Trephination has been practiced all over the world with evidence being found showing its use from the late Palaeolithic up until today. Trephination, trepanning, trephining – whatever you want to call it, is basically a surgical intervention where a hole is drilled or scraped into the human skull. This intentional perforation of the cranium exposes the dura mater – the thick membrane that surrounds your brain, to treat health problems related to intercranial diseases or release pressured blood build-up from and injury. Given our Neolithic ancestors weren’t really aware of the dura mater and intercranial pressure, it’s a good question as to why they started casually drilling holes in their noggins, but seeing as I currently have an almighty migraine where the thought of someone drilling into my head in an attempt to cure is actually pretty appealing, I have an idea. It’s believed Neolithic people would perform trephination as part of a religious practice, as well as being performed on individuals who were seen as acting abnormally and therefore needed the evil spirits released from their heads, with plentiful evidence people would then wear the removed bone as a protective amulet. However, there has also been evidence that trephination was used for therapeutic purposes, with indications it was used as a primitive emergency surgery after head wounds to remove fragments of bone from a skull fracture as well as to clear out the blood that often pools under the skull after a blow to the head. Although such injuries can be caused by accidents, falls and even wild animals, it has been noted that trephination is more widely practiced in areas where weapons that could cause skull fractures were used.
Over time, there appear to be 5 main methods of trephination. Firstly, as in the image above are created with rectangular intersecting cuts. These were first made with flint, obsidian, or other hard stone knives and as time progressed, metal knives.
The second method was scraping the skull with flint or again obsidian, and this would have taken a while, to say the least. In an experiment, Paul Broca, a leading authority on the human skull in the late 1800’s demonstrated he could recreate these openings by scraping with a piece of glass, but stated a thick, adult skull took him 50 minutes “counting the periods of rest due to fatigue of the hand”. This was a particularly common method and continued into the Renaissance in Italy.
Thirdly was another common method which was cutting a circular groove, then lifting off the dick of bone – which in excavations have been shown to have been repurposed into the previously mentioned amulets, and this method was still in use until fairly recently in Kenya.
The fourth method, which involves the use of a circular trephine (literally a drill to …drill into your head) or crown saw is believed to have developed from the third. The trephine is a hollow cylinder with a toothed lower edge, with this tool even being described in detail by Hippocrates. By the first century, this tool had evolved to have a transverse handle and a central pin and looked little different from trephines used today.
Finally, the fifth method was to drill a circle of closely spaced holes, then cut or chisel the bone between the holes. To achieve this, a bow may have been used for drilling, or simply rotated by hand… which I can only imagine would have sucked. This method was later adopted by the Arabs and became a standard method in the Middle Ages.
There are obviously a large amount of risk involved in drilling holes in your head, these are from both direct or indirect complications – the most obvious being damage to the brain, as well as infection, blood loss, haemorrhage and unsurprisingly death due to the trauma. Trephination leaves little room for error and has a high incidence of mortality if the dura mater is penetrated. Aside from the obvious issues, infection also posed a huge risk. Exactly the same as today, if contaminated tools were used, or if the resulting wound wasn’t kept clean this could lead to the wound becoming septic and if the infections was not caught and treated immediately, it could, and if you’re thinking of jumping on the head hole bandwagon, can be fatal or lead to significant and permanent brain damage. However, archaeological findings have shown, besides these risks’ trephination the usual estimates for survival although varying from culture to culture, range from 50 to 90 percent, with the larger majority on the higher side. Back in the 19th century, doctors and academics at the time couldn’t believe this rate of success, with some outright saying it was impossible. This was largely due to the high mortality rate seen at that time from trephination – but by that time, these procedures were being undertaken in hospitals, which due to the infection control knowledge at the time were basically filthy and breeding grounds for disease actually making it more fatal than it had been in Neolithic times.
In Europe, in addition to its uses in treating head injuries trephination became seen as an important therapy for not only epilepsy, but mental illness – perhaps linking back to the Neolithic belief of letting those demons out. The use of trephination for epilepsy begins as early as the 1st century CE and lasted into the 18th century. In the 13th century text “Quattuor magistri” it was recommended to open up the skulls of epileptics so “that the humors and air may go out and evaporate”, nonetheless by the 17th century using trephination for epilepsy finally started being viewed as an extreme measure, only being used if all else failed, before its use declined in the 18th century where its purpose became more to remove localised pathologies. In the case of mental illness, it’s use in this manner was documented by Roger of Parma in 1170, who in his “Practica Chirurgiae” wrote “For mania or melancholy a cruciate incision is made in the top of the head and the cranium is penetrated, to permit the noxious material to exhale to the outside. The patient is held in chains and the wound is treated, as above, under treatment of wounds.”. This belief continued, with boring holes in your head to cure ‘madness’ being advocated by Robert Burton in “Anatomy of Melancholy” (1652) as well as Oxford neuroanatomist and physician Thomas Willis (1621-1675). The school of thought surrounding the idea that mental illness could be solved by trephination continued up until the 18th century when most surgeons had given up the procedure “for psychiatric aberrations or headache without evidence of trauma. Thus, the skull was never to be trephined for ‘internal disorders of the head’” and that was that, really.
As mentioned before, trephination is still used in modern medical practice, used as a treatment for epidural and subdural hematomas, and surgical access for other neurosurgical procedures, such as intercranial monitoring. Modern surgeons prefer to use the term craniotomy, and to be able to perform one diagnostic imaging must be performed, which allows for accurate examination and evaluation. Also, unlike our Neolithic ancestors, the chunk of skull removed is replaced as soon as possible.
Then there’s the other reason… other than a fucking killer migraine, you’d want to drill a hole in your skull, and given the opportunity… I’d take it. That reason is to get high. Yep. And someone managed it! His name is Joey Mellen. Born in 1939, Joey, a psychonaut and consciousness explorer is still an advocate for the procedure explaining how he believes the blood constriction caused by the fusing of the skull between the ages of 18 and 22 causes a reduction in brain power, so therefore, more blood in the brain equals heightened perception, accounting for the extraordinary responses of the brain when high (this guy obviously hasn’t seen me with the munchies inhaling half a bag of Reese’s pieces before realising they’ve still got the paper wrappers on). Anyway, he believes that trephination frees the brain from a solid bone prison, allowing it to pulse like that of a child and increase circulation. One of the great 60s pioneers of mind expansion, Mellen has written a book about his trephination called Bore Hole which I definitely recommend, and he also filmed the self-trephination of his then partner Amanda Feilding for a documentary entitled Heartbeat in the Brain. With the combination of a migraine and pandemic related boredom… Where do I sign up?