Trauma and treatment in the British Isles in the Historic Period • 227 



LIMITATIONS OF THE EVIDENCE 



There arc a number of significant restraints on the data for 

 these classes of evidence but the main areas become readily 

 apparent. They are brietly reviewed here and discussed in 

 more detail later in the paper. 



FRAGMENTARY SKELETONS. Investigation of a large number 

 of cemetery sites from different areas of the British Isles was 

 considered essential to obtain a valid picture of trauma. How- 

 ever, the number of cemetery sites examined precluded es- 

 timation of an absolute incidence of particular fractures. Data 

 was not available for counts of individual bones for most of 

 the sites. First, it was not feasible in terms of time to under- 

 take this work as part of the research, and second, it was felt 

 that it was not a particularly relevant area of study for the 

 subject matter of this project. 



AGE AT FRACTURE. Agc-spccific incidence rates of fractures 

 have been quoted by many workers in human skeletal reports 

 but, in fact, these data mean little. Fractures evident on skel- 

 etons could have occurred at any time prior to death. There is 

 currently no method of estimating at what age a fracture 

 occurred in ancient skeletal material beyond about one year 

 after the injury, unless the fracture occurred close to death 

 and there is extant evidence of very new bone formation or 

 primary callus. 



SUBADULT FRACTURES. Grccnstick fractures occurring in 

 childhood, even in modem populations, may heal and re- 

 model so well that the original fracture line may not be visible 

 on x-ray. In ancient populations these fractures may not be 

 recognized even macroscopically. 



RECENT ANTEMORTEM FRACTURES. Fracturcs Occurring 

 shortly before death may be difficult to distinguish from 

 postmortem fractures of bone due to burial and/or excavation. 



STRESS FRACTURES. Stress fractures will not be identified 

 unless all the bones of every skeleton are x-rayed. Even so, 

 many will not be evident on an x-ray. 



SKULL INJURIES AND BRAIN DAMAGE. Consideration of skull 

 injuries and their potentially associated brain damage can be 

 problematical. Some types of head injuries induce con- 

 trecoup damage to the brain while others produce direct 

 damage to the subjacent brain. In addition, complications of 

 skull injury can be complex and multifactorial. 



TREPANATION. In somc cascs it is difficult to distinguish 

 between postmortem holes in the skull and trepanation and, 

 of those trepanations which have no injury associated with 

 them, one can only speculate on the raison d'etre. 



ART AND LITERATURE. Representations of past events in an 

 or literature are inevitably controlled by the author's or art- 

 ist's preferences or interpretation, and their validity as evi- 

 dence of disease or therapy is questionable. 



MODERN PRIMITIVE SOCIETIES. These populations are sepa- 

 rated in both space and time from ancient British societies but 

 they may be comparable in terms of their disease concepts 

 and treatment. 



ARCHEOLOGiCAL EVIDENCE. Interpretation of archcological 

 evidence is controlled by the remains studied. All material 

 remains are a sample of what was actually deposited in the 

 ground and many factors determine their survival and ex- 

 cavation. For example, splints u.sed for fractures were proba- 

 bly constructed from biodegradable material, such as wood, 

 and either do not survive to be excavated due to site-specific 

 soil conditions or were not buried with the skeleton. Most 

 fractures seen by the paleopathologist are healed and there- 

 fore do not need to remain splinted at death and burial. 



Notwithstanding the limitations present in all forms of 

 archcological research, the potential for the study of trauma- 

 tic lesions in human skeletal remains is considerable. 



This paper does not present a definitive analysis of results 

 because the research program is still in progress. This report, 

 which is therefore interim, seeks to outline the sources of 

 evidence used and the rationale thereof, the observational 

 methodology and the criteria of analysis of those sources. 



METHOD 



SKELETAL EVIDENCE 



The skeletal evidence for bone fractures is extensive as 

 shown by previous analysis of human remains. This evidence 

 occurs in varying incidence throughout different populations 

 and periods of time, although there is, as yet, little data 

 available on fracture incidence in the past. 



Location of skeletons in museums, archeology and an- 

 thropology departments in universities, and in archcological 

 units was often difficult. A total of approximately 30,000 

 individuals were located in institutions around Britain. Ap- 

 proximately 6000 individuals have been examined to date. 

 An attempt was made to look at equal numbers of skeletons 

 from the time periods of interest. Table 1 lists the cemetery 

 populations studied (Figure 1). The Roman, Anglo-Saxon, 

 Medieval, and post-Medieval periods were chosen for study 

 because of the availability of skeletal material and contem- 

 porary documentary, art, and archcological evidence for 

 these eras. The availability and numbers of prehistoric re- 

 mains in Britain would not give a representative study, and 

 additional types of evidence of prehistoric context are not 

 always available. 



Zagreb Paleopalholofiy Symp. 1988 



