Our brains are a real mystery. Ignoring the Terminal Man era quandary of whether or not our brains are powerful enough to understand how they themselves work (yes, I’m name-checking Michael Crichton here), what’s really absurd is that everything we do is controlled by a fragile blob of grey jelly. The thing is, our brains apparently aren’t all that frail, as evidenced by arcane ridiculousness like the story of Phineas Gage.
Okay, so this is cool, but I know you’re wondering what this brainy talk has to do with anything. Well, I just found out something absolutely astonishing: We oh-so-resourceful humans have been performing brain surgery — successfully, mind you — for up to 10,000 years. In fact, the act of cutting open the skull is likely the oldest surgical procedure humans have ever performed.
In a 2007 paper published in Italian medical journal ACTA Otorhinolaryngologica Italica, Dr. Giorgio Sperati undertakes the massive task of tracking craniotomies throughout history. According to Sperati, evidence suggests that craniotomies — surgeries involving removing a section of the skull in order to access the brain — were first being performed in the Neolithic Age, which lasted from 8000-5000 BC. (The paper was revealed to me today by Memorial Hermann hospital’s Twitter stream, where the first live-tweeting of a brain surgery happened today.)
Of course, such an incredible finding didn’t come about without contention. Medical historian Henry E. Sigerist wrote that prehistoric skulls with surgical perforation were found in France as early as 1685. But for nearly a hundred years those holes, which were mostly found in the parietal or occipital bones, were attributed to trauma, not surgery. It wasn’t until the late 1700s that anthropologists M. Prunières and Paul Broca suggested that the marks were the result of surgery, although they originally argued that such surgery was inspired by mystic, rather than medical, causes.
However, the procedure eventually was used for treatment purposes. Opening the skull can relieve brain pressure, which, according to Sperati, can “lead to an improvement in certain pre-existing neurological symptoms, such as headache, paresis, [and] convulsive states.” Whatever the original reason for cutting open skulls, these positive effects likely increased the surgery’s popularity. Sperati notes that nearly half of patients survived ancient craniotomies — and with evidence of regrown bone around the incisions on some skulls, some of those patients must have lived for years. That’s a stunning fact considering neolithic surgeons didn’t have operating rooms, antibiotics, anything resembling sterile conditions — or even metal tools.
Sperati thus delves into the nitty-gritty details:
The medicine men of neolithic times had thus reached an incredible technical ability in performing this type of surgical procedure despite the fact that they only had primitive tools such as pointed or sharp cutting tools derived from silica or obsidian.
Only much later were metallic instruments used, made of copper or bronze, such as gouges, curettes, scalpels, knives of various forms, some of which very special, such as the "tumi", or scalpel, in ancient Perù. It is worthwhile taking a closer look at the drill, one of the very oldest tools known. Originally, it was probably derived from a technique used by early man to produce fire, by rapidly rubbing, between the palms of their hands, a rod hammered into a piece of wood that with an inflammable agent would catch fire. If the rod was of hard material, it would make the pre-existing hole larger or even create a new one and the observation of this peculiarity probably led to the birth of the early drill. It consisted in a small sharp rod made of hard stone or metal which was swivelled rapidly between the hands; to obtain greater speed, a cord could be passed around it, the ends of which were pulled alternately with a very rapid "to and fro" movement. Another improvement was made by fixing the perforating rod to the strings of a bow thus making it possible for this manoeuvre to be performed by one person alone.
Here’s an example of an Egyptian bow drill being used for beads. Imagine that drilling into your head.
Sperati traces skull surgery up until it spawned the modern disciple of neurosurgery, and it’s quite a read. But I can’t get past the idea of an ancient shaman boring slowly into my dome to cure a headache. The fact that such surgery was relatively successful is a testament to the resilience of our own brains. (Although, of course, it’s impossible to tell that, even if the patients survived for a few years, whether poking around their heads with stone tools actually produced improvements.)
But I think what’s fascinating about Sperati’s paper in a broader sense is its demonstration of how stumble-bumble the scientific (if we can call it that) process in prehistoric times, and even more recently. For just about as far back as we can tell, discoveries in science and medicine have been thanks to a mix of curiosity, luck, and brazen action. (It takes a bold person to convince someone else to submit to stone-age surgery.) I mean, the FDA has only been around since 1906, and even then people were getting prescribed opium and amphetamines.
So these days, even as clinical drug trials drag on forever and the slow approval process for medical procedures has athletes flying around the world, I guess we’re pretty lucky to be living in an age of careful research where the majority of us aren’t stuck being guinea pigs. I’ll tell you one thing though: after hearing about Neolithic craniotomies, I’m now going to feel even worse when I let loose with a string of horrific expletives next time I stub my toe.
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