THEORY AND PRACTICE OF MEDICINE
When we consider that amidst all the light which the latter half of
the nineteenth century sheds upon the subject, the theory and practice
of medicine amongst western nations are still enveloped in darkness,
and are constantly changing, it is not to be wondered at that a nation
like the Siamese is almost wholly in the dark upon such a subject. The
Rev. D. B. Bradly, M.D., the oldest missionary in Siam, and who for
many years practised medicine in Bangkok, has prepared an abstract of
the Siamese "Theory and Practice of Medicine," which was published in
the _Bangkok Calendar_ of 1865, and from which the abstract which I
shall give at present is mainly taken.
The Siamese believe the human system to be composed of four
elements--water, air, fire, and earth, and that disease is simply a
derangement in the proportions of these elements. They believe also
that all nature is constituted in the same way, and that the elements
without, are continually operating upon the elements within the body,
producing health or disease. For instance, if fire from without enters
the body in undue proportions, it will derange the healthy equilibrium
of the same element within, and will produce one or more of the
diseases into which fire enters, such as fevers, measles, small-pox,
&c. Each element is supposed to have its season of influence to
produce disease, just as the fruits of the earth have their seasons.
Their medical books, and common parlance, both say that in such and
such months, wind produces most disease, and in such and such other
months, fire produces most, and so with all the other elements. The
internal elements are also supposed at certain times to become
deranged from causes wholly internal. For instance, one of their
theories in regard to apoplexy is, that the internal wind blows from
all parts of the body upon the heart, with such force that it is often
ruptured, and death immediately ensues. The other theory is, that the
wind has fled, and left a vacuum in the upper story, and it must be
forced back again, if a cure is to be effected.
All diseases are produced either from an excess or diminution of one
or more of the four elements; and, according to their theory, wind
produces more disease than any, or all of the other elements combined.
If you ask any Siamese what is the matter with him, in nine cases out
of ten, he will answer, _"Pen lom"_--it is wind, or disease produced
by wind.
Their theory also teaches that all vital motions of the body are
primarily produced by wind taken into the system by inhalation, as
wind enters a bellows, and proceeds to the heart, and the heart by its
expansions, invites it into the body, and then, by its own power it
passes to all parts, and is the approximate cause of all internal
circulation.
There are two grand divisions of internal wind, viz., that above, and
that below the diaphragm. Strictures in the chest, headache, epilepsy,
and apoplexy, are produced by wind beating upward. Colic, flatulency,
inflammation of the bowels, &c., are caused by wind from above beating
downward.
It is seldom however, that disease runs its course without involving
two or more of the other elements. For instance, in case of a common
boil, the wind first drives the blood from all quarters into the
locality of the disease, where it stagnates, being invested by wind.
Secondly, the water from the blood consequently settles in that place,
as water in a tea-kettle before the fire is applied. Thirdly, the
internal fire having nothing to drive it away, acts upon the water,
and heats it to scalding. And, fourthly, the earth, inclusive of the
crassiment of the blood, which had stagnated, and other solid matter
in the locality, become diseased from great heat, and are consequently
decomposed and melted down into matter. Anasarca, or general dropsy,
belongs to the water-class, and is produced by the watery parts of the
blood settling under the skin, and among the muscles, causing the
parts to puff outward. But water is not the sole cause; there is also
a diminution of fire. If fire had been present in due proportions, it
would have dried up the surplus water, as the sun dries up the dew.
In the hot season, heat from without combines with heat from within,
and produces an unhealthful degree of heat in the body, and causes
disease of the fire-class. In the rainy season too much water is
absorbed into the system, filling intensely the natural vacuum in the
upper part of the head, and produces disease of the water-class. The
earth produces disease through her mists and vapors. Cholera is
supposed to arise from this source.
They also believe that spirits, good and evil, have great power over
the elements, and have much to do in producing disease. They are
consequently held in continued dread of them, and use every means to
propitiate them. They never start on a journey, or enter a forest
where fevers prevail, without first making an offering to the spirits.
They believe that medicine has power to counteract the deranged
elements, and restore them to a healthful equilibrium. The origin and
practice of medicine they believe to have been supernatural. Their
medical books declare that the father of medicine was so privileged,
that wherever he went, every individual member of the vegeto-medical
kingdom was sure to summon his attention, and speak out, revealing its
name and medical properties; and since the days of miracles have
passed away, the science is only now to be acquired by following
closely the original medical books.
They have four classes of medicines, each calculated to counteract the
disturbances caused by each of the four elements. The _modus operandi_
of each individual class is supposed to be as various as the specific
diseases. For instance, medicine for wind in the head is quite
different, and acts differently from medicine for wind in the bowels.
A sternutatory snuff, a wash for the head, a patch or plaster, may
dispel the wind in the head, whilst it will require a carminative to
allay the storm in the bowels. It is believed that wind of every kind
may not only be expelled from the body by way of the esophagus and
rectum, but also by the pores of the skin, and all the secreting
organs of the body. It may hence be drawn off by suction; as cupping,
poultices, bleeding, and scarification. They also attempt to drive the
surplus wind from one part of the body to another part where it may be
wanting. If the disease arise from a deficiency of wind, they try to
raise an artificial breeze in the system by appropriate medicines.
Giddiness is supposed to arise from a deficiency of wind blowing
upward upon the brain, and the upper part of the skull becomes a
vacuum. They consequently fill the stomach as full as possible with
food, and put the patient to bed, and he will awake quite well. If
there is a want of heat, they produce artificial heat; and if there is
too much, they employ a refrigerating treatment. If there is too much
water, they try to draw it off by drastic cathartics. In all their
treatment they employ opposites.
Their medicines are derived chiefly from the vegetable kingdom, and
from those kinds too which are indigenous to their own country. Some
few articles are brought from China, and sold by the Chinese
apothecaries. Barks, roots, leaves, chips, fruits, and herbs,
constitute the great bulk of their _materia medica_. They also employ
some articles belonging to the animal kingdom, such as bones, teeth,
sea-shells, fish-skins, snake-skins, snake's galls, urine, birds'
eyes, &c. They have also a few from the mineral kingdom, such as
stones, saltpetre, borax, lead, antimony, sulphate of copper, table
salt, sulphate of magnesia, and rarely mercury. They have a few gums
also, of which aloes and gamboge are the chief.
But few articles of the vegetable kingdom however, escape enlistment
in the war against disease. They depend more upon great combinations,
than upon the power of a single ingredient, and consequently scores of
kinds, or ingredients, often figure in a single dose. Dr. Bradly says
he has seen one instance in which one hundred and seventy four
ingredients were employed in one prescription, and the whole to be
taken at three doses. The work of preparing medicines is therefore
onerous. Vegetable combinations are used chiefly in a state of
decoction or infusion. They frequently speak of a patient having taken
four or five pots full--a pot holding from two to four quarts. They
knew nothing of tinctures until European physicians came amongst them,
and they are slow to adopt them.
After such a system, it may readily be supposed that their physicians
are in keeping with it. They are wholly self-taught, or, more
properly, untaught. They have nothing like medical colleges, or a
system of medical discipline. They are like too many in our own
country who rush into the study of medicine without a sufficient
literary or scientific education upon which to base a medical
education, and thus prostitute a noble profession. Without a correct
knowledge of their own language, they read a few of their medical
manuscripts, and start out for a patient, following the manuscript
very closely in their treatment. Should they get a patient who is
pretty sick, and he recover in spite of their treatment, their
reputation is made. The reputation once made seldom wanes, for the
physician's tongue helps him out of a great many scrapes. If he loses
a patient, the spirits or some other insurmountable object have always
been in the way.
It is seldom however, that a man professes to be a general
practitioner; they turn their attention to specialities. One will be
renowned for fevers, whilst another will have a reputation in cases of
small-pox. The Siamese physicians are held in great esteem by the
people, an esteem but little less than that offered to princes and
nobles, but of a different kind. That given to the latter is a kind of
servile reverence, but the former is a true esteem. They have two
general classes of physicians, viz., the royal physicians and the
people's physicians. The former class are appointed by the King to
practice in the palace, and amongst the princes and nobles, and
receive a small salary from the royal treasury. The latter class are
self-appointed, and receive no regular salary, but depend upon their
fees for their living, and as a general thing make it pay better than
the other class. A common physician of reputation is frequently
promoted to be a royal physician.
They have also another kind of doctors who profess to cure certain
kinds of diseases by shampooing and manipulating. They are well versed
in the locality of the muscles, tendons, and blood-vessels. They
gently press these points, and when one is tired and weary, it has a
soothing effect, and produces sleep, and in some diseases it may prove
beneficial. I have found it very beneficial at times of great
weariness and lassitude.
The common physicians are always employed by the job, and always on
the condition, no cure no pay. Sometimes, if the disease is chronic,
and but little hope of recovery, they stipulate to pay a certain sum
in case of an alleviation of the disease, and so much more in case of
a permanent cure. A bargain is always struck by the patient himself,
or by his friends, before the physician takes charge of the case.
Sometimes, if a doctor sees his patient is going to die, and he be the
loser, he will take "French leave" without giving the friends any
notice whatever of his intentions. Generally however a more honorable
course is pursued, and the doctor gives up the patient, and releases
the friends from all obligations, and they are at liberty to call
another doctor. The physician is thus changed frequently, several
times before death or recovery, each new one putting in for a higher
bid. They have also a kind of domestic water treatment, by copious
bathing, which in many cases is far more beneficial than their
nostrums.
They are also great people for recipes, and many of the temples have
these recipes inscribed by scores upon the walls, and upon little
marble tablets, for the benefit of the poor, and all others who wish
to use them. The king frequently makes merit by having these recipes
thus inscribed. The following one for small-pox, will serve as a
specimen:
"One portion of conch-shell; two kinds of aperient fruit, one portion
of each; two kinds of sour leaves, one portion of each; one portion of
asafoetida, one of borax, one of ginger, nine kinds of pepper,
including the hottest, a portion of each; four kinds of cooling roots,
a portion of each; one of an astringent root; four kinds of drastic
cathartics, including the fruit and leaves of the croton plant, one
portion of each; one of rhubarb, and one of Epsom salts. Boil in three
measures of water until it be diminished to one measure of the
decoction. Then squeeze out the oily parts, dry, and pulverize. A
woman may take the weight of thirty cents in silver, and a child may
take the weight of seven and one-half cents in silver. It will purge
off everything in the bowels."
They have as yet little or no confidence in European physicians and
medicines. They however, are obliged to acknowledge their ability as
surgeons, and they are beginning to have confidence in quinine in the
treatment of fevers. They know nothing of anatomy; and consequently
nothing of surgery. They do not pretend to lance even a common boil,
but depend upon opening it with poultices.
The first amputation was performed in Siam by Dr. Bradly, in 1837. A
company of priests at the dedication of a temple were playing with
fireworks, when a cannon burst, and killed several and wounded many
more. Dr. Bradly offered his professional services, but all the
wounded refused, except two. He amputated the arm of one of them, and
dressed their other wounds, and they soon recovered, but all the
others died. Inoculation for small-pox was introduced by the
missionary physicians in 1838. They found themselves surrounded by the
disease, and being without vaccine virus, they inoculated their own
children as the next best thing that could be done. It acted so well
that the king sent a number of the royal physicians to examine into
it, and learn how it was done. Having learned, he sent them out
through the city to inoculate.
Vaccination was introduced in 1840, from a scab sent out from Boston
_via_ the Cape of Good Hope. It finally died out, and was again
renewed from time to time. It is now constantly kept up by Dr.
Campbell, a Scotch physician, in connection with the English
Consulate. The natives no longer hesitate to have their children
vaccinated, and it has done much towards staying the ravages of the
small-pox.
The first operation for cataract was successfully performed by Dr.
Bradly, upon the eyes of a distinguished nobleman and minister of
state.
They know nothing of obstetrics, and those cases where nature needs to
be assisted, are left to die. Superstition too, has enveloped the
whole afiair in silly and ridiculous notions. Since they believe in
the transmigration of souls, and that the spirits of all persons who
are born have existed in some previous state, their books on midwifery
pretend to teach parents how they may know whence their children came,
and whether the expected stranger will be a boy or girl. There is also
a choice in the day of the week upon which a child is born. Wednesday
and Thursday are particularly favorable for robust constitutions, and
bright intellects. Children born on Sunday, are liable to be careless
and reckless all their lives.
This business is almost wholly committed to elderly women or midwives.
Male physicians are seldom called in on such occasions, unless the
case requires extraordinary skill, and then they are as ignorant as
the midwives themselves. They always attempt to assist natural labor
by the use of domestic medicines, shampooing, and other manipulations,
and in many instances do positive injury by deranging natural labor.
Facts however, prove that parturition amongst the Siamese is much
shorter and easier than amongst Europeans and Americans. One reason
is, that they have more of the animal in their natures, and doubtless
the kind of dress they wear has much to do with it--their dress being
more in accordance with nature.
It is after the birth of the child that the Siamese mothers have to
endure torture. It is a custom amongst them, as immutable as the laws
of the Medes and Persians, that the mother after the birth of the
child, must lie by a hot fire from five to thirty days. After the
first child they must remain by the fire about thirty days, but the
time gradually diminishes with every subsequent birth. She is placed
on a hard board, with nothing under her but a thin mat, and no
clothing but a narrow waist-cloth and is thus obliged to lie within
four or five feet of a hot fire. This is generally, too, in a small
room, with no chimney, but the fire is on an open furnace, and the
smoke is allowed to escape as best it can. In such a climate as Siam,
this must be positively injurious, and it certainly makes young
mothers look prematurely old. It is not known whence this custom
originated. It is also practised amongst the Cambodians, Peguans,
Burmese, and Cochin Chinese.