Cranial surgery as early as Bronze Age Israel

Risky treatment: Archaeologists have uncovered the oldest evidence in the Middle East of trepanation – an operation that involves drilling a hole in the skull – in Israel. The operation took place around 3,500 years ago on a man of high social status. This apparently suffered from congenital malformations, and his skeleton also shows traces of an acute infection. Although the patient did not survive his skull surgery, the find proves that high-ranking people had access to complex medical care as early as the Bronze Age.

Thousands of years ago, people in different regions of the world performed surgical openings in the skull. In this so-called trepanation, a hole is cut, scraped or drilled into the skull. Archaeological finds show that several of these patients survived the risky procedure. There is also evidence that primeval surgeons practiced on animal skulls .

However, it is unclear what purpose the trepanations served. Both medical indications – for example to reduce intracranial pressure – and ritual reasons, for example to let evil spirits out or divine powers in, are discussed.

Trepanation in the Ancient Orient

A team led by Rachel Kalisher of Brown University in Rhode Island has now found two skeletons belonging to brothers in a burial site in the ancient city of Megiddo in Israel. One of them had had a trepanation. According to the analysis, the brothers lived in the late Bronze Age around 1500 BC and belonged to a high family. Her tomb bordered on a Bronze Age palace and was furnished with rich objects.

The find is the earliest evidence of trepanation in the ancient Near East. “We have evidence that trepanation was a universal, widespread type of surgery for thousands of years,” says Kalisher. “But we don’t see them that often in the Middle East — there are only about a dozen examples of trepanations across the region.” of a lever a square hole was created.

Skull surgery for medical problems?

The research team assumes medical causes as the reason for the operation. For example, the skeleton of the Bronze Age patient showed abnormalities suggestive of a congenital syndrome, including an extra molar. The younger brother of the patient also had individual developmental anomalies in his jaw, although these were less pronounced.

In addition, Kalisher and her team found signs of an acute infectious disease in both skeletons. According to the researchers, the porosity of the bones and indications of inflammatory reactions could be consistent with leprosy. If confirmed, it would be the earliest evidence of this bacterial disease in the Middle East.

“However, leprosy is difficult to recognize because it affects the bones in different stages, which don’t occur in the same order or with the same degree of severity in everyone,” explains Kalisher. “It is therefore difficult for us to say with certainty whether these brothers had leprosy or another infectious disease.”

Social status facilitated medical treatment

According to the analyzes, the operated person was between 21 and 46 years old – an astonishingly high age for a person who probably suffered from a congenital disease. Kalisher suspects that the reason for this was probably his high social status. “Those who belonged to the elite probably had to work less, possibly had access to a special diet and medical care. In this way, it was possible to survive a serious illness longer,” she explains.

However, the skull operation did not extend the life of the operated person: Since the bones around the opening show no signs of healing, the research team concludes that the man died shortly after the operation. It is unclear whether the operation was the cause of death or whether it was simply unable to combat the underlying, fatal condition. The younger brother who was not operated on also died – according to the researchers, probably from the infectious disease. He reached an age of about early 20s. (PLoS ONE, 2023, doi:10.1371/journal.pone.0281020 )