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Knowledge of Skull Base Anatomy and Surgical Implications of Human Sacrifice Among Pre-Columbian Mesoamerican Cultures

Knowledge of Skull Base Anatomy and Surgical Implications of Human Sacrifice Among Pre-Columbian Mesoamerican Cultures

See the corresponding retraction, DOI: 10.3171/2018.5.FOCUS12120r, for full details.

Neurosurg Focus 33 (2):E1, 2012

Knowledge of base anatomy and surgical implications of among pre-Columbian Mesoamerican cultures

Raul Lopez-Serna, M.D.,1 Juan Luis Gomez-Amador, M.D.,1 Juan Barges-Coll, M.D.,1 Nicasio Arriada-Mendicoa, M.D.,1 Samuel Romero-Vargas, M.D., M.Sc.,2 Miguel Ramos-Peek, M.D.,1 Miguel Angel Celis-Lopez, M.D.,1 Rogelio Revuelta-Gutierrez, M.D.,1 and Lesly Portocarrero-Ortiz, M.D., M.Sc.3 1Department of Neurosurgery, Instituto Nacional de Neurologia y Neurocirugia “Manuel Velasco Suárez;” 2Department of Spine Surgery, Instituto Nacional de Rehabilitación; and 3Department of Neuroendocrinology, Instituto Nacional de Neurologia y Neurocirugia “Manuel Velasco Suárez,” City, Mexico

Human sacrifice became a common cultural trait during the advanced phases of Mesoamerican civilizations. This phenomenon, influenced by complex religious beliefs, included several practices such as decapitation, cranial deformation, and the use of human cranial bones for skull mask manufacturing. Archaeological evidence suggests that all of these practices required specialized knowledge of skull base and upper cervical anatomy. The authors con- ducted a systematic search for information on skull base anatomical and surgical knowledge among Mesoamerican civilizations. A detailed exposition of these results is presented, along with some interesting information extracted from historical documents and pictorial codices to provide a better understanding of skull base surgical practices among these cultures. Paleoforensic evidence from the Great Temple of indicates that Aztec priests used a specialized decapitation technique, based on a deep anatomical knowledge. Trophy were submitted through a stepwise technique for skull mask fabrication, based on skull base anatomical landmarks. Understanding pre-Columbian Mesoamerican religions can only be realized by considering them in their own time and according to their own perspective. Several contributions to medical practice might have arisen from anatomical knowledge emerging from human sacrifice and decapitation techniques. (http://thejns.org/doi/abs/10.3171/2012.6.FOCUS12120)

Key Words • skull base • forensic anthropology • funeral rites • shamanism

efore the discovery of the by Chris- the first agricultural settlements, several common social topher Columbus in 1492, the central region of and cultural features evolved among Mesoamerican soci- the continent, known as (extend- eties, such as complex calendar and numeral systems, rich Bing from Central Mexico to Nicaragua), was inhabited and colorful mythological traditions, advanced astronom- by prosperous ancient civilizations that flourished before ical knowledge, and a distinct architectural style, whose the Spanish colonization that began in the 16th century.14 vestiges still remain. Human sacrifice became a common Pre-Columbian Mesoamerican societies (, Ma- cultural trait during the advanced phases of Mesoameri- yans, , , and ) shared not only can civilizations.5,12 This phenomenon, influenced by a geographical area but also several cultural traits.14 As complex religious beliefs, included several practices such early as 7000 to 6000 bc, they domesticated the wild teo- as decapitation,3,9,12 cranial deformation,20 and the use of sinte and gradually transformed it by selection of seeds human cranial bones for skull mask manufacturing.15 Ar- into the ancestor of modern maize. It became the major chaeological evidence suggests that all of these practices crop of Mesoamerican societies by the time of Spaniard required specialized knowledge of cranial, skull base, exploration.2,13,18 Improvement of agricultural techniques and upper cervical anatomy.10 In the context of a world of and domesticationRetracted of maize and other vegetables (beans, perpetual war among tribes and -to-hand combat,3 squash, and chilies), as well as the raising of turkeys and considerable surgical applications might have emerged the Mexican hairless dog (Xoloitzcuintli), caused a tran- from this anatomical knowledge, such as the use of gold sition from paleo-Indian hunter-gatherers (foragers) to and silver to perform cranioplasties, refined surgical tech- established agricultural villages.16 niques to treat combat wounds, and the development of During the centuries following the establishment of protection devices.11

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Systematic Search temples dedicated to the gods and Tezcatli- poca.6 The Great Temple of Tenochtitlan represented the We conducted a systematic search for information axis mundi of Aztec civilization, and most of the religious on skull base anatomical and surgical knowledge among practices were performed there (including decapitation); Mesomerican civilizations. For this purpose, we exam- thus it is not surprising that most of the Aztec osteologi- ined the collections of the Mexican National Institute of cal specimens come from this site, where they gradually Anthropology and History and the National Autonomous accumulated over a period between 1440 and 1502 ad.4 University of Mexico, as well as previous reports of os- teological and pictorial collections obtained from excava- tions at some major archeological sites. Knowledge of Skull Base Anatomy and the A detailed exposition of these results is presented, Practice of Human Sacrifice Among Aztecs along with some interesting information extracted from historical documents and pictorial codices, to provide the Fray Bernardino de Sahagun, known as one of the reader with some valuable information concerning the most important chroniclers of the 16th century, exten- existence of skull base surgical practices among these sively described the Aztec way of life in his 12-volume ancient cultures. . From this written evidence, it is known that parents decided the future profession of their ba- The Aztecs and the Great City of Tenochtitlan bies immediately after birth. Future priests had to go to the Calmecac, where they received a rigorous education The Aztecs, also known as , inhabited the based on a specific program. As suggested by chroniclers, land we now call the , where Mexico Aztec priests may have begun their training as early as 5 City is situated. The ancient city of Tenochtitlan—the years old, and they had to learn both theory and practice, Aztec’s capital, whose vestiges still remain next to Mex- such as the technique for human sacrifice and decapita- ico City’s Metropolitan Cathedral (Metropolitan Cathe- tion. The Aztec priests were experts on anatomy of in- dral of the Assumption of Mary of )—was ternal and external anatomical structures and used spe- founded in 1323, on a little swampy islet in Texcoco. cific names for brain (cuayolotl) and head (tzontecomatl). According to legend, this unexpected place was selected Furthermore, they distinguished the skull base and upper by Aztec religious leaders because it is where they saw a 6 cervical spine (cuitla) as an independent structure from golden eagle perched on a paddle cactus, eating a snake. the rest of the cranium (cuech) and spine (xo).7 Graphic representation of this legend is depicted on the Paleoforensic evidence from more than 1000 bone Mexican coat of , which can be seen on the white specimens found in 19 offerings from the Great Temple stripe of the Mexican flag. indicates that Aztec priests used a specialized and sys- Over the decades, the Aztec civilization formed a tematic decapitation technique, possibly based on a deep powerful warrior empire that expanded its political and knowledge of skull base anatomy.4 Some osseous marks economical hegemony beyond the Valley of Mexico. At show a recurrent pattern among different specimens and the maximal extent of the , Tenochtitlan ex- correspond to cuts inflicted on the occipitocervical junc- tended its power as far as the shores of the Gulf of Mexico tion with fine tools, probably obsidian or quartz knives and Pacific Ocean.18 (tecpatl; Fig. 1 left).7 These V-shaped indentations, located Inspired by their religious beliefs, the Aztecs launched 9 periodical ritual battles against their enemies, which pro- over the upper cervical vertebrae and , vided them with victims for sacrifice. According to the might have followed a blunt dissection of the upper , Duran Codex, these battles, known as “flower wars,” were with the intention of damaging the upper spinal cord and instigated by the Aztec emperor Tlacaelel after a great lower medulla oblongata. All cases of decapitation were famine, in an attempt to please the gods and obey their performed with the individual lying on his or her back; wishes.5,11 after the victims were sacrificed, the priests decapitated them between the fifth and sixth cervical vertebrae (Fig. The Great Temple (Huey Teocalli) was the main reli- 10 gious building of Tenochtitlan. It was a twin temple dedi- 1 right). Trophy skulls had 3 possible uses: as an offering cated to 2 gods: Tlaloc, god of rain, and Huitzilopochtli, inside the temple, with the flesh intact; for public display god of war. According to Aztec tradition, the temple was on a skull rack (); and for fabrication of orna- built on the exact site of the city’s stone foundation.9 Dur- mental masks (Fig. 2). ing the Spanish conquest of Tenochtitlan, the Great Tem- ple, like most of the ancient city, was almost destroyed, Anatomical Landmarks for Skull Mask and its building materials were reused to erect the new Fabrication: Abrasion Technique colonial city over the remains of the ancient Aztec capi- tal. The location of the Great Temple was forgotten until Life and death were not separate states for Meso- the 20th century, when workers from the National Elec- american civilizations; the vital force was eternal, and life tric CompanyRetracted discovered it by accident during excavation on Earth constituted only a momentary lapse of eternity. work next to the Mexico City Metropolitan Cathedral. Skull masks represented a link between life and death, The archeological site of the Great Temple of Tenoch- which explains why their fabrication was not an isolated titlan covers an area of almost 4000 m2. Some of its most practice, but a common phenomenon among Mesoameri- important buildings are the Great Temple itself, the ball can civilizations.15 court, the Calmecac (school for the wealthy class), and the Evidence from osteological collections from several

2 Neurosurg Focus / Volume 33 / August 2012 Neurosurgical implications of human sacrifice in Mesoamerica

logical diseases.7 Aztecs had their own Terminologia An- atomica and used specific terms for various neurological disorders; they knew that severe cranial trauma (cuech- poztequi) could cause hallucinations (chichihualayatl) and deep stupor (yohualtetzahuitl); in fact, there is arche- ological evidence of cranial trepanation in an attempt to treat these lesions.19 However, Aztecs knew perfectly well Fig. 1. Photographs of bones found at the Aztec Great Temple at that severe trauma or penetrating wounds (tlaxilli) on the Tenochtitlan. Left: Lateral aspect of the atlas. A V-shaped mark (ar- skull base and upper cervical spine (cuitlapoztequi) were row) was made on its lateral mass. Right: C-5 articular facet with severely disabling and mostly lethal. Aztec physicians signs of trauma next to its articular surface (arrow). C-5 and C-6 were (ticitl) knew that surviving these lesions would make the preferred levels for decapitation among Aztec priests. Reproduced someone “macocoltzin,” which literally means “man with with permission from the National Institute of Anthropology and History crippled ,” and thus lesions of the cuitlapoztequi (INAH)/Museo del Collection. were not usually treated because of their poor progno- Mesoamerican cultures (Aztec, , , and Ma- ses. Ancient Mesoamerican physicians were interested in yan) suggests that the fabrication process of skull masks neurosurgery, and several sculpted models and figurines followed a stepwise standardized approach (Fig. 3).4 First, coming from the Totonac civilization represent examples the was removed and temporal muscles were elevated of skull base disorders, such as orbitary tumors and post- downward, to the level of the zygomatic arches, as suggest- traumatic facial paralysis (Fig. 4). ed by marks of flesh scraping over temporal squamae. Sec- Other examples of primitive skull base surgery can ondly, the parietal bones, , and the posterior be found in Mayan remains. Health care and medicine part of the temporal bones were excised by a combination among the ancient Mayans was delivered only by a very of percussion and cleavage by abrasion. Preservation of the select caste of priests and physicians, who received exten- at this stage is a common finding among masks, sive education and specialization. Archeological sources perhaps explained by the hardness of the sphenoid wing. show several ancient Mayan medical practices, such as The third part of the process involved abrasion of the lower suturing of wounds with human , fracture reductions, and middle ; at this stage, preservation of the poste- and dental prostheses made of turquoise and jade. An- rior clinoid process and is a common finding cient Mayan dentistry and craniofacial surgery must have among specimens, which suggests some aesthetic or sym- been able to treat complex pathologies of the skull base, bolic value of the sellar region. Finally, some materials— such as mandibular and maxillary tumors.1 mainly conch and pyrite—were encrusted within the orbits, Considering the level of expertise and specializa- and obsidian, quartz, or flint knives were placed in the oral tion among Mayan physicians, along with other practices and nasal cavities.4 Once finished, skull masks occupied such as cranial deformation20 and human sacrifice,5 it is the same level in the offerings that the effigies of gods did; not baseless to speculate that this civilization might have this fact can give us insight into their extraordinary icono- closed the gap between anatomy and pathology in terms graphic value.15 of skull base knowledge, given that there is archeological evidence of successful surgical of maxillary and middle fossa abscesses through trepanation.19 The Influence of Anatomical Knowledge on Therapeutics Discussion The practice of decapitation might have influenced the way Mesoamericans conceived of and treated neuro- The reasons that pushed ancient Mesoamerican civi- Retracted

Fig. 2. Images showing 3 uses of trophy skulls after decapitation. A: Plate 4 of the Borgia Codex depicting the burial of a tro- phy skull inside a temple. B: Plate of the Ramirez Codex showing a pallisade with human crania (Tzompantli). C: Ornamental skull mask encrusted with stones. Reproduced with permission from the National Institute of Anthropology and History (INAH).

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Fig. 3. Images demonstrating aspects of the skull mask fabrication technique. Left: Once the scalp was removed and the was elevated, the first step involved fracture and removal of the temporal squama (shaded area 1). Second, the parietals, occipital, and posterior part of the temporal bones were removed by bending the bony edges and by abrasion methods (shaded area 2). The third step involved abrasion of the lower and middle clivus (shaded area 3). Finally, some objects and materi- als were encrusted within the orbital, oral, and nasal cavities (4). Right: Skull mask ornamented by this method. Reproduced with permission from the National Institute of Anthropology and History (INAH). lizations to the practice of human sacrifice may appear human skull masks. Understanding pre-Columbian Me- totally unacceptable from today’s perspective, as it might soamerican religions can only be realized by considering have appeared to European conquerors and friars. As them in their own time and according to their own per- quoted by Morales, “the cult to pagan gods, and the way it spective. For this reason, we tried to provide the reader was practiced in such a complex religion… [struck] friars with a glance into this culture’s cosmogonies. These civi- not only [as] weird, but also abominable….”17 lizations lived in an extremely dangerous world, marked Once definitively established in Mesoamerica, Span- by almost constant war among tribes, and suffered natu- ish conquerors and friars launched a long-lasting cul- ral disasters without actually understanding them. Nega- tural conquest that gradually erased all traces of Aztec tive effects of war and nature on society were what they society and history, including the destruction of almost feared most, and due to the impossibility of predicting all codices and the burial of temples and entire cities.18 or modifying their negative effects and influences, a very Fortunately, some archeological remains of the rich complex religious system emerged, based on war and na- Mesoamerican tradition survived through codices kept ture deities. The cult of these gods and its practices, such by friars; today we can combine these sources with the as human sacrifice, tried to establish communication with information available from osteological collections to divine forces and secure their favor. From their perspec- recreate the processes of decapitation and fabrication of tive, intimacy with gods through worship would have helped these ancient societies exert some effects on fertil- ity, maize rising, rain, and other events of extraordinary importance for their daily lives.12 According to , life and natural forces arose from the buried bodies of the sacrificed gods. The people of Tenochtitlan believed that human sacrifice was a sort of payment of human debt to the gods for their own lives, which were made possible through the sacrifice that the gods had pre- viously made for them.3 Despite its evident religious roots, the practice of human sacrifice, and especially decapitation, must have involved certain technical nuances that required a good level of anatomical knowledge.5 Although neurosurgery was not yet a developed surgical technique,8 archeologi- cal findings suggest the existence of what can be seen as a primitive form of skull base dissection among Aztec Fig. 4. PrecolumbineRetracted Mesoamerican figurines possibly showing ex- priests. Because they had to train in a specialized educa- amples of skull base pathologies. Left: Ceramic mask (Totonac civili- 3 zation, 14th century) showing a right orbital tumor. Right: Stone anvil tional system, these priests learned not only a standard- (Totonac civilization, 14th century) depicting right-side facial paralysis. ized surgical technique, but also a body of anatomical Note the deviation of contralateral structures. Reproduced with permis- knowledge and the uses of specialized surgical instru- sion from the National Institute of Anthropology and History (INAH). ments. It is uncertain whether the body of knowledge

4 Neurosurg Focus / Volume 33 / August 2012 Neurosurgical implications of human sacrifice in Mesoamerica emerging from decapitation might have enriched the . 5 Demarest A: Overview: Mesoamerican human sacrifice in practice of medicine among Aztecs, given that physicians evolutionary perspective, in Boone EH, Benson BP (eds): (ticitl) constituted a different profession, but there is evi- Ritual Human Sacrifice in Mesoamerica. Washington, DC: Dumbarton Oaks Research Library and Collection, 1984, pp dence of interest in skull base pathologies among Aztec 227–247 physicians as well. 6. Duran FD, Heyden D: The History of the Indies of (Civilization of the American Indian Series) (au- thor’s transl). Norman, OK: University of Press, Conclusions 1994, pp 1–68 Several contributions to medical practice might have 7. Gonzalez Y: El sacrificio humano entre los mexicas. Mexico City: Fondo de Cultura Económica, 1985, pp 1–45 arisen from anatomical knowledge emerging from hu- 8. Goodrich JT, Ponce de Leon FC: Medical and surgical prac- man sacrifice and decapitation techniques in ancient Me- tice as represented in cultural figures from the pre-conquest soamerica. The widespread use of these practices among Mesoamerican territories. World Neurosurg 74:81–96, 2010 these ancient civilizations suggests their high symbolic 9. Graulich M: Ritos aztecas. Las fiestas de las veintenas. value. Based on the existence of a specialized caste of Mexico: Instituto Nacional Indigenista, 1999, pp 2–80 doctors and priests, we can hypothesize about the level of 10. Haglund W, Sorg MH: Forensic Taphonomy: The Postmor- expertise they might have achieved through the continu- tem Fate of Human Remains. Boca Raton, FL: CRC Press, ous practice of these early stepwise skull base surgical 1997, pp 201–222 11. Hassig R: : Imperial Expansion and Politi- procedures. cal Control. Norman, OK: University of Oklahoma Press, 1995, pp 5–13 Disclosure 12. Hubert H, Mauss M: Essai sur la nature et la fonction du sac- rifice, inMélanges d’histoire des Religions. París: Ancienne The authors report no conflict of interest concerning the mate- Librairie Germer Balliere et C, 1971, pp 1–130 rials or methods used in this study or the findings specified in this 13. Johannessen S, Hastorf CA (eds): Corn and Culture in the paper. Prehistoric New World. Boulder, CO: Westview Press, 1994, Author contributions to the study and manuscript prepara- pp 5–22 tion include the following. Conception and design: Lopez-Serna, 14. Kirchhoff P: Mesoamérica. Sus límites geográficos, com- Arriada-Mendicoa, Romero-Vargas, Ramos-Peek, Celis-Lopez, posición étnica y caracteres culturales. , Mexico: Al Revuelta-Gutierrez, Portocarrero-Ortiz. Acquisition of data: Lopez- Fin Liebre Ediciones Digitales, 2009, pp 2–12 Serna, Coll, Portocarrero-Ortiz. Analysis and interpretation of 15. Markman PT, Markman RH: Masks of the Spirit: Image data: Lopez-Serna, Gomez-Amador, Coll, Romero-Vargas, Ramos- and Metaphor in Mesoamerica. Berkeley, CA: University of Peek, Celis-Lopez, Portocarrero-Ortiz. Drafting the article: Lopez- Press, 1990, pp 95–96 Serna. Critically revising the article: Lopez-Serna, Gomez-Amador, 16. Marlowe F: Hunter-gatherers and human evolution. Evol Anth Coll, Arriada-Mendicoa, Romero-Vargas, Revuelta-Gutierrez, 14:54 – 67, 2005 Portocarrero-Ortiz. Reviewed submitted version of manuscript: 17. Morales F: Franciscanos y mundo religioso en México. Lopez-Serna, Arriada-Mendicoa, Ramos-Peek, Celis-Lopez, Mexico City: UNAM, 1993, pp 4–18 Revuelta-Gutierrez, Portocarrero-Ortiz. Approved the final ver- 18. Prescott WH: The History of the Conquest of Mexico. New sion of the manuscript on behalf of all authors: Lopez-Serna. York: Modern Library, 1998, pp 7–14 Administrative/technical/material support: Lopez-Serna, Gomez- 19. Romero J: Dental mutilation, trephination and cranial defor- Amador. Study supervision: Gomez-Amador. mation, in Stewart TD (ed): Handbook of Middle American Indians: Physical Anthropology. Austin, TX: University of References Texas Press, 1970, pp 50–67 20. Romero-Vargas S, Ruiz-Sandoval JL, Sotomayor-González 1. Bartelink EJ, Wright LE: Benign mandibular tumours: two A, Revuelta-Gutiérrez R, Celis-López MA, Gómez-Amador case studies from the Maya lowland site of Tikal, Guatemala. JL, et al: A look at Mayan artificial cranial deformation prac- Int J Osteoarchaeol 21:351–359, 2011 tices: morphological and cultural aspects. Neurosurg Focus 2. Benz BF, Cheng L, Leavitt SW, Eastoe C: El Riego and Early 29(6):E2, 2010 Maize Agricultural Evolution, in Staller J, Tykot RH, Benz BF (eds): Histories of Maize: Multidisciplinary Approaches to the Prehistory, Linguistics, Biogeography, Domestication, and Evolution of Maize. Waltham, MA: Academic Press, Manuscript submitted April 7, 2012. 2006, pp 73–80 Accepted June 7, 2012. 3. Carrasco D: City of Sacrifice: The Aztec Empire and the Please include this information when citing this paper: DOI: Role of Violence in Civilization. Boston: Beacon Press, 2000 10.3171/2012.6.FOCUS12120. 4. Chavez-Balderas X: Human Sacrifice and Mortuary Treat- Address correspondence to: Raul Lopez-Serna, M.D., Depart- ments in the Great Temple of Tenochtitlan. Mexico: Fun- ment of Neurosurgery, Instituto Nacional de Neurologia y Neuro- dación para el Avance de los Estudios Mesoamericanos, 1997 cirugia, Av. Insurgentes Sur 3877, Col. La Fama, C.P. 14269, Tlal- pp 1–44 Retractedpan, Mexico City , Mexico. email: [email protected].

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