Pramāṇa · Search · About · API

History of Technology in India, Vol. I: From Antiquity to c. 1200 A.D. v1.c21.s4.t3: Methods of treatment for piles and fistula-in-ano

History of Technology in India, Vol. I: From Antiquity to c. 1200 A.D. v1.c21.s4.t3

Language
English

Methods of treatment for piles and fistula-in-ano

v1.c21.s4.t3.1

There are four methods of treatment for piles. They are medicinal treatment, caustics, fire or cautery and surgery. Out of them, the piles which have a narrow pedicle, are projecting and moist should be treated by surgery. The soft, extensive, deeply situated and projecting ones are curable by caustic treatments while rough, firm, thick and hard ones are curable by fire cautery.

v1.c21.s4.t3.2

Technique

v1.c21.s4.t3.3

*Surgical operation* - A large pile mass having a narrow pedicle, moist and projecting, should be treated by surgery.

v1.c21.s4.t3.4

*Pre-operative* - The patient suffering from piles should be oleated and sudated. He should then be made to sit in a covered and clear place in modern climatic condition, on a clear sky day and on a flat plank or on a bed. The anus should face towards the sun with the patient in the supine position, and the upper part of his body held in someone else’s lap.

v1.c21.s4.t3.5

The waist should be raised a little higher. The neck and the legs should be fixed firmly by a strap and held firmly by assistants. Thereafter, his anus should be lubricated with *ghṛta* (clarified butter) and a sterilized well lubricated rectal speculum should be introduced in the rectum along its passage slowly while the patient is straining.

v1.c21.s4.t3.6

Thus, the piles should be visualised and examined properly by the surgeon and the projecting pile mass should be clipped off with a knife and cauterized with fire to prevent bleeding. Thereafter, the pile mass should be mollified by the application of *ghṛta* mixed with *madhuka* and the instrument should then be taken out.

v1.c21.s4.t3.7

*Post-operative* - Following the surgical operation, the patient should be made to get up and sit in warm water, whereas cold water should be sprinkled over him. He should then be taken into a room for post operative care with proper instructions.

v1.c21.s4.t3.8

Technique of caustic application (Kṣāra)

v1.c21.s4.t3.9

Following the pre-operative procedure as mentioned earlier adopted in the surgical operation, the pile mass should be pressed by a probe, wiped with a piece of cotton swab or a piece of cloth, caustic (Kṣāra) should be applied on it. Following this application of caustic, the opening of the instrument should be covered by the hand of the surgeon and should let it remain until the counting of one hundred (approximately one minute). Then after wiping, the caustic may be applied again, taking into consideration the strength of caustic as well as the severity of the disease. The application of the caustic should be stopped when the piles show the color of a ripe *jambu* fruit (Bluish black) and get depressed and shrivelled. Thereafter, the caustic should be washed away by sour gruel, curd, butter milk, vinegar or by the juice of citrous fruits. Then the pile mass should be mollified by the application of *ghṛta* or any medicated soothing oil and the instrument should then be taken out.

v1.c21.s4.t3.10

The post-operative management of the patient should be maintained as described earlier. The remaining pile masses may be treated one by one at intervals of a week each. In case of multiple piles the right one should be handled first; after the right, the left one and after the left the posterior one; lastly the anterior one should be treated in the same fashion. The post- operative management and the dietary regimen should be according to the instructions mentioned by Suśruta.

v1.c21.s4.t3.11

Fistula-in-ano (Bhagandara)

v1.c21.s4.t3.12

*Surgical technique (General)*: The patient should be soothed by the application of medicated oil and his body should be fomented by immersing him in a receptacle of warm water. He should be put on a bed, positioned as described for the treatment of piles. The surgeon should examine closely as to where the mouth of the fistula is directed, outward or inward. Then a probe should be introduced carefully while the patient is straining and the fistulous opening located, raised on a probe, and cut by the knife; or else fire cautery or caustics should be used after proper assessment. This is the general surgical treatment for all types of fistulae.

v1.c21.s4.t3.13

*Specific Treatment (Surgical)*: In cases of the *Śataponaka* type of fistula, the surgeon should connect one fistulous track with another by incising the tissues in between. External fistulae interconnected with one another should be excised separately (not all together). Thus, in a case of *Śataponaka* fistula (fistula having multiple openings), the wound should not be opened wide.

v1.c21.s4.t3.14

*Types of Incisions for Śataponaka Fistula*: In a case of aforesaid fistula, the wise surgeon should make *Laṅgalaka* (Plough or T-shaped), *Ardha-laṅgalaka* (T or T like), *Sarvatobhadra* (circular), or *Gotirthaka* (semicircular) types of incisions.

v1.c21.s4.t3.15

An incision equal to both sides is known ‘*Laṅgalaka*’; while an incision with one short arm is called *Ardhalangalaka*. An incision encircling the anus except the perineal raphe is known as *Sarvatobhadraka*. An incision made by introducing the knife from one side called ‘*Gotirthaka*’.

v1.c21.s4.t3.16

All discharging passages should be cauterized by the fire cautery by the surgeon. The *Śataponaka* type of fistula is difficult to treat in the delicate and the timid.

v1.c21.s4.t3.17

Post-operative management should be carried out precisely mentioned by Susruta in each type of fistula accordingly. There are five types of fistulae and each of them has its specific management which should be referred to the Suśruta Samhita.

v1.c21.s4.t3.18

*Kṣāra-Sūtra* (thread prepared by alkalies): The application of *Kṣāra-sūtra* in cases of fistula-in-ano has commanded wide reputation and W.H.O. has extended recognition to it, considering its supremacy as well as the most simple technique. The chances of recurrences are rare. The patient can carry on his usual duties following the application of this medicated thread without any problem.

v1.c21.s4.t3.19

Preparation of alkali thread or *Kṣāra-sūtra* - Surgical linen thread size 20 may generally be used for this purpose. This thread is impregnated into the lotion of (*haridrā*) turmeric. Then the latex of *Snuhi* is being applied on the thread and number of coating be done to enhance the activity of the thread. It should be used as fresh prepared or it can be stored carefully keeping away from the moisture. The alkali thread prepared from *Apamārga* and *Ark* may also be used.

v1.c21.s4.t3.20

*Technique* - This prepared thread should be used through a specifically designed smooth, curved needle from the external opening of the fistula and should be taken out through the internal opening of the fistulous track. The surgeon should guard the needle putting his finger in the rectum to protect the rupture of the rectal wall. Then the thread should be knotted moderately and the dressing with *ghṛta* or medicated oil be done. The thread should be changed weekly till the fistulous track is completely excised. This technique is universally appreciated and adopted. This Kṣāra-sūtra is being made available in the market in the sealed tubes.

Cites (1)