Introduction
Life in the Middle Ages was full of dangers for most Scots.1
Peasants had to handle a team of eight oxen, and cope with tree felling, building houses, and constructing and maintaining drainage ditches. Life was hard but less risky for urban artisans. The populace also could be caught up in wars against the English, and strife between magnates.
Trauma experienced by medieval Scots can be calculated by measuring the prevalence of fractures in the occupants of medieval graveyards. There have been two particularly useful studies. One relates to Carmelite Friaries at Aberdeen, Perth and Linlithgow, and the other to a Premonstratensian priory at Whithorn.2,3
Current situation
Table I presents the age distribution of men and women in Scotland from birth up to the age of 65 years for 1997 to 1998.4 Adjustment of the age distribution for fractures in Scotland from birth to 65 years gives an overall prevalence of 7.2%. The analysis was limited to subjects up to 65 years in an attempt to compensate for the low life expectancy of individuals in the medieval period. Even with this approach, however, the median age of the current sample of 46 years is much higher than the median age of death in the Middle Ages. 2,3
|
Table I
Age structure for population of Scotland, 1997-8. | |
|---|---|
| Age Group in Years | Percentage of Population |
| 0-4 | 6.0 |
| 5-14 | 12.7 |
| 15-24 | 12.7 |
| 25-44 | 29.8 |
| 45-64 | 23.0 |
Aberdeen, Perth and Linlithgow
(13th to 16th Centuries)
Excavations were conducted on three Carmelite Priories.2 The graves were plain and contained men, women and children indicating that the graveyards were used for the general populace as well as the clergy. A source of bias is that the subjects probably lived in an urban rather than a rural environment. A further concern is there often was insufficient material for gender definition or the identification of fractures. It also should be noted that skeletal ageing only is accurate prior to fusion of diatheses and epiphyses.5 Age thereafter is assessed from the severity of osteoarthritis, a condition modified by both genetic and enviromnental factors. This means that osteologists concentrate on a bone age as opposed to a chronological one. Table II gives speculative ages for subjects interred in the three priories. 44.2% were aged under 18 years and only 3.8% over 45 years, with a median age of death for those over 18 years of 30.6 years.
The prevalences of fractures were 11(9.2%) out of 120 for Aberdeen; 2(9.5%) out of 21 for Perth; and 13(6.5%) out of 201 for Linlithgow to give an average of 7.6%. Where gender could be established there were 10(13.5%) fractures in 74 males and 2(3.4%) in 59 females.
|
Table II
Age groups of subjects from Aberdeen, Linlithgow and Perth | |
|---|---|
| Age Group | Number |
| Fetal | 5(1.5) |
| Perinatal (+/- 2 months) | 13 (3.8) |
| Infant (2 months - 2 years) | 40(11.7) |
| Child (2 - 6 years) | 40(11.7) |
| Young Juvenile (6 - 12 years) | 27(7.9) |
| Old Juvenile (12 - 18 years) | 26(7.6) |
| Immature* | 11(3.2) |
| Subadult (18 - 25 years) | 26(7.6) |
| Young adult (skeletal maturity) | 72(21.1) |
| Middle aged adult (some degeneration) | 32(10.1) |
| Old adult (severe degeneration) | 13(4.1) |
| Adult* | 37(10.8) |
| Total | 342 |
| * Insufficient material to determine age group accurately.
Data taken from Table 9, page 122, Cross and Bruce. 2 | |
Review of fracture sites revealed that there were four skull fractures with three on the left side and one on the mid-line. A number of individuals had fractured ribs, with one having ribs fractured in two places suggesting a crush injury. Fractures of the fibula also were common. One fibula was broken at the upper end suggesting a direct blow, but the others were at the lower end suggesting a fall from a height. There also were a fracture of a tibia, fracture of a 5th metatarsal and two fractures of the pelvis. Fractures of the upper limb were ‘less common’, the usual site being the lower end of the radius. There also were two fractures to the surgical neck of the humerus, and two fractured metacarpals. Five individuals had multiple fractures. Most of the long bone fractures had callus formation indicating that they occurred a considerable time before death. There usually was satisfactory alignment of the segments indicating skilled nursing and surgical care.
Whithorn (14 th and 15th Centuries)
The cemetery overlay earlier ones dating back to the 5th Century. 6 It contained the remains of men, women and children most of who probably lived in the small town of Whithorn.3
A total of 512(31.9%) out of 1605 individuals were adjudged as under the age of 18 years, and only18(1.1%) as over 45. It was noted that there were 65(4.0%) out of all 1605 subjects who had evidence of fractures, and, amongst individuals in whom gender could confidently be determined, 31(14.3%) of 217 males and 13(5.1%) of 253 females had fractures.
Thirteen (0.8%) out of 1605 subjects had sustained a fractured skull. In those whose gender was established there was a skull fracture in six(1.9%) of 314 males and four (1.1%) of 356 females. In seven the left parietal bone was involved, in four the frontal bone and in two the occipital bone. The following lesions were noted.
Data were recorded on fractures of long bones dividing these into groups where the proximal, middle or distal segment or whole bone was available. It is difficult to present the findings numerically other than commenting that long bone fractures were uncommon. Within the limitations of the small number available, they appeared more common in males than females. As with the previous survey, most long bone fractures showed satisfactory healing, and alignment.
Other burials in Scotland
No fractures were found in 20 skeletons excavated from a medieval cemetery near Dunbar Castle.7 The picture was the same in 75 subjects disinterred from a medieval graveyard at St Mary’s Church, Dundee.8 The negative results may relate to small sample sizes. They also emphasise the low prevalence of previous fractures in a medieval population.
Burials elsewhere
Data are available from the excavation of a cemetery at St Helen-on-the-Walls in York dating from 1100 to 1550.9 There was a 2.9% prevalence of fractures, the most common long bone sites being the radius and ulna. As in Scotland, the segments of the fractured bones were well aligned.
A particularly relevant study was based on a medieval rural cemetery at Raunds England.10 There the prevalence of long bone fractures in 170 individuals was 19.4%, compared with ones of 5.5%, 4.9% and 4.7% at three comparable urban sites. Males had a marginally greater proportion of fractures than females. Further investigations of rural cemeteries are required before drawing too many conclusions from this small and possibly atypical sample.
Conclusions
Details on the prevalence of fractures in the Middle Ages should be treated with caution. In many cemetery excavations there is insufficient burial material for skeletal analysis, fractures may be missed on incomplete skeletons, and large numbers are required for effective statistical analysis. Babies and young children usually are under-represented.
It also is clear that the greater median age of the modern sample provided more time for individuals to sustain a fracture. Bias was reduced, however, by a marginal decline in the incidence of fractures in modern subjects between the ages of 45 years and 64 years.4
Despite deficiencies in the collection of data, it is interesting that a 7.2% prevalence of fractures in the 1998 population is almost identical to that of 7.3% in the Carmelite friaries, and within the same range as that of 5.0% at Whithorn. It would seem that the risk of a fracture was much the same in medieval and modern Scots.
The disparity in urban fracture rates between males and females in medieval Scotland may be due to tasks undertaken by artisans being more risky than those of women who either stayed at home or were involved in sedentary work. The suspicion that there might have been a higher rate of fractures in rural areas needs further evidence for substantiation.
Despite an impression of tranquillity and low fracture rates, a number of males and females sustained head injuries inflicted by clubs, swords and sling shots. The fact that females sustained a high proportion of these suggests that chivalry played little part in the behaviour of men-at-arms when raiding a town. Two skulls with partial trepanning marks emphasise the use of this operation ever since prehistory for a variety of medical and surgical conditions.11
In both series there were diverse fractures of the long bones of both the upper and lower limbs, but the number of these is too small to speculate on their distribution or causes. The striking feature was that there was a substantial amount of callus around the fractures and satisfactory alignment of the two segments. It would appear that one aspect in which barber surgeons were expert was in the immobilisation of fractures.
The impression overall then is that, in terms of trauma, life within small medieval towns was not particularly hazardous. This all changed when the townspeople found themselves in the middle of a war, or a battle between magnates. Allowing for inaccuracies inherent in the methodology, the prevalence of fractures was within the range encountered in Scotland today. Perhaps it us who should be looking at why things are not a lot better.