Trephine trepanning trepan surgeons tool surgery skull antique medical vintage

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Trephine trepanning trepan surgeons tool surgery skull antique medical vintage:
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Trepanning, also known astrepanation,trephination,trephiningor making aburr hole(the verbtrepanderives via Old French via Medieval Latin from the Greek noun of relevant meaningtrypanon, literally \"borer, auger\")[1][2]is a surgical intervention in which a hole isdrilledor scraped into thehuman skull, exposing thedura materto treat health problems related to intracranial diseases. It may also refer to any \"burr\" hole created through other body surfaces, including nail beds. It is often used to relieve pressure beneath a surface. Atrephineis an instrument used for cutting out a round piece of skull bone.

In ancient times, holes were drilled into a person who was behaving in what was considered an abnormal way to let out what they believed were evil spirits.[3]Evidence of trepanation has been found in prehistoric human remains fromNeolithictimes onward. Cave paintings indicate that people believed the practice would cureepilepticseizures,migraines, andmental disorders.[4]The bone that was trepanned was kept by the prehistoric people and may have been worn as a charm to keep evil spirits away. Evidence also suggests that trepanation was primitive emergency surgery after head wounds[5]to remove shattered bits of bone from a fractured skull and clean out the blood that often pools under the skull after a blow to the head. Such injuries were typical for primitive weaponry such asslingsand war clubs.[citation needed]There is some contemporary use of the term. In modern eye surgery, a trephine instrument is used incorneal transplant surgery. The procedure of drilling a hole through a fingernail or toenail is also known as trephination. It is performed by a physician or surgeon to relieve the pain associated with asubungual hematoma(blood under the nail); a small amount of blood is expressed through the hole and the pain associated with the pressure is partially alleviated.

Contents[hide]

1History
- 1.1Prehistoric evidence
- 1.2Pre-Columbian Mesoamerica
- 1.3Pre-modern Europe
2Modern medical practices
3Voluntary trepanation
4See also
5References
6External links

History[edit]Diorama showing Neolithic trepanning which involved cutting into the skull using stone tools to remove a small area of boneThe perimeter of the hole in this trepanatedNeolithicskull is rounded off by ingrowth of new bony tissue, indicating that the patient survived the operation.Trepanated skull from Chalaghantepe (Aghdam),5th millennium BC.Museum of History of Azerbaijan,Baku.13th century trepanation1525 engraving of trepanation byPeter Treveris(taken fromHieronymus Braunschweig\'sBuch der Cirurgia. Hantwirckung der Wundartzny1497).Dr. John Clarketrepanning a skull, ca. 1664, in one of the earliest American portraits. Clarke is alleged to have been the first physician to have performed the operation in theNew England Colonies.18th-century French illustration of trepanation.Trepanation instruments, 18th century; Germanic National Museum in NurembergPrehistoric evidence[edit]

Trepanation is perhaps the oldest surgical procedure for which there isarchaeologicalevidence,[6]and in some areas may have been quite widespread. At one burial site inFrancedated to 6500 BC, 40 out of 120 prehistoric skulls found had trepanation holes.[7]Many prehistoric and premodern patients had signs of their skull structure healing, suggesting that many of those subjected to the surgery survived. Another skull with a trepanation hole was found at burial site Chalaghantepe (Agdam Rayon,Azerbaijan) dated to the5th millennium BC.

More than 1500 trephined skulls from the Neolithic period (representing 5 to 10% of all Stone Age skulls) have been uncovered throughout the world– from Europe,Siberia, China andthe Americas.[citation needed]Most of the trephined crania belong to adult males, but women and children are also represented. Evidence suggests that the trepanations were carried out to bring back to life prominent members of thehuntinggroup who were thought to be \"dead\" and could be made \"undead\" by opening the skull, according to the primitive conception ofdeathand dying held by Neolithic people from their beliefs ofmagicas well as their experience ofhead injuriesduring hunting.[8][9][10]

Pre-Columbian Mesoamerica[edit]Main article:Trepanation in Mesoamerica

In the more recent times evidence for the practice of trepanation and an assortment of othercranialdeformation techniques comes from a variety of sources, including physical cranial remains of burials, allusions in iconographic artworks and reports from the post-colonial period.

AmongNew Worldsocieties trepanning is most commonly found in theAndeancivilizations such as the pre-Incancultures, for example the Paracas cultureIcasituated in what now is Ica located South of Lima. It has also been found in theMuisca Confederation[11](in modern-day Colombia) and theInca Empire. In both, evencranioplastyexisted. Its prevalence among Mesoamerican civilizations is much lower, at least judging from the comparatively few trepanated crania that have been uncovered.[12]

Thearchaeological recordin Mesoamerica is further complicated by the practice of skull mutilation and modification carried outafterthe death of the subject, to fashion \"trophy skulls\" and the like of captives and enemies. This was a widespread tradition, illustrated in pre-Columbian art that occasionally depicts rulers adorned with or carrying the modified skulls of their defeated enemies, or of the ritualistic display ofsacrificialvictims. Several Mesoamerican cultures used a skull-rack (known by itsNahuatlterm,tzompantli), on which skulls were impaled in rows or columns of wooden stakes. Even so, some evidence of genuine trepanation in Mesoamerica (i.e., where the subject was living) has survived.[citation needed]

The earliest archaeological survey published of trepanated crania was a late 19th-century study of several specimens recovered from theTarahumaramountains by the NorwegianethnographerCarl Lumholtz.[12][13]Later studies documented cases identified from a range of sites inOaxacaand centralMexico, such asTilantongo, Oaxaca and the majorZapotecsite ofMonte Albán. Two specimens from theTlatilcocivilization\'s homelands (which flourished around 1400 BC) indicate the practice has a lengthy tradition.[14]

A study of ten low-status burials from theLate Classicperiod atMonte Albánconcluded that the trepanation had been applied non-therapeutically, and, since multiple techniques had been used and since some people had received more than one trepanation, concluded it had been done experimentally.[citation needed]Inferring the events to represent experiments on people until they died, the study interpreted that use of trepanation as an indicator of the stressful sociopolitical climate that not long thereafter resulted in the abandonment of Monte Alban as the primary regional administrative center in theOaxacanhighlands.[citation needed]

Specimens identified from theMaya civilizationregion of southern Mexico,Guatemalaand theYucatán Peninsulashow no evidence of the drilling or cutting techniques found in central and highland Mexico. Instead, the pre-Columbian Maya apparently used an abrasive technique that ground away at the back of the skull, thinning the bone and sometimes perforating it, similar to the examples from Cholula. Many skulls from the Maya region date from the Postclassic period (ca. 950–1400), and include specimens found atPalenqueinChiapas, and recovered from theSacred Cenoteat the prominent Postclassic site ofChichen Itzain northern Yucatán.[15]

Pre-modern Europe[edit]

Trepanation was also practiced in the classical andRenaissance[citation needed]periods.Hippocratesgave specific directions on the procedure from its evolution through the Greek age, andGalenalso elaborates on the procedure. During theMiddle Agesand theRenaissance, trepanation was practiced as a cure for various ailments, including seizures and skull fractures. Out of eight skulls with trepanations from the 6th to 8th centuries found in southwesternGermany, seven skulls show clear evidence of healing and survival after trepanation suggesting that the survival rate of the operations was high and the infection rate was low.[5]

In the graveyards of pre-Christian(Pagan)Magyars, archeologists found a surprisingly high frequency (12.5%) of skulls with trepanation, although more than 90% only partial (these served probably ritual purposes).[16]The trepanation was performed on adults only, with similar frequencies for males and females, but increasing frequency with age and wealth. This custom suddenly disappears with the onset of the Christian era.

Modern medical practices[edit]

The prefrontal leucotomy, a precursor tolobotomy, was performed by cutting atrephinehole into the skull, inserting an instrument, and destroying parts of the brain.[17]This was later made unnecessary by the development of the \"orbital transit\" lobotomy where a spike was inserted through the eye-sockets (see thelobotomyarticle).

Trepanation is a treatment used forepiduralandsubdural hematomas, and for surgical access for certain other neurosurgical procedures, such as intracranial pressure monitoring. Modern surgeons generally use the termcraniotomyfor this procedure. The removed piece of skull is typically replaced as soon as possible. If the bone is not replaced, then the procedure is considered acraniectomy. Trepanation instruments are now available with diamond-coated rims, which are less traumatic than the classical trephines with sharp teeth. They are smooth to soft tissues and cut only bone.[18]

Voluntary trepanation[edit]

Althoughpseudoscience, the practice of trepanation for other claimed medical benefits continues. Moreover, some proponents[19]point to recent research[where?]on the increase in cranial compliance following on trepanation, with resulting increase in blood flow,[20]as providing some justification for the practice. Individuals have practiced non-emergency trepanation for psychological purposes. A prominent proponent of the modern view isPeter Halvorson, who drilled a hole in the front of his own skull to increase \"brain blood volume\".[7]

The most prominent folk theory for the benefits of self-trepanation is offered byBart Huges, alternatively spelled Bart Hughes and sometimes called \"Dr. Bart Hughes\", although he is not a doctor but rather a librarian by trade. He was better known for his advocacy of drug use and trepanation and in 1965 he drilled a hole in his own head with a dentist drill as a publicity stunt. Hughes claims that trepanation increases \"brain blood volume\" and thereby enhances cerebral metabolism in a manner similar to cerebralvasodilatorssuch asginkgo biloba. No published results have supported these claims.

In a chapter of his book,Eccentric Lives & Peculiar Notions,John Michellcites Huges as pioneering the idea of trepanation in his 1962 monograph,Homo Sapiens Correctus, which is most often cited by advocates of self-trepanation. Among other arguments, Huges contends that children have a higher state of consciousness and since children\'s skulls are not fully closed one can return to an earlier, childlike state of consciousness by self-trepanation. Further, by allowing the brain to freely pulsate Huges argues that a number of benefits will accrue.

Michell quotes a book calledBore Holewritten byJoey Mellen. At the time the passage below was written, Joey and his partner,Amanda Feilding, had made two previous attempts at trepanning Mellen. The second attempt ended up placing Mellen in the hospital, where he was reprimanded severely and sent for psychiatric evaluation. After he returned home, Mellen decided to try again. He describes his third attempt at self-trepanation:

After some time there was an ominous sounding schlurp and the sound of bubbling. I drew the trepan out and the gurgling continued. It sounded like air bubbles running under the skull as they were pressed out. I looked at the trepan and there was a bit of bone in it. At last!

Feilding also performed a self-trepanation with a drill, while Mellen shot the operation for the short film \"Heartbeat in the Brain\", which was long thought to have been lost. Portions of the film can be seen in the documentaryA Hole in the Head.[21]

Michell also describes a British group that advocates self-trepanation to allow the brain access to more space and oxygen. Other modern practitioners of trepanation claim that it holds other medical benefits, such as a treatment for depression or other psychological ailments. In 2000, two men fromCedar City, Utahwere prosecuted for practicing medicine without a license after they performed a trepanation on an English woman to treat her chronic fatigue syndrome anddepression.[22]