In 400 BCE, famous Greek physician Hippocrates wrote a work on treating injuries to the head. Inside, he advised other physicians on when and how they should treat patients by trepanning. In the time of Hippocrates, the use of stone tools had given way to metal. And the tool that Greek physicians would have used was essential a circular drill. It would be turned by crank or bow. And as the tip of the drill spun, it would saw a small hole in the bone of the skull. Unlike in earlier trepanations, we know exactly why Hippocrates suggested the procedure.
In the work, Hippocrates lays out exactly which patients needed to be trepanned and why. “When an indentation by a weapon takes place in a bone it be attended with fracture and contusion, and even if contusion alone, without fracture, be combined with the indentation, it requires trepanning,” he advised. In modern terms, Hippocrates was describing a skull fracture resulting in brain injury. If he didn’t understand the role of the brain in the body or why trepanning would have helped for this type of injury, he at least knew that it seemed to save people’s lives.
In such cases, the brain begins to swell, pushing up against the skull. It can often be fatal. By removing a portion of the skull, trepanning relieved the pressure on the brain, preventing serious damage. Even today, it remains a common procedure for these types of injuries, although doctors now refer to it as a “craniectomy.” So while trepanning might seem a little brutal, it’s actually still sometimes necessary. For Hippocrates, sawing through someone’s skull when they were still conscious was often the right thing to do. In fact, he was ahead of his time in many ways.
In the Middle Ages, we actually see a shift backward in many areas of medicine, including trepanning. Around the 10th century, people in Hungary were still using trepanning as a ritual. There are several surviving skulls from the period with holes cut into them that seem to have been ritualistic. And in the 15th century, trepanning was performed by doctors throughout Northern Europe in an attempt to cut through to “The Stone of Madness.” Doctors assumed that people with mental illnesses actually had a stone in their brain that could be removed to cure them. It’s a far cry from the careful, clinical observations of Hippocrates.
It’s also important to remember that if trepanning seems like a brutal to us, it likely did to people at the time as well. After all, it’s unlikely anyone ever looked forward to being trepanned. But people in pre-modern societies had a different relationship with medicine than we do today. Medicine was crude by our standards. Any type of surgery would have been painful by necessity in a time before anesthesia. There simply wasn’t an alternative. People at the time probably understood and accepted that. Trepanning, by contrast, wasn’t more painful than most procedures. And in fact, it probably saved many lives.
Where did we find this stuff? Here are our sources:
“Drilling holes in the skull was never a migraine cure – here’s why it was long thought to be”. Katherine Foxhall, The Conversation. March 2018.
“On Injuries of the Head”. Hippocrates, University of Adelaide. December 2014.
“Why our ancestors drilled holes in each other’s skulls”. Robin Wylie, BBC Earth. August 2016.