Trepanation! Not Just For Headaches: Tibial Surgery in Ancient Peru

Illustration of trepanation from 1800s France, via Wikimedia

Over the past two years, I’ve been commuting from my home to my university. It’s about an hour drive each way (unless it’s snowing, and then it could be two hours each way), and honestly- it has gotten to be quite boring. Over the last semester, I’ve changed from listening to books on tape, or rather books on iPhone, to listening to podcasts. One of my favorites is Sawbones, a marital tour of misguided medicine. My own research into the dead often overlaps with the history of medicine, so it’s been interesting to hear the historical and folkloric side of medical past. One of the most interesting medical procedures throughout history, and that continues today, is trepanation. Trepanation is primarily known as the technique whereby a hole is drilled, cut or sawed into the head of a human being for medical purposes (For more on this, see my first post, second post and third post on cranial trepanation). But new evidence shows that this might not be limited to just skulls, in fact, the technique may have been used for other purposes when there was a buildup of pressure in the bone.

A new study by Toyne (2015) examines possible evidence for the use of the trepanation technique applied to lower leg bones. The sample was found in the Chachapoyas region of Peru, at the Kuelap site, which dates from 800–1535 CE. The city was a powerful political and social center in this region, and was occupied by a large population. As Europeans began exploring this area of South America, they wrote about some of the surgical techniques practiced by these people. Numerous texts speak of the skills of the indigenous healers and note the presence of specialists who could deal with significant injuries, diseases and complicated medical treatments. Other bioarchaeological examples of surgery from this region and period show that they were able to do quite complex surgical interventions with success- the human remains show signs of amputations with clear healing of the bone. Trepanation of the skull was more common in this area, and many of the injuries show that the individual lived beyond their treatment, and in some cases lived for a long time.

Tibia of the first individual with trepanation drilling, Toyne (2015)

The two individuals under investigation include two males that were found in normal burial locations with evidence of traditional funerary behavior. The first individual is a male, aged 30 to 34 years old, who was buried lying on his back. Despite the surgical intervention, the individual was otherwise healthy and lacked major signs of stress in the majority of the skeleton. However, the end of the tibia (lower leg bone) shows a series of drilled holes similar to those found in cranial trepanations. The drilled holes reach from the outside to the center of the tibia, and were likely used to relieve pressure from an injury to this area that caused fluid build-up in the leg (i.e. intraosseous infection
and abscess of the metaphysis). Sadly, there is no healing of the injury, which means the individual died around the time that this drilling occurred.

The second individual is an adolescent male who has evidence of two holes drilled into the middle of the tibia. The holes go from the exterior to middle of the bone, suggesting, like the first individual, that there was some type of internal infection that caused buildup of fluid in the bone. Again, there is no evidence of healing or remodeling, suggesting the individual didn’t live long after the surgery occurred.

The use of trepanation for a leg injury is a rare phenomenon for this region, despite the more widespread use of this technique for cranial trauma. Most likely, the drilling was done to relieve pain and drain fluid from the infected area. However, Toyne (2015) also notes that this procedure done on the leg without successful healing may indicate that the individual doing the drilling was a novice who was learning the technique on the recently deceased or they were removing bone from the living individual to create a pendant or amulet- however both these are fairly unlikely given the normal burial within the city. More likely, the individuals here suffered some type of trauma or infection that led to the need for surgical intervention, but both sadly died during the procedure.

Toyne (2015) concludes that the use of the trepanation method on the tibia may represent either a local tradition or an inventive application of the well-known and proven surgical method for new problems. These two cases are the first reported application of the trepanation technique to a post-cranial (non-skull) bone for surgical or medical treatment. It is interesting to see people being creative with medical techniques in order to improve or save the lives of their society. Trepanation was a risky surgery, and I always think about the first individual who was brave enough to try it. So it makes sense that once that proved effective for relieving pressure beneath bone, that they would try it elsewhere.

Works Cited

Toyne, J. (2015). Tibial surgery in ancient Peru International Journal of Paleopathology, 8, 29-35 DOI: 10.1016/j.ijpp.2014.09.002