Chapter CLX - The Nidanam of abscesses etc.

Dhanvantari said:—Hear me, O Sushruta, now discourse on the ætiology and symptomology etc., of abscesses, (Vidradhi) and Gulmas (internal glands). Ingestion of stale, dry, parchifying, or extremely hot food may be set down as the primary cause of Vidradhis and Gulmas. The blood vitiated through such factors as gratification of carnal propensities by unnatural means, use of hard and uneven beds, etc., vitiates, in its turn, the skin, flesh, fat, and bones of the body, and takes refuge in the abdominal cavity, causing a round or extended swelling to appear either in the inside or on the surface of the body, attended with an excruciating, aching pain, which is called a Vidradhi. The morbific principles of the body, such as the deranged Vayu, Pittam and Kapham, either severally or combinedly, may give rise to an abscess, which may likewise occur in any part of the body, which has been profusely bled. An external abscess appearing at, any part of the body as an outcome of profuse blood-letting is found to have a knotty formation. An internal tumour, on the other hand, is always found to be deep-seated, compact as an internal gland (Gulma) and chequered with orfices, like an ant-hill, through which secretions are exuded. The patient complains of impaired digestion in this internal type of Vidradhi, which proves fatal in many instances.

The spleen, liver, lungs, heart, urinary bladder, intercostal, and inguinal regions principally form the seats of these internal abscesses. A heavy palpitation of the heart, enhancing the pain, is experienced when an abscess occurs in that locality. The abscess assumes either a blackish or bluish red colour, is slow in its growth and suppuration, and regular in its formation. Loss of consciousness, vertigo, tympanites with suppression of the stool and urine, and bleeding, attended with a kind of indistinct report, are the distressing symtoms which are found to supervene. An abscess orignated through the action of the deranged Pittam assumes either a red, copper, or black colour, and is attended with fainting, fever and a burning sensation. The abscess is rapid in its growth, and suppuration sets in early in the Pittaja type. An abscess of the Kaphaja type is tinged grey, and is attended with an itching sensation, and shivering. Numbness of the affected part, yawning, and heaviness of the limbs, with a non-relish for food are the symptoms which further characterise this Kaphaja tyye (type?). An internal abscess of the Sannipata type, like an external one of the same kind, is slow in growth and suppuration. It assumes a black colour, becomes studded over with belbs, and is attended with an intolerable burning pain, with fever and loose motions of the bowels. 1 he external abscesses have all their origin in the deranged condition of the Pittam. There is another kind of external abscess which is peculiar to women. The blood, enraged by a blow or hurt, may give rise to another kind of Vidradhi.

The blood in any part of the body, that has been wounded, becomes agitated through the action of the local Vayu (nerve force). The enraged blood, failing to find out an outlet, mixes with the deranged Pittam, and produces a kind of abscess, which is attended with all the symptoms peculiar to the deranged Pittam and vitiated blood.

Different symptoms are exhibited according to the variation in the seat of an abscess in the body, as for example, an internal abscess, occurring about the region of the umbilicus, brings on an obstinate tympanites, while the one, which appears in the urinary bladder, produces painful micturition. An abscess of the spleen brings on dyspnœa, and an unquenchable thirst. An abscess in the lungs produces constriction of the larynx, while the one in the heart produces a pain all over the body. An abscess, occurring inside the intercostal region, produces vertigo, fainting, a digging pain in the heart, and the peculiar form of dyspnœa known as Tamaka shvasa (described before). An abscess, occurring inside the inguinal regions, about joint of the thighs, or about the union of the back and waist (sacrum), produces the incarceration of the wind and a kind of intolerable pain.

The non-suppurated, suppurating, and suppurated stages of an abscess should be ascertained in the manner of any other swelling. An internal abscess, occurring in the region above the umbilicus, with its head pointing upward, bursts out in the stomach, and evacuates its contents through the passage of the anus. An internal abscess, occurring in the rectum, mouth, or the umbilicus, and exuding its (peculiar) secretion, should be regarded as indicating a painful prognosis. An internal abscess of the Sannipata type appearing in any of the aforesaid localities in the body produces an alteration in the composition of the local tissues, while an external -one, occurring about the umbilicus, or in or above the urinary bladder, runs to suppuration and bursts. An internal abscess, fully developed, is always found to suppurate, while the one, that is not well developed, gives rise to many a supervening, distressing symptom in its immature stage.

A peculiar kind of abscess is found to occur in the uterus of wicked women, who are addicted to the sinful practice of effecting miscarriage of their pregnancy. The swellings in the uterus, caused by frequent abortions, become compact and condensed, and are thus transformed into abscesses. A mammary abscess should be regarded as an external one to all intents and purposes. An internal abscess can never occur in any of the reproductive organs of a girl, owing to the comparatively greater thinness of blood that courses in the female economy, during childhood. It is the aggravated and obstructed Vayu (nerve force) that should be regarded as the primary cause of all swellings. The local Vayu, any wise aggravated, courses down from the region of union between the penis and the scrotum, finds lodgment in the spermatic chord of the testes, presses upon the local vessels, and produces a swelling of the scrotum by vitiating the fat of the locality. The disease is called Vriddhi Roga, which admits of being divided into seven different types. A preponderance of the deranged Vayu in a Vidradhi Roga of this type, whether external or internal, is followed by copious micturitions. In the Vataja type of this Vriddhi Roga, the swelling (scrotal tumour) becomes inflated, parched and rough to the touch, marked by a burning sensation in its inside. In the Pittaja type, the swelling assumes a vermilion tint like that of a ripe Audumvara fruit (Ficus Indica), and is attended with heat, burning, and suppuration. In the Kaphaja type, the swelling becomes cold, heavy, glossy, and slightly painful, attended with an itiching sensation. In the Raktaja type (Hematocele) (due to the action of the contaminated blood), the swelling becomes compact, and is covered with a crop of belbous eruptions on its surface, its other features being one with those described under the head of Pitaja type of Vriddhi. The swelling in the type originated through the action of the deranged fat and Kapham becomes soft and rounded like a palm fruit. The type known as Mutraja Vriddhi (Hydrocele, usually appears in those who are in the habit of voluntarily suppressing their urine. The patient leads a sort of quiscient life, and does not evince any desire for any thing in special. The swelling becomes distended with serous accumulations, and suffers a perceptible diminution in size, if its fluid contents are in any way evacuated.

Cold ablutions and use of articles of fare, that tend to aggravate the bodily Vayu, are the factors which produce a kind of ring-like swelling at the bottom of the scrotum, producing painful micturition. The Vayu aggravated by voluntary repression of natural urgings of the body to urination or defecation, or by violent physical exercise or straining of the lower limbs in any unnatural posture, or suck like aggravating factors, tends to produce a determination of blood to the lower limbs and inguinal regions, instantaneously causing the appearance of a ring-like glandular swelling (hernia) in the groin. Neglected at the outset, a case of this type of Vriddhi Roga may run into one of Gulma, attended with tympanites, pain, and hosts of other distempers. Firmly pressed, the ring-like, protuberant, swelling rises upward, making a distinctly audible report. The type (Rakta Vriddhi) is incurable, while the swelling in a case of Vataja Vriddhi continues in the same size, traversed by a network of dry, bluish red veins. The aforesaid diseases may be divided into eight different types according as the morbific principles of the deranged Vayu, Pittam, and Kaphah severally or combinedly act as their exciting and underlying factors.

The eighth kind of abscess (Vidradhi) is that, which occurs in any of the generative organs (ovary or uterus, etc.) of women of impaired menstrual functions. Even a strong patient (during an attack) is afflicted with fever, dysentery, vomiting, rigor, and hunger, and gets emaciated. A Vidradhi-patient, who partakes of boiled rice, or drinks copiously, or bathes, or fasts, during an attack, is soon overwhelmed with fits of fainting. Diaphoretic or emolient measures should not be resorted to in a case of Vidradhi, and expedients calculated to promote a free and healthy circulation of blood should be at once tried, no matter whether the morbific principles have been eliminated from the body of the patient with the help of suitable purgatives, or not.

In a case of Vataja Vidradhi, the wind and the filthy matter are either combinedly emitted from the abscess, or they may be separately emitted at different times. The aggravated Vayu, coursing through the capillaries, sometimes gives rise to bloody discharge from a Vataja abscess, while obstructing the upward and downward passages of the body it brings on a violent aching pain.

A Gulma (internal gland) is tangible (can be caught hold of with the hand) like a stone, hot, and glandular in shape. The Vayu, aggravated through fasting, suppression of stool or urine, or obstruction of the channels of the body, finds lodgment in the abdominal cavity, and dries up, in virtue of its own parchifying property, the feces and mucous accumulated therein in the shape of a hard lump, which is called Gulma.

The deranged Vayu continuing in its own locations acts independently, while located in the seat of any other morbific principle of the body (such as the Pittam and Kaphah) it acts subservient to that principle. The consolidated lump of Kapham, solidified in combination with mucous, and which is found to occupy the region either about the umbilicus, sides, or thoracic or abdominal cavity, is called a Gulma.

In the Vataja type of Gulma, fever with an excruciating headache, enlarged spleen, a rumbling or croaking sound in the intestines, loose motions of the bowels, a pricking pain in the limbs, and difficult or painful urination are the symptoms, which are invariably exhibited. The patient suffers from an œdematous swelling of the face and extremities, or from a general anasarca. The ball-like tumour rolls about, or shifts from one place to another, in the region of its location, the skin of the patient becomes parched and dark, the pupils of the eyes are dilated, and the sight is perceptibly impaired. The patient complains of a creeping sensation in the Gulma, as if hosts of ants are traversing its inside, and the ball-like tumour is perceived to be shifting from place to place.

In the Pittaja type, symptoms such as Epilepsy, acid eructations with loose motions of the bowels and a burning sensation in the body, perspiration, thirst, chlorosis, and anasarca are found to be mainfest (manifest?). In the Kaphaja type, the Gulma becomes hard, heavy, and fixed, attended with insomnia, or fretful sleep at irregular hours, obesity, nausea, white or dark colour of the skin, heaviness of the head, and a sensation, as if the body has been packed with a wet compress, with a non-relish for food are also present. The deranged Kaphah in the system is aggravated or suffers a diminution at times without any apparent reason, scorching its specific seats in the organism. The distressful concomitants in this desease such as, hæmorrhage etc., soon manifest themselves through the deranged condition of the specific organs they are found to attack, thus bringing on a complication which invariably proves fatal. The type known as Rakta-gulma (ovarian tumour) which occurs in women is found to be hard, raised and compact. The type should be attributed to the concerted action of the deranged Vayu, Pittam and Kaphah, etc., and is marked by an excruciating pain and rapid suppuration.

A long exposure to the wind by a woman, during her menses, or by one suffering from any kind of uterine or vaginal disease, tends to augment and aggravate the Vayu in her system. The Vayu, thus aggravated, obstructs the orfice of the menstrual duct, and the blood accumulated, each month, in her abdominal cavity, produces all the symptoms of pregnancy. Nausea, appearance of milk in the mamme, and a fretful mood are the symptoms, which characterise this disease in which the patient becomes fastidious in her taste, and evinces her desires for various kinds of food, as in true pregnancy. The deranged Pittam, in contact with the aggravated Vayu, leads to the accumulation of blood in the uterus, and the Gulma, generated in consequence thereof, manifests symptoms which are peculiar to both of them (Vayu and Pittam), The accumulated blood in the uterus produces an intolerable aching pain in that viscus, attended with pain in the vagina, and a fetid, water-like, vaginal discharge, or leucorrhœa. The gulma in this type sometimes develops all other symptoms of pregnancy. All these types of Gulma should be regarded as having their origin in excessive or unnatural gratification of sexual propensities.

The food tong remains undigested in the stomach of a Gulma-patient, and the growth and progress of an abscess are arrested as soon as a Gulma makes its appearance in the body of the patient. A Vidradhi (abscess) is so called from the fact of its soon running to suppuration. A Gulma, occurring in the abdominal cavity, is marked by a burning sensation in the pelvic cavity, and a pain in the inside of the Gulma like that, which is experienced in an enlarged spleen. The complexion of the patient becomes pale and sallow, the strength of the body is diminished, the digestion is impaired, and the stool and urine are suppressed. External symptoms develop themselves, and the patient complains of a pain in his limbs and abdomen, or about the umbilicus, while the reverse is the case (i e., in cases where the preceding symptoms are not exhibited). Cough, palour, bulging out of the abdomen, rumbling sound in the intestine, tympanites, and an excruciating pain in the abdomen are the symptoms, which are found to supervene. When in combination with the preceding symptoms, emission of flatus or rising of eructations are stopped, the disease is called anaha. A thick, raised, knotty, and stone-like gland, appearing in a case of Gulma, is called Ashthiha. When the Vayu incarcerated in the stomach gives rise to an excruciating pain, accompanied by all the foregoing symptoms, the disease is called Pratya-shthila. Bulging out of the abdomen, suppression of stool, dulness of the senses with a rumbling sound in the intestines, tympanites, and distension of the abdomen are the symptoms, which mark all types of Gulma.