PALEOMEDICINE AND SURGERY

11 May

PALEOMEDICINE AND SURGERY
Evidence of disease and injuries among  ancient humans  and other  ani- mals  is incomplete  for  epidemiological  purposes,  but  more  than  suf- ficient  to  establish  the  general  notion  of their  abundance. Therefore, we would like to be able to determine  when uniquely human  responses to the suffering caused by disease and injury began. For example, a CT scan of a 36,000-year-old  Neanderthal skull which had  obviously  suf- fered a blow with a sharp stone implement revealed a degree of healing around the  wound.  To  have  survived  the  injury  for  at  least  several months  would  have  required  care  and  perhaps  wound  treatment  by other  members  of the group.  Such cases lead to the question:  at what stage  did  human   beings  begin  to   administer   care  that   would   be recognized as a form of medicine or surgery?

Clues  to  the  existence of paleomedicine  must  be evaluated  even more  cautiously  than  evidence of disease. For  example, the ‘‘negative imprints’’ that appear  to be tracings of mutilated  hands found in Paleo- lithic cave paintings  may record  deliberate  amputations, loss of fingers to  frostbite,  magical  symbols  of unknown  significance,  or  even some kind of game. Early humans  may have learned to splint fractured  arms or legs to alleviate the pain caused by the movement  of injured  limbs, but there is little evidence that  they learned  to reduce fractures.  More- over, well-healed fractures can be found among wild apes. Thus, the dis- covery of healed  fractures,  splints,  and  crutches,  does not  necessarily prove the existence of prehistoric  bonesetters.

Ancient  bones and  skulls may try to tell us many things, but  the

enemies of preservation  often  mute their  testimony  and  generate  false clues leading to pseudodiagnoses. Except for violent deaths  in which a weapon  remains  in the  body,  ancient  bones  rarely  disclose the  cause of death.  A hole in the skull, for example, might have been caused by a weapon,  the  bite  of a large  carnivore,  postmortem damage  caused by burrowing  beetles, a ritual performed  after death,  or even a surgical operation known as trepanation. A discussion of a Peruvian  trepanned skull at the 1867 meeting of the Anthropological Society of Paris stimulated  the search for more examples of prehistoric  surgery.  Even- tually,  trepanned  skulls  were  discovered  at  Neolithic  sites  in  Peru, Europe,  Russia,  and  India.  The  origin  and  dissemination  of this pre- historic  operation remain  controversial, but  the  procedure   certainly appeared  in both  the Americas  and the Old World  before the voyages of  Columbus.   Whether  the  operation developed  in  one  culture  and spread  to  others  or  evolved independently  in different  regions  is still the  subject  of  heated  debate.  It  is impossible  to  determine  just  how frequently  such operations were performed,  but  some scholars  believe that  the operation was performed  more frequently  during the Neolithic period  than  in later prehistoric  times.

Although  trepanation is sometimes mistakenly referred to as ‘‘pre-historic brain surgery,’’ a successful trepanation involves the removal of a disk of bone  from  the cranium,  without  damage  to the brain  itself. When scientists first encountered such skulls, they assumed that the operation must have been performed  after death  for magical purposes. However,  anthropologists  have  discovered  that  contemporary tribal healers  perform  trepanations for  both  magical  and  practical  reasons. Prehistoric  surgeons  may  also  have  had  various  reasons  for  carrying out  this difficult and  dangerous  operation. The operation might  have been  an  attempt   to  relieve  headaches,   epilepsy,  or  other  disorders. In  some  cases,  the  operation might  have  been  a  rational   treatment for traumatic injuries of the skull. Perhaps  it was also performed  as a desperate  measure  for intractable conditions,  rather  like lobotomy,  or as a form of shock therapy  or punishment. Despite the lack of reliable

anesthesia  or antiseptic technique,  evidence of well-healed trepanations indicates   that   many   patients   survived,   and   some  even  underwent additional trephinations.

Three  major  forms  of trepanation were used  by prehistoric  sur-

geons.  One  technique  involved  creating  a  curved  groove  around the selected  area  by  scraping  away  bone  with  a  sharp   stone  or  metal instrument. When the groove became deep enough,  a more-or-less  cir- cular  disk,  called  a  button or  roundel,  could  be  removed  from  the skull.  Boring  a  series  of  small  holes  in  a  roughly   circular  pattern and then cutting  out the button of bone with a sharp  flint or obsidian knife was the method  most commonly  used in Peru. The patient  could wear the disk as an  amulet  to  ward  off further  misfortunes.  In  some regions, surgeons performed  partial  or perhaps  symbolic trephinations. That  is, the potential  disk was outlined  with a shallow crater,  but  left in  place.  Some  skulls  bear  thin  canoe-shaped cuts  that  form  a  rect- angular   shape,  but  square  or  rectangular  excisions  may  have  been reserved for postmortem rituals.

Another  prehistoric  operation that  left its  mark  on  the  skull  is called ‘‘sincipital mutilation.’’ In this operation, the mark is the scarring caused  by cauterization (burning).  Neolithic  skulls  with  this  peculiar lesion have been found  in Europe,  Peru, and India.  In preparation for the application of the cauterizing  agent,  the surgeon  made  a T- or L- shaped  cut in the scalp.  Cauterization was accomplished  by applying boiling oil, or ropes of plant fibers soaked in boiling oil, to the exposed bone.  In either case, permanent  damage  was done to the thick fibrous membrane  covering the bone.

Most  of  the  prehistoric   victims  of  this  operation were  female, which  might  mean  that  the  procedure   had  a  ritualistic  or  punitive function  rather  than therapeutic purpose.  During  the Middle Ages, this operation was  prescribed  to  exorcise  demons  or  relieve  melancholy. Doubtless,  the operation would dispel the apathy  of even the most mel- ancholic  patient,   or  would  give the  hypochondriac a  real  focus  for further  complaints.

In looking at the decorative motifs for which the human frame serves as substrate, objectivity is impossible.  What  is generally thought of as cosmetic surgery in our society—face-lifts, nose jobs, and liposuction— would  be  considered  mutilations  in  societies  that   treasured   double chins, majestic noses, thunder thighs, and love handles. While most of the cosmetic surgery  of prehistoric  times  has  disappeared  along  with  the soft parts of the body, some decorative processes affected the bones and teeth. Such customs include deforming, or molding the skulls of infants, and  decorating  or selectively removing  teeth.  Unusually  shaped  heads might  also  reflect  traditional methods  of  caring  for  or  transporting infants.  For  example,  cradle-board pressure  during  infancy  can  alter the contours  of the skull. Considerable evidence remains to suggest that tattooing and circumcision were not uncommon in ancient times. Direct evidence can only be found  in well-preserved mummies,  but studies of similar  customs  in contemporary traditional societies can  expand  our understanding  of  the   myriad   possibilities   for   prehistoric   cosmetic surgery.

Since the 1990s, women’s health  reformers  have been attempting to  end the traditional practice  of female circumcision,  also known  as female  genital  mutilation,  which  is  still  practiced   in  more  than   25 countries  in Africa  and  the Middle  East.  Generally,  the painful  ritual is performed  with crude instruments, without  anesthesia  or antiseptics. Although  the ritual  is prohibited by many  African  nations,  it is often performed   secretly.  The  World   Health   Organization  estimates  that 130 million girls and  women have undergone  some form of cutting  of the clitoris. In the most extreme form of female circumcision, still prac- ticed widely in Somalia and Ethiopia,  the outer labia are sliced off and the remaining  tissue is sewn shut. Female circumcision is seen as a way of ensuring  chastity  and was often practiced  as a coming of age ritual and a prerequisite  to marriage.

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