The Pathology of Trepanation: Differential Diagnosis, Healing and Dry Bone Appearance in Modern Cases

Abstract

Trepanation has been practiced in many primordial cultures dating as far back as the Neolithic Age in Europe, and has been detected world-wide in anthropological and palaeopathological material. After the first scientific notice (Broca, 1867), cases from every well-documented period and region are known today (Aufderheide, 1985; Bennike, 1985; Stevens, 1991). This kind of rather difficult operation was well-mastered in Europe, particularly during the Neolithic period. Survival rates were very good as suggested by the many known healed specimens, as compared to the very unhealed cases, although a comprehensive and solid quantiative and nosological study is missing so far. Naturally the indication of trepanation cannot be inferred directily for scriptless times. Yet the number of healed skull injuries not directly associated with the trephination shows that there must have been medical reasons. Another indirect source for inferences of reasons are extra-European descriptions; the classic and well-known east African case of the “hat-on-hat-off-man” (Margetts, 1967) is a key example: in original cultures, i.e. nonEuropean and non-modern ones, the obvious corporal damage has often been seen to be associated with, or sometimes dominated by, some kind of spiritual evil. Then the head must be opened to set free that black spirit, not only to perform a medical treatment.

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