Indian Medicine (Medicin), translated by C. G. Kashikar c12.50

c12.50

For stone and lithuresis many authors like Vṛnda 34, Vang 506-516 prescribe various decoctions, powders, solutions in ghee and oil and the like which, taken internally, dissipate or dissolve the stone. Bhāv 2.357 speaks only in short about the extracting with a hook of a stone which could not be cured by medicines and injections in the urethra. Car 6.26.40 mentions along with other medicines a drink that cures the stone "in case a surgeon does not extract it". Cf also Hārīta 639,317. According to Cakra 223, if the stone is not cured by medicines, a surgeon (śalyavid, sastrakarmavid) should press it down in order to bring it between the anus and the urethra with two fingers inserted in the anus, then should make a cut to the left side at a distance of a barley-corn from the scrotum and should remove the stone. If unfortunately he cuts the bladder without bringing out the stone, the patient dies. He must remove the stone completely and must remove the blood from the bladder. When the stone is removed, he lets the patient bathe in warm water, anoints the wound with honey and butter and gives him sugar to eat in order to purify the urine, then a drink with urine-purifying substances for three days, rice with milk upto the 10th day, then perspiring remedy, then washing and anointing the wound. If it is not cured after 10 days, it is cauterized. If unfortunately the stone remains stuck to the navel (?), the navel is cut and the stone is extracted out. Exhaustive descriptions of important stone operations are given in Su 4.7; AS 4.13; AHr 4.11. The stone-disease is a dangerous ailment comparable to the god of death. It can be cured by medicines in the beginning; in a later stage an operation is needed. Since, however, even an expert surgeon is apt to make a mistake, permission must first be obtained from the king before undertaking the same. During the operation the patient should take support of a strong man. The patient should be seated on a bench and should be fast tied to the same with cords or ties. The entire region around and beneath the navel should be rubbed and should be kneaded with the fist until the stone comes down. When the stone is brought beneath the navel, the surgeon should insert the forefinger and middlefinger of the left hand smeared with oil and nails cut, in the anus of the patient along the perineum until he feels the stone, should bring it between the anus and the urethra and press on it, until it is prominent as a growth. If the patient faints during this procedure, the operation should be given up on account of the risk of life. Otherwise an incision should then be taken with a knife on the left side, a barley-corn farther from the scrotum, in certain conditions on the right side, corresponding to the size of the stone. The stone should not be dissipated or broken, lest the small remainders might grow again; so one must remove it completely with a hooklike instrument (agravaktra). In women the uterus lies close to the bladder; therefore, one must take no incision in the womb, as it would cause a wound-canal (fistula) carrying the urine outside. In men also the urine comes out if the urethra is cut. Other wounds can lead to death or impotence. A single incision of the bladder heals up again; the wound is to be treated as described by Cakradatta (see above); eventually it is to be burnt out after 7 days. If a stone or lithuresis develops in the urethra, one should try to wash it out with the urine. If it does not go out, one should take an incision with a knife and extract it out with a hook. The operated person must avoid for one year after healing riding on a horse or an elephant, travelling in a carriage, swimming, climbing up a hill or a tree, eating heavy food and intercourse with women.