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, viâ 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 anæsthetic), 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 anæsthetic) 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.”