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Without the aid of modern anesthesia or, for that matter, modern disinfection, a Bronze Age practitioner of some kind wielded a tool with a sharp, beveled edge and began a grisly business. In about 1500 B.C., the primitive surgeon cut away a polygon of scalp just above the left eye and peeled it off, leaving scratches in the bone below. Then began the painstaking process of slicing into the “living bone,” according to a new archaeological study, leaving remarkably clean grooves and carving out segments finally removed using “leverage.” But don’t worry: the researchers believe the inch-wide hole stopped short of breaching the protective dura mater membrane that surrounds the brain. Read More: The Earliest Evidence of An Amputation is 31,000 Years Old Ancient Surgery This dramatic process, a type of trephination or craniotomy, still occurs today, albeit in a much different form – to reduce brain swelling and respond to other emergencies. In the ancient world, would-be surgeons sometimes used primitive drills or saws on people, and even a child, with brain traumas, scurvy or intracranial infection, sometimes killing them. “We have evidence that trephination has been this universal, widespread type of surgery for thousands of years,” says Rachel Kalisher in a press release, a Ph.D. candidate at Brown University and the lead author of the study. The new case stood out, in part, because of its location in the Near East, where trephinations rarely show up in the archaeological record, and because the surgery, a medical “Hail Mary,” lacked a clear impetus. A Procedure for the Ancient Elite Researchers unearthed the man’s burial site underneath a residential home in the once prosperous city of Megiddo, in what is now modern Israel, a much fought-over town along the important Via Maris trade route. They found bone fragments from the procedure, suggesting the patient or someone else had stuck them back in the wound to aid in healing. The investigators also uncovered food offerings and fine ceramic vessels, plus the bones of the man’s brother, indications that the two held an elite status in the nearby palace. Locals had buried the two in a dirt pit close to another, larger tomb underneath the building, filled with 17 bodies decked out with gold, silver and bronze jewelry, and fine bone inlay. The brother who received the trephination died soon after, the study concluded, as the bones showed no signs of healing. Many other bones belonging to the man showed a different type of damage, telltale pitting and “pencilling” that made them look like weathered driftwood. What was this, and how did it relate to Bronze Age brain surgery? Ancient Disease The researchers looked for answers and proposed that, perhaps, the brothers had suffered the lesions from a years-long infection such as osteomyelitis, syphilis, tuberculosis or leprosy. Of these possibilities, leprosy stood out because it is often shared between family members, who must remain in close contact for months to transmit the disease. The ancient disease attacks the skin, peripheral nervous system and even the bones themselves. Read More: Ancient Medical Treatments Still Used Today While leprosy doesn’t directly affect the brain, it can cause neuropathic pain, a burning sensation, blindness and the hallmark sores and bumps, including on the face. While one of these could have prompted the operation, Kalisher is still looking for answers. With help from the Max Planck Institute for Evolutionary Anthropology, she’s now testing the bone lesions for leprosy DNA. If successful, she’ll have identified one of the earliest cases of leprosy in the world and drawn closer to explaining the Megiddo trephination. “You have to be in a pretty dire place to have a hole cut in your head,” she says in a press release. The unnamed patient may have also suffered from a number of congenital conditions that somehow precipitated the surgery, the study surmised, due to him having a relatively common skull “suture” or groove, and the presence of an extra molar on his jaw. But the study couldn’t confirm any such condition.