Good morning. Headaches again, huh? Let me just go get the Black and Decker. All my other instruments are still in the autoclave. Oh, don’t grimace like that. You want budget? You’re getting budget. Hell, if you make it, this one will be totally free – I promise.

TREPANATION: NOTHING LIKE A LITERAL HOLE IN THE HEAD!

What are the positives of this treatment?

Trepanning, the medical art of drilling a literal hole in a person’s skull, might be one of the oldest medical treatments in the world. We have archaeological evidence from the late Neolithic age – over seven thousand years ago – that features skulls with various sizes of holes in them, from locations all over the world, including Europe, Siberia, China, Africa, and the Americas. The word comes from the ancient Greek trypanon, for “auger” or “borer”.

Unlike some of the other pamphlets in this series, it’s not like trepanning is an unknown treatment – indeed, its gruesome nature has given it some star power amongst fringe medical practitioners for centuries. While it’s best known for the belief in surgeons trepanning skulls in order to release various evil demons or spirits that might be found in a person’s body, there is also significant evidence to support it being used as a legitimate, though very primitive, surgical technique. For patients with head wounds or possible loose bone fragments suffered from various forms of blunt force trauma, a trepanation might have been the difference between life and death.

While skulls with round holes from drill bits are likely the best known examples of trepanation, there’s significant evidence that indicates a number of different trepanation techniques were used around the world. One such notable one, found in late Neolithic England, sees some skulls with signs of having layers of bone gently scraped away in order to penetrate the skull, rather than using sharp objects to quickly pierce the bone.

Because we have been able to find many cases of preserved human skulls that show not only evidence of trepanning, but also evidence of healing and bone growth around the rim of the hole, it is thus apparent that the procedure does, in some circumstances, actually offer some medical benefit.

Well, they’re incredibly risky to perform – particularly when you lack the specialized equipment to properly carry out the procedure. Death – or, arguably worse, debilitating cognitive impairment or mental illness – was unfortunately a common feature of those subjected to the treatment, especially in its most primitive forms. We haven’t even mentioned the added issue of performing a trepanation without the use of any anesthetic – as was standard practise for millennia, despite the near-certainty of excruciating pain for the patient.

That said, the risk and pain didn’t do all that much to quell the practise for thousands of years – trepanning wouldn’t reach its zenith as a medical treatment until the seventeenth century. Eventually, with the advent of the far more precise and accurate craniotomy, trepanation mostly died out by the nineteenth century, though it was still apparently being performed in some field hospitals during the First World War.

What are some real-life examples of this treatment? 

Even those its use has mostly vanished over the last four hundred years or so, trepanation has undergone a minor renaissance over the last few decades – much to many people’s surprise. One notable case is that of Amanda Feilding, Countess of Wemyss and March, who in 1970 elected to perform a self-trepanation, using a local anesthetic and an electric drill, in order to enhance blood flow to the brain. (As a known British person, this put her in contention for that year’s Upper-Class Twit Of The Year grand prize.) After running for Parliament twice on the platform of free trepanation surgeries being made available to all British subjects, she now serves as the director of the Beckley Foundation, an alternative medicine organization and NGO dedicated to the study of altered consciousness and drug reform. She also had a second trepanation performed later, and even had her husband, a former Oxford professor, get a hole in his own head as well.

How can we improve this treatment for the future?

Why do we need to improve it? It works – and unlike a Barrett .50-cal, a headshot doesn’t mean instant death. Trepanation has the potential to unite patients of all beliefs, be they political, religious, economic, social, medical, or otherwise – and I strongly advocate that we push our health insurance companies to cover this procedure.

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I have to run – I hear sirens. If you don’t hear from me, I’m probably in Tijuana – but don’t tell anybody. Especially my family. Not sure when I’ll be back, but do make sure you lock the clinic door on your way out. Help yourself to anything you like out of the medicine cabinets – but just make sure you don’t mix things into the same bottle. Gotta go! Remember – you’ve never heard of me!

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Information for this article taken from here, here, here, here, here, here, and here. 

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Thanks to everyone who’s enjoyed this series over the last few months – it has been a real treat for me to get to tag along with Dr. David Chao to learn all about the finest points on how not to be a physician. The [DFO] CFL Beat returns next week in this same timeslot – I look forward to once again bringing you news about the best football that Canada has to offer!  – The Maestro