вход по аккаунту


Disease and mortality in the early bronze age people of Bab edh-Dhra Jordan.

код для вставкиСкачать
Disease and Mortality in the Early Bronze Age People of
Bab edh-Dhra, Jordan
Department of Anthropolog?, National Museum of Natural History,
Smithsonian Institution, Washington, D C. 20560
K E Y WORDS Paleopathology . Mortality
. Early Bronze Age
During the 1977 field season a t the Early Bronze Age site of
Bab edh-Dhra 92 individuals were recovered from underground shaft tomb
chambers. Morbid conditions found in these skeletons include trauma, possibly
two cases of tuberculosis, osteomyelitis, post-menopausal osteoporosis and congenital anomalies. Of the 92 skeletons recovered 56 (61%)were 18 years of age
or older, 28 (30%)were between 1 and 18 years of age and 8 (9%)were less than
one year of age.
Disease, particularly of the infectious variety, is one of the most important factors affecting human populations. In man's more recent past plague and epidemic decimated
major cities and were important factors in the
demise of some human populations !McNeillt
'77). The role of disease in human adaptation
is, thus, one of the important problems in the
study of human biological history. As with
most problems in physical anthropology,
sources of data are less than desirable. Of
these sources skeletal remains are the most
ubiquitous but morbid conditions which affect
the skeleton are relatively rare. For example
skeletal responses to infectious disease are
largely limited to chronic conditions. Acute
conditions, such as those typically associated
with epidemic, rarely affect the skeleton and
skeletal manifestations in those that do may
be non-specific. Despite these limitations
there is much that can be learned about the
history of disease and the effect of disease on a
human population through the study of skeletal remains.
I should like t o review the evidence for several morbid conditions found in the skeletal
remains from the Early Bronze Age cemetery
of Bab edh-Dhra in Jordan. The skeletons in
this report were obtained during excavations
in the cemetery in May and June of 1977.
Bab edh-Dhra is located near the shores of
the Dead Sea about one kilometer east of El
Mazra, a modern town located adjacent to
AM. J. PHYS. ANTHROP. (1979) 51: 589-598.
the northern portion of the Lisan peninsula
which juts out into the Dead Sea from Jordanian shore. The most prominent feature of the
site of Bab edh-Dhra is the ruin of the large
fortified town. The outer stone wall encompassed an area of approximately nine acres
and provided housing for a minimum of 600
people. The cemetery is located south of the
town ruin. The boundaries of the cemetery
have not yet been carefully defined but clearly
they encompass several square kilometers and
c o n t a i n t h o u s a n d s of h u m a n s k e l e t o n s
(Lapp, '68).
Burials in the cemetery are in underground
tombs or ground level charnel houses. Differences in burial practice reflect cultural
changes taking place during the occupation of
the site. This occupation lasted from about
3150 to 2200 B.c., a period corresponding to the
Early Bronze Age. This period also corresponds with the early dynastic period in Egypt
and the development of major centers of
civilization in Mesopotamia.
During the Early-Bronze-Age occupation of
Bab edh-Dhra there are three major subphases. The first of these (EB I) lasted from
3150 to 3000 B.c. This period of settlement precedes the construction of the fortified town.
The construction and occupation of the fortified town occurred between 3000 and 2350
B.C. (EB 11-111).The town was destroyed a t
the end of this period but the site continued to
be used until 2200 B.C. (EB IV). During the EB
1 subphase the burials, typically, were secondary and were placed in underground shaft
tombs. Primary burial in charnel houses is primarily associated with the occupation of the
fortified town. After the destruction of the
town, burial was in underground tombs. The
skeletal material in this report is exclusively
from the Early Bronze I shaft tombs.
The shaft tombs were prepared by excavating a shaft about one meter in diameter and
one to two meters deep. In the wall near the
bottom of the shaft one or more entryways,
about one-half meter square, would be excavated and behind this a round or oblong chamber was dug about two meters in diameter and
one meter in height. Tomb gifts, primarily pottery, would be placed on the periphery of the
tomb chamber with skulls arranged to the left
of a central long-bone pile. An average of three
skeletons would be placed in each chamber.
The entryway would be sealed and apparently
the shaft was backfilled after all the chambers had been used.
During the excavations of the cemetery a t
Bab edh-Dhra in 1977 29 chambers containing
human remains were excavated. On the basis
of the work completed thus far, a total of 92
individuals was buried in these tomb chambers. Skeletal remains in four o f these chambers contained lesions of interest to the paleopathologist. It should be emphasized, however,
that the skeletal remains were generally in a
poor state of preservation and although the
count of individuals is probably close to reality, it is possible that some pathological material was not recovered. The teeth were in
particularly poor condition. Very often the
crowns had been sheared off postmortem a t
the cemento-enamel junction. It was generally possible to determine the broad categories
of age for each skeleton on the basis of gross
observation. More precise estimates of age
must await more adequate reconstruction and
histological analysis of long-bone sections.
The categories were infant, encompassing the
time period from birth to one year of age, child
(subadult) from 1year of age to 18 years of age
and, adult 18 years of age and older. The
choice of 18 years as the upper limit for childhood is somewhat unconventional but reflects
the realities of working with fragmentary and
fragile specimens. Most of the epiphyses of the
major long bones begin to fuse by 18. The basioccipital synchondrosis fuses a t approximate-
ly 18 years and the third molar erupts a t about
the same age. These features frequently can
be evaluated in poorly preserved skeletons
where more precise determination of age a t
earlier. perhaps more appropriate, ages is
more difficult.
We recovered very little evidence of trauma.
One possible example was found in tomb
chamber A80N. This chamber had been partially silted in. The skeletal remains were
poorly preserved and difficult to recover. The
specimen in question consists of the proximal
half of a left, adult humerus. The articular
surface is flattened and has considerable development of osteoarthritis on the periphery
of the joint snrface (fig. 1).The joint surface
itself is irregular with some porosity in the
central portion of the surface. The position of
the humeral head relative to the shaft is
abnormal with the entire head displaced distally.
There are two possible explanations for this
abnormality. The first is a fracture through
the neck of the humerus with subsequent
fusion in the abnormal position. The second
possibility is traumatic separation of the proximal epiphysis (epiphysiolysis) during the
growth phase of the individual with subsequent healing in the distally displaced position. The neck of the humerus is unusually
short suggesting a deficiency in growth. Such
a deficiency would be expected with slipped
epiphysis since t h e cartilage growth zone
tends to remain with the epiphysis thus disrupting further growth of the humeral neck.
For this reason slipped epiphysis rather than
fracture would, in my judgment, be the preferred diagnosis.
An example of trauma resulting from intentional violence is seen in the skull of an adult
male of about 45 years of age at the time of
death. This skeleton was found in shaft tomb
chamber AlOON and, with the two children’s
skeletons also found in the chamber, is the
only example of primary burial found in any of
the underground chambers excavated in 1977.
The skull vault of the adult male has two depressed lesions. One of these was on the frontal bone, the other was located on the right
parietal bone. Both lesions appear to be the result of a blow but showed extensive remodeling indicative of complete healing of the
The two children whose skeletons were
Fig. 1 The proximal left humerus (left) of a n adult from the A80N shaft tomb chamber in t h e Early
Bronze Age cemetery a t Bab edh-Dhra, Jordan. This specimen is compared with a normal left humerus
(right) from a modern dissecting room skeletal specimen. Note the distal deviation of the humeral head and
the shortened neck of the humerus
found in this chamber were about five and
seven years of age a t death. The skull of the
older child has a well circumscribed, lytic
lesion on the sphenoid (fig. 2). The lesion involves the medial pterygoid lamina as well as
the body of the sphenoid on the left side. The
lesion measures 25 mm in its long axis, about 1
cm wide and 1 cm deep. The lesion is slightly
porous but overall has a smooth compact bone
surface indicative of a chronic condition. A
tumor of the nasal passage is possible. Wells
('64: pp. 74-75) has noted the presence of
tumors of the naso-pharynx in ancient skeletons. He also reports that malignant carcinoma of the naso-pharynx is the most common malignancy in children and teenagers in
parts of Africa today. Strouhal ('76) has described similar neoplasms in Egyptian archeological skeletal remains. However, the circumscribed nature of the lesion in the child's skull
from Bab edh-Dhra does not suggest an
invasive malignancy. Another possible cause
of this lesion is tuberculosis. Rokitansky
(1855: p. 175) indicates that tuberculosis
often affects the body of the sphenoid. In untreated cases of tuberculosis the highest mortality occurs about seven years of age, thus
the age of this specimen is compatible with a
diagnosis of tuberculosis.
A documented case of tuberculosis in an 8year-old child shows a destructive lesion on
the body of the sphenoid (fig. 3) in almost the
identical place as the child from Bab edhDhra. This case is from the Pathology Museum a t the University of Strasbourg, France
(Museum No. 5266). In addition to the lesion
on the sphenoid, there are destructive lesions
of the right frontal bone and left mastoid process. The lesion in the sphenoid body is less circumscribed than the lesion seen in the Bab
edh-Dhra child. However, in my opinion, the
lesion in the child's skull from Bab edh-Dhra
is more compatible with a diagnosis of tuberculosis than malignant tumor.
It may be no more than an interesting coincidence but the most obvious and dramatic
pathological conditions found during our excavations in 1977 were from a single shaft
tomb chamber A100E. A total of ten individuals were buried in this chamber. Four of
these were infants. Of the remaining six individuals, three had skeletal lesions which probably would have produced noticeable effects
during life.
The first of these cases is a young male skeleton about 18 years of age. The morbid condition is limited to the lumbar vertebrae (fig. 4).
All of these vertebrae show varying degrees of
Fig. 2 The skull base of B 6 to 7-year-old child from the AlOON shaft tomb chamber in the Early Bronze
Age Cemetery at Bab edh-Dhra, Jordan. Note the well circumscribed lytic lesion on the left portion of the
sphenoid body (arrow).
porosity on t h e bodies, however this condition
is minimal on the first two vertebrae. The
third lumbar vertebra has periosteal reactive
bone on t h e anterior cortex of t h e body, particularly on t h e left side. The inferior portion
of the fourth vertebral body is completely destroyed leaving only t h e superior surface and
a portion of t h e left cortex. There is considerable formation of reactive bone on t h e remaining surfaces adjacent to t h e disk and there is a
cloaca through t h e remnant of the left cortex
of the body. The exposed surface of t h e cancellous bone is somewhat scalloped. The almost complete destruction of the vertebral
body would have resulted in kyphosis in t h e
living individual. The fifth lumbar vertebra
has considerable periosteal, reactive bone and
a large osteophyte on t h e antero-superior, left
portion of t h e body. There is no evidence of disease on the transverse or spinous processes.
The sacrum is normal except for almost complete spina bifida occulta. The destructive
nature of t h e morbid process on the fourth
lumbar vertebra, with minimal bony reaction
and healing, is strongly suggestive of tuberculosis. Differential diagnosis would include
consideration of osteomyelitis, brucellosis,
mycotic infections and Echinococcus infestation. Of these additional possibilities extensive destruction of a vertebral body resulting
in collapse and kyphosis is rare except for
osteomyelitis. In osteomyelitis, spinous and
transverse processes are often involved. The
morphology and distribution of t h e lesions
favors a diagnosis of tuberculosis.
Derry, ('38: p. 198) suggests t h e existence of
tuberculosis in ancient Egypt by 3300 B.C.
However, t h e first firm evidence of tuberculosis is reported by Smith and Ruffer ('10) in
a n Egyptian mummy dated to t h e twenty-first
Fig. 3 The skull base of a n 8-year-old child from the Pathology Museum a t t h e University of Strasbourg,
France (Museum No. 5'266). The lesions on the skull are attributed to tuberculosis. Note t h e lytic lesion on
the left portion of'the sphenoid body (arrow)
dynasty (ca. 1000 B c 1. Morse e t al. ('64) reviewed several possible cases of bone tuberculosis in ancient Egyptian material. Certainly
the young male skeleton from Rab edh-Dhra
represents one of the earliest, possible cases of
An adult female skeleton also from shaft
tomb chamber AlOOE shows evidence of osteomyelitis and osteoporosis. Pubic symphysis
morphology suggests a n age in excess of 50
years. All of t h e bones are abnormally light.
The sacrum, for example, weighs 42 grams
while another sacrum, almost identical in size
and from t h e same tomb chamber, weighs 68
grams. This suggests a n abnormal reduction
in bone mass of about 35%.The gross size and
shape of t h e vertebrae and pelvis are normal
although there is a slight bulge in the pelvic
canal from bone remodeling induced by t h e
pressure of the femoral heads. The cortical
surface of t h e pelvic bones have patches of
porous bone, particularly in areas adjacent to
muscle or ligament attachments. Although
the long bones are less severely affected,
roentgen films of the humeri show cortical
thinning and loss of density characteristic of
osteoporosis. A section of t h e midshaft of t h e
right femur reveals considerable porosity of
the compacta near t h e endosteal surface.
There is no evidence of abnormal osteoclastic
resorption as would be expected if t h e abnormal loss of bone density were due to hyperparathyroidism.
In modern clinical practice abnormal loss of
bone density (osteoporosis) is a well-known
clinical syndrome and is most frequent in
post-menopausal women. Its cause is not
known but the syndrome is associated with
diminished estrogen secretions. Post-menopausal osteoporosis would be the preferred
diagnosis for t h e loss of bone mass in the adult
female skeleton from tomb A100E.
In addition to osteoporosis, t h e skeleton also
exhibits lesions which are a response to infec-
Fig. 4 A left lateral view of the lumbar vertebrae of a young adult skeleton from the AlOOE shaft tomb
chamber in the Early Bronze Age Cemetery a t Bab edh-Dhra, Jordan. The body of the fourth vertebra has
largely been destroyed. There is a sinus through the remnant of the cortical wall on the left side of this vertebra (arrow). The fourth and fifth vertebrae are not fused.
tion. The lesions are particularly pronounced
on the left tibia and fibula which are fused between the distal joint surfaces. On the anterior portion of the distal ends of both these
bones there is a large, circumscribed lesion of
periosteal reactive bone (fig. 5 ) . This bone is a
reaction to an overlying skin ulcer. In addition, the right tibia, fibula and femur show
evidence of reactive bone suggestive of a disseminated osteomyelitis. The focus for this
dissemination could have been the skin ulcer
but i t is also possible that the ulcer was a complication of osteomyelitis. Krogman (‘40: p.
46) describes a fused left tibia, fibula and
talus from a male skeleton dated between
3000 and 2000 B.C. and excavated from the prehistoric site of Tepe Hissar in Iran. Krogman
suggested arthritis or osteomyelitis as possible causes. There was no sequestrum. His
figure 3d shows the anterior view of the specimen and indicates that trauma might be con-
sidered as well. There is no evidence of ulcer in
the figure.
The third example of skeletal pathology
from shaft tomb chamber AlOOE is found in
the skeleton of an adult male who was a t least
50 years of age. The skeleton is normal except
for the bones of the right hip and the presence
of separate neural arches on the fourth and
fifth lumbar vertebrae. The acetabulum is enlarged and shallow with considerable osteoarthritis on the periphery of the joint (fig. 6).
The corresponding head of the femur is enlarged. There are two defects on the joint surface of the femoral head. On the anterior,
inferior surface there is a curved depression
about one centimeter wide and two centimeters in length. The lesion is porous but well
circumscribed indicating a longstanding condition. The arch of the curve corresponds t o
t h e curve of the anterior edge of the acetabular rim and i t seems likely that the surface of
Fig. 5 The anterior view of the distal, fused tibia and fibula of an adult Female probably over 50 years of
age found in shaft tomb chamber AlOOE in the cemetery a t Bab edh-Dhra, Jordan. Note the large, oval, circumscribed area of reactive bone on both the tihia and fibula (arrows) resulting from the bony reaction to an
overlying ulcer
the femoral head frequently articulated with
the rim. The second defect is a deep but rather
narrow groove in the posterior, inferior surface of the joint. The groove begins a t the pit
for the ligamentum teres and continues posteriorly through the boundary of the joint surface. This defect is due to abnormal pressure
on the joint surface by the ligamenturn teres
perhaps during dislocation. Another possibility is that the ligamentum teres was abnormally elongated during dislocation. When the
head was in the normal anatomical position
the excess portions of the ligament would be
pressed between the joint surfaces. There is
increased surface irregularity and a slight
groove in the corresponding joint surface of
the acetabulum. The morphology of the components of this joint clearly indicate chronic
antero-superior dislocation of the hip. Whether this is due to a congenital problem or
trauma is not clear. Arguing in favor of a
traumatic origin is the fact t h a t the left hip is
normal. However, there is no evidence of
trauma and the acetabulum is shallow which
favors a diagnosis of congenital hip dislocation. In my opinion the evidence would favor
the later interpretation.
A careful demographic analysis of the skeletal material from Bab edh-Dhra must await a
more careful sorting and reconstruction of the
skeletal remains. For the present, a preliminary analysis of the skeletal material from
Early Bronze I shaft tombs reveals that, of the
92 individuals recovered from the tomb chambers, 56 (61%)were adults 18 years of age or
older, 28 (30%)were between 1and 18 years of
age, and eight 19%) were between birth and
one year of age. Angel ('76) found a similar
distribution of deaths in Early Bronze Age
skeletons from Karatas in Turkey. In a sample
Fig. 6 The skeletal components of the right hip from an adult, male skeleton over 50 years of age from
shaft-tomb chamber AlOOE in the cemetery a t Bab edh-Dhra, Jordan. Note the enlarged but shallow
acetabulum and the t w o grooves in the articular surface of the femoral head (arrows).
of 584 individuals, 34 (6%)were less than one
year of age, 160 (27%)were between 1 and 14
years of age and 390 (67%)were 14 years of
age or older. Angel uses a lower age limit for
the subadult age range (14 versus 18 years)
than I have used. This partially explains the
differences in the subadult and adult age
categories between the two Early Bronze Age
skeletal samples.
Angel's study of Middle Bronze Age skeletons from Lerna, Greece ('71: p. 70) indicates
t h a t almost 36%of the skeletons were infants.
This is a much higher infant mortality than
that found a t Bab edh-Dhra or Karatas. The
problem with such comparisons is that one
must assume that the same proportions of
infants who die are buried in the cemeteries.
Assuming that the differences in frequency of
infants in the cemetery reflect differences in
infant mortality a possible explanation for the
Early Bronze I people of Bab edh-Dhra is that
their more nomadic way of life meant less exposure to endemic infectious diseases prevalent in the later, more sedentary people of
In spite of rather high (by modern, Western
standards) subadult mortality (39%) a t Bab
edh-Dhra it is clear that many of' the adults
lived beyond 50 years. There is minimal evidence of disease in the skeletons. This is not
surprising since most diseases do not affect
the skeleton. Indeed, one of the paradoxes of
skeletal paleopathology is the possibility that
the lack of evidence of skeletal disease in a
cemetery population may be indicative of diminished resistance to infectious disease. Individuals lacking evidence of skeletal disease
may be dying of acute diseases or in the acute
phase of chronic diseases. This possibility is
based on the fact that skeletal reaction, particularly to infectious disease, occurs primarily when the individual's immune response is
sufficiently adequate to insure survival beyond the acute phase of a disease.
Evidence of tuberculosis in the skeleton
from tomb AlOOE is of considerable interest
for paleopathology and the history of disease.
There are very few mummy or skeletal specimens of purported tuberculosis any
earlier in time. The presence of osteomyelitis
in another skeleton from the same tomb chamber suggests the presence of organisms causing osteomyelitis by the Early Bronze Age and
supports Jones' ('10: pp. 283, 287) observation
that lesions in an ancient Nubian specimen
were most likely due to osteomyelitis. On theoretical grounds Cockburn ('63: pp. 68-102)
has argued t h a t infectious diseases of today
have a long history of association with man.
The evidence in t h e Bab edh-Dhra skeletal remains provides evidence t h a t the history of
some morbid conditions extends back at least
t o the Early Bronze Age.
I should like to acknowledge t h e generous
cooperation of Drs. Walter E. Rast and R.
Thomas Schaub, t h e co-directors of t h e expedition to Bab edh-Dhra. The Smithsonian Research Foundation, HrdliEka Fund, the American Schools of Oriental Research and the Jordanian Department of Antiquities provided
support for t h e cemetery excavations in 1977.
A note of appreciation also goes to Mrs.
Katharine Holland for her assistance in typing t h e manuscript. The technical assistance
of Mrs. Agnes Stix and Ms. Jacquin Schulz is
also appreciated.
Angel, J. L. 1971 The People of Lerna. Smithsonian Institution Press, Washington, D.C.
_ _ 1976 Early Bronze Karatas people and their
cemeteries. American J. Archaeo., 80: 385-391.
Cockburn, A. 1963 The Evolution and Eradication of
Infectious Diseases. The Johns Hopkins Press, Baltimore.
Derry, D. E. 1938 Pott’s disease in ancient Egypt. Medical Press and Circular 197 (Old Series): 196-199.
Jones, F. W. 1910 General pathology, fractures and dislocations in human remains. In: Archeological Survey of
Nubia. Report for 1907-1908, No. 2, Cairo.
Krogman, W. M. 1940 The skeletal and dental pathology
of an early Iranian site. Bulletin of the History of Medicine, 8: 28-48.
Lapp, P. W. 1968 Bab edh-Dhra tomb 76 and Early
Bronze I in Palestine. Bulletin of the American Schools of
Oriental Research, 189: 12-41.
McNeill, W. H. 1977 Plagues and People. Anchor Press,
Garden City. New York.
Morse, D., U. H. Brothwell and P. J . Ucko 1964 Tubercu~
losis in ancient Egypt. American Review of Respiratory
Diseases, 90: 524-541.
Rokitansky, K. 1855 A Manual of Pathological Anatomy, Vol. 3. Translated from the last German edition by
Charles H. Moore. Blanchard and Lea, Philadelphia.
Smith, C . E., and M. A. Ruffer 1910 Pottsche Krankheit a n
einer Aegyptischen Mumie aus der Zeit der 21 Dyuastie
(um 1000 V. Chr.). In: Zur Historischen Biologic der
Krankheitseneger. K. Sudhoff, ed. Leipzig, 2: 9-16.
Strouhal, E. 1976 Tumors in the remains of ancient
Egyptians. Am. J. Phys. Anthrop.. 45: 613-620.
Wells, C. 1964 Bones, Bodies and Disease. Frederick A.
Praeger, New York and Washington.
Без категории
Размер файла
1 690 Кб
people, edh, dhra, disease, bronze, age, bab, jordan, mortality, early
Пожаловаться на содержимое документа