CONTENTS i TREPANATION ii CONTENTS CONTENTS iii TREPANATION History, Discovery, Theory Edited by ROBERT ARNOTT Centre for the History of Medicine, The Medical School, University of Birmingham, UK STANLEY FINGER Department of Psychology, Washington University, St. Louis, Missouri, USA C.U.M. SMITH Aston University, Birmingham, UK With the Support of BOLESLAV LICHTERMAN Postgraduate Medical Academy, Moscow, Russia RUPERT BREITWIESER Institute for Ancient History, University of Salzburg, Austria LISSE ABINGDON EXTON (PA) TOKYO This edition published in the Taylor & Francis e-Library, 2005. “To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.” Library of Congress Cataloging-in-Publication Data Applied for Copyright © 2003 Swets & Zeitlinger B.V., Lisse, The Netherlands All rights reserved. No part of this publication or the information contained herein may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, by photocopying, recording or otherwise, without written prior permission from the publishers. Although all care is taken to ensure the integrity and quality of this publication and the information herein, no responsibility is assumed by the publishers nor the author for any damage to property or persons as a result of operation or use of this publication and/or the information contained herein. Published by: Swets & Zeitlinger Publishers www.szp.swets.nl ISBN 0-203-97094-2 Master e-book ISBN ISBN 90 265 1923 0 (Print Edition) CONTENTS v Contents Preface ix Part 1: Trepanation: Discovery and Palaeopathology Chapter 1. Ephraim George Squier’s Peruvian Skull and the Discovery of Cranial Trepanation Hiran R. Fernando & Stanley Finger 3 Chapter 2. On the Birth of Trepanation: The Thoughts of Paul Broca and Victor Horsley Stanley Finger & William T. Clower 19 Chapter 3. The Pathology of Trepanation: Differential Diagnosis, Healing and Dry Bone Appearance in Modern Cases Andreas G. Nerlich, O. Peschel, Albert Zink & Friedrich W. Rösing 43 Part 2: Trepanation in Europe Chapter 4. Review of Trepanations in British Antiquity Focusing on Funerary Context to Explain their Occurrence Charlotte Roberts & Jaqueline McKinley 55 Chapter 5. Trepanations and Pseudotrepanations: Evidence of Cranial Surgery from Prehistoric and Early Historic Ireland Barra Ó Donnabhain 79 Chapter 6. Ancient Trepanations and Differential Diagnosis: A Re-Evaluation of Skeletal Remains from Denmark Pia Bennike 95 Chapter 7. Trepanation in the Portuguese Late Neolithic, Chalcolithic and Early Bronze Age Periods Ana Maria Silva 117 Chapter 8. A Neolithic Case of Cranial Trepanation (Eira Pedrinha, Portugal) Rui Pedro Gama & Eugénia Cunha 131 vi CONTENTS Chapter 9. New Cases of Cranial Trepanation Gaspare Baggieri & Martina di Giacomo 137 Chapter 10. Celtic Trepanations in Austria Rupert Breitwieser 147 Chapter 11. A Bregmatic Ossicle Resembling a Trepanation from an Eleventh-Century Skeleton Excavated from a Cemetary Area Now Within the Prague Castle, Czech Republic Marshall Joseph Becker 155 Chapter 12. Prehistoric Trepanations in Russia: Ritual or Surgical? Maria Mednikova 163 Chapter 13. Cranial Surgery: The Epipalaeolithic to Neolithic Populations of Ukraine Malcolm Lillie 175 Part 3: Trepanation in Africa, Asia and The Americas Chapter 14. Perforating Skull Trauma in Ancient Egypt and Evidence for Early Neurosurgical Therapy Andreas G. Nerlich, Albert Zink, Ulrike Szeimies, Hjalmar G. Hagedorn & Friedrich W. Rösing 191 Chapter 15. Four Cases of Trepanation from Mongolia, Showing Surgical Variation Naran Bazarsad 203 Chapter 16. Trepanations and Perforated Crania from Iron Age South Siberia: An Exercise in Differential Diagnosis Eileen Murphy 209 Chapter 17. Trepanation in Prehistoric South America: Geographic and Temporal Trends over 2,000 Years John W. Verano 223 Chapter 18. Pre-Columbian Skull Trepanation in North America James L. Stone & Javier Urcid 237 CONTENTS vii Part 4: Trepanation in Western Medicine Chapter 19. Galen and the Uses of Trepanation Julius Rocca 253 Chapter 20. Lorenz Heister (1683-1758) and the “Bachmann Case”: Social Setting and Medical Practice of Trepanation in Eighteenth-Century Germany Marion Maria Ruisinger 273 Chapter 21. The Evolution of Cranial Saws and Related Instruments John Kirkup 289 Part 5: Global Perspectives and Future Research Chapter 22. Trepanation from the Palaeolithic to the Internet Charles C. Gross 307 Chapter 23. Why Trepan? Contributions from Medical History and the South Pacific Graham Martin 323 Chapter 24. An Overview from Neolithic Times to Broca F. Clifford Rose 347 Chapter 25. The Future Direction of Research Don Brothwell 365 Subject Index 373 Author Index 391 Name Index 399 viii CONTENTS “I have the honour to present to the Academy an ancient Peruvian skull on which trepanning was performed during the lifetime of the individual” Paul Broca, 1867 CONTENTS ix Preface After examining the pre-Columbian skull sent to him by United States diplomat to Peru, E. G. Squier, in 1867, French surgeon-anthropologist Paul Broca astounded the world of science and medicine by suggesting that the cranial opening was the result of some form of prehistoric surgery. Moreover, the Inca on whom the procedure had been performed had survived the ordeal by a few weeks. This was not the first reported example of a man-made opening of a skull, nor was it by any means the earliest. But it was the first case of trepanation to be correctly identified, interpreted, and accepted, and as such it made people think about why the skulls of living people were opened in the distant past. Clearly, the Squier skull marked the start of serious study and intense fascination with trepanation. Within a few decades, scholarly (and sometimes not so scholarly) contributions were beginning to fill the journals. This growth has continued to accel- erate and researchers today are by any standard exceedingly prolific. In 1975 Guido Majno remarked that the number of papers on the subject of cranial trepanation prob- ably exceeds the number of specimens known throughout the world! Today, even with more skulls unearthed, we would be pressed to think of the multiple. Despite the exponential growth of research on this subject, something important has been lacking. Simply put, there is little cohesion. The study of cranial trepanation has, over the years, gone in many different directions, and the leading scholars now actively involved represent many regions, disciplines, and approaches. These diverse researchers, historians, and theorists, however, have rarely come together, never mind engaging in a large group discussion to consider common problems and future direc- tions for the field. The need for more interaction, more cooperation, and a fruitful exchange of ideas was apparent to all of the editors of this volume. The “time had come”, we all agreed, for research on cranial trepanation to be taken forward. This volume arises out of the first International Colloquium on Cranial Trepanation in Human History, which was held at the University of Birmingham (UK) between the 7th and the 9th of April, 2000. The idea for this much-needed colloquium was conceived by Robert Arnott of the Department of Ancient History and Archaeology (now of the Centre for the History of Medicine) of the University of Birmingham. It was officially supported by the International Society for the History of the Neuro- sciences, the Institute of Ancient History of the University of Salzburg (Austria), and the Russian Postgraduate Medical Academy (Moscow). The conference was truly an international gathering, as had been hoped for by the organizers, bringing together 89 scholars from 16 countries across four continents. Before Birmingham, many of these scholars had not only never met each other, but in some cases had never even heard of each other’s work. Taking the podium with slides too numerous to count were archaeologists, anthropologists (physical and social), pa- thologists, anatomists, surgeons, historians of medicine, and others with their own specializations. The material they described (all papers were in English) ranged chro- nologically from the Epipaleolithic Ukraine to eighteenth-century Germany. Geograph- ically they not only covered the rich terrains of Eastern and Western Europe and the x PREFACE New World, but also recent finds from Polynesia and even Mongolia. Many participants addressed the features of crania and theorized about the patho- logical conditions that might have led to the surgery. But there were also discussions about the evolution of instruments and thoughtful reassessments of specimens studied in the past and the methodologies used. The doyen of British paleopathology, Don Brothwell, fittingly closed the symposium by telling those in the audience where, from his perspective, new efforts should be directed. Because there had not been a book providing an extensive, up-to-date overview or synthesis of our understanding of cranial trepanation in human history, it was decided early on that the material presented at the Birmingham conference should be edited and published under one cover. Our intent was not only to serve laboratory and field scientists, but to provide a balanced volume on cranial trepanation for any profession- al or layman who might have an interest in this fascinating subject. The opening chapters in this volume deal with how trepanned skulls were initially found, and the theories