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Primitive medicine

In the long process of discovering which plants are edible, humans in the Stone Age also identify many which seem to cure ailments or soothe a fever.

Herbal medicine is the earliest scientific tradition in medical practice, and it remains an important part of medicine to this day - in a line descending directly from those distant beginnings. The early physicians stumbled upon herbal substances of real power, without understanding the manner of their working.

The snakeroot plant has traditionally been a tonic in the east to calm patients; it is now used in orthodox medical practice to reduce blood pressure. Doctors in ancient India gave an extract of foxglove to patients with legs swollen by dropsy, an excess of fluid resulting from a weak heart; digitalis, a constituent of foxglove, is now a standard stimulant for the heart. Curare, smeared on the tip of arrows in the Amazonian jungle to paralyze the prey, is an important muscle relaxant in modern surgery.

The long centuries of primitive experiment mean that Susruta, a physician working in India in about the 6th century BC, is able to list hundreds of herbal remedies.

Even so, herbal substances form only a small part of the repertoire of the tribal physician, for it is generally agreed that serious illnesses have spiritual rather than physical causes. The doctor's main duty is to appease or expel the evil spirit troubling the sick person.

Incantation, spells and self-induced trances (often assisted by herbal drugs) form the standard practice of the medicine man or shaman. Even the world's earliest surgical operation, practised at least 4000 years ago, is more probably intended to strengthen the doctor's own powers than to cure a patient.

A hole in the head: perhaps from 2000 BC

The earliest surgical operation in human history is carried out in prehistoric times in several parts of the world - in Europe, in Asia and particularly in Peru, where well-preserved mummies survive. Many of these mummies have the hole in the skull which is the result of trepanning (also known as trephining or trephination).

Healing in the bone around the wound in these mummies, and in skulls found elsewhere, suggests that as many as 50 percent of the 'patients' survive the operation.

The reason for the alarming decision to cut a hole in a living skull is likely to have been religious rather than medical in any modern sense. To let out evil spirits perhaps; or to give spiritual authority to a shaman who submits himself to the knife.

Merely by surviving the operation the shaman proves that he is favoured by the spirits. And his hole in the head, healed over with a flap of skin, will continue to suggest that he has an open channel of communication with unseen influences.

It is not known how such operations were done. One method may be cutting and scraping away at the bone of the skull with a sharp flint, until a hole is virtually rubbed away. Another may be making a circle of small holes with a flint drill and then cutting between them.

Whatever the method, it is to be hoped that there is a herbal mixture of some kind to serve as at least a mild form of anaesthetic.

Medicine in India: from the 6th century BC

Susruta, the founding father of Indian medicine, establishes a tradition later enshrined in a classic text, the Susrutasamhita. He identifies 1120 diseases, lists 760 medicinal drugs, and says that the surgeon's equipment amounts to 20 sharp instruments (including knives, scissors, saws and needles) and 101 blunt ones (such as forceps, tubes, levers, hooks and probes).

His explanation of how to rebuild a patient's nose has given him the status of the first plastic surgeon. This is an important operation in ancient India. Amputation of the nose is a punishment for adultery.

Indian medicine enshrines the theory that the human body consists of three substances, and that health requires a balance between them. They are usually translated as spirit, phlegm and bile.

Greek medicine will later advance a similar theory, but one based on four humours rather than three.

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