Trepanations from the 5th to 3rd Millennia BC in Southern Russia

In this post we present selected parts of the very interesting and informative paper titled “New Cases of Trepanations from the 5th to 3rd Millennia BC in Southern Russia in the Context of Previous Research: Possible Evidence for a Ritually Motivated Tradition of Cranial Surgery?“, by  Julia Gresky et al., 2016.

Trepanation is a worldwide phenomenon discussed by innumerable authors. Evidence of surgical opening of the cranium is recorded in archaeological material from the Mesolithic period onwards, throughout almost the entire world. In Eurasia, the earliest trepanation is considered to be of a cranium from the Mesolithic site of Vasilievka III, Ukraine. For Eurasia trepanations are documented from all time periods, being especially frequent in the Neolithic to Eneolithic-Bronze Age and the medieval period.

A number of different classifications for the various reasons behind trepanation exist in the literature. For Russia, the best-known classification is that of Mednikova which includes the following categories: 1) Surgical, made for medical purposes, usually after a skull fracture. 2) Ritual, mostly made postmortem to make an amulet. 3) Preparation for brain extraction following mummification. 4) Symbolic, usually incomplete trepanation, only reducing the external lamina. In this classification only the first category is physical-therapeutic, the other three have a cultic or ritual basis.

There are several cases of ritual skull treatments recorded in the western part of Russia. The tradition of symbolic trepanations is known from medieval crania from Hungary and Bulgaria, and dates back to material of the Upper Paleolithic in Russia.

In Southern Russia we found several more crania displaying trepanations in the midline, in most cases in the region of lambda and obelion. As a group, they stood out because of their similiar location of the hole in a dangerous place on the cranium.

During the late 5th millennium BC, cultural groups of the Eneolithic occupied the northern circumpontic area and the areas between the North Caucasus and the Lower Volga. For the first time, individual inhumations were placed below low burial mounds. During the 4th millennium BC, the area split into two cultural spheres. In the northern steppe area communities continued with the burial practice of crouched inhumations below low mounds, with this culturally transforming into the early Pit Grave culture. In contrast, in the Caucasian foothill zone and the neighbouring steppe, the Majkop-Novosvobodnaya culture emerged. Similarly, during the 3rd millennium BC, two cultural spheres influenced the area: The North Caucasian Culture dominated the Caucasian foothills for the next five centuries, while in the steppe area between the Lower Don and the Caucasus, regional groups of the Catacomb Culture existed side-by-side.

The oldest group of individuals with trepanations are found in the North Caucasian variant of the late circumpontic Eneolithic and date to the last third of the 5th millennium BC. Three individuals with trepanations date to the Middle Bronze Age.

Frequently, trepanation holes may be mistaken for pathological and congenital skull defects. Pathological skull perforations may result from various infectious processes, cysts, and tumors, metabolic diseases leading to, for example, biparietal thinning, or congenital conditions, such as incomplete closure of the fontanel, enlarged parietal foramina, congenital cranial dysraphism, specifically encephalocele, or congenital meningocele. The presence of cut marks in the cases made by grooving and the similarity in location and patterns of the cases made by scraping make pathological or genetic reasons for the lesions unlikely.

As in most cases of trepanations worldwide, most of the 13 trepanned people (n=10/13) died in adult age (20–40 years). The three other persons died in juvenile, mature and senile age. The unhealed or partly healed trepanations show a wide age-range for the operation: Two individuals were trepanned when they were 20–25 years, one between 25 and 35, one between 40 and 49, and one between 50 and 69. Unfortunately, in the well-healed trepanations, the age at which the operation was undertaken cannot be determined because after healing the holes do not show any tendency to decrease in size. However, the healed trepanations can still provide some information about age. The trepanations of seven individuals were well healed before they died at the age of 30–40 years. The well-healed trepanation of the 14- to 16-year old individual indicates that the operation was also being undertaken on younger juveniles, as the operation must have been performed at the latest at the age of 10–12 years, considering that it takes a minimum of four years until complete healing, although perhaps a little less, due to the faster metabolism of young age. It seems that most of these trepanations were carried out before the age of thirty years but they were also performed on older individuals. Assuming that these trepanations were not due to trauma or for any therapeutic reasons, it may be possible that they had a ritual purpose in early age.

In the Stavropol region, more males had been trepanned (3 males, 1 female, 1 of indeterminable sex). This may be due to the fact that the main focus of investigation was on graves within burial mounds, which are mostly of males, with approximately three times more males than females having so far been found (91 males, 32 females, 14 of indeterminable sex).

In the sample that is the focus of this article, only scraping and grooving were used. These two methods are particularly difficult to distinguish, especially if the lesion is completely healed and the rims are remodeled. In addition, in many cases, a clear distinction between operation methods is not possible because the surgeons used various techniques within the same operation.

Altogether, 11 of 13 (84.6%) trepanned individuals show signs of healing. In eight of 13 cases the trepanation was survived for a long time (61.5%). The 84.6% (or the minimum value of 61.5%) survival rate matches that, 50–90%, found amongst trepanations from a variety of different cultures and periods.

Any possible correlation between healing and age is difficult to assess because of the different methods used.

The decision where to perforate the skull can be related to medical aspects, for example, pain in specific areas or the idea of where pain sources should be localized. However, the ethnographic analogies demonstrate that, in the case of ritual trepanations, the position is related to ideas about where spiritual sources are localized. Therefore, specific recurring points for trepanation that are not typical locations for pathological changes of the head can be an indicator for a nontherapeutic motive behind trepanning.

in all cases presented here, the holes are situated midline. In 9 out of 13 cases, the parietal foramina are included within the hole, meaning the veins were potentially destroyed. To trepan in this very risky location requires detailed knowledge of how deep the scraping or grooving can go before the sagittal sinus is penetrated and of how to stop any bleeding of the parietal emissary veins. Therefore, these cases of trepanation may be evidence for early, specialized surgeons. The only reasons for trepanning in this dangerous area should be treatment for severe injury or disease, such as cranial fractures. However, most fractures and associated trepanations found in archaeological populations are not located in this area but in the (left) parietal and frontal bones.

The large variety of reasons behind trepanation makes it difficult to define clearly the distinct cause for trepanation in archaeological material. If a surgical intervention was performed because of cranial trauma or other diseases, for example, intracranial tumors, the reasons for the operation may be directly visible on the bone. Therapeutic treatment for chronic headache, epilepsy, insanity, or evil spirits is impossible to verify on the bones. In many cases of trepanned prehistoric crania without any visible correlation between the operation and disease, there is a tendency to assume a ritual or sacral motivation. Conversely, many authors refute ritual motives for trepanation. Therefore, it is desirable to attempt to provide additional arguments for one or the other theory when discussing reasons for trepanation. To this end, information about specific rituals or burial customs, and the accumulated frequency of particular types of trepanation in one region could be useful.

The apparent desire to place the hole in the midline even though this is one of the most dangerous areas of the cranium may have to be considered as having as specific ritual purpose.

Many of the cases (a maximum of 8 of 13) reported here showed evidence for any special rites. Another argument for a ritual motivation in the Caucasian and Lower Don trepanations is their high frequency related to the known number of burials in this area. Only 60 burials dating to the late 5th millennium BC are known, of which ten individuals were trepanned. The number of Eneolithic burials is rather low, which indicates that perhaps not all members of a community were buried in a way that archaeologists could detect. Thus the high frequency of trepanned individuals is astonishing. Perhaps burial as well as trepanation was restricted to special members of these societies, elites, or shamans. Unfortunately, it is not possible to estimate the frequency of trepanations in the midline in the Bronze Age within one culture as we mainly examined individuals from burial mounds, which included those from different time periods. However, in the cases we investigated, in the Stavropol and Rostov-on-Don region during the Eneolithic and Bronze Age, the number of trepanations located on the midline without signs of trauma (13 cases) outnumbers those with a probable traumatic cause (6 cases).

The region of Southern Russia seems to be a center for ritual trepanations performed by skilled surgeons, with the specific position of the hole in the head implying a possible ritual reason for trepanning.

Research-Selection for NovoScriptorium: Maximus E. Niles