Kent County Times

Archaeologists know that people have practiced cranial trephination, a medical procedure that involves cutting a hole in the skull, for thousands of years. They’ve turned up evidence that ancient civilizations across the globe, from South America to Africa and beyond, performed the surgery.

Now, thanks to a recent excavation at the ancient city of Megiddo, Israel, there’s new evidence that one particular type of trephination dates back to at least the late Bronze Age.

Rachel Kalisher, a Ph.D. candidate at Brown University’s Joukowsky Institute for Archaeology and the Ancient World, led an analysis of the excavated remains of two upper-class brothers who lived in Megiddo around the 15th century B.C. She found that not long before one of the brothers died, he had undergone a specific type of cranial surgery called angular notched trephination. The procedure involves cutting the scalp, using an instrument with a sharp beveled edge to carve four intersecting lines in the skull, and using leverage to make a square-shaped hole.

Kalisher said the trephination is the earliest example of its kind found in the Ancient Near East.

“We have evidence that trephination has been this universal, widespread type of surgery for thousands of years,” Kalisher said. “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.”

Kalisher’s analysis, written in collaboration with scholars in New York, Austria and Israel, was published on Wednesday, Feb. 22, in PLOS ONE. 

wo brothers, up close

Israel Finkelstein, who co-authored the study and serves as director of the School of Archaeology and Maritime Cultures at the University of Haifa, said that 4,000 years ago, Megiddo stood at and controlled part of the Via Maris, an important land route that connected Egypt, Syria, Mesopotamia and Anatolia. As a result, the city had become one of the wealthiest and most cosmopolitan cities in the region by about the 19th century B.C., with an impressive skyline of palaces, temples, fortifications and gates. 

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

According to Kalisher, the two brothers whose bones she analyzed came from a domestic area directly adjacent to Megiddo’s late Bronze Age palace, suggesting that the pair were elite members of society and possibly even royals themselves. Many other facts bear that out: The brothers were buried with fine Cypriot pottery and other valuable possessions, and as the trephination demonstrates, they received treatment that likely wouldn’t have been accessible to most citizens of Megiddo.

“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 said. “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.”

In her analysis, Kalisher spotted several skeletal abnormalities in both brothers. The older brother had an additional cranial suture and an extra molar in one corner of his mouth, suggesting he may have had a congenital syndrome such as Cleidocranial dysplasia. Both of the brothers’ bones show minor evidence of sustained iron deficiency anemia in childhood, which could have impacted their development. 

Those developmental irregularities could explain why the brothers died young, one in his teens or early 20s and the other sometime between his 20s and 40s. But Kalisher said it’s more likely that the two ultimately succumbed to an infectious disease. A third of one brother’s skeleton, and half of the other brother’s, shows porosity, legions and signs of previous inflammation in the membrane covering the bones — which together suggest they had systemic, sustained cases of an infectious disease like tuberculosis or leprosy. 

Original source can be found here.