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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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Art
5 Things You Might Not Know About Ansel Adams

You probably know Ansel Adams—who was born on February 20, 1902—as the man who helped promote the National Park Service through his magnificent photographs. But there was a lot more to the shutterbug than his iconic, black-and-white vistas. Here are five lesser-known facts about the celebrated photographer.

1. AN EARTHQUAKE LED TO HIS DISTINCTIVE NOSE.

Adams was a four-year-old tot when the 1906 San Francisco earthquake struck his hometown. Although the boy managed to escape injury during the quake itself, an aftershock threw him face-first into a garden wall, breaking his nose. According to a 1979 interview with TIME, Adams said that doctors told his parents that it would be best to fix the nose when the boy matured. He joked, "But of course I never did mature, so I still have the nose." The nose became Adams' most striking physical feature. His buddy Cedric Wright liked to refer to Adams' honker as his "earthquake nose.

2. HE ALMOST BECAME A PIANIST.

Adams was an energetic, inattentive student, and that trait coupled with a possible case of dyslexia earned him the heave-ho from private schools. It was clear, however, that he was a sharp boy—when motivated.

When Adams was just 12 years old, he taught himself to play the piano and read music, and he quickly showed a great aptitude for it. For nearly a dozen years, Adams focused intensely on his piano training. He was still playful—he would end performances by jumping up and sitting on his piano—but he took his musical education seriously. Adams ultimately devoted over a decade to his study, but he eventually came to the realization that his hands simply weren't big enough for him to become a professional concert pianist. He decided to leave the keys for the camera after meeting photographer Paul Strand, much to his family's dismay.

3. HE HELPED CREATE A NATIONAL PARK.

If you've ever enjoyed Kings Canyon National Park in California, tip your cap to Adams. In the 1930s Adams took a series of photographs that eventually became the book Sierra Nevada: The John Muir Trail. When Adams sent a copy to Secretary of the Interior Harold Ickes, the cabinet member showed it to Franklin Roosevelt. The photographs so delighted FDR that he wouldn't give the book back to Ickes. Adams sent Ickes a replacement copy, and FDR kept his with him in the White House.

After a few years, Ickes, Adams, and the Sierra Club successfully convinced Roosevelt to make Kings Canyon a national park in 1940. Roosevelt's designation specifically provided that the park be left totally undeveloped and roadless, so the only way FDR himself would ever experience it was through Adams' lenses.

4. HE WELCOMED COMMERCIAL ASSIGNMENTS.

While many of his contemporary fine art photographers shunned commercial assignments as crass or materialistic, Adams went out of his way to find paying gigs. If a company needed a camera for hire, Adams would generally show up, and as a result, he had some unlikely clients. According to The Ansel Adams Gallery, he snapped shots for everyone from IBM to AT&T to women's colleges to a dried fruit company. All of this commercial print work dismayed Adams's mentor Alfred Stieglitz and even worried Adams when he couldn't find time to work on his own projects. It did, however, keep the lights on.

5. HE AND GEORGIA O'KEEFFE WERE FRIENDS.

Adams and legendary painter O'Keeffe were pals and occasional traveling buddies who found common ground despite their very different artistic approaches. They met through their mutual friend/mentor Stieglitz—who eventually became O'Keeffe's husband—and became friends who traveled throughout the Southwest together during the 1930s. O'Keeffe would paint while Adams took photographs.

These journeys together led to some of the artists' best-known work, like Adams' portrait of O'Keeffe and a wrangler named Orville Cox, and while both artists revered nature and the American Southwest, Adams considered O'Keeffe the master when it came to capturing the area. 

“The Southwest is O’Keeffe’s land,” he wrote. “No one else has extracted from it such a style and color, or has revealed the essential forms so beautifully as she has in her paintings.”

The two remained close throughout their lives. Adams would visit O'Keeffe's ranch, and the two wrote to each other until Adams' death in 1984.

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presidents
George Washington’s Incredible Hair Routine

America's Founding Fathers had some truly defining locks, but we tend to think of those well-coiffed white curls—with their black ribbon hair ties and perfectly-managed frizz—as being wigs. Not so in the case of the main man himself, George Washington.

As Robert Krulwich reported at National Geographic, a 2010 biography on our first president—Washington: A Life, by Ron Chernow—reveals that the man “never wore a wig.” In fact, his signature style was simply the result of an elaborately constructed coiffure that far surpasses most morning hair routines, and even some “fancy” hair routines.

The style Washington was sporting was actually a tough look for his day. In the late 18th century, such a hairdo would have been worn by military men.

While the hair itself was all real, the color was not. Washington’s true hue was a reddish brown color, which he powdered in a fashion that’s truly delightful to imagine. George would (likely) don a powdering robe, dip a puff made of silk strips into his powder of choice (there are a few options for what he might have used), bend his head over, and shake the puff out over his scalp in a big cloud.

To achieve the actual ‘do, Washington kept his hair long and would then pull it back into a tight braid or simply tie it at the back. This helped to showcase the forehead, which was very in vogue at the time. On occasion, he—or an attendant—would bunch the slack into a black silk bag at the nape of the neck, perhaps to help protect his clothing from the powder. Then he would fluff the hair on each side of his head to make “wings” and secure the look with pomade or good old natural oils.

To get a better sense of the play-by-play, check out the awesome illustrations by Wendy MacNaughton that accompany Krulwich’s post.

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