Chapter CLXXVIII - The Nidanam of Variola

Now hear me, O Sushruta, discourse on the Nidanam of Masurika (Variola), etc. Ingestion of pungent, saline or alkaline articles of fare in inordinate quantities, use of incompatible articles of food, eating before the digestion of a previous meal is digested, use of stale food, Simbi seeds, and Madhvalukas, exhalations from poisonous trees, marshy grounds, etc., use of vitiated water for drinking purposes, exposure to wines charged with poisonous miasm, and influences of malignant planets are the factors which tend to aggravate the morbific principles in the human organism, and these pathogenetic factors, in combination with the consequently poisoned blood, bring on an attack of Masurika (small-pox). The disease is so named from the fact of the resemblance of its eruptions to lentil seeds. Eruptive fever with lassitude and a desire to stretch the limbs, vertigo and a distaste for all things and concerns of life, discolouring and swelling of the skin (eruptive rashes) and redness of the eyes are the symptoms, which mark the premonitory stage of Masurika. In the Vataja type of Masurika the pustules become hard, rough, and reddish brown, attended with an excruciating pain in the limbs. These pustules are very slow of suppuration. In the Pittaja type of Masurika a breaking pain is experienced in the limbs. Cough, rigour, apathy, lassitude, parchedness of the palate, lips, and tongue, and thirst with a non-relish for food are its symptoms. The pustules become white, red, or yellow, attended with a kind of extreme pain and burning sensation, and suppuration is found to set in later. In the Raktaja type of Variola, loose motions of the bowels with an aching pain in the limbs, thirst with a non-relish for food, stomatitis, and inflammation of the conjuctivæ with a high fever are the symptoms which speedily manifest themselves in conjunction with the other specific features of the Pittja type of this disease. Water-brash, a non-relish food, heaviness of the limbs, headache, a sensation as if the body has been tied with a wet compress, somnolence and physical languor are the symptoms which mark the Kaphaja type of Masurika. The pustules are found to be white, thick, glossy, and marked by a little pain and an itching sensation about them, taking time to be fully suppurated. In the Sannipatika type of Masurika the pustules assume a bluish colour, are dipped at the centre, and look elongated like thrashed paddy. They are very slow to suppurate, being attended with an extreme pain and a copious fetid discharge. The type of small pox, known as Charmadala, in which constriction of the larynx with a non-relish for food, numbed pain in the limbs, delirium, and want of comforts are developed, should be regarded as incurable. Red eruptive rashes of the same elevation with the follicles of bodily hairs, due to the aggravated condition of the deranged Kaphah and Pittam, of which cough, fever and a repugnance for food mark the premonitory stage, are called Romanthika (measles).

The eruptions in cases of Tvakgata Masurika (Chicken pox) are found to be belbous in their character, which secrete a water-like fluid when they burst. These eruptions have their origin in the vitiated condition of the serum. Those which have their origin in the vitiated condition of the blood assume a blood-red colour. The cuticles of these pustules are extremely thin. They bleed when burst, and prove curable if the blood is not extremely poisoned. In the type which has its origin in the diseased condition of the flesh, the pustules become hard, and glossy, and are possessed of thick cuticles. They suppurate later and thirst and fever with an aching, itching sensation in the body are found to supervene. In the type which has its origin in the diseased condition of the bodily fat, the eruptions are soft, slightly elevated, and circular in shape, attended with an extremely high fever. Hyperperaxia, mental aberration and delirium are also developed and scarcely its victim escapes with life. In the type which has its origin in the diseased condition of the marrow, the pustules become small sized and of the same colour with the surrounding skin, and are slightly raised and flat like thrashed paddy. There is loss of consciousness, nerve and vein amestomoses and regions about the unions of bones and ligaments (Marmas) seem as if being torn asunder and the bones seem as if being bored with drills. This disease is highly fatal, the patient expires on the very day of the attack. In the type which is due to the diseased condition of the semen, the eruptions look as if they are suppurated, while in fact they are not. They are small, glossy and extremely painful. Epileptic fits, loss of consciousness, and insanity with a burning sensation in the body and superficial coldness and heaviness of the limbs form the specific symptoms of this type of Masurika, which invariably proves fatal.

Of the several types of Variola, those that are respectively due to the action of the deranged Pittam, Kaphah, or Pittah and Kaphah combined, or have their respective seats in the lymph chyle or blood speedily yield to medicine. Those which are due to the deranged condition of the bodily Vayu, or of the Vayu and Pittam, or of the Vayu and Kaphah, are comparatively more difficult to cure, while cases of Sanni-patika origin should be abandoned as incurable.

In the Sannipatika type, the eruptive pustules are either coloured like the red corals, or like the ripe Jambolin or Tamala flowers, or like iron-dust. Cough, hiccough, mental aberrations, hyperperaxia, delirium, convulsions, thirst, hæmorrhage from any of the upper apertures of the body, a wheezing sound in the chest and violent fits of vertigo are the symptoms which point to an unfavourable prognosis in Variola. A small-pox patient affected with excessive thirst, or with any nervous disease, such as Apatanaka (hysterical convulsion) and found breathing through the mouth, should be regarded as already within the clutches of death. A painful œdematous swelling about the wrists, elbows or shoulder-blades marks the sequel to an attack of small pox. These swellings are extremely hard to cure.