“You fancy getting the trepanning done?” - John Lennon
Trepanning is the ancient method of neurosurgery. A hole is drilled into the head for various different reasons, culminating in the removal of a piece of the skull. Trepanning is still in practice today, however, it has been rebranded as a craniotomy and the tools and skillset have progressed. But, ultimately, the procedure remains the same. We have evidence of trepanning going back to prehistoric times, it is one of the oldest surgical practices in history. The earliest trepanned skull was discovered at a Neolithic burial site in France, and is more than 7,000 years old. Mostly, the procedures were carried out to relieve pressure on the brain as a result of a blow endured during battle. Some were carried out to allow liquid to escape for the same reason. Others were performed to allow a suspected demon to escape from a ‘possessed’ host and we also have evidence that trepanning was carried out for decoration purposes, as a recently discovered 2,000 year old skull alludes to. Trepanning, comes from the Greek word 'trypanon', meaning a device for boring holes.
In 1865, in the ancient Inca city of Cuzco, Ephraim George Squier archaeologist and ethnologist, received an unusual gift from his hostess. The gift was a skull from an enormous nearby Inca burial ground. What was unusual about the skull was that a hole slightly larger than a half-inch square had been cut out of it. Squier’s judgment was that the skull hole was not an injury but was the result of a deliberate surgical operation. He also made the assertion that the individual had survived the surgery. When the skull was presented to a meeting of the New York Academy of Medicine, the audience refused to believe that anyone could have survived a trephining operation carried out by a Peruvian Indian. The assumption was that an operation of this magnitude was highly advanced the the skillset needed was not present at the the time this person had the supposed operation. Squier then brought his Peruvian skull to Europe’s leading authority on the human skull, Paul Broca, professor of external pathology and of clinical surgery at the University of Paris. After examining the skull and consulting some of his surgical colleagues, Broca confirmed what Squier suspected and was certain that the hole in the skull was due to trephination and the patient had indeed survived. Confirming that these albeit primitive operations were being performed successfully even though the reason for them was still unknown.
Clubs and slingshots were the usual causes of fractured skulls in battle, a frequent injury Peruvian surgeons may have been skilled at mending, physical anthropologist John Verano of Tulane University states that Gold or silver were often used in this type of procedure. A Peruvian warrior was repaired using metal in one of the earliest-known examples of complex surgery in the world, according to Oklahoma Osteology museum. The man returned from battle with a broken skull that ancient surgeons bound with a metal plate, according to the museum. The damage was such that the Peruvian healers were compelled to seal the fracture or leave the wounded man with permanent injuries. The warrior is believed to have survived. These operations were undertaken without the use of modern anaesthesia or sterilisation techniques. Remarkably, the success rate for trepanned patients in the Inca era was roughly 80 per cent, according to a 2018 study published in World Neurosurgery. The skull in question was also elongated as part of a tradition common to Peru at the time. Elongation was carried out at a very young age with two pieces of either bark or wood that were bound around the head with a strip of cloth to compress the skull. While there are several factors behind elongation, it’s typically thought to have signified beauty, intelligence and high status.
Intentional head lengthening has been found in a number of cultures across the world, from the Americas and Central Asia to Australia, Europe, Scandinavia and the Caribbean. Medical historians refer to the 18th century as the “trepan century.” This is because at that time, European surgeons became particularly interested in the possible uses of this practice. During the 18th century trepanation first took the form of veterinary treatment. Veterinarians would carry it out on domestic animals to treat various infections or remove tumours. Throughout the century, doctors used trepanation to treat concussions and brain inflammation. In the 19th century, trepanation rose and fell from medical favour, though trepanations were particularly popular during the American Civil War period (1861–1865). At this time, doctors recommended them for cleaning and treating head wounds. Eventually, trepanation gave way to the sophisticated procedure of craniotomy. This, however, has not meant that trepanation has entirely fallen from favour. Over the past couple of centuries, some people have become convinced that this ancient practice could offer them both physical and spiritual benefits. A British artist Amanda Feilding decided to perform a self-trepanation in 1970. She was convinced that it would restore proper blood flow to the brain. Feilding believed that as our skull bones harden in infancy, blood flow to the brain is reduced. This, she believed, puts us at risk of neurodegenerative conditions and trepanation could solve that problem.
Twice, in 1979 and 1983, she ran for the British Parliament, asking that the NHS start providing trepanation to British citizens as part of their healthcare service. Trepanation also caught the imagination of musician John Lennon. He asked Paul McCartney to research the topic so that they could get it done together. In 2024 craniotomies have taken the place of trepanation. It is essentially the same operation and used for the same ailments, tumours, brain bleeds, aneurysms and swelling. Neither surgery is something that one should look forward to, especially not for decoration purposes like this ancients. However, we have the added benefit of anaesthesia and paracetamol to aide recovery.
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