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Earliest Evidence Of Bronze Age Brain Surgery Discovered In Israel

Only the rich could afford a hole in the head.


Ben Taub


Ben Taub

Freelance Writer

Benjamin holds a Master's degree in anthropology from University College London and has worked in the fields of neuroscience research and mental health treatment.

Freelance Writer

Bronze Age trephination skeleton

The skeletons were found near to a Bronze Age palace in Megiddo. Image credit: Kalisher et al., 2023, PLOS ONE, CC-BY 4.0

Two high-status brothers who occupied the Bronze Age city of Megiddo apparently went to extreme lengths to cure a nasty disease that left them with porous bones. Describing the discovery of the siblings’ gnarly remains, the authors of a new study reveal that one of the brothers underwent a type of cranial surgery called angular notched trephination, which involves cutting a hole in the skull.

While a small number of similar procedures appear in the Bronze Age Levantine archaeological record, this is the earliest example of trephination ever discovered in the region. Estimated to have taken place sometime in the fifteenth or sixteenth centuries BCE, the ancient surgery sheds new light on the type of medical care available to the elites who once lived in the opulent city of Megiddo, in what is now Israel.


Occupying an important strategic position on a major trading route, Megiddo rose to prominence as one of the wealthiest cities in the Near East around 4,000 years ago. The two brothers were buried with a cache of valuable grave goods in a residential area next to a palace, indicating that they were elites – possibly even royalty.

Ironically, the pair’s terrible health can also be seen as evidence of their high social status, since the poorer classes typically died long before their illnesses became reflected in their bones due to a lack of access to medicine. In contrast, both brothers appear to have survived their illness for some time, allowing it to ravage their skeletons. This indicates that they probably received medical care that few could afford.

“These brothers were obviously living with some pretty intense pathological circumstances that, in this time, would have been tough to endure without wealth and status,” said study author Rachel Kalisher in a statement. “If you’re elite, maybe you don’t have to work as much. If you’re elite, maybe you can eat a special diet. If you’re elite, maybe you’re able to survive a severe illness longer because you have access to care.”

Bronze Age trephination
a-b: Magnified edges of the trephination, each with a 2 mm scale bar. c: All four edges of the trephination, scale bar is 1 cm. d: Reconstructed location of trephination on head. Image credit: Rachel Kalisher et al

Despite this, both brothers died young, with one perishing in his late teens or early twenties while the other expired between the ages of 21 and 46. Both skeletons show extensive porosity, lesions, and signs of inflammation in the membranes covering the bones, all of which suggest they may have suffered from leprosy.


“Leprosy is hard to identify because it affects the bones in stages, which might not happen in the same order or with the same severity for everyone,” explained Kalisher. “It’s hard for us to say for sure whether these brothers had leprosy or some other infectious disease.”

Whatever condition the brothers were suffering from, the researchers say that the trephination “was meant as an intervention to deteriorating health.” Unfortunately, however, the skull surgery was a disaster, as a lack of bone healing suggests that the patient died almost immediately after the procedure.

Throughout history, trephination has been used as a means of releasing pressure from the brain following head trauma. Less frequently, the procedure has been conducted on individuals with diseases such as scurvy, epilepsy, or bone inflammation. 

“However, there are no archaeological examples of trephination on an individual exhibiting diffuse, extensive lesions as is the case in our study,” write the researchers.


While the study authors can’t be sure exactly why this particular Bronze Age brother sought out the procedure, Kalisher says that “you have to be in a pretty dire place to have a hole cut in your head.”

The study has been published in the journal PLOS ONE.


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