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KEY WORDS cervical-root caries; oral pathology; posterior teeth; coca chewing; Peru
ABSTRACT In this study, we describe the dental compared with results of a test for coca use derived from
health of four prehistoric human populations from the hair samples from the same individuals. The hair and
southern coast of Peru, an area in which independent dental studies exhibited an 85.7% agreement. Thus, we
archaeological evidence suggests that the practice of coca- have demonstrated the validity of a hard-tissue technique
leaf chewing was relatively common. A repeated pattern of for identifying the presence of habitual coca-leaf chewing
cervical-root caries accompanying root exposure was in ancient human remains, which is useful in archaeolog-
found on the buccal surfaces of the posterior dentition, ical contexts where hair is not preserved. These data can
coinciding with the typical placement of coca quids during be used to explore the distribution of coca chewing in
mastication. To further examine the association between prehistoric times. Simultaneously, we document the den-
caries patterning and coca chewing, caries site character-
tal health associated with this traditional Andean cultural
istics of molar teeth were utilized as indicators for esti-
practice. Am J Phys Anthropol 114:242–257, 2001.
mating the likelihood of coca chewing for adults within
© 2001 Wiley-Liss, Inc.
each of the study samples. Likelihood estimates were then
Theories about the prehistoric distribution of co- (Moseley, 1992); 4) Moche ceramic portraiture illus-
ca-leaf chewing in ancient Andean peoples have trating a spatula being used to remove lime from a
been the subject of considerable debate, particularly gourd container, in preparation for coca chewing in
the pervasiveness and geographical distribution of the north coast of Peru (Lumbreras, 1974); 5) burial
coca chewing (e.g., Leigh, 1937; Murra, 1986; inclusions showing dried coca leaves and lime held
Naranjo, 1981). In attempting to understand the in gourd bottles and bone spatulas from the Late
distribution of coca chewing in the ancient Andes, Preceramic culture in coastal Peru (2500 BC–AD
studies have been conducted in multiple disciplines, 1800) (Lanning, 1967); and 6) a stone sculpture de-
including biology (Cartmell et al., 1991; Aufderheide picting coca chewing in highland Tiwanaku Bolivia
et al., 1991); dental anthropology (Thompson, 1903; (Kolata, 1993). There are many reports on the ar-
Leigh, 1937; Klepinger et al., 1977; Elzay et al., chaeological evidence of coca chewing on the coast,
1977; Turner, 1993; Langsjoen, 1996); archaeology but few for the highlands.
(Lanning, 1967; Lumbreras, 1974; Menzel, 1977, In addition to the discovery of extensive coastal
Naranjo, 1981; Moseley, 1992); and botany (Molina
artifacts and coca paraphernalia, a prehistoric site
et al., 1985; Plowman, 1984, 1985 ). The findings and
from the Zaña Valley in northern Peru has been
conclusions from these reports, however, have not
reported to contain evidence of lime production
always been consistent.
Leigh (1937), for example, reports less frequent (Dillehay, 1992; Dillehay et al., 1991). The authors
coca chewing on the coast than in the highlands, report that lime or cal was produced from travertine
whereas most other studies suggest a coastal em- and calcite deposited at the headwaters of local
phasis (e.g., Moseley, 1992; Lumbreras, 1974; Lan- creeks. They suggest that the lime extracted from
ning, 1967). Archaeological evidence documenting a
predominantly coastal distribution includes: 1) coca
quids distending the cheeks of mummies from the Grant sponsor: Bioanthropological Foundation; Grant sponsor: Uni-
coastal Cabuza culture, Chile (⬃A.D. 500) (Cartmell versity of Chicago; Grant sponsor: National Science Foundation.
et al., 1991); 2) coca quids found in the mouths of
*Correspondence to: Etty Indriati, Laboratory Bioantropologi dan
mummies with accompanying coca leaf-filled textile Paleoantropologi, PO Box 23/YKBS, Yogyakarta 55002, Indonesia.
bags in the coastal Chiribaya region (Aufderheide et E-mail: indriati@idola.net.id
al., 1991); 3) Moche ceramic paintings depicting coca
chewing on the north coast of Peru (AD 100 – 800) Received 26 October 1998; accepted 23 October 2000.
addicts (76%; 115/151). These findings suggest that previously been ignored in distributional studies.
the cervical segment of teeth is more susceptible to This method, we feel, provides an important contri-
caries formation than other areas in the oral cavity. bution to this anthropological question.
This is perhaps because cementum is less dense In conducting this research, we examined the den-
than enamel, and therefore the cementum at the tal health of prehistoric individuals who had previ-
root is more prone to caries compared to the enamel ously been tested for coca use through hair analysis
at the crown of the teeth. (Aufderheide et al., 1991). From these data, we de-
veloped a quantitative dental technique for identi-
FOCAL POINT OF THIS STUDY
fying coca chewing, which in turn enabled us to plot
The current study attempts to utilize dental evi- the prehistoric distribution of coca chewing based on
dence to help resolve some of the contentious issues the percentage of identified coca chewers in our
regarding the biological effects of coca use. Previous south-central coastal Andean populations.
research suggested that coca chewing induces xero-
MATERIALS AND METHODS
stomia, thus causing cervical-root caries on the mo-
lar area where the coca quid is typically positioned One of us (E.I.) examined the dental health of 86
during chewing. The availability of research sub- individuals from four prehistoric sites in southern
jects (prehistoric individuals established as coca coastal Peru (AD 800 –1350): Chiribaya Alta, Alg-
chewers through evidence of positive traces of coca odonal, Yaral, and Chen-Chen (Table 1, Fig. 1). The
substance; Aufderheide et al., 1991) provided an inhabitants of these sites were primarily maize ag-
opportunity to study the dental lesions of these in- riculturalists who supplemented their diets with a
dividuals. This in turn enabled us to develop a sys- variety of other domesticated and wild resources
tematic method for identifying coca chewing in skel- (Dendy, 1991). The first three samples have been
etal populations and thereby aid in research on the examined for coca use via radioimmunoassay by
distribution of coca chewing in prehistoric Andean Aufderheide et al. (1991), using preserved hair
populations. samples. Aufderheide et al. (1991) applied radio-
We hypothesize, based on previous archaeological immunoassay (RIA) to test for the presence of co-
findings, that coca chewing was pervasive in prehis- caine metabolite remnants, namely benzoylecgnonie
toric Andean populations. We define a systematic (BZE). They took 30 mg of hair from each individual
dental method for identifying coca chewing that has studied, rinsed the hair with 100 ml sterile water,
COCA CHEWING IN PREHISTORIC COASTAL PERU 245
and centrifuged it. The rinsed water was used for
analysis of the presence of BZE. This analysis was
done with an antibody reactive with cocaine and
cocaine metabolite. RIA was monitored by a gas
chromatography-mass spectrometry method (GCMS).
Aufderheide et al. (1991) found an excellent correla-
tion in samples tested by RIA and GCMS. They set
the “cutoff” value differentiating reactive (positive)
from nonreactive (negative) at 5 ng of BZE/10 mg of
hair.
One of us (J.E.B.) randomly selected samples aged
20 –50 years (average age about 33 years, Table 1)
from Chiribaya Alta, Algodonal, and Yaral popula-
tions. Sex was determined through pelvic and cra-
nial morphology (Buikstra and Mielke, 1985); age
was determined by pubic symphysis morphology
(Suchey et al., 1986) and lateral anterior cranial
suture closure (Lovejoy et al., 1985). E.I. scored the
dental remains without knowledge of the results of
the radioimmunoassay tests.
We scored the following variables: tooth presence,
antemortem and postmortem tooth loss (Turner et
al., 1991), stage of dental wear (Scott, 1979; Smith,
1984), direction of attrition, slope of the teeth and
wear angle of occlusal surface (Smith, 1984), and
caries location and extent of calculus formation
(Dobney and Brothwell, 1986). Root exposure was
measured from the cemento-enamel junction to the
alveolar bone, and coded as 1– 4: 1, if the distance
was 1–ⱕ3 mm; 2, for ⬎3–ⱕ4 mm; 3, for ⬎4 –ⱕ5 mm;
and 4, for ⬎5 mm. If abscesses were present, the
location was recorded as either buccal or lingual. Fig. 2. a: Mandible, left view. On lower first and second
molars, note triangular root caries with severe root exposure but
Careful observation of dental pathological condi- intact crowns. This is an example of a strong indicator for coca
tions revealed a repeated pattern of buccal caries on chewing. b: Close-up of described area.
the cervix of molar teeth, frequently extending api-
cally and accompanied by severe root exposure (Figs.
2a,b, 3). We subsequently hypothesized that this
pattern could be the primary indicator of coca leaf ence of molar roots loosing crowns, and antemortem
chewing (CLC) resulting from the quid (chewed coca loss of molars) because they are obvious and do not
leaves with the addition of lime) being placed di- require a visual demonstration. However, Figure 4
rectly on the area. Other dental features considered represents the drawing of these weak indicators.
as secondary indicators included buccal crown car- As indicated in Table 2, strong indicators are at-
ies, interproximal caries, presence of only molar tributed only to lower molars. If all lower molars
roots being exposed, and antemortem loss of molars. were present, the maximum possible number of
These dental variables are listed and quantified in strong indicators in one individual is 6, with one
Table 2; together they form the dental technique indicator corresponding to each lower molar. In
used to identify coca chewers. On both lower and many examples, however, molars were lost before
upper molars we divided these parameters into death. Antemortem loss could be due to caries, pul-
three categories: strong, mild, and weak expres- pitis, or periodontitis, which may or may not be
sions, as detailed in Table 2, and illustrated in Fig- associated with coca chewing. We therefore included
ure 4. We used these indicators to place each indi- antemortem molar loss as a weak indicator of coca
vidual into categories of either a definite, probable, chewing. In addition to antemortem molar loss, post-
or possible coca chewer, or nonchewer, as indicated mortem tooth loss also occurred in the archaeologi-
in Table 2. Photographs of strong indicators are cal remains. To cope with the problem of antemor-
presented in Figures 2 and 3 in the form of cervical- tem loss of molars, we determined that the presence
root caries with irregular alveolar resorption on the of 2 strong indicators and accompanying mild or
buccal surface of lower molar teeth. An example of a weak indicators was sufficient to place an individual
mild indicator in the form of root caries on the in- in the “definite coca chewer” category (⫹CLC). We
terproximal surface of an upper molar tooth is seen describe the identification categories of coca chewers
in Figure 5 (MI-2604). We do not present a photo- in Table 2, as part of the dental technique. Results of
graph of weak indicators (interproximal caries, pres- coca-chewer determinations were compared to the
246 E. INDRIATI AND J.E. BUIKSTRA
TABLE 2. Dental techniques developed to identify coca chewers
Categories of variables on molar teeth used to identify
coca-chewers
1. Strong
Lower molars with deep and wide cervical-root caries on the
buccal surface, with severe root exposure equal or more
than 3 mm from the cemento-enamel junction.
2. Mild
A: Upper molars with deep and wide cervical-root caries on
the buccal surface, with severe root exposure less than 3
mm from the cemento-enamel junction.
B: Cervical-root caries on the mesial, distal, and lingual
surfaces of upper and lower molars;
C: Cervical-root caries on the buccal surface of premolars,
when their adjacent molars were lost antemortem;
D: Buccal-pit caries and caries on the buccal crown.
3. Weak
A: Interproximal caries;
B: Presence of molar roots only;1 Antemortem loss of
molars1
Identification categories of coca chewers
1. Definite coca-leaf chewer (⫹CLC): two strong indicators
present, along with accompanying mild or weak indicators.
2. Possible coca-leaf chewer (⫹?CLC): one strong indicator and
at least one mild indicator present.
3. Possible coca-leaf chewer (⫹??CLC): at least one mild
indicator present, or the percentage of mild indicators
relative to number of molars observed is at least 33%.
4. Noncoca-leaf chewer (⫺CLC): may or may not display mild
indicators. If displaying mild indicators, the percentage of
mild indicators relative to number of molars observed is
below 33%.
1
In our later study (Indriati, 1998), the presence of molar roots
only and antemortem loss of molars are in fact strong dental
variables for coca chewers.
Fig. 3. Mandible, right view. On lower first molar tooth, note
deep triangular root caries following root outline on buccal sur- ificity tests (Dawson-Sanders and Trapp, 1990, p.
face, with occlusal surface and buccal crown caries-free. We de-
fine this as an example of a strong dental indicator for coca
231).
chewing. RESULTS
General findings
results of hair analyses (Aufderheide et al., 1991) for Because tooth wear, abscess presence or absence,
the same individuals. and calculus are not the focus of our study, we do not
Statistical analysis present these data by specific categories such as
tooth type or age cohort. Instead, these observations
We use the chi-square statistical test to compare merely provide a general background of the oral
the frequency of coca chewing between males and health of the Andean populations we are studying.
females. Specificity and sensitivity tests establish The teeth generally exhibit slight to moderate wear
the significant concordance between dental tech- (Scott, 1979 for anterior teeth; Smith, 1984 for pos-
nique and hair analysis. Sensitivity and specificity terior teeth). Abscesses are uncommon and, when
are two means of describing test accuracy (Ingelfin- present, are usually on the buccal surface. Calculus
ger et al., 1983) that are commonly used in clinical is slight to moderate (Dobney and Brothwell, 1986),
medicine. “If all persons with the disease have ‘pos- suggesting normal pH in the oral environment. Root
itive’ tests, we say that the test is sensitive to the exposure varies in severity. Overall dental structure
presence of the disease. If all persons without the is therefore sound and should not, by itself, lead to
disease test ‘negative,’ we say that the test is specific irregular caries patterns. However, in cases where
to the absence of the disease,” according to Ingelfin- severe root exposure is observed, it is usually accom-
ger et al. (1983). Ingelfinger et al. (1983) also state panied by root caries that developed first at the
that if a test is sensitive and specific, no ambiguous cemento-enamel junction and then extended api-
interpretation occurs, but this condition rarely hap- cally on the buccal surface. This condition primarily
pens. We therefore define a threshold of 75% concor- affected molars, which is consistent with our hy-
dance between two tests as significant. The applica- pothesis concerning the quid position in the cheek
tion of specificity and sensitivity tests in our study is region during coca chewing.
useful to establish the probable positive rates of true
coca chewers and probable negative rates of true Caries rates
nonchewers. We tested the dental test (CLC) against In measuring caries rates, we calculated the total
a hair assay (BZE) by applying sensitivity and spec- adult tooth count in total mouths, which can include
COCA CHEWING IN PREHISTORIC COASTAL PERU 247
Fig. 4. Illustration of variable categories. Location and shape of caries for strong, mild, and weak indicators of coca chewing, as
described in Table 2. Dark areas indicate caries. Superscripts refer to upper teeth and subscripts refer to lower teeth. M, molar teeth;
P, premolar teeth. A, B, C, and D refer to the text in Table 2.
one or more caries per tooth. Each of the four popu- 2), ranging from 2.3–26.9 %. This frequency also far
lations is characterized by a high total caries rate, surpasses caries rates in mixed subsistence econo-
ranging from 30.1–54.5% (Table 3). This is signifi- mies (0.44 –10.3%) and among hunter-gatherers (0 –
cantly higher than the caries rates for most agricul- 5.3%). The high caries rate and high incidence of
tural peoples reported by Turner (1979) (see Table root caries in our study prompted the examination of
248 E. INDRIATI AND J.E. BUIKSTRA
viduals chewing coca occasionally but ceasing to body; thus, using coca at those times prior to death
chew coca sometime (from 2–3 months to 2 years) facilitates coca detection. Ceasing coca use more
before death, rendering cocaine undetectable in than 2 years prior to death would not leave detect-
their hair (⫺BZE). Coca metabolite products remain able chemical signals in hair (Aufderheide et al.,
stable from 2 months up to 2 years in the human 1991; Cartmell et al., 1991), even though dental
250 E. INDRIATI AND J.E. BUIKSTRA
TABLE 7. Identification of probable coca-leaf chewer (⫹?clc)1
lime, which is added to coca leaves to create a ball of that quids of various substances cause gingival re-
coca quid during chewing. The lime transforms al- cession and lead to root exposure in nondietary mas-
kaloids from the leaves into free bases (Rivier, 1981) ticatory habits. However, the extent to which the
and thus adds flavor to the coca (Allen, 1986). The exposed roots lead to caries in each case depends on
substances included in the coca quid vary from veg- the quid’s chemical properties.
etable ash, burned shells, ash of quinoa and cani-
hua, or plantain roots of cacao pods (Rivier, 1981). Implications for the prehistoric distribution of
Therefore, long-term usage could chronically irritate coca chewing
gingivae and buccal mucosa where the quids are
Several important studies of coca chewing among
typically positioned. The location of buccal mucosal
modern populations (e.g., Allen, 1986, 1988;
lesions among living coca chewers (Hamner and Vil-
Bastien, 1985; Buck et al., 1968) indicate a high
legas, 1969) confirms the location of CRC with buc-
degree of consistency with regard to the percentage
cal alveolar resorption in our skeletal samples, with
of coca chewers in ancient and contemporary groups
independent archaeological evidence of coca chew-
(Aufderheide et al., 1991; Cartmell et al., 1991).
ing.
These findings strengthen the argument that usage
Lesions associated with other nonmasticatory patterns have remained stable over long periods of
chewing habits time, i.e., from Late Middle Horizon times to the
present day. This stability is presumably due to
Other nonmasticatory habits exist in various so-
strong cultural factors; many workers maintain that
cieties, such as betel-nut chewing and tobacco chew-
coca chewing is a pervasive tradition still playing a
ing. These two chewing habits have much in com-
dominant role in Andean lives including religious,
mon with coca chewing, as the users form quids and
social, medicinal, and economic life (Allen, 1986,
keep them in their cheeks for a sustained period of
1988; Carter et al., 1980; Morales, 1989; Naranjo,
time. Do these chewing habits produce the same
1981; Rostworowski, 1973; Weil, 1981, 1986). The
lesions as with coca chewing? Just as coca quids
strong cultural factors that preserve the ancient cul-
induce both mechanical and chemical irritation
tural traditions were also evident in the form of coca
within the oral cavity, so do betel quids and tobacco
leaves which have been found in prehistoric burials
quids. However, the ultimate effects produced by
for tomb offerings (Aufderheide et al., 1991) and are
other forms of chewing differ substantially. While
still used as tomb offerings today (Harris, 1982;
coca quids induce xerostomia and therefore cause
Bastien, 1985).
caries on the exposed roots, the substances of betel
quids and tobacco quids do not induce xerostomia. In
Age at which coca chewing is adopted
fact, betel leaves have been found to have an anti-
septic effect due to their ethanol-based content, and In modern Peruvian Indians, the age at which
betel solutions have proven to be useful in cleaning coca chewing begins typically ranges from 15– 24
root canals during root canal treatment in dentistry years, but as people get older, they tend to adopt the
as a substitute for hydrogen peroxide (Indriati, habit (Carter and Mamani, 1986). Hamner and Vil-
1997). Betel-nut chewing, however, causes an abnor- legas (1969), however, report a lower average age of
mal lining of the oral mucosa (Chin and Lee, 1970) 10 –16.5 years among Aymarans and Quechuans in
and tooth discoloration (Rooney, 1993). Bolivia. Results suggest that prehistoric Indians
Clinical studies show that tobacco chewers exhibit might have started to chew coca within the same
gingival recession (Robertson et al., 1990; Greene et time range as modern Indians, between age 10 –16.5
al., 1992). Professional baseball players who habit- years.
ually chew tobacco or use snuff show a loss of gingi- Our results show an absence of strong indicators
val attachment and a line of oral mucosa and gingi- but a presence of mild and weak indicators among
val recession at the site where the tobacco quid is individuals aged 20 –25 years. Most individuals aged
most commonly placed. However, they typically lack about 25 years bear only mild and weak coca chew-
caries. In the study by Robertson et al. (1990) of 423 ing indicators, as seen in cases 11, 16, 25, 47, and 71
tobacco users, 46% had mucosal lesions following (Table 8). Older individuals, 30 – 45 years old, have
this pattern. The gingival tissue adjacent to mucosal strong dental indicators and are identified as either
lesions showed greater recession and loss of attach- probable (case 83; Table 7) or definite (cases 2, 6, 14,
ment. Mandibular gingivae were much more fre- 57, 60, and 73; Table 6) coca chewers. The dental
quently affected (94%) than maxillary gingivae (4%). markings found among people aged about 20 –25
The higher frequency of mandibular gingival reces- years suggest that our subjects might have started
sion was due to quids being placed relatively low to chew coca when they were 10 –16.5 years old,
across the mandibular gingivae. Unlike coca-chew- similar to the Aymaran and Quechuan coca chewers
ers who suffer root caries, tobacco chewers did not studied by Hamner and Villegas (1969). The age
suffer such caries. Thus while tobacco chewing may range of 10 –16.5 years is likely to be the age at
cause oral cancer and mucosal keratinization (Pind- which prehistoric Indians reached puberty and thus
borg et al., 1980), it does not lead to caries (Gibbs, were not considered children anymore, resulting in
1952; Van Reenen, 1954). We therefore conclude both social permission to chew coca and probably
COCA CHEWING IN PREHISTORIC COASTAL PERU 255
also full participation in rituals where coca chewing incidence of coca chewing (59.8%). Even higher us-
was involved. age rates have been found among miners of highland
Argentina (65%, 70/107; Schinder and Rider, 1989).
Distribution of coca chewers between males A third study among the Aymara in Bolivia identi-
and females fied 69% of the population as coca chewers (Indriati,
1998). This difference is probably correlated with
Coca chewing was found to be roughly evenly dis-
tributed between males and females in the prehis- the commonly known trait of coca as reducing the
toric Andes. In our study, the percentage of female symptoms of altitude sickness. The physiological
chewers was slightly higher than that of male chew- benefits of coca use include increased stamina (Brut-
ers (46.9% vs. 32.3%), although the difference was saert et al., 1995), maintained higher core body tem-
not significant statistically (2 ⫽ 1.84, P ⫽ 0.17; peratures (Hanna, 1974), increased blood pressure,
Table 10). This gender difference is consistent with and temporary euphoria (Weil, 1981). These studies
the hair study by Aufderheide et al. (1991), where support the veracity of Andean beliefs that coca
the difference was 55.6% vs. 35.3% (also not statis- chewing helps them work long hours, and relieve
tically significant; 2 ⫽ 1.72, P ⫽ 0.19; Table 12), sorrow and work at high altitudes. These beneficial
and with findings from a prehistoric coastal popula- functions of coca are perhaps additional strong fac-
tion in northern Chile studied by Cartmell et al. tors for the survival of coca chewing which is also
(1991), i.e., 60.7% vs. 53.3%. In addition, research by rooted in cultural beliefs.
Indriati (1998) on modern Aymarans in Bolivia is While these studies appear to suggest that coca
consistent with that cited for prehistoric popula- usage has, if anything, increased since ancient
tions: more female chewers (70.4%) than male chew- times, we believe this conclusion to be premature.
ers (67.4%). However, this difference was again not Whenever there is material loss of physical evidence
statistically significant. The slightly higher number in human archaeological remains, as there is here
of female chewers may be due to sampling error. due to postmortem tooth loss, caution should be
employed in making conclusions about percent us-
Overall prevalence of coca chewing age. It is clear, however, that the studies of both
ancient and modern populations find usage rates of
Our determination that 40.7% of three combined approximately one half to over two thirds in a given
populations chewed coca is consistent with the im- population. While we cannot yet draw accurate con-
plications suggested by the discovery of artifacts clusions on relative pervasiveness, it is clear that in
depicting coca chewing in the coastal regions of the both modern and ancient populations, coca-leaf
ancient Andes (Lanning, 1967; Lumbreras, 1974; chewing was a widespread cultural and physiologi-
Moseley, 1992). On the other hand, our finding con- cal phenomenon.
tradicts Leigh (1937), who relied on dental lesions of
calcareous accretion to identify coca chewing and ACKNOWLEDGMENTS
concluded that chewing was more dominant in the
highlands. Exclusion of prehistoric highland sam- This study was largely funded by the Bioanthro-
ples from our study does not permit us to draw pological Foundation, the University of Chicago, and
conclusions as to whether coca chewing was common the National Science Foundation in various grants
in the highlands. A study by one of us (E.I.), how- to J.E.B. We are thankful to Dr. Aufderheide, who
ever, indicated that 49% of prehistoric highland peo- provided unpublished radioimmunoassay results as
ple from the Tiwanaku sites of Lukurmata, a gold standard. The late Dr. Albert Dahlberg was
Akapana, Marcapata, Putuni, and Mollokontu (Ti- generous in allowing E.I. to use his laboratory space
wanaku IV–V, dated ⬃300 –1500 AD) chewed coca and contributed alginate and spoon trays for casting
(Indriati, 1998). This suggests that coca-leaf chew- the teeth upon her departure for Peru. Hu-Friedy
ing was indeed common in the ancient highlands. Chicago Dental Supply contributed three sets of di-
This, in turn, confirms archaeological evidence of agnostic kits. Dr. Sonia Guillen was most helpful
coca chewing in the highlands as suggested by stone when we studied the skeletal collection in Ilo, Peru.
sculptures of Tiwanaku elites with distended cheeks Prof. Russell Tuttle, Dr. Deborah Blom, and Paula
(Fierens, 1991; Kolata, 1993). Tomczak contributed critiques and comments on
The overall prevalence of coca chewing is similar earlier drafts of this paper. Michael Torbenson of the
in both the dental technique and the BZE method. Pritzker Medical School at the University of Chicago
The frequency (40.7%) of coca chewers in our study shared valuable discussions on the statistical tests.
of ancient Andeans approximates that reported by We are also thankful to Susan Antón of the Univer-
Aufderheide et al. (1991) (47.5%) and Cartmell et al. sity of Florida who commented on the final draft.
(1991) (46.6%) in their investigations of Chiribaya
remains in late prehistoric coastal Chile. However, LITERATURE CITED
several modern studies appear to suggest that usage
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