Contrary to what many people believe,"cave men" and other "primitive" people were not medically ignorant. There is plenty of evidence around the world that humans have been treating diseases, setting broken bones and caring for wounds for thousands, if not tens of thousands, of years.

The most spectacular practice of very early medicine was trephination, the surgical exposure of the brain. The operation consisted of opening the scalp to uncover the cranial bone, cutting out a round or square piece of bone, cleansing and dressing the opening and, finally, replacing the scalp flap. Since the skull is generally insensitive to pain, especially on the top, no drugs were needed to anesthetize the patient during the operation -- which took anywhere from 30 minutes to several hours to perform. The presence of new bone growth around the incisions indicates the remarkable fact that about half the patients survived the procedure.

Left: Two Paleolithic skulls from Denmark reveal healed and unhealed trephined openings. The skull at right shows how new growth began at the edges and filled in much of the opening. The skull at left indicates the patient died before the bone had time to grow again.

Right: Cross-hatch trephination, achieved by intersecting stgraight cuts, was performed in Peru some 12,000 years ago. Survival depended on the location of the boring. If it touched on the sagittal suture -- the midline at the top of the skull -- fatal hemorrhaging often occurred.

Exactly why early people practiced trephination is not known. It may have been a means of allowing "spirits" to leave the skull, thus relieving the patient from headaches, epilepsy, melancholia, or other disorder. Some operations may have been performed as part of some larger religious ritual. And, of course, many were probably performed because the "surgeon" had reason to believe the procedure would cure whatever was ailing the patient.

Right: The sculpted scene on the handle-tip of this Peruvian tumi (trephining knife) shows how the operation was performed. The patient is held as the surgeon scrapes through to the bone with his bronze scalpel. This instrument was designed for cross-hatched cuts like those shown in the picture above right.

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Alan E. Nourse. The Body. New York:Time Incorporated, 1964.

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