Chapter VIII - Surgical instruments

Now we shall discuss the Chapter which treats of instruments used in connection with a surgical operation. (Shastravacaraniya-adhyaya).

These instruments are twenty in number such as, the Mandalagra, the Karapatra, the Vriddhipatra, the Nakhashastram, the Mudrika, the Utpalapatra, the Arddhadhara, the Suchi, the Kushapatra, the atemukha, the Shararimukha, the Antarmukha, the Trikurchaka, the Kutharika, the Vrihimukha, the Ara, the Vetasapatraka, the Vadisha, the Dantashanku, and the Eshani.^[1]

The kutharika (small, blunt axe) measures seven fingers and a half in the handle, the blade is half a finger in width and is blunted like the tooth of a cow. The Vrihimukha measures six fingers in its entire length and its top is like that of a Vrihi seed, and the edge is cut into small thornlike projections. The Ara resembles the awl of a cobbler and measures ten fingers in its entire length, the blade is wide as the seed of a sesamum and has the girth of a Durva (grass) stem. The Vetasapatra (knife) resembles the leaf of a Vetasa plant. The blade is four fingers in length, one finger in width, and is keenly edged, the handle measuring four fingers in length. The Vadisha is shaped like a modern fishing hook. The Danta-shanku (pincers for extracting teeth) somewhat resembles the Vrihimukha in shape. The face of an Eshani (probe) is like that of a Gandupada (earth-worm).

Of the abovesaid instruments the Mandalagra and the Karapatra should be used in incising and scraping. The Vriddhipatra, the Nakhasastra, the Mudrika, the Utpalapatra, and the Arddhadhara, should be employed in incising (Chedana) and excising (Bhedana); and the Kushapatra, the Shuchi, the atemukha, the Shararimukha, the Trikurchaka and the Antarmukha should be made use of in exudating or secreting (Visravana). The Kutharika, the Vrihimukha, the Ara, the Vetasapatra and the Suchi (needle) should be used in puncturing. The Vadisha and the Danta-Shanku should be used in extracting solid bodies. The Eshani (probe or director) in probing or searching the course or direction of the pus (in a suppurated part), and the Suchi (needle) should be used in suturing. Thus we have explained the eight different functions of the instruments in connection with surgical operations.

Now we shall deal with the mode of handling the abovesaid instruments.—The Vriddhipatra and other instruments for excising (Bhedana) should be caught hold of at a part between the blade and the handle. In acts of scraping the Vriddhipatra and the Mandalagra should be handled with the palm of the hand slightly turned up. The instruments for secreting should be caught hold of at the roots of their blades at the time of using them, while in the case of a king, an old man, a timid or a delicate person, a child, a woman and specially in the case of a prince of the royal blood, the Trikurchaka should be used when any secreting or exudating operation would be necessary. The handle of a Vrihimukha should be kept concealed within the palm of the hand and the blade should be caught hold of with the thumb and the index finger (Pradeshini). The Kutharika should be first supported on the left hand and then struck with the thumb and third finger of the right. The Ara, the Karapatra and the Eshani, should be caught hold of at their roots. The rest of the surgical instruments should be grappled according to requirements.

The abovesaid instruments are shaped like things which their very names imply, as have been already described. The Nakashastram and the Eshani measure eight fingers in length. The Suchi (needle) shall be described later on. The top-ends of the Vadisha and the Danta-Shankhu Dental pincers are a little bent down and their faces are made to resemble sharp thorns, or the newly sprouted leaves of a barley plant. The top-end of an Eshani closely resembles the mouth of an earth-worm. The length of a Mudrika should be made equal to that of the top phalanges of the index finger (of a man of average height.) A Shararimukha measures ten fingers in length. The rest of the instruments are mostly made to measure six fingers in length.

Commendable features in a Surgical instrument:—

Instruments that are fitted with handles of easy grip and are made of good and pure iron, well shaped, sharp, and are set with edges that are not jagged and end in well formed points or tops, should be deemed as the best of their kind.

Curvature, bluntness Kuntha—lit: -incapable of cutting hair, unequal sharpness of the edge, rough-edgedness, over-thickness, over-thinness, over-lengthiness, and over-shortness are the defective traits in a surgical instrument. Those possessed of contrary features should be used. But a Karapatra set with a very rough (dentated) edge may be used for the purpose of sawing the bones.

A surgical instrument meant for excision Bhedana should be set with an edge as thin as that of a Musura pulse lentil seed, while an instrument used in scraping should be set with an edge half as thin as that of the former. An instrument used either in connection with the measures of secretion or cutting by uplifting (Vyadhana) should be set with an edge as fine as the human hair, while an instrument of incision should have an edge half as thin as that of the former.

Surgical instruments should be tempered with one of the three substances such as, alkali, water, and oil. Instruments used in cutting an arrow, a bone, or any foreign matter (Shalya) pricked into the human body, should be tempered with alkali, whereas those that are made use of in cutting, cleaving, and lopping off the flesh (from an affected part), should be tempered with water. Instruments used in opening Vyadhana) a vein (Shira) or in cutting open a nerve Snayu should be tempered with oil, and should be whetted upon a species of stone-slab resembling a Masha pulse in colour, and their set-edge should be protected by putting it in a sheath made of Shalmali wood.

Authoritative verses on the subject:—

An instrument, well-ground, well-shaped, fitted with a convenient handle and capable of (laterally) cutting a hair in two and made according to measures laid down in the Shastras, should be alone used in a surgical operation.

The Inferior or substitutive instruments (the Anu-Shastras):—

The skin of bamboos, crystals, bits of glass, Kuruvindas (a sort of crystal) leeches, fire, alkali, nails, the leaves of trees known as Goji, Shephalika and Shakapatra, the tender sprouts of corn, hair, and the fingers, should be included within the category of the minor instruments of surgery and (which may be used in certain instances in substitution for the principal and usual ones.

Metrical texts:—

The four articles such as strips of bamboo skin, crystals, bits of glass, and the rock known as Kuruvinda, should be used by an intelligent physician in incising or excising (Bhedana) operations, where the patient would be found to have a dread of the knife, or too young to be surgically operated upon with it, or where the proper instrument cannot be procured. The nails of fingers should be used in operations of incising, excising or extracting in (substitution for the instruments enjoined to be used for the purpose), when such a course would appear feasible. The processes of applying alkalis, leeches and cauterisation will be dealt with later on. In Diseases affecting the eyelids or the cavity of the mouth, operations for the purposes of secreting or evacuating (the accumulated pus or phlegm), may be performed with the leaves of Shakapatra, Shephalika or Gojis. In the absence of a probe or director, searching may be done with the help of a finger, or with a hair, or with a corn sprout. An intelligent physician should deem it his imperative duty to get his surgical instruments made by a skilful and experienced blacksmith, and of pure, strong and sharp iron (steel). A physician, skilled in the art of using surgical instruments, is always successful in his professional practice, and hence the practice of surgery should be commenced at the very outset of medical studies.

 

Thus ends the eighth chapter of the Sutrasthana in the Sushruta Samhita which treats of Surgical Instruments.

Footnotes and references:

[1]:

The Mandalagra measures six fingers in length and is provided with a round or circular face. The Karapatra is the same as the modern saw. The term Vriddhipatra signifies a razor. A Vriddhipatra measures seven fingers in length, the handle alone measuring five fingers. The Nakhasastra is the same as the modern nail-clipper, the blade of the instrument measuring a finger in breadth. The Utpalapatra resembles a lotus leaf in shape. The Arddhadhara (lancet) measures eight fingers’ breadth in length, being one finger broad at the middle, and two fingers at the blade. The Suchi. is the same as the modern needle. The Kushapatra is so called from its resemblance to the blade of a Kusha-grass. An atemukha resembles the bill of a bird of the ate species. The blade of an atemukha measures two fingers in length, the handle measuring five fingers and thus giving an entire length of seven fingers. The Shararimukha (scissors) is so-called from the resemblance of its blades to the bills of a Sharari bird and looks somewhat like a modern black-smith’s clipper, the measure of its entire length being twelve fingers. The Antarmukha is semicircular in shape and is provided with a toothed edge like that of a hand-saw. The Trikurchaka (trocar) is provided with three separate blades. The intervening space between the couple of blades attached to a handle measuring five fingers in length, is equal to the width of a Vrihiseed, its entire length being eight fingers.