Trepanning

Trepanning is among the oldest and most quietly accepted forms of crude surgery in Everwealth, neither outlawed nor truly trusted, merely endured where desperation outweighs fear. The act, the boring or carving of holes into the skull to ease pain or “free” trapped spirits, walks the narrow line between medicine and ritual. To some, it relieves “soul pressure,” a swelling of madness or grief within the head. To others, it is an exorcism performed with tools rather than prayers. Whatever the name, it remains the final resort of those with no other remedy but faith in a sharp edge.   Procedure:
In the borderlands and mining towns, trepanning is considered a cure for headaches, seizures, hallucinations, and melancholy. When fevers run high or the mind turns inward, families summon the nearest bone-driller, a hedge surgeon, barber, or even a priest with a steady hand. The patient is held down, the scalp parted with a razor or heated blade, and the skull scraped, twisted, or drilled until the “spirit’s vent” opens. Some fill the hollow with salt, others leave it bare to the air, claiming the wind carries sickness away. The patient is told to rest where light can touch their brow; darkness, they say, calls the spirits back in. Many never wake. Those who do often claim to feel “cleaner,” their thoughts like fresh snow before the thaw.   Tools of the Trade:

• Bone Awls and Flint Borers - Favored by rural surgeons, turned by hand until the skull “sighs.”

• Carpenter’s Augers - Reused from workshops, their spiral grooves said to guide the soul outward.

• Eel-Jaw Cutters - Used in Woodsend and Bordersword, prized for their curved bite and ease of cleaning.

• The Whisperdrill of Flint Maw - A relic said to spin of its own accord when brought near a haunted man.

• Ash-Salt and Honey Dressings - Pressed into the wound to keep rot and spirits alike from settling in.

Cleanliness is inconsistent at best. Some boil their tools in oil; Others anoint them with wine or prayer. Infection is treated as the spirit’s revenge for being disturbed.   Beliefs and Practices
Across Everwealth, trepanning is bound to the belief in “soul pressure”, the notion that sorrow, guilt, or possession gathers behind the eyes until it must be bled like a blister. In Opulence, trepanned patients are said to “see through walls” for a time, an illusion born of trauma and loss of blood. In the highlands near Twin Brother’s Pass, the act is ritualized, holes filled with silver dust to “anchor the mind.” The Knights of All-Faith, in their more deranged chapters, perform it upon penitents as a cleansing rite, boring the skull until the sinner’s thoughts “run clear.” Among miners and frontiersmen, trepanning is simply called “venting.” They say the mountain keeps what the body cannot.   Risks and Outcomes
Survival depends on luck, not skill. Skull fractures, blood loss, infection, and brain fever are common. Those who live are often marked by tremor, fits of laughter, or dull serenity. Yet the sight of a trepanned survivor, head bound in rags and eyes calm as glass, inspires more reverence than pity. Some communities treat the healed as holy, believing they have looked upon the spirit world and returned. Others whisper that the hole never truly closes, that the soul still leaks through, little by little, until the light inside goes out for good.   Cultural Standing Neither sanctioned nor forbidden, trepanning is tolerated wherever The Scholar's Guild lacks reach. In the hinterlands around Catcher's Rest, it is simply part of life, children grow up knowing someone with a scar above the brow. In Merchant's Meet, street surgeons advertise “quick relief for restless minds,” their stalls lined with copper drills and bloodied cloths. Only the cities enforce restrictions, though even there, quiet rooms and desperate families keep the tradition alive behind shuttered doors.