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Cranial Trepanation Surgery Four Thousand Years Ago in Catalonia

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Some groups that arrived in Catalonia four millennia ago from Central Europe, metal prospectors in the area of Solsona(Catalonia), present a high frequency of cranial trepanation, associated with brachycrania. In the set of 146 crania of the BronzeAge in Catalonia, Fisher’s exact test showed that the group of brachycranials of Solsona is statistically associated with cranialtrepanation. Some cases of the surgical technique used in cranial trepanations are described.
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Global Journal of Anesthesia &
Pain Medicine
Research Article
Cranial Trepanation Surgery Four Thousand Years Ago in
Catalonia
Daniel Turbón*
Zoology and Anthropology Sub Dept of Evolutionary Biology, Ecology and Environmental Sciences. Faculty of Biology, University of
Barcelona, Avda. Diagonal 643, 08028 Barcelona, Spain
*Corresponding author: Daniel Turbón, Zoology and Anthropology Sub Dept of Evolutionary Biology, Ecology and Environmental
Sciences. Faculty of Biology, University of Barcelona, Avda. Diagonal 643, 08028 Barcelona, Spain.
Received: April 9, 2022 Published: April 18, 2022
ISSN: 2644-1403
DOI: 10.32474/GJAPM.2022.05.000202
Summary
Some groups that arrived in Catalonia four millennia ago from Central Europe, metal prospectors in the area of Solsona
(Catalonia), present a high frequency of cranial trepanation, associated with brachycrania. In the set of 146 crania of the Bronze
Age in Catalonia, Fisher’s exact test showed that the group of brachycranials of Solsona is statistically associated with cranial
trepanation. Some cases of the surgical technique used in cranial trepanations are described.
Keywords: Cranial Surgery; Trepanation; Bronze Age; Catalonia.
Introduction
Figure 1: Skull 6 from the Bronze Age dolmen El Collet de Su (Solsona, Catalonia) Museum of Archeology of Catalonia. Left:
Note the copper arrowhead stuck in the parietal and a greenish area produced by the humidity of the burial. Right: Approach
to the arrowhead, which must have been broken in an attempt to extract it, leaving a portion included in the parietal.
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Glob J Anes & Pain Med
Citation: Daniel Turbón*. Cranial Trepanation Surgery Four Thousand Years Ago in Catalonia. Glob J Anes & Pain Med 5(1)-2022. GJAPM.
MS.ID.000202. DOI: 10.32474/GJAPM.2022.05.000202
445
Megalithism was a cultural phenomenon characterized by
mass burials made with large blocks of stone in the Western
Mediterranean and Atlantic Europe, from the late Neolithic to the
Bronze Age. Burials appear in dolmens (simple chamber tombs) and
in sepulchral caves from the Bronze Age, from the 2nd millennium
BC. The major advances made in recovering and sequencing the
DNA of ancient bones, has brought the biodynamics of populations
of the European Bronze Age back into the spotlight [1-7].
Paleogenomics has provided a reasonable reconstruction of certain
human migrations, the dissemination of domestication processes,
farming and diseases, and even the kinship of prehistoric family
clans. There was also intensive prospecting for metals such as gold,
copper and tin [8]. Groups of these prospectors reached Catalonia
from northern Italy and northern France via the Rhone valley [9-
10]. Some megalithic burials are associated with brachycephalic
and copper mines (Figure 1), such as in the Solsona area, near
the Catalan Pyrenees (Figure 2). This article is a review of some
cases of cranial trepanation associated with small migrations, most
likely from minorities of metal prospectors in the Bronze Age,
their association with the exploitation of copper and the surgical
technique used in cranial trepanations.
Figure 2: Archaeological sites of Catalonia from the Bronze Age. The Solsona area (circle) registers a high frequency of
brachycraniums and cranial trepanations, although this coincidence also appears in nearby geographical areas. 1) El Collet de
Su, 2) Clarà, 3) Aigües Vives, 4) El Vilar de Simosa, 5) Torre d’en Cornet, 6) Cova de l’Heura, 7) Roda de Ter.
Cranial Trepanation in e Catalan Bronze Age
An osteological study of the human remains of the Catalan
Bronze Age showed that a minority group of foreigners of Central
European origin settled mainly in Solsona (Figure 2) and in
particular in three settlements that were very close to each other:
the megaliths of El Collet, Clarà and the burial cave of Aigües Vives.
The immigrants, who differed from the local population for being
brachycranial (very wide and short head) and for their association
with copper mining and the practice of cranial trepanation, mixed
with the local population and reused the megalithic tombs and
burial caves [11-12]. It is now known that brachycephalisation,
or globular crania, is an evolutionary trend that started in the
Mesolithic period [13]. This process took place in a number of
populations around the world and has a strong genetic basis [13].
In the context of the European Bronze Age, brachycephaly is a useful
population marker since the short and wide heads differ from the
long and narrow heads of the previous populations, among which
the former end up being diluted [8].
Three crania were later discovered near the Solsona area at the
settlement of ‘Bauma del Ossos de la Torre d’en Cornet’ (Sallent)
(Figure 2) [14]. Cranium 1 (Figures 3 left & 4) shows the mark
of a scalp practiced on the head to reach the bone, which maybe
because of a lesion in the periosteum followed of a tuberous
hyperosthosis. The incision does not differ from those practiced
by current neurosurgeons (Figures 3 left & 4). It appears to be
a wide trepanation in the right parietal, with signs of evident
        
due to the curvature of the bone. The medial part is surrounded
by an arched parasagittal line, formed by moderate erosion and
       

base. This is the only case where there is objective proof of a pre-
operative incision, although this does not permit us to suppose that
similar practices took place in other trepanations.
Citation: Daniel Turbón*. Cranial Trepanation Surgery Four Thousand Years Ago in Catalonia. Glob J Anes & Pain Med 5(1)-2022. GJAPM.
MS.ID.000202. DOI: 10.32474/GJAPM.2022.05.000202
Volume 5 - Issue 1 Copyrights @ Daniel Turbón
Glob J Anes & Pain Med
446
Figure 3: Trepanned skulls from the Bronze Age using the abrasion technique from Catalonia. Left: side view of skull 1 Bauma
from Ossos de la Torre d’en Cornet (Sallent, Catalonia). Manresa County Museum. Right: Trepanned skull from Roda de Ter
(see Figure 2).
Figure 4: Orthogonal graphs of Bronze Age skull 1 from Bauma dels Ossos de la Torre d’en Cornet (Sallent, Catalonia).
Manresa County Museum. Pointed arch: tuberous hyperostosis resulting from the incision to lift the scalp. T: trepanation by
abrasion. C: Chord. F and F’: postmortem ssures.
It is a typical intentional trepanation in which abrasive
techniques are used, and where there was a long period of post-
operative survival, given that the scarring is complete. The
following factors support this notion: a) the diploic cavities are
           
grooved reaction; c) a hyperostotic reaction can also be seen

that the diploic cavities diminish in size the closer they are to
the perforation. Abrasion was almost certainly used since all the
characteristics of the technique can be seen here. However, the
surrounding ring of progressive thinning of the bone is made up of a
thin fringe of only 10 mm (Figure 4, centre), which is not commonly
seen in this technique, since it tends to be much wider. The intense
brachycephaly of this cranium creates a very curved parietal area,
which explains this peculiar feature. The same explanation can be
used for the trepanation another cranium found close to Roda de
Ter (Figure 2 & 3 right).
Statistical Test
It is possible to establish if the practice of trepanation is
related to the group of short and wide heads in the Solsona area
in the Bronze Age (Figure 2), in the set of 146 Catalan Bronze
Volume 5 - Issue 1 Copyrights @ Daniel Turbón
Glob J Anes & Pain Med
Citation: Daniel Turbón*. Cranial Trepanation Surgery Four Thousand Years Ago in Catalonia. Glob J Anes & Pain Med 5(1)-2022. GJAPM.
MS.ID.000202. DOI: 10.32474/GJAPM.2022.05.000202
447
     
very low frequencies between the trepanned subjects (Table 1),
the P values were computed using Fisher’s Exact Test [15]. This
test considers all possible cell combinations that would result in
the marginal frequencies and computes the probability of a 2x2
contingency table using hyper-geometric distribution. The result is

manner, a probability of between 262 that the Catalan Bronze Age
brachycephalics of Solsona included in this frame are not related to
trepanation. This test did not use the trepanned cranium of Cova
de l’Heura (Figure 2) since the total number of non-trepanned
crania is unknown. However, if we include it, the above conclusions

153. Obviously, the link between brachy craniums and trepanation
is a cultural coincidence.
Table 1: Fisher’s exact test for a 2 x 2 table. Bronze Age skulls
from Catalonia.
Brachycranium Not Brachycranium Total
trepanned 5 4 9
not trepanned 17 120 137
total 22 124 146
Trepanation and Pain
Trepanation is no more painful than any other perforating or
cutting wound in any other part of the body, since no pain is felt
in the bone, meninges or brain. The scalp bleeds profusely, with
the exception of the temporal and facial arteries, the bleeding can
be stopped with effective compression or a horizontal tourniquet
above the ears, by cauterising or applying powdered substances.

Complications were many and varied in type and severity, such as
haemorrhaging, neurological lesions, infections and bone necrosis.
In 4000 BC, the Sumerians used the poppy (Papaver somniferum).
Its fame comes from its high contents in alkaloids obtained from
the sap that exudes from cuts made to the bud, which is used to
         
reference made to the use of opium. Frequent use was made in
Babylonian medicine of opium, mandrake, cannabis (Cannabis
sativa), beer and wine. The civilisations of ancient Egypt (1000-
1500 B.C.) began to use plant narcotics, such as poppy, cannabis,
and mandrake (Mandragora autumnalis), a species of phanerogam
that belongs to the Solanaceae family and was extensively used in
Europe for medicinal purposes. The Hearst Papyrus mentions that
these plants were cultivated in India and Persia. The Ebers Papyrus
(1550 BC) describes in great detail the use of opium as a treatment
for headaches. Some Babylonian cylinders and Mesopotamian bas-
reliefs show the heads of Papaver somniferum, both for anaesthetic
 
mixture of opium, mandrake and henbane (of the Belladona family).
Alcohol, marihuana and extreme cold have also traditionally been
used in surgery.
Disclosure statement

ORCID
Daniel Turbón ® https://orcid.org/0000-0002-4782-6657
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Citation: Daniel Turbón*. Cranial Trepanation Surgery Four Thousand Years Ago in Catalonia. Glob J Anes & Pain Med 5(1)-2022. GJAPM.
MS.ID.000202. DOI: 10.32474/GJAPM.2022.05.000202
Volume 5 - Issue 1 Copyrights @ Daniel Turbón
Glob J Anes & Pain Med
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We generated genome-wide data from 69 Europeans who lived between 8,000-3,000 years ago by enriching ancient DNA libraries for a target set of almost four hundred thousand polymorphisms. Enrichment of these positions decreases the sequencing required for genome-wide ancient DNA analysis by a median of around 250-fold, allowing us to study an order of magnitude more individuals than previous studies and to obtain new insights about the past. We show that the populations of western and far eastern Europe followed opposite trajectories between 8,000-5,000 years ago. At the beginning of the Neolithic period in Europe, ~8,000-7,000 years ago, closely related groups of early farmers appeared in Germany, Hungary, and Spain, different from indigenous hunter-gatherers, whereas Russia was inhabited by a distinctive population of hunter-gatherers with high affinity to a ~24,000 year old Siberian6 . By ~6,000-5,000 years ago, a resurgence of hunter-gatherer ancestry had occurred throughout much of Europe, but in Russia, the Yamnaya steppe herders of this time were descended not only from the preceding eastern European hunter-gatherers, but from a population of Near Eastern ancestry. Western and Eastern Europe came into contact ~4,500 years ago, as the Late Neolithic Corded Ware people from Germany traced ~3/4 of their ancestry to the Yamnaya, documenting a massive migration into the heartland of Europe from its eastern periphery. This steppe ancestry persisted in all sampled central Europeans until at least ~3,000 years ago, and is ubiquitous in present-day Europeans. These results provide support for the theory of a steppe origin of at least some of the Indo-European languages of Europe.
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Die Autoren untersuchen im Beitrag Grubengräber unter Grabhügeln (Kurgane) von der gesamten Unteren Donau auf ihre Bestattungssitte, Grabausstattung, Stratigraphie und Les sépultures à fosses ou à puits sous tumulus (kourgane) de la culture Yamna dans la vallée inférieure du Danube font l’objet de notre article. Nous nous penchons sur les questions concernant les rites funéraires, le mobilier des sépultures, la stratigraphie et les datations radiocarbone. Ces dernières comprennent 17 dates AMS récemment obtenues en Munténie du nord, la plupart inédites. On peut distinguer deux groups de sépultures. Un premier groupe consiste en sépultures à fosses plus ovales que rectangulaires; les corps sont fléchis sur le côté, il y a peu d’ocre et les récipients (en céramique de production apparemment locale) sont rares. Les sépultures de ce groupe sont pour la plupart les sépultures primaires à l’intérieur des tumuli. En utilisant des datations radiocarbone obtenues récemment pour les sépultures 3B et 5 B à Ariceşti IV (et en partie celles de la sépulture 2/3 de Păuleşti II), comté Prahova, nous démontrons que the groupe date d’avant environ 3050/3000 cal BC, probablement recouvrant tout le dernier tiers du IVe millénaire BC. Le second groupe présente toutes les caractéristiques de la culture classique ‘Yamna’: sépultures primaires et secondaires, fosses surtout rectangulaires et couvertes de poutres, corps en décubitus avec jambes fléchies, taches ou morceaux d’ocre, mobilier rare où on remarque quelques anneaux de chevelure en métal précieux. La céramique est à nouveau rare, mais quand elle est présente il s’agit souvent de gobelets décorés au cordon, très semblables aux gobelets de la culture de la céramique cordée de l’Europe du centre et du nord. Les datations radiocarbone de ces sépultures de ce groupe datent d’après environ 3050/3000 cal BC, et il est peut-être même possible de les subdiviser le long des parties plates et raides de la courbe de calibration, c’est-à-dire allant d’environ 3050/3000 à 2880 cal BC, et ensuite depuis environ 2880 à 2580 cal BC. Ceci pourra en fin de compte nous permettre de distinguer uns phase ‘Yamna’ ancienne d’une phase plus récente. En bref, et après avoir examiné plus de 500 datations radiocarbone et/ou dendrochronologiques provenant d’une zone allant de l’Oural à la Tisza, le phénomène des sépultures à puits ou fosses couvre une période allant d’environ 3500 cal BC à 2400 cal BC. En incluant les sépultures plus anciennes de Suvorovo-Novodanilovka (Ve millénaire BC.) et certaines sépultures (ou kourganes) de la culture des steppes attribuées à Cernavoda I et cultures associées (première moitié du IVe millénaire BC), il devient évident qu’un courant d’échange existait de façon continue durant 2000 ans entre le nord-est, le nord et l’ouest du Pont-Euxin. Quoique nous supposons que la culture ‘Yamna’ a surtout vu une vague intense de migrants venants de l’est au sein d’un milieu social, économique et idéologique nouveau, il reste à établir si les premières sépultures à fosses sous tumulus du Danube inférieur datant d’à partir de 3300 cal BC étaient un apport de peuples des steppes apparentés à des peuplades du nord du Pont-Euxin avec traditions funéraires de type Nizhne-Mikhailovka et Kvityana, ou s’il s’agit plutôt de rites appartenant à une population locale qui aurait intégré de nouvelles coutumes ‘orientales’ dans ses propres rites funéraires. Il est fort probable que nous avons affaire à une combinaison des deux possibilités. The Pit-Graves under burial mounds (Kurgans) of the Lower Danube region are being assessed in terms of their burial customs, funeral equipment, stratigraphy and radiocarbon dates. The latter comprise 17 recently performed AMS dates from Northern Muntenia, most of them yet unpublished. Two distinct burial groups can be separated: A first consists of graves with more oval than rectangular grave-pits, predominantly side-crouched body positions of the deceased, few ochre, and rare but seemingly local pots. Graves of this group are mostly the primary graves in their mounds. By using some already published and the newly obtained
Ancient DNA Analysis of 8000 B.C. Near Eastern Farmers Supports an Early Neolithic Pioneer Maritime Colonization of Mainland Europe through Cyprus and the Aegean Islands
  • E Fernández
  • A Pérez-Pérez
  • C Gamba
  • E Prats
Fernández E, Pérez-Pérez A, Gamba C, Prats E (2014) Ancient DNA Analysis of 8000 B.C. Near Eastern Farmers Supports an Early Neolithic Pioneer Maritime Colonization of Mainland Europe through Cyprus and the Aegean Islands. PLoS Genetics 10(6): e1004401. doi: 10.1371/ journal.pgen.1004401