Trepanation: History, Discovery, Theory

Abstract

I cannot avoid describing Trepanation: History, Discovery, Theory as a book you need like a hole in the head. The description may be unfair, but no one can deny that it is written by enthusiasts for enthusiasts. The authors are 35 of the 89 experts who gathered for the First International Colloquium on Cranial Trepanation in 2000. From the editorial introduction it is clear that this multidisciplinary meeting was scientifically very productive. But (presumably because it was the first meeting on the subject) everyone appears to have been allowed to have their say, with all the contributions included, apparently unedited. As a result the book contains more information about trepanation than a non-enthusiast could possibly wish for, much of it repeated several times in different chapters. So, despite having an interest in the history both of medicine and of neurosurgery, I confess to finding a lot of the book of limited appeal. What did I enjoy? The early sections on Broca and Horsley's very different contributions to the debate on why trepanation was performed are fascinating, principally for the information they give us about the two men. For a pathologist, Broca's minute description and discussion of the Peruvian skull sent to him by the American anthropologist EG Squier is a model of conciseness and a delight to read—though a subsequent chapter on bone pathology seems rather short on details of microscopic and ultrastructural changes, which I should have thought might have been of great value. I liked Professor Bennike's discussion of the differential diagnosis of holes in the skull and possible pitfalls for anthropological interpretation, a topic also covered by several other contributors. Professor Bennike does not mention the leptomeningeal cysts that follow some childhood skull fractures, and at least one of the cases illustrated in the book looked identical to one that I have seen of ‘growing fracture’ presenting in an adult. After reading his chapter and a subsequent one about a bregmatic ossicle masquerading as trepanation, I began wondering about the pathogenesis of some of the many other early skull defects illustrated. However, even a sceptic cannot deny that trepanation was flourishing by Galen's time. And it is with the arrival of Galen in Part 4 (Trepanation in Western Medicine) that the real interest of this book lies for a medic, with Dr Rocca's descriptions of Galen's dissections, his instructions to would-be trepanners, and his amazing series of experiments compressing the ventricular system in an intact animal. The next chapter by Dr Ruisinger gives a fascinating historical account of trepanation and evacuation of a subdural haematoma carried out on an unfortunate patient in stages over several days in 1753, under the supervision of Lorenz Heister. A learned description by Mr Kirkup of instrumentation used in trepanation completes the section. After that the book rather lost my attention. It is a pity there is so much duplication, but if you have a detailed interest in the subject this volume will prove a valuable and authoritative resource.

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