Pembroke’s Clinic: Trepanning Pt. 1 – History

London, 1872

On My Humble Self:

James Trepan 1My name is Doctor-Chirurgeon James D. Pembroke. My work is simply this: to learn about and extend the utility and usefulness of the modern homo sapiens, a most interesting and curious creature. The periodicals and weeklies have yet to have their fill of me, and promote a most insidious and inaccurate perspective of my ‘exploits’. Needless to say, some things are true and some are not.
(I shall not waste time here denying or clarifying the statements of these sensationalist rags. The tripe they publish misses the point entirely; more concerned with subscribers, these writers care little about the work itself, that is, the study of the human body and mind. Certainly, those concerned with the frivolities of morality and compassion may have cause for concern with my methods and procedures).

Introductions aside, I’d like to begin my tenure in this journal with a study of the history of the oldest medical procedure known to humankind (other than murder): trepanning, or trephining. This article will be broken into three parts. This week I shall discuss the history of trepanning, the following week I will cover the spiritual and medicinal reasons for the practice in ancient society, and lastly I shall discuss the application of the procedure, as performed in a recent clinic during a journey into the center of the Earth (some may know of this expedition, and may even have been fortunate enough to witness the procedure first hand).

Introductions of the procedure

James Trepan 2Trepanning is this: the drilling, scraping or cutting, known colloquially as burring, of an aperture or hole into the human cranium, the skull. Trephining is also a common term, and different only etymologically. Trepanning is derived from the Greek trupanon, literally ‘a borer’ whereas trephining is derived from the French meaning ‘three ends’, a reference to 17th century apparatus using three legs to steady the central drill component. In my experience I have found this equipment to be ineffective.

Historically, the procedure can be dated back to around 7,000-10,000 BC, where early skulls have been located from Incan and Mayan burial and refuse sites, as well neolithic human sites in Europe. These skulls show apertures that do not appear to have been caused by contusion or trauma, leaving archeologists to conclude that the holes are intentional. Before one makes any assumptions as to the apparent barbarism of these early procedures, consider this: evidence of bone growth over the created aperture shows that the majority of those who underwent the procedure appeared to have survived, to the tune of 70-90%. Compare that with the current 19th century rates of survival that stand at little more than 10%. I will speak more of this paradox in the later installments of this essay.

It should be noted that in the many cultures that utilized trepanning as either an empirical or spiritual practice, strong evidence exists that suggests that removed medallion of bone were used as jewelry and bodily ornamentation. Clearly, earlier societies had a far more enlightened perspective than that of present day; we attempt to hide evidence of our mortality rather than acknowledge it as the rhythm of existence, much in the same way that we hide our aged population, and our waste. But excuse my digression.

James Trepan 3

Trepanning Methods

Throughout the ages, methods of trepanation fell into five categories, largely dependent on the tools, materials and technological development of the civilization in question:

1) Rectangular intersecting cuts, using stone knives or sharpened flint.
2) Scraping of the skull – erosion of the skull exterior until revealed dura-mater
3) Drilling smaller holes in a circle to allow for saws to complete the removal
4) Grooving: eroding the bone in a circular indent
5) Circular saw, known as a crown saw, a hollow tube with toothed or serrated ends.

The procedure, demonstrated by my former colleague Professor Broca using traditional scraping tools, can take upwards of an hour to complete. One can only imagine what that might have felt like. My readers might briefly indulge me in a demonstration: First, close your eyes to focus the mind’s attention, and then using your finger, scratch heavily at your scalp. Dig in a little, feel the noise and reverberations of your finger tips through the mass of your skull. Now, imagine that someone is meaning to break through your endo-skeletal armor in in a similar way, however with a blunt scraping tool, or a rough-toothed saw. Most of these operations were done without the aid of dulling herbs or sedatives. The procedure must have been nothing less than excruciating…

More recent use of trepanning was performed by Spigelius (1578-1625) who is said to have performed the procedure seven times on the same patient. One must wonder if the good doctor was running out of places to drill, but as a great man said: “Restore a man to his health, his purse lies open to thee.”

Next week we will be examining the historical reasons and incentives for trepanning as a medical or spiritual practice.

(Partial photo credit to Dark Catt studios)

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