When I woke up this morning I had one of my unfortunate and very painful migraines, oh my! Pain pounding in my temples and the feeling of a truck’s worth of cotton wool being pressed into the back or my eye balls. Not fun, day ruined. But it got me thinking, not for the first time, the prehistoric people had definite method behind their madness. Trephination has been practiced since, well who knows when, but we have evidence for it from as far back ad 6500 BC! When one suffers from headaches sometimes it feels like if you could just relieve that pressure all would be good. Don’t go drilling holes in your head please but do listen to one of the many medical traditions which links the ancient to the modern periods.
Trephination from the 15th Century The Cure of Folly, by Hieronymus Bosch
Trephination (AKA. 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. Trephination has been used to treat health problems associated with intracranial diseases, epileptic seizures, migraines and mental disorders by relieving pressure. There is also evidence it was used as a primitive form of emergency surgery to remove shattered pieces of bone from fractured skulls after receiving a head wound, and cleaning out the pools of blood that would form underneath the skull.
Evidence for trephination occurs from prehistoric times from the Neolithic onwards. The main pieces of archaeological evidence are in the forms of cave paintings and human remains; the skulls themselves from the 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 BC; one third of the skulls found at the site. The percentage of occurrences though here 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 that indicate that the patient lived for years after the event, even sometimes having trephination performed again later in life and again surviving the experience.
Skull with multiple trephination holes showing signs of healing from pre-Columbian Mesoamerica
From pre-Columbian Mesoamerica we find evidence on physical cranial remains in burials in addition to iconographic artworks and reports from the post-colonial period. The occurrences are widespread throughout South America, from the Andean civilisations and pre-Incan cultures such as the Paracas culture in Ica in South Lima where burials show signs of trephination, skull mutilation and modification. In Mexico, Guatemala and the Yucatan Peninsula, archaeological evidence dates from between 950 and 1400 AD. The earliest archaeological survey from the American continent published is from the late nineteenth century when the Norwegian ethnogapher Carl Lumholtz performed surveys of the Tarahumara mountains. Lumholtz’s publications were the precurser to documented cases from Oaxaca, Central Mexico and the Tlatilco civilisation.
From Europe in the Classical and Renaissance periods we have evidence of trephination from archaeological and literary sources; including within the famous and essential writings of Hippocrates and Galen where it is termed in the Greek ἀνάτρησιζ. One thing that strikes one when dealing with evidence from both America and Europe is just how widespread this technique was and how it appeared as a major surgical technique on both continents independent of influence and association.
The Hippocratic Treatises make mention of trepanning in the chapter on the 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.’
Galen also makes mention by explaining the technique of trephination and the risks involved to the patient:
‘For when we chisel out the fragments of bone we are compelled for safety to put underneath the so-called protectors of the meninx, and if these are pressed too heavily on the brain, the effect is to render the person senseless as well as incapable of all voluntary motion.’
Much of the archaeological evidence from Europe for trephination comes from south-western Germany dating to as early as the stone age. But the cranial evidence for the procedure is widespread throughout Europe; Ireland, Denmark, France and Italy in particular. And there is considerable evidence from Russia and China. The early documents from classical Greece and anthropologist’s observations of pre-modern people in Peru has shown that the people involved had a knowledge of the risk involved in the procedure. Publications detailing the technique from Mote Alban conclude that there was a process of non-therapeutic experimentation for some time which explored the use of different techniques and sizes of burr hole.
Han and Chen have completed a particularly interesting study of the archaeological evidence of trephination in early China. They looked as six specimens from five sites ranging from 5000-2000 BP which showed cranial perforation in prehistoric China. The earliest skull analysed by Han and Chen was the M382 Cranium from Fuikia aite, Guangrao, Shandong. M382 was the skull of an adult male of the Dawenkou culture which shows a hole which was 31mm at the widest point. Evidence of healing shows that the patient recovered and lived for a considerable time before he later died. M382 was radiocarbomn dated to around 5000 BP. Han and Chen bring up one particularly interesting hypothesis to why trephination was performed: to obtain bone discs from people alive or dead for protection from demons. This would suggest, if correct, that in prehistoric China there was a cohabitation of ideas concerning human and supernatural intervention in association with illness and disease.
Incan Skull
What we can conclude about trephination is that this ancient surgical technique was astonishingly widespread and was practiced 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. But some skulls show us the risks of the operation as well. Some skulls uncovered have had evidence that the procedure was abandoned mid-operation as the trephining is incomplete.
It may seem a strange thing that this technique was used throughout the world in different places and periods unrelated to one another. But there is a logic in the way a wish to relieve pressure may naturally lead to trephination as an accepted answer. After all, in theory trephination works, and in some cases in practice. This is why the technique is still used for multiple reasons in modern medicine. For instance, trephination is used in some modern eye surgeries such as a corneal transplant; it is just termed differently as a form of pseudoscience called a craniotomy. It is also modern in modern intracranial pressure monitoring and in surgery for subungal hematoma (blood under the nail) because one can also refer to trephination in reference to the nails and other bones.
Well there you go, there are my pearls of wisdom for the day. Trephination. Oldest surgical technique supported by archaeological evidence. Still used today. That’s pretty cool 
And my headache is better.
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Recommended Reading:
Han, K., and Chen X., The Archaeological Evidence of Trepanation in Early China
Lisowski, F.P. 1967. Prehistoric and early historic trepanation. In Don Brothwell and A.T.Sandison (eds.), Diseases in Antiquity, pp. 651-672. Springfield: Charles C Thomas.
Oakley, K.P., W. Brooke, R. Akester, and D.R. Brothwell 1959. Contributions on trepanning or trephination in ancient and modern times. Man 59 (133):93.
Piggott, S. 1940. A trepanned skull of the beaker period from Dorset and the practice of trepanning in Prehistoric Europe. Proceedings of Prehistoric Society n. s. 6(3): 112-132.
Wehrli, G.A. 1937. Die trepanation in fruheren jahrhunderten. Ciba-Ziho 91:15-22.
Wölfel, D.J. 1937. Sinn der trepanation. Ciba-Ziho 91: 2-6.
Related articles
- The Mystery of Trephination (neuroskeptic.blogspot.com)
