Massage is an extremely popular and important health strategy across the KhoeSan
Amongst rural Khoi there was often a clear sense of old Khoi sicknesses that healers knew how to treat. Typical accounts of old sicknesses from northern and southern Namibian Khoi predominantly included: //âutas, ≠gaob (heart), //has (uterus), /gûis (intestine), !arab, ≠gurub (leg pain) and /gôaron //ōs (children’s sickness). One lady expressed old illnesses as heart falling, liver falling, intestine up and down. Another, from Hoachanas, made a particularly interesting inclusion, ≠oa ≠ga, to go mad, literally ‘wind put in’. In the early eighteenth century Kolben suggested that if the cause of a headache was ‘wind in the head’ then massage was applied to the nape of the neck. The phenomenon of wind in the head is well known amongst Sesfontein Damara. It is associated with the uterus or wind of the uterus moving to the head and causing madness amongst women who have just given birth and have been subsequently exposed to a draught. Treatment entails a warm pot lid or rock being placed on the low abdomen to draw the wind/organ back down. If not treated the victim not only goes mad but could well die.
All these sicknesses relate to moving organs or moving wind, an often interchangeable idea. Barring ≠oa ≠ga they all require massage as the principle form of treatment.
To better understand the role of massage I shall proceed with a description of six key Khoi massage treatments. This is then followed by a short account of massage amongst Bushmen.
Most massage is undertaken using Vaseline, or if this is not available the practitioner’s spittle. Some Khoisan use animal fat, normally cow or goat, stored in a horn, although this is unusual and is deemed ‘old time’ treatment. Schultze (1907) observed that Hottentots used a small horn filled with goat fat mixed with powdered plants and parts of animals. The fat was believed to have curative properties when applied to the body. The extra ingredients held additional specific potencies. In 1838 Alexander reported a Nama girl with a horn for fat and a tortoise shell filled with buchu. Tortoise shells of buchu, or sâi (sā) are relatively common amongst contemporary Khoi and San. The fragrant plant powder is sometimes lit and wafted over people or mixed with fat and rubbed on them. One lady suggested that making a mixture of fat and herbs to massage with was no longer the practice because of the time it took to prepare.
(A.) //gôaron //ōs ( (s)tuib, Nama) “children’s sickness”
//gôaron //ōs is not a precise category. The term relates to a sickness that generally affects babies and young children, and rarely adults. Signs indicative of /gôaron //ōs may include a protruding chest, often described in reference to the resultant hollow below the sternum, stiffness of the body, posterior arching (extension) of the back and head, rigidity of limbs, and possibly panting and speechlessness. A baby may have loss of appetite, fever, vomiting and, or, diarrhoea. It may have blue lips and blue sclera. Urine may be pink, and stools are regularly said to be green. If the stool is black the baby will soon die. A key sign is a sunken soft patch on the front of the baby’s skull (anterior fontanel). The status of this fontanel is important to both Khoi and San, as it is amongst other African peoples. The nineteenth century Cape /Xam believed ‘the head’s hollow place is that which the mantis has pressed down’.  Schapera observed that new born Hottentot babies had a powder and salve of ostrich egg shell rubbed on their forehead, nose, temples and thickly on their anterior fontanel ‘to prevent the entry of disease’. In Sesfontein they rub the fontanel with Vaseline to prevent skin sores.
Reflecting the broad nature of the /gôaron //ōs category, in biomedical settings the signs and symptoms of /gôaron //ōs are variously interpreted as meningitis, gastroenteritis, dehydration and malaria. Causes of /gôaron //ōs include a baby being shocked or stressed either before or after it is born. An angry, stressed or depressed mother can induce /gôaron //ōs in her unborn child. A child may further develop /gôaron //ōs if it has wind in its stomach, an excess of mucous, cries excessively, has intestines that are moved down or does not have enough fat. A forty three years old Nama lady from Swakopmund suggested that the winds of unknown people, sweaty men and menstruating women can all enter a woman during pregnancy and lead to /gôaron //ōs in her unborn child.
Whilst massage does not follow strict protocols of practice the following represents a summary of the common elements of /gôaron //ōs treatment. Babies are often, but not necessarily, massaged by women. The practitioner will typically stabilize the baby on her lap by either cradling the baby’s torso between her two hands, one either side under the armpit, or by drawing the baby’s body close to her chest whilst working on the child’s abdomen or limbs. An alternative is for the practitioner to be seated in a chair and have the baby prone or supine on her lap.
The sickness is treated in a number of ways depending upon the particular nature of the /gôaron //ōs presentation and the skills of the intervening healer. This sort of massage follows very similar patterns to that carried out more routinely to aid development of the child. Using Vaseline as a lubricant, the massager will generally work over the entire body of the baby, but focusing particularly on the region deemed to have the primary problem. For a coughing baby the chest might be the focus and for a stiff baby all the joints and the spine. For a cough the practitioner works largely with her hands clasped around the chest under the armpits. In this position, with the baby facing away, the thumbs can be used in a rotatory fashion, working up and down the spine. The hands are further rotated forwards and backwards with a slight sequence of compression and release whilst the fingers are rubbed around the front of the child’s chest to the sternum and back again. With the baby held securely, all limbs will be held within a closed hand that is worked a few times down the length of the limb, including firmly over the feet and hands and well into the joints, armpits and groin. Massage can go up or down a limb. Appropriately firm flattened fingers are used to palpate tensions in the abdomen. If the intestines have moved, small repetitive drawing movements are used with two fingers to bring them back into position. Usually this entails working from the side of the abdomen towards the centre and perhaps up or down. Although treatment patterns varied, a common treatment schedule was twice a day, for two minutes, over three days.
Massage is normally combined with a powdered remedy used either orally or directly applied to the body during the procedure. Ingredients of this medicine varied according to local availability, inherited tradition and, occasionally, personal initiative. Burnt and ground ostrich eggshell was a common ingredient. To that might be added kidney of the bat eared fox, jackal liver, elephant dung, aardwolf dung, the aardwolf anus gland, wild pig stomach and various plants, such as //ao ≠guis (Rehoboth district).
(B.) //âutas (Hoernlé, //autus, ‘paralysis)
// âutas is a general term for people who are !om ( to coagulate, congeal, clot; solidify, set) and !hora (cripple) A key feature of //âutas treatment is palpation for perceived knots or lumps in ‘arteries’ or tendons – particularly those behind the knee. A diagnostic characteristic of //âutas is being able to insert one’s finger deeply between the lower lumber vertebrae. //âutas often involves stiffening and bending of a limb or a twisting of the neck, side bending of the tongue and perhaps adduction or abduction of an eye. The problem was more often, though not exclusively, associated with older people and rarely with babies.
Damara in Windhoek believed //âutas could come from a ‘stroke’ caused by ‘high blood pressure’, from ‘Polio’ or from ‘Rheumatics’ (all related in English). Others associated //âutas with rheumatoid arthritis and osteoarthritis. These labels reflect diagnoses given to //âutas sufferers by biomedical practitioners. //âutas, like other limb dysfunction disorders and Polio, was characteristically known to ‘divide the joints’. The idiom of separation and discontinuity is important and common. One Hai//om man related that if he has incisions on his knees with extract of the plant kaikai in them, if someone were to walk in front of him the incisions could ‘divide the hip joints of the person’.
Treatment of //âutas depended upon the region affected and varied between new and principally urban approaches and older and rural. Bertha, a lady from Windhoek, treated //âutas with vigorous mobilization of affected spastic joints using a pumping action. Atypically she massaged affected limbs with a Menthol rub and Deep Heat. A different Windhoek lady tied a black thread around the affected limb to ‘push the //âutas down’. A red thread would have made the sickness stronger. In Sesfontein healers aimed to ‘bring the joints together’ by pressing hard with the thumbs, on the wrist, elbow, knee or ankle, according to whatever joint was affected. They emphasized that the patient must not talk to the practitioner before, during or immediately after the massage. Some practitioners massaged with a combination of burnt and ground ostrich egg shell, ground kudu skin, their ‘dirtiness’ (scrapings and sweat off their skin) and extract from a plant, //horape. Treatment of //âutas varies considerably depending on the severity. One Windhoek lady massaged the whole body for between half an hour and three hours, every other day and often for months.
Infertility is commonly ascribed to fallopian tubes becoming twisted. Massage is used to relocate them. Often I experienced some confusion over the difference between the uterus and the fallopian tubes and it was not clear that the Khoi ‘traditionally’ distinguished the two. Firm flattened fingers are used to palpate tensions in the lower abdomen and draw tight underlying tissues towards the uterus. Treatment lasts around fifteen minutes and might well include whole body massage. If the problem is severe and the patient has started hearing strange things, then treatment might take between three to five days.
Pregnant women are routinely massaged to ensure both the baby and the mother’s organs are in the right place. This aids health of the mother and baby, promotes an easy birth and prevents miscarriage. A massager will feel for differences in tension of the mother’s belly and back, and seek freedom of movement for the baby. Treatment is carried out both with the patient supine and on her side. The flattened hand is repetitively drawn across the abdomen into the midline from the periphery and up from the lower abdomen working firmly and smoothly to the midline around the umbilicus. It is considered important to work on the back and particularly the low back. With the patient lying on their side the practitioner rubs firmly out from the spine and towards the sacrum.
If the baby is perceived to be in the wrong position the practitioner attempts to move it to a better position. If a mother is not massaged, it is thought the baby will be born stiff. Treatment lasts between fifteen minutes and half an hour and will be carried out periodically throughout the pregnancy. The frequency of treatment depends upon a number of variables. To turn a baby might take two treatments, one to turn it and another a few days later to check. Persistent low back pain related to pregnancy might require repeated regular treatments carried out every other day until birth, or for short periods at monthly intervals.
(D.) Baby massage.
Babies are routinely massaged to ‘make them supple and to be strong’. It is a phenomenon mentioned by some of the earliest European observers. They, like subsequent observers, did not see any more in this than an almost straightforward common sense. At one level there is undoubtedly a commonality of ground in an acceptance that rubbing and stretching makes a body feel good, but the Khoisan notion of strong is tied to both ideas of free movement of wind and to the properties bestowed by substances rubbed on the child. Certainly in older contexts a rich range of plants were mixed with baby rubbing fat. These days Vaseline is used and other substances tend to be given orally, but this is not always the case. Baby massage follows the pattern outlined for /gôaron //ōs. Treatment lasts in the region of ten to twenty minutes.
(E.) Heart and Liver
The heart is the seat of wind, blood and feelings. Wind from fizzy drinks or wind that blows and enters the body through the mouth, nose, ears and pores at the base of body hairs, can all make the heart turn. Amongst some Khoisan bad thoughts can both originate in the heart and trouble the heart. An !arab problem is a key cause of heart problems. Symptoms of a bad heart are breathlessness, restlessness and bad dreams. When the heart moves it turns to the left or right and does not travel far. Movement of the heart is only deemed to be slight and the heart cannot be massaged firmly. Seated opposite the patient the practitioner mainly applies deep pressure with their flattened right hand to the patient’s left lateral chest wall. The practitioner’s left hand sits diagonally over the sternum. The hands are almost imperceptibly approximated for something in the region of ten to fifteen minutes. Treatment is usually carried out over two days with a day in between.
The liver is believed by Khoi to move downwards, known as aâi gere //na. This can be caused by wind or drinking poisonous things, like too much coffee. Liver problems cause generalized sickness and abdominal discomfort. The liver is treated by gentle lifting of tissue in the liver region. Seated opposite the patient the practitioner places their left hand under the lateral right ribs of the patient and gently presses upwards, occasionally adjusting the contact to regather the tissue. Treatment is for ten to fifteen minutes for two days with a day in between. Coffee is also sometimes tied up against the liver overnight. The coffee is thought to push the poison out. Some Damara use a goat liver in a similar manner; they again tie it on and leave it overnight. If by the morning the liver is dark, it has taken the poison out.
!arab problems are commonly encountered amongst Nama and Damara and thought to be potentially fatal. The !arab, or ‘pumpy pumpy’, roughly equates with the aortic artery, which is sometimes palpable in thin people in the midline of the abdomen, below the umbilicus. The word !arab also means the main bed of a river in Khoekhoegowab.
In its normal state the !arab should beat gently. Some Khoi believed the !arab beats because of the heart and movement of blood; others that it was itself a beating organ. Problems arise when the !arab moves either a little bit backwards or to the side, usually the left, and possibly as far to the side as the nipple line. If the !arab moves, the patient may suffer loss of appetite, vomiting or diarrhoea. It causes sharp ‘sticking’ pains in the stomach and chest from ‘wind sticking’. It may pump harder and ‘stand up’ and move under the heart. This will in turn affect the heart function and could consequently lead to chest pain, shortness of breath (/huwa) and feelings of dizziness. If it ‘stands up’ it might break and the person die. The most common cause of !arab problems is lifting heavy objects. Other causes are shock, lying in the wrong position, moving intestines, wind from food and the cold. Treatment entails gentle drawing in of the abdomen to the midline, below the umbilicus, working with firm flattened hands away from the side where the !arab is deemed to lie. To move the !arab back may take three days, working for about fifteen minutes at a time, every other day.
What scant attention Bushmen massage has received in recent years has very largely been associated with the healing dance and movement of n/um. When these rubbing accounts are better contextualized within broader massage practices, a Bushman overlap of ideas becomes evident between n/um and arrows and furthermore between arrows and wind, sweat and potency. Massage is perceived to move arrows and wind in the body. These become knowable through belching or the pain of the arrow sitting misaligned in the body or the manifestation of sickness brought by the arrow, like that arising from the poison of a hunting arrow in the victim.
Amongst the Bushmen I encountered, massage was tried in the case of many sicknesses, including whole body pain, stomach problems, diarrhoea, backache, head ache, neck pain, breathing problems, heart and gall bladder problems, swollen breasts, dead people lodging inside someone and malaria. Many Ju/’hoan massaged using their own saliva, believing it held inherent healing properties. Frequently the practitioner would also chew certain plants prior to spitting on their hands. For malaria the plants /goe and zow /oh were chewed. Some Ju/’hoan used particular animal fats mixed with /goe for malaria. /goe was a plant used in the majority of Ju/’hoan treatments. Fat, it was believed, ‘takes the pain down’, which was linked in the mind of some with massage ‘cooling’ the body. Different types of fat helped different problems. Kudu fat was known to help leg pain. Coughs were also massaged and certainly into recent times tuberculosis was treated with massage, apparently with some success. One Ju/’hoan man reported massaging tuberculosis sufferers with the plant gnum /um. This, he said, was in the days when they just thought of it as a ‘stabbing’ chest pain, before they had heard its name.
Bushman explanations varied as to why massage worked. One person related that massage was effective when there was not enough water in the heart, and hence in the blood. When blood dried up and stopped moving it caused pain. Massage kept the blood moving. This idea seems to tie in with the common notion of black blood, like dried blood, often being the cause of pain. These inter-related notions seem further tied to wider Khoisan association between, death, heat and drying up of fluid or pools of water – which is not perhaps surprising considering the environment in which they live.
Some Bushmen knew the same illnesses I encountered amongst the Khoi. They used massage for movement of the !arab, heart, intestines and uterus, and some, like Khoi, belched during treatment. Belching, they said, ‘makes the blood clean’. Cleanliness of blood links into notions of dark, ‘dirty’ blood and further associations, also common amongst other Africans, concerning the dangerous liminal status of menstruation, birth and death. There is further proximity between Khoi and Bushmen ideas evident in shared notions of wind travelling through the arteries and the need to massage tendons to make them loose, and hence allow the passage of wind.
 Kolb cited by Laidler, ‘Manners and Medicine’, p. 171.
 Cited by I. Schapera, The Khoisan Peoples of South Africa: Bushmen and Hottentots (London, Routledge, 1930), p.390.
 J.E. Alexander, An Expedition of Discovery into the Interior of Africa, Through the Hitherto Underscribed Countries of the Great Namaqua, Boschmans and Hill Damara (London: Henry Colburn, 1838), p. 268.
 Dorothea Bleek, A Bushman Dictionary (New Haven, American Oriental Society, 1956), p. 502.
 Schapera, Khoisan Peoples, p. 262.
 In the context of paralysis treatment Hoernlé noted the use of a plant ‘//autus heip’, literally ‘//autus plant’, Certain Rites, p. 78.
 W.H.G. Haacke and Eliphas Eiseb, Khoekhoegowab –English, English-Khoekhoegowab Glossasy / Mîdi Saogub (Windhoek, Gamsberg Macmillan, 1999), p. 94.
 Ibid., p. 102.
 See Low, Khoisan Healing.