Living with Holes in the Head: A regional study on the nature and survival rates of trepanation in Pre-Colonial Peru Jennifer Stacey s1829424 Figure 1: A pencil drawing depicting a large trepanation, found in Paracas on the south coast of Peru. Held at the Museo Nacional de Antropología, Arqueología, y Historia, Lima, Peru (Stacey 2019). 1 Living with Holes in the Head: A regional study on the nature and survival rates of trepanation in Pre-Colonial Peru Jennifer Stacey (s1829424) Thesis BA3 (1043SCR1Y-1819ARCH) Supervisor: Dr. R. Schats Specialisation: Bioarchaeology (Osteology) University of Leiden, Faculty of Archaeology Leiden, 01/02/2019 (Final Version) 2 Table of Contents 1. Introduction ............................................................................................................. 5 1.1. Defining Trepanation ............................................................................................... 5 1.2. Trepanation in Peru.................................................................................................. 5 1.3. Aims & Research Questions ..................................................................................... 8 1.3.1. What were the characteristics of trepanation in Pre-Columbian Peru? .......... 8 1.3.2. What is the survival rate of trepanation in Pre-Columbian Peru? ................... 9 1.4. Approach & Materials .............................................................................................. 9 1.5. Thesis Outline ......................................................................................................... 11 2. Context & Archaeological Background ................................................................. 13 2.1. Archaeological Periods ........................................................................................... 13 2.2. Context of Materials .............................................................................................. 15 2.2.1. Apurímac Department .................................................................................... 15 2.2.2. Cusco Department .......................................................................................... 16 2.2.3. Amazonas Department ................................................................................... 17 2.2.4. Lima Department ............................................................................................ 18 3. The Nature of the Trepanations ........................................................................... 20 3.1. Method of Trepanning ........................................................................................... 20 3.2. Location of Trepanation ......................................................................................... 24 3.3. Biological Profiles ................................................................................................... 27 3.4. Number of Trepanations ........................................................................................ 30 3.5. Additional Characteristics of Trepanation ............................................................. 33 4. The Survival Rate of the Trepanations ................................................................. 35 4.1. Biology of Trepanation ........................................................................................... 35 4.2. Survival Criteria ...................................................................................................... 37 4.2.1. Stage 0 ............................................................................................................ 37 4.2.2. Stage 1 ............................................................................................................ 38 3 4.2.3. Stage 2 ............................................................................................................ 39 4.3. Intra-operative Complications ............................................................................... 40 4.4. Post-operative Complications ................................................................................ 41 4.5. Survival Rate ........................................................................................................... 42 4.6. Methodological Influences of the Survival Rate .................................................... 43 4.6.1. Technique of Trepanation vs. Survival ........................................................... 44 4.6.2. Location of Trepanation vs. Survival .............................................................. 45 5. Discussion............................................................................................................... 47 5.1. Confounding Factors .............................................................................................. 47 5.1.1. Pseudo Trepanation ....................................................................................... 47 5.1.2. Issues with the Sample ................................................................................... 49 5.1.3. Issues with the Survival Criteria ..................................................................... 49 5.2. Age-at-death vs. Survival........................................................................................ 50 5.2.1. Age-at-death of Stage 0 and 1 ........................................................................ 51 5.2.2. Age-at-death of Stage 2 .................................................................................. 52 5.3. Comparisons with other Trepanation Studies ........................................................ 53 5.3.1. Methods of Trepanning .................................................................................. 54 5.3.2. Location of Trepanation ................................................................................. 55 5.3.3. Biological Profiles ........................................................................................... 56 5.3.4 Survival Rates of Trepanation.......................................................................... 58 5.4. Possible Reasons for Ancient Peruvian Trepanning ............................................... 60 6. Conclusion .............................................................................................................. 62 6.1. What were the characteristics of trepanation in Pre-Columbian Peru? ................ 62 6.2. What was the survival rate of trepanation in Pre-Columbian Peru? ..................... 63 6.3. Future Research ..................................................................................................... 63 7. Abstract .................................................................................................................. 65 4 1. Introduction 1.1. Defining Trepanation This thesis aims to define the characteristics of trepanation in Pre-Columbian Peru, as well as the survival rate of this procedure. Trepanation, or trephination, is the act of creating an opening in the cranium vault. It is a form of cranial modification which has been found in areas around the world with similar diagnostic features (Verano 2016, 1). Peruvian individuals have been found with deliberate cranial trauma for over a century (Fernando & Finger 2003, 3; Heaney 2018, 350) and this has been the subject of many theories – from ritual to ancient surgery. Trepanation is interesting to study because it can enable us to understand more about a Peruvian practice whose history has been overlooked. Since the Spanish invasion, the practice was almost entirely distinguished within Peru, and not written about. The existence of Peruvian trepanation was only considered by scholars after evidence was found of deliberate cranial hole-making within Neolithic Europe. Because of this, it is important to utilise the archaeological evidence available to us in order to learn about this forgotten practice. Unfortunately, few region-wide studies have been performed on this subject, and survival rates have often been published on small sample sizes. This thesis will combat this by combining these studies to create an overview of the practice. 1.2. Trepanation in Peru Trepanation is a phenomenon that appears regions and decades apart. The etymology of the word “trephination” has lingual roots from Ancient Greek society. The word is a derivative from the term for “borer” (trypanon), in which the instrument would be the “trepan”. Since recent times, it has been understood that the practice of trepanation has a history in both the Western 5 and Eastern parts of the world – existing in parts of China (Hobert & Binello 2017, 451; Lv et al. 2013, 897), regions of Neolithic Europe (Bennike 2003, 95; Nicklisch et al. 2018, 216; Prioreschi 1991, 296), the Mediterranean (Crubézya et al. 2001, 417; Riccomi et al. 2017, 9), Russia (Gresky et al. 2016, 665), North Africa (Nikita 2013, 370), the Near East (Erdal & Erdal 2011, 505), North America (Stone & Miles 1990, 1015), Central America (Wilkinson 1975, 838) and other parts of South America besides Peru (Gomez 1973, 585). While death may be an expected result of this practice, many cases show that it is possible to survive the procedure. This is shown through ancient cases of healing. Surviving a trepanation would involve the opening of the scalp layers and the cranial vault, producing a highly hazardous lesion to care for. After this, infections are of an increased likelihood due to the extensive and constraining healing process an individual must go through. Despite this, long-term survival