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International Journal of Paleopathology xxx (2013) xxx–xxx

Contents lists available at SciVerse ScienceDirect

International Journal of Paleopathology

journal homepage: www.elsevier.com/locate/ijpp

Research Article

Shattered lives and broken childhoods: Evidence of physical child

abuse in ancient Egypt
Sandra M. Wheeler a,∗ , Lana Williams a , Patrick Beauchesne b , Tosha L. Dupras a
a
Department of Anthropology, University of Central Florida, 4000 Central Florida Blvd., Orlando, FL, 32816, USA
b
Department of Anthropology, University of California, Berkeley, 232 Kroeber Hall, Berkeley, CA, 94720, USA

a r t i c l e i n f o a b s t r a c t

Article history: Much can be learned about cultural attitudes of violence towards children from the analyses of their
Received 19 January 2013 skeletal remains and mortuary patterns of the communities in which they lived and died. A bioarchaeo-
Received in revised form 28 March 2013 logical approach integrating biological, socio-cultural, and physical environments is used in analyzing the
Accepted 29 March 2013
remains of a 2–3-year-old child from Kellis 2, a Romano-Christian period cemetery in the Dakhleh Oasis,
Egypt. The skeletal remains of this individual show an unusual pattern of trauma and healing events, pos-
Keywords:
sibly indicating multiple episodes of non-accidental trauma. Macroscopic, radiographic, and histologic
Dakhleh Oasis
analyses show the extent of the skeletal trauma and healing, while stable carbon and nitrogen analyses of
Skeletal trauma
Paleohistology
bone and hair reveal metabolic disturbances and changes in diet correlated with these traumatic events.
Radiography Results from the differential diagnosis demonstrate that this individual exhibits skeletal fracture and
Stable carbon and nitrogen isotopic healing patterns consistent with repeated non-accidental trauma, which may or may not have resulted
analyses in death. In addition, this individual may also represent the earliest documented case of violence against
children from an archaeological context.
© 2013 Elsevier Inc. All rights reserved.

1. Introduction Very few cases of child abuse or non-accidental childhood

Clinically, child abuse is defined as maltreatment of a child
by either parents or caretakers, and can include physical, sexual,
and emotional abuse, as well as emotional and/or physical neglect
(Campbell, 2001). Soft tissue injuries are the most common pre-
sentation in modern cases of child abuse, and 10–70% of physically
abused children manifest some form of skeletal trauma (Cramer
and Green, 2003). Skeletal trauma resulting from intentional phys-
ical contact is the only type of child abuse that may be accessible
when analyzing skeletal remains from archaeological contexts.
Interpreting skeletal evidence of accidental or non-accidental trau-
matic injury can be problematic because of the implication of
human malevolence or intent to harm. Further, in many societies,
the physical discipline of children is socially accepted because it is
considered beneficial, or not harmful (Walker et al., 1997; Walker,
2001). However, when instances of traumatic injury are viewed and
interpreted within their larger archaeological, social, and environ-
mental contexts, it is possible to constrain the range of alternative
explanations for the observed trauma.
trauma have been documented in the archaeological record (e.g.
Blondiaux et al., 2002; Lewis, 2010; Gaither, 2012), however lack
of publication cannot be taken as evidence that trauma of this
type was a rare occurrence in the past. Numerous factors includ-
ing adult-centered research design, poor preservation, taphonomic
processes, excavation techniques, and differential collection of
juvenile remains, potentially limit the analysis and interpretation of
skeletal trauma and its association with violence towards juveniles
in the past (Lewis, 2007). This study concerns the analysis of a com-
pletely skeletonized individual aged between two and three years
from the Romano-Christian period cemetery of Kellis 2, located in
the Dakhleh Oasis, Egypt (Fig. 1). While this individual shows pat-
terns of skeletal trauma consistent with clinical cases of childhood
non-accidental trauma, this case is also the oldest representation
of probable physical child abuse in the archaeological record.
2. Materials and methods
2.1. Dakhleh Oasis, Egypt and Kellis

The Dakhleh Oasis is located approximately 250 km west of the

∗ Corresponding author. Tel.: +1 407 823 2227; fax: +1 407 823 3498.
E-mail addresses: Sandra.Wheeler@ucf.edu (S.M. Wheeler),
Lana.Williams@ucf.edu (L. Williams), pbeauchesne@gmail.com (P. Beauchesne),
Tosha.Dupras@ucf.edu (T.L. Dupras).
Nile Valley and is one of five major depressions in Egypt’s Western
Desert (Fig. 1). The Oasis is noted for seasonal extremes in tem-
perature, varying from 25 ◦ C by midday in winter to 40–50 ◦ C by
midday in summer (Blume et al., 1984; Giddy, 1987). Precipitation

1879-9817/$ – see front matter © 2013 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.ijpp.2013.03.009

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Fig. 1. Location of the Dakhleh Oasis and the Kellis 2 cemetery (inset) in Egypt.

is relatively rare, with a mean annual rainfall of 0.3 mm/year, so
the inhabitants’ agrarian lifestyle requires them to be dependent
on water supplies from artesian wells and local springs (Schwarcz
et al., 1999). The town of Kellis (mid-first to fourth century A.D.)
is located along an ancient desert trade route that runs through
the Dakhleh Oasis (Hope, 2001; Bowen, 2003). During its occupa-
tion, Kellis was considered an important economic and political
hub and the town center included numerous households, Egyptian
and Roman temples, a Roman bathhouse, two churches and many
Roman vaulted brick tombs (Knudstad and Frey, 1999; Hope, 2001,
2002, 2003).
2.2. Kellis 2 cemetery and Burial 519
The Kellis 2 cemetery flanks the eastern portion of Kellis and is
one of several common burial grounds used by the town’s inha-
bitants. To date, 770 individuals have been excavated from this
cemetery (Fig. 2), and archaeological survey indicates there could
be upwards of 4000 burials. Of those excavated 701 have been
analyzed, 158 of which are aged between birth and about 15
years (Wheeler, 2012). Although archaeological evidence suggests
a more restricted utilization of 150–360 A.D. (Hope, 2003), several
radiocarbon dates from skeletal material indicate that Kellis 2 was
used as early as A.D. 50 and as late as A.D. 450 (Stewart et al., 2003).
The cemetery is characterized by the presence of low mud-brick
superstructures and simple rectangular pits dug into the hard-
packed Nubian clay. Most individuals are interred individually in
rectangular graves and placed in an extended supine position with
their heads to the west, their arms to the sides or over the pelvis,
and feet placed side-by-side or crossed. Individuals are typically
wrapped in linen shrouds bound by linen cords or bands, and have
little to no grave goods (Birrell, 1999). The individual described
here, Burial 519, was undisturbed and all bones and teeth were
present. Because of the excellent state of preservation, hair, skin,
and nails were also present (Fig. 3a). No grave goods were associ-
ated with the burial. Burial 519 was buried in a similar fashion to
all other juveniles in the cemetery (Wheeler, 2009), and its location
within the cemetery did not distinguish it as being atypical (Fig. 2).
2.3. Macroscopic, radiologic, histologic and isotopic analysis
Detailed macroscopic observations of the skeletal lesions and
fractures of Burial 519 were observed under natural light and
recorded using standard methods (Buikstra and Ubelaker, 1994).

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Fig. 2. The location of Burial 519 (inset) in the Kellis 2 cemetery.

Plain film radiographs were taken of all skeletal elements using a

Fig. 3. In situ image of Burial 519 with arrows showing complete fracture of humeri
and right clavicle (a); schematic of Burial 519 showing distribution of fractures,
cribra orbitalia, and areas of periosteal reactions and new bone formation (NBF) (b).
Faxitron X-ray Cabinet System with Kodak EC1 film (90 s at 60 kVp
and 0.3 mA). No screens were used as image quality was found to be
superior without them. A GE Medical Systems Scanner (80 kVp and
450 mA in 2 × 2 bin mode, 45 ␮ slices) was used to scan the fracture
of the left humerus to distinguish the type of new bone formation
observed. MicroView 2.0.29 viewer was used for the image capture
of the micro-CT slices.
A small section of bone was cut from the mid-region of the
right 11th rib for histological analysis. The rib was cleaned and
dehydrated using an ascending ethyl alcohol series to remove
excess moisture and facilitate complete infiltration of the methyl-
metacrylate resin. Thin-sections (70–100 ␮) were produced from
the embedded rib using a Buehler Petrothin system. Microscopic
analysis was conducted under polarized and plane light using an
Olympus BX41 upright microscope and mounted digital camera. A
hilfsobject red 1st order quartz compensator (Olympus model U-
P521) was used along with a polarizing lens (Maltese cross pattern
in secondary osteons can be seen), aiding in the visualization of
collagen bundles and any potential diagenetic alteration (Schultz,

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2001). Histological images were captured at 40× and 100× magni-
fication with the mounted digital camera.
Isotopic analyses of hair, skin, nail, and bone collagen were con-
ducted at the Laboratory for Stable Isotope Science at Western
University, Canada. Bone collagen was extracted following method-
ology described by Longin (1971) and Chisholm et al. (1982). Hair
samples were cleaned using 2:1 methanol and chloroform solu-
tion; skin and nail were cleaned using 2:1 chloroform and methanol
solution (Williams et al., 2011). All samples were rinsed and ultra-
sonicated in deionized and distilled water for 30 min, dried for 48 h
at 50 ◦ C, then pulverized prior to weighing. All samples were ana-
lyzed on a Costech elemental analyzer interfaced with a Thermo
Finnigan Deltaplus XL continuous flow isotope ratio mass spectrom-
eter. Diagenesis was determined by carbon to nitrogen (C:N) ratio,
and all samples for this study are well preserved and fall between
ratios of 2.9 and 3.6. Duplicate precision for the analyzed tissues
was ±0.2‰ for ı13 C and ±0.3‰ for ı15 N.
3. Results
3.1. Macroscopic analysis and radiography
Burial 519’s age was estimated using a combination of dental
development, cranial and postcranial fusion, and epiphyseal devel-
opment. Burial 519’s deciduous mandibular canine root lengths are
half complete, the first and second deciduous mandibular molar
root lengths are three-quarters and half complete respectively, and
the mandibular first permanent molar crown is complete (Fig. 4b),
all of which is consistent with an age of between two and three
years (Moorees et al., 1963; Smith, 1991; Buikstra and Ubelaker,
1994). All cervical and thoracic neural arches and all but the neural
arches for the fifth lumbar are fused to each other but none are fused
to the centrum, the pars lateralis and pars basilaris are not yet fused
to the occipital squama, and the foramen of Huschke is present
bilaterally, all of which is consistent with the age of between two
and three years (Scheuer and Black, 2000). Distributions of frac-
tures, cribra orbitalia, periostitis, and new bone formation for Burial
519 are presented in Table 1 and Fig. 3b. Active cribra orbitalia is
present in both orbits (Fig. 4a). A previous study has shown that
66% of the 1–3-year cohort at Kellis 2 display cribra orbitalia, and of
those, 95% display active lesions (Wheeler, 2012). Slight new bone
formation on the temporal and zygomatic processes is present,
as well as on the medial and lateral surfaces of the mandibular
condyles (Fig. 4b). No fractures of the cranium or osteopenia of
the skeleton was noted. Both humeri exhibit complete, transverse
fractures of the proximal third of the diaphyses. Upon excavation,
a lattice of new bone bridged the fracture site on the left humerus,
suggesting that some of the periosteum may have remained intact
after the fracture occurred. This new bone was delicate and broke
upon removal from the feature. The level of new bone formation
suggests that the fracture occurred several weeks prior to death
(Islam et al., 2000; Klotzbach et al., 2003). The margins of bone at
the fracture site of both humeri are slightly rounded and the tra-
becular bone within the proximal portion of the humeri exhibits
a smoothed appearance, indicating healing prior to death, possi-
bly a minimum of one week after the time of fracture (Maples,
1986) (Fig. 5a). Periosteal reactions encircle the diaphysis of the
right radius, and distal portion of the ulnar diaphyses exhibit asym-
metrical new bone formation. Ribs seven (left) and eight (right)
display hard callus formations at the posterolateral/anterolateral
portion of the ribs, suggesting the presence of well-healed fractures.
Most ribs exhibit periostitis on the external and visceral surfaces in
varying degrees, although lower ribs exhibit the most pronounced
bony reactions (Fig. 5b). The medial third portion of the right clav-
icle displays a complete transverse fracture with no evidence of
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healing, indicating a perimortem occurrence. Further, the edges
of the fracture are splintered, showing that sufficient compression
forces were applied while the bone was fresh to fatigue the clavicle
to its failure point, resulting in raised splintered margins on the con-
cave aspect of the fracture (Fig. 6a). Both scapulae exhibit new bone
formation on the ventral and dorsal surfaces, most prominently at
the medial borders and superior and inferior to the spinous pro-
cesses (Fig. 6b). The right ilium exhibits a compression fracture
with plastic deformation on the superior aspect of the iliac crest
(Fig. 6c), showing no new bone formation, indicating a perimortem
occurrence. The left ilium also exhibits a compression fracture on
the superior aspect of the ilium with new bone formation anterior
to the fracture. New bone formation is evident on the ramus of the
right ischium and the acetabular surface of the right pubis exhibits
a fracture in the early stages of healing. The right transverse process
of the first lumbar and the right lamina of a lower thoracic verte-
bra exhibit hairline fractures and slight new bone formation at the
fracture sites (Fig. 7). New bone formation is seen on the medial
diaphysis of the left tibia, the anterior border of the right fibula, the
floor of the sinus tarsi on both calcanei, and on the proximal plan-
tar surfaces of the metatarsals. No fractures are associated with the
new bone formation at these locations and may be associated with
other pathologic conditions. The only dental pathology noted on
erupted teeth was the presence of localized hypoplasia of the pri-
mary canine (LHPC; Skinner, 1986) on the labial surface of the left
mandibular and maxillary canine.
3.2. Micro-CT and histology
MicroCT scanning of the left proximal humerus aided in the visu-
alization of the new bone formation at the fracture site, including
a sclerotic margin directly beneath the affected area, which was
not readily apparent in standard radiographs. Images captured on
the sagittal and transverse planes show a normal appearance of
the cortex, and the new bone formation shows a sunburst pattern
that is proliferative and unorganized, indicating a rapid occurrence,
probably as a response to trauma rather than infection (Fig. 5a).
Taphonomic changes from soil and plant intrusions, crystal forma-
tion (such as brushite), bacteria, and fungi can mimic pathological
processes and must be considered as agents of pseudopathology
(Stout and Simmons, 1979; Hackett, 1981; Grupe et al., 1993;
Schultz, 2001), thus, prepared thin-sections of the right 11th rib
were observed under plane light and no evidence of pseudopathol-
ogy was found. Observation of this image was repeated under
polarized light and diagenetic changes were not evident. Colla-
gen preservation is excellent, as measured by the preservation and
coloration of Maltese cross patterns in osteons under the hilfsob-
ject compensator. The cortex of the rib appears to be normal and
well preserved, and the new bone formation previously described
macroscopically and radiologically is seen quite clearly histolog-
ically (Fig. 5b). The new bone formation is proliferative in nature
rather than osteolytic, as no resorption or destruction of the under-
lying cortex occurred. The reactive bone is comprised of woven
bone (disorganized and non-lamellar) and resembles the “roman
aqueduct” formation described by Schultz (2001). Close examina-
tion under plane and polarized light (with hilfsobject compensator)
reveals that the new bone was deposited on the subperiosteal
surface, rather than emerging from the normal condition of the
underlying cortical bone. This new bone formation, being separate
from the underlying cortex, implies a non-inflammatory and most
likely a hemorrhagic origin from rupture to the periosteum.
3.3. Isotopic analyses
Stable isotope ratios of light elements like carbon (ı13 C) and
nitrogen (ı15 N) in body tissues serve as valuable indicators for
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Fig. 4. Composite image and radiograph of Burial 519 showing active cribra orbitalia in both orbits (a); radiograph of mandible showing development of the dentition with
detail photograph showing degree of new bone formation on medial portion of right ramus (b).

Table 1
Summary of skeletal fractures for Burial 519.

Bone Side Type of fracture Sign of healing Visible on X-ray

Humerus Right Complete transverse, proximal third Lattice of new bone over fracture site, sclerosis Yes
Left Complete transverse, proximal third Slightly rounded margins Yes
Clavicle Right Complete medial third None Yes
Rib 8th Right Well-healed Hard callous Yes
7th Left Well-healed Hard callous Yes
Thoracic Vertebra Right Hairline on lamina Slight new bone formation Difficult
Lumbar Vertebra Right Hairline on transverse process Slight new bone formation Difficult
Ilium Right Superior compression None Difficult
Left Superior compression Slight new bone formation Difficult
Pubis Right Superior compression Sclerosis Yes

biological processes and provide important insights into human
nutritional physiology and its interactions with both physical and
social landscapes (see reviews: Katzenberg, 2008; Sealy, 2001). ı13 C
and ı15 N values (Table 4) were obtained for hair, skin, nail and bone
collagen of Burial 519 and compared with ı13 C and ı15 N values of
Kellis 2 children of the same age cohort (N = 46) (Fig. 8).1 The ı13 C
values for skin, nail, and bone collagen in Burial 519 are within the
range of variation for the Kellis 2 comparative sample. ı13 C values
for hair, however, are consistently depleted in relation to the com-
parative sample, decreasing over the 2–5 month period followed by
1.5‰ enrichment over the month prior to death. Age-related and
seasonal dietary shifts between C3 and C4 grains have been iden-
tified in hair within the Kellis 2 population; however, the pattern
of depletion seen here is not consistent with the Kellis 2 weaning
pattern (Dupras et al., 2001; Dupras and Tocheri, 2007), nor is it
consistent with the seasonal dietary shifts discerned in the overall
Kellis 2 population (Williams, 2008).
4. Discussion

4.1. Clinical comparisons

1
Stable isotope values are expressed as parts per mille (‰) using the ı notation. While no one particular fracture or trauma is diagnostic for
ı = [(Rsample /Rstandard ) − 1] × 1000. R = 13 C/12 C for ı13 C; and R = 15 N/14 N for ı15 N. child abuse, there are particular patterns that are associated with

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Fig. 5. Composite image and radiograph of left posterior humerus with detail photograph showing fracture margin and circumferential new bone formation in the diaphysis.
Far right image shows micro-CT image capture of proximal portion of humerus showing sagittal (s) and transverse (t) planes and areas of new bone formation (arrows)
(a); radiograph and photograph of right 11th rib with detail photograph of new bone formation on visceral surface. Far right image shows rib thin-section with new bone
formation (arrow) (×40 mag.). Dashed line indicates location of rib thin-section (b).

non-accidental trauma (Abel, 2011). The pattern of skeletal trauma
with differential stages of healing and new bone formation
observed in this individual are consistent with clinical patterns
of skeletal trauma found in victims of non-accidental trauma or
physical child abuse. Complete fractures occur more commonly in
children with multiple traumas, as these are associated with high-
velocity injuries (Wilber and Thompson, 1998; Love et al., 2011).
Head trauma due to abuse is noted as the leading cause of infant
death from injury in clinical cases (Gerber and Coffman, 2007),
however the older age of Burial 519 may explain the lack of cranial
fractures in this case. Clinically, humeral fractures are more com-
monly associated with physical child abuse (Caviglia et al., 2005;
Love et al., 2011). Transverse fractures of the humerus tend to be
associated more frequently with obstetric injury or direct blows
to the upper arm or shoulder (Ogden, 2000). Although fractures of
the proximal humerus most often occur in younger individuals, a
directed high-energy force would be needed to produce the bilat-
eral transverse humeral fractures like those seen here (Resnick,
1996; Carty, 1997; Galloway, 1999; Green and Swiontowski, 2003).
Furthermore, the new bone formation on the diaphyses of the arms
is consistent with stripping of the periosteum from bone when an
arm or leg is forcefully grasped or pulled when shaken (Caffey,
1974).
Accidental clavicle fractures are rare in children under the age
of two years, with the exception of birth trauma (Carty, 1997).
Clavicle fractures in young children are the result of sudden trac-
tion to the arms by violent shaking, and in older children they are
caused by falls with the arm held against the side of the body (Abel,
2011; Ogden, 2000). When clavicle fractures do occur, fracture of
the medial third occurs infrequently (only 3–5% of clavicular frac-
tures), whereas fractures of the middle and lateral third are more
common (Brogdon, 1998). Rib fractures, particularly in differen-
tial stages of healing, are regarded as virtually diagnostic of child
abuse (Cadzon and Armstrong, 2000), as they are seldom seen in
infants and young children even in response to violent trauma (e.g.,
auto accidents) (Bulloch et al., 2000; Cramer and Green, 2003). The

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Fig. 6. Photograph of superior right clavicle with detail photograph of complete perimortem fracture of medial third portion; arrow pointing to raised cortical bone on
concave surface of fracture margin (a); radiograph and photograph of ventral aspect of right scapula with detail image of new bone formation (b); radiograph and photograph
of medial aspect of right ilium, pubis and ischium with detail photographs showing plastic deformation on iliac crest and healing fracture of the superior portion of the pubis
(lateral aspect shown on far right) (c).

presence of rib fractures, especially when other long bone fractures
are present, is clinically diagnostic of child abuse in children of
any age (Abel, 2011; Campbell, 2001). The most commonly asso-
ciated action to cause rib fractures is picking a child up by the chest
and shaking. This motion may cause fracture of the rib head and
neck, and anterior-posterior compression can cause fractures in
the angle of the rib (Carty, 1997; Kleinman et al., 1995). The asso-
ciated rib fractures in Burial 519 are well healed, and most likely
occurred when this individual was an infant or less than two years
old. Further, the well-healed rib fractures are located in the pos-
terolateral/anterolateral region, an area that is vulnerable to direct
impacts and generally not associated with fractures from shaking
(Love et al., 2011).
The most common mechanism for isolated fractures of the
vertebral neural arch, particularly of the thoracic and lumbar verte-
brae, is a direct blow (Ogden, 2000). The new bone formation at
the fracture site suggests these fractures occurred within a few
weeks of the trauma (Islam et al., 2000; Klotzbach et al., 2003). The
pattern of fractures and differential stages of healing in the pelvic
bones indicate multiple traumatic events. The significance of these
fractures is unclear because there is a dearth of clinical reports on
the type of pelvic fractures observed here; however, pelvic frac-
tures almost always result from high-energy directed forces such
as those created in motor vehicle accidents (Abel, 2011; Ablin et al.,
1992; Kleinman, 1998). In children, pelvic rami fractures usually are
caused by high-velocity trauma and have a significant number of
associated injuries (Canale and Beaty, 2001). As it is unlikely that
the individual in this case suffered from a high velocity injury, it is
more likely that these injuries were associated with non-accidental
trauma. In clinical investigations, fractures of the pubic rami can
suggest child sexual abuse (Starling et al., 2002). It is suggested
that any fracture to the hip bones (innominates) that occur out-
side of a high-energy scenario is suspicious for child abuse (Abel,
2011). Overall, the observed pattern of trauma rules out a single
event as the causative factor as there are numerous fractures in
different stages of healing indicating multiple events. Fatal injury
from accidental falls during childhood is very rare (Abel, 2011).
The prevalence of trauma in the Kellis 2 juvenile is relatively low,
with only 5.7% of juveniles aged birth to about 15 years exhibiting
skeletal fractures (Table 3). There is only one other Kellis 2 juvenile
analyzed that displays evidence of multiple skeletal fractures. This
individual was an older juvenile whose traumas all occurred as a
single event around the time of death (Wheeler, 2009). The type and
location of these traumas indicate an accidental death related to a
high fall or high-velocity impact, and not related to non-accidental
trauma. The pattern of trauma observed in Burial 519 is unique
in the Kellis 2 juvenile population in both the pattern and extent
of skeletal fractures, as well as the differential pattern of healing
throughout the skeleton.
Histologically, while reactive bone on the ribs appears to be the
result of non-severe hemorrhaging, new bone formation on the
humeri, as visualized using micro-CT, suggests that the trauma was
more severe as the reactive bone formed a disorganized, sunburst-
like pattern. The periosteal reactions were nearly identical in that
they were non-inflammatory (infectious) proliferative reactions
and most likely of hemorrhagic origins, which suggests trauma
as its etiology. This interpretation supports the pattern of injury
observed in this individual.
Isotopically, the ı15 N values for skin, nail, and bone collagen
from Burial 519 also fall within the range of variation for the com-
parative sample, but all tissues are depleted in 15 N in relation to the
comparative mean. ı15 N values for hair in Burial 519 are depleted

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Fig. 7. Photograph and detail of lower thoracic neural arch showing a hairline fracture of the right lamina with slight new bone formation (arrow) (a); photograph and detail
of first lumbar neural arch showing a hairline fracture of the right transverse process with minor plastic deformation and slight new bone formation (arrow) (b).

by an average of 3‰ in relation to the comparative sample, with
two notable periods of change: a 1.5‰ enrichment at four to five
months followed by a 2.0‰ depletion over the one to three months
prior to death. In children, changes in body composition occur-
ring in response to trauma, infectious or inflammatory processes,
and nutritional concerns can be indirectly measured on the basis
of relationships among metabolic reactions (Beisel, 1975, 1977).
Trauma, for example, promptly initiates a catabolic response result-
ing in negative nitrogen balance in the body (Stableforth, 1986).
However, if nutritional challenges outweigh the effects of trauma,
cumulative losses can lead to anabolic nutritional depletion and a
positive nitrogen balance, mimicking recovery from the catabolic
state (Beisel, 1975). These rapid changes in routing of nitrogen and
protein synthesis are detectable in hair, skin, and nail tissues and
have been shown in both clinical and archaeological research to
indicate timing of nutritional depletion or trauma and subsequent
recovery (Hatch et al., 2006; Mekota et al., 2006; Williams et al.,
2011).
While it is recognized that supplementary foods were
introduced into the Kellis 2 diet starting at around six months of
age, and breastfeeding continued until about three years of age
(Dupras et al., 2001; Dupras and Tocheri, 2007), the weaning pro-
cess cannot solely account for this pattern, nor for the overall level
of depletion seen in the ı15 N values of Burial 519. The overall trend
in 13 C depletion during the 2–5 months prior to death could have
been brought about by reduced consumption of protein-rich foods
during episodes of trauma, acute infection or febrile illness (Beisel,
1977; Stableforth, 1986). In cases of extreme nutritional depletion,
ı13 C values are directly proportional to body mass index (BMI), with
a decrease in ı13 C values related to a decreased supply of protein
during nutritional depravation (Hatch et al., 2006; Mekota et al.,
2006). We believe that the depleted ı13 C values 2–5 months prior
to death are primarily the result of a decrease in protein intake,
possibly at the starvation level. The 13 C enrichment over the one
month prior to death may indicate a final effort to feed the child a
special diet consisting of C4 grains and/or milk from C4 -fed dairy
animals, which was also used at Kellis during the weaning process
(Dupras et al., 2001) and in the early months of pregnancy for morn-
ing sickness (Williams, 2008), suggesting C4 foods may have played
a special role in illness.
Patterns of trauma and healing within the skeleton of Burial 519
suggest multiple trauma events occurred in the months prior to
death. The 15 N enrichment seen four to five months prior to death
correlates directly with the onset of depletion in ı13 C values. The
correlation in 13 C depletion and 15 N enrichment in the hair may
indicate a severe decrease in protein intake, possibly brought on
as a side effect of the pain and inflammation experienced by the
child during this time. An individual suffering from prolonged or
severe protein malnourishment may produce a trophic level effect
within their own body, causing enriched ı15 N values in their tis-
sues as the body becomes anabolic and enters a positive nitrogen
balance (Beisel, 1977; Hatch et al., 2006; Mekota et al., 2006). In

Please cite this article in press as: Wheeler, S.M., et al., Shattered lives and broken childhoods: Evidence of physical child abuse in ancient
Egypt. Int. J. Paleopathol. (2013), http://dx.doi.org/10.1016/j.ijpp.2013.03.009
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Table 2
Differential diagnosis of diseases associated with diseases mimicking non-
accidental trauma in children. Presence of the skeletal manifestations in Burial 519
is noted.a

Disease Present in Burial 519

Osteogenesis imperfecta
Osteopenia No
Dental malformation No
Diaphyseal fractures Yes
Infantile cortical hyperostosis
<6 months No
Severe new bone formation No
Mandibular involvement Yes
Clavicle involvement No
Diaphyseal fracture Yes
Exuberant bony callus No
Leukemia
New bone formation Yes
Leukemic lines (radiolucent lines) No
Osteolytic lesions No
Anemia Yes
Osteopenia No
Sclerotic lesions No
Childhood hypophosphatasia
Short stature No
Osteomyelitis No
Flared metaphyses No
Physiologic new bone formation
<6 months No
Diaphyseal involvement Yes
Single-lamellar bone No
Rickets
Diaphyseal fracture Yes
New bone formation Yes
Flared metaphyses No
Osteopenia No
Bowing of weight-bearing long bones No
Copper deficiency
Abnormally kinky hair No
“Sunken” chest, abnormal sternum, sternal ribs No
Diaphyseal periosteal reactions Yes
Metaphyseal spurring and widening No
Scurvy
Diaphyseal fractures Yes
Osteopenia No
New bone formation Yes
Flared metaphyses No
a
From (Resnick, 1996; Brill et al., 1998; Campbell, 2001; Cramer and Green, 2003;
Love et al., 2011).

addition, depleted ı15 N values are associated with fracture trauma

and enriched ı15 N values are seen in response to the body’s repair
process (Katzenberg and Lovell, 1999). The healing in the bilat-
eral fractures of the humeri points to these injuries occurring
in the month prior to death, which may account for the change Fig. 8. ı13 C and ı15 N values for hair, skin, nail, and bone collagen of B519 () com-
to a special diet, rather than traditional means of breast feeding pared with ı13 C and ı15 N range of values for the same tissues in Kellis 2 children
from the same age cohort ( = mean values).
and supplementary foods. We suggest the rapid 15 N enrichment
and subsequent depletion between trauma events represents a
combination of catabolic recycling of nitrogen derived from the
breakdown of existing proteins in the body and subsequent tissue 4.2. Differential diagnosis
repair, as well as possible anabolic nutritional depletion mimicking
recovery from the trauma events. It is important to note that other pathological conditions may
produce skeletal changes similar to those resulting from non-
accidental trauma towards children. Those conditions likely to
Table 3 produce similar pathological changes include, but are not limited
Prevalence of skeletal trauma by age cohort for the Kellis 2 juveniles.a to, osteopenia, osteoporosis, osteomalacia, proliferative bone for-
Age Cohort n/N % mation osteogenesis imperfecta, infantile cortical hyperostosis (or
Caffey’s Disease), childhood hypophosphatasia, copper deficiency
Birth–12 months 3/85 3.5
1–3 years 2/32 6.3 (or Menkes Disease), physiologic new bone formation of infancy,
4–9 years 1/26 3.8 leukemia, scurvy, and rickets (see Heldrich, 2011 for a complete
10–15 years 3/15 20.0 review). The clinical and archaeological literature reports that
Total 9/158 5.7
hypertrophic osteoarthropathy, hypervitaminosis A, osteomyeli-
a
From (Wheeler, 2009). tis, temporary brittle bone disease, congenital insensitivity to pain,

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Table 4
Isotopic values for B519 and Kellis 2 (K2) comparative age cohort (N = 46).

B519 Hair Nail Skin Bone

TSDa ı13 Cb ı15 N C:N ı13 C ı15 N C:N ı13 C ı15 N C:N ı13 C ı15 N C:N

1m −19.7 15.2 3.6 −19.8 18.1 3.2

2m −21.1 15.8 3.5 −19.0 21.0 3.5
3m −20.7 16.3 3.3 −19.6 18.3 3.3
4m −20.4 16.9 3.4
5m −19.5 15.7 3.2
6m −19.8 15.6 3.4
3y −19.2 17.8 3.3

K2 Cohortc Hair Nail Skin Bone

TSD ı13 C ı15 N C:N ı13 C ı15 N C:N ı13 C ı15 N C:N ı13 C ı15 N C:N

1m −19.3 19.5 3.4 −20.0 19.8 3.3

2m −19.3 19.4 3.3 −19.9 21.4 3.4
3m −19.5 19.6 3.3 −20.0 18.9 3.4
4m −19.4 20.2 3.4
5m −19.2 20.4 3.2
6m −18.9 20.6 3.3
3y −18.5 19.5 3.2
a
TSD (Time since death in months (m) or years (y)).
b
All isotopic values reported as ı13 C (‰) relative to VPDB and ı15 N (‰) relative to AIR; precision of analysis determined by duplicate sample analyses, which for ı13 C was
±0.04‰, and for ı15 N was ±0.05‰. Accuracy assessed using laboratory keratin standard, which gave an average ı13 C value of −24.01 ± 0.04‰ and an average ı15 N value of
+6.31 ± 0.05‰ for 18 analyses. Values of −24.07‰ ı13 C and +6.36‰ ı15 N obtained for this standard through calibration with carbon standard NBS-22 (−30.0‰) and nitrogen
standard IAEA-N1 (+0.40‰).
c
Isotopic values for Kellis 2 age cohort represent mean values for the comparative study sample (N = 46).

and congenital syphilis may also mimic skeletal manifestations
associated with non-accidental trauma towards children (Cramer
and Green, 2003; Lewis, 2007). These diseases that mimic child
abuse and their skeletal manifestations are summarized in Table 2
with the presence or absence of those manifestations in Burial 519
noted. The pattern of skeletal trauma and skeletal lesions observed
in Burial 519 are not fully consistent with the skeletal manifes-
tations of the conditions presented in Table 2, perhaps with the
exception of scurvy, as Burial 519 exhibits some of the osteologi-
cal descriptions of the condition, including new bone formation on
the mandibular rami and temporal processes, abnormal porosity
of the cortex and new bone formation on several skeletal ele-
ments including the supraspinous and infraspinous fossae of the
scapulae (Ortner et al., 2001). Localized hypoplasia of the primary
canine (LHPC; Skinner, 1986) is present on the labial surface of
the left mandibular and maxillary canine. Among the Kellis 2 juve-
nile population, 33% of individuals display LHPC (Wheeler, 2009).
Although the exact etiology of LHPC is unknown, its presence has
been attributed to minor trauma or compression to the develop-
ing canine crown (Skinner and Hung, 1986, 1989), deficient bone
mass in early infancy (Skinner and Newell, 2000), and groups of
low socioeconomic status who are nutritionally stressed (Lukacs
and Walimbe, 1998). The remainder of the skeletal lesions man-
ifested in Burial 519 suggests the presence of other nutritional or
disease stressors contributing to the overall morbidity and perhaps
mortality of Burial 519. Co-morbidity with other conditions should
not be ruled out and may have also affected Burial 519’s suscepti-
bility to fracture and healing. Isotopic results support physiological
changes resulting from multiple traumatic events, which correlate
with patterns of trauma and healing in Burial 519.
4.3. Historical and archaeological comparisons
To understand the pattern of trauma observed in Burial 519 it
is useful to contextualize this individual first within the Kellis 2
juvenile population and then within the broader Roman context.
The overall prevalence of trauma in the Kellis 2 juvenile popula-
tion is relatively low, with only 5.7% (9/158) of juveniles exhibiting
skeletal fractures (Wheeler, 2009) (Table 3). The fractures in the
youngest age cohort are likely related to birth trauma, given the
age of the individuals (all are aged 0–6 months). Fractures repre-
sented in the 1–3-year cohort include those of Burial 519 as well
as an individual with a well-healed fracture of the left radius and
ulna. Fractures in the 4–9-year cohort include a well-healed cranial
fracture and the10–15-year cohort includes two individuals with
well-healed cranial depression fractures, and one exhibits multiple
fractures of the ribs, thoracic and lumbar vertebrae, sacrum, femora,
tibia, calcanei and talus bones. The pattern and extent of fractures
and lack of healing in this individual indicate a single traumatic
event, possibly a fall from a great height (Wheeler, 2009). The third
individual exhibits a well-healed metaphyseal fracture of the prox-
imal humerus and a well-healed fracture of the left ninth rib. As a
whole, the unique pattern of trauma seen in Burial 519 stands out
within the Kellis 2 cemetery juvenile sample. The multiple fractures
in differential stages of healing, along with the varied degrees of
asymmetrical new bone formation, strongly parallel clinical diag-
noses of child abuse. Distribution of new bone formation on the
scapulae and mandible, and stable isotope results, however, sug-
gest other metabolic and/or nutritional deficiencies may also be
involved, which may also be indicative of neglect and abuse.
Taking historical evidence into account, maltreatment of chil-
dren in the Roman Empire does not seem to be an uncommon
occurrence. Romans perceived childhood as a fully separate stage
over the life course, one that demanded much from children in
light of our current notions of childhood well-being (Harlow and
Laurence, 2002). It is important to recognize that the strain placed
on children was not out of indifference, but for the perceived benefit
of the child so that they may become proper adults in Roman soci-
ety. In the Roman world view, newborns entered the world soft and
shapeless and it was a parents’ duty to literally form and mold the
developing body into fully human form (Dupont, 1993). Weakness
or softness was considered moral weakness and as a result Romans
treated their children with considerable severity. For example, at
birth infants were often immobilized on a plank of wood for a short
period so that their limbs could not move (Garnsey and Saller,
1987), in an effort to ensure proper growth. Infants and children
were also routinely bathed in cold water as to not soften them with
the feel of warm water (Garnsey and Saller, 1987). Educators, from

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within or outside the family, would routinely beat children for mis-
takes made during lessons (Aldrete, 2004). Children would also be
put to work as young as five years old (Redfern, 2007). As a number
of Roman scholars have noted (Dupont, 1993; Harlow and Laurence,
2002), Romans loved their children immensely and these practices
were not done out of malice. It is also important to remember that
infant mortality was shockingly high, estimated to be around 300
per 1000 births, compared to 10 per 1000 today in the West (Toner,
2009). Although many Roman cultural practices infiltrated Egypt
during the period of Roman rule, it is still not known, however,
how these attitudes may have influenced perceptions of child-
hood and actions of adults in Roman Egypt, particularly in light
of the fact that previous time periods in ancient Egypt advocated
the value and preciousness of children (Robins, 1993). It has been
shown that frequent corporal punishment of children is predicted
by higher levels of social stratification and political integration, eco-
nomic hardship, and in societies where non-relative caretakers help
raise children. Further, societies are likely to practice corporal pun-
ishment to prepare children for living in a society with native or
imposed power inequality (Ember and Ember, 2005). Perhaps this
case signals that some Roman beliefs regarding corporal punish-
ment of children did filter into Egyptian practice. Given the rarity
of bioarchaeological evidence for non-accidental trauma in ancient
Egypt, however, it appears that child maltreatment in this fashion
represents aberrant behavior.
5. Conclusions
The rarity of archaeological publications concerning child abuse
cannot be taken as evidence that violence directed at children
was a rare occurrence in the past. It is likely that many cases are
overlooked because of incompleteness of remains or contextual
information, or the fact that non-accidental injuries can be mis-
diagnosed, just as with clinical cases, or that complete collection of
juvenile remains is a relatively recent archaeological goal. The con-
text and multiple methods of investigation employed to interpret
the pattern of trauma observed in Burial 519 highlight the unique
nature of this archaeological case. The application of multiple lines
of evidence - macroscopic pattern of skeletal trauma, the histologic,
radiographic and isotopic evidence, as well as the contextual inter-
pretation of the Kellis 2 juvenile sample - supports a diagnosis of
non-accidental trauma, likely physical child abuse. Although only
a fraction of the cemetery has been excavated, given that this is
the only juvenile of 158 (0.6%) between the ages of birth and about
15 years that displays multiple traumas of this nature at differ-
ent stages of healing suggesting multiple traumatic events, it may
be speculated that non-accidental trauma of this extent was rare
at Kellis. Further, this incident of non-accidental trauma could be
classified as physical child abuse and may be interpreted to have
occurred at the social level of the individual home, and it was not
a wide-spread occurrence in the community at large, supporting
the general belief that children were a valued part of ancient Egyp-
tian society. At present, this individual represents the oldest case
of non-accidental traumatic injury reported from an archaeological
context.
Acknowledgements
The authors would like to extend their thanks to the Egyptian
Ministry of State for Antiquities for their continued support and
to all the members of the Dakhleh Oasis Project (DOP) and the
DOP Bioarchaeology Team. Thanks also to Dr. D. Holdsworth at
the Robarts Research Institute for the generous micro-CT scanning
and to the Bioarchaeology Laboratory, both at Western Univer-
sity in Ontario, Canada. This research was funded in part by the
Please cite this article in press as: Wheeler, S.M., et al., Shattered lives and broken childhoods: Evidence of physical child abuse in ancient
Egypt. Int. J. Paleopathol. (2013), http://dx.doi.org/10.1016/j.ijpp.2013.03.009
11
Department of Anthropology, Western University, SSHRCC, and the
CRC of Canada.
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