Bronze Age 5-year-old's skull found in Uzbekistan is the oldest known evidence of surgery in Central Asia

The 4,000-year-old skull of a Bronze Age child buried in what's now Uzbekistan bears scars from a cranial surgery known as trepanation. It is the oldest documented evidence of surgery in Central Asia and one of the oldest examples of surgery in all of Asia, the researchers report.

The skeleton of the child, who died at about age 5, was unearthed in April. The body had been buried in a single grave alongside the body of a child who died at about 3 years old, researchers said in a translated statement.

The 5-year-old's skull has "clear signs of cranial trepanation" involving stone or bone tools, according to the statement. Trepanation was commonly performed in ancient times, perhaps in attempts to treat maladies like epilepsy, migraines or behavioral problems. But the researchers noted that the "frontier between medicine and ritual" would have been far less defined at that time than it is now.

A research team from Italy and Uzbekistan made the discovery in the Northern Bactria region, near the border with Afghanistan.

Ancient Oxus

The excavations focused on the site of the prehistoric settlement of Djarkutan, and the researchers dated the grave to the late third millennium B.C. At that time, Djarkutan was an urban center of the Oxus civilization, an Early Bronze Age culture that dominated Central Asia from about 2500 to 1500 B.C. The ongoing project to investigate the site and other aspects of the Oxus civilization began in 2024.

Archaeologists sometimes call the Oxus civilization the Bactria-Margiana Archaeological Complex, or BMAC. It was centered along rivers and in oases in the region, and it is renowned for its advanced agricultural economy and rich material culture. The demise of the Oxus civilization is thought to have been triggered by climatic changes that caused important rivers to dry up.

While evidence of ancient trepanations is relatively common in some places, the fact that this surgery was performed on a young child is perplexing, the researchers said.

"Djarkutan continues to surprise us," Enrico Ascalone, an archaeologist at the University of Salento who led the excavation, said in the statement. "A cranial trepanation on a child, four thousand years ago, in Central Asia: until yesterday it was unthinkable. Today it is in our data."

Yet the discovery also leaves mysteries. "Which group of 'specialists' within the town could have practiced such an intervention? What anatomical and surgical knowledge did such an operation presuppose? And why a five-year-old?" the team wrote in the statement. They hope to answer those questions in further investigations in the coming months.