Making Holes in the Skull:
Ancient Psychosurgery?

Neolithic trepanned skulls


Just imagine: a hole of 2.5 to 5 cm of diameter, drilled by hand into the skull of a living man, without any anesthesia or asepsis, during 30 to 60 long minutes. This is maybe the most ancient form of brain surgery known to man: it is called trepanning (from Greek trupanon, borer) or trephining. And one of the reasons for performing this bone-chilling procedure was perhaps the same that motivated modern surgeons, such as Dr. Egas Moniz, to perform psychosurgery, in order to alleviate mental symptoms.

Skulls with signs of trepanning were found practically in all parts of the world where man has lived. Trepanning is probably the oldest surgical operation known to man: evidence for it goes back as far as in 40,000 year-old Cro-Magnon sites.

Trepanning was "fashionable" on and off along the ages, probably with different reasons. It was practiced in the Stone Age, in Ancient Egypt, in the Greek and Roman pre-historic and classic times, in the Far and Middle East, among the Celtic tribes, in China (ancient and recent), India, among the Mayans, Aztecs and Incas, among Brazilian indians (karaya and eugano), in the South Seas, and in North and Equatorial Africa (where they are still in use, incredibly as it may seem).

The first historical and medical accounts of trepanning in Antiquity were made in 1867, by E.G. Squier, in North America, and by Paul Broca, in Europe.

Aztec trephining knife made of bronze
and gold (1200-1400 AC)


"Crown" trephines from the 17th century

We will never know how and when primitive man came to the discovery of trepanning, and we can only speculate on the reasons for which they were carried out. The specialists think that, according to culture and time, these reasons could be:

  • Magical and religious rituals, to bring luck and to offer sacrifice, etc. In many cultures (mainly those which were known as head-worshippers, because they attributed special significance to the head and brain in their religion), trepanning was very common, and the round slab of bone taken out of a skull is used as an amulet. There is the possibility that the large number of trepanned skulls found in military posts were from enemies, who were used as suppliers of these amulets.
  • Shamanistic therapies, mainly due to the conviction that opening the skull would liberate "bad spirits" or demons that inhabited the patient’s body. These trepanations could then be considered "psychosurgeries", in the sense that probably the most common indications were mental diseases, epilepsy, blindness, etc.
  • For the treatment of legitimate medical conditions, such as strong headaches, skull fractures and wounds, osteomyelitis, encephalitis, elevated intracranial pressure due to hematomas, hydrocephalus and brain tumors, etc. In fact, for some of these conditions, trepanning shows a true therapeutic effect, and it is still used by neurosurgeons. In the South Seas and in North African tribes (rifkabyla and hausa) and Kenya (kisi), trepanning is carried out particularly for relieving war wounds inflicted to the head. The Father of Medicine, Hippocrates, wrote detailed instructions on how to perform skull trepanning for a variety of medical conditions,
  • From the Middle Ages well into the 18th century in Europe, trepanning was common as a medical procedure very much like bloodletting, i.e.; it had no medical usefulness per se. Repeated trepanning was common; for instance it is related that Prince Philip of Orange was trepanned 17 times by his physician. De La Touche, a French physician trepanned 52 times one of his patient, within a two-month period! Many physicians, from the Roman times on, also believed that the bone slabs (called rondelles) taken from trepanned skulls had therapeutic value when pulverized and mixed with other beverages given to the patients for several diseases.

Ancient Greek metal trephines

Trepanning was performed either by bone abrasion (by using a sharp-edged stone or volcanic glass knifes) or by cutting (using semicircular trephines, which cut by means of a swinging motion, such as those found in the Central and South America civilizations). The Egyptians invented the circular trephine, made by a tube with serrated borders, which cuts much easier by means of rotation, and which was then extensively used in Greece and Rome, and gave origin to the "crown" trephine, used in Europe from the first to the 19th century. One of the major inventions in trephine technology was the central spike, which was used to center the rotational movement, so that a better precision was achieved.

How long took a surgical trepanning?

When it is made in a single session (yes, in some cultures the trepanning is made in several sessions, which can take up to 12 days!), it takes from 30 to 60 minutes of continuous sawing or drilling. Paul Broca, the ubiquitous French neurosurgeon and anthropologist, determined this experimentally in animals and cadavers, in 1867.

19th century trephine saw
Did patients survive such a drastic operation, without antibiotics, asepsis or anesthetics?
It is hard to believe, but judging from the number of skulls which showed healing and bone regeneration at the borders, the proportion of "patients’ who survived the ordeal of a trepanning was quite high, from 65 to 70 %. Out of 400 skulls examined by one researcher, 250 indicated recovery. In modern times (14th to 18th centuries) this proportion was much lower, sometimes approaching zero. Birner (1996) cites that a professional "trepanator" named Mery, lost all his patients in 60 years of activity. The most common cause of death was infection of the meninges or of the brain, or hemorrhage. If these factors are carefully controlled (for example, by interrupting the action of the trephine before it touches the brain meninges), it is quite a safe operation. In 1962, a Peruvian neurosurgeon performed a trepanning on a head-trauma patient, using the surgical instruments of ancient Peru. The patient survived.

Surgery:  (The ancient knowledge of Surgery)

On prehistoric brain surgery anatomist Professor Kappers reminisced, "It is even probable that the trephine holes found in prehistoric skulls 50,000 years old were made for curative purposes".

(Ref: )

Featured Items

  • Trepanning (Cranial surgery)
  • Prehistoric Dentistry.

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In ancient Egyptian medicine the skills and knowledge of doctors developed from the legacy of the prehistoric age. Doctors in ancient Egypt were usually also priests, and religious rituals continued to be used alongside rational treatments as both were believed necessary for a cure. Important deities invoked in medicine included Imhotep, the god of healing, who was formerly doctor to Pharaoh Zoser in the 3rd millennium BC, and Thoth, god of wisdom and learning.

A system of medical training was established in the temples and a written language developed using hieroglyphics. Medical treatments were recorded on papyri such as the Papyrus Ebers and the Papyrus Edwin Smith. The standard work used by Egyptian doctors was the Book of Thoth, a collection of ritual and rational treatments. The religious practice of mummification, in which the organs of the body were removed, helped Egyptian doctors to gain an understanding of human anatomy, although dissection was banned for religious reasons. However, Egyptian doctors began to practise basic surgery such as the removal of growths on the skin or cataracts from the eyes. Egyptian doctors believed that illness was often caused by the body’s channels becoming blocked because of rotting food in the stomach, a practical theory based on their observation of the River Nile. Patients affected were given emetics to make them vomit or laxatives to loosen their bowels and clear the blockage.


Cranial Surgery (Trepanning):

Trepanation is perhaps the oldest surgical procedure for which there is evidence, and in some areas may have been quite widespread.

An ancient site in Ishtikunuy, located near Lake Sevan, in Armenia yielded two particular skulls from approx’ 2,000BC that showed evidence of head surgery. The first was he skull of a woman with a head injury which made a hole a quarter of an inch wide. A plug of animal bone had been inserted in its place. The fact that the woman survived was evident from the cranial growth around the plug before she died. The second skull as another woman, who had had a blunt object that had splintered the inner layers of the cranial bone. The ‘Surgeon’ cut a larger hole around the puncture and removed the splinters. Evidence shows that she survived another 15 years. Obsidian razors have been found at the site that are still sharp enough to be used today. (Ref: 9)

The well-preserved skull of Gadevang Man, a prehistoric ‘bog body’, dated 480-60 BC, found in Denmark. The skull shows signs of surgical trepanning.

The precise cuts that can be seen on some of the trephined skulls, and the re-growth of the bone (which proves that the patient/victim survived the operation), do indicate that prehistoric people had the ability and knowledge to besuccessful surgeons. 

Out of 120 prehistoric skulls found at one burial site in France dated to 6500 BC, 40 had trepanation holes. Surprisingly, many prehistoric and pre-modern patients had signs of their skull structure healing; suggesting that many of those that proceeded with the surgery survived their operation.  (1)

Archeologists have found trepanned skulls dating from the late Neolithic, some 5,000 years ago. Now a team of French and German researchers has suggested that the procedure goes back even further, to at least 7,000 years ago.
The evidence comes from the French village of Ensisheim. To date, archeologists there have unearthed 45 graves containing 47 individuals. One grave held the remains of a 50-year-old man who had two holes in his skull. Both holes were remarkably free of surrounding cracks and were clearly the result of surgery, not violence. One hole, in the frontal lobe, is about 2.5 inches wide; the second, at the top of the skull, is about an inch wider.
Most questionable trepanations are rather small, and with some you cannot tell the shape of the original hole that was made within the skull, or whether it was a fracture, says archeologist Sandra Pichler of Freiburg University in Germany, a member of the team. But in our case you can still see the very straight, slanting edges of the larger trepanation, and this is artificial. There is no natural explanation for a hole like that.
Both holes had time to heal before the man died–the smaller hole is completely covered over with a thin layer of bone; the larger is roughly two-thirds covered–and neither shows signs of infection. So they must have had a very good surgeon, and there must have been some way or another of avoiding infection, Pichler says. Pichler and her colleagues estimate that it would take at least six months, and perhaps as much as two years, for such extensive healing. Since the two holes did not heal to the same degree, it’s likely they were made during two separate operations.
The team doesn’t know why the man was operated on. Nor can they be sure exactly how the trepanations were performed, although the cut marks indicate that the bone was removed by a mixture of cutting and scraping. Stone Age tools were certainly up to the task: flint knives are actually sharper than modern scalpels.
The trepanations were done so perfectly that this can’t be the oldest one, Pichler says. They must have practiced somehow, and the knowledge of how to do this kind of operation must have been passed down, Pichler says. The fact that there are two trepanations is further corroboration: if there had been just one, you could say that they were lucky. But if you survived two such operations, your surgeon must have known what he was doing.


Trepanation in the Indus Valley culture: The skull on the right was found in a Harrapan setting,  circa 4,000 B.P. The link below leads to fascinating article describing a Neolithic skeleton with multiple-trepanated skull found in Kashmir, the archaeological circumstances of the find, the dating, the background, the skeletal evidence, the details of the trepanation and possible affiliations to the Indus civilization. It speculates briefly about possible medical grounds for the surgery.


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Open Heart Surgery.

The Soviet Academy of Sciences announced in 1969 that a number of ancient skeletons, found in central Asia showed signs of surgery having been performed in the area of the heart. Every feature corresponded to what today is called a ‘Cardiac Window’, enabling surgeons to perform open heart surgery. (9)


(Extract from ‘THE TIMES’, Thurs April 12th 2001)…

Prehistoric dentists may have been using stone drills to treat tooth decay up to 9,000 years ago, a team of archaeologists has discovered.

Excavations at a site in Pakistan have unearthed skulls containing teeth dotted with tiny, perfectly round holes. Under an electron microscope, they revealed a pattern of concentric grooves, that were almost certainly formed by the circular motion of a drill with a stone bit.

The discovery, which was made at an archaeological dig in Mehrgarh, in Baluchistan Province, offers the earliest evidence of human dentistry.

The excavated village belonged to a civilisation that thrived between 8,000and 9,000 years ago, whose members cultivated crops and made jewellery from shells, amethyst and turquoise.

Andrea Cucina, of the University of Missouri-Columbia, who found the molars with telltale marks, said: “At this point we can’t be certain, but it is very tantalising to think they had such knowledge of health and cavities and medicine to do this”.

Dr Cucina, whose research is reported in New Scientist magazine, said the holes would probably have been filled with some sort of medicinal herb to treat tooth decay. Any filling would long ago have decomposed.

The dental discovery was made while Dr Cucina was washing teeth from the Mehrgarhing and spotted the tiny hole in the biting surface of a molar. The hole was too perfectly round to have been caused by bacteria and the tooth had been found in a jawbone, ruling out the possibility that it had been pierced to be strung on to a necklace.

The Top of the hole was rounded from chewing, suggesting that it was made while the owner was still alive.

MSNBC (2006) – Proving prehistoric man’s ingenuity and ability to withstand and inflict excruciating pain, researchers have found that dental drilling dates back 9,000 years.

Primitive dentists drilled nearly perfect holes into live but undoubtedly unhappy patients between 5500 B.C. and 7000 B.C., an article in Thursday’s issue of the journal Nature reports. Researchers carbon-dated at least nine skulls with 11 drill holes found in a Pakistan graveyard.

That means dentistry is at least 4,000 years older than first thought — and far older than the useful invention of anesthesia.