Patterns of Cranial Trauma in a Prehistoric Population from Central California

Evidence of cranial trauma was investigated in a skeletal sample from the site CA-Ala-329 located on the eastern side of San Francisco Bay, Central California. The sample included 365 crania, including 134 adult males, 104 adult females, 22 adults of indeterminate sex and 105 subadults. Evidence of cranio-facial fracture was found in eight individuals, one of whom is an adolescent. Thus, the frequency in adult crania of traumatic injury is 7/260 (2.7 per cent). Of the seven individuals of known sex displaying such cranial trauma, all are male. The injuries are generally suggestive of some form of interpersonal aggression, with five healed vault fractures, one lesion with an embedded obsidian fragment (a probable projectile point) and two healed facial fractures. Further clear evidence of interpersonal aggression has been previously determined in this sample and has been reported at even higher levels elsewhere in California. © 1997 by John Wiley & Sons, Ltd.     

Trauma in the Crusader period city of Caesarea: a major port in the medieval eastern Mediterranean

Caesarea is the first fortified city to undergo palaeopathological analysis of its Crusader period inhabitants. This study of the 12th and 13th century population aims to determine the major types of trauma present, whether from weapon injuries or accidents. Since the Crusades were known for the significant number of battles and raids that took place, weapon injuries were expected to be common. Thirteen cases of trauma are described and a highly unexpected pattern has come to light. These cases do not include one single example of weapon‐related trauma. Every fracture is of a type expected from accidents or interpersonal violence without weapons. Possible explanations include the location of the city deep within Frankish territory and the robust city walls giving effective protection to the inhabitants, and also that the population were involved in activities that left them prone to accidents but not weapon injuries. The other important finding from this study was that the cases of lower limb long bone spiral fractures had healed in a near‐anatomical alignment. This is not what we would expect, as a proportion of these injuries would normally have been unstable and tend to heal poorly aligned. The good position could have resulted from surgeons' use of splints to immobilise the bones while they healed. This suggestion is supported by laws of the kingdom of Jerusalem, which stated that surgeons were to be punished if they allowed such fractures to heal at an angle. Copyright © 2006 John Wiley & Sons, Ltd.     

Palaeoepidemiological Patterns of Trauma in a Medieval Nubian Skeletal Population

Evidence of trauma was investigated in a well-preserved skeletal sample from the Medieval Sudanese Nubian site of Kulubnarti. The skeletal materials derive from two temporally over-lapping Christian cemeteries, dating from the sixth to circa the sixteenth century. The available sample consisted of the skeletons of 146 adults which were investigated for fractures of the long bones, crania and the hands and feet, as well as for dislocations and muscle pulls. Results showed a high incidence of long bone fractures, seen especially in the forearm, and involving 33.5 per cent of individuals. Many of these lesions indicated quite severe injury, and an unusually high number of affected individuals (27 per cent) showed multiple long bone involvement. Conversely, only one possible cranial fracture was apparent. Fractures were also found in 13 hand and seven foot elements. In addition, one hip dislocation and evidence of pulled tendons in 11 individuals were also observed. Compared to other similarly controlled samples, the Kulubnarti population stands out for its high prevalence of healed fractures, the high proportion of multiple involvement and the severity of numerous lesions. The forbiddingly harsh and uneven terrain of this region of Nubia was most likely a major influence on the unusually high prevalence and pattern of traumatic lesions in this group. © 1997 by John Wiley & Sons, Ltd. Int. J. Osteoarchaeol., 7 : 103–114 (1997) No. of Figures: 5. No. of Tables: 5. No. of References: 25.     

‘Parry’ fractures and female-directed interpersonal violence: Implications from the Late Archaic Period of west Tennessee

The recognition of a high frequency of ‘parry’ fractures in the females from the Late Archaic Period (2500–1000/500 BC ) west Tennessee site of Eva prompted a more thorough examination of female-directed interpersonal violence in prehistoric Tennessee sites. The study examined forearm fractures in eight (N = 308) Late Archaic Period hunter-gatherer sites and five (N = 501) Mississippian Period (c. AD 1200–1600) agriculturalist sites. On the basis of chi-square test results, there does not appear to be any gender bias in forearm fracture occurrence in the Archaic Period. The high frequency of female ‘parry’ fractures at Eva was an artefact of the ratio of females to males. More importantly, craniofacial trauma data do not support an aetiology that would explain mid-shaft forearm fractures as a result of interpersonal violence.     

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.     

Radiographic clues to fractures of distal humerus in archaeological remains

Today, distal humeral fractures occur most frequently in children and adolescents, and are usually the result of a fall onto extended arms, or less often on flexed elbows. Trauma to the distal humerus at the physis and epiphyses often produces non‐displaced or mildly displaced fractures that are difficult to recognize radiographically. To help identify these types of injuries, clinicians have developed two measurement techniques that are applied to the X‐rays of the injured bones. In a preliminary attempt to assess the usefulness of these measurement techniques for recognizing trauma in archaeological skeletal remains, 25 humeri from two Ontario ossuary samples were submitted to radiography. Clinical data on distal humeral fractures, their incidence, and mechanisms of injury were also used to interpret the lifestyles and cultural activities of the aboriginal individuals under study. While only one healed fracture was suspected after gross observation, a total of four fractures were ultimately identified using the two measurements, the humerotangential‐angle (HTA) and the anterior hunieral line (AHL). Our results provide indirect, but telling, evidence of accidental childhood injuries to distal humerus in an archaeological population. Copyright © 2001 John Wiley & Sons, Ltd.     

Trauma to the Skull: A Historical Perspective from the Southern Levant (4300BCE–1917CE)

Background: Although the southern Levant is commonly perceived as having been a violent region throughout history, few studies have explored the pattern and intensity of skull trauma through time in the general population. The aim of this study is to follow changes in traumatic injury patterns in the southern Levant, over an extensive period of 6,000 years. Methods: 783 archaeological skulls from the Tel Aviv University osteological collection were examined for evidence of trauma. The specimens were divided into three periods: Chalcolithic‐Bronze‐Iron Age (4300–520 BCE), Hellenistic‐Roman‐Byzantine Period (332 BCE‐640 CE), and Early and Late Arab Period (640–1917 CE). The characteristics of injury on each skull were recorded. Results: A high frequency (25%) of traumatic lesions to the skull was evident among historic populations of the southern Levant, a rate that did not fluctuate significantly over 6,000 years. The most common pattern of trauma was minor circular depressed injuries. Most of the injuries were located on the parietal or frontal bones. Traumatic lesions were more frequent in males than in females, and in mature individuals than in adolescents and children, during all periods. Conclusions: The rate of trauma in the southern Levantine populations was shown to be considerably higher than in other archaeological populations worldwide. The fact that no significant differences in trauma rates were found over time implies that socio‐economical shifts (from agrarian to urban populations) had little impact on the local populations’ aggressive behavior. In contrast, changes in type of injury, from blunt force trauma to sharp force trauma and eventually projectile trauma, reflects changes in weaponry over time. The accumulated characteristics of cranial trauma pattern (type, location, side, size, sex, age) suggest that most of the individuals studied were not engaged directly in warfare. Rather, most injuries seem to be due to blows given during interpersonal violent encounters. Copyright © 2012 John Wiley & Sons, Ltd.     

Analysis of ante mortem trauma in three modern skeletal populations

When archaeological skeletons are assessed, the prevalence (and patterns of bone involvement) of trauma is important. The number and pattern of fractures can be used to gain insight into the occurrence of interpersonal violence, workload and living conditions. However, the question remains as to how these results should be interpreted—such as what constitutes high or low levels of trauma? The aim of this study was to investigate the occurrence of trauma in a population of modern Greeks living in Crete, as well as South African (SA) whites and blacks in the Pretoria Bone and Raymond Dart collections. The sample comprised mostly of older individuals (n = 90–100 within a sex‐population group). Each skeleton was studied for healed trauma. For the vertebrae, only spondylolysis was assessed. In the Greek sample, it was found that 42% of the males and 46% of females had at least one fracture, with corresponding figures of 63 and 44% for SA whites and 83 and 69% for SA blacks. Radius, rib and femur fractures were most common in Greeks, with skull, radius and ribs most common in SA whites and skull, ulna and ribs in SA blacks. These prevalences of trauma are high, but the composition of the samples (mostly of lower socio‐economic origin) should be kept in mind. It may also be questioned whether these individuals reflect the society as a whole. It seems that the fractures in Greeks are mostly related to old age due to falls and accidents (radius and hip fractures), while the SA black sample reflects high prevalences of interpersonal violence (such as cranial vault and ulna fractures). The SA white sample follows a comparatively moderate pattern of trauma. These comparative figures may be useful when assessing trauma in other skeletal populations. Copyright © 2009 John Wiley & Sons, Ltd.     

Evidence of interpersonal violence at the Chalcolithic village of Shiqmim (Israel)

Three circumscribed depressed fractures were found on the skull of an adolescent boy recovered from a primary intramural burial at the Chalcolithic site of Shiqmim, northern Negev, Israel dated to (∼4500–3200 BCE). The fractures were located on the left side and back of the skull. They are circular in outline and have sharp margins containing numerous small bone fragments. These indicate that the skull was fractured when the bone was still fresh and were the probable cause of death. The location of the fractured areas is typical of blows inflicted by a right‐handed individual in face‐to‐face conflict. The size and shape of the fractures, suggests that they were inflicted by a blunt instrument, possibly a mace head. The absence of any signs of healing or infection indicates that all fractures occurred within a short space of time and resulted in death. Neither biological characteristics nor burial pattern show any unique features that distinguish this individual from others recovered at this site. Copyright © 2003 John Wiley & Sons, Ltd.     

The parry problem

Injuries classified as parry fractures, normally the result of a direct blow when the forearm is raised to shield the face, are significant in bioarcheological interpretations because the parry fracture is perceived as an indicator of interpersonal (or extramural) violence. It is therefore necessary that these injuries be correctly identified in order to properly interpret the trauma pattern and its social implications for abuse, gender and power relations among ancient people. Common acute forearm fractures are reviewed here and quantitative guidelines that define the parry fracture configuration are presented. The parry criteria include: (1) an absence of radial involvement, (2) a transverse fracture line, (3) a location below the midshaft (<0.5 adjusted distance to the lesion's center), and (4) either minor unalignment (<10°) in any plane or horizontal apposition from the diaphysis (<50%). A sample of 278 adults from northern Sudan dated to the Nubian Bronze Age (ca. 2500–1500 BC) contained 38 individuals with forearm fractures. Of these fractures, 21 out of the 28 ulna injuries were identified as parry fractures using the parry criteria. Fewer females suffered from parry fractures than when ulna injuries were identified by location on the ulna alone. The use of the parry criteria may not always affect the results significantly, but here interpersonal violence directed against women and amongst ancient Nubians was found to be less prevalent than implied in earlier studies. The absence of perimortem parry fractures suggests that the Kermans interred within mass burials were not physically forced to their graves. Chronic ulna stress fractures associated with sports and habitual activities must also be considered as a differential diagnosis of this injury.     

Childhood trauma in several populations from the Iberian Peninsula

A study was conducted on a collection of 123 juvenile skeletons from various sites dating to the Bronze Age (Argar culture) and from the medieval cemeteries of La Torrecilla, Villanueva de Soportilla and San Baudelio, all in the Iberian Peninsula. No cranial trauma was observed. However, four postcranial fractures were found, including three from Castellón Alto, a typical Argaric village of some urban complexity built on steep terraces in high and rugged terrain. The combination of a hazardous environment and a climate that encourages outdoor play may explain the relatively high frequency of childhood trauma in the burials from the Argar culture. Copyright © 2006 John Wiley & Sons, Ltd.     

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.     

Fracture patterns among the Nubians of Semna South,Sudanese Nubia

A collection of 592 individuals from the site of Semna South in Sudanese Nubia was studied for evidence of healed fractures of the skull and appendicular skeleton. The sample included 241 males, 239 females, 109 subadults and three adults for whom a sex could not be determined. Potential analytical and interpretive bias due to vagaries of preservation was quantified and examined. Almost 21% of the adults exhibited at least one healed fracture, while only two subadults showed such trauma. Rates of fractures, calculated for each bone, varied from a high of 17.9% for the cranium to a low of 0% for the right femur. Some fractures were likely caused by the physical environment, for example, falls along the rocky shores of the Nile. Other trauma, such as craniofacial fractures, found in both males and females, may have been due to interpersonal violence. The high rate of craniofacial trauma may indicate that this group experienced social stress which could have precipitated or intensified interpersonal violence. Copyright © 1999 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.     

The skeleton of a medieval male with multiple traumatic fractures from Piazza della Signoria,Florence, Italy

We report on the palaeopathology of a medieval skeleton of a young adult male with multiple traumatic fractures found in 1989 in Piazza della Signoria, Florence, Italy. The skeleton presents ante mortem fractures of the right ulna and femur, and left tibia and fibula. We reconstruct the dynamics of the accident based on the location and type of fractures. Then we discuss the impact of this severe trauma on the subject's living conditions based on articular and enthesic modifications of the skeleton. Copyright © 2010 John Wiley & Sons, Ltd.     

Craniofacial trauma in the Prehispanic Canary Islands

The current project is a study of craniofacial trauma in a large sample (n = 896) of Prehispanic Canary Islanders (PCIs). The possible causes and social implications of the trauma found are considered, with reference to archaeological and historical data. Variables include the island, period and ecology, the sex and age of the individuals, the distribution of lesions across the skull (by side and by individual bone) and ante‐mortem tooth loss. The results show a fairly high trauma rate (16%), a low prevalence of peri‐mortem trauma (3.8% of all lesions), higher prevalence of trauma in males than in females (25% vs. 13% of all individuals), more cranial than facial lesions (8.9% vs. 3.5% of all elements) and more lesions on the left side of the skull (6.7% vs. 4.5% of all elements) which suggests that the lesions were sustained through intentional rather than accidental agency. There was no correspondence between trauma prevalence and ecology. The archaeological and historical data support the assertion that the lesions may be the result of skirmishing between groups, using weapons such as slingshots, stones and staves. The presence of edged‐weapon lesions on some individuals suggests that these may have been the victims of contact‐period European groups. Copyright © 2007 John Wiley & Sons, Ltd.     

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.     

Trauma and amputations in 19th century miners from Kimberley,South Africa

Trauma is the result of violent accidental or therapeutic events that cause physical or psychological injury. The frequencies and types of trauma within a population can give important information regarding their lifestyle as well as the quantity and quality of medical care available to them. The purpose of this study was to assess the incidence of trauma in the Gladstone sample population with regards to the presence of interpersonal violence a hazardous working environment strenuous working requirements and the availability of medical care. The individuals studied here were diamond miners from Kimberley dating to the late 19th century. A total of 107 well‐preserved skeletons were excavated from unmarked graves after accidental discovery. This sample included 86 males 15 females and 6 individuals of unknown sex. The majority of individuals (71%) were between 19 and 45 years of age. The remains were most likely those of migrant mine workers of low socioeconomic status who had passed away at the local hospitals. All bones were visually assessed for macroscopic indications of traumatic bone alterations and compared to standard palaeopathological texts and photographs. A total of 27% (n = 28) of the individuals in the sample presented with well‐healed healing or perimortem fractures. Fractures to the skull encompassed 49% (n = 20) of all the fractures that were observed. A total of six (6%) amputations were noted. Spondylolysis was observed in 7% (n = 7) of the individuals within the sample and longstanding subluxation was noted in two individuals. The high incidences of cranial fractures within this population are suggestive of high levels of interpersonal violence while long bone fractures spondylolysis and evidence of longstanding subluxations are indicative of the strenuous work requirements and the high‐risk environment to which these individuals were exposed. When considering the presence of well‐reduced fractures and healed amputations it seems that adequate medical care was available to at least some members of this community. Copyright © 2009 John Wiley & Sons Ltd. This article was published online on 17 February 2009. An error was subsequently identified. This notice is included in the online and print versions to indicate that both have been corrected 3 November 2009.     

Bioarchaeological Investigation of Possible Gunshot Wounds in 18th Century Human Skeletons from Korea

Notwithstanding the relative abundance of bioarchaeological evidence of pre‐20th century gunshot wounds discovered at European and American archaeological sites, similar findings in East Asian countries have been very rare. In this study, we report evidence of possible gunshot wounds sustained by two individuals buried in Joseon tombs of Korea. The shapes of the trauma seemed to indicate low‐velocity projectiles, most likely musket balls. To our knowledge, this is the first bioarchaeological report specifically concerning possible gunshot‐wound evidence in East Asian skeletons recovered from archaeological fields. Copyright © 2011 John Wiley & Sons, Ltd.     

A sixteenth‐century warrior grave from Uppsala,Sweden: the Battle of Good Friday

Little is known about the Battle of Good Friday in Uppsala. The historical records are scarce and of limited extent. Moreover, the more spectacular event of the Stockholm Bloodbath has drawn most of the attention from both the contemporary public and later historians. This is why the discovery of a mass grave in the steep slope of Uppsala Castle in 2001 has provoked much interest. An analysis of the osseous material showed that the remains of at least 60 male individuals, mostly between 25–34 years of age, were buried in the excavated area. The demographic profile is largely similar to other European war‐related skeletal assemblages of the same era. Sharp force trauma was exhibited primarily on the skulls, with no obvious dominance to either side. The trauma distribution pattern suggests that the battle was not fought face‐to‐face. Blade wounds concentrated in specific regions imply a standardised technique when delivering the blows. The combination of commingled bones and articulated elements suggests that the individuals were in different stages of skeletonisation when buried. Copyright © 2004 John Wiley & Sons, Ltd.