Visiting a medical practitioner was quite an experience 50 years ago. We used to call them doctors in India, which we continue to do so even now. There were mainly 2 categories then- degree holders (MBBS) and diploma holders (LMP). For all minor ailments like fever, boils, indigestion etc the best bet was the LMP. LMPs were quick in diagnosing and prescribing medicines due to their profound experience. LMPs were proficient in all round activities; consultation, surgery and also specialist role at times. There were less postgraduates and specialists in those days.
Doctors used to visit homes of patients especially the wealthy and middle class during evenings. They also attended 24hours during emergencies.
Doctors visited patients in their cars or 2 wheelers and carried patent brown coloured leather bags fully packed with instruments and medicines. It was customary to receive a doctor at the gate and carry the bag for him.
Bulk of the people went to Government hospitals followed by private clinics. Clinics were more utilitarian with one or two wooden benches for the waiting patients and either an inside closed room or a screened partition for consultation. Usually a dispensary was attached to the clinic with a “compounder” for preparing and issuing medicines in liquid form called as “Mixture”.
Almost all doctors in those days adopted the same standard procedure for, examining the patients. The first one was to check the pulse. Next thing done was listening to the various sounds made in the chest cavity with the help of a stethoscope. We as children simply loved the cold button of the instrument when kept on the chest and the back. When we were asked to breathe in and breathe out with force, we either spat out or coughed; as we were unaware of the process of deep breathing.
The most difficult task was holding the thermometer in the mouth without biting it. While the adults managed with little effort, children always found it quite difficult. After the lapse of an unbearable amount of time the doctor would slowly extract the thermometer and try hard to read the mercury. The doctor most of the time found it difficult to read. As a cross check he would place his palm on the forehead or neck of the patient.
The next set of observations were; pumping the stomach with hand for any pain; checking of glands on the neck; checking the throat with mouth wide open with the aid of a torchlight; Pulling the lower eyelid down to check for anemic condition. It was compulsory to register the weight by using a weighing machine provided in a corner of the clinic. Children used to make liberal use of it. The physical examination was the most time consuming part of the entire consultation.Doctors had to rely on symptoms and physical examination in those days, as against plethora of analytical methods available today.
Finally before prescribing the medicines there used to be a “Viva Voce” with the patient. The most asked questions were:
• Any headache? How is the throat? What food you ate in the morning? Normal motion?
In a typical Indian family answers would be provided by every one around except the patient. Invariably my mother used to accompany me to doctor till I reached the age of 15. She used to answer all the questions of the doctor. The other practice was a bunch of patients from the same family would visit the doctor together. This practice was more due to the joint family system prevailing at that time. This was also an ingenuous way of paying only a single consultancy fee in some cases.
Before prescribing the medicines the doctor would ask “Do you need an injection?” Parents controlled their children with the threat of injection if they misbehaved. Children were always averse to this process as the method inflicted lot of pain. But adults had different view. Injections were less costly as compared to medicines and were found more effective than mixtures, powders and tablets. One doctor did confide to my father that he had to give saline water injections to some of his patients as otherwise they felt that the doctor was useless.
The advent of the wonder drugs was yet to take place, and the strongest medicines were based on Sulfa or Penicillin. Most of the fevers were treated with mixtures, which were combination of medicinal powders in a dissolving liquid medium. There were also some doctors who prescribed powders. But due to its bitter taste, everyone including adults shunned the powder. Hence the need for the mixture arose, which was easier to swallow and contained slight sugar. Also mixtures did not produce side effects but took longer time to cure. The compounder attached to the dispensary prepared the mixtures based on doctor’s instructions. Mixtures were in multifarious colours. We children had preference on colours. I used to resist drinking the rose mixture, which was pink in colour but bitter in taste. There was also a dark green mixture, which tasted better. I resisted drinking the rose mixture but my mother used a trick to make me drink. She would offer to give me a spoonful of sugar if I opened my mouth. She would put the sugar in the mouth followed with the rose mixture in quick succession.
Mixtures and tablets were prescribed usually for 2 days only. Patients had to visit the clinic after 2 days and again check with the doctor for further treatment. Even a simple fever entailed absence from school or work for a week. Doctors in those days believed in giving total rest to the body and prevent outside exposure. They were also great believers in nourishment and advised consumption of fruits, fruit juices, Horlicks and fruits. I have not seen any doctor advising in similar lines today.
There were very few doctors who opted for a blood test in those days. Probable reasons were lack of enough labs and also of analysts. Most of the fevers were allowed to have their run for more than a weak. The only precaution taken was to prevent the fever from reaching high by applying wet cloth over the forehead. An attendant would sit by the side of the patient and apply the wet cloth usually dipped in water mixed with Odicologne at frequent intervals. Liberal use of pain balms and eucalyptus oil on the forehead was also another method widely practiced to reduce headaches during high fever. Cases of people getting in to coma and passing out were also frequent. But compared to today the patients were kept in airy and clean rooms. They were isolated from other inmates of the house as for as possible. Greater attention was paid on diets and fruits were given regularly to patients as part of their recovery programme.
As for as children were concerned a great hurdle they have to cross during childhood was the Tonsils operation. India was a hot bed of throat infections in those days as the environment was highly polluted and there was no protected water supply. There was no sanitizing of vessels carrying water and unclean hands were dipped often in to water containers. While children went after Ice creams, which were a novelty in those days, the preparation was through unhygienic process. Ice creams were bought from street vendors who peddled the ware in hand carts. The Ice cream man often dipped freely his sweat and grime covered hand in to the thermos flask and take out Ice cream sticks.
The first thing the doctor did in cases of sore throat of children was to check for inflammation of the Tonsils. He would swipe the Tonsils with iodine dipped cotton swab with the help of a stick. If the trouble persisted for a long time doctors usually went for the removal of Tonsils. Nobody took care in controlling the cause. In those days most of the children around 10 years of age had their tonsils removed. The importance of Tonsils as a trap for infections was understood much later and the injurious surgery was aborted.
Another external medical practice, widely followed was “enema”. Constipation was a prevalent nuisance in those days as there was absolutely no control over quality and amount of food consumed. Any dinner was bound to have minimum 3 courses with combination of hot, sweet and oily dishes mixed liberally with Ghee (clarified butter). There were many brands of Laxatives available in the market. The newspapers carried regular advertisements on these brands. It was customary in the Indian households to give a dose of Castor oil once in a month to children so that their intestinal track was thoroughly cleaned.
If a doctor found laxatives ineffective he immediately recommended the “enema” process. There was no need for the doctor or a well-trained person to carry out the process. Most of the people in that period had experience. In our house my uncle used to help my grandfather several times in a year with the “enema” apparatus.
Apart from the use of western medicines large scale use of home remedies, and Ayurveda medicines were also prevalent. Faith cure was also another process which was mostly resorted to by the poor. I am intending to write on these practices separately.
To bring out a comparison of treatment between yesteryear and now, I would like to describe a recent experience. I had a swelling on the tip of my middle finger on the left hand, which was causing lot of pain and persisted for more than 4 days. I went to the out patient ward of a hospital nearby. The consulting doctor there asked me to see the surgeon in the ground floor as I might require an operation. The P.A. to the surgeon told me to get registered as an outpatient in their office. It took another half an hour to complete the process and I had to pay Rs.300 for consultation and registration fees.
The surgeon after checking and asking me many questions on my health, like BP and sugar levels asked me to wait at the OP ward where the surgery would take place. I was injected with a local anesthesia on the finger, which had absolutely no effect. When the swelling was operated the pain was terrible and intolerable. After resting me for another half an hour and giving an Anti tetanus injection I was asked to go home and come for dressing the next day. I had to pay Rs.700 to wards medicines, operation and service charges before I left the place. I had 2 more dressings on consecutive days, which entailed additional expense of Rs.150.
I still remember the operation I had when I was around 8 years of age. I had a boil on my leg, due to an infection. The doctor who did the operation was a lady with a LMP diploma. She never told me that she was going to operate before hand. She just applied few drops of disinfectant on the skin around and was talking about some household affair to my mother standing by my side. Suddenly she pierced the boil with a swift stroke of a knife which she had kept hidden in her hand and pressed hard the boil with her fingers. All the puss and blood inside spurted out. I had a flash of acute pain but it was gone in a jiffy after she applied little sulfa powder over the wound and bandaged. My mother paid the usual consultation fee of Rs.10.
Going to a doctor surely was much more pleasant in those bygone years as compared to the present jet age. While cures are faster today, the process involves lot more procedures, medical tests, expensive medicines and hefty doctor fees. The role of a general practitioner has got reduced significantly and even for minor ailments the specialist has to be consulted. The practice of doctors visiting patients at their homes has come to a stop excepting for the very rich. Today’s doctors cannot function without costly equipments like ECG, scanners and x-ray machines, which are available only in a hospital. The prognosis on patients is based on analytical reports rather than on physical observation as was done in olden days.
