Blue Bridge Lane
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Fishergate House
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While fractures were as common in the past as they are today, the type and distribution of broken bones sustained depends upon the environment in which the population lives. Factors influencing fracture frequency include rough terrain, hard physical labour or dangerous work, contact with large or aggressive animals (Björnstig et al 1991), frequent adverse weather conditions, interpersonal violence or the presence of large proportions of elderly people.
Fractures may be caused by acute injury (blows, falls), underlying pathology (osteoporosis or cancer, which weakens the bone), or repeated stress (exercise in athletes, or marching in soldiers). Fractures can be transverse, oblique, spiral or comminuted (multiple splintering), compressed or impacted. Children tend to suffer from greenstick fractures, which cause bending, but not complete separation of the bone ends (similar to the appearance of broken green wood). Fractures can be closed, without skin surface contact, or open, allowing bacteria to enter the fracture site and cause infection (Roberts and Manchester 1995, 67).
Episodes of trauma cannot be accurately dated, because several factors, including the nature of the injury, health and age of the individual, and the site and type of fracture can affect the rate of healing. Bone heals by forming a blood clot (haematoma) at the site of injury, which is then invaded by cells which form a hard mass after two to six weeks, called callous (Plate 19, right). This mass turns gradually to bone and forms a solid bridge across the fracture site after six to twelve weeks (Dandy and Edwards 1998, 45-46). For one to two years after the injury, remodelling of the fracture site takes place, with eventual restoration to smooth bony architecture ibid. As a general rule, bones join after eight weeks, which can be doubled for the weight-bearing bones of the lower limb and halved for fractures in children ibid, 92). During the healing process, the injured part of the body has to rest, which in the past would have made individuals dependent on the welfare of the community they lived in (Roberts and Manchester 1995, 94). Fracture healing is not always successful, as bone ends may not unite, or may overlap, causing shortening or secondary infection. Fractures are very painful and mal-alignment of healed fractures is often crippling.
Bonesetters were the medieval forerunners of orthopaedic surgeons, and were responsible for the reduction, manipulation and splinting of broken bones (Roberts and Manchester 1995, 95-96). Additionally, they would have administered other treatments, such as herbal remedies, which could range from the sensible, such as application of comfrey ('knitbone') and violet or pansy ('bonewort') to deliberate infection of wounds ibid, 96). There is little archaeological evidence for treatment of fractures, probably because most splints and other types of support would have been made from organic materials and would have degraded. However, four splints have been found in medieval archaeological contexts in Europe, including one at St Andrew's. This was made of copper and was found around the infected knee of a mature adult male (Stroud 1993). Grauer and Roberts (1996) suggest that the evidence for successful healing of fractures at St Helen's implies that even the poorer residents of York had some access to fracture treatment.
Twenty-eight individuals (11.5%) from the Fishergate population had suffered one or more fractures (Table 36), including eleven mature adults, ten old middle adults, three young middle adults, two further adults and one adolescent. However, as all fractures observed were well-healed, it was not possible to establish the age at which they had occurred. The greater number of fractures in older individuals may not necessarily suggest greater susceptibility to breaking bones with greater age, as a result of osteoporotic brittleness of the bones, but rather, an accumulation of fractures during life.
| Site | Date | No. of skeletons | Male adult | Female adult | All fractured long bones | Adults with fractured long bones | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| No. | % | No. | % | No. | % | No. | % | |||
| Fishergate House | medieval | 244 | 5/57 | 8.8 | 2/53 | 3.8 | 10/2283 | 0.4 | 7/131 | 5.3 |
| Chichester | C11-17th | 351 | 27/139 | 21.1 | 5/73 | 6.8 | 41/1554 | 2.6 | 32/212 | 15.1 |
| St-Helen-on-the-Walls | C10th-1550 | 1041 | 18/247 | 7.3 | 11/285 | 3.9 | 41/4938 | 0.8 | 30/533 | 5.6 |
| St Nicholas Shambles | C11-12th | 234 | 5/90 | 5.6 | 3/71 | 4.2 | 18/296 | 6.1 | 8/161 | 5 |
| Blackfriars | 1263-1538 | 250 | 12/148 | 8.1 | 4/64 | 6.3 | 16/1861 | 0.9 | 14/212 | 6.6 |
| Whithorn | C13-15th | 1605 | 18/314 | 5.7 | 5/356 | 1.4 | 23/9563 | 0.2 | 22/670 | 3.3 |
| St. Andrew's Fishergate | C10-16th | 402 | 15/220 | 6.8 | 5/89 | 5.6 | 26/3235 | 0.8 | 50/309 | 6.5 |
| Hull Magistrate's Court | 1316-1540 | 249 | 8/139 | 5.8 | 6/58 | 10.3 | 22/1965 | 1.1 | 14/216 | 6.5 |
Only one of the children (0.9% of children) from Fishergate House, a sixteen to seventeen year old adolescent, had sustained a bone fracture - a greenstick fracture to the upper shaft of the left tibia. The fracture was well-healed, but the bone was bent laterally. Comparative populations had higher prevalence rates, including Wharram Percy (1.3% of children), St Helen's-on-the-Walls (2% of children), Raunds (Lewis 2002a, 49) and Hull Magistrate's Court (10% of children). The relatively small number of fractures observed in children may be due to particularly good remodelling of young bones, often causing complete obliteration of the fracture (Roberts 2000b, 345; Wakely 1996, 81).
When comparing the prevalence rate of long bone fractures from this population with that from other populations (Table 36), it can be noted that the overall fracture rate by bone (0.4%) and individual (5.3%) was relatively low. Five (8.8%) males and two (3.8%) females suffered from one or more fractured long bones. It is possible that males were most likely to suffer fractures as a result of their occupation, or because they were greater risk-takers.
Although the long bone fracture rate at Fishergate House was low, the prevalence of rib fractures was high (Plate 19). Fifteen individuals (6%) had sustained between one and nineteen rib fractures during life, resulting in a total of seventy-nine fractured ribs (Table 37). Although ribs were also the most common bone to be fractured at Hull Magistrate's Court, only eleven (4.4%) individuals had sustained rib fractures, with a total of fifteen ribs affected. At York Minster, ribs were also the most common fracture site, with 9% of individuals affected (Lee 1995, 565).
| Context | Age | Sex | Type | Bone | Side | Element | Part | Evidence | Complications |
|---|---|---|---|---|---|---|---|---|---|
| 1091 | ma | f | smith's | radius | right | shaft | distal | well-healed | anterior angulation |
| 1099 | 26-35 | f | transverse | clavicle | right | shaft | central | well-healed | shortened |
| 1101 | 26-35 | f | transverse | 4 ribs | left | 5, 7- 9 | shaft | well-healed | some un-united |
| 1113 | 26-35 | m | transverse | rib | left | 11th | angle | well-healed | - |
| 1113 | 26-35 | m | compression | thoracics | bilateral | body | anterior rim | cod fish | lipping, bone destruction. |
| 1117 | 26-35 | m | oblique | radius | left | shaft | distal | well-healed | - |
| 1117 | 26-35 | m | transverse | ulna | left | shaft | distal | well-healed | dorsal displacement |
| 1117 | 26-35 | m | avulsion | fibula | right | malleolus | metaphysis | ligament injury? | - |
| 1130 | 26-35 | m | compression | thoracics | bilateral | 7th, 8th | posterior | crushed body | destruction of rims |
| 1139 | 46+ | m | compression | thoracics | bilateral | 7th, 8th | body | crushed body | - |
| 1139 | 46+ | m | transverse | rib | right | 9th | shaft | well-healed | - |
| 1139 | 46+ | m | oblique | hand phalanx | right | 5th proximal | distal | well-healed | slight angulation |
| 1147 | 26-35 | m | oblique | fibula | right | shaft | distal | well-healed | lat angulation, |
| 1150 | 46+ | f | transverse | 2 ribs | left | central | angle, shaft | well-healed | - |
| 1159 | 26-35 | f | oblique | metacarpals | right | 5th | proximal | well-healed | - |
| 1163 | 46+ | m | transverse | 3 ribs | bilateral | l 7, 10, r 5 | angle, shaft | well-healed | periostitis |
| 1176 | 26-35 | m | transverse | 19 ribs | bilateral | l 4, 6, 8, 9, 11, 12; r 9; ? 4 | angle, shaft | well-& unhealed | 2 woven bone, 1 mal-aligned |
| 1184 | 26-35 | m | transverse? | ulna | left | shaft | distal | hand fall in kids | osteitis? Thickened |
| 1184 | 26-35 | m | transverse | scapula | left | whole body | glenoid-med | well-healed | callous formation |
| 1184 | 26-35 | m | transverse | 18 ribs | bilateral | l 6-10; r 2, 4, 6, 8, 10-12 ?2 | angle, shaft | well-healed | callous |
| 1190 | 46+ | f | transverse | rib | ? | 2nd | shaft | well-healed | - |
| 1218 | a | u | oblique | foot phalanx | left | 5th proximal | distal | a | thick, contorted |
| 1228 | 46+ | m | transverse | rib | right | 8th | shaft | well-healed | - |
| 1237 | 26-35 | f | transverse | metacarpals | left | 5th | distal | well-healed | ant-med angulation |
| 1251 | 26-35 | f | transverse | hand phalanx | ? | 5th proximal | shaft | well-healed | short, twisted |
| 1273 | ad | f | greenstick | tibia | left | shaft | proximal | not certain | lateral bending |
| 1282 | 26-35 | m | oblique | clavicle | right | shaft | central | well-healed | shortened |
| 1282 | 26-35 | m | oblique | carpals | left | scaphoid | oval facet | healed | un-united |
| 1282 | 26-35 | m | transverse | 2 ribs | left | 8th, 12th | shaft | well-healed | callous formation |
| 1282 | 26-35 | m | unknown | cervicals | bilateral | 5th, 6th, 7th | all | twisting, overlap | fusion, neck angulation |
| 1320 | a | u | compression | foot phalanx | right | 1st distal | all | distorted | crushed? arthropathy |
| 1327 | 46+ | m | transverse | 3 ribs | right | 10th, 12th, 1? | angle | well-healed | enthesopathies |
| 1332 | 26-35 | m | oblique | fibula | left | shaft | distal | well-healed | enthesopathies |
| 1385 | 46+ | m | transverse | 4 ribs | right | 7-9th, 12th | shaft | well-healed | 2 displaced, periostitis |
| 1441 | 46+ | m | transverse | 4 ribs | right | 10th, 3 ? | shaft | healed | 1 un-united, callous |
| 1441 | 46+ | m | compression | vertebrae | bilateral | 8th thoracic | body | healed | - |
| 1484 | 46+ | f | transverse | 3 ribs | left | 7th, 10th, 11th | angle | well-healed | - |
| 1560 | 26-35 | m | oblique | carpals | right | scaphoid | articular facet | un-united | oa |
| 1579 | 46+ | f | transverse | 10 ribs | bilateral | l 4, 7-10; r 7, 2 ? | all | healing | un-united displaced, periostitis |
At Fishergate House, five females had sustained rib fractures (11% of females with extant ribs were affected). Female rib fractures were concentrated on the left side, but were bilateral in one case. Nine males had suffered from rib fractures (19% of males with extant ribs affected). The majority of the fractures were concentrated on the left side of the body or were bilateral. In those cases where a relatively high number of ribs were affected, ribs were usually fractured on both sides; when more than three ribs on one side of the chest are fractured, the other side rarely remains intact (Dandy and Edwards 1998, 162). While isolated cracks can heal quickly and are often treated in the same way as severe bruises ibid, 159), fractures of a number of ribs can interfere with breathing, which may cause serious complications.
Single rib fractures are often caused by a direct blow to the chest, back or side, although in elderly patients ribs can break as a result of severe coughing fits (Dandy and Edwards 1998, 159). Alternatively, rib fractures have been observed following falls and compression of the chest. Upper rib fractures are associated with extreme force (Tomczak and Buikstra 1999, 255). Although most rib fractures were located in the lower ribs, two second (upper) rib fractures were observed. Broken ribs can be very painful and can cause complications such as breathing problems, perforation of the lung, liver or heart, atelectasia (failure of the lung to expand normally) and secondary infection or respiratory failure (Dandy and Edwards 1998), and while they are unlikely to be the direct cause of death, the associated organ trauma can often be fatal.
In all but two individuals from Fishergate House, the fractures were well-healed. A mature adult female (C1579) had ten broken ribs, which were still undergoing healing at the time of death. The pattern of fractures suggested an impact from the side, rather than the front or back, and showed evidence for secondary infection in the form of new periosteal bone formation near the fracture sites, which may have been responsible for her death. However, this woman had also suffered from a blunt force depression injury of the skull (discussed below), which was in the process of healing. The complications associated with this injury could also have been fatal. It is possible that the rib fractures and cranial blunt force injury occurred at the same time, as the result of an attack or accident.
An old middle adult male (C1176) sustained nineteen broken ribs, some of which were healed, whereas others were in the process of healing, suggesting that the fractures were caused as a result of two or more different incidents. New periosteal bone formation was noted on two of the broken fragments, suggesting a possibly fatal secondary infection. Two further individuals with rib fractures (C1163 and C1385) showed evidence for periosteal new bone formation at the ribs, which may have been a secondary complication of the fractures. Other complications included ununited fractures (C1101, C1051, C1441 and C1579) and mal-alignment of fractures (C1176, C1385, C1579).
Tomczak and Buikstra (1999, 255) found that an impact from behind tends to fracture ribs near the spine, and force to the side of the chest fractures the ribs either near the spine, or at the front of the chest, near the sternum. Compression injuries to the chest, on the other hand, cause rib fractures at the curved parts of the ribs, at the side of the body ibid. Most rib fractures in this population were located at the shafts of the rib, suggesting side impact. However, a number of fractures were noted at both the shaft and angle, and may be indicative of antero-lateral impact.
The high prevalence rate of rib fractures at Fishergate House suggests that this population was particularly susceptible to this type of injury. Although more males suffered from broken ribs, the fractures were not sex-specific. Causes for the fractures could not be established, but it is possible that many of the rib fractures in this population were activity-related. It is probable that the individuals with a number of rib fractures would not have been able to carry out their usual daily tasks while the ribs were in the early stages of healing.
An old middle adult female had sustained a compression fracture of the second lumbar vertebra. The severity of the fracture had produced a large depression at the right side of the vertebral body (Plate 20, right). Three individuals (1.2%) had sustained compression fractures of the thoracic vertebrae. Compression injuries are caused by vertical force, such as falling and landing on the feet or bottom (Dandy and Edwards 1998, 155). The fracture caused crushing of the anterior vertebral body, with 'cod fish' appearance in the ninth vertebra of C1113, the seventh and eighth thoracic vertebrae of C1130 and the 8th vertebra of C1441. Injuries to the thoracic vertebrae are usually rare, as the reduced mobility of this part of the spine provides some protection against injury. When they do occur, fractures of the thoracic vertebrae can be severe and can cause paraplegia ibid, 154), although no evidence for paralysis in the form of wasting of the limbs was observed in these individuals.
The fifth and sixth cervical vertebrae of a young middle adult male (C1282) were also thought to have been crushed, causing an overlap of the fifth over the sixth vertebra and fusion of the fifth to seventh cervical vertebrae. However, the spinous process of the fifth cervical vertebra was also angulated, suggesting an alternative cause, with possible rupture of the supraspinous ligament and avulsion of the spinous process. The same individual also sustained two fractured ribs and a broken left wrist.
An old middle adult male had sustained a horizontal transverse fracture to the body of the left scapula (medial border-glenoid cavity). The fracture was well-healed with callous formation along the fracture line. Scapula fractures are very rare, as it is protected by a thick layer of muscles. However, the blade of the scapula can be fractured by direct trauma, falls, crushes and assault (Dandy and Edwards 1998, 186). These fractures are also rare in forensic contexts, which may be due to the great force required to break this bone (Tomczak and Buikstra 1999, 255), suggesting that scapula fractures are caused by considerable violence, severe force and violent trauma ibid. Scapula fractures are often associated with rib fractures, as in this individual, who suffered from eighteen broken ribs, as well as a broken left ulna, all of which may be related to the same incident. If this is the case, then a fall from a height or a violent attack may be the most likely causes for the injury patterns.
Upper limb fractures were less common in this population than in other medieval populations (Table 38; Table 39). There were no humerus fractures, but two fractures each of the ulna, radius and clavicle.
| Bone | Male | Female | Subadult | Total adult fracture rate | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Right | Left | Right | Left | Right | Left | |||||||||
| No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | |
| Clavicle (central) | 1/42 | 2.3 | - | - | 1/33 | 3 | - | - | - | - | - | - | 2/154 | 1.3 |
| Humerus | - | - | - | - | - | - | - | - | - | - | - | - | 0/172 | 0 |
| Radius (distal) | - | - | 1/38 | 2.6 | 1/40 | 2.5 | - | - | - | - | - | - | 2/239 | 0.8 |
| Ulna (distal) | - | - | 2/38 | 5.2 | - | - | - | - | - | - | - | - | 2/161 | 1.2 |
| Femur | - | - | - | - | - | - | - | - | - | - | - | - | 0/186 | 0 |
| Tibia (proximal) | - | - | - | - | - | - | - | - | - | - | 1/76 | 1.3 | 0/187 | 0 |
| Fibula | 1/43 | 2.3 | 1/41 | 2.4 | - | - | - | - | - | - | - | - | 2/181 | 1.1 |
| Site | Clavicle | Humerus | Radius | Ulna | Femur | Tibia | Fibula | |||||||
| Fishergate House | 2/295 | 0.7 | 0/335 | 0 | ||||||||||
| 2/380 | 0.5 | 2/303 | 0.7 | 0/348 | 0 | 1/342 | 0.3 | 2/321 | 0.6 | |||||
| Chichester | 11/261 | 4.2 | 2/243 | 0.8 | 7/218 | 3.2 | 6/217 | 2.8 | ½28 | 0.4 | 6/276 | 2.3 | 8/111 | 7.2 |
| St-Helen-on-the-Walls | na | na | 7/891 | 0.8 | 10/770 | 1.3 | 11/752 | 1.5 | 1/937 | 0.1 | 6/864 | 0.7 | 6/725 | 0.8 |
| St Nicholas Shambles | na | na | 2/38 | 5.3 | 5/57 | 8.8 | 4/49 | 8.2 | 2/53 | 3.8 | 3/50 | 6 | 2/49 | 4.1 |
| Blackfriars | na | na | 1/369 | 0.3 | 5/370 | 1.4 | 2/371 | 0.5 | 2/393 | 0.5 | 2/393 | 0.5 | 1/358 | 0.3 |
| Whithorn | na | na | 0/1650 | 0 | 7/1327 | 0.5 | 2/1530 | 0.1 | 4/2408 | 0.2 | 7/1819 | 0.4 | 7/829 | 0.8 |
| St Andrew's Fishergate | na | na | 2/528 | 0.4 | 4/523 | 0.8 | 7/518 | 0.8 | 1/577 | 0.2 | 3/558 | 0.5 | 9/531 | 1.7 |
| Hull Magistrate's Court | 2/268 | 0.7 | 5/304 | 1.6 | 6/246 | 2.4 | 0/305 | 0 | 2/354 | 0.6 | 4/269 | 1.5 | 2/204 | 1 |
The two clavicular fractures affected the central shaft of the right bone, one in an old middle adult female (C1099), and the other in a young middle adult male (C1282). Clavicular fractures are amongst the most common fractures in modern patients (Dandy and Edwards 1998, 181). Many are caused by landing on an outstretched hand or by direct impact against the bone, such as being thrown off a horse and landing on the ground ibid. The human clavicle acts as a strut to hold the shoulder and arm away from the body, and when the clavicle is broken, the strut effect is lost and the ends of the clavicle are pushed together, often causing overlapping and bone healing with mal-union. However, both clavicle fractures were well-healed (Plate 21, right). In adults, clavicles take around six weeks to heal ibid, 182), suggesting that the injuries in these two individuals were at least this old. Both clavicles affected were considerably shortened as a result of the fracture.
Two individuals had sustained fractures of the lower shaft of the radius. One of these was a Smith's fracture of the right radius of a mature adult female (C1091), which was well-healed but mal-aligned, with anterior angulation. Smith's fractures are caused by falling and landing with the hand in a flexed position. This fracture is often unstable and can result in deformities, as seen in this female (Dandy and Edwards 1998, 210).
A fracture of the left radius of an old middle adult male (C1117) may have been caused by the same incident as the fracture of the left ulna and right fibula, all of which were well-healed. Fractures of both forearm bones are frequently observed in modern patients following a fall on the outstretched hand (Dandy and Edwards 1998, 210). The fractured part of the lower ulna is dorsally (backward) displaced, which is common in this type of injury. Another broken ulna was noted in an old middle adult male (C1184), who had sustained the injury to the lower part of the left bone. Osteitis (infection of the cortex of the bone, discussed above) may have been a secondary complication of this fracture. This individual also suffered from a broken shoulder blade and eighteen broken ribs.
Fractures of the wrist were noted in two cases: the left scaphoid of a young middle adult male (C1282) and the right scaphoid of an old middle adult male (C1560). Scaphoid fractures are the most common carpal fractures, as this bone bridges two rows of carpals in the wrist and is therefore exposed to more stress than other bones of the wrist (Dandy and Edwards 1998, 221-222). Scaphoid fractures occur as a result of violent hyperextension of the wrist, often during falls (Wakely 1996, 82). Both fractures showed evidence for healing in the form of new bone formation, but the broken ends were not united, causing secondary osteoarthritis at the new joints. Non-union occurs in 75% to 90% of scaphoid fractures (Morgan and Walters 1984, 233), and can be very painful. Avascular necrosis (death of bone as a result of poor blood supply) may result or, as in this case, osteoarthritis ibid, 241). Scaphoid fractures are relatively uncommon in archaeological populations.
Several hand injuries were noted in this population, including two broken fifth metacarpals, which are particularly prone to fracturing. A young middle adult female (C1159) had sustained an oblique fracture to the proximal part of the fifth metacarpal, which was well-healed, but slightly displaced. This type of trauma is caused when the little finger is held and twisted, resulting in a rotational deformity (Dandy and Edwards 1998, 224). The fracture of the left fifth metacarpal of an old middle adult female (C1237) was located at the neck of the bone. According to Dandy and Edwards ibid, 224), an injury at this site occurs only when hitting an object or person with a clenched fist, and is commonly seen in boxers (Watson 1985). This suggests that this woman may have been involved in inter-personal violence.
Two proximal fifth hand phalanges (little finger bones) were also broken and healed in a mature adult male (C1139) and a young middle adult female (C1251). Hand phalanx injuries are very common today, in both the left and right hands (Barton 1977). These injuries are usually caused by falls or blows with the fist, but can also be due to crushing, pulling and twisting ibid, 2). Fractures of the hand can disrupt the fine balance of motion and strength in the hand, leading to significant problems (Watson 1985). It is probable that three of the individuals with hand bone fractures, whose bones were shortened or mal-aligned, suffered from some disability.
Only a few lower limb fractures were observed in this population. These included three fibula fractures, a broken toe, a crushed foot and a broken tibia. Tibial fractures tend to be caused by direct trauma, or repeated stress. Tibial fractures tend to occur in older children and are the most common lower limb injuries in children (Glencross and Stuart-Macadam 2000, 200). In this case, the fracture was well-healed, suggesting that it had occurred some time before death.
The right fibula malleolus (lower joint) of an old middle adult male (C1117) was sheared off (avulsion fracture). Lateral fibula malleolus avulsion is caused by trauma to a ligament (lateral collateral ligament) or violent abduction of the foot (Dandy and Edwards 1998, 268). The injury can be very painful and unstable. A further old middle adult male (C1147) suffered from a broken lower end of the fibula, which was well-healed, but slightly mal-aligned. Active inflammatory lesions on this fibula may be a consequence of the fracture, or may be due to a separate cause. Finally, the lower end of the left fibula of a young middle adult male (C1332) was broken and well-healed.
The fifth left proximal foot phalanx of an adult of undetermined sex (C1218) was fractured and healed, but contorted and enlarged. Foot phalanges are in a vulnerable position and are particularly prone to breaking when falling objects land on them. This may have been the cause for a right first distal foot phalanx fracture in an adult of undetermined sex (C1320). The toe was compressed with complete distortion of its shape. Adjacent phalanges exhibit erosive lesions around the joints and a small distorted bone fragment was found to be associated with the foot. However, the numerous enthesopathies on the lower legs, as well as the erosive lesions may suggest that these lesions were caused by spondyloarthropathy (discussed above).
Although the incidence of long bone fractures at Fishergate House compared with that from other medieval populations was low, the severity and distribution of fractures in this population illustrates the constant risk of sustaining injuries during daily activities and as a result of interpersonal violence. As in other medieval populations, forearm and fibula fractures were the most common limb fractures observed. However, unlike other medieval cemeteries, where many individuals with broken bones had secondary complications such as inflammatory new bone formation (Grauer and Roberts 1996), these lesions were rare at Fishergate House. Instead, mal-alignment of bones was the most common complication following fracture, and inflammatory bone formation (some cases of which may not have been associated with the fracture), non-union and osteoarthritis were rarely encountered. Unlike St Helen's-on-the-Walls, where most individuals appear to have had access to fracture treatment ibid, the evidence suggests that at Fishergate House, this treatment was not available.
In terms of the spatial distribution of fractures across the excavated area, only one individual from each of Interventions 2 and 4 was found to suffer from fractures. However, fractures were extensively and evenly distributed throughout Intervention 1.
Skeletal injuries present clear documentation of conflicts in the past and are thus the only direct evidence for violent interaction. This is important, because historical accounts of conflicts can be used as propaganda, frequently omitting or glossing over the extent of cruelty and violence. Documentary sources record little of the experiences of the common soldier, but these people can be found during archaeological excavations of cemeteries. There are examples of inclusions of battle victims in a number of medieval parish and monastic cemeteries. Weapon-related trauma victims include four individuals (1.6% of the population) from Hull Magistrate's Court (Holst et al, forthcoming), two individuals from Blackfriars, a male from St Nicholas Shambles, twenty-nine individuals (7.2%) from St Andrew's Phase 6 and ten individuals from St Margaret in Combusto in Norwich (Stirland 1996). All of these individuals were male adults, or adults of undetermined sex.
Injuries caused by weapons were found in nine individuals (3.7%) from Fishergate House (Table 40), including seven males (12.2%) and two females (3.8%), with a total of twenty-eight injuries. Unexpectedly, all but three of the trauma victims were mature adults over the age of forty-five. This does not correspond with the notion that men were sent into battle in the prime of their life, as supported by the demographic profile of the Towton soldiers, whose mean age was thirty years, with the majority between the ages of twenty-one and forty-five (Boylston et al 2000). The greater age of the trauma victims at Fishergate House may be due in part to the fact that five individuals had survived the traumatic incident and exhibited signs of healing.
| Context | Age | Sex | Expression | Bone | Side | Element | Part | Evidence | Complications/ weapon |
|---|---|---|---|---|---|---|---|---|---|
| 1115 | 46+ | f | part missing | humerus | left | proximal | medial | healed | periostitis, osteoarthritis, weapon unknown |
| proliferation | clavicle | left | lateral joint | inferior | healed | proliferation, weapon unknown | |||
| part missing | scapula | left | glenoid, acromion | new joint | healed | osteoarthritis, weapon unknown | |||
| 1139 | 46+ | m | depression | cranium | left | parietal | posterior, superior | well-healed | sword |
| 1147 | 26-35 | m | depression | cranium | right | parietal | eminence | well-healed | blade or blunt |
| 1402 | 46+ | m | blade | cervicals | bilateral | body, processes | right 3/4 | unhealed | from supero-left |
| blade | thoracics | bilateral | processes | right 3/4 | unhealed | 2nd blow | |||
| 1412 | 46+ | m | blade | cranium | left | frontal | orbit-superiorly | healed, anterior blow | fracture line; periostitis |
| 1486 | 46+ | m | blade | cranium | bilateral | frontal | parallel to coronal | unhealed | fracture lines, sword |
| blade | cranium | left | frontal, parietal | parallel to sagittal suture | unhealed | fracture lines, sword | |||
| blade | cervicals | bilateral | 3rd | all | unhealed | sword | |||
| blade | thoracics | bilateral | 12th | inferior & central body | unhealed | sword | |||
| blade | lumbars | bilateral | 1st | superior body | unhealed | knife | |||
| blade | ribs | right | 9-11th | shaft | unhealed | sword | |||
| blade | humerus | right | distal shaft | medial, posterior | unhealed | sword | |||
| penetrating | scapula | right | neck | dorsal, posterior | unhealed | knife, diamond-shaped | |||
| blade | radius | left | midshaft | lateral | unhealed | slice, defence | |||
| blade | carpals | left | triquetral | articular surface | unhealed | shallow | |||
| penetrating | femur | left | neck | anterior | unhealed | bladed weapon? | |||
| 1488 | 26-35 | m | blade | clavicle | right | medial shaft | superior | unhealed | sword? |
| blade | mandible | left | ramus | superior, angle | unhealed | sword | |||
| blade | pelvis | right | pubis | ramus, body | unhealed | sword | |||
| blade | cervicals | bilateral | 2nd | dens | unhealed | sword | |||
| blade | cervicals | bilateral | 1st | articular facet | unhealed | sword | |||
| 1551 | 18-25 | m | blade | cranium | bilateral | occipital, r parietal | central | unhealed | sword |
| blade | lumbars | right | 2nd, 3rd | antero-lateral body | unhealed | sword | |||
| penetrating | pelvis | right | ilium | central, superior | unhealed | sword | |||
| 1579 | 46+ | f | depression fracture | cranium | bilateral | saggital suture | posterior | healing | blunt force trauma |
Almost all of the injuries inflicted were caused by sharp force (85.7%), characterised by linear blade or cutting injuries (Figure 20). Weapons in the medieval period included long and cross bows, lances, spears, poleaxe, battle axes, maces, battle hammers and swords. Additionally, other instruments, such as agricultural implements, could have been used in conflicts. There were three further penetrating injuries, all of which were diamond-shaped and affected the scapula, pelvis and femur. Only one injury (3.6%) was caused by blunt force trauma, and this had healed before death.
Figure 20. Distribution of weapon trauma
A blunt weapon caused a depression fracture on the top of the skull of a mature adult female (C1579). When a blunt instrument forcefully strikes the skull, the bone bends inwards, causing compression at the outer part of the skull and tension at the inner part. The initial fracture appears at the point of tension at the inner table, and progresses outwards (Berryman and Jones Haun 1996). The injury was sub-oval, with a slight triangular tendency, 16.3mm by 21.5mm in size and depressed by 2mm. Any number of blunt objects could have caused this injury. The trabecular (spongy) bone was still exposed, although the edges of the injury were smooth, suggesting that it was in the process of healing when death occurred. This individual had also sustained ten rib fractures, suggesting that either a violent attack or serious accident were responsible for these injuries.
The cause of injury in the second mature adult female (C1115) could not be established. The whole left shoulder joint, including the scapula, clavicle and humerus was severely distorted, with parts of the bones missing, but additional loose unrecognisable bone fragments. The injuries suggest that a weapon or sharp implement had severed the shoulder from underneath the joint, slicing part of the shoulder joint off (the medial humeral head and neck, and the glenoid cavity) and cutting away some of the soft tissue of the armpit. The implement did not fully penetrate the joint, but left the uppermost part of the shoulder intact. Incredibly, the formation of a new joint, with secondary osteoarthritis and evidence for inflammatory new bone formation, illustrates that not only did this woman survive the initial injury, with its accompanying blood loss, muscle and bone injury and risk of infection, but she also recovered enough use of her arm to produce secondary osteoarthritis, forming a shiny eburnated surface at the site of the newly formed joint. She also suffered from a slipped femoral epiphysis (discussed below), with severe osteoarthritis in the right hip joint, which may have been related to the shoulder injury.
Three males had received blade injuries to different parts of the body, and had also been partially decapitated. A mature adult male (C1402) was partially but fatally decapitated. The perpetrator had attacked the man from behind, slicing from the upper left to the lower right parts of the fifth cervical vertebra, but stopping before the vertebra was completely severed. A second cut was noted on the second thoracic vertebra (Plate 23, right), slicing the bone from the right, downwards to the left, again not cutting the vertebra completely. The injuries were inflicted with a thin bladed weapon, such as a sword. The reasons for the incomplete cuts may be threefold: it is possible that the blows were not strong enough to penetrate the substantial muscles of the neck region; alternatively, the blade may have been blunt and therefore unable to penetrate the vertebrae. Modern tests on sheep using a variety of weapons suggest that only a forceful blow with a sharp weapon is able to cut through the muscles and bones of the neck region. A further possibility is that the attacker aimed to kill, but not to decapitate, so there was no need to completely severe the skull from the body. The skull was buried in a normal anatomical position with the body. This skeleton had been cut by a pit from the chest downwards, and thus any further injuries to the body were lost.
The second partially decapitated individual, also a mature adult male (C1486), had sustained nine blade injuries and three penetrating injuries, some of which could have caused death. He had sustained two cuts across the frontal bone (forehead) and right parietal, carried out with large sharp bladed weapons, such as a sword (Plate 24, right). The initial cut sliced across the forehead and probably came from the front and right-hand side. The strength of the blow caused fracture lines to form at either end of the cut. The second blow, which probably came downwards from the front and above, dissected one of the fracture lines, therefore making it possible to establish the sequence of injuries. It ran from the left eye orbit almost to the back of the head, and was very deep, with a fracture line extending to the back of the head. As the second blow came from above, it is possible that the victim had started to collapse and was possibly on his knees. The assailant probably stood in front of him when dealing the fatal second blow.
This individual was also partially decapitated by an upwards cut from right to left, but the cut had not penetrated the vertebra completely. Further cuts were seen in three more vertebrae, one of which had sliced the transverse process off a thoracic vertebra. The twelfth thoracic and first lumbar vertebrae were cut from behind with a knife, which penetrated the lower back muscles, pushing between the two vertebrae through the cartilage and piercing the spinal canal, probably causing paralysis.
The right ninth, tenth and eleventh ribs showed evidence for two blade injuries. An oblique cut sliced through the right tenth rib at the lateral part of the shaft (right side), which severed the rib completely and also cut into the upper part of the eleventh rib. A further nick was noted on the right side of the ninth rib, on the inner rib surface. This suggests that this individual was stabbed twice, probably with a sword from the front left through the abdomen and into the ribs on the right side. The fact that the ribs on the left side were not affected may suggest that the thrust was upwards, from below the left ribs. A diamond shaped injury in the right scapula (Plate 25, right) suggests that a knife stabbed the shoulder through the muscles and just penetrated the bone, leaving a partially detached fragment of bone, also termed 'twig peel' at the exit wound. The knife had entered the shoulder from a slight angle from the above right.
This man also suffered injuries to the limbs, including a cut to the mid-shaft of the left radius. A slice of bone had been cut off the lateral surface of the radius, but was present in the grave beside the arm, suggesting that it had adhered to the arm by the soft tissue. This also implies that the victim of this vicious attack had been buried relatively soon after death, before decomposition had set in and this superficial part of the bone would have become detached from the skeleton. The injury may have been a defence wound, while the forearm was held in front of the body or face for protection. Alternatively, the arm may have been beside the body and caught a downward blow. There was also a shallow cut on the right elbow (distal humerus), at the back and centre of the lower part of the upper arm bone. Another shallow cut was noted on the left triquetral (carpal bone in the wrist), suggesting another possible defence injury. This man received only one injury to a lower limb; this was a penetrating injury which came from the inner lower part of the left thigh upwards and entered the bone at the neck of the femur, below the hip joint.
None of the many injuries sustained by this individual had healed, suggesting that they had all occurred at or around the time of death. Paralysis would have been caused by the lower vertebral injury, whereas the cranial and neck cuts would have been fatal. The other injuries would have incapacitated this individual considerably. The evidence of cut marks originating from two different weapons suggests that at least two individuals attacked their victim, one armed with a sword and the other with a knife. It is probable that this was a battle injury, rather than murder, with the assailants suffering from 'red mist' effect and not stopping when their victim was already dead.
A further partial decapitation was observed in a young middle adult male (C1488), whose second cervical vertebra (axis) was cut through from the upper right to the lower left. The first cervical vertebra (atlas) was eroded, but exhibited a partial cut, again suggesting incomplete decapitation. The same cut that severed the neck vertebrae also penetrated the lower jaw (left mandibular ramus), severing the roots of the left teeth. The vertebral and mandibular cut was carried out with the end of the sword blade, though not the tip. A further cut affected the left part of the lower jaw as well, cutting vertically downwards, parallel to the side of the head. Protruding features, including the ear and parts of the lower jaw, would have been sliced off. This individual also sustained a cut to the upper part of the shaft of the right clavicle, which came from the direction of the head and moved outwards to the right. One would have assumed that the presence of the head would have hindered this cut, unless this had already been removed. It was not possible to say whether this victim was attacked from the front or from behind. A further weapon injury, which probably occurred while the man was still standing, entered his abdomen from the front left towards the right and sliced deeply into his right hip joint, severing vital organs. The severity and quantity of these injuries suggest that this individual was also a battle victim, rather than attacked because of a personal feud. While the abdominal and decapitation injuries would have proved fatal, the clavicular and head trauma would have been disabling.
A further male mature (C1412) adult had sustained a sword cut to the left part of the frontal (forehead), which ran from the left orbit upwards for a length of 46mm. The force of the blow caused a fracture line to form from the top of the injury into the suture between the orbit and nose. The cut, which was probably inflicted with a sword, was deep at the orbit, but shallower at the upper parts of the forehead, probably not penetrating the cranium at its upper part. The cut and the fracture line were well-healed, implying that this man had survived the injury for some time, but active periosteal inflammatory lesions on the ridge above the left orbit and area around the cut were indicative of secondary infection, which may eventually have proved fatal.
Another mature adult male (C1139) had also survived a weapon injury. On the left upper part of the skull (superior left parietal) was a well-healed depression injury, which was 14mm by 30mm in size. Despite the well-rounded nature of the edges of this injury, it was possible to determine that this individual had been attacked from the left with a bladed weapon, which hit the parietal at an angle of thirty degrees. The injury did not penetrate the skull and the individual survived the attack. Slight micro-porosity of the outer table of the skull suggested a possible slight scalp infection, which may have been related to the injury. It is possible that a right ninth rib fracture, a vertebral compression fracture, and an oblique fracture of a right 5th proximal hand phalanx (little finger), the latter of which can occur when hitting with a clenched fist, may be related to the same event.
An old middle adult male (C1147) had also sustained a small depression fracture to the upper part of the right side of the skull (eminence of right parietal). This injury was oval, 23mm by 17mm in size and shallow. It was very well-healed, making it difficult to identify the nature of the weapon and direction of the blow; it could have been caused either by blunt force or by a bladed weapon. A fractured fibula and two broken left ribs, which were well-healed, may be related to the cranial injury.
The only young adult male with weapon-related trauma (C1551) had sustained three injuries, and was attacked from the front and back. A large sword cut hit this individual from behind, and crossed the skull from the back left to the central top of the head (Plate 26, right). The cut was 131mm long, and the force of the blow was so strong that the cranial sutures surrounding the site of the blow opened. Additional fracture lines formed at both ends of the cut. This injury would undoubtedly have been fatal, as it would have penetrated deep into the brain. An additional superficial blade injury was noted on the second and third lumbar vertebrae, on the anterior side (front) of the vertebral bodies. Although superficial on the vertebrae, this cut would have penetrated the lower abdomen from the front and left-hand side, penetrating the stomach and pancreas. Finally, a penetrating injury was noted on the right hip (blade of ilium). The tip of the weapon, probably a sword, penetrated the bone from the front left. All three injuries would have been fatal, again suggesting a 'red mist' effect, which is frequently observed in situations of interpersonal violence.
Weapon injuries were mostly concentrated on the skull, followed by the arms, hands, shoulders, and the neck (Figure 20). Trauma to the back and abdomen was slightly less common, with chest and leg trauma being least prevalent. This suggests that the skull was the most likely target, and this is supported by modern forensic cases, in which the head (including the face) and neck are the parts of the body most likely to be attacked (Larsen 1997, 156). In the past, while head injuries were usually very common, facial injuries were relatively rare ibid.
It is probable that the prevalence of post-cranial injuries was underestimated at Fishergate House, as further injuries may only have affected the soft tissues. Additionally, it is possible that some of the healed fractures, especially those of the ribs, may have been related to the same event which produced the weapon injuries. The arm injuries may have been defence wounds, but may also have included glancing blows. The neck was obviously a principal target, although full decapitation was not necessarily intended.
As in other medieval cemeteries, sharp force injuries were most prevalent. This was also observed in the 1185 skeletons from the Battle of Visby and the soldiers from Towton (Courville 1965; Novak 2000). Sharp force injuries were concentrated on the skull and chest, a trend which has also been observed in modern forensic contexts (Gruspier 1999). Only one blunt force injury was observed, located on the skull. It is, however, possible that some of the bone fractures were related to weapon trauma and were also caused by blunt force. Three penetrating injuries were noted, all of which were thought to be caused by bladed weapon points, as they were diamond-shaped.
Injuries which did not penetrate the cranium completely, such as the depression injuries (C1139, C1147 and C1579) and one blade injury (C1412), were more likely to heal than those which had fully penetrated the skull bone. However, the presence of healing did not provide information on the presence or severity of post-traumatic complications. Depressed fractures can often lead to varying degrees of brain damage, both directly under the fracture, and at a distance from the site, whereas linear blade injuries tend to cause brain damage directly beneath the injury (Roberts and Manchester 1995, 81). Brain damage may result from increased collections of blood inside the skull, leading to a lack of oxygen in the brain tissue and subsequent necrosis (death) of these tissues ibid. Further complications include epileptic seizures, or infection of wounds, as observed in C1412, often leading to rapid physical deterioration and death ibid, 82). It is difficult to infer the amount of damage to the soft tissues from the skeletal evidence, as there is little correlation between the size of the skull injury and the extent of the injury to the brain (Aufderheide and Rodríguez-Martín 1998, 23).
When the distribution of the burials of the individuals with weapon trauma was plotted (Figure 21), it became apparent that the three individuals with healed single cranial injuries were buried in Intervention 1, or the northernmost part of Intervention 4; the female suffering from shoulder trauma was located at the eastern edge of Intervention 1. The individuals with single- and multiple-bladed weapon trauma had been interred without exception in Intervention 4.
Figure 21. Plan of weapon trauma burials
A whole range of situations can lead to a rise in violent conflict, including population expansion, increasing social complexity, restriction of valued resources, social and cultural disruptions, poor health and famine (Larsen 1997; Judd and Roberts 1998). When analysing documentary sources for York during the medieval period, numerous conflicts can be found, ranging from small skirmishes to large battles, and it would be impossible to pinpoint the specific events which had led to the deaths of the weapon trauma victims found at Fishergate House. Furthermore, it was not possible to determine whether all weapon injuries related to the same event, or whether they were the result of a number of conflicts, including personal disputes, or murder.
Osteochondritis dissecans
Osteochondritis dissecans is characterised by necrosis (death) of part of the joint area, with separation of a small bone fragment from the joint surface, which can become completely disconnected and remain as a loose body within the joint capsule, or may be reabsorbed or reattached. Osteochondritis dissecans is most commonly observed at the knee, ankle and elbow (Aufderheide and Rodrígu e z-Martín 1998, 82). The condition tends to have little effect in adolescents, who are most likely to suffer from osteochondritis dissecans. Adults with the condition, on the other hand, can suffer pain, interlocking and instability of the joint (Clanton and DeLee 1982, 59). The initiating mechanism for osteochondritis is now thought to be multifactoral, but is related to trauma at a susceptible location (Frederico et al 1990). Osteochondritis is related to other conditions which are associated with fragmentation and collapse of joints, such as Scheuermann's disease of the spine and Perthes' disease of the hip (Roberts and Manchester 1995, 87), all of which effect males more often than females.
Five individuals (2%) suffered from osteochondritis dissecans, with the greatest number of lesions in an eleven to thirteen year old adolescent (C1087), who suffered from the condition in both knee joints, the right ankle and atlas (Table 41). The remaining individuals with osteochondritis dissecans included two females and two males, all but one of whom had two lesions. A young middle adult male (C1065) suffered from osteochondritis in both big toes, whereas an old middle adult male (C1188), had lesions in both knee joints. Around half the modern cases with knee osteochondritis tend to have a previous history of knee injuries (Resnick et al 1989); however, neither the adolescent nor the adult male was found to have suffered from knee injuries affecting the bone.
| Context | Age | Sex | Expression | Bone | Side | Element | Part |
|---|---|---|---|---|---|---|---|
| 1065 | 26-35 | m | oval lesion | foot phalanges | bilateral | 1st proximal | proximal joints |
| 1087 | 11-13 | n | oval lesion | tibia | bilateral | condyles | lateral |
| oval lesion | tibia | right | malleolus | medial | |||
| oval lesion | cervicals | bilateral | 2nd | superior facet | |||
| 1095 | 26-35 | f | oval lesion | humerus | right | capitulum | articular surface |
| oval lesion | tarsals | left | calcaneus | talar surface | |||
| 1188 | 36-45 | m | oval lesion | femur | bilateral | distal | condyles |
| 1484 | 46+ | f | oval lesion | humerus | right | distal | capitulum |
Both females, a young middle adult (C1095) and a mature adult (C1484), suffered from lesions in their right elbows (Plate 27, right). Osteochondritis lesions of the elbow tend to be more common on the right side and are thought to be activity-related (Aufderheide and Rodríguez-Martín 1998, 83). The younger female also had a lesion on her left ankle. The lesions were generally oval and between 3mm and 18mm in diameter, with a depth of between 1mm and 5mm. However, in an old middle adult male (C1188), both fragments had become reattached to the lesion and had healed.
Perthes' disease
Perthes' disease usually occurs during childhood (between the ages of five and nine), and is caused by obstruction of the blood supply to the growing femoral head, with avascular necrosis (death of bone). It is characterised by softening of the femoral head, causing it to gradually reform over a number of years, which eventually results in a head which is larger and flatter than normal (Dandy and Edwards 1998, 323). The femoral necks also become shortened coxa vara producing a 'mushroom-like' appearance to the femoral head (Aufderheide and Rodríguez-Martín 1998, 84). The skeletal changes also affect the hip part of the joint (acetabulum), which becomes enlarged, flattened and elongated. The condition is usually unilateral. The consequence of the condition is degenerative joint disease, which affects 100% of children over the age of ten with Perthes' disease ibid. The condition may be mistaken for slipped femoral epiphysis, congenital hip dislocation, coxa vara, hypothyroidism or trauma.
One individual, a mature adult male (C1051) was thought to suffer from Perthes' disease, having a grossly enlarged left femoral head with a 'mushroom-like' appearance (Plate 12). The articular part of the head was smooth, with a shiny eburnated surface, surrounded by considerable osteophyte formation. The left hip joint of the pelvis compensated for the deformed femoral head by enlargement of the joint. However, the femur sat at a right angle in the hip joint and the leg could only be moved slightly up or down. This explains why the individual was buried apparently with the left leg flexed, which resulted in the truncation of the knee by a later burial. This individual, who also suffered from fourteen broken ribs, active lower leg inflammation and osteoarthritis in a number of joints, must have been in considerable pain and would have been severely disabled by his condition.
Avascular necrosis
Avascular necrosis (death of the bone) may be an alternative diagnosis for the distortion of the femoral head of this individual. The causes for avascular necrosis of the femoral head are still obscure, although it has been related to hip dislocation, hip fracture, limb immobilisation and even degenerative joint disease (Aufderheide and Rodríguez-Martín 1998, 89). It affects mainly adults between the ages of thirty and fifty and causes eventual deformation of the femoral head, with flattening and a 'mushroom-shaped' appearance. The condition can spontaneously resolve, but often results in degenerative joint disease ibid.
Slipped femoral capital epiphysis
Slipped femoral capital epiphysis is the result of a stress fracture of the neck of the femur, which usually occurs during adolescence, between the ages of eight and thirteen (Aufderheide and Rodríguez-Martín 1998, 90). This allows the femoral head to slip downwards and can lead to avascular necrosis. The neck of the femur becomes short and thick, but the head is not greatly deformed. However, secondary degenerative joint disease often causes additional distortions. A mature adult female (C1115) suffered from coxa vara in both femora and a slipped femoral head in the right femur (Table 42). The femoral head was distorted, with additional bone formation at the lowermost part of the head and eburnation at the joint surface. Atrophy (wasting) of the right tibia may suggest that this leg had not been used for some time. However, the distortion of the femoral head, with its 'mushroom-like' appearance, may suggest an alternative diagnosis of Perthes' disease or avascular necrosis. It is also possible that the appearance of the femoral head may have been caused by trauma, such as a fracture, especially considering that this individual's armpit and shoulder joint were partially cut away as a result of violent conflict or an accident.
| Context | Age | Sex | Pathology Type | Expression | Bone | Side | Element | Part | Evidence |
|---|---|---|---|---|---|---|---|---|---|
| 1106 | 10-12 | n | Perthes' disease? | flattened femoral heads | femora | bilateral | proximal | head | a |
| 1115 | 46+ | f | slipped head | mushroom appearance | femur | right | proximal | head | aetiology uncertain |
| 1117 | 36-45 | m | os acromiale | non-fusion | scapula | bilateral | acromion | acromion | a |
| 1190 | 46+ | f | spondylolysis | separation | lumbars | bilateral | 4th, 5th | spinous process | a |
| 1312 | 36-45 | f | os acromiale | non-fusion | scapula | right | acromion | acromion | left not affected |
| 1327 | 46+ | m | spondylolysis | separation | lumbars | right | 5th | spinous process | a |
| 1385 | 46+ | m | Perthes' disease? | Flattened heads, short necks | femur | bilateral | proximal | heads | a |
| 1521 | 46+ | f | spondylolysis | separation | lumbars | right | 5th | spinous & transverse process | a |
| 1553 | 36-45 | m | os acromiale | non-fusion | scapula | left | acromion | acromion | right not affected |
| 1583 | 46+ | m | avulsion | concave lesion | pelvis | right | ilium | body | aetiology uncertain |
Os acromiale
Activity-related trauma can be observed occasionally in skeletons from archaeological contexts. Os acromialeis characterised by non-fusion of the acromion process of the scapula to the spine of the scapula. This developmental anomaly is thought to be caused by severe stress to the rotator cuff muscles during growth, preventing natural fusion of the bones. In modern populations, os acromialewas noted in two boxers, where it was attributed to their intensive training during adolescence (Hershkovitz et al 1996, 170). Stirland (1984) and Knüsel (2000b) have argued that this condition might be linked to archery in skeletal populations from the Mary Rose and from Towton (1461).
At Fishergate House, only three individuals suffered from this condition (1% of the population), all of whom were aged between 2 6 and 35. One case of os acromiale was found in Intervention 4, while the remaining two cases were distributed across the central and eastern parts of Intervention 1. It was bilateral in a male (C1117), but affected a female (C1312) only on the right side and a male (C1553) only in the left shoulder. In total, 1.8% of right acromiae were affected and 1.7% of left acromiae. The prevalence was considerably higher in the Towton soldiers, with 6.9% of right scapulae and 10.3% of left scapulae affected (9.2% of the population) (Knüsel 2000b, 115). The prevalence rate of os acromiale in the Mary Rose group was 10.6%, with 13.5% of individuals from this population suffering from the condition ibid. However, os acromiale is also likely to occur as a result of other strenuous activities, as the prevalence was greater in females (7%) at Hull Magistrate's Court than in the males (2%) (Holst et al forthcoming). Knüsel ibid has argued that the laxity in the shoulder joint caused by os acromialewould allow greater overhead rotation motions, helpful for some activities.
Spondylolysis
Spondylolysis refers to a condition which is characterised by the separation of vertebrae into two parts, the vertebral body and the spinous process (Merbs 1996). This occurs primarily in the lumbar vertebrae and is the result of genetic predisposition and repetitive stress or fatigue fracturing, often caused by mechanical loading of the spine. It may also be congenital in origin, but in such cases, it tends to affect the cervical vertebrae.
Spondylolysis can be seen in varying proportions in different populations, with a 8% rate in modern populations, but a much higher prevalence in specific ethnic groups, such as Eskimos (40%) (Albanese and Pizzutillo 1982, 497). Three individuals from Fishergate House suffered from the condition, all of whom were mature adults, with separation of the spinous process of the fourth or fifth lumbar vertebra. Two individuals suffered from additional degenerative joint disease in the vertebral bodies, and the only male affected (C1327), also showed evidence for degenerative joint disease and osteoarthritis in the vertebral articular facets. His spinous process had detached and later re-attached, but the lines of separation could still be clearly observed below the articular facets (Plate 28, right). The condition may cause pain, but not in all patients ibid, 499).
Normally, spondylolysisaffects men more often than women, but in the Fishergate population, 3.8% of females and only 1.8% of males were affected. The general prevalence of this condition was low, with 1.2% of the entire excavated population affected, as compared with St Andrew's (2%), Blackfriars (2%) and Hull Magistrate's Court (7%). As spondylolysis is thought to be indicative of high physical pressure on the back, the low incidence of this condition at Fishergate House implies that this population suffered less back strain than other populations. However, the relatively high prevalence of Schmorl's nodes at Fishergate House contradicts this theory. There are two additional explanations for the low incidence of spondylolysis: it is possible that the population studied did not have an inherited predisposition for this condition. Alternatively, the back strain which produces Schmorl's nodes may have a different origin to that which produces spondylolysis. This may also account for the greater prevalence of spondylolysis in females, and the greater incidence of Schmorl's nodes in males.
It is often possible to observe evidence for soft tissue trauma on skeletal remains from archaeological contexts, including ossified haematomas (blood clots). One possible haematoma was noted on the right squamous (ear region) of a mature adult male (C1313), although an alternative diagnosis suggests that this might have been a benign tumour, termed osteoma (discussed below). Haematomas can be the result of direct blunt force trauma, or tearing of muscle fibres, causing blood to collect and clot. If the muscle is exercised too soon following the injury, the blood clot may ossify, producing a bony lump at the site of the haematoma.
Soft tissue trauma can also be noted at the sites where muscles and ligaments attach to the bone. Muscle attachments reflecting the stress of muscular pull can provide a record of an individual's habitual activities during life (Hawkey and Merbs 1995, 324). Muscular stress markers can take the form of depressed lesions on the bone surface, termed 'cortical bone excavations', or of ossified insertions of ligaments, seen as bony outgrowths and termed ' enthesopathies'. Enthesopathies are frequently caused by constant microtrauma, but may also be the result of inflammatory disease (spondyloarthropathy), endocrine (CPPD) or degenerative diseases (DISH), as well as severe sudden trauma (Osgood-Schlatter) (Resnick and Niwayama 1983). Cortical bone excavations, on the other hand, are unlikely to be disease-related and therefore simply reflect continual microtrauma at muscle attachment sites (Hawkey and Merbs 1995, 329). Research in modern patients has found that these defects may cause pain (Brower 1977, 677).
Bone is a dynamic material which can change its morphology, size and robustness in response to prolonged activity (Knüsel 2000a, 383). As a result, greater activity and mechanical loading causes the bone to become more irregular, with ridges and depressions caused by muscle action. Often, a continuum exists between this robusticity and musculoskeletal stress lesions, with some muscle insertions becoming prominent. Constant stress can cause enthesopathies or cortical bone excavations when they lose the capacity to properly absorb the stress imposed (Hawkey and Merbs 1995, 329). The dominant arm tends to have more extensively developed muscle attachments. It was, however, found that certain activities, such as archery, promote muscle development of the left arm (Knüsel 2000b).
At Fishergate House, both enthesopathies and cortical bone excavations were recorded for both sex groups and all ages. They were graded as slight, moderate or severe and their prevalence was calculated. Males had a greater prevalence of both enthesopathies and cortical bone excavations than females and a considerably greater prevalence than children.
Most musculoskeletal stress markers observed in children were cortical bone excavations, rather than enthesopathies. This finding was expected, considering the fact that enthesopathy formation as part of a disease tends to be more common in older age. In both adults and children, enthesopathies were more common in the lower limb, whereas cortical bone excavations were more frequently observed in the upper limb.
It was found that some muscular injuries showed a tendency for asymmetry, while others were equally common and severe in the left and right bones. Bone excavations at the site of the costoclavicular ligament attachment (which is vital in stabilising the sterno-clavicular joint) on the clavicle were found to be common in all adults, especially in the right bone, and particularly in males. This corresponds with the marked asymmetry observed in the measurements of the length and robusticity of the right clavicles, which was thought to be activity-related (discussed above).
Muscle attachments for pectoralis major (which attaches to the upper part of the humerus, and medially rotates and adducts the arm) were also very prominent on the right humerus in males, but few were observed in females. Teres major has the same function as pectoralis major, but cortical bone excavations at attachment sites for this muscle were common in both males and females, with a strong left bias.
Attachment sites for rectus femoris(which attaches to the patella, extends the leg at the knee and flexes the thigh at the hip) were more frequently observed on the right side. Soleus is a muscle that originates at the back of the upper tibia and attaches to the heel, where it is responsible for flexing the foot (with the toes pointing downwards). This muscle was clearly asymmetric towards the left, particularly in females. A left bias was also noted in the Achilles tendon, which is responsible for the same action.
In both juveniles and adolescents, asymmetry with a strong bias towards the right side was noted in the costoclavicular ligament, similar to the trend observed in adults. However, lateral asymmetry of muscle insertions of children showed a bias towards the right in deltoid (attaches to the clavicle, and allows adduction, abduction and rotation of the upper arm) and pectoralis major.
In most individuals, including children, the quantity and severity of enthesopathies and cortical bone excavations increased with advancing age. However, there were a number of exceptions, including lesions at the site of the costoclavicular ligament, which were most commonly noted in young male and female adults. Traumatic lesions at the insertions of biceps brachii(attaches to the upper radius, flexes the forearm and upper arm and rotates the wrist through supination) were more common in younger females and in older males. In both males and females, cortical bone excavations at the insertions of soleus were much more common in younger males and females. This is significant, especially considering the great prevalence of lesions for this muscle in the children (60% of juvenile tibiae and 75% right and 67% left adolescent tibiae were affected). This suggests that individuals with severe muscular stress on the lower legs, shoulder and lower arm were more likely to die at a young age, perhaps as a result of the physical strain endured.
The distribution of enthesopathies and cortical bone excavations suggests extensive use of the rotator cuff muscles in females, especially of subscapularis and supraspinatus, two muscles which strengthen the shoulder joint and abduct the upper arm, with suscapularis also medially rotating the arm, flexing, extending and adducting the upper arm.
Males were also commonly found to show lesions at the attachment sites for subscapularis, but with an equally high prevalence for infraspinatus (laterally rotates, abducts and adducts the arm), teres major (medially rotates, adducts and extends the arm) and pectoralis major (adducts, flexes and rotates the arm, depresses the arm and shoulder). A further high prevalence of muscular stress markers were noted in the lower legs of the males at the attachments of soleus (plantar flexes foot) and rectus femoris(extends the leg at the knee, flexes the thigh at the hip). Both males and females showed a high prevalence of bone excavations at the insertion of the costoclavicular ligament, and enthesopathies for the Achilles tendon.
Once again, the sexual dimorphism of musculoskeletal stress markers in the Fishergate House population suggests that males and females were carrying out different occupational activities. These involved the rotator cuff muscles of females and the upper arm and lower leg muscles of males. It appears that males suffered greater muscular stress overall, with more enthesopathies than females and a considerably greater prevalence of bone excavations. This is also supported by the greater prevalence of Schmorl's nodes and fractures in males. Degenerative joint disease, on the other hand, was broadly similar in males and females.
An attempt was made to compare all activity-related skeletal markers, including measurements, e nthesopathies, cortical bone excavations, degenerative joint disease (DJD) and osteoarthritis, with the aim of testing relationships between these skeletal indicators. In both males and females, a concentration of bone excavations and enthesopathies was found in the right clavicle and right upper humerus (the right shoulder joint) and this corresponded with the robust nature of the two bones as compared with those from the left side. However, more DJD was noted at the left clavicles than at the right, especially the lateral clavicular joint in females and the left medial joint in males. Interestingly, enthesopathies for subscapularis were more prevalent in the left humerus in both sexes, whereas lesions for supraspinatus were more common in the right shoulders.
It is noteworthy that DJD tends to be located on opposing sides to the more prominent muscular lesions. In the forearm, for example, radius and ulna length were greater in the right in females, with more DJD in the wrist and elbow. However, the prevalence of muscle attachments for biceps (forearm flexion) and triceps (forearm extension) was greater on the right side. This trend was the same for males, but on the opposite sides. In the lower limb, the right femur in males was more robust and longer than the left, whereas the left tibia was longer in both sexes on the left, with more prevalent muscular lesions at the leg and heel.
This comparative analysis of different activity-related skeletal expressions suggests that both males and females used their right shoulder muscles to a greater extent than the left. However, actions carried out with the lower arm and upper legs are distinct in both sexes, with greater flexion and extension of the left forearm in females and the right in males. The opposing upper leg (female right leg and male left leg) was subject to greater strain, whereas both sexes appeared to use their left leg for more strenuous activities than the right. Where greater prevalence of asymmetric muscle lesions was similar for both sexes, the frequency of DJD corresponded as well. Similarly, where a side distinction between males and females in muscle lesions could be observed, DJD also showed different side prevalence for males and females. However, a higher prevalence of DJD was commonly found on the opposite side of the body as compared with the enthesopathies and bone excavations.
Further possible cases for activity-related markers were observed in two individuals, in the form of atrophy (wasting of the bone). One of these was a mature adult female (C1115), with a probable slipped femoral epiphysis, causing distortion of the femoral joint. It would have been difficult and painful for her to use the leg, and resulting disuse had probably caused the atrophy of her right tibia.
A further individual with atrophy of the left humerus was a ten to fourteen year old juvenile. This child was unusual in many ways, with infection of the eye orbit, a defect in the ear, unusually small teeth and a congenital defect of the sternum. It is possible that all of these conditions are related to the humeral atrophy in some way. However, the arm may not have been used for a different reason which could not be identified.
The evidence for traumatic injuries has been found to be important in dispelling prejudices about the past. The notion that children were often the targets of violence was not substantiated, despite the large proportion of children in this population. Only minimal evidence for fractures was found in children, and no weapon trauma was seen in any of the children. Similar findings from other medieval cemeteries suggest that child abuse with skeletal trauma is a modern phenomenon (Larsen 1997, 157).
Fractures were observed in 11.5% of the population and were found to increase with age. Few long bone fractures were noted in the populations as a whole as compared with other medieval cemeteries, although the male prevalence rate for long bone fractures was relatively high. Although most bones were well-healed, the majority of fractures exhibited evidence for mal-alignment, suggesting limited use of splints. Rib fractures constituted the largest proportion of fractures; they affected all adult age groups and both sexes, but were more common in males. The frequency and severity of the rib fractures suggests that they may have been caused by activity-related accidents. The presence of injuries which required severe force, such as upper rib and scapula injuries, may alternatively imply violent attacks.
The lower prevalence of fractures and musculoskeletal markers of stress in females as compared with males may be due to the gender division of labour, with males engaging more actively in physical labour for crafts, production, agriculture and fishing, and women being more involved in household tasks and independent trades. However, the high prevalence of Schmorl's nodes in both males and females suggests that females were also involved in hard physical work. The greater number of fractures in males may, therefore, be attributed to a higher incidence of interpersonal violence. Nevertheless, it appears that some of the women from Fishergate House also engaged in interpersonal conflict, as implied by the hand fractures, which are indicative of hitting with a clenched fist.
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