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Ancient skull was drilled and harvested for medicine in the 18th century

Ancient skull was drilled and harvested for medicine in the 18th century

The skull of a man who was beheaded in the 15 th century was at the center of a mystery until experts revealed the cranium was harvested to be used as medicine.

Within the crypt of Italy’s Otranto Cathedral resides an unnerving sight – the skulls and bones of some 800 men sit behind large glass panels, staring out as a commemoration of a tale of religious resistance. The dead men, alleged to have been executed by invading Ottoman Turks in 1480, are known as the “martrys of Otranto.”

Skulls and bones of ‘the Martyrs of Otranto’ stare out from behind glass panels in Otranto Cathedral, Italy. Laurent Massoptier, Wikimedia Commons

According to Discovery News , one of these skulls is unique in that it possesses 16 perfectly round holes on its top. How the holes were made, and for what purpose, confounded experts and visitors to the cathedral. However researchers were recently able to determine that the holes were trepannated – or drilled – into the skull after death as a way of harvesting the ground-up powder.

The skull was kept behind the glass and could not directly be accessed by researchers, but visual examination determined the holes were all regular, round shapes. Eight of the 16 holes were bored all the way through the skull, notes Discovery News.

Skull and bone powder was thought to treat many illnesses and diseases, such as epilepsy, paralysis or stroke. These ailments and others were believed to be caused by demons or magical influences.

A research paper on the skull has been published in the Journal of Ethnopharmacology . It details the findings of Gino Fornaciari, professor of history of medicine and paleopathology at the University of Pisa, and colleagues.

18th-century French illustration of trepanation.

Fornaciari and colleagues surmise that the depressions and holes were drilled into the skull long after the death of the victim, and were made by a tool specifically designed to pulverize the bone into powder. He describes the tool as “a particular type of trepan, with semi-lunar shaped blade or rounded bit; a tool of this type could not produce bone discs, but only bone powder.”

Rounded drill bits used in trepanning wherein the bone is pulverized so as to collect the powder. Credit: Gino Fornaciari et al.

The skull specimen is significant. The unique evidence supports known texts and historical accounts of bone powder use in medicine. It is also of interest to the researchers due to its religious context.

The 813 ‘martyrs of Otranto’ are known as the patron saints of the Italian city of Otranto. They are said to have died on Aug. 14, 1480 after a 15-day assault on the city by an overwhelming Ottoman force. Thousands were slaughtered, and thousands more women and children were sold into slavery. Any soldiers or fighting men who lived through the siege were taken prisoner. The story goes that they were instructed to convert from Christianity to Islam. When they refused, it is said they were beheaded one by one in a mass execution, and their skulls and bones now reside in Otranto Cathedral.

Skull of ‘the Martyrs of Otranto’ in Otranto Cathedral, Italy. Andrea Marutti/ Flickr

Fornaciari and colleagues theorize that as the remains were considered to be from martyrs and saints, the bones were likely regarded as having potent medicinal properties, a “powerful ingredient for pharmacological preparations.”

Valentina Giuffra, from Pisa University’s division of paleopathology and co-author of the study told Discovery News, “The head was considered the most important part of the human body. It was believed that right there invisible spiritual forces remained active even after death.”

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French chemist Nicolas Lémery (1645 –1715) wrote in his work “Pharmacopée universelle”, that powdered skull, when combined with water and swallowed, was an effective treatment for “illness of the brain,” reports LiveScience. Lémery continued, “The skull of a person who died of violent and sudden death is better than that of a man who died of a long illness or who had been taken from a cemetery: the formers has held almost all of his spirits, which in the latter they have been consumed, either by illness or by the earth.”

In the 18 th century skull powder was used as medicine to treat illnesses. This jar label represents “CRAN(IUM) HUM(A)N(UM) P(RE)P(ARA)T(UM)”. Credit: Museum of Pharmacy, Cracow

It’s not known why that particular skull was chosen out of the many to be drilled. The researchers can only suggest that the procedure took place when the skulls and bones were being carefully arranged within the glass cabinets, in 1711.

Much has been gleaned on the practice of trepanation and ancient surgery, with archaeological finds revealing trepanning surgeries performed in Siberia 2,000 years ago, leg drilling surgery in prehistoric Peru, and skull trepanation in skulls in Turkey dating back to 9000 B.C.

This historically significant holy (and holey) skull gives a rare glimpse into the world of historical medicine, and the use of human remains in pharmacological treatments.

Featured Image: Skull with multiple drill markings. Credit: Gino Fornaciari/University of Pisa

By Liz Leafloor


Ancient Iranian medicine

The practice and study of medicine in Persia has a long and prolific history. [1] The Iranian academic centers like Gundeshapur University (3rd century AD) were a breeding ground for the union among great scientists from different civilizations. [2] [3] These centers successfully followed their predecessors’ theories and greatly extended their scientific research through history. Persians were the first establishers of modern hospital system. [4] [5]

In recent years, some experimental studies have indeed evaluated medieval Iranian medical remedies using modern scientific methods. These studies raised the possibility of revival of traditional treatments on the basis of evidence-based medicine. [6]


A Hole in the Head: A History of Trepanation

A detail of a 17th-century naval surgeon’s trephination kit. The trephines are very similar to both ancient Roman and modern ones.

In 1865, in the ancient Inca city of Cuzco, Ephraim George Squier, explorer, archeologist, ethnologist and U.S. charge d’affaires in Central America, received an unusual gift from his hostess, Señora Zentino, a woman known as the finest collector of art and antiquities in Peru. The gift was a skull from a vast nearby Inca burial ground. What was unusual about the skull was that a hole slightly larger than a half-inch square had been cut out of it. Squier’s judgment was that the skull hole was not an injury but was the result of a deliberate surgical operation known as trepanning and furthermore, that the individual had survived the surgery.

When the skull was presented to a meeting of the New York Academy of Medicine, the audience refused to believe that anyone could have survived a trephining operation carried out by a Peruvian Indian. Aside from the racism characteristic of the time, the skepticism was fueled by the fact that in the very best hospitals of the day, the survival rate from trephining (and many other operations) rarely reached 10 percent, and thus the operation was viewed as one of the most perilous surgical procedures. The main reason for the low survival rate was the deadly infections then rampant in hospitals. Another was that the operation was only attempted in very severe cases of head injury.

Squier then brought his Peruvian skull to Europe’s leading authority on the human skull, Paul Broca, professor of external pathology and of clinical surgery at the University of Paris and founder of the first anthropological society. Today, of course, Broca is best known for his localization of speech in the third frontal convolution, “Broca’s area,” the first example of cerebral localization of a psychological function, but at this time his fame seems to have been primarily for his craniometric and anthropological studies.

The trephined Inca skull given to Ephraim George Squier. It now resides in the American Museum of Natural History.

Broca and More Skulls

After examining the skull and consulting some of his surgical colleagues, Broca was certain that the hole in the skull was due to trephination and the patient had survived for a while. But when, in 1876, Broca reported these conclusions to the Anthropological Society of Paris, the audience, as in the United States, was dubious that Indians could have carried out this difficult surgery successfully.

Seven years later a discovery was made in central France that confirmed Broca’s interpretation of Squier’s skull, or at least demonstrated that “primitives,” indeed Neolithic ones, could trephine successfully. A number of skulls in a Neolithic gravesite were found with roundish holes two or three inches wide. The skulls had scalloped edges as if they had been scraped with a sharp stone. Even more remarkable, discs of skull of the same size as the holes were found in these sites. Some of the discs had small holes bored in them, perhaps for stringing as amulets. Although a few of the discs had been chiseled out after death, in most cases it was clear from the scar formation at the wound’s edge that the interval between surgery and death must have been years. Trephined skulls were found of both genders and of all ages. Virtually none of the skull holes in this sample were accidental, pathological, or traumatic. Furthermore very few of the skulls showed any sign of depressed fractures, a common indication for trephining in modern times.

Trephined skulls have been discovered in widespread locations in every part of the world, in sites dating from the late Paleolithic to this century.

These findings finally established that Neolithic man could carry out survival trephination but left unresolved the motivation for this operation. At first, Broca thought that the practice must have been some kind of religious ritual, but later he concluded that, at least in some cases, it must have had therapeutic significance. Broca actually wrote more papers on prehistoric trephination and its possible motivation than he did on the cortical localization of language. Since Broca’s time thousands of trephined skulls have been found and almost as many papers written about them. They have been discovered in widespread locations in every part of the world in sites dating from the late Paleolithic to this century. The usual estimates for survival of different samples of trephined skulls range from 50 percent to 90 percent with most estimates on the higher side.

Methods of Trephining

Across time and space five main methods of trephination were used. The first was rectangular intersecting cuts as in Squier’s skull. These were first made with obsidian, flint, or other hard stone knives and later with metal ones. Peruvian burial sites often contain a curved metal knife called a tumi, which would seem to be well suited for the job. (The tumi has been adopted by the Peruvian Academy of Surgery as its emblem.) In addition to Peru, skulls trephined with this procedure have been found in France, Israel, and Africa.

The second method was scraping with a flint as in skulls found in France and studied by Broca. Broca demonstrated that he could reproduce these openings by scraping with a piece of glass, although a very thick adult skull took him 50 minutes “counting the periods of rest due to fatigue of the hand.” This was a particularly common method and persisted into the Renaissance in Italy.

Different methods of trephining: (1) scraping (2) grooving (3) boring and cutting (4) rectangular intersecting cuts.

The third method was cutting a circular groove and then lifting off the disc of bone. This is another common and widespread method and was still in use, at least until recently, in Kenya.

The fourth method, the use of a circular trephine or crown saw, may have developed out of the third. The trephine is a hollow cylinder with a toothed lower edge. Its use was described in detail by Hippocrates. By the time of Celsus, a first-century Roman medical writer, it had a retractable central pin and a transverse handle. It looked almost identical to modern trephines including the one I used as a graduate student on monkeys.

The fifth method was to drill a circle of closely-spaced holes and then cut or chisel the bone between the holes. A bow may have been used for drilling or the drill simply rotated by hand. This method was recommended by Celsus, was adopted by the Arabs, and became a standard method in the Middle Ages. It is also reported to have been used in Peru and, until recently, in North Africa. It is essentially the same as the modern method for turning a large osteoplastic flap in which a Gigli saw (a sharp-edged wire) is used to saw between a set of small trephined or drilled holes. (I used this method as a graduate student, too.)

“Trepan” Versus “Trephine”

The relationship between the terms trepan and trephine is a curious one. The terms are now synonyms but have different origins and once had different meanings. In Hippocrates’ time the terms terebra and trepanon (from the Greek trupanon, a borer) were used for the instrument that is very similar to the modern trephine. In the 16th century, Fabricius ab Aquapendente invented a triangular instrument for boring holes in the skull. (He was Harvey’s teacher and the discoverer of venous valves.) It had three arms with different-shaped points. Each of the ends could be applied to the skull using the other two as handles. He called it a “tre fines” from the Latin for three ends, which became trafine and then trephine, and by 1656 it was used as a synonym for trepan, as a term for the older instrument. In another version of the etymology, a quite different triangular instrument for boring a hole in the skull was invented in 1639 by John Woodall, a London surgeon, who also called his instrument a tres fines, which became trefina and then trephine and, eventually, a synonym for trepan. More generally, in Renaissance times and later, trephination was a popular operation and a great variety of instruments for carrying it out were invented.

Why did so many cultures in different periods cut or drill holes in the skull? Since most trephined skulls come from vanished nonliterate cultures, the problem of reconstructing the motivations for trephining in these cultures is a difficult one. However, there is information about trephining in Western medicine from the fifth century BCE onward as well as about trephining in recent and contemporary non-Western medical systems. Both of these sources may throw light on the reasons for the practice in earlier times. In the following sections we consider trephination in Hippocratic medicine, in ancient Chinese medicine, in European medicine from the Renaissance onward, in contemporary non-Western medicine, and on the Internet today.

Greek Medicine

The earliest detailed account of trephining is in the Hippocratic corpus, the first large body of Western scientific or medical writing that has survived. Although there is no question that there was a famous physician called Hippocrates in the fifth century BCE, it is not clear which of the Hippocratic works were written by him. The most extensive discussion of head injuries and the use of trephining in their treatment is in the Hippocratic work On Wounds in the Head.

A 17th-century naval surgeon’s trephination kit.

This treatise describes five types of head wounds. Interestingly, however, the only type for which trephination is not advocated is in cases of depressed fractures. Even when there is not much sign of bruising, drilling a hole in the head is recommended. The trephining instrument was very similar to the modern trephine, except that it was turned between the hands or by a bow and string rather than by using a crosspiece. The Hippocratic writer stressed the importance of proceeding slowly and carefully in order to avoid injuring the [dural] membrane. Additional advice was to “plunge [the trephine] into cold water to avoid heating the bone . . . often examine the circular track of the saw with the probe. . . . [and] aim at to and fro movements.” Trephining over a suture was to be studiously avoided.

The Hippocratic doctors believed that stagnant blood (like stagnant water) was bad. It could decay and turn into pus. Thus, the reason for trephining, or at least one reason, was to allow the blood to flow out before it spoiled.

Apparently the Hippocratic doctors expected bleeding from a head wound and the reason for drilling the hole in the skull was to allow the blood to escape (“let blood by perforating with a small trepan, keeping a look out [for the dura] at short intervals”). Since they presumably had no notion of intracerebral pressure, why did they want the blood to run out? Although the reasons for trephining are not discussed in “On Wounds in the Head,” they seem clear from other Hippocratic treatises such as “On Wounds and On Diseases.” The Hippocratic doctors believed that stagnant blood (like stagnant water) was bad. It could decay and turn into pus. Thus, the reason for trephining, or at least one reason, was to allow the blood to flow out before it spoiled. In cases of depressed fractures, there was no need to trephine since there were already passages in the fractured skull for the blood to escape.

By Galen’s time (129–199) trephining was in standard use in treating skull fracture for relieving pressure, for gaining access to remove skull fragments that threatened the dura, and, as in Hippocratic medicine, for drainage. Galen discussed the techniques and instruments in detail and advocated practicing on animals, especially the Barbary “ape” (Macaca sylvana). He was well aware of avoiding damage or pressure on the dura and indeed carried out experiments on the effect of pressing on the dura in animals.

Trepanation in Ancient China

The possibility that trepanation was practiced in ancient China is suggested by the following story about Cao Cao and Hua Tua, from a historical novel attributed to Luo Guanzhong, written in the Ming dynasty (1368–1644) and set in 168–280 at the end of the Later Han dynasty. Cao Cao was commander of the Han forces and posthumously Emperor of the Wei dynasty, and Hua Tuo was (and still is) a famous physician of the time.

Cao Cao screamed and awoke, his head throbbing unbearably. Physicians were sought, but none could bring relief. The court officials were depressed. Hua Xin submitted a proposal: “Your highness knows of the marvelous physician Hua Tuo? . . . Your highness should call for him.”

Hua Tuo was speedily summoned and ordered to examine the ailing king. “Your Highness’s severe headaches are due to a humor that is active. The root cause is in the skull, where trapped air and fluids are building up. Medicine won’t do any good. The method I would advise is this: after general anesthesia I will open your skull with a cleaver and remove the excess matter, only then can the root cause be removed.” “Are you trying to kill me?” Cao Cao protested angrily . . . [and] . . . ordered Hua Tuo imprisoned and interrogated.

Ten days later Hua Tuo died. His medical text was lost upon his death.

Western Medicine

From the Renaissance until the beginning of the 19th century trephining was widely advocated and practiced for the treatment of head wounds. The most common use was in the treatment of depressed fractures and penetrating head wounds. However, because of the high incidence of mortality particularly when the dura was penetrated, there was considerable debate in the medical literature throughout this long span about if and when to trephine. Besides trephining in cases of skull fracture, the Hippocratic practice of “prophylactic trephination” in the absence of fracture after head injury continued to persist. For example, in the 1800s Cornish miners “insisted on having their skulls bored” after head injuries, even when there was no sign of fracture.

The practice of trephination was so dangerous that the first requirement for the operation was said to be “that the wound surgeon himself must have fallen on his head.”

Until the early 19th century trephination was done in the home. However, when the operation was moved to hospitals, the mortality was so high that trephination for any reason including treatment of fractures and other head injury declined precipitously. The practice was so dangerous that the first requirement for the operation was said to be “that the wound surgeon himself must have fallen on his head.” Or as Sir Astley Cooper put it in 1839, “If you were to trephine you ought to be trephined in turn.” It was against this background that the discovery of Neolithic trephining was so unbelievable to the American and French medical communities in the middle of the 19th century. Eventually, the introduction of modern antisepsis and prophylaxis of infection at the end of the 19th century, as well as an increased understanding of the importance of intracerebral pressure in head injury, allowed trephination to return as a common procedure in the management of head trauma.

In modern neurosurgical practice, trephining is still an important procedure but it is no longer viewed as therapeutic in itself. It may be used for exploratory diagnosis, for relieving intracerebral pressure (as from an epidural or subdural hematoma), for debridement of a penetrating wound, and to gain access to the dura and thence the brain itself (for example, to provide a port through which a stereotactic probe can be introduced into the brain.)

Epilepsy and Mental Disease

In the European medical tradition, in addition to its use in treating head injury, trephining has been an important therapy for two other conditions, epilepsy and mental illness.

A 16th-century woodcut of a trephination in the home. Note the man warming a cloth dressing, the woman praying, and the cat catching a rat.

The tradition of trephining as a treatment for epilepsy begins as early as Aretaeus the Cappadocian (ca. 150), one of the most famous Greek clinicians, and lasted into the 18th century. The 13th-century surgical text “Quattuor magistri” recommended opening the skulls of epileptics so “that the humors and air may go out and evaporate.” However, by the 17th century trephination for epilepsy was beginning to be viewed as an extreme measure, as in Riverius, “The Practice of Physick” (1655):

If all means fail the last remedy is to open the fore part of the Skul with a Trepan, at distance from the sutures, that the evil air may breath out. By this means many desperate Epilepsies have been cured, and it may be safely done if the Chyrurgeon be skilful.

One 13th-century text recommended opening the skulls of epileptics so “that the humors and air may go out and evaporate.”

By the 18th century the incidence of trephining for epilepsy had declined and its rationale changed. Now rather than the idea of allowing an exit for evil vapors and humors, the purpose was to remove some localized pathology. By the 19th century trephining for epilepsy was confined to the treatment of traumatic epilepsy, that is, cases associated with known head injury.

Another use of trephining was as a treatment for mental disease. In his “Practica Chirurgiae,” Roger of Parma (ca. 1170) wrote:

For mania or melancholy a cruciate incision is made in the top of the head and the cranium is penetrated, to permit the noxious material to exhale to the outside. The patient is held in chains and the wound is treated, as above, under treatment of wounds.

Robert Burton, in “Anatomy of Melancholy” (1652), also advocated boring a cranial hole for madness, as did the great Oxford neuroanatomist and physician Thomas Willis (1621–1675).

Hieronymus Bosch’s The Cure for Madness (or Folly), also known as The Stone Operation shows a surgical incision being made in the scalp.

Probably the most famous depictions of apparent trephining for mental disease are in early Flemish Renaissance painting. Thus, Hieronymus Bosch’s The Cure for Madness (or Folly), also known as The Stone Operation, shows a surgical incision being made in the scalp. The inscription has been translated in part “Master, dig out the stones of folly.” There are similar depictions of the removal of stones from the head by Peter Bruegel, Jan Steen, Pieter Huys, and other artists of the time.

By the 18th century, “most reputable and enlightened surgeons gave up the practice of . . . [trephination] . . . for psychiatric aberrations or headache without evidence of trauma. Thus, . . . the skull was never to be trephined for ‘internal disorders of the head.”’

Trephining in Africa

Herodotus describes the Libyans as cauterizing the heads of their children to “prevent them being plagued in their afterlives by a flow of rheum from the head.” And indeed, trephined skulls have been found among the people he was probably writing about, the Tuareg nomads.

An important source of information on the motivations for trephination is contemporary traditional practitioners and their patients. There are literally hundreds of 20th-century accounts of trephination, particularly in Oceanic and African cultures. Especially detailed and recent ones concern the Kisii of South Nyanza in Kenya and include photographs of the surgical instruments, practitioners, and patients X-rays of the skulls of surviving patients detailed interviews and even a documentary film.

The ancient Greek historian Herodotus describes the Libyans as cauterizing the heads of their children to “prevent them being plagued in their afterlives by a flow of rheum from the head.”

Trephining among the Kisii is carried out primarily for the relief of headache after some kind of head injury. According to Margetts, it is not done for “psychosis, epilepsy, dizziness or spirit possession.” The operation is carried out by general practitioners of medicine and takes a few hours. Restraint rather than anesthesia is used. The hole in the skull is usually made by scraping with a sharp knife with a curved tip to avoid injuring the dura. Various medicines are administered before, during, and after surgery but their nature does not seem to have been studied. Mortality, by one authority, is described as “low, perhaps 5 per cent.” The practitioners and patients seem to be quite satisfied with the results of the operation.

Although headache after head injury is the most prevalent reason given for trephining by contemporary practitioners of traditional medicine in Africa and elsewhere, other reasons are cited in the literature such as “to let out the evil spirits which were causing an intractable headache.”

Trephining on the Internet

Today, the practice of trephining is not confined to surgical suites or traditional medicine men. It is advocated by the International Trepanation Advocacy Group as a means of enlightenment and enhanced consciousness. Their general idea is that when the skull sutures close in childhood it “inhibits brain pulsations causing a loss of dreams, imagination and intense perceptions.” Trephining a small hole, they say, “restores the intracranial pulse pressure which leads to a permanent increase of the brain-blood volume which leads to accelerated brain metabolism and more areas of the brain functioning simultaneously” and “increased originality, creativity and…testosterone level.” Beyond such “physiological” arguments, the group supports the practice by pointing out its ancient, widespread, and continuing presence in other cultures. This particular form of alternative medicine recently gained considerable if not entirely positive publicity: In November 1998 it was featured on ER, the television soap opera set in an emergency ward.

Much of the defense for alternative medicine treatments is that they must work because they have been around for such a long time, an apparently attractive argument for the increasing popularity of five-thousand-plus-year-old Chinese traditional medical practices. However, the case of trephining suggests that just because a procedure is very old does not mean it is necessarily an effective one, at least for enhanced enlightenment and creativity.

Trepanation as an Empirical If Not a Rational Procedure

The most common view of the prehistoric and the non-Western practice of trephining, especially in the absence of a depressed fracture, was that it represented some kind of “superstition,” “primitive thinking,” “magic,” or “exorcism.” Yet an examination of the reasons for the practice among the Hippocratic and early European doctors as well as among contemporary Kenyan practitioners suggests a different view. Trephining may have appeared, in these contexts and cultures, to have been an effective empirical approach to head injury and the headaches that often accompany them. Headaches after head injury often do feel like “a pounding” and “pressure” inside the head and thus the idea that a hole in the skull would relieve them is not necessarily magical or bizarre. Furthermore, epidural bleeding does sometimes accompany head injury, and in these cases trephining might have actually reduced intracranial pressure. Finally, the apparently excellent survival rate meant that the procedure, at least until it moved into a hospital setting, may have met the prime requirement of medicine, “do no harm.”

POSTSCRIPT

The first International Colloquium on Cranial Trepanation in Human History was held at the University of Birmingham in April 2000. Papers from this unique three-day meeting were published as Trepanation: History, Discovery, Theory, which provides the most complete review of the subject to date. A major achievement of the meeting was the demonstration that trepanation was widespread in many regions of Europe, Asia, Africa, Oceania, and the Americas in both preliterate and literate periods. The volume also contains illustrations of trephined skulls from many cultures and of the great variety of instruments used.

Another interesting development was the return of E. L. Margetts to the Kisii of Kenya, whose trepanning practices he had studied 25 years earlier. He estimates that there may now be more than 100 surgeons carrying out the operation. Unlike in the past, they now use modern Western local anesthetics injected into the scalp prior to surgery. However, the reasons for the very low rate of infections still have not been studied systematically.

Since my original article, there seems to have been an increase in Internet sites advocating trepanning and often self-trepanning for the treatment of, among other disorders, depression, chronic fatigue syndrome, and stress and to improve mental “energy and vigor.”

The British Medical Journal took these developments seriously enough to issue a warning of their dangers:

Doctors have warned about the dangers of trepanning after the launch of several websites promoting the “do it yourself ” surgery and the case of a Gloucestershire woman who drilled a 2 cm diameter hole in her skull. Concern has been expressed about the growing interest in trepanning for several conditions, including depression and chronic fatigue syndrome. Concern is also growing about the increasing promotion of trepanning, including videos, T-shirts, and a virtual trepanning shopping mall on the internet.

Trepanning received widespread publicity when the surgeon Stephen Maturin carried out the procedure on a sailor in view of the assembled crew in the film Master and Commander: The Far Side of the World, based on the Patrick O’Brian naval novels about the Napoleonic Wars.

Charles G. Gross was a pioneering neuroscientist who specialized in vision and the functions of the cerebral cortex. This essay is excerpted from his book “A Hole in the Head: More Tales in the History of Neuroscience.”


The History of Mental Illness: From Skull Drills to Happy Pills

The limitlessly varied personalities of human beings have fascinated both scientists and fellow members of society throughout the existence of humankind. Of particular interest has been what happens when man&rsquos mind turns against him, and what can be done, if anything at all, to reverse this tragic event.

Attempts to treat mental illness date back as early as 5000 BCE as evidenced by the discovery of trephined skulls in regions that were home to ancient world cultures (Porter 10). Early man widely believed that mental illness was the result of supernatural phenomena such as spiritual or demonic possession, sorcery, the evil eye, or an angry deity and so responded with equally mystical, and sometimes brutal, treatments.

Trephining (also referred to as trepanning) first occurred in Neolithic times. During this procedure, a hole, or trephine, was chipped into the skull using crude stone instruments. It was believed that through this opening the evil spirit(s)--thought to be inhabiting one&rsquos head and causing their psychopathology--would be released and the individual would be cured (&ldquoMeasuring&rdquo). Some who underwent this procedure survived and may have lived for many years afterward as trephined skulls of primitive humans show signs of healing. Pressure on the brain may have also incidentally been relieved (Butcher 28). This procedure endured through the centuries to treat various ailments such as skull fractures and migraines as well as mental illness, albeit with more sophisticated tools such as skull saws and drills developed solely for this purpose (&ldquoMeasuring&rdquo).

In ancient Mesopotamia, priest-doctors treated the mentally ill with magico-religious rituals as mental pathology was believed to mask demonic possession (Alexander 19). Exorcisms, incantations, prayer, atonement, and other various mystical rituals were used to drive out the evil spirit. Other means attempted to appeal to the spirit with more human devices--threats, bribery, punishment, and sometimes submission, were hoped to be an effective cure (Alexander 8).

Figure 1: A depiction of treppaning from the painting Cutting the Stone (circa 1494) by Hieronymus Bosch.

Hebrews believed that all illness was inflicted upon humans by God as punishment for committing sin, and even demons that were thought to cause some illnesses were attributed to God&rsquos wrath. Yet, God was also seen as the ultimate healer and, generally, Hebrew physicians were priests who had special ways of appealing to the higher power in order to cure sickness. Along the same spiritual lines, ancient Persians attributed illness to demons and believed that good health could be achieved through proper precautions to prevent and protect one from diseases. These included adequate hygiene and purity of the mind and body achieved through good deeds and thoughts (Alexander 20-22).

Ancient Egyptians seem to be the most forward-thinking in their treatment of mental illness as they recommended that those afflicted with mental pathology engage in recreational activities such as concerts, dances, and painting in order to relieve symptoms and achieve some sense of normalcy. The Egyptians were also very advanced in terms of medicine, surgery, and knowledge of the human body. Two papyri dating back to the sixteenth century BCE, the Edwin Smith papyrus and the Ebers papyrus, document early treatment of wounds, surgical operations, and identifies, very likely for the first time, the brain as the site of mental functions.

These papyri also show that, despite innovative thinking about disease, magic and incantations were used to treat illnesses that were of unknown origin, often thought to be caused by supernatural forces such as demons or disgruntled divine beings (Butcher 28). Ancient Egyptians also shared the early Greek belief that hysteria in women, now known as Conversion Disorder, was caused by a &ldquowandering uterus,&rdquo and so used fumigation of the vagina to lure the organ back into proper position (Alexander 21).

In all of these ancient civilizations, mental illness was attributed to some supernatural force, generally a displeased deity. Most illness, particularly mental illness, was thought to be afflicted upon an individual or group of peoples as punishment for their trespasses. In addition to the widespread use of exorcism and prayer, music was used a therapy to affect emotion, and the singing of charms and spells was performed in Babylonia, Assyria, the Mediterranean-Near East, and Egypt in hopes of achieving a cure (Rosen).

Beliefs about mental illness and proper treatments were altered, and in some cases advanced, by early European thinkers. Between the 5 th and 3 rd centuries BCE, Greek physician Hippocrates denied the long-held belief that mental illness was caused by supernatural forces and instead proposed that it stemmed from natural occurrences in the human body, particularly pathology in the brain. Hippocrates, and later the Roman physician Galen, introduced the concept of the four essential fluids of the human body&mdashblood, phlegm, bile, and black bile&mdashthe combinations of which produced the unique personalities of individuals (Butcher 29).

Through the Middles Ages, mental illness was believed to result from an imbalance of these humors. In order to bring the body back into equilibrium, patients were given emetics, laxatives, and were bled using leeches or cupping (MacDonald 187). Specific purges included a concoction developed by Ptolemy called Hiera Logadii, which combined aloes, black hellebore, and colocynth and was believed to cleanse one of melancholy. Confectio Hamech was another laxative developed by the Arabs that contained myrobalans, rhubarb, and senna (MacDonald 187). Later, tobacco imported from America was popularly used to induce vomiting (MacDonald 188). Other treatments to affect the humors consisted of extracting blood from the forehead or tapping the cephalic, saphenous, and/or hemorroidal veins to draw corrupted humors away from the brain (MacDonald 191). In addition to purging and bloodletting (also known as phlebotomy), customized diets were recommended. For example, &ldquoraving madmen&rdquo were told to follow diets that were &ldquocooling and diluting,&rdquo consisting of salad greens, barley water, and milk, and avoid wine and red meat (Porter 42).

Custody and care of the mentally ill were generally left to the individual&rsquos family, although some outside intervention occurred. The first mental hospital was established in 792 CE Baghdad and was soon followed by others in Aleppo and Damascus&mdashmass establishment of asylums and institutionalization took place much later, though (Butcher 32). The mentally ill in the custody of family were widely abused and restrained, particularly in Christian Europe. Due to the shame and stigma attached to mental illness, many hid their mentally ill family members in cellars, caged them in pigpens, or put them under the control of servants (Porter 92). Others were abandoned by their families and left to a life of begging and vagrancy.

The social stigma attached to mental illness was, and to some extent still is, pronounced in countries that have strong ties to family honor and a reliance on marriages to create alliances and relieve families of burdensome daughters. In China, the mentally ill were concealed by their families for fear that the community would believe that the affliction was the result of immoral behavior by the individual and/or their relatives. The mentally ill were also thought to have &ldquobad fate&rdquo that would negatively influence anyone who associated with the disturbed individual, scaring away potential suitors and leading to the idea that mental illness was contagious (Phillips 10).

Historically in Greece, &ldquoa mentally ill [family] member implies a hereditary, disabling condition in the bloodline and threatens [the family&rsquos] identity as an honorable unit,&rdquo therefore treatment of the mentally ill in these cultures meant a life of hidden confinement or abandonment by one&rsquos family (Blue 305). Mentally ill vagrants were left alone to wander the streets so long as they did not cause any social disorder. Those who were deemed dangerous or unmanageable, both in family homes or on the streets, were given over to police and thrown in jails or dungeons, sometimes for life ( Stigma 43). Particularly in Europe during the Middle Ages, beatings were administered to the mentally ill who acted out as punishment for the disturbances their behavior caused and as a means of &ldquoteaching&rdquo individuals out of their illnesses. Others who were considered nuisances were flogged out of town (Rosen).

Through the Middle Ages and until the mass establishment of asylums, treatments for mental illness were offered by humanistic physicians, medical astrologers, apothecaries, and folk or traditional healers (MacDonald 175). Aside from secular exorcisms, prayers, charms, amulets, and other mystical treatments were available. In the 17 th century, astral talismans were popular and were easily made using brass or tin emblems with astrological signs etched into them and cast at astrologically significant times. These were worn around the neck of the afflicted while they recited prayers (MacDonald 213-214). Also worn around the neck were scraps of Latin liturgy wrapped in paper, bundled with a leaf of mugwort or St. John&rsquos Wort and tied with taffeta (MacDonald 214). Amulets were also used, supplemented by prayers and charms, to soothe troubled minds, prevent mystical infection, and protect against witches and evil spirits (MacDonald 214). Sedatives during the 17 th century consisted of opium grains, unguents, and laudanum to &ldquoease the torment&rdquo of mental illness (MacDonald 190). Continued on Next Page »


3. Trepanation

There is evidence of this practice, Trepanning, in the Neolithic. It consists of piercing the skull with a sharp element -or with metal knives when they already existed- to reach the brain.

This method was intended to cure from migraines to epilepsies or psychosis. In ancient civilizations, such as the Egyptian or the Mayan, “it is not known for sure if the practice consisted of a surgical intervention or responded only to a ritual,” says Dinarès.

The fact of suffering a Trepanning did not have to be synonymous with death. Trepanned skulls with signs of survival have been found.

This is demonstrated by the growth of new bone around the trepanation hole ”, emphasizes this Egyptologist Said medical practice is in force today. For example, to drain a hematoma. It is a common technique for neurosurgeons.


The 16th-Century guy, Paracelsus, a German-Swiss physician, spread the benefits of drinking fresh blood for maintaining the vitality of the body — his followers became so obsessed with blood that they even suggested taking it out of a living body.

The blood needed to be fresh, and this requirement was quite challenging. Back then, the poor could not afford the expensive medicines composed of complex compounds. Thus, they relied on cannibal medicine.

To reap the most benefit of such practices, they used to stand at executions, pay a small amount and drink the warm blood of the condemned — simply gross.

By this single incident, one can perceive the power the executioner of the 16th century possessed. One was labelled as a great healer in the German countries, a social helper who benefited people.

People also had options — raw or cooked blood. Many preferred the blood to be cooked thus, in 1679, a recipe got introduced from Franciscan apothecaries detailing the procedure to make marmalade.

Blood was considered potent in terms of spiritual context. People believed that blood carried the soul thus, freshest blood was deemed most effective.

There was a blood preference with respect to gender. People often preferred to consume young men’s blood while the other times’ blood of virginal young women.


History of Mental Illness Prior to the 1900s Plus Cruel and Ineffective Treatments of the Times

While mental illnesses have been present in humans since the beginning of recorded history, it was not until the end of the 19th and start of the 20th century, that we saw the development of psychoanalysis. During this period, mental hygiene movements sprang up in many of the developed countries. These were aimed at preventing insanity through public health initiatives which included clinics, the development of clinical psychology, psychiatry and social work.

Prior to this time, however, the understanding and treatment of mental illness were not linear or progressive endeavors.This was mainly due to the disparity in the belief systems each major society espoused, in addition to the fact that abnormal behavior to one society, was normal to another.

Therefore, behaviors that deviated from cultural norms were often labeled as due to mental disorders. Frequently, these characterizations were used as a way to silence and control individuals or groups deemed dangerous to the status quo, especially when religious institutions were threatened.

While today mental illness is frequently identified by whether sufferers pose a risk of harm to themselves or to others their illnesses interfere with their normal work or harm their relationships with family and friends these were not considerations prior to the 19th century.

Last Judgment by Jacob de Backer. This painting depicts the Devil as often seen in Christian art, wielding a trident as his scepter and signature weapon By Jacob de Backer - Own work (BurgererSF),

Public Domain, https://commons.wikimedia.org/w/index.php?curid=22376613

How Ancient Civilizations Viewed Mental Illness

In ancient times, mental disorders were often considered the product of supernatural occurrences and an indication of a battle between good and evil. Often depicted as the work of the devil, those suffering from mental illness were at times perceived as evil or to have lost their souls. Accordingly, many early civilizations employed not only religious priests but also shamans, sorcerers and magicians to treat behaviors considered deviant.

In some societies mental disturbances were thought to be caused by the imbalance of fluids or due to diseased organs of the human body. Some societies, as in the case of ancient Greece, proposed the idea that chemical imbalance based on the four humors (black bile, yellow bile, phlegm, and blood) were the cause of mental illness.

Muslim physician Avicenna probed the connection between the mind and the body in his �non of Medicine”. The �rs Papyrus” from ancient Egypt made connections between mental illnesses and physical ailments such as heart conditions.

The pseudoscience known as Phrenology developed by German physician Franz Joseph Gall in 1796, involved the measurement of bumps on the skull to predict mental traits. This notion was based on the concept that different parts of the brain possessed unique functions. The shape of the skull reflected how these areas performed. Therefore by implication, mental disorder could be diagnosed using this methodology.

A psychogenic (psychological in origin) approach to mental illness did not begin to take place until late in the 18th and throughout the 19th century. In fact, the word ‘psychogenic’ was introduced into psychiatry in 1894 by German doctor Robert Sommer. This period, perhaps, was the beginning of what we understand today to be ‘modern psychiatry’.

How Different Societies Treated Mental Illness

Due to the different belief systems of past societies and cultures, individuals branded as being mentally ill, received a wide array of different treatments and care. Hence, societies where mental illness was considered to originate from physical or biological factors would treat sufferers with bloodletting, trephination, herbal medicines and purgatives mostly as a way of balancing the humors. In societies where demonic possessions were blamed for abnormal behavior, exorcism or other forms of mystical rituals would be performed.

In all societies isolation in asylums, temples or even chained in dungeons were methods used with those mentally ill people deemed violent.

Following in this article, how different societies viewed and treated mental illness will be discussed. Additionally, the reader will learn about some of the treatments used in pre-modern times that were cruel and ineffective.

A mosaic of Hippocrates on the floor of the Asclepieion of Kos, with Asklepius in the middle, 2nd-3rd century

Mental Illness in Ancient Greece

In ancient Greece around 400 BCE, Hippocrates was an early proponent of the idea that psychological disorders were caused by biological factors, therefore rejecting supernatural reasons for madness. He classified four categories of mental illness: epilepsy, mania, melancholia and brain fever.

All of these having a somatogenic origin (cellular or organic) rather than psychogenic. Under this biological model he identified syphilis as a disease that caused mental disorders. He also postulated the theory in which hysteria is caused by the uterus wandering freely within the female body and hence an illness affecting women only.

As in ancient Rome, Greek medical practitioners considered madness to be associated with aimless wandering and violence. Socrates, however, felt that demented people possessed certain positive attributes, namely the capacity for making prophesies poetic inspiration the madness of lovers and other mystical powers.

This broad-minded approach to mental illness allowed him as well as his followers, Plato and Aristotle, to explore and discuss human feelings such as pleasure pain motivation rationality. They theorized as to whether personal traits are innate or the product of experience a subject that continues to be debated by psychologist even today. This wide range of topics investigated by the Greek philosophers can be considered a precursor to today’s psychology.

The Hospital of St. Mary of Bethlehem was established in London in 1247 as a hospice. It later became the Hospital of Bethlem. Eventually known as Bedlam. The patients were known as "lunatics." Public Domain,

Europe’s Middle Ages

Some eight-hundred years after the Classical Greece period ended, Europe was on the cusp of the Middle Ages. A time when logic and the pursuit of knowledge gave way to religious fervor, superstition and the Christianization of pagan Europe. This was a time when the theories regarding mental illness shifted back to the spiritual from the physical. As the knowledge accumulated by the Greeks was lost and Christianity spread, demonic possessions became the basic assumption for any aberrant behavior.

Responsibility for treating the mentally ill shifted to the Catholic priests, subsequently, mystical rituals as exorcisms, prayers and other religious ceremonies were used as a way to treat the afflicted. While in general, the mentally ill were allowed their freedom, granting they were not dangerous, many of the people deemed insane or demented were often labeled as witches or to be inhabited by demons.

Dr. Philippe Pinel at the Salpêtrière, 1795 by Tony Robert-Fleury. Pinel ordering the removal of chains from patients at the Paris Asylum for insane women.

Institutions, Asylums and Treatments

At the beginning of the 1400s, the first European institution specifically for the insane was established in Valencia, Spain. From this point forward Europeans increasingly isolated the mentally ill with the handicapped, vagrants and delinquents. Those considered demented were treated inhumanely, often chained to walls in dungeons.

It wasn’t until the late 1700s, long after the Middle Ages that some reforms were instituted in how the mentally ill were treated. In France, physician Phillipe Pinel of the Bicêtre insane asylum forbade the use of chains and shackles. He removed patients from dungeons, provided them with sunny rooms and allowed them to exercise on the asylum grounds.

During this period of time mental treatments were diverse. Bloodletting baths diet change in order to rid the sufferer from noxious humors exorcism Holy Communion sexual diversion for the lovesick and as extreme as head surgery or trephination, were among the most common treatments for the mentally afflicted.

Ayurveda - Photo by Katherine Hanlon on Unsplash

Ancient India

In 400 BCE, the ancient Indian Yoga Sutra describes external causes of mental illness to be due to the sins committed during current and previous lives of the patients. These sins included disregarding related deceased persons, superhuman agents, deities, ghosts and celestial beings. Each of these entities could bring on different symptoms depending on the severity of the sin.

The ancient Hindu scriptures Ramayana and Mahabharata which date back to 700 and 400 BCE respectively, describe depression and anxiety as reflections of abstract metaphysical entities, supernatural agents, sorcery and witchcraft. The Charaka Samhita from 600 BCE, a part of the Hindu Ayurveda traditional medicine system, saw all ill health including mental maladies to be due to the imbalance of wind, bile and phlegm, considered the three body forces called Tri-Dosha.

This corresponded to the three elements of the universe: air, fire, and water. Ayurveda suggests the causes of this imbalance to be inappropriate diet, disrespect to the gods, mental shock due to excessive fear or joy and faulty bodily activity. It recommended treatments to include certain herbs, ointments, charms, prayers and moral or emotional persuasion.

Treatments

The earliest form of psychotherapy in India included the use of talismans, charms, prayers and sleeping in temples during the performance of rituals. It was believed that shocking a patient was a way bring back mental stability. Subsequently, patients would be terrorized by being exposed to snakes, elephants, lions, tigers, or men dressed as bandits.

Aged ghee, a form of clarified butter could be administered. Additional substances used were: Tinospora cordifolia (Heart-Leaved Moonseed), horse radish mixed with the asafetida plant, centella asiatica and roots of serpentine. When sin and witchcraft were suspected it was customary to chain the afflicted in jails and asylums.

A Corundum Evil Eye Amulet from Mesapotamia 𩣚nieliness

By Danieliness - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=12567621

Middle East During the Middle Ages

Islamic Persian and Arabic scholars integrated ancient Greek concepts into religious thought developing ideas regarding melancholia, mania, hallucinations, delusions, hysteria and other mental disorders. These ailments were generally connected to loss of reason through brain disorders but also with spiritual and mystical implications. Many medical practitioners thought dementedness was caused by the possession of a possibly good or bad 𠇍jinn” or genie. During the early stages of the Middle Ages, patients suspected of harboring a djinn inside of them risked being beaten in order to exorcise the entity.

Diagnosis and treatment for mental disorder in the early periods of the Muslim world evolved into identifying three types of conditions: (1) The organic (somatogenic) approach based on pathology and biological factors. (2) The psychological (psychogenic) approach with an emphasis on intrapsychic processes and conflict. (3) The magical or sacred approach which views insanity through a supernatural and divine perspective.

The first psychiatric hospitals or asylums were founded in Arabic countries. going back to 705 A.D. in Baghdad. After which other institutions were established in Cairo and Damascus. The main purpose of these institutions was to isolate and treat the mentally ill. Treatments included healers (Sufi masters) that would exorcise spirits called jinns, through the reading of the Quran, prayers, playing music, dancing and more drastically beating the patient, sometimes with sticks. A practice that continues until today.

Acupuncture points, drawing from a Chinese manuscript in the Bibliothèque Nationale de France.

Courtesy of the Bibliothèque Nationale, Paris - Public Domain

Ancient China

Records from ancient China going back to 1100 BCE point to a combination of a somatogenic and supernatural approach to the understanding as well as treating dementedness. The use of Traditional Chinese Medicine (TCM) which emphasized herbal medications, acupuncture and 𠇎motional therapy” was common throughout the Middle Kingdom.

Symptoms, mechanisms and treatments for mental illness as described in the Huangdi Neijing or Esoteric Scripture of the Yellow Emperor emphasized connections between bodily organs and emotions. Accordingly, each of the 𠇏ive Viscera” — liver, heart, spleen, lungs and kidney —𠂪re regarded as organs that store each of the 𠇏ive Intents” — hun-soul, spirit, po-soul, will and intent. The Five Viscera were also said to correspond with different emotions —𠂪nger, joy, worry, sorrow and fear.

Therefore, when a visceral organ experienced change, the mental state corresponding to it would change as well. Conversely, any imbalance in emotions would also cause change in the corresponding organ.

However, the Huangdi Neijing also accepted that demonic possession played a part in mental illness. TCM practitioners of this era felt that certain spaces of emotional outbursts such as funeral homes or instances of trauma could open up the Wei Chi allowing for an individual to be possessed by a spirit or demon. According to the Chinese philosophy of Wuxing or 𠇏ive stages”, which was used to describe interactions and relationships between phenomena, mental illness represented the imbalance between the yin and yang.

Cover of book by Thomas Willis&apos &apos&aposPathologiae cerebri et nervosi generis specimen&apos&apos (1667) It is an important work on the pathology and neurophysiology of the brain. Willis contributed to the development of psychiatry.

Europe and the Americas 16th to 18th Centuries

Europe

Prior to the period between the 16th and 18th century supernatural theories of mental illness dominated Europe. Common treatments for dementedness were based on superstition, astrology and alchemy. They included prayer, touching of religious relics, confession and atonement.

Commencing in the 13th century those deemed to suffer mentally, especially women were persecuted as witches or as possessed by the devil. At the height of these witch hunts in 1563 Johan Weyer a Dutch physician, occultist and demonologist wrote De Praestigiis Daemonum et Incantationibus ac Venificiis (On the Illusions of the Demons and on Spells and Poisons) a treatise against the persecution of witches. He argued that these were nothing more than women suffering from mental illness. He further argued that insanity was not due to demonic possession but rather faulty metabolism and disease.

Similarly, in 1584, Reginald Scot an English parliamentarian authored The Discoverie of Witchcraft, which also railed against the belief that witchcraft existed. In his writing he exposed how the so-called miraculous feats of magic were done. Unfortunately, the Catholic Inquisition banned both of their writings and witch hunting did not experience a decline until more than 100,000 witches were burned at the stake sometime between the 17th and 18th centuries.

Toward the end of the 16th century the establishment of hospitals and asylums to treat the mentally ill as well as to house the poor, homeless, unemployed and criminals began to flourish. Wars and economic depression produced vast numbers of undesirables that people demanded their separation from society, consequently sent to these institutions. Two of the most famous institutions were St. Mary of Bethlehem in London, eventually known as Bedlam, and the Hôpital Général of Paris. Most of those confined in these institutions were held against their will, lived in filth and often chained to walls. These institutions were open to public viewing for a fee.

During this time dementedness was viewed somatogenically with similar treatments to other physical illnesses which included bloodletting, purgatives and the inducement of vomiting. However, the mentally ill were viewed and treated as wild animals. They suffered through harsh treatment including restraints in chains or strapped to chairs and beds.

As asylums became privatized their owners boasted of their ability to use the ‘whip’ in order to maintain order and keep those institutionalized subdued and under control. However, treatment in the few public asylums left in Europe, was equally barbaric.

Sometime in the 18th century, protests over the conditions under which the mentally ill lived grew. A more humanitarian approach became popular. In many hospitals throughout Europe chains were removed and good hygiene was encouraged. Patients received recreation and occupational training as well as the ability to move around the grounds of the institution.

America

America’s approach to the mentally ill mirrored Europe. Asylums such as the Pennsylvania Hospital in Philadelphia and the Williamsburg Hospital in Williamsburg, Virginia established in 1756 and 1773 respectively, followed the established somatogenic theory of mental illness. Benjamin Rush considered the father of American psychiatry embraced and taught treatments such as bloodletting, gyrators and tranquilizer chair. However, when the Tuke’s York Retreat in London, England became the model for best practices in the treatment of the insane in 1772, most private asylums in the United States followed suit shortly after.

However, it wasn’t until 1817 when psychogenic treatments such as compassionate care and physical labor became a standard among the new American asylums. Institutions such as the Friends Asylum in Frankfort, Pennsylvania and the Bloomingdale Asylum in New York City adopted a moral approach to treating patients.


History of Cloves

Like the history of many spices, the history of cloves goes back many centuries. In fact, this spice was one of the first to be traded and evidence of cloves have been found in vessels dating as far back as 1721 BC. Native to the Malucca Islands, as many spices are, cloves were once a treasured commodity prized by the Ancient Romans.

But it wasn't just the Romans who enjoyed cloves. The Chinese were said to use them as far back as 226 BC. Apparently they chewed the flowerettes prior to having an audience with the Emperor so that their breath would not smell bad.

Along with nutmeg, cloves were one of the most precious spices of the 16th and 17th century, and control of them spurred expeditions as well as wars. In 1522, Magellan's ship returned from its fateful trip around the world (Magellan himself was killed in the Philipines at the Battle of Mactan.) with a ship loaded with cloves and nutmeg, much to the delight of Spain. Of course, everyone wanted in on the trade since cloves were worth more than their weight in gold. In 1605 the Dutch found their way to the Moluccas and dipped their hand into the spice trade.

In fact, the Dutch wanted a monopoly on cloves, so they went about destroying clove trees that sprouted up anywhere outside of their control. This ended up causing quite an uprising because native tradition was to plant a clove tree upon the birth of a child and the life of the tree was psychologically tied directly to that of the child. If something happened to the tree, that did not bode well for the particular child with whom it was associated. The native islanders came to hate the Dutch wherever they extended their tree burning campaign.

But monopolies never last forever. It did not take long for others to try their hands at the clove trade. By the 18th century cloves were being grown in other places including Zanzibar, Madagascar, Brazil, Mauritius, Ternate, Tidore, and Tanzania, among other places. With the disolution of the trade monopoly, the price of cloves came down and eventually cloves became a favorite spice for all classes of society, the world over.

This spice gets its name from the French word "clou" which means nail, as many have remarked on how much cloves look like nails. The clove is the dried flower bud of an evergreen tree. The essential oil is said to have many medicinal properties and has been used for centuries to cure many ailments. Most interestingly, cloves have long been used to aid in dentistry as they have local anesthetic properties.

Although they are underappreciated for their medicinal uses today, cloves have been used historically to treat many ailments. They have antiseptic, antibacterial, antifungal, antispasmodic, antiviral, antiparasitic, analgesic, and simulative properties making them a great overall healer. They can be used to stimulate the mind as well as prevent nausea, diarrhea, ease coughs, aid in digestion, and even treat conditions like malaria and cholera. They can also be used topically to treat acne, styes and sores.


Contents

Pre-Islamic Edit

The medical history of ancient Persia can be divided into three distinct periods. The sixth book of Zend-Avesta contains some of the earliest records of the history of ancient Iranian medicine. The Vendidad in fact devotes most of the last chapters to medicine. [7]

The Vendidad, one of the surviving texts of the Zend-Avesta, distinguishes three kinds of medicine: medicine by the knife (surgery), medicine by herbs, and medicine by divine words and the best medicine was, according to the Vendidad, healing by divine words: [8]

Of all the healers O Spitama Zarathustra, namely those who heal with the knife, with herbs, and with sacred incantations, the last one is the most potent as he heals from the very source of diseases.

Although the Avesta mentions several notable physicians, the most notable--Mani, Roozbeh, and Bozorgmehr—were to emerge later. [9]

The second epoch covers the era of what is known as Pahlavi literature, where the entire subject of medicine was systematically treated in an interesting tractate incorporated in the encyclopedic work of Dinkart, [10] which listed in altered form some 4333 diseases. [11]

The third era begins with the Achaemenid dynasty, and covers the period of Darius I of Persia, whose interest in medicine was said to be so great that he re-established the school of medicine in Sais, Egypt, which previously had been destroyed, restoring its books and equipment. [12]

The first teaching hospital was the Academy of Gundishapur in the Persian Empire. Some experts go so far as to claim that, "to a very large extent, the credit for the whole hospital system must be given to Persia". [13]

According to the Vendidad, physicians, to prove proficiency, had to cure three patients of the followers of Divyasnan if they failed, they could not practice medicine. At first glance, this recommendation may appear discriminant and based on human experimentation. But some authors have construed this to mean that, from the beginning, physicians were taught to remove the mental barrier and to treat adversaries as well as friends. [14] [15] The physician’s fee for service was based on the patient’s income.

The practice of ancient Iranian medicine was interrupted by the Arab invasion (630 A.D.). However, the advances of the Sassanid period were continued and expanded upon during the flourishing of Islamicate sciences at Baghdad, with the Arabic text Tārīkh al-ḥukamā crediting the Academy of Gondishapur for establishing licensure of physicians and proper medical treatment and training. Many Pahlavi scripts were translated into Arabic, and the region of Greater Iran produced physicians and scientists such as Abū ʿAlī al-Ḥusayn ibn ʿAbd Allāh ibn Sīnā and Muhammad ibn Zakariya al-Razi as well as mathematicians such as Kharazmi and Omar Khayyám. [16] They collected and systematically expanded the Greek, Indian, and Persian ancient medical heritage and made further discoveries. [17]

Medieval Islamic Period Edit

One of the main roles played by medieval Iranian scholars in the scientific field was the conservation, consolidation, coordination, and development of ideas and knowledge in ancient civilizations. Some Iranian Hakim (practitioners) such as Muhammad ibn Zakariya ar-Razi, known to the West as Rhazes, and Ibn Sina, better known as Avicenna, were not only responsible for accumulating all the existing information on medicine of the time, but adding to this knowledge by their own astute observations, experimentation and skills. [18] [19] "Qanoon fel teb of Avicenna" ("The Canon") and "Kitab al-Hawi of Razi" ("Continens") were among the central texts in Western medical education from the 13th to the 18th centuries. [20] [21]

In the 14th century, the Persian language medical work Tashrih al-badan (Anatomy of the body), by Mansur ibn Ilyas (c. 1390), contained comprehensive diagrams of the body's structural, nervous and circulatory systems. [22]

Cranial surgery and mental health Edit

Evidence of surgery dates to the 3rd century BC when the first cranial surgery was performed in the Shahr-e-Sukhteh (Burnt City) in south-eastern Iran. The archaeological studies on the skull of a 13-year-old girl suffering from hydrocephaly indicated that she had undergone cranial surgery to take a part of her skull bone and the girl lived for at least about 6 months after the surgery. [23]

Several documents still exist from which the definitions and treatments of a headache in medieval Persia can be ascertained. These documents give detailed and precise clinical information on the different types of headaches. The medieval physicians listed various signs and symptoms, apparent causes, and hygienic and dietary rules for prevention of headaches. The medieval writings are both accurate and vivid, and they provide long lists of substances used in the treatment of headaches. Many of the approaches of physicians in medieval Persia are accepted today however, still more of them could be of use to modern medicine. [24] An antiepileptic drug-therapy plan in medieval Iranian medicine is individualized, given different single and combined drug-therapy with a dosing schedule for each of those. Physicians stress the importance of dose, and route of administration and define a schedule for drug administration. Recent animal experiments confirm the anticonvulsant potency of some of the compounds which are recommended by Medieval Iranian practitioners in epilepsy treatment. [6]

Obstetrics and gynecology Edit

In the 10th century work of Shahnama, Ferdowsi describes a Caesarean section performed on Rudaba, during which a special wine agent was prepared by a Zoroastrian priest and used as an anesthetic [26] to produce unconsciousness for the operation. [27] Although largely mythical in content, the passage illustrates working knowledge of anesthesia in ancient Persia.


Making Holes in the Skull: Ancient Psychosurgery?

J ust imagine: a hole of 2.5 to 5 cm of diameter, drilled by hand into the skull of a living man, without any anesthesia or asepsis, during 30 to 60 long minutes. This is maybe the most ancient form of brain surgery known to man: it is called trepanning (from Greek trupanon , borer) or trephining. And one of the reasons for performing this bone-chilling procedure was perhaps the same that motivated modern surgeons, such as Dr. Egas Moniz , to perform psychosurgery , in order to alleviate mental symptoms.

Skulls with signs of trepanning were found practically in all parts of the world where man has lived. Trepanning is probably the oldest surgical operation known to man: evidence for it goes back as far as in 40,000 year-old Cro-Magnon sites.

Trepanning was "fashionable" on and off along the ages, probably with different reasons. It was practiced in the Stone Age, in Ancient Egypt, in the Greek and Roman pre-historic and classic times, in the Far and Middle East, among the Celtic tribes, in China (ancient and recent), India, among the Mayans, Aztecs and Incas, among Brazilian indians (karaya and eugano), in the South Seas, and in North and Equatorial Africa (where they are still in use, incredibly as it may seem).

The first historical and medical accounts of trepanning in Antiquity were made in 1867, by E.G. Squier, in North America, and by Paul Broca , in Europe.

Aztec trephining knife made of bronze
and gold (1200-1400 AC)

"Crown" trephines from the 17th century

  • Magical and religious rituals, to bring luck and to offer sacrifice, etc. In many cultures (mainly those which were known as head-worshippers, because they attributed special significance to the head and brain in their religion), trepanning was very common, and the round slab of bone taken out of a skull is used as an amulet. There is the possibility that the large number of trepanned skulls found in military posts were from enemies, who were used as suppliers of these amulets.
  • Shamanistic therapies, mainly due to the conviction that opening the skull would liberate "bad spirits" or demons that inhabited the patient's body. These trepanations could then be considered "psychosurgeries", in the sense that probably the most common indications were mental diseases, epilepsy, blindness, etc.
  • For the treatment of legitimate medical conditions, such as strong headaches, skull fractures and wounds, osteomyelitis, encephalitis, elevated intracranial pressure due to hematomas, hydrocephalus and brain tumors, etc. In fact, for some of these conditions, trepanning shows a true therapeutic effect, and it is still used by neurosurgeons. In the South Seas and in North African tribes (rifkabyla and hausa) and Kenya (kisi), trepanning is carried out particularly for relieving war wounds inflicted to the head. The Father of Medicine, Hippocrates , wrote detailed instructions on how to perform skull trepanning for a variety of medical conditions,
  • From the Middle Ages well into the 18th century in Europe, trepanning was common as a medical procedure very much like bloodletting, i.e. it had no medical usefulness per se . Repeated trepanning was common for instance it is related that Prince Philip of Orange was trepanned 17 times by his physician. De La Touche, a French physician trepanned 52 times one of his patient, within a two-month period! Many physicians, from the Roman times on, also believed that the bone slabs (called rondelles ) taken from trepanned skulls had therapeutic value when pulverized and mixed with other beverages given to the patients for several diseases.

Ancient Greek metal trephines

Trepanning was performed either by bone abrasion (by using a sharp-edged stone or volcanic glass knifes) or by cutting (using semicircular trephines , which cut by means of a swinging motion, such as those found in the Central and South America civilizations). The Egyptians invented the circular trephine, made by a tube with serrated borders, which cuts much easier by means of rotation, and which was then extensively used in Greece and Rome, and gave origin to the "crown" trephine, used in Europe from the first to the 19th century. One of the major inventions in trephine technology was the central spike, which was used to center the rotational movement, so that a better precision was achieved.