Doctors Who Treated the Harappans

Dilshad Fatima

University of Allahabad, Prayagraj, India

Keywords: Harappan Doctors, Paleo-Pathology, Skeleton, Burials, Disease, Orthopaedic, Anaemic.

Abstract: The system of burying dead has been in existence since primitive times. When Marshal, some hundred years

ago contented that cremation was the only mode of disposal of the dead was taken seriously with all the claims

of superior and standardized ceramic tradition, seals and sealing, weighing system, lapidary art, city layout

and planning and even distribution of resource. However, later researches into the Harappan Civilization

brought to light a system of burying their cadavers. Hitherto scholars like A. K. Sharma, Lucas, Kennedy and

the likes have worked on these skeletal remains to report the causes of death as well as the nutrition levels

and how well they coped with their injuries. The present paper intends to study in detail paleo-pathological

diagnosis and interpretation of diseases prevailing in those times and their treatments, pointing to the possible

existence of various medical branches and specialists of doctors.

1 INTRODUCTION

The introductory excavated site Harappa is the brand-

site of the Harappan Civilization that flourished from

c. 2600-1900 BCE in the River Valley of Indus

Ghaggar-Hakra in modern India and Pakistan. The

Harappa Civilization is characterized by

standardization in well-planned cities, ceramic

traditions, seals and sealings, weighing systems,

lapidary art and their system of burying cadavers.

From the very Stone-age, pieces of evidence of

burying humans have been reported from many sites.

As Harappans are known to have disposal of their

dead, and the same was learnt at various sites during

the course of the excavations. The usual method of

the disposal of the dead was to in turn the body in a

pit, sometimes lined with mud bricks. The body was

laid supine in an extended position, with the head

towards the north. Over a dozen exemplary burials

were excavated. In all these case studies the pit was

rectangular, with either sharp or rounded-off corners

and large enough to take in an extended human body

(Ghosh, 1969). Over the decades a variety of ways of

disposing of their dead have been brought to the

notice many with the skeletal remains and some

without. A number of necropolises have also come to

light in recent times. Burials with skeletons not only

show the rituals and customs associated with the dead

giving an insight into the society’s view of life after

death but the skeletons also provide the health chart

of the people buried. There are several injuries and

diseases like Exostosis, Joint Diseases, burning

marks, Dental attrition, Trauma, Congenital

Perforation, Hematopoietic Disorders, Infection and

Inflammation, Sharp Cut marks, Neoplasia,

Hydrocephaly and Trepanning, Crippled man,

Paralytic man etc., which have come to notice that

need to be discussed in detail and uncover the

existence of Doctors in Harappa-Civilization.

Hitherto scholars like A. K. Sharma, Lucas, Kennedy

etc. have worked on these skeletal remains and so far,

only cultural, social, and technological aspects have

been approached and examined the vestiges. Only

further studies would be able to throw some light on

this issue in a manner that skeletal remains from the

graves have thrown some interesting sidelight on

numerous substantive stances of Paleopathological

diagnosis and interpretation. One of the remains has

proved that there might be Neurosurgeon existed in

3000 BCE because a skull of a child was unearthed

from Kalibangan to be rather unusually large, a

hydrocephalic patient. To treat this, the ‘Harappan

Neurosurgeon' took recourse to trephination,

perforations on the right temporal region and possibly

some heated instrument used to brand it. Another

instance of trephination has been reported from

Lothal.

This paper is specifically focusing on the diseases

and their treatments which might have been taken

after these diseases were diagnosed. Archaeologists

Fatima, D.

Doctors Who Treated the Harappans.

DOI: 10.5220/0012500800003792

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 1st Pamir Transboundary Conference for Sustainable Societies (PAMIR 2023), pages 667-671

ISBN: 978-989-758-687-3

667

and anthropologists have reported such details in

unearthed skeletons from sites such as Kalibangan,

Lothal and Harappa, as only bones can be collected

and observably studied. So, keeping that in mind, this

paper would tackle the diseases which had occurred

in bones only. So, there is great potential in this paper

to have a clear picture of from where the Harappa’s

pathology evolved that would have given rise to the

Paleopathological existence, which can be dated back

to the Harappa civilization. The Harappan sites

contain one of the richest and continuous records of

hominine behavior. These evidences have been

yielded in diverse palaeoecological settings. The

pattern of disease or injury that affects any group of

people is never a matter of chance. It is invariably the

expression of stresses and strains to which they were

exposed, a response to everything in their

environment and behavior. It reflects their genetic

inheritance (which is their internal environment), the

climate in which they lived, the soi1 that gave them

sustenance and the animals or plants that shared their

homeland (Calvin, 1994). Diseases and injuries

reflect the happenings, which at times get occurred in

bones. The occurrence of disease or injury has a

particular pattern which is influenced by the

individual's occupations or a specific sustained

activity, at times by climatic environments and

dietary habits. Palaeopathology attempts to study

such variations and abnormalities reflected in the

anatomical and morphological profile. Some of the

deformities may be since birth itself. Such

abnormalities can be studied mostly through the

skeletal remains recovered from various

archaeological excavations at Harappan sites.

Scholars have made strenuous efforts in the study of

palaeopathology; however, it is difficult to be too

precise while arriving at conclusions. This becomes

difficult, particularly in the absence of clinical

knowledge and training. Even then some attempts can

be made. In the majority of skeletons, no trace of the

cause of death is present, only those, which get

recorded in bones can be studied. Human skeletal

remains were excavated and examined in the

laboratory. During the course of the study, the author

noticed certain pathological and other interesting

features, some of which are described below:

2 HYDROCEPHALY AND

TREPHINING

The huge globular size of the child's skull from

Kalibangan suggests a case of hydrocephaly, caused

due to excessive accumulation of fluid in the brain.

This swelling and accumulation of fluid results in

severe pain. The right side of the child's skull from

Burial no. 9 at Kalibangan shows three small

trephined holes on the squamous part of the temporal,

above the right acoustic meatus. The black streak

joining the upper two holes and running up to the

opisthocranion might have been caused by some hot-

pointed instrument. The burning mark and the holes

suggest that probably some sort of primitive surgical

operation was performed on the skull of the child to

give him relief from severe pain, caused by the

swelling of the skull. This also accounts probably for

the presence of more than usual sutural marks or

wormain bones on the same skull. Another example

of Trephination has been earlier observed in one of

the human skulls from Lothal. At Lothal the operation

was performed on the right parietal bone of a child of

about 9-10 years of age. As per Dr S. K. Basu, "the

right parietal bone shows a deficiency anteriorly at

the anterior and lower quadrant almost mid-way

between the parietal eminence and the squamous

suture (Rao, 1979). In the absence of any bone repair,

one would conclude that the person did not survive

long after the cut was done or the cut was made post-

mortem." These trephinations appear to have been

made with some sharp instrument with circular edges,

the margins of the perforations do not show any

osteogenesis in the form of callous formation. The

cutting edges of the circular openings are neither

smooth nor beveled indicating that these perforations

were made post-mortem. These have always been

regarded as post-mortem cuts made the evidence of

trephination for medical purposes at Kalibangan is the

earliest instance of a surgical operation in the world

which goes back up to the middle of the third

millennium BCE. The above instances of trephination

substantiate the later literary references to

Neurological surgery practiced in India.

3 SUPRATROCHLEAR

FORAMEN

It is an anatomical variation where a perforation

presents in the lower end of the humerus bone, which

is also called epitrochlear foramen. Certain jobs

require robust and repeated action of the elbow,

which impacts the humerus by olecranon and

coronoid processes of the ulna on the olecranon fossa

region, which is reported from two skeletons at

Kalibangan that show such enlarged perforations. The

presence of such enlarged perforations in both the

PAMIR 2023 - The First Pamir Transboundary Conference for Sustainable Societies- | PAMIR

668

humerus bones is indicating that the man was

engaged in such a type of work as wood cutting. The

man could manage to survive for many years, as some

had not died immediately after injury, so it is

assumed, that there might be some kind of aid used to

carry work on, which pieces of evidence help us to

make an assumption about the existence of specialists

concerned with orthopaedics.

4 EXOSTOSIS

At times the excess formation of a bone on the surface

of a bone, resulting in extra growth, takes place due

to some injury. This is due to the clotting of blood on

the damaged muscle. This phenomenon has been

observed in the proximal end of the right ulna

belonging to the skeleton from Burial no. eight at

Kalibangan, in the form of a craggy mass of bone on

the upper part of the shaft. The result was triangular

outgrowth bone as compared to the normal one on the

right. The cut marks around it suggest that an

orthopaedic specialist attempted surgery on this

extra-grown bone.

5 DENTAL ATTRITION

The description of dental remains from Harappa is

woefully incomplete and dental remains from Lothal,

Rupar and Kalibangan have not yet been published,

however, it can be surmised that the Kalibangan

Harappans were at least not vigorous flesh

consumers. Anadi Pal, who studied the permanent

dentition of 314 individuals represented by skeletal

remains unearthed from Harappa, Mohenjodaro,

Kalibangan, Lothal and Rupar etc. concluded that the

dental health of the ancient Indians was better than

that of the people of contemporary civilizations. As

the Harappan sites are located in different

geographical and slightly different climatic zones,

naturally having different food habits, the collective

conclusion is likely to give a distorted picture. The

right first and second molars and premolars of the

mandible from the skeleton from Kalibangan show

marked attrition of the cusps. The attrition is not

uniform on all the teeth. The left teeth are relatively

free from any marked wear and tear. The attrition of

right molars and premolars can be attributed to two

causes, firstly habit of using the left side more for

chewing and secondly coarse food, mixed with

powdered stone grains. The presence of powdered

stone may be due to the use of crumbly sandstone

grinders (Emery, 1963). This is also supported by the

recovery of grinders of sandstone from Kalibangan

excavations. Incidentally, it may not be out of place

to mention here that among all the skeletons

recovered from the excavation, teeth are present in

good condition even in the skeletons of persons of

advanced age. This general absence in antemortem

loss of teeth in Kalibangan skeletons even in that of

grown-up adults could observe. The stated data above

is suggesting about the contemporary existence of the

dentist.

6 CRIPPLED MAN

Another oblong burial from Kalibangan oriented in

the north-south direction, length-wise, yielded a

human skeleton and its closer examination showed

that the skeleton belonged to a male adult of about 30

years of age (Sharma, 1999). A glance at the in-situ

condition of the skeleton revealed that the individual

was a crippled man, showing marked pathological

deformities of the radius, ulna and hand bones of the

left side. The left hand was placed in a prone position

with the carpal and metacarpal bones badly twisted to

left outwards so that the thumb bones rested below

the bones of the second phalanges and the rest of the

fingers were twisted outwards from its point. A

comparative analysis between the ulna and radius

bones of the two sides showed that the left radius was

smaller from its right counter and similarly left ulna

was shorter from its right counter respectively. The

position of different bones and their size show that the

left side is deformed. In the case of left foot bones, it

was noticed that, though all the metatarsal bones were

present, phalanges were represented only by

rudimentary bones. These retarded rudimentary

phalanges indicated the pathological deformity of the

right foot. The left femur and tibia were shorter in

comparison to their right counterparts. So, this can be

stated that there must have been a doctor who treated

this man so that at least he could have walked

antemortem.

7 JOINT DISEASE

Joint diseases have not been commonly found in the

remains of Harappa. This appears most often in the

spine, where it affects both the synovial posterior

facet joints and the non-synovial joints between

vertebral bodies (Lovell, 1994). Not every articular

surface was observable for pathological lesions,

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669

because of preservation issues and difficulty

extracting skeletal elements from a clay-like matrix in

some locations of the cemetery. Around 160

appendicular joints, were examined for evidence of

marginal lipping, pitting, and eburnation. Overall, the

knee was the joint most affected by the degenerative

change. Eburnation is considered to be the most

severe expression of degenerative joint disease and

among the Harappans it affects the knee, wrist, and

ankle. Only the knee displays all three conditions. As

this has been recovered in many skeletal remains

from various sites, so it made us think that either

Harappans were using mobility aids without any

treatment or there might be an orthopedic specialist,

who diagnosed joint disease and attempted a

treatment as well.

8 HEMATOPOIETIC DISORDERS

One possible case of porotic hyperostosis (Lovell,

1997) and another of cribra orbitalia, both thought to

represent an anaemic condition, unfortunately, are

documented only by fragments of bone, and diploic

expansion could not be confirmed. These lesions are

consistent, however, with acquired iron deficiency,

which often results from chronic infection or

excessive blood loss caused by gastrointestinal

parasites.

9 INFECTION AND

INFLAMMATION

One individual exhibited a lesion indicative of a

localized infection, secondary to a penetrating wound

on a pedal phalanx. Other inflammatory lesions are

generalized and affect the shafts of long bones.

Although postmortem damage hinders diagnosis,

these non-specific lesions indicate a chronic

inflammation of the periosteum that affected one or

more long bones in five individuals, predominantly

on the tibia and fibulae.

10 TRAUMA

Several injuries were observed in the Harappan

remains and resulted from both direct and indirect

trauma. Ten individuals exhibited a total of 13

traumatic lesions, but only six of these individuals

were complete skeletons in primary contexts so

interpretation is fraught with difficulty (Lovell 2014).

Two adult females from primary contexts exhibit

vertebral crush fractures. The distal right radius of a

middle-aged female exhibits a Colle’s fracture that

perhaps resulted from falling onto an outstretched

hand. Of the 28 adult crania in the Harappa sample,

two exhibited traumatic lesions. One adult female had

remodelled lesions on the occipital bone, at least one

of which may be due to a blow to the back of the head.

Cranial trauma is thought to be more likely due to

interpersonal violence than to accidents. Other

injuries may also result from interpersonal violence.

A well-healed scapular fracture, involves the lateral

border and body in a middle-aged female, although

this injury can only be caused by a blow or a fall.

Furthermore, a fall from a greater height is unlikely,

because the articulating clavicle and humerus are

unaffected and such falls usually are associated with

additional injuries. Two well-healed rib fractures

were also observed, one in an adult of indeterminate

sex found among commingled elements and the other

in an adult female with healed trauma to the occipital

bone. There is a possibility of some kind of treatment

just after the fall off by analyzing the skeletal

remains, as it is not proven that this was an accidental

death.

11 CONCLUSIONS

Although excavations at Harappa in recent decades

have substantially increased, the amount of

information about the skeletal remains has not been

well recorded and published. Harappans were very

meticulous about the location of the cemetery area

(Sharma, 1977-78). The first fully published report is

by Lovell (1994, 1997 & 2014) with proper

descriptions of the skeletal paleopathology of the

adult remains excavated in 1987 and 1988, and of a

skeleton excavated by Dr R. Mughal in 1966. The

Harappans were very meticulous about the location of

the cemetery area. At Kalibangan, it is located

southwest of the habitation area, on the left bank of

Saraswati, far away from the living area. In order to

have better and more comprehensive knowledge

regarding patterns in diseases' occurrence during

Harappan times and related treatments, this study

would be worthwhile to identify the treatments.

Detailed study of skeletal remains would be helpful

for making palaeo-pathological theories.

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