Civil War Era Trepanning Instruments

By Dr. Michael Echols, American Civil War Surgical Antiques

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.

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 is a saw that 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 or spike which holds and guides the outer cutting edge of the saw.  There are two main types of trephine saws: the earlier crown type and the later Galt type.

Above: Upper-left is is the earlier crown type cutting edge trephine, which is pre-1860's.  Lower left is the later Galt type lateral cutting surface, which is post-1860's.  On the right is the earlier crown type showing the centering spike, which is adjusted into the bone to prevent wandering of the blade or perferation of the soft tissues during cutting.

There is some confusion about exactly when the Galt type trephine appeared, but both types, crown and Galt, are seen in surgical sets during the Civil War, with the Galt type predominating later in my experience.  A 'Galt' type conical crown has been noted earlier than 1860 when Galt presented his design.  The details of the handle and shaft serve to differentiate the earlier and later versions.  Experience being the test.  (See Edmonson' book on the History of American Surgical Instruments )

Instruments usually found in a self-contained Civil War era trepanning set: (These same instruments can be found in most amputation sets as part of the normal complement of instruments.)

Above: Left, A c. 1861-65 Civil War U. S. Army Hosptial Department trepanning set by Hernstein, (N.Y.); Right, a c. 1830-40's trepanning set with blued Hey saw and ivory bone brush.

Above: Left, a c. 1870 Galt style brass and unplated steel tapered trephine with ebony wood handle.  On the right is a post-1880 all metal, chrome plated (sterilizable) trephine with a 'crown' type cutting tip.

Above: A trepanning scalpel for tissue incision.  The handle is ebonized wood and cross-hatched.

Above: A Hey bone saw with ebonized wood handle used in conjunction with the trephine.

Above: A bone brush with ebonized or gutta percha handle for removal of bone dust from cutting.

Above: An all metal handled bone rasp and lenticular lifting instrument for removal of bone edges and lifting the bone fragments after being cut.  This whole instrument is unplated steel with cross-cut handle areas.

These types of trepanning sets were used during the Civil War, were part of larger sets in some cases, and were marked 'U.S.A.' on the brass plate in the instance of the Union U.S.A Hospital Dept. sets.  Typically most larger amputation sets had a neurosurgical componet, consisting of the above instruments.  European sets tend to be much more extensive and ornate.

Dr. Michael Echols is a long-term collector/researcher of surgical antiques and is not a dealer.  For additional information, see the web site:

American Civil War Surgical Antiques

If this information was helpful, please check the 'YES' box "Was this guide helpful" at the bottom of this page.