I was a house-surgeon in medicine in P.M.C.H. under Dr. B.Dhar, a great man in medicine. Unfortunately he left India for Great Britain and settled there long years ago. Dr. S. N. Arya was junior to him and both were working in the same ward.
Once, Dr. B.Dhar admitted one case in the ward. Dr. S. N. Arya examined the case and said politely, “sir! this case seems to be extrapyramidal syndrome”. If my diagnosis will be correct I will take a four-ana-coin from you.” Dr. Dhar agreed and gave him a four-ana-coin.
On this grand success we requested and rather compelled him for a grand tea-party in the college canteen. Soon after the round was completed, we left for tea-party and enjoyed a lot.
About twenty years back I was posted in Sadar Hospital Saharsa. One day coming after Ward-rounds, I saw a big crowd in the Deputy-Superintendent’s Chamber. All doctors and staff were present there surrounding a patient, son of the Medical Officer-In-Charge, Bariyahi, Kahra PHC.
The patient was standing with his tongue protruding out with salivation. All the doctors were silent-expectators with a blank look and speech round.
In those days many experienced Surgeons & Physicians who were M.D., M.S., MRCP & FRCS were there at Sadar Hospital Saharsa. The hospital looked like and gave the pleasure of a tiny medical college, the P.M.C.H. of Koshi. We had occasional healthy discussions over some interesting patients.
I asked, have you taken Siquil?’’ The patient nodded his head and said, ”Only one tablet sir.” I said, ”I have made my diagnosis.” Then, Dr. Sarawgi bounced on me and said, ”Doctor you have just come and didn’t examine the case even for a second and say that I have made my diagnosis. Do you think diagnosis a joke? This is a very complicated case of medicine.” Dr. Sarawgi was an M.R.C.P having hot temperament and was senior to me. I replied him, ”Sir, this is a case of Extrapyramidal Syndrome”. “You are a surgeon how you could say that”, Dr Sarawgi said as if he was the only authorized person to diagnose the difficult cases. He did not know that medicine is never taught. One learns it if he has interest in medicine and he didn’t know the line of Sushruta, the father of modern surgery – that a man can’t be a true surgeon without the knowledge of medicine.
There has never been a greater teacher than a keen interest.
You can’t limit medicine by your degree alone. Keen observation is also a very important thing which counts.
I am a peace-loving person and believe in simplicity. I said very politely, ”Sir, protrusion of tongue after taking even a single tablet of Phenothiazine group of drugs is a definite sign that patient has developed extrapyramidal syndrome.” “Even one tablet!” Dr.Sarawgi remarked, As if one tablet was not enough in his opinion. I told if the patient is hyper-sensitive or the patient is de-hydrated due to repeated vomiting or he has kidney failure. Sir the steel man, master of judo karate, Bruslee of Hongkong died of taking a single tablet of analgesic. All doctors present there agreed with me and called a very brilliant spot-diagnosis by Dr.Jha. Dr.K.S.Mishra (M.D.) and Dr.R.P.Yadav (MS, FRCS) were very happy and congratulated me like anything.
Very recently I was sent for to see a very critical patient in a junior doctor’s clinic and examined the case and asked the doctor “which drug have you given?” The doctor told about all the drugs and Serenace (haloperidol) - Antipsychotic drug 1 ample i.m. injection b.d for three days. I stopped all drugs and prescribed a few ones and whispered in the doctor’s ear, “It is all due to your drug Serenace. It is Extrapyramidal Syndrome.”
Recently I stayed with a close friend of mine at Sahibganj due to some personal work. A boy in his neighborhood used to come and go time without numbers. I asked about him as he seemed a mental case. They said, “He is under treatment of a Psychiatrist at Ranchi.” I found tremor in his fingers, rigidity of limb muscles and Akathecia (means the patient wants to move, can’t stay at one place). I said he is suffering from Extrapyramidal Syndrome due to Antipsychotic drug.
History taking is not so simple as it looks, if the patient is not educated, intelligent and co-operative it becomes rather tedious to take correct history. The patient makes his own diagnosis and tries to co-relate things in his own way. Many patients do not feel the importance of giving correct history especially the drug history because such a good and costly drug cannot do harm in his opinion. Only wise and experienced doctor can get correct history by asking twisted question. Even doctors ignore that such a common drug can cause any harm.
They think some big and common disease like the police who always think of some noted and listed criminals for any mischief in his area. Another misguiding feature is high fever which leads and compels us to diagnose encephalitis.
In children the heat regulating Centre is not well developed and if there is malnutrition then the heat regulating Centre virtually leaves to work. So, any change in temperature due to any simple infection and reasons leads to hyperpyrexia, convulsions, stupor and coma and compels us to diagnose encephalitis.
Some time we search our lost spectacles and we have to search the whole house. Better we close our eyes and look and see where I have used it the last moment and where I could have left it. Things become easy if we think with close eyes for any diagnosis. The great philosopher, John Hemphered has said, “Eyes do not see which mind does not know”.
I have seen the cases only on the T.V. flashes and the epidemic of encephalitis is happening continuously for more than 15 years, and on repeated culture no virus is seen. This epidemic is being repeated not only at Muzaffarpur but at many places in India which compelled me to think about drug disaster - Phenothiazine disaster like Thalidomide Disaster in West Germany and Great Britain in the year 1960-61. Not easy to diagnose and much more harder to eradicate in the present scenario where (a) New drugs introduction in the market is so easy (b)The pharmaceutical companies are growing like wild fire. (c) Quackery is so prevalent and has become a good source of earning and honour. (d) All drugs are available without prescription. (e)Corruption is on its top. (f) Administration is deaf and dumb. If you look carefully and take the history properly about 30% cases admitted in medical colleges are due to iatrogenic (due to drugs and doctors) causes.
These types of cases where diagnosis seems to be at fault should be flashed in detail on TV Channels so that doctors sitting at a distance should use their discretion and make a common and correct opinion after discussion among themselves.
