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3. Trephining in Ancient Peru


One of the more important of medical phenomena, historically speaking, is that of trephining- a “surgical operation in life on the head and skull.” Skulls 8,000 years old, bearing the marks of trephination, are about the only evidence available of the medical activities of prehistoric man in the Old World. Such skulls also provide the earliest evidence of medical activates in the New World stone age- which in most areas lasted until the coming of white men in the 1500’s A.D.

Whether the practice of trephining originated independently in various parts of the world, or stemmed from some original center in the Old world, remains undetermined. Evidences of the practice of making openings in human skulls by artificial surgical means may be traced from prehistoric days until the present. Trephined skulls have been found in France and in other parts of Europe, in northern Africa, Asia, New Guinea, Tahiti, and New Zealand. In the New World the practice had extensive distribution, evidences having been found from Kodiak Island in Alaska, among both inland and west coast Indians, and on through the American to the Andes regions of South America. There is school of anthropologists and ethnologists who believe that the ancient people of North and South America crossed a once existing natural land bridge across the Bering Strait, bringing with them techniques and cultures from Eurasian sources. These people are thought to have penetrated as far as South as the Straits of Magellan, where, according to Junius Bird, nomadic hunters existed in the seventh millennium B.C Hrdlicka states his belief that. “With a procedure of such complexity [as trephining], it would seem much more probable that it had spread from some original centre in the Old World until finally it was transmitted to America. Its extensive distribution [in the Western Hemisphere] speaks strongly for its Asiatic transmission.’

Peru apparently was the center of intensive practice of trephining in the New World. In this area, use of the operation can be traced from well before the beginning of the Christian era until the twentieth century.

The ancient Peruvians had no written language, in the manner of ancient European and Asian civilizations, and we are unable to read the knotted strings (quips) that probably served them as records and documents. Therefore, most information about the Peruvians stems from the examination of mummies and the funereal bundles that surrounded them, and from their magnificent pottery, on which were represented many figures of persons having diseased conditions, including mutilations resulting from such infections as Utah (leishmaniasis ) and Carrion’s disease. Medical sconces and procedures also are depicted on these ancient Peruvian ceramic ‘documents”, which were fashioned with great skill, artistry, and no small degree of native humor.

Although nomads existed much earlier, and definite centers of civilization can be identified in South America as early as 2500 B.C., it was among the sedentary peoples along the narrow western coast lines that evidence of trephining is most abundant. The Chime and Mohican civilizations, dating from about 500 B.C., show such evidence. Their graves contain many trephine skulls, and their pottery, into the shaping of which went reflections of almost every daily activity, show trephination scenes. The richest source of data on the subject, civilized people who occupied an area around the Maracas peninsula, south of Lima. This divination preceded the founding of the Inca Empire by several centuries, and it had been forgotten by the time the Incas were conquered by the Spaniards.

“The people of Maracas were not only artistic geniuses [as demonstrated by their exquisite, intricate weavings, feather art, and fire engraved pottery] but men of science, as well,” says Rebecca Carrion Cachet. “Great conquests were made in the field of medicine and especially that of surgery… There are audacious trephinations which cover extensive areas of the skull. The openings were covered with gold plates.”

The percentage of successfully trephine skulls in Peruvian collections is unique. These ancient Peruvians succeeded in an operation that, up to the end of the nineteenth century, was regarded by Western surgeons as highly dangerous. Evidence of repetition of the operation on an individual has been found: one skull bears five trephination holes. That the patient survived is demonstrated in many instances by evidence that postoperative healing process had taken place.

Frequent employment of trephination in Peru might have been associated with several common disorders. Wounds of the head undoubtedly were a primary reason, as Muniz and McGee point out: “If we take into account the class of offensive weapons [slings, large wooden clubs, star-maces, stone clubs and hatchets] used by the ancient Peruvians in their terrible conflicts, almost hand to hand, it will easily be comprehended that complex fracture of the skull with depression of its bony plates must have been very common.’ Many trephine skulls indicate that such comminuted fractures preceded the operation. Yet trephination probably was used also in attempts to relieve headaches of mental disease. The prevalent practice of artificially deforming the skull (occipital flattening, and frontal-occipital flattening) may have given rise to a higher frequency of these affections than would have been found in areas where such practices were not customary. Possibly the operators sought to free demons and devils rather than to relieve cranial pressure.

“Whatever the reasons were,” as Wakefield and Dellinger point out. “They must have appeared to be adequate to those concerned, for the operation was tremendously dangerous under the conditions with which primitive man was forced to contend… a certain authority in favor of the operator and his assistant must have been a necessary qualification.”

Peruvians used sharp knives of obsidian, stone, and bronze for trephination, as well as bone instruments, bandages, native cotton, and other auxiliary items. Procedures included trimming, scraping, sawing, and cutting. Some openings were made by crisscross cutting: others were square, polygonal, circular or oval. Drilling aloe was employed. No part of the cranial vault was sacred. Hardwick wrote:
“The primitive surgeon not infrequently dared more than would the modern. Some of the operations, and successful at that, were performed directly over the blood sinuses…Andean primitive surgeons used various objects for ‘stoppers.’ In some cases these consisted of a gourd, or perhaps a bone; in others they used portions of shell; rarely, beaten silver.”

Ancient surgeons also evidently realized the dangers of exposure of wounds to open air, and applied dressings.Trephined skulls have been found with dressings in place.

Trephining was only one of the accomplishments of ancient Peruvian surgeons. They also opened inflamed sinuses, excised tumors, amputated limbs and replaced them by prostheses. Amputation was carried out not only as a surgical procedure, but also a punitive or ritual procedure in ancient Peru.

In spite of these advances, Peruvian medicine remained strongly allied to religious practices. Disease was thought to be largely the consequence of sin. Confession, accepted by a special group of priests, and purification rites were prominent forms of treatment. Disease also was diagnosed and treated by a strange type of transference rite. That, says Ackerknech, is how the guinea pig, a native of Peru, started its unhappy career in medicine. Guniea pigs were first held over the affected part of the patient to absorb the disease-causing principle, then slaughtered and studied for diagnosis. Sacrifice, was another form of treatment.

Gradual passage from super naturalistic to naturalistic explanations for disease is to be found in the Peruvian belief that winds and seasons produced certain diseases. The disease-producing winds originally were thought of as wind-spirits and wind-gods; but grad3ually they became regarded as regularly operating natural forces. This concept had an important influence on Peruvian preventive medicine, probably the next greatest accomplishment of ancient Peru.

Some procedures were magic-religious rites; but clean water supplies, good drainage, and legal regulation of diets, sex life, and working hours were effective far beyond the religious sphere. As in Europe, the clysters were traditionally employed as a therapeutic measure.

An original practice of Peruvian medicine, in looking out for the general welfare of the populace, was careful consideration of geographical origins of troops and populations when sending expeditions either to highland or lowland locations and climates. In a country of such diverse altitudes, rapid changes of habitat could not be made safely.

Healers of Incan Peru were supported by products of the Emperor’s fields, or the “fields of the sun.’ The sick and crippled were fed with produce from the “land of the clan.’ In an attempt to discourage primitive specialization, Incan law required that surgeons, bleeders, and other healers also should be competent herbalists.

One of Peru’s greatest contributions to civilization was its outstanding collection of medical plants, many of which were unknown in Europe prior to the Spanish expeditions of the sixteenth century. Among the better known were coca leaves, source of cocaine, and cinchona bark, source of quinine. Evidence indicates that these drugs were known and employed for many centuries before Europeans came to the New World. In addition to medicinal plants, Peruvians uses remedies derived from animal and mineral sources.

Without question, ancient Peruvian medicine may be compared very favorably with medical practices of such old World civilizations as Egypt and Mesopotamia.


On the dry, Sun swept pacific coastline of the Maracas peninsula, a first-century Peruvian surgeon is pictured beginning a trephining operation with the aid of knives of glass-hard obsidian, a crude plant narcotic, cotton, and bandages. Assistants immobilize the patient, and a priest seeks supernatural intervention through incantations and prayers as the slow and highly hazardous operation proceeds.


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