What Did Maya Surgeons Do for Patients?

Maya surgery was a developed specialty within the broader tradition of Maya healing described in the page on Maya medicine, healers, and herbal remedies. The four principal kinds of operation were skull trepanation, dental modification and inlay, bone-setting and wound treatment, and ritual bloodletting. Each was performed with obsidian, flint, bone, or wooden instruments; each was done by a specialist within the healer class; and each left a record on the bones, the teeth, and the inscriptions of the Classic period. The ritual context is treated in Maya rituals of bloodletting and sacrifice, and the diagnostic categories of Maya medicine are described in the related page on Maya religion, mythology, and cosmology.

Trepanation: the most dramatic operation

Trepanation — the surgical opening of the skull — is the most distinctive Maya operation, and the one best documented in the archaeological record. The operation was performed on a living patient to relieve pressure from a depressed skull fracture, to remove a bone fragment, to treat a chronic headache or a neurological condition, or, in some cases, for ritual reasons. The operation was done with an obsidian-tipped or flint-tipped drill, by scraping with a stone tool, or by a combination of the two. The patient was anesthetized with alcohol (typically balché), datura, or tobacco, and the wound was dressed with powdered copal or other herbal preparations.

The record of trepanation in the Maya area is extensive. Hundreds of trepanated skulls are known from sites as far apart as Chichen Itza in the northern lowlands, the highland Guatemalan site of Kaminaljuyu, and the central Peten lowlands. The mortality rate from the operation, judged by the proportion of skulls showing evidence of healing around the operation site, varies from about 50 percent in some series to over 80 percent in others. The successful operations are evident in skulls that show a clear ring of new bone growth around the opening, indicating that the patient survived for months or years after the operation. The failed operations, with no bone growth, are equally common in the archaeological record.

The sites of the operations are not random. The most common are the frontal bone, the parietal bones, and the occipital bone, with smaller numbers of operations on the temporal and the mastoid. The operation was performed on both men and women, and the patients ranged in age from children to elderly adults. The selection of operation site is consistent with the practical purpose of relieving pressure from a depressed fracture, but a small number of operations on the parietal and frontal bones of apparently healthy skulls suggest that the operation was also performed for ritual or magical purposes.

Dentistry: the inlay of jade, pyrite, and turquoise

Maya dental practice included both routine treatment and cosmetic modification. The routine treatment included the removal of abscessed teeth, the cleaning of carious lesions, and the use of natural fillings. The cosmetic modification included the inlay of the front teeth of the elite with disks of jade, pyrite, hematite, and turquoise. The inlay was placed in a small cavity drilled into the labial surface of the tooth, often after the removal of a small portion of the enamel, and cemented in place with a mineral adhesive. The inlay was visible in the smile and was a marker of elite status.

The operation was performed on living patients, as the modern X-ray study of buried remains has shown: the inlay is in situ in the tooth, and the bone of the jaw shows no evidence of post-mortem disturbance. The patients were adult members of the elite, and the operation was performed by a specialist dentist who had trained in a long apprenticeship. The best-known examples are the dental inlays of Copan, where a study of the dental remains of the royal tombs has shown a high rate of inlay among the elite; Tikal; Palenque; and the central lowland sites of the Late Classic period.

The technique required a high degree of skill. The cavity had to be drilled into the labial enamel without penetrating the dentin and killing the tooth; the inlay had to be shaped to fit the cavity; and the adhesive had to hold the inlay in place for the life of the patient. The fact that many of the inlays are still in place in skulls that are 1,200 to 1,500 years old is evidence of the technical skill of the Maya dentist.

Bone-setting and wound treatment

The skeletal record of the Classic period shows evidence of fracture treatment, dislocation reduction, and the management of complex wounds. The most common fractures are those of the long bones of the arms and legs, the clavicle, the ribs, and the nose. The simple fractures are typically healed in good alignment, often with the callus of a clean break, indicating that the bone was set and splinted. The complex fractures — multiple breaks, compound fractures, and the fractures of large bones — are typically healed in less perfect alignment, with the bone sometimes shortened, sometimes angled, and sometimes with a residual callus that shows the operation was performed without the benefit of modern orthopedic tools.

The treatment of dislocations is less visible in the archaeological record, but the surviving iconography shows healers manipulating joints, and the colonial sources describe the practice. The Maya healer used traction, manipulation, and the application of herbal poultices to reduce the dislocation and to relieve the pain. The same practitioner would have used similar techniques on the battlefield, where the most common injuries were those of the limbs, the head, and the abdomen.

The treatment of wounds included the cleaning of the wound, the removal of foreign material, the application of an herbal poultice, and the bandaging of the wound. The Maya used copal resin as a wound-dressing, sometimes mixed with honey, and used the leaves and bark of various plants as poultices. The colonial sources describe the use of spider webs and the application of animal fat as wound dressings, but the practice is not well documented in the archaeological record.

Bloodletting: the operation of the pul

The pul was a specialist in ritual bloodletting, and the operation was the most commonly performed surgical procedure of the Maya. The blood was drawn from the tongue, the ears, the genitals, the calves, and other parts of the body, using obsidian lancets, stingray spines, bone awls, and the whips made from the dried tail of the stingray. The operation was performed for ritual purposes — to mark a calendrical period-ending, to communicate with the ancestors, to mark the inauguration of a king — and for medical purposes, as a treatment for headaches, eye complaints, fever, and skin conditions.

The ritual context is described in Maya rituals of bloodletting and sacrifice and is also treated in Why did the Maya practice bloodletting?. The medical context is described in the page on Maya medicine, healers, and herbal remedies.

The instruments of the pul are well documented. The obsidian lancet is a small, sharp, leaf-shaped piece of obsidian, often with a wooden or bone handle. The stingray spine is a natural hypodermic needle, sharp enough to penetrate the skin and leave a small wound. The stingray-tail whip is a length of dried stingray tail, lashed to a wooden handle, and used to strike the patient and draw blood. The bone awl is a small pointed bone, often from a deer or a turkey, used to draw small quantities of blood for tests or for ritual purposes.

The operation was performed in a ceremonial setting. The patient — often a king, a noble, or a high-ranking healer — was seated on a low platform or a stone bench, and the pul would draw the blood with a careful stroke, the blood being collected on bark paper or on a piece of cotton. The blood was then burned as the paper was burned, with the rising smoke understood to feed the gods and the ancestors. The operation is depicted in the Maya murals of Bonampak, San Bartolo, and Calakmul, and the instruments are described in the iconography of the Maya art, architecture, and monuments overview.

Battlefield surgery and the treatment of captives

The Maya were a warlike society, and the skeletal record shows evidence of injuries consistent with the weapons of the day: obsidian-edged wooden clubs, flint-tipped spears, and the atlatl-and-dart combination. The most common battle injuries were the depressed skull fractures caused by the wooden club, the puncture wounds of the spear and dart, and the slashing wounds of the obsidian-edged weapons. The treatment of these injuries was the responsibility of the healer and the pul, and the surviving skeletal record shows evidence of successful treatment in many cases.

The treatment of captives is a separate question. Captives taken in war were typically used for sacrifice, and the sacrificial context — including the extraction of the heart, the beheading, and the display of the body — is described in Maya rituals of bloodletting and sacrifice. The role of the healer in the care of captives is not well documented, but the evidence suggests that the Maya made some effort to keep captives alive and in good health until the time of their sacrifice. The treatment may have included the dressing of wounds and the provision of food and water.

The training of the surgeon

The training of the Maya surgeon is not well documented, but the practice was clearly a long apprenticeship within a family or a school. The trainee would have learned the identification of the plants used in anesthesia, the preparation of the instruments, the operation itself, and the post-operative care of the patient. The training would have included the memorization of an almanac of the operation, a tzolk’in-based table that paired day-names with specific operations and outcomes, in the same way that the healer learned the almanac of the medical practice.

The surgeon was a respected member of the community, and the role was hereditary in many cases. The position was associated with the elite, and the surgeons of the major royal courts — the royal court of Palenque, the Tikal dynasty, the Copan court — were among the most prestigious members of the court. The same pattern is described in the Maya priesthood and shamanism page.

Sources

Aveni, A. F. (2001). Skywatchers of Ancient Mexico. University of Texas Press. — link
Saturno, W. A. et al. (2012). Ancient Maya astronomical tables from Xultun, Guatemala. Science 336 (6082), 714–717. — link
Berlin, E. A. & Berlin, B. (1996). Medical Ethnobiology of the Highland Maya of Chiapas, Mexico. Princeton University Press. — link
Sharer, R. J. & Traxler, L. P. (2006). The Ancient Maya (6th ed.). Stanford University Press. — link
Coe, M. D. (1993). The Maya (5th ed.). Thames & Hudson. — link