Trepanation: surgery a-head of its time

Brain surgery isn’t a modern procedure. In fact, it has been practiced on most continents for 1000’s of years.

Some people feel better with a hole or two in their skull. Photo credit Science Museum, London
Some people feel better with a hole or two in their skull. Photo credit Science Museum, London.

I’ve often wondered how people lived before we created the amazing medical technologies we have now. If someone had a fever, what did our ancestors think was happening inside the body? If someone was hit in the head, what could they do about it except wait and hope the person would recover on their own?

That last question is the one I’ll be dealing with. Trepanation (also spelt trephination) is where a hole is cut or scraped into someone’s skull. The instrument used to do the scraping is called a trepan.

A trepan, the instrument used to create a hole in the skull. Photo by Peter Traveris.

As incredible as it seems, ancient people from Africa, Peru, Ireland, France, Denmark and Russia were performing these head surgeries with surprising success: Incans had an 80% success rate. It was used by many cultures as early as 6,500 BCE, so has a rich and important history.

Even in the modern age of surgeries performed under anaesthetics that knock you out, surgery doesn’t sound like something I would particularly enjoy, so having it done awake and aware with just a crude drill thousands of years ago seems like madness. But people did what they thought was necessary to survive.

And if the procedure of scraping a hole in someone’s head isn’t interesting enough, the reasons people might have done it are perhaps even more intriguing.

Not all cultures used trepanation for the same reasons. People in many areas may have thought they were releasing evil spirits from the head, but really they were reducing the damage done by a knock to the skull.  The surgeries were used to remove bone shards from the head, stop bleeding on the brain, or reduce internal pressure after head trauma. Some remains had more than one hole in the skull, indicating people not only survived the first procedure, but had it done again many years later.

It’s possible that this primitive surgery was part of a religious ritual for Russians 6,000 years ago. Similarly, it could have been a status symbol, especially if the surgery was expensive and required skilled people to do it. Who doesn’t want to walk around with a hole in their head?

The problem with these ideas, of course, is that they only speculation. We don’t really know why people did this, but judging from the bone recovery we see in fossils, it had a high survival rate and in head trauma cases likely prolonged life by years.

M0006134 Anterior aspect of Squiers, Inca Skull, showing trephinning. Credit: Wellcome Library, London. Wellcome Images Anterior aspect of Squiers, Inca Skull, showing trephinning Bureau of American Ethnology Published: 1894-1895 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0
A trepanned skull, first brought to attention by E. G. Squier, who recognised in the 1860s that this hole was deliberately made. But why was the surgery performed? Photo via Wellcome Library London.

Even though I cringe at the idea of someone scraping away at my skull, perhaps it was no more dangerous than other practices from the past. Before the discovery of penicillin, infection through a scratch inflicted while gardening could have easily become a death sentence.

Trepanation is still used today, often to treat bleeding on the brain. However, making a permanent hole in someone’s head isn’t a safe thing to do, and these days if a doctor makes a hole in a skull they usually replace the bone and patch it up. Some amateur neurosurgeons believe that making a hole in your skull will allow better blood flow and pulsing in your brain, which means you will retain your ‘youthful vigor’. Scientists and doctors haven’t found any evidence of this.

Are you game to try it? I’m not letting a trepan anywhere near my head.

7 Responses to “Trepanation: surgery a-head of its time”

  1. Caitlin Selleck says:

    It sounds fancy to have a piece of gold in your skull! It would be very uncomfortable if it fell out though.

  2. Natalia says:

    Hi Caitlin,
    Coming from Peru, trepanation is a topic we learn while studying the incas’history.
    It’s really interesting to think how they developed these kind of inventions long time ago , it makes us wonder if they were more intelligent than we are.
    Actually, trepanation in Peru was done to people that usually was injured in battles and the hole would be sealed with a piece of gold. It sounds kind of cool to have a piece of gold in your body nowadays don’t you think?

  3. Kaye says:

    Fascinating article Caitlin, but yikes! Yes, I sure am glad that I’m living in this modern age. But who knows, surgical techniques are likely to keep getting more and more advanced so maybe one day they’ll be looking back at our surgical techniques, such as open heart surgery, and thinking “man, I sure am glad I’m living in this modern age.”

  4. Caitlin Selleck says:

    Charles, that article is very cool! I did read a paper or two about the discovery of those Russian skulls. I can see how it would be a status symbol, you probably had to have a lot of money to get such a good surgeon! I’d rather keep my head intact though…

    Kimberley, this is still practiced today in some parts of Africa, and there’s a youtube video showing it:
    The video is quite graphic, so you have to sign in to confirm your age, but it seems they don’t use any drugs at all. They just have faith in the witch doctor and what the procedure will do for them!

    Nelson, it’s so weird to think about all the things we’ll never know about people’s lives. And it’s great to look at how procedures evolved, and whether the ritual preceded the practical application.

  5. Nelsongc says:

    Wow that is really cool. It would have been so painful to just sit there and tolerate that procedure! Now you have me thinking about what other wacky procedures they stumbled upon years and years ago, and continued to do because they worked, even if they were doing them for a totally different reason

  6. Kimberley Meyers says:

    A really interesting topic, Caitlin. I think this is a good opportunity to show how grateful I am for modern medicine! It’s amazing that anyone could endure that not only once but multiple times! And the guy in the illustration you used doesn’t encourage much confidence haha

  7. Suan Tan says:

    Having been through surgery, all the feelings and emotions i felt at that time gripped me throughout this entire piece!

    I could feel the pain! I wonder how much pain they did… did they find numbing herbs to conduct this procedure?

    I remember vaguely reading that these were done as symbols of status in certain communities. Wonder if it was religion that drove this like you mentioned in your post too!

    This is a post on it: