Chapter XXVII - Removal of foreign bodies

Now we shall discourse on the Chapter which deals with the modes of extracting splinters (Shalyapaniya-adhyaya).

There are two kinds of Shalyas. A Shalya is either loose or firmly fixed to its seat within the body. We shall presently speak of the fifteen different modes of extracting a loose Shalya, which are as follows, viz.: Extraction by natural expulsive functions of the body (Svabhaba), by suppuration or putrefication (Pacana), by excising (Bhedana), by bursting (Darana), by pressing (Pidana), by rubbing (Pramarjana), by blowing with the mouth of medicinal powders into the affected part (Nirdhmapana), by the administration of emetics (Vamana), by an exhibition of purgatives (Virecana) by washing (Prakshalana), by friction with the fingers (Pratimarsha), by straining as at the time of defecation (Pravahana), by sucking (achushana), by applying a magnet (Avaskanta) and by exhilarating (Harsha).

An embedded foreign matter is usually expelled from the eyes, etc, by inducing lachrymation, sneezing, eructation, coughing, micturition, defecation, and the emission of flatus.

A Shalya, or any other foreign matter which has penetrated into the deeper tissues of flesh, should be extracted by setting up suppuration in the affected locality. The putrid flesh would loosen the fixture of the Shalya, the weight of the secreted pus and blood causing it to drop down.

The seat or the locality of a fixed Shalya should be opened by an incision in the event of its not being ejected even after the establishment of the local suppuration. If the Shalya fails to come out even after the incision, the affected part should be pressed with the fingers, or medicines, endued with the virtue of exerting pressure, should be applied over its surface. A particle of any fine matter, accidentally dropped into the eye, should be removed with sprays of cold water, or by blowing into it with the mouth, or by rubbing it with hair or the fingers.

A residue of digested food or mucous, a remnant of any food matter (aharashesha) misdirected into the nostrils, or any small splinter loosely pricking thereto (Anu-shalya), should be expelled by breathing hard, or by coughing upward through the nostrils (Utkasha), or by blowing through the nose. A morsel of food, acting as an obstructing Shalya in the cavity of the stomach (amashaya), should be ejected by rubbing (Pratimarsha) the fingers against the lining of the throat, or against the region of the epiglottis, while such a morsel brought down into the intestines, should be evacuated by administering purgatives (Virecana).

The pus or any other morbid matter found within the cavity of an ulcer should be removed by washing it, while incarcerated flatus, or obstructed scybala or retained urine, or obstructed fetus, should be borne down and expelled by means of straining.

Any deranged Vayu or watery secretion incarcerated in any part of the body, as well as poisoned blood or vitiated breast-milk, should be sucked off with the mouth, or with a horn.

A loose, unbarbed arrow, lodged in a wound with a broad mouth and lying in an Anuloma direction, should be withdrawn by applying a magnet to its end. A shaft of grief, driven into the heart by any of the multifarious emotional causes, should be removed by exhilaration and merry-making.

A shaft (Shalya), whether large or small, may be withdrawn from its place in either of the two ways known as the Anuloma and Pratiloma. The Anuloma consists in withdrawing a Shalya through a way other than that of its penetration, while the contrary is called the Pratiloma.

A Shalya lodged in a place lying close to the spot of its penetration (Arvacīna) should be extracted through the way by which it has entered (Pratiloma). On the other hand, a shaft or Shalya, piercing deep into any part of the body, but not coming out by the other side (Paracīna), should be drawn out through a way other than that of its penetration (Anuloma).

A shaft, piercing deep into any part of the body so as to reach the other side of the wounded limb or part, (but not cutting out clean through it owing to the diminution of its original momentum), and remaining protruded in the heaved up flesh, should be extracted through a channel other than that by which it has originally penetrated (Anuloma), and by stirring or striking it with the hand or a hammer. The heaved up flesh should be opened with an incision, when found possible of being so opened, and the embedded Shalya should be drawn out by stirring or striking it with the hand as laid down before.

A Shalya, lodged in any soft part of the abdomen, chest, arm-pits, inguinal regions or ribs, should not be cut open or struck with hammer, but should be tried to be removed with the hands through the way of its penetration (Pratiloma), in failure whereof the Shalya should be extracted with surgical appliances (Shastra) or any other surgical instruments (Yantras).

Authoritative Verse on the Subject:—

A patient, fainting away (during the course of such a surgical operation), should be enlivened by dashing cold water over his face. He should be solaced with many a hopeful and cheering word, and a nourishing diet such as, milk, etc. should be given him, and his vital parts should be protected.

Then having extracted the Shalya, the incidental wound or ulcer, the blood having been wiped of, should be fomented with heat or by applying warm clarified butter to its surface in the event of it being found fit to be so treated i.e., (devoid of pain and unattended with further bleeding). Cauterisation should be resorted to where the condition of the wound would indicate such a measure. After that, the wound should be plastered (Pradeha) with honey and clarified butter, and bandaged with a piece of clean linen; and directions as to the diet and nursing of the patient should be given (as previously laid down).

A Shalya, lodged in a vein or a ligament (Snayu), should be extracted with the help of a probe. The shaft (Shalya), lodged in the body and lying buried under the incidental swelling, should be extracted by firmly tying blades of Kusha grass around its body. A shaft (Shalya), lodged in a spot situated anywhere close to the heart, should be withdrawn by the way by which it has entered; and the patient should be enlivened with sprays of cold water, etc. during the operation.

A Shalya, lodged in any other part of the body and that is difficult to extract, and that produces pain and local inflammation, should be removed by cutting the part open. In the case of a shaft (Shalya) which has pierced into the cavity of a bone, the surgeon should firmly press the affected bone with his legs, and pull out the embedded shaft with all his might by gripping it with a surgical instrument, in failure whereof a strong man should be asked to firmly catch hold of the patient, and the Shalya should be pulled out with the help of a gripping surgical instrument as before.

As an alternative, the bottom of the shaft should be tied to the string of a bow, strung and fully bent down; and the Shalya should be ejected with the means of a full twang. As an alternative, a horse should be harnessed in the fashion known as the Pancangi-vandhana (lit. bound in the five parts of the body), and the end of the Shalya should be bent down and tied to the bridle. Then the horse should be so whipped as to raise its head first, thus pulling out the embedded shaft (Shalya) from its seat of lodgment by the jerk of its head. As an alternative, a high and tough bough of a tree should be lowered down and tied to the bent end of the shaft as in the preceding case. The bough should be then let loose, thus pulling out the shaft (Shalya) with its rebounding force.

A shaft (Shalya), lodged in a bone and lying protruded in the heaved up local flesh (situated in a place other than the inguinal regions, abdomen, or arm-pits, etc.), should be stirred by striking it on the head with an Asthila a round stone,—a short hammer according to certain authorities), or with a stone or hammer, and should be taken out by the way of its penetration.

The feather of a barbed shaft, lying embedded in a bone situated at a part of the organism where the existence of such a foreign matter is calculated not to create any special discomfort, should be first crushed by putting pressure on the heaved up or protruded flesh, and the shaft then should be gently pulled out of its seat of lodgment.

In the case of a bit of shellac being accidentally pricked into the pharynx, a metal tube should be first inserted into the passage, and then a heated metallic rod should be reached down to the obstructing shellac through its inside. The shellac, thus melted by the heat of the inserted rod, would naturally stick fast to it, which should be then condensed by an injection of cold water poured down through the aforesaid tube; after that the rod should be withdrawn thus carrying away the melted shellac at its end.

According to certain authorities, any other obstructing foreign matter accidentally introduced into the pharynx should be withdrawn with the help of a rod, soaked in melted wax or shellac, and then inserted into that passage, all other procedure being the same as in the preceding instance.

In the case of a bone Shalya (such as the bone of fish etc.) having accidentally stuck fast in the throat, a bundle of hair, tied to a string of thread, should be inserted into the gullet of the patient, the physician holding the other end of the string in his hand. Then a copious quantity of water, or of any other liquid substance, should be poured down into his throat, so as to entirely fill his stomach. After that some kind of emetic should be given to the patient, and the string should be pulled out as soon as the bundle of hair would be felt to have struck below the obstructing bone or Shalya, which would naturally come out with the pull. As an alternative, the top end of a soft twig, as is generally used in cleansing the teeth, should be bruised into the shape of a brush, and the thorn or the Shalya should be removed with its help. The incidental wound should be treated by making the patient lick a compound of clarified butter and honey, or of the powders of the Triphala, saturated with honey and sugar.

The body of the patient should be pressed or rubbed, or he should be whirled round by the ankles, or generally measures, calculated to induce vomiting, should be adopted in a case where he would be found to have swallowed a stomachful of water (as in a case of drowning). As an alternative, he should be buried under the ashes up to his chin.

Strong wine should be given to the patient, or he should be slapped on the shoulders, so as to cause him to suddenly start in a case where a morsel of food would be found to have obstructed and stuck fast in his gullet. A tight gripe about the throat of a person with a creeper, rope or the arm of an antagonist, tends to enrage the local (Kapha), which obstructs the cavity of the passage (Srota) producing salivation, foaming at the mouth and loss of consciousness. The remedy in such cases consists in lubricating and diaphorising the body of the patient with oil and heat, and in administering strong errhines (Shiro-Virecana), and the juice or extract of meat which is possessed of the virtue of subduing the deranged Vayu.

Authoritative Verses on the Subject:—

An intelligent physician should remove a Shalya with due regard to its shape, location and the adaptability of the different types of surgical instruments to the case under treatment. A physician should exercise his own discretion in extracting feathered shafts (Shalyas) from their seats of lodgment, as well as those that are difficult of extraction.

A physician is at liberty to exercise his own skill and wisdom, and to devise his own original means for the extraction of a Shalya with the help of any surgical instruments when the abovesaid measures would prove abortive. A Shalya, not removed from the body and left in its place of lodgment, brings on swelling, suppuration, mortification of the affected part, and a sort of excruciating pain, and may ultimately lead to death. Hence a physician should spare no pain to extract a Shalya from its seat of lodgment.

 

Thus ends the twenty-seventh Chapter of the Sutrasthana in the Sushruta Samhita, which treats of extraction of Shalya.