HEALING RITUALS TRADITIONS, AND MAGIC

11 May

HEALING RITUALS,  TRADITIONS, AND MAGIC
Paleopathologists must  make  their  deductions  about  the  antiquity  of infectious diseases with limited and ambiguous data; however, their conclusions must be consistent with modern biomedical knowledge. Infectious   diseases  have  affected   human   evolution   and   history   in complex and subtle ways. Endemic and epidemic diseases may determine the density of populations, the dispersion  of peoples, and the diffusion of  genes,  as  well as  the  success or  failure  of  battles,  invasions,  and colonization. Thus, one way to test hypotheses  about  disease in ancient times is to examine the pattern of disease among contemporary peoples whose   culture   entails   features   similar   to   those   characteristic    of prehistoric  societies.

Even if transistor radios,  communication satellites, and television have turned  the world  into  a global  village, it is still possible  to  find people who live in relative isolation, maintaining  a way of life that seems little changed  from the Old Stone Age. Until  recently, anthropologists and historians generally referred to such people as ‘‘contemporary primitives.’’ Of course,  in terms of biological  evolution,  contemporary primitives are as far removed from Paleolithic peoples as any professor of anthropology, but the patterns  of their lives may be similar to those of early hunter-gatherers, nomadic  followers of semidomesticated ani- mals, or proto-agriculturalists. Because cultural  patterns  are a product of history,  not biology, the term ‘‘traditional  society’’ is now generally substituted for the term  ‘‘primitive,’’ which carries a rather  pejorative connotation. The newer terminology  is, however, somewhat  confusing because of the various shades of meaning associated with the term ‘‘tra- ditional.’’ Where possible, we shall use the term ‘‘traditional  society’’; where necessary for clarity,  we shall refer to ‘‘tribal societies’’ or ‘‘so- called primitives.’’ Many  pathogens   are  species  specific,  but  diseases  like  bubonic plague, malaria, yellow fever, and tuberculosis are formidable exceptions to this rule. Wild or domesticated  animals  can serve as reservoirs  for many  diseases  transmitted to  humans  directly  or  via  insect  vectors.

The survival of pathogens  that are species specific depends on the pathogen’s virulence, the size and population density of the host group, the immune response mounted  by the host, and the pathogen’s ability to find new victims. Certain  pathogens  can only be transmitted during the acute  phase  of  the  disease,  because  the  pathogen   disappears   upon recovery or death.  When such an organism  is introduced  into  a small population, virtually  all  individuals  become  infected  and  recover  or die. Such diseases could not establish permanent  residence among small bands  of Stone Age peoples. New disease patterns  became part  of the price paid for living in large, densely populated, permanent  towns and cities  which,  as  Thomas  Jefferson  warned,  were  ‘‘pestilential  to  the morals, the health, and the liberties of man.’’ Pathogens  that  remain in the host during convalescence, persist in chronic lesions, or establish permanent  residence in healthy carriers are likely to find new victims even among small bands of people. Some dis- eases are caused by commensal organisms—those that live harmlessly in or  on  their  host  until  some  disturbance triggers  the  onset  of  illness. Commensalism  indicates a long period of mutual adaptation; thus, such diseases may be the most  ancient.  Variant  forms  of proteins,  such as sickle cell hemoglobin,  may reflect evolutionary adaptations in the host population to ancient  scourges like malaria.

It  is often  assumed  that  modern  and  so-called  primitive  people differ in their  susceptibility  and  resistance  to disease. Comparisons of crude  mortality  rates  for  ‘‘moderns’’ and  ‘‘primitives’’ are,  however, likely to  be very misleading.  Mortality rates  during  an  epidemic may reflect the kind  of care given to the sick rather  than  some mysterious quality called ‘‘resistance.’’ During an explosive epidemic in a small, iso- lated population, there may be no healthy adults left to feed infants and care  for  the  sick. Those  who  might  have  survived  the  epidemic may, therefore,  die because  of the lack of food,  water,  and  simple nursing care.

In general,  the trait  shared  by all forms of ancient  medicine is a supernatural orientation, a  belief in  magic.  In  this  context,  magic  is not  a  trivial  concept;  the  belief in  magic  has  influenced  and  shaped human  behavior more deeply and extensively than scientific or rational- ist modes of thought,  as we are pleased to call our own way of explaining the world. In societies where magical and scientific beliefs coexist, one cannot  predict  which will be stronger  or more influential.  Even today, people may vacillate between alternative systems of medicine, depending on particular circumstances,  perhaps  relying on modern  medicine for a broken  arm and magical medicine for ‘‘spirit possession.’’ Magic  plays  an  important  role  in  many  cultures;  it  provides

answers  to  questions  that  cannot  be  answered  by  existing  logical  or rational  knowledge.  Magic may be so closely related to religion that  it is difficult to define the borderline between them. The primary difference between a prayer  and a spell is the assumption that  magical practices, correctly  performed,  must bring  about  the desired  reaction.  A prayer, in contrast, is an  appeal  for  aid  from  a supernatural being  who  has the power to grant  or deny the request.

In primitive medicine, the supernatural is involved in all aspects of disease and  healing.  Because disease and  misfortune  are attributed to supernatural agents,  magic  is essential  to  the  prevention,   diagnosis, and treatment of disease. All events must have a cause, visible or invis- ible. Thus,  diseases for  which there  are  no obvious  immediate  causes must be caused by ghosts, spirits, gods, sorcery, witchcraft,  or the loss of one of the victim’s special souls. Illness calls for consultation with those who have the power to control the supernatural agents of disease: the shaman,  medicine man, wise woman, diviner, priest, soul-catcher,  or sorcerer. A close examination  of the roles and powers assigned to such figures reveals many specific differences, but for our purposes  the gen- eral term ‘‘healer’’ will generally suffice. Most societies, however, differ- entiate   between  the  healers   and   herbalists   who  dispense  ordinary remedies and the shamans  or priest-like healers who can intercede with the spirits  that  affect weather,  harvests,  hunting,  warfare,  conception, childbirth,  disease, and misfortune.

Although   the  shaman  or  medicine  man  performs  magical  acts, including  deliberate  deceptions,  he or she is neither  a fake nor  a neu- rotic.  The  shaman  is likely to  be as sincere as any  modern  physician or  psychiatrist  in the  performance of healing  rituals.  When  sick, the medicine man will undergo  therapy  with another  medicine man, despite knowledge of all the tricks of the trade.

For the shaman,  the cause of the disorder  is more significant than the symptoms because the cause determines the manner of treatment, be it herbs or exorcisms. Diagnostic aids may include a spirit medium, crys- tal gazing, and divination. Having performed the preliminary diagnostic tests, the healer might conduct  a complex ritual  involving magic spells, incantations, the extraction  of visible or invisible objects, or the capture and return  of the patient’s lost soul. To drive out or confuse evil spirits, the shaman  may give the patient  a special disguise or a new name, offer attractive  substitute  targets,  or  prescribe  noxious  medicines  to  trans- form the patient  into an undesirable  host.

The shaman  may dispense powerful drugs and closely observe the patient,  use knowledge of animal behavior  for diagnostic tests, and dis- pense powerful drugs, but it is the ritual, with its attempts  to compel the cooperation of  supernatural powers,  that  is of  prime  importance to healer, patient,  and community.  For example, certain traditional healers had their patients  urinate  on the ground  near an ant hill. The behavior of the ants would provide a low-cost diagnostic  test for diabetes.  Out- siders may see the healing ritual  in terms of magical and practical  ele- ments,  but  for  healer  and  patient  there  is no  separation between  the magical and empirical  aspects of therapy.  In a society without  writing or precise means of measuring  drug concentrations and time intervals, strict  attention to  ritual  may provide  a means  of standardizing treat- ment,  as well as a reassuring  atmosphere. The shaman  cannot  isolate and  secularize pharmacologically active drugs,  because  of the holistic nature  of the  healing  ritual.  But  the  problem  of evaluating  remedies and procedures  is more difficult than  generally assumed.  Thus, a mod- ern  physician  is  no  more  likely  to  conduct   a  double-blind  trial  of generally accepted  remedies than  the traditional medicine man.

Practitioners of ‘‘modern medicine’’ find it difficult to believe that the obvious superiority  of scientific medicine has not caused the disap- pearance of all other systems of healing. Yet traditional and alternative systems of medicine continue  to  flourish  in America,  Europe,  Africa, China, India, and the Middle East. On the other hand, traditional medi- cine has been influenced by modern  theory  and practice.  Today’s sha- man may dispense both  penicillin and incantations in order  to combat both  germs and evil spirits.

Ultimately,   the  success  of  any  healing  act  depends  on  a  com- bination of social, psychological, pharmacological, and biochemical factors.  Where  infant  mortality  is high  and  life expectancy  low,  the healer is unlikely to confront  many cases of metabolic  diseases among the young, or the chronic degenerative diseases of the elderly. Many per- ceptive practitioners of the healing arts have acknowledged  that,  left to themselves, many diseases disappear  without any treatment at all. Thus, if a healing ritual  extends over a long enough period,  the healer will be credited  with curing a self-limited disease. Given the dubious  value of many remedies, recovery is often a tribute  to the patient’s triumph  over both  the disease and the doctor.

Because of the uncertainties involved in evaluating  the treatment of disease, historians of medicine have often turned to the analysis of sur- gical operations as a more objective measure of therapeutic interventions. But even here there  are difficulties in comparing  practices  carried  out under greatly differing circumstances, by different kinds of practitioners, with different  goals and  objectives. One surprising  aspect  of so-called primitive surgery is the fact that  surgical operations for purely medical reasons  may be rare  or nonexistent  in a particular tribe,  although  the

shaman   may  wield  the  knife  with  great   skill  and   enthusiasm   for ceremonial, decorative, or judicial purposes. Ritual scarification, for example,   may  signify  caste,   adulthood,  or   the  ‘‘medicine  marks’’ thought to provide  immunization against  disease, poisons,  snakebites, and  other  dangers.   Just  how  effective  such  protection  might  be  is open  to question,  but  there  have been reports  of African  healers who impregnated  ‘‘medicine cuts’’ with  a mixture  of snake  heads  and  ant eggs.  When  twentieth   century  scientists  discovered  how  to  detoxify toxins  with  formalin,  which is present  in ant  eggs, the  African  ritual suddenly seemed less bizarre.

Although   amputation for  ritual  purposes  or  punishment   is not uncommon in tribal and ancient societies, interest in medically indicated amputation is rare.  Some native  American  surgeons,  however,  ampu- tated frozen fingers and, in Africa, the Masai are noted for successfully amputating fractured  limbs. Some prehistoric  peoples performed  ampu- tations  as a form of punishment  or as part  of mourning  rituals.  Muti- lations of the genital organs are often components of puberty rites. Circumcision  and  clitorectomy  are  the most  common  operations, but some tribes practiced  more exotic mutilations.

Traditional surgeons  developed  many  ingenious  methods  of clos- ing wounds. Sewing is, of course, an ancient skill, but in the absence of antiseptic  techniques,  applying  needle and  thread  to a wound  is likely to  lead to  serious  infection.  There  is a better  chance  of success when the  skewer  and  thread  method,  which  is commonly  used  to  close  a stuffed  turkey,  is applied  to wounds.  A remarkable technique  devised by surgeons  in Africa,  India,  and  the Americans  depended  on the use of  particular species of  termites  or  ants.  The  appropriate insect  was brought   into  contact  with  the  wound  and  stimulated  to  bite.  When the insect’s body  was broken  off, the jaws remained  as natural suture clamps.

To combat  bleeding, traditional surgeons used tourniquets or cau- terization  or  simply packed  the  wound  with  absorbent materials  and covered it with bandages. Masai surgeons, however, repaired torn blood vessels with suture  thread  made from tendons.  Wound  dressings often contained  noxious  materials,  such as cow dung  and  powdered  insects, as well as ingredients that might function  as astringents  and antiseptics. Traditional wound dressings might contain  pharmacologically valuable ingredients,  such as ergot,  which is present  in rye smut,  but  symbolic values are likely to predominate. The odds of finding penicillin, or other effective antibiotics  in  earth  taken  from  a  recent  grave  are  actually vanishingly small.

Traditional surgeons  were often  quite skillful in the treatment of fractures  and dislocations,  although  the treatment might be considered incomplete  until  the  appropriate  incantations were  recited  over  the splints or a lizard’s head was tied to the wound. The shaman  could also

shaman   may  wield  the  knife  with  great   skill  and   enthusiasm   for ceremonial, decorative, or judicial purposes. Ritual scarification, for example,   may  signify  caste,   adulthood,  or   the  ‘‘medicine  marks’’ thought to provide  immunization against  disease, poisons,  snakebites, and  other  dangers.   Just  how  effective  such  protection  might  be  is open  to question,  but  there  have been reports  of African  healers who impregnated  ‘‘medicine cuts’’ with  a mixture  of snake  heads  and  ant eggs.  When  twentieth   century  scientists  discovered  how  to  detoxify toxins  with  formalin,  which is present  in ant  eggs, the  African  ritual suddenly seemed less bizarre.

Although   amputation for  ritual  purposes  or  punishment   is not uncommon in tribal and ancient societies, interest in medically indicated amputation is rare.  Some native  American  surgeons,  however,  ampu- tated frozen fingers and, in Africa, the Masai are noted for successfully amputating fractured  limbs. Some prehistoric  peoples performed  ampu- tations  as a form of punishment  or as part  of mourning  rituals.  Muti- lations of the genital organs are often components of puberty rites. Circumcision  and  clitorectomy  are  the most  common  operations, but some tribes practiced  more exotic mutilations.

Traditional surgeons  developed  many  ingenious  methods  of clos- ing wounds. Sewing is, of course, an ancient skill, but in the absence of antiseptic  techniques,  applying  needle and  thread  to a wound  is likely to  lead to  serious  infection.  There  is a better  chance  of success when the  skewer  and  thread  method,  which  is commonly  used  to  close  a stuffed  turkey,  is applied  to wounds.  A remarkable technique  devised by surgeons  in Africa,  India,  and  the Americans  depended  on the use of  particular species of  termites  or  ants.  The  appropriate insect  was brought   into  contact  with  the  wound  and  stimulated  to  bite.  When the insect’s body  was broken  off, the jaws remained  as natural suture clamps.

To combat  bleeding, traditional surgeons used tourniquets or cau- terization  or  simply packed  the  wound  with  absorbent materials  and covered it with bandages. Masai surgeons, however, repaired torn blood vessels with suture  thread  made from tendons.  Wound  dressings often contained  noxious  materials,  such as cow dung  and  powdered  insects, as well as ingredients that might function  as astringents  and antiseptics. Traditional wound dressings might contain  pharmacologically valuable ingredients,  such as ergot,  which is present  in rye smut,  but  symbolic values are likely to predominate. The odds of finding penicillin, or other effective antibiotics  in  earth  taken  from  a  recent  grave  are  actually vanishingly small.

Traditional surgeons  were often  quite skillful in the treatment of fractures  and dislocations,  although  the treatment might be considered incomplete  until  the  appropriate  incantations were  recited  over  the splints or a lizard’s head was tied to the wound. The shaman  could also

Primitive medicine has often been dismissed as mere superstition, but it has much in common  with the medical practices of ancient civili- zations and with the folk beliefs that persist and even flourish alongside modern  medicine. Accounts  of the medicine of primitive or traditional societies often  overemphasize  exotic  and  magical  aspects,  leaving the impression  that  an  unbridgeable chasm  exists  between  such  medical systems and those of modern  societies. The customs  that  seem bizarre in other  cultures  are,  however,  sometimes  similar  to  our  own  quaint and charming  folk practices.

When  we  analyze  traditional  and  folk  medicine,  the  apparent chaos of specific details can generally be reduced to a few almost univer- sal  themes.  Indeed,  as  we survey  the  history  of  medicine,  the  same themes will often reappear  in only slightly different  forms. Folk  medi- cine, like primitive  medicine,  generally  views disease as a malevolent invader  and  the body  as a battlefield.  Our  vocabulary  for  illness still reflects this idea: we are ‘‘attacked’’ by disease, and we ‘‘fight off ’’ infec- tion until the disease is ‘‘expelled’’ from our system. Thus, it would not be unreasonable to expect to cure a patient  by luring the invader out of the body and transferring it to a suitable receiver. For  example, a des- perate parent  might force a dog to eat a sandwich containing  hair from a  child  with  whooping  cough.  If  the  dog  coughed,  the  child  would recover. A related approach, generally known  as dreckapothecary,  uses remedies designed to drive out  the invader  by dosing  the patient  with vile,  nauseating,   and  disgusting  concoctions.   Presumably,   saturating the patient with remedies containing  excrements, noxious insects, rancid fat, foul smelling plants,  and so forth,  will make the body an unattrac- tive abode  for a fastidious  invader.

The doctrine of signatures is another  guiding principle of folk medi-cine. According  to this concept, God  has furnished  the world with dis- eases and  remedies  and  has  taught  us  that  nothing  exists without  a purpose.  Therefore,  we may  assume  that  God  has  marked  potential remedies with some sign hinting at their medicinal virtues. For example, a plant remedy for jaundice might sport yellow flowers and remedies for heart  disease might be found  in plants  with heart-shaped leaves.

Many  folk  remedies  require  the  parts  and  products  of animals.

Selection of the appropriate remedy may be guided by either the prin- ciple of opposites or the principle  of similars. For  example,  if roasted rabbit  brains  failed to cure excessive timidity,  courage  might be found in the blood of a ferocious beast. Lowly animals such as mice and moles were used in remedies for warts, coughs, fevers, fits, and bedwetting, but no creature has served the healing art as diligently as the leech. Accord- ing to folk beliefs, this natural medical device can selectively remove the ‘‘bad blood’’ from arthritic  joints and reduce the swelling of a black eye.

Insects and insect products  remain important components  of folk reme- dies. Those who might ridicule the use of spider webs to stop bleeding

may laud  the virtues of honey  in the treatment of bee stings, coughs, colds, rheumatism,  and tuberculosis.

In addition  to herbs, animal parts and products,  and minerals, folk

remedies include charms,  spells, prayers,  relics, amulets, and images of gods or saints. Rings containing  quicksilver were probably  just as effec- tive in warding off headaches as copper bracelets are in curing arthritis. Tar-water  tea,  an  American  folk  remedy  prepared  by  soaking  ropes from  old  ships  in cold  water,  was popularized  in Europe  by Bishop George   Berkeley  (1685–1753),  who  praised   it  as  a  panacea   cheap enough  to be used by the poorest  people and  safe enough  for infants. According  to  the  good  bishop,  the  violent  opposition   of  physicians and apothecaries  to such inexpensive folk remedies proved that doctors feared only an outbreak of good health.

On the other hand, we should remind ourselves that the ingredients in many traditional remedies are so exotic, nauseating,  or toxic that the prescriptions were more likely to scare people out of their illness than to cure them. When faced with the choice of consuming ‘‘boiled black bugs and onions,’’ or pleading guilty to good health, many marginally ill and malingering patients must have chosen the latter course. In modern societies, the spells and rituals that once surrounded the taking of reme- dies have virtually disappeared. But vestiges of these actions remain in the ‘‘old wives’ tales’’ told by people entirely too sophisticated to believe such stories any more than they would worry about  a broken  mirror  or Friday  the thirteenth.

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