PIONEER MEDICAL MISSION WORK IN KERMAN [3]
Pioneer Medical Mission work in Kerman--Waiting for drugs
and instruments--Native assistant proves a broken reed--First
operation in Kerman--An anxious moment--Success--Doctrine of
"savab" convenient to the Moslem--Fanaticism tempered with
prudence--Opium slaves--Persian therapeutics--Persian quacks and
their methods--Sure way of curing cancer--Hysteria.
"Charms for lovers, charms to break,
Charms to bind them to you wholly,
Medicines fit for every ache,
Fever and fanciful melancholy."
R. Bridges.
We had been appointed to open a Medical Mission in this city, and as
soon as our temporary residence in Isphahan was finished, proceeded
to our original destination. We arrived at Kerman early in 1901, and
received a hearty welcome from the only other European there--the
Rev. A. R. Blackett, also of the Church Missionary Society. Two
houses were secured, both outside the city wall; in one we took up
our residence, while the other was made into a dispensary, and small
temporary hospital. Unfortunately we arrived before our supply of
drugs and surgical instruments, so we had to do our best with the
very small stock of medicines borrowed from our stations in Isphahan
and Yezd. However, patients began to come in large numbers, and the
out-patient department was soon in full swing. We had brought with us
from Isphahan two Armenians to act as assistants, one for dispensing,
the other (a man who had been employed in the Mission for many years)
to interpret and help generally in the work. I had hoped much from
this last-named assistant, and had relied upon him greatly for advice
and help, as he had been in Kerman before, and knew the people; but I
soon found him a "broken reed." He was married and had a large family,
which he had been obliged to leave behind in Isphahan, and very soon
he began to show signs of home-sickness. Then he commenced to imagine
himself ill, and developed symptoms of different ailments. In the
first place he one day came to me with a woeful face, and besought me
to carefully examine his chest, for he was convinced he was developing
phthisis. After being reassured on this point, he became absolutely
sure that he had heart disease; next his kidneys troubled him, and
so on, until he became a confirmed hypochondriac, and completely
useless for work. One day I remember his coming to me imploring
that I would inject morphia to relieve him of the intense pain from
which he was suffering. I gravely took the hypodermic syringe, and
carefully injected distilled water, and the pain disappeared with
lightning rapidity!
However, I had to send him home, and I believe that, once safely
reunited to his family, he at once lost all his symptoms, and was
able to resume his old work at the hospital.
In the meanwhile my surgical patients were clamouring for operations,
more especially those afflicted with cataract. I had opened another
dispensary in the city itself, and many poor blind people had come
for treatment. It went to one's heart to have to send them away day
after day with the same disheartening story. "The instruments have not
yet come; until they arrive, nothing can be done." I fear that many
commenced to think that the English doctor was a fraud, and that his
excuses concerning the instruments resembled those framed by their
own "hakims" to hide their own ignorance. At last the boxes actually
arrived. They had to be brought by caravan from Bushire (the port in
the Persian Gulf) to Kerman, via Shiraz and Yezd, a distance of some
eight hundred miles, taking a couple of months.
We admitted our first in-patient, a well-known merchant in the city,
who had been blind for three years with cataract. The Persian surgeons
also operate for this disease, using the old Eastern operation known as
"couching." An incision is made into the white of the eyeball (without
any anaesthetic), then a thick, blunt probe is worked into the interior
of the eye, directed so as to dislocate the lens. If successful, the
lens drops back into the posterior chamber of the eye, and the patient
"sees," but alas, the vision obtained is, in ninety-eight cases out
of a hundred, only temporary! Twenty-four hours later, inflammation of
the eye supervenes, and the sight is gone, and the eye lost. Needless
to say, the operator obtains his fee either before the operation is
done, or during the few hours that his patient is rejoicing in his
newly found vision; then if he is wise he disappears from the town,
and resumes his practice elsewhere. However, during eight years'
practice in the East, and having had the opportunity of examining
thousands of eyes, I can remember two cases only where this operation
had been done and there had been no subsequent inflammation, but the
great majority of eyes are lost.
Well, we had our first Kerman cataract patient, and it seemed to
us as though the whole future of the little pioneer Medical Mission
depended upon the success or failure of that operation.
The day fixed for the operation arrived: a Persian doctor practising
in the city had requested leave to be present, no doubt on behalf of
the many friends of the patient, to report particulars and see fair
play. The patient was brought in, looking exceedingly nervous. After
a short prayer (a practice almost invariably adopted in medical
missionary hospitals, and much appreciated by the patient, even though
he be a fanatical Moslem), the operation was started. I am afraid we
were all unduly nervous, the possible consequences for good or ill to
the Mission assuming undue proportions. At any rate everything went
wrong; the cocaine (used as the anaesthetic) would not work, the old
man could not keep his eye still, and would look up when he was told
to look down. I was only able to complete the incision, and that with
the greatest difficulty; and fearing to proceed further, the patient
getting more and more excited, I had reluctantly to postpone the
operation for a couple of days. We all felt very depressed, except,
perhaps, the Persian "hakim," who doubtless greatly relished the
failure of the English doctor. However, two days later we tried again,
the Persian hakim once more being amongst the spectators. Much prayer
had been offered up that this time there might be no hitch. Everything
at first went well; the patient lay quite quietly, moved his eye
exactly as he was told, the cocaine proved satisfactory, the incision
was remade, and other preliminary steps in the operation disposed of:
then came the hitch. In the European method of operating for cataract,
the opaque lens is extruded from the eye by gentle pressure, through
the incision first made. Well, when the time came for the lens to be
extruded, it would not budge! I tried all possible means of extraction
without success (afterwards I discovered that adhesions had formed
between the lens and the curtain of the eye, as a result of the first
operation). The perspiration ran down my face, as I realised what
this second failure meant, not so much for my own reputation, but
the hindrance it would prove to the success of the work I loved. I
glanced at my wife: she was looking very anxious. I looked at my
assistants: their faces were pictures of dismay. They had seen me
before in Isphahan do many a cataract, and could not imagine what
had gone wrong. The Persian doctor looked particularly happy: he
smiled as he politely expressed his sorrow that I was experiencing
any difficulty in bringing the operation to a successful issue. It
certainly was an awkward fix--perhaps the most awkward that I have
ever been in; but as I lifted up my heart in silent prayer to God,
asking for guidance, the thought flashed into my mind, "The man has
both eyes blind: you have failed with the one; do the other at once,
and it will prove successful."
Gently covering the eye that had proved a failure, I explained matters
to the patient, obtained his permission, thoroughly cleansed his other
eye, and proceeded to operate, meeting with no difficulty and easily
extracting the lens, to the palpable disappointment of my Persian
medical friend, and was overjoyed to find that the patient old man
had obtained exceedingly good vision. After a week the patient went
back to his friends, seeing well, and full of gratitude for all the
kindness and care he had received. I saw him some months later, and
inquired whether he cared to let me have another try at the eye that
had proved unsuccessful; but he refused, saying he was an old man,
and had obtained good sight with the one, and did not need to see
with the other. Of course the result of this first operation had been
anxiously awaited by many, and since it proved successful, we soon
had our little temporary hospital full, and had no further trouble
in getting in-patients. I have described this case rather fully,
avoiding technical terms as far as possible, as it illustrates fairly
well the difficulties and responsibilities met with and tackled by
pioneer workers, be they missionary or official.
The Persians (especially the Kermanis) have a great idea of doing
"savabs" (good works), hoping to reap their reward hereafter. This is
common to the West as well as the East; but the Kermanis in addition
hold a convenient doctrine, namely, the appropriation of the savabs
of infidels for themselves! At least one of the chief mullahs in
Kerman surprised me somewhat by the cordial reception he accorded me;
but later said, "How glad he was that I had come to Kerman and was
doing such 'good works' amongst the sick and poor, as hereafter God
would credit the true Moslems with all the savabs done by infidels,
who of course could derive no benefit at all from their performance."
As Kerman is a city proverbial amongst the Persians for its great
wickedness, I could understand the old mullah's satisfaction, as
doubtless he felt that many of their savab accounts were rather
low and needed a trifle of "credit," which might with advantage be
obtained from the savabs of an infidel doctor!
Once yearly the Persians celebrate the death of the martyrs Hassain
and Hussein, as has already been described in a previous chapter. We
had a good opportunity of witnessing this Persian Passion Play
while in Kerman. The sword-dancers, clad in white garments, work
themselves up into a frenzy, gashing their heads with the swords
and sometimes inflicting severe wounds. A true believer is supposed
to have his self-inflicted wounds healed spontaneously through the
agency of Hazrati Ali (grandson of the prophet Mohammed); but I was
a little amused by the appearance of several of these devotees at
my out-patient clinique some days previous to the "celebration,"
all of them begging for a little English ointment to keep by them
for use in case miraculous healing should be delayed.
As has been already mentioned, the curse of Kerman is opium; everybody
smokes or eats it--generally the former. The native doctors are partly
responsible, as they recommend the drug as a "cure-all"; but even the
cultured Kermani smokes opium, possibly to relieve the monotony of his
life! Cases of poisoning repeatedly occur, and some of these we were
called upon to treat. Our dispensary had a small garden attached to it,
and when the Mission had gained the confidence of the people it was
no uncommon sight to see several opium patients being treated at the
same time in this garden. The treatment used, though somewhat vigorous,
proved very effective. A man would arrive at the dispensary, escorted
by an excited throng of relatives. On inquiry we would find that he
had taken a big dose of opium to end his life: afterwards repenting,
he had confessed to his relatives, and they had at once brought him
to the English doctor. The treatment began with the administration of
a strong emetic followed by repeated doses of strong coffee; then he
would be handed over to the care of an attendant, with instructions to
walk him round and round the garden and prevent his going to sleep. The
native assistants and the patient's friends, armed with sticks, carried
out these instructions, and at the first signs of languor exhibited
by the unfortunate man he would be beaten and kept effectually awake!
One day I was summoned in haste to the house of an influential Kermani;
his only son, a child of two years, had been poisoned with opium. It
is a common practice in Kerman for mothers to keep their babies from
crying by giving them a little opium to suck. This boy's mother had
given him a big lump by mistake, and grew alarmed when she found
that all her attempts to wake him were ineffectual! On arriving
at the house with my assistant, we had considerable difficulty in
making our way into the courtyard, as it was thronged with all the
relatives and friends; the neighbouring houses were crowded, a great
multitude thronging the flat roofs, which commanded a good view of
the courtyard belonging to the patient's father. On examining my
little patient I found him nearly dead, exhibiting all the symptoms
of an overdose of opium. However, for over an hour we worked away,
washing out the child's stomach, injecting strong coffee, &c., all in
the open air before the excited multitude, and gradually the little
patient showed signs of recovery. When he had come completely round
and was crying vigorously, there was great rejoicing. Thinking the
opportunity too good a one to be lost, I asked my assistant to tell
the father that God had heard prayer and restored him his child,
and that we would now like him to join with us and thank God for
answering our prayers, if he would tell the crowd what we intended
doing. Although the father was a mullah, and had the reputation of
being very fanatical in his hatred of Christians, he at once consented
to our proposition, announcing to the crowd our intention. During
the short thanksgiving prayer every head was bowed and not a sound
of protest heard, while Christian and Moslem alike returned thanks
to the great God who had heard and answered prayer. Medical Missions
had once again won a triumph over Moslem fanaticism, and the scowls
and threatening looks which had greeted our arrival were replaced by
cordial thanks and vehement expressions of gratitude!
Persian therapeutics are very simple, dating back to the time of
Hippocrates. All diseases are divided into two classes--hot and
cold--to be treated accordingly with hot or cold remedies. All foods
are similarly classified. With this knowledge, plus a few Persian
medical books and an appropriate turban, the native quack sets
up as a doctor. His impudence and native wit are inexhaustible;
he will cheer his patients with extracts from Hafiz or Ferdosi
(the great Persian poets), talk learnedly of vapours, and have a
specific for every mortal ailment. The quack physician is amusing,
and probably confines himself to fairly harmless compounds; but the
Persian surgeon is a man to be avoided at all costs. Of course, I
am only here speaking of quacks; in Teheran there is a good medical
school, and many of the graduates from that school proceed to Paris
or Berlin, and return fully qualified to exercise their profession;
but they also have to compete with these native quacks.
I remember one case of a poor man brought to the dispensary with
a big swelling on the left knee, which prevented his straightening
the leg. Careful examination convinced me that the case was one of
malignant cancer of the thigh bone, and that nothing could be done
but amputation. This was explained to the patient and his father, who
indignantly rejected the proposed operation. I lost sight of the man,
but some weeks later one of my assistants asked me if I remembered
the case; on my replying in the affirmative, he informed me that the
patient had since died. It seems after leaving the dispensary the
father had taken his son (a young man twenty years old) to a native
surgeon (who combined the exercise of his profession most appropriately
with the trade of a butcher) and asked his advice, saying the English
doctor had advised amputation of the leg; but he had refused, as
the swelling caused little pain, and all his son wanted was to be
able to straighten his leg so that he might once again walk. "Oh,"
replied the butcher, "that's easily done; that English doctor knows
nothing; I will cure him." So he got the father and other men to hold
the unfortunate youth firmly and some other helper to seize the leg;
then seizing a huge slab of stone in both his hands, he brought it
down with all his force on the bent knee. The leg was straightened
... and needless to add, the poor patient only survived a few days.
My wife has written quite sufficient about the Persian women to
enable her readers to appreciate the monotony of their lives behind
the veil. This is more especially true of the upper classes, who
have no need to work for their living. In Kerman the usual result
is that many of these poor women suffer from hysteria. I have often
been called in to treat some of these patients, and have found them
develop almost all the varying types of that curious disease; but
one of the most interesting cases I ever remember occurred in Kerman.
I had been treating the unmarried daughter of one of the wealthiest men
in the city, and had prescribed for her some simple bismuth mixture,
as she had complained of indigestion. Two days later her brother
came galloping his horse to the dispensary, and demanded to see me
immediately. He was greatly excited, and said that his sister had
been taking the medicine I had prescribed for her and had suddenly
gone blind. This was in the early days of the Medical Mission, and
I was especially anxious to win the confidence of the people, so did
not at all appreciate this complication. I assured the brother that
I would return with him at once, and informed him that the medicine
could not possibly have caused the blindness; but he was not at all
appeased. Upon reaching the house I found all the family distracted
with grief, and not at all inclined to be cordial. Moreover, they
had called in a native eye-doctor, who had gravely announced that
the blindness was most certainly due to the patient having taken
the infidel's medicine! In order to reassure the parents I bade them
bring the bottle of medicine, and, finding there were still two or
three doses left, called for a glass, poured out the remainder, and
drank it. This seemed to reassure them partially, so they allowed me
to examine the girl. She was a nervous, highly-strung patient, and I
had expected to find that she had been malingering; but to my surprise,
upon thorough examination I convinced myself that she had really gone
blind. Examination of the interior of the eyes showed no disease,
and upon inquiry, finding that she was the subject of periodical
hysterical attacks, I ventured to predict to the parents that with
suitable care and supervision the girl would regain her sight. They
were still inclined to be sceptical, but ten days later I heard that
my prediction had come true and that she was quite cured. Similar cases
of hysterical loss of vision are on record, but are exceedingly rare.
Barely had we managed to get the little Medical Mission well started
when circumstances connected with my wife's health arose that
forced us to leave at a moment's notice the people we had learnt to
love. Fortunately the work was not given up; another doctor succeeded
me, and now there is a flourishing Medical Mission with two hospitals,
one for men and the other for women patients, with a lady doctor and
nurse; while the influence exerted by that Mission is felt throughout
the whole of the great Kerman province, which stretches eastwards
to the border of Beloochistan, and is bounded on the south by the
Persian Gulf.