Trepanning is one of the oldest recorded surgical procedures and has been documented world wide. Although trepanning was used over many time periods, the procedure was first used in the Stone Age. Researchers have found evidence of trepanation used in North America, South America, Africa, and Europe (Missios, 2007).

Trepanation in North America:
-Gradual scraping of the skull in small circles was the most common used technique. Many North American Indian tribes, including Kwatkiutl and Pueblo Indians, used techinques very similar to trepanation to treat the mentally ill (Arnott, Finger, & Smith, 2003).

Trepanation in South America:
– Trepanned skulls have been found in Peru and Bolivia and have been said to have up to seven holes (Clower & Finger, 2001).

Trepanation in Africa:
– Trepanation was most common in countries such as Kenya and Tanganyika for headaches and seizures (Clower & Finger, 2001).

Trepanation in Europe:
– Skulls were found in France by Paul Broca and other researchers. It was noted that inside and near the skulls were pieces of skulls suggesting that the patients wore or carried around the fragments as charms (Clower & Finger, 2001).
At first researchers thought that the holes found in ancient skulls were from weapons or accidental breakage. After observing the similiarities in the holes, scientists began to attribute the holes to trepanation (Clower & Finger, 2001). Trepanation was used for every condition from headaches to insanity and eplipsy (Kidd, 1946).

How was Trepanation performed?
During the Stone Age, doctors used sharpened stones to scrape the skull and drill holes into the head of the patient. Over the years, wooden trepans and then metal trepans were used in addition to stones (Missios, 2007). Circular or rectangular holes would be cut by drills such as the one pictured to the left. The procedure was performed on men, women, and children, but predominantly on males.


Influence of Trepanation
Neurosurgeons, neurologists, psychologists, and anthropologists have all been interested in trepanation. Most importantly, it was Paul Broca who studied trepanation and created his own theory on the procedure (Clower & Finger, 2001).

Ephraim George Squier was the first to introduce the discovery of trepanation to Paul Broca. When researching in Peru, Squier found a skull that had obvious holes drilled into it. He took the skull to Broca hoping that he could create some conclusion for this incomplete skull. Broca noticed that there were no fractures or unusual cracks around the hole, therefore he noted that the Peruvian culture had performed advanced surgeries before Europe (Clower & Finger, 2001).
From Broca’s research he developed a theory on the process of trepanation. He proposed:
“1.) We practiced in the Neolithic epoch a surgical operation that consisted of opening the cranium to treat certain internal diseases…2.) The crania of the individuals who survived this trepanation were considered to enjoy particular properties of a mystical order, and when these individuals died we often cut out from their cranial walls the ovals which served as amulets” (Clower & Finger, 2001).
In this he wanted to prove that trepanation was done intentionally by human hands and was not a cause of “aggressive blow”. If aggressive blow were the case then Broca believed that the majority of skulls would have been male and more holes would have been on the left side of the skull and on the front side. Broca also points out the importance of the fragments found near the skulls. He believed that since the hole released the evil spirits within the head, then the fragment removed resembled good luck that protected the individual and their family from the evil that the individual was able to escape (Clower & Finger, 2001).
Broca’s theory on trepanation was the true beginning of putting together reasoning behind this treatment in the Stone Age. Because of his work, other anthropologists and psychogists began to question and criticize his findings. Broca was able to show how people in the Stone Age were able to successfully perform advanced, invasive surgeries.


Arnott, R., Finger, S., & Smith, C. (2003). Pre-Columbian skull trepanation in North America. In R. Arnott, S. Finger, & C. Smith (Eds.) Trepanation: History, Discovery, Theory, (pp. 240-244). The Netherlands: Swets & Zeitlinger Publishers.

Clower, W. T., & Finger, S. (2001) Discovering trepanation: The Contribution of Paul Broca. Neurosurgery, 49, 1417- 1425.

Durand, V. M., & Barlow, D. H. (2005). Introduction to abnormal psychology and the DSM-IV-TR. In M. Taflinger (Ed.) Essentials of Abnormal Psychology Fourth Edition (pp. 1-15). Belmont, CA, US: Wadsworth Publishing.

Ellydean123 (2008, August 28). The History of Mental Illness: A MontFort College Documentary [Video File]. Retrieved from:

Kidd, G. E. (1946). Trepanation amount the early Indians of British Columbia. Men and Books 55, 513- 516.

Missios, S. (2007) Hippocrates, Galen, and the uses of trepanation in the ancient classical world. Neurosurgical Focus, 23, 1-9.

Page created by: Taylor Warner

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