Trephination

     Most people associate Civil War medicine with amputations and saws.  There were a lot of amputations performed when bones in the arms or legs were shattered, and in most cases it was the best method of treatment they had.  But what happened to the soldiers who suffered skull fractures?  Amputation would not be a good treatment in this case!

     Civil War surgeons would have reached for their trephining (or trepanning) kit.  Trephining is a procedure in which a cylindrical saw-like instrument called a trephine is used to cut a hole into the skull in order to relieve pressure on the brain or remove a blood clot.  This is a procedure which predates the Civil War.  In the Middle Ages it was used as a remedy for headaches, seizures, and “evil spirits”.  Some prehistoric human skulls have even been found with evidence of trephining.  



This is a diagram of a trepanning kit from an 1860 Snowden & Brother catalog (Philadelphia) which lists the instruments that were contained in the kit. Take a look at those prices too!



     

     The scalpel would be used first to cut a flap of skin from the area.  Next the trephine would be used to cut a hole in the bone.  Many trephines have a spike (identified as the "sliding centre" in the diagram) which was used to hold the instrument in place while it was rotated. 

    

This trephine is actually made in two parts. The wooden handle is removable and can be used with trephines of different sizes. The small round handle on the metal shaft is used to control the depth of the spike inside the blade.

Here you can see the spike that was used to anchor the blade in place.

     Another instrument which was used to reduce skull fractures was a Hey's saw.  It has a double-edged blade with one flat side and one curved side.  Once you've seen one, you'll easily recognize other Hey's saws.





The Hey’s saw was named after an English surgeon, William Hey.

A small bone brush was used to remove any bone dust produced by the saws. This one has a wooden handle and natural bristles.

Next an instrument called an elevator was used to raise or remove the portions of bone which were putting pressure on the brain. 

     Some symptoms of pressure on the brain from a skull fracture which have been noted in case studies are loss of consiousness, convulsions, headache, nausea, paralysis, and confusion.  In some cases, the symptoms would disappear shortly after a trephination.  Overall though, there was a pretty high mortality rate for these patients; less than half of them survived the procedure.

     If you are curious you can read about some actual trephining cases from the Civil War here: 
http://www.braceface.com/medical/Civil_War_Articles/Trephining_during_Civil_War.htm

    

     Though I would love to be able to purchase a trephining kit for the museum at the Civil War era prices listed above, it appears that price would only get me the following item:

     I wonder what a Civil War surgeon would have thought of this....

     Photos courtesy of the National Museum of Civil War Medicine