A. U. A
Surgical Ethics
Front matter
THE
CHOWKHAMBA SANSKRIT STUDIES VOL, LX,
SURGICAL ETHICS
IN
AYURVEDA
BY
Dr G D SINGHAL
M S FRCS (Ed)
Lecturer in the Dept of Surgery College of Medical Sciences
and Surgeon S S Hospital
Banaras Hindu University
Fellow the Royal Society of Medicine London Member
Association of Surgeons of India and of the Indian
Med cal Association Founder member and
Asst Secretary, The Indian Society
of Endocrinology and a
Rotarian
&
Pt DAMODAR SHARMA GAUR, A M S
Reader in the Dept of Basic Principles Post graduate
Institute of Indian Medicine BH U
Author of Abhinavam Prasutitantram Ayurvedadarsha
Samgrabah Shabdartha Shārıram and
Abhinava Shariram
THE
CHOWKHAMBA SANSKRIT SERIES OFFICE
Post Box 8 VARANASI-1 (India)
Phone 3145
Publisher The Chowkhamba Sanskrit Series Office, Varanası-1
Printer Vidya Vilas Press, Varanası-1
Edition
First, 1963
Price Rs 5-00
291182
© The Chowkhamba Sanskrit Series Office
Gopal Mandir Lane Varanası-1
(INDIA)
1963
'HONE 3145
जनन् ।
MAN
पूज्य श्री विष्णु हरि जी डालमिया
को
सादर सप्रेम समर्पित
No text on this page.
FOREWORD It is matter of great pleasure to write a foreword for the monograph on Surgical Ethics written by Dr G D Sioghal and Shri Damodar Sharma Gour That surgery as practiced by Sushruta and his followers in the ancient days was of a very high order is a well known fact Although the art of surgery of those days can by no means be compared with the most exciting advancements of modern era, one can certainly take advantage of the remarkable contributions they have made in some of the spheres of surgery This will enable the modern surgeon to improve not only the care of his surgical cases but his attitude towards surgery as well It will not be out of place to mention here that due to the great progress made in the various techniques of surgery in the recent times we are more often liable to forget the importance of psychological and philosophi cal aspects of the care of surgical patients Many a times these factors would greatly help us to improve the total care of the patients if proper attention is paid during the pre operative, operative and post operative ( 4 ) periods Therefore, this monograph will serve as an important guide to all those interested in knowing the non operative methods of management of the surgical patient both from the historical point of view and the aspect of improving these measures to suit the modern times Those who wish to dive deep in the subject may well refer to the original books from where these abstracts have been made By giving an easy and readable explanation of the original texts quoted in the monograph the authors have rendered sincere service for anvancing the cause of surgical science as a whole KN Udupa MS FRCS(C) F ACS Varanasi 4 12 63 Prof & Head of the Dept of Surgery Principal College of Medical Sciences, BHU Varanası CONTENTS Pages 1 Foreword 2 Introduction 3 Acknowledgement 4 OTTENETET 5 धन्यवादार्पणम् 6 Abbreviations 3 9 15 19 22 23 Part 1 Pages 27-36 GENERAL ETHICS ( सामान्यं सदृत्तम् ) A The would be medical graduate B Qualities of a doctor in general с The high ideals of medical profession D The four great ethical principles E Ideals of a doctor F Doctor's duty towards the faithful patient G Behaviour towards ladies H Joint consulations I Importance of differentiating between curable and non curable cases J Special qualities of a surgeon K The nursing attendants (6) Part II Pages 37-45 PROFESSIONAL & ACADEMIC ETHICS ( व्यावसायिक शैक्षणिकं च सवृत्तम् ) A There is no end to the learning of Ayurveda Anatomy and pathology as the basis of surgery C Knowledge has to be thorough D The value of related sciences E Both academic qualifications and practical experience are equally important and essential F The specialist and the specialities Part III Pages 47-58 PRE-OPERATIVE ETHICS (पूर्वकर्मसद्वृत्तम् ) Forewarned is forearmed B Self assessment C The correct pre operative diagnosis D Emphasis on thorough history takin', phy sical examination and repeated assessment E The treatment should be regulated accord mg to the severity of the disease and the condition of the patient F Importance of the power of resistance G Choice between surgery and conservative treatment H The requirements should be collected beforehand 1, Preoperative localisation of the foreign body J Preoperative light diet and starvation (7) Part IV Pages 59-74 OPERATIVE ETHICS (प्रधानकर्मसदत्तम् ) A Asepsis and antisepsis B Care in the use of instruments С The Incision (1) Qualities of an incision (2) The correct technique of incising (3) Direction of incision (4) The counter incisions (5) Extension of incision (6) Dangers of improper incision D Choice of operation E Importance of blood F Importance of fluid replacement 10 time Replacement by identical substance which has been lost H Shock I Careful Hæmostasis J Final check up before closure K The correct technique of suturing L Cardiac arrest Part V Pages 75-82 POST OPERATIVE ETHICS ( पश्चात्कर्मसद्वृत्तम् ) A B С D The Post operative ward and the bed Care of the patient Caution in the use of strong medicines Check the result Post operative dressing and bandage Post operative sedation E F
( 8 )
Part VI
Pages 83-86
THE ETHICS AND IMPORTANCE OF
EXPERIMENTAL SURGERY
(योग्याकरणसद्वृत्तम् )
Part VII
Pages 87-90
QUACKS
( कुवैद्यवृत्तम् )
Part VIII
Pages 91-94
ETHICS TOWARDS THE DYING
( मुमर्पसद्वृत्तम् )
Part IX
Pages 95-98
ETHICS IN EMERGENCY SURGERY
(आत्ययिकसदृत्तम् )
References
Page 99
INTRODUCTION 1 This work is the first joint venture of a modern surgeon in association with a great Ayurvedic scholar When I first met Pt Damodar Sharma Gaur, about a year ago, I was immediately struck by his vast know ledge of Ayurveda In him I found a man dedicated to the cause of Ayurveda with a scientific unbiased outlook and a hard working person as seen by his numerous publications I was just looknig for some one like him after the great interest in the scientific study of Ayurveda created by my father in law, that great Indian, Dr Raghuvira, Founder Director of International Academy of Indian Culture, New Delhi, 2 The proposal of Pt Gaur Ji to jointly write a book incorporating most of the surgical ethical princi ples in Ayurveda applealed to me very much This book is a result of the same 3 This book has been written for the students of Ayurveda, the medical historians, the modern surgeons and physicians, the orientalists specially the Indologists and for anyone interested in Ayurveda from amongst the educated class of public in general It presents to them in a simple, concise and methodical way the ethics of surgery in Ayurveda 4 Ayurveda literally means 'the science of life It is now available in the classical treatises of Carka, Susruta, Vāgbhatta etc Susruta, the Father of ancient Indian Surgery was updoubtely a great surgeon His writings show that surgery had advanced to unimaginable heights in those days The ethical principles enunciated and ( 10 ) practised then were of the heighest order Unfortuna tely having obtained such high ideas regarding the causes, diagnosis and treatment of diseases, their scienti fic study was not pursued These text books were written in Sanskrit The English translation of some of them is still not yet available to the western scholars Most of what is available has been written by translators and not by authors who ought to know something about the subject also There is a great need for the modern surgeons and physicians to delve into the oceonic depths of these valueable treasures and pick out the pearls of wisdom of medical science, leaving aside the pebbles of the scientifically unconfirmed material 5 In this work quotations from these treatises have been given which deal with the ethical principles of surgery in particular and of medicine in general Their English translation has been done, the source mentioned and the least possible critical notes added showing its modern applicability No attempt has been made to be exhaustive Only a representative selection has been done It has been left to the reader to derive the inference The efforts of the authors would have been duly rewar ded, if they could only provoke some new interest amongst the modern surgeons physicians and historians in particular and of the medical world in general towards the ancient Indian system of Medicine 6 The ethical principles have been placed into nine groups in the following order-General ethics, Professional and Academic ethics, Pre operative ethics, Opera tive ethics, Post operative ethics, Experimental Surgery ethics, Quacks, Ethics towards the dying and Ethics in Emergency Surgery ( 11 ) 7 The First Part (General Ethics) deals with the qualities of a would be medical graduate and that of a doctor in general The doctor was entitled to surgical practice only after obtaining a theoretical and practical knowledge of the subject, passing the qualifying examination and registration by the state The high ideals of medical profession and the four great ethical principles were emphasized This part also deals with the ideals of a doctor, his duties towards the faithfal patient, his behaviour towards the ladies and ethics and importance of joint consultations The special qualities of a surgeon and of the nursing attendants are also given The Second part (Professional and Academic Ethics) - emphasizes on anatomy and pathology as the basis of surgery as also on the importance of a thorough knowledge of the subject and of the related sciences For a surgeon, both academic qualifications and practical experience were considered equally important and essen tial Surgeons were recognised as specialists Surgical treatment was carried out in three stages as is done even today, the pre operative, operative and post operative stages The Third Part (Preoperative Ethics) beings by tellung that "Forewarned is forearmed All the problems were to be considered beforehand, patients were to be correctly diagnosed after taking proper history, thorough physical examination and investigations Repeated assessment of the patient was advised to avoid being mislead during treatment Self assessment of the doctor was considered necessary regarding his capabilities The treatment was to be regulated according to the severity of the disease and the condition of the patient Importance of the ( 12 ) power of resistence was shown Choice was to be made between surgery and conservative treatment All requirements for the operation were to be collected beforehand The patient was given light diet only or was kept stary ing before the operation The Fourth Part (Operative Ethics ) shows that asepsis and antisepsis was practised in India by Ayurvedic surgeons long before the importance of bacteria was shown in Europe with the discovery of microscope Caution and care in the use of instruments was advised The four precautions advised in the use of knife then hold good exactly for the dermatome today The incision was considered from its various aspects such as its qualities, the correct technique of incising, its direction, the counter incisions, extension of incision and dangers of improper incision Consideration was given to the choice of operation Importance of blood, of fluid replacement in time, and of replacement by an identical substance to that which has been lost was mentioned Shock, first aid and artificial respiration on a sinking patient were known Haemostasis was stressed and four methods of stopping the bleeding were practised Final check up of the wound before closure was advised, and suturing was to be done by the correct technique Cardiac arrest and its importance were shown The Fifth Part ( Post operative Ethics ) deals with the post operative ward and the bed, care of the patient, caution in the use of strong medicines, the post operative dressings and bandages and the relief from pain It was advised to check the result The Sixth Part deals with the ethics and importance of experimental surgery ( 13 ) The Seventh Part is devoted to a consideration of the quacks The Eighth and Ninth Parts deal respectively with the ethics towards the dying and the ethics in emergency surgery 8 It would have been much better if I had been able to give comments and paralled quotations from the modern text books and journals of surgery along with the Ayurvedic material Due to the almost insatieable desire of Pt Gaur Ji to be absolutely accurate in translating the Ayurvedic quotations, the publication already was getting long overdue Addition of the critical notes would have delayed it further However I am concious of the many omissions and errors that will be pointed out by the learned readers These will be rectified and some more comments added on modern surgical principles at another occasion G D Singhal Varanası Noy 13th 1963
No text on this page.
ACKNOWLEDGEMENT I express my sincere gratitude to Prof K N Udupa, MS, FRCS (C), FACS, Principal, College of Medical Sciences and Superintendent S S Hospital, Banaras Hindu University, Varanasi for his invalueable help and encouragement throughout the preparation of this work I am also thankful to him for kindly writing the foreword My father in law, that great and eminent Indian Sayant late Prof Dr Raghuvira was responsible in no mean way for moulding my ideas from purely modern medicine and surgery to a keen interest in ancient Indian system of medical science-Ayurveda He was an Indian in every drop of his blood, in every cell of his body and any feeling of nationality that I have in me today is due to him Any amount of written words to express my sincere gratefulness to that revered figure would fall short of my respectful feelings for him Syt J Dalmia, one of the closest friends of Dr Raghuvira, has provided me with indispensable help on occasions, more than one Never have I turned in vain from him for any help that I required Compared with his vast resources on the one hand and the highest Indian ideals that he holds on the other, one cannot but be impressed by his greatness My own thought processes have been influenced in no small way by trying to emulate his great ideas ( 16 ) Shri Jyoti Bhushan Ji Gupta, popularly and affecti onately known as Bhaiyya Ji honorary treasurer of the Banaras Hindu University has always been kind and helpful to me His keen interest and constant proddings about the progress of my work and his fatherly feelings towards me have always been a source of great inspiration and encouragement I am also grateful to Sh N H Bhagwatı, Vice Chan cellor of the Banaras Hindu University, Dr Lokesh Chandra, Director International Academy of Indian Culture, New Delhi, Sh Mohan Lal Ji Goenka of Bankura, Dr DS Kothari, Chairman University Grants Commission, New Delhi and to Prof AK Narain Prin cipal, College of Indology BHU for their helpful criticisms and for their sincere desire to see the glorious past of India brought to the light of the day I would like to take this opportunity of thanking my wife for looking after the house and children so well while I was busy preparing the manuscript and for never complaining when I should have given more time to her I am thankful to Sh Atma Ram Ji Dhandbania of The Annapurna Mills (Varanasi for providing me with a Hindi typewriter, without which it would have been very difficult to prepare the press copy To Pt Damodar Sharma Gour, I shall remain ever grateful for introducing me in such a lucid and masterly way, to a subject which I previously considered to have gone out of date His invalueable co operation and patience throughout the preparation of this work has been exemplary
( 17 )
To the publishers, Sh Chowkhamba Sanskrit Series
Office I express my feelings of indebtedness for so readily
agreeing to publish the work and for bringing it out so
soon and so efficiently They have been doing a great
service to the cause of Sanskrit and to that of India
Their patience, willingness and help at all times in the
production of this work has heen enviable
G D Singhal
Varanası Noy 13th 63
No text on this page.
प्रामुखम आयुर्वेदार्थतत्त्वाऽग्रहणपरतया हन्त पाश्चात्त्यतन्त्र- प्रायो लोकोऽभिजातस्तदिह विमुखता हर्तकामस्य नित्यम् । भूयो भूयोऽपि धन्वन्तरिकरुणतया वैद्यके प्राच्यतन्त्रे, भक्तबन्धाय भूयान्मम तु पुनरय यनसन्तानतन्तु ॥ इह खलु भारते वर्षे देशान्तरेभ्यो बहुकालात् प्रागेव लोकानु ग्रहप्रवृत्तोऽष्टाङ्गप्रविभक्त सुरनरतिय॑गायुरारोग्यप्रदो निखिल वैद्यकतन्त्राणा निदानभूत शाश्वतिकश्चायुर्वेदोऽतिशयेन समुन्नति पथमारूढो बभूवेति नाऽविदितमस्ति नीरजस्तमसामितिहास विदाम् | न च शास्त्रमिद केवलम् इहलोकहित सामान्यविज्ञान मात्र किन्तर्हि पुरुषार्थचतुष्टयसाधकत्वादुमयलोकहित पूर्ण क्रियात्मक च जीवनदर्शनम् | आयुषो वेद आयुर्वेद इति सज्ञाऽ प्यस्यान्वथैव । उच्यतेऽपि- 'अत्रायत्तमैहिकमामुष्मिक च श्रेय' इति । -सु० सू० ११४ 'तस्यायुष पुण्यतमो वेदो वेदविदा मत । वक्ष्यते यन्मनुष्याणा लोकयोरुभयोहितम् ॥ इति च । -च० सू० ११४३ सर्वविधदु खविमोचनपुर सरम् अभ्युदयनि श्रेयससिद्धिरेव च दर्शनशास्त्राणा परम प्रयोजनम् । आयुर्वेदे हि यथा रोगो रोगहेतुरारोग्य भैषज्यमिति सामान्यो पक्रमहशा व्यूहचतुष्टय वर्ण्यते तथैव ससार ससारहेतुर्मोक्षो मोक्षा- पायश्चेति व्यूहचतुष्कमपि नैष्टिकचिकित्साङ्गत्वेनोपवय॑ते । एव तत्त्वमीमासा, प्रमाणमीमासा, तर्कवादमीमासा, आचारमीमासा, मनोमीमासा चेति दर्शनागभूता विषयविशेषा अपि यथास्थल (20) सुगुम्फिता दृश्यन्ते | आत्महितसम्पादनक्षमत्वे सति प्रजाहित- सम्पादनक्षमत्व चायुर्वेददर्शनस्य दर्शनान्तरेभ्यो वैशिष्टयम् । वय चात्र सम्प्रति वेदस्यायुष आचारमीमासैकदेशमधि कृत्य प्रवृत्ता | सवृत्त हि सर्वेषु क्षेत्रेषु परमावश्यक विशेषतश्च चिकित्साक्षेत्रे | प्रतिक्षेत्र स्वार्थपरायणताऽनुशासनहीनता च याऽ वलोक्यते तयोर्हेतु सद्वृत्तस्य शिक्षणानुपालनाऽभाव एवेति तद्विद | पुण्यतममपि चिकित्साशास्त्र सद्वृत्तहीन चेद्धीनकोटिक पण्यविक्रयमात्र स्यात् । श्रूयते च-'यो म कामादपि ह काम' इति निन्दावचोऽपि । 'नार्थार्थ नापि कामार्थमथ भूतदया प्रति । वर्तते यश्चिकित्साया स सर्वमतिवर्तते - इति चरकोक्त (चि० शश५८) लक्ष्य सवृत्तहीनाना न कथमपि सम्भवति । अत- एवर्षिप्रणीतेषु सहिताग्रन्थेषु सद्वृत्ततया कृत कर्त्तव्योपदेश पदे पदे परिलक्ष्यते । अथैकदा "न चैव ह्यस्ति सुतरमादर्वेदस्य पार तस्मादप्रमत्त शश्वदभियोगमस्मिन् गच्छेत्” इति चरकोपदेश, “कामये दु खतप्ताना प्राणिनामार्त्तिनाशनम्" इति गीतोपदेश च दिवानिश कर्मण्यवतारयता विहतायुर्वेदोपवनसौरभविमुग्वमानसेन सुश्रुतेनेव विश्रुतेन शल्यकोविदेन सर्वेषामस्माकमध्यक्षप्रवरेण डा० के० एन० उडुपमहोदयेन सविशेष जनोऽयमनुरुद्ध आयुर्वेदस्य शल्यतान्त्रिकाणा सवृत्तवचसा निबन्धनाय सालानुवाद प्रकाशनाय च । मयाऽपि यथामति काले तदेतत् सर्व सम्पाद्य समर्पितम् , अवशिष्ट तु केवलमाडग्लानुवादकार्यम् , यदर्थमहमपि चिरात् पात्रविशेषस्यानुकाङ्क्षायामासम् । सौभाग्याच्चैकस्या परिषदि नवशल्यतन्त्रकुशलेन भारतीय- सस्कृतौ बद्धसहजानुरागेण आयुर्वेदाध्ययनार्थ कमपि सहयोगिन मपेक्षमाणेन डा० जी० डी० सिंघलमहाशयेन सह मे परिचयो जात सलापश्च । एकेनैकस्याकूत सम्यगवबुद्ध निर्णीतञ्च यत् कुतो नावाभ्या पवन्धन्यायेनापि नवसर्गारम्भ क्रियेत, येन न पूर्वजाना निधिभूतस्यायुर्वेदस्य लीन वैज्ञानिक स्वरूप जगत ( 21 ) पुरस्तात् प्रकटीभवेत् , पाश्चात्त्यवैद्यबन्धुषु व्याप्तो भ्रमराशिश्च शनै शनैदूरीभवेत् । परमसुहृदो डा० सिघलमहोदयस्यायुर्वेदा- नुरागेण तत्त्वबुभूषया दृढसङ्कल्पेन क्रियातत्परतया कर्मकौशलेन च भृश प्रभावितोऽहमादित एव । अत परश्चावाभ्या सोत्साह कर्मणि प्रवृत्ताभ्या निबन्धोऽय मापूरितो मासषट्केन, साधु सवृत्तश्चापि । सोऽय भगवतो धन्वन्तरेरनुग्रह एव मन्तव्य । प्रबन्ध एष नवसु प्रकरणानुक्रमेषु प्रविभक्तो वर्तते सामान्यसवृत्तम् , व्यावसायिक शैक्षणिक च सवृत्तम्, पूर्वकर्मसवृत्तम् , प्रधानकर्मसवृत्तम् , पश्चात्कर्म- सवृत्तम् , योग्याकरणसवृत्तम् , कुवैद्यवृत्तम् , मुमूर्षसवृत्तम् , आत्ययिकसवृत्त चेति। अथैवमेवान्य “आदिबलजन्मबलप्रवृत्ता प्रजाविकारा आयु- वेदसम्बोधश्च" (Concept of the Hereditary and Congenital Anomalhes in Ayurveda) इत्येवसशक उभाभ्यामप्यावाभ्या चिकित्साविज्ञानमहाविद्यालयस्य शारीरविभागाध्यक्षाणा डा. समेरसिहमहोदयाना सहयोगेन विरच्यमान आस्ते । सोऽप्य- चिरेणैव प्रकाशमेष्यति । एव सुक्षेत्रे बीजन्यासबुद्धथा क्रियमाणो युगानुरूप प्रयत्न सन्तान पाश्चात्यवैद्यबन्धूना नवविज्ञानाभिषिक्तहृदयान्तरस्थलीषु आयुर्वेदाङ्कुरजनने प्रभवति चेत् सफलो मे प्रयास इति विनिवेद्य विरमति । धन्वन्तरित्रयोदशी २०२० स्नातकोत्तरम् आयुर्वेदसस्थानम् हिन्दूविश्वविद्यालय , काशी। विदुषा विधेयो दामोदरशर्मगौडः
धन्यवादार्पणम्
प्रबन्धमिममवधानेन निरीक्ष्य महनीययाऽवतारिकयाऽलड्डुर्वतो
मूलप्रवर्तकस्याध्यक्षप्रवरस्य डा० के० एन्० उडुपमहोदयस्य
नामातिधारयामि | एव मुद्रणे प्रकाशने च साहाय्यकारिण
चौखम्बासस्थानाधिकारिणोऽपि मे चिरमनुस्मरणीया । डा०
सिघलमहाभागस्तु प्रथितस्य प्रबन्धशरीरस्य प्राणभतो प्रथयितुश्च
रसायनभूत एवेति किमधिक ब्रुवे | सर्वेभ्य एवैभ्यो भूरि भूरि
धन्यवादान समर्पयति-
१३।१२६३)
वाराणसी
स्नेहाधीनो
दामोदरशर्मगौडः
ABBREVIATIONS CS Caraka Samhita 9 > > > > CSI C S II CS III CS IV CSV C S VT CS VII CS VIII KS > > > > > > 2 > Sūtra Sthānam Nidāna Vimāna Shārıra Indriya Cikitsa Kalpa Siddhi Kashyapa Samhita Susruta Samhita Sūtra Sthānam Nidāna Shārıra Chikitsa Kalpa Uttar Tantra Vägbhatta (Younger) Vrddha Vāgbhatta (Elder) > 1 SS SSI SS II S S III S S IV SSV SS VI V V V > Both Vägbhattas Sūtra Sthānam Shărira Nidāna Cikitsa Kalpa Siddhi Uttar Tantra 1 II HII IV V VI
SURGICAL ETHICS IN AYURVEDA
(शल्यतान्त्रिक
सवृत्तम् )
No text on this page.
PARTI
GENERAL ETHICS
( सामान्यं सद्वृत्तम् )
A
B
The would be medical graduate
Qualities of a doctor in general
The high ideals of medical profession
The four great ethical principles
с
D
E
Ideals of a doctor
F
Doctor s duty towards the faithful patient
Behaviour towards ladies
H
Joint consultations
I Importance of differentiatiog between curable
and non curable cases
J Special qualities of a surgeon
K The nursing attendants
No text on this page.
PART I GENERAL ETHICS सामान्यं सद्वृत्तम् (A) The Would Be Medical Graduat भिषग्बुभूधुर्मतिमान् अत स्वगुणसम्पदि। पर प्रयत्नमातिष्ठेत् प्राणद स्याद् यथा नृणाम् ॥ च० २० १.१३३ "A wise student aspiring to be a doctor should try to increase bis proficiency in all aspects to the best of his ability by all possible means so that he may be con sidered a life giver to people CSI 1 133 (B) Qualities of a Doctor in general- Susruta dealt with three essential aspects before a doctor was entitled to surgical practice (१) अधिगततन्त्रेण, उपासिततन्त्रार्थन, दृष्टकर्मणा कृतयोग्येन, शास्त्रं निगदता, राजानुज्ञातेन, (२) नीचनखरोम्णा, शुचिना शुक्लवस्त्रपरिहितेन, ३) सुमनसा, कल्याणाभि- व्याहारण, अकुहकेन, बन्धुभूतेन भूताना, सुसहायवता वैद्येन विशिखाऽनुप्रवेष्टव्या। सु० सू० १०॥३ (1) Completion of the Medical education- “Practice can be started only after having read and thoroughly studied the science of medicine, having seen ( 30 ) and performed the operations himself having passed the appropriate tests and thence obtained the permission of the governing authority' (2) External appearance- "The hairs should be worn short and the nails pared Personal hygiene and cleanliness should have been taken care of He should wear white and sober dress (3) Personal behaviour- "On his visits he should go with a cool balanced mind, wishing every body, without trying to show off and with an attitude of help to all He should be accom panied by an able assistant S SI 103 (C) The High Ideals of Medical Profession- (१) नहि जीवितदानाद्धि दानमन्यद् विशिष्यते । च. चि. १४६१ "No other gift is better than the gift of life c s VỊ 1 4 61 २)नार्थार्थ नापि कामार्थमथ भूतदया प्रति। वर्तते यश्चिकित्साया स सर्वमतिवर्तते ॥ च० चि० ११४५८ "He who treats his patients only on humanitarian grounds without desiring any money or personal benefit in return, s upersedes all other physicians C S VÌ 1 4 58 (३)कुर्वते ये तु वृत्त्यर्थ चिकित्सापण्यविक्रयम् । ते हित्वा काञ्चन राशि पाशुराशिमुपासते ॥ चलचि० १।४।५९ ( 31 ) Those who trade their medical skill for personal livelihood can be considered as collecting a pile of dust, leaving aside the heap of real gold' c S VÌ 1 4 59 (४) परो भूतदया धर्म इति मत्वा चिकित्सया। वर्तते य स सिद्धार्थ सुखमत्यन्तमश्नुते ॥ च. चि. ११४। २ “He who regards kindness to humanity as his supreme religion and treats his patients accordingly, succeeds best in achieving his aims of life and obtains the greatest pleasures c s VỊ 1 4 62 (D) The Four Great Ethical Principles (१) सर्वत्र मैत्री करुणातुरेषु निरामदेहेषु नृषु प्रमोद । मनस्युपेक्षाऽपकृति बजत्सु वैद्यस्य सद्वृत्तमलङ्करोति ।। वृ० वा० उ० ५० (पृ ४१९) "Friendship with all, sympathy towards the sick, feeling of profound satisfaction upon recovery and over looking even those who feel 111 towards him are sufficient to fulfil the ethical requirements of a doctor v v VI 50 (p 419) २) मैत्रीकारुण्यमार्तेषु शक्ये प्रीतिरुपेक्षणम् । प्रकृतिस्थेषु भूतेषु वैद्यवृत्तिश्चतुर्विधा ॥ च० सू० ९।२६ “Friendship, sympathy towards the sick, interest in cases according to one s capabilities and no attachment with the patient after his recovery these are the four ethical principles of a doctor' CS 1926 ( 32 ) (E) Ideals of a Doctor- सर्वप्राणिभृता शर्म आशासितव्यम् । अहरहरुत्तिष्ठता चोप विशता च सर्वात्मना चातुराणामारोग्ये प्रयतितव्यम् । जीवि तहेतोरपि चातुरेभ्यो नाभिद्रोग्धव्यम् । मनसाऽपि परस्त्रियो नाभिगमनीया , सर्व च परस्वम् । निभृतवेशपरिच्छदेन भवि तव्यम्, अशौण्डेन, अपापेन, अपापसहायेन, श्लक्ष्णशुक्ल धर्म्यधन्यसत्यशय॑हितमितवचसा, देशकालविचारिणा, स्मृति मता, शानोत्थानोपकरणसम्पत्सु नित्य यत्नवता च । विज्ञानवताऽपि च नात्यर्थमात्मनो ज्ञाने विकस्थितव्यम् , आप्ता दपि विकत्थमानादुद्विजन्त्येके। च०वि० ८।१३ “Always pray for the well being of all creatures Fullest effiorts should be tried to cure the sick throughout the day and night, however you may be engaged Have no ill feeling towards a patient even for the sake of your living or life You should not commit adultery even in thought, nor covet others possessions Try to be simple and modest in your dress as well as in appearance Do not be a drunkard Neither do a sin nor associate yourself with any sinner Your language should be gentle pure, righteous, courteous, worthy, true, wholesome and moderate You should take your past experience into account Always try to increase your knowledge and equipment Do nt boast too much of your knowledge, even though you may possess it Others get offended by the boastfulness of even capable persons CS III 8 13 (F) Doctor's Duty Towards The Faithful Patient- मातर पितर पुत्रान् बान्धवानपि चातुर । अप्येतानभिशत वैद्ये विश्वासमेति च ॥
( 33 ) विसृजत्यात्मनात्मान न चैन परिशङ्कते। तस्मात्पुत्रवदेवैन पालयेदातुर भिषक् । सु० सू०२॥ ४३, ४४ "The patient may doubt his relatives, his sons and even his parents but he has full faith in the physician He gives himself up in the doctor s hand and has no misgivings about him Therefore it is the physicians duty to look after him as his own son SSI 25 43 44 (G) Behaviour Towards Ladies- न स्त्रीभि प्रेष्याभिरपि सहोपहास गच्छेत् , न चासाम- पूजापुरस्कृत नाम गृह्णीयात् , मान्यस्थानेनैव ब्रूयात् । न च भर्तुर विदितं स्त्रीभ्य किञ्चिदादद्यात् , न चाविदित प्रविशेत् । कश्यप (पृ. ४०-४१) “He should not c it jokes with the ladies or even with female servants, he should not call them by such dames which appear undignified he should be respectful towards them He should not try to mix up or be friendly with them No offering of any kind should be accepted from a woman without the knowledge of her husband or guardian, he should not enter the place without previous information K Sp 40,41 , (H) Joint Consultations- (१) वैद्यसमूहो नि संशयकराणाम् । च० सू० २५१४० १ “Doubts can be cleared by a group of physicians CSI 2540 ( 34 ) (२) न चान्यभिषभिर्विरोध गच्छेत् , सयुक्तश्च तैरौषध प्रकल्पयेत्। कश्यप० (पृ० ४१) "You should not have all feeling towards other physi cians but the management should be done after consulting them " K Sp41 (1) Importance of Differentiating between Curable and Non curable Cases- (१) साध्यासाध्यविभागको शानपूर्व चिकित्सक । काले चारभते कर्म यत्तत् साधयति ध्रवम् ॥ च० सू० १०१७ "The doctor who differentiates Intelligently between curable and non curable cases and provides appropriate treatment to the former in time is always successful CSI 10 7 (२) अर्थविद्यायशोहानिमुपक्रोशमसशयम् । प्राप्नुयानियतं वैद्यो योऽसाध्यं समुपाचरेत् ।। च० सू० १०१८ “The doctor who treats incurable cases definitely sustains a financial loss, diminishes his professional skill and reputation and also gets a bad name CSI 108 (J) Special Qualities of a Surgeon-- शौर्यमाशुक्रिया शस्त्रतक्ष्ण्यमस्वेदवेपथू। असम्मोहश्च वैद्यस्य शस्त्रकर्मणि शस्यते ॥ सु० सू० ५।१० ( 35 ) "Boldness, swiftness, sharpness of instruments, no sweating or trembling of hands and confidence are the praiseworthy qualities of a surgeon at the time of operation SSI5 10 (K) The Nursing Attendants- शोलशौचाचारानुरागदाक्ष्यप्रादक्षिण्योपपन्नान् उपचार- कुशलान् सर्वकर्मसु पर्यवदातान् सूपौदनपाचकस्नापकसवाह- कोत्थापकसवेशकौषधपेषकाच परिचारकान् सर्वकर्मस्वप्रति- कूलान् ( उपकल्पयेत्)। च० सू० १५७ ‘Only such nurses should be employed who have a noble character, are attentive towards cleanliness, are well behaved and affectionate towards the patient, are alert and have a helpful attitude, are expert in carryiog out the ordered treatment and have a thorough knowledge of their job In addition such nurses should also be employed who are dieticians, are expert in giving baths and shampoes are masseures, or are expert in changing postures and in preparing medicines They should faith fully and obediently carry out the given orders CSI 15 7
No text on this page.
PART II
PROFESSIONAL AND ACADEMIC ETHICS
( व्यावसायिक शैक्षणिक च सदृत्तम् )
A There is no end to the learing of Ayurveda
B Anatomy and pathology as the basis of surgery
C Knowledge has to be thorough
D
The value of related sciences
E
Both academic qualifications and practical
experience are equally important and essential
F The specialist and the specialities
No text on this page.
PART II
PROFESSIONAL AND ACADEMIC
ETHICS
व्यावसायिक शैक्षणिक च सद्वृत्तम्
(A) There is No End to The Learning of Ayurveda
न चैव ह्यस्ति सुतरामायुर्वेदस्य पारम् । तस्मादप्रमत्त
शश्वदभियोगमस्मिन् गच्छेत् । । भूयश्च वृत्तसौष्ठवमन
सूयता परेभ्योऽप्यागमयितव्यम् । कृत्स्नो हि लोको बुद्धिमता
माचार्य शत्रुश्चाबुद्धिमताम् ।
च० वि० ८1१४
"There is no end to the learning of Ayurveda Hence
you should cautiously and constantly devote yourself to
it In addition, you should increase your professional
skill by learning from others without being jealous The
intelligent would regard the whole world as their teacher
whereas the upintelligent would think the same as their
enemy
CS III 8 14
(B) Anatomy and Pathology as the Basis of
Surgery
(१) शरीरसख्या यो वेद सर्वावयवशो भिषक् ।
तदज्ञाननिमित्तेन स मोहेन न युज्यते ॥
च० शा० ७११९
(40)
"The surgeon who knows the structures fo all the
organs of the body cannot be mislead into errors et ana
tomical ignorance
CS IV 7 19
(२) शरीरे चैव शास्त्रे च दृष्टार्थ स्याद्विशारद ।
दृष्टश्रुताम्या सन्देहमवापोह्याचरेत् क्रिया ॥
सु० शा० ५.५१
Only he can be considered an expert ( surgeon ) who
is well versed in the practical and descriptive anatomy
Therefore, one should start the procedures (of surgery)
after clearing away the doubts by actually seeing ( the
surgical anatomy concerned ) and consulting ( the appro
priate literature)
SS III 5 51
(३) शानबुद्धिप्रदीपेन यो नाविशति तत्ववित् ।
आतुरस्यान्तरात्मान न स रोगाश्चिकित्सति ॥
च.वि. ४/१२
The physician who does not try to illuminate the
patient's basic internal (pathological ) derangements with
the help of the light of his knowledge, can not treat the
case properly
CS III 4 12
(C) Knowledge Has To Be Thorough
सूक्ष्मा हि द्रव्यरसगुणवीर्यविपाकदोषधातुमलाशयमर्म
सिरास्नायुसन्ध्यस्थिगर्भसम्भवद्रव्यसमूहविभागा , तथा प्रनष्ट
शल्योद्धरणवणविनिश्चयभग्नविकल्पा , साध्ययाप्यप्रत्याख्येयता
च विकाराणाम् , पवमादयश्चान्ये सहनशो विशेषा ये विचिन्त्य
(41) माना विमलविपुलबुद्धरपि बुद्धिमाकुलीकुर्यु कि पुनरल्पबुद्धे, तस्मादवश्यमनुपदपादश्लोकमनुवर्णयितव्यमनुश्रोतव्यं च । सु० सू० ४१ Minute consideration of the drug ( drayya ) for their taste ( rasa ), medicinal properties (guna ), potency or active principles (virya ) and reactionary effects (vipäka), of humours ( dosa ), tissues ( dhātu ) and excretory pro ducts ( mala), of viscera (asaya), vital organs ( marma) vessels ( sırā ) nerves (snayu), joints ( sandhi) and bones and cartilages ( asthi ) of developmental factors of the foetus of extraction of foreign matters lodged in the body, of differntial diagnosis of ulcers and wounds, of varieties of fractures and dislocations, of curability, palliativity and incurabilliy of the diseases and of thousands of such other problems baffle even those learned persons who possess a clear and vast knowledge what to speak of men with lesser intelligence Hence, it is very necessary for the teachers to explain thoroughly each verse and part thereof and for the stu dents to listen to these attentively SS I 4 5 (D) The Value of Related Sciences (१) एक शास्त्रमधीयानो न विद्याच्छास्त्रनिश्चयम् । तस्माद् बहुश्रुत शास्त्र विजानीयाचिकित्सक ॥ सु० सू० ४७ “A person who studies one branch of science only can not arrive at proper conclusions, therefore a physician should try to learn as many related sciences as possible SSI 47 ( 42 ) (२) अन्यशास्त्रोपपन्नाना चार्थानामिहोपनीतानामर्थवशात् तेषा तद्विद्येभ्य एव व्याख्यानमनुश्रोतव्यम् , कस्मानोकस्मिन् शास्त्रे शक्य सर्वशास्त्राणामवरोध कर्तुम् । सु० सू० ४।६ "In order to be able to understand the related sciences whose reference has to be taken in medical science because of necessity one should listen to the lectures given by specialists of that branch, as it is not possible to include all branches of science in one subject SSI 46 (३) सतताध्ययन वाद परतन्त्रावलोकनम् । तद्विद्याचार्यसेवा च बुद्धिमेधाकरो गण ॥ सु० चि० २८१२७ "In order to broaden your knowledge and outlook, you should study the subject regularly, take part in scientific debates and discussions, observe the allied sciences and take training from specialists of those branches SS IV 28 27 (E) Both Academic Qualifications and Practical Experience are Equally Important and Essential (१) यस्तु केवलशास्त्रज्ञ कर्मस्वपरिनिष्ठित । स मुह्यत्यातुर प्राप्य प्राप्य भीरुरिवाहवम् ।। सु० सू० ३४८ “He who knows theory only but is not so good in practical work gets bewildered on being confronted with a patient, in the same way as a coward feels on the battlefield SSI 348
(43)
(२) यस्तु कर्मसु निष्णातो धाष्ट्राच्छास्त्रबहिष्कृत ।
स सत्सु पूजा नाप्नोति वध चाहति राजत ॥
सु० सू० ३।४९
"On the other hand, he who is good in practical work
because of his boldness, but lacks theoretical knowledge,
is not respected in the cultured society, actually he
deserves punishment by the government
SSI 349
३) उभावेतावनिपुणावसमर्थो स्वकर्मणि ।
अर्धवेदधरावेतावेकपक्षाविव द्विजौ ॥
सु० सू० ३१५०
“Both these types of persons cannot be considered
experts and they are not capable of doing their work
properly, they possess one sided knowledge only and can
be likened to birds who have one wing only
SS I 3 50
(४) यस्तूभयशो मतिमान् स समर्थोऽर्थसाधने ।
आहवे कर्म निर्वोदु द्विचक्र स्यन्दनो यथा ॥
सु० सू० ३१५३
"Only that intelligent person who knows both theory
and practical work is capable of obtaining success in the
same way as only two wheeled vehicle is useful in the
battle field'
SS I353
(F) The Specialist And The Specialities
The surgical case was advised to be handled only by
a surgeon, The sub-specialities within surgery itself were
recognised
(44)
(१) पराधिकारेषु न विस्तरोक्ति ,
शस्तेति तेनात्र न न प्रयास ।
च० चि० २६।१३१
"It is not fair for a physician to interfere in the field
of a surgeon, hence I am not going into the details of
this subject
c S VỊ 26 131
(२) तत्र धान्वन्तरीयाणामधिकार क्रियाविधौ ।
वैद्याना कृतयोग्याना व्यधशोधनरोपणे॥
च० चि० ५।४४
'In such surgical cases, experienced surgeons only,
well versed in the techniques of operation, aspiration and
the art of healing, are authorised to perform operations
CS VI544
(३) दाहे धान्वन्तरीयाणामत्रापि भिषजा बलम् ।
क्षारप्रयोगे भिषजा क्षारतन्त्रविदा बलम् ।।
च.चि. ५६३
"Thus experts in the use of caustic or hot cauterization
should only handle the cases which fall in their domain'
c s VÌ 5 63
Classification Preoperative, Operative and Post Operative Stages- त्रिविधं कर्म-पूर्वकर्म, प्रधानकर्म, पश्चात्कर्मेति, तद् व्याधि प्रति प्रत्युपदेयाम । सु० सू० ५३ “The entire course of surgical treatment is classified into three stages-Pūrva Karma ( Preoperative Measures ), Pradhāna Karma (Operative Procedures ) and Paschāta Karma ( Post operative Care ) Each disease will be dealt with according to these headings' SSI 53
No text on this page.
PART III
PRE-OPERATIVE ETHICS
( पूर्वकर्मसदृत्तम् )
A
Forewarned is forearmed
B
Self assessment
с
D
The correct pre operative diagnosis
Emphasis on thorough history taking, physical
examination and repeated assessment
The treatment should be regulated according to
E
the severity of the disease and the condition of
the patient
F Importance of the power of resistance
Choice between surgery and conservative treat
ment
H
I
The requirements saould be collected beforehand
Pre operative localisation of the foreign body
Pre operative light diet and starvation
No text on this page.
PART III
PREOPERATIVE ETHICS
पूर्वकर्मसवृत्तम्
(A) Forewarned is Forearmed
(१) परीक्ष्यकारिणो हि कुशला भवन्ति ।
च० सू० १०॥५
"Safety is in their hands only who give consideration
to all the problems beforehand'
CS ] 105
(२) परीक्षायास्तु खलु प्रयोजनम् प्रतिपत्तिज्ञानम् ।
च० वि० ८1१३२
“The aim of thorough (preoperative ) examination is
to foresee the problems that they might have to face and
to have thought about the methods to tackle them
CS III 8 132
(३) ज्ञानपूर्वकं कर्मणा समारम्भ प्रशंसन्ति कुशला ।
च०वि० ८६८
“The experts advice that before taking any problem
in hand, prior consideration should be given to it intelli
gently
CS IIT 868
4
( 50 ) (४) तस्माद् भिषक् कार्य चिकीर्षु प्राक् कार्यसमारम्भात् परीक्षया केवल परीक्ष्यपरीक्ष्याथ कर्म समारभेत कर्तुम् । च० वि० ८७९ Therefore a practitioner who is keen to carry out any procedure should first of all examine and thoroughly investigate the same before carrying on the actual treat ment CS III 8 79 (५) सम्यगभिनिवर्तमान कार्याभिनिवृत्ताविष्टफलानुबन्ध कार्यमभिनिवर्तयत्यनतिमहता प्रयत्नेन । च० चि० ८८६ “A person who does his work in a correct and metho dical way completes it easily and obtains the desired results CS III 8 68 , (६) प्रवृत्तिनिवृत्तिलक्षणसंयोगे तु गुरुलाघव सम्प्रधार्य सम्यग अध्यवस्येद् अन्यतरनिष्ठायाम् । च० वि० ८१३४ “In complicated cases where some of the signs and symptoms indicate and others contraindicate a particular form of treatment the pros and cons of both should be weighed thoroughly before arriving at a proper conclu sion, which should then be carried out" CS III 8 134 (B) Self Assessment आत्मानमेवादित परीक्षेत गुणेषु, कार्यस्याभिनिर्वर्तने समर्थोऽस्मि न वेति । कश्चिदहमस्य च० वि०८1८६ ( 51 ) First of all one should consider his own merits as to whether he is capable of performing that particular work or not' CS III 886 (C) The Correct Preoperative Diagnosis (१) विप्रतिपन्नास्तु खलु रोगविक्षाने, उपक्रमयुक्तिशाने विप्रतिपद्यन्ते । च० वि०७४ , 'Those who really fail to diagnose a case correctly are also not able to render the correct treatment CS III 74 (२) त्रिविध खलु रोगविशेषविज्ञानम् , तद्यथा आप्तोपदेश प्रत्यक्षमनुमान चेति। च०वि०४३ There are three methods of diagnosing a casema sound theoretical knowledge gained by a review of the authoritative literature, complete physical examination of the patient and a process of deriving the proper inference CS III 43 (३) त्रिविधेन खल्पनेन ज्ञानसमुदयेन पूर्व परीक्ष्य रोगं सर्वथा सर्वमयोत्तरकालमध्यवसानमदोष भवति। न हि ज्ञाना- वयवेन कृत्स्ने शेये शानमुत्पद्यते । च०वि० ४।५ “When a conclusion is derived after thorough conside ration of the problem from these three aspects, it is without any error Full concept about the case cannot be achieved by considering it in parts only CS, III 45 ( 52 ) (D) Emphasis on Thorough History Taking, Physical Examination and Repeated Assessment (१) मिथ्यादृष्टा विकारा हि दुराख्यातास्तथैव च । तथा दुष्परिमृष्टाश्च मोहयेयुश्चिकित्सकम् ॥ सु० स० १०७ * Not taking a correct history and not doing a thorough examination by inspection and palpation can mislead the physician SS I 107 (२) प्रश्नेन च विजानीयाद् देश काल जाति सात्म्यमात समुत्पत्ति वेदनासमुच्छ्राय बलमन्तरग्निं वातमूत्रपुरीषाणा प्रवृत्त्यप्रवृत्ती कालप्रकर्षादींश्च विशेषान् । सु० सू० १०॥ The following points should be specially interrogated from the patient-residence, climate of the locality con cerned race and caste the articles which suit his cons titution and those to which he is sensitive onset and history of present illness The intensity and nature of pain, general health, appetite bowel, micturition dura tion of illness etc SS I 105 १ The history included the following points also (३) तत्र प्रकृतिर्जातिप्रसक्ता च कुलप्रसक्ता च देशानुपा तिनी च कालानुपातिनी च वयोऽनुपातिनी च प्रत्यात्मनियता चेति । जातिकुलदेशकालवय प्रत्यात्मनियता हि तेषा तेषा पुरुषाणा ते ते भावविशेषा भवन्ति । च० इ० १ "Race and caste, familiar peculiarities, residence, climatic conditions of that place, age and personal habits
( 53 )
of the patient-these are the factors which influence the
individual variations amongst persons
CSV 15
,
(४) तस्मादातुर परीक्षेत प्रकृतितश्च विकृतितश्च सार
तश्च सहननतश्च प्रमाणतश्च सात्म्यतश्च सत्वतश्च आहारशक्ति
तश्च व्यायामशक्तितश्च वयस्तश्चेति, बलप्रमाणविशेषग्रहणहेतो ।
च० वि० ८।९४
The constitutional pattern, pathological state, con
dition of the components, compactness and somatome
tric measurements of the body, dietary habits, psycho
logical make up, appetite and digestive power, exercise
tolerance and age of the patient should be examined
and considered to ascertain the degree of his strength
CS III 894
(५) मुहुर्मुहुश्च रोगाणामवस्था आतुरस्य च ।
अवेक्षमाणस्तु भिषक् चिकित्साया न मुह्यति ॥
“The physician, who repeatedly assesses the disease
process and examines the condition of the patient, is
not mislead easily in treatment
(६) व्याभ्यवस्थाविशेषान् हि ज्ञात्वा ज्ञात्वा विचक्षण ।
तस्या तस्यामवस्थाया तत्तच्छेय प्रपद्यते ॥
च०नि० ८।३७
“The wise doctor, recognising the different stages of
the disease process, prescribes the appropriate treatment
for those conditions
CS II 8 37
(54) (७) आतुरमुपक्रममाणेन भिषजाऽऽयुरादावेव परीक्षित- व्यम् , सत्यायुषि व्याभ्यृत्वग्निवयोदेहबलसत्वसात्म्यप्रकृतिभे- षजदेशान् परीक्षेत । सु० सू० ३५४३ "Before starting the treatment of a patient, his expectancy of life must be determined by the physician In hopeful cases, the examination should be conducted along these lines-nature of the disease, residence and seasonal variations, appetite age, physical condition and general health of the body, psychological aspects, the articles which suit his constitution and those to which he is sensitive, temperament of the patient and conside ration of appropriate treatment' SS I 353 (E) The Treatment Should be Regulated According to the Severity of The Disease And The Condition of the Patient- (१) तत्र सर्वाण्येवौषधानि व्याध्यग्निपुरुषबलान्यभिस- मीक्ष्य विदध्यात् । सु० सू० ३९।१० "All forms of treatment should be done only after full consideration of the intensity of the disease, the general condition of the patient and his digestive and metabolic powers' SS I 30 10 (२) न ह्यतिबलान्याग्नेयसौम्यवायवीयान्यौषधानि अग्नि क्षारशस्त्रकर्माणि वा शक्यन्तेऽल्पबले सोदुम् । तथा बलवति बलवन्याधिपरिगते स्वल्पमौषधमपरीक्षकप्रयुक्तमसाधकम् भवति। च०वि० ८९४ (55) “Very powerful medicines thermal and caustic treatment or major surgical procedures are beyond the capacity of toleration by the patients with poor general con dition Similarly, weak medicines given without adequate consideration to a strong patient with severe disease is not successful CS III 8 94 (३) अतिस्थूलो दुर्बलोऽपचितो वा व्याधिबलमेव ताव- दसमर्थ सोढु कि पुनस्तथाविधो भेषजमेवम्वेगम् । अतिबलानि संशोधनानि तथानिक्षारशस्त्रकर्माण्यल्पसत्वमातुरमल्पबल वा अतिपातयेयु । वृ० वा० ० २३ (पृ० १७०) "Very obese, very weak or emaciated patients cannot bear the brunt of the disease let alone the burden of excessively powerful treatment Such patients usually succumb to strong eliminating medicines, very energetic thermal and caustic treatment and major operations V V I 23 (p 170). , (F) Importance of the Power of Resistance-- (१) तत्र वय स्थाना दृढाना प्राणवतां सत्ववता च सुचिकित्स्या व्रणा , एकस्मिन् वा पुरुषे यत्रैतद् गुणचतुष्टयं तस्य सुखसाधनीयतमा । सु० सू० २३३३ , “The wounds heal very well in the following types of persons-young, strong and in patients with good physical and mental stability If all the four qualities are present in a patient, it is a pleasure to treat his wound S SI 23 3 ( 56 ) (२)स क्षीण कृच्छ्रता याति यात्यसाध्यत्वमेव च । तस्माद् रक्षेद् बल पुसा बले सति हि जीवितम् ॥ सु० उ०३९/१४७ • Upless taken care of, a patient in poor general con dition goes from bad to worse and later he may go beyond possibility of any recovery As life depends on the power of resistance, every effort should be made to protect it and increase it SS VI 39 147 (G) Choice between Surgery and Conservative Treatment (१) कुशलस्यापि वैद्यस्य यत सिद्धिरिहाऽध्वा । उपक्रमो जघन्योऽयमत स परिकीर्तित ॥ सु० चि. ० ७.२८ "As it is impossible to guarantee success in such cases by even experienced surgeons, it is recommended that this type of surgical procedure should be done only as a last resort SS IV 7,28 , (२) अक्रियाया ध्रुवो मृत्यु क्रियाया संशयो भवेत् । तस्मादापृच्छ्य कर्त्तव्यमीश्वर साधुकारिणा ॥ सु० चि० ७।२९ “When death is certain by non-operative treatment and surgery offers the only doubtful hope, it should be carried out after taking the consent of the guardian in order to justify himself १ SS IV 729 ( 57 ) (H) The Requirements Should be collected Before hand (१) भिषजा प्रागेव सम्भारा उपकल्पनीया भवन्ति । न हि सन्निकृष्टे काले प्रादुर्भूतायामापदि सत्यपि क्रयाक्रये सुकर माशु सम्भरणमौषधाना यथावत् । च० सू० १०३ * The doctor should collect and get ready with all the requirements beforehand Although facilities for getting the things may be there, at the crucial moment when complications arise it is not equally easy as if the drugs were available then and there CS I 153 -- २) अतोऽन्यतम कर्म चिकीर्षता वैद्येन पूर्वमेवोपकल्प यितव्यानि यन्त्रशस्त्रक्षाराग्निशलाकाशृङ्गजलौकालाबूजाम्बवौष्ठ- पिचुप्रोतसूत्रपत्रपट्टमधुघृतवसापयस्तैलतर्पणकषायालेपनकल्क- व्यजनशीतोष्णोदककटाहादीनि, परिकर्मिणश्च स्निग्धा स्थिरा बलवन्त । सू० सू० ५।६ “A surgeon wishing to do an operation should collect the following things beforehand instruments (both blunt and sharp), caustics, fire, probes (includes other such rod like insruments as sound, director etc ), horn ( an instrument used for cupping ), leeches, gourd (blood sucking apparatus ), jāmbavośtha (a cauterizing needle or probe ), cotton, gauze, suture and ligature materials, medicinal leaves bandages, honey, ghee, lard, milk, oil (to be used as ointment and soothing dressing ) refre shing liquids, decoctions, ointments, paste, fans (coolers), cold water, hot water and lowls etc
(58)
He should also have a team of assistants who should
be affectionate, steady and strong'
SS I 56
(1) Preoperative Localisation of the Foreign Body
शल्याकृतिविशेषाश्च स्थानान्यावेक्ष्य बुद्धिमान् ।
तथा यन्त्रपृथक्त्व च सम्यक् शल्यमयाहरेत् ।।
सु० सू० २७।२३
“Wise surgeon should find out the exact size and
shape of the foreign body, its exact location in the body
should be known beforehand and appropriate instrument
for its removal selected preoperatively, before taking the
foreign body out'
SS I 27 23
(J) Preoperative Light Diet and Starvation
(१)
लघुभुक्तवन्तम्
आतुरम्
सु० सू० ५७
“Before all operations the patient should take light
diet only
SS I 5 7
(२) मूढगर्भोदरार्थोऽश्मरीभगन्दरमुखरोगेष्वभुक्तवत
कर्म कुर्वीत ।
सु० सू० ५/१६
“The patient should be completely starving before
such surgical procedures as artificial or instrumental
delivery, abdominal conditions piles calculus disease,
fistula in ano, and surgical conditions of the mouth
SSI 5 16
PART IV
OPERATIVE ETHICS
(प्रधानकर्मसत्तम् )
A Asepsis and Antisepsis
B Care in the use of instruments
с The Incision
(1) Qualities of an 18cision
(2) The correct technique of incision
(3) Direction of incision
(4) Tha counter incisions
(5) Extension of incision
(6) Dangers of improper incision
D Choice of operation
E Importance of blood
F Importance of fluid replacement in time
G Replacement by identical substance which has
been lost
H Shock
I Careful Hæmostasis
J Final Check up before closure
K The correct technique of suturing
L Cardiac arrest
No text on this page.
PART IV
OPERATIVE ETHICS
प्रधानकर्मसद्वृत्तम्
(A) Asepsis And Antisepsis
(१) निशाचरेभ्यो रक्ष्यस्तु नित्यमेव क्षतातुर ।
सु० उ०६०३
"Patients in whom there is a break in the continuity
of tissues should always be protected from dangerous and
invisible creatures ( nišācara )
SS VI 60 3
Note It is remarkable that the conception of dan
gerous and invisible creatures existed in those days, even
in the absence of microscope
मास
(२) हिंसाविहाराणि हि महावीर्याणि रक्षासि
शोणितप्रियत्वात् क्षतजनिमित्त वणिनमुपसर्पन्ति ।
सु० सू० १९/२३
"The powerfully virulent and harmful organisms, to
whom flesh and blood is very dear, invade the patients
tissues through the portals of entry of ulcers and wounds
SSI 19 23
Note To day the bacteriologist employs meat broth
and blood agar plates to culture the bacteria
( 62 ) (३) नाऽसवृतमुख कुर्यात् श्रुतिहास्यविजृम्भणम् । वा० सू० २।३५ "One should not sneeze, laugh or yawn without covering the mouth" V I 2 35 Note This was to prevent airborne bacterial infec tion, the organisms coming from nose or mouth No one is permitted to enter the modern operation theatre without a cap and mask for the same reason (4) Protection of the wound from flies मक्षिका व्रणमागत्य नि क्षिपन्ति यदा कृमीन् । श्वयथुक्षिते तैस्तु जायते भृशदारुण ॥ सु० चि० ११११९ "When flies come and drop the invisible organisms on the wound they flourish on it and a severely painful swelling appears SS IV 1 119 (५) अग्नितप्तेन शस्त्रेण, छिन्द्यात् ॥ सु० चि० २।४६ ( अन्यथाऽतप्तशस्त्रच्छेदने पाकमय स्यात्-डहण .) "The surgical instruments should be used only after having been heated in the fire (Otherwise by using unheated instrument the risk of suppuration is present- Commentary by Dalhana on the same) SS IV 2 46 Note Could there be any better exposition of aesp tic surgery ? Suśruta should really be called 'Originator of Aseptic Surgery (63) (६) भग्नं नैति यथा पाकं प्रयतेत तथा भिषक् । पक्कमाससिरास्नायु तद्धि कृच्छ्रेण सिध्यति ॥ सु० चि० ३२६९ "The surgeon should make efforts so that in (com pound) fracture infection does not supervene Because suppuration of muscles, ligaments, vessels and nerves lead to great difficulties in the healing of fracture SS IV 369 (B) Care in the Use of Instruments (१) शस्त्रक्षाराग्नयो यस्मान्मृत्यो परममायुधम् । अप्रमत्तो भिषक् तस्मात्तान् सम्यगवचारयेत् ॥ वृ० वा० सू० ४० (पृ० २७४ ) "As sharp instruments, caustics and thermal cautery are great weapons of death the surgeon should use them very carefully with a balanced state of mind! vv I 40 (p 274) . (२) अजानता गृहीते तु शस्त्रे कायनिपातिते । भवन्ति व्यापदश्चैता बहवश्वाप्युपद्रवा ॥ सु० शा० ८।२१ "When a person unconversant with the handling of surgical instruments, uses them on the patients, above mentioned accidents and other complications are liable . to occur SS III 821 (3) An Advice to the Plastic Surgeons in the use of Dermatomes यदा सुनिशितं शस्त्रं रोमच्छेदि सुसंस्थितम् । सुगृहीत प्रमाणेन तदा कर्मसु योजयेत् ॥ सु० सू० ८।१४ ( 64 ) “When the blade of the knife has been made so sharp that it can slice the hair into two, the different parts of the instruments have been fixed properly, the adjustments regarding the measurements have been done correctly and it has been held in the proper way only then should it be used in surgical operations SSI 8 14 Every single word mentioned here holds true Note till to day (C) THE INCISION (1) Qualities of an Incision तत्रायतो विशाल सम सुविभको निराश्रय इति व्रण गुणा । सु० सू० ५८ “These are the qualities of a good incision--it should be of adequate length, extensible, having regular and uniformly cut edges, having all the layers cleanly incised and should be independent SS I 5 8 (2) The Correct Technique of Incısıng सकृदेवापहरेच्छस्त्रमाशु च । सु० सू० ५७ “The incision should be made swiftly in one stroke only SS I 5 7 Note "A sharp knife should always be used and the skin should be cut cleanly at one stroke throughout the distance required' (Farquharson, 1962) (65) (3) Direction of incision (१) अनुलोमं शस्त्रं निदध्यात् । सु० सू० ७ "The incision should be made in the direction of hairs SSI 5 7 (२) तत्र भ्रूगण्डशङ्खललाटाक्षिपुटौष्ठदन्तवेष्टककक्षाकुक्षि वडक्षणेषु तिर्यक् छेद उक्त । सु० सू० ११३ The incision should be oblique in the following regions-eyebrow, cheek temple forehead, eyelid lip, gum, axılla belly and groin SSI 513 (३) चन्द्रमण्डलवच्छेदान् पाणिपादेषु कारयेत् । अर्धचन्द्राकृतींश्चापि गुदे मेढ़ व बुद्धिमान् ॥ सु० सू० १४ The experienced surgeon should make the incision like a full moon (circular), or like a half moon (semicir cular) in the upper and lower limbs and about the anus and penis SSI 5 14 Note Examples of circular incisions are limb am putations circumcision and partial amputation of the penis The value of making semicircular incisions along lines of cleavage (Langer's lines) has been recognised only lately Surgical incisions made along Langer s lines heal with a minimum of scar tissue, incisions across the lipes heal with a heaped up or broad scar (Last, 1959) 5 .
( 66 ) (4) The Counter Incisions एकेन वा व्रणेनाऽशुध्यमाने नाऽन्तरा बुद्धयाऽवेक्ष्याऽपरान् वणान् कुर्यात् । सु० सू० ५।११ Counter incisions should be given at some distance, if one incision is not enough to clear the wound comple tely ' SSI 5 11 Note Counter incisions have to be given to provide adequate drainage, e g in dependent parts after incising a breast abscess and in flanks after splenectomy or chole cystectomy etc (5) Extension of Incision यतो यतो गति विद्यादुत्सगो यत्र यत्र च । तत्र तत्र वण कुर्याद् यथा दोषो न तिष्ठति ॥ सु० सू० ५.१२ "In whichever direction, the tracks lead and whereever pockets are present, at all those places incisions should be made so that no offensive material should be left' SS I5 12 (6) Dangers of Improper Incision अन्यथा तु सिरास्नायुच्छेदनम् , अतिमात्रं वेदना, चिराद् व्रणसरोहो, मासकन्दीप्रादुर्भावश्चेति । सु० सू० ५.१२ "If the above mentionedprecautions are not taken, there is danger of injuring the blood vessels and nerves
( 67 )
and causing excessive pain There is also a delay in
wound healing and keloids are likely to form'
-
SSI 515
(D) Choice of Operation
(१) स्वबुद्धया चापि विभजेत् कृत्याकृत्याश्च बुद्धिमान् ।
सु० सू० १८।३४
"The learned, with the help of his own knowledge,
should try to choose between the procedures which should
be carried out from those which have to be rejected'
SS I 1834
(२) उत्पद्येत हि साऽवस्था देशकालबल प्रति ।
यस्या कार्यमकार्य स्यात् कर्म कार्य च गहितम् ॥
च० सि० २।२६
“Circumstances arise sometimes, depending upon the
part affected, age and general condition of the patient
or upon the residence of the patient, the prevailing
climatic conditions and the severity of the disease, when
a recommended procedure become contraindicated and a
prohibited method of treatment becomes indicated
CS VIII 2 26
(३) न चैकान्तेन निर्दिष्टेऽप्यर्थेऽभिनिविशेद् बुध ।
स्वयमण्यत्र वैद्येन तळ बुद्धिमता भवेत् ॥
च०सि० २।२२
“The wise doctor should not adhere exclusively to
what is written in the books, but use his own discretion
and reasoning
CS VIII 2 25
( 68 )
(४) तस्मात् सत्यपि निर्दिष्टे कुर्यादूह्य स्वयं धिया ।
विना तर्केण या सिद्धिर्यदृच्छासिद्धिरेव सा ।।
च०सि० २०२८
।
“Although the authorities may recommend a certain
procedure, one should himself think about it intelligently,
because an unreasoned out procedure, even if it is success
ful can be considered only a chance success
CS VIII 2 28
(E) Importance of Blood
(१) देहस्य रुधिर मूल रुधिरेणैव धार्यते।
तस्माद् यत्नेन सरक्ष्य रक्तं जीव इति स्थिति ॥
सु० सू० १४१४४
' Blood is the origin of body , the body totally
depends upon it hence every attempt must be made to
preserve it In otner words blood is equivalent to the life
atself
SSI 1444
(२) तद्विशुद्धं हि रुधिरं बलवर्णसुखायुषा ।
युनक्ति प्राणिनं प्राण शोणित ह्यनुवर्तते ॥
च० सू० २४१४
“Pure blood ( containing adquate amounts of all its
constituents ) imparts strength, complexion and a healthy
life to the individual Actually the whole mode of life
of a person depends upon blood
CSI 24.4
(F) Importance of Fluid Replacement in Time
सद्य. क्षीणो हि सद्यो वै तर्पणेनोपचीयते।
च० सू० २३।३१
( 69 )
"In a case of quick loss of fluid, immediate replace
ment restores the balance and stabilizes the patient
CSI 23 31
(G) Replacement by Identical Subtance Which Has
Been Lost
तत्रापि स्वयोनिवर्धनद्रव्योपयोग प्रतीकार ।
सु० सू० १५/१०
Best treatment of any lost substance is replacement
by an identical expander
SS I 15 10
Note-Modern treatment of burns with plasma loss
demands that plasma or its substitute dextrayen
should be given as plasma expander within the
first 48 hours of burn
(H) Shock
(१) रुजाभिभूतं तु तत शरीरम् ,
प्रलीयते नश्यति चास्य संज्ञा ।
अतो हि शल्यं विनिहर्तुमिच्छन् ,
मर्माणि यत्नेन परीक्ष्य कर्षेत् ।।
सु० शा०६/२०
“After an accident or foreign body introduction, the
body feels intense amount of pain and conciousness is
gradually lost, resulting in shock In case surgical
intervention is required and extraction is considered
desirable, it should be done only after carefully exami
ning the vital organs
SS III 6 20
"
( 70 ) (2) First Aid and Artificial Respiration for Impending Shock on a Sinking Patient शीतलेन जलेनैन मूर्च्छन्तमवमेचयेत् । सरक्षेदस्य मर्माणि मुहुराश्वासयेच्च तम्॥ सु० सू० २७।११ "Cold water should be sprinkled on the patient who is gradually loosing conciousness, his vital parts should be protected and his breath should be revived again and again SSI 27 11 , (1) Careful Haemostasis (१) अथ शल्यमुद्धृत्य, निर्लोहित वणं कृत्वा, स्वेदार्ह मग्निघृतप्रभृतिभि संस्वेद्यावदा, प्रदिह्य सर्पिमधुभ्या, बद्ध्वा चाचारिकमुपदिशेत् । सु० सू० २७४१२ "After incision and removal of the cause of trouble? and having made the wound bloodless, having fomented with beat or by applying warm ghee etc having caute 1 The reference to context in this chapter is that of extrac tion of foreign bodies although the word Shalya has been used in Ayurved to imply all those causes in which their surgical removal is urgently indicated ºg any foreign body, collected pus obstructed foetus concoeled haematoma, tumours etc Modern surgery emphasizes on meticulous haemostasis The hazards of improper control of bleeding are only too well known Making the gbee hot would probably have sterilized it and its application on the wound would have served two 2 (71) rized', if necessary, having applied a paste of ghee and having bandaged, instructions should be given regarding its further management SS I 27 12 (२) चतुर्विधं यदेतद्धि रुधिरस्य निवारणम् । सन्धान स्कन्दन चैव पाचन दहन तथा ॥ सु० सू० १४१३९ “These are the four methods of stopping the bleedingsandhānams, skandanam', pacanamt, and dahnams SS I 1439 (J) Final Check up Before Closure १) पाशुरोमनखादीनि चलमस्थि भवेश्च यत् । अहृतानि यतोऽमूनि पाचयेयुभृश वणम् ॥ रुजश्च विविधा कुर्युस्तस्मादेतान् विशोधयेत् ॥ सु० सू० २५११८, १९ concious purposes--haemosta sis and a soothing effect especially during surgery on a or semiconcious patient as was practised in those days Hot swabs are used even to day to check the bleeding and clean the surgical wounds 1 Cauterization is a valuable method of haemostasis in surgery to day The diatbermy machine used for coagu lating or cutting is an indispensable armamentarium of the modern operation theatre Many scientific articles have been published on its use Process of helping the inherent tendency of vessels to contract by applying astringent lotions Process of thickening or coagulating the local blood Process of setting up suppuration in the wound Process of cauterisation 2 5 (72) Dust hairs, nails, loose bone pieces and such other (foreign) matter, when found in the wound ( befor clo sure), should be removed, because if they are not removed they would produce extensive suppuration and different types of pain SS 25 18, 19 (२) यथास्थान स्थिते सम्यग् अन्त्रे सीव्येदनुव्रणम् । स्थानादपेतमादत्ते जीवित कुपितं च तत् ॥ वा० उ० २६१४७ “The parities should be sutured only after replacing the intestines correctly at their appropriate places If it remains displaced (from its normal anatomical position), it can create trouble to the extent of taking life! V VI 26,47 (K) The Correct Technique of Suturing ततो वर्ण समुन्नम्य स्थापयित्वा यथास्थितम् । सीव्येत् सूक्ष्मेण सूत्रेण ॥ सु० सू० २५।२० "Then, having raised the edges of the wound and having brought them into apposition, they should be sutured by a fine thread' SSI 25, 20 (L) Cardiac arrest (१) आज्यशेषेण चास्य प्राणान् समालभेत । सु० सू० ५।१० प्राणशब्देनात्र हृदयादय उच्यन्ते, प्राणाधिष्ठानत्वात् , तान् समालभेत म्रक्षयेद् अभ्यञ्जयेदित्यर्थ, प्राणाप्यायनार्थम्- उल्हण ( 73 ) Ghee should be massaged over the vital parts for the recovery of life SSI 5 18 and Dallhana , (It could be considered a variant of external cardiac massage advocated recently by Kouwenhoven et al (1960), and others in place of open chest cardiac massage for cases of cardiac arrest ) (२)स ना संन्याससन्यस्त काष्ठीभूतो मृतोपम । प्राणैवियुज्यते शीघ्रं मुक्त्वा सद्य फला क्रियाम् ॥ दुर्गेऽम्भसि यथा मजद भाजन त्वरया बुध । गृह्णीयात् तलमप्राप्त तथा संन्यासपीडितम् ॥ च० सू० २४१४४,४५ “Sudden loss of conciousness and vital functions (eg cardiac arrest) making the patient almost dead and wood like demands measures which are immediately effective, otherwise bis life would be extinct soon In such cases action should be taken with the same quickness with which a wise person would try to grab a utencil which has fallen in deep waters before it reaches the bottom CSI24 44&45 "
No text on this page.
PART V
POST OPERATIVE ETHICS
(पश्चात्कर्मसद्भूत्तम् )
A
B
The Post operarive ward and the bed
Care of the patient
Caution in the use of strong medicines
C
D
Check the result
E
Post operative dressing and bandage
Post operative sedation
F
No text on this page.
PART V
POST-OPERATIVE ETHICS
पश्चात्कर्मसद्वृत्तम्
(A) The Post-operative Ward and the Bed
(१)व्रणितस्य
प्रथममेवागारमन्विच्छेत् , तश्चागार
प्रशस्तवास्त्वादिक कार्यम् ।
सु० सू० १९३
R
"First of all a ward for the operated case should be
selected That place should be well planned, well equip
ped and well arranged
SS I 193
(२) तस्मिन् शयनमसम्बाधं स्वास्तीर्ण मनोश प्राक्शिरस्कं
सशस्त्रं च कुर्वीत ।
सु० सू० १९८५
“The surgical bed should be of adequate dimensions
(size) and well provided with mattresses and drawsheets,
pleasant to look at, the head end should face towards
east and it should be well guarded
SS I 195
(३) तस्मिन् सुहृदुभिरनुकूल प्रियंवदैरुपास्यमानो यथेष्ट
मासीत।
सु० सू० १९७
"The patient should lie comfortably on such a bed
attended upon by sympathetic and affectionate friends
( 78 ) and relatives, who should be good conversationalists also SS I 19 7 (B) Care of the Patient १)निर्वातमागारं प्रवेश्याचारिकमादिशेत् । सु० चि ६४ "Having admitted the patient to such a ward, which is not exposed to blasts of wind, clear directions should be given regarding further management SS IV 6 4 (२) उत्थानसवेशनपरिवर्तनचक्रमणोच्चैर्भाष्याद्यासु आत्मचेष्टासु अप्रमत्तो व्रण सरक्षेत् । सु० सू० १९११ "The patient should carefully protect the wound from his own activities such as getting up, lying down, turning on the side or while he is up and about, or speaking loudly etc SS I 19 11. , (३) तत्र विसंसे व्यापन्ने च क्रियाविशेषैरविरुद्धैर्बलमा प्याययेत् । सु० सू० १५।२८ "In cases of lowered or deranged vitality, improvement in the condition should be tried by special restorative measures, which should not be injurious in any other respect SSI 1528 (४) रक्षेद् बलं चापि नरस्य नित्यं, तद्रक्षितं व्याधिबलं निहन्ति ।। सु० चि० १८३ ( 79 ) “Patient's general health should always be maintained, as it helps to lessen the intensity of the disease process SS IV 183 (५) दीर्घकालातुराणा तु कृशाना व्रणशोषिणाम् । बृहणीयो विधि कार्य कायाग्निं परिरक्षता ॥ सु० चि० १११२३ The chronically sick emaciated patient and those in whom discharging ulcers have been present for a long time causing debility, an attempt should be made to increase his weight by feeding him with a highly nutritious diet, without upsetting the gastro intestinal tract , SS IV 1 123 (6) Importance of Healing From the Bottom-(eg Operated Fistula-in-ano) न चैन त्वरमाण सान्तर्दोष रोपयेत् , स ह्यल्पेनाऽप्यपचा रेणाभ्यन्तरमुत्सङ्ग कृत्वा भूयोऽपि विकरोति । सु० सू० ५।३७ Due to haste, the wound should not be allowed to heal up leaving some insipid matter or pus underneath, as it would lead to recurrence on the slightest provocation S SI537 (C) Caution in the Use of Strong Medicines (e g Antibiotics) विभ्रशो विषवद् यस्य सम्यग् योगो यथामृतम् । कालेऽववश्यं पेय च तस्माद् यत्नात् प्रयोजयेत् ॥ च० क० १२१८५
(80)
When due to certain unavoidable circumstances,
such medicine is indicated whose correct use produces
nectar like effects but may act as poison if improperly
administered, it should be used with skill and care
CS VII 12 85
(D) Check The Result
It was advised to check the results of operation
post operatively As an example signs of correct
reduction after fracture or dıslecation is cited here
(१) अस्थिभग्नं च्युत सन्धि सन्दधीत समं पुन ।
समेन सममङ्गेन कृत्वाऽन्येन विचक्षण ।
च. चि. २०६८
“The expert surgeon should reduce correctly the frac
tured bone or a dislocated joint, comparing it with the
opposite normal part
C S VI 25 68
(२) भग्नं सन्धिमनाविद्धमहीनाङ्गमनुल्वणम् ।
सुखचेष्टाप्रचार च सहितं सम्यगादिशेत् ।।
सु० चि० ३१७०
"A dislocated joint should be regarded reduced corre
ctly only if it is unlocked, is not shortened in length,
is not unduly prominent and is freely movable without
pain'
SS IV 3 70
(E) Post Operative Dressing and Bandage
१) तत कल्केनाच्छाद्य, घना कवलिका दत्वा,वस्त्रपट्टेन
बध्नीयात् ।
सु० सू० ५।१७
(81) “After this, medicinal pastes should be applied over the wound which should then be covered by a thick layer of pad and bandaged, SSI 5 17 (2) The second dressing ततस्तृतीयेऽहनि विमुच्यैवमेव बध्नीयाद् वस्त्रपट्टन, न चैनं त्वरमाणोऽपरेधुर्मोक्षयेत् , द्वितीयदिवसे परिमोक्षणाद् विग्रथितो व्रणश्चिरादुपसरोहति, तीव्ररुजश्च भवति । सु० सू० ५॥३५ “After this the old bandage should be opened on the third day and reapplied exactly as before There is no hurry to open it on the second day If the bandage is opened on the second day, it may lead to delayed beal ing and cause more pain SSI 5 35 (3) Further dressings अत ऊर्ध्व दोषकालबलादीनवेक्ष्य कषायालेपनबन्धाहाराचा रान् विदध्यात् । सु० सू० ५।३६ “After this (third day), during further dressings lotions, ointments, bandages, diet and the period of am bulation and other activities should be varied depending upon the condition of the wound, the prevailing climatic condition of the year (hot, cold or humid etc ) and the general condition of the patient S SI536 ४) हेमन्त शिशिरे चैव वसन्ते चापि मोक्षयेत् । व्यहाद् द्वयहाच्छरद्ग्रीष्मवर्षास्वपि च बुद्धिमान् ॥ सु० सू० ५।३९
(82)
"In winter and spring the dressing should be changed
every
rd day and in summer and rainy season every
second day
SSI539
.
१
(F) Post operative sedation
या वेदना शस्त्रनिपातजाता तीवा शरीरं प्रदुनोति जन्तो ।
घृतेन सा शान्तिमुपैति सिक्ता कोणेन यष्टीमबुकान्वितेन ॥
सु० सू० ५।४१
“Severe pain due to the operative procedure making
the patient restless can be relieved by gently applying
luke warm ghee mixed with mulethi (Glycerrhiza Glabra)
SSI 541
PART VI
THE ETHICS AND IMPORTANCE OF
EXPERIMENTAL SURGERY
( योग्याकरणसद्वृत्तम् )
No text on this page.
PART VI THE ETHICS & IMPORTANCE OF EXPERIMENTAL SURGERY योग्याकरणसद्वृत्तम् Definition of Yogyā (१) कर्त्तव्यकर्मण सम्यग्योगाय तत्सदृशकर्माभ्यासो योग , तेन योगाय प्रभवतीति योग्या। चक्रपाणि (सु० सू० ९१) "To obtain complete success in the aimed (operating) work, practise of similar operations before hand is called yoga ( experiment), and performance of such practise is called yogya' Commentary by Cakrapānı on SSI 9 1 (२) तस्मात् कौशलमन्विच्छन् शस्त्रक्षाराग्निकर्मसु । यस्य यत्रेह साधर्म्य तत्र योग्या समाचरेत् ॥ सु० सू० ९/६ “Therefore he who wants to be expert in the use of surgical operations and caustic or thermal cauterization should practice the same experimentally on similar problems" SSI 96
(8)
(३) प्रयोगशस्य वैद्यस्य सिद्धिर्भवति नित्यश ।
तस्मात् परिचयं कुर्याच्छलाणा ग्रहणे सदा ॥
सु० सू०८/२०
“That surgeon always gets success who is well versed
in the art of using surgical instruments, therefore he
should always be trying to acquire knowledge in the use
of various instruments
SS I820
(४) एवमादिषु मेधावी योग्याहेषु यथाविधि ।
द्रव्येषु योग्या कुर्वाणो न प्रमुह्यति कर्मसु ॥
सु० स० ९/२
“An intelligent surgeon who does experimental
surgery methodically on such articles as stated above does
not lose the presence of his mind while doing the actual
operation
SSI915
PART VII
QUACKS
( कुवैद्यवृत्तम् )
No text on this page.
PART VII
QUACKS
कुवैद्यवृत्तम्
(१) शास्त्र गुरुमुखोद्गीर्णमादायोपास्य चासकृत् ।
य कर्म कुरुते वैद्य स वैद्योऽन्ये तु तस्करा ॥
सु० सू० ४१८
"The physician who learns the science of medicine
under the guidance of his preceptors and regularly takes
the practical training and then practices medicine is a
real physician, others are quacks'
SS I 4 8
(२) स्नेहादिष्वनभिज्ञो यश्छेद्यादिषु च कर्मसु ।
स निहन्ति जन लोभात् कुवैद्यो नृपदोषत ॥
सु० सू० ३.५२
"The practitioner who dues not know medical proce
dures (eg massage, heat therepy, medication, purgation,
stomach wash by the vomitting technique and enema etc)
and surgical techniques (e g incision, drainage, tapping,
curettage, sounding, probing etc ) is a quack Such a
person kills people due to his greediness, and survives
only because of the negligence of the government
S SI352
(90) (३) यश्छिनत्याममज्ञानाद् यश्च पकमुपेक्षते । श्वपचाविव मन्तव्यौ तावनिश्चितकारिणौ ॥ सु० स० १७११० “Surgery by him who ope is an unripe swelling, as also of his who neglects a 'ripe abscess is based on indecision and both of them should be regarded as quacks S SI 17 10 (8) आम विपच्यमान च सम्यक् पक्वं च यो भिषक् । जानीयात् स भवेद् वेद्य शेषास्तस्करवृत्तय ॥ सु० सू० १७६ "He who knows when the abscess is unripe, has a tendency towards ripening or is fully ripe is the real doctor Others are q lacks SS I 176 (५) ओषध्योऽमृतकल्पास्तु शस्त्राशनिविषोपमा । भवन्त्यरुपहृतास्तस्मादेतान् विवर्जयेत् ।। सु० सू०३१५१ "Medicines equivalent even to nectar ( a fluid which when orally taken makes the person immortal and eternally young) when prescribed by quacks may act like fatal weapons, lightening or poisons, hence one should avoid the quacks SS I III 51
PART VIII
ETHICS TOWARDS THE DYING
( मुमूर्षुसद्वृत्तम् )
No text on this page.
PART VIII
ETHICS TOWARDS THE DYING
मुमूर्षुसवृत्तम्
(१) दृष्टारिष्मपि चातुर न तत्त्व ब्रूयात् ,
नित्यमाश्वा
सयेत् ।
कश्यप (पृ. ४१)
“Even after having noticed the signs of impending
death the doctor should not tell that to the patient
instead constant reassurance should be given
KS p 41
(२) हसित चायुष प्रमाणमातुरस्य जानताऽपि त्वया न
वर्णयितव्य तत्र यत्रोच्यमानमातुरस्याऽन्यस्य वाऽप्युपघाताय
सम्पद्यते।
च०वि०८।१३
“Diminished expectancy of patient s life, even if you
know, should not be mentioned at such place where if
so said, it would hurt the patient or someone else'
CS III 8 13
(३) यावत् कण्ठगत प्राणस्तावत् कार्या प्रतिक्रिया।
कदाचिदैवयोगेन दृष्टारिष्टोऽपि जीवति ॥
भैषज्यरत्नावली
"Appropriate treatment must be carried out till the
last breath of the patient s life because sometimes luckily
even the dying patient may survive'
--Bhaisajya Ratnāyalı
PART IX
ETHICS IN EMERGENCY SURGERY
( आत्ययिकसद्वृत्तम् )
PART IX
ETHICS IN EMERGENCY SURGERY
अत्ययिकसद्वृत्तम्
अतिपातिषु रोगेषु नेच्छेद् विधिमिमं भिषक् ।
प्रदीप्तागारवच्छीजं तत्र कुर्यात् प्रतिक्रियाम् ॥
सु० सू० ५।४०
"In emergency cases, the doctor should not apply
the routine methods of treatment, instead he should act
as if his own house is on fire ”
SSI540.
समाप्तश्चायं प्रबन्धः
भिषजा साधुवृत्ताना भद्रमागमशालिनाम् ।
अभ्यस्तकर्मणा भद्रं भद्रं भद्राभिलाषिणाम् ॥
वा० उ०४०७७
REFERENCES
1
Caraka Samhitā Edited by Vaidya Jädavaji Trikamji
Acharya, (1941), (1945) N S Press, Bombay
2 Farquharson, E L (1962) Text book of Operative
Surgery, 2nd Ed P 1
E S Livingston Ltd , Edinburgh
3
Kouwenhoven, W B, Jude JR, and Knicker
bocker, GG (1960) J Amer Med Ass 173
1064
4
Last RJ (1959) Anatomy, Regional and Applied
2nd ed p 2
J & A Churchill Ltd, London
5
Susruta Samhita Edited by Nārāyan Ram Acharya
NS Press, Bombay
6 Vägbhatta Asthanga Hridaya
7 Vrddha Vägbhatta Ashtanga Sangraha