SCIENTIFIC CORRESPONDENCE First evidence of brain surgery in Bronze Age Harappa

Abstract

We report here the first unequivocal case of ancient brain surgical practice, known as trepanation, observed ~ 4300 years ago in a Bronze Age Harappan skull. A decade ago, a Neolithic skull from Burzahom in the Kashmir Valley was reported with multiple trepanations as the first case from the Indian subcontinent. The trepanation, also called trephination or trephining, had been the oldest craniotomic surgical procedure practised by mankind since the Stone Age by way of drilling or cutting through the skull vault of a living or recently deceased person. It was first noticed in Peru and later in Europe as well around 5000 years ago, and thought to have spread to Asia ~ 4000 BP in the Bronze Age Jericho of Palestine. Most scholars noticed striking similarities in trepanation techniques across the continents, and therefore consider it as an important evidence for prehistoric movements of people and for transfer of surgical skills from one society to another. Presence of trepanation in the Indus Civilization was suspected about four decades ago on a child's skull from Lothal , and on Harappan and Kalibangan skulls, but not ascertained, except those on the Burzahom skull. The present study confirms and reports the occurrence of trepanation in one Harappan male skull (H-796/B; Figure 1) kept in the Palaeoanthropology Repository of the Anthropological Survey of India, Kolkata. The trepanated Harappan skull has come from Cemetery H, which contained crude red ware but not typical Harappan ceramics. The lower Stratum II (H2) of Cemetery H formed about two dozens of the extended burials with the heads facing eastward and the knees flexed, whereas the upper Stratum I (H1) contained pot/jar/urn burials with skulls and a few long bones along with red ware. The cause of trepanation in the Harappan skull could be understood in the light of similar cases elsewhere. Scholars argued for different motives for trepanations in different regions and societies of the world, but a majority consider most of these as definitely surgical operations of therapeutic use either for repairing a fracture of the skull resulting from blows of sticks or stones, or to remove splinters and clotted blood, or alleviate persistent headaches. In South America and the Mediterranean region alone more than half of the Iron Age trepanations were practised on traumatic crania by the similar techniques of boring and cutting . In addition, there were trepanned surgical cases intended to get relief from certain intracranial vascular catastrophes, otitis media, mastoid inflammation, vertigo, neuralgia, coma, delirium, meningitis, convulsions, epilepsy, intracranial tumours, mental diseases, and syphilitic lesions in Peru . Interestingly, trepanations are still practised by the traditional medicine-men in Bolivia for head injuries, and in Melanesia in certain cases of headache, epilepsy or insanity, and also to enhance longevity. There were also cases where posthumous trepanations were performed to obtain roundels of human skull bone for making necklace as charms or amulets to ward off the evil spirits or as a talisman to counter the demons. Some scholars thought that the Burzahom multiple trepanations done for roundels, but this proved an error of diagnosis of the trepanation since in parietal osteoporosis, the normal bone shelves into a thinned area which is extremely fragile and breaks down post-mortem, for one reason or another, leaving an opening with a more or less bevelled circumference and apparently healed. The Harappan case is clearly of a cranial trauma visible on the parietals as a horizontal linear depression with cracked margins, probably resulting from a severe blow using a strong wooden stick. The trephined hole is just on the right superior temporal line at the terminus of the traumatic line. A clear rim of 3 mm width at the internal border of the hole is the evidence of osteogenesis or healing, indicating that the victim survived for a considerable time after the operation. Thus, trepanation was practised as a common means of surgery during the Bronze Age in the Indian subcontinent, which could have been a precursor to the later Ayurvedic surgical practices fol-lowed in ancient India as well.

Full text

SCIENTIFIC CORRESPONDENCE
CURRENT SCIENCE, VOL. 100, NO. 11, 10 JUNE 2011 1621
First evidence of brain surgery in Bronze Age Harappa
We report here the first unequivocal case
of ancient brain surgical practice, known
as trepanation, observed ~ 4300 years ago
in a Bronze Age Harappan skull. A decade
ago, a Neolithic skull from Burzahom1–3
in the Kashmir Valley was reported with
multiple trepanations as the first case
from the Indian subcontinent. The trepa-
nation, also called trephination or tre-
phining, had been the oldest craniotomic
surgical procedure practised by mankind
since the Stone Age by way of drilling or
cutting through the skull vault of a living
or recently deceased person. It was first
noticed in Peru4,5 and later in Europe
as well6,7 around 5000 years ago, and
thought to have spread to Asia ~ 4000 BP
in the Bronze Age Jericho of Palestine8,9.
Most scholars7 noticed striking similari-
ties in trepanation techniques across the
continents, and therefore consider it as
an important evidence for prehistoric
movements of people and for transfer of
surgical skills from one society to
another.
Presence of trepanation in the Indus
Civilization was suspected about four
decades ago on a child’s skull from
Lothal10, and on Harappan and Kaliban-
gan skulls11, but not ascertained, except
those on the Burzahom skull1–3. The pre-
sent study confirms and reports the
occurrence of trepanation in one Harap-
pan male skull (H-796/B; Figure 1) kept
in the Palaeoanthropology Repository of
the Anthropological Survey of India,
Kolkata. The trepanated Harappan skull
has come from Cemetery H, which con-
tained crude red ware but not typical
Harappan ceramics. The lower Stratum II
(H2) of Cemetery H formed about two
dozens of the extended burials with the
heads facing eastward and the knees
flexed, whereas the upper Stratum I (H1)
contained pot/jar/urn burials with skulls
and a few long bones along with red ware.
The cause of trepanation in the Harap-
pan skull could be understood in the light
of similar cases elsewhere. Scholars
argued for different motives for trepana-
tions in different regions and societies of
the world, but a majority consider most
of these as definitely surgical operations
of therapeutic use either for repairing a
fracture of the skull resulting from blows
of sticks or stones, or to remove splinters
and clotted blood, or alleviate persistent
headaches. In South America and the
Mediterranean region alone more than
half of the Iron Age trepanations were
practised on traumatic crania by the simi-
lar techniques of boring and cutting12. In
addition, there were trepanated surgical
cases intended to get relief from certain
intracranial vascular catastrophes, otitis
media, mastoid inflammation, vertigo,
neuralgia, coma, delirium, meningitis, con-
vulsions, epilepsy, intracranial tumours,
mental diseases, and syphilitic lesions in
Peru13. Interestingly, trepanations are
still practised by the traditional medi-
cine-men in Bolivia14 for head injuries,
and in Melanesia15 in certain cases of
headache, epilepsy or insanity, and also
to enhance longevity. There were also
cases where posthumous trepanations
were performed to obtain roundels of
human skull bone for making necklace as
charms or amulets to ward off the evil
spirits or as a talisman to counter the
demons5,16–18. Some scholars thought that
the Burzahom multiple trepanations done
for roundels18, but this proved an error of
diagnosis of the trepanation1 since in
parietal osteoporosis, the normal bone
shelves into a thinned area which is extre-
mely fragile and breaks down post-
mortem, for one reason or another, leaving
an opening with a more or less bevelled
circumference and apparently healed.
The Harappan case is clearly of a cra-
nial trauma visible on the parietals as a
horizontal linear depression with cracked
margins, probably resulting from a se-
vere blow using a strong wooden stick.
The trephined hole is just on the right
superior temporal line at the terminus of
the traumatic line. A clear rim of 3 mm
width at the internal border of the hole is
the evidence of osteogenesis or healing,
indicating that the victim survived for a
considerable time after the operation.
Thus, trepanation was practised as a
common means of surgery during the
Bronze Age in the Indian subcontinent,
which could have been a precursor to the
later Ayurvedic surgical practices fol-
lowed in ancient India as well.
1. Sankhyan, A. R. and Weber, W. H. G.,
Int. J. Osteoarchaeol., 2001, 11, 375–
380.
Figure 1. The trepanated Harappan male skull H-796/B in the Palaeoanthropology Repository
of the Anthropological Survey of India, Kolkata in three views: a, the left lateral view showing
the trepanated hole; b, the postero-lateral view showing the horizontal linear traumatic fracture
on the occipital bone; c, an enlarged view of the trepanated site showing the rim of callous
formed due to healing, and d, the trepanated Burzahom female skull showing signs of multiple
trepanations (after Sankhyan and Weber1).

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CURRENT SCIENCE, VOL. 100, NO. 11, 10 JUNE 2011
1622
2. Sankhyan, A. R., J. Anthropol. Surv.
India, 2004, 53, 119–126 (in Hindi).
3. Sankhyan, A. R., In Encyclopaedia of the
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5. Broca, P., Bull. Soc. Anthropol. Paris,
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6. Piggott, S., Proc. Prehist. Soc., 1940, 6,
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7. Brothwell, D. R., J. Paleopathol., 1994,
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8. Parry, T. W. and Starkey, J. L., Man,
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9. Giles, M., In Lachish III: The Iron Age.
The Wellcome–Marston Archaeological
Research Expedition Near East, 1953.
10. Sarkar, S. S., Ancient Races of the Dec-
can, Munshiram Manoharlal, New Delhi,
1972.
11. Roy Chowdhury, A. K., J. Asiatic Soc.
Bengal, 1973, 15, 203–204.
12. Erdal, Y. S. and Erdal, O. D., Int. J.
Osteoarchaeol., 2010, 1–30.
13. Rytel, M. M., Q. Bull. Northwestern
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14. Oakley, K. P., Brooke, W., Akester, A.
R. and Brothwell, R. R., Man, 1959, 59,
93.
15. Crump, J. A., J. R. Anthropol. Inst.,
1901, 31, 167.
16. Dechelette, J., Manuel d archéologie
préhistorique, Picard Derry, Paris, 1908.
17. Forgue, É., In Histoire génerale de la
médicine, de la pharmacie, de l art den-
taire et de l art vétérinaire (ed. Laignel-
Lavastine, M.), Albin Michel, Paris,
1938, vol. 2, pp. 350–450.
18. Basu, A. and Pal, A., Human Remains
from Burzahom, Anthropological Survey
of India, Calcutta, 1980, Mem. No. 56.
Received 22 March 2011; accepted 18 May
2011
A. R. SANKHYAN*
G. R. SCHUG
Anthropological Survey of India,
Indian Museum Campus,
Spirit Building,
27 Jawaharlal Nehru Road,
Kolkata 700 016, India
*For correspondence.
e-mail: arsankhyan@gmail.com
A modified method to isolate genomic DNA from plants without liquid
nitrogen
With the development of various mole-
cular markers based on PCR, like
RAPDs, SSRs, STRs, AFLP and PCR–
RFLP, molecular biology has greatly en-
hanced the speed and efficiency of crop
improvement and breeding programmes,
rDNA technology and genomic DNA
library construction. A pre-requisite for
applying these methods is the ability to
isolate high-quality genomic DNA of ade-
quate quantity. A good extraction proce-
dure is considered to be one which
results in DNA of reasonable purity
without the use of harmful chemicals.
DNA extraction has been reported from
various plant species using the cetyl-
trimethyl ammonium bromide (CTAB)
procedure1 and its modifications2,3. Most
extraction methods employ expensive
and hazardous procedures of grinding
plant tissue in liquid nitrogen (N2) to
break down the cell wall of plants4,5 or
freeze-drying (lyophilization)6. Procure-
ment and storage of liquid nitrogen may
be difficult for many laboratories and
handling of the same is also cumber-
some. Thus any method not using liquid
nitrogen is helpful. The omission of a
grinding step in liquid nitrogen has been
applied by many workers mostly using
soft tissues such as flower petals7 or
young leaves8,9. In the present study a
quick, simple and cheap procedure to
isolate DNA from plants has been devel-
oped, which involves alternate cold
(–80°C) and heat shock (60°C) treat-
ments in order to break down the cell
wall without using liquid N2, which is
suitable for various molecular biology
applications. The extracted DNA was
successfully subjected to PCR amplifica-
tion of the ITS (internal transcribed
spacer) region of rRNA gene, restriction
digestion of the amplified product,
microsatellite fingerprinting and RAPD
successfully.
Samples of young, tender, leaves of
ten plants species (Desmodium gigani-
cum, Aegle marmelos, Solanum xantho-
carpum, Solanum indicum, Tribulus
terresteris, Oroxylum indicum, Boerha-
via diffusa, Trianthema portulacastrum,
Trianthema monogyna and Datura in-
noxia) were collected from the Botanical
Garden of Panjab University, Chandigarh
and various other nurseries. The plant
tissue was washed well with water and
sterilized by wiping it with 70% alcohol.
The fresh weight of the plant tissue was
taken and then it was chopped into fine
pieces and subjected to DNA isolation.
Simultaneously leaves of the same
species were dried at 60°C and also pro-
cessed for extraction of DNA.
DNA was extracted by the following
steps:
• Pre-chill the mortar–pestle at –80°C
for 15 min prior to the start of the
experiment. Alternatively, it can be
pre-chilled at –20°C for 1 h.
• Transfer the finely chopped plant tis-
sue (300 mg) and dried tissue sepa-
rately to chilled mortar–pestle and
keep it at –80°C for 20 min or at –20
for 1 h.
• Grind the plant tissue into fine powder,
transfer it to 1.5 ml microfuge tube
and incubate it at 60°C for 5 min.
• Keep it again at –80°C for 15 min or
at –20 for 1 h.
• Finally, thaw the powdered tissue by
pouring equal volume (300 μl) of hot
(65°C) 2× CTAB buffer (100 mM Tris
[pH 8], 20 mM EDTA [pH 8], 1.4 M
NaCl, 2% CTAB w/v, 2%PVP
40,000) and 1/10th volume of
β
-mer-
captoethanol, and mix well.
• Add one volume (600 μl) of chloro-
form/isoamyl alcohol (24 : 1) and mix
thoroughly to form an emulsion.
• Centrifuge in a microfuge for 15 min
at 12,000 rpm.