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Classics in Indian Medicine 48 THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 23, NO. 1, 2010 Classics in Indian Medicine WILLIAM ELMSLIE, MD ARTHUR NEVE, FRCSE ERNEST F. NEVE (1832–72) (1859–1918) (1861–1946) William Elmslie initially studied at Arthur Neve did his medical training Ernest F. Neve followed in his the University of Aberdeen and at the University of Edinburgh in brother’s footsteps and trained at graduated in 1864 from the 1876. After working in Edinburgh Edinburgh and joined him in University of Edinburgh. He went to for some years, he joined the Church Kashmir in 1886. He served as Kashmir in 1865 when he heard of Missionary Society and went to honorary/consulting surgeon at the the plight of the people there because Kashmir in 1882. He was head of same hospital until his death. His of the practically non-existent health the Kashmir Mission Hospital for range of surgery and his services. Elmslie was the first person 37 years until his death in 1919. contributions to the people of to practise western medicine in Besides being a skilful surgeon, he Kashmir are evident when one Kashmir. He was a dedicated surgeon was a Himalayan mountaineer of realizes that he published papers who, because of resistance from the repute and was the author of such on cataract surgery, tubercular Maharaja and the local officials, was books as Kashmir, Ladakh and Tibet, lymphadenitis, caesarean section forced to hold his clinic under a tree Picturesque Kashmir, and Thirty in osteomalacia, besides kangri and later in a tent! In fact, after some Years in Kashmir. During World War cancer. He was also one of the years, the Maharaja opened a rival I, he served as a Major in England, founders of the Kashmir State Leper hospital. Elmslie was perhaps the and later, in France. In 1919, he Hospital in 1892 and was an first person to describe what we now returned to Kashmir where he was honorary superintendent. Like his term as ‘kangri cancer’ and also given additional charge of the State elder brother, he was a mountaineer correctly suggest its aetiology. He Leper Asylum. He died of a fever and writer and wrote Beyond the Pir also did lithotomies for bladder suddenly on 5 September 1919 and Panjal, Things Seen in Kashmir and stones and contributed greatly was awarded a state funeral by the A Crusader in Kashmir, a biography during the cholera outbreaks. He Maharaja of Kashmir. He was the of Arthur’s life and work. He too had planned to bring out a dictionary subject of two biographies, Arthur served (as Captain) in the army of the Kashmiri language, but died Neve of Kashmir written by A. P. during World War I. For over a young of a liver disease in Gujarat on Shepherd and published by the decade after retirement, he con- 18 November 1872. Church Missionary Society, London tinued to stay in Kashmir, where in 1926 as well as A Crusader in he eventually died in 1946. Kashmir written by Ernest Neve. The photographs on this page have been reprinted with permission from the Church Mission Society (CMS), Oxford, UK through the good offices of Mr Ken Osborne. THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 23, NO. 1, 2010 49 ETIOLOGY OF EPITHELIOMA AMONG THE KASHMIRIS BY W. J. ELMSLIE. In the beginning of the month of May, 1865, a the affection as it presents itself in Kashmir. While the Medical Mission Dispensary was opened in Sirinagar, disease is rarely met with before 40 in England, no the capital of Kashmir, under the auspices of the fewer than 7 out of the 20 cases treated at the Medical Punjab Medical Mission Society, and was kept open Mission Dispensary, Sirinagar, occurred before that till the middle of October, when the season, as it is age, and one little patient was only three years old. called, comes to an end, and all Europeans, whatever It must not be supposed that the table gives the true may be the nation to which they belong, are compelled state of matters with respect to the comparative to quit the valley, unless they be in the pay of His frequency of the disease as occurring amongst males Highness the Maharaja of Kashmir and Jummoo. and females ; for very many of the women, in common About the same time this year the dispensary was re- with the great majority of Asiatic women, entertain a opened, and has been daily frequented by the sick, strong and all but insuperable antipathy towards both men and women of the city and the adjoining European skill and medicine, more especially when country. The total number of patients belonging to the their ailments are situated in parts of the body where a valley who have, up to the present date (18th spurious delicacy dictates to the pitiable and ignorant September), applied at the dispensary for medicine sufferers that it is preferable to allow them to remain and treatment is 5,080 and of this number no fewer uncared for and untreated, than expose them to the than 30 have been cases of unmistakeable epithelioma, gaze of a foreigner and a white face. It seems probable as was clearly and indubitably shown by the history, that the apparent dislike of the European physician symptoms, and microscopical characters of the disease. entertained by native women is mainly due, in very These figures yield the most remarkable and unusually many instances at least, to the evil and bigoted influence high proportion of one case of epithelioma in every 254 of their male relatives and friends. But be this as it may, patients. The following table exhibits briefly, at a this antipathy of native women towards the Doctor of glance the names, sexes, ages, country, sites of disease, another continent is nevertheless true, and should be and treatment of these 20 cases of epithelioma. constantly remembered when statistics are brought Epithelioma, as it occurs at home, is a disease forward to show the comparative frequency of particular which seldom makes its appearance before the age of diseases among native men and women, for if it is 40; more frequently affects men than women ; as to forgotten, the statistics are sure to lead to an erroneous situation, is partial to the lower lip, the penis, the conclusion. Although, therefore, it would appear from scrotum, the vulva, the os uteri, the bladder, the the mere inspection of the table that the frequency with larynx and the tongue, and is generally supposed to be which epithelioma affects men and women in Kashmir, produced by some sort of irritation. Now it will readily is pretty similar to what it is at home, nevertheless, be observed, on inspecting the prefixed table, that knowing and remembering this fact respecting the there are certain remarkable differences existing strong objections which native women have to European between the disease as it is met with in England, and physicians, we have good reason for believing that a much larger proportion of women suffer from epithelioma than the prefixed table would lead us to conclude. Table of twenty cases of Epithelioma treated at the Medical Mission One of the most curious and interesting points dispensary, Sirinagar, Kashmir. connected with epithelioma as it obtains amongst the Number Names Sex Age Country Site Treatment degraded Kashmiris, is its remarkable preference for 1 Mukhti… Female 20 yrs Kashmiri Abdomen Excision 2 Rajbah… Male 38 ”” ” ” the abdomen and inner aspects of the thighs. It would 3 Razakh… ” 30 ””Left thigh ” be hasty and unwarrantable, with our present very 4 Gafara… ” 24 ””Right thigh ” limited observation and experience, to say that 5 Razakh… ” 50 ”” ” Would not submit to epithelioma occurs in no other situations among the treatment pitiable inhabitants of the Fair Valley, but certainly, so 6 Naki… ” 21 ””Abdomen Excision far as the disease has been seen at the Medical Mission 7 Gulab… ” 60 ”” ” ” 8 Jamil… ” 70 ””Right thigh ” Dispensary, Sirinagar, these are the two sites it has 9 Doni… Female 40 ””Abdomen ” invariably occupied. What can be the cause of this most 10 Adna… Male 50 ””Left thigh ” 11 Alam… ” 50 ””Abdomen ” note-worthy preference as to situation? That there 12 Hatim… ” 50 ””Left thigh ” must be something special and peculiar in the habits 13 Fazli… Female 42 ””Abdomen ” and customs of the Kashmiris to account for this 14 Sadik… Male 19 ”” ” ” 15 Gafara… ” 03 ”” ” ” exclusive choice of the abdomen and thighs on the part 16 Jamah… ” 60 ”” ” ” of epithelioma, seems pretty certain, and we believe 17 Mouli… Female 60 ”” ” Caustics that something to be what we shall now proceed to 18 Sadik… Male 50 ”” ” ” 19 Akldar… ” 60 ””Right thigh ” relate. 20 Masihena… ” 50 ””Abdomen ” The clothing of the Kashmiris, both men and women, [Reprinted with permission from Indian Medical Gazette (Indian Med Gazette 1866;1:324–6).] 50 THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 23, NO. 1, 2010 consists essentially of one long loose woollen garment, they have denominated kangris. These kangris or which extends from the neck to the ankles, and is not portable braziers are made of clay of varying fineness, very unlike a woollen night-gown. So far as this article and are usually covered with wicker-work, more or of clothing is concerned, men and women are dressed less ornamented according to the price of the article. exactly alike. The men, however, frequently wear a Men and women, young and old, rich and poor, Hindu kamarband round their waists when they have a journey and Mussulman, all have their kangri, and all consider to make, or some piece of work to perform which it indispensable in the cold season.
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