Diet, Nutrition, and Activity at Khirbat Al-Mudayna: Inferring Health in an Historical Bedouin Sample

DIET, NUTRITION, AND ACTIVITY AT KHIRBAT AL-MUDAYNA: INFERRING HEALTH IN AN HISTORICAL BEDOUIN SAMPLE

THESIS

Presented in Partial Fulfillment of the Requirements for

the Degree Master of Arts in the Graduate School

of The Ohio State University

Joshua W. Sadvari, B.A.

● ● ● ● ●

The Ohio State University 2009

Thesis Committee Approved by Professor Clark Spencer Larsen, Adviser

Professor Paul W. Sciulli

Professor Samuel D. Stout ______Adviser Anthropology Graduate Program

Joshua W. Sadvari

2009

ABSTRACT

A bioarchaeological analysis of skeletal pathology in an historical (13th-18th centuries) Bedouin sample (n=28) from Khirbat al-Mudayna and the surrounding Wadi ath-Thamad region of Jordan was used to address questions regarding the overall health of an agropastoralist group. Global History of Health Project data collection standards were used for recording non-specific stress, oral health, trauma, degenerative joint disease, specific pathological conditions, and long bone metrics. Comparisons of health

and quality of life indicators at the intra-site level provided insight into aspects of

Bedouin society, such as a sexual division of labor, and revealed a mosaic pattern of

health differences reflective of both pastoral and agricultural subsistence components.

Inter-site comparisons made between the Khirbat al-Mudayna sample and two other Near

Eastern groups situated the Bedouin sample within a larger regional context. The present

analysis illustrates the complex relationship between subsistence, dietary quality, and

health, as indicated by skeletal pathology.

Dedicated to the memory of my father, Lawrence G. Sadvari

I love you, and I miss you.

iii

ACKNOWLEDGMENTS

Over the course of my graduate school experience at The Ohio State University, I

have become indebted to many individuals, without whom the present research would not

have been possible. My deepest appreciation and thanks go to Dr. Clark Spencer Larsen,

my adviser, for his guidance, patience, and the many opportunities with which he has

provided me in terms of teaching and research. Thank you also to the members of my

thesis committee, Drs. Clark Spencer Larsen, Paul W. Sciulli, and Samuel D. Stout , for

their perspectives on my research, their suggestions and advice, and their commitment.

Many thanks go to Dr. Margaret Judd, my undergraduate adviser at the University

of Pittsburgh, for her patience with me in the earliest stages of my career in anthropology,

her many comments and suggestions regarding the present research, and for allowing me

access to her lab during data collection. I must also acknowledge funding provided (to

Dr. Judd) by the Central Research Development Fund at the University of Pittsburgh,

which supported the AMS dating for the present project, as well as funding provided by the University Center of International Studies (UCIS) Research Abroad Program at the

University of Pittsburgh, which supported my participation in the Wadi ath-Thamad

Project excavations during the summer of 2006. Thank you also to Dr. P.M. Michèle

Daviau of Wilfrid Laurier University for accepting me into the Wadi ath-Thamad Project,

iv giving me my first fieldwork experience, and for allowing me access to the skeletal remains analyzed in the present study.

My appreciation and gratitude go to Drs. Clark Spencer Larsen and Richard H.

Steckel of the Global History of Health Project for providing me with a project laptop and software, the use of which allowed me to collect data for this research. Thank you to

Dr. Tracy Betsinger and Leslie Williams of the Global History of Health Project for answering all of my questions regarding the project software and for successfully rectifying any of my initial technical difficulties. Many thanks to Dr. Jeffrey H. Cohen for imparting his wisdom regarding writing and publishing as an anthropologist and for his editorial comments and suggestions on the earliest drafts of this thesis.

Thank you to my cohort-mates, particularly Lise Byars, Kristie Martin, and David

Martinez, with whom I shared many fruitful discussions as well as moments of frustration, success and joy. Many thanks go to Erica Chambers for mentoring me in the ways of success as a Graduate Teaching Associate, but more importantly, for being a great friend. Thank you to my lovely girlfriend Meghan-Tómasita Cosgriff-Hernández for listening to my ever-changing list of “things I have to do before I’m done,” and always being understanding and accepting. Last, but certainly not least, thank you to my beautiful mother, Shirley R. Sadvari, without whose constant love and support, none of my past, present, or future accomplishments would be possible.

VITA

May 27, 1985……………………………….. Born – Windber, Pennsylvania, USA

2007………………………………………… B.A. Anthropology, University of Pittsburgh (Pittsburgh, PA)

2007………………………………………… M.A. Fellow, The Ohio State University (Columbus, OH)

2008 – present………………………………. Graduate Teaching Associate, The Ohio State University

FIELDS OF STUDY

Major Field: Anthropology

TABLE OF CONTENTS

Page Abstract ………………………………………………………………………………….. ii Dedication ………………………………………………………………………...…….. iii Acknowledgements ……………………………………………………………………... iv Vita …………………………………………………………………………………...… vi List of Tables ………………………………………………………………...…….….... ix List of Figures …………………………………………….…………………..………… xi

Chapter 1: Introduction ………………..………………………………………………… 1

Chapter 2: Materials and Methods ……………..………………………………….…….. 8

2.1 Non-specific stress indicators …………....…………………………….. 14 2.2 Oral health ……………………...……………………………….…….... 15 2.3 Trauma …………………………………………………………………. 16 2.4 Degenerative joint disease ……………………………………………... 16 2.5 Specific pathological conditions ……………………………………….. 17 2.6 Long bone metrics ……………………………………………………... 18

Chapter 3: Results ………..…………………………………………………………….. 20

3.1 Khirbat al-Mudayna: Non-specific stress ……………………………… 23 3.2 Khirbat al-Mudayna: Oral health ………………………………………. 26 3.3 Khirbat al-Mudayna: Trauma ……………………………………….…. 29 3.4 Khirbat al-Mudayna: Degenerative joint disease ……………………… 31 3.5 Khirbat al-Mudayna: Specific pathological conditions ….…………….. 34 3.6 Khirbat al-Mudayna: Long bone metrics …………….……………....… 34 3.7 Inter-site comparisons: Non-specific stress ….………………………… 35 3.8 Inter-site comparisons: Degenerative joint disease ……………...…….. 40 3.9 Inter-site comparisons: Trauma …………….………………………...... 42

Chapter 4: Discussion …………………………………………………………..….…... 43

4.1 Khirbat al-Mudayna: Non-specific stress …….……………………...... 43 vii

4.2 Khirbat al-Mudayna: Oral health ……………….…………………….... 44 4.3 Khirbat al-Mudayna: Trauma ……….…………………………….….... 45 4.4 Khirbat al-Mudayna: Degenerative joint disease ………………….…... 46 4.5 Khirbat al-Mudayna: Specific pathological conditions …………….….. 47 4.6 Khirbat al-Mudayna: Long bone metrics …………………….…….….. 48 4.7 Inter-site comparisons: Non-specific stress…………………………...…49 4.8 Inter-site comparisons: Degenerative joint disease ……………………. 49 4.9 Inter-site comparisons: Trauma …………………………….………….. 50

Chapter 5: Conclusion ………………………………………..…………….………...... 51

References Cited …………………………………………………………………....….. 54

Appendix A: List of Khirbat al-Mudayna and Wadi ath-Thamad Burials …….………. 59

viii

LIST OF TABLES

Table Page

1 Age and sex distribution of the Khirbat al-Mudayna historical Bedouin sample ………………………………………………………………………….. 21

2 Age and sex distributions of the QAIA pastoral nomad and Rehovot agricultural villager samples (from Perry 2007) ……………………………………….…… 21

3 Intra-site comparisons of non-specific stress indicators at Khirbat al- Mudayna ……………………………………………………………………….. 23

4 Results of Fisher’s Exact Test comparisons of cranial porosities by sex at Khirbat al-Mudayna …………………………………………………………..... 24

5 Results of Fisher’s Exact Test comparisons of dental enamel hypoplasias at Khirbat al-Mudayna …………………………………………………...……….. 25

6 Results of Fisher’s Exact Test comparisons of osteoperiostitis at Khirbat al- Mudayna ……………………………………………………………………….. 25

7 Tetrachoric correlation between all non-specific stress indicators at Khirbat al- Mudayna ……………………………………………………………………..… 26

8 Intra-site comparisons of oral health indicators at Khirbat al-Mudayna ………. 27

9 Results of Fisher’s Exact Test comparisons of dental caries at Khirbat al- Mudayna ………………………………………………………………..……… 29

10 Results of Fisher’s Exact Test comparisons of abscesses at Khirbat al- Mudayna ……………………………………………………………………….. 29

11 Results of Fisher’s Exact Test comparisons of AMTL at Khirbat al- Mudayna ……………………………………………………………………..… 29

12 Rates of trauma by skeletal element based on sex at Khirbat al-Mudayna ……. 30 ix

13 Trauma frequency based on total number of skeletal elements at Khirbat al- Mudayna ……………………………………………………………………….. 31

14 Results of Fisher’s Exact Test comparisons of trauma at Khirbat al- Mudayna ……………………………………………………………………….. 31

15 Degenerative joint disease by sex at the site of Khirbat al-Mudayna …….…… 32

16 Rates of non-specific stress indicators in the QAIA and Rehovot comparative samples (from Perry 2007) …………………………………….……………..... 37

17 DJD by joint based on sex for the QAIA and Rehovot groups (from Perry 2002) ……………………………………………………………….……….….. 41

18 Results of Fisher’s Exact Test comparisons of trauma rates in three Near Eastern groups …………………………………………………………………….……. 42

LIST OF FIGURES

Figure Page

1 Interaction between mobility and mode of subsistence (modified from Cribb 1991) …………………………………………………………………………...... 3

2 Map of archaeological sites in west-central Jordan (from Daviau 1997b) ……… 9

3 Map illustrating the locations of the QAIA cemetery in Jordan and the site of Rehovot in Israel (from Perry 2007) …………………………………………… 22

4 Non-specific stress by sex at Khirbat al-Mudayna …………………………….. 24

5 Oral health indicators by sex at Khirbat al-Mudayna ………………………….. 28

6 The proportion of joints affected by DJD for each joint group at Khirbat al- Mudayna ……………………………………………………………………...... 32

7 The proportion of joints affected by DJD for each joint group based on sex at Khirbat al-Mudayna (Males – solid, Females – cross-hatched) ……………….. 33

8 Cranial porosities by sex in three Near Eastern integrated subsistence groups ... 37

9 Dental enamel hypoplasias by sex in three Near Eastern integrated subsistence groups …………………………………………………………………………... 38

10 Osteoperiostitis by sex in three Near Eastern integrated subsistence groups ….. 39

11 The proportion of joints affected by DJD based on sex in three Near Eastern groups …………………………………………………………………………... 41

CHAPTER 1: INTRODUCTION

Skeletal pathology is a reflection of the overall health status of an individual and,

when extended to the level of a population, provides important information regarding environmental and social factors affecting a particular group of people. Two critical

factors that influence quality of life and health status are subsistence pattern and dietary

quality. A bioarchaeological analysis of skeletal pathology in an historical Bedouin

sample excavated from Khirbat al-Mudayna in Jordan is used to address questions

regarding the overall health of a group practicing an integrated subsistence pattern, with

pastoral and agricultural components, and consuming a diet associated with this

subsistence strategy. I hypothesize that the pastoral and agricultural components of an

integrated subsistence strategy will affect the health and quality of life of individuals

practicing such a strategy in distinctive ways, and these effects will be reflected in terms

of skeletal pathology.

Bioarchaeological research has the potential to provide tremendous insight into

the health and quality of life of past populations. However, bioarchaeological analyses in

the Near East, and in Jordan in particular, are in short supply (Bikai and Perry 2001,

Cheyney 1995, Findlater et al. 1998, Grauer and Armelagos 1998, Perry et al. 2007, Perry

and Al-Shayab 2005, Rose and Burke 2004). Many archaeological projects in Jordan fail

to emphasize the analysis of human skeletal remains, and information regarding 1 commingled or poorly preserved remains is rarely reported (Perry 2002, 2007). In addition, the lack of research priorities involving cemetery excavation, as well as the scarcity of pastoral nomad cemeteries in the archaeological record, limits the availability of Near Eastern skeletal samples for addressing bioarchaeological research questions

(Perry 2007). Judd (in press) points out that the paucity of bioarchaeological research in

Jordan is not a result of disinterest, but rather the consequence of factors such as the discovery of isolated burials among archaeological features and pervasive looting, both modern and historically. My study provides an opportunity to answer questions regarding quality of life and health, not only in a Near Eastern skeletal sample, but in a

Bedouin group practicing an integrated subsistence economy with a pastoral component.

The Arabic term badawi, from which “Bedouin” is derived, refers to a nomadic inhabitant of the desert who depends on herds of camels and sheep for subsistence (Marx

1967). Though this may be the original connotation of the word “Bedouin,” its meaning changed over time as a reflection of the changing Bedouin lifestyle. The integrated subsistence pattern of the Bedouin is described as a continuum ranging from a desert way of life, in which only brief contact is made with agricultural communities, to an almost completely agricultural existence, in which villagers continue to refer to themselves as

“Arabs” or “Bedouin” despite their sedentary lifestyle (Hobbs 1989). Cribb (1991) argues that an integrated desert life way is comprised of two independent dimensions, subsistence and mobility, both of which can be viewed as a continuum. The subsistence continuum ranges from a pastoral extreme to an agricultural extreme, while the mobility continuum ranges from nomadic to sedentary. The relationship between these two

continuums can be represented by a probability space, in which groups practicing an

integrated subsistence pattern are located based on their positions along the pastoral- agricultural and nomadic-sedentary continuums (Figure 1).

Figure 1. Interaction between mobility and mode of subsistence (modified from Cribb 1991).

Cribb (1991) demonstrates that groups practicing an integrated subsistence

economy may differ substantially from one another in their relative positions along the pastoral-agricultural and nomadic-sedentary continuums despite their similar classification under the umbrella term of integrated subsistence. The degree of

integration between pastoralism and intensive agriculture in Bedouin groups is influenced

by a mixture of ecological (e.g. geology, soil, climate, and water availability), economic,

political, and familial factors. The interaction of these various factors places a particular

group in a distinctive position within Cribb’s probability space, and from this position, a

unique suite of subsistence- and diet-related factors can affect the quality of life and

overall health status of this particular group.

The interaction of pastoral and agricultural modes of production is important not

only within groups practicing integrated subsistence, but between such groups as well. In

the groups existing close to the extremes of Cribb’s (1991) probability space (i.e. pastoral

nomads and sedentary agriculturalists), one mode of production dominates the other. A

mutual dependence between groups defines a symbiotic relationship that exists as the agricultural villagers provide the desert nomads with vegetable foodstuffs and the nomads provide the villagers with animals for transportation, herding, and meat (Coon

1958, Hobbs 1989). This mutual dependence and trade can lead to the establishment of similar dietary patterns, in terms of raw ingredients and preparation techniques, between the pastoral nomads and the sedentary agriculturalists (Coon 1958, Palmer 2002).

The traditional Bedouin diet consists of meals based on mixtures of grain and milk products, which is a combination of the dominant agricultural and pastoral elements of the village and nomadic economies of the Bedouin (Palmer 2002). Wheat and barley are the staple crops of the Bedouin, but other crops including millet, lentils, beans, chick peas, tomatoes, apricots, and dates may also be grown depending on the environmental conditions and availability of water (Coon 1958, Hobbs 1989, Palmer 2002). Milk

obtained from domesticated animals, such as camels and goats, is also a primary source

of nourishment for the Bedouin (Hobbs 1989, Musil 1928). Meat is considered a luxury

item among pastoral nomads as their domesticated herds serve a greater economic

purpose than food (Coon 1958, Hobbs 1989). Meat consumption of domesticated

animals, therefore, may be more prominent in the diet of sedentary agriculturalists that

benefit from trade with the nomads. Some hunting of gazelle and ibex does occur among

the nomads, which provides another source of meat aside from the occasional sheep,

goat, or camel that is slaughtered (Hobbs 1989). Dietary similarities between pastoral

nomads and sedentary agriculturalists, the two extreme groups within the integrated subsistence probability space, suggest that diet will be a minimal factor as I define any differences in quality of life and health between such groups. In other words, skeletal indicators of health influenced by diet should show similar patterns in most integrated subsistence groups, regardless of their position within Cribb’s (1991) probability space.

The factors associated with a particular group’s degree of subsistence integration, such as terrain, activity and migration patterns, workload, interaction with livestock, and close living conditions, should assume a prominent role in explaining any observed health differences between such groups. For example, Bedouin are exposed to a harsh desert environment, rugged terrain, and a physically-demanding lifestyle, especially during large-scale herd movements and community-wide migrations. Bedouin individuals, whether sedentary agriculturalists or nomadic pastoralists, may face elevated levels of exposure to zoonotic pathogens due to interaction with livestock and herding dogs (Qaqish et al. 2003, Smith and Horwitz 2007). Bedouin may also face the spread of

5 disease due to close living conditions within agricultural villages or when a nomadic community is camped rather than migrating at any given time. As the significance of any one of these factors will vary with regard to different integrated subsistence groups, their effect on quality of life and health for any particular group should also be expected to vary. As such, a distinct pattern of health and quality of life differences should be anticipated when bioarchaeological analyses are conducted among integrated subsistence groups.

I will compare skeletal pathology in an historical Bedouin sample with an integrated subsistence pattern, in which pastoralism and agricultural production played major roles, to a primarily pastoral nomadic sample and a sedentary agricultural sample from the Near East (Perry 2002, 2007). I hypothesize that skeletal indicators of health heavily influenced by diet and nutrition will be similar among all three samples due to the similar dietary patterns of most integrated subsistence groups. For the historical Bedouin sample from Khirbat al-Mudayna, I hypothesize that factors related to both components of an integrated subsistence pattern, pastoralism and agriculture, will be visible in terms of skeletal pathology and will reflect a mosaic pattern of health differences.

Additionally, I hypothesize that the sexual division of labor characteristic of Bedouin society will contribute to differences in health and quality of life between males and females at Khirbat al-Mudayna. Regarding inter-site comparisons, I hypothesize that differences in health and quality of life between the three Near Eastern samples included in the present analysis will primarily reflect differences in lifestyle associated with activity, workload, and living conditions, as opposed to factors associated with diet.

The idea of a mosaic pattern of health differences illustrates the complexity of bioarchaeological analyses regarding integrated subsistence groups. The degree of integration along the pastoral-agricultural and nomadic-sedentary continuums will affect different groups in distinctive ways depending on their position in Cribb’s (1991) probability space. Interactions between groups in different relative positions in this probability space can serve to homogenize certain factors, such as diet, which could have profound effects on nutrition and overall health status. As such, there is likely no simple relationship between subsistence pattern and health. Rather, some integrated subsistence groups will be adversely affected in certain respects, while other groups will not be similarly affected, and these differences will be reflected pathologically in skeletal remains.

CHAPTER 2: MATERIALS AND METHODS

The skeletal remains analyzed in the present study consist of 28 individuals from an archaeological sample excavated at Khirbat al-Mudayna and several small, dispersed sites in the surrounding wadi region. The main tell of the site is on the south bank of the

Wadi ath-Thamad in west-central Jordan, approximately 45 kilometers south of the modern day capital of Amman (Figure 2). Excavations at the site have uncovered evidence of dense occupation during the Iron Age II and Nabataean-early Roman periods.

Regional survey has uncovered a number of additional sites in the area surrounding

Khirbat al-Mudayna. The Iron Age II sites were comprised mostly of strategically placed watch towers or agricultural installations. The Nabataean-early Roman sites were mostly agricultural settlements located in close proximity to the wadis overlooking farmland

(Daviau 1997a).

Figure 2. Map of archaeological sites in west-central Jordan (from Daviau 1997b).

The location of Khirbat al-Mudayna on the wadi was important to the subsistence strategy of its inhabitants. These settlements were located in a zone where grain and vegetables could be grown when rainfall was sufficient and the wadi was not dry, and where animals such as sheep and goats could be pastured (Daviau and Dion 2002).

Remains of storage jars and other vessels signify extensive food storage by the site’s inhabitants, and the importance of animal husbandry is evident from the large quantities

9 of butchered animal bones, primarily sheep and goat (ibid.). This archaeological evidence indicates that the ancient inhabitants of Khirbat al-Mudayna practiced an integrated subsistence economy with both pastoral and agricultural components, which the Bedouin occupying that area still use today.

Though the Iron Age II and Nabataean-early Roman periods may have marked the heaviest occupation of Khirbat al-Mudayna, the burials analyzed in the present study are thought to be historical Bedouin. Simpson (1995) divides Islamic burial criteria, which would be expected to be followed in Bedouin groups, into various categories including interment and orientation, grave goods, grave markers, and cemetery location. In regards to interment and orientation, Bedouin burials are normally primary, single inhumations, though multiples graves may be constructed in times of war or epidemic. The body is laid in the grave either on its back (supine) or lying on its right side with the head to the west and the face towards Mecca, which is located south-southeast relative to Khirbat al-

Mudayna (Insoll 1999, Simpson 1995). However, variability can exist in the orientation of Islamic burials, and Simpson (1995) notes that some Bedouin burials may be oriented away from Mecca due to a genuine uncertainty on the part of one or more individuals as to the true direction of this Islamic holy city.

In terms of grave goods, Islamic burials are generally characterized by an absence of artifacts (Insoll 1999). Simpson (1995) states that despite this Islamic prohibition of grave goods, Bedouin burials have frequently been found to contain artifacts such as coins, beads, rings, bracelets, and various other items of jewelry. Bedouin graves, if commemorated at all, are generally marked by either piles of unworked stones or circular

stone features (Insoll 1999, Simpson 1995). In regards to cemetery location, Islamic graves tend to cluster in distinct cemeteries found on dry, raised ground (i.e. agriculturally poor areas) beyond the settlement. In the case of nomadic Bedouin, however, individuals may simply be buried near their tent so that isolated Bedouin burials are often found (Simpson 1995). Also of interest in the case of semi- or fully-nomadic

Bedouin groups is the possibility of death occurring during the migration of a community from one area to another. In such an event, the body may be placed in a shallow grave and covered with stones or earth as noted by Musil (1928) among the Rwala Bedouin, or

the deceased may be interred in the ruins of ancient structures (Burckhardt 1831).

Of the 28 burials included in the present analysis, eight displayed the array of

characteristics typical of Muslim Bedouin burials. Nine additional burials displayed

variations of the sort noted by Simpson (1995), primarily in the form of a different orientation or the presence of grave goods. Such grave goods included beads and bead

necklaces, along with metallic (copper) rings and bracelet fragments. Grave goods of this

sort have been previously noted in other Muslim burials by Toombs (1985) and,

therefore, bolster the idea that these burials belong to historical Bedouin. One of the

burials classified as a variant was that of an individual buried in the typical Muslim

orientation but located in a cave tomb. Although unusual, Simpson (1995) describes a

similar mortuary practice among Muslim individuals at the site of Artas. Of the

remaining 11 burials, ten are composed of disarticulated remains or lack adequate

contextual information to be discernible as Bedouin or otherwise, possibly as a result of

looting which has become prevalent in this region (Daviau et al. 2006). The final

remaining burial belonged to a child of approximately one year of age and associated

with a sarcophagus. Such a burial is an anomaly for this sample as coffins of any sort are

rarely used by Muslims, although they are not strictly forbidden (Simpson 1995).

Based on the 17 (60.7%) burials displaying either typical Bedouin burial

characteristics or within the realm of plausible variations described by Simpson (1995),

the skeletal material analyzed in this study was considered to be part of an historical

Bedouin sample. Until recently, estimates of the date for this sample were based in large

part on the presence of artifacts, specifically two bracelet fragments dating to the

Ottoman period (13th-17th centuries) recovered near the MT E99:27 burial (Daviau et al.

2006). The latter end of this date range has recently been extended through the analysis of a tooth sample from the WT 112:B1:39 burial through accelerator mass spectrometry

(AMS) radiocarbon dating. The date range reported through this analysis is 210 +/- 48 years BP (Judd personal communication).

Data for the present study were collected using the Global History of Health

Project standards (Steckel et al. 2006). Adult sex was assessed based on morphological

features of the cranium and os coxae. Cranial features evaluated in sex determination

consisted of the nuchal crest, mastoid process, supraorbital margin, prominence of

glabella, and mental eminence (Acsadi and Nemeskeri 1970). Sexually dimorphic

features of the os coxae were scored using the systems described in Buikstra and

Ubelaker (1994) and the Recommendations for Age and Sex Diagnoses of Skeletons

(Workshop of European Anthropologists 1980). Os coxae features that were considered

included subpubic concavity, subpubic angle, ischiopubic ramus ridge, ventral arc, arc

composé, greater sciatic notch width (Acsadi and Nemeskeri 1970), and presence of the

preauricular sulcus. Subadult sex was not assessed due to the general absence of sexually

dimorphic features in young children/juveniles (Chamberlain 2006). However, sex was

tentatively determined for the two adolescent individuals on the border of the subadult-

adult ranges.

Adult age was estimated based on endocranial and ectocranial closure of the

coronal, sagittal, and lambdoid sutures as well as on os coxae morphology. Changes to the pubic symphyseal face were scored using the Suchey-Brooks system, and the

auricular surface of the ilium was also assessed when observable (Buikstra and Ubelaker

1994). Subadult age was estimated based on the stages of dental development (Ubelaker

1989), epiphyseal fusion (Baker et al. 2005, Buikstra and Ubelaker 1994), and long bone

diaphyseal length (Hoffman 1979).

Overall health status of individuals in this skeletal sample was evaluated using a

variety of factors including:

● non-specific stress indicators

● oral health

● trauma

● degenerative joint disease

● specific pathological conditions

● long bone metrics

2.1 Non-specific stress indicators

Non-specific stress indicators are comprised of cranial porosities, dental enamel hypoplasias, and osteoperiostitis. Cranial porosities, such as cribra orbitalia and porotic hyperostosis, have been linked to a variety of conditions, including iron deficiency anemia, infections, and general nutritional deficiencies (Larsen 1997, Ortner et al. 2001,

Ortner et al. 1999, Schultz 2001). Cribra orbitalia is a form of lesion on the roof of the eye orbit ranging from slight pitting to severe porosity. Similar lesions found on ectocranial vault surfaces, most commonly on the parietals and occipital, are known as porotic hyperostosis. Dental enamel hypoplasias result from a deficiency in enamel development caused by systemic pathological stress associated with infectious disease, neonatal disturbances, and nutritional deprivation (Goodman and Rose 1991, Larsen

1997). Hypoplastic enamel defects provide a good index of levels of developmental stress within an individual and can be indicative of multiple or prolonged stress episodes.

Osteoperiostitis is reactive bone formation representing a basic inflammatory response resulting from bacterial infection, traumatic injury, or other pathological processes

(Larsen 1997, Ortner and Putschar 1985). Periosteal lesions are characterized by irregular elevations of bone surfaces with or without cortical thickening. These lesions can be highly-localized and limited to a single skeletal element, or they may involve multiple elements in the case of a systemic infection (Larsen 1997). Due to their possible formation from multiple etiological pathways, cranial porosities, dental enamel

14 hypoplasias, and osteoperiostitis are best regarded as non-specific stress indicators rather than attributed to specific diseases.

2.2 Oral Health

Oral health indicators consist of carious lesions, abscesses, and antemortem tooth loss. Dental caries is a disease process characterized by the focal demineralization of dental hard tissues by organic acids produced through the bacterial fermentation of dietary carbohydrates (Larsen 1997). Carious lesions are stained, irregularly-walled cavitations involving the partial or complete loss of tooth crowns or roots (ibid.). Dental caries is also a good indicator of diet, as carbohydrate consumption, is a major causal factor of carious lesions. A dental abscess is a cavity in the alveolar bone surrounding a tooth root that forms when exposure of the pulp chamber leads to a pyogenic infection, and the resulting pus collects locally near the root apex (Buikstra and Ubelaker 1994,

Dias and Tayles 1997, Roberts and Manchester 2005). Abscess formation is generally associated with pulp exposure, which can be due to progressive caries or heavy attrition.

Antemortem tooth loss (AMTL) frequently results from carious lesions, but it can also derive from advanced periodontal disease, heavy attrition, or trauma (Kelley et al. 1991,

Lukacs 1995). AMTL is a good index of oral health because it is indicative of other pathological processes that may no longer be visible in the dentition due to exfoliation of the tooth prior to death.

2.3 Trauma

Skeletal trauma provides evidence of accidental injury as well as interpersonal

violence. Different physical and social environments provide the context for different types of injuries observed within a skeletal sample. Accidental injuries reflect the hazards associated with day-to-day living (Larsen 1997). For example, traversing rugged, mountainous terrain or high levels of physical activity are typically associated with fractures (e.g. lower limb, distal radius, and rib fractures) resulting from falls or other accidental injuries (ibid.). Skeletal trauma indicative of interpersonal violence varies across social landscapes, and a high degree of violent injuries may denote a particularly stressful period for a population. In the present analysis, trauma was assessed based on its location in the skeleton, the type of injury (i.e. fracture and type, amputation, weapon wound), and the degree to which the injury had healed (i.e. well- healed, partially-healed, possible perimortem).

2.4 Degenerative joint disease

Degenerative joint disease (DJD) provides evidence of individual workload and activity, which allows researchers to make inferences about overall quality of life in a population. The primary contributing factor to the development of DJD is mechanical stress associated with physical activity (Larsen 1997). The physical manifestations of

DJD include osteophytic lipping around the joint margin, erosion of bone on the joint surfaces (pitting), eburnation, and in the most severe forms, destruction of the joint

16 surface (Larsen 1997, Roberts and Manchester 2005). Assessing the distribution of DJD within a population based on the joints affected and variation with sex/age is informative with regards to the activity patterns of individuals and subgroups within that population.

In the present analysis, DJD was scored in terms of both presence and severity for the temporomandibular joint, six limb joint groups (shoulder, elbow, hip, knee, wrist/hand, and ankle/foot) and the cervical, thoracic, and lumbar areas of the vertebral column.

2.5 Specific pathological conditions

Evidence of various specific pathological conditions, including treponematosis, tuberculosis, leprosy, diffuse idiopathic skeletal hyperostosis, scurvy, and rickets was also noted if present. Treponematosis is represented by four closely-related disease syndromes: venereal syphilis, nonvenereal (endemic) syphilis, yaws, and pinta (Larsen

1997, Mandell et al. 1990, Ortner and Putschar 1985). Treponemal infection is introduced via the skin or mucous membranes, and the hard tissue manifestations of treponematosis are characterized by inflammatory responses and stellate/“worm-eaten” lesions on bone surfaces with close proximity to the skin, such as the cranial vault and anterior tibia (Larsen 1997). Whereas treponemal disease results in proliferative bone lesions, tuberculosis results in the progressive destruction of bone tissue. Tuberculosis is most commonly expressed in the form of erosive vertebral lesions of the lower back

(lower thoracic and lumbar vertebrae) as well as resorptive changes to the pleural rib surfaces (Buikstra 1981, Larsen 1997, Ortner and Putschar 1985, Roberts et al. 1994).

Like treponematosis and tuberculosis, leprosy is an infectious disease. Skeletal

17 manifestations of leprosy include disfiguration and atrophy of the nasal/maxillary areas of the skull as well as the fingers and toes (Larsen 1997).

Diffuse idiopathic skeletal hyperostosis (DISH) is a noninfectious example of a specific pathological condition with skeletal manifestations. DISH is an enthesopathic condition of the paraspinal ligaments characterized by flowing ossification along the anterolateral aspect (most commonly of the right side) of at least four contiguous vertebral bodies (Roberts and Manchester 2005). Scurvy and rickets are also noninfectious pathologies resulting specifically from nutritional deficiencies. Scurvy results from a diet deficient in vitamin C and is characterized by substantial new bone apposition on the surfaces of the long bones and/or pathological pitting on the bones of the face (e.g. maxilla, zygomatic bone) and the cranial vault (e.g. frontal, parietal, squamous portion of the temporal, and greater wing of the sphenoid) (Ortner et al. 2001,

Ortner et al. 1999). Rickets results from a diet deficient in vitamin D and is characterized by metaphyseal expansion and cupping of the limb bones, bowing of the leg bones, expansion of the sternal ends of the ribs, and porotic cranial changes (Schultz 2001).

2.6 Long bone metric analysis

Long bone metric analysis was undertaken on the femur using whole (external) bone measurements. Measurements included maximum length, anteroposterior midshaft diameter, mediolateral midshaft diameter, and maximum head diameter. These measurements provide an indication of femoral robusticity, which reflects mechanical demands due to body weight during locomotion, the overall degree of mobility, and

18 subsistence-related activities (Ruff 1987). Adult maximum femur length correlates with height and is often utilized in stature estimation (Jantz 1992, Trotter 1970). Adult stature is highly influenced by environmental factors (e.g. diet and disease), and when used in conjunction with other indicators, it can provide a good measure of the overall level of stress within a population (Huss-Ashmore et al. 1982, Larsen 1997).

CHAPTER 3: RESULTS

Individuals from Khirbat al-Mudayna and the surrounding Wadi ath-Thamad region were examined for skeletal markers of non-specific stress, oral health, trauma, degenerative joint disease (DJD), and specific pathological conditions. Long bone metric analysis based on femoral length and robusticity was also conducted. The demographic profile of this historical Bedouin sample is presented in Table 1. Statistical comparisons were made at the intra-site level based on sex distribution and at the inter-site level based on the degree of integrated subsistence and sex distribution. A sample of Roman-period

(2nd-3rd century CE) pastoral nomads from the QAIA cemetery in Jordan and a sample of

Byzantine-period (5th-6th century CE) agricultural villagers from the site of Rehovot in

Israel (Perry 2002, 2007) were used for inter-site comparisons to place the agropastoralist group from Khirbat al-Mudayna into a larger regional context. The demographic profiles for the two Near Eastern comparative samples are presented in Table 2, and the locations of the QAIA cemetery and Rehovot are illustrated in Figure 3. Inter-site comparisons were conducted using data for non-specific stress markers, degenerative joint disease, and skeletal trauma. The computer package SAS 9.1 was used in performing all statistical analyses presented below. All statistical tests were carried out at the α=0.05 level of significance.

Total sample (N=28) n % Male 8 50.0 Sex Female 6 37.5 Indeterminate 2 12.5 Birth-3.9 years 11 39.3 4-12.9 years 1 3.6 13-19.9 years 2 7.1 Age 20-34.9 years 5 17.9 35-49.9 years 4 14.3 50+ years 2 7.1 Indeterminate adult 3 10.7

Table 1. Age and sex distribution of the Khirbat al-Mudayna historical Bedouin sample.

QAIA pastoral nomads Rehovot agricultural villagers Total sample (N=128) Total sample (N=96) n % n % Male 45 35 32 33 Sex Female 54 42 37 39 Indeterminate 29 23 27 28 Birth-3.9 years 6 5 7 7 4-12.9 years 10 8 14 15 13-19.9 years 8 6 4 4 Age 20-34.9 years 44 34 16 17 35-49.9 years 40 31 38 40 50+ years 10 8 14 15 Indeterminate adult 10 8 3 3

Table 2. Age and sex distributions of the QAIA pastoral nomad and Rehovot agricultural villager samples (from Perry 2007).

Figure 3. Map illustrating the locations of the QAIA cemetery in Jordan and the site of Rehovot in Israel (from Perry 2007).

3.1 Khirbat al-Mudayna: Non-specific stress

Skeletal markers of non-specific stress episodes include cranial porosities (i.e.

cribra orbitalia and porotic hyperostosis), dental enamel hypoplasias, and osteoperiostitis.

At Khirbat al-Mudayna, eight (40.0%) of the 20 individuals with observable cranial

elements displayed cranial porosities. Those individuals with cranial porosities were

further separated into individuals with cribra orbitalia, porotic hyperostosis, or both.

Based on these subgroupings, four (22.2%) of the 18 individuals with at least one

observable eye orbit displayed cribra orbitalia, four (20.0%) of the 20 individuals with at

least one observable parietal bone displayed porotic hyperostosis, and zero individuals

displayed the presence of both. (Table 3, Figure 4). Performing a Fisher’s Exact Test

using cranial porosity data from Khirbat-al Mudayna (Table 4) indicated that no

significant differences existed between males and females at this site for the prevalence

of cribra orbitalia (two-sided p=0.4000) or porotic hyperostosis (two-sided p=0.4545).

Cribra orbitalia Porotic DEHs Osteoperiostitis hyperostosis n/N1 % n/N2 % n/N3 % n/N % Total 4/18 22.0 4/20 20.0 11/14 78.6 9/28 32.1 Adults / Total 1/11 9.1 2/12 16.7 9/11 81.8 8/16 50.0 Adoles. Males 0/6 0.0 2/6 33.3 5/6 83.3 4/8 50.0 Females ¼ 25.0 0/5 0.0 3/4 75.0 3/6 50.0 Subadults 3/7 42.9 2/8 25.0 2/3 66.7 1/12 8.3

Table 3. Intra-site comparisons of non-specific stress indicators at Khirbat al-Mudayna.

1 Number of individuals with at least one observable eye orbit. 2 Number of individuals with at least one observable parietal bone. 3 Number of individuals with at least one observable maxillary/mandibular incisor or canine. 23

Figure 4. Non-specific stress by sex at Khirbat al-Mudayna.

Frequency % Fisher’s Exact Test p-value

Cribra Males 0/6 0.0 Males vs. Females Orbitalia Females 1/4 25.0 p=0.4000 Porotic Males 2/6 33.3 Males vs. Females Hyperostosis Females 0/5 0.0 p=0.4545

Table 4. Results of Fisher’s Exact Test comparisons of cranial porosities by sex at Khirbat al-Mudayna.

Examination of dental enamel hypoplasias (DEHs) at Khirbat al-Mudayna indicated that 11 (78.6%) of the 14 individuals with at least one observable maxillary/mandibular incisor or canine were affected by stressful episodes resulting in

DEH formation (Table 3, Figure 4). A Fisher’s Exact Test using DEH data from Khirbat

al-Mudayna (Table 5) showed that no significant difference existed between males and females at this site for the prevalence of DEHs (two-sided p=1.0000).

Frequency % Fisher’s Exact Test p-value DEH Males 5/6 83.3 Males vs. Females Females 3/4 75.0 p=1.0000

Table 5. Results of Fisher’s Exact Test comparisons of dental enamel hypoplasias at Khirbat al-Mudayna.

Assessment of osteoperiostitis at Khirbat al-Mudayna revealed that 9 (32.1%) of the 28 individuals exhibited periosteal reactions (Table 3, Figure 4). A Fisher’s Exact

Test using osteoperiostitis data (Table 6) showed that no significant difference existed between males and females at Khirbat al-Mudayna for the prevalence of periosteal reactions (two-sided p=1.0000).

Frequency % Fisher’s Exact Test p-value Osteoperiostitis Males 4/8 50.0 Males vs. Females Females 3/6 50.0 p=1.0000

Table 6. Results of Fisher’s Exact Test comparisons of osteoperiostitis at Khirbat al- Mudayna.

Analysis of non-specific stress indicators at Khirbat al-Mudayna indicated that individuals at this site suffered from moderate to high levels of stress. It is possible that 25

these levels stemmed from broad, systemic conditions, which would be demonstrated by

the association of multiple non-specific stress markers to one another. Tetrachoric

correlation was used to calculate the association of stress indicators in this historical

Bedouin sample (Table 7). The correlation between porotic hyperostosis and

osteoperiostitis was found to be positive (0.6505), while all other correlations between

non-specific stress markers were negative. Of the six tetrachoric correlation values, only

the correlation between porotic hyperostosis and osteoperiostitis reached significance

(p=0.0312).

Cribra Por. Hyperos. DEHs Osteoperiostitis Orbitalia Cribra Tetrachor. Orbitalia corr. p-value Por. Hyperos. Tetrachor. -0.0627 corr. p-value 0.8888 DEHs Tetrachor. -0.1397 -0.2749 corr. p-value 0.7770 0.5822 Osteoperiostitis Tetrachor. -0.5105 0.6505 -0.3052 corr. p-value 0.1385 0.0320 0.5035

Table 7. Tetrachoric correlation between all non-specific stress indicators at Khirbat al- Mudayna.

3.2 Khirbat al-Mudayna: Oral health

Indicators of oral health include carious lesions, abscesses, and AMTL. Of the 28 individuals in the sample under study, 14 (50%) had dental material (erupted permanent

26 teeth/alveoli) available for analysis. Of 279 observable permanent teeth, 4.3% displayed carious lesions (Table 8). In terms of the 405 observable alveoli, 1.7% were affected by abscesses, and 10.4% showed evidence of AMTL (Table 8). The rates of carious lesions, abscesses, and AMTL for males and females are displayed graphically in Figure 5.

Dental caries Abscesses Antemortem Tooth Loss n/N4 % n/N5 % n/N6 % Total 12/279 4.3 7/405 1.7 42/405 10.4 Adults / Total 12/269 4.5 7/395 1.8 42/395 10.6 Adoles. Males 8/180 4.4 4/212 1.9 13/212 6.1 Females 4/71 5.6 3/154 1.9 29/154 18.8 Subadults 0/10 0.0 0/10 0.0 0/10 0.0

Table 8. Intra-site comparisons of oral health indicators at Khirbat al-Mudayna.

4 Number of erupted permanent teeth. 5 Number of erupted permanent tooth positions (alveoli). 6 Number of erupted permanent tooth positions (alveoli). 27

Figure 5. Oral health indicators by sex at Khirbat al-Mudayna.

The differences in rates of dental caries, abscesses, and AMTL between males and females at Khirbat al-Mudayna were tested for statistical significance through a Fisher’s

Exact Test. No significant differences existed between males and females at this site for the prevalence of dental caries (two-sided p=0.7449, Table 9) or abscesses (two-sided p=1.0000, Table 10). However, a Fisher’s Exact Test using AMTL data revealed that females displayed a significantly higher rate of tooth loss than males (two-sided p=0.0002, Table 11).

Frequency % Fisher’s Exact Test p-value Dental caries Males 8/180 4.4 Males vs. Females Females 4/71 5.6 p=0.7449

Table 9. Results of Fisher’s Exact Test comparisons of dental caries at Khirbat al- Mudayna.

Frequency % Fisher’s Exact Test p-value Abscesses Males 4/212 1.9 Males vs. Females Females 3/154 1.9 p=1.0000

Table 10. Results of Fisher’s Exact Test comparisons of abscesses at Khirbat al- Mudayna.

Frequency % Fisher’s Exact Test p-value Antemortem Males 13/212 6.1 Males vs. Females Tooth Loss Females 29/154 18.8 p=0.0002

Table 11. Results of Fisher’s Exact Test comparisons of AMTL at Khirbat al-Mudayna.

3.3 Khirbat al-Mudayna: Trauma

Of the 28 individuals analyzed in this study, ten (35.7%) displayed evidence of

skeletal trauma. Trauma in this sample was limited to adolescents and adults, and the

overall trauma rate increased to 62.5% when only the 16 adolescent/adult individuals

were considered. The prevalence of trauma in the Khirbat al-Mudayna sample was

further quantified based on the percentage of skeletal elements displaying evidence of

traumatic injury between the sexes (Table 12) and overall trauma frequency based on the 29 total number of skeletal elements in the sample (Table 13). Of the ten individuals affected by trauma, six (60.0%) displayed such evidence on multiple skeletal elements.

One adult female (aged 45-55 years) exhibited evidence of traumatic injury on 11 separate skeletal elements. As the next highest occurrence of trauma within a single individual was the presence of injuries on three separate skeletal elements, this adult female (MT N63:12) was considered to be an outlier and excluded from further statistical analysis. Performing a Fisher’s Exact Test based on the total number of skeletal elements present at Khirbat al-Mudayna (Table 14) indicated that no significant difference existed between males and females at this site for the prevalence of traumatic injury (two-sided p=0.3802).

Males n/N % Females n/N % Craniofacial 1/144 0.69 Craniofacial 2/100 2.0 Scapula 0/14 0 Scapula 2/8 25.00 Clavicle 0/14 0 Clavicle 2/9 22.22 Humerus 0/12 0 Humerus 0/7 0 Radius 1/13 7.69 Radius 0/10 0 Ulna 0/14 0 Ulna 0/9 0 Wrist/Hand 0/276 0 Wrist/Hand 0/95 0 Os Coxa 1/15 6.67 Os Coxa 0/9 0 Femur 0/16 0 Femur 1/7 14.29 Patella 0/12 0 Patella 0/4 0 Tibia 0/15 0 Tibia 1/8 12.50 Fibula 1/15 6.67 Fibula 1/8 12.50 Ankle/Foot 1/218 0.46 Ankle/Foot 0/39 0 Sternum 0/7 0 Sternum 0/1 0 Ribs 3/151 1.99 Ribs 7/90 7.78 Vertebrae 2/176 1.14 Vertebrae 0/39 0 Total 10/1112 0.90 Total 16/443 3.71

Table 12. Rates of trauma by skeletal element based on sex at Khirbat al-Mudayna. 30

Trauma rate by skeletal element Trauma rate by skeletal element (including MT N63:12) (excluding MT N63:12) n/N % n/N % Total 27/1705 1.58 16/1619 0.99 Males 10/1112 0.90 10/1112 0.90 Females 16/443 3.61 5/359 1.39

Table 13. Trauma frequency based on total number of skeletal elements at Khirbat al- Mudayna.

Frequency % Fisher’s Exact Test p-value Trauma by Males 10/1110 0.90 Males vs. Females element Females 5/359 1.39 p=0.3802

Table 14. Results of Fisher’s Exact Test comparisons of trauma at Khirbat al-Mudayna.

3.4 Khirbat al-Mudayna: Degenerative joint disease

A moderate to high prevalence of DJD was found in the historical Bedouin

sample from Khirbat al-Mudayna, with 54.5% of 167 observable joint groups displaying

signs of osteoarthritis. For the intra-site analysis, DJD was evaluated based on

differences observed between joint groups as well as differences observed between the sexes (Table 15). The proportion of DJD by joint for the entire sample is represented graphically in Figure 6, while the proportion of DJD based on sex is illustrated in Figure

Males n/N % Females n/N % TMJ 1/7 14.3 TMJ 1/4 25.0 Shoulder 5/14 35.7 Shoulder 4/7 57.1 Elbow 10/14 71.4 Elbow 0/4 0.0 Hip 14/16 87.5 Hip 6/7 85.7 Knee 13/16 81.3 Knee 2/4 50.0 Wrist/Hand 7/14 50.0 Wrist/Hand 2/8 25.0 Ankle/Foot 9/16 56.3 Ankle/Foot 1/5 20.0 Cervical 3/7 42.9 Cervical 1/3 33.3 Thoracic 4/7 57.1 Thoracic 1/3 33.3 Lumbar 3/7 42.9 Lumbar 0/0 . Total 69/118 58.5 Total 18/45 40.0

Table 15. Degenerative joint disease by sex at the site of Khirbat al-Mudayna.

Figure 6. The proportion of joints affected by DJD for each joint group at Khirbat al- Mudayna.

Figure 7. The proportion of joints affected by DJD for each joint group based on sex at Khirbat al-Mudayna (Males – solid, Females – cross-hatched).

Aside from the lack of evidence for DJD in the elbow joint of females, likely due to small sample size, the distributions of DJD between the sexes at Khirbat al-Mudayna were roughly similar. Two-way ANOVA without replication was used to quantify the

variation seen in DJD prevalence in the Khirbat al-Mudayna sample based on two factors,

sex and joint group. The data used in the two-way ANOVA were the proportions of joints affected by DJD for each joint group between males and females. Percentage data have an absolute minimum of 0% and an absolute maximum of 100%. Any distribution of proportions with a mean close to either of these extremes (0-30% or 70-100%) is

unlikely to have a normal distribution due to these absolute limits (McKillup 2005, Sokal and Rohlf 1995). A substantial number of the proportions within the present data set fell between 0-30% and 70-100%. Therefore, the arcsine transformation was used to convert the percentages into radians in an effort to give the data sets for each of the joint group a more normal shape than if the data had been left in the form of proportions. The statistical analysis revealed no significant difference in the prevalence of DJD between males and females (F=3.20, two-sided p=0.1116) or between the different joint groups

(F=1.42, two-sided p=0.3169).

3.5 Khirbat al-Mudayna: Specific pathological conditions

Two (7.1%) of the 28 individuals under study displayed skeletal markers of

specific pathological conditions, and the observed markers were indicative of

tuberculosis in both instances. An adult female (aged 18-30 years) exhibited resorptive lesions on the pleural surface of seven ribs. Additionally, an adult male (aged 28-40 years) displayed erosive lesions on the pleural surface of ten ribs, as well as on the fourth and fifth lumbar vertebrae. No evidence for other specific conditions such as treponematosis, leprosy, diffuse idiopathic skeletal hyperostosis (DISH), scurvy, or

rickets was observed in the Khirbat al-Mudayna skeletal sample.

3.6 Khirbat al-Mudayna: Long bone metrics

Metric analysis was undertaken on all adult individuals for whom an intact femur was available for measurement (n=10). Maximum femoral length was assessed, and

34 stature was estimated using the regression formulae of Trotter (1970) for males and the modified regression formulae of Jantz (1992) for females. In the Khirbat al-Mudayna sample, the mean adult stature was calculated to be 164.37 +/- 5.97 cm based on measurements from eight males and two females.

Femoral midshaft index, which is calculated by dividing the anteroposterior external midshaft diameter (Dap) by the mediolateral external midshaft diameter (Dml), was used to assess the mechanical demands associated with subsistence-related activities and the overall degree of mobility in males and females at Khirbat al-Mudayna (Ruff

1987). Increasing values above 1.0 indicate greater relative anteroposterior strength and thus a greater degree of mechanical stress and mobility. The mean Dap/Dml value for this historical Bedouin sample was 1.06. Femoral midshaft index was further analyzed on the basis of sex with males exhibiting a mean index of 1.10 and females displaying a mean index of 0.99. A two-tailed Monte Carlo test was used to test whether this difference in mobility index between males and females was statistically significant. The Monte Carlo analysis revealed that this difference between the sexes approached statistical significance (two-sided p=0.0593) with males displaying a higher degree of mechanical stress and overall mobility than females.

3.7 Inter-site comparisions: Non-specific stress

The purpose of inter-site comparisons between the QAIA pastoral nomad group, the Khirbat al-Mudayna integrated subsistence group, and the Rehovot sedentary agriculturalist group was to assess the possible adverse health and quality of life effects

associated with each of the varying degrees of subsistence integration found in these

three groups. The demographic profile of the historical Bedouin sample from Khirbat al-

Mudayna can be found in Table 1, while detailed descriptions of the two comparative samples can be found in Perry (2002, 2007). Two-way analysis of variance (ANOVA) without replication was used in the present analysis to quantify the variation seen between these three groups based on two factors, subsistence pattern and sex. As the data used in the two-way ANOVA were the proportions of occurrence for each non-specific stress marker in males and females in each of the three Near Eastern samples, the arcsine transformation was again employed.

The rates of non-specific stress indicators in the Khirbat al-Mudayna sample is presented above in Table 3, while the rates of non-specific stress indicators for the QAIA nomads and Rehovot agriculturalists are presented in Table 16. For the inter-site comparisons, data regarding cribra orbitalia and porotic hyperostosis have been combined into one group, cranial porosities. The proportion of individuals displaying evidence of cranial porosities by sex for each of the three Near Eastern samples is represented graphically in Figure 8. Two-way ANOVA revealed no significant difference in the prevalence of cranial porosities between males and females (F=0.35, two-sided p=0.6135) or between the three integrated subsistence groups (F=0.24, two-sided p=0.8086).

Cranial Porosities7 DEH8 Osteoperiostitis QAIA Rehovot QAIA Rehovot QAIA Rehovot n/N % n/N % n/N % n/N % n/N % n/N % Total 6/25 24 16/73 22 1/8 14 35/51 68 17/128 13 14/96 15 Total 5/22 23 4/47 9 1/6 20 26/36 72 16/107 15 13/71 18 Adult Male 0/14 0 2/21 10 1/1 100 11/14 79 9/45 20 6/32 19 Female 4/7 57 1/25 4 0/4 0 14/21 67 7/54 13 7/37 19 Subadult 1/3 33 12/22 55 0/2 0 6/11 55 1/18 6 1/25 4

Table 16. Rates of non-specific stress indicators in the QAIA and Rehovot comparative samples (from Perry 2007).

Figure 8. Cranial porosities by sex in three Near Eastern integrated subsistence groups.

The proportion of individuals exhibiting dental enamel hypoplasias for the QAIA,

Khirbat al-Mudayna, and Rehovot samples is depicted in Figure 9. Two-way ANOVA

7 Number of individuals with observable cranial elements in each sample (Perry 2007). 8 Number of individuals with an observable central maxillary incisor or mandibular canine (Perry 2007). 37 demonstrated that the difference in DEH prevalence between these three groups fails to reach statistical significance (F=0.15, two-sided p=0.8686). In addition, no significant difference in the prevalence of DEHs existed between males and females in these three groups (F=1.54, two-sided p=0.3402).

Figure 9. Dental enamel hypoplasias by sex in three Near Eastern integrated subsistence groups.

The proportion of individuals exhibiting osteoperiostitis on at least one skeletal element for the QAIA, Khirbat al-Mudayna, and Rehovot samples is shown in Figure 10.

The graph shows that both males and females at Khirbat al-Mudayna display elevated levels of periosteal reactions in relation to the two comparative samples. Two-way

ANOVA showed that the prevalence of osteoperiostitis differs significantly between the three integrated subsistence groups (F=55.49, two-sided p=0.0177). A Tukey a posteriori test revealed that the Khirbat al-Mudayna sample forms a Tukey grouping, while the QAIA and Rehovot samples form a single Tukey grouping, indicating a significantly higher prevalence of osteoperiostitis in the historical Bedouin group in relation to the two comparative samples.

Figure 10. Osteoperiostitis by sex in three Near Eastern integrated subsistence groups. 39

3.8 Inter-site comparisons: Degenerative joint disease

The pastoral nomad sample from the QAIA cemetery in Jordan and the agricultural village sample from Rehovot in Israel were used in the inter-site comparisons regarding DJD prevalence in three Near Eastern groups. The distributions of DJD by joint for the QAIA and Rehovot samples are presented in Table 17, while more detailed descriptions of the occurrence of DJD in these two samples can be found in Perry (2002).

The purpose of the inter-site comparison was to evaluate differences in DJD prevalence in males and females between the three integrated subsistence groups. Two-way

ANOVA without replication was used to quantify the variation seen in DJD prevalence in the three Near Eastern samples based on two factors, integrated subsistence group and sex (Figure 11). This graphical representation shows a lower prevalence of DJD in the

QAIA pastoral nomad group compared to the Khirbat al-Mudayna and Rehovot groups.

The arcsine transformation was again employed as the data used in the two-way ANOVA were the proportion of joints affected by DJD for males and females between the three subsistence groups. Two-way ANOVA without replication showed that, although males displayed a higher occurrence of DJD than females in all three samples, this difference failed to reach statistical significance (F=9.88, two-sided p=0.0880). However, a significant difference was observed between the three subsistence groups (F=20.98, two- sided p=0.0455). A Tukey a posteriori test revealed that the Khirbat al-Mudayna and

Rehovot samples formed a group, and the QAIA and Rehovot samples also formed a group. Therefore, only the Khirbat al-Mudayna and QAIA samples exhibited a significant difference regarding the prevalence of DJD.

QAIA Rehovot Males Females Males Females N % N % N % N % All 503 23 649 19 1045 46 1315 33 Shoulder 31 6 35 6 53 64 68 51 Elbow 32 19 41 15 56 66 68 44 Wrist 41 15 13 23 56 50 69 36 Hand 31 10 23 9 55 13 68 9 Hip 37 5 44 7 56 30 71 17 Knee 29 10 31 6 59 59 65 57 Ankle 20 0 28 0 53 40 64 28 Foot 15 0 21 5 51 20 66 11 Cervical 69 36 248 5 157 32 228 17 Thoracic 160 35 135 48 304 47 382 33 Lumbar 73 38 79 34 145 68 166 58

Table 17. DJD by joint based on sex for the QAIA and Rehovot groups (from Perry 2002).

Figure 11. The proportion of joints affected by DJD based on sex in three Near Eastern groups.

3.9 Inter-site comparisons: Trauma

Inter-site comparisons regarding the prevalence of skeletal trauma again utilized

the pastoral nomad sample from the QAIA cemetery in Jordan and the agricultural village

sample from Rehovot in Israel as comparative samples. Detailed descriptions of the

occurrence of trauma in these two samples can be found in Perry (2002, 2007). A

Fisher’s Exact Test was performed to test whether a significant difference in total trauma

rate, based on the percentage of skeletal elements affected, existed between the Khirbat

al-Mudayna sample and either of the two comparative samples. The test revealed that no significant difference in overall rates of skeletal trauma existed between the Khirbat al-

Mudayna sample and the pastoral nomad sample from the QAIA cemetery (two-sided p=0.8790, Table 18). However, performing a Fisher’s Exact Test using data from the historical Bedouin sample of Khirbat al-Mudayna and the agricultural village sample from Rehovot showed that these two samples exhibited a significant difference in rates of skeletal trauma (two-sided p=0.0336, Table 18).

Frequency % Fisher’s Exact Test p-value

Trauma by Khirbat al- 16/1619 0.99 Khirbat al-Mudayna vs. QAIA element Mudayna p=0.8790 QAIA9 33/3450 0.96 Khirbat al- 16/1619 0.99 Khirbat al-Mudayna vs. Rehovot Mudayna p=0.0336 Rehovot10 41/7860 0.52

Table 18. Results of Fisher’s Exact Test comparisons of trauma rates in three Near Eastern groups.

9 Perry (2002, 2007). 10 Perry (2002, 2007). 42

CHAPTER 4: DISCUSSION

An analysis of skeletal markers of diet, nutrition, and physical activity in an

historical Jordanian Bedouin sample revealed evidence of substantial adverse health effects and diminished quality of life. As hypothesized, the profile of skeletal pathology in this sample showed an assortment of conditions, reflective of both the pastoral and agricultural components on an integrated subsistence strategy, though delineating the

conditions resulting primarily from the pastoral component, and those present as a result

of the agricultural component, becomes exceedingly difficult. Rather than making this

distinction, it is most practical to characterize this Bedouin sample as an agropastoralist group, in which the whole suite of pathological conditions may be greater than the sum of

its parts.

4.1 Khirbat al-Mudayna: Non-specific stress

An examination of non-specific stress indicators in an historical Bedouin sample

from Khirbat al-Mudayna indicated that individuals at this site suffered from moderate to

high levels of stress, likely associated with multiple factors such as nutritional deficiency,

infectious disease, and associated temporal events. Levels of non-specific stress were

similar between males and females suggesting that neither sex was at a substantial

disadvantage in terms of living conditions and access to resources. Any sexual division

of labor or social stratification patterns within this historical Bedouin group did not lead

to sizeable health differences between males and females in terms of non-specific stress.

Non-specific stress markers were also analyzed for co-occurrence in the Khirbat al-

Mudayna sample, as researchers believe that the presence of multiple stress indicators

within an individual signifies the existence of broad, systemic stress associated with

disease, malnutrition, and other deleterious conditions (Goodman et al. 1984, Huss-

Ashmore et al. 1982, Perry 2002). A significant correlation (Tetrachoric correlation=0.6505, two-sided p=0.0320) existed between porotic hyperostosis and

osteoperiostitis in the Khirbat al-Mudayna sample. Therefore, individuals displaying

non-specific stress markers at this site were probably affected by multiple deleterious

conditions during their lifetimes.

4.2 Khirbat al-Mudayna: Oral health

The Khirbat al-Mudayna historical Bedouin group displayed a 4.3% rate of

carious lesions, which is characteristic of groups practicing a mixed subsistence strategy

(Turner 1979). Males and females at Khirbat al-Mudayna showed similar rates of dental

caries and abscesses, based on teeth/alveoli present for analysis. However, females

displayed a significantly higher rate of AMTL than did males (two-sided p=0.0002),

which calls for an investigation of the possible underlying causes of tooth loss in females.

Attrition-induced and caries-induced pulp exposure are two major factors that can

contribute to AMTL (Lukacs 1995). The mean value of attrition did not differ

significantly between males (3.29) and females (3.52) as revealed by a Monte Carlo

analysis (two-sided p=0.6313). Therefore, it becomes increasingly likely that the higher rate of AMTL in females is the result of a dental caries, with many carious teeth no longer observable due to exfoliation during the individual’s lifetime.

The increased rate of AMTL in Bedouin females and the likelihood that such tooth loss is due in large part to dental caries provide insight into the practices of daily life associated with food preparation in Bedouin society and their role in the development of dental pathologies. Bedouin society is characterized by a marked sexual division of labor, in which females are responsible for the preparation of meals with cereals (e.g. wheat and barley) often providing the staple ingredient (Coon 1958, Hobbs 1989, Musil

1928, Palmer 2002). Therefore, cariogenic foods were more readily available for

consumption among Bedouin women, which may explain the significantly higher rate of

AMTL among females in this sample. Similar results regarding dental caries have been observed in other geographical regions and largely attributed to a sexual division of labor

(Larsen et al. 1991, Lukacs 1996).

4.3 Khirbat al-Mudayna: Trauma

Skeletal trauma was present in the form of partially and completely healed cranial and post-cranial fractures in this historical Bedouin sample. The distribution of skeletal trauma in the form of depressed cranial fractures as well as various post-cranial fractures provides an indication that intentional injury (i.e. interpersonal violence) and accidental injury both played a role in generating the trauma patterns seen in this sample. Ten

adolescent/adult individuals displayed the occurrence of skeletal trauma, and of this

demographic grouping, four individuals (40.0%) showed evidence of depressed cranial fractures. Larsen (1997) states that physical confrontation and interpersonal violence are

universally present in all human societies at one point or another, and the presence of

cranial fractures in this sample indicates that Bedouin are by no means an exception to

this rule, though whether the source of these injuries came from within the society or

between different groups cannot be determined. Despite the mutual benefits received by nomads and settled villagers through trade relations, interactions between these groups always keep open the possibility for hostility and conflict (Hobbs 1989). Furthermore, in

his study of the Rwala Bedouin, Musil (1928) attested to the nearly constant raiding and warfare occurring between different tribal groups.

The majority of the post-cranial fractures seen in the Khirbat al-Mudayna sample were found in the ribs. Trauma was also observed in the scapula, clavicle, radius,

vertebrae, os coxa, femur, tibia, fibula, and the bones of the foot. The occurrence of post-

cranial fractures in this sample reflects the hazards associated with day-to-day living,

particularly movement over the rocky, rugged terrain in this part of Jordan and

mechanical demands associated with physical activity (i.e. vertebral compression

fractures).

4.4 Khirbat al-Mudayna: Degenerative joint disease

An analysis of DJD within the historical Bedouin group from Khirbat al-Mudayna

showed no significant difference in DJD prevalence between males and females. As

46 previously noted, a sexual division of labor generally exists within Bedouin society, with women tending crops and keeping small animals near the camp settlements and men traveling away from the camps to pasture their herds (Hobbs 1989). Although males and females at the site of Khirbat al-Mudayna may have been engaging in different labor activities, the relatively high prevalence of DJD in males and females and the roughly similar patterns of DJD on a joint-by-joint basis indicate that both sexes were subject to a heavy workload and physically-demanding lifestyle.

4.5 Khirbat al-Mudayna: Specific pathological conditions

Evidence of tuberculosis, in the form of erosive lesions on the pleural surfaces of the ribs and on vertebral bodies, was present on two (7.1%) of the 28 individuals analyzed. No skeletal evidence for the presence of other specific pathological conditions was noted in this Bedouin group. The low prevalence of specific pathological conditions may be due to a combination of factors such as small sample size or death of affected individuals before skeletal manifestations of a disease process could occur (Wood et al.

1992). It is also possible that the low prevalence of specific conditions associated with nutritional deficiency and infection are absent because these factors did not play a major role in influencing overall health and quality of life within this sample. However, the high percentage of subadults/adolescents (14/28, 50%) within this sample and the high rates of indicators of stress and infection, such as cranial porosities (40%), dental enamel hypoplasias (78.6%) and osteoperiostitis (32.1%) provide strong evidence that this was not the case.

4.6 Khirbat al-Mudayna: Long bone metrics

Metric analysis of the femur in Bedouin individuals from Khirbat al-Mudayna indicated that the mean adult stature in this sample was 164.37 +/- 5.97 cm. This stature calculation is similar to estimated values of stature in two historical Bedouin samples excavated in the Israeli Negev (Goldstein et al. 1976). The mean femoral midshaft index for the Khirbat al-Mudayna sample was 1.06, a value similar to that of a modern Bedouin sample (1.10) reported by Hershkovitz et al. (1993). Comparing the mean Dap/Dml for the entire Khirbat al-Mudayna sample with the mean Dap/Dml of various hunter-gatherer and

agriculturalist groups places the historical Bedouin sample closer to agriculturalists than to foragers (Ruff 1987). This result is surprising given the degree of movement in

Bedouin groups, and it suggests that agriculture may have played a greater role in the overall subsistence economy of this sample compared to pastoralism. Males (1.10) displayed a higher femoral midshaft index than did females (0.99), and this difference neared statistical significance (two-sided p=0.0593). Such a difference likely reflects varying mechanical demands based on a combination of larger stature in males compared to females and distinctive mobility patterns developing from a sexual division of labor, with Bedouin females generally remaining near the camp settlements and males traveling far from the camps to pasture their herds (Hobbs 1989).

4.7 Inter-site comparisons: Non-specific stress

In terms of inter-site comparisons of non-specific stress, the prevalence of cranial

porosities and dental enamel hypoplasias did not differ significantly between the three

Near Eastern integrated subsistence groups. However, the prevalence of osteoperiostitis

was significantly greater (two-sided p<0.0001) in the Khirbat al-Mudayna sample compared to the QAIA pastoral nomad group and the Rehovot agricultural village sample. Seven of the nine individuals exhibiting osteoperiostitis at Khirbat al-Mudayna

displayed periosteal reactions on multiple skeletal elements, indicating the presence of widespread or systemic infection (Larsen 1997). The high rate of infectious disease at

this site suggests a physical and social environment conducive to the spread of disease,

such as constant interaction with livestock and exposure to zoonotic pathogens, as well as

close living conditions within agricultural villages or when a nomadic community is

camped rather than migrating at any given time.

4.8 Inter-site comparisons: Degenerative joint disease

An inter-site comparison of the prevalence of DJD revealed a significant

difference between the Khirbat al-Mudayna and QAIA pastoral nomad samples. The

lower prevalence of DJD in the QAIA group was surprising because of the high degree of

mobility associated with pastoral subsistence. The difference in DJD prevalence between

this historical Bedouin sample and the QAIA pastoral nomads indicates that sedentary

agriculture played a considerable role in the subsistence economy of the Khirbat al-

Mudayna group and was a physically-demanding endeavor. Furthermore, these results

suggest that the coupling of a sizeable degree of mobility associated with pastoralism and

a heavy workload associated with agriculture in integrated subsistence groups contributes

to a lifestyle that is substantially more physically-demanding than that associated with

pastoral nomadism alone.

4.9 Inter-site comparisons: Trauma

The overall trauma rate in the Khirbat al-Mudayna sample, based on all skeletal

elements present for analysis, was 0.99%. No significant difference existed between this

historical Bedouin sample and the QAIA pastoral nomad sample (two-sided p=0.8790),

while the Khirbat al-Mudayna group and the sedentary agriculturalists of Rehovot did

exhibit a significant difference in overall trauma rate (two-sided p=0.0336). On the

surface, this may suggest that trauma in the historical Bedouin sample is more similar to

patterns seen in the QAIA pastoralists than to the Rehovot agriculturalists. However,

Perry (2002, 2007) notes only a minor contribution of violent trauma in the QAIA sample

compared to that seen at Khirbat al-Mudayna. The patterns of accidental injury may be

similar between the historical Bedouin group and the QAIA nomads, but the difference seen in the proportion of violent trauma illustrates that subsistence is only one of many factors (e.g. temporal events, within/between group interactions) that can result in

skeletal trauma. Thus, while it is essential to take a comparative approach to patterns of skeletal trauma observed in different societies, it is equally important to consider trauma on a site-by-site and group-by-group basis.

CHAPTER 5: CONCLUSION

The present study illustrates the complex nature of the relationship between subsistence pattern, dietary quality, and health, as inferred through analysis of skeletal pathology. Individuals in an historical Bedouin sample from the site of Khirbat al-

Mudayna and the surrounding Wadi ath-Thamad region of Jordan displayed an assortment of pathological conditions, reflecting the combined influences of pastoralism and agriculture. As analysis of skeletal pathology is undertaken in agropastoralist groups such as this Bedouin sample, the difficulty in distinguishing the health effects primarily attributable to the pastoral component and those primarily attributable to the agricultural component becomes evident. Instead of viewing the sample in light of these two distinct but related subsistence components, it is more reasonable to consider the entire suite of pathological conditions present in agropastoralist groups in terms of the total subsistence strategy resulting from the interaction of pastoral and agricultural modes of production.

The agropastoralist Bedouin sample from Khirbat al-Mudayna displayed moderate to high levels of non-specific stress, and the co-occurrence of multiple stress markers indicated that individuals suffered from broad, systemic stress associated with disease and malnutrition. Non-specific stress markers at Khirbat al-Mudayna were found to have a similar prevalence in males and females suggesting that the sexual division of labor in Bedouin society did not adversely affect one group more than another in terms of 51

stress. Comparing the historical Bedouin sample to a group of pastoral nomads and a

group of sedentary agriculturalists showed similar rates of stress markers associated with nutritional deficiency (i.e. cranial porosities and dental enamel hypoplasias). This result

supports the hypothesis that mutual dependence between pastoralist, agropastoralist, and

agriculturalist groups in the Near East leads to similar dietary patterns, and these dietary

similarities, as inferred from nutritional stress, are reflected pathologically in these

groups. While the degree of nutritional stress in these three groups seems alike, the

prevalence of non-specific infection, based on rates of osteoperiostitis is higher in the

agropastoralist group compared to the other two samples. Such a result suggests that the

physical and social environment associated with agropastoralism may be especially

conducive to the spread of disease.

Similar levels of degenerative joint disease between males and females at Khirbat

al-Mudayna again indicated that a sexual division of labor did not adversely affect one

group more than another in terms of overall workload. The high prevalence of DJD in

Bedouin males and females suggests that men and women alike were engaging in

physically demanding activities. Compared to the pastoral nomad and sedentary

agriculturalist groups, the Khirbat al-Mudayna sample displays higher levels of DJD,

providing evidence that the integration of pastoralism and agricultural into a single

subsistence strategy contributes to a lifestyle that is more physically demanding that a

subsistence pattern focusing on a single mode of production.

Trauma patterns at Khirbat al-Mudayna point to significant contributions of

intentional and accidental injuries, in males and females alike. This contrasts with the

52 two comparative samples in that violent injury in these groups is noted to contribute only minimally to overall trauma patterns. The increased role of violent trauma in the Khirbat al-Mudayna sample must be attributed to group- and site-specific factors, and any attempt to interpret violent trauma as a function of a particular subsistence strategy is highly speculative if not impossible.

By situating an historical Bedouin sample from Khirbat al-Mudayna into a larger regional context, the present study supports the hypothesis that diet is a minimal factor in defining health differences between integrated subsistence groups. Although a mosaic pattern, or assortment, of pathological conditions is noted in this Bedouin group, hypotheses regarding the delineation of conditions associated with pastoralism and those associated with agriculture are more difficult to address. It seems advisable to direct research questions associated with subsistence pattern, dietary quality, and health in a manner that is concerned with the total subsistence strategy of a group, rather than attempting to assign health differences within a society to any single mode of production.

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APPENDIX A

LIST OF KHIRBAT AL-MUDAYNA AND WADI ATH-THAMAD BURIALS

Global History of Sex Age Preservation12 Notes13 Health Project ID11

00836_1220455114593_ Indeterminate 1 – 2 years Fair 1128_MT A16:10 00836_1220465200906_ Indeterminate 0.5 – 1 years Fair PH 1128_MT N64:21 00836_1220470433531_ Female 22 – 32 years Fair DEH, PER, AMTL, 1128_MT N64:20 Trauma (Right femur fracture, Right tibia amputation, Right fibula amputation) 00836_1220532599828_ Male 30 – 39 years Poor 1128_MT N64:20b 00836_1220536503187_ Indeterminate 0.5 – 1 years Poor 1128_MT B31:L3 00836_1220541535843_ Indeterminate 1.33 – 2.67 years Good CO 1128_MT N54:8 00836_1220547674593_ Female 12 – 18 years Poor DEH, PER 1128_MT N74:17 00836_1220557630656_ Indeterminate 12 – 18 years Good DEH, Trauma 1128_MT L13:25 (Depressed cranial vault fracture) 00836_1220624652875_ Female 45 – 55 years Fair PER, AMTL, Trauma 1128_MT N63:12 (Two depressed cranial vault fractures, Right scapula fracture, Left scapula fracture, Left clavicle fracture, Seven rib fractures) 00836_1220635691531_ Indeterminate 2 – 4 years Poor CO, DEH 1128_MT N42:12 00836_1220709562140_ Female 18 – 30 years Good CO, DEH, CAR, ABS, 1128_MT L33:36 AMTL, Trauma (Depressed cranial vault fracture), Tuberculosis 00836_1220719818000_ Male 45 – 55 years Excellent DEH, ABS, AMTL, 1128_MT T92:8 Trauma (Depressed cranial vault fracture, Left ilium fracture) 00836_1220729671453_ Indeterminate Indeterminate Poor PER 1128_MT B31:3

11 Abbreviated Burial ID is highlighted in bold print. 12 Excellent – more than 75% of all skeletal elements present for analysis, Good – 50-75% of all skeletal elements present for analysis, Fair – 25-50% of all skeletal elements present for analysis, Poor – less than 25% of all skeletal elements present for analysis. 13 CO – cribra orbitalia, PH – porotic hyperostosis, DEH – enamel hypoplasia, PER – osteoperiostitis, CAR – dental caries, ABS – dental abscess, AMTL – antemortem tooth loss. 60

00836_1220733924078_ Female Indeterminate Poor 1128_MT G9:6 00836_1220738368390_ Indeterminate 0.25 – 0.75 years Poor 1128_MT G9:4 00836_1220792919968_ Indeterminate Indeterminate Poor 1128_MT G9:11 00836_1220793878578_ Male 18 – 26 years Excellent DEH, PER 1128_MT E99:27 00836_1220878308828_ Male 25 – 35 years Good PH, DEH, PER, CAR, 1128_WT 140:3 AMTL, Trauma (Rib fracture, proximal foot phalanx fracture) 00836_1220889003468_ Male 35 – 50 years Good PER, ABS, AMTL, 1128_WT 112:B19 Trauma (Left radius fracture, T11 vertebra fracture) 00836_1220897671734_ Indeterminate 0.5 – 1 years Poor 1128_WT 112:B13 00836_1220900577734_ Female Indeterminate Poor CAR, ABS, AMTL, 1128_WT 112:B16 Trauma (Left clavicle fracture) 00836_1220906602578_ Male 30 – 40 years Excellent DEH, CAR 1128_WT 112:B1:39 00836_1220965407515_ Indeterminate 7 – 11 years Excellent PH, DEH, PER 1128_MT U29:14 00836_1220976413296_ Indeterminate 0.5 – 1 years Fair 1128_WT 112:B2:19 00836_1220985250968_ Male 30 – 40 years Excellent DEH, Trauma (Right 1128_MT U29:20 fibula fracture, T11 vertebra fracture) 00836_1220996014375_ Indeterminate 0.67 – 1.33 years Good CO 1128_MT B2:9 00836_1221052737000_ Indeterminate 0.67 – 1.33 years Good 1128_WT 61A 00836_1221059586875_ Male 28 – 40 years Excellent PH, PER, Trauma (Rib 1128_MT N43:27 fracture), Tuberculosis