A REVIEW OF DR. MAX BARTEL'S WORK, "DIE MEDICIN 
DER NATURVCELKER, ETHNOLOGISCHE BEITRtEGE 
ZUR URGESCHICHTE DER MEDICIN." 
LEIPZIG. 1893. PP. 334. 
With a Condensation of the Subject Matter on Primitive 
Minor and Major Surgery.* 
GEORGE M. KOBER, M. D., 
Washington, D. C. 
[Reprinted from Virginia Medical Monthly, December, 1895.] 
I have just read Dr. Max Bartel's work on the "Medicine 
of Primitive Peoples," and as it contains a number of in- 
teresting facts, I have been tempted to translate for your 
benefit some of the more striking examples of minor and 
major surgery related by this learned author. 
While it is doubtless true that many of their methods in 
minor surgery are based upon the assumption that diseases 
are the result of some evil spirits implanted in the body, 
who manifest their presence by pain or other subjective 
symptoms, and that, for the purpose of curing the patient, 
it is necessary to open the body and let the devil out, this 
cannot possibly be the basis of procedure in all instances, 
and is certainly not the case with many of their major op- 
* Read at a meeting of the Medical and Surgical Society of the Dis- 
trict of Columbia, November 11th, 1895. 2 
erations, which appear to be well planned and executed. 
Daily observation must have convinced them, at an early 
stage of their history, that injuries are the result of natural 
causes in their conflict with wild animals, or other tribes, or 
accidents, while engaged in the chase, sports, or daily avo- 
cations ; and the very fact that the causes were apparent, 
and that they were not dealing with some supernatural inter- 
nal foe, may have inspired them with courage in the man- 
agement of wounds, and with extended experience, their 
skill and methods naturally improved, until we see them 
perform operations which, up to within a few years, were 
rarely attempted by the most civilized operators. 
A method of dry cupping by means of sucking the parts 
with the mouth of the medicine-man appears to be in vogue 
among the natives of Australia and North America; some- 
times this suction is continued until blood oozes from the 
part; this has been observed among the Onkanagans of 
British Columbia, the Klamaths, Koroks, and the natives 
of Australia, not only in the treatment of a number of dis- 
eases, but also in inflammatory conditions, bites of serpents 
and scorpions, and in the management of arrow-wounds and 
bleeding surfaces. 
The Indians of lower California and Northern Mexico, 
the Fiatheads and Mincopies, frequently combine with the 
above method scarification by means of sharp fragments of 
stone or flint, and the Dakotas, Winnebagos, and the Karaya 
Indians of Brazil, and some of the tribes in Alaska, use 
special implements made of flint for this purpose. The 
Australian negroes and Mincopies use sharp fragments of 
glass; the natives of Southern Mexico and the Mosquitos 
employ fish bones, and some tribes in Mexico resort to 
thorns. The Ashantis scarify the parts with a thorny leaf, 
and the natives of Watubela Island pick up a fold of the 
skin by means of a bamboo forceps, and then scarify the 
part. Scarification, either singly or combined with subse- 
quent suction by the mouth, appears to be a very common 
method for the local abstraction of blood, corresponding to 
our dry and wet cupping. The Navajo and Chippewa In- 3 
dians have become more refined, and, instead of the mouth, 
apply a hollow reed; and those of Alaska place the hollow 
tibia of an eagle over the diseased part and then apply suc- 
tion. A still more refined method is in vogue among the 
natives of North Africa, the Kaffirs, and Basuthos of South 
Africa, the Islands of Suang, Sermata, Leti, Moa, and La- 
kor in the Malayan Archipelago, and the Winnebagos, Creek 
and Dakota Indians of our own country. These peoples 
employ the horns of buffalos or cows; the points are per- 
forated, the lower and large end is applied over the diseased 
parts, the air is exhausted by suction, and the opening is 
quickly closed with a piece of soft wax. These methods 
are quite commonly resorted to, not only for the extraction 
of the evil spirit, but also for the relief of inflammatory pain 
and neuralgia. 
Venesection appears to be employed by a number of In- 
dian tribes, many of whom have special instruments, re- 
sembling the point of a knife, tied to a stick, and generally 
made from a piece of flint. The Kwixpagmut Indians, at 
the mouth of the Yukon river in Alaska, use a small iron 
knife, and the natives of Australia resort to fragments of 
quarz or sea-shell. A very novel, if not amusing, method 
of venesection is practiced by the Indians of the Isthmus, 
who shoot their arrows at the patient with sufficient precau- 
tion to prevent deep penetration until a vein is struck. 
Such anatomical ignorance is nowhere else found, for the 
Karaya Indians of Brazil open the frontal vein for the re- 
lief of headaches, the Honduras open a vein in the thigh or 
leg, while the Indians of Central California take blood from 
the right arm if the disease is located in the trunk, and 
from the left arm if located in the extremities; the old Peru- 
vians opened a vein at the root of the nose. 
Circumcision, and other ritual operations, are frequently 
practiced by the primitive races. The natives of Northern 
and Central Africa and the Mohammedans of Asia employ 
a razor, the ancient Hebrews use a flint knife, and the in- 
habitants of the Malayan Archipelago resort to a sharp piece 
of bamboo; some employ the circular method, while others, 4 
like the Serang Islanders, simply split the prepuce; for this 
purpose the operator, usually an older man, stretches the 
prepuce over a piece of wood, places the knife longitudinally 
over it, and drives it home by means of a solid block of 
wood; haemorrhage is controlled by tamponade and the 
application of styptic powders. 
The girls of the Malayan Islands are subjected to a slight 
excision of the praeputium clitoridis, the operation being 
formed by women. In East Africa, a portion of the mons 
veneris and the labia majora are excised usually with a 
dirty razor. By means of suitable position and fixing the 
thighs, or the introduction of a few stitches, union of the 
vulva is effected; the insertion of a small tube prevents 
complete closure and admits of the escape of urine and 
menstrual fluid. This operation has been styled infibula- 
tion. Before marriage, the old union is partly divided, and 
just before parturition the opening is still further enlarged, 
while, after recovery from confinement, the operation of 
closing the vulva is frequently repeated. 
Cosmetic operations, such as tabooing, the formation of ge- 
ometrical scars, perforation of the lips, nose and ears for 
the suspension of ornaments, are of course very common. 
Among the natives of the Malayan Archipelago, a beastly 
habit of perforating the glans penis, for the purpose of in- 
serting foreign bodies for erotic purposes, is in vogue, while 
others make an incision on the dorsum of the penis and in- 
sert a small gravel, or some other foreign body, and allow 
it to become encysted. V. Miklucho-Maclay reports that 
the natives of the Northwest Coast of Australia split the 
lower half of the glans penis from the meatus downwards 
for purely erotic purposes. 
Removal of Foreign Bodies.-For this purpose quite a 
number of expedients are resorted to. The Karaya Indians 
of Brazil employ sharp fish-teeth for the extraction of 
thorns, splinters, insects, and other foreign bodies. The 
Haussa of Northwestern Africa employ primitive iron for- 
ceps. The treatment of abscesses consists primarily in the 
application of poultices; this has been observed among the 5 
natives of Australia, Easter Island, and Engano; among 
the Ashantis and North American Indians, a favorite ap- 
plication consists of hot mashes of leguminous leaves and 
ashes. The medicine-man of lower California does not hes- 
itate to open an abscess by means of suction with his mouth, 
whilst the Frazer River Indians, the Bilgulas, and the ne- 
gros of Victoria, scarify or incise the part with iron or bone 
knives; the South-sea Islanders of Tahiti, Samoa and Tongo 
open obstinate abscesses and boils with their scarifying im- 
plements made of fragments of shell, flint, and glass, large 
thorns, or the tooth from a shark. Hamilton witnessed 
among the Nicobares the application of the lower jaw of a 
fish supplied with very sharp teeth, which was driven into 
the tissues by a blow with a block of wood ; profuse haem- 
orrhage ensued, and the abscess terminated in speedy reso- 
lution. The Dayakes of Borneo open their abscesses and 
boils with a wooden knife; the Kirgise according to Pallas, 
treat carbuncles, after making numerous punctures, by the 
application of tobacco and ammonia, and Corre attests that 
he saw the Fullahs of Rio Nunez treat an ulcer by compres- 
sion with a sheet of native copper. 
Dental operations are fully attended to; they often use 
files and chisels, but do not hesitate to resort to the hammer 
and brute force for the removal of teeth. The people of 
Sokoto, however, have an instrument closely resembling the 
modern gum-lancet, and very fair shaped forceps. 
Wound Treatment.-Most of the primitive people permit 
their trivial wounds to heal under the scab ; some, however, 
like the Karoks, Ashantis, Dakotas, the natives of South Aus 
tralia or New Guinea, and of lower California, apply poul- 
tices prepared from pounded leaves and juicy barks. The 
Karayas of Brazil dust their wounds with powdered char- 
coal, and the inhabitants of Engano Island apply hot ashes 
or leaves. The Samoans fumigate their wounds with the 
smoke from black walnut wood, whilst some of the tribes in 
Southern California prepare ointments, and others of Alaska 
have perfected plasters from cedar-rosin. 
The negroes of Victoria are said to control haemorrhage in 6 
ordinary wounds by suction ; they also believe in compres- 
sion and free drainage, and after suppuration subsides, they 
cover the parts with rosins; they also appreciate the neces- 
sity of reopening the wound in case it becomes foul or un- 
healthy. 
Whilst many deny that our North American Indians 
possess any therapeutic knowledge, it is nevertheless true 
that in suppurative and sloughing wounds, the Shaman pre- 
pares a decoction of willows, and by blowing it either 
directly from his mouth or by the use of a reed, he thor- 
oughly cleanses the wound, and thus employs, whether un- 
knowingly or not, I do not pretend to say, an antiseptic 
solution, the active principle of which we all know is sali- 
cylic acid; moreover, the Dakotas, in suppurative wounds, 
not infrequently introduce drains made of the bark of trees, 
and also employ a primitive syringe made from an animal 
bladder and a quill. 
Attemps to close wounds with sutures are not infrequent. 
Schoolcraft refers to some of our Indian tribes who employ 
sutures made of sinew or tree-bark, which are permitted to 
remain until after the sixth day. The natives of South Aus- 
tralia resort to compression, and the Winnebagos never per- 
mit ugly-looking wounds to heal by first intention, but 
keep them open, so as to heal from the bottom. 
Bartels gives a very interesting account of a visceral injury 
in the person of an Indian chief, who received a punctured 
wound of the chest anteriorly between the fourth and fifth 
ribs, implicating the lung and resulted in profuse haemor- 
rhage, which the Shaman was unable to control. During a 
violent fit of coughing, a portion of the injured lung was 
forced through the opening and became incarcerated ; this 
stopped the haemorrhage, but it puzzled the medicine-men 
what to do with the protruded viscera. They finally con- 
cluded that to return it into the cavity might result in a 
renewal of haemorrhage, and therefore decided to cut it off, 
boil it, and feed it to the patient. This was done, the inter- 
nal wound filled up with granulations, and the chief made 
a good recovery, with the exception of a pulmonary hernia, 7 
which manifested itself, however, only during violent fits of 
coughing. 
Another Indian, in an encounter with a grizzly bear, re- 
ceived the benefit of his paws in the shape of two ugly 
wounds, one affecting the left side of the face, tearing the 
cheek and ear and destroying the eye; the other penetrated 
the thorax in two places, blood and air escaping from the 
pleural cavity. The Indian was picked up for dead and 
carried to his tepee. Upon showing signs of consciousness, 
he was placed in a position favorable for drainage, and the 
wounds were assiduously bathed with some mucilaginous 
decoctions, and at the expiration of a few months, he was 
sufficiently well to take a long journey to the agency of 
Sault St. Marie. 
Baker reports the case of a native of Ceylon who encoun- 
tered a wild boar ; the animal having been slightly wounded, 
threw the native down and performed a rapid abdominal 
section ; a companion rushed to Weddah's assistance, re- 
placed the protruded intestines and applied an abdominal 
bandage. Baker saw the subject a few years afterwards, 
and an immense ventral hernia and a transverse bluish 
ciccatrix eight inches in length, attested the narrow escape 
of this native. He does not state whether a suture was 
employed or not; nevertheless, the case must be considered 
as a remarkable recovery from abdominal injury with vis- 
ceral protrusion. 
A few years ago, I was called to see an Indian girl who 
had been bitten by a rattle snake; the arm was enormously 
swollen, and the child showed profound constitutional 
symptoms, and would probably have perished if her father 
had not applied a buckskin ligature above the elbow. The 
wound in the thumb had been freely sucked and the en- 
tire arm covered with a poultice of chopped fresh lupine. 
Gunshot Wounds.-It is somewhat surprising that there 
are so few data concerning the treatment of this class of 
wounds. My experience is that the Indians, as a rule, pay 
very little attention to gunshot flesh wounds, and simply 
permit them to heal under the scab, corresponding to our 8 
primary occlusive method. In the treatment of shot frac- 
tures they resort to retentive splints, but do not pay suffi- 
cient attention to the reposition of the fragments. Bartels,, 
in speaking of the treatment of arrow wounds, refers to the 
Opoates of Mexico, who remove all blood clots by suction 
with the mouth, and afterwards dust the wound with peyote 
powder. In the course of two days, the wound is washed 
and again dusted with this powder; and after treatment 
every other day in this manner, the wound is dusted over 
with finely-powdered lechugilla root. This tribe is said also 
to employ balsams, prepared from the leaves of maguey, 
lechugilla, date-palm and rosemary. The Karok Indians 
cover their arrow wounds with tar from the pin us edulis. 
According to Bowditch, shot injuries of the extremities 
among the Ashantis, especially when complicated with 
hsemorrhage, usually prove fatal, as they have no means 
for the control of arterial bleeding. Wolff, in speaking of 
the negroes of Quango, rather admires their surgical skill, 
for he saw a man with a shot fracture of the tibia, dressed 
with a suitable splint made from swamp grasses, and ex- 
tending above the knee and below the malleoli. This splint 
secured perfect immobility of the fragments, and was, more- 
over, supplied with a fenestrated opening for the escape of 
the wound secretions. 
The Mincopies dress their shot wounds with leaves; and 
the Samoans, for the purpose of removing a barbed spear 
or arrow, make a counter-opening and push the missile 
through. The control of haemorrhage appears to be a diffi- 
cult task for most of the primitive people, and the majority 
are helpless in the face of blood. The Haidah Indians and 
some tribes in Alaska, resort to eagle-down, while the Da- 
kotas, Winnebagos and other tribes employ vegetable styp- 
tics; some in conjunction with compression. 
The Karayas of Brazil have recourse to circular con- 
striction ; and the natives of Humphrey Island and Mana- 
hiki apply the spongy part of an old cocoanut. In Mo- 
rocco, circular compression, and, if necessary, the applica- 
tion of hot pitch are employed. The South Sea Islanders- 9 
have some sort of primitive tourniquets, and use them in 
the treatment of arterial hsemorrhage, in connection with a 
native fabric made of the paper mulberry tree. The North 
American Indians, in violent nose-bleeding, stuff the nostrils 
with hot pulverized charcoal. 
The actual cautery appears to be a favorite remedy among 
primitive people for all kinds of ailments. The Mincopies 
apply a large flat and carefully heated stone in the treat- 
ment of skin diseases over the affected part. The Twana- 
Chemakum and Klallam Indians apply hot pieces of cedar 
bark in the treatment of rheumatic affections. The natives 
of Gilbert Island use hot pieces of cocoa-shell, and the In- 
dians of Southern California resort to the actual cautery by 
means of a live coal in the treatment of a primary syphi- 
litic ulcer. In Morocco, China and Japan, the cautery iron 
is used in a variety of surgical and other diseases. 
Fractures and Dislocations.-On the whole, the results of 
treatment of these injuries by primitive people are disap- 
pointing, and very few of them appear to have the slightest 
idea of the mechanism of these injuries. While it is true 
that many of them apply retentive splints, few appreciate 
the necessity of reposition of the fragments, extension and 
counter-extension, and the results are seen in many badly 
united limbs. The Creek and Winnebago Indians are said 
to have obtained some very gratifying results, while the na- 
tives of Southern Australia also manage their case quite 
well by the application of splints and clay. In many in- 
stances, after straightening the limb, it is surrounded with 
a casing of clay, which in time hardens and prevents dis 
placement. Bartels mentions a fracture of the femur thus 
treated, where there was no perceptible lameness or short- 
ness ; and in the case of a boy who sustained a fracture of 
the jaw by the fall from a horse, treated by the application 
of a clay-mask over the entire face, the result was equally 
satisfactory. 
Amputations.-Judging from the meagre data, it would 
appear that such operations are rarely performed. In Mo- 
rocco, the ablation of one or both hands is frequently pre- 10 
scribed as a mode of punishment; and Quedenfeldt reports 
that in these cases the haemorrhage is controlled by the ap- 
plication of hot pitch. Corre declares that the stumps are 
very neat and symmetrical, but we have no record where 
the operation was seen by an intelligent witness. 
Hernia is also rarely referred to, although it is well known 
that the umbilical variety is quite common, especially 
among the tribes of Africa. Moore saw a medicine-man at 
Radschputana apply a hot iron over an injured hernia, 
thus proving his ignorance of the nature of the case; a na- 
tive of the Loyalty Island operated upon himself for a 
femoral hernia, but perished in consequence. Schoolcraft 
says that our Indian tribes are perfectly at sea in the treat- 
ment of strangulated hernia, while in the reducible form 
they employ very suitable bandages. Quedenfeldt's collec- 
tion of trusses from Morocco shows that they treated their 
cases quite intelligently. 
Operations on the genito-urinary organs are frequently men- 
tioned. Castration appears to be a favorite treatment in 
hydrocele and orchitis, especially among the natives of 
Fahiti, Samoa, Tonga and the Loyalty Island. The Chi- 
nese are fond of the moxa in the treatment of vesical cal- 
culus. Moore saw a case at Radschputana where a vesical 
concretion had wedged itself in the neck of the bladder and 
finally ulcerated through the rectum. While most of the 
natives of India now seek relief at the hands of European 
surgeons, the operation is frequently performed by profes- 
sional stonecutters, much in the same way as it was done a 
century ago in Europe-viz: the finger is introduced into 
the rectum and the stone pressed against the perineum, an 
incision is made over the protruding part, and after dividing 
the walls of the bladder, the stone is removed by means of 
forceps. 
We have the history of a Kiowa chief who, in 1862, re- 
ceived an arrow wound in the right buttock; the shaft was 
removed by the Indian medicine-man, but the iron head hav- 
ing penetrated quite deeply, was permitted to remain. Im- 
mediately after the injury the patient voided bloody urine, 11 
but the wound healed kindly, and for six years the chief 
was able to engage in the chase without inconvenience. In 
August, 1869, difficulties in micturition and other symp- 
toms pointing to vesical calculus, induced him to seek the 
advice of Dr. W. H. Forwood, U. S. Army, at Fort Sill, who 
removed, by lateral lithotomy, an egg-shaped calculus which 
weighed nineteen drachms, and was found to consist of a 
uniform deposit of triple phosphate around the iron arrow- 
head. The patient was almost convalescent on the eighth 
day, when his band carried him to his camp sixty miles 
away, where an epidemic, of.fever was pievailing, and he 
died nineteen days afterwards. The specimen is now in the 
Army Medical Museum. 
According to v. Miklucho-Maclay, a peculiar operation, 
called "Mika" and "Kulpi,"is practised on boys at the 
age of twelve and fourteen, among the Diegerrie tribe, 
residing along Cooper's Creek, in Australia, consisting 
in a complete splitting of the urethra along the lower sur- 
face of the penis from the orifice to the scrotum According 
to Taplin,the operation is performed as follows: A suitable 
piece of kangaroo bone is introduced into the urethra as far 
as the junction of the scrotum, and using this as a guide, 
the operation is completed by means of a flint knife or shell 
fragment; sometimes the incision is made without a guide, 
the penis being placed on a piece of tree bark. After the 
operation, a piece of soft bark or a piece of bone is inserted 
to prevent adhesion of the wound surfaces. Of the effects 
of the operation, we are told that the urethra is no longer a 
canal, but a shallow groove, with the outlet close to the scro- 
tum, and they have to urinate in a feminine fashion. During 
a relaxed condition, the penis is very much shrunken, and 
has the appearance of a large button, while during an erec- 
tion, it is broad and flat, and in coitus the spermatic fluid 
is ejaculated outside of the vagina. The motive for this 
mutilation is stated by the natives to be a limitation of the 
offsprings, while others simply declare it to be the custom 
of their ancestors, and they follow it. The women of Nasim 
confirm the statement that men thus operated upon cannot 12 
beget children. It is a noteworthy fact that the finest 
specimen of manhood in some tribes are spared from this 
mutilation ; but among the Nasims, the custom appears to 
be reversed, as only the more promising types are selected 
as a mark of special distinction for this operation; and the 
Reporter adds, that they are special favorites among the 
women. Some of the natives of Brazil are reported to re- 
sort to external urethrotomy for the removal of a peculiar 
transparent fish about two c. m. in length, which is apt to 
slip in the urethra during bathing. 
Operations on the Neck and Trephining.-Corre reports a 
ease of extirpation of the cervical glands among the Ful- 
lahs in the territory of Rio-Nunez, and Flegel brought some 
instruments on his return from Haussa, which are used for 
the removal of membranes and secretions in the treatment 
of throat diseases; the instruments consist of hooks, tongue 
depressors and hollow chissels and spade-shaped implements. 
Primitive Trephining is practiced among the natives of 
Uvea, one of the Loyalty Islands. Samuel Ella, who has 
lived a long time among them, says that they are still in 
the stone age, and that it is a common belief among them 
that headaches, neuralgia, vertigo and other head symp- 
toms are the result of a crack of the skull or pressure upon 
the brain, and the remedy consists in making a crucial or 
T-shaped incision over the soft parts, and subsequently 
scraping the skull with a piece of glass until the dura mater 
is reached through an opening about the size of a silver dol- 
lar. Sometimes the operation in the hands of an inexperi- 
enced operator, or in consequence of impatient friends, is 
extended to the pia mater, and the patient dies in conse- 
quence ; as it is, about 50 per cent, prove fatal, but owing 
to superstition this barbarous custom has become so preva- 
lent that half of the adult population are seen with a hole 
in their skull. Ella adds, that it has been reported to him 
that sometimes a piece of cocoanut shell is placed over the 
opening to protect the membrane, the plate having been 
previously reduced to a suitable thickness, and neatly pol- 
ished. Formerly the tooth of a shark was extensively used 13 
in the operation, now they prefer a fragment of glass, and 
usually elect a point for the operation near the junction 
of the sagittal and coronial suture. 
George Turner confirms these observations, and says that 
whilst the mortality is great the curative effects are also 
well marked. Indeed, if these natives only lose 50 per cent, 
of their cases, the result is as good if not better than those 
obtained by civilized surgeons before the antiseptic era. 
Mr. Umlauff, of Hamburg, is in possession of a mummy 
from New Caledonia, which shows that the patient perished 
during the operation, for, as Bartels remarks, the operation 
was incomplete, and shows no reparative attempts, and that 
it was not performed postmortem for the purpose of libera- 
ting the soul or spirit of the deceased, is shown by the very 
incompleteness of the operation. 
Trephining is a very ancient operation, as shown by the 
numerous skulls found in different parts of the world, which 
date back to the neolithic period. Pruniers and Paul 
Broca have made a special study of the subject, and whilst 
some of the skulls indicate that the operation was performed 
postmortem, a goodly number present signs of reparative 
efforts, and others indicate that many of the subjects sur- 
vived the operation for some time. In none of the speci- 
mens, had the operation its seat in the frontal bone, whilst 
in the mummy referred to, and in a collection of pre- 
columbian, Peruvian skulls, the operation was invariably 
over the frontal bone. Squier, who has studied many of 
the specimens, is of the opinion that the Peruvians exe- 
cuted the operation by means of a chisel. 
Abdominal Operations.-It must be a matter of agreeable 
surprise to the abdominal surgeon to learn that some of the 
brilliant operations have been performed by primitive ope- 
rators. Bartels quotes Bancroft, who cites the case of an 
Onkanagan Indian, upon whom the abdomen was laid open 
and a large amount of fat removed ; the wound was closed 
with stitches and the patient recovered. A Chippeway In- 
dian is reported to have successfully performed Caesarian 
section upon his own wife, whilst Felkin, in 1879, witnessed 14 
at Kahura, in the Uganda of Central Africa, a Caesarian sec- 
tion, peformed by one of the medicine men of the tribe, and 
describes the operation as follows: 
The woman, a primipara, aged 20, was placed upon a re- 
clining couch, and after a partial stupefaction by means of 
banana wine, she was secured across her chest to the bed 
with a broad bandage made of bark fibre, another bandage 
secured her thighs, the ankles being held by an assistant; 
a second assistant stood on the right side of the bed and 
fixed the abdomen, whilst the operator with knife in his 
right hand, stood on the left side of the bed. After mur- 
muring some incantation, he washed his own hands and 
the abdomen of the patient with some banana wine and 
subsequently with water. He uttered a shrill note, which 
was answered by the multitude without, and made his in- 
cision, reaching from the pubis to the umbilicus, dividing 
the abdomen and uterus with one stroke of the knife, so that 
the amniotic fluid gushed forth. All bleeding points in the 
abdominal wall were promptly touched by an assistant with 
a red hot iron. The operator quickly enlarged the uterine 
incision, whilst an assistant held the wound apart, and 
when the uterine opening was sufficiently enlarged, he ex- 
tracted the child, which was given to another assistant, and 
the umbilical cord was promptly divided. The operator 
now laid his knife aside, and rubbed and pressed the womb 
with both hands; he also introduced his right hand into 
the uterine cavity and dilated the cervix with two or three 
of his fingers, and then removed the placenta and blood 
clots through the abdominal wound. In the meantime the 
operator endeavored to secure firm contraction of the womb, 
while the assistant cautiously applied the actual cautery to 
all bleeding points, and another assistant was kept busy try- 
ing to prevent protrusion of the intestines. The uterine 
wound was not sutured; the assistant relaxed his hold of 
the abdominal wound, which was covered with a porous 
grass mat, and the patient was lifted up and partly turned 
upon her side to permit, of free drainage of the abdominal 
cavity, after which she was gently placed upon her back, 
the mat removed, and the abdominal wound closed by 
means of seven slender but well polished nails, resembling 
accupressure needles and a twisted suture made of vegeta- 
ble fibre. The wound was covered with a thick paste, made 
from the chewed pulp of two different roots, over which a 
warm banana leaf was laid, and the whole secured by a 15 
firm bandage made of Mbugu-fibre. The woman bore the 
operation without complaint, and one hour afterwards 
rested very comfortably. 
Felkin reports that the temperature on the second even- 
ing after the operation was 101°, and pulse 108. The child 
was put to the breast two hours after the operation ; on the 
third morning the dressings were removed, and a few of the 
needles; the remainder were taken out on the fifth and 
sixth days. There was very little pus, which was removed 
by means of a spongy pulpa: and on the eleventh day the 
wound had entirely healed. 
It may be argued that the ancient Peruvians resorted to 
trephining for the purpose of liberating an evil spirit, but 
no such superstitious notion could have actuated the opera- 
tion just referred to, or the following instances, which actu- 
ally pre-suppose physiological knowledge, in so far as ova- 
riotomy has been performed by primitive people for the ex- 
press purpose of rendering the woman sterile. Roberts saw 
such a case in India, and Mac- Gillivray noticed at Cape 
York, in Australia, a dumb female on whom ovariotomy 
had been performed by a native medicine-man, so that 
she might not give birth to mute children. Rotsh observed 
among the natives of Australia, at Parapitshure Lake, a pe- 
culiar looking girl, who avoided the company of other 
women and was almost in constant company of young 
men, sharing their occupatiop and hardships, though mani- 
festing no special fondness for them.. The native guide 
pointed to the large cicatrices in the groin of this unfortu- 
nate girl, and in broken English explained, " All same 
spayed cow." Rotsh adds, that she was not the only spe- 
cimen he saw, but that it was the custom to supply a lim- 
ited number of hetaira, who cannot become mothers. 
In conclusion, permit me to repeat that the within notes, 
with slight exceptions, are a condensation of the subject- 
matter, compiled by Dr. Bartels, whose work is a monument 
of pains taking research and a most important ethnological 
contribution to the early history of medicine. 
1819 Q Street, N. W.