Bulletin of the History of Medicine

Bulletin of the History of Medicine 78.1 (2004) 205-206

Robert Arnott, Stanley Finger, and C. U. M. Smith, eds., with the support of Boleslav Lichterman and Rupert Breitwieser. Trepanation: History—Discovery—Theory. Lisse, The Netherlands: Swets & Zeitlinger, 2003. xii + 408 pp. Ill. $99.00, €99.00 (90-265-1923-0).

The first International Colloquium on Cranial Trepanation in Human History convened eighty-nine scholars from sixteen countries at the University of Birmingham (U.K.) in April 2000. The organizer, Robert Arnott, with his co-editors, recognized the need to have this conference published in book form. Having been on both ends of this process, I can state that such efforts are rewarding but also extremely trying for the editors and contributors. The immediate problem is whether editors should simply ask the speakers to submit a written version of their talks, or whether there should be a true effort at editing the papers. The first course is easier but often results in considerable redundancy. The latter course results in a more laconic work, but requires an extraordinary degree of editing and rewriting for all concerned.

The editors in this case appear to have taken the first approach, which is by no means the easy way out. Their preface is an important part of the book, as it provides an overview of the topics addressed and a discussion of the etymology of the word "trepanation" vs. "trephination," a distinction that is also addressed in several of the chapters. Speculation on the reason for trepanation is also introduced, for the first but not the last time. Editorial input is seen in the careful organization of the book into five major sections: the first historical and clinical, the next two geographical (covering Europe, Africa, Asia, and the Americas), the fourth on trepanation in Western medicine, and the fifth a global overview and a look to future research.

The first two chapters are somewhat repetitive reviews of the history of the discovery of trepanation as a practice of some antiquity, while the third chapter, by Andreas Nerlich, O. Peschel, Albert Zink, and Friedrich Rösing, is possibly the most valuable in the book, as it details the changes occurring in the skull throughout the healing process. It has long been believed that the absence of evidence of healing indicates death during or immediately after the procedure. [End Page 205] Nerlich et al., working with modern cases, teach us that healing does not become evident until more than seventy days have passed, and that the defect is never completely closed. The geographic chapters provide a worldwide listing of known cases, and note that a number of other disorders have been misdiagnosed as trepanations. These chapters will be useful as reference material.

The section "Trepanation in Western Medicine" starts with Galen and takes us into the twentieth century, with case reports and extensive discussions of techniques. The final section starts from the Paleolithic and ends with that most twenty-first-century device, the Internet. Charles Gross reports on the International Trepanation Advocacy Group Web site. He notes that although the persistence of alternative-medicine methods can be based on the assumption that they must work because they have been around a long time, the truth is that an old procedure is not necessarily an effective one. I would add that the persistence of this practice as "a means of enlightenment and enhanced consciousness" (p. 320) is more likely an indication of the gullibility of the general public. Don Brothwell's final chapter is an excellent example of what such chapters should be: a brief review of the book is followed by a discussion with many more questions than answers, pointing the way to the aptly titled "Future Direction of Research."

Three indexes (subject, author, and name) close the book. A listing of the professional degrees of the authors would have been a useful addition. The book does suffer from redundancy, but it will be an essential addition to the library of anthropologists and physicians interested in this ancient form of surgery.