Whanganui Regional Museum holds a fascinating collection of material from Whanganui Hospital used during the 20th century.
Whanganui Regional Museum holds a fascinating collection of material from Whanganui Hospital used during the 20th century.
Today if we have a headache, we drink a glass of water and take some paracetamol.
But in the past, a much more drastic practice could have been used to relieve the pain.
Trepanation, also known as trephination, was the act of drilling a small hole in the skull. The term comes from the Greek "trypanon" which translates as auger or drill.
Archaeological remains date the practice back to 6000BC. Skulls with drilled holes have been found in North and South America, Europe, China and North Africa, with an estimated 5 per cent of Neolithic remains showing evidence.
The first written record of trepanation comes from the Hippocratic Corpus, a collection of medical texts associated with Hippocrates, the father of modern medicine. These date to 450-340BC and include such advice as cooling the trypanon with cold water to prevent heating the bone while drilling.
A trephine from Whanganui Hospital, used during the 20th century to allow access for brain surgery. Whanganui Regional Museum Collection Ref: 1995.44.224
But why was it done? The Hippocratic Corpus recommended the procedure for head wounds. Doctors of the time believed stagnant blood could rot and turn into pus which would cause "distress and madness". If someone had received a blow to the head, it was advised to drill a small hole to let the blood out before it rotted, even if there was no fracture or bruising. It was not advised for depressed fractures as the resulting hole was sufficient.
Based on skeletal evidence, trepanation was primarily used for treating head injuries, although it has been used for treating other disorders. It was recommended for epilepsy in a 150AD Greek medical text, and again in a 13th century European text which stated a hole was needed to let the bad humours of Hippocratic medicine (bile and phlegm, for example) causing the disease to escape. By the 19th century it was only recommended if epilepsy had developed after a head injury.
Another text from 1170AD recommends it for treating mania and melancholy, believing the brain was infected with noxious material which caused depression. This text also recommended securing the patient in chains until the wound had healed.
A skeleton dating to medieval Italy indicates it was used to relieve headache and high blood pressure. The skeleton of a pregnant woman featured an unhealed trepanation wound. It is believed she suffered from pre-eclampsia and the 4.6mm hole was drilled to help relieve the pain and pressure.
Other societies have practised it for cultural reasons, with some anthropologists suggesting it was used during rituals to "let demons out", or as a rite of passage.
The practice was at its highest in 14th-16th century South America where 80 per cent of patients survived. The mortality rate in Europe was not so successful and the use of trepanation was debated there for centuries. Attitudes turned towards the end of the 19th century with the discovery of antiseptics and other infection prevention methods, and a better understanding of intracranial pressure.
Towards the end of the 20th century trepanation found a resurgence as some believed it could increase creativity and enhance consciousness, although this has not been medically proven. The fad caused specialists to issue formal statements advising people not to try it at home.
Trepanation was the precursor to neurosurgery and has been replaced by a craniotomy where a section of the skull is removed to allow access to the brain, and later replaced. It is only performed under anaesthetic and in exceptional circumstances for exploratory diagnosis, relieving pressure from haematoma, or access for neurosurgery.
The Whanganui Regional Museum holds a fascinating collection of material from the Whanganui Hospital used during the 20th century. One of the pieces is the trephine pictured, used to remove a small section of bone and allow access to the brain for diagnosis and neurosurgery. It wasn't this rusty when in use, however.
• Sandi Black is the archivist at Whanganui Regional Museum
