A human skull showing signs of trepanation

Trepanning

Trepanning – the practice of drilling or scraping a hole into a human skull – is one of the oldest surgical procedures known

It may sound gruesome, but it has been used for thousands of years to treat certain health problems, even though it has never been proven to work.

The oldest trepanned skull was discovered at a Neolithic burial site in France and was found to be more than 7,000 years old. Trepanation is thought to have been practiced by ancient Egyptians, Chinese, Romans, Greeks and many other civilisations, using sharpened pieces of flint.

Through the years, many explanations for the procedure have been suggested. In ancient times it may have been done as a tribal ritual to allow evil spirits to ‘escape’ through the head. It has also been performed as a cure for headaches, epilepsy and some mental disorders.

Trepanation is more common than you might think: it is performed every day by brain surgeons. For brain surgeons to relieve a cerebral ulcer or evacuate a haemorrhage, the skull must first be ‘trepanned’ (ie a hole must be drilled to allow the surgeon to carry out the procedure). The difference here is that once the procedure is complete, the surgeon replaces the hole in the skull so it can heal.

In true trepanation, the hole made in the head is not refilled, and the skin around the skull is allowed to reform over it. The first few trepanned skulls were found between the 17th and 19th centuries, but it wasn’t until an American journalist and archaeologist, Ephraim Squier, presented a trepanned skull in New York that interest grew.

He presented the Peruvian skull at a time when brain size and race were being hotly debated; therefore, there was a large amount of interest in this skull from an ancient and ‘primitive’ culture. Although this was new excitement surrounding an ancient practice, trepanation was still being performed in certain groups throughout this period, although much less during the 19th century.

From past to present

In the past 50 years trepanation has undergone a revival in Western culture, although doctors in the UK do not perform the procedure. In 1965 a Dutch man named Bart Hughes became enamoured with the concept that the volume of blood in the brain controls one’s wellbeing. He believed that in a sealed skull, the brain can’t pulsate with the heartbeat, and therefore a limited amount of blood is present in the total volume of the brain. Relieving this pressure, and allowing the brain to pulsate, would increase the volume of blood in the brain and therefore increase how energetic you felt.

The theory behind this comes from the fact that when humans are born, their skulls are not fully formed. Bart Hughes and other trepanation advocates believe this is part of the reason for the energy and spontaneity that children possess that is lost in adulthood.

He performed the procedure on himself using a local anaesthetic, a scalpel and an electric drill. After the operation was deemed a success, he instantly began preaching about his ‘increased state of consciousness’. However, none of his work has been published in any scientific journals.

Since then, several procedures have been reported. There was one notable report in the UK in 2000, when a British woman travelled to the USA to undergo a trepanation to cure her chronic fatigue. The procedure went slightly wrong when she severed a protective membrane around the brain and she was rushed into intensive care to repair the damage. Luckily, she survived. Trepanation is a mystery of medicine. Although there is little evidence to show its positive effects, and huge risks are associated with the procedure, it seems curiosity continues to attract people to the procedure, at least 7,000 years since it was first performed.

Lead image:

A human skull showing signs of trepanation.

Wellcome Library, London

References

Questions for discussion

  • Do you think the benefits of trepanation are plausible?
  • Would you ever consider such a procedure?

About this resource

This resource was first published in ‘Inside the Brain’ in January 2013 and reviewed and updated in November 2017.

Topics:
Neuroscience, History, Health, infection and disease
Issue:
Inside the Brain
Education levels:
16–19, Continuing professional development