PREHISTORIC SURGERY. 7 from its probable resemblance to the practice of the healing art by barbarous races. Thus philologists assert that among popular medical terms, those denoting affections of the skin are common to the greatest number of branches of the Aryan race, from which we may, perhaps, conclude that such diseases were especially prominent among our uncivilised and not overcleanly ancestors in their earliest homes. So, too, the discovery of cakes made of poppy seed in the ruins of the Swiss lake dwellings may indicate that opium, the most important of drugs, was also one of the earliest to be used by man.3 Particularly interesting is the evidence, recently brought forward, of the frequent performance in prehistoric times of the operation of trephining, or removal of a part of the skull vault. At a meeting of the French Association, held in Lyons, 1873, Dr. Prunières exhibited a disc of bone, excised from a human skull, which had been found under a dolmen in Lozère. In the following year he showed a number of similar discs, with accompanying skulls, in some of which signs of repair indicated that the patient had long survived the operation, though, in the majority, the bone must have been removed either shortly before death or post mortem. Attention was thus directed to the subject, and resulted in the collection of several hundred trephined skulls from prehistoric burial-places in France alone, upwards of sixty being found in one cave, while traces of a similar practice were discovered in countries so remote as Bohemia, Portugal, Peru, and Japan. The accompanying ornaments and weapons were usually those characteristic of the later stone or bronze age, and the operation seems to have been performed by means of flint implements in one of three ways, by sawing, by a chisel-like action, or by boring a series of holes close to one another. In some cases striæ and scratches round the wound betray a bungling operator, but many are done with much skill, considering the rudeness of the instruments. The various explanations which have been given to 1 account for the frequency of the operation can only be briefly mentioned here. In one or two instances a diseased state of the bone indicates a therapeutic object, and the idea that the operation may have sometimes been performed for the cure of epileptic fits following an injury is supported in a recent paper on the subject by Professor Victor Horsley. But the theory most generally accepted is the one put forward by Broca. That celebrated anatomist and anthropologist noticed that in some cases more than one operation had been performed, one piece of bone having been removed long before death, and one or more others taken from the same skull post mortem, each including part of the healed margin of the old wound. On this he founded his theory that the operation was a sort of religious rite or initiation, the survivors of which acquired a special sanctity, so that, after death, parts of their skulls were sought as amulets, and became so valuable that they were often forged, not only from other human skulls, but from the bones of animals, for similar discs have been found manufactured from a stag's antlers. We might perhaps combine these two hypotheses, as, indeed, Broca himself afterwards suggested. Epilepsy is, of all diseases, the one most universally attributed to supernatural agencies, and the repeated cure of epileptiform attacks by means of trephining might, not impossibly, have invested the operation with the character of a religious rite, rendering those who underwent it especially proof against the assaults of evil spirits. In the majority of cases the operation was performed on the young, and Broca supposes that, whenever a neolithic baby had fits, a hole was scraped in its head to let out the imaginary demon; if the fits ceased, and the child survived, it was ever afterwards looked upon with peculiar respect. That the excised fragments of bone were used as amulets is indicated by many of them being perforated, and, in the fact that they are found in burial-places, Broca saw one of the earliest proofs of belief in a future state, and in a spiritual PREHISTORIC SURGERY. 9 world where protection against ghostly enemies might be no less necessary than here. Others have supposed that the object of the operation was to enable the spirit to escape from the body, or to facilitate its return, apertures, apparently for this purpose, having been found in many ancient burial mounds. It would thus be connected with the practice, not altogether extinct in modern England, of throwing open the windows of a room where death has recently occurred with the view of favouring the exit of the departed spirit. The discs of bone, it is suggested, might have been worn, not so much as charms against demons as in the hope of acquiring the former possessor's wisdom and cunning, just as a modern savage eats his enemy's heart in order to get his courage. It is important to notice that a very similar custom still exists in the South Sea. In the Island of Uvea, for example, headache and other cerebral disorders are attributed to a crack in the skull or to pressure on the brain, and the recognised treatment is to scrape a hole through the bone near the top of the head. The implement formerly used was a shark's tooth, but since the advent of civilisation broken glass has been substituted. The mortality is about one in two, and few of those who recover are relieved of their symptoms; but such is the force of custom, that there are Isaid to be few adult males on the island who have not undergone the operation. The process is said to last over an hour, and one hardly knows whether to admire more the endurance of the patient, or the boldness and perseverance of the operator.* NOTES. 1 Signs of disease and injury are met with in fossil remains of the early periods, but the cases of greatest interest are those collected by Prof. Schmerling of Liège from the caves of Belgium. He found that caries of the bones of the lower jaw and fore-legs was very common, probably as the result of bites or other injuries; but he also describes a case of anchylosis of the cervical vertebræ, and a lumbar vertebra which was nearly destroyed by disease before the animal died. The cave bear, like the animals in our modern zoological gardens, seems to have been very liable to rickets, and in some cases its joints present the characteristic deformities of rheumatoid arthritis (Ossements Fossiles, vol. ii. 180). 2 Schrader, Sprachvergleichung und Urgeschichte, 1883, p. 409. 3 Keller, The Lake-dwellings of Switzerland (trans. 1878), p. 523. * See Broca, Sur la trepanation du crane et les amulets craniennes a l'epoque neolithique, Paris, 1877; Journal of the Anthropological Society, vols. xi. and xvii.; Joly, Man before Metals (International Scientific Series); Medical Times, 1874, p. 50. The dates of the works quoted here and elsewhere are those of the editions which I have consulted, not necessarily the first. III. MEDICINE AS PRACTISED BY UNCIVILISED MAN. It may be well to preface our survey of medical history by a brief glance at the practice of the art by barbarous races, for we shall thus not only obtain some idea of the probable character of primitive medicine, but shall also find traces of many beliefs and practices which have survived under modified form in civilised communities. Only the briefest sketch of this vast subject can be here attempted. In striking contrast to that tendency to materialism not altogether unjustly attributed to modern medicine, savage theories of disease are typically spiritualistic. This seems to be due partly to the habit, common to savages and children, of attributing life to everything, partly to the inherent nature of the subject. Disease and death, whatever they are, affect the inmost being of man, and even the most degraded savage holds that his inmost being is spirit, not body. How can merely physical agencies affect a spirit? Why should a simple blow on the head drive the soul from the body? The question has puzzled one of the greatest of physicians. "If Plato were alive," writes Galen, "I should like to ask him why great losses of blood, a draught of hem DEMONIC THEORIES OF DISEASE. II lock, or a severe fever, should separate soul and body, for, according to Plato, death takes place when the soul removes herself from the body" (Kühns edit., iv. 775). If the savage does not perceive a difficulty, it is because he at once explains it by a supernatural theory of disease. Sometimes this theory is carried out to its fullest extent. Thus the Abipones hold that man is naturally immortal, and that even those killed in battle die not from their wounds, but from the enchantments of the hostile medicine men: if there were no medicine men, there would be no death. Even when the logic of facts has compelled the belief that clubs and arrows can kill without the aid of sorcery, faith in the spiritual origin of diseases remains unaltered. The supernatural agencies which cause them are, however, of the most varied kind. Thus we may distinguish (i.) independent disease demons; (ii.) human enemies, who may act either by means of spirits of disease, over whom they have acquired authority, or by their own supernatural powers; (iii.) the spirits of the dead; (iv.) the spirits of animals killed in hunting. The belief in diseases caused by a good but angry divinity, who is to be appeased by prayer and sacrifice, belongs to a different and higher stage of civilisation. For examples of these various forms of belief the reader must refer to other sources, but some of the customs founded upon them, which are of medico-historical interest, may be here considered. The savage medicine man, who treats his patient on the excellent principle of removing the cause of the disease, has discovered at least three different methods of getting rid of a demon. First, the body of the patient may be rendered an unpleasant abode for the intruding spirit, and that in many ways. The sufferer may be vigorously squeezed and pommelled, beaten, starved, fumigated by evil-smelling substances, or be given nauseous medicines, which are especially useful if they act as emetics. To the first of these practices we may, perhaps, attribute the origin of that more systematic rubbing, undoubtedly of great antiquity, which has been re-introduced into scientific medicine under the name of |