AFGHAN SURGEONS AND PHYSICIANS.
Accidents from machinery in motion. The “dressers of wounds” in
Afghanistan. Their methods of treating dislocations, fractures, and
wounds, and the awful results of the same. The “Barber surgeons.”
Tooth drawing and bleeding. The Hindustani “Doctors.” “Eye Doctors”
and their work. The Hakims or Native Physicians. Treatment of
disease by the People. Aspect in which European Physicians are
viewed by the different Classes.
[Sidenote: Machinery Accidents.]
One morning soon after our arrival in Kabul, when I was at the Erg
hospital, a messenger arrived in a great hurry to say a man had been
injured at the Workshops. I jumped on my horse, which was waiting, and
galloped off. Just outside the Workshop garden, on the road by the
river bank, I saw the heavy portable engine with a crowd of people
round it. Mr. Pyne was there in the middle of the crowd, and a man, one
of the Afghan workmen, was lying on the ground. I examined the patient
and found he was dead. Mr. Pyne was very upset and at first refused
to believe it. He sent off a man to the shops for whisky, and begged
me to send someone to the hospital for ammonia. I did so, though, of
course, it was useless. They were moving the engine to the Salaam Khana
or Durbar Hall to work the dynamo for the electric light there, but no
one in the crowd seemed to have seen how the accident occurred, whether
the man was crushed under the wheel or whether he had been struck on
the head. There was no inquest, and post mortem examinations were not
viewed with favour.
Later on, when the machinery was put together and some of it was in
working order, accidents and deaths were, as might be expected, of
frequent occurrence. In stepping over the shafting which ran across the
entrance to one of the shops, about a foot above the ground, the long
sheepskin postîn or coat would catch, and the wearer be whirled round
and killed. Familiarity breeds contempt, and in spite of accidents it
took a long time to educate the ordinary Afghan, after he had got over
his first awe, up to the point of learning that machinery in motion
should be approached with circumspection.
They had a way of putting their fingers under the punches of the
cartridge machines, forgetting that the punch would inevitably come
down at its appointed moment. It took one man in the palm, I remember,
and I had to amputate his first and second finger and his thumb.
Another got his hand between some steel rollers in motion, and but for
the fact that Mr. Pyne was on the spot and at once threw the machine
out of gear, the arm would have gone too. As it was, the skin was taken
neatly and cleanly from the wrist and turned backwards like a glove
over the finger tips. The bones of the hand were crushed, and I wished
to amputate in the lower forearm; but the man, who was brought to the
hospital, refused to have the hand taken off because he could move the
fingers a little. I pointed out the danger he was running of further
serious results, but he would not consent.
As he refused the only treatment that I felt was suitable, I could not
undertake to treat him, and he was removed to his home in the city.
I do not know who attended to his hurts, probably one of the native
“dressers,” but four or five days afterwards he sent a friend to beg
that I would come and remove the hand. Unfortunately, it was too late;
“tetanus,” or lockjaw, had set in.
[Sidenote: Afghan Treatment of Dislocations.]
The “dressers” of wounds in Afghanistan are a body of
men--natives--whose duty it is to dress wounds and ulcers, set broken
limbs, and probe for bullets. They have no knowledge of even the
groundwork of their profession. Never having dissected, nor studied
anatomy, they are quite ignorant of the position and shape of the
bones, to say nothing of the course and distribution of the larger
arteries of the human body, so that the abscess knife and the scalpel
put into the hands of one of these men work grievous harm. They carry
about with them a flat tin box, with partitions inside, something
like a paint box; and in it is a collection of most filthy looking
ointments of different colours. These they plaster on indiscriminately;
if one does not cure an ulcer perhaps another will. For dislocation
of joints a mixture of flour and yolk of eggs smeared on is a certain
specific; they have no idea of reducing the dislocation. For a broken
bone, flour and yolk of eggs again comes in. Say the bone of one arm
is broken between the shoulder and elbow, the following treatment is
adopted. Some narrow strips of calico, smeared with the flour and egg
mixture, are bound tightly round the limb at the seat of injury; thus
breaking the first law of surgery, that no bandage be put on under
a splint. Over this bandage are arranged longitudinally four or five
narrow pieces of wood about five inches long, very like those you buy
in a bundle for firewood, and utterly useless as splints, and another
bandage is wound firmly over these; there is no padding with cotton
wool. The patient is then left. The result is, of course, that the limb
below the bandages becomes exceedingly swollen and painful.
When the pain has reached such a pitch that it is no longer bearable,
the patient releases his arm from the bandages, and the dresser is
sent for to readjust them, so that the unfortunate limb is relieved
for a time before it is tortured afresh. In spite of the dresser the
bone sometimes unites, usually at a more or less obtuse angle; but
not uncommonly, especially in compound or comminuted fractures, the
pressure is taken off too late, and the whole limb mortifies. The
patient, after months of suffering, may or may not recover. I have had
them brought to me with the broken end of the bone protruding from a
hanging mass of stringy and sloughing muscle and tendon, the rest of
the limb being hidden from sight by unclean rags.
Such “dressers” as I could get hold of I put through an examination at
the hospital, to try and find out what they knew, and endeavoured to
teach them some elementary facts in anatomy and one or two common sense
rules in surgery, but only one of them would even pretend to learn, and
he was a humbug. They all knew better than I did how to treat wounds
and ulcers, and set broken limbs, and they received any suggestions of
mine in offended silence. I showed up one or two, pointing out the
disastrous results of their treatment, but it did no good. I only had
an extra enemy or two to consider, for they were very venomous.
[Sidenote: The Barber Surgeons.]
Besides the comparatively modern “dressers,” there is another body
of men in Kabul who practise the noble art of surgery, namely, the
“barbers.” The line they specially take up is that of bleeding and
tooth drawing. They have very rough forceps for the latter operation,
and when, as not infrequently happened, they snapped the crown of a
tooth off instead of extracting it, they passed the patient on to me.
It is annoying for a surgeon to have to extract broken but firmly-fixed
fangs from an injured and bleeding jaw. It is not a pretty operation at
all.
For fevers, dyspepsia, gout, headache, or any feeling of malaise, the
barbers bled their patients--but besides these, which may be called the
_irregular_ bleedings, there are regular bleedings every spring and
autumn. These are generally done out of doors by the road side. The
barber, squatting down by the side of his patient, makes his incision
at the bend of the elbow: fortunately, not into the vein immediately
over the great artery of the arm, the one usually bled from in England,
but into one adjoining. The patient holds out his arm and allows the
blood to drip on to the ground till he thinks enough has run away.
There is not the slightest attempt made to measure the quantity of
blood lost. The only precaution taken is to avoid drinking any water
for twenty-four hours afterwards, lest it should mix with the rest of
the blood in the vein and make it thin; or if they do drink any they
hold the wounded arm above their heads to prevent the water running
into it! Wet cupping, too, is performed by the barbers and dressers,
and is a very popular means among the townsfolk of getting rid of
their blood. It is a common thing to see an Afghan scarred all over
the shoulders and loins. Cupping is employed generally as a remedy for
muscular rheumatism. The custom was introduced some years ago by the
Hindustani hospital assistants, who, after having had in India some
slight training in the European system of medicine, found their way
into Afghanistan under the guise of “doctors.” The majority of these
were unqualified men, and were quite unfit to be anything but hospital
assistants. Let loose upon the people they have worked as much havoc
among the sick as a similar number of the hakims could have done.
[Sidenote: Eye Doctors and Hakims.]
There are also native “eye doctors!” These may do good sometimes by
accident, though I never heard of a case, but they do an incredible
amount of harm: for eye diseases, on account of the glare and the dust,
the absence of proper treatment and ordinary care are very common in
Afghanistan.[1]
[1] The commonest affections I met with were granular lids, chronic
entropion, corneitis, nyctalopia, and cataract.
Finding out that I sometimes used sulphate of copper--an astringent
and caustic--of which there was plenty to be had in the bazaars, they
would put this powdered into any eye--say, of a child who had ulcer of
the cornea! The Hindustani hospital assistants were not much wiser, for
they sometimes used solutions of sulphate of zinc, a similar remedy,
for the same purpose. The eye being irreparably damaged the patient is
then handed on to me, and the Hindustani, like the dresser, smugly says
that “If _he_ couldn’t cure the patient, neither could the Feringhi.”
However, the people and the Amîr judged, I found, according to general
results. I remember in Turkestan a soldier getting leave of absence,
travelling down to Kabul, and bringing his old mother on a donkey the
two hundred odd miles over the mountains, for me to cure her eyes. They
were past all hope.[2] The painful part of the affair was that they
would not believe I _could_ not, but that I _would_ not restore her
eyes; and the old woman went down on her knees to implore.
[2] Entropion, with nebulous and vascular cornea in an old woman of
seventy.
There was one old fellow, an “eye doctor,” in Kabul, whom I used to
notice on my way to the hospital. He sat in a hut of rushes and mud by
the roadside, with his medicines in little packets before him. I often
wished he would come and have a little elementary instruction in the
“eye.” But he had such a sour expression when I went by, and he never
would look at me, that I did not suggest it to him.
The hakims--the physicians of Afghanistan--practise purely as
physicians; they do not use the knife surgically, rarely even for
bleeding. When they find it necessary to treat an abscess, they apply
an irritating ointment which causes ulceration of the skin. Since the
introduction of European drugs into Afghanistan some of the hakims have
made use of them; but as they do so in ignorance of their therapeutic
properties, the results are rarely satisfactory, and, in some cases,
are disastrous. They have great faith in the healing properties of a
purge, but do not consider it has had any effect unless it acts at
least twenty times. The way is prepared by administering every day for
a week a large bowl of laxative mixture; afterwards, one or more bowls
of a drastic purge are given. Some of the people seem to establish
toleration of this class of medicine, and require a large dose before
they are acted on; but with a vast number this mode of treatment,
combined with the custom of eating largely of ripe and semi-ripe fruit,
certainly predisposes them to the obstinate and often fatal bowel
affections that are such a scourge in the spring and autumn.
These bowel troubles, according to a popular native idea, are caused
by drinking tea immediately after having eaten fruit, particularly
mulberries. There is no doubt, however, that some of the cases are
due to the debilitated and enfeebled state of the digestive organs,
produced by the malarial poison, the immediate exciting cause often
being the sudden change in temperature experienced when climbing a
mountain after a residence in the hot valleys. Other cases are due to
the presence of minute intestinal parasites, the ova of these being
ingested during the drinking of impure water, a common custom among the
careless Afghans.
[Sidenote: Treatment of Disease by Hakims.]
The hakims practise, I was informed, according to the Yunani or ancient
Greek system of medicine. The only books I could obtain on this system
were written in Arabic, and this was an obstacle to my studying them;
but, whatever the teaching of their books may be, the hakims I found
knew nothing whatever about anatomy, physiology, or pathology. Their
treatment of disease is entirely empirical. They act according to
“authority.” Studying disease, not in the living subject, but in their
books only, they have made no progress whatever upon the teaching of
their ancestors. A sick man is brought to them, and some prominent
symptom forces itself upon their notice. This is at once diagnosed as
the disease. For instance, pain in the abdomen is to them “colic.”
It is described in their books and a certain line of treatment is
directed. They do not examine their patient, or attempt to find a cause
for his pain; nor do they differentiate between different forms of
colic, for they have not noticed that pain in the abdomen is sometimes
unconnected with the bowel. As an example, Perwana Khan, the Deputy
Commander-in-Chief in Kabul (“Dipti Supersala”), was for some weeks
attended by the hakims, who, reporting him to be suffering from colic,
administered purge after purge. As, however, he did not seem to be
getting any better, the Amîr desired me to examine him. I found he
had acute pain in the left loin, shooting downwards; the attacks of
pain came on, he said, after he had been riding on horseback, and he
had other symptoms, all pointing unmistakably to stone in the kidney.
I administered suitable medicine for the relief of the pain, and he
was overjoyed, imagining himself cured. I explained, however, to His
Highness what was wrong.
To the hakims dropsy is a disease, and can be cured by the treatment
set forth in their books. No attempt is made to discover the cause
of the dropsy--whether it is due to kidney disease, heart, liver,
lung or blood disease--it is simply an accumulation of gas (bâd) in
the tissues! In diseases of the chest, they do not, of course, employ
auscultation with a stethoscope, nor percussion; and bronchitis,
pneumonia, and phthisis are classed together under the name of sûrfa,
or cough. This, they say, is due to an accumulation of “slime”
(balgham) in the body. In some cases the sûrfa is accompanied by dard
i sîna, or pain in the chest, and occasionally blood as well as slime
is coughed up: these are recognized as bad cases. I have related the
case of the young brigadier in Turkestan, cousin of the Sultana, whom
the hakims were treating for sûrfa, and who was dying of an improperly
treated pneumonia, which had, eventually, become tubercular. As I did
not want to have the credit of killing him, I sent in my report to the
Amîr at once. The hakims did not in the least mind my being sent for to
their cases, after they had become hopeless; for, like the dressers,
they said, “Behold, the Feringhi doctor cannot cure them any more than
we.”
Malarial fevers are diagnosed as “cold fever” or “hot fever” (tap i
larza--tap i gurrum), according to whether there is a shivering stage
or not. They are treated by copious bleedings and purgings, and by
very low diet. Malarial fever, however, being due to the presence in
the blood corpuscles of a microscopic animal, an amæba, the treatment
that the hakims adopted was not likely to be very successful. Quinine
in sufficient dose destroys this organism, but the hakims would rarely
give it, or if, following my plan, they did so, they gave it in doses
so small as to be useless, for they said, “Quinine is _hot_, and,
therefore, bad for fever.”
What they meant I do not know.
The hakims divide not only malarial fevers into “hot and cold,” but
they arrange all diseases into these two classes, and I was asked of
almost every disease that came under my notice whether it were hot or
cold; for instance, whether dyspepsia were hot or cold. The reason for
the classification in the case of malarial fevers is obvious enough,
but for the other diseases I never was able to find out upon what they
founded their conclusions. It certainly was not simply whether the
patient had fever or not.
It was particularly embarrassing when the Amîr asked the question, and
I once told His Highness that in Europe we did not speak of diseases
as being either hot or cold, that it was often impossible to consider
them as either one or the other. His Highness was quite indignant at
my denying what apparently seemed to him such a self-evident fact, so
much so that he doubted if my interpreter had translated what I had
said correctly. After that, when I was asked, I told the interpreter
to class the disease as hot or cold, according to the custom of the
country.
[Sidenote: Treatment of Disease by the People.]
In the distant villages, where there is no hakim, and the priest’s
amulet has failed to cure, the people either go untreated or treat
themselves. A popular mode of treatment for diseases of bones and
joints, and also for almost any pain in the chest, abdomen, or back,
is the employment of the “actual cautery.” A piece of live charcoal is
placed against the skin until a deep burn is produced; this is done in
two or three places, the scars, of course, remaining till the end of
the patient’s life.
Another custom, mostly for diseases accompanied by fever, is to kill a
sheep, skin it rapidly, and at once wrap the patient in the hot skin.
I do not know that it does any harm. The Amîr himself, when suffering
from gout, and when the hakims had failed to relieve him, employed this
essentially Afghan mode of treatment for his leg and foot. Afterwards
he sent for me.
For wounds, ulcers, or abscesses the villagers bind on either a piece
of fresh sheepskin, which they leave on till it stinks, or a piece
of an old water bag (mussack), which they soften afresh by soaking.
Sometimes they plaster on mud or clay. In the case of ulcers, the
fact that they _never_ heal under these circumstances does not seem
to strike the Afghans, and they continue in the old custom. If the
discharge oozes from under the clay they plaster on a little more.
Cover a sore, get it out of sight, is the golden rule of hakims,
dressers, and people. The condition of the ulcer when the clay is
removed is indescribable. In some cases the only possible treatment is
the removal of the limb.
[Sidenote: The Feringhi as a Healer.]
I noticed that the richer and more educated Afghans did not seem so
ready to avail themselves of European medical aid as the poorer people,
and it struck me there were two reasons for this. First, that the
hakims took the trouble to explain to the richer people, from whom
they expected to receive fees, that Europeans use deadly poisons in
their medicines, which are just as likely to kill as to cure. A certain
amount of weight attaches to this by the often unfortunate results
of medical treatment by the Hindustani hospital assistants. The other
reason seems to be due, not to the hakims, but to the influence of
the priests. The more religious of the Afghans apparently look upon a
European as one who, by the help of the Powers of Evil, has in this
world the gifts of knowledge, skill, and wealth, but who in the next
life must inevitably be consigned to eternal torment. Doubtless with
his deadly poisons he can cure diseases if he wish, but it is not wise,
and, indeed, is scarcely lawful, for a sick man to make use of him.
They feel it will offend God less if, before they traffic with the
evil one by employing a Feringhi doctor, they use all lawful and right
means to become well, such as trying the efficacy of prayer, or the
wearing of amulets and charms: should these fail, by placing themselves
under the care of their hereditary physicians, the hakims, who attended
their fathers and their fathers’ fathers. They can always call in the
Feringhi as a last resource.
The peasants and the hillmen, the soldiers and the poorer townsfolk--in
fact, all those who are but occasionally under the influence of the
priests, and from whom the hakims can expect a small, if any fee--these
are ready enough to trust themselves, when sick, to European medical
skill. They take advantage of that which seems to them good, as an
animal might, without entering upon the deeper question whether it is
religiously right or wrong--in fact, they even look upon a doctor as
one to be classed with Dewanas or madmen, and prophets, who are all
more or less sacred.
It must be a powerful reason, such as the fear of being poisoned or
damned, that prevents the richer Afghans from employing European
medical aid, for they have to pay the hakims, whereas at the hospital
no fees or presents were received, and it is not the nature of an
Afghan to pay for a thing if he can get it for nothing.
[Illustration]