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 Parallel Medical Traditions

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.

Chinese Medicine

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 classification of physicians went to great extents:

From Chou Li

Surgical castration has been practised since classical Chinese times until quite recently. A twentieth century account states:

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 Medicine

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:

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.