Chapter CLXXXIII - The Nidanam of Goitre scrofula and glandular swellings

Now hear me, O Sushruta, discourse of the Nidanam of Galaganda, (goitre) scrofula, and glandular swellings etc. A large or small, pendent swelling (growth) at the neck is called Galaganda (Goitre). The morbific principles of the deranged Vayu, and Kaphah, as well as the deranged fat, by taking recourse to the Manyas (muscles of the neck) severally give rise to different forms of Goitre, marked by their respective specific symptoms. In the form of Goitre originated though the action of the deranged Vayu, the swelling (growth) assumes either a vermilion or a twany brown colour, covered over with nets of black veins, and is attended with an aching pain in its inside. Suppuration is markedly absent or is seldom established in the swelling in this form of Galaganda. A vapid taste in the mouth, together with a feeling of parchedness of the throat and the palate, is the specific concomitant of the type of Goitre which has its seat in the deranged Kaphah. The swelling is felt cold and firm to the touch, and becomes heavy and glossy in this type of the disease. A sweet taste in the mouth, together with the feeling of a sticky mucous-deposit lying on the lining membranes of the throat and the palate, forms the specific features of the type of Goitre which is brought about through the agency of the deranged fat. The swelling, which is marked by the presence of'a little pain and an excessive itching sensation, becomes heavy, looks grey and glossy, and is found to be markedly slow in its growth and suppuration. It emits a kind of offensive smell and hangs down short-based from the neck (of the patient) like a pendent gourd, decreasing or increasing in size as the patient loses or gains flesh. The face of the patient looks glossy with a sort of oily deposit on the skin of the cheeks and forehead, and a sort of croaking sound is heard inside the body of the goitre. A patient with a goitre of more than a year’s growth and afflicted with dyspnœa, weakness, aphonia, looseness of the limbs and a distaste for food should be abandoned as beyond all cure.

Strings of glandular swellings to the size of Karkandhu or Jujube stones, and occurring about the arm pits, inguinal or submaxillary regions or about the nape of the neck etc., through the agency of the deranged fat and Kaphah are called Gandamalas. These swellings are found to be very slow of suppuration. The disease in which some of these glands are found to suppurate and to spontaneously burst and secrete their contents, immediately followed by fresh crops of such glandular swellings in the affected region is called Apachi (scrofula). Cases of scrofula in which the glandular swellings do not appear in strings^[1] are curable, while those in which the strings of glands are affected in succession and which exhibit the supervening symptoms of fever, cough, catarrh, pain at the sides pleuro-dynia), vomiting etc., baffle the ingenuity of even the best of physicians (Vaidyas.)

The morbific principles of the deranged Vayu etc., by vitiating the flesh, blood, tat and the vessels of the body, give-rise to isolated nodular swellings, winch are marked by their considerable elevation. These swellings are called Granthis. In the Vataja form of Granthi, the swelling seems as if it is being drawn about or burst open, or as if a scorpion has been stinging into it, or as if its contents are being churned about. It assumes a black colour and looks like an inflated bladder although fluctuating under pressure,^[2] and secretes, a kind of thin, transparent fluid, on bursting. In the Pittaja form of Granthi, the glandular swelling assumes a reddish or yellowish colour, and a variety of sucking, burning, tearing pain is felt in its inside. It secretes a thin, transparent, hot fluid on bursting. In the form of Granthi, which has its origin in the deranged Kaphah, the glandular swelling, becomes slightly painful and hard like a stone. It is marked by a greyish tint or by the absence of any colour at all. The specific itching sensation of the deranged Kaphah is experienced, and the swelling, which is remarkably slow in its growth and suppuration, secretes a kind of thick, cold, white discharge, on bursting. In the type of Granthi, which is due to the deranged condition of the bodily fat the swelling decreases or gains in size with the emaciation or fattening of the body of the patient. It looks glossy and large, marked by a little pain, and a considerable itching sensation and secretes a discharge of the colour of sesame-cake, on bursting. The deranged bodily Vayu, aggravated through over-fatiguing physical exercise and such like aggravating factors, finds lodgment in the veins and nerves, and gives rise to elevated nodular swellings by contracting, contorting (drawing up) and withering them up. Such swellings are called shiraja Granthis (varicose veins,. Neuroma) which happening to be shifting and painful, should be regarded as incurable. A varicose vein about any of the Marma Sthanas (described before), even if happening to be painless and non-shifting in its character, should be regarded as incurable.

The mobific principles of the deranged Vayu, Pittam, etc., by lying incarcerated in any part of the organism and by affecting the flesh and blood, give rise to firm, painless, round, large sized, short-based growths, which are very slow of growth and suppuration. These growths are found to be considerably deep-seated in the flesh of the affected region and are called tumours (Arvudas). The several types-of tumours recognised in practice have their respective seats in the deranged Vayu, Pittam, Kaphah, blood, flesh,, and fat, and the specific features of each of these types are identical with those of Granthis brought about through the agency of each of these morbific principles of the organism. Now hear me, O Sushruta, describe the symptoms of the types of tumours, which originate from a vitiated condition of the flesh and blood.

The deranged Pittam and vitiated blood, by drawing up and contracting the veins, give rise to a kind of tumours, which are marked by secretion and a partial suppuration. They are very rapid in their growth, and are found to constantly bleed. These tumours are called Raktarvudas. Jaundice results from constant bleeding in cases of Raktarvudas. The flesh of any part of the body, affected through the effect of a hurt or injury, produces a kind of firm (non-shifting), hard, glossy, painless, or slightly painful swelling (tumour) of the same colour with the surrounding skin which is marked by little or no suppuration. These tumours are called Mansarvudas. The exciting factor in all cases of Mansarvudas should be regarded as the deranged Vayu. A deep seated Mansarvuda appearing in persons, who are in the habit of taking meat diet, each day, through the vitiation of flesh, should be regarded as incurable. Even Mansarvudas of curable types appearing about any of the Marmas and marked by copious discharges, as well as those which are firm and crop up in any of the external ducts of the body, should be regarded as incurable. A tumour, which appears on a pre-existing one, is called Adhyarvudam by the wise. A tumour suddenly or gradually appearing on a pre-existing one through the agency of any two of the morbific principles of the body should be likewise regarded as beyond the province of medicine. Suppuration is never found to set in in tumours owing to the presence of excessive Kaphah or fat in their inside, as well as in consequence of the morbific principles of the organism continuing therein in an unresolvable condition.