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International Journal of Osteoarchaeology

Int. J. Osteoarchaeol. 10: 177 – 188 (2000)

Foot Amputation by the Moche of Ancient
Peru: Osteological Evidence and
Archaeological Context
Department of Anthropology, Tulane University, 1021 Audubon St., New Orleans,
LA 70118, USA
Fundación Augusto N. Wiese, Jiron Carabaya No. 501, Lima, Peru

ABSTRACT Three probable cases of foot amputation, with healing, in skeletal remains associated with the
Moche culture (AD 100–750) of northern coastal Peru are described. Each case exhibits
non-functional tibio-talar joints with proliferative bone occupying the normal joint space. The
robusticity of the tibiae and fibulae suggest renewed weight-bearing and mobility following
recovery. The osteological evidence is consistent with details shown in Moche ceramic
depictions of footless individuals. A footless Moche skeleton with wooden prostheses, described
in 1913 by Peruvian physician Vélez López, appears to represent a fourth example of this
procedure. The Moche surgical approach was similar to a technique that would be pioneered in
western medicine by the Scottish surgeon Sir James Syme some 1500 years later. Copyright
© 2000 John Wiley & Sons, Ltd.

Key words: amputation; Moche; palaeopathology; Peru; surgery; Syme amputation

Introduction other Roman physicians of the first century AD
(Meade, 1968). Evidence that amputations were
Amputation and trephination are the two most performed in the pre-contact New World is
common forms of ancient surgery described in more illusory, as it is based strictly on archaeo-
the palaeopathological literature (Steinbock, logical evidence. Possible examples of amputa-
1976; Ortner and Putschar, 1981). Trephined tion have been reported in skeletal remains from
skulls are known from many parts of the world, North, Central, and South America (Morse,
and there is no question that the practice has 1969; Hurtado, 1970; Saul, 1972; Friedmann,
considerable antiquity in both the Old World 1973; Stewart, 1974; Merbs, 1989), although
and the Americas (Aufderheide and Rodrı́guez- some of these probably represent non-union of
Martin, 1998). Evidence for the practice of fractures rather than amputation (Stewart,
amputation in prehistoric times is less convinc- 1974). Pre-hispanic artistic depictions of indi-
ing. Bloom et al. (1995), Mays (1996), and viduals missing feet, hands, or entire limbs have
Aufderheide and Rodrı́guez-Martin (1998) also been used to suggest that amputations were
provide recent reviews of possible cases of am- performed in the Americas before European
putation in the archaeological record, emphasiz- contact (Tello, 1924; Donnan, 1978; Urteaga-
ing some of the problems in diagnosis. In the Ballon, 1991).
Old World, written descriptions of amputation This report describes three recently-discov-
date back as early as the sixth century BC, and ered cases of what appears to be surgical ampu-
the practice is well-described by Celsus and tation of the foot by disarticulation of the ankle
* Correspondence to: Department of Anthropology, Tulane Uni- joint in skeletal remains associated with the
versity, 1021 Audubon St., New Orleans, LA 70118, USA. Tel.:
+ 1 504 8623049; fax: + 1 504 8655338; e-mail: ver- Moche culture (AD 100–750) of northern coastal Peru. The remains were recovered in
Copyright © 2000 John Wiley & Sons, Ltd. Received 6 April 1999
Revised 10 November 1999
Accepted 14 November 1999

1994. J. Case III was discovered Figure 1. Case descriptions Case I Cases I and II were excavated at the archaeolog. contained the project and supervises the field research. exception of the bones of the feet. West Sector ical complex of El Brujo. and the Augusto N. valley (Figure 1). Articulated leg bones of Case I (anterior view). Verano et al. El Brujo Complex. Los An- common pattern of healing followed by re.W. Wiese Foundation of Peru Tomb 4. Tomb 4 sity of Trujillo. The bony response in each directed by Glenn Russell of the Institute of case is remarkably similar. The burial searcher with the El Brujo Project since 1995. 1996). with the other author (JWV) has been an affiliated re. which has been the focus of a major Peruvian archaeological project co-directed by archaeologists from the Univer. National Institute of Culture. complete skeleton of an adult male. was one of four individuals—two adult and two directing the analysis of human remains recov. a zooarchaeol- Brujo and Mocollope in the lower Chicama river ogist for the Mocollope Archaeological Project. Figure 2. University of California.. One of west side of one of the two major adobe plat- the authors (RFJ) is a co-director of the El Brujo forms at El Brujo (Huaca Cao). Ltd. 10: 177–188 (2000) . geles. adolescent males—found in simple graves ered from excavations. An. Copyright © 2000 John Wiley & Sons. other author (LSA). Int.178 J. Osteoarchaeol. Analyses of the human remains described newed adaptation to weight-bearing and in this report were conducted by JWV and the locomotion. excavated in 1995 from a unit on the since 1991 (Franco et al. Map of the north coast of Peru. 1995 and 1998 at the archaeological sites of El and collected by Thomas Wake. and seems to reflect a Archaeology.

No offerings were found in Tomb 4 (Franco et al. Figure 5. suggesting that they were of relatively low status. 1995). 10: 177–188 (2000) . as well as cranial suture closure (following guidelines presented in Buikstra and Ubelaker. All foot bones are absent. Distal ends of tibiae and fibulae. placed in architectural fill below an intact layer of adobe bricks. The distal tibiae and fibulae show non-functional joint surfaces. Osteoarchaeol. Copyright © 2000 John Wiley & Sons. Case I (anterior oblique view). Male sex is indi- cated by the morphology of the os coxae and skull.Moche Foot Amputation 179 lar surface. Case II (posterior view).. including morphology of the pubic symphysis and auricu- Figure 4. despite their loca- tion close to the platform. Ltd. Few grave offerings were found with these individuals. 1994) suggest an age at death of approximately 35–39 years. Multiple skeletal age indicators. Case I. Radiograph of tibiae and fibulae. Left tibia and fibula. Int. Figure 3. J.

10: 177–188 (2000) . All synovial joints are normal in appearance. No artifacts were recovered with the status chamber tomb within the Huaca Cao remains. foot recovered. 25–35 years) is estimated from epiphyseal closure and auricular surface morphology. with joint spaces filled with irregular growths of pyramid at El Brujo in 1998. missing only the skull. The right fibula also shows an inward bending of the lateral malleolus similar to what was seen in Case II. Int. The distal tibia and fibula show anterior inferior iliac spines are strongly devel. bony ankylosis at the fibular notch. Adult age is indi- dense bone (Figures 2 and 3). The left ankle joint is normal in appearance. cal. appears normal (Figure 10). Ltd. proximal to the appearance. Osteoarchaeol. Female sex is indicated by a wide greater sciatic notch. the ankle joint is grossly pathologi- ankle joints. and a pronounced preauricular sulcus (Figure 7). wrist joints show incipient degenerative changes (marginal lipping on the coronoid processes of both ulnae and on articular facets of the distal Case III radii). mated from the size and robusticity of the and there is no evidence of bony reaction. auricular surface elevation. The bones oped. The bones associated with a looted tomb examined in were recovered from the fill of a disturbed high 1998. The are abnormally flattened and bent inward (Fig- knee and hip joints appear normal as well.W. Distal ends of left tibia and fibula. bones. Her remains were found tibia and fibula of an adult male. cated by complete epiphyseal union. some elements of the upper limbs and shoulder girdles. with in-filling of the normal joint space with new bone (Figures 8 and 9).180 J. Weight and robusticity of the tib. Case II (anterior The left calcaneus. and both elbow and size. with the exception of the right ankle. suggesting strong hip flexors. The skeleton is approximately 85% complete. The tibio-talar joint cavity is filled with iae and fibulae appear normal. The distal tibio. Copyright © 2000 John Wiley & Sons. J. the only bone of the left oblique view). Figure 6. but the location and form of the tomb suggests it is associated with the Moche occupa- tion of the site. most bones of the hands and left foot and portions of the os coxae and left fibula. While the proximal tibia is normal in either lytic or proliferative. sex is esti- fibular articulations are normal in appearance. and both medial and lateral malleoli bone thickness in radiographs (Figure 4). as does cortical dense bone. MOC98-1 Case II Mocollope BRU M98-4 Disturbed Burial Huaca Cao. Verano et al. Young adult age (ca. El Brujo Complex Case III is a largely complete skeleton of a This specimen consists of the associated left young adult female. The ures 5 and 6). It shows a pattern of bony reaction similar to Cases I and II. Bones of are otherwise normal in gross appearance and the upper limb are robust.

the distal ends of the affected limbs following healing. in another (Case III) only one ankle is ion. and feet are The bilateral symmetry demonstrated by Case I commonly represented in this group (Weiss. port from details shown in representations of fected bones suggests that weight was placed on footless individuals in Moche art. 10: 177–188 (2000) . defect. Ltd. Weight bearing is further indicated by the plastic deformation of the medial and lateral malleoli seen in Cases II and III. What best fits the cases. The reaction is one of bony prolifera. showing age and sex indicators. the relatively on the affected limb. laterality in Case II cannot be deter. since this is not a reported congenital joint(s). major developmental malfor- tion limited to the tibio-talar joint space. fol- mined. The proliferative bone phology of the tibia and fibula—something that appears well organized and remodelled in all is not seen in these cases. Urteaga-Ballon. Moreover. 1978). Int. with mation of the foot or ankle would be expected no involvement of the metaphyses or diaphyses to lead to changes in the robusticity and mor- of the tibia or fibula. moval of a diseased or traumatized foot is a ual differences. In one example (Case I) both ankles are observed pattern of bony changes. weight. J. In a review of inflammation of the long bone metaphyses or published collections we have found nearly 100 Copyright © 2000 John Wiley & Sons. This scenario draws sup- normal size. Indi- viduals with missing limbs. as only an isolated tibia and fibula were lowed by healing and renewed weight-bearing recovered. Bones of the pelvic area of Case III. through disarticulation of the ankle joint. is intentional amputation of the foot affected. in our opin- involved. Amputation in Moche art Moche art is well known for ceramic vessels depicting individuals with physical defects and Differential diagnosis pathological conditions (Donnan. 1991).Moche Foot Amputation 181 Figure 7. and robusticity of the af. Osteoarchaeol. Patterning of osseous reaction diaphyses argues against loss of the feet as a direct result of infection—although surgical re- The three cases described above show individ. Congenital absence of the feet is overall patterning of bony reaction in the ankle unlikely. and the lack of any indication of infection or 1984. but strong similarities in the possibility. In all three individuals. hands.

which can affect the oral and nasal mucosa ceramic vessels showing persons with missing directly. Some appear to illustrate congenital defects like cleft lip. 1976. and appear to mark a depressed area in between the lateral and medial malleoli. Leishmaniasis does not affect the hands or feet. and representative example of a Moche ceramic ves. J. These appear to be prostheses de- signed to permit weight-bearing and locomotion following loss of the foot. leaving the malleoli as marginal protuberances. and the hands and feet secondarily (as limbs or extremities. Urteaga-Ballon. Such an anatomical feature would be expected if a foot were amputated by disarticulation at the ankle. Right tibia and fibula compared with left tibia. The most common are a result of trauma and secondary infection). nose and lip deformities are visible in 63% of amputees (Table 1. Copyright © 2000 John Wiley & Sons. Auf- the elbow. Ortner and Putschar. Moche art thus is not a simple one. 1991). followed does not appear to have been present in the by those missing a single foot (26%).182 J. Int. sel depicting a footless individual. 1913. Not all cases of lip and nose deformities in Moche art can be attributed to intentional mutilation. Such grooves are com- monly shown in Moche depictions of footless individuals (see also Figure 12).W. while others show lesions more suggestive of an infectious disease such as mucocutaneous leish- maniasis. or being held in the hand as if in the act of placing or removing the object (Figure 12). Tello. Indeed. 1991). 1991). Figure 11). 10: 177–188 (2000) . Ltd. individuals missing both feet (\50%). Most scholars suggest that Moche amputations were a form of punishment rather than an attempt to treat infection or other disease (Vélez López. Case between missing limbs and facial deformities in III (anterior view). Of particular interest is a readily visible median groove on the end of each leg stump. Verano et al. 1924. Support for this argu- ment comes from the observation that many Moche representations of individuals with miss- ing limbs also show what appears to be inten- tional mutilation of the nose and lips. and hands (Table 1). Less New World before European contact (Stein- common are those missing arms. The relationship Figure 8. There has been much speculation about what the Moche were communicating in their depic- tion of amputees. in the ceramic sample we examined. Some Moche ceram- ics show individuals wearing the objects and standing upright (Urteaga-Ballon. Figure 11 is a derheide and Rodrı́guez-Martin. Many individuals with missing feet are shown with cup-like objects placed over the terminal ends of leg stumps. Osteoarchaeol. which is endemic in portions of Peru today (Urteaga-Ballon. Leprosy. 1998). arms distal to bock. however. 1981.

J. meaning of amputation in Moche society. 1978). but none wear elaborate headdresses or other signifiers of high rank. It is significant. Int. (Arsenault. Osteoarchaeol. until putees that we have examined appear to be recently there was little skeletal evidence to males. Most individuals are shown seated in a cross- legged position. how- ever. Examples are also known in Moche art of skeletal figures wearing a prosthesis over a miss- ing foot in scenes that appear to represent a procession or dance. 10: 177–188 (2000) . Right and left lower leg bones with left calcaneus. Obvious performed. Copyright © 2000 John Wiley & Sons. and in the afterlife as well such as the Moche. although individuals as special attendants to the nobility this seems unlikely in a coastal Peruvian culture in Moche society.Moche Foot Amputation 183 Figure 9. indicating that amputations were performed on women as well as men. Case III (anterior oblique view). or lying prone. Whatever the function or All Moche artistic representations of am. that Case III is of female sex. Ltd. Comparison of right and left ankle joints. pothesizes that amputation may have been a Case III. although identifying gender in Moche art suggest that surgical amputation was actually is difficult in some cases (Lyon. Figure 10. Moche gender signifiers such as prominent breasts or braided hair were not observed. therefore. some are depicted standing (usually holding a long stick for support) or seated on the back of a camelid (probably a llama). One recent study of the iconography of Moche footless individuals hy. Frostbite damage to the feet as a motive for form of ritual mutilation that marked certain amputation has been suggested to us. 1993). while others have an outstretched hand as if begging (Figure 11). kneeling. Some individuals are shown playing a drum. Amputees in Moche art are commonly shown wearing a head cloth and a tunic. a few have ear spools or necklaces.

Both forearms 5 One hand 0 Based on his examination of the material. 10: 177–188 (2000) . Courtesy of the San Diego Museum of Man (Catalog c 1981-14-17).W. He described these objects as Figure 11.184 J. hands. Peruvian physician Vélez López pub- cases lished a description of a footless Moche skele- Single foot 26 ton found at the site of Mocollope in the Both feet 55 Arm 2 Chicama River Valley (Vélez López. 1913). Verano et al. Frequency of missing feet. Copyright © 2000 John Wiley & Sons. Moche ceramic vessel showing an individual with missing feet and mutilation of the nose and lips. J. as evidenced by wear on their Individuals with facial mutilation 62 inferior surfaces. Int. and other body Previous osteological evidence for parts in a sample of 99 Moche ceramic vessels showing apparent amputation or mutilation amputation in pre-hispanic Peru Body part missing Number of In 1913. Osteoarchaeol. Table 1. Ltd. The Both arms 6 skeleton was found with wooden prostheses Forearm and hand 6 over the distal ends of the tibiae and fibulae. he Both hands 2 concluded that the skeleton was a double am- Both hands and both feet 1 putee who had used the prostheses for some Individuals with prostheses 24 period of time.

J. collected by Ales Hrdlicka in 1913 from a logical site of Mocollope. Unfortunately. Vélez López concluded that (Verano. this suggests some activity ton or prostheses. 1993) lacked bones of the feet. The bone terminates at While other possible cases of amputation in the proximal third of the diaphysis. A female skeleton buried in a nearby tomb was missing both hands. Several retainer burials recently excavated from royal Moche tombs at Sipán in the Lam- bayeque River Valley present similar problems. If these feet belonged to one of López did not publish photographs of the skele. interest because it appears to present a case Another example of a possible healed ampu- similar to those described in this report. as anyone who has worked with museum collections can attest. fibulae was too poor to identify cut marks or ance. or other features that might confirm amputation other pathology. The the preservation of the distal ends of tibiae and tibiae were reported to be normal in appear. Several cases of Moche burials with either ‘extra’ parts or ‘missing’ parts illustrate the problem of confident identification. Unfortunately. it was reportedly excavated at the archaeo. the vidual. the central highlands. infection. More. where Case III (this disturbed communal tomb near Huarochiri in report) was found in July of 1998. and its present were sacrificed to accompany a high status indi- whereabouts are unknown. 1978). Ltd. since both individuals been in a private collection. with no evidence of swelling. nan. but were found in an adjacent room. but found that simple wooden cups padded with wool. tation from Peru is an isolated proximal humerus over. inter- Figure 12. indi- cating that some activity involving dismember- were intentionally amputated—probably as a ment was going on at the site (Alva and form of punishment. Cut marks (indicating perimortem re- moval) or bony reaction to antemortem trauma (as in Cases I–III described above) should be present if a hand or foot was in fact amputated. Donnan and Mackey suggest that the hands may have been removed from the occupant of one tomb and placed with the other. the ankle bones were skeleton described by Vélez López is of great fragmentary and cut marks were not identified. 1993). however. 10: 177–188 (2000) . and shows pre-hispanic Peruvian skeletal remains have obvious healing in the form of closure of the been described. Christopher Donnan and Carol Mackey described an adult male Moche burial from Huanchaco in the Moche River Valley that included extra articulated hands as grave offerings (Donnan and Mackey. Osteoarchaeol. Moche ceramic vessel showing an individual with a preted as ‘guards’ for the tombs (Alva and Don- cup-like prosthesis. One of us (JWV) examined these skeletons. medullary cavity and smoothing of the distal Copyright © 2000 John Wiley & Sons. 1997). Int. neither hand nor forearm bones were examined for cut marks. Courtesy of the American Museum of Natural History (Catalog c B4919).Moche Foot Amputation 185 Hand and foot bones are notorious for being lost in archaeological excavations. Unfortunately. the footless guards. Vélez Donnan. The skeletons of two young adult males. they are more problematic. the presence of which might have re- solved the question. The material appears to have related to mortuary ritual. Nevertheless. Two articulated human feet the feet were not lost as a result of disease.

Proximal third of left humerus collected by Hrdlicka scalpel. the foot itself is removed by surgical disarticulation of the tibio-talar joint using a Figure 13. as does the issue of surgical technique. along with Moche artistic depic- Diego Museum of Man (Catalog c 1915-2-668). dure successfully. Thus. a tool that was unknown in Peru prior to Eu- ropean contact. While in the classic Syme procedure the medial and lateral malleoli are subsequently sawed off to provide a more stable support surface for the patient. In our opinion. Osteoarchaeol. trans- diaphyseal amputations of limbs would not be expected to be found in the New World prior to the European introduction of metal saws.186 J. Wilson. 1973. Merbs. however. While repeated grooving with a sharp knife could theoretically cut through a long bone diaphysis. The lack of secure dating and associated and lateral malleoli may have made standing Copyright © 2000 John Wiley & Sons. the degree of angulation of the terminal end (visible in Figure 13) also seems inappropriate if the bone was intention- ally sectioned. tions of amputees showing the protruding malleoli of the tibia and fibula. although a healed fracture with cates that they were able to perform this proce- non-union is considered an alternative diagno. 1992. Peru (posterior aspect). 1980). Moche foot amputation: surgical approach While metal saws date back to before the eighth century BC in the Old World (Symes et al. they were unknown in the Americas prior to European contact. skeletal elements makes this case problematic. who agree that it may be the degree of healing seen in Cases I–III indi- an amputation. 1992). Verano et al. Ltd. Skeletal evidence from Cases I–III pre- near Huarochiri. Syme method some 1500 years ago. The specimen has been studied Moche developed a technique similar to the and described by several researchers (Rogers. The amputation of a hand or foot by disarticulation at the wrist or ankle joint. In 1842. demonstrating that it provided superior results to traditional above-ankle trans- tibial amputations in terms of healing and pa- tient mobility (Wagner. 1998). Scot- tish surgeon Sir James Syme popularized a tech- nique for amputating feet by disarticulation at the ankle joint. Courtesy of the San sented here. The retention of the medial sis. Int. could be done with simple cutting tools. Moreover. It is diffi- cult for us to imagine sectioning a humerus through the diaphysis without using a saw. fracture with non-union seems a more likely explanation in this case.. suggests that the end (Figure 13).W. 10: 177–188 (2000) . J.

although re. Spanish Aufderheide AC. Los Angeles. 1998. The authors are grateful to Thomas Wake and Donnan CB. Buikstra JE. TX. Coloquio Sobre la Cultura Moche. 1993. Figure 1 Complejo El Brujo: Resultados Preliminares. but these may simply la cultura Mochica del Peru: un ensayo sobre la represent continuities of Moche artistic themes. Cam- in the sixteenth century do not describe ampu. Bloom RA. AD 900–1200). 1995. Rodrı́guez-Martin C. are most grateful. grateful to the late Dr Guillermo Wiese de Osma. bridge University Press: Cambridge. tical and research support for JWV and LSA dence that the Moche of ancient Peru per. Arkansas Archaeological Survey: Fayetteville. The chroniclers who observed Inca culture firsthand Cambridge Encyclopedia of Human Paleopathology. century AD. El personaje del pie amputado en Peru (ca. Int. Los Angeles. during their fieldwork in Peru. teological specimen in Figures 11–13. New cent clinical studies have demonstrated that in York. but Moche art (JWV. Standards for Acknowledgements Data Collection From Human Skeletal Remains. Amputation of the hand in the 3600- amputation been found in Inca period skeletal year-old skeletal remains of an adult male: the first remains. Eisenberg E. Project funding for the El Brujo excava- some cases a superior outcome can be achieved tions is generously provided by the Augusto N. Artistic depic. The authors are particularly without resection of the malleoli (Pavot. Symbolic Communication. American Museum of Natural History. Donnan CB. Mujica E Copyright © 2000 John Wiley & Sons. Peru. Bloom AI. Kahila G. Ancient Burial Patterns of the Moche Valley. Osteoarchaeol. 1994. mission to study the skeletal remains from Mo. Tulane University Committee on Research given the tools available at the time. Actas del Primer Museum of Cultural History. References tions of individuals with missing feet disappear along with the Moche culture in the late eighth Alva W. case reported from Israel.Moche Foot Amputation 187 and walking difficult even with prostheses like ure 12 was photographed with permission of the those described by Vélez López. arqueologı́a del poder. Arquitectura y permission to photograph the ceramics and os. Gálvez C. for his dedication to Moche archaeology and for Conclusions his friendship and wise counsel. In is courtesy of Donald McClelland of the Fowler Moche: Propuestas y Perspectivas. CA. Latin American Antiquity 4: The actual practice of amputation may have 225–245. nor have any unequivocal examples of P. 1994. tory: Los Angeles. for which their formed successful amputations of the feet. 1993. individuals with missing arms are known from CA. for per. Moche Art of Peru: Pre-Columbian Glenn Russell of the Institute of Archaeology. disappeared with the Moche as well. suggests that examples may exist. 1973). (JWV) and the Roger Thayer Stone Center for cal evidence for amputations of hands or arms Latin American Studies at Tulane University has not been found to date. Osteologi. A few ceramic vessels showing Fowler Museum of Natural History: Los Angeles. Museum of Cultural His- University of California. and to Alana Cordy-Collins and Rose Austin. 1978. Vásquez S. Tyson of the San Diego Museum of Man for Franco R. Ubelaker DH (eds). The Wiese Foundation and the research staff of the El Brujo We believe that the three cases presented here Archaeological Project provided generous logis- represent the first well-documented skeletal evi. Travel and research support Amputation by disarticulation of the ankle joint for this study was provided by grants from the would have been a simple and logical approach. Mackey CJ. Uceda S. International Journal of Osteoarchaeology 5: 188–191. Donnan CB. Decoración Mochica en La Huaca Cao Viejo. Chairman of the Wiese Foundation. Fig. by performing a Syme ankle disarticulation Wiese Foundation. University of Texas Press: collope. Smith tation. 1978. J. LSA). Royal Tombs of Sipán. Why the Moche performed amputations will no doubt remain a subject of speculation. Ltd. the subsequent Lambayeque culture of northern Arsenault D. 10: 177–188 (2000) .

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