Trepanation, the intentional creation of a hole in the human skull, is widely considered the oldest known surgical procedure. This practice predates modern medical techniques, including anesthesia and aseptic practices, and has been documented across numerous ancient civilizations globally. Although newer archaeological discoveries suggest earlier surgical feats, trepanation remains the most enduring and geographically widespread evidence of complex ancient surgery.
Trepanation: The Mechanics of the Ancient Procedure
Trepanation involves penetrating the cranium to expose the dura mater, the thick membrane covering the brain. The process was accomplished using several distinct methods, relying on the tools available. Techniques included scraping away the bone gradually with abrasive materials like flint or obsidian flakes until the skull was perforated.
Another common approach involved circular grooving, where a sharp tool carved a ring into the bone until the central piece could be removed. Later, more sophisticated tools, such as the Incan tumi knife or primitive rotary drills, were used to bore multiple holes. Regardless of the technique, the goal was always to remove a section of the bone flap without damaging the underlying brain tissue or blood vessels.
Archaeological Evidence Establishing Antiquity
The historical claim of trepanation’s antiquity is supported by finds dating back to the Neolithic period, approximately 7,000 years ago. Evidence from Mesolithic sites in North Africa, Ukraine, and Portugal suggests the practice may stretch back as far as 10,000 years. A trepanned skull found at the Neolithic site of Ensisheim in France is over 7,000 years old.
The indicator of a successful surgery is the presence of osteogenesis, or new bone growth, around the edges of the opening. This healed bone margin confirms the patient survived the operation for a significant amount of time. In some ancient Peruvian cultures, the survival rate following the procedure has been estimated at over 60%. The widespread discovery of successfully healed trepanned skulls across Europe, Asia, and the Americas establishes the procedure as a common form of early surgical intervention.
Motivations: Why Early Humans Practiced Skull Surgery
The reasons for this surgery were likely a combination of therapeutic and ritualistic purposes. The most practical medical motivation was to treat head trauma, such as depressed skull fractures caused by weapons or accidents. Removing fragmented bone and relieving pressure from intracranial hematomas (blood pooling under the skull) were immediate, life-saving interventions.
Trepanation was also practiced to address symptoms associated with neurological or mental health conditions. Practitioners may have used the procedure to treat chronic headaches, epilepsy, and various mental disorders. In these cases, the operation was often rooted in the belief that a hole in the skull would allow evil spirits, or “bad humors,” to escape the body and cure the affliction.
Other Early Surgical Interventions
While trepanation has long been cited as the oldest surgery, a significant recent discovery has shifted this historical perspective. Archaeological evidence from Borneo points to a successful surgical amputation dating back 31,000 years, making it the earliest known surgical operation. This Paleolithic-era skeleton of a young person shows a deliberately and skillfully removed lower leg that had healed, suggesting advanced anatomical knowledge and community care.
Other ancient surgical practices focused on orthopedics and dentistry. Ancient Egyptian medical texts, such as the Edwin Smith Papyrus (c. 1600 BCE), detail a systematic approach to treating fractures and dislocations. Practitioners used wooden splints secured with linen bandages soaked in resin or gum to immobilize and set broken bones. Prehistoric dentistry is documented in the Indus Valley as far back as 7000 BCE, where dentists used bow drills to remove decay and filled cavities with materials like bitumen and medicinal herbs.