Sushruta Samhita, volume 1: Sutrasthana
Chapter VII - Surgical appliances
Surgical instruments number one hundred and one in all, of which the hand is the most important, inasmuch as (all of them depend on the hand for their principal auxiliary) and as none of them can be handled without it; and further because all surgical operations pre-eminently require its co-operation. Any foreign or extraneous substance, which finds a lodgment in the human system and becomes painful to the body and the mind alike, is called a Shalya; and surgical instruments are the means of extracting it (from its seat or place where it is embedded).
(Surgical) Appliances may be divided into six different groups or types, such as the Svastika, the Sandansha, the Tala, the Nadi Yantras, and the Shalakas, besides those that are called the minor or accessory appliances (Upa-yantras).
The Svastika instruments (forceps) in their turn, are divided into twenty-four sub-classes; the Sandansha instruments (tongs) into two; the Tala Yantras into two; the Nadi Yantras (tubular) into twenty; and the Shalakas (bougies) into twenty-eight; while the Upa-yantras admit of being divided into twenty-five different types. These instruments are all made of iron which may be substituted for any other similar or suitable substance where iron would be unavailable.
The mouths of these appliances are usually made to resemble those of birds and beasts, and hence they should be made to resemble the mouths of some particular animal in shape, or otherwise, according to the advice of old and experienced physicians (surgeons), or according to the directions as laid down in the Shastras (Medical books of recognised authority), or according to the exigencies of the case, or after the shape and structure of other appliances used on similar occasions.
Appliances should be made neither too large nor too small, and their mouths or edges should be made sharp and keen. They should be made with a special eye as to strength and steadiness, and they should be provided with convenient handles.
Appliances of the Svastika class should be made to measure eighteen fingers in length; and their mouths should be made to resemble those of lions, tigers, wolves, hyenas, bears, cats, jackals, deer, Ervarukas (a species of deer), crows, cormorants, Kururas (a species of bird), Hasas (a species of sparrow) vultures, falcons, owls, kites, herons, Bhringarajas (a species of bird), Anjalikamas, Avabhanjanas, Nandimukhas. and such like beasts and birds. The two blades or halves of a Svastika should be welded together by means of a bolt resembling a Masura pulse lentil in size, and the handles should be turned inward in the shape of a mace, or an Ankusha. Appliances of this type should be used in extracting any thorn or foreign matter which may have entered into the bones.
Sandanshas tongs are divided into two classes as they are soldered together with or without a bolt. They should be made to measure sixteen fingers in length, and should be used to withdraw any thornlike substance from below the skin, flesh, veins or nerves.
The Tala Yantras which measure twelve fingers in length, may be divided into two classes as the single Tala and the double Tala. The former resemble the scales of fish in shape, while the latter, according to certain authorities, are made to resemble the entire mouth of a fish of the Bhetuli species. These Yantras are used in extracting splinters from inside the nose, ears and other external channels or passages of the body.
The Nadi Yantras (tubular instruments like syringe, enemas, etc. with a passage or aperture running through their entire length) are constructed in a variety of shapes and for various purposes. Some of them are open at one end, while others are open at both. These instruments are used for the purpose of extracting any shalya that has pricked into the external canals or passages of the body, or for inspecting the seat of affection as in piles, etc., or for sucking (blood, etc. from any affected part), or simply as accessories to other surgical appliances. The length and circumference of a Nadi Yantra should be made to commensurate with those of the passage (Srota) or outlet of the human system into which it is intended to be introduced. We shall describe, later on, the types of Nadi Yantras which are to be used in connection with such diseases as fistula in ano, piles, etc. or in tumours and ulcers, in Mutradvriddhi (Hydrocele) in Niruddha Prakasha (Phimosis), in Niruddha Guda (stricture of the rectum) and in ascites, as well as those to be used for the purpose of injecting anything into the urethra, the bowels, the vagina and the uterus, or are used in connection with medicated inhalation, or with those that are known as the Alavu Yantras (gourd used for cupping).
The Shalaka-Yantras (bougies) are of various shapes and serve a variety of purposes. The lengths and girths of these instruments should be determined according to the necessity of each individual case. Four probes or directors (shalaka) in two pairs, are used for the purposes of searching (Eshana) pus in a suppurated part or limb, or in connection with uplifting, cutting and thereby withdrawing a shalya from the part it has pricked into, or with a view to transfer such a body from one place to another (Chalana), or for the purpose of extracting it (Shalya) from the affected part. The mouths of the two types of these directors respectively resemble those of a Gandupada (earthworm) and of a Sharapunkha (Tephrosia Purpurea, Pers) while the other two are respectively headed like the hood of a serpent and a fish hook. A couple of directors are used for the purpose of withdrawing a foreign matter (Shalya) imbedded in any outer canal of the body (Srotas). The top-ends of these directors are bent down a little, and they resemble a lentil seed in size. Six types of directors or probes are used in cleansing (the pus from an affected part of the human organism) and their top-ends are fitted with caps of loose cotton. The three sorts of directors used in applying alkaline medicines, are shaped like ladles, and their mouths resemble the cavities of little stone mortars (Khala.) Of the six sorts of directors used in connection with the process of cauterisation (Agni-Karma) three are mouthed like the Jamboline fruit, while the other three are faced like a mace or a spear (Ankusha). A kind of director used in removing nasal tumours, is mouthed like the half of the kernel found in the inside of a Jujube-stone, with a little dip in the middle, its lip or end having a keen or sharp edge. The ends of the type of probe used in applying Anjanams (medicated collyria) to the eyelids are wrought into two small round lobes like the Matara pulse and are blunted, while the sort of probe used in cleansing the urethra, is made round like the end of the stem of a Malati flower.
The Upa-yantras or minor surgical accessories:—
include such substances as rope, the Venika (braided hair), silk thread, the bark and the inner-skin of trees, creepers, linen, Ashthila (stones), large oval shaped pebbles, a hammer, the palms of the hands, the soles of feet, fingers, tongue, the teeth, the nails, hair, the mane of horses, branches of trees, a magnet, alkali, fire, and medicine, and such acts as spitting, straining (kunthana), exhilaration and intimidation.
Metrical texts —
These accessories should be applied to the entire body of a patient, or to any part thereof such as, the arteries, the viscera, or the joints, according to the necessities of each case to be determined by the surgeon.
The Functions of Surgical Instruments:—
are striking out (Nirghatana-lit:—withdrawing a Shalya by moving it to and fro), injection or filling, binding, up-lifting, cutting and thereby withdrawing a Shalya, resetting by means of a twirling motion, removing of a Shalya from one place to another, twisting, expanding, pressing, purifying of a passage, drawing off, attracting, bringing to the surface, uplifting, lowering down, applying pressure all round a part, or an organ, agitating, sucking, searching, cutting or cleaving, straightening, washing or flushing, stuffing the nose and cleansing. They number twenty-four in all.
The intelligent surgeon shall exercise his judgment and determine the nature of the surgical operation required in each individual case, for surely the shalyas requiring a surgeon’s aid are infinitely varied in their character.
An appliance Yantra) which is too thick, or (made of inferior metal and hence) not substantially made, or too short or too long, or does not admit of being easily handled and is incapable of taking in the entire Shalya, or is curved, loosely fitted, or soft-bolted, or loosely tied up with cords, (should not be used in surgical operations). These are the twelve defects of a surgical instrument.
The use of an instrument devoid of the abovesaid defects and measuring eighteen fingers in length, is commended in surgical operations, Shalyas which are manifest and visible to the naked eye, should be extracted with the instruments of the Sinha-mukha (lion-mouthed) type, while those that can not be seen, should be removed with the help of the Kanka-mukhas (heron-mouthed) instruments, etc., according to the directions laid down in the Shastras medical or surgical works of recognised authority). The Kanka-mukhas are the best of all other types of instruments, inasmuch as they can be inserted and taken out without the least difficulty, are capable of drawing out a Shalya with the greatest ease, and are applicable to all parts of the human body (be they an artery or a bone-joint.)
Thus ends the seventh chapter of the Sutrasthana of the Sushruta Samhita which treats of the shape, construction and dimensions of surgical appliances.
Footnotes and references:
According to certain authorities hundred is here indefinitely used for a large number.