The authors also point out that now “we have evidence literally from the time of Neanderthals that people have provided care for one another, even in challenging circumstances.”

For thousands of years, mankind has conducted cranial trephination, a medical treatment that includes cutting a hole in the skull, according to archaeologists.

They have found proof that the surgery was done in ancient societies all over the world, from South America to Africa and beyond.

Now, thanks to a recent dig at the ancient city of Megiddo in Israel, we know that one type of trephination has been around since at least the late Bronze Age.

Rachel Kalisher, a doctoral student at Brown University’s Joukowsky Center for Archaeology and the Ancient World, undertook an investigation of the unearthed bones of two upper-class brothers who lived in Megiddo about the 15th century B.C.

She discovered that one of the brothers had had angular notched trephination cranial surgery shortly before his death.

The process entails cutting the scalp, carving four intersecting lines in the skull using a tool with a sharp beveled edge, and creating a square-shaped hole with leverage.

The trephination, according to Kalisher, is the first example of its sort discovered in the Ancient Near East.

“We have evidence that trephination has been this universal, widespread type of surgery for thousands of years,” remarks Kalisher. “But in the Near East, we don’t see it so often — there are only about a dozen examples of trephination in this entire region. My hope is that adding more examples to the scholarly record will deepen our field’s understanding of medical care and cultural dynamics in ancient cities in this area.”

In partnership with academics from New York, Austria, and Israel, Kalisher’s study was released today in PLOS ONE.

Brothers

According to co-author of the study and director of the School of Archaeology and Maritime Cultures at the University of Haifa, Israel Finkelstein, Megiddo was situated on and held control over a significant land route known as the Via Maris that connected Egypt, Syria, Mesopotamia, and Anatolia 4,000 years ago.

By about the 19th century B.C., the city had developed into one of the richest and most cosmopolitan in the area, with a spectacular skyline of palaces, temples, walls, and gates.

“It’s hard to overstate Megiddo’s cultural and economic importance in the late Bronze Age,” according to Finkelstein.

According to Kalisher, the two brothers whose bones she examined were from a residential area that was next to the late Bronze Age palace at Megiddo, indicating that they were likely wealthy people and maybe even royal.

It is supported by a number of other facts, such as the brothers’ burial with exquisite Cypriot pottery and other priceless items and the fact that they underwent care that most Megiddians probably couldn’t afford, as shown by the trephination.

“These brothers were obviously living with some pretty intense pathological circumstances that, in this time, would have been tough to endure without wealth and status,” Kalisher adds. “If you’re elite, maybe you don’t have to work as much. If you’re elite, maybe you can eat a special diet. If you’re elite, maybe you’re able to survive a severe illness longer because you have access to care.”

During her analysis, Kalisher found several problems with both brothers’ bones. The elder sibling had an extracranial suture and an extra tooth in one corner of his mouth, indicating he may have been born with a congenital condition such as Cleidocranial dysplasia.

Both of the boys’ bones reveal slight signs of infantile iron deficiency anemia, which might have hampered their growth.

These developmental anomalies may explain why the brothers died young, one in his teens or early twenties and the other in his twenties and forties.

Nonetheless, Kalisher opined that the two were more likely to have passed away from an infectious condition in the end. In the membrane covering the bones, a third of one brother’s skeleton and half of the other brother’s exhibit porosity, legions, and evidence of prior inflammation, all of which combined imply they had systemic, prolonged instances of an infectious illness like leprosy or TB.

Although some skeletal evidence refers to leprosy, it is difficult to infer instances of leprosy from bones alone, according to Kalisher. She is presently doing DNA analysis of certain lesions in the bones in collaboration with scientists at the Max Planck Institute for Evolutionary Anthropology in Germany.

These brothers will be among the first known cases of leprosy in the world if they discover bacterial DNA that is associated with the disease.

“Leprosy can spread within family units, not just because of the close proximity but also because your susceptibility to the disease is influenced by your genetic landscape,” Kalisher points out. “At the same time, leprosy is hard to identify because it affects the bones in stages, which might not happen in the same order or with the same severity for everyone. It’s hard for us to say for sure whether these brothers had leprosy or some other infectious disease.”

It’s also difficult to determine, according to Kalisher, whether one brother’s cranial surgery was brought on by the illness, congenital issues, or something else.

Yet, she is certain of one thing: If the angular notched trephination was intended to keep him alive, it was a failure. After the operation, he passed quite quickly—days, hours, or possibly even minutes later.

Investigating medical past

There is still a lot archaeologists don’t know about trephination, Kalisher added, despite all the evidence that has been discovered over the last 200 years.

For instance, it’s unclear why some trephinations are round, indicating the use of an analog drill, while others are square or triangular.

Moreover, it is unclear what ancient peoples were even attempting to heal, how prevalent the treatment was in each locale. (To alleviate pressure in the brain, doctors currently conduct a similar technique termed a craniotomy.)

Kalisher is conducting a follow-up research project that will examine trephination across many geographies and historical periods in an effort to shed additional insight on ancient medical procedures.

“You have to be in a pretty dire place to have a hole cut in your head,” Kalisher adds. “I’m interested in what we can learn from looking across the scientific literature at every example of trephination in antiquity, comparing and contrasting the circumstances of each person who had the surgery done.”

Apart from expanding colleagues’ knowledge of early trephinations, Kalisher believes her research will demonstrate the general public that ancient cultures did not always follow “survival of the fittest” ideas, as many may believe.

Contrary to popular belief, Kalisher said that there was a lot more compassion and tolerance in ancient times. 

“We have evidence literally from the time of Neanderthals that people have provided care for one another, even in challenging circumstances. I’m not trying to say it was all kumbaya — there were sex- and class-based divisions. But in the past, people were still people.”

Source: 10.1371/journal.pone.0281020

Image Credit: Getty and Rachel Kalisher et al