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Art and Images in Psychiatry
December 2004

The Cure of Folly

Author Affiliations


Arch Gen Psychiatry. 2004;61(12):1187. doi:10.1001/archpsyc.61.12.1187

Tis not amiss to bore the skull with an instrument, to let outthe fuliginous vapors. . . . Guinerius cured a nobleman inSavoy by boring alone . . . by means of which, after two years[of] melancholy and madness, he was delivered.

Robert Burton, Anatomy of Melancholy, 16521(p450)

Trepanning is the removal of a piece of bone from the skull withoutdamage to the underlying blood vessels, meninges, and brain. It may be theworld’s oldest known surgical procedure, having been practiced throughoutthe world since the late Paleolithic period. The earliest detailed accountis from Hippocrates2 (ca 460 to 355 BC) in the fifth century BC; it was to be performedfor wounds of the head within 3 days following a contusion and within 2 weeksfor suspected infections. Modern recognition of its historical importancebegan in 1865 when an American diplomat, Ephraim George Squier (1821-1888),brought a skull from an Inca burial site near Cuzco, Peru, to Paul Broca,Professor of External Pathology and Clinical Surgery at the University ofParis, to authenticate therapeutic trepanning by the Incas.3 Aftercareful personal review and consultation, Broca confirmed that a surgicalprocedure had taken place and that bone healing was consistent with postoperativesurvival.4 Subsequent discoveries of Neolithictrepanning in France heightened Broca’s interest and resulted in hispublishing more scientific reports on prehistorical trepanation than on thecortical localization of language,4 for whichhe is best known. Trepanning was primarily practiced for head wounds but alsofor epilepsy and headache. Its use for mental illness was far less commonand largely anecdotal. As Burton1 proposes,such use was based on beliefs about the evacuation of vapors.