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'x9591 S9 193-94.
CONTRIBUTIONS ON TREPANNING OR TREPHINATION
IN ANCIENT AND MODERN TIMES*
b1,
DR. K. P. OAKLEY, F.B.A., MISS WINIFRED M.' A. BROOKE, A. ROGER AKESTER and
D. R. BROTHWEL
INTRODUCTION
Trepaniung, trephining or trephination has a
133 long history. As far as wc know it was first
practised in Europc during ncolithic tintes: occasionally by
the Early Danubians (e. 3000 B.c.) and frequcntly by the
`battle-axc' pcoplc who constructed chambered tonibs
in thc Scinc-Oise-Manic arca of France around 2,000
So niany skulls in thcir tonibs have been trephined
tuat it scenis probable that thc operation had sorie ritual
significante; roundels of hurtan skull bonc have been found
in early prehistoric graves (fig. i), suggesting that such objects
froni a Pre-Inca or Early Inca grave in the Cusco district
of Peru (c. A.D. i,ooo) : al¡ the trcphinc holes in this skull
show signs of hcaling, indicating that the opcration was
successful and that the patient recovered on eacli occasion.
In prirnitive trephination, the piece of bone removed
front tlic braincase is usually oval or circular, but thc nietliod
now preferred of removing a rectangular piece by mearas
of cross-cuts was already being elnployed in carly tintes,
as the ncatly trephined skull frota an Iron Age burial pit
at Lachish (c. 600 B.C.) serves to illustrate (Plate Fc).
KENNETH P. OAKLEY
TREPHINING BY A MEDICINEMAN IN BOLIVIA, 1950
FIG. I. PERFORATED ROUNDELS OF HUMAN SKULL BONE FROM
LATE NEOLITIIIC GRAVES IN VALLE DE PETIT-MORIN, MARNE
.1/ter Peyrony. Scale about 3 actual sizc
were treated as fetishes by prehistoric pian. Hippocrates,
on tlie other hand, describes the use of treplünation in classical tintes as a regular nicthod of trcating certain types of
head w-ound. Among more primitive' societies in recent
time nicdicincnicn liave pcrfornied this operation both as a
rational surgical renicdy and as a nicans of securing fragr--nts of traman skull-widely regardcd as powerful
h objects (Albert Schweitzer, Oit the Edtie o f the
Primeval Forest, 1934, p. 51). Trepltination is occasionally
perfornicd in modem hospitals, but whcrcas tic surgcon
of today uses a steel trcphinc (or more conunonly a circular
saw driver by ara electric motor), and is aided in his task
by ara sthetics and antiseptics, the medicinenian nianages to
perfornt thc sanie operation without such aids, sonictinics
using thc crudest imaginable instrunients (fig. 2c).
Tw-o accounts of trephination by nicdicincnicn, one in
South Anicrica, the othcr in North Africa, are reproduced
below and serve as a colourful conuncntary ora primitive
surge ry.
Tw-o rcniarkable exaniplcs ofancicnt trephination, involying a high ordcr of surgical skill, wcrc recently investigated
in the Anthropological Laboratory of the Britisli Muscunt
(Natural History), and are described hcrc by Mr. D. R.
Brothwcll. Tlic first (Plato Fa), a skull with four trcphinc
holes, was discovered in 1958 by Dr. Kathleen Kenyon in
a Bronzc Age grave in Jericho (c. 2,000 In.c.); the second
(Plate Fb), a skull trephined no less than severa times, was
collected by thc late Dr. Donald Stafford Matthews in 1956
* 1I'ith Píate F and tour te.v-t figures
In May, 1950, 1 staycd for a wcek or more at the Baptist
Mission at Huatahata ora Lake Titicaca ¡ti the Andes.
Thcre thcy liad a capable trained nurse who liad several
clinics in villages further ora; and during nty stay she
confidcd some of licr troubles to nie. Wc all bccanie
anxious over tlie outconic of onc case.
At the next village therc was a fiesta whilc 1 was thcre.
1 took some photographs of tic picturesque dances and
costuines, but niy camera was thrown dowli by a drunken
nian as it grew more rowdy. The Baptist Mission did not
allow their converts to attend such fiestas, but oneyoung man
disobcyed the role and was hit on thc head with a broken
bottlc, which did a fair amount of daniage. On returning
honre he was afraid to confess and ask the nurse to attend
to his wounds, so he went to the local medicinenian who
oponed a blood vessel on his temple as a remedy, and thc
nian nearly bled to death. His relations were friglitened
and called tlic nurse who gave injcctions, stopped thc bleeding and dressed tlic wounds. Eithcr thc following day or the
onc after, when she visitcd hcr patient she found tliat the
medicinenian had removed hcr dressing and was telling
the boy that thc troubec was blood under thc bone, and
he should let liini trepan his head, removing Clic bone and
thc blood bencath it. For some days che discussion went
ora, thc nurse doing all she could to stop the man. (I left
before tlie outconic was decided.)
The nurse told nic that when she first canic to Huataliata
two or thrcc years earlier, the medicinenian trepanned thc
hcad of anothcr young nian there and she saw hirn doing
the opcration. He first niade both thc patient and hiniself
drunk, no doubt ora chicha, thc conimon Bolivian drink.
He did thc opcration with a rusty rail and a stone (uscd 1
belicve as a haninier). He did not put back thc piece of
bone he removed, but later on thc skin hcaled ovcr tlic holc.
Although the patient recovered he was ncvcr able to work
again.
Different nicdicincnicn, the nurse said, specialized in
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BIBLIOTECA li"jCtn ,,,
COCHABAMBA - BO^UVlA
different cures; this one went in for opening veins and
arteries and trepanning. He had opened the jugular vcin to
cure one patient of mumps ! The Baptists had triad to get
the police to stop the man as his practicas were ¡Ilegal, but
they were afraid to take any action-possibly they belicved
in the man themselves. I was told elsewhere that some of
the medicinemen are very good at setting bones. 1 met
with one case of a man who brokc his collarbone about
Ioo miles from the nearest doctor and refused to take the
journey for treatment. About six weeks later the same man
escorted me on a mule to a place wherc I could reach a
lorry, and he seemed to be using his hand and arm on the
damaged side quite well.
The people at Huatahata were mostly Aymara . 1 do not
know for certain whether the medicineman who did the
trepanning was Aymara, but I think that he was. There
are Quechua around the end of Lake Titicaca , 1 believe;
but the Aymara are usually in thesc highcst villages and
the Quechua lower down. Huatahata is at 13,ooo feet.
WINIFRED M. A. BROOKE
TREPHINING BY A TIBU MEDICINEMAN IN
TIBESTI, 1957
During the Cambridge Tibesti Expedition , 1957, a party
composed of members of Cambridge University and of the
ioth Armoured Division in Tripoli penetrated the region
•
D
FIG. 2. TREPHINING IN TIBESTI
A. The patient (a Tibu) who complained of lhcadacAcs. B. Top of his head, showinq oval trephining star in the arca of bregma;
a second (circular) trephininq star f rther back is obscured by hair (note also the camel tick). C. The instruntents asad fiar
trephining by the Tibu witch-doctor. D. The roundels of bona cut out of the patient's skull, with the
epaulette in which thcy
viere carried.: Scale: the circular fragmcnt is about the size of a five-shilling pirca.
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