At the Court of the Amîr: A Narrative

by John Alfred Gray

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.

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.

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]

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.”