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= Trepanation In Peru =

Background Information of Ancient Peru
Peru is located in South America on the Andean Cordillera, which is one of the hardest and most difficult terrains to live on earth. A couple of centuries ago, Ecuador, Bolivia, Peru, some parts of Argentina and Chile were part of the Andean culture. The climate is divided into three regions: the coast, the sierra, and the jungle. According to Marino and Marco, “Archaeologists have dated the first evidence of humans in the Andes to the time after the last glacial period (the Wisconsin period), approximately 10,000 BC” (Marino, 940-950). Archeologists have slowly uncovered a Peruvian history of advanced, well-organized societies that despite the difficulties of the terrain and natural disasters, they were able to survive until a couple of centuries ago (Marino, 940-950). The Spanish conquests, diseases and war caused the destruction of the Inca Empire. The Inca culture overpowered and took in other cultures. The Inca culture was a very organized civilization. Because of their organization, great number of warriors and loyalty to the culture they were able to conquer their enemies. Later, it became an empire, which was governed by an Inca, supreme ruler. The Inca ruler was seen as a God. One of the main duties of an Inca was to expand the empire. According to, Marino and Marco, the Inca Pachacutec was one of rulers who expanded the empire to Ecuador, Chile and Argentina. He was considered sort of an Andean Alexander the Great (Marino, 940-950). Before the conquistadors came to the Americas, the Inca Empire was in decline. Inca Huayna Capac had to two sons: Huazcar and Atahualpa. His first son, Atahualpa, was from a concubine. In the other hand, Huazcar was conceived by the main wife of the Inca. To be an Inca, one must be born from the main wife and be the first son. Since none of them met both requirements, they went into war. The empire was divided. At this moment, when the empire was at its weakest, the Spanish came and conquered the Inca empire.

Background Information of Trepanation
Trepanation is the oldest cranial surgery in the world (Marino, 940-950). This is a surgery in which a doctor drills or scraps a hole into your skull to treat problems related to intracranial diseases. Before the 19th century, anthropologists have found skulls with holes on them. Paul Broca, the French leading anthropologists of the mid 19th century, wasn’t certain that trepanation was performed on the skulls found in Europe (Clower, 1417-1426). According to Clower, “For a long time, these openings [holes on the skull] had been thought to result from weapons, posthumous tampering, or accidental breakage.” In 1865, Ephraim George Squier In 1865, Ephraim George Squier encountered what it seemed to be a trepanned Peruvian skul (Clower, 1417-1426). According to Finger and Fernando, “One of the greatest discoveries in the history of cranial trepanation was the Inca skull fragment obtained in 1865 in Cuzco, Peru, by Ephraim George Squier.” After presenting the skull to anthropologists in New York, Squier decided to have Broca analyze it (Buckland, 7-21). According to Broca, “The Peruvian skull represented a case of ‘advanced surgery’ from the New World before the European conquest” (Clower, 1417-1426). The Peruvian skull, found by Squier, has a cross-hatching technique of trepanation. Before the Squier’s skull, anthropologists didn’t have enough evidence that holes on skulls found in Europe didn’t happen by accidents. The Peruvian skull explicitly showed that the hole on the skull was man-made and that the opening was made “with a burin, or tool like that used by engravers on wood and metal” (Clower, 1417-1426.)

Squier and the encouter with the Peruvian Skull
In 1863, Presiden Abraham Lincoln sent Squier to Peru to settle a U.S financial dispute with the Peruvian Government (Finger and Fernando). While there, Squier had the opportunity to learn more about the culture and history. Squier spent most of his time exploring Inca monuments and man-made artifacts. Since Squier was a respected diplomat, scholar and an admirer of Peru’s cultural history, he received an invitation from a wealthy woman in Cuzco, Peru (Buckland, 7-21). The woman’s residence was a big museum-house type home. While looking at the hundreds of artifacts, he encountered the trepanned skull (Finger and Fernando). In one of his books, Squier wrote: “In some respects, the most important relic in Sefiora Zentino's collection is the frontal bone of a skull, from the Inca cemetery in the valley of Yucay, which exhibits a clear case of trepanning before death. The sefiora was kind enough to give it to me for investigation, and it has been submitted to the criticism of the best surgeons of the United States and Europe, and regarded by all as the most remarkable evidence of a knowledge of surgery among the aborigines yet discovered on this continent; for trepanning is one of the most difficult surgical processes” (Finger and Fernando).

Why did the Ancient Peruvians trepan?
Anthropologists in the 19th century didn’t believe that indigenous people had any understanding of the physiological functions of the brain or, for that matter, anything like a sophisticated medical surgery (Clower, 1417-1426). They believed that ancient Peruvians trepanned because of:

Religious Beliefs
According to some anthropologists, ancient neurosurgeons believed that evil sprits could have inhabited craniums, which caused intense pain to the patience. The only way to remove the evil spirits was by performing a trepanation surgery (Loughborough, 416-422). The hole on the skull was the way out for the evil spirits (Loughborough, 416-422). According to Broca, ancient doctors gave cranial amulets to important individuals, who were considered in their tribe to be a character of sanctity. These amulets provided good luck, averted evil spirits, and it protected the individuals and their families from being possessed by the same spirit again (Clower, 1417-1426).

Other anthropologists believed that the Incas, over time, came to an understanding of the physiological functions of the brain. Victor Horsley’s, an anthropologist of the 19th century, believed that the Incas trepanned to cure epilepsy (Finger and Clower)

Epilepsy
According to British anthropologist, Victor Horsley, “the cranial holes made during the Neolithic period were not placed randomly. Not only were the forehead and face avoided, but the holes seemed concentrated on the vertex of the head, above his so-called motor area” (Finger and Clower 48). He believed that all or most of the skulls had holes on the vertex of the head where, according to him, “is known to be more especially the seat of representation of movement. This region of the brain, moreover, is the seat of origin of that special form of convulsions which is known as Jacksonian epilepsy” (Finger and Clower 48). Horsley believed that a depressed fracture above this region could cause extreme pain and probably epilepsy. The use of trepanation in that case would have stopped or reduced most of the pain.

Most of the anthropologist at the time after they analyzed the Peruvian skull came to the conclusion that the Incas used trepanation to treat cranial fracture and to relieve a buildup of blood and intracranial pressure that could have been caused by a closed head injury (Clower and Finger 49).

Head Fractures
Many Peruvian skulls have been found with head fractures produced by a blow on the head with a weapon. Such impacts can cause the brain to internally bleed, build-up fluid and inflammation, which require surgical intervention (Andrushko). In these cases, trepanation was used to create a hole where the fracture was to let the hematomas drain. The most common skull fracture found on Peruvian skulls was the depressed fracture (Andrushko). According to expert in anthropology, John Verano, the majority of depressed fractures were produced by blows from clubs and sling stone, weapons used in the Andes (Andrushko). In a depressed fracture, the skull is displaced inside, towards to dura mater. In this skull fracture, the displaced bone can cause pressure to the brain and destroyed brain tissue. In ancient Peru, trepanation was needed to “elevate depressed fractures, remove bone fragments and smooth broken edge, and possible to drain epidural hematomas” (Andrushko). According to Verano, trepanation in Peru might have evolved through time. About 28% out of 457 trepanned skulls that he studied were associated with visible skull fracture. He believes that trepanation clearly served as a treatment for depressed fractures, although it might have evolved through time as a treatment for headaches or other neurological disorders (Andrushko). Other motives for the use of trepanation could have been caused by spears. Nott believed that the Peruvian skull that showed no presence of fractures could have been trepanned because of a small perforation on the skull. The evidence of a small perforation on the skull would have been removed by the surgery itself. According to him, a sharp pointed weapon, such a spear could have produced a small perforation on the skull (Finger and Fernando). These small skull perforations can cause a build-up of blood with in the cranium (Finger and Fernando).