अथातः शस्त्रावचारणीयमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥१॥
Now we shall discuss the Chapter which treats of instruments used in connection with a surgical operation. (Sastravacaraniya adhyaya). 1
विंशतिः शस्त्राणि । तद्यथा- मण्डलाग्रकरपत्रवृद्धिपत्रनखशस्त्र – मुद्रिकोत्पलपत्रकार्द्धधार- सूची – कुशपत्राटीमुखशरारिमुखान्तर्मुखत्रिकूर्चक- कुठारिका – व्रीहिमुखारावेतसपत्रक – बडिश – दन्तशङ्क्वेषण्य इति ॥ २॥ –
These instruments are twenty in number such as, the Mandalagra, the Karapatra, the Vrddhipatra, the Nakhasastra, the Mudrika, the Utpalapatra, the Arddhadhara, the Suci, the Kusapatra, the Atimukha, the Sararimukha, the Antarmukha, the Trikurcaka, the Kutharika, the Vrihimukha, the ara, the Vetasapatraka, the Badisa, the Dantasanku, and the Esani.’ 2
1. The Mandalagra measures six fingers in length and is provided with a round or circular face. The Karapatram is the same as the modern saw. The term Vrddhipatra signifies a razor. A Vrddhipatra measures seven fingers in length, the handle alone measuring five fingers. The Nakhasastra is the same as the modern nail-clipper, the blade of the instrument measuring a finger in breadth. The Utpalapatra resembles a lotus leaf in shape. The Arddhadhara (lancet) measures eight fingers’ breadth in length, being one finger broad at the middle.
तत्र मण्डलाग्रकरपत्रे स्यातां छेदने लेखने च वृद्धिपत्रनखशस्त्रमुद्रिकोत्पलपत्रकार्द्धधाराणि छेदने भेदने च । सूचीकुशपत्राटीमुखशरारिमुखान्तर्मुखत्रिकूर्च्चकानि विस्रावणे कुठारिकाव्रीहिमुखारावेतसपत्रकाणि व्यघने सूची च। बडिशं दन्तशङ्कुश्चाहरणे । एषण्यैषणे आनुलोम्ये च । सूच्यः सेवने । इत्यष्टविधे कर्म्मण्युपयोगः शस्त्राणां व्याख्यातः ॥३॥
Of the abovesaid instruments the Mandalagra and the Karapatra should be used in incising and scraping. The Vrddhipatra, the Nakhasastra, the Mudrika, the Utpalapatraka, and the Arddhadhara, should be employed in incising (Chedana) and excising (Bhedana); and the Kusapatra, the Suci, the Atimukha, the Sararimukha, the Trikurcaka and the Antarmukha should be made use of in exudating or secreting (Visravana). The Kutharika, the Vrihimukha, the Ara, the Vetasapatraka and the Suci (needle) should be used in puncturing. The Badisa and the Danta-Sanku should be used in extracting solid bodies. The Esani (probe or director) in probing or searching the course or and two fingers at the blade. The Suci is the same as the modern needle. The Kusapatra is so called from its resemblance to the blade of a Kusa grass. An Atimukha resembles the bill of a bird of the Ati species. The blade of an Atimukha measures two finguers in length, the handle measuring five fingers and thus giving an entire length of seven fingers. The Sararimukha (scissors) is so-called from the resemblance of its blades to the bills of a Sarari bird and looks somewhat like a modern black-smith’s clipper, the measure of its entire length being twelve fingers. The Antarmukha is semicircular in shape and is provided with a toothed edge like that of a hand-saw. The Trikurcaka (trocar) is provided with three separate blades. The intervening space between the couple of blades attached to a handle measuring five fingers in length, is equal to the width of a Vrihiseed. Its entire length being eight fingers.
The kutharika (small, blunt axe) measures seven fingers and a halt in the handle. the blade is half a finger in width and is blunted like the tooth of a cow. The Vrihimukha measures six fingers in its entire length and its top is like that of a Vrihi seed, and the edge is cut into small thorn-like projections. The Ara resembles the awl of a cobbler and measures ten fingers in its entire length, the blade is wide as the seed of a seasamum and has the girth of a Durva (grass) stem. The Vetasapatram (knife) resembles the leaf of a Vetasa plant. The blade is four fingers in length, one finger in width, and is keenly edged, the handle measuring four fingers in length. The Badisa is shaped like a modern fishing hook. The Danta-sanku (pincers for extracting teeth) somewhhat resembles the Vrihimukham in shape. The face of an Esani (probe) is like that of a Gandupada (earth-worm).
direction of the pus (in a suppurated part), and the Suci (needle) should be used in suturing. Thus we have explained the eight different functions of the instruments in connection with surgical operations. 3
तेषामथ यथायोगग्रहणसमासोपायः कर्म्मसु वक्ष्यते । तत्र वृद्धिपत्रं वृन्तफलसाधारणे भागे गृह्णीयाद् भेदनान्येवं सर्व्वाणि वृद्धिपत्रं मण्डलाग्रञ्च किञ्चिदुत्तानपाणिना लेखने बहुशोऽवचार्य्यम् । वृन्ताग्रे विस्रावणानि। विशेषेण तु बालवृद्धसुकुमारभीरुनारीणां राज्ञां राजपुत्राणाञ्च त्रिकूर्च्चकेन विस्रावयेत् । तलप्रच्छादितवृन्तमङ्गुष्ठप्रदेशिनीभ्यां व्रीहिमुखम् । कुठारिकां वामहस्तन्यस्तामितरहस्तमध्यमाङ्गुल्याऽङ्गुष्ठविष्टब्धयाऽभिहन्यात् । आराकरपत्रैषण्यो मूले। शेषाणि तु यथायोगं गृह्णीयात् ॥४॥
Now we shall deal with the mode of handling the abovesaid instruments. The Vrddhipatra and other instruments for excising (Bhedana) should be caught hold of at a part between the blade and the handle. In acts of scraping the Vrddhipatra and the Mandalagra should be handled with the palm of the hand slightly turned up. The instruments for secreting should be caught hold of at the roots of their blades at the time of using them, while in the case of a king, an old man a timid or a delicate person, a child, a woman and specially in the case of a prince of the royal blood, the Trikurcaka should be used when any secreting or exudating operation would be necessary. The handle of a Vrihimukha should be kept concealed within the palm of the hand and the blade should be caught hold of with the thumb and the index finger (Pradesini). The Kutharika should be first supported on the left hand and then struck with the thumb and third finger of the right. The Ara, the Karapatra and the Esani, should be caught hold of at their roots. The rest of the surgical instruments should be grappled according to requirements. 4
तेषां नामभिरेवाकृतयः प्रायेण व्याख्याताः । तत्र नखशस्त्रैषण्यावष्टाङ्गुले, सूच्यो वक्ष्यन्ते । (प्रदेशिन्यग्रपर्व्वप्रदेशप्रमाणा मुद्रिका | दशाङ्गुला शरारिमुखी, सा च कर्त्तरीति कथ्यते ।) शेषाणि तु षडङ्गुलानि ॥५॥
The abovesaid instruments are shaped like things which their very names imply, as have been already described. The Nakasastra and the Esani measure eight fingers in length. The Suci (needle) shall be described later on. The top-ends of the Badisa and the Danta-Sanku (Dental pincers) are a little bent down and their faces are made to resemble sharp thorns, or the newly sprouted leaves of a barley plant. The top-end of an Esani closely resembles the mouth of an earthworm. The length of a Mudrika should be made equal to that of the top phalanges of the index finger (of a man of average height.) A Sararimukhi measures ten fingers in length. The rest of the instruments are mostly made to measure six fingers in length. 5
तानि सुग्रहाणि, सुलोहानि, सुधाराणि, सुरूपाणि, सुसमाहितमुखाग्राणि, अकरालानि, चेति शस्त्रसम्पत् ॥६॥
Commendable features in a Surgical instrument: Instruments that are fitted with handles of easy grip and are made of good and pure iron, well shaped, sharp, and are set with edges that are not jagged and end in well formed points or tops, should be deemed as the best of their kind. 6
तत्र वक्रं, कुण्ठं, खण्डं, खरधारमतिस्थूलमत्यल्पमतिदीर्घमतिह्रस्वमित्यष्टौ शस्त्रदोषाः । अतो विपरीतगुणमाददीत, अन्यत्र करपत्रात्; तद्धि खरधारमस्थिच्छेदनार्थम् ॥७॥
Curvature, bluntness (Kuntha-lit: incapable of cutting hair), unequal sharpness of the edge, rough-edgedness, over-thickness, over-thinness, over-lengthiness, and over-shortness are the defective traits in a surgical instrument. Those possessed of contrary features should be used. But a Karapatra set with a very rough (dentated) edge may be used for the purspose of sawing the bones. 7
तत्र धारा भेदनानां मासूरी, लेखनानामर्द्धमासूरी, व्यधनानां विसावणानाञ्च कैशिकी, छेदनानामर्द्धकैशिकीति । बडिशं दन्तशङ्कुश्चानताग्रे। तीक्ष्णकण्टकप्रथमयवपत्रमुख्येषणी गण्डुपदाकारमुखी च ॥८॥
A surgical instrument meant for excision (Bhedana) should be set with an edge as thin as that of a Musura pulse (lentil seed), while an instrument used in scraping should be set with an edge half as thin as that of the former. An instrument used either in connection with the measures of secretion or cutting by uplifting (Vyadhana) should be set with an edge as fine as the human hair, while an instrument of incision should have an edge half as thin as that of the former. Hook and tooth scater should be frontly bending. Three types of probe director are first one being like the face of a shorp thorn, second one being like newly grown leaf of barley and third one being like the form and face of a round worm. 8
तेषां पायना त्रिविधा क्षारोदकतैलेषु । तत्र क्षारपायितं शरशल्यास्थिच्छेदनेषु । उदकपायितं मांसच्छेदनभेदनपाटनेषु । तैलपायितं सिराव्यधनस्नायुच्छेदनेषु । तेषां निशाणार्थं श्लक्ष्णशिला माषवर्णा, धारासंस्थापनार्थं शाल्मलीफलकमिति ॥९॥
Surgical instruments should be tempered with one of the three substances such as, alkali, water, and oil. Instruments used in cutting an arrow, a bone, or any foreign matter (Salya) pricked into the human body, should be tempered with alkali, whereas those that are made use of in cutting, cleaving, and lopping off the flesh (from an affected part), should be tempered with water. Instruments used in opening (Vyadhana) a vein (Sira) or in cutting open a nerve (Snayu) should be tempered with oil, and should be whetted upon a species of stone- slab resembling a Masa pulse in colour, and their set-edge should be protected by putting it in a sheath made of Salmali wood. 9
भवति चात्र ।
यदा सुनिशितं शस्त्रं रोमच्छेदि सुसंस्थितम् । सुगृहीतं प्रमाणेन तदा कर्म्मसु योजयेत् ॥ १० ॥
Authoritative verses on the subject: An instrument, wellground, well-shaped, fitted with a convenient handle and capable of (laterally) cutting a hare in two and made according to measures laid down in the Sastras, should be alone used in a surgical operation. 10
अनुशस्त्राणि तु त्वक्सारस्फटिककाचकुरुविन्दजलौकोऽग्निक्षारनखगोजीशेफालिकाशाकपत्रकरीरबालाङ्गलय इति ॥ ११ ॥
The Inferior or substitutive instruments (the Anu-Sastras) : The skin of bamboos, crystals, bits of glass, Kuruvindas (a sort of Vol. 1-5 crystal) leeches, fire, alkali, nails, the leaves of trees known as Goji, Sephalika, Sakapatra and Karira the tender sprouts of corn, hair, and the fingers, should be included within the category of the minor instruments of surgery and (which may be used in certain instances in substitution for the principal and usual ones.) 11
शिशूनां शस्त्रभीरूणां शस्त्राभावे च योजयेत् । त्वक्सारादिचतुर्व्वर्ग छेद्ये भेद्ये च बुद्धिमान् ।। १२ ।।
आहार्य्यच्छेद्यभेद्येषु नखं शक्येषु योजयेत् । विधिः प्रवक्ष्यते पश्चात् क्षारवह्निजलौकसाम् ।।१३।।
ये स्युर्मुखगता रोगा नेत्रवर्त्मगताश्च ये। गोजीशेफालिकाशाकपत्रैर्विस्रावयेत्तु तान्। एष्येष्वेषण्यलाभे तु बालाङ्गुल्यङ्कुरा हिताः ||१४ ।।
शस्त्राण्येतानि मतिमान् शुद्धशैक्यायसानि तु । कारयेत् करणप्राप्तं कर्म्मारं कर्म्मकोविदम् ।। १५ ।।
प्रयोगज्ञस्य वैद्यस्य सिद्धिर्भवति नित्यशः । तस्मात् परिचयः कार्य्यः शस्त्राणां ग्रहणे सदा ।।१६।।
Metrical texts: The four articles such as strips of bamboo skin, crystals, bits of glass, and the rock known as Kuruvinda, should be used by an intelligent physician in Incising or excising (Bhedana) operations, where the patient would be found to have a dread of the knife, or too young to be surgically operated upon with it, or where the proper instrument cannot be procured. The nails of fingers should be used in operations of incising, excising or extracting in (substitution for the instruments enjoined to be used for the purpose), when such a course would appear feasible. The processes of applying alkalis, leeches and cauterisation will be dealt with later on. In diseases affecting the eyelids or the cavity of the mouth, operations for the purposes of secreting or evacuating (the accumulated pus or phlegm), may be performed with the leaves of Sakapatra, Sephalika or Gojis. In the absence of a probe or director, searching may be done with the help of a finger, or with a hair, or with a corn sprout. An intelligent physician should deem it his imperative duty to get his surgical instruments made by a skilful and experienced blacksmith, and of pure, strong and sharp iron ( steel). A physician, skilled in the art of using surgical instruments, is always successful in his professional practice, and hence the practice of surgery should be commenced at the very outset of medical studies. 12-16
इति सुश्रुतसंहितायां सूत्रस्थाने शस्त्रावचारणीयो नामाष्टमोऽध्यायः ॥८॥
Thus ends the eighth chapter of the Sutrasthana in the Susruta Samhita which treats of Surgical Instruments.
