Significance
          Neurocranial fractures and their aftermath took a toll on people in premodern societies, much like today. Archaeological information on skeletal trauma, however, typically consists of mere tallies of injuries, much like other disease-related lesions. We quantify the increased risk of dying for men with healed cranial vault fractures, an approach that can be adapted to any pathological condition. In medieval to early modern Denmark, head-injured men experienced a relative risk of dying about double that of modern people, probably in large part because of differences in medical care and social support. This approach provides a means of measuring the extent, hence consequences, of excess injury and disease-related mortality across the full range of human societies extending into the distant past.</jats:p

Boldsen, Jesper L

Milner, George R

Weise, Svenja

PubMed

To date, no estimates of the long-term effect of cranial vault fractures on the risk of dying have been generated from historical or prehistoric skeletons. Excess mortality provides a perspective on the efficacy of modern treatment, as well as the human cost of cranial injuries largely related to interpersonal violence in past populations. Three medieval to early modern Danish skeletal samples are used to estimate the effect of selective mortality on males with cranial vault injuries who survived long enough for bones to heal. The risk of dying for these men was 6.2 times higher than it was for their uninjured counterparts, estimated through a simulation study based on skeletal observations. That is about twice the increased risk of dying experienced by modern people with traumatic brain injuries. The mortality data indicate the initial trauma was probably often accompanied by brain injury. Although the latter cannot be directly observed in skeletal remains, it can be inferred through the relative risks of dying. The ability to identify the effects of selective mortality in this skeletal sample indicates it must be taken into account in paleopathological research. The problem is analogous to extrapolating from death register data to modern communities, so epidemiological studies based on mortality data have the same inherent possibility of biases as analyses of ancient skeletons.</p

Syddansk Universitets Forskerportal

English