Chapter CLXXXIX - The Nidanam of traumatic ulcers etc

Dhanvantari said:—Now hear me, O Sushruta, discourse on the Nidanam of Sadyo Vranas (traumatic ulcers). Wounds inflicted with weapons of variously shaped edges, necessarily assume a variety of shape. Wounds may be described as cut (Chhinna). Incised (Bhinna), Pierced (Viddha), Kshatam (ulcerated), Pichchhitam (thrashed) and Ghrisam (bruised or contused). Now hear me describe the characteristic features of each of them. A straight or oblique, extensive cut in which the local flesh is entirely cut away is called Chinna. A piercing of any of the chambers or viscera of the body with a fine-topped weapon of the nature of a spear, etc., furnishes the example of a pierced or incised (Bhinna) wound, which is usually found to be attended with a discharge. The stomach, the abdomen, the liver, the spleen, the heart, the urinary bladder, the kidneys, the lungs, and the cecum are called the Koshthas. A perforation of any of these Koshthas usually exhibits the following symptoms, viz., fever with a burning sensation in the body, hæmorrhage from the nose, mouth anus or the urethra, epileptic fits, dyspnœa, tympanites, with a disinclination to take any food, suppression of the stool urine and flatus, parchedness of the body even inspite of a copious perspiration, emission of an iron-like smell from the mouth, as well as of an offensive smell from the skin, and an aching pain at the sides and about the cardiac region. Now hear me describe the detailed and specific symptoms of perforation of each of the Koshthas. Vomiting of blood follows the accumulation of blood in the stomach, and an. excruciating colic and excessive distension of the abdomen are found to instantaneously supervene. Pain and heaviness of the limbs are developed when the blood is accumulated in the abdominal cavity, coldness of the lower extremities being one of its specific and distinctive traits. A wound caused by the piercing of a sharp-topped substance into any part of the body, whether with or without the piercing substance lying within its inside, is called a Biddha (pierced) wound. A wound, which is neither a cut nor an incision, but partakes of the nature of the both and whose cavity is of an irregular shape, is called a Kshata. Any part of the body thrashed with the underlying bones by beating, and becoming smeared with blood and marrow furnishes the examples of a Pichchhita (thrashed) wound. An abraded wound is called a Ghrishta Vrana. Secretion of hot serum and breaking of the local skin form its principal characteristics. A traumatic wound with any extrinsic matter (shalyam) lying imbedded in its cavity is marked by a swelling of tawny brown colour, studded over with pustular eruptions and constant bleeding and a pain about its seat, which becomes extremely sensitive and can not bear the least touch. A Shalyam (extrinsic matter), which is pierced into any of the aforesaid Koshthas of the body, by passing through the layers of the local skin, or through any of the local veins and arteries, produces symptoms that have been described before in this connection. A wise surgeon (Vaidya), having any regard to his professional good name, should not take in hand the treatment of a patient with a pierced Kostha, whose eyes have become blood-red, whose breath, face and extremities have become cold, whose complexion has assumed an ashy colour, and from the cavity of whose wound the piercing dart has not been extracted and the accumulated blood has not been let out. Vertigo, delirium, prostration, unconsciousness, languor, heat, looseness of the limbs, epileptic, fits, Urdhavata, pain and other distressing symptoms of the deranged Vayu, discharge of blood resembling the washings of meat, and cessation of all organic functions of the body are the general symptoms, which are exhibited in connection with perforation of any of the bodily Marmas. Ulcers produced through the agency of two of the morbific principles of the body, or brought about through the concerted action of all of them, exhibit symptoms which are respectively peculiar to each of them. Ulcers appearing in young persons of judicious and moderate habits and in a season of the year in which the morbific principles acting as their exciting factors are spontaneously aggravated, and occurring in parts of the body which are easily accessible, readily yield to medicinal treatment. Ulcers possessed of features other than the foregoing ones, are very hard to cure. Ulcers brought about through the concerted action of the three Doshas and attended with the abovesaid supervening distresses baffle all medicimal treatment. A putrid condition of the cavity of an ulcer, as well as a discharge of blood or pus from its inside, and exhalation of an offensive odours therefrom indicate that it is not yet asepsised. An ulcer whose cavity has assumed a tongue-like colour, studded over by healthy granulations, should be regarded as a cleansed (Shuddha) ulcer. An ulcer, which is marked by the absence of any discharge, and whose cavity has assumed a colour like that of a pigeon, and which has become firm, surrounded by crops of pustular eruptions, should be regarded as being granulating. Ulcers whose cavities have been entirely filled up and which are marked by the absence of any pain or swelling and whose cicatrixes have become of the same colour with the surrounding skin, should be regarded as healed up ulcers (Rudha Vranas). Ulcers appearing in lepers and in persons afflicted with diabetes or pthisis as well as in those suffering from the effects of any poison, or those which appear on pre-existing ulcers should be regarded as extremely hard to cure- An idiopathic ulcer(?) secreting a discharge of fat, clotted blood, or of marrow should be regarded as beyond all cure, whereas a traumatic ulcer attended with a similar discharge may prove amenable to medicine. Exhalation of a smell like that of wine, Eagle wood, clarified butter, Champaka or lotus flowers, or of any other celestial or fragrant smell from an ulcer indicate the impending death of the ulcer patient. In cases of piercing of the arteries the bleeding becomes excessive. The discharged blood has a colour like that of a cochineal insect and the deranged and aggravated Vayu of the incidental wound produces blindness, convulsions etc., Piercing of any ligament (Snaya) produces curvature or archedness of the affected part of the body, with a gone feeling in the limbs, loss of functions of the part of the ligament affected and an intolerable pain, the incidental wound taking a long time to be healed up. The piercing of any fixed or moving bone-joints of the body is followed by an excessive and extremely painful swelling about, and loss of function of, the affected joint. Whereas in a case of piercing of a bone-shaft the pain continues without respite during the whole day and night, and the patient fails to find relief in any posture whatsoever, Erysipelas, paralysis, stiffness and numbness of veins or arteries, convulsions, swooning, mania, fever with an excruciating pain in the wound, excessive thirst, paralysis, of the mandibles, cough, vomiting, dysentery, hic-cough, dyspnœa, and shivering are the sixteen distressing and dangerous concomitants of Sadyovranas.