CHAPTERXXVIII.TREATMENT OF THE SICK.Thetreatment of the sick among the Laos ranks as a distinct profession. Although the Laos doctors may not have classified their knowledge of diseases in a way that we should call scientific, and although a white foreigner might be so unsolicitous of his own bodily welfare as to prefer the chance of nature to the professional skill of the whole Laos faculty, still, their system of medicine is quite an extensive one and embraces some very abstruse subjects. The Laos doctors are not required to have a diploma and do not attend any medical school, nor do they, as a rule, serve an apprenticeship; they just take to doctoring naturally. Some of them are widely known as successful general practitioners; others gain considerable notoriety in the treatment of certain diseases and become specialists of wide reputation. Some three or four medical books, treating of the mysteries of vital phenomena and learnedly elucidating the doctrine of the four elements, enrich Laos literature; these classic volumes also contain invaluable formulæ, and the doctor who is so fortunate as to own one of these books is held in high repute for his superior learning, notwithstanding he may not be able to decipher a line of it. Practically, the Laos, so far as the average doctor is concerned, have no medical treatises.The Laos are without a definite knowledge of any of the organs or functions of the human body; no Harvey or Sylvius has ever arisen among them. All of their theories concerning the bodily functions and the four elements are merely philosophic guesses. Imagination has taken the place of reason and experiment. Speculation furnishes them with a satisfactory solution of the problem, “Why is it that instead of flesh (muscles) only, tendons are found in the human body?”The Laos divide diseases into two classes. The first class includes all those disorders which may be considered as simply disturbances of equilibrium caused by an undue preponderance or diminution of one of the four elements—wind, fire, earth and water; the second class embraces all those more serious disorders of the human system which are due directly or indirectly to the influence of offended spirits.The Laos materia medica embraces a considerable variety of medicines, nearly every one of which is supposed to be a specific in some disease; and, although his ideas of the medicinal qualities of these drugs may be entirely theoretical, not to say fanciful, the Laos doctor administers them just as freely as if he had experimentally demonstrated their physiological properties. The bones, teeth, blood and gall of the tiger, bear, elephant, rhinoceros and crocodile are among the most highly-esteemed remedies; besides their specific curative properties, these medicines impart the courage of the tiger, the stability, dignity and longevity of the elephant, the solemnity and tranquillity of the crocodile, the equanimity, contentment and philosophic indifference to external things and other virtues characteristic of the rhinoceros. Likewise, they eat the bones of the raven to protect them from evil spirits, and perhaps also to enable them to eat with impunity and relish of any dish; it is to be feared that certain purloining instincts of this bird have been communicated in this way!Patient observation and intelligent experimental investigation are entirely unknown to the Laos medicine-man; it is doubtful if he has, either by intelligent experiment or by accident, arrived at one solitary verifiable fact either in physiology or therapeutics; satisfied with his supposed stock of knowledge, he has no desire to increase it.When called to see a patient the Laos doctor states authoritatively what the ailment is; then proceeds to prepare a dose of medicine, which process it is interesting to watch. Seating himself upon a mat on the floor, he calls for the medicine-stone—a block of fine sandstone kept in nearly every house—and upon it rubs his drugs, which are carried in the crude form. The dose is composed of indefinite proportions of various roots, herbs and minerals, the teeth, bones, blood and gall of the tiger, bear, crocodile, etc., egg-shells, and anything else that the doctor may have; for, perhaps with a view to alternative conditions, he uses a portion of every drug he has, thus leaving slim chances of any unrecognized or latent symptom remaining untouched. The portions of the various drugs worn off by these rubbings are carefully washed into an earthen vessel, and water to the amount of about half a gallon is added; this makes one dose, or, in case the patient is not strong enough or is not of sufficient capacity, the medicine is to be administered in small doses—say half a pint or so—every half hour. This kind of treatment is continued for two or three days, or, if the patient is exceptionally vigorous, it may continue longer, a new doctor usually taking charge of the patient on each succeeding day. The attending physician usually remains by his patient day and night until it is decided to call in another doctor or until convalescence is established. If the patient grows worse, two or three doctors are called in during the day, each one promising to effect a cure, and each in turn is dismissed if an immediate improvement is not evident. This is continued until the exhausted sufferer no longer tosses to and fro, but lies unconscious, breathing hard, the patient watching of the fond mother or sister is nearly over, the anxious pleading whisper is hushed, and the death-wail tells that another home is desolate, another soul seeks its eternal destiny.As already mentioned, the Laos imagine many diseases to be caused by spirits. Those diseases which are peculiarly fatal, and over which they can exercise little or no control, are supposed to be due to agencies outside of nature. This belief encourages a disposition to neglect the investigation of natural causes and to multiply the instances of supposed supernatural manifestations. Thus the appeal to the supernatural to account for those deadly diseases so common in tropical climates strengthens and extends the superstitious belief which alone furnishes this interpretation of the mysterious phenomena of nature. This tendency to bring the intellectual faculties under subjection to the imagination is, of course, not limited to the realm of diseases, for every extraordinary phenomenon is supposed to be supernatural. The prevalence of fatal diseases and the frequency of epidemics secure this stronghold of superstition; any scheme which has for its object the elevation and enlightenment, the religious and intellectual regeneration, of the Laos must include efficient medical work, for in no other way can these superstitions be more immediately affected than by the rational treatment of diseases.This belief in the supernatural causation of diseases is not confined to those disorders which are of rare occurrence: many forms of disease of every-day occurrence are attributed to spirits. Rheumatism is said to be caused by a “swamp-spirit;” the treatment for it might be said to be more surgical than medical. When a person is afflicted with a swamp-spirit, the doctor takes an axe or a large knife and draws the edge of it along the affected part, without, however, touching it, at the same time advising the spirit to return to its former abode.Epileptic seizures are supposed to be due to spirits, and the proper treatment is for two or more men to stand upon the thighs and pelvis of the unfortunate sufferer, and so prevent the entrance of the spirit into some of the vital organs. This plan is said to be quite successful, as many patients so treated have recovered.The absurdities of superstitious belief among the Laos might be multiplied indefinitely: these instances are, however, sufficient. Impressed with a sense of their utter helplessness in dealing with those mysterious agencies which are so hostile to them, they invariably conclude that man is subject to the government of invisible and malignant beings of whom he can know nothing, and whose anger, when aroused, no merely material agencies can appease. So in every case of sickness offerings must be made to the offended spirits; readings from the sacred books and prayers must be rehearsed.These beliefs, however, as long as they remain general and theoretical, are mild in their effects in comparison with another superstition of the Laos, which I must not fail to mention. Abandoning the vague and general, in this superstition their belief becomes terribly specific: they imagine that the spirit or essence of one living person may enter the body of another person and inflict serious injuries, and, unless expelled, even destroy life; furthermore, they can ascertain whose spirit it is. This kind of spirit they termPee K’a. Hysteria, delirium, variation of surface temperature are among the symptoms supposed to indicate this kind of possession. The treatment is a specialty, and the doctors who understand these cases gain great notoriety and are sent for from far and near to exorcise the spirits. The exorcism involves a practice full of savage cruelty to the patient and of barbarous injustice to the unfortunate neighbor whose spirit is accused of having entered the patient. I had repeatedly requested permission to witness an investigation of one of these cases, and at last had an opportunity. I learned that the patient had some months ago suffered from a protracted illness (probably typhoid fever), and during her illness had lost the power of speech. She recovered gradually and became quite well and strong, but was still unable to speak. One day she went with a party of children to a temple, and while there spoke a few words more or less distinctly; her companions became alarmed and ran home. Supposing the case to be one of witchcraft, the owner (the girl was a slave) sent for the spirit-doctor; three of these specialists were present when I reached the place. After asking some questions concerning the previous illness of the patient, a consultation was in order, the most important feature of which seemed to be the drinking of a bowl of arrack (whiskey distilled from rice); these spirit-doctors took frequent and prolonged draughts; they drank as if to slake an ancient thirst. I thought they liked it, but I was informed that the learned doctors drank simply in order to facilitate their communication with the spirit, and that the chances were that they did not like the taste of whiskey.Having at length decided upon a suitable line of action, the doctors proceeded to the investigation of the case. The most eminent of the doctors—at least the one who had consumed the most whiskey—took a tiger’s tooth, and, muttering some gibberish, drew it along the side and back of the patient, leaving deep scratches; the patient, unable to speak, of course writhed and struggled. At length, after a deeper incision (which drew the blood), the patient uttered an audible cry; this sound was interpreted by the ferocious, drunken spirit-doctors to indicate the situation of the spirit. With a vigorous thrust in the side, while his assistant, thinking he had discovered the spirit in another region, was equally attentive, the chief inquisitor with foul and abusive language ordered the spirit to leave. The exorcism was a failure, and the spirit refused to make itself known, though pressingly flattered to do so by the persuasive and forcible eloquence of these three drunken, demoniac savages.In these investigations any injury inflicted is directed against the spirit, and any answers to questions asked by the doctor or the friends of the patient are supposed to proceed from the spirit; so the doctor asks the name of the spirit, and the patient, if conscious or partly so, will, in order to escape torture, give the name of some acquaintance, probably some near and intimate neighbor; for usually some suspicion will have been expressed. The name of some one having been mentioned by the patient, various questions concerning the domestic relations of the family of the person named are asked, such as the names of all the members of the family, the number of cattle they own, the amount of money they have, and sundry other questions concerning things supposed to be known only to members of the family. If to all these questions satisfactory answers are given, the person whose name is mentioned is accused of witchcraft, and, together with all his family, all in the house, must leave the neighborhood; everything belonging to them, except such articles as can be easily removed, is committed to the flames; they cannot sell their gardens nor rice-fields nor any other possession, since no one will risk the supposed contamination. The accused cannot settle in any adjoining neighborhood, but must go as strangers into some distant province occupied only by others like themselves driven from their homes upon charges of witchcraft. All the accumulations of a lifetime of thrift and economy may at any time be sacrificed to the whims of this blind credulity. This superstition is one of the greatest social evils; indeed, it entails more serious injury than all other beliefs and practices combined. No one receives any benefit from it; it is purely destructive. Hundreds of families are yearly driven from their homes in obedience to the requirements of this degrading prostitution of the human intellect.Medical Missionary Work among the Laos.Since the establishment of the Cheung Mai mission in 1867 the missionaries have made the care of the sick a part of their regular work. Dr. Vrooman was the first missionary physician sent to Cheung Mai; he was compelled, on account of his health, to leave there in 1873, having remained only about two years. Dr. Vrooman’s successor arrived in Cheung Mai in the spring of 1875. During the six months ending Sept. 30, 1875, about six hundred patients received treatment of the foreign doctor. The work has increased steadily since that time; in the year ending Sept. 30, 1882, thirteen thousand persons received treatment. This increase in seven years from about one thousand to thirteen thousand a year indicates that the work of the medical missionary supplies a demand.Because of having no hospital accommodations, the work has been chiefly dispensary work, while as many as could be personally attended have been visited at their homes. Notwithstanding this large increase in the number of patients treated, the results of the medical work have not been very gratifying. The difficulties with which one has to struggle in dispensary work or house visitation are so great as to render any effort almost devoid of satisfactory results from a professional point of view; and, obviously, the conditions which interfere with the medical work will also interfere with the missionary work; in fact, what are molehills in the former become mountains in the latter.The houses of the Laos are located and built in violation of all hygienic considerations, and in addition to the counteracting influences arising from the imperfect sanitary surroundings, the foreign physician has to contend against persistent meddlesome interference with his directions; and in this contention he wages a losing warfare, for he has arrayed against him that influence which is so potent everywhere—namely, the prestige of ancient superstitions sanctioned by ignorance and custom. In the treatment of diseases the skill of the most competent physician is of no avail without the faithful and skillful execution of his orders, which can be accomplished alone by an intelligent and sympathizing nurse—I might rather say, a trained nurse. The foreign physician is usually sent for as a last resort, and is simply expected to perform a miracle; and unless he in a measure satisfies the wildest requirements he is pronounced a failure, and his presence is considered as rather an intrusion and a source of mischief; for he forbids ceremonies which are supposed to be essential to the welfare of the household, a neglect of which may occasion both immediate and remote disaster. Although spirit-worship and other religious observances are of paramount importance in their homes, they willingly neglect them when treated upon our own premises.Upon entering a sick chamber the physician finds the air almost suffocating, and must conduct his examination by the dim light of a small wax taper, for in the construction of a Laos house the principal object to be attained seems to be the utter exclusion of light, there being no doors or windows except the necessary entrance. The examination concluded, the physician gives his directions concerning the management of the patient and goes his way, with the assurance that his instructions will be regarded by the friends of the patient as of some importance or as utterly insignificant, just according to their own views of the case.Dispensary work is equally unsatisfactory. The friends of the patients come to the dispensary and describe as well as they can the most obvious symptoms, and from the information obtained in this exceedingly unsatisfactory way an opinion as to the nature of the patient’s ailment must be arrived at and a prescription made. The results of such a method could not be otherwise than unsatisfactory even with intelligent nursing and a faithful observance of directions. As to the nursing of the sick among the Laos, it is sufficient to state that it is such as to seriously compromise any favorable tendencies, and the directions given by the physician are usually subject to any amendments that may be suggested by the inclinations of the patient or the opinions of nurses or friends. If supposed to be seriously ill, the patient is visited by a throng of relatives, friends and acquaintances, and is disturbed by a ceaseless hum of voices; elderly ladies entertain one another at the bedside of the patient with the fullest accounts of the nature, course, duration and proper treatment of similar cases which they have witnessed, some of them relating the circumstances of the marvelous cures effected by some skillful doctor while others dwell upon the melancholy import of the symptoms.Having concluded his daily routine of dispensary work, the foreign doctor makes his second visit to his patient. Arrived at the house, he probably finds it filled with the relatives and friends of the patient, all devoutly attending a reading from the Buddhist scriptures by a priest or a number of priests, according to the means of the patient; long prayers and chants are rehearsed, sacred water is sprinkled over the patient, offerings of flowers and wax tapers are made to the household spirits. After this ceremony, which lasts for several hours, the patient passes into the hands of a native doctor.
Thetreatment of the sick among the Laos ranks as a distinct profession. Although the Laos doctors may not have classified their knowledge of diseases in a way that we should call scientific, and although a white foreigner might be so unsolicitous of his own bodily welfare as to prefer the chance of nature to the professional skill of the whole Laos faculty, still, their system of medicine is quite an extensive one and embraces some very abstruse subjects. The Laos doctors are not required to have a diploma and do not attend any medical school, nor do they, as a rule, serve an apprenticeship; they just take to doctoring naturally. Some of them are widely known as successful general practitioners; others gain considerable notoriety in the treatment of certain diseases and become specialists of wide reputation. Some three or four medical books, treating of the mysteries of vital phenomena and learnedly elucidating the doctrine of the four elements, enrich Laos literature; these classic volumes also contain invaluable formulæ, and the doctor who is so fortunate as to own one of these books is held in high repute for his superior learning, notwithstanding he may not be able to decipher a line of it. Practically, the Laos, so far as the average doctor is concerned, have no medical treatises.
The Laos are without a definite knowledge of any of the organs or functions of the human body; no Harvey or Sylvius has ever arisen among them. All of their theories concerning the bodily functions and the four elements are merely philosophic guesses. Imagination has taken the place of reason and experiment. Speculation furnishes them with a satisfactory solution of the problem, “Why is it that instead of flesh (muscles) only, tendons are found in the human body?”
The Laos divide diseases into two classes. The first class includes all those disorders which may be considered as simply disturbances of equilibrium caused by an undue preponderance or diminution of one of the four elements—wind, fire, earth and water; the second class embraces all those more serious disorders of the human system which are due directly or indirectly to the influence of offended spirits.
The Laos materia medica embraces a considerable variety of medicines, nearly every one of which is supposed to be a specific in some disease; and, although his ideas of the medicinal qualities of these drugs may be entirely theoretical, not to say fanciful, the Laos doctor administers them just as freely as if he had experimentally demonstrated their physiological properties. The bones, teeth, blood and gall of the tiger, bear, elephant, rhinoceros and crocodile are among the most highly-esteemed remedies; besides their specific curative properties, these medicines impart the courage of the tiger, the stability, dignity and longevity of the elephant, the solemnity and tranquillity of the crocodile, the equanimity, contentment and philosophic indifference to external things and other virtues characteristic of the rhinoceros. Likewise, they eat the bones of the raven to protect them from evil spirits, and perhaps also to enable them to eat with impunity and relish of any dish; it is to be feared that certain purloining instincts of this bird have been communicated in this way!
Patient observation and intelligent experimental investigation are entirely unknown to the Laos medicine-man; it is doubtful if he has, either by intelligent experiment or by accident, arrived at one solitary verifiable fact either in physiology or therapeutics; satisfied with his supposed stock of knowledge, he has no desire to increase it.
When called to see a patient the Laos doctor states authoritatively what the ailment is; then proceeds to prepare a dose of medicine, which process it is interesting to watch. Seating himself upon a mat on the floor, he calls for the medicine-stone—a block of fine sandstone kept in nearly every house—and upon it rubs his drugs, which are carried in the crude form. The dose is composed of indefinite proportions of various roots, herbs and minerals, the teeth, bones, blood and gall of the tiger, bear, crocodile, etc., egg-shells, and anything else that the doctor may have; for, perhaps with a view to alternative conditions, he uses a portion of every drug he has, thus leaving slim chances of any unrecognized or latent symptom remaining untouched. The portions of the various drugs worn off by these rubbings are carefully washed into an earthen vessel, and water to the amount of about half a gallon is added; this makes one dose, or, in case the patient is not strong enough or is not of sufficient capacity, the medicine is to be administered in small doses—say half a pint or so—every half hour. This kind of treatment is continued for two or three days, or, if the patient is exceptionally vigorous, it may continue longer, a new doctor usually taking charge of the patient on each succeeding day. The attending physician usually remains by his patient day and night until it is decided to call in another doctor or until convalescence is established. If the patient grows worse, two or three doctors are called in during the day, each one promising to effect a cure, and each in turn is dismissed if an immediate improvement is not evident. This is continued until the exhausted sufferer no longer tosses to and fro, but lies unconscious, breathing hard, the patient watching of the fond mother or sister is nearly over, the anxious pleading whisper is hushed, and the death-wail tells that another home is desolate, another soul seeks its eternal destiny.
As already mentioned, the Laos imagine many diseases to be caused by spirits. Those diseases which are peculiarly fatal, and over which they can exercise little or no control, are supposed to be due to agencies outside of nature. This belief encourages a disposition to neglect the investigation of natural causes and to multiply the instances of supposed supernatural manifestations. Thus the appeal to the supernatural to account for those deadly diseases so common in tropical climates strengthens and extends the superstitious belief which alone furnishes this interpretation of the mysterious phenomena of nature. This tendency to bring the intellectual faculties under subjection to the imagination is, of course, not limited to the realm of diseases, for every extraordinary phenomenon is supposed to be supernatural. The prevalence of fatal diseases and the frequency of epidemics secure this stronghold of superstition; any scheme which has for its object the elevation and enlightenment, the religious and intellectual regeneration, of the Laos must include efficient medical work, for in no other way can these superstitions be more immediately affected than by the rational treatment of diseases.
This belief in the supernatural causation of diseases is not confined to those disorders which are of rare occurrence: many forms of disease of every-day occurrence are attributed to spirits. Rheumatism is said to be caused by a “swamp-spirit;” the treatment for it might be said to be more surgical than medical. When a person is afflicted with a swamp-spirit, the doctor takes an axe or a large knife and draws the edge of it along the affected part, without, however, touching it, at the same time advising the spirit to return to its former abode.
Epileptic seizures are supposed to be due to spirits, and the proper treatment is for two or more men to stand upon the thighs and pelvis of the unfortunate sufferer, and so prevent the entrance of the spirit into some of the vital organs. This plan is said to be quite successful, as many patients so treated have recovered.
The absurdities of superstitious belief among the Laos might be multiplied indefinitely: these instances are, however, sufficient. Impressed with a sense of their utter helplessness in dealing with those mysterious agencies which are so hostile to them, they invariably conclude that man is subject to the government of invisible and malignant beings of whom he can know nothing, and whose anger, when aroused, no merely material agencies can appease. So in every case of sickness offerings must be made to the offended spirits; readings from the sacred books and prayers must be rehearsed.
These beliefs, however, as long as they remain general and theoretical, are mild in their effects in comparison with another superstition of the Laos, which I must not fail to mention. Abandoning the vague and general, in this superstition their belief becomes terribly specific: they imagine that the spirit or essence of one living person may enter the body of another person and inflict serious injuries, and, unless expelled, even destroy life; furthermore, they can ascertain whose spirit it is. This kind of spirit they termPee K’a. Hysteria, delirium, variation of surface temperature are among the symptoms supposed to indicate this kind of possession. The treatment is a specialty, and the doctors who understand these cases gain great notoriety and are sent for from far and near to exorcise the spirits. The exorcism involves a practice full of savage cruelty to the patient and of barbarous injustice to the unfortunate neighbor whose spirit is accused of having entered the patient. I had repeatedly requested permission to witness an investigation of one of these cases, and at last had an opportunity. I learned that the patient had some months ago suffered from a protracted illness (probably typhoid fever), and during her illness had lost the power of speech. She recovered gradually and became quite well and strong, but was still unable to speak. One day she went with a party of children to a temple, and while there spoke a few words more or less distinctly; her companions became alarmed and ran home. Supposing the case to be one of witchcraft, the owner (the girl was a slave) sent for the spirit-doctor; three of these specialists were present when I reached the place. After asking some questions concerning the previous illness of the patient, a consultation was in order, the most important feature of which seemed to be the drinking of a bowl of arrack (whiskey distilled from rice); these spirit-doctors took frequent and prolonged draughts; they drank as if to slake an ancient thirst. I thought they liked it, but I was informed that the learned doctors drank simply in order to facilitate their communication with the spirit, and that the chances were that they did not like the taste of whiskey.
Having at length decided upon a suitable line of action, the doctors proceeded to the investigation of the case. The most eminent of the doctors—at least the one who had consumed the most whiskey—took a tiger’s tooth, and, muttering some gibberish, drew it along the side and back of the patient, leaving deep scratches; the patient, unable to speak, of course writhed and struggled. At length, after a deeper incision (which drew the blood), the patient uttered an audible cry; this sound was interpreted by the ferocious, drunken spirit-doctors to indicate the situation of the spirit. With a vigorous thrust in the side, while his assistant, thinking he had discovered the spirit in another region, was equally attentive, the chief inquisitor with foul and abusive language ordered the spirit to leave. The exorcism was a failure, and the spirit refused to make itself known, though pressingly flattered to do so by the persuasive and forcible eloquence of these three drunken, demoniac savages.
In these investigations any injury inflicted is directed against the spirit, and any answers to questions asked by the doctor or the friends of the patient are supposed to proceed from the spirit; so the doctor asks the name of the spirit, and the patient, if conscious or partly so, will, in order to escape torture, give the name of some acquaintance, probably some near and intimate neighbor; for usually some suspicion will have been expressed. The name of some one having been mentioned by the patient, various questions concerning the domestic relations of the family of the person named are asked, such as the names of all the members of the family, the number of cattle they own, the amount of money they have, and sundry other questions concerning things supposed to be known only to members of the family. If to all these questions satisfactory answers are given, the person whose name is mentioned is accused of witchcraft, and, together with all his family, all in the house, must leave the neighborhood; everything belonging to them, except such articles as can be easily removed, is committed to the flames; they cannot sell their gardens nor rice-fields nor any other possession, since no one will risk the supposed contamination. The accused cannot settle in any adjoining neighborhood, but must go as strangers into some distant province occupied only by others like themselves driven from their homes upon charges of witchcraft. All the accumulations of a lifetime of thrift and economy may at any time be sacrificed to the whims of this blind credulity. This superstition is one of the greatest social evils; indeed, it entails more serious injury than all other beliefs and practices combined. No one receives any benefit from it; it is purely destructive. Hundreds of families are yearly driven from their homes in obedience to the requirements of this degrading prostitution of the human intellect.
Medical Missionary Work among the Laos.
Since the establishment of the Cheung Mai mission in 1867 the missionaries have made the care of the sick a part of their regular work. Dr. Vrooman was the first missionary physician sent to Cheung Mai; he was compelled, on account of his health, to leave there in 1873, having remained only about two years. Dr. Vrooman’s successor arrived in Cheung Mai in the spring of 1875. During the six months ending Sept. 30, 1875, about six hundred patients received treatment of the foreign doctor. The work has increased steadily since that time; in the year ending Sept. 30, 1882, thirteen thousand persons received treatment. This increase in seven years from about one thousand to thirteen thousand a year indicates that the work of the medical missionary supplies a demand.
Because of having no hospital accommodations, the work has been chiefly dispensary work, while as many as could be personally attended have been visited at their homes. Notwithstanding this large increase in the number of patients treated, the results of the medical work have not been very gratifying. The difficulties with which one has to struggle in dispensary work or house visitation are so great as to render any effort almost devoid of satisfactory results from a professional point of view; and, obviously, the conditions which interfere with the medical work will also interfere with the missionary work; in fact, what are molehills in the former become mountains in the latter.
The houses of the Laos are located and built in violation of all hygienic considerations, and in addition to the counteracting influences arising from the imperfect sanitary surroundings, the foreign physician has to contend against persistent meddlesome interference with his directions; and in this contention he wages a losing warfare, for he has arrayed against him that influence which is so potent everywhere—namely, the prestige of ancient superstitions sanctioned by ignorance and custom. In the treatment of diseases the skill of the most competent physician is of no avail without the faithful and skillful execution of his orders, which can be accomplished alone by an intelligent and sympathizing nurse—I might rather say, a trained nurse. The foreign physician is usually sent for as a last resort, and is simply expected to perform a miracle; and unless he in a measure satisfies the wildest requirements he is pronounced a failure, and his presence is considered as rather an intrusion and a source of mischief; for he forbids ceremonies which are supposed to be essential to the welfare of the household, a neglect of which may occasion both immediate and remote disaster. Although spirit-worship and other religious observances are of paramount importance in their homes, they willingly neglect them when treated upon our own premises.
Upon entering a sick chamber the physician finds the air almost suffocating, and must conduct his examination by the dim light of a small wax taper, for in the construction of a Laos house the principal object to be attained seems to be the utter exclusion of light, there being no doors or windows except the necessary entrance. The examination concluded, the physician gives his directions concerning the management of the patient and goes his way, with the assurance that his instructions will be regarded by the friends of the patient as of some importance or as utterly insignificant, just according to their own views of the case.
Dispensary work is equally unsatisfactory. The friends of the patients come to the dispensary and describe as well as they can the most obvious symptoms, and from the information obtained in this exceedingly unsatisfactory way an opinion as to the nature of the patient’s ailment must be arrived at and a prescription made. The results of such a method could not be otherwise than unsatisfactory even with intelligent nursing and a faithful observance of directions. As to the nursing of the sick among the Laos, it is sufficient to state that it is such as to seriously compromise any favorable tendencies, and the directions given by the physician are usually subject to any amendments that may be suggested by the inclinations of the patient or the opinions of nurses or friends. If supposed to be seriously ill, the patient is visited by a throng of relatives, friends and acquaintances, and is disturbed by a ceaseless hum of voices; elderly ladies entertain one another at the bedside of the patient with the fullest accounts of the nature, course, duration and proper treatment of similar cases which they have witnessed, some of them relating the circumstances of the marvelous cures effected by some skillful doctor while others dwell upon the melancholy import of the symptoms.
Having concluded his daily routine of dispensary work, the foreign doctor makes his second visit to his patient. Arrived at the house, he probably finds it filled with the relatives and friends of the patient, all devoutly attending a reading from the Buddhist scriptures by a priest or a number of priests, according to the means of the patient; long prayers and chants are rehearsed, sacred water is sprinkled over the patient, offerings of flowers and wax tapers are made to the household spirits. After this ceremony, which lasts for several hours, the patient passes into the hands of a native doctor.