History of the Practice

The practice of trepanation was not confined to any one geographical area or time period. It dates back as far as 6,000 BC in areas ranging from Africa to Ukraine and Portugal. Although it originated in the Stone Age, it carried over into the Neolithic period as well, the practice being used in locations such as the Czech Republic, France, and South America. It then evolved into a more of a modern day practice with the Romans and Greeks, potentially being used by even Hippocrates and Galen. Although there is evidence that it continued to be practiced in medieval Europe, there are few concrete examples of such occurring. Finally, the practice reached South America in between the 14th and 16th centuries A.D. Although the practice of trepanation has been used for centuries, it has greatly evolved, with major difference not being just in the physical act of cutting the hole, although the tools used did vary, but in the reasoning behind it (Cohut 2019).

Tools and Their Use

First, lets look at the way in which different tools were used to carry out the same act between cultures. As the years progressed, the tools and knowledge of modernizing societies progressed as well. From skulls found dated back to the Neolithic era (around 10,000 BC) in central France we learned that the holes made were about “two or three inches wide [with] scalloped edges” (Gross 2019) which indicated the use of sharp, hard stones. Using flint, the skull would be scrapped until a hole was formed. This practice was believed to persist into renaissance in Italy (Gross 2019). Practice then shifted to using a circular trephine which was a hollow cylinder with a rough edge that drilled through the skull or you could drill closely spaced holes and chisel the bone out between the holes. The latter was standard in the middle ages and an adopted method used by the Arabic people (Gross 2019).

Why Trepanation?

In many societies, trepanning was a medical solution to skull injuries. Following a skull fracture many cultures including African, Greek, and even early Western turned to the use of trepanation to relieve pressure and allow removal of skull fragments (Gross 2019). In fact, the Incas found that picking out broken pieces of bone following a head injury was something that allowed a lot of people to heal (Cohut 2019). In contrast to this, early Greek culture believed that drilling a hole in the skull would “let the evil air…breathe out” (Gross 2019) which was their cure for things like epilepsy and certain mental illnesses. To them, stagnant blood was bad and needed a way to be let out quickly and trepanation was the solution. This practice ended by the 18^th century. So, while most trepanation was believed to be done for medical reasons, it is hard to say that conclusively. There is still a lot of mystery surrounding the practice and its possible ritual uses as “most trephined skulls come from vanished nonliterate cultures” (Gross 2019).

Trepanation in Modern Western Culture

Today, we don’t see the use of trepanation carried out in the way that it previously was. Instead, in the world of Western medicine, a procedure known as a craniotomy may be performed. While this is similar, it involves replacing the missing piece of skull after a brief period of time rather than allowing the skull to remain open. It is also used in a more exploratory nature to allow direct access to the brain for invasive surgery or diagnostic purposes rather than being used as the sole therapeutic intervention.

Want to learn more?

• Check out the book by John. W. Verano Holes in the Head. This book dives deep into the practice of trepanation and focuses on a research project that examined more than 800 trepanned skulls from around the world. Specific focus is placed on Peru as it holds the highest number of skulls that have been trepanned than anywhere else in the world. This book looks at the cultural, archaeological, and historical context surrounding the practice.

• The Earliest Animal Cranial Surgery: from Cow to Man in the Neolithic is an article that looks at ancient trepanation practices and how they evolved from being practiced on animal skulls to human skulls. It tried to answer the question of whether or not people were actually practicing the technique on animals to then carry out on humans as far back as the Neolithic era.

• This video focuses on the practice of trepanation in Peruvian culture. It shows the tool that was used to drill into the skull and remove the bone. It also presents actual skulls to demonstrate the size of the holes that were made and how you can tell that the holes were healed.

Works Cited

Cohut, Maria. 2019. “Curiosities of medical history: Trepanation.” Medical News Today. Retrieved September 28, 2020. (https://www.medicalnewstoday.com/articles/326281)

Gross, Charles. 2019. “A Hole in the Head: A History of Trepanation.” The MIT Press Reader. Retrieved September 28, 2020. (https://thereader.mitpress.mit.edu/hole-in-the-head- trepanation/)