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Artificial Cranial Modification in the Ancient World

Carl T. Feagans
Anthropology 5349
Final Paper
May 12, 2009
Carl T. Feagans

Artificial Cranial Modification in the Ancient World

The practice of artificially modifying the human skull has been a part of human culture as
far back as 45,000 years BP (Trinkaus1982), and it has been shown to occur on every inhabited
continent (Dingwall 1942; Ortner 2003). Two primary forms of artificially modifying the human
skull include trephination, the deliberate and surgical creation of a hole in the cranial vault, and
the application of pressure on the crania of infants or toddlers to reshape the cranial vault from
its natural form. Various hypotheses exist to explain the origins and reasons for these practices in
human cultures in both the ancient and modern worlds, but none appear to be conclusive, though
several do seem to be compelling when reviewed in the light of other archaeological and
ethnographic data.


Trephination as a practice in prehistory was first noted by E. George Squier in 1865

(Andrushko and Verano 2008; Fernando and Finger 2002) but has been shown to exist in most
inhabited regions of the world and in periods of human history and prehistory as far back as the
Neolithic (Finger and Clower 2002; Walker 1997). Trephining is the act of surgically perforating
in the skull for perceived therapeutic purposes (Ortner 2003) and the term is often used
interchangeably with "trepanation," however, Ortner makes an effort to differentiate between
"trephination" and "trepanation." The latter refers to the act of creating a perforation by use of an
instrument. The former indicates that a section of bone is actually removed from the skull. The
term "trepanation" is derived from the Greek term trypan, meaning "to pierce" (Knowles 1903).

Squier's Incan skull is one that shows a scraping of the frontal bone in four regions such
that a rectangular piece of bone was removed as a result (fig. 1). The instrument used was likely
an obsidian or chert blade and the perforation exhibits no indication of healing so the patient very
likely died during the procedure. The discovery of this skull created a sensation within the
archaeological and historical community (Fernando and Finger 2002), the sentiment at the time
creating an expectation that cranial surgery by "primitives" or "savages" would be a complex
task far removed from their abilities. Squier's example was a clear and indisputable example of
human ingenuity, knowledge and understanding in the ancient world, not to be confused with
prior skulls which were suggested, but never concluded, to be trephined due to ambiguous and
misunderstood morphology, perhaps due to healed nature of remodeled bone. Squire's discovery
was not healed and the cross-hatch pattern was, unmistakably, an intentional modification of a
human skull by human hands.

Squier's discovery inspired and fascinated Paul Broca in France, who thought very highly
of Squier and his work (Fernando and Finger 2002). Broca presented the skull to his colleagues
in Paris in 1867 and was fascinated not only with the idea of pre-Columbian Peruvians
performing cranial surgery but with the reason for the surgery to begin with. The shared

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hypothesis between Squier and Broca wass that an injury associated with a sharp weapon
requiring immediate attention and relief motivated the surgery. Broca's fascination with the
trephined skull from Peru was perhaps instrumental in his ability to recognize the practice of
trephining in the Neolithic skulls recovered by his associate P. Barthelemy Prunieres, which
dated to approximately 5,000 - 5,500 years ago (Fernando and Finger 2002; Finger and Clower
2002). Initially, the holes in these skulls were thought to be postmortem cuts designed to permit
the skulls to be used as ritualistic drinking vessels. However, Broca noted the smoothed portion
of bone that was believed by Prunieres to be polished for drinking, was actually healed bone and
that the individual was trephined during his lifetime and survived the process long enough to
begin the healing.

Also discovered at the site were small discs of bone, rounded and polished near the
skulls. Because of their ovoid and generally round appearance, these bits of bone, removed from
trephined holes, were called "rondelles." The term was coined by Prunieres (Finger and Clower
2002) and still in use today. His hypothesis, also still in use, was that they were removed from
the skulls of individuals while alive and worn as jewelry or adornments to ward off demons or
spirits. Broca and Prunieres had differing ideas of what began the practice of trephination:
Prunieres believed Neolithic surgeons observed over time the cause and effect of cranial injuries
and discovered that the bone itself caused problems and that trephining the injury site would
relieve the pain, convulsions, delirium, etc. of the patient. Broca, however, believe that their
motivations were superstition and not science. This he based on the fact that evidence of injuries
was absent, signs of fractures weren't there. In developing this hypothesis, Broca considered
modern “primitives” that he was aware of like the Kabyle Berbers of North Africa, reasoning that
Neolithic societies were likely to behave as modern “primitives” who associated superstitious
causes to actual ailments and were known to perform trephination to remove evil spirits and
demons. Broco hypothesized that Neolithic surgeons reacted first to superstition then recognized
the therapeutic advantages of trephination.

This hypothesis still has traction today ( Finger and Clower 2002; Han and Chen 2007;
Sankhyan and Weber 2002; Ortner 2003; Smith 1990) and is mentioned in a report of the
analysis of a skull from a Neolithic woman found in Burzahom, India which dates to between
4300 to 4000 BCE (Sankhyan and Weber 2002). This skull exhibits 11 attempted and successful
trephinations (fig. 2) each circular or oval and up to 14 mm in diameter. Osteogenesis and
sclerosis were not evident, therefore the trephinations must have been done consecutively and in
a short period of time by the individual's death. One of the hypotheses that Sankhyan and Weber
discuss involves magico-religious practices and the need to obtain rondelles for cranial amulets.
Supporters of this hypothesis point out the skeleton was treated with red ochre. Sankhyan and
Weber point out, however, that most Neolithic Phase II skeletons are treated with red ochre, both
human and animal. In addition, rondelles could easily have been obtained from the unsuccessful
trephinations on the skull with deeper cuts, but these cuts aren't present -nor are there examples
in India of the use of rondelles for magico-religious purposes.

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No clear evidence for the casting out of evil spirits, demons, devils or other superstitious
motivations appear to exist in the archaeological record to date and the idea remains an
hypothesis, though one that may be intuitive given the superstitious nature that can exist among
human culture as pointed out by Broca (Finger and Clower 2002). The intuitiveness of the
hypothesis is such that it appears in both academic and popular texts and writings. Comer (2009),
in his Abnormal Psychology, discusses the idea that South Americans (ostensibly the Inca) used
trephination as a supernatural response to severe abnormal behaviors such as hallucinations or
melancholia and he goes on to equate the practice to Western exorcisms. Han and Chen (2007)
mention supernatural motives only as one of several hypotheses, noting that the practice of
obtaining rondelles in prehistoric Europe and more recently in Africa was done on postmortem
skulls. The other three hypotheses Han and Chen mention are: therapeutic surgeries for head
injuries; surgical procedures to alleviate headaches, epilepsy, insanity and Down's syndrome; and
for “longevity and fashion reasons.” In the skulls they evaluated, Han and Chen discovered that
many exhibited evidence of skull fracture, supporting the head injury hypothesis.

In support of the findings of Han and Chen, Andrushko and Verano (2008) analyzed 66
skulls obtained from 11 Cuzco-region burials in Peru, which exhibited 109 trephinations in all.
Most of the methods of trephining these skulls included circular cutting and scraping. They
discovered the survival rate among the individuals they analyzed to be 83% evidenced by the
well-healed bone of most individuals, some of which exhibited multiple, well-healed
trephinations. The key hypothesis Andrushko and Verano set out to test was that use of
trephination as a medical treatment as opposed to cultural motivations.

What they discovered was that great care was taken to promote healing and prevent
infection. The perforations were positioned on the cranial vault so as to avoid musculature and
vulnerable regions of the skull like the temporal bones and the nuchal planum of the occipital
bone. On one one of the individuals that didn't survive the trephination, a “clump of organic
material” was found over the perforation which also included the reinsertion of the excised bone
in the cranium. Andrushko and Verano noted the lack of evidence for infection in the skulls they
examined and hypothesized that this may have been limited through the application of antiseptics
like balsam, saponins, cinnamic acid, and tannin. In support of one of their primary hypotheses,
Andrushko and Verano found that 44% of the skulls they examined displayed evidence of cranial
trauma adjacent to the site of trephination, supporting the notion that trephinations among these
individuals were motivated by medical treatment rather than cultural practices expected of
magico-religious reasons. They also note that trephining can “obliterate” evidence of injury
through the removal of fractured bone, indicating that there could have existed injuries among
the trephined skulls which are no longer evident. In addition they noted the presence of
mastoiditis three skulls that were trephined, which could imply that injury might not be the only
motivation for medical trephination among this population.

Whether a cultural practice for magico-religious purposes, which satisfy superstitions and
attempt to appease the supernatural, or a logical, reasoned, and therapeutic response to a medical

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problem, trephination has been a part of human culture since at least the Neolithic. In the Near
East, trephined skulls were found which dated to about 7,000 BCE. Hippocrates writes of the
practice in 460-377 BCE:

...the contusion, whether the bone be laid bare or not; and the fissure, whether apparent
or not. And if, when an indentation by a weapon takes place in a bone it be attended with
fracture and contusion, and even if contusion alone, without fracture, be combined with
the indentation, it requires trepanning...those [bones] which are most pressed and broken
require trepanning the least (Hippocrates 1849).

Of interest to anthropologists and archaeologists is the notion that humans as early as the
Neolithic may have already made a link between behavior and the mind with the contents of the
skull (Fernando and Finger 2002). While many authors on the topic of trephination include the
hypothesis of magico-religious necessity in their works, none demonstrate conclusively that it
was the primary or necessary reason for the practice in prehistory. And, while this hypothesis is
also not ruled out, there is ample evidence that other motivations were certainly at work.

Skull Shaping

In addition to cranial surgery, another artificial modification of the human skull present in
the archaeological record, which is perhaps better known, is skull shaping. Like trephination, this
practice of modifying the shape of the human skull is present on every inhabited continent and at
various periods in human history and prehistory. It even appears in the archaeological record of
Neanderthals (Trinkaus 1982). Like trephination, several hypotheses exist to offer explanations
why this practice was done. And, like trephination, the likelihood of a given hypothesis seems to
have more or less probability depending upon the culture being examined.

The human skull can be artificially modified either intentionally or unintentionally.

Unintentional occurrences usually involve the use of cradle boards (Cheverud and Midkiff 1992;
Tiesler 1999; Fletcher et al 2008), a device used by parents, usually mothers, to manage infants
while they perform their own day to day tasks. It can be stood up near the mother or worn on her
back (fig. 3). The constant pressure on the occipital bone, especially if the habit of binding the
infant to the board is employed, causes lateral growth of the skull and “a permanent effect on the
skull” (Dingwall 1931). Often in cradle boards and cradles, the infant will routinely and
habitually favor a particular head position, depending on the directionality of the light source in
the room. Dingwall also notes that accidental deformation can result from carrying the infant
tightly to the mother so that the head is “pressed with some force” against the mother's body,
resulting in the flattening of one side of the infant's head. Dingwall also points out that
unintentional cranial deformation can result from head coverings and head dressing applied just
after birth, though he admits it is difficult to know what extent this is intentional or unintentional
or whether an unintended practice resulted in an intentional desire to achieve aesthetic results
once the culture correlated the cause and effect. Ortner (2003:163) supports Dingwall's

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observations and suggests that artificial cranial deformities can be caused by an infant or child
being positioned on a hard surface with little movement while sleeping. He continues to suggest
that only "slight pressure ... for a few hours per day but over a long period of time" could be
sufficient to result in gross cranial deformity.

Cheverud and Midkiff (1992) describe intentional skull shaping as “the intentional
alteration of cranial development by application of external appliances which constrain
expansive growth of the neurocranium to particular dimensions and regions … usually
performed to achieve some culturally defined ideal form.”

Intentional modification of cranial shape appears to occur on every inhabited continent.

Ortner (2003) makes note of its prevalence in the ancient and modern world, stating that it exists
in some form on every continent but excludes Australia. This contradicts other researchers,
however, and Hisock (2007) summarizes bioarchaeological research of the 1980s and 1990s
which concludes that intentional cranial deformation was present at Cooboo Creek, Kow Swamp,
and Cohuna in Australia at the Terminal Pleistocene. Ortner likely didn't include these examples
since their cranial deformations were previously argued to be examples of unmodified, robust
Homo erectus. Recent osteologic research on these skeletons as well as genetic research has
concluded that these are Pleistocene H. sapiens with cranial modifications and that they represent
one of at least two founding populations, for which cranial modification was a common practice
(Hiscock 2007, 95-96; Anton and Weinstein 1999).

For a description of osteological characteristics of the different types of artificial cranial

deformations, Neumann (1942) provides six separate types (fig. 4). 1) Obelionic deformation. In
this type, the cranial vault between the anterior parietal and the temporal regions are broadened
in the plane between the bregma and the lambda. The flattened region is approximately 30-40
degrees compared to the ear-eye plane. 2) Artificial lambdoid flattening. Occipital deformation
occurs with an angle of 50-60 degrees to the ear-eye plane. 3) Simple occipital deformation.
Neumann suggests this is probably unintentional and his typology here is consistent with cradle-
boarding mentioned elsewhere (Ortner 2003; Dingwall 1931). In this type of deformation, the
angle of the flattened region on the occipital is near to 90 degrees of the ear-eye plane and often
exhibits an asymmetrical appearance. 4) Bifronto-occipital deformation. This is a bilateral
flattening that results in a narrow frontal bone and often associated with a moderate degree of
vertical flattening on the occipital bone. 5) Fronto-vertico-occipital deformation. Pronounced
flattening of the frontal bone along with simple vertical flattening of the occipital bone. 6)
Fronto-parieto-occipital deformation. In this type, three planes are flattened, nearly at right
angles. This type differs from the previous in that cranial development is impeded on the
superior regions of the parietals causing compensatory development in a lateral direction. 7)
Parallelo-fronto-occipital deformation. In this type, Neumann suggests that development in the
occipital region is affected by the placement of “a pad a the base of the occiput in such a manner
as to produce rough parallelism with that of the frontal bone.” Lateral cranial development as
compensation results.

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Neumann's research was primarily focused on sites in the Eastern United States and, thus,
his observations of morphological types was limited those relevant and present. In other parts of
the ancient world, somewhat different morphological types exist. Blom (2005) describes cranial
modification as a cultural practice in southern Peru and includes fronto-occipital modification
similar to that described by Neumann as a type that exists there as well, but she also notes an
additional, “distinctly different,” form, which she refers to as annular-oblique and is thus
described by Blom.

The annular oblique type is considerably different from the fronto-occipital types of
cranial modification and would have produced a visible difference in head shape. An
elongated, tubular vault, produced by circumferential compression from bands of textiles
that encircled the frontal, temporal, parietal (below the temporal line) and occipital
bones characterized these crania (Blom 2005: 9).

Blom's study examined the cultural aspects of intentional cranial modification in Peruvian
society, focusing on regional differentiations between the Moquegua and Katari valleys. She
found that, while the fronto-occipital type of cranial deformation was culturally preferred in the
Moquegua valley, it was the annular-oblique type that found favor among those in the
neighboring Katari valley. The actual presence of cranial modification between the two regions
presented no statistical difference. Both valleys were equally likely to practice cranial
deformation. Blom found, however, that when she controlled for the type of deformation the two
valleys completely favored one over the other. She also discovered that in the capital city of
Tiwanaku in the highlands, both types were present. Previous researchers, she notes, considered
the difference in forms at Tiwanaku as representative of differences in class with the annular
form belonging to a priestly class. Blom's research brings this into question and demonstrates the
importance of bioarchaeological approaches to examining social complexity and culture in the
ancient world.

The intentional skull shaping among the members of Tiwanaku society occurred at
around 500 – 1100 CE (Blom 2005), but the practice is far older and has even been demonstrated
to have occurred among Neanderthal society at around 45,000 years ago (Trinkaus 1982) and
thus, as a practice, intentional cranial modification may not have been limited to recent humans.
Trinkaus describes two cranial vaults that “exhibit contours that contrast with those of other
Neandertals and suggest that they experienced cranial deformation” while still alive. These
crania were recovered from Shanidar Cave in Iraq where evidence for the first intentional burial
was also discovered. In addition, one of the skeletons recovered at this site demonstrated
evidence that others within the society cared for and protected an infirmed member of the society
(Trinkaus 1982; Pettitt 2005). Trinkaus concluded that the distinctive shapes of the crania, which
are consistent with intentional cranial modification in more recent humans, could not have been
“produced by the small amount of postmortem distortion present in the specimens” and the
discovery adds to the growing evidence for aesthetic sense already present among early humans.

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Intentional skull shaping is also present in the archaeological record throughout

Mesoamerica and is often associated with nobility or elites status or, at least, the desire to appear
from a noble lineage (Dingwall 1931). In data sets used by Tiesler (1999), it was shown that head
shaping was found in over 88% of the crania examined and she notes that the practice is present
since the Preclassic (2000 BCE to 250 CE) through the beginning of the Postclassic (c. 900 CE).
Tiesler's description is of a society that embraces head shaping for a wide chronological period
and with regional and local variations in shape due to varied methods of shaping. She points out
that sex was not a determination, females were as likely as male to have intentionally shaped
heads, and, in general, there was no elevated social status associated with having a head that was
intentionally shaped, however, erect deformation appeared “more frequently at higher levels in
the social structure.” Tiesler concludes that while head shaping is an important indicator of social
integration and diversity within Mesoamerican society, it isn't necessarily associated to position
or status within society.

In looking for an explanation for why humans intentionally shape their skulls, some
researchers have turned to ethnographic studies. Beatrice Blackwood and P. M. Danby (1955) of
the University of Oxford presented their ethnographic findings to the Second International
Congress of Anthropological and Ethnological Sciences held in Copenhagen in 1938 on the
intentional cranial deformations performed by the people on the island of New Britain in Papua
New Guinea. There, the Arawe people practiced head-binding of infants to produce a very
characteristic elongation of the cranial vault which varies depending upon the method by which
the binding materials are applied to the infant skull (fig. 5). Cranial vaults Blackwood and Danby
described very much resembled the fronto-occipital and annular crania of the Inca skulls
described by Blom (2005).

Blackwood and Danby (1955) assert that the practice among the Arawe was “purely an
aesthetic one” and had no magico-religious or class motivations associated with it. There were no
rituals or or ceremonies involved and appeared to be done simply because it was found
aesthetically pleasing and as an established tradition. However, Blackwood and Danby were
unable to comment on where the practice originated from since no stories or legends existed
among the Arawe to provide any insight, nor was there a written or icongraphic history of the
practice to examine. It was noted in their report that nearly every child, regardless of sex, had
their head bound to induce an elongated shape, but they also reported that a tiny but growing
minority abstained from the practice, perhaps do to the influence of Christian missionaries and
increasing contact with populations outside of the Arawe region. For the majority that continued
the practice, the bindings were applied almost immediately following birth. The binding is made
from the stem of a vine called talis and wrapped many times around the cranium starting just
above the eyes and around the back of the head. Blackwood and Danby don't describe the point
at which the bands pass on the back of the head, but Dingwall (1931, p.138) describes bindings
in Melanesia as passing around the occiput. As a cultural practice, Blackwood and Danby point
out that the bindings are “removed every day, at the discretion of the mother” and that the child

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is treated with a “black paint, applied by the mother's palm, with considerable pressure on the
forehead.” Blackwood and Danby describe in their observations a child exhibiting pronounced
deformation at only one day old, which is consistent with Ortner's (2003) suggestion that
deformation can occur in just a short amount of time. Still, Blackwood and Danby state that the
bindings are used for up to a year or until the child could “run alone” but observed that the length
of time bindings were worn was not consistent from child to child and mother to mother,
reminding us that the practice, while cultural, wasn't mandatory and that there were no taboos in
avoiding binding which might be associated with magico-religious practices.

Blackwood and Danby also make observations of the effects that binding had on the
skulls they examined. While Dingwall (1931) suggested that suture closure might be hastened
due to the compression of bindings, they discovered this not to be the case, nor did they discover
the marked irregularities they initially expected in the course of sutures and conclude that
“pressure between adjacent bones is not an important factor in suture closure. They did note an
increase in height further forward in the cranial vault in females than males, which they
attributed to both the longer periods of binding that female children appeared to endure as well as
the less rugged nuchal area on female crania. Blackwood and Danby also suggested that because
the deformations caused by binding force the mass of the cranium posteriorly, the nuchal
muscles do less work to counterbalance the weight of the face and mandible. In some of the
crania they examined, the nuchal lines were nearly absent. In addition, one cranium exhibited an
unusual angle with mandibular condyles which were “rotated backwards.” They also found that
their samples had increases in heights associated with the upper face, nasion, and orbitals.

Cheverud and Midkiff (1992) also noted that artificial cranial modification had some
affect on the mandible. They examined 82 mandibles from the prehistoric Peruvian-Ancon series
which had their associated crania previously scored by degree of fronto-occipital flattening. The
crania were either unmodified, slightly modified, modified, or greatly modified. What they
discovered was that fronto-occipital flattening can affect mandibular morphology. The
compensatory lateral increases of cranium can result in an increased intercondylar width, and a
decrease in anterior-posterior depth. The overall shape of the mandible is thus changed.

Various suggestions for the origins and motivations of intentional cranial modifications
exist depending on the observations of various researchers at various sites representative of the
ancient and modern worlds. Blackwood and Danby (1955) conclude in their ethnographic
observations of modern humans in Melanesia that the motivations are purely aesthetic and
devoid of magico-religious influences, ethnic identity, or expression of social or elite status.
Blom (2005) concluded that there was an ethnic identification component and a drive to create
symbolic boundaries between environmental niches. For Torres-Rouff (2002), cranial vault
modification was not "merely an aesthetic choice but a social signifier of great importance." She
studied the same populations as Blom and concludes that "[t]hrough cranial vault modification,
the body can be made into a symbol of ethnic or community identity, with members of a
particular group sharing this physical characteristic that differentiates them from others."

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Blackwood and Danby (1955) reported that the Arawe shaped their skulls for purely
aesthetic purposes and much the same was reported by another ethnographer who traveled
southwest Macedonia in the 1920s. Margaret Hasluck wrote (1947):

The Konia Turks, whose heads are naturally on the massive side, desire, as they said, 'to
flatten the forehead' and 'to make the head high and flat instead of tumba (round). The
Albanians, who also dislike 'heads like apples,' do not need to bandage the heads of their
babies because they achieve the flat effect of their admiration by strapping the infants to
a board...”

Hasluck also quotes a passage of Hippocrates that includes, “[t]he people believe that
longheadedness is a mark of distinction.

Another inspiration for in vivo cranial modification might be ancestor worship.

Blackwood and Danby (1955) note that not long before the time the Arawe were observed by
them, there existed a tradition of exhuming their dead to conduct a second series of funerary rites
in which skulls are placed in a structure after being washed in the sea and painted with red ochre.
Perhaps one of the best known instances of ancestor worship that involves skull modification
comes from Jericho in the Near East. Fletcher et al (2008) describe in detail the plastered skulls
of Jericho and make a novel correlation between antemortem and postmortem deformations. The
skulls they examine originate from the Pre-Pottery Neolithic (PPN) B period of the Levant at
about 10,500 – 8,700 years ago. One of the skulls, D113 (fig.6) is in the British Museum and was
one of seven plastered skulls recovered by Kathleen Kenyon from the PPNB level of Jericho in
1953. The PPNB is an important period of human history because it represents a transition from
a foraging lifeway to a more sedentary, agricultural one along with a marked increase in
population densities and expansions within the Levant (Watkins 2005; Renfrew and Bahn 2008 ).

Mortuary practices of PPNB, as described by Fletcher et al (2008), originate in the PPNA

and the Late Natufian:

The persistence of this practice overarches different subsistence and cultural modes for
around four millennia. Cranial removal in the Middle PPNB was also expressed
symbolically in wall paintings and decapitation of figurines at sites such as Ain Ghazal,
Jericho and Catalhoyuk (Fletcher et al 2008: 310-311).

Caches of skulls like the one that Kenyon recovered in Jericho have been found at other
sites, their facial features remodeled in plaster and often painted with cowrie shells added to
represent eyes (Watkins 2005). There is no evidence that the individuals who had their skulls
plastered were of high status or elites of the settlements. There is, however, evidence of burials
associated with the settlements which had skulls removed while other bodies were dumped
unceremoniously in waste pits also associated with the settlements. The number of burials found

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are not sufficient enough in number to account for the population sizes of these settlements
(Watkins 2005).

There is speculation that the skulls included a sort of covering or wig since they were
plastered on the base, sides and face but not the cranial vault itself (Fletcher et al). The net like
patterns found on the cranial vaults of skulls recovered from Nhal Hemar may support this
hypothesis since it may represent braided hair or a woven headdress. But the question remains,
why were some skulls selected and others not (Watkins 2005: 221-223; Fletcher et al 2008: 318)
Fletcher et al suggest that the removal, decoration and curation of artificially modified skulls was
not a mortuary practice but, rather, a life practice in which these carefully plastered and painted
skulls were ritual symbols of the relationship between life and death. To get to this conclusion,
they demonstrated that the skulls, thought only to be modified postmortem, were also modified
antemortem. Fletcher et al used radiographic analysis to examine the skulls and show that there
existed evidence for in vivo cranial modification due to a varied thickness of the inner table of
the cranial vault. In non-modified skulls, this thickness is uniform and consistent, but in skulls
that have been modified, the thickness varies. They also note the painted stripes across the
parietal bones of one skull, which might represent the method of binding the cranium.

Fletcher et al describe the possibility that the skulls were chosen for their morphology
and they cite previous research which indicates that the preference was for crania with “low wide
faces and broad vaults,” which also happen to be present in many of the culturally modified
skulls described earlier. Interestingly enough, Fletcher et al note, too, that the plastering of the
facial features was done without regard for what the individual actually looked like, consistent
with attempting to achieve and ideal form and that the resulting skull was not intended to be a
realistic representation of the living individual. They also discuss the hypothesis that the skulls
are chosen based on their sex and part of the veneration of elder males, but because of the fact
that plastering obscures characteristics for determining sex, this may not actually be the case. In
addition, evidence for the plastering of female and child skulls seems to refute this ancestor cult
hypothesis altogether.

Along with the radiographic evidence that the plastered skulls were modified in vivo,
there also exists cultural evidence for the aesthetic appeal for certain head shapes in Neolithic
iconography by way of figurines that exhibit elongated skulls (Meiklejohn et al 1992; Hole et al
1969). Female figurines excavated from Tell Ramad depict an elongated form (Meiklejohn et al
1992: 95) and at the Late Neolithic to Middle Chalcolithic site of Coga Mish in Iran, 38 human
figurines were recovered, three of which were of human heads that exhibit a round frontal view,
but are clearly flattened and elongated in the back, consistent with in vivo cranial modification.
Indeed they each have a painted black band encircling the head which could represent bandage
bindings (Hole et al 1969). The Late Neolithic through Middle Chalcolithic also produced
evidence of skulls intentionally modified during the lives of the individuals. Ganj darra, Ali
Kosh, Choga Safid, and Choga Mish each produced skulls where the individuals had undergone
shaping in vivo by use of bindings as infants and were variously male and female (Meiklejohn et

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al 1992: 86-89). At Ganj Darra and Choga Safid, each skull excavated had indications of
intentional cranial modification. This, when considered that not all skulls were selected for
burial, seems to indicate a preference for skulls modified in vivo when it came time for burial,
caching and postmortem modifications like plastering.

As Fletcher et al pointed out, the inclusion of females and children as the recipients of
antemortem and postmortem modifications would seem to disassociate the practices from
ancestor worship. Fletcher et al conclude that, while ancestor worship as an explanation would
appear inadequate, the “generalized veneration of ancestral ties may reflect attempts to cope with
the social and economic stresses associated with the changing economic and subsistence
strategies of the PPNB and the growth of permanent large-scale centres such as Jericho [and] it
becomes easier to accept that children a well adults could have assumed a significant role in
linking living communities with their past.” The modification of the human skull in the Pre-
Pottery Neolithic may very well have been a way of ensuring heredity and kinship within a
growing and diversifying population that was becoming increasingly sedentary, which may
explain the preference for skulls modified in vivo for postmortem veneration.

But if it is established that intentional cranial modification creates an aesthetically

pleasing form for some cultures (Dingwall 1931; Blackwood and Danby 1955; Fletcher et al
2008; Meiklejohn et al 1992; Blom 2005), the question could remain as to why this would be the
case. Insight to this could be found by exploring the value, meaning and extent of artistic
representation and appreciation within human cultures. Rudolf Arnheim (1983) discussed
caricature and deviation in the artistic representations of various cultures and notes that
deviations from the norm comprise the “very root of perceptual dynamics and therefore of
expression, artistic and otherwise.” He notes that deviation is a key component of visual
dynamics and that where shape deviates from a standard it can create a caricature of the original,
that is to say, features characteristic of the norm are accentuated and highlighted. The parts of the
original that make it unique or special become perceptually and visually enhanced.

Perhaps the former foragers, now agriculturalists, of the Pre-Pottery Neolithic had
ancestors within their societies who were considered inspirational leaders and founders of the
societies themselves -individuals who were remembered as having skull shapes and sizes that,
while not outside the normal range for H. sapiens sapiens, were nonetheless noticeably different.
Perhaps, in an attempt to venerate these leaders or founders, or to establish kinship with them,
parents began the practice of binding their infants' heads to ensure this link to the past and to
their ancestors. Perhaps something similar can be said for Andean societies in and around
Tiwanaku where diversity and ancestry both appeared to be appreciated and venerated. The
Arawe, who reported no other reason than aesthetics, may have been creating self-caricatures of
an ideal form of an ancestor long forgotten, but still venerated unintentionally.

The true origins of artificial but intentional cranial modifications may never be known or
understood and they may, indeed, be as numerous as the number of cultures throughout human

Carl T. Feagans

history and prehistory that practiced it. But the continued study and attempts to understand this
practice can help avoid making unintended assumptions that might affect the conclusions of
researchers examining cultures that practiced it. Head shaping may not be a way of exerting
dominance over another group or demonstrating elite status; trephination may not simply be a
method of releasing spirits and demons.

Carl T. Feagans


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Figure 1: Trephined skull recovered Figure 2: Trephined skull recovered by

by Squier Sankhyan and Weber (2001) in Burzahom,
India 4000 years BP

Figure 3: Cradleboarded infant with


Carl T. Feagans

Figure 4: From Neumann, 1942

Carl T. Feagans

Figure 6: Plastered skull from the Pre-

Figure 5: Skull shaping of the Arawe, Pottery Neolithic B of Jericho, from
from Blackwood and Danby, 1955 Fletcher et al, 2008