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Paleoepidemiolgical patterns of trauma in a prehistoric population from central California.

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AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 115:13–23 (2001)
Paleoepidemiolgical Patterns of Trauma in a Prehistoric
Population From Central California
Robert Jurmain*
Department of Anthropology, San Jose State University, San Jose, California 95192-0113
KEY WORDS
fracture; cranial injury; projectile wound
ABSTRACT
Skeletal trauma was investigated in a
large collection of human remains from central California
(N ⫽ 162 aged and sexed adults). Lesions investigated
included cranial and long bone fractures, projectile
wounds, and dislocation. Long bone fractures were found
in 10.5% of individuals; overall, incidence by element was
2.3%. In addition, cranial injuries were found in 4.4% of
complete adult crania. Projectile wounds were seen unambiguously in four individuals (with embedded obsidian
fragments) and strongly suggested in two other individuals with partially healed lesions. Finally, one case of traumatic hip dislocation was also observed. In both incidence
and patterning of injuries, this population is similar to
other archeological groups from California. This evidence
further supports earlier reports indicating that interpersonal aggression was quite common in prehistoric California. Am J Phys Anthropol 115:13–23, 2001.
Traumatic injuries produce some of the most dramatic skeletal lesions seen in paleopathology. As
reported in case studies, they can sometimes inform
us of significant events in the lives of individuals.
While intriguing as this information is, even more
useful is the understanding of how various types of
traumatic injuries are patterned within and among
human populations.
This report describes patterns of traumatic injuries in a large well-preserved collection of human
remains from CA-SCl-038, a site located in the
Santa Clara Valley, central California. Lesions resulting from cranial and postcranial fractures,
weapon wounds, and dislocations were found in
these remains, and their epidemiological patterns
are generally congruent with other similar reports
from prehistoric California. Moreover, in conjunction with these other data from California, evidence
from SCl-038 further documents a distinctive epidemiological pattern from this region of North America.
Because they are probably the most easily diagnosed and among the most common types of skeletal
trauma, fractures have traditionally inspired the
most interest from paleopathological investigators.
Although individual case reports predominated for
much of the twentieth century, some early work was
quite systematic. Detailed data on fracture prevalence by individual element as well as comprehensive clinical comparisons were presented by Wood
Jones (1910) in his famous analysis of trauma in
Lower Nubian skeletal remains.
Such systematic analysis of skeletal trauma, however, was not equaled for some time, but the innovative analysis by Lovejoy and Heiple (1981) again
stimulated wider interest in population studies of
fractures. Other investigations which adopted such
an approach and also used some of the same methodological rigor advocated by Lovejoy and Heiple
(1981) included those by Bennike (1985), Jurmain
(1991), Grauer and Roberts (1996), Kilgore et al.
(1997), Judd and Roberts (1999), and Neves et al.
(1999).
These paleoepidemiological studies focused primarily on postcranial fractures, and there have
been, to date, fewer investigations of cranial
trauma. However, some notable exceptions do exist
(e.g., Bennike, 1985; Walker, 1989, 1997; Webb,
1995; Jurmain and Bellifemine, 1997; Lambert,
1997).
Penetrating weapon wounds are another form of
serious injury which has been described from various geographic locales. Most notably, from Europe,
metal weapon injury from swords or axes has been
quite frequently reported (e.g., Brothwell, 1961;
Wells, 1964; Bennike, 1985; Waldron, 1994; Anderson, 1996). Similar types of injuries have also been
described in the New World by Hutchinson (1996)
for a postcontact site in Florida. In prehistoric contexts from North America, weapon wounds most
commonly result from lithic projectiles. Primarily
anecdotal reports of such projectile injury have come
from a variety of locations, including Ohio (Hooton,
1920), Missouri (Black, 1979), New York (Pfeiffer,
©
2001 WILEY-LISS, INC.
©
2001 Wiley-Liss, Inc.
*Correspondence to: Robert Jurmain, Department of Anthropology,
San Jose State University, San Jose, CA 95192-0113.
E-mail: rjurmain@email.sjsu.edu
Received 16 May 2000; accepted 31 January 2001.
14
R. JURMAIN
Fig. 1.
Location of site, CA-SCl-038.
1985), Arizona (Merbs, 1989), South Dakota (Willey,
1990), Illinois (Milner et al., 1991), and Tennessee
(Smith, 1996, 1997).
In the New World, the most frequent occurrence of
such projectile lesions, however, has been observed
at sites in California (Tenney, 1986; Jurmain, 1991;
Lambert and Walker, 1991; Lambert, 1994, 1995).
Indeed, especially from sites in both central and
southern California, the incidence of such lesions is
as high as for any region in the world.
A final category of injury which has only been
rarely reported from archaeological contexts is traumatic dislocation. Diagnostic skeletal lesions resulting from dislocation are never common and are usually subtle in manifestation. Thus, descriptions of
such lesions in the literature are mostly anecdotal in
nature (Wood Jones, 1910; Ortner and Putschar,
1981; Jurmain, 1991; Kilgore et al., 1997).
MATERIALS AND METHODS
SCl-038, the “Yukisma site,” is a large cemetery
located in the northern Santa Clara Valley, approximately 6 miles south of the current edge of San
Francisco Bay (Fig. 1). The site was excavated in
1994 as part of an archaeological mitigation program resulting from expansion of the Santa Clara
County Elmwood Correctional Facility and was carried out by the Ohlone Families Consulting Services.
All osteological analyses were conducted under the
supervision of the author in the Physical Anthropology and Archaeology Laboratory at San Jose State
University.
Radiometric dating of 21 organic samples placed
the site’s occupation between ca. 240 BC and AD
1770 (Bellifemine, 1997). Distribution of dated burials as well as sequencing of temporally sensitive
artifacts suggest that the site was fairly continuously occupied during this 2,000-year span; however, temporal distinctions of burials within the site
are not precise enough to allow sytematic partitioning of the sample.
Systematic archaeological excavation retrieved a
large number of burials, many of which were excellently preserved. A total of 239 field-designated
grave lots contained an estimated 228 individuals.
Aging and sexing were done using standard osteological techniques (Ubelaker, 1989; Bass, 1991),
with sex assessment augmented by metrical evaluation (Dittrick and Suchey, 1986) as well as determination of mandibular morphology (Loth, 1996).
Age determination for adults in this sample was
based on pubic symphysis (Katz and Suchey, 1986)
and auricular surface (Lovejoy et al., 1985) remodeling.
Adults are utilized in this investigation, with
adult status based on fusion of all major appendicular epiphyses and/or fusion of the spheno-occipital
suture. A total of 162 adult individuals (aged ⬎15
years) could also be reliably sexed. Of these, 102 are
male (63%) and 60 (37%) are female (Table 1). The
average age at death for males (32.2 years) was
significantly less than that estimated for females
(37.2 years) (t-test, two-tailed probability ⫽ 0.003;
t-value ⫽ ⫺3.07; df ⫽ 144). For all aged individuals
in the sample (including subadults; N ⫽ 198), the
average age at death was 27.8.
Evaluation of fractures and other traumatic lesions was based on gross analysis, supplemented by
plain radiography. All elements with suggestive lesions visible on gross examination were radiographed; in addition, a radiographic survey was also
done, utilizing a representative sample of long bones
from all individuals. Unless otherwise indicated,
statistical comparisons were done using chi-square
analysis, and, where appropriate, a Yates correction
was employed.
In the postcranial skeleton, the presence of fracture
was determined for the long bones (clavicle, humerus,
radius, ulna, femur, tibia, and fibula). Following the
methodology proposed by Lovejoy and Heiple (1981),
only complete long bones were included in tabulating
prevalence; a complete long bone is here defined as
being at least two-thirds present, with all major articular areas preserved. Evidence of long bone fracture
was confirmed macroscopically through assessment of
bilateral asymmetry (including shortening of affected
side), angular deformation, and presence of fracture
callus. Moreover, radiographic evidence of fracture callus or remnant of original cortex further corroborated
diagnosis. Craniofacial injury was assessed similarly,
but also included evaluation of cranial vault depression fractures. Likewise, presence of dislocation was
diagnosed through gross observation of joint remodeling changes, especially those relating to attachment of
the joint capsule and alterations to the articular surface(s). Projectile/perforating wounds were established
by the presence of embedded projectile fragments (in
15
PATTERNS OF TRAUMA IN CENTRAL CALIFORNIA
TABLE 1. Sex and age distribution of SCl-038 sample
Male
Female
Indeterminate
Totals
0–10
11–20
21–30
31–40
41–50
51⫹
“Adult”
0
0
29
29
11
8
19
38
37
3
3
43
34
11
0
45
16
23
1
40
0
4
0
4
4
11
0
15
four cases) or perforations diagnosed on gross examination and radiographically and strongly indicated in
two other cases. In no case, however, was wound
trauma diagnosed solely on the basis of archaeological
context. Although such diagnosis has been suggested
by others (e.g., Wendorf, 1968; Lambert, 1994, 1997),
the vagaries of archaeological preservation and recovery make such data almost impossible to use in sample
comparisons (see further discussion below).
RESULTS
Long bone fractures
A total of 23 long bone fractures was found in 17
different individuals. Among the affected individuals, 5 were female (8.3% prevalence) and 12 were
male (11.8% prevalence); however, the difference is
not statistically significant. For the combined sample of sexed adults (N ⫽ 162 individuals), prevalence
of long bone fracture was 10.5%. Thirteen individuals display one lesion, two individuals have two fractures each, and another two individuals have three
long bone fractures. Thus, the proportion of affected
individuals with multiple lesions (4/17) is 23.5%.
A more explicit way to see the pattern of fracture
involvement is to evaluate individual elements. A
total of 1,018 complete long bones from sexed adults
was available for analysis. Thus, the combined incidence of involvement was 23/1,018 (2.3%). In addition, another 32 complete long bones were found in
adult burials of individuals designated as “indeterminate sex.” In the entire sample of adult complete
long bones, the combined fracture prevalence was
23/1,050 (2.2%).
Table 2 shows the data for long bone fractures by
element, side, and sex. The most commonly affected
element is the ulna (10/151 ⫽ 6.6%), followed by the
radius (3.6%) and humerus (2.1%). The forearm accounts for 69.6% of all long bone fractures, and,
overall, the upper appendage for 82.6% of involvement. There is little difference in left (2.1%) as compared to right (2.4%) side involvement. However, for
the ulna, there is a predilection for more left side
involvement (80% of cases), and this pattern is seen
to the same degree in both males and females. Still,
given the relatively low prevalence here, this side
difference did not reach statistical significance (P ⫽
0.10).
Regarding sex differences, there are also no statistically significant differences for any element, although the strongest predilection is found in the
radius, where 5 of the 6 affected cases are among
males (P ⫽ 0.50). Patterns of sex differences can also
be assessed by body segment (i.e., upper vs. lower
TABLE 2. Distribution of long bone fractures by side and sex1
Left
Clavicle
Male
Female
Humerus
Male
Female
Radius
Male
Female
Ulna
Male
Female
Femur
Male
Female
Tibia
Male
Female
Fibula
Male
Female
Totals
Right
N
n
N
n
46
32
0
0
49
32
0
0
50
27
0
0
47
18
2
1
51
34
2
1
49
27
3
0
43
29
4
4
47
25
1
1
41
16
0
0
43
19
2
0
55
25
0
0
53
31
1
0
40
28
517
0
0
11
43
18
501
1
0
12
(2.1%)
1
(2.3%)
n, number of fractured elements.
appendage). In males, 75% (12/16) of long bone fractures occur in the upper appendage, while females
have all (N ⫽ 7) fractures confined to the upper limb.
However, this difference is not statistically significant (P ⫽ 0.39). The overall pattern for both sexes,
with almost 83% of lesions found in the upper limb,
is significant (chi-square ⫽ 4.27; df ⫽ 1; P ⫽ 0.04).
The age distribution of affected individuals is
shown in Table 3. There is little indication in these
data of a significant increase in involvement with
advancing age, except that no young adults (⬍21
years) are involved. When looking at age and sex
involvement simultaneously, it can be seen that in
individuals less than 41 years of age, 91% of fractures are among males; conversely, for older adults
(41⫹), 67% of involvement is found in females. However, this apparent differential fracture involvement
is largely a product of the age distribution of the
sample (see Table 1). Indeed, chi-square analysis of
the age-partitioned sample (21– 40; 40⫹) by sex does
not reveal a significant sex difference in either age
group.
Of the 17 involved individuals, 15 could be aged
accurately (the remaining two, one male and one
female, were each aged as “35⫹”). In these subsamples of affected individuals, males (N ⫽ 11) averaged 35.63 years of age, while females (N ⫽ 4)
averaged 43.5 years. When compared to the overall
16
R. JURMAIN
TABLE 3. Prevalence of long bone fractures by age and sex1
16–20
21–30
31–40
41⫹
Age
N
n
N
n
N
n
N
n
Male
Female
Totals
11
8
19
0
0
0
37
3
40
5
0
5
34
11
45
5
1
6
16
27
43
2
4
6
(0%)
1
(12.5%)
(13.3%)
(14.0%)
n, number of fractured elements.
Fig. 2.
Ununited fracture, midshaft, left ulna. Female, aged 30 –50 years.
age data, affected males are slightly older (by 3.4
years), and involved females are somewhat older
than the overall female mean (by 6.3 years).
A further interesting feature of long bone fracture
involvement is that two of the lesions are ununited
(in two individuals, involving a left ulnar shaft and
a right humeral head). Such lesions have only rarely
been reported by paleopathologists (e.g., Stewart
(1974) found fewer than 10 such lesions among several thousand burials). Nevertheless, more recent
reports of skeletal samples from Nubia (Kilgore et
al., 1997) and California (Jurmain 1991) found several such lesions (four from Nubia and five from
California). In all these other cases, the affected
elements were from the forearm, as was one of the
examples from SCl-038 (Fig. 2). However, the other
ununited element, a right humeral head, is a most
unusual example. The failure to join suggests that
the limb was not immobilized during healing, which
would be not unusual for the forearm, but most rare
for injuries to the arm.
In addition to the 23 long bone fractures, another
10 individuals displayed other postcranial fractures.
The most serious of these was a healed pelvic fracture (ischio-pubic ramus) in an adult male. Other
lesions included two hand fractures (both metacarpals), three rib fractures (two of them in one individual), two vertebral compression fractures, and
three foot fractures (two phalanges, one metatarsal).
Cranial injuries
Apart from the long bone involvement, seven individuals at SCl-038 displayed cranial fractures (one
of whom, an adult male, also had a fractured left
ulna). From the sample, 159 adult crania were fairly
complete (at least 50% present); thus, the prevalence of cranial injury at SCl-038 is 7/159 (4.4%).
Five of the seven cases of cranial injury are restricted to the vault, and one to the face, and one
individual has both facial and vault involvement.
The vault injuries are to the frontal (two cases), left
parietal (two cases), and right parietal (two cases).
The facial injuries are to the nasal bones (in an
individual also with vault injury) and to the malar.
The most severe case of cranial injury was to a
young female, aged 18 –20 years, who displays a
large lytic lesion to her left parietal. The lesion is
located near lambda, just left of the midline, and
measures approximately 18.3 mm in diameter (Fig.
3). The injury perforates both inner and outer tables,
and the edges are very well-rounded (although a
small remnant of inner table is still present). Diagnosis suggests perforating trauma, approximately 2
years prior to death; moreover, the individual most
likely suffered from severe behavioral/neurological
symptoms (Bruce Ragsdale, personal communication, 1995).
In the cranium, as in the postcranium, there is not
a strong indication of sex bias among injured individuals. Of the 7 affected individuals, 4 are male and
3 are female.
Perforating wounds
Embedded projectiles are direct evidence of
weapon wounds, and four cases of such injury are
present at SCl-038 (for adult postcrania yielding a
prevalence of 2.5%). All embedded fragments are
made of obsidian, and involved individuals include
three males and one individual of indeterminate sex.
Affected elements include a hand phalanx, a lumbar
vertebra (Fig. 4), a rib, and a femur. The embedded
fragments are generally small (⬍5 mm), with the
exception of a fairly large obsidian projectile (7.9 ⫻
4.8 mm) in the femur of a young male (age ⬃16
PATTERNS OF TRAUMA IN CENTRAL CALIFORNIA
17
Fig. 5. Healed traumatic hip dislocation, proximal left femur.
The head is slightly mushroomed, and the muscle insertions on
the greater trochanter are heavily remodeled.
Fig. 3. Healed lytic lesion of left parietal, suggestive of a
perforating wound. Female, aged 18 –20 years.
ing a partially healed lytic lesion most likely resulting from perforating wounds. The first of these, in
the cranium of a young female, produced a massive
cranial fracture and is discussed above (Fig. 3). The
second probable injury was found in the distal right
femur of a middle-aged male, aged 30 – 45 years.
There are three lytic lesions evident, the largest on
the medial condyle measuring 9.6 ⫻ 13.5 mm (the
lesion is very round, circumscribed, and tapered).
There are also two smaller apertures on the distal
surface, and on x-ray, all three lesions communicate.
The suggested etiology explaining these changes is
probable projectile injury with likely secondary osteomyelitis.
Dislocation
Fig. 4. Embedded obsidian projectile, L5 centrum, right side.
The lesion is well-healed. Male, aged 30 – 45 years.
years). In three cases, on gross examination and
radiographically, bony reaction and healing are evident, but there is no such accommodation in the
large femoral wound. The age range of involved individuals varies from 16 –35 years, with an average
of 23.8 years for affected cases (compared to 32.2 for
all males).
Somewhat less direct evidence of weapon trauma
comes from two additional individuals, each display-
One case of a likely traumatic hip dislocation was
identified in this sample. The affected individual, a
male aged 25⫹, displays remodeling changes to both
his left acetabulum and proximal femur. The acetabular surface is much enlarged, with a maximum
diameter exceeding the contralateral by approximately 14%. The superior rim of the affected side is
extended approximately 30 mm, thus most likely
producing a pseudarthrosis. The left femoral head is
slightly mushroomed, with moderate marginal lipping, and the greater trochanter displays hypertrophic remodeling, probably resulting from a muscle
pull (m. gluteus minimus) (Fig. 5).
DISCUSSION
The types and patterning of traumatic injuries at
SCl-038 are quite similar to observations from other
prehistoric California localities.
18
R. JURMAIN
TABLE 4. Prevalence of long bone fractures in various skeletal populations1
SCl-038 (U.S.)
N
Clavicle
159
Humerus 142
Radius
161
Ulna
144
Femur
119
Tibia
164
Fibula
129
Totals
1,018
Danish
(Denmark)
Ala-329 (U.S.)
Libben (U.S.)
St. Helens
(U.K.)
Raunds (U.K.)
Kulubnarti
(Sudan)
n
%
N
n
%
N
n
%
N
n
%
N
n
%
N
n
%
N
0
3
6
10
2
1
1
23
0.0
2.1
3.7
6.9
1.7
0.6
0.8
2.3
291
300
301
290
313
315
237
2,047
2
1
13
15
0
5
0
36
0.7
0.3
4.3
5.2
0.0
1.6
0.0
1.8
386
703
608
607
998
852
364
4,518
5
1
9
13
0
6
2
36
1.3
0.1
1.5
2.1
0.0
0.7
0.5
0.8
260
450
369
351
347
349
257
2,383
15
3
20
11
9
5
9
72
5.8
0.7
5.4
3.1
2.6
1.4
3.5
3.0
891
770
752
937
864
725
4,938
17
10
11
1
6
6
41
0.8
1.3
1.5
0.1
0.7
0.8
0.8
171
178
167
164
186
163
86
1,115
12
2
8
6
2
3
6
39
7.0
1.1
4.8
3.7
1.1
1.8
7.0
3.5
262
276
259
260
281
232
218
1,788
n
%
1
0.4
10
3.6
16
6.2
34 13.1
3
1.1
0
0.0
3
1.4
67
3.7
Statistical comparisons, overall long bone fracture prevalence, SCl-038 compared with
Ala-329
Libben
Danish
St. Helen-on-the-Walls
Raunds
Kulubnarti
1
Chi-square
P
df
0.90
1.53
16.85
16.21
2.89
4.63
0.34
0.22
0.0000
0.0001
0.09
0.03
1
1
1
1
1
1
n, number of fractured elements.
Long bone fractures
Long bone fracture prevalence is 2.3%, compared
to 1.8% from another site in the same region previously analyzed by the author (Jurmain, 1991). This
other site is Ala-329, on the eastern side of San
Francisco Bay, approximately 14 miles north of SCl038.
Employing a broader geographic basis for comparison (Table 4), long bone involvement at SCl-038 is
generally intermediate in prevalence. The other
North American site (Libben) from Ohio (Lovejoy
and Heiple, 1981) shows a very similar overall fracture prevalence, although there is a greater involvement of the clavicle in that sample. Of the three
European samples, the Danish (prehistoric/historic)
group (Bennike, 1985) is significantly less involved
(0.8%; P ⫽ 0.0000), as is the British urban medieval
sample (Grauer and Roberts, 1996) from St. Helenon-the Walls (0.8%; P ⫽ 0.0001). However, the British medieval sample from Raunds, recently reported
by Judd and Roberts (1999), shows a higher overall
involvement (3.5%) than seen at SCl-038; the difference is not statistically significant. Finally, a similar
overall involvement (3.7%) to that at Raunds was
also found by Kilgore et al. (1997) for a Nubian
medieval group; the difference in prevalence in the
Nubian sample from that at SCl-038 is significant
(P ⫽ 0.03).
Some general conclusions can be drawn from
these overall fracture data. Prehistoric North American samples tend to be moderately involved, while
most European groups appear much less commonly
affected. An exception to this latter pattern is apparent in the rural (Raunds) materials, and Judd
and Roberts (1999) argue persuasively this elevated
incidence of fractures relates to injury risks associated with farming. The Kulubnarti sample of Nubian farmers is the farthest outlier, and its high
fracture prevalence has been interpreted by Kilgore
et al. (1997) to reflect risks of falling on an extremely
rugged terrain. Interestingly, the highest rates of
fracture are found not among hunter-gatherers or
urban dwellers, but among rural agriculturists. The
nature of the increased risks in the groups that
practiced farming, however, might vary considerably. In Britain, many of the injuries were probably
caused by close work with domestic animals; however, in Nubia, large domestic animals were not a
major part of the farm economy.
The pattern of long bone fracture involvement also
differs considerably among the comparative population samples. At Libben and Raunds, the clavicle is
the most frequently fractured element (at Raunds
the fibula is equally involved), but at other localities
clavicular fracture is rare. At Raunds, 75% of the
clavicular fractures were among males, and Judd
and Roberts (1999) suggest that equestrian accidents (as well as injuries from close work with other
large animals, such as oxen) could have been important risk factors. In the Libben materials, Lovejoy
and Heiple (1981) diagnosed many of the lesions
solely from radiographic evidence; thus, the method
and ultimate quality of ascertainment may differ
from that obtained in the other samples.
Forearm fractures strongly dominate at SCl-038
(70% of long bone involvement) as well as at Ala-329
(78% of all long bone fractures). Likewise, in the
Danish (61%), St.-Helen-on-the-Walls (51%), and
Kulubnarti (75%) materials, injuries of radii and
ulnae make up the majority of fractures. At Libben,
such trauma constitutes exactly 50% of fracture involvement, and it is least common at Raunds (36% of
fractures). Within the upper appendage, those
groups with the highest relative forearm involvement (SCl-038, Ala-329, Danish, and Kulubnarti),
the ulna is more commonly involved than the radius.
Conversely, in the other three groups, the forearm
elements are about equally involved (at St. Helen-
PATTERNS OF TRAUMA IN CENTRAL CALIFORNIA
on-the-Walls, Raunds), or the radius predominates
(at Libben).
At SCl-038, the strongest degree of asymmetric
involvement is in the ulna, although, as mentioned
above, this difference is not statistically significant.
Of some note, however, it is the left side that predominates (80% of ulnar lesions). It would perhaps
be tempting to conclude such lesions were due to
parrying blows (so-called “parry fractures”) from a
right-handed attacker. However, such an hypothesis
is ill-founded, on several counts. Firstly, such parry
fractures (clinically sometimes called “nightstick
fractures”) are thought mostly to manifest near the
midshaft. At SCl-038, only two ulnar fractures occur
in the middle third of the diaphysis, while the remaining six (75%) are found at the distal end (where
falls are a more likely etiology). Secondly, even when
ulnar fractures are located midshaft, the cause is
not clearly a result of aggression, a point well emphasized by others (Smith, 1996; Kilgore et al., 1997;
Judd and Roberts, 1999). Isolated midshaft fractures of the ulna probably indicate impact by a
sharp object to a pronated appendage. However,
such injuries can occur when, for example, an individual falls against a sharp edge of a boulder or a
piece of farm equipment. It is thus not justifiable to
assume that all (or even most) ulnar midshaft fractures relate to interpersonal aggression, especially
in the absence of other corroboratory skeletal evidence (see below).
Cranial injuries
The prevalence of craniofacial fractures in the
SCl-038 sample (7/159 ⫽ 4.4%) is moderately high
by worldwide standards, but not remarkable when
compared with other groups from prehistoric California. For example, Bennike (1985), in her Danish
series, found generally low rates of cranial injury,
rising to a peak of 4.6% for the medieval period (an
even higher prevalence was found in the Mesolithic
sample, but here only 12 crania were complete
enough for analysis). In a systematic overview of
varied skeletal samples from Siberia, Spain, the UK,
and the US, Walker (1997) found the following (combined) prevalence rates: nasal bones (7.0%), frontal
(4.6%), and parietal (3.9%). Robb (1997) also reported the prevalence of cranial fractures at 8.9%
from an Italian Iron Age site (N ⫽ 56).
Owsley et al. (1994) examined a large sample
(⬃500 skeletons) from Easter Island and found a
2.5% prevalence of craniofacial injury. From Australia, Webb (1995) reported extremely high rates of
cranial injury from most regions (almost always
greater than 15%, and in one area rising to 26.2% of
female crania and 27.7% of male crania).
In the New World, outside California, several investigators reported on cranial injury (e.g., Hooton,
1930; Snow, 1948; Stewart and Quade, 1969; Morse,
1969; Miles, 1975; Ferguson, 1980). In all these
studies, prevalence rates of cranial injury varied
from 2–5% of individuals. There are also several
19
contexts from various regions of North America
where large-scale violence produced very high rates
of perimortem cranial trauma. These cases of probable massacre and dismemberment have been described for Crow Creek, South Dakota (Willey,
1990); Norris Farms, Illinois (Milner et al., 1991);
and Koger’s Island, Alabama (Bridges, 1996). In addition, widespread perimortem cranial injury associated with cannibalism has been reported in North
America, especially from the southwestern US
(White, 1992; Turner, 1993). Indeed, a recent report
documented a similar pattern at the 100,000-yearold Moula-Guerey Neandertal site in southern
France (DeFleur et al., 1999).
Excepting these unusual circumstances of mass
violence, in North America, generally, the highest
incidence of craniofacial trauma has been reported
from sites in California (including Baja). One exception is the investigation by Newman (1957), where
in an all-male sample (N ⫽ 121), only 2.1% of individuals were involved. In contrast, Walker (1989)
found in his highly systematic study of 744 crania
from the Santa Barbara Channel region 19.4% of
individuals with cranial vault injuries (for adults
only, the frequency translates to 19.9%; N ⫽ 717).
Compared to the 4.4% prevalence at SCl-038, this
difference is highly significant (chi-square ⫽ 22.15;
df ⫽ 1; P ⫽ 0.000).
Similarly, in a smaller series (N ⫽ 49) from Baja
California, Tyson (1977) reported a remarkable 30%
of individuals with traumatic cranial involvement.
Again, the difference from SCl-038 is statistically
significant (chi-square ⫽ 27.20; df ⫽ 1; P ⫽ 0.000).
Lastly, from the neighboring Ala-329 site, 2.7% of
adult crania (N ⫽ 260) were involved (Jurmain and
Bellifemine, 1997). Although showing somewhat
less prevalent craniofacial injury than at SCl-038,
this difference is not statistically significant (P ⫽
0.51).
All the investigators involved in the above research relating to California sites have commented
on the likelihood of interpersonal aggression contributing to the relatively high levels of craniofacial
injury. Tyson (1977), in addition, postulated that
self-mutilation may also have played a significant
role, a factor also considered by Webb (1995) as
relating to his Australian series.
Perforating wounds
That aggression was fairly common in prehistoric
California is indicated by more direct evidence. At
SCl-038, four individuals have embedded fragments
of obsidian projectiles, and another two individuals
have partially healed lytic lesions strongly indicative of perforating wounds. There are further suggestive clues, as well, from archaeological context,
including the finding in situ of a large obsidian point
in the vertebral column of a 31– 40-year-old male.
The artifact was found between T1 and T2, but there
was no bone alteration whatsoever on either vertebra. It is thus difficult to see how including such
20
R. JURMAIN
indirect evidence of skeletal trauma could be used
systematically as paleoepidemiological evidence.
Nevertheless, some researchers have included such
data in their tabulation of projectile trauma incidence. For example, Wendorf (1968), in an analysis
of the late Paleolithic Jebel Sahaba site in Nubia,
found a very high incidence, leading him to conclude
that “almost half the population probably died violently” (p. 993). However, of the 24 individual involved cases counted by Wendorf (1968), only four
actually displayed embedded projectile fragments.
The remaining 20 cases were included solely on the
basis of archaeological association. From the data of
Wendorf (1968), the revised frequency of relatively
complete adults showing such bone involvement
translates to 9.8% (4/41), rather than more than
50%.
Similarly, Lambert (1994, 1997) reported in a
large southern California sample a prevalence of
2.2% of individuals (38/1,744) actually showing embedded projectiles. She also argued, from suggestive
nicks and archaeological context, that an additional
20 individuals were likely involved. Lambert (1997)
concluded that to ignore these other indirect clues
suggesting trauma would “likely result in a serious
underrepresentation of the actual number of victims.” Clearly, Lambert (1997) is correct is this assertion, but in paleopathology we are inevitably underestimating actual morbid conditions. Given that
some individuals incur bony injury from projectiles,
several more would almost certainly have suffered
strictly soft-tissue wounds. While we can confidently
assess the former (bone involvement), we can never
accurately estimate the latter. In order to conduct
systematic paleoepidemiology, our population comparisons must be as equivalent as possible (i.e., controlling for degree of completeness, age, and sex). To
introduce into our epidemiological comparisons a
variety of further uncontrollable variables, tied to
site disturbance and precision of archaeological recovery, makes any conclusions ambiguous at best.
As pertaining to the present analysis, it is probable that the obsidian projectile found in the upper
thoracic spine of the middle aged male was there at
the time of death. However, it is only because the
burial was not disturbed and was excavated with
good archaeological controls that such an assertion
can be made. It is empirically reasonable to mention
this case, but not entirely sound to count it for comparative purposes. Thus, the most rigorous evidence
of projectile trauma from SCl-038 is the four cases
showing embedded objects.
Moreover, in prehistoric North America, California groups show by far the highest prevalence of
such weapon wounds. Research (Walker, 1989; Lambert and Walker, 1991; Lambert, 1994, 1997) in the
Santa Barbara Channel region has added greatly to
our knowledge of such injuries in California. Moreover, from a survey of numerous individuals
(⬎2,000) from several sites in central California,
Tenney (1986) found 18 embedded projectiles in 13
individuals. Lastly, from a site (Ala-329), also in
central California, the highest prevalence has been
reported for a single locality (12 embedded projectiles in 10 individuals; N ⫽ 248). Moreover, the
prevalence of projectile injury at SCl-038 (4/162 ⫽
2.5%) is quite high, even by California standards
(while less common than at Ala-329, the difference is
not statistically significant; P ⫽ 0.57).
Fracture patterning
From both the evidence of craniofacial injury and
the more direct evidence of projectile wounds, it is
evident that, as elsewhere in California, interpersonal aggression was common at SCl-038. Of interest, as well, the pattern of forearm (especially ulnar)
fractures does not conform to the more direct evidence. As argued elsewhere (Kilgore et al., 1997;
Jurmain, 1999), the interpretation of “parry fractures” is seen as highly ambiguous and is best
avoided in paleoepidemiological interpretations of
past populations.
The soundest interpretation comes from a consideration of the more conclusive evidence. Individual
fractures are less informative than the pattern of
fracture involvement as distributed among different
body segments. This last point has been much emphasized by Berger and Trinkaus (1995) in their
intriguing interpretation of traumatic injuries
among Neandertals. Through comparison with contemporary clinical data (including, especially, rodeo
performers), Berger and Trinkaus (1985) concluded
that Neandertals suffered common physical misfortune from “frequent close encounters with large ungulates unkindly disposed to the humans involved.”
In the comparisons of fracture patterns, Berger and
Trinkaus (1985) tabulated data for four body segments (head/neck; trunk/pelvis; upper appendage;
and lower appendage). For purposes of comparison
with California archaeological samples, these data
were retabulated (Table 5) to include three body
segments (head/neck; and upper and lower appendages). The trunk and pelvis were deleted, since recovery of ribs is not usually complete and, moreover,
will vary between sites. Thus, in order to ensure
comparability, only those better-represented body
segments are included.
The distribution of fractures seen in the various
samples is intriguing and mostly contrasts in proportion of head/neck injuries. Rodeo performers
have the highest proportion of such injuries, followed by Neandertals (and these groups are not
statistically significantly different from one another). SCl-038 has the third highest proportion of
head/neck injuries, and, interestingly, the distribution of fractures by body segment is not significantly
different from that seen in the Neandertal sample
(although it is significantly different from the distribution in rodeo performers). The patterning of fractures at the two central California sites (Ala-329 and
SCL-038) is in many ways similar. However, of all
the archaeological samples, the most distinctive is
21
PATTERNS OF TRAUMA IN CENTRAL CALIFORNIA
1
TABLE 5. Pattern of fracture involvement by body segment in various populations
Upper
appendage
Head/neck
SCl-038
Ala-329
Neandertals2
Rodeo performers2
Kulbubnarti (Sudan)
Lower appendage
N
%
N
%
N
%
Total fractures
7
8
7
71
1
23
18
41
55
1
19
31
7
47
61
63
71
41
36
90
4
5
3
11
6
13
11
18
9
9
30
44
17
129
68
Statistical comparisons
SCl-038 vs. Neandertals
SCl-038 vs. Rodeo
Ala-329 vs. Neandertals
SCl-038 vs. Ala-329
SCl-038 vs. Kulubnarti
Ala-329 vs. Kulubnarti
Neandertal vs. Rodeo
1
2
Chi-square
P
df
2.26
9.83
6.43
0.42
14.38
10.66
1.93
0.32
0.007
0.04
0.81
0.0008
0.005
0.38
2
2
2
2
2
2
2
%, proportion of fractures by body segment.
Data from Berger and Trinkaus (1995).
that from Kulubnarti, which shows an extremely
low rate of cranial injury. Conversely, these medieval Sudanese Nubians show unusually high levels
of upper appendage involvement. Another possible
avenue of investigation concerns the distribution of
fractures within the upper appendage. In the investigation of the medieval farming community from
Raunds, Judd and Roberts (1999) found a proportionately high incidence of clavicular fracture, and
they attributed this patterning to likely injury from
close contact with large animals. From a preponderance of head and neck injuries, Berger and Trinkaus
(1995) drew a similar conclusion. To date, no investigation has collated the evidence of both types of
injuries to evaluate possible patterns. The patterning at SCl-038 (and at Ala-329) reveals fairly high
craniofacial involvement, but a very low incidence of
clavicular injury. Still, these results are not surprising; these central California groups were huntergatherers, but most likely did not regularly physically engage the largest fauna at close contact.
These data on fracture patterning suggest some
potentially informative trends. Firstly, the most distinctive component across population samples relates to the proportion of head/neck injuries. In
those populations with the highest levels of such
lesions, risk factors appear to derive from either
dangerous contact with large animals or from interpersonal conflict. In groups exposed to neither type
of risk, craniofacial injury can be expected to be
infrequent. This informative relationship of elevated
craniofacial injury to interpersonal aggression was
noted previously (Smith, 1996; Kilgore et al., 1997).
Finally, there is a cautionary note to be added: it
is often not possible to distinguish behavioral patterns from traumatic injuries, even when rigorously
evaluating patterns of involvement. Sometimes
skeletons convey unambiguous evidence of the lives
of past peoples. More often, however, the evidence is
less clear, thus challenging skeletal biologists to
make judicious interpretations.
CONCLUSIONS
Several interesting patterns of traumatic skeletal
involvement at SCl-038 are apparent from this investigation:
1) The prevalence of long bone fracture (by individual ⫽ 10.5%; by element ⫽ 2.3%) is moderate
when compared to other sites in North America
and elsewhere.
2) As in most other archaeological samples, a majority of the long bone fractures occur in the forearm.
3) Cranial fractures are also fairly common, paralleling results from other California locales (but
are significantly less than frequencies reported
from southern California).
4) Embedded projectile points are seen quite frequently, again a similarity with other prehistoric
California groups.
5) From the combined evidence of craniofacial injury and projectile wounds, it is apparent that
interpersonal aggression was common.
6) Other less common traumatic involvement
found at SCl-038 includes traumatic hip dislocation (one case), ununited fracture (two cases),
and nasal fracture (one case). While relatively
infrequent even today, these types of lesions
have, to date, been reported extremely rarely in
most paleopathological studies. More close
evaluation of skeletal remains might well improve diagnosis of these types of traumatic
manifestations (and, as relating to nasal injury, such an approach was also argued persuasively by Walker, 1997).
22
R. JURMAIN
ACKNOWLEDGMENTS
The analysis of the human remains from CA-SCl038 involved a team of researchers, and I am most
indebted to these colleagues at San Jose State:
Lorna Pierce, Anton Musladen, Leon Pappanostos,
Sandra Weldon, David Calleri, Muriel Maverick, Susan Rodriquez, Susan Morley, Viviana Bellifemine,
Victoria Wu, and Alan Leventhal. I am also deeply
grateful to Rosemary Cambra, Chairwoman of the
Muwekma Ohlone Tribe, as well as other members
of the Muwekma Ohlone Tribe, for their continued
support and encouragement. The research project
was directed by Muwekma Ohlone descendants and
the osteological analysis conducted at San Jose
State was contracted through the Ohlone Families
Consulting Services to the San Jose State University Foundation. Following completion of analysis,
the skeletal remains were returned to the Muwekma
Ohlone Tribe and were reinterred. Grateful acknowledgment is also due the San Jose State University Student Health Services for providing radiographs, and to the Instructional Resources Center
Photography Department, and to Jean Shiota of the
Almquist Center for Instructional Development for
assistance with figures. I am also grateful to the two
anonymous reviewers who provided useful suggestions to improve this article, and I am especially
thankful to Emöke Szathmáry, editor, for her guidance and professionalism. This article is dedicated
to the memory of my friend and colleague, Tony
Musladen (1923–1998).
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