English
c -Ol 504 ANCIENT HINDU MEDICINE cutting instrument ) ; ( 8 ) Needle ( sTicM, a- slender, sharp-pointed instrument, used for punc¬ turing the tissues, for guiding the thread in su¬ turing or for passing a ligature round an artery); ( 9 ) Bistoury ( kusa-patra, a long, narrow-bladed knife, shaped like the ‘kusa’ grass—Eragrotis cynosuroides ) ; (10) Haxok-bill scissor {ati-niukha, an instrument with two blades, held together by a rivet, moving on the pivot and cutting against each other, resembling the bill of ‘atf bird—Tur- dus Ginginianus ) ; ( 11) Scissor {sarari-mukha, resembling the long and slender beak of heron ) ; ( 12 ) Concave bistoury ( antaramukha, having curved blade inside ); (13) Trocar {trikurohchaka,. an instrument for withdrawing fluid from a cavity or for use in paracentesis, consisting of a metal tube— ‘cannula\ open at both ends, in which fits a rod with a sharp three-cornered tip, which is withdrawn after the instrument has been pushed into the cavity ; trocar is derived from Erench- Hrois' — three, -I- ‘corre’—side, having the same meaning of ‘ tri-kurchchaka' ) ; (14) Lenticular knife ( kutharikd, an axe-like knife, resembling- cow’s tooth ) : ( 15 ) Aspirating needle ( vrihi- mukha, a hollow needle, used for withdrawing fluid from a cavitj^ an aspirator tube being attached to one end, the other end, shaped like SURGEKY 505 the rice grain, being thrust into the cavity) ; (16) Iredectomy knife ( ard, an arrow-headed knife, resembling an owl) ; (17) Scalpel {vetasa-patra) a pointed, long and slender knife with convex edge, resembling the rattan leaf) ; (18) Hook (vaclisa^ an instrument curved or bent near its tip, used for fixation of a part or traction); (19) Scaler (danta sahku^ an instrument to remove tartar from the teeth ) ; (20) Fine-pointed probe ( esan'i, used for dilating contracted lacrymal puncta or examining the lacrymal canals). Uses : Of them, the Circular Knife and the Saw can be used for excision and scarifica¬ tion ; Lancet, Canalicular Knife, Gum Lancet, Thumb Lancet and the Amputating Knife for excisionandincision ; Needle,Bistoury, Hawk-bill Scissor, Scissor, Concave Bistoury and the Trocar for drainage ( of the fluid cavities ) ; Lenticular Knife, ilspirating Needle, Iredectomy Knife and the Scalpel for puncturing ; the Needle can also be used for puncturing ; Hook and the Scaler for extraction(scraping of tartar from the teeth etc. ) ; Eine-pointed Probe for finding out the passage and the direction of a sinus ; and Needles for suturation. In these eight kinds of action the use of ‘sastra’ (sharp instruments) are- described. 506 AKCIENX HINDU MEDICINE The way these insti’uments shall he handled, shall he described now. The lancet and other incis¬ ing instruments should he held hy the top and the middle of the handle. T'or scarification, the Lancet and the Circular Knife should be held with slightly bent hand. All the drainage instruments should be held by the top of the handle. J?or the drainage of the fluid cavities, children, the aged, the delicately constituted, the timid, women, kings and the princes, the Trocar should be employed. Of the Aspirating needle, the Aspirator should be held in the palm of the hand, and the needle between the thumb and the index finger. The handle of the Lenticular knife should be held in the left hand, and the index and middle fingers of the right hand should be pressed upon it during operation. Iredectomy Knife, Saw and the Fine-pointed Probe should be held by the root ( middle of the handle ). The rest of the instruments should be held properly ( as to give the most effective result ). The shapes of these instruments are indicated by their nomenclature. And the Canalicular Knife and the Fine-pointed Probe are eight fingers’ breadth long ( about 5 inches ). Needles shall be described later. The extremity of the Hook and the Scaler is slightlv curved, and it is SURGERY 507 .barp like the thorn or fine like the young leaf- blade of Hordeum hexastichum. The orifice of the Fine-pointed Probe is like that of an earthworm. The Gum Lancet is of the size of the top phalanx of the forefinger. The Scissor is ten fingers’ breadth long ( about 6 inches ). And the rest of the instruments are about 6 fingers’ breadth long ( about 4 inches ). Good InstrmnenU : The instruments which have good handles, are made of good iron (steel), i are sharp, well-formed, and whose edges are fine and even, and without indentation, are the best. Defective Instruments : The instruments that are bent, blunt, broken, jagged, too cumbersome, too light, too long or too short, are defective (these are the eight defects in sharp instruments ). The sharp instruments that have the opposite quali¬ ties of these, are to he used, excepting that of the Saw, where the jagged sharpness is necessary for sawing bones, for which it is used. Edges of the Instruments : The edge of the incising instruments should be like the thickness uf the tip of Ervum lens, of the scarifying instru¬ ments, half the thickness of that of Ervum lens, of the puncturing and the draining instruments like that of hair, and of the excising instrument half the thickness of the tip of hair. 508 ANCIENT HINDU MEDICINE Sterilization of the Instruments : Steriliza¬ tion {iKcyana ) of the instruments can be accom¬ plished in three ways : (1) hy caustics ; (2) hy water ( hy boiling the instrument in v'ater ) ; (3) by oils (by immersingthe instruments in antiseptic oils ). The instruments that are used in the excision ( extirpation ) of missiles, foreign bodies and bone ( saw ) should be sterilized by caustics. The instruments for the excision and incision of the tissues should be sterilized in water. The instruments that are used for the excision of vessels and tendons, should be sterilized in ( antiseptic and boiling ) oils. Tor sharpening the instruments, pale, polished stone should be nsed, and to prevent the dullness of the edge ( and rusting ), they should be incased in a bos, made out of the wood of silk-cotton tree ( Bora- bax heptaphyllum ). The instruments that are very sharp and bright, and supplied with good handles and are of proper size, should only be used in operation.” Susriita I. 8. 2-10'®’^. 197. Tsjfa; srorfsi i cf?5ijr i fk- - vD -3 cl cTH ^RTt ^ I SURGERY 509 Lesions that need Excision Operation : ^‘Excision ( or extirpation ) should be performed I *4 l 4 ^: ^ 4 % I 4I^^Ii744t4: ^T^T?i: II '0 4Tpa4T W4 41^154*41^ I fTOr44JlfiT I l4i^4^ 4141?^- ?T^r ^T^H4TO^ f4^T4^e^ I cT4m^Tf4444l- f4^^qTft^4[lrf I ^KT4\K44 44^ 1 TOlftl g 44T4>1 53^l4TcT 1| 8 ^4r 4Ti?r^K4T?i44: 4T44I s^T^mU I m 4^514?44414^^#, ^ ^ 4=^44^ ( 4f^^ 4^55^^14414 #44i^4T4WI444^^ I 44^1 44J4414TT\^# I 4trs55444^4t^4414IT iif44rT I 441^ ^ 5^4Tft^Wt 4T 41-^'4lf4 4i^ I $4lPa ^ 4?^^14 || a, 41K ^4¥ir4I ^44lft4B^I4]4iT^l\4TvfTr4 3I^444 11 i j 44 441 114?* ^4if ^4I44rci^4I4f4^4[44l^fe^f4^^ ^- ifj!^, w^^Rt^rl#f^fc[ n c ^qj- qi5}^T fgft'iT I eta '^RqTRci 3!<;3p5iri%r^^^3 I .■{^31P!1I§ ^^fsi^T II <!; 610 ANCIENT HINDU MEDICINE in fistula-in-ano, tubercles, suppurative tumors^ non-suppurative tumors, gummata, wart, foreign bodies in bones and tissues, hairy moles, Sarcoma, tonsillitis, sloughing tendons-muscles and vessels, tumor of the palate, condyloraata, myxoma of the gullet, chancre, fibroma and myoma. Lesions that need Incision : Incision (lancing) should be made in all ( suppurative ) tumors, except those caused by the derangement of the three humors ( non-suppurative tumors ), erysipe¬ las, oscheopyedema, bubo, diabetic boils, carbun¬ cle, galactoposterma ( or mastosyrinx ), pustules of the penis, stye, pustules of the foot, fistula, suppurative tonsillitis, suppurative eruption of the penis, gumma of the cornea, pustular abscess¬ es, abscess on the palate, gum-boils, the tumors or sinuses that develop after suppuration, cyst formed round tlie nucleus of a calculus, or any other kind of suppurative tumor. Lesions that need Scarification : Scarification should be made in the four forms of throat inflammation,leucoderma, ranula, inflammation of the gum, tubercles, lachrymal fistula, epiglottitis. cRr ii ?o SURGERY 511 gummata of the throat, psoriatic patches, and granulations. Lesions that need Junctures : Punctures should be made in cirsoid aneurysm, hydrocele and ascites. Lesions that need Pi'ohing : Probing should be made in fistulas, fistulas with foreign bodies, or those extending sideways. Lesions that need Extraction ; Extraction should be made in three kinds of gravel, tartar on the teeth, wax in the ears, calculi, foreign bodies ( missiles ), mal-presentation of the fetus and the impacted feces in the rectum. Lesions that need Lrainage :—Drainage should he performed in all kinds of (suppurating) tumors except those that develop by thG derangement of the three humors (non-supj)ura- tive tumors), lepromata, painful abscess, car¬ buncle, otorrhea, elephantiasis, toxic blood (blood in the infected region), furuncle, erysipelas, cysts, three kinds of chancres (hard, mixed, and soft chancres), breast-abscess (or fistula), suppura¬ tive bubo, pyorrhea, abscess and gummata of the palate, dental caries (causing suppuration in the gum), gingivitis, epulis, ulocase, gumboil, chancre of the lips, and pustules. Lesions that need Saturation ;—Suturation '512 ANCIENT HINDU MEDICINE should only he made in those places which have been opened and been completely , drained off (the foreign matter), or the fresh wounds near the movable joints. Wounds that are not fit for snturaiion: Sutures should not be applied to those wounds cau.