Perforated skulls found during Tallinn rescue excavations are likely 18th-century. Combined with prior data, the results imply Estonian cranial surgery and autopsy began at the same time as in Western Europe.
Archaeological rescue excavations in urban cemeteries over the past decade have unearthed a wealth of skeletal remains, including some remarkable finds.
Osteoarchaeologist Martin Malve of the University of Tartu writes that osteological analysis has revealed several perforated skulls or skull bone fragments with incision marks, which help understand the history of cranial surgery in Estonia. According to him, the history craniotomy, or the removal of part of the skull to gain access to the brain, has not been extensively researched here.
Estonian archaeological bone material contains little surgically treated human bones. For now, there are one possible and two confirmed cases of patient trepanation – incising the skull to access its content – but, for example, no cases of amputation-related limb removals.
The perforated skulls probably date from the 18th century: from C. R. Jakobsoni 13 and Tõnismäe cemeteries in Tallinn, the cemetery of the Naval and Army Hospital in Tallinn, and a burial chamber in Tallinn's St. Nicholas' Church (Niguliste). In addition to the finds in Tallinn, there is also a possible dissected skull from a grave at the foot of the choir loft in Koeru Church.
The cases listed above are mostly isolated fragments rescued from soil disturbed during construction or excavation, so it is nearly impossible to match such loose bones to a specific skeleton or to determine an exact burial date.
Before the findings of the previous decade, the only known instances of craniotomy in Estonia were related to the anatomical dissection, or autopsy, in the two complete skeletons found in 1932 in Haapsalu, but only a few bones have now survived. In all the skulls or bone fragments found, the brainstem was cut open with a saw around the perimeter to avoid damaging the soft tissue inside, such as the brain. Clear blade marks are visible and the incisions cut through all the brainstem bones: frontal, radial, temporal and occipital.
One of the Tallinn anatomized skulls, pictured below on the left, discovered on the C. R. Jakobsoni 13 plot, is probably from the burial site of the Russian garrison. In the center is the illustration of the saw-cut of the lower part of the skull from the church of St. Nicholas. On the right is the top part of the removed skull at the Tõnismäe suburban cemetery.
The angles of the cuts and the marks examined suggest that a flat, straight-bladed tool was used to open the skull.
The skulls were sawn through the orbits and the lower part of the occipital joint. The width of the saw cut through the bone was about 2–3 mm. The heads were opened fairly uniformly, with little variation in the position of the saw cuts, suggesting experienced and regular practitioners.
In the Middle Ages, brain surgery was mainly performed by barbers and sauna keepers - doctors wanted to avoid staining their hands with such "bloody work." Their medical training at the time included some anatomy, but not on human skeletons. The Pope had forbidden it. Only animals, such as pigs, could be dissected.
Generally speaking, in Europe from the 18th century onward, it was permitted to dissect executed criminals and suicides to determine the cause of death, study anatomy, and understand disease processes. In exceptional cases, the bodies of ordinary citizens could also be dissected.
It is likely that a similar development took place in Estonia, as the earliest known evidence of dissection dates from the 18th century. The practice of dissection in medical schooling probably became more widespread after the Great Northern War (1700-1721), and it is possible that such examinations were performed by military surgeons.
Since criminals and suicides were not interred in the consecrated cemetery and, for example, could not be buried at the church of St. Nicholas, it is difficult to say to whom these sculls belonged or why they were found in those cemeteries. One speculation is that the authorities wanted to confirm the cause of death. Regarding the find at the C. R. Jakobsoni 13 plot, there is some indirect evidence to suggest that the body belonged to a criminal.
For example, the church book mentions a Haapsalu dungeon inmate who was dissected after death. The two cases of sawed skulls are linked to hospitals: the Tallinn land and naval hospital cemetery and the suburban Tõnismäe cemetery that was also used by a local hospital at the time. The study thus suggests that dissection has become part of doctors' training.
While the discoveries made during the last decade shed some light on medical education in the 18th century in Estonia – we know, for example, that the number of dissections increased here at the same time as in other European countries – it is still very marginal, and it is future archaeological finds of possibly well-preserved, completely dissected skeletons that could provide better information about the location and process of human autopsy for schooling purposes.
The article is published in the archaeological journal Tutulus.
Editor: Jaan-Juhan Oidermaa, Kristina Kersa