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.     

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.     

An Examination of the Spatial–Temporal Isolation Model in a Nilotic Population: Variation across Space and Time in Nubians Using Cranial Discrete Traits

Nubian biological evolution has come under much scrutiny in preceding years with strong opinions dividing scholars' beliefs as to how it occurred. A new approach is necessary to elucidate subtleties of their population structure in order to shed light on the complex subject. This study employs a spatial–temporal model in an effort to test if in situ biological evolution was the mechanism for biological change. Biological distance was calculated from the phenotype using 20 cranial discrete traits observed in Nubian samples from the sites of Semna South, Kerma, and the islands of Hesa and Biga. The periods represented at Semna South are Meroitic, X‐Group and Christian, whereas the Kerma site yielded skeletal material from the Kerma period, and the islands of Hesa and Biga date to the Christian period. Mahalanobis D² with a tetrachoric matrix was used to calculate biological distances among the samples, and three‐way Mantel tests were applied to the distance, spatial and temporal matrices. Time was not significantly correlated with biological distance. However, an inverse relationship of time and biological distance is expected under the spatial–temporal model. A lack of significant geographic correlations, as found here, is unusual in most populations, but given the spatial construct of the sites along the Nile, this relationship is not completely unexpected. The lack of significant correlation among time, space and biological distance does not support the in situ hypothesis. Copyright © 2011 John Wiley & Sons, Ltd.     

Who were the Meroites? A biological investigation into the Nubian post‐hiatus group

Scholars have identified a hiatus in the archaeological record of Lower Nubia that spans approximately 1000 years. This interval may represent a desertion of Lower Nubia by its inhabitants. Evidence of occupation did not reappear in the area until the Meroitic time period. However, the identity of the returning people has been the subject of speculation. In order to determine who the Meroites of Lower Nubia were, 20 cranial non‐metric traits were observed on six Nubian groups, representing five time periods. Two groups date to time periods immediately before (Kerma) and immediately after (X‐Group) the Meroitic period. Three additional Nubian groups (two Christian samples from different sites and Sesebi, a contemporary sample) were utilised as outgroups to elucidate a clearer picture of the relationship among the six samples. Mahalanobis D² with a tetrachoric matrix was employed for calculating biological distances among the groups. Principal coordinates analysis produced two clusters of Nubians, where the Meroitics clustered with other Nubian groups. Specific distance scores indicate the Meroites were biologically similar to individuals from the time periods prior to and after their arrival in Lower Nubia. The Meroites therefore appear to be a Nubian group returning to Lower Nubia after its desertion. Copyright © 2009 John Wiley & Sons, Ltd.     

The woman of Pritschoena: an example of the German neolithic neurosurgery in Saxony-Anhalt

We present an outstanding example of successful prehistoric double trephination dating between 2700 and 2200 BC, most likely to the Corded Ware culture, at the end of the Neolithic Age. The particularity of this case is the presence of a double trephination, one frontal over the sinus sagittal superior and one parietal right. There is evidence that the patient survived months to years after the operations. The purpose of the procedure is not known. The case confirms the astonishing degree of technical skills reached in Saxony-Anhalt over 4500 years ago without anesthetic, antiseptic, or technologic aids.     

The woman behind the syndrome: Frey's syndrome — the untold story*

We present an outstanding example of successful prehistoric double trephination dating between 2700 and 2200 BC, most likely to the Corded Ware culture, at the end of the Neolithic Age. The particularity of this case is the presence of a double trephination, one frontal over the sinus sagittal superior and one parietal right. There is evidence that the patient survived months to years after the operations. The purpose of the procedure is not known. The case confirms the astonishing degree of technical skills reached in Saxony-Anhalt over 4500 years ago without anesthetic, antiseptic, or technologic aids.     

Diagnostic criteria for identification of seashell as a trephination implement

Scanning electron microscopy has been applied to experimentally cut bone samples and an ethnographical example of trephination on a human skull in order to produce diagnostic criteria for the identification of mollusc shells as cutting implements used in trephination. Shell scrapes are identifiable by parallel striations in the direction of cut, crossed at 90° by chatter marks caused by uneven movement of the fragile shell-edge across the bone surface.     

A temporal bone lesion in a modern subject to explain a defect in the Kabwe skull

The skull of a dissection room subject was noted to have a hole in the left squamous temporal bone similar to a lesion in the Kabwe (Broken Hill) skull. Kabwe man has an 8 × 8 mm hole situated 2 cm above and slightly anterior to the left external auditory meatus (EAM). This report describes a possible mechanism for the causation of that lesion, which is illustrated by features on a modern skull. The subject is a 55-year-old man who died from carcinoma of the stomach in 1942. The skull was macerated, defatted and stored after the cadaver had been dissected by medical students. In the squamous temporal bone there was an oval shaped 9 × 8 mm hole. The base of the oval was situated 11 mm above the superior margin of the EAM with the central axis of the hole being in line with the anterior margin of the EAM. This hole forms the base of a larger intracranial pit measuring 21 mm in diameter. The hole has an irregular margin except superiorly where it is smooth and rounded, indicative of healing. Intracranially, the petrous temporal bone displayed a marked exophytic, bony outgrowth suggestive of a chronic infective condition. The tegmen tympani contained a hole 3 mm in diameter in the middle of the exophytic area. No sign of disease in the mastoid process was noted. These findings are compatible with advanced chronic ear disease which has tracked into the extradural space through the tegmen tympani, become loculated, and then eroded the squamous temporal bone. The Kabwe skull shows signs compatible with chronic ear disease. It is suggested that a mechanism similar to the one described in the modern skull could explain the lesion in the left squamous temporal bone of Kabwe man.     

Partial cranial trephination by means of Hippocrates' trypanon from 5th century BC Himera (Sicily,Italy)

The paper deals with a new case of partial cranial trephination found in one of the necropolises of the Greek colony of Himera in Sicily. It is one of the very few cases of cranial trephination of Greek classical age. Macroscopic as well as radiological investigations prove that the operation was perimortal as no growth of new bone could be detected, SEM‐EDS microanalysis of the piece revealed the traces left by the tool used during trephination. The review of ancient Greek and Latin medical and surgical texts permitted us to establish that the tool used in Himera was a (trypanon) mentioned by Hippocrates and named terebra by Latin authors. Copyright © 2010 John Wiley & Sons, Ltd.     

SHEEPSKIN FROM ANCIENT KERMA, NORTHERN SUDAN

Summary. The material described came from the Ancient Kerma civilisation (c. 2000 B. C.) and comprised 19 haired skin samples from Kerma itself with a further nine from the site of Kadruka. Diameter distributions were determined on hair cut from the skin, and the skin itself was sectioned histologically in a plane parallel to the skin surface.
Most of the samples had a non-fleeced'Hair'type of coat, but three were immensely interesting in suggesting fleeces of hairy medium type, which represents the first indication of the development of a fleece.
The distribution of most of the hair diameters was that of the winter coat suggesting that the animals had been killed during the winter. This was supported by the presence of inactive wool roots within the skin.     

The Obvious in a Nutshell: Science,Medicine, Knowledge,and History

The scope and mission of the history of science have been constant objects of reflection and debate within the profession. Recently, Lorraine Daston has called for a shift of focus: from the history of science to the history of knowledge. Such a move is an attempt at broadening the field and ridding it of the contradictions deriving from its modernist myth of origin and principle of demarcation. Taking the move from a pluralistic concept of medicine, the present paper explores the actual and possible contributions that a history of knowledge can offer to the history of medicine in particular. As we will argue, the history of medicine has always been a history of knowledge, but for good reasons has always stuck to the concept of medicine as its object and problem throughout the ages, including the modern, scientific one. We argue that, in the history of medicine, the demarcation between scientific and non‐scientific represents an accident, but is not foundational as in the case of natural science. Furthermore, the history of medicine programmatically played a role in at least two academic domains (history proper and medical education), adjusting historical narratives of medical knowledge to its audience. Accordingly, we underscore that the history of both science and medicine, as traditionally defined, already provides room for almost the whole spectrum of approaches to history. Moreover, their different myths of origin can, and indeed must, be included in the reflexivity of the historical gaze. We argue that the position towards a history of science, medicine, or knowledge is not a question of narrative or theory, rather, it is a question of relevance and awareness of extant contexts.     

Wind and temperature effects on F-region medium-scale gravity waves estimated using a multi-layer atmospheric model

Diurnal variations in the propagation direction of atmospheric gravity waves, and the travelling ionospheric disturbances to which they give rise, have been observed in many experimental observations and several modelling studies have demonstrated that this is primarily due to the corresponding diurnal rotation in the direction of the thermospheric wind. Other variations have been attributed to seasonal or other effects, but the effects of variations in the thermospheric temperature have not previously been analysed in detail. We present results from a study of the propagation of gravity waves through a layered atmosphere in which the thermospheric wind and temperature are derived from a three-dimensional time-dependent model. The analysis has been carried out for a range of wave speeds and periods, and for a range of times, seasons and propagation azimuths. Results suggest that a significant diurnal variation in the transmission coefficient for waves propagating through the thermosphere exists with seasonally dependent maxima. Transmission increases for increasing wave period up to about 50 min, after which it remains approximately constant. Maximum transmission occurs for wave phase speeds around 200–250 m/s and falls to zero for speeds less than about 100 m/s. An exception to this rule occurs for waves with periods less than 40 min and speeds less than 50 m/s for which significant transmission appears to be theoretically possible.     

Fractures of the lower limbs and their secondary skeletal adaptations: a 20th century example of pre‐modern healing

This study focuses on an old male skeleton, which shows severe fractures of the right femur and of the left tibia and fibula. The skeleton, complete and in a good condition of preservation, comes from a Sardinian osteological collection (from the beginning of 1900 AD) with known age, sex and life‐activity. The features of the fractures and pattern of joint disease, enthesis development and enthesopathies have been studied in order to ascertain a possible cause for these traumatic events, the functional implications for postural and locomotory behavior and, finally, the eventual evidence of medical treatment. Copyright © 2004 John Wiley & Sons, Ltd.     

Trepanation in Italy: A Review

This paper reviews and discusses cases of skull trepanation in ancient Italy on the basis of information provided by the literature. A total of 54 individuals from 43 different Italian archaeological sites were found to have evidence of trepanation. The analysis of evidences of trepanation in Italy has demonstrated that no differences can generally be perceived between the trepanned individual and the social context of the burial, leading to exclude a special role of the former within the group. Trepanation in Italy covers a time span of approximately 7000 years, the most ancient cases dating back to the fifth millennium bc and the most recent to the 18th–19th centuries ad . The geographic distribution appears quite homogeneous, with a prevalence of cases in Central Italy and abundant evidence from prehistoric Sardinia. The majority of individuals show a single trepanation, whereas others present skulls with multiple holes. Trepanation in Italy was reserved to adult individuals, except for some rare cases, and shows a relevant preponderance for the male sex. The most diffused technique is scraping; cutting and drilling are less attested, especially as unique techniques for trepanation, but they were used more frequently in combination with scraping. Trepanation could in some cases be hypothesised as therapeutic intervention for the treatment of a traumatic wound or of other pathologies, whereas in other cases, a number of evidences are attested of trepanation performed as probable ritual intervention or as experimental surgery; in the remaining cases, the reasons for trepanation are unclear or not determinable. A high percentage of long‐term healing associated with trepanation has been evidenced. Copyright © 2017 John Wiley & Sons, Ltd.     

Remembering a Vietnam War Firefight: Changing Perspectives over Time

Intense, deadly combat is one of the most traumatic of humanexperiences. How veterans remember it and how they retell it,is explored in this article by Marine Corps Oral Historian FredH. Allison. Allison compares two interviews of the same Marinetalking about the same horrific Vietnam firefight in which fiveof eight Marines on a reconnaissance patrol were killed. Oneinterview took place in-country two days after the firefight,the other 34 years later. The early interview is an oral snapshotof the world of a combat Marine, while the later interview isa study in how memory reconstructs a combat experience. In comparingthe two interviews the reader can begin to understand how veterans'memory works to organize and make comprehensible an event thatmight not have been orderly or comprehensible in the first place.     

Architecture,Power, and Communication: Case Studies from Ancient Nubia

Monumental architectural remains are among the most impressive relics of the ancient civilizations. Of course, this is also true for ancient northeast Africa. In this contribution, monumental architecture is considered not just as a static marker and manifestation of power, often embedding the state itself in the landscape, but as a location, a setting for performing public activities which are producing and replicating social relations. Some case studies of the Kerma and Meroitic cultures of ancient Nubia are discussed. Hypotheses on the ceremonies taking place are proposed.     

Trephination as a possible treatment for scurvy in a middle bronze age (ca. 2200 BC) skeleton

Although trephination of sub-adults in antiquity is rare, scurvy both infantile and adult, is even more rare in the archaeological record. Pathological changes appearing in the maxilla, mandible and orbits of a child of 8–9 years of age are highly suggestive of infantile scurvy. Advanced forms of this metabolic disturbance lead to severe subperiosteal haemorrhaging, at times turning the skin of the face and skull black. This condition may have led to the trephination along the sagittal suture as a form of blood letting in hopes of draining the subperiosteal haemorrhage in the cranium. Although cause and effect are often confusing in antiquity, the surgical intervention presented here led to the ultimate death of the child.     

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.     

Skeletal metastatic carcinoma: A case from 15th–20th century Coimbra,Portugal

This paper discusses the differential diagnosis of unusual and distinct pathological changes in the skeletal remains of a 40+‐year‐old female from 15th–20th century Coimbra (Portugal). The most affected area seems to have been the skull, but multiple lesions, lytic and/or blastic, have been found throughout the post‐cranial skeleton, more specifically in the scapulae, clavicles, humerus, sternum, ribs, sacrum, innominates and femurs. The differential diagnosis of the lesions gave rise to several possible pathological conditions, namely, Langerhans cell histiocytosis (granulomatosis or Histiocytosis X), multiple myeloma and metastatic carcinoma. Various macroscopic and radiological aspects lead us to consider metastatic carcinoma as the most probable diagnosis. Despite the argumentative identity of the possible primary lesion, age, sex and the mixed nature of the osseous response are consistent with cancer of the breast but do not exclude other carcinomas, namely lung cancer. With temporal and regional differences emerging in the frequency of malignant tumours, the identification of new cases becomes important, particularly from geographic areas where few cases have been reported. In fact, the present report adds to the only case of metastatic carcinoma detected in non‐identified Portuguese human skeletal remains until now. Copyright © 2009 John Wiley & Sons, Ltd.     

Evidence of Stress Fracture in a Homo antecessor Metatarsal from Gran Dolina Site (Atapuerca,Spain)

We present the palaeopathological analysis of a right fourth metatarsal (ATD6‐124) recovered from the Atapuerca–Gran Dolina site (Spain). This fossil, ca. 1 Ma, belongs to Homo antecessor, the earliest known European hominin species. The metatarsal exhibits a proliferative lesion on its medial periosteal surface. Periosteal reaction can be the bone response to a wide number of injurious processes. We describe a lesion on the basis of macroscopic and microscopic analyses, including microtomography and scanning electron microscopy. Externally, the osteoblastic lesion presents a highly porotic and disorganised morphology. Internally, we observe a series of micro‐fractures on the compact bone that do not affect the medullary canal. We provide a differential diagnosis and suggest that the ATD6‐124 lesion could correspond to a pedal stress fracture, also known as fatigue or march fracture. Stress fractures have been related to a load increase and muscular fatigue. This type of fracture has been widely reported in the foot of soldiers and athletes, which are usually engaged in strenuous, excessive or prolonged locomotive activities. Despite its high frequency in these groups, stress fractures have not been reported as such in fossil collections, with the exception of a metatarsal belonging to the Sima de los Huesos site (Atapuerca). Copyright © 2013 John Wiley & Sons, Ltd.