Dr. Ian Carr
Professor Emeritus, Faculty of Medicine, University of Manitoba
Pre-industrial people the world over have practised healing in broadly similar ways. The healer, man or woman, was often an elder of the group, wise in the practical and spiritual ways of the people, and a respected community figure. Priest and healer were usually the same.
Disease was thought to be due to either natural or supernatural causes; the latter was due either to the intrusion into the body of an evil spirit or substance, or the loss of the person's own spirit. Treatment was given by a shaman, or healer whose function was partly priestly; the shaman used a wide variety of plant remedies, some pharmacologically active, remedies of animal origin, often excreta, mood modification by psychological or pharmacological means, and magic. Charms and talismans were commonly used, and the doctrine of sympathies accepted.
The medicine of Canadian aboriginal people was a good example. In the centuries since the European conquest, there has doubtless been some contamination of the folk medicine with European medicine. Much of this has probably happened within the last fifty years. The difference between first peoples across the North American continent was as wide as that across Europe, but as across Europe there were common threads. One of these was the close relationship between religious belief and healing, which not only renders it difficult for those of another culture to understand, but sometimes leads to a reluctance to explain.
For these reasons a specific view-point is presented, of healing as seen over fifty years ago, among the Iroquois of Ontario and New York and the Chippewa of Minnesota and Ontario. This changed little from that seen by Champlain in the early 17th century, and differed little in sophistication from that practised by Europeans in Upper Canada in the 1820's.
As recently as 1940, the Iroquois of New York and Ontario still lived in longhouse groups clustered around a dance or ceremonial house, the longhouse, where they gathered for ceremonial and religious purposes. Wooden masks, skilfully but grotesquely carved played an important part in their ritual, and were alleged to be portraits of the strange quasi human beings whom the forest hunters met at nightfall, darting from tree to tree, and resembling disembodied heads with long snapping hair. These beings were held to be involved in the cause and cure of disease, and were invoked and worshiped in complex dance rituals, sometimes under the influence of tobacco and or other drugs. The dancers were members of medicine societies which were at least partly exclusive.
Treatment involved plant remedies, of varying pharmacologic effectiveness; the Chippewa around 1925 used around 200 plants in different ways, for the treatment of a wide variety of common ailments, in a manner similar to European herbal folk medicines two centuries before. Medicines were given orally, by inhalation or by enema. Often the healer would induce altered consciousness, perhaps in a sweat lodge, would let blood, and use supernatural or magic remedies. Many of the procedures were psychotherapeutic. Straightforward physical remedies were used for straightforward lesions: fractures were appropriately splinted.
It is interesting to compare these healing techniques with contemporaneous European methods. In Upper Canada between 1795 and 1819, statutes were passed to prevent unqualified persons from practising medicine. In 1829, treatments in vogue included horseback riding for pulmonary tuberculosis, scotch snuff plaster for croup, leek poultices for gout and a decoction of carrots for jaundice. Dropsy was treated by bleeding, tapping, and plantain and liverwort. Ague was known to be related to mosquito bites, and was treated with Peruvian bark, but it was alleged that the incorporation of the bark in a waistcoat would protect a child. A course in the history of medicine is not the place for discussion of the modern medicine of Canadian First Peoples. It should be noted in any comparison that it is the medicine of a sustainable society.
The healing practices of several great societies grew up in relative isolation from western medicine, and until recently influenced it relatively little. These practices were little influenced until recently by western style "industrial" revolutions.
Coexistent with the medicine of Sumeria, Egypt , Greece and Rome was that of China. China and the Western world had little contact until the irruption of Western imperialism in the 19th Century. The Chinese civilization was complex, with a rich, cultured upper class, a durable civil service, and widespread poverty and starvation. Dynasty succeeded dynasty, from about 1800 BC, till the constitution of the Republic in 1912, and throughout there persisted a continuous medical tradition. Western medical knowledge was introduced in the 1800's, and developed under missionary influence, but it was not till after the Chinese Revolution of 1949 that any integration of the two medical traditions appeared. This accelerated after diplomatic ties were re-established with the Western world in 1979.
An important early medical figure was Shen Nung (3000 BC) an emperor who wrote the Pen Tsao, or Great Herbal; such drugs as opium, rhubarb, and croton oil, arsenic , sulphur and ephedrine were then in use, the latter derived from the plant ma huang. Later Huang Ti, another Emperor wrote the Huang Ti Nei Ching or Yellow Emperors Book of Medicine, in which the statement was made All blood flows in a circle. Much Chinese medicine was semimagical. Massage was an important mode of treatment as was acupuncture, insertion of fine needles at pre-determined points. Moxibustion, the burning of dried fragments of vegetable matter on the body surface was also used. Inoculation against smallpox was practised by blowing crusts up the patients nose. Cretins were given thyroid. Cannabis was used (AD 1100) as an anaesthetic.
Other great Chinese medical classics included the Pien Chao, or Secrets of the Pulse (6th Century BC) , the I Ching or Book of Changes, the Chou Li , or Institutions of the Chou (2nd Century BC) the Guang Ji Fang or General Formulary of Prescriptions (723 AD) and the Quiao shi Zhu Bing or Qiaos Suystematic Treatise on Diseases and their Aetiology.
The medical profession was divided into many grades or classics. The Yellow Emperor wrote:
The superior physician helps before the early budding of the disease. He must first examine the three regions of the body and define the atmosphere of the nine subdivisions so that they are entirely in harmony. . .Therefore he is called the superior physician.
The inferior physician begins to help when (the disease) has already developed, he helps when destruction has already set in. And since his help comes when the disease has already developed, it is said of him that he is ignorant.
Hence, the sages did not treat those who were already ill, they instructed those who were not yet ill. . . .To administer medicines to diseases which have already developed and to suppress revolts which have already developed is comparable to the behavior of those persons who begin to dig a well after they have become thirsty, and of those who begin to cast weapons after they have already engaged in battle. Would these actions not be too late?
The classification of physicians went to great extents:
|Service of the Chief of Physicians||Service of the Physician for Simple Diseases|
|First-class graduates||2||Second-class graduates||8|
|Apprentices||20||Service of the Ulcer Physicians|
|Service of the Food Physician||Service of the Physician for the Animals|
|Second-class graduates||2||Third-class graduates||4|
From Chou Li
Surgical castration has been practised since classical Chinese times until quite recently. A twentieth century account states:
When about to be operated on, the patient is placed in a semi-supine position on a broad bench. One man squatting behind him grasps his waist, and another is told to look after each leg. Bandages are fastened tightly round the hypogastric and inguinal regions, the penis and the scrotum are three times bathed in a hot decoction of pepper pods, and the patient, if an adult, is solemnly asked, whether he repents or will ever repent his decision. If he appears doubtful he is unbound and dismissed, but if his courage has held out, as it usually does, all the parts are swiftly swept away by one stroke of a sickle-shaped knife, a pewter-plug is inserted into the urethra, and the wound is covered with paper soaked in cold water and is firmly bandaged. The patient, supported by two men, is then walked about the room for two or three hours, after which he is permitted to lie down. For three days he gets nothing to drink nor is the plug removed from the urethra. At the end of this period the dressings are changed, and the accumulated urine is allowed to escape. The parts generally heal in about one hundred days...About two percent of all cases prove fatal, some by hemorrhage, some by extravasation, and some doubtless by sepsis...For a long time there is incontinence of urine.
The extensive Chinese pharmacopoeia was classified by function: different classes of drugs were held to be specific to induce perspiration, to reduce excessive heat inside the body, to counteract rheumatism, to reduce cold sensation in the body, to reduce dampness in the body, to lubricate dry symptoms, to induce vomiting, to induce bowel movements, to promote digestion,to suppress cough and sputum,to regulate energy,to regulate blood,to regain consciousness,to constrict and obstruct movements,to expel or destroy parasites, for ulcers and tumours, for external applications. The Western and Chinese concepts of medicine can be compared by examining attitudes toward angina pectoris. The Western concept suggests that this symptom is due to myocardial ischaemia and anoxia, and can be treated by reducing oxygen demand through bed rest, oxygen therapy, nitrites, and where indcated such things as beta blockers and anticoagulants. The Chinese concept suggests stagnation of blood and phlegm, and recommends acupuncture, plum blossom needle therapy, and complex polypharmaceuticals , with such ingredients as licorice root, orange peel and the faeces of the flying squirrel.
Indian civilization is old, but before the invasion of India by Alexander the Great, (356-323 BC) time is hazy, and dates imprecise. The Indus River cities of Mohenjo Daro and Harappa have been dated in the period 2700-1500 BC.
The Hindu holy books, the Vedas, date mostly from before 1000 BC; the principal source of medical information, the Ayur-Veda dates from before the first century AD (or CE). This is a divinely inspired epic poem cycle containing wisdom on drugs and medicine--magic, drugs, charms, amulets, chants and mantras against the demons of fevers, fractures, wounds and snake-bite.
Ayur Vedic medicine was priestly medicine, and stressed the maintenance of health, rather than the treatment of disease. It was divided, not unlike the Royal College of Physicians of Canada, into internal medicine, diseases of the head, surgery, toxicology, demonic disease, paediatrics, rejuvenation and aphrodisiacs.
There were three semi-legendary physicians of great wisdom--Caraka, Susruta and Vagabhata, living probably in the first millennium BC. They wrote of mantras, of diet and drugs, of subjection of the mind. They talked of three humours--wind bile and phlegm, and described over 100 superficial vital points or marmas. A wound at some of these was fatal.
They described diagnosis based on history, clinical appearance, examination of blood and body fluids and excretions, notably how to diagnosis the "honey urine disease," by taste. There was an extensive herbal pharmacy. They prescribed elaborate care of pregnant women. Malaria, plague, tuberculosis and small-pox were described.
Surgery is described as surprisingly extensive, considering that it was carried out without benefit of much anatomical knowledge, or anaesthesia; it included treatment of fractures, caesarean section, lithotomy, couching for cataract, tonsillectomy, amputations, and thoracotomy to drain pus, repair of trauma to the abdominal wall and viscera. They let blood, cauterized and used enemas. Their most spectacular surgical achievement was plastic replacement of the external nose, damaged in battle or removed as judicial punishment for adultery. Rhinoplasty by rotation of the forehead flap implied considerable surgical skill. Ants were used as sutures. Susruta's advice in cases of intestinal perforation:
According to others ... large black ants should be applied ... and their bodies should be separated from their heads after they had firmly bitten the perforated parts with their jaws. After that the intestines with the heads of the ants attached to them should be gently pushed back into the cavity and reinstated in their original situation therein.
Susruta, wrote of the characteristics of a good medical student, of a good hospital, and of surgical treatment of an abscess:
The apprentice, "should be of tender years, born of a good family, possessed of a desire to learn, strength, energy of action, contentment, character, self-control, a good retentive memory, intellect, courage, purity of mind and body, and simple and clear comprehension, command a clear insight into the things studied, and should be found to have been further graced with the necessary qualifications, of thin lips, thin teeth and thin tongue, and possessed of a straight nose, large, honest, intelligent eyes, with a benign contour of the mouth, and a contented frame of mind, being pleasant in his speech and dealings, and usually painstaking in his efforts.
In the first place a mansion must be constructed under the supervision of an engineer well-conversant with the science of building mansions and houses. It should be spacious and roomy. The element of strength should not be wanting in it. Every part of it should not be exposed to strong winds or breezes. One portion at least should be open to the currents of wind...
It should not be exposed to smoke, or the Sun, or dust, or injurious sound and touch and taste and form and scent. It should be furnished with staircases, with pestles and mortars, privies, ...and cook-rooms.
After this should be secured a body of attendants of good behaviour, distinguished for purity or cleanliness of habits, attached to the person for whose service they are engaged, possessed of cleverness and skill, endued with kindness, skilled in every kind of service that a patient may require...competent to cook food and curries, clever in bathing or washing a patient...or raising the patient or assisting him in walking or moving about, well-skilled in making or cleaning beds, patient and skillful in waiting upon one that is ailing, and never unwilling to do any act that they may be commanded to do. A number of men should also be secured that are skilled in vocal and instrumental music, in hymning encomiums and eulogies, conversant with and skilled in reciting verses and pleasant discourses and narratives and stories and legendary history...fully conversant with all the requirements of time and place, and possessed of such politeness as to become agreeable companions. The mansion should also be stored with an adequate supply of partridge, hare, spotted deer, black antelope, black-tailed deer, etc...
A cow also should be kept, yielding copious milk, of a quiet disposition, healthy, having all her calves living...So also should be kept little vessels or cups, larger vessels for washing the hands and face, water-vessels or jars, small jars or pitchers, dishes, metallic or earthen jars, cauldrons or pans...hollow vessels for covering articles, wooden or metallic ladles, mats...deer-skins and sheep-skins, rags, cloths made of cotton and wool, strings and cords, beds and seats, vessels called Bhringaras full of water and flatter vessels for holding spittle and evacuations, all placed ready for use, good beds placed upon bedsteads and overlaid with white sheets and containing pillows, for use when sleep is needed, beds and carpets for lying down or sitting upon...and diverse kinds of instruments, domestic and surgical. Smoking tubes, enemas...brushes and brooms, balances and weights, measuring vessels and baskets, Ghee, oil, fat, marrow, honey, treacle, salt, fuel, water, honey-wines, sour gruels of different varieties, different kinds of wines, whey, butter-milk, sour gruel of paddy or rice, and the different varieties of animal urine [as drugs!] should also be kept ready...
So also...emetics and purgatives, and articles that are both emetics and purgatives, those that are astringent, that increase the appetite, promote digestion, cool the system, and destroy the wind [the most dangerous of the three doshas] should be kept ready...Other things, again, that may conduce to the ease, comfort, and happiness of the patient, should similarly be kept ready.
The operating room was to be the great outdoors, so the patient was directed to sit on the ground, facing east, while the servant tied his hands and feet. The surgeon tested his steel blade by cutting a human hair. Then, with "courage, light handedness, non-shaking, non-sweating, sharp instruments, self confidence and self command," and facing west, he cut the skin and helped the pus to flow out, while the servant dashed cold water on the face and eyes of the patient. Afterward the wound was washed with an "astringent" decoction of herbs and wiped thoroughly dry with clean linen. A plug of lint, soaked in a herb preparation, was "plastered over with the paste of sesamum, honey and clarified butter...and...inserted deep into the wound." Then came another plaster, spread on against the direction of the hair (pratiloma), to make it penetrate better; followed by a thick layer of tow, "such as the leaves and bark of the Indian fig-tree;" and finally a wrapping of linen.
The patient could now relax, while the vaidya recited the appropriate mantras. The servant produced a long, light, flexible tube and began to set up the nadi-sveda. This was an important operation. The word nadi is Sanskrit for "tube," and sveda has the same root as "sweat." The operation was in effect a sort of steam bath, with the double purpose of chasing away the pain as well as the malignant spirits.
Fever was treated by fasting, purging, or drinks of diluted barley gruel; or allegedly by the famous therapy for the chills of fever cited by Susruta:
Damsels young, beautiful and skilled in the sport of love, with faces glowing like the full moon of autumn and darting forth beams of love from their languid blue-lotus-like eyes, with eye-brows fumigated and scented ... should be asked to take the patient into a firm embrace like a forest-creeper entwining itself around a sylvan tree, and the girls should be told to keep off as soon as the patient would feel himself heated. Susruta does not advise how to treat fever in women.
These writings are much like the Hippocratic writings, and influenced the healing practices of many millions of people for many centuries. Traditional Hindu healing is still widely used in India, and is being integrated to some extent with Western medicine. The healing practices in Pakistan are of different origin being descended from mediaeval Arabic medicine, with a considerable classical Greek (Hippocratic) influence.