Prehistoric or current primitive cranial operations

Humankind demonstrates boundless curiosity, mostly expressed through the activities of a small number of individuals, whose achievements affect all members of society. The extent and distribution of pre-historic trepanation and trepanation in contemporary unsophisticated societies are reviewed. In the great majority of cases the intention of trepanation has been therapeutic, even if the understanding of underlying pathophysiology is not the same as that which scientific societies now accept. This review demonstrates variation in surgical technique. In the Atlas Mountains it was unacceptable to operate on the cranial sutures whereas in New Ireland it was not important. Pain relief was unnecessary in Melanesia because the patients were largely unconscious following injury. In South America, there was access to the coca leaf which could help with pain relief. In East Africa, one patient described the application of a powder to his wound which was thought to be for pain relief. The nature of the powder remains unknown. There were differences in the indications for trepanation. In New Britain, the operation was performed only for cases of fracture. In nearby New Ireland, epilepsy and certain forms of mental disturbance were also indications. In North and East Africa, the indication was most frequently headache following trauma. Most of these trepanations did not involve drilling, which is the main subject of this book.