A 7000-year-old Ancient Medical Practice
Trepanation
Trepanation, also known as trepanning, trephination, or trephining or burr holing is one of humanity’s oldest forms of surgery and also one of its most gruesome. It is an ancient medical practice that has been used for thousands of years.
Trepanning is a surgical procedure that involves drilling a hole in the skull to expose the brain. The practice has a long and fascinating history, with evidence of trepanning dating back 7000 years ago in the annals of civilization.
Trepanning was a risky procedure, and many patients did not survive the surgery. In addition to the risk of infection, there was also the risk of brain damage, as the surgeon had to be careful not to damage the delicate tissues of the brain.
While it may seem barbaric by today’s standards, it was a crucial medical treatment for many ancient cultures and played a significant role in the development of modern medicine. The practice of trepanning serves as a reminder of the enduring human desire to understand and control the workings of the human body and mind.
Theories
Researchers are still unclear on how this form of brain surgery was first delivered. Some theories speculate that it might have been a form of tribalistic ritual, while others believed it was a method for releasing the evil spirits that were believed to possess the sick and mentally ill.
Another theory is that the surgery was generally used to treat common ailments such as epilepsy, headaches, abscesses, skull fractures and blood clots. The reasoning behind this theory comes from Peruvian skulls, providing evidence showing that many of the patients survived the procedure.
People in the Neolithic era might have practised their trepanation skills on the skulls of animals, sometimes when the animal was alive, as a form of veterinary intervention to save the animal.
In addition to its use as a medical treatment, it is believed that in some cultures, trepanning was performed as part of a ritual or initiation ceremony, with the belief that the procedure could help the individual achieve a higher level of consciousness or spiritual enlightenment.
Historic Evidence of Trepanning
Trepanning has a long and celebrated history, with evidence of the practice dating back as far as the Neolithic era. The first evidence of trepanning comes from skulls discovered in France and Spain, dating back to around 6500-7000 BCE. These skulls have been found to have small, circular holes drilled into them, which is believed to be evidence of trepanning.
More than 1,500 skulls from the Neolithic period that have been trephined have been uncovered worldwide, from Europe, Siberia, China, and the Americas. While the majority of the trephined crania belonged to adult males, women and children were also represented.
Both the ancient Romas and the ancient Greeks practised some form of trepanation. This received attention from Hippocrates and Galen, both forefathers of modern medicine.
“In the fifth century BCE, physicians practising under the guidance of Hippocrates believed that stagnant blood, like stagnant water, could decay and turn into pus (i.e., liquid produced in infected tissue). For that reason, trephining allowed blood to flow out before it spoiled. This eventually fell out of practice due to low survival rates and infection.” – Source: Osmosis.org
Hungarian populations between the 9th–11thcentury AD performed ritual trepanation after death.
In Medieval Europe, the practice of trepanation fell in disuse and became less common, with only a few recorded cases across the whole of Europe.
In addition to Europe, evidence of trepanning has also been found in South America, Africa, and Asia. In South America, trepanning was practised by the Incas, who believed that the procedure could cure a variety of ailments, including headaches, seizures, and mental illness. In Africa, trepanning was practised by the ancient Egyptians, who used the procedure to treat head injuries and relieve pressure on the brain.
Tools and Methods Used in Trepanning
Trepanning was typically performed using a variety of tools, including stone knives, bone saws, and flint scrapers. The actual method of trepanning varied depending on the time and place, but generally involved making a small incision in the scalp and then using a sharp tool to drill a hole in the skull.
The risk of infection and brain damage was high, but the potential benefits of relieving pressure on the brain or achieving spiritual enlightenment were seen as worth the risk.
In some cases, trepanning was performed using a simple hand-held drill, which was made by attaching a sharpened piece of stone to a wooden handle. The drill was then rotated manually, with the surgeon carefully monitoring the pressure and speed of the drill to ensure that it did not damage the brain.
In other cases, trepanning was performed using more complex instruments, such as trepanning forceps. These forceps were designed to grasp the skull and hold it steady while the surgeon used a sharp tool to drill the hole. The forceps were also used to remove any bone fragments that were created during the procedure.
Trepanning in Modern Medicine
Throughout history, trephination has been a medical technique used to relieve intracranial pressure and headaches. Initially, the belief was that stagnant blood could turn into pus and the procedure was used to allow the blood to flow out before it spoiled.
The 18th century is known as the “trepan century” due to the increased interest European surgeons had in trepanation during this time. The practice first took hold in the animal industry, and veterinarians would carry out the practice on domestic animals.
Doctors began using it to treat concussions and brain inflammation and by the end of the century, there was disagreement among medical professionals regarding the efficacy of the procedure. During the American Civil War (1861-1865), trepanation was frequently recommended for treating head injuries.
However, due to low survival rates and infection, this practice fell out of use. At the end of the 19th century, physicians learned about the importance of modern antisepsis and infection prophylaxis, leading to the return of trephination for therapeutic purposes. This included the treatment and management of head trauma, intracranial disorders, and brain tumours.
Today, trepanning is still used in some medical procedures (Craniotomy), although the technique has been refined and modernized to reduce the risk of complications. In modern medicine, trepanning is often used to relieve pressure on the brain caused by a variety of conditions, including blood clots, brain tumours, and traumatic brain injuries.
The procedure is typically performed using a high-speed drill, which allows the surgeon to create a precise hole in the skull without damaging the surrounding tissue. The surgeon will carefully monitor the patient’s vital signs throughout the procedure to ensure that there are no complications.
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