Trepanation

**Trepanation** is an ancient surgery technique practiced by many cultures in Fayos. The technique involves the scraping, drilling, or cutting of a hole into the skull to allow for the brain to 'expand'. The practice received a new resurgence in the late Ancient Era after its incorporation into the Northern Modern Medicine teachings.

## Description

The surgeon performing the trepanation will use a special tool, called a trephine, to begin the boring. If the hole is to be made on an area besides the forehead, the hair will be shaved away, either all or some depending on the will of the surgeon. The trephine will be placed onto the site, then twisted so that the cylindrical surgical blade can bore through the bone of the skull. Usually, the patient is anesthetized so as to minimize movement, though some simply use heavy restraints. Once the bone ends and the outer layer of the brain is revealed, the surgeon stops, pulling back the trephine with the bone fragment intact. The wound is then wrapped in a bandage, usually about the head and quite loosely. This completes the operation as typically done in the north or among other civilized nations.

Older techniques or those practiced outside the field of Northern Modern Medicine tend to be more primitive. Usually a piece of flint or an iron knife is used to scrape away the bone slowly, typically in small rectangular or square sections. These practices are quite old, with skulls as far back as 5000 AE showing signs of multiple surgeries and even recoveries.

## History

Skulls from as far back as the early 5000s AE show signs of trepanation and healing from the surgeries. These skulls, found in south western Kudd, Cadan, and Ihjarga show the widespread implementation of the technique. Remains from Caldos show trepanation holes starting around 4500 AE, though arguments for these being related to natural occurring phenomenon have been made. Evidence to show spread among the newly arriving Nordurens begin in 2000 AE. Most, if not all, of these trepanations were done with the scraping flint technique.

Beast races tend to not perform these operations, which have never been recorded among the Gnolls. Certain similar operations are performed by the Sxthni but these are more inline with ritual or sacrificial activities. The Cadanites have practiced trepanation prior to their curse and the bull men quickly adapted the operation to their new massive bovine skulls. Cadanites still scrape massive bore holes into their skulls after head injuries to relieve bleeding. Typically, these are later covered by golden plates or leather straps.

Trepanation for ritual reasons fell out of practice among the humans of Fayos in the mid 1000s AE, though medical use flourished. The Asinum-Bail of Kudd produced many medical manuals describing the benefits of trepanning among other surgeries. The practice had almost completely disappeared in the north until its reintroduction in 80 AE by followers of Northern Modern Medicine attempting to cure the insane of their psychic ailments. Followers subscribing to the work of Sir Luka Petrikov and Madame Dijana Vedric's Theory of Psychic Degradation believed that if holes were bored into the skull, evil spirits and influences would flee the body. Trepanation and lobotomies became new and fashionable starting in 80 AE and continuing into the 100 ME. Even now in Skjol and especially Fleur, it is not uncommon to see ladies walking about with gilded forehead ornaments framing their trepan hole.

## In Northern Modern Medicine

Nothern Modern Medicine attempts to solve the illnesses plaguing the mind and body that previously proved incurable. These include mental illnesses, such as depression, anxiety, homosexuality, and physical deformities, such as cleft palettes, tumors, cerebral palsy, and others. The school believes that these can be cured through caromancy, psychic divination, and therapeutics. Trepanation is considered a form of surgical caromancy and is quite popular as a cure for mental illnesses. The spike in trepanning as a cure all has lead to its widespread use in the north, almost like a fashion accessory.