Object of the month: Drilling the head

9 April 2013
 Bronze Age skull from Jericho. Wellcome Images.

Bronze Age skull from Jericho. Wellcome Images.

Why do so many surviving skulls from the stone age bear the marks of early brain surgery? Muriel Bailly digs deeper into the history of one particular skull in our collection.

While studying archaeology I had always been fascinated by the impressive scientific knowledge of our ancestors, especially in medical sciences. As there is no better place than Wellcome Collection to study the history of medicine, I was very pleased when I first started working here and discovered that there is a trepanned skull from Jericho dated from 2200 BCE on display in the Medicine Man gallery.  This trepanned skull shows that our ancestors were already capable of practicing successful craniotomy 4000 years ago, and with access to neither anaesthetic nor antiseptic!

The word ‘trepanation’, or ‘trephination’ is derived from the Greek typaron meaning to bore, and it literally means to drill a hole into the skull. It is the earliest form of surgery known to us: the first evidence of trepanation has been dated from 6500 BCE for a specimen found in the French necropolis of Ensisheim (Alsace). All around the globe, archaeologists have found specimens dated from the Neolithic period (10 000 BCE/4000–2500 BCE) presenting evidence of trepanation. The hole would have been made by scraping the bone with sharp stones such as flint or obsidian while the patient was still conscious, although they would potentially pass out from the pain.

A large number of trepanned skulls have been found in Europe, Africa and Southern America, proving that this was a common technique. But why would our ancestors want to put themselves through this much pain?

Meticulous studies have shown that trepanation was essentially carried out on young men and that most specimens presented evidence of head injury. The percentage of those who recovered from the operation (including our specimen at Wellcome Collection, who survived repeated trepanations) shows the astonishing degree of technical skill of people from the Neolithic era, but leaves the question of motive open. Researchers today still have different interpretations of this practice. Indeed, since science and magic were – at that time – of the same nature, it is difficult to differentiate the ritual or magical motives of trepanation from the therapeutic or medical ones.

Because a large number of trepanned skulls also show evidence of head injury, some researchers see a therapeutic motive to this practice. This procedure was carried out to relieve the blood pressure underneath the surface of the skull, as well as to remove bone fragments from the wound. In that case, what about the other percentage of the population who underwent trepanation and do not have evidence of head trauma? It is strongly believed that trepanation may have been used to cure various diseases that are believed to have their seat in the head, such as headache, epilepsy and even depression.

Our specimen at Wellcome Collection suffered four trepanations and managed to survive all of them. There is evidence of regrowth of the bone, indicating that the individual lived on for many years after the operations. In addition to the trepanned holes, we can see evidence of head injury on the top of the skull, supporting the idea that this person had trepanations as a medical treatment following an intracranial trauma.

During the Neolithic period, Jericho was a very important settlement. Various city-states were established on the land, and the presence of large defensive walls suggest that the city-state kings were frequently attacking each other. Between 2400 and 2000 BC, the size of the settlements diminished under the pressure of Bedouin attacks. Could our specimen – dated 2200 BCE – have gained this injury during one of these battles? It is possible, although we will never be sure.

After the Neolithic period trepanation became much less common, to such a point that during the 18th and 19th centuries surgeons would reject the procedure outright, owing to its almost one hundred per cent chance of mortality! However, you’d be mistaken if you thought the procedure had died out altogether. It’s still practiced today in its early form – as opposed to our modern craniotomy – by medicine men in Kenya and Algeria.

Muriel Bailly is a Visitor Service Assistant at Wellcome Collection.