Ancient Surgery Makes Comeback

Sept. 27, 2000 -- Advocates of a crude form of surgery called trepanation, which involves drilling holes into the skull, want to bring the practice back — from prehistoric times.

The art of cranial surgery was practiced up to 5,000 years ago in Europe, and until a few centuries ago on many other continents, according to archaeologists who have found skulls with carefully carved, man-made holes in them. Evidence of healing and bony scar tissue around the holes shows that many of these people lived long lives after going under the knife.

“If you cut a hole in someone’s head, as it heals, the edges smooth out,” says John Verano, an archaeologist at Tulane University who is writing a book on the surgery. “A spongy kind of bone will grow between the gaps.”

From Ancient to Modern Surgery

Trepanation still exists today, but in a different form. In the past few decades there have been a handful of notable cases of people trying the surgery.

The most famous, perhaps, is Amanda Feilding, a British woman who drilled a hole in the top of her head believing that it would bring about a higher state of consciousness — which it has, she says.

Feilding believes something is lost when the skull bones that encase the brain fuse completely together as people grow older, although scientists say there is no evidence that this is true.

“When you’re a child, the arteries in the brain can pulsate more fully,” Feilding says. “The membrane around the brain can expand and the little arteries in the head can expand. The point of trepanation is to give the brain back that pulsation.”

However, one surgeon who observed the videotape of Fielding performing the procedure reportedly noted she could have killed herself in the effort.

Other doctors say there is no scientific evidence to suggest that trepanation is anything but dangerous.

Dr. Michael Sisti, a neurosurgeon at Columbia Presbyterian Medical Center in New York, told 20/20 earlier this year that drilling a hole in the skull will not improve one’s lifestyle.

“It’s an assault,” he said. “It’s not a procedure. It’s really a form of self-mutilation. Even doctors who are interested in becoming neurosurgeons require a process of five to seven years of intense training and education to learn the techniques that make this kind of procedure safe.”

Sisti also said none of his patients has ever, after thousands of procedures that involved entering the skull, told him that they felt rejuvenated after brain surgery.

Sling Stones, Not Arrows

While modern-day trepanation enthusiasts hope to free their minds, so to speak, by drilling holes in their heads, archaeologists are still trying to learn what motivated our ancient ancestors to practice the surgery. One explanation is the operation may have been performed in what was an early form of the emergency room.

Archaeologists think most of these ancient operations were performed to treat individuals who had suffered massive head trauma, most likely in combat. Early surgeons probably performed trepanation to remove splinters of skull bone and relieve pressure from blood clots that formed when blood vessels were broken.

The procedure probably evolved through a bit of trial and error, says Verano. After it worked on one individual, scientists think the early surgeons probably tried it again, learning not to puncture the membrane that surrounds the brain.

Verano says weapons like sling stones and clubs were widely used in prehistoric South America, where the largest group of trepanned skulls — about 1,000 in private and public collections — exists in the nations of Peru and Bolivia. The majority of the skulls date from 500 B.C. until the 16th century A.D., according to Verano.

He thinks the use of heavy, blunt weaponry contributed to the medical need for trepanation. Unlike warriors with spears and arrows who would normally aim for the chest, wielders of dull weapons would most likely strike their victims in the head. Early doctors were probably operating on people who had suffered life-threatening injuries.

The techniques used for early cranial surgery varied through time in South America, says Verano. Ancient Peruvians performed the surgery with obsidian — volcanic glass — in the early days but eventually switched over to bronze and other metal tools when technology provided them.

Many Ways to Cut Bone

To cut the skull bone, scientists believe the ancient surgeons used a variety of techniques. The earliest included scraping at the skull, gently removing layers of bone until breaking through to the brain. This method was used most often in ancient England, according to Charlotte Roberts, a paleopathologist at the University of Durham in Britain, who has studied the phenomenon of skull surgery there. The modified skulls that she has studied — about 50 crania from 3,000 B.C. to the 16th century A.D. — had holes ranging from about half an inch to 6 inches.

“That one didn’t live,” she says of the person with the 6-inch hole.

Other ancient surgeons cut straight incisions in the skull and joined them at an angle to create wedge-shaped holes in the head. Another method was to carve circular grooves in the skulls, cutting discs of skull bone out of the crania. The least successful method, and one that was most likely very traumatic for patients, says Roberts, was the boring of a series of holes into the head and breaking the bone that joined them.

When Feilding decided to put a hole in her head in 1970, she used a much more modern tool: an electric foot-operated dentist’s drill. Feilding, then 27 years old, applied a local anesthetic to her scalp and taped glasses to her face to prevent blood from dripping into her eyes. Then, using a mirror for guidance, she bored a hole about a half-inch wide in the top of her head just above the hairline while a friend filmed the procedure. She says she immediately felt better.

“I found it gave me more energy, lifted me up, made me more buoyant,” she says.

Over time the feeling that she had after the operation faded, says Feilding. So in February of this year, Feilding had a doctor in Mexico City drill another, larger hole on the right side of her head. To ensure that it wouldn’t grow over, she had a piece of wax inserted in the wound to inhibit the growth of bone. Her husband, a former Oxford University professor (who, incidentally, once instructed now-President Bill Clinton), also had a hole made in his skull.

Feilding says the results were similar in the second surgery as in the first.

Feilding says she gets hundreds of requests a year through her Web site from people who ask her how to get trepanned by a licensed physician. Most of them won’t be able to, as Feilding found, because few doctors will agree to perform the procedure. Feilding has taken up the cause in local politics, running for local office twice (she lost both times). And she is constantly lobbying the British government to pay for trepanation and research into the effects of the operation.

Interpreting the Evidence

Feilding asserts she isn’t the first to believe in the theraputic effects of trepanation.

“In the past, trepanation was done for skull trauma — from battleaxes and such,” she says. “But I think there is evidence that was used to get rid of headaches, or to ‘let spirits out,’ which we call schizophrenia now, or even to ‘let the light in’ for the priest caste. I think there is a wider variety of uses than archaeologists give ancient man credit for.”

Indeed, there are a few skulls in the archaeological record that can’t be explained as head trauma victims, according to Verano. These skulls have an astounding four to seven holes in them. Vernano suspects these were probably patients who had problems that would not go away.

“We have those people today in our society, too,” he says. “These were probably the equivalent to modern-day hypochondriacs.”

Verano says he would strongly dissuade anyone today from seeking the operation for its purported psychological benefits — even if it is a practice that’s been around for millennia. “I doubt there’s anything to it. I tell them I think they’re on the wrong path.”