# The Pearl of Asia/Chapter 30

xxx. Practice of Medicine – Native Doctors.
The Siamese formerly believed that the human system is composed of four elements: water, wind, fire and earth; that disease is simply a disarrangement of these elements; hence if fire from without, the heat of the sun, for instance, enters the body in undue proportion fevers, small-pox, etc., necessarily follows. Each element is claimed by the physicians to have its regular seasons, similar to climatic changes. In the native books that they read they are told that during such a month that wind is prone to prevail and beget disease, another month fire. Appoplexy, they say, is caused by an internal wind blowing upon the heart with such strength as to rupture it. The theory of the native doctors is that all diseases are produced from an excess or diminution of one or more of the four elements. Wind, lom in Siamese, seems to be the leading element, and in nineteen cases out of twenty a sick person, when questioned, will reply as to what ails him, “pen lom,” it is wind. They believe that it enters the system by inhalation and proceeds to the lead as wind enters into a bellows; without it the blood would not flow, perspiration cease, bile stagnate, bowels inactive and the waste gates of the system remain closed. It is supposed that there are two divisions of wind, above and below the diaphragm. Rheumatism, epilepsy, etc., are caused by the wind blowing upward; colic, pains in the loins, legs, etc., by ​its blowing downward, It is seldom that a disease runs its course without all of the elements being called into play, water especially, as in eases of dropsy, which is caused by the fire not having sufficient force to dry up the water, as the sun does the mists and fog, and they think that fever and cholera are caused by the invisible mists and vapors that exhale from the ground, miasma. They also believe that spirits, good and evil, produce a multitude of human ills, and the people are in continual dread of them, conscious of the demerit that has accrued to them since the beginning of their existence, hence they perform many acts in the way of propitiating them. They have an idea that medicines have the power to counteract the element deranged and thus restore the body to health. The origin of medicine is claimed to be miraculous and they have nostrums for each and every ailment; for instance, a remedy for the head would be very different from that for the bowels. A snuff, a plaster to the temples or a wash for the eyes may calm the wind in the head, while something entirely different, taken internally, will dissipate the storm in that region upward or downward, or through the pores of the skin; wind may also be withdrawn by cuping, poulticing, etc., in fact that health may be restored by medicines which have the power to drive the surplus elements out of the system or to parts of the system that need it. Giddiness they attribute to a deficiency of wind blowing upward, hence a vacuum in the brain; their mode of treatment is to make the patient eat his fill and then go to sleep. For small-pox and cutaneous eruptions, they use a variety of medicated effusions of a cooling nature. If the disease is from the effects of too much ​water they will use drastic cathartics, if from a predominance of solids of the earth they will try to render the system more plastic by the use of fluids.
Their medicines are chiefly derived from the vegetable kingdom mainly indigenous to the country, but a small portion is imported from China by the Chinese doctors. Sometimes they employ articles that belong to the animal kingdom, such as tiger and other bones, teeth, sea-shells, fish and snake skins, urine, eyes of birds, cats and cattle, snake's bile and other such stuff; also saltpeter, borax, blue-stone, lead, antimony, salts, mercury, etc.; they also use aloes and gamboge, and of late years quinine has become very popular with them as a tonic. In Bangkok modern medicines are extensively used, especially pills. In the interior the old method still prevails and the native practitioner doses the unfortunate, who may be in his power, with the vilest of decoctions, as there is not a weed or shrub that grows that they do not put to some use. An American physician, who was conversant with their practice, assured me that in one of their prescriptions they had one hundred and seventy-five ingredients, to be taken in three doses, and they are sure enough doses, as the common way of paying a doctor is by the potful thirty to sixty cents per pot, each holding from two quarts to one gallon, and a dose is as much as a man can swallow at one time, frequently a quart. They also make pills, some of them of huge dimension, so large that they have to be cut up and softened in a cocoanut shell of water, then taken in a fluid state. Fifty years ago tonics were unknown until introduced by the western physicians, the native doctors accounting it a sin to use a drop of ardent spirits; but this ​dread has given away before the practice of drinking introduced by the Europeans, and now many of the Siamese partake of strong drink not only as a medicine, but as a stimulant.
The native doctors, as a general thing, are self taught, but now the King has made arrangements to have a large class taught at Wang Lang hospital, where several eminent physicians lecture and take charge of the classes. Hitherto when a man was desirous of becoming a doctor he read one or two books or manuscripts on a special subject and practiced in accordance with what he had read. Sometimes he will read a number of books and manuscripts, and witness the practice of an older doctor and then in a year or so branch out as a full-fledged doctor. They make one or two diseases a specialty, none of them attempt to become a general practitioner of medicine. They know but little in regard to surgery and will send for miles to secure the services of a foreign physician. Doctors stand high in the estimation of the people; they look to them as their natural protectors, not only against the effects of disease, but the spells that the spirits may cast over them, and when a doctor fails of a cure he always attributes it to the spell of a witch or a spirit beyond the power of human skill to avoid, and thus retains the confidence of his dupes. The King always has a number of native physicians in his employ who live in or near the palace. He also has two regular physicians, Drs. Gowan and Haves, the latter an American of the modern school, and he is doing much towards advancing the young men in the hospitals in the study of medicine and surgery, introducing all of tho latest works and medicines. The ​princes and nobles now call in a foreign physician when they are needed, and several physicians are doing an extensive business in Bangkok and vicinity. Thus, in the march of progress they have learned to ignore the old custom of employing none but native doctors, since they have witnessed the remarkable cures effected and skillful operations performed by the American and other physicians. The Siamese are very generous to their physicians and frequently after the patient is convalescent he will send presents to him, the most beautiful and fragrant flowers, in the form of chandeliers and baskets, to be suspended in his room.
The fee for a "job of healing" is never less than eight or more than twenty ticals, but aside from this the law allows a special fee of three and a half ticals called k'wan kow-k'aya. This is divided into two parts, k'wan kow consists of a proffer of a tical and a half in silver, which is stuck on the bottom of a wax candice, then the candle is stood upright in a brass basin or some other utensil; a little rice, salt, pepper, onions, bananas, etc., is added and an incantory form recited over it by the doctor, an offering to propitiate the spirit of the great medical teacher Komara-P'at, who lived during the days of Buddha, beseeching him to exert his influence in the spirit world over the diseases of men. No doctor will ever undertake a case if this rite is overlooked. The kaya is the ticals, for the cost of the medicine, be the same little or much, but he can't claim it until the patient is restored to health. They also have another rite, an appeal to the spirits in behalf of the patient, which they do by moulding little clay images of men, women, cattle, or some other ​symbol of animated nature, which they place on a small float on stand made of banana leaf on which he puts the statuets together with some rice, salt, pepper, betel, ceri leaf⟨,⟩ etc., lighting it with a small taper and then carries it into the street or commons or sets it afloat on the river or canal, leaving it to care for itself. This is done in the hope that the offering may be acceptable to the spirits and that they will dispel the storm that is beating on the sick one. This is called krabon, and if successful the doctor receives a tical and a half. The native doctor has nothing to distinguish him from the common run except a box that he carries under his arm holding about a half bushel of pills, powders and other nostrums.
One mode of treating fevers is by water, medicated drinks and frequent bathing in tepid water, ablutions and fomentations. A common mode is showering the patient, the attendant nurse or a priest blowing the water from his mouth, which falls gently and agreeably upon the sick one like a warm spray. Some of the Siamese remedies are valuable, while others are ridiculous; for instance, the following for "morbitic fever," as given by Bishop Pallegoix: "One portion of rhinoceros' horn, one portion of elephant's tusk, one of tiger's and the same of crocodile's teeth, one of bear's teeth; one portion composed of three parts⟨:⟩ bones of vulture, raven and goose; one portion of bison and another of stag's horn; one portion of sandal⟨.⟩ These ingredients to be mixed together on a stone with pure water; one-half the mixture to be swallowed, the rest to be rubbed into the body; after which the fever will leave."
The following is an abstract of a recipe for the ​worst type of small-pox, taken from a Siamese Mss. of the highest authority. It contains twenty-eight ingredients, to-wit: "One portion of conch shell; two kinds of aperient fruit, one portion of each; one portion of asafœtida ; one of borax; one of ginger; nine kinds of pepper, including the hottest spices, a portion of each; four kinds of cooling roots, a portion of each; two kinds of sour leaves, one portion of each; one of an astringent root; four kinds of drastic cathartics, including the fruit and leaves of the Croton plant, one portion of each; one of rhubarb, and one portion of Epsom salts. Boil in three measures of water until it be diminished to one measure of the decoction, then squeeze out the oily parts of it, dry and pulverize, A woman may take one salung's weight of it. A child may take a fuang's weight. It will purge off everything in the bowels."
The following are specimens of medical recipes taken from a Siamese Mss. on the treatment of snakebites. The author states it as being an important fact to be taken into consideration in forming a diagnosis, that the bite of a venomous serpent, and indeed any other wound or sore on the left side of a female and right side of a male, are unfavorable to a cure, and that the reverse is favorable; and furthermore, that there is a difference in the curative capabilities of all wounds according to the day of the weeks on which they were inflicted, as there is also in the time of the day — the morning being much more favorable than the evening.
One of the prescriptions comprises nineteen ingredients, among which is a portion of the jaw of a wild hog, and one of a tame hog and one of a goat; a por​tion of goose bone and one of a peacock; a portion of the tail of a fish, and one of the head of a venomous snake. These, being duly compounded and mixed, form an excellent receipt for use in all cases where the venom has produced tetanus or lockjaw.
Another prescription is called a general sternutatory to be blown into the nose in cases of a venomous bite or other poisoned wounds. It comprises seventeen ingredients, as wood, bark, nutmeg, camphor, flowers, the bile of four kinds of venomous snakes and of a wild hog. This, it is said, may be used with much utility also by women who cannot lie by the fire after childbirth, and in eases of epilepsy and asthma.
Another recipe is a compound to be taken internally, being briefly as follows. The bile of two kinds of buffaloes, of two kinds of hogs, of a goat, of a sheep, of a fresh water alligator, of a large tortoise, of a salt, water alligator, of a sword fish, of a shark, and of thirty kinds of snakes — so much for the bilious part of it. Then there is to be added four kinds of stone, alum, and ratsbane; five kinds of iron, five kinds of bulbous roots, and borax; seven kinds of flowers and fruit; seventeen kinds of leaves; a little gum and resin; seven kinds of medicated water, etc., etc.; being in all one hundred and seventy-four different ingredients. These, being all intimately mixed, are to be divided into three doses. It is termed a large and excellent remedy for the bites of all kinds of venomous snakes.
Another is a snuff made of five kinds of lotus flowers, calculi taken from the livers of cattle, many kinds of animals' teeth, several kinds of roots, two kinds of ratsbane, being twenty-nine ingredients in all. When well mixed, rehearse over it some form of incantation thirty​seven times. Then add twenty-two other ingredients of equal parts. This is said to heal all kinds of poisoned wounds.
Then follows a recipe for an external application in the form of a paste or poultice, consisting of the eyes of vultures, crows and cats; and three kinds of animal deposition found on trees. These having been intimately united, then take nine wax candles, and place them on as many floats made of plantain stalk or leaf, each ornamented with flowers. Then the doctor is to take nine salungs (each equal to fifteen cents), nine handfuls of rice, nine ceri leaves, and nine betel nuts, and make an offering of them one on each float or altar to the Teacher of Medicine. Then he is to take the residue, rub together, dry in the sun, and make into slugs. Then gild the slugs and rub them up in a little water, und apply to the wound.
Following the above is a direction for an enchantment with a view to call the snake to suck out the poison of the wound which it has inflicted, viz.: Take proof spirits three bottles. Let the doctor officiating repeat the form of the incantation. Then let him drink one of the bottles of spirits and enchant over it. If the snake does not come, let him take a second bottle and proceed in the same way. If on drinking the third bottle, with an enchantment, the snake does not come, the patient must die. In case the snake comes, let the doctor take three cowries in his hand, and then rehearse one form of the enchantment, and then another seven times repeated for the purpose of charming the snake to come to the left side of the doctor; for if he comes to the right side a contention will ensue. Then let the ​doctor brush off the poison from the wound with a handful of meyom leaves seven times, when the form of incantation must be rehearsed over the three bottles. Then if the patient can eat betel he will get well.
Siamese Obstetrics.
Superstition has invested the whole subject of native midwifery with the most silly and ridiculous notions, and some very pernicions and cruel. In accordance with the teachings of Buddhism, the Siamese believe that there never have been any new creations of animal or intelligent beings, hence that all living creatures that ever have been, or ever will be born, are simply and only transmigrations from previous states of existence — that all mere animal beings, have once been in a higher state in some previous life, in the form of men or women on earth, or as angels in heaven or devils in hell, and that mankind have all transmigrated to their present state either from some of the many heavenly worlds, or from some of the many infernal abodes.
The native books on midwifery make an earnest business of teaching parents how they may know whence their new-born infants have come, and soberly state certain signs by which they may know whether their expected child is to be a son or daughter.
Their books say that there is great choice to be had between the different days of the week on which a child shall be born — Wednesdays and Thursdays being regarded as more favorable than any other day for the development of vigorous constitutions and bright intellects. Children born on Sundays are thought to be peculiarly liable to be careless and reckless all their days.
Besides these days of every week, they pay much ​regard to other days, months and years, which their astrological books show to be the most auspicious for the birth of children.
There are a thousand other superstitious observances connected with this subject, which tend greatly to enslave and dwarf the mind of the mother. Happy should all other mothers be that they have not been brought up under such chains of ignorance and consequent misery.
The superstitions surrounding childbirth are peculiar and cruel. Those who practice obstetrics are generally old women, a doctor is seldom called in except on rare occasions, and the midwives endeavor to aid natural labor by means of domestic medicines, shampooning, etc, at times doing much serious mischief. The cruelest part of their procedure is immediately after childbirth, causing the mother to lie by a hot fire for a period of from five to thirty days. If it is the first child she is doomed to lie thirty days within four feet of a fire always uncomfortably warm, much of the time hot enough to blister, on a bare board without a mattress or the least thing to soften the hard plank. This must continue night and day, at the same time wearing nothing but a thin cotton cloth around her hips to shield her from the fire, and she is forced to keep turning constantly as the heat becomes too much for her to bear, in a climate where a fire is anything but pleasant to a person in good health, let alone an enfeebled woman, and this too in a small room without any chimney to carry off the smoke of the burning wood, so that the eyes of the patient are almost blinded as well as her body half baked. This is called "lying by the fire." The fire-place is a box about four feet ​long by three wide, from eight to ten inches deep, filled with clay, on the top of which the wood is piled and kept burning for the time required. The bench on which the woman lies is of the same height and is brought into immediate contact with it. No one knows the origin of this most pernicious custom, cruel in the extreme, but it is practiced by a number of the East Indian nations. Every effort has been made by the foreign physicians to abolish this practice, but so far without any signal success. In a few instances the wives of His Majesty and of some of the princes have dispensed with this barbarous custom, but the old midwives continue to have their way and the poor mothers are still systematically roasted.
The Siamese are rapidly advancing in their knowledge of anatomy. A few years since they absolutely knew little concerning the human frame; they had a vague knowledge of a few of the bones and tendons, but knew nothing in regard to the nerves, having no word to designate them. Concerning the arterial circulation they had the most novel ideas, imagining the pulse to be a conductor of wind. Ask a native when feeling his pulse what causes it to beat. As in other cases, he will reply "pen lom," it is wind. They formerly imagined that the chest and abdomen were one, which they termed bowels; that the passages to the lungs and stomach were one and that the heart could be reached through the esophagus. A foreign doctor had been called in to treat one of the princes who was suffering with palpitation of the heart. Ten royal physicians were in attendance, who had been physicing him on the supposition that there was a direct passage from the mouth to the heart, hence they ​had been administering cathartics for the purpose of expelling the wind that was supposed to be pent up in his heart causing the trouble. It was a new idea to them that there was no road to the heart except by way of the circulation of the blood or by the systematic influence of the nervous system. They regarded the liver as having so slight a fastening as to be liable to get out of its place, sinking down among the intestines and producing grave complaints by its erratic wanderings. Even up to the present time the students and native doctors at Wang Lang hospital could hardly be made to understand that there were kidneys in the human body, nor realize of what use they could be in the system. They know but little concerning surgery, they but seldom use a lancet, and treat cancers and tumors with a poultice made up of many ingredients, more injurious than beneficial. It was a long time before the natives would submit to a surgical operation; now that they have realized the beneficial effects of Western skill, they are not slow in catching on to a good thing, our surgeons and doctors are in demand, sometimes having to go hundreds of miles in the interior to amputate or set a limb. Thus it does not take long to break down the barrier of prejudice with them when they are to be benefited. It is well that the Siamese are inveterate bathers, otherwise the way that they live in filthy huts disease should run riot among them, the walls and floors of theirvooms being stained with betel saliva and other filth. No wonder that cholera has here its abiding place the year round, its natural home, as it has come there to stay. Vaccination is very popular with the people, having been introduced into the king​dom by an American missionary in 1840, and now the King has instructed the native doctors to vaccinate the people at his expense.
One of the worst diseases in Siam and the Asiatic coast is leprosy. Hundreds of these miserable diseased wretches can be seen begging by the wayside for alms in all stages of the dread disease. Some with fingers and toes gone, others with noses and lips off, their blackened gums protruding in the most hideous manner, while many are a mass of hideous ulcers, barely able to crawl into the shade of a tree and point to the cocoanut shell that holds the few coppers tossed to them by the charitable. The native doctors never undertake to do anything for a leper; they say it is useless, and so far science has been unable to cure or alleviate the ravages of this worst of all human ills. It is impossible to tell the number of the lepers in Bangkok, but I have seen at least one hundred at Wat Kok soliciting alms, and to the credit of the Siamese they contribute liberally to these unfortunates whom they think the spirits have persecuted for some misdemeanor committed in another period of their existence. While it is asserted that the disease is not contagious, it would be well if these unfortunates were housed and cared for, as their appearance is horribly repulsive. It is generally supposed that there is a large number in the city that no one sees but their relatives, those at the wats being paupers whose only chance for subsistence is what is given to them. Outside of the lepers there are but few beggars in Siam, only these who are deformed, crippled or otherwise objects of charity, and they are generally found around the temples.