. (5) It has been sufficiently established that the chaul¬ moogra oil contains one or more agents which exert a marked therapeutic action in leprosy. '■ We can not as yet say the disease is cured, ' since we have no test adequate to-establish such | u. verdict. Whetlier or not the apparent cures ' ai’e real and permanent, it is evident that we ' have a valuable agent at our disposal for the ^ ■control of the disease. ^ In Burma and Assam, four Vcwieties of ' DISEASES 379 Chaulrnugra trees (Sydnocarpus castancc, JSydno- carputs anthelmintioa in Siam Avhere it is known as Maikr(ibao tree. Gynocardia odoratta and Taraktogenos kur^ii, spoken of by the Burmese as ‘kalaw' ) are seen together, and they® can not be easily distinguished one from the other without accurate botanical description. The trees, leaves, fruits and the oils are very similar. Only the genuine chaulmoogra Taraktogenos kurzii lacks the double testa on the fruit of the other varieties, and the oil deidvatives of the ^Tarakto- genos kurzii’ liave the potent thei’apeutic value. Others only possess it to a lesser extent.c VIII. Diseases of the Genital Organs. “Vrddhi {oscheoneub^ is, the vascular swelling of the sac (scrotum) containing the testes, due to various lesions. Pain in the bladder, groin, testes and the penis are its prodromal symptoms. The scrotum is distended and rough like a bladder filled with gas, and without any apparent cause there is pain due to the gas, in * The vivid description of the Chaulmoogra tree is given Avith illusti’ations in the March content of the National Geographic Magazine, Washington, 1922, by J. F. Rock Avho was sent the U. S. A. Department of Agriculture to secure the seeds of Chaulmoogra. 380 ANCIENT HINDU MEDICINE vata vrcldhi {emphysema may be classified under two divisions : (1) benign, where the gas is intro¬ duced into tlie tissues through a local wound or where its source is from some distant wound which communicates with the air-passages or bowels ; and (2) malignant, where gas is genera¬ ted in connection wuth bacterial fermentation. The benign form gets well spontaneously. Por the malignant form, incision, drainage and thorough disinfection are necessary). The scrotum has the color of the ripe fruit of *Jicus glomerata’ and it ( inflammation ) grows and suppurates rapidly, in ^pitta-vrddhV {epidi- dymo-orchitis' in which the symptoms somewhat differ according to whether tlie epididymis or the testis is more affected. On tl\e whole the symp¬ toms are more severe with the latter than with the former, though suppuration is more frequent in epididymitis. Premonitory symptoms are fever, headache and general malaise, followed by tenderness and pain in the affected parts. This disease might arise from the extension of the chronic gonorrheal inflammatory process or secondary manifestation of syphilis in interstitial or gummatous forms. The patient must be put to bed and have the scrotum raised and supported with a pillow and ice-bag. The bowels DISEASES 381 are to be opened with a purgative to remove internal congestion and light liquid food should be given as milk. After the inflammation has subsided, hot lead-lotion dressings or hot fomen¬ tations can be used advantageously to increase the vascularity of the part, thus aiding in the removal and absorption of the inflammatory products. If suppuration takes place, the abscess must be incised, drained off and the abscess cavity disinfected. If the lesion is of syphilitic origin, antisyphilic treatment is very beneficial ). It is tense, slightly painful, cold and pruritic in ^slesma-wddhi* ( edema is common as the scrotum being elastic and distensible, is especially liable to be invaded by general dropsical effusions ). The scrotum encloses a dark tumor and has all the symptoms of epididymo-orchitis iu ^rakta- vrddhV (Jiematocele which is a tumor caused by collection of blood in the cavity of the tunica vaginalis. It differs from hydrocele in that it is not transparent. It is usually associated with some traumatism, and is accompanied by in¬ flammatory symptoms. Any variety of hydrocele or spermatocele may rapidly refill with blood, after being tapped, thus forming hematocele or by filaria. Hemorrhage also may take place into 382 ANCIENT HINDU MEDICINE the loose tissues about the cord, forming a tumor, sometimes called, diffused hematocele or the cord. Eor treatment, the sac should be incised autiseptically, the clot reiuoved, tiie cavity irrigated, and drainage established and continued until such time as the obliteration of the sac by granulations has been accomplished ). It is boggy, glistening, pruritic, slightly pain¬ ful and looks like the fruit of the palmyra tree ( Borassus flabelliformis) in ‘medo-v'i'ddhi' ( elephantiasis, the Scrotum is a favorite seat of this affection. The growth is slow, painless and progressive and maj'- reach the weight of ISO pounds or more, and is caused by the block¬ ing of the afferent lymph ducts by the adult worms and the eggs of Eilaria bancrofti. The disease is confined to high temperature region and the e£;g of tlie Eilaria bancrofti is introduced into the body by tlie bite of the mosquito, belonging to different species wliich are known to be its carrier as Oulex fatigans, Mansonia unifor- mis, Mansonia pseudotitillans, Pyretopborus costalis, Myzomia rossii, Myzorhynchus nigerri- mus, Cellia albimana. Tlie only effective treat¬ ment of the disease is operative removal which is vej-y ea^y and successful, if special attention is paid to antisepsis, so that there can be no DISEASES 383- septic absorption from the stump. To keep the skin clean and aseptic, and to choose the parts of the skill as flaps are ratlier important factors of a successful operation. The pedicle is clamped and the scrotal tissue removed, care being taken to leave the testicles cind penis and ligaturing the A'essels as they are exposed. The exposed testicles become covered by granulation and cicatrization ). Due to the retention of urine, the scrotum' palpitates like a leather-bag filled with water ; it is boggy and in this disease, there are stran¬ gury, pain in the testes and edema of the scrotum; it is called. ‘matra-vrddhV [urinary extravasation or hydrocele, possibly the latter. Urinary extravasation invades the scrotal tissues, causing a tumefaction as in simple edema (slemua-vrddhi liydrosscheocele). The urine however excites greater irritation than serous effusion, and consequently the scrotal tissues speedily become infiltrated by inflammatory exudates. If it be not relieved with a puncture- needle, trocar or incision, it usually results in abscess formation. Vaginal hydrocele on the other hand, consists of a collection of fluid, more or less serous, in the cavity of the tunica vaginalis. Perhaps by ‘slesma-vrddhV (osche- 384 ANCIENT HINDU MEDICINE dema) hydrocele was meant. But according to the tradition, 'imUra-vrddhi^ is taken for hydrocele. The etiology of vaginal hydrocele is yet obscure. In the tertiary stage of syphilis, there is diffuse gummatous infiltration or the formation of localized gumma in the testes accompanied usually by a small hydrocele. In infancy the hydrocele is generally .connected with gastro-intestinal fermentation ; in childhood and early adult life, it is very often associated with some abnormal condition of the testicle or spermatic cord; later in life it is perhaps concerned with the vascular changes that take place with the degenerative involution of the testes]. ^‘Susrutall. 12. 2-5* 165. i firet Iv fjq: t!v5iqfmrv<u;KrvfHq?j wrl; cir ii 'o fcT II a ftcfifqqiqff'j^f’ qlqifViqtcirtr vraii ^g^jprqiqit fqriiTifi, i qffe^ri^- qi’Ss "Cqi8t eft kwi i cn^iqivniqffsit 'll vfciffq cit ^?ll’ II s. DISEASES 385 Treatment : “‘In *vata~vrdclki’ (emphysema) apply soothing salve and emplasterum (anila- = relief of = soothing) ; in case it is of a suppurative type (malignant emphysema), use a pustulant and after it has suppurated, incise (and drain) it without hurting the raphe, and treat it according to the prescribed rules in tliese cases.