In 2016, archaeologists discovered the skeletal remains of two brothers buried more than 3,400 years ago in Megiddo located in the Jezreel Valley in Northern Israel. After analysis, researchers now claim the brothers suffered from health problems and one was even treated by trepanation; the removal of a piece of bone from his skull.

The study, titled “Cranial trephination and infectious disease in the Eastern Mediterranean: The evidence from two elite brothers from Late Bronze Megiddo, Israel” was published in PloS One, a nonprofit open-access publisher. The article explained that the two people were buried together beneath the floor of an elite early Late Bronze Age I (1550–1450 BCE) domestic structure at the urban center of Megiddo. They were identified as brothers through ancient DNA analysis. The younger brother died in his early 20s between 1550-1450 BC, the older between 21-46 a few years later. They suffered from severe chronic infectious diseases, perhaps leprosy or tuberculosis, and the disease had destroyed some of their bones. Their ailments were identified through analysis.

“Each exhibited extensive bone remodeling consistent with chronic infectious disease,” the researchers reported. “Additionally, one brother had a healed fracture of the nose, as well as a large square piece of bone cut from the frontal bone (cranial trephination)… We propose that a shared epigenetic landscape predisposed the brothers to acquiring an infectious disease and their elite status privileged them enough to endure it.”

Both brothers were buried with fine ceramic vessels and high-quality food offerings, suggesting they were of high social status, and their high status may have been one reason they lived for many years in spite of their debilitating conditions.

The older brother had a square piece, about three centimeters long, removed from the front of his skull. The marks in the skull bear no signs of healing, leading researchers to conclude that the procedure was done just before his death, perhaps in a desperate yet unsuccessful attempt to save his life.

“The totality of the evidence suggests that this was a person who had been ill for a long period of time, so maybe they had some kind of surgery or an attempted life-saving procedure,”  Rachel Kalisher, a doctoral student in archaeology at Brown University and lead researcher,  said. “We have evidence that trypanism has been a widespread form of surgery for thousands of years. But in the Near East we don’t see it that often, only about a dozen cases of trypanism have been found in the whole region,” she added.

The hole was made by scoring the skull and carefully levering out pieces from the center. If the assessment is accurate, this would be the most ancient case of trepanation discovered to date.

The researchers noted that the evidence for cranial surgery is rare, implying that it was prohibitively expensive and, therefore, limited to the wealthy elite. 

“The infrequency of trephination in the region indicates that only selected individuals could access such a procedure, and the severity of the pathological lesions suggests the procedure was possibly intended as curative to deteriorating health,” the report wrote. “Ultimately, both brothers were buried with the same rites as others in their community, thus demonstrating their continued integration in society even after death.”

Others disagree with the assertion, believing that the skull was altered after death for ritual purposes. 

Located about 80 miles north of Jerusalem, ancient Megiddo was strategically located overlooking a pass through the Carmel Ridge overlooking the rich Jezreel Valley from the west. Known in Greek as Armageddon, The pass is the nexus of a trade route connecting Mesopotamia with Egypt. Megiddo plays a prominent role in the New Testament Book of Revelation. Archaeologists suggest the site has been populated since around 7000 BCE and hosted a “Great Temple” 5,000 years ago.