अष्टमोऽध्यायः । अथातो मूढगर्भनिदानं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥
Now we shall discourse on the Nidana of Mudhagarbha (false presentations and difficult labour). 1
ग्राम्यधर्मयानवाहनाध्वगमनप्रस्खलनप्रपतनप्रपीडनधावनाभिघातविषमशयनासनोपवासवेगाभिघातातिरूक्षकटुतिक्तभोजनशोकातिक्षारसेवनातिसारवमनविरेचनप्रेङ्ङ्खोलनाजीर्णगर्भशातनप्रभृतिभिर्विशेषैर्बन्धनान्मुच्यते गर्भः, फलमिव वृन्तबन्धनादभिघातविशेषैः ।। २ ।।
Causes of Mudha-garbha: Sexual intercourse during pregnancy, riding on horseback, etc., or in any sort of conveyance, a long walk, a false step, a fall, pressure on the womb, running, a blow, sitting or lying down on an uneven ground, or in an uneven posture, fasting, voluntary repression of any natural urging of the body, partaking of extremely bitter, pungent, parchifying articles, eating in inordinate quantities of Sakas and alkaline substances, diarrohea (Atisara), use of emetics or purgatives, swinging in a swing or hammock, indigestion, and use of medicines which induce the labour pain or bring about abortions, and such like causes tend to expel the faetus from its fixture. These causes tend to sever the child from the uterine wall with its placental attachment owing to a kind of Abhighata (uterine contraction) just as a blow tends to sever a fruit from its pedicel. 2
सु० नि० स्था० 5
स विमुक्तबन्धनो गर्भाशयमतिक्रभ्य यकृत्प्लीहान्त्रविवरैरवस्त्रंसमानः कोष्ठसंक्षोभमापादयति । तस्या जठरसंक्षोभाद्वायुरपानोमूढः पार्श्वबस्तिशीर्षोदरयोनिशूलानाहमूत्रसङ्गानामन्यतममापाद्य गर्भं व्यापादयति तरुणं शोणितस्रावेण । तमेव कदाचिद् विवृद्धमसम्यगागतमपत्यपथमनुप्राप्तमनिरस्यमानम् अपानवैगुण्यसम्मोहितं गर्भं मूढगर्भमित्या-चक्षते।।३।।
Definition : The faetus, thus severed and dislodged from its seat, leaves the uterus and getting down through the space between the liver, spleen and the intestines, produces irritation in the abdomen (Kostha). The Apana Vayu thus obstructed through the spasmodic contraction of her abdomen, produces any of the following symptoms, viz., a sort of spasmodic pain in the sides, or in the neck of the bladder, or in the pelvic cavity, or in the abdomen, or in the vagina, or Anaha (tympanites with obstruction, etc.) or retention of urine. and destroys the faetus, if immature, attended with bleeding. In case the faetus continues to develop and is brought in an inverted posture at the entrance to the vaginal canal, and is impacted at that place, or if the Apana Vayu gets disordered and consequently cannot help the expulsion of the same, such an obstructed faetus is called Mudha garbha. 3
ततः संकीलः प्रतिखुरो बीजकः परिघ इति । तत्र, ऊर्ध्वबाहुशिरः पादो यो योनिमुखं निरुणद्धि कील इव स कील:; निःसतहस्तपादशिराः कायसङ्गी प्रतिखुरः; यो निर्गच्छत्येकशिरोभुजः स बीजक:; यस्तु परिघ इव योनिमुखमावृत्य तिष्ठेत् स परिघ:; इति चतुर्विधो भवतीत्येके भाषन्ते । तत्तु न सम्यक्; कस्मात् ? स यदा विगुणानिलप्रपीडितोऽपत्यपथमनेकधा प्रतिपद्यते, तदा संख्या हीयते । तत्र, कश्चिद्द्वाभ्यां सक्थिभ्यां योनिमुखं प्रतिपद्यते; कश्चिदाभुग्नैकसविथरेकेन; कश्चिदाभुग्नसक्थिशरीरः स्फिग्देशेन तिर्यगागतः; कश्चिदुरः पार्श्वपृष्ठानामन्यतमेन योनिद्वारं पिधायावतिष्ठते; अन्तः पार्वापवृत्तशिराः कश्चिदेकेन बाहुना; कश्चिदाभुग्नशिरा बाहुद्वयेन; कश्चिदाभुग्नमध्यो हस्तपादशिरोभिः; कश्चिदेकेन सक्थ्ना योनिमुखं प्रतिपद्यतेऽपरेण `पायुम्; इत्यष्टविधा मूढगर्भगतिरुद्दिष्टा समासेन । तत्र द्वावन्त्यावसाध्यौ मूढगर्भी, शेषानपि विपरीतेन्द्रियार्थाक्षेपकयोनिभ्रंश- संवरणमक्कल्लश्वासकासभ्रमनिपीडितान् परिहरेत् ।। ४ ।।
Classification and Symptoms : Cases of Mudha-garbha may be roughly divided into four different classes such as the Kila, the Pratikhura, the Bijaka and the Parigha. The sort of false presentation in which the child comes with its hands, legs and head turned upward and with its back firmly obstructed at the entrance to the vagina, like a stake or a kila, is called Kilah. The sort of presentation, in which the hands, feet and head of the child come out, with its body impacted at the entrance to the vagina, is called Prathikhura. The type in which only a single hand and the head of the child come out (with the rest of its body obstructed at the same place), is called the Bijaka. The type in which the child remains obstructing the head of the passage in a horizontal position, like a bolt, is called the Parigha. Certain authorities aver that, these are the only four kinds of Mudhagarbha. But we can not subscribe to the opinion (which recognises only four kinds of false presentations), inasmuch as the deranged Vayu (Apana) can present the faetus in various different postures at the head of the vaginal canal. Sometimes, the two thighs of the child are first presented, and sometimes it comes with a single leg flexed up. Sometimes the child comes with its body, bent double, and thighs drawn up, so that only breech is obliquely presented. Sometimes the child is presented, impacted at the head of the passage with its chest, or sides, or back. Sometimes the child is presented with its arm around its head, resting on the side, and the hand coming out first. Sometimes only the two hands are first presented, the head leaning on one side; sometimes the two hands, legs and the head of the child, the rest of the body being impacted at the exit in a doubled up posture. Some times one leg is presented, the other thigh being impacted at the passage (Payu). I have briefly described these eight sorts of presentation of which the last two are irremediable. The rest should be given up as hopeless if these are attended with the following complications viz., deranged senseperception of the mother, convulsions, displacement or contraction of the reproductive organ (yoni) a peculiar pain like the after-pain of child birth, cough, difficult respiration, or vertigo. 4
भवन्ति चात्र | कालस्य परिणामेन मुक्तं वृन्ताद्यथा फलम् । प्रपद्यते स्वभावेन नान्यथा पतितुं ध्रुवम् ॥ ५ ॥
एवं कालप्रकर्षेण मुक्तो नाडीनिबन्धनात्। गर्भाशयस्थो यो गर्भो जननाय प्रपद्यते ।। ६ ।।
कृमिवाताभिघातैस्तु तदेवोपद्रुतं फलम् । पत्यकालेऽपि यथा तथा स्याद् गर्भविच्युतिः ।। ७ ।।
आचतुर्थात् ततो मसात् प्रस्रवेद् गर्भविच्युतिः । ततः स्थिरशरीरस्य पातः पञ्चमषष्ठयोः ।। ८ ।।
Memorial verses : As a fruit, fully matured, is naturally severed from its pedicel and falls to the ground and not otherwise, so the cord, which binds the foetus to its maternal part, is severed in course of time, and the child comes out of the uterus (into this world of action). On the other hand, as fruit, worm-eaten or shaken by the wind or a blow, untimely falls to the ground, so a foetus will be expelled out of its mother’s womb, before its time. For four months after the date of fecundation, the faetus remains in a liquid state, and hence its destruction or coming out of the womb termed by the name of abortion. In the course of the fifth and sixth months the limbs of the foetus gain firmness and density, and hence, its coming out at such a time is called miscarriage. 5-8
प्रविध्यति शिरो या तु शीताङ्गी निरपत्रपा । नीलोद्धतसिरा हन्ति सा गर्भ स च तां तथा ।। ९ ।।
गर्भास्पन्दनमावीनां प्रणाश: श्यावपाण्डुता । भवत्युच्छ्वासपूतित्वं शूलञ्चान्तर्मृते शिशौ ।। १० ।।
Prognosis: The enceinte who violently tosses her head in agony (at the time of parturition) and the surface of whose body becomes cold, compelling her to forego all natural modesty, and whose sides and abdomen are covered with nets of large blue-coloured veins, invariably dies with the dead child locked in her womb. The death of the foetus in the womb may be ascertained by the absence of movements of the foetus (in the womb) or of any pain of child-birth, by a brown or yellow complexion of the enceinta, cadeverous smell in her breath,
and colic pain in the abdomen and its distension owing to the continuance of the swollen and decomposed child in the womb. 9-10
प्रपीडितः । मानसागन्तुभिर्मातुरुपतापैः गर्भो व्यापद्यते कुक्षौ व्याधिभिश्च प्रपीडितः ।। ११ ।।
बस्तमारविपन्नायाः कुक्षिः प्रस्पन्दते यदि । तत्क्षणाज्जन्मकाले तत् पटियित्वोद्धरेद् भिषक् ॥ १२ ॥
The death of a child in the womb may result from some emotional disturbance of its mother, (such as caused by bereavement or by loss of fortune during pregnancy); while an external blow or injury (to the womb) or any serious disease of the mother may also produce the like result. A child, moving in the womb of a dead mother, who had just expired (from convulsions etc.) during parturition at term, like a goat (Bastamara) should be removed immediately by the surgeon from the womb (by Caesarean Section);¹ as a delay in extracting the child may lead to its death. 11-12, 1. Caesarean Section means incision of the uterus through the abdominal walls and extrication of the foetus there from. Operation like this upon a dead subject requires no skill of a surgeon. Any one can do it without the help of any anatomical knowledge. In modern times, when the mother’s life is in peril, and the expulsion of the foetus becomes nearly impossible, by the natural passage, owing to an existence of deformity either in the parturient canal or in the forms and structures of the foetus, to save both mother and child this operation is principally undertaken.
The evidence of similar attempts, in ancient India, is found recorded in passages like what we have just translated and that the operation was practised on living subjects, there is not the least doubt about it. This custom is still preserved in Central Africa, and it is possi that the Egyptians like Hindu philosophy and religion learnt this also from the Hindus. “Felkin”, says “Baas in his History of Medicine p. 70 “saw a case of the Caesarean operation in Central Africa performed by a man. At one stroke an incision was made through both the abdominal walls and the uterus. The opening in the latter organ was then enlarged, the haemorrhage checked by the actual cautery, and the child removed. While an assistant compressed the abdomen, the operator then removed the placenta. The bleeding from the abdominal walls was then checked. No sutures were placed on the walls of the uterus but the abdominal parietes were fastened together by seven figure-of-eight sutures, formed with polished iron needles and threads of bark. The wound was then dressed with a paste prepared from various roots, the woman placed quietly upon her abdomen, in order to favour perfect drainage, and the task of the African Spencer Wells was finished. It appears that the patient was first rendered half unconscious with banana wine. One hour after the operation the patient was doing
Additional Text: The bladder is ruptured, the dead child lies like a weight upon the placenta and is pressed upward on the spleen, liver and gall bladder. The mother shivers and is oppressed with tremor, dryness of the tongue, dyspnoea and perspiration. She complains of a cadaverous smell in her breath and stands in danger of imminent
well. And her temperature never rose above 101 F. nor her pulse above 108. On the eleventh day the wound was completely healed, and the woman apparently as well as usual.
When we read this evidence of Felkin, we are reminded of the operative steps as described in our own ancient book of Surgery from which modern surgeons have been able to borrow the operation of rhinoplasty. It is a great pity that while in Africa the same practice is still retained infact, we in India by spurious attempts and disgraceful contortions, substitutions of false readings and dismal knowledge of grammar and rhetoric try to prove in the face of strong evidence that in ancient India Caesarean Section was attempted only on cases where one might not perspire.”
If we take faya: in the sense of a woman whose life is in great danger” and not exactly in the sense of a woman who is dead” as recommended by Dalhana and Arunadutta (and which might have been the meaning if instead of fa a word like had been used in the text), we find at once that Weber’s remark in his History of Indian Literature p. 270 “that in Surgery they (the Hindus) attained to high proficiency’ is not based on the solitary evidence of rhinoplasty alone.
= In performing obstetric operations with success examples like this are not rare. If the two different readings and af be taken conjointly into consideration we are impressed with the idea that in ancient India Caesarean operations were very frequently undertaken in cases of puerperal eclampsia, where the mother had been in the deplorable condition of a goat suffering from cramps and convulsions as well as in cases of an accidental death not unlike that which fell to the lot of the poor mother of him in whose name the operation is called. = goat HR destroyer (See Monier William’s Dictionary) hence a goat-destroyer a tiger or wolf or in cases where the presence of deformity in the parturient canal or of malformation of the foetus prevented the natural delivery of a living child. The incision is not to be made anywhere else but exactly in the place where Felkin saw the illiterate Negro successfully apply his knife, the selection of afd grodas suggested by some commentators being a tempest on a tea pot especially when the subject is beyond the grave. In a living subject the selection of a proper site for the operation is of course very commendable. Hence we venture to suggest that extraction of the living foetus from the womb by making incision through this part of the pelvis was also attempted later on. We extract here the two different readings and leave our readers to judge whether we are correct to draw the above inferences. By these symptoms a physician shall know the death of the child in the womb. This portion is partly recognised by Brahmadeva and is totally rejected by Jejjatacarya as spurious.
इति सुश्रुतसंहितायां निदानस्थाने मूढगर्भनिदानं नामाष्टमोऽध्यायः ।। ८ ।।
Thus ends the eighth Chapter of the Nidana Sthana in the Susruta Samhita, which treats of Nidana of difficult labour and false presentations.