Trepanation is derived from the ancient Greek word trypanon, meaning auger – a large corkscrew tool. While generally used to bore holes in wood, the auger wasn’t limited to just carpentry.
The Greeks had begun trepanning for medical purposes as early as the second millennium BC. Hippocrates, considered the “father of modern medicine,” recommended trepanation for the treatment of head injuries. Given the numerous military conflicts, these were a common affliction of the time.
In his renowned work On Injuries of the Head, Hippocrates categorised various types of skull fractures and outlined when trepanation should be performed. He advised using the procedure in specific cases to prevent further harm, for example, to drain trapped blood or to lift skull fragments pressing on the brain.
Centuries later, the Roman physician Galen, another pioneer in biomedicine, also endorsed trepanation. He recommended it as a way to relieve pressure inside the skull and to drain areas filled with pus (which he described as “phlegmatous” regions).
Similar methods for draining have also been described in early Chinese literature. In the 14th-century text Romance of the Three Kingdoms, author Luo Guanzhong writes:
Your Highness’s severe headaches are due to a humor that is active. The root cause is in the skull, where trapped air and fluids are building up. Medicine won’t do any good…After general anesthesia, I will open your skull with a cleaver and remove the excess matter, only then can the root cause be removed.
Today, doctors continue to trepan skulls for drainage and pressure relief, but it’s commonly referred to as a craniotomy, or burr-hole surgery, depending on the incision size. The technique is also used to remove tumours and blood clots.
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