What is your favorite surgery? Mine, without a doubt, is trepanation. Trepanation is the deliberate creation of a hole in the head using surgery, exposing the Dura Mater (thick covering) of the brain. This website, "The Trepanation Guide" which advocates trepanation, describes it as "...oldest surgical procedure practiced by mankind." I found what I consider a more responsible description in Wikipedia as "perhaps the oldest surgical procedure for which there is archaeological evidence." After all, doesn't it seem reasonable that soft tissue surgeries, such as castration or appendix removal, may have been performed or attempted, without leaving a trace?
Evidence of trepanation is widespread, and has been traced back to neolithic times in Europe and at least 2500 years ago in South America. Below are pictures of an Incan skull from Peru (left). In ancient Peru trepanation was apparently fairly common--approximately 1000 Incan skulls have been identified. The picture on the right was discovered in Germany. One archaeological site in France identified 40 out of 120 skulls that had been trepanated. Many trepanated skulls have multiple holes, with the margins of "successful" surgeries often showing signs of healing. Sharper edged holes may indicate an "unsuccessful" surgery. Success rates have been estimated 75-80% in South America, and a remarkable 90% in Europe.
I find it surprising that, given the absence of antibiotics and modern anesthesia, that they had any success at all.
Why would anyone want to have a hole bored in their head? One can imagine that ancient humans might have used the technique to try and treat headaches, dizziness, epilepsy, evil spirits, tumors, head injuries, hematomas, etc.--virtually anything that might be related to the head. But, widespread use of trepanation and the presence of as many as 4, 5 or even 7 holes, might suggest a ritual aspect of the surgery. With the advent of modern medicine, trepanning has largely, gone the way of blood letting and bulbing, as an archaic treatment. There are modern, defensible uses of trepanation, to treat hematomas and assorted brain surgeries, but, of course, the bone is generally replaced after the surgical procedure (Many docs play golf. I wonder if they mumble to themselves "Always replace your divots," at the close of surgery.)
However, there are a few advocates of the surgery for its supposed psychological benefits. Bart Huges, sometimes spelled Hughes, saw trepanation as a "pathway to higher consciousness." A recurring theme that I see in advocates is that it is an attempt to increase blood flow to the brain in an attempt to recapture the plasticity and "happier and more energetic" state of mind in an infant. The rationale is that the flexible fontanel (soft spot) in a baby's cranium allows for more blood flow, which is restricted with hardening of the skull as we mature. The result of the surgery, as the "Trepanation Guide" expresses it, is that you are “…happier, more energetic and less prone to crippling bouts of ennui. You'll ascend to the child's plane of acute consciousness from which you disembarked to enter the lowly malaise of adulthood."
Hmm, to put it mildly, I have my doubts regarding the benefits.
Joey Mellen wrote a book called Bore Hole, which described his experiments with trepanation. His first attempt was unsuccessful. Mellen ended up hospitalized and was recommended for "psychiatric evaluation." His second attempt, with the aid of his girlfriend Amanda Fielding, worked. As Mellen described it,
“After some time there was an ominous sounding schlurp and the sound of bubbling. I drew the trepan out and the gurgling continued. It sounded like air bubbles running under the skull as they were pressed out. I looked at the trepan and there was a bit of bone in it. At last!”
Yeeesh, not something I would want to go through. Fielding later trepanned herself. Here is a link to an interview with Amanda Fielding, who founded the Beckley Foundation, which investigates consciousness and advocates drug reform, ran for office in the British Parliament in 1979 and 1983, although she described her candidacy as more of an "art project," intended to "try to get the medical profession to agree that [tepanation] is an interesting subject and is worthy of research,"rather than a serious attempt to get elected. Below is an interesting campaign poster.
There is an hour long documentary called "A Hole in the Head," which is available for purchase. I haven't seen the film, but it might be interesting.
If you want more info more on trepanation I recommend the Skeptic's dictionary and from this article from Charles D. Gross at Princeton.
Let me close with a couple videos. On the left is an interview with Bobby Lund, an advocate of trepanation, and on the right is a toe-tappin' light-hearted look at the process(along with some other interesting history of anatomy) from Zoochosis.
Scot Bastian Ph.D. is a scientist and artist who lives in Seattle WA.