The paper discusses the results of studying three cases of trepanation of skulls obtained from ordinary burials in mounds of the IV-III centuries BC in the territory of Gorny Altai. The reasons for carrying out these operations are established, the degree of their success is characterized, and the execution technologies are reconstructed. Methods of macroscopic examination of skulls using optics, multi-slice computed tomography, X-ray fluorescence and mass-spectral analysis of bone tissue were used. It is established that trepanations were not ritual, but therapeutic in nature. The data obtained suggest that the population of the Altai-Sayan Highlands of the IV-III centuries BC had sufficient medical knowledge to perform complex operations on the skull. Since the surgical instruments were made of tin bronze, which in the IV-III centuries BC in Southern Siberia was smelted only on the territory of the Minusinsk Basin by Saragashen culture carriers, it is likely that at least two successful trepanations in the Altai Mountains could have been performed by healers from the Minusinsk Basin.

Keywords: trepanation, neurosurgery, Pazyryk culture, Saragash culture, early nomads, Scythian time, X-ray fluorescence analysis, mass-spectral analysis, tracological analysis.

Introduction

The early nomads who settled the territory of Gorny Altai in the Scythian era, approximately 2,500 BC (VI-early II century BC), are a rather complex ethno-cultural community. It is represented by the Pazyryk and Kara-Koba cultures and the Chumysh-Ishim group of monuments (Kubarev, 2001; Mogilnikov, 1983a; Surazakov, 1983). Among them, the first one is the most famous. Thanks to the formation of permafrost and ice lenses in the burial chambers of the Pazyryk mounds, objects made of wood, leather, felt, wool and silk fabrics, as well as mummies and skeletons of people and horses were preserved in them. The study of these artifacts allowed us to reconstruct many features of economic activity and everyday life, economic relations with carriers of other cultures and the population that already existed in a number of regions of the states, the social structure of Pazyryk society, the system of its sacred representations and ritual practices. The anthropological composition was studied and information about the mitochondrial gene pool of Pazyryk people was obtained. Synthesis of the results of archaeological, anthropological, and paleogenetic studies of the Pazyryk culture together with ethnographic, linguistic, and genetic data related to the present-day history of the Pazyryk culture.-

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The study of ethnogenesis in the Altai-Sayan region and adjacent regions of Siberia and Central Asia allowed us to carry out the most complex stage of the analysis of the archaeological phenomenon - the reconstruction of ethnogenesis (Molodin, 2000). Other groups of early nomads have not been studied in such detail. Nevertheless, cultural parallels to the elements of the burial complex and anthropological features are analyzed in detail. It should be noted that the carriers of the Pazyryk culture took an active part in their ethnogenesis.

It would seem that the archaeological community could not be studied more fully. Nevertheless, there is an aspect in the culture of the early nomads of Altai that has not yet attracted the proper attention of researchers. We are talking about the level of their medical knowledge and the capabilities of healers, as we can judge on the basis of skeletal pathology. Perhaps the most striking impression is left by the amazing results of lifetime trepanations of skulls: they are performed so skillfully that the operated people lived quite a long time after the operations. This article deals with these cases.

Material and methods

In a large (about 150 skulls) craniological collection of Scythian nomads of Gorny Altai, we found 3 specimens. with intravital trepanations. One of them (men aged 50-60 years) comes from mound 3 of the Bike III burial ground, located in the eponymous tract in the valley of the middle course of the Katun River, on its right bank, 6 km from the village. Elanda and 17 km from the village. V. D. Kubarev, who studied this burial ground, attributed it to the culture of the early nomads of Altai and dated it within the V-IV centuries BC. He noted the ethnocultural specificity of this monument (along with other burial complexes of the Middle Katun) in comparison with the burial mounds of the Pazyryk culture, expressed as in the features of funerary rites, and in the originality of ceramic dishes. The researcher found the influence of the more northern Bolsherechenskaya and western Saka cultural and historical communities (Kubarev, 2001).

Two skulls with trepanations were found in the Kyzyl-Jar mound groups IV (mound 2, inventory number in the anthropological collection of Tomsk State University 2009, a woman aged about 30 years was buried) and V (mound 3, number in the same collection 2012, a man aged 40-45 years was buried), located in the southern part of the region. in a high-mountain valley of the same name tract, 7-8 km from the village of Beltir Kosh-Agachsky district of the Republic of Gorny Altai. Excavated by V. A. Mogilnikov. In the first group, all burials were made in stone boxes, in the second-in stone boxes, a grave with a lining and in a log cabin. The researcher dated the monuments of the IV-III centuries. He noted the relative diversity of the funeral ritual, which, in his opinion, is due to the mixing of various ethnic groups - local Pazyryk and newcomers from the territory of Eastern Kazakhstan (Mogilnikov, 19836).

Judging by the nature of the burials, the number and composition of the accompanying inventory, all three operated individuals were ordinary members of their ethnic and tribal groups. The combination of basic racial and diagnostic features on buried skulls allows us to assign them to the same anthropological type, characterized by the large size of the brain capsule and facial region, mesomorphic proportions estimated by the ratio of transverse and longitudinal diameters, orthognathic vertical and flattened horizontal profile of the face, medium-high angle of protrusion of the nasal bones and high bridge of the nose. We assume that this anthropological type is autochthonous for the early nomads of Gorny Altai. It can be attributed to the southern Eurasian anthropological formation**.

*We do not set out to present a historiographical overview in this article, we only want to emphasize that the worldwide popularity of the Pazyryk culture is due to the work of many researchers. Let us point out several monographic publications that most fully reflect the content and analysis of this archaeological phenomenon: [Rudenko, 1953, 1960; Kubarev, 1987, 1991, 1992; Polosmak, 1994, 2001; Phenomenon..., 2000; Population..., 2003].

**It is a large systematic unit of anthropological classification proposed by one of the authors of the article based on the results of craniological studies of representatives of a wide cultural and chronological spectrum of Southern Siberia and Central Asia [Chikisheva, 2012]. Craniological variants of this formation are distinguished by the Mongoloid-Europoid intermediacy of the racial-diagnostic complex of features, which does not depend on mestizo processes, but goes back to the ancient undifferentiated anthropological layer of the supraclassical level. The area of this morphological complex is connected with the central mountain-steppe regions of Eurasia: it includes the valleys of Gorny Altai, Sayan, Dzungarian Alatau and Tien Shan. According to the currently available paleoanthropological materials, the duration of the "functioning" of this area has been established - from the second half of the IV millennium BC to the turn of the AD.

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This article is of a generalizing nature and is methodologically based on a contextual synthesis of the results obtained by us and published materials of other researchers. By context, we mean the totality of historical factors and circumstances recorded by archaeological data and written sources, in the environment of which the phenomenon of surgical healing existed among the early nomads of Gorny Altai.

Methodically, trepanation cases were investigated in several aspects. A practicing neurosurgeon and radiologist evaluated the adequacy of the operations performed from the standpoint of modern medicine. They used methods of macroscopic examination of skulls using surgical optics and multislice computed tomography (MSRI). A tracer and a specialist in mass spectral analysis developed the problem of instruments used during operations*. Anthropologists have summarized the complex of results obtained, considering the achievements of ancient surgeons as a highly informative historical source on contacts of carriers of archaeological cultures in Eurasia. A similar hypothesis has already been proposed for reconstructing the system of contacts between communities and populations of the New and Old Worlds (Brothwell, 1994). As a result of these studies, we have gained a fairly complete understanding of the features of performing this surgical operation - difficult to perform and associated with risks of complications and death, even in today's high - tech surgery-by early nomads 2500 years ago.

We excluded from consideration the sacred aspect of manipulating a person's head, which includes post-mortem trepanations, which are a "technological" stage of embalming corpses or a ritual for freeing the soul from the body of the deceased, and focused on the healing significance of this procedure. We hope that the information we have received adds new colors to the picture of the cumulative achievements of the original world of nomadic peoples of antiquity.

Results and discussion

Trepanation on the skull of a man from mound 3 of the Bike III burial ground is located on the left parietal bone 15 mm from the coronal suture and 50 mm from the sagittal one (Fig. 1). There are pronounced signs of bone neoplasms, confirmed by MSCT data (Fig.2), which indicates a long life of the individual after surgery. The trepanation opening is semi-oval in shape. Its external dimensions are 45 x 52 mm, and its internal dimensions are 22 x 34 mm.

The skull has a congenital deformity in the form of flattening of the right half of the occipital bone due to uneven closure of the occipital sutures - lambdoid plagiocephaly (lambdoid plagiocephaly), which at this age has no clinical significance and does not require treatment according to modern concepts. There are no signs of cranial trauma, computed tomography does not reveal changes characteristic of meningioma, and the motives for the operation remain unclear. It is quite possible that we are seeing a case of treating a head injury that left no marks on the skull. It is impossible to exclude parasitic brain damage that required the intervention of a surgeon. In modern Siberia, there are often cases of brain damage with cysticercosis and echinococcosis that require surgical treatment. Pastoralists of the Altai region bred cattle, sheep, goats, horses, and pigs in Scythian times, as evidenced by the analysis of fauna from layer 8 of Denisova Cave (Derevyanko and Molodin, 1994, p.14; Vasiliev and Grebnev, 1994), which allows us to assume the possibility of similar infestations.

On a male skull from mound 3 of the Kyzyl-Dzhara V mound group, a round trepanation hole is made in the left parietal bone at a distance of 12 mm from the sagittal suture (Fig. 3). Its external dimensions are 63 x 64 mm, its internal dimensions are 40 x 41 mm. The edge of the defect is beveled due to the removal of part of the outer plate.

The reason for the operation in this case is clearly defined as the treatment of a skull injury, as evidenced by traces of a linear fracture in the left temporal and parietal bones. It was most likely caused by a right-handed opponent hitting the left parietal-temporal region. Visual signs of bone neoplasm are determined both along the edge of the defect and along the fracture line. It is known that the healing of such a fracture stretches for many years [Prakticheskaya neurosurgiya, 2002]. MSCT showed good bone regeneration and healing (Figure 4). The nature of the fracture extending to the sagittal suture, under which the sagittal sinus is located, makes it highly likely to suspect the development of an epidural hematoma due to a traumatic rupture of the sinus margin. The successful trepanation performed by the Pazyryk surgeon was aimed at intracranial contents. The hole is very convenient for evacuation of intracranial hematoma: it has sufficient

* A detailed description of the research methods used by them with a description of the nuances of the methods is being prepared for publication.

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Fig. 1. Skull of a man from mound 3 of Bike III burial ground.

a-frontal projection; b-projection of a 3/4 turn to the right; c-lateral projection; d-vertical projection.

2. Trepanation defect on the skull of a man from Kurgan. 3 burial grounds of Bike III.

a - a photo taken with photographic equipment; b - the result of MSCT examination - a cross-section through a trepanation defect in a horizontal projection.

Fig. 3. Skull of a man from mound 3 of the Kyzyl-Jar V mound group.

a-frontal projection; b-lateral projection (arrow indicates linear fracture); c-occipital projection.

dimensions, centered on the fracture line, all layers of the parietal bone removed.

On the skull of a young woman from Kurgan. 2 of the Kyzyl-Jar IV mound group, a rounded trepanation opening (Fig. 5) with an outer diameter of 39 x 36 mm and an inner diameter of 23 x 16 mm was made in the posterior half of the parietal region. Its center runs strictly along the sagittal suture. The hole has a through character: all layers of bone are removed-compact plates (external and internal) and spongy substance. There are no signs of bone neoplasm, this conclusion was confirmed by MSCT (Fig. 6), which did not detect the reorganization of bone beams. Examination of the skull and MSCT data indicate that the woman

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4. Results of MSCT examination of the skull of a man from mound 3 of the Kyzyl-Jar V mound group.

a-volume model of the skull (arrow indicates a linear fracture); b - section through the trepanation defect in the lateral projection; c-horizontal section through the surface of the trepanation defect.

Fig. 5. The skull of a woman from Kurgan. 2 of the Kyzyl-Jar kurgan group IV.

a-lateral projection; b-frontal projection; c-vertical projection.

she was seriously injured in the form of a fracture of the right temporal bone and the base of the middle cranial fossa. Judging by the nature of the damage, this is the result of a fall from a height. The data obtained indicate that the victim died either during the operation, or shortly after its completion, or the trepanation was performed posthumously. As the tracological analysis of the surgical field showed, the method of its implementation differed from two operations with a safe outcome for patients.

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6. Trepanation defect on the skull of a woman from Kurgan. 2 of the Kyzyl-Jar kurgan group IV.

- a photo taken with photographic equipment; b, c - the result of MSCT examination: b-horizontal section through the surface of the trepanation defect; c - section through the trepanation defect in a vertical projection.

Turning to the discussion of the results obtained, we focus on the success of two of the three operations performed by early nomads. First of all, it is due to the adequate size of the holes and their location in safe places to avoid massive bleeding. Such operations require medical knowledge. Was it possible that their system originated in the culture of the early nomads of Eurasia, or were its individual elements, in particular neurosurgical knowledge, introduced to the world of steppe pastoral societies from the surrounding sovereign-type societies, where conditions were created for the development of science?

There are no objective written sources in which contemporaries would tell about different aspects of the life of the Sako-Siberian tribes. At the same time, the works of ancient authors summarized by Herodotus are widely known, who are well acquainted only with the country of the Black Sea Scythians (Herodotus ' Scythia) and mainly from the words of the Scythians, who received ideas, often very distorted, about their close and distant neighbors (Herodotus, 1999). All the tribes that inhabited the unexplored outskirts of the ecumene to the north and east of Scythia, developed by the Greeks, are mentioned in a context close to mythological. The Scythians themselves were savage peoples for ancient authors. Archaeological discoveries of the XX-XXI centuries revealed to the world the richest sacred content and artistic flavor of the cultures of the early nomads of Eurasia, providing material for reconstructing complex worldviews and mythological representations of ethno-cultural groups.

When considering the facts of healing skills, the utilitarian aspect comes to the fore, associated with the need to apply certain physical actions to the living human body, which implies understanding the principles of its structure and physiology. Complex surgical procedures require special talent and long-term individual training of the doctor by mentors. Accordingly, the technique of performing operations of each individual surgeon should be based on the basic techniques adopted in the "school" where he studied. In order to identify a possible source of medical knowledge among the Pazyryk population, we analyzed the main ancient treatises that systematically described methods of surgical treatment of diseases and injuries in the oldest states of the Old World. These include the Egyptian papyri of Ebers (XVI century BC) [The papyrus Ebers, 1930] and Smith (XVII century BC) [Wilkins, 1964], the Indian Sushruta Samhita (IV century AD) [An English translation of the Sushruta Samhita..., 1907] and "Hippocratic collection "(Latin: "Corpus Hippocraticum") - the first set

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works of ancient Greek physicians, compiled in the third century BC (Hippocrates, 1936)*.

Common to all treatises is that the indications for both non-invasive medical procedures and invasive interventions in the bone tissue of the skull are injuries. There is no information about the treatment of pathologies of a tumor, vascular, infectious or parasitic nature. The only source that discusses in detail the concept of treating head injuries by trepanation is the work of Hippocrates "On head wounds". Other works offer exclusively non-invasive methods of healing that do not involve special surgical manipulations with bone tissue. It should be noted, however, that this information does not fully correspond to the state of paleoanthropological sources. Trepanations are recorded in almost all cultural centers of the Old World. Archaeologists have discovered trepanated skulls in two large series of mummies and skeletons from Egyptian necropolises, dated, however, within very wide limits: Western Thebes (Thebes West) - 1500-500 years BC, Qubbet-el-Hava (Qubbet-el - Hava) - 3000-500 years BC. [Nerlich et al., 2003], but including the interval synchronous to the era of the early nomads of Eurasia - the late period of the history of Ancient Egypt. Of the 1,482 individuals examined, ten had traces of trepanations (oval or rounded) performed by cutting and scraping methods, and nine had intravital ones with a good prognosis of survival after surgery. Representatives of the upper and middle social strata of Egyptian society are buried in both necropolises. Differential diagnoses of these populations include diseases such as malignant metastatic tumors. Benign tumors were found on the operated skulls, but their localization does not coincide with the areas of trepanations, which were performed mainly to remove broken fragments from an open wound. It is difficult to judge why trepanation as a method of treatment is not mentioned in the papyri of Ebers and Smith, perhaps they entered the practice of Egyptian doctors at a later time.

Successful therapeutic trepanations were found in paleoanthropological materials originating from China: six skulls from five sites dating back 2000-5000 years, dating back to the Neolithic, Bronze, and Early Iron ages (HanKangxin and ChhenXingcan, 2007). Operations were mainly performed to treat injuries of various etiologies, involving large areas of the skull. Some wounds have traces of infection and puncturing the site of inflammation for therapeutic purposes. Thus, materials from China indicate the long-term and consistent use of surgical operations in the medical practice of carriers of different cultures in this territory. We do not have scientifically analyzed information in the paradigm of Western medicine from the medical treatises of ancient China, but it is generally recognized that its states had their own powerful tradition of healing, which has not lost its relevance in the modern era.

So far, only one trepanated skull is known in India. It comes from a Burzahom burial site in Kashmir, dated 4300-4000 AD. The skull of a young woman was found to have 11 holes of various diameters drilled consecutively over a very short period of time. Researchers consider this trepanation as an unsuccessful attempt to treat a certain mental illness, the consequences of which the patient did not survive [Sankhyan, Weber, 2001]. Thus, there is no reason to assume that the neurosurgical direction was formed in the medical practice of ancient India. Although the ritual aspect of manipulating the tissues of the head was certainly present here: this trepanation could have been part of a developed medical ritual ceremony, from which only the trepanated skull has survived [Ibid.].

All cultures of the Early Iron Age in Northern and Northwestern Eurasia have known cases of trepanation. For some areas, the existence of this manipulation can be traced up to 12 000 - 10 000 Thus, in the territory of Western Siberia, an Early Neolithic burial site of the Sopka-2 burial ground, which has a date of 8,005 ± 100 years BC (Molodin, 2001), revealed a skull with traces of tre-

* The Hippocratic Collection was compiled many years after the death of Hippocrates (460-377 BC). The question of what works Hippocrates himself left behind is still not completely resolved. According to the traditions of that time, doctors did not sign their writings, and all of them eventually turned out to be anonymous. "Corpus Hippocraticum" was compiled in the famous Alexandrian repository of manuscripts, founded by Ptolemy I-Soter, the first ruler (323-282 BC) of Hellenistic Egypt. As you know, at his behest, manuscripts of scientists were brought to Alexandria from all over the world, systematized in catalogs, studied, translated and copied. Among them were 72 medical works written in Greek, in the Ionian dialect. Thus, Alexandrian scientists have preserved for posterity the works of Greek doctors who lived in the V-III centuries BC. Most researchers believe that Hippocrates owned the most outstanding works of the collection: "Aphorisms", "Prognostics", "Epidemics", "On the air, water, terrain", "On fractures", "On head wounds", " On ancient medicine "(Sorokina, 2009).

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panacea (Polos'mak, Chikisheva, and Baluyeva, 1989; Krivoshapkin and Zelman, 2012).

The most complete picture of the geographical and cultural-chronological distribution of trepanations is presented in the works of M. B. Mednikova [2001, 2003, 2004], who summarized almost the entire body of published sources, which saves us from the need to delve into this aspect of the study of medical and ritual practice and allows us to extract facts to solve the question of the origin of trepanations among the early nomads of the These works show that symbolic, incomplete trepanations were widespread among the carriers of archaeological cultures of the Old World, in which a section of the outer compact bone plate was removed or its integrity was violated in some way in certain groups of people undergoing the initiation rite. Also, the ritual post-mortem performance of complete trepanations with the removal of a bone fragment to extract brain tissue during the preparation of the deceased for burial is widely recorded. This implies a certain familiarity with the mechanical properties of the skull bones, the anatomy of the brain capsule itself and the tissues that fill it, as well as the existence of specially designed tools, which is an important prerequisite for the next step - the transition to invasive intervention in the head tissue for therapeutic purposes. This conclusion is confirmed by the data of paleoanthropology-evidence of ritual and therapeutic trepanations is often found on the same necropolis. In some cases, in the absence of a paleopathological justification for the operation and traces of the reaction of bone tissue surrounding the trepanated area, researchers find it difficult to differentiate between the intravital and postmortem nature of trepanation.

One of the most important rites among the early nomads of the Eurasian steppes is the preservation of the body shell of deceased tribesmen. The methods of mummification were different: embalming (soaking the corpse's tissues with natural substances that prevent their decomposition), freeing the body from internal organs and sometimes muscles, the skull from the brain, filling the released cavities with special compositions of herbs with antiseptic properties. The reasons for carrying out such complex procedures were not only sacred, but also utilitarian. So, the farewell of relatives and friends to the deceased took a long time, since it was necessary to go around many nomads scattered across the steppe. Nomads of Central Asia and Southern Siberia had to preserve the dead for several winter months, during which it was impossible to carry out burial. Dissection of the bodies of the deceased contributed to the formation of anatomical knowledge in their environment, possibly more complete and objective than that of the population of warm climatic zones, who had no problems with burial throughout the year and lived in crowded settlements and proto-cities. This could be another prerequisite for the development of surgical methods in the healing practice of nomads in Central Asia and Siberia.

Thus, based on the identified prerequisites, it is possible to assume the development of surgical methods for treating head diseases (traumatic, of course, not reliably of any other etiology) in the autochthonous environment of the Scythian-Siberian cultural and historical community. We must also remember that the Early Iron Age coincides with the time of the existence of states in Egypt, Greece, the Levant, Near Asia, India, and China, where scientific centers functioned and medical knowledge was accumulated, from where it could be spread through political contacts, military expansion, and economic migrations.

An important role in performing a surgical operation is played by tools. In archaeological research, the tools of any kind of human activity are the basis for identifying cultures. Special tools for performing trepanations on the monuments from which the skulls originate, as well as among the accompanying equipment from all known burials of the Scythian period in the territory of Gorny Altai, were not found. However, bronze knives are found in almost all graves of the Pazyryk culture, regardless of their social status. The knife is an extremely necessary and versatile tool in the daily life of a cattleman. It is also suitable for performing surgical manipulations.

However, the operation could not only be performed with a bronze knife. For this purpose, a tool made of flint or iron is quite suitable. When cutting or scraping tools are inserted into bone tissue, which is a very hard substance, particles of the materials from which they are made should 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 hypothesized that obliteration of the wound surface in patients who survived surgery preserves particles or individual molecules of substances used in the treatment process in their bone tissue and protects them from physical and chemical factors of the soil after burial. Therefore, we applied X-ray fluorescence and mass-spectral analysis of bone tissue.

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skull tissues of successfully operated individuals (Bike III, Kyzyl-Jar IV) in order to determine the material from which surgical instruments were made. The bone tissue under the regenerated layer contained copper and tin particles, while arsenic particles were absent. This indicates that the tools used for trepanning were made of pewter bronze. This fact may point us to the origin of the instruments used to perform trepanations.

S. V. Khavrin in a series of works on spectral analysis of bronze products from Scythian monuments of the Altai-Sayan region revealed the chronological dynamics of changes in the metal formulation and its local-territorial patterns. The researcher showed that in the territory of Gorny Altai in the Early Scythian period (VII-VI centuries BC), bronze with a tin content of more than 10 % (tin bronze) prevailed (Khavrin, 2008). In the V century BC (with the beginning of the development of Pazyryk cultural traditions), it was replaced by

7. "Surgical instruments" from the collection of the Minusinsk Museum.

- a knives; b-lancets; c-saws; d-tweezers; e-probes.

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The metal in which tin was absent or present in a very small amount (1-2%) is arsenic copper (Khavrin, 2007a, 2008; Stepanova and Khavrin, 2005). A similar situation is observed in Tuva, where the vast majority of metal objects on the monuments of the Aldy-Belsky culture (VII-VI centuries BC) are made of tin bronze (the tin content in the alloy reaches 20-25 %), and in the materials of the Uyuk - Saglyn culture that replaced it (VI-V centuries BC) - from arsenic copper (Khavrin, 2002a). In the Minusinsk basin in the Early Scythian period, the metal was mainly arsenic copper, and at the stage of development of the Bijin (VI century BC) and Saragashen (V-III centuries BC) cultures, bronze, in which the tin concentration reaches 14-16 % [Khavrin, 2002b, 2007b].

Comparing two facts: the synchronicity of burials, from which trepanated skulls of the time of existence in the Minusinsk basin of the Saragash culture originate, and the operation performed with a pewter bronze tool, we can assume that this tool was made by Saragashen foundry workers. This possibility is indicated by the bronze tools stored in the Minusinsk Museum named after N. M. Martyanov (Fig. 7). Archaeologists N. V. Leontiev (reference to his oral report is given in the monograph of M. B. Mednikova [2001]) and A. Nagler [2012] identified their purpose as medical. It is difficult to speak about the dating of the tools, since the archaeological context is unknown, since they were bought by the museum staff in the late XIX-early XX century, when mass looting of mounds took place on the Yenisei. However, A. Nagler, taking into account the metal (bronze) from which the objects are made, the quality of casting and the semi-bronze-coated surface of most of them, dated these things to the early Iron age [Ibid.]. N. V. Leontiev, focusing on the shape of the pommel, attributed the tools to the Saragashen stage of Tagar culture, i.e. IV-III centuries BC.*

A. Nagler found analogies to the shapes of the objects under consideration in the collections of instruments from medical kits of Roman doctors stored in German museums. 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 of the Roman doctors themselves actually copy the Greek ones developed by doctors of the Hellenistic era, and possibly even the "school" of Hippocrates. From this parallel, the connection of the Saragashen culture carriers with the medical centers of Greece is outlined, albeit shaky. Surgeons from the Hellenistic world who came to the territory of the Minusinsk basin due to circumstances could practice their skills both here and in neighboring tribes. Gorny Altai and the Minusinsk basin are not isolated from each other, and they are not separated by a large distance.

The main principle of training a doctor in accordance with the recommendations of Hippocrates was practical activity, and as the best school for doctors - accompanying troops in military campaigns. Greek military surgeons could get into Southern Siberia (Asian Scythia). In particular, this possibility is suggested by one of the models of Pazyryk kulyurogeny proposed by L. S. Marsadolov. It is based on the introduction of population groups from the Central Asian region to the territory of Gorny Altai under the influence of events related to the defeat of Assyria by the Medes and Lydians, their struggle with the Scythians and Cimmerians in the VI century BC (Marsadolov, 1999). It is possible that the exodus to the east of the Central Asian groups continued later during the military expansion of Alexander the Great (334-325 BC). Military surgeons who participated in these campaigns could find use for their skills in any village, any society and pass on their knowledge to local healers, especially since nomads cannot be denied access to medical services. awareness of human anatomy. Instruments from surgeons ' kits could be copied by local master casters.

Conclusion

Based on the totality of data obtained during the study of trepanation cases recorded on the skulls of early nomads of Gorny Altai, we can conclude that they practiced such an operation for medical rather than ritual purposes. The level of development of diagnostics and performing surgical manipulations among doctors who performed trepanations was quite high. They had extensive knowledge of cranial anatomy and intracranial venous reservoirs.

The operations were performed using a single technology, but not all of them were successful for the patients. Probably, at all times, the human factor, the factor of choosing a doctor, was crucial. This suggests the existence of different schools of Scythian healers and their individual training. Surgery has always been an art, not a craft. This attitude remains relevant in the 21st century.

* M. B. Mednikova refers to this conclusion, which was transmitted in a personal conversation [2001]. P. V. Volkov also examined this collection of instruments, consulted N. V. Leontiev, and agreed with its dating.

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We cannot be sure that the surgeons who performed the analyzed operations came from the native Pazyryk culture, so we conclude that the early nomads of Southern Siberia as a whole had a high level of medical knowledge development. It is also impossible to exclude the possibility of their origin from the territory of East Kazakhstan, the influence of the population of which can be seen in the material complex of Bike III, Kyzyl-Jar IV and V burial grounds. However, one of the authors of the article reviewed the craniological collections of early nomads from the burial grounds of Ust-Naryn, Pchela, Malaya Krasnoyarka, Kyzyl-Tu, Ust-Bukhtarma in Kazakhstan (funds of the Department of Anthropology of the MAE RAS), and no cases of trepanation were recorded there.

In addition, the result of mass-spectral analysis of bone tissue from the operated areas indicates that the surgical instruments were made of tin bronze, which in the IV-III centuries BC in Southern Siberia was smelted only on the territory of the Minusinsk basin by carriers of the Saragash culture. This fact, as well as the discovery of bronze objects in the materials of this culture, which surprisingly resemble the instruments of doctors, suggest that at least two successful trepanations in the Altai Mountains were performed by healers from the Minusinsk basin.

List of literature

Vasiliev S. K., Grebnev I. E. Holocene mammalian fauna of Denisova Cave //Derevyanko A. P., Molodin V. I. Denisova cave. Novosibirsk: Nauka Publ., 1994, Part L, Appendix 3, pp. 167-180.

Herodotus. Istoriya [History] / transl. and notes by A. G. Stratanovsky. - M.: LADOMIR, ACT, 1999. - 740 p.

Hippocrates. Selected books, Moscow: Biomedgiz Publ., 1936, 736 p.

Derevyanko A. P., Molodin V. I. Denisova cave. Novosibirsk: Nauka Publ., 1994, Part 1, 262 p.

Kubarev V. D. Kurgany Ulandryka [Mounds of Ulandryk]. Novosibirsk: Nauka Publ., 1987, 301 p. (in Russian)

Kubarev V. D. Kurgany Yustyda [Mounds of Yustyda]. Novosibirsk: Nauka Publ., 1991, 189 p. (in Russian)

Kubarev V. D. Saylyugem mounds. Novosibirsk: Nauka Publ., 1992, 141 p. (in Russian)

Kubarev V. D. Bike I, III: funerary monuments of the Scythian epoch of the middle Katun // Antiquities of Altai: Izv. laboratories of Archeology. Gorno-Altaisk, 2001, No. 7, pp. 120-145.

Marsadolov L. S. Pazyryk phenomenon and attempts to explain it // Results of the study of the Scythian era of Altai and adjacent territories. Barnaul: Alt. State Publishing House. Un-ta, 1999, pp. 104-107.

Mednikova M. B. Trepanations in the ancient peoples of Eurasia. Moscow: Nauch. mir Publ., 2001, 314 p. (in Russian)

Mednikova M. B. Ritualnoe posobenie u drevnykh narodov Evrazii po dannym antropologii [Ritual initiation among the ancient peoples of Eurasia according to anthropology]. - 2003. - N 1. - p. 147-156.

Mednikova M. B. Trepanations in the ancient world and the cult of the head. Moscow: Aleteya Publ., 2004, 205 p. (in Russian)

Mirsky M. B. Surgery from antiquity to the present. Moscow: Nauka Publ., 2000, 799 p.

Mogilnikov V. A. Kurgany Kara-Koba II [Kurgans of Kara-Koba II] / / Archeologicheskie issledovaniya v Gornom Altae v 1980-1982 godakh. Gorno-Altaisk: GANIIIYAL, 1983a, pp. 52-89.

Mogilnikov V. A. Kurgany Kyzyl-Jar II-V i nekotorye voprosy sostava naseleniya Altay v vtoroi polovinei I millennii B.C. [Kurgans of Kyzyl-Jar II-V and some issues of the Altai population composition in the second half of the first millennium BC]. - Gorno-Altaisk: GANIIIYAL, 1983b. - p. 40-71.

Molodin V. I. Pazyryk culture: problems of ethnogenesis, ethnic history and historical destinies / / Archeology, Ethnography and Anthropology of Eurasia. - 2000. - N 4. - p. 131-142.

Molodin V. I. Monument Sopka-2 on the Omi River. Novosibirsk, IAET SB RAS Publ., 2001, 128 p. (in Russian)

Nagler A. Fundamental'nye problemy arkheologii, antropologii i etnografii Evrazii: K 70-letiyu akademika A. P. Derevyanko [Fundamental Problems of Archeology, Anthropology and Ethnography of Eurasia: To the 70th anniversary of Academician A. P. Derevyanko]. Novosibirsk: IAET SB RAS, 2012, pp. 337-351.

The population of Gorny Altai in the Early Iron Age as an ethno-cultural phenomenon: origin, genesis, historical destinies (according to archeology, anthropology, and genetics). Novosibirsk: Publishing House of the Siberian Branch of the Russian Academy of Sciences, 2003, 286 p.

Polos'mak N. V. "Vultures guarding gold". Novosibirsk: Nauka Publ., 1994, 124 p. (in Russian)

Polos'mak N. V. The Riders of Ukok. Novosibirsk: Infolio-press, 2001, 336 p. (in Russian)

Polos'mak N. V., Chikisheva T. A., Baluyeva T. S. Neolithic burial grounds of Northern Baraba. Novosibirsk: Nauka Publ., 1989, 103 p. (in Russian)

Practical neurosurgery: a guide for doctors / ed. acad. B. V. Gaidar Russian Academy of Medical Sciences. St. Petersburg: Hippocrates Publ., 2002, 648 p.

Rudenko S. I. Kul'tura naseleniya Gornogo Altay v skifskoe vremya [Culture of the population of the Altai Mountains in the Scythian period].

Rudenko S. And Culture of the population of the Central Altai in the Scythian period. - Moscow; L.: Publishing House of the USSR Academy of Sciences, 1960. - 360 p.

Sorokina T. S. Istoriya meditsiny [History of Medicine], Moscow: Akademiya Publ., 2009, 560 p.

Stepanova I. F., Khavrin S. V. O khronologicheskikh osobennostey obshchestvariya iz pogrebal'nykh kompleksov scifskogo vremeni srednoi Katun [On the chronological features of inventory from the burial complexes of the Scythian time of the Middle Katun]. Novosibirsk: Novosibirsk State Pedagogical University. un-t Publ., 2005, vol. 2, pp. 155-163.

Surazakov A. S. Kurgany epokhi rannego zheleznogo v mogilniku Kyzyk-Telan I: K voprosu o otdelenii karakobinskaya kul'tury [Mounds of the Early Iron Age in the burial ground of Kyzyk-Telan I: K voprosu o otdelenii karakobinskaya kul'tury]. Gorno-Altaisk: GANIIIYAL Publ., 1983, pp. 42-52.

The phenomenon of Altai mummies. Novosibirsk, IAET SB RAS Publ., 2000, 320 p. (in Russian)

page 140
Khavrin S. V. Metal ' skifskikh pamyatnikov Tuva i kurgana Arzhan [Metal of Scythian monuments of Tuva and Arzhan Kurgan]. 100th anniversary of the birth of M. P. Gryaznov. - SPb., 2002a. - Book 2. - p. 171-173.

Khavrin S. V. Tatarskie bronzy [Tatar bronzes]. Archeology. The ritual. Culture: collection of articles dedicated to the 60th anniversary of M. L. Podolsky. St. Petersburg: [B. I.], 20026, pp. 183-193.

Khavrin S. V. Metal of monuments of the Pazyryk culture from the Chui and Ursula mounds // Kubarev V. D., Shulga P. I. Pazyryk culture (Chui and Ursula mounds). Barnaul: Alt State University Publ., 2007a, pp. 278-281.

Khavrin S. V. Tatarskie bronzy Shirinsky raion Khakasii [Tatar bronzes of the Shirinsky district of Khakassia]. Saint Petersburg: Kult-Inform-Press, 20076, pp. 115-122.

Khavrin S. V. Analysis of the composition of Early Scythian bronzes in Altai // Shulga P. I. Equipping a horse and military belts from the Altai. Barnaul: Azbuka Publ., 2008, part 1: Early Scythian Time, pp. 173-178.

Chikisheva T. A. Dynamics of anthropological differentiation of the population of the South of Western Siberia in the Neolithic - Early Iron age. Novosibirsk, IAET SB RAS Publ., 2012, 468 p. (in Russian)

An english translation of the Sushruta Samhita based on original Sanskrit text, with a full and comprehensive introduction, translation of different readings, notes, comparative views, index, glossary and plates: in 3 vol. / edited and published by Kaviraj Kunja Lai Bhishagranta. - Calcutta: Koviraj Kunja LaiBhishagratna, 1907. - Vol. 2: Nidana-sthana, S'arira-sthana, Chikitsita-sthana and Kalapa-sthana. - 762 p.

Brothwell D. R. Ancient Trephining: Multi-focal Evolution or Trans-World Diffusion? // J. of Paleopathology. - 1994. -Vol. 6, N 3. -P. 129 - 138.

Han Kangxin, Chhen Xingcan. The archaeological evidence of trepanation in early China // Indo-Paciphic Prehistory Association Bull. - 2007. - Vol. 27. - P. 22 - 27.

Krivoshapkin A. L., Zelman V. L. Neurosurgery in Siberia // World Neurosurgery. - 2012. - Vol. 77, N 2. - P. 252 - 256.

Nerlich A. G., Zink A., Szeimies U., Hagedorn H. G., Rosing E. M. Skull Trauma in Ancient Egypt and Evidence for Early Neurosurgical Therapy // Trepanation: History, Discovery, Theory / eds. R. Arnott, S. Finger, C.U.M. Smith. - Leiden: Swets & Zeitlinger, 2003. - P. 191 - 208.

Sankhyan A. R., Weber G. H. D. Evidence of Surgery in Ancient India: Trepanation at Burzahom (Kashmir) over 4000 Years Ago//Int. J. Osteoarchaeol. -2001. - Vol. 11. - P. 375 - 380. - Doi: 10.1002/oa.579

The papyrus Ebers / translated from the German Version by CP. Bryan. - L.: Geoffrey Bles, 1930. - 167 p.

Wilkins R. H. Neurosurgical Classic - XVII Edwin Smith Surgical Papyrus // J. of Neurosurgery. - 1964. - March. - P. 240 - 244.

The article was submitted to the Editorial Board on 03.10.13, in the final version-on 18.11.13.

Abstract

Three trepanned crania from 4th-3rd century BC low-ranking burials in Gorny Altai are described. The probable motives behind such operations are discussed, their efficiency is assessed, and their techniques are reconstructed using optical macroscopic examination, computerized multi-layered tomography, X-ray fluorescence, and mass spectrometry of bone tissue. Trepanations were apparently medical rather than ritual. Our data support the idea that the 4th-3rd century BC inhabitants of the Altai-Sayan highland had enough knowledge and skills to perform complex cranial surgery. Because the instruments used were made of tin bronze, and the Minusinsk Basin was the only place in southern Siberia where such bronze was smelted (by the Saragash people), at least two successful trepanations were probably performed by immigrants from that region.

Keywords: trepanation, cranial surgery, Pazyryk culture, Saragash culture, early nomads, Scythian period, X-ray fluorescence, mass spectrometry, traceological analysis.

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