Cranial Trephine

The serrated T-handled instrument at the top is a trephine. These are battlefield surgical instruments. They are replicas which can be purchased for the historical demonstration here. Trephines were used in ancient Egypt for access to the brain. They were described by Kocher in a 1914 book in which he published techniques on how to use the device. The trephine is basically a circular drill bit the one could get at Home Depot today. We don’t use such devices in present day neurosurgery.

The center point is to drive through the skull to position the bit before you proceed to drill. If you look closely you will see the point is too long. It will pierce the brain long before the drill has made a hole in the skull. Crude and dangerous, but then again if you have to use this on a battlefield casualty, it’s probably not going to end well.

Another thought came to me as the demonstrator described how the other instruments were used to probe for and remove the lead balls in the wounded soldiers. Why? You don’t remove the lead. That’s not what is going to kill you. It’s damage to vital organs and the uncontrolled bleeding that will kill you. General anesthesia is not until the 1900’s, so bite the rawhide!

To this day though some things don’t change. It’s been a while since I had to remove a bullet. But I still ask for a metal kidney shaped basin. In today’s OR’s it’s all plastic. The nurses scramble around to get one from some back closet shelf. Then carefully holding the bullet fragment 12 inches above the basin, I release it to hear the satisfying clunk of bullet in the metal basin. For those of you who watched ‘Gunsmoke’ on television as a kid, you will understand.