TREPANATION

You need this procedure like you need a hole in the head. Now, just stay still while we get the drill lined up . . .

Wherein we learn that drilling a hole in one’s own head as an attempt to treat disease is actually a pretty bad idea, believe it or not—except when it isn’t, which is an even stranger thought. But when you’re down to that option, it’s likely to be appealing anyway, compared to worse alternatives . . . right?

We try to take it pretty easy on those ancient medical practitioners here at Sawbones, broadly speaking. Sure, we’ll give them some razzing. A bit of gentle ribbing, perhaps. But we understand that many of them were just doing their best and really wanted to help people.

But when our misguided predecessors start drilling holes in each others’ heads, you might assume we’d dispense with that courtesy. That, well, that’s just wrong, isn’t it? That’s where your brain is, right? Shouldn’t we be keeping it intact?

The shocking thing, as it turns out, isn’t that the ancients were making holes in perfectly good skulls. It’s that some of them were saving lives.

A LITTLE OFF THE TOP

“Trepanation” is derived from the Greek word trypanon which means “to bore,” which is a funny choice for what has to be one of history’s most “you’ll pay for your whole seat but you’ll only need the edge” thrill-level procedures, especially in the pre-anesthesia days. And we’re heading back to the pre-pre-pre-anesthesia era.

The oldest trepanned skull was found in a neolithic burial site in Ensisheim, France, which would place the practice as being at least 7,000 years old. Now, if we had only found the one, we could have chalked it up to the misguided surgical efforts of an ancient quack. But this was not an isolated incident. Despite the fact that drilling a hole in your head is usually, wowza, just a super bad idea, it was practiced throughout the ancient world in Egypt, China, Greece, India, Rome, and in early American civilizations.

What could it fix? Well “being too good at math,” for starters. But the ancient cultures that practiced it had numerous and varied reasons for doing so. They believed it could fix everything from headaches to epilepsy, anxiety to evil spirits.

JUSTIN VS SYDNEE

JUSTIN If you in your day-to-day life are ever told that the treatment you’re employing is also useful for dismissing evil spirits, here’s a good life hack: Throw a chair through the nearest window, attach a grappling hook to the ledge and rappel right the heck out.

SYDNEE No, actually, please don’t do that. That sounds very dangerous.

JUSTIN It’s fine Syd, just having a little fun. Reader gets it, we’ve been kidding around like this. It’s kind of our thing.

SO HOW’D THEY DO IT?

Let’s say you wanna drill a hole in your head, but you don’t want a bunch of newfangled technology getting in the way. You want a hand-drilled classic, like grandpa used to do. We hear you.

LAST CHANCE TO BAIL:

Hey! If you’d prefer not to understand how to destroy a skull on a deep, personal level, this would be an ideal time to bounce.

You’ve got plenty of options with regard to size. The holes the ancients drilled could range from a few centimeters to half the skull (which may not even qualify as a hole anymore at that point, but why quibble?). The most popular real estate for drilling tended to be right at the top through the parietal bone, followed by occasional holes in the occipital or frontal bones. If you wanted to get really fancy, you could even try the temporal region.

Trepanation methods varied throughout history, but all were similar in one key way: We were trying to make a hole in a thick, hard bone designed to keep things out.

Initially, some ancient cultures would use sharp stones, such as flint or obsidian, to sort of scrape the bone away. A tool called a tumi was used in Incan cultures for this purpose. It was a ceremonial knife that you would use to create sort of a tic-tac-toe board or hashmark on the skull, and then pry out the square of bone inside. This seems really intense, but don’t worry! The surgeon would be bracing your head tightly between his knees while he did this, and he was a professional.

In ancient Greece, trepanation was mainly done for the purpose of relieving pressure on the brain in the case of a skull fracture. Practitioners had a number of tools for the job. Among them was our favorite, the terebra, a cross-shaped boring tool that made tiny skull holes in a pattern until you could punch out the bone inside. Yes, a skull perforator. Good for trepanation, but also handy for scrapbooking!

JUSTIN VS SYDNEE

JUSTIN I don’t know how boring a party has to be before you start poking around for skulls, but I imagine the answer is “pretty flipping boring.”

SYDNEE I always poke around for skulls.

JUSTIN You’re the best.

By the 12th century, our suite of tools for skull perforation had evolved to a point where circular cuts, rather than jagged hashes, were the standard (progress!). The Medieval era brought with it mechanical drills, circular saws, and all kinds of terrifying props lifted straight from Jigsaw’s torture den. Even though these things were documented, we seemed to have completely forgotten this history by the 19th century.

JUSTIN VS SYDNEE

JUSTIN That’s sad, in a sense. Those drills do look really cool. But, you know Syd, it’s probably for the best, considering that, well, we’re talking about increasingly creative ways to straight-up murder people.

SYDNEE Well, actually Justin, you might be surprised to learn that trepanation wasn’t necessarily the death sentence you are assuming.

JUSTIN You’re joking.

SYDNEE Shh; don’t spoil the next section.

CAN’T WRAP MY HEAD AROUND THE IDEA

Let’s say you gathered up all the trepanned skulls that researchers had found over the years. After you were either arrested or made the subject of a reality TV show, you’d notice something interesting. By charting new bone growth after the procedure (you know how to do that in this hypothetical) as well as the presence of multiple holes, you could infer a trepanation survival rate of around 60 percent. You might be tempted to scoff at that, oh so snooty 21st-century dweller, but maybe first go make a big hole in your head and let us know how it works out. (Note, if you’re perusing this in a bookstore, please pay for it and exit the store first.)

Drilling a hole in one’s head is so unintuitive, in fact, that it took modern folks a little while to believe it could even be done (without the patient’s think-meat gooshing out of their head, that is).

The first evidence of this practice in days gone by—a trepanned skull, naturally—was found in 1685 by Bernard de Montfauchon in France, and subsequently disregarded. In 1816, another skull turned up, also in France, and it was understood that a craniotomy (that’s drilling in the skull) had occurred. But the medical community still assumed the procedure had happened after death or . . . you know . . . during.

JUSTIN VS SYDNEE

SYDNEE We’re saying that they died as the result of a traumatic, penetrating head wound and open skull fracture.

JUSTIN Yes, sweetheart, I think they get it.

HEY, WHAT A PARTY FAVOR!

All of this speculation changed as a result of a party in Peru in the 1860s. Ephraim George Squier, an archaeologist, journalist, and U.S. Commissioner to Peru, made the key discovery at a party held by the very wealthy Señora Zentino. She had an amazing collection of pre-Colombian art and artifacts, and among these antiquities, he noticed a skull with a hole in it.

With Zenito’s permission, he took the skull to the United States, and presented it to the New York Academy of Medicine. While many agreed that the skull did seem to present evidence of a surgery done while the patient was still alive, a vocal minority still argued that the injury had to be postmortem. There was simply no way that a patient could have survived this procedure. Surely, even primitive societies would have known better than to attempt it. Something everyone agreed on: No ancient, nonwhite civilization could have beaten the hyper-advanced modern white man to such a complex surgical feat. Ah, racism, the great uniter.

BROCA JUMPS TO THE HEAD OF THE CLASS

With a hearty “I’m outta here, and I’m takin’ my skull with me!” shouted over his shoulder, Squier then crossed the Atlantic to Pierre Paul Broca—physician, anatomist, and founder of the Anthropological Society of Paris. One hiccup: Broca was also one of the main proponents of the racist ideas that had kept others from accepting the validity of Squier’s theory. But in this case, Broca let the science do the talking and agreed that the skull did seem to represent an early form of trepanation.

“What astonishes me is not the boldness of the operation,” Broca said at the time, “as ignorance is often the mother of boldness.” Just couldn’t leave well enough alone, could you Paul?

Broca published his and Squier’s findings and, in doing so, stoked the medical community’s interest in trepanation. The hole-having-head hunt was on, and by 1867, many more crania had been discovered in France and Peru. After collecting loads of skulls (and presumably staging some pretty radical haunted houses), medical historians finally reached a consensus. Not only were these holes made intentionally while the patient was still alive, but that this practice crossed geographical and cultural barriers throughout history.

Sydnee’s Fun Medical Facts

Every med student knows the name Broca. “Broca’s Area” of the brain is the third convolution of the left frontal lobe next to the lateral sulcus and if it is damaged the result is Broca’s, or expressive, aphasia. With this condition, someone would be able to understand what they heard, but their own speech would seem stilted and labored.

TREPANATION FOR FUN AND PROFIT

In the 1960s, a Dutchman named Bart Huges who had attempted (but not completed) medical school, learned about the ancient procedure and became obsessed with it. In lieu of any actual evidence as to why trepanation had occurred, he began to theorize that it was a way to regain the joy of youth. Why? Well, babies have fontanelles or “soft spots,” open areas between the bones in their skull to allow for growth.

Huges believed that children are so happy and open-minded (literally and figuratively) thanks to these spots and, by comparison, the skulls of adults are just too darn restrictive. If we could just recreate those holes in our heads, he thought, we would be able to reconnect with our joyful past. We could loosen our ties, spread open our skulls, and just be.

JUSTIN VS SYDNEE

JUSTIN I think it’s pretty messed up that babies come with a self-destruct button, but Sydnee says I shouldn’t call it that.

SYDNEE I’ll grant you, they can be kind of unnerving, but don’t worry. These holes close naturally as we age.

His impressively odd, yet medical-sounding, explanation for this phenomenon hinged on a concept he called “bloodbrainvolume.” Actually, it’s better if we let Huges explain:

“I met [someone who] used to stand on his head . . . for considerable periods of time. When I asked him why he did it, he said it got him high. [Later, I was given] some mescaline, and it was then that I got my first clear picture of the mechanism, realizing that it was the increase in the volume of brainblood [sic] that gave the expanded consciousness . . . [which] must have been caused by more blood in the brain which meant there must have been less of something else. Then I realized that it must be the volume of cerebrospinal fluid that was decreased.”

(A side note about Huges which should be zero percent surprising at his point: He was also convinced that psychedelic drugs could achieve these same effects, but only temporarily. He called drugs like LSD, mescaline, and marijuana “psychovitamins.” He also named his daughter Maria Juana.)

Sure, he could have just made a hole in the bottom of his spine to let out the extra fluid, but that wound would heal, so it would only be a temporary fix. Huges realized he could relieve the pressure with a hole in the skull, and those things never heal, so he’d be golden!

He published his theory as both The Mechanism of BloodBrainVolume (BBV) and Homo Sapiens Correctus in 1964. Also of note: he published it on a scroll, which made it awful hard to shelve in your average medical library.

THE SEARCH FOR AN OPEN-MINDED DOCTOR

For two years, Huges traveled around looking for a surgeon willing to help him prove his theory, but none agreed. So in 1965, armed with only the completely made up theory of bloodbrainvolume, Huges drilled a hole in his head, using an electric drill and a scalpel. (In hindsight, we should have listed those items among the things Huges was armed with.) He revealed the fruits of his roughly forty-five minutes of labor to an awestruck, and probably grossed-out, crowd in Amsterdam as an art happening. The “art” part is debatable, however, it’s hard to argue that something most definitely did happen there.

His next trip was to the local hospital for an X-ray of his new “third eye,” but once the doctors saw what he had done, he was detained in the psychiatric ward for three weeks.

While few were inspired to copy his actions, the two followers he gained were all-in. Joseph Mellen and his wife Amanda Fielding both sought their own at-home, Huges-inspired neurosurgical procedures. Mellen wrote an autobiography centered around his experience called Bore Hole. Not to be outdone, a short film was made of Fielding’s trepanation adventure called Heartbeat and the Brain. (Presumably because Dumb and Dumberer was taken.)

A self-styled trepanation evangelist, Fielding attempted to bring the procedure to the mainstream by running for British Parliament (twice). She only got a total of 188 votes, but that’s not a bad showing, considering the entirety of her platform was “free trepanation for all.”

Another fan of Huges, Peter Halvorson, went on to form the International Trepanation Advocacy Group, ITAG. This group still exists today, working to find surgeons who will perform elective trepanation and research the effects that this procedure has in terms of blood flow and volume and cerebral function. As of yet, not much evidence exists, but honestly, who’d show up for that clinical trial.

Wikimedia Commons

DO WE STILL DO THIS?

We do have legitimate reasons to drill holes in the skull in modern medicine, but they have nothing to do with bloodbrainvolume, because that is not a real thing. Nothing to do with evil spirits either, for that matter. In case you were wondering.

But it is a fact that in cases of intracranial bleeding, pressure on the brain tissue can result in damage. In emergencies, the treatment to preserve brain function is to drill a hole to relieve pressure or remove a piece of the skull temporarily. During brain surgery, it is also necessary to remove a piece of the skull and this must be left out at times due to post-op swelling. It can be kept safe in . . . you’ll never guess where.

Go on, guess. Nope? The abdomen. Aren’t bodies the coolest?

SURPRISE POP QUIZ

Hey kids! Can you select all of the strange things that head-drilling enthusiast Bart Huges actually said in interviews? Don’t be fooled by the ones that seem just too bananas to be the genuine article—this partisan of trepanation carried around some very, shall we say, interesting thoughts in his head.

• “With enough blood, the central nervous system is a better doctor than your doctor.”

• “Eat a salad every day.”

• “Gravity is the enemy. The adult is its victim—society is its disease.”

• “My problem is how to explain to the adult that he has too little blood in his brain to understand, if he has too little blood in his brain to understand that.”

• “I suppose in cases of severe adulthood, there might be a depression immediately after the operation in a period of retrospection.”

• “I think it’s a good idea to exchange the unnecessary words for colors, and keep the few left for communication of information.”

• All of the above. And more.

ANSWER KEY: All of them. He said all of those words. In that order.

Also, he had a point about how awesome salad is.