Evidence of amputation as medical treatment in ancient Egypt

The use of surgical techniques in ancient Egyptian medicine has only been suggested indirectly through ancient medical texts and iconography, and there is no evidence of amputation as a means of therapeutic medical treatment. This paper presents four cases of amputation from the archaeological site of Dayr al‐Barshā, Egypt. Two of the cases (dated to the First Intermediate and Middle Kingdom periods, respectively) are from individuals that display bilateral amputations of the feet, one through the metatarso‐phalangeal joints, the other a transmetatarsal amputation. The exact reason for the amputation, perhaps from trauma or disease, is unknown. The particular healing patterns of the distal ends of the amputations suggest these individuals used foot binding or prosthetic devices. Another case represents a healed amputation of the left ulna near the elbow, dated to the Old Kingdom. The final case represents a perimortem amputation of the distal end of the right humerus. The exact date of this individual is unknown, but most likely pertains to the Old Kingdom or First Intermediate period. This individual seems to have suffered a traumatic incident shortly before death, sustaining many fractures, including a butterfly fracture on the right humerus. Several cut marks were identified on top of the butterfly fracture, indicating amputation of the arm at this point. All four cases support the hypothesis that the ancient Egyptians did use amputation as a therapeutic medical treatment for particular diseases or trauma. Copyright © 2009 John Wiley & Sons, Ltd.     

Morphological Characteristics of Healthy and Osteoarthritic Joint Surfaces in Archaeological Skeletons

Osteoarthritis is a major health concern in living populations, as well as being one of the most common pathological lesions identified in the archaeological record. The aetiology of the disease remains unclear, with a multi‐factorial influence of physical strain, age, genetics, and obesity. Previous studies have identified a relationship between the presence of knee osteoarthritis on the distal femoral joint and the morphology of the intercondylar notch, patellar groove, and medial condyle. The current study expands this research to investigate the relationship between distal femoral, distal humeral, and proximal ulnar joint morphology and osteoarthritis with 3D shape analysis techniques. These methods provide a more detailed analysis of joint morphology in order to determine any relationship between 3D shape and osteoarthritis. The results indicate a complex relationship between joint shape and knee osteoarthritis, with eburnated right femora showing a statistically significant association. The shapes associated with eburnated or affected femoral joints can be explained by osteophyte development, and therefore likely represent systematic shape changes and not a particular joint shape predisposing individuals to the condition. There was no identifiable relationship found in the proximal ulna or distal humerus, indicating that joint shape is unlikely to influence the development of the condition in the elbow joint and that any shape changes produced by osteoarthritis are not systematic or quantifiable. The joints analysed in this study were highly influenced by asymmetry, sexual dimorphism, and allometry, resulting in a small sample size of affected joints in many datasets. Further analyses of large skeletal samples are needed to more thoroughly investigate the possible relationship of distal femoral joint shape and osteoarthritis. Copyright © 2013 John Wiley & Sons, Ltd.     

Ancient injury recidivism: an example from the Kerma period of ancient Nubia

A topical trend in clinical research has been the study of repeat trauma, referred to by clinicians as “injury recidivism,” which lends itself to the assessment of accumulated injuries among ancient people. The present investigation examined the healed injuries among two archaeological skeletal samples from the Kerma period (ca. 2500–1500 BC) of Sudanese Nubia. Both groups were known to have a high prevalence of multiple trauma—80% of 54 adults from the rural sites (O16 and P37) located near Dongola and 42% of 212 adults from the urban site of Kerma sustained nonfatal injuries. It was observed that a higher frequency of multi‐injured adults displayed one or more violence‐associated injury (cranial trauma, parry fracture). When all injuries were considered 38% of individuals with violence‐related injuries had other traumatic lesions in contrast to 22% of individuals who experienced injuries associated with accidental falls (e.g., Colles', Smiths', Galeazzi, and paired forearm fractures), although this difference was not significant. When only the skulls and long bones were evaluated 81% of adults with multiple injuries to these major bones bore one or more violence‐related injuries, while 60% of adults with single injuries sustained violence‐related injuries. Most individuals with multiple injuries were male and less than 35 years of age; there was no significant difference in the frequency of violence‐ or accident‐related multiple injury between the rural and urban communities. Although it cannot be established whether or not some of an individual's injuries were experienced during simultaneous or independent incidents, the pattern of multiple injury among these two ancient Nubian skeletal samples reflected the profile of injury recidivism observed by modern clinicians cross‐culturally. Copyright © 2002 John Wiley & Sons, Ltd.     

Chinese Indentured Mine Labour and the Dangers Associated with Early 20th Century Deep‐level Mining on the Witwatersrand Gold Mines,South Africa

Trauma analysis in archaeological human remains can aid our understanding of cultural practices, socio‐economic status, environmental and social conditions, and even aspects of a person's occupation. For this reason, fracture patterns and frequencies can be useful in making inferences about the environment people lived and worked in. This is especially true for the 20th century mining industry where unskilled migrant labourers were often subjected to harsh working and living conditions. In this study, the skeletal remains of 36 Chinese indentured mine labourers, who worked and died on the Witwatersrand mines, South Africa, during the period ad 1904–1910, were assessed for evidence of trauma. Historical information suggests that these indentured Chinese labourers were unfamiliar with the workings of deep‐level mines and as a result sustained many work‐related injuries. Analyses suggest low frequencies of ante‐mortem trauma. In the few instances where they occurred, these healed fractures most probably reflect injuries already sustained in China, some time before Chinese indentured employment on the Witwatersrand mines. A high frequency of traumatic lesions, specifically peri‐mortem fractures, however, suggests a drastic shift in their working environment attesting to the hazardous working conditions associated with deep‐level mining in the early 20th century. Copyright © 2015 John Wiley & Sons, Ltd.     

Injuries to the skeleton due to prolonged activity in hand-to-hand combat

Two complete skeletons from the Hamman-Todd collection of the Cleveland Museum of Natural History (CMNH) show a suite of pathological lesions that suggest the individuals had been involved in boxing or other hand-to-hand combat. These lesions were studied and compared with medical and autopsy records. The aims of the research were to estimate the accumulated damage to the bones over time, to characterize the different types of the damage, and to establish criteria for hand-to-hand combat or violence for archaeological material. Our inspections showed that besides the muscle markings developed and the numerous healed fractures that are expected when someone is involved in such activities, other types of lesion are present that are helpful for a proper differential diagnosis. These are: degenerative changes at the lesser tuberosity of the humerus; focal necrotic changes/bone growth on the trochlea of the humerus; necrotic changes on the distal head of the ulna; bony patches on upper limb bones only; secondary centres of ossification failing to fuse (mainly in vertebrae and acromion); a huge conoid tubercle on the clavicle; bony spurs on the distal articular head of the metacarpals; necrotic changes on the femoral head next to the fovea and on the roof of the acetabulum; and a developed bony ridge for the attachment of the iliotrochanteric ligament. Finally, we propose a set of criteria that will help to identify people in archaeological material who were involved in hand-to-hand combat.     

An exploration of character traits and linear measurements for sexing mountain gazelle (Gazella gazella) skeletons

The skeletal elements of mountain gazelle (Gazella gazella) have proven difficult to sex with statistical confidence due to wide overlap in the body size of the two sexes. We studied a sample of 53 modern mountain gazelle skeletons to determine which character traits and metric measurements best predict sex. The success of the character traits was determined using blind tests while the metrics were examined using discriminant function analysis. The most useful elements include the previously identified horn core, pubis and atlas, but also some new bone portions that preserve well in the archaeological record (e.g., distal tibia, distal metacarpal and metatarsal, and second phalanx). Surprisingly, two elements commonly used in sexing analyses (distal humerus and astragalus) were not among the most effective elements. Although cutting points and discriminant functions for sexing gazelle bone portions are presented here, they do not account for potential body size change and thus are not suited for direct application to archaeological assemblages. Instead, we provide guidelines for application to archaeological gazelle assemblages, most importantly a regression analysis that considers the sex ratios obtained from multiple measurements to predict the sex ratio of archaeological gazelle populations.     

A Large‐Scale Palaeopathological Study of Hip Fractures from Post‐Medieval Urban England

Hip fractures have high incidence rates in many current groups and are associated with high morbidity, mortality, and considerable expenditure. Although hip fractures associated with significant traumatic events can occur at any age, many hip fractures occur in older adults. To date, few hip fractures have been reported from archaeological skeletal material, and a number of hypotheses have been suggested for this. This research presents a comprehensive assessment of hip fractures in archaeological bone; 1597 adult (18+ years) skeletons from eight urban post‐medieval sites from England dating from the 18^th and 19^th centuries were recorded, and contemporary medical texts reviewed. This adult sample included 834 males and 652 females as well as 11 persons of undetermined sex. Ways of classifying and describing fractures in the clinical literature were reviewed and a methodology applicable to paleopathology determined. Of this sample, 15 (0.94%) had fractures in the femoral neck or intertrochanteric area: nine males, four females, and two individuals of undetermined sex. The numbers of fractures in males were interesting and most likely represent examples of accidental trauma as well as osteoporosis‐related fractures, the latter receiving growing awareness in recent clinical literature. Overall there was an age‐related trend with more individuals aged 50+ years with fractures than in other age categories. Underlying osteoporosis was potentially a complicating factor in five individuals and was likely associated with a vitamin D deficiency osteomalacia and a metastatic neoplastic condition in a further two cases. Fractures occurring close to the time of death and healed fractures were observed, indicating that the risk of mortality following this trauma was not consistent across this 18^th and 19^th century sample. Skeletal and historical evidence presented in this study indicate that the impact of hip fracture injuries varied, with survival likely linked to the fracture type. Copyright © 2016 John Wiley & Sons, Ltd.     

Disentangling long bones of foxes (Vulpes vulpes and Alopex lagopus) from arctic archaeological sites

To discern the presence of two anatomically close species within an archaeological assemblage is always a problem for the analyst. A particularly interesting case is the distinction between the red fox (Vulpes vulpes) and the arctic fox (Alopex lagopus), which is often determined using non-rigorous criteria and producing results that must be regarded with caution. Classical methods for separating these two species and determining sexual dimorphism, and eventually the sex ratio, such as analyses using uni- and bivariate plots, are based on arbitrarily fixed limits between sexes. In this text, a more robust statistical method termed mixture analysis (MA) is used to determine the species of limb bones from foxes. First, the MA is applied to a sample of each species using metric data taken from a collection of present-day fox skeletons. Afterwards, the MA is applied to archaeological samples dated to the Dorset period and retrieved from the Tayara site (near Salluit, South Hudson Strait, Nunavik). The results clearly demonstrate that the greatest length (GL) of long bones, especially the humerus and tibia, is the best measurement for distinguishing the species, followed by the distal breadth and the proximal breadth; and that GL is better suited for sexing foxes. The results of MA applied to the Tayara site collection lead to the conclusion that the red fox is present along with the arctic fox among the assemblage, and that there is no fox body size change during the last two millennia in the Eastern Arctic.     

Avulsion injuries of vertebral endplates

Bone changes resulting from avulsions involving vertebral endplates have had little, if any, systematic attention in palaeopathological literature. To gain insight into their occurrence and into their variety, two archaeological skeletal collections covering the period AD 1455–1824 were examined. Additional skeletal material was used to illustrate typical examples. A quarter of the 44 adults who had adequate numbers of vertebrae at all spinal levels showed minor to major vertebral endplate changes as a result of avulsion injuries. The male/female ratio was 7:4. The ratio of individuals with injuries contracted during their youth and during their adulthood was 3:8 (n=11). Approximately half of the affected individuals showed such changes in multiple vertebrae. In about one third of the cases, concomitant vertebral fractures, which did not involve the endplates, were recorded. Since the existing classifications of endplate changes from avulsion injuries were developed on the basis of clinical diagnoses made by means of X‐ray or by autopsy, an adapted and extended outline for palaeopathological use is proposed. A series of differential diagnoses is discussed. Although, in general, the poor preservation of archaeological spines hampers epidemiology, the diagnosis of spinal avulsion injuries offers interesting information at the individual level. Copyright © 2000 John Wiley & Sons, Ltd.     

An investigation of historical and archaeological evidence for age‐related bone loss and osteoporosis

A growing awareness of the problems caused by osteoporosis‐related fractures has led to increased investigation of the condition in past populations. The present study seeks to examine the ways in which osteoporosis‐related fractures may be explored through different approaches; modern clinical information, historical records of fractures and analysis of archaeological bone may provide fuller information on the condition. The three types of fractures upon which this study focuses are fractures of the femoral neck, Colles' fractures and vertebral compression fractures. The results of the investigation clearly demonstrate the way in which the various sources produce a slightly different picture of the condition. The archaeological significance of the different types of fractures was found to be the reverse of that which would be suspected in the light of information derived from historical sources and the clinical literature. To date vertebral crush fractures have been the most commonly found osteoporosis‐related fracture in archaeological material, but their significance to people in the past is likely to have been minimal. In contrast hip fractures have rarely been reported from archaeological bone material, but historical information makes it clear they were well known, and knowledge derived from clinical sources emphasizes the serious consequences of such a fracture for the affected individuals. The results indicate the value of undertaking a multi‐disciplinary approach where possible. Copyright © 2002 John Wiley & Sons, Ltd.     

Documenting Archaeological Mortuary Features using High Dynamic Range (HDR) Imaging

This technical note presents a refined technique for photo‐documenting archaeological mortuary features using High Dynamic Range (HDR) imaging. Mortuary features in archaeological context can be complex and delicate given the wide variability in grave constructions and preservation of human skeletal remains. It is therefore critical to obtain the greatest detail possible when photo‐documenting these features. HDR techniques represent more contrast in photographs and provide greater detail across the DR of illumination within mortuary features—where complex arrangements of human remains can obscure or darken other elements or associated funerary objects, making them difficult to identify in traditional photographs. HDR can be employed with most standard digital single lens reflex cameras used for archaeological field projects, is easy to learn and employ (as described here), can be processed and produced with commonly used photo editing programs, and is ideal for use in unpredictable conditions that are often encountered with archaeological mortuary features and in field conditions. Copyright © 2013 John Wiley & Sons, Ltd.     

Cooked Bones? Method and Practice for Identifying Bones Treated at Low Temperature

Is it possible to determine low‐temperature cooking in archaeological bones? The indirect exposure of bones to fire at low temperature (≤ 100 °C), linked to cooking, produces macroscopic modifications on these bones. These modifications have not been clearly or systematically described previously. Instead, physicochemical changes at nanometric level are only now beginning to be understood. In this paper, our principle aim is to explore new methods and techniques that correlate macroscopic features such as smoothness or light transparency with physicochemical characterization results that could aid towards detecting cooked bones in the archaeological record. This study then selected 11 archaeological samples, both human and non‐human. Bones were considered to be thermally treated or not, on the basis of macroscopic criteria. Complementary characterization techniques were used to study morphology (scanning electron microscopy and small angle X‐ray scattering), structure (X‐ray diffraction and transmission electron microscopy), local composition (energy‐dispersive X‐ray spectroscopy) and texture (gas adsorption). Indeed, fractal dimension, particle size, crystalline percentage or specific surface area may well explain some of the macroscopically observed modifications on these samples. The possibility that such apparent modifications may also be due to diagenesis is also considered. From an archaeological point of view, the results are promising. Our characterization of human and non‐human bones demonstrates that physicochemical techniques are complementary and provide good criteria against which to distinguish boiled from un‐boiled archaeological samples. Copyright © 2013 John Wiley & Sons, Ltd.     

A palaeopathological study of Colles' fracture

This work is an osteological study of four cases of Colles' fracture from a 3rd–4th century AD British archaeological site. Each case was from an elderly female. Investigation of the degree of malunion suggests lack of effective reduction for these fractures. The poor anatomical outcome appears generally to have resulted in poor functional outcome; detailed anatomical study provided evidence for impairment of function of the distal radioulnar joint, ulnocarpal abutment and scapholunate diastasis, conditions which would probably have caused long‐term residual disability. Copyright © 2006 John Wiley & Sons, Ltd.     

Observations on the undersurface of the skeletalized human acromion in two populations

In late life, the humeral impingement disorder becomes common due to degenerative changes in the rotator cuff which allow the proximal humerus to press against the acromion in elevation of the arm, so producing facets on the tip region of the subacromial surface and on the lateral margin of the greater tubercle of the humerus. To discover what changes occur prior to those described, 184 acromions below the age of 55 years were examined. During the 18–25 year period, the subacromial surface showed patterns of formation of surface trabeculae of new bone, some associated with union of the epiphysis or with remodelling as a response to the presence of the proximal humerus at a distance of 10–15 mm; others indicated a subacromial attachment of the coraco‐acromial ligament. As early as 30 years of age, flattening of the surface trabeculae of bone was noted in association with compression lipping of the outer margin of the greater tubercle of the humerus, the part that crosses closest to the subacromial surface during elevation of the arm. Although resembling changes found in the impingement disorder, in both populations by the age of 35 years the changes were too common to be so and were not associated with the erosive pitting of the upper surface of the tubercle regarded as the earliest bony criterion of degenerative change in the cuff. It is postulated that, in the normal shoulder joint, in raising the arm, pressure is exerted, perhaps transiently, in the subacromial bursa and adjacent soft tissues which induces the compressive changes described. Probably due to the physically arduous lifestyle of the islanders, these changes occurred earlier among them; so did (but later) cuff degeneration indicated by erosion of the humeral tubercle. Copyright © 1999 John Wiley & Sons, Ltd.     

1H‐NMR AND 31P‐NMR CHARACTERIZATION OF THE LIPID FRACTION IN ARCHAEOLOGICAL OINTMENTS

Lipids are a broad group of naturally occurring molecules, which includes fats, oils, waxes, sterols, terpenes, fat‐soluble vitamins, monoglycerides, diglycerides, phospholipids and others. Lipids have been widely used in human history and they are often present in archaeological finds. In particular, in the field of medicine and cosmetics, lipids have been employed as base in the preparation of unguents, salves and balms. The characterization of these products and their degradation products induced by ageing is important for an understanding of the ancient pharmaceutical techniques and to assess the state of conservation. ¹H‐NMR and, for the first time, ³¹P‐NMR spectroscopy have been applied to the characterization of such compounds. By derivatization of the samples with 2‐chloro‐4,4,5,5‐tetramethyl‐1,3,2‐dioxaphospholane, it is possible to recognize, quantify and evaluate the degradation degree of lipids in archaeological unguent samples. With this new approach, lipids have been recognized in 17th‐century archaeological ointments from the Aboca Museum. Moreover, severe hydrolysis and oxidation markers have been detected.     

Multiple Injury and Health in Past Societies: An Analysis of Concepts and Approaches,and Insights from a Multi‐Period Study

Earlier clinical and bioarchaeological studies found that injury recidivists were most likely to be young adult males. Since then, the clinical meaning of the injury recidivist has expanded to include all individuals with multiple injuries, and other aspects of health have been considered. Our study sought to apply these advances to paleopathology and place multiple injuries in a wider context by investigating: the age and sex distribution of those with single and multiple fractures, and if people with multiple injuries had poorer general health. The sample of 213 males and 190 females (≥18 years old) from six populations in England, Siberia, and Sudan ranged in date from the 3rd century BC to the mid‐19th century AD. Health variables included cribra orbitalia, porotic hyperostosis, periostitis, Schmorl's nodes, enamel hypoplasias, dental caries, and periodontitis. Ante‐mortem injuries were: fractures (0/1/≥2), myositis ossificans, dental trauma, and sharp‐force injuries. The data were analysed using chi‐square and hierarchical loglinear analyses (P = 0.05). No significant three‐way association between age, sex, and injury was found. There was no difference between the sexes when individuals with single versus multiple injuries were compared. There were significant differences in the age‐distribution of people with 0 and 1/≥2 fractures. Males and those 26–35 years old were most likely to have fractures and multiple injuries. Porotic hyperostosis was significantly associated with fractures. There was no significant relationship between general poor health and multiple injuries. Copyright © 2016 John Wiley & Sons, Ltd.     

Rib fractures in the archaeological record: a useful source of sociocultural information?

Investigation of palaeopathological fractures has been shown to provide important information on past societies. However, despite the fact that rib fractures are amongst the most commonly recorded types of fractures in archaeological bone, little attention has been paid to them. Although there will be sites with badly preserved ribs, making their study difficult, this will not always be the case. Recent clinical investigations have highlighted the potential significance of rib fractures with regard to morbidity and mortality, and their importance in relation to health is now appreciated. This study investigates rib fractures in 352 adults from St. Martin's churchyard, Birmingham, England. The crude prevalence of rib fractures was found to be 15.6% and the true prevalence rate 2.3%. The majority of the fractures occurred in males, and those buried in vaults were less likely to have a fracture than individuals from earth‐cut graves. In 11 individuals the fractures were healing at the time of death, and in these cases death was probably related to one of the complications that are frequently linked to fractured ribs. Certain types of accidents may have been linked to these more serious fractures, as 70% occurred in the same anatomical area. Other rib fractures were associated with pathological conditions, such as osteomalacia and osteoporosis. Overall, the study of the rib fractures in this collection provided valuable information that aided interpretation of the lifeways of individuals investigated. It is argued that where preservation permits, studies of fractures in archaeological bone should include ribs. Copyright © 2005 John Wiley & Sons, Ltd.     

Trauma in the city of Kerma: ancient versus modern injury patterns

Injuries, whether accidental or intentional, have incapacitated humans and their primordial ancestors throughout time, although the injury mechanisms have become increasingly more technologically sophisticated. Interpretation of injury aetiology among past peoples is challenging, and often impossible, however, clinical research from developing countries provides a useful analogy with which to evaluate trauma or health patterns of an ancient society. This paper presents a systematic analysis of cranial and postcranial skeletal trauma among 223 adults who were excavated by George Reisner in 1923 from the city of Kerma (1750–1550 BC), Egypt's ancient nemesis in the struggle for control of the Nile River trade route. A total of 156 injuries (fractures, dislocations and muscle pulls among the skull, long bones, extremities and torso) were observed among 88 individuals, 48 of whom had one injury only. The skull was the most frequently traumatized element (11.2%) followed by the ulna (8.3%); 2.4% (48/2029) long bones were fractured. The modal distribution of the Kerma fractures was compared to the fracture distributions of two samples from India and Nigeria where falls were the most common cause of injury. Some characteristics of the three injury patterns were shared: males suffered the greatest frequency of injury, the economically active people (25 to 50 years of age) presented the most injuries among adults, and a small proportion of the victims had more than one major injury. However, the Kerma distribution of the fractured bones varied dramatically from the clinical injury distributions: the ulna and skull were among the least frequently injured bones in the modern samples, while the radius, humerus and lower leg were the most commonly traumatized elements among the modern people, but rare among the ancients. The configuration of the ulna and skull injuries at Kerma was characteristic of those associated with blunt force trauma in other clinical assessments and the absence of these specific lesions from the modern samples where accident was the primary injury mechanism presents a persuasive argument for interpersonal violence among the ancient Kerma people. Copyright © 2004 John Wiley & Sons, Ltd.     

Universal methodology for developing univariate sample-specific sex determination methods: an example using the epicondylar breadth of the humerus

In this paper we present a new methodology for developing sample-specific metric sex determination methods using unidentified individuals that can be applied to archaeological samples. This methodology does not require the assessment of sex of a large sample from pelvic morphological features as a first step in developing the method and instead is developed from a sample of individuals with sex unknown. The procedure involves using the overall mean of a measurement collected from the sample of unknowns as the discriminant criteria for determining the sex of the individuals in that same sample. Experiments with various sample sizes and sex ratios using distal humerus measurements from the Coimbra Collection (Portugal) suggest that allocation accuracies of 83–96% can be expected when the sample used to develop the method is greater than 40 individuals and the sex ratio is less than 1.5:1. The utility of the methodology is explored using the Lisbon Collection (Portugal) and an archaeological sample from Belleville (Canada) is tested as an example. The Lisbon Collection data indicate that joint measurements of long bones will provide the highest allocation accuracies. The results from the Belleville sample confirm that humerus joint measurements consistently provide the highest allocation accuracies (88–100%) even when the sex ratio in the sample used to develop the method is estimated at 1.9:1.