Skeleton brothers shed light on ancient brain surgery

A recent excavation in the ancient city of Megiddo, Israel, has found new evidence that one type of brain surgery dates back to at least the late Bronze Age.

Archaeologists know that humans have been practicing cranial trephination, a medical procedure that involves cutting a hole in the skull, for thousands of years. They have found evidence that ancient civilizations across the globe, from South America to Africa and beyond, performed the surgery.

“You have to be in a pretty tough place to cut a hole in your head.”

Rachel Kalisher, a PhD candidate at Brown University’s Joukowsky Institute for Archeology and the Old World, led an analysis of the excavated remains of two noble brothers who lived in Megiddo around the 15th century BCE.

She found out that not long before one of the brothers died, he had undergone a specific type of cranial surgery called a superior angular trephination. The procedure involves cutting the scalp, using an instrument with a sharp beveled edge to carve four diagonal lines in the skull, and using a crowbar to make a square hole.

The trephination is the earliest such example found in the Ancient Near East, says Kalisher.

Kalisher is kneeling in a pit containing ancient pottery.
(Credit: Rachel Kalisher)

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

Who were the brothers?

Coauthor Israel Finkelstein, who serves as director of the School of Archeology and Maritime Culture at the University of Haifa, says 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 was one of the richest and most cosmopolitan cities in the region around the 19th century BCE, with an impressive skyline of palaces, temples, fortifications, and gates.

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

According to Kalisher, the two brothers she analyzed came from a locality directly adjacent to Megiddo’s late Bronze Age palace, suggesting that the pair were members of elite society and perhaps even royals. themselves. Many other facts show that: The brothers were treated with fine Cypriot pottery and other valuable possessions, and as the trephination shows, they received treatment that would probably not have been accessible to most of the citizens of Megido.

“It’s clear that these brothers were living with some pretty severe pathological circumstances that, during this time, would have been difficult to endure without wealth and status,” says Kalisher. “If you’re a minority, maybe you’re not working as much. If you are a minority, you may be able to eat a special diet. If you’re a minority, you may be able to live longer from a serious illness because you have access to care.”

In his analysis, Kalisher observed several skeletal abnormalities in both brothers. The older brother had an extra 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 sibling bones show little evidence of persistent iron deficiency anemia during childhood, which may have influenced their development.

Those developmental irregularities could explain why the brothers died young, one in his teens or 20s and the other sometime in his 20s to 40s. But Kalisher says it’s more likely that both eventually succumbed to an infectious disease. A third of one brother’s skeleton, and half of the other’s, show porosity, legions, and signs of previous inflammation in the film covering the bones—which together indicate that they had sustained, systemic cases of an infectious disease such as tuberculosis or leprosy.

Kalisher says that while some skeletal evidence points to the presence of leprosy, it’s tough to deduce cases of leprosy from bones alone. She is currently working with researchers at Germany’s Max Planck Institute for Evolutionary Anthropology to perform DNA analyzes of specific lesions in the bones. If they find bacterial DNA consistent with leprosy, these brothers will be among the world’s earliest documented examples of leprosy.

“Leprosy can spread within family units, not only because of proximity but also because your genetic landscape affects your susceptibility to the disease,” says Kalisher. “At the same time, it is difficult to recognize leprosy because it affects the bones in stages, which will not happen in the same order or with the same intensity for everyone. It is difficult for us to say for sure whether these brothers had leprosy or some other infectious disease.”

It’s also hard to know, Kalisher says, whether it was disease, congenital conditions, or something else that prompted one brother to undergo cranial surgery. But there’s one thing she knows: If the angular trephine meant to keep him alive, it didn’t work. He died shortly after the surgery – within days, hours, or maybe even minutes.

‘People were still people’

Despite all the evidence of trephination revealed in the last 200 years, says Kalisher, there are many archaeologists who still do not know. It is not clear, for example, why some trephinations are round – suggesting the use of some type of analog drill – and some are square or triangular. It is also not clear how common the procedure was in each region, or what the ancients were even trying to treat. (Doctors today perform a similar procedure, called a craniotomy, to relieve pressure in the brain.)

Kalisher is pursuing a follow-up research project that will investigate trephination across multiple regions and time periods, which she hopes will shed more light on ancient medical practices.

“You have to be in a really bad place to cut a hole in your head,” says Kalisher. “I’m interested in what we can learn from looking across the scientific literature at every example of a trephine in antiquity, comparing and contrasting the circumstances of each person who underwent the operation.”

Besides enriching her colleagues’ understanding of early trephinations, Kalisher says she hopes her analysis also shows the general public that ancient societies did not necessarily have the principles of “survival of the fittest,” as many would imagine.

“In antiquity, there was a lot more tolerance and a lot more care than people think,” says Kalisher. “We have evidence literally from the time of the Neanderthals that people cared for each other, even in challenging circumstances. I’m not trying to say it was all kumbaya—there were divisions based on sex and class. But in the past, they were still human.”

The study appears in the journal PLOS ONE. Additional co-authors come from the University at Albany, the WF Albright Institute for Archaeological Research in Jerusalem, the University of Haifa, and the University of Innsbruck.

The excavation for the study was funded by the Shmunis Family Foundation.

Source: Brown University

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