Sturdy timber and majestic sails, the icons of the Age of Sail, trailblazing a path through the ages of masted ship warfare, now silenced.  In its place, clanking metal engines within giant hulks of iron, steam and black smoke pouring from funnels atop new ships of battle.  The age of the dreadnought has come to fruition.  The development of more powerful armaments have spurned, out of necessity, the birth of ships caste of metal shells; more effective protection for the seamen within, against an onslaught of shells so concentrated in explosive power as to turn the wooden ships of previous eras to naught but splinters and smoldering driftwood.  Harnessing the wind was no longer a task of vital importance; the will of captains may now be fulfilled to greater effect as their control over their vessel is expanded with the inclusion of engines for maneuvering and speed.  Despite these epic advancements, and the modernization of seaworthy vessels more akin to the ships known in modern times, such novel technologies and arms bring with them a menagerie of possible traumas and wounds, mostly unknown to sailors and seaman who previously sailed similar waters.  Let us dissect the means and methods of incurring wounds suffered by the sailors in the age of the dreadnought.  I have chosen, due to a huge array of potential injuries, to focus on the burn wounds caused by explosive shells.


Making ships of iron was an absolutely ingenious idea, used to great effect against wooden ships carried over from times when their lot ruled the oceans.  Most navies became keenly aware of the fact that their vessels crafted from wood would soon become obsolete in the face of unstoppable evolution.  This evolution was characterized by the progression of regular solid iron shot to the more modern, and exponentially more effective, explosive shot.  By the time of the American Civil War, and the first battle between ironclads mixed with wooden ships of war, it became abundantly clear that the ironclad had become the quintessential warship and would soon comprise the world’s fleets en masse.
There was, of course, no dearth of mutilation and injury during the age of the masted battleship-of-the-line.  Balls of iron, splintering wooden panels, and a veritable lack of means to cope with said injuries.  However, the new ironclads, though very protected from shots used effectively against previous generations of warships, including the early types of explosive shot, were soon prey to advanced types of the same weaponry.  These advanced types gained the ability to pierce armor, thus severely limiting the proposed invincibility of ironclads against conventional naval weaponry.  Should one of these breach the outer shell of the ironclads, what might occur within, and what might happen to the crew members in the immediate proximity?  The iron walls of the ship, though reasonably proficient at preventing entry of the concussive wave produced by a nearby explosion, were equally, if not more, proficient at encapsulating the explosive force should one of the shells gain entry to the ship’s innards.  The high heat and force generated in such a small area was absolutely devastating to anything living.  If one can imagine, for a moment, being on the inside of a grenade as it explodes, then we might gain a picture of what these poor souls were subjected to when a shell burst in their cabin.  This also says nothing of the hazards surrounding them.  Machinery, stoves, crowded bunks; all turned into weapons when propelled by the force of explosion, thus creating shrapnel not of wood, but metal, and thus all the more devastating.  What might happen to a human body subjected to such intense heat and concussive force?  It follows that the first, and most obvious, organ to be affected by the flames would be the skin.


Our skin covers our bodies, protecting our inner organs from exposure to the elements and disease by infection or worse.  Without getting overly medical, we can describe the skin as having three layers.  The first, and outermost, layer is the epidermis.  This is the layer we see on all humans since it lies on the outside, and should be the only layer visible at that.  The epidermis is most responsible for our skin’s protective function, and is thus the most durable due to the keratinized squamous cells that line it.  The next layer, directly beneath the epidermis, is the dermis.  The dermis cushions our skin against depression and strain, allowing it to accommodate and morph with objects, providing a separate but equally important protective attribute when compared with the epidermis.  The dermis is also home to all the glands and blood vessels supplying the skin, as well as the hair follicles.  The third layer of skin is known as the hypodermis.  This layer is, in reality, not actually considered a part of the skin proper, but it does function to attach the previous skin layers to underlying bone and muscle, as well as help supply blood vessels and nerves to the layers above.  The hypodermis is comprised of loose connective tissue, and elastic fibers which further help to give our skin the elasticity it needs to be an effective means of protecting our inner bodies.


In turn, there are generally considered to be three major classifications of burns: first degree, second degree, and third degree.  First-degree burns are usually minor, akin to a sunburn, with redness and swelling of the affected tissue, but the person is expected to make a full recovery.  Second-degree burns are obviously more serious, often penetrating past the superficial layer of epidermis down into part or the whole of the dermis.  These burns often require the care of a physician to prevent scarring, and make take 3 or more weeks to heal fully.  The third-degree burns, the most dangerous of the three, result in loss of the epidermal layer with damage to the tissues below.  Third-degree burn patients often require acute medical care, and the loss of the epidermal layer as well as the dermal appendages (glands and hair follicles) necessitate skin grafting in a large percentage of victims.  Aside from the likely increase in pain, why is that the two latter burn gradations are so much more dangerous?  The simple answer, and one which we touched upon in a previous discussion, is entry of ectopic bacteria and infectious agents.  You see, one of our skin’s most important features is its ability to prevent entry of the huge number of bacteria that live benignly on the outside of our bodies.  This was previously discussed with regard to splinter wounds from cannonshot during the age of sail, and though this type of injury if somewhat different, it still follows that any laceration or injury to the skin would provide the perfect means for the bacteria living outside our body to find their way in to areas in which they do not belong.  Infection was, in some ways, as much of a problem during the age of the dreadnought as during the age of sail.  Penicillin, discovered in 1928, and other such miracle drugs would not be discovered for many years.  Though, it is of course unclear how much benefit such victims would receive from antibiotics, due to the nature of their wounds.

Breaking the variation of burns down by proximity to the blast, we would certainly expect that the crew members closest to the point of explosion, either due to the concussive force crushing their organs or stopping their heart, or the intense heat doing instant damage to the same, would  have died instantly, some likely unknowing of their fate.  Many would likely have suffered the most grievous of burns, likely full thickness and third-degree, however, they would have been lucky enough to not have to suffer through the aftermath of such wounds.  The shrapnel from the exploding shell, as well as that provided by exploding metal set pieces, would provide another means of death, such that if the force or heat were not enough to do one in, metal shards flying at untold speed would likely finish the job.  Those sailors slightly farther, but close enough to receive very similar burns were likely some of the most grievous and painful cases during the whole of sea warfare during World War I.  Of particular note was the fuel present in these new ships, needed to power their new, mechanical engines, and all but unnecessary in the age of sail.  Should this petrol, or similar fluid ignite and make contact with the crew, the results would be gruesome as it can continue burning well after the initial explosion.  Moving further out from the point of explosion, it is possible we would see burns of decreasing intensity, yet the sectioning of the ships coupled by the relatively small spaces and the ability of the flames to travel and fill these spaces, often times caused a large dichotomy in the blasts effect on sailors.  Those nearest obviously suffered grievously, but those farther and in different section might often have been unaware of the plight of their fellow crew until after the fact.  This was quoted as being so in Keegan’s The Price of Admiralty, where sailors reported not knowing a shell had burst in the ship despite being less than 50 yards away.  This lends credence to the point that, although these ships were reasonably good at keeping the shells out, it might be argued that they were even more capable of containing a blast within a certain area.  There was very little the naval surgeons could do to provide reprieve from the pain and agony of a third-degree burn, and should the sailor’s body be robust enough to fight off death for an extended period, the bacteria introduced into the wound would more than likely take their toll.


Though the human body is covered with many different strains of bacteria, the one most dangerous in burn victims is Pseudomonas aeruginosa.  This bacteria is fairly ubiquitous, being found in the soil, water sources, and our very skin; however should it gain entry to the deeper layers of tissue, it would grow and replicate with ease due to its ability to utilize many different resources as food.  This bacteria is still a problem in burn victims in hospitals, and due to its adaptability, it can live in the most unlikely of places: medical machinery, hospital equipment, etc.  Since antibiotics are utilized during the modern era, many of the other bacterial species which also might have afflicted these unfortunate sailors can be more easily dealt with, however, Pseudomonas remains a threat.

I will conclude with a quote from Keegan’s The Price of Admiralty (page 153), one which I feel gives a true sense of the horror faced by the sailors suffering from burn wounds, and the disturbing, hopeless task faced by the naval surgeons who attempted to treat them.

“In the ankle deep flood, blood-stained bandages and countless pieces of small debris of war floated to and fro…the most dreadful cases were the ‘burns’ - but this subject cannot be written about.”

If you asked a physician during the 18th century, I imagine he would say it does.  Back in the early days of somewhat more modern medicine (my favorite era), and well before we had any real concept of what was causing the diseases that we saw, and still sometimes see, on a daily basis, many physicians and scientists drew the conclusion that that which smells bad to you, must also be bad for you.  This theory, termed the miasmatic theory of disease, is to me, one of the most fascinating, unbelievable, yet also logical components of the history of medicine.  You’re likely thinking, “I might agree with fascinating and unbelievable, but logical?”  Absolutely!  Let’s think about it, and put it into a context which might be more relevant to your average person in modern era.  If you go into a gym locker room that is never cleaned and smells just terrible, isn’t it your primary instinct to either get out of there immediately, or at least spend as little time in there as possible?  Yes, of course you now know that the bad smells might signify microbes, bacteria, and potential infection, however, what if you had no idea that those things existed?  You spend some time in the room, likely you are fine, but then another several thousand people come in and out of there over the course of a year.  It is likely that at least a few of those individuals will get sick or receive a nasty infection.  Your average 18th century physician, having no real knowledge of bacteria, viruses, or fungi, might decide that since all the people in question went into this locker room, and in turn, since noxious fumes are instinctively avoided by humans, that the two put together must therefore lead us to disease.  Just one example of this is, of course, never enough on which to base a rather grand conjecture such as the miasmatic theory of disease, however, if we compound our one example with other such instances, then we clarify the steps which many physicians likely took to get to the point of associating noxious smells with dangerous illness.

Here is another example from the same era regarding yellow fever, an infection caused by the yellow fever virus.  Many explorers, sailors, and workers who ventured into swamplands often times found themselves or their party with a most heinous illness.  Yellow fever consists of general flu-like symptoms (headache, fever, nausea, vomiting) which often subside after some days, however, in some instances the disease can progress to a more advanced state.  This “toxic phase” is often comprised of spiking fevers, jaundice (yellowing of the skin, thus yellow fever) due to damage of the liver by the infectious organism, and finally bleeding from the eyes and anywhere along the gastrointestinal tract (i.e. from mouth to anus).  This internal bleeding can cause the vomit to turn black, a product of the blood interacting with the acids in our stomach.  This infectious disease is, as I said earlier, caused by the aptly named, yellow fever virus, whose vector is the mosquito, Aedes aegypti.  Now, it follows that since these mosquitoes can carry this virus, and that swamplands and marshes are the breeding grounds of mosquitoes, it is perfectly reasonable to assume that the chances of getting yellow fever increase considerably when we spend time in such landscapes.  However, to the physician 250 years ago, with no knowledge of vectors or viruses, a very different conclusion might take form.  Since swamps are rife with noxious fumes, compounded with the fact that many individuals who went into the swamps came out sick, we might assume it was the fumes themselves that carried the disease.  If we extrapolate this pattern to world at large, we find very similar “relationships.”  For example, many captains aboard sailing vessels felt it of utmost importance to clear the ship of noxious smells by cleaning rigorously and  often, with the result being lower rates of disease compared to ships with less meticulous cleaning regimens.  Again, we know that cleaning the ship also likely reduced the amount of harmful bacteria aboard, however wouldn’t that also cause the smell to improve since fumes from bacteria can often be the source of the bad smell?  Scurvy was thought to be caused by the sea air, cholera was though to be caused by the spread of poisonous fumes, and so on.

This theory permeated the thinking of healthcare workers for much of the age of sail, often to the detriment of the sailors.  Many suffered from scurvy, beriberi, and other such illnesses, without the proper means or understanding for a cure.  Instead, the physicians, though logically so, often focused on decreasing the amount of noxious fumes for the person instead of seeking to discover what might actually cure the illness through what we might term “rudimentary experimentation.”  That is, trying out different medications or dietary changes until one proves useful in treating the disease.  This was how the discovery of vitamin C as a cure for scurvy came to fruition.  More on that topic in future postings!
*Images courtesy of Wikipedia

Rice.  One of the most prominent and relied-upon staples, cooked in any variety of dishes the world over, and a vital source of nutrition for millions of people on our planet.  I love it; one of my favorite foods that, at times, it seems I just cannot get enough of.  However, this seemingly innocuous ellipsoid was, at one point, the source of an illness that ravaged a large portion of the Royal Fleet in the 18th and 19th centuries.  One arguably more virulent and more mysterious than that of even the famous scurvy.  The disease I speak of is called beriberi; an illness which killed many sailors in the age of sail, and perplexed physicians and surgeons for around a century.

You may ask: what kind of a name is “beriberi” anyway?  If so, you would be joining the masses who, for more than two centuries, have asked that very same question and received the same ambiguous, imprecise answer, “We’re not sure.”  How can this be??  Almost every characterized disease has its roots in the foundations of modern medicine, forged through the use of Latin, and a carefully sculpted (though I can assure you it does not always seem so) and beautifully convoluted (think Rube Goldberg here) terminology.  We have a meticulously documented name, differential description, set of symptoms, and so on, for just about every ailment under the sun, so how is it possible that for this one we “just don’t know?”  I must admit that the enigmatic origins of the disease’s name piqued my interests.  Zachary Friedenberg, author of the book I am now reading (and also enjoying immensely) titled, Medicine Under Sail, describes the proposed origins for the title of beriberi.  It is thought that it might originate from Sri Lanka, where beri beri literally means, “I can’t, I can’t.”  This was in reference to the fact that the affected were so sick that they could not rise to greet the doctor when he arrived to treat them.  Another postulated source for the name comes from the Arabic words, bhur (which means shortness of breath - or asthma) and bhari (which means marine).  Regardless of the number of conjectures, the definitive source of the name is lost to history.

As for the symptoms of beriberi, they were anything but ambiguous, and followed a definitive course to certain death during the age of sail.  They began with anesthesia (loss of sensation) and tingling in the lower extremities, which was followed by edema and swelling in the same region.  The edema spread to include the entirety of the legs, as did the numbness and weakness of the muscles, eventually leading to paralysis.  In the thorax, the edema was just as prominent and significantly more dangerous.  As it affected the lungs, breathing became labored and difficult.  The heart followed with searing pain developing, and leading, both eventually and imminently, to sudden death.  This was, of course, a terrible and hopeless situation for the affected because as soon as it was contracted, they were given a death sentence; the people they looked to for treatment and guidance not only being powerless to help them, but also at a loss to even tell them what it was that was killing them.  Autopsies were performed on the patients who died of beriberi, and some startling findings were made.  The entirety of the chest cavity was filled with fluid, and it was obvious that the peripheral nerves (apart from the central nervous system - brain and spinal cord) had been greatly affected by the disease course.

The strangest factor, at least to the surgeons of the time, was the pattern of who contracted this disease.  The lascars, or Indian crew members serving aboard British naval vessels, contracted beriberi in droves.  Their living condition were poor and unsanitary; a factor that many pointed to as the source of the disease.  However, the other crew members living in direct proximity to them did not contract the illness.  It was also noticed that the Japanese, and far-Eastern cultures, were diagnosed far more often than those of the West.  This aspect was despite socioeconomic status.  Therefore, many concluded and wrongly so, that diet had nothing to do with it.  If a poor person with a poor diet in the Britain did not get it, but a similar person in Japan did, then the diet was obviously not the cause.  As an aside, this sort of egocentric rationalization speaks volumes to the view that the “superior” powers of the world had.  To me, it is almost unbelievable that one could even come to such conclusions since any person could easily recognize that a diet in one country is different than the diet in another.  Many did notice this, the age of sail was not devoid of great thinkers, but it is the huge amount of people who did not see this that leaves one befuddled.  The miasma theory (previous post) showed its face as well, with many surgeons pointing to the poor quality of the air aboard ships as the cause of beriberi.  However, the more astute and creative thinkers of the time did begin to notice patterns in the diets of those affected with the disease versus those who less likely to contract it.  There was one staple that all of their cultures shared, and this was, of course, rice.

What was it about the rice that caused beriberi?  It was the vitamins, or rather, the lack thereof.  Rice is an excellent source of one of the most important vitamins, thiamine (also called vitamin B1).  Thiamine is an essential factor in our body’s ability to metabolize carbohydrates, proteins, and fats.  As one might imagine, if we become deficient, this spells trouble for many bodily processes as these building blocks are absolutely necessary for our body to function correctly.  The milling and refining process of the time, used in the harvesting and preparation of rice for consumption by the masses, effectively cleansed the rice of any measurable amount of this vitamin.  Therefore, people eating this milled rice as a large, or the sole, staple in their diet, would almost certainly come down with beriberi.  It took nearly a century for this very simple relationship between deficiency and disease to be brought to light.  This was in part due to the lack of creative thinking, but even more so, due to the lack of proper means of elucidation.  In modern times, we can easily measure the amount of thiamine in a food source, however, such methods were obviously not in existence during this period.  Many were aware of this, even then, yet they persevered despite their frustrating lack of resources.  Thomas Christie, Inspector General of Hospitals in Colombo, Ceylon in the early 19th century recorded the following in his characterization of beriberi: “I can suppose the difference to depend on some nice chemical combination which I have not sufficient confidence in my knowledge to explain.” (Friedenberg 2002)  The cause was eventually clarified, yet many crew members suffered grievously and died agonizing deaths in the interim.

You open your eyes to pitch black.  Your neck is sore; you have been leaning against this wooden wall for what seems like ages.  What time of day is it?  How long have I been here?  You put your hand out to prop yourself up and feel the slimy wall.  Your hand slips down to the floor and you feel fluid, bringing it to your face reveals it as vomit.  Is this mine? A body next to you stirs and rolls over in his sleep, and as he rolls, you hear the clink of chains and feel your leg being pulled with him.  The rusted, serrated edges of the cuff on your leg stings as it digs deeper into the wounds it created over the many weeks it has hugged your flesh.  Your wits return to you as you remember where you are and how you arrived here, as does the realization that you have not used the bathroom in some time, and you need to now.  Dysentery is an unkind affliction, and the necessity to defecate overtakes you like a storm.  You attempt to wake your mate, the one cuffed to you, vigorously yet fail to wake him despite the fact that you are now violently shaking him.  The bucket is on the other side of the hold, you know there is no way you are going to make it there in time, especially with your partner in such an obtunded state.  You go where you are, in the darkness.  You are a slave aboard a slave ship; ripped from your home in Africa, chained in the dark hold for weeks on end, only to arive in the West Indies and be traded for rum or sugar and forced into a harsh life of servitude.
These experiences, as I described above, were not uncommon in the slave trade.  These individuals were seen as subhuman, and often treated as such.  Often kept in the dark hold of a ship for weeks on end, with little in the way of nutrition and exercise.  The slave trade was often described as being a “triangular trade,” with three legs to the voyage.  The first leg was the departure of ships from their European ports (Britain, Portugal, France, etc.) to their arrival at the western coast of Africa.  Here, the slave traders would engage in a number of sordid means of acquiring slaves.  The first, and most simple, would be to go and capture them themselves.  Another, and exponentially more effective means of acquisition was to coerce the local chieftains or groups of Africans to bring the slaves, through means of force or otherwise, to the slave ships in exchange for goods of value.  This method proved to be of great efficacy for the simple reason that the local peoples were more apt to trust their own.  It is plain to see that the slave trade not only brought misery in a direct way, to those unfortunate enough to be captured and forced into the trade, but also created an atmosphere of distrust and deception that changed the fundamental ways in which Africans interacted with each other during that period.  It is nearly impossible to imagine the horror of having your child, or children, disappear with little to no trace, and not knowing what happened to them for some time, if ever.  This was compounded by the fact that, once actually aboard the ship, the slaves would have their fitness and assessed ability to work judged by the ship’s surgeon, with those deemed as too old or infirm sent back to land.  The boats filled with slaves being sent back were full of screaming individuals, not out of rejoice due to being sent back, but out of fear.  Being sent back to land, due to an inability to work, meant being slaughtered.


The second leg of the trip was from the western coast of Africa to the West Indies in the Caribbean.  This segment of the trip was where scenes like the one I described above were most likely to occur.  The hold in which the captives were interned, was something out of hell.  There were often hundreds of slaves jammed into a relatively small space with little in the way of light, if any.  The only receptacle for defecation and urination being a singular bucket, that was often overfilled, and nearly impossible to get to.  The result was that many of the slaves went to the bathroom in whatever part of the hold they could get to.  Many of them suffered from dysentery, whose most prominent symptom is diffuse, violent, watery diarrhea; we can imagine what sorts of situations may have occurred with this in mind.  The cuffs around the legs of the slaves were often the source of infections and gangrene, making moving even more painful and unlikely.  They were all usually chained in pairs, so that the fate of one would mean the fate of another.  Friedenberg, in his book, Medicine Under Sail, describes instances of slaves attempting to jump overboard, only to have their partner (to whom they were chained) drown, thus thwarting their escape.  It was an effective means of preventing such daring methods of attempted flight from captivity.  Some captains were kind enough (relatively speaking, of course) to allow the slaves time on the deck in order to get exercise and fresh air.  However, many captains were cruel and never allowed such “indulgences,” often despite the advice of the surgeon aboard the ship.
Speaking of the captains, we can imagine that the slave trade, by and large, enticed men with relatively “loose morals” to come and commandeer the ships.  It is possible that many were forced to do so, a fact I am unsure of, however, many seemed to not only feel comfortable with such a loathsome occupation, but in fact reveled in it.  The most brutal means of discipline were all that would suffice aboard many slave ships.  Attempted escapes and insurrections, if quelled, would bring down harsh punishments on the slaves involved.  Brutal lashings to the point of near-death, being tied to the riggings during harsh weather and storms, and so on.  The crew of the slave ships was not spared from the often malicious and sadistic wills of the captains.  They would undergo very similar means of punishment for crimes that many would judge to be minor.  Friedenberg tells of an elderly sailor who merely complained about the quality of the drinking water aboard the ship, and as a punishment, was forced to swallow a pump bolt.  These sailors and crew, as for all naval fleets, were often impressed into the service; poor and malnourished vagrants taken off the streets, or convicted felons, placed on a ship, forced to follow the strict guidelines and unfamiliar orders which they had never before experienced.  They were usually terrible, undisciplined sailors who deserted at the first opportunity.  This atmosphere was obviously not conducive to the honor and pride that was expected of sailors in the service of the crown (whatever crown that might be).
And what of the surgeons?  Were they as horrible as the captains in whose service they were employed?  The fact of the matter is that, despite this being a generalization, many were poor doctors right out of medical school, with little in the way of career choices at that point in time.  They took up a position on the slave ships in order to make some money and actually practice medicine, usually with their tenure not lasting more than one voyage due to the horrid conditions forced on the slaves, and the offenses to their morals.  They often tried their best to provide medical treatment and care for the slaves, though this was often in direct opposition to the orders of the captain.  Many of the diseases they came across were those that were frequently seen aboard sailing vessels of the age.  Afflictions such as scurvy and beriberi were extremely commonplace due to the poor nutrition of the slaves, and dysentery was rampant.  Gangrenous infections from the chains, or any other injurious source, were also relatively commonplace.  Yellow fever and malaria were often brought aboard by both the slaves and the crew who set foot ashore in Africa, as we know these diseases are common in hot and marshy landscapes.  Bilious fever, likely named because of jaundice suffered by victims of hepatitis, was also relatively commonplace and reported by various surgeons.  This disease is caused by viruses, the aptly named hepatitis viruses, of which there are five main identified viral subspecies (A, B, C, D, and E).  The one afflicting the slaves was most likely hepatitis A, since it is transmitted via the fecal-oral route (slaves were defecating in the hold amongst each other) through contaminated food or drinking water, and is highly contagious.  Many surgeons tried to keep careful records of the infirm and injured slaves aboard the ships, and attempted to provide proper care despite the vile conditions forced upon them.  They often spent countless hours in the hold, despite the horrid stench and prevalence of infectious disease, so that they might treat those slaves most in need.  Though it is likely that not every surgeon felt so inclined to help, it seems that many did despite the circumstances, and often had their conscience so offended that they never set foot on a slave ship again.

The third, and last, leg of the voyage involved taking the rum and sugar received in compensation for the slaves back to the European country from which the ship set sail.  All of that suffering, misery, inhumanity, and disease for an extra shot of rum at the bar and a few extra cubes of sugar in one’s tea.  The depths to which some humans will sink at times seems immeasurable.

Image via Wikipedia

http://bit.ly/932zHv

The above link leads to an article detailing how archaeologists have discovered what appear to be tools utilized in brain surgeries performed nearly 4000 years ago.  

The obsidian blades have been found in the Black Sea province of Samsun in Turkey.  Questioning of the archaeologists yielded some very interesting finds as detailed below:

What makes you think they were used for surgery?

We have found traces of cuts on skulls in a nearby graveyard. Out of around 700 skulls, 14 have these marks. They could only have been cut with a very sharp tool. At this time, 4000 years ago or more, it could only have been an obsidian blade. The cut marks show that a blade was used to make a rectangular opening all the way through the skull. We know that patients lived at least two to three years after the surgery, because the skull has tried to close the wound.

Have you uncovered any clues to why this surgery was performed?

There seem to be three main reasons. The first is to relieve the pressure of a brain haemorrhage; we found traces of blood on the inside of some of the skulls. The second is to treat patients with brain cancer, as we can see pressure traces from the cancer inside some of the skulls. And the final reason was to treat head injuries, which seem to have been quite common. The people of Ikiztepe got their copper from mines in the local mountains, and we think they had to fight other local people for access to it.

Are there any other examples of such early skull surgery?

A few skulls with cut marks have been found at other Bronze Age sites in this region, but other than these I have not found any parallel. There is a Neolithic skull found at a site in central Anatolia with a hole drilled into it. But the surgeons at Ikiztepe were cutting a rectangular opening. It is a much more sophisticated technique.

Thought this was interesting and worth passing along.