Today, we wonder why a man has a hole in his head.
The University of Houston's College of Engineering
presents this series about the machines that make
our civilization run, and the people whose
ingenuity created them.
For years I've been seeing
something in books and museums that's troubled me.
I've wanted to talk about it but haven't had the
knowledge I needed. Now I know that knowledge
Consider a case in point: It's a stone-age European
skull -- a fine patrician head. There's a round
hole in the top, three inches in diameter. The
edges of the wound are healed over. The hole was
cut carefully and intentionally, and the victim
survived. This is very sophisticated surgery.
We find skulls like this all over the world. The
hole in one from ancient Peru is just over the
right ear -- an inch in diameter. An old skull from
Judea has a square hole in the back.
The ancients were doing this surgery -- this
trepanning of human skulls -- at least as long ago
as 5000 years. They dared to cut into heads of
living people -- people they knew. They did it
without anesthetic. Yet they cannot tell us why
they did such a thing. This was before they had
writing; so we can only guess.
My 1970 encyclopaedia says flatly that ancients
opened skulls to let out the evil spirits of
disease. That tune changes in more recent articles.
It's more likely that neolithic surgeons opened
skulls to clean up local skull fractures and remove
bone splinters. They used trepanning to relieve
So: was this surgery the work of science or of
superstition? When we try to answer, our
20th-century superstitions confuse us. Does lancing
a boil release evil spirits or dead blood cells? If
the result is the same, do we care? The useful
question isn't, "What did stone age doctors believe
about the process?" but "Did the process achieve
healing?" Medicine is, after all, an empirical art.
We judge what we do by success or failure.
Maybe some answers lie among modern primitive
people. When Europeans came here, they found the
Native Americans suturing wounds, setting bones,
and doing amputations. They even opened the chest
to drain abscesses. They knew how to use a
bewildering array of herbal cures.
Two trepanned Aborigine skulls, only a few hundred
yours old, recently turned up in Australia. Maybe
all this cutting and sawing into flesh and bone was
done to the songs of a spirit world. But I can't
see how that either adds to, or takes from, its
validity as empirical science.
In the end, we never will know why our stone-age
ancestors trepanned human skulls -- not for sure.
But I'll bet they did more good than harm with it.
One thing we have to learn, over and over, is that
our forbears were bright, inventive, risk-takers --
and that we have underrated them far too often.
I'm John Lienhard, at the University of Houston,
where we're interested in the way inventive minds
Lyons, A.S., and Petrucelli, R.J. II, Medicine:
An Illustrated History. New York: Harry N.
Abrams, Inc. Publisher, 1987.
In the following articles, we bear in mind that the
verbs trephining and trepanning are near synonyms.
(A modern trephine is a power driven circular saw.
The older surgical trepan was a brace and bit that
removed a circular bone plug.)
Webb, S.G., Two Possible Cases of Trephination from
Australia. American Journal of Physical
Anthropology, Vol. 75, 1988, pp. 541-548.
Prioreschi, P., Possible Reasons for Neolithic
Skull Trephining. Perspectives in Biology and
Medicine, Vol. 34, No. 2, Winter 1991, pp.
296-303. (see also a discussion of this article in
Vol. 35, No. 2, 1992, pp. 311-313.)
A much earlier set of speculations on the purpose
of trepanning is given in the five articles in the
Sept. 1939 issue of Ciba Symposia,
Vol. 1, No. 6.
Most early trepanning was done to males. Some 50 to
80 percent of the people trepanned lived to tell
about it. A very small fraction of all ancient
skulls have been trepanned. In a few cases we find
skulls that have been trepanned several times.
I am grateful to Larry Wygant, University of Texas
Medical Branch at Galveston, for advice and for the
Ciba Symposium source.
The Engines of Our Ingenuity is
Copyright © 1988-1997 by John H.
(photo by John Lienhard)
An Eighteenth Century case of trephining tools
from John Fulton's collection at Yale
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