Author : Wahid Ahmad
In 1865, Ephraim George Squier received a unique gift: a mysterious skull from the Inca city of Cuzco. The Skull had a hole larger than half an inch. Squier believed this hole resulted from ancient surgery, and he was amazed to learn that the person who had undergone this procedure had survived. In this article we will explore one of the most mysterious and oldest surgical procedures known to humanity.
After being fascinated by the skull, Squier shared the skull with doctors in New York, but they were skeptical. They found it hard to believe that someone could survive such a surgery in the past, given the high risk of infections back then.
Later, Squier went to Paris to meet with physical anthropologist Paul Broca. After studying the skull and collaborating with other medical experts, Broca became convinced that the hole was indeed created through a deliberate procedure called trepanation, and the individual had lived for a significant time afterward. However, in 1876, when Broca shared this information in Paris, many remained doubtful, especially about the idea that ancient people, particularly from indigenous communities, could carry out such a complex surgical procedure successfully.
Nevertheless, seven years later, a discovery in France provided strong evidence that individuals from ancient times, even distant history, were skilled at performing trepanation. Archaeologists found skulls with round holes at a burial site. The edges of these holes seemed carefully made with sharp tools. Pieces of skull matching the holes were found, some with smaller holes that might have been used as charms.
Scarring around the holes indicated these individuals had survived for many years after the surgery. These skulls belonged to people of different ages and genders. Most holes were intentionally made and not due to accidents, with only a few showing signs of traumatic head injuries similar to today's reasons for trepanation. This discovery supported Broca's belief that ancient individuals could indeed perform trepanation surgeries successfully and live through the process.
Trepanation, was widespread across history and various regions of the world, including the Americas, Europe, Africa, and Asia. It dates back thousands of years and shares techniques among different civilizations.
Evidence of trepanation exists globally since the Stone Age, but pinpointing its exact origin is debated. The practice spans from the Mesolithic period to modern times, with healed or healing trepanations found. The earliest confirmed evidence comes from Neolithic times, possibly in Andean South America and Africa. Pioneers like Squier and Broca highlighted its antiquity in Peru. In Europe, it was prevalent around 5000 years ago, while Asia shows evidence from around 4000 years ago in Palestine. Europe and North Africa saw more trepanations in the Mesolithic and Neolithic periods, with the practice continuing into the Bronze and Iron Ages, diminishing after the Medieval period. Trepanation is also evident in the Indian subcontinent, with Neolithic-era finds in Kashmir, Harappan sites, and Maski, Karnataka, suggesting a practice over 4000 years ago. Assuming trepanation existed since the early Stone Ages, it was likely practiced in multiple parts of the world simultaneously.
In the Indian subcontinent, trepanation evidence dates back to the Bronze Age, around 4300 BC, during the Indus Valley Civilization. Harappan sites like Lothal and Kalibangam revealed skulls with square and circular holes, indicating trepanation practices. A skull from the Iron Age in Maski, Karnataka, and a Neolithic-era skull from Burzahom in Kashmir provide further evidence.
Indian mythology contains stories of brain surgery, though these lack proof. Ancient scriptures and Ayurvedic texts mention brain surgery, and the Bhoja Prabandham describes King Bhoja's headache treatment involving cranial surgery. Jivaka, a surgeon to Lord Buddha, is considered an ancient neurosurgery pioneer, known for complex surgeries like trephination and intracranial mass removal. Susruta, considered the father of Indian surgery, detailed skull-related procedures in his works, discussing surgeries like trephination, excision, probing, suturing, and draining, often related to warfare injuries. However, definitive evidence of ancient brain surgery in Indian literature remains uncertain.
Prehistoric Neolithic pit-dwellers of Burzahom practiced trepanation, with skulls showing stages of holes being made. The process seemed gradual, involving shallow depressions initially, followed by deeper holes while keeping the inner bone intact. Skilled individuals likely used different tools for distinct stages, possibly even bronze tools for certain steps. The entire trepanation process seemed to have been carried out swiftly, in successive stages. Evidence of bone healing was inconclusive, leading to differing opinions. It remained uncertain whether the patient survived the procedure.
Trepanation, spanning different eras and regions, has employed a diverse range of methods and tools. These techniques encompass scraping, grooving, boring, cutting, and creating intersecting cuts.
In the Scraping Technique, a sharp oval object like a flint stone was rubbed against the skull's targeted area. This practice persisted in France and Italy until the 14th century. Broca replicated this using glass, successfully creating openings in thick skulls in less than an hour.
The Grooving Technique involved using a pointed tool to etch round or oval grooves, repeating the process until reaching the inner bone layer. This method was prevalent in African regions, foreshadowing the circular trephine or crown saw.
Historical figures like Hippocrates and Celsus detailed the Trephine Technique, utilizing a hollow cylinder with a toothed lower edge and handle to make circular skull openings. This method's evolution led to modern drills and tools such as the Hudson brace.
Some methods featured a Rectangular Grooving Technique, wherein a sharp oval stone was applied perpendicularly to the skull, creating four linear grooves forming a rectangle. Initially using stone knives and later transitioning to metal tools like the tumi knife of the Peruvian Incas.
In the Closely-Spaced Hole Technique, a circle of closely-spaced holes was drilled, followed by cutting or chiseling the bone between these holes. This approach was employed by diverse cultures, including Arabs, Middle Ages practitioners, and those in Peru and North Africa.
Trepanation, has been utilized for various purposes across history and cultures. The practice has encompassed therapeutic and cultural motivations, resulting in its multifaceted applications.
Medical historian Dr. Plinio Prioreschi suggests that Neolithic societies practiced trepanation to revive individuals who were perceived as dead due to injuries or illnesses. These injuries often caused momentary or prolonged unconsciousness, which primitive societies believed was a form of temporary death. The trepanation procedure was seen as a way to bring back these individuals to life or reverse the state of being dead.
Prioreschi's theory is grounded in the observation that minor head injuries, rather than fatal ones, led to moments of unconsciousness and then recovery. This pattern of undying after a head injury, as well as the general understanding of injuries and death during that time, influenced the practice of trepanation. The procedure was carried out to create an opening in the skull, allowing the supposed evil spirits or good spirits to leave or enter the body, leading to the revival of the individual.
Furthermore, Prioreschi proposed that trepanation was reserved for prominent members of these ancient societies and their families. This could explain why only a fraction of Neolithic skulls show evidence of trepanation.
Ancient Greek Hippocratic writings discussed trepanation's potential to relieve pressure, drain stagnant blood, and prevent its deterioration into pus. Accounts from ancient China mentioned trepanation for medical reasons, such as alleviating trapped fluids causing headaches.
In Western medicine, trephination gained prominence from the Renaissance to the 19th century as a treatment for head injuries. However, its associated high mortality rates led to a decline in its usage. Modern neurosurgery eventually embraced trephination due to advancements in infection prevention, using it for diagnostics, pressure relief, and accessing the brain.
Trepanation was occasionally attempted to alleviate conditions like convulsions, headaches, epilepsy, and infections. In ancient China, trephination aimed to alleviate headaches from trapped fluids. Among the Kisii tribe in Kenya, it was done to ease persistent headaches attributed to evil spirits.
In European medicine, trepanation was considered a remedy for epilepsy and mental disorders. Some texts advocated skull openings to release humors and air as a cure for epilepsy. By the 17th century, its use for epilepsy declined.
In certain cultures, trepanation held spiritual significance, believed to facilitate the entry or exit of illness-causing spirits. For instance, Libyans cauterized children's heads to protect them in the afterlife.
Theories suggest trepanation might have been performed to obtain skull disks roundels for charms or amulets.
Presently, the International Trepanation Advocacy Group advocates trepanation for heightened consciousness and creativity. However, medical professionals critique this stance due to potential risks and lack of scientific substantiation.
In conclusion, trepanation has played diverse roles across history and cultures. Although it has garnered attention and experimentation, its efficacy remains uncertain, sparking debates within the medical community. Trepanation's historical journey encompasses various therapeutic and cultural dimensions, contributing to its complex narrative.