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Pre-1870 American Cased Surgical and Amputation Sets

 

Trepanning

Trephine, neurosurgery, trepan

By Dr. Michael Echols

Trepanning is the medical process of drilling or cutting a hole into the skull in order to relieve pressure on the brain tissue, lift a compression fracture of the skull, or remove a blood clot on the brain.  If a person had a concussion with depression of the skull bone, that depressed area would need to be lifted or removed and then the clot under the concussion removed to alleviate trauma induced symptoms.

The process is documented to have been performed as far back as 4000 years ago by the Inca Indians of Peru.  If you would like more information on this procedure and the history, please do a search for the words: trephine, Inca, neurosurgery, trepanning, trepan on google.com.

Trepanning (pronounced: tree-panning), as was frequently practiced in America during the 1800's, was performed with an instrument called a trephine (pronounced: tray-feene or tree-fine) which actually saw cuts a circular hole in the scull.

The scalp over the skull is first incised with a scalpel, a flap laid back, and the hole bored or saw cut by a twisting motion of the trephine.  In some types of trephines, there is a center drill which holds and guides the outer cutting edge of the saw.  There are two types of trephine saws, the earlier crown type and the later Galt type.

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Scalpel for tissue incision

 

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Trephine with 'Galt' style saw (assembled)

Another instrument used for this procedure is the Hey saw, which has both a straight and curved tooth edge for cutting into the skull.

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Hey saw used to cut into the skull bone

The circular piece of bone, about the size of a nickel is then removed by using one end of a  lenticular or bone rasp to lift out the bone, then the edges of the bone would be smoothed with the rasp. 

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Bone file for smoothing edges and lifting out parts of bone.

Any bone dust could then be removed with the bone brush before cutting into the dura, which is the outer covering of the brain.

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Bone brush to remove bone sawdust from the cutting site.

Examples of American cased trepanning sets

Wiegand & Snowden, c. 1830

 

 

Fig. 1: Cased Trepanning set                                 Fig. 2: Trepanning instruments

In figure 1, is a cased trepanning set by Wade and Ford.  The set contains a lenticular bone rasp, scalpel, Hey saw, crown type trephine, wood handle for the trephine, and both a crown and a Galt type trephine (disassembled). 

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Fig. 3: Trephanning cased set                  Fig. 4: instruments from case

 

The set in figure 3 is by Gemrig, contains a bone brush and is missing the scalpel.  Figure 4 shows the individual instruments from the Gemrig set.  The trephine is assembled with a crown type trephine saw.

 

These type of cased sets were issued to the Union surgeons during the Civil War and made by makers like Gemrig.

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