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Trepanation: The History of One of the World's Oldest Surgeries

During the 1860s, a United States diplomat named E.G. Squier traveled to Cuzco, Peru. While visiting the home of a wealthy woman who collected antiquities, he was shown an ancient skull. Discovered in an ancient Inca cemetery in the Valley of Yuca, the skull dated to pre-Columbian times and had a large, rectangle-shaped hole near its top front.

Squier—a well-educated polymath whose areas of expertise also included archaeology and Latin American culture—was immediately intrigued. So in 1865, Squier brought the skull to New York, where he presented it to members of the New York Academy of Medicine.

Squier believed that the skull was clear evidence that Peru’s ancient people had performed prehistoric brain surgery. The hole’s cross-hatched outlines were the work of a human hand; Squier noted that they were most likely made with a burin, a tool used by engravers on wood and metal. Even more shockingly, he observed, the skull showed signs of healing—meaning the patient had survived the procedure for at least one to two weeks before they died.

Members of the medical community were skeptical, and didn't believe that the cuts were made prior to death. So Squier sought the opinion of renowned French surgeon and anthropologist Paul Broca. In turn, Broca looked at the skull, and concluded that early indigenous societies had been performing “advanced surgery” long before Europeans arrived.

The practice of drilling or scraping a hole into the skull’s cranial vault to expose the brain’s dura mater and treat brain injuries is called trepanation. First mentioned by the Hippocratic corpus, it’s one of the world’s oldest surgeries. (In fact, the word trepanation comes from Greek, and means “auger” or “borer.”) Today, the medical community would refer to it as a craniotomy.

Throughout history, trepanation has been practiced in nearly every part of the world. It was performed in ancient Greece and Rome, and is today even reportedly used in parts of Africa, South America, and the South Pacific. In ancient Greece, it was used to relieve pressure, remove skull fragments from the brain after a traumatic accident, and for drainage. From the Renaissance until the beginning of the 19th century, trepanation was routinely used to treat head wounds, and into the 18th century, it was used to treat epilepsy and mental disorders.

The Victorian physicians of Squier and Broca's time had never considered that “primitive” cultures throughout history may have attempted the procedure. Also, since survival rates from the surgery were so poor due to hospital-acquired infections, they doubted that ancient patients could have lived for long following the operation.

After Broca acknowledged Squier’s find, scientists began discovering trepanned skulls across the globe, dating back to the Neolithic period. Hole-filled heads were discovered in Western Europe, South America, and the Americas. Over the years, it became clear that trepanation was attempted by many societies across the globe, starting in the late Paleolithic period.

Techniques varied from culture to culture. Prehistoric trepanations performed in early Peru were done with a ceremonial knife called a tumi, which was used to scrape or cut through the bone. The Hippocratic school invented the trephine drill, which bored holes into the skull. In the South Pacific, they sometimes used sharpened seashells; in Europe, flint and obsidian. By the Renaissance period, trepanation was routinely performed, and a range of instruments had been developed. However, due to the high infection rate, the practice soon waned.

Trepanation was performed on young and old, male and female. In many instances, the prehistoric patients had lived for years after the surgery. According to writings by Charles Gross, a professor of neuroscience at Princeton University, estimates for survival range from 50 to 90 percent. However, in many cases, the surgeon's motive for performing trepanation remains unclear.

John Verano, a professor of anthropology at Tulane University who studies trepanation in Peru, tells mental_floss he's convinced that “in Peru, the South Pacific, and many other parts of the world, trepanation began as a very practical treatment for head injuries. Say somebody has a head wound that’s torn up their skull. You’d clean it out and remove little broken fragments and allow the brain to swell a little bit, which it does after injuries.”

In some instances, trepanned skulls show clear evidence of trauma—meaning there must have been an underlying reason why the procedure was performed. However, archaeologists have also uncovered trepanned skulls that don’t show depressed fractures. Squier's famous skull, for instance, didn't indicate any signs of a head wound. Skulls with multiple holes have also been unearthed, revealing that patients sometimes had—and survived—more than one surgery.

According to Verano, modern eyewitness accounts from Africa and the South Pacific state that trepanation is still used to treat head wounds, headaches, or pressure on the brain. In other parts of the world, it’s thought that trepanation might have once been used to release evil spirits, or to treat insanity or epilepsy. But without any written record, we’ll never quite know why these kinds of surgeries were performed in the absence of obvious injury.

Individuals who underwent trepanation weren't administered anesthesia. Did the procedure hurt?

As Verano points out, they might have likely been unconscious during the surgery if they had suffered a head wound. Otherwise, they would have been awake. “The scalp has a lot of nerves, so it hurts to cut your scalp,” Verano says. “It also bleeds a lot, but then it stops. But the skull has very few nerves, and the brain has no nerves.” But Verano also points out that ancient trepanners weren’t cutting through the brain’s dura mater. (If they did, the patient would have gotten meningitis and died.) 

In today’s modern Western hospital, trepanation is no longer viewed as its own curative procedure. It’s used to debride a wound (remove dead or infected tissue), relieve pressure in the skull, or perform exploratory surgery. However, it’s fascinating to realize that the surgery survived many millennia—and that as early as prehistoric times, humans were already connecting the brain’s functioning to the body. We can only wonder what people of the future will think of our own modern brain surgeries

Additional Sources: A Hole in the HeadTrepanation (Studies on Neuropsychology, Development, and Cognition)

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Getty Images (Johnson) / iStock (ghosts)
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History
When Lexicographer Samuel Johnson Became a Ghostbuster
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Getty Images (Johnson) / iStock (ghosts)

Dr. Samuel Johnson is today best known for his Dictionary of the English Language (1755), which remained the foremost authority on the English language until the Oxford English Dictionary appeared more than a century later. The dictionary took Johnson nine years to complete, for which he was paid the princely sum of 1500 guineas—equivalent to $300,000 (or £210,000) today. Although it wasn’t quite the commercial success its publishers hoped it would be, it allowed Johnson the freedom to explore his own interests and endeavors: He spent several years editing and annotating his own editions of all of Shakespeare’s plays, and traveled extensively around Britain with his friend (and eventual biographer) James Boswell—and, in 1762, helped to investigate a haunted house.

Johnson—who was born on this day in 1709 and is the subject of today's Google Doodle—had a lifelong interest in the paranormal, once commenting that he thought it was “wonderful” that it was still “undecided whether or not there has ever been an instance of the spirit of any person appearing after death. All argument is against it, but all belief is for it.” According to Boswell, however, he was more of a skeptic than an out-and-out believer, and refused to accept anything without seeing the evidence for himself. So when the news broke of an apparently haunted house just a few streets away from his own home in central London, Johnson jumped at the chance to perhaps see a ghost with his own eyes.

The haunting began in the early 1760s, when a young couple, William and Fanny Kent, began renting a room from a local landlord, Richard (or William—sources disagree, but for clarity, we'll use Richard) Parsons, at 25 Cock Lane in Smithfield, London. Soon after the Kents moved in, Richard’s daughter, Betty, began to hear strange knocking and scratching sounds all around the house, and eventually claimed to have seen a ghost in her bedroom.

Richard soon discovered that William was a widower and that Fanny was in fact his deceased wife's sister; under canon law, the pair couldn't be married, and Richard became convinced that the ghost must be that of William's deceased first wife, Elizabeth, blaming William’s presence in the house for all of the strange occurrences. He promptly evicted the Kents and the noises soon subsided—but when Fanny also died just a few weeks later, they immediately resumed and again seemed to center around Betty. In desperation, a series of séances were held at the Cock Lane house, and finally Fanny’s ghost supposedly confirmed her presence by knocking on the table. When questioned, Fanny claimed that William had killed her by poisoning her food with arsenic—an accusation William understandably denied.

By now, news of the Cock Lane Ghost had spread all across the city, and when the story broke in the press, dozens of curious Londoners began turning up at the house, queuing for hours outside in the street hoping to see any sign of supernatural activity. According to some accounts, Parsons even charged visitors to come in and “talk” to the ghost, who would communicate with knocks and other disembodied noises.

But with the suspicion of murder now in the air, the Cock Lane haunting changed from a local curiosity into a full-blown criminal investigation. A committee was formed to examine the case, and Johnson was brought in to record their findings and investigate the case for himself.

On February 1, 1762, one final séance was held with all members of the committee—Johnson included—in attendance. He recorded that:

About 10 at night the gentlemen met in the chamber in which the girl [Betty] supposed to be disturbed by a spirit had, with proper caution, been put to bed by several ladies. They sat rather more than an hour, and hearing nothing, went down stairs, when they interrogated the father of the girl, who denied, in the strongest terms, any knowledge or belief of fraud … While they were enquiring and deliberating, they were summoned into the girl’s chamber by some ladies who were near her bed, and who had heard knocks and scratches. When the gentlemen entered, the girl declared that she felt the spirit like a mouse upon her back.

But the committee were suspicious. Betty was asked to hold out her hands in front of her, in sight of everyone in the room:

From that time—though the spirit was very solemnly required to manifest its existence by appearance, by impression on the hand or body of any present, by scratches, knocks, or any other agency—no evidence of any preternatural power was exhibited.

Johnson ultimately concluded that it was “the opinion of the whole assembly that the child has some art of making or counterfeiting a particular noise, and that there is no agency of any higher cause.” And he was right.

As the investigation continued, it was eventually discovered that Richard Parsons had earlier borrowed a considerable amount of money from William Kent that he had no means (nor apparently any intention) of repaying. The two men had a falling out, and Parsons set about elaborately framing Kent for both Fanny and Elizabeth's deaths. The ghostly scratching and knocking noises had all been Betty’s work; she hidden a small wooden board into the hem of her clothing with which to tap or scratch on the walls or furniture when prompted.

The Parsons—along with a servant and a preacher, who were also in on the scam—were all prosecuted, and Richard was sentenced to two years in prison.

Although the Cock Lane haunting turned out to be a hoax, Johnson remained open minded about the supernatural. “If a form should appear,” he later told Boswell, “and a voice tell me that a particular man had died at a particular place, and a particular hour, a fact which I had no apprehension of, nor any means of knowing, and this fact, with all its circumstances, should afterwards be unquestionably proved, I should, in that case, be persuaded that I had supernatural intelligence imparted to me.”

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The King of Kong © Jim Naughten. Courtesy of Michael Hoppen Gallery
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geography
The Mountains of Kong: The Majestic West African Range That Never Existed
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The King of Kong © Jim Naughten. Courtesy of Michael Hoppen Gallery

If you look closely at a 19th century map of Africa, you’ll notice one major way that it differs from contemporary maps, one that has nothing to do with changing political or cartographical styles. More likely than not, it features a mountain range that no longer appears on modern maps, as WIRED explains. Because it never existed in the first place.

A 19th century map of West Africa
From Milner's Descriptive Atlas, 1850

The “Mountains of Kong” appeared on almost every major commercial map of Africa in the 1800s, stretching across the western part of the continent between the Gulf of Guinea and the Niger River. This mythical east-west mountain range is now the subject of an art exhibition at London’s Michael Hoppen Gallery.

In "Mountains of Kong," stereoscopic images by artist Jim Naughten—the same format that allowed Victorians with wanderlust to feel like they’d seen the world—reveal his view of the world of wildlife that might have existed inside the imagined mountains. As the gallery describes it, “he imagines a fictitious record made for posterity and scientific purposes during an expedition of the mountain range.” We’ve reproduced the images here, but to get the full effect, you’ll have to go to the gallery in person, where you can view them in 3D with a stereoscope (like the ones you no doubt played with as a kid).

Toucans fight a snake in two almost-identical side-by-side images.
The Toucans © Jim Naughten. Courtesy of Michael Hoppen Gallery

Naughten created the images by taking two photographs for each, and moving the camera over some 3 inches for the second photo to make a stereoscopic scene. The landscapes were created by shooting images of Scottish and Welsh mountains and dioramas in natural history museums, using Photoshop to change the hues of the images to make them seem more otherworldly. His blue-and-pink-hued images depict fearsome apes, toucans sparring with snakes, jagged peaks, and other scenes that seem both plausible and fantastical at the same time.

The Mountains of Kong appeared in several hundred maps up until the 20th century. The first, in 1798, was created by the prominent geographer James Rennell to accompany a book by Scottish explorer Mungo Park about his first journey to West Africa. In it, Park recounts gazing on a distant range, and “people informed me, that these mountains were situated in a large and powerful kingdom called Kong.” Rennell, in turn, took this brief observation and, based on his own theories about the course of the Niger River, drew a map showing the mountain range that he thought was the source of the river. Even explorers who later spent time in the area believed the mountains existed—with some even claiming that they crossed them.

Two colobuses stand in a tree on a mountaintop.
The Colobus © Jim Naughten. Courtesy of Michael Hoppen Gallery

The authority of the maps wasn’t questioned, even by those who had been to the actual territory where they were depicted as standing. Writers began to describe them as “lofty,” “barren,” and “snow-covered.” Some said they were rugged granite peaks; others described them as limestone terraces. In almost all cases, they were described as “blue.” Their elevation ranged from 2500 feet to 14,000 feet, depending on the source. Over the course of the 19th century, “there was a general southward ‘drift’ in the location,” as one pair of scholars put it.

Though geographers cast some doubt on the range’s existence as time went on, the Mountains of Kong continued to appear on maps until French explorer Louis-Gustave Binger’s Niger River expedition between 1887 and 1889, after which Binger definitively declared their nonexistence.

By 1891, the Mountains of Kong began dropping off of maps, though the name Kong still appeared as the name of the region. By the early 20th century, the mountains were gone for good, fading into the forgotten annals of cartographic history.

[h/t WIRED]

All images courtesy Michael Hoppen Gallery.

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