CHAPTER XIII

PIONEER MEDICAL MISSION WORK IN KERMAN [3]

Pioneer Medical Mission work in Kerman--Waiting for drugs and instruments--Native assistant proves a broken reed--First operation in Kerman--An anxious moment--Success--Doctrine of "savab" convenient to the Moslem--Fanaticism tempered with prudence--Opium slaves--Persian therapeutics--Persian quacks and their methods--Sure way of curing cancer--Hysteria.

"Charms for lovers, charms to break, Charms to bind them to you wholly, Medicines fit for every ache, 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, via 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 anaesthetic), 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 anaesthetic) 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."

As Kerman is a city proverbial amongst the Persians for its great wickedness, I could understand the old mullah's satisfaction, as doubtless he felt that many of their savab accounts were rather low and needed a trifle of "credit," which might with advantage be obtained from the savabs of an infidel doctor!

Once yearly the Persians celebrate the death of the martyrs Hassain and Hussein, as has already been described in a previous chapter. We had a good opportunity of witnessing this Persian Passion Play while in Kerman. The sword-dancers, clad in white garments, work themselves up into a frenzy, gashing their heads with the swords and sometimes inflicting severe wounds. A true believer is supposed to have his self-inflicted wounds healed spontaneously through the agency of Hazrati Ali (grandson of the prophet Mohammed); but I was a little amused by the appearance of several of these devotees at my out-patient clinique some days previous to the "celebration," all of them begging for a little English ointment to keep by them for use in case miraculous healing should be delayed.

As has been already mentioned, the curse of Kerman is opium; everybody smokes or eats it--generally the former. The native doctors are partly responsible, as they recommend the drug as a "cure-all"; but even the cultured Kermani smokes opium, possibly to relieve the monotony of his life! Cases of poisoning repeatedly occur, and some of these we were called upon to treat. Our dispensary had a small garden attached to it, and when the Mission had gained the confidence of the people it was no uncommon sight to see several opium patients being treated at the same time in this garden. The treatment used, though somewhat vigorous, proved very effective. A man would arrive at the dispensary, escorted by an excited throng of relatives. On inquiry we would find that he had taken a big dose of opium to end his life: afterwards repenting, he had confessed to his relatives, and they had at once brought him to the English doctor. The treatment began with the administration of a strong emetic followed by repeated doses of strong coffee; then he would be handed over to the care of an attendant, with instructions to walk him round and round the garden and prevent his going to sleep. The native assistants and the patient's friends, armed with sticks, carried out these instructions, and at the first signs of languor exhibited by the unfortunate man he would be beaten and kept effectually awake!

One day I was summoned in haste to the house of an influential Kermani; his only son, a child of two years, had been poisoned with opium. It is a common practice in Kerman for mothers to keep their babies from crying by giving them a little opium to suck. This boy's mother had given him a big lump by mistake, and grew alarmed when she found that all her attempts to wake him were ineffectual! On arriving at the house with my assistant, we had considerable difficulty in making our way into the courtyard, as it was thronged with all the relatives and friends; the neighbouring houses were crowded, a great multitude thronging the flat roofs, which commanded a good view of the courtyard belonging to the patient's father. On examining my little patient I found him nearly dead, exhibiting all the symptoms of an overdose of opium. However, for over an hour we worked away, washing out the child's stomach, injecting strong coffee, &c., all in the open air before the excited multitude, and gradually the little patient showed signs of recovery. When he had come completely round and was crying vigorously, there was great rejoicing. Thinking the opportunity too good a one to be lost, I asked my assistant to tell the father that God had heard prayer and restored him his child, and that we would now like him to join with us and thank God for answering our prayers, if he would tell the crowd what we intended doing. Although the father was a mullah, and had the reputation of being very fanatical in his hatred of Christians, he at once consented to our proposition, announcing to the crowd our intention. During the short thanksgiving prayer every head was bowed and not a sound of protest heard, while Christian and Moslem alike returned thanks to the great God who had heard and answered prayer. Medical Missions had once again won a triumph over Moslem fanaticism, and the scowls and threatening looks which had greeted our arrival were replaced by cordial thanks and vehement expressions of gratitude!

Persian therapeutics are very simple, dating back to the time of Hippocrates. All diseases are divided into two classes--hot and cold--to be treated accordingly with hot or cold remedies. All foods are similarly classified. With this knowledge, plus a few Persian medical books and an appropriate turban, the native quack sets up as a doctor. His impudence and native wit are inexhaustible; he will cheer his patients with extracts from Hafiz or Ferdosi (the great Persian poets), talk learnedly of vapours, and have a specific for every mortal ailment. The quack physician is amusing, and probably confines himself to fairly harmless compounds; but the Persian surgeon is a man to be avoided at all costs. Of course, I am only here speaking of quacks; in Teheran there is a good medical school, and many of the graduates from that school proceed to Paris or Berlin, and return fully qualified to exercise their profession; but they also have to compete with these native quacks.

I remember one case of a poor man brought to the dispensary with a big swelling on the left knee, which prevented his straightening the leg. Careful examination convinced me that the case was one of malignant cancer of the thigh bone, and that nothing could be done but amputation. This was explained to the patient and his father, who indignantly rejected the proposed operation. I lost sight of the man, but some weeks later one of my assistants asked me if I remembered the case; on my replying in the affirmative, he informed me that the patient had since died. It seems after leaving the dispensary the father had taken his son (a young man twenty years old) to a native surgeon (who combined the exercise of his profession most appropriately with the trade of a butcher) and asked his advice, saying the English doctor had advised amputation of the leg; but he had refused, as the swelling caused little pain, and all his son wanted was to be able to straighten his leg so that he might once again walk. "Oh," replied the butcher, "that's easily done; that English doctor knows nothing; I will cure him." So he got the father and other men to hold the unfortunate youth firmly and some other helper to seize the leg; then seizing a huge slab of stone in both his hands, he brought it down with all his force on the bent knee. The leg was straightened ... and needless to add, the poor patient only survived a few days.

My wife has written quite sufficient about the Persian women to enable her readers to appreciate the monotony of their lives behind the veil. This is more especially true of the upper classes, who have no need to work for their living. In Kerman the usual result is that many of these poor women suffer from hysteria. I have often been called in to treat some of these patients, and have found them develop almost all the varying types of that curious disease; but one of the most interesting cases I ever remember occurred in Kerman.

I had been treating the unmarried daughter of one of the wealthiest men in the city, and had prescribed for her some simple bismuth mixture, as she had complained of indigestion. Two days later her brother came galloping his horse to the dispensary, and demanded to see me immediately. He was greatly excited, and said that his sister had been taking the medicine I had prescribed for her and had suddenly gone blind. This was in the early days of the Medical Mission, and I was especially anxious to win the confidence of the people, so did not at all appreciate this complication. I assured the brother that I would return with him at once, and informed him that the medicine could not possibly have caused the blindness; but he was not at all appeased. Upon reaching the house I found all the family distracted with grief, and not at all inclined to be cordial. Moreover, they had called in a native eye-doctor, who had gravely announced that the blindness was most certainly due to the patient having taken the infidel's medicine! In order to reassure the parents I bade them bring the bottle of medicine, and, finding there were still two or three doses left, called for a glass, poured out the remainder, and drank it. This seemed to reassure them partially, so they allowed me to examine the girl. She was a nervous, highly-strung patient, and I had expected to find that she had been malingering; but to my surprise, upon thorough examination I convinced myself that she had really gone blind. Examination of the interior of the eyes showed no disease, and upon inquiry, finding that she was the subject of periodical hysterical attacks, I ventured to predict to the parents that with suitable care and supervision the girl would regain her sight. They were still inclined to be sceptical, but ten days later I heard that my prediction had come true and that she was quite cured. Similar cases of hysterical loss of vision are on record, but are exceedingly rare.

Barely had we managed to get the little Medical Mission well started when circumstances connected with my wife's health arose that forced us to leave at a moment's notice the people we had learnt to love. Fortunately the work was not given up; another doctor succeeded me, and now there is a flourishing Medical Mission with two hospitals, one for men and the other for women patients, with a lady doctor and nurse; while the influence exerted by that Mission is felt throughout the whole of the great Kerman province, which stretches eastwards to the border of Beloochistan, and is bounded on the south by the Persian Gulf.