A Bioarchaeological Assessment of Health and Trauma in Post-Imperial Peru

C. Angely Mondestin, Department of Anthropology, Haverford College and Danielle S. Kurin, Department of Anthropology, Vanderbilt University
Introduction
Traumatic violence may result in the subsequent compromised health of individuals. This paper reports on the bioarchaeological evidence for violence and compromised health among different skeletal sub-populations in highland, prehistoric Peru. Human skeletal remains affiliated with the post-imperial Chanka society (AD 10001400) were examined to see if patterns of ante-mortem traumatic injury due to violent conflict are associated with Porotic Hyperostosis (PH) and Cribra Orbitalia (CO). Cranial remains (n = 37) from three Chanka sites currently housed in the Municipal Museum in Andahuaylas, Peru were examined.

Methods
Standard bioarchaeological methods were employed in the analysis of human remains (Buikstra and Ubelaker 1994). The age and skeletal sex of each individual was determined based on dimorphic characteristics. Among the 37 crania present in the study, sex estimation was determined for all but two crania. In order to correlate sex with porotic hyperostosis and cribra orbitalia, these two crania were taken out of the study, making the new total N=35. Cranial modification was assessed in terms of absence and presence (see Hoshower et.al. 1995). To ascertain how violence was experienced within this society, crania were examined for evidence of trauma (Lovell 1997). To ascertain intent and lethality, locations of affected areas on bone were documented, and the number and types of fractures and concomitant abnormal bone changes were described. The timing of fractures, based on healing, was also examined. Wound shape and size was documented in an attempt to determine the mechanism of injury and class of weapon used. Impact location and radiating fracture directions were recorded to determine the victims position relevant to the direction of force (Galloway 1999). Porotic hyperostosis and cribra orbitalia were identified by the presence or absence of each pathology. The degree to which PH and CO were expressed as well as the location on the cranium were coded using Standards (Buikstra and Ubelaker 1994). In order to study PH and CO as distinct markers and analyze the possible relationships they have with trauma in a meaningful way, any cranium that was coded with a PH or CO degree of barely discernible was instead listed as having no PH or CO present. Data were analyzed in terms of percentages, frequencies, Chi-square (using Yates correction to account for the small sample size) and Fishers exact testing. Left: Healed facial fracture caused by blunt-force trauma; Right: Healed depression fracture on the cranial vault, with detail.

SITES: 1. MASUMACHAY 2. RANRA CANCHA 3. MINA CACHIHUANCARAY The Study Region: Andahuaylas, Apurimac, Peru.

Comparison of PH/CO frequencies by Cranial Modification 120 (N=35)

Comparison of PH/CO frequencies by Sex (N=35) 120

A Chaka Burial Cave containing multiple, secondary internments. Human remains and associated artifacts were transported to the Andahuaylas Museum for analysis.

100 80 60 PH CO

100 80 60 40 20 0
PH CO

Post-Imperial Andean Society (AD 1000-1400)

There is a strong consensus among researchers that no central state emerged in the Andes during the period after the disintegration of the Wari and Tiwanaku empires and before the advent of the Inka empire (Covey 2008). Like other post-imperial cultural groups (Tung 2009, Torres-Rouff and Costa 2006) one society of the time, termed Chanka, is thought to have witnessed endemic, violent conflict (Lumbreras 1974). Indeed, previous research on the Chanka suggests that both lethal, and non-lethal violence, in the form of cranial fractures affected over half the population (Kurin and Gomez 2008). While unhealed fractures suggest injuries which occurred at or around the time of death, healed, or healing injuries indicate that an individual survived a violent encounter. However, individuals who survived a traumatic blow to the skull may have suffered from unintended physiological, psychological, and social after-effects which could have been ultimately detrimental to their health.

40

Left: Porotic Hyperostosis on the occipital and parietals, with detail; Right: Cribra Orbitalia in both orbits.

Preliminary Results
Sex distribution among the study population (N=35) Age distribution among the study population (N=35) 3% (n=1) Adolescents Distribution of cranial modification among the study population (N=35)

20 0

Cranial Modification No Modification PH: (Yates correction)= 5.593, p < .01; Fishers exact P value = .009.
Comparison of trauma lethality frequencies by Sex (N=35)

Females

Males

Comparison of trauma presence by Cranial Modification (N=35)

100
23% (n=8) Females 43% (n=15) Young Adults 77% (n=27) Males 46% (n=16) Middle Adults 57% (n=20) No Modification 43% (n=15) Cranial Modification

100% 90% 80% 70% 60% 50% 40% 30%

50% (n=4/8) of Females had modification (27% of the total sample). 41% (n=11/27) of Males show modification (73% of the total sample).

90 80 No Trauma Both Ante- and Peri-Mortem Only PeriMortem Only AnteMortem 70 60 50 40 30 20 10 0 Males Females Cranial Modification No Modification (Yates correction)= 8.283 p < .004; Fishers exact P value = .0015. Trauma No Trauma

Stone weapons (maces and sling stones) associated with the Chanka of Andahuaylas

20% 10% 0%

Compromised Health from Skeletal Remains

Porotic hyperostosis (PH) is osseous evidence of an increase in the cranial diplo at the expense of the outer table, which results in thinning and porosity of the cortex. In cases of acquired anemia, hemoglobin insuffiencies cause the body to increase production of red blood cells, thus causing marrow hypertrophy. The subsequent expansion outward produces diploic bone. Similar to PH, cribra orbitalia (CO) presents itself as porotic bone in the orbits, and may be a precursor to PH since the thin outer lamina of the orbit is less resistant to pressure from expanding marrow cavities than the cranial vault (Wapler et. al 2004). One of the proposed causal factors of PH and CO is acquired anemia (Palkovitch 1987). This type of anemia has various proposed etiologies, including low iron dietary intake (Kent 1986), inhibited iron absorption (El-Najjar et. al. 1976), parasitic load, (Stuart-Macadam 1992) nutritional deficiencies, and blood loss caused by traumatic injury (Walker et. al, in press). This study tests the assumption that traumatic injury among the Chanka may have resulted in major blood loss, possible subsequent infections, and thus iron depletion, causing porotic hyperostosis and cribra orbitalia. Such injuries (such as non-lethal injuries to the face) may have also physically inhibited a victims ability to consume foods, leaving them susceptible to vitamin and mineral deficiencies. Thus, those individuals with healing and healed injuries are expected to demonstrate a higher frequency of PH and CO than their un-injured neighbors. This study systematically characterizes porotic hyperostosis (PH) and cribra orbitalia (CO)known indicators of compromised health with diverse etiologies, and tests associations between the presence or absence of PH and CO, and patterns of healed traumatic injury within an archaic, non-state population.
Left: Percentage of population with Porotic Hyperostosis (N = 35)

31% (n =11 ) NO Porotic Hyperostosis 69% (n = 24) Porotic Hyperostosis Present

20% (n = 7) NO Cribra Orbitalia

Left: Percentage of population with Cribra Orbitalia (N=35)

Initial Conclusions
1. Individuals who received non-lethal injuries had higher frequencies of PH and CO than individuals who received either only lethal trauma, or no trauma at all. Differences in PH frequencies between these groups are significant. 2. Females experienced higher frequencies of PH and CO than males, but the difference is not significant. 3. Age does not appear to have any correlations with PH and CO or ante-mortem trauma in this sample. 4. Individuals with cranial modification have both significantly higher frequencies of PH, and traumatic injuries than individuals without cranial modification. CO does not significantly correlate with cranial modification. 5. Males received more lethal trauma and less non-lethal trauma than females, but this difference is not significant. 6. While the correlation between PH and ante-mortem trauma was found to be statistically significant, the relationship between CO and ante-mortem trauma holds no statistical significance. The results of this study are limited by the small sample size, and various etiologies of PH and CO that exist. Furthermore, correlation does not necessarily mean causation. Although these results are consistent with the hypothesis, there is currently no sufficient evidence to assert any causal relationship between ante-mortem trauma and PH/CO.

80% (n =28) Cribra Orbitalia Present

Distribution of cranial trauma within the study population (N=35)

Distribution of trauma lethality within the wounded subpopulation (N = 22)

Documenting Violence
Archaeological skeletons provide the only direct evidence of violent interpersonal interactions in past societies (Larsen 1997:119). The life history of an individual is sedimented in their bones, and includes biologically-based information related to the health of an individual, but also culturally-mediated changes to the skeleton, including evidence of interpersonal physical conflict. Non-random patterns of cranial fractures, specifically, may be a reliable proxy for violence (Walker 2001, Lovell 1997). Analysis of fracture patterns can help to reveal whether an injury was accidental or intentional, and if that injury was lethal, or non-lethal. These classes of morbidity data can then be collated with variables such as age and sex, and in this study, CO and PH. This allows us to examine evidence of compromised health as a possible consequence of violent interaction for specific individuals, sub-population groups, and ultimately entire populations.
90 80 70 60 50 40 30 20 10 0 Ante-Mortem Either Peri-Mortem or No Truama 37% (n = 13) 63% (n = 22) Trauma No Trauma

9% (n = 2) 31% (n = 7) Only Peri-Mortem Only Ante-Mortem Both Ante- and PeriMortem

60% (n = 13)

Ante-mortem trauma and PH/CO (N=35) Left: Comparison of frequencies of PH and CO between the sub-population group with only ante-mortem trauma, and the amalgamated sub-population group consisting of individuals both with no trauma and only peri-mortem trauma.

Acknowledgments
Research by CAM was supported by the Frederica de Laguna Fund and the Summer Internship Fund, Bryn Mawr College, and a Humanities Research Grant, Haverford College. Research by DSK was supported by a Fulbright-Hays Doctoral Dissertation Research Fellowship, the Center for Latin American Studies, the Center for the Americas, and the College of Arts & Sciences, Vanderbilt University. Special thanks to DE Gomez Choque, and the Proyecto Bioarqueologico Andahuaylas Team. Correspondence: amondest@haverford.edu; danielle.s.kurin@vanderbilt.edu
AAPA 2010, Albuquerque, NM

Chanka Crania. Left: Cranial Modification; Right: Unmodified Cranium

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PH CO

Left: Well-healed cranial depression fracture; Right: Peri-mortem cranial depression fracture.

PH: (Yates correction)= 4.201, p < .04; Fishers exact P value =.027