Hippocrates (ca 460 BC to ca 370 BC).

Abstract

The chapter begins with a review of some of the background thinking during Hippocrates time. The brain was considered to be the location of the soul which was the essence of subjective experience. However, this was not a brain function as such but rather a location where the pneuma reacted with the soul. Hippocrates' monograph on cranial trauma begins with a description of the bones and sutures. He then systematized the classification of cranial injury. He sensibly advised accurate diagnosis into one of the types of injury he described and supported extension of any skin opening to facilitate diagnosis of the bone, the injury of which was his primary concern. His description of operative technique has rarely been surpassed, placing emphasis on care and methods for the avoidance of further injury. He also emphasized the importance of probing during trepanation to avoid damaging the dura and underlying brain. In addition, he insisted on using water to cool the trepan. All of this was positive. However, the respect in which he was held in subsequent generations meant that two albeit understandable errors were perpetuated. The first error was the use of prophylactic trepanation to permit the drainage of the pus which he believed would inevitably develop under a fissure. The second was to avoid trepanning at sutures, the reasons for which proscription are not clearly stated. In conclusion, it may be noted that what limited reporting of results is available demonstrates that Hippocrates trepanations were largely not successful.