An excerpt from "Silent Musings"

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 An excerpt from
"Silent Musings"

By Prof. Alaf Khan

Circumcisions

Boys in the villages and in most of the cities were circumcised by barbers in those days. I myself, my two elder brothers, all my cousins and nephews have been the victims of the barber’s open razor. None of us, luckily, contracted tetanus that still flourishes in our rural environment and claims many lives.

Prof. Alaf Khan 

Circumcision was celebrated as a festive event. Women sang, danced and played drums and flutes every evening for a week or so preceding the amputation.  Finally, bursts of aerial gunfire meant that the boy’s foreskin was no more.  Male guests were seated in a circle at the time of circumcision. The barber squatted on the ground in the center. His screaming little prey was seated on a crude stool or an earthenware pitcher turned upside down.  Some adult relative brought the boy’s hands and forearms from behind his knees and clasped his wrists on the inside of his knees. This posture made the boy’s masculine assets readily accessible to the barber’s razor.  Hard as the barber tried to conceal his razor from the boy, the hapless soul knew the fate of his foreskin. The man holding the boy would shout ˜Look!  Look up;  see that kite up there? See that crow?. And in an instant the amputated foreskin would be tossed over to a waiting dog or cat. The barber always carried a small aluminum bowl as well. Other young lads, more or less the victim’s age, were asked to pass urine into that container just before the surgery.  The circumcised bleeding penis was washed a few times with that freshly passed urine. Close by his right side, the barber kept a small tin plate on which he burnt some old cotton rags to make fresh warm ashes. The bleeding surface was covered with generous helpings of the ashes in several layers.  A piece of clean-looking linen was wrapped round the organ’s bleeding end.

This combination of warm ashes and equally warm urine was, in fact, not such a primitive quackery as it sounds.  Lord Joseph Lister of Glasgow Royal Infirmary is credited with antiseptic surgery. His Lordship ought, in all fairness, to share the glory with our village barbers who used the best sterile things of the era:  freshly passed male urine and freshly burnt cotton rags.  I was struck by the empirical wisdom of using fresh urine when a young Afghan fighter consulted me during the Soviet occupation of Afghanistan.  “What’s the problem, I asked.  ˜Nothing, Doctor Saib.  But please get my urine tested for germs and any other poisons˜Any reason?,  I asked.  ˜Well Doctor Saib, we often clash with the Shuravis (Soviets)  in some remote gorges.  When one of us is hit by a bullet or a shrapnel, the rest of us quickly pass urine on his wound to wash it clean.  And I don’t know if my urine is safe for that job.

The urine and the ashes were the forerunners of carbolic soap, antiseptic liquids, surgical spirit and Band Aids.

The barber, with a large square mirror in hands, shuffled slowly in front of the guests who sat in a circle.  The mirror was held to each guest one by one. Each guest to whom the mirror was heldpaid the barber some cash.  I never understood the origin and meaning of this custom of Holding the Mirror to Someone. It could possibly mean that the barber was telling the guest to look at his grey beard and balding scalp, and recall the day when he to lost his foreskin to the barber’s razor.  History does indeed repeat itself, in Muslim culture at least.

Circumcision ceremony in the urban areas, specially in Peshawar city, was more like a wedding until recent years.  It was, in fact, called the mini-wedding (chootee shaadee). The boy was adorned with floral wreaths, colourful attire and garlands of currency notes atop an equally decorated horse.  Taken out in a procession in the city streets on the day of his forthcoming ordeal, the barber’s prey was accompanied by dancers, drummers,  bagpipers, flute players and singers. Coins were showered on him by relatives, friends and neighbors.  Scores of kids from the neighborhood walked along the resplendent lad and his mount. These children tangled over the raining coins like two rugby teams in a ferocious tackle.  These spectacular rituals are, alas, no more. The advent of surgeons and their crushing forceps have killed these colourful scenes.

The village barber’s leather bag always contained a few additional implements of his trade. A leather strap (tourniquet) and scalpel (nishtar) were used for venesection (bloodletting) as treatment for a wide range of maladies. Even those already anemic due to hookworm infestations were thought to have foul blood and were subjected to bloodletting (Fasd)!   Amazingly, the clients usually survived these additional blood losses. 

Another item in a barber’s bag was a tin box containing fine sand and a few shriveled up, and ravenously hungry, leeches. When allowed to suck the patient’s blood, the leeches would swell to many times their starving sizes.  Leeches are unique in having a mouth at each end and a row of stomachs along each side of the body.  They also release an anti-clotting chemical once their mouths puncture the patient’s skin. This ensures a steady flow of blood into their stomachs by preventing clot formations at the puncture site.

There are about 650 species of leeches in the world.  Only one, Hirudo medicinalis, is still in medical use.  After a long spell of disrepute, the leech, like the maggot, is back in business as scavenger of dead tissues and clots under the skin in cases of gangrene.  Stalin was leeched in 1953 in his terminal illness, but the angel of death proved smarter than the Russian leeches. The medicinal leech has been the physician’s ally since the year 900 CE.

Therapeutic leeching and bloodletting were, incidentally, prevalent in Britain and Europe till not that long ago.  London imported 7.2 million leeches from Bordeaux and Lisbon at a cost of 900,000 British Pounds.  The import had dropped to 2,000 leeches per year by 1940 at 20% of the previous cost per leech.  France exported 10 million leeches in 1825 and retained three million for domestic use. It, however, had to re-import 41. 5 million of them to meet the rising domestic demand.  Our village barbers, after all, were not all that silly in recruiting the services of starving leeches. Incidentally, some people sarcastically refer to members of my profession as leeches because some of us doctors do suck our patient’s wallets dry. But, like the medicinal leech, we might also be doing some occasional good to our patients, even if inadvertently.

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