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Evidence for Remedial Medical Treatment of a Severe Knee Injury from the Fishergate Gilbertine Monastery in the City of York

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Evidence for Remedial Medical Treatment of a Severe Knee Injury from the Fishergate Gilbertine Monastery in the City of York Journal of Archaeological Science (1995) 22, 369–384 Evidence for Remedial Medical Treatment of a Severe Knee Injury from the Fishergate Gilbertine Monastery in the City of York Christopher J. Knüsel Calvin Wells Laboratory, Department of Archaeological Sciences, University of Bradford, Bradford, West Yorkshire BD7 1DP, U.K. Richard L. Kemp York Archaeological Trust for Research and Excavation Ltd., 55 Piccadilly, York YO1 1PL, U.K. Paul Budd Ancient Metallurgy Research Group, Department of Archaeological Sciences, University of Bradford, Bradford, West Yorkshire BD7 1DP, U.K. (Received 8 September 1993, revised manuscript accepted 10 March 1994) During the analysis of a skeletal population from the Fishergate site in the City of York, an individual from the eastern part of the cemetery associated with the Gilbertine monastic foundation of St. Andrew revealed evidence of a chronic septic arthritis, secondary to a severe right knee twist-fracture, and bone adaptation in response to altered biomechanical loading. This disability had been the subject of remedial medical treatment with copper-alloy plates. Their presence, only the fourth such treatment thus far recorded from the mediaeval period, and the sole example applied to a lower limb, suggests that monastic houses, or those buried at these establishments, and specifically those associated with the Cistercians, had preferential access to medical specialists. Keywords: MEDIAEVAL, INJURY, TREATMENT, SPLINT, BRONZE. The Archaeological Context of Burial Sk 251 south with a rectangular nave, central crossing, north and south transepts with attendant eastern chapels, t. Andrew’s Priory of the Gilbertine order lay on and a presbytery. The eastern range comprised a the south-eastern side of the City of York, chapter house, dormitory and latrines, and to the north S beyond the Walmgate section of the mediaeval was a refectory. The western range had been destroyed defences, and directly east of the confluence of the in the early 20th century. The three ranges enclosed a Rivers Foss and Ouse (SE 60655115). The Priory’s small cloister garth, and were linked by a cloister alley. church, cemetery and claustral complex were subjected Uniformity in the size of the rooms and of the con- to archaeological excavation between February 1985 struction techniques reveal that, although built in and September 1986, and the majority of the complex stages, the entire Priory was probably conceived as a was fully examined under the direction of one of us single entity and built over a period of about 30 years (R.L.K.), for York Archaeological Trust, in advance of from the last decade of the 12th century to the second redevelopment for housing and a hotel. The full results decade of the 13th century. The Priory was dedicated of this work are being prepared with a grant from to St. Andrew in 1202. HBMC (Historic Buildings and Monuments Commis- Associated with the church and chapter house in its sion) as a series of publications that will appear in the original form were numerous burials in a series of Archaeology of York. The Priory structures will appear concentrations, including the presbytery, the north as volume AY11/2, whilst the human remains have transept chapel, the east cloister alley, the central appeared as volume AY12/2. crossing, the nave, the area south of the nave and the The Priory in its original guise (Period 6a, c. area east of the presbytery/chapter house. This last 1195–1300) comprised a long cruciform church to the group comprised 49 individuals of which the vast 369 0305-4403/95/030369+16 $08.00/0 ? 1995 Academic Press Limited 370 C. J. Knu¨sel, R. L. Kemp and P. Budd Figure 1. Anterior view of the injured right knee. The tibial plateau crush fracture can be seen laterally. majority were adult males, and included burial Sk 251 dentition, and dental caries of the root of the left (Context 10266) on the northernmost fringes. This maxillary second molar which has produced abscessing group of burials were undoubtedly associated with the of the alveolar process. This disorder has also probably first phase of the church as they were carefully aligned produced a localized infection indicated by reactive with its walls. bone in the floor of the hard palate. The teeth are worn The Priory church, chapter house, dormitory and to an extent that they score in the 35–45 (5) range of latrines were evidently rebuilt in the 14th century Brothwell’s (1981) dental wear method of age assess- (Period 6c), and historical evidence indicates that this ment, which for the population as a whole is not may have taken place in the second quarter of the 14th abnormal (Stroud & Kemp, 1993). The basic pattern is century. The new church was rebuilt to the west and one of a generalized crown destruction and a consid- occupied the area of the former nave, a reduction of erable exposure of secondary dentine. This individual 60% from the original. The eastern end of the first also presents with cribra orbitalia, which Stuart- church, including the central crossing, and north and MacAdam (1992) has recently suggested to be a lesion south transepts were never replaced; the walls were associated with anaemia and is perhaps an adaptive robbed of their stone and the area flattened. The response of the body to a high parasitic load. In burials to the east of the presbytery were, therefore, addition to these pathological conditions this indi- unlikely to have been added to after this demolition, vidual also possesses several discreta or non-metric and can hence be dated to between the start of the 13th traits, including mandibular tori, and a shovel-shaped century and the mid-14th century when the rebuilding left maxillary central incisor, as well as agenesis of all took place. third molars. Analysis of the Corporeal Remains Pathological Description of the Burial The right knee-joint of this individual appears abnor- Burial Sk 251 is that of an older adult male who was mal on both naked-eye and radiographic examination. probably at least 45 years of age at death, if not The right tibia articulates with the corresponding fe- somewhat older. Application of Lovejoy et al.’s (1985) mur in a laterally rotated and posteriorly displaced auricular surface method and Katz & Suchey’s (1986) fashion and is about 30) out of its normal anatomical pubic symphysis method suggest an age at death in the alignment (Figure 1). A large osteophyte protrudes early seventh decade of life. Apart from a major anteriorly from the tibial plateau and the entire surface traumatic disorder treated below, this individual also of the femoral condyles and tibial plateau have a presents signs of periodontal disease, heavy dental porous, lytic appearance, especially prominent on the calculus build-up on and crowding of the anterior medial epicondyle of the femur (Figure 2). A marked Mediaeval Knee Injury Treatment 371 Figure 2. Inferior view of the right femur and superior view of the right tibia demonstrating the extent of subchondral bone affectation. patch of disorganized and highly trabecular bone on Osteophytes appear within the area of the enthesis the posterior surface of the tibial plateau immediately for the medial head of M. gastrocnemius and M. posterior to the tibial spines extends to the margin of adductor magnus on the posterior aspect of the distal the tibial plateau and corresponds with a similar patch femur. It is no longer possible to discern the markings of rarefied bone on the posterior surface of the lateral left by the anterior and posterior cruciate ligaments condyle of the femur. A flange expansion (exostosis) within the intercondylar region of the distal right is present along the lateral condylar portion of the femur, although the lateral epicondylar area retains the right femur. Periosteal new bone has formed in the markings of the entheses for the lateral collateral knee area of the soleal line of the right proximal tibia ligament, M. popliteus, and the lateral head of M. and encompasses the entire distal femur including gastrocnemius. There is, however, a pit-like depression the popliteal space and proximal fibula. The distal on the lateral posterior margin of the associated tibia third of the right femoral shaft has a swollen appear- which may represent part of the tibial attachment of ance and the nutrient foramen is expanded. Two the posterior cruciate ligament. osteophyte-free, thumbprint-shaped depressions are present on the lateral aspects of the femur and tibia Discussion of the Primary Injury amidst this periosteally deposited new bone. The dimensions of the articular surfaces of both From the examination of radiographs of this the right femur and tibia are asymmetric when com- individual’s right tibia, it is apparent that he had pared with homologous elements of the left side. suffered a comminuted fracture of the lateral condyle Although the biepicondylar breadth of the distal right of the tibial plateau with dislocation and twisting of the femur has been only minimally affected, the bicondy- tibia posteriorly and laterally (i.e. a rotary fracture- lar breadth is noticeably altered by the presence of dislocation). This type of injury results from forced reactive bone. The right-side bicondylar breadth abduction of the flexed knee and simultaneous rotation measures 7·35 cm, whereas that dimension of the left of the tibia. Often in this type of injury a fragment of member measures only 7·0 cm. The maximum proxi- bone from the tibial rim is displaced, and it is likely mal breadth, a transverse measurement across the that it is this fragment which has formed a nearthrosis condylar surfaces of the tibia medio-laterally, is from the previously identified anteriorly placed osteo- 8·0 cm in the right member and 7·4 cm in the left, phyte of the tibia.
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