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.     

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.     

‘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.     

Adult fracture patterns in prehistoric Thailand: a biocultural interpretation

The prevalence and distribution patterns of trauma in samples of human skeletal remains can reflect the risks to which the community was exposed in daily activities or as a result of interpersonal violence. This paper describes the patterns of non‐vertebral fractures in skeletal samples from four prehistoric Thai sites in terms of long bone fracture rates and individual prevalence rates. The sites range in date from c. 2000 BC (Neolithic) to 400 BC (late Bronze Age), and in environment from coastal estuarine to seasonally dry upland plains. These differences in the natural and cultural environment provided a basis for comparison among the samples representing nearly 300 adult individuals. The types of fractures ranged from simple to severe, but most had healed successfully with few limiting complications. The small bones of the hands and feet as well as clavicle and forearm bones were most frequently fractured among all samples. Overall there was an increase in the major long bone fracture rates from the Neolithic (0.3%) to the Bronze Age (3.0%) that may reflect a change in subsistence activities such as land clearance for the intensification of rice agriculture. The prevalence of ulnar fractures is particularly high in the Bronze Age, and the analysis of their possible cause, combined with evidence for craniofacial fractures, is suggestive of the presence of interpersonal violence in a small number of individuals. Copyright © 2006 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.     

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 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.     

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.     

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.     

Lucayan–Taíno burials from Preacher's cave,Eleuthera, Bahamas

In March 2007, three prehistoric skeletons were excavated and analysed from Preacher's Cave on the northern aspect of the island of Eleuthera in the Bahama archipelago. The human skeletal remains represent two males and one female dating to AD 800–1300. The first is a female in the 30s with mild osteoarthritis of the joints and spine and several healed fractures who may have been an important community elder. The second is a male in the 20s with Schmorl's nodes who may have been a shaman or even a victim of interpersonal violence. The third is a male in the mid to late 20s also with marginal osteoarthritis of the joints and spine who may have been a ceremonial leader and village headman. The high incidence of carious lesions implies a cariogenic diet possibly rich in starchy foodstuffs or even fructose. The presence of grave goods and plaited mats suggest that at least two individuals may have been of high status. This study emphasises the significance of caves to Lucayan–Taíno mythology, cosmology and mortuary practice. Copyright © 2010 John Wiley & Sons, Ltd.     

Age-dependent cortical bone loss in a medieval population

Age-dependent cortical bone loss was studied in a skeletal assemblage from a British medieval site using metacarpal radiogrammetry. Significant loss of bone was found in the females but not in the males. The magnitude of bone loss in the older females relative to their younger counterparts was found to be similar to that reported for modern European subjects. Low cortical bone was associated with healed fractures of the highly trabecular bone of the axial skeleton, and this observation is suggestive that weakening of the skeleton due to loss of bone substance precipitated such fractures, as it does in modern Western women. The broad similarities between the medieval and modern data may call into question the importance of lifestyle factors in influencing the severity of osteoporosis, at least as far as loss of cortical bone is concerned.     

Life on the Edge of the Arctic: The Bioarchaeology of the Keldudalur Cemetery in Skagafjörður,Iceland

Burials were examined from the late Viking Age early medieval Christian cemetery at the farm of Keldudalur in the Skagafjörður region, Northern Iceland. The cemetery likely served a single household for about 100–120 years, from the beginning of the 11th century AD to the turn of the 12th century. Cemetery inhabitants represent a population that lived through the transitional period when Christianity was established in Iceland. The changes are visible in the mortuary record with the changeover from outlying pagan graves to enclosed Christian cemeteries situated on the farmsteads. Keldudalur is one of the numerous early Christian family cemeteries that littered the 11th century Skagafjörður landscape. The burials included 53 well‐preserved skeletons of 27 adults and 26 subadults. Various factors such as fluctuating climate and environmental conditions, and seasonal or periodical availability of resources have the potential for impacting human diet and health over time. To assess the health status of the burials, data were collected for a number of health status indicators such as stature estimation, developmental enamel defects, porotic hyperostosis, infectious disease, trauma, degenerative joint diseases, dental caries, calculus and tooth loss. Results suggest that inhabitants of Keldudalur experienced periodic stress and rigorous living conditions. Infant mortality was great, although if individuals survived childhood, the age expectancy was fairly high. There was no obvious evidence for interpersonal violence or endemic infectious disease. However, the common occurrence of growth disturbances, generalised periostitis, trauma and degenerative joint disease all point to a number of stressors in the lives of the people at Keldudalur, which is suggestive of a resilient people living and adapting to a harsh and periodically resource scarce subarctic environment. Copyright © 2015 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.     

Comparative Study of Perimortem Weapon Trauma in Two Early Medieval Skeletal Populations (AD 400–1200) from Ireland

Violence was a reality of life in early medieval Ireland (AD 400–1200). Its omnipresence is indicated from numerous narratives of regicide, mortal conflicts, battles and warfare that survive in ancient myths, legends and annalistic accounts. The archaeological evidence of violence and conflict is mainly identified in the osteoarchaeological record, and approximately 13% of all skeletal populations from excavated early medieval cemeteries in Ireland have shown evidence of weapon trauma. This study considers the osteological representation of violent deaths in two contemporaneous Irish skeletal populations dating to this period: Mount Gamble in County Dublin and Owenbristy in County Galway. This analysis involves assessing the different anatomical regions of the body for evidence of lesions that can be attributed to weapon trauma. The results indicate that these populations are likely to have been exposed to violence under differing circumstances; the evidence suggests that the individuals from Mount Gamble may have been well equipped or skilled at interpersonal battle, in contrast to the majority of individuals from Owenbristy who may have been unprotected and unprepared. The presence of two adolescents and two adult females amongst the victims from the latter population gives insight into a wider social dimension of weapon trauma in early medieval Ireland. There is also evidence of postmortem mutilations and decapitations, which reflect ritualistic aspects of violence. Copyright © 2012 John Wiley & Sons, Ltd.     

Spondylolysis in a pre‐contact San Francisco Bay population: behavioural and anatomical sex differences

Spondylolysis refers to a separation of the spinal body from the arch. Researchers have documented that these fractures occur due to stresses related to activities involving the lower limb and back. Spondylolysis in sacral and lumbar vertebrae of 146 (66 males, 66 females, 14 indeterminates) California Amerinds were examined to determine whether sex differences were present. Sacral anatomy (i.e. sacralisation and lumbarisation, sacral base angles, and superior facet morphology) was analysed in relation to spondylolysis and sex, to explore whether sex differences could be better explained through activity patterns or anatomical variation. Spondylolysis afflicted 24 individuals (16.4%). Males had more than twice the rate of spondylolysis than did females (26% and 11%, respectively). Activity patterns, such as thrusting and throwing shafted obsidian points, could explain the sex differences. Males were most frequently buried with obsidian point artefacts, whereas females were buried with mortar and pestles. For sacral anatomy, only males had lumbarisation, and all other anatomical variation had no significant sex differences. Lumbarisation related to spondylolysis in males. In this study, sacral anatomical variation could not fully account for sex differences in spondylolysis; activity patterns provided a better explanation. Nonetheless, anatomical variation may predispose males to spondylolysis, or spondylolysis may affect sacral anatomy. Copyright © 2008 John Wiley & Sons, Ltd.     

A re-assessment of Basketmaker II cave 7: massacre site or cemetery context

Our ongoing investigation of early maize farming in the American Southwest has entailed stable isotope analysis and accelerator radiocarbon dating of Basketmaker II remains from sites in the Four Corners region. Here we report radiocarbon dates on a large mortuary assemblage excavated by Richard Wetherill in 1893 from a burial cave in southeastern Utah. It has long been thought that all individuals interred in Cave 7 were massacred in a single violent attack given embedded projectiles and evidence for blunt force trauma. However, accelerator radiocarbon dates on purified bone collagen (n = 96) do not lend strong support to this argument, even among the subset of individuals with clear evidence for violent injuries. Moreover, nearly 80% of Cave 7 burials examined in the study show no evidence of perimortem trauma and no adult females or subadults under the age of 12 appear to have suffered violent deaths. Rather than an anomalous single-event massacre, the Cave 7 radiocarbon dataset suggests that raiding and intra-group, male/male violence was episodic among Basketmaker groups in southeastern Utah. Population densities were relatively high and individuals interred in Cave 7 and elsewhere in the region were heavily dependent on maize agriculture, a prehistoric economic strategy typically characterized by high amplitude fluctuations in productivity. Variability in the array of grave goods accompanying Cave 7 male burials and elsewhere suggests competitive social differentiation likely heightened during periods of resource shortfall leading to intra-group conflict, raiding and perhaps ritualized acts of violence.     

Consequences of conquest? The analysis and interpretation of subadult trauma at Puruchuco-Huaquerones, Peru

This paper examines bioarchaeological evidence of violence and traumatic injury on subadult skeletal remains from two Late Horizon (A.D. 1470-1540) cemeteries within the archaeological zone of Puruchuco-Huaquerones, Peru. Here we present the frequency and types of traumatic lesions on the 242 subadults analyzed. We observed significant increases in the frequency of subadult trauma, particularly among the burials associated with Spanish Conquest. Specifically, we noted a statistically significant increase in the frequency of cranial trauma in a subsample of individuals from one of two cemeteries at the site, 57AS03. These perimortem cranial injuries suggest an intensification of violence and lethality that may have affected the children from this community. We then discuss the biocultural implications of this analysis within the context of Spanish invasion and conquest.     

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.     

Childhood Cranial Trauma from a Late Roman and Merovingian Context from Michelet,Lisieux, France

The Michelet necropolis in Lisieux, France, dating to the late Roman and Merovingian period, comprises of a large number of well‐preserved subadult remains offering a unique opportunity to better understand childhood trauma in the past. The focus of this study was to determine the amount, type and mechanisms of trauma evidenced in subadults from the 4th–8th century AD, and explore potential circumstances surrounding the trauma. The remains of 109 subadults from the Michelet necropolis were examined for the presence of cranial and post‐cranial trauma. Three individuals exhibited perimortem trauma, one individual had an antemortem cranial injury, and no cases of post‐cranial trauma were identified. Cranial trauma affected 4.1% of children with observable cranial remains (N  = 4/97). The children affected were young (2–7 years old), making it unlikely that they would have participated in militaristic activities. Based on the location, morphology and mechanism of injury identified, it is likely that the perimortem injuries sustained by three children were not accidental. The presence of a number of cranial injuries from this site may be related to increased stress in the community related to the decline of the Roman Empire in Gaul, possible raiding barbarian groups during the 4th–5th centuries, or stresses related to the Gallic aristocracy solidifying political powers in northern Gaul during the 5th–7th centuries AD. The consideration and inclusion of childhood trauma in bioarchaeological analyses allows for a more detailed and in‐depth understanding of violence and childhood in the past. Copyright © 2017 John Wiley & Sons, Ltd.     

Skeletal trauma in the burials from the royal church of St. Mary in medieval Oslo

The considerable collection of skeletal remains from the royal Church of St. Mary (c.1050–1540 AD) in Oslo constitutes part of The Schreiner Collection at the Department of Anatomy, University of Oslo. The remains reveal a high incidence of skeletal trauma, especially injuries caused by sharp‐edged weapons and extensive violence. Evidence of sharp force trauma was primarily observed on the crania. There were a surprisingly few injuries on postcranial skeletal elements. The injuries were mostly observed on middle‐aged and older men, but also on women and subadults. Some of these injuries may be linked to the civil wars in Norway during the 12th and 13th centuries. In most cases, the trauma distribution pattern suggests standardized fighting techniques. Copyright © 2010 John Wiley & Sons, Ltd.