Neurosurgery 7000 years ago in central Italy

Catignano is a prehistoric village near Pescara, Central Italy. It was established during the 5th millennium BC by a small community of archaic farmers.1Tozzi C Un aspetto della corrente culturale della ceramica dipinta in Abruzzo: il villaggio di Catignano (Pescara).Q Ricerche Sci. 1978; 100: 95-111Google Scholar The village contains some human skeletal remains, including a skull whose particular lesions attracted the attention of anthropologists.2Germanà F Fornaciari G Trapanazioni, craniotomie e traumi cranici in Italia. Giardini Editore, Pisa1992Google Scholar The sample is a partial skull that belonged to a mature woman, and presents deep, extended remodelling of the cranial vault (figure). The lesions are two large funnel-shaped depressions: one on the top of the interparietal suture, and the second near the centre of the left parietal. The two depressions have small holes that completely cross the braincase at their bottoms. We have no doubts about the artificial origins of these lesions.2Germanà F Fornaciari G Trapanazioni, craniotomie e traumi cranici in Italia. Giardini Editore, Pisa1992Google Scholar Macroscopic, microscopic, and radiographic analyses reveal close analogies with lesions characteristic of scalping.3Hamperl H The osteological consequences of scalping.in: Brothwell DR Sandison AT Diseases in antiquity. Thomas, Springfield1967: 630-634Google Scholar The scraping of the cranial vault was evidently done with a rough lancet, probably a stone knife—rounded, concentric movements that eroded and detached the periostium, then excavated the cranial bone surface, were probably used. The margins of the lesions are irregular, and tiny buttons of new-formed bone because of the postsurgical activities of small incompletely removed periostium fragments occur in several small areas over the bottoms of the lesions. Why was this complicated and unusual surgery done? Radiographs clearly reveal a line of increased bone density in the left side of frontal bone, which probably corresponds with a healed, well cicatrised fracture. Therefore, we speculate that sugery was related to this healed fracture rather than ritual reasons. We know of paleopathological cases in which cranial trepanations were done to remove inflected bone fragments produced by depressed fractures of the cranial vault. Even some Roman surgeons—eg, Galenus4Capasso L Le origini della chirurgia italiana. Ministero Beni e Attività Culturali, Rome1993Google Scholar—described this surgical technique in detail. Therefore, the Catignano female probably had complex braincase traumatism with multiple fractures of the cranial vault.2Germanà F Fornaciari G Trapanazioni, craniotomie e traumi cranici in Italia. Giardini Editore, Pisa1992Google Scholar Surgical treatment was circumscribed to the two parietal fractures, which were probably depressed, and was not extended to the frontal bone in which the fracture was little and composed. The degree of resorption and new bone formation, given standards obtained through experimental trepanations on dogs,5Campillo D Healing of the skull bone after injury.J Paleopathol. 1991; 3: 137-149Google Scholar suggest that the woman survived at least 1 year after treatment. Thus, the origin of the lesions is explained, but what was the prehistoric surgeon's degree of anatomical knowledge? How did he control the profuse haemorrhage typical of scalp cuts? How did he produce sedation? With which substances did he control infections? The prehistoric surgeon clearly dealt with all these difficulties successfully. The success is all the more impressive given that the treatment was done with a stone lancet and involved the meninges 7000 years ago.