Trepanning

Trepanning

‘Of all the particular Operations requir’d by the Diseases of the Head, scarce any of them are so considerable, or occur so frequent, as that of the Trepan’.

Pierre Dionis, A Course of Chirurgical Operations, Demonstrated in the Royal Garden at Paris (London, 1733), p. 266.

Guilhelmus Fabricius Hildanus, Opera quae extant omnia … (Frankfurt, 1682), p. 81.

The term ‘trepanning’ (also referred to as trepanation) is derived from the Greek word ‘trypanon’, meaning a borer.[1] As Goodrich notes, trepanning is an ancient form of surgery, and certainly thousands of skull indicating that trepanning has taken place have been found in Europe, North Africa, the Middle East and South America.[2] Ellis dates the practice as far back as 10,000 BC and it was well known to ancient Greek doctors: the ancient Greek physician, Hippocrates (c. 460-c. 370 BC), warned surgeons not to go deeper than the dura mater (the membrane that surrounds the brain), because of the risks involved and most surgeons followed this advice.[3]

Worth’s collection of surgical texts demonstrate the advances made in instruments for trepanning during the sixteenth, seventeenth and eightenth centuries: Fabricius of Aquapendente (1533-1619), Professor of Surgery and Anatomy at the University of Pavia, invented the hand trepan, which was duly illustrated by his pupil, Johannes Scultetus, in his Armamentarium chirurgicum (Leiden, 1693). Wilhelm  Fabricius Hildanus (1560-1635), sometimes called the ‘Father of German Surgery’, was likewise credited with a number of innovations in tools for trepanning : in particular, he was responsible for developing an ‘Elevatorium’ which raised depressed fractures of the skull.[4] Thomas Brugis (fl. 1640), another author collected by Worth,  credits John Woodall (1556?-1643) with inventing the ‘Trafine’, which Brugis considered to be ‘of more use than the Trepan’ though he advised young surgeons to first practice using it on a calf’s head.[5]

Jean Jacques Manget, Bibliotheca chirurgica, sive Rerum ad artem Machaonicam quoquô modô spectantium thesaurus absolutissimus; … (Geneva, 1721), plate IX.

Many of these new tools were illustrated in compendium works, such as Jean Jacques Manget’s Bibliotheca chirurgica, sive Rerum ad artem Machaonicam quoquô modô spectantium thesaurus absolutissimus; … (Geneva, 1721) but more detail was provided by surgeons such as Pierre Dionis (1643-1718) who concentrated on describing how such implements should be used. As Marion Maria Ruisinger notes, Dionis was a little trigger happy when it came to trepanning, arguing that it should be used immediately if someone fell to the ground unconscious after a blow to the head.[6]

 Pierre Dionis, Cours d’operations de chirurgie, demonstre’es au Jardin Royal … (Paris, 1714), p. 433.

Dionis describes an early eighteenth-century trepanation, using these instruments, as follows :

‘The Chirurgeon must being with the Choice of the Crown which he intends to use ; wherefore I shew you three of different Sizes, the one larger F, the middling on G, and the little one H, and being determin’d by the Nature and Figure of the Wound it self, he pitches on that which is most convenient : He presents it to the Place to which he is resolve’d to apply it, remembring that it must not touch the Lips of the Wound of the Pericranium, which would give the Patient a most sensible Pain in the Operation ; and then he turns the Crown once or twice round, to mark the Circumference which is to bound the Trepan, and to discover the middle. He next takes the Gimlet I, on which he mounts the Piercer K, which he fixes on the Place traced out by the point of the Pyramid which was in the Crown, and turning it five or six Rounds, he makes a small Orifice of the depth of a half Line, or the four and twentieth Part of an Inch, which serves to lodge the Point of his Pyramid, and so to conduct the Crown, that it shall not waver either on one side or the others.

The Piercer being taken out of the Gimlet, the Chirurgeon fixes in its stead the Crown G, which he is to use, and places it on the mark’d Place ; and then with his Left-hand holding the Top or Ball of the Gimlet, on which he leans his Fore-head, he turns the Instrument with his Right-Hand, against the Grain of the Teeth of the Saw, that they may cut …’[7]

Sources

Brugis, Thomas, Vade Mecum: or, a Companion for a Surgeon. Fitted for Sea, or Land; Peace or War (London, 1681).

Ellis, Harold, The Cambridge Illustrated History of Surgery (Cambridge, 2009).

Goodrich, James Tait, ‘How to get in and out of the skull : from tumi to ‘hammer and chisel’ to the Gigli saw and the osteoplastic flap’, Neurosurgical Focus, vol. 36, no. 4 (2014), 1-15.

Jones, E.W., ‘The Life and Works of Guilhelmus Fabricius Hildanus (1560-1634): Part 1’, Med Hist., vol. 4, no. 2 (1960), 112-34.

Jones, E.W., ‘The Life and Works of Guilhelmus Fabricius Hildanus (1560-1634): Part 2’, Med Hist., vol. 4, no. 3 (1960), 196-209

Ruisinger, Marion Maria, ‘Lorenz Heister (1683-1758) and the ‘Bachmann Case’: Social Setting and Medical Practice of Trepanation in Eighteenth-Century Germany’, in Robert Arnott, et al. (eds) Trepanation. History, Discovery, Theory (Abingdon, 2005), pp 273-88.

Zimmerman, Leo M. and Ilza Veith, Great Ideas in the History of Surgery (Baltimore, 1961).

Text : Dr Elizabethanne Boran, Librarian of the Edward Worth Library, Dublin.

[1] Ellis, Harold, The Cambridge Illustrated History of Surgery (Cambridge, 2009), p. 4. Ellis notes that the more modern term ‘trephination’ indicates the use of a sharply pointed instrument.

[2] Goodrich, James Tait, ‘How to get in and out of the skull : from tumi to ‘hammer and chisel’ to the Gigli saw and the osteoplastic flap’, Neurosurgurical Focus, vol. 36, no. 4 (2014), 1.

[3] Ellis, The Cambridge Illustrated History of Surgery, p. 4.

[4] Jones, E.W., ‘The Life and Works of Guilhelmus Fabricius Hildanus (1560-1634): Part 2’, Med Hist. vol. 4, no. 3 (1960), 204.

[5] Brugis, Thomas, Vade Mecum: or, a Companion for a Surgeon. Fitted for Sea, or Land; Peace or War (London, 1681), pp 199-200.

[6] Ruisinger, Marion Maria, ‘Lorenz Heister (1683-1758) and the ‘Bachmann Case’: Social Setting and Medical Practice of Trepanation in Eighteenth-Century Germany’, in Robert Arnott, et al. (eds) Trepanation. History, Discovery, Theory (Abingdon, 2005), p. 279.

[7] Dionis, Pierre, A Course of Chirurgical Operations, Demonstrated in the Royal Garden at Paris (London, 1733),