Man and his Maladies
That does not leave women out. So let us make it “Maladies of Mankind,” nay, humankind. One that has persistently daunted us, persistently held as obscure across oceans and continents, is not what Siddhartha Mukherjee calls the “Emperor of Maladies.” It is syphilis, a disease with a hoary history, discussed in comparative secrecy and shame, patients and doctors avoiding its mention by name, settling for an innocuous communication moniker, STD, which stands for sexually transmitted disease.
Syphilis was all but taken for gone a few years ago, with antibiotics providing a sure cure and healthcare facilities becoming readily available. As a boy, I had no clue why people talked about it in a hushed tone. It took a while to learn that syphilis and gonorrhea were associated with sins of sex. Quacks and vendors of holistic medicine were having a field day as far as it went but soon the veil of secrecy was dropped. When we celebrate the conquest of syphilis, we are faced with reports of an alarming recrudescence of this shameful sickness.
World data for syphilis is 7 million cases. The number is the largest ever in 70 years in America. Between the last two years, there is an increase of 32 per cent. In England, since 1948, there has never been such widespread incidence as now. Corresponding figures for other countries are equally distressing. What is even more daunting is that, for one thing, syphilis can cause stillbirths or deformities and, for another, scientists have no explanation yet for this sudden spurt.
In the past century, we have had satisfying experiments with public healthcare. Smallpox was a dreaded condition in my childhood. I remember the dreadful scene in our neighbourhood when Kunchukutty Amma was brought back home from her workplace one accursed evening. She ambled along the narrow path between thorny fences, a swollen figure helped up by two men, somewhat of daredevils who had little regard for their safety. They had to keep vigil for two days till her delirious end, casting an ominous pall of terror in the village. When the awaited death came, they were appropriately inebriated, rolling the body in a mat and disposing it off in an unmarked grave on the other side of the hill. There were gory stories galore of half dead people buried alive. Soon smallpox was eradicated.
Not equally dreaded were other maladies, though pretty painful. Scabies, whooping cough, diarrhea, fever--they were all dealt with using home medicines or no medicines. Nine out of ten kids had protracted spells of scabies, which required unkind scrubbing and washing in late afternoons. Local physicians prescribed an assortment of oils and potions which had what effect no one knew. With potable water being increasingly available, and toilets dug up with government help across the country, disease control became easy.
Our village doctors were Kochukuttan, Balan and Varunni, the last being a Christian vaidya. For some reason, I could not conjure up the vision of a vaidya as a Christian. It took a long while to come to terms with the sociology of medicine. Gangadharan was our resident homoeo expert, who had his education by post from some Kolkata racket. He had built an exclusive clinic with his name and qualification duly inscribed. Whenever in doubt, which was not unoften, he would consult a text that was hard for him to read. Those were the days when influenza, which became later a less intimidating flu, spread across the subcontinent.
Gangadharan never asked for a consultation fee. Anything was good enough for him just as was nothing. Ungrudgingly he would accept a 25 paise coin. That was perhaps the village ethics. Fees became a rigorous ingredient of medical practice in course of time. In a northern town, Calicut, there was an associate professor of medicine, Abdul Ghafoor, who put up a notice at his doorstep that he took Rs25 for a consultation. That was for the benefit of patients who had plans to give more. At one stage, Calicut had within a radius of two kilometres a hundred drug stores. That became an adopted town of poet M N Paloor who bemoaned that “in this twentieth century, he made anacin his staple food.”
Time was less complicated when anacin or aspro was not prescribed as a panacea for all ills. Every condition became a state of sickness that needed a doctor’s intervention. Arthur Hailey’s protagonist in Strong Medicine, Andrew Jordan, was wont to advise his daughter not to treat and pretend to cure any self-limiting disease. That was not a fashionable counsel in a medico-social system which that perceptive theologian, Ivan Illich, characterized as “hospitalization of society.” In an extremist vein, Illich debunked doctors as causes of diseases themselves, as agents of iatrogenesis.
Such bouts of extremism were perhaps an antidote to the deterioration of medicine as trade but, like all prophets of extremism, Illich was lapsing into hyperbole to stress his argument. If society tended to be hospitalized, it also helped reduce pain and put death off by a few days, months, years. Life expectancy was, in my boyhood, 50 years plus. Without such “hospitalization,” life span could not have been increased by twenty years or more. More babies would have died, more, perhaps, than death in an advanced age. Just as the pharmaceutical industry introduced new drugs to suit anticipated diseases, medical education became big business.
Before Kerala’s discredited Ashoka University was exposed in the early eighties when it sold fake or forged certificates as a matter of rule, admission to medical colleges was on the basis of the marks obtained in the qualifying examination. Then began the mushrooming of medical teaching shops. An architect friend based in Chennai was offered for his wife a medical package consisting of post-graduation and a super speciality degree--all for a pittance of one crore rupees. That was two decades ago. And that was a thousand times more than Balan Vaidyan or Doctor Gangadharan would have treated as a reasonable remuneration for advice.
New drugs and new devices need new diseases to be identified. In good old days, death followed a brief illness at home. Hospitalization was not mandatory or prolonged. Hospitalization in itself was a prelude to death. When a seriously sick person was to be taken to hospital, there was manchal, a bed hung on a sturdy bamboo pole, two hefty men carrying it, sending a throaty signal to those on the way. It was an eerie sound they made, much like the sound of death. Ambulance vans, their lights flickering and their sounds hooting, replaced the traditional contraptions in good time.
Midwives were local women, traditionally trained. Conception and delivery are so common that they seemed to need any external assistance. After all, old guards would say, animals went through the exercise with no one else to help. As for humans, who need the sophistication of labour rooms and a battery of attendants, are now waking up to the need for death aides, death doula, as they are called. Death may or may not be the end of existence. Yet it is an important aspect of life which requires the services of a doula, a palliative professional, to assist in the process of dying. Alua Arthur, a death doula, whose mission is to reduce terminal pain, says one way to make life less uneasy is to think of death positively. They have a word for that as well: Thanatology, science of death. Not to be mistaken for revivalism, our forebears had long thought about it: Effortless death, life without misery. Anayasena maranam, vina dainyena jeevanam. That was Acharya Drona’s last prayer.
Since the days of scabies and whooping cough to the worsening syphilis scene, we have had a succession of sickening sicknesses. Conditions of head and heart naturally figure in them foremost. Diseases or conditions not familiar to humans so far are coming up with a clamour for new magical cures. Comatose condition is perhaps growing in depth and spread. That involves a fractured memory which was not long or dreaded twenty years ago, though Krishna Vasudeva had talked about the memory in disrepair leading to the total collapse of the neural system.
So let us wait for new diseases to be cured by new drugs. There was a situation when the growth process involved a progression from childhood to youth to old age--and death. There is a new situation projected by Alvin Toffler in his presentation of the early arrival of the future. He called it progeria, old age in youth. Maybe we will have a medicine for that condition too. Don’t we already have medicine for contrary conditions, a medicine for sleeplessness, another medicine for sleepiness? How true was Illich’s extremist formula, hospitalization of society!
