Brain surgery c. 2000 BCE

Archaeologists at Ikiztepe, Turkey unearthed two glass obsidian blades they believe were used for neurosurgery 4,000 years ago. Why do they think these were tools for Bronze Age brain surgery? Because they found scarred skulls there too. New Scientist interviewed excavation director Önder Bilgi:
 Data Images Ns Cms Mg20727750.200 Mg20727750.200-1 300 What makes you think they were used for surgery?

We have found traces of cuts on skulls in a nearby graveyard. Out of around 700 skulls, 14 have these marks. They could only have been cut with a very sharp tool. At this time, 4000 years ago or more, it could only have been an obsidian blade. The cut marks show that a blade was used to make a rectangular opening all the way through the skull. We know that patients lived at least two to three years after the surgery, because the skull has tried to close the wound.

Have you uncovered any clues to why this surgery was performed?

There seem to be three main reasons. The first is to relieve the pressure of a brain haemorrhage; we found traces of blood on the inside of some of the skulls. The second is to treat patients with brain cancer, as we can see pressure traces from the cancer inside some of the skulls. And the final reason was to treat head injuries, which seem to have been quite common. The people of Ikiztepe got their copper from mines in the local mountains, and we think they had to fight other local people for access to it.

"Scalpels and skulls point to Bronze Age brain surgery"



  1. Trepanation was also practiced by the Incas and other pre-Columbian civilizations in the Americas. Just goes to show you that the only real difference between us moderns and “primitives” is that we can control electricity and they couldn’t. Just about everything we can do they could do also, using nothing more than brain power and brute force.

    1. Hm. Don’t see them crossing continents in a day worth of travel.

      Cultural exchange was quite limited because of the lack of writing.

      If you had a ruptured appendix, that was basically the end of it, as was diabetes, though of course they had little of the modern, diet based variety.

      Internal wounds, likewise.

      Need a new heart or just born with a crossed artery? Tough luck.

      Allergic to bee stings? Better stay away from that honey tree.

      Yes, humans back than were as smart as their descendants today and they did know a lot of stuff we thought they couldn’t possible know, but no, they couldn’t do all that we can do today, not by along shot.

      Which isn’t a bad thing, as it’d imply that we can do everything the people of the year 9000 CSM do. Which would be quite disappointing.

      1. which is why I qualified it by saying “just about”. The Mayas mapped the heavens and made a very accurate calendar, all without the help of any electronics. That’s just one example. All we moderns have done is refine knowledge. The basics of mathematics, including geometry, were figured out thousands of years ago by humans who just sat there and used their brains. If you were born with a birth defect severe enough to limit your survival, then you’re right – but that’s just Darwin for you. Same for diseases and allergies. As for fast travel – is that really such a great thing? I don’t see how that ability has improved humanity much, except for obnoxious tourists and being able to send troops into war much faster. Cultural exchange may have been limited but it was still possible back then and don’t assume they had no language simply because we can’t understand what they left behind.

        Bottom line – there ain’t much difference between us and them, brainpower wise. Take away our technology and then where would we be? An Ipod is no substitute for a camp fire.

  2. You just know the ‘Dr.’ was flinging poo moments earlier, and didn’t wash his hands.

    But really, imagine you are back 4,000 years. Is there a language to communicate your problem? Was there a specific person you would see, or did everyone know how to do this? Had to be a strong family structure, you would need a few days to recover from this… in that time, you need someone to care for you.

    I would imagine archeology in 4,000 years will be boring, everything we do today is recorded and stored somewhere. Digging won’t get you anything you can’t access in your Encyclopaedia Brittanica neural implant.

    1. I’m quite sure that about everyone safe sociopaths were part of a family back then. The modern bachelor or bachelorette with no family ties who can get along by getting all needed services in ex hang for money is a, well, modern invention.

    2. Many archaeologists support a claim that the pyramids in egypt were built as early as 2600 BC. I believe we can establish that there was definitely a language, communities, and sanitation (at least better than doctors with feces on their hands) by the time 2000 BC rolled around. Humankind doesn’t normally lose that much knowledge THAT quickly.

    3. Don’t be so sure our own history is so well preserved. All of the media we have degrades. CDs don’t last forever. Even the fancy gold ones degrade over time. This assuming we’ll even have the technology to READ that data in 4000 years.

      As for language, I’m pretty sure we know how to say “my head hurts” 4000 years ago, and that we noticed if one guy was better at punching holes in heads than everyone else. I know that some people think 4000 years is 2/3rds of the way to the dawn of time and all but anthropologically, we’re not talking cave men.

  3. I am a physician and have been in neurosurgeries as assistant, what is described here are Rustic forms of trepanation.
    Cutting through skull is just one step in a neurosurgery, REAL neurosurgery is much more complex and the training of a neurosurgeon takes at least 6 years of residency. This is one of the most difficult specialties in medicine.
    A little cut in sensitive or motion areas (or any other important areas of the brain), will make that person damaged for the rest of his life.
    In my opinion the “patients” in which these “neurosurgeries” were made, died after the procedure, if not instantly or by hemorrhage, then because of infection-sepsis.

    1. Except that there are many examples of ancient trepanned skulls that show evidence of survival and healing.

      1. Oh, yes?
        Did you visit them at the hospital and filmed their recovery? or did you read that wikipedia article on trepanning?
        I have seen patients being amputated, because of infection after surgical procedures less complex than exposing the brain.

        I would like to read your source articles on survival rate after ancient trepanning.

        1. Well, the trepanation holes show bone growth on the edges. I suppose it’s possible that Beverly Crusher went through a space-time anomaly and used her bone stimulator on the corpses…. Although that wouldn’t explain how people survive well-documented home trepanation in this very decade.

          1. Bone growth edges? I doubt it, maybe they used a tool to make the edges rounded, and someone is confusing that with bone growth.
            Oh and examples of recent trepanning, could not compare to ancient ones, because we HAVE antibiotics, contrary to ancient civilizations.

          1. Trepanning history article is not the same as scientific paper article, showing the survival rate of ancient trepanning.

          2. I understand why you got your surgical green undies in a bunch over a possibly inappropriate comparison of trepanation with neurosurgery, but attacking the archaeological and historical research that indicates success of this ancient surgical procedure is an epic medical history FAIL (what are they teaching you in med school these days?). If you want literature citations specifically for the Neurophilosophy post, contact the blogger. In the meantime, enjoy these peer-reviewed articles from PubMed:

            Andrushko, V.A. and J.W. Verano. 2008.
            Prehistoric trepanation in the Cuzco region of Peru: a view into an ancient Andean practice. Am J Phys Anthropol. Sep;137(1):4-13.

            “The predominant methods used were circular cutting and scraping-methods that proved highly successful with an overall 83% survival rate and little ensuing infection. Survival rates showed a significant increase over time, apparently reflecting improvements in trepanation technique through experimentation and practical experience.”

            Carod-Artal, F.J. and C.B. Vázquez-Cabrera. 2004. [Neurological paleopathology in the pre-Columbine cultures of the coast and the Andean plateau (II). The history of cranial trepanations.] [in Spanish] Rev Neurol. May 1-15;38(9):886-94.

            “Signs of trepanation have been found in 5% of skulls and 80% of these show evidence of the ‘patient’ having survived such an intervention. Some of them have several holes in different stages of healing… CONCLUSIONS: Cranial trepanation was very successful despite the rudimentary methods and instruments employed to perform it.”

            Stone, J. and Miles, M. 1990. Skull Trepanation Among the Early Indians of Canada and the United States. Neurosurgery 26: 1015-1020.

            “About 90% of the trepanations showed evidence of healing, indicating survival.”

            And a PDF of an article whose title you’re not going to like:

            Piek, J., Lidke, G., Terberger, Th. 2008. Ancient Trephinations in Neolithic People – Evidence for Stone Age Neurosurgery? Nature Precedings: hdl:10101/npre.2008.1615.1

            If you want to personally examine ancient trepanned skulls for signs of healing, your nearest museum of natural history or anthropology may have some. The museum in the small city where I grew up had a large trepanation exhibit with both casts and original skulls, some showing obvious bone growth around the edges of the cuts.

  4. If you wanna be happy for the rest of your life/get yourself a big obsidian knife. They won’t be callin’ you a jokah/when you sacrifice ’em to Tezcatlipoca!

    (Not sure where this is originally from. I heard or read it somwhere, and it embedded itself in my cortex.)

  5. Yes, they were not lacking in the brainpower department, but their accumulated knowledge was quite smaller – to claim that we did nothing but “refine” it is patently absurd.

  6. There seem to be three main reasons. The first is to relieve the pressure of a brain haemorrhage; we found traces of blood on the inside of some of the skulls. The second is to treat patients with brain cancer, as we can see pressure traces from the cancer inside some of the skulls. And the final reason was to treat head injuries, which seem to have been quite common.

    Isn’t it more likely that the surgery *caused* hemorrhages? Or that the cancer was common and incidental? I can believe the fact that they did trepanation and that people survived, but as a treatment for brain cancer or hemorrhage? That seems like a gigantic stretch.

    1. Indications for trepanation are discussed in the Hippocratic treatise “On injuries of the head” (ca. 400 BCE):

      The sophisticated understanding and application of trepanation in Hippocrates’ time no doubt reflect generations of accumulated experience with this procedure back to preliterate times.

      Another overview from The Neuroscientist Vol. 5, No. 4, 1999:

      The more information I find on this subject, the more gobsmacked I am that someone claiming to be a physician is so ignorant of it. I hope never to meet “DrPretto” on the other side of a scalpel.

  7. I am not a Surgeon, nor Paleopathogist, I do not believe in everything I read.

    You are insulting my quality as medical doctor just for doubting your history lesson?

    1. You are insulting my quality as medical doctor just for doubting your history lesson?

      More for your complete ignorance of one of medicine’s founding documents (which is reportedly still taught in medical schools – guess you skipped that class) and your appalling failure to use a search engine. Anyone who won’t use Google to prevent him from making a fool of himself is not someone I’d trust to do research into issues that affect my health.

    2. “I am not a Surgeon, nor Paleopathogist, I do not believe in everything I read.”

      Apparently not even peer reviewed articles by those who actually know something about this topic (unlike you).

      You were wrong and are unable to admit it. Wait…I actually do believe that you MUST be a doctor given that quality.

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