Medicine in the Pre-Columbian Americas

When the conquistador Hernán Cortes and his followers crossed the Gulf of Mexico for the first time in the year 1519, they expected to find primitive natives like those encountered in the Caribbean islands to the east. Instead, they found the Aztecs, rulers of the greatest empire in the New World, with advanced forms of government, planned cities, engineering and architectural skills, a system of writing and recording history through pictograms, a developed agriculture, and a sophisticated understanding of mathematics and other sciences, including medicine. The Spaniards’ astonishment was further compounded when they first saw and later conquered the Aztecs’ capital Tenochtitlan (present-day Mexico City), which rivaled the capitals of Europe.

To the south, another people, the Mayans, were settled in the Yucatan peninsula, Guatemala, and Honduras. Although in decline for centuries (having already abandoned some of their cities), the Mayans exhibited a cultural and scientific sophistication whose equal was only rarely found in the Old World. Even further south, in the Andes, was the extensive empire of the Incas.

The civilizations of the New World which so astonished the Europeans were, at that time, experiencing the final waves in a history that extended back thousands of years. Besides the three major civilizations mentioned, many other tribes, some quite advanced, others seminomadic hunters, had also existed.

About thirty-five hundred years ago, in the humid jungles of Tabasco and Veracruz, the Olmecs, a sensitive, brilliant people, began a civilization which was to define much of the cultural values of all the peoples of Mesoamerica. At about the height of their splendor, however, the Olmecs suddenly disappeared for reasons unclear even today. Fifteen hundred years ago the Maya achieved impressive advances in art and science. Their calendar was more accurate than many formerly used in the Old World, and they were able to predict with uncanny accuracy eclipses and even the movements of the planets.

About the year A.D. 1000, the people called Toltecs established their empire in central and southern Mexico, which was perhaps the first politico-military state in the New World. Several hundred years later, the hitherto semibarbarian and culturally insignificant Aztecs migrated into the area and within a century had established complete dominance. Like the Toltecs before them, they adopted many of their predecessors’ cultural qualities, which derived ultimately from the Olmecs. In the coastal regions of Peru, centuries before the birth of Christ, organized communities with rich cultural histories already existed, and, in the Bolivian Andes, the ruins of Tiohuanaco tell of a past splendor whose era we cannot precisely fix.

The Aztecs and other tribes believed that before the appearance of man a race of giants or gods had sacrificed themselves for the maintenance of the sun and that it was necessary for man to continue this practice. Blood was thought to sustain the sun, and elaborate sacrificial altars were constructed where, with sharp obsidian knives, priests tore beating hearts from living human beings! A large number of people throughout Mesoamerica were sacrificed in this way, and, to maintain an adequate supply for sacrifice, local wars often had the express purpose of providing victims. The Spaniards cited this abhorrent practice to justify the forced conversion to Christianity and subjugation of native populations.

An unfortunate side effect of Spanish rejection of some aspects of native culture (because they were “works of the devil” or “magic”) was the destruction of the vast majority of local records, including the history and literature of many societies. Hence, our reconstruction of pre-Columbian life depends in large part on the chronicles of the Spaniards themselves (both conquistadores and missionaries) or of natives converted by them. Fortunately, the intense fascination of the conquerors with the conquered led to a rich and extensive reporting, colored only by religious and philosophical differences.

Attitudes toward Disease

The pre-Columbian cultures maintained an intricate blending of religion, magic, and science to combat sickness, similar to the medicine of primitive societies: religion because certain gods were responsible for diseases whereas others would protect their devotees; magic since many diseases thought to be caused through enchantment by enemies or rivals had to be cured through magic; science in that plants, minerals, and medical procedures were used whose value is accepted to this day. Without doubt, however, magic and religion were more important than science.

Disease represented a loss of balance between favorable and unfavorable influences. It was important to determine the responsible force in order to placate or expel it. For the pre-Columbian native, nothing was natural, not even death; a supernatural power toyed with mankind, as in other ancient civilizations. Causation was inevitably otherworldly, but the origin and development of disease would vary according to the circumstances.

The decline of Mayan society might have had some connection to the persistence of endemic, contagious disease, most probably yellow fever, or “black vomit,” as it was characterized by the Maya in their pictograms and by the Spanish conquerors. It is possible that this disease was responsible in part for the Mayan exodus from their homes and temples, their abandonment of magnificent cities later covered over for centuries by the jungle.

Medicine and its Practitioners

In most societies of Mesoamerica, primitive medical practices coexisted with sophisticated concepts and procedures. As in the primitive medicine of less advanced civilizations, magical practices (the invocation of spirits or influences) were mingled with procedures shown by experience to be effective, procedures employed largely in response to an immediate need, such as a wound, an injury, or severe pain.

As in most primitive societies, the roles of doctor, witch doctor, and priest were commonly united in the same person. In the Americas, the witch doctor relied heavily upon ceremonial clothing and ritual gestures as he would kneel beside the sick person, rub the diseased part, and then attempt to suck out the cause of disease. In front of relatives and friends gathered around the sick person, the witch doctor with grotesque gesturing, would regurgitate arrowheads, small toads, and other strange things to which the disease had been attributed (as did the Amerindian medicine man and the Congo witch doctor).

Another kind of healer-priest was the Old World shaman, characterized by his use of trances. In the New World, shamanism was widespread throughout the continents, but its presence was especially strong in both the extreme north and south (in Chile, for instance), and that is cited as supporting the theory that the original inhabitants of the Americas came from Asia.

Another characteristic of these practitioners was the separation they made between magical practices (which they, in general, retained for themselves) and simple surgical procedures (which were commonly entrusted to lesser personages). The witch doctor set himself apart from the general population, and his clothing and way of life distinguished him. Not only did his embellishments signify distinction and superiority over other members of the group, but they were intended to produce a terrifying aspect which would impress and frighten demons.

Even though all these characteristics of the healer-priest seem to have been common to the various pre-Columbian populations, his different attributes were adapted to the social organization of each group. Among the Maya, who possessed a theocracy, the art of healing was entrusted to the hemenes, priests who were organized into a true medical society whose knowledge was thought to be inherited from the gods. In addition, there were hechiceros of lesser status who did not form part of the priestly caste and were responsible for the practice of bleeding, treating wounds, opening abscesses, and reducing and treating fractures.

Among the Aztecs, the medical profession acquired a hereditary character. It was a father’s duty to entrust the knowledge of medical functions to his son; nevertheless, the son was not permitted to practice while his father was alive. Healers were divided into a series of specialties. The most common was the healing with herbs and by means of external manipulations done by the tictl, who combined with invocations and magical gestures some knowledge of the human body and the properties of plants and minerals. In addition to this specialist (which we might call clinical healer), others were entrusted with the tasks of pulling teeth, attending births, and setting fractures. The high quality of medical care by Aztec physicians was reflected in the conquistadores’ common preference for them over their own physicians trained in Europe. Philip II sent one of his doctors, Francisco Hernandez, to Mexico to study the native medicine and put together a catalog of medicinal plants.

The treatment of disease is in large part dependent upon the concept of causation: if a disease is believed to be magically or supernaturally derived, then curative procedures will be likewise of a magical nature. On the other hand, when drugs and medical procedures are thought to be effective, an empirical medicine will result which will incorporate them. The healer-priest of the Americas combined both types of treatment. Therapy was based upon herbs, mineral substances, animal products, and simple procedures, like bleeding, enemas, and plasters, but also on religio-magical endeavors such as ritual dances and offerings.

Medications

In Mexico, the climate favored the growth of many species of plants which were of great importance to Aztec doctors. Many years before Europeans cultivated them, Montezuma maintained a royal nursery of medicinal plants which supplied medications to the rest of the kingdom. Among these were narcotics, numerous medicines for diarrhea, drugs to induce abortion, and salves for skin diseases. But above all, the Aztecs preferred drugs which induced purging, vomiting, or sweating to expel bad spirits.

The Incas employed many plant remedies, especially quinine derived from cinchona bark, which was effective in the treatment of malarial fevers, and the coca leaf (containing cocaine), which was used both to calm and stimulate. Other common plant-derived drugs were atropine, ipecacuana, curare, theophyllin, and many another medicine which appears in today’s pharmacopeia.

Plants whose principal active components caused profound psychic effects fulfilled an important function in the religious ceremonies as well as in medical practices. The three basic plants used were peyotl, a type of cactus, teonancatl, a variety of fungus, and ololiuqui, a type of vine; their active substances were mescaline, psilocybin, and psylocine. Among these plants, we should also include the chamico, which has an atropinic effect and had widespread use in Chile.

Surgery

Surgical procedures were highly developed among some of the pre-Columbian peoples. Wounds were cleaned and closed with astringent vegetable concoctions or egg substances of divers birds and then covered with feathers or bandages made of skin. Common bleeding was controlled by placing masticated herbs over the wounds. In addition, the ancient Peruvians stanched scalp bleeding by wrapping a large cord with a type of gauze around the head several times at the base of the skull, like a tourniquet, until sufficient pressure stopped the bleeding. Among both the Incas and other pre-Columbian peoples, the surgeon was often a separate practitioner who looked after wounds and performed bloodletting and other lesser surgical practices. He also accomplished the astonishing feat of trepanning the human skull. Many skulls, some with several trepanations in different stages of healing (which indicates survival), have been found and testify to the skill of this practice. Here, too, it is not known what the purpose was.

Public Health

The Aztecs formed an empire which was startling to the conquistadores not only for its material and cultural splendor but also for its cruelty and lack of concern for human life. Violence was a principal cause of death among the Aztecs, whether in war or upon the sacrificial altars. Nevertheless, the Spaniards were also astonished by the sophisticated means of maintaining public health in the fabulous Aztec capital Tenochtitlan. A system of drainage provided adequate disposal of wastes, and in each street (as we are told by the conquistador Bernal Diaz) there were public latrines which allowed personal privacy. Refuse was carefully collected and buried outside the city limits, and cleaning the streets was the responsibility of each district. Thus, at the beginning of the sixteenth century, Tenochtitlan was not only a prosperous city but also a healthy one. In none of the numerous Aztec codices were epidemics described. The first one to devastate the city, smallpox, occurred after the arrival of the Spaniards. (The venerable question of whether syphilis was exported to Europe from the New World by the returning sailors of Columbus or whether it was always endemic in Europe and Asia before its epidemic spread remains unsettled.)

The cultures of the pre-Columbian Americas had medical practices closely resembling those of primitive societies; yet their civilizations were highly developed in many other respects.

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Albert S. Lyons, MD

Albert S. Lyons, MD (1912-2006) was a surgeon at Mount Sinai School of Medicine and The Mount Sinai Hospital from the 1940s until his death. Starting in the 1960s, he also served as the Historian and then Archivist for the institutions. In that role, he served as a resource on the history and would answer questions from researchers. He recorded this tape to provide information about the history of thoracic surgery at Mount Sinai. Dr. Lyons discusses the following Mount Sinai surgeons: Howard Lilienthal, MD; Harry Wessler, MD; Amiel Glass, MD; Harold Neuhof, MD; Sidney Yankauer, MD; John Garlock, MD; Albert A. Berg, MD; and Paul Kirschner, MD.

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