Summary: An excavation at Megiddo, Israel reveals an astonishing 3,500-year-old skeleton with evidence of the earliest brain surgery performed in the Middle East.
For they are demonic spirits, performing signs, who go abroad to the kings of the whole world, to assemble them for battle on the great day of God the Almighty… And they assembled them at the place that in Hebrew is called Armageddon. – Revelation 16:14,16 (ESV)
Surgery in the Rich City of Megiddo
Megiddo, called Armageddon in the New Testament Book of Revelation, is an important site in northern Israel where the Bible says the final battle for the end of the world will happen (Rev. 16:16). It is also the place of a recent study published in the journal PLOS ONE, that provides evidence of the earliest brain surgery, about 3,500 years ago, discovered in the Middle East.
This discovery gives a rare snapshot into the ancient times of the Bible, particularly the lives of the wealthy who were able to afford physicians trained in this difficult surgery. Surprisingly, complex medical procedures such as brain surgery were happening in Israel during Old Testament times.
The remains of two brothers were uncovered beneath the floor of a Late Bronze-era building during an excavation at Tel Megiddo. The shocking part of the find came when one of the skulls was found to have undergone a precise surgical procedure called trephination, where a hole is carefully cut in the skull without affecting underlying tissue.
The frontal bone of the skull had a square-shaped space cut by a sharp instrument that had also been used to cut the bone into smaller pieces to remove them, most likely as a medical procedure to treat head trauma by releasing pressure on the brain. There are only a few dozen examples of this type of surgery in the archeological records, with this being the earliest example so far, by at least several centuries.
“We have evidence that trephination has been a universal, widespread type of surgery for thousands of years,” said Rachel Kalisher, a PhD student at Brown University’s Joukowsky Institute for Archaeology and lead author of the study.
“Usually when you study human remains, you’re studying the accumulated change that they experienced throughout their lives, but this was one moment captured,” Kalisher explained.
Kalisher’s Study of Genetic Relationships
Rachel Kalisher joined the dig at Megiddo as part of her dissertation research about multigenerational households and family structures. The deceased brothers in this study lived during a unique time in the city’s history when families buried their dead beneath their houses. Usually human remains excavated are located in cemeteries and burial sites outside of the city, but this situation is special.
“The context at Megiddo is really different because we’re not talking about a cemetery with all types of different people together,” she said. “People are directly tied to their houses, which means they’re directly tied to their socioeconomic status.”
Kalisher is working with the Harvard Medical School and Hebrew University to map the DNA of bone fragments and genetic relationships between families buried under each house. This burial practice lasted until 1400 BC, when the area became a province of the Egyptian empire, according to Prof. Israel Finkelstein, the director of the School of Archaeology and Maritime Cultures at the University of Haifa and one of the co-authors of the paper on this study.
Rich but Very Sick Brothers
The two skeletons of the brothers were found during the 2016 dig season, buried together beneath the floor of their home located in one of the richest parts of Megiddo. Under their remains was an elaborate stone tomb filled with gold, bronze, silver and bone ornaments.
The brothers were from a wealthy family who lived a tragic life during the 15th century, roughly between 1550 – 1450 BC. Evidence shows they died within 1-3 years of each other, with the younger brother dying first, in his late teens to early 20s. The elder brother died a few years later, between the ages of 20 and 40, shortly after the cranial trephination surgery.
Interestingly, both brothers exhibited evidence consistent with chronic infectious disease suggesting they were sick for a long time. The bones recovered from both were exceptionally porous and marked with lesions, leading archaeologists to hypothesize they suffered from a systemic illness such as leprosy, tuberculosis, or a genetic disease.
Certain indications found on the skeletons, including the presence of an extra molar and atypical face structure of the older brother, point to developmental delays, possibly from a genetic disorder such as Cleidocranial dysplasia or Down syndrome. Both men showed evidence of being severely anemic, which can also stunt growth.
“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 Kalisher. “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.”
“[They] were part of the wealthiest class living at Megiddo, which was itself quite a wealthy city,” Kalisher continued. “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.”
The Precision of Trephination Surgery
Doctors today still perform a variation of trephination surgery, called a craniotomy, which is used to relieve swelling in the brain after a traumatic brain injury. In Bible times, trephination was sometimes used to treat people with conditions such as epilepsy, scurvy, sinusitis and intracranial disorders.
Signs from the discovered skull indicate the older brother was alive when this procedure was done. “It still seemed to be what we call ‘green bone,’ so it was still living at the time, and we can tell this based on the coloration of the bone, the smoothness and shininess of the bone, and also that the inner table of bone itself was preserved.” Kalisher explained. “With this [cut to the skull] not going all the way through and hurting the underlying soft tissues, there was some kind of caution exercised.”
The surgery was exceptional with very precise cuts at around 90 to 100 degrees leaving smooth edges. “This trephination is called an ‘angular notch definition’ and what that means is essentially these intersecting hashes would be drawn and then parts wedged out piece by piece,” Kalisher said.
“The precision of this surgical procedure, at least to me, seems like something that would have been done by a professional, especially if you’re talking about an elite individual with the means to get that experience.”
The City of Megiddo
“The location where they [the brothers] were found is very close to the palace of Megiddo,” explained Prof. Finkelstein, who has been digging at Tel Megiddo since 1994. “You can see the elite manifestations from the architecture and other aspects.”
Megiddo was inhabited continuously from around 7,000 – 500 BC and the ancient city appears in “all the great archives of the Middle East,” according to Finkelstein. “When a site is mentioned in so many historical records, you can make a link between the site and historical processes,” he added.
This city is mentioned in the Hebrew Bible, the New Testament, and in Assyrian, Egyptian, and Hittite documents, as being a prosperous and important trade hub along the Via Maris, a crucial land route that connected Egypt, Syria, Mesopotamia and Anatolia.
The Surgery’s Ultimate Failure
Archaeologist Tim Maloney from Griffith University commented on the study calling it
“fascinating and horrific. Most typically in this sort of Bronze-Age era … [trephination was] typically used as a proactive treatment for acute trauma, battle trauma and injuries of the like.”
“The human cranium is an incredibly robust part of the skeleton. At minimum, it must have taken hours to create those notches. Although it seems rather crude and 80s-horror-movie-looking, it was, at the same time, quite precise and conducted by surgeons that had a good understanding to not penetrate the soft tissue layers beneath the bone.”
Evidence suggests that the brother with the surgery died soon after the procedure because no healing in the bones can be observed. He may have died within minutes, days or weeks of the surgery. “We’re talking about a really short period of time … he did not survive very long,” Kalisher said. “He may have died from the procedure or maybe was fatally ill already. His skeleton had extensive bone lesions, a sign of some kind of infection.”
“It could be that this trephination was some kind of intervention to a declining state of health, but because I don’t know exactly what the disease was, I can’t say for certain,” she explained.
The DNA preservation of the brothers makes the case “remarkable,” said Dr. Maloney.
“DNA preservation confirmed that they were brothers, they lived in the same socio-economic [setting] and probably in the same domestic setting, sharing similar genetic traits but also genetic predisposition to these diseases.”
The excavation provided “an absolute smorgasbord of horrific health conditions” in both skeletons. “Those biological circumstances combined with a pretty clear social status is unique to archaeology,” he added.
“What I think is most remarkable from this, and all other early cases for medical interventions in our shared human story, is that it’s a strong case for a caring society,” he said. “It might sound simple to think of people caring for their family, their brothers, their children, their community, but there’s rarely direct archaeological evidence for that social community care.”
It is fascinating to wonder about the circumstances of these brothers at this time. Were they Canaanites or Israelites? Depending on whose chronology one considers, this time could equate to anywhere from before the Conquest of Canaan (the majority view) to the period of the Judges (Rohl, Bimson) – or even afterward (those who favor an Exodus at the end of Egypt’s Old Kingdom).
According to the biblical account, Megiddo was initially defeated by the Israelites but they were unable to expel the Canaanite population. By the time of kings David and Solomon, Megiddo was firmly in Israel’s hands and it was one of the cities fortified by Solomon. Physicians were known to operate in Israel and elsewhere.
Is there no balm in Gilead?
Is there no physician there?
Why then has the health of the daughter of my people
not been restored? – Jeremiah 8:22 (ESV)
Conclusion
The Megiddo brothers’ prolonged survival with such illnesses indicates that even thousands of years ago, the rich received better healthcare than the poor. “Their socio-economic status allowed them to survive much longer,” Kalisher said.
The reason for the whole trephination procedure is still a mystery. Was it intended to heal the brother, done as a desperate last resort, or perhaps a religious or spiritual practice? “We’re calling it a medical treatment, but it’s speculation,” said Kalisher.
Studies such as these demonstrate how intelligent and medically advanced people were during Bible times, 3,500 years ago. It’s amazing how they understood bone structure and knew how to cut into the skull without damaging tissue underneath. What other surprising finds will be discovered from archaeological excavations to further our understanding about people in Israel during Old Testament times?
Keep Thinking!
TOP PHOTO: A close view of the trephination procedure discovered at Tel Megiddo in northern Israel and the piece of the skull that was removed. (credit: Rachel Kalisher)
