Medicine in Meso and South America

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Medicine in Meso and South America
RUBEN G. MENDOZA,JAY R. WOLTER
Ancient America provides a unique case study for
examining the independent development of medicinal
practices and technologies in non-Western societal
contexts. Initial European contacts with New World
cultures of the early sixteenth century made clear that
aboriginal medical systems and technologies embodied
principles of a holistic –mental, somatic, spiritual, and
supernatural –approach to healing. While the great
centers of New World civilization provide our most
complete record of medical practices and technologies,
many localized native populations contributed to the
extensive body of technical knowledge and expertise
associated with herbal, chemical, surgical, extraso-
matic, or ritual approaches to healing and public
hygiene. From South American gold and other metal-
based dental fillings, cranial trephination, postcranial
surgery, and coca-based anesthetics, to Mesoamerican
intramedullar nails, medicinal enemas, surgical sutures
and cauterization, caesarean sections, topical anes-
thetics, poultices, and birth control, the list of ancient
American medical practices and technologies is as
impressive as it is extensive.
Because of the breadth and diversity of these
practices in the Americas, we can only examine a
narrow sampling specific to ancient Mesoamerica and
Peru. The following discussion will move from a
consideration of basic Native American concepts
pertaining to the causes of disease to the examination
of specific case studies concerning the development
and sophistication of Native American practices. The
perspectives in question are drawn from contact era
sixteenth-century accounts of the Aztec and Inca
civilizations. One should bear in mind that the New
World Inquisition inhibited and condemned the exer-
cise of Native American medical practices. Through the
entire duration of the colonial era (ca. AD 1521–1824)
these practices were thought to be the work of sorcerers
and other native practitioners in league with the Devil.
European colonials actively sought to destroy ancient
medical works, along with pagan practices and
practitioners, throughout the contact era. While early
chroniclers attempted to document such practices, they
openly disparaged them, and every effort was made to
minimize their significance by comparison with
European practices of the time by way of blatantly
ethnocentric and racist assumptions about the mental
life and intellectual contributions and potential of
America’s aboriginal inhabitants. In those few in-
stances where a concerted scientific effort was made to
collect information on the medical practices of such
groups as the Aztec (Sahagun 1932), the distribution or
publication of such works was prohibited for centuries.
Much of our knowledge of contact era medical
practices is derived from the detailed chronicles
compiled to document the cultural history of the Aztec
and Inca civilizations. For example, medical anthro-
pologist Bernard Ortiz de Montellano (1990) has
subdivided Aztec concepts pertaining to the causes
and treatment of disease into three categories: super-
natural or religious, magical, and natural or physical.
He indicates that the Aztec held a holistic world view
pertaining to the causes and cures of disease, and refers
us to the work of Mexican ethnohistorian, Lopez
Austin: “the origin of illness is complex, including and
often intertwining two types of causes: those that we
would call natural –excesses, accidents, deficiencies,
exposure to sudden temperature changes, contagions
and the like –and those caused by the intervention of
nonhuman beings or of human beings with more than
normal powers. For example, a native could think that
his rheumatic problems came from the supreme will of
Titlacahuan, from the punishment sent by the tlaloque
for not having performed a certain rite, from direct
attack by a being who inhabited a certain spring, and
from prolonged chilling in cold water; the native would
not consider it all as a confluence of diverse causes but
as a complex”(Lopez Austin 1974: 216–217). This
complex view required that the physician reconcile a
variety of conceptual, spiritual, and physical dimen-
sions in the course of diagnosis and treatment. Aztec
doctors were required to balance herbal and other
chemical treatments with interpretive models of causa-
tion ranging from the supernatural and magical to the
natural, or a complex mix of both. The supernatural and
magical, encompassing astrological interpretations

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such as those prevalent in sixteenth-century Europe,
were of the greatest interest to early contact-era
European chroniclers.
Botanical Knowledge
While the botanical repertoire of New World peoples is
discussed elsewhere within this encyclopedia, the
relative significance of botanical specimens and
knowledge to New World medical traditions necessi-
tates brief consideration. It should be noted that recent
research in this area makes clear the great contributions
made by Native Americans (Schultes 1994). The
surviving Aztec herbal known as the Codex Badianus
provides one of the most extensive listings of botanical
specimens identified with the medication and treatment
of a variety of ailments. However, in his efforts to make
the herbal, authored by the Aztec doctor Martin de la
Cruz, palatable to a European audience, Juan Badiano,
the chronicler who prepared the document for submis-
sion to King Charles, modified it to incorporate
European medical beliefs regarding the role played
by temperature in illness, diagnosis, and treatment.
The large body of medicinal knowledge identified
with the Americas, and subsequently adopted by
European-based medical systems, included such an-
cient Native American medicinal and hallucinogenic
substances as coca (Erythroxylon coca), mescaline
(Lophophora williamsii), nicotine (Nicotiana taba-
cum), quinine (Quina cinchona), psilocyben (Psilocybe
mexicana), dopamine (Carnegiea gigantea), anodyne
analgesics (Solandra guerrerensis), the ergot alkoloid
D-lysergic acid (Ipomoea violacea), and genipen-based
antibacterial agents (Chlorophora tinctoria). To this list
may be added medications and related chemicals and
supplements ranging from N-dimethylhistamine to
atropine, seratonin, tryptamine, kaempferol, prosopine,
pectin, and camphor –to name but a few. These served
Aztec physicians in a variety of capacities. Ortiz de
Montellano has documented the medicinal properties
of many of the herbal and chemical treatments admi-
nistered by Aztec physicians. Included in that listing
are diuretics, laxatives, sedatives, soporifics, purgatives,
astringents, hemostats, hallucinogens, anesthetics, eme-
tics, oxytocics, diaphoretics, and anthelmintics. Fur-
thermore, there was a variety of antibiotic or antiseptic
treatments for treating wounds, medicating infections
and fractures, and performing surgery. These included
the herbal vasoconstrictor comelina pallida, maguey
or agave sap, for its hemolytic, osmotic, and detergent
effects, hot urine in lieu of other available sources
of sterile water, and mixtures of salt and honey which
have been determined to provide enhanced antiseptic
functions.
Recent studies of the “hidden chemical wealth of
plants”used by the Native American tribes of the
Amazon rain forest provide but one more point of
departure for gauging the range and extent of pre-
Columbian medical traditions (Schultes 1994). In his
recent summary of the pharmacology of the Kofan and
Witoto tribes of the Amazon Basin, ethnobotanist
Richard Evans Schultes has observed that “the forest
peoples’acquaintance with plants is subtle as well as
extensive. The Indians often distinguish “kinds”of a
plant that appear indistinguishable, even to the ex-
perienced taxonomic botanist.”This taxonomic acute-
ness extends to the level of being able to distinguish
chemovars, or the basic chemical constitution of a
specific subvariety, by visual inspection alone. Despite
an estimated 80,000 species of higher plants in the
Amazon, fewer than 10% have been “subjected to even
superficial chemical analysis.”Such a store of indige-
nous botanical knowledge recently prompted Schultes
to ask “why not regard the Indians of the Amazon
Basin as a kind of phytochemical rapid-assessment
team already on the ground?”
Medical Specialists and Personnel
While it is clear from all accounts that herbal specia-
lists existed in all regions of pre-Columbian America,
the existence of a broader corps of trained medical
specialists and personnel is less evenly documented. So
intent were early contact-era European chroniclers on
disparaging and discouraging pagan forms of medicine
that much was done to reduce the role of medical spe-
cialists from Native American communities. In most
instances, medical specialists ranging from herbalists to
physicians were simply referred to as sorcerers or
charlatans. Given the relatively impoverished state of
European medicinal practices of the early sixteenth
century, it is no wonder that most European chroniclers
of Native American medical traditions expressed out-
right contempt for Native American physicians and
their medical practices and traditions. Despite deliber-
ate errors of omission and commission, surviving
documents provide indications of the broad sophis-
tication in Native American medicinal practices.
As for the documented existence of a scientific
tradition with trained practitioners specialized in
specific forms of surgical treatment, we are informed
by archaeologist Burland that, in a region above Lima,
Peru, there existed an ethnic enclave known as the
Yauyos with whom the Inca collaborated in the
training of specialists in the art of cranial trephination
or skull surgery. The patient was drugged, and pain was
alleviated by way of the application of direct pressure
to nerve endings in the affected area. In such instances,
trephination was used only as a last resort, whereby the
diseased or smashed bone was cut away from the skull.
Other forms of surgery included the “removal of a torn
spleen, cleaning out of ulcers, and the cleaning and
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after-care of wounds”(Burland 1967). Professional
alliances between the Inca and Yauyo allowed for the
exchange of technical knowledge and technicians.
Accounts of the work of Yauyo physicians indicate that
they were highly trained and had developed a formal
discipline based on a corp of specialists. Apparently,
herbal specialists of highland Peru were organized into
“local confraternities,”while medical specialists and
physicians –camasca or soncoyoc –were sponsored
by the Inca state and “highly trained within their own
kind of collegiate discipline.”This latter point is of
paramount significance in establishing the existence of
a specialized corps of medical personnel, and as such,
the makings of a formally constituted and state-
sponsored scientific tradition specialized in the treat-
ment and trephination of the human cranium.
According to medical historian Gordon Schendel
(1968), technical distinctions were made between
“old”and “new”school physicians. At European
contact, old school physicians were thought of as
more traditional and more adept at conveying medical
and spiritual beliefs pertaining to the art of healing,
whereas the physicians of the new school engaged
specialized methods and medical procedures. Among
the Aztec, medical specialists included the tlana-
tepat-ticitl or healer who “cured with medicines which
were digested or applied on the skin”(Guzman Peredo
1985), the texoxotlaticitl or surgeon whose skills
included bloodletting, and the papiani-papamacani or
herbalist. Other terms utilized to identify Aztec medical
specialists included texoxtl, or surgeons, and the
tlamatepatli or medical interns of the texoxtl surgeons.
The tecoani were the bloodletters; the temixiuitiani
were the midwives. The papiani were the pharmacol-
ogists or herbal pharmacists. The panamacani are
identified with pharmacognosists, or those individuals
specialized in the identification; collection, and dis-
pensing of herbal remedies, a specialty not unlike that
of the plant pharmacologists of the Amazon Basin.
Schendel has also documented the existence of a variety
of specialists and areas of medical specialization,
including internists, psychiatrists or psychotherapists,
anesthesiologists, dermatologists, dentists, obstetri-
cians, gynecologists, orthopediatricians, ophthamolo-
gists, urinogenital surgeons, and other practitioners
specialized in the administration of tonsillectomy and
embryotomy. In all areas of medical endeavor,
specialists were held accountable for their actions
and practices by their peers, as well as by the
community at large.
Other specialists included those who used chiroprac-
tic methods, whereby “these doctors, in the case of
falls, usually strip the patient and rub his flesh; they
make him lie face downwards and step on his back. I
have seen this myself, and I have heard patients say that
they felt better…the pity of it is that there are even
Spanish men and women who believe them (Aztec
physicians)] and are manipulated to serve their needs
and evil”(Cervantes de Salazar 1936, as cited in
Guzman Peredo 1985). Spanish Friar Bernardino de
Sahagun commended the technical expertise of Aztec
physicians and noted that they “had great knowledge of
vegetables; moreover, they knew how to perform
bloodletting and to reduce dislocated bones and
fractures. They made incisions. They healed sores
and the gout. They cut the fleshy excrescence in cases
of ophthalmia (inflammation of the eyes).”
Surgical Practices
As our discussion of medical specializations makes
clear, pre-Columbian medical practices, particularly
those pertaining to surgical methods, were comprehen-
sive and sophisticated in scope. According to conquest
period chronicles, “Aztec battle surgeons tended their
wounded skillfully and healed them faster than did the
Spanish surgeons …[and] …one area of clear Aztec
superiority over the Spanish was the treatment of
wounds. European wound treatment at that time
consisted of cauterization with boiling oil and reciting
of prayers while waiting for infection to develop the
‘laudable pus’that was seen as a good sign”(as cited in
Ortiz de Montellano 1990). Medical historian Miguel
Guzman Peredo cites Fray Bernardino de Sahagun:
“Cuts and wounds on the nose after an accident had to
be treated by suturing with hair from the head and by
applying to the stitches and the wound white honey
and salt. After this, if the nose fell off or if the treatment
was a failure, an artificial nose took the place of the real
one. Wounds on the lips had to be sutured with hair
from the head, and afterwards melted juice from the
maguey plant, called meulli, was poured on the wound;
if, however, after the cure, an ugly blemish remained,
an incision had to be made and the wound had to be
burned and sutured again with hair and treated with
melted meulli.”The citation makes clear the availabili-
ty of prosthetic or cosmetic devices, the use of sutures,
and the application of maguey or agave sap as an
antibiotic ointment.
The Aztec also maintained a complex typology
for mapping human anatomy and physiology. They
identified specific body parts, organs, and their res-
pective biological functions, and employed anatomical
terms for the articular surfaces and attachments of
limbs, as for instance in the use of the terms acolli,
moliztli, maquechtli, and tlanquaitl, for the articulation
of the shoulder, elbow, wrist, and knee, respectively.
According to Guzman Peredo, “those physicians had
more than elementary concepts of the different organic
functions. They knew, for example, of the circulation of
the blood. They even became aware of the throbbing at
the tip of the heart; this they called tetecuicaliztli. The
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radial pulse was called tlahuatl.”Armed with such
knowledge, the Aztec “used traction and counter
traction to reduce fractures and sprains and splints to
immobilize fractures”(Ortiz de Montellano 1990).
Perhaps one of the most significant medical innova-
tions concerns the use of the intramedullar nail.
Bernardino de Sahagun (1932) noted that in instances
where bone fractures failed to heal, “the bone is
exposed; a very resinous stick is cut; it is inserted
within the bone, bound within the incision, covered
over with the medicine mentioned.”The intramedullar
nail was not rediscovered by Western medicine until
well into the twentieth century.
The most outstanding example of the empirical
reliability and effectiveness of a pre-Columbian
medical tradition centering on surgical applications
was the use of cranial trephination or skull surgery.
Examples of the practice have been documented from
throughout South, Middle, and North America. An
extensive review of this practice can be found
elsewhere in the encyclopedia.
Our review of pre-Columbian medicinal practices
raises many more questions than can be addressed in
this essay. Clearly, the European predilection for
accommodating only that which suited prevailing
eurocentric modes of thought contributed to the uneven
documentation of significant Native American medical
innovations and practices. A selected recounting of
significant innovations should take into account
practices centered on (a) holistic concepts of health,
(b) state-sponsored public health programs, (c) an
extensive body of anatomical terminology, (d) the
existence of confraternal medical associations and
state-sponsored medical corps, and specific practices
centered on medical innovations such as those pertain-
ing to (e) cranial trephination, (f) prosthetic and
cosmetic devices, (g) antibiotic and antiseptic oint-
ments and medications, (h) intramedullar nails, (i)
formal procedures for the maintenance of dental health
and hygiene, (j) psycho- and logo-therapeutic, or
image-based, psychological approaches, and not sur-
prisingly, (k) the largest pharmacological repertoire of
effective and affective herbal and chemical remedies
ever documented in the ancient world. Ultimately, any
assessment of pre-Columbian medical traditions and
innovations will need to contend with the fact that
scholars have only just begun to scratch the surface of
this New World of lost science and tradition.
See also: ▶Trephination,▶Ethnobotany,▶Colonial-
ism and Medicine
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AU1 The references Ankli (2002), Cichewicz (1996),
Classen (1993), Cobo (1990), Cruz (2000), Gall
(1997), Guerra (1971), Kunow (2003), Lopez
(1974), Lux (2001), Majno (1975), and Mesoamer-
ican Healers (2001) are not cited in text. Please cite
in text or delete from list.