Contents lists available at ScienceDirect International Journal of Paleopathology journal homepage: www.elsevier.com/locate/ijpp Time after time: individuals with multiple fractures and injury recidivists in long eighteenth-century (c. 1666–1837) London Madeleine Mant a,b, ⁎ a Memorial University of Newfoundland, Department of Archaeology, Queen’s College, 210 Prince Philip Drive, St. John’s NL A1B 3R6, Canada b McMaster University, Department of Anthropology, Chester New Hall, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada ARTICLE INFO Keywords: Trauma Injury Recidivism Multiple fracture Accident ABSTRACT Investigating injury recidivism and individuals with multiple injuries is an area of growing interest in bioarchaeology. Differentiating between whether an individual sustained multiple injuries, represented by antemortem healed fractures, in one incident or in multiple incidents over the life course, is a major challenge. This research analyzed the skeletal remains of 721 adults (402 males, 319 females) from five post-medieval cemeteries from London, UK, known to include working class individuals for evidence of skeletal trauma – fractures, myositis ossificans, subluxations/dislocations, blunt force trauma, and sharp force trauma. A total of 164 individuals had more than two fractures; males were significantly more likely to have multiple (2+) fractures than females. An investigation of fracture recidivism incorporating a relative timeline of fracture events was possible because 14 individuals (12 males, two females) were identified as injury recidivists, meaning they had a combination of antemortem healed, antemortem healing, and/or perimortem fractures. This paper ex- amines the distribution and relative timing of these fractures, incorporating contemporary clinical as well as social and historical context, noting that the majority of the fractures were likely to be caused by accidental mechanisms. 1. Introduction Injury recidivism is both a contemporary health problem and a challenging subject to access in bioarchaeology. The term trauma re- cidivist was introduced to the clinical literature by Reiner et al. (1990), following the example of Sims et al. (1989) who noted that repeated trauma should be considered a chronic disease. Reiner et al. (1990) outlined the clinical definition of an injury recidivist as a male of low socioeconomic status with a mean age of 26 years, who within a few years of his first admission (at the average age of 20 years) would suffer another fracture or injury. Further clinical literature quickly adopted the term in many key studies based upon urban American hospital admittances (e.g., Cesare et al., 1990; Goins et al., 1992; Hedges et al., 1995; Kaufman et al., 2016; Kaufmann et al., 1998; Kennedy et al., 1996; Madden et al., 1997), many of which focused upon deviant and violent behaviour. Clinical interest in recidivism continues apace, with broader international studies (e.g., Caufield et al., 2004; Dowd et al., 1996; Sayfan and Berlin, 1997) and increased attention to gendered, social, and demographic contexts that may influence exposure to re- peated trauma (e.g., Kwan et al., 2011; Richardson et al., 2016; Rogers et al., 2014; Toschlog et al., 2007). Judd (2002a) was the first to apply the concept of recidivism to bioarchaeology, investigating and comparing multiple injuries in an- cient Nubian individuals. She determined that many of these ancient individuals aligned with the clinical definition of an injury recidivist and identified differences in fracture type and distribution between rural and urban groups. This key study laid out criteria for the in- vestigation of injury recidivism in archaeological samples: adults must be grouped by age and sex; data should be grouped as individuals with no fractures, one fracture, and two or more fractures; and all injuries must be included. Judd (2017); Judd and Redfern (2012), and Redfern et al. (2017) outline the challenges in trauma research in bioarch- aeology, and studies of recidivism specifically. As Judd (2002a, p. 93) asserts, “in clinical investigation, injury recidivism is determined by the number of times that an individual sought medical treatment for injury, but the exact number of injuries presented on each occasion are often unstated.” In bioarchaeological studies, it is generally impossible to determine the total number of episodes in which individuals suffered multiple fractures (due to the remodeling of fracture calluses); there- fore, researchers must use the total number of fractures per individual https://doi.org/10.1016/j.ijpp.2018.08.003 Received 16 May 2018; Received in revised form 6 August 2018; Accepted 9 August 2018 ⁎ Corresponding author at: Memorial University of Newfoundland, Department of Archaeology, Queen’s College, 210 Prince Philip Drive, St. John’s NL A1B 3R6, Canada. E-mail address: mmant@mun.ca. International Journal of Paleopathology 24 (2019) 7–18 1879-9817/ © 2018 Elsevier Inc. All rights reserved. T