Chapter XVI - Puncturing and Bandaging the ear

Now we shall discuss the Chapter which treats of the piercing and bandaging of the lobules of ears (Karna-Vyadha-Vandha-Vidhi-adhyaya).

The lobules of the ears of an infant are usually pierced through for protecting it (from the evil influences of malighant stars and spirits) and for the purposes of ornamentation as well. The piercing should be performed on a day of bright fortnight marked by the auspicious lunar and astral combinations, and in the sixth or the seventh month of the year reckoned from its beginning (Bhadra). The child should be placed on the lap of its nurse, and benedictions should be pronounced over it. Then having soothed it and lured it with toys and playthings, the physician should draw down with his left hand the lobules of its ears with a view to detect, with the help of the reflected sun-light, (the closed up) apertures that are naturally found to exist in those localities. Then he should pierce them straight through with a needle held in his right hand, or with an awl (Ara), or with a thick needle where the appendages would be found to be too thick. The lobule of the right ear should be first pierced and then the left in the case of a male child, while the contrary should be the procedure in the case of a female. Plugs of cotton-lint should be then inserted into the holes of the pricked ear-lobules, which should be lubricated or rubbed with any unboiled oil. A copious bleeding attended with pain would indicate that the needle has passed through a place other than the natural (and closed up) fissure described above; whereas the absence of any serious after-effect would give rise to the presumption that the piercing has been done through the right spot. Any of the local veins incidentally injured by an ignorant, bungling surgeon, may be attended with symptoms which will be described under the heads of Kalika, Marmarika, and Lohitika.

KaIika is marked by fever and a burning pain in the affected part and swelling. Marmarika gives rise to pain and knotty (nodular) formations about the affected region, accompanied by (the characteristic inflammatory) fever; while in the last named type (Lohitika) symptoms such as, Manya-Stambha (numbness of the tendons forming the nape of the neck), Apatanak (a type of tetanus), Shirograha (headache) and Karna-shula (ear-ache) exhibit themselves, and they should be duly treated with medicinal remedies laid down under their respective heads. The lint should be speedily taken out from a pierced hole which is marked by extreme pain and swelling, etc., on account of its being made with a blunt, crooked or stunted needle, or owing to its being plugged with a deep and inordinately large lint, or to its being disturbed by the aggravated bodily humours (Doshas), or to its being made at a wrong place. An unguent composed of Madhuka, Eranda roots, Manjistha, Yava, Tila, honey and clarified butter pasted together, should be thickly plastered over the affected part until the ulcers are perfectly healed; after which the lobules of the ears should be again pierced through according to the directions laid down before.

The lint should be removed, each third day, and a thicker one should be inserted in its stead on each successive occasion, and the part should be rubbed with (unboiled oil) as before. For the expansion of the fissures, (sticks of Nimba or Apamarga, or rods of lead) should be inserted into them after the subsidence of the accompanying symptoms and deranged bodily humours (in the locality).

Metrical Text:—

The fissures thus expanded may ultimately bifurcate the lobules of the ears owing to the effects of the deranged bodily humours Dosha), or of a blow. Now hear me discourse on the mode of adhesioning them (with suitable bandages).

These unions or adhesions admit of being briefly divided into fifteen different kinds, viz., the Nemi-sandhanaka, the Utpala-Bhedyaka the Valluraka, the asangima, the Ganda-karna, the aharyaya, the Nirvedhima, the Vyayojima, the Kapata-sandhika, the Ardha-kapata-sandhika, the Samkshipta, the Hina-karna, the Vallikarna, the Yasthi-karna, and the Kakaushthaka.

Out of these, the process, known as the Nemi-sandhanaka, should be used in cases where each of the bifurcated lobes of the ears would be found to be thick, extended, and equal in size. The process, known as the Utpala-Bhedyaka, should be used in cases where the severed lobes of the ears would be found to be round, extended, and equal in dimensions. The process, Valluraka should be resorted to in cases where the severed lobes of the ears would be found to be short, circular and equal in size. The process, known as the Asangima, should be adopted in cases where the anterior surface of one of these severed appendages would have a more elongated shape than the other. The process, known as the Ganda-Karna, consists in slicing off a patch of healthy flesh from one of the regions of the cheeks and in adhering it to one of the severed lobes of the ears which is more elongated on its anterior side than the other (Plastic-operations). In the case of extremely short lobes, the flesh should be cut off from both the cheeks and adhered to them, the process being known as the Aharyaya. The lobes of the ears which have been completely severed from their roots are called Pithopamas. The process known as the Nirvedhima should be resorted to in such cases by piercing the two Putrikas (Tragus and Anti-tragus) of the ears.

The process known as the Vyayojima should be made use of in cases where one of the bifurcated lobes of the ear should be found to be dissimilar to the other as regards its, thickness or thinness. The process known as Kapata-Sandhika consists in bringing about an adhesion, on the posterior side, between one of the bifurcated lobes and another, which is elongated on the anterior side of the ear. The adhesion is so called from the fact of its resembling the closing of the two leaves of a door (Kapata). The process knov'n as the Ardha-Kapata-Sandhika consists in bringing about an adhesion on the anterior side between the shorter one of the two parts of a bifurcated earlobe with the part, elongated on the posterior side, like a half-closed door.

The ten aforesaid processes of adhesion may be successfully brought about and their shapes can be easily pictured from the meanings of their respective names.

The remaining five sorts such as the Samkhipta etc., are seldom attended with success and hence are called impracticable (Asadhayas). The process Samkhipta has its scope in the case where the auricle (Shashkuli) has been withered up and one of the bifurcated lobes is raised, the other being reduced and shortened. The process of Hina-karna should be adopted in cases where the supporting rim of the lobe (pinna) has been entirely swept away and its exterior sides and the cheeks are sunk and devoid of flesh. Similarly the adhesive process known as the Vallikarna is indicated in cases where the lobes are short, thin and unequal. The adhesion known as the Yasthi Kama is indicated in cases where the thin and severed ear-lobes are run across with veins and made of knotty or nodular flesh. The case in which the ear-lobe, being permeated with a little quantity of blood, is fleshless and ends in a narrow tip or end, furnishes the occasion for Kakusthakapali.

The five abovesaid adhesions, if followed by swelling, inflammation, suppuration and redness of the affected part and found to be secreting a sort of slimy pus or studded over with pustular eruptions, may be apprehended as not to be attended with success.

Authoritative verses on the subject:—

The exact middle point of the external ear should be pierced (with a knife) and the severed parts should be pulled down and elongated in the case where both the parts of a bifurcated ear-lobe would be found to have been entirely lost or eaten away. In the case where the posterior one of the two bifurcated parts would be found to be longer or more elongated, the adhesion should be effected on the anterior side; whereas the contrary should be the case where the anterior one would appear to be more elongated. Only the remaining one of the two bifurcated parts of an ear-lobe would be pierced, cut in two and adhesioned on the top, in the case where the other part would be found to be gone. A surgeon well-versed in the knowledge of surgery (Shastras) should slice off a patch of living flesh from the cheek of a person devoid of ear-lobes in a manner so as to have one of its ends attached to its former seat (cheek). Then the part, where the artificial ear-lobe is to be made, should be slightly scarified (with a knife), and the living flesh, full of blood and sliced off as previously directed, should be adhesioned to it (so as to resemble a natural ear-lobe in shape).

A surgeon, wishing to effect any sort of adhesion other than those described before, should first collect the articles enumerated in the chapter on Preliminary Measures to Surgical Operations, together with milk, water, Dhanyamla (fermented rice boilings), Suramanda (transparent surface-part of wine) and powders of earthen vessel. Then the hair of the patient, whether male or female, should be gathered and tied up in a knot, and the patient should be given a light food (so as to keep up his strength without hampering his digestion); after which his friends and relations should be asked to hold him firm. Then having ascertained the particular nature of adhesion to be effected in the case, the surgeon should examine the local blood by incising, excising, scarifying or puncturing the affected lobes as found necessary, and determine whether the same is pure or vitiated. Then having washed the blood with Dhanyamla and tepid water, if found vitiated through the action of the deranged (Vayu), or with milk and cold water in the event of the same being contaminated by the deranged Pitta, or with Suramanda and warm water in the case of its being vitiated by the action of the disordered Kapha, the surgeon shall bring about the adhesion by again scarifying the affected parts of the ear, so as not to leave the adhesioned parts elevated (raised), unequal and short. Of course the adhesion should be effected with the blood being still left in the parts that had been scraped. Then having anointed them with honey and clarified butter, they should be covered with cotton and linen, and tied with strings of thread, neither too loose nor too tight, and dusted over with powders of baked clay. Then directions should be given as regards the diet and nursing of the patient, who may be as well treated with the regimen laid down in the chapter on Dvi-vraniya.

Authoritative verses on the subject:—

The patient should be careful not to disturb the bandage and avoid physical exercise, over-eating, sexual intercourse, exposure to, or basking in, the glare of fire, fatiguing talk, and sleep by day. For three consecutive days the ulcer should be anointed with unboiled oil; and cotton soaked in the same substance should be placed over it, which is to be altered, each third day, till healing.

The incidental ulcer should not be tried to be healed up as long as the local blood (blood in the ulcer) is not fully purified; or so long as there is Hemorrhage from the seat of the affection or the local blood continues feeble. An ulcer, adhesioned with the least of the Vayu-vitiated blood continuing in its inside, will spontaneously burst or break open afresh. It will be again attended with pain, burning, redness and suppuration in the event of its being closed with a little quantity of Pitta-deranged blood incarcerated in its inside. Adhesioned even with a little quantity of Kapha fouled blood in its cavity an ulcer is marked by itching and numbness. An ulcer adhesioned with the continuance of an active Hemorrhage from its inside is marked by a brown or blackish yellow swelling. An ulcer, adhesioned at a time when the local blood, though otherwise good or pure, has been thinned or weakened through excessive bleeding, is followed by a corresponding emaciation (thinness) of the adhesioned part. The lobule of the ear thus adhesioned should be gradually pulled down and elongated after the complete healing of the local ulcer and the subsidence of its concomitant symptoms, and after the cicatrix has assumed the colour of the skin of the surrounding part. Otherwise the adhesioned part may be characterised by pain, swelling, inflammation, burning and suppuration, or the adhesion may again fall off. An adhesioned ear-lobe, unaccompanied by any of the distressing or unfavourable symptoms, should be gradually elongated by rubbing it with an unguent composed of the milk, fat, and marrow of any such animals and birds as the Godha, the Pratudas, the Vishkiras, the anupas, or the Audakas as would be available, and clarified butter and the oil expressed out of the seeds of white mustard, boiled with the decoction or Kvatha of Arka, Alarka, Vala, Ativala, Ananta, Apamarga, Ashvagandha, Vadari-gandha, Kshira-Shukla, Jalashuka and the drugs forming the group known as the Madhura, which should be previously prepared and carefully stowed in a covered receptacle.

Metrical texts:—

Then the above medicinal unguent should be applied or rubbed over the lobe of the affected ear, whereby all the disturbing or unfavourable symptoms would be subsided, thus favouring its firm and steady growth. Similarly a plaster composed of Yava, Ashvagandha, Yashtyahva, and Tila, pasted together might be rubbed over the affected ear-lobe with advantage. Oil prepared and boiled with the essence of Shatavari, and Ashvagandha, or Payasya, Eranda, Jivana and milk increases the growth of an ear-lobe. The lobe of an ear, which refuses to grow in size in spite of being fomented and lubricated as above indicated, should be scarified with slight longitudinal incisions on its anterior side (that is on the side nearest to the cheeks) and not on the posterior one, as such a procedure might be attended with dreadful results.

An ear-lobe should not be tried to be elongated just after the adhesion of its two severed parts, inasmuch as the centre of the adhesion, still being raw, might cause them to fall off again. Thus an ear-lobe under the circumstance should be gradually elongated, only when it would be found to be marked by the growth of hair on its surface, and the hole or the perforation has assumed a circular look, and the adhesion has become firmly effected, well-dried, painless, even and level in its entire length.

The modes of bringing about an adhesion of the two severed parts of an era-lobe are innumerable; and a skilled and experienced surgeon should determine the shape and nature of each according to the exigencies of a particular case.^[1]

Rhinoplastic operations:—

Now I shall deal with the process of affixing an artificial nose. First the leaf of a creeper, long and broad enough to fully cover the whole of the severed or clipped off part, should be gathered; and a patch of living flesh, equal in dimension to the preceding leaf, should be sliced off (from down upward) from the region of the cheek and, after scarifying it with a knife, swiftly adhered to the severed nose. Then the cool-headed physician should steadily tie it up with a bandage decent to look at and perfectly suited to the end for which it has been employed (Sadhu Vandha). The physician should make sure that the adhesion of the severed parts has been fully effected and then insert two small pipes into the nostrils to facilitate respiration, and to prevent the adhesioned flesh from hanging down. After that, the adhesioned part should be dusted with the powders of Pattanga, Yashti-madhuka and Rasanjana pulverised together; and the nose should be enveloped in Karpasa cotton and several times sprinkled over with the refined oil of pure sesamum. Clarified butter should be given to the patient for drink, and he should be anointed with oil and treated with purgatives after the complete digestion of the meals he has taken, as advised (in the books of medicine). Adhesion should be deemed complete after the incidental ulcer had been perfectly healed up, while the nose should be again scarified and bandaged in the case of a semi or partial adhesion. The adhesioned nose should be tried to be elongated where it would fall short of its natural and previous length, or it should be surgically restored to its natural size in the case of the abnormal growth of its newly formed flesh. The mode of bringing about the adhesion of severed lips is identical with what has been described in connection with a severed nose with the exception of the insertion of pipes. The physician, who is well conversant with these matters, can be alone entrusted with the medical treatment of a King.

Additional Text:—

O Sushruta, again I shall deal with diseases which affect the lobule of an ear under the circumstance described above The deranged bodily Vayu, Pitta and Kapha, either jointly or severally, give rise to several types of diseases which affect the lobule of an ear. The deranged Vayu produces numbness and an erysipelatous swelling and ulcer about the affected ear-lobe, while an erysipelatous ulcer in the locality accompanied by swelling, burning, suppuration, etc., should be ascribed to the action of the deranged Pitta. Heaviness, numbness and swelling of the ear-lobe accompanied by constant itching in the affected locality mark the action of the deranged Kapha. The medical treatment in these cases consists in effecting a subsidence of the particular deranged humour by means of diaphoresis, lubrication, Parishekas (medicated plasters) or blood-letting as the case may be. These measures should be moderately applied and a nutritive and invigorating food should be prescribed for the patient. The physician who is well familiar with the actions of the deranged bodily humours as described above, should be looked upon as alone entitled to take in hand a case, which falls under the head of one of the preceding types.

Now I shall enumerate the names of the several diseases which affect a severed lobe of the ear and describe the symptoms which each of them develops in succession. They are known as Utpataka, Utputuka, Shyava, Bhrisam-kandujata, Avamantha, Sakanduka, Akundaka, Granthika, Jamvala, Sravi and Dahavana. Now hear me discourse on the nature of medicinal treatment to be adopted in each of them.

Remedies:—

A plaster composed of the drugs known as Apamarga, Sarjarasa, Patala bark and Lakuca bark pasted togather, or a medicated oil prepared and boiled with the preceding substances should be applied in a case of the Utpataka type, wherea a case of the Utputuka type would prove amenable to a medicinal plaster consisting of Shampaka, Shigru, Putika, the fat and marrow of a Godha and the milk and bile of a she-deer, she-buftalo or sow, pasted togather; or(?) to a medicated unguent composed of the abovesaid substanees duly boiled with oil. Similarly, a medicinal plaster composed of the drugs known as Gauri, Sugandha, Shyama, Ananta, Tanduliyaka, or an oil prepared and boiled with the extract of the preceding drugs, would prove beneficial in a case of the Shyava type of the desease. In a case of the Vrisha-Sakundaka type, the affected part should be rubbed or lubricated with an unguent or medicated oil prepared with the boiled extract of Patha, Rasanjana, Kshaudram, and warm Kanjika. or a plaster composed of the same drugs and substances should be applied over the diseased locality.

In a case of ulceration, the ulcerated ear-lobe should be rubbed with the oil prepared and boiled with the drugs known as Madhuka and Kshira-kakoli, or with those which form the group known as the Jivakadi-Varga; while in a case where Vringhana measures are to be adopted, lard prepared from the fat of a Godha, boar, or snake might be used with advantage. In the Avamanthaka type the diseased ear-lobe should be washed and covered with a plaster composed of the drugs known as Prapaundarika, Madhuka, Samanga and Dhavam, or rubbed with oil prepared and boiled with the same drugs. Similarly, a case of Kandu-Juta (accompanied with itching) would yield to a plaster composed of the drugs known as Sahadeva, Vishvadeva, and Saindhava salt pasted with goat’s milk, or to the medicated oil boiled and prepared with the same drugs and substances. In a case of the Granthika type (accompanied by the formation of knotty growths in its inside) the knotty growths or glandular formations should be first removed, and the affected locality should be bled with a surgical instrument and dusted with powdered Saindhava salt. Likewise, in a case of Jamvala type, blood-letting should be resorted to by scarifying the seat of the disease, which should be then washed with a spray of milk. The ulcer should be healed after the perfect purification of its internal morbid???s. A case of the Sravi (secreting) type would readily yield to a????inal plaster composed of the drugs known as Madhuparni, and Mad??am, or of Madhuka pasted with honey, or to the medicinal oil? prepared and boiled with the same drugs and substances. A case of the Dahyamana (burning) type should be treated with a plaster composed of the drugs known as the five Kalkas and Madhuka pasted together and mixed with clarified butter, or with a pasted compound of the drugs which form the group of the Jivakadi Varga with a quantity of clarified butter added to it.

 

Thus ends the sixteenth chapter of the Sutra-Sthana n in the Sushruta Samhita which treats of the Piercing and Bandaging of lobes.

Footnotes and references:

[1]:

See Additional Text and Remedies at the near end of this chapter.