Rugine, part of trephination set

Rugine with wooden handle, part of trephination set by Sirhenry, France, 1771-1830

A rugine is a type of surgical scraper to remove connective tissues to give the surgeon as clear a view of the bones as possible, including the skull. This instrument pre-dates ideas about infection causes and their prevention during operations. Any surgery was risky due to the potential for infection. Trephination, the cutting of a hole in the skull, was likely done as a last resort.