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.
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.
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.