‘The Bioarchaeology of Care’: A Case Study From Neolithic Vietnam (Tilley & Oxenham 2011)

A recent article in the International Journal of Palaeopathology, ‘survival against the odds: modelling the social implications of care provision to seriously disabled individuals’ by Tilley & Oxenham (2011), has proposed a new methodology (the ‘bioarchaeology of care’) highlighting the functional impacts of pathologies, possible and probable health challenges encountered, and the nature of support required to sustain life for disabled individuals in the archaeological record.  Make no mistake- this is a bold, interesting and arresting improvement in the field of palaeopathological studies.

Man Bac Burial 9 (Tilley & Oxenham 2011: 37)

The focus of the investigation is the individual called Man Bac burial 9 (hereafter referred to as M9), from a Neolithic cemetery site (1700-2000BC) located in Ninh Binh province of northern Vietnam, 100km north of Hanoi (Tilley & Oxenham 2011: 36).  Excavations between 1999 & 2007 uncovered 95 individuals, with the site occupying a mouth of an estuary of the Red River Delta.  The archaeological evidence suggests a ‘hunter gather economy’, with a focus on aquatic and terrestrial vertebrate fauna (Tilley & Oxenham 2011: 36).

The individual under study was a  male between 20-30 years old, buried in a north to south flexed position on his right side, in contrast to the normal mortuary practice of extended supine east-west orientation.  The skeleton of M9 exhibits extreme disuse atrophy of the lower and upper limbs (as evidenced by the gracile bones), alongside full ankylosis of all cervical and first three thoracic vertebrae, permanent torticollis, and bilateral temporomandibular joint degeneration; a ‘diagnosis of Klippel Feil Syndrome type III has been proposed’ (Tilley & Oxenham 2011: 36).   It is thought that M9 survived for approximately 10 years with disabilities (minimally paraplegia/maximally quadriplegia) so severe that he relied on assistance for nearly ever aspect of his life.

The methodology identified the context of care for M9, (as above), included reviewing the socio-cultural context, general health, and the Man Bac physical environment.  Next, Tilley & Oxenham (2011: 37) reviewed current clinical literature and split the care needed by M9 into a) basic and b) advanced care.  Basic care consists of the daily necessities of life- dressing, food, water, transport & dressing, whilst advanced care includes maintenance of personal hygiene, managing long term environmental and physical concerns, general health maintenance, dedicated nursing, medical intervention as needed and continued well-being.

Tilley & Oxenham (2011: 40) are right in assessing that it can never be known how the Man Bac society identified and understood illness, but assume that the same basic  physiological responses were the same.  The methodology is still under development, and I look forward to it being applied to further archaeological individuals and cultures (Larsen 1997, Roberts & Manchester 2010).

Ninh Binh (Wikipedia 2012)

My only reservation regarding the methodology and approach of the researchers & archaeologists are the dangers inherent in applying a care scheme (or ‘retrospective attribution of motive’) onto a culture from which we are substantially removed from, both in space and time.  Regarding what is, and what can be classed as a disability, together with differing cultural and world views, means that disability can never be classed easily (Roberts & Manchester 2010).  The ever resourceful IFA have produced a recent paper on employing disabled people, and it helps to  highlight how Britain’s own views on disabilities have, and continue, to change (see this post for the social, medical and charitable models of disability).

Regardless, this is an interesting and much-needed review of how disabled individuals are examined in a cultural context.  The use of modern clinical data alongside the environmental, archaeological and palaeopathological evidence is well presented, and produces interesting results whilst making the best use out of available evidence.  On the last note, it is noted that the cultural values exhibited & recorded are key in giving a partial insight into the life and care of M9; hopefully this methodology will be developed further and used again, however it should not be used carte blanche without the full context of evidence available.

Bibliography

Larsen, C. 1997. Bioarchaeology: Interpreting Behaviour From The Human Skeleton. Cambridge: Cambridge University Press.

Roberts, C. & Manchester, K. 2010. The Archaeology of Disease Third Edition. Stroud: The History Press.

Tilley, L. & Oxenham, M. F. 2011. Survival Against the Odds: Modelling the Social Implications of Care Provision to Seriously Disabled Individuals. International Journal of Palaeopathology. Vol 1 (2) pp.35-42. (Access required).

Waldron, T. 2009. Palaeopathology: Cambridge Manuals in Archaeology. Cambridge: Cambridge University Press.

Whittington, K. 2011. Employing People with Disabilities- IFA Practise Paper. Reading: IFA.

Blog Mention In The Newsletter Of The Society For Archaeological Sciences

My blog, alongside Powered By Osteons & Bones Don’t Lie, have been mentioned in a brief article in the newsletter of the Society for Archaeological Sciences, Vol 34, No4 pp.27-28 (Winter 2011).  The short article, by Gordon F. M. Rakita (Associate Editor),  discusses bioarchaeology and the recent American Anthropological Association’s annual meeting.  It highlights the need for scientific archaeologists, and archaeology as a field a whole, to reach out and make use of social networking sites, blogs and other websites in disseminating news, views, experiments and research data.  It is imperative that as many researchers, educators, lecturers & field workers as possible make archaeology accessible to the public.  After all, we are all indebted to history, and archaeology as a whole is largely government, council &/or business funded.  I am humbled to be mentioned by name and by website, and pleased that my writing is being read.

Also, miraculously, I’m still on the front page for archaeology at the University of Hull– alas the long hair is no more….

My Name In Print! (S.A.S. Vol 34. No 4. pp.27-28)

10.02.12 Update:  Both Kristina Killgrove & Katy Meyers have wrote about this piece at their respective blogs, and provide interesting views regarding the advent of the blog as an important bioarchaeology outreach tool.

Rakita’s (2011: 27-28) article is quoted in full below:

“Of late, there have been several calls for anthropologists to reach out and engage the public. For example, Jerry Sabloff (2011), in his distinguished lecture at the American Anthropological Association’s annual meetings, strongly urged us to actively speak and write to a public audience and develop mechanisms (at least within academia) to reward those who do so. In particular, he suggested (p. 414) that ―One of the most promising areas of outreach—and perhaps the launching pad of the future for public intellectuals in anthropology—is blogging.

Sabloff is just one such prominent anthropologist to advocate for blogging. Likewise, paleoanthropologist and blogger himself, John Hawks (2010, 2011) has continued to advocate for anthropologists to reach out to the public through blogging or other forms of public discourse.

Writing as I do from a public university in the state of Florida, I am keenly aware that the public and our elected officials often have a clouded understanding of the nature of our discipline and our contributions to society. Certainly we make such contributions, but we often fail to tout or otherwise advertise these contributions. As a result, we often have to play catch-up when others define who we are and what we do. In the wake of Florida Governor Scott’s comments regarding anthropology, many rushed into the public debate to emphasize the scientific aspects of modern anthropology. None were more effective than the presentation developed by Charlotte Noble and other graduate students at the University of South Florida.

But I can’t help but wonder if this entire incident would have happened, or if such a response would have been necessary, had anthropologists been more active in communicating the value and knowledge of our field to the public. This is especially true for scientific archaeologists who both seek public funding and require public laws to preserve the cultural resources that we know are so important to our communities. For this reason, I want to highlight several blogs that are dedicated to bioarchaeology or bioarchaeology themes.

These are the blogs I’ve tuned my RSS feed reader to: 

• Powered by Osteons by Kristina Killgrove 
• Bones Don’t Lie by Katy Meyers 
• These Bones of Mine by David Mennear

Each of these regularly discusses exciting new finds or developments within bioarchaeology. They help me keep up with the literature, make connections between disparate research threads, and (perhaps most importantly) remind me why I decided to be a bioarchaeologist in the first place. 

So if you’re interested in the field of bioarchaeology, tune in, and don’t drop out. And if you’re not interested in bioarchaeology but some other aspect of scientific archaeology, then I guarantee there’s probably a blog for it out there. If not, then why not start one yourself.

References Cited

• Hawks, John 2010 Public engagement | john hawks weblog.
• Hawks, John 2011 Blogs, academic discourse in economics | john hawks weblog.
• Sabloff, Jeremy A 2011 Where Have You Gone, Margaret Mead? Anthropology and Public Intellectuals. American Anthropologist 113, no. 3: 408-416.” 

The Don Epic by Mikhail Sholokhov (1905-1984)

During the my gap year between university degrees, I volunteered heavily and looked longingly for paid employment.  Alas that was not forthcoming in any shape or form, and as I traveled the miles to and from York to gain valuable archaeological experience, I realised I needed reading material to occupy my mind (when no interesting passengers to engage with were forthcoming!).  During my early school years I hated learning to read, I loathed the minutes and hours spent trying to visualise and make sense of sentences and words; I wanted to be free, running in the back garden, digging up the dirt.  Now I won’t stop reading!  If I am bored, I’ll scan around and read everything in sight.  Now I only wish I could remember all of what I’ve read but such is life.

Scanning my dad’s book shelf high and low, I realised I had not read hardly any of Russia’s distinctive, world class and moving literature; from either the all encompassing and demanding Tolstoy or Dostoevsky, or regime changers such as Solzhenitsyn, or any Nabokov or Pasternak.  I had made my way through the Beat writers alongside most works by Kurt Vonnegut, some Bret Easton Ellis, a lot of Joseph Heller, a good dose of David Foster Wallace, plenty of Bernard Cornwall, and a good clutch of Will Self’s work; I gorged upon travel books (and still do); I’d read some of the classics such as Camus, Melville  & Shelley, and engorged on plenty of modern novels; but here was a whole swathe of literature to which my mind drew a blank.  Aside from a (mighty) Stalin biography or two, Imperial Russian and USSR literature classics were a mystery to me.

And so, I scanned the shelves and found novels by Tolstoy & Solzhenitsyn amongst others.  Possibly in a foolish move, I worked my way backwards, reading through Solzhenitsyn’s short stories and novels (Cancer Ward, One Day In The Life of Ivan Denisovich, August 1914, Matyrona’s Place, and An Incident At Krechetovka Station), and found a movingly painted portrait of a country that had changed drastically, and a population who had been through much.

After reading through these books, my eyes fell onto a writer who was also producing books at the same time on the same subjects as Solzhenitsyn.  Mikhail Sholokhov, a Nobel Prize winner for literature, was a name I did not recognise but would come to love.  I stumbled upon his Don epics, consisting of two parts, firstly And Quiet Flows The Don & its  sequel The Don Flows Home To The Sea, and I was entranced by the comings and goings of the Melekhov family, center stage in a cast of gregarious Don cossacks in a country that is ripped apart before and during World War One, and the subsequent Russian Revolution of 1917 and Civil War that led to the formation of the Soviet Union.

The story concentrates on this one family, and in particular on Grigori Panteleevich Melekhov, who falls in love with his neighbours wife, Aksinia Astakhov.  It is a moving family portrait, vast in scope and beautifully told, and rightly compared to Tolstoy’s epic War and Peace.  Ultimately I cannot do it justice here, and so I implore you the reader to find and read the book yourself – I promise you will not be bored.

Since reading the Don epic, I have started to read Anna Karenina by Tolstoy, which was only slightly marred by the fact I had to hand my University library copy in 60 pages short of the ending (and the local libraries haven’t got a copy!).  Meantime I have picked up a copy of Gogol’s Dead Souls, and finding his writing style very different from his near contemporary Tolstoy, and both  of the Soviet era writers Solzhenitsyn and Sholokhov.

I am intensely glad I have started to have uncovered the vast travel trove of literature that Russia has to offer, and long may it continue.  I have found novels that have since lain close to my heart (especially Cancer Ward by Sozhenitsyn) and characters that will stick with me throughout my life.

Skeletal Series Part 9: The Human Hip

In this post I shall be discussing and looking at the three main elements that make up the human pelvis (or the pelvic girdle, a homology to the shoulder girdle).  The bones that make up the pelvis are the Ischium, Ilium & the Pubis.  The Sacrum has been discussed in an earlier post on the spine.  During the development of the hip, these three elements remain singular, fusing together during adolescence to become one single unit during early maturity to become the Os Coxa (White & Folkens 2005: 246).

The main elements in the human hip, and as a whole Referred to as the Os Coxa. NB acetabulum faces laterally.

The hip is a fantastic wealth of skeletal knowledge.  The two most basic and fundamental traits of the person, the age and biological sex of the individual, can be found in articles by Brooks & Suchey (1990) and by Patriquin et al. (2005), which both use morphological features of the pelvis to estimate sex and age of the individual under study.  Many muscles also insert and attach along the borders, rims and edges of the pelvis, especially anchoring those that are key in movement during bipedal locomotion (Schwartz 2007: 147).  The hip, and its component parts, are most distinctive in shape and size.  Odd looking, hard to figure out at first, and looking like nothing else (a top heavy hourglass is one view), the Os Coxa can can be hard to identify and orientate, especially in smaller fragments.

Juvenile ilium (top), ischium (bottom right) and pubis (bottom left) (Image credit: Bone Clones 2006).

Excavation

Unfortunately during excavation, the first thing that the pick ax, spade or trowel is likely to hit is the most anterior part of the hip, the pubic symphysis, as in most human burials the body lies prone and face up, in a supine burial (see Brothwell: 3 for other burial positions).  This can lead to destruction of this joint, which can lead to loss of information on age and sex of the individual.  However, during normal inhumation excavation the grave cut can be clearly distinguished, and a pattern of working from top to bottom or bottom to top can help limit the amount of damage during excavation (White & Folkens 2005).

The author excavating a Medieval skeleton in Germany in 2011. Note the damaged anterior aspect of the Pubic Symphysis, which is outlined in red.

Pelvic Anatomy and Elements:

Acetabulum

The acetabulum  makes up the socket to receive the head of the femur (thigh), and is equally made up of a portion of the three elements of the hip which fuse during early adolescence.  This joint is necessarily much more stable then the non-weight bearing shoulder joint- it is much deeper, has the ligamentum teres (a ligament that attaches to the femoral head and the hip) and is covered by much stronger and denser musculature (White & Folkens 2005: 246).  As the main weight bearing joint, the bone is also much denser with thicker cortical bone.

Ilium

The ilium is the largest of the three parts of the os coxa, and sits superiorly above the ischium and pubis, and it is often described as ‘blade like’ (Schwartz 2007: 148) as it is a thin but strong plate of curved bone.  On the lateral side of the blade, three gluteal lines (anterior, inferior & posterior) are visible which are the muscle attachment sites for the large gluteal muscles.  The main landmarks along the upper ridge is the iliac crest, which can be felt on yourself, and begins anteriorly with the anterior superior iliac spine and ends in the posterior superior iliac spine (White & Folkens 2005: 247).  The auricular surface of the medial ilium articulates with the sacrum (and is a very useful age estimator- Buckberry & Chamberlain 2002).  The greater sciatic notch is also generally a good indicator of the biological sex of the individual.

Anatomical landmarks on the right hip (Image credit: Pearson Education 2010).

Ischium

The ischium is the butt bone, literally the bone which takes the weight whilst we are sitting on a chair!  The key features of this element of the hip is that a lot of muscles attach to the posterior ischial tuberosity.  The ischial tuberosity muscle attachments include the origins of the hamstring muscles (semimembranosus, semitendinosus, adductor magnus & biceps femoris) (White & Folkens 2005).  Alongside the pubic bone, the ischium also includes the obturator foramen, a gap (in life covered by a membrane) where a number of internal gluteal muscles converge and provide stability for the hip.

Pubis

The pubic bone makes up the anterior part of the hip as a whole and includes a cartilaginous joint, just above the genitalia in living individuals.  The pubic symphysis, as this joint is called, is also a good indicator of biological sex because of the shape below it (the  pubic arch) and also age because of age related changes in the bony surface of the pubic symphysis (Schwartz 2007: 230).  The pubic bone also includes a superior and inferior pubic ramus, literally the corpus of the bone, which help support numerous muscle attachments, namely the adductors (adductor brevis, longus & magnus) of the medial compartment of the thigh.

The  major landmarks of the pelvic bones in anatomical position.

Discussion

For the discussion on the hip we shall talk about septic arthritis (SA).  SA is mostly common in the hip and knee, and rarely presents in the elbow or shoulder.  Although it is rare in the archaeological record, it is nonetheless recorded in a number of examples (i.e. Yukon individuals in the Natural Museum of National History in Washington, US), and it pays to be able to recognise it (Roberts & Manchester 2010: 154).  The condition is fairly uncommon, and the aetiology of SA is when an infection reaches a joint, normally through one of three means- i) the haematogenous route (most common), ii) a penetrating injury or iii) its spread from metaphysis (Marsland & Kapoor 2008).  The bacteria, or germ, normally infects the synovial fluid which may be inflamed from disease or trauma, and ‘proliferation of bacteria cause an inflammatory response by the host with numerous leucocytes migrating into the joint’ (Marsland & Kapoor 2008: 136).

Main outcome of septic arthritis (Image credit: http://www.aidmyarthritis.com).

At this point the variety of enzymes and breakdown products that are produced helps to damage the articular cartilage very quickly, and if left will produce permanent damage (Waldron 2009: 89).  The prognosis is good if treated promptly, however in the archaeological record this is quite unlikely due to the high risks of re-infection and complications such as joint destruction, avascular necrosis (mostly at the hip) & the ‘seeding of infection’ to other places (Marsland & Kapoor 2008: 137).  Again, the diagnosis of septic arthritis in the archaeological record is hindered by confusion with similarities to tuberculous infection, and difficulties in diagnosing multiple diseases that may present themselves on any one individual (Roberts & Manchester 2010: 154).  In the hip, the surface and surrounding area (lunate surface) of the acetabulum would be highly damaged, with a rough appearance and feeling as the bony lytic destruction took hold (Waldron 2009).

Bibliography

Brooks, S. & Suchey, J. M. 1990. Skeletal age determination based on the os pubis: a comparison of the Acsádi-Nemeskéri and Suchey-Brooks methods. Human Evolution 5– N.3: 227-238.

Brothwell, D. R. 1981. Digging Up Bones: The Excavation, Treatment and Study of Human Skeletal Remains.  Ithica: Cornell University Press.

Buckberry, J.L. & Chamberlain, A.T.  2002.  Age estimation from the auricular surface of the ilium: a revised method.  American Journal of Physical Anthropology 119: 231-239.

Larsen, C. 1997. Bioarchaeology: Interpreting Behaviour From The Human Skeleton. Cambridge: Cambridge University Press.

Marsland, D. & Kapoor, S. 2008. Rheumatology and Orthopaedics. London: Mosby Elsevier.

Mays, S. 1999. The Archaeology of Human Bones. Glasgow: Bell & Bain Ltd.

Patriquin, M.L., Steyn, M. & Loth, S.R. 2005.  Metric analysis of sex differences in South African black and white pelves.  Forensic Science International 147: 119-127.

Roberts, C. & Manchester, K. 2010. The Archaeology of Disease Third Edition. Stroud: The History Press.

Schwartz, J. H. 2007. Skeleton Keys: An Introduction to Human Skeletal Morphology. New York: Oxford University Press.

Waldron, T. 2009. Palaeopathology: Cambridge Manuals in Archaeology. Cambridge: Cambridge University Press.

White, T. & Folkens, P. 2005. The Human Bone Manual. London: Elsevier Academic Press.

2011 In Review

So it seems as if a few archaeological blogs are posting stats up for year in the form of the annual reports for their blogs- here is mine!

Admittedly it is not very exciting reading, but it is good to know that this blog attracts a general worldwide readership.  I dearly hope that some good, and maybe even some learning, comes from reading my posts.  As always, please feel free to comment on any mistakes or exciting things or finds I have made or would find interesting.  One day I will revamp this blog to make it more user friendly (apologies for the awesome/horrible graphics and colour collisions!).

2011 has been full of beautiful surprises and adventures to far away lands.  I’ve thoroughly enjoyed every minute, and have been thankful to the wonderful people I have met in the course this year, and in the adventures of digging, researching, revising, dissecting & osteologising!  So, if you are reading this and you know me, thank you for making it a wonderful year.

I’ve finally took part in a cemetery excavation, not in the UK, but in Germany courtesy of Grampus Heritage, I’ve made and met many intelligent and interesting friends on a new university course, & I’ve gained valuable skills and knowledge from experts.

The WordPress.com stats helper monkeys prepared a 2011 annual report for this blog.

Here’s an excerpt:

The Louvre Museum has 8.5 million visitors per year. This blog was viewed about 130,000 times in 2011. If it were an exhibit at the Louvre Museum, it would take about 6 days for that many people to see it.

Click here to see the complete report.

I’ve also made it onto this list here- http://www.online-biology-degree.com/human-biology, and been linked in various other blogs, which is good to know.

Although I have not updated this blog properly in regards to the Skeletal Series posts, I always welcome guest posts and other archaeological/osteological/forensic guest articles.  Please feel free to email me or leave a comment below.  I always want to take this opportunity to thank those who have emailed me with interesting articles, tales of bones found and nods to new research and updates.  It is thoroughly welcome, so cheers for taking the time to contact me.

I hope every reader has a happy, safe and wonderful 2012.  Thank you once again for reading the ramblings of a graduate student!