The medical ideas and practices among primitive cultures of today show considerable variety, differing in accord with geography and a society’s historical heritage. Yet there are similarities which seem to be common to most primitive societies, and these may offer clues about the nature of medicine before recorded history.
Health and Disease
Judging from what we know of present-day primitive cultures, religion, magic, and medical treatment were seen in prehistory as inseparable from each other. The supernatural world was immanent in all things, affecting one’s health, livelihood, and social activities, but not all illnesses were thought to be religiously or magically generated. Primitive man apparently often distinguished between ordinary conditions (such as old age, coughs, colds, and fatigue) and illnesses caused by spirits and evil forces that required the special services of a medicine man, shaman, or witch doctor.
The primitive patient and healer, believing in and seeking supernatural origins for most happenings, including sickness, were psychologically prepared for the effectiveness of magic. Illness could result, for instance, from the projection of an evil force or foreign object into a person by magic or sorcery. Even at a distance an effigy (or a hair or discharge from the body) could be manipulated by certain people to make the victim sicken or die. Remnants of these ancient superstitions are still with us in voodoo and the symbolic burning of someone in effigy. In some societies there were both good and bad spirits; in others, spirits were benign when pleased, harmful when offended.
Also, the dead often lingered in spirit form, trying to take over the bodies of the living. Some primitive funeral ceremonies were based on diverting the spirit of the departed from its intentions by appeasement with offerings or by preventing the spirit from recognizing members of the family. On the other hand, in addition to the risk of being possessed by a spirit, there was a danger of losing one’s own soul.
A sick or disabled person was regarded in different ways by different peoples. Among the Cherokees and Navahos the ill were treated with kindness, the crippled and deformed with acceptance. In tribes faced with famine, suicide by the aged was often an accepted means of removing the burden of their dependence. The Eskimos set their old folks out unsheltered on the ice when food supplies were low. In some primitive groups the disabled were killed and eaten to preserve their life force for the tribe. Among the North American Indians, those who recovered from serious illness were looked upon with awe as possessed of unusual powers.
As for the mentally ill, primitive societies have shown the same variety of attitudes as advanced cultures. To some a deranged individual might appear to harbor an evil spirit and was therefore to be shunned, maltreated, or killed; to others the spiritual forces inside the person were worthy of respect. Among the Eskimos and Siberian peoples, psychotic behavior might signify the qualifications for becoming a shaman, who was chosen, or chose himself, just because of psychic experiences.
At the core of ministering to the sick was a central figure. We know him as medicine man among the North American Indians, shaman (the word is Tungusic) among the Eskimos and Siberian groups, and as witch doctor in the Congo. We tend to use the names interchangeably, although there are differences. Sometimes this healer was the sole practitioner in a tribe or clan. In larger groups there might be a number of them, even organized into a secret society. They all had certain characteristics in common. The healer was accorded a high place socially and politically, and he was considered learned in tribal lore and traditions.
A man’s entrance into this calling might follow a recurring dream, a strong sense of mission, or an overt demonstration of unusual psychic power. Apprenticeship to an experienced doctor was common, and rituals and trials often accompanied his training. Women could also follow this special career, and in many primitive societies they were fully accepted as healers and sorcerers.
In virtually none of the primitive societies was entrance into this vocation taken lightly. Among the American Indians and also in the African Congo, a doctor could amass wealth but was vulnerable to attack if his medicine was “bad”; that is, if he did not utilize all the accepted methods. The outcome did not always have to be successful, but the techniques were expected to be above reproach. This resembles our contemporary legal strictures requiring medical procedures to conform to the standards of the community.
Although curing the sick was an important activity, the primitive healer was also responsible for protecting his people against bad weather, poor harvest, loss of flocks, or almost any catastrophe, and all religious ceremonies were under his charge. In the Congo, there were special witch doctors for virtually every ailment and every event. There were similar specializations among the Amerindians. For instance, the Arizona Indians had a specialist for the weather, for sicknesses, for injuries, and for snakebite. For illnesses not requiring religious rites, herbalists—male or female—were usually consulted, but chants and prayers accompanied the administration of drugs. Among the Ural-Altaic communities the supernatural duties of a shaman might be divided among a communicator with the spirits, a soothsayer foretelling events, and a sorcerer to cast magical spells.
The healer required special accessories. The shaman of Siberia had his drum, a distinctive hat, sometimes a mask, and a voluminous coat containing many magical and symbolic items. The North American medicine man carried a complex store of therapeutic and religious items in his medicine bag (which was sometimes a human scrotum) : parts of animal and human bodies, plants, sticks, stones, and instruments such as a sucking tube.
The term “medicine” among the Indians of North America covered much more than just remedies for illness. Every venture had its “medicine” : beneficial acts were “good medicine,” unsuccessful efforts were “bad medicine.” Every brave carried a medicine bag in which his good luck and the power of his spiritual force symbolically resided. Losing one’s medicine bag was a catastrophe.
Since illness among primitive peoples was caused by gods, spirits, and magic, the purpose of diagnosis was to determine the offense committed and the person or spirit administering the punishment. Was any taboo violated? Was any person wronged? Having taken the “history,” a witch doctor might consult the gods—sometimes while in a trance—to discover which spirit or mortal was casting the spell. If the patient’s soul were lost, had it wandered to some remote spot or did it inhabit someone else? Various means of divination were used: casting of bones, observing the reactions of animals to poison, moving beads to the chanted names of likely suspects. In some cultures, people thought responsible for casting a spell might be forced to undergo ordeals by poison, fire, or water to determine if they were guilty.
Treatment could be complicated, involving elaborate ceremonies, chants, mystical signs, charms, and fetishes. The African witch doctor might ensnare the offending spirit in a cockroach enticed into a basket trap by bits of food or blood. The Amerindian medicine man might spend days in dancing, shouting, and beating drums. The point of the healing rites was to drive out evil spirits, lure back a lost soul, or propitiate an offended god.
A special type of therapy indigenous to American Indians of the West was the sand painting. Elaborate, colored designs were constructed in the sand to provide a medium through which the spirits could act to cure a sick person. The paintings were begun at sundown and had to be destroyed by the next nightfall lest this powerful medicine cause harm rather than good.
Sometimes a more direct attack was mounted, as for example by sucking, cupping, bleeding, fumigating, and using steam baths. Among American Indians the practice of appearing to suck out an offending object from a patient’s ear, scalp, or other part was common, but it is probable that removing the foreign object was to the medicine man as much a symbolic act as it was deception.
There was also considerable rational empiricism in the magical methods. Religious rituals were frequently accompanied by the secular manipulations of massage, poultices, and drug lore, but the explanation for their use may have been supernatural. The American Indians had an especially rich knowledge of medicinal herbs. Some drugs were used for magical purposes because they suggested some aspect of the disease: yellow plants for jaundice, hairy plants for baldness, thistles for sore throat. However, one can compile a huge list of plant decoctions which were empirically effective for specific ailments. Medicinal plants seem to have been well understood by medicine men who used them according to their pharmacologic action: antifebrile, laxative, emetic, antispasmodic, diuretic, local analgesic, respiratory-soothing, pain-relieving, sedative, stimulating. Hallucinatory drugs were favorably known in many primitive societies, and the Omaha, Kiowa, and Fox tribes of the American West even organized societies of peyote (mescal) button devotees. Other plant substances such as jimsonweed produced the mental state suitable for certain ceremonies of the Mariposa Indians.
Surgery consisted principally of treatment for wounds and injuries to the bones. Among the peoples who applied salves and other substances to open wounds, sealing them off and preventing drainage, it is likely that infection was common. On the other hand, some primitives took pains to keep wounds protected and dry. When sewing up lacerations with strips of tendon and needles of bone, some Amerindian tribes (the Dakotas, for instance) placed a strip of bark between the wound edges which probably permitted drainage and promoted healing from the inside out.
Hemorrhage was controlled by pressure, tourniquet, cautery, and styptic plant substances, for ligature of blood vessels was apparently unknown. Although amputations were performed, they seem to have been mainly ritualistic. Removal of spears and arrows was sometimes accomplished with great skill. Small abscesses were drained, and the tribes of the Great Lakes region are said to have opened abscesses of the chest cavity.
The treatment of fractures among the American Indians was sophisticated in some tribes. They fashioned splints of wood and casts of hardened hides, with – openings to permit further treatment of compound fractures where bone protruded through the skin. Reduction of dislocations was also practiced. Surgical procedures were not always performed by the medicine man, for there were often others skilled in this kind of work.
During surgery, drugs were used to deaden the senses or to relieve severe pain from a wound. In Central Africa a beverage which may have been alcoholic was used to lessen consciousness. Before some tribal ceremonies, a performer would smear his skin with plant substances which numbed it and permitted him to bear intense heat and the pain of sharp instruments.
Trepanation was practiced in many ancient primitive societies, as it had been in prehistoric times, and in recent primitive cultures the procedure seems to have been ritualistic or a way of letting out spirits. Whether there was also an earlier more pragmatic medical use in treating skull injuries, as some have suggested, is not known.
Obstetrics was in the hands of women. Attitudes varied with the group and its environment, but most nomadic peoples seem to have had less concern for pregnant women than the more settled groups. In many tribes of North America the afterbirth (placenta) was expelled by massage (the Credé maneuver practiced in modern hospitals today). Among some peoples, women returned to work almost immediately after delivery; among others, days or even weeks were spent in recuperating. Certain groups practiced couvade, a custom whereby the father takes to bed as if bearing the child and goes through ritual acts which presumably draw away evil spirits that might harm the mother and baby.
Public Health and Hygiene
Apparently primitive societies were subject to many of the same diseases which afflict humans today if we are to judge by the multiplicity of ailments under the care of specialized shamans, including stomach upsets, diarrheal diseases, respiratory illnesses, rheumatic ailments, and menstrual disorders. However, some diseases were definitely introduced later by advanced civilizations. For instance, the virtual absence of immunity of American Indians to smallpox and yellow fever suggests that these illnesses were not indigenous. On the other hand, sleeping-sickness among Africans was dealt with often by witch doctors and was probably an affliction of long standing. Unsettled questions still remain on the origins of some epidemic scourges among the primitive communities such as syphilis and tuberculosis.
There were methods of preventing disease other than ceremonial and religious among some primitives, but the time of their introduction is unknown. Long before the colonial period in Africa, some tribes had practiced a type of protection against smallpox by variolation (inserting fluid from smallpox blisters under the skin). This was aimed at producing a mild form of the disease which would save the person from severe illness, for it was recognized that one never acquired it a second time. In some parts of Asia smallpox scabs in water had been pricked into the skin since ancient times, and the Chinese were known to blow powdered scabs into the nostrils. Whether these methods were the heritage of prehistory has not been determined.
In some respects the ill or wounded primitive may have been better off than the sick of a more advanced civilization since he was often isolated in a separate hut or lodge with less chance of contracting (or transmitting) infections. In contrast one can cite the frequent contagions in medieval hospitals and the terrible wound gangrenes in the poorly ordered hospitals of the American Civil War.
The Heritage of Primitive Man
In developing ways of coping with the problems and afflictions of life, primitive man arrived at some solutions which have continued to be effective into modern times. By trial and error he found plant and mineral substances which even today are used to alleviate specific complaints. Primitive man also observed that some dread diseases never struck a person twice and worked out ways of purposely contracting a mild case rather than risk the full-blown effects. He recognized that excessive bleeding could be stopped by applying extreme heat to a wound, but he also believed that releasing moderate amounts of blood by opening a vein improved certain conditions.
Of course many of his most favored techniques had no rational or pharmacological basis, but he certainly recognized the psychological benefits to the sick of a healer’s even appearing to do something effective, that under certain conditions the body seems better able to cure itself.
We do not know in what remote period primitive man first decided to invest the healing arts entirely in a specialist, but by the time mankind had reached the stage of “civilization” the doctor was already in practice.