Hektoen International

A Journal of Medical Humanities

Bioarchaeological findings support ancient representations of surgical limb amputation, part two: Examples from the New World

Peter de Smet
Nijmegen, Netherlands

Case 4: Finger amputation among the ancient Maya


The vessel in Fig. 1 is in the collections of the Ethnologisches Museum in Berlin (inv.no. IV Ca 15186 a). It was found to contain the phalanges of a little finger together with an obsidian blade that could have been used for its removal.2 In view of these contents, it may not be coincidental that the figurine only has four fingers on its right hand—incorrectly described as four fingers on the left hand in the original report.

Fig. 1.1 (left). Lidded ceramic vessel. H. 14.5 cm. Maya culture. Found at La Cueva near Santa Cruz Verapaz, Guatemala. Ethnologisches Museum, Berlin, inv.no. IV Ca 15186 a. Inside were the phalanges of a little finger (IV Ca 15186 b) together with an obsidian blade (IV Ca 15186 c; L. 5.7 cm). © Ethnologisches Museum, Berlin. Reproduced with permission.
Fig. 1.2 (center). Left hand of figure
Fig. 1.3 (right). Right hand of figure

Other ancient Maya representations of missing phalanges, fingers, or even hands have also been reported.1 Among the most clear-cut examples is a stone relief on the Temple XIX platform at Palenque (Fig. 2). A general caveat concerning these images is that they may not always portray surgical amputation, as it can be difficult to exclude other causes, such as a pathological deformity.4

Fig. 2. Male figure on the pier of the Maya Temple XIX in Palenque, who is missing the distal end of the second digit on his left hand.3 His full name is probably Muwaan Chanul Ahn and he seems to occupy a relatively low social position.4 © Mesoweb.org. Photo by Jorge Pérez de Lara; reproduced with permission.5

Some authors believe that the Maya obtained fingers from living people as part of mortuary rites.3,6,7 Geller recalls that modern Yucatec Maya mothers remove portions of one of their own fingers after the death of a child. She suggests that such practices would have bound mother and child beyond death and would have served as a permanent reminder to the mother’s loss.8,9 This cannot be the full story, however, because it does not explain why some Maya artefacts portray male persons with missing phalanges1 (e.g., Fig. 2) and why a single deposit in the Belize Valley yielded some 200 bowls with 225 phalanges.10 It is therefore expedient to look at other possible explanations as well (see Table 1).

Table 1. Possible reasons of finger and/or hand removal among the ancient Maya, as collected by McCauley on the basis of ethnohistoric and iconographic sources1
Voluntary/Involuntary PracticeDescription of Practice  
VoluntaryMourning mothers of deceased children cutting off portion of finger to be left in burial
Sacrificial ritual as an extension of bloodletting ritual, cut off finger to bleed through instead of simple cuts
InvoluntaryWarriors cutting off hands/fingers of defeated enemies to keep as trophies
Religious authorities cutting off hands of human sacrifice victims to be consumed or used as ritual objects


McCauley identifies 52 archaeological Maya sites that yielded 124 separate finger caches including 23 sites with 62 deposits of so-called finger bowls (vessels with human phalanges inside) and 31 sites with isolated instances of hands and/or fingers spread over 52 deposits.1 These numbers suggest that ritual deposition of amputated fingers and phalanges may have been fairly common among the ancient Maya, particularly in western Belize and the Petén region of Guatemala.1,3

Case 5: Foot amputation in pre-Columbian Peru


Various ceramic vessels of the pre-Columbian Moche culture (AD 100–800) portray individuals missing a foot (or both feet) which are generally believed to represent foot amputees. A medically interesting detail of the example in Fig. 3.1 is the groove across the leg stump which can be observed in several other examples of Moche amputees.13,15,16 This seems to indicate that both malleoli were preserved in their original position, which strengthens the hypothesis that ankle disarticulation was the main type of Moche foot amputation.13,17

Fig. 3.1 (left). Stirrup spout vessel representing person with amputated right foot and nasolabial mutilation. Ceramic (blackware). H: 18.0 cm. Moche culture, Peruvian North coast. 100–800 century AD. Prov: Klaus Kalz, Berlin, DE; Peter Pleuss, Solingen, DE. Photo by Peter de Smet. CC BY-NC-ND 4.0.
Fig. 3.2 (right). Stirrup spout vessel representing person placing (or removing) a cup-like prosthesis for his amputated left foot. Ceramic (blackware). H: 17.7 cm. Moche culture, Peruvian North coast. 100–800 century AD. Prov: Museo Larco, Lima, PE, inv.no. ML002724. CC BY-NC-ND 4.0.

A survey of 800 Moche ceramics of medical interestin the Ethnologisches Museum in Berlin yielded 127 footless examples, 42 of which depict amputees placing a cup-like prosthesis on their leg stump (or removing it).14 This suggests that Moche foot amputees could survive their surgery (Fig. 3.2) and raises the question of which roles such individuals would have played in Moche society.

Arsenault distinguishes two different types of footless figures in Moche iconography: one type served the ruler in the world of the living, e.g., by supervising the selection and preparation of food offerings. The other type seems to have been a major servant to the ruler in the afterlife. In other words, being footless could have been perceived as a symbol that transcended life and death.18 At least twelve of the 127 examples in Berlin are situated in the realm of the dead (see Fig. 4.1 for an eloquent example).14

Fig. 4.1 (left). Vessel representing a scene in which a skeleton with a foot prosthesis is participating in a procession of skeletal dancers and musicians.18 Ceramic. H: 21.4 cm. Moche culture, Peruvian North coast. 100–800 century AD. Prov: Ethnologisches Museum Berlin, inv.no. VA 17883 (see for a similar example in Berlin VA 47984). Photo by Peter Jacob. CC BY-NC-SA 4.0.
Fig. 4.2 (right). Stirrup spout vessel portraying an amputee with two missing feet and nasolabial mutilation who is beating a handheld drum. Moche culture, Peruvian North coast. 100–800 century AD. © Zemanek-Münster, Würzburg, DE. Reproduced with permission from 102 Auction, Apr 13, 2024, Lot 71.

Another remarkable feature of the figure in Fig. 3.1 is nasolabial mutilation, which occurs more often than not in Moche foot amputees.13 Bourget suggests that this type of facial mutilation was meant to create a skull-like appearance.19 Benson wonders whether persons with a foot prosthesis played a role in the transition of high-ranked Moche to the next world. She recalls that the Moche would hold community rites in the cemetery sometime after a burial, in which they drank corn beer and danced (presumably to the beat of music).20 This fits with Bernier’s claim of a strong connection between death and music making in Moche iconography.21

A connection between being footless, death, and music making is not only suggested by the representation in Fig. 4.1 but also by the stirrup spout vessel in Fig. 4.2. It portrays a musician with nasolabial mutilation and two missing feet, who is beating a handheld drum (see for another example inv.no. ML002224 in the Museo Larco in Lima). This reinforces the assumption that the surgical signs in Moche vessels do not depict a punitive or therapeutic intervention but portray a symbolic or magical concept.


In 1913, Vélez Lopez described the skeleton of an adult with two amputated feet, who had been using wooden cup-like prostheses padded with wool.13 Unfortunately, his description was not accompanied by photographs and the present whereabouts of the skeleton are unknown.22

Four recent reports offer more detailed bioarchaeological data about nine cases of foot amputation in pre-Columbian Peru, all of which showed signs of healing.13,17,23,24 The four oldest cases dated to the Moche culture (AD 100–800)13,23 and the youngest case to the Inca empire (AD 1470–1532).24 Two cases came from the Wari culture (AD 400–1000) and were found in an antechamber, where they apparently served as guardians of the main burial chamber.


The five cases presented here come from three different continents. They involved both antemortem and perimortem amputations and both voluntary and involuntary practices. They targeted fingers and phalanges (case 4); whole hands (cases 1, 2); feet (cases 2, 3, 5), and feet with part of lower leg (case 3). The cases also illustrate that early peoples practiced amputation for a variety of reasons (see Table 2). Iconographic portrayal of therapeutic amputation is not included in this survey but the bioarchaeological details of case 1 shows that this medical type of amputation was sometimes performed. In cases 3 and 5, bioarchaeological signs of healing were observed, which ties in with archaeological reports of healed limb amputation in other early cultures.25

Table 2. Main reasons for amputation in early cultures and indigenous societies (*)
Reason for amputation (*)Case(s)
To mark victory (by trophy-taking and/or disabling enemies in this life or the next)1,2
As punishment for socially unacceptable behaviour3
To express grief and procure bonding beyond death4
To create an outer sign of magical power5
To make sacrifices to deities 
To mark group membership 
As method of medical healing 
(*) After Tables 1-3 in McCauly 2018.26 Her ten different reasons have been reduced here to seven by merging antemortem and perimortem practices with a similar reason and by excluding a reason (namely, as a sign of marital status) that was only found in one group. The descriptions of reasons have been reworded but without changing their basic meaning.


The author is grateful to Ute Schüren (Ethnologisch Museum Berlin), Joel Skidmore (Mesoweb.com), and Zemanek-Münster (Würzburg) for permissions to reproduce Figs. 5, 6, and 8.2.


  1. McCauley B. A multidisciplinary analysis of ancient Maya finger caches. Burnaby: Simon Fraser University; 2019.
  2. Seler E. Antiquities of Guatemala. In: E. Seler E, E. Förstemann E, P. Schellhas P, C. Sapper C, and E. P. Doeseldorff EP, eds. Bulletin Smithsonian Institution Bureau of American Ethnology 28. Washington: Government Printing Office; 1904: 75-121.
  3. Scherer AK. Mortuary landscapes of the classic Maya: rituals of body and soul. Austin: University of Texas Press; 2015.
  4. Stuart D. The inscriptions from Temple XIX at Palenque: a commentary. Austin: Pre-Columbian Art Research Institute, University of Texas; 2005.
  5. Pérez de Lara J. A look at the hand and arm gestures of the characters on the Palenque Temple XIX Bench. 2002. Mesoweb: an exploration of Mesoamerican cultures. Available at: https://www.mesoweb.com/features/gestures/index.html [accessed Jun 20 2024]. 2002.
  6. Chase AF, Chase DZ. A mighty Maya nation: how Caracol built an empire by cultivating its middle class. Archaeology 1996; 49(5): 66-72.
  7. Gann TWF. The Maya Indians of southern Yucatan and northern British Honduras. Smithsonian Institution: Bureau of American Ethnology Bulletin 64. Washington: Government Printing Office; 1918.
  8. Geller PL. Parting (with) the dead: body partibility as evidence of commoner ancestor veneration. Ancient Mesoam 2012; 23(1): 115-30.
  9. Geller PL. The sacrifices we make for and of our children: making sense of pre-Columbian Maya practices. In: Baadsgaard A, Boutin AT, Buikstra JE, eds. Breathing new life into the evidence of death: contemporary approaches to mortuary analysis. Santa Fe: School for Advanced Research Press; 2012: 79-105.
  10. Cheetham DT. The role of ‘terminus groups’ in Lowland Maya site planning: an example from Cahal Pech. In: Garber JF, ed. The ancient Maya of the Belize Valley: half a century of archaeological research. Gainesville: University Press of Florida; 2004: 125-48.
  11. Friedmann LW. Amputations and prostheses in primitive cultures. Bull Prosthet Res 1972; 10: 105-38.
  12. Urteaga-Ballon O. Medical ceramic representation of nasal leishmaniasis and surgical amputation in ancient Peruvian civilization. In: Ortner DJ, Aufderheide AC, eds. Human paleopathology: current syntheses and future options. Washington, D.C.: Smithsonian Institution Press; 1991: 95-101.
  13. Verano JW, Anderson LS, Franco RG. Foot amputation by the Moche of ancient Peru: osteological evidence and archaeological context. Int J Osteoarchaeol 2000; 10: 177-88.
  14. Heck J. Krankheit und Körperdeformation in Darstellungen auf Moche-Tongefäßen: Analyse und Synopse aus ärztlicher Sicht. Baessler-Arch 2004; 52: 105-24.
  15. Mead CW. Old civilizations of Inca land. New York: American Museum of Natural History; 1924.
  16. Padula PA, Friedmann LW. Acquired amputation and prostheses before the sixteenth century. Angiology 1987; 38(2 Pt 1): 133-41.
  17. Więckowski W. A case of foot amputation from the Wari imperial tomb at Castillo de Huarmey, Peru. Int J Osteoarchaeol 2016; 26: 1058-66.
  18. Arsenault D. El personaje del pie amputado en la cultura mochica del Peru: un ensayo sobre la arqueologiadel poder. Lat Am Antiq 1993; 4(No.3): 225-45.
  19. Bourget S. Sex, death, and sacrifice in Moche religion and visual culture. Austin: University of Texas Press; 2006.
  20. Benson EP. The worlds of the Moche on the north coast of Peru. Austin: University of Texas Press; 2012.
  21. Bernier H. Music in the ancient Andes. Metropolitan Museum of Art, New York, Apr 2010. Available at: https://www.metmuseum.org/toah/hd/muan/hd_muan.htm [accessed Jun 10 2024]. 2010.
  22. Vélez Lopez LR. Las mutilaciones en los vasos antropomorfos del antiguo Peru. Proceedings of the XVIII session of the International Congress of Americanists Part II. London; 1913: 267-75.
  23. Chauchat C, Gutiérrez B, Deverly D, Goepfert N. Recherches sur l’élite de la société mochica: la plateforme Uhle à Moche, sur la côte nord du Pérou. Les nouvelles de l’archéologie 2008; (111-112): 116-22.
  24. Phillips M, Cruz V, Martin EK, Smith DR, Delgado Elias B, etal. Two (missing) left feet: caring for foot amputees in Late pre-Hispanic Túcume, Lambayeque Peru. Bioarchaeol Int 2021; 5(1-2): 1-20.
  25. Mays SA. Healed limb amputations in human osteoarchaeology and their causes a case study from Ipswich, UK. Int J Osteoarchaeol 1996; 6: 101-13.
  26. McCauley B, Maxwell D, Collard M. A cross-cultural perspective on Upper Palaeolithic hand images with missing phalanges. J Paleolit Archaeol 2018; 1: 314-33.

PETER AGM DE SMET is a retired Dutch drug information pharmacist, clinical pharmacologist and emeritus professor of pharmaceutical care at the UMC Radboud Nijmegen. He is still active as ethnomedical and ethnopharmacological researcher.

Summer 2024



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