A Shalyam, lodged in any other part of the body and that is difficult to extract, and that produces pain and local inflammation, should be removed by cutting the part open. In the case of a shaft (Shalyam) which has pierced into the cavity of a bone, the surgeon should firmly press the affected bone with his legs, and pull out the embedded shaft with all his might by gripping it with a surgical instrument, in failure whereof a strong man should be asked to firmly catch hold of the patient, and the Shalyam should be pulled out with the help of a gripping surgical instrument as before.
As an alternative, the bottom of the shaft should be tied to the string of a bow, strung and fully bent down; and the Shalyam should be ejected with the means of a full twang. As an alternative, a horse should be harnessed in the fashion known as the Panchangi-vandhanam (lit. bound in the five parts of the body), and the end of the Shalyam should be bent down and tied to the bridle. Then the horse should be so whipped as to raise its head first, thus pulling out the embedded shaft (Shalyam) from its seat of lodgment by the jerk of its head. As an alternative, a high and tough bough of a tree should be lowered down and tied to the bent end of the shaft as in the preceding case. The bough should be then let loose, thus pulling out the shaft (Shalyam) with its rebounding force.
A shaft (Shalyam), lodged in a bone and lying protruded in the heaved up local flesh (situated in a place other than the inguinal regions, abdomen, or arm-pits, etc.), should be stirred by striking it on the head with an Asthila a round stone, - a short hammer according to certain authorities), or with a stone or hammer, and should be taken out by the way of its penetration.
The feather of a barbed shaft, lying embedded in a bone situated at a part of the organism where the existence of such a foreign matter is calculated not to create any special discomfort, should be first crushed by putting pressure on the heaved up or protruded flesh, and the shaft then should be gently pulled out of its seat of lodgment.
In the case of a bit of shellac being accidentally pricked into the pharynx, a metal tube should be first inserted into the passage, and then a heated metallic rod should be reached down to the obstructing shellac through its inside. The shellac, thus melted by the heat of the inserted rod, would naturally stick fast to it, which should be then condensed by an injection of cold water poured down through the aforesaid tube; after that the rod should be withdrawn thus carrying away the melted shellac at its end.
According to certain authorities, any other obstructing foreign matter accidentally introduced into the pharynx should be withdrawn with the help of a rod, soaked in melted wax or shellac, and then inserted into that passage, all other procedure being the same as in the preceding instance.
In the case of a bone Shalyam (such as the bone of fish etc.) having accidentally stuck fast in the throat, a bundle of hair, tied to a string of thread, should be inserted into the gullet of the patient, the physician holding the other end of the string in his hand. Then a copious quantity of water, or of any other liquid substance, should be poured down into his throat, so as to entirely fill his stomach. After that some kind of emetic should be given to the patient, and the string should be pulled out as soon as the bundle of hair would be felt to have struck below the obstructing bone or Shalyam, which would naturally come out with the pull. As an alternative, the top end of a soft twig, as is generally used in cleansing the teeth, should be bruised into the shape of a brush, and the thorn or the Shalyam should be removed with its help. The incidental wound should be treated by making the patient lick a compound of clarified butter and honey, or of the powders of the Triphala, saturated with honey and sugar.
The body of the patient should be pressed or rubbed, or he should be whirled round by the ankles, or generally measures, calculated to induce vomiting, should be adopted in a case where he would be found to have swallowed a stomachful of water (as in a case of drowning). As an alternative, he should be buried under the ashes up to his chin.
Strong wine should be given to the patient, or he should be slapped on the shoulders, so as to cause him to suddenly start in a case where a morsel of food would be found to have obstructed and stuck fast in his gullet. A tight gripe about the throat of a person with a creeper, rope or the arm of an antagonist, tends to enrage the local (Kapham), which obstructs the cavity of the passage (Srota) producing salivation, foaming at the mouth and loss of consciousness. The remedy in such cases consists in lubricating and diaphorising the body of the patient with oil and heat, and in administering strong errhines (Shiro-Virechanam), and the juice or extract of meat which is possessed of the virtue of subduing the deranged Vayu.
An intelligent physician should remove a Shalyam with due regard to its shape, location and the adaptability of the different types of surgical instruments to the case under treatment. A physician should exercise his own discretion in extracting feathered shafts (Shalyas) from their seats of lodgment, as well as those that are difficult of extraction.
A physician is at liberty to exercise his own skill and wisdom, and to devise his own original means for the extraction of a Shalyam with the help of any-surgical instruments when the abovesaid measures would prove abortive. A Shalyam, not removed from the body and left in its place of lodgment, brings on swelling, suppuration, mortification of the affected part, and a sort of excruciating pain, and may ultimately lead to death. Hence a physician should spare no pain to extract a Shalyam from its seat of lodgment.
Thus ends the twenty-seventh Chapter of the Sutraslhanam in the Sushruta Samhita, which treats of extraction of Shalyam.