Arctic Medical Research, Vol. 47: Suppl. 1. pp. 296-302, 1988

EMPIRICAL HEALING AMONG THE ALASKA NATIVES An historical perspective

R. Fortuine

Alaska Native Medical Center, Anchorage, Alaska, USA

Abstract. Traditional medicine may reasonably be split between magico-religious heal­ ing (e.g. by shamans) and empirico-rational healing (e.g. by use of plant or animal substances). In general, severe or mysterious illnesses, which could not be explained away by everyday experience, were treated by the former, and common or familiar ill­ nesses or injury were treated by the latter. Empirical healers included family members, herbalists, masseurs, surgeons, and sometimes even shamans. This paper discusses empirical healing among the Eskimos, Aleuts, and Indians of Alaska. It is based on an examination of the earliest available historical records, amplified by 20th century an­ thropological studies. Pregnancy, childbirth, maturation, and old age all bring with them certain hazards to health and well-being. Pregnancy and parturition, especially, can end in disaster even though they are normal physiological processes. Alaska Natives, like other people, developed rational ways of dealing with the inevitable complications of the various stages of life. Some of these practices were also closely bound up with magical beliefs and taboos, such that it is not always easy to determine to which healing realm they belong. The situation is clearer with the treatment of common illnesses and injuries. All Alaska Native cultures had a rich tradition of healing by the use of plant and animal substances and by surgery. Physical modalities such as heat, cold, manipulation, and hydrotherapy were also used in selected areas. Despite the diversity of techniques, however, certain common methods of treatment were widely distributed, for example blood-letting, and the use of oils of fish and sea mammals. Undoubtedly some empirical techniques were effective in relieving pain or hastening healing from injuries. Others, however, had no therapeutic effect, and still others had serious potential for harm. Traditional empirical healing is still very much alive in many parts of Alaska. Practices have evolved over the years, however, in order to treat new types of illness and to take advantage of new kinds of technology. Native healers, in fact, are probably practicing their skills more openly now than a generation ago, because of a resurgence in interest in traditional values.

Arctic Medical Research, vol. 47: suppl. 1, pp 296-302, 1988.

Man's earliest healing techniques were probably em­ were self-limited; they caused discomfort and perhaps pirical, that is, based on reason and experience. For ex­ indisposition, to be sure, but usually not lasting ample, it is natural to rest when sick, relieve pain by disability or death. The more severe illnesses or in­ splinting a broken limb, or apply heat to a swollen juries, on the other hand, were ascribed by most tradi­ joint. Empirical healing may be contrasted with tional cultures, including those of Alaska, to magical magical healing, or more precisely, magico-religious forces, or to evil spirits. These threats to health could healing. The treatment of everyday health problems, not be so easily explained away, except by the idea of such as colds, diarrhea, snowblindness, cuts, arthritis, malignant influences which remained mysterious to and the problems of pregnancy, were in the realm of the sufferer. To treat such illnesses it was necessary to the former. These conditions were familiar to everyone find and remove the cause, a task requiring the skills and in many cases could be attributed to carelessness, and knowledge of a shaman, or "medicine-man". or to some indiscretion of diet or daily routine. Most In this paper I will limit myself to empirical healing

Circumpolar Heahh 87 Fortuine: Healing among the Alaska natives 297

as it was practiced in earlier times by the major ethnic Other empirical healers, usually women, developed groups of Alaska-the Eskimos, Indians, and Aleuts. the techniques of massage, or "holding," as it was call­ In the restricted space available, I can do no more than ed among the Aleuts (4,p293). Similar methods, touch on the major types of empirical healing and give although differing in detail, were in use among the a few specific examples of each. Chugaches (5,p116) and northern Eskimos (6).

HEALERS METHODS OF HEALING Empirical healing was primarily in the domain of the Plants patient himself or members of his immediate family. Pla~,,s have found application in healing throughout Some techniques probably remained the possession of th.: world since the earliest rimes. In some areas of a single family group, while others quickly became the Alaska, however, their use was limited by the lack of property of the community and ultimately of the access to them during the long winter season. Conse­ culture itself. quently. 1t is not surprising that the more southern Inevitably, certain individuals became spe.:1ally peoples-Aleuts, Koniags, and Tlingit-Haidas-had skilled in the healing arts and were called upon for help the richest herbalist tradition. The Aleuts treated by other members of the community. Not surprisingly many types of illness and injury with plant derivatives. they usually worked for a fee-fish, meat, sinew, .:ir Wounds, fever, respiratory illness, diarrhea, stomach some sort of useful crafted item, such as a weapon or pains, constipation, sore eyes, and rheumatism were tool. Most successful healers were described as older among those conditions for which a specific remedy persons, presumably a reflection that they had ac­ was available (4,p293;7,pl76;8). The Koniags used quired their skills over a long period of time. plant extracts for the treatment of boils, diarrhea, sore Midwives were probably the first empirical healers. throat, and later, venereal disease, to name a few Women in childbirth have always had helpers, whether (l,p177;9,p129-30). Their neighbors the Chugaches, simply the mother or grandmother of the parturient, likewise, had plant therapies for dropsy, earache, or else an experienced woman of the community. Their frostbite, and even for initiating the flow of milk task, in Alaska as elsewhere, was to give advice during (5,p117). In southwestern Alaska the Yupiks used pregnancy, and to tell the expectant mother how to medicinal plants both internally and externally, the lat­ conduct herself during labor and delivery, and the im­ ter often in the form of a poultice. Other plants they mediate postpartum period. Midwives were a sour.:e of boiled to make a kind of infusion, or tea, and boiled strength and encouragement for the mother, while at still others and inhaled the vapors (2,p5;10). The arctic the same time they ensured that certain cultural norms Eskimos, in contr~t, made little use of plants were observed. (ll,p328) excepc along the Kobuk and Noatak rivers Another important type of healer made use of and in the interior. Among the Indians, the Tlingits plant, animal, or inorganic substances. Among the and Haidas made good use of many plants growing Koniags and Central Yupiks, at least, such persons h.. xuriantly in the damp, temperate climate of were usually women and highly respected in the com­ southeastern Alaska. Among other conditions they munity (l,p177; 2,p3). Among the Tlingit, on the other treated in this way were arthritis, black eye, stomach hand, female herbalists were not held in particular problems, constipation, respiratory infections, sores, esteem (3,p.29). and upen wounds (12,p349;l 3,p284). The Athapaskan Surgeons were another type of empirical healer IndianF of the interior also employed many healing known throughout Alaska, but particularly important plants, particularly in the form of infusions and among the Aleuts and Koniags. They often displayed poultices. a broad range of manual skills that served not only in Although the local flora differed in various parts of the care of injuries and internal illnesses, but also in Alaska, certain plants seem to have been widely used the preparation of individuals for ritual ornamenta­ for healing, even taking into account the difficulty in tion. Aleut surgeons, usually male, were renowned for identifying some of the plants mentioned in the early their anatomical knowledge and passed on their accounts. Devil's club (Echinopanax horridum) was Special skills to their favored sons and grandsons the principal ingredient of several remedies used by the (4,p293). Koniag surgeons, contrary to the practice Tlingits (14) and Chugaches (5,pll7) for such diverse elsewhere in Alaska, were often women (l,p177). conditions as burns, dropsy, arthritis, stomach ulcers,

Circumpolar Health 87 298 Arctic medical history and traditional medicine black eyes, and constipation. The Eyak Indians bathed (23,pl!O). Further north the Eskimos of the Kobuk the newborn in an extract of devil's club (15,p160). River chewed dried young bank swallows for sore Various Artemisia species, or sage, found medicinal mouth, or held a grayling fin between their teeth for use both internally and externally by the Aleuts (8), toothache (24,p18). Bear gall enjoyed a great reputa­ Central Yupiks (2,p5), Northern Eskimos (6), and tion for the treatment of arthritis among the Tlingits Athapaskans (16,pll6), for example for wounds, and certain Athapaskan groups (25,p37). In the in­ respiratory disease, and gas pains. The Aleuts, 8 terior the Indians used the vapors from cooking fish Chugaches (5,pll7), and Northern Eskimos (17) eggs for snow blindness; for earache they burned the employed extracts of aromatic yarrow (Achillea end of a ground squirrel's tail and allowed the smoke borealis) for conditions like stomach pains, nose to enter the affected ear (l8,p230). According to some, bleeds, boils, and wounds. A few local plants had more the gastric juice of the porcupine was believed to have specialized properties. The Aleuts used a kind of pond diuretic properties (19,p109). scum to treat sore eyes and their neighbors the Koniags Human body fluids also found uses. For the Aleuts administered to women in labor an extract of an the saliva of a girl at menarche, or of an elderly man, unknown plant, said to be found only on a single had healing properties (4,p224;26,p105). The Yupik island (l,p177). The Yupiks used ptarmigan willow Eskimos applied saliva or human milk to the eyes to (Salix planijolia) extracts for open sores, and various treat snow blindness (2,p8). Both the western and nor­ fungi of the "puff-ball" type for stomach disorders thern Eskimos found urine helpful to staunch bleeding and wounds (2,p6;10). The Athapaskans found multi­ from a cut or other open wound (ll,p329). The Yupiks ple uses for spruce gum (18,p229;19,pl09), and the sometimes used blood from the nose to heal sores in Tlingits even produced a kind of "medicated steam" the mouth. On Nunivak Island nasal mucus, together for headache by heating the hollow end of a giant kelp with seal blood, was sometimes applied to fresh bums (13,p284). (2,p8).

Animal Substances Surgery Healing substances derived from animals were All the Alaska Native peoples used surgical techni­ understandably more popular in the northern areas of ques, although to a markedly different extent. Some, Alaska, where plant life was less prominent. More than like the Aleuts and Koniags, considered surgery a any other single remedy, seal oil was a mainstay for the separate healing art with its own special practitioners; Northern Eskimos and only slightly less for the among the Tlingit, on the other hand, surgery seemed Yupiks. This panacea was taken internally for its lax­ to be relatively insignificant, except as an adjunct to ative properties and applied externally for cuts, the ministrations of the shaman. Among the western bruises, burns, and even for dry skin. Seal oil drops and northern Eskimos and the Athapaskans, surgery were administered for earache or a stuffy nose was performed when the need arose by shamans, ex­ (20,p214;6). The Yupik Eskimos seemed to prefer ran­ perienced individuals from the community, and not in­ cid oil, especially mixed with a kind of moss, for open frequently by members of the family. sores (2,p8-9). On the northern coast whale blubber Surgeons used several kinds of instruments, in­ also found many therapeutic uses, for example for cluding knives, short-bladed lancets, chisels, long, nose-bleeds, boils, wounds, and even diaper rash narrow awls, and needles. Some of these were adapted (l l ,p328). In the Pacific Rim area other oily substances from existing tools, while others were apparently were more readily available. The Tlingits and Haidas designed specifically for surgery. In early times they employed the oil derived from the candlefish, or were crafted from flint, bone, ivory, shell, and even eulachon, for earache, respiratory diseases, and jade. gastrointestinal disorders (21). The Aleuts found warm Virtually all Alaska Natives ornamented their faces fish oil or the fat from foxes useful in the treatment of and to some extent other parts of the body. These wounds (4,p292). decorations were often quite elaborate, not to say strik­ In southwestern Alaska the perianal glands of the ing, and each probably had some ritual meaning. beaver were said to be helpful for rheumatism, chest Although the specific patterns were characteristic for pain, sore throat, and wounds (22.p90). Likewise, each culture, common themes included lip, nose, and Eskimos of the area applied fresh raw seal liver to ear ornaments, and tattoos. All forms of durable or­ frostbite and otter dung to some kinds of skin rashes namentation required some type of surgical prepara-

Circumpolar Health 87 Fortuine: Healing among the Alaska natives 299

tion, including incisions, perforations, or multiple would plunge a sharp, stone lancet deep into the skin needle punctures. These procedures were usually per­ and twist it about to break up the loculations of pus formed at birth or at the time of puberty by a shaman, (1,pl77). Other populations used bone needles to in­ local practitioner, or family member. cise and drain boils (1S,p229). Labrets, or lip ornaments, were especially charac­ It was a natural extension of the treatment of teristic of the Alaska Natives, with each cultural group abscesses to the treatment of painful, swollen joints, displaying its distinctive patterns. The Aleuts (27 ,p85), throobing headaches, or even sore, swollen eyes by the Koniags (28,pl95), and Chugaches (29,p350) wore te:..hnique of piercing, or "poking." The principle elaborate decorations of bone, stone, ivory, wood, oehind this procedure was tc open a passage in the skin shell, or mother-of-pearl at the corners of the mouth to let out the bad humors causing the pain and swell­ or in a horizontal slit below the lower lip. Tlingit and ing. The piercing was often quite superficial and rarely Haida women displayed a large circular or oval caused significant bleeding. The Aleuts (4,p292-3), wooden disk in an incision in the lower lip, a practice especially. developed this method to a high art, but it that greatly distorted the face and caused difficulty in was also usl"d extensively by the Yupik (23,pllO) and eating, drinking, talking, and, according to one northern Eskimos (34,p422-3). observer, even kissing (30,pll6). The Eskimos usually Bleeding, or the other hand, involved opening a restricted themselves to a large round labret of ivory or specific vein, or at least making a deep cut with a stone at each corner of the mouth (31,p921-2). lancet, in order to cause a moderate amount of active These decorations, plus the nearly universal practice bleeding. Often highly vasculai tissues, such as the of wearing ornaments around the external ear or scalp, tongue, nose, or face, were selected for the inci­ through the nose, required either a full-thickness lip in­ sion. Bleeding was employed by the Koniags, for exam­ cision up to three or four centimeters in length, or else ple, to treat many types of internal illnesses, including multiple punctures through the pinna of the ear or the heart trouble, asthma, loss of appetite, swelling, and nasal septum. abdominal pain (l,p17S). After sufficient blood had The second main type of surgical therapy was been removed, the bleeding was sometimes stopped by directed toward the repair of injury. The Aleuts holding the edge5 of the wound together or by apply­ (32,pll), Koniags (l,pl78), and Yupiks (2,p59) were ing some substance such as fresh fish, or a powder known to suture wounds, using a bone needle and made from rotten fir wood (9,pl29). sinew or hair. Penetrating injuries could result from a Still other types of surgical treatment were develop­ projectile, like an arrow, spear, dart, or harpoon, or ed for specific diseases. For example, Koniag surgeons they might simply be due to an unpleasant encounter sometimes cut for urethral stone, and allegedly even with a fishhook, splinter, or the jaws of a trap. removed corneal opacities, possibly pterygia, by Whenever possible objects of this kind were removed means of a body louse attached to a hair (l,pl78). by enlarging the entry wound and then cutting around the foreign object in order to remove it (l,pl78). From Other Modes of Treatment time to time amputation of an extremity was found Massage had special uses during pregnancy and necessary, more commonly resulting from severe childbirth. Aleut midwives massaged a woman's ab­ frostbite than from an accident. The operation was domen beginning in the early gestation period and in­ fairly easy when due to severe cold injury, since with creasingly frequently until the time of labor. Im­ the passage of time the gangrenous area became clear­ mediately following delivery they agair massaged the ly demarcated as well as conveniently anesthetized. mother's abdomen, chis time to "gather up birth," as Healing was by a slow process of granulation they expressed it. Failure to provide this treatment cor­ (33,pl22). rectly was believed to endanger the mother's ability to A third type of condition which sometimes required bear more children (4,pJ89-90). Aleut midwives were surgical intervention was pain and swelling, the most also said to be skillful in diagnosing malpresentation obvious example being from an abscess. Boils and car­ of the fetus during late pregnancy and to have suc­ buncles were very prevalent in some parts of Alaska, cessfully performed external version (26,p41). At especially Kodiak Island, where they were said to be Anaktuvuk Pass a man sometimes performed external the commonest illness (28,p201). There the surgeon in­ version by massage of the abdomen in late pregnancy cised the swelling with a sharp shell and sometimes (20,p211). Koniag midwives pummeled the mother's sucked out the pus. For larger abscesses, however, he abdomen during the birth process in order to hasten

Circumpolar Health 87 300 Arctic medical history and traditional medicine delivery and reduce birth pains (l,pl64). On the CONCLUSIONS Kuskokwim a midwife sometimes pressed down on the mother's abdomen or squeezed her from behind to The history of traditional medicine throughout the speed the birth process (2,p32-33). l\vo Chandalar world is that of cultural convergence. Techniques of Kutchin midwives sometimes worked as a team, one of surgery or methods of treating internal illnesses have them massaging the mother's abdomen from behind had a remarkable sameness about them, whether and the other standing in front and exerting counter­ originating in West Africa, New Guinea, the high presure upwards under the axillae (35,p57). Andes, or Alaska (39). Moreover, in our own Western Although reports of induced abortion are unusual, medical tradition, less than two hundred years ago some Northern Eskimos attempted it in early preg­ physicians and surgeons were bleeding, suturing nancy by pressing down hard on the gravid abdomen, wounds, applying poultices, and administering inter­ or even by having someone jump up and down on it nal herbal remedies in ways not fundamentally dif­ (33,pl21). ferent from those of Alaska Native healers of the same The newborn also received a massage in some era. cultures. Aleut midwives kneaded the baby's abdomen Empirical medicine was a highly developed art shortly after birth, by which they' 'gathered up his en­ among the Alaska Natives, with of course the details trails into the proper place" (4,pl90). The Tlingits of its application differing somewhat among the massaged the abdomen to induce vomiting and thus various cultural groups. Many common themes rid the infant of all impurities (36,p318). emerge, however, such as the use of bleeding, massage, Massage, or tnore properly manipulation, was fur­ certain plants, and sea mammal oils. But despite their ther employed in the treatment of sprains, disloca­ similar healing practices, Alaska Native cultures dif­ tions, and fractures. Eskimos of the Noatak Rivet fered markedly from each other because of their massaged a sprained or dislocated limb to reduce pain geographical isolation, ethnic diversity, and the and swelling and to bring the extremity into better dissimilar biospheres in which the people found their alignment, but apparently did not try to reduce a frac­ subsistence. No doubt some aspects of the material ture (6). The Nunivak Island Eskimos and those of the and intellectual culture, including healing, were passed northern interior and coast all tried to reduce fractures from one group to another through trade and warfare, by manipulation, following which they applied a splint but in general each had to learn to cope in its own uni­ made of birchbark, (18,p229), whalebone (33,pl21- que way. 2), wood, or dried caribou hide (2,p20). In light of these considerations, it is probable that Heat had important therapeutic uses. The Tlingits, empirical medicine developed more or less de novo Aleuts, Athapaskans, and Northern Eskimos bathed within each major Alaskan culture. Each healer's in hot volcanic pools for the relief of arthritis, skin skills, including those of the shaman, developed large­ diseases, and other illnesses. A particularly renowned ly by trial and error in response to the specific health healing site was the hot springs a few kilometers south problems that faced his or her group. of Sitka, which were used by generations of Tlingits Was Alaskan empirical medicine helpful? Of course (28,p231) and later appropriated for use first by the it was, or it would not have survived. Many Alaska Russians and then by the Americans. Although the Natives still consult their own healers sometimes steambath was probably introduced in most parts of before and sometimes after they visit (if at all!) the Alaska by the Russians, some evidence exists that this physicians of the Alaska Area Native Health Service. enormously popular form of refreshment was also in­ Most illnesses, in any event, are self-limited and pose digenous to the people of Kodiak Island (37 ,p30). no serious threat to health. In such cases the Native Among the Yupiks, heat in the form of a hot stone or practitioners often have just as much to offer as we ashes wrapped in a damp cloth was found to be helpful from the medical establishment have. In fact, they fre­ for arthritis (2,plO). The Kutchin Athapaskans quently offer more, since the Native patient may have sometimes had a patient lie naked over heated rocks greater confidence in a culturally acceptable remedy covered with moss (35,p71). than in the pills and potions of a modern clinic. With Cold, an abundant commodity in Alaska, also confidence in the healer comes a greater effort to get found uses in healing. Some Yupik Eskimos stuffed well. snow in the mouth to control nosebleed, or applied Native methods of healing were largely reasonable cold rocks to the head to treat headache (38,p202). and based on physiology and pathology as the healer

Circumpolar Health 87 Fortuine: Healing among the Alaska natives 301

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