By Dr Bob Weston
Trepanning Dummy held in the St Bartholomew Hospital Museum and Archive
Trepanning is one of the oldest known surgical procedures, dating back to at least the Neolithic period. Trepanning was the process of drilling, cutting or a scraping a hole in the skull to relieve pressure, or in ancient times to allow the evil spirits or vapours of the mentally ill to escape. Evidence of this practice has been recovered from all corners of the world, and fragments removed from skulls in this way were also used as amulets to ward off disease.
Trepanning was also possibly used for religious purposes, and in Graeco-Roman times, was employed in cases of epilepsy. Hippocrates mentions the use of trepanning in his ‘On Injuries to the Head’, where it was outlined as a procedure to allow a surgeon to lift bone on the skull which had been depressed through injury .
In some cases multiple holes were drilled, as shown on the skull in Image 1, which dates from 2200–2000 BC, and was excavated from a tomb in Jericho in January 1958. This skull shows four separate holes made by trephination which had begun to heal, suggesting that this highly dangerous procedure was by no means fatal.
The 3-D model you see above is a true-to-life digital replica of a wooden dummy in the shape of a head, currently displayed at the St Bartholomew Hospital Museum and Archive. This object, approximately life-sized, is believed to have been used to demonstrate the procedure of trepanning circa 1800–50, and is therefore possibly a teaching aid.
The institution of St. Bartholomew’s Hospital dates back to the twelfth century, and we know that the procedure of trepanning was carried out at St Bart’s from an October 1653 record, when the Governors declared: ‘No surgeon or his man is to trepan the head … but with the approbation and by the direction of the Doctor’ . It is likely that this edict was maintained to the time of the model’s introduction to the hospital.
In pre-historic times trepanning was probably achieved with a flint or obsidian knife. By the middle ages the tools used resembled those used by carpenters when the procedure was performed by surgeons. Certainly by the sixteenth century a version had been devised which looks like a brace and bit, with interchangeable parts.
Surgery was taught at St Bartholomew’s since at least 1843, yet provision of a model on which to practice the art of trepanning is rare and is not referred to in medieval or early modern surgical treatises. It is probable that apprentice surgeons normally used the skulls of cadavers for this purpose.
A range of tools such as those below were employed in the procedure:
In addition to physical pain, patients must surely have been under considerable emotional distress when undergoing this operation, bearing in mind that there were no anaesthetics available before the mid-nineteenth century. He or she may have been given wine, or a soporific such or laudanum (an opiate) to dull the senses, and infection was another cause of concern which could prove fatal . A final complication, according to the Persian physician Avicenna (c.980—1037), was the risk of apoplexy if the dura mater had been compressed or punctured . All of these risks must have caused significant anxiety and apprehension among practitioners and patients contemplating the prospect of the procedure.
It is unlikely that students who were shown the model as a teaching aid in the nineteenth century would have had a strong emotional reaction to it. This was a time when St Bart’s students regularly acted as assistants in actual operations and were exposed to far more emotionally charged sights. However the neutral facial expression on the dummy may have been a deliberate strategy – the blank eyes echo illustrations of the unexpressive faces in medical treatises such as this, perhaps drawn this way to mask the pain experienced by patients:
At some point in the dummy’s history, it acquired an incredibly battered and scuffed appearance beyond what would be associated with normal wear and tear. This suggests that the dummy may have been kicked around or, due to its semi-rounded shape, brought joy to the staff of the hospital in games of football!
This seemingly careless approach to the inanimate model contrasts with emotional responses of visitors to the museum today. Many have reported feeling unsettled by the dummy’s features and the terrifying medical procedure that it represents.
When you view the dummy in full 3-D rotation, how does it make you feel? Tell us in the comments below.
About the author
Dr Robert Weston is an Honorary Research Fellow at the University of Western Australia. His interests are focussed on early modern European medical history.
1. Hippocrates, Classics Archive. http://classics.mit.edu//Hippocrates/headinjur.html (accessed 26/10/2016).
2. Norman Moore, The History of St. Bartholomew’s Hospital 2 Vols. (London, 1918) 2, 497.
3. Jeremy C. Ganz, ‘Trepanation and surgical infection in the 18th century’, Acta Neurochir, 2014, 156 (3): 615–23.
4. Mohammad Ghannaee Arani et al., ‘Ibn Siba’s (Avicenna) Contributions to the Treatment of Traumatic Injuries’, Trauma Monthly, 2012, 17 (2): 303.