Inca and the Andes

Cords, not script

An empire that kept its accounts on knotted cords

The Inca kept records without writing. The khipu, from the Quechua word for knot, is a thick primary cord hung with thinner pendant cords carrying knots in patterned positions, spun from cotton and camelid fiber. UNESCO calls it the main record-keeping tool of the empire, dated roughly 1400 to 1532 CE, and counts 923 khipus inventoried in museum collections across three continents.

Almost everything written about Andean healers was therefore set down after the Spanish conquest. Jan Elferink, surveying those sources, warns that many chroniclers were priests who treated Andean religion as the work of the devil, and that their reports on healing therefore have to be read with suspicion. Even Felipe Guaman Poma de Ayala, an Andean author, wrote his 1,200-page illustrated chronicle for a Spanish king.

The chroniclers missed the largest thing in front of them. Elferink notes that none of them mentioned trepanation, the most impressive surgical achievement in the region. Two records survive, one in ink and one in bone, and only the ink could be edited.

Trepanation in the Andes

What Andean surgeons did to the living head

Trepanation is the cutting or scraping of an opening through the vault of a living skull. Andean surgeons used scraping, circular cutting, sawing, drilling, and combinations of these, working with tumi knives, obsidian blades, and other tools recovered from Peruvian sites. Circular cutting and scraping dominate the Cuzco sample.

The reason was injury. Verano states that the evidence links the surgery to patients with severe head trauma rather than to ritual or to raising consciousness. Andean warfare ran on clubs, slings, and thrown weapons, which break skulls. Andrushko and Verano found that most Cuzco openings sit where a right-handed opponent's blow would land.

It was common surgery in some communities. The Cuzco survey screened 411 crania to find its 66 trepanned individuals, and at one site 21 of 59 skulls had been opened. Nineteen of the patients in that survey were women, which points to conditions other than combat wounds among the reasons for operating.

Healed bone as an outcome

How a skull records whether the patient lived

Bone answers the question a chronicle cannot. A patient who died at or near the time of surgery leaves sharp, raw margins at the opening. A patient who lived leaves remodeled bone, the edges smoothed and rounded as the living skull closed over the wound across months and years.

Every trepanned skull is therefore an outcome, and more than 800 of them form a clinical series spanning nearly two thousand years. Researchers can sort survival by culture, by region, and by century, then watch the craft change. Elferink puts the inference plainly: the high proportion of skulls showing healing means the operations were carried out carefully by experienced surgeons.

The single most telling case is the man MacCurdy described in 1923, whose skull carried seven separate openings and no fatal one. Whoever operated on him the seventh time was working with a technique that had already been proved six times on the same head.

The improvement curve

Andean survival rates rose across eighteen centuries

The gain was in technique, and the study that measured it says which technique. Kushner, Verano and Titelbaum conclude that the successful operations were shallow ones that did not pierce the dura mater, the tough membrane wrapping the brain. Over centuries, surgeons adjusted the size and the placement of the opening and learned where the venous sinuses run.

Andrushko and Verano report the same movement inside a single region. Across their 11 Cuzco sites, survival rose significantly over time, and they attribute the rise to experimentation and practical experience rather than to any change in tools.

That is a manual craft improving because its practitioners tracked what happened to their patients. Nobody wrote the results down. The correction was carried in hands and in teaching, and it shows up eighteen centuries later as a number in bone.

The healers named in Quechua

Who practiced medicine in the Andes

The 1608 Vocabulario compiled by the Jesuit Diego González Holguín is the closest thing to a professional register. It glosses hampi camayoc as the physician or surgeon. The word joins hampi, medicine, with camayoc, the official charged with something. The same pages give chukri hampicamayok for the surgeon who treats wounds, circay camayoc for the bloodletter, circana for his lancet, and huachachik for the midwife.

The chronicles add roles the dictionary does not explain. The moscoc was a diviner consulted on whether a sick person would live or die, working from a hair or a piece of clothing slept on overnight. Confession to a ritual specialist called the ychuri was itself treatment, and the chronicler Polo reports that households confessed when a child, a wife, or the local lord fell ill.

Elferink's warning applies hardest to the chronicle material. Illness understood as a consequence of sin sits close to the Christian preoccupations of the men writing it down, so how much of that framing is Andean and how much is Spanish remains open. The occupational vocabulary is firmer ground, because it is Quechua.

Bonesetting and plasters

Fractures, wounds, and the plants applied to them

Andean healers worked the frame as well as the skull. The chronicler Cobo describes a distinct class of healers who treated broken and dislocated bones and gave the patient close attention. More than twenty plants are described in the sources for fractures and dislocations, applied for the most part as a plaster laid over the injured site.

Wounds, ulcers, and skin disorders were the other area of deep experience. Warfare with clubs, slings, and arrows supplied the caseload. Medicine and manual work sat inside one word: the term for a surgeon carries hampi, medicine, inside it, which is why Elferink reads plant preparation as part of surgery rather than as a separate trade.

Some of the practice can only be inferred, and the scholarship says so. Elferink proposes that strongly fermented chicha, possibly with espingo seeds added, sedated patients, and that plants rich in tannins, saponins, and resins served as antiseptics. Rifkinson-Mann suggested the tannin-rich ratanhia root for stopping bleeding. These are proposals about method. The outcome is the part the bone settles.

Coca, the daily medicine

The leaf Andean people have used for three thousand years

Coca is the plant most closely bound to Andean life. Analysis of mummified human remains from northern Chile indicates its use as early as 1000 BCE. The method has changed little: dried leaves are held in the cheek with a pinch of alkaline ash, which frees the active compounds for slow absorption.

Biondich and Joslin, reviewing the tradition in 2016, list the established uses. Relief of gastrointestinal distress, stomach pain, nausea, and indigestion. Management of the stresses of working at altitude. Suppression of appetite and of fatigue during long physical labor. Care of oral lesions and dental pain.

The whole leaf carries a small fraction of the cocaine content of the isolated alkaloid, and the two are not interchangeable. Biondich and Joslin also record a paucity of medical data on safe use of the leaf, and state that controlled trials would have to come before any medical recommendation.

The Kallawaya today

Itinerant healers still walking their circuits in Bolivia

The Kallawaya practice in the mountainous Bautista Saavedra region north of La Paz, in Bolivia. UNESCO describes itinerant healers, men by tradition, who treat patients with medical and pharmaceutical knowledge held in a system of transmission and apprenticeship in which traveling itself is essential. Crossing different ecosystems on foot is how the command of plants is built.

Kallawaya women take part in the rites, care for pregnant women and children, and weave textiles patterned with the cosmovision. Musical ensembles called kantus play drum and pan flute during ceremonies. Within their kinship groups, the ayllus, the healers transmit a craft language called Machaj Juyai. Carmen Beatriz Loza counts eight Kallawaya ayllus and reports that few speakers remain fluent. Its origin is argued, with the ancient Puquina language and the secret speech of the Inca rulers both proposed.

Loza records the persecution of the Kallawaya elite in the seventeenth century, during the Church campaign known as the extirpation of idolatry. She records the mass emigration to Peru in the nineteenth century. She records the Kallawaya healers who served in the early twentieth century as official doctors to President Augusto Bernardino Leguía. UNESCO lists the tradition today as threatened by acculturation and by weak legal protection for Indigenous knowledge.

Ayni and communal work

The Andean rule of reciprocity, and what it does not claim

Ayni is cooperative labor exchanged between community members of equal standing. Mink'a is the communal obligation every member contributes to. Quechua vendors in Chinchero, interviewed in 2018, described both as central to community life since before the Inca. They named community, reciprocity, and harmony as the content of a good life.

The clearest working example is the Q'eswachaka rope bridge. Four Quechua communities, Huinchiri, Chaupibanda, Choccayhua and Ccollana Quehue, renew it every year in a three-day communal work, twisting grass into ropes about 70 meters long and weaving the span. UNESCO inscribed the knowledge, skills, and rituals of the renewal in 2013, and records that the annual event structures the life of the participating communities all year round.

Ayni governs social and economic exchange, and the ethnographic record keeps it there. None of the Chinchero vendors named health among the things that make life good. The medical claim comes from a different source, the chronicles, which report Andean illness understood as a relationship in disorder.

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