Surgical instruments number one hundred and one * in all, of which the hand is the most important, inasmuch as (all of them depend on the hand for their principal auxiliary) and as none of them can be handled without it; and further because all surgical operations pre-eminently require its co-operation. Any foreign or extraneous substance, which finds a lodgment in the human system and becomes painful to the body and the mind alike, is called a Shalyam; and surgical instruments are the means of extracting it from its seat or place where it is embedded .
(Surgical) Appliances may be divided into six different groups or types, such as the Svastika, the Sandansha, the Tala, the Nadi Yantras, and the Shalakas, besides those that are called the minor or accessory appliances (Upa-yantras).
The Svastika instruments (forceps) in their turn, are divided into twenty-four sub-classes; the Sandansha instruments (tongs) into two; the Tala Yantras into two; the Nadi Yantras (tubular) into twenty; and the Shalakas (bougies) into twenty-eight; while the Upa-yantras admit of being divided into twenty-five different types. These instruments are all made of iron which may be substituted for any other similar or suitable substance where iron would be unavailable.
* According to certain authorities hundred is here indefinitely used for a large number.
The mouths of these appliances are usually made to resemble those of birds and beasts, and hence they should be made to resemble the mouths of some particular animal in shape, or otherwise, according to the advice of old and experienced physicians (surgeons), or according to the directions as laid down in the Shastras (Medical books of recognised authority , or according to the exigencies of the case, or after the shape and structure of other appliances used on similar occasions.
Appliances should be made neither too large nor too small, and their mouths or edges should be made sharp and keen. They should be made with a special eye as to strength and steadiness, and they should be provided with convenient handles.
Appliances of the Svastika class should be made to measure eighteen fingers in length; and their mouths should be made to resemble those of lions, tigers, wolves, hyenas, bears, cats, jackals, deer, Ervarukas a species of deer, crows, cormorants, Kururas a species of bird), Hasas (a species of sparrow-vultures, falcons, owls, kites, herons, Bhringarajas (a species of bird, Anjalikarnas, Avabhanjanas, Nandimukhas. and such like beasts and birds. The two blades or halves of a Svastika should be welded together by means of a bolt resembling a Masura pulse lentil in size, and the handles should be turned inward in the shape of a mace, or an Ankusha. Appliances of this type should be used in extracting any thorn or foreign matter which may have entered into the bones.
Sandanshas tongs are divided into two classes as they are soldered together with or without a bolt. They should be made to measure sixteen fingers in length, and should be used to withdraw any thornlike substance from below the skin, flesh, veins or nerves.
The Tala Yantras which measure twelve fingers in length, may be divided into two classes as the single Tala and the double Tala. The former resemble the scales of fish in shape, while the latter, according to certain authorities, are made to resemble the entire mouth of a fish of the Bhetuli species. These Yantras are used in extracting splinters from inside the nose, ears and other external channels or passages of the body.
The Nadi Yantras tubular instruments like syringe, enemas, etc. with a passage or aperture running through their entire length) are constructed in a variety of shapes and for various purposes. Some of them are open at one end, while others are open at both. These instruments are used for the purpose of extracting any shalyam that has pricked into the external canals or passages of the body, or for inspecting the seat of affection as in piles, etc., or for sucking (blood, etc. from any affected part), or simply as accessories to other surgical appliances. The length and circumference of a Nadi Yantra should be made to commensurate with those of the passage (Srota) or outlet of the human system into which it is intended to be introduced. We shall describe, later on, the types of Nadi Yantras which are to be used in connection with such diseases as fistula in ano, piles, etc. or in tumours and ulcers, in Mutradvriddhi (Hydrocele) in Niruddha Prakasha (Phimosis), in Niruddha Guda stricture of the rectum) and in ascites, as well as those to be used for the purpose of injecting anything into the urethra, the bowels, the vagina and the uterus, or are used in connection with medicated inhalation, or with those that are known as the Alavu Yantras (gourd used for cupping).
The Shalaka-Yantras bougies are of various shapes and serve a variety of purposes. The lengths and girths of these instruments should be determined according to the necessity of each individual case. Four probes or directors shalaka in two pairs, are used for the purposes of searching Eshana pus in a suppurated part or limb, or in connection with uplifting, cutting and thereby withdrawing a shalyam from the part it has pricked into, or with a view to transfer such a body from one place to another Chalanam , or for the purpose of extracting it Shalyam from the affected part. The mouths of the two types of these directors respectively resemble those of a Gandupada earthworm and of a Sharapunkha Tephrosia Purpurea, Pers while the other two are respectively headed like the hood of a serpent and a fish hook. A couple of directors are used for the purpose of withdrawing a foreign matter Shalyam imbedded in any outer canal of the body Srotas . The top-ends of these directors are bent down a little, and they resemble a lentil seed in size. Six types of directors or probes are used in cleansing the pus from an affected part of the human organism | and their top-ends are fitted with caps of loose cotton. The three sorts of directors used in applying alkaline medicines, are shaped like ladles, and their mouths resemble the cavities of little stone mortars (Khala.) Of the six sorts of directors used in connection with the process of cauterisation (Agni-Karma) three are mouthed like the Jamboline fruit, while the other three are faced like a mace or a spear (Ankusha), A kind of director used in removing nasal tumours, is mouthed like the half of the kernel found in the inside of a Jujube-stone, with a little dip in the middle, its lip or end having a keen or sharp edge. The ends of the type of probe used in applying Anjanams medicated collyria to the eyelids are wrought into two small round lobes like the Matara pulse and are blunted, while the sort of probe used in cleansing the urethrals made round like the end of the stem of a Malati flower.
The Upa-yantras or minor surgical accessories - include such substances as rope, the Venika (braided hair , silk thread, the bark and the inner-skin of trees, creepers, linen, Ashthila (stones), large oval shaped pebbles, a hammer, the palms of the hands, the soles of feet, fingers, tongue, the teeth, the nails, hair, the mane of horses, branches of trees, a magnet, alkali, lire, and medicine, and such acts as spitting, straining (kunthanam), exhilaration and intimidation.
These accessories should be applied to the entire body of a patient, or to any part thereof such as, the arteries, the viscera, or the joints, according to the necessities of each case to be determined by the surgeon.