Chapter XXVIII - Prognosis of wounds

Now we shall discourse on the Chapter, which deals with the favourable or unfavourable prognosis of an ulcer. (Viparitaviparita-Vrana-Vijnaniya -adhyaya).

Metrical Text:—

Certain fatal or unfavourable symptoms (Arishtas)^[1] unmistakably presage the death of an ulcer-patient, as a flower, smoke and cloud respectively herald a fruit, fire and rain. In most cases, the ignorant cannot interpret aright these fatal symptoms owing to their extremely subtile nature, or out of ignorance or stupidity, or because such symptoms are very closely followed by the death of the patient.

These fatal indications serve as sure precursors of death in a patient, unless warded off by the blessings of holy Brahmanas, who are free from low desires or animal propensities, and are also accustomed to practise the Yoga and other religious penances; or death may be averted with the help of men who are initiated into the mystery of concocting life-giving elixirs (Rasayana).

Many such indications do not prove instantly fatal but bring on death in course of time, just as diseases, supposed by some to be due to the influence of malignant planets, take time before they become patent out of their incubative stages. An attempt to cure a doomed patient is only repaid by failure and the ridicule of the world, and hence an intelligent physician should make it worth his while to carefully observe and study these fatal indications. A contrariety of the natural smell, colour, taste, (sensation, sound, touch, etc.) of an ulcer indicates a near and fatal termination of the disease.

An ulcer emits a pungent, sharp, or fishy smell under the respective influences of the deranged Vayu, Pitta and Kapha. An ulcer, deranged by the action of the vitiated blood, emits a smell like that of iron (Loha-gandhi), while one, originated through the concerted action of the deranged humours, emits a smell characterised by the distinctive features of each of them. On the other hand, an ulcer, due to the joint action (of the deranged Vayu and Pitta), emits a smell like that of fried paddy; one, due to the action of the deranged Vayu and Kapha, emits a smell like that of linseed oil; whereas one, brought about by the action of the deranged Pitta and Kapha, smells like sesamum oil. All those odours, marked by a somewhat fishy character, should be deemed the natural odours of ulcers, and any other smell should be held as a contrary or unnatural one.

An ulcer emitting a sweet smell like that of wine, or fragrant aloe wood (Aguru), clarified-butter, Jati flower, Champaka, sandal, lotus or any celestial flower (Divyagandha), should be regarded as the precursor of death. Similarly, a smell like the one which characterises a dog, horse, mole, crow or a bug, or like the one emitted by dry, putrid meat, or resembling the smell of earth or slime, should be likewise deemed unfavourable or fatal in an ulcer.

A physician should give up a case where an ulcer, though it has assumed a blackish, saffron or Kankustha colour fa sort of mountain earth) through the action of the aggravated Pitta, is divested of the burning, sucking and drawing pain, which is peculiar to that morbiferous diathesis. Similarly, an ulcer, which, though brought about through the action of the deranged Kapha, has become cold, hard and whitish as natural in one of the Kaphaja type, should be given up as soon as it is marked by a burning pain. Likewise an ulcer, due to the action of the deranged Vayu, and characterised by a blackish hue and a thin secretion, and which is found to invade the vital principles of the body, should be abandoned by a physician, whenever found to be entirely devoid of pain.

An ulcer, which makes a gurgling or groaning sound, or one which is characterised by an extreme burning sensation, or is confined to the skin and the flesh, and is marked by the emission of wind with a loud report, is sure to have a fatal termination. Likewise, one, which is characterised by extreme pain, though not otherwise seated about any of the vital parts of the body, or which is cold on the surface, though attended with an extremely burning sensation in its inside and vice versa, should be deemed the precursor of death. Similarly, an ulcer should be regarded as fatal, that is shaped like the barb of a spear, or a Kunta (a kind of barbed dart or spear), or like a banner, chariot, horse, or an elephant, or like a cow, an ox, a temple, or a palace.

A wise physician, with any regard to his own reputation, should abandon a patient laid up with an ulcer which appears to have been dusted over with a sort of pulverised crust, or who has been suffering from one accompanied by loss of flesh and strength, cough, difficult respiration and aversion to food. An ulcer, which occurring at any of the vital parts of the body secretes a copious quantity of pus and blood, and refuses to be healed even after a course of proper and persistent medical treatment, is sure to have a fatal termination.

 

Thus ends the twenty-eighth Chapter of the Sutrasthana in the Sushruta Samhita, which deals with the favourable and unfavourable prognosis of ulcers.

Footnotes and references:

[1]:

The symptoms which are developed by the deranged bodily humours in the organism of a man at a time when they have passed beyond all medical cure, and when the body serves as a mere passive back-ground for those phenomena, awaiting its impending dissolution, are called Arishtas.