The skull of Chios: trepanation in Hippocratic medicine

Abstract

Cranial trepanation is the oldest neurosurgical operation and its roots date back to prehistory. For many centuries, religion and mysticism were strongly linked to the cause of diseases, and trepanation was associated with superstitions such as releasing evil spirits from inside the skull. The Hippocratic treatise “On injuries of the head” was therefore a revolutionary work, as it presented a systematic approach to the management of cranial trauma, one that was devoid of spiritual elements. Unfortunately, there are only a limited number of skeletal findings that confirm that the practice of trepanation was performed as part of Hippocratic medicine. In this historical vignette, the authors present a trepanned skull that was found in Chios, Greece, as evidence of the procedure having been performed in accordance with the Hippocratic teaching. The skull bears a parietal bur hole in association with a linear fracture, and it is clear that the patient survived the procedure. In this analysis, the authors examine the application of the original Hippocratic teaching to the skull of Chios. The rationalization of trepanation was clearly a significant achievement in the evolution of neurosurgery.

Precision Neurosurgery: A Path Forward

“…The first Greek physicians helped to better understand these concepts. Hippocrates in the fourth century BC [9,10], who is considered the father of medicine, explained in his Omnia Opera Hippocratis that the knowledge of physiology allowed for a better understanding of manual technique and that the technique alone was not enough to guarantee high quality surgery. Galen, in the second century A.D., elaborated on Hippocrates' work, in addition to perfecting anatomical knowledge through the observation of a large number of subjects and taking care of injured gladiators [11].…”

Why Study the History of Neuroscience?

“…(B) The raspatory (left), the serrated trepan or trephine (center), and the trepan (right) were used for scraping, sawing, and drilling, respectively. Used with permission from Tsermoulas et al (2014). Panel (C) is adapted from Hanson (1999).…”

Cranial trepanation and healing process in modern patients—Bioarchaeological and anthropological implications

“…Broca, 1876; Rakowsky and Roudenko, 1914; Pales, 1944; Dastugue, 1973; Brenot and Riquet, 1977; Jamet, 1998; Weber and Wahl, 2006; Lv et al ., 2013; Beyneix, 2015; Petrone et al ., 2015) and the Bronze Age (e.g.von Lettow‐Vorbeck and Pastor Abascal, 2003; Silva, 2003; Açıkkol et al ., 2009; Papagrigorakis et al ., 2014), but the practice persisted till more recent periods, especially during the Antiquity (e.g. McKinley, 1992; Roberts and McKinley, 2003; Nikita et al ., 2013; Tsermoulas et al ., 2014) and the Middle Ages (e.g. Smrčka et al ., 2003; Bereczki and Marcsik, 2005; Mariéthoz and Curdy, 2005; Holck, 2008; Rubini, 2008; Fabbri et al ., 2012; Thompson, 2013; Simalcsik et al ., 2014).…”

“…First, as the same trepanation is monitored over time on several occasions, this approach will permit a diachronic observation of the healing process, which is impossible for autopsied cases. Second, as more and more studies of archaeological cases employ CT scanning to assess lesions (Alt et al ., 1997; Alt and Jeunesse, 2006; Mountrakis et al ., 2011; Papagrigorakis et al ., 2014; Tsermoulas et al ., 2014; Gresky et al ., 2016), it is imperative to explore the internal structure of the craniotomy margins in modern cases.…”