12 May

The Aztec Empire was the last of a succession of indigenous civili- zations—Olmec, Mixtec, Zapotec, Toltec, and others—that once flour- ished in Mesoamerica, the region that now comprises most of modern Mexico, Guatemala, Belize, Honduras, and El Salvador. Despite the upheavals associated with the rise and fall of various early civilizations, the general belief system and traditions of Mesoamerican culture included a sacred calendar and a solar calendar, hieroglyphic writing, a complex pantheon of deities, and blood sacrifices. After the fall of Toltec civilization, the Aztecs established an empire that dominated the region from the fourteenth to the sixteenth century. Their capital city, Tenochtitla´ n (now Mexico City), had a population that probably exceeded two hundred thousand. The magnificent garden city of the Aztecs had evolved from marshy islands in a shallow lake. When the Spanish Conquest began in 1519, Herna´ n Corte´s (1485– 1547) proved adept at exploiting tribal divisions and tensions within the Aztec Empire. According to Spanish accounts, Tenochtitla´ n was constructed on a grand scale, as demonstrated by its buildings, temples, pyramids, monuments, roads, aqueducts, fountains, bathhouses, public latrines, and gardens. The Spanish tried to destroy the great temple of Tenochtitla´ n and all vestiges of Aztec religion, but some ancient ruins remain within the heart of modern Mexico City. Water management has always been one of the major problems of urban development. Spanish observations and archeological evidence suggest that the drinking water available to residents of Tenochtitla´ n was better than that of most sixteenth-century European cities. Personal cleanliness was so highly valued that even the common people bathed daily.

Steam baths were considered essential for purification, relaxation, and as a means of fighting off fevers and poisons. In keeping with the high value the Aztecs placed on cleanliness, the streets of Tenochtitla´ n were swept and washed daily by hundreds of street cleaners, who were supervised by health officers and inspectors. Law and customs prohibited dumping refuse into the lake or canals. Night soil (human excrement used as fertilizer) was collected and taken by barge to farms on the mainland. Urine was collected for use in dyeing cotton cloth. Prior to contact with Europeans, strict attention to cleanliness might have mitigated the spread of indigenous diseases. Nevertheless, dysenteries, gastrointestinal disorders, rheumatism, and respiratory infections must have been fairly common, and drawings and pottery figures seem to depict the hunchback characteristic of tuberculosis of the spine. The Aztecs developed many measures and institutions to promote the health and welfare of the residents of the capital city and distant territories. Shelters or hospitals for warriors, the sick, and needy indi- viduals, staffed by government-supported doctors, were established throughout the Empire. European observers noted that begging, which was so common in Europe, was virtually unknown in the Aztec Empire. The highly centralized government collected tribute from subject nations, in the form of maize, cocoa, and other foods, as well as cotton, rubber, gold, and feathers. A public assistance department distributed maize to the poor and supplied food as needed in times of crop failures.

To control contagious diseases, Aztec rulers established a system of strict quarantines and had physicians send patients to isolation centers. Considering the wealth, power, complexity, and sophistication of the Aztec Empire, it is difficult to comprehend how Herna´ n Corte´s, who came to the New World in 1519 with about six hundred men and a limited supply of horses and gunpowder weapons, was able to capture the Aztec capital in 1521 and dismantle the foundations of a remarkable civilization. Despite the advantages of gunpowder weapons, given the differences in the numbers of Spanish soldiers and Aztec war- riors, a purely military confrontation would certainly have been won by the Aztecs.

Many other factors, however, favored the invaders, includ- ing growing tensions within the Aztec empire. Many scholars argue that smallpox, a highly contagious viral disease previously unknown in the Americas, was the most powerful of Corte´s’s allies. Although Corte´s and his comrades seemed unaware of the devastation caused by a dis- ease so familiar to residents of the Old World, Native American sur- vivors came to see the smallpox epidemic of 1520 as the turning point in their history. Aztec chronicles refer to the time before the arrival of the Spanish as a comparative paradise where the people were free of small- pox and other deadly fevers. When Europeans came, they brought fear and disease wherever they went. Spanish observers said that God had cursed Mexico with plagues of Biblical proportion so that the natives died by the thousands of smallpox, measles, war, famine, slavery, work in the mines, and other forms of oppression. A Spanish ship apparently brought smallpox to the New World in 1516. Attempting to contain a smallpox epidemic in Santo Domingo in 1519, Spanish officials imposed quarantine regulations.

By that time, the disease was already causing outbreaks among Native Americans along the coast of Mexico, as Corte´s and his army prepared to attack the Aztec empire. Smallpox quickly spread throughout central Mexico, and migrated north and south through the most densely populated regions of the Americas. Europeans did not directly observe the impact of early epidemics in North America, but when Hernando de Soto (1496?–1542) explored Florida in 1539, he found evidence that many areas had already been depopulated. Just how far the first waves of smallpox traveled is uncertain, although some historians argue that European diseases did not reach northeastern North America until the early seventeenth century. Nevertheless, archeological evidence suggests that disease-induced population declines occurred in some areas of North American as early as the sixteenth century, well before significant direct contact between Native Americans and Europeans. Thus, European reports from the Americas after the smallpox epidemics of the 1520 are likely to reflect societies that had already been devas- tated by epidemic disease. Some historians suggested that the Conquest was possible because the Aztecs were overcrowded, malnourished, starving, and unable to cope with disease. As proof of this hypothesis, they argue that the Aztecs used human sacrifice to satisfy their need for protein. Others contend that the Aztecs were quite successful up to the time of the Con- quest and that human sacrifice served important religious and political purposes unrelated to a quest for dietary protein.

Although the Spanish conquerors helped create the image of the Aztecs as followers of a bar- baric religion that demanded the sacrifice and consumption of huge numbers of war captives, independent evidence supports the conclusion that human sacrifice and ritual cannibalism were indeed integral aspects of Aztec religion. According to Aztec beliefs, human beings had to support the essen- tial balance of the universe by offering their own blood to the gods and performing ritual human sacrifices. To make blood sacrifices, the Aztecs slashed their tongues, ear lobes, or sexual organs with obsidian blades, fish spines, stingray spines, or agave thorns. Members of the elite were expected to perform the various rituals, fasts, and autosacrifices even more enthusiastically than the common people, because their blood was especially valuable. Human sacrifice was not an unusual aspect of ancient cultures, but the magnitude of human sacrifice practiced by the Aztecs was appar- ently unprecedented. Many of the early Spanish accounts of the horrific extent of cannibalism were, however, based on hearsay evidence from enemies of the Aztecs. In any case, charging the Aztecs with sacrificing and eating thousands of war captives provided a rationale for the Spanish campaign to eradicate Aztec culture and religion. Some scholars have argued that the economic, social, and nutritional base of the Aztec Empire encouraged human cannibalism. According to the ‘‘nutritional cannibalism’’ hypothesis, the Aztecs had so depleted their resources that the elite class turned to cannibalism as a source of high quality protein.

Aztec warfare and sacrifice, there- fore, served as a means of coping with population growth, environmen- tal degradation, uncertain harvests, and protein deficiency. Critics of this hypothesis insist that all classes in Aztec society— nobles, commoners, and slaves—generally consumed sufficient calories and had access to adequate levels of plant and animal proteins. Human sacrifice, therefore, was not a response to famine and population pres- sure. Moreover, those who engaged in ritual cannibalism held the most privileged place in society and were presumably the least likely to be suf- fering from protein deficiency. The Aztecs were accused of many atroc- ities, but they were not typically accused of cannibalizing the bodies of those who died in battle, nor did the practice of cannibalism coincided with times of scarcity. Generally, rites of sacrifice and cannibalism peaked at harvest time, which suggests that they were rituals of thanks- giving. Although the Aztecs were masters of human sacrifice, and con- ducted rituals in which they removed the heart, flayed the skin, and performed other mutilations of their unfortunate captives, they did not seem to have had an abstract interest in anatomy and dissection.

The Aztec agricultural system provided a diet that was certainly different from, but not necessarily inferior to that of contemporary Europeans. The agricultural techniques used by the Aztecs could feed a large population because of the intensive use of human labor, appropriate crop varieties, recycling of nutrients, efficient use of water resources, and the intercropping of maize, beans, and squash, the traditional Indian food triad. Maize, the basic food plant of the Aztec, Inca, and Maya civilizations, can grow where it is too dry for rice and too wet for wheat. Religious rites, paintings, and ceramic figures acknowledged the importance of maize in Aztec society. Excessive dependence on maize is associated with nutritional deficiencies, such as pellagra, but a diet that combined maize, beans, and squashes provides nutritional balance. Moreover, Native Americans prepared maize in ways that increased the availability of essential nutrients. The Aztec diet also included a variety of vegetables, fruits, algae, and drought-adapted plants, such amaranth, mesquite, and maguey.

In comparison to Europeans, the Aztecs had relatively few domesticated animals, but they did keep llamas, dogs, and guinea pigs. They supplemented their basic diet with insects, fish, amphibians, reptiles, wild birds, and small mammals—such as grasshoppers, ants, worms, frogs, tadpoles, salamanders, iguanas, armadillos, weasels, and mice. Although the Spanish considered these Aztec delicacies totally repulsive, many insects and amphibians are actually quite nutritious. Europeans may not have appreciated the superiority of pre- Conquest Aztec standards of public health, sanitation, and personal hygiene, but they were impressed by the knowledge of Aztec physicians and herbalists. Corte´s considered native doctors quite skillful, and especially valued their knowledge of medicinal herbs. Aztec rulers estab- lished zoos and botanical gardens in which herbalists cultivated plants from many regions in order to concoct and study potential remedies. Before new remedies were used by members of the elite, they may have been tested on potential sacrificial victims or members of the lower classes.

The information herbalists and healers collected might have been included in pre-Conquest codices, but Spanish soldiers and priests destroyed all the Aztec texts that they could find. Eventually some Spanish priests worked with Aztec informants to reconstruct parts of the old medical lore. Because of their military and economic domination over much of Mexico, Aztec religious and medical practices diffused throughout the region. Thus, the little that is known about Aztec beliefs and practices can probably be generalized to other Mesoamerican cultures. Like most ancient cultures, the Aztecs believed that the agents that caused disease could be supernatural, magical, or natural. Medical practices, therefore, involved a mixture of magic, religion, and empirical science.

For ill- nesses and conditions that did not respond to the usual domestic medi- cines, people consulted members of the medical community. Although medical practitioners apparently developed specialized knowledge and techniques, healers retained both medical and priestly attributes. Priests, shamans, and other kinds of healers drove out or neutralized the evil spirits that caused disease through the use of prayers, spells, charms, amulets, and other magical devices. Aztec healing rituals included con- fession, purification rites, massage, and exploration of the body in order to find ‘‘object intrusions’’ that caused serious illnesses. Healers found diagnostic clues by studying the patient’s appear- ance, behavior, and dreams.

After consulting the viscera of an animal oracle, a healer might prescribe amulets and talismans made of shells, crystals, stones, or animal organs. If wearing these protective devices proved unsuccessful, a shaman could help the patient pass the disorder to a new victim. Healing rituals might involve penance, self-mutilation, baths, incantations, inhaling smoke, or eating images of gods made out of amaranth dough. Hallucinogenic agents were essential aspects of the diagnostic and curative procedures for certain illnesses. A shaman might ingest hallucinogens and travel to other worlds to consult supernatural beings and then return with a diagnosis and perhaps a remedy. Rituals that symbolically honored the gods, such as burning various oils and resins to produce an aromatic smoke, might also have practical value in driving away noxious insects.

Aztec priests served a large pantheon of gods and goddesses, including many that were associated with certain kinds of disease, spe- cific remedies, and medical practitioners. Numerous gods ruled over daily life and many of them demanded human and animal sacrifices. The gods could afflict individuals or whole societies as punishment for personal or collective transgressions. There were gods that were linked to medicinal herbs, skin diseases, respiratory diseases, dysentery, sleep and the interpretation of dreams, women’s diseases, and child- birth. Diagnosing the cause of supernatural ailments and performing the rites of appeasement required the services of healers who served the appropriate gods. In terms of specialization of functions, Aztec healers might be characterized as phlebotomists, surgeons, or internists who dealt with disorders of the eyes, stomach, bladder, and so forth. Aztec dentists treated inflamed gums, extracted ulcerated teeth, and performed cosmetic procedures. The art of healing could be passed down from father to son, through apprenticeships, or studied at certain temples where priests taught their students about the relationships among gods, diseases, and healing, as well as astrology and the art of casting horoscopes.

Sorcery might be indirectly involved as a cause of traumatic wounds, but the immediate causes of sprains, dislocations, fractures, and poisoning by venomous snakes and insects were usually quite ob- vious. In the treatment of fractures and sprains, Aztec healers compared favorably with their European counterparts. Razor-sharp obsidian scal- pels and blades were used in surgery, bloodletting, and rituals of self- mutilation. Researchers who studied obsidian instruments and weapons suggested that the usefulness of these artifacts might have been one of the reasons pre-Columbian cultures did not develop European-style metallurgy.

A general concern for cleanliness must have been a great advan- tage in Aztec surgery and obstetrics. Preparations containing narcotic plants and fungi, such as jimson weed, marijuana, mescaline, and peyote, probably contributed to pain relief. Wounds, boils, and abscesses were washed and dressed with various herbs, oils, poultices, and ointments. Surgeons set fractures, using splints and casts, and closed wounds with sutures made of human hair. Aztec and Maya sur- geons performed trepanations, although the Inca are best known for this operation. Head wounds were also treated by covering them with protective plasters made of resins, egg white, feathers, blood, and ashes. In addition to medicinal herbs, Aztec remedies contained minerals, such as jade and charcoal, and animal parts and products, such as bile, venom, urine, antlers, pulverized bones, and honey.

An elastic gum, later known as India rubber, was used to make enema syringes. Chronicles by Spanish observers, including physicians and clergy- men, provide early glimpses of disease and medical practices in the New World, but such records introduced many distortions. Unable and unwilling to accept unfamiliar doctrines, Europeans attempted to force New World concepts into classical European theories. Although some missionaries were interested in Aztec civilization, their goal in collecting information about pre-Contact customs was primarily to expedite the conversion of the Indians to Christianity. Missionaries wanted to under- stand Indian religions, deities, and rituals so that they could detect for- bidden rituals disguised as Christian worship. Priests even prohibited the use and cultivation of amaranth, a staple Aztec grain that provides high quality protein, because it was used in native healing rites.

Typi- cally, images of native gods were made of amaranth dough and eaten during religious festivals. To Spanish priests and conquistadors, this seemed a parody of the Catholic Eucharist. After the Conquest, amaranth became quite rare, but in the 1970s, nutritionists rediscovered its value. After the Conquest, the establishment of Spanish missions resulted in devastating epidemics of smallpox, measles, and other diseases among Indians removed from their villages and forced to provide labor for their new rulers.

Missions were established by Spanish priests to consolidate groups of formerly dispersed natives to in order to facilitate their conversion to Catholicism. Missionized Indians experienced dis- ruption of their traditional social systems, overcrowding, unsanitary conditions, malnutrition caused by an increasingly restricted diet, epi- demic diseases, a harsh workload, all of which led to decreases in birth- rates and increases in mortality rates. Surveys carried out by colonial authorities in the seventeenth century documented the continuing decline in Indian populations, the increasing demands for tribute and labor, and the breakdown of Native American communities. Missionaries established colleges in New Spain as early as the 1530s where they trained Aztecs as scribes and translators in order to compile ethnographic information and expedite the conversion of the Indians. Accounts of Aztec drugs have, therefore, been preserved in a few texts written in Nahuatl, the language of the Aztecs, and translated into Spanish or Latin. Important natural histories of New Spain were also compiled by Spanish physicians. In 1570, King Philip II sent Francisco Herna´ ndez (1517–1587) to the New World to gather information about the ‘‘natural things’’ found in the new Spanish empire.

Herna´ ndez was expected to consult local doctors, medicine men, and herbalists, test the alleged properties of New World herbs, trees, and medicinal plants, and determine which might provide new drugs. Although Herna´ ndez generally remained close to Mexico City, native doctors and herbalists gave him information about hundreds of plants and animals that were unknown in Europe. Herna´ ndez attempted to confirm the alleged medi- cal virtues of New World species by conducting clinical trials at hospi- tals in Mexico City. When he returned to Spain, Herna´ ndez had hundreds of illustrations and notes in Na´ huatl, Spanish, and Latin describing some three thousand plants. Hailed by admirers as the Span- ish Pliny, Herna´ ndez composed a multivolume natural history of New Spain and a report on the history and customs of the native peoples. According to Herna´ ndez, the Aztecs knew the curative and economic aspects of some 1,200 medicinal plants. In addition to purges, febrifuges, tonics, and so forth, the New World provided novel intoxicating pre- parations, from which chemists eventually isolated various hallucino- gens, psychoactive drugs, anesthetics, analgesics, and narcotics. Although Herna´ ndez evaluated Aztec medicinal materials and treatments in terms of classical European humoral theories, he noted the usefulness of Na´ huatl taxonomies.

To make his work more widely accessible, Herna´ ndez had it translated from Latin into Spanish and Na´ huatl. Unfortunately, the great treatise he had planned was not published during his lifetime. Other naturalists prepared abstracts and excerpts that were prized by physicians for many generations. After Mexico fell to the conquistadors in 1521, it became the Spanish Colony of New Spain, along with much of Central America, Texas, California, Arizona, New Mexico, and so forth. By 1523, the Aztec capital had been largely rebuilt with palaces and fortresses for the new military government; churches, hospitals, and schools were constructed on the ruins of Aztec temples and palaces. During some three hundred years of colonial rule, Spanish administrators and settlers attempted to transplant European medical institutions and ideas into a world devastated by military conquest, epidemic disease, and the collapse of the indigenous social structure. With little regards for local conditions, officials attempted to establish in New Spain the same rigid laws, licensing requirements, and institutional structures that governed medical practitioners, pharmacists, and midwives in Spain. Except for herbal lore, indigenous medicine was condemned, suppressed, and virtually extinguished. In time, however, a unique form of medicine evolved that incorporated elements of indigenous practice and Hippo- cratic traditions. Although the Spanish destroyed the hierarchy and authority of the Aztec Empire, they could not readily change the folk beliefs of indige- nous peoples.

Indeed, the most fundamental beliefs of the common people were much older than the Aztec Empire and had survived the rise and fall of previous conquerors. In Mexico today, traditional healers, known as curanderos and brujos, continue to attract patients. Advocates of modern medicine generally see such traditional healers as obstacles to medical progress and threats to the public health. But the remedies of the curanderos may reflect a mixture of ancient Aztec practices, folk- lore, and Hippocratic theories.

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