Sushruta Samhita, volume 4: Cikitsasthana
by Kaviraj Kunja Lal Bhishagratna | 1911 | 123,229 words
This current book, the Chikitsa-sthana (english translation), deals with therapeutics, surgical emergencies, geriatrics, aphrodisiacs and various other subjects. The Sushruta Samhita is the most representative work of the Hindu system of medicine. It embraces all that can possibly appertain to the science of medicine. Susruta-samhita is recognized...
Chapter XV - The medical/surgical treatment of the fetus
Now we shall discourse on the (surgical and medical) treatment of the cases of difficult malpresentation of the fetus and of difficult labour (Mudha-Garbha). 1.
The extraction of a fetus, acting (in the womb) as an obstructing Shalya (foreign matter lodged in the body), is the most difficult of all surgical operations, inasmuch as actual contact or actual manipulation is the only means accessible to a surgeon in the region of the pelvic cavity, the spleen, the liver, the intestines and the uterus. All surgical acts in respect of the fetus or the enceinte, such as lifting up, drawing down, changing of postures (version), excision, incision, the cutting of limbs and section, pressure, the straightening and the perforating of the abdomen, could not be done otherwise than by actual contact of the hand, which may sometimes prove fatal to the fetus or to the enciente. Hence the king should be first informed (as success in these cases is often uncertain) and all acts should be performed with the greatest care and coolness.
We have stated before that the fetus is generally presented in cases of difficult labour in eight different postures or forms. The obstruction of the child in the passage of parturition (Garbha-Sanga) may be effected in three different ways, owing to its head, shoulders or hips being presented in a wrong way and held fast in the passage. Every care should be taken and no pains spared to bring a child alive into the world, which is not already dead in the womb. The sacred verses (Mantras), possessing of the virtue of bringing out the fetus, should be recited in the hearing of the enciente in the case of a failure in the first attempts at effecting parturition. The mantras are as follows. 2.
“O thou beautiful damsel, may the divine ambrosia’ and the Moon god with Citra- bhanu and the celestial horse Uccaih-Shravas take their residence in thy room; may this water-begotten nectar, help thee, O lady, in swiftly casting off thy womb. May the Sun, the Vasavas and the Wind-god (Pavana) in the company of the saline Ocean give thee peace. The incarcerated beasts have been freed from their fastenings and binding chords. The Sun god has freed his rays of light. Freed from all danger, come, O, come, O child, and rest in peace in these precincts,” 3.
Proper and useful medicinal remedies should also be employed for the delivery of the child.
Postures of the Fetus:—
In the case of the fetus being dead in the womb, the enciente should be made to lie on her back with her thighs flexed down and with a pillow of rags under her waist so as to keep it a little elevated. Then the physician should lubricate his (own) hand with a compound consisting of earth, clarified butter and (the compressed juice of) Shallaki, Dhanvana and Shalmali and inserting it into the passage of parturition (Yoni) should draw out the dead fetus (downward with the hand). 4.
In the case of a leg-presentation (Sakthi), the fetus should be drawn downward by pulling its legs. In case where a single leg (Sakthi) is presented, the other leg of the fetus should be expanded and then it should be drawn downward.
In the case of the presentation of the buttocks (Sphik) (breech presentation), the buttocks should be first pressed, and lifted up and then the fetus should be drawn downward by the legs. In the case of a longitudinal presentation (the child coming stretched cross-wise) like a belt and arrested in the passage, its lower extremities should be pushed upward with the hand and the child should be drawn out with its upper part (viz., the head, etc.), thus pointed downward, and brought straight into the passage of parturition. In a case of the head being hung back a little on one side, the shoulder should be lifted up by pressing it (with the hand) after chafening it, so as to bring the head at the door of the passage and the child should be drawn straight downward. Similarly in the case of the presentation of the two arms, the shoulder should be lifted up by pressing it (with the hand) and, the head being brought back to the passage, the child should be drawn downward. The remaining two kinds of false presentation (Mudha- garbha) previously described (in the eighth Chapter of the Nidana Sthana) should be considered as irremediable. The applications of instruments (Sastra) should be the last resort when such manipulatory measures would fail. 5.
But even in such irremediable (Asadhya) cases, surgical operations should not be made if the fetus could be detected alive in the womb, as such a course (as the cutting of the fetus, etc.) would fatally end both as regards the child and its mother. 6.
Operations involving destruction of the Fetus-Craniotomy:—
In cases where there would be any necessity of using an instrument for the purpose of delivery, the enciente should be encouraged (with hopes of life) before making the surgical operation. The head or skull of the child in such cases should be severed with the knife known as the Mandlalagra or the Anguli-shastra; then having carefully taken out the particles of the skull-bone (Kapala), the fetus should be drawn out by pulling it at its chest or at the shoulder with a Sanku (forceps). Where the head would not be punctured and smashed, the fetus should be drawn out by pulling it at the cheeks or the eye-sockets. The hands of the fetus should be severed from the body at the shoulders, when they (the shoulders) would be found to have been obstructed in the passage and then the fetus should be drawn out. The abdomen of a child, dead in the womb, should be pierced and the intestines drawn out, in event of the former being swollen into a flatulent (Vata) distension like a leather bag (for holding water), as such a procedure would remove the stiffness of its limbs, and then it should be drawn out. The bones of the thighs (Jaghana-kapala) should be first cut out and removed, where the fetus would be found to have adhered fast to the passage with its thighs (Jaghana). 7.
In short, that part of the body of the fetus should be severed and removed which prevents its (fetus) withdrawal from the womb and the life of the mother should be saved at all hazards. The different types of false-presentations should be ascribed to the abnormal coursing of the deranged Vayu (in the uterus), and hence an intelligent physician should adopt, after careful considerations, proper remedies (for its pacification). An intelligent physician should not waste a single moment in drawing out the fetus, as soon as it would be found to be dead in the womb, since neglect in such cases leads to the instantaneous death of the mother, like an animal dying of suffocation. An erudite physician, well-versed in anatomy, should use in such cases a Mandalagra instrument for the purpose of cutting out (the fetus), since a sharpe-edged Vriddhi-patra may sometimes hurt the mother during the operation. 9–10.
A non-falling placenta (Apara) should be extracted in the way indicated before or the enciente should be firmly pressed and the placenta extracted with the hand. Her body should be constantly shaken or her shoulders constantly rubbed at the time (of extracting the placenta) after lubricating the passsage of parturition with oil. 11.
Thus having extracted the Shalya (foetus), the body of the mother should be washed with warm water and anointed with oil, etc. Oil should also be copiously applied to the passage of parturition as it would soften the Yoni and alleviate the pain therein. After that, powdered Pippali, Pippali-roots, Shunthi, Ela, Hingu, Bhargi, Dipyaka, Vaca, Ativisha, Rasna and Cavya should be given in a Sneha (clarified butter, etc.), for the (proper) discharge (i.e., purification) of the Doshas (lotia) and for the alleviation of the pain. A plaster, or a decoction, or a pulverised compound of the said drugs without the addition of any Sneha (clarified butter, etc.) may also be given to her. As an alternative, the physician should ask the parturient woman to take Shaka -bark, Hingu, Ativisha, Patha, Katu-rohini and Tejovati prepared and administered in the preceding manner. Then for three, five or seven days, Sneha (clarified butter, etc.) should again be given; or the patient should be asked to take well prepared Asavas and Arishtas at night time. A decoction of the bark of Shirisha and Kakuhha should be used for washing (Achamana) purposes and the other supervening distresses (i.e.,) complications) should be remedied with proper medicines. 12–A.
Diet and regimen of conduct:—
The mother should always be neat and clean and subjected to a course of a small quantity of wholesome and emollient diet and to daily anointments and fomentations; and she should be advised to renounce all anger. Milk cooked with the Vayu-subduing drugs should be used for the first ten days. Meat-soup should then be prescribed for another such period, after which a diet should be prescribed according to the patient’s health and nature. This regimen should be observed for a period of four months, after which, the patient would be found to have regained her health, strength and glow of complexion, without any complications, when the medical treatment, etc, should be discontinued. 12–14.
The following Vala-Taila should be used for applying into the Yoni (Vagina, etc.), for anointing the body and for drinking and eating purposes (i.e., along with other food) as well as for Vasti-Karma, as the oil is highly efficacious in curbing the action of the deranged and aggravated bodily Vayu. 15–A.
The Vala Taila:—
An adequate quantity of sesamum oil should be cooked with eight times as much of the decoction of each of the following; viz., Vala roots, Dasha-mula and the three combined drugs of Yava, Kola and Kulattha and with eight times as much of milk and (one-fourth as much of) a paste (Kalka) compound of the drugs included in the Madhura group as well as with Saindhava- salt, Aguru, Sarja-rasa, Sarala- Kashtha, Deva-daru, Manjishtha, Chandana, Kushtha, Ela, Kalanusariva, Mansi, Shaileya, Teja-patra, Tagara, Shariva, Vaca, Shatavari, Ashva-gandha, Shata-pushpa and Punarnava. After the completion' of its cooking the oil should be kept carefully in a goldën, silver, or earthen pitcher with its mouth well-stoppered. This oil is known as the Vala-Taila and proves curative in all diseases due to the action of the deranged Vayu. A newly delivered woman should use this oil in adequate doses, according to her physical condition. Women wishing to be mothers and men seeking the blessings of fatherhood should use this Taila, which proves equally beneficial in cases of an emaciation of the body due to the action of the deranged Vayu, weariness of the body through hard labour, and also in cases of hurt or injury to any vital and vulnerable part of the body (Marma), in cases of fractured bones, convulsions, Vata- Vyadhi, hiccough, cough, Adhimantha, Gulma and dyspnea. A case of hernia would likewise yield to the continuous use of this oil for six months. The essential and vital principles (Dhatus) of the organism of a man are shtrengthened through its use and his youth will suffer no decay. It should be used alike by kings, king- like and wealthy persons, as well as by those of a delicate and ease-loving temperament. 15–B.
Seeds of sesamum should be successively soaked a number of times in a decoction of Vala roots and then dried (in the manner of a Bhavana saturation). The oil pressed out of such sesamum should be successively cooked a hundred times with the decoction of Vala- roots. This being done, the oil should be poured into an earthen pitcher and the patient, while taking it in adequate doses, should live in a lonely chamber protected from the wind. After its digestion, the patient should partake of milk and boiled Shashtika rice. A Drona measure of the oil, should in this way, be gradually taken and the regimen of diet (milk and Shashtika rice, etc.) should be observed for double that period. This oil is efficacious in improving one’s strength and complexion and adds a century (of years) to the duration of one’s life, and at the same time absolves him from all sins. It is said that the use of each succesive Drona measure of this oil adds a century to one’s days on earth. 16.
Oils may similarly be prepared with each of Ativisha, Guduci, Aditya-parni, Saireyaka, Virataru, Shatavari, Tri-kantaka, Madhuka and Prasarani, and may be prescribed by an experienced and erudite physician. 17.
Nilotpala and Shatavari should be cooked in milk. The milk thus prepared should be again cooked with sesamum oil successively a hundred times and a paste of all the drugs used as a paste in the Vala Taila should be added to it at the time of cooking. The therapeutic virtues of all these oils are the same as those of the Vala-Taila and the same regimen of diet and conduct should be observed in all such cases. 18.
Thus ends the fifteenth Chapter of the Chikitsita Sthana in the Sushruta Samhita which deals with the medical treatment of Mudha- garbha.
Footnotes and references:
The oil should be introduced into the vaginal canal by means of Pichu, i e., cotton plugs soaked in oil, etc.
This decoction should be specially used for 1 washing the uterus (Yoni).—Ed.
Four seers of sesamun oil, thirty-two seers of the decoction of the Vala-roots, thirty-two seers of the decoction of Dasha-mula, thirty-two seers of the decoction of the drugs Yava, Kola and Kulattha taken together, thirty-two seers of milk and one seer of the paste compound (Kalka) should be taken in the preparation of the oil.
Vala would be the Kalka in this oil, says Dallana. But he also says that some authorities hold that the Kalkas used in the Vala-Taila should be used as the Kalka in this oil as well.