The other remedy, or that known as the dam, is akin to what is known in Western surgery as a “moxa.” A piece of cloth is rolled up in a pledget of the size of a shilling, steeped in oil, placed on the part selected by the doctor, and set alight. It burns down into the flesh, and a hard slough is formed; this gradually separates, and leaves an ulcer, which heals by degrees. This remedy is used for every conceivable illness, a particular part of the body being selected according to the disease or the diagnostic ability of the doctor who applies the remedy. Thus, in people who have suffered from indigestion you will often see a line of scars down each side of the abdomen. For neuralgia, it is applied to the temples; for headache, to the scalp; for rheumatism, to the shoulders; for lumbago, to the loins; for paralysis, to the back; for sciatica, to the thighs; and so on indefinitely. I have counted as many as fifty scars, each the size of a shilling, on one patient as the result of repeated applications of this remedy. The Afghans have extraordinary faith in both these treatments, and I have sometimes sat in a village listening to an argument in which some young fellow, lately returned from a visit to a mission hospital, recounted the wonderful things he had seen there, to which some old conservative greybeard retorted: “What do we want with all these new-fangled things? The dzan and the dam are sufficient for us.” As formerly in the West, so still in Afghanistan, the village barber performs the ordinary surgical operations, such as opening an abscess or lancing a gum.
The women all claim a greater or less knowledge of such surgery and medicine as they think necessary for them. After one of the village frays, when the warriors come back to their homes more or less cut and wounded, the women of the household at once set about their treatment. If there is severe hæmorrhage some oil is quickly raised to boiling-point in a saucepan, and either poured into the wound, or if, for instance, a limb has been cut off, the bloody stump is plunged into the oil. This, no doubt, acts as an effective, though somewhat barbarous, hæmostatic. If the bleeding is only slight, a certain plant gathered from the jungle is reduced to ashes, and these ashes rubbed on the wound. In the case of a clean cut the women draw out hairs from their own head, and sew it up with their ordinary sewing-needles, and I have sometimes seen flesh wounds which have been quite skilfully sewn up in this way. They are less skilful in the application of splints. In most neighbourhoods there is some village carpenter who prides himself on his skill in the application of splints to broken bones; but in most cases he bandages them too tightly, or with too little knowledge of the circulation of the limb, so that not a year passes in which we do not get one or more cases of limbs which have become gangrenous after quite simple fractures through this kind of treatment.
Almost the only drugs which are used to any extent in Afghanistan are purgatives, and especially those of a more violent and drastic nature. Nearly every Afghan thinks it necessary to be purged or bled, or both, every spring, and not unfrequently at the fall of the year too. Scarcely any illness is allowed to go to a week’s duration without the trial of some violent purge. Sometimes the purge is given with so little regard to its quantity and the vitality of the patient that it results in rapid collapse and death. In other cases a latent dysentery is excited, which may result in an illness lasting many months, and leaving the patient permanently weakened thereby. The seasonal blood-lettings are performed, as in the West, from the bend of the arm, this position having, no doubt, come down to the practitioners of both East and West from the ancient Greeks; but in the case of illness, while the physicians of the West have had their practice revolutionized by modern ideas of anatomy and physiology, those of the East still follow the humoral and hypothetical pathologies of Hippocrates and his predecessors. These practitioners know the particular vein in the particular limb or part of the body which has to be selected for venesection in any particular illness. I have known a young doctor from England lose at once the confidence which the people might up to that time have had in his medical knowledge, because in a case of illness to which he was called he recommended venesection, and the patient’s medical attendant who was to carry out the treatment made the, to him, very natural inquiry, “From what vein?” The English doctor said: “It does not matter.” Both patient and medical attendant not unnaturally assumed that he was either a very careless doctor or an ignoramus, and, in either case, that they had better call in a fresh opinion.
Cataract is a very common complaint in Afghanistan, and from time immemorial there have been certain hakims, or native practitioners, who operate on this by means of the old process of couching. These men usually itinerate about the country from village to village, as in most cases the old men and the old women who are suffering from cataract are unable to undertake the journey to a town where one of these practitioners lives; or it may be that their relations are not willing to take the trouble for someone whose working days are apparently over. In some cases no doubt the operation results in good sight, but in the majority other changes which take place in the eye as a result of the operation lead before long to total blindness. As, however, the hakim seldom goes over the same ground again till after the lapse of several years, his reputation does not lose by these failures, as it would have done if he were always resident in one place. The tooth extracting of the village is usually entrusted to the village blacksmith, who has a ponderous pair of forceps, a foot and a half to two feet long, hung up in his shop for the purpose. Where the crown of the tooth is fairly strong and prominent the operation generally results in a short struggle, and then the removal of the aching tooth; but if the tooth is very carious, or not prominent enough for a good grip, the results are often disastrous, even to fracture of the jaw, and these ultimately come to the mission hospital for repair, several often turning up in one day.
At one time smallpox was terribly rife in Afghanistan, and even now no village can be visited without seeing many who are permanently disfigured by it. When an Afghan comes to negotiate about the price of an eligible girl for marrying to his son, one of the first questions asked is, “Has she had the smallpox?” and if not, either the settlement may be postponed until she is older, or else some deduction is made for her possible disfigurement if attacked by the disease. Many times fathers have brought their daughters to the hospital with the scars left by smallpox in their eyes, begging me to remove them, not so much for the sake of the patient as because the market value of the daughter will be so much enhanced thereby. The custom of inoculation was at one time almost universal in Afghanistan. A little of the crust of the sore of a smallpox patient was taken and rubbed into an incision made in the wrist of the person to be inoculated. The smallpox resulting, though usually mild, was sometimes so severe as to cause the death of the patient, and the people have not been slow to recognize the great advantages which vaccination has over inoculation. Only two circumstances deter the people from universally profiting by the facilities offered by the British Government. The first reason is that very often the vaccinators are underpaid officials, who use their opportunities for taking bribes from the people, and make the whole business odious to them. The other is, that they have a widespread superstition that the Government are really seeking for a girl, who is to be recognized by the fact that when the vaccinator scarifies her arm, instead of blood, milk will flow from the wound; she is then to be taken over to England for sacrifice, and the parents are afraid lest their girl should be the unlucky one.
[1] More probably from the Greek κοφινος.—J. C.