Trepanning is alive and well in mainstream modern medicine.

Trepanning is alive and well in modern medicine.

They just don’t call it that any more, and of course it’s done with modern methods.

Re: Cecil’s column: What’s the story on trepanation? (Sept. 6, 2002)

It’s well-known that injured tissue, including brain, tends to have some swelling. And in the case of brain injuries, the increased intra-cranial pressure caused by that swelling often leads to additional brain damage, often even worse than the original injury.

So the emergency treatment sometimes includes removal of a chunk of skull to relieve pressure. Aside from the modern methods employed, and the removal of a whole piece of skull rather than just drilling a hole, how is this substantially different in its basic idea from trepanning?

It’s called decompressive craniectomy these days.

A high-profile and well-publicized example was the assassination attempt of Rep. Gabrielle Giffords of Arizona on January 8, 2011.

It isn’t different, and every medical doctor I’ve asked has readily agreed that the two procedures are the same thing. The only thing that’s really changed in five thousand years is that the drills are better.

One doctor handed me a pamphlet about drilling an emergency bore-hole in the field. Can be done in under five minutes, apparently.

Tibetan Buddhist shamen, when attending to the dying, often drill a hole into the top of the skull, in the belief that the orifice your soul exits your body affects your reincarnation. The higher on the body, the better the reincarnation. The shaman saves the removed pieces, stringing them together to make a mala or rosary of sorts. Both to pray with and as a resume of their experience assisting souls to their next incarnation.

Decompressive craniectomy has a specific purpose, to temporarily relieve pressure caused by swelling.

Trepanation often has many supposed purposes, for permanent brain freeing and mystical mumbo jumbo reasons.

Just like leaches are occasionally used in modern medicine. They are very useful for helping reattached limbs and digits regain bloodflow at the capillary level. And maggots can be useful in debriding infected wounds.

Doesn’t mean the ancient versions were sensible.

No. What’s changed in five thousand years is we understand what the Hell we’re doing now, why it works, and when not to do it.

Trepanation for head trauma is sometimes appropriate. Other times, it will kill you. Unless you understand the difference, you aren’t doing medicine, you’re doing magic. Trepanation for psychosis is utterly useless, even though voices in your head can sound like demons and opening a door to let them escape sounds reasonable enough if you’re a shaman who has no idea what he’s doing.

Like it or not, science has advanced, and we’re better off because of it. Trying to impute modern knowledge to previous cultures insults both ends of the equation.

On the other hand, it’s possible that the healer for a warlike tribe noticed that open-head wounds surprisingly had a better survival rate than some kinds of closed-head wounds, and concluded that, when a patient had one of those closed-head wounds, it might be better to turn it into an open-head wound. That healer might or might not understand why it works, but it could still be a conclusion arrived at via the scientific method.

To this day, don’t a lot of pharmaceutical drugs say in their data sheets that “the mechanism of action is not known”? (Isn’t aspirin one of those?)

If that’s true, then a certain amount of modern medicine is no more than mystic shamanism + modern jargon.

Or, more-or-less, what Chronos just wrote.

Wrong, because we test drugs and figure out whether they work, even if research about how they work is ongoing, and we determine exactly what they do in the body to the best of our abilities.

Shamanism is faith. It’s not amenable to being disproven, so it’s pointless to test it: Things work because the shaman says they do, and if you die anyway, it isn’t due to the shamanistic ritual being wrong, it’s due to the gods killing you off for their own ineffable reasons.

Science makes progress. Shamanism, and religion in general, does not.

So how do you drill an emergency bore-hole so it relieves the pressure, rather than causing the brain to squirt out the hole?

Carefully, one supposes.

If you trepan someone suffering from cranial rectitis he’ll end up with shit for brains.

I would imagine the same way you would perform an emergency heart transplant:
You don’t, and leave it to a trained professional who knows what they’re doing.

Then who are the pamphlets for?