Nicholas Senn.

Around the world via India : a medical tour online

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LIBRARY

UNIVERSITY OF
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SAN DIEGO



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BIOMEDICAL LIBRARY

UNIVERSITY OF CALIFORNIA, SAN DIEGO

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AROUND the WORLD
via INDIA ^^

A MEDICAL TOUR

BY

Ntdplaa £rmt. JK.B.. Pj.S., SKJL, (SIM.

Professor of Surgery University of Chicago — Professor and Head of the
Surgical Department Rush Medical College — Surgeon-in-Chief St.
yosepb's Hospital — Attending Surgeon Presbyterian Hospital
— Surgeon General of Illinois- — Lieutenant Colonel and
Chief of the Operating Staff with the Army in tin-
Field During the Spanish-American War, etc.



CHICAGO:

AMERICAN MEDICAL ASSOCIATION PRESS

1905



PREFACE

Gbts booh is more especially
intenoeb for mv. professional
frtenbs wbom If bave met
ourtna mv. travels in biffer=
ent parts ot tbe worlb, ano
to wbom IF am cbteflv ln=
bebteb for manv courtesies
anb mucb information. (Tbe
teit consists of a sertes of
articles publisbeb in £be
Journal of tbe Hmerican
/IBcbical association burtng
tbe last six montbs of tbe
sear past. /Iftanv new illus=
trations bave been abbeb
wbicb tbe autbor bopes will
enbancetbe value of tbe booh

N. SENN
Chicago, June 15, 1905



CONTENTS



Page.
Travel as a Means of Post-Graduate Medical Educa-
tion 9

Leprosy in the Hawaiian Islands: The Proposed Es-
tablishment of a Government Bacteriologic Institute —
Segregation — A Fighting Leper — The Leper Settlement
on the Island of Molokai— A Government Bacteriologic
Laboratory and Station for the Scientific Study of Lep-
rosy — The Island of Molokai as a Home for Lepers. ... 21

Father Damien, the Leper Hero: A Heroic Brother — The
Leper Priest Dies of Leprosy 29

Medical Affairs in the Hawaiian Islands: Historical
Sketch of the Islands — Climate — Native Population —
Prevailing Diseases — The Medical Profession — Queen's
Hospital — Medical Society of the Hawaiian Territory. 45

Our Possession in Samoa from a Medical Standpoint:
Sketch of the History of the Islands of Samoa — Our
Samoan Island — Climate — The People — Present Form of
Government — Kava Drinking — Native Houses — Diseases
— Hospitals 61

New Zealand: The Ocean Voyage — Climate — (Natives —
Auckland — Auckland Hospital — Medical Profession .... 85

Australia: The Kangaroo — Climate — Prevailing Diseases
—People — Natives — The Mika or Kulpi Operation —
Surviving Aborigines — Sydney — 'Hospitals — Sydney Hos-
pital — Royal Prince Alfred Hospital — Medical Profes-
sion 99

The Melbourne Hospitals: The Melbourne Hospital —
Radical Cure for Inguinal Hernia — Prostatectomy — Al-
fred Hospital — Melbourne Hospital for Sick Children —
St. Vincent's Hospital — A Trip to the Giant Eucalyptus
Trees 125

The Adelaide Hospitals: The Adelaide Hospital —
Adelaide Children's Hospital — Gallstone in Elephants —
Postmortem on a Zebra — Private Hospitals in Australia
-Terrace Hospital — Clareton Hospital 139



VI CONTENTS.

i

Page.
Medical Education in Australia: Sydney University
and Medical School — Melbourne University and Medical
School — Adelaide University and Medical School 155

Ceylon : From Australia to Ceylon — Island of Ceylon; Its
Climate. People; Prevailing Diseases — Soysa Bacterio-
logic Institute, Colombo — The General Civic Hospital —
Ceylon Medical College — Leper Asylum at Hendala —
Leper Buddhist Celebration — City of Kandy — The An-
nual Buddha Celebration — Botanical Garden — Kandy
' General ( 'ivic Hospital 167

India: Madras Medical College — Dress, for Natives Only
— Madras Government General Hospital — Carcinoma in
India — Abscess of the Liver — Aneurism of Common and
External Carotid Arteries — Hydatid Cyst of Tibia — Rhi-
noscleroma 197

Bengal Medical College: Female Certificate Class —
The Surnomoye Hostel — Military Pupil (lass — Mid-
wives and Dias 213

Calcutta Government General Hospital: The City of
Jaipur and Mayo Hospital; Splenic Anemia — Piroplasma

Donovani 229

Grant .Medical College and the Hospitals of Bombay:
Pathologic Museums — Pneumonic Plague — Syphilitic
Fibrosis of the Lung — Aneurism of the Heart — Hepatic
Abscess — Enormous Calculus of the Bladder — Ainhum of
the Small Toe — Mycetoma or Madura Foot — Anesthetic-
Leprosy — Guinea Worm — Jamsetjee Jeejeebhoy Hospital
— Prevalent Diseases — Homeless Leper Asylum, Batunga
- — The Plague Research Laboratory of the Government of
India, Parel — 'Bombay Bubonic Plague Hospital — A
Cobra Den — Calmette's Antivenene 247

Four Thousand Miles Through India by Rail in Mid-
summer: Attractions of India — Master and Servant —
Indian Summer Climate — The People — Indian Art — No-
table Medicinal Trees of India — Benares Monkey Tem-
ple — A Benares Saint — Hindu Cremation — Taj Mahal —
Delhi — A Parsee Woman Doctor — A Sick Elephant — A
Crocodile Tank — A Belated Bridal Ceremony — Feast of
the New Moon — A Faithful Roman Catholic Priest—
Elephanta Caves — A Grewsome Charnel House 277



ILLUSTRATIONS



Figube. Pack.

1. Tubercular Leprosy in a Young Native Girl 2:<

2. Tubercular Leprosy in a Hawaiian 24

3. Island of Molokai 25

4. Anesthetic Leprosy iii a Native Woman 27

5. Baldwin Home for Leper Boys, Kalawao. Molokai... 28

G. Father Damien 31

7. Kalawao Leper Settlement. Molokai. Established by

the Hawaiian Government in 1865, Showing Also

Father Damien's Church 35

S. Father Damien's Grave 41

9. Natives and Native House 47

10. Luan, National Hawaiian Feast 49

11. The Government House, Honolulu 51

12. Queen Emma, Consort of King Kamehameha III.... 53

13. Queen's Hospital, Honolulu, Established by King

Kamehameha III and Queen Emma in ISflO 55

14. Tutuila, Samoa, U. S. Naval Station 63

15. Flag-raising Ceremonies 65

16. Samoan Women and Child 67

17. Tamasese, Fine Specimen of Samoan 71

IS. A Native of Tutuila Affected with Elephantiasis Af-
fecting All Extremities 75

19. Native Hospital in Pago Pago, Tutuila 79

20. Swa Dance in Tutuila, July 4, 1904, in Front of Naval

Hospital 83

21. Maori Women 89

22. Auckland Hospital 95

23. Australian Aborigines 110

24. Aborigines of Central Australia in War Dress Ill

25. Young Native Mother and Infant 115

26. The University of Sydney, Overlooking Victoria Park. 119

27. The Original Medical School, University of Sydney... 120

28. View of Sydney Hospital from the Northwest 121

29. The Operating Theater. Sydney Hospital 122

30. Adelaide Hospital 141

31. View on the Grounds; Adelaide Childrens' Hospital.. 149

32. Medical School L T niversity of Sydney 161



VJ1I ILLUSTRATIONS.

Figure. Page.

33. A Singhalese 175

24. Singhalese Woman 179

35. Leper Asylum at Hendala 189

36. Tooth of Buddah 191

37. Madias Medical College and Government General Hos-

pital 198

38. Another View of Madras Medical College and Govern-

ment General Hospital 199

39. Chondrosarcoma of Humerus and Scapula 203

40. Bengal Medical College, Calcutta 213

41. Quarters for Military Pupils 215

42. Eden Hospital, Calcutta 221

43. Elephantiasis of Legs 223

44. An Undiagnosed Case 225

45. Native of Jaipur 230

46. Hindu Dancing Girl 231

47. Piroplasma Donovani 243

48. A Parsee 249

49. Anatomy Building, Grant Medical College 251

50. Madura Foot 257

51. Keloid of Punctured Lobe of Ear 259

52. Operating Room, Jamsetjee Jeejeebhoy Hospital 261

53. Hindu Snake Charmer 273

54. Master and Servant 285

55. Hindu Butler 287

56. An Indian Faquir 295

57. An Arab Jew in India 297

58. Hindu Women 301

59. A Sikh Priest 305

60. Low Caste Hindu Girls 307

61. An Illustration of Hindu Architecture 311

62. The Colonnade in the Hindu Temple at Rameshwaram. 31:;

63. Open Air Cremation 317

64. Swami Bhaskara Nand Saraswati, the Famous Ascetic

of Benares 320

<;.">. Taj Mahal 321

66. Tower Near Delhi 325

67. City of Delhi 327

68. Native Policemen 331

»i!). Botanical Garden, Calcutta 337

70. Towers of Silence 343



TRAVEL AS A MEANS OF POST-GRADUATE
MEDICAL EDUCATION.



For the second time I am on a tour around the world
— this time in an opposite direction, from East to West,
via India. I leave San Francisco on the steamer Sierra.
July 7, and if I am spared the disease-producing effects
of the tropical climate and not delayed by failing to
make timely connections, I expect to reach New York
on the Kronprinz Wilhelm, October 11. Three years
ago I girdled the globe via Siberia in three months
and twenty days. That trip was replete with informa-
tion of all sorts, general and professional, and the
pleasure of it was enhanced by the companionship of
my friends, Prof. D. R. Brower and Drs. Mastin and
Frank.

I am very well aware of the fact that midsummer
is the wrong time to undertake a journey through India,
owing to the intensit}^ of the heat, but I expect to re-
ceive at least a partial recompense for the expected
sufferings incident to unfavorable climatic conditions
by avoiding crowded hotels, cars and steamers, which
so often detract from the pleasures and benefits of travel
during the winter season, when the tourists elbow their
way over this popular pathway around the world. This,
at least, was my experience in visiting the Holy Land
and Egypt during the summer months on a former oc-
casion.

Beside, the duties of my college work are such as to
preclude all possibility of seeing India at the most de-
sirable time. My friends who had comtemplated mak-



10 AROUND THE WORLD VIA INDIA.

ing this long journey with me have all, one after the
other, decided otherwise, so I shall find myself alone
for once from one end of the world to the other. This
isolation also has its advantages and charms. The time
will belong to me exclusively and I shall dispose of it
in the most profitable manner in studying the different
places of greatest interest, the people, their customs
and habits. I shall also devote special attention to
matters pertaining to our profession and report from
time to time to the readers of The Journal the results
of my observations. Experience has taught me that in
traveling in tropical countries the best means to counter-
act the baneful effects of heat is work, mental and physi-
cal. It is under the influence of prolonged heat that
inactivity begets mental and physical languor, while
exercise of body and mind increases the force of the
enfeebled circulation and stimulates the organs of secre-
tion and excretion to greater activity. Before leaving
the Pacific Coast I desire to discuss very briefly the
subject indicated by the title of this, my first communi-
cation, and in doing so I fully realize what Cicero said
of letter-writing:

"We write differently when we think that those
(inly to whom we write will read our letters, and in
a different style when our letters will be seen by
many."

My prospective letters mean letters to the over 31,000
subscribers of the official organ of the American Medi-
cal Association, many of whom I count among my most
esteemed and intimate friends, hence my diffidence and
uneasiness in beginning.

From time immemorial travel has been recognized as
an important element in acquiring a general education
and in obtaining proficiency in the professions, arts,
sciences and trades.

It is the study of men and manners in different
(limes and varying social and political conditions that
proves so useful in enlarging the views of life and



TRAVEL AS A MEDICAL EDUCATION. 11

weighing its possibilities. Horatius was fully aware of
this when he wrote:

"The knowledge <>f liicn and manners is the firsi
principle and fountain head of good writing."

Before machinery usurped the place of hand labor
mechanics and tradesmen acquired their technical
knowledge by serving as apprentices for a number of
years under the supervision of an acknowledged master,
and after having obtained the required proficiency they
spent another year or two, their Wander jahrc, in travel-
ing from place to place in perfecting themselves in their
vocation by familiarizing themselves with the practical
work of different masters, before they considered them-
selves fully qualified to take their independent stations
in life. In this manner they acquired a reliable knowl-
edge of the details of their work, which no one master
could impart. If travel and observation and practice
under different masters in the acquirement of a thor-
ough knowledge of the different trades are such im-
portant factors of success in the world of business, it
must appear very evident that the same means are even
more desirable and efficient in the study of medicine
and in keeping pace with the wonderful advancements
and improvements of the most progressive of all profes-
sions. In this age of research and discoveries, the
science and the practice of medicine and surgery are
undergoing revolutionary changes from day to day-
and the ceaseless search for truth and facts makes it
necessary for the modern practitioner to keep abreast
with the latest and best pertaining to his calling.

In our day this means much. It was not so in the
remote past, when the authority of writers of popular
text-books remained unchallenged for centuries. We
live in an age characterized by progressiveness. deep
scientific investigation, free and sharp criticism. Theo-
ries advanced by one are overthrown by another unless
they stand the crucial test of successful repetition by



1^ ABOUND THE WORLD VIA INDIA.

acknowledged leaders in the profession. What was new
yesterday may become old and obsolete to-morrow. Sci-
entific work is no longer confined to a few favored
institutions; it may be seen in all parts of the civil-
ized globe. Nations and institutions are now engaged
in a laudable competition to excel in blazing new path-
ways through the still unexplored territories of scientific
medicine. It is by the concerted, systematic, scientific
investigation of disease in all climes and under varying
conditions that we must look for more radical measures
in the prevention and more successful treatment of
disease. There is no time in the life of a medical man
when he feels more confident and competent to battle
successfully with disease and perform the most diffi-
cult operations than on the day he leaves his alma ma-
ter, diploma in hand, ready to seek his place in the
crowded ranks of his future profession. If the new as-
pirant for a liberal patronage is honest, it will not take
him long to discover his shortcomings and crave for
more knowledge. He will be made painfully aware of
the fact that

"Because all the sick do not recover, therefore
medicine is no art." — Cicero.

The completion of the study of medicine, even in
the best equipped medical colleges and universities, fur-
nishes at best but the foundation for the subsequent
post-graduate education. If the foundation is firm and
the building material contributed later substantial and
in sivfficient abundance, the resulting structure will re-
sist fire, wind and storm, a lasting monument to the
builder. If the foundation is defective and the build-
ing material not of the right sort, failure and disap-
pointment will surely follow misdirected efforts, no
matter how earnest and persistent they have been.
The successful physician and surgeon will be the one
who, with the day of his graduation, enters on a ra-
tional, well-planned, systematic post-graduate course of



TBAVJEL AS A MEDICAL EDUCATION. 13

the study oi' medicine and its allied sciences. This
constitutes a life stud)-. Without it the practice of
medicine inevitably soon degenerates into a miserable
trade The reading of new text-books and the be.-t
current medical literature, passive and active work in
medical societies, local, national and international, lab-
oratory work in the office and local hospitals, are well
calculated to meet the needs of the ambitious, conscien-
tious practitioner, but they will not suffice in giving
him the best possible opportunities to keep in touch
with the spirit and practice of the extraordinary age
in which we live. Reading and seeing are two entirely
different things. The eye is the great educator in tech-
nics of all kinds. It is one thing to read the descrip-
tion of a complicated operation; it is another thing to
see it performed by the hands of a master. Text-
books, valuable as they are, are but poor substitutes
for actual instruction and demonstrations in clinical
and laboratory methods. Personal intercourse with
prominent men in the profession imparts a stimulation
for more earnest and more effective efforts not obtain-
able to the same extent in any other way.

A personal acquaintance with men who have earned
a well-merited reputation in the advancement of our
profession is a source of great gratification and excites
a new interest in the work he has accomplished. The
study of strange diseases in distant countries fills a gap
which a college education and subsequent reading can
not fill. An accurate knowledge of climatic conditions
and their effects on health and disease can only be ac-
quired by travel.

For the professional man, and especially for the phy-
sician, travel opens a field of learning and affords op-
portunities the importance of which can not be over-
estimated. In order that travel may yield the desired
results, both physically and mentally, it must be care-
fully planned and properly conducted. The demands



14 AROUND THE AVORLD VIA INDIA.

on the time and energies of an exacting, laborious
practice are such that fatigue, bodily and mental, must
follow sooner or later. Of all learned professions the
medical is the one in greatest need and most deserving
of a long, free-of-care annual vacation. It is hard to
make the public believe this, but it is nevertheless true.
During the summer months the complicated mechanism
of the law comes to a standstill and the lawyers take
their vacation without crippling their bank account to
any considerable extent. The fashionable churches
close their doors when the members of the congrega*
tions leave for their luxurious summer homes, and the
rectors and preachers, with purses well filled with gold
by their appreciative parishioners for their vacation
expenses, leave the great cities and spend their allotted
leisure weeks and months where they are sure to find
rest, comfort and recreation. It is the physician who
is expected to work from one end of the year to the
other, ready for call by day and night, in sunshine
and storm. It is the physician whose annual income
suffers when he leaves his practice for a much-needed
outing. It is the physician who carries away with him
the weight of. his responsibilities to a greater extent
than the members of any other profession when away
from daily routine work. The public must be made to
understand that medical men are entitled, above any
other profession or class of men, to an annual vacation,
and that such vacation, properly spent, will bring to
their patients better service, and will be one of the most
important factors in promoting the science of medi-
cine, public hygiene and sanitation.

Where and how shall the physician spend his vaca-
tion ?

"Travel, in the younger sort, is a part of educa-
tion; in the elder, a part of experience." — Bacon.

The physician who has the interests of his patients
and profession at heart will not be content, like most



TRAVEL As A MEDICAL EDUCATION. L5

professional and business men, to spend his precious
vacation time in idleness at some fashionable seashore
or mountain resort or to imbibe the questionable pleas-
ures of city life. The working time of a professional
career is too short to waste time by idleness or dissi-
pation. Rest to him means work of the right kind.
What wears a busy doctor out is not the physical work
he does, but the care and sense of responsibility it car-
ries with it. The greatest pleasure to him is to see
others work, and the sweetest rest a freedom from care.
Brain fatigue is more frequently caused by care, real or
imaginary, than overwork. A man in average health
can do an incredible amount of congenial work, but
it is care that furrows the face and blanches the hair
prematurely.

Relieved of care the physician on his vacation is in
the best possible mood to reap the benefits of the work
of others near and far. The visits to laboratories, hos-
pitals and museums, the personal contact with col-
leagues in different countries, the inspection of new in-
struments, the practical work in the operating room and
laboratory will become to him fascinating and instruc-
tive object lessons. The genuine feeling of fraternity
among medical men throughout the entire world will
insure to the earnest and honest seeker of knowledge
a most friendly reception, provided the visitor conducts
himself properly. The American, born in a land where
the idea of equality among men is pre-eminent, in order
not to give unintentional offense, must adapt himself
to the customs of the countries he visits, and thereby
secure the good will and friendship of those whose work
he is privileged to see.

In Europe the matter of titles conferred by the gov-
ernments on medical men is confusing to the American
visitor. Fortunately our forefathers guarded against
anything reminding one of royalty to take foothold on
our soil. In Europe and any of the European posses-
sions and Japan a titled person must be recognized and



16 AROUND THE WORLD VIA INDIA.

treated as such. The title of professor there means
much more than with us, for the reason that it can not
be made use of without, being granted by the govern-
ment. A professor must, therefore, not be addressed
as doctor, as is customary in our country, where the
freshman medical student does not hesitate to make
use -of this common and familiar term in addressing his
teachers, and if he comes from some rural district,
where physicians are too familiar with their clients and
neighbors, he may be bold enough to shorten the word
to "doc."

As soon as a European professor is honored by a
government title he has a decided preference for the
latter, hence, if he is a Lord, Sir, Excellency, Geheim-
rath. Baron, Pasha. Bey, etc., he expects to be addressed
by the titles with which he has been honored.

Another thing the traveling physician should always
be mindful of, and that is not to pester the teacher or
operator with unnecessary questions. Many of these
men we meet are very busy, and their temper is some-
times ruffled by overwork. The assistants, less burdened
with responsibilities, are always glad to give the re-
quired information if approached properly and at an
opportune time. The firing of questions, often of an
irrelevant nature, at a busy, overburdened professional
man, is in exceedingly bad taste, and can hardly fail
to excite his displeasure. The physician away from
his cares and strenuous duties should not undertake to
teach or to instruct, but should devote all available time
to add to his knowledge by seeing, hearing and reading.
The visiting plrysician must become a well-squeezed
sponge, ready and eager to absorb, slow in offering .ad-
vice and in exhibiting his operative skill. The display
of technical skill in strange hospitals and clinics should
be discouraged, as the operator labors under the great
disadvantages of doing his work with unfamiliar instru-
ments and strange assistants, and for these and other
obvious reasons can not do himself and his patient jus-



TRAVEL AS A MEDICAL EDUCATION". 17

tice, The traveling post-graduate medical student, un-
less he intends to devote considerable time to labora-
tory work, should not remain at any one place for any
length of time. It does not take long to become fa-
miliar with methods of teaching and details of operative
technic. It is more profitable, and certainly more inter-
esting, to see ten men operate ten times each than to
see any one man operate a hundred times. Travel, as
a means of post-graduate medical education, does not
necessarily imply that the time should be spent in great
medical centers, as is too often the case. Some of the
very best medical and surgical work is now being done


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