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Indian Medicine (Medicin), translated by C. G. Kashikar c13: VI. External Diseases

Indian Medicine (Medicin), translated by C. G. Kashikar c13

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VI. External Diseases

c13.1

§ 66. Small-pox¹:— Small-pox does not occur in the Atharvaveda and the Bower MS. Su, AS, AHr and even Sārngadhara mention it only under smaller ailments (kṣudraroga) which are mostly skin-diseases. Caraka passes it over in his enumeration of diseases (1. 19) and mentions it only briefly along with measles as an eruption on the whole body that is to be treated like St. Anthony's fire and leprosy (6.12). It is called masūrikā, masūri, "lentil-disease" of the form of pustules. Thus Vāgbhaṭa says (AS 6.36; 3.15 = AHr 6.31.8) : "( Small-pox is ) hard pustules on the limbs and in the mouth, of the size and colour of a lentil (masūra) and is named thereafter (and is) connected with heat, fever and pain"; similarly Su 2. 13.38. Small-pox is to be treated like other skin-diseases, chiefly with ointments (Su 4.20.31). AHr 2.5.111 points out the dangerousness of small-pox : one on whose body masūrikā appear like small coral balls and quickly disappear, is no more. AHr 3.10.38 also mentions it as a disease consequent to diabetes. The later works contain precise information. Small-pox originates from injurious food, particularly pungent or salt, and other defects in diet, from air and water that are corrupted (by poisonous flowers and the like), and from the appearance of an irritated planet. This last cause is related to small-pox epidemic, since the small-pox appears in those regions where the angry planets are visible (Caraka). The disease is introduced by fever, itch, tearing pain in limbs, uneasiness, giddiness, swelling of the skin, change of complexion and redness in eyes. In the case of vāta the pustules are dark-red, rough, hard, cause violent pain and become ripe slowly. This variety is incurable. In the case of pitta they are red, yellow or white, cause burning and violent pain and ripen quickly. There is pain in joints, cough, shaking, uneasiness, weakness, dryness of palate, lips and tongue, thirst and loss of appetite. In the case of blood there is diarrhoea, heat in the body, thirst, uneasiness and loss of appetite, inflammation of the mouth, redness in eyes, and especially strong fever, as well as the signs as in pitta. In the case of kapha the pustules are white, glittering, very big, cause itch, but little pain and ripen slowly. At the same time there is phlegmatic flow, paresis, headache, heaviness in limbs, nausea, loss of appetite, sleep, weakness and dislike. In the case of all doṣas they are big, blue, sunk in the middle, very painful, ripen slowly, contain stinking pus and are called carman. There is difficulty in swallowing, loss of appetite, weakness, talking astray and disgust and the disease is scarcely or not at all curable. Further varieties depend on whether the pustules invade the chyle, blood, flesh, fat, marrow, bone or the generative element. If they invade the skin (i. e. chyle) they resemble a waterdrop, are very harmless and let out water when they crack (water-pox). In blood they have the colour of blood, ripen slowly, have a thin skin, contain blood. In the remaining varieties the symptoms are worse by degrees and the pustules invading the bones or the generative element bring death quickly. The following are additional signs of incurable disease: the pustules appear like corals, Jambū fruit, iron-bullets or lentils, there is cough, hiccup, delirium, violent fever, talking astray, disgust, faint, thirst, heat and uneasiness, blood flows from the mouth, nose and eyes, a rattling is heard in the throat and the respiration is extremely painful, the patient breathes by nose only with exertion and is troubled by thirst. A swelling on the elbow, wrist or shoulder-blade arising after the small-pox is scarcely curable. Among the numerous remedies for small-pox mention may be made of the internal use of quicksilver (pārada, Cakra, 315) which is certainly not very old, and of the various recipes for mixture of medical stuffs with cold or very cold water (MN 316-21; Vr 56; Vang 700-9; W 314-8; Bhāv 2.4.53-9).

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Śitalā— an apparently later subsidiary form of this disease, is mentioned in connection with the cold treatment for small-pox which in all probability is meant for fever accompanying it. This name of small-pox represented even at present in modern Indian languages, is referred to only in Bhāv, yet the śitalikā connected with this is mentioned as a popular designation for small-pox (lokāśrayā saṃjñā) already in Dallana on Su 2.13.38 i. e. in the 12th century. The Bhāv (16th century) divides śitalā into seven kinds, but describes eight kinds. 1. The big śitalā (bṛhatī) is characterized by the appearance of which is preceded by fever. After seven days the pustules become visible, within next seven days they ripen, in the third week they dry up and disappear by themselves. 2. kodravā originates from vāta and kapha, the pustules appear like the rice kodrava (Paspalum scrobiculatum), do not become ripe, but are cured without medicine within 7-10 days. 3. ūṣajarūpā—" appearing like insects" is caused by heat. 4. pāṇisahā—" enduring the hand".

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The pustules itch, but tolerate the scratching with hand and dry after seven days. 5. *sarṣapikā*—"mustard corn": the pustules have the colour like that of a yellow mustard. 6. *rājikākṛti*—"having the form of *rājikā*, a kind of mustard" (*Sinapis ramosa*). This variety is caused by heat, occurs only in children and dries up easily by itself. 7. The pustules are red, elevated and round, like a red spot, there is pain, fever precedes them and lasts for three days. 8. *carmajā*—"originated in the skin": the pustules become blended together. Vernacular names are also mentioned along with the Sanskrit names. The cure of *śītalā* results in many cases easily and without treatment; other cases are incurable in spite of all remedies. The remedies, particularly for the first variety, consist of sprinkling the split up or unripe pustules with ash of cowdung, applying cold (*śītala*) water which need not be boiled even during the fever, removing the patient to a cold (*śītala*) distant place where nobody is permitted to meet him, driving out the flies with twigs of *nimba* and yellow candock leaves, giving a decantation (*phāṇṭa*) of cold water with sandal-wood and other fever remedies for pacifying the fever. It is, however, said that "many physicians generally give no medicine". In the whole house *nimba* leaves should also be spread over. Principally, however, the goddess *śītalā* who governs all forms of appearance of this disease should be worshipped with sacrificial gifts, ceremonies and a hymn from the *Skandapurāṇa* which a pious Brāhman should recite. The hymn is denoted as *śītalaṣṭakam stotram*, and the goddess *śītalā* riding on an ass is invoked therein as the life-elixir for a patient who has got fever, is affected with bad smelling (pus) and is deprived of eyesight (*Bhāv* 2.4.59-63).

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The cult of seven small-pox sisters whom the above seven forms of *śītalā* evidently correspond and particularly the *śītalā* is even at present very much spread in North India. *Śītalā* rides on an ass, she resides in the *nimba* tree, that is why the patient is also fanned with *nimba* leaves, *nimba* leaves are hung in the door of the patient's room and are put in a waterpot in the patient's room. *Śītalā* is specially worshipped by women and children, because the above sixth variety of *śītalā* is confined to children. *Camariyā*—the oldest of the small-pox sisters whom a particularly bad form of small-pox with confluent pustules is attributed, corresponds to the eighth *carmajā* or *camaragoṭī*. In south India also the divination of small-pox is a common practice. A goddess *Basurī* prevailing there in the 17th century is perhaps to be identified with *masūrī*.⁴ At present small-pox is evidently the most prevalent children's disease and one of the most dangerous diseases in India⁵. In view of the above information small-pox appears as a difficult, complicated and epidemic disease from *Mādhavanidāna* onwards. In AHr it is considered as dangerous; in Su, AS it is only a light skin-trouble which, according to Wise⁶, is to be considered as a mild form of the later epidemic small-pox, and in the oldest medicine it is completely absent. The often expressed view that small-pox existed in India much earlier than in Arabia and that it reached Arabia from India is thus in no way to be considered as certain; still less acceptable is the view of Chevers⁷ that the priests of *śītalā* were the oldest vaccinators. No trace of any vaccination can be discovered in older medical literature⁸, the worship of *śītalā* as small-pox goddess is foreign to it and no personification of the small-pox appears among the numerous ancient personifications of children's diseases.

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⁴ (1) Cf. herewith Orth, *Bemerkungen uber das Alter der Pockenkenntnis in Indien und China*. Janus v, 391-6. 352-8. (Amsterdam 1900). and my addenda to it, Janus v, 577 ff.

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⁵ (2) Cf. Wise, *Commentary*, pp. 235ff.

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⁶ (3) Crooke, *Popular Religion of Northern India* (London 1896), 1. 125-36.

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⁷ (4) Cf. Stuart, *Madras Census Report* (Madras 1898) pp. 58 ff.; Orth, l. c. (5) Cf. *General Report on the Census of India* 1891, 62. (6) *Review of the History of Medicine*, 2, 108. Orth, l. c.

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⁸ (7) *Diseases of India*, 45 ff. (8) The Sanskrit citation on vaccination communicated by Ainslie (cf. Bohlen, *Das alte Indien*, 2, 219) is evidently a modern falsification. cf. Haas, ZDMG 30, 660 ff.

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§ 67. Minor Diseases (*kṣudraroga*):— This group of diseases originally also comprising small-pox is already alluded to in the Bower MS (1.100, cf. 2. 86) and consists chiefly of different affections of skin. The group consists of 36 diseases in AS and AHr, 44 in Su, 43 in MN and 60 in Sārng. MN excludes small-pox from the group and treats it as an independent disease (§ 66). The following enumeration is based on MN, the meanings are mostly given in the appendix to Dutt, *Nidāna* 193 f.:— 1. *ajagallikā*— warts in children. 2. *yavaprakhyā*— very hard snob or humpback in flesh of the size of a barley-corn. 3. *antrālaji* (*andhālaji*-Suśruta)— a firm round tumour (abscess) with little pus. 4. *vivṛtā*— round tumours appearing like ripe figs. 5. *kacchapikā*— scrofulous gland-swelling.

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6. *valmika* ("anthill")—slowly swelling snob on the throat, hands and feet etc. expanding like erysipelas. 7. *indraviddhā* (*indravṛddhā*)—Herpes. 8. *gardabhikā*—round painful boil (*lichen circumscriptus*—Dutt). 9. *pāṣāṇagardabhā*—mumps, parotitis. 10. *panasikā*—a hard, excessively painful boil in the ear. 11. *jālagardabhā*—a kind of St. Anthony's fire, there is light swelling on the skin with heat and fever. 12. *irivellikā*—Carbuncle on the head. 13. *kakṣa*—a painful abscess in or near the armpit. 14. *gandhamālā* (*gaṇḍamālā*?)—a similar abscess on the skin. 15. *agnirohiṇī*—painful boils in the armpit, causing internal heat and fever and burning like flaming fire; these cause death after 7, 10, 12 or 14 days (*acute abscess* according to Dutt). 16. *cipyā*—nail-abscess, onychie. 17. *kunakhā*—Psoriasis on the nails. 18. *anuśayī*—a deep abscess on the foot. 19. *vidārikā*—lumplike abscess in the groins and armpit. 20. *sarkarārbuda*—an open cancerlike abscess from which a fluid appearing like a mixture of honey, butter and fat flows; the abscess then dries up and becomes hard, thereupon a bad smelling liquid of varied colours suddenly comes out with blood. 21. *pādadārī*—cracking of the foot caused by walking. 22. *kadara*—a hardening of the foot caused by wound with thorns and the like. Corn on the foot. 23. *alasa*—a painful tumour between the toes ("wet corn on the foot"—Dutt) 24. *indralupta*—falling of the hair, baldness. 25. *dāruṇaka*—scales on the head ("tinea versicolor of scalp"—Dutt). 26. *aruṃśikā*—favus. 27. *palita*—immature grey hair. 28. *mukhadūṣikā*—pimples on the face of young people. 29. *padminīkaṇṭaka*—a kind of tetter. 30. *jaṭumaṇi*—hairy mole. 31. *maśaka*—black warts. 32. *tilakālaka*—dark mole. 33. *nyaccha*—liver-spot. 34. *vyaṅga*—brown mole on the face. 35. *nīlikā*—black mole on the face or on the body. 36. *parivartikā*—constriction of the foreskin. Phimosis. 37. *avapāṭikā*—Spannish collar, paraphimosis. 38. *niruddhaprakāśa*—constriction of the urethra. 39. *sanniruddhaguda*—constriction of the rectum. 40. *ahipūtanā*—Erythem or wound in the anus of children. 41. *vṛṣaṇakacchu*—itching eruption on the scrotum. 42. *gudabhraṃśa*—prolapsis of the rectum. 43. *sūkaradaṃṣṭraka*—a kind of erysipelas, redness of the skin with itching and fever (Su 2.13; MN 321-37; AS 6.36; AHr 6.31; Vang 70 ff.; Bhāv 2.4.63 ff.; cf, Car 1.17).

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The treatment consists particularly of powdering and smearing the skin with various pastes and ointments, in many cases e. g. in corn on the foot and the abscess vidārikā, an operation is to be resorted to, or cauterizing and branding of the diseased place. Nourishing and perspiring remedy, nasal remedy, dressing, blood-letting, medicines are also recommended. In the prolapsis of rectum (gudabhraṃsa) one should warm the anus, apply oil to it, then again push back the prolapsed part and perform dressing with a leather perforated in the middle; the anus is then to be fomented very often. A rat whose intestines are taken out serves as a fomenting medium (Su 4.20; AS 6.37; AHr 6.32; Vang 1. c.; Bhāv 1. c.).

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§ 68. Leprosy and allied Skin-diseases :— By kuṣṭha, a very dangerous skin-disease causing the most wretched deformation— the so-called black leprosy is in general to be understood. According to the Smṛtis, sinners of the highest grade are punished with kuṣṭha in their future birth¹; therefore, the kuṣṭhin is incapable of inheriting² unless he has practised penance in order to remove the sin³. In the medical literature, however, kuṣṭha appears mostly to have a wider meaning. In the Bower MS, Hoernle has always translated it as "skin-disease". The following are mentioned as causes : food and drink that are injurious or mutually unsuitable (e.g. milk with fish)⁴, suppression of vomiting and of natural excretions in general, physical exercise or excessive heat after a rich meal, a cold bath after experiencing heat, fatigue or anxious excitation, sexual intercourse while having indigestion, mischief against a Brāhman or a spiritual teacher and others, also sins made in an earlier birth. The following are the preliminary signs : the skin appears glittering and rough, there is excessive perspiration or no perspiration, decolourization, heat and itching of the skin, numbness of certain parts of body, exceedingly strong painfulness of wounds or abscesses, quick aggravation and slow cure of the same and of a rough place remaining after the cure, dark colour of blood, goose-skin, red eruption, pain, weakness etc.

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Usually 18 forms of kuṣṭha are distinguished, and are divided into 7 major and 11 minor forms; in particulars, however, the enumerations differ. According to Mādhava the following are the major forms : 1. kāpāla — with black or reddish, dry and rough spots like potsherd (kapāla), acute pain, very dangerous. 2. audumbara — the spots or boils are like a fig (udumbara) are accompanied by pain, heat, redness and itching, the hair on the body become brown. 3. maṇḍala — the spots are white or red, hard, wet, glittering, circular, coherent, scarcely curable. 4. *ṛkṣajihva*— the spots are rough, red on the edges, dark in the middle, painful, formed like the tongue of a bear (*Ṛkṣajihva*). 5. *puṇḍarīka*— the spots are bright red on the edges red in the middle, elevated, like a red lotus-flower. 6. *sidhma*— the spots are white or coppercoloured, small, giving dust if rubbed, appear mostly on the chest and resemble the blossom of gourd. According to Dutt, Pytiriasis, a kind of Herpes with dustlike scales is meant. 7. *Kākaṇa*— resembles in colour the seed of *Kākaṇantikā* (*Abrus precatorius* that is black in the middle, red at the edges), suppurates and aches violently. This form is incurable. While these seven major forms can at least be related for the most part to real leprosy, the eleven minor ones are apparently related to the most varied other skin-diseases. 8a. *ekakuṣṭha*— the skin is sweatless, the spots are big and appear like scales. 8b.

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*carman*— the skin is felt rough like that of an elephant. The former disease is Ichthyosis according to Dutt, the latter Hypertrophy of the skin. 9. *kiṭibha*— dark coloured scars, felt rough and hard, Keloid according to Dutt, that exists in compact rolls arising mostly from the thickening of the skin. 10. *vaipādikā*— violently painful cracks of hands and feet, Psoriasis on foot according to Dutt. 11. *alasaka*— the skin is covered with itching red snobs, a kind Herpes. 12. *Dadrumaṇḍala*— itching, red, elevated spots. According to Dutt ringworm is hereby meant, but this has nothing to do with a disease of the head-skin. 13. *carmadala*—the skin is red, painful, itching and suppurated vesicles are formed that are sensitive to touch. Impetigo. 14. *pāmā*—tiny but numerous vesicles accompanied by discharge, itch and burns. Eczema or wet tetter. 15. *Kacchu*— similar painful scraping with violently burning pustules on the hands and buttocks. 16. *visphoṭa*— dark-red swellings with thinner skin. Boils. 17. *Śatāru*— red or darkcoloured numerous abscesses with heat and pain. Furuncle. 18. *vicarcikā*— itching, dark, severely wet spots or boils. Psoriasis (according to Dutt) or wet tetter. Further divisions depend upon the place of the disease in one of the seven elements of the body; the forms staying in the skin, blood or flesh are only curable.

c13.13.4

In fat particularly there is lameness of hands, inability to walk, decay of limbs, spreading of wounds from one part of body to the other. In marrow and bones there is prolapsis or decay of nose, redness of eyes, maggots are formed in the wounds, the voice is choked. If present in the *śukradhātu* of the father and in the menstrual blood of the mother, the leprosy is transferred to both the offsprings.

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Generally *kuṣṭha* is fatal if there are maggots, thirst, heat and weak digestion, if all *doṣas* are deranged, if abscesses occur and discharge, if the eyes are red, the voice is hoarse and if medicines are ineffective (on account of weakness). According to Su 2.5 *kuṣṭha* is the worst of all diseases and one who dies due to that is again attacked by it in the future birth. *Kuṣṭha* is also contagious like fever, consumption, opthalmia and the epidemic diseases ("small-pox and the like"—comm.) by constant contact, breathing together, eating together, lying or sitting together, clothes, garlands and ointments. The expansion of *kuṣṭha* from skin to the remaining elements of the body is compared with the gradual expansion of the roots of a tree on the earth. The most numerous recipes for *kuṣṭha*, especially the most varied decoctions with butter and oil are meant for internal as well as external treatment. Generally an emetic should be used once in a fortnight, a purgative in a month, a nasal remedy every third day and blood-letting every six months (AHr 4.19.96 = AS 4.21.120 = Su 4.9.43 = Vr 51, 138). The patient should also keep diet, should practise pious ceremonies and penance, should keep short hair and nails, should avoid overexertion, intercourse with women, flesh and spirituous drinks; then he will be cured (Car 2.5; 6.5; Su 2.5; 4.9; AS 3.14; 4.21; AHr 3.14; 4.19; MN 294-305; Bhav 2.4.18 ff.; Vang 647 ff.; Vr 51.).

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*Śvitra*—"white leprosy" is frequently mentioned along with *kuṣṭha* as minor disease which occurs in subsequent births as a punishment for minor misdeeds. Closely connected or identical with this is *kilāsa*, already coming in the Atharvaveda as a disease characterized by white and grey spots and referred as a white leprosy (*śvetakuṣṭha*) by the commentators. According to Datt (61) leucoderma is meant by *kilāsa* in medicine. Probably, however, the white (smooth or anesthetic) leprosy is at the same time meant thereby, since both the diseases are frequently met with in India and are so difficult to distinguish that at the last census special instructions had to be given on that point. According to Suśruta, *kilāsa* is differentiated from *kuṣṭha* by the fact that the former rests only in the skin and is without discharge. According to AS, AHr, MN, *śvitra* or *kilāsa* can invade blood, flesh and fat and is then worse successively. The disease is curable if the hair on the body are not white (but black), the spots are not big and are not confluent or appear like burnwounds.

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Otherwise it is incurable especially if it appears on the genitals, palms or lips ( Su 2.5.13; AS 3.14; AHr 3.14.37-41; MN 202-5 ). The treatment is similar to that for *kuṣṭha*. Many recipes are used for both the diseases ( Vr 1. c.; Bhāv 2.4 ).

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According to Dutt, leprosy is meant by *vātarakta*, *vātasoṇita*, *vātāsṛj*. *Vātarakta* is caused by corrupted blood that immediately runs in the feet and is towed there. The blood is corrupted by hot food and drink and other defects of diet, sleep by day, long walk in heat, want of movement, grief, anger etc., particularly if one lets hang the legs from a carriage or a riding animal ( AS, AHr ). According to Suśruta, there is in the feet pain, pricking, dryness, numbness or excessive burning, or they only itch, but are white, cold and swollen. According to AS, AHr the preliminary signs of *vātarakta* are similar to those in *kuṣṭha*. There is, moreover, fatigue, looseness of limbs, itching, convulsion, joint-trouble, pricking, heaviness and numbness in the knees, legs, thighs, hips, shoulders, hands, feet and joints. These signs come and go. *Vātarakta* is first *uttāna*, i. e. confined to the skin, then *gambhīra* " deep " when it catches hold of all the seven elements of the body, so that the limbs grow crooked and the patient becomes lame or limps ( Car, Su, AS ). In the variety caused by *vāta* there is severe pain, convulsion and joint-trouble, the tumour is black, the vessels, fingers and joints grow crooked, the limbs are stiff and benumbed and shiver. In blood there is a copper-red painful swelling with pricking in the skin. In the variety caused by *pitta* there is excessive heat, suppurating abscesses, numbness and delirium. In the variety caused by *kapha* heaviness, insensibility, coldness of the skin, itching and little painfulness. Many times the ailment spreads over the body after it has reached the ankle-bone and wrist. The disease is incurable if an open wound rises up to the knee or the tumour bursts and suppurates, or vitality and flesh are reduced or if there are other bad complications like sleeplessness, breathlessness, decomposition of flesh, faint, delirium, fever, numbness, erysipelas, crookedness of fingers and toes, lameness, formation of glands etc. The treatment is partly external, partly internal. Many decoctions in butter and oil are especially recommended ( Car 6.29; Su 2.1; 4.5; AS 3.16; 4.22; AHr 3.16; 4.22; MN 187-90; Bhāv 2.2; Vang 405-25; Vr 9 ). From the above symptoms *vātarakta* cannot exclusively be identical with leprosy, but covers also gout and rheumatic ailments¹, perhaps other skin diseases.

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¹ [Note: The footnote text is missing from the provided image, but the reference mark exists in the text.]

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(1) Visnu 45, 2. (2) Cf. my Tagore Law Lectures, 276 ff. (3) Cf. Colebrooke's Digest (London 1801) 3, 304 ff. (4) This belief exists in India even at present. cf. Census of India 1891, 23, 366. (5) Manu 11.51, Visnu 45.13. (6) Cf. Zimmer, l. c. p. 391, Bloomfield, SBE 42, 266. (7) Cf. a. g. Census of India, 1891, 16, 305. "The Indian Leprosy Commission" published in 1889-90 a Report on the present position of leprosy in India. (8) Cf. Wise, Commentary, p. 265 note. Avinashchandra Kaviratna's Caraka translation, p. 217 note.

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§ 69. Inflammations and Tumours:—By *śotha*, *śvayathu*, *śopha*, "swelling" every marked swelling of the skin on any place is to be understood. According to Car 1.18 there are three or seven varieties of *śotha* resulting from the *dosas* or their combination, or two varieties according as they are originated from internal or external (*āgantu*) causes. External or accidental causes are: wounds of every kind, contact with leaves, fruit or juice of Bhallataka (*Semecarpus anacardium*)¹, stinging insects (*śūka*)², poisonous plants, the sweat, skin or urine of poisonous animals, the biting and wound by the horns or claws of poisonous or non-poisonous animals, sea-water, poisonous wind and burning wounds. Internal causes of *śotha* are: improper use of medicines, severe form of vomiting, cholera, leprosy, abortion and other diseases, injurious food and drink etc. *Śotha* is dangerous if it appears in the middle of the body, or is spread all over the body, fatal if it appears on half of the body or spreads upwards. The case is also hopeless if there is breathlessness, thirst, vomiting, fever, weakness, loss of appetite, hiccup, diarrhoea and cough, if the *śotha* spreads from the feet in men and from the mouth in women, or from the anus in both the sexes, if it is old, has its place in belly, throat or in a vital place, is extensive or hard, or attacks children, old people or the weak. According to Caraka local inflammations and swellings on the tongue (*upajihvikā*, *adhijihvikā*), on throat and larynx (*galaśuṇḍi*, *galagaṇḍa*, *galagraha*), on gums (*upakuśa*), on stomach (*udara*, *gulma*), St. Anthony's fire (*visarpa*), red ulcers or boils (*piḍakā*), copper-red and painful boils (*alajī*, also Vedic) and others also belong to *śotha*. The treatment is more internal than external. The diet is also to be regulated carefully (Car 1.18; 6.12; Su 4.23; AS 3.13; 4.19; AHr 3.13; 4.17; MN 243-8; Bhāv 2.3; Vr 39; Vāng 561-74).

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¹ [1]

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² [2]

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By *śopha*, Su, AS, AHr (cf. also Car 6.25) mean inflammations; suppurating growth, apparently what is called *vraṇaśotha* i. e.

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a swelling consequent to pus formation in later pathology (MN, Vang, Bhav ), cf. § 78. There are six varieties of sopha or vraṇasotha, which depend upon the doṣas, blood or external causes, and are distinguished by their colour, consistence, painfulness and kind of development. There are further three stages of an inflammation of which the unripe (āma) is recognised by little heat and painfulness, coldness, hardness and little elevation of the tumour and unchanged colour of skin. In the ripening (pacyamāna) inflammation there is violent pain like that by pricking of a needle, ant or scorpion, pricking by knife, stroke of a club, burning or cauterizing and the like, the patient finds no rest in standing, sitting or lying, the tumour gets more elevated like a blown leather bag, the skin becomes pale, there is fever, heat, thirst and loss of appetite. In the ripe (pakva) condition the pain relaxes, the skin is whitish, there is diminished swelling, wrinkles appear on the skin, the skin springs up, the tumour can be pressed in by fingers, but again gets elevated, the above-mentioned phenomena cease and the appetite returns. One should first press the inflammation by fingers, then extract blood by means of leeches and the like, then should apply plaster to it, fourthly cut it up, fifthly apply purifying substances, sixthly healing substances, lastly remove the disfigurements (Su 1.17 = Vr 44 ). Before the operation the patient should have eaten something, so that he may not faint, and if he is accustomed to drink or cannot tolerate the pain, he should be given a strong drink, so that he may not feel the knife in the intoxication (Su 1.17; AHr 1.29 ). The avoidance of an operation in a ripe abscess leads to the result that the pus seeks a way out forcibly and forms a fistula, cf. § 77. On the other hand, the opening of an unripe abscess causes severe loss of blood, disturbance of flesh, arteries, sinews etc. and other bad complications (Su 1.17; AS 1.38; AHr 1.29; MN 265-7; Vr 44; Bhav 2.3; Vang 606 ff. ).

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§ 70. St. Anthony's fire, Boils, Nettle-rash, Measles :— The visarpa, parisarpa, " St. Anthony's fire, Erysipelas " ( cf. Vedic

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(1) According to Dutt, Mat. Med. 141 the cauterizing juice of Bhallataka is used even at present for curing artificial wounds or scars. (2) These suka were employed also as stimulants when one applied them to the penis. Other similar stimulants were, therefore, called suka, cf. Kama-sutra 369. The 18 sukadosas pretendedly arising from these suka, inflammations and abscesses on the genitals, of which four are incurable, form a special subject of Indian medicine ( Cf. Su 2.14; AS 6.38 f.; AHr 6.33 f.; MN 289-93; Vang 645 ff.; Vr 50. ).

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visarpaka, SBE, 42, 531, 601) is also compared with leprosy (kuṣṭha) and the name shows that it is spread over on all parts (sarvato visarpaṇāt or visaraṇāt, vividham sarpati). According to Caraka the causes of its origination are excessive use of salt, sour, pungent, hot fluids and other defects of diet, also wounds, poisonous wind etc. By vāta, the place affected by visarpa is brown or reddish, swollen, extremely painful, and if one does not take proper steps against it, it is covered with quickly bursting, small, reddish or dark pustules, there is also constipation and retention of urine. By pitta, the affected part is copper-red, green, yellow, blue, black or red, and pustules are formed which are excessively burning and quickly ripening. By kapha, the place is swollen, not very red or painful, the pustules ripen slowly, the discharge is white and bad smelling. By vāta and pitta, the part appears like extinguished coal or extremely red, the pustules resemble blisters. This form is called agnivisarpa or āgneya. By kapha and pitta, the place is covered with red, yellow or whitish vesicles, and is dark, burning, deeply suppurating and without discharge. This is the incurable form kardamavisarpa. By kapha and vāta, a group of very painful glands (granthimālā) is formed, so it is called granthivisarpa. By all doṣas the disease affects all limbs and all elements of the body and shows all the above signs. This form is incurable. Granthivisarpa is incurable if the following complications occur:— fever, diarrhoea, hiccup, breathlessness, vomiting, faint etc. Agnivisarpa is also incurable if it quickly affects the major parts and brings forth numbness, sleeplessness or sleepiness, uneasiness, gouty pain in the joints. The first three forms are curable; however, unfavourable signs accompanying them are also mentioned. The treatment of curable forms should commence with emetics, fasts, purgatives, blood-letting and the like, external treatment (kriyā bāhyā) with ointments, cold poultices, plasters etc. should follow only afterwards. According to the above descriptions carbuncles and other abscesses are also to be understood by visarpa besides St. Anthony's fire (Car 6.21; Su 2.10; 4.17; AS 4.20; AHr 4.18; MN 309-14; Vr 54; Vang 689-95; Bhāv 2.4).

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The visphota, visphoṭaka "boils" are already referred to as a form of leprosy (kuṣṭha, § 67). They are also mentioned under kṣudra-roga (§ 67) in AS 6.36, AHr 6.31 as very painful pustules which are even worse than small-pox. According to Madhava, they resemble the blisters, are related to fever, proceed from blood and pitta and appear either only on one place or all over the body. By all dosas they are pressed in the middle, elevated on the edges, hard, without much pus, there is burning, redness, thirst, semi-consciousness, vomiting, faint, pain, fever, delirium, shivering and sleepiness. This form is incurable. Red pustules that appear like guñjā seeds, i. e. red with a black spot or like corals, are also incurable. The treatment is, as in the case of visarpa, first internal, then external. In recipes also visarpa and visphoṭa are frequently mentioned together ( MN 314-16; Vr 55; Vāng 695-99; Bhāv 2.4 ).

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Śītapitta, udarda— nettle-rash according to Wise and Dutt, is apparently foreign to the older pathology, yet AS 2.2, AHr 2.2 mention a form of the same connected with a cold eruption and udarda in fever. The disease is caused by cold wind and begins with thirst, loss of appetite, nausea, feebleness, heaviness in limbs, redness of eyes, whereupon an elevation resembling a bite of a wasp is formed on the skin with itching, pricking, vomiting, fever and heat. The disease is especially called udarda ( erysipelas, St. Anthony's fire ) if it occurs in cold season, is due to kapha and is characterised by elevations that are itching, round and pressed in the middle. Koṭha ( urticaria evanida -Dutt) an eruption with many, round, itching, red spots, arises especially from insufficient or wrong application of emetics in the case of corrupted stomach. If occurred repeatedly, this ailment is called utkoṭha. The treatment of this disease which is apparently considered as a minor one is similar to that of visarpa and kuṣṭha ( MN 305 f.; Vr 52; Vāng 677-9; Bhāv 2.4 ).

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The measles that often appear at present in India as epidemic and claim a big mortality are almost unknown to the older medicine. Caraka mentions the romāntikā briefly in the chapter on śotha ( 6.12.88 ) where he describes them as small spots spreading on the whole body accompanied by fever, heat, thirst, itch, loss of appetite and nausea. They are omitted in his list of diseases ( 1.19 ). According to Mādhava who treats them as a kind of small pox, the romāntī are small red dots with elevation equal to hair-roots. Accompanying signs are cough and loss of appetite, the fever comes beforehand. In the recipes also the measles appear along with small pox ( MN 318; Vr 56; Bhāv 2.4; Vāng 701 ).

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§ 71. External and Internal Abscesses :— By the oft mentioned ailment *vidradhi*, *vidradhikā* (Vedic *vidradha*) which also comes as a consequence of diabetes, various abscesses and inflammations are meant. According to Car 1.17.95 the name is derived from brisk burning or demolition (*śīghravidāhitvāt*). There are external and internal *vidradhis*. Caraka identifies the latter with *granthi* "growth, deep seated abscess" that has its place in heart, lungs, liver, spleen, stomach, kidney, navel or groins. Ripe abscesses empty their contents from the mouth if their place is in the upper half of the body and from the anus if in the lower half of the body, from both sides if their place is in the navel. Those in the heart, navel or bladder or due to three *doṣas* are fatal. In all *vidradhis* the pain is very acute as by cutting with a knife, by throw of a spear or by burning with fire. In the ripening condition the pain is like the stinging of a scorpion (Car 1.17). Caraka describes other *vidradhis* and *granthis* in the chapter on *śotha* (6.12) :— *vidradhi* on the palate with burning and redness of flesh, *dantavidradhi*— a tumour on the gums, *granthi* which must be cut out lest it may recur, *arbuda* which are of similar quality and are to be treated like *granthi* etc. According to Su, MN, *vidradhi* is a dangerous, deep-rooted painful, round or oblong tumour. By *vāta* it is black or red, of changing size, extremely painful, grows and ripens slowly, the discharge is faint-coloured. 2. By *pitta*, its colour is like that of a ripe fig or dark brown, it is accompanied by fever and heat, grows and ripens quickly, the discharge is yellow. 3. By *kapha*, it is (big) like a dish, whitish, cold, glittering, not very painful, grows and ripens slowly and itches, the discharge is white. 4. By *tridoṣas* the colour, pain and the pus are of different kinds; this form is incurable. 5. By wounds the signs are as by *pitta*, but by neglecting the wounds, there occurs fever, thirst and heat. 6. By blood the tumour is surrounded by small black dots, is dark-coloured, causes violent burning and pain, otherwise shows similar signs as by *pitta*. The internal *vidradhis* are to be distinguished from the external *vidradhis*. The internal *vidradhis* correspond to the abscesses in heart etc. described above according to Caraka. If they burst from upwards (from the mouth) they are fatal. *Makkalla*, the abscess of the confined woman due to retention of blood is also here considered, cf. § 49, and the difference between *gulma* (cf. § 54) and *vidradhi* is explained. The former tumour does not ripen, because it does not contain flesh and blood, the latter ripens, i. e. suppurates, because it contains much flesh and blood. For vidradhi the application of leeches and mild purgatives, plasters and poultices and various medicines etc. are recommended ( Su 2.9; 4.16; AS 3.11; 4.15; AHr 3.11; 4.13; MN 260-5; Vr 43; Bhav 2.3; Vang 600-6. ).

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§ 72. Growths, Tumours, Scrofulous Tumours, Goitre :— The granthi and arbuda mentioned in § 71 are besides spoken of mostly in conjunction with scrofulous and other swellings. According to AS, AHr granthi " growth " is a round and big tumour. If fleshy, it is glittering, big, hard. If fatty, it is wet, movable and lets out tough, copper-coloured, white or black fat ( lipoma ?). If bony, it is caused by fracture of bone, and is deep or superficial. If vascular, it is free from twitching and pains. If caused by a wound it is connected with heat and itching. Granthis that are big hard, movable and occur in a major part, in throat or in bowels, are incurable.

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The arbudas are, according to AS, AHr, bigger than the granthis, according to Susruta round, firm, absolutely painless, big, deep-rooted, of slow growth, without pus and can appear on any part of the body. There are six varieties of arbudas two of which are incurable : one pertaining to blood ( sonitārbuda ) in which a considerable discharge of spoiled blood takes place and the other pertaining to the spoiled flesh ( māmsārbuda ) in which there arises a painless, stone-hard tumour.

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If a firm, round or elongated tumour occurs on the joints of jaws, armpit, the collar-bone or the arm, or in the neck, or in the cervical region by the accumulation of fat and phlegm, around which other tumours of the size of a myrobalan or like eggs of fish are formed, it is called apaci ( Vedic apacit )¹ on account of the swelling (caya). These small tumours cause itching and little pain, discharge a liquid when they burst, disappear, then new ones are formed. If the disease has lasted for a number of years, it is scarcely curable ( Susruta ). Closely connected or identical with this is gandamālā " chain of glands " consisting of numerous small tumours ( ganda ) of the size of jujube or myrobalan that are formed in the armpit, on the shoulder, neck, cervical region or in the groins, cause little pain, ripen slowly, disappear, but always recur for a long time, and are incurable if there is cold, pain in the sides, cough, fever and vomiting ( MN, AS, AHr ). Evidently scrofulous tumours are meant by these.

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¹ apacit

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Connected with *gaṇḍamālā* is *galagaṇḍa* "throat-tumour", i.e. goitre which frequently occurs in Terai even at present¹. A big or small tumour that hangs from the neck like testicles is called *galagaṇḍa*. If fatty, the goitre is smooth, heavy, whitish, bad smelling, itching and scarcely aching, hangs down like a cucumber with small root, diminishes or grows just like the body, the mouth glitters, the voice is reserved. The ailment is incurable if the patient breathes with difficulty, the place is soft, the goitre is already an year old, the patient is exhausted and is hoarse (Su, MN). In AS, AHr elephantiasis and fistula are added here in place of goitre.

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Immature *granthis* are to be treated like *śotha* (cf. § 69), mature ones are to be pressed and to be cleansed and then to be cured like wounds. For *arbuda* similar rules as for *granthi* are applicable (Vr 41, 26, 34). Moreover, operations with knife, cautery branding, application of leeches, plaster and various medicines are also recommended. The extirpation must be complete, lest the tumour would recur. *Apacī* can be cured by applying an ointment formed by a mixture of ash of mustard leaves and other things with goat's urine, emetic and purgative are to be used internally. Fumigation, blood-letting from the wounded place, branding of the same, sneezing remedy etc. are also recommended as for *gaṇḍamālā*. On similar smearing and blood-letting in the Vedic medicine in the case of *apacit*, see Kausika sūtra 30.16 (Caland); Bloomfield, SBE 42, 504. For goitre various lukewarm poultices and plasters, blood-letting, nasal remedy etc. are to be applied. Internally cow-urine or she-buffalo urine with different additions and other medicines. Steps can also be taken for the excision of tumour (Car 6.12; Su 2.11; 4.18; AS 6.34; AHr 6.29; MN 251-58; Vr 41; Bhāv 2.3; Vang 582-92).

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§ 73. Elephantiasis :- This disease, known by the deformed swelling, appears in the law-books as a punishment by destiny for the breach of a vow for chastity in an early birth¹. As the name denotes, *ślīpada* chiefly arises on the foot; because the doṣas with an excess of phlegm penetrate in the lower half of the body, beginning

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(1) Cf. Bloomfield, *American Journal of Philology*, XI, 320 ff., SBE 42, 504. (2) Chevers, l. c. p. 361.

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with the groins and upper thigh, affect the flesh and blood and reach the foot in course of time, where they gradually bring about a firm swelling (AS, AHr). If caused by vāta it is hard, black, rough, the skin cracks, there is pain without occasion, the pain is violent and there is fever. By pitta the ślīpada is yellowish, a little soft, accompanied by fever and heat. By kapha it is smooth, whitish, heavy (bhārika "forming a load") immovable, big, oversaturated with outgrowth of flesh and painless. Ślīpada is incurable after one year and if it is excessively big, resembles an anthill and dribbles excessively etc. "According to some authorities" ślīpada arises, besides on the foot, on hands, nose, lips and ears, and also on the eyes and penis. It occurs especially in such regions as contain stagnant waters, are swampy and cold in all seasons. The surgeon should open a vein above or below the ankle-bone according to the tridoṣas, or on the big toe. Different plasters and smearings are then described, heat is also to be applied, the patient should fast or drink castor oil with cow-urine for a month or take an enemeta; in extreme cases the swelling should be branded (Car 6.20.93; Su2.12; 4.19; AS 6.33; AHr 6.29; MN 258-60; Vr 42; Bhāv 2.3; Vang 594-600). The elephant-foot and similar monstrously big tumours on the scrotum as well as the elephantoid swelling are met with even at present in India especially in swampy regions¹.

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(1) Viṣṇu 45.29. (2) Chevers l. c. 263.

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§ 74. Swollen testicles, Hernia, Hydrocele :— The general expression vṛddhi "growth" seems to mean every diseased swelling of the scrotum, while the cognate vardhma, vardhman (vradhna, bradhna, bradhma) which is held by Aruṇadatta as fully synonymous, is used in the restricted meaning "Hernia"; cf. Bhāv 2.3; Vang 580. However, in Car 1.18.36 both the readings vṛddhi and bradhna are found in the description of the disease in which the deranged vāta comes in the testicles from the groins as a result of swelling and pain; cf. also Bhāv 2.273. The same disease appears to be described in Car 6.12.89 f. where mention is made of testicles swollen by vāta which protrude out the intestines and again are replaced and are to be operated; this is apparently hernia. According to Vang 580 a painless swelling of the testicles is called kuranda. According to MN 248-50=AHr 3.11=AS 3.11=Vang 574=Bhāv 2.3 the deranged vāta penetrates

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Into the scrotum from the groins, causing swelling and pain, and brings about *vṛddhi* in the testicles. There are seven kinds of this ailment according as it is due to one of the three doṣas or due to blood, fat, urine or the descending bowels. By urine *vṛddhi* is caused by habitual retention of urine, is painful and soft and is shaken like a leather-bag filled with water while walking, urinary diseases also occur, and a round elevation is formed below the testicles. This seems to be hydrocele (Wise). The incurable disease *antravṛddhi* (Hernia) is caused by the entrails. If vāta is aggravated by food that disturbs it, by cold baths, suppression or provoking of natural excretions, carrying loads, long journeys on foot, dislocations and other disturbances, it spoils a piece of small intestines and drives it downwards from its original place, and thus causes a growthlike tumour in the groins. If the tumour is not treated, the vāta causes a painful swelling of the scrotum that goes back inside with noise if pressed and comes again at the close of the pressure. According to Su 2.12.6 the swelling of the scrotum is oblong and resembles a bladder.

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In all kinds of *vṛddhi* riding, physical exertion, cohabitation, suppression of natural excretions, movements, excess in eating, fasts and heavy food should be avoided. In ripe tumours an incision should be taken; a fatty tumour should be wrapped with a piece of cloth and then, after encouraging the patient, should be cut up with a scalpel (*vṛddhipattra*) sparing the testicles and the spermatic cord, and the fat should be taken out, then the wound should be smeared with sulphate of iron and rock-salt, dressed or sewn and treated with oil. In hydrocele a piece of cloth should similarly be laid around and then, as in dropsy (cf. 8.54), an incision should be taken below the spermatic cord with a *vrīhimukha* (Trocar), the fluid should be tapped with a tube and then dressing should be made. Hernia on scrotum is incurable. On the other hand, hernia in the groins should be treated with emetics, smearing, oily enemeta and the like, eventually should be branded with a halfmoon-shaped (*ardhenduvaktra*) red-hot iron (Su 4.19; AS 4.15; AHr 4.13; Vr 40; Bhāv 2.3; Vang 576-81).

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§ 75. Other Diseases of the Male Organ :— Along with *vṛddhi* *upadaṃśa* is mentioned. This disease of the penis is caused by wound of the same at the coitus with hands, nail or teeth¹, neglect of washing

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after cohabitation, or use of foul water for washing, intercourse with a woman who is menstruating, is unclean or is suffering from some female disease, forced intercourse, use of śuka (cf. § 69) and other stimulants and the like. The tumours or pustules caused by it are black, fig-coloured, white etc. according to the doṣa responsible for it. If the flesh on the penis is vanished, corroded by maggots so that the testicles only remain, then the case is hopeless. One who does not take any steps immediately after the beginning of the disease, but continues sexual intercourse, has his penis demolished by tumour, maggots, heat and pus, and he dies. First the use of oil and warmth is recommended, then a vessel in the middle of the penis is opened or a leech is applied and purgative and emetic are given; an enema should be given to feeble patients. According to the kind of the disease, various warm and cold smearings, washings and poultices are applied. The surgeon must try to prevent the discharge of pus and to remove quickly the accumulated pus with knife (Su 2.12; 4.19; AS 6.38; AHr 6.33; Vr. 49; Bhāv 2.4; Vang 639-43)

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A disease coming in MN, Bhāv, Vang is liṅgavarti or liṅgārśas ("Penis-abscess"), a growth on the genital that resembles a cock's comb, with abscesses that are oblong, occurring on one another, phlegmatic and painful and is scarcely curable. The tumour is to be completely cut out and branded, or it is to be rubbed with an extract of *Berberis asiatica*, realgar and other medicines (MN 288 ff.; Bhāv 2.4; Vang 639-43). According to Dutt, *Nidāna* 169 f., *liṅgavarti* is syphilis and *liṅgārśas* is warts. Häser has identified *arśas* coming in Su 2.2 with syphilis. It is caused by foul flesh and blood in the penis, begins with itch, then a wound occurs on it if it is scraped, puffed outgrowths caused by foul flesh and discharging phlegmatic blood are formed within (in the glands-Ḍallaṇa) or on the external skin, and they demolish the penis and potency. Similar bad smelling outgrowths in the vagina stop menstruation. Apparently the same disease is meant by *arśas*, *liṅgārśas*, and *liṅgavarti*, but whether syphilis is meant is equally doubtful even though in the Vedic names of the disease which Bloomfield¹ relates to syphilis, the above symptoms (cock's comblike etc.) could be related to syphilitic Condylomata.

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The identification of "syphilis" with the disease *phiraṅga*, *phiraṅgaroga*, *phiraṅgāmaya* "the Franc disease" is certain which, however, is mentioned in the works of the 16th century, especially in Bhāv 4.50-2³ along with boils and the small pox. There its name is explained by the fact that it frequently occurs in the land of France (*phiraṅgasamjñake deśe*) i. e. in Europe. It is a gland-disease (*?gandharoga* for *gandaroga*?) that is caused by physical contact with a *phiraṅgin* (European), (and particularly-comm.) by intimate intercourse with a *phiraṅginī* (European woman), and belongs to the diseases originating from external cause (*āgantuja*). 1. External *phiraṅga* resembles the vesicular disease (*visphoṭa*, of. § 70 ) and causes little pain. If the vesicles burst, they are to be looked upon as wounds and are easily curable. 2. The internal *phiraṅga* occurs in the joints, causes pain and swelling like rheumatism and is difficult to cure. 3. The external-internal causes the signs of 1 & 2, is painful, very much protracted and very scarcely curable⁴. Bad complications in *phiraṅga* are: thinness, loss of vitality, depression of the nose, indigestion, wasting and crookedness of bones. External *phiraṅga* is curable if it is new and free from complications. The internal is scarcely curable, external-internal is incurable if the patient has become weak and if there are complications. As the chief remedy for *phiraṅga*, mercury⁵ (*pārada, karpūrarasa*) is recommended, especially internally, e. g. in a pill with wheat which is to be swallowed in without allowing to touch the teeth, also externally as smearing substance, or when it is fully pulverized between the hands. Saltish and sour things should not be eaten after internal use, also exercises, heat, long journey on foot and especially sexual intercourse should be avoided. A further specific medicine for *phiraṅga* is *cobacīnī, copacīnī*, a well known remedy for syphilis in India even at present which, according to Bhāv 1.1 is also called *dvīpāntaravacā* apparently from its foreign origin. This is sārsāparilla, the root of smilax which must have come to the Portugese in Goa about 1535 A. D. as a remedy against *Lues* through Chinese traders,⁶ and is known in Europe only since the 16th century. The Berlin MS in which *phiraṅga* is described,⁷ appears to be an excerpt from Bhāv.⁸ The European origin of *phiraṅga* cannot, therefore, be doubted.

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