Two medieval ‘trepanations’ – therapy or swindle?

During the 1991–1992 excavation of the ruins of the medieval cathedral in Hamar, Norway, the broken skull of an elderly man was found, showing evidence of an incomplete trepanation. The ‘surgeon’ had obviously tried to penetrate the skull surface around bregma in an irregular circle of 23 × 21 mm. Upon investigation, the skull revealed a reactive‐pathological area of the internal surface of the occipital bone, which probably represents a respite after a meningeal disorder (a tumour or an infectious process), causing us to suggest that the trepanation was meant to cure the patient's increasing headache. However, as a second skull with similar marks was found in the same churchyard, another explanation seems possible. Because the brain tumour in the first case may have altered the patient's mental state, we may surmise that these incomplete operations were an attempt to remove from these patients' heads the ‘Stone of Madness’, which was then commonly considered to be the reason for psychiatric diagnoses as well as persistent headache, and often depicted in European art, most notably in the 16 th and 17 th centuries. The second skull, revealing an even more incomplete attempt, did not show any skeletal pathology at all. Copyright © 2007 John Wiley & Sons, Ltd.