Silent Musings of a Senile Physician- An excerpt

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 Silent Musings of a 
Senile Physician - An excerpt

By Dr. Alaf Khan

The village barber’s leather bag always contained a few additional implements of his trade. A leather strap (tourniquet) and a scalpel (نشتر) were used for venesection (bloodletting) as treatment for a wide range of maladies. Even those already anemic due to hookworm infestations or heavy monthly bleedings were thought to have foul blood and were subjected to bloodletting (فصد).  Amazingly, the clients usually survived these additional blood losses. This may sound like witchcraft, but it has a respectable ancestry in European medical practice. King Charles-II of England suffered a stroke in 1685. A team of Royal Physicians drained two cupfuls of his blood through venesection. His Majesty then had an enema, a sneezing powder, and one further venesection. His shaven scalp and naked feet were then branded with hot iron pokers. The king had fits. Powdered pearls, mixed with a good amount of pigeon dung, were made into a paste and rubbed on the royal feet. Finally, an extract of human skull bones was made into a potion and 40 drops of it poured into His Majesty’s mouth. Charles-II died that day.


Dr. Alaf Khan

The 17th-century English medicine differed very little from the healing art of my childhood era in the villages. Some of these methods persist even today in the remote hilly areas and in the tribal belt of Pakistan. Branding inflamed joints with hot iron pokers was practiced by physicians in the England of yore. Blacksmiths practiced this healing art in the rural milieu of my childhood.  I have known dozens of persons with ghastly-looking burn scars on their knees and spines. I vividly remember the sickening sight of two persons who were screaming and held in place by relatives while the blacksmith’s hot pokers released smoke, smell and vapors of charring skin and fat.

The shoulder bag of a barber of that era also contained a tin box containing fine sand and a few shriveled up, 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, has been (and still is) in medical use.  After a long period of disrepute, the leeches, like the maggots, are back in business as scavengers 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 deathproved smarter than the Russian leeches. The medicinal leech has been the physician’s ally since the year 900 CE. Therapeutic leeching and bloodletting, incidentally, were 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 price.  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 soaring domestic demand. Our village barbers were not all that stupid in recruiting the services of starving leeches. Incidentally, people sometimes refer to our medical fraternity as leeches. Some of us admittedly do suck our patients wallets dry.  But, like the medicinal leeches, we might also be doing some occasional good to our patients, even if inadvertently.

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 There were two or three ˜dentists” in the whole of Peshawar city during the 1940s Even those were probably dental technicians who practiced dentistry. Dental extraction in the villages was one more of the barber’s many duties. I had three of my milk teeth pulled out with crude pliers with long handles made for our barber by the local blacksmith. Agony was a gross understatement for the pain one endured as uncle barber pulled the decaying bone out.

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European barbers, like ours, were the professional forebears of the present-day surgeons.  From barber to the more respectable Master Barber, and then Member of the Worshipful Society of Master Barbers, was a long struggle. The Worshipful Society’s merger with the Guild of Surgeons of England ultimately resulted in the Chartering of the Royal College of Surgeons of England. With the British Empire encircling the world, Fellowship of the Royal College of Surgeons (FRCS) became not only a mark of expertise but also a status symbol globally.

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