DISEASES IN ANTIQUITY

A Survey of the Diseases, lnjuries and Surgery

~Y of Early Populations

Compilecl and Edited by

DON BROTHWELL British Musewn (Natural History) l ondon, England

anel

A. T. S A N D I S O N Pathology Department University of Glasgow W cstern lnfìrmary Glasgow, Scotland

With a Foreworcl by W A R R E N R. O A W S O N

CHARLES C THOMAS • PUBLISHER Springfield • Illinois • U.S.A. Contents

Page

FoREWORD-Warren R. Dawson ...... vii EDITORIAL PROLEGOMEXON: THE PRESENT AND FUTURE ...... xi

EDITORIAL A CKNOWLEDGMENTS ···········------······················································ XV

SECTION I INTRODUCTORY STUDIES Chapter

l. PsEUDOPATIIOLOGY- Calvin Wells ...... 5 2. CALCINOSIS lNTERVERTEBRALIS, WITH S PECIAL REFERENCE TO SIMILAR CHANCES FouNn IN MuMMIES OF A NCIE.t'IT EcYPTIANs- P . H. K. Gray ················-- ···············---········································································ 20 3. GENERAL CoNSIDERATIONS OF THE EvmENCES OF PATHOLOGICAL CoN- DITIOKS Fomrn Ai\IO!\"C F ossIL ANTh'l ALS-R oy L. Moodie ...... 31 4. NOTES ON DISEASES AND HEALED FRACTURES OF vVILD APEs- Adolph H .

0 Schult;::; •.••.•.••...... •••••••••...••.. .••••••••.....•...... •.•.....•...... •••••••••.•....•. ... .•••••• ••••.....• 47 5. THE B10-CULTURAL BACKGROUND TO D1SEASE-Don Brothtvell --····----··------56 6. HEALTH At"'D DISEASE IN CoNTEMPORARY PRIMITIVE SocmTIES-lvan V . Polunin ·····-····················--···································-················-······················· 69 7. TRE EcYPTIAN MEDICAL PAPYRr-Warren R. Dawson ...... 98

SECTION Il CONTRIBUTIONS TO PARASITOLOGY

8. THE ANTIQUITY OF DrsEASEs CAUSED BY BACTERL.\ AXD VmusEs, A REv IEw OF TIIE PROBLE).I FRO).II A BACTERIOLOc1sT's POINT OF Vrnw-Ronald Hare ····· -- ············-- ·- ··················--- ·-···· ···· ···························· 115 9. TRYPANOSO~IIASis IN PREHISTORIC AND LATER H u)..IAN PoPULATION:>, A TENTATI\'E lù:cO)l"STRTJ CTIOK- Frank L. Lambrecht ...... 13:! 10. THE Hm.·IAN TREPON.EMATOsEs-C. J. Hackett -----·················-·---·············---· 152. 0 11. T HE PREVALENCE OF MALARIA IN ANCIENT - W . H. S. Jones . ••••• 170 12. NoTE ON THE PRESENCE OF " BILHARZIA H AE::-.IATOBIA" IN EcYPTIAN Mu"Mi\IIES OF TRE TWENTIETH DYNASTY ( 1250-1000 n.c. )-Mare 0 . Armancl Ruffer • ...••••.•....•..•••...... •...... •.•.•..••...•. ...••.•••...... •.• 177 13. PARAsrnc DrsEAsEs-A. T. Sandison ...... 178 14. THE REcovERY OF PARASITE Eccs rno111 ANCIE)l"T CESSPIT A1'""D LATRINE D EPOSITS: AN APPROACH TO THE STUDY OF EARLY p ARASITE l NFEC-

TIONS-A. W. Pike ···· -· ··-- -········································································· 184

xvii xviii Diseases in Antiquity Contents xix

SECTION lii SECTION V GEOGRAPHIC STUO IES SOMATIC OISEASE

well ...... 349 0 51. PRIMITIVE SURGERY-Erwin H. Ackerk.necht ...... •...... ••••...•....•.••.. 635 27. A REvrnw OF TRE PALAEOPATHOLOGY OF THE ARTHRITIC DrsEASES-J. B. 52. PREHISTomc A>'\' o EARLY Hrs To nrc TREPA.i'IATION-F. P. Lisowski ...... 651 Bourke ...... 352 53. TREPAN ATION OF THE Sk'ULL BY THE ~v1 EDICIXE - ~IE:-< OF PRnnTIVE CUL­ 28. OSTEITI$ FIBROSA IX A SKELETON OF A PREHJSTORIC AMERICA-"< l:-\DIA.."l"- TURES, WITH PARTICULAR REFERENCE TO PRESEXT-OAY TATIVE EAST H enri Stearns Denninger" ...... 371 AFRICAN PRACTICE- Edu;ard L. Margetts ...... 673 2.9. PoRonc HYPEROSTosrs OR OsTEOPOROs 1s Snr:METRICA- J . Lawrence 54. REPUTED EARLY EGYPTIA:-< D ENTAL 0PERATIOK, AN APPRAISAL- F. Filce Angel ...... 378 L eek ·················-··································· ...... 702 30. A NEW APPROACH TO PALAEOPATIIOLOGY: HARRis's LrNEs-Calvin W ells 390

31. THIN NINC oF THE PARIETAL BoNEs IN EARLY EcYPTIAN PoPULATIONs SECTION VII AND lTS AETIOLOGY I N THE LIGHT OF .MODERN 0BSERVATIONS- MENTAL ABNORMALITY Thomas Lodge ...... 405 55. .MENTAL D1sORDER IN ANTIQUITY-Gerald C. Moss ...... 709 32. BIPARIETAL THINKING IN EARLY BRITAIN-Don Brothwell ...... 413 56. .MENTAL D 1SEASES OF ANCIENT MESOPOTAl\IIA-J. V. Kinnier Wilson ...... 723

33. HISTORICAL NOTES OK SOME VITA:\nN DEFICIDICY DrsEASES IN CmNA- 57. SEXUAL BEHAvroUR IN Axc mxT Soc IETIEs- A. T . Sandison ...... 734

0 T'ao Lee • . ••...... ••••...... •••• •...... ••.•.•.. • ..•••• •••...•.•••••••..••...... 417 Index ...... 757 34. MAJOR CONGENITAL ANO~lALIES OF THE SKELETON: EVIDE1'CE FROl\1 EARLIER PoPULATIONs- Don Brotlw;ell ...... 423

35. H ER:-

situateci almost on the mid-line a little behind the vertex, mainly on the right si

"71 oe: !::! i r'1 Nl ~ p

0 l:S ~- .2. -t:: ~"" - ""

~ ~:;­ .....e;; ~ o -'te:; · ~...... ;:::. ~ F 1cu11E 2c.

F 1currn 2d.

F1cunE 2. Cranial injury in Homo erect11 s peki11 e11 .<;is. a . Depressed fracture in left par­ asagittal region in skull X. b. Fracture lines ( arrows) running through the left frontal bone and through cliastases of frontal-parietal suture :md into parietal suture linc and from thence into the right parietal bone. Other minor fracture lines into hoth parietal hones. Lesions probably producecl by heavy blows with a cl 11h to cranial vault. ( Courtesy Natio11al Geologie Survey of China.) c. Severe linear frnctme with depres­ sion of fragments ( Skull XI ) . lnjury probably fatai due to crush ing hlows w ith largc O) o rock. d. Basai view of same specimen. "' 610 Oiseases in Antiquity Cranial In;uries in Prehistoric Man 611

on top of the skull are the incidental work outer portions of both temporal bones and cf man, although the possibility cannot be approxirnately the posterior three-fourths entirelv excluded that at least those lesions of the two parietal bones. A portion of the which, indicate that they were produced by maxilla, including almost the entire al­ pointed or blunt agents [also gross crushing veolar process, the palate, :8.oor of the nasal injuries] may have been caused by stones cavities and maxillary sinus was also re­ falling from the roof of the on a living covered. Of the marks of injury, the individua!. Later on the skulls were broken author writes: as carrion by camivores, probably hyaenas, 0 After preparation and adjustment of those which lived in the cave and cracked the pieces which appeared to have been freshly ··- bones as long as they were fresh. broken it is obvious that the brain case had ... My early suggestion still stands, namely: been crushed, apparently with great farce. that the strange selection of human bones Cracks spread aver the entire calotte, there [ the calvaria l we are facing in Choukoutien are deep impressions where the occipital and has been made by Sinanthropus himself. H e temporal bones have telescoped into each hunted his own kin as he hunted other animals other, and most of the fragments have been and treated ali his victims the same way. dislocateci. A wide cleft also passes through W hether he opened the human skulls far both cap and base in an oblique direction ritual or culinary purposes cannot be decided from the right at the front to the left at the on the basis of the present evidence of his rear. Apparently, these injuries occurred not cultura! life, but the breaking of the long­ only before fossilization, but before the flesh bones of animals and man alike, apparently for had decomposed; otherwise mineralization the purpose of removing the marrow, indi­ could not have fìxed the bones and bone cates that the latter alternative is more likely. fragments in sc ch unnatural positions. An The remains of his meals became the prey of excellent example of this dislocation and sub­ his predatory neighbors at the foothills of Il sequent fixation in the wrong p lace by fossili­ Choukoutien. zation may be observed on the fragment FIGURE 3 Cranial injuries ( depressions in outer frontalis, sca, scar; b. Normo occipitalis, i injury designateci as bp. It is probably the b asilar table) in Homo erectus pekinensis. a. norma c. normo verticalis. -i, injury; sca, scar. CRANIAL INJURIES IN THE process of the occipital bone which was PITHECANTHROPINES ANO SOLO MAN broken from its normai position by the blow OFJAVA cleaving the skull and has been turned to the These injuries are probably due to some in this series of prehistoric skulls as fol­ A report on another skull, now consid­ left side of the outer surface of the base type of stone axe. In addition to these lows: ered to be Homo erectus previously called where it is still attached. The maxilla displays larger and perhaps more characteristic in­ If we recapitulate all the facts, the follO\v­ ( Pithecanthropus robustus ), is also avail­ the same signs of violence. Severa! cracks juries, a number of the specimens showed ing is evident: ( I ) all Sinanthroptts skulls able for study (Weidenreich, 1945). This extending aver the plate have produced some abrasions which were most abundant in lack the centrai parts of the b ase; ( 2) some skull, represented only by the posterior dislocations; in particular, the left side of the alveolar process has been affected and moved Skull III. Weidenreich considered three of them show lesions or scars at the top of the part of the calvarium, was found by A. inward. possible causes for this type of mark: ( 1) skull the form of which indicates that they Von Koenigswald in the Trinil beds of falling stones in cave-ins; ( 2 ) cutting in­ have been inflicted by axe- or knife-like im­ Sangiran, Java. This calvarium resembled In J ava, there has also been recoverecl plements; ( 3) some skulls exhibit, on the up­ struments in the hands of man, and ( 3) so closely that of Dubois, Homo ( Pithe­ a group of Upper Pleistocene skull frag­ per part of the vault, depressed fractures with teeth marks of predatory animals. He canthropus ) erectus that its fìnder assumed ments which may be considered to be concludes, however, that they were ac­ radiating fissures indicating that the b low had hit the skull while it was impressible; ( 4) it to be the same form ( von Koenigswald, Neandertaloid or late advanced Pithe­ tually the effects of cutting instruments there are cranial bones and fragments of them 1937 ). This specimen too showed evi­ canthropines in type. Oppenoorth ( 1932 ) ( Weidenreich, 1928). with irregular indents at the injuries and dence of a cranial injury. described fragments of eleven such skulls The author summarizes bis observations scratches on the surface. My verdict is that The skull consisted of almost the entire of Homo soloensis or Solo Man. These on the nature and canses of cranial injuries the destruction of the base and the blows occipital bone, including the major part skulls consisted only of the brain pan, the of the occipital foramen and condyles, the facial parts and cranial base being rnissing, 612 Diseases in Antiquity presumably having been purposely de­ ded in it. This observation would imply tached. In one of these specimens ( Skull that Neandertal man used hafted weapons, V), wounds of the skull were found in the for such a blow could not ha ve been de­ occipital region. It was presumed that li vered with an axe-head in the hand. this individual had been killed by a blow on the back of the head ( von Koenigswald, Cranio/ lnjury in European 1937 ). Neandertalers When workmen discovered the pecu­ CRANIAL INJURIES IN NEANDERTAL liarly shaped skull cap while blasting in MAN the Neander Valley in Prussia in 1856, it As good fortune would have it, au in­ was not realized for some time that this vestigation of Neandertal crania iudicates represented a distinct variety of fossil man. the fairly common occurrence of traumatic Although it had no evident signs of trauma damage. It has been estimated that about (nor, for that matter, did the skulls or 40 per cent of these skulls found in Europe, portions of skulls of similar type found at North Africa and Western Asia give un­ in 1848 and at Spy, in equivocal evidence of injury. Since Nean­ 1886), the discovery of a group of skulls FIGURE 4a. dertal man apparently did not often sur­ at Krapina, in 1889 by Gorjanovic­ vive beyond the age of fifty years, it is Kramberger did suggest the occurrence of suspected that many of them died a violent cranial injury as the cause of death. Here death. The very fact that the brain pan in a Palaeolithic ( Ylousterian) shelter were alone is found ( the basal or facial parts found portions of from ten to twelve skulls of the skull being missing) has suggested together with other bones which suggested to some that this portion had been cut that at least twenty individuals of both away to expose the brain as a tender titbit sexes and all ages were represented. The for the assailants. If this is the case, the fragmentation of the skulls was so exten­ Neandertalers were cannibals, and any as­ sive as to suggest violence rather than ac­ sociated fracture of the vault or base of cidental crushing. To strengthen this con­ the skull was but a mark of an intended clusion one specimen consisting of the lethal cranial injury. supra-orbitai portion of a frontal bone Whatever the intelligence of Neandertal showed some cuts such as might have been man and his contemporaries, it is clear produced by a flint knife or axe. that his world was one in which violence That not all representatives of Neander­ played an important role. And this vio­ tal man in 'Western Europe met a violent lence was not limited to the bodies of man, end is well established by the discovery for in the skulls of prehistoric animals as of fairly intact skulls and complete skel­ well the characteristic effects of trauma etons at La Chappelle-aux-Saints, Le Mou­ are to be found. stier and at . While nothing As yet, the only specimens implying has been written about traumatic lesions injury to the head of prehistoric animals of the skull in this latter group, the pub­ FIGURE 4b. by Neandertalers or his human contemp­ lished photographs of the male skull pre­ sent faint linear markings that may indi­ oraries are those of the skulls of the giant FIGURE 4. Cranial injury in Rhodesian Man. A. Rounded puncture wound of the left cave bear as found in the Drachenbole, cate antemortem fracture lines and seem tempora} region. B. Drawing of the endocranial cast showing a defect of the skull at a Stvria, South . The skull of one of worthy of re-examination from this point branch of the middle meningial artery. The location of this defect suggests that this th~se animals still has a stone axe imbed- of view. The skull recovered at individuai may have died of an extradural haemorrhage secondary to the puncture wound. 61-! Diseases in Antiquity

( also considered as an accidental burial) ~aps some fine radiating linear fracture was so broken that it would be difficult if marks. It is clearly not an effect of the not impossible to differentiate signs of hand-axe but rather that of a sharp pointed trauma in life from postmortem crushing. weapon, a rounded wooden or stone spear The subject of cranial injury in Neander­ point or an antler prong of a primitive tal man of Europe may be best illustrated pick. Yearsley' s opinion is that the sharp by one of the discoveries at Ehringsdorf. margins of the defect suggest its occur­ This specimen was proved to be the skull rence about the time of death ( the mastoid of a young adult (estimateci to be between defect, on the other hand, shows some eighteen to thirty years of age) possibly rounding off of its margins, suggesting that of a female subject. The traumatic chronicity ). It is also highly pertinent to lesions ( Fig. 1) are described by Weiden­ know that the endocranial cast further reich ( 1928) as "unmistakable dents on the shows this perforation to lie directly along frontal bone made partly by sharp, partly the course of the inferior division of the by dull stone implements, render it prob­ left middle meningea! artery ( Fig. 4 ). lt able that the individuai had been killed. is entirely possible that Rhodesian man The violence resulted also in breaks of died of the effects of middle meningeal the cranial bones and separation at sutures. hemorrhage, either extra- or subdural, or The fact that the basai parts of the skull both. are missing, having broken away, lead to the conclusion that" the skull was thus INJURIES OF UPPER PALAEOLITHIC AND broken far the purpose of extraction of the LATE STONE AGE CRANIA IN CHINA brain [ cannibalism]." A study of more recent generations of man, shown by their cranial morphology CRANIAL TRAUMA IN RHODESIAN MAN to be clearly' Homo sapiens sapiens, sheds Another Upper Pleistocene skull, that further light on the problem of ancient of the so-called Rhodesian man discovered cranial injury. In a series of skulls recov­ in Northem Rhodesia at the Broken Hill ered from the Upper Cave Choukoutien Mine, may bear evidence of the effects ( considered to be U pper Palaeolithic) was of trauma. Details of the pathological found unmistakable evidence of violence. changes were originally given by Yearsley Such signs were faund in four of seven ( 1928). The puncture hole ( Fig. 4) in crania sufficiently intact far criticai study the squamous portion of the left temporal ( Weidenreich, 1939). bone was described as follows: Skull I. This skull displayed a typical It is strongly presumptive that the perfora­ round depressed fracture in the left tem· tion B is not an instance of primitive "trepan­ poroparietal region. If the skull here referred ning" but was due to a wound in:Hicted by to is the same as that described by W'eiden­ some sharp instrument during !ife and was reich ( 1943 ) as the "Old Man" of the Upper not the cause of death. Cave of Choukoutien, this depressed fracture occurred about midway along the coronai PLATE 5 Cranial injuries in Upper Palaeolithic specimens of Asia. a. Calotte of a The perforation of which Yearsley suture and appears to be less than an inch in man from the U~per Cave of Choukoutien, showing multiple linear and puncture speaks is a small round aperture with a diameter ( Fig. 268. Plate LXXXIX of his wounds of th~ n:i1dfrontal and right and left parietal wounds (skull I ) . b. Another slightly irregular margin. The photograph monograph of "The Skull of Sinanthropus U pper Palaeo!tthic skull from this site, considered to be that of a woman ( skull II ) of the cranial interior suggests some chip­ Pekinesis," 1943). The fracture line appeared whose death was evide~tly due to an acute penetrating injury in the left parietal regio~, ping of bone around its margins and per- to show no healing :md, hence could only probably made by a p1ck-axe type of weapon. The penetrating defect was associateci with a series of radiating linear fractures. 616 Diseases in Antiquity Cranial lnjuries in Prehistoric Man 617 have been just antemortem, if not at or after llpper portion of the coronal suture to enter evidently by physical violence at the time of its edges, from which radiating cracks the time of death ( Fig. 51). the parietal bone; ( 3 ) upward and rnesialward of their death. may be seen. From its size, it is clear that Skull II. This specimen is described as crossing the frontal midline near the vertex A study of the cranial lesions (in addi­ the dura and leptomeninges were pene­ the skull of an adult female. The skull is to enter the right parietal bone, and ( -! ) tion to supporting the thesis of Weiden­ trateci and the brain wounded ( Fig. 6c ) . shown in Fig. 267 and 268, Plate LXXXIX of laterally to the right crossing the frontal bone reich and others that the calvaria had been It was thought that the woman m ust have the Weidenreich ( 1943 ) monograph, as well quite horizontally to enter the right tempora! broken into to get at the brain) indicate as in his 1939 article. It presents a rounded region. Another frac ture connects ( 3 ) a nd survived for some time, for the appearance three possible mechanisms of cranial in­ perforation about 20 mm in diameter just ( 4 ) bounding \.vith them an equilateral tri­ of bone around the defect suggested to behind the lower portion of the left coronai angular fragment with its apex almost in the jury. Gross crushing injuries such as might Broca that the wound had suppurateci and suture, in the anterior and inferior part of the rnidline. This would suggest multiple blows be produced by large rocks projected with healed. The nature of the wound suggests left parietal bone. Radiating fracture lines as Weidenreich states, perhaps with a c\ub malignant purpose or resulting acciden­ that it was produced by a stone axe, prob­ extend ( 1) anteriorly and slightly upward with a projecting point or knob. tally by rock falls in are character­ ably hafted in this case in order to deliver across the frontal bone; ( 2) upward, curving Skull IV. Only part of the calvarium ( the istic. Only such an injury could readily such a powerfrù blow. In the same group slightly forward to cross the anterior part of frontal and both parietal bones) of the skull account for the ·extensive fracture lines and of bones, a femur of a male showed evi­ the left parietal bone; ( 3) backward and up­ is represented in this specimen. There was an gross displacement of fragments involving dence of a healed fracture. ward to the sagittal suture dividing the irregular comrninuted area about 20 by 30 mm even the base of the skull. Gross commi­ In a course of excavations at Laugerie­ parietal bone into two unequal parts, and ( 4) in diameter with multiple indriven fragments nution of the cranium may further imply Basse on the bank of the Vézère opposite backward and slightly downward to the rnas­ found in the lower frontal bone in the midline. the application of force by large clubs. The toid region ( Fig. 56) . Weidenreich believed On the interior of the skull at this point was the site of Cro-Magnon, Massénat, Lalande gutter-like depressions occasionally found that this lesion was produced by "a spear-like found a depression of the fragments of the and Cartailhac ( 1872 ) discovered a hu­ weapon piercing the skull from above" ( and inner table. Linear fracture lines extended also suggest that these clubs were not al­ man skeleton, the remains of an individuai laterally ). Another picture of this skull horizonally from the lateral ends of this de­ ways large or massive but were of the type who had apparently been crushed while ( Weidenreich, 1943) shows multiple fractures fect, that extending to the left meeting at of billet club used throughout history and asleep by the falling rock under which he of the right parietal region as well. Weiden­ right angles a second long linear fracture until recently in the South Seas. It is ob­ lay. A large irregular defect was found reich believes that the radiating fracture line extending to the left parietal region. vious that some type of pointed weapon in the left tempora! fossa, which very likely lines ( possibly those of the opposi te side Here a second depressed fracture with radia­ was also used, in some instances perhaps a represented a depressed skull fracture of the skull) were produced by crushing ting lines was found. A third was found in an hand-axe but in others a more rounded ( Munro, 1912). blows from club-like weapons. It is more almost symmetric situation in the right parietal point, such as the prong of a deer horn, Another skeleton was found in 1888 by likely that one weapon produced the penetra­ bone. The suggested selective location of hafted in some fashion to constitute a pick Teaux and Hardy near Perigeaux in the ting woun

,! I

FIGURE 6a. FIGURE 6b.

FICUllE 6d.

PLATE 6 Cranial Injuries in the late prehistoric and protohistoric periods. a. and b. Two traumatized skulls considered to be of Mesolithic culture found in "skull nest" at Ofnet Bavaria. The crani:ll injmies suggest blows with a stone-headed axe. Q. Cranial injury in a Cro-Magnon fernale. Recent incised wound in left frontal region. d. Multiple linear fractures of the cranial vault presumed to be made by blow with a stone axe ( after Hollander).

ing had taken piace after fragments of found at Obercassel, , and studied bone had been removed, for the margins by Verworn, Bonnet and Steinman ( 1914) of the defect were well rounded off. The disclosed evidence of an old injury of the victim of the injury had undoubtedly sur­ right parietal bone. In this case, also, the vived her injury for many months if not victim must bave survived for some time. years. A different type of injury is portrayed The skull of one of two skeletons of the by the specimen studied by De Boye. In

FIGU RE 6c. late Palaeolithic ( Magdalenian ) period this sktùl recovered from a cavern at Vii- 610 Diseases in Antiquity Cranial lnjuries in Prehistoric .Han 621 levevard, , were found embedded covered in various parts of Europe. From upper angle was in line with the coronai museum collections of the world could be three tranchard transversal arrow points. Great Britain, for example, Rolleston (in suture. examined speci.fìcally far injury. The skull described by Mollison ( 1936) Greenwell, 1877) described a skull of a But even this concise survev is sufficient as being found at Ofnet ( skull 21 ) and man aged about thirty to thirty-five years . CRANIOCEREBRAL INJURIES IN to point out that before written history, considered to be that of an adult male of found at Langton vVold, Yorkshire. A de­ PROTOHISTORIC PEOPLES OF AFRICA, man suffered a variety of head injuries. Mesolithic date, is one of very unusual scription of this Bronze Age skull included ASIA, THE SO UTH SEAS AND Since his industries were simple, industria! interest. A series of penetrating wounds, a comment on a shallow gutter wound. THE NEW WORLD accidents were few, and most of the evidently due to a sharp edged weapon iA. more recent study of antemortem injury With the development of the protohis­ cranial wounds and fractures noted in such as an axe are found in the right in early British crania by Brothwell ( 1961 ) toric cultures which actually belong to àncient specimens are the result of blows frontal, the right temporal, the right gives freg,uencies shown in the following Egypt, the Near East, Greece and Rame, delivered with mallcious intent. Cross parieto-occipital ( 2 ) regions, and at the Table I. injuries to the skull and brain became in­ crushing injuries resulting from large creasingly common ( Courville, 1949). stones or clubs are betrayed by multiple, T ABLE I DISTRIBUTION OF ANTEMORTEM INJURY TO THE SKULL (BRITAIN) Similar studies on cranial injuries among extensive fractures, at times with deforma­ the early Peruvians ( Courville and Abbott, tion of the head. Simple linear fractures Other Parts Face 1942), arnong the islands of Oceania suggest blows with smaller clubs or blunt (generai) Nose T ota[ Period Frontal Parie tal of the Vault ( Courville, 1951 ) and the Indians of North weapons. Penetrating wounds irnply Neolithic-Bronze Age 7 6 I I 3 18 America ( Courville, 1948) and of Cali­ pointed and hafted striking weapons of fornia ( Courville, 1952), from prehistoric Iron Age--Anglo-Saxon 13 Il o 4 2 30 stone or metal. Incised wounds with sharp as well as protohistoric and historic pe­ edges bespeak weapons of better make T ota I 20 17 5 5 48 riods, have provided evidence of the grad­ and suggest that the flint axes were being ua! evolution of medica! knowledge and polished or that bronze axes were in use. vertex. The fracture lines about these N umerous other cases of cranial injury in treatment of cranial injuries. There is, how­ penetrating defects are sharp, indicating European specimens have been described, ever, still a need for further studies of REFERENCES that the wounds were recent, presumably but only two selected examples need be craniocerebral injury and in particular with BLACK, D., 1925: The human skeletal remains from the the cause of the individual's death. given here. accurate and detailed statistics such as Sha Kuo T'un cave deposits in comparison with There is some question whether all the Hollander ( 1928) described a portion of given in Hoot.on's ( 1930) classic analysis those from Yang Shao Tsung and with North China skeletal materia!. Palaeont. Sinica Ser. D., Voi. I, fragmented skulls in the "skull-nests" at a protohistoric calotte found at Reinbeck, of the Indians of Pecos Pueblo. Not only fase. 3. Ofnet, Bavaria, represent the effects of Germany, which consisted essentially of a does his data permit tbe study of injury BwCA, P., 1868: Sur !es criìnes et ossements des Eyzies. injury ( see Fig. 6a, b ). One of these nests frontal bone marked by numerous fracture through the dimension of time, but also Bull. Soc. Anthrop. 2nd ser., 3:350. --, 1873: The troglodytes, or cave-dwellers of the contained twenty-seven human skulls. The lines ( Fig. 6d). He concluded that the according to age-grouping ( Table II). valley of the Vezere . •4.nn. Report Smithsonian Inst. heads represented by these skulls were ob­ fracture was the result of a blow with a p. 310. viously removed for purposive placement stone axe in the left parietal region which SU MMARY AND CONCLUS IONS BROTHWELL, D. R., 1961: The palaeopathology of early shattered the cranial vault. There was Brirish man; an essay on the problems of diagnosis, in these nests. The presence of the skulls The examples given above, especially and analysis. /. Roy. Anthrop. Inst., 91 :3Q.t. alone, particularly those of children imply evident healing in the fracture lines. of late prehistoric and protohistoric speci­ COURVILLE, C. B., and Aasorr, K. H., 1942: Cranial burial by relatives. Another skull, described by Du Chaillu mens could probably be duplicateci many injuries of the Pre-Columbian Incas, with comments ( 1890), found in a graveyard of Roman on their mechanism, effects, and lethality. Bui/. times aver if the crania in the numerous Los Angeles Neuro/. Soc., 14: 101. date at Varpelev, Zeeland, Denmark, was INJURIES TO THE HEAD IN THE LATE evidently that of an adult male. This PREHISTORIC AND PROTOHISTORIC specimen presented evidence of trauma in TABLE II PERIOD IN EUROPE SKULL FRACTURES CONSIDERED IN RELATION TO AGE-GROUP IN PECOS the form of a triangular defect in the left P UEBLO INDIANS. (DATA FROM HOOTON, 1930) In cultures which are contemporary frontoparietal region, made by some sharp­ with early historic peoples, there is in­ edged weapon ( presumed to be a sword, Tota[ Age Croup Sub-Adult Young Adult creasingly abundant evidence of injuries but more likely a narrow-bitted axe ). Middle Aged Old Afjected to crania. A number of such crania from Short radiating fractures extended from Percentage of the Neolithic to Ages have been dis- the two lower angles of the defect; the 581 indidduals 13.04 8.70 52.17 26.09 3.96 622 Diseases in Antiquity

CouRV!LLE, C. B., 1948: Cranial injuries among the Basse. Materia1Lx VII (Cited by Munro, R., 1912. Indians of North America. A preliminary report. pages 132 and 133) MoLLISON, T ., 1936: Zeichen gewaltsamer Verletzungen Bull. Los Angeles Neuro!. Soc., 13:181. - - , 1949: lnjuries to the skull and brain in ancient an den Ofnet-Schadeln. Anthrop. Anzeig., 13:79. 4 Egypt. Some notes on the mechanism, nature, and MuNRO, R., 1912: Palaeolithic man and terramara 1 effects of cranial injuries from predynastic times to settlements in Europe. New York, Macmillan. Chapter 49 the end of the Ptolemaic period. Bull. Los Angeles OPPENOORTH, W. F. F., 1932: Homo (Javanthropus) Neuro!. Soc., 14:53. soloensis. Een plistociene mensch van ]ava. Dienst The Evidence for lniuries to the Jaws - - , 1951: Injuries to the skull and brain in Oceania, Mijnbouw Nederlandsch-lndie, Wetensch. Meded. with reference to the mechanism and nature of such No. 20, p. 49. injuries, the measures used in protection against TESTUT, L., 1889: Recherches anthropologiques sur le them, and their treatment particularly among the squelette quarternaire de Chancelade. (Cited by V. ALEXANDERSEN Melanesians. Bull. Los Angeles Neuro!. Soc., 16:17. Munro, 1912, p. 134). - -, 1952: Cranial injuries among the early Indians voN KoEN!GSWALD, G. H. R .. 1937: Ein Unterkieferfrag­ of California. Bull. Los Angeles Neuro!. Soc., 17: ments des Pithecanthropus aus den Trinilschichten 'J1R.AUMATIC lesions of bones bave been Extensive crushing involving fractures of 137. Mitteljavas. Amsterdam. Prov. K. Akad. Wetensch, Du CHAILLU, P. B., 1890 : T he Viking Age: T he early 40:883. J. observed in skeletal remains of man the zygomatic arch, maxilla and the man­ history, manners and customs of the ancestors of the VERNWORN, M., BoNNET, R., and SntNMAN C., 1914: from all periods, from Palaeolithic times to dible were reported. lt is likely that mace­ English-speaking nations. New York, Scribner. Der diluviale Menschbefund von Obercassel bei Yf iddle Ages. Injuries to the skull were heads made of hard diorite were responsi­ GoRJANOVIC-!