Trauma

Trauma is a pathological condition that varies in type and frequency depending on culture and physical environment. Trauma to the skeleton can be divided into two categories: (1) accidental or unintentional trauma, such as fracture that results from a fall, and (2) intentional trauma or injury purposefully caused by another human being. Intentional trauma includes injury resulting from violence (Figure V. 1.1) in warfare or interpersonal conflict, which may result in broken long bones or a fractured skull, as well as trauma induced by a therapeutic procedure.

One of the most remarkable forms of trauma in antiquity was a surgical procedure known as trephination, whereby a portion of the skull was removed, great care being taken to avoid penetration of the underlying dura. Trephination was first reported for Paleolithic Poland (Gladykowska-Rze-czycka 1981). The procedure apparently became more common in the Neolithic period, in France, England, Denmark, Germany, Italy, and Russia, and it continued into the Middle Ages (Steinbock 1976). Trephined skulls have also been reported from the Near East for the Neolithic period through

Figure V.l.l. Probable unhealed ax wound in an adult male skull from a rock tomb at Lisht in Upper Egypt dated between the Twentieth and Twenty-fifth Dynasty (c. 1100-655 B.C.). Bone fragment produced by the blow at the time of death is reflected to the right. Note the lack of remodeling on the cut surface indicative of death at the time of or shortly after the trauma. (From Catalog no. 256384, National Museum of Natural History, Washington, D.C.)

Figure V.l.l. Probable unhealed ax wound in an adult male skull from a rock tomb at Lisht in Upper Egypt dated between the Twentieth and Twenty-fifth Dynasty (c. 1100-655 B.C.). Bone fragment produced by the blow at the time of death is reflected to the right. Note the lack of remodeling on the cut surface indicative of death at the time of or shortly after the trauma. (From Catalog no. 256384, National Museum of Natural History, Washington, D.C.)

the Iron Age (Wells 1964a; Lisowski 1967; Ortner and Putschar 1981; Rathbun 1984) and from the eastern Mediterranean for the Bronze and Iron ages (Ortner and Putschar 1981; Grmek 1989); however, in the Near East and eastern Mediterranean the practice apparently was not common.

Evidence of healing, as indicated by antemortem remodeling of cut edges in trephined skulls, is common. But even when there is no evidence of healing, death may have been caused by factors other than the surgical procedure, such as a blow to the head, to which the trephination was a therapeutic response (Lisowski 1967; Ortner and Putschar 1981).

Although it may not be possible to determine all the reasons that trephination was performed, among some populations treatment for trauma seems to have been a common objective. Perhaps mental illness and epilepsy served as additional reasons. In Danish skulls trephination is found almost exclusively in male specimens, with the left side being the one most commonly operated on (Bennike 1985). This pattern suggests that trephination was the therapeutic procedure for a blow to the cranium, resulting from violence among men and usually inflicted by a right-handed opponent.

Other types of trauma found in archeological skeletal remains reveal information about early lifestyles. In general, male skeletons show a higher rate of trauma, especially violent trauma, than do female skeletons. In the eastern Mediterranean, from the

Early Neolithic (c. 6500 B.C.) to the Roman period (A.D. 120), the frequency of skull wounds in men ranged from a high of 20 percent in the Early Neolithic to a low of 3 percent in the Classic period (650 B.C.). For women, the frequencies were 3 to zero percent for the same periods (Angel 1974). In Iran between 5000 and 500 B.C., there was a much higher rate of head wounds among men than among women (Rathbun 1984). At the site of Hissar in Iran, occupied from the Chalcolithic through the Early Bronze Age (4000-2000 B.C.), W. M. Krogman (1940) noted that men suffered three times more head wounds than women. In contrast, for the same time period in neighboring Iraq, T. A. Rathbun (1984) found no difference in rates of head trauma between the sexes. In fact, the postcranial material he studied for both Iran and Iraq revealed no differences between the sexes. Yet a Late Period site (664-323 B.C.) in Egypt revealed cranial trauma in 20 percent of the adult males and 8.3 percent of the adult females (Strouhal 1986).

Another pattern in the early skeletal material is the rarity of evidence of fracture or trauma in children (Grmek 1989). Specifically, this has been noted for Bronze Age Greece (Angel 1957), Denmark from the Mesolithic period through the Middle Ages (Bennike 1985), Mesolithic western Europe (Meiklejohn et al. 1984), and Late Period Egypt (Strouhal 1986). These observations, however, pose a potential methodological problem. Remodeling associated with growth generally obliterates any evidence of fracture in children, particularly if it occurs in early childhood. Thus, evidence of fracture or other trauma in children is often not seen in skeletal remains unless the child died shortly after the traumatic event.

One of the fractures most frequently seen in the pre-Roman world was caused when an individual, in attempting to protect the head, absorbed a blow with the forearm. This injury, called a parry fracture, most often involved the left ulna.

There have been several surveys of the incidence of forearm fractures. J. Angel (1974) found that, in prehistoric Greece and Turkey, forearm fracture was the most common form of injury. F. Wood-Jones (1910a) reported that, in pre-Dynastic through Byzantine Nubia, 31 percent of all fractures occurred in the forearm, with the ulna being broken more often than the radius and the left side more often damaged. In a British Neolithic to Anglo-Saxon series (c. 3500 B.C. to A.D. 600) fracture of the forearm bones (radius and ulna) was the most common form of postcranial injury, representing almost 49 percent of all fracture cases (Brothwell 1967).

In the eastern Mediterranean the next most common fracture site was the lower thoracic vertebrae. Fracture of the vertebral region also showed the least amount of difference between men and women (Angel 1974).

Fractures of the lower extremity are uncommon in the eastern Mediterranean (Angel 1974). In Nubian skeletons from the pre-Dynastic to Byzantine periods fractures of the foot are rare, and those of the leg are less frequent than those of the arm (Wood-Jones 1910a). In Mesolithic to medieval Danish skeletal material, fracture of the lower extremities is rare (Bennike 1985).

A review of the literature on trauma reveals several chronological trends. For the Mesolithic period through Iron Age, the rate of trauma generally seems to decrease. However, this decrease is related primarily to accidental trauma; the incidence of violent trauma appears to remain the same. For example, Angel observed that, in the eastern Mediterranean, the general rate of fracture decreased with the development of civilization but the rate of violent injury to the head remained the same (Angel 1974). Although P. Bennike (1985) did not find any time-related pattern for the postcranial Danish material, her data reveal that cranial trauma decreased over time. She also found that trauma to the skull was more common in the Mesolithic (8300-4200 B.C.) than in the Neolithic (3200-1800 B.C.), and more common in the Neolithic than in the pre-Viking Iron Age (c. 500 B.C. to A.D. 800). Bennike did not differentiate between accidental and intentional trauma.

The tendency for the incidence of trauma to decrease through time was also noted for western Europe (Meiklejohn et at. 1984) and for Iran and Iraq (Rathbun 1984). C. Meiklejohn and colleagues (1984) tentatively hypothesize that the reduction in trauma, in Mesolithic and Neolithic Europe, which in their sample was a reduction in overall accidental trauma, was due to a more sedentary existence. Rathbun (1984) observed an apparent tendency for trauma in material from Iran and Iraq to decline from the preagricultural to the urban phases several thousand years later. Although he could not differentiate between accidental and intentional trauma in the earlier skeletal material, he noted that much of the trauma of the later periods appeared to be due to human violence.

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