Study: Bronze Age remains in Israel show signs of trepanation End-shutdown

Enlarge / Two Bronze Age skeletons (brothers) were found at Tel Megiddo in Israel. One showed evidence of trephination.

Just a couple of weeks ago, we reported that scientists had analyzed the skull of a medieval woman who once lived in central Italy and found evidence that she underwent at least two brain surgeries consistent with the practice of clambering now a recent article published last week in the journal PLoS ONE reported evidence of trephination in the remains of a man buried between 1550 and 1450 BC. C. in the archaeological site of Tel Megiddo in Israel.

cranial clambering—the drilling of a hole in the head—is perhaps the oldest known example of cranial surgery and one that is still practiced today, albeit rarely. Usually involves drilling or scraping a hole in the skull to expose the hard matter, the outermost of the three layers of connective tissue, called the meninges, that surround and protect the brain and spinal cord. Accidental puncture of that layer could lead to infection or damage to the underlying blood vessels. The practice dates back to between 7,000 and 10,000 years ago, as evidenced by cave paintings and human remains. During the Middle Ages, trepanning was performed to treat ailments such as seizures and skull fractures.

in the case of the medieval woman skull, an oval area in the center of the cross-shaped defect was evidence of a well-healed trephination procedure. Metal surgical tools were probably used to make a cross-shaped incision in the top of the head, scraping the scalp off the bone, a historically well-documented method of trephination, which could also explain the signs of inflammation and/or infection. . . The second surgery likely occurred shortly before the woman’s death. It is one of the few archaeological pieces of evidence of trepanning that has been performed on early medieval women to have been found, although why the woman in question underwent such a risky invasive surgical procedure remains speculation.

This latest trepanning report concerns one of two brothers (based on DNA testing of the remains) buried together at Tel Megiddo, which is located in the Jezreel Valley. The settlement once controlled part of an important land route connecting Egypt with Syria, Mesopotamia and Anatolia called the Via Maris, making Tel Megiddo a thriving urban center during the Middle and Late Bronze Age. The remains of the two brothers were found in a tomb near the city’s Bronze Age palace, along with many fine objects, suggesting that the site was part of the palace complex, perhaps a residence for high-ranking officials. .

AB: Enlarged edges of the trephination.  C: The four edges of the trephination.  D: reconstructed location of the trephination in the head.
Enlarge / AB: Enlarged edges of the trephination. C: The four edges of the trephination. D: reconstructed location of the trephination in the head.

One skeleton was largely intact (Individual 1), while the bones of the other (Individual 2) were disarticulated and partially covered by goat or antelope remains. The authors believe that Individual 2 was buried between one and three years before his brother in a different location, then exhumed and reburied along with his brother in a new pit, hence the disarticulation.

In particular, Individual 1 had a small hole, about 32x31mm at its widest point, formed by a series of intersecting notches, in the frontal bone of its skull where a portion of the skull had been removed. The authors report that the instrument used was likely to have a sharp, beveled edge, given the cleanliness of the margins. They also noted smaller scratches “consistent with opening the scalp, a necessary step before bony excision.” There were no signs of bone healing, suggesting that the brother died during or within a week of the trephination.

The archaeologists also recovered two excised pieces of cranial bone with cuts on at least two sides, indicating that the procedure was done piecemeal. According to the authors, all the evidence is consistent with a process known as angular notching, in which a flap of skin is removed, followed by one or two initial grooves, stopping before drilling into the soft tissues below (the hard matter). Once all the slotted pieces had been cut, the practitioner removed them all at once. The authors suggest that these pieces may have been placed back in the hole after the procedure to promote healing. But lacking “proper hygienic storage conditions”, fatal complications are likely to occur.

Removed cranial pieces.  Trephination with reshaped excised skull piece (left).  Both external pieces found during analysis (right).
Enlarge / Removed cranial pieces. Trephination with reshaped excised skull piece (left). Both external pieces found during analysis (right).

The authors offered speculative thoughts as to why a trephination might have been performed. The bones of both siblings showed evidence of developmental abnormalities that were most severe in Individual 1, who had a fourth molar and two frontal bones that had not fully fused (metopic suture). Both are consistent with a rare skeletal disease called Cleidocranial dysplasia. (Actor Gaten Matarazzo, who plays Dustin in Strange thingshas this condition.)

There were also indications of extensive bone lesions in both brothers, signs of a probable chronic debilitating disease. Leprosy is a possible candidate as it is known to spread throughout family units, with males between the ages of 10 and 19 being the most susceptible. However, “it is notoriously difficult to identify leprosy in fragmented archaeological skeletal remains,” the authors wrote; therefore, “we cannot identify a single underlying disease without further biomolecular testing.”

The authors also assume that the brothers were wealthy and of high rank, having survived for so long in that condition and having been buried with so many good things near the palace. Furthermore, an intervention such as trephination would have been quite rare and reserved for those with access to highly trained physicians. According to the authors, only four other cases of this type of angular notch trephination have been found in the region, and none showed signs of postoperative healing, indicating that those individuals also died shortly after the procedure.

DOI: PLOSONA, 2023. 10.1371/daily.pone.0281020 (About DOIs).

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