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Indian Medicine (Medicin), translated by C. G. Kashikar c14: VII. Diseases of the Head

Indian Medicine (Medicin), translated by C. G. Kashikar c14

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VII. Diseases of the Head

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§ 82. Eye-diseases¹:— The diseases of the part of the body above the collar-bone (*ūrdhvāṅga*, *ūrdhvajatru*) form a special group the treatment of which is gathered together under the name *śālākya* i. e. finer surgery, especially ophthalmology, from *śalākā*—probe, particularly for piercing the eye-skins. The Bower MS 2.848-90 and 1.68 ff. mentions cataract (*kāca*, *timira*) and many other eye-diseases. According to Su 6.1.29 f. there are 76 eye-diseases : 10 from *vāta*, 10 from *pitta*, 13 from *kapha*, 16 from blood, 25 from all *doṣas*, 2 external. The same number is given by Car 6.26.72 f. where reference is made to ophthalmological works (*śālākyatantra*) for details. According to Bhāv 2.4.87 there are 78 eye-diseases. cf. § 35. Causes of origination of eye-diseases (*netra-*, *akṣi-roga*) are : cold bath after hot exposure, looking at a distance, irregularity of sleep, dust or smoke, suppression of excretions or excessive vomiting, too much crying, grief or anger, wounds, sexual extravagance, defective diet etc. (Su 6.1.26-28; MN 366 ff.). The most important individual diseases according to Mādhava are :

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1. Of the whole eye. Ophthalmia (*abhiṣyanda*, frequent even at present) of four kinds which, if neglected, lead to difficult ophthalmia (*adhimantha*) with pain as if the eye were torn out and half of the head were crushed, and by wrong treatment causes loss of eyesight within 5-7 days or even earlier. Suppuration of the eye (*netrapāka*). There is itch, secretion, dropping, pain and tumour. A particularly painful and incurable form of *adhimantha* demolishing the visual faculty is called *hatādhimantha*. If *vāyu* moves the eyebrows and eyes alternately with violent pain, it is called spasmodic convulsion (*vātaparyāya*). The dry irritation of the eye (*śuṣkākṣipāka*) or scrofulous ophthalmia (Dutt) is that in which the eye pinches and burns. *Anyatovāta* : the *vāyu* in the ears, head etc. causes pain in the eyebrows and the eyes. *Amlādhyuṣita-iritis*. *Sirotpāta*-the veins in the eyes become copper-coloured, with or without pain. If neglected, this develops into *sirāpraharsa* whereby one continually drops copper-coloured drops and cannot see.

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2. On the black part (*kṛṣṇa*) in the eye. *savraṇaśukla*-ulcer on the cornea with very hot discharge. *avraṇaśukla*-white spots without ulcer, i. e. non-transperancy of the cornea. *akṣipātātyaya*—

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opacity of the whole cornea with suppuration. *ajakājāta*—“goat’s excreta”, i. e. *prolapsus iridis* (Dutt, Hirschberg).

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3. On the pupil or lense (*drṣṭi*). By a disturbance of the first eye-skin or membrane (*paṭala*) one sees everything indistinctly. By disturbance of the second the eyesight is very corrupted; one sees flies, gnats, diaphrams, circles, flags, rays, rings and the like and thinks distant as near and near as distant. By disturbance of the third one sees big objects as covered with cloth, face without ears, nose and eyes and the like. A disturbance of the fourth membrane stops the vision completely and is called *timira* (darkness) or *liṅganāśa* (loss of sight, cataract). If this dangerous disease is not fully developed, one can see the Sun, moon and the stars and lightning in the sky. Among the different kinds of cataract and allied diseases, the following are prominent: disturbance by *pitta*, by which one sees everything yellow; disturbance by *kapha*, by which night-blindness (*naktāndhya*) which is frequent even at present, takes place; *hrasvajādya*—whereby one sees small objects by day only with trouble; *nakulāndhatā*—whereby one sees by day everything spotted; *gambhirikā*—“deep”, i. e. atrophy of the eye.

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4. On the white (*śukla*) in the eye. *Arman*—“wing-skin” (Pterygium) of five kinds; among them *adhimāṃśarman*—a stretched, thick, liver-coloured new formation. *Śukti*—tumours, brown, flesh-coloured or conch-coloured dots. *Arjuna*—a singular dot with the colour of hare’s blood. *Piṣṭaka*—a white outgrowth. *Jāla*—“Netlike” and *Sirāvarta*—“full of vessels”, phlyctenular inflammation? *Balāsa*—a brass-coloured, soft, waterdroplike dot, membrane-cyste?.

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5. On the joining part (*sandhi*). *Pūyālasa*—a ripe, painful and suppurating abscess on the *sandhi*. *Netranāḍī*—lachrymal fistula is fourfold according to the nature of the discharge. *Parvaṇikā* and *alaji* are copper-red, painful outgrowths on the ridge of the cornea. *Kṛmigranthi*—between the eyelids and eyelashes, phthriasis (Hirschberg).

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6. On the eyelids. *Utsaṅgapiḍakā*—internally open and copper-red pustule on the lower eyelid. Cyste? *Kumbhikā*—barleycorn (Hirschberg). *Poṭhakī*—dropping, painful pustules. *Vartmaśarkarā*—eyelid gravel (Hirsch). *Arśovartman*—hard corns (Hirsch). *Śuṣkārśas*—“dry growths” (Hirsch). *Añjananāmikā*—a soft, little painful, small outgrowth. *Bahalavartman*—hard growths allover the eyelid. *Vartmabandhaka*—the swollen eyelids do not wholly cover the eye. *Kliṣṭavartman*—acute catarrh (Hirsch). *Vartmakardama*—Blenorrhoea (Hirsch). *Śyāvavartman*—eczema? *Praklinnavartman*—external painless swelling, internally severe dropping. *Aklinnavartman*—the eyelids as if pasted. *Vātahatavartman*—lagophthalmus (Helfreich). *Arbuda*—an internal growth. *Nimeṣa*—twinkling lideramp. *Śoṇitārbuda*—growth in the middle, which grows again if cut out. *Lagaṇa*—a big, hard, painless growth. *Bisavartman*—external swelling and manifold perforation of the lids, inflammation of the spleen (Hirschberg). *Kuñcana*—fall of lids (Hirsch). *Pakṣmakopa*—introversion of the eyelashes, entropion? *Pakṣmaśāta*—fall of hair on the eyelashes with burning of the lids (Hirsch). (MN 366-403; Cf. Car 6.26.102 f.; Su 6.1-7; AS 6.11-20; AHr 6.8-16; Vang 783 ff.; Bhāv 2.4). On *kukūṇaka* of children see § 50.

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(1) Cf. Hirsch, *Geschichte der Ophthalmologie* in Grafe und Samisches Handbuch 7, 238-42 (Leipzig 1877). Hirschberg, *Geschichte der Augenheilkunde*, ibid. 2nd edition, 31-50 (Leipzig 1899). Magnus, *Geschichte des grauen Staares* (Leipzig 1876).

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§ 83. Treatment of eye-diseases :— According to Bower MS 1.78 ff., 2.847 ff., especially facial plaster, washings or injections (*ācyotana*), ointments particularly of antimony, and suppository should especially be used. Car, Vṛnda and other authors say nothing of the operative treatments. On the contrary, all 76 eye-diseases except the 24 difficult or incurable ones are to be treated, according to Su 6.8, with excision, scarification and other operations.

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Cataract operation¹: "In middle (moderate) temperature the surgeon should himself sit in the morning in a bright place on a bench which is as high as his knee, opposite the patient who is sitting at a lower level, has bathed and eaten and sits fastened (on the ground) (held by a servant sitting behind him-AS). After warming the eye of the patient with the breeze of his mouth, and rubbing it with the thumb and after perceiving the impurity in the pupil (lense), he takes the lancet (*śalākā*) with the forefinger, middle finger and thumb fast in his hand while the patient looks at his own nose and his head is held firm. He inserts it in the natural opening (pupil) on the side, ½ finger far from the black and ¼ finger from the external eye-corner and moves it upwards to and fro. He pierces the left eye with the right hand and / or the right eye with the left. If he has pierced rightly, then there comes a noise and a waterdrop flows out without pain. While encouraging the patient, he moistens the eye with woman's milk and then scratches the eye-apple with the edge of the lancet without causing pain. He then pushes the phlegm in the eye-apple gradually towards the nose where the patient must direct it by drawing up in the nose. Whether the diseased place (doṣa) is firm or moving, he foments the eye from outside. If the patient can now see the objects (shown to him), then the surgeon should pull out the lancet slowly, should place greased cotton on the wound and let the patient lie down with fastened eye."

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¹ Cataract operation

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Ophthalmia (abhiṣyanda) is to be treated with fasting, plaster, hot poultices, blood-letting, purgative, anointing and infusing by drops. In bird's skin (arman) the eye is first to be smeared with lemon juice and salt for the purpose of relaxing, then the flesh-plate in the hanging arman should be seized with a hook, it should be extracted out with the needle and thread and it should be cut off with a rounded knife. An outgrowth (?parvanī) is also to be seized with a hook and to be cut off in the middle, otherwise to be treated like arman. Scarifications come into consideration especially in the case of diseases of eye-lids; the eye is to be moistened with a piece of cloth dipped in warm water and then to be scratched with a knife or leaves (Car 6.26. 221 f.; Su 6.8-19; AS 6.12-20; AHr 6.9-16; Vang; Bhāv l.c.; Vr61).

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(1) The description given here is from AHr 6.14. It is simpler and clearer than the parallel passage Su 6.17-55 ff. translated by Stenzler in Haser l. c. 32 f., by Weber in Magnus l. c. 179 and by G. Oppert in Hirschberg l. c. 38 f. Also cf. AS 6.17.

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§ 84. Ear-diseases :— There are twenty-eight ear-diseases (karṇaroga) according to Su, and twenty-five according to AS, AHr. MN records the following ear-diseases : Karṇaśūla-Otalgia. Karṇanāda-ringing in the ears; one hears manifold noises, as of beating kettledrums or shells. Bādhirya-deafness, is caused when the vāyu blocks the auditory passage. Karṇakṣveḍa-noise in the ear. Karṇasrāva-Otorrhoea, is caused by a blow or diving in water or suppuration of an abscess. Karṇagūthaka-formation of earwax. Karṇapratināha-the earwax is fluid and comes out of the nose and mouth

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with severe headache. *Kṛmikarnaka*— maggots or mites originating in the ear; the winged insects or hundred-footed accumulating in the auditory passage also cause violent pain. *Karṇavidradhi*— abscess in the ear, from wound or from the doṣas. *Karṇapāka*—suppuration in the ear. *Pūtikarnaka*, stinking discharge from the ear. *Paripoṭaka*, inflammation of the lobe of the ear. *Utpāta*, (*Utpāta*) a suppurating tumour on the lobe of the ear caused by external causes. *Unmanthaka*— tumour. *Parilehin*— Eczema (MN 352-57, cf. Su 6.20; Car 6.26.210 f.; AS 6.21; AHr 6.17; Vang 760-2; Bhāv 2.4).

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Filling the ear with oil and various medicinal stuffs appears to be the most usual procedure for these diseases; thus the Bower MS 2.532 ff. has six recipes for preparing the oil or ghee with long pepper and other substances in order to fill the ear therewith in *karṇaśūla*, *karṇanāda*, *karṇakṣveḍa* and *karṇaruja*. Later authors give similar recipes, e. g. the recipes denoted as *kṣārataila* which is good for otalgia, deafness, stinking discharge, ringing in the ears, suppuration and maggots (Vr 59.16-20=AHr 6.18.26-30). As the stuffs to be used, the following are also mentioned: ginger-juice, honey, salt, garlic, devdar, lemon-juice, urine of different animals, etc. Nasal remedy, fumigation, washing, local warmth, emetic and purgative, conveying steam through a reed (*nāḍīsveda*), gargling and other cures are also recommended. Exercise, diving with the head, sexual intercourse should be avoided. Earwax should be removed with a pointed instrument (*śalākā*); insect or impurities in the same way, or by sucking with a horn. For ear-abscess the procedure should be the same as for other abscesses. For maggots in the ear, maggot-remedies are to be resorted to (Car 6.26.212 f.; Su 6.21; AS 6.22; AHr 6.18; Vang 762-71; Bhāv 2.4; Vr 59). For diseases of lobe of the ear, plasters are to be particularly applied (Su 1.16.26 f.).

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§ 85. Otoplasty, Rhinoplasty, Cheiloplasty :— Manu 8.125 mentions the ears and nose among the parts of the body on which punishments are to be executed. Cutting of nose was the usual punishment for adultery. Such judicial demolitions may perhaps be looked upon as the chief cause for the introduction of Indian surgery in relation to the treatment of cut off ears and nose. If one is deprived of the lobe of the ear, an expert surgeon should cut from his cheek a piece of living skin in such a way that it remains connected with the cheek

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and should manufacture a lobe of the ear therefrom after scarification of the place (Su 1.16.14 f.; AS 6.22). If one has lost his nose, the surgeon should cut a leaf of equal size from a tree, place it on the cheek and cut out from the same an equal-sized piece of skin and flesh, suture the cheek with needle and thread, scarify the existing piece of nose, put on quickly but carefully the cut up skin on it, join it properly with a large bandage and stitch the (new) nose firmly. Then he should put in carefully two reeds in order to ease the breathing and when it is elevated thereby, he should moisten it with oil and sprinkle it with red sandal and other blood-sucking powders. White cotton should then be placed on it and it should often be sprinkled with sesame oil. The operated person should then be given ghee and later a purgative. Suśruta also appears to have spoken of the intersection of the bridge. If after cure the nose has too much flesh or skin, it should be cut up and stitched once more. If it falls short, it should be enlarged. For cut up lips similar procedure as for nose-making should be adopted except putting in of the reeds (Su 1.16.27 f.; AS 6.22; AHr 6.18.59 ff.).

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The Indian rhinoplasty has acquired certain fame by its early appearance and its effect on the plastic operation of European surgeons (Carpue, Grafe, Dieffenbach, perhaps also Branca and Tagliacozza )¹. Although in the operations of Indian surgeons attested in the 18th century, the skin of the forehead was used for the nose reparation, the connection of the same with the old method using the skin of the cheek cannot be doubted². Haas explained Suśruta's description of the rhinoplasty as a maceration of a similar passage from Celsus (7.9) and pointed to a remark in Cakradatta's commentary on Suśruta according to which the whole Suśruta passage would be spurious (anārṣa)³. However, the description in Celsus has only a distant similarity with that of Suśruta, and according to Dallana "Jaiyyata, Gayadāsa and others" i. e. the oldest commentators recognised the passage as genuine⁴; its antiquity is also warranted by the parallel passages in AS, AHr containing many further details.

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(1) Cf. Zeis, Litteratur und Geschichte der plastischen Chirurgie (Leipzig 1863) 61 f. (with Roth's translation of Susruta 1. 16 ), Bardeleben, Lehrbuch der Chirurgie und Operationslehre 1. 744 ff. (7th ed. Berlin 1874). (2) Zeis, l. c. 213 (3) ZDMG 30, 659. (4) cf. Roth, ZDMG 48, 140, Dallana 156.

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§ 86. Nasal Diseases :— According to Suśruta there are 31 nose-diseases, according to Bhāv 34 nose-diseases (nāsāroga), according to AS, AHr only 18 pīnasa. In pīnasa, according to Mādhava, the nose is constipated, dry or full of phlegm, heated and one suffering from it has neither taste nor smell. In unripe or acute pīnasa there is heaviness in head, loss of appetite, thin discharge from the nose, indistinctness of voice, frequent spitting. In ripe pīnasa there are similar symptoms, but the phlegm remains toughly stuck to the nose, the voice and appearance of phlegm are normal. In pūtināsya (Ozena) the breathing from the mouth and nose is bad smelling. In nāsikāpāka excessively suppurating abscesses are formed. Pūyarakta—discharge of pus mixed with blood, is the result of derangement of doṣas or of wounds. Of sneezing (kṣavathu) there are two kinds. In bhraṃśathu there is tough salt phlegm, in dīpta there is hot breath from the nose, in pratināha, it is constipated, in srāva it is fluid, in nāsāparitoṣa the respiration is much hampered by the dryness of phlegm in the nose. The five kinds of cold or catarrh (pratiṣyāya) are exhaustively described. By long duration this disease which is related to pīnasa is incurable, maggots are caused in the nose, as is the case frequently in ‘peenash’ even to the present day according to Chevers. There is also deafness, blindness, smelllessness, dangerous eye-disease, tumour, indigestion and cough. Of different kinds of abscesses, swellings and polypus of the nose which are denoted as arbuda, śotha and arśas, there are 7+4+4=15 kinds besides the 4 kinds of raktapitta i. e. epistaxis (MN 358-65; cf. Su 6.22-24; Car 6.26.102-115; AS 6.23; AHr 6.19; Bhāv 2.4.127 ff.; Vang 771 ff. ).

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§ 87. Mouth-diseases :— The diseases of the mouth cavity (mukharoga) fall into the diseases of lips, gums, teeth, tongue, palate,

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For these diseases—especially for pīnasa, pūtināsya, bhraṃśathu, nāsāsrāva, nāsāśoṣa and pratiṣyāya infusions (avapīḍa) and other nasal remedies are prescribed. Many recipes are related to pīnasa. Persons suffering from this are advised to stay in a house protected from wind, they should cover the head with a heavy piece of cloth, should avoid cold water, intercourse with women, very dry food, grief and anxiety, fresh spirituous drinks. In cold affection, fumigation should be applied (Car 6.26.116-139; Su 6.23; AS 6.24; AHr 6.20; Vr 60; Bhāv; Vang l. c.)

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throat, and the whole mouth cavity; in all they are 65. By derangement of doṣas, blood, flesh or fat, the lips become rough, hard, stiff, painful, yellow, red, swollen etc., there appears an eruption, or there arise maggots, pus or watery discharge. GUMS :-sītāda—scurvy, dantapuṭa—swelling at the teeth, dantaveṣṭa—inflammation of gums with bloody suppuration, saiśira—painful tumour on the teeth roots, mahāsaiśira—burning inflammation of the gums with foul breath from the mouth, vaidarbha—tumour on the tooth-roots by wound to the same, khalivardhana—supernumerary tooth, karāladanta—projecting tooth, adhimāṃsaka— tumour on wisdom tooth, dantamūlagatā nāḍī—teeth fistula. TEETH :-dālana—toothache, kṛmidantaka—caries, bhañjanaka—breaking of teeth, dantaharṣa—sensitive tooth, dantaśarkarā—tooth-tartar, kapālikā—hard, pernicious tooth tartar, śyāvadantaka— brown burnt teeth. TONGUE :- By vāta it becomes sprung up and benumbed. By pitta, hot and covered with reddish elevations. By kapha, heavy and thick and surfeited with thorny outgrowth. A severe swelling on the tongue with suppuration on the root of the tongue is called alāsa—Glossitis; a tumour like a second tongue upajihvā—Ranula. PALATE :- galaśuṇḍī—swollen tonsils; tuṇḍikerī—abscess of the tonsils; adhruṣa (abhruṣa)—a red and very painful tumour with fever; kacchapa—a painless tumour, hypertrophy of tonsils; tāluarbuda—tumour in the middle of the palate; māṃsasaṃghāta—painless tumour; puppuṭa—painless tumour of the size of a berry; tāluśoṣa—inflammation of the palate; tālupāka—abscess on the palate. On the diseases of the throat see § 64. MOUTH :- sarvasara—spread inside everywhere, pustules in the whole mouth, painful or painless, three kinds by vāta, pitta and kapha ( MN 337-51 and Dutt, Nidāna 206 ff. of. Car 6.26.170-174; Su 2.16; AS 6.25; AhR 6.21; Bhāv 2.4.135 f.; Vang 738 ff.).

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For diseases of lips special ointments should be applied, so also gargling remedies and other mouth remedies, leeches, local warmth etc.; for affection of gums blood-letting as well as gargling remedies, application of powder to the gums, plaster, cutting off of corrupted flesh on the tooth-root and extracting the painful and supernumerary teeth irrespective of whether they are loose or firm, branding etc. For toothache gargling with lukewarm water, decoctions, warming, fumigation, nasal remedies are recommended; tooth-tartar is to be removed without injuring the tooth-root; loose teeth are to be extracted. In diseases of teeth one should not take sour fruit, cold water, dry or very hard things, also should not chew nauseous sticks for cleansing the teeth. For diseases of the tongue cauterizing, water-gargling, scarification, fumigation, nasal remedies are to be applied. Swollen tonsils should be extracted out and one should cut out a piece of them. Similar tumours on the palate should be operated or scarified; for inflammation of and abscess on the palate, gargling with water is particularly prescribed. For the affections of the whole mouth salt-powder, water, gargling, nasal remedies and the like are indicated (Car 6.26.175-200; Su 4.22; AS 6.26; AHr 6.22; Vr 58; Bhāv; Vang l. c.).

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§ 88. Head-diseases :-Diseases of the head (siroroga) arise from smoke, heat, frost, excess of sleep or want of sleep or excess in use of water and spirituous drinks, suppression of tears or weeping, maggots, unfavourable smells and other causes (AS, AHr.). 1. By vāta suddenly violent headache arises which becomes particularly severe at night, but is reduced by bandage and warmth. 2. By pitta heat in the head is caused as if by glowing coals, relief comes at night and by the use of cold things. 3. By kapha the head is heavy, stiff and cold, eyelids and mouth are swollen. 4. By tridoṣas combination of these symptoms. 5. By blood the symptoms are as by pitta, besides there is sensitiveness to pressure. 6. By destruction of fat and other basic elements in head, severe headache arises which is reduced by warming, blood-letting and similar measures. 7. By maggots blood and pus come from the nose. 8. Caused by the Sun, sūryāvarta. In the eyes and eyebrows there is severe pain at sunshine which ceases at night. 9. anantavāta, violent pain in the neck, eyes, eyebrows and temples. 10. ardhāvabhedaka- migraine. 11. śaṅkhaka- severe pain in the temples (MN 404-11; Su 6.25; cf. Car 6.26.140; AS 6.27; AHr 6.23; Bhāv 2.9; Vang 836 ff.).

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The treatment is partly internal with different ghee-decoctions and regulation of diet, partly external with nasal remedies, plastering, washing, dipping the head in cold water, poultices, blood-letting, fumigation, warmings etc. (Car 6.26.141-169; Su 6.26; AS 6.28; AHr 6.24; Vr 62; Bhāv; Vang l. c.).

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