Bronze Age tomb sheds light on ancient medical care
Editor’s Note: This blog article contains images of human skeletal remains.
While archaeology is not brain surgery, sometimes it can find evidence for it in the ancient past. This was the case for the archaeologists at Tel Megiddo who uncovered a 3,500-year-old burial containing the remains of two brothers, one of whom underwent a surgical procedure known as trephination where part of the skull is removed. As discussed in the journal Plos One, the brothers showed signs of various severe medical conditions, yet had received medical care that extended their lives far beyond what would be expected.
Roughly 3,500 years ago, a small pit was opened in the floor of a wealthy home in Canaanite Megiddo and the body of a man (who was between 21 and 46 years old when he died) was placed inside. This was not the first burial in the pit, however, as only a few years earlier the man’s younger brother—who was possibly a teenager when he died—was buried in the same place. The home’s subfloor burial—a common Canaanite funerary tradition—included rich grave goods that conveyed the family’s elite status and its care for a deceased loved one.
The archaeologists were not surprised to uncover the burial, as other subfloor burials had already been found beneath the building. What did surprise them, however, was the condition of the skeletal remains. DNA analysis of the bones revealed that the two men were brothers, and both showed signs of genetic defects and systemic infectious diseases. Most surprising, however, were the marks of trephination identified on the skull of the older brother, a rare and dangerous procedure in the ancient world. Only a few dozen cases of trephination have been identified in the ancient Near East, with this example being one of the oldest. According to the excavators, this trephination procedure was likely intended to relieve or treat the patient’s illness.
The tomb, dated to the Late Bronze Age I (c. 1550–1450 BCE), was located beneath an elite residence, possibly the home of a royal official. A century earlier, another tomb had been dug below the floor of the home, which contained at least 17 individuals, as well as gold, silver, and bronze jewelry, ceramic vessels, and decorative bone inlays. The tomb of the brothers was much smaller and found only a few feet away from the earlier burial.
The brothers’ illnesses were apparently long-lasting, as evidenced by the extensive damage found in their bones in the form of lesions and porosity. Although it is not certain what caused these issues, one explanation is leprosy, which can remain active for decades and is known to spread within families and especially to adolescent males.
It may also be the case that the brothers’ shared genetic defects predisposed them to additional illnesses. In both men, genetic defects were seen in dental issues, such as extra teeth, while the older brother also had an unusual facial structure and a persistent metopic suture, a condition in which the skull’s front bones do not fully fuse. Based on these conditions, the archaeologists hypothesize that both brothers suffered from developmental problems and perhaps a genetic bone disease, such as cleidocranial dysplasia. Both brothers also showed signs of anemia, which can also hamper growth.
Whatever their conditions, the brothers lived long enough for them to leave extensive marks on their physiology. This was at least partially due to their social class, as individuals from lower classes could not afford the care needed to extend life. This is evidenced by the higher percentage of wealthy individuals with signs of long-endured diseases compared to those from lower classes. As Rachel Kalisher, the primary author of the study, told The Times of Israel, “These brothers were elite, they were part of the most wealthy class living at Megiddo, which was itself quite a wealthy city. They weren’t part of the average population, and that’s what we believe allowed them to survive as long as they did with the illness that they had.”
Trephination was likely performed on the older brother to alleviate some of these conditions. The procedure was carried out by removing a section of the scalp, then making grooves into the bone along the surgical area to cut it away from the rest of the skull. In this case, the hole in the skull measured about 1 by 1 inch. These pieces of bone were then removed from the head all at once. This procedure would have served to alleviate pressure on the brain caused by head trauma, although curative cases are also known.
Given the skill and precision needed for such a procedure, the trephination must have been carried out by a highly trained practitioner. This further demonstrates the great wealth of the family and their ability to access such medical care. Unfortunately, the surgery was not successful. Examining the bones surrounding the surgical area, no signs of regrowth were found, suggesting the brother died immediately or soon after the procedure.
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