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Moments in Surgical History
September 2000

Trephination

Arch Surg. 2000;135(9):1119. doi:10.1001/archsurg.135.9.1119

WHEN ROBERT RIPLEY (1893-1949) started his famous cartoon feature in 1918, the many odd and unusual facts were labeled "Believe It or Not." The stories were so amazing that the average reader had a difficult time understanding how such "strange" things could occur. A similar scenario surrounds the early history of trephination. That human beings in the preanesthetic era (ie, before 1846) had their skulls bore open and that the patient lived to tell about it is a surgical "believe it or not." Trephination (or trepanation) remains the earliest example of actual major surgery, although when and why skull boring originated are matters of scientific conjecture. However, skulls from the Mesolithic (Middle Stone Age) cultural period have been found to have round depressions suggestive of rudimentary trephination efforts, which would date the earliest examples at 10,000 BC. Certainly, since many Neolithic (New Stone Age) trephinated skulls have been found throughout Western Europe and Asia, it is theorized that such primitive surgery was widely used by 3000 to 2000 BC.

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