Caring for the injured: Exploring the immediate and long-term consequences of injury in medieval Cambridge, England.

OBJECTIVE: To combine paleopathological and biomechanical analysis to reconstruct the impact that a severe skeletal injury had on an individual's ability to function and participate in medieval society. MATERIALS: Three medieval individuals from Cambridge, England with ante-mortem fractures to the lower limb were analyzed. METHODS: Plain X-rays were used to determine the degree of malunion, rotation and overlap of each fracture. Cortical bone architecture of the injured individuals and 28 uninjured controls were analyzed using micro-computed tomography (µCT). Clinical and functional consequences were examined using the Bioarcheology of Care framework. RESULTS: The mechanism of injury, the secondary complications, and the extent of the care received was reconstructed for each individual. Bilateral asymmetry in the cortical bone architecture revealed the long-term alterations to each individual's gait. CONCLUSION: Each of these individuals survived a severe injury resulting in chronic physical impairment, though not all would have been considered 'disabled'. SIGNIFICANCE: This research contributes to the discussion about medieval care provision and social constructions of disability by illustrating how an interdisciplinary approach provides insight into the experiences of those with physical impairments. The integration of µCT imaging within the Bioarcheology of Care model is a novel approach with great potential for application across the field. LIMITATIONS: Biomechanical analysis was restricted to cortical geometry. SUGGESTIONS FOR FUTURE RESEARCH: Further study of bilateral asymmetry in trabecular architecture could complement our understanding of altered loading modalities in past societies.

Buried with their Buckles On: Clothed Burial at the Augustinian Friary, Cambridge.

GIRDLE BUCKLES ASSOCIATED with several groups of burials at the later-medieval Augustinian friary in Cambridge indicate that clothed burial was common, with a much higher prevalence than usual for the period. The clothed burial was highly regularised, in terms of both the garments worn and the types of buckles used, and apparently limited to members of the Augustinian Order. The buckles were primarily supplied by the friary, rather than representing individual choices, and there is evidence that the girdles that individuals were buried with were those they used in life. These buckles functioned on several levels, as symbols of both corporate and personal identity. Discoveries at other English Augustinian friaries demonstrate specific typological parallels, indicating broader connections, networks and identities. Although buckles are common late-medieval items, those from the Cambridge Augustinian friary present a unique opportunity to contextualise their use by one segment of society.

Inhumés avec leur ceinture : inhumations habillées au monastère des Frères de l'ordre de Saint-Augustin, à Cambridge par Craig Cessford, Andrew Hall, Bram Mulder, Benjamin Neil, Ian Riddler et Justin Wiles, avec les contributions d'Esther Cameron et de Quita MouldLes boucles de ceinture associées à plusieurs groupes de sépultures de la fin du Moyen-Âge, au monastère des Frères de Saint-Augustin à Cambridge, indiquent que l'inhumation des corps habillés était pratiquée couramment, bien plus que ce n'était usuel à cette période. L'inhumation des défunts habillés était hautement codifiée, aussi bien en termes des vêtements portés et des types de ceinture, et se limitait apparemment aux membres de l'ordre des Frères de Saint-Augustin. Les boucles étaient fournies principalement par le monastère, plutôt qu'un choix individuel, et certains éléments suggèrent que les ceintures portées par les défunts étaient celles qu'ils portaient dans la vie. Ces boucles étaient symboliques à plusieurs niveaux, à la fois d'une identité corporatiste et individuelle. Les découvertes dans d'autres monastères anglais de l'ordre des Frères de Saint-Augustin présentent des parallèles typologiques spécifiques, indiquant plus largement des liens, des réseaux et des identités. Bien que les boucles soient couramment retrouvées à la fin du Moyen-Âge, celles du monastère des Frères de Saint-Augustin à Cambridge nous donnent une unique opportunité de contextualiser leur utilisation par un segment de la société.

Gräber mit Gürtelgarnituren: Bekleidete Bestattung im Augustinerkloster, Cambridge von Craig Cessford, Andrew Hall, Bram Mulder, Benjamin Neil, Ian Riddler und Justin Wiles, mit Beiträgen von Esther Cameron und Quita MouldGürtelgarnituren aus mehreren Gräbergruppen des spätmittelalterlichen Augustinerklosters in Cambridge deuten darauf hin, dass die Beisetzung in Kleidern dort üblich war und einen für die damalige Zeit ungewöhnlich hohen Verbreitungsgrad hatte. Die Beerdigung in Kleidern war sowohl in Bezug auf die getragenen Kleidungsstücke als auch auf die Art der verwendeten Schnallen stark reglementiert und offenbar auf Mitglieder des Augustinerordens beschränkt. Die Schnallen wurden vorwiegend vom Kloster beschafft und stellten keine individuelle Wahl dar. Es gibt jedoch Hinweise darauf, dass es sich bei den Gürteln, mit denen die Personen bestattet wurden, um diejenigen handelte, die sie zu Lebzeiten getragen hatten. Die Schnallen fungierten auf mehreren Ebenen als Symbole sowohl der korporativen als auch der persönlichen Identität. Funde in anderen englischen Augustinerklöstern zeigen spezifische typologische Parallelen, die auf umfassendere Verbindungen, Netzwerke und Identitäten hinweisen. Gürtelschnallen waren im Spätmittelalter zwar weit verbreitet, die aus dem Augustinerkloster in Cambridge stammenden Schnallen bieten jedoch eine einzigartige Gelegenheit, ihre Verwendung seitens einesbestimmten Gesellschaftssegments zu kontextualisieren.

Sepolti con le proprie fibbie: sepolture vestite nel convento agostiniano di Cambridge di Craig Cessford, Andrew Hall, Bram Mulder, Benjamin Neil, Ian Riddler e Justin Wiles, con contributi di Esther Cameron e di Quita MouldLe fibbie per cintura associate a diversi gruppi di sepolture presso il convento agostiniano tardomedievale di Cambridge indicano che la sepoltura vestita era una pratica usuale, con una prevalenza maggiore del solito in quel periodo. La sepoltura vestita seguiva regole molto precise sia per quanto riguarda gli indumenti indossati, sia per le fibbie impiegate e, a quanto pare, era limitata ai membri dell'ordine agostiniano. Le fibbie venivano principalmente fornite dal convento anziché rappresentare scelte individuali e risulta che le cinture con cui erano sepolti gli individui erano quelle che usavano da vivi. Queste fibbie avevano molteplici valenze come simboli sia di identità personale che collegiale. I ritrovamenti presso altri conventi agostiniani inglesi dimostrano specifici paralleli tipologici, il che indica l'esistenza di legami, reti e identità più estesi. Benché le fibbie siano oggetti comuni nel Basso Medioevo, quelle del convento agostiniano di Cambridge offrono la straordinaria possibilità di contestualizzarne l'uso da parte di un settore della società.

Assessing the relative benefits of imaging with plain radiographs and microCT scanning to diagnose cancer in past populations.

OBJECTIVE: To determine the degree to which plain radiographs (x-rays) and microCT scans can improve accuracy in the diagnosis of cancer in human remains from past populations. MATERIALS: The skeletal remains of 143 individuals from medieval Cambridgeshire, dating from 6th-16th century CE. METHODS: Visual inspection of the skeletons for lesions compatible with malignancy, coupled with plain radiographs and microCT scans of the pelvis, femora and vertebra. RESULTS: Three individuals had visually apparent metastases on their skeletons. Plain radiographs did not identify further individuals with cancer, but did show further lesions in bones with normal external appearance. MicroCT scans identified cancer in two further individuals with normal visual appearance and normal plain radiographs. CONCLUSIONS: Imaging human skeletal remains increases the detection rate of cancer in human skeletal remains. We found microCT scanning to be a much more sensitive imaging modality than plain radiography. It improved our diagnostic accuracy and enabled us to more reliably distinguish between malignant lesions and taphonomic change. SIGNIFICANCE: Future studies investigating the prevalence and nature of malignancy in past populations would benefit from systematic microCT scanning of pelvis, femora and vertebrae of skeletons to optimise their diagnostic accuracy. LIMITATIONS: MicroCT scanning is more expensive than plain radiographs, and may not be easily accessible to biological anthropologists. SUGGESTIONS FOR FURTHER RESEARCH: To apply this approach to skeletal series from different time periods and geographical regions, where the types of cancer existing in the local population may differ from those we studied in medieval Britain.

The prevalence of cancer in Britain before industrialization.

BACKGROUND: To plan for cancer services in the future, the long view of cancer prevalence is essential. It might be suspected that cancer prevalence before tobacco and industrial revolution pollutants was quite different to today. METHODS: To quantify the degree to which cancer prevalence may be changing over time, the authors analyzed 143 skeletons from 6 cemeteries from the Cambridge area (6th-16th centuries). Visual inspection coupled with screening using both plain radiographs and computed tomography scans was used to detect malignant lesions. RESULTS: A total of 3.5% of individuals showed evidence for metastases. Factoring in modern data for the proportion of those with cancer that die with bone metastases, this suggests a minimum prevalence of all cancers at the time of death in medieval Britain to be approximately 9% to 14% of adults. CONCLUSIONS: This figure compares with a 40% to 50% prevalence of cancer at the time of death for modern Britain. The difference may be explained by the effects of modern carcinogens, the spread of viruses that trigger malignancy, industrial pollutants, and longer life expectancy. LAY SUMMARY: Until now, no one has been able to work out how common cancer was before the time people were exposed to tumor-inducing chemicals from tobacco and industrial factories. In this novel study, the authors have determined the percentage of people living in medieval Britain who had cancer metastases to bone at the time of their death and then compared that with modern data. It was found that cancer was approximately 25% as common in medieval times as it is today. This article suggests cancer was much more widespread in medieval times than was previously realized.

Gout and 'Podagra' in medieval Cambridge, England.

OBJECTIVE: To estimate the prevalence rate of gout and to explore the social factors that contributed to its development in the various sub-populations in medieval Cambridge. MATERIALS: 177 adult individuals from four medieval cemeteries located in and around Cambridge, UK. METHODS: Lesions were assessed macroscopically and radiographically. Elements with lytic lesions were described and imaged using micro-computed tomography (µCT) to determine their morphology. RESULTS: Gout was identified in 3 % of the population. Individuals buried in the friary had highest prevalence (14 %), with low prevalence rates in the Hospital (3 %) and town parish cemetery (2 %), with no cases in the rural parish cemetery. Gout was more prevalent during the 14th-15th centuries than the 10th-13th centuries. CONCLUSION: The high prevalence rate of gout in the friary is at least partly explained by the consumption of alcohol and purine-rich diets by the friars and the wealthy townsfolk. Medieval medical texts from Cambridge show that gout (known as podagra) was sometimes treated with medications made from the root of the autumn crocus. This root contains colchicine, which is a medicine that is still used to treat gout today. SIGNIFICANCE: This is one of the first studies to assess the epidemiology of gout in medieval England and suggests that gout varied with social status. LIMITATIONS: Our sample size precludes statistical analysis. SUGGESTIONS FOR FURTHER RESEARCH: Additional studies that assess the epidemiology of gout in medieval Europe is needed in order to be able to fully contextualize these findings.

Intrapopulation variation in lower limb trabecular architecture.

OBJECTIVES: Trabecular structure is frequently used to differentiate between highly divergent mechanical environments. Less is known regarding the response of the structural properties to more subtle behavioral differences, as the range of intrapopulation variation in trabecular architecture is rarely studied. Examining the extent to which lower limb trabecular architecture varies when inferred mobility levels and environment are consistent between groups within a relatively homogenous population may aid in the contextualization of interpopulation differences, improve detectability of sexual dimorphism in trabecular structure, and improve our understanding of trabecular bone functional adaptation. MATERIALS AND METHODS: The study sample was composed of adult individuals from three high/late medieval cemeteries from Cambridge (10th-16th c.), a hospital (n = 57), a parish cemetery (n = 44) and a friary (n = 14). Trabecular architecture was quantified in the epiphyses of the femur and tibia, using high resolution computed tomography. RESULTS: The parish individuals had the lowest bone volume fraction and trabecular thickness in most regions. Multiple sex differences were observed, but the patterns were not consistent across volumes of interest. DISCUSSION: Differences between the three groups highlight the great variability of trabecular bone architecture, even within a single sedentary population. This indicates that trabecular bone may be used in interpreting subtle behavioral differences, and suggests that multiple archaeological sites need to be studied to characterize structural variation on a population level. Variation in sex and group differences across anatomical locations further demonstrates the site-specificity in trabecular bone functional adaptation, which might explain why little consistent sexual dimorphism has been reported previously.

Osteobiography: The History of the Body as Real Bottom-Line History.

What is osteobiography good for? The last generation of archaeologists fought to overcome the traditional assumption that archaeology is merely ancillary to history, a substitute to be used when written sources are defective; it is now widely acknowledged that material histories and textual histories tell equally valid and complementary stories about the past. Yet the traditional assumption hangs on implicitly in biography: osteobiography is used to fill the gaps in the textual record rather than as a primary source in its own right. In this article we compare the textual biographies and material biographies of two thirteenth-century townsfolk from medieval England-Robert Curteis, attested in legal records, and "Feature 958," excavated archaeologically and studied osteobiographically. As the former shows, textual biographies of ordinary people mostly reveal a few traces of financial or legal transactions. Interpreting these traces, in fact, implicitly presumes a history of the body. Osteobiography reveals a different kind of history, the history of the body as a locus of appearance and social identity, work, health and experience. For all but a few textually rich individuals, osteobiography provides a fuller and more human biography. Moreover, textual visibility is deeply biased by class and gender; osteobiography offers particular promise for Marxist and feminist understandings of the past.

Dizziness in older people: at risk of shared therapeutic nihilism between patient and physician. A qualitative study.

BACKGROUND: Dizziness-related impairment is a strong predictor for an unfavourable course of dizziness in older people. In this study we explored the experiences of older patients with significant dizziness-related impairment and their wishes and expectations regarding general practitioner (GP) care. Knowing the expectations and priorities of people with dizziness may enable the GP to provide tailor-made care, which in turn may substantially increase the quality of life and decrease the use and costs of health care. METHODS: We conducted a qualitative study with semi-structured interviews. We selected patients from ten Dutch general practices. Patients were invited to participate in the study if they were ≥ 65 years, visited their GP because of dizziness and were significantly impaired due to dizziness (Dizziness Handicap Inventory ≥ 30). We applied content analysis to the semi-structured interviews. RESULTS: Thirteen participants participated, seven were female. Analysis of the interviews resulted in the overall theme "Dizziness in older people: at risk of shared therapeutic nihilism by the patient and the GP". Firstly, this can explained by the fact that participants frequently presented dizziness as a secondary complaint when they visited the GP for another complaint. Secondly, participants reported that the GP often could not help them with any treatment. Despite a poor therapeutic outcome, the vast majority of participants was satisfied how the GP handled their dizziness. Yet, understanding the cause of dizziness seems important for dizzy older patients. CONCLUSIONS: Despite significant dizziness-related impairment, older dizzy patients may not present dizziness as main reason for encounter. Presenting dizziness as a secondary complaint may give GPs the - wrong - impression that the dizziness-related impairment is only mild. GPs need to be aware of this potential underreporting. Knowing the cause of dizziness seems important for older patients. Yet, GPs regularly did not succeed in identifying the underlying cause of dizziness. Therefore, GPs should manage the expectations of older dizzy patients regarding diagnosis and successful treatment, by informing them about the uncertainty and unpredictability of dizziness. We also recommend GPs to focus on improving functional ability; this is the key to escape from therapeutic nihilism by the GP.