ABSTRACT

Keywords: Lorenz Heister (1683-1758), trepanation, history of surgery, eighteenth century, case study

In the eighteenth century, cranial trepanation belonged to the standard techniques a surgeon was supposed to have mastered. Pierre Dionis stated in his “Cours d’Opérations de Chirurgie” that no other operation on the head or the eyes was performed more frequently, not even the couching of the cataract (Dionis, 1734, p. 529). The “drilling of the skull” challenged the surgeon’s skill in two respects: on the one hand, the intricate handling of the various instruments made high demands on his manual dexterity; on the other, the unique circumstances of head trauma required a considerable degree of social competence and sensibility on his part. Surgery was performed at that time on conscious patients with visible diseases. Trepanation may be regarded as the only exception to this rule. Only in the case of severe head trauma was the surgeon confronted with an unconscious patient and an invisible disease. In what follows the double challenge of trepanation – the difficulty of carrying it out and its unusual social setting – will be illustrated by the example of Lorenz Heister and the “Bachmann case”.