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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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The Sky Was No Limit: The WASP Women Pilots of WWII
Wikimedia Commons // Public Domain
Wikimedia Commons // Public Domain

Shirley Slade sat on the wing of a plane and looked off into an uncertain future. Slade—clad in her flight suit with pigtails guarding against Texas wind—was posing for the July 19, 1943 issue of Life magazine, and the composition between the aircraft and its operator was a juxtaposition spelled out in the cover headline: "Air Force Pilot."

Slade was one of more than 1000 women who had been solicited by the U.S. government to enter an intensive seven-month training course that would make them the first female pilots to enter the Air Force. What had been a boy's club was being forced into a kind of reluctant gender neutrality as a result of World War II and severe pilot shortages. By recruiting women, the Air Force could maintain delivery of aircraft, ferry supplies, and perform other non-combative functions that fueled the war efforts. Collectively, the group would become known as WASPs: Women Airforce Service Pilots.

While all of these women risked their lives—and more than a few lost them—they were not perceived as equals. Because they were designated as civilians, they were denied military honors and compensation. As the war wound down, men returning from combat jockeyed to take the WASPs' places as active-duty pilots. Occasionally, the women would be used in target practice. It would be decades before the women of WASP would finally get their due.

 
 

America's entry into World War II following the attack on Pearl Harbor heralded a new policy of rationing. Food, materials, and manpower were doled out carefully, but demand for pilots quickly exceeded the available personnel. By 1942, the Air Force realized they would have to tap into new sources in order to continue their campaign.

Jacqueline Cochran had a solution: A pilot in her own right and a contemporary of Amelia Earhart, Cochran knew there was a strong contingent of female fliers who had licenses and had logged air time who could be recruited for support missions. She petitioned the Air Force, including commanding general Henry Harley "Hap" Arnold, to approve a training program that would ultimately relocate volunteers to Avenger Field in Sweetwater, Texas. Another pilot, Nancy Harkness Love, submitted a similar proposal.

WASP pilot Elizabeth Remba Gardner looks out from her plane while on a Texas runway
WASP pilot Elizabeth Remba Gardner
Wikimedia Commons // Public Domain

Cochran and Love were up against considerable resistance to involving women in military efforts. General Dwight D. Eisenhower once admitted he was "violently against" the idea (before concluding that none of his concerns came to light and women were an integral part of the effort). Internally, there was concern as to whether women would even be capable of handling a massive aircraft like the B-29 bomber, so superiors hedged their bets by creating two organizations.

Love was put in charge of the Women's Auxiliary Ferrying Squadron (WAFS)—an organization to ferry planes—while Cochran was put in charge of the Women's Flying Training Detachment, which did whatever the Army Air Corps required of it. A little under a year later, these two groups were merged into a single organization: the WASPs. This new group demanded that incoming women logged at least 35 hours of flight time before coming to Sweetwater. More importantly, the women would be considered civilians, not military personnel.

Roughly 25,000 women applied; around 1900 were accepted and 1100 completed training. On their own dimes, these women streamed into Texas to begin the seven-month program that taught them every aspect of military flying except for gunnery duty and formation flying. Every day in the barracks included intensive lessons, physical fitness training, and studying. At night, the women would dance, sing, or play ping-pong. Life described their ambitions as "piloting with an unfeminine purpose" and noted that some of the women needed cushions in order to sit comfortably in planes designed for male bodies. Their mascot, a tiny winged sprite named Miss Fifinella, was designed by Disney, and the patch appeared on many of their jumpsuits and plane noses.

According to Life, the Air Force reported that the women were faster on instruments while the men "had better memory for details." But in virtually every way that counted, the magazine wrote, there was no practical difference in ability.

Graduates were dispatched to bases around the country, though the most pressing job was ferrying new aircraft from factories to places like Newark, New Jersey, where the planes would make the jump overseas. The women shuttled 12,000 of these planes during the war. They also escorted military chaplains from base to base on Sundays for religious services and operated test flights for repaired aircraft to make sure they were safe to fly in combat. Sometimes, they'd be tasked with towing targets behind them so soldiers could use live ammunition for combat practice.

Simulated combat may have been nerve-wracking, but it was no more dangerous than the actual flying and the very real possibility that the WASPs would experience equipment malfunction or fuel issues. In the two years the squad was active, 38 women perished during missions. At the time—and for decades afterward—the families of those women were denied many of the basic privileges afforded to the families of their male counterparts. When a WASP died, her colleagues—not the government—would pitch in to pay for her burial. Their families were prohibited from putting a gold star in their windows, a sign of a military casualty, nor were they "allowed" to drape the American flag over their coffins.

 
 

On December 20, 1944, the WASPs were sent home. The war wasn't yet over, but men returning from the front lines were dismayed that jobs they expected to find waiting for them were being occupied by women. Despite Cochran's petition to have the WASPs permanently incorporated into the Air Force, Congress turned her down.

WASP pilots are photographed circa 1943
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The pride the women had felt serving their country turned to confusion. By being classified as "civilians," the WASPs found little respect for their efforts. When entering the workforce after the war, some even became flight attendants, as no commercial airline would hire a female pilot.

In the 1970s, the Air Force announced they'd be accepting female recruits for the "first time," a proclamation that angered the surviving WASPs. Their efforts had largely gone unheralded, and now it seemed like the government was wiping them from history completely. Petitioning for recognition and receiving aid from fellow war ferry pilot Senator Barry Goldwater, they were finally granted military status on November 23, 1977.

As the WASPs aged, a handful got the chance to enjoy another honor. In 2010, the women were awarded the Congressional Gold Medal for their efforts. After flying 77 different types of planes over 60 million miles during wartime and being largely ignored for decades, it was recognition that was long overdue.

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The Bizarre Death of Bridget Cleary, the Irish "Fairy Wife"
The town of Tipperary, Ireland
The town of Tipperary, Ireland
Amergin, Flickr // CC BY-NC 2.0

The policemen had been combing the green yards and fields of Ballyvadlea, Ireland, for a week when they finally found Bridget Cleary. The 26-year-old's body had been wedged beneath several inches of clay and a jumble of thorn bushes, but her corpse showed wounds caused by something much worse than branches: Her spine and lower limbs were so badly burned that parts of her skeleton were exposed. She was naked, except for a stocking and one gold earring, and her head was encased in a sack.

The judge would later describe the events leading up to Bridget's death as demonstrating "a degree of darkness in the mind, not just of one person, but of several—a moral darkness, even religious darkness." It was the end of the 19th century, not exactly the Middle Ages, but those involved in the end of Bridget's life had become convinced that she wasn't really herself—and that a supernatural creature had taken her place.

GONE WITH THE FAIRIES

Bridget was the wife of a cooper named Michael Cleary, and the pair were regarded around town as a relatively happy couple. They shared their cottage, in a remote townland near Tipperary, with Bridget's father, Patrick Boland, and had no children. Michael was nine years Bridget's senior and earned a decent salary; she brought in some extra income by working as a seamstress and egg-seller. By all accounts, they were more prosperous than their neighbors, likely thanks to her resourcefulness. As a literate, independent, and fashionably dressed working woman, she was part of an emerging class in a rural society that had long been based in agriculture and the oral tradition.

It was also a society steeped in legends of the supernatural. Fairy belief, in particular, was pervasive in Irish rural societies at the time, and had long coexisted with Christian doctrine. Children grew up hearing legends of the Little People from their earliest days, and learned how to appease them by leaving untasted food on the table, for example, or saying "bless them" whenever the fairies were mentioned. The fairies were blamed for everything that went wrong—lost items, spoiled milk, bad crops. As one County Sligo man interviewed at the start of the 20th century told an anthropologist, "Nothing is more certain than that there are fairies."

Bridget herself was known to be fascinated by the beings, and to take trips to the most fairy-ridden spots around town. She may have visited such a spot on Monday, March 4, 1895, when she went to deliver eggs to her father's cousin, Jack Dunne, near Kylenagranagh Hill. The area was home to a ringfort, an early medieval circular fortified settlement believed, in Irish folklore, to be a "fairy fort," and thus to be avoided at all costs. Yet Bridget often visited the fort, and she likely spent time there that Monday after delivering the eggs.

It was a cold morning, the mountains still covered in the snow that had fallen the previous day, and after the two- or three-mile walk Bridget couldn't seem to warm up once she got back home. She spent the following day in bed, shivering and complaining of "a raging pain in her head."

That Saturday, her father walked four miles in the heavy rain to ask the doctor to call on her. But the doctor wasn't able to visit until the following Wednesday, and by then her husband had also gone to summon him twice. They should have been reassured by the doctor's diagnoses—"nervous excitement and slight bronchitis"—but it wasn't this ailment that worried Michael. He was convinced that the bed-ridden woman in their cottage was "too fine," in his own words, to be his wife, and that she was "two inches taller" than the woman he had known. At some point, Michael had developed the belief that Bridget had been replaced by a fairy changeling as she passed near the fairy fort on Kylenagranagh Hill.

"ARE YOU BRIDGET BOLAND?"

It is likely that this idea was planted in Michael's head by his confidante, Jack Dunne. According to Irish historian Angela Bourke, who has researched the case extensively, the 55-year-old Dunne was a charismatic man rumored to have the power of divination. He was known in the area as a seanchaí, a sort of storyteller well-versed in fairy mythology.

On Wednesday afternoon, after the doctor's visit, a priest visited. He wasn't overly concerned about the illness, but decided to administer the last rites in case it worsened. The ceremony emphasized the fact that Michael could lose his wife, which distressed him even more. He talked to Dunne, who urged him to act immediately, or the "real" Bridget would be lost forever. "It is not your wife is there [sic]," the older man reminded him. "This is the eighth day, and you had a right to have gone to Ganey"—the local "fairy doctor"—"on the fifth day."

The cooper duly visited Ganey following morning. He came back with a mixture of herbs that needed to be boiled in "new milk," the nutrient-rich first milk produced by a cow after calving.

That night, Michael forced the bitter concoction down Bridget’s throat while Dunne and three male cousins pinned her down in bed. Relatives outside the house heard someone—likely Michael—shouting, "Take it, you witch, or I'll kill you!" The men threw urine at her and shook her, yelling, "Away with you; come home Bridget Boland, in the name of God!" Other relatives and neighbors came and went, witnessing her ordeal and hearing her screams, but were too scared to intervene. Michael asked his wife to answer her name three times: "Are you Bridget Boland, wife of Michael Cleary, in the name of God?" The men then brought her to the fireplace and held her over the grate—ordeals by fire were known to drive out the fairies—while they repeated the questioning.

By midnight Thursday night, the ritual seemed to be completed. Bridget was "wild and deranged," according to her cousin Johanna, but her husband seemed satisfied, and her relatives thought there had been some sort of catharsis. The following morning, at Michael's request, the priest said mass in Bridget's bedroom in order to banish the "evil spirits" that were left in the house.

"IT IS NOT BRIDGET I AM BURNING."

An image of fairies from fairies from "The Poetical Works of Percy Bysshe Shelley"
Fairies from "The Poetical Works of Percy Bysshe Shelley"
British Library, Europeana // Public Domain

On Friday, March 15, for the first time in 11 days, Bridget got out of bed and dressed in her usual, fashionable clothes "to give her courage when she would go among the people," as Johanna later told the magistrates. Several family members had joined them in their cottage for tea later in the day when an argument erupted. Bridget had asked for some milk, which had rekindled Michael’s suspicions; fairies are known in folklore to yearn for fresh milk.

Bridget was probably exhausted, and she didn't want to be questioned any more. "Your mother used to go with the fairies and that is why you think I am going with them," she told her husband. Michael was furious. He demanded that she eat three pieces of bread and jam—perhaps to reinforce his control over her—asking her to say her name again. She answered twice and ate two of the three pieces, but when she hesitated for a moment with the third, her husband flung her on the ground and threatened her: "If you won't take it, down you will go."

Michael jabbed his knee into her chest, forcing the bread and jam down Bridget's throat. He began tearing off her clothes, leaving only her chemise, then grabbed a hot stick from the fire and held it close to her mouth. He struck her head against the floor, then set her chemise alight. Within a few minutes, he had also poured paraffin lamp oil over her, encouraging the flames.

As her body was burning, Michael said in front of shocked relatives: "She's not my wife. She's an old deceiver sent in place of my wife." Relatives yelled at Michael to put out the flames, but Bridget "blazed up all in a minute," according to their later testimony. They huddled in fear in a nearby bedroom, the flames soon barricading their way.

Once the flames had died down, Michael wrapped her body in a sheet and shoved it in an old bag. Then he left the house, locking Bridget's relatives inside with the corpse. They waited for about an hour, praying. When Michael returned, he was wielding a knife and threatened to kill Bridget's cousin Patrick Kennedy if he didn't help him bury Bridget's body. "Come on out here now," he shouted. "I have the hole nearly made." The two men carried the body to a boggy area about a quarter-mile uphill from the cottage, and buried it in a shallow hole. Back in the cottage, Michael made the rest of the family swear they wouldn't tell the authorities.

ON A WHITE HORSE

The following morning, an agitated Michael arrived at Drangan church with Dunne. Dunne wanted Michael to speak to a priest, but when the priest saw him kneeling in front of the altar—weeping, tearing his hair, and asking to go to confession—he thought he wasn't fit to receive the sacrament. He spoke to Dunne instead, who hadn't been at the cottage at the time of Bridget's death, but told the priest that Michael had claimed to have burned his wife the previous night. "I've been asking them all morning to take her up and give her a Christian burial," Dunne added. Bewildered, thinking them both insane, the church minister reported their conversation to a police sergeant.

For the next few days, the police searched for Bridget and questioned her friends and relatives. Even though Michael spoke about emigrating or committing suicide to escape the law, he still hoped his "real wife" would come back: For three consecutive nights starting the day after visiting the priest, he waited at the ringfort on Kylenagranagh Hill, where he believed she would appear, galloping on a white horse. He said he would only have to cut the ropes that bound her to the animal so she would be his forever.

On Wednesday, March 20, the Royal Irish Constables issued arrest warrants for eight people from Bridget's circle, as well as Denis Ganey, the "fairy doctor." Two days later, police found Bridget's body. The prisoners were brought before the magistrates on March 25, ushered in by the angry screams of a crowd who had learned of the case through extensive press coverage. On July 5, 1895, after a two-day trial, Michael was found guilty of manslaughter and imprisoned, along with Jack Dunne, Patrick Boland, and four of Bridget’s cousins, including Patrick Kennedy. The judge ruled out a verdict of murder, explaining they all had acted out of genuine belief.

Michael was released in 1910, after which he boarded ship for Montreal. Dunne served a three-year prison sentence before returning to the area, where he kept working as a laborer. "God knows I would never do it but for Jack Dunne," Michael had reportedly said not long after burning Bridget. "It was he who told me my wife was a fairy."

ILLNESS—OR INFIDELITY?

During her illness, Bridget was visited by her aunt, Mary Kennedy, and told her, "He [Michael]'s making a fairy of me now. He thought to burn me about three months ago." Her words suggest this wasn't the first crisis of its kind.

Although we can only speculate about the couple's disagreements, there were rumors in Ballyvadlea that Bridget had a lover. Contemporary newspapers reported Michael saying his wife "used to be meeting an egg-man on the low road" [sic], but the rumors pointed to young caretaker William Simpson, who had visited the Clearys' cottage with his wife the night before Bridget’s death. In his court testimony, Simpson explained he had arrived as the four men were restraining Bridget, and he had asked them to leave her alone.

Although Michael and the other people involved in the killing were never formally psychiatrically assessed, a 2006 article from the Irish Journal of Medical Science suggested that Michael may have been suffering from a psychotic state known as Capgras syndrome, which involves the belief that a person has been replaced by an impostor. The authors suggest Michael "may have developed a brief psychotic episode" as he struggled to deal with his wife's illness, sleep deprivation, and the recent death of his father—news of which had reached him in the middle of his attempted "cure" on Thursday night. In Capgras syndrome, the socio-cultural context of the sufferer determines the nature of the impostor, which can be another person or even a supernatural being, such as an alien or a fairy changeling.

In her discussion of the supernatural beliefs related to the case, Bourke notes that the message of fairy legends is that "the unexpected may be guarded against by careful observance of society's rules." Bridget Cleary was ambitious, independent, and childless; a modern woman. She didn't conform to the patriarchal norm, which may have made her appear, to some in her life, as closer to the fairy realm than to their own.

Even today in Tipperary, her story hasn't been entirely forgotten. The local children have a nursery rhyme that runs: "Are you a witch or are you a fairy, / Or are you the wife of Michael Cleary?"

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