The treatment of head injury during the Renaissance.

During the Renaissance, a new spirit of rational inquiry, combined with renewed understanding of ancient Greek and Roman philosophy, encouraged many new developments in medicine and surgery. Traditional teachings, often combined with superstition and a belief in magical and empirical cures, had dominated medical thinking for over a thousand years; after the Renaissance, this ignorance was gradually replaced by fresh thought, based on logic, observation, and experiment. Surgeons, by nature practical men, whose daily work forced them to regard hard facts as more important than arcane theories, played an important role in this process, despite their comparatively low social status as "artisans" rather that academics. In this article we review the evidence regarding the performance of trepanning during the Renaissance. This operation had originally been used for superstitious or religious purposes, had fallen largely into disuse, but was then reintroduced in severe head injuries on a somewhat more rational basis. Trepanning, or making a surgical hole in the skull, is known to have been performed since prehistoric time as a means of allowing unwanted spirits or vapours out of the head. As a treatment for head injury it was never popular among surgeons, in view of the great risks involved and the skill and instruments needed. A natural desire to avoid painful treatments if possible motivated the search for an alternative to surgery. Dino del Garbo (died 1327), a member of the Florentine guild of surgeons and physicians, noted that it was widely believed that skull fractures could be cured by the use of plasters alone without the surgical procedures recommended, in one form or another, by most authoritative textbooks.' Dino attributed the belief in the efficacy of plasters used alone to the extreme willingness of the public to believe in such cures and to the ignorance or deceit of empirics. Dino was evidently well aware of the difficulty of diagnosing head wounds by palpation and observation and asserted that the empirics either could not themselves tell skull fractures from other head wounds or else inflated their own powers by claiming that any head wound they had cured was a skull fracture. Furthermore literature on surgery and head wounds was scanty. With the exception of a few brief tracts on phlebotomy and sites for cautery, most of the medical handbooks available until the 11th century had little or nothing to say about surgery that was not then distinguishable from the rest of medical practice. Greek surgery was largely inaccessible until the 15th and 16th centuries. The Hippocratic treatise On wounds of the head provided the principal source in the works of Celsus (first century AD), Galen (second century AD), and Paul of Aegina (seventh century AD). These were too long and complicated to be of any practical use to early medieval western practitioners. Hippocrates' emphasis was on how to reach an accurate prognosis to convey to the relatives and not direct surgical intervention. Hippocrates discusses which kinds of missiles produce torn flesh or broken bones, whether the missile came from above or from the side, and so on. Francisco Arceo (1493-1571), a military Spanish surgeon whose treatise on wounds of the head was influential both in England and the rest of Europe, remarks on how the operation of trepanning is unpopular (the words in parentheses were added by the contemporary English translator):