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I History. Traditional medicine of aboriginal Australia. Roger Byard, MB, BS. It has been estimated that the aboriginal population ofAustralia at the timeĀ ...
I History

Traditional medicine of aboriginal Australia Roger Byard, MB, BS

It has been estimated that the aboriginal population of Australia at the time of Eiropean colonization in 1788 was around 300 000.' Not a great number for so vast an area, perhaps, but understandable given the nomadic life led by the scattered tribal groups. While interaction with early explorers was often amicable,2 later contact with the British was marked by bloodshed, epidemics and the extinction of entire tribes. Against this background of chaos the traditional aboriginal healers, whom Elkin described as "men of high degree',3 tried to provide adequate health care. Confronted with new diseases such as smallpox, measles and influenza, as well as alarming new forms of trauma such as bullet wounds, it is difficult to envisage how they could have dealt with such an appalling situation. However, they did deal with it - often quite successfully - and in tribal areas today the old medicine can still be found, a tribute to the perseverance of these "clever men".3 w M X agic holds a special significance for tribal aboriginal people, who believe that disease results from sorcery4 or disruption of the spirit, and is Roger Byard is a fellow in anatomical pathology at the Hospital for Sick Children in Toronto. 792

followed only secondarily by physical symptoms.5 Treatment of major ailments therefore firstly involves spiritual matters, such as divining the person responsible for causing a patient's ill health. Native doctors must undergo complex initiation rites before they are taught the methods for curing, and sometimes inflicting, such diseases. To become a healer an aboriginal boy would be selected by the tribal elders either because of above-average intelligence and interest in tribal lore, or because he had experienced a vision in which he was called to the profession. In some areas the position was almost an hereditary one, with special powers being handed down from father to son.3,6 Once considered worthy of undergoing the initiation rites, the student began an intensive training period. A number of tribes believed that medicine men were actually killed by ancestral spirits during training and then had their internal organs removed and replaced with a new set.7 As well, magical materials such as quartz crystals and power-stones were believed to be inserted into the student's body to enable him to converse with the spirit world.6 After the ordeal of training ended the healer was then able to communicate freely with the sky gods and the dead. Not all the initiation rites dealt with the abstract, however. Among the Wiimbaio an aspiring

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"internist" would be plastered with human excrement and required to carry a humerus from an exhumed corpse that he occasionally had to nibble on.7 Other procedures such as subincision opening the ventral portion of the penile urethra with a stone knife to create an exaggerated hypospadius - were also carried out.L8 Once trained, these "men of high degree" were often involved in both "white" or "black" magic - curing or causing illness. In curing ceremonies healers used techniques such as massage and sucking to remove disease-causing objects. It is interesting to note that use of sleight of hand and apparent trickery to.produce "illness-causing" quartz crystals or bone fragments has often been condemned by western observers. However, some observers consider this apparent deception a "noble fiction": the objects produced merely served as concrete representations of truths that cannot be exposed to the uninitiated. What better evidence to support this than to note that healers who became ill would themselves undergo identical rituals at the hands of other healers.3 These rites are thus valid links in an intricate psychosocial and medical philosophy, not mere chicanery. Included in the five major categories of illness found in tribal societies - sorcery, soul loss, taboo violation, intrusion of disease-causing objects and intru-

Roger Byard photos

sion of disease-causing spirits9 is a belief in sympathetic magic. This holds that a person is inexorably linked to possessions or body parts, including nail parings, hair cuttings and excreta, because of a natural "sympathy".7 If a sorcerer can obtain any of these materials, he will therefore be able to cause serious illness, or even death. A well-known form of death curse in Australia involves the use of a "pointing bone". The bone, which can be from a person, kangaroo or emu, is attached to a rope braided from human hair and pointed towards the victim while a curse is "sung". The Aborigines believe that either the victim's blood or soul is drawn down the rope towards the waiting sorcerer, or that a magical disease-causing object is sent along the rope to embed itself in the unsuspecting victim's body.' My only personal experience in this area, which sparked my interest in traditional medicine, occurred while I was working in a small hospital in an aboriginal community in northern Australia. I had admitted a young woman who appeared undernourished, listless and seriously ill. I thought that she probably had a urinary tract infection that had progressed to septicemia, common in malnourished patients. Surprisingly, all tests were normal, although they did indicate a mild

degree of dehydration. I repeated them, took cultures and began intravenous fluids and antibiotics anyway, preferring to believe in laboratory error rather than admitting that I was- stumped. Predictably, the therapy had little effect and at the end of the week she showed only marginal improvement. Over the next several weeks she remained a puzzle. Slow improvement led to her eventual discharge - better, but undiagnosed. At no time had she spoken to me or the nursing staff, although she obviously understood most of our conversations. Eventually the mystery was explained by one of the older aboriginal women. When the girl's tribal elders discovered that she had been working as a prostitute, they had held council and summoned a sorcerer to carry out their sentence., He did this by obtaining one of her possessions and then "singing" (cursing) her through the object. In the old days this was the equivalent of a death sentence: the victim wasted away and died after learning about the sorcerer's invocation. Having seen my patient, I can understand how absolute belief in this "magical power" could cause a terrified victim to refuse fluids and thus succumb rapidly to dehydration and acute renal failure. Why didn't my patient die? I can only guess that her relative

Rock painting of ancestral spirit

"detribalization" made her less susceptible to the power of the tribal magician. Alternatively, she may have viewed my daily rituals of palpation, percussion and auscultation as a form of counterstethoscope versus magic quartz crystal, thermometer versus pointing bone. All of this is conjecture, though, and the real reason for her survival will never be known. Although the Aborigines were well versed in magic, they also made extensive use of herbal remedies and minor surgical procedures. There is no doubt that they had a wide knowledge of medicinal plants, but detailed studies were rare in the early days of colonization and much of their pharmacopoeia has been lost. However, even in the 1960s there were more than 124 different plant species that were believed to have therapeutic quali-

ties."0

Coughs, colds and laryngitis

Rock painting found in North Australia shows dancing sorcerers -

For

prescribing information see page 768D

were treated with a concoction made from pulverized wattle tree roots that had been soaked in water to make a syrup.10 They also had quite an array of herbs and plants that could induce vomiting. For example, Aborigines in Tasmania used the rubbery leaves of a plant known as "pig face"11 that can still be found growing over eroding campsites. In northern QueensCMAJ, VOL. 139, OCTOBER 15, 1988

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developed. The cuttlefish, related to the squid and octopus, has a central cuttle bone composed of plates of porous calcified material. Readily available along Tasmania's beaches, they become powdery as they dry. The high salt content renders them sterile and hygroscopic - a perfect packing material for weeping sores.11 Major surgery was generally not found among any of the native groups and although amputation by burning a limb off in a fire has been described,14 operations such as trepanation of the skull were unknown. Given the lack of effective anesthetic agents other than pituri, a mild narcotic, the hesitation in performing involved procedures is understandable. Bloodletting was common in most tribes and I have witnessed its use among the Yolgnu people of Arnhem Land, in northern Australia, to treat headache. In Tasmania nearly any form of illness seemed to invoke cutting "to let the pain out". For example, pains in the abdomen, chest, joints and head led to vigorous cutting. Excessive bleeding was then staunched with a pack of clay and leaves.11 Orthopedics was limited to setting broken bones externally. However, this was done quite accurately, if museum collections are representative of the general population. The concept of limb immobilization was known and splints were made of bark or human bones. Apparently, the use of exhumed bones had some magical significance.15 Two of the most well known operations performed in aboriginal Australia were circumcision and subincision. With circumcision, the foreskin was removed as a standard part of initiation ceremonies, while subincision was a procedure reserved for a group of men, including healers, who possessed specialized knowledge. In presenting this overview of traditional Australian and Tassymptoms.13 In Tasmania an interesting manian aboriginal health practherapy for skin diseases- tices and beliefs I wanted to demground cuttlefish bone -also onstrate some of the complexity

land small pieces of tree bark were chewed to induce vomiting and relieve abdominal pain."2 The ubiquitous eucalyptus (gum) tree was used for everything from gastrointestinal upset to fever.10 Eucalyptus oil can still be purchased over the counter in Australia for use as a decongestant. Gum tree bark was pounded into a poultice to be held against the head or strips of bark were wrapped around the abdomen for pain relief.13 The tree's resin was taken to relieve constipation and the gum was also powdered and applied to skin sores, with or without an overlay of the inner bark. Toothaches were treated by packing wads of inner bark from the custard apple or several other trees against the decayed tooth. Other concoctions were prepared to treat earaches, dysuria and skin diseases. The leaves of the pitosporum, held against the breast, were believed to help the flow of milk in new mothers.10 Abortion-inducing agents used for population control in an often harsh environment were also known. To a lesser extent, the Aborigines used animal derivatives in their healing practices. Animal fat liniments for "rheumatism" and musculoskeletal pain .were in wide use, with the types of oil used depending on the availability of local animals. For example, in Tasmania the oil of the "mutton bird" was used,11 while on the mainland goanna oil, obtained from a lizard, was a remedy adopted by early settlers. Snake and emu fat were also used as liniments and wound dressings. Boiled stingray or iguana liver were considered remedies for constipation, presumably because of their high oil content, whereas diarrhea could be treated with a few handfuls of raw green ants.12'14 Clay was also taken for stomach upsets, much as we now take aluminumhydroxide mixtures for relief of

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that has been achieved by these nomadic and technologically unsophisticated people. On a practical level, their knowledge of herbal medicine and simple surgical procedures was undoubtedly astute and while their medicomagical beliefs are often difficult to comprehend, it is probably unwise to dismiss them out of hand. Their methods simply haven't been examined in enough detail for an accurate assessment to be made.

References 1. Berndt RM, Berndt CH: The World of the First Australians, 2nd ed, Ure Smith, Sydney, 1977 2. Plomley MJB: The Baudin Expedition and the Tasmanian Aborigines: 1802, Blubber Head Press, Hobart, 1983 3. Elkin AP: Aboriginal Men of High Degree, 2nd ed, University of Queensland Press, St. Lucia, 1977 4. Maddock K: The Australian Aborigines: A Portrait of Their Society, Penguin Press, London, 1972 5. Berndt RM, Berndt CH: The First Australians, Ure Smith, Sydney, 1967 6. Eliade M: Shamanism: Archaic Techniques of Ecstasy, 2nd ed, Princeton University Press, Princeton, New Jersey, 1974 7. Roheim G: Animism, Magic and the Divine King, Routledge and Kegan -Paul, London, 1972 8. Pounder DJ: Ritual mutilation: subincision of the penis amongst Australian Aborigines. Am J Forensic Med Pathol 1983; 4: 227-229 9. Hughes CC: Medical care: ethnomedicine. In Logan MH, Hunt EE Jr. (eds): Health and the Human Condition: Perspectives on Medical An-

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thropology. Wadsworth Publishing Co., Belmont, California, 1978 Blainey G: Triumph of the Nomads: A History of Ancient Australia, Griffin Press, Adelaide, 1975 Ling Roth H. The Aborigines of Tasmania, 2nd ed, F. King & Sons, Halifax, 1899 Roth WE: Superstition, magic and medicine, North Queensland Ethnographic Bulletin No. 5. Brisbane Government Printer, Brisbane, 1903 Scarlett N, White N, Reid J: "Bush medicine": the pharmacopoeia of the Yolgnu of Arnhem Land. In Reid J (ed): Body, Land and Spirit: Health and Healing in Aborginal Society, University of Queensland Press, St. Lucia, 1982 Bates D: The Passing of the Aborigines, 2nd ed, Frederick A. Praeger, New York, 1967 Colliver FS: The aboriginal and his medicine chest, Anthrop Soc Queensland Newsletter 1972