Medicine, Magic, and Religion

EDICINE, magic, and religion are abstract terms, 
each of which connotes a large group of social 
processes, processes by means of which mankind has 
come to regulate his behaviour towards the world 
around him. Among ourselves these three groups of 
process are more or less sharply marked off from one 
another. One has gone altogether into the background 
of our social life, while the other two form distinct 
social categories widely different from one another, and - 
having few elements in common. If we survey man- 
kind widely this distinction and separation do not exist. 
There are many peoples among whom the three sets 
of social process are so closely inter-related that the 
disentanglement of each from the rest is difficult or 
impossible; while there are yet other peoples among 
whom the social processes to which we give the name of 
Medicine can hardly be said to exist, so closely is man’s 
attitude towards disease identical with that which he 
adopts towards other classes of natural phenomena. 

METHODS OF INQUIRY 

In any attempt to study a social institution there are 
three chief lines of approach and methods of inquiry. 
We may examine the institution historically, seeking 
to learn how it has been built up, how this advance has 
taken place here and that there; we may study the 
social conditions under which it has progressed in one 

place, been stationary in another, and degenerated in 
a third; and we may attempt to go back to its origin, 
and ascertain the steps by which it has become differen- 
tiated from other institutions, and has acquired an 
independent existence. 

A second method is the psychological. We may 
attempt to study the states of mind, individual and 
collective, which underlie the acts, again individual 
and collective, the sum of which make up the institution 
in question. 

The third method, which may be called the socio- 
logical method, is the inquiry into the relations of the 
social processes which we are attempting to study to 
other social processes, in order to determine the 
interactions between the two. 

Since the object of the FitzPatrick Lectures is the 
study of the history of medicine, it might seem that the 
first of these three lines of inquiry should form their 
subject. This would certainly be so if medicine were 
everywhere the independent and self-contained institu- 
tion which it is among ourselves; but if my opening 
statement is correct this is very far from being the case. 
A necessary preliminary to any knowledge of its history 
must be the study of its relations to those other social 
processes with which it is associated. This preliminary 
task will occupy us in these lectures, which will deal 
with certain prolegomena to the early history of 
medicine, rather than with the history of medicine itself. 

It would be quite impossible within the scope of this 
book to deal with the subject exhaustively. My object 
will be rather to consider lines of inquiry by which the 
subject may be studied ; and for this purpose I shall 
limit myself as far as possible to one part of the world, 
viz. Melanesia and New Guinea, which have been 
especially the field of my own researches, with occa- 
sional references to the allied culture of Australia. The 

THE SOCIAL PROCESSES 

time has gone by in sociology when we tried to under- 
stand human institutions by comparing examples 
taken at randon from every part of the world. The 
present trend‘ in the science which deals with these 
- matters is to limit inquiries to a series of related peoples. 
If we reach conclusions by means of such inquiries, we 
can then proceed to see if they will apply in other parts 
of the world. 

DEFINITION OF THE SOCIAL PROCESSES 

I must begin by defining the three kinds of social 
process which are to be the subject of our study. The 
distinction between magic and, religion is one which 
has long tried the ingenuity of students of human 
society. Among many peoples, including those with 
whom this book will especially deal, it is far from easy 
to draw any definite line between the two, and we need 
a term which will include both. A word which is some- 
times used in this sense in English is magico-religious, 
and, in default of a better, I shall use it occasionally 
in this book. The use of this word will imply a certain 
attitude towards the world. If the matter be looked at 
from our point of view, this attitude would be one in 
which phenomena are dealt with by supernatural 
means. I say if regarded from our point of view because, 
of course, the use of the word supernatural implies 
the existence of the concept of the natural, and it is 
just this concept, as we have it, which is lacking among 
the people with whom I shall deal. The essence of 
medicine, as we now understand it, is that it regards 
disease as a phenomenon subject to natural laws, to 
be treated as we treat any other department of nature. 
The distinction between the attitude of the modern 
practitioner of medicine and the magico-religious 

1 [This was written in 1915. Since then there has been a change 
of attitude. ] ‘ 

tod 

attitude depends on the difference in the concept of 
disease in the two cases. One chief object of this book 
will be to discover what is the nature of the concept 
of disease among whose who fail to distinguish medicine 
from magic and religion. 

While the main topic will thus be the nature of the 
concept of disease among certain peoples of rude culture, 
and the relation of this concept to those underlying 
magic and religion, it will be interesting to pay atten- 
tion to the distinction between these two groups of 
social process. A full study of this distinction would 
take us too far from our main subject, and I must be 
content to use a provisional distinction, which will be 
useful for descriptive purposes. When I speak of 
magic, I shall mean a group of processes in which man 
uses rites which depend for their efficacy on his own 

' power, or on powers believed to be inherent in, or the 

attributes of, certain objects and processes which are 
used in these rites. Religion, on the other hand, will 
comprise a group of processes, the efficacy of which 
depends on the will of some higher power, some power 
whose intervention is sought by rites of supplication 
and propitiation. Religion differs from magic in that 
it involves the belief in some power in the universe 
greater than that of man himself. 

Magic and religion are thus differentiated from one 
another by their attitude towards the means by which 
man seeks to influence the universe around him. 
Medicine, on the other hand, is a term for a set of social 
practices by which man seeks to direct and control 
a specific group of natural phenomena—viz. those 
especially affecting man himself, which so influence his 
behaviour as to unfit him for the normal accomplish- 
ment of his physical and social functions—phenomena 
which lower his vitality and tend towards death. By 
a process of generalization, society has come to classify 

CONCEPT OF DISEASE 

these phenomena together, and has distinguished them 
from other groups of natural phenomena under the 
name of disease. As I have already said, one of the 
chief tasks of this book will be to ascertain how far 
this notion of disease, this category of the morbid, 
exists among the peoples included in our field of study ; 
and we shall do this mainly by means of an inquiry 
into the processes by which man reacts to those 
phenomena we call morbid. 

CONCEPT OF DISEASE BY VARIOUS PEOPLES 

One way of approaching the problem will be to 
inquire how far different groups of mankind have set 
apart certain members of the community to deal with 
the morbid. When we have evidence of such division 
and specialization of social functions, we shall have 
at the same time definite evidence that those who have 
reached this specialization of function have also reached 
a stage of thought in which they separate morbid from 
other natural phenomena. One point of nomenclature 
may be considered here. In dealing with the subject 
of medicine from the comparative point of view, and 
among peoples of rude culture, we are met by a diffi- 
culty arising out of the wealth of the English language 
in terms for practitioners of the healing.art. When in 
this book I am to speak of those members of the 
community whose special business it is to deal with 
disease, am I to call them doctors, medical-men, 
medicine-men, physicians, or what? Medicine-men 
might seem the most appropriate of these, in that it 
is not a term used of our own practitioners, and will 
thus carry with it no connotation derived from our 
civilization. It suffers, however, from the disadvantage 
that it comes to be widely used in anthropological 
literature for sorcerers and dealers in various forms of 

magic, who may have no dealing with the morbid, and 
certainly exercise no therapeutical activities. I propose 
therefore, to use the old English term “ leech ’’. When 
I speak of a leech I shall mean a member of society 
whose special function it is to deal with the cure of 
disease. He may have other functions, such as the 
formation of rain, the promotion of vegetation, or even 
the production of disease itself ; but in so far as he is 
dealing with the cure of disease he will be, in the 
nomenclature I shall use, a leech. 

One of the methods, then, by which we may seek 
to ascertain how far different peoples of the world 
distinguish morbid from other natural phenomena is 
by inquiring how far they distinguish the leech from 
the sorcerer or the priest. The chief line of inquiry, 
however, will be an examination of the processes by 
which man at different stages of culture deals with 
disease. We shall find that, even when there is no clear 
differentiation of the leech from other members of 
society, mankind has theories of the causation of 
disease, carries out proceedings which correspond with » 
those we call diagnosis and prognosis, and finally has 
modes of treatment which, even if they have little in 
common with our own remedies, nevertheless may be 
regarded as making up a definite system of therapeutics. 

I have said that one of my chief objects will be an 
attempt to discover the nature of the concept of disease 
held by different peoples. I must first say a word about 
what we mean when we speak of a people possessing 
and acting on such a concept. I do not mean sucha 
clear concept as is held, say, by the writer of an 
European textbook of medicine, a concept capable of 
being expressed by the formula we call a definition. 
Such a concept is the result of a very advanced process 
of generalization and abstraction, and we all know how 
difficult it is to frame such a definition, even with the 

CAUSATION OF DISEASE 

large system of exact knowledge which we possess. It 
is evident that when we speak of the concept of disease 
held by such a people as the Melanesians we mean no 
exactly formulated definition, but a more or less vague 
system of ideas, which, though not distinctly formulated 
by a people, yet directs their behaviour—their reactions 
towards those features of the environment which we 
have classified together under the category of disease. 

BELIEFS AS TO CAUSATION OF DISEASE 

One element of the concept of disease, and perhaps 
the most important, is that it includes within its scope 
the factor of causation. There are usually clear-cut 
ideas concerning the immediate conditions which lead 
to the appearance of disease. One happy result 
of this fact is that we are able to approach our subject 
by way of etiology, and are thus led to deal with the 
medicine of savage peoples from the same standpoint 
as that of modern medicine, which rests, or should 
rest, entirely upon the foundation of etiology. By 
starting from etiology we shall find ourselves led on as 
naturally to diagnosis and treatment, as is the case in 
our own system of medicine. 

If we examine the beliefs of mankind in general 
concerning the causation of disease, we find that the 
causes may be grouped in three chief classes : (1) human 
agency, in which it is believed that disease is directly 
due to action on the part of some human being ; 
(2) the action of some spiritual or supernatural being 
or, more exactly, the action of some agent who is not 
human, but is yet more or less definitely personified ; 
and (3) what we ordinarily call natural causes.. 

Among ourselves there are indications of the presence 
of all three kinds of belief, and this was certainly so in 
the not very remote past. We now only think of human 

agency in cases of poison and injury, and then only as 
the means by which the action of natural causes has 
been directed. The second category still exists in the 
“hand of God ”’ of our statutes, and in the oral rites of 
our religion, but has ceased to take any part in orthodox 
medicine, though it still plays some part in the 
behaviour of the laity towards disease. In the pro- 
fessional art of medicine, and in the practice of the 
majority of the laity, the attitude towards disease is 
directed by the belief in its production by natural 
causes, meaning by this a body of beliefs according to 
which disease comes into being as the inevitable result 
of changes in our environment quite independent of 
human or superhuman agency. 

If, on the other hand, we examine the culture of any 
savage or barbarous people, we find that their beliefs 
concerning the causation of disease fall in the main into 
one or other or both of the first two categories, while 
in many cases the third category can hardly be said 
to exist, and even then we cannot assign the beliefs 
to the category of natural causation. I shall deal with 
these cases more fully in the second chapter. For the 
present I shall confine my attention to those cases in 
which the native ideas concerning causation bring 
them within the realm of magic or religion. In this 
chapter I shall deal with cases which must either be 
definitely classed with magic, or belong more nearly to 
this category than to that of religion. 

It would greatly simplify the treatment of our 
subject if the line of cleavage between the cases of 
causation of disease by human and non-human agency 
corresponded with the distinction between magic 
and religion. When writing this book I was at one 
time inclined to throw the distinction between magic 
and religion on one side, and describe the facts with 
which I shall have to deal under the headings of human 

DISEASE OR INJURY ASCRIBED TO MAGIC 

and non-human agency. Such a plan, however, would 
only have avoided a difficulty which it is better to 
face, for if we treat medicine from the sociological 
standpoint we must study it in relation to other 
recognized social processes. Unless we are prepared 
to throw the categories of magic and religion aside 
altogether, they cannot be ignored in any discussion of 
the social relations of medicine. 

DISEASE OR INJURY ASCRIBED TO MAGIC 

The concept of magic which at present holds good 
in sociology and ethnology is largely influenced by the 
art called by this name in our own Middle Ages. The 
best known form of mediaeval magic was one in which 
non-human, spiritual agents took a most important 
part. These beings acted as the immediate producers 
of disease and other effects, the magical character of 
the proceedings resting on the belief that the non-human 
agents had come in one way or another under the power 
of the human magician. 

The magic of many peoples of rude culture, including 
those of the area with which I especially deal, differs 
widely from this in that disease or injury is, In many 
cases, ascribed to purely human agency, even when to 
us the real cause of the condition would seem to be 
obvious. This mode of causation is not merely brought 
into play to explain cases of illness which have no 
obvious antecedent, but also those in which what we 
should call the natural cause is obvious. Thus, if a 
man is killed or injured by falling from a tree in the 
Island of Ambrim in the New Hebrides, the fall is not 
ascribed to a loose branch, or to some failure of co- 
ordination of the movements of the climber, but the 
accident, as we loosely call it, is put to the account of 
the sorcerer. It is probable that the sequence of ideas 
in the Melanesian mind is that, in a business so familiar 

y 

as that of climbing trees, accidents would not happen 
unless someone has interfered with the normal course 
of events. Ifa sorcerer had not loosened a branch, or 
produced an illusion whereby the victim had seen a 
branch where there was none, he would not have 
fallen to the ground. 

Similarly, death or injury in battle is not ascribed 
to the superior skill of the enemy, or to a failure of 
defence, but it is believed that a sorcerer has directed 
the missile of the assailant, or has interfered with the 
defensive motions of the victim, or the integrity of his 
weapons. A case of snake-bite is not ascribed to the 
act which, according to our ideas, is natural to a 
venomous animal, but it is believed that the snake has 
been put in the path of the victim by a sorcerer, or 
has been endowed with special powers by a sorcerer ; 
or it may even be held that the animal which has bitten 
the victim is no ordinary snake, but the sorcerer himself 
in snake-like form. 

To those whose main category of the causation of 
disease is human agency there is a firmly rooted belief 
in this mode of production, not only where causation 
would otherwise be mysterious or unknown, but also 
in those cases where the cause would seem, even to the 
most uninstructed lay mind in our own community, to 
lie within the province we call natural. It may be 
noted, moreover, that such ideas concerning the 
causation of disease are not empty beliefs devoid of 
practical consequences, but act as the motives for 
processes of treatment in case of injury, or for acts 
of revenge if the magical process should lead to the 
death of the victim. If we were so to define magic as 
to identify it with the exclusive action of human 
beings, this part of our subject would soon be treated. 
The art of diagnosis would consist in the discovery of 
the human agent, and the essential elements in the 

DISEASE OR INJURY ASCRIBED TO MAGIC 

treatment would be the use of measures which would 
lead the sorcerer to put an end to the actions by which 
he is effecting his maleficent purpose. 

In addition to these cases of purely human agency, 
there are many others in which our records tell us 
explicitly of conditions closely similar to those of our 
own Middle Ages, in which the immediate cause of the 
disease is the action of some non-human being, who is 
either under the control of human agency from the 
beginning, or is capable of being brought under such 
control when it is desired to influence the results 
produced by its action. In such cases the methods of 
diagnosis and treatment are often indistinguishable 
from those employed where the morbid condition is 
ascribed to direct human agency. Disease or injury 
believed to be produced by spiritual agency is treated 
without any element of those processes of supplication 
and propitiation as would be necessary to bring them 
within the scope of our definition of religion. 

In those cases in which a leech acts through the inter- 
mediation of non-human beings, our records often leave 
us in doubt whether the curative actions should be 
regarded as magical or religious. A decision on this 
question can only be reached through an exact 
knowledge of the rites, manual and verbal, by which the 
leech effects his purpose ; and itis only rarely that field- 
workers record these, being too often content to base 
their opinions on inferences contaminated by ideas 
derived from their own sphere of knowledge and 
interest. 

My own opinion—it is nothing but an opinion—is 
that, as our exact knowledge of the leechcraft of different 
parts of the world increases, we shall find that the 
religious element in medical rites has been underesti- 
mated, or even ignored where it exists. At any moment, 
however, in the history of a science we must base our 

arguments upon the recorded facts: and in the account 
which I shall give, my object will be to illustrate the 
difficulties and uncertainties of the subject, rather than 
lay down any definite conclusions. 

The cases I shall consider in this chapter are those 
in which it is believed that disease is directly due to 
human agency, and those in which on the available 
evidence it would seem that the methods of diagnosis 
and treatment depend on power believed to be inherent 
in the leech and his rites, or become effective through 
the intermediation of non-human beings, who need no 
definite rites of propitiation and supplication to 
persuade them to intervene in the curative process. In 
considering these cases it will be useful to distinguish 
certain classes, according to the nature of the process 
by which it is believed that disease can be produced ; 
the method of treatment being as a rule such as would 
follow from the nature of the cause. 

Three main classes may be distinguished: (1) Those 
in which some morbific object or substance is projected 
into the body of the victim ; (2) thosein which some- 
thing is abstracted from the body; and (3) those in 
which the sorcerer acts on some part of the body of a 
person or on some object which has been connected 
with the body of a person, in the belief that thereby 
he can act on the person asa whole. These three classes 
will now be considered in detail. 

DISEASE ASCRIBED TO OBJECT OR INFLUENCE 
PROJECTED INTO ViIcTIM’s Bopy 
The class of cases in which the cause of disease is 
supposed to be some object or substance which has 
been projected into the body of the victim fall into two 

groups, according as the morbific objects have found 
their way into the body of the victim by direct human 

ASCRIPTION OF DISEASE 

agency, or by the action of some non-human agent. 
Both kinds are of frequent occurrence in Australia, 
where material objects such as stones, crystals, frag- 
ments of bone, or leaves are believed to be projected 
into the body, in some cases by sorcerers, and in other 
cases by spiritual beings, who thus punish intrusion 
into their sacred haunts or other offence. Disease is 
also produced in this manner among the Massim of 
New Guinea.} 

In Melanesia this mode of production of disease by 
the projection of material objects into the body seems 
to be exceptional. Where disease is believed to be due 
to such projection, it is usually held that some invisible 
influence has been projected into the body, and even 
where some material substance has been introduced, it 
is not supposed that the object itself produces the 
disease. This is ascribed rather to some morbific 
essence or effluvium, of which the material object is 
but the carrier and visible sign. 

A good example of such a mode of production of 
disease, which occurs in more than one part of Melan- 
esia, is by means of an instrument called, in the Banks 
Islands, ¢amatetikwa, or ghost-shooter. A mixture of 
leaves, a dead man’s bones, and other ingredients are 
placed in a slender bamboo, which the sorcerer holds in 
his hands, with the thumb over the open end, till he 
sees his enemy, when the removal of the thumb allows 
the evil influence to reach the victim. Dr. R. H. 
Codrington has recorded? some dramatic cases, in 
which this method was employed, that very well 
illustrate the profound belief in its efficacy. By means 
of suggestion the ghost-shooter will kill a powerful and 
healthy man in a couple of days. A less direct pro- 

1C. G. Seligmann, The Melanesians of British New Guinea, 
Cambridge, 1910. 
2 The Melanesians, London, 1891, p. 205. 

cedure, customary in the Banks Islands, and there 
called talamatai, is to wrap a parcel consisting of a 
dead man’s bone, or part of an arrow which has killed 
a man, in leaves and place it on the path over which 
the person whom it is desired to injure will shortly 
pass. The magical principle will spring out of the 
bundle, and pass into the body of the victim. 

In cases of illness thus caused by the introduction 
of morbific objects or essences into the body of the 
patient, the treatment follows directly from the etiology, 
its aim being to extract the object or essence from the 
body, and thus remove the cause of the disease. For 
this purpose it is not always, or even usually, necessary 
to discover the agent by whom the objects have been 
introduced. In communities that ascribe disease to 
this cause there are men and women who are believed 
to have the power of removing objects, usually by 
sucking some part of the body; after which a stone, 
crystal, or other object is shown tothe patient, as having 
been removed by the process. Since, in many such 
cases, the disease has been produced by a suggestion, 
set in action by the knowledge of some cause of offence 
to one believed to have the power of producing disease 
in this way, the sight of the object thus said to have 
been removed effects a rapid cure in removing the 
suggestion. In some cases, and especially in those in 
which the projected substance is of an immaterial 
kind, it may be necessary to discover the agent who 
alone can remove what has been implanted in the body, 
and in this case some method of divination is usually 
employed to discover by whom the disease has been 
produced. 

ASCRIPTION OF DISEASE 

DISEASE ATTRIBUTED TO ABSTRACTION OF PART OF 
Bopy OR SOUL 

The second mode of production of disease is that in 
which it is believed that something is abstracted from 
the body. Examples of this occur in Australia, where 
the abstraction of the kidney fat, or, perhaps more 
correctly, of the fat of the omentum, forms one of the 
most widely held beliefs. In New Guinea and Melan- 
esia this belief does not, so far as we know, exist ; but 
in many parts of these regions the people believe in the 
causation of disease by the abstraction of the soul or of 
some part of it. The Melanesian examples of this 
process, are all, so far as we know, due to spiritual 
agency. 

Thus, in the Banks Islands, the ataz or soul may be 
taken from a man by one of the spirits called vu. The 
treatment consists in the recovery of the soul by one 
called gismana, whose atat leaves his body in sleep and 
seeks out the soul of the patient. 

Another example, of which we have a full record,? 
comes from the Gazelle Peninsula of New Britain and 
Duke of York Island, where it is believed that disease 
is produced by one of a group of beings called kata, which 
have the body or tail of a snake and the head of a man. 
The kava usually acts in this way on one who has 
intruded on its haunts, or taken fruit without proper 
authorization from trees in the district it inhabits. 

If anyone falls ill in these places, the people resort to 
a process of divination to determine whether the 
disease is due to the action of a Raza, or has arisen in 
some other way. The diviner places under his arm-pit 
a piece of shell-money enclosed in a lime-strewn banana 

_ 1W. H. R. Rivers, History of Melanesian Society, Cambridge, 
1914, vol. i, p. 165. 
2 J. Meier, Anthropos, vol. iii, 1908, p. 1005. 

leaf, and falls into a sleep. He then learns, not only 
how the disease has been produced, but, if it is due to 
a kaia, he is able to tell the nature of the fault which 
has incurred the anger of the half-snake half-human 
being. The diviner, who also acts as a leech, then 
proceeds to carry out his treatment. 

In the Duke of York Island, lying between the 
northern end of New Britain and the southern end of 
New Ireland, this treatment is as follows: The leech 
sprinkles lime on a dracaena leaf, enfolds it in a leaf of 
another kind, and places the packet so formed on a fire 
until it is almost carbonized. The patient then stands 
with raised arms, and the leech passes the hot packet 
over his body with movements resembling the 
curves of the body of a snake, while the patient stamps 
on the ground so as to shake off the influence of the 
kata. Then the leech opens the packet and takes there- 
from a pinch of the lime, over which he incants the 
following formula :— 

_. “Lime of exorcism. (I banish the octopus jaet 

banish the #eo snake; I banish the spirit of the Ingzet 
(a secret society) ; I banish the crab; I banish the 
water-snake ; I banish the balivo snake; I banish the 
python ; I banish the kava dog (a special kind of dog, 
unlike the existing dog of New Britain, which forms ~ 
one of the companions or familiars of the kata. The 
other animals mentioned in the formula are also 
familiars of the kaza). 

“Lime of exorcism. I banish the slimy fluid; I 
banish the kefe creeping-plant ; I banish To Pilana ; 
I banish To Wuwu-Tawur; I banish Tumbal. One 
has sunk them right down deep in the sea. Vapour 
shall arise to hold them afar; clouds shall arise to 
hold them afar; night shall reign to hold them afar ; 
darkness shall reign to hold them afar; they shall 
betake themselves to the depths of the sea.” 

ASCRIPTION OF DISEASE 

This is a literal translation of the original. Father 
Meier gives the following as the expression of its full 
meaning :— 

‘“‘ This is lime for exorcism with which I drive away 
the octopus, the different kinds of snake, the spirit of 
the Jngzet and the kata dog. This is the lime with 
which I drive away the slime of the kava pool, the 
creeping-plant called kete, and the kaza called To 
Pilana, To Wuwu-Tawur, and Tumbal. I have sunk 
them and they are now below in the deepest depths of 
the sea. Thick vapour, impenetrable cloud, dark 
night and black darkness shall surround them and block 
their way for ever to the upper world so that they shall 
remain for ever in the infinite abyss of the sea.”’ 

When the formula is finished the leech blows the 
lime over the patient and more lime is smeared on his 
body, especially in the epigastric region, on the arms 
near the shoulders, and on the ears and great toes. 
The packet is then thrown away, and the upper part 
of a coconut three-quarters ripe is husked with the 
teeth, and a hole bored in the shell round which red 
ochre issmeared. The leech then rubs in his hands the 
bloom of a species of mint, puts the fragments in the 
nut, and utters the following formula over the nut to 
act upon its milk :— 

“The coconut of exorcism. I banish the slime of the 
kaia; I banish the slime of the crab; I banish every 
pool with yellow slime; away with every swarm of 
teo snakes; away with the spittle of the ¢eo snake ; 
away with To Wuwu-Tawur; away with all the sap 
of the kete creeper; away with every alai-pukat 
creeper ; away with all red-brown water (water con- 
taining reddish algae). 

‘‘T banish every water of the kata; away with 
every octopus; away with all the blood of the tree- 
snake. 

‘‘T banish every puffed-up belly; I banish every 
dried-up shrub and grass; I will fetch his soul again 
from the hollow of the kaza.’”’ (The kata are said to 
dwell in hollows in the hills.) 

The leech then bespatters the patient with saliva, 
gives him the coconut to drink, takes his fee, and goes. 

This production of disease by the kata comes in 
several respects very near the domain of religion, but 
I have included an account of the proceedings connected 
with it in this chapter because the treatment bears no 
evidence whatever of any appeal to, or propitiation of, 
higher powers. The attitude towards the kava itself 
is evidently that of the exorcist acting on a being who 
is believed to be capable of control by the leech through 
his knowledge of the proper rites, manual and verbal. 
It is, of course, possible that behind the whole pro- 
ceedings there may be the idea of appeal to some 
higher power of which the formulas provide no evidence ; 
but we can only act on the evidence before us, and this 
shows no trace of any such idea. We have here an 
example of social activity which we must provisionally 
label as magic, but of a magic which differs funda- 
mentally from that of the Australian or inhabitant of 
Torres Straits, a magic which approaches in its general 
character, as well as in many of its details, that of our 
own.-Middile-Ages: It is not a process by which one 
person counteracts the injurious influence, of another 
person, but one by which a human being, through the 
knowledge of the appropriate rites, is able to act upon 
a non-hunian being in such a way as to counteract his 
influence. 

MAGICAL ACTION ON SEPARATED PART OF VICTIM’S 
Bopy oR TOUCHED OBJECT 

The third kind of process which I have included under 

the heading of magic is that in which disease is believed 

MAGICAL ACTION ON VICTIM’S BODY 

to be produced by acting upon some separated part of 
the body of the victim, or on some object which has 
been in contact with him This kind of magic, usually 
known as sympathetic magic, has been so frequently 
considered? that it is hardly necessary to consider 
cases in detail. I propose to confine my attention to 
one example, which may help us to understand the 
exact nature of the process more clearly than has 
hitherto been possible. This example has only 
recently been recorded by Keysser,* a missionary 
among the Kai, an inland people of the north-eastern 
part of New Guinea. This procedure is of especial 
interest in that it shows the presence among this 
people of ideas concerning sympathetic magic which 
brings it into close relation with our second category, 
in which disease is produced by the abstraction of 
something from the body. According to Keysser, 
the Kai believe in a soul-substance which permeates 
not only every part of the body, but also extends its 
presence to anything which has been in contact with 
_ the body. When a sorcerer secures part of the body 
of his proposed victim, or an object which has been in 
contact with his body, he is believed to be really 
securing part of the soul of the person, and it is by the 
action of his magical processes upon this isolated 
portion of the soul that the rites of the sorcerer produce 
their effect. 

A sorcerer who thus secures part of the soul-substance 
of one whom he wishes to injure, repairs to a lonely hut 
situated in a spot reputed to be the haunt of a ghost or 
other spiritual being, so that it is avoided by all except 
those who have undergone special initiation into this 

1 See especially J. G. Frazer, The Magic Art, London, 1911. For 
examples from Melanesia, cf. Rivers, op. ctt., i, 156. 

2 In Deutsch Neu-Guinea, by R. Neuhauss, Berlin, 1911, vol. iii, 
p. 135. 

mode of magic, or have in some other way acquired 
knowledge which enables them to visit the spot with 
impunity. Often several sorcerers act in concert, each 
performing the rites I am about to describe, at first 
independently and later in concert. 

The fragment of the body of the victim, or of some- 
thing which he has touched, by means of which the 
sorcerer acts, is called gé. It may be hair, a drop of 
sweat, excrement, remains of food, or even a piece of 
wood which the victim has touched. The gd must 
have been freshly removed from, or been in contact 
with, the body of the victim, so that the sorcerer can 
be confident that it still contains the soul-substance of 
his victim. In order to ensure its retention the  ¢@ is 
put at once in a piece of bamboo, which is hidden and 
kept warm by being placed in the arm-pit of the 
sorcerer. The ¢¢ must not be taken near fire or smoke, 
nor must it be brought into contact with water, or 
with any sharply pointed object, for all these condi- 
tions tend to expel the soul-substance from its resting- 
place. 

As soon as possible the sorcerer wraps the g@ in a 
leaf of which caterpillars are fond, with the idea that, 
as the leaf is eaten by caterpillars, so will the body of 
the victim be eaten by worms. The gé wrapped in the 
leaf is put in a small bamboo, which must have been 
taken from a place inhabited by ghosts or spirits. 
Fragments of the bark of certain trees are added to the 
packet ; some are added in order to make it heavy, 
for it is by means of the weight of the packet that one 
judges whether the soul-substance is present or has 
disappeared. Another tree, the bark ofwhich is added, 
has a very thick stem, and is used in the hope that the 
body of the victim will swell, while the bark of the 
other trees is added on account of their evil smell. The 
bamboo and bark are wrapped in another leaf and bound 

MAGICAL ACTION ON VICTIM’S BODY 

up with a creeper which withers very quickly, pointing 
thus to the rapid wasting and death of the victim. 
The packet so made is closely bound till it is just of a 
size to go into a larger piece of bamboo, which must 
also come from the abode of a ghost or spirit. This is 
put in yet another bamboo, which is sealed with the 
inspissated sap of a tree and covered with shells. As 
the packet is thus wrapped and sealed, the sorcerer 
calls to the white cockatoo: ‘‘ Cockatoo, Cockatoo, 
come and tear open the body of X; bite his entrails 
to pieces so that he dies.’”” The packet is then bound to 
a rod, and over it are sung words by means of which 
the spirits are summoned from the hollow where they 
dwell to take the soul of the victim to the home of the 
dead. The packet is wrapped in a prickly creeper so 
that the body of the victim shall be tormented with 
painful stings, and then in a leaf with fine hairs which 
tickle and irritate the skin, and the whole is wrapped in 
a withered leaf of the bread-fruit tree, with the idea 
that, as the leaf falls to the ground, so shall the body of 
the victim wither and fall into the grave. 

During all these proceedings the sorcerer murmurs : 
“ Oha and Wakang ; ye two giant lizards; lay your- 
selves on his soul and press upon it so that all joyful 
springing and all pleasure shall cease. Stop his ears 
so that he no more hears and his thoughts become 
confused.” As these words are uttered the sorcerer 
beats with his open hand upon the packet, in order that 
painful blows may affect the body of the victim. The 
packet is then bound once more with a creeper, while 
the following formula is uttered: ‘‘ Fall and rot like 
the gherkins. Let the victim disappear in pains. May 
his limbs writhe in pain. May his whole body writhe 
in pain. May his entrails become contracted in pain. 
May his generative organs be distorted in pain.” 
These proceedings are not carried out once merely, but 

are repeated again and again, it may be for many 
months. 

Every other day the sorcerer enters the lonely hut 
where he keeps the imprisoned soul and treats it in 
this way, putting the packet on each occasion upon the 
ashes of the fire, and this goes on until the victim 
begins to sicken, when the proceedings enter upon a 
new phase. The packet is heated at the fire after being 
covered with fine prickles, and the bark of a tree 
covered with tubercles is added so that the body of 
the victim may be covered with similar lumps. The 
packet is bespattered with the chewed root of a hot 
peppery plant so that the victim shall have fever. 
The fire at which the packet is heated must be made 
only of certain woods and of a creeper, the section of 
which darkens when it is cut, with the idea that the 
skin of the victim shall darken and his blood become 
black. Every day, if possible, the packet is laid on the 
fire with the words: 

“Fagle and Hawk. Ye both, here is your prey. 
Seize it with sharp claws. 

Rend his body and tear it to pieces. Then may 
corruption and worms, maggots and beetles 
utterly destroy his body.” 

At every repetition of this spell the packet is turned 
round by an assistant, while the sorcerer himself 
mimics the agony of his victim. He cries, shouts, and 
groans, as if in pain. He complains to his friends who 
visit him, and prays for help and sympathy, and his 
assistant comforts him in the way of one who visits 
a friend in so grievous a situation. Finally, the 
sorcerer groans like a dying man, imitates the death- 
rattle, draws his last breath, and pretends to be dead. 
Before leaving the packet for similar treatment on 

MAGICAL ACTION ON VICTIM’S BODY 

another day he puts it between pieces of wood weighed 
down with a stone, and covers the whole with ashes. 

In order to reassure himself from time to time that 
the soul is still in the packet, the sorcerer goes to the 
hut in the darkness and listens. If he hears a rustling 
in the roof of the hut, or any other sound, he is satisfied 
that the soul is still there, and that his labours still 
await their reward. To assist his purpose, however, 
he must submit to many hardships and restrictions. 
He must not bathe nor let rain touch his skin. He 
may only drink the water of puddles which have been 
heated in the sun, for the cool water of a stream would 
allay the burning fever of his victim. Even pure water 
of any kind may be regarded as unsafe, and the 
sorcerer may drink only water which has been used for 
cooking. He must not eat boiled vegetables, but 
must roast his favo at a fire. During the whole pro- 
ceedings he must abstain from sexual intercourse, 
nor should he take food from men who have not so 
abstained. 

In the hut where the packet is kept there must be 
deathly silence. No one must speak aloud nor cough 
loudly. All conversation must be conducted in whispers. 
No wood may be broken, and such noise as that pro- 
duced by treading on twigs must be avoided. The hut 
itself consists of two chambers, in the smaller of which 
the packet is kept, and no light is allowed to enter this 
chamber, so that the imprisoned soul may receive no 
ray of hope for its escape. 

The whole proceedings reach their climax at a feast 
which has brought together the people of many parts. 
The sorcerer and his companions leave the rest, and 
assemble in the lonely hut. All those who have been 
carrying out these rites bring their bundles with them. 
These are weighed on the open hand, so as to judge 
whether the soul is still present, and those found to be 

too light are set aside. The rest are put in an old pot 
covered with sherds, strewn with ashes, and surrounded 
with a ring of fire. Then the sorcerers imitate the 
sickness of the victim, after which the packets are 
taken from the spot and laid on an open fire so that 
the outer coverings are consumed, with the idea of 
bringing the disease of the victim to a crisis. The 
sorcerers writhe as if in mortal pain, sigh, groan, and 
utter loud complaints. Their friends visit them, pity 
them, and express opinions about the people by whom 
they may have been bewitched. While some of the 
sorcerers are thus simulating mortal sickness, others 
take the packets from the fire and wring them between 
pieces of cloth, with the idea that the victim shall be 
smitten with mortal agony, his throat and heart pressed 
together, his breath driven out, and he himself driven 
to death by terror and despair. The pieces of cloth 
are cut and each packet falls to the ground, while 
some mimic the death of the victim and others utter 
his death-wail. At the same time a tree in the 
neighbourhood is felled, to which the name of the 
victim is given. 

Finally the packet is thrown in the fire so that the 
coverings are completely burnt, and the bamboo 
vessels within it are wrapped in bark and beaten 
violently with a stone, while the death-scene is again 
portrayed. While some lie as if dead upon the ground, 
others talk about them and their affairs and put on 
women’s head-dresses and wail as if they were women. 
They utter the reproaches of one village against another, 
and threaten fearful revenge. The wordy war leads to 
blows, and with cudgels and sticks to represent weapons 
the sorcerers fight in mockery of the combat which will 
follow the death of the victim. 

TREATMENT 

TREATMENT: MAGICAL OR RELIGIOUS NATURE OF 
RITES 

The treatment of the morbid conditions produced 
by these magical proceedings is inspired by beliefs of 
the same order, consisting of measures to counteract 
the rites of the sorcerer. The method frequently found 
elsewhere, in which the sorcerer himself is induced by 
payments or other means to remove his spell, in this 
case to release the imprisoned soul-substance, is not 
mentioned by Keysser, but the release of the soul is 
brought about by other means. A friend of the victim 
may secretly free the soul from its prison, or the libera- 
tion may be effected in a symbolic manner. A magical 
receptacle, in which some soul-substance has been put, 
is rubbed against the breast, back, and legs of the 

patient, to portray the return of his own soul-substance 
to his body ; and the receptacle is then torn asunder to 
show that the soul is free. The action is repeated three 
times, on each occasion with a different formula, and 
by the power of these actions the soul-substance which 
has not been sufficiently closely bound can again be 
made free. The principle underlying another method 
is that of the extinction of fire by water, some of the 
soul-substance of the patient being placed in the cool 
water of a mountain stream. In still another method 
some of the soul-substance of the patient is enclosed 
in leaves and hidden within a hollow stone, which is 
then thrown into a deep pool. The therapeutical 
measures thus employed by the Kai in order to cure 
disease produced by magic thus reveal the same 
dependence of treatment on etiology which we have 
found among other peoples and in proceedings of 
other kinds. 

These elaborate rites of the Kai would be regarded by 
all ethnologists as an example of magic, but they have 

several features which bring them very near to religion. 
The formulas are not decisive in this respect, though 
more than one seems to have in it a note of appeal to 
higher powers. Still more significant of the religious 
attitude is the ordinance that certain of the objects 
used in the rites must have come from the abode of 
ghosts or spirits. The methods of treatment, on the 
other hand, seem to be purely magical, and taking the 
rites as a whole they must certainly be regarded as 
magical rather than religious. 

CONCRETE NATURE OF BELIEFS UNDERLYING THE 
RITES 

The rites of the Kai provide characteristic examples 
of the two kinds of sympathetic magic, known respec- 
tively as imitative, or homceopathic, and contagious 
magic. The principle which has hitherto been held 
to underlie these forms of magic is of a more or less 
mysterious kind. 

Thus, Sir James Frazer! refers the belief in the 
connexion between a person and a separated part of 
his body to a relation “‘ which we may conceive as a 
kind of invisible ether, not unlike that postulated by 
modern science for a precisely similar purpose—namely, 
to explain how things can physically affect one another 
through a space which appears to be empty ”’. 

Sir James Frazer does not, of course, intend this 
explanation of contagious magic to be anything more 
than a figurative expression, in the language of modern 
science, of the modes of thought which determine the 
actions of savage man. Into whatever equivalents, 
however, we translate his language, the ideas thus 
held to form the basis of contagious magic will have an 
abstract, if not mystical, character which I believe to 

1 Ob. cit., vol. i, p. 54. 

CONCRETE NATURE OF BELIEFS 

be opposed to the concrete nature of the mental 
processes of peoples of rude culture. Often the savage 
performs rites of the most complex kind merely because 
this course of action has been prescribed for him by the 
immemorial traditions of his community, but where 
direct motives for his actions can be discovered they 
have a concrete character very different from that 
suggested by the metaphor of Sir James Frazer. 

The special interest of the blend of medicine and 
magic practised by the Kai lies in the concrete and 
definite character of the beliefs which underlie these 
elaborate rites. The savage has few concepts more 
definite than that of the soul and of its continued 
existence after death. We have only to qualify this 
concept by the addition of the belief that the soul is 
divisible to give us the principle which underlies the 
magic of the Kai, a principle as definite as any of those 
which underlie the religious conduct of civilized man. 
The contagious magic of the Kai rests, not on any 
mystical belief in action at a distance, but on the 
belief that the sorcerer has in his possession part of 
the soul of another person, part of the vital essence of 
the person which he wishes to destroy. The conduct 
of the sorcerer might be held to imply a belief that 
action upon the part is equivalent to action upon the 
whole, but it is probable that there is rather confusion 
between part and whole, or more correctly, in the case 
of the Kai, between soul and soul-substance. That this 
is sO is suggested by the confusion between soul and 
soul-substance which occurs in several parts of the 
account given by Keysser. 

We only know of the concept of a divisible soul- 
substance in New Guinea and the Malay Archipelago, 
and we must await further evidence to show how widely 
diffused it is throughout the world. All that we can 
say now is that this concept affords an explanation 

of much in the ways of savage man which is at present 
mysterious and unintelligible. 

There is probably little justification for ascribing 
the other main variety of sympathetic magic to any 
vague mysterious principle. The rites of the Kai are 
full of acts which show a belief in the efficacy of imita- 
- tion, many of their features depending on the idea that 
the imitation of an event will bring that event to pass. 
This principle, often summed up in the phrase, “ like 
produces like,’’ is one in which there is nothing vague 
or indefinite. It may only seem so to the more scientific 
of our number because we have ceased to believe in it 
as a law of natural causation, though, as we all know, 
a variant of it forms the basis of a system of medicine 
which still flourishes among us. Such positive know- 
ledge as we possess concerning the psychological 
processes underlying the blend of medicine and magic 
leads us into no mystical dawn of the human mind, but 
introduces us to concepts and beliefs of the same order 
as those which direct our own social activities.

N the first chapter I dealt especially with the 
relations between medicine and magic, using the 
latter term for two kinds of processes: that in which 
disease is ascribed to direct human agency, and that 
in which the methods of treatment involve no element 
of appeal to higher powers, in spite of the fact that 
disease is ascribed to the action of spiritual beings. 

PROCESSES OF DIAGNOSIS AND PROGNOSIS 

It may have been noted that little was said about 
the processes of diagnosis and prognosis. Although 
the nature of the belief in causation directly determines 
the mode of treatment, the discovery of the cause 
usually needs no special rite. It is inferred immediately 
by the patient or his friends from their knowledge of 
acts, on the part of the patient, which would have 
offended a man or spirit believed to have the power of 
inflicting disease. 

Where definite rites are performed for the purpose 
of diagnosis these often have a religious character, even 
where the treatment appears to be entirely of a magical 
order. Thus, in Murray Island, in Torres Straits, 
disease is believed to occur by the action of certain men 
who, through their possession of objects called zogo and 
their knowledge of the appropriate rites, have the power 
of inflicting disease. Thus, one zogo is believed to make 
people lean and hungry and at the same time to produce 
dysentery ; another will produce constipation, and a 
third insanity. 

When anyone falls ill the patient may know at once 
whom he has offended, so that no special process of 
diagnosis is necessary, but often the patient or his 
friends have recourse to certain men who own a shrine 
called tomog zogo, where a process of divination is 
carried out. This shrine consists of a number of stones 
and shells arranged so as to form an irregular plan of 
the island.1 The place is visited at daybreak by those 
who have special knowledge. If a lizard comes out of 
one of the shells, the house or village which that shell 
represents will indicate the abode of the person by 
whom the sickness has been produced. If two lizards 
come from different shells and fight, the shell from which 
the victorious lizard has emerged would represent the 
abode of the sorcerer. This shrine was also consulted 
for the purpose of prognosis, a dead lizard being a sign 
of the death of the patient. Various other forms of 
divination are practised. In Murray Island, and still 
more in the western islands of the Torres Straits, the 
skulls of relatives are used for this purpose, the ghost 
to whom the skull belonged in life giving the desired 
information in a dream.? 

In the case of the tomog zogo of Murray Island we do 
not know enough of the attitude towards the animals 
who provide the material for diagnosis to enable us to 
say how far the process can be called religious, but the 
reference to the skulls of ancestors, which takes place 
in these and other islands of Torres Straits, certainly 
belongs to the category of religion, forming part of a 
religious cult of ancestors. 

The cult of ancestors is still more definite in Melan- 
esia. In many parts of that ethnographic province 
this cult provides an example of religion of a relatively 

+ Report Cambridge Expedition to Torres Straits, vi, 1908, p. 261. 
2 Ibtd., v, p. 362, and vi, p. 266. 

PROCESSES OF DIAGNOSIS AND PROGNOSIS 

high order, in which the elements of supplication and 
propitiation are clearly present. It may be noted that, 
here again, the appeal to the ghosts of ancestors may 
take place for the purpose of diagnosis in rites which 
have otherwise a definitely magical character. 

Methods of prognosis are even more apt to have a 
purely religious character. Thus, when a chief in the 
island of Ambrim in the New Hebrides is gravely ill, 
little seems to be done by way of treatment ; but the 
son or brother of the sick man takes a pig to a heap of 
stones called worwor, which had been built when the 
chief acquired his rank. After killing the pig on the 
worwor it is left there as a gift for the ghosts of the 
chief’s ancestors. That night the ghost of the father 
of the sick man will talk to his son or brother in his 
sleep, and will say whether the sick man will or will not 
recover. In the latter case, the people may not be 
content with the adverse prognosis, but will kill a 
second pig of a kind more valuable than the first, in the 
hope of obtaining a more favourable answer. At the 
same time prayer is offered to the ancestor to allow 
the sick man to stay with his friends. The only treat- 
ment employed is to rub the sick man, but this is 
evidently of little account beside the strictly religious 
practices of divination by dream and of prayer, by 
which the people seek to discover, and, if need be, 
attempt to avert a fatal result. 

It is, I think, a matter of interest that the aid of 
superhuman or divine powers should show itself so 
definitely in connexion with prognosis. It is instructive 
that this difficult and uncertain art should, in such a 
people as the Melanesians, bring out more clearly than 
any other aspect of their leechcraft the close inter- 
dependence of medicine and religion. 

DISEASE ATTRIBUTED TO INFRACTION OF TABOO 

The close relation between the practice of medicine 
and the cult of the dead ancestors exists all 
through Melanesia, but probably the combined rites 
have nowhere reached a greater pitch of elaboration 
than in the western islands of the British Solomons, 
where the subject was carefully studied by Mr. A. M. 
Hocart and myself some years ago. (I am greatly 
indebted to Mr. Hocart for his permission to publish 
this preliminary extract from our joint work.) 

In the little island of Mandegusu or Eddystone, where 
Mr. Hocart and I spent several months, we found 
between the treatment of disease and certain religious 
practices, especially that of taboo, a connexion so 
intimate that the account of medical practice is at the 
same time an account of taboo. The relation between 
the two is so close that it would be impossible to deal 
with one independently of the other. Nearly every 
disease which occurs in this little island is ascribed to 
the infraction of a taboo on the fruit of certain trees, 
especially the coconut and betel-vine, the taboo, as 
well as the sign by which it is known, being called kenjo. 
The process of kenjo has a large number of varieties, 
each variety being the property of a man or small 
group of men, the right to practise being acquired, 
partly by purchase from, partly through instruction by, 
one already in possession of the art. The knowledge 
thus acquired concerns a number of rites, one carried 
out when the taboo is imposed, another when it is 
removed, and still another to allow fruit taken from 
tabooed trees to be used. In addition, a number of 
rites are learnt, by means of which to cure or ameliorate 
the disease which falls on one who uses fruit from the 
tabooed trees without the performance of the rites 
which should accompany its removal. Each of these 

DISEASE AND TABOO 

rites has a special name, salanga being that used for the 
therapeutic process. With certain exceptions, all belong 
to the same man or group of men. Thus, it is only a 
man who is able to impose or remove the taboo who is 
able to treat the disease produced by its infraction, and, 
as we Shall see shortly, there is a close resemblance 
between the rites connected with the process of taboo 
and those of the more strictly medical kind. 
Mr. Hocart and I found about a hundred examples 
of such conjoined processes of taboo and medicine, 
and obtained a record of more than sixty. The follow- 
ing is an example of one of these processes, namely, 
that connected with the taboo called kivengge, the 
infraction of which produces epilepsy and other 
convulsive seizures. 

The sign of the kenjo is put up on or by the side of 
the tree or trees to be tabooed, and consists of several 
plants, the number of leaves or shoots of each plant 
being usually four, the sacred number of the island. 
The taboo sign of kivengge also includes a stone and a 
coral, both of which irritate the skin when touched, 
as well as the butterfly called kivengge, the common 
use of this word for the butterfly and epilepsy being 
due to the resemblance between the movements of 
the insect and those of the disease. 

The leaves and other objects are put in a forked stick 
by the side of the tree to be protected with the following 
formula :— 

‘““ This is yours, ye spirits of the kenjo; this yours, 
ye four old women, four old women who knew the 
kenjo. Ye four old women in Mbakia, be favourable. 
Noemali, be favourable. Kiambakia, Tupombakia, 
Saemali, Mbukumenia. Grant my prayer against 
the man who steals the kenjo. Ye two ipa, grant my 
prayer.” The proper names mentioned in this formula 
are those of dead women, who once knew the process, 

while the fifth is that of a special tomate or ghost, the 
tomate kivengge, apparently a personification of epilepsy, 
derived perhaps from some dead man who suffered from 
the disease. The /¢pa is a special kind of fish. 

If the owner of the tree wishes to use any of its fruit, 
four sprigs of a plant called myou are swept over the 
fruit with the words, ‘“‘ I sweep it down to throw it 
away. Do not return to this man. Go away to thy 
mother; go away to thy father. Go away.” These 
words indicate that some influence is thus removed 
from the fruit, and there is reason to believe that this 
influence is that of the tomate or ghost by whom epilepsy 
is believed to be produced. 

If it is desired to remove the taboo altogether from 
the tree, the leaves and other objects making up the 
kenjo sign are thrown away in some unfrequented spot, 
so that there is no danger that it shall be trodden upon, 
a proceeding which is believed to have fatal results. 
When the kenjo is removed, the following formula is 
uttered: ‘“‘ Depart and go to the sky, do not remain 
on earth, thou spirit of the kenjo. Depart. Be cooled 
in the fresh water. Depart, looking to the sun ; depart, 
looking at the sky; go up and adhere to the thunder 
that sounds in the sky. Go back, not to return. 
Depart.”’ 

When anyone suffers from epilepsy or other con- 
vulsive seizure which is recognized as kivengge, he and 
his friends consult one known to have the power of 
imposing the kenio kirengge. 

This man visits the patient and strokes him from the 
head downwards with four leaves called myou, some 
moss, soot and scrapings of wood, uttering the formula : 
“Stroke away. Stroke down and away. Cease thou. 
Let the man live; donot return. They have given me 
a good ring.”’ The last clause of this formula, and two 
in that used in removing the taboo refer to the fee, 

THE RELIGIOUS. ELEMENT 

the chief money of the island consisting of arm-rings. 
The patient is then fumigated with the smoke of certain 
leaves, and the patient’ sniffs the smoke while the leech 
utters over him the words: ‘‘ Be favourable, thou 
ancient woman. Thou new spirit: Ye four ancient 
women...’ Leaves are then put round the neck of the 
patient with the words, “ Be favourable, thou. Favour 
thisman. Let him live.” A fillet is then put round the 
head of the patient, and a girdle of leaves over his 
shoulder, with the words, ‘* Be favourable and let the 
fits cease.’’ After saying these words the leech leaves 
the patient, and goes away without looking back. This 
treatment is carried out on the last four days of the 
waning moon. It is performed on two successive days ; 
then a day is left for the spirit or spirits of the kenjo 
to work, and then on the fourth day the rites are again 
performed, this setting aside of the third day for the 
action of the higher powers being a regular feature of 
the salanga process of a kenjo. At the end of four 
months the whole process is repeated. 

At the end of the treatment four small puddings 
are burnt on a fire by the leech with the words, “‘ Here 
is the pudding for you, the spirit of kzvengge. Be 
favourable. Let this man go. Let me not return here- 
after.’’ Four other puddings are put in the thatch of 
the patient’s house. 

THE RELIGIOUS ELEMENT 

The religious element in these rites is obvious. The 
note of supplication runs through all the formulas, 
which can definitely be regarded as prayers to beings 
who have the power to withhold that for which they 
are asked. The burnt-offering at the end of the whole 
proceedings has clearly a propitiatory character, and 
may also be regarded as a thank-offering to the ghostly 

being or beings through whose intervention the 
successful treatment has been brought about. 

The special point of interest, however, in these 
proceedings is the intimate blending of the therapeutic 
process with the institution of taboo, which both in this 
and other parts of Melanesia has a definite religious 
character. Disease is held to be the result of the 
infraction of a taboo imposed in the name and under the 
sanction of the ghosts of the dead. Taking the fruit 
of trees so protected is not punished by the offender’s 
fellow men, but punishment comes directly from the 
higher powers without any human intervention. The 
rites of the leech are only the means by which the help 
of these higher powers is obtained. They are designed 
to remove the misfortune which has followed the 
breaking of the taboo, which must be regarded as a 
sin rather than a crime. Though I have called the 
human agent a leech he might more fitly or just as 
fitly be regarded as a priest, whose special privilege 
it is to call on the higher powers to remove the penalty 
which the sufferer has brought upon himself by his 
sacrilege. Though the arm-ring given as a fee is kept 
by the leech, it is regarded as given to the spirits 
through whose activity the cure is brought about. 

In addition to their beliefs in the production of 
disease by the ghosts who watch over tabooed trees, 
the natives of Eddystone Island also believe in a number 
of beings with special names, such as Mateana, Sea, 
Ilongo, Paro, Mbimbigo, to whom the power of pro- 
ducing disease is ascribed. These beings are personifica- 
tions of natural phenomena such as thunderbolts, 
shooting stars, and the rainbow, and most of them have 
special haunts, often associated with the presence of 
shrines. Intrusion on these haunts is one of the causes 
to which disease is ascribed ; but these beings are believed 
to inflict disease quite apart from any offence on the 

RELIGIOUS CHARACTER 

part of the victim. The most frequent mechanism, 
however, by which they are believed to produce 
sickness is through the breaking of a taboo. When a 
man falls ill with symptoms ascribed to Mateana, it is 
supposed that the disease has been inflicted by Mateana, 
owing to the infraction of a special taboo associated 
with this being, and called kenjo Mateana. It is 
assumed that Mateana would not have afflicted the 
sufferer with fever if he had not broken the taboo 
associated with this being. It is probable that we have 
here an example of fusion between two different 
beliefs, one in the production of disease by a personifi- 
cation of the thunderbolt, and another according to 
which disease is ascribed to a transgression of the 
institution of taboo. 

RELIGIOUS CHARACTER ACQUIRED BY MAGICAL 
PROCESS 

I hope to deal with this process of fusion on another 
occasion. All that I need point out now is that both 
the elements in this process of fusion are clearly of a 
religious character. Two sets of belief concerning the 
causation and treatment of disease have been unified 
without in any way destroying the religious character 
of the product of the fusion. There are, however, 
examples in Eddystone Island in which a similar 
process of fusion has given a religious character to_ 
processes for the production of disease which would 
otherwise fall clearly into the category of magic. Thus, 
the breaking of one kind of taboo exposes the trans- 
gressor to the action of one of a number of men called 
njiama, whose powers closely resemble those ascribed 
in many parts of the world to the evil eye. One who 
breaks this taboo falls ill with a set of symptoms, which 
are believed to show the action of a njiama. In some 

of these cases blood gushes from the mouth of the 
patient, who dies at once, but in slighter cases there is 
a definite rite of treatment which follows lines similar 
to those of other curative rites connected with taboos. 

The infraction of another kenjo, kenjo mba, brings as 
its consequence a disease ascribed to the action of a 
sorcerer called mba, who is believed to produce disease 
by acting on a fragment of food or an object which has 
been used by the person on whom it is intended to 
inflict illness, the case thus falling into the third 
category of magic described in my first lecture. The 
action of a mba can take place quite independently of 
the breaking of a taboo, but the tendency of the people 
to regard disease as a punishment for sin is so strong 
that a sorcerer 1s not supposed to be able to effect his 
purpose unless his victim puts himself in the wrong 
by breaking a taboo. 

The acquirement of a religious character by a process 
which is primarily of a magical kind shows itself in 
another way in connexion with the sorcery of Eddy- 
stone Island. When a person is afflicted with illness 
believed to be due to the action of a mba, the essential 
part of the treatment consists in the recovery of the 
fragment of food or other object, called penubenu, by 
means of which the sorcerer acts upon his victim. This 
penupenu may be recovered in two ways. In one 
the relatives of the patient go to a man reputed to have 
the power of divination in respect of this condition. 
The diviner holds up an arm-ring and recites the names 
of all the persons believed to. possess magical powers, 
and when one of the names is mentioned the arm-ring 
begins to revolve. The person of the sorcerer having 
been thus revealed, the relatives visit him and accuse 
him of the deed. The suspected man may confess at 
once, and restore the hidden Jenupenu to his victim. 
If he refuses to confess he is suspended by one arm to 

RELIGIOUS CHARACTER 

the bough of a tree. Asa rule a confession soon follows, 
but if there is long delay it isconcluded that some mistake 
has been made in the divination by which the diagnosis 
was reached, and the suspended and suspected person 
is released. It may be noted that the patient in such 
a case will recover, because his mind is freed from the 
idea that his illness is due to the action of a sorcerer. 

This mode of procedure departs from that proper 
to magic in the recourse to divination by the arm-ring, 
a process which definitely depends on the agency of an 
ancestral ghost. Thesuspension of the supposed sorcerer 
has the character of an ordeal, but with no obvious 
religious character. In the other mode of procedure in 
cases in which the action of a mba has been diagnosed, 
the religious character is evident. A man with especial 
knowledge and powers appeals to certain spirits called 
tomate kurt, who are believed to be able to find the 
penupenu in order to restore it to the sick man, the 
recovery of the penupenu being accompanied by rites 
similar to those by which the diseases incurred through 
breaking of a taboo are cured. 

The religious character of the medical art is thus so 
strong in Eddystone Island that procedures which are 
primarily of the same order as the magic of other places 
are both diagnosed and treated by means involving 
the supplication and propitiation of the spirits of the 
dead, who are the chief objects of the religious rites of 
the people. There seems to have been in action a 
process of unification whereby the most diverse modes 
of regarding disease, modes which clearly belong to 
wholly different categories elsewhere, have been brought 
under one head in respect of diagnosis and treatment. 
The same holds good to a certain extent of the beliefs 
in causation, in that it is held that the production of 
disease by human agency would not be effective unless 
the sufferer had rendered himself liable to such 

maleficent action by his transgression of a religious 
ordinance. 

The close relation between religion and the pro- 
duction and cure of disease occurs in many parts of 
Melanesia. Thus, in those islands which possess the 
institution of totemism, disease is said to follow any 
infraction of totemic ordinances, such as killing or 
eating the totem. Since these ordinances have the 
nature of taboos, we are again brought into contact 
with the relation between medicine and taboo. In the 
New Hebrides, where taboo is especially associated with 
certain complex organizations in which men rise from 
rank to rank by the killing of pigs, the transgression 
of these taboos brings sickness in its train. This 
religious character of leechcraft does not, however, 
stand alone in Melanesia, but is often accompanied by 
magical practices of the most definite kind. In some 
places, asin the Banks and Torres Islands, and probably 
m New Britain and New Ireland, these take the most 
important place in the lives and thoughts of the people. 
In other parts the religious aspect of leechcraft is 
_ predominant, and, as we have already seen in Eddystone 
Island, this predominance may be so great that magic 
may become altogether subordinated to that view of 
disease according to which it is regarded as a punish- 
ment for sin. 

INDEPENDENT OCCURRENCE OF DISEASE 

I must now consider briefly those cases in which 
disease is believed to arise independently of any 
action on the part of human beings or of higher powers. 
This belief exists in many parts of Melanesia and New 
Guinea, and is probably universal, though it has 
attracted little notice beside the more striking customs 
which show the relation of leechcraft with magic and 
religion. 

INDEPENDENT OCCURRENCE OF DISEASE 

The diseases thus regarded are such as we are 
accustomed to group together as “‘ minor ailments ’”’. 
It is especially when disease appears to threaten life 
that people begin to think of human or spiritual agency. 
As among ourselves, these ‘“‘minor ailments’ are 
largely treated without the aid of any specialized 
practitioners, and by measures which correspond with 
our domestic remedies. Thus, Professor Seligman 
tells us! that, among the Sinaugolo of New Guinea, a 
sorcerer is only consulted when ordinary treatment has 
been found of no avail. 

In some cases the beliefs which underlie the treat- 
ment of the grave examples of disease are also concerned 
in the treatment of these minor ailments. Thus, in 
Eddystone Island, certain sores on the limbs which 
are believed to ‘‘ come of themselves ”’ are yet treated 
by measures similar to those employed in diseases 
ascribed to the infraction of a taboo, and one such 
treatment is accompanied by a burnt-offering to 
spiritual beings, which offering forms a feature of the 
curative rites of a taboo. 

Because certain cases of disease are not ascribed to 
direct human or spiritual agency, we must not conclude 
that they therefore fall within the domain of what we 
should call “ natural’”’ causation. If we inquire into 
the beliefs concerning the causation of these minor 
ailments in such a place as Eddystone Island, we are 
told that they are believed to come of themselves and 
are not, therefore, the occasion of rites such as naturally 
follow disease ascribed to the neglect of religious 
injunctions. It would seem that these diseases attract 
little attention, and do not afford material for specula- 
tion. It is true that many of the troubles thus believed 
to ‘‘ come of themselves ’’ are common and a source of 

1 Journ. Anth. Inst., 1902, xxxii, p. 300. 

great discomfort, though, as a rule, they do not threaten 
life. It is a question whether it is not their very 
frequency which takes them out of the magical and 
religious spheres. It is the exceptional, or at any rate 
the less habitual, incidents of life that tend to excite the 
speculations of mankind,! and occurrences so frequent 
in the tropics as the outbreak of sores on the limbs 
tend to remain without the circle of medico-religious 
interest, just as our own colds and other habitual ail- — 
ments remain to a large extent without the scope of 
our own medicine. 

VARIETY IN LEECHCRAFT 

The belief in the occurrence of disease independently 
of human or spiritual agency introduces an element of 
variety into the leechcraft of savage peoples. Even 
when it is decided that some human or spiritual agency 
has been at work, there may still remain ample scope 
for variety in the treatment adopted. If we can judge 
by the following experience in Eddystone Island, such 
peoples as the Melanesians put their faith in many 
doctors, and are not content with one physician or one 
remedy. 

A man who had acted as one of our assistants in this 
island fell ill with apical pneumonia. After he had been 
ill for a few days I heard that he was anxious to be 
treated by me, and I attended him for the rest of his 
_ illness. He was already being treated by a noted leech 
of the island, Kundakolo, to whom I owe much of my 
knowledge of Eddystone medicine. On one of my later 
visits another of our assistants, also a noted leech, who 
went with me, carried out a course of treatment 
consisting of rubbings, spittings, and prayers as soon 
as I had finished my interview, his treatment being 

1 Cf. W. H. R. Rivers, Folk Lore, 1912, xxiii, p. 307. 

LEECH AND PRIEST 

designed to remedy the sweating which was at that 
time the chief cause of complaint. I thus knew during 
my attendance on the patient that I had two rivals 
in my art, but it was only after the patient had recovered 
that we learnt there had been at least a dozen. The 
first diagnosis had been that the patient was suffering 
from sorcery, or mba, and three different leeches were 
called upon in succession to carry out different forms 
of treatment for this condition. I then began my visits, 
but at the same time two other practitioners were 
called in, who performed two other “cures” for 
sorcery. The diagnosis of mba was then given up, this 
being about the time of the crisis, and a woman then 
carried out the treatment for 27zama, on the supposition 
that the patient had fallen under the spell of the evil 
eye. This was followed by a treatment assigned to 
cure a symptom ascribed to a being named Ave, whom 
we shall meet again shortly. This was followed by 
three separate “‘ cures ’’ for a condition called tagosoro, 
usually produced by the action of the beings called 
Mateana and Sea. As these were not wholly successful, 
the original diagnosis of mba was made the basis of the 
next treatment. A month later the patient was 
considering whether he would not call in another 
practitioner to treat him again for ¢agosoro, on account 
of his failure to recover his strength completely. At 
one stage of illness, when the patient was delirious and 
insisted on walking about naked, his friends had 
considered the propriety of calling in a practitioner 
skilled in the treatment for the infraction of keno 
tuturu, which has as a result a condition of insanity 
ascribed to beings, called ¢utuvu, who live in the bush. 

DIFFERENTIATION OF LEECH FROM PRIEST 

The high degree of specialization of medical function 
which exists in Eddystone Island may serve as an 

introduction to a subject I have until now left on one 
side. In the first chapter I stated that one of the means 
by which it is possible to distinguish medicine from 
magic and religion is an inquiry how far the leech is 
differentiated from the sorcerer and the priest. In the 
‘area with which I am specially dealing in these lectures, 
it may be said at once that there is little evidence of 
such differentiation. In Australia, New Guinea, and 
Melanesia, it would seem that the simpler remedies, 
of which I spoke just now, may be used by anyone, 
there being in this respect no differentiation of the 
leech frorn the general body of the people. Those who 
combine the practice of medicine with that of magical 
or religious rites usually acquire their art by a special 
process, either of initiation or instruction, and in 
Melanesia such knowledge has always to be purchased. 
The most complete instruction in any branch of medico- 
magical or medico-religious art is of no avail to the 
pupil unless money has passed from himself to his 
instructor. This instruction and purchase, however, 
nearly always include both the production and cure 
of disease, where disease is ascribed to human agency, 
and the power and knowledge to perform rites other 
than those of a curative nature where medicine is 
allied with religion. 

In Eddystone Island, however, a distinct step has 
been taken towards the differentiation of the leech 
from the priest. A man who buys the knowledge which 
enables him to impose a taboo necessarily buys at the 
same time the knowledge of the process by means of 
which to treat the illness which follows infraction of 
the taboo. It does not follow, however, that he uses this 
part of his knowledge. Certain men of the island have 
acquired a special reputation for success in the applica- 
tion of remedies, such men being called tinoni salanga. 
In these tznoni salanga we have clearly present the 

Lege AND PRIEST 

beginning of the differentiation of the leech from the 
priest. It may be interesting to mention some of the 
conditions which seem to have brought about this 
distinction. One is that a tinont salanga who wishes 
his treatment to be successful should use a special kind 
of shell-instrument, called a vikevike, with which to 
cut and scrape roots or other ingredients of his pharma- 
copoeia. One who steps over this instrument angers 
the tomate or ghostly ancestor from whom the leech 
derives his powers, the ghost showing his anger by the 
infliction of illness. Owing to the danger so incurred 
men who have bought the knowledge of a taboo will 
sometimes decline to use their knowledge of the 
associated treatment, and leave that part of their art 
to others willing to take the risk. Another deterrent 
is the need for sexual abstinence on the part of a leech, 
especially in certain rites, such as those for the cure of 
ulcers. ‘ 

There is another indication that medicine in the 
strict sense of the term 1s becoming dissociated in Eddy- 
stone Island from the religious attitude. The influence 
of the being called Mateana shows itself in the occur- 
rence of fever, pain, and weakness, this complex of 
symptoms being called tagosovo. At the present time 
there seems to be a distinct tendency to diagnose and 
treat fagosoro as a morbid entity, independently of any 
belief in the anger of Mateana or the transgression of 
a taboo. This was probably the case in the three 
treatments for fagosoro carried out on the patient I 
have already mentioned, while the treatment for 
symptoms ascribed to Ave may also have been of a 
similar nature. It is possible, however, that this 
modification of the leechcraft of Eddystone Island is 
due to recent European influence. This may also be 
true of the movement towards specialization of the 
leech, for one of the first results of such external 

influence is to lower resistance to the dangers and 
hardships which so often accompany the religious and 
magical rites of savage man. 

It must be noted that the widespread failure to 
distinguish the leech from the sorcerer or priest is not 
due to any failure in the specialization of medical 
function itself. Indeed, the matter is rather the other 
way. Such people as the Papuan or Melanesian have 
carried the differentiation of medical function in some 
respects to a far higher pitch than even we have 
reached in our highly specialized medical art. In 
Eddystone Island the treatment of different diseases 
is so highly specialized that one man will treat 
rheumatism, another fever, a third epilepsy, and a 
fourth insanity, although in each case the cure of 
disease is intimately associated with certain religious 
functions. An example of similar specialization in 
Torres Straits has already been given in this lecture, 
and still another example is found in the island of Tami 
on the north-eastern coast of New Guinea, where one 
man knows how to cure pain in the chest, another pain 
in the abdomen, a third rheumatism, and a fourth 
catarrh.1 Specialism is thus present in a pre-eminent 
degree; but this specialism has taken a direction which 
has probably been antagonistic to the development of 
that kind of differentiation of social function which 
among ourselves, after centuries of progress, has made 
medicine a wholly independent department of social life. 

EPIDEMIC DISEASE 

A few special points remain for consideration. I have 
so far treated disease as if it were a condition which 
only affects individuals, and have said nothing of those 
cases of disease in which a whole population or a large 

1 In Neuhauss, Deutsch Neu-Guinea, iii, 516. 

EPIDEMIC DISEASE 

portion of it suffers simultaneously from disease. I 
have now to consider what is the attitude of the 
peoples we are considering towards epidemic disease. 

Here, as in individual cases of disease, we find 
medicine intimately blended with magic or religion. 
Among those peoples whose lives are dominated by 
magic, epidemics are ascribed to the action of sorcerers, 
but it is supposed that they are produced by the 
sorcery of members of some other village or some other 
island. I have recorded 1 a case from the Banks 
Islands, in which a man, who wished to injure a woman 
who had refused to marry him, held a bamboo contain- 
ing certain ingredients so that the wind should carry 
its influence to the island where the woman was living. 
An epidemic illness which shortly followed was ascribed 
to his action. Payment was made to the sorcerer, who 
sent young coconuts to which he had imparted power 
(mana), and the milk of these coconuts was poured at 
the door of every sufferer, so that the epidemic might 
be stayed. 

For an example of epidemic disease ascribed to the 
agency of higher powers, I may return to Eddystone 
Island. Here such disease is supposed to be due to the 
action of a being or beings, called Ave, whose coming is 
indicated by the presence of broken rainbows, shooting 
stars, red clouds, and showers of fine rain while the 
sun is shining. The symptoms of the disease usually 
produced by Ave are fever, headache, and cough. The 
Ave probably were spirits or ghosts associated with 
certain neglected shrines in Eddystone. Dysentery 
epidemics are ascribed to Ave from Ysabel. 

When an epidemic ascribed to Ave visits the island 
the people appeal to one who knows the appropriate 
rites. This man, with certain companions, visits a now 

1 The History of Melanesian Society, i, p. 158. 

disused village. After uttering the names of certain 
ghosts, probably those of his predecessors in the 
knowledge of the rite, he proceeds: ‘“‘ You, at the root 
of the sky, come down and depart. There is an end of 
the men, there is an end of the chiefs; an end of the 
chiefs’ wives; an end of the chiefs’ children. Come 
and depart thou, etc.,” the prayer ending with an 
exclamation like a bark, when all present shout. Then 
the root of turmeric is distributed, and all chew it and 
spit it about the path as they go towards the shore, 
making as much noise as possible, with the idea of 
driving away the Ave. When they reach the shore the 
leader in the ceremony folds a large leaf so as to make 
it like a canoe. In this imitation vessel he puts ashes, 
some of the leaf used in thatching a house, and five 
small shell ornaments called ovala. He then utters the 
following words: ‘‘ You! Go to Ysabel; go to 
Choiseul (neighbouring islands). Do not stay in 
Mandegusu.”’ The canoe is then taken out to sea and 
put on the waves, so that it goes away from the island. 
It is believed to carry the Ave back to the place 
whence it came. 

RELATIONS OF ECONOMICAL AND JURIDICAL NATURE 

The chief object of this discussion has been to show 
the intimate relation of medicine with magic and 
religion among certain peoples who rank low in the 
scale of general culture. It may have been noticed 
that this tie carries with it other relations of an econ- 
omical and juridical kind. Thus, the kenjo of Eddy- 
stone Island is not merely an example of an intimate 
blend between medicine and religion, but at the same 
time it involves the institution of private property. 

The people of Eddystone Island form a good example 
_ of communism in goods, large groups of persons owning 

ECONOMICAL AND JURIDICAL RELATIONS 

land and certain other property in common. The 
process called kenjo, which we have so far studied in 
its relation to the social categories of medicine and 
religion, is also a means by which certain kinds of 
property—namely the fruit of certain trees—are kept 
for the special use of individual persons. It is a social 
practice by which a communistic people have pro- 
gressed some way along the path of individualism. 

The kava rites of the Gazelle Peninsula and the Duke 
of York Island, which I described in the first chapter, 
afford another example of a similar process. The half- 
snake, half-human being called kata is believed to 
abstract the soul of any person who takes fruit from 
the trees of the district it inhabits, persons from other 
districts being specially prone to suffer from its action. 
It is probable that the belief in the efficacy of this 
being is definitely fostered by the inhabitants of a 
district, as a means of protecting their property from 
the people of neighbouring districts. It would be very 
wrong to regard the institutions of the Solomon 
Islands and New Britain as inventions of the people in 
the interests of private property. The belief in the 
production of disease as a punishment for theft, how- 
ever, provides a motive which tends to perpetuate the 
ideas and practices which bring medicine into so 
intimate a relation with religion. We have here only 
one of countless examples showing that among peoples 
of rude culture the distinction of social categories from 
one another is far more difficult than among ourselves. 
The religious character of the medical art among such 
peoples is only one example of the way in which 
religion and the religious attitude permeate every part 
of their social life. Religion among such people is not 
a matter for one day in the week, but influences every 
act of their daily lives. 

THE PART PLAYED BY SUGGESTION 

Another subject well illustrated by the proceedings 
described in this book is the evidence concerning the 
part played by suggestion in the production and cure 
of diseases among such people as the Papuans and 
Melanesians. There can be no question that such 
processes as I have recorded here are efficacious. Men 
who have offended one whom they believe to have 
magical powers sicken, and even die, as the direct 
result of their belief ; and if the process has not gone too 
far they will recover if they can be convinced that the 
spell has been removed. Similarly, one who hasintruded 
on the haunt of a ghost or spirit will suffer, it may be, 
fatal illness, because he believes that he has lost his 
soul; and he will recover after the performance of rites 
to which he ascribes the power of restoring the lost 
soul to his body. Doubtless, with this real factor of 
suggestion there is mixed up much deception, especially 
on the part of those to whose special knowledge the 
production and cure of disease is ascribed. If one falls 
ill with symptoms which by popular belief are ascribed 
to a sorcerer, or to some spirit whose influence is believed 
to be under the power of a priest, the sorcerer or priest 
is only too ready to accept the role ascribed to him to 
earn money and at the same time enhance his reputa- 
tion for medico-magical or medico-religious powers. 

At the same time there is reason to believe that he is 
not wholly a deceiver, but in some measure shares the 
general belief in his own powers. Even that degree of 
intimacy with those who practice medico-magical and 
medico-religious arts which is possible to such a visitor 
as I have been among several peoples, is enough to 
show the sincerity and earnestness of many of these 
practitioners. I believe that, in many cases, it is the 
same among ourselves, and that a study of our own 

RATIONALITY OF THE LEECHCRAFT 

quacks and charlatans, with that amount of care which 
we devote to the Australian or the Melanesian leech, 
would show us the impostor far less than is usually 
supposed. Imposition there is, no doubt, but, if such 
a study were carried out from a psychological point of 
view, it would often reveal the enthusiast and the 
crank in even greater measure than the impostor. 
Not only will the study of peoples of rude culture help 

us to estimate aright the part taken by fraud and decep- 
tion in certain forms of the medical art of the civilized 
world, but, what is far more important, it will help us 
also to understand better the place taken by suggestion 
both in the production and the treatment of disease. 
From the psychological point of view the difference 
between the rude arts I have described in this book 
and much of our own medicine is not one of kind, but 
only of degree. 

RATIONALITY OF THE LEECHCRAFT 

The chief lesson, however, impressed upon us by the 
facts brought forward here, is one the importance of 
which reaches far beyond the limits of our special 
subject. This lesson is the rationality of the leechcraft 
of such peoples as the Papuan and the Melanesian. 
The practices of these peoples in relation to disease are 
not a medley of disconnected and meaningless customs, 
but are inspired by definite ideas concerning the 
causation of disease. Their modes of treatment follow 
directly from their ideas concerning etiology and 
pathology. From our modern standpoint we are able 
to see that these ideas are wrong. But the important 
point is that, however wrong may be the beliefs of the 
Papuan and Melanesian concerning the causation of 
disease, their practices are the logical consequence of 
those beliefs. 

We may say even that these peoples practice an 
art of medicine which is in some respects more rational 
than our own, in that its modes of diagnosis and treat- 
ment follow more directly from their ideas concerning 
the causation of disease. According to the opinion of 
the civilized world, these ideas of causation are wrong, 
or contain but grains of truth here and there; but 
once grant these ideas, and the body of medical practice 
follows therefrom with a logical consistency which it 
may take us long to emulate in our pursuit of a medicine 
founded upon thesciences of physiology and psychology. 

I tried to show, in the first chapter, that the concepts 
underlying the magical procedure of savage man have 
not the vague and indefinite character often assigned 
to them, but form clear and relatively concrete motives 
for the complex procedures of the sorcerer and leech. 
These concepts form the starting-point of his logical 
processes, and the general conclusion which can, I 
believe, be drawn from the facts before us, is that these 
logical processes are as definite as the premises from 
which they start. 

There can be no greater hindrance to progress in our 
attempts to understand the mind of the man of lowly 
culture than the belief so widely held, that his actions 
are determined by motives having that vague and 
lawless character ascribed by many to the thought of 
savage man. There are even those who hold that such 
peoples as the Papuan and Melanesian have not yet 
reached the logical stage of thought.1 I believe there 
is no single department of social life in which it cannot 
be shown that this view is false. I have elsewhere 
attempted a demonstration of its falsity in one depart- 
ment of social life.2 I hope the facts brought forward 

1 Lévy-Bruhl, Les Fonctions Mentales dans les Sociétés Inférieures, 
Paris, 1910. 

2 “The Primitive Conception of Death,’ Hibbert Journal, 1912, 
x, p. 393. 

RATIONALITY OF THE LEECHCRAFT 

here are sufficient to show that, in the department of 
his activity in which he endeavours to cope with 
disease, savage man is no illogical or prelogical creature, 
but that his actions are guided by reasoning as definite 
as that which we can claim for our own medical 
practices. 

It must be noted, however, that the examples of 
leechcraft which have been recorded in this book have 
not always formed part of a strictly logical and con- 
sistent system. An instance from Eddystone Island 
is the way in which the causation of disease by such 
agencies as Mateana and Sea, as well as by the evil eye 
and sorcery, has become subservient to the ancestor- 
cult which underlies the kenjo. The indefiniteness 
of the beliefs connected with the being called Ave gives 
_ another instance from the same island. As an example 
from New Guinea may be mentioned the employment, 
by the Kai, of several remedies, such as bleeding and 
massage, which do not, so far as we know, immediately 
follow from their ideas concerning the causation of 
disease. Such cases lead us to a set of problems which 
I have left on one side in this book, problems which 
would lead us to a mode of studying early medicine 
too large to be included in the scope of this course of 
lectures—namely, the study of the transformations 
suffered by medical beliefs and practices as the result 
of the contact and blending of peoples. I have dealt 
with two only of the methods by which social facts may 
be studied—the sociological and the psychological. 
I must leave the far more difficult problem of the 
historical relations of medicine, magic, and religion 
for another occasion.

[* the previous chapters I have been dealing with 
the relations between medicine, magic, and religion 
descriptively, and from the sociological and psycho- 
logical points of view. I showed that, in Melanesia 
and New Guinea, which I chose as the region to illus- 
trate my subject, there is an intimate connexion 
between three sets of social process, which are clearly 
distinguished from one another by ourselves and other 
civilized peoples. I dealt briefly with some of the 
psychological factors underlying the union between 
three kinds of process, but left altogether on one side 
any consideration of the mechanisms by which the 
relations between medicine, magic, and religion had 
come into being, and those by which processes so 
closely related in one part of the world had elsewhere 
become distinct and self-contained departments of 
social life. I have chosen this historical and evolu- 
tionary treatment for the second half of this book. 

EVOLUTION OF SOCIAL CUSTOMS AND INSTITUTIONS 

I must begin by considering briefly the general 
problem concerning the nature of the evolutionary 
process in its relation to the history of human society. 
The practice of medicine is a social process, subject to 
the same laws, and to be studied by the same methods 
as other social processes. The chief aim of this book 
is, by means of the relations between medicine, magic, 
and religion, to illustrate the principles and methods 
which should guide and direct the study of the history 
of social institutions. 

INDEPENDENT EVOLUTION 

If I had been writing only a few years ago my mode 
of treatment would have been very simple. At that 
time, in common with most students of human society, 
I believed that, after a dispersal widely over the earth, 
which had taken place at an epoch so distant as to place 
its study almost without the range of practical science, 
mankind had evolved his customs and institutions 
with a high, even in some cases a complete, degree 
of independence. When I found close similarity of 
custom or belief in widely separated places, I wascontent 
to ascribe it to a process of independent evolution, the 
course of which had been determined by the tendency 
of the human mind to respond in certain uniform ways 
to the action of its physical and social environment. 
I should have been content with the position, that the 
close relation of medicine to magic and religion which, 
in Chapters I and II, I endeavoured to demonstrate for 
Melanesia and New Guinea, represents only one stage 
in a process of differentiation whereby one kind of 
social activity has developed elsewhere into three 
distinct departments of social life. I should have held 
that Melanesia and New Guinea have preserved for us 
a stage in the evolution of human society in which this 
differentiation has made so little progress that it is 
still difficult to distinguish medicine from magic and 
religion, while, among ourselves, the process of differ- 
entiation has gone so far that each of the two depart- 
ments which our society has preserved has its own 
specialized practitioners, its own code of social regula- 
tions, and its own body of beliefs concerning the 
relation of mankind to his surroundings. 

Moreover, when comparing the pathological ideas 
and the diagnostic and therapeutic practices of different 
peoples, I should have held any similarities which 

INDEPENDENT EVOLUTION 

became apparent to be the natural result of the unity 
of action of the human mind. Thediseases of one part 
of the world are so much hke those of another that I 
should have regarded it as the most natural thing in 
the world that mankind should have evolved similar 
beliefs concerning the nature of disease and similar 
practices by which to modify or neutralize its 
effects. 

I should have explained the similarities between the 
beliefs and practices of medicine, and those of magic 
and religion, ina similar manner. I should have argued 
that, whether magic and religion have grown out of the 
beliefs and sentiments of mankind towards the mysteries 
of nature or towards those of his own birth, life, and 
death, or towards both together, these mysteries are 
everywhere similar in character. I should have 
regarded it as natural that the mind of man in the 
making should have reacted towards them in ways so 
similar as to have produced the worship of the sun and 
other heavenly bodies, of vegetation and of other 
natural forces, together with the cults of the dead which 
are found in so many parts of the earth. It would not 
have surprised me that a body of customs and beliefs 
embodying the reaction of mankind towards the 
appearances of nature, or of his own life, should be 
closely connected with those embodying his attitude 
towards disease. If then, as now, I had given a pre- 
eminent degree of importance to the great mystery of 
death, as the most important motive in the develop- 
ment of the religion of mankind, the connexion of 
religion with the art designed to meet disease, the 
harbinger of death, would have seemed especially 
natural. I should have dwelt on the vast part which 
ideas connected with death and the life after death 
have taken in the religious development of mankind, 
and should have regarded the close connexion between 

, o7 

medicine and religion as the natural consequence of 
the intimate relation between disease and death. 

In this brief sketch of what I should have said if I 
had written a few years ago, there is much which I still 
believe to be true. That running through the history 
of mankind there has been in action a process of 
specialization of social function stands beyond all 
doubt, and I should have been keeping strictly within 
the truth in regarding the increasing distinction of 
medicine from magic and religion as an example of this 
process of specialization. There would also have been 
much truth in the supposition that disease and death 
are so closely connected that, even if the earth had 
been divided up into independent and self-contained 
departments, we should have expected much similarity 
in the reaction of different groups of mankind towards 
them. The fault I now find with the account I have 
just given is not so much that it is false, but that it is 
far from being the whole truth. It errs by giving a far 
too simple account of a process which has in reality 
been exceedingly complex. 

TRANSMISSION AS A FACTOR IN HUMAN CULTURE 

The great change which has taken place in our 
ideas concerning the value of such a scheme of evolu- 
tion as I have sketched is due to several causes. I have 
time to-day only to mention one. This is that until 
recently far too little attention has been paid to the 
influences of degeneration in the history of human 
society. At one time the savage and barbarous cultures 

1 [In his Presidential address to the Section of Anthropology at 
the meeting of the British Association for the Advancement of 
Science (see Proceedings for 1911), Dr. Rivers has given an account 
of his change of attitude, which really initiated the new movement 
in ethnology, which the present book does so much to illuminate. 
Compare also chapter vi (‘‘The Aims of Ethnology’’) of his book 
Psychology and Politics (1923).] 

TRANSMISSION IN HUMAN CULTURE 

of mankind were universally regarded as examples of 
degeneration, but with the general acceptance of the 
doctrine of evolution, degeneration was forgotten or 
neglected. In accordance with the general course of 
the progress of knowledge an idea, which had till then 
been dominant, was thrust aside ; and even the many 
cases where degeneration in human society is obvious 
were ignored or held to be of little account. As one 
among many examples of this neglect, I may mention 
that students were led to attach great importance to 
the rude means of navigation now found on many parts 
of the earth. The possibility that this rude condition 
may have been the result of degeneration was neglected. 
It was concluded that voyages on the sea had taken no 
appreciable part in the early wanderings of mankind. 
Since, in the absence of communication by sea, the 
existing connexions between the different continents 
are insufficient to explain the present distribution of 
mankind, ancient land connexions were assumed, thus 
putting back the dispersal of mankind to so remote a 
date as to leave ample scope for processes of indepen- 
dent development. It is only necessary to show that 
the art of navigation might not only degenerate but 
even disappear,! and voyages by sea again enter into 
our schemes ? of the early peopling of the earth, thus 
bringing transmission out of the lumber-room into 
which it had been cast by most students of human 
society. 

Once we acknowledge transmission as an important 
factor in the history of human culture, once we 
appreciate the important part taken by degeneration 3 

1 W. H. Rivers, ‘“‘ The Disappearance of Useful Arts’, Festschrift 
tillegnad Edvard Westermarck, Helsingfors, 1912, p. 109. 

2 G. Elliot Smith, ‘‘ Ancient Mariners,’ Report and Proceedings 
of the Belfast Natural History and Philosophical Society, Session 
1916-17, p. 46. 

3 [This theme has been elaborated in W. J. Perry’s book, The 
Children of the Sun (1923).] 

in this history, many old problems can be seen in 
quite a new light. When we find a mode of treating 
disease closely related to a magical or religious practice, 
it becomes possible that the relation does not represent 
a stage in a process whereby medicine is gradually 
being differentiated from magic or religion, but the 
process may be rather one of assimilation. A thera- 
peutic practice, devoid of any magical or religious 
character in its original home, may acquire this 
character when introduced elsewhere. The magical 
or religious guise thus obtained by a_ therapeutic 
practice would, in sucha case, be due to the prominence 
of magic or religion in the culture of the people among 
whom the practice has been introduced. On the other 
hand, a magical or religious practice may have aspects 
which, toa people who possess a genuine art of medicine, 
suggest therapeutic or hygienic applications. These 
may lead to its becoming part of the medical art of its 
new home, and to the complete disappearance of its 
magical or religious character. In each case the 
relation of medicine with magic or religion is due to a 
process of assimilation, whereby an introduced practice 
has been endowed by the people who have adopted it 
with the features characteristic of their own culture. 
Instead of human culture presenting us with a 
simple process of direct evolution, we have a highly 
complex process of interaction between peoples and 
their cultures, producing blended products, in the case 
before us, blends of medicine with magic and religion, 
which need new methods of inquiry and long years of 
patient study before the exact nature of the process, 
the whole instead of the partial truth, can be attained. 

IN VARIOUS COUNTRIES 

RELATIONS OF MEDICINE, MAGIC, AND RELIGION IN 
VARIOUS COUNTRIES 

In the preceding chapters I dealt with a limited area, 
with Melanesia and New Guinea, and even then I 
attempted no full survey, but was content to pick out 
a few salient examples to illustrate the relations of 
medicine with magic or religion. Before I enter on the 
special task of this book, I must briefly sketch the nature 
of the relations between medicine, magic, and religion 
in other parts of the world. In this survey I shall 
begin with the countries adjacent to Melanesia. 

AUSTRALIA 

Australia is characterized by the large part taken by 
human agency in the beliefs concerning the production 
of disease. According to the prevailing views, this 
continent is held to be the special home of magic, and 
there is no doubt that the Australian attitude towards 
disease is closely bound up with practices resembling 
those to which the name of magic is usually given. 

It is noteworthy, however, that the form of magic 
most widely spread over the earth, that known as 
sympathetic, rarely occurs in Australia. It is excep- 
tional in this continent to act upon some part of a 
person with the idea of inflicting disease upon him. 
The usual process by which an Australian sorcerer 
inflicts disease is to point at his victim a bone from a 
dead person. It is believed that he is able to project 
some morbific influence into his victim, the process 
resembling one of which I gave an example, from the 
Banks Islands, earlier in this book. 

The use of part of a dead man in this process raises 
the question, whether the method of the Australian 
sorcerer comes as definitely within the sphere of magic 
as is usually supposed. It is possible that this and 

other of his methods do not depend altogether, perhaps 
not at all, on a belief in non-human agency. The 
Australians certainly believe in the production of 
disease through the action of spiritual beings, such as 
the ghosts of the dead, and especially the ghosts of 
certain beings to whom tradition assigns the ancestry 
of the social group, or the introduction of new elements 
of culture. Australia thus presents examples of both 
the chief categories of causation which are found in 
Melanesia, but it is a question whether the cases which, 
on superficial observation, seem clearly to belong to the 
category of magic may not be only the degenerate 
products of a former belief in the production of disease 
by spiritual beings, and especially by the ghosts of the 
dead. 

In any case, the immediate agent to whom the 
Australians usually ascribe the occurrence of disease 
is a human being, and, in accordance with this belief, 
the object of the friends of a person who becomes ill 
is to discover and propitiate the man to whose action 
the disease is ascribed. The process of diagnosis is 
mainly or exclusively directed to discover the human 
agent, and the only treatment is to convince the patient 
that his spell has been removed. Whether disease is 
ascribed to human or spiritual agency, the therapeutic 
practice is usually based on the belief that the agent 
has implanted in the body of his victim some material 
object—a piece of bone, a crystal, or a pebble—as the 
vehicle of the disease. It is by the supposed extraction 
of such an object that the cure is effected, suction being 
the most frequent process by which the object is 
removed. 

POLYNESIA 

While Australia, lying on one side of Melanesia, 
provides, at any rate from certain points of view, an 

POLYNESIA 

example of the relation between medicine and magic, 
Polynesia, lying upon the other side, shows us a striking 
example of the intimate relation between medicine 
and religion. In some parts of Polynesia magic appears 
to be absent and, with the exception of a few simple 
remedies, the cure of disease is sought by means of 
direct appeal to higher powers, and especially to those 
beings called atwa, who are almost certainly derived 
from the ghosts of dead ancestors. 

In this part of the world especial importance is 
attached to the process of prognosis, which is carried 
out by men who enter into conditions of trance, in 
which they are believed to be possessed by the ghosts 
of the dead. In this condition the possessed person 
answers inquiries concerning the outcome of the illness, 
and the friends of the patient are content to accept 
_ the fiat thus issued, and do not seek to interfere with 
the result by the employment of any therapeutic 
measures. Among some peoples of Polynesia medicine 
can hardly be said to exist, so exclusively do the people 
rely upon divine help in their attitude towards disease. 
Even where definite therapeutic remedies are employed 
there is often eveidence that these are of recent intro- 
duction. Thus Mariner states! that the Tongans 
looked to the gods for relief from disease, using for 
this purpose rites of invocation and sacrifice, They had 
learnt from the Fijians, not long before Mariner’s stay 
in the islands, the surgical procedures which form 
almost the only measures which can be regarded as 
strictly therapeutic. 

In some parts of Polynesia the abstraction of blood, 
usually by means of incisions and scarifications, is a 
favourite remedy. Vapour and cold baths and massage 
are also employed as therapeutic measures, but little 

1 Tonga, 1817, ii, p. 242. 

use is made of herbs or other internal remedies in most 
parts of Polynesia. An extensive vegetable pharma- 
copoeia has been recorded from New Zealand, but, 
according to Elsdon Best,! the greatest living authority 
on the Maoris, this is a recent growth. Before the 
coming of European influence the Maoris were content 
to rely mainly upon spiritual agencies similar to those 
invoked by the inhabitants of other parts of Polynesia. 
Such internal remedies as were used in Tonga had been 
derived from Fiji.? | 

The medical practice of the Hawaiian Islands, though 
intimately connected with religion, contains more 
elements of a medical character. David Malo,? a 
native authority, says that the medical treatment of 
the sick was a matter that belonged to the worship of 
the gods. The treatment was applied by a kahuna, or 
priest, but it included the administration of a number 
of herbs, as well as the use of the vapour bath. The 
religious character of the treatment is shown, however, 
by offerings to the gods at different stages, and when 
the patient was chief no medicine was ever adminis- 
trated without prayer. 

In parts of Polynesia there is a belief in the produc- 
tion of disease by human agency, and by the employ- 
ment of procedures resembling the magic of other 
places; but beliefs of this kind are of little account 
beside the religious attitude. In some islands they 
appear to be completely absent, one island where this 
is certainly the case being the small Polynesian settle- 
ment of Tikopia, which lies upon the fringe of 
Melanesia.‘ 

1 See W. H. Goldie, Transactions of the New Zealand Institute, 
xxxvii, 1904, p. 2. 

2 Mariner, loc. cit. 

3 Hawaiian Antiquities, Honolulu, 1903, p. 144. 

4W.H.R. Rivers, History of Melanesian Society, Cambridge, 1914, 
vol. i, p. 315. 

O4 

POLYNESIA 

INDONESIA 

The Malay Archipelago, now usually known as 
Indonesia, is of especial interest in relation to Melan- 
esia, Polynesia, and Australia, because it is almost 
certain that the chief external influences which have 
reached these areas came by way of this archipelago. 
Indonesia is the seat of much recent contact with the 
-Chinese, while before this many parts of it were 
saturated with Hindu influence. Probably as the result 
of the many influences to which it has been exposed, the 
medical art of Indonesia presents more variety than 
that of Melanesia or Polynesia. The occurrence of 
disease is ascribed to human agency, as well as to the 
activity of evil spirits, of the ghosts of ancestors and 
relatives, and of beings who can definitely be regarded 
as gods. 

One of the modes in which purely human agency is 
believed to produce disease is by acting upon separated 
parts of the body, the so-called sympathetic magic ; 
and though the evidence is not conclusive, it would 
appear that this form of magic rests upon the belief 
in a divisible soul-substance similar to that held by 
the Kai of New Guinea.t In Melanesia and Australia 
it is sometimes difficult to be sure whether the injurious 
effects which follow the rites of a sorcerer do not 
depend upon the administration of poisons. In Indo- 
nesia this use of poisons stands beyond doubt, the most 
striking example being the production of a lingering 
intestinal complaint, often ending fatally, by the 
administration of powdered bamboo. Even when the 
morbid effects can confidently be ascribed to a poison, 
however, the utterance of incantations and other 
actions of the poisoner show that the process is not 
far removed from magic, and the agent himself prob- 

1 Vide supra, p. 19. 

ably fails to distinguish between measures in which 
he administers actual poisons, and those in which the 
morbid effects are entirely due to the belief of the victim 
in the magical powers of one whom he has offended. 

The belief in the production of disease by magic, 
however, plays a relatively small role in Indonesia 
compared with that in which disease is ascribed to the 
action of spiritual or divine beings. One of the most 
frequent beliefs is that, also widely prevalent in 
Melanesia, in which disease is ascribed to the abstrac- 
tion of the soul or soul-substance. It is believed that 
the soul is sometimes devoured by the spirits who steal 
it, in which case a fatal issue is inevitable. In other 
cases the soul can be recovered by a priest, and the 
nature of the rites performed for this purpose shows 
clearly that the beliefs of this kind come definitely 
into the category of religion. 

An important feature of the rites performed by a 
priest when dealing with disease in the island of Nias 4 
is that he makes images of wood called adu, which 
probably represent ancestral ghosts. Many different 
kinds of adu, bearing special names, are made for 
different kinds of illness. Thus, one kind is made up 
when the patient is suffering from fever, with swollen 
feet and a sensation of heaviness in the limbs, another 
when fever is accompanied by nightmares, and a third 
when there are also pains in head and body. The adu 
are made in different forms, an important feature 
being that the more serious the illness the larger is 
the number of kinds of wood that must be used. In 
one case, the adu ba mbumbu, made when all other 

+{. PK, de Zwaan, Die Heilkunde dey Niasser, Haag, 1913, 
Pps oe 784: 

2 [It is more likely that they represent the life-giving dragon, the 
naga, or the mythical ‘‘ crocodile ’’, which is believed to restore 
health by restoring the deficiency of vital parle see causing the 
illness.—G. E. S.] 

INDONESIA 

remedies have failed, from 50 to 1,000 images are made 
of as many kinds of wood as can be obtained. 

An adu is treated in various ways. It may be hung 
on a tree as an offering to the evil spirit who is believed 
to be producing the disease, or it may be set up before 
the patient, or before or on the roof of his house. .It 
may be thrown into a river, the belief in this case 
being that the disease has entered the adu, and is 
carried away by the stream. The disease may also 
be transferred from the patient by touching him with 
a young pig, which is then slaughtered and its blood 
smeared on the adu. 

Various rites accompany the use of the adu. Offer- 
ings may be made to the beings to whom the action of 
the disease is ascribed, and in the case of the adu ba 
_mbumbu the priest climbs on the roof of the patient’s 
house to pray to the “ sun-god’”’. The patient may be 
isolated and his diet regulated, and he may be given 
remedies, such as fungi from the tree believed to be 
inhabited by the evil spirit to which the disease is 
ascribed. 

In some cases the occurrence of disease is believed to 
affect a person because he or his relatives have com- 
mitted an offence against the beings to whom the 
disease is ascribed, but, so far as our information goes, 
it appears that more often disease is believed to come 
about through the will of spirit or god, independently 
of any sin on the part of the patient. 

In addition to the measures which depend upon 
appeal to non-human and divine beings, remedies of the 
domestic order are frequently employed. This branch 
of medicine seems to have reached a higher degree of 
development than in Oceania, for these remedies are 
used by special practitioners, often women, called 
dukun, in the island of Nias, who use massage and 
various internal remedies. Though definite informa- 

tion is lacking, it is probable that the letting of blood 
by means of scarification and cupping is also the 
business of these practitioners. 

I have dealt at some length with the medicine of 
Australia, Polynesia, and Indonesia, because the 
culture of these three areas stands in a special relation 
to that of Melanesia. With few exceptions the people 
of Melanesia, Polynesia, and Indonesia regions, some- 
times known collectively as Austronesia, speak lan- 
guages which belong to closely related families, and 
have many other practices in common. We should 
therefore expect to find the similarity in their medical 
arts, and in the relation of these to magic and religion, 
which we have seen actually to exist. I must deal with 
the medicine of other parts of the world more briefly. 

INDIA 

Corresponding with its advanced civilization, we 
find in India an extensive pharmacopcela and a 
surgery from which that of Europe has taken more 
than one lesson. The practice of rhinoplasty was 
borrowed from India, while the first performance of 
surgical operations under hypnotism was largely due 
to the experience of this practice gained by Esdaile 
in this country. 

Even this relatively advanced art, however, seems 
to have greatly degenerated from that which belonged 
to Indian medicine about the fifth century a.D., the 
degeneration apparently being due to the gradual 
preponderence of an old indigenous art over one intro- 
duced and developed by an immigrant people. Even 
at its best times, however, the close relation of medicine 
with religion was shown by the special practice of the 
medical art by members of the priestly Brahminic 
caste. At the present time the frequent use of formulas 
when remedies are administered shows clearly how 

INDIA 

close is the alliance between medicine and religion, 
even among the more highly civilized sections of the 
Indian population. 

Among the less advanced sections of the community 
the connexion between medicine and religion is still 
more definite. The folk medicine of India at the present 
time is chiefly based on the belief that disease depends 
upon possession by a spirit, and the historians of 
Indian medicine speak of possession as characteristic 
of its earliest stage. 

When disease is ascribed to possession the rational 
remedy is to rid the patient of that by which he is 
possessed, and, as we should expect, rites of exorcism 
are very prominent in Indian medicine and religion. 
In India we also meet the idea of disease as a punish- 
ment for sin, the beings who thus inflict disease when 
offended including both ghosts of ancestors and 
gods. 

Not only is a disease believed to fall upon man as a 
punishment for offences which he has committed in 
his present life, but the doctrine of transmigration has 
brought with it the belief that disease may occur as 
punishment for offences committed in a former exis- 
tence, and that they are to be remedied by the per- 
formance of religious penances. 

One people of India, the Todas, whose culture is 
in many ways peculiar, exhibit an interesting phase in 
the specialization of medicine and religion. There is 
a definite distinction between the priest and the leech, 
together with a close similarity in the formulas of the 
therapeutic measures of the one, and the divinatory 
and religious rites of the other. 

1 W. H.R. Rivers, The Todas, London, 1906, p. 271 

CHINA AND JAPAN 

China presents us with an example of medicine which 
resembles in many respects that of our own Middle 
Ages. The main doctrine upon which Chinese medicine 
rests is that disease depends on disturbance of the 
normal equilibrium between the blood, the humours, 
and the life-spirit. The chief element in the system of 
diagnosis is a highly elaborate examination of the 
pulse. 

On the therapeutic side there is a very extensive 
pharmacopeceia, one writer alone enumerating no less 
than 1,892 remedies. Animal substances are frequently 
used, while the moxa, acupuncture, and massage are 
employed with great frequency. 

The medicine of Japan is largely borrowed from 
China, and presents very similar characteristics ; but 
was placed on a more rational basis by a number of 
physicians from the sixteenth century onwards. 

AFRICA 

In Africa, as in the parts of the world already con- 
sidered, disease is ascribed to both human and spiritual 
agency, but several African peoples show a belief in 
the production of disease by natural causes to a far 
greater extent than in Austronesia. 

The belief in human agency usually takes the form 
of sympathetic magic, depending on the belief that 
disease can be brought upon a man by acting upon 
some part of him. This belief in magic is especially 
prominent in West Africa, and is probably more 
characteristic of the Negro than of the Bantu. 

Several kinds of spiritual beings are believed to 
inflict disease, but the ghosts of the dead seem to be 
the most important. In some places a distinction is 
made between the ghosts of ordinary people and those 

AFRICA 

of chiefs or kings. There is also found the belief in 
special gods connected with disease, and, as in other 
parts of the world, it is epidemic disease which is 
especially ascribed to these deities. 

The most frequent way in which disease is inflicted 
takes the form of possession, but the belief in the 
causation of disease by the absence of the soul or of the 
life-principle occurs in West Africa. 

The motives which are believed to lead ghosts or 
other spiritual agents to inflict disease are usually the 
breaking of a taboo, or the neglect to make offerings, 
tend graves, or perform the rites which the spirits 
believe to be their due. If the relatives of an orphan 
do not give the child the social position which belongs 
to it, it is believed that the ghost of the child’s father 
may inflict disease upon them. 

In cases where disease is ascribed to possession by a 
spirit the natural remedy is exorcism, which is effected 
either by direct appeal to the spirit or deity, but more 
frequently by means of a power believed to belong to 
an object prepared in certain ways, the fetich which 
is so characteristic of African culture that the term 
‘“‘ fetichism ”’ has come to be widely but loosely applied 
to the whole of African religion. A frequent form of 
fetich is the horn of an ox filled with various substances 
to which virtue is imparted by certain rites. Another 
frequent mode of treatment is to carry out rites 
designed to tranfer the disease, or rather the spirit 
causing the disease, to some object, such as a tree or 
animal, or to another human being. In the last case 
the spirit of the disease is believed to pass into a model 
of the patient in clay, which has been in contact with 
the patient’s body. The object so animated is then 
put by the roadside or some other place, where it will 
enter the body of the next passer-by.1 This method 

1 J. Roscoe, The Baganda, London, 1911, p. 344. 

closely resembles the form of magic, in which a sorcerer 
inflicts disease upon an enemy ; but differs from it in 
that the African purpose need not be malicious, but 
disease is brought upon the passer-by in the interest 
of one who is already ill. 

In some cases in which the occurrence of disease 
follows an offence, such as adultery on the part of a 
woman while bearing or nursing a child, it is believed 
that the disease can only be cured by confession and 
rites of purification.1 

An important place in African medicine is taken by 
amulets, designed to avert disease. These often 
resemble the fetiches used for the treatment of disease. 

Several African people seem to possess in a definite 
form the idea of the causation of disease by climatic 
or other natural conditions, in which case their remedies 
may be purely medical and devoid of any religious 
character, though the nature of the remedies usually 
brings them nearer to those of the Middle Ages than 
of our own time. This development of a genuine art 
of medicine has been recorded among several Bantu 
peoples, but seems to have reached its greatest height 
among the Masai,2 who are said never to ascribe 
disease to the action of spirits, and only rarely to human 
agency. We are told of only one disease, elephantiasis 
of the scrotum, which is regarded as a punishment 
for sin. 

In addition to the modes of combating disease which 
are closely related to magic or religion, most African 
peoples employ remedies of a domestic kind which 
can be used by all, or measures employed by those 
who possess the necessary skill, but are yet quite 
distinct from the priests or wizards, who carry out 
rites which are magical or religious as well as medical. 

1 J. Roscoe, op. cit., p. 102. 
2 M. Merker, Die Masai, Berlin, 1904, p. 174. 

AMERICA 

Among the remedies of this kind are blood-letting in 
the form of cupping, massage, various forms of surgery, 
and many internal remedies. 

Among the Masai the internal remedies are known 
to all, and it is only surgical procedures which are 
practised by specialized practitioners. In some parts 
of Africa a man may have a reputation for success in 
the treatment of some one form of disease. As was 
found to be the case in Melanesia, where there has been 
specialization of medical function it has often pro- 
ceeded along lines different from, and it may be even 
antagonistic to, those which would promote the 
separation of medicine from magic and religion. 

AMERICA 

This continent affords a good example of the intimate 
relation between medicine and religion, the combina- 
tion having developed to such an extent that most of 
the religious rites, rites often very elaborate and pro- 
longed, have as their main purpose the treatment of 
sickness. 

The belief in the production of disease by human 
agency exists in North America, but it is less important 
and frequent than in many other parts of the world. 
When sickness is produced in this way, the agent is 
usually one who has many other functions in addition 
to those connected with disease. 

Sickness is more usually ascribed to the action of 
ghosts or spirits, who act either on account of a natural 
malevolence, or because they have been offended by 
some lapse on the part of the victim, especially the 
breaking of a food taboo, or failure to follow the many 
observances connected with childbirth, puberty, 
menstruation, and coitus. 

The most frequent belief concerning the mode of 
production of disease is to ascribe it to the introduction 

into the body of some noxious agent, which, though 
apparently primarily of a spiritual kind, is often objec- 
tified or personified. A frequent object thus regarded 
as the immediate cause of disease is a piece of bone, and 
as frequently an animal, either a worm or insect, or it 
may be an animal as large as a bear or otter. A less 
frequent belief concerning the causation of disease is 
that which we have met elsewhere, in which disease is 
ascribed to the absence of the soul or one of 
several souls. Disease may also be assigned to 
natural causes, such as the action of the moon or of 
the winds. 

As elsewhere, the chief lines of treatment of disease 
in America are the logical outcome of the beliefs in 
causation. They consist of rites of exorcism, in which 
the disease possessing the patient is driven away by 
incantations, the noise of rattles and drums, and other 
means. In other cases the objectified disease is 
abstracted by sucking or other forms of legerdemain. 
When disease is ascribed to a loss of the soul, it is 
recovered by a leech; and it is sometimes believed that, 
as in Indonesia and Melanesia, the soul of a leech leaves 
his body in order to recover the lost soul of the patient. 
Disease may be transferred to an animal or to another 
person. In the highly developed rites of the medicine 
societies of the Pueblo Indian, the Navaho and Apache, 
all the members of the society assist in the rites 
designed to restore health to a sick person, who defrays 
the whole cost of the ceremonial. 

In addition to these lines of treatment, which bring 
medicine into such close relations with religion, a 
number of measures, including plants as internal 
remedies, blood-letting, cauterization, poulticing, mas- 
sage, and vapour baths, are employed. 

The civilized peoples who inhabited Mexico and 
Central America when these countries were conquered 

AMERICA 

by the Spaniards practised an art of medicine which 
bore a general resemblance to that of other parts of 
America, though of a more advanced kind. 

Among the Aztecs, of whose medicine the record is 
most complete, the occurrence of disease was usually 
ascribed to the gods, though sorcery was occasionally 
held responsible. An illness was often believed to 
follow some fault on the part of the patient, usually 
some breach of ritual. There were special gods of 
disease. In Mexico they not only inflicted disease, 
but there were special deities of healing, one such 
being a goddess of herbs, and another one who had 
discovered the curative properties of turpentine. 

Corresponding with this belief in the divine origin 
of disease, diagnosis and prognosis often took the 
form of divination, and the course of an illness was 
foretold by scrying in a mirror or in water, or by the 
unravelling of a knot. The remedies included an 
extensive pharmacopceia, in which plants predominated, 
while bleeding, vapour baths, and massage were widely 
employed. Rites of exorcism were also used, while 
among this advanced people we meet again the form 
of treatment in which the leech pretends to suck from 
the body of his patient a pebble or other object, which 
was held to have been implanted there by human or 
spiritual agency, and to have been the cause of the 
illness. 

Disease was also transferred from one person to 
another. A figure of dough, made in human form, was 
placed by the roadside so that it might enter the next 
passer-by, a process bearing the closest resemblance 
to one I have already mentioned as occurring in West 
Africa. 

The existing rude peoples of Central America practice 
similar methods. One tribe of the Mosquito Indians 
of Nicaragua has the peculiar custom that six persons 

are urged to eat as much as possible, especially of 
green turtle. 

In many parts of South America the belief in human 
agency in the production of disease is especially promi- 
nent. Thus, in British Guiana, every disease is regarded 
as the work of a sorcerer, and an illness ascribed to his 
spells is treated by one of a class of practitioner, who 
pretends to extract an object placed in the body of 
the patient by the sorcerer.}. 

The Incas of Peru had an extensive pharmacopeeia, 
and practised vinesection, but we do not know that 
their religious rites were as closely connected with 
health and disease as was the case among the Aztecs 
and Mayas. The Mapuche of Chili ? have two classes 
of priest, of which one also acted as leeches, while 
surgeons form still another body of specialized prac- 
titioners. Those who were at once leeches and priests 
are said to be concerned with spirits, to whose action 
it would seem that disease was attributed. The 
Mapuche use many herbs and employ venesection, 
massage, and vapour-baths. 

SIMILARITY IN VIEWS ON CAUSATION AND TREAT- 
MENT OF DISEASE 

This survey, brief though it be, is sufficient to show 
how great a similarity exists between different regions 
of the earth in the general character of the beliefs 
concerning the causation of disease, and in the measures 
which are used to combat its effects. As I have already 
said, these similarities have been held by most students 
of human society to be the result of uniformity in the 
working of the human mind in response to its environ- 
ment. They are held to be examples of similarity in 

1 E. im Thurn, Among the Indians of Gutana, London, 1883, 

pp. 329 sqq. 
2 ©. Aichel, Arch. f. Geschichte d. Medizin, 1913, vi, p. 161. 

CONSIDERATION OF RIVAL VIEWS 

the course of evolution, owing to similarity of the 
materials which the process of evolution moulds and 
uniformity of the agency by which this moulding is 
carried out. Only when the similarities occur among 
neighbouring peoples, who though distant from one 
another, are known to have been in contact, has it 
been customary to explain them by the transmission 
of culture from one place to another. Otherwise they 
have been supposed to have arisen independently, and 
this view is still! widely held. Its advocates fail to 
see how in early stages of his culture man can have 
moved about the world with sufficient freedom to 
produce the wide dispersal of object and custom which 
must have occurred if these similarities are due to 
transmission. I propose to consider the rival views, 
according to which these similarities depend upon 
transmission, or are the result of processes of independent 
origin. . 
CONSIDERATION OF RIvAL VIEWS 

I may first point out how favourable a case for 
independent origin is presented by the phenomena of 
disease. Many of the similarities of culture which 
are believed to have come into being independently 
in different parts of the world, relate to features of 
man’s environment which are far from uniform. Thus, 
different parts of the earth show great differences in 
the apparent movements of the sun, and in the course 
and nature of the seasons. As great variations are 
shown in the nature and annual changes of vegetation, 
and in the natural features of land and sea. If the 
human mind is the same everywhere, these differences 
in the physical environment should lead us to expect 
diversity rather than uniformity in the customs 
relating to them. Where we find similarities of reaction 

RSL917; 

towards the sun, the seasons, vegetation, and other 
natural conditions in places where Nature presents 
herself under such widely diverse aspects, the advocate 
of the independent origin of these similarities is met 
at the outset by a serious difficulty. 7 

This initial difficulty is not present, or is present 
in much less degree, where man himself is more directly 
concerned. The phenomena of birth and death are 
the same everywhere. The difficulty which here meets 
the believer in independent origin is to explain the 
great diversity which is shown by a man’s mode of 
reaction towards the occurrences of his own life. 

This similarity of conditions throughout the world 
is also presented, though in somewhat less degree, by 
the phenomena of disease. With our advanced 
knowledge we recognize a considerable degree of 
diversity in the diseases of different parts of the world, 
but, in his ruder phases of development, man deals with 
symptoms rather than with diseases, or, more strictly 
speaking, does so in even greater measure than our- 
selves. The chief manifestations of disease, pain, 
fever, disturbances of the digestion, swellings, ulcera- 
tions, and eruptions, are much the same everywhere, 
and present a body of appearances showing so great 
a natural similarity that disease offers a most favour- 
able opportunity for the advocates of independent 

1 [A very curious method of controversy has recently been devised 
by certain ethnologists, more especially in America, to evade the 
logical consequences of their claim for uniformity of reaction. 
Without consciously abandoning the doctrine of independent 
development of custom and belief, they somewhat inconsequently 
accuse those of us who criticize their interpretation of the facts of 
exaggerating the resemblances, which with a singular lack of 
cogency they pretend are superficial and spurious. But they seem 
to forget that the theory of the similarity of the working of the 
human mind, of which those who make the protests are themselves 
the champions, is wholly based upon the assumption that the 
resemblances are real and fundamental! Within recent years both 
Dr. Clark Wissler (The American Indian) and D. S. G. Morley (The 
Ruins of Copan) have employed this strange method of attack in 
criticizing me.—G. E. S.] 

BELIEFS IN CAUSATION OF DISEASE 

origin. If they fail to show that similarities in the 
reaction of mankind towards disease have been the 
result of independent discovery and invention, it is 
difficult to see where they are likely to succeed. 

Two WIDELY DIFFERING BELIEFS IN CAUSATION OF 
DISEASE 

I can only consider briefly two problems suggested 
by the material laid before you in this book. These 
will serve to illustrate the kind of situation with which 
we are confronted in this subject. 

The sketch I have given, of the beliefs and practices 
of different regions of the earth in relation to disease, 
has brought out certain differences in the distribution 
of the customs which bring medicine into intimate 
relations with magic and religion. 

The belief in the production of disease by the abstrac- 
tion of the soul, of some part of the soul, or of one of 
several souls, appears to be limited to Indonesia, 
Papuo-Melanesia, and America. We do not know of it 
in Asia; and, though disease may be ascribed to absence 
of the soul or of the vital principle in West Africa, 
this belief does not appear to have given rise to the 
organized system of practices which we find in Indo- 
nesia and, to a less extent, in America. 

India and Africa, on the other hand, are pre-eminently 
the seat of the belief in the production of disease by 
possession. These two beliefs, one in the production 
of disease by the addition of something to the body of 
the patient, the other in the abstraction of something 
from it, are more or less opposed to one another.! If 
the phenomena of disease are much the same all the 

1 These opposed beliefs may sometimes be brought into relation 
with one another. Thus the Ewe-speaking peoples of West Africa 
believe that when the soul of a person quits his body it provides an 

opportunity for a wandering, homeless spirit to enter and produce 
disease. A. B. Ellis, The Ewe-speaking Peoples, London, 1890, p. 107. 

world over, and if the similarities of belief and action 
are due to the uniformity of the human mind, how 
comes it that men should have been led to these very 
different beliefs and why should these beliefs have 
different distributions ? 

The advocate of independent origin ought to be 
able to point to something in the nature of the diseases 
of Indonesia, or in their relation to the environment, 
which led the inhabitants of this region to attach 
so great an importance to the abstraction of the soul, 
while the peoples of India and Africa failed to make 
such a discovery, or, if they believed in the absence of 
the soul as a cause of illness, failed to make it the basis 
of their system of therapeutics. 

Still more difficult is the task of explaining the co- 
existence of these widely different, if not opposed, 
beliefs among one people, as in North America. If, as 
the majority of students of American ethnography 
hold, the culture of this continent has been the result 
of a wholly independent process of development, we 
should hardly expect to find two such widely different 
modes of conceiving the essential nature of disease. 
The co-existence of two such concepts is far more 
naturally explained as the result of the contact of | 
peoples and the blending of their cultures. 

This solution of the problem becomes still more 
natural when we find the belief in the production of 
disease by the abstraction of a soul especially frequent 
and important on the western side of the American 
continent—viz. in that part which forms one shore of 
an ocean, on the other side of which this belief flourishes. 
Very significant in this connexion is the condition 
found among the Songish, whose women are able to 
cure disease due to causes other than loss of the soul, 
while a lost soul can only be recovered by one of a 
special class of shamans. 

REMEDIES OF THE “DOMESTIC” ORDER 

REMEDIES OF THE ‘“‘ DOMESTIC’? ORDER 

The second problem which I choose for the purpose 
of illustration, is suggested by certain difference which 
distinguish the domestic remedies of many peoples 
from those which are, or should be, applied only by 
persons with especial qualifications. Earlier in this 
book I showed that the means of combating disease 
adopted by the peoples of Melanesia and New Guinea 
follow naturally from their beliefs concerning its 
causation. Once we know the Melanesian or Papuan 
theory of disease, their diagnostic and therapeutic 
measures are seen to be only the logical consequences 
of this theory. Actions which may seem meaningless 
or even ridiculous on superficial examination, are only 
the natural outcome of the views which the people hold 
concerning the nature of the disease. I stated, how- 
ever, that there were exceptions. It is in the remedies 
which may be applied to anyone, and do not need the 
services of a specially qualified practitioner, that these 
exceptions are most apparent. 

These remedies correspond very closely with those 
which among ourselves we call ‘“‘ domestic ’’—remedies 
used by anyone in cases of slight illness, or at the first 
onset of more serious illness before its gravity is 
recognized. Just as among ourselves, the doctor is 
only sent for when domestic remedies fail, or when the 
illness is at once seen to be serious, so do the Melanesian, 
Papuan, and other lowly peoples only consult the 
sorcerer, priest, or leech when their remedies of the 
domestic order fail, or when the gravity of the case 
demands more powerful measures. 

The nature of these domestic remedies is well 
illustrated by the Kai, a people of North-Eastern New 
Guinea, of whose prolonged and complex ritual, based 
on the belief in abstraction of the soul or soul-substance, 

Ihave given so fullan account (see pp. 91 seg.) Inaddition 
to the measures which involve the activity of the sorcerer 
or leech, the Kai use a number of remedies which seem 
to have no connexion with the concept of soul-substance. 
For wounds they use a rude kind of poultice made 
of the powdered fruits of the cycas-palm covered with 
its leaves, and various kinds of leaf or bark are believed 
to have a healing action upon wounds. 

The abstraction of blood is an almost universal 
remedy. Freshly inflicted wounds are made to bleed 
as freely as possible, and unless this is done it is 
believed that the wound will never heal. It is held 
that the bad blood flows away, while the good blood 
remains in the body. Headache is treated by cuts on 
the forehead, made with splinters, formerly of obsidian 
and now of glass. In cases of nasal catarrh a stick is 
thrust into the nostrils to make them bleed, and this 
treatment is also used in cases of illness in which the 
nose is not itself affected. Blood is also drawn by 
leeches applied to parts of the body which are the seat 
of pain. 

For pain in the chest with difficulty of breathing, 
the people stroke the chest with a kind of nettle, and 
this remedy is also used to get rid of the muscular pain 
which follows long marches or the bearing of very 
heavy loads. Vapour-baths, used for rheumatic pains, 
are produced by heated stones, lying on and covered 
by leaves, placed in a hole dug in the earth. The 
painful part of the body is exposed to the vapour 
which rises from the leaves, or steam may be produced 
by putting hot stones into the coconut vessels which 
are used to carry water. Kneading of the body is 
sometimes employed. A curious remedy is used for 
deafness due to occlusion of the external auditory 
meatus. A small chafer is introduced into the passage 
and may remain there for several days. This method 

REMEDIES OF THE “DOMESTIC” ORDER 

of cleaning what Keysser calls the Augean stable of 
the Papuan ear is believed to be highly efficacious in 
the restoration of hearing. 

This lowly people of New Guinea thus use more or 
less rude forms of five modes of treatment which are 
found widely over the earth—viz. poulticing, blood- 
letting, massage, vapour-baths, and counter-irritation. 
Moreover, these practices stand apart from the system 
of therapeutics based on the belief in the production 
of disease by human or spiritual agency, which bulks 
so largely in the minds of the people. 

It would be easy to point out ways in which each 
one of the measures found among the Kai might have 
been discovered by the process called chance or 
accident. The whole history of invention shows, 
however, that new discoveries do not arise in this way, 
but are the direct outcome of the physical and social 
conditions in which they have their birth. Even if 
inventions come to fruition by mere accident, it would 
still be difficult to accept the position that these rude 
savages discovered, independently and by chance, five 
of the procedures of our own mediaeval and modern 
medicine. 

If we are to explain the independent origin of these 
Papuan practices, we ought to be able to show that 
they arose out of the body of beliefs concerning the 
causation of disease, and this is just what we cannot 
do. The Kai have a definite body of beliefs concerning 
the causation of disease, to which corresponds a definite 
system of therapeutics, but this system does not 
include the remedies I have just enumerated, nor 
does it seem possible to show that these remedies are 
in any way connected with the dominant beliefs 
concerning the causation of disease. 

ORIGIN OF ABOVE PRACTICES 

The survey of the medicine of other parts of the 
world which I have given in this chapter shows that 
what is true of the Kai is true of nearly all the more 
lowly peoples of the earth. When we find such peoples 
practising venesection and cupping, and using massage 
and vapour-baths, etc., these: practices do not form 
part of the blend of religion and medicine which is the 
most striking characteristic of the attitude of these » 
peoples towards disease. They are not practised by 
the special class of persons who combine in various 
degrees the functions of the priest and leech, but they 
may be performed by anyone, or by persons who have 
acquired a special reputation for skill in these respects 
by practice and ability, not through the special pro- 
cesses of initiation which are usually necessary for the 
practice of the rites in which medicine and religion are 
so closely blended. In many cases even these forms 
of treatment are exercised by women, who are so often 
rigorously excluded from participation in medico- 
religious rites. 
Most of the peoples of the earth who use blood- 
letting, massage, and vapour-baths, have certainly not 
been led to these practices by motives arising out of 
the ideas and beliefs regarding disease which dominate 
the larger part of their behaviour in the presence of 
disease. If they have arisen independently in different 
parts of the earth, they have not grown out of the 
magico-religious atmosphere which surrounds disease. 
They must rather be ascribed to some kind of reaction 
against this religious atmosphere, to a movement on 
the part of the general body of the people against a 
view of disease forming part of a system of beliefs which 
regulate behaviour, not only towards disease, but 
towards many other aspects of nature. The special 

ORIGIN OF ABOVE PRACTICES 

arguments against independent origin, which each of 
the customs suggests when examined independently, 
are strongly reinforced by the absence of any relation 
to the body of beliefs which determine the attitude of 
the more lowly peoples of the earth towards disease. 

It is, of course, open to the advocates of independent 
origin to say that such practices as blood-letting and 
vapour-baths, as they exist in New Guinea, are only the 
beginnings of a movement towards rational medicine 
among a people who had till then been altogether 
dominated by a system of sorcery or priestcraft. They 
may say that the rude forms in which these remedies 
occur are natural as the first product of trends of 
thought which have produced the more elaborate and 
finished forms of these practices among ourselves. In 
response to such an argument | will now make only 
one suggestion. 

Highly as we rate our own civilization, it did not 
enable us to discover for ourselves practices which, 
according to advocates of independent origin, must 
have been discovered by the Melanesian and Papuan. 
We acquired our practices of bleeding and counter- 
irritation from the Greeks or Arabs, our massage from 
the French or other continental people, and our vapour- 
baths from the Turks and Russians. The civilization 
of which we are so proud did not of itself suffice to 
teach us these remedial arts, but we had to acquire 
them by contact and mixture with other peoples. If we 
are to accept the teachings of those who believe in the 
independent origin of such practices in Africa, Asia, 
Oceania, and America, we shall have to accept the 
position that the savage or barbarous peoples who 
inhabit these continents and islands were somehow 
able to discover arts which we, who think ourselves so 
greatly their superiors, were content to learn from 
other peoples.

N the last chapter I gave some account of the 
present condition of the science of ethnology 
in its bearing on the problems raised by the complex 
relations between medicine, magic, and religion. 
It was seen that there is a great similarity throughout 
the world, not only in those practices which bring 
medicine into intimate relations with magic and 
religion, but also in the domestic or strictly medical 
remedies so often found side by side with those used 
by the magician and the priest. The problem now 
in special need of solution is whether these similar 
practices have arisen independently in different parts 
of the earth, or have developed in some one locality, 
whence they have been carried to their present areas 
of distribution by the wanderings of people. 

In the last chapter I illustrated certain difficulties 
which meet us when we attempt the explanation of 
these similarities on the hypothesis of independent 
origin. The co-existence of two more or less opposed 
beliefs concerning the causation of disease in America, 
and the failure to derive the domestic remedies of 
a lowly Papuan people from their theory of disease, 
are difficult to explain on this hypothesis, while they 
are easy to understand if the movements of mankind 
over the earth’s surface in early times were more 
extensive than has hitherto been supposed. 

It is one thing, however, to state a case for trans- 
mission. It is another thing to demonstrate its 
importance in the history of human culture. The 

case for this mode of explaining the similarities of 
human culture will only be complete when we are 
able to point to certain regions of the earth as the 
places of origin of similar practices, and when we have 
discovered by whom the practices were carried over 
the earth and the course taken by these travellers. 
I propose to begin to-day with a brief consideration 
of the methods by which the science of ethnology 
is now seeking the solution of such problems as those 
suggested by the facts laid before you in the last 
chapter. 

METHODS OF SOLVING THE PROBLEMS 

In considering the methods by which we may hope 
to attain a knowledge of the manifold changes which 
have taken place in the relations between medicine, 
magic, and religion during the history of mankind, 
the first point to be noted is that we cannot expect 
to succeed if we limit our attention entirely to the 
special subject we are hoping to elucidate. The 
social life of man is so complex, the various elements 
of which it is built up form so closely interwoven 
a structure, especially in the lowly examples of culture 
with which we are now dealing, that we cannot expect 
to understand a part except in its relation to the 
whole. | 

THE IMPORTANCE ATTACHED TO NUMBERS 

I may illustrate this subject by considering for 
a moment a feature of medical practice in which 
numbers are concerned. It is the custom of certain 
peoples that a therapeutic measure shall be repeated 
a definite number of times—three, four, five, or 
seven, as the case may be. A striking example from 
Eddystone Island, in the Solomons, was given in 
Chapter II (see p. 33). In this island, a treatment 

THE IMPORTANCE ATTACHED TO NUMBERS 

usually lasts for four days, sometimes for four days 
in each of four successive months. 

This importance of the number four in medical 
practice is far from unique. The ancient Egyptians 
also had a four-day cure, and among the Cherokee 
of North America the normal length of a course of 
treatment is four days. 

Whether this striking agreement between ancient 
Egypt, the Solomon Islands, and North America 
is the result of the spread of culture, or whether 
the period of four days has been independently chosen 
in the three widely separated localities, is not a problem 
which can be settled by the study of medicine alone. 
Both in Eddystone Island and North America the 
fourfold nature of the medical rites forms only part 
of a system which makes the number four of the 
greatest importance throughout the whole range 
of ceremonial, whether medical, magical, or religious. 
In both places the four-day cure is only one manifesta- 
tion of a belief which ascribes special virtue to the 
number four. 

A wider survey shows that, though we. do not know 
of a four-day cure in Indonesia, the number is of 
great importance not only in religious ceremonial 
but also in connexion with disease. Thus, when 
a patient is isolated with an adu in front of him in the 
island of Nias, the isolation lasts for four days. Again, 
in the proceeding of initiation by which a youth is 
fitted for the duties of a priest, his instruction in the 
proper use of the gong and in the appropriate formulas 
lasts for four days. In a different department of 
custom, food is put aside for the use of the ghost for 
four days after death, and for these four days the 
people do not go into the rice-fields. Again, in 
countries so widely separated as Greece and Japan, 

1 J. Mooney, Journ. Amer. Folk-lore, 1890, iii, 48. 

we find a four-fold classification prominent. For 
Greece, I need only refer to the four elements, the 
four humours, etc. The question whether the existence 
of a four-day cure in Egypt, Eddystone Island, and 
North America is due to transmission or to independent 
origin is only part of the much larger question whether 
Egypt, Greece, Indonesia, Japan, the Solomon Islands, 
and North America possess geographical, climatic, 
or other feature in common which have led their 
inhabitants to attach particular importance to the 
number four, or whether this number acquired in 
some one part of the world a religious importance 
with which it passed elsewhere as a constituent element 
of a migrant culture.} 

THE CRITERION OF COMMON DISTRIBUTION 

This need for a broad and comprehensive study | 
becomes especially apparent in the chief method by 
which the ethnologist is now striving to build up 
schemes of the history of human institutions. For 
_ this purpose one of his chief instruments is the criterion 
of common distribution. If we map out the distribu- 
tion over the earth of two customs between which 
no natural relationship can be discovered, and find 
that the areas of distribution correspond, and if this 
correspondence of distribution cannot be traced to any 
uniform climatic or other geographical conditions, 
we conclude that the association between the two 
customs came into existence in some part of the earth, 
and was spread thence by the movements of people, 
either in the course of definite migrations or for the 
purpose of trade.? 

1 [It was not until August, 1918, in the year following the delivery 
of these lectures, that Dr. Rivers admitted the Egyptian origin of 
civilization—after three years of discussion and critical examination 

of the evidence.] 
1 [Exploitation is perhaps the more appropriate word.] 

SOME DIFFICULTIES MET WITH 

Thus no natural connexion can be found between the . 
worship of the sun and the practice of building 
megalithic monuments. When, therefore, we find 
these two customs associated together in some parts 
of the world, while both are absent in others, the 
chances against their independent origin become 
very much greater than if no such agreement of 
distribution existed. When instead of two such 
associated customs we find many, the chances against 
their independent origin become very great. 

SOME DIFFICULTIES MET WITH 

We are at present only on the threshold of the quest 
by which we may hope to break up the complex web 
of human culture into its component strands, by 
which we may assign each element of culture to 
a definite movement of mankind. Our immediate 
task is to show the principles to be employed in this 
quest, and the methods by which these principles 
may be applied. I propose to devote the chief part 
of this chapter to certain difficulties which meet us 
when we use the criterion of common distribution 
as our test for transmission. 

If a culture has been transported over the earth from 
a locality in which it has developed, we must expect to 
find gaps in the chain of evidence. We must expect 
that one element of culture will fail to implant itself 
here and another there; that other elements will 
-be modified in their new home, sometimes, perhaps 
to such an extent as to make it difficult to recognize 
the relation of the final product to the custom in which 
it had its source. I will begin by formulating a 
principle which may guide us in our inquiry into 
such cases of disappearance and modification. I shall 
then inquire whether it is possible to see the working 
of this principle when we study the nature and distribu- 

tion of a small group of therapeutic and hygienic 
customs. 

I have already suggested that a medical practice 
in a new home may lose its therapeutic character 
and become part of a indigenous magical or religious 
cult. On the other hand, an introduced magical 
or religious practice may receive a therapeutic applica- 
tion which it did not possess in its original home. 

FORMULATION OF GUIDING PRINCIPLE 

The kind of process which ensues when a culture 
is transplanted into a new home may be formulated 
as follows. Transplanted elements of culture tend 
to take root in a new home in so far as they are in 
harmony with the physical and cultural nature of their 
new environment, and, if they succeed in taking root, 
tend to become modified in the direction of the 
indigenous culture by which they are assimilated. This 
proposition has two parts—one dealing with the success 
or failure of new elements of culture to survive in a new 
home; the other, with the tendency to modification 
which shows itself in greater or less degree in cases 
of success. 

Factors AFFECTING SUCCESS OR FAILURE OF 
TRANSPLANTED ELEMENTS OF CULTURE 

Physical conditions are often such as to prevent 
the introduction of customs which would otherwise 
form part of a culture-complex. Thus, the absence 
of suitable earth may lead to a disappearance of 
pottery, or the difficulty of obtaining stone may lead 
to the degeneration of megalithic monuments, so that 
they resemble those of other parts of the world in 
form only and not in size. | 

Less obvious, but quite as important, are characters 

TRANSPLANTED ELEMENTS OF CULTURE 

of the social environment into which a new element 
of culture is conveyed. This environment may be 
so adverse to the newly-introduced practice that, if 
this succeeds in implanting itself at all, it soon withers 
and disappears under the opposition of indigenous 
trends of thought and action. Thus, it is probably 
the very different nature of the social environment 
of Melanesia and Polynesia which has led to a remark- 
able difference between these two regions in respect 
to their use of strictly medical practices. Medical 
and surgical remedies comparable with those of civilized 
peoples are of more frequent occurrence in Melanesia 
than in Polynesia. Even when strictly medical or 
surgical practices are found in Polynesia, there is 
often evidence that they have only recently been 
introduced. This difference between the two ethno- 
graphic provinces presents us with a striking problem 
which seems at first sight difficult to explain, either on 
the hypothesis of transmission, or on that of independent 
origin. The Polynesians are undoubtedly more 
intelligent people than the Melanesians, and, if we 
take our own civilization as the standard, Polynesian 
culture has reached a considerably higher level of 
development than that of Melanesia. If we believe 
that any medical and surgical remedies have been 
discovered independently in this part of the world, 
it is difficult to understand why the more intelligent 
and cultivated people should have fallen behind in 
these discoveries. 

If, on the other hand, we look at the matter from 
the point of view furnished by the hypothesis of 
transmission, we meet a problem of great interest. 
If this hypothesis is to work we shall have to find 
some reason why medical and surgical practices have 
been adopted by the lowly Melanesian in fuller measure 
than by the cultured Polynesian. I suggest that the 

reason becomes apparent if we apply the principle 
which I have just enunciated. 

We have seen that the special characteristic of the 
Polynesian is the highly religious nature of his life. 
Disease is ascribed wholly to the action of gods and 
other spiritual beings, and its cure is mainly, in some 
cases entirely, sought by means of appeal to these 
higher powers. In Melanesia, on the other hand, 
disease is ascribed either to direct human agency, 
or to spiritual agency which is more or less under 
human guidance or control. The measures employed 
to remedy the action of spiritual beings involve the 
intervention of persons whose knowledge and power 
are believed to be essential to success. 

Let us now try to imagine the nature of the process 
which would follow the introduction of a medical 
or surgical practice among each people. There can 
be little question which would give it the heartier 
reception, which culture would be endowed with 
beliefs and sentiments to form the more appropriate 
soil for the growth of the new custom. 

However closely a system of medicine be founded 
upon the belief in the working of a natural law, there 
can be no question that, in fact, and still more in the 
minds of both practitioner and patient, success depends 
upon individual skill and on the human factor. 
If this be so among ourselves, how much more must it 
be true of medical and surgical remedies introduced 
by strangers among a people who know nothing of 
natural law as we understand it? Such people will 
inevitably ascribe any success which follows the applica- 
tion of the remedy to the power of the man who has 
brought it among them, and by whom it is applied. 
The human factor will bulk so largely in their estimate 
of the value of the new remedy that its use will at 
once fall into line with those indigenous practices 

TRANSPLANTED ELEMENTS OF CULTURE 

which involve the idea of human agency. Toa people, 
on the other hand, imbued with the belief in the 
agency of higher powers, such remedies will not 
appeal. They may even be regarded as sacrilegious 
attempts to struggle against the will of the gods. 
If, when certain medical remedies were introduced 
into Oceania, the differences between Melanesian and 
Polynesian were what they are to-day, or even if they 
were of the same general order, we are furnished with 
an explanation of the greater prevalence of strictly 
medical practices among the more lowly people. 
This example suggests how the presence or absence 
of an introduced medical practice may be determined 
by the nature of the indigenous culture into which 
it is received, by the degree in which it is adapted 
to the beliefs and sentiments natural to the people. 
_ .An example of a different kind is given in the 
- distribution of blood-letting in the East. This practice, 
in the form of venesection, cupping, and leeching, 
is well established in India, but is almost completely 
absent in China, although several of the medical arts 
of this country are known to have come from India. 
Those who have recorded the absence or rarity of 
blood-letting in China note that it is due to the dislike 
of the spilling of blood which is characteristic of its 
people, a dislike which is chiefly responsible for the low 
state of Chinese surgery. That the practice of blood- 
letting is not indigenous in China is rendered highly 
probable by the existence of the dry method of cupping. 
If we believe that this practice has been developed 
independently in China, we shall be driven into the 
position that a people, who so objected to the sight of 
blood that the almost universal practice of blood-letting 
is hardly known among them, were nevertheless led to 
discover a high specialized therapeutic measure which 
elsewhere is intimately associated with blood-letting. 

Still another indication that the knowledge of blood- 
letting reached China is shown by the fact that leeches 
are used for a medical purpose. They are sometimes 
applied to the cervix uteri in order to induce abortion. 

The absence or rarity of blood-letting, combined with 
the process of dry-cupping and the medicinal use of 
leeches, receive as natural explanation if the various 
forms of blood-letting known in India were transported 
to China, but met with a poor reception, owing to their 
being in conflict with the beliefs and sentiments 
of the Chinese in connexion with blood, while the 
practice of dry-cupping, which does not involve the 
spilling of blood, became an important: part of their 
therapeutic practice. 

MODIFICATION OF PRACTICES AFTER INTRODUCTION 

I can now turn to the second part of my subject, 
the modification of introduced practices due to the 
influence of the environment, physical and social, 
to which they are exposed. I may begin by considering 
a few examples of this process of modification taken 
from other departments of social life. 

The modification of introduced practices occurs 
through the whole range of human culture. When- 
ever an element of culture, whether it be a word, 
a grammatical form, a religious practice, a social 
custom, or a material object, passes from one part 
of the world to another, it tends to become changed 
in the process, it does not remain in its new pone 
what it was in its old. 

In the domain of language, the process is so obvious 
that comment is hardly needed, especially to us whose 
speech is full of words taken from languages widely 
different from its original Anglo-Saxon basis. I 
may refer, however, for a moment to the words with 
which the English language is now being enriched 

PRACTICES AFTER INTRODUCTION 

as a consequence of the war. The new French and 
German words which are finding their way into our 
speech not only differ from the original in grammatical 
form, and still more in pronunciation, but they are 
acquiring special meanings, and in some cases have 
already assumed a form which would make it difficult 
for the most expert philologists to trace their origin. 
The derivation of the “ napoo”’ of the British soldier 
from the “il n’y a plus”’ is a good example. 

Another striking example of modification occurs 
in the case of decorative art. A mode of artistic 
expression introduced into a new home never remains 
the same. The art of a country resembles every 
other product of human society in becoming con- 
ventionalized and subject to definite laws or canons. 
No new form of art can escape the influence of these 
conventions. Thus, an introduced human motive 
may be changed as the result of its assimilation by 
a conventionalized geometrical art, so that no one 
would recognize the human form in the final product, 
if it were not. for intermediate forms which give the 
clue to its origin and development. 

The laws governing the modification of introduced 
elements of culture, which I have illustrated by 
examples taken from language and art, apply also to 
the practices and beliefs which make up the art of 
medicine. If medical and surgical practices have 
been transmitted from one part of the world to another 
we must not expect exact resemblances. Not only 
must we look for modifications, developments, and 
simplifications, but we must also be prepared for 
changes so great that, without intermediate stages 
in the process of transformation, it would be impossible 
to recognize a practice, perhaps no longer therapeutic 

1W. H. R. Rivers, Rep. Brit. Assoc., Dundee, 1912, p. 599 ; 
History of Melanesian Society, Cambridge, 1914, ii, p. 374. 

at all, into which an introduced medical practice 
has been transformed. 

EXAMPLES SUGGESTED AS MODIFICATIONS OF 
TRANSMITTED PRACTICES 

I shall now consider some examples in which 
practices, the transportation of which from one part » 
of the earth to another I shall assume, seem to have 
suffered change. As I have already said, the scientific 
demonstration of such change can only be a gradual 
process resting upon a far wider study than is possible 
on such an occasion as this. My object to-day is 
rather to suggest certain medical and surgical processes 
as fit subjects for this line of study. 

BLOOD-LETTING 

I will begin with a possibility suggested by the 
Chinese attitude towards blood-letting, which I dealt 
with just now. We saw that though the letting of 
blood is rarely practised in China, the closely allied 
practice of dry-cupping is taking a prominent place 
in the medical practice of its people. The possibility 
is suggested that this practice arose in China as the 
result of the modification of wet-cupping, as a 
result of the objection of the Chinese to the shedding 
of blood. Whether this be so, or whether dry-cupping 
is the only survivor of a group of introduced practices, 
is a question which can only be answered on the basis 
of a wider survey than is possible here (I may say now 
that this survey will almost certainly show that the 
practice of dry-cupping did not arise in China). 

Another case in which the practice of blood-letting 
may have suffered modification, in aim if not in 
method, is suggested by the frequency of blood-letting 
as a religious rite. In many parts of the world the 
letting of blood by means of incisions or scarifications 

MASSAGE 

forms part of a religious ritual, while in other cases 
it is a feature of the customs accompanying mourning 
for the dead, and other social practices, which probably 
have or have had a religious significance. The problem 
arises whether there is any relation between this 
form of blood-letting and that which has a therapeutic 
purpose. We know of a few facts which point to 
a connexion between the two kinds of practice. Thus, 
in Polynesia the letting of blood by means of gashes 
and scarifications as a therapeutic practice is specially 
characteristic of the western islands, such as Samoa, 
and seems to be in vogue to a much smaller 
extent in the Eastern Pacific. A similar difference 
characterizes the two regions in regard to the letting 
of blood for religious purposes, of which we hear 
far more in the Western than in the Eastern Pacific. 
The common distribution of the therapeutic and 
religious forms of blood-letting in the Pacific suggests 
that there is a definite connexion between the two. 
It is possible that we have here a case in which a 
medical practice, introduced into the highly religious 
atmosphere of Polynesia, has come to form part of 
religious ceremonial and ordinary social custom, 
while still continuing to be used therapeutically. 

MASSAGE 

The modification of a medical practice when 
introduced into a new environment would seem to 
be well illustrated by massage. I have elsewhere * 
drawn attention to this possibility. The natives of 
Eddystone Island in the Solomons employ manipula- 
tions which so closely resemble those of our own 
massage that, if simply observed, and not made the 
subject of special inquiry, they would undoubtedly 

1 Proc. Internat. Congress of Medicine, London, 1913, section xx1iil, 
p. 139. 

be regarded as the equivalent of this remedy as 
practised by ourselves. Inquiry showed, however, 
that the object of the manipulations of the Eddystone 
leech in one case was to act upon an imaginary octopus, 
which was supposed to have taken up its abode in 
the body of a patient, while in other cases the object 
was to extract from the body an immaterial object 
or principle, which was held to be the cause of fever 
or other form of disease. 

That the manipulations of the Solomon Islands 
stand in a definite relation to massage is rendered 
highly probable by the occurrence of genuine massage 
among the Polynesians, a people with whose culture 
that of Melanesia has much in common. Thus, 
in Samoa! two forms of massage are practised, each 
with a special name. That called milimil: consists 
of gentle rubbing with the finger-tips, while the other, 
lomilomt, takes the form of kneading movements 
similar to those of our own practice. Both are used 
to remove pain, and as a restorative in cases of fatigue. 

In the Tonga Islands three different operations 
are recognized.?, One called mzlz consists of rubbing 
movements; another, fota, takes the form of com- 
pression ; while in the third, called tugitugi, the body 
is beaten. Massage is widely used in other parts 
of Polynesia. Sometimes it assumes peculiar forms. 
Thus, in the Hawaiian Islands, heavy objects are 
rolled along the body; in the Tongan Islands a man 
who is fatigued will get three or four children to 
trample him all over; and a similar method is used 
in the Eastern Pacific. 

Massage is widely employed in America, and is very 
prominent in the therapeutic system of China and 
Japan. In Japan the practice is said to go back 

1 J. B. Stair, Old Samoa, 1897, p. 165. 
2 Mariner, Tonga, London, 1817, ii, 350. 

MASSAGE 

to the time of the Emperor Jimnu (660-585 B.c.). 
The blind are employed as masseurs, and the move- 
ments they use include rubbing, kneading, pressing, and 
striking, according to definite rules. Chamberlain! 
records a feature of Japanese massage which is of distinct 
interest in relation to the point which I am now 
considering. He notes that formerly the Japanese 
always massaged the limbs downwards, and have only 
adopted the practice of rubbing towards the trunk 
from Europeans. This downward direction of move- 
ments is characteristic of Melanesia and other places, 
where it is intended to expel injurious agencies from 
the body, the object being to force or induce the 
spirit inhabiting the limb to quit it at the extremity. 
There is no question that the massage of Japan is 
a practice as definitely therapeutic as among our- 
selves, but the centrifugal direction of its manipula- 
tions suggests a relation to the belief in the causation 
of disease by objects or beings which it is the object 
of the massage to expel. 
These examples are, I think, sufficient to show that 
there is a connexion between the therapeutic and 
hygienic art of massage and the manipulations by 
which many peoples extract or expel from the body 
agencies, material, or immaterial, which they believe 
to be the causes of disease. I must be content now 
to raise the problem, and leave for a survey on a far 
wider basis the consideration whether the latter usage 
‘has arisen through modification of an introduced 
therapeutic practice, or whether the therapeutic use 
has grown out of an older practice, resting upon 
magical or religious beliefs. I will only say here that 
in Oceania there is little doubt about the answer. 
The highly developed massage of Polynesia has almost 
certainly been introduced into Melanesia either by 
1 Things Japanese, London, 1905, p. 316. 

the Polynesians themselves, or more probably by 
the immigrant people who form the upper stratum of 
~ Polynesian society. If so introduced, it has certainly 
been modified in accordance with the indigenous 
ideas of the Melanesian concerning the causation 
and nature of disease. 

SWEAT-BATHS 

In the case of massage I have been dealing with the 
relation between a practice so definitely therapeutic 
that it forms part of our own system of medicine 
and a group of practices which, while still related to 
disease, yet bear the stamp of magic or charlatanry 
rather than of genuine medicine. A problem of 
a different kind presents itself in the use of vapour- 
baths, which, in one form or another, have a very wide 
distribution among the peoples of the earth. 

The practice of exposing the body, or some part of it, 
to heat so as to produce sweating is found in a more 
or less crude form in Melanesia, New Guinea, Polynesia, 
Africa, and America, as well as in the eastern countries 
from which we have ourselves largely or altogether 
derived the practice. (The sweat-houses of Ireland 
suggest that the practice is ancient in Northern Europe, 
and that the modern Russian and Turkish forms 
are only improved forms of an old and indigenous 
Celtic or Teutonic practice.) Thus, in Melanesia, 
an injured limb will be exposed to the vapour rising 
from damp leaves or moss placed over a fire. In 
the Hawaiian Islands! the patient is enclosed in 
a hut within which steam is produced, and a similar 
practice occurs in Africa where, for instance, the 
Ba-Ronga? enclose a sick man in a small hut made 

1 David Malo, Hawaiian Antiquities, Honolulu, 1903, p. 146. 
* H. A. Junod, Life of a South African Tribe, Neuchatel, 1913, 
li, 426. 

CIRCUMCISION AND SUB-INCISION 

of mats, and, by putting a pot with live embers by his 
side, cause him to sweat profusely. 

The country in which the vapour-bath has reached 
its highest pitch of development is America, where, 
especially on the west coast, among the advanced 
Pueblo Indians of New Mexico and Arizona, and 
among the ancient Aztecs of Mexico, the sweat-house 
is a most important social institution. Among many 
North American peoples it was the representative 
of the men’s club-house of Melanesia, and other parts 
of the world, which it resembled in the feature that 
women were rigorously excluded from its precincts. 
Among the Pueblo Indians the sweat-house has been 
described! as at once the bath-room, town-hall, 
council chamber, club-room, and church of the people. 

If there is anything in common to the sweat-house of 
America and the vapour-baths of other parts of the 
world, it is evident that a process of modification 
must have taken place. If so, there can be little 
doubt that this process has been one in which a thera- 
peutic and hygienic practice introduced into America 
has undergone a process of development, probably 
through a process of fusion with other social practices, 
whereby it has become one of the most important 
social institutions of the people. 

CIRCUMCISION AND SUB-INCISION 

A striking example of modification of an introduced 
practice is provided by circumcision among ourselves. 
At the present time this operation is performed in 
this country for two wholly different purposes. Among 
one section of the population it is a religious rite, 
intimately bound up with the social traditions of 
those who practise it, while among the general body 
of the people it is a hygienic practice still in process 

1 H. H. Bancroft, Native Races of the Pacific States, London, 1875, 
i, p. 537. 

of development, and gradually coming more and more 
into vogue on account of its practical value. 

There is no doubt that the great increase in the 
frequency of circumcision in this country is due to 
Jewish influence. The observation of the beneficial 
hygienic effects of the operation among the Jewish 
section of the population has made an operation, 
which formerly only entered into our system of surgery 
in cases of special need, one which is performed in 
childhood on a large section of the population. We 
have here a clear example in which an introduced 
religious practice has had a definite effect in fostering, 
if not in producing, a measure of hygienic surgery. 

There is reason to suppose that one of the most 
extraordinary mutilations known to be practised by 
mankind is an example of a change in the opposite 
direction, an introduced surgical procedure having 
become a religious or magico-religious rite. The 
aborigines of Australia practise on their youth a 
mutilation, formerly known as the “terrible rite ”’ 
and now as sub-incision, in which the urethra is 
opened to a great part of its length, sometimes from 
the perineum to the meatus. It is generally supposed 
that this operation is limited to Australia, and since 
this continent is usually regarded as one of the strong- 
holds of the advocates of independent origin, ethno- 
logists have been content to regard sub-incision as 
a wholly independent invention of the Australian 
aboriginal, an extension of the idea of mutilation of 
the genital organs, of which circumcision is the most 
frequent and widespread example. 

A very similar operation, however, is practised 
in Fiji and Tonga, where it has a purely therapeutic 
purpose. Although the practice was originally Fijian, 
our most complete description of it comes from Tonga. 

1 Mariner, Tonga, 1817, ii. 

CIRCUMCISION AND SUB-INCISION 

The urethra is opened and a thread passed, so that 
one end hangs from the artificial opening and the other 
from the meatus. The thread acts as a seton, and 
is occasionally drawn backwards and forwards so as 
to produce pain and the discharge of blood. The 
operation is a favourite remedy for tetanus, and 
Mariner saw several cases in which its employment 
was followed by recovery. The operation is also 
employed in cases of injury accompanied, or believed 
to be accompanied, by extravasation of blood into 
the abdominal cavity, the motive being to get rid 
of the blood by way of the urethra. 

The close resemblance between the Australian and 
the Fijiian practices suggests that they are related 
to one another. To suppose that two peoples, not 
very remote from one another geographically and 
resembling one another to some extent physically, 
were led to devise this extraordinary operation in 
total independence of one another, makes too great 
a demand on scientific credulity. We can be confident 
that the practice has been transmitted from one 
people to the other, or more probably, that the 
Australian and Fijiian practices are two different 
manifestations of a custom belonging to a migrant 
people who reached both localities. Here, as in the 
cases already considered, the evidence is not sufficient 
to show the primary purpose of the operation. It 
seems most likely that we have here an example 
of a surgical remedy which, introduced into Australia 
among a people greatly interested in mutilation as 
a feature of the ceremonial of initiation into manhood, 
was adopted and applied to this new purpose. 

SoME POINTS RAISED IN RELATION TO DISTRIBUTION 
OF CUSTOMS 

If the hypothesis of transmission holds good, certain 
practices would seem to have been modified in the 
process of introduction among peoples with beliefs 
and customs widely different from those of the locality 
where the particular practices had their source. My 
aim has been to show that, in any attempt to work out 
the distribution of medical practices, we must study 
not merely the obviously diagnostic and therapeutic 
measures, but must also look for other manifestations, 
sometimes in a guise strangely different from that 
of the original custom. 

It will not be possible to consider how far we can 
now construct a scheme in which the practices I have 
to-day considered can be assigned to definite move- 
ments of mankind over the earth’s surface. In the 
scheme of migration put forward by Professor Elliot 
Smith! to account for the common distribution 
of megaliths, mummification, sun-cult, and other 
elements of culture, one of the customs I have con- 
sidered to-day is included. The distribution of 
massage has suggested to Elliot Smith that this 
practice was carried over the earth by a people who 
mummified their dead, worshipped the sun, and 
constructed dolmens and other rude monuments 
of stone. It will not be possible here to consider 
this aspect of the subject fully; I must be content 
to point to a few facts which must be taken into 
account in such inquiries. 

The distribution of the practice of blood-letting 
in Polynesia suggests that it belongs to a relatively 
late influence. It is especially prominent, both in 

1 The Migrations of Early Culture, Manchester, 1915. 

DISTRIBUTION OF CUSTOMS 

religious rites and therapeutic practice, in the Samoan 
and Tongan Islands of the Western Pacific, where 
there is reason to suspect the relatively late influence 
of a people who, instead of exposing their dead on 
platforms, interred them in stone vaults in the extended 
position. In Melanesia we know of the practice of 
blood-letting in places where the influence of the 
people who interred their dead in the extended position 
is especially prominent. The distribution of blood- 
letting in Oceania suggests that it belongs to the 
relatively late influence of a people who interred 
their dead. The therapeutic practice of blood-letting 
is very prominent in India, and there is reason to 
believe that it is by the movements of a people who, 
while influencing India, were themselves largely 
influenced by its culture, that the practice of blood- 
letting has been spread over the earth. 

The practice of massage, on the other hand, occurs 
throughout the Pacific, and is especially prominent . 
in the eastern islands, such as Tahiti, where the dead 
are mummified on platforms or in canoes. The 
Polynesian distribution suggests the association of 
massage with a movement earlier than that which 
carried the practice of blood-letting. 

Another point suggested by the distribution of 
customs which I have considered briefly in this 
chapter, is that sweat-baths and massage have travelled 
over the earth in company; just as they are closely 
associated among ourselves, so do they seem to be 
associated among many other peoples, suggesting 
that their diffusion was due to one and the same 
influence. 

There are many other points which I should have 
liked to raise if there had been time. I can only 
refer here to the highly specialized character of such 
processes as venesection and cupping, which make 

it most unlikely that they have been discovered 
independently by the rude peoples who now practise 
them. I may also mention the frequent association 
throughout the world of the use of the cold plunge 
after the sweat-bath—a custom so little natural 
that its practice in Polynesia greatly excited the 
apprehensions of the early missionaries, who were 
evidently ignorant that a cold plunge was a feature 
of the sweat-bath of their own culture. 

SCANTINESS OF AVAILABLE EVIDENCE 

I have now considered a number of practices found 
in different parts of the world, with the object of seeing 
how they bear scrutiny under the two hypotheses 
of independent origin and transmission. I hope 
to have succeeded in showing that the hypothesis of 
independent origin furnishes a very inadequate explana- 
tion of the wide distribution of these practices, 
and often leads us into positions wholly at variance 
with the primary assumptions upon which the 
hypothesis rests. I have not been able to bring forward 
any absolutely conclusive evidence in favour of 
transmission, nor, when transmission seems probable, 
have I been able to point decisively to any one move- 
ment of mankind as its vehicle. As I have already 
stated, this is partly due to the fact that the demonstra- 
tion of transmission must be reached by an argument 
in which each element of culture is studied in its 
relation to others, so that it only becomes possible 
through a far more comprehensive study than is 
possible on such an occasion as this. My object has 
been rather to suggest problems and consider the 
principles which we must follow in attempting their 
solution. 

One fact which makes it impossible at present to 
reach any positive conclusion on these topics is the 

HISTORY AND EVOLUTION 

scantiness of the available evidence. There are few 
branches of human culture about which we know 
so little as in the case of medicine. Owing to the 
intimate relations between medicine, magic, and 
religion, much is to be learnt about the reaction 
of man towards disease from a study of the many 
researches on magic and religion which the wide 
interest in these subjects has produced. If the many 
medical men whose work takes them among peoples 
of lowly culture would take as much interest in the 
study of the ruder phases of their art as is taken by 
the missionary in the study of the religions he is 
trying to displace, we should soon be provided with 
a rich mass of ore from which to extract material 
for the construction of a history of the earlier phases 
of the practice of medicine. 

HISTORY AND EVOLUTION 

At the beginning of this book I distinguished 
between the historical and the so-called ‘‘ evolutionary ’”’ 
treatment of the subject. It is with the historical 
aspect that I have so far chiefly dealt, with the ways 
in which the course of the history of medicine has 
been influenced by the movements of man and his 
culture over the earth’s surface. We have seen 
that this course has not been one of simple progress, 
such aS was once supposed to be characteristic of 
evolution. On the contrary, there has been revealed 
a complicated process of transformation in which 
it seems as if therapeutic measures of a more cr less 
advanced kind, measures perhaps founded upon 
a rational pathology, have been transformed into 
religious or magical rites, or into social practices 
which have passed from generation to generation 
through the conservatism of mankind. The history 
of medicine, as illustrated by the ruder forms of human 

culture, seems to show a course in which degeneration 
has played as great a part as progress. 

It must be noted that, when I speak of degeneration 
as shown by the transformation of medical practices 
into magical or religious rites, this is true only in 
so far as their medical character 1s concerned. We 
can only regard in this light a transformation by 
which a medical practice has wholly lost its therapeutic 
character. Few will object when we regard the 
transformation of a medical practice into a magical 
rite as an example of degeneration, but when we are 
dealing with transitions in the direction of religion 
it is necessary to bear in mind that the transformed 
medical practice may fulfil as high a social purpose 
as it fulfilled in its original character. 

The frequency with which we seem to have found 
degeneration is largely due to the special character 
of this study, to its special occupation with the more 
backward peoples of the earth, peoples among whom 
we might expect to find degeneration bulking more 
largely than it would do in a wider survey of human 
society. As I have already said, we are only now 
emerging from a period in the study of human society 
during which the factor of degeneration has been almost 
wholly neglected or greatly underrated, even in the 
case of the ruder phases of human culture. In seeking 
to show how great a part degeneration has played, and 
is still playing, in the history of human society, we 
must be careful not to go to the opposite extreme, 
and overrate its frequency and importance. 

COMPLEX NATURE OF THE PROCESS 

If we survey the history of the practices which make 
up man’s behaviour towards disease, there can be no 
question that, running through the complex web of 
change which this history shows, there has been a 

COMPLEX NATURE OF THE PROCESS 

constant thread of progress. The degenerations and 
transformations shown so frequently in the history 
of medicine have only served to complicate a process 
in which man has succeeded more and more in bringing 
disease under control, in reducing the frequency 
and severity of pain, in remedying the many disabilities 
resulting from disease, and in rendering life longer 
and more secure. 

This course has been complicated by two factors 
which have run counter to this progress. The growth 
of civilization has brought with it new forms of disease, 
or has increased the frequency of the old, chiefly 
as a result of inadequate adjustments of social means 
to the increasing complexity of social life. Thus, 
hardly an occupation has been developed by civiliza- 
tion which has not brought with it some new form, 
or has increased the liabilities to some old form, of 
disease. Perhaps still more important has been the 
increased tendency to instability of the mental life, 
due to the greater strain and stress to which advancing 
civilization exposes mankind. While man has been 
slowly forging weapons with which to combat disease, 
other lines of social progress have been producing 
new morbid states, to combat which these and still 
other weapons are required. 

Again, the movements of mankind over the earth’s 
surface, which have been one of the chief instruments 
in the progress of medicine, as of human culture in 
general, have themselves been the means by which 
mankind has distributed disease. In some cases the 
seeds of disease thus distributed have been the chief 
factors in the degeneration of culture, and in the 
disappearance of peoples who were the bearers of 
a culture from which perhaps our own advanced 
civilization might have much to learn. These ways, 
in which advancing culture has increased the 

opportunities for the onslaughts of disease, and has 
distributed its seeds, only serve, however, to com- 
plicate and obscure a process which is very real. 
Those who object to the crude evolutionary hypotheses 
of the last century do so, not because they believe 
the hypotheses of evolution to be false, but because 
their advocates have treated as simple a process which 
has been exceedingly complex. The opposition which 
is now showing itself more and more as this century 
progresses is not so much to evolution as to the 
evolutionist. 

THE INFLUENCE OF CULTURAL MIXTURE ON PROGRESS 

Not only have these discussions led us frequently to 
the process of degeneration, but this degeneration 
seems to have.been especially the result of the contact 
of peoples and the blending of their cultures. Here 
again, however, the frequency with which we have 
found degeneration as the outcome of this contact 
and blending is due to the special limitations of the 
scope of this book. If we extend our survey we 
find that the history of medicine resembles that of 
every other branch of social life, in showing us an 
abundance of cases in which the movements of peoples 
and of their cultures have promoted progress. This 
is nowhere better illustrated than in the history of 
the movements whereby the cultures of India, 
Mesopotamia, Egypt, and Greece were brought into 
contact, producing a great wave of progress which 
overflowed to Italy and Spain, and through these 
channels came to have so great an influence on the 
medical art of our forefathers. 

This influence of cultural mixture upon the course 
of progress has now reached a stage in which the 
movement of people, in the older sense, is no longer 
necessary, The universal diffusion of the art of 

INFLUENCE OF CULTURE MIXTURE 

printing has so made the world one, that an advance 
in medicine rising in any part of the earth rapidly 
becomes the property of the whole. Even in the 
later phases of the history of medicine, however, 
the course has not been wholly one of progress. The 
history of the practice of blood-letting, which this 
country acquired in the schools of Italy and Spain 
as a legacy from the medicine of Greece and Arabia, 
cannot be regarded as an example of progress. At 
the present time I believe that we are witnessing 
a similar exaggerated and uncritical application 
of the introduced art of massage. Nevertheless, 
behind all these exaggerations and misapplications 
of introduced practices, which still occur in the practice 
of medicine, and behind all the transformations 
which have characterized the different stages of 
its history, there stands out the vast importance 
of the contact of peoples and the blending of their 
cultures as a main, if not the chief, source of progress. 
The earlier history of mankind seems to have been 
one in which d fferent parts of the earth were subject 
to long periods of isolation, relative or complete, 
in which progress stagnated or turned to degeneration. 
Then came some movement of mankind by which 
elements of culture were diffused and, when trans- 
planted into places where culture had stagnated, 
acted as the stimuli to new processes of evolution 
and progress. The nature of the process which took 
place in each region depended on many things: 
on the nature of the indigenous culture and of the new 
elements; on the relative numbers of the migrant 
and indigenous peoples ; on the difference in the level 
of their cultures; on the nature of the interaction 
between the two peoples, whether peaceful or warlike ; 
and on many other factors. 

THE EFFECT ON MEDICINE OF MIXTURE OF CULTURES 

Of especial importance, so far as medicine is 
concerned, has been the prevailing tendency of the 
indigenous culture in the direction of magic or religion. 
When a people stand at a level of culture in which 
medicine has a rational basis, so that its practice rests 
on principles deserving to be ranked as scientific, 
the mixture of cultures will lead to development 
in medicine. Introduced medical practices will not 
only stimulate the growth of the indigenous art, 
but may lead to modification of the introduced practice, 
modifications designed to make it a more fit instrument 
with which to combat disease. If, on the other hand, | 
the indigenous culture is dominated wholly by the 
religious attitude, the result, unless the introducers 
of the new art are especially numerous or powerful, 
may only be to deprive this of the purpose to which 
it is primarily adapted, and to convert it into a practice 
so closely associated with religion, and apparently 
partaking so wholly of the religious spirit that it may 
be difficult to recognize in it any relation to the art of 
medicine. 

Similarly, if the indigenous people are wholly given 
over to magic, an introduced medical practice may so 
assimilate itself with the native mode of thought 
that again its medical character and rational basis 
may be lost or greatly obscured. 

Not only does the comparative study of medicine, 
magic, and religion serve well to illustrate the complex 
character of human progress, but it may also teach 
us much concerning the nature of the evolutionary 
process by which the complexity is brought about. 
It is generally held that one of the chief features 
of the process of evolution is the increase in specializa- 
tion of function. That the evolution of human society 

MEDICINE AND RELIGION 

is generally characterized by such increasing specializa- 
tion of social function stands beyond all doubt. We 
can have no better example of it than the differentia- 
tion between the leech, sorcerer, and priest, which 
has occurred in the history of medicine, magic, and 
religion. It is a question, however, whether increasing 
specialization is characteristic of evolution throughout, 
or whether it is not rather a necessary feature. I 
should like to call it even a necessary evil feature 
of the middle stages of evolution. I believe that 
there are now becoming apparent, in many departments 
of social life (I recognize it especially in that of science), 
indications that specialization can be carried too far, 
and that with further advance we may come again 
to those close interrelations between the different 
aspects of human culture which are characteristic 
of its earlier stages. 

THE RELATIONS BETWEEN MEDICINE AND RELIGION 

I will conclude by considering briefly whether 
this movement contrary to, or across, the growth 
of specialization is not illustrated by the relations 
between medicine and religion. 

In the first part of the book I considered briefly the 
part taken by faith and suggestion in the success of 
the measures by which the ruder forms of human society 
have endeavoured to overcome the effects of disease. 
It is the firm belief of savage and barbarous peoples 
in the efficacy of the rites carried out by the leech, 
sorcerer, and priest which is the most frequent cause 
of their success. As medicine has progressed and 
has been differentiated from magic and religion, 
this play of psychical factors has not ceased. Few 
can now be found who will deny that the success 
which attended the complex prescriptions, and most 

of the dietetic remedies of the last generation, was 
due mainly, if not entirely, to the play of faith and 
suggestion. The salient feature of the medicine 
of to-day is that these psychical factors are no longer 
allowed to play their part unwittingly, but are them- 
seives becoming the subject of study, so that the present 
age 1s seeing the growth of a rational system of psycho- 
therapeutics. One feature of this system, which is 
already becoming clear, is that it must take account 
of agencies which have till now been held to be the 
function of the priest rather than of the physician. 
If medicine is to maintain its hold on certain aspects 
of disease which should come properly within its 
sphere, it must find that it has much to learn from 
the priest, if, indeed, some kind of collaboration 
between the two is not often desirable. A striking 
feature of the last twenty years in this country is the 
frequent combination of priest and physician in one 
person, while in America, a regular system of collabora- 
tion between the two has come into being in what is 
known as the Emmanuel movement.! 

As medicine comes to extend its scope to the wider 
study of disorder of the mind, and reaches a higher 
recognition of the part taken by psychical factors 
in the causation and treatment of disease, not only 
will the work of the physician be found to overlap 
the function of the priest, but also those of the teacher, 
the jurist, the moralist, the social reformer. Just 
as there are problems and individual cases of disease 
which need the collaboration of priest and physician, 
so are there cases in which the physician, the teacher, 
the moral and social reformer, can help one another 
far more profoundly and successfully than they have 
done in the past. 

1 See Religion and Medicine, by E. Worcester, S. McComb, and 
I. H. Coriat, London, 1908. 

MEDICINE AND RELIGION 

The study of the latest phase of the history of 
medicine shows us a limit to the increasing specializa- 
tion of function as a character of. social evolution. 
The relations which seem to be coming into existence 
between medicine and religion resemble in some degree 
those which we have seen to characterize the early 
phases of its history. They differ chiefly in that the 
later phase recognizes explicitly, and is learning to 
understand, a set of conditions which were once allowed 
to play their part unregarded and unstudied. In the 
domain of the medicine of the mind—and its scope 
is far wider than is usually supposed—the course 
of history seems to be showing us that the close inter- 
dependence of different departments of human culture 
will be just as much a character of its latest and its 
highest phase, as it was characteristic of its earliest 
and its lowest. 

ar Died , 
ied

MIND AND MEDICINE}! 

HE early relationships between mind and medicine 
ate intimately bound up with the process by 
which medicine grew out of magic and religion. The 
history of medicine reveals a long and chequered 
progress, still far from complete, in which Man’s 
attitude towards disease slowly became different 
from that he held towards the many other mysteries 
by which he was surrounded. His endeavours to 
cope with disease took at first two directions. In 
one he ascribed disease to the action of beings different 
from himself, but capable of being reached by rites 
of prayer and propitiation. . Since these rites, wherever 
we study them, reveal an attitude of respect and 
appeal and imply powers which man does not himself 
possess, it seems legitimate to regard the beings 
to whom they are addressed as higher and more 
powerful than himself. The general body of rites 
and beliefs forming the means of intercourse between 
Man and these higher powers make up the aspect 
of life we call religion. One of Man’s early modes of 
behaviour towards disease may thus be regarded 
as forming part of religion and the religious attitude. 
In the other direction disease was ascribed to the 
action of other human beings, or of beings of a non- 
human kind believed to be amenable to processes 

1 [A Lecture delivered in the John Rylands Library, the 9th of 
April, 1919. For permission to reprint this lecture I am indebted 
to the Chief Librarian, Dr. Henry Guppy.] 

rg 

of a compulsive nature, and therefore less powerful 
than Man himself, so that the attitude adopted towards 
them implied neither respect nor appeal. When his 
efforts to deal with disease took this direction, Man 
compelled or induced the being to whom disease 
was ascribed to withdraw the agencies by which 
the illness was being produced, or himself employed 
measures designed to negative their effects. Beliefs 
and measures of this kind make up the aspect of 
life known as magic, but this aspect is less capable 
of definition than religion and needs analysis into 
several distinct elements. One of these is certainly 
‘degenerate religion, beliefs and rites no longer implying 
any reference to higher powers which at one time 
formed their motive and sanction. 

The great majority of the measures by which existing 
savage peoples attempt to cope with disease fall into 
one or other of the two categories of religion and © 
magic. All that we know of the history of mankind 
suggests that it was only after long ages, and in some 
few parts of the earth, that Man reached a conception 
of disease according to which it is ascribed to processes - 
similar to those underlying modern systems of medicine. 
The emergence of medicine from its intimate associa- 
tions with religion and magic is closely connected with 
the gradual substitution of the concept of physical 
causation for the spiritualistic agencies of the animism 
which formed the early attitude towards nature. 
The growth of medicine is closely bound up with 
the development of the concept of a natural world 
as opposed to a world we now regard as supernatural. 

All the evidence at our command goes to show that, 
as Man relinquished his early animistic interpretation 
of the universe, this was replaced by explanations 
of a materialistic kind. In so far as events were 
not ascribed to spiritual beings or to direct ~ human 

agency, they were believed to depend on the action 
of material agents. The agents thus supposed to . 
be effective in the production of disease during the 
history of medicine have been of two chief kinds. 
Among peoples who have been especially influenced 
by beliefs concerning animals, this branch of creation 
has been prominent in their theories concerning 
the production of disease. Elsewhere the evident 
connexion of the blood with life has led to the belief 
that disease is predominantly due to an altered 
character of this fluid, and this belief formed the 
starting-point of the humoral pathology which for 
so many centuries formed the basis of medicine. 
The two great developments of our own time in 
medicine have followed these two main lines of early 
belief. For the worms and snakes ! of savage medicine 
have been substituted the microscopic and _ ultra- 
microscopic organisms of the germ theory of disease, 
while the place of the old humours has been taken 
by the alteration in the proper proportion of internal 
secretions which is now coming to be recognized 
as the immediate cause of so many morbid states. 

During the long period in which medicine was 
occupied in substituting these material agents for the 
spiritual beings to which all disease was once ascribed, 
little if any room was left for agencies which come 
within the modern connotation of mind. 

When Man thought of the production of disease by 
other than material agents, his concept of the activity 
involved was very different from that of “ mind” 
as held by ourselves, or at any rate by the psychologist. 
The agency to which he ascribed disease was spiritual 

1 When these early beliefs are regarded as previsions of the germ- 
theory, it should be remembered how naturally they follow from the 
general beliefs concerning animals characteristic of certain forms of 
human culture. 

rather than mental, and was conceived as having 
form and capacity for independent existence. It 
might be a spirit which had never been human or 
had human associations, or one which had once had 
a human habitation, but had come through the death 
of its host to acquire an independent existence, or, 
lastly, it might be a soul which still had its customary 
seat within a human body, but could leave it in sleep 
or trance to act as the producer of disease. 

Though at this stage of human culture there is no 
trace of the modern concept of mind as distinguished 
from spirit, we can see clearly that most of the processes 
by which disease was thought to be produced and was 
treated are such as would act through the mind. 
The manifold lines of treatment by which human 
or spiritual agents were induced to cure disease acted, 
if they were successful, through the agency of faith 
and suggestion. The curative measures, which are 
still being employed by many peoples, act through 
the same processes, and owe their success to the faith 
they inspire, or to the more mysterious property 
we call suggestion. 

It is necessary, however, to distinguish the produc- 
tion and treatment of disease by agencies acting 
through the mind from the knowledge that the measures 
used act in this manner. Though remedies acting 
through the mind were probably the earliest to be 
employed by Man, the knowledge that the remedies 
act in this way is one of the most recent acquirements 
of medicine. It is said that the Japanese of the 
sixteenth century understood the action of remedies 
through the mind,! while the great importance attached 
by the Hindus to the mental, as opposed to the material, 
makes it probable that they also had more than an 

1M. Neuburger, History of Medicine, London, 1910, vol. i, p. 78. 

MIND -AND MEDICINE 

inkling of the rdle of mental factors in the treatment, 
if not in the production, of disease. How far this may 
be so must be left to special students who will examine 
the original authorities with an eye to the possibility 
that the agencies in which these peoples believed were 
spiritual rather than mental in nature. If we confine 
our attention to our own culture, it is only within 
the last fifty or sixty years that there has been any 
clear recognition of the vast importance of the mental 
factor in the production and treatment of disease, 
and even now this knowledge is far from being fully 
recognized either by the medical profession or the 
laity. 

For the first definite movement in this direction we 
have, as so often happens in the history of human 
culture, to thank external influence, in this case that 
of India. The first great stimulus to the study of the 
mental factor in disease came from the need to under- 
stand the mysterious action of hypnotism. Though 
this agency had long been known in Europe, as in all 
other parts of the world, and had been brought 
prominently to notice at the end of the eighteenth 
century by the activity of Mesmer, the knowledge 
which the Abbé Faria brought to Europe from India 
acted as a great stimulus to its scientific study, in 
which Braid of Manchester holds a foremost place, 
while the later experience of Esdaile in India did much 
to help the practical utilization of hypnotism in this 
country. 

About this time there was setting in the wave of 
materialism which was to dominate European thought 
for many years. Under this influence the new agent 
was regarded as a form of magnetism or other physical 
force. It was only slowly that there came into being 
the now generally accepted view that the agency 
through which hypnotism produces its effects is 

suggestion. This is a process comparable with volition, 
imagination, or other similar concepts which, wholly 
devoid of any implication of the independent action 
of a spiritual being, had been reached by the new 
and slowly developing science of psychology. The 
study of hypnotism and allied processes led students 
to distinguish clearly the important influence of 
suggestion in the production and treatment of 
disease. 

The phenomena of hypnotism having led students 
to the definite recognition of the mental factor in 
medicine, it was natural that attention should be 
directed to the influence of other mental conditions. 
This development followed many directions. The 
general public, less under the influence of the prevailing 
materialism of science than the medical profession, 
and more ready to accept any new. doctrine which 
could be made to harmonize with the old spiritualistic 
view of disease, adopted with enthusiasm many new 
systems of healing. In most of these the vast power 
of religious faith was explicitly recognized. In some, 
such as Christian Science and the ‘“‘ New Thought ”’, 
etc., the cardinal element of faith was made the 
_ starting-point of intellectual constructions, which gave, 
or seemed to the believers to give, a rational basis 
for the success that these new movements so often 
obtained. At the same time, within the medical 
profession, especially among French-speaking peoples, 
there came into existence a definite system of psycho- 
therapeutics in which suggestion and other agencies 
were assigned their rdles, and principles were laid 
down to indicate the scope of these agencies and the 
means of turning them to best advantage. In Switzer- 
land P. Dubois? laid stress on the helpfulness of 

1 Les Psychonéuroses et leur traitement moral, Paris, 1908; trans- 
lated by S. E. Jelliffe and W. A. White as The Psychic Treatment of 
Nervous Diseases, New York and London, 1906. 

explaining what he called the philosophy of disease, 
while in France J. Déjérine and E. Gauckler,! in more 
scientific fashion, compiled a most valuable text- 
book of the principles and methods of psycho-therapy. 

Independently, growing out of dissatisfaction with 
the practical use of hypnotism, a third line of approach 
was taken by the Viennese physician, Sigmund Freud. 
It had been found by earlier workers that hypnotism 
was often the means of reaching experience which 
had been so completely forgotten that by no effort 
of the will could it be recalled. Working in conjunc- 
tion with Breuer,? Freud found the process of bringing 
these buried memories to the surface led to the 
disappearance of hysterical symptoms of long duration, 
and the two authors founded upon this experience 
a theory of hysteria according to which its symptoms 
are the indirect expression of old mental injuries 
(traumata), especially those of early childhood. 

Later, Freud found that the buried memories which 
manifested themselves in this morbid manner 
could be brought to the surface more securely 
and with greater therapeutic efficacy, though less 
expeditiously, without the aid of hypnotism. By 
means of his method of free association, starting as 
a rule from clues provided by dreams, Freud was 
led to formulate a theory of the unconscious and an 
elaborate scheme of the mechanism by which it is 
related to and acts upon the conscious. In the course 
of this work Freud was led to the conclusion that 
the mental experience which had been cut off from 
the general body of consciousness was nearly always 

1 Les Manifestations fonctionelles des Psychonéuroses, Paris, 1911 ; 
translated by S. E. Jelliffe as The Psychoneuroses and their Treatment 
by Psychotherapy, Philadelphia and London, 1913. 

2S. Freud, Selected Papers of Hysteria and other Psychoneuroses 
(Nervous and Mental Disease Monograph Series, No. 4), New York, 
1912. 

connected with sex. His work, and still more that of 
his disciples, came to deal so exclusively with sexual 
factors that the general body both of the medical 
profession and the laity refused to give this movement 
the attention it deserved. They failed to recognize 
the immense importance of the mental mechanisms 
laid bare by Freud’s method of analysis, and the 
body of evidence which was thereby provided to 
illustrate the influence of the unconscious. 

One of the most important aspects of Freud’s work 
was that the role he assigned to the unconscious 
enabled him to adopt in the most complete manner 
the principle of determinism within the mental sphere 
which had been of such value in the progress of physical 
science. It is essential to this progress that the 
student shall believe implicitly, or at the least act 
as if he so believe, that every physical event has its 
physical antecedent, without the presence of which 
it would not itself have come into existence. The 
progress of physical science depends largely on the 
robustness of the faith in this law of causation, which 
allows no residue or anomaly, however insignificant 
it may seem, to be put on one side as due to chance 
or accident. The successful worker in science makes 
such residue or anomaly the subject of patient 
investigation until its occurrence has been traced to 
its antecedents, antecedents which may open new 
paths to the understanding of experience which till 
then had had no adequate explanation. 

So long as the attention of students of mind was 
confined to the sphere of the definitely conscious, 
there was no opening for the application of a similar 
doctrine of determinism within the sphere of the 
mental. Recognizing that the principle of psychical 
determinism must hold good if psychology is to become 
a science, some students had put forward hypothetical 

mental dispositions where no antecedents could be 
detected in consciousness, but these were too vague 
to be of any assistance in research. It is of no service 
to postulate a disposition of which one knows nothing, 
which stands in no known relation to any other part 
of a construction. Other students definitely threw 
over any attempt to apply the principle of determinism 
within the sphere of mind, and were content to seek 
for physical causes in the form of physiological 
processes or dispositions whenever the study of conscious 
process failed to provide an adequate explanation. 

The special value of Freud’s work is due to the 
fact that he was not content merely to put forward 
unconscious dispositions as the antecedents of changes 
in consciousness, but was enabled by the knowledge 
derived from his analyses to formulate a definite scheme 
of the unconscious region of the mind and of its relation 
to the conscious. This scheme is of necessity to a 
large extent hypothetical, and as with all hypotheses of 
such complexity, it will certainly require modification, 
but growing experience is pointing more and more 
surely to the truth of its main assumptions. 

For several years before the outbreak of the war 
many were coming to acknowledge the great 
importance of mental factors in the production and 
cure not only of diseases obviously mental in nature, 
but also of many which had been held to be wholly 
physical. There was, however, no general agreement 
concerning the principles which should underlie 
a system of psychological medicine. There was even 
no general belief in the possibility of principles which 
could act as the basis and inspiration of research. From 
the one system which could have provided such 
basis and inspiration the majority of workers were 
estranged, partly owing to the undue weight laid 
upon sex by its adherents, partly owing to the 

unsatisfactory form in which the new doctrines had 
been put before the public. 

The effect of their recent experience upon the 
opinions of the medical profession has been profound. 
Perhaps the most striking feature of the war from the 
medical point of view has been the enormous scale 
upon which its conditions have produced functional 
nervous disorders, a scale far surpassing any previous 
war, although the Russo-Japanese campaign gave 
indications of the mental and nervous havoc which 
the conditions of modern warfare are able to produce. 
While certain of these disorders are the result in part 
of physical causes, such as cerebral concussion or 
illnesses specially affecting the nervous system, it 
has gradually become clear, even to the firmest believer 
in the dependence of mind on body, that in the great 
majority of cases the conditions upon which the 
disorder depends are purely mental. All are coming 
to see the profound effect of mental shock and strain 
in weakening the powers of control by which instinctive 
processes are normally held in check, if not completely 
suppressed. Moreover, it has become clear that, 
in the vast majority of cases, the morbid processes 
which have been set up by shock or strain are not 
connected with the sexual instinct, but depend on 
the awakening of suppressed tendencies connected 
with the still more fundamental instinct of self- 
preservation. While the nature of the war-neuroses 
is satisfactorily explained by the Freudian mechanisms 
of suppression, conversion, defence-reaction, com- 
promise-formation, etc., they lend no support to the 
exclusively sexual origin of neurosis, which has been 
the chief obstacle to the general acceptance of Freud’s 
doctrines. It cannot yet be said that the essential 
features of these doctrines have met with general 
acceptance, but the state of the matter is now very 

different from the widespread neglect, or even reproba- 
tion, which existed before the war. The great majority 
of students of the neuroses are now prepared to 
consider Freud’s position, to accept such parts of his 
doctrine as seem to them supported by the facts, 
and to suspend judgment concerning those parts 
for the truth of which they do not deem the existing 
evidence sufficient. 

I have dealt at length with the controversial topic 
of Freud’s views concerning the neuroses because 
he, more than any other worker, has emphasized 
the mental factor in disease and more thoroughly 
than any one else has based his work on a determinism 
which is as essential to the progress of psychology 
and psycho-pathology as determinism within the 
physical sphere is essential to the progress of the 
sciences which deal with the material world. 

In the foregoing sketch of the history of the relations 
between mind and medicine I have considered at 
some length one of the most important principles 
of psychological medicine, viz. the principle of psychical 
determinism. This principle is of especial importance 
in connexion with the art of diagnosis, for only those 
who believe firmly that every mental symptom has 
its mental antecedent will have the patience and 
courage to probe deeply enough into the history: of 
a patient. They will not rest content until they have 
discovered not only the events which acted as the 
immediate conditions of the disease, but also those 
factors producing the special qualities of the patient’s 
mental constitution which made it possible for these 
conditions to produce so great and so disastrous 
an effect. A firm belief in the principle of psychical 
determinism is the most important condition of success 
in the diagnosis and treatment of functional nervous 
disorders. 

I propose now to consider some other of the more 
important principles which underlie success in the 
treatment of these disorders. One such principle 
may be regarded as a consequence of psychical 
determinism. It is a general rule of medicine that 
the physician must not be content to treat symptoms, 
but having traced these symptoms to their source, 
should by suitable remedies attack this source and 
treat the symptoms through the conditions by which 
they have been produced. This principle holds 
good for psychological medicine. If it is believed 
that the symptoms have been produced by psychical 
factors, it will follow that the remedies must also be 
psychical in nature. I do not suppose that even 
the crudest materialist, having once acknowledged 
that the symptoms depend upon a fright in childhood, 
a reproach concerning a misdemeanour in youth, 
or an anxiety in adult life, would expect to produce 
any permanent improvement by the administration 
of a drug or the performance of a surgical operation. 
It must be pointed out, however, that such measures 
may be successful in some cases, not merely through 
their psychical effort, but because, by removing 
secondary disturbances, they may break a vicious 
circle and thereby give an opening for the action of 
intrinsic mental forces working towards recovery. 
The vis medicatrix nature applies in the mental as 
well as in the material sphere. 

Another principle which is now meeting with 
general acceptance ‘n psychological medicine is that 
functional nervous and mental disorders depend 
essentially on disturbance of the instinctive and 
emotional or affective aspectsof the mind. It is now 
widely acknowledged that in the attempt to get back 
to the roots of these disorders it is necessary to look 
for experience which had a strong emotional tone. 

This principle has long been more or less explicitly 
recognized, and underlies such general beliefs as are 
expressed in the adage that it is worry and not work 
which kills. But it is only recently that we have 
learnt to appreciate the extent of its application 
and to use it in treatment as a guide of the first 
importance. It has long been known that, in the more 
explicitly mental disorders of insanity, no good is 
done by reasoning with the patient as a means of 
countering his delusions. It seems even that such 
reasoning may only intensify and fix the delusions 
by driving the patient to adopt the part of an advocate. 
We now see that this is a necessary consequence 
of the emotional basis of the disorder. The delusions 
are the product of a process of rationalization, by 
means of which the patient has tried to account for 
his abnormal emotional state. Treatment directed 
to these secondary products wholly fails to touch 
the deeper and essential factors. 

The modern theory of emotion connects it closely 
with instinct. There is reason to believe that the 
emotional factor in neurosis is the expression of some 
instinctive tendency which has been suppressed 
on account of its incompatibility with social standards. 
Neurosis occurs when, through some shock or strain, 
the agencies which keep the tendency in check are 
weakened, allowing it again to come into conflict 
with social standards. The form which the neurosis 
takes depends on the process by which Nature attempts 
to solve this conflict. 

I must be content with this brief description of some 
of the more important principles upon which rests 
our modern system of psycho-therapy, and pass on 
to consider some of the main agencies which are 

1 See British Journ. Psych., 1918, vol. ix, p. 236, and Mental 
Hygiene, 1918, vol. ii, p. 513. 

utilized by the practitioners of this branch of medicine. 
I shall lay stress especially on the three agencies of 
self-knowledge, self-reliance, and suggestion. 

The agency of self-knowledge, which, following 
Dr. W. Brown, I have elsewhere! called autognosis, 
covers a wide field in which two main sections can be 
distinguished. Where the morbid state depends on 
some experience or tendency which lies within the 
region of the unconscious, self-knowledge as a thera- 
peutic agency will consist in bringing the buried and 
unconscious experience to the surface. The uncon- 
sclous experience has to be brought into relation 
with the general body of experience, which is readily 
accessible to consciousness, and so made part of it 
that it ceases to act as a separate force in conflict 
with the general body of conscious experience. 

The other main form of the agency of self-knowledge 
comprises the processes by which a sufferer is brought 
to understand elements of conscious experience which 
are being misinterpreted, and through this mis- 
understanding are helping to maintain, even if they did 
not help to produce, the morbid state. 

Between these two forms lie a large variety of 
processes in which there is a mingling of the unconscious 
and conscious elements brought into relation with 
one another, thus doing away with the conflicts upon 
which the disorder depends and restoring harmony 
within the personality. 

It may seem that the role here assigned to the process 
of self-knowledge is in contradiction with what has 
been said earlier concerning the failure of appeal to 
the intellectual, and the necessity of attacking the 

1 Art. ‘* Psycho-therapeutics ”’, Hastings’ Encyclopedia of Com- 
parative Religion and Ethics, vol. x, p. 433. This article may be 
consulted for information concerning other therapeutic agencies 
which I do not consider in this chapter. 

instinctive and emotional basis of the disorder. The 
intellectual element, however, though secondary, is 
present and must not be neglected. Experience 
shows that, while the direct attack upon the intellectual 
aspect of a neurosis or psychosis will fail, a line of 
treatment in which the intelligence of the patient is 
brought to bear on the part taken by instinctive 
and emotional factors in the production of his illness 
may be of the utmost value. Indeed, success in 
treatment depends largely on the possibility of 
diverting the intellectual activity from a channel 
which is forcing it into an asocial or antisocial direction, 
and leading it into one which will again enable the 
patient to live in harmony with the society to which 
he belongs. 

Where the sufferer from neurosis is intelligent, 
the mere exposure of the faulty trend, and the 
demonstration of the process in which this trend 
took its origin, may be sufficient. The patient only 
needs to be started on the right path, and his own 
intelligence will lead him back to health and happiness. 
In other cases the faulty trend has been so long in 
action that a lengthy process of re-education may 
be necessary to put the morbid process in the proper 
light, and reduce the power which through habit 
has been acquired by the secondary products of the 
morbid process. In other cases, again, the intelligence 
of the patient may not be sufficient to enable him 
to solve the conflict unaided, and the process of 
re-education has to assist the patient to understand 
the nature of his disorder and the processes by which 
he can again place his steps upon the path of health. 

The next agency I have to consider is one which 
may be summed up under the term self-reliance. 
There is a pronounced tendency for sufferers from 
neurosis to avoid the unpleasant at all costs. Since 

all social duties, even those in which the nearest 
relatives are involved, are liable to become irksome 
or positively distressing, the patient seeks quiet and 
solitude, and if left alone these antisocial tendencies 
may become a habit, converting one who before his 
illness was a social favourite into a recluse or 
misanthrope. Aches and bodily discomforts which 
in health are disregarded, and when so treated soon 
cease to annoy, are liable in neurosis to grow in 
intensity and insistence. They may so absorb the 
attention that the sufferer’s efforts are exclusively 
devoted to the avoidance of all conditions, such as 
noise and excitement, which aggravate, or seem to 
him to aggravate, his troubles. He is apt to resort 
to drugs, either at his own or his physician’s instance, 
and since these are merely palliative and do not touch 
the roots of his malady, they only serve to accentuate 
his pains and worries, even if he escapes the greater 
evil of a definite drug-habit. He strives to banish 
from his mind all distressing thoughts and memories, 
including experience so arresting that, if his efforts 
were not exclusively turned towards the avoidance 
of immediate pain, he would at once recognize the 
futility of his attempt. 

One of the first steps in the treatment of such cases 
is to persuade the patient to forego any adventitious 
aids, such as drugs or electricity, upon which he has 
come to rely. Assisted by a process of re-education 
designed to show their subjective nature, he must be 
encouraged to fight his pains and discomforts by his 
own strength. He must be convinced of the futility 
of his attempts to escape from the thoughts and 
memories which distress him, and shown by trial that 
when these painful experiences are faced they are far 
less terrible than they seem to be when kept at a 
distance. He must be encouraged to mix with his 

fellows in spite of the immediate discomfort which 
this produces, and here again he must learn by 
experience that the pains of the reality do not equal 
those of anticipation. 

The policy of facing his troubles instead of running 
away from them has certain effects of a far-reaching 
kind, which are due to a special mode of reaction 
of the mind when in the presence of the painful. 
By repressing unpleasant thoughts and memories 
the patient is assisting a process by which we tend 
to suppress painful experience and dissociate it from 
the general body of consciousness. When thus 
suppressed and dissociated, however, such experience 
does not cease to exist, but by its activity produces 
many of the most painful features of the illness, 
distressing dreams and nightmares being the symptoms 
which form the most direct consequence of the 
repression and suppression. By facing his troubles 
in place of striving to banish them, the dreams or 
other troubles due to repression may disappear, or 
so alter their character as not to interfere with comfort 
and health.! Owing to the malign power of repressed 
experience, the policy of facing the painful may have 
effects reaching far more widely than might be expected 
from the normal experience of health, that a trouble 
faced loses half its terror. 

The third agency I have to consider is suggestion. 
Though this term is freely and confidently used 
in psychological medicine, there is little agreement 
concerning its exact meaning, and much is included 
among its activities which has little to do with it in 
nature.2_ I use the term for a process which belongs 

1 For examples of the beneficial effects of this kind see The 
Repression of War Experience, Proc. Roy. Soc. of Med., 1918 (Section 
of Psychiatry), vol. xi, p. 1. 

2 For its distinction from faith as a therapeutic agency, see Art. 
‘“‘ Psycho-therapeutics ’’ in Hastings’ Encyclopedia. 

essentially to the instinctive side of mind. It is the 
representative in Man of one aspect of the gregarious 
instinct, the instinct which makes it possible for all 
the members of a group to act in unison so that they 
seem to be actuated by a common purpose. According 
to this view it 1s a process which differs essentially 
in nature from those mental processes which produce 
uniformity of behaviour by endowing the members 
of a group with a common idea or a common sentiment. 
Its activities le definitely within the unconscious 
sphere, so that when the physician employs suggestion 
consciously he is using in an artificial manner an 
agency which belongs properly to the region of the 
unconscious. 

The most striking form in which Man has come to 
use suggestion consciously and wittingly is hypnotism. 
All gradations are met in practice between this 
definitely conscious use, and cases in which the 
physician acts upon his patient and moulds him to his 
will by the unconscious process of suggestion, without 
recognizing the true nature of the process which is 
taking place. As a rule, the more unwitting the 
use of suggestion the greater is its power and efficacy. 
On this foundation rests the success of quacks, for 
they advocate and use their nostrums in blissful 
ignorance of the process upon which their efficacy 
really depends. The physician who knows enough 
to distinguish between the influence of suggestion 
and other modes of action a remedy possesses, may 
signally fail to attain the success of a quack because 
the instinctive process of suggestion is not being 
employed in the manner natural to it. 

One of the greatest difficulties of psychological 
medicine arises out of the opposition, if it be not 
definite incompatibility, between suggestion and the 
group of agencies which rest upon the principle of 

self-reliance. The action of suggestion can never 
be excluded in any form of medical treatment, whether 
it be explicitly designed to act upon the mind or 
whether ostensibly it is purely physical in character. 
It is when suggestion is used wittingly, and especially 
when it is directed to produce a definite hypnotic or 
hypnoidal state, that the conflict with the principle 
of self-reliance becomes most definite. In these cases 
the patient is definitely led to rely on a power, in 
this case that of the physician, other than his own. 
Even when, as in the most recent developments 
of hypnotic treatment, suggestions are given in the 
hypnotic state designed to strengthen the self-reliance 
and volitional control of the patient, he cannot have 
the confidence, and especially the confidence in the 
future, which is given by a recovery which he can 
clearly trace to his own efforts. The whole process 
differs essentially from that in which the action of 
the physician has been limited to helping the agency 
of self-knowledge and placing the steps of the patient 
on the right path. Even if the hypnotic suggestion 
should succeed in strengthening the will and assisting 
the patient to face his troubles, his satisfaction and 
confidence must in some degree be tarnished by the 
knowledge that this result is due to the action of 
another person and not to his own activity. 

There is also a certain amount of conflict between 
hypnotic treatment and remedies which rest on the 
principle of self-knowledge. We do not yet understand 
the nature of hypnotism. Even to the physician this 
remedy partakes of that mysterious character which 
belongs to aspects of nature which have not yet 
been brought into relation with the rest of our scientific 
knowledge. To the patient, this mystic character 
must be far greater. In a fully satisfactory system 
of mental medicine the treatment should follow 

logically from the pathology. The remedies should 
stand in a definite and intelligible relation to the 
causes by which the illness has been produced, and the 
processes by which these causes have produced their 
effects. The intrusion of a mysterious agency 
interrupts the continuity of blended diagnosis and 
treatment. It disturbs the process by which the 
patient is led towards recovery by knowledge of the 
conditions through which he was led astray. 

In spite of these difficulties arising out of conflicts 
with the main principles of psycho-therapy, there are 
certain cases in which the use of hypnotism is justified. 
A faulty trend of thought or conduct may by habit 
have become so fixed that it requires a process more 
drastic than mere persuasion to break it, or the unaided 
strength of the patient may be insufficient to enable 
him to stand up against the pains or horrors of his 
malady. In such cases the experience which has 
produced or helped to produce his illness may by this 
treatment be buried still more deeply than before ; 
no lasting and complete success can be expected unless 
the treatment is continued sooner or later in accordance 
with the leading principles of self-knowledge and 
self-reliance. If, however, the patient can be protected 
from undue stress, hypnotic or other form of suggestive 
treatment may enable him to pass through life without 
manifest nervous or mental disorder. 

Another and perhaps more legitimate mode of 
using hypnosis is in the interest of diagnosis. Dis- 
sociated or forgotten experience may be recovered 
more speedily by means of hypnosis than by the 
process of free association, the analysis of dreams, 
or other means of gaining access to the unconscious. 
Such use of hypnotism as an instrument of self- 
knowledge need interfere very little with the principle 
of self-reliance, the hypnotic process merely giving 

the knowledge from which the therapeutic process 
starts and upon which it is based. 

Though hypnotic treatment can thus be justified in 
certain cases, it is rarely necessary. It is generally 
used, firstly, as a short cut to immediate results 
without regard to the future, and secondly, because 
the striking and theatrical character of these results 
greatly impresses a public accustomed to consider 
the needs of the moment as more important than 
a complete and lasting cure. 

I must be content with this brief account of a few 
of the more important principles of mental therapy 
and of the agencies which are available in putting 
these principles into practice. I shall conclude this 
chapter by pointing out that these basic principles of 
mental medicine are also those of all sound systems 
of education, and underlie success in social life, in health, 
as well as in disease. 

In the case of one process, the attainment of self- 
knowledge as a means of treatment, the resemblance 
with a social process of normal health is so obvious 
that the physician has come to use a term derived 
therefrom. The process by which a faulty trend 
of feeling, thought, or conduct is diverted into a more 
healthy channel is generally known as re-education. 
This only differs from the ordinary process of education 
in the nature of the knowledge and attitude to be 
acquired. The agency of self-reliance, which I have 
made of such fundamental importance in psycho- 
therapy, is of equally great importance in education, 
though this importance is inadequately recognized in 
modern educational practice. This failure is due to 
the fact that it is far easier to pour facts into a pupil 
than to develop an attitude of mind, just as it is far 
easier to pour medicine into a patient than to instil 
hope, patience, and self-reliance. 

The influence of suggestion in education resembles 
in many respects that which I have assigned to it 
in medicine, and is of especial importance owing to 
the great suggestibility of children. The importance 
lies in the power of suggestion in relation to that func- 
tion of education by which it develops an attitude 
of interest in the intellectual, the beautiful, or the 
noble. Nothing assists the development of such 
an attitude more than the mental atmosphere which 
the teacher has produced, just as no factor is of greater 
importance in therapeutics than the atmosphere 
of hope and trust produced, whether in home or 
hospital, by a skilful physician. In each case this 
atmosphere is produced in the main by suggestion, 
and in education as in medicine this success is the 
greater the more unwittingly this agency is used. The 
success of a great teacher, or that which so often comes 
to new movements in education, even when based on 
wrong principles, is due to the infective enthusiasm 
and personality of the teacher acting through an 
agency quite distinct from the matter he teaches. 
As in medicine, the danger to which such a teacher 
is open is that he may rely too greatly on this influence, 
and fail to recognize its conflict with the principles 
of self-knowledge and self-reliance. 

The principles which I have here put forward as 
suited for the treatment of mental disorders of the 
individual are equally appropriate to the treatment 
of the faulty trends and disorders of society as a whole. 
The statesman whose duty it is to find remedies for 
such faulty trends and disorders has, like the physician 
of the individual, to discover the deeper conditions 
by which they have been produced, and may do much 
to amend the evil by remedies based upon this know- 
ledge. He can hardly, however, expect a lasting 
cure unless he tell the people what is wrong and where 

they have gone astray. Without such self-knowledge 
his work is liable to be upset by later conditions which 
would be innocuous if the community had been led 
to see and understand the nature of their earlier 
misfortunes. 

Moreover, the self-knowledge of the community 
is like that of the individual in that the social group 
is even more subject than the individuals of which 
it is composed to the influence of conditions lying 
deeply beneath the surface. It is generally recognized 
that the factors upon which social disorders depend 
usually go far back in the history of the people, factors, 
not only in conflict with later social standards, but 
also in many cases with existing social conditions. 
To understand the evil and find the right remedy, 
inquiries are needed which go so far into the past 
that they lie altogether outside the memories of the 
people and can only be reached by special processes 
of historical research and _ sociological reasoning. 
These factors belong just as much to the unconscious 
of the folk-mind as the factors producing a neurosis 
or psychosis belong to the unconscious region of the 
individual mind. 

The importance of self-reliance in disorders of the 
body politic is as great as that of self-knowledge. 
A nation which refuses to face the facts and is content 
to swallow every placebo and nostrum of its politicians 
cannot expect to gain thereby the permanent improve- 
ment of any disorders by which it is effected. Even 
if the remedies of its rulers be wise, only a temporary 
effect can be expected if the people rely too much 
on this wisdom, and fail to make a united effort to 
remedy the faults of their society. 

It is less easy to compare the role of suggestion 
in the group with that it takes in determining the 
fate of the individual. Suggestion is essentially 

a process tending to produce unanimity in the social 
group, and its action is even more inevitable when we 
are dealing with social than with individual disorders. 
The physician who knows that suggestion cannot 
be excluded, but that its influence may be for good or 
evil, will be forewarned and forearmed, and this 
is equally true of the statesman. Suggestion is 
responsible for panic or collapse, just as it may be 
responsible for harmony to a more useful end. The 
wise statesman who understands the _ pervasive 
and yet elusive nature of this agency may by such 
understanding do much to avert its more malign 
aspects and turn it to a useful purpose, while a people 
who understand may be prevented from falling victims 
to the excesses of which this agency is capable. In 
the society, as with the individual, the potency of 
suggestion is the greater, the more unwittingly it is 
in action. And as in medicine its greatest dangers 
may be averted through knowledge, so may much be 
done to avert danger and make suggestion an instru- 
ment for good in social and political life if its nature 
and mode of action are understood. 

Closely connected both with education and states- 
manship is the subject of ethical training. Here the 
importance of self-knowledge and self-reliance is 
so well recognized that it is not necessary to dwell 
upon it at length. It must be enough to point out 
that the principles so universally accepted as the means 
of treating faulty trends in those aspects of behaviour 
which, though clearly abnormal, are yet usually 
regarded as lying within the bounds of health, have 
been shown in this lecture to hold good for the 
correction of morbid tendencies which lie definitely 
within the region of disease. The modern theory 
of psychological medicine supports the close relation 
between mental disease and crime to which all recent 

developments in sociology and jurisprudence are 
tending. Moreover, if the principles of psychological 
medicine here put forward are accepted, they should 
remove, or go far towards removing, the obstacle 
to the acceptance of this close relation which is 
presented by the problem of moral responsibility. 
It will be seen that the recognition of crime as a 
manifestation of disease, far from implying an absence 
of responsibility, would on the lines laid down in this 
lecture lead us logically to treatment which does not 
differ greatly from that implying such responsibility. 
The mode of treating crime and moral disorder which 
is suggested by its relationship to disease differs from 
the older method, in that the erring person would 
not be merely exhorted to exert his will, but would 
be shown how his faulty trend has been produced, 
and would thus be assisted in the application of his 
voluntary efforts. 

It is a striking fact that the organization which 
has by long experience acquired the most highly 
developed system of treating moral defect, the Catholic 
Church, lays great stress on the apparently minor 
faults which have led up to definitely immoral conduct, 
and directs the attention and efforts of the penitent 
to these quite as much as to the conduct which is 
the immediate occasion for penance. This close 
resemblance of the traditional practice of the Catholic 
Church with that of the most modern systems of 
psycho-therapy leads me to the place of religion 
in psychological medicine. From one point of view 
the use of religious motives in treating mental disorder 
is definitely in conflict with the principle of self- 
reliance. For the essence of religion is that it inculcates 
reliance upon a power other than that of the sufferer. 
Some degree of such conflict there must always be, 
and in many of the forms in which religion is adopted 

as a therapeutic agency this conflict is pronounced. 
But in the most recent developments of religious 
doctrine, in which it is recognized that the higher 
power acts through normal mental process, the conflict 
becomes of no great account. The modern religious 
teacher does not tell the sufferer that he will get rid 
of his troubles by the mere act of faith, but counsels 
self-examination and self-help. To put his advice into 
simple language, he says that God only helps those 
who help themselves, and thus adopts a line which 
in essentials is that advocated in this lecture. In 
thus treating religion as a therapeutic agency, I 
recognize that I am dealing only with one aspect of 
the matter. I could not, however, leave the subject 
wholly on one side. It is necessary that those who 
employ religious agencies in the treatment of disease, 
whether they be physicians or priests, should realize 
that in so doing they are running in some degree 
counter to one of the principles of psychological 
medicine, for if this fact is recognized they will avoid 
the evils which might accompany too crude an applica- 
tion of the religious agency. Moreover, no treatment 
of the subject of mind and medicine would be complete 
which ignores religion. One of the most striking 
results of the modern developments of our knowledge 
concerning the influence of mental factors in disease 
is that they are bringing back medicine in some measure 
to that co-operation with religion which existed 
in the early stages of human progress.