History and evolution of trepanation

Trepanation is one of the oldest surgical procedure being practiced by humans. Skulls with holes bored in them have been found by archaeologists from as far back as 3000 BC. The oldest of these occur in the Danube Basin. Hundreds of skulls with traces of trepanation are known all over Europe--in Denmark, Sweden, Poland, France, Spain, and the British Isles. A Swedish physician, Professor Folke Henschen, reports that Soviet archaeologists, along the Dnieper River in the 1960s, found crania with oval left-side trepanation holes of 16-18 mm (0.6-0.7 in) diameter. These were thought to date from the Mesolithic, or Middle Stone Age. If so, we must raise the age of this practice to some 12,000 years. Trepanation in Sweden, 1761 The greatest Swedish surgeon of the eighteenth century was Olaf af Acrel, chief physician at the Seraphim Hospital. He described the purpose of trepanation as follows: "Trepanation of the skull is intended to release what has forced its way out of the bloodvessels, or to lift up and remove what, having been forced in, causes meningitis (irritation of the brain membrane) -- or to both of these ends together," The amazing thing about such crania is that evidence exists for the patients having survived the operation. Holes in bone are healed by new formation of bone tissue, and the sharp edges of bored or hacked holes become rounded off by so-called callus tissue. This proof of healing is more the rule than the exception. In one study of skull material from the Yantyo tribe in Peru, a researcher found callus tissue in 250 out of 400 crania. Verifications in Europe are fewer, but even here it has been confirmed that most of the patients survived. Further proof of this--and reason for believing in the method--is the discovery of skulls which were trepanned more than once. The record seems to be held by an Inca at Cuzco with seven bore-holes, at least some of which were made on separate occasions. In England, during the late Middle Ages, trepanners used special saws of the kind shown here -- according to a 15th-century manuscript based on the ancient Greek writings of Hippocrates, who had recommended trepanation for light head wounds. Archaeologists have found that such saws, and other fine tools for wound treatment, were used as early as 300 BC by Celtic warrior-surgeons in Germany and Hungary. Nowadays, trepanation is performed to relieve acute pressure on the brain. The usual cause is internal bleeding after a blow on the head. In this case, the operation has a rational justification. The Stone Age finds, and customs of primitive peoples, indicate that our ancestors also used trepanation for such injuries. However, the great majority of skulls show that the operation was done on an intact cranium with no previous signs of violence. Here it must have been intended to relieve an apparent excess of pressure, which is easy to imagine in the event of, for example, migraine or sudden headaches of other kinds. Magic has obviously played a role as well. The belief that an evil spirit lives in the head and must be let out is very old. But the possibility of repeatedly letting out such spirits has, so far as we know, never existed. Werner von Heidenstam s fine description of a Stone Age leader in The Swedes and their Chieftains (1908) must, sadly, be ascribed to fantasy: "On their bare heads, a small lid was attached over a round hole, which had been bored right in the crown-bone. Such a hole was held in great reverence, and belonged only to the most eminent. Through it, evil vapors were able to escape, and the sunlight could enter to absorb their spirits after death." There were at least four different methods of trepanning. The crudest was to simply scrape a hole in the skull-cap, with patience and a piece of flint or a polished mussel-shell. A second method was to make a circular cut in the bone with a flint or obsidian knife, and to deepen it until the hard brain-membrane was reached. Alternatively, and doubtless worse for the patient, a hammer and chisel were used to cut four grooves in a cross shape, then lift out the square piece at their center. Most elegant, though, was the procedure which gave this operation its name. With a drill-bore, called trypanon in Greek, a wreath of tiny holes was made. These could be united easily with a chisel or knife. Such an operation took little time even with primitive tools. An adept French surgeon, J. Lucas-Championnière (1843-1913), experimenting with instruments of flint, needed only 35 minutes to complete the operation. During the nineteenth century, a scientist travelling in the South Pacific saw a medicine-man do it in half an hour. His patient woke up after several days of unconsciousness and regained perfect health! The medicine-men or shamans who dealt with trepanations stood high in society. They could also earn a fortune from the practice. Not only may we assume that they were well rewarded by every cured patient and his family. In addition, they conducted a lively trade with the pieces of bone which they extracted from people s skulls. Such amulets were greatly prized for magical protection from illness and accidents. Researchers have even wondered whether the demand for skull-bone contributed to the prescription of trepanations. There are actual records of amulets measuring about 8-9 cm (3.1-3.5 in). No medical reason can exist for making such enormous holes, and it is very unlikely that the patients survived the serious risk of infection with meningitis.

If you need more information, you are welcome to contact us-
Contact us
(Best viewed at 800 X 600 resolution)