The lobules of the ears of an infant are usually pierced through for protecting it (from the evil influences of malignant stars and spirits) and for the purposes of ornamentation as well. The piercing should be performed on a clay of bright fortnight marked by the auspicious lunar and astral combinations, and in the sixth or the seventh month of the year reckoned from its beginning (Bhadra). The child should be placed on the lap of its nurse, and benedictions should be pronounced over it. Then having soothed it and lured it with toys and playthings, the physician should draw down with his left hand the lobules of its ears with a view to detect, with the help of the reflected sun-light, (the closed up) apertures that are naturally found to exist in those localities. Then he should pierce them straight through with a needle held in his right hand, or with an awl (Ara), or with a thick needle where the appendages would be found to be too thick. The lobule of the right ear should be first pierced and then the left in the case of a male child, while the contrary should be the procedure in the case of a female. Plugs of cotton-lint should be then inserted into the holes of the pricked ear-lobules, which should be lubricated or rubbed with any unboiled oil. A copious bleeding attended with pain would indicate that the needle has passed through a place other than the natural (and closed up) fissure described above; whereas the absence of any serious after-effect would give rise to the presumption that the piercing has been done through the right spot. Any of the local veins incidentally injured by an ignorant, bungling surgeon, may be attended with symptoms which will be described under the heads of Kalika, Marmarika, and Lohitika.

Kalika is marked by fever and a burning pain in the affected part and swelling. Marmarika gives rise to pain and knotty (nodular) formations about the affected region, accompanied by (the characteristic inflammatory) fever; while in the last named type (Lohitika) symptoms such as, Manya-Stambha (numbness of the tendons forming the nape of the neck), Apatanak (a type of tetanus), Shirograha (headache) and Karna-shula (ear-ache) exhibit themselves, and they should be duly treated with medicinal remedies laid down under their respective heads. The lint should be speedily taken out from a pierced hole which is marked by extreme pain and swelling, etc., on account of its being made with a blunt, crooked or stunted needle, or owing to its being plugged with a deep and inordinately large lint, or to its being disturbed by the aggravated bodily humours (Doshas), or to its being made at a wrong place. An unguent composed of Madhuka, Eranda roots, Manjistha, Yava, Tila, honey and clarified butter pasted together, should be thickly plastered over the affected part until the ulcers are perfectly healed; after which the lobules of the ears should be again pierced through according to the directions laid down before.

The lint should be removed, each third day, and a thicker one should be inserted in its stead on each successive occasion, and the part should be rubbed with (unboiled oil) as before. For the expansion of the fissures, (sticks of Nimba or Apamarga, or rods of lead) should be inserted into them after the subsidence of the accompanying symptoms and deranged bodily humours (in the locality).

Metrical Text

The fissures thus expanded may ultimately bifurcate the lobules of the ears owing to the effects of the deranged bodily humours (Dosha), or of a blow. Now hear me discourse on the mode of adhesioning them (with suitable bandages).

These unions or adhesions admit of being briefly divided into fifteen different kinds, viz., the Nemi-sandhanaka, the Utpala-Bhedyaka the Valluraka, the Asangima, the Ganda-karna, the Aharyaya, the Nirve-dhima, the Vyayojima, the Kapata-sandhika, the Ardha-kapata-sandhika, the Samkshipta, the Hina-karna, the Vallikama, the Yasthi-karna, and the Kakaushthaka.

Out of these, the process, known as the Nemi-sandhanaka, should be used in cases where each of the bifurcated lobes of the ears would be found to be thick, extended, and equal in size. The process, known as the Utpala-Bhedyaka, should be used in cases where the severed lobes of the ears would be found to be round, extended, and equal in dimensions. The process, Valluraka should be resorted to in cases where the severed lobes of the ears would be found to be short, circular and equal in size. The process, known as the Asangima, should be adopted in cases where the anterior surface of one of these severed appendages would have a more elongated shape than the other. The process, known as the Ganda-Karna, consists in slicing off a patch of healthy flesh from one of the regions of the cheeks and in adhering it to one of the severed lobes of the ears which is more elongated on its anterior side than the other (Plastic-operations). In the case of extremely short lobes, the flesh should be cut off from both the cheeks and adhered to them, the process being known as the Aharyaya. The lobes of the ears which have been completely severed from their roots are called Pithopamas. The process known as the Nirvedhima should be resorted to in such cases by piercing the two Putrikas Tragus and Anti-tragus of the ears.

The process known as the Vyayojima should be made use of in cases where one of the bifurcated lobes of the ear should be found to be dissimilar to the other as regards its thickness or thinness. The process known as Kapata-Sandhika consists in bringing about an adhesion, on the posterior side, between one of the bifurcated lobes and another, which is elongated on the anterior side of the ear. The adhesion is so called from the fact of its resembling the closing of the two leaves of a door (Kapatam), The process known as the Ardha-Kapata-Sandhika consists in bringing about an adhesion on the anterior side between the shorter one of the two parts of a bifurcated eai-lobe with the part, elongated on the posterior side, like a half-closed door.

The ten aforesaid processes of adhesion may be successfully brought about and their shapes can be easily pictured from the meanings of their respective names.

The remaining five sorts such as the Samkhiptam etc., are seldom attended with success and hence are called impracticable (Asadhayas). The process Samkhiptam has its scope in the case where the auricle (Shashkuli) has been withered up and one of the bifurcated lobes is raised, the other being reduced and shortened. The process of Hina-karna should be adopted in cases where the supporting rim of the lobe (pinna) has been entirely swept away and its exterior sides and the cheeks are sunk and devoid of flesh. Similarly the adhesive process known as the Vallikarna is indicated in cases where the lobes are short, thin and unequal. The adhesion known as the Yasthi Kama is indicated in cases where the thin and severed ear-lobes are run across with veins and made of knotty or nodular flesh. The case in which the ear-lobe, being permeated with a little quantity of blood, is fleshless and ends in a narrow tip or end, furnishes the occasion for Kakusthakapali.

The five abovesaid adhesions, if followed by swelling, inflammation, suppuration and redness of the affected part and found to be secreting a sort of slimy pus or studded over with pustular eruptions, may be apprehended as not to be attended with success.