Trepanation (Draft) Mogg Morgan (mandox2000@yahoo.

.com) Trepanation is one of the oldest therapeutic procedures on the human skull of which there is objective evidence. It originated in the Epi-paleolithic (i.e. late stone-age anything as late as say 4000BC) and was widespread in both the Old and New World. Its occurrence in Ancient Egypt has, for the best part of this century, been a topic of controversy amongst scholars. More skulls have been exhumed and studied in the Nile valley than any other region, and the supposed absence of evidence of the practice there is an enigma. Despite the embarrassment of riches for archaeologists of Ancient Egypt, most commentators seem to agree that the topic has been in a state of stagnation and isolation from the newer disciplines of anthropology and ecological research.1 Physical anthropological evidence is inconclusive, in part on account of the absence of Epi-Paleolithic skeletal remains from Egypt proper, in part also because of the woefully inadequate study of the once abundant Pre-dynastic cemetery record in Egypt.2 Despite these difficulties, the Egyptologist Frederick Wood Jones made a tentative report of the discovery of trepanation as early as 1910. A few years later the widow of M A Ruffer published a posthumous paper by her husband, (sadly killed by what she terms the enemy in world war one), a paper entitled Studies in Paleopathology: Some recent researches on Prehistoric Trepanation, Journal of Pathology and Bacteriology 22: 90-104 (1918). This paper made another tentative report of the discovery of a possible trepanned skull. These scant pieces of evidence made it feasible for other scholars to maintain that there was no textual reference to the practice in any of the extant medical papyri or inscriptions. However, the advent of new imaging technology such as MRI scanners have provoked a recent re-examination of the evidence and exhibits that have lain long dormant and forgotten in anatomical collections have been re-examined. The amazing results are reported in a major new study by Wolfgang Michael Pahl entitled Altgyptische Schdelchirurgie: published by Gustav Fischer Verlag 1993. This is such a detailed study that it would take several pages to examine in depth its many fascinating images. But put simply it presents clear evidence of trepanned skulls from the time of the pyramids (4th dynasty c.3500 BC) through all periods up until the end of Egypt in the late Roman period, when no doubt the practice was preserved amongst the Copts and later inhabitants of the territory. From these detailed scans of the recently examined skulls, Pahl has been able to reconstruct the kind of tool used by the ancient physicians to trepan the skull. Armed with this reconstruction it is possible to look again at the ancient medical texts, and identify carved reliefs showing the actual tool. A fine example of this comes from the north wall of the temple at Kom Ombo, near Aswan in Upper Egypt. These reliefs, not normally seen by tourists, show a set of commonly used surgical instruments, and in one of the registers the trepanation tool is clearly recognisable [see figure on http://www.antiquemed.com/invention.html]. Trepanation seems to have been used for a variety of conditions, these include treatment of abscesses; management of traumatic head wounds caused by accidents and violence; as a possible treatment for dementia and other mental illnesses and almost certainly as some kind of attempt to alter consciousness. Several different kinds of incision are known, made on patients ranging from children to very old men and women. Survival rates were good, although repeat treatments were sometimes necessary.

1 2

See Karl W Butzer, Early Hydraulic Civilization in Egypt, (University of Chicago Press 1996) p. 1 Butzer, op cit p. 10

Gazetteer of skulls showing possible signs of Trepanation Uvo Hlscher The Excavation of Medinet Habu Vol V Post-Ramesside Remains Chicago 1954 King Horsiese's (22nd Dyn) mummy was completely destroyed, apart from a skull presumed to be from his tomb. This skull has in the forehead a roughly quadrilateral hole, which suggests a trepanation (Plate 10B). Dr Douglas E Derry, the anatomist in Cairo to whom the skull was submitted for study, considered that this hypothesis could not be proved. He concluded that Horsiese lived a while after the infliction, whatever its nature may have been p10.