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2003 Edition, January 1, 2003

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ISBN: 978-1-4822-8727-1
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Product Details:

  • Revision: 2003 Edition, January 1, 2003
  • Published Date: January 1, 2003
  • Status: Active, Most Current
  • Document Language: English
  • Published By: CRC Press (CRC)
  • Page Count: 387
  • ANSI Approved: No
  • DoD Adopted: No

Description / Abstract:


After examining the pre-Columbian skull sent to him by United States diplomat to Peru, E. G. Squier, in 1867, French surgeon-anthropologist Paul Broca astounded the world of science and medicine by suggesting that the cranial opening was the result of some form of prehistoric surgery. Moreover, the Inca on whom the procedure had been performed had survived the ordeal by a few weeks.

This was not the first reported example of a man-made opening of a skull, nor was it by any means the earliest. But it was the first case of trepanation to be correctly identified, interpreted, and accepted, and as such it made people think about why the skulls of living people were opened in the distant past.

Clearly, the Squier skull marked the start of serious study and intense fascination with trepanation. Within a few decades, scholarly (and sometimes not so scholarly) contributions were beginning to fill the journals. This growth has continued to accelerate and researchers today are by any standard exceedingly prolific. In 1975 Guido Majno remarked that the number of papers on the subject of cranial trepanation probably exceeds the number of specimens known throughout the world! Today, even with more skulls unearthed, we would be pressed to think of the multiple.

Despite the exponential growth of research on this subject, something important has been lacking. Simply put, there is little cohesion. The study of cranial trepanation has, over the years, gone in many different directions, and the leading scholars now actively involved represent many regions, disciplines, and approaches. These diverse researchers, historians, and theorists, however, have rarely come together, never mind engaging in a large group discussion to consider common problems and future directions for the field. The need for more interaction, more cooperation, and a fruitful exchange of ideas was apparent to all of the editors of this volume. The "time had come", we all agreed, for research on cranial trepanation to be taken forward.

This volume arises out of the first International Colloquium on Cranial Trepanation in Human History, which was held at the University of Birmingham (UK) between the 7th and the 9th of April, 2000. The idea for this much-needed colloquium was conceived by Robert Arnott of the Department of Ancient History and Archaeology (now of the Centre for the History of Medicine) of the University of Birmingham. It was officially supported by the International Society for the History of the Neurosciences, the Institute of Ancient History of the University of Salzburg (Austria), and the Russian Postgraduate Medical Academy (Moscow).

The conference was truly an international gathering, as had been hoped for by the organizers, bringing together 89 scholars from 16 countries across four continents. Before Birmingham, many of these scholars had not only never met each other, but in some cases had never even heard of each other's work. Taking the podium with slides too numerous to count were archaeologists, anthropologists (physical and social), pathologists, anatomists, surgeons, historians of medicine, and others with their own specializations. The material they described (all papers were in English) ranged chronologically from the Epipaleolithic Ukraine to eighteenth-century Germany. Geographically they not only covered the rich terrains of Eastern and Western Europe and the New World, but also recent finds from Polynesia and even Mongolia.

Many participants addressed the features of crania and theorized about the pathological conditions that might have led to the surgery. But there were also discussions about the evolution of instruments and thoughtful reassessments of specimens studied in the past and the methodologies used. The doyen of British paleopathology, Don Brothwell, fittingly closed the symposium by telling those in the audience where, from his perspective, new efforts should be directed.

Because there had not been a book providing an extensive, up-to-date overview or synthesis of our understanding of cranial trepanation in human history, it was decided early on that the material presented at the Birmingham conference should be edited and published under one cover. Our intent was not only to serve laboratory and field scientists, but to provide a balanced volume on cranial trepanation for any professional or layman who might have an interest in this fascinating subject.

The opening chapters in this volume deal with how trepanned skulls were initially found, and the theories that some of the most fertile minds of nineteenth-century science and medicine (e.g., Squier, Broca, Pruniéres, Horsley) had about the operation. After a discussion about the pathology of trepanation, attention is drawn to discoveries made in various European countries (e.g., Great Britain, Denmark, Portugal, Austria, Russia). Subsequent sections of the book deal with the revelations stemming from new and older discoveries made in Egypt, Asia, and throughout the vast territory of the Americas.

Once this global tour is completed, the history of trepanation in Western medicine is addressed. Chapters in this section deal with Galen, who trepanned skulls in ancient Rome, Lorenz Heister, a German physician called upon to trepan patients in the eighteenth century, and the history of cranial saws and related instruments. Some global perspectives and overviews are provided in the next section of this volume, and these are followed by Brothwell's fitting epilogue on future directions for researchers in this field.

Among the ideas that came out of this multidisciplinary meeting was a need to build a common terminology. One of the areas discussed was the fundamental point of whether "trepanation" or "trephination" should be used. Medical and etymological dictionaries were consulted, but they provided little definitive help; many English dictionaries, in fact, preferred "trephination" to the probably more commonly used word "trepanation".

Della Cook (2000) has explored the background of the two competing words and, with the support of the Oxford English Dictionary (1971 edition), points out that "trepan" was first used in about 1,400 AD to describe a crown saw employed as a surgical instrument. The word, we read, derives from the Greek trepanon, a borer.

The first use of the newer word "trephine" is often thought to be by John Woodall, sometime Master of the Company of Barber-Surgeons of London (Woodall, 1639). Stedman's dictionary (1982, p. 1478) provides an etymology for "trephine". We are told that it is "... contrived fr[om] L. tres fines, three ends; probably suggested by trepan.". Woodall actually wrote: "The Trefine is an instrument of mine owne composing although it may be said to be a derivative or Epitomy of or from the Trepan upon it (a tribus finibus) from the three ends thereof.". Hence, although Woodall did not invent the instrument, he certainly described it and is probably most responsible for passing the word trephine into common English usage (Grmek, 1975; Cook, 2000).

The question we were forced to ask ourselves was "Does it matter whether "trepan" and "trepanation" or "trephine" and "trephination" are used? Perhaps it does not. There are many papers published using both forms of the word, and no meaning is lost. Nor is there any possibility of misunderstanding. From this perspective, although perhaps not to the purist, the usage of "trepanation" and "trephination" is a quaint language diversity that probably can be indulged. Nevertheless, most of the contributors to this volume do show a preference for "trepanation", which is older and perhaps has become the more generic form of the word.

So, where are we now and what are some of the more important conclusions reached by the authors of the many chapters in this volume? First of all, the data show that trepanation was surprisingly more widespread than many people had previously believed. In addition, although Neolithic trepanation in France and pre-Columbian trepanation in Peru have received most of the press, the roots of trepanation seem to extend further back into antiquity than is often realized.

As for the specific reasons for birth and success of trepanation, they may be many. The general belief is that, as Squier, Broca, Pruniéres, and Horsley suggested during the second half of the 1800s, it was probably a therapeutic intervention. This, of course, is not to deny that the practice could also have had religious overtones or served some social purpose. But the consensus is that it probably evolved as a means to treat head injuries or perhaps diseases that people of the distant past might have associated with supernatural forces.

Today, there are still many areas in the trepanation domain that need further work, including validating currently accepted theories for trepanation in the distant past. Chronology and dating are two additional issues that call for further refinements and improvements. Still another perplexing matter is the thorny problem of how trepanation seemingly diffused from one society to another.

Happily, a start has now been made. As witnessed at the Birmingham conference, and as will be seen in the chapters of this volume, there is now a great resolve to carry out further interdisciplinary research. New projects in the field and in the laboratory, and new theoretical and historical work, will undoubtedly take us in unforeseen directions. Without question, when researchers interested in trepanation meet again - and they will - they will certainly have much more to talk about. It is gratifying to think that some of it will have been stimulated by what transpired in the auditorium and afterward in Birmingham.

Finally, no international conference can be organised, never mind a successful conference, without a dedicated team of supporters. The organizers of the Birmingham conference and the editors of this book wish to thank Siân Williams and the rest of the team on the ground at the University of Birmingham, which included Tikshna Mandal and a band of enthusiastic student helpers, for their help. The meeting could not have happened without them or the generous help and support of the Head of the Department of Ancient History and Archaeology, Professor John Hunter.

We also wish to acknowledge the following organizations for their financial support and help: The University of Birmingham, Birmingham City Council, Forth Medical Limited, and the Bioanthropology Foundation. Thanks also go to Arnout Jacobs and Laura Martin of our publisher, Swets and Zeitlinger, for their efforts and gentlemanly reminders (to one of us!) to deliver all the manuscripts, as promised, by autumn of 2001.

All of the people mentioned here, but most of all the talented, dedicated, and scholarly contributors to this volume, made the book you see in front of you both possible and, in our estimation, worthwhile. We hope it stimulates your imagination as much as it did ours, and that it is a harbinger of exciting things to come.