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Holes in the Head: The Art and Archaeology of Trepanation in Ancient Peru

2017; Duke University Press; Volume: 64; Issue: 4 Linguagem: Inglês

10.1215/00141801-4174520

1527-5477

Christopher Heaney,

Archaeology and Rock Art Studies

Trepanation is a cranial surgery whose extraordinary global antiquity unfurled after its 1865 identification in a Pre-Columbian skull from Peru. For those who have never heard of it, this book will be mind-opening. For those who have, bioanthropologist John W. Verano’s long-awaited and assiduously researched contribution transforms its discussion from backhandedly ethnocentric surprise—“Indigenous Andeans operated on each other’s skulls for medical reasons?”—to a tool capable of turning still-implicit hierarchies within the histories of science and medicine on their head.Consider this: nineteenth-century surgeons in Europe and North America reported 75–90 percent mortality rates when they peeled back the scalps of their patients to relieve intracranial bleeding and to remove bone fractures impinging on the dura mater and brain beneath. Over the past twenty-five years, Verano has examined approximately eight hundred trepanned Peruvian skulls in museums across the Americas to show that Indigenous surgeons’ survival rate in the two millennia before the conquest was more than 50 percent. When limited to skulls collected from the royal Inca estate of Ollantaytambo in the Urubamba River Valley, a full 75.3 percent showed signs of long-term healing.The question of why three centuries of Europeans failed to recognize Indigenous Peruvian excellence at trepanation haunts this reconstruction of those healers’ handiwork. Eleven elegantly written chapters, three co-written by colleagues in bioanthropology and neurosurgery, detail the practice’s regional variation, evolution of technique, and history of study. Peruvian knowledge-practices bridged its past and present. The Inca-era skull whose tic-tac-toe opening convinced anthropologists Ephraim George Squier and Paul Broca of Indigenous trepanation’s medical purpose—and called Europeans’ attention to their own previously unidentified Neolithic trepanations—was collected before 1865 by an elite Cusqueña antiquarian named María Ana Centeno de Romainville. Other North American anthropologists cast trepanation as a “skillless” operation until Julio Tello, a Peruvian archaeologist of Indigenous descent, in the early twentieth century proved its therapeutic causes and clear successes with some four hundred trepanned skulls collected from his highland home of Huarochirí.Verano reexamines their collections and those from elsewhere, such as the southern Peruvian coast, where South American trepanation seems to have begun some 2,500 years ago. His careful analysis demonstrates how the practice managed cranial injuries typical of blunt-force Andean warfare and precipitous topographies. He delineates the trepanners’ variable methods (scraping, linear cutting, circular grooving, and drilling), their rates of success, and the clustered geography. Particular areas seem to have been “centers” of healing and apprenticeship so trustworthy that, in one case, a Cusco-region patient returned for seven trepanations, all of which he survived.Cases like his suggest the iceberg of meaning hiding beneath a practice that early colonial-era Andeans either hid from the Spanish or the Spanish ignored. Some trepanned crania show no signs of trauma, which suggests either an operation that successfully eliminated an offending fracture or more nuanced diagnoses of the health of the patient. Verano and his collaborators emphasize medical explanations, noting how modern trephination and craniotomy address chronic headaches or loss of cognitive function caused by externally invisible intracranial mass lesions. This is the side to err on given how North American anthropologists initially dismissed Andean surgery as “thaumaturgic.” Yet, the rich and recent work by Claudia Brosseder and others also emphasizes colonial healing’s sacred aspect—an observation as true of Europeans’ medicine as Andeans’. This reviewer therefore wonders what meditating on trepanation’s post-conquest afterlife allows; what it meant—spiritually, politically—to restore life to a nearly dead person whom missionaries and European healers failed. This is beyond Verano’s bailiwick, but references to Bolivian Aymara trepanners as late as the 1950s tantalize; his observation that “the final chapter on trepanation in ancient”—and perhaps contemporary—“Peru has yet to be written” (289) is thrilling. Until then, Holes in the Head—richly illustrated with some 290 figures, most of them Verano’s own photographs of successful and unsuccessful trepanations—is as close to art as scholarship comes, a careful evocation of an intellectual and care-filled world that defies final diagnosis.