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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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iStock // Ekaterina Minaeva
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Man Buys Two Metric Tons of LEGO Bricks; Sorts Them Via Machine Learning
May 21, 2017
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iStock // Ekaterina Minaeva

Jacques Mattheij made a small, but awesome, mistake. He went on eBay one evening and bid on a bunch of bulk LEGO brick auctions, then went to sleep. Upon waking, he discovered that he was the high bidder on many, and was now the proud owner of two tons of LEGO bricks. (This is about 4400 pounds.) He wrote, "[L]esson 1: if you win almost all bids you are bidding too high."

Mattheij had noticed that bulk, unsorted bricks sell for something like €10/kilogram, whereas sets are roughly €40/kg and rare parts go for up to €100/kg. Much of the value of the bricks is in their sorting. If he could reduce the entropy of these bins of unsorted bricks, he could make a tidy profit. While many people do this work by hand, the problem is enormous—just the kind of challenge for a computer. Mattheij writes:

There are 38000+ shapes and there are 100+ possible shades of color (you can roughly tell how old someone is by asking them what lego colors they remember from their youth).

In the following months, Mattheij built a proof-of-concept sorting system using, of course, LEGO. He broke the problem down into a series of sub-problems (including "feeding LEGO reliably from a hopper is surprisingly hard," one of those facts of nature that will stymie even the best system design). After tinkering with the prototype at length, he expanded the system to a surprisingly complex system of conveyer belts (powered by a home treadmill), various pieces of cabinetry, and "copious quantities of crazy glue."

Here's a video showing the current system running at low speed:

The key part of the system was running the bricks past a camera paired with a computer running a neural net-based image classifier. That allows the computer (when sufficiently trained on brick images) to recognize bricks and thus categorize them by color, shape, or other parameters. Remember that as bricks pass by, they can be in any orientation, can be dirty, can even be stuck to other pieces. So having a flexible software system is key to recognizing—in a fraction of a second—what a given brick is, in order to sort it out. When a match is found, a jet of compressed air pops the piece off the conveyer belt and into a waiting bin.

After much experimentation, Mattheij rewrote the software (several times in fact) to accomplish a variety of basic tasks. At its core, the system takes images from a webcam and feeds them to a neural network to do the classification. Of course, the neural net needs to be "trained" by showing it lots of images, and telling it what those images represent. Mattheij's breakthrough was allowing the machine to effectively train itself, with guidance: Running pieces through allows the system to take its own photos, make a guess, and build on that guess. As long as Mattheij corrects the incorrect guesses, he ends up with a decent (and self-reinforcing) corpus of training data. As the machine continues running, it can rack up more training, allowing it to recognize a broad variety of pieces on the fly.

Here's another video, focusing on how the pieces move on conveyer belts (running at slow speed so puny humans can follow). You can also see the air jets in action:

In an email interview, Mattheij told Mental Floss that the system currently sorts LEGO bricks into more than 50 categories. It can also be run in a color-sorting mode to bin the parts across 12 color groups. (Thus at present you'd likely do a two-pass sort on the bricks: once for shape, then a separate pass for color.) He continues to refine the system, with a focus on making its recognition abilities faster. At some point down the line, he plans to make the software portion open source. You're on your own as far as building conveyer belts, bins, and so forth.

Check out Mattheij's writeup in two parts for more information. It starts with an overview of the story, followed up with a deep dive on the software. He's also tweeting about the project (among other things). And if you look around a bit, you'll find bulk LEGO brick auctions online—it's definitely a thing!

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8 Common Dog Behaviors, Decoded
May 25, 2017
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Dogs are a lot more complicated than we give them credit for. As a result, sometimes things get lost in translation. We’ve yet to invent a dog-to-English translator, but there are certain behaviors you can learn to read in order to better understand what your dog is trying to tell you. The more tuned-in you are to your dog’s emotions, the better you’ll be able to respond—whether that means giving her some space or welcoming a wet, slobbery kiss. 

1. What you’ll see: Your dog is standing with his legs and body relaxed and tail low. His ears are up, but not pointed forward. His mouth is slightly open, he’s panting lightly, and his tongue is loose. His eyes? Soft or maybe slightly squinty from getting his smile on.

What it means: “Hey there, friend!” Your pup is in a calm, relaxed state. He’s open to mingling, which means you can feel comfortable letting friends say hi.

2. What you’ll see: Your dog is standing with her body leaning forward. Her ears are erect and angled forward—or have at least perked up if they’re floppy—and her mouth is closed. Her tail might be sticking out horizontally or sticking straight up and wagging slightly.

What it means: “Hark! Who goes there?!” Something caught your pup’s attention and now she’s on high alert, trying to discern whether or not the person, animal, or situation is a threat. She’ll likely stay on guard until she feels safe or becomes distracted.

3. What you’ll see: Your dog is standing, leaning slightly forward. His body and legs are tense, and his hackles—those hairs along his back and neck—are raised. His tail is stiff and twitching, not swooping playfully. His mouth is open, teeth are exposed, and he may be snarling, snapping, or barking excessively.

What it means: “Don’t mess with me!” This dog is asserting his social dominance and letting others know that he might attack if they don’t defer accordingly. A dog in this stance could be either offensively aggressive or defensively aggressive. If you encounter a dog in this state, play it safe and back away slowly without making eye contact.

4. What you’ll see: As another dog approaches, your dog lies down on his back with his tail tucked in between his legs. His paws are tucked in too, his ears are flat, and he isn’t making direct eye contact with the other dog standing over him.

What it means: “I come in peace!” Your pooch is displaying signs of submission to a more dominant dog, conveying total surrender to avoid physical confrontation. Other, less obvious, signs of submission include ears that are flattened back against the head, an avoidance of eye contact, a tongue flick, and bared teeth. Yup—a dog might bare his teeth while still being submissive, but they’ll likely be clenched together, the lips opened horizontally rather than curled up to show the front canines. A submissive dog will also slink backward or inward rather than forward, which would indicate more aggressive behavior.

5. What you’ll see: Your dog is crouching with her back hunched, tail tucked, and the corner of her mouth pulled back with lips slightly curled. Her shoulders, or hackles, are raised and her ears are flattened. She’s avoiding eye contact.

What it means: “I’m scared, but will fight you if I have to.” This dog’s fight or flight instincts have been activated. It’s best to keep your distance from a dog in this emotional state because she could attack if she feels cornered.

6. What you’ll see: You’re staring at your dog, holding eye contact. Your dog looks away from you, tentatively looks back, then looks away again. After some time, he licks his chops and yawns.

What it means: “I don’t know what’s going on and it’s weirding me out.” Your dog doesn’t know what to make of the situation, but rather than nipping or barking, he’ll stick to behaviors he knows are OK, like yawning, licking his chops, or shaking as if he’s wet. You’ll want to intervene by removing whatever it is causing him discomfort—such as an overly grabby child—and giving him some space to relax.

7. What you’ll see: Your dog has her front paws bent and lowered onto the ground with her rear in the air. Her body is relaxed, loose, and wiggly, and her tail is up and wagging from side to side. She might also let out a high-pitched or impatient bark.

What it means: “What’s the hold up? Let’s play!” This classic stance, known to dog trainers and behaviorists as “the play bow,” is a sign she’s ready to let the good times roll. Get ready for a round of fetch or tug of war, or for a good long outing at the dog park.

8. What you’ll see: You’ve just gotten home from work and your dog rushes over. He can’t stop wiggling his backside, and he may even lower himself into a giant stretch, like he’s doing yoga.

What it means: “OhmygoshImsohappytoseeyou I love you so much you’re my best friend foreverandeverandever!!!!” This one’s easy: Your pup is overjoyed his BFF is back. That big stretch is something dogs don’t pull out for just anyone; they save that for the people they truly love. Show him you feel the same way with a good belly rub and a handful of his favorite treats.

The best way to say “I love you” in dog? A monthly subscription to BarkBox. Your favorite pup will get a package filled with treats, toys, and other good stuff (and in return, you’ll probably get lots of sloppy kisses). Visit BarkBox to learn more.

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