Surgical procedures are not a modern invention. Finds from the Stone Age and early advanced civilisations show that people were already performing targeted operations on the head 7,000 to 10,000 years ago. An even older find from Borneo pushes this timeline back as far as around 31,000 years. What ancient healers achieved, without any knowledge of anaesthesia, antibiotics or sterile techniques, borders on a miracle from today’s perspective – and deserves a closer look.
Here’s what you can expect in this article
- Key points at a glance
- Trepanations: surprisingly successful skull operations
- Case study: Spain – two skull operations around 4,500 years ago
- Case study: Megiddo (Israel): skull surgery in the Bronze Age
- Animal experiments and practical work: the Neolithic cow skull from France
- Other ancient surgical procedures: amputations, dentistry and fracture treatment
- How were these operations carried out without modern technology?
- Why were such procedures carried out? Medical and ritual motives
- Significance for the history of medicine
- Frequently asked questions about ancient medicine and trepanation
Reading time approx. 10 mins.
Key points at a glance
- Complex operations such as trepanations and amputations were already being carried out thousands of years ago – with survival rates ranging between 40 and 90 per cent, depending on the site and the study.
- Archaeological finds from Spain, Israel and South-East Asia show clear signs of healing on bones, indicating that patients actually survived the procedures.
- Ancient surgeons worked without modern anaesthesia, antibiotics or sterile operating theatres, but used tried-and-tested techniques and herbal painkillers.
- The reasons for these procedures were both medical (trauma, infection, intracranial pressure) and ritual-religious.
- These early operations are important precursors to modern surgery and neurosurgery.
Trepanations: surprisingly successful skull operations
Trepanation refers to the deliberate opening of the skull bone by scraping, drilling or cutting. This technique was most widespread between the 4th and 2nd millennia BC, though individual finds date back to the early Neolithic period, some 7,000 to 10,000 years ago. Studies of hundreds of skulls from Europe, the Andes region and the Middle East reveal widely varying, but overall remarkably high, survival rates – ranging from around 40 per cent at some sites to 70 or 80 per cent at others. The clear evidence lies at the edge of the opening itself: newly formed bone that tells the story of a successful operation.
Trepanation techniques and their characteristics
| Technique | Description | Distinctive feature |
|---|---|---|
| Scraping technique | Slow, layer-by-layer removal using a rough stone tool | Was considered particularly gentle, as it reduced the risk of brain injury |
| Drill holes | Circular pits created using a drill | Frequently found in Europe and the Andes |
| Sawing / cutting | Rectangular or linear cuts, sometimes using a lever technique | More risky, but quicker to perform |
Typical indications included head injuries, skull fractures, intracranial pressure, chronic headaches and neurological symptoms. In many cases, ritual motives also played a role – in ancient times, medical and spiritual interpretations of illness were virtually indistinguishable.
Case study from Spain: two skull operations carried out around 4,500 years ago
The find from Camino del Molino in southern Spain, scientifically described in a study published in 2023, provides one of the most impressive pieces of evidence for successful ancient surgery. During the excavation of this Copper Age burial site in Caravaca de la Cruz – one of the largest known sites of its time, with over 1,300 people buried there – archaeologists discovered the skeleton of a woman aged between approximately 35 and 45, dated to 2,566 to 2,239 BC.
Her skull showed two distinct, slightly overlapping openings in the region of the right temple: one circular, the other oval. The traces of the scraping technique are clearly visible under the microscope. The research team identified remodelled, newly formed bone at both sites – a clear indication that the woman survived both procedures and lived for some time afterwards. This is also one of the rare archaeologically documented cases of double trepanation in a woman from this period.
The location of the incisions in a region with a particularly high concentration of blood vessels demonstrates exceptional precision and anatomical understanding. Modern anaesthesia did not exist. It is likely that physical restraint and herbal substances such as opium, henbane or ephedra were used for pain relief.
Case study: Megiddo (Israel) – Skull surgery in the Bronze Age
A find from Tel Megiddo in Israel, dated to around 1550 to 1450 BC, reveals a rectangular trepanation opening on one of two brothers, whose kinship was confirmed by DNA analysis. Rachel Kalisher, then a PhD student at Brown University, led the investigation. The method used, known as ‘angular notched trephination’, consisted of four intersecting linear incisions followed by a lever technique to remove the square piece of bone.
The two brothers belonged to the upper class – they were buried beneath the floor of a house in the affluent part of the city, together with valuable Cypriot pottery. However, no signs of bone healing are visible on the skull of the man who underwent the procedure: he presumably died immediately or shortly after the operation. Both brothers’ bones show signs of a severe, long-standing infectious disease; the researchers suspect tuberculosis or leprosy, though definitive confirmation through DNA analysis is still pending. The trepanation was presumably a final, desperate attempt at treatment. The case also illustrates the extent to which social status determined access to specialised medical care – an inequality that runs through the entire history of medicine.
Animal experiments and practice: the Neolithic cow skull from France
A Neolithic cow’s skull from the Champ-Durand site in France, dated to around 3400 to 3000 BC and described in 2018 in the journal *Scientific Reports* by Fernando Ramirez Rozzi and Alain Froment, shows signs of trepanation performed by humans. X-ray and scanning electron microscope analyses confirm that the incision marks resemble contemporary human skull surgeries down to the last detail. Two interpretations dominate the academic debate:
- Early veterinary medicine: an attempt to treat a sick animal.
- Practice subject: targeted training for future operations on humans.
The cow’s skull shows no signs of healing – the animal did not survive the procedure. Nevertheless, the study is regarded as the earliest known evidence of planned, experimental surgery in prehistory. Surgical skills were evidently learnt systematically and passed down through generations – earlier than researchers had long assumed.
Other ancient surgical procedures: amputations, dentistry and fracture treatment
Skull operations are just one example from the broad spectrum of ancient surgery. Amputations, dental treatments and fracture care were also carried out – and signs of healing prove that patients survived these procedures. The level of surgical knowledge varied greatly from region to region: highly developed techniques can be found in Egypt, Mesopotamia, India and pre-Columbian America.
Foot amputation around 31,000 years ago
A spectacular discovery from a cave in Borneo (Indonesia), described in 2022 in the journal *Nature* by a team led by Tim Maloney (Griffith University), significantly shifts our understanding of early human history. The skeleton of a young person shows a precisely amputated left lower leg, including the foot, which was presumably removed whilst the individual was still a child; it dates back to at least 31,000 years ago. The clear evidence of bone healing proves that the individual survived the procedure for at least a further six to nine years. Until this discovery, an approximately 7,000-year-old amputation from France was considered the oldest known evidence – the Borneo operation pushed this milestone back by more than 24,000 years in one fell swoop.
This refutes the long-held assumption that systematic surgery only emerged with the advent of agriculture. The procedure required detailed knowledge of anatomy and blood vessels – a clear indication of specialised healers as early as the Upper Palaeolithic, long before any settlement patterns emerged.
Ancient Egyptian surgery and wound treatment
Egypt’s role in the history of medicine is exceptionally well documented through textual sources. The Edwin Smith Papyrus, whose surviving copy is dated to around 1600 BC and which is thought to be based on an even much older original from the Old Kingdom, systematically describes surgical procedures:
- Treatment of skull and facial injuries.
- Splinting of fractures.
- Wound treatment using dressings and honey (which has antibacterial properties).
The texts make a rational distinction between cases classified as ‘treatable’, ‘doubtful’ or ‘untreatable’ – an early, astonishingly sober approach to prognoses, almost entirely devoid of the magic otherwise typical of Egyptian medical texts.
Dentistry and minor surgical procedures
Dental treatments are among the oldest known surgical procedures. Finds from the Neolithic period show drill holes in teeth to relieve pressure, primitive fillings made of wax or resin, and extracted decayed teeth. Bone healing and further tooth wear prove that these procedures were carried out on living patients. Abscesses were also lanced and superficial tumours removed.
How were these operations carried out without modern technology?
Ancient surgeons had to manage without antibiotics, sterile instruments or modern anaesthesia. Nevertheless, they used systematic techniques that were, from today’s perspective, astonishingly effective.
Tools and techniques
Typical instruments included flint or obsidian blades, some of whose cutting edges were sharper than those of today’s surgical scalpels, as well as bone and metal tools made of copper and bronze, and wooden and stone drills. The scraping technique was considered particularly safe: the gradual removal of the skull bone reduced the risk of damaging the underlying brain. Different shapes of incisions – round, angular, linear – point to specialised regional schools.
Pain relief and historical anaesthesia
| Method | Effect |
|---|---|
| Physical restraint | Prevents movement, making the procedure possible in the first place |
| Alcohol | Mild sedation |
| Opium (opium poppy) | Pain relief (raw opium contains approximately 8–15 per cent morphine, depending on the variety and region) |
| Henbane | Atropine-like sedative and anaesthetic |
| Ephedra | Stimulant with additional pain-relieving effects |
These remedies alleviated the pain, but the procedures remained extremely distressing. Carrying them out quickly minimised both the suffering and the risk of infection.
Risk of infection and wound healing
Infections were one of the greatest dangers of ancient surgery. Nevertheless, many wounds healed if the instruments were cleaned and the wound was subsequently covered with honey or resin. Honey has an osmotic antibacterial effect, whilst pine resin contains antimicrobial terpenes. Evidence of bone healing found in archaeological remains suggests that patients did not die of sepsis within the first few weeks.
Why were such procedures carried out? Medical and ritual motives
The reasons for trepanations and other operations were varied, with often clear overlaps between medical and ritual motives.
Medical indications
- Skull fractures following a blow or a fall.
- Depressed bones following physical trauma.
- Chronic intracranial pressure and persistent headaches.
- Neurological disorders such as seizures.
Amputations were primarily intended to save lives – in cases of severe injury or progressive infection. Successful recovery required careful haemostasis and consistent follow-up treatment.
Ritual, social and symbolic contexts
Some cranial openings have no obvious medical cause. This is particularly strikingly demonstrated by a group of 13 skulls from the Eneolithic and Bronze Age periods in southern Russia (5th to 3rd millennium BC): All the openings are located exactly at the same, surgically particularly delicate spot in the centre of the head, at the so-called obelion – with no discernible injury or illness as the cause. Remarkably, 11 of the 13 skulls show signs of healing, meaning that those affected often survived the procedures for years. Further evidence of ritual functions is provided by finds from Central Europe, such as Switzerland, where round bone discs removed from trepanation holes were carried as amulets. Religious and medical beliefs were closely intertwined: healing was often understood as an intervention into the spiritual causes of illness.
Significance for the history of medicine
These early operations demonstrate impressively that even very early societies had specialised healers with practical knowledge of anatomy. Many techniques – such as relieving pressure in cases of brain injury, amputations and wound care – are direct conceptual precursors to modern surgical principles.
Modern archaeology, palaeopathology and imaging techniques such as CT and micro-CT are constantly bringing new details to light and providing an increasingly nuanced picture of ancient surgery. Anyone wishing to understand the origins of medicine need not start with Hippocrates, but must go back millennia earlier – to the caves of Borneo and the fields of Neolithic Europe.
Frequently asked questions about ancient medicine and trepanation
How much pain did patients suffer during such ancient operations?
Surgeries without modern anaesthesia were extremely painful. Alcohol and herbal anaesthetics only partially alleviated the agony. Some patients lost consciousness due to shock or blood loss, which shortened the procedure but also made it more risky. The fact that some people show signs of repeated trepanations with evidence of healing – as in the Spanish case study – indicates that they consciously accepted this pain, presumably in the hope of relief from severe, persistent ailments.
How common were such operations really in antiquity?
They varied greatly from region to region. Worldwide, an estimated 5 to 10 per cent of skulls recovered from Neolithic sites show signs of trepanation; in certain locations in France, the proportion is significantly higher. Soft-tissue operations such as amputations are far less frequently visible archaeologically and are therefore scarcely recorded statistically. Regions that have been continuously inhabited over the long term, such as the Mediterranean basin, the Andes and the Middle East, yield a disproportionately high number of finds – which is partly due to better conditions of preservation.
Were ancient surgical procedures really planned, or were they more a matter of chance?
Recurring patterns in the shapes of the incisions, tool marks and the location of the skull openings clearly point to established techniques. Survival rates of up to 90 per cent in certain groups of finds can hardly be explained by pure chance. Early surgeons had no knowledge of modern physiology, but possessed practical, experiential knowledge that was refined from generation to generation through observation.
Were there already precursors to hospitals or specialised surgeons?
Not hospitals in the modern sense. However, temples, healers’ houses and palace centres served as places of care. Texts from Mesopotamia and Egypt already distinguish between surgeons specialising in external procedures and other healers practising magical-religious therapies. Specialisation in wound care, fracture treatment or childbirth can already be seen in the Bronze Age – an early form of the division of labour in medicine.
How do modern doctors view these ancient surgical techniques?
Today’s doctors criticise the lack of sterility and the high risks involved, but acknowledge the astonishing technical skill. Principles such as relieving pressure within the skull, early amputation in cases of severe infection and careful haemostasis are still applied today, albeit in a modified form. Research into ancient surgery helps us to better understand the development of surgical methods and to contextualise the cultural conceptions of illness and healing in historical societies.
