I’ll Keep My Skull Intact, Thanks

Lots of brain-related books land on my desk. But A Hole in the Head: More Tales in the History of Neuroscience by Charles G. Gross, recently released in paperback by MIT Press, may be the first one with such an evocative cover:

A Hole in the Head

That’s a hole in the head, alright.

So I had to read the chapter that gives the book its name. A warning to delicate readers: reading about trepanation (also called trephination) is not for the faint of heart. Here’s why:

Left image

Right brainTop: Trepanation tools used by a 17th century naval surgeon. Bottom: Marks left from (1) scraping (2) grooving (3) boring and cutting and (4) rectangular cuts.

Be glad I left out a drawing from 1761 of a doctor using one of these tools. Yikes.

When archaelogist Ephraim George Squier received the very skull pictured on the book’s cover as a gift from a Peruvian antiquities dealer in 1865 and brought it to the attention of the medical community, no one could believe it (the skull is now at the American Museum of Natural History). The survival rate of trepanation procedures in the mid-1800s was a mere 10 percent. How could an ancient Incan receive such a procedure and, based on analysis of the skull, live to tell the tale?

Since Squier’s skull discovery, archaelogists have found thousands more skulls with trepanation marks from across time and continent—Neolithic, ancient Chinese, Roman, Kenyan. Researchers estimate that the survival rate of ancient trepanations may have been as high as 90 percent.

Why was trepanation so common? We’ll never know for certain why prehistoric cultures performed the surgery. In the Fifth Century BCE, writes Gross, Hippocrates recommended it for all head wounds except those involving “depressed fractures” to “allow the blood to escape.” In Gross’ words, Galen (129-199) recommended trepanation “for relieving pressure, for gaining access to remove skull fragments that threatened the dura, and…for drainage.” It was also used to treat mental illness and epilepsy.

It wasn’t until trepanation moved to a hospital setting in the mid-1800s that the mortality rate skyrocketed. But now that we know about sanitation and sterilization, neurosurgeons today use trepanation successfully, writes Gross, “for exploratory diagnosis, for relieving intracranial pressure…for debridement of a penetrating wound, and to gain access to the dura and thence the brain itself.”

To this day, some still advocate for the use of trepanation as treatment, thinking that it will increase blood flow to the brain and improve brain function. As Gross says, “Just because a procedure is very old does not mean it is necessarily an effective one, at least for enhanced enlightenment and creativity.”

Those sound like wise words to me.

–Johanna Goldberg

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