The article discusses the results of a multidisciplinary study of technologies for performing three intravital trepanations, traces of which were found on skulls from the craniological collection of nomads of the Altai Mountains of the Scythian period (IV-III centuries BC). To determine the nature of surgeons ' actions, as well as the tools they used, experimental traceological and physico-chemical methods of bone tissue research were used: mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass-mass- inductively coupled plasma spectrometry, X-ray fluorescence energy dispersive analysis using synchrotron radiation, magnetic resonance imaging. It was established that all trepanations were performed by curettage and were performed in two stages. Bone tissue in the operated area did not contain iron and arsenic particles, but showed high concentrations of copper and tin molecules. This indicates that the tools used for trepanning were made of pewter bronze. An experimental knife of the form common among the early nomads of Southern Siberia, made of an alloy of copper, tin and zinc, successfully performed trepanation on the skull of a corpse.

Keywords: trepanation, Pazyryk culture, Scythian time, experimental tracological analysis, mass spectral analysis, X-ray fluorescence analysis.

Introduction

The successful performance of complex surgical operations, recorded from paleoanthropological materials dating back centuries and millennia before the turn of the millennium, leaves a strong impression and encourages the most in-depth study of such achievements in healing practice. This is especially true for intravital trepanations, during which a section of the skull was removed and the intracranial contents were exposed - the underlying vessels, dura mater, and sometimes the brain itself*.

This work was supported by the Russian Foundation for Basic Research, project No. 13-06-00153a.

* It is also customary to refer to the category of intravital trepanations as manipulations in which the internal bone plate was not exposed. They are called symbolic (Bartucz, 1950). Such trepanations have been recorded since the Upper Paleolithic period [Mednikova et al., 2012], have a cult significance [Mednikova, 2001, 2003, 2004], and are considered as "a kind of tradition to cover one's body with scars, scars, and tattoos" [Mednikova, 2004, p.142]. In this article, we will

Interest in the topic of prehistoric trepanations began in 1865, when Ephraim George Squier, a diplomat, US representative in Central America, as well as an archaeologist and ethnologist, brought back a skull originating from Inca burial sites in Peru with four incisions made on the right half of the frontal bone perpendicular to its surface and forming a rectangular shape. the hole is about half an inch in size (Fernando and Finger, 2003). The identified distinct signs of healing at the edges of the hole indicated that the patient survived for at least several weeks after surgery. Despite the fact that this fact was confirmed by the famous French physician, anatomist and anthropologist Paul Broca, few people believed in the possibility of successful trepanation in the conditions of primitive ancient medicine. In the mid-19th century, the survival of patients after trepanation in the best hospitals in Europe rarely exceeded 10%, which was associated with an extremely high risk of infectious complications and the use of this operation only in extremely severe patients with traumatic brain injury [Gross, 1999]. Even today, with advanced neurosurgical technologies, successful cranial trepanation requires serious knowledge and training from the surgeon, and the procedure itself is not considered absolutely harmless and is equated in its severity to a brain injury [Prakticheskaya Neurosurgiya, 2002]. In addition to the technical difficulties of opening the skull, the doctor performing the operation faces the need for effective anesthesia of the patient, stopping bleeding from the abundantly supplied soft tissues of the skull and bone, as well as preventing the development of infection in the wound.

In the 20th century, anthropologists discovered and studied hundreds of trepanated skulls dating from the Epipaleolithic to the 18th century. This material allowed us to identify five main methods of performing trepanations [Lisowski, 1967; Saul F. P., Saul J. M., 1997].

1. Formation of a rectangular hole by intersecting incisions of the bone. This particular trepanation was first recorded on a skull from Peru. The hole was made with a knife made of flint or obsidian.

2. Scraping the bone. Paul Broca used a piece of glass to perform such trepanation on the skull of an adult corpse, taking 50 minutes (Finger and Clover, 2003).

3. Cutting out a circular groove with subsequent lifting of the bone disc. This method was widely used until recently in Kenya (Gross, 1999).

4. Formation of a rounded trepanation window by means of a crown saw (trepan). This method was described by Hippocrates, refined by Roman physicians, and used in modern medicine [Fabbry et al., 2012].

5. Drilling round holes in close proximity to each other and then cutting between them with a chisel or chisel. This technology was recommended by the Romans, adopted by the Arabs, and used in the Middle Ages. Its continuation was a method that in some cases is still used today, despite the presence of high-speed electric and pneumatic drills equipped with craniotomes with routers made of high-strength alloy steel. It consists in the fact that between the holes drilled by the cutter, the bone is cut through with a Zhigli file (wire with sharp edges), held under the bone above the dura mater using a conductor.

It was found that the curettage method provided the highest survival rate for ancient trepanations (Kirkur, 2003). When comparing the probability of bone healing on a large material from Anatolia, the best result was recorded with the scraping technique compared to sawing and drilling [Erdal Y. S., Erdal O. D., 2011].

Any of the selected trepanation methods has variants that depend on the materials used to make surgical instruments, the basic techniques adopted by each "medical school", the technique mastered by a particular surgeon, and on his personality. Even in modern medicine, the training of a surgeon and his practical activities are strictly individual, since surgery was and remains more an art than a craft.

Our research is devoted to a detailed study of the technologies of performing three lifetime trepanations on skulls from the craniological collection of nomads of Gorny Altai of the Scythian period (IV-III centuries BC). Its results were partially used in the article [Chikisheva et al., 2014], where we summarized the specifics of the cultural and historical context of these trepanations, assessing their adequacy with the help of the following methods: We also analyzed written sources - medical treatises reflecting the state of the theory of neurosurgical treatment in well-known medical centers of archaeological eras*.

we do not consider the methods of applying these symbols to the human body, but rather explore the technology of performing true surgical trepanations.

* We are talking specifically about theory, since the practical results of its application are not always found on paleoanthropological material. A hypothesis explaining-

Fig. 1. General view of trepanation marks on the examined patients

tortoises, a -mound 3 of Bike III burial ground; b - mound 3 of Bike III burial ground. 2 of the Kyzyl-Jar IV mound group; b-mound 3 of the Kyzyl-Jar V mound group.

Material and methods

Technologies for performing trepanations were studied on three skulls: a male (50-60 years old) from mound 3 of the Bike III burial ground (the mound was studied by V. D. Kubarev [2001]), and a female (about 30 years old). from Kurgan. 2 kurgan groups of Kyzyl-Jar IV and men's (40-45 years old) from mound 3 of the Kyzyl-Jar V mound group (both mounds were studied by V. A. Mogilnikov [1983]). All of them come from ordinary burials of nomads of different ethno-tribal groups as part of the carriers of the Pazyryk archaeological culture.

Based on the experience of experimental studies in the archaeology of North and Central Asia (Volkov, 2013), the laboratory of the Institute of Electrotechnical Research of the Siberian Branch of the Russian Academy of Sciences conducted a tracological study of traces on the surface of trepanated skulls, which allowed us to determine the nature of surgeons ' actions in their operations and make some assumptions about the design of the instruments they used. The examination was carried out using binocular microscopes, the observed features of the bone surface structure during its operational and postoperative deformation were recorded with special macro photography equipment (Fig. 1).

Tools specially designed for performing trepanations were not found on the monuments from which the skulls originate, as well as among the accompanying equipment from all other known burials of the Pazyryk culture. Therefore, we applied modern methods of physico-chemical analysis of cranial bone tissue taken from trepanated areas in order to understand what material the surgical instruments were made of. When cutting or scraping tools are inserted into bone tissue, which is a very hard substance, their particles remain on the operated surface. Even modern surgical instruments made of high-strength steel are worn off when cutting, sawing, or drilling bones in operations or anatomical studies.

We suggested that the bone tissue around the trepanation opening may contain particles or individual molecules of substances used in the treatment process. To detect them, there were

The reason for this discrepancy between the detailed description of recommended surgical manipulations on the skull and the low frequency of occurrence of trepanated skulls with obvious indications for this operation was proposed by a group of scientists who studied trepanations in the craniological collection from necropolises of Egypt dating back 3,000 - 500 years BC [Nerlich et al., 2003]. The researchers suggested that the Egyptian doctors ' understanding of the extreme complexity, originality and danger to the patient's life of opening the skull made this operation worthy of description in special treatises, but did not contribute to its implementation.

Fig. 2. Incision marks at the first (a) and second (b) stages of trepanation on the skull of a man from mound 3 of the Kyzyl-Jar V mound group.

Two highly sensitive methods of elemental analysis* were used: 1) inductively coupled plasma mass spectrometry (ICP-MS) on a high-resolution ELEMENT mass spectrometer (Finnigan MAT) after acid decomposition in the MARS-5 microwave system. Determination of chemical element concentrations was performed according to external calibration with an internal standard, using Merck multi-element reference solutions as calibration solutions; 2) X-ray fluorescence energy-dispersive analysis using synchrotron radiation (SI-EDRFA), which was performed on the original VEPP-3 equipment. Chemical element concentrations were calculated using the "external standard" method. A BCR-32 phosphorite sample certified by the Joint Bureau of Standards of the European Economic Community (Brussels) was used as a standard. To detect ferromagnet (iron) particles, if they were preserved in bone tissue, magnetic resonance imaging (MRI) was used on a GE Signa Infinity device (1.5 T).

Results and discussion

All three trepanations were performed by curettage. From the traces left on the surface of the studied skulls, it is possible to establish a certain sequence of actions of surgeons during operations. The inevitable initial part of manipulations is the removal of the skin from the site of the intended trepanation. There are no traces of such actions on the examined skulls. Given the relatively good preservation of the bone surface on all three samples, it can be assumed that the scalping was performed with high quality. The autopsy was performed in two stages.

At the first, main stage of trepanation, the surface layer of bone was removed with a sharp cutting tool without perforating the skull. Traces of such actions can be clearly traced on the surface of a male skull from mound 3 of the Kyzyl-Jar V mound group. The area with these traces reflects the characteristic kinematics of the cutting tool. The plane of bone cutting is located tangent to the spherical surface of the skull (Fig. 2, a). The penetration of the cutting tool at the first stage was performed at a relatively sharper angle than at the second. The cutting plane during bone perforation has a noticeably larger angle of inclination inside the volume of the skull (Fig. 2, b). The same tool was probably used during the two stages of the operation. However, differences in the orientation of the cutting planes suggest that when removing the surface layer of the bone, its movements had a relatively long "working stroke", and when the skull was pierced, they were more frequent and shorter. Traces of bone cutting at the first stage have the appearance of "petal", cellular depressions with a relatively wide cut field (Fig. The sequence of their formation indicates a confident movement of the same type of tool (Fig. 3, b). At the second stage, the surgeon's hand made shorter cutting movements, in which the tool left a "step" structure on the bone (Fig. 4).

When describing the traces of the first and second stages of cranial bone cutting, differences in the dislocation of operational actions should also be noted. The plane of the first, surface section does not always coincide with the pre-planned site of the final perforation of the skull (Fig. 5). It is quite possible that at the first stage of trepanation, surgeons did not attach much importance to the danger of their manipulations. More precise actions can be traced at the final perforation of the bone.

The second stage of trepanation, judging by the identified traces, was carried out in two ways. In the first case, the bone was cut with the same tool as the surface layer was removed, and with similar movements. Such actions were observed on a male skull from mound 3 of the Kyzyl-Jar V mound group. The second method is recorded on a female skull from the burial mounds. 2 of the Kyzyl-Jar IV burial mound group and the male of the Bike III burial mound 3. Judging by the traces of trepanation, we can assume that-

* The authors are grateful to Yu. P. Kolmogorov and I. V. Nikolaeva, who performed bone sample analysis at the Siberian Synchrotron Radiation Sharing Center of the Institute of Nuclear Physics SB RAS.

3. Traces of cutting at the first stage of trepanation (a) and undulation of the external contour of the cutting zone (b) on a skull from mound 3 of the Kyzyl-Jar V mound group

4. Cutting zones at different angles at each stage of trepanation (skull from mound 3 of the Kyzyl-Jar V mound group).

Fig. 5. Relative inaccuracy of the choice of the skull opening zone at the first stage of trepanation (skull from mound 3 of the Kyzyl-Jar V mound group).

It should be assumed that penetration into the cranial cavity was performed not by cutting, as in the first method, but by straight, parallel to the long axis of the tool, "piercing" movements. This type of action resulted in "stepped" edges of the resulting hole (Fig. 6). Probably, with such a final perforation of the skull bone, the "piercing" movements were irregular. It can be assumed that as soon as operative actions made it possible to pick up the removed bone fragment, it was separated from the skull by the usual cutting motion. The traces of more frequent, but not as deep, penetrating "piercing" movements observed on the skull from mound 3 of Bike III burial ground (Fig. 6, b) indicate that in this case the surgeon acted more cautiously, with greater accuracy determining the place of perforation of the skull and the hole configuration. We can note a certain confidence in the operational movements of surgeons of the past. Traces of unintentional, but quite natural when cutting bone chips were not recorded.

The surgical instruments used by the Pazyryk healers of the Altai Mountains could have been made of flint, iron, or bronze. The high-field MRI scanner did not detect ferromagnet particles (in this case, iron) in the bone tissue around the trepanation holes. According to the results of SI-EDRFA, the copper content relative to the "external standard" for samples from Bike III, Kyzyl-Jar IV and V is 94.0; 78.0 and 23.8%, respectively, with an error of 20.0 %, tin-636.0; 2.7 and 6.0 with an error of 15.0 %. ICP-MS of the same samples showed that the concentration of copper in them is 87,0,97,0 and 21,0 mcg/g, tin - 480.0; 6.6 and 5.3 mcg/g. Relatively high content of titanium, vanadium, chromium, and nickel molecules in bone tissue-

Fig. b. "Stepwise" contour of the final perforation zone on mound skulls. 2 of the Kyzyl-Jar IV burial mound group (a) and from the Bike III burial mound 3 (b).

Content of chemical elements in bone tissue from the areas of trepanation

la and iron (see table) are also characteristic of the surrounding soil, since these elements are present in significant quantities in the composition of rock-forming minerals. The high concentration of manganese and zinc is explained by the fact that they can enter isomorphically into the structure of hydroxylapatite contained in human bones, replacing calcium in it. As is known from numerous literature sources, apatite is a good sorbent for these elements, and they can accumulate in significant quantities over time. No traces of arsenic were found in the studied samples.

Thus, judging by the high concentration of copper and tin molecules in the bone tissue and the absence of arsenic, the instruments used for trepanning were made of pewter bronze. We analyzed the work on spectral analysis of bronze products from the Scythian period,

published by S. V. Khavrin, they came to the conclusion that tin bronze was actively used in the IV-III centuries BC by nomads of the Minusinsk basin - carriers of the Tagar culture at the Saragashen stage of its development. We also suggested that trepanations in Pazyryk patients could have been performed with tools made by Saragashen foundry workers [Chikisheva et al., 2014].

Experimental verification of the results of the traceological analysis confirms our assumption with a certain degree of probability. It consisted in performing trepanation on the skull of a cadaver with a knife of a fairly common form among early nomads of Southern Siberia, made by A. P. Borodovsky from an alloy containing copper, tin and zinc (Fig. 7). The experimental operation was performed by one of the authors of the article, a practicing neurosurgeon. It took 28 minutes to obtain a hole with a diameter of 25 mm and expose the dura mater (Fig. 8). A significant refinement of the operation model proposed based on the results of trasological analysis of trepanation traces on Pazyryk skulls refers to the initial moment of its implementation. Using the characteristic shape of the knife tip, the surgeon formed a hole in the compact bone layer in the center of the surgical field, then moving to its periphery.

In the Minusinsk Regional Museum of Local Lore named after N. M. Martyanov (MKM) there are tools that, according to their functional capabilities, could well have been used for surgical manipulations at the end of the last millennium BC. The most typical of them are shown in Figure 9. These tools are part of the collection and represent lifting material collected in 1901. Knives were found near the villages of Vostochnoye (Fig. 9, 1, 2), Berezovka (Fig. 9, 3), Bely Yar (Fig. 9, 4), Martyanovo (Fig. 9, 5). The overall dimensions of these products and the length of the cutting part are shown below: 1 - 179 * 12 * 3,3 mm, 113 mm. 2 - 153 * 22 * 2,2 mm, 81 mm. 3 - 154 * 17 * 2,6 mm, 88 mm. 4 - 178 * 26 * 2,9 mm, 96 mm. 5 - 186 * 39 * 4,5 mm, 120 mm. Tools of this type leave bone-cutting marks similar to those seen on the trepanated skulls described above. Instruments similar in shape and function to the tools from the MCM collection (Figs. 9, 7) found in the area of the villages of Beiskoe and Listvyagovo could be used as lancets during operations. The standard blade thickness is 1.5 mm, the width is 7 - 9 mm. The total length of products is from 104 to 126 mm. An instrument similar to exhibit No. 3250 from the MKM collection (Fig. 9, 8) could be used as a probe during trepanations, and a tool from the same collection No. 8688 (Fig. 9, 9), its length is 125 mm, cross - section diameter is 3 mm, could be used as tweezers.

All of the above products have morphological and functional analogies in the synchronous instruments of European surgeons, and the closest ones are in the medical kits of ancient Roman doctors [Mednikova, 2001, 2004; Nagler, 2013]. As you know, the development of Ancient Roman culture, including medicine, was greatly influenced by the Greek world. The first surgeons in Rome were Greek doctors [Mirsky, 2000], and the surgical instruments used in Roman medicine actually copied the Greek ones developed in the Hellenistic era. This does not mean a direct exchange of medical experience between people separated by thousands of kilometers and living in different civilizations. But such facts are a reason for more detailed archaeological studies of ancient connections of carriers of different cultures.

7. Experimental knife made by A. P. Borodovsky.

Fig. 8. The skull on which trepanation was performed with an experimental knife.

9. Probable surgical instruments of the Saragashen stage of Tatar culture (exhibits from the collection of the Minusinsk Museum).

1-5-knives (N 2087, 2093, 2094, 2096, 208); b - saw (N 701) and its working sections (a-c); 7-lancet (N 9330) and its working sections (a, b); 8 - probe (9350) and its working sections (a, b). working area (a-b); 9-tweezers (N 8688).

In the collection of the Minusinsk Museum of Local Lore, four artefacts were also identified, the wear marks on which allow us to identify them as saws based on relatively solid organic material (Figs. 9, 6). Tracological analysis of the working surface of the tools revealed a number of signs indicating their use for sawing horn or bone. It is possible that we have another type of tools that can be attributed to surgical instruments. They have no analogues in European archaeological collections. Product dimensions N 699, 700 and 701 are 213 * 30; 205 * 43 and 200 * 40 mm, respectively. The thickness of the saw blades is the same and decreases from the base to the end from 2.5 to 1.5 mm. The teeth of the tools are formed by cuts perpendicular to the blade using an unidentified tool. The separation of teeth was initially absent and was formed later, during the disposal of tools. Items found at d. Panachevo Kuraginsky district.

Conclusion

An expert analysis of trepanation cases found in the early nomads of the Gorny Altai of the IV-III centuries BC, using experimental tracological and physico-chemical methods of bone tissue research, showed that the healers who performed these operations had an effective surgical technology and were very skilful and accurate in its application. All trepanations were performed by curettage in two stages. Each case is characterized by an individual "handwriting" of the surgeon. These features are noticeable at the second stage of the operation, when the doctor was preparing the operating field for the procedure of skull perforation. Thus, we can assume that the analyzed trepanations were performed by three surgeons.

Bone tissue in the area of trepanations did not contain iron particles and arsenic molecules, but showed high concentrations of copper and tin molecules. This is svide-

This indicates that the operations were performed with tools made of pewter bronze, which in the IV-III centuries BC was used in Southern Siberia on the territory of the Minusinsk basin by the carriers of the Tatar culture at the Saragashen stage of its development.

No special instruments that could be considered surgical in terms of morphological and functional parameters were found on the monuments of the Pazyryk culture. But among the bronze products made by Saragashen foundry workers, there are items that meet such parameters. Some of them are authentic (knives, saws), others find analogies in synchronous medical kits found in Europe (lancets, probe, tweezers). These facts suggest that the exchange of medical knowledge may have been much broader than other cultural achievements.

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The article was submitted to the Editorial Board on 01.09.14, in the final version-on 10.09.14.

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