Skull Trephination in the Carpathian Basin (8th - 13th Century A.D.)

Abstract

In memoriam et honorem Professor L. Bartucz From prehistoric times we have a few trephined skulls; from the Roman period, none. A few are found from the time of the Great Migrations. From the 8th and especially the second half of the 9th C. (i.e. from the time of Hungarian conquest) the number of trephined skulls rises suddenly. The trephinings are usually round or oval, but the extent varies: (a) only the tabula externa, (+ diploe) are removed (symbolic trephining), or (b) all the three layers of calvarium (tabula externa. + diploe + tabula interna) are removed (surgical trephining). There are multiple trephinings too. Around half of the trephinings are at the vertex (bregma region). Mortality was less than 31%. The number of trephined skulls diminishes rapidly after the Christian ization of the Hungarian people, but there is a difference in the rate at which the symbolic and surgical forms of trephination disappear. Two maps indicate the location of excavations where trephined skulls were found, covering the major part of the Carpathian Basin which was occupied by the invading Hungarians. A third map indicates the sites in the South Russian steppe region where similar trephined skulls were found, for the most part accompanied by grave furniture similar to that buried with the 9th C. Carpathian Hungarians. The trephination was executed with a fine chisel (Bartucz, Nemeskeri). Most surgical trephinings were made to correct wounds or fractures. By means of recent analogies, we may suppose that the others were made in cases of headache. Sometimes a thin silver or bronze sheet was found, positioned as though to protect the opening. Key words: Trephining, Hungarians, Carpathian Basin, Middle Ages Chronology From prehistoric times - especially from the Copper Age - we have only some trephined skulls from the Carpathian Basin, meanwhile from the several centuries spanning the period of the Roman imperium of Pannonia (West Hungary), Dacia (East Hungary) and the southern parts of the Carpathian Basin is not a single archeological-anthropological finding of trephined skulls. We have again a few findings from the early part of the Great Migration time period. The number of excavated trephined skulls rises slowly in the so-called Late Avarian period (8th-9tli C.). From the end of the 9th C. i.e. from the Hungarian conquest, we can observe a sudden rise of trephined skull's number, and after this peak - lasting three centuries - a similarly sudden decrease of it. (Fig. 1.) The below mentioned investigators attribute the sudden decrease of skull trephining in the 11th C. to the Christianization of the Hungarians, but we do not have any convincing prove of this ,hypothesis. There were some scattered cases in the 12th and 13th centuries, after this period were none, whereas wartime and peacetime cranial traumata and headache might have occurred later on in a similar or in a much greater number too. Types of Trephination From a pathophysiological point of view we may distinguish two main types of in vivo trephinings. (Postmortem trephinings are not available in the Hungarian material): (a) only the tabula externa (+ diploc) are removed in one or more circumscript regions = symbolic trephining. (b) all the three layers of calvarium (tabula externa + diploe + tabula interna) are removed, i.e. the skull vault is opened = surgical trephining. Both types occurred in multiple forms (2 - 7 symbolic trephinings on the same skull) and also in combined forms (symbolic + surgical trephinings on the same skull). The multiple ones were made mostly at different times, i.e. subsequently. In the opinion of L. Bartuez resp. J. Nemeskeri and co-workers, whose results I have outlined, these trephinings were made by a fine chisel. Trephinings made bya trepan or bya saw are unknown in the Hungarian material. The heater worked behind the sitting patient and made numerous fine incisions round the circumference of the planned opening. …