The tending of sick persons is a task assigned to women in Tibet, and the peculiar notions prevailing about the treatment of patients makes this task doubly onerous. Tibetan doctors strictly forbid their patients to sleep in the day-time, and so those who tend them have to follow this injunction of the doctors and keep the unfortunate patients awake. The patients are not allowed to lie in bed but are made to remain leaning upon some supports specially prepared for them. One or more nurses sit by their sides to give them any help they need, and above all to prevent them from going to sleep. These nurses cannot long stand the strain of constant watching, and therefore they are relieved in turn, to resume the task after they have taken more or less rest. The nurses faithfully attend to their duty, are very quiet so as not to annoy the patients, wakeful as they are, and above all to satisfy any of their wants, to comfort and humor them, and also to keep the rooms clean. This cleaning must be judged strictly by a Tibetan standard, for viewed from the Japanese standpoint it hardly deserves the name. The patients are also kept comparatively clean, considering the general filthy habits of the Tibetans. The effect of this insanitary condition at once makes itself felt to the olfactory sense of a foreigner who is accustomed to more perfect arrangements at home, for as soon as he enters the room a peculiar offensive smell greets his nose.

But the most important and tiresome part of the nursing duty is to keep the patient awake, and sometimes nurses are specially appointed to attend to this work. These nurses keep beside them a bowl containing cold water and one or two wooden sprinklers. When the patient is about to fall asleep, a nurse sprinkles water on his face, and this has the effect of preventing sleep. When this water-sprinkling fails, the nurse embraces the patient from behind and slightly presses him forward. Sometimes they call the patient by name and cause him to recover consciousness. The patient is thankful for the trouble taken by the nurses, being well aware that they do it in obedience to the doctor’s orders, and from their wish to ensure his recovery.

The idea that a patient must not be allowed to sleep in the day-time is strongly impressed on the minds of Tibetans, both professional and non-professional. The doctors enjoin both on him and on the nurses to observe this point strictly as the first essential for his recovery, and any person who comes to visit him first of all gives a similar warning. “Don’t allow him to fall asleep,” repeats the visitor to the nurses, and reminds them that they are principally responsible for carrying out faithfully this cardinal necessity in the treatment of the patient.

When a patient dies, the neighbors suspect that his nurses may not have been strict enough, and must have suffered him to fall asleep!

I tried to find out the reasons that have brought about this strange medical custom, and it was easy for me to make enquiries, having been obliged to play the part of a quack doctor through the earnest importunities of the simple-minded Tibetans. So far as I could ascertain from those enquiries, the idea seems to be that patients suffering from some diseases are liable to develop more fever when they sleep in the day-time, while patients suffering from a local disease, resembling dropsy, not unfrequently die while asleep or while in a state of coma. It seems to have been derived from some cases that occurred some time in the past, the unscientific doctors of Tibet having jumped to a general conclusion from certain specific occurrences. I need hardly add that this non-sleep prescription is efficacious (if ever it is efficacious at all) for the Tibetans only. When at times I suffered from disease while in Lhasa I slept as freely as I wished, and of course I found myself feeling all the better for it.

The fact is that, in Tibet, superstition plays a far more important part than medicine in the treatment of diseases.

People believe that a disease is the work of an evil spirit which enters the body of a person, and therefore they conclude that that spirit must first be exorcised before a patient may be entrusted to the care of a doctor. There being various kinds of evil spirits, some high Lama must be consulted in order to determine which particular one has possessed a given patient. A priest before whom the matter is brought consults books on demonology, then pronounces that the disease is the work of such and such an evil spirit, and that for exorcising him such and such a service must be performed.

The consulting priest may specify the name of a Lama when the service to be read is one of importance, but when it is an ordinary one it may be performed by any Lama. At the same time the consulting priest issues directions about medical treatment—that a doctor should be called in after the service has been performed for so many days, or that such and such a doctor should be invited simultaneously with the religious performance, or that medical aid may be dispensed with altogether.

These directions are given orally when the Lama who issues them is one of secondary position, but when he is one of exalted rank the directions are written by one of his attendants and the sheet is authenticated by the mark of his own seal.

The Tibetans put implicit faith in the directions issued by such high Lamas, and follow them literally. For instance, when the Lama directs them not to seek the aid of medicine, say for the first five days, and orders the patient only to perform the rites of exorcism during that period, they are sure to do so. A patient, who might have recovered had the aid of medicine been at once invoked, may then die, but his family will never blame the Lama for it. They will rather hold him in greater respect than before, attributing to him an extraordinary power of foresight. They will say that he had foreseen the hopelessness of the patient’s case, and therefore told them not to take the unnecessary trouble of calling in the aid of a doctor until after the lapse of five days. The reverend priest knew, they think, that the patient would die by that time. Anybody who should dare to hold the Lama responsible for the death of the patient would run a serious risk of being denounced by the faithful believers as a heretic and as a person of depraved mind. Even those who at heart condemn the mischievous and fatal meddling of the priests in the case of diseases prudently keep silence, for fear of calling down upon themselves the wrath of the fanatical populace.

To speak the truth, the Tibetan doctors hardly deserve to be trusted. The word ‘doctor’ as applied to them is a gross outrage on the noble science, for they possess merely the knowledge (and this too of a very shallow kind) of the primitive medicine of ancient India. As even that knowledge is the result of oral instruction transmitted from father to son for many generations, and not acquired from studying medical works or from investigation, the Tibetan ‘doctors’ are utterly incompetent for the important function assigned to them.

The doctors practically possess only one stock medicine, which is the root of a certain poisonous herb called tsa-tuk in Tibet. Being a strong stimulant it is fatal in a large dose, and even a limited quantity causes a temporary paralysis of the different parts of the body and sometimes violent diarrhoea. A change of any kind is likely to be taken as a hopeful sign by patients, and so the Tibetan doctors always use more or less of this drug for all kinds of illness, just as the Japanese doctors were accustomed to use liquorice-root in olden days.

Knowing as I do how untrustworthy and even dangerous the prescriptions of Tibetan doctors are, I sometimes thought that if the choice between the two evils had to be made I should rather recommend to sick people an exclusive reliance on prayers and faith-cure instead of on the risky medicines prepared by these quacks.