how was trepanation performed

As many as five main methods were found for trephination:

• Rectangular intersecting cuts
• Scraping utilizing an abrasive instrument such as flint
• Circular grooving
• Boring and cutting by a circular trephine or crown saw
• Burr hole done by drilling several circle holes closely to create a space and then cut/chisel the bone between the hole. [24]

Full Answer

How is trepanation performed?

Although there are some subtle differences in how people performed trepanation throughout the ages and in different parts of the world, the basics remain unchanged. This procedure — also known as “trepanning” or “trephination” — requires drilling a hole into the skull using a sharp instrument.

What is the history of trepanation?

Evidence also suggests that trepanation was primitive emergency surgery after head wounds to remove shattered bits of bone from a fractured skull and clean out the blood that often pools under the skull after a blow to the head. Hunting accidents, falls, wild animals, and weapons such as clubs or spears could have caused such injuries.

What is trepanning and why was it used?

Indeed, scientific understanding of the human body would elude civilizations for hundreds of years, leaving them with usually a combination of folk-remedies and superstition. One such practice was known as trepanning, a procedure in which a hole was drilled into the human skull, usually as a means of preventing death due to a head injury.

What was the objective of trephination?

The objective of trephination was to allow blood to drain from the skull. According to Hippocrates, stagnant blood was bad, as it could decay and turn into pus. Therefore, trephination was a means to allow the blood from the injured part of the head to flow out before it turned bad.

Was trepanning painful?

With zero anesthesia, this made for a particularly painful, even life-threatening, procedure. However, the survival rate of these operations was surprisingly high. Even up to the modern day, trepanning has its strong adherents.

What is the trepanation procedure?

Trepanation. Trephination is the surgical procedure in which a hole is created in the skull by the removal of circular piece of bone, while a trepanation is the opening created by this procedure (Stone and Miles, 1990).

What is trepanation and why was it performed?

In ancient times, trepanation was thought to be a treatment for various ailments, such as head injuries. It may also have been used to treat pain. Some scientists also think that the practice was used to pull spirits from the body in rituals. Many times, the person would survive and heal after the surgery.

When was trephining first used?

The tradition of trephining as a treatment for epilepsy begins as early as Aretaeus the Cappadocian (ca. 150), one of the most famous Greek clinicians, and lasted into the 18th century.

Can you survive with a hole in your skull?

"Physical damage to one part may be fatal, but in another it may have very little effect." Rose adds: "If the lower regions of the brain or spinal cord are damaged - regions that control heart rate, breathing etc - the consequences are likely to be fatal.

Is trepanation still used today?

Is trepanation still used today? Trepanation is not used in neurosurgery for medical purposes now. However, another procedure, called a craniotomy, is done that involves temporarily creating a hole in the skull to remove fluids or release pressure, and then closing the hole after a definite period.

Did trepanning do anything?

Out of eight skulls with trepanations from the 6th to 8th centuries found in southwestern Germany, seven skulls show clear evidence of healing and survival after trepanation, suggesting that the survival rate of the operations was high and the infection rate was low.

How does a hole in the skull heal?

In cases of large hematomas or solid clots, your healthcare provider may advise another procedure to remove the material around the brain. For example, a surgeon may remove a larger piece of bone from the skull to treat the brain, and then put the piece of skull back in place to heal.

How long was trephination used?

The oldest discovered skulls showing evidence of trepanation date back to the Mesolithic period — around 6000 B.C. They emerged in North Africa, Ukraine, and Portugal.

Did they used to drill holes in skulls?

Evidence of holes being drilled into the skull for medical purposes, or “trepanation,” has been traced back to the Neolithic period — about 4000 B.C. — and it might have been practiced even earlier.

What is the difference between lobotomy and trepanation?

Trepanation is also used for surgical access to help relieve intracranial pressure. Lobotomy is another surgical treatment that involves drilling a hole in a person's skull.

Why did they drill holes in skulls?

This procedure — also known as “trepanning” or “trephination” — requires drilling a hole into the skull using a sharp instrument. Nowadays, doctors will sometimes perform a craniotomy — a procedure in which they remove part of the skull to allow access to the brain — to perform brain surgery.

How does a hole in the skull heal?

In cases of large hematomas or solid clots, your healthcare provider may advise another procedure to remove the material around the brain. For example, a surgeon may remove a larger piece of bone from the skull to treat the brain, and then put the piece of skull back in place to heal.

What is trepanation in ancient times?

In ancient times, holes were drilled into a person who was behaving in what was considered an abnormal way to let out what people believed were evil spirits. Evidence of trepanation has been found in prehistoric human remains from Neolithic times onward.

Why is trepanation important?

Michell also describes a British group that advocates self-trepanation to allow the brain access to more space and oxygen. Other modern practitioners of trepanation claim that it holds other medical benefits, such as a treatment for depression or other psychological ailments. In 2000, two men from Cedar City, Utah, were prosecuted for practicing medicine without a license after they performed a trepanation on an English woman to treat her chronic fatigue syndrome and depression.

How many prehistoric skulls have trepanation holes?

At one burial site in France dated to 6500 BCE, 40 out of 120 prehistoric skulls found had trepanation holes. Many prehistoric and premodern patients had signs of their skull structure healing, suggesting that many of those subjected to the surgery survived.

Why is trepanning practiced today?

The practice of trepanning also continues today due to belief in various pseudoscientific medical benefits. Some proponents claim that trepanning results in increased blood flow. Individuals have practiced non-emergency trepanning for psychological purposes. A prominent proponent of the modern view is Peter Halvorson, who drilled a hole in the front of his own skull to increase "brain blood volume".

What is a trepanning?

Trepanning, also known as trepanation, trephination, trephining or making a burr hole (the verb trepan derives from Old French from Medieval Latin trepanum from Greek trypanon, literally "borer, auger") is a surgical intervention in which a hole is drilled or scraped into the human skull. The intentional perforation of the cranium exposes ...

Where are trephined skulls found?

More than 1,500 trephined skulls from the Neolithic period (representing 5 to 10% of all Stone Age skulls) have been uncovered throughout the world – from Europe, Siberia, China and the Americas. Most of the trephined crania belong to adult males, but women and children are also represented. A cow skull dating to 3400-3000 BCE upon which trepanation had been performed was discovered in France.

Which period had the largest number of trepanned skulls?

The Bronze Age was found to be the period with the largest number of trepanned skulls in ancient China.

Trepanation in pre-Columbian Mesoamerica

In pre-Columbian Mesoamerica, evidence for the practice of trepanation and an assortment of other cranial deformation techniques comes from a variety of sources, including physical cranial remains of pre-Columbian burials, allusions in iconographic artworks and reports from the post-colonial period.

Trepanation as a Pseudoscience

The use of trepanation in the modern era is considered a pseudoscience. For trepanation to be considered a genuine science it would have to follow these guidelines set forth by Stephen S. Carey author of A Beginner’s Guide to Scientific Method :

Who was the trepanator in China?

The possibility that trepanation was practiced in ancient China is suggested by the following story about Cao Cao and Hua Tua, from a historical novel attributed to Luo Guanzhong, written in the Ming dynasty (1368–1644) and set in 168–280 at the end of the Later Han dynasty. Cao Cao was commander of the Han forces and posthumously Emperor of the Wei dynasty, and Hua Tuo was (and still is) a famous physician of the time.

Why is trephining not discussed in the Hippocratic treatise?

The Hippocratic doctors believed that stagnant blood (like stagnant water) was bad. It could decay and turn into pus.

Why did Broca see a hole in his skull?

After examining the skull and consulting some of his surgical colleagues, Broca was certain that the hole in the skull was due to trephination and the patient had survived for a while. But when, in 1876, Broca reported these conclusions to the Anthropological Society of Paris, the audience, as in the United States, was dubious that Indians could have carried out this difficult surgery successfully.

Why did Hippocratic doctors drill holes in the skull?

Apparently the Hippocratic doctors expected bleeding from a head wound and the reason for drilling the hole in the skull was to allow the blood to escape (“let blood by perforating with a small trepan, keeping a look out [for the dura] at short intervals”). Since they presumably had no notion of intracerebral pressure, why did they want the blood to run out? Although the reasons for trephining are not discussed in “On Wounds in the Head,” they seem clear from other Hippocratic treatises such as “On Wounds and On Diseases.” The Hippocratic doctors believed that stagnant blood (like stagnant water) was bad. It could decay and turn into pus. Thus, the reason for trephining, or at least one reason, was to allow the blood to flow out before it spoiled. In cases of depressed fractures, there was no need to trephine since there were already passages in the fractured skull for the blood to escape.

How did Broca reproduce skulls?

Broca demonstrated that he could reproduce these openings by scraping with a piece of glass , although a very thick adult skull took him 50 minutes “counting the periods of rest due to fatigue of the hand.”.

Where is trephining found?

The earliest detailed account of trephining is in the Hippocratic corpus, the first large body of Western scientific or medical writing that has survived. Although there is no question that there was a famous physician called Hippocrates in the fifth century BCE, it is not clear which of the Hippocratic works were written by him. The most extensive discussion of head injuries and the use of trephining in their treatment is in the Hippocratic work On Wounds in the Head.

When were trephined skulls discovered?

Trephined skulls have been discovered in widespread locations in every part of the world, in sites dating from the late Paleolithic to this century.

Where was trepanation performed?

Throughout history, trepanation has been practiced in nearly every part of the world. It was performed in ancient Greece and Rome, and is today even reportedly used in parts of Africa, South America, and the South Pacific. In ancient Greece, it was used to relieve pressure, ...

Where was the Trepanation?

Squier traveled to Cuzco, Peru. While visiting the home of a wealthy woman who collected antiquities, he was shown an ancient skull. Discovered in an ancient Inca cemetery in the Valley of Yuca, ...

Why is trepanation used in ancient Greece?

In ancient Greece, it was used to relieve pressure, remove skull fragments from the brain after a traumatic accident, and for drainage. From the Renaissance until the beginning of the 19th century, trepanation was routinely used to treat head wounds, and into the 18th century, it was used to treat epilepsy and mental disorders.

What was the technique used to cut through bone?

Techniques varied from culture to culture. Prehistoric trepanations performed in early Peru were done with a ceremonial knife called a tumi, which was used to scrape or cut through the bone. The Hippocratic school invented the trephine drill, which bored holes into the skull. In the South Pacific, they sometimes used sharpened seashells; in Europe, flint and obsidian. By the Renaissance period, trepanation was routinely performed, and a range of instruments had been developed. However, due to the high infection rate, the practice soon waned.

What is the practice of drilling a hole in the skull called?

The practice of drilling or scraping a hole into the skull’s cranial vault to expose the brain’s dura mater and treat brain injuries is called trepanation. First mentioned by the Hippocratic corpus, it’s one of the world’s oldest surgeries. (In fact, the word trepanation comes from Greek, and means “auger” or “borer.”)

Why is trepanation used?

According to Verano, modern eyewitness accounts from Africa and the South Pacific state that trepanation is still used to treat head wounds, headaches, or pressure on the brain. In other parts of the world, it’s thought that trepanation might have once been used to release evil spirits, or to treat insanity or epilepsy. But without any written record, we’ll never quite know why these kinds of surgeries were performed in the absence of obvious injury.

What was the skull of Peru's ancient people?

Squier believed that the skull was clear evidence that Peru’s ancient people had perform ed prehistoric brain surgery. The hole’s cross-hatched outlines were the work of a human hand; Squier noted that they were most likely made with a burin, a tool used by engravers on wood and metal.

What is trepanation in the Incas?

Trepanation: How the Incas needed that like a hole in the head. Surgery is a highly technical skill that requires years of training, intense medical knowledge, and advanced tools. Even with the best of conditions, there are still risks to surgery, risks that can threaten the very life of the person under the knife.

Why do people trepan?

The Ancient City Of Machu Picchu in Peru. Some practiced trepanation under the belief that it would excise evil spirits that dwelt within the human head, leading to strange behavior. Trepanning, while it might seem barbaric, is a legitimate medical practice, as long as it’s being used to treat blood build-ups from head injuries.

What was the mortality rate for trepanation during the Civil War?

During the Civil War, the mortality rate for trepanation was between 46 percent and 56 percent. When compared to the ancient Inca civilization, it would seem that somehow the Incan surgeons had a leg up on American surgeons in the 1800s.

Which culture excelled at this type of surgery?

One culture that excelled at this type of surgery was the Incan people. Dr. John Clarke trepanning a skull, c.1664, in one of the earliest American portraits. Clarke is alleged to have been the first physician to have performed the operation in the New England Colonies. The Incan Empire in South America was the largest and one ...

Did the Incans keep written records?

However, these are mainly theories because the Incans did not keep written records, as they had no formal system of writing. While the secrets of how the Incan surgeons were able to perform trepanation are long lost to history, the fact remains that their civilization had one of the highest success rates in the world.

Where did trephination occur?

Evidence for trephination occurs from prehistoric times from the Neolithic period onwards. The main pieces of archaeological evidence are in the forms of cave paintings and human remains; the skulls themselves from prehistoric times. It is the oldest surgical procedure for which we actually have archaeological evidence. At one site in France, burials included forty instances of trephination from around 6500 BCE; one third of the skulls found at the site. The percentage of occurrences there though is fairly high and percentages largely differ between sites and continents. It is from the human remains found at such sites that we know that the surgery had a fair survival rate. Many skulls show signs of healing and indicate that the patient lived for years after the event, even sometimes having trephination performed again later in life and again surviving the experience.

Where in the Hippocratic Treatises does it say "trepanning"?

The Hippocratic Treatises make mention of trepanning in the chapter on injuries of the head, which states: 'For a person wounded to the same . . . extent . . . will sustain a much greater injury, provided he has received the blow at the sutures, than if it was elsewhere. And many of these require trepanning.'.

What is trephination surgery?

Trephination (also known as trepanning or burr holing) is a surgical intervention where a hole is drilled, incised or scraped into the skull using simple surgical tools. In drilling into the skull and removing a piece of the bone, the dura mater is exposed without damage to the underlying blood-vessels, meninges and brain.

What can we conclude about trephination?

What we can conclude about trephination is that this ancient surgical technique was astonishingly widespread and was practised on the living and the dead in association with head trauma and for other reasons including the spiritual and the experimental. The cranial evidence which appears is from a range of patients of different ages and sexes, showing that the operation was performed on men, women and children. Evidence of healing and multiple burr holes indicate that there was a survival rate and some were even operated on repeatedly. However, some skulls show us the risks of the operation as well. Some skulls uncovered are evidence that the procedure was abandoned mid-operation as the trephining is incomplete.

How long did the patient live after trephination?

Many skulls show signs of healing and indicate that the patient lived for years after the event, even sometimes having trephination performed again later in life and again surviving the experience.

What evidence does cranial surgery show?

The cranial evidence which appears is from a range of patients of different ages and sexes, showing that the operation was performed on men, women and children. Evidence of healing and multiple burr holes indicate that there was a survival rate and some were even operated on repeatedly.

When did Han and Chen study trephination?

They looked at six specimens from five sites ranging from 5000-2000 BP which showed cranial perforation in prehistoric China.

Why Was Trephination Performed?

The Greek physician Hippocrates deals extensively with head injuries in his On Wounds in the Head . In this work, five types of head wounds are described, and trephination is recommended for all but one of them. The objective of trephination was to allow blood to drain from the skull.

What is a trephination?

Trephination (known also as trepanning, trepanation, trephining, or making a burr hole), is a surgical procedure, which involves the drilling of a hole in the skull of a living person. Trephination is considered to be one of the oldest surgical procedures in the world, and evidence for this practice is found as early as the Neolithic period.

Why did trephination continue in Europe?

Trephination continued in Europe during the Middle Ages, thanks to the immense influence of Hippocrates and Galen on the practice of medicine in the West.

How many trephined skulls are there?

According to a 2015 article by Miguel A. Faria in Surgical Neurology International , more than 1500 trephined skulls have been found at Neolithic sites around the world, including Europe, the Americas, Russia, and China.

Why did Galen use trephination?

Therefore, trephination was a means to allow the blood from the injured part of the head to flow out before it turned bad. Later on, during the time of Galen, trephination was a standard procedure not only for draining blood, but also for relieving pressure, and to remove skull fragments after a traumatic accident.

Where are trephined skulls found?

A number of trephined skulls from the Graeco-Roman period, for instance, have been found in the area of modern-day Israel. At the site of Acco, for instance, a trephined skull from the Hellenistic-Roman period was unearthed, whilst another four were discovered in a Roman cemetery in the Jordan Valley near Jericho.

What was the problem with spongy bone?

Nevertheless, hemorrhages from the exposure of spongy bone was a problem that had to be overcome by the surgeons. Whilst the Mesopotamians stopped the bleeding with plants, ancient Egyptian papyri from 3000 BC prescribed the application of fresh meat on wounds. As fresh meat contains hemostatic properties, it is able to decrease bleeding.

Overview

History

Tools and methods

Risks

Voluntary trepanation

See also

External links