Break a Leg! Fracture Treatment in Iron Age and Roman Britain

Medical treatment, despite our own Western perspective of science, is a cultural trait. How we choose to treat different forms of trauma, the methods of recovery, and the beliefs surrounding medicine are all culturally dictated. In our own society there are constant debates over the necessity to get certain vaccinations, whether one should be active or in bed during certain sicknesses, the actual efficacy of chicken noodle soup, or if the entire thing could be healed simply by being less ‘stressed’. We rely on science and popular belief, which change drastically over time. There have long been debates over the changes that occurred in health with Romanization. Examination of skeletal remains have shown both improvement and decline in overall health. A study by Redfern (2010) takes a different approach and looks at the cultural change in medical beliefs and practices through physical remains.

Ancient Roman Medical Tools, via Flickr user vignish2011

Redfern (2010) examined 270 sexed adults and 190 subadult individuals for
evidence of ante mortem fractures and surgical practice in Dorset. The goal was to assess changes in treatment from the Iron Age (5th c. BCE to 1st c. CE) to the Romano-British period (1st c. to the end of the 4th c. CE). It is assumed that the Romans brought some semblance of science and progress to these barbarian cultures, but new analysis shows this isn’t necessarily true. The analysis of healed fractures requires careful assessment of the bones. When a fracture heals the remodeled bone can be obviously altered, especially if the bone doesn’t set correctly, or only slightly expanded if the healing is good. Examining surgery is harder as the distinction between a surgical tool and weapon can be difficult, and requires attention to details around the injury. Other forms of healing done to the soft tissue or through herbal remedies cannot be determined from the skeletal remains.

Other evidence of medical intervention can be helping in understanding treatment in the past and changes in medicine. In Iron Age German sites they found found probes, retractors and bone saws that would have been used in surgery. In Essex they found an Iron Age doctor’s burial which included scalpels, hooks, spring forceps, saw, needles and a scoop probe. Herbs and spices found in the grave may also be indicative of herbal remedies. Evidence of Roman medicine is much richer including medical texts, instruments, inscriptions and depictions.  However, most of these are found within the Mediterranean. Roman medical equipment is found in Britain, but it is primarily located at military sites and it isn’t known whether the average individual would have had access to this type of care.

Posterior view of a healed apposition fracture in the left tibia and fibula of a Romano-British male, via Redfern 2010

In order to assess healthcare and change, Redfern examined 270 sexed adults and 190 subadult individuals dating from the 5th c. BCE to the end of the 4th c. CE. From the Iron Age there were 64 males, 51 females and 80 subadults. From the Romano-British period there were 96 males, 59 females, and 110 subadults. Individuals were taken from 21 cemeteries around the Dorset region. She recorded fractures based on location, type of fracture, healing, and whether it resulted in deformity (change in angle, rotation, shortening or bones rebuild next to rather than end to end) or associated degenerative problems like arthritis. Surgical treatment was identified based on the type of trauma, presence of cut-marks, and presence of surgical artifacts.

Within the Iron Age population she found that there were a number of high risk fractures (those that would be difficult to heal or possibly cause nerve damage) that were well set and didn’t develop infection. This suggests that the medical practitioners were able to effectively cope with a wide range of traumas. Non-union was only present in one individual, which likely means most individuals were given proper care and rehabilitation after the fracture. There was also only one individual who displayed apposition (where fracture bones heal next to one rather than properly end to end), which means that splinting of bone was highly likely to hold the break in place and properly set it. In the Roman period there is an increase in healed fractures that are deformed. This doesn’t necessarily mean that the medical knowledge decreased or practitioners were worse, but may be a sign that individuals were not given proper rehabilitation time. There is an increase in the number of surgeries, with a variety of trepanations and amputations occurring in the Roman period.

The research on fractures shows that both Iron Age and Romans knew how to properly treat this types of injuries. With conquest there is not a drastic change in individual health or treatment of fractures, but there is increased surgery which likely meant introduction of new knowledge. This study is quite interesting because it adds to the story of Romanization, changing it from one of a civilizing process to one of the rise of a new syncretic culture.

Works Cited
ResearchBlogging.orgRedfern, Rebecca (2010). A regional examination of surgery and fracture treatment in Iron Age and Roman Britain International Journal of Osteoarchaeology, 25 (4) DOI: 10.1002/oa.1067

16 responses to “Break a Leg! Fracture Treatment in Iron Age and Roman Britain

  1. “In the Roman period there is an increase in healed fractures that are deformed. This doesn’t necessarily mean that the medical knowledge decreased or practitioners were worse, but may be a sign that individuals were not given proper rehabilitation time.”

    But I suppose that the higher rate of deformities might mean that the bones were poorly set and that doctors were in fact worse—? Also, it seems odd that there were more amputations in the Roman period. I’m wondering what that could mean.

    • Yes, it could mean that they weren’t as skilled at setting the bones. I think what the author was doing here is making the alternative argument because we know Romans had the medical knowledge to properly set bones- so the question is why weren’t these set well? It may be that the Romans had younger less skilled military medical doctors in the provinces. The increase in amputations could be due to a number of reasons. First, lack of amputations for the Iron Age may mean that they didn’t know how to do this procedure or didn’t have the medical skills to pull it off. Second, the military nature of the Romans in Britain may mean they got into problems that required amputation more. Or maybe a combination of these two (or a third option I didn’t even think of!!)

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  3. options: #3 pre-romans might have preferred to deal with infection with some lost (or more likely hopelessly ineffective) anti-biotic instead of amputation. #4 there might have been a religious prohibition against amputation (vide Bob Marley).
    The poor/conquered/oppressed-people didn’t get good care/time to recover hypothesis fits in (too?) neatly with a marxist narrative 😉
    The Roman=military equation is counter-intuitive, as Roman Britain was relatively peaceful. Does the sample have any confirmed military?

    • @jkmol: Sorry to disabuse you of the notion that Roman Britain was relatively peaceful. It was far from that, with constant rebellions taking place. The size of the standing garrison there at all times during the Empire is an indication of this: 4/3 legions and the same or greater number of auxiliaries – for a tiny island. Spain had one legion. All of N. Africa incl Egypt had 2, and so on – far greater areas with far smaller garrisons. I refer you to de la Bedoyere’s book on the Roman army in Britain among others, if you’d like more proof of that.
      Best wishes.

      • Great point Ben. Roman Britain was not peaceful, although neither was the Late Iron Age prior to conquest. Unlike many other provincial areas, Roman Britain was in fact mostly militarized due to the constant uprisings (early uprisings in the southeast, then later there was consistent trouble with attempt to dominate the north- which explains the Antonine and Hadrian wall). We do know that the ‘Roman’ population analyzed was military due to the strong Roman presence within the grave and the site.

      • Roman Britain was certainly not monolithic either. Neither in space nor in time. I would imagine the army to be concentrated more towards the North, and Wales. And the 3rd and 4th centuries to be fairly prosperous. But I might let De la Bedoyere disabuse me as soon as I get my hands on his book. Looked the article up, but it is firmly behind a paywall so I won’t speculate on it anymore.

  4. Coming from both an orthopaedic and military background, The younger more inexperienced medicus may find themselves on the frontier in Brittania a lot faster than an exeprienced one training under a greek physician in Italy. Furthermore, we could assume these soldiers were likely asked to return to duty faster out of nessesity. I think we can also assusme a lot of these subjects may have been in the Legions since they had better access to the best care available. Yes?

  5. Bottom line. the aforementioned situations above could reasonable explain a higher rate of malunions ( especially amputations) in Roman Britan at the time.

    • Thanks for the personal perspective! It would make sense that this most distant province wouldn’t get the most attention. In fact, one of the problems with holding Britain was often that the best soldiers were in other more important provinces like Germany, the eastern Mediterranean and parts of Italy.

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  9. Could it be, that the druids were the ones doing most of the surgery before the romans took over? And since most of the druids were killed, there simply might have been a great lack of surgeons? Especially for those would not, or could not go to a roman surgeon.
    Just a thought.

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