Perspectives in Biology and Medicine

POSSIBLE REASONS FOR NEOLITHIC SKULL TREPHINING PLINIO PRIORESCHI* Primitive cranial trephining (i.e., surgical opening of the skull performed with primitive tools and techniques) is one of the most enduring surgical practices. It started during the European Neolithic Age (80003000 b.c.) and persisted in Europe until medieval times. It is still performed today, although more and more rarely, in Africa, South America, and Melanesia. Neolithic trephined skulls have been found in France, Spain, Portugal , North Africa, Italy, Great Britain, Switzerland, Germany, Austria, Belgium, Denmark, Sweden, Poland, and Russia. Primitive trephining was also practiced in America, primarily in Peru but also in North America [1, 2] as far north as Canada [3] although the validity of the North American specimens as examples of real trephining has been questioned [4]. In addition, specimens have been found in China, Japan, and Afghanistan [5, pp. 651—672]. To date, more than 1,500 have been discovered [6]. A large number (over 50 percent in some reports) of the trephined skulls show evidence of bone healing around the edges of the trepanation holes, which indicates that the patient often survived the operation [4]. The operation consisted in removing a piece of the skull (usually from a parietal bone but sometimes from the frontal or occipital area) to expose the dura mater. We assume that, at least in the successful cases, the dura mater was not perforated because meningitis would have followed almost inevitably, and the patient would not have survived long. In primitive trepanning performed in modern times, the dura mater is also avoided [7, p. 31]. The author expresses gratitude to Drs. Arthur C. Aufderheide and Guido Majno for their critique and suggestions. *School of Medicine, Creighton University, California at 24th Street, Omaha, Nebraska 68178.© 1991 by The University of Chicago. AU rights reserved. 0031-5982/91/3402-0714$01.00 296 I Plinio Prioreschi ¦ Neolithic Skull Trephining The majority of trephined specimens show single openings, but some have been found to have had two or more, and a skull from Cuezo in Peru shows seven healed openings [4]. Trepanation was practiced on living individuals (as shown by the healing at the edge of the hole), and it is generally accepted that it was also performed on the dead [5; 8, p. 112; 9, p. 31]. The operation was performed on men, women, and children [5], but mostly on adult males [10, p. 104]. A small fraction of the total number of Neolithic skulls was subjected to this surgical procedure (probably about 6-10 percent, a figure based on the average of the numbers reported by various authors [10-15]), and in some cases the trephinings are incomplete [11, 16]. Although very few European specimens show signs of fracture [5; 10, p. 104], in South American specimens fractures are frequent [5, 17]. In fact, about halfofPeruvian trephined skulls have fractures [6]. The motives for Neolithic trephining have been the object of speculation since the first specimens were discovered in the nineteenth century. Generally it is surmised that, on the living, the operation was performed to provide an opening for the escape (or the entrance) of evil spirits, either for therapeutic reasons (e.g., for headaches, fractures, infections, insanity, convulsive disorders) or for purely religious reasons, or for both [5; 8, p. 1 12]. As for the trephining of the skull of the dead, it has been suggested that it was done to acquire rondelles (the disks of bone obtained from cutting circular holes in the skulls), which were used as charms, amulets, or talismans [5]. Although the immediate goal of craniotomy was almost surely, as commonly believed, to provide an opening for the escape (or entrance) ofspirits, gods, or demons, it is difficult to determine what the therapeutic goal might have been—that is to say, what primitive man wanted to accomplish by letting supernatural beings enter or escape through those openings. In the South American specimens, the frequent coexisting fractures suggest that trephining often may have been related to trauma. A question , however, remains concerning the nature of that relation. Neolithic man most likely had no concept of undisplaced fractures, and even ifhe had, he could not diagnose such a fracture in...