Trepanation, the practice of drilling a hole in your head to let your brain "breath", was used to treat ailments like epilepsy, or possession by evil spirits. Even today, some groups practice self trepanation.
Wikimedia CommonsOil on panel depiction of a trepanation by artist Hieronymus Bosch.
Despite what the gory illustrations suggest, the act of drilling holes into a person’s head was not a medieval torture tactic. This act, called trepanation, was actually a treatment and cure for ailments like epilepsy or “possession by evil spirits” used for thousands of years across the world.
The first examples of trepanation appear in the historical record over 10,000 years ago, making it one of the oldest surgical procedures in history. Even today, trepanation is still used in medical setting and even practiced by metaphysical groups around the world.
Dive into the history of this bizarre medical practice.
How Was Trepanation Performed?
Prismo Archivo / Alamy Stock PhotoIllustration of trepanation from the 14th century.
Using a pick, a person would pierce or scrape down to expose the dura mater, the membrane surrounding the brain, of the subject to the open air. Typically, trepanation was done without any numbing techniques.
In ancient times, the practitioner would use tools made of flint, obsidian, or stone to scrape into the skull. In Andean societies, they would use ceremonial knives to do the procedure.
The Greeks and Romans were the first groups to create tools specifically for trepanation, including a device that would roll between a practitioner’s hands. Even today, surgeons use a trephine to cut out pieces of bone.
The depth and intensity of the cuts would depend on the practitioner’s experience and culture. Most of the operations were performed only once per person, but a small number of recovered skulls show repeated operations throughout an individual’s lifetime.
MITThe four most common methods of trephining: (1) scraping; (2) grooving; (3) boring and cutting; (4) rectangular intersecting cuts
There were five methods of trepanation, the first of which was a scraping technique commonly used in during the Renaissance in Italy. The practitioner would use a glass tool to scrape layers of bone off the skull.
The boring and cutting method involved cutting groves into the skull before lifting the bone off the head. In prehistoric times, the scrapping method was most common, but the other methods slowly developed as technology became more advanced.
However, the procedure doesn’t come without risks. Recipients risk infection, hemorrhage, and trauma to the skull that can lead to a quick death. According to a 2017 study, estimates for survival rates for earlier versions of this procedure hover around 40%, but other sources put the range at 50 to 90%. Given the age of many of the samples, it is often difficult to determine whether the recipient lived or died.
The Purpose Behind The Oldest Surgery In The World
It was thought that drilling or scraping away layers of the skull and exposing the dura mater (the membrane surrounding the brain and spinal cord) to air would benefit the victim and cure his or her ailments.
Dr. Miguel A. Faria, Jr., associate editor-in-chief of Surgical Neurology International and retired neurosurgeon, explained:
“Trephination (or trepanation) of the human skull is the oldest documented surgical procedure performed by man. Trephined skulls have been found from the Old World of Europe and Asia to the New World, particularly Peru in South America, from the Neolithic age to the very dawn of history. We can speculate why this skull surgery was performed by shamans or witch doctors, but we cannot deny that a major reason may have been to alter human behavior – in a specialty, which in the mid-20th century came to be called psychosurgery!”
While most cases of trepanation seem to have treated illnesses or trauma, skulls from trepanation patients dating back to the Copper Age in Russia tell another story.
Wikimedia / CC BY-SA 2.0 Trepanated skull of a 50-year-old woman from around 3,500 B.C.
According to the BBC, archeologists in Russia’s Rostov-on-Don discovered unusual trepanation marks on a number of skulls from around 3,500 B.C. The marks were found on the “obelion” of the skull, roughly where a high ponytail would lie. This is a rare spot for a trepanation, as it’s exceedingly dangerous to puncture the obelion.
Maria Mednikova of the Russian Academy of Sciences in Moscow suggested that these kinds of trepanations had a ritual purpose to mystically transform those who undertake them and imbue them with powers they couldn’t achieve otherwise.
How Did Different Cultures Approach This Practice?
UC Santa Barbara A skull from Peru, c. 1000–1250 C.E.
As explained, trepanation has been documented in different cultures around the world. Although most historical accounts of the practice stem from Europe, there is evidence that cultures in Asia and the South Pacific practiced trepanation as well.
The earliest written account of trepanation comes from Hippocrates, an ancient Greek physician, in the 5th century B.C.E. In his Hippocratic corpus, Hippocrates explains the medical practice and how it can be used to treat ailments, according to the book A Hole in the Head:
“Plunge [the trephine] into cold water to avoid heating the bone…often examine the circular track of the saw with the probe [and] aim at to and fro movements.”
In Asia, researchers believe that trepanation was practiced albeit rarely. In a historical novel by Ming Dynasty writer Luo Guanzhong, characters discuss trepanation as a treatment for headaches.
“Your Highness’s severe headaches are due to a humor that is active. The root cause is in the skull, where trapped air and fluids are building up. Medicine won’t do any good. The method I would advise is this: after general anesthesia I will open your skull with a cleaver and remove the excess matter, only then can the root cause be removed.”
Then, in 2007, archaeologists discovered a handful of trepanned skulls in China spanning across a period of thousands of years. Most of the skulls date back to the Bronze Age.
In East Africa, trepanation was common during the medieval period. The last documented case of the practice occurred in 1958.
In the South Pacific, researchers discovered evidence of trepanation using seashells.
Finally, in the Americas, trepanation has been documented among Andean civilizations, central Mexican civilizations, and even among the Maya (although their technique was slightly more abrasive than traditional trepanation).
The Use Of Trepanation In Metaphysical Groups
Wellcome CollectionDiagram of trepanning instruments.
This process, as queasy as it may make a modern audience, was practiced widely up through medieval times and even happens today.
The idea of self trepanation began as a way to increase one’s mental power and attachment to the metaphysical. Several public figures have advocated for trepanation to increase brain performance, including most notably Bart Huges who operated on himself with a dentist drill in 1965.
Huges would go on to inspire others, including Joey Mellen, the author of Bore Hole. Mellen, with the help of Amanda Fielding, performed three trepanations on himself.
Amanda Fielding was also the director of the Beckley Foundation, a group that researches consciousness, and a patient of trepanation. Alongside her partner, Fielding operated on herself.
Science Museum, LondonNine piece trepanation set used to puncture the skull of a patient, circa 1770.
Curious about the procedure from friends and unable to find a doctor willing to perform it on her, Fielding set up a drill, exposed her dura mater, wrapped up her head in a scarf, then ate a steak, and went to a party. She claims the procedure was “like the tide coming in: there was a feeling of rising, slowly and gently, to levels that felt good, very subtle,” and points to a smoothing of her dreams as a result of the trepanation.
Even as an advocate, Fielding cautions that more research needs to be done to understand the benefits (and dangers) of trepanation. So, don’t bust out the drill and grill up a steak quite yet.
After reading about trepanation, learn about another weird medical practice in bloodletting. Then learn about the horrifying “cures” of Dr. Henry Cotton, America’s biggest quack.
