Massage amongst the KhoiSan
Massage is a primary health strategy of the KhoiSan. Surprisingly massage has received virtually no
academic interest despite, as early as 1918, the anthropologist Winifred Hoernlé having made the
remarkable observation  that illness could be caused by the movement of organs. Treatment of this
movement, she reported, involved massaging the organs back to their correct respective positions
(Hoernlé 1918: 77).

To me this report suggested that the KhoiSan, or at least the Nama amongst whom Hoernlé was working,
held an understanding of organ movement based upon some sort of knowledge of organs of the body,
probably their function and at least an idea of  their ‘symptomatic function’ if they were perceived to be
malfunctioning. This consideration led me to the question, might the Nama  have a specific theory of
disease and perhaps even a medical system?

Subsequent research established that ideas of organ movement are essential to KhoiSan health
strategies. Furthermore,  my research reveals that massage is a significant health strategy used  in cases
of organ movement and a considerable number of other problems.

Massage is distinctive between the Nama, Damara and Topnaar on the one hand and the Ju/'hoansi
Bushmen on the other, although there are practical and ideational overlaps in treatment strategies. These
differences become far less clear within the massage practices of the Khoe speaking Bushmen, the
Hai//om, ≠Khomani and the Nharo and  many northern !Kung.

I have included here two films that highlight different massage strategies:
1. Damara in Sesfontein Namibia (2001) demonstrating massage of an
!arab problem. The !arab largely  
equates to the aortic artery. It is believed that if the
!arab moves to the side it might fatally affect the heart.
Symptoms are lower abdominal discomfort typically associated with symptoms of heart trouble, principally
mental disturbance, anxiety, palpitations or bad dreams.
2. A more systematic massage performed by two Ju/'hoan Bushmen (2007). This might be carried out for
general feelings of being unwell or for  back ache or other muskulo-skeletal discomforts.

Note the deep reflective thinking hands of the Damara massage. This venerable lady exceptionally treated
all manner of problems although she was not thought of specifically as a healer. Her hands respond to the
tissues. She used Vaseline although cow fat or other animal fats would have been used in the past. Her
hands and her rhythmic movement, that teases the abdomen into a relaxed condition, reveal years of
experience coupled with a systematic ways of treating
!arab problems.

The Ju/'hoan massage is notable for its speed. Again the hands are thinking their way around the body.
The concentration seems initially on the joints and limbs although, as the end sequence in which the
practitioner rubs the body reveals, a deeper thinking concerns  how the body sits and "things" sit in the
body. The chanting and rubbing near the end of the footage is highly reminiscent of that found in
Bushmen healing dances and indicates how similar ideas and performances enmesh massage and
dancing within consistent Bushmen ways of thinking about and practising "medicine". The things that sit in
the body are the arrows or thorns of "supernatural potency" that are woken in the healing dances and
employed to treat the sick.
A.W. Hoernlé, ‘Certain Rites of Transition and the Conception of !Nau among the
Hottentots’, Harvard African Studies, 2 (1918), 77.
All KhoiSan I encountered believe that illness flows from the sick through the person treating them.
The healer must remove the sickness from their own body during, or at the end of, the treatment.
This may be done through repeated belching or a flinging of the arms away from the body. The
former is more typically Khoe speaker's behaviour and the latter Ju/'hoan.
An excerpt from a pre-published version of: Chris Low,‘Finding and Foregrounding Massage in Khoisan Ethnography’,  
JSAS  33:4 (Dec. 2007), 783-799

Massage treatments:
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

(C.) Pregnancy
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.

(F.) !arab
!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.

© 2009 Chris Hewson Low, All Rights Reserved