(CNN) When archaeologists discovered the burial site of two brothers who lived in 15th century BC Israel, they were surprised to discover that one of them had undergone brain surgery shortly before his death.
The discovery marks the first example of trepanation, a type of cranial surgery, found in the ancient Near East.
Trepanation, also known as trephination, involves drilling a hole in the skull – and there are examples of medical procedures dating back thousands of years.
The remains of the brothers, who lived in the Bronze Age between 1550 BC and 1450 BC, were found during an excavation of a tomb in the ancient city of Tel Megiddo.
The older brother, estimated to be between 20 and 40 years old, had an angular notched trepanation. His scalp was cut, then a sharp, beveled instrument was used to draw four intersecting lines on the frontal bone of the skull, which made a 30 millimeters (1.2 inch) square-shaped hole.
A study detailing the findings published Wednesday in the journal PLOS ONE.
“We have evidence that trepanation has been this universal and widespread type of surgery for thousands of years,” study author Rachel Kalisher said in a statement. She is a doctoral candidate at the Joukowsky Institute of Archeology and the Ancient World at Brown University in Providence, Rhode Island.
“But in the Near East we don’t see it that often – there are only a dozen examples of trepanning in that whole region. I hope adding more examples to the scientific record will deepen the understanding of our field of medical care and cultural dynamics in the ancient cities of this region.
Curiously, the pieces of bone removed from the skull were included in the grave – but that wasn’t the only unusual find made about the brothers as researchers studied their bones.
Bronze Age Brethren
The city of Tel Megiddo was part of the Via Maris 4,000 years ago. This crucial land route linked Egypt, Syria, Mesopotamia and Anatolia, according to study co-author Israel Finkelstein, director of the School of Archeology and Maritime Cultures at the University of Haifa.
Tel Megiddo controlled part of this trade route, making it a wealthy and cosmopolitan city full of palaces, temples and fortifications.
“It is difficult to overstate the cultural and economic importance of Megiddo during the Late Bronze Age,” Finkelstein said.
The tomb was discovered in an area adjacent to a late Bronze Age palace in Tel Megiddo, leading scholars to believe the pair were either high-ranking elite members of society. , or maybe even members of the royal family. DNA testing revealed the two were related and likely brothers.
THE Men were buried with Cypriot pottery, food, and other valuables similar to those found in other high-status local graves.
And in life, both brothers were seriously ill. Their skeletons are scarred with signs of disease, including extensive lesions suggesting chronic and debilitating conditions. But both were able to survive for many years despite their ailments.
“These brothers were obviously living with quite intense pathological circumstances that, at that time, would have been difficult to bear without wealth and status,” Kalisher said. “If you’re in the elite, maybe you don’t have to work out as much. If you’re in the elite, maybe you can go on a special diet. If you’re in the elite, you may be able to survive a serious illness longer because you have access to care.”
The younger brother died in his teens or early twenties, likely succumbing to an infectious disease such as tuberculosis or leprosy.
The older brother had an extra molar, so he could have suffered from a genetic condition like cleidocranial dysplasia which impacts teeth and bones, the researchers said.
Researchers cannot say why the older brother needed trepanation. The practice was used to relieve pressure in the skull or treat symptoms of epilepsy and sinusitis. Ancient Mesopotamian texts also suggest the operation could have been “curative on supernatural or otherworldly conditions,” Kalisher said.
“The skeletal evidence tells us that this individual endured a disease for an extended period, which, assuming it was untreated, likely progressed,” Kalisher said. “This elite individual was privileged to endure the infection for a long period of time and also underwent a high profile cranial operation, leading us to speculate that the trepanation was performed in direct response to a declining condition. “
Regardless of why the older brother had the surgery, he died days or hours later, due to the lack of bone healing the researchers noted during their analysis.
Breaking old medical cases
Many questions remain after studying the bones of the two brothers, Kalisher said.
Although skeletal evidence suggests the brothers had leprosy, further research is needed to establish a clear determination. If the analysis reveals bacterial DNA that matches leprosy, the brothers may have experienced one of the first documented cases of the disease.
“Leprosy can spread within family units, not only because of closeness but also because your susceptibility to the disease is influenced by your genetic landscape,” Kalisher said.
Kalisher is also puzzled as to why the skull pieces removed from the older brother were included in his burial. Only two other examples have been found in the past, in England and Peru.
“In our study, we consider whether the excised bone pieces were reinserted into the head because the practitioner thought it would facilitate healing,” Kalisher said. “But, I also come back to the medicinal/magical dichotomy that we impose on the past. It is possible that the excised bones also had another, non-medical purpose leading to their inclusion with the individual. It is simply unknowable for us. . So for now, that mystery remains unsolved.”
There are broader questions about ancient trepanning researchers, like why some were made using analog drills to create round holes, while others are square or triangular.
But when it comes to the brothers, it’s clear that the pair weren’t considered outcasts or “others” due to their health issues. People close to the brothers cared for them and ensured they were buried according to proper burial traditions, the researchers said.