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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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Ramones Karaoke, Flickr // CC BY-NC 2.0
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Fake It Until You Make It: 10 Artificial Ruins
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Ramones Karaoke, Flickr // CC BY-NC 2.0

The love of ruins, sometimes called ruinophilia, has for centuries inspired the creation of clever fakes—a host of sham facades and hollowed-out castle shells found on grand English, European, and even American estates. The popularity of constructing artificial ruins was at its peak during the 18th and 19th centuries, but architects occasionally still incorporate them today.

Why build a structure that is already crumbling? Between the 16th and 19th centuries, the popularity of counterfeit ruins was influenced by two factors—a classical education that enforced the ideals of ancient Greece and Rome, and the extended tour of Europe (known as The Grand Tour) that well-to-do young men and women took after completing their education. Travelers might start in London or France and roam as far as the Middle East, but the trip almost always included Italy and a chance to admire Roman ruins. More than a few wealthy travelers returned home longing to duplicate those ruins, either to complement a romantic landscape, to demonstrate wealth, or to provide a pretense of family history for the newly rich.

Here are a few romantic ruins constructed between the 18th and 21st centuries.

1. SHAM CASTLE // BATHAMPTON, ENGLAND

Sham Castle (shown above) is aptly named—it’s only a façade. The "castle," overlooking the English city of Bath, was created in 1762 to improve the view for Ralph Allen, a local entrepreneur and philanthropist as well as to provide jobs for local stonemasons. From a distance it looks like a castle ruin, but it's merely a wall that has two three-story circular turrets and a two-story square tower at either end. The castle is not the only folly (as such purely decorative architecture is often called) that Allen built. He also constructed a sham bridge on Serpentine Lake in what is now Prior Park Landscape Garden—the bridge can't be crossed, but provides a nice focal point for the lake. Today, Sham Castle is part of a private golf course.

2. WIMPOLE FOLLY // CAMBRIDGESHIRE, ENGLAND

Building a structure that looks as if it's crumbling does not preclude having to perform regular maintenance. The four-story Gothic tower known as Wimpole Folly in Wimpole, Cambridgeshire, England, was built 1768-72 for Philip Yorke, first Earl of Hardwicke and owner of the Wimpole Estate. Owned by Britain’s National Trust, the ruin threatened to truly crumble a few years ago, so restoration efforts were needed. The last restoration was so well done it won the 2016 European Union Prize for Cultural Heritage. The Wimpole Estate is now open to the public for walks and hikes.

3. CAPEL MANOR FOLLY // ENFIELD, ENGLAND

Capel Manor at Bulls Cross, Enfield, England has been the site of several grand homes since the estate’s first recorded mention in the 13th century, so visitors might be tempted to believe that the manor house's ruins date back at least a few centuries. But that sense of history is an illusion: The faux 15th-century house was built in 2010 to add visual appeal to the manor gardens, which have been open to the public since the 1920s.

4. ROMAN RUIN // SCHONBRUNN PALACE, VIENNA, AUSTRIA

The Roman Ruin was built as a garden ornament for the 1441-room Schonbrunn Palace in Vienna, one of the most important monuments in Austria. The ruin was once called The Ruins of Carthage, after the ancient North African city defeated by Roman military force. But despite the illusion of antiquity, the ruins were created almost 2000 years after Carthage fell in 146 B.C.E. The ruin’s rectangular pool, framed by an intricate semi-circle arch, was designed in 1778 by the architect Johann Ferdinand Hetzendorf von Hohenberg, who modeled it on the Ancient Roman temple of Vespasian and Titus, which he had seen an engraving of.

5. THE RUINEBERG // POTSDAM, GERMANY

One of the earliest examples of artificial ruins in Germany was the complex of structures known as The Ruinenberg. Frederick the Great, King of Prussia, had a summer palace in Potsdam, near Berlin, that was said to rival Versailles. In 1748 Frederick commissioned a large fountain for the palace complete with artificial ruins. The waterworks part of his plan proved too difficult and was soon abandoned, but not before designer Georg Wenzeslaus von Knobelsdorff constructed the ruins. The complex includes Roman pillars, a round temple, and the wall of a Roman theatre. Since 1927 the site has belonged to the Prussian Gardens and Palaces Foundation, Berlin-Brandenburg.

6. PARC MONCEAU // PARIS, FRANCE

Elegant Parc Monceau is located in the fashionable 8th arrondissement of Paris near the Champs-Elysees and Palais de l’Elysée. In 1778, the Duke of Chartres decided to build a mansion on land previously used for hunting. He loved English architecture and gardens, including the notion of nostalgic ruins, so he hired the architect Louis Carrogis Carmontelle to create an extravagant park complete with a Roman temple, antique statues, a Chinese bridge, a farmhouse, a Dutch windmill, a minaret, a small Egyptian pyramid, and some fake gravestones. The most notable feature of the park is a pond surrounded by Corinthian columns, now known as Colonnade de Carmontelle.

7. HAGLEY PARK CASTLE // WORCESTERSHIRE, ENGLAND

The ruins of the medieval castle at Hagley Park in Worcestershire are definitely fake, but they were built with debris from the real ruin of a neighboring abbey. The folly was commissioned by Sir George Lyttelton in 1747 and designed by Sanderson Miller, an English pioneer of Gothic revival architecture. The castle has a round tower at each corner, but by design only one is complete and decorated inside with a coat of arms. The grounds, which also feature a temple portico inspired by an ancient Greek temple, some urns, and obelisks, are now privately owned and not open to the public.

8. TATA CASTLE RUINS // TATA, HUNGARY

French architect Charles de Moreau (1758-1841) was a scholar of classical Roman architecture known for his ability to counterfeit impressive ruins. Nicholas I, Prince Esterhazy of Hungary, hired him to work on Tata Castle and to create the ruins of a Romanesque church for the palace’s English Garden. Even though the ruin Moreau created was fake, he built it with the stones of a real ruin, the remnants of the early-12th-century Benedictine and later Dominican abbey of Vértesszőlős. A third-century ancient Roman tombstone and relief were placed nearby.

9. BELVEDERE CASTLE // MANHATTAN, NEW YORK

Frederick Law Olmsted and Calvert Vaux designed Central Park in the mid-1800s, and their plan for creating romantic vistas included the construction of a folly known as Belvedere Castle. The Gothic-Romanesque style hybrid, overlooking Central Park’s Great Lawn, was completed in 1869. Although the folly was designed as a hollow shell and meant to be a ruin, it eventually served a practical purpose, housing a weather bureau and exhibit space. The castle also provides a beautiful backdrop for Shakespeare in the Park productions, evoking the royal homes that play prominent roles in the Bard’s works.

10. FOLLY WALL IN BARKING TOWN SQUARE // LONDON

In a borough known for its real historic buildings, the ancient wall found in London’s Barking Town Square might look centuries old. It’s not, and ironically, the wall is part of the square’s renovation efforts. The wall was built by bricklaying students at Barking College using old bricks and crumbling stone items found at salvage yards. Known as the "Secret Garden," named after the children’s book about a walled garden, the wall was designed to screen a nearby supermarket and was unveiled in 2007.

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Lovely Vintage Manuals Show How to Design for the Human Body
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IA Collaborative

If you're designing something for people to hold and use, you probably want to make sure that it will fit a normal human. You don't want to make a cell phone that people can't hold in their hands (mostly) or a vacuum that will have you throwing out your back every time you clean the house. Ergonomics isn't just for your office desk setup; it's for every product you physically touch.

In the mid-1970s, the office of legendary industrial designer Henry Dreyfuss created a series of manuals for designers working on products that involved the human body. And now, the rare Humanscale manuals from Henry Dreyfuss Associates are about to come back into print with the help of a Kickstarter campaign from a contemporary design firm. Using the work of original Henry Dreyfuss Associates designers Niels Diffrient and Alvin R. Tilley, the guides are getting another life with the help of the Chicago-based design consultancy IA Collaborative.

A Humanscale page illustrates human strength statistics.

The three Humanscale Manuals, published between 1974 and 1981 but long out-of-print, covered 18 different types of human-centric design categories, like typical body measurements, how people stand in public spaces, how hand and foot controls should work, and how to design for wheelchair users within legal requirements. In the mid-20th century, the ergonomics expertise of Dreyfuss and his partners was used in the development of landmark products like the modern telephones made by Bell Labs, the Polaroid camera, Honeywell's round thermostat, and the Hoover vacuum.

IA Collaborative is looking to reissue all three Humanscale manuals which you can currently only find in their printed form as historic documents in places like the Cooper Hewitt design museum in New York. IA Collaborative's Luke Westra and Nathan Ritter worked with some of the original designers to make the guides widely available again. Their goal was to reprint them at a reasonable price for designers. They're not exactly cheap, but the guides are more than just pretty decor for the office. The 60,000-data-point guides, IA Collaborative points out, "include metrics for every facet of human existence."

The manuals come in the form of booklets with wheels inside the page that you spin to reveal standards for different categories of people (strong, tall, short, able-bodied, men, women, children, etc.). There are three booklets, each with three double-sided pages, one for each category. For instance, Humanscale 1/2/3 covers body measurements, link measurements, seating guide, seat/table guide, wheelchair users, and the handicapped and elderly.

A product image of the pages from Humanscale Manual 1/2/3 stacked in a row.

"All products––from office chairs to medical devices—require designs that 'fit' the end user," according to Luke Westra, IA Collective's engineering director. "Finding the human factors data one needs to achieve these ‘fits' can be extremely challenging as it is often scattered across countless sources," he explains in a press release, "unless you've been lucky enough to get your hands on the Humanscale manuals."

Even setting aside the importance of the information they convey, the manuals are beautiful. Before infographics were all over the web, Henry Dreyfuss Associates were creating a huge compendium of visual data by hand. Whether you ever plan to design a desk chair or not, the manuals are worthy collectors' items.

The Kickstarter campaign runs from July 25 to August 24. The three booklets can be purchased individually ($79) or as a full set ($199).

All images courtesy IA Collaborative

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