The Hippocratic Legacy in Cranial Trauma Surgery: from On Head Wounds to Rogerius Frugardi’s Chirurgia, and the Semantic Transformation of “Trepanation” in Scholarship

Abstract

The Hippocratic treatise On Head Wounds (Περί Των Εν Κεφαλήι Τρωμάτων) stands as the earliest recorded account of surgical techniques for cranial fractures resulting from trauma. Its descriptions of surgical procedures, tools, and methodologies have been widely referenced in modern medical and archaeological scholarship. Researchers frequently compare these Hippocratic practices with evidence of cranial surgery observed across various historical and cultural contexts, from prehistoric times through antiquity. Despite its historical importance, interpretations of the treatise are sometimes shaped by modern assumptions rather than a faithful reading of the original text. Certain retrospective analyses, written more than two millennia later, present incomplete or inaccurate assessments, often due to misinterpretations of the primary source. These studies occasionally attribute deficiencies in surgical methodology or empirical knowledge to Hippocrates himself. Additionally, the 19th-century introduction of the term trepanation –which has come to encompass all surgically induced cranial openings– has contributed to a generalized and often misleading classification of ancient surgical practices.

This article revisits the surgical concepts outlined in On Head Wounds, focusing on operative techniques, instrumentation, and textual evidence. It also examines the evolving interpretation of these procedures from antiquity to the Renaissance, emphasizing the need for greater precision in discussing Hippocratic contributions and the impact of terminological imprecision on archaeo-anthropological discourse.