JOURNAL OF CRITICAL REVIEWS

ISSN- 2394-5125 VOL 7, ISSUE 12, 2020

REVIEW OF CAUSES AND ORIGINS OF CRANIAL TREPANATION IN THE SARMATIAN OF THE LOWER VOLGA REGION

Evgeny V. Pererva1

1Volgograd Institute of Management, Branch of the Russian Presidential Academy of National Economy and Public Administration»Gagarin Street, building 8, Volgograd, 400066, ORCID 0000-0001-8285-44612 [email protected]

Received: 14 Feb 2020 Revised and Accepted: 25 April 2020

ABSTRACT:The cranial trepanation is one of the most frequently performed operations on skull by modern and ancient surgeons. In the scientific literature trepanation is often associated with the widespread manipulations in ancient peoples` bodies, such as deliberated head or extremities deformation, scalping, artificial scarification, decapitation, truncation of limbs, etc. Nowadays it is known that trepanation is the therapeutic or ritual manipulation performed in vivo or posthumously by various techniques. Reconsideration of all these criteria allows anthropologists evaluating the nature of development of medical knowledge of ancient societies; determining the degree of technical sophistication of ancient doctors and comprehending the traditions and customs of peoples who lived on earth in the distant past. The paper endeavors to summarize and consider cases of craniotomy on the materials dating back to the Sarmatian era. The presented study also provides an evaluation of the cases described from the point of view of the technique of carrying out the and other manipulations, and the reasons for their conduct. An attempt was made to find the sources of the spread of the tradition of skull trepanation in the nomadic peoples of the Early inhabited the Lower Volga region. KEYWORDS: Trepanation, the , ancient societies, skull, Early Iron Age, the Lower Volga region.

I. INTRODUCTION Paleoanthropological materials belonging to the Sarmatian culture are a unique source of information that allows anthropologists and historians to study the way of life of the early of the Lower Volga region. In virtue of the study of the Sarmatian bone remains, ancient authors` data on the physical appearance of the population who had burial mounds in the South Russian has been confirmed. The anthropologists have proved the widespread existence of the Sarmatian tradition to deliberate artificial skull deformation using scalping techniques; such tradition at a late stage of the Sarmatians’ history was described by and Ammianus Marcellinus. Paleoanthropological analysis of the nomadic remainings dating back to the early Iron Age also confirmed that the Sarmatians practiced military field . Currently the main focus of archaeological and anthropological research is concentrated on the discovered skulls with traces of trepanation; those skulls belong to the Sarmatian nomads originating from the territory of the Lower Volga region. 3 internal capsules with perforations dating from the first centuries AD were discovered over the past 25 years. Trepanation of the head is one of the oldest operations performed on the human skull [Brothwell, 1972; Mednikova, 1997]; along with the deliberated and unintentional artificial deformation of the skull, limb amputation and scalping it was known in many ancient peoples of all the continents across the globe [Lisin, 2004; Fialkov, 2010]. The very first mentions of trepanation were found in the works of ancient Greek healers Hippocrates and . Hippocrates, who lived between 460-370 BC, gives evidence for trepanation in the chapter 9 of his treatise ‘On the wounds of the head’. The ancient doctor described in details the causes and methods of conducting therapeutic operations on the head; he also gave some recommendations on monitoring the patient after the [Hippocrates, 1994]. Greco-Roman physician Galen lived six centuries later, in 129-200 AD. In his scientific work on head injuries he also cites the methods of trepanation and suggests the reasons for this surgery. In addition, the doctor gave a description of various instruments for trepanation: chisel, crown trephine, drill trephine, etc. [Mission, 2007, p. 5- 7].

1812 JOURNAL OF CRITICAL REVIEWS

ISSN- 2394-5125 VOL 7, ISSUE 12, 2020

Trepanation of the skull was carried out for various purposes in the ancient peoples. M.B. Mednikova [1997] indicates cause-effect fact that underlies the most classifications of trephine holes and the reasons for such manipulations. As a matter of fact, there are two main ways at the present time to classify such trepanations: 1. Technique or method of performing surgeries on the skull [Wilson, Cantab, 1923; Lisovski, 1967; Brothwell, 1972, Verano, 2003, Erdal, 2011]. 2. Classification of trepanation by purpose (Nemeskeri, Kinga-Kralovansky, Brothwell, 1972; Boev, 1992; Aufderheide, Rodriguez-Martin 1998, Mednikova, 2001, 2004; Rubini 2008]. Russian scientific studies of trepanation cases of the skull as a historical source of data reveal the level of knowledge in such fields of science as traumatology and anatomy of the human body, the level of development of religious ideas and customs - and generally, as a historical phenomenon. The studies began with the work of Dmitry Anuchin who attempted to interpret the findings made by Filipp Nefedov during excavations of the ancient settlement near the Vetluga River in 1883, namely pendants or amulets made from the human skull (1895). Anuchin analyzed this subject in detail referring to similar findings and descriptions of trepanized skulls from Western Europe and South America. In the same work Anuchin also considered a case of incomplete trepanation, performed on the skull from the Princes Hill (hillfort in the Novgorod region), suggesting that in this case the surgery was carried out using a similar to a chisel [Anuchin, 1895]. The earliest cases of trepanation in the Lower Volga area were localized in the north of Saratov region. So, A.L. Nechitailo described the case of trepanation on the skull which was found by Igor Dremov in 1985 in an Eneolithic burial on the Volga River near the town of Engels. The internal capsule of the brain belonged to a male; the surgery was performed in vivo by scraping with a flint [Nechitailo, 2004, p. 61-62]. Another ancient manipulation of a therapeutic nature carried out on the cranium and dating to the Khvalynsk culture was studied by A.A. Khokhlov. On the skull from the burial 21 of Khvalynsk II burial grounds the anthropologist revealed superficial trepanation at the wound site which testifies to the good medical skills of the ancient healers [Khokhlov, 2012, p. 121-122]. The presented paper is an attempt to determine the causes and possible origins of the trepanation tradition using the materials of Sarmatian culture from the Lower Volga region.

II. RESEARCH METHODS AND MATERIALS 4 cases of trepanation in Sarmatians discovered in the findings from the territory of the Lower Volga region are considered in the paper. Case 1. The skull from the Don region (the modern territory of the Volgograd region, the Kalmyk republic and the Rostov region) presumably comes from the burial grounds of the flood zone of the future Tsimlyansk ; the skull was dug by the Volga-Don archaeological mission under the guidance of Mikhail Artamonov in 1949-1951 (2009, p.18). The radiography of the skull was published by D.G. Rokhlin in 1965; the bone remains is originating from the burial dating back to the early Sarmatian time of the 3rd-1st centuries BC. Case 2. L.V. Gurenko conducted archaeological mission in the Kumylzhensky District of the Volgograd region near the Glazunovskaya village in 1996; the mound of the Late Sarmatian burial of the 3rd-4th centuries has been excavated. A skull with traces of trepanation and a lower jaw with holes were discovered in the burial (Gurenko, 1997). The source of the case was an ‘Act of Forensic Medical Examination No. 8’ of 5-10 February of 1998, prepared by forensic medical expert V.V. Sidorov. The medical expert conducted a macroscopic examination of a 30-year-old man's cranial capsule. Case 3. Protective excavations of mounds near the village of Peregruznoye of the Oktyabrsky District of Volgograd Region have been conducted in 2010. Bone remains of a 25-30 year-old woman with skull defects identifiable as trepanations were recovered during the archeological works in the burial mound 3 and mound 45. The burial was attributed to the Middle Sarmatian culture dating back to the 1st century AD. The cranium of the woman was examined macroscopically. Radiographic study of the skull was carried out in 2 projections: left lateral and straightforward from the distance to the object of 1 m. The radiation power used was at 70kW, 40 mА with the holding time of 0.16 sec. The X-ray device Medics-P-AMIKO was used to conduct radio graphical study. Case 4. During archaeological works in 2017 on the territory of the Verbovsky I burial ground, a burial mound No. 26 with one tomb dating back to the early 2nd century AD has been discovered. The tomb contained a skull of a 35-45-year-old woman with three trepanation holes; this skull was thoroughly examined. For differential diagnosis the method of computed tomography was applied; the study was carried out on a 128- slice Computed Tomography Scanner SOMATOM Definition (Siemens) with two X-ray tubes, collimation slide 5 mm, 2 mm and 0.6 mm width and a 0.4 mm increment in the reconstruction of raw data. Multiplanar reformations (MPR's) in the sagittal and frontal projections and three-dimensional reformation using the three-dimensional visualization method were performed. The recommendations set forth in the works of M.B. Mednikova [1997, 2001] were utilized when describing the deformation performed on the skull from the Verbovsky I burial ground. Also, the methods of forensic medical

1813 JOURNAL OF CRITICAL REVIEWS

ISSN- 2394-5125 VOL 7, ISSUE 12, 2020 examination and traumatology of mechanical injuries were used on skeleton bones when determining post-mortem or in vivo nature of the revealed cranium deformations (Smolyaninov 1959, Pigolkin 2002 et al.).

Figure 1. Map-scheme of the Volgograd region and the location of trepanned skulls: 1. The location of the burial grounds of the flood zone of the future Tsimlyansk reservoir; 2. Burial mound Glazunovsky; 3. Burial ground Peregruznoe I; Burial ground Verbovsky I.

Figure 2. X-ray of the skull of Sarmatian III-I cc. BC with a successful trepanation in the region of the cranial vault (Rokhlin, 1965, p. 174).

1814 JOURNAL OF CRITICAL REVIEWS

ISSN- 2394-5125 VOL 7, ISSUE 12, 2020

Figure 3. Trepanation hole on the skull of the Sarmatian middle III - beginning of the IV centuries. AD from the burial mound Glazunovsky.

Figure 4. Trepanation of the skull of a Sarmatian woman from burial 3 of burial mound 45 of burial ground Peregruznoe I, I c. AD

Figure 5. Trepanation of the skull of a woman from the burial I-first half of the II AD burial ground Verbovsky I.

Case Description As it was mentioned above, there are relatively few cases of discovery of calciuses wearing signs of cranial trepanations dating from the Sarmatian time and originating from the territory of the Lower Volga region.

III. THE SKULL FROM THE DON REGION This is the earliest case of trepanation in the Sarmatians of the 3rd-1st centuries BC. Noteworthy is that in the parietal bone there was a circular opening with smooth contours due to the presence of closed plates covering the spongy substance and connecting with the outer and inner plates of the parietal bone. The scientific cooperation exchange confirmed the absence of any traces of complications. The surgery most likely had a therapeutic nature. [Rokhlin, 1965, p. 174, 195].

IV. THE SKULL FROM THE GLAZUNOVSKY MOUND The study of the skull and its lower jaw was carried out by the forensic medical expert V.V. Sidorovy who determined that in the posterior part of the parietal bone (32 mm on the right from the -shaped seam and 23 mm from the right branch of the lambdoid suture) there was an oval-shaped trepanation hole with a tissue defect of 7x6 mm in size. The edges of the damage were rounded out from the outside; the walls were chamfered in the

1815 JOURNAL OF CRITICAL REVIEWS

ISSN- 2394-5125 VOL 7, ISSUE 12, 2020

direction from the rear to front, from right to left and downward. At six, four and eight o'clock positions, discoloration of the inner bone plate was detected with the formation of two notches and one protruding defect of the coal scallop. During the study of the mandible at the base of both vertical branches V.V. Sidorov also discovered artificial holes. The analysis of manipulations on the skull allowed the expert to come to the conclusion that the lesions in the area of both vertical branches of the lower jaw were made in-vivo by drilling directed from the inside outwards and backwards, which could be performed as a ritual action. Trepanation in the posterior part of the parietal bone to the right was accomplished by the twisting action of a cylindrical-conical tool with three projecting ribs on the lateral surfaces - possibly a pike of the arrow with a metal tip [Sidorov, 1996].

V. SKULL FROM THE PEREGRUZNOYE I BURIAL A circular defect of 5x5 mm without perforation in the cranial cavity was found when examining the cerebral capsule on the right parietal bone of the skull (Fig. 4). An 8 mm through hole was observed at 6 mm from the first lesion and 22 mm from the craniological point Bregma touching the sagittal suture. The defect was round in shape; there were no traces of inflammatory process in the area of performed trepanation. The entrance edges of the hole were evenly sharp, but without traces of bone fracture. The edges of the exit hole on the inner surface of the skull were also even and had no traces of damage; cracks have not been observed. The entrance and exit holes in the cranial cavity were of the same size, without traces of expansion. The walls of the hole were also even; the structure of the bone plate was clearly seen through the cut. Judging by the nature of the hole and the absence of chips, incisions and fractures, this surgery was most likely performed using a drill with a semicircular tip as a tool by rotation.

VI. SKULL FROM VERBOVSKY I BURIAL GROUND Along the lambdoid suture on the border of the scales of the occipital bone and the left parietal bone three trepanation holes with clear and even contours in the left parietal bone were located in the projection of the sagittal suture (Fig. 10a, b). The inner walls of the holes were 0.6 mm thick and slightly serrated. The first full hole (Fig. 7a) was located on the left parietal bone 20 mm from the arrow-shaped suture and 26 mm from the anthropological landmark point Lambda. The second hole was located in the swept seam with a slight displacement of 10 mm to the left side from the point Lambda. The third perforation was located on the left side of the occipital seam with a slight shift to the bottom. The results of macroscopic description of the findings and their examination with the computed tomography scan, as as the archaeological context itself, allows drawing the following conclusions: the method of trepanation was drilling; the absence of traces of healing indicates premortal or posthumous nature of trepanation; the presence of a rich burial inventory in the tomb from which the cranium was extracted, the multiplicity of holes and their localization may indicate the symbolic-ritual significance of the performed manipulation [Mamontov et. al., 2018, p. 88].

VII. DISCUSSION The holes in the skull performed by drilling (most likely posthumously or immediately before death) with symbolic or ritual significance have been discovered in three out of four above-described Sarmatian trepanation cases: Verbovsky, Peregruznoye I and Glazunovsky burial grounds. The case described by D.G. Rokhlin, originating from the excavations of M.I. Artamonov (the earliest one, since the skull belongs to a representative of the Early Sarmatian culture) was the only trepanation most likely performed by technique of scraping. Judging by the fact that the researcher observed no traces of the inflammatory process in the surgical spots, and there were also some signs of successful healing after such manipulation, it can be assumed that the operation was of a therapeutic-surgical nature. The earliest trepanation cases of the scraping type in the Volga region were described by I.I. Gokhman (1989, p.7) in the scientific materials of the Age. The cases of trepanation recorded by S.I. Rudenko on skulls from the Pazyryk and Shibinsk burial mounds of the Scythian time in Central (1960, pp. 300-331), and by E. Murphy on the woman from the burial of the Scythian time in the Aymyrlig cemetery complex in Southern (VIII 21. Sk.3) (2003) are territorially and chronologically closer to the cases described in presented paper. T.A. Chikisheva, A.V. Zubova et al. also investigated cases of trepanations on the anthropological materials of the early nomads from the burial grounds of Gorny Altai of 4th-3rd centuries BC. According to the scientists, such operations on the heads were performed for surgical purposes, and the method for carrying out the trepanation was scraping (2014, p. 130-141). D.A. Kirichenko studied trepanations performed by scraping on the skulls from the territory of Azerbaijan (Sheki region and Mingechaur) dating back to the Sarmatian-Alan time. In both cases the author concluded that the

1816 JOURNAL OF CRITICAL REVIEWS

ISSN- 2394-5125 VOL 7, ISSUE 12, 2020 operation was of ritualistic nature. As Kirichenko believed, the individuals did not survive the surgeries; or the manipulations were performed posthumously [Kirichenko, 2007]. Thus, the findings of trepanized skulls from adjacent territories suggest that the emergence of skills for therapeutic trepanation in the Sarmatians of the Volga region could be a consequence of the transfer of eastern traditions. At the same time, one cannot deny that the manipulations might have been performed under the influence of ancient medicine achievements. However, in this case, the first option appears more credible, since it corresponds to the archaeological context of the origin of the Sarmatian antiquities in the territory of Southern Russia. All the materials on the procedure of trepanation obtained from the research of the Verbovsky, Peregruznoye I and Glazunovsky burial grounds can be combined since the technique of the manipulations performed was drilling. Drilling is one of the most common ways of carrying out trepanation in different peoples across the globe [Drennan, 1937; Wilkinson, 1975; Gokhman, 1989; Rawlings, Rossitch, 1994; Brothwell, 1994; Campillo, Safont et al., 1999; Crubezya et al., 2001; Sankhyan, Weber, 2001; Nystrom, 2006; Buzhilova, Dobrovolskaya, Mednikova, 2006; Acikkol et al., 2009; Likovsky, Malykova, et al., 2010; Erdal, Erdal, 2011; Pitsios, Zafiri, 2012; Kurin, 2013; Chorney, Gandhi et al., 2014; Beisenov, Kitov, 2014; Tiago, Silva et al., 2015-2016]. Geographically and chronologically the closest materials are the findings of drilling trepanation on the skulls discovered in Kazakhstan, and Transcaucasia. Thus, P. Boev and O. Ismagulov described a trephined skull from the Karabulay burial mound near the Kounrad district of the Karaganda Region of the Kazakh SSR. The skull box belonged to a man of 35-40 years; the burial was attributed to the 5-3 centuries BC. The scientists found 6 holes located obliquely from the upper medial to the lower medial side of the skull, on the back of the left temporal bone and on the upper left side of the occipital. The diameter of the holes ranged from 7 to 7.5 mm [Boev, Ismagulov, 1962, p.131-132]. The possible reason for trepanation of the skull was a therapeutic operation probably caused by man’s endocrine disorder; meanwhile the researchers admitted the possibility of patient's death during the surgery or even post-mortem trepanation [Boev, Ismagulov, 1962, p.131-132]. M.B. Mednikova finds the last option more likely to be the reason [Mednikova, 1997, p. 139]. The research team of A.Z. Beisenov, A.O. Ismagulov, E.P. Kitov and A.O. Kitova studying the population of Central Kazakhstan described cases of trepanation in 11 sculls (referring to the Tasmolin culture of 8th-5th centuries BC). 10 out them had through round holes made by drilling perforations. The operations were performed on nine male and one child's skull. In all cases the defects were localized on the occipital bone or back of the parietal bones. The number of perforations on the skulls varied from 1 to 15. In addition to trepanation on some skulls, traces of scalping as well as special crosswise incisions were observed in the surgical spots [Beisenov et al., 2015, p. 112-126]. According to researchers the cause of posthumous trepanation most likely was the need of preserving the body for longer period of time before the burial ceremony (Beisenov et al., 2015, 133). This conclusion was made by Beisenov et al. on the basis of analysis of ethnographic data of the peoples of Kazakhstan and the spread of the mummification rite among the ancient peoples who inhabited this territory. B. Naran and D. Tumen submitted a description of the skull 47-4 (AT-129) from the Chandman (Ulang) burial ground of the 7th-3rd centuries BC on the territory of Mongolia. Remarkable are the 7 trepanation holes on the cerebral capsule; several of them were drilled. Traces of healing were not revealed, therefore, the researchers came to the conclusion that the patient died during the trepanation or the manipulation was performed after his death [Naran, Tumen, 1997, p. 126-127]. Naran and Tumen did not indicate the cause of trepanation; the scientists only suggested that all holes were made in stages, perhaps before death or posthumously [Naran, Tumen, 1997, p. 127]. Anahit Khudaverdyan reported the trepanation performed by drilling on the skull of a young woman from the tomb of the 1st burial ground of Karmir (9th-8th centuries BC) on the territory of Armenia. A through hole measuring 14 × 12.5 mm was revealed in the sagittal seam. The edges of the lesion testify to the premarital or postmortem character of trepanation [Khudaverdyan, 2015, p. 122]. An overview of the trepanation findings carried out by a drill from adjacent territories indicates the eastern roots of this custom. The cult traditions of manipulating the human skull, along with the presence of eastern innovations in the material culture of the Sarmatians of this time probably originated in the vast territory from Central to Middle . Considering the reasons for the skull holes appearance in the Middle Sarmatian women, whose remains were found in the Peregruznoye I and Verbovsky burial grounds, as well as in the late Sarmatian man from the Glazunovsky burial ground, one should start from interpretations and explanations of the cases of trepanation that were revealed on the anthropological materials of the early Iron Age. So, referring to the work of Hungarian scientists D.A. Kirichenko reviewed the findings of trepanized skulls of the Sarmatian time on the territory of modern Hungary. Studying the Hungarian materials Kirichenko described three surgical operations that were performed in vivo and had a favorable outcome. There was also another case of a postmortem operation on the skull found in the burial No. 52 of the Csengele cemetery, which was of a ritual symbolic nature. The operations on all skulls from Hungary were performed by scraping and cutting (Kirichenko, 2016, p. 114].

1817 JOURNAL OF CRITICAL REVIEWS

ISSN- 2394-5125 VOL 7, ISSUE 12, 2020

S.I. Rudenko found mummified corpses with trephined skulls in the Pazyryk Barrow II dating back to the Scythian era (5th century BC). Similar findings were made by Rudenko in the Shibinsk mound of the 2nd-1st centuries BC [Rudenko, 1953, p. 342-360]. Rudenko explained the causes of skull trepanations from this burial mound by the funeral rite traditions of Pazyryk culture [Rudenko, 1949, p. 97-109]. Later Rudenko expressed another idea on the causes of skull trepanations from the Pazyryk barrows. He linked these manipulations to the extraction of the brain, which was necessary for the mummification of the corpse [Rudenko, 1953, p. 104-145]. S.V. Kiselev described the features of the archaeological antiquities of the Tashtyk culture on the Yenisei River and recorded the cases of post-mortem occipital area trepanations of the skull. Some scientists (incl. I.S. Rudenko) suggested that the manipulations were carried out to extract the brain and prepare the corpses for mummification. Kiselev, however, argued that trepanation and mummification in the times of Tashtyk burials (2nd century BC – 5th century AD) were a fairly common custom in the peoples of the East (Kiselev, 1951, p. 403]. L.V. Kyzlasov explained trepanation on the skulls of the Tashtyk culture by the fact that the corpse before the burial apparently was turned into a skeleton ‘for what there was a posthumous trepanation of the skull ...’ [Kyzlasov, 1960]. This point of view was reasonably criticized by A.N. Lipsky, who studied in detail the ethnography of funeral rites of the northwestern Mongols, Altaians, Khakas, Tungus, Nanai and other Siberian nationalities. Traces of this kind of customs in the above-mentioned peoples were not found. The researcher suggested that trepanation should be associated with a religious or therapeutic purpose, which was intended to ‘release’ or ‘expel’ the causing pain spirit that has settled in a head [Lipsky, 1966, p. 107]. Cases of posthumous trepanation found among the materials of Tashtyk culture were also studied by I.I. Gokhman. According to the researcher the amount of trephined skulls in some repositories reached 80-90%. All the trepanations were localized to the occipital part; the types of this manipulation varied in each cemetery, which indicates the spread of specific traditions [Gokhman, 1989]. M.B. Mednikova investigated artifacts of the Late Tengar period discovered in the burials of Samokhval, Tagarskiy Island and Kyzyl-Kul'. Using numerous anthropological materials Mednikova described post-mortem trepanations differing greatly and in various methods of performance. The reason for the implementation of these manipulations with the skull box by representatives of the Tagar culture the scientist attributed to the ritual actions [Mednikova, 1997, p. 138; 2000, p. 211]. A.D. Grach revealed cases of trepanation in the anthropological materials of the Saglyn culture from the burial grounds of Sagly-Bazhi II and Mazhalyk-Khovuzu I and II on the territory of the Republic of Tuva. Skull trepanation holes were made in frontal, occipital, parietal bones; Grach suggested that perforations were made to extract the brain. The author indicated that such manipulations were usually common for the corpse embalming, which was widespread in various areas of the ancient world: Assyria, Media, and also among the Persians and Egyptians. In addition, the researcher pointed out that the embalming of corpses of deceased noblemen was the custom among the various tribes of the ‘Scythian’ world [Grach, 1980]. The special attention should be paid to the works of E. Murphy, who explored the anthropological materials of the Aymyrlig cemetery located in the Ulus-Khem area of the Tuva Republic. The academician studied the skull of a woman with a hole in the left part of the frontal bone which was performed for therapeutic purposes; and perforation on the skull of a teenager performed posthumously as part of a ritual or for another (possibly trophic) purpose [Murphy, 2003]. The similar case with perforations on the lower jaw found in a skull from the Glazunovsky burial ground was described by E.P. Kitov, who studied skulls from the Berel Burial Mounds dating back to the Pazyryk culture of the 4th-3rd centuries BC. The researcher found through holes drilled posthumously on both branches of the lower jaw of a 45-55 year-old man from the mound 16 (p. 238). Kitov suggested that perforations on the lower jaw were probably made to fix the jaw in its natural state after the removal of the muscles; the arrangement of the holes indicates its fixation to the cheekbone arch (p. 240). Thus, most of the researchers (I.S. Rudenko, A.D. Grach, S.V. Kiselev, L.V. Kyzlasov, E.P. Kitov et al.) referring to the wide dissemination among the peoples of of the ritual of mummification of corpses and the presence of traces of trepanation on their skulls (as well as to the other ethnographic similarities of the Kazakh people) put forward the hypothesis that trepanation was a preliminary or preparatory procedure for the mummification of the corpse or its embalming. That way the ancient operators were releasing the skull of the deceased person from biomass, which undergoes rapid decomposition, making the cerebral capsule hollow or filling it with a preservative for better integrity of external soft tissues. This point of view certainly had a right to exist, especially with respect to the of Central and Middle Asia. In cases with anthropological materials from the territory of the Lower Volga region, such an explanation of skull trepanation is unlikely since the tradition of mummification and embalming with respect to peoples from this territory is not confirmed by written sources and archaeological studies. At the same time, an overview of the findings of posthumous trepanations, as well as an interpretation of their purpose, makes it possible to suggest that trepanation on Sarmatian skulls from the burial grounds of Verbovsky I, Peregruznoye I and Glazunovsky was of ritual character. The appearance of postmortem drill trepanation in the

1818 JOURNAL OF CRITICAL REVIEWS

ISSN- 2394-5125 VOL 7, ISSUE 12, 2020

Sarmatians of the middle and late stages was most likely the proof of common cultural and religious development of the Sarmatian world and cultures of Central and Middle Asia of the first centuries AD, which in general terms has been confirmed by archaeological material. A.S. Skripkin back in 1992 proposed a hypothesis of the significant influence of the cultural traditions of the population of Central and Middle Asia on the Sarmatian world of the Volga-Don region; such hypothesis can be satisfactorily explained by a series of migrations from these eastern regions in the last centuries BC and the first centuries AD. An important nomadic unification (which was led by the Huns who practiced aggressive policies towards the neighbors) resulted in significant cultural transformations on the territories of Southern Siberia, Kazakhstan and Central Asia. Old Scythian traditions were replaced by new stereotypes, subsequently strengthening the new innovative processes on the territory of the Lower Volga region in the 1st century AD. Since that time the Chinese and Bactrian type of have spread in the Sarmatian burials; the same goes for small cast bronze cauldrons with plums and handles in the form of animal figures, matched in many details with nearby cult dishes; bracelets with conical thickenings at the ends, having a wide range of analogies in Central Asian antiquities; and some types of weapons (ceremonial daggers in a sheath with lobes for fastening, bows with bony pads, and swords with a ring-shaped top) [Skripkin, 1992, p. 19-20]. Also, since the very same time the Tamga(s) (normally the emblem of a particular tribe, clan or family) identical to Central Asian and Mongolian antiquities became widely spread in the Volga region, the Don and the Northern Black Sea coast. All these changes in cultural traditions are currently associated with the appearance of the in the Lower Volga and Greater Black Sea area. According to A.S. Skripkin, the foundation of the Alan ethnos was formed in Central Asia on the basis of the nomadic peoples of the eastern and others [Skripkin, 1992, p. 39-40]. A similar theory was developed by S.A. Yatsenko, who pointed out that the formation of social and cultural stereotypes among the population of the Lower Volga, the Lower Don and the Northern Black Sea regions was influenced by the genetic connections of the ancestors of the Alans with the South-Kazakhstan Nomadic empire with the heyday in the Kangyu (Kangha) era [Yatsenko, 2006, p. 123-125]. In this regard noteworthy is the trepanation case from the Glazunovsky burial ground; the ground itself was performed in the so-called T-shaped catacomb. As per V.Yu. Malashev (2009) and M.V. Krivosheev (2017), the use of this kind of grave constructions might have been associated with the traditions that are typical for the Alan and Early Alan culture of the Central Caucasus [Malashev, 2009, p. 49; Krivosheev, 2017, p. 23]. The answer to the question of origins and parallels of the phenomenon of trepanation in the Sarmatians of the middle and late stages appears obvious. Apparently, along with funeral traditions and innovations in material culture which were observed in archaeological complexes of the 1stt-2nd centuries AD and 2nd-4th centuries AD, migrants from the east brought customs associated with manipulations on the head, for example, trepanation and deliberated artificial skull deformations occurred in 70% of cases in the late Sarmatians. Considering several circumstances related to the archaeological context of the burial grounds of Verbovsky and Peregruznoye in reference to what kind of information they can provide to comprehend the reason for the appearance of holes in the skulls: 1. Burial 1 from the mound 26 of the burial ground Verbovsky I has a high degree of similarity with burial 3 from the mound 45 of the burial ground Peregruznoye I. First, speaking of chronological perspective: both graves were attributed to the 1st-2nd centuries AD, and a set of funeral inventory objects was similar in many respects. Secondly, both burials also contained fragments of large ceramic vessels made on a potter's , fragments of stucco, various small syringes, censers and balsamarium, bronze mirrors, iron implements (prickers, needles), bone spoons, a large and diverse set of beads and amulets, and literally identical sets of gold plaques [ burial ground Peregruznoye ..., 2014, p. 66-67]. Thirdly, it is the same construction of the grave with rectangular pit. 2. According to the scientists examined the excavations of Verbovsky I and the Peregruznoye I, the women buried there probably belonged to the wealthy strata of the Sarmatian population, since the accompanying inventory of these graves was quite expressive. In this regard, those censers, bone spoons, amulets and a set of individual objects (shells, pendants from fragments of ceramics, chalk and bronze) that could well be amulets also - all the artifacts found in the burials allows assuming the possible fulfillment by the woman of priestly duties [Yatsenko, 2007, p. 4]. Thus, it will be appropriate to recall the assumption made by I.S. Rudenko that the trepanation of the skull in the Pazyryk barrows was practiced exclusively with regard to influential persons, since no trepanations were found on skulls from the mediocre burials [Rudenko, 1949, p. 97-109]. A.Z. Beisenov and E.P. Whales also indicated high social status of individuals with postmortem drilling trepanation of the skull, calling the burials of these people the elite of the Tasmolinsk culture. This conclusion was drawn on the basis of the large size and complexity of the constructions of the sepulchral structures, as well as the presence of the prestigious inventory of the Early Saka period [Beisenov, Kitov, 2014, p. 31].

1819 JOURNAL OF CRITICAL REVIEWS

ISSN- 2394-5125 VOL 7, ISSUE 12, 2020

3. A ritual to render harmless or as it is also called a ritual looting of the grave was conducted in both burial places. The rituals were characterized by a partial (burial of Peregruznoye) or complete (burial of Verbovsky) destruction of the posthumous bodily integrity. The latter circumstance deserves a special attention. Rites of ritual robbery and neutralization of the deceased were quite widespread in ancient peoples of . An extensive scientific literature is devoted to the problem of interpretation of such ritual practices, among which the works of S.A. Tokarev [1990], Yu.A. Smirnov [1997], V.S. Flerov [2000], O.V. Zaitseva [2005] should be recalled. Descriptions of the ritual to render harmless and ritual plundering in Scythian-Sarmatian burials and their interpretations are available in the works of S.A. Abramova [1968], V.S. Flerova [2000], M.A. Grigoryeva, S.G. Leonova [2015], N.A. Gavrelyuk, N.P. Timchenko [2016], S.A. Yatsenko [2016], E.V. Vdovichenkova, S.M. Il'shenko [2016] and A.V. Antipenko [2016]. With respect to the fact that in relation to individuals from the burial grounds of Peregruznoye I and Verbovsky I the above-described manipulations were carried out as a rite of rendering the deceased (in a form of plundering the burial and violating the integrity of the skeleton) it can be assumed, that trepanation on the skulls of women discovered in the burials of the middle Sarmatian time could also have been performed within the framework of these ritual actions. The symbolic meaning of trepanation of the skull in this case becomes a part of the funeral rite or special ritual aimed at providing protection from a deceased who could harm relatives or community.

VIII. CONCLUSIONS 1. The origins of the trepanation tradition of the Lower Volga Sarmatians could be traced to the ancient peoples who lived in Central and Middle Asia in 8th-1st centuries BC. Most likely, ethnological and political processes that took place in this territory led to the emergence of new cultural traditions (including posthumous trepanation) among the populations of the South Russian steppes in the first centuries AD. 2. The Sarmatian remains originating from the Lower Volga region often carry traces of trepanation made by drilling techniques, performed with a tool less than 6-8 mm in diameter; analogies are found in the relics of Western, Central and Eastern Kazakhstan of 5th-3rd centuries BC according to drilling type of trepanation performed. 3. There is no doubt about ritual and symbolic significance of the manipulations performed on Sarmatian skulls discovered in the burial grounds of Verbovsky, Peregruznoye and Glazunovsky. At the same time, an open question remains whether within the framework of what ritual or tradition these artificial manipulations with the human skulls were carried out: a preparatory procedure for the mummification of the corpse or its embalming; preparation of the corpse for burial or long-term storage; the deliverance of the corpse, ‘liberation’ or ‘expulsion’ of the enshrouded spirit that caused pain; ritual looting and sabotage with the purpose of ‘locking’ the unwanted dead. 4. The Sarmatians of the Lower Volga region could have performed operations on the skull not only for ritual or symbolic purposes. The nomads of the south of Russia in the early Iron Age era knew how and were able to perform therapeutic trepanation, which, as in the case of posthumous perforations, most likely originates from the territory of Siberia and Kazakhstan. 5. The problem of interpreting of perforations on the lower jaw of the man from the Glazunovsky burial remains unresolved. Traces of healing revealed do not allow correlating this case with the perforations described by E.P. Kitov on the skull of the Pazyryk culture from the Berel burial ground in Eastern Kazakhstan.

IX. ACKNOWLEDGMENTS This work was supported by grant No. 18-18-00137 ‘Contacts and Interrelations of the Population of Ural-Volga and Kazakhstan Steppes in the Period of Late Bronze and Early Iron Ages’ from the National Scientific and Technical Foundation. X. REFERENCES

[1] Abramova, S.A New burials of Sarmatian time from Kabardino-Balkaria // SA, 1968, № 3: 114-130. [2] Antipenko, A.V. Ritualization of the deceased in the Sarmatian-Alans of Crimea [Obryad obezvrezhivaniya umershego u sarmato-alan Krymskih predgoriy] // ‘Ancient necropolises: funeral and memorial rites, funerary architecture and necropolis planigraphy’, November 28-30, 2016, Institute for the History of Material Culture of the Russian Academy of Sciences (St. Petersburg). (Electronic source) http://www.archeo.ru/struktura-1/otdel-arheologii-centralnoi-azii-i-kavkaza/meropriyatiya- otdela/drevnie-nekropoli

1820 JOURNAL OF CRITICAL REVIEWS

ISSN- 2394-5125 VOL 7, ISSUE 12, 2020

[3] Anuchin, D.N. Amulet from human bone and trephination in ancient times in Russia // Materials of X Archaeological Meeting in Vilno. Moscow: 1895, v. 1. № 4:17. [4] Archaeological encyclopedia of the Volgograd region / Volgograd regional сulture сommittee, Eds. A.S. Skripkin et al. Volgograd: VSU Publishers, 2009: 334, [1]. [5] Boev P., Ismagulov O. Trepanned skull from the Kazakh SSR [Trepanirovannyi cherep iz KSSR] // Soviet Encyclopedia, №2, 1962: 131-132. [6] Beisenov A.Z., Kitov E.P. Posthumous craniotomy in elite burials of the Saka era in Central Kazakhstan // Altai State University Bulletin, 2014, №4-2. (84):31-41. [7] Beisenov A.Z, Ismagulova A.O., Kitov E.P., Kitova A.O. Population of Central Kazakhstan in the I millennium BC // Almaty: A.H. Margulan Archaeological Institute publishers, 2015: 188. [8] Buzhilova A.P., Dobrovol'skaya M.V., Mednikova M.К. On problem of reconstruction of social interrelations of population of Barabinskaya (an analysis of traumas and injuries based on anthropological materials from Sopka 2 series) // AEAE, 2006. № 3:148-156. [9] Vdovchenkov E.V., Ilyashenko S.M. Ancient robberies of the Tanais necropolis (to the formulation of the problem) [Drevniye ogrableniya nekropolya Tanaisa] // Ancient necropolises and settlements: post- burial rituals, symbolic burials and grave robbings. Materials of Institute for the History of Material Culture of the Russian Academy of Sciences (St. Petersburg), v. 46. Nevskaya Knizhnaya Tipografiya, 2016:157-168. [10] Gavrilyuk N.A., Timchenko, N.P. Ancient cemeteries and settlements: post-burial rites, symbolic interments, and robberies // Materials of Institute for the History of Material Culture of the Russian Academy of Sciences (St. Petersburg), v. 46. Nevskaya Knizhnaya Tipografiya, 2016:129-133. [11] Herodotus. Ἱστορίαι (The Histories in nine books). Leningrad, 1972:599. [12] Hippocrates. Selected works: Airs, Waters, and Places (de aere, aquis, locis), Moscow, 1994: 275–307. [13] Gokhman I.I. Paleoanthropology and prehistoric medicine. Moscow, MSU Publishers, 1989:5-16. [14] Grach A.D. Ancient nomads in the center of Asia. Moscow: 1980: 256. [15] Grigoryeva M.A., Leonova S.G. ‘Shock and awe’: the rite of neutralization in the burial practice of the Iranian-speaking nomads of the North Caucasus [“Strah i trepet”: obryad obezvrezhevaniya v pogrebal’noi praktike iranoyazychnyh kochevnikov Severnogo Kavkaza] // KANT Journal, №3 (16), 2015:16-21. [16] Gurenko L.V. Proceedings of archeological studies in the Kumylzhensky district of the Volgograd region (Glazunovskaya village) in 1996. [17] Zaitseva O.V. Burials with impaired anatomical integrity of the backbone: research methods and interpretations. Thesis for a Candidate Degree in History, author’s abstract, Tomsk, 2005:278. [18] Kirichenko D.A. Skull trepanation in antiquity // Azərbaycan arxeologiyası vəetnoqrafiyası, 2007, №1: 63-67. [19] Kiselev S.V. Ancient History of Southern Siberia. Moscow, Nauka publishers, 1951: 364. [20] Krivosheev M.V. Eastern Traditions and Innovations in Sarmatian Monuments of Second Half of the 2nd – 4th cc. // VSU Bulletin, Series 4: History, Areas studies, Foreign affairs. 2017, vol. 22. № 4:17- 27. [21] Balabanov M.A., Pererva E.V. et al. Burial mound: interdisciplinary research results: monograph / VSU Publishers 2014:360. [22] Kyzlasov L.R. Tashtyk era in the history Khakass- depression (I BC - V AD). Moscow, MSU Publishers, 1960:198. [23] Lipsky A.N. On the use of ethnography for the interpretation of archaeological materials [K voprosu ob ispol’zovanii etnografii dlya interpretacii arheologicheskih materialov] // Soviet Ethnography, 1966, № 1:105-118. [24] Lisitsyn Yu.P. . BooksMed, 2004:400. [25] Ammianus Marcellinus. Roman History . St. Petersburg: Aleteia, 1994:559. [26] Malashev V.Yu. Late Sarmatian Culture: upper chronological border // Russian archaeology, 2009. -№ 1: 47-51. [27] Mednikova M.B. About the spread of postmortem trepanations in Central Asia // Russian archaeology 1997, №4:130-188. [28] Mednikova M.B. Post-mortem trepanations in Central Asia // Moscow: Scientific World Publishing House, 2001:304. [29] Mednikova M.B. Trepanations in the ancient world and a head cult // Moscow: Aleteia, 2004:203. [30] Naran, B. Traumatic injuries on the skulls of the Chandmansky burial ground // Russian archaeology 1997, №4:122-130. [31] Nechitailo A.L. Eneolithic burials with perforated skulls in the steppes of Eurasia // Proceedings of the First International Lower Volga Archaeological Conference. Abstracts. Volgograd, 2004:61-64.

1821 JOURNAL OF CRITICAL REVIEWS

ISSN- 2394-5125 VOL 7, ISSUE 12, 2020

[32] Pererva E.V. The case of trepanation among the Sarmatians (according to anthropological materials from the Peregruznoe 1 repository) [Sluchai trepanacii u sarmatov po materialam mogil’nika Peregruznoe 1] // VSU Bulletin, XXIII Series, 2012, №2:123-133. [33] Mamontov V.I, Obramenko I.E., Pererva E.V. Trepanation of the Cranium from the middle Sarmatian times on the Volgograd region territory // MSU Bulletin, Series 23: . 2018, № 1:86-100. [34] Pigolkin, Yu.I., Barinov, E.Kh., Bogomolov, D.V., & Bogomolova, I.N. Forensic Medicine. Moscow: GEOTAR-MED, 2002:360. [35] Rokhlin D.G. Diseases of Ancient : human bones of various epochs—normal and pathologically changed. Moscow/Leningrad: Nauka Publishers, 1960:302. [36] Rudenko S.I. Altai culture of the age // KSIIMK Journal of Institute for the History of Material Culture, Issue XXVI, 1949:97-109. [37] Rudenko S.I. The culture of the Gorny Altai population in the Scythian Period // Moscow/Leningrad: 1953:402. [38] Rudenko S.I. The culture of the population of Central Altai in the Scythian time. Moscow/Leningrad: 1960:360. [39] Sidorov V.V. Act of Forensic Medical Research No. 8 // Gurenko L.V. Proceedings of archeological studies in the Kumylzhensky district of the Volgograd region (Glazunovskaya village) in 1996. [40] Skripkin, A.S. Asiatic Sarmatia. The Problems of Chronology, Periodization and Ethno-Political History / PhD Thesis, Moscow, 1992:46. [41] Smolyaninov V.M. Forensic Medicine: textbook for medical school. Moscow: Medgiz, 1959:368. [42] Smirnov Yu.A. Labyrinth: the mythology of premeditated burial [Labirint: mifologiya prednamerennogo pogrebeniya] // Moscow, 1997:8. [43] Tokarev S.A. Early forms of religion. Sat articles. M., Politizdat, 1990:662. [44] Fialkov L. History of medicine // Haifa, JKDesign, 2010:474. [45] Flerov V.S. The Alans of the Central Ciscaucasia of the 5th – 8th centuries: the rite of neutralization of the deceased. / Studies of Klin-Yar expedition [Alany Cebtral’nogo Predkavkazya V–VIII vekov: obryad obezvrezhivaniya pogrebyonnyh]. Moscow: Polymedia, 2000:142. [46] Khokhlov A.A. Ritual skull injuries in members of the Khvalynsk Eneolithic culture of the Volga region [Ritual’nye travmy na cherepah u nositelei hvalynskoi eneoliticheskoi Povolzhya] // Ethnographic review, № 2, 2012: 118-125. [47] Khudaverdyan A.Yu. Trepanation in the Late and Early Iron Age in Armenia // Bulletin of archeology, anthropology and ethnography, 2015 № 2 (29): 115-127. [48] Chikisheva T.A, Zubova A.V, Krivoshapkin A.L, Kurbatov V.P, P.V. Volkov P.V, Titov A.T. Trepanation among the early nomads of Gorny Altai // Archeology, Ethnography and Anthropology of Eurasia, 1 (57) 2014:130-141. [49] Yatsenko S.A. Costume of the Ancient Eurasia (the Iranian-Speaking Peoples). Moscow, 2006:664. [50] Yatsenko S.A. Woman-‘sacrificers’ of the early nomads (on the example of noble Sarmatians of the 1st century BC - 2nd century AD) [O zhenshinah – “zhricah” u rannih kochevnikov (na primere zantnyh sarmatok 1 v. do n.e. – 2 veka n.e] in World Outlook of the Peoples of Southern Siberia and Central Asia in Historical Retrospective, Issue 1, Barnaul, 2007:1-8. [51] Yatsenko S.A. The nature of the ancient robberies of the mounds of two groups of the Sarmatian elite of I-II centuries AD // Ancient necropolises and settlements: post-burial rituals, symbolic burials and grave robbings. Materials of Institute for the History of Material Culture of the Russian Academy of Sciences (St. Petersburg), v. 46. Nevskaya Knizhnaya Tipografiya, 2016:47-156. [52] Acikkol A., Gunay i., Akpolat E., Gulec E. A middle Bronze Age case of trephination from central Anatolia, Turkey // Bull. Int Assoc. Paleodont., 2009. Vol. 3 (2). P. 28-39. [53] Berry A.C. Berry R.J. Epigenetic variation in the human cranium // J. Anat. № 101. 2. 1967. Pp. 361- 379. [54] Boev P. Historical trephinations in Europe // Diachronic trends in historical anthropology. Sbornik Narodniho Muzea v Praze. XLVI, № 3–4. 1992. Р. 140-143. [55] Brothwell D.R. Digging up Bones / D.R. Brothwell. – London: Trustees of British Museum, 1972. – 316 p. [56] Brothwell D.R. Ancient Trephining: Multi-focal evolution or Trans-World Diffusion? // Journal of Paltopathology, 1994. Vol. 6. № 3. P. 129-139. [57] Chorney M.A., Gandhi Ch. D., M.D., Prestigiacomo Ch.J. Berengario’s drill: origin and inspiration // Neurosurg Focus, 2014. Vol. 36 (4). E7. P. 1-7. [58] Crubezy E., Bruzek J., Guilaine J., Cunha E., Rouge D., Jelinek J. The antiquity of cranial surgery in Europe and in the Mediterranean basin // C. R. Acad. Sci. Paris, Sciences de la Terre et des planets / Earth and Planetary Sciences. 2001. Vol. 332. P. 417-423.

1822 JOURNAL OF CRITICAL REVIEWS

ISSN- 2394-5125 VOL 7, ISSUE 12, 2020

[59] Campillo D., Safont S., Malagosa A., Puchalt F.-J. Four trepanned skull from 5th and 16th century in Spain. Surgery or ritual? // Cronos, 2 (2), 1999. P. 261-283. [60] Drennan M.R. Some Evidence for a Trepanation Cult in the Bushman Race // Medical Journal S.A. Tydskrif vir Geneeskude. Maart 27. 1937. P. 3-6. [61] Erdal Y.S., Erdal O.D. A Review of Trepanations in Anatolia with New Cases\\ International Journal of Osteoarchaeology, 2011. Vol. 21. P. 505–534. [62] Kurin D.S. Trepanation in South-Central During the Early Late Intermediate Period (ca. AD 1000– 1250) // American Journal of Physical Anthropology, 2013. Vol. 152. P. 484–494. [63] Likovsky Ja., Malykova Dr., Brzobohata H., Stranska P. Causation and methods of skull trepanation in the past from the point of view of the latest findings from the Czech territory // Anthropologie, 2010. Vol. XLVIII/1. P. 19-32. [64] Lisowski F.P. Prehistoric and Early Historic Trepanation // Diseases in Antiquity. Springfield, Charles C Thomas, 1967. P. 651–872. [65] Murphy E.M. Trepanations and Perforated Crania from Iron Age South Siberia: An Exercise in Differential Diagnosis // Trepanation: History, discovery, theory. Lisse: Swets & Zeitlinger Publishers, 2003. P. 209–221. [66] Missios Symeon M.D. Hippocrates, Galen, and the uses of trepanation in the classical world // Neurosurg. Focus / Volume 23, July, 2007. P. 1-9. [67] Nemeskeri J., Kralovansky A., Harsanyi L. Trephined skulls from the tenth century. // Acta Archaeologica Academiae Scientiarum Hungaricae. 1965, T. XVII. pp. 343-367. [68] Nystrom K.C. Trepanation in the Chachapoya region of Northern Peru // International Journal of Osteoarchaeology, 2007. Vol. 17. Issue 1. P. 39-51. [69] Rawlings Ch. R., Rossitch E. The History of Trephination in Africa with a Discussion of Its Current Status and Continuing Practice //Surg. Neurol. № 41. 1994. P. 507-513. [70] Rubini M. A Case of Cranial Trepanation in a Roman Necropolis (Cassino, Italy, 3rd Century BC) // International Journal of Osteoarchaeology, 2008. Vol. 18. P. 95–99. [71] Pitsios Th., Zafiri V. Cases of Trephination in Ancient Greek Skulls // International Journal of Caring Sciences 2012 September – December, Vol. 5. Issue 3. P. 239-245. [72] Tiago T., Ana Maria S., Collado G.H., Oosterbeek L. Prehistoric trepanation in the Iberian Peninsula: a new case from the province of Badajoz (Extremadura, Spain) // Antropologia Portuguesa Vol. 32/33, 2015/2016. P.47-60. [73] Sankhyan A.R., Weber G.H.J. Evidence of Surgery in Ancient : Trepanation at Burzahom (Kashmir) over 4000 Years Ago // International Journal of Osteoarchaeology, 2001. Vol. 11. P. 375– 380. [74] Verano J.W. Trepanation in Prehistoric Souht America: Geographic and Temporal Trends over 2,000 Years // Trepanation. History, Discovery, Theory; 2003, p. 223–236. [75] The Cambridge Encyclopedia of Human Paleopathology by Arthur C. Aufderheide & Conrado Rodriguez-Martin. United Kingdom, Cambridge University Press, 1998. [76] Wikinson R.G. Trephination by drilling in ancient Mexico // Bull. N.Y. Acad. Med. 1975. Vol. 51. № 7. P. 838-850. [77] Wilson Parry T., Cantab M.D. Trephination of the living human skull in prehistoric times // The British Medical Journal, March 17, 1923, p. 457-461.

1823