CHAPTER VI.

PRIMITIVE SURGERY. Arrest of Bleeding.—The Indian as Surgeon.—Stretchers, Splints, and Flint Instruments.—Ovariotomy.—Brain Surgery.—Massage.—Trepanning.—The Cæsarean Operation.—Inoculation. Primitive man, from the earliest ages, must have been a diligent student of medicine; it has indeed been wisely said that the first man was the first physician. That is to say, he must have been at least as careful to avoid noxious things and select good ones as the beasts, and, as in the lowest scale, he must have been able in some degree to observe, reflect, and compare one thing with another, and so find out what hurt and what healed him, he would at once begin to practise the healing art, either that branch of it which is directed towards maintaining the health or that of alleviating suffering. When his fellow-men were sick and died, he would be led to wonder why they perished; and when other men stricken in like manner recovered, he would speculate as to the causes of their cure. It is probable that at first little attention was paid to the loss of blood when an artery was severed. Soon, however, it would be remarked that under such conditions the man would faint, and perhaps die. In process of time it would be observed that when the injured blood-vessel was by any means, natural or artificial, closed, the man quickly recovered. Then some one wiser than the other would bind a strip of fibre or a piece of the skin of a beast around the bleeding limb, and the hæmorrhage would cease, and the operator would gain credit and reward. He would then, naturally, give himself airs, and pretend, in course of time, to some importance, and so become a healer by profession. It would soon be noticed that those who, in the search for berries in the woods, ate of certain kinds, more or less promptly died, and those who had abstained from their use survived. It would be understood that such berries must not be eaten. Or again, a man suffering from some pain in his stomach would eat of a particular plant that seemed good for food, and his pain would be relieved: it might be ages before primitive man would arrive at the conclusion that there was some connection between the pain and its disappearance after eating of the plant in question; but in process of time the two things would be associated, and everybody would use the curative plant for the particular pain. It is natural to suppose that many such things would happen, and we know as a fact that they have so happened in numberless instances. Probably empirical medicine, in the most ancient times and amongst the most savage tribes, had an armoury of weapons against pain and sickness not greatly inferior to our own Materia Medica. The origin of the use of most of our valuable medicines cannot be discovered. “As no man can say who it was that first invented the use of clothes and houses against the inclemency of the weather, so also can no investigation point out the origin of medicine—mysterious as the sources of the Nile. There has never been a time when it was not.”[87] The origin of surgery is probably much older than that of medicine, if by the term surgery we mean the application of herbs to wounds, either as bandages or on account of their healing properties, and the use of medicinal baths the like. Mr. Gladstone, in an address to a society of herbalists, which was reported in the _Daily News_, 27th March, 1890, said that an accident which occurred to himself, when cutting down a tree, illustrated the very beginning of the healing art. He cut his finger with the axe, and found that he had no handkerchief with him with which to bind up the wound, so he took a leaf of the tree nearest to him, and fastened it round his injured finger. The bleeding stopped at once, and the wound, he declared, healed much more quickly and favourably than previous injuries treated in a more scientific manner. There is no doubt whatever that this is a good example of the primitive manner of treating cuts and other flesh wounds. The cooling properties of leaves would be recognised by the most primitive peoples; and as a cut or other wound, by the process of inflammation, at once begins to burn and throb, a cooling leaf would be the most natural thing to apply. Some leaves which possess styptic and resinous properties would staunch bleeding very effectually, and the mere act of binding round the cut an application like a leaf would serve to draw together the edges of the wound, and afford an antiseptic plaster of the most scientific nature. It was, in fact, by just such means that the valuable styptic properties of the matico leaves were first discovered by Europeans. If, in the depths of the forest, an Indian breaks his leg or arm (said Dr. Kingston in his address at the British Medical Association meeting at Nottingham, 1892), splints of softest material are at once improvised. Straight branches are cut, of uniform length and thickness. These are lined with down-like moss, or scrapings or shavings of wood; or with fine twigs interlaid with leaves, if in summer; or with the curled-up leaves of the evergreen cedar or hemlock, if in winter; and the whole is surrounded with withes of willow or osier, or young birch. Occasionally it is the soft but sufficiently unyielding bark of the poplar or the bass-wood. Sometimes, when near the marshy margin of our lakes or rivers, the wounded limb is afforded support with wild hay or reeds of uniform length and thickness. To carry a patient to his wigwam, or to an encampment, a stretcher is quickly made of four young saplings, interwoven at their upper ends, and on this elastic springy couch the injured man is borne away by his companions. When there are but two persons, and an accident happens to one of them, two young trees of birch or beech or hickory are used. Their tops are allowed to remain to aid in diminishing the jolting caused by the inequalities of the ground. No London carriage-maker ever constructed a spring which could better accomplish the purpose. A couple of crossbars preserve the saplings in position, and the bark of the elm or birch, cut into broad bands, and joined to either side, forms an even bed. In this way an injured man is brought by his companion to a settlement, and often it has been found, on arrival, that the fractured bones are firmly united, and the limb is whole again. This is effected in less time than with the whites, for the reparative power of these children of the forest is remarkable. In their plenitude of health, osseous matter is poured out in large quantity, and firm union is soon effected. The reparative power of the aborigines, when injured, is equalled by the wonderful stoicism with which they bear injuries, and inflict upon themselves severest torture. They are accustomed to cut into abscesses with pointed flint; they light up a fire at a distance from the affected part (our counter-irritation); they amputate limbs with their hunting-knives, checking the hæmorrhage with heated stones, as surgeons were accustomed to do in Europe in the time of Ambroise Paré; and sometimes they amputate their own limbs with more _sang froid_ than many young surgeons will display when operating on others. The stumps of limbs amputated in this primitive manner are well formed, for neatness is the characteristic of all the Indian’s handiwork. The aborigines are familiar with, and practise extensively, the use of warm fomentations. In every tribe their old women are credited with the possession of a knowledge of local bathing with hot water, and of medicated decoctions. The herbs they use are known to a privileged few, and enhance the consideration in which their possessors are held. The Turkish bath, in a simpler but not less effective form, is well known to them. If one of their tribe suffers from fever, or from the effects of long exposure to cold, a steam bath is readily improvised. The tent of deer-skin is tightly closed; the patient is placed in one corner: heated stones are put near him, and on these water is poured till the confined air is saturated with vapour. Any degree of heat and any degree of moisture can be obtained in this way. Europeans often avail themselves of this powerful sudatory when suffering from rheumatism. The aborigines have their herbs—a few, not many. They have their emetics and laxatives, astringents and emollients—all of which are proffered to the suffering without fee or reward. The “Indian teas,” “Indian balsams,” and other Indian “cure-alls”—the virtues of which it sometimes takes columns of the daily journals to chronicle—are not theirs. To the white man is left this species of deception.[88] Mr. E. Palmer says that there is a tribe of Australian aborigines, called “Kalkadoona,” adjoining the Mygoodano tribe of the Cloncurry, who practise certain surgical operations at their _Bora_ initiations of youths. They operate on the urethra with flint knives. The same custom can be traced from the Cloncurry River to the Great Australian Bight in the south. The females are in some of the south-western tribes operated on in some manner to prevent conception. It is supposed that the ovary is taken out, as in the operation of spaying.[89] Such operations are sometimes performed with a mussel-shell. Sir John Lubbock says of the Society Islanders that “they had no knowledge of medicine as distinct from witchcraft; but some wonderful stories are told of their skill in surgery. I will give perhaps the most extraordinary. ‘It is related,’ says Mr. Ellis, ‘although,’ he adds with perfect gravity, ‘I confess I can scarcely believe it, that on some occasions, when the brain has been injured as well as the bone, they have opened the skull, taken out the injured portion of the brain, and, having a pig ready, have killed it, taken out the pig’s brains, put them in the man’s head and covered them up.’”[90] Massage in one form or another has been practised from immemorial ages by all nations. Captain Cook tells us, in his narrative of the people of Otaheite, New Holland, and other parts of Oceania, that they practise massage in a way very similar to that which is employed by more civilized nations. For the relief of muscular fatigue they resort to a process which they call toogi-toogi, or light percussion regularly applied for a long time. They also employ kneading and friction under the names of Miti and Fota. African travellers inform us that the medicine-men use these processes for the relief of injuries to the joints, fractures, and pain of the muscles. Our word shampooing is said to have been derived from the Hindu term chamboning. Dr. N. B. Emerson, in 1870, gave an account of the lomi-lomi of the Sandwich Islanders. He says that, “when footsore and weary in every muscle, so that no position affords rest, and sleep cannot be obtained, these manipulations relieve the stiffness and soothe to sleep, so that the unpleasant effects of excessive exercise are not felt the next day, but an unwonted suppleness of joint and muscle comes instead.”[91] When we receive a blow or strike our bodies against a hard substance, we instinctively rub the affected part. This is one of the simplest and most effectual examples of natural surgery. When the emollient properties of oil were discovered, rubbing with oil, or inunction, was practised. The use of oil for this purpose in the East is extremely ancient. Amongst the Greeks there was a class of rubbers who anointed the bodies of the athletes. The oil was very thoroughly rubbed in, so that the pores of the skin were closed and the profuse perspiration thereby prevented. After the contest the athlete was subjected to massage with oil, so as to restore the tone of the strained muscles. These aliptae came to be recognised as a sort of medical trainers. A similar class of slaves attended their masters in the Roman baths, and they were also possessed of a certain kind of medical knowledge. Discussing the origin of the operation of trepanning, Sprengel says that “nothing is more instructive, in the history of human knowledge, than to go back to the origin, or the clumsy rough sketch of the discoveries to which man was conducted by accident or reflection, and to follow the successive improvements which his methods and his instruments undergo.”[92] The name of the inventor of this operation is lost in the night of time. Hippocrates gives us the first account of trepanning in his treatise on Wounds of the Head. We know, however, that it was performed long before his time. Dr. Handerson, the translator of Baas’ _History of Medicine_, says that human skulls of the neolithic period have been discovered which bear evidences of trepanning.[93] The operation of cutting for the stone, like many other of the most difficult operations of surgery, was for a long time given over to ignorant persons who make a speciality of it. Sprengel attributes this injurious custom to the ridiculous pride of the properly instructed doctors, who disdained to undertake operations which could be successfully performed by laymen.[94] The Bafiotes, on the coast of South Guinea, practise cupping. They make incisions in the skin, and place horns over the wounds, and then suck out the air, withdrawing the blood by these means.[95] “Felkin saw a case of the Cæsarean operation in Central Africa performed by a man. At one stroke an incision was made through both the abdominal walls and the uterus; the opening in the latter organ was then enlarged, the hæmorrhage checked by the actual cautery, and the child removed. While an assistant compressed the abdomen, the operator then removed the placenta. The bleeding from the abdominal walls was then checked. No sutures were placed in the walls of the uterus, but the abdominal parietes were fastened together by seven figure-of-eight sutures, formed with polished iron needles and threads of bark. The wound was then dressed with a paste prepared from various roots, the woman placed quietly upon her abdomen, in order to favour perfect drainage, and the task of this African Spencer Wells was finished. It appears that the patient was first rendered half unconscious by banana wine. One hour after the operation the patient was doing well, and her temperature never rose above 101° F., nor her pulse above 108. On the eleventh day the wound was completely healed, and the woman apparently as well as usual.”[96] The South Sea Islanders perform trepanning, and some Australian tribes perform ovariotomy.[97] The missionary d’Entrecolles was the first to inform the Western world of the method of inoculation for the small-pox, which the Chinese have followed for many centuries.[98] In many countries, and from the earliest times, says Sprengel,[99] it has been customary to inoculate children with small-pox, because experience has shown that a disease thus provoked assumes a milder and more benign form than the disease which comes naturally.