Early example of cranial surgery identified in late Bronze Age tomb

This discovery represents the earliest example of a particular type of cranial trephination found in the ancient Near East.

Recent analysis of an individual excavated from an elite Late Bronze Age tomb, dated to c.1550-1450 BC, at the ancient city of Megiddo, Israel, has revealed that they underwent a particular type of cranial trephination – and the earliest example of its kind found in the ancient Near East.

Cranial trephination is a medical procedure that involves cutting a hole in the skull. It has been practiced for thousands of years across the globe.

The sharp edges of the trephination area are show in the left image, and in the right are two extant skull pieces found during analysis. IMAGE: Kalisher et al. 2023

Situated in the Jezreel Valley, the ancient city of Megiddo controlled part of the Via Maris, an important land route that connected Egypt, Syria, Mesopotamia, and Anatolia. By around the 19th century BC, Megiddo had become one of the region’s wealthiest cities.

Unearthed during excavation work at the city in 2016, the tomb contained the remains of two adult males, and subsequent ancient DNA analysis revealed them to be brothers.

The location of the burial – in a domestic area adjacent to Megiddo’s late Bronze Age palace – and the inclusion of grave goods such as fine Cypriot pottery and food offerings suggest that the brothers were elite members of society.

Skeletal analysis of both individuals was carried out in a recent study led by Rachel Kalisher, a PhD candidate at Brown University’s Joukowsky Institute for Archaeology and the Ancient World.

Rachel Kalisher during excavations in Megiddo. IMAGE: Rachel Kalisher

It revealed that one of the brothers had undergone a specific type of cranial surgery called angular notched trephination. This would have involved cutting the scalp using an instrument with a sharp bevelled-edge to carve four intersecting lines, and then removing a square-shaped section of the skull.

This discovery represents the earliest example of its kind found in the ancient Near East.

Analysis also revealed several skeletal abnormalities in both brothers which could indicate that they had a congenital syndrome. Lesions and evidence of inflammation also suggest that they had suffered systemic, sustained cases of an infectious disease such as tuberculosis or leprosy.

However, whether it was a congenital condition or infectious disease that prompted one brother to undergo trephination is unclear.

The skeletal evidence, however, indicates that the surgery was not successful, as he is estimated to have died within a week of the procedure.

Pictures a and b show magnified edges of the trephination area, and picture c shows all four edges. Picture d is a reconstruction of the trephination area. IMAGE: Kalisher et al. 2023

‘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.’

Kalsiher, working alongside researchers at the Max Planck Institute for Evolutionary Anthropology, is currently conducting aDNA analyses in order to shed further light on the cause of the skeletal lesions.

The full findings of the study have been published in the journal PLOS ONE.