Chapter XVII - Features of unripe and ripe swelling

Now we shall discuss the Chapter which deals with the mode of distinguishing between suppurating and nonsuppurating swellings. Ama-pakkaishaniya-adhyaya.

Diseases such as, Granthi (Aneurism), Vidradhi, (abscess) and Alaji (inflammation of the edge of the cornea) etc. are ushered in by a preliminary swelling which subsequently develops symptoms peculiar to each of them. These diseases differ in their symptoms and outward shape. A swelling which may appear at any part of the body, and is round, elevated, even, or uneven in its (surface) is called a Shotha (swelling). It restricts itself to the skin and flesh of its locality and is characterised by the several or concerted action of the deranged bodily humours. The Shothas (swelling) admit of being divided into six different types according as they are caused by the action of the deranged Vayu, Pitta, Kapha or blood, or are due to the concerted action of the three fundamental humours of the body, or are of traumatic origin.

Now we shall describe the symptoms which mark the respective actions of the humours in a welling. A swelling due to the action of the deranged vayu assumes a reddish or blackish hue and is shifting its character. It feels rough and soft to the touch, and is marked by a sort of aching pain (peculiar to the deranged Vayu) which vanishes at intervals.

A swelling, due to the action of the deranged Pitta, assumes a yellowish hue. It is soft and fluctuates under pressure, and is marked by an accumulation of blood in its body. It swiftly shifts from one part of the body to another, accompanied by a burning, sucking pain. A swelling, brought about through the deranged condition of the Kapha, assumes a grey or whitish colour. The skin becomes glossy and cold, and the swelling very slowly changes its original site, if it shifts at all, accompanied by pain and itching. A swelling engendered through the concerted action of the three bodily humours successively manifests the symptoms and assumes the colours respectively peculiar to each of them. The symptoms which mark a swelling due to the action of the vitiated blood are identical with those which are exhibited in a swelling of the Pittaja type with the exception of the blackness of the part (and an increase of heat). A swelling due to an external blow traumatic) manifests symptoms peculiar to the Pittaja and blood-origined types.

A swelling, which does not yield to internal and external remedies on account of an excessive accumulation of the deranged local humours, or through (the?) insufficient or contrary effects of the remedial a?? shows sign of suppuration.

Now hear me describe the symptoms, which respectively mark an unsuppurated, suppurating or suppurated swelling. The unsuppurated or immature stage continues as long as the skin of the swelling retains its natural hue, marked by a little pain and heat in its inside, and coldness, hardness and a slight elevation of its surface.

The suppurating stage gives rise to a sensation of pricking pain in the affected locality. The swelling seems as if it is being pricked with needles, or bitten or wandered over by a host of ants, or cut with a knife, or pierced with a spear, or thrashed with a club, or pressed with the hand, or scraped round with fingers, or burnt with a fire or an alkali. The patient complains of a sort of sucking, burning pain in the swelling of a fixed or shifting character. The patient, as if stung by a scorpion, does not find comfort in any place or position. The hue of the local skin is changed and the swelling goes on increasing like an inflated leather bag; and fever, thirst, a burning sensation and aversion to food etc. gradually supervene.

The suppurated stage is marked by an amelioration of the local pain and a yellowishness of the skin over the swelling, which cracks and seems too big, thus giving??e to folds in the integument. The swelling exhibits the??? ation under pressure and shows perceptible signs large c??inution. Moreover, it yields to pressure and reaches its former height when the pressure is removed. The pus or the suppurated matter changes its place, or shifts from one part of the swelling to another under pressure like water in a bloated leather bag. The distressing symptoms gradually subside; the patient again evinces a desire for food, and feels a constant inclination for scratching the affected part which is characterised by a sort of aching pain. Sometimes, as in cases of traumatic swelling or in those brought about by a deranged condition of the Kapha, the suppurating process is restricted to the deeper tissues of the affected part and hence fail to exhibit its characteristic symptoms—a fact which often misleads a physician (surgeon) as regards the true state (lit:—whether suppurated or not) of the accompanying swelling. But the knowledge that a process of suppuration, occurring in the deeper tissues of an affected part, is accompanied by alleviation of the pain and swelling which becomes as compact as a stone and cold to the touch, and the local skin resuming its natural colour, would unquestionably ward off all apprehensions for error of judgment.

Authoritative verses on the subject:—

A physician (surgeon) who is fully conversant with the symptoms which are respectively exhibited by (an inflammatory) swelling in its unsuppurated, suppurating and suppurated stages, is alone worthy of the epithet; the rest are but impostors. Since there can be no pain without the intervention of the deranged Vayu; and no suppuration can set in without the action of the deranged Pitta; nor pus, without the action of the deranged Kapha; it is evident that a suppurated swelling is marked by the combined and simultaneous action of the three deranged humours of the body.

According to certain authorities, the deranged Pitta gets the preponderance over the local Vayu and Kapha, and transforms the blood into pus out of its own preponderant energy.

The incision or opening of a swelling in its inflammatory or unsuppurated (lit. immature, unripe) stage is attended with the destruction of the local flesh, ligament, bone, vein, or joint, and is usually followed by excessive Hemorrhage. The incidental wound becomes extremely painful. Many distressing symptoms begin to manifest themselves in succession and cavities are formed inside the wound which may lapse into a case of Kshata-Vidradhi (a type of ulcerated abscess).

On the other hand, a fully suppurated swelling, left unopened for a long time out of fear or ignorance by the attending physician, is attended with symptoms which are fraught with dreadful consequences. The accumulated pus, unable to find an outlet, is infiltrated and attacks the deeper tissues of the affected part, and forms large cavities or sinuses in their inside, thus converting the disease into one of a difficult or incurable type.

Authoritative verses on the subject:—

The physician (surgeon) who opens an unsuppurated or unripe swelling out of ignorance, as well as the man who neglects a fully suppurated one, should be looked upon as the vilest Chandala for his wrong or incorrect diagnosis. The patient should be provided with a meal before the surgical operation, or strong wine should be given him, if he is found to be addicted to the habit of taking any. The effect of a good meal under the circumstance will be to keep up the strength of the patient and to guard against his swooning during the operation, while the effect of wine will be to make him unconscious of the pain. The rule as regards the feeding and anesthetising (wine giving) of the patient should be strictly adhered to, since the internal vital principle of a man is invigorated by the strength of his body which is the product of lymph-chyle, the essence of food, and the quintessence of the five material principles. A swelling, no matter whether limited or extensive, spontaneously runs on to suppuration, if not medicinally treated, or left to nature. The base of such a swelling goes on extending. It becomes unequally suppurated and reaches an unequal elevation, thus affecting the deeper tissues of the part and swiftly running into one of an incurable type. A swelling, which does not yield to the application of medicated plasters or to corrective or blood-letting measures, speedily and uniformly suppurates, and is marked by a small and restricted base and a circular or conical elevation. As a blazing fire fed by gusts of favourable wind soon consumes a withered forest, so the incarcerated pus, in the absence of any outlet, attacks and eats away the healthy flesh, veins and nerves of an organism.

Surgical acts in connection with an abscess (Shotha) may be divided into seven kinds such as

1. mutilation (Vimlapana) of the swelling by massage,
2. Avashecana (bleeding or application of leeches)
3. Upanaha (poulticing)
4. Patana (opening or incision)
5. Shodhana (purification of the internal morbid matter of an incised boil with corrective medicines)
6. Ropana (healing)
7. and Vaikritapaha (restoring of the natural colour of the skin to the cicatrix).

 

Thus ends the seventeenth Chapter of the Sutrasthana in the Sushruta Samhita which treats of how to distinguish between suppurating and non-suppurating swellings.