The History of Craniotomy

THE HISTORY OF CRANIOTOMY: AN ACCOUNT OF THE METHODS WHICH HAVE BEEN PRACTICED AND THE INSTRUMENTS USED FOR OPENING THE HUMAN SKULL DURING LIFE By LAMBERT ROGERS, M.Sc., F.R.C.S., Edin., F.A.C.S. CARDIFF, WALES ’Tis Man’s worst deed sequence, to get into the habit of thinking To let the things that have been, run to that most of the achievements of present waste day surgery are peculiar to this century, And in the unmeaning Present sink the or perhaps even to this last decade; that Past.—Lowell there was no such thing as surgery, in Ideas are born; they develop; they are the real sense, until almost within the transformed; they never die. The history memory of, say, our grandfathers. of ideas is the history of the race. They It is a very salutary corrective to this are the real events. Let them be never so impression or assumption to glance back new or strange, they have their roots in for a little upon the history of surgery in the far past with a continuity of growth. the past. Sir Andrew Macphail If any of us have acquired this Introduction impression or assumption, this paper Familiar though most of us may prove a salutary corrective such are with the modern methods as that to which Prof. Young refers, of performing craniotomy, not but it was not with this high object all of us are equally well that its preparation was undertaken acquainted with the way in which but because of a much more lowly the operations practiced today have one. At one stage in his ascent of evolved from the more primitive efforts the Mountain of Purgatory, Dante of our surgical forefathers. Nor do all of reached a high terrace from which, us realise how ancient an operation while resting for a moment, he turned craniotomy really is, how many and to the East and remarked to his varied have been the methods practiced conductor: “all men are delighted for its performance and how curious to look back,” and from the terrace and highly ingenious have been certain reached by the practice of cerebral of the implements used by its prac surgery today I am delighted to look titioners. back and report the retrospect. Prof. Archibald Young130 in his While the knowledge gained by presidential address for the year 1924 the toil of one generation soon be to the Royal Medico-Chirurgical So comes the commonplace of the next, ciety of Glasgow, used these words: it is equally true that the discoveries of our forefathers have a habit of Many addresses and lectures have been written in recent years, and many papers attaining a new importance many contributed to medical journals, whose decades later. This is well exemplified chief purpose has been to dilate upon the in the history of surgical craniotomy. great advances of modern surgery. The It will be seen that certain instruments lay Press has contributed its quota to used for performing the operation the same process of what one may almost in quite recent years and even some call self deception. We are too apt, in con of the most modern had their proto types which were used by our surgical formed even before this, namely in the forefathers many decades before and Campigny or Early Neolithic Period. were subsequently lost or forgotten. Many prehistoric human skulls In an introduction to an account of have been discovered and continue surgical instruments in Greek and to be unearthed with pieces of bone Roman times, published in 1907, the missing from them. The defects in the author, Mr. J. S. Milne, remarked bone are due to various causes. They that prior to the publication of his may have been produced by a deliber essay, no systematic attempt to re ate operation performed during the construct the surgical armamentarium life of the subject, and it is with holes of the ancients had been made, that so produced that this paper is con comparatively little attention had cerned; but on the other hand they been given to this department of may have been caused by commi archaeology, and that literature bear nution, the result of violence such as ing on it was scarce. If this applies to that from spears or clubs; they may surgical instruments generally, it does have been produced by disease during so with greater force as regards those life, by defective development in instruments appertaining to a par early life, by post-mortem decay or ticular operation such as opening the injury by the picks or shovels with skull. A research into the literature which the skulls were unearthed, or has failed to reveal any systematic they may have been the work of and comprehensive account of this necrophilous beetles, portions of the aspect of the history of surgery so elytra of which were identified in that the time seems opportune to connection with certain cranial open present this brief history of the meth ings around which a notable con ods which have been practiced and the troversy141 raged some years ago. instruments used for opening the From the types of opening known to human skull during life. result from each of these various processes, however, the nature of the Part i. Neolithic bone destruction, and the fact that signs of reparation around the bony L’origine de la chirurgie cranienne se edges of holes produced some time perd dans la nuit des temps.—Velpeau. before death are apparent after death, Sir William Osler78 described the it is possible to recognise attempts modern operation of cerebral decom made to remove bone discs from the pression as the oldest known surgical skulls of the living. There are numer procedure, and it is certain that the ous examples of successful attempts operation of opening the skull during so made upon neolithic skulls. life dates back to the very dawn of In the British Isles there are but civilisation. In all probability the few examples but France is rich in operation was performed as far back them,* many having been unearthed as the Carnac Epoch of the Neolithic * Some ideas of their frequency will be Period which is supposed to have gathered from the fact that at Vendrest, 60 ended in northwestern Europe about miles east of Paris, remains of over 120 indi viduals were found buried in a neolithic tomb the year 2000 b.c.123 That distin and no less than 8 of the skulls had been guished French neurologist and anthro opened during life and discs of bone removed pologist, Paul Broca,9-14 gave sound therefrom. Badouin, M. Societe Prehistorique reasons for thinking that it was per Franjaise. 1911. since 1865 when M. Prunieres,87-91 also, while more recently Dr. Wilson a medical practitioner of Marvejols Parry, 119.123.124 after investigating the in the department of La Lozere, first question very minutely and perform aroused interest in them by a dis ing much experimental work relating covery which he then made near to it, concluded that the openings Aiguieres. In a dolmen there he found were made with sharp flakes of either a human skull from which a large flint or obsidian used to scrape out portion of bone had been removed. a hole or to plough a groove in the Part of the edge of the hole in this bone until the gradually deepened skull was polished and Prunieres sur groove ultimately perforated the skull mised that the skull had been used by and released a bony rondelle. Dr. a neolithic savage as a drinking cup, Parry claims that boring a series of a custom not infrequent among sav small holes and connecting these by ages, and that the bone edge had been sawing, the method suggested by worn smooth by the lips of drinkers Lucas-Championniere as that used for from it. Broca12 however pointed out making the larger openings, is a very that the polishing was really due to arduous procedure taking considerably a healing process which during life longer to perform than what he calls had taken place in a wound made in “push ploughing” out a bone disc and the skull for removing a rondelle of that for this reason and also because of bone. Prior to this it had not been the absence, in his opinion, of any evi realised that in prehistoric times our dence of the bored holes in the great primitive ancestors used to remove majority of the French neolithic speci discs of bone from the living skulls of mens, he believes the usual method of their fellow tribesmen with imple performing the operation to have been ments made of stone. The effect of the simpler furrowing out of a circular this startling discovery on contempo or oval groove with a sharp stone. rary thought can well be imagined, What were the possible reasons for for it was not long before ample producing these openings in the skull? confirmation of Broca’s hypothesis In his treatise on Prehistoric Problems, was forthcoming. Dr. Robert Munro74 asks, “Were the Speculation next centered around motives that guided the hand of the the methods of making these openings neolithic operator inspired by thera in the skull and many and varied were peutic exigencies or by religious senti the suggestions put forward to account ments? Was the result of the operation for them. Lucas-Championniere61 gave to benefit the individual in this or it as his opinion that they were made in a future world?” Dr. Munro then either by scraping or else by first drill proceeds to discuss these questions at ing a series of small holes and then con length.

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