Between 1900-1960 in the United States accidents increased in frequency as cause of death from seventh to fourth place (Table I.1). Much of this increase paralleled technological advancements that were taking place during this interval. In the Aberdeen area Indian Health Service Chart Book for June 1985 accidental death for regional Native Americans (171.8/100,000) was second only to heart diseases (208.1/100,000). Just less than half the American Indian accidental deaths were motor vehicle related.
For some time prior to 1900 fatal and disabling accidents from natural or human mediated causes were quite well documented for the immigrant population in the Upper Missouri River Basin territory. Unfortunately, little demographic information exists relating to the frequency, severity, and sequellae of traumatic episodes in the regional aborigines.
Deaths caused by injuries are usually from soft tissue damage. Bone injury alone infrequently is fatal, so it is uncommon to find the proximate cause of death in skeletons. If an injury involving the skeleton is survived, structural and/or functional alterations that follow usually leave at least some indellible imprint upon it, identifiable on gross examination or with radiographs. Osseous modification remaining may represent one or more violent episodes during an individual's life. In many instances the general type of injury, the circumstances, and the length of time elapsed between the accident and death can be estimated from the appearance of the injured body part.
During the Dry Bones study, many indicators of injuries during life and in the para-mortem and post- mortem periods have been identified in human and other animal skeletons. In specific skeletons the effects of physical violence have usually been clearly visible in or upon single and multiple bones, nearby and regional joints, the periostium, and tissues contiguous to bone. Our experiences with ante-mortem violence are considered here; para-mortem and post-mortem skeletal damage have been discussed in Chapter 1.
Specific injuries identifiable in regional skeletons included residua of fractures, dislocations, sprains and torn ligaments, degenerative joint disease secondary to physical violence, amputation, penetrating wounds, para-mortem and non-lethal scalping with prolonged survival, bone spurs and cysts of traumatic origin, calcified subperiostial hematoma (blood clot), nasal septal deformities that frequently appear following facial injury, and pathological fractures. There has been no evidence of purposeful ante-mortem bone manipulation suggesting surgery. A few skulls have had altered posterior parietal and occipital contours attributable to cradle board pressure during infancy, but there has been no man-made cranial deformation in any of the cultures indigenous to this region. Degenerative bone changes attribut able to life style or from the trauma of everyday living are presented in Chapter 6.
Many different cultures and time periods were represented by skeletons evaluated between 1962 and the present as part of the Dry Bones survey. Environmental conditions and the different archaeological techniques used to procure specimens have modified individual and collective skeletal completeness, and to a certain extent have complicated the search for residua of injury. In addition, early studies were focused primarily upon the craniofacial area. Therefore, to facilitate comparison, data have been prepared to reflect the period in history, and the culture and geographic location. There was no remnant of physical injury inthe 14 oldest skeletons we examined (Hilde GravelPit, 39LK7, near Madison, SD, culture unknown,carbon dated to 3800 BP +/-110 yr).
In total we saw 192 putative and established Plains Woodland skeletons, the greatest number from the DeSpiegler (northeastern SD) and Ufford (southeastern SD) Sites (Table 2.1), and lesser numbers from the Arbor Hill (39UN1), Bloom (39HS1), Brandon (39MH1), Daugherty (39RO10),Enemy Swims (39DA3), Hartford Beach (39RO4),Madison Pass (39LK2), Newton Hills (39LN10), Scalp Creek (39GR1), Thomas Riggs (39HU1), and Wolf Creek (39HT201) sites. In the latter group of skeletons findings attributable to injuries included 3 craniofacial and one postcranial healed fractures, 37 nasal septal deformities, 4 upper and 6 lower extremity joint alterations, two examples of focal periostitis, and two projectile (arrow) wounds.
The 151 skeletons at The Historical Society of North Dakota were from several time frames and repre sented the Arikara, Arikara-Mandan, Assiniboin, Cheyenne, Chippewa, Cree, Crow, Hadatsa, Mandan, Middle Plains Woodland and Sioux (Table 2.1). For many skeletons provenience was limited. Because these skeletons were evaluated early in the Dry Bones project, primary emphasis was upon craniofacial disorders. This, plus the fact the specimens were incompletely processed when evaluated, largely restricted the information obtained from them to craniofacial abnormalities. Mandan skeletons from the Double Ditch Site (32BL8, 1675-1781, Table 2.1) were the largest single aggregate from North Dakota.
In the W.H. Over Collection specimens at The University of South Dakota the greater majority were Arikara, followed in frequency by Middle Plains Plains Woodland, a few Sioux and other known cultures, and specimens for which there is little or no provenience (Table 2.1). The Swan Creek, Mobridge, and Four Bears (Arikara), and Ufford (Woodland) skeletons, listed separately in Table 2.1, are actually part of the Over Collection. Although studies done upon the Over Collection in 1962 were focused on the craniofacial area, a complete skeletal survey to locate residua and sequellae of injuries was conducted later.
The best statistical data relating to injuries sustained by regional aborigines came from salvage ar chaeological and Crow Creek massacre material. The pre-1492 A.D. proto-Arikara Crow Creek village was located near the Missouri River in mid-South Dakota. The sources of the greatest number of salvage specimens, all Arikara, ranging in time from 1650 to 1832 A.D., and all located close to the Missouri River in mid and upper central South Dakota, include the Larson, Leavenworth, Mobridge (MO-1, MO-2), and Sully sites. For most of the salvage archaeology material there is excellent provenience, and extensive anthropomorphic data have been compiled. Osteopathological information relating to injuries that occurred during life has been obtained from all sites but for the 486 (minimal estimate) Crow Creek and 71 Larson village remnants there are in addition findings indicating physical violence at the time of death. Information from the these multiple sources has provided an excellent profile for accidents and injuries that affected many people.
Repaired and remodeled injuries were found in 49 bones from the Crow Creek mass grave (Table 2.2) (361). Generally these bones were quite well preserved, but dismemberment, fragmentation, and conditions existing in the para-mortem period precluded assessment for all injuries that could have occurred, or evaluation for multiplicity of injuries in individual skeletons.
Table 2.4. Trauma by Category: Larson Site
Cemetery and Village
Cemetery (N=621) Village (N=71)
_____________TIn__TId____%T___TIn__TId___%T
Fracture 121 92 47.1 31 23 45.6
Scalping 5 5 1.9 17 17 23.3
Projectile 6 6 2.3 0 0 0.0
Periostitis, 23 13 8.7 2 1 2.7
focal
Dislocation 9 6 3.4 1 1 1.4
Sprain, 10 10 3.8 5 4 6.8
avulsion
Heterotopic 36 29 13.6 9 7 12.3
bone
Unknown 50 27 19.0 9 7 10.9
TIn = Total injuries/catagory, multiple in
some individuals.
TId = Total traumatized individuals each
catagory.
%T = % total injuries each catagory.
From: Deitrick 1980, pp. 31-32.
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Thirty fractures comprised the single largest manifestation of physical injury. Twelve were craniofacial, 11 were in the upper and 4 were in the lower extremities. Miscellaneous fractures in other bones, dislocations, epiphysitis, projectile wounds, ante-mortem scalping, and nasal septal deformities comprised the remainder.
For comparison, Tables 2.3 and 2.4, adapted from data compiled by Lynn Deitrick (89), contain the indicators of musculoskeletal injuries sustained during the lifetimes of Arikara people who lived and died of natural causes in northern South Dakota 1750-1785 (Larson Site cemetery), and 71 of their contemporaries who were massacred in 1785 (Ch. 1) (89). She found ante-mortem fractures, several multiple, in 92/621 (14.8%) of cemetery and 31/71 (43.6%) of village (massacre) skeletons, a much higher frequency than was apparent at Crow Creek. Other manifestations of ante-mortem accidents were more similar in frequency to the findings at Crow Creek.
Deitrick compared the frequency of skeletal injury at the Larson Site with that found in Arikara cemetery populations at Mobridge MO-1 (1650-1700 A.D.), MO-2 (1700-1750 A.D.), and Leavenworth (1800-1832) Sites (Table 2.5) (89). Differences in data processing between the Larson and the latter three sites limited her comparison of dislocations, heterotopic bone, and focal periostitis as manifestation of previous injury. Repaired fractures were much less frequent at both Mobridge Sites, and were about one third as frequent at Leavenworth. Other forms of injury were more comparable in all sites.
The effects of physical trauma, especially fractures, were found in all populations represented, but were considerably more frequent in cemetery and massacre skeletons from the late 18th century Larson cemetery and village. Over looking the unequal representation of skeletal components and different recording techniques, the frequency of demonstrable healed fractures per population was almost identical at mid-14th century Crow Creek (30/486, 6.2%) and the early 19th century Leavenworth (16/261, 6.1%) Sites, and somewhat lower in the Mobridge villages that existed 1650 to 1750 A.D.
FRACTURE, CRANIO-VERTEBRAL
CALVARIUM
Figures 2.1 A, B, C, demonstrate a healing defect that represents a recent injury to the left parietal area (D). A post-mortem defect, produced at exhumation (P.D.) is in the mid-frontal area. Fading fracture lines (F L) are obvious in radiographs (Figs. 2.1 B and C), but are invisible on the gross specimen. The lateral radiograph (Fig. 2.1C) shows the area of bone injury overlying the middle meningeal artery (MMA). This situation is hypothesized to be the result of an injury to the calvarium involving the middle meningeal artery, undoubtedly complicated by a sub-dural hematoma (blood clot on the brain). Death caused by brain damage was speculated to have occurred about 2-3 months after the injury (133). The skeleton was disarticulated, so it was impossible to evaluate the remainder of the skeleton for other evidence of trauma, or for neurological deficit.
Skull injury accompanied by bleeding intracranially occurs frequently today, especially in automobile wreck victims, such that neurosurgeons must constantly suspect it. Prompt treatment usually is followed by recovery, with little or no residua.
Figure 2.1. C. Skull #15109, lateral radiograph.
Figure 2.2. C. Skull with healed fracture, left frontal area (arrow).
In Figure 2.2C the skull of an adult male has a deeply depressed (20 mm), well healed fracture in the left frontal region (arrow). The skull was not otherwise abnormal. Radiographs (Fig. 2.2 A,B) show medial displacement of the fragments and dense reparative bone at the fracture lines. The degree of healing ind icates the injury took place many months previously.
The fact that this individual had survived for quite an extended interval after serious injury (and apparently was functional at the time of the mid-14th century massacre), attests to the resiliency of 14th century aborigines, and gives evidence that life support measures were available and adequate for the situation.
Figure 2.3. U.S. National Museum, 325-342, Hrdlicka Collection. Mobridge, SD Arikara female, 35 yr.
The occipital region of an adult female skull in Figure 2.3 has the remodeled residual of an old penetrating injury. All three tables of the bone are involved; the defect's edges are smooth and eburnated. In the gross specimen the relatively symmetrical oval shaped defect suggests having been produced by a blow with a cutting instrument that broke open the soft tissue over the skull, fractured the occipital bone, and was followed by loss of a fragment(s) of devitalized bone. The smooth edges and the degree of wound healing indicates long term post injury survival. There was no evidence of the effect of osteomyelitis and no other defect in the skull. The cause of death was not apparent. Radiographs are not available for this specimen. Although the defect's appearance and smooth edges could easily be suspected as due to trepanation, penetrating injury is more likely. Surgery in general and trepanation specifically were not a part of the ancient Upper Missouri River Basin culture (See Fig. 2.19 and text).
A parietal area fracture in a Crow Creek adult male skull that was followed by aseptic necrosis (loss of non-vital bone) of a bone fragment and pseudo-cyst formation is presented in Chapter 4 (Fig. 4.10).
FRACTURE, FACIAL BONES
2.4A. A unilateral healing mid-face fracture extends through the left anterior facial region. Typically, LeFort II fractures involve the infraorbital foramen, a weak portion of the maxillary bone. Rather than healing with full thickness bone, the maxillary sinus anterior face was replaced by fibrous tissue, no longer a part of the specimen. There is no evidence of osteomyelitis. The fracture lines are still vis ible but blurred and the bone in the repaired area is thin, indicating that the injury occurred some time before death. Because the infraorbital margin is slightly depressed, the possibility is excellent that the individual involved was bothered by diplopia (double vision) afterwards. Such injuries are caused by a blow to the cheek.
2.4B. There are bilateral fresh undisplaced midface infra-orbital fractures, sustained about the time of death during the mid-14th century massacre. Nasal septal deflection is an incidentalabnormality. 2.4C&D. LeFort lines I, II, III, are common places for facial fractures, in structurally weak areas (96).
Although isolated breaks are possible in specific LeFort lines, facial fractures today more commonly are mixed variants of the classical Le Fort lines.
NASAL PYRAMID FRACTURES
Residua of nasal fractures have been frequent in skeletons representing all cultures and time periods, such that many were not recorded. In the 486+ pre-Columbian Crow Creek skeletons, healed nasal fractures were in 5/392 (1.3%) identifiable skulls, and markings indicating para-mortem nasal mutilation were on four skulls (Table 2.2). Nasal septal injuries may accompany bone fractures.
NASAL SEPTAL INJURY
Figure 2.5. Over Collection, No. 23. Arikara male 25-30 yr.
The vomerine (bony) nasal septum is obviously thickened and bent to the right side, causing quite severe airway obstruction. There is compensatory hypertrophy of the left middle turbinate bone. During life the anterior cartilagenous portion of the septum would very likely have been warped.
Nasal septal injuries can affect either or both the cartilagenous and the bony portions, but technically are usually not classified as fractures. Septal injuries are frequently followed by functional deficit.
Previously, nasal septal alterations were reported by age and sex in 191/365 (52.3%) Over Collection skulls (Table 2.6) (301). Deformity of the septum is frequent in aboriginal Dakota Territory skeletons from all cultures and time periods (Tables 2.1, 2.2). Abnormal septums were in 13/129 (10%) of identifiable pre-Columbian Crow Creek and 4/90 (7.7%) established Middle Plains Woodland skulls, in 3/24 (12.4%) Mandan, and in 181/458+ (39.5%) Arikara skulls. The pre-Columbian skulls represent homogeneous cohorts, the Over Collection skeletons included skulls from both small homogeneous groups and random samples.
Table 2.6. Nasal Septal Deflection
In 365 South Dakota Skulls
_Age_________Male___Female___Unknown__Total
B - 10 yr 1 - 2 3
11 - 20 2 7 3 12
21 - 30 33 37 4 74
31 - 40 51 24 1 76
41 plus______21_______6________-_______27_
Total 108 74 10 = 192
From: Steele et al 1965.
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In the U.S. today about 1/3 of the male adult and 1/10 female adults have some degree of nasal septal deformity. Personal observations from clinical studies at South Dakota Indian reservation hospitals showed that deviated nasal septums are in about 1/3 of both males and females. Contrary to the opinion of Post that nasal septal deformities are the result of relaxed selection (264), in South Dakota Indians deviated septa can usually be correlated with trauma to the nose, most often during the growth period in life.
The importance of nasal septal deformities is that by obstructing the nose they are usually thought to be a factor predisposing to chronic and recurrent infections in the nose and paranasal sinuses. The high frequency of nasal septal deflections in the Native Americans past and present is notable because of these implications. Although their frequency mirrors a vigorous life style often complicated by facial trauma, it might be questioned whether the increased frequency observed in American Indians also represents a differential growth pattern in the Indians' mid-face. In addition, because it is a portion of the embryonic palate, the nasal septum's role in the production of palatal clefting has been questioned (Ch. 7).
Nasal obstruction secondary to combined septal warping and allergic changes are illustrated and discussed in Chapter 3 (Fig. 3.16).
VERTEBRAL-SACRAL INJURIES
COMPRESSION FRACTURE
Figure 2.6. 39BF11 Crow Creek. Proto-Arikara female ?, adult.
Vertebrae, thoracic #11 & 12, and lumbar #1. Definite sex identification was not possible, but because the vertebrae were small and had moderately severe osteoporotic changes it is theorized they are female. The body of the 12th thoracic is compressed anteriorly. Two possible causes for this deformity are advanced: 1. the after-effect of a compression fracture, or 2. osteoporotic degeneration followed by vertebral body collapse, precipitated by mild trauma. The vertebral collapse is demonstrated better from this perspective, but while making the photograph the first lumbar was reversed to show a paramortem cut mark on the vertebral body's lateral surface.
One other fracture involving a thoracic vertebral spine was identified at Crow Creek. Anterior compression of vertebral bodies, mostly in the lower thoracic and lumbar areas, but also in the cervical area, has been quite frequent. The major problem presented has been in differentiation between residua of trauma and the effect of osteoporosis added to a vigorous life style. An additional factor precluding accurate analysis for evidence of vertebral trauma is the fact that preservation has generally been much poorer for vertebrae than for skulls and long bones. Vertebral changes associated with aging or osteoporosis are discussed in Chapters 5 and 6.
A few vertebral process fractures were found in other skeletal groups. Except in massacre skeletons, sacral injuries have not been identified regionally.
APPENDICULAR SKELETON FRACTURE
Figure 2.7. A&B. Schematic callus at completion of primary healing, and after remodeling.
The mechanism of callus modification is illustrated, and a well healed, remodeled, transverse mid-ulnar fracture demonstrates an excellent end result following ancient long bone injury. Little or no functional disturbance would be expected in such circumstance. The degree of healing and re-modeling suggests the injury occurred at least 6 months before death. Although this is in the location of parry fractures, reportedly frequent in European and Egyptian skeletons (187), parry fractures have not been common in our experience in this portion of the globe.
A transverse fracture had occurred in the proximal femur of a man who lived at Crow Creek village during the 14th century. The photograph and radiographs show the dense, partially remodeled callus, testifying that the injury had healed, and indicating the individual survived for a considerable interval afterward. Osteomyelitis does not appear to have occurred. The 25 degree angulation deformity and about 8 cm shortening of the affected leg should have caused considerable difficulty walking and probably was complicated by hip and back pain. Paradoxically, degenerative changes are minimal upon the proximal femoral articular surface. The extended survival with areasonably good functional result indicate some form of fracture treatment, and the availability of life support measures during convalescence. The innominate bone and acetabulum were not identified for this individual.
Figure 2.9. Monat Cliff Burial Site, Treasure County, Montana (ca. 1880) Crow, adult male.
The femur of an adult male who lived during the late 1800s was broken proximally and distally by spiral fractures. The breaks have healed but with shortening and angulation, and slight rotation at both ends. Because this injury was in an historic skeleton, a horse-rider fall and roll-over accident must be suspected as cause for the injury (Ch. 1, Fig. 1.1). The extent of healing indicates long post-injury survival, and the presence of physical support while the individual was convalescing. The angulation and shortening of the bone demonstrate that minimal rudimentary bone setting techniques, probably only crude splints applied to the injured leg, were available to this individual. The absence of alterations at tributable to osteomyelitis confirm the impression this injury was not an open fracture.
Injuries fractured the femora during life in more Missouri Basin adult male skeletons, representing individuals from other cultures and periods in history. Both had survived for an interval sufficient for complete healing and remodeling of the calluses. One was prehistoric Woodland (Over Collection, 39DA3, Enemy Swims Mounds) and the other was an historic Arikaka from the Leavenworth Site (Ch.1, Figs. 1.3, 1.11).
Figure 2.10. 39HT2 Hofer Mound, south central SD. Woodland ?, male, adult.
In Figure 2.10 a fracture involved the lateral tibial condyle and extended into the knee joint of a probable adult Woodland male. Figure 2.11 diagrams the mechanism causing such injuries. The fracture has healed during which time a portion of the lateral tibial plateau fragment has been resorbed. Roughening of the tibia's articular surface and hypertrophic lipping at the periphery of the joint indicate early degenerative changes of traumatic arthritis (degenerative joint disease- DJD), secondary to the injury. Absence of the femur for this museum specimen, precluded evaluation for concomitant abnormalities. The presence of degenerative changes indicates survival of the individual and use of the leg for quite some time after the injury. Very likely this knee was painful and caused disability.
Figure 2.12. 39SL4 Sully Site. Arikara male, adult.
A horizontal defect we interpreted as a healed fracture, extends through the midportion of the posterior surface of an adult patella. Its counterpart is normal. The injured patella is larger than its mate, indicating altered growth following the injury. Patellar fractures notoriously heal poorly, even with optimum care, making this an unusual circumstance in a primitive setting. This abnormality is distinguished from a develop mental bipartite patella by the fact that bipartite patellae form side-by-side, and by the differential growth of the patellae (198).
Alterations in post-cranial appendicular skeletal bones secondary to healed fractures were in skeletons from all time periods and populations in the Missouri Basin. Clavicular deformities secondary to injury during life have been quite common, and a number were not recorded. The variable but too often poor preservation or non-availability of ribs has precluded an assay for injuries to the thoracic cage. Injuries involving the scapula and pelvis have been infrequent.
DISLOCATION
The right hemi-pelvis and the proximal femur have changes compatible with a long standing hip dislocation. The femoral head is pitted, eroded, and largely destroyed by degenerative alterations produced by wear in the pseudo-joint. The old hip socket, visible in 2.13A. about 5.0 cm. inferior to the new acetabulum, has largely been remodeled. Hypertrophic new bone in the area of the neo-acetabulum and bony fusion in the sacro-iliac joint mirror the unusual mechanical stresses forced upon these joints by the altered hip joint dynamics. Degenerative articulation changes are present in the lower thoracic and lumbar spine, and the L-5 & S-1 vertebrae have separate neural arches (spondylolysis). The L-5 vertebral centrum is dis placed anteriorly over S-1 (spondylolisthesis). Although there is no way to determine when this hip was dislocated, the closed epiphyses and the mature development of the bones suggest that it occurred during adult life, and the affected person managed to survive for an extended interval.
It is expected that this hip injury was accompanied by severe discomfort and disability for the remainder of this individual's life. The non-reduced hip dislocation and long survival indicate physical assistance to the injured in proto-South Dakota, and the end result attests to the the efficacy of treatment for such injuries at that period in time.
The osseous changes remaining in this skeleton should be compared with those interpreted as second ary to congenital hip dislocation or Perthes disease (Ch. 7, Figs. 7.25, 7.26), and the changes visible in Figure 2.24, attributed to aseptic necrosis of a humeral head. In addition to the possible causes discussed for Figure 2.24, unreduced shoulder dislocation in a juvenile is also a consideration.
SPRAINS and TORN LIGAMENTS
Figure 2.14. From different archaeological sites. Arikara, adults.
Heterotopic ossification appearing as new bone spurs attached to the distal ends of three fibulae are the result of pulling, tearing injuries to the ankle and foot, with or without concomitant fractures. Although undoubtedly painful and disabling at inception, all appear healed and quiescent. Similar manifestations of previous trauma were also apparent in proximal tibia-fibula articulations. Such changes have been observed quite frequently during the Dry Bones survey, and have not predominated in any culture or time period. Although these lesions have been present primarily in the appendicular skeleton, other body components have been affected.
Osseous tumors, probably residua of physical trauma, presented as heterotopic bone or spurs on 14 bones from the Crow Creek skeletons (Ch. 4, Table 4.5). Deitrick identified similar lesions in 36/628 (5.7%) Larson cemetery, 9/71 (12.7%) Larson village, 5/261 (2.0%) Leavenworth cemetery, and none of MO-1 and MO-2 skeletons (Table 2.5) (89).
Figure 2.15. No provenience. Arikara. Adult male tibia.
A well demarcated, oval shaped mass of organized periostial new bone is on the anterior surface of the tibia. It represents a calcified subperiostial hematoma. This was an isolated abnormality in a well preserved skeleton and is presumed to have been secondary to physical trauma such as "barking the shin." Such lesions have been common in Missouri Basin tibii.
The tibia's anterior surface has minimal soft tissue protection and is frequently subjected to direct blows, making it the most frequent location for hematomata. Because hematomas can ossify, or can be resorbed totally or partially, dry bone findings have depended upon the reparative response and the time elapsed between the individual's injury and death.
In addition to their association with physical trauma, organized or unorganized subperiostial hematomata may signal blood clotting deficiencies and processes affecting capillary fragility, a notable example being scurvy. Scorbutic hematomata frequently appear on the tibii (302). Because many more lesions interpreted as subperiostial hematomata in various stages of organization were discovered in Crow Creek skeletons, it was hypothesized that the massacre victims had been affected by scurvy previously, and probably were scorbutic (affected by scurvy) at the time of their deaths (Ch. 5).
Because most bones are well protected by soft tissue, skeletal damage from abrasion type injuries has not been a common finding during this research. However, the structural modification visible upon the scapular spine from one adult male skeleton could only be explained satisfactorily as the result of a dragging, abrasion, injury (Fig. 3.5, 39WW1, Leavenworth cemetery, Arikara male, 25-35 yr.). Osteomyelitis secondary to bone exposure is illustrated graphically in this specimen, and the reaction appears to have been active at death. Probably this injury was in some way a contributory factor to the ultimate fatal outcome. Possible mechanisms for this abnormality discussed (Ch. 3).
Figure 2.16. The medial (upper) and anterior sur-aces of a knee show the distal femur, patella,and proximal tibia from a robust adult male. The specimen washed out of a river bank near Bismark,ND in about 1976. There is no provenience and no other components of the putative Arikara-Mandan skeleton were found. The distal tibia is amputated and the proximal portion is firmly fused to the distal end of the femur in the knee flexed position. The patella is fused to the distal femur in the flexed position. The bone at the distal end of the tibia is remodeled and smooth, indicating that whatevercaused this deformity occurred many months or years before death. Moderately severe inflammatory reaction is present on the articular surfaces of the three bones suggesting involvement of the articular cartilages preceding fusion of the bones.
Although the exact mechanism of this abnormality will never be known, the general appearance of the affected bones suggests possibilities as to the sequence of events. This abnormality is not characteristic of congenital or developmental origin, and does not resemble the effect of neoplasm. To the surgeon who performs below-the-knee amputations, the fact that the bones are fused in the flexed position is an important clue as to what must have transpired.
When the leg must be amputated below the knee, for effective rehabilitation the amputation stump must be splinted post-operatively for an interval "in the extended position" (straight out), so the knee does not become flexed permanantly by the overpowering action of the stronger flexor (posterior) muscles. If the knee remains flexed over an extended interval, the extensor (anterior) muscles atrophy and the knee is fixed in flexion, as demonstrated here.
In addition to amputation and fixation in flexion, the articular cartilage injury and fusion of the knee suggest the presence of another pathological process. Two different mechanisms that might explain the total findings exhibited are: 1. a traumatic below-the-knee amputation accompanied by soft tissue infection and septic arthritis, and 2. lower extremity gangrene precipitated by altered circulation in the extremity, complicated by joint involvement.
Circulatory changes are common in elderly individuals' lower extremities, due to arteriosclerosis, and in diabetics. Diabetes is extremely common in Indians who live in the Aberdeen Indian Area today, and gangrenous lower extremities necessitating leg amputation are not unknown. No good evidence is available as to the antiquity of diabetes in this region, but the possibility exists that this specimen represents the effect of arteriosclerotic or diabetic vascular disease with gangrene. Auto-amputation complicated by septic arthritis might have occurred.
Remembering North Dakota's reputation for very cold winters, an additional consideration for the amputated lower extremity would be frostbite of the foot, followed by gangrene, and either manipulative or auto-amputation (77, p.267).
To date, no other convincing osteological evidence of amputation has been found in Dakota Territory skeletons. In regard to the practice of amputation among the aborigines in the Americas, Vogel stated:
Indians are wholly strangers to amputation, Lawson wrote, yet he described their amputation of a portion of the feet of captives, and the grafting of skin over the exposed end, which then healed. and, citing Maximilian of Wied, On the western Plains, fingers were sometimes amputated as punishment or to display grief, and Bourke exhibited a Cheyenne necklace made of human fingers (335, pp.56,192).
Ortner and Putschar noted that amputation "was part of initiation rites" of North American Indians, but presented no specimens illustrating the effects of amputation (246, p.94). Morse reported and illustrated an instance of probable amputation of the right hand (225, p.10), and Strothers described a lower leg amputation in a prehistoric Huron skeleton (308).
Figure 2.17. 39BF11 Crow Creek. Proto-Arikara male, adult.
Figure 2.17. In the 486+ pre-Columbian Crow Creek skeletons one flint chip, probably an encysted projectile tip, was embedded in the lateral surface of an innominate bone. During excavation three arrow points were discovered in the soil surrounding the mass burial. A tiny flint chip, probably the tip of a scalp ing weapon was embedded in the frontal bone of an adult skull (Ch.1, Fig. 1.22 C).
Figure 2.18. A skull on exhibit for many years at the Over Museum at the University of South Dakota had a metal projectile 12 cm in length partially lodged intracranially, ostensibly having penetrated the head through the left orbit. This could easily have been the cause of death.
Figure 2.18. Over Collection, Skull #76. Historic Dakota. Forestburg, SD. Male, 25-30 yr.
Despite the fact that bows and arrows and spears were a part of each of the cultures evaluated during this study, very few projectile tips were found embedded in bone. This could testify to the skill of these people in extracting projectiles, or it could be due to the fact that most projectile injuries affected soft tissue and did not involve bone. In scaffold or other non-interment burials, points that produced fatal wounds through soft tissue damage alone may have dropped out of the corpse as the soft tissue decomposed and were lost post-mortem.
Deitrick tabulated projectile injuries in skeletons from four northern South Dakota sites and found them in 6/621 (0.9%) of Larson cemetery skeletons, 4 in males, 2 in females, all over 15 years of age, but none in Larson earthlodge skeletons (Table 2.3, 2.4). Three points were in vertebrae, two lumbar and one thoracic. One each was embedded in the sternum, scapula, and humerus. Three male skeletons with projectile injuries had facial fractures and one skull was scalped. At the Mobridge sites projectile injuries were in 1/167 (0.6%) MO-1 and 1/242 (0.4%) MO-2 skeletons. At Leavenworth they had occurred in 2/261 (0.76%) individuals. She indicated that a metal arrrow tip and a bullet had caused Leavenworth Site bone injuries (89).
Radiographs of a tumor on the medial surface of an adult innominate bone (Fig. 4.6) showed a tiny radiolucent area in the depths of the mass, probably a retained foreign particle. This is hypothesized to have been the result of a non lethal projectile wound. Because this is a museum specimen, further investigation was not possible. The amount of new bone production in this lesion suggests exuberant inflamma tory material.
A small chert fragment in embedded and partially encysted within an adult distal fibula (Fig. 3.l5). There is no evidence of active or residua of osteomyelitis. The encystment indicates long term retention of the foreign particle.
Figure 2.19. Over Collection, #4461. Cultural affiliation unknown. Male 30-40 yr.
In the left frontal region of a well preserved skull there is a round hole about 2.0 cm. in diameter and a label attached to it identifying the defect as "Bullet hole above left eye." Inset shows defect magnified. The only provenience was notes dating to the early 1900s left by William H. Over: "#4461. Drawer 6, Case 33. Skull with bullet hole, found while grading Court House yard at Vermillion [SD]. Donated by Charles Sundling. "(Alex, R. Personal communication. SD State Archaeology Lab., Ft. Meade, SD) Sketchy information obtained from former Over Museum personnel (Gant, R., Hurt, W., Personal communications) sug gested the skull may have been White, but in a personal communication P. Willey (Anthropology Osteology Laboratory, University of Tennessee-Knoxville) reported that racial discriminate function analysis placed this specimen within the Indian range, close to the White/Indian section point.
Bone at the defect's edges is sharply cut on the lateral and medial surfaces, beveled slightly toward the outer surface, and has no shattering or implosion effect as might be expected with a bullet wound. Reparative response is absent in the gross specimen and in radiographs (not illustrated). No other abnormality existed in Skull #4461. Independently, three radiological consultants interpreted this defect as the result of trepanation (Steele, JP, Yankton, SD, Walton, CL, Knoxville, TN, Read, R, Sioux Falls, SD). The lack of reparative response argues for para-mortem origin. All evidence strongly suggests this defect is man-made.
Intravital trepanation was not a feature of the Great Plains culture, but a skull was found at the Sully Site mutilated by a hole drilled into the parietal bone for a thong to carry it as a trophy (Ch. 1, Fig. 1.8). Phenice from Kansas described and illustrated eight skulls with artificial openings in the occipital area that he proved were of post-mortem origin, made to facilitate display of the skulls (263). The cranial alterations he illustrated do not resemble the defect in this skull.
Although aboriginal trepanation was not indiginous to this region, the finding in discriminate function tests that skull #4461 falls close to the White/Indian section point provides a tantalizing suggestion as to the origin of this unusual defect. Instruments for trepanation similar to those in Figures 2.20A&B have been available for many hundred years (40,147), and were accessable to medical practitioners during the frontier days in this region. It is entirely possible the individual represented by this skull could have lived as a White man and was treated with such an instrument by a doctor who practiced in this region during the frontier days (131).
Reverte reported five trephined skulls dating to medieval Spain. He described four trepanations as drilled, round, and funnel shaped. The illustration of Reverte's Case No. 1, is extremely similar to our findings in Skull #4461 (274).
Figure 2.21. An isolated occipital bone fragment was found near Mobridge, SD, by an amateur archaeologist and referred for evaluation. It has parallel horizontal cuts in its outer cortex. The marks are not artifacts, and probably came from para-mortem scalping. To identify the origin of these marks and the type of instrument used to make them, William Bass (University of Tennessee) made experimental cuts on a piece of dry human rib (Fig. 2.21B) with a steel knife (left) and a flint knife (right). It was concluded that the marks upon the child's skull came from a steel knife, indicating the likelihood of post White trader-contact origin.
Figure 2.22. The medial and lateral surfaces of a fragmented pre-Columbian adult calvarium have changes indicating an inflammatory process on the bone's outer surface. This is manifested by a large, demarcated, oval shaped defect involving the majority of the calvarium's superior surface. A smooth, rounded border is at the edge of the affected bone. The base of the defect is composed of irregularly roughened bone. The outer table of the parietal bone is thin. On the parietal bone's medial surface vascular markings are accentuated commensurate with dilitation of the small blood vessels penetrating the bone, as part of the reparative response to the inflammatory process on the bones's external surface.
Figure 2.22. 39BF11 Crow Creek. Proto-Arikara, adult.
Figure 2.23. 39CA4 Rygh Site. Arikara, male 35-40 yr.
These findings sugggest that the injury to this skull occurred quite some time prior to death. The inflammatory process appears to have been in the healing phase at the time of death. Another adult skull with similar changes in the outer and inner surface of the calvarium was found in the Crow Creek mass burial. Because these skulls were in the communal post-massacre grave these individuals had survived the scalping injury, only to perish in the catastrophe.
In the post-Columbian Larson cemetery skeletal population, findings indicating osteomyelitis as an aftermath of scalp evulsion, probably complicated by meningitis, were in an adult Arikara female's skull (Ch. 3, Fig. 3.4). The inflammatory process in that skull appears to have been active at the time of demise, suggesting that it was a factor contributing to death. Three other skulls with similar changes were found in the same cemetery, leading Deitrick to conclude these all represented purposeful scalp avulsion (89).
Figure 2.23. The anterior portion of a skull discovered at the Rygh Site (1600-1650 A.D.) by an amateur archaeologist, now a part of a private collection, is highlighted to show an area of disfigurement in the outer table of the frontal bone. The smooth, slightly raised, anterior and lateral margins of the defect present the appearance of reactive new bone formation at the periphery of an area of resorption of the outer table. All affected portions of the bone are smooth, indicating post-injury remodeling. The inner table of the frontal bone was not remarkable. Radiographs were not diagnostic and gave no clues to ex plain the cause of this abnormality. The oval shaped pattern of the defect suggests that the injury affected the pericranium and was limited by this membrane. A direct blow to the head with injury to the bone's outer table and the pericranium, complicated by hematoma formation must be considered. However, the most likely possibility as cause for this injury to the bone several years prior to death of the individual, is that of non-lethal scalping.
The effect on a person subjected to non lethal scalping is influenced by a number of factors that include the physical condition of the individual, the quantity of blood lost, the consequences of accompanying trauma, and the plane of dissection through which the scalp is removed. If the scalp is avulsed in the plane between the pericranial soft tissues (galea aponeurotica and pericranium), healing is more rapid and infection is less likely, due to protection by the pericranium. If scalping includes the pericranium or if it is injured during the process, the bone's surface is exposed, predisposing to infection. Osteomyelitis and meningitis are predictable complications.
Controversy exists today as to the antiquity of scalping in the Americas, and whether this practice antedated or was introduced by invaders from Europe. In two national publications within the past seven years, the origin of scalping in North America has been discussed, inconclusively. An article in a popular syndicated Sunday suppliment carried by many newspapers in the United States was entitled, "Don't Blame the Indians for Scalping." It was reported that, "Scalping began when the Dutch colonists offered cash for scalps of hostile tribesmen they wanted cleared out of the New York and New Jersey area." It contended that scalping was brought here from Europe and had not been practiced prior to European invasion (95). In another publication a reader responded to an article relating to scalping at Wolstenholme Towne in 17th century colonial America (169), "I thought scholars were in agreement that scalping was a European practice, introduced to the Indians during the French and Indian War. Is there, in fact evidence to support Indian practice of scalping as early as 1622?" (155).
Conclusive evidence exists in human skeletons from the Upper Missouri Basin that scalping was prevalent in this region both before and after European intrusion. In addition, scalping was not limited to the dead corpse. In pre-1492 Crow Creek skeletons para-mortem scalping as part of the massacre was apparent in 271/315 (66%) identifiable frontal bones (Ch 1, Table 1.4). In addition, in this same skeletal cohort residua of scalping antedating death was in two skulls (360,361). In the Larson village (1785 A.D.) para-mortem scalping cut marks were on 17/71 (23.9%) of the massacre victims, and evidence of ante- mortem or paramortem scalping was on 5/621 (0.8%) of the cemetery skulls. Deitrick did not find evidence of scalping in skulls from the Mobridge (MO-1, MO-2) or the Leavenworth Sites (89).
Other historical and archaeological references corroborate the Upper Missouri River Basin findings that not only did scalping antedate European contact in the Americas but also the act was not limited to the dead body. Both in the North American aborigines and in European settlers, non-lethal scalping with long term survival has been reported (30,63,232). Bruesch (63) discussed non-lethal scalping in Tennessee during the 18th century:
"In March of the same year (1777) Frederick Cavlit was badly wounded and nearly the whole of his head was skinned. Doctor Vance was sent for and staid several days with him. The skull- bone was quite naked, and began to turn black in places, and, as Doctor Vance was about to leave, he directed me, as I was stationed in the same fort with him, to bore his skull as it got black, and he bored a few holes him- self, to show the manner of doing it. I have found that a flat pointed straight awl is the best instrument to bore with, as the skull is thick, and somewhat difficult to penetrate. and, The scalped head cures very slowly, and if this kind of flesh [proud flesh] rise in plac- es, higher than common, touch it with blue- stone water [copper sulphate], dress it once or twice a day, putting a coat of lint over it every time you dress it, with a narrow plaister of ointment. and, It skins remarkably slow, generally taking two years to cure up."
ASEPTIC NECROSIS
Figure 2.24. Marked deformity and resorption of bone are the findings in an adult humerus head. Although this abnormality could have been of infectious origin, this is a common location for malunion and angular deformity. This defect is hypothesized as the result of injury to the humeral capital epiphysis and avascular necrosis of the head caused by impaired blood supply. Two possible mechanisms for this defect, illustrated schematically in Figure 2.24B&C include, 2.24B- separation of the humeral greater tubercle epiphysis, and 2.24C- separation at the humeral head epiphysis (both of which fuse at 18-21 yr.), followed by faulty joint function and degeneration of the humeral head.
Figure 2.24. No provenience.
A. Proximal humerus.
Figure 2.24B. Schematic injuries.
PSEUDOARTHROSIS
Figure 2.25. A fracture involving the ulna's olecranon process was healed by fibrous rather than bony union. The false joint (pseudoarthrosis) has disturbed function promoting hypertropicdegenerative changes (arthritis). The degree ofhealing and joint derangement suggest this injury occurred some time before death. We have encountered few manifestations of pseudoarthrosis in regional skeletons.
Figure 2.25. 39SL4 Sully Site. Arikara male, adult.
ALTERED MATURATION (attributable to injury during development)
Figure 2.26. There is 2.5 cm. difference in the length of fibulae found with an adult skeleton. It is assumed these two bones belonged to the same individual. In addition, the bottom fibula has inflammatory periostitis and spicular newbone formation on its surface suggesting an inflammatory reaction. The entire surface of the fibula is affected and there is no obvious fracture. Inflammation of the bone and its periostium during development, whatever its cause, affected the epiphysis and altered growth.
Figure 2.26. 39HU2 Oahe Village. Over Collection. Arikara female, adult.
Another example of disparate growth is that induced in a patella by a fracture (Fig. 2.12).
Traumatic and inflammatory processes affecting the epiphyses, especially in long bones during rapid development, often disturb maturation by stimulating or retarding growth. The closer an injury is to the epiphyseal plate the greater is the potential for altered growth. In young children, uncorrected epiphy seal injury is followed by body asymmetry (Ch. 7, Figs. 7.25, 7.26).
ANGULATION of BONE FRAGMENTS (accompanying healing)
Figure 2.27. Long bones very noticeably altered in shape, probably secondary to physical violence during the period of growth are demonstrated. In 2.27A, an isolated radius is angulated laterally 25 degrees in its midportion. Most likely, faulty healing after a fracture produced this situation. The open radial head epiphysis suggests this was from an individual slightly less than 15 years of age at death. Unfortunately, no other skeletal components were available for this museum specimen.
In 2.27B, a right fibula is bowed, but its left counterpart and the right tibia, are normal.This deformity is interpreted as disparate growth caused by some stimulus during development.
Human remnants evaluated during the Dry Bones Survey have provided graphic and statistical evidence of the effect of accidents upon the people who lived in this region during more than a millennium. The end results of injury to bones provide dramatic evidence of traumatic events that transpired during life, such that the search for residua of trauma has long been a treasuretrove for paleopathologists. However, in our experience the residua or sequellae of bone injury have been relatively infrequent statistically. Accidents, at least those causing detectable osseous changes, appear to have been much less frequent in the past than they are in regional Native Americans today.
Fractures have comprised the largest group of ante-mortem injuries during all time intervals represented, followed in frequency by heterotopic bone formation and bone spurs. Para-mortem scalping was in both pre and post Columbian massacre skeletons, and ante-mortem scalping took place in both eras. Dislocations occurred during the millennium, but were not common. Retained projectiles from arrow and spear wounds were observed in some skeletal cohorts, but were infrequent. Other type injuries occurred sporadically.
The physical characteristics of individual bones have predetermined the type of injuries and influenced the mode and rapidity of healing. Bones usually heal at relatively predictable rates. Although it is not possible to prognosticate the speed at which a given fracture will heal, the most constant and reliable factor is the individual's age. A rough estimate of the fracture healing interval is: In infants union is rapid and complete in 4-6 weeks; In adolescents union is less rapid, but usually complete in 6-8 weeks; In adults union is slower, 10-12 weeks, sometimes 16-20 weeks; In the aged healing is much slower (92). Considering these factors, it often has been possible to postulate not only the cause and healing sequence of injury in ancient bones, but also to estimate the interval between the injury and death of the individual.
Modifications attributable to ante-mortem injury in regional skeletons have been contingent upon: 1. the body part affected and the type and severity of the injury; 2. the time elapsed between the injury and death; 3. the age and sex of the individual; 4. the healing (bone-setting) skills available at the time; and 5. complications such as osteomyelitis, malnutrition, or other factors.
In regional skeletons during healing bone usually was replaced in kind. However, some reparative processes were altered such that fibrous tissue substituted for bone, producing pseudoarthrosis. Or, contiguous non-osseous tissues were ossified forming bone spurs, heterotopic (metaplastic) bone, and calcified hematomas. This phenomenon is explained by the fact that tissues of mesodermal origin (bone, cartilage, muscle, fibrous tissue) have pleuripotential for growth or repair, and may take a seemingly different form, depending upon the stimulus and the milieu. When healing was faulty or when joints were involved by trauma, later in life degenerative changes often developed in affected and nearby joints.
Complicated bone and joint injuries were encountered occasionally. These included osteomyelitis, delayed or non-union, angular deformity, growth retardation or stimulation, avascular or aseptic necrosis, and degenerative joint disease (traumatic arthritis).
Comparison of the type, severity, and location of injuries that occurred during different time intervals and in several cultural groups was enhanced by Deitrick's work with skeletons from the Mobridge (MO1, MO2), Larson, and Leavenworth Sites. Excluding minor differences in types, generally the injuries were quite similar. Overall, there was considerably more evidence of accidents and injuries in people who lived and died at the late 18th century Larson Site than was apparent in pre-Columbian and other contem poraneous people. Although the reason for this difference is not immediately apparent, is interesting to speculate what part the coming of the horse and the migration of the Sioux into the Dakota Territory may have played in this difference.
Both in pre and post-1492 skeletons severe injury had not precluded prolonged survival. Undoubtedly the affected individuals were disabled and knew physical pain, but the fact of survival suggests the availability of effective life support measures during convalescence, and assistance after recovery. Although by 20th century standards the end results of many fractures would be unacceptable, the healing achieved was adequate to sustain life.
Long term survival occurred after penetrating wounds. Encysted projectile parts indicate that if infection was introduced it was overcome. The intruding material was incorporated into the injured bone and retained as an inert foreign object. This suggests that the aborigines were able to treat projectile injuries and the indiginous immune system was effective in controlling microorganisms introduced by projectiles.
The demonstration of scalping and other corporeal mutilation in pre-Columbian Crow Creek skeletons establishes these practices as part of their culture, and indicates that they antedated European arrival. In addition, non-lethal scalping with prolonged survival occurred in the region before and after 1492. Residua of aggressive trauma and the archaeological demonstration that it was necessary for 14th century Upper Missouri Basin inhabitants to live in walled, moated villages, corroborates the contention that warfare,pitting one tribe or village against another, existed in 14th century North America. In the final analysis, longitudinal human skeletal changes in this region attributable to injuries and accidents are similar to those in comparable North American indiginous populations. Until firearms, metal objects, and the horse were obtained from Europeans, the aborigines were in a stone age culture. The physical findings in skeletons relating to accidents that occurred in thisregion during more than a millennium are exactly what would be expected in a stone age culture in transition into the iron age.
Markup:
Larry J. Zimmerman, 12/30/97
