CHAPTER VIII.
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.