SOME STRAY OBSERVATIONS IN DIFFERENT INDIAN SUB-COMMUNITIES

SOME STRAY OBSERVATIONS IN DIFFERENT INDIAN SUB-COMMUNITIES

O P Kapoor
Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

Infestation by Taenia Saginata (beef tapeworm) is not uncommon in Muslims who have eaten infected beef. On hearing the complaint that they are passing "worms" in the stools, stool examination is asked for. Very often this does not reveal ova of tape worms. They are then arbitrarily administered polyanthelmintic drugs like mebendazole or pyrvinium preparations which have no effect on this parasite (specially in the dose prescribed).

These patients pass segments, about an inch long, through the anus. These may not be passed with the stools but may come out of anal canal and wriggle on the perineum. This causes local irritation and in turn mental tension. This can be so severe, that after visiting a number of doctors with no relief, they even get suicidal ideas.

Infestation by E. Vermicularis : Many Indian patients specially Christians suffer from thread worm infestation. This is in spite of being treated by many doctors. I advice treatment of all the family members at the same time. They are given mebendazole 100 mg twice a day for 3 days or a single dose of pyrvinium 5 mg/kg body weight or pyrantel palmoate 10 mg/kg body weight. It is very important that the treatment must be repeated after 2 weeks. The so called single dose therapy is absolutely inadequate for eradicating thread worms. It is also equally important that during this period of two weeks all night clothes and the bed linen should be laundered every day. The fingernails should also be cut and carefully scrubbed before every meal. Very often Christian female patients, correlate the relapse of threadworm symptoms with consumption of chocolates!!

White discharge "Dhatu" in urine : Many Hindu and Muslim patients complain of passing "Dhatu" in the urine. My colleague urologists do not believe this to be a "complaint". Most of them send these patients for a prostatic massage and smear examination of the prostatic secretions for bacteria and pus cells. They also ask for a culture. By now I have seen hundreds of stereotype reports showing 3-5 pus cells and growth of some normal non pathogenic organisms in the culture reports. I do believe in the entity of chronic prostatitis and the difficulties in treating these patients. However the latter type of patients usually have a history of exposure and complain of spotting of an early morning discharge at the tip of the penis. But there are certainly other patients with no history of exposure and only cornplaining of passing "Dhatu" in the urine, specially on straining while passing stool. A majority of these patients have spermaturia and only require to be given an adequate explanation.

Dribbling of Urine : Mistaken for the urethritis syndrome. Very often I see patients investigated extensively by urine cultures, prostatic massage and invasive tests like cystoscopy for an absolutely normal 'complaint' of soiling the clothes after passing urine.

All males pass a few drops of urine after finishing the act of micturition. This is the residual urine in the shaft of penis. It should ideally be mopped up with tissue paper, if found to be of nuisance value. Muslim patients get concerned with this otherwise normal phenomenon, as it interferes with their religious prayers.

Symptoms of Neurosis of the Tongue: This is very common in the population who use tongue cleaners. In my opinion tongue cleaning with the tongue cleaners is not required for proper health and hygiene. In many patients, the tongue shows minimal coating when they have never used a tongue cleaner. It is possible that patients look at the tongue too much in detail and so develop a tongue neurosis. The coating which they complain of is more often than not a normal variation in different population. It is not due to a disease.

Many of our Hindu and Muslim patients are "Paan" eaters. The paan coating in such patients could be used to our advantage for diagnostic purposes. If there is presence of glossitis, then that much area of the dorsum of the tongue will not be covered by paan coating. Also the pallor of the bald patch helps in diagnosis of anaemia.

Palpation of Abdomen : In order to palpate the abdomen for enlarged liver, spleen, colon or any other lump, the whole abdomen starting from the lower chest, right upto both the groins-should be exposed naked. In practice there are difficulties experienced in examining Maharashtrian women and fisherwomen, who wear a nine yard saree with a dozen knots. It becomes impossible to undress such a patient for abdominal palpation. But I do remember seeing one such patient, who was seen by many specialists for chronic abdominal pain. After my secretary and I spent more than five minutes helping her to undress her saree, I was rewarded by finding an abdominal lump in the fight iliac fossa.

In many male Hindu Maharashtrian patients, even though they remove all the clothes within a few seconds, the abdominal palpation is hindered by the tight thread around the waist which they wear on religious grounds. During the hospital rounds, the staff nurse (who always carried scissors) would immediately cut the string, before the boss loses his temper.

The backless blouses of female patients from Saurashtra, are a good reminder to doctors who do not examine the back during the clinical examination of respiratory system. Remember that all the physical signs of the pleural fluid or a cavity in the lung, are present at the back and such female patients have not to be told to undress the blouse, for examining the respiratory system specially the back (even the front of the chest is easier to examine).

Many a male Muslim patients show a callosity on the forehead. A Hindu doctor will not realise the significance of this. This indicates that the patient does namaz-five times a day regularly and with an extra dedication. Such patients are more God fearing than others. They are not to be asked embarrassing questions like history of consumption of alcohol or a history of venereal disease.

Extensive tattooing marks all over the body are not uncommonly seen in certain Hindu Saurashttian women. It is worth remembering that tattooing is one of the methods of transmitting Viral B Hepatitis. AIDS virus can also be transmitted through the same. Rarely one sees tetanus following tattooing. Lead poisoning is another theoretical possibility.

Some elderly male patients apply "Surma" or "Kajal" (cosmetic) in the eyes. A number of Hindus and Muslims in our country apply the same. It has no disadvantage but only advantages. Those who have an immature cataract can have a better vision in the evenings, than people who do not apply "Surma" or "Kajal". This is due to the effect of belladonna present in these cosmetics because of which the pupils get dilated.