Chapter XII - Thermal cautery

Now we shall discuss the Chapter which treats of cauteries and the rules to be observed in their use (Agni-Karma-Vidhi-adhyaya).

A fire (cautery) is better than an Alkali as far as its healing property is concerned. A disease burnt with fire, is cured for good and knows no recrudescence; and diseases which ordinarily baffle the skill of a surgeon or a physician, and never prove themselves amenable to medicinal or surgical remedies, are found to yield to fire (cauterisation).

The following drugs, articles and substances should be understood as accessories to an act of cauterisation, viz., Pippali, the excreta of goats, the tooth of a cow (Godanta), Shara, a rod, the surgical instrument known as the Jamvavaustha, articles made of copper or silver, honey, treacle, oil, or any other oily substance. Out of these, Pippali, the Godanta, Shara and the rod should be (made red hot and) used in cauterising the affected part in a disease which is restricted only to the skin; similarly the surgical instsument known as the Jamvavaustha, as well as the appliances made of copper or silver should be used in a disease which is seated in the flesh. Honey, treacle and oil should be (boiled and) employed in cauterising the disease which affects any of the veins, nerves, bones or bone-joints.

Cauterisation is admissible in all seasons of the year except summer and autumn; but no such distinction should be observed in cases of impending danger, when it should be practised with the help of such appliances of a contrary (cooling) nature, [as wet sheets, cooling drinks and cooling plasters, etc.]

In all diseases and in all seasons of the year, the patient should be fed on a diet of slimy (mucilaginous) food before actually applying the cautery; while the patient should be kept on an empty stomach before the act where the complaint would be a case of Mudagarbha (false presentation), fistula in ano, hemorrhoids or a disease affecting the cavity of the mouth.

According to certain authorities the processes of cauterisation may be grouped under two heads according as the skin or the flesh is cauterised. The present work does not lay any injunction against the cauterisation of any nerve, vein, bone or bone joint (as stated before). A burning of the skin is accompanied by a peculiar bursting or cracking sound. The skin becomes contracted and emits a fetid smell. Similarly, in a case where the flesh is burnt, (the affected part) assumes a dove color of (blackish brown), marked by pain and a little swelling, and the incidental ulcer becomes dry and contracted. In the case where a nerve or a vein is burnt, the ulcer presents a raised (elevated) and black aspect with the stoppage of all secretions; while an ulcer incidental to the cauterisation of any of the bone joints has a parched red hue and becomes hard and rough.

The regions of the eye-brows, forehead and temple-bones, should be cauterised in diseases affecting the head as well as in a case of Adhimantha (Ophthalmia). In diseases affecting the eyelids the eye should be covered over with a moist piece of Alaktaka (a thin pad of red pigment principally used in dyeing the feet of ladies) and the roots of the eyelashes should be duly cauterised. Cauterisation is specifically enjoined to be resorted to in cases of glandular inflammation, tumour, fistula in ano, scrofula, elephantiasis, Carmakila, warts, Tilakalaka, hernia, sinus hemorrhage, and on the occasion of cutting a vein or a bone joint, as well as in the event of the vital wind (Vayu) being extremely agitated and lodged in the local skin, flesh, vein, nerves and the bone-joints and giving rise to excruciating pain in and about the ulcer which in consequence presents a hard, raised and inert surface.

The modes of cauterisation vary according to the seat of the disease, and number four in all, viz., the Ring, the Dot, the Lateral or Slanting lines, and the Rubbing modes.

Authoritative verse on the subject:—

A physician, after having Carefully considered the seat of the disease and judiciously ascertained the patient’s strength and the situations of the Marmas the vital parts of the patient’s) body, should resort to cauterisation with an eye to the nature of the malady and the then prevailing season of the year.

The part, after being properly cauterised, should be rubbed with an unguent composed of honey and clarified butter. A man of bilious temperament or with a quantity of bad blood lying stagnant and locked up in any part of his body, or of lax bowels, a person with any foreign substance (such as a thorn or a splinter still lodged in his body), a weak or an old man, an infant, or a man of timid disposition, or a person afflicted with a large number of ulcers, as well as a patient suffering from any of the diseases in which diaphoretic measures are forbidden, should be regarded as a subject unfit for cauterisation.

Now we shall describe the characteristic symptoms of the several kinds of burns other than those caused (for surgical purposes). Fire feeds both upon fatty and hard fuels, [such as oil and logs of wood etc.]. Hot or boiling oil has the property of permeating or entering into the minutest nerves and veins, and hence, it is capable of burning the skin, etc. Accordingly an ulcer incidental to such a burning (scald) is characterised by extreme pain, etc.

Burns may be grouped under four distinct heads viz., the Plushta, the Dur-Dagdha, the Samyag-Dagdha and the Ati-Dagdha. A burn characterised by the discolouring of its seat and extreme burning and marked by the absence of any vesicle or blister, is called the Plushta, from the root “plusha” to burn. A burn, which is characterised by the eruption of large vesicles or blisters, and assumes a red colour, and is characterised by excessive burning and a kind of drawing pain, and which suppurates and takes a long time to heal, is called the Dur-Dagdha (bad burn or scald). A burn, which is not deep (superficial) and assumes the colour of a ripe Tala fruit, and does not present a raised or elevated aspect and develops the preceding symptoms, is called the Samyag-Dagdha (fully burnt one). A burn in which the flesh hangs down, and where the veins, nerves and bones are destroyed, accompanied with fever, burning, thirst, fainting and such like disturbances, and which leads to a permanent disfiguration of the body, retarding the healing of the incidental ulcer which leaves a discoloured cicatrix even after healing, is called the Ati-Dagdha (over burnt one). A physician should try to heal any of these four types of burns with the measures already laid down before.

Authoritative verses on the subject:—

The blood of a man is agitated and made hot by fire, and the blood thus heated tends to excite or causes it to raise the bile. And since fire and bile (Pitta) are similar in their taste, essence, effect, potency and natal factors, the effects of Pitta (burning sensation etc.), are naturally aggravated and augmented through a contact with fire. Blisters or vesicles crop up in rapid succession and mark the seat of burning, and fever, thirst, etc., supervene.

Now I shall describe the course of medical treatment to be adopted for the cure of burns. Hot and dry fomentations, as well as warm plasters should be applied to a burn of the Plushta type, and a course of hot food and drink should be likewise prescribed for the patient. The blood becomes thin when the body is diaphorised by means of warm fomentations, and water, in virtue of its natural cooling properties, tends to thicken the blood. Hence warm fomentations or applications exercise curative virtues in the case of a burn of the foregoing type, and water or cold applications produce the contrary effect.^[1]

Both warm and cold measures are to be adopted in the case of a burn of the Dur-Daghdha type, the medicinal remedies consisting of cold applications and unguents of clarified butter.^[2]

A plaster composed of Tugakshiri, Plaksha, Chandana, Gairika, and Amrita (Guduci), pasted together with clarified butter, should be applied over a bum of the Samyag-Dagdha type, or the flesh of domestic or aquatic or amphibious animals should be pasted and plastered over the affected part. A burn of the present type, marked by excessive burning, should be medicinally treated in the same manner as a case of bilious abscess (Pitta-vidradhi).

In the case of a burn of the Ati-Dagdha (over-burnt) type, the loose or the dangling integuments (skin) and flesh should be removed, and cold applications should be made over the ulcer. Then the affected part should be dusted over with pulverised Shali rice, or a plaster composed of the pulverised skin of Tinduki and clarified butter pasted together, should be applied over its surface.^[3] The affected part should be covered over with the leaves of Guduci, or of lotus, or other aquatic plants, and all measures and remedial agents, indicated in the case of a bilious erysipelas, should be resorted to in the present instance as well.

A plaster composed of bee’s wax, Madhuka, Sarjarasa, Manjistha, (red) Chandana and Murva pasted together and boiled with clarified butter should be regarded as beneficial to burns of all types to promote rapid healing.

In the case of a burn from boiling oil, clarified butter or such like substances should be externally applied and all measures which promote dryness of the part (Ruksha) should be adopted without the least hesitation.

Now we shall describe the symptoms which become manifest in a person [whose nostrils and larynx] are choked with smoke.—The respiration becomes laboured and hurried and the abdomen is distended accompanied by constant sneezing and coughing. The eyes look red and seem as if burning. The patient breathes out smoke and fails to catch any other smell than that of it. The sense of hearing is considerably affected; the sense of taste becomes inert; fever, thirst and a burning sensation supervene; and the patient drops down utterly unconscious.

Now hear me discourse on the course of medical treatment to be adopted in the case of one over-powered with smoke.—Emetics in the shape of clarified butter mixed with sugarcane juice or milk saturated with the juice of grapes, or lumps of sugar-candy dissolved in an adequate quantity of water, or any acid potion slightly sweetened, should be administered to the patient. The contents of the stomach are speedily discharged by vomiting; the distension of the abdomen is removed; the smell of smoke in the breath is mitigated, and the accompanying fever,with (its concomitants) of sneezing, languor, thirst, cough, laboured breathing etc. is abated, and the patient is restored to consciousness. Gargles having a sweet, saline, acid or pungent (katu) taste restore the sense-perception of the patient, and gladden his mind. Medicated snuffs in adequate quantities should be administered by a well-read physician to such a patient, whereby his head, eyes and neck would be able to resume their normal functions. And a course of diet, which is light, emollient and not acid in its reaction, should be prescribed.

Cooling measures or applications should be prescribed or made in the event of any part of the body being scorched by excessive heat, or by being exposed to a draught of hot and parched wind. Similarly, hot and emollient measures or applications should be resorted to where any part of the body has become frozen or shrivelled by snow or cold winds. A person struck by lightning should be regarded as beyond the pale of medicine.^[4]

 

Thus ends the twelfth Chapter of the Sutrasthana in the Sushruta Samhita which treats of Cauteries and the rules to be observed in their use.

Footnotes and references:

[1]:

By arresting the radiation of the incarcerated heat and thereby favouring the elevation of the local temperature and the increase of the burning sensation.

[2]:

Cold applications and cooling measures should be resorted to in the case of a deep and excessive burn, while the contrary should be held as the correct remedy in the case of a slight and superficial one.

[3]:

Several authorities prescribe Tinduki bark and human cranium powdered together and mixed with clarified butter, while others prescribe a decoction of Tinduki bark.

[4]:

Additional texts:—Where the scorching would be found to be considerably extensive; otherwise such measures as lubrication with medicated unguents etc. should be adopted in a case where the patient is picked up alive.