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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.
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
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
448
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DOI: 10.32474/GJAPM.2022.05.000202