Quaternary International xxx (2012) 1e9

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Quaternary International
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Archaeological and palaeopathological study on the third/second century BC grave from Turfan, China: Individual health history and regional implications
Xiao Li a, e, Mayke Wagner b, *, Xiaohong Wu c, Pavel Tarasov d, Yongbin Zhang e, Arno Schmidt f, Tomasz Goslar g, h, Julia Gresky b
a

School of Chinese Classics, Renmin University of China, 59 Zhongguancun St., Haidian District, Beijing 100872, PR China Eurasia Department, German Archaeological Institute, Im Dol 2-6, 14195 Berlin, Germany School of Archaeology and Museology, Peking University, 5 Baiyi Rd., Haidian District, Beijing 100871, PR China d Institute of Geological Sciences, Palaeontology, Free University Berlin, Malteserstrae 74-100, Building D, 12249 Berlin, Germany e Turfan Academy, 224 Gaochang Rd., Turfan 838000, PR China f Otto Bock HealthCare, Max-Naeder-Str. 15, 37115 Duderstadt, Germany g Faculty of Physics, Adam Mickiewicz University, ul. Umultowska 85, 61-614 Poznan, Poland h _ 46, 61-612 Poznan, Poland Poznan Radiocarbon Laboratory, ul. Rubiez
b c

a r t i c l e i n f o
Article history: Available online xxx

a b s t r a c t
This paper presents an archaeologicalepalaeopathological case study from Turfan (western China). Although this area is located outside of the two focus regions of the special issue (Baikal and Hokkaido), it once belonged to the same cultural sphere and experienced intensive contacts and exchanges with the neighbouring regions. The case study presented here combines detailed palaeopathological analysis of human skeletal remains with precise age determination and archaeological and regional contexts, demonstrating the high potential of such studies in arid and semi-arid China. The current paper also presents an unusual early case of prosthetic leg use from western China. The skeleton of a 50e65-yearold man and his wooden leg prosthesis discovered in a tomb in Shengjindian graveyard (Turfan, China) have been examined. Macroscopic lesions observed on ribs two to eleven, between the fth and sixth cervical vertebra, and on the left knee joint are probably due to tuberculosis infection. The inammatory process led to osseous ankylosis of the knee, xing it at 135 exion and 11 internal rotation, making walking impossible. The lost mobility of the disabled shank was regained by using an externally tted wooden prosthesis which consists of thigh stabilizer, peg, leather straps, sheep/ goat horn reinforcement of the peg tip, and horse/Asiatic ass hoof as sink resistance. Heavy traces of wear and absence of muscle atrophy indicate long-term use of the prosthesis. Ten radiocarbon dates on the prosthesis, human bones and wood pieces from the same grave suggest the most probable age of the burial is about 300e200 BC (68% condence interval), thus introducing the oldest functional leg prosthesis known to date. The results provide some support for a DNA-based hypothesis that the spread of tuberculosis in Asia was related to intensied inter-regional contacts and higher residential mobility during the rst millennium BC. 2012 Elsevier Ltd and INQUA. All rights reserved.

1. Introduction The BaikaleHokkaido Archaeology Project (BHAP: http://bhap. arts.ualberta.ca/project description) aims to explore prehistoric hunter-gatherer lifeways in Northeast Asia, through an intensive comparative analysis of two long-term regional trajectories of Holocene cultural and environmental change in the Lake Baikal (Russia) and Hokkaido (Japan) regions. BHAP promotes the examination of human and environmental records with high temporal
* Corresponding author. E-mail address: mwa@zedat.fu-berlin.de (M. Wagner). 1040-6182/$ e see front matter 2012 Elsevier Ltd and INQUA. All rights reserved. doi:10.1016/j.quaint.2012.05.010

resolution and the implementation of the individual life history approach (Weber et al., 2010; this volume) to archaeological research. The latter approach has been dened as a suite of laboratory and macroscopic methods which (i) give detailed information about individuals through examination of their skeletal remains in conjunction with archaeological and environmental contexts; (ii) provide insights into the variation of past human behaviour at the individual and community level; and (iii) allow robust comparison with the high-resolution records of past environments and with regional climate model simulations (Weber et al., 2010). Furthermore, comprehensive dating and detailed comparative analyses of cemetery complexes allow tracing the

Please cite this article in press as: Li, X., et al., Archaeological and palaeopathological study on the third/second century BC grave from Turfan, China: Individual health history and regional implications, Quaternary International (2012), doi:10.1016/j.quaint.2012.05.010

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cultural dynamics, interaction patterns, mobility and health of larger populations in a wider area (e.g. Weber et al., 2002). Infectious diseases like tuberculosis might be used as a proxy for human health and movement in the broader region (Roberts and Buikstra, 2003; Taylor et al., 2007; Suzuki et al., 2008). Our paper presents an archaeologicalepalaeopathological case study from Turfan (western China). Although this area is located outside of the two focus regions of the special issue (Baikal and Hokkaido), it once belonged to the same cultural sphere and experienced intensive contacts and exchanges with the neighbouring regions (e.g. Di Cosmo, 2002; Parzinger, 2006). Following methodological principles of BHAP, the case study presented here combines detailed palaeopathological analysis of human skeletal remains with precise age determination and archaeological and regional contexts, demonstrating high potential of such studies in arid and semi-arid China. The current paper also presents an unusual early case of prosthetic leg use from western China. Standing on ones own feet is synonymous for self-sufciency. An individual whose foot or lower leg is disabled or lost due to accident or disease ultimately needs cultural intervention for survival. Walking sticks or crutches are the simplest supporting tools helping to regain mobility, but they keep the hand and arm occupied. The use of a functional articial shank allows the person to lead a close-to-normal life. Therefore, the invention of a prosthesis e a device to replace a missing or disabled limb e was a great advance in medical engineering. Considerations about the earliest use of leg prosthetic devices commonly start with indirect textual evidence, e.g. the Hegesistratus story recorded by Herodotus (484e425 BC) about an articial wooden foot (Bliquez, 1996; Knoche, 2006), suggesting that foot prostheses were already known in the Graeco-Roman world in the fth century BC (Finch, 2011). The oldest prosthesis of a big toe was reported by Nerlich et al. (2000) in Thebes, Egypt, dated around 950e710 BC. To date, the oldest case of prosthetic leg use was discovered in Capua, Italy, in 1885 (Bourguignon and Henzen, 1885; Sudhoff, 1917; von Brunn, 1926) and dated to about 300 BC based on the typology of accompanying vases (von Duhn, 1887). The Capua leg assigned to a mans skeleton with right leg missing from the mid-calf had a wooden core and luxurious bronze sheeting, indicating the owners wealthy status. The device once acquired by the Museum of the Royal College Surgeons London was lost during the Second World War and its functionality has remained uncertain. In China, historical texts report foot or leg amputation as one of the ve punishments from the late second millennium BC onwards and a bronze gurine of an invalid with an amputated lower limb attached to a vessel is dated to about 900 BC (Shaughnessy, 1999). However, no examples of prosthetic devices or skeletons with healed amputations have been reported to date. Midway between the Graeco-Roman and Chinese worlds a wooden peg-leg next to a well preserved human skeleton was excavated near Turfan in the Uygur Autonomous Region Xinjiang, China (Fig. 1). The Shengjindian archaeological site is assigned to the Subeixi (Subeshi) culture, conventionally dated to the rst millennium BC (Chen, 2002; Han, 2007; Xinjiang, 2011). The current study discusses the construction details, wear, and numerical age of the leg prosthesis discovered at the Shengjindian site and pathological changes in the skeletal remains of its user. 2. Materials and methods 2.1. Grave setting and archaeological context The Shengjindian graveyard (Fig. 1) is situated about 35 km east of modern Turfan on the upper terrace, which belongs to the valley

crossing the Flame Mountains in the eastern part of Tian Shan. The mean temperatures in Turfan are 9.5  C in January and 32.7  C in July. The annual precipitation is about 16 mm, reecting an extremely dry climate (Domrs and Peng, 1988). In total, 31 tombs were excavated at Shengjindian in 2006e2008. The current study is focused on the tomb 2007TSM2 (further named M2), which contained the wooden peg-leg found near the well preserved skeleton of its user. Construction of the tomb (Fig. 2) and grave goods (Fig. 3) match the general features of the whole graveyard and do not indicate an unusual social status of the deceased. Organics including reed- and wheat-straw mats and wooden beams covering the tomb opening were well preserved. Wheat straw and sand lled a 110 cm deep vertical shaft where the skeleton of a woman was found (Fig. 2A). The remains of the male invalid buried in a supine exed position were found in a side chamber (Fig. 2B). Signs of a secondary opening indicate that the tomb was constructed primarily for the man, and the woman was interred later. Partially displaced or missing small bones of the mans skeleton reported by the excavators likely resulted from this later opening. The grave goods (Fig. 3) are limited in quantity and quality and include ceramic cups, a jar and a wooden plate placed next to the head, and fragments of two reex bows and the peg-leg found right of the mans body (Fig. 2A). The nearly complete skeleton of the man was available for palaeopathological investigation. The whole graveyard including tomb M2 belongs to the Subeixi culture, associated with the Cheshi (Ch-shih) state known from Chinese historical sources (Sinor, 1990). Archaeological and historical data attest it as society with a developed agro-pastoral economy, that existed in and north of the Turfan Basin (Fig. 1) during the rst millennium BC. The Subeixi weaponry, horse gear and garments (Mallory and Mair, 2000; L, 2001) resemble those of the Pazyryk culture (Molodin and Polosmak, 2007), suggesting contacts between Subeixi and the Scythians living in the Altai Mountains. 2.2. Dating For reliable age determination three samples from the peg-leg and seven other samples representing tomb M2 were submitted to the Radiocarbon Dating Laboratory at Peking University. The accelerator mass spectrometry (AMS) radiocarbon dates are provided in Table 1. Resulting radiocarbon dates were calibrated against the IntCal09 calibration curve (Reimer et al., 2009) using the SEQUENCE deposition model in the Bayesian software, OxCal (v4.1.5; Bronk Ramsey, 2008, 2009; https://c14.arch.ox.ac.uk/oxcal/ OxCal.html).

80 KAZAKHSTAN

Tian
KYRGYZSTAN

Shan

90 Urumqi B ogd han aS

Turfan

SJD Site

CHINA
40 0 200 km
Fig. 1. Map showing the main physiographic features of the Uygur Autonomous Region Xinjiang in western China and the location of the Shengjindian (SJD) archaeological site (indicated by a black square).

Tarim Basin

Please cite this article in press as: Li, X., et al., Archaeological and palaeopathological study on the third/second century BC grave from Turfan, China: Individual health history and regional implications, Quaternary International (2012), doi:10.1016/j.quaint.2012.05.010

X. Li et al. / Quaternary International xxx (2012) 1e9

cm

50

Fig. 2. (A) Photographic view and (B) cross-section of the tomb M2 containing the remains of a male invalid (indicated by _) in a side chamber and a woman (indicated by \) in a vertical tomb shaft. The red arrow in the upper gure points to the wooden leg prosthesis. (For interpretation of the references to colour in this gure legend, the reader is referred to the web version of this article.)

sample of the SEQUENCE (i.e. BA10799), but the order of calendar dates of individual samples within the PHASE remained unknown. The leather sample (BA101092), which shows oldest radiocarbon age of all was declared as independent of the other samples and calibrated individually. The calibration results obtained with such assumptions are presented in Fig. 4. In this gure the light silhouette shows age distribution of calibrated 14C date treated as purely individual (i.e. independent of dates of other samples), and the dark silhouette shows modelled age distribution constrained by the conditions of SEQUENCE and PHASE as described above. Noticeably, the wood samples if calibrated individually show bimodal probability distribution with two maxima around 320 BC and between 200 and 50 BC (Fig. 4). However, the SEQUENCE model discriminates the younger maximum almost entirely, so calendar ages of the wood samples appear all around 320 BC, the calendar age of the male bone between 315 and 150 BC (95% condence interval) and the calendar age of the female bone between 290 and 115 BC (95% condence interval). After calibration, the younger 14C dates of the analyzed wood samples match the older calendar dates. This inversion correlates quite well with the shape of the calibration curve, which shows a distinct wiggle between ca. 2170 and 2240 14C BP (Reimer et al., 2009). The relatively old age of the leather sample might indicate its truly older age. It is easy to imagine that the leather piece was used for a long time before it was nally cut into stripes and attached to the peg-leg. Available publications reporting radiocarbon dates of leather samples from western Eurasia (van der Plicht et al., 2004; Hall et al., 2007; Pinhasi et al., 2010; Strydonck et al., 2010) do not indicate any technical difculties with dating ancient leathers and recommend quite simple chemical pretreatment of such samples. Whether the 14C date from the M2 tomb could be altered due to the technologically different leather-making process used in ancient China remains an issue for further research. This matter, however, does not inuence analysis and results presented in the current study. The considerations given above are valid if 14C dates of bones are not affected by the diet-caused reservoir effect, which might be signicant. For example, Olsen et al. (2010) demonstrated that the radiocarbon dates on human bones from the Neolithic cemetery in NE Germany were up to 800 years older due to freshwaterinuenced diet of the human population. However, the Shengjindian site is located in a dry area, where the lakes and rivers suitable for shing are absent. The archaeological record also suggests a terrestrial diet for the local population and does not provide evidence for shing. 3. Results and interpretations 3.1. The peg-leg owner Based on the morphology of skull and pelvis (using the methods of Ferembach) the peg-leg owner was a man (Acsdi and Nemskeri, 1970; Ferembach et al., 1980). Cranial suture closure and tooth wear (Brothwell, 1981; Buikstra and Ubelaker, 1994), and the wear of Symphysis pubica (McKern and Stewart, 1957) suggest the age of 50e65 years old. Well preserved long bones allowed his body height to be estimated as 170.4e178.2 cm (Pearson, 1899;  Breitinger, 1938; Cern and Komenda, 1982). His left knee joint (Fig. 5) displayed complete bony fusion of femur, patella, bula, and tibia, i.e. osseous ankylosis with xation at 135 exion and 11 internal rotation. A few different causes, such as inammation in or around the joint, rheumatism or trauma, might have resulted in this most pronounced pathological change. Medical inspection of the fused leg bones using X-ray images (Fig. 5A) and computed tomography (CT) supported the elimination of fracture or other

The fact that the man found in the tomb M2 died when he was ca. 60-year-old should be considered. According to Geyh (2001), some kind of reservoir effect should be taken into account in such a case. Because the carbon in human bones is incorporated during the whole life, and mostly during the rst 20 years, the average 14C signature in the bone, corresponds to the time well before the mans death. For a ca. 60-year-old man the correction of about 30 10 years is thus necessary (Geyh, 2001). Therefore, in calibrating 14C age of this bone, reservoir-correction of the IntCal09 calibration curve was used (for the 20-year-old woman, no correction was needed). Taking into account archaeological background information, it is assumed that the sample BA10800 (female rib) must be younger than the sample BA10799 (male rib), and BA10799 must be younger than the seven wood samples BA10791eBA10797, which were grouped in PHASE of the SEQUENCE dened above. Thus, all samples in this PHASE were considered to be older than the next

Please cite this article in press as: Li, X., et al., Archaeological and palaeopathological study on the third/second century BC grave from Turfan, China: Individual health history and regional implications, Quaternary International (2012), doi:10.1016/j.quaint.2012.05.010

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Fig. 3. Burial objects from the tomb M2 used for discussion and radiocarbon dating (Table 1), including (A, C) ceramic cups and (B) ceramic jar, (D, E) fragments of two reex bows, (F) wooden wedge, and (G) wooden food-serving plate.

mechanical trauma of the knee joint as the cause. In the case of rheumatoid arthritis, more joints should be affected, but none of the others showed comparable lesions. Osseous ankylosis caused by inammatory processes (Muirhead Little, 1909; Hadjistamoff, 1960; Kim et al., 2000; Bae et al., 2005) is often due to infection with either Mycobacterium tuberculosis or Mycobacterium bovis, both members of the M. tuberculosis complex (Kim et al., 2000; Teklali et al., 2003; Taylor et al., 2007). Infection may inuence humans at a site of initial inoculation or spread throughout the body (Roberts and Buikstra, 2003; Lewis, 2011): for instance it

commonly spreads to the lungs, but may also affect spine, hip joint and knee joints (Moon, 1997; Kim et al., 1999). In the male skeleton, apart from the ankylosed knee joint, periostitis on the visceral surface of the ribs as a probable palaeopathological indication of pulmonary tuberculosis (Pfeiffer, 1991; Roberts et al., 1998; Mays et al., 2002; Santos and Roberts, 2006) has been observed on ribs two to eleven (right side more affected than left) (Fig. 6A). Necrotic lesions in combination with new bone formation between the fth and sixth cervical vertebrae (Fig. 6B) may indicate skeletal tuberculosis infection (Pl et al., 1999;

Table 1 AMS radiocarbon dates processed on samples from the tomb M2 at the Shengjindian site, which contained the prosthesis. All dates were generated in the Radiocarbon Dating Laboratory at Peking University, China. The dates expressed in 14C BP (radiocarbon years before 1950 AD, conventionally taken as the present) were converted to calendar years (BC) using OxCal v4.1.5 calibration software (Bronk Ramsey, 2008, 2009). Laboratory number Grave number Dated material/archaeological context
14

Radiocarbon date, C BP (1-sigma)

Calibrated individual dates, BC (95% conf. interval) From To 45 59 46 166 106 57 51 137 204 235

Calibrated related dates, BC (95% conf. interval) From 360 388 377 379 360 356 375 315 290 406 To 280 216 186 216 176 170 184 150 115 235

BA10791 BA10792 BA10793 BA10794 BA10795 BA10796 BA10797 BA10799 BA10800 BA101092

M2 M2 M2 M2 M2 M2 M2 M2 M2 M2

Wood/plate Wood/bow Wood/bow Wood/wedge Wood/wedge Wood/prosthesis Wood/prosthesis Bone/male rib Bone/female rib Leather/prosthesis

2115 2170 2140 2185 2155 2135 2145 2190 2235 2300

35 55 50 35 25 25 45 35 30 25

348 380 360 377 356 350 359 347 389 406

Please cite this article in press as: Li, X., et al., Archaeological and palaeopathological study on the third/second century BC grave from Turfan, China: Individual health history and regional implications, Quaternary International (2012), doi:10.1016/j.quaint.2012.05.010

X. Li et al. / Quaternary International xxx (2012) 1e9

extremities show a similar maximum length (Table 2), indicating the osseous xation happened after complete fusion of the epiphyses. The measurements of the midshafts of femur and tibia (Table 2) show almost no bone loss on the affected side, suggesting that the disability did not occur early in life. X-ray radiographic images (Fig. 5A) allow the reconstruction of bone formation processes from bone remodelling within the inner structure of the bone, followed by depletion of the normal load lines of the bone and nally reduction of trabecular bone because the leg was not used for walking any more. CT scans do not provide any information beyond that supplied by the radiographs. The high degree of exion of the lower limb made standing and walking on it unfeasible and horseback riding would have been greatly hindered, if not impossible, due to the internal rotation. The wooden peg-leg supported standing and short-distance walks. Pronounced muscle attachment sites on all bones indicate that the man remained physically active. 3.2. Technical characteristics of the peg-leg The general appearance and details of the wooden peg-leg found in the tomb M2 are presented in Figs. 7e9. Being 89.2 cm long the device consists of three components (Fig. 7). These are a at, lateral thigh-plate stabilizer (width 8.8 cm, maximum thickness 2.5 cm) and a round distal peg (diameter 3.6 cm) made in one piece from softwood, likely poplar; robust sheep/goat horn to reinforce the tip of the peg; and a horse or Asiatic ass hoof as sink resistance, as a basket on ski poles. One side of the thigh plate (the inside) clearly shows the outline of the knee (Fig. 8A) and substantial thinning of the plate in its lower part (Fig. 8C) as a result of long-term rubbing. The surface of the outer side is dark and rough except for the shiny top-end indicating covering by garment. These features show that the peg-leg was fastened to the outside of the left leg. The top-end of the thigh plate has two holes with straight upward friction grooves likely accommodating a waist strap. At the transition from at stabilizer to round peg the device was partly broken and repaired with a leather strap making use of the lowest of the lateral holes (Fig. 7B). The other six lateral holes on each side served to fasten it around the thigh. Some holes show remains of chisel-cut marks smoothed over time by the leather straps. How the prosthetic leg was secured against superior displacement from the weight that the users body placed on it with each step remains unclear. It does not appear that the pathological exed knee was accommodated in a cup or other structure, as stumps were in more recent industriallymanufactured prosthetic legs. Surely the thigh straps alone were not tight enough to resist superior displacement. The preserved straps (widths 0.5e1 cm) and deep downward friction marks on both the outer and inner faces (Fig. 9) permit a tentative reconstruction of fastening as follows. A single short strap was routed through two neighbouring holes, both ends coming out on the inside of the plate. One end was sliced in two; the other had a cut eyelet and linked up with a strap or button which might have been xed to a thigh casing. In this way the stabilizer would be fastened to the thigh at six stable xation points (three on each side). As no leather or wood thigh casing has been found in the grave the problem of xation remains unsolved. The distal peg end was forced into a straightened horn which must be of goat or sheep on account of its ring structure. Its pointed front side is bevelled from dragging over hard ground (Fig. 8D). A hoof was pulled over the horn and secured in place with a leather strap run through a horizontally drilled hole penetrating the horn (Fig. 8B, D). No metal was found in the device, even though bronze and iron were already in use in this society.

Fig. 4. Results of calibration of 14C dates of the samples from the tomb M2. Light sihouettes present calibration of independent 14C dates, dark silhouettes present calibration of related dates (details in the text). For the sample 10799, 30-yr reservoircorrection of the IntCal09 calibration curve was used. The 1-s (68%) and 2-s (95%) ranges are given by the horizontal brackets beneath the probability densities.

Ortner, 2003; Roberts and Buikstra, 2003), though osteophytosis and osteoarthritis may also cause similar changes. Rib lesions (especially pronounced in the left third and fourth rib) recognized in the female skeleton from the same grave (Fig. 6C, D) may suggest another possible case of tuberculosis within the Shengjindian population. However, other diseases can not be completely excluded before microbiological investigation of all skeletal remains, which merits a separate study. The surface of the bones affected by the ankylosis is smooth, suggesting the active inammatory process stopped years before death. Smooth bone is remodeled mature, lamellar bone that can only form after the succession of an active infection. Both lower

Fig. 5. (A) X-ray radiographic image and (B) photograph of the exed ankylosed left knee of the prosthesis owner from the tomb M2.

Please cite this article in press as: Li, X., et al., Archaeological and palaeopathological study on the third/second century BC grave from Turfan, China: Individual health history and regional implications, Quaternary International (2012), doi:10.1016/j.quaint.2012.05.010

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Fig. 6. (A) Periosteal lesions on the seventh left rib, (B) necrotic lesions in combination with new bone formations on the distal surface of the fth cervical vertebra of the 50e65year-old male individual, and (C) periostitis on the visceral surface of the third and (D) fourth left rib of the 19e20-year-old female individual buried in the tomb M2 are indicative of tuberculosis.

4. Discussion The whole region of Xinjiang, including Turfan has an extremely dry and continental climate, which allows very good preservation of organic material (e.g. Wagner et al., 2009 and references therein). For decades, mummies from the Tarim and Turfan basins have attracted international attention (Mallory and Mair, 2000; L, 2001). Despite the extremely good preservation of human corpses and skeletons in archaeological excavations in Xinjiang, detailed palaeopathological studies are still rare (Schultz et al., 2007; Gresky et al., 2008; Wagner et al., 2011). The recently published archaeological and palaeopathological record of early rst millennium BC mounted pastoralists from the Liushui cemetery in the Kunlun Mountains, south of Tarim basin (Wagner et al., 2011) and the current results obtained from the Shengjindian cemetery (this study), demonstrate the high potential of the non-destructive examination methods of human osteological remains (Katzenberg and Saunders, 2008) from western China and encourage application of the individual life history approach to the entire cemetery populations. This will allow new insights into the local and regional archaeological record and provide rich and comprehensive material for inter-regional comparisons with results generated by the Baikal-Hokkaido Archaeology Project.

The Shengjindian cemetery complex belongs to the late rst millennium BC, i.e. a period when the Turfan depression in the eastern foothills of Tian Shan as well as the Lake Baikal region were part of the wide Inner Asian activity zone of the Xiongnu confederation of tribes with complex economy embracing mobile pastoralism and sedentary agriculture, and recognised in the archaeological record by characteristic ornaments (e.g. Psarras, 1996), weaponry (e.g. Reisinger, 2010), and tomb constructions (Konovalov, 2008). The region south of Lake Baikal came under the control of the Xiongnu tribes about 200 BC (Parzinger, 2006). Their northernmost outpost e Ivolginskoe e discovered near Ulan-Ude, only 80 km from Lake Baikal (Davydova, 1985), was a permanent settlement with wooden houses and four rings of defence walls separated by water ditches. The inhabitants were involved in pottery making, bronze and iron casting, cultivated millet, barley and wheat, and kept sheep/goats, cows and horses, as well as pigs and dogs. By the late rst millennium BC, the Xiongnu confederation was threatening the northern and western borders of dynastic China (e.g. Di Cosmo, 2002). Historical sources note that Turfan was the key area for both the Xiongnu and the Chinese in exercising control over eastern central Asia (Sinor, 1990). However, surprisingly little information is available about the society which inhabited the area. Subsistence practices, settlement patterns,

Table 2 Measurements of the lower extremity bones (following Martin and Saller, 1957) of the male individual buried in the tomb M2. Bone Maximum length (mm) Right Femur Tibia Fibula 475 390 380 Left 470 400 385 Midshaft circumference (mm) Right 95 87 e Left 100 86 e Transverse midshaft diameter (mm) Right 28.1 22.7 e Left 28.8 22.1 e Sagittal midshaft diameter (mm) Right 31.5 30.1 e Left 32.3 30.3 e

Please cite this article in press as: Li, X., et al., Archaeological and palaeopathological study on the third/second century BC grave from Turfan, China: Individual health history and regional implications, Quaternary International (2012), doi:10.1016/j.quaint.2012.05.010

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Fig. 7. Wooden leg prosthesis from the tomb M2. (A) Drawing of the inner face (attached to the body), and (B) drawing and (C) photograph of the outer face.

burial customs, political and cultural contacts still need to be inferred from the archaeological record. Beside the already mentioned relationships to the Xiongnu and dynastic China, the contacts of the Cheshi state (Subeixi culture) with the Scythian Pazyryk culture of the Altai Mountains suggested by the similarities in weaponry (i.e. characteristic bows from M2 tomb), horse gear and garments (Mallory and Mair, 2000; L, 2001; Parzinger, 2006) should also be investigated. An early case of a prosthetic leg from western China presented in the current study contributes to the knowledge of early medical practices in general and the use of limb prosthetics in particular. The shank of the man from Shengjindian was not amputated, but fully disabled. The peg-leg replaced the disabled limb and, therefore, deserves to be termed a prosthesis. The above mentioned Capua prosthesis was missing a thigh apparatus for secure fastening. Only a number of iron rods with holes at the proximal rim suggest xing with straps at the waist band. Optically more than functionally, it restored the users physical integrity when sitting on a chair or riding a horse (Bliquez, 1996). The burial context indicates that the user of the Turfan prosthesis was a commoner. Neither elegant nor made of precious materials, the device is unique in terms of technical design,

robustness and functionality. Together with the reex bows from M2 and other tombs it demonstrates the high woodworking skills of the society. Except that no stump was accommodated in the Turfan peg-leg and a horn plus hoof were used instead of iron for reinforcement of the tip, the ancient device resembles the industrially manufactured or home-made leg prosthetics used two thousand years later, for example after the American Civil War (1861e1865) and the First World War in Europe (1914e1919) (Lazenby and Pfeiffer, 1993; Knoche, 2006). The basic mechanical components: lateral stabilizer, leather straps, and peg are the same. The pathological changes in skeletal remains reported here may add to knowledge of tuberculosis history (Roberts and Buikstra, 2003). In particular, Asian records of tuberculosis are still rare (Pechenkina et al., 2007). Fusegawa et al. (2003) identied M. tuberculosis DNA in adult and child skeletons from the wealthy graveyard near Turfan belonging to the same period (202 BCe200 AD) and cultural complex as the Shengjindian site. Their inference of an outbreak of tuberculosis was later called into question because no macroscopic skeletal lesions were found (Pechenkina et al., 2007). Suzuki et al. (2008) reported a case of spinal tuberculosis from Korea dated to the rst century BC, relating it to population movements from China to Korea and Japan.

Please cite this article in press as: Li, X., et al., Archaeological and palaeopathological study on the third/second century BC grave from Turfan, China: Individual health history and regional implications, Quaternary International (2012), doi:10.1016/j.quaint.2012.05.010

X. Li et al. / Quaternary International xxx (2012) 1e9

the Korean Peninsula (Wagner et al., 2011), the rst millennium BC may therefore be crucial for the spread of tuberculosis into eastern Asia. 5. Conclusion This article reported the oldest known fully functional leg prosthesis. It was found in a grave of a male individual in Xinjiang, China, radiocarbon-dated to about 300e200 BC. He probably suffered from tuberculosis infection that resulted in rib and vertebral lesions but, most remarkably, in osseous ankylosis of the left knee. Similar to modern-era cases of below-the-knee amputation, the missing (in this case, disabled) shank was replaced by an externally tted prosthesis. It is the oldest preserved material evidence of a fully functional leg prosthesis. The simple but effective construction of wood, sheep/goat horn, horse/ass hoof, and leather strikingly resembles the peg-legs manufactured from the late 19th to the mid-20th century in America and Europe. Heavy traces of wear on the prosthesis and the absence of muscle atrophy of regions of the skeleton other than the affected leg indicate an active lifestyle for several years after the leg became immobile. Acknowledgements Our thanks are due to the excavation team, Turfan hospital, Chen X.C., Pan Y., J. Evers, Prof. N. Benecke, M. Hochmuth, and P. Wertmann for assistance, and to Prof. S. Pfeiffer for valuable comments. This work is contribution to the Bridging Eurasia (supported by the German Archaeological Institute, CIC FU Berlin and DFG TA 540/5-1) and to the HumaneEnvironment Interactions (supported by the Canadian Institute for Advanced Research) research programs. Finally, we thank Dr. D. White and G. Shephard for polishing English, and Prof. A. Weber and two anonymous reviewers for their thorough review and constructive suggestions, which help us to improve this manuscript.
Fig. 8. Detail photographs of leg prosthesis showing (A) the outline of the knee, (C) thinning of the thigh plate by rubbing over a long period, and (B, D) fastening of the hoof with a leather strap penetrating the horn tip.

References
Acsdi, G., Nemskeri, J., 1970. History of Human Life Span and Mortality. Akadmia Kiad, Budapest. Bae, D.K., Yoon, K.H., Kim, H.S., Song, S.J., 2005. Total knee arthroplasty in stiff knees after previous infection. The Journal of Bone and Joint Surgery 87-B (3), 333e336. Bliquez, L., 1996. Prosthetics in classical antiquity: Greek, Etruscan, and Roman prosthetics. In: Haase, W. (Ed.), 1996. Rise and Decline of the Roman World II, vol. 37.3. Walter de Gruyter, Berlin, pp. 2640e2676. Bourguignon, A., Henzen, G., 1885. Scavi di Santa Maria di Capua. Bullettino dellInstituto di Correspondenza Archeologica 7/8, 169 (in Italian). Breitinger, E., 1938. Zur Berechnung der Krperhhe aus den langen Gliedmaenknochen. Anthropologischer Anzeiger 14, 249e274 (in German). Bronk Ramsey, C., 2008. Deposition models for chronological records. Quaternary Science Reviews 27 (1e2), 42e60. Bronk Ramsey, C., 2009. Bayesian analysis of radiocarbon dates. Radiocarbon 51, 337e360. Brothwell, D.R., 1981. Digging Up Bones. The Excavation, Treatment and Study of Human Skeletal Remains. Ithaca, New York. Buikstra, J.E., Ubelaker, D.H., 1994. Standards for data collection from human skeletal remains. In: Proceedings of a Seminar at the Field Museum of Natural History Organized by Jonathan Haas. Arkansas Archaeological Survey Research Series 44. Fayetteville, AR.  Cern, M., Komenda, S., 1982. Reconstruction of Body Height Based on Humerus and Femur Lengths (Material From Czech Lands). IInd Anthropological Congress of Ale s Hrdli cka, rst ed. Univerzita Karlova, Praha, 475e479 pp. Chen, G., 2002. Subeixi wen hua de yuan liu ji yu qi ta wen hua de guan xi. Xiyu Yanjiu 2, 11e18 (in Chinese). Davydova, A.V., 1985. Ivolginskii kompleks (gorodishche i mogilnik) e pamyatnik khunnu v Zabaikale. Izdatelstvo Leningradskogo Universiteta, Leningrad (in Russian). Di Cosmo, N., 2002. Ancient China and Its Enemies: The Rise of Nomadic Power in East Asia. Cambridge University Press, Cambridge. Domrs, M., Peng, G., 1988. The Climate of China. Springer, Berlin. Ferembach, D., Schwidetzky, I., Stloukal, M., 1980. Recommendations for age and sex diagnosis of skeletons. Journal of Human Evolution 9, 517e549.

Furthermore, Taylor et al. (2007) could identify M. bovis DNA in human remains from southern Siberia dated to 360e170 BC. Together with the published results, our evidence shows a wide frontier of disease. Archaeologically and textually known for an increase in residential mobility and the spread of complex pastoralism and mounted warfare in Eurasia between the Black Sea and

Fig. 9. Detail photographs of leg prosthesis showing a section of the thigh plate (inside and outside) with lateral holes, preserved leather straps, and deep friction grooves.

Please cite this article in press as: Li, X., et al., Archaeological and palaeopathological study on the third/second century BC grave from Turfan, China: Individual health history and regional implications, Quaternary International (2012), doi:10.1016/j.quaint.2012.05.010

X. Li et al. / Quaternary International xxx (2012) 1e9 Finch, J., 2011. The ancient origins of prosthetic medicine. The Lancet 377 (9765), 548e549. Fusegawa, H., Wang, B.H., Sakurai, K., Nagasawa, K., Okauchi, M., Nagakura, K., 2003. Outbreak of tuberculosis in a 2000-year-old Chinese population. Kansenshogaku Zasshi 77, 146e149. Geyh, M.A., 2001. Bomb radiocarbon dating of animal tissues and hair. Radiocarbon 43, 723e730. Gresky, J., Wu, X.H., Wagner, M., Schmidt-Schultz, T., Schultz, M., 2008. Alltagsstress in Liushui: Krankheitsbilder des Bewegungsapparates im bronzezeitlichen Westchina. Eurasia Antiqua 14, 167e191 (in German). Hadjistamoff, B., 1960. Operative method for correction of heavy exional ankylosis of the knee joint with no loss of bone. Acta Orthopaedica Scandinavica 29, 247e255. Hall, D.W., Cook, G.T., Hall, M.A., Muir, G.P., Hamilton, D., Scott, E.M., 2007. The early medieval origin of Perth, Scotland. Radiocarbon 49, 639e644. Han, J.Y., 2007. Xinjiang de qing tong shi dai he zao qi tie qi shi dai wen hua. Wenwu, Beijing (in Chinese). Katzenberg, M.A., Saunders, S.R. (Eds.), 2008. Biological Anthropology of the Human Skeleton. John Wiley & Sons, New York. Kim, Y.H., Cho, S.H., Kim, J.S., 1999. Total knee arthroplasty in bony ankylosis in gross exion. The Journal of Bone and Joint Surgery 81-B, 296e300. Kim, Y.H., Kim, J.S., Cho, S.H., 2000. Total knee arthroplasty after spontaneous osseous ankylosis and takedown of formal knee fusion. Journal of Arthroplasty 4 (15), 453e460. Knoche, W., 2006. Prothesen der unteren Extremitt: die Entwicklung vom Altertum bis 1930. Verlag Bundesfachschule fr Orthopdie-Technik, Dortmund (in German). Konovalov, P.B., 2008. The Burial Vault of a Xiongnu Prince at Sudzha (Ilmovaia Pad, Transbaikalia). Vfgarch.press uni-bonn, Bonn. Lazenby, R.A., Pfeiffer, S.K., 1993. Effects of a nineteenth century below-knee amputation and prosthesis on femoral morphology. International Journal of Osteoarchaeology 3, 19e28. Lewis, M.E., 2011. Tuberculosis in the non-adults from Romano-British Poundbury Camp, Dorset, England. International Journal of Paleopathology 1 (1), 12e23. L, E.G., 2001. Ancient corpses of Subeshi. In: Wu, B.H. (Ed.), The Ancient Corpses of Xinjiang. Xinjiang Renmin, Urumqi, pp. 94e112. Mallory, J.P., Mair, V.H., 2000. The Tarim Mummies. Thames & Hudson, London. Martin, R., Saller, K., 1957. Lehrbuch der Anthropologie. Gustav Fischer Verlag, Stuttgart. Mays, S., Fysh, E., Taylor, G.M., 2002. Investigation of the link between visceral surface rib lesions and tuberculosis in a medieval skeletal series from England using ancient DNA. American Journal of Physical Anthropology 119, 27e36. McKern, T.W., Stewart, T.D., 1957. Skeletal Age Changes in Young American Males, Analyzed From the Standpoint of Identication. Environmental Protection Research Division (Quartermasters Research and Development Center, U.S. Army Natick, MA), Technical Report No. EP-45. Molodin, V.I., Polosmak, N.V., 2007. Die Denkmler auf dem Ukok-Plateau. In: Parzinger, H. (Ed.), Im Zeichen des Goldenen Greifen: Knigsgrber der Skythen. Prestel, Mnchen, pp. 140e147 (in German). Moon, M.-S., 1997. Tuberculosis of the spine. Controversies and a new challenge. Spine 22 (1), 1791e1797. Muirhead Little, E., 1909. Some notes on ankylosis of the knee. The Journal of Bone & Joint Surgery s2e6, 454e459. Nerlich, A.G., Zink, A., Szeimies, U., Hagedorn, H.G., 2000. Ancient Egyptian prosthesis of the big toe. The Lancet 356 (9248), 2176e2179. Olsen, J., Heinemeier, J., Lbke, H., Lth, F., Terberger, T., 2010. Dietary habits and freshwater reservoir effects in bones from a Neolithic NE German cemetery. Radiocarbon 52 (2e3), 635e644. Ortner, D.J., 2003. Identication of Pathological Conditions in Human Skeletal Remains, second ed. Academic Press, San Diego. Pl, G., Dutour, O., Dek, J., Huts, I. (Eds.), 1999. Tuberculosis Past and Present. Golden Books/Tuberculosis Foundation, Budapest. Parzinger, H., 2006. Die frhen Vlker Eurasiens vom Neolithikum bis zum Mittelalter. Verlag C.H. Beck, Mnchen (in German). Pearson, K., 1899. Mathematical contribution to the theory of evolution. V. On the reconstruction of stature of prehistoric races. Philosophical Transactions of the Royal Society A 192, 169e244. Pechenkina, E.A., Benfer Jr., R.A., Ma, X.L., 2007. Diet and health in the Neolithic of the Wei and Middle Yellow River basins, Northern China. In: Cohen, M.N., Crane-Kramer, G. (Eds.), Ancient Health: Skeletal Indicators of Agricultural and Economic Intensication. University Press of Florida, Gainesville, pp. 255e272.

Pfeiffer, S., 1991. Rib lesions and New World tuberculosis. International Journal of Osteoarchaeology 1, 191e198. Pinhasi, R., Gasparian, B., Areshian, G., Zardaryan, D., Smith, A., Bar-Oz, G., Highamet, T., 2010. First direct evidence of chalcolithic footwear from the Near Eastern Highlands. PLoS ONE 5 (6), e10984. doi:10.1371/journal.pone.0010984. Psarras, S.K., 1996. Pieces of Xiongnu art. Central Asiatic Journal 40 (2), 234e259. Reimer, P.J., Baillie, M.G.L., Bard, E., Bayliss, A., Beck, J.W., Blackwell, P.G., Bronk Ramsey, C., Buck, C.E., Burr, G.S., Edwards, R.L., Friedrich, M., Grootes, P.M., Guilderson, T.P., Hajdas, I., Heaton, T.J., Hogg, A.G., Hughen, K.A., Kaiser, K.F., Kromer, B., McCormac, F.G., Manning, S.W., Reimer, R.W., Richards, D.A., Southon, J.R., Talamo, S., Turney, C.S.M., van der Plicht, J., Weyhenmeyer, C.E., 2009. IntCal09 and Marine09 radiocarbon age calibration curves, 0e50,000 years cal BP. Radiocarbon 51, 1111e1150. Reisinger, M., 2010. New evidence about composite bows and their arrows in Inner Asia. The Silk Road 8, 42e62. Roberts, C.A., Buikstra, J.E., 2003. The Bioarchaeology of Tuberculosis. A Global View on a Reemerging Disease. University Press of Florida, Gainesville. Roberts, C., Boylston, A., Buckley, L., Chamberlain, A., Murphy, E., 1998. Rib lesions and tuberculosis: the palaeopathological evidence. Tuberculosis and Lung Diseases 79 (1), 55e60. Santos, A.L., Roberts, C.A., 2006. Anatomy of a serial killer: differential diagnosis of tuberculosis based on rib lesions of adult individuals from the Coimbra identied skeletal collection, Portugal. American Journal of Physical Anthropology 130, 38e49. Schultz, M., Schmidt-Schultz, T.H., Wu, X.H., 2007. Ergebnisse der palopathologischanthropologischen Untersuchung der menschlichen Skeletfunde aus dem Grab 26 von Liushui, Xinjiang (China). Eurasia Antiqua 13, 181e197 (in German). Shaughnessy, E.L., 1999. Bronze fangding vessel. In: Yang, X.N. (Ed.), The Golden Age of Chinese Archaeology. National Gallery of Art, Washington, pp. 246e247. Sinor, D. (Ed.), 1990. The Cambridge History of Early Inner Asia. Cambridge University Press, Cambridge. Strydonck, M.V., Boudin, M., Guerrero Ayuso, V.M., Calvo, M., Fullola, J.M., ngeles Petit, M., 2010. The necessity of sample quality assessment in 14C AMS dating: the case of Cova des Pas (Menorca e Spain). Nuclear Instruments and Methods in Physics Research Section B 268, 990e994. Sudhoff, K., 1917. Der Stelzfu aus Capua. In: Mitteilungen zur Geschichte der Medizin und Naturwissenschaften, vol. 16, 291e293 pp. (in German). Suzuki, T., Fujita, H., Choi, J.G., 2008. Brief communication: new evidence of tuberculosis from prehistoric Korea e population movement and early evidence of tuberculosis in Far East Asia. American Journal of Physical Anthropology 136 (3), 357e360. Taylor, G.M., Murphy, E., Hopkins, R., Rutland, P., Chitov, Y., 2007. First report of Mycobacterium bovis DNA in human remains from the Iron Age. Microbiology 153, 1243e1249. Teklali, Y., El Alami, Z.F., El Madhi, T., Gourinda, H., Miri, A., 2003. Peripheral osteoarticular tuberculosis in children: 106 case-reports. Joint Bone Spine 4 (70), 282e286. van der Plicht, J., van der Sanden, W.A.B., Aerts, A.T., Streurmanvan, H.J., 2004. Dating bog bodies by means of 14C-AMS. Journal of Archaeological Science 31, 471e491. von Brunn, W., 1926. Der Stelzfu von Capua und die antiken Prothesen. Sudhoffs Archiv fr Geschichte der Medizin 18, 351e360 (in German). von Duhn, F., 1887. La Necropoli di Suessula. In: Mitteilungen des Archologischen Instituts des Deutschen Reichs, Rmische Zweigstelle II, 271e274 pp. (in Italian). Wagner, M., Wang, B., Tarasov, P., Westh-Hansen, S.M., Vlling, E., Heller, J., 2009. The ornamental trousers from Sampula (Xinjiang, China): their origins and biography. Antiquity 83, 1065e1075. Wagner, M., Wu, X.H., Tarasov, P., Aisha, A., Bronk Ramsey, Ch., Schultz, M., SchmidtSchultz, T., Gresky, J., 2011. Radiocarbon-dated archaeological record of early rst millennium B.C. mounted pastoralists in the Kunlun Mountains, China. PNAS 108 (38), 15733e15738. Weber, A.W., Link, D.W., Katzenberg, M.A., 2002. Hunter-gatherer culture change and continuity in the Middle Holocene of the Cis-Baikal, Siberia. Journal of Anthropological Archaeology 21, 230e299. Weber, A.W., Katzenberg, M.A., Schurr, T.G. (Eds.), 2010. Prehistoric HunterGatherers of the Baikal Region, Siberia: Bioarchaeological Studies of Past Lifeways. University of Pennsylvania Museum of Archaeology and Anthropology Press, Philadelphia. Xinjiang, tu lu fan xue yan jiu yuan, Xinjiang, wen wu kao gu yan jiu suo, 2011. Xinjiang Shanshan Yanghai mu di fa jue bao gao. Kaogu xuebao 1, 99e150 (in Chinese).

Please cite this article in press as: Li, X., et al., Archaeological and palaeopathological study on the third/second century BC grave from Turfan, China: Individual health history and regional implications, Quaternary International (2012), doi:10.1016/j.quaint.2012.05.010