Saturday, November 12, 2011

Skull surgery, the hot new trend.

Examples of 16th century trepanation instruments.

There is a wealth of historical records of the presence of trepanation in many cultures. For the uninformed, trepanation is the (somewhat outdated) process of putting a hole in the skull of a living person, mostly for surgical practices, although the process tends to have more spiritualistic roots. It has been known for a while that the earliest signs of this skull-drilling have been found in numerous forms and in various parts of Europe, South America, the Middle East, and even some parts of Egypt and greater Africa, with findings dating as far back as 3000 B.C. in the Danube River basin, and as far back as 11,000 B.C. in modern-day Morocco. However, a recent archaeological study released this past August suggests evidence of trepanation in a previously unforeseen location.

Anthropologist Efthymia Nikita, along with her colleagues at the University of Cambridge, recently published a paper in the International Journal of Osteoarchaeology outlining the analysis of three skulls of Garamantian men, excavated by past researchers near the ancient capital of Garama (currently southwestern Libya). The skulls contained various styles and sizes of holes and indentations. The Garamantes were a people who thrived in the northern Sahara from around 1100 B.C. to 600 A.D. The paper can be found in its entirety here. *NOTE: a subscription to the journal may be required to view the paper. Columbia students can follow this link, and search for "Evidence of Trephinations among the Garamantes."

Perforation (arrow 1) and depression (arrow 2) in the skull of a Garamantian young adult male.  (Nikita et al, p3) 

In the article, Nikita and her team have surmised that the holes studied in two of the three skulls (Individuals GER011.T20 and TAG012.T3) are concrete evidence of the practice of trepanation in the northern Sahara (Nikita et al, p5). This is an important find for a number of reasons. First, it backs up the evidence of North African trade routes from 2000 - 3000 years ago, since the dates on these artifacts match up with those of other findings of trepanation in other parts of Africa and southern Europe/the Mediterranean. Second, it establishes the fact that humans and material goods were not the only things crossing trade borders during this era.

Trepanations (arrows 1 and 2) in individual GER011.T20. Through a lengthy analysis by Nikita's team, this was discovered to be the skull of a middle-aged man, around 55 years old. Noticeable signs of healing indicate a "successful" surgical procedure, in that the patient survived. (Nikita et al, p3)

According to this article about the finding from Science News, Nikita stated, given the evidence of these trade networks, that "the knowledge of cranial surgical techniques must have been among the cultural traits that spread among populations." This is a significant reveal with regards to the migration and mutation of culture in Africa. The expansion of certain medical practices, including this ancient form of skull surgery, contributes to the various other ideas spread through migration and trade, such as various forms of artisanship.

Most people in the medical community would say that trapanning, being the oldest form of surgery known to man, and once thought to cater an unbelievably wide range of medical circumstances, is somewhat of an obsolete practice. Despite this, there is a group that still thinks it to be a perfectly reasonable practice. The International Trepanation Advocacy Group (ITAG) firmly supports the practice, under the hypothesis that "making a[n] opening in the skull favorably alters the movement of blood through the brain and improves brain functions which are more important than ever before in history to adapt to an ever more rapidly changing world." That debate, however, is for another time.

(As a side note, the wonderfully cliché relaxing background music on ITAG's website provides a great distraction from their sub-par grammatical structure.)


  1. Trepanning always fell in the same mental category as phrenology to me, albeit more invasive--antiquated practices that revolve around the mysticism of the head and mind. Both are based on the idea that there is a bridge between the outside and inside, as it were--between mental processes and the head's physicality/anatomy.

    I think it's interesting that this mysticism exists, but mostly I wonder how it is that people first came to it--how they came to associate the anatomical head with the intangible realm of thoughts, thereby facilitating such practices as trepanning. Of course now we know that the wrinkly, meaty brain in our skulls is responsible for furnishing our fears, dreams, and desires--but how could the first trepanners? The sentinels of sense are located in a crown of ears and eyes about our brow, but they sought spirits everywhere from the parietal to occipital lobes. I suppose that it may have been an ailment as mundane as the migraine that caused the first foray into a practice as arcane as skull drilling.

  2. Interesting piece Andrew - I wonder how the authors know that this was spread along trade routes and not an independent invention. It makes me wonder what other lines of evidence one could adduce to strengthen their case?