In the Bonesetter's Waiting Room (15 page)

Historically at the centre of the global diamond and pearl trade, Hyderabad, where Hakim Sultan Rasool was born and trained, had also long been a region in which cultures interacted – not just in architecture, music and poetry, but also in sciences and medicine. After its conquest by the Muslim Bahmani Sultanate in 1347, Hyderabad prospered through a peaceful co-habitation between the original inhabitants and settlers of Persian, Turk and Arab origin. The city's rulers and royal sponsors fostered an environment in which Unani continued to grow and develop in conversation with local Ayurvedic doctors, incorporating the indigenous herbal plants they used. The exchange was by then no longer novel, as there are records of Ayurvedic scholars spending time in Iraq at the invitation of the Abbasid Caliphate in the eighth and ninth centuries; one, known as Manka, translated a key surgical Ayurvedic text while there, under the title
Kitab-Shawasoon-al-Hind.
Plants of Indian origin, such as sandalwood, had already been written about by the tenth-century scholar Al-Biruni and after the early fourteenth century, the exchange of medical knowledge in Hyderabad continued to travel in both directions.

This scientific tradition of exchange, experimentation and determining physical bases for health and disease is something that long-established hakims like Sultan Rasool continue to follow. Often, as his father, grandfather and great-grandfather would have done, his initial experiments were on himself. Meanwhile the Indian government's Central Research Institute of Unani Medicine, which has branches in thirteen Indian states, has since 2013 been conducting research using standardised clinical trial protocols – currently for conditions that include vitiligo, sinusitis, viral hepatitis, hypertension, diabetes and angina. The institute also works on scientifically validating Unani theory which, like the four humours of ancient Greece, is based on the idea of balance. Humours translates as
akhlat
in Arabic and Unani's humours are called
dam
(blood),
balgham
(phlegm),
safra
(yellow bile) and
sauda
(black bile). At the research institute, Tulsamma, a geneticist, told me of her project using the DNA of a thousand patients to try to understand whether their temperaments correlate with variations in their genomes. This would entail looking at samples of people all classified as having a dominance of one or other of the humours and matching that against information from their genomes.

Although the humours do form the basis of Unani theory and prescription, watching many of the hakims I spent time with in Hyderabad – as their unending stream of patients came in for fifty-rupee consultations through the day and even into the small hours of the morning – the traditional pulse-reading diagnosis I had heard of seemed almost entirely replaced by stethoscopes, sphygmomanometers and blood-sugar strips. The old methods of observing the patient's urine or stools are also now used in only very few cases. Cauterising and cupping, I was told, are time consuming and herbal formulations are used to balance excesses of
balgham
in the brain or
dam
in the body instead.

When I asked the hakims why treatment had changed, they invariably made the point that new tools do not belong to any one kind of medicine. ‘Patients are all used to these kinds of measurements now,' Hakim Sultan Rasool began. ‘I can diagnose from pulse readings, but I can't tell something like heart murmurs from doing this. For that I use a stethoscope. Normally, when a patient comes, first I do a differential diagnosis [to compare symptoms which may be similar in more than one disease, to determine which is most likely], to identify where there is pain or tenderness; which region, which organs are related to the problem. If there is something on the right, for example, it might be the liver, and if there is liver enlargement, is it jaundice, hepatitis?'

The patients who came from the large, smartly outfitted waiting room (predominantly women in black hijabs and jilbabs) into Hakim Sultan Rasool's intentionally tiny consulting room (‘If it were large the whole family comes in together and then the patient may not be able to speak freely'), are here for both common ailments – sore throats, sinusitis, allergies, joint pains – and more challenging conditions such as thyroid problems, arthritis, paralysis, diabetes. In the hakim's mixed Unani and general medical clinic, one of three he owns in Hyderabad, his dispensary stocks his own herbal formulations as well as biomedical ones – simple painkillers and medicine for digestion, mostly. ‘My patients come for both allopathic and Unani, they want both. Unani can cure diseases allopathic medicines do not cure, chronic conditions.' The hakim pulled out several tiny plastic pouches, each of which seemed to contain one small piece of gravel of varying size. ‘These are renal stones.
Ham log treatment dey
, I have treated the patients who had them with Unani medicines instead of them having surgery. But if a patient comes to me with appendicitis, cases requiring major surgery, for carcinomas, I will send them to an allopathic hospital. I will use whatever is helpful to the patient,' he finished, ‘because my aim is to make them better.'

After being shown out by his nurse, a girl dressed in a clean white medical coat from beneath which the vibrant colours of her salwar kameez and dupatta were desperately trying to escape, I set off to meet another family of hakims, this time specialists in bone setting – the healing of sprains, strains and other muscle pains, as well as fractures and full breakages.

As well as the hakims who deal in herbs and heart rates, there is another branch of Unani which had fascinated me for some time: the bone setters. I had seen itinerant street dentists set up their barber chairs and frightening array of sharp tools in the most unlikely places – under bridges, between market stalls – so I was keen to see for myself something that (for the more confident bone doctors, at least) would amount to street surgery. The one thing that doctors across India's state-sanctioned AYUSH healthcare system had told me repeatedly was that their treatments had no side effects. Not like allopathy, they would say.

Broadly speaking, the medicines that fall under AYUSH are seen by its patients and by many doctors as being natural and therefore risk free. This can be a very misleading idea, considering that any chemical ingredient that has an effect on the body – whether that chemical is natural or made in a laboratory – can always have related risks. After all, some of the most potent poisons known to man, such as belladonna, taxine alkaloids (from yew trees) or tetrodotoxin, are not laboratory made, but naturally derived. Still, when it comes to a type of medicine that involves not herbs but the physical manipulation of broken bones, there is a much more evident risk that it could end very badly in the hands of the wrong practitioner.

For this reason, bone setting theoretically operates under the radar within Indian healthcare, though in cities across the country bone setters offer their services to millions of people every day from their street stalls, windowless one-roomed shops and even specialist hospitals, some of which reportedly boast X-ray and MRI machines. In a roundabout way, India's government does support the study of this type of healing as a folk or traditional system that, if research could validate its safety and efficacy, might one day be given the official nod and be taught in Indian medical colleges. In keeping with its apparently relaxed view, not having a licence seems of no official consequence to the doctors or their patients, who appear to rely more on word-of-mouth recommendation. The lack of official status, though in some ways a boon for the bone setters, can leave them at risk of extortion by both criminal gangs and fraudulent officials, especially if they don't have formal training or state backing. But whether or not they can hang a licence on their walls, to their patients, many bone doctors are highly respected for their efficiency and efficacy, low cost and accessibility.

In the great breadth and diversity of Indian medicine, I had come across multiple bone-setting traditions across the country. These included families of bone setters of Fateh Kadal, Nowhatta and Hazrtabal in Jammu and Kashmir; Marma medicine in Kerala, which in times past repaired injuries related to fencing and their martial art Kalarippayattu; and more famously, a fourth-generation family practice from Puttur, a town in the southern state of Andhra Pradesh. In 1881 the first of their bone setters discovered a bone-healing herb by serendipity of sorts. While out hunting, Gopal Raju had caught a rabbit, breaking some of its bones in the process, and had wrapped the injured animal in leaves to take it home for the pot. But by the time he got there, the rabbit was able to walk, albeit with a severe limp. Suspecting the plant he had used was medicinal, Raju redesignated the rabbit from supper to his greatest experiment – he made a paste out of the leaves, applied it to the animal and reportedly watched it heal completely in a matter of days. (The herb is kept secret to this day by practitioners but has since been identified in a study by a taxonomist as Kasamarda, or
Cassia occidentalis
.)

Over subsequent years Raju experimented with chickens, calves and sheep, retrospectively incorporating ideas from Ayurveda's key text on surgery. The story goes that he then became part of the First World War war effort in India, when his services were employed by the British government for treating wounded soldiers and civilians. His brother's grandson, who had trained in general medicine, took up his great uncle's folk practice, opening a hospital that continues to be family run and is now one of two in the area, in addition to several smaller village clinics. Though the hospitals see more than 300 patients a day, the Kasamarda is still only gathered from the places in which it grows wild.

In Delhi and Jaipur the expertise of the
pahelwan
(wrestler) bone setters is well known, so much so that they must also contend with charlatans trading on the name without the necessary experience. Inside the walls of the spectacular city of Jaipur, many who specialise in treating fractures, sprains, injuries and muscular problems claim descent from the pink city's fifty-two historic wrestling schools, tracing their familial expertise to specialist knowledge developed by a direct ancestor. Among the bright and bustling streets of the old city, patients are bandaged and have healing balm applied in shops or at the doctors' homes. A few of these are romantically faded
havelis
– formerly grand courtyard houses often gifted to the wrestler by a ruler, which also housed the families' own wrestling rings. But when the princely states of Rajputana were formally dissolved after independence, courtly wrestlers in the newly formed Rajasthan sought alternative sources of income, making the transition from sportsmen to sports therapists. In Jaipur, almost all bone doctors produce home-made herbal remedies: in fact, rather than just physical manipulation, they say it is the knowledge of plants – committed to memory – and the ability to combine them that really makes the healing possible. As well as helping them to use formulations they find effective, this knowledge of plants, much as Hakim Sultan Rasool demonstrated to me when he selected leaves, berries and barks, allows evolution and expert experimentation to improve on what is already in use.

Many similar practices around the country are rooted in folk or martial and sporting traditions, but some bone setters do practise through association with what are India's codified, professionalised forms of AYUSH medicine – in Hyderabad, possibly particularly so with the Unani tradition.

As Ramal and I left Hakim Sultan Rasool to meet Hyderabad's most famous family of bone setters, we crossed the city's Purana Pul, the ‘old bridge' over the Musi River. Behind us, the breathtaking Golconda fort of the Nizams of Hyderabad, with its curving stone turrets and old walls – once so splendid that they were covered with diamonds to catch the light from the candelabras that illuminated the castle at night – was receding into the distance. We drove on past bustling bazaars, romantically faded buildings along the perfect street grids and wooden shuttered shops, some embellished with ornate Saracenic arches and columns. We passed Hyderabad's most famous monument, the Char Minar (‘four towers,' or minarets), which, with all of the drama of the Arc de Triomphe, towers over the intersection of four main roads. Still used by some as a mosque, it had been built by Sultan Muhammad Quli Qutub Shah in 1591, Ramal told me, to give thanks at the end of a cholera epidemic that had devastated Golconda.

Hyderabad's history was marked by the recurrence of these plagues: again, 300 years later in 1897 and then after 1910, no fewer than eighteen occasions during the British rule of India. The death toll was horrific each time – between 1911 and 1912 alone, nearly 17,000 inhabitants succumbed. In 1935, right next to the Char Minar and opposite the grand Mecca mosque, His Exalted Highness Nizam Sir Mir Osman Ali Khan Siddiqi Asaf Jah VII, the last Nizam of Hyderabad (and the richest man in the contemporary world), opened a large hospital dedicated to the study, teaching and practice of Unani medicine.

Unani clinics and medicines are certainly more visible in parts of India in which there are large Muslim populations (much of Hyderabad included). Its development through Islamic scholars under the early caliphates associates it with the religion with which it travelled into India; and yet even in those early years Unani had been in fruitful dialogue with Ayurveda, through Indian vaidyas who had been invited to the Arab world. In India today, as in the era of Hyderabad's rule by its Nizams, Unani is by no means exclusively used by Muslims, any more than Ayurveda is used only by Hindus. The Unani hospital the Nizam built in Hyderabad in 1935 housed 150 beds; but next door, he also attached an Ayurvedic section at great expense. Reflecting the contemporary importance of Unani and Ayurveda as well as the medicine promoted by the British, the building of these hospitals had followed the construction of a grand general Western medical hospital, boasting 400 beds and placed by the banks of the Musi. Like the Char Minar Unani hospital, it too had been designed in a splendid Indo-Saracenic style. Topped with onion domes and towers like something out of the
Arabian Nights
, the buildings are still magnificent today, but theirs is now a faded beauty. Although families like the hakims I met and unqualified street traders both run practices that are largely thriving, the investment from the state is insufficient to maintain the premises they use in their former glory. Crumbling plaster, paint bleached by the elements, damp and the neglect of underfunding are clearly apparent, and there are also reports of deeper infrastructural challenges. There are insufficient nurses and doctors, and years of neglect have left some wards unfit for use.