Squier and Discovery of Trepanation

E. George Squier and the Discovery ofCranial Trepanation: A Landmark in the

History of Surgery and Ancient Medicine

STANLEY FINGER and HIRAN R. FERNANDO

] NE of the greatest discoveries in the history of cranialtrepanation was the Inca skull fragment (Fig. i) ob-tained in 1865 in Cuzco, Peru, by Ephraim GeorgeSquier (1821-1888). This specimen, now dated be-tween 1400 CE and 1530 CE, and currently housedin the American Museum of Natural History in

New York City, possesses a rectangular opening measuring 15 mmby 17 mm. The opening could only have been made by humanhands, and the individual subjected to this surgery seemed to surviveit by about two weeks.

Squier's specimen caused an immediate sensation as the first skullfrom an ancient, "primitive" culture to be widely recognized as acase of trepanning, a word that derives from the Greek trypanon,meaning to auger or bore. Although a trepanned skull from Peru hadbeen depicted by Samuel George Morton (1799—1851) in his CraniaAmericana of 1839, the opening was misinterpreted as an example ofa battlefield wound.1 In addition, there were a few much older tre-panned skulls unearthed in Europe, but they, too, had been misinter-preted prior to 1865. In a very real way, Squier's large cranial fragmentstimulated scientists to look for other examples of trepanned skullsand to reconsider existing skull specimens thought to have beenbroken by animals, injuries, or natural forces.

Although the Squier specimen is now often shown or described

1. Samuel George Morton, Crania Americana: Or a Comparative View of the Skulls of theVarious Aboriginal Nations of North and South America (Philadelphia, Perm.: Simpson, Mar-shall & Co, 1839).

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354 jorrrnal of the History o f Medicine : 1/01. 56, October zoo1

Fig. I . Ephraim George Squier's illustration of the trepanned Inca skuU that he obtained in Peru. From Squier, (n. 3 3 ) .

verbally in books and articles on the history of trepanation, little if any information is provided about Squier as the man behind the skull or about his theory of cranial fracture. The first purpose of this essay is to present biographcal infornlation about Squier, an American writer, diplomat, and self-taught archaeologist, in cultural context. The second is to chronicle the sequence of events that led him to South America and to his famous example of Peruvian trepanning.

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Finger & Fernando : Squier and Trepanation 355

The third is to show how the specimen was received and interpreted,first by members of the New York Academy of Medicine in 1865,then by Paul Broca (1824-1880) in 1867, and subsequently by others.Its fourth purpose is to present Squier s own explanation for trepana-tion, which differs from that of Broca and, as will be seen, now hassolid scientific support.

It will be shown that Squier began his career in archaeology bystudying the mounds, artifacts, and skulls of the Indians living inOhio. Hypothesizing that landmarks south of the border might havebeen made by the descendants of these early Americans, he jumpedat the opportunity to go to Central America and then to SouthAmerica when given a chance to serve in the American diplomaticcorp. It was after officially representing the United States in Peruthat he encountered the trepanned Inca skull. His specimen drewwidespread interest because it suggested that some sort of "brainsurgery" had been performed in the Americas before the EuropeanConquest. It also raised questions about race, brain size, and intelli-gence, subjects that greatly interested scientists and laymen at thetime.

If there were a single theme that emerged and was sustainedthroughout Squier's multifaceted life, it was his patriotic fervor. Hispatriotism could be seen in his journalism, in his diplomacy, and inhis archaeology.2 He was a fiercely nationalistic individual who be-lieved that the United States was a great country with an even greaterfuture. Where he parted from most of his contemporaries was in hisstrong belief that he could actually show that his homeland also hada great past, one that flourished even before the famous explorerscrossed the Atlantic from Europe. Squier s ethnocentric approach tothe world around him would guide him from his initial excavationsin Ohio, to Central America, and finally to Peru, where he encoun-tered the now-famous trepanned skull.

2. The period of 1830—1840 in particular was characterized by rising ethnocentrismamong those engaged in American science. Thanks to newspapers and the popular press,the scientific audience also changed. Once the domain of highly educated and wealthygentlemen philosophers, science and especially curiosities also became the talk of the com-mon man. This development, along with social prestige, attracted inquisitive Americanamateurs to investigate their country's prehistory, geology, and life sciences. For more onthe changing face of American science during Squier's time, see Donald Zochert, "Scienceand the common man in ante-bellum America," in Nathan Reingold, ed., Science in AmericaSince 1820, (New York: Science History Publications, 1976), pp. 7-32.

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356 Journal of the History of Medicine : Vol. 56, October 2001

FORMATIVE YEARS

Ephraim George Squier (Fig. 2) was born on 17 June 1821 in thetown of Bethlehem, Albany County, New York.3 His lineage can betraced to Samuel Squier, lieutenant, auditor, and friend of OliverCromwell (1599—1658). Ephraim Squier, his grandfather, fought atBunker Hill during the American Revolutionary War. His father Joelwas a Methodist clergyman who married Katherine Kilmer, whodied when George was twelve. Squier had two younger half-brothers:Charles, who died in 1868, and Frank, who became a paper manufac-turer in New York City.

The Squier family had modest resources and George spent hisboyhood years attending various local schools in New England, edu-cating himself, and working on his grandfather's farm. He did someteaching and had an interest in civil engineering. Economics, andespecially the financial downturn brought on by the Panic of 1837,however, led him to consider other careers, including journalism.Squier subsequently relocated to New York, where he wrote forvarious newspapers, including the Literary Pearl (1840—1841) and theLady's Cabinet Magazine (1841—1842). H e also founded The Poet'sMagazine (1842), in which he published many of his own poems.

Squier's journalism led him to take stands on political issues andincreasingly drew him into local and national politics. Among otherthings, he wrote for The New York State Mechanic and elsewhere onthe subject of prison reform. When The New York State Mechanicfailed in 1843, Squier became the editor of the Whig Daily Journal

3. Biographical information on Squier can be found scattered in a variety of sources,including several articles, a few books of letters, the preface to a catalogue of his bookscompiled by his nephew, Frank Squier (b. 1881), dissertations, obituaries, and biographicaldictionaries. The sources used here are: Jerry E. Patterson and William R. Stanton, "TheEphraim George Squier manuscripts in the Library of Congress: A checklist," Biblio. Soc.Am., 1959, 53, 309-26; Rafael H. Valle, "Ephraim George Squier," Soc. Sci. "AntonioAlzatc"— Memoires, 1922, 40, 509-18; Biographical material attached to a report by Squier,"Our foreign relations," Am. Whig Rev., 1850, 6 (n.s.), 345—52; Don C. Seitz, Letters fromFrancis Parkman to E.G. Squier (Cedar Rapids, Iowa: Torch Press, 1911), pp. 41, 60; MaryW. Williams, "Letters of E. George Squier to John M. Clayton, 1849-1850," Hisp. Am.Hist. Rev., 1918, 1, 426—34; Frank Squier, A Collection of Books by Ephraim George Squier(New York: Frank Squier Paper Co, 1939); Charles L. Stansifer, "The Central Americancareer ofE. George Squier" (Doctoral Thesis, Ann Arbor, MI: University Microfilms, 1967);Mariana Mould de Pease, "Ephraim George Squier y su vision del Peru" (Bachiller enHumanidades, Pontifica Universidad Catolica del Peru, 1981); Terry A. Bernhart, "Ofmounds and men: The early anthropological career of Ephraim George Squier" (DoctoralThesis, Ann Arbor, MI: University Microfilms, 1990); Anonymous, "Death ofE. G. Squier,"New York Times, 18 April 1888, p. 8.

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Finpr G Fernando : Sqtrier and Trepatlariot~ 3 57

Fig. 2. Ephrairn George Squier ( I 82 I - I 8 8 8 ) in 1849, at the start of his archaeo- logcal career, from Frank Squier, (n. 3) .

in Hartford, Connecticut. This new periodical was used to generate local support for Whig presidential candidate Henry Clay (1777- I 852). O n 23 May I 843 he penned a letter to his parents explaining, "I secretly determined to devote my talents, were they great or small, to the advancement of the social and intellectual interests of the mass of my country~nen."~

During this time, Squier began to supplenlent his meager income

4. Squier to parents, 23 M a y I 843. Squlrr Papers, New York Historical Soclety; c~ted by Stansifer, (n. 3). p. 6 .

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by writing books. His first book, The Chinese as They Are, was writtenin 1843 and was about the British rule of Canton.5 Throughout hislife, Squier feared and hated the British. He despised how they treatedothers and he was more than a little concerned (paranoid may bethe better word) about British motives, especially their overtures inthe New World.

MOUNDS AND ARCHAEOLOGY

In 1845, after the defeat of Henry Clay by Martin van Buren (1782-1862), Squier moved to Chillicothe, a town in south-central Ohio,where he accepted an offer to become the editor of the Scioto Gazette(the oldest paper west of the Allegheny Mountains). He left the paperfifteen months later, after he was elected clerk of the Ohio Houseof Representatives.

The ancient Indian mounds surrounding Chillicothe attractedSquier's interest (Fig. 3). American archaeology had been in its infancyprior to the 1840s. Historians Gordon Willey and Jerome Sabloff, infact, refer to the era between 1492 and 1840 as "the SpeculativePeriod."6 A lot of what was written about the mounds before andduring this time came from explorers, settlers, chroniclers, and "ro-mancers," who mentioned them in journals and books (sometimesembellished), along with almost everything else they encountered.

Not only were most descriptions not based on careful measure-ments and excavations, but there was also rampant speculation aboutthe mound builders. Some claimed they came from Atlantis, a fewpointed to the lost tribes of Israel, and still others wrote about theirpossible Asian origins. Most authors believed that the nomadic NativeAmerican "savages" and their immediate ancestors did not have theintelligence to build these structures; if some Indians did build themounds, they were of a race long vanished.7 Adding to the confusion,

5. Ephraim George Squier, The Chinese as Tliey Are; Tlieir Moral and Social Character(Albany, N.Y.: George Jones, 1843).

6. Gordon R. Willey and Jerome A. Sabloff, A History of American Archeology (San Francisco,Cal.: W. H. Freeman and Co., 1974), pp. 21-41.

7. Some of the "evidence" then presented for the "vanished race" idea included: howfew Indians remained, in contrast to the numbers that existed when the mounds were built;the fact that many of the Indians were recent immigrants from the Eastern United States;the belief that the Mound Builders practiced large-scale agriculture, whereas the local Indianswere backward, nomadic hunters; the assertion that the modern Indians were uncivilizedsavages incapable of such an accomplishment; the allegation that the present Indians had anaversion to labor; and the contention that the newer Indians did not care about the mounds,

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Finger G Fernando : Squirr and Trepanation 3 59

Fig. 3 . An illustration of one of the most impressive ancient mounds (Grave Creek). From Squier and Davis, (n. 9).

some notable public figures, including General and later ninth Presi- dent William Henry Harrison (1773-1 841), New York Governor De Witt Clinton (1769-1828), and Jefferson's Secretary of the Treasury, Albert Gallatin ( I 76 I - I 849), also speculated fi-eely about the North American mounds and the mound builders.

Squier published his first book on the mounds and their contents in 1847.~ Observations or-1 the Aboriginal Mounds ofthe Mississippi Valley, consisting of only 72 pages, included descriptions of some of the Ohio earthen mounds (more than ro,ooo exist in Ohio alone), as well as the pottery, sculpture, pipes, and human bones found in them. He was helped by Ohio native Edward Hamilton Davis (18 I I-1888),

and thrrefore could not have inherited the tradition. For more on the history ofthe vanished raw idea, scc Robert Silvcrberg, dlfirtnd Brrildcrs L$ ,4niictlf ,411lcriia: 771c .4r~/1acolyy qf !fil

Myfh (Greenwich, Conn.: New York Graphic Society, 1968). 8 . Ephram George Squler, Observarions on the Aboriginal Mounds id the Mississippi Vallry

(New York: Bartlett & Welford, I 847).

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who had been excavating the mounds before Squier arrived in thestate. Davis was a physician (Medical College of Cincinnati, 1838),a member of the American Ethnological Society (Squier also becamea member), and a collector of native antiquities.

Squier received much more attention from the scientific commu-nity when his expanded work, Ancient Monuments of the MississippiValley, was published in 1848. This time Davis was given the secondauthorship.9 From the text we learn that Squier, with his backgroundin engineering and publishing, played the leading role in the mapping,drawing, and writing. As for Davis, he played the dominant role inthe natural sciences and in the relics and their restoration. Moneyfrom Davis's medical practice helped to fund the explorations.

The combined efforts of Squier and Davis were blessed by theAmerican Ethnological Society, which was then under the presidencyof Albert Gallatin. Although Gallatin was looking for someone tocompile all that could be substantiated about the mounds, the societyhe governed did not have the funds to publish the volume. Hence,the book was presented to the Smithsonian Institution and was fol-lowed by official letters of recommendation. It represented the two-year-old Smithsonian's first foray into publishing and was volume Iin their Contributions to Knowledge series.10

Under the direction of American physicist Joseph Henry (1797—1878), the first secretary of the Smithsonian, the new institution waspiloted away from politics, commercialism, and speculation.11 Henrypersonally edited the Squier and Davis manuscript, which he receivedearly in 1847. Coming from a background in electricity, magnetism,and meteorology, he demanded rigorous scientific standards, moredata, and additional information, all of which the authors strove tomeet in their revisions. Henry did not hesitate to admonish the

9. Ephraim George Squier and Edward Hamilton Davis, Ancient Monuments of the MississippiValley (Washington, D.C.: Smithsonian Institution, 1848). Being highly valued, in demand,and rare, this work was reprinted in 1973 by the Peabody Museum (Harvard) and in 1998by the Smithsonian Institution. For an informative, modern review of this book, see PaulD. Welch, "Ancient Monuments of the Mississippi Valley by E. G. Squier and E. H. Davis: Thefirst classic of US archeology," Antiquity, 1998, 278, 921-27.

10. James Smithson (1765-1829), an English chemist, funded the establishment of theAmerican institution that was to bear his name "for the increase and diffusion of knowledge."The Smithsonian opened its doors in 1846.

11. For more on Joseph Henry and how he ran the Smithsonian, see Wilcome E.Washburn, "Joseph Henry's conception of the purpose of the Smithsonian Institution," inWalter M. Whitehill, ed., A Cabinet of Curiosities, (Charlottesville: University of VirginiaPress, 1967).

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authors for speculating ("Your labors should be given to the worldas free as possible from everything of a speculative nature").12 Hence,most of the book was devoted to detailed descriptions of the moundsfrom Ohio and some nearby states (which were divided into differenttypes), and to the several thousand "remains of ancient art" unearthedby the authors.

Squier and Davis stated in their Preface that they hoped theirsystematic investigations of the mounds would shed light on thehistory of the Americas and the origin and migrations of the Americanrace. In part by counting tree rings, they correctly guessed that someof the two hundred mounds they examined were 1000 years old, ifnot older.13 Although restricted in their ability to speculate, they didmake the following statement in the last chapter of their book: "Wemay venture to suggest that the facts thus far collected point to aconnection more or less intimate between the race of the moundsand the semi-civilized nations which formerly had their seats amongthe sierras of Mexico, upon the plains of Central America and Peru,and who erected the imposing structures which from their number,vastness, and mysterious significance, invest the central portion of thecontinent with an interest not less absorbing than that which attachesto the valley of the Nile."14 In a footnote in the same section ("Con-cluding Observations"), the authors even quoted Gallatin, who be-lieved that the great civilizations of Central and South America hadmuch in common with the North American mound builders.15 Itseems clear that Squier, the American patriot, was now aspiring toshow the world that his United States had an illustrious archaeologicalpast—a past perhaps even comparable to that of Egypt, Greece, orRome.

12. Curtis M. Hinsley, Jr., Savages and Scientists: The Smithsonian Institution and the Develop-ment of American Anthropology (Washington, D.C.: Smithsonian Institution Press, 1981), pp.34-40, p. 36.

13. Squier and Davis, (n. 9) Ancient Monuments. The idea of counting the rings of treesat American archaeological sites did not originate with Squier and Davis. In 1788, ReverendManesseh Cutler (1742—1823) used the method to argue that the mounds were from thefourteenth century, if not earlier. See Silverberg, (n. 7) Mound Builders, p. 30.

14. Squier and Davis, (n. 9) Ancient Monuments, p. 301.15. Squier and Davis, (n. 9) Ancient Monuments, pp. 302-3. The contemporary view is

that mounds of Mexico and Peru, and the art forms and other cultural achievements ofCentral and South America, did not originate from mound builders of the Mississippi Valley,as believed by Squier, even though these cultures share some common features. See Silverberg,(n. 7) Mound Builders, pp. 294-337. Gallatin, it should be noted, thought the mound builders,or at least their agriculture and other cultural influences, headed north from Mexico, not

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Aboriginal Monuments of the State of New York followed a year later.16

These mounds proved not nearly as old as those in Ohio, and theywere found by Squier to be erected by Iroquois Indians. Hence, theOhio mound builders could not have come from New York, as Squierhad originally postulated. This project was also supported by theSmithsonian and it became volume II in their Contributions to Knowl-edge series, but this time with Squier as sole author.

These first two books from the Smithsonian set a new standardand led American archaeology out of the speculative period intowhat historians Gordon Willey and Jerome SablofF have called the"classificatory-descriptive" period." In their words, Squier and Davis'sbook "was the best descriptive study published up till then." Theyfurther noted that the "active involvement of a government body aswell as a professional anthropological society in archeological field-work and, especially, publication also indicated a marked change inthe trends of archaeological development in the New World."17

SQUIER AND THE AMERICAN SCHOOL

Squier had now become a national figure and was heralded in somecircles as one of the foremost archaeologists of America's past.18 InEurope, he was praised by Alexander von Humboldt (1769—1859),the first of his many famous correspondents. Humboldt wrote: "WithDoctor Morton's Crania Americana, the work of Mr. Squier constitutesthe most valuable contribution ever made to the archaeology andethnology of America."19

In the United States, Samuel Morton, who held medical degreesfrom the Medical College of Pennsylvania (1820) and the Universityof Edinburgh (1823), was one of his strongest and most influential earlysupporters. After seeing a prepublication draft oi Ancient Monuments ofthe Mississippi Valley, Morton, who was now on the faculty of theMedical College of Pennsylvania, wrote: "I am convinced that this

south from the United States, where the mounds date from approximately iooo BCE toabout 1700 CE. Silverberg, (n. 7) Mound Builders, p. 233.

16. Ephraim George Squier, Aboriginal Monuments oj the State of New York (Washington,D.C.: Smithsonian Institution, 1948).

17. Willey and SablofF, (n. 6) American Archeology, pp. 43-44.18. Squier is still regarded by some authors as "the first authoritative voice in American

archaeology." See William Stanton, T\\e Leopard's Spots (Chicago: University of ChicagoPress, i960), pp. 82, 87. Also see Welch (n. 9).

19. Quoted in Seitz, (n. 3) Letters, p. 350.

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work constitutes by far the most important contribution to the Ar-chaeology of the United States ever yet submitted to the public."20

Morton's glowing words appeared on the back cover of Squier's earlierObseruations on the Aboriginal Mounds of the Mississippi Valley, wherethe new book was being announced. Squier and Davis, in turn,acknowledged Morton's guidance in conducting the research that ledto the book published by the Smithsonian.

In addition to Morton, other members of the American schoolof archaeology who now corresponded with Squier were George R.Gliddon (1809-1857), who had previously lived in the Middle Eastand even visited him in Chillicothe, and Josiah Nott (1804-1873).All three, and many others, wanted to see and use Squier's findings.In fact, Squier had written to Morton in Philadelphia before publica-tion of the book to ask if he would be willing to compare the moundbuilder skulls he and Davis expected to find with "aboriginal remainsof Mexico, Central America and Peru."21 Morton, a prodigious collec-tor of crania who had presented several mound builder skulls fromthe United States and Peru in his Crania Americana, replied affirma-tively. Squier followed up by sending a drawing of an Ohio moundbuilder's cranium to Morton, who considered it a perfect exampleof the native American race.22 Morton assigned the skull to his Tol-tecan family division, which included the culturally advanced Peruvi-ans (his other division was called "barbarous tribes"). This craniumwas the only one from the mound builder period that Squier andDavis found intact (most were badly crushed by the weight of theoverlying deposits).

Morton, Nott, and Glidden, along with Swiss-born Louis Agassiz(1807-1873), who considered Morton's Crania Americana the mostimportant book ever written on the races, opposed the Biblical ac-count of creation and believed in the plurality of the human speciesstemming from multiple creations.23 They further adhered to thenotion that native Americans (excluding Eskimos, who were classified

20. Morton, back cover of Squier, (n. 16) Aboriginal Monuments.21. Stanton, (n. 18) Leopard's Spots, pp. 82-83.22. Squier and Davis, (n. 9) Ancient Monuments, p. 289; Stanton, (n. 18) Leopard's Spots,

pp. 84-85.23. Morton, (n. 1) Crania Americana; Josiah C. Nott and George R. Glidden, Types of

Mankind (Philadelphia, Penn.: Lippincott, Grambo & Co., 1856). For secondary sources onthe racial issue, see Stephen J. Gould, "American polygeny and craniometry before Darwin:Blacks and Indians as separate, inferior species," in The Mismeasure of Man (New York: W W.

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as Mongols with Indian language) constituted an indigenous, isolatedAmerican group or race, one designed to fit the climate of theAmericas.24 The evidence for such a classification and the subdivisionof the American group into Toltecan family and barbarous tribescame from skull morphology, cranial capacity, other anatomical mea-sures, and artifacts. This material was precisely what was being col-lected and catalogued on North American soil by Squier, who increas-ingly (but erroneously) believed that the ancient mound buildersconstituted a separate but widespread race of farmers with moreadvanced cultural achievements (e.g., art, edifices, customs, religions)than the savage Indian hunters who eventually displaced them.

The idea that the Ohio earthworks were built by people morecivilized than the modern Indians, but not as civilized as the Europeansand their descendants in America, had been around for some timebefore Squier began his excavations. For example, early in the 1800s,Caleb Atwater (1778-1867) argued that the mound builders occupiedthis intermediate position on the civilization or technology ladder.He not only thought that the mound builders and Indians wereseparate races, but also believed that the mound builders came to theUnited States from Asia and later migrated to Mexico, where theyadvanced from earth to stone building as their civilization flourished.Samuel Morton, it should be noted, disagreed with Atwater on theracial issue and lumped the mound builders together with the Indiansinto one race. Still, he placed the mound builders into the Toltecanfamily, which he viewed as more advanced than the barbarous tribes.Before the nineteenth century had ended, it was shown that Atwater(and Squier) were wrong to think that the mound builders wereexterminated or forced to migrate because of the ruthless savageswho also opposed the European settlers. Instead, it became clear thatthe mound builders were, in fact, the ancestors of the seemingly lesscivilized Indians who followed them. One late-nineteenth-centurythinker who considered the highly advanced and vanished race ofmound builders nothing more than an imaginative romantic fallacyor an alluring myth was Major John Wesley Powell (1834—1902). Itwas Powell who helped found the Smithsonian's Bureau of American

Norton & Co., 1981), pp. 30—72; Lester D. Stephens, Science, Race and Religion in the AmericanSouth: John Bachman and the Charleston Circle of American Naturalists (1815-1895) (Chapel Hill:University of North Carolina Press, 2000); Stanton, (n. 18) Leopard's Spots.

24. Morton, (n. 1) Crania Americana.

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Ethnology in 1879. Some of Powell's thoughts about the moundbuilders being the ancestors of the Indians and representing manydiverse stocks can be found in the Bureau of American Ethnology'sFirst Annual Report (1879-1880). A decade later, Powell had CyrusThomas (1825—1910) look into the mounds. Thomas's scholarly Cata-logue of Prehistoric Works East of the Rocky Mountains played a moredecisive role when it came to dismantling the myths.25

Mainly relying on data from skull measurements, these membersof the so-called American school also believed that the Americangroup was intellectually inferior to modern Caucasians, and thereforenot suited for civilization. Peruvian skulls, which Squier would havea chance to see on site in 1865, were an important part of this picture.As noted by Stephen J. Gould in his biting critique of Morton'ssample, the status of the American group as a whole was pulled downby a fairly large percentage of small Inca skulls.26

These individuals further viewed blacks as lower in status thanAmerican Indians, but disagreed with one another on the use ofcranial measurements and other anthropological data to promoteslavery.27 In particular, Nott, who was a Southerner, used cranial andother anthropometric measurements to justify his pro-slavery politics.In contrast, Glidden, who at times worked with Nott, claimed notto have a political agenda when collecting data and attending to hisscience. As for Morton, he lived in the North and died a decadebefore the American Civil War began; he was not driven to collectskulls and study the races because he wanted to address the institutionof slavery.

Squier, it should be emphasized, refused to live in states whereslavery existed and questioned some of these beliefs. He viewed theSouth as hostile to the principles of liberty and the republican idealshe embraced in his politics. In a letter to his parents written on theeve of the American Civil War, his personal views on the races andslavery were expressed rather bluntly. He used terminology that was

25. Caleb Atwater, Description of the Antiquities Discovered in the State of Ohio and OtherWestern States, in Archaeologia Americana, Transactions and Collections, vol. i (AmericanAntiquarian Society, 1820). Cyrus Thomas, Catalogue of Prehistoric Works East of the RockyMountains (Washington, D.C.: Bureau of Ethnology, Smithsonian Institution, 1891). For thecontributions of both Powell and Thomas in social and cultural context, see Silverberg, (n.7) Mound Builders, pp. 166-221.

26. Gould, (n. 23), p. 57.27. Stanton, (n. 18) Leopard's Spots; Gould, (n. 23); Stephens, (n. 23) Science.

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common at the time, but which would be unacceptable today. Heexplained that he had a "precious poor opinion of niggers, or anyof the darker races," but "a still poorer one of slavery."28 Squier, thepatriot, had his own, independent agenda.

CENTRAL AMERICA

In 1848, General Zachary Taylor (1784-1850), a Whig, was electedpresident. Lacking a financial benefactor to pay for his travels, Squiersaw the election as a golden opportunity for funding new researchsouth of the border while also helping his country. With the helpof Gallatin, William Prescott (1796-1859), and other friends, hesuccessfully lobbied Taylor and the Whigs for a diplomatic appoint-ment to Central America. The Whigs favored learned men, and hisappointment as Charge-d'Affaires of the United States to the republicsof Central America allowed him to make his first visit to CentralAmerica. He served in Nicaragua, Honduras, and San Salvador fromApril 1849 until September 1850.

Being a writer with a strong patriotic streak, Squier publishedmany works and articles about Central America, its history, its people,and its commercial value to the United States. He remained verysuspicious of the British and believed they had less-than-neutral inten-tions in the area. He suspected they were planning to control shippingand commerce between the two oceans, which was a growing concernbecause of the westward expansion of the United States and thediscovery of gold in California. To his credit, he played a central rolein persuading the British to agree to the Clayton-Bulwer Treaty,which held that neither Britain nor the United States would seizecontrol over any of the Central American countries.

Squier returned to Central America in 1853, this time to promotean inter-oceanic railway in Honduras as secretary of the HondurasInter-Oceanic Railway Company. His newest hope, which was neverfulfilled, was to make enough money as a businessman to devote hisremaining years to archaeological studies.

To help cover travel and related expenses, as well as to enhancehis own fame, Squier wrote Travels in Central America in 1852, Observa-tions on the Archeology and Ethnology of Nicaragua in 1853, Notes onCentral America in 1855, and even completed a novel, Waikna: Adven-

28. Quoted in Stanton, (n. 18) Leopard's Spots, p. 193.

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tures on the Mosquito Shore, under the pseudonym Samuel A. Bard in1855.29 In 1856, he received a medal from the Geographical Societyof France in recognition of his extensive research, and in i860 hepublished Nicaragua: Its People, Scenery, Monuments, Resources, Condi-tion, and Proposed Canal. He also made contributions to the Encyclope-dia Britannica and wrote treatises on a myriad of other topics, includingone called The Serpent Symbol and the Worship of Reciprocal Principlesof Nature in America?0

Squier enjoyed his stays in Central America. He delighted in thepeople, was awed by the sites, and delved into the archaeology. Whenwriting about the present and past cultures of the region, he was inhis element. But it is also clear that he had a political agenda (mainly,do everything possible to keep the British out), and that he couldsee the potential of the region through the eyes of a businessman.

PERU

Because of his diplomatic skills and obvious interest in the region,in 1863 President Abraham Lincoln (1809—1865) appointed SquierMember, Mixed Commission under Claims Convention of Jan. 12,1863, between the United States and Peru. Lincoln's objective was tosettle a U.S. financial dispute with Peru. Although Squier's diplomaticresponsibilities were relatively minor, this appointment gave him anopportunity to learn more about South American culture and prehis-tory. In particular, it allowed him to compare the stone edifices ofthe Incas with the mounds he had explored years earlier in theMississippi Valley. Squier was probably still hoping to show that someof the most impressive stone structures of Central and South Americacould be traced back to the primitive, earthen mounds he had writtenabout in his own United States.31

William Prescott was influential in securing this assignment forSquier just as he had also done for Squier's first appointment to

29. Ephraim George Squier, Travels in Central America, Particularly in Nicaragua, etc. (London:Longman & Co, 1852); "Observations on the archaeology and ethnology of Nicaragua,"Trans. Am. Ethnol. Soc, 1853, J, 83-158; Notes on Central America; Particularly the States ofHonduras and San Salvador (New York: Harper and Brothers, 1855); Samuel A. Bard [pseud-onym of E. G. Squier], Waikna; or, Adventures on the Mosquito Shore (New York: Harper &Brothers, 1855).

30. Ephraim George Squier, Nicaragua: Its People, Scenery, Monuments, Resources, Condition,and Proposed Canal (New York: Harper & Brothers, 1860); Tlie Serpent Symbol and the Worshipof Reciprocal Principles of Nature in America (New York: George P. Putnam, 1851).

31. Squier, (n. 8) Observations; Squier and Davis, (n. 9) Ancient Monuments.

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Central America in 1849. Prescott was an expert on ancient Mexico,and he had published his stimulating History of the Conquest of Peruin 1847.32 Squier would open the first chapter of his own book onPeru citing Prescott's work and mentioning the influence Prescott'swritings had on him when he began to explore the monuments ofthe Mississippi Valley.33 Squier wrote about the "warm, personalfriendship of that distinguished historian" and added that he wasespecially inspired by Prescott's call for others to discover and carefullystudy the monuments and artifacts of the Incas before they could bedestroyed by treasure hunters or lost to natural forces.

Squier arrived in Peru in July 1863 and completed his diplomaticwork in November. He then began to collect material for a newbook, Peru: Incidents of Travel and Exploration in the Land of the Incas.With his "compass, the measuring-line, the pencil, and the photo-graphic camera," he spent some eighteen months in a sustained effortto "meet the rigorous demands of science." Clements Markham(1830—1916), another noted mid-nineteenth-century explorer ofPeru, would later praise Squier's work: "The work of E. G. Squieris, on the whole, the most valuable result of antiquarian researchesin Peru that has ever been presented to the public."34

Squier devoted most of the archaeology in his book to the Incamonuments and their man-made artifacts. Nevertheless, he also seizedthe opportunity to collect skulls, some with artificial distortions

32. William H. Prescott, History of the Conquest of Peru (New York: International BookCo, 1847).

33. Ephraim George Squier, Peru: Incidents of Travel and Exploration in the Land of the Incas(New York: Harper & Brothers, 1877). Squier describes Prescott's influence on him on pp.1-2.

34. Squier, (n. 33) Peru, p. 3. Clements R. Markham, "A bibliographical spectrum onthe historical sources of Inca civilization," in Anne Paolucci, ed., Justin Winsor and C. R.Markham: Cultures of the Aztecs, Mayas, and Incas (Whitestone, N.Y.k: Council on NationalLiteratures, 1996), p. 181. Markham was a slightly later explorer of Peru than Prescott. Hebriefly visited Peru while in the Royal Navy between 1845 ar>d 1848. He returned as acivilian to Peru in 1852 and 1853, and spent time exploring the Inca remains in and aroundCuzco, once the capital of the Inca civilization. His last trip to Peru was in 1861-1862.Markham is mentioned in Squier's book on Peru. In fact, Squier [(n. 33), p. 588] tells usthat the coat of arms on the title page of Peru was taken from Mr. C. R. Markham's "Peruand India," and is the one "granted to the royal Inca family by Charles V. of Spain, afterthe Conquest." Markham cited Squier in a very positive way in his later writings, includinghis two-volume The Incas of Peru (London: Smith, Elder & Co., 1910), where he calledSquier's accounts "the most accurate and intelligent" (vol. I, 209). For more on Markham,see Peter Blanchard's, Markham in Peru (Austin: University of Texas Press, 1991), based onMarkham's Travels to Peru in 1853, which he started in 1908 and worked on until his deathin 1916.

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(lengthening or broadening and shortening) not recognized as such byMorton. He even illustrated an "artificially distorted and lengthened"Aymara skull in Peru.

In appendix B of his book Squier tells the reader that he presentedfifty-six skulls from Peru to Harvard's Peabody Museum of AmericanArchaeology and Ethnology, in Cambridge, Massachusetts. ProfessorWyman, the curator, examined the collection and published histhoughts about them in the Fourth Annual Report of the PeabodyMuseum. What may be most telling of Squier's own thoughts aboutthe Peruvian skulls and matters of intelligence can be gleaned fromthe Wyman quotations Squier selected for inclusion in his appendixB. Wyman compared the Incas with the Australian aborigines andthe Hottentots, all of whom had small crania (about 1230 cc), evenwhen compared to the "barbarous tribes of America." But unlikethe Australians and Hottentots, Wyman explained, the Incas had"established a complex civil and religious polity, and made greatprogress in the useful and fine arts—as its pottery, textile fabrics,wrought metals, highways and aqueducts, colossal architectural struc-ture, and court of almost imperial splendor, prove." Therefore, hewent on, "the relative capacity of the skull is to be considered merelyas an anatomical, and not as a physiological characteristic, . . . [and]brain-measurements cannot be assumed as an indication of the intel-lectual position of races any more than of individuals."35 In otherwords, and obviously in accord with Squier's thoughts, the smaD-brained but artistic Peruvians were not at all lacking in intellect, asMorton and most others had assumed after pondering a sample ofsmall Inca skulls. The artistic and other remarkable cultural achieve-ments of the Incas proved that skull measurements, when presentedin isolation or out of context, could present a very distorted pictureof the real capabilities of a given race.

DISCOVERY OF THE TREPANNED SKULL

Being a respected diplomat, archaeologist, writer, and admirer ofPeru's rich cultural history, Squier received an invitation to visit thehome of a wealthy woman in Cuzco, Peru. It was while he was ather spacious museum-home that he encountered the trepanned skull.It stood out from hundreds of other artifacts, which he described as

35. Squier, (n. 33) Peru, pp. 580-85.

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the finest and most valuable collection of museum-quality pieces ofpre-Columbian art in Peru.

In his thick book on Peru, where the skull itself is described in amere one paragraph of text and a one paragraph note at the end,Squier wrote:

In some respects, the most important relic in Sefiora Zentino's collectionis the frontal bone of a skull, from the Inca cemetery in the valley of Yucay,which exhibits a clear case of trepanning before death. The sefiora waskind enough to give it to me for investigation, and it has been submittedto the criticism of the best surgeons of the United States and Europe, andregarded by all as the most remarkable evidence of a knowledge of surgeryamong the aborigines yet discovered on this continent; for trepanning isone of the most difficult surgical processes. The cutting through the bonewas not performed with a saw, but evidently with a burin, or tool like thatused by engravers on wood and metal. The opening is fifty-eight hundredthsof an inch wide and seventy hundredths long.36

THE NEW YORK ACADEMY OF MEDICINE

Recognizing the historical significance of the skull with the irrefutablyman-made opening, Squier had brought it back to New York. Therehe allowed Dr. August K. Gardner (1821-1876) to inspect it andshow it to members of the New York Academy of Medicine. Whattranspired was summarized in the minutes of the Bulletin of the NewYork Academy of Medicine on 6 December 1865.37 Gardner agreedwith Squier's contention that an operation for trepanning had beenperformed with some sort of a gouging instrument during the Inca'slife. He also agreed that there was evidence of new bone forming,which suggested that this individual survived the operation by at leasta few weeks. As put in the minutes:

The skull showed that during the patients life an operation for trephininghad been performed, a square-shaped piece of bone having been removedfrom the frontal bone, by what would appear to have been a gouginginstrument. At one portion of the opening there seemed to be evidenceof the attempt on the part of nature to form new bone, to repair the injurydone by the operation.38

36. Squier, (n. 33) Peru, pp. 456-57.37. Anonymous, "Committee reports of December 6, 1865," Bull. N.Y. Acad. Med.,

1862-1866, 2, 530.38. Ibid.

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Nevertheless, one of the members of the New York Academy ofMedicine, Dr. Post, stated that he did not see clear evidence of areparative process. He therefore joined with those who were thinkingthat the cutting might have been performed after the time of death.Gardner replied that the new bone growth was more discernibleduring the daytime than at night, when viewed under gaslight. Andwith this difference of opinion the meeting of the academy wasadjourned.

PAUL BROCA

Given such skepticism, Squier felt a need to solicit additional expertopinions. In particular, he wanted a judgment by someone whoseknowledge, expertise, and creditability were unlikely to be ques-tioned. Paul Broca was, in his mind, just the person he needed.39 Hewas the highly respected founder of the Societe d'Anthropologie de Parisand, in the eyes of many people, the leading authority on humangroups and the family of man. He was also known for his discoveriesabout language (1861) and cerebral dominance (1865), for his skillas a surgeon, and for advancing medicine as applied science. Generallyslow to take a position, Broca was a thoughtful man who consideredall possibilities—and when he spoke, people usually listened.

Broca had been interested in skulls since about i860, especiallythe relationship between skull size and intelligence, one of the topicshotly debated at the meetings of his fledgling anthropological society,which was concerned with everything about the human group andits subgroups.40 He read Morton carefully and even used some of histechniques (e.g., packing with lead shot) to study crania. Further, heinitially believed, as did Morton and his American followers, thatthere are strong relationships between intelligence, cranial capacity,and brain volume.41

Like Morton, Nott, Glidden, and Agassiz, Broca believed in multi-

39. The best biography of Broca is still Francis Schiller's, Paul Broca (Berkeley: Universityof California Press, 1979).

40. Ibid., pp. 136-64.41. Steven J. Gould, "Measuring heads: Paul Broca and the heyday of craniology," in (n.

23) Mistneasure of Man, pp. 73-112. Broca did not have the unanimous support of hisanthropological society on the issue of brain size and intelligence. In 1861 Pierre Gratiolctargued that brain size is not a good correlate of intelligence. Later, Broca concluded thatsmall size is a reliable sign of mental inferiority, but that large brain size is not alwaysindicative of high intelligence.

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pie creations. But caught up in the Darwinian revolution of 1859,Broca quickly embraced evolution. Hence, he rejected the oldernotion that the human groups are fixed entities, and with it thepopular belief that only pure races could prosper. Moreover, he foundslavery, even for people with small brains and low intelligence, inex-cusable and repulsive.

Like most everyone else at the time, Broca initially believed thatthe races could be ranked by intellect, which was believed to have areasonable physical correlate in cranial capacity. Yet it was his ownresearch on cortical localization of function (conducted between 1861and 1865) that eventually led him to conclude that the front of thebrain is more important for intelligence than the pedestrian occiputor back of the cerebrum.42 Hence, modern Parisians may have smallercrania/brains than long-dead Basques, Cro-Magnons, or perhaps eventhe Totonac Indian from the Gulf of Mexico whose huge skull PierreGratiolet (1815-1865) exhibited in 1861, but modern Frenchmencould still be superior in intelligence.

From these and other perspectives, it is easy to understand whyBroca was interested in the trepanned Peruvian skull that he wasasked to examine in 1867. First, he probably wanted to see an Incaskull like the ones described in Morton's Crania Americana with hisown eyes. Second, he had formulated his own theory about Morton'sAmerican group, and the study of crania was one way of testing hisown growing belief that there were actually many distinct Americangroups. Third, his society had devoted several meetings during thesummer of 1862 to issues pertaining to the physical and culturalcharacteristics of the Native Americans. And fourth, there was now anew issue with its own unique scientific and philosophical challenges:Could the Incas, who possessed significantly smaller brain cases thanmodern Caucasians, have been performing something like brain sur-gery? As put by Broca s biographer Francis Schiller when describingthe then-common French view: "Savages, Indians, and such, mayhave made pottery, but surely they could not have aspired to makingtrephine holes."43

42. Paul Broca, "Remarques sur le siege de la faculte du langage articule; suivies d'uneobservation d'aphemie (perte de la parole)," Bull. Soc.Anat. (Paris), 1861, 6, 330-57, 398-407;"Sur le siege de la faculte du langage articule." Bull. Soc. Anthropol., 1865, 6, 337-93; StanleyFinger, Minds behind the Brain (New York: Oxford University Press, 2000), pp. 137-54.

43. Schiller, (n. 39) Broca, p. 158.

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What Broca concluded about Squier s Peruvian skull was publishedin two places in 1867.44 He would subsequently write many morearticles about trepanation. But all of those that followed dealt exclu-sively with much older Neolithic skulls and associated artifacts un-earthed in his native France (some with his own hands) several yearsafter the presentation of Squier's specimen.45 He did not return tothe New World finding.

After careful examination, Broca concluded that the openings onthe Peruvian skull piece had to be the result of some kind of "ad-vanced surgery" on a living person. But before presenting his ownarguments, he began by praising Squier as an established authorityon New World archaeological matters and as a scientist whose goodname guaranteed the authenticity of the specimen. In Broca's words:"Mr. Squier is the most renowned archaeologist in America. He isa specialist in Peruvian antiquities, and his high level of competencecannot be questioned."46 Broca's glowing accolades for Squier werefollowed by a short, informative note given to him by Squier. Itdescribed the Inca cemetery from which the skull was obtained andits dating.

Broca next described the denuded part of the cranium, explaining

44. Paul Broca, "Cas singulier de trepanation chez les Incas," Bull. Soc. Anthropol., 1867,2 (2nd ser.), 403-8; "Trepanation chez les Incas," Bull. Acad. Med., 1867, 32, 866-72. Otherthan having slightly different titles and opening words, these publications are identical. Fora complete English translation of Broca's report, see Hiran Fernando and Stanley Finger,"Ephraim George Squier's Peruvian skull: A landmark in the history of cranial trepanation,"in Trepanation: History, Discovery, Theory, ed. Robert Arnott, Christopher Smith, StanleyFinger, Rupert Breitweiser and Boleslav Lichterman, (Lisse, the Netherlands: Swets andZeitlinger, in press).

45. For a review of Broca's work on Neolithic trepanned skulls, see William Clower andStanley Finger, "Discovering trepanation: The contributions of Paul Broca," Neurosurgery,2001, 48, in press. Broca's own writings on the subject include: "Discussion," Bull. Soc.Anthropol., 1874, 9 (2d ser.), 189-205; "Sur les trepanations prehistoriques," Bull. Soc.Anthropol., g (26 ser.): 542-57, 1874; "Sur la trepanation du crane et les amulettes craniennesa l'epoque Neolithique," Congres Internationa] d'Anthropologie et d'Archeologique Prehis-toriques (Session a Budapest). Rev. Anthropol., 1876, 3,101 -96; "Sur les trepanations prehisto-riques," Bull. Soc. Anthropol., 1876, 11 (2d ser.), 236-51; 431-40; "Sur l'age des sujets soumisa la trepanation chirurgicale neolithique," Bull. Soc. Anthropol., 1876, 11 (2d ser.), 572-76;"Discussion," Bull. Soc. Anthropol., 1876, u (2d ser), 279—85; "Pretendues amulettes cranien-nes," Bull. Soc. Anthropol., 1876, 11 (2d ser.), 461-63; "Trepanations prehistoriques; cranestrepanes a l'aide d'un eclat de verre," Bull. Soc. Anthropol., 1876, 11 (2d ser.), 512-13;"Amulettes craniennes et trepanation prehistorique," Rev. Anthropol., 1876, j , 106-7; "Dela trepanation du crane, pratiquee sur un chien vivant, par la methode neolithique," BullSoc Anthropol. 1877, 12 (2d ser.), 400; "Trepanation de crane par le procede prehistorique,"Bull. Soc. Anthropol., 1877, 12 (2d ser.), 477-78; "Sur la trepanation du crane et les amulettescraniennes a l'epoque neolithique," Bull. Acad. Med., 1877, 6, 710-14.

46. Broca, (n. 44), "Cas singulier," p. 404.

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that he believed the subject must have died more than a week after theoperation. He said that his colleague, Monsieur Nelaton, thought thePeruvian might have survived the operation by some fifteen days. Theserevelations led to a detailed description of the opening and to suppositionsabout the kind of instrument that could have produced such an opening.Again, Broca respectfully acknowledged Squier's help.

But why, asked Broca, was such an operation performed?

There is no fracture or fissure of either external or internal table . . . andthe surgeon who performed the operation could consequently only begoverned by functional troubles when diagnosing the existence of an intra-cranial lesion. Was this diagnosis correct? Did the operation succeed inevacuating a fluid poured into the cranium? I am far from affirming this,but am tempted to believe it. In effect, the internal table around the openingis the seat of a very different alteration from that which existed on theexternal table around the denudation. . . . These peculiarities and severalothers, which would take too long to detail, are well explained, if wesuppose that there had been for some days before the operation an effusionof blood under the dura mater.47

Broca did not speculate on what might have caused such hemorrhag-ing. What was important to him was that he could find no clear signsof fracture—nothing to suggest an open head injury.

Broca concluded:

What astonishes me is not the boldness of the operation, as ignorance isoften the mother of boldness. To trepan on an apparent fracture at the bottomof a wound is a sufficiently simple conception and does not necessitate theexistence of advanced surgical arts. But here the trepanning was performedon a point where there was no fracture, and probably not even a wound,so that the surgical act was preceded by a diagnosis. Whether this diagnosiswas correct, as is probable, or false, we are in either case authorized toconclude that there was in Peru, before the European era, a surgery alreadyvery advanced—and this entirely new notion is not without interest forAmerican anthropology.48

SQUIER'S AND NOTT'S EXPLANATIONS

Although Broca believed that something occurring internally wasthe reason for the trepanation (a theory he would subsequently extendto French Neolithic skulls, albeit with reference to childhood seizure

47. Ibid., pp. 407-8.48. Ibid., p. 408.

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disorders), Squier disagreed. He believed that the operation was per-formed to treat a break in the skull, which in turn could have hadsecondary effects (like bleeding) that could well have affected brainfunction. He presented this argument in an appendix to his book onPeru. Squier also invited prominent physician Josiah Clark Nott towrite a note expressing his thoughts on the reason for trepanation.Notts opinion, which was in line with Squier's own, also appearedin the appendix.49

Nott (Fig. 4) was born in Columbia, South Carolina, and studiedmedicine in his home state, in Pennsylvania, and in France. He becamea distinguished surgeon but is best remembered for his writing andpolemics about the races and how they influenced society and history.According to one of his biographers, "Nott was to become a ferventsouthern polemicist who defended white supremacy with all the zealof a South Carolina slave owner while urging the freedom of scientificinquiry from religious orthodoxy."50 As previously noted, he ques-tioned the Old Testament on a single human creation, and he basedhis conclusions partly on differences in skull shapes and brain sizesamong the races.

Two of Nott's best known books, both written with George Glid-den as second author, were Types of Mankind and Indigenous Races ofthe Earth, and both were owned by Squier.51 Because Squier respectedNott, even if he did not share his racial convictions or philosophy,and because he had been in contact with him for some time, heasked for his opinion on the skull.

Nott explained that the rectangular opening could well have beenmade to treat a puncture wound caused by a sharp, pointed weapon,such as a Peruvian spear. He reasoned that small skull perforations,like those made by a bayonet or dirk, can cause a buildup of bloodwithin the cranium and inflammation. The affected patient mayexhibit abnormalities that increase in severity over time, includingdelirium and coma. Such signs and symptoms would provide therationale to trepan and, if the operation removed sufficient injuredbone, there would be no trace of the fracture or other bone injury.

49. Squier, (n. 33) Peru, pp. 579-80.50. Robert Horsman, Josiah Nott of Mobile: Southerner, Physician, and Racial Tlieorist (Baton

Rouge: Louisiana State University Press, 1987), p. 81.51. Nott and Gliddon, (n. 23) Types; Indigenous Races of the Earth (Philadelphia: Lippincott,

1857).

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376 Jorrrnal of the History of Medicine : Vol. 56, October zoo1

Fig. 4. Josiah Clark Nott (1804-187j), one of Squier's many American correspondents. From the National Library of Medicine collections.

After presenting Nott's note, Squier initiated his own conmentary with some descriptions of the bronze, sharply pointed spears, lances, 2nd arrowheads of the ancient Peruvians. He explained that among the ruins of Grand Chimu, where the Chimus (Yuncas) and Incas fought a major battle, he personally encountered many skeletons with skulls showing evidence of violence. In his own words: "Some were crushed in, as if from the blows of a club; others were cleft, as if by the stroke of a battle-axe, and others perforated, as if by lances or

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arrows, exhibiting a small square hole corresponding precisely withwhat would probably be made by the weapons I have described."52

He then mentioned that he even found a perforated skull, subse-quently lost while being transported to the United States, with abronze arrow still sticking in it. Notably, it exhibited no radiatingfissures.

With these observations, Squier concluded that Nott was probablycorrect in hypothesizing that a battle wound led to a break in theskull with deleterious behavioral consequences. In contrast to Broca,he concluded that the Inca surgeon who operated on the skull fromCuzco was not guided by symptoms alone, but by a puncture or afracture of the cranium that was subsequently removed.

WHAT HAPPENED TO SQUIER?

Squier recognized the importance of the Peruvian skull fragmentfrom the start. Broca's support for the his contention that the surgeryhad been performed on a living person could only have bolsteredhis belief that the relic would bring him still greater fame as a NewWorld archaeologist, even if he and Broca saw different motives forthe operation. Yet minimal space was devoted to the skull in Squier'slarge book on Peru, and most of what was written was confined toan Appendix. Admittedly, Peru contained a drawing of the trepanation(Fig. 1), but the fact remains that this cranium, which would changehow people would view ancient medicine and the Inca culture, wasnot a focal point in this book.

One possible explanation for not devoting more book space tothe relic is that Squier had been thinking from the start (or at leastafter hearing back from Broca and Nott) about publishing a separatepaper or short monograph on the relic. But if this were the case, henever followed though. In fact, he seemed to have had nothing moreto say about trepanation and his Peruvian skull than what came outin Peru, and that book appeared in 1877, a full ten years after Brocapublished his comments on the skull.

Did Squier change his mind and believe the openings were madeafter death? Did he come to question the age or authenticity of thespecimen? Did he simply lose interest in archaeology? As an American

52. Squier, (n. 33) Peru, p. 580.

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diplomat, did he face higher priorities? Did he no longer relish beingin science or in the public eye?

After Squier served as consul for Honduras in New York in 1869and then published Honduras, Descriptive, Historical, and Statistical,53

but before he published Peru: Incidents of Travel and Exploration in theLand of the Incas in 1877, Squier experienced severe marriage difficul-ties and a mental breakdown. He had married Miriam FlorenceFolline of New Orleans in 1858. He then began working for a friend,Frank Leslie, as chief editor of Leslie's Weekly. Leslie had an affairwith Squier's wife, which resulted in Squier's divorce from Miriam.This weighed heavily on Squier. It affected his ability to think criti-cally, his drive for scholarly work, and even his desire to write.

In 1874 Squier was declared legally insane. In that same year, theAmerican Museum of Natural History in New York bought mostof his archaeological material from Peru (including the trepannedskull), Central America, and the United States. Two years later hisentire library was sold at an auction.54

Squier seemed to have some rational periods prior to 1877, duringwhich he worked on Peru with the help of his brother Frank, whotook care of him. Eventually the book was completed—some fourteenyears after he had visited Peru. His last book of significance, alsowritten with his brother's help, was Honduras and British Honduras,published in 1880.55 Squier died in Brooklyn on 17 April 1888,divorced and without children.

Squier was eulogized in the New York Times and elsewhere for hiswritings, patriotism, and archaeological research on the Americas.Surprisingly, his obituaries did not mention the Peruvian skull frag-ment that is so well known in archaeological and anthropologicalcircles today as the first case of trepanning to be widely recognizedas such from an early, non-Western culture.

53.Ephraim George Squier, Honduras, Descriptive, Historical, and Statistical (New York:Holt & Williams, 1870).

54. F. Squier, (n. 3) Preface to books, p. 1. According to another Frank Squier, his nephew,his library was auctioned ofF by Bangs, Merwin & Co. on 24 April 1876, in New YorkCity. Today, many of his surviving books and papers can be found in the Library of Congress.In 1864, while Squier was in Peru, Davis (who had gone on to become a professor at theNew York Medical College) sold most of what had been collected from the mounds ofOhio to William Blackmore of London. In 1924 it was sold again, this time to the BritishMuseum.

55. Ephraim George Squier, Honduras and British Honduras (New York: Charles Scribner'sSons, 1880).

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Finger & Fernando : Squier and Trepanation 3 79

Squier had guided archaeology out of its speculative period intoa new period characterized by data collection, careful measurements,and classification. He was the author of many books on the Americas,served as first president of the Anthropological Institute of New York(1871), and was a member of many scientific societies.56 But morethan anything else, he was first and foremost an American patriot—aman who did everything he could to enhance America's prestige inthe world at large, including delving into his country's archaeology,from which he drew bold conclusions about its cultural past and itsrightful place in world history.

POSTSCRIPT

It was not until 1885 that the second trepanned Peruvian specimento receive broad Western recognition came forth, this time from asite near Lima.57 It is now estimated that well over than 1000 trepannedskulls from Peru (some more than 2400 years old) are in museumsand collections.58 The majority of these skulls have oval or roundopenings made by scraping. Rectangular and triangular openings,like the one described by Squier, are considerably less common,although the features of the cranial surgery vary with the culture,the time, and the site.

Given these numbers, it is fitting to return to Squier's hypothesisthat trepanation might have been performed by the Incas to treatskull breaks caused by weapons of war. Although Broca dismissedthis idea in favor of an internal problem, mainly because Squier'sspecimen did not exhibit any evidence of cranial fracture, Squier andhis friend Nott both maintained that a skilled surgeon could haveremoved all of the breakage when making the four intersecting cuts.

Of course, it would be myopic to think that trepanning was per-

56. Among the societies Squier belonged to were the American Ethnological Society,the Academy of Natural Sciences of Philadelphia, the American Association for the Advance-ment of Science, the Historical Societies of New York and Massachusetts, the ArchaeologicalInstitute of London, the Society of Antiquities of France, and the Royal Society of Antiquitiesof Denmark. Squier also received honorary degrees, including one from Princeton Universityin 1848.

57. Otis T. Mason, "The Chaclacayo trephined skull," Proc. U.S. Nad. Mus., 1855, 8,410-12;

58. Stephanie Rifkinson-Mann, "Cranial surgery in ancient Peru," Neurosurgery, 1988, 23,411 —16; Frank P. Saul and Julie M. Saul, "Trepanation: Old World and New World," inSamuel H Greenblatt, ed., A History of Neurosurgery (Park Ridge, 111.: American Associationof Neurological Surgeons, 1997), pp. 29-35; Julio O. Trelles, "Cranial trepanation in ancientPeru," World Neuroi, 1962, 3, 538-45.

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formed for only one reason in Peru, or in any other culture for thatmatter. Nevertheless, the accumulated data would suggest that Squierand Nott were on the right track. What we now know is that therewere two males for each female that was subjected to trepanation inPeru, and that only about 7 percent of the subjects were children.Additionally, some 70 percent of the Inca skulls show signs of healingand other evidence of survival. Such statistics, combined with thefact that there is no evidence that the ancient Peruvians made amuletsfrom cranial bones of the deceased, would imply that trepanation wasnot performed in Peru as a post-mortem rite.59

Roy L. Moodie (b. 1880), who has long been cited for his analysesof large numbers of Peruvian skulls, recognized during the T920Sthat trepanning was frequently associated with skulls found near thefortresses and war zones of the highlands of Peru, as opposed to morepeaceful coastal sites.60 The fact that the highland Peruvians foughtmany battles, and other considerations, such as gender and age, ledhim and then others to conclude that trepanation was often performedin ancient Peru to treat cranial fractures. This conclusion is furthersupported by the observation that most Peruvian specimens showdamage in the frontal or parietal region of the skull, which wouldbe expected from combat. The data also show that there are signifi-cantly more trepan holes on the left side than the right side of thehead, which is precisely what would be expected if blows weredelivered by right-handed adversaries.61

59. For statistics based on more than 600 trepanned crania from Peru, see John W. Verano,"La trepanacion tratamiento terapeutico para fracturas craneales en el antiguo Peru," Estud.Anthropol. Biol., 1997, 8, 65-81; see also: A. Earl Walker, 77ie Genesis of Neurosdcnce (ParkRidge, 111.: American Association of Neurological Surgeons, 1988); Rifkinson-Mann (n.58); Saul and Saul (n. 58). On healing, see Raul Marino Jr. and Marco Gonzales-Portillo,"Preconquest Peruvian neurosurgeons: A study of Inca and Pre-Columbian trephinationand the art of medicine in ancient Peru," Neurosurgery, 2000, 47, 940-50; Verano, op. cit.,p. 70. On post-mortem rites, seejudson Daland, "Depressed fracture and trephining of theskull by the Incas of Peru," Ann. Med. Hist., 1935, 7, 550—58; Juan B. Lastres and FernandoCabieses, Trepanacion del Craneo en el Antiguo Peru (Lima, Peru: Universidad Nacional delCuzco, i960); Manuel A. Mufliz and William J. McGee, "Primitive trephining in Peru,"Bur. Am. Ethnol. Annu. Rep., 1897, 16, 11-72.

60. Roy L. Moodie, "Studies in paleopathology, XXIII Surgery in Pre-Columbian Peru,"Ann. Med. Hist., 1929, 11, 698-728.

61. Francisco Grafia, Esteban D. Rocca, and Luis R. Grafia, Las Trepanaciones Craneanasen el Peru y en la Epoca Prehispanica (Lima, Peru: Sanmarti y Ca, 1954); Gilbert Horrax,Neurosurgery: An Historical Sketch (Springfield, 111.: Charles C. Thomas, 1952); George G.MacCurdy, "Human skeletal remains from the highlands of Peru," Am.}. Phys. Anthropol.,1923, 6, 217-329; Lambert Rogers, "The history ofcraniotomy: An account of the methodswhich have been practiced and the instruments used for opening the human skull during

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Of course, the most important fact is that careful inspection hasnow revealed that many of the Peruvian skulls still exhibit signs offracture after trepanation. This is why many scientists now agree thattrepanation was readily practiced as a surgical technique to treatdepressed cranial fractures, at least by the Incas.62 To cite one example,John Verano, an anthropologist who is currently studying hundredsof skulls from Peru, estimates that more than half of the adult malesfrom the central highlands of Peru suffered cranial fractures. Veranofurther contends that more than a quarter of the trepanned skullsfrom this region still exhibit visible evidence of fractures.63

It is unfortunate that Squier, with his fertile mind and deep appreci-ation of cultural history, did not live to witness the full impact of hisdiscovery or the emergence of new support for his cranial breakagetheory, especially from modern studies with very large samples. Heprobably would have been elated and eager to contribute more. Squierwas an enthusiastic and remarkable pioneer of nineteenth-centuryAmerican archaeology—a self-educated man who cared deeply forhis country and who helped clear the way for others to see openedcrania and cultural achievements in the New World in very newways.

life," Ann. Med. Hist., 1930, 2 (n.s.), 495~5H; Verano, (n. 59); Walker, (n. 58) Genesis, pp.8—10; Daland, (n. 59); T. D. Stewart, "Stone Age skull surgery: A general review withemphasis on the New World," Ann. Rep. Smithsonian lnst., 1958, 469-91.

62. Julio C. Tello, "Prehistoric trephining among the Yauyos of Peru," Proc. Int. Cong.Americanists, 1913, 18, 75—84; Robert E. Popham, "Trepanation as a rational procedure inprimitive surgery," Univ. Toronto. Med.]., 1954,3;, 204-11, 207; J. B.Jorgensen, "Trepanationas a therapeutic measure in ancient (pre-Inka) Peru," Ada Neurochirurg., 1988, 93, 3-5;Verano, (n. 59); Moodie, (n. 60); MacCurdy, (n. 61).

63. Based on hundreds of cases of trepanning, Verano, (n. 59), p. 74, gives the followingstatistics for the central mountain region of Peru: left = 50%, right = 35%, medial = 15%.For additional comments on the left side being strongly preferred by skull surgeons inancient Peru, see Rifkinson-Mann (n. 58); Stewart, (n. 61); Walker, (n. 59) Genesis, p. 6;Grafia et al., (n. 61).

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Squier and Discovery of Trepanation

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