Cuzco in Peru was the heart of the Inca Empire, which once included parts of the regions that are now Argentina, Bolivia, Chile, Colombia, and Ecuador. The Incas had conquered vast territories, encompassing very diverse environments, and subdued people of very different cul- tures. The remarkable Incan road system, which depended on relay runners and rest houses, allowed the Inca rulers to communicate with ofﬁcials throughout the empire. The ruins of many agricultural terraces, irrigation canals, and cities in Peru predating the Inca Empire testify to complex societies that once ﬂourished in this region. There is con- siderable archeological evidence in the region of periods of population growth accompanied by the rise of complex societies, followed by periods of collapse and decline, long before European contact. Incan civilization lasted only about a hundred years, but it was at its peak when Francisco Pizarro (1475?–1541) and his small band of treasure hunters arrived in 1532. Fortunately for Pizarro, the leadership of the Inca Empire had recently been weakened by a struggle for the throne after the death of the king and other important members of the Inca nobility, possibly from smallpox.
Within two years, Pizarro had captured and executed Atahualpa (1502?–1533), whose reign as emperor began in 1525, and destroyed the foundations of the Incan empire. Pizarro’s success was apparently aided by the devastating im- pact of European epidemic diseases that had preceded direct European contact. A catastrophic epidemic, which might have been smallpox, swept the region in the mid-1520s, leaving the Empire vulnerable to Pizarro’s plans for the conquest of Peru. Subsequent epidemics, which may have included typhus, inﬂuenza, smallpox, and measles, devastated the region by the end of the sixteenth century. In the 1550s, descendants of Incan nobles recited the oral history and traditions of their ancestors for scribes like Juan de Betanzos who transcribed the memoirs that were later published as Narrative of the Incas. Unlike the Mayas and Aztecs, the Incas did not develop a system of writing, but their professional ‘‘rememberers’’ encoded and recorded information by using quipus (or khipus), knotted strings in many colors. Spanish conquerors and missionaries, suspecting that quipus might contain accounts of Inca history and religion, as well as more mundane ﬁnancial records, burned whole libraries of quipus. Archeologists origi- nally thought of the quipu as a textile abacus or mnemonic device, but some scholars believe that certain complex quipus might contain more than ﬁnancial records and census data. If quipus recorded words as well as numbers they would represent a unique writing system, but this possi- bility remains controversial. No Incan ‘‘Rosetta Stone’’ has been discov- ered and no khipus have been deciphered. Archeologists are gaining new information about Incan civilization through explorations of recently discovered sacred places and hidden cities, as well as analyses of artifacts and human remains at well-known archeological sites like Machu Picchu. In 1911, Hiram Bingham III dis- covered Machu Picchu, a city ﬁfty miles from Cuzco. Bingham popular- ized the expression ‘‘lost city’’ through his inﬂuential books, Machu Picchu: A Citadel of the Incas and Lost City of the Incas. Machu Picchu was probably one of many private estates and country retreats of the Inca nobility. Skeletons examined by physical anthropologists indicate that many families lived and died at Machu Picchu. The simplicity of grave goods, however, suggests that the bodies are those of people who worked at the estate, rather than the nobles who used the site as a retreat. The skeletal remains indicate that the workers were fairly well fed, although their diet was heavily based on corn, and tooth decay was common. Workers apparently came from many different parts of the empire, as indicated by differences in the shapes of their skulls. Different ethnic groups created distinctive cranial deformations by binding the heads of their infants. The discovery of an ancient cemetery on the outskirts of Lima, Peru, might reveal even more about life, health, disease, and social organization among the Inca than the discovery of another ‘‘lost city.’’ The dry soil of the coastal Peruvian desert provided excellent conditions for preservation, even though the bodies were not embalmed. By 2003, archeologists had uncovered the remains of more than two thousand Incas, but the cemetery contains many more graves, as well as priceless artifacts. The mummies represent a wide spectrum of age groups and social classes.
In many cases, the hair, skin, and eyes were still intact. Many of the bodies were buried in groups known as mummy bundles, some of which contained as many as seven individuals and weighed about four hundred pounds. These cocoon-like bundles were made by wrapping bodies together in layers of raw cotton and patterned textiles. Some bundles contain adults and children, as well as grave goods, including tools, weapons, utensils, pottery, foods, textiles, implements for sewing and weaving, ornaments, and so forth. Some mummies were buried with headdresses that marked them as members of the nobility. ‘‘False heads’’ (large cotton-ﬁlled bumps, often covered with wigs), another sign of high social status, were found in about 40 mummy bundles. Well-preserved human mummies have also been found at other sites in Peru and Chile. Pottery ﬁgures found in Peruvian archeological sites indicate that the Incas were quite familiar with Verruga peruana, the eruptive stage of Carrio´ n’s disease. Spanish observers described illnesses consistent with both the eruptive skin lesions of Verruga peruana and the acute febrile stage known as Oroya fever. The bacteria that cause Carrio´ n’s disease can be found in various small animals in South America. Human beings become infected when the infectious agent is transmitted by the sandﬂy. Until the 1870s, when thousands of workers died of the acute febrile form of the disease during the construction of a railroad from Lima to Oroya, the disease was one of many obscure fevers and skin disorders found in rural areas. In 1885, Daniel A. Carrio´ n (1859– 1885) demonstrated the fundamental identity of Verruga peruana and Oroya fever by inoculating himself with blood from a verruga patient. He died of Oroya fever, which, in the absence of antibiotics, has a very high mortality rate. Ten years later, Ernesto Odriozola (1862–1921) published an account of Carrio´ n’s experiments and named the disease in his honor. Leishmaniasis might have been brought to the Americas along with the slave trade, but some Peruvian pottery ﬁgures depicted deformities of the lips and nose that represent an indigenous disease known as uta, or American leishmaniasis. Medical knowledge and surgical practice, as well as the organi- zation of the Incan medical community, were apparently highly developed. An elite group of hereditary physicians attended the Inca emperor, but other physicians, surgeons, herbalists, and healers pro- vided care for the general populace. Therapeutic methods included herbal remedies, baths, bleeding, massage, various forms of wound treatment, and so forth. In addition to managing wounds, fractures, and dislocations, Peruvian surgeons performed major operations, such as amputation and trepanation (trephination), perhaps with the help of coca leaves. Thousands of trepanned skulls, found in archeological sites, provide the most dramatic testimony to the surgical skills of Native American healers. Coca, a shrub that the Incas considered sacred, is the source of cocaine and other alkaloids. Sixteenth-century observers said that the natives of Peru planted coca in the forests of the Andes, gathered the leaves, spread them on cloths, and allowed them to dry in the sun. The dry leaves were mixed with wood ash or unslaked lime and chewed to ward off fatigue, relieve drowsiness, lift the spirits, and make it pos- sible to endure extreme exertion, despite hunger, thirst, and cold. Coca mixed with tobacco and other substances was said to produce a state of intoxication. Modern physiological research supports the traditional belief that Peruvian Indians used coca because it promoted adaptation to hunger, cold, and fatigue at high altitudes. In the 1860s, an American diplomat visited Cuzco, where he acquired a collection of curiosities that included a trepanned human skull, which he sent it to Paul Broca (1824–1880), the French anthro- pologist. Broca’s discussion of the skull at the 1867 meeting of the Anthropological Society of Paris stimulated the search for more exam- ples of prehistoric surgery.
Trepanned skulls were eventually found in the Americas, Europe, Africa, and Asia, leading to debates about whether the technique developed in one culture and spread to others, or indepen- dently evolved in separate regions. The origins of various forms of trepanation are obscure, but the procedure certainly appeared in both the Americas and the Old World before the voyages of Columbus. Probably more than half of all ancient trepanned skulls in the world have been found in Peru. Before the operation, both the patient and the surgeon probably chewed coca leaves, which would provide both mood elevation and a coca juice extract that the surgeon could apply to the skull as a local anesthetic. Despite the seriousness of this operation, many patients recovered and went on to live a normal life- span. Some individuals survived two or three operations, as indicated by skulls with multiple trepanations and evidence of healing. The opera- tion was probably done to treat severe headaches, epilepsy, and head injuries, such as depressed skull fractures caused by close encounters with clubs, sling stones, or the star-headed mace during battles. Tre- panation can remove bone fragments and relieve pressure on the brain. Studies of hundreds of Peruvian trepanned skulls, dated from about 400 B.C.E. to the 1530s, have distinguished four methods of tre- phination: scraping, rectangular incision, circular incision, and drilling and cutting. Scraping involved wearing away an area of bone until the dura mater was reached. Rectangular incision involved cutting four grooves to form a square and lifting out a piece of bone. Circular cut- ting had the best rate of success and survival. The surgeon rapidly cut circular grooves deeper and deeper into the skull until a piece of bone could be removed.
Drilling a series of holes next to each other and then cutting out a piece of skull was quite rare and very dangerous, because of the possibility of puncturing the brain. Researchers ﬁnd that many elements of traditional medicine have been passed down for more than ﬁve hundred years by the inhabitants of the Andean region of Peru and Bolivia. Like most traditional systems, the healing art was based on magic, empiricism, and religion. A rare intermingling of Western medicine and traditional Indian culture occurred during the 1930s in Puno, an isolated, mountainous region in southeastern Peru. At that time, interest in native medical concepts and practices had been encouraged by the emergence of a nationalistic move- ment called indigenismo, which emphasized and celebrated native tra- ditions and culture. The movement stimulated the work of Manuel Nun˜ ez Butro´ n (1900–1952), a physician who organized an Indian rural sanitary brigade in Puno. The goal of the sanitary brigade was to respect native values, use native workers, promote smallpox vaccination, improve sanitation, ﬁght typhus, and so forth. The census of 1940 indicated that this region had a ratio of one health worker per 24,000 people. The ratio in Lima was one medical professional per 350 people. Members of the brigade served as itinerant doctors, but within little more than a decade, the call for modernization replaced the idealization of traditional culture and the brigades disappeared.