Putting fracture reduction on repeat: an analysis of the long-term health consequences of differential treatment in industrial-era London

Traumatic injury is the leading cause of mortality in over ten percent of all deaths worldwide, and is becoming a major global issue. Treatment can prevent injury related mortality, but access to it is constrained by culture. Further, those that survive the injury event may develop long-term health conditions, including subsequent injury. To understand how culture might constrain access to treatment in the present, and why such a constraint might have long-term health consequences, this study investigated patterns of treatment and subsequent injury in two socioeconomically disparate communities from Industrial-era London (AD 1700-1850). It was hypothesized that the quality of treatment received (1) was unevenly distributed among the population, and (2) influenced the likelihood of subsequent injury. Fractures and their complications were recorded for forty-six individuals curated at the Museum of London Centre for Human Bioarchaeology, thirteen individuals from the high-status Chelsea Old Church sample, and thirty-three individuals from the low-status St. Bride’s Lower Churchyard sample. The prevalence of fracture complications, including fracture deformity and non-union, were first compared between samples, and then between individuals with single and multiple fractures. The results suggest that (1) socioeconomic status did not deter individuals from seeking treatment for their injuries in either community, and (2) the quality of treatment received did not influence the likelihood of subsequent injury. These results highlight the importance of considering the avenues for treatment available in a given cultural context, and demonstrate that other factors beyond the complications surrounding a prior injury may influence lived experiences with future injury. Further, this research calls attention to the problems inherent in making inferences about treatment in the archaeological record. Limitations aside, it has the potential to inform the discourse on industrialization and its influence on access to treatment.