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Medical Practice in the Pre-Conquest Americas: From Coca to Brain Surgery
Among the Americas’ pre-Columbian civilizations, medicine comprised three primary elements: plant-based remedies, surgical procedures, and spiritual practices designed to cleanse the body and appease the gods. Each of the “big three” pre-conquest civilizations—the Inca, the Aztecs, and the Maya—developed its own unique medical practices, which included everything from brain surgery to anesthesia, mastering techniques that their European counterparts were still struggling with.
The Inca Empire: Revolutionizing Surgery
Urpu, a vessel for chicha, a fermented corn beer with medicinal use, Peru, 1400-1535 CE. Source: The Metropolitan Museum of Art, New York
When it came to addressing the causes of illness in the Inca empire, “medicine” relied heavily on religious rites and rituals performed to drive out evil spirits. Illness was usually believed to be the consequence of displeasing a god, so the cure was to make said god happy again. With a large pantheon of gods and spirits, the average person living in the Inca empire would have little idea who to beg for forgiveness, but fortunately, priests (ichuris), could intervene on their behalf. After observing the patient to determine which god they had angered, priests would prescribe some combination of remedies: offerings, sacrifices, or spiritual rites were common, including ceremonies that scholars compare with (relatively) modern-day exorcisms.
In addition, the Inca held an annual purification ceremony each year in the spring to ward off the illnesses that often thrived in the rainy season. The Situa, according to Spanish chronicler Guaman Pomo de Ayala, included numerous cleansing elements. On the first day of the celebration, warriors gathered in Cusco and brandished spears to drive away disease while houses and streets were cleansed with water. By night, people ran through the city with torches, ultimately throwing them in the river to banish the associated evil spirits. The following day, citizens would go to streams and rivers to bathe themselves and then feast. A special dough, called sancu, was prepared by mixing ground maize and blood, and rubbed on the body as another cleansing ritual, as well as consumed.
Coca leaves, photo by David Mercado for Reuters. Source: The Irish Times
As the empire aged and expanded, plant-based remedies, as well as surgical procedures, were incorporated into Inca medical practice to treat the symptoms of illness and injury. Without a written language, much of the medical knowledge the empire built has been lost to time, but the evidence that does remain demonstrates that ultimately, the Inca developed a number of effective plant-based medicines and became experts in a surprising form of surgery: the craniotomy.
The Inca used a number of common plants to treat the symptoms of illness or injury, including cinchona bark—the source of quinine, still used today—to treat fevers and plant resins for wound care. Chicha, a fermented beer made from corn, was used for sedation. The most (in)famous medicinal plant, though, is coca.
Coca was domesticated thousands of years ago and was sacred to the Inca. Known almost exclusively today as the source of cocaine, one of the (many) alkaloids in the leaf, coca was used in numerous ways in the Inca empire: the leaves were burned as offerings to the gods, read by priests to divine the future, and even functioned as de facto currency, as they could be used to pay tributes to the empire.
As medicine, the coca leaf had many functions as well. Prepared in various ways, it could be used as a local anesthetic, a topical pain reliever, and a digestive aid. Chewing the leaves provided energy while relieving hunger and thirst. And though the Inca had no way of knowing, the leaves contain a number of essential vitamins and minerals that could be absorbed through chewing them. A number of these uses continue today among Indigenous communities in the Andes, and coca tea is drunk by millions of tourists hoping to avoid altitude sickness.
A skull from the Inca empire boasting five healed trepanation holes. Source: World Neurosurgery, Volume 114, June 2018.
In terms of physical medical procedures, evidence indicates that the Incas performed a great deal, including dentistry, minor amputations, and c-sections, but were masters of a form of surgery most societies were still struggling with hundreds of years after the conquest: trepanation.
Trepanation, a broad term that encompasses a variety of methods of boring into the skull, was widely practiced in the Inca and pre-Inca civilizations, and at the peak of the empire, the survival rate was impressive: as high as 80%. The Inca refined their technique over time and may have used their medicinal plant knowledge to improve outcomes by sedating patients, administering pain relief, and caring for wounds to prevent infection.
Why they performed so many skull surgeries is unclear. While it was a relatively common practice to treat head wounds—relieving pressure on the brain—skulls have been found with multiple healed incisions, suggesting it was being used to try to treat illness as well.
The Mayan Civilization: Communing With the Gods
Vase depicting a woman, possibly a healer, preparing and helping administer an enema, 8th-9th century CE, Guatemala. Source: The Metropolitan Museum of Art, New York
For the Maya, the key to good health was keeping one’s life force, ch’ulel, in balance. Healers, who were highly trained priests, were responsible for balancing this life force when it got out of whack, as evidenced by illness. These healers would (and in some communities today, continue to) use special divining tools to consult the gods and determine the cause and appropriate treatment for an illness.
Another important tool in their spiritual toolbelt came in the form of hallucinogens. Tobacco, mushrooms, and other mind-altering plants were prepared and consumed—sometimes as drinks but also as enemas—to induce a trance that would allow shamans to connect more directly with the gods in order to access the knowledge they needed for healing. One deity in particular seems to have played a central role in guiding these priests: Ixchel, goddess of medicine. According to Spanish chroniclers, healers and priests honored Ixchel with a feast during the third month of the Mayan year.
Once these healers had succeeded in channeling divine guidance, their treatments might involve various rituals and repentance designed to appease the gods and realign the patient’s body and soul, as well as herbal remedies, which could be smoked, ingested, or rubbed on the skin. The hallucinogens used by shamans might also be offered to patients for pain relief.
Excavation of a Mayan steam bath in Peten, Guatemala, 1934. Source: Penn Museum, Philadelphia
These rituals and herbal remedies were often used in combination and might be supplemented by another tradition: sweating it out. Long before Rome made baths famous, the ancient Maya and their predecessors were building sweat houses, and scholars believe they had both a ritual and medical use. Known more often by the Nahuatl word, temazcal, the word for these houses in Mayan was zumpul’che, translated as “a bath for women after childbirth and for sick persons used to cast out disease in their bodies.”
Two types of sweat houses appear in the archeological evidence: larger, “elite” baths that appear at ceremonial sites and smaller community baths. Researchers believe ritual purification ceremonies would be carried out at the ceremonial sites for rulers, elites, and perhaps athletes before or after the traditional ceremonial ball game. Smaller houses discovered in more rural communities indicate sweat baths were also used by commoners. Some scholars believe that those suffering specifically from what the Maya deemed “cold” illnesses would visit the sweat bath to restore warmth to the body, while others suggest that they were used to address any illness, even mental, purifying the body by sweating out harmful toxins, spirits, or whatever might be causing sickness.
While plants and bathing worked for many illnesses, some medical problems required a more physical approach. When it came to surgery, minor amputations and sutures using human hair were fairly common, but the Maya stood out with the new heights they took dentistry to. Records and artifacts attest to the Mayans filling cavities, using copper tools to scrape away tartar, treating painful teeth with herbal poultices or pulling them, and even using saline mouthwash post-treatment.
An example of Mayan dental modification: teeth inlaid with jadeite. Photo by David Dennis. Source: Sciworthy.com
In a society where a trip to the dentist is usually faced with dread, it can be hard to fathom anyone voluntarily submitting to tooth drilling and fillings, but a great deal of Mayan dentistry was actually done for non-medical reasons—they just liked having pretty teeth. Not only did the Maya perform dental fillings for what seem to be aesthetic purposes, but they were quite good at it—teeth have survived thousands of years with their fillings intact.
Dental modification has been documented throughout Mesoamerica, the most common form being tooth filing, where notches or grooves were carved into teeth or teeth were filed down to points. A second, less common practice was dental inlays. Small holes were drilled in permanent teeth—very skillfully, as evidenced by the perfectly round shapes and ability to not drill into the tooth pulp—and inlaid with jade, pyrite, or other jewels or minerals. Scholars believe the practice was primarily done to denote social status or perhaps to indicate familial ties.
The most recent research into the practice suggests even more skill than previously noted. The plant-based sealants used to hold the inlays in place, in addition to withstanding thousands of years, in some cases also had antibiotic, antifungal, and anti-inflammatory properties that would promote dental health and prevent tooth decay.
The Aztec Empire: Keeping It Clean
Basalt sculpture of Xipe Totec, the flayed god, 1400-1500 CE. Source: Kislak Collection, Library of Congress
Of the pre-conquest medical practices in present-day Latin America, perhaps the most is known—outside the remaining Indigenous groups themselves—about the Aztecs, thanks in part to chroniclers like Friar Bernardino de Sahagún, who learned Nahuatl so he could more accurately capture life among the Mexica in New Spain. His General History of the Things of New Spain, usually referred to as the Florentine Codex, documents, among other things, the illnesses Mexica healers treated, the herbal remedies used, how they cared for wounds, and the rituals practiced to prevent and cure illness.
The deeply religious Aztec society believed most illness was caused by angering gods; the type or location of the illness or pain could indicate which god had been insulted. Tlaloc, the water god, for example, was considered responsible for gout and illnesses associated with water or dampness, while the flayed god, Xipe Totec, would demonstrate his anger with boils or skin infections. Still, it was best to consult a priest to not only figure out who was upset but also what the prognosis was—a prediction that might be determined in a similar fashion to reading tea leaves, where corn or grains would be thrown on a surface and their physical arrangement would reveal the patient’s fate.
Illustration from the Codex Magliabechiano showing a Mexica healer throwing maize kernels to determine a patient’s fate, mid-16th century CE. Source: Dumbarton Oaks
Scholars have determined that prior to the conquest, there were far fewer epidemic diseases in the Americas than in Europe, despite the population of major cities like Tenochtitlan rivaling that of Paris. In the case of the Mexica, this was in large part because they had mastered something Europeans were still struggling with, and that was key to preventing disease: hygiene.
Streets were swept and watered daily, public toilets were available in every neighborhood, and human waste was recycled for use as fertilizer and mordant. Fresh drinking water was provided through aqueducts. Bathing, a suspiciously uncommon practice among the Spanish at the time, was a regular occurrence, with the conquistadors noting that Montezuma bathed twice a day.
The Mexica even had two different “soap” plants that allowed them to lather up. While the Aztec dedication to cleanliness was prompted by their spiritual beliefs, not knowledge of germs and bacteria, the end result was the same: healthier people.
Excerpt from the Badianus Manuscript, considered the first medical book of the Americas, 1552 CE. Source: Wellcome Collection
That’s not to say no one ever fell ill, of course, and for that, the Aztecs had a wealth of plant-based remedies. Moctezuma I, the empire’s 15th-century ruler, created a botanical garden that held thousands of species of plants, many of which were used to treat illness and injury and continue to be used today.
Present-day research has found that a significant percentage of the herbs Aztecs used are truly effective, with many containing compounds found in modern medicines. Common plant-based treatments included wild tobacco for gout, guava for digestion, sarsaparilla as a diuretic, and plume poppy for constipation.
According to the Badianus Manuscript, a compendium of Aztec herbal remedies written by Martín de la Cruz in the 16th century, other ailments Aztec healers might treat with herbs included being “harassed by an evil wind,” “stupidity of mind,” “goaty armpits of sick people,” and being struck by lightning. (It seems reasonable to take the faithfulness of the translation from Nahuatl to Latin to English with a grain of salt.)
Illustration showing a head wound being treated with maguey sap. General History of the Things of New Spain by Fray Bernardino de Sahagún: The Florentine Codex. Book XI: Natural Things, 1577. Source: Library of Congress
The Aztec empire’s reputation for violence is exaggerated but not unwarranted—there was a lot of fighting going on even before the conquest, which, unsurprisingly, meant a lot of injuries to be treated. As a result, Mexica healers became quite skilled at setting bones, performing minor surgeries with obsidian tools, and wound care.
While the hygiene practices in the empire reduced the likelihood of wounds becoming infected, modern research has shown that how Aztec healers treated wounds was equally important. According to the Florentine Codex, “The juice of the small maguey, when still tender, is later pressed out…salt is mixed in…With it is healed one who is wounded in the head, or someone who is cut somewhere…”
Modern research shows that the sap of the maguey actually contains antibiotic components. The addition of salt likely helped by inhibiting bacteria growth as well. One other component of Aztec wound care, however, is unlikely to be adopted by modern medicine: the washing of fresh wounds with hot urine.
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