Andean People Already Perfected Skull Surgery Thousands of Years Ago

In ancient Peru, trepanation – removing a section of a person’s skull using a hand drill or a scraping tool – was much more common than today. But it was much more dangerous, too. The risky process was applied to treat a variety of ailments, from head injuries to heartsickness.

Around 2,000 years ago, a ‘doctor’ in ancient Peru used some simple device to scrape a hole in the skull of a living human being. Apparently, much of the patient’s fractured upper skull was removed without applying modern anesthesia or sterile techniques. Yet, the patient survived.

Look at this 2000-year-old Peruvian elongated skull. The metal piece was surgically implanted in it, most probably after the person returned from battle. The the broken bone surrounding the repair is tightly fused together indicates it was indeed a successful surgery. Perfect job.

But that’s all we really know about it. Or is it?

But, hey, wait… what’s an elongated skull anyway? Well, it’s achieved by distorting the normal growth of a child’s skull by applying force. Terrifying, isn’t it?

Even though it might sound gross today, deforming the skull intentionally predates written history. The practice was widespread in a number of cultures in different geographic locations and times, still occuring today in a few areas, including Vanatu. The most prominent examples include some extremely elongated skulls discovered in Peru in the 1920s by Peruvian archaeologist, Julio Tello. Scientists believe the intentional deformation was practiced by ancient Peruvians because of spiritual or religious reasons, in an effort to look more like their deities.

The Paracas skulls on display at the National Museum of Archaeology, Anthropology and History in Lima, Peru. Fisrt discovered Photo: Silentlight87

But back to trepanation (if elongation wasn’t enough). The ancient Peruvians left us evidence of the practice from 1000 years later, too (the skulls from that era were not elongated). Excavating burial caves in the south-central Andean province of Andahuaylas in Peru, U.C. Santa Barbara archaeologist Danielle Kurin and colleagues unearthed the remains of 32 individuals that date back to the Late Intermediate Period (ca. AD 1000-1250). Among them, 45 separate trepanation procedures were in evidence.

But hey (again), why would you want to remove a section of a person’s cranial vault anyway? According to Kurin, “when you get a knock on the head that causes your brain to swell dangerously, or you have some kind of neurological, spiritual or psychosomatic illness, drilling a hole in the head becomes a reasonable thing to do.”

Kurin reckons trepanations first appeared in the south-central Andean highlands during the Early Intermediate Period (ca. AD 200-600), although the technique was not universally practiced. Nevertheless, it was considered a viable medical procedure until the Spanish banned the practice in the early 16th century. That said, she wanted to know how trepanation came to exist in the first place. So she looked to a failed empire to get some answers.

New bone growth at the trepanation site on the side of the head indicates a successful procedure. However, the holes drilled at the top of the skull were as the individual was dying or shortly after he died. Photo: Danielle Kurin

“For about 400 years, from 600 to 1000 AD, the area where I work — the Andahuaylas — was living as a prosperous province within an enigmatic empire known as the Wari,” she said. “For reasons still unknown, the empire suddenly collapsed.” And the collapse of civilization, she noted, brings a lot of problems.

“But it is precisely during times of collapse that we see people’s resilience and moxie coming to the fore,” Kurin continued. “In the same way that new types of bullet wounds from the Civil War resulted in the development of better glass eyes, the same way IED’s are propelling research in prosthetics in the military today, so, too, did these people in Peru employ trepanation to cope with new challenges like violence, disease and depravation 1,000 years ago.”

A cutting method was employed for this incomplete trepanation. The patient died before the bone plug could be removed successfully. Photo: Danielle Kurin

Kurin’s research proves that various skull surgery practices and techniques were being employed around Peru at the same time. They either applied scraping or cutting, or used a hand drill. “It looks like they were trying different techniques, the same way we might try new medical procedures today,” Kurin said. “They’re experimenting with different ways of cutting into the skull.”

Sometimes the surgical intervetions were successful, with the patient fully recovering. At other times, things didn’t work out so well. “We can tell a trepanation is healed because we see these finger-like projections of bone that are growing,” Kurin explains. “We have several cases where someone suffered a head fracture and were treated with the surgery; in many cases, both the original wound and the trepanation healed.” It could take several years for the bone to regrow, and in a subset of those, a trepanation hole in the patient’s head might remain for the rest of his life, thereby conferring upon him a new “survivor” identity.

Several trepanation holes were drilled over an area of mottled, inflamed bone. The surgery may have been done to alleviate the pain caused by serious infection. Photo: Danielle Kurin

Reserachers speculate that every time a patient died, the skull was donated to science – and was used for educational purposes. “The idea with this surgery is to go all the way through the bone, but not touch the brain,” said Kurin. “That takes incredible skill and practice.”

“As bioarchaeologists, we can tell that they’re experimenting on recently dead bodies because we can measure the location and depths of the holes they’re drilling,” she continued. “In one example, each hole is drilled a little deeper than the last. So you can imagine a guy in his prehistoric Peruvian medical school practicing with his hand drill to know how many times he needs to turn it to nimbly and accurately penetrate the thickness of a skull.”

Ancient practitioners used various tools to create trepanations of distinct sizes and shapes. Photo: Danielle Kurin

Kurin doesn’t consider drilling a hole in someone’s head a form of torture. “We can see where the trepanations are. We can see that they’re shaving the hair. We see the black smudge of an herbal remedy they put over the wound,” she said. “To me, those are signs that the intention was to save the life of the sick or injured individual.”

With most of the trepanned crania already studied residing in museums such as the Smithsonian Institution, the remains excavated by Kurin from the Andahuaylas caves presently comprise perhaps the largest well-contextualized collection of trepanned skulls in the world.

“Most were collected by archaeologists a century ago and so we don’t have good contextual information,” she explained.

New bone growth at the trepanation site on the side of the head indicates a successful procedure. However, the holes drilled at the top of the skull were as the individual was dying or shortly after he died. Photo: Photo: Danielle Kurin

By using radiocarbon dating and insect casings to determine how long the bodies were left out before they skeletonized or were mummified, Kurin is able to tell exactly where, when and how the remains she found were buried, as well as who and what was buried with them. Using multi-isotopic testing, she’s even be able to reconstruct what they ate and where they were born. “That gives us a lot more information,” she said.

“These ancient people can’t speak to us directly, but they do give us information that allows us to reconstruct some aspect of their lives and their deaths and even what happened after they died,” she concluded. “Importantly, we shouldn’t look at a state of collapse as the beginning of a ‘dark age,’ but rather view it as an era that breeds resilience and foments stunning innovation within the population.”

Let’s hope it will work out like that in our time, too.

Sources: 1, 2, 3, 4, 5, 6, 7

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