Before there were humans on earth, there was disease. But were the diseases of early animals the same as those of evolving humans? And how did early humans treat their illnesses? For possible clues one must search among the surviving prehistoric skeletons and artifacts.
Studies of animal fossils have shown that prehistoric creatures were subject to manifold diseases and injuries. Fractures seem to have been common, and while some healed with little deformity, others show effects of infection (osteomyelitis), poor apposition of the bony fragments, and extensive calluses (bone “scars” associated with healing). Possibly the earliest callus known is in the arm bone of a reptile of the Paleozoic Permian period. Inflammations of both the surface of bones (periostitis) and their inner substance (osteitis) have also been reported. Arthritis in dinosaurs and prehistoric bears was evidently so common that scholars have named it “cave gout.”
Paleopathology, a term given wide circulation by Sir Marc Armand Ruffer in the nineteenth century, is the study of the abnormalities which can be demonstrated in the human and animal remains of ancient times. Investigations of human remnants from historic periods have uncovered many disease entities, for instance tuberculosis and parasitic infestation in the mummies of ancient Egypt, but what of the bony remains of humans from prehistory? Clear-cut abnormalities in their skeletons and teeth also testify to the prevalence of a number of pathologic conditions. In addition, some of the bone irregularities (decalcification, overgrowths, and thickenings) may represent secondary effects of general illnesses.
Questions are still unanswered concerning some types of illness. For example, although Egyptian mummies show characteristics of tubercular disease of the spine, the same kind of infection has rarely been found in Neolithic bones. Nor is it yet incontrovertibly determined whether certain pathologic changes in ancient bones recovered in the Americas are attributable to pre-Columbian syphilis or to a different spirochetal disease, or whether the bones belong to a later period than supposed. Bone wasting (osteomalacia) has been interpreted by some as a sign of poor nutrition, but true rickets appears to have been rare, probably because living outdoors most of the time would have been preventive. Even the specimens claimed to be rickets were uncovered only in northern climes.
Fossil teeth show signs of erosion, abscess, and pyorrhea. When the first specimens were discovered in the nineteenth and early twentieth centuries, the now-abandoned concept that focal infections of the teeth and tonsils were a cause of arthritis was prevalent. Paleopathologists therefore linked tooth infection with the arthritis seen in prehistoric skeletons. This habit of judging the past by tenets of the present has been with us through the centuries. Cavities (caries) were also a problem by late Paleolithic and certainly Neolithic times. They became a common disorder in ancient Egypt, especially in its later history.
When it comes to prehistoric diseases of the soft parts, except for inferences drawn from changes in the bones, clear-cut evidence is absent because of failure of the tissues to survive. No bodies or organs earlier than 4000 B.C. have been discovered. Microscopic imprints on rocks seem to indicate the presence of bacteria in prehistoric periods, but since even now the vast majority of the billions of microorganisms are not harmful we have no way of knowing whether these were pathogenic (disease producing).
In the mummies of early Egypt, arteriosclerosis, pneumonia, urinary infections, stones, and parasites have been identified, which may suggest that such conditions also prevailed in earlier unrecorded epochs. We do not know whether prehistoric man suffered arteriosclerosis, but its very presence—sometimes in advanced degree—in ancient Egyptian mummies may have bearing on our modern ideas concerning its causes. If early humans existed without strains similar to those of technically advanced civilization, then stress would have an unlikely relation to arteriosclerosis. It does appear, however, that man’s illnesses, for the most part, have been mere continuations of the diseases and bodily mechanisms of the creatures who preceded or accompanied him.
What of the length and quality of life in prehistoric times? About 2600 B.C., the legendary “Yellow Emperor” of China is supposed to have said in the great Canon of Medicine, “I have heard that in ancient times the people lived to be over a hundred years, and yet they remained active and did not become decrepit in their activities.” The emperor’s rosy view of the distant past is not borne out by the findings. Bones from Paleolithic, Mesolithic, and Neolithic periods strongly suggest that a lifetime was much shorter than in more recent epochs, averaging approximately thirty to forty years.
In virtually all reported studies, men seemed to have lived longer than women, the common assumption being that pregnancy and childbirth were responsible for the difference. Skeletons of early women have been uncovered with fetuses wedged tightly in the pelvis, and also with newborns buried beside them. However, difficult labor was probably less common in the earliest millennia, the numbers of births per woman were much fewer than often assumed, and infection after delivery was probably infrequent. Furthermore, even after childbearing age women had shorter life expectancies than men of comparable age (the opposite of recent experience). A possible explanation for the shorter life spans of prehistoric women is that chronic malnutrition, starting in infancy and continuing through childhood, made women less resistant to illness. According to this idea, men and boys, as leaders, hunters, and warriors, were considerably better fed than women and girls who were the home laborers, crop cultivators, and childbearers.
How did early humans treat their illnesses? Some writers have surmised from the self-treatment of sick animals—licking wounds, delousing one other, and eating emetic grasses—that prehistoric man also employed similar care. In the first century of the Christian Era, Pliny repeated the tall tale about the hippopotamus which when ill would plunge its knee into a sharp reed to let out blood and heal itself (another example of applying the tenets of one’s own time to other epochs—in this instance the idea that bloodletting was an effective medical treatment).
Was animal instinct a compelling force that enabled humans to find food, plants, substances, and procedures to nurture themselves? If so, it may have been the beginning of healing methods. The almost reflex rubbing of an injured part, using heat to relieve discomfort, and applying cold to deaden pain may all parallel the similar activities of animals who wallow in cool water and apply mud to irritated areas. Sucking skin that is pierced by insect stings and exerting pressure to stop bleeding possibly also could have been useful “medical” therapy performed by early man.
However, we also know that not all manipulations are beneficial. Nor were they necessarily well handled by prehistoric humans. For example, in noticing that menstruation relieved bodily tensions did prehistoric people thereby embark on the system of bloodletting that was to dominate healing practices for thousands of years? Or did phlebotomy (opening a vein) result from philosophical speculation rather than empiric observation?
We do not know whether any treatment was used by the earliest humans. Salutary outcome of sickness or injury does not necessarily mean that therapy was employed; many illnesses and wounds heal themselves. In one collection of prehistoric specimens, over half of the fractured bones seem to have healed with good results, but well-aligned healing of fractured bones of wild animals has also been observed. Furthermore, we have to guess at the knowledge of the body possessed by early humans. Cave pictures have received considerable attention and a variety of interpretations. For instance, the remarkable drawing in red ochre of a mammoth in the Pindal cave in Spain, presumably of the Paleolithic period, shows a leaf-shaped dark area where the heart should be. Whether this was meant to represent the ear, the heart, some other part, or was merely a decoration is not known. If it is truly the drawing of a heart it would be the first anatomical illustration.
Did prehistoric people develop a cult of healing? A painting in the Trois Frères cave in France of an erect, possibly dancing figure with deer head or mask has been thought by some to represent the first shaman, or healing priest. Another Paleolithic fragment shows a reindeer stepping over a supine pregnant woman. Was this a ritual to transmit strength or was it a medical method to hasten labor?
In the Neolithic period (about 10,000-7,000 B.C.) humans apparently shifted from food-gathering to food-producing. One can assume that medicinal herbs were among the plants grown, but whether and when they were recognized to possess healing properties is not known. It is also possible that more secure shelter and more regularly available food led to fewer illnesses. With the use of tools Neolithic men and women became craftsmen. They may also have used implements for surgical purposes since examples of trepanation (removal of a segment of bone from the skull) dating to the Neolithic period have been discovered in France. Signs that the skull wound was healing indicate that a fair proportion survived the operation. However, each of many possible reasons for the procedure has had its advocates. That it may have been a religious rite is suggested by its performance even sometimes on the dead and by use of the removed button of bone (“rondelle”) as an amulet. It may have had a magico-medical purpose of letting out a demon, as has been observed in some primitive peoples. On the other hand, it could have been a treatment for fractures or a means of removing bone splinters. Indeed trepanation may have been employed at different times for all of the above reasons.
Although the knowledge of prehistory is considerable from fossils, paleontology, physical anthropology, paleopathology, sculpture, and cave art, the answers to many of our questions are still conjectural. Folklore, known medical practices of primitive peoples, and the archaeological and literary evidences of ancient civilizations may well give additional indications of what preceded them, but this information can also be misleading since primitive societies and ancient cultures themselves have often undergone change through the centuries.