Biblical city yields unusual case of 3,500-year-old head surgery
Archaeologists excavating the ancient city of Megiddo in modern-day Israel have discovered a window into medicine’s ancient past: the 3,500year-old bones of two brothers, both bearing signs of an infectious disease, and one scarred from cranial surgery that might have been an attempt to treat the illness.
A recent paper in the journal PLOS ONE describes the discovery, which is one of the region’s earliest examples of a widely practiced type of surgery that creates an opening in the skull. The work should help scientists and anthropologists understand how surgeries developed and became more effective over time.
The procedure, known as cranial trephination, was performed thousands of years ago in different parts of the world, including Europe, Africa, China and South America. A 2020 paper listed trephination as one of “the first three procedures that marked the dawn of surgery,” along with circumcision and bladder-stone removal.
Versions of the procedure, called either a craniotomy or craniectomy, are still practiced “as emergency treatment for brain swelling, bleeding, as well as for surgeries to treat epilepsy and to remove some tumors,” said John Verano, who is a professor of anthropology at Tulane University and described the new paper as an interesting case report.
Although the electric drills used today are a far cry from the handheld flints and metal tools used thousands of years ago, the objective — making a hole in the skull — is the same. However, Verano stressed that trephination was not brain surgery.
“They were careful not to cut through the membrane protecting the brain, which would lead to meningitis and death if not done under strictly sterile conditions,” he said.
Archaeologists and anthropologists cannot be certain what conditions ancient healers were treating by cutting into the skull, but most speculation centers on serious head injuries. Other possibilities include epilepsy, mental illness and swelling in the brain.
“It’s a piece of a larger story from which we’re still missing major chapters,” said Rachel Kalisher, an author of the paper and doctoral candidate in archaeology at Brown University’s Joukowsky Institute for Archaeology and the Ancient World.
The brothers’ bones were found in 2016 buried beneath the floor of a
Bronze Age house in Megiddo, which, roughly 4,000 years ago, was a wealthy, cosmopolitan city on a major trade route connecting Egypt, Syria and Mesopotamia.
Kalisher said archaeologists have not found evidence to suggest that the patient received any kind of anesthesia before the surgery. But even if anesthesia had been used, it would have done little good.
“In a nutshell, anesthesia would only be useful for deadening the nerves in the scalp, as there are no sensory nerves in the skull bone,” Verano said. “So the pain would be brief when the scalp is cut. Also, if the patient had a head injury, they might be unconscious or delirious, and thus relatively insensitive to pain.”