How Did Trepanation Work?

One of the earliest, most common medical treatments in history (and prehistory!) involved drilling a hole in the patient's skull. Learn more about trepaning in this episode of BrainStuff, based on this article: https://health.howstuffworks.com/medicine/surgeries-procedures/trepanation.htm

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Episode Transcript

Speaker 1 (00:01):
Welcome to Brainstuff, a production of iHeartRadio. Hey Brainstuff. Lorn
Vogelbomb here. If you had to guess and hadn't looked
at this episode's title, what would you think the oldest
known surgical procedure might be? Maybe a cesarean section, amputation, appendectomy.

(00:22):
It might sound strange, but the surgery that humans have
been trying their hand at since Neolithic times is trep
nation or trepanning, the practice of drilling a hole in
the skull to treat health problems related to intracranial diseases,
to release pressure from a head injury, or to provide
an escape patch for evil spirits. And now you might

(00:45):
think that having a caveman cut a hole in your
head would be a bad idea, and that's understandable, but
it appears to have been a pretty popular treatment all
the same. For the article this episode is based on,
How Stuff Works. Spoke by email with doctor mcgell Thria,
a medical historian and retired professor of neurosurgery in the
Mercer University School of Medicine in Macon, Georgia. He said

(01:08):
more than fifteen hundred terpanned skulls have been found throughout
the globe, from Europe and Scandinavia to North Africa, and
from Russia and China to North and South America, particularly
in Peru. Perhaps the greatest concentrations are found in the
Eurasian land Mass and South America. So yeah, it was widespread.

(01:29):
If you take all the skulls that we have from
the Late Neolithic period, but that's about four thousand and
to twelve thousand years ago, collected from all over the globe,
between five and ten percent of them have a hole
in them that was made while the person was still alive.
These skulls most commonly belonged to men, but women and
children weren't excluded from the procedure. The holes were definitely purposeful,

(01:52):
and sometimes the owners of these skulls seemed to have
survived the procedure, at least for a while. The big
question is why. According to Farrea, although we can't see
into the minds of primitive medical practitioners, a trepination seems
to have been a go to remedy for a variety
of maladies, perhaps by shamans in order to cure or

(02:15):
alter behaviors or mental illness. As some historians have suggested,
cranial surgery may have been performed on important members of
society or hunting groups in order to resuscitate them during
a grave illness or after sustaining a wound. The ancient
Roman medical practitioner Hippocrates and later Galen wrote about trepination
as a means of removing damage tissue and elevating depressed

(02:37):
skull fractures, but reasonably cautioned against penetrating the thick membrane
that encases the brain or the brain itself, as they
noted it resulted in serious complications such as infection, seizures,
and often death. Faria explained the Romans used instruments called
terrebri that resembled the more primitive toomeys of the Incas.

(02:59):
The terreb in turn, was the forerunner of the modern
burr whole manual drill. During the Middle Ages and the Renaissance,
trepination was performed not only for skull fractures, but also
for madness and epilepsy. A famous painting by Hieronymous Bush
depicts the extraction of the stone of madness. In the

(03:20):
European medical tradition, trepination was mostly practiced in the treatment
of epilepsy and mental health issues. Like mania and melancholy.
One surgical text from the twelve hundreds recommended trepination for epilepsy,
so that quote, the humors and air may go out
and evaporate, the humors being the leading medical theory of

(03:40):
the time and place, which stated that four bodily fluids
representing four elements or temperaments, ruled over our well being.
By the sixteen hundreds, trepination was beginning to be viewed
by the medical community as a last resort, though it
remained a go too for treating head wounds through the
eighteen hundreds. The procedure may have been the most popular

(04:02):
and successful in what's now Peru. Between the thirteen and
fifteen hundreds, used for treating skull fractures in the Inca Empire,
which outfitted soldiers primarily with bashing type weapons, the survival
rate for trepination reached over seventy percent. The history of
trepination is long and sometimes questionable, but it's important to

(04:24):
note that doctors do still practice it today for a
variety of different elements, though they don't call it trepination anymore.
That's a term used by medical historians these days. Burr
holes are made in the skull in order to biopsy
brain tissue or diagnosed brain lesions, treat skull fractures, remove
brain tumors, or cliff cerebral aneurysms. But when the hole

(04:45):
is enlarged, it's called a craniotomy. Today's episode is based
on the article you need It Like a Hole in
the Head, the ancient medical art trepination on houstofworks dot
com written I J. Justslyn Shields. Brainstuff is production of
I Heart Radio in partnership withoustuffworks dot Com and is
produced by Tyler Klang. Four more podcasts from my heart Radio.

(05:08):
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