J o h n T H E A R L E (Br i sbane , Aus t ra l i a )

C45

PALAEOLITHIC MEDICINE, WITH PARTICULAR REFERENCE TO

CHILDREN OF AUSTRALIAN ABORIGINES

Aus t ra l i a is t he l a rges t l a n d m a s s in t h e S o u t h e r n H e m i s p h e r e hav ing an a rea of 8,000,000 squa re k i l ome t r e s . I t s i so la t ion explains m u c h of i t s s t r a n g e n e s s of a n i m a l a n d p l an t life a n d a lso t h e very special ized e thnology of i t s or ig inal h u m a n se t t l e r s — t h e Aus t r a l i an Abor ig ine .

Al though t h e r e m a y h a v e been s o m e Asian con tac t w i t h Aus t ra l i a p r io r t o d o c u m e n t e d h i s to ry , t h e f irs t ev idence of ou t s ide inf luence c a m e in the 17th cen tu ry , ini t ia l ly w i t h t h e D u t c h a n d l a t e r b y t h e Br i t i sh in 1770. F r e n c h scientif ic expedi­t ions in t h e S o u t h Pacif ic w e r e a lso i m p o r t a n t a t t h e t i m e a n d indeed m u c h of t h e ear ly e thno logy of t h e Aus t r a l i an Aborigines w a s r e c o r d e d by G e r m a n a n d F r e n c h sc ien t i s t s (1).

Before t h e a r r iva l of E u r o p e a n s in Aust ra l ia , Aborigines occupied t h e e n t i r e con t inen t , inc lud ing T a s m a n i a . The i r n u m b e r s w e r e e s t i m a t e d a t approx ima te ly 300,000. The denses t popula t ion w a s a r o u n d t h e coas t l ine w h e r e food w a s m o r e plentiful , b u t b o t h t h e coas ta l a n d i n l a n d Aborigines w e r e n o m a d i c . I n l a n d t r ibes r e q u i r e d to u s e l a rge a r e a s to m a i n t a i n t he i r ex is tence . T h e s e h u n t e r - g a t h e r e r s r equ i red the re fo re to exis t in sma l l g roups a n d co-operate for surviva l . The hun te r -g a t h e r e r (or palaeol i th ic) life exis ts even t oday in s o m e Cen t r a l Aus t r a l i an t r ibes . I t is bel ieved t h a t pa laeo l i th ic c u l t u r e s h a v e evolved r i ch sp i r i tua l a n d re l ig ious t r a d i t i o n s . An u n d e r s t a n d i n g of th i s rel igion a n d w a y of life is neces sa ry t o explain t h e Abor ig ines ' a t t i t u d e to hea l th , d i sease a n d t h e i r r i tua l i s t i c p rac t i ces .

T h e Aborigines bel ieved in a n o rde r ly t r a d i t i o n a l w a y of life. « T o t e m i s m » h a s a lways b e e n a d o m i n a n t a n d unifying concept a m o n g Aus t r a l i an Aboriginals ; i nc luded a m o n g s t th i s w a s ( a n d is) symbol iza t ion prov id ing l inks b e t w e e n m a n , m y t h i c a l th ings , physica l a n i m a t e a n d i n a n i m a t e objec ts . F o r example , t h e Kan­ga roo t o t e m . A m o n g s t m o s t Abor ig ina l t r ibes , m e n took p a r t in t h e m a i n r i t ua l ro les . W o m e n h a d the i r o w n c o m p l e m e n t a r y roles , b u t w h e r e l a rge r i t ua l i s t i c c e r emon ie s w e r e c o n c e r n e d t h e w h o l e t r ibe t o o k pa r t .

Abor ig ines a r e anc i en t people a n d f i rs t r e a c h e d t h e Aus t r a l i an c o n t i n e n t by a l and b r idge f rom N e w Guinea a n d S o u t h E a s t Asia s o m e 30,000 y ea r s ago. The i r pa laeo l i th ic a n d mic ro l i th i c cu l t u r e w a s i so la ted f rom ex t e rna l inf luences un t i l about 2 cen tu r i e s ago. Because of t h e size of t h e c o n t i n e n t it is imposs ib le t o de sc r i be in deta i l al l t h e r i t ua l i s t i c p rac t i ces a n d d i sease d i s t r i bu t ion for every t r ibe . I ndeed , i n fo rma t ion in m a n y a r e a s is l ack ing a n d in fe rence m u s t b e m a d e f rom an thropo log ica l s tud ie s a n d s o m e sources often unsc ien t i f i c in t h e i r m e t h o d . I t is p robab ly app rop r i a t e in t h i s conference , t o e x a m i n e severa l of t h e ve ry earliest h i s to r i ca l p r ac t i c e s in med ic ine , w h i c h w a s p robab ly t h e n o r m i n every c u l t u r e t h r o u g h o u t t h e w o r l d before r e c o r d e d t i m e .

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For chi ld b i r t h t h e a r r a n g e m e n t s w e r e p r imi t ive : a b u s h h u m p y o r h u t was e rec t ed a w a y f rom t h e c a m p . Labour w a s c o n d u c t e d in t h e squa t t i ng posi t ion a n d w a s p robab ly m a d e eas ie r by vulval in i t i a t ion m u t i l a t i o n — c a r r i e d ou t in ado lescence . A t r iba l r e la t ive w a s in a t t e n d a n c e a n d food w a s suppl ied d u r i n g the p u e r p e r i u m by femal re la t ives . The p l acen t a w a s d e t a c h e d af te r i t s del ivery a n d t h e co rd cu t w i t h a s tone o r shell . C o n t e m p o r a r y ev idence w o u l d sugges t t h a t t e t a n u s m u s t h a v e been c o m m o n , a l t h o u g h t h e r e is n o proof of th i s .

Soft t i - tree b a r k w a s u s e d a s a d iaper o r napk in , a s i t w a s a t t h e m e n s t r u a l pe r iod (2). Babies w e r e of ten suck led un t i l t hey w e r e four o r five y e a r s old. Fish , if avai lable , w a s t h e f i rs t food given to t h e chi ld, a t a b o u t one year , w i t h m o t h e r chewing it before giving it to h e r infant . Mangrove pods w e r e a lso given as food a t th i s t i m e , a f te r being cooked in a n e a r t h oven, s teeped w i t h w a t e r a n d s ieved t h r o u g h a sma l l bag — re su l t i ng in a th ick g reen i sh pea soup.

In fan t ic ide w a s c o m m o n . If t w i n s w e r e born , t h e w e a k e r one w a s kil led, usua l ly be ing choked w i t h sand . Second babies b o r n w i t h i n t h r e e y ea r s of t h e l a s t chi ld usua l ly m e t t h e s a m e fa te , a l lowing suck l ing t o c o n t i n u e for four t o five yea r s (3). Pa laeol i th ic people e v e r y w h e r e k n e w t h a t for life to con t inue , t h e m o t h e r could only p rov ide n o u r i s h m e n t for one ch i ld u n d e r 3-4 y e a r s .

T h e s y s t e m of persona l m u t i l a t i o n w a s to a c e r t a i n ex t en t evolved for a chi ld ' s m i n d to b e i m b u e d w i t h t h e i m p o r t a n c e of h a r d e n i n g t h e body.

S imple m u t i l a t i o n w a s p r ac t i s ed in ch i ldhood . Boys in s o m e t r ibes w o u l d t a k e a p iece of b u r n i n g coal f rom t h e fire a n d lay i t on t h e n a k e d sk in of t h e i r f o r e a r m . I t w a s left t h e r e un t i l a b l i s te r w a s f o r m e d as t h e coal fizzled. Whi l s t th i s w a s going on t h e boy b i t h i s lips t oge the r a n d c l inched t h e fist of t h e suffer ing a r m to suppress t h e pa in . The r e s u l t a n t s ca r w a s a lesion w h i c h t h e boy possessed w i t h p r ide (4). We see today , w i t h t a t t o o s , a r e s idue of th i s ea r l i e r pa laeol i th ic p rac t i ce .

In i t i a t ion ce r emon ie s p layed a n i m p o r t a n t ro l e in life. I t w a s r e q u i r e d of an Aborigine t h r o u g h o u t Aus t ra l i a to pass t h r o u g h c e r t a i n r i t es a n d ce r emon ie s w i t h o u t w h i c h h e wou ld no t be cons ide r ed m a t u r e a n d the re fo re a l lowed t h e privi leges of t h e a d u l t c o m m u n i t y . The ru les w e r e pa r t i cu l a r ly s t r i c t w i t h r e spec t to the m a l e s a n d t h e c u s t o m in Aus t ra l ia , b u t n o t e l sewhere , w a s largely r e s t r i c t e d to m a l e s . The c e r e m o n i e s w e r e a lways a c c o m p a n i e d by a sec re t ive c e r e m o n y .

Nose p ierc ing w a s t h e f i rs t a n d leas t i m p o r t a n t a n d involved t h e lower flesh po r t i on of t he s e p t u m of the nose . S o m e t r ibes p inched a ho le t h r o u g h t h e f lesh w i t h t he i r f ingernai ls wh i l s t t h e chi ld w a s stil l young. O t h e r s u s e d sha rpened bones , s t i cks o r spears w i t h t h e f a the r u sua l ly ope ra t i ng on h i s son a n d t h e m o t h e r on t h e d a u g h t e r . The per fora t ion w a s kep t open by m e a n s of a s h o r t rod , f requent ly t u r n e r abou t (5).

T o o t h avuls ion w a s usua l ly c a r r i e d o u t a t ado lescence w h e n one of t h e f ront inc isors w a s k n o c k e d out . Often t h e c e r e m o n y w a s c a r r i e d o u t as a g r a n d affair w i t h m a n y boys a n d gir ls be ing ope ra t ed on a t t h e one t i m e . T h e g u m w a s f irs t s e p a r a t e d as fa r d o w n as possible w i t h t h e f inger nai l a n d t h e e n d of a po in ted s t ick : t h e n a th i cke r , b l u n t s t ick w a s applied a t r i gh t angles to t h e r o o t a n d h a m m e r e d w i t h a s t one (6). An uppe r t oo th w a s a lways k n o c k e d o u t so as to a l low t h e spir i t to escape a t dea th .

C i rcumcis ion w a s of m o m e n t o u s i m p o r t a n c e a n d w a s s o m e t i m e s a c c o m p a n i e d l a te r by subinc is ion , a g r u e s o m e p rac t i ce in w h i c h t h e u r e t h r a w a s spl i t a var iab le d i s t ance d o w n i ts l ength .

Areas in w h i c h t h e s e ope ra t ions w e r e done v a r i e d a s c a n b e seen in t h e m a p . C i rcumcis ion w a s t h e occas ion on w h i c h t h e t r u t h of g rowing m a n h o o d w a s m a d e c lea r t o t h e boy. A m i d s t m u c h p o m p a n d c e r e m o n y t h e boy's m o u t h w a s

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gagged, t h e legs forced a p a r t a n d t h e foresk in h a c k e d t h r o u g h w i t h a s tone knife , t h e c r u s h i n g effect of t h i s c r u d e s tone t e n d i n g to s top h a e m o r r h a g e . I t is impos­sible t o s t a t e t r u e r e a s o n s for c i r cumc i s ion as so m a n y m y t h s s u r r o u n d i ts or igin. These m y t h s o r ig ina ted b o t h f rom t r iba l folklore a n d va r ious an th ropo log i s t s ' i n t e rp r e t a t i ons of t h e s e c u s t o m s . Theor ies a d v a n c e d inc lude a symbol ic r e t u r n to a m a t r i a r c h a l socie ty (7), a fo rm of con t r acep t ion (8), a n d t h a t i t r e s u l t e d in t h e p reven t ive p rac t i ce for ba lan i t i s in d r y e n v i r o n m e n t a l condi t ions , even tua l ly b e c o m i n g r i tua l i s t i c p r a c t i c e p r io r t o e n t r y in to m a n h o o d (9).

I n s o m e a r ea s subinc is ion , k n o w n as t h e « Miki » o r « K u l p i » ope ra t ion w a s p rac t i ced . I t cons i s ted general ly , a t t h e age of puber ty , of cu t t i ng t h e lower wal l of t h e u r e t h r a so t h a t i t w a s spli t comple te ly open f rom below, t h e cleft Some­t i m e s ex tend ing only half way b a c k , s o m e t i m e s t h e w h o l e w a y b a c k to t h e s c r o t u m . S o m e t i m e s a m e r e pe r fo ra t i on w a s m a d e . The o r g a n w a s n o longer a tube . T h e incis ion w a s m a d e w i t h a sha rp edged piece of quar tz , shel l o r flint. B leed ing w a s m i n i m i z e d w i t h s a n d a n d t h e edges of t h e w o u n d b u r n t w i t h h o t s tones t o cau te r i ze , a n d kep t a p a r t t o p r even t a d h e r i n g w i t h b i t s of s t ick, wood , b a r k o r bone. The r e su l t w a s a p e r m a n e n t slit, cleft o r opening. T h e t i m e va r i ed a t w h i c h th i s w a s done , f rom 8 days up to pube r ty a n d w a s even p e r f o r m e d on a d u l t s .

I t is difficult to be c e r t a i n of t h e r ea son for th i s opera t ion . S o m e s t a t e t h a t it is n e c e s s a r y for a m a l e t o become a t h o r o u g h m a l e or « Kulpi », a l lowing h i m to appear before w o m e n in the n u d e s t a t e . Milne Robe r t son s t a t e d t h a t i t gave relief f rom i n f l a m m a t i o n of t h e u r e t h r a (10).

I t h a s a lso been sugges ted t h a t i t w a s done so t h a t a m a n could n o t h a v e too m a n y c h i l d r e n a n d th i s w a s suppor t ed b y t h e c u s t o m in t hese a r e a s of pul l ing o u t t h e nipples of young w o m e n so t h a t they cou ld no t suck le ch i ld ren . S o m e bel ieved t h a t it w a s p e r f o r m e d as a t o t e m i c belief to i m i t a t e t h e k a n g a r o o h e r o w h i c h h a s a sma l l hypospad ia s (11). More r ecen t ly Mor r i son (12) h a s sugges ted t h a t i t w a s p e r f o r m e d t o rel ieve s t r u c t u r e of t h e u r e t h r a following c i r cumci s ion .

W h a t e v e r t h e r eason , t h e r e s u l t a n t effect w a s t h a t t h e m a l e h a d a n u n p l e a s a n t u r in i f e rous o d o u r a n d t h a t , for m ic tu r i t i on , t h e penis h a d to b e r a i s ed by h a n d a n d t h e legs wide ly s e p a r a t e d .

If w e cons ide r nex t t h e m o r e c o m m o n p rob l ems encoun te r ed , t he m o s t impor­t a n t a r e as fol lows.

S n a k e b i te w a s t r e a t e d by i m m e d i a t e l y p inch ing t h e p a r t b e t w e e n t h e f inger a n d t h u m b t o squeeze o u t t h e blood. As soon as t h e blood ceased to flow, a p o s s u m sk in w h i c h h a d been h e a t e d as h o t as possible w i t h o u t be ing spoi led w a s applied. W h e n th i s w a s cool, it w a s r e m o v e d a n d t h e p u n c t u r e w a s s u c k e d wh i l e t h e a n i m a l sk in w a s be ing r e h e a t e d . This p r o c e d u r e w a s r e p e a t e d for t h r e e q u a r t e r s of a n hou r . A b i te f r o m a d e a t h adde r , w h o s e v e n o m is e x t r e m e l y po ten t , w a s cons ide r ed hopeless ly fa ta l a n d n o t r e a t m e n t w a s u n d e r t a k e n .

S t i r l ing in 1896 r e c o r d s t h a t t h e na t ives of Cen t r a l Aus t r a l i a u s e d t o t r e a t s n a k e b i t e by ty ing a l i ga tu re above t h e p u n c t u r e wh ich they t h e n sucked (13).

I n s o m e p a r t s s inging b y the m e d i c i n e m a n w a s t h e m e t h o d chiefly re l ied upon, b u t l iga tu res w e r e a l so t i ed above t h e b i te .

F o r m i n o r a i l m e n t s t h e serv ices of t r iba l doc to r s w e r e no t cal led for a n d t h e na t ives appl ied t h e i r o w n r e m e d i e s . These inc luded h u m a n blood col lected in a bag, t h e n dabbed all over t h e body f rom h e a d to hee l s . Axil lary s w e a t w a s bel ieved to have wonde r fu l cu ra t i ve p roper t i e s . Inc i s ions w e r e m a d e over a n in f l amed a n d painful k n e e o r s h o u l d e r w i t h a s t one scalpel . Poul t ices of box t r ee b a r k w e r e appl ied t o c u r e a b a d h e a d a c h e . A m u l e t s w e r e w o r n to re l ieve o b s c u r e pa in . This is c o m p a r a b l e t o today ' s p r a c t i c e of w e a r i n g copper b race l e t s , o r c a r r y i n g a h a r e ' s

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foot in t h e pocket . An e x t r a c t of w i ld s t r a w b e r r y j u i c e w a s cons ide red useful for dysen te ry , wh i l s t t h e r ed sap of wi ld p e a r w a s u s e d for s t o m a c h d i s o r d e r s .

Fo r ser ious i l lnesses the t r iba l doc to r w a s s u m m o n e d . Hi s m e t h o d w a s t o f irs t i m p r e s s t h e aud ience by va r ious an t i cs , m a s s a g e t h e p a r t t r oub led a n d p ress i t un t i l h e e x t r a c t e d a s u b s t a n c e w h i c h h e sa id w a s t h e cause of t h e t roub le . Here -s le ight of h a n d c a m e in to play a n d usua l ly cons i s t ed of p roduc ing pieces of qua r t z , s tone , bone or cha rcoa l f rom t h e affected pa r t . This impl ic i t fa i th exceeds t h e fa i th hea l ing disciples of m o r e c u l t u r e d c o m m u n i t i e s today .

B u r n s w e r e of ten extens ive d u e t o c a r r y i n g f i res t icks , o r t h e p r a c t i c e of a n infant lying b e t w e e n t h e fire a n d m o t h e r a t n igh t . I n s o m e a r e a s t h e b u r n w a s dabbed w i t h t h e fat of a ca rpe t snake , wh i l s t in o t h e r s r e d o c h r e w a s applied.

T h e Aboriginal t r e a t m e n t of w o u n d s s e e m s to have been f r augh t w i t h d a n g e r of sepsis , ye t s o m e of t h e m o s t severe a n d ex tens ive w o u n d s r ecove red w i t h o u t m u c h t rouble . The i r m e t h o d of t r e a t m e n t w a s t o lay a l a rge fea the r , ideal ly an eagle-hawk's fea ther , a t t h e b o t t o m of t h e w o u n d a n d over th i s w a s p u t p o w d e r e d cha rcoa l o r a shes f rom t h e fire a n d t h e n to fill t h e cav i ty w i t h w e t pipe clay. Over th i s w a s p laced a b o u n d p a d of t i - t ree b a r k a n d t h e w o u n d b o u n d w i t h p o s s u m fur s t r ing . T h e d re s s ings w e r e c h a n g e d as n e e d e d b u t kep t on un t i l t h e w o u n d c o n t e n t s w e r e g radua l ly e x t r u d e d . T h e eagle-hawk's f ea the r w a s kep t for f u r t h e r use .

F o r f r ac tu re s , confl ic t ing ev idence exis ts w i t h r e g a r d s t o t h e i r t r e a t m e n t . S o m e h a d no knowledge of se t t ing f r ac tu re s , o t h e r s e n c a s e d t h e l i m b in b a r k f rom t r ee s s u c h a s t i - t rees . A s t u d y of f r a c t u r e d bones f rom m u s e u m m a t e r i a l showed t h a t ev idence of un ion af te r f r a c t u r e w a s good even by m o d e r n s t a n d a r d s , sugges ted a wel l cons ide red m e t h o d of t r e a t m e n t a n d immobi l i za t ion .

I n t h e a r e a s of hyg iene t h e na t ives w e r e comple te ly ignoran t . The i r u r i n e a n d exc re t a w e r e r e g a r d e d as p a r t of t hemse lves , a s t h e e s sence of t he i r bodies , so they w o u l d n o t b u r n faeces because f i re ki l ls a n d t h e y w e r e a f ra id of ki l l ing the essence . They did n o t w a s h , ce r ta in ly n o t for w a s h i n g ' s s ake .

I t c a n be seen t h a t a s t u d y of c o n t e m p o r a r y pa laeol i th ic m e d i c i n e p rov ides a w i n d o w to t h e or ig ins of m e d i c a l p r ac t i ce of m o d e r n w e s t e r n m a n . W e see « w i t h surpr i s ingly l i t t le a l t e r a t i on » c u l t u r a l ove r tones of m o d e r n m e d i c i n e t h a t h a v e su rv ived 10 o r 20,000 mi len ia of po ten t i a l modi f ica t ion .

I n t o t e m i s m w e see t h e or ig ins of m o d e r n gene t ics w h i c h a l t h o u g h fo rma l i sed a s rep l ica t ion of DNA, neve r the l e s s stil l unif ies m e m b e r s of ex t en d ed k i n d r e d s — in exact ly t h e s a m e w a y as a c o m m o n t o t e m spir i t b u t in t i m e s gone by.

Pa laeol i th ic in fan t i c ide h a s i t s echoes in c o n t e m p o r a r y deba te conce rn ing w h e t h e r o r n o t t r e a t m e n t shou ld be offered t o a b n o r m a l ch i ld ren .

Pa laeo l i th ic m u t i l a t i o n is re f lec ted in m o d e r n ear-pierc ing, t a t o o i n g a n d cosme t i c su rge ry al l of w h i c h po ten t ia l ly involves u s a s doc to r s sub jec ted t o t h e d e m a n d s of ou r p a t i e n t s in f luenced by t h e d e m a n d s of fash ion .

I n i t i a t i on c e r e m o n i e s such as « c i r c u m c i s i o n » r e m a i n p rac t i ca l ly u n c h a n g e d for l a rge sec t ions of society.

T h e m a n a g e m e n t of s n a k e b i t e r e m a i n s j u s t a s con t rove r s i a l t o d a y a s m u s t h a v e been t h e case t h o u s a n d s of ye a r s ago as j u d g e d by t h e p l e t h o ra of t r e a t m e n t s in b o t h anc ien t a n d m o d e r n m e d i c i n e .

32

R E F E R E N C E S

1. J .H. Pearn, « Ring the bel l and w i n a cigar. S o m e early exper iments on the m e a s u r e m e n t of h u m a n strength in Port Jackson and Van Dieman's Land », Med. J. Aust . , 2 (1978), pp . 167-169.

2. L.P. Winterbotham, « Primit ive Medical Art and Medic ine Men of Austral ia », Med. J. Aust . , 1 (1954), p p . 461-464.

3. Ib id . 4. H. B a s e d o w , « The Austral ian Aboriginal », Preece and Sons , Adelaide, (1925), p . 85. 5. H. B a s e d o w , « The Austral ian Aboriginal », Preece and Sons , Adelaide, (1925), p . 230. 6. Alec. H. Chisholm (Ed. ) , The Austral ian Encyc lopaedia , Angus and Robertson , Sydney , (1958),

p . 85. 7. C.E. Cook, « Medic ine and the Austral ian Aboriginal : A Century of Contact in the Northern

Territory », Med. J. Aust . , 1 (1966), p . 559. 8. A.P. E lk in , « Unders tanding the Australian Aborigine », Angus and Robertson , Sydney , (1938). 9. J. Morrison, « The Origins of the Pract ices of Circumcis ion and Subinc i s ion a m o n g the

Austral ian Aborigines », Med. J. Aust . 21st. Jan. , 1967, p p . 125-126. 10. M i l n e R o b e r t s o n , in Zei tschri f t fur E t n n o l o g f e Bd, X I V 1882 , p . 2 7 . 11. J. Cawte, in A.A. Abbie « The Original Austral ians >», Reed, Wel l ington, (1969), p . 150. 12. J. Morr ison , « The Origins of the Pract ices of Circumcis ion and Subinc i s ion a m o n g the

Austral ian Aborigines », Med. J. Aust. 21st. Jan. , 1967, p p . 125-126. 13. E.C. St ir l ing, « H o r n Expedi t ion », IV, (1896), p . 131.

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