Hello. I just want to make some follow-up points about trephination in response to your comments. First, trephination was not an optional treatment for most people with traumatic head injury in Peru. Imagine getting hit hard enough with a star-shaped club that it fractures the skull. There is an area of broken bone and soft-tissue mess that must be removed and cleaned up. The Inca method was to cut a large "X" in the skin over the area. The corners at the center of the X were pealed back, revealing a large square area of the skull. The trephination was made by scraping away broken bone and rendering a round, smooth opening. This was covered and over time, considerable healing occurred. The bone opening does not close but a layer of tissue grows over the opening, much of it derived from the dura. Presumably Peruvians lived many years with these soft areas on the head. Since the Peruvian practiced cranial deformation, these areas may have conveyed status. Who knows? At least they were a conversation starter.
In Africa, trephination was practiced by itinerate trephiners up to the 1960s at least. They may still practice today. They also treat scalp injuries essentially the same way but don't enter the skull. The movie someone mentioned was a movie of one of these practitioners conducting a trephination. These treatments were done with shortened hacksaw blades and other modified metal tools. Someone also mentioned this in the context of pain since the patient calmly holds a bowl while blood and fluids drain into it. Keep in mind that once you get past the scalp, there are few pain receptors and relatively little blood. One paper on this had a photograph and X-rays of one African man who received multiple trephinations for headache. He was missing the entire top of his skull. He covered the sunken area with a small woolen cap. Of course, trephinations are regularly performed by neurosurgeons today. A craniotomy starts with a trephination. They use a very fancy saw that cuts a limited depth opening. They also make every attempt to keep the bone piece healthy to place it back in the opening. You can do this if the trephine is part of surgery for tumors etc. Many traumatic injuries cannot have the bone piece or pieces placed back in. Trephination was practiced in virtually every place in the world, all through history. Different groups performed a variety of procedures for many different reasons. Most of the reasons were health related. In the South Seas, trephination was used as a prophylactic for seizure disorder. They replace the missing skull piece with a shaped piece of coconut. In the middle east, the trephination was covered with a poltice that included lots of honey. In medieval times in Europe some trephinations may have been done to release humors. However, I believe this is a largely unsubstantiated myth. The usual Intro Psych book shows a trephined skull from prehistoric Peru, a picture of a European getting his head opened and text that states that trephination was used to release spirits or humors. This mistaken description has extended down through the ages and resulted in a great misinterpretation of what was is a very practical treatment for head injury. Only in Peru did the frequency of trephination reach a level far above the rate of any other culture. This was simply because they conducted warfare using clubs with angular pieces of stone, many star-shaped. They also used sling stones. Remember David and Goliath? In Peru, Goliath would have received a trephination on the spot to remove the stone and broken bone. There is no evidence from trephination that the practitioners learned anything about localized brain function. I was hoping to discover this by analyzing patterns of practice over time, across groups etc. The data isn't there. If the Peruvians had lived a little longer, it is likely that someone would have described the practice. The Inca had no written records. The earliest clear record of at least lateralized brain function is in the Edwin Smith medical papyrus. There is described contralateral hemiplegia, seizures and aphasia. The papyrus does not describe trephination. However, it is mysteriously incomplete. Presumably there were also other Egyptian documents that may have described many other medical procedures, including trephination, that were lost to antiquity. Where is Indiana Jones when we need him the most? Here is a link: http://www.neurosurgery.org/cybermuseum/pre20th/epapyrus.html Mike Williams ************** Wondering what's for Dinner Tonight? Get new twists on family favorites at AOL Food. (http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001) --- To make changes to your subscription contact: Bill Southerly ([EMAIL PROTECTED])
