522 health and disease: Africa works of ancient doctors such as Dioscorides Muslim doctors and doctors in China and India used a wide variety of drugs to treat numerous ailments Medieval peoples could successfully perform basic types of surgery, though some did not produce the desired effects Many practitioners knew how to set broken bones Inca doctors would cut holes in their patients’ skulls to treat headaches, and most patients survived this operation In Europe barbers had the joint duties of cutting hair and conducting such surgical procedures as excising tumors or amputating limbs In India, Ayurvedic practitioners could remove bladder stones and cataracts The best Islamic doctors could perform a number of complicated operations, including removal of breast tumors and thyroid cysts In many cases basic nursing care was the best that medical workers could offer European monks and nuns cared for the poor and the sick by providing their patients a comfortable place to rest and a good diet The Maya used massage therapy to treat infertility and to ease pregnancy Ethiopian doctors gave their patients steam baths Islamic doctors built hospitals to provide a comfortable place for patients to receive treatment and convalesce Many medieval health practices seem downright dangerous The Maya would bind the heads of their infants to elongate them, causing the skull to become misshapen They sometimes gave patients enemas of alcohol, which can be poisonous Childbirth in the medieval period was extremely dangerous Midwives or female family members assisted at most births Most of these assistants had little or no training in obstetrics or hygiene and consequently could offer little real help to mothers who were in trouble Ill-trained midwives could harm mothers and spread infection from their unwashed hands Many women bled to death or died from infection after birth It is no wonder that life expectancies were relatively short lived in areas with high incidence rates of malaria and yellow fever acquired genetic defenses against these particular ailments but also were more inclined to have sickle-cell anemia, a painful genetic blood disorder The harsh disease climate led Africans to give their children temporary names and put tattoos and scarifications on their bodies to dissuade the spirits believed to cause disease and death from taking them Europeans were led by the proliferation of tropical diseases to dub western Africa the “white man’s grave,” and, until the development of antimalarial drugs like quinine, that proliferation largely prevented European settlement in Africa except along the coastline and in the cape of southern Africa, which enjoyed relatively milder disease climates The trade routes of Africa, Europe, and Asia effectively exposed the populations of these continents to numerous contagious diseases The trans-Saharan and Indian Ocean trade routes predate the medieval period, but both saw significant increases in traffic between the 1250s and 1500s, thereby speeding the transfer of trade, culture, religion, and microbes Population groups along these two trade routes— which included much of western Africa and the coastline of East Africa—had the greatest exposure to worldwide diseases and consequently developed a certain degree of immunity against epidemics Contagious diseases were passed inland as well, via internal trade routes, though many of these communities suffered less-virulent epidemics The degree of immunity conferred by previous outbreaks can be seen by the fact that Africa largely avoided the “virgin soil” epidemics that so drastically affected peoples in the Americas and Oceania, Africa by Karen Flint Africa is a huge continent with numerous ecological zones where a number of tropical diseases flourished in the medieval period but also were contained by geographical features as well as by public health initiatives undertaken by local population groups These diseases included malaria, blackwater fever, yellow fever, sleeping sickness, bilharzia, typhoid, and river blindness In addition, Africans encountered a number of parasites that not only created their own discomforts but also led to ailments resulting from nutritional deficiency Malnourishment weakened the immune system, causing greater susceptibility to disease and infection Persons who Kilga, a support for a water jar, 12th century; marble kilga were designed to hold a large jar of unglazed earthenware that allowed water to filter through into the stone receptacle beneath, thus filtering the polluted water of the Nile and making it fit to drink. (© The Trustees of the British Museum)