CHAPTER VI MEDICAL WORK

Likiang had no hospital. There was a French-trained Nakhi doctor who, evil tongues said, assumed the title after a couple of years’ work as a male nurse at a Kunming hospital. However, he belonged to a prominent local family, and that distinction alone opened the door for him into local ‘society’. He was a nice, polite man, and we became friends. His younger brother, an army officer, was a devil incarnate, and also a bandit. He shot several villagers in cold blood, robbed an official escort of their guns and all but caused my own death. Once his brother invited me to an official dinner at his house. There were many guests and I was assigned a seat at the table opposite him. As was the custom, we all toasted each other from time to time. Although I had drunk in moderation, the fellow taunted me by saying that I could not take much more than another cup. I told him that I was quite all right for at least three more. He toasted me and offered me a cup which I emptied. I remembered no more. It was only late next afternoon that I regained consciousness. I felt like dying and was in bed for three days. Since there were no secrets in town that were not known sooner or later, I learned that the wretch had put chloroform into my wine. I was fortunate to have recovered at all, and never went to that house again.

As the Nakhi doctor was always busy with his wealthy clients and did not care anyway for the villagers’ patronage, the poor people had nowhere to go to for medical attention except to some quack medicine shops. Having previously qualified as a doctor’s assistant myself, I obtained from the American Red Cross in Kunming a small supply of drugs and medicines and my private office upstairs became also my clinic.

I had made it known far and wide that I was ready to treat all simple and easily recognizable afflictions and diseases, but nothing complicated or requiring surgical intervention. The treatment would be entirely free of charge as the medicines had been donated by the American Red Cross, and the clinical work was encouraged by my headquarters as a useful adjunct to the promotion of the co-operative movement. If I had expected a rush of patients, I was sorely mistaken. Nobody would come even if asked. The very fact that the treatment and medicine were free was a serious deterrent. Who would give something for nothing? people reasoned. They assumed that any free drugs were useless or, what is more, probably poisonous. However, I had already made a start with my friend Wuhan’s cousin. His eyes had recovered and he was trumpeting my fame all over his village.

After a few days several women came with children. Some had eye diseases and the children had worms. They were all duly treated and supplied with medicine. In a week’s time the market-place was shaken with stories of miraculous cures, and long ascarides, wrapped in leaves, were exhibited to those who wanted to see for themselves. My reputation was made: and soon, from early morning till nightfall, the patients came, on the average about fifty a day, with no regard for hours or holidays. Most of my patients were poor village women afflicted with eye troubles of all sorts, caused by dirt and acrid wood smoke. Very soon, however, they began to complain.

‘It is true,’ they said, ‘our eyes are much better, but this black medicine you put in does not seem to be good, for we do not even feel it. A really good medicine must be strong and painful — then we really know that we are being cured.’

Of course I used mostly argyrol, which was very efficacious in these cases, but it was not painful. To appease my wavering clientele, I mixed some chinosol with argyrol. Chinosol may also be used as an eye medicine, but it hurts terribly for a few minutes. When they came next time I put this desirable medicine in their eyes. They collapsed on the floor, writhing in their agony. I awaited their reactions with some trepidation after they had recovered. Wiping their streaming eyes with their aprons, they sang in unison.

Lah-da han! Hao da han! (How peppery! How good!)’

They were absolutely delighted: it was a wonderful experience, they all said. ‘This is the drug! It is precious!’ And then they came in droves, bringing their friends with them and asking for that same medicine or nothing. In long rows they sat in the courtyard and fell, as if struck by lightning, as soon as I had put in the drops. Afterwards they always laughed and chattered in their delight.

Whilst the sore eyes formed almost a women’s monopoly, men came in an endless procession with their thighs and buttocks covered with scabies. They were so thick that they looked like fish scales. I had a big stock of sulphur ointment for this affliction, and at first I used to give them small pots of it, telling them to rub it in at night. In a week or two they used to come back complaining that the ointment was no good at all. Indeed, the awful scabs were still there. I had to change my tactics. With their pants down, I threw them on a low broad bench, face down, and rubbed them with all my might with powdered sulphur and vaseline, adding a pinch here and there as required. I rubbed until all the scabs were on the floor in little heaps, and the raw and bleeding flesh was clear. Then I rubbed some more sulphur in. The victims screamed and groaned,and staggered home hardly able to walk. After two or three such treatments their skin was as clear as that of a new-born babe. Of course, they were overjoyed and did not know how to thank me. It was hard and dirty work and I could not handle more than five such patients a day, so exhausting was it.

These skin diseases were, of course, a result of dirt and lack of personal hygiene. The Nakhi, both men and women, never took a bath. They washed only three times in their lives — when they were born, when they were about to be married, and when they were dead. In any other climate but Tibet and Likiang such a state of affairs would be intolerable. The people would smell like putrid corpses and would die of infections. But it was not really so bad in the dry mountain air of these high altitudes. The dirt simply dried and fell off in tiny scales. There was never any offensive odour from the people in the town and the villagers smelled like pinewood smoke. As for myself, I had a wooden tub made and took a hot bath in it in our little garden behind the house. I was partially visible over the wall and the women, passing along the crest of the hill, always laughed and shouted rude remarks. My cook took the bath after me in the same water, being too lazy to boil another lot. After him about ten of his Nakhi friends took turns until the water looked like pea-soup. Perhaps it was better than no bath at all.

Nakhi men also liked pain as a proof that the medicine or treatment was good. The men whom I cured of scabies were ecstatic in the description to their friends of the exquisite tortures they had endured at my hands and strongly advised them to come to my clinic with their sores. Some had deep ulcers on their legs. They said how much they suffered from these sores and hoped that I would cure them. Of course, they added, it must be awfully painful if the right treatment was applied, but they did not mind. I knew exactly what they meant. With big tweezers I tore off their scabs and dug out the wounds almost to the bone with cotton dipped in alcohol. They yelled and twisted. I filled the cavities with sulphathiazole, bandaged and sealed with elastoplast. Shaken but smiling, they always said what a marvellous experience it was. In three weeks or a month they were healed and I was invaded by others with still more horrible sores.

Goitre was a prevalent disease. However, it did not affect the Nakhi so much as the various tribes living along the Yangtze River and the Chinese emigrants from Szechuan who had settled in the forests and, of all places, in the great 11,000 feet deep Atsanko Gorge which the mighty Yangtze had cut for its passage through the Snow Range. Some goitres were of great size, pendant on both sides of the throat, creating an obscene resemblance to a backside. Of course, the best treatment for the goitre is its removal by surgical means. To do this these poor people would have to travel to Kunming and pay high fees at a hospital there. It would be useless to suggest such a trip to a man whose whole fortune perhaps amounted to only a couple of dollars. Even a trip to Likiang, without a reason, was an expensive undertaking for them. They could not remain in town for the length of the treatment. So something quick had to be devised. I gave them as large doses of potassium iodide as I thought possible, short of killing them. I confess I had some very close shaves. A Lissu witch-doctor lay for two days in semi-coma after the treatment; others had attacks of iodism. However, all survived and I saw them again a month later. The goitres were half the size and, after a few more treatments, became very small and hardly noticeable, but, I must admit, they were still there, and I never succeeded in removing them altogether.

Leprosy, now genteelly called Hansen’s disease not to offend the sensibilities of those who believe that a change in the name makes the disease less virulent and frightening, was not common among the Nakhi. If there was any, it had been brought from outside, and about this the people were very watchful. I remember a case when a Nakhi, who had been residing for years somewhere beyond Hsiakwan, came back to his village to rejoin his family. He was seen to be in an advanced stage of leprosy, and the villagers came to him en bloc and asked him either to go back or to commit the ceremonial suicide. He chose the latter. He was given a bowl of the dread black aconite boiled in oil. Afterwards they had his body cremated.

The Minkia, White Lissu and Szechuanese settlers had a few cases of leprosy: the Tibetans too. But it was not so common as the missionaries’ reports would lead us to believe. There was a small leprosarium near Erhyuen, 150 miles south, in the Minkia country, but it was only half filled. I am not a scientist and have not conducted any systematic research or read much about the causes that produce leprosy. However, during my many years of residence and travel in China and along the Tibetan border I had time to observe and compare the conditions under which the people who had the greatest incidence of leprosy, and those who had the least, lived and worked. There were some verdant and rich valleys, which looked a veritable paradise to the eye, and yet the people there had leprosy. Why? There were other places, seemingly less fertile and fortunate, where the inhabitants were quite healthy. Why? I visited and stayed often in the Moshimien valley in the Sikang province, where a great Roman Catholic leprosarium, housing 500 inmates, was situated. This hidden valley was surely one of the most beautiful places in the world. At least 8,000 feet up it was hemmed in by great snow mountains and the climate was a perpetual spring. Two roaring torrents of pure glacier water cascaded down both sides of the valley. There were vast forests on the foothills: carpets of flowers covered alpine meadows and clearings in the forest: some 6f the rarest lilies in the world grew wild along the ridges: the air was heavy with the fragrance of so many flowers, myriads of bees buzzed around and the soil was black and rich. The Catholic mission had all kinds of fruit-bearing trees in its orchards and the vegetables of all descriptions in the well-laid-out and watered gardens. There were luscious tomatoes and big pimentos along the rows of cabbages and French beans.

And yet the valley was accursed. It had probably about 300 households or more of Szechuanese settlers and there was at least one leper in every house. So bad was Moshimien’s reputation for leprosy that the people of Tachienlu, the provincial capital just across the Yajagkan Range, would not buy a chicken or egg, not at any price, if they knew it came from the Moshimien valley.

I decided to make a close observation of the people’s habits and food in order to form, at least, a hypothesis of the cause of the dread disease in this happy corner. The inhabitants were dirty, in fact dirtier than usual, and the houses were dingy and filthy. Why? I asked. The water was too cold for bathing, they told me. As to their diet, they ate twice a day, late in the morning and soon after sunset, on beancurd, powdered chillies to make it palatable and soup made of sliced potatoes; and of course there was rice. Day after day and night after night they ate the same poor food. Sometimes it was a turnip soup, instead of a potato one, or boiled horse-beans were added to the menu. Once a week a slice or two of old salt pork might be added to the potatoes in the soup. I asked about eating chickens, eggs and fresh pork and vegetables, like those grown in the mission garden, which they could plant likewise. No, they said, it would be too luxurious to eat chickens, eggs and fresh pork — that was all for sale and they needed money. Yes, I thought, they certainly needed the money to buy opium which they smoked all day long. As for the new-fangled vegetables in the missionaries’ gardens, their ancestors had lived well enough without them, and what was good for them is good enough for us, they said. Besides, they added, certain vegetables, especially the tomatoes, were reputed to be poisonous as they had originated as a fruit of the sin between dogs. What about the missionaries? I retorted. None of them has died from eating these vegetables. ‘Ah,’ men replied knowingly, ‘you foreigners have different bodies, and what is good for you is death for us.’

They all looked weak, emaciated, with parchment-like skin, their eyes feverish with opium. What could one do to help them, to persuade them? The kindly Catholics certainly tried everything they could, but all was in vain against the dullness and obduracy of these people fanatically entrenched in their ignorance.

At the invitation of some Black Lolos I went from Moshi-mien to a village called Helluva further down the wonderful Tatu River. Then I had to climb to the mysterious Yehsaping plateau, 11,000 feet high, where these Lolos lived. Their houses were poor but very clean and they looked hale and hearty. I stayed with them several days. Even apart from the special feasts arranged for me, they ate well. They used pork, chickens and beef constantly — roasted, fried or boiled. They ate potatoes and buckwheat cakes and drank buckwheat and honey wine, called zhiwoo, with every meal. They did not smoke opium. They were dirty too, but very healthy. Not one of them had leprosy and the very mention of it made them shudder.

The Minkia around Likiang existed on a monotonous diet of rice with a little of beancurd or its equivalent, or rice and chillies only. And they had leprosy. The Szechuanese and White Lissu were also mean about their food and also had leprosy. It was only among the Nakhi, of the tribes in and around Likiang, who had such a varied and rich diet, both poor and wealthy, that there was no leprosy.

Whatever other factors cause leprosy, the disease seems to find fertile ground among the people who exist on a poor and monotonous diet. Dirt may or may not be a contributing factor: malnutrition, due to unvaried food, certainly is. The Tibetans of lower classes also have an unvaried diet, consisting of the eternal tsamba — parched barley or wheat flour — and butter tea, and they too have leprosy.

The treatment of leprosy, even with the present-day revolutionary sulpha drugs, which had not yet appeared there in those days, was at best very slow and uncertain. I felt I was not qualified to handle such cases and passed them on to the missionaries in the south to their infinite delight.

I thought the real plague of Tibet and border regions was not leprosy but the venereal diseases. Judging from all reports and travellers’ accounts, Tibet and Yungning region had at least 90 per cent of their population afflicted with one form or another of these souvenirs d’amour. Such a widespread prevalence was due, of course, to the practice of free love still prevailing in those parts. Likiang was comparatively free from this blight, thanks to the strictness of its marriage institution and the injunction that all Nakhi men should confine their amorous attentions strictly to the female members of their own tribe. If there were any Nakhi afflicted with these unmentionable diseases, they certainly had picked them up outside Likiang. Returning soldiers were the most likely suspects in such cases.

The Tibetans, and to some extent the Liukhi, the matriarchic tribe living in Yungning territory, had during decades or perhaps even centuries developed very considerable immunity to syphilis. With most of them it now has a very mild form and even the third stage is not so destructive as it could be among other races. However, this benignity of the syphilis of the Tibetan variety does not extend to other races, particularly in the case of Europeans. In a European the virulence of the disease, contracted from a Tibetan, is so great that, without prompt treatment, a fatal ending ensues in about three months.

The prevalence of syphilis and gonorrhoea in Tibet and Yungning has a marked effect on the birth-rate. The population in Tibet is definitely shrinking, and the children in Yungning suffer from keratitis which is a result of congenital syphilis. The Tibetan Government has been greatly concerned and had plans for a wholesale treatment of venereal diseases, but nothing much has been accomplished because of the magnitude of the undertaking. This immense and heartrending problem is further aggravated by the light-hearted carelessness and utter unconcern of the afflicted parties. They never think, for instance, that syphilis is anything more serious than a common cold and, since its first stage does indeed resemble the onset of a cold or flu, the ignorant man thinks that his own diagnosis is correct. Therefore, when they came for treatment they always said that it was just a cold and there was really nothing to worry about. They always got a shock when I told them that it was something else, and I remember a well-to-do Tibetan who came to see me with well-defined symptoms of this confidential disease. He was horrified when I told him the truth.

‘No, no!’ he cried. ‘It is only a cold.’

‘How did you get it ?’ I asked.

‘I caught it when riding a horse,’ he replied.

‘Well,’ I said, ‘it was the wrong kind of horse.’

In a long procession they came — the Tibetans, Liukhi and occasionally other tribesmen. But I do not remember really that I had any Nakhi with syphilis or gonorrhoea. As I have said, the Tibetan syphilis was benign, and after two or three shots they usually recovered, but in most cases it was an ungrateful and hopeless task. In two or three weeks they returned with a fresh infection. It was a Sisyphean work for the most part, and I must admit I got tired of it.

Such was my clinic. Sick people came all the time, day in and day out, year after year. There were other diseases too. I tried my best to diagnose them and help. There were even attempts to make me attend difficult childbirths, but I drew a line at that as I had not had any experience at all in such matters. All the time I was extremely careful, and I would have been murdered if one of my patients had died.

The clinic made me acquaintances far and wide, and a number of pleasant and enduring friendships developed. I never took a cent for my attendance and medicines, but sometimes the people did bring a few eggs or a pot of honey, and it was not easy to decline these simple gifts. I remember I tried to refuse some eggs an old lady brought me, and she was quite indignant.

‘Why do you refuse?’ she asked in a shrill voice. ‘These eggs are fresh and good. I am not offering you anything dirty.’ What could I say?

However, to run this clinic was not all plain sailing, for the cunning merchants and shopkeepers of Likiang were always after my medicines. Some were disarmingly frank. Said they: ‘You get your supplies from the American Red Cross’—later it was the International Red Cross—’free of charge and you give the medicine away also free of charge. These are good valuable medicines and cost a lot on the black market. Why not sell us at least a half? Nobody would know. We are prepared to pay well and a goodly amount of hard cash will not harm you’; and they rubbed their hands in anticipation. I was neither angry nor did I show them to the door. My Chinese etiquette was as near perfect as is possible for a foreigner. I do not remember exactly what I said, but it was something infinitely polite and completely satisfying as to why I was unable to part with the medicines.

Then unsuspected attacks came from other quarters. Women started dropping in daily asking for ten tablets of santonin for a child at home, twenty aspirins for an ailing husband, ten or twenty sulphadiazines for somebody else also confined to bed, and so on in infinite variety. At first I did not hesitate, admiring them for walking so far over the hill to help their relatives or friends. It was when my cook had reported that he saw our santonins, sulphadiazines and aspirins being sold on the market at fifty cents a tablet, that I sat up and took notice. Immediately a notification was posted on the door, requiring all patients to present themselves to my clinic in person if they wanted any medicines. This helped, and afterwards I was careful not to give much medicine for follow-up treatment except when I knew for certain that the patient could be trusted: but there were wild scenes and much reviling whenever I refused point-blank some grand lady’s request for packets of medicine.

Another favourite trick to the same end were the notes from very highly placed officials demanding that so much of a particular drug should be sent to him by bearer, usually an orderly. I always did send a few grains, profusely apologizing that momentarily that particular drug was almost out of stock. Even my charming Nakhi doctor friend quickly learned the way to my door to borrow this or that drug, promising to return its equivalent in a few days, though, of course, nothing was ever returned. Very soon I had to invent all sorts of excuses to stop the drain on my stocks of medicaments which were intended solely for use among poor villagers.

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