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Archive for the ‘Health’ Category

Foot Pain, An English “Infection”

Foot PainPicture yourself in eighteenth century England. I would rather be in Liverpool, walking on cobbled streets late in the evening, drunk like a skunk, heaving out of a tavern called ‘The Turtle’s Tale’, slightly distracted by the cat calls and hoarse laughter of the hookers clamouring in the shadows, high heeled, their pelvis swaying and then suddenly the clippity-clop clippity-clop, is it that beautiful hooker stalking me or is it a carriage horse from a nearby lane? I remain blurred.

The ballrooms of Victorian England are full to the brim, the velvet, silk, artificial mannerisms and obviously the awful clippity-clop of the heels striking a rhythm louder than the piano music cannot keep pace with the swish of the clothes or hushed conversations in the corners.

The rooms of Mr. James Steiner, Osteopath and Podiatrist to her Royal Highness on the second floor of St. Georges Street, West End London are full of woman of all class, the rich and the famous, high class hookers and con women with their surnames ending in St. Claire, all having a common ailment, the burning feet syndrome or more specifically heel pain.

They have been treated albeit unsuccessfully by the streetside quacks with magical balms, dipping the foot in warm horse’s urine sometimes hitting the plantar aspect with wooden hammers and sometimes tickling the nerves with a peacock feather, but to no avail.

The osteopaths used massage, sometimes corkscrewing the foot in directions as the muse dictated and sometimes dipping them in hot and cold water simultaneously keeping the banter of irrelevant conversations at the same time.

The Harley Street physicians looked at them with disdain, ‘It’s the foot that is meant to cause pain and the mind that must tolerate this pain’ they said

Russian criminals posing as magic charlatans, having escaped from Tsarist Russia found refuge in London. They advertised their exotic titles, wares and equally exotic powers. Many beautiful well heeled women with heel pain fell to their charms. Their long beards and moustaches took the attention of these women from their foot sometimes even permanently.

Robert Wentworth an anatomist and a barber surgeon went to the extent of exhuming a dead body and dissecting the foot. He found nothing significant but went on to explain in his treatise the fascia, nerves and the calcaneal bone which individually or in combination may cause such a pain.

Eighteenth Century India, still under the various Maharajas, it’s beautiful women always indoors showed diseases common to a tropical climate but rarely a heel pain or a painful foot that refuses to be cured.

Beautiful nautch girls danced in havelis and even on the bare back of Maharajas while holding on to a tree trunk. The right amount of pressure with their heels on their spine would relieve off the back ache. Unani Medicine flourished and people were healed off their aches and pains.

Modern Orthopaedics talks about a bony projection called calcaneal spur which might irritate a nerve or create a bursa that would cause pain. It is also referred as Plantar Fascitis or inflammation of the fascia underneath the foot.

I have operated on these spurs but unfortunately pain was never relieved. In fact the patient was left with an ugly scar and a chronic pain from the healing tissues.

The various treatments that may be followed are -

Decreasing activity
Stretching in bed the calf muscles
Taping in standing position
Application of Ice
Injection with Hydrocortisone
Losing weight
Arch Support
Extracoporeal shock wave therapy
A Below Knee Plaster cast for six weeks
Non Stroidal Anti-Inflammatory Drugs

So what might be the cause of foot pain, is it footwear that was prevalent in Western countries, can there be a genetic component or is it a symptom of a wider systemic disease like the rheumatoid disease? I won’t be able to tell. My friend Glory Sasikala, a well known poet from Chennai suffers from this ailment. The physicians suspected that she might be having a thyroid or a diabetic disorder trying to connect the foot pain to a metabolic disease. Her blood sugar and thyroxin levels are found to be normal.

Meanwhile I think of the clippity-clop, the beautiful high heeled damsels wishing if only I could have been there during that period.

This first appeared at

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Ramblings of a Bone Setter

Traditional Bone Setting of a Broken Jaw


Modern Orthopaedics is shaped on the skills laid down by centuries of tradition handed over by Bone Setters from all over the world. Liverpool is not only famous for its cobbled streets, drunken brawls at the wharf, the prettiest of wimps trading their wares, the Beatles but also to one Hugh Owen Thomas who is considered, the father of British Orthopaedic Surgery. His father Evan Thomas was an unqualified Bone Setter from the hills of Wales. He suffered bitter opposition from qualified doctors which gave him this firm determination of sending all his five children to Edinburgh to study for a Medical Diploma that would protect their profession of Bone Setting. Hugh was the eldest of all. Quoting from Watson – Jones, Fractures and Joint Injuries, ‘Power, prestige and reward were as nothing to him, but he won such a place in the hearts of seamen, dockers and housewives that when he died in harness they lined the streets of Liverpool in thousands, sobbing testimony to the friend they had lost’.

I hasten to write a few words after hearing the news that my close friend, internationally renowned novelist Shreekumar Varma is afflicted with a sudden backache. Backache is one such ailment which is claimed as their own by the Physicians, Surgeons, Orthopaedicians and even the Neurosurgeons, not to forget the Chiropractors and Osteopaths too. It just depends on the patient, where ever he may stray over. I have seen patients with back ache crawling to me and patients who have tearfully confessed about their severe pain and antics they had resorted and patients whose back ache disappeared after talking to them on anything and everything except the back. The pathophysiology of a back ache is such vast and diverse that this wont be the right column to talk about it.

Gwalior is a small town in Central India that I belong to. I had been practicing Orthopaedics from a small surgery which was sandwiched between a tea shop owned by an overweight Sindhi and a motorcycle repair shop owned by a sharp Punjabi. My morning use to start with having cups of sweetened cardamom tea in my surgery with a host of bone setters from close and a far. I respected them for their art and they loved me as I encouraged them to see me if they ever encountered any complication.

Traditional bone setting is a secret that is zealously guarded and oils and herbs that are used vary from country to country. ‘Khapatcchi’ is a word commonly used by Indian bone setters for a variety of splints made from recyclable materials. These bone setters knew their anatomy well and treated with utmost caution. There were complications which an over enthusiastic bone setter caused but such incidents were not uncommon with qualified orthopaedic surgeons too.

My friend the Punjabi and Sindhi use to help me with the traction as I applied the plaster bandage. There were times when my friend, the busy motor cycle repair man use to tell me, ‘ Do you think I should pour some engine oil on the road so that we can get a few more patients.’The bone setters were available on the narrow streets of Muslim quarters of Old Gwalior.

The Low Back Ache is treated traditionally by ‘Kale Ghore ka Naal’. Well it means that a black horse will have to bump you kindly with his hooves as you stand with your back facing his ample back. This was a real answer as I saw people queuing up for a bump. I yearned for that one too. The Islamic Butchers at my place are also traditional healers. My friend Salim Javed who has the biggest butchery in the town claims that Back Ache can be cured by maalish, a massage by lamb fat. Back Ache was also treated as documented in colonial literature by a lithesome lady dancing on her heels over the back of a patient while holding on to a tree trunk. The right amount of pressure which is needed to pop in the disc was known to these beautiful qualified well endowed women.


Chinese Traditional Bone Healers

I saw back ache being treated by Auricular Acupuncture at Colombo General Hospital in Sri Lanka. I had gone there to study Acupuncture under the guidance of the late Professor Anton Jayasuriya. Acupuncture that deals essentially with neurological pathways has been successful in treating chronic low back pain. I also saw African Traditional healers, Sangomas treating Low Back Pain with blade pricks. I feel it has to do with the Acupuncture points used by the Chinese Physicians. The Roman Physicians used the ‘Feather Treatment’ by tickling the back with a feather and sponging alternatively with hot and cold water. Low back Ache was a regular post orgy phenomenon in the days of Julius Caesar.

Delhi has the largest number of Bone Setters in India. In fact there is a street leading to the Cargo Section of the airport that is lined with shops of Bone Setters jostling with cargo offices. Most of them have a picture of a well muscled man showing the many ways he can treat the pathological bone. At the end it is always written ‘Shartiya Illaj’, which means guaranteed treatment. The Bone Setting tradition in India has always a relationship with the sport of wrestling. The wrestlers know the fine art of manipulation of sprains and strains and therefore they are also called as Ustad.

On a chilly morning in January this year, I decided to pay a visit to this market of Bone Setters in Delhi. Ustad Masood Ali comes from a family of traditional bone setters. He is six feet tall and has an awesome well oiled moustache. I introduced myself to him. He kissed me on both cheeks and held me in his arms. I told him the reason of my visit to his clinic. He said that before we start talking, I must have a drink of a milk shake mixed with almonds. His assistant brought two tall steel glasses in a jiffy that had the creamiest of milk with almonds. Ustadji’s moustache was covered with a layer of the cream. He told me in a Punjabi / Urdu dialect about his roots and the profession that he practices. His father came from Lahore during the pre-partition days. He teaches wrestling and has his own aakhara (ring). He wouldn’t allow me to photograph him as there are a lot of animosities between fellow bone setters. He feels that he doesn’t want to hurt anybody. I left Ustad Masood with a great feeling and happiness, the taste of the Almond Milk shake still lingers in my tongue.

The Dalai Lama had Mongolian Bone setters in his team of personal physicians.
This is an excerpt of Lama Chimpa’s diary written in 1950 from Ayur Vijnana Vol.6 Spring 1999 edition –

“Bone setting in Mongolia is a very interesting subject indeed. Soon after an accidental bone fracture or a dislocation of a bone, the Mongols think about nothing else than approaching the “Bariachi”, a bone setter, who has no medicines and no surgical instruments. The Bariachi just holds the fractured or dislocated part of the sufferer’s body with his or her own hands, twisting it here and there, for some time, without any pain on the patient. This born healer, who is just a lay man, neither spells any charms nor performs any rituals, but will then advice the patient to take some rest. These bone setters cure bone disorders perfectly. After the treatment, there will be no complain at all, however serious the injury may be. The injured person will be normal soon after getting such a treatment. The strange thing about this treatment is that these healers have neither any medical knowledge nor do they know any charms or magic. They are just ordinary lay persons having no training of any kind. They are born as bone setters. Their hands work as magical instruments. Such healers come from a family of traditional bone setters. Their sons and daughters are all bone setters. At times, the children of such a family do the same work as their elders. But generally they do not allow their young children to practise bone setting, as they do the treatment on contract, like a business. If the case is serious and the patient is wealthy, they will demand more money for the treatment. Otherwise, they are quite generous and do not take any fee from a poor person. But if a wealthy person does not pay adequately, the treatment may be defective. In this case, it is not possible for the patients to approach another such healer, because, according to their professional rule, no one can interfere with a case which is dealt with by another traditional healer. So, a Mongolian knows very well that he has no alternative but to pay whatever the bone setter demands, if he wants to be cured perfectly.”

It is not surprising to know that the actual art and science of Bone Setting may have trickled down the Silk Route. Mughal armies brought this technique with them as they came to India invading from the north. The knowledge of manipulation and healing was well known since centuries. When the British occupied India, they found a well reinforced orthopaedic system in perfect practice. Medical Practitioners attached to the East India Company picked up this art from local bone setters and took it with them back home.

I came across a novel titled ‘The Bone Setters Daughter’ written by Amy Tan. The story and characters are very much like as in the novels of Han Suyin.The central portion of The Bonesetter’s Daughter written by Amy Tan takes place in China in the remote, mountainous region where anthropologists discovered the Peking man in the 1920s. Here superstition and tradition rule over a succession of tiny villages. And here Lu Ling grows up under the watchful eye of her hideously scarred nursemaid, Precious Auntie. As she makes clear, it’s not an enviable setting:

I noticed the ripe stench of a pig pasture, the pockmarked land dug up by dragon-bone dream-seekers, the holes in the walls, the mud by the wells, the dustiness of the unpaved roads. I saw how all the women we passed, young and old, had the same bland face, sleepy eyes that were mirrors of their sleepy minds.

Nor is rural isolation the worst of it. Lu Ling’s family, a clan of ink makers, believes itself cursed by its connection to a local doctor, who cooks up his potions and remedies from human bones. And indeed, a great deal of bad luck befalls the narrator and her sister Gao Ling before they can finally engineer their escape from China. Along the way, familial squabbles erupt around every corner, particularly among mothers, daughters, and sisters.

The art and science of Bone Setting is very much alive as are traditions, superstitions and folklores that surround it. I might have raised the ire of my fellow bone practitioners but I believe it is necessary to have an open mind and let all forms of knowledge flow in.

South African Orthopaedic Surgeons have refused to accept this as an article as they are made to believe that this type of mumbo jumbo would pollute the science of Bone Healing.

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