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Pathology of Bedouin skeletal remains from two sites in Israel.

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Pathology of Bedouin Skeletal Remains from
Two Sites in Israel
MARCUS S. GOLDSTEIN, BARUCH ARENSBURC
AND
HlLEL NATHAN
D e p a r t m e n t oj A n a t o m y n n d Anthropology, Sacklei Medical School,
Tel A u i v University, Tel A v m , Israel
KEY WORDS
Negev . Israel
Skeletal pathology . Bejel . Historic Bedouin
Ecology.
.
Frequency of pathology and of some anomalies in skeletons of
Bedouin living about 200 BP, uncovered in the Israeli Negev, is considered
in relation to particular bone, sex, age-group, and kinds of defects. The environment of the Bedouin in relation to his “health-status” is noted. Two-thirds of the
skeletons had one or more different bones with defects. Incidence of crania with
defects was: males, 26% ; females, 18%; the highest incidence occurred at age
35-49. Alveolar abscesses occurred in 28% of maxillae, 9% of mandibles. Of
the long bones, the tibia was most frequently affected ( 1 5 % ) : swelling of the
shaft, relatively common, was apparently caused by bejel, a non-venereal form
of syphilis, similar to yaws, endemic to the Bedouin. Forty-eight percent had
defective vertebrae, usually an arthritic manifestation of one kind or another;
half of this group had defects in more than one region of the spine. Defects also
occurred relatively frequently in the innominata, sacrum, scapula, and clavicle,
mostly arthritic lesions except in the sacrum in which the percentage with
sacral hiatus was high. Average age at death was, males, 43 years, females,
33 years (adults only), and 28 years for all ages.
ABSTRACT
We here report on pathological conditions
and anomalies observed on the skeletal
remains of Bedouins from two archaeological sites in Israel. One site is Tel Harif,
near the present Kibbutz Lahav, some 30
km north of the city of Beersheva; the
other is Tel Sheva, about 10 km east of‘
Beersheva (fig. 1). The tels (Hebrew for
mounds) appear to have been winter meeting grounds, Tel Harif for the nomadic
Ramadin tribe and Tel Sheva probably for
the Abu Ragiek tribe. The material from
each site is dated approximately 200 BP,
based on Turkish coins from Tel Harif and
typical Bedouin glass beads and bracelets
of the period from Tel Sheva.
Skeletal remains alone cannot, of course,
reveal a full or exact picture of morbidity;
indeed, pathological conditions noted in
the skeleton usually are not the cause of
death. And many if not most pathological
conditions observed on the bones of the
skeleton can be the result of a variety of
causes or diseases (Stewart, ’66; Morse,
’69; Brothwell, ’61; Goldstein, ’69). Nonetheless, pathological conditions observed
AM. J . P H Y S . ANTHROP.. 45: 6214340.
in skeletal remains, particularly with regard to prevalence in a “population” and
with due regard to environmental and social factors involved can be of significant
historical as well as social-biological import (Angel, ’46; Cassedy, ’66; Brothwell
and Sandison, ’67; Armelagos, ’69). Indeed
Lambrecht (’67) considered diseases “an
important selective factor”, and cites a
quotation by Darwin in his prologue to
“On the Origin of Species”, to this very
effect.
Although a considerable published literature is extant on the Bedouin (Musil,
’28; Field, ’52; Seltzer, ’40; Shanklin, ’35,
’46; Coon, ’58; Marx, ’67; Muhsam, ’66;
Bonne et al., ’70; Arensburg, ’73), data on
their morbidity or skeletal pathology are
very scanty. One notable exception is the
book by Hudson (‘58), a sociological and
medical study of Bejel, or non-venereal
syphilis, among a Bedouin group in Syria
between 1926-1936. Field (’52), i n a primarily anthropometric study of several
Bedouin groups, gives observations on dentition and vision; and Musil (‘28) in a n
62 1
622
M. S. GOLDSTEIN, B . AKENSBIJRG AND H . NATHAN
J
I
i
NEGEV
I
I
!
!
j
I’
I
!
I
Figure 1
ethnographic study of the Rwala Bedouin
tribe in Syria noted diseases “universally
known” among them. Various observations
related to health status of the Bedouin
(e.g. nutrition, demography) occur and will
be referred to subsequently.
MATERIAL AND METHODS
Some 106 crania and their postcranial
bones were recovered from Tel Harif. These
were secondary burials found in several
caves; with few exceptions, the bones were
scattered and could not be assembled as
individual skeletons. However, the whole
“population” of the caves representing this
“recent” period was recovered and com-
prises the material of the present report.
At Tel Sheva the skeletal remains were
found as individual burials, and hence
many of those recovered were more or less
complete skeletons. Crania and postcranial
bones of about 90 individuals from this site
were examined. However, the Tel Sheva
remains probably represent only about 50 o/n
of the total “population” from this site,
the remainder had been destroyed in the
course of archaeological excavations as a
result of an unfortunate notion that “recent” skeletal material was of no scientific
value.
The Tel Sheva skeletal material was excavated by Prof. Y. Aharoni of Archaeological Institute, Tel Aviv University; the Tel
Harif material was excavated by our own
Department.
Crania and postcranial bones were examined separately. Sex and age were estimated on the crania, and sex was assayed
on each bone from Tel Harif and on the
“complete” postcranial skeletons from Tel
Sheva; in the latter, estimates of sex on
the skull and postcranial skeleton were
checked.
Only pathological conditions that could
be classified as moderate or marked in
severity (or manifestation) have been tabulated. The criteria of classification or “diagnosis” of a condition was based largely
on the excellent descriptions and illustrations provided by Morse (‘69).
Although the two Bedouin sites are fairly
close one to the other and the skeletal remains are of approximately the same period, we consider them separately primarily
because Bedouin tribes have tended to
marry within their own group (Marx, ’67;
Muhsam, ’66). Hence the material uncovered presumably represents two more or
less separately inbred groups. A relatively
high incidence of metopic suture among
them (21.18 ,both sexes, both sites combined) may well be a morphological indication of family segregation. A comparison
of the two groups metrically (table 1) indicates that the Tel Sheva peoples were significantly taller on the average, and tended
to have larger crania than at Tel Harif; it
is clear, however, that both groups belonged
to the same Mediterranean dolichocranic
ethnic stock (Arensburg, ’73).
Most Bedouin are buried in shallow
graves (formerly also in caves), and “after
623
PATHOLOGY OF BEDOUIN SKELETAL REMAINS
TABLE 1
Comparzson of severul measurements between Bedouin skeletal remazns of adultsfrom
Tel Harif a n d Tel Sheva urchaeologzcal sites (Measurements are in
mm, except crantal index)
Male
Site and variable
Number
Tel H a n f
Stature 3
Maximum length
Maximum breadth
Basion-bregma height
Porion-bregma height
Bizygomatic breadth
Nasion-prosthion
Cranial index (percent)
25
36
35
32
37
22
36
35
Tel Sheva
Stature 3
Cranial length
Cranial breadth
Basion-bregma height
Porion-bregma height
Bizygomatic breadth
Nasion-prosthion
Cranial index (percent)
12
38
39
23
34
24
32
37
Mean
Female
SD
Number
Mean
SD
1615 I
180.8 1
132.8 1
128.8
110.1 1
122.7
65.2
73.7
35.5
6.1
4.9
6.2
16
27
26
24
26
15
25
25
1494 2
175.4
130.8
127.3
108.4
119.5
63.5
74.6
39.5
5.0
3.8
4.4
3.6
5.6
3.7
3.1
1664
188.4
136.3
130.1
113.1
125.3
66.7
72.6
42.5
7.0
5.4
5.5
4.8
7.6
4.9
3.3
11
24
1525
178.9
132.6
125.4
107.2
118.6
64.8
73.7
22.1
7.1
4.5
6.3
6.4
3.5
3.4
3.3
4.4
5.3
3.4
3.5
21
14
17
11
15
20
Difference hetween Tel Harif and Tel Sheva significant at .01 level.
Significant at the 5% level.
Based on maximuin length, right femur and calculated according to Pearson (1899).(Stature according to the left femur was: Tel Harif, male No. 38, Mean, 1615, S.D. 44.1; female - No. 21. Mean, 1507,
S.D.39.0. Tel Sheva. m a l e - Nu. 12, Mean 1652, S.D. 44.8; female- No. 9, Mean 1526, S.D. 20.5).
1
2
3
a few years the site is obliterated and the
dead person is forgotten” (Marx, ’67).
Environmental and social factors
The major sources for this section, unless otherwise noted, have been Marx (‘67)
and Muhsam (‘66). As noted in figure 1 ,
the Israeli Negev is a n extension of the
Sinai peninsula. The Hebrew word Negev,
usually rendered in English as Southland,
actually means dry land, desert, although
not all parts of the Negev were always
barren. Temperature in the Negev in winter months can undergo extensive and
rapid changes, from below freezing to
30” C.
The Negev, although largely a desert
region, could and did sustain small nomadic populations at subsistence level formerly.
The term Bedouin usually refers to nomadic Arabs, “dwellers of the desert”.
Bedouin groups have been divided into
“true” nomads, subsisting on the camel
only and completely pastoral, in contrast to
semi-nomadic or completely settled groups
(Coon, ’58), although various degrees of
nomadism have been discerned even in the
first group (Muhsam, ’66; Marx, ’67). Different Bedouin groups have ranged virtually throughout the Middle East, e.g. i n
Israel, Jordan, Syria, Iraq, Saudi Arabia,
The major forces contributing to nomadism
of the Bedouin were and are the need for
water, a search for pasture, and least important, bad sanitary conditions, i.e., emplacements becoming too soiled with hum a n and animal excrements.
Estimated number of Bedouin in the
Negev about 1946 range from 55,000 to
90,000, a population divided into some 95
tribes. The average number of families i n
a tribe was 168. Families camping together
tended to be related and to belong to the
same clan. Inbreeding within the tribe or
even within smaller social units was common. Marriage was often consummated
when the bride was considered nubile, as
early as 12 or 13 years. One source, however, (Sebai, ’74), referring to a community
in Saudi Arabia notes that marriage of a
Bedouin girl is usually delayed until 18
“as a Bedouin girl is needed for herding
the goats and sheep,” although he subse-
624
M. S. GOLDSTEIN, B. ARENSBURG AND H . NATl1AN
depression in the skull was during the life
of the individual, it is difficult to judge:
one sees people with similar depressions on
their heads walking about, apparently not
affected by the condition. The depression
usually occurred on the frontal, less frequently on the parietal, and occasionally
both on frontal and parietal bones. Atlantooccipital synostoses appeared only in the
Tel Harif crania, whilst osteoporosis, palate
cyst, and cholesteatomata were obRESULTS
served only i n the adults of the Tel Sheva
Crania. Table 2 gives frequency of cra- material.
Stewart (‘50) has commented on a posnia from Tel Harif and Tel Sheva, respectively, with pathology by kind of defect. sible relationship between abscessed teeth
The incidence of affected crania is consid- and arthritic conditions, and we were
erably higher at the latter site, 30% vs. tempted to include alveolar abscess as a
19% (among the adult females 27% to pathology of the skull. However, i n many
10%). A marked differential between the instances only a part of the skull was presexes i n proportion of crania with pathology served (e.g. maxilla), providing informaoccurs only in the Tel Harif material.
tion on the dentition, but none on the skull.
A depression in the skull, occasionally Hence the incidence of alveolar abscess
more than one, probably the result of a has been considered separately. If alveolar
blow, is the most common “pathological” abscess had been included in table 2, the
condition observed, occurring in about 10 % incidence of crania with pathology would
of the crania at both sites. How serious a have risen to 39.5% and 28.9 % among the
quently admits that “marriage for girls
might be as early as 13 years or even
younger”.
Likely enough, in view of the relative
stability of the Bedouin ecological niche
and their social conservatism, the aforementioned environmental and social conditions prevailed essentially during the lifetime of the Bedouin whose skeletal remains
are the present source of study.
TABLE 2
F r e q u e n c y of B e d o u i n c r u n i a uith p a t h o l o g y iexcludinq dental c o n d z t i o n v j ,
by site, s e x a n d k i n d of p a t h o l o g y
Male
Total crania
Pathological crania:
Number
Percent
Buth sexes
Female
Children
T.H.
T.S.
T.H.
T.S.
T.H.
T.S.
T.H.
T.S.
38
34
38
33
76
67
30
23
10
26.3
9
26.5
4
10.5
9
27.3
14
18.4
18
26.9
6
20.0
9
39.1
N u m b e r of c r a n i a
K i n d s of p a t h o l o g y
Depressionis) (trauma?)
Depression
palate exostoses
cribra orbitalia
cholesteatomata
Depression
Depression
tumor
Tumor
Cholesteatomata
Atlanto-occipital synostosis
Atlanto-occipital synostusis
inflammatory lesions
on mastoid process
Osteoporosis/pitting
Palate cyst
Arthritic condyles of
mandible
Fracture
Sword(?) wound
Cribra orbitalin
+
+
+
+
6
-
-
2
2
8
4
1
-
1
-
-
-
-
-
-
1
1
1
1
-
-
2
-
-
-
1
1
-
1
-
__
-
-
1
-
1
-
1
-
-
-
1
-
-
-
2
-
1
-
3
2
1
I
1
__
-
1
2
-
+
Note: T.H. = Tel Harif; T.S. = Tel Sheva.
2
-
1
-
-
1
-
-
1
1
1
-
1
1
2
1
-
-
1
2
-~
___
4
-
-
-
-
4
5
625
PATHOLOGY OF BEDOUIN SKELETAL REMAINS
often extensive and deep, involving several
teeth, usually the molar region although
they also occurred in all regions of the
maxilla except that of the incisors.
Impacted teeth occurred relatively infrequently (4.6% in the maxilla, 3.3% in the
mandible, combined sites); and congenitally missing third molars occurred somewhat more frequently in the mandible than
in the maxilla (12.2% vs 9.2%, combined
sites). Interestingly, the frequency of third
molar hypodontia in Egyptian F’redynastic
crania is given as 12.2% (Brothwell et al.,
’63), precisely the frequency found in the
mandible of the Bedouin of the present
report.
Incidence of crania with many teeth lost
antemortem is surprisingly low (13 96 , combined sites), especially in view of the relatively high frequency of crania with alveolar abscess; age is of course a significant
factor in antemortem tooth loss; more than
a third of the crania manifesting a loss of
six or more teeth occurred at age 50 or
over (table 5). Field (‘52) found in 136
Bedouin males in Sinai, (average age 40.6
males and the females respectively at Tel
Harif and 32.4% and 59.6% among males
and females at Tel Sheva.
Frequency of crania with defects by age
is considered in table 3. The high proportion of children with cranial defects, especially in the age group 7-17 at both Tel
Harif and Tel Sheva, is noteworthy, albeit
the results must be considered tentative
in view of the small numbers of crania
represented. Among the adult group, the
peak of affected crania apparently occurred
by age 3 5 4 9 . The substantially higher
proportion of pathology at Tel Sheva than
at Tel Harif is here again discerned (32%
vs. 19%).
Dental pathology and anomalies
As indicated in table 4, the incidence
of crania with alveolar abscess was about
the same at Tel Harif and Tel Sheva in the
maxilla (28-29 % ), but relatively more than
twice as frequent in the mandibles of the
latter. The incidence was much higher in
the maxilla than in the mandible (28%
vs 9 % , combined sites). The abscesses were
TABLE 3
Frequency of Bedouin crania w i t h pathology (excluding dental conditions),
by site and age group: Both sexes
Tel Sheva crania
Tel Harif crania
Age group
All ages
Under 7
7-1 7
18-34
3549
50 and over
1
Pathological
Pathological
Total
Number
Percent
Total
Number
Percent
106
24
7
36
26
13
20
3
3
5
6
3
18.9
12.5
42.9
13.9
23.1
23.2
84
16
27
6
3
5
8
5
32.1
37.5
42.9
26.3
34.8
26.3
1
7
19
23
19
Excludes 6 “adult” crania for which age could not be estimated
TABLE 4
Bedouin crania with dental conditions, by site a n d j a w . Adults, both sexes
Jaw and
site
Alveolar
abscess
Total
crania
Impactions
Congenitally
missing M3’s
No.
Percent
No.
Percent
No
Percent
7
Maxilla
Tel Harif
Tel Sheva
62
69
18
19
29.0
27.5
4
2
6.5
2.9
5
11.3
7.2
Mandible
Tel Harif
Tel Sheva
40
50
2
6
5.0
12.0
2
1
5.0
2.0
3
8
16.0
7.5
626
M. S. GOLDSTEIN, B. ARENSBUKG AND H . NATHAN
years), that 64% had “no” or “few” teeth
lost, 15% had “some” lost, and 21% had
many teeth lost (Field’s “plus” and “double
plus”). Our results on the crania seem
fairly comparable with Field’s findings on
the living, particularly in regard to the
high proportion of adults with no or very
few teeth lost.
Long bones
As noted in table 6, the tibia was the
most frequently affected of the long bones.
No consistent difference in relative fiequency of long bones with pathology is apparent between the Tel Harif and Tel Sheva
groups.
The kinds of pathological conditions
found in the long bones are indicated in
tables 7 and 8. More than one “condition”
i n a bone appears to be not uncommon. To
be sure, two or more conditions in a long
bone may be the response to the same disease, e.g. lipping and exostoses may be the
result of an arthritic infection, or perhaps
even a manifestation of the aging process.
Swelling of the shaft, especially in the
tibia, was the most frequent condition both
in the Tel Harif and Tel Sheva remains.
Swelling in the tibia was either localized,
usually approximately in the middle of the
shaft, or general (one-half or more of the
shaft); each type occurred in about equal
frequency. Too, the swelling was either
smooth (4 of 21) or rough (13 of 21), 5
cases of swelling were inadvertently not
specified as to rough or smooth. In regard
to sex of tibiae with swelling, no difference
in relative frequency is apparent at Tel
Harif, whereas all of the six tibiae with
swelling from Tel Sheva were adjudged female. Swelling in all long bones other than
the tibia was localized, with the exception
of two ulnae.
In regard to the likely cause(s) of the
swelling, it is of pertinent interest that
Hudson (’58) illustrates this same condition in the Syrian Bedouin, and considers
it a manifestation of bejel, a non-venereal
form of syphilis acquired in childhood and
transmitted by contact.
TABLE 5
Freqziency of crania w i t h antemortem tooth loss in Bedouin skeletal remains from
israel, by jaw and age-group: Adults, both sexes
Maxilla
Number of
teeth lost
All a g e s 1 20-34
Mandible
50f
Allac-es
131
50
47
28
90
31
30
19
None
Very few (1-2)
Few (3-5)
Many (6-10)
Very many (1 1
53.4
22.1
7.6
9.9
6.9
70.0
22.0
4.0
4.0
55.3
17.0
10.6
10.6
6.4
28.6
28.6
7.1
14.3
21.4
54.4
18.9
14.4
8.9
3.3
71.0
19.4
6.4
3.2
60.0
16.7
13.3
10.0
42.1
-
-
100.0
100.0
100.0
100.0
100.0
100.0
+)
Total
-
80-34
so+
35-19
Total number
Percent
3549
5.3
15.7
21.1
15.8
100.0
100.0
Includes six crania of adults fur which age could not he estimated
TABLE 6
Frequency of long bones with pathology, by site: Adult, both sexes, right and left
Site
Tel Harif
Total number
Pathological.
Number
Percent
Tel Sheva
Total number
Pathological :
Number
Percent
Femur
Tihia
Fibula
155
169
128
6
3.9
99
8
8.1
24
Humerus
146
Ulna
123
Radius
129
1,1.2
16
12.5
13
8.9
17
13.8
13
10.1
73
87
90
52
75
13
17.8
8
9.2
8
8.9
4
7.7
8
10.7
627
PATHOLOGY OF BEDOUIN SKELETAL REMAINS
TABLE 7
Number of leg bones w i t h specified conditions, by type of Eong bone and site: Bedouin
skeletal remains (adults, combined sexes, right and left)
Tel Harif
Tel Sheva
Conditions
Femur
Total bones with pathology
Swelling of shaft only
with osteoporosis and bowing
Inflammatory lesions o d y
with osteoporosis
Arthritic lesions only
with lipping
with lipping and osteoporosis
Lipping only
Osteoporosis only
Fracture with exostoses
Fracture with distortion,
lipping and osteoporosis
Distortion only
Exostoses
Striations, marked
Bowing, marked
Tibia
6
Fibula
Femur
Tibia
Fibula
24
16
6
13
a
15
1
-
2
3
-
2
2
-
1
-
2
2
-
-
2
2
3
1
1
1
-
-
1
2
1
-
2
3
TABLE 8
Number of arm bones w i t h specified pathological conditions, by type ofbone and site:
Bedouin skeletal remains (adults, combined sexes, right and left)
Tel Harif
Tel Sheva
Condition(s)
Humerus
Total bones with pathology
Swelling of shaft only
with Lipping
with Osteoporosis
with Arthritic lesions
Inflammatory lesions only
Arthritic lesions only
with Lipping
with Resorption and osteoporosis
with Lipping and osteoporosis
Lipping only
Osteoporosis only
Fracture healed
with Distortion
Exostoses
Bowing, marked
Tumor
Withered
Ulna
Radius
Humerus
Ulna
Radius
4
8
3
1
-
Swelling of the shaft of the tibia was a
fairly common occurrence at least in some
American Indian groups, e.g. 26% in
Texas Indian skeletal remains (Goldstein,
’59), and probably i n other groups, and so
far as is known, was not caused by bejel.
Indeed, Stewart (‘66), citing a study by
Hoyme (‘62) on skeletal pathology in an
American Indian group, points to four cate-
gories of inflammatory changes in the long
bones found by the latter, namely (1) specimens with slight surface changes; (2)
frank infection, osteomyelitis; ( 3 ) localized
swellings; and (4) considerably larger areas
and more obvious bone involvement.
The “withered” ulna and radius, apparently of the same individual, suggest
early poliomyelitis. Whether the pronounced
628
M. S. GOLDSTEIN, B. ARENSBURG AND H. NATHAN
bowing in the long bones can be considered
pathological, is not certain.
Although the relative frequency of Bedouin long bones of the leg with pathology
(combined sites) appears to be lower than
in the American Indian, especially in the
tibia, the percentages tend to be higher
in the Bedouin arm bones, as noted below:
Tibia
Femur
Bedouin (present study)
15.3%
5.5 %
Humerus
Radius
8.9%
10.3%
Texas Indians (Goldstein, ’59)
30.3
8.6
6.4
6.7
Vertebrae
The incidence of defective vertebrae at
Tel Harif and Tel Sheva, respectively is
given i n table 9. The very high proportion
of defective atlases in the Tel Harif material is i n sharp contrast to the v e q low figure at Tel Sheva (33% vs 4 % ) . The single
defective atlas from the latter site is a n
open neural arch. In the lumbar vertebrae
also the percentage affected at Tel Harif
appears significantly higher than at Tel
Sheva (47% vs 33%).
Kinds of defects in the vertebrae, both
sites combined, are indicated in table 10.
In the cervical vertebrae, the most common pathology is arthritic lesions, usually
eburnation on the articular facets, associated not infrequently with lipping of the
borders (37%). Open neural arch in the
lumbar vertebrae has been reported in the
literature (Stewart, ’31, ’32; Lester and
Shapiro, ’68); in the present survey only
three cases of open neural arch were observed, in the atlas. Two instances of a n
atlas synostosed to the occiput occurred i n
the Tel Harif material; synostoses in the
axis was with the first cervical. According
to Morse (’69), “A fusion of the atlas to
the occipital bone is a rare occurrence. In
life, if the fusion is complete, there is usually no disability”. In all, 30 different vertebrae were synostosed, or 2.0% of the
total number. Lipping and arthritic lesions
were relatively most frequent by far in the
thoracic and lumbar vertebrae (69% and
81 70).
One of the present authors (Nathan, ’62)
in a n earlier study on the subject reached
the conclusion that vertebral osteophytes
in man develop as a protective mechanism
against pressure. This concept appeared to
be supported by a n experimental study of
osteophyte formation in rats (Gloobe and
Nathan, ’73).
Since more or less complete skeletons
were available only from Tel Sheva on
which sex could be estimated with a fair
degree of confidence, the factor of sex in
the incidence of defective vertebrae could
be examined in this material. Substantially higher proportions of the cervical
and lumbar vertebrae were found defective
in males, whereas a somewhat higher percentage of defective thoracic vertebrae occurred in the females (table 11).
In terms of individuals affected, of 78
skeletons from Tel Sheva providing data
on vertebrae, 48.7% had one or more defective vertebrae, and as indicated below,
one-half of the latter had defects in more
than one region of the spinal column:
Percent of skeletons with defective vertebrae:
Cervical only
6.4
Thoracic only
3.8
Lumbar only
14.1
Cervical
thoracic
1.3
Thoracic
lumbar
15.4
Cervical
thoracic
lumbar
7.7
+
+
+
Total
+
48.7
Other parts of the skeleton
The innominate, sacrum, scapula and
clavicle were also examined for pathology
and anomalies. As seen in table 12, defects
occurred relatively frequently i n all these
bones, apparently more so at Tel Harif
than at Tel Sheva (combined sexes), except
in the scapula. In regard to sex, the number of bones available and in reasonably
good condition was rather small when divided by sex and site, and the results therefore can be considered only tentative albeit
suggestive. Thus there is a n apparent tendency for pathology to occur relatively
more frequently in the bones of the males,
especially at Tel Harif, with the exception
of the innominata. In the latter, the percentage of hip bones affected in the females
is more than twice that of the males.
The frequency of different kinds of defects in these bones, by sex, combining the
data from both sites in order to provide
larger series, is given in table 13. The innominata of females here manifest more
than three times the incidence of pathol-
629
PATHOLOGY OF BEDOUIN SKELETAL REMAINS
TABLE 9
Frequency of defective vertebrae in Bedouin skeletal remains, by site
and vertebral group: Adults, both sexes
Tel Harif
Vertebrae
Tel Sheva
Defective
At1 as
Axis
Other cervical
All cervical
Thoracic
Lumbar
Defective
Total
Number
Percent
Total
45
41
224
310
384
98
15
8
30
53
60
46
33.3
19.5
13.4
17.1
15.6
46.9
25
27
132
184
324
177
Number
Percent
4.0
18.5
11.4
11.4
20.7
33.3
1
5
15
21
67
59
TABLE 10
Incidence of defective vertebrae i n Bedouin skeletal remains f r o m two sites
by type of vertebru and hind of defect: Adults, both sexes
Cervical vertebrae
Kinds of defects
Atlas
Total vertebrae
Defective vertebrae
Number
Percent
Axis
70
68
16
22.9
13
19.1
Other
356
45
12.6
All
494
74
15.0
Thoracic
Lumbar
708
2 75
127
17.9
105
38.2
Percent of total numbel
Lipping
with: Osteoporosis
Pitting
Exostoses
Thin neural arch (marked)
Arthritic lesions
with Lipping
Pit tin g
Exostoses
Erosionlresorption
Tumor
Transverse foramen missing
Osteoporosis
Pitting (marked)
Compressed body
with: Divided spine
open
lipping
transverse foramen
Open transverse foramen
Enlarged transverse foramen
Exostoses
Fracture
Synostoses 1
with: Lipping
Pitting
porotic
Lipping
arthritic
Lipping
Body erosion/cavities (marked)
Thin neural arch (marked)
Open neural arch
Bridged articular facets
Double facets
Divided spine
Vertebral arch missing
Resorption of articular process
+
+
+
+
1
Includes each synostosed vertebra
1.4
1.4
1.5
-
2.0
1.4
-
10.3
-
3.6
2.0
-
1.6
1.2
-
0.2
4.1
1.4
-
-
1.4
4.3
-
1.4
0.3
0.3
1.1
-
2.9
-
-
4.1
3.0
0.1
0.8
0.3
-
-
1.4
6.3
-
-
0.7
1.8
0.4
0.7
1.7
0.4
0.2
0.6
0.4
0.4
0.2
1.6
-
-
0.6
0.7
0.7
1.1
0.7
-
1 .O
-
1.4
4.3
1.4
-
0.4
-
0.6
-
18.3
1.7
0.4
1.4
1.4
-
3.0
0.3
0.3
-
-
-
0.2
0.6
0.2
0.6
0.4
-
-
-
-
0.7
0.6
-
0.4
0.4
-
-
0.7
0.4
0.4
630
M. S . GOLDSTEIN, B. ARENSBURG AND H. NATHAN
TABLE 11
Incidence of defective vertebrae in Bedouin skeletal remains from Tel
Shevu, by type of vertebrae and sex: Adults
Cervical
Vertebrae
Male
Total number
Female
79
Defective :
Number
Percent
Thoracic
Male
94
13
16.5
117
6
6.4
Female
180
28
23.9
ogy noted in the males, especially in the
prevalence of lipping and exostoses.
In the sacrum, the most common defect
appears to be spina bifida, with males more
prone thereto than females (36% vs 16%),
a sex difference also noted among the
Eskimo (Stewart, ’32). The latter gives data
on hiatus sacralis i n the Eskimo and cites
data on Japanese from Hasebe (‘12), according to the ‘lowest level at which the
dorsal arch closed”. A ‘‘partial bifida”
according to our estimate included an open
sacral canal from S3 down, and occurred
in 12.7% of the Bedouin sacrums, compared with 6 . 1 % in the Eskimo and 16%
in the Japanese for a like hiatus sacralis.
The incidence of complete bifida, 12.7%
in the Bedouin (both sexes), is also higher
than that found in the Eskimo or Japanese
(4.1 % and 8 % , respectively).
Bennett (‘72) and Ferembach (‘63),
among others, have remarked on probable
environmental a s well as genetic components accounting for the occurrence of
lumbo-sacral malformations and hiatus
sacralis. Vertebral synostoses in the sacrum
refers to the fifth lumbar vertebra, including sacralization.
Lumbar
52
28.9
Male
Female
76
a7
31
40.8
24
27.6
The scapula of males and females, although about equally affected, have a somewhat different pattern of defects, the latter having a higher incidence of arthritic
lesions (18% vs 1 1 % ) whereas the males
manifest more cases of lipping (15% vs
3 % ). The percentage of male clavicles with
defects is twice that of the female clavicles,
the most common defect i n each being
arthritic articular surfaces.
In regard to location of the pathology,
i n the pelvis, arthritic lesions were noted
most frequently in the auricular region,
although other areas were also involved
(e.g. symphysis, acetabulum); lipping was
also usually on the auricular borders. Osteoporosis was widespread in one instance,
on the auricular surface, body of the pubis,
and acetabular fossa.
A healed fracture in the scapula was observed at the neck of the glenoid fossa.
Arthritic lesions in the scapula occurred
at various articular surfaces, about equally
frequent in the glenoid and acromial joints,
in the latter even apparently causing distortion; lipping was generally on the borders of the glenoid fossa. The one instance
of erosion or resorption and osteoporosis,
TABLE 12
Frequency of pathological innominutes, sacra, scapulae, and clavicles in Bedouin
skeletal remains, b y site and sex: Adults
Tel Harif
Tel Sheva
Sex
Innominata
Sacrum
Male
Fernale
Both sexes
37
53
90
9
7
17
Male
Female
Both sexes
16.2
39.6
30.0
55.6
42.9
52.9 1
1
One sacrum was not “sexed”.
1
Scapula
35
32
67
Clavicle
Total number
22
24
46
Innominata
23
21
44
Puthological: Percent of total
36.4
4.4
22.9
42.9
12.5
25.0
22.7
30.4
17.9
Sacrum
Scapula
Clavicle
20
18
38
11
31
42
24
30
54
35.0
16.7
26.3
27.3
32.3
30.9
25.0
6.7
14.8
1
+
One sacrum w a s not "sexed"
Percen t w i t h .
Arthritic
lesions
with : lipping
osteoporosis
cyst
erosion
vertebral
synostoses
spina bifida
Lipping
with: osteoporosis
spina bifida
synostosed
vertebra
spina bifida
Inflammatory
lesions
with: lipping
osteoporosis
cyst
exostoses
fracture
spina bifida
co m p 1e te
partial
2.2
2.7
-
-
-
4.0
25
Female
55
-
4.0
12.7
7.3
-
-
2.2
2.2
-
6.5
-
-
-
4.3
6.5
11
23.9
-
8.0
1.8
-
-
-
__
3.6
1.8
-
4.0
19 '
34.5
46
Male
2.2
17.8
10.3
3.4
6.8
6
24.0
'
Both
sexes
Puthological bones
12
41.4
29
Male
Sacrum
-
2.2
-
0.7
-
-
-
-
12.7
0.7
-
-
-
18.9
1.4
~
-
1.5
2.7
-
3.7
3.7
-
37
27.6
134
sexes
Both
5.4
5.4
-
30
40.5
All
Number
Percent
Female
74
Male
Innominata
Total bones
Conditions
TABI,E 1 3
-
-
1.6
1.6
-
-
-
-
1.6
-
-
1.6
-
12.7
1.6
1.6
22.2
14
63
Female
Scapula
-
-
-
2.2
2.2
-
-
1.o
1.o
-
-
-
-
3.0
-
-
1.o
2.0
-
12.0
2.0
22
22.0
100
Both
sexes
-
Female
Clavicle
-
-
-
2.2
-
-
-
2.2
-
19.6
2.2
14
30.4
46
Male
0.9
-
0.9
0.9
0.9
0.9
-
3.7
-
~-
0.9
-
9.2
3.7
0.9
25
22.9
109
sexes
Both
Percentage fr e que nc y and kinds of defects in certazn boner of Bedouin skeletons
from t w o siteq, by s e x Both sztes c o m b i n e d , a d u l t s
632
M. S . GOLDSTEIN, B. AKENSBURG A N D H . N A T H A N
respectively, occurred on the neck of the
glenoid fossa, the cyst refers to a large hole
with rounded edges. It may be noted that
“cyst” refers to a n abscess-like cavity,
whereas “erosion” connotes destruction or
resorption on the surface. Anderson (‘68)
shows a photograph, the dorsal view of a
right scapula with a long oval hole in the
infraspinous fossa near. the root of the
spinous process, very much resembling the
cyst noted in the Bedouin scapula of the
present report, In the clavicle, arthritic
lesions and lipping frequently occurred on
the sternal end, occasionally on the acromial surface, the single cyst noted was on
the sternal articular surface.
Pathology in zndivzduals
As already observed, “individual” skeletons were available from Tel Sheva. In the
course of examining the various bones in
this group, it was our impression that not
only one but several parts of one skeleton
often manifestedpathology. Table 14 checks
this point, as well as bears on the question
of pathology in a “population” rather than
in a series of particular bones. Thus, fully
two-thirds (67%) of the skeletons had one
or more different bones of the skeleton
with defects. Moreover, over one-third
(36%) exhibited more than one part of the
skeleton with pathology, as many as six
different bones being involved in some individuals. The very high frequency of vertebral involvement, alone and in conjunction with other bones, is noteworthy.
Fairly complete skeletons of eight children were available. The tibiae of one and
the humerus of another, manifested pathology. namely, marked inflammatory lesions.
Since most of the skeletons were incomplete, the frequency of pathology noted
is most likely a n under-estimate.
Age at death
A logical corollary to the consideration
of pathology, especially its frequency in a
population, would seem to be the question
of average life-span. A few comments on
the age structure and average age at death
of the Bedouins represented by the present
skeletal material therefore may be in order.
Age was estimated primarily on the skull,
based on location and extent of suture closure, wear of teeth, and any other available indicator. Estimates were at 5-year
TABLE 14
Skeletons from Tel Skeuu w i t h defects, by
parts of the skeleton affected:
Both sexes, adults
Number
Total skeletons
Skeletons with no pathology
Skeletons with defects only in:
Vertebrae
Dentition (abscess)
Sacrum (spina bifida)
Fibula
Pelvis
Ulna
Skull (depression & cribra orbitalia)
Skeletons with various bones affected.
Vertebrae and clavicle
scapula
sacrum
radius
ulna
Radius and sacrum (Spina bifida)
Tibia and pelvis
Femur and fibula
Mandible, fibula, and vertebrae
Tibia, humerus, and vertebrae
Tibia, fibula, and humerus
Dental abscess, pelvis, and radius
Dental abscess, scapula, and vertebrae
Femur, humerus, scapula,
and vertebrae
Humerus, ulna, clavicle,
and vertebrae
Pelvis, sacrum, clavicle,
and vertebrae
Pelvis, scapula, dental abscess,
and vertebrae
Dental abscess, ulna, scapula,
and vertebrae
Dental abscess. pelvis, femur,
tibia, and vertebrae
Tibia, ulna, clavicle, scapula,
sacrum, and vertebrae
Skull (dental abscess &osteoporosis),
femur, tibia, humerus, radius,
scapula
73
24
11
4
3
2
1
1
1
4
3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
intervals, i.e. 20 years, 25 years, 30 years,
etc., except in the case of children.
Our results indicate average age at death
for each site (both sexes) as follows:
Tel Harif
Tel Sheva
Number
Mean age
S.D
I10
106
26.2
29.1
17.43
20.34
The difference between the means is
small and not statistically significant.
Combining both sites and checking age
by sex, and distribution by age-period (table 15), we find age at death among females
much lower than among males, indicated
by the averages (33 years vs 43 years) as
633
PATHOLOGY OF BEDOUIN SKELETAL REMAINS
TABLE 15
Frequency o f a g e - g r o u p s a n d m e a n a g e , b y sex
Male
Tel Hurif a n d T e l S h e w sites c o m b z n e d
Female
Both sexes
Age-group
Number
0- 2
3- 6
7-1 7
18-19
20-34
35-49
5059
60
+
Total
Mean age
S.D.
1
2
Percent
Number
Percent
Number
-
38
12
15
62
55
53 2
17
20
17.6
5.6
6.9
2.8
25.5
24.5
7.9
9.2
216
27.6
18.92
100.0
-
-
-
-
2
2.7
20.3
37.8
17.6
21.6
3
40
24
4
4
4.0
53.3
32.0
5.3
5.3
15
28
13
16
74
43.0
12.43
100.0
-
75
32.6
11.03
-
100.0
-
-
Percent
-
Sex of children (0-17 years) was not determined
Includes one case of sex undetermined.
well as by the proportions in the age dis- others semi-nomadic, and still others as
tribution, very likely the result of a high sedentary, i.e. living and working in cities
maternal death rate. Since the sex of skel- and towns. All Bedouins under Israeli jurisetal remains of children is usually practi- diction, moreover, receive medical and hoscally impossible to determine with any pital care when needed, as do Israelis in
degree of reliability, mean age by sex re- general, and our intention had been to obfers to subadults and adults only (18 years tain their medical records to check freand over). It is noteworthy that the Greeks quency and kinds of morbidity and patholduring their Classical period (650-350 BCE) ogy as complementary and comparative
also manifested a n approximately 10 year data to defects found on the skeletal redifferential between the sexes i n mean age mains. Regrettably, this could not be
at death: adults, males, 44.1 years, females, achieved at this time. The prospectus is
35.9 years (Angel, ’69). Average age, in- mentioned, however, because a comparicluding children, both sexes combined, was son of results on skeletal remains and on
the living of the same ethnic stock, if at
27.6 years.
Our Bedouin skeletal remains, taking all feasible, we think might be revealing.
We would remark on the swelling in the
the adult period as beginning at age 18,
indicate 22.8% aged 50 and over (both long bones, presumably the result of bejel.
sexes). It is of interest that a much lower “The word bejel and its relatives bishel
proportion of the Greeks of the Classic pe- and belesh are probably derived from a n
riod, mentioned above, reached age 50 and Old Arabic root-word meaning sores, which
over (11 % males, 8 % females, computed carries no venereal connotation. Bejel
among Bedouins appears to be a thoroughfrom Angel, ’69).
Considering the relatively harsh ecolog- ly domesticated disease . . . nobody dies of
ical niche in which the Bedouins lived, it. It is more reasonable to believe that
some 200 years ago, with infant and ma- bejel is the lineal descendant of yaws
ternal death rates probably high, average brought over from Abyssinia and Central
life span must have been low, possibly even Africa by migrants and slaves in prehislower than the average of 27 years sug- toric times. .” (Hudson, ’58). Also, accordgested by their recovered skeletal remains. ing to Hudson “Those who are familiar
with yaws will confirm the observation
DISCUSSION
that . , . bejel illustrations are not to be
Bedouin groups still live in the Sinai distinguished from those obtained from
and Negev, as well as in other regions of corresponding lesions in yaws”. Indeed,
the Middle East. In the Israeli Negev and Hudson noted that “of 1,160 Bedouins who
probably elsewhere, some Bedouin could acknowledged bejel, two-thirds stated they
even now be considered “pure” nomadic, had acquired it in childhood” and “most
634
M. S. GOLDSTEIN. B. ARENSBURG AND H. NATHAN
of the adults who had early lesions said
they had caught bejel from children”. Also,
“General pain i n the bones, particularly
at night, was a complaint of about onefifth of the Bedouins, and pain in specific
bones, particularly the tibiae, was present
in another fifth. The commonly accepted
explanation for bone pain in syphilis is inflammation of the periosteum, and this may
be present without revealing itself except
in tenderness of the bones to pressure. At
the same time many of the Bedouins doubtless had aching bones from upspecified
causes, such as exposure to the extreme
diurnal variation in temperature during
spring and fall, inadequate clothing during the forty days of harsh winter, and the
habit of sleeping on the hard ground
throughout the years. Syphilitic periostitis
was a n aggravating factor and when present could usually be identified. As to arthritis the knee was the most vulnerable
joint”.
A physician who has provided medical
care to Bedouins for some 30 years, kindly
informed us that bejel as a n endemic disease in the present Bedouin groups has
virtually disappeared in recent years. This
circumstance may be the result of better
hygienic conditions, use of antibiotics, other
improved living conditions, singly or combined.
Several sources do give information on
health status of living Bedouin groups.
Some of the observations of Hudson (’58)
in this regard have already been cited. Also
pertinent are his observations that:
“. . . many children were being born with a
poor prospect of survival beyond the first decade. Infant mortality was due not only to comrnon factors of poor nutrition and hygiene. but
to epidemics of measles, the dysenteries, and
other acute infections. After thc years of early
maturity death again began making inroads.
There were few industrial accidents, of course,
but the women. worn out by manual labour
and child-bearing, began in their thirties to
look like old crones, and men were sub,ject to
physical stresses i n work a n d climate. There
were no barriers to the spread of tuberculosis;
m a n y succumbed to i t - a n d to arnebiasis.
Pneumonia was very common, a n d t h e anaemia caused by hookworm”.
Marx (‘67), in his study of Bedouins in
the Israel Xegev, reports that:
“Many Bedouin. including wealthy, people.
suffer from nutritional deficiencies caused by
their unbalanced diet. This results i n anything
from a general state of physical weakness to
tuberculosis, to which Bedouins are more
prone than any other section of the population. . (and) diseases a r e made the more contagious by the closeness of living i n a small
tent”.
Musil (‘28) lists “diseases most universally known” among the Bedouins: smallpox, ulcers, violent fever, rheumatic pains,
pains in the spine, diseases of the eye, measles, eruptions on parts of the body, venereal disease (“it is very rare among the
Rwala”). And he notes that, “Fractures
are healed by a Bedouin versed i n the art”.
Thus the living Bedouin in recent years
apparently suffered from diverse and severe illnesses, more or less induced or aggravated by environmental and social factors, e.g. lack of sanitation or personal
cleanliness and insufficient and inadequate
nutrition. Coon (’58) has remarked with
respect to the Bedouin that “Both the villager and the nomad lead hard, healthy,
out-of-door lives”. Coon apparently referred
to “true” nomadic Bedouin, whereas the
groups observed by Hudson, Marx and
M u d appear to have been mainly seminomadic. However, at least some of the
aforementioned diseases most likely affected the “true” nomads, a category which,
moreover, as previously noted, was not
absolute. And, no doubt, at least some of
the aforementioned “diseases” left their
imprint on the skeleton, as was in fact
demonstrated by Hudson. Thus the harsh
climatic conditions especially in the winter
months were probably conducive to rheumatic conditions. Poor nutrition as a significant factor in cribra orbitalia, osteoporosis, and other bone lesions or defects
has been noted by Nathan and Haas, ’66;
Carlson et al., ’74; Hughes and Hunter,
’70 and probably others.
After all that has been cited above in
regard to the prevalence of morbidity, high
rate of mortality, and relatively short average life span of the Bedouin in the recent
past, in regard to basic relationships between habitat and its resources and even
population density and distribution. the
Bedouin evidently adapted well and survived. With many Bedouin in Israel “settling” in the towns and cities, their nurnbers are increasing and what concomitant
changes are taking place in their morbid-
PATHOLOGY OF BEDOUIN SKELETAL REMAINS
ity and life span are matters for further
study.
ACKNOWLEDGMENTS
We gratefully acknowledge the support
from the “Colonel Joe Allon Center” which
made the “Digs” at Tel Harif possible. We
take this opportunity also to thank Professor Y. Aharoni, Head of the archaeological expedition at Tel Sheva, who generously made available to us the skeletal material for this site, and Professor H. Muhsam of the Department of Demography at
the Hebrew University of Jerusalem for
the critical perusal of the paper.
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PLATE 1
EXPLANATION OF FIGURES
1
Radius a n d ulna, with markedly atrophic (withered), distal ends, most
probably combined with other malformations (congenital?) of the
h a n d . From Tel Harir.
2
( a ) Marked swelling. characteristically heavy, plus periostitis (bejel?)
left tibia compared with
(b) normal left tihia. From Tel Harif.
3
Fibula a n d ulna of same individual showing similar lesions a s 2 a . From
Tel Harif.
4
Humerus from Tel Harif. Lower extremity irregular atrophic articular
surfaces, with resorption (chronic dislocation of forearm'?). Exceptionally large septa1 aperture.
5
Fibula from Tel Harif: atrophic (markedly thin); also markedly bowing.
PATHOLOCY OF BEDOUIN SKELETAL REMAINS
M S . Goldstein. B . Arenshurg and H. Nathan
PLATE 1
637
PATHOLOGY OF BEDOUIN SKELETAL REMAINS
M. S Goldctein, R. Arenshurg and H. N a t h a n
638
6
Marked arthritic and deformed head of femur, articular surface irregular with marked hyperstotic reaction i n periphery or lipping (LeggPerthe's disease?). From Tel Harif.
7
Deformation of head of humerus, with distortion; also cxostoses i n
neck. (Fracture?). Lateral view. From Tel HariC
8
Mandible from Tcl EIarif, with deep abscess.
9
Male right auricular surfacc of iliac bone, very irregular, (marked arthritic) with marked lipping. From Tel Harif.
10
Cervical vertebra (3), with marked arthritic articular facet (of left upper articular process); also marked lipping. Discal surfaces are irregular due to calcium apposition. (From Tel Harif).
PLATE 2
PATHOLOGY OF BEDOUIN SKELLTAL REMAINS
M S Goldstein, B Arensbulg and H Nathan
Bedouin crania with pathology
11
1149, male. age 20, from Tel Harif. Left unilateral fusion of atlas to
condyle of' occipital bone; right atlanto-occipital joint remained patent.
12
H47. female, age 20, from Tel Sheva. Depression, deep and round, on
left frontal at coronal suture. with a corresponding endocranial bulge
(healed; traumatic ?); similar lesion on right parietal affecting outer
table only (osteoperiostites due to infection or specific disease, possibly
bejel).
13
H17, female (?), age 3 5 . from Tel Harif. Two round lesions on frontal
similar to that on right parietal of'(12).
14
H72. male '?,agc 60, from Tel Harif. Depressed fracture of squama, left
temporal: apparently healed along temporal-parietal suture: not healed
along lower part of squama parallel to zygnmatic process.
PLATE 3
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