CHAPTER XIII

PIONEER MEDICAL MISSION WORK IN MOSUL (NINEVEH) [6]

Winning the confidence of the people--Native surgery--Difficulties to be overcome--Backward patients--Encouraging work--Prevalent diseases--Lunatics--Possible future of Mesopotamia.

"... My soul is full Of pity for the sickness of this world; Which I will heal, if healing may be found!"

Sir E. Arnold.

It is often thought that in the East, whenever an English doctor arrives at a city, patients throng to him from all quarters. This is only partially true, at least in the near East. If medicine and attendance are granted free indiscriminately, doubtless at first crowds will attend the out-patient department, many coming merely out of curiosity. If good work is to be done, it is better to make some charge, however small, exempting only the very poor. This principle has, I believe, been adopted by all our medical missionaries, and fees thus earned go to help in making the work self-supporting.

The European doctor in Persia or Turkey has first to win the confidence of the people, and this is sometimes no easy matter. On our arrival in Mosul we rented a house in the centre of the city, which had two compounds. We lived in the inner compound, and made the outer into a dispensary and small hospital. At first everything looked rather hopeless, the house being an old one and nearly in ruins. However, we made a big stable into a waiting-room for the patients; other rooms were patched up and transformed into consulting-room, dispensary, operating theatre, and wards, all of a most primitive kind. In this great city of 60,000 to 80,000 people our staff consisted of my wife and me and two native assistants, who had been trained in our Baghdad Medical Mission.

There was no lack of physicians in the city, but excluding two or three Turkish army doctors, and one or two others with Constantinople diplomas, the rest were quacks of the most pronounced type. Nearly every old lady in the city thinks herself competent to treat diseases of the eye, the barbers are the surgeons, bone-setters abound, hereditary physicians are by no means scarce. These latter inherit "herbal prescriptions" from their forefathers, and though now forbidden to practise by the Turkish Government, yet contrive to visit many houses as a "friend" after dark, and earn enough for a livelihood. The Dominicans (who have a large Mission in Mosul) also give away many medicines, and have now a qualified native doctor. But though there is much "physicking" in Mosul, but little surgery is done, and that gives the opportunity for the European doctor to step in. Arab surgery is of the crudest description. Let one sample suffice. A poor Arab woman was brought to the dispensary, soon after we started work, by her father. She complained of not being able to breathe through her nose. On examining her throat I found that the upper air passage had become shut off from the back of the throat as a result of old inflammation. Upon further inquiry I elicited the following history. Two years before, the patient had developed a bad sore throat. Her father took her to the native surgeon, who had the poor woman's mouth held forcibly open, while he proceeded to cure the sore throat by rubbing it with a red-hot flattened piece of iron!

Gradually we commenced to win the confidence of the people: they came in ever-increasing numbers to the dispensary. Gathered together in the waiting-room would be a crowd composed of many different nationalities--Christians, Moslems, Jews, Kurds from the mountains, Bedouins from the desert, Yezidees (the so-called devil-worshippers), a motley throng, listening quietly and without interruption to the reading and exposition of the Gospel, ere passing one by one through the doctor's consulting-room, for the treatment of their multitudinous diseases. The medical missionary is called upon to do his best to cure every ailment; he must be ready to accept heavy responsibilities, there are no "specialists" to consult, often he is without the help of any trained nurse, and in pioneer work, at least, he has no properly equipped hospital, and must perforce perform most serious operations under the worst possible conditions. In addition to all this, in lands under Mohammedan rule there is always the risk of a riot if a patient should die in a Christian hospital, especially on the operating table. Yet despite all these drawbacks, it is a grand life, revealing to a man his own utter weakness, and making him rely more and more upon his God.

Soon we were able to commence admitting in-patients, being forced to limit admission to surgical cases. At first there was considerable difficulty in getting the patients to come on the actual day fixed for the operation; each one was anxious for his neighbour to be the first. Finally I was compelled to threaten to put a black mark against the name of any patient who had agreed to come in for operation and then failed to put in an appearance, adding that that patient would have to wait a long time before having a chance offered a second time. This had the desired effect, a woman needing a small eyelid operation being the first to brave the terrors of the Feringhi hospital.

In due course, instruments and dressings all having been prepared, the patient, in a condition of mortal terror, was led into the operating room, and induced to lie on the table. But alas, her fears gained the mastery, and she instantly jumped up, ran out of the room, and disappeared from the dispensary. This was not encouraging, but a few days later a little Jew boy suffering from vesical stone (a very common disease in Mosul, especially amongst children) was brought to the hospital by his father. We persuaded him to enter the hospital with his boy, and thus finally gained our first in-patient. The stone having been removed, and the boy making a good recovery, we had no further difficulty in getting in-patients. Our six wooden beds soon all had occupants, then we added six more beds; finally, obtaining a neighbouring house for our own residence, we made our old house (the inner compound) into a small hospital for women and children. Thus we were able to accommodate twenty-four patients, and as each had at least one friend, we often had over fifty people resident on the premises. It is this in-patient work that gives the most encouraging opportunities to the medical missionary. There in his little hospital he has patients of all creeds, lying side by side; many have been relieved or cured by operation, and will listen gratefully to all the teaching they can get. Each patient before the operation hears the doctor pray a short prayer, asking God to bless the operation and cause it to be successful. Day after day, week after week, he receives instruction, and gains an entirely new idea of what Christianity really is, and when he leaves the mission hospital and returns to his home, whether in the city or in a distant mountain village, all his old bitter opposition to Christianity has disappeared, and often he will send other patients for treatment to the English mission. The following statistics, for two years only, may prove interesting, as showing the far-reaching influence of even a badly equipped, undermanned medical mission:--

Total attendance of out-patients 24,519 Operations performed {197 Major} 569 {372 Minor} Total number of in-patients 288 Number of villages and towns, excluding Mosul, from which patients have come to the dispensary 348

This last item is especially interesting; excluding Mosul (from which naturally most of our patients are drawn), 348 different towns and villages (some as many as ten days' journey) have sent us patients, and yet the work is barely started!

To illustrate the effect of a medical mission in disarming opposition, I may add that, in 1907, when it was feared that, owing to the need for retrenchment, the Society would have to close the work in Mosul, a petition, signed by most of the prominent Mohammedan residents, including the chief mullahs, was brought to me, asking that I would remit it at once to the Society. It was a request that the Medical Mission should not be withdrawn, as it had been such a boon to the inhabitants of the city. In a very wonderful manner God heard and answered our prayers, and the Mission is not to be closed, but rather it is hoped to equip it more thoroughly.

The operations most frequently called for in Mosul are those for "cataract" and vesical stone, but patients come with many other diseases, both surgical and medical. The city is full of phthisis; the insanitary conditions under which the vast majority of the inhabitants live favour its rapid dissemination. Smallpox and typhoid fever are very common, and once these diseases have been definitely diagnosed, neither the patient nor his friends will permit any further medical treatment. For the latter disease the patient is kept on fairly strict diet until he "perspires." This to the native mind denotes the end of all possible danger, so he is then pressed to eat anything and everything, with disastrous results. Malaria, dysentery, hepatic abscesses are also rife; there have also been epidemics of cholera and plague, but not of late years. Once the projected Baghdad Railway (which will pass through Mosul) is an accomplished fact, we may expect the importation of plague from the south, unless the most stringent precautions are taken.

The Bedouin Arab can rarely be persuaded to stop in the city; after the freedom of life in the desert, he feels stifled within the four walls of a house. Ere leaving Mosul I had a curious demonstration of this fact. An old blind Arab was brought to me by his son, suffering from double cataract. I told him that by means of a simple operation he might once again be able to see, but that he would have to stay in the hospital for a few days. He indignantly refused, saying he would rather remain blind the rest of his life than sleep beneath a roof. In vain did his son plead with him, and finding that I would not operate at once and allow him to be treated as an out-patient, the old man went sorrowfully away.

Every in-patient admitted had to bring a friend to help to nurse him, as we had no proper hospital equipment and no trained nurse. Only twice in the three years did I break this rule, both times with disastrous results. The first was a poor old man from a village some days' journey from Mosul. He was poor and friendless, also blind with "cataract"; reluctantly I allowed myself to be influenced by his pathetic pleadings, and admitted him without any one to look after him. Prior to his admission he had been bitten on the calf of one leg by a dog, and complaining of pain from this wound, we dressed it with a simple boracic fomentation. Unfortunately this dressing was forgotten and left on the leg. The eye was in due course operated upon successfully, and the patient received the usual strict injunction to lie still for twenty-four hours. At the first dressing everything seemed all right; two days later I found to my sorrow that the eye had suppurated, and that there was no hope of saving the vision. The strictest inquiry was at once instituted, but for some time we could discover no clue as to how the eye had become infected; then the truth came out. It appeared that the second night after the operation the old man commenced to feel a slight pricking pain in the eye that had been operated upon (not an uncommon symptom after "cataract" extraction, with no bad significance as a rule). The pain seemed similar to that which he had felt in his leg, which had been relieved by the application of the boracic fomentation. The patient reasoned thus with himself: "It is night time, I had better not call for the doctor; but the medicine on my eye is evidently doing no good, while that put on my leg cured a similar pain to this at once, so I had better take off this bandage from my eye and replace it with the one on my leg"! This he had proceeded to do, and consequently lost his newly acquired sight.

The other case was somewhat similar, but the patient was a fanatical Moslem priest, whom I afterwards found out was a well-known "majnoon" (madman). He also had been admitted alone, and we had but little trouble with him until after the operation (also for "cataract") had been performed. A few hours later my assistant came running to me, and said: "Doctor, that old cataract patient declares that he must and he will say his prayers. We have done our best to prevent him, but in vain." Now a Mohammedan, before he prays, performs certain ablutions, which include washing his hands and face; so I at once ran up to the ward, but, alas! we arrived too late. The old priest had taken off his bandage, washed his face and hands, said his prayers, and was quite unable to understand why the Hakim Sahib should be angry! We gave the poor old man some lotion and a shade for his eye, and sent him back to his home (as he lived in Mosul), refusing to accept any further responsibility. Some weeks later my assistant met the old priest in the bazaar, quite pleased with himself, for he had actually obtained sufficient sight to find his way about alone.

Fortunately the majority of the patients are more reasonable, and quickly learn to submit more or less to "hospital regulations." Children sometimes proved troublesome, especially boys, when accompanied by a crowd of relations. I remember one morning, when making my daily round, coming across a group of people surrounding a little boy six years of age. He had been ordered a dose of castor oil, and had made up his obstinate little mind that he would not take the nasty stuff. Being a boy, and only son and heir, he had been spoilt most royally. Father, mother, aunt, grandmother, and friends each in turn tried persuasion, varied by gentle threats, all in vain. He beat and (I am sorry to say) cursed the women, his mother included, and sullenly refused to accept the medicine from his father, despite sundry promises of sweets, money, &c.

After watching the scene with some amusement I stepped forward, took the cup containing the obnoxious castor oil, and forcibly administered the dose without regarding the boy's shrieks and tears. Then I read the parents a little lecture upon the evil result of spoiling their children, which I fear had but scant result.

Often do I feel ashamed as I note how patiently pain and diseases are borne by these poor people. It is always "the will of God," and therefore there is no use complaining, and little use rebelling. Time after time have I had to gently break the news to some poor patient, who may have come long distances to see the English doctor, that his blindness could not be cured by operation, being caused by what is popularly known as black cataract (glaucoma). A few (usually women) would go away weeping, but the vast majority both of men and women would quietly respond, "Alhamd'llillah" (Praise be to God), with but little sign of emotion.

So far as I know there is but one asylum for cases of mental diseases in the whole of the Turkish Empire, and that one is at Asfariyeh, near Beyrout, and belongs to an English society. The usual method of dealing with lunatics in Mosul is, if they are apparently harmless, that they are allowed to wander about freely and treated kindly; but once they develop symptoms of mania they are treated as wild beasts, put into a dark room, and chained to a wall. But we possess a specialist in "mental diseases" in Mosul, belonging to an old Mohammedan family, who has a great reputation for the treatment of "lunatics." In the courtyard of his house he has had dug several deep wells, and beside each well is placed a large tub, having a hole in the bottom which communicates with the well. The poor madman is made to work from sunrise to sunset, drawing water from the well and pouring it into the perforated tub, being told that he may leave off when he has filled the tub. If he refuses to work, he is unmercifully beaten. Several cures are said to have resulted from this treatment.

There is nothing so potent as the in-patient work of a hospital in overcoming opposition. Amongst our numerous "cataract" patients was an Arab from Singar (a mountainous district near Mosul). He came armed with a perfectly unnecessary introduction, in the shape of a letter from one of the chief Mohammedans in the city. After he had regained his sight and had left the hospital, ere returning to his mountain home he went to this "big" Moslem to thank him. He found himself the centre of a large and curious throng, who questioned him severely upon his experiences in the "Christian" hospital. Some of the more fanatical (it was in the early days of the Mission) did not scruple to speak against the hospital and the English hakim; but, like the man in St. John's Gospel, this Arab was not afraid to testify of what had been done for him, "for," said he, "you can say what you like--one thing I know, before I was blind, now I can see."

But enough--I fear to tire my readers; but ere closing I would like just to refer to the possible future of Mesopotamia. One thing is certain, a few years more will exhibit great changes. I have already referred to the Baghdad Railway. As I write it is rumoured that the German Government have at last obtained a further concession from the Sultan of Turkey, which will allow them to continue the line another five hundred miles, piercing Mount Taurus and reaching near to the city of Mardin (some ten days' journey north of Mosul). When this is accomplished the rest of the work is quite simple. The line from Mardin to Baghdad (passing through Mosul) should present no difficulties, and Mosul (with the ruins of Nineveh) will become easy of access from Europe.

In the next place there is the question of the navigation of the Tigris. Ere long there is no doubt that boats will be allowed to come up the river from Baghdad to Mosul, and possibly on up to Diabekir (300-400 miles north of Mosul). This will mean an enormous increase in trade, both in imports and exports.

Finally, there is that fascinating problem of the irrigation of the Mesopotamian desert. The remains of old canals are still visible, and it needs nothing but an energetic government willing to spend a comparatively small sum, plus the services of a capable engineer, to transform the whole of that desert between the two great rivers Euphrates and Tigris into a veritable Garden of Eden, even as it must have been in the days of old, when huge armies were able to find sufficient provender for man and beast throughout the whole of that vast region. The "finale" of that great province, containing the ruins of so many ancient cities, has not yet been written; and there are many signs which tend to suggest to the thoughtful observer that, ere another century has passed, Mesopotamia may once again take its place, and that no mean position, amongst the kingdoms of the earth!

NOTES

[1] "A Year amongst the Persians."

[2] By Dr. A. Hume-Griffith.

[3] By Dr. A. Hume-Griffith.

[4] By Dr. A. Hume-Griffith.

[5] Extract from "The Literary History of the Arabs," by R. A. Nicholson, M.A.

[6] By Dr. A. Hume-Griffith.