withdrawing a Shalyam by moving it to and fro), injection or filling, binding, up-lifting, cutting and thereby withdrawing a Shalyam, resetting by means of a twirling motion, removing of a Shalyam from one place to another, twisting, expanding, pressing, purifying of a passage, drawing off, attracting, bringing to the surface, uplifting, lowering down, applying pressure all round a part, or an organ, agitating, sucking, searching, cutting or cleaving, straightening, washing or flushing, stuffing the nose and cleansing. They number twenty-four in all.
The intelligent surgeon shall exercise his judgment and determine the nature of the surgical operation required in each individual case, for surely the shalyas requiring a surgeon's aid are infinitely varied in their character.
An appliance (Yantra) which is too thick, or made of inferior metal and hence) not substantially made, or too short or too long, or does not admit of being easily handled and is incapable of taking in the entire Shalyam, or is curved loosely fitted, or soft-bolted, or loosely tied up with cords, 'should not be used in surgical operations). These are the twelve defects of a surgical instrument.
The use of an instrument devoid of the abovesaid defects and measuring eighteen fingers in length, is commended in surgical operations.
Shalyas which are manifest and visible to the naked eye, should be extracted with the instruments of the Sinha-mukha (lion-mouthed) type, while those that can not be seen, should be removed with the help of the Kanka-mukhas (heron-mouthed) instruments, etc., according to the directions laid down in the Shastras (medical or surgical works of recognised authority). The Kanka-mukhas are the best of all other types of instruments, inasmuch as they can be inserted and taken out without the least difficulty, are capable of drawing-out a Shalyam with the greatest ease, and are applicable to all parts of the human body (be they an artery or a bone-joint.)