Tag Archives: Palaeopathology

Publication of New Developments in the Bioarchaeology of Care: Further Case Studies and Expanded Theory

28 Oct

As I have recently discussed on a blog post about recently published or forthcoming bioarchaeology books, I too have had a book chapter published in a new edited volume for the Bioarchaeology and Social Theory series, as produced by Springer.  The volume is titled New Developments in the Bioarchaeology of Care: Further Case Studies and Expanded Theory (£82.00 hardback or £64.99 ebook) and it is edited by Lorna Tilley and Alecia A. Shrenk.  The volume presents new research regarding the bioarchaeological evidence for care-provision in the archaeological record.  Using the associated Index of Care online tool, bioarchaeological researchers can utilize the four-stage case study approach to analyze and evaluate the evidence for care-provision for individuals in the archaeological record who display severe physical impairment likely to result in a life-limiting disability, or to result in a sustained debilitating condition which limits involvement in normal, everyday activities.  (For further information see a full book description below).

In short, my chapter investigates the public reception and engagement of the bioarchaeology of care theory and methodology as proposed by Lorna Tilley in a slew of recent publications (see bibliography).  As an inherent part of this the chapter discusses the ethical dimensions within the approach used for analyzing physically impaired individuals in the archaeological record, and the potential evidence of care-provision as seen on the osteological remains of the individual and contextual archaeological information.  Proceeding this is a walk-through of traditional and digital media formats, presented to provide a contextual background for the communication of the theory and methodology which is subsequently followed by two bioarchaeology of care case studies, Man Bac 9 from Neolithic Vietnam and Romito 2 from Upper Palaeolithic Italy, which help to summarize the public perception and importance of the research conducted to date within this new area of investigation and analysis.  In the conclusion best practice advice is provided for researchers conducting education outreach with regards to publicizing the bioarchaeology of care research and its results via both traditional and digital media formats.

The following information is taken from the Springer press release (and is used with the permission of Lorna Tilley) regarding the volume, both its aims and its content:

Book Overview

Only in the last five years has the topic of health-related care found acceptance as legitimate subject matter for archaeology.  In 2011, a case study-based ‘bioarchaeology of care’, designed to provide a framework for identifying, analysing and interpreting evidence for likely disability and associated care response, was proposed; the approach generated academic and wider public interest, and from this time on it has continued to evolve as bioarchaeologists apply it to cases of likely caregiving and broader theoretical questions of care provision within their areas of specialisation.’

New Developments in the Bioarchaeology of Care: Further Case Studies and Extended Theory 

The volume ‘marks an important milestone in this evolutionary process.  Its origins lie in a symposium entitled ‘Building a Bioarchaeology of Care’, held during the Society for American Archaeology 2015 annual meeting, which brought together an international, cross-disciplinary group of scholars to explore this theme.  This book contains 19 chapters, most based on symposium presentations, the first substantive chapter providing an overview of the bioarchaeology of care methodology and last situating the bioarchaeology of care approach, and the chapters in this book in particular, within the discipline of bioarchaeology more generally.  The 16 chapters that comprise the core of this volume offer content which is always original, often methodologically innovative, and frequently challenging, and are organised under three headings.

In the first section, Case studies: applying and adapting the bioarchaeology of care methodology, Chapters 2-9 focus primarily on the care given to one or more individuals who experienced (variously) a congenital disorder, acquired disease, accidental or intentional injury and who date to prehistory (Bronze Age, United Arab Emirates), through later Pre-Columbian (southern United Sates and Peru) and Mediaeval periods (United Kingdom and Poland), to relatively modern times (late 18th century London).  These chapters also contribute to bioarchaeology of care theory, however, because each one, in some way, has implications for how we conceptualise past caregiving or for how we might improve current research methods.


The volume cover piece, published as a part of the Bioarchaeology and Social Theory series by Springer. The paperback version will be released at some point in the near future, but it is available now as a hardback and as an ebook. Image credit: Lorna Tilley/Springer.

In the second section, New directions for bioarchaeology of care research, Chapters 10-16 explore alternative perspectives for illuminating past health related care behaviours.  Respectively, they address the scope for applying the bioarchaeology of care methodology to mummified remains; the potential for research into past caregiving to focus on demographic sectors of the population which are often overlooked – specifically children and the aged; the prospects for acknowledging psychological, spiritual and/or emotional forms of support in bioarchaeology of care studies; the modification of the bioarchaeology of care model to allow an assessment of institutional healthcare efficacy at both an individual and a population level; the development of a biocultural model for examining the origins of health-related caregiving; and the potential relevance for bioarchaeology of care studies of an online application supporting research into clinical and social implications of living with disease.

In the third section, Ethics and accountability in the bioarchaeology of care, Chapter 17 interrogates the principles, assumptions, values and beliefs that are likely to influence carriage of bioarchaeology of care research, and Chapter 18 considers ethical responsibilities involved in communicating bioarchaeology of care research findings in the public domain, and discusses some practical ideas for information-sharing.’

The volume isn’t cheap by any stretch of the imagination, so if you are a student or a researcher interested in this topic I highly recommend that you advise your university or institution library to order a copy.  If you are a member of the public I recommend again that you use your local library and order a copy in or use the inter-library loan system in order to source a copy of the volume.  Alternatively individual authors of the chapters may upload their sections of the volume to their own respective academic social media websites, such as on ResearchGate or Academia.edu, if they have a profile.  For instance you can read my chapter here.  It also always worth emailing the researcher in question if you are interested in accessing their work and are unable to locate the writing online.  From a quick internet search it seems Google Books also has the book scanned and it is partially available here.

Further Information

  • The online non-prescriptive tool entitled the Index of Care, produced by Tony Cameron and Lorna Tilley, can be found at its own dedicated website.  The four stage walk-through is designed to prompt the user to document and contextualize the appropriate archaeological and bioarchaeological data and evidence in producing the construction a ‘bioarchaeology of care’ model.
  • Kristina Killgrove has, in her Forbes bioarchaeology reportage, recently discussed one of the chapter case studies of a Polish Medieval female individual whose remains indicate that she had gigantism, or acromegaly.  Check out the post here.
  • My 2013 These Bones of Mine interview with Lorna Tilley, of the Australian National University, can be found here.  The interview discusses the origin of the bioarchaeology of care and the accompanying Index of Care tool and the surrounding issues regarding the identification of care-provision in the archaeological record.

Bibliography & Further Reading

Killgrove, K. 2016. Skeleton Of Medieval Giantess Unearthed From Polish Cemetery. Forbes. Published online 19th October 2016. Available at http://www.forbes.com/sites/kristinakillgrove/2016/10/19/skeleton-of-medieval-giantess-unearthed-from-polish-cemetery/#476236b6413b. [Accessed 28th October 2016]. (Open Access).

Mennear, D. J. 2016. Highlighting the Importance of the Past: Public Engagement and Bioarchaeology of Care Research. In: L. Tilley & A. A. Shrenk, eds. New Developments in the Bioarchaeology of Care: Further Case Studies and Expanded Theory. Zurich: Springer International Publishing. 343-364. (Open Access).

Tilley, L. & Oxenham, M. F. 2011. Survival against the Odds: Modelling the Social Implications of Care Provision to the Seriously Disabled. International Journal of Palaeopathology. 1 (1): 35-42.

Tilley, L. & Cameron, T. 2014. Introducing the Index of Care: A Web-Based Application Supporting Archaeological Research into Health-Related Care. International Journal of Palaeopathology. 6: 5-9.

Tilley, L. 2015. Theory and Practice in the Bioarchaeology of Care. Zurich: Springer International Publishing.

Tilley, L. 2015. Accommodation Difference in the Prehistoric past: Revisiting the Case of Romito 2 from a Bioarchaeology of Care PerspectiveInternational Journal of Palaeopathology. 8: 64-74.

Tilley, L. & Shrenk, A. A., eds. 2016. New Developments in the Bioarchaeology of Care: Further Case Studies and Expanded Theory. Zurich: Springer International Publishing.

Publication of ‘Theory and Practice in the Bioarchaeology of Care’ by Lorna Tilley

23 Nov

There is a new publication out by the bioarchaeological researcher Lorna Tilley, a PhD graduate from the Australian National University in the School of Archaeology and Anthropology, which introduces the theory and practice in the bioarchaeology of care methodology.  The methodology aims to investigate and identify instances of care provision within the archaeological record through case study analysis of individuals who display evidence for physical impairment, either through disease process or acquired trauma, of a disabling nature which may have required care in order to survive to their age-at-death.  Focused, for the moment, on the prehistoric periods, the publication introduces a number of case studies spanning the Palaeolithic (including Homo neanderthalensis) to Neolithic periods from a variety of geographic and cultural contexts.  An introduction to the model, the background and the four stages of analysis, can be found here.

As a matter of disclosure I should add here that I helped to (briefly) edit the second chapter of the publication for Lorna and that my name, and this site, are mentioned in the acknowledgment section.  (I have to admit it is pretty awesome seeing my name in print!).

Tilley Book cover

The cover of the publication, as a part of the Bioarchaeology and Social Theory series published by Springer, and series edited by Debra L. Martin, is now available. The hard back volume retails for the sum of £90.00 and in ebook form for £72.00. A paperback version will be released at some point and will be cheaper. Image credit: Lorna Tilley/Springer.

Without further ado here is the abstract to the volume:


‘Characteristics of the care given to those experiencing disability provide a window into important aspects of community and culture.  In bioarchaeology, health-related care provision is inferred from physical evidence in human remains indicating survival with, or recovery from, a disabling pathology, in circumstances where, without such support, the individual may not have survived to actual age at death.  Yet despite its potential to provide a valuable perspective on past behaviour, caregiving is a topic that has been consistently overlooked by archaeologists.  Theory and Practice in the Bioarchaeology of Care presents the ‘bioarchaeology of care’ – a new, case study-based approach for identifying and interpreting disability and health-related care practices within their corresponding lifeways context that promises to reveal elements of past social relations, socioeconomic organisation, and group and individual identity that might otherwise be inaccessible.  The applied methodology, supported by the Index of Care (a freely-available web-based instrument), consists of four stages of analysis, with each stage building upon the content of preceding one(s): these stages cover (i) description and diagnosis; (ii) assessment of disability impact and the corresponding case for care; (iii) derivation of a ‘model of care’ provided; and (iv) interpretation of the broader implications of the provision and receipt of this care.

This book looks first at the treatment of health-related caregiving in archaeological research, considering where, and why, this has fallen short.  Succeeding chapters establish the context and the conceptual foundations for undertaking bioarchaeological research into care provision, including defining and operationalising terminology surrounding ‘disability’ and ‘care’; examining debate around social and biological origins of care, and considering the implications for addressing caregiving motivations and practice; and presenting a theoretical framework for exploring the collective and individual decision-making processes involved in caregiving.  Two chapters then detail the four stages of the bioarchaeology of care methodology and application of the Index of Care, and these are followed by three case studies that illustrate the methodology’s application.  These chapters explore, respectively, the care given to Man Bac Burial 9 (Neolithic Vietnam), the Neandertals La Chapelle-aux-Saints 1 and La Ferrassie 1 (European Upper Middle Palaeolithic), and Lanhill Burial 7 (early British Neolithic), and they demonstrate the variety, richness and immediacy of insights attainable through bioarchaeology of care analysis.  Most importantly, these studies confirm that the bioarchaeology of care’s focus on caregiving as an expression of collective and individual agency allows an engagement with the past that brings us closer to those who inhabited it.  The final chapter discusses some future directions for bioarchaeology of care research, and considers how research findings might inform modern values and practices.’

Next Steps

As exciting as the above publication is I can also confirm that there will be a multi-authored edited volume, which is presently titled as New Developments in the Bioarchaeology of Care: Further Case Studies and Extended Theory, to be published mid next year by Springer.  The volume is the culmination of a session on the topic held at the Society for American Archaeology annual meeting back in April 2015, which was held in the beautiful city of San Francisco (see the list of presenters, and their topics, here).  I have also contributed a chapter to this volume on the topic, and the importance of, public communication within bioarchaeology of care research.  I am pretty excited to read the other contributions from a range of bioarchaeologists, historians and philosophers.  So keep your eyes peeled for that!

If there are any potential bioarchaeological researchers out there that are interested in analyzing the evidence for care provision, then I’d recommend checking out the above publication and utilizing the Index of Care tool within your own research (see also Tilley & Cameron 2014).  Only by other researchers incorporating the above methodology, and improving upon it when and where possible, are bioarchaeologists going to be able improve our own understanding of care in the archaeological record as a response by past populations and individuals to instances where care may have been provided.  Care, and the archaeological and osteological evidence for care provision, has been, and continues to be, a contentious issue within the discipline (Tilley & Oxenham 2011).  However it is also an area where a range of investigative research strands and new scientific techniques can be brought together to provide a fuller holistic approach, to both the archaeological record itself and to the individuals who populated it.

Further Information

  • The online non-prescriptive Index of Care tool produced by Lorna Tilley and Tony Cameron can be found here.  Researchers are very much welcome to use the step by step process during the analysis of case studies and are asked to provide critical feedback that will help improve the tool for future users.
  • Read an interview here with Lorna and myself, which was conducted back in 2013, where we discuss her work with the bioarchaeology of care model and the importance of using it to deduce the evidence for care provision in the archaeological record and the importance of recognising this.

Bibliography and Further Reading

Tilley, L. & Oxenham, M. F. 2011. Survival against the Odds: Modelling the Social Implications of Care Provision to the Seriously Disabled. International Journal of Palaeopathology. 1 (1): 35-42.

Tilley, L. 2012. The Bioarchaeology of Care. SAA Record. 12 (3). (Open Access).

Tilley, L. & Cameron, T. 2014. Introducing the Index of Care: A Web-Based Application Supporting Archaeological Research into Health-Related Care. International Journal of Palaeopathology. 6: 5-9.

Tilley, L. 2015. Theory and Practice in the Bioarchaeology of Care. New York: Springer.

Guest Post: Telling Stories about the Dilmun Bioarchaeology Project by Alexis Boutin

26 Jun

Alexis T. Boutin is associate professor of anthropology and coordinator of the cultural resources M.A. program at Sonoma State University.  In addition to co-directing the Dilmun Bioarchaeology Project, she is starting a new community-based field project that studies the casualties and legacy of California’s Bear Flag Revolt of 1846.  Read more at her Academia.edu page or faculty webpage.  When not working or chasing after her children, Alexis spends her free time…actually, she doesn’t have any free time. 

Like most good stories, this one starts in an unassuming way: a lone researcher, flipping through yellowed index cards in the wooden drawer of a museum registrar’s card catalog, stumbles across one for human remains from “Saudi Arabia; Bahrein Island”.  Casually mentioning the find over lunch with her colleague, who happens to be a curator at the museum, he expresses interest in helping her dig deeper into the collections and archives to find out how these bones came to be in the museum.  Thus was born the Dilmun Bioarchaeology Project in late 2008 (Porter and Boutin 2012).  The researchers in question are Alexis Boutin, now of Sonoma State University, and Benjamin Porter, of University of California Berkeley.  The museum is the Phoebe A. Hearst Museum of Anthropology.  The bones, and associated artifacts, belong to the only substantial assemblage from ancient Dilmun in a North American museum. And they have many stories to tell.

Peter Cornwall’s search for Dilmun

We must begin with Peter Bruce Cornwall, the scion of a distinguished family with deep roots in northern California.  He found privilege in his education at Andover, Toronto, and Oxford, but was challenged by the deafness that afflicted him late in childhood.  As a doctoral student in Anthropology at Harvard, Cornwall’s objective – which his advisor would call a “mania” – was to locate the place named in ancient Near Eastern texts as Dilmun.


1. Peter Cornwall’s 1932 yearbook photo from Phillips Academy Andover.

Dilmun served as a setting for Mesopotamian creation myths and fantastical events.  For instance, the hero Gilgamesh found Utnapishtum there, a former king who was granted immortality after a great flood in a story that mirrors that of the biblical Noah.  Dilmun also was well-known as a trading emporium in commercial networks extending to the Ur III societies of Mesopotamia, Magan in Oman, and Meluhha, the Harappan societies of the Indus River Valley.  But modern scholars had never agreed upon Dilmun’s actual location or extent.


2. Map of the Arabian peninsula, with ancient locales identified. Image by Benjamin W. Porter.

After overcoming the doubt of his academic advisors at Harvard and eventually winning limited backing from the Hearst Museum, Cornwall sailed for Bahrain in Fall 1940.  His journey was made no easier by its route across the Pacific and Indian oceans in the midst of World War II.  Cornwall excavated human remains and artifacts from at least 24 tumuli, or burial mounds, on Bahrain, followed by survey and surface collection at 16 or more archaeological sites in eastern Saudi Arabia.


3. Cornwall’s team excavating a tumulus in Bahrain. Courtesy of the Phoebe A. Hearst Museum of Anthropology.

The cost of shipping the finds to his northern California home was covered by the Hearst Museum, in return for their eventual accession there.  Cornwall’s analyses allowed him to conclude that Dilmun was a political entity that ran along the eastern edge of the Arabian Peninsula from Kuwait to Qatar and was centered on Bahrain.  After publishing his PhD dissertation and several journal articles, Cornwall donated the assemblage to the Hearst Museum as promised in 1945, but provided minimal assistance with its accession.  He then began to withdraw from the academic world, moving to Rome and reportedly spending the rest of his days travelling and collecting art and antiquities, before dying in his late 50s of cirrhosis of the liver.  Although Cornwall’s contribution to Gulf archaeology has lived on in the works of many others (e.g., Bibby 1970, Crawford 1998, Højlund 2007, Potts 1990), the location of the materials that helped him make this discovery was not known outside of the Hearst Museum.

The Dilmun Bioarchaeology Project

Some 4000 years after these people died and 65 years after their remains were brought to California, Porter and I identified this assemblage (referred to hereafter as the “Cornwall collection”) as a rich source of information about life and death in ancient Dilmun.  Although the materials donated by Cornwall had been inventoried during their accession to the Hearst, they had undergone no further systematic analysis since that time.  Working with students from Sonoma State and UC Berkeley, we have determined that the Cornwall collection includes over 3,700 objects made from materials including metal, bone, ivory, pearl, shell, and alabaster, although stone and ceramic objects dominate.  The datable objects derive mostly from the Early Dilmun period, ca. 2050-1800 BCE.  This was a period of unprecedented political and economic prosperity in Dilmun, as suggested by fortified settlements, temple complexes, administrative seals, and imported goods.

When people died in Early Dilmun, their bodies were laid to rest in distinct mortuary monuments that are still visible across the island today.  These mounded tumuli usually consist of a stone lined burial chamber covered by a cone of sediments and gravels.  In most tombs, one or sometimes two individuals were interred, often in a relaxed fetal position.  Surrounding them were ceramic vessels, jewelry, metal weapons, and very rarely alabaster vessels or ivory objects.  A sheep or goat might also be included, likely an offering for the deceased to carry into the afterlife.  Not all tumuli had the same level of elaborate commemoration.  Differences in the size of monuments and the amount and quality of objects indicate that the privileged and wealthy were granted the most elaborate burial conditions.

The human remains in the Cornwall collection represent a minimum of 34 people.  Twenty-four adults, as well as one adolescent, were sufficiently well-preserved to permit sex estimation.  Nineteen are males/probable males, while six are females/probable females.  Of the skeletons for whom an age category could be estimated, the vast majority are adults, with middle adults (35-50 years) being the best represented.  However, adolescents, children, infants and one fetus are also present in smaller numbers.

Figure4 (1)

4. The author at work in the Hearst Museum collections. Photo by Colleen Morgan.

Unfortunately, the notes that Cornwall deposited in the Museum’s accession files are very limited.  They contain very few associated field notes, such as photographs of the burials, the position of bodies, and even the geographic coordinates for specific tumuli around the island.  We are not sure if Cornwall produced this documentation in the first place, or perhaps he never gave it to the Hearst Museum.  We are hopeful that someone will come forward with missing information about Cornwall’s research from a family archive.  Nevertheless, important insights can be gained from the Cornwall collection when its contents are analyzed in the context of better-documented research in Bahrain and surrounding regions.


5. Cylindrical wheel-thrown ceramic jar (9-4680) typical of Early Dilmun burial assemblages. Photo by Colleen Morgan. Courtesy of the Phoebe A. Hearst Museum of Anthropology.

Bioarchaeological analysis of skeleton 12-10152 provides a powerful example of one ancient Dilmunite’s experiences in life and death.  Cornwall excavated the remains of this person—a male who was at least 60 years old when he died—from a tumulus in the Dar Kulayb mound cemetery near Bahrain’s western coast.  No durable objects were buried with him, although multiple bones (including the skull) from a sheep (Ovis aries) or goat (Capra hircus) suggest that he did receive a large portion of a recently butchered animal.  The three stories that follow illustrate how bioarchaeological data from one skeleton (here, 12-10152) can be assembled and interpreted in various ways, to tell multiple stories through multiple media.

The Osteological Version

Analysis of 12-10152’s skeleton reveals a long lifetime of physical activity based on degenerative joint disease (DJD) throughout his skeleton.  Degenerative joint disease occurs when chronic stress on joints progressively damages articular cartilage and, eventually, underlying bone surfaces.  Bone formation and destruction characterize DJD, including the breakdown of articular cartilage, formation of osteophytes at joint margins and entheses, degeneration and consequent porosity of the articular surface, sclerosis, and eburnation caused by direct bone-on-bone contact (Larsen 2015; Ortner 2003).  This male’s DJD is more severe in the right shoulder, facet joints of three cervical vertebrae, lower lumbar vertebral bodies, hips, and knees.  The degeneration of the right shoulder joint is particularly marked, with significant osteophyte growth on the articular margins of the right humeral head, and extensive eburnation here and on the glenoid fossa of the scapula.  Osteophyte formation on the distal femora, more extensive on the left side, indicates degeneration of both knee joints.  The articular surface of the left patella (the only one extant) exhibits macroporosity and destruction of the subchondral bone.


6. Severe degenerative joint disease affecting 12-10152’s right humerus. 6a) eburnation of humeral head (superior view); 6ab) osteophyte growth on margins of humeral head (posterior view); 6c) eburnation of posterior face of glenoid fossa (right scapula, medial view). Photos by the author. (Click to enlarge).

As was common for the elderly of Early Dilmun, this male experienced extensive antemortem tooth loss.  His mandible is edentulous, and all but five of his maxillary teeth had fallen out by the time of his death.  Moderate DJD of the right temporomandibular joint is evident.  The left side is unaffected.  Atrophy of the right half of the mandible is also apparent, perhaps caused by a preference for the non-arthritic left side when chewing.  In a forthcoming publication, we compare his skeleton with those of two other elderly males in the Cornwall collection to explore how masculinity was embodied in Early Dilmun (Porter and Boutin forthcoming).


7. Extant cranial skeleton of 12-10152. Note antemortem loss of all teeth in mandible. Photo by the author. (Click to enlarge).

The Visual Version

The comparatively good preservation of 12-10152’s cranial and post-cranial skeleton provided an excellent opportunity to tell his story visually, through a forensic facial reconstruction.  This method had already been employed by the Dilmun Bioarchaeology Project on a teenage boy from Early Dilmun with excellent results (Boutin et al. 2012), and we hoped that a facial reconstruction of this older man could provide unique insights about embodied experiences toward the end of life.

Creating a replica of the skull is the first step in facial reconstruction.  For 12-10152, whose remains are very delicate and brittle, stereolithography—scanning the skull with lasers to create a digital file—was the best option.  Dr. Sabrina Sholts (now of the Smithsonian Institution) obtained multiple scans of each portion of the fragmented skull with a NextEngine 3D laser scanner. After she processed the data on a laptop, the resulting digital files were sent to GoEngineer in Santa Clara, CA, where they were “printed” three-dimensionally in plastic.  I brought these plastic cranial bones to the studio of forensic artist Gloria Nusse (San Francisco State University), where she and I worked together to rearticulate them into a model on which the face could be reconstructed.


8. Printed components of 12-10152’s skull, before and after re-articulation in Ms. Nusse’s studio. Photos by the author. (Click to enlarge).

When the plastic skull replica was ready, Nusse attached tissue depth markers at standard cranial landmarks.  Next, she used oil-based modeling clay to simulate the cranio-facial muscles, with “skin” of the same material eventually added to meet the height of the markers.  Once the basic form of the face had been completed, Nusse made small adjustments to the shapes of certain features, such as the eyelids and lips, and used a sponge to texturize the facial skin.  She carefully incorporated skeletal features distinct to 12-10152 into his visage: for example, the atrophied and edentulous nature of his mandible gave his lower face a sunken and asymmetrical appearance.  Nusse collaborated with Porter and me to create the hair and eye color, hair style, and dress for 12-10152’s reconstruction.  Our decisions were informed by texts and iconography from ancient Mesopotamia (which are lacking from early Dilmun), as well as a survey of publicly available photographs of modern Arabian Gulf citizens.  The resulting reconstruction has been displayed with that of the teenage boy in an exhibit entitled “From Death to Life in Ancient Bahrain,” which has traveled to several university museums in California.


9. Facial reconstruction of 12-10152 by Gloria Nusse, on display at Sonoma State University. Photograph courtesy of Alexis Boutin. (Click to enlarge).

The Narrative Version

The final way that I tell 12-10152’s story is in fictive narrative format, which is informed by the Bioarchaeology of Care and Bioarchaeology of Personhood models.  Having described the Bioarchaeology of Personhood in print before (Boutin 2011, 2012), I provide just a few highlights here.  Essentially, I have taken Clark and Wilkie’s (2006) concept of an Archaeology of Personhood and adapted it to focus on the relationship between human skeletal remains and embodied experience.  These models feature a less ethno- and temperocentric emphasis on individuality than other (bio)archaeological approaches to identity.  One of the only constants is the passage of time, which is marked bodily by aging.  Although age should not be privileged over other axes of personhood (e.g., gender, class, ethnicity, etc.), it is age that undergirds their fluidity over the life course.  So the Bioarchaeology of Personhood attends to the stories that skeletons tell us about how their personhoods were embodied across the life course.

In addition to telling these stories in traditional academic language and scholarly venues, I also write fictive narratives about the skeletons I study.  This allows me to draw together socio-historic contextual data, clinical research on health and illness, and bioarchaeological analysis in a way that provides a more humanizing view of past personhoods.  But no matter how well-substantiated, these narratives are always the products of my imagination.  They could be told in different ways by different authors, depending on which lines of evidence s/he chooses to prioritize.  For this reason, the qualifying term “fictive” (after Wilkie 2003) is essential.  I have also found the Bioarchaeology of Care (Tilley 2015) to be an extremely useful heuristic tool in creating fictive narratives based on the Cornwall collection.  I particularly appreciate how its focus on the provision of health care and support foregrounds the notion of community: each and every life course plays out in concert with those of others to which it is inextricably linked – mothers, husbands, children, neighbors, dynasts, etc.  What follows is an excerpt of a fictive narrative about 12-10152’s life course, focusing on the care and support that he may have required during old age.

The heat and dust rose in waves from the road as the young men padded by, their arms full of recently harvested dates.  I envied them in more ways than one.  “Grandfather, your stew is ready.”  It’s been many years since I was able to shimmy up the date palms, let alone chew my favorite date nut treat.  But even the few teeth left in my head are enough to enjoy my granddaughter’s fish-and-vegetable stew (as long as she cooks it long enough and I remember to chew on the left side).  Finding my walking stick with my left hand and heaving myself up with a grunt, I make my way into the house.  A wince and a groan as I raise my right arm to take the bowl from my granddaughter.  Ah well – if you live long enough to see your great-grandchildren, some aches and pains are to be expected.

The End

The Dilmun Bioarchaeology Project aims to maximize the interpretive possibilities of the human remains that we have the privilege to study.  Telling 12-10152’s story in various ways reminds us that identities are always multi-faceted and that there is no one “right answer” to how bioarchaeological evidence can be interpreted.  Another example of this approach can be seen in the multiple stories that we have told about a young woman with disabilities (12-10146) from the Cornwall collection.  These include an osteological analysis of her skeletal pathologies (Boutin and Porter 2014), a narrative telling of her embodied experiences in the recent Bioarchaeology of Care session at the 2015 SAAs (with a manuscript in preparation for International Journal of Paleopathology), and a full-body reconstruction by Ms. Nusse planned for 2015-2016.  Documentation and analysis of the Cornwall collection will conclude over the next couple of years, with the results to be published in a book entitled Embodying Dilmun: The Peter B. Cornwall Expedition to Eastern Arabia and Bahrain.  Will this be the final word on life and death in ancient Dilmun? As the saying goes, the best stories never end.

Bibliography and Further Reading

Boutin, A.T. 2012. Crafting a Bioarchaeology of Personhood: Osteobiographical Narratives from Alalakh. In A. Baadsgaard, A. T. Boutin and J. E. Buikstra (eds.), Breathing New Life Into the Evidence of Death: Contemporary Approaches to Bioarchaeology. Santa Fe: School for Advanced Research Press, 109-133. (Open Access).

Boutin, A.T. 2011. Written in Stone, Written in Bone: The Osteobiography of a Bronze Age Craftsman from Alalakh. In A.L.W. Stodder and A. M. Palkovich (eds.), The Bioarchaeology of Individuals. Gainesville: University Press of Florida, 193-214. (Open Access).

Boutin, A.T. & and Porter, B.W. 2014. Commemorating Disability in Early Dilmun: Ancient and Contemporary Tales from the Peter B. Cornwall Collection. In B.W. Porter and A.T. Boutin (eds.), Remembering the Dead in the Ancient Near East: Recent Contributions from Bioarchaeology and Mortuary Archaeology. Boulder: University Press of Colorado, 97-132.

Boutin, A.T., Nusse, G.L. Nusse, Sholts, S.B. & Porter, B.W. 2012. Face to Face With the Past: Reconstructing a Teenage Boy from Early Dilmun. Near Eastern Archaeology. 75(2): 68-79.

Bibby, G. 1970. Looking for Dilmun. London: Collins.

Clark, B. & Wilkie, L.A. 2006. The Prism of Self: Gender and Personhood. In S. M. Nelson (ed.), Handbook of Gender Archaeology. Lanham, Md.: AltaMira Press, 333-364.

Cornwall, P.B. 1943. The tumuli of Bahrain. Asia and the Americas. 42: 230–234.

Cornwall, P.B. 1944. Dilmun: The history of Bahrein Island before Cyrus. Unpublished Ph.D. dissertation, Department of History, Harvard University.

Cornwall, P.B. 1946. On the location of Dilmun. Bulletin of the American Schools of Oriental Research. 102: 3–11.

Crawford, H.E.W. 1998. Dilmun and its Gulf Neighbours. Cambridge: Cambridge University Press.

Højlund, F. 2007. The Burial Mounds of Bahrain: Social Complexity in Early Dilmun. Moesgaard: Jutland Archaeological Society Publications.

Larsen, C.S. 2015. Bioarchaeology: Interpreting Behavior from the Skeleton. 2nd edition. Cambridge: Cambridge University Press.

Littleton, J. & Frohlich, B. 1993. Fish-eaters and Farmers: Dental Pathology in the Arabian Gulf. American Journal of Physical Anthropology. 92:427-447. (Open Access).

MacLean, R. & Insoll, T. 2011. An Archaeological Guide to Bahrain. Oxford: Archaeopress.

Ortner, Donald J. 2003. Identification of Pathological Conditions in Human Skeletal Remains. 2nd edition. San Diego: Academic Press.

Porter, B.W. & Boutin, A.T. 2012. The Dilmun Bioarchaeology Project:  A first look at the Peter B. Cornwall Collection at the Phoebe A. Hearst Museum. Arabian Archaeology and Epigraphy. 23: 35-49.

Porter, B.W. & Boutin, A.T. Forthcoming. The Elders of Dilmun: A Bioarchaeological Analysis of Masculinity from the Peter B. Cornwall Collection. In L. Gregoricka and K. Williams (eds.), Life and Death in Ancient Arabia: Mortuary and Bioarchaeological Perspectives. Gainesville: University Press of Florida.

Potts, D.T. 1990. The Arabian Gulf in Antiquity, Vols. 1 & 2. Oxford: Clarendon Press.

Tilley, L. 2015. Accommodating Difference in the Prehistoric Past: Revisiting the Case of Romito 2 from a Bioarchaeology of Care Perspective. International Journal of Paleopathology. 8: 64-74. (Open Access).

Wilkie, L.A. 2003. The Archaeology of Mothering: An African-American Midwife’s Tale. New York: Routledge.

Literature Travels

28 Aug

In a brief aside from osteoarchaeology, I thought I’d focus a quick entry on what I’ve been reading lately as I wait for my arm to heal.  I have a particular soft spot for travel literature, so I’ve been delving into some classic books from the 20th century.  Among these are American writer John Steinbeck’s 1962 travelogue Travels with Charley, Austrian writer Stefan Zweig’s 1943 autobiography The World of Yesterday, and the British explorer Wilfred Thesiger’s 1959 memoir Arabian Sands.

By chance my current haul of literature deals with the themes of cultural change (and, in the case of Zweig’s, the devastation of his previous way of life with the rise of Nazism in Europe) and the beauty of the natural landscape in their respective environments.  Thesiger, for instance, relates his constant worries of the impact of petrochemical prospection and development in his beloved and desolate deserts in Saudi Arabia and Oman and the anticipated effects on the Bedouin (Bedu) way of life.  Steinbeck, meanwhile, mourns a population that he barely knows any longer, even as his magnificent and diverse body of work champions their history and lifestyles.

I’m currently in the middle of Thesiger’s memoir detailing his epic 1945-1950 explorations in Abyssinia (modern day Ethiopia) and the Empty Quarter in Arabia (Rubʿ al Khali, one of the largest sand deserts in the world spanning parts of Saudi Arabia, U.A.E., Yemen and Oman).  I’m struck by his lucid description of Bedouin life, of their harsh but close living environments and tight social structures.  As with reading any literature endeavor care must be taken in understanding the motives of the writer, but it is clear that Thesiger held the Bedouin close to his heart and set about emulating and living their lifestyle as close as he could and was allowed to.

During his numerous journeys into the Empty Quarter Thesiger often acted as an impromptu medic, dispensing medicines he had brought with him to his guides and friends as needed.  In one scene he highlights the use of old remedies that have been passed down in Bedu culture:

During the days that I was at Mughshin my companions often asked me for medicines.  Bedu suffer much from headaches and stomach trouble.  Sometimes my aspirin worked, but if not the sufferer would get someone to brand him, usually on his heels, and would announce a little later that his headache was now gone, and that the old Bedu remedies were better than the Christian’s pills.  Bedu cauterize themselves and their camels for nearly every ill.  Their bellies, chests, and backs are often criss-crossed with the ensuing scars.” (Thesiger 2007: 112).

One first thought by me was the fact that branding would certainly make you forget about headaches quickly!

However it also reminded me of perhaps the most famous iceman in Europe, Ötzi, an individual who lived and die around c.3300 BC during the European Chalcolithic period.  Ötzi, whose naturally mummified body represents the oldest so far found in Europe, has evidence for many distinct line and cross tattoos across his preserved body.  The location of the majority of his 50+ tattoos could possibly be related to the underlying pathologies that are present on his bones.

Radiological investigations have highlighted evidence for osteochondrosis and spondylosis in the lumbar (lower back) region, knee and ankle joints in Ötzi’s skeleton, whilst microscopic analysis of his gut has highlighted evidence for a whipworm (Trichuris trichiura) infestation (Dorfer et al. 1999: 1024).  It has been suggested that the tattoos could relate to an early form of acupuncture to help with the pain, or aches, that Ötzi probably felt (Dorfer et al. 1999: 1025), rather than the tattoos reflecting, or assuming, a purely decorative or ritual form (Scheinfeld 2007: 364).

In the case of the brandings that Thesiger describes in his travels with the Bedu above it is obvious that they have a functional aspect in their use as a treatment for illness, but it is likely that there is deeper meaning ascribed to them.  As such I should probably head back to reading the book!


Dorfer, L., Moser, M., Bahr, F., Spindler, K., Egarter-Vigl, E., Giullén, S., Dohr, G. & Kenner, T. 1999. A Medical Report from the Stone Age? The Lancet. 354 (9183): 1023–1025. (Open Access).

Scheinfeld, N. 2007. Tattoos and Religion. Clinics in Dermatology. 25 (4): 362-366.

Steinbeck, J. 2000. Travels with Charley. Penguin Modern Classics.

Thesiger, W. 2007. Arabian Sands. London: Penguin Classics.

Zweig, S. 2014. The World of Yesterday. London: Pushkin Press.

* Publication dates are for modern editions.

Pain, Briefly

17 Jun

Just a quick note here.  I had the good luck of hearing historian Joanna Bourke on BBC Radio 4 program Start the Week yesterday morning who was on the show debating the topic of her latest publication titled, The Story of Pain: From Prayer to Painkillers.  The book focuses on trying to understand and contextualise the feeling of bodily and physical pain from the 18th century AD to the modern period.  Bourke, who is a Professor of History at Birkbeck, University of London, presents a holistic history of understanding pain in which the topic is approached from numerous angles, including not just the medical but also the cultural, religious and political.  The book also deals with the personal experience of pain and the nature of suffering, both in the individual sense and within wider society from the family out.  It certainly looks like an interesting and enlightening read.

Having read a few reviews of the book itself, and of having heard Bourke herself discuss the differences in understanding the many types of pain, it reminded of sociologists Ann Oakley’s 2007 book Fracture , of which I discussed a little here.  Although Oakley’s book is a much more personal and reflective study with its focus on the modern health perspective, Bourke (2014) also discusses the role and changes that medicine has gone through in the past and present approaches and treatments when considering illnesses and patients themselves.  Of particular interest on the radio show this morning was Bourke’s assertion that different cultures experience pain in a myriad of ways.  This, of course, made me think of how bioarchaeologists approach the archaeological record and how we try to understand palaeopathology in relation to the individual osteobiographic context, within the population and society that the person lived in, together the original context of the landscape environment of the archaeology site (read more about osteobiographical examples here).

Bioarchaeology is, as a field, a burgeoning area of archaeological research, one that ably and actively straddles the humanities and science divide with ease.  Bioarchaeologists often complement their normal macro and micro assessment of the skeletal remains with the regular use of the latest scientific techniques and refinements, including but not limited to stable isotopic and ancient DNA analysis, to help understand the processes, implications and contexts of a pathology within a population.   This often includes trying to contextualise and understand traumatic or congenital pathologies that can be present in the skeletal remains of humans (White & Folkens 2005).  It must be remembered of course that only a small fraction of diseases known ever affect or actively present on bone itself (Waldron 2009).

Pain though is rarely considered when describing a pathology that is present on an archaeological bone.  This is partly due to the nature of the limitations of archaeology, but also partly due to the existing bioarchaeological literature.  Care to not exceed the evidence must take precedence, otherwise bioarchaeologists risk inflating the boundaries between the known and the unknown.  Pain itself is a uniquely personal feeling and it can be a difficult feeling to describe.  It can also be paradoxical as to know pain is to be reminded that you are alive, but to know that pain means it is also a warning that life is threatened.

As a purely personal perspective I have recently found out something rather interesting about my own skeletal biology.  As readers of this blog may be aware that I have McCune-Albright Syndrome (MAS) and, as a part of this, polyostotic fibrous dysplasia.  MAS is, as far as it is currently possible to tell, a fairly rare bone disease that can lead to fractures and bowing of the bones (more information here and also Dumetriscu & Collins 2008) amongst other things.  Having broken a good number of the long bones of my body, I am now acutely aware of what a fracture feels like.  Recently however, and completely unbeknownst to myself beforehand, I learnt that I have been fracturing my ribs for a number of years, as both x-rays and a CT scan showed a fair amount of bone re-modelling and faint healed fracture lines on a number of ribs.

Why hadn’t I noticed?

Partly it was because the fractures themselves weren’t that painful (I am well aware that rib fractures are usually pretty painful).  In fact I have been aware for years that I occasionally pull the superficial or intercostal rib muscles on either side periodically, and that this had always led to a good few days of unease if I slept on the affected side, coughed or laughed too hard.  I had put this down to using the wheelchair more over an extended period of time starting from my mid adolescence, following on from several major surgeries on the femora.  I reasoned that due to repetitive nature of the motion of wheeling in a manual wheelchair the muscles were bound to get sore and fatigued at some points.


A copy of the posterior to anterior x-ray of my own chest. Although the healed rib bruises and fractures cannot clearly be seen on it, the constriction of the chest wall is highlighted (black arrows).  This can have an effect on the air intake of the lung capacity.  Generally fractured ribs are left to heal naturally unless there has been puncturing of internal organs by the ribs themselves, in which cases surgery is needed.  (Read more here).

I was well aware that the ribs are one of the more common areas of the body to be affected by MAS, along with the femora and cranial bones, yet I paid little attention to what I thought was a pulled muscle  (Dumetriscu & Collins 2008, Waldron 2009).  I could still move relatively fine afterwards, and it certainly wasn’t that painful.  So, as you can imagine, I was somewhat surprised to hear that I had at least four previous rib fractures that had healed, which were clearly evident on the X-rays and the scans taken of my chest as I saw.  I should state though that it is likely to have been a mix of micro, hairline and full fractures on pathologically diseased bone, and not traumatically induced fractures which, I hear, can be extremely painful.

As such, and having heard Bourke talk about how individuals cope with pain, it should be taken into account by bioarchaeologists that skeletal pathology probably elicited different responses dependent on the social and cultural context of the individual.  This is of course important when considering the impact of a pathology present on the bones.  This, necessarily, becomes more problematic as we reach further into history and prehistory, where the lack of contextual and written evidence can be missing or non-existent.

However, as archaeologist and bioarchaeologists, we must also continually ask questions regardless and especially when skeletal material has already been analysed.  New techniques, theories or methodologies are only useful once they have been applied to the existing archaeological record and are repeatedly tested against what we think we know.

Alongside Bourke on the Radio 4 show was the current director of the Wellcome Trust, Jeremy Farrar, who discussed his experiences as a medical doctor and the possible implications of the overuse antibiotics, and Norman Fowler, a conservative MP who oversaw the public health campaign against the spread and threat of HIV/AIDS in the 1980’s in Britain.  Each guest on the program was well worth a listen.

It is safe to say that Bourke’s work is another book that I shall be adding to my ever increasing pile.

Further Information

  • Listen to the Start the Week program, on which Professor Bourke appeared, on BBC Radio 4 here.
  • A review by The Guardian of the History of Pain: From Prayers to Painkillers book be found here.


Bourke, J. 2014. The History of Pain: From Prayer to Painkillers. Oxford: Oxford University Press.

Dumitrescu, C. E. & Collins, M. T.  2008.  Overview: McCune-Albright SyndromeOrphanet Journal of Rare Disease3 (12): 1-12. (Open Access).

Oakley, A. 2007. Fracture: Adventures Of A Broken Body. Bristol: Policy Press.

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

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

aRNA: A Helpful Friend In Palaeopathology?

20 Dec

It is another quick post from me highlighting another researcher’s work but it is one well worth reading!  Over at So Much Science, So Little Time researcher Dr Kristin Harper has highlighted an intriguing possibility on the direction for the future of palaeopathology.

What is aRNA?

Harper’s post highlights the possible value of aRNA ( ancient Ribonucleic acid) in the investigation of viruses (think influenza and coronaviruses such as SARS) in past human populations in her post on the ability of researchers being able to obtain aRNA samples from 700 year old maize samples.  RNA performs a variety of important functions in the coding, decoding, regulation and expression of genes; essentially RNA acts as the messenger which carries instructions from DNA (Deoxyribonucleic Acid) for controlling the synthesis of proteins in living cells.  DNA itself is the molecule that encodes the genetic instructions that are used in the development and functioning of all known living organisms (including many viruses) however, unlike DNA, RNA is composed of shorter single strands of nucleic acids.  This has made it particularly vulnerable to degradation in archaeological contexts.

The best place to search for evidence of aRNA strands in the human skeleton in an archaeological context would be in the dental pulp cavity, specially the molar teeth.  This seems to be the place where diagenesis  has the least effect on the human skeleton due to both the tough enamel coating found in human teeth and the tooth sockets themselves being fairly protected inside the mandible and maxilla, which is where cortical bone is often dense due to the biomechanics of mastication (Larsen 1997).

I should point out here that the area of genetics is not my specialty but it is an area of inherent interest for me, especially in its applications to palaeoanthropology and palaeopathology.

Why Could This Be Important?

The foundations of palaeopathology are built on the observed changes in human skeletal material and palaeopathology itself often specifically focuses on markers of stress or trauma that can be found in the macro or micro skeletal anatomy.  As a consequence of this many diseases (and indeed traumas) are ‘invisible’ in the archaeological record as they leave no marker of note on the skeleton itself.  The diseases and syndromes that do leave a lesion (which can include blastic and/or lytic lesions) are often said to leave pathognomonic lesions that are, at a basic level, an indicator of the disease or infection processes behind the bone change.

So, as you can imagine, quite often in human osteology we have a ‘healthy’ skeleton of an individual that has died at such and such an age but with no obvious cause of death.  In essence we have the osteological paradox, where those who do contract a disease and die shortly afterwards leave no evidence of bone lesions (or trace of the cause of death) in comparison to individuals who do have severe pathological bone changes but have evidently lived long enough for the disease itself to alter the skeletal architecture; it is, in short, the question of discerning the health of a past population (Larsen 1997: 336).  This is a simplified version of the osteological paradox, a discussion outlining the paradox and it’s full implications and discussion points can be found in Woods et al.’s (1992) article (available online here).

This can have serious effects on our estimates of disease prevalence in history and prehistory, especially in the cases of viruses as they can often kill quickly and leave no skeletal marker.  However because they are cells that were once alive they do leave behind evidence of traces of aRNA.  So any new methodology of being able to extrapolate aRNA of past infections from human skeletal material is welcome as this could potentially open up new insights into past populations and population dynamics.

Further Information


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

Woods, J. W., Milner, G. R., Harpending, H, C. & Weiss, K. M. 1992. The Osteological Paradox: Problems of Inferring Prehistoric Health from Skeletal Samples. Current Anthropology. 33 (4): 343-370. (Open Access).

Infectious Disease Part 2: Malaria and Associated Anaemic Conditions

5 Oct

This second post, and the first part, deal with biomolecular approaches and research studies in detecting  the presence of infectious diseases in human bone from archaeological material.  The recent coming of age of biomolecular techniques, as applied to archaeological material, has provided a rich and complex source of information in helping to uncover how infectious diseases spread in the historic and prehistoric past.  The second post, here, describes recent research focused on Malaria and associated anaemic conditions, including Sickle Cell Anaemia and Thalassaemia.  The first post can be found here.


It has long been realised that malaria can only be recognised in skeletal remains via indirect evidence of presentation of the following pathological lesions- porotic hyperostosis, cribra orbitalia and marrow hypertrophy- which are taken as evidence of the presence of anaemia, the main contributor of mortality in malarial victims (Roberts & Manchester 2010).  However there is no pathognomonic bone lesion for either Plasmodium vivax or P. falciparum, the main human species of malaria causing Plasmodium genus  (Gowland & Western 2012: 303, Roberts & Manchester 2010: 233), and the above skeletal lesions have varying aetiologies including anaemia, osteitis, parasitic infection, and other interrelated deficiency diseases which are still not clearly understood (Gowland & Western 2012: 302).  To securely diagnose malaria in skeletal material, DNA identification of the Plasmodium genus must take place, and even then current Polymerase Chain Reaction (PRC) tests ‘do not appear to be able to amplify routinely the DNA of malaria pathogens from ancient bones’ (Gowland & Western 2012: 302).

Recent immunological techniques to identify antigens have also been used to isolate and identify P. falciparum, although false positives can occur as a result of contamination or diagenetic factors(Gowland & Western 2012: 302).  Gowland & Western (2012) have recently proposed a spatial epidemiological model for malarial spread in Anglo-Saxon England, which highlights the re-surging interest in malaria in the modern context as well as one affecting a past population.  This holistic approach used GIS data with diagnosed porotic hyperostosis in skeletal remains, mosquito (Anopheles atroparvus) habitat information and historical data in presenting a locality data set for malaria infected individuals (Gowland & Western 2010: 304-305).  The modelling of palaeopathological, climatic, and historical data, provides new information on disease range, mechanism of transmission, and infection localities.  However, there are also complicating factors in assessing and diagnosing malaria from other diseases, as noted below (Roberts & Manchester 2010: 234).

Particularly important are two inherited haemolytic anaemia’s, thalassaemia and sickle-cell anaemia, who are characterised by abnormal haemoglobin and increased destruction of red blood cells (Jurmain et al. 2011: 312, Roberts & Manchester 2010: 232).  Thalassaemia is a genetically determined disorder which is caused by a ‘problem of haemoglobin synthesis’ (Roberts & Manchester 2010: 233).  This results in failure or depression of synthesis of the chain, this leads to pale cells with low hemoglobin content which are then rapidly destroyed once formed.  There are three grades of the disease, minor, intermediate and major, the last of which includes severe anemia and possible bone changes; the range of the disease is typically centered in the Mediterranean, Middle East and Far East (Roberts & Manchester 2010: 233).  The importance is that it is seen as an adaptive response to malaria infection through the development of this heritable disease; that the high red blood cell turnover stalls and negates any effect of malarial infection.  Archaeological evidences comes from Greek, Turkish and Cypriot populations deriving from marshy contexts, which are ideal breeding grounds for mosquitoes, the prime vector for malaria (Roberts & Manchester 2010: 233).

Sickle-cell anaemia occurs as a result of the deformation and destruction of red blood cells which leads to over enlargement of bony centres (centered on the skull, pelvis, vertebrae) and over-activity of marrow production as the body produces more red blood cells (Waldron 2009).  This inheritable disease range is mainly located in Central and Eastern African populations who have high rates of the disease, but also affects Indian, Middle Eastern, and Southern European populations (Roberts & Manchester 2010: 234).  Jurmain et al. (2011: 312) remark that the sickle-cell allele hasn’t always been effective in malarial negation in human populations, and primarily came to prominence during the advent of agriculture, and in particular during the last 2000 years in Africa.  The origin of the mutation of the allele responsible, HB5 in haemoglobin, has been dated to 2100 to 1250 years ago in African populations (Jurmain et al. 2011: 312).  Although malaria infection has only relatively recently affected human populations, it has become a powerful selective force that still affects large portions of the world’s population today.

In conclusion, biomolecular approaches to archaeological and osteological remains are vital in unraveling past populations and the natural world (Jurmain et al. 2011).  The interactions between wild and domesticated animals, humans, insects and the environment are a prerequisite for understanding the mode of transmission and virulence of infectious diseases (Barnes et al. 2011, Gowland & Western 2012, Jurmain et. al 2011).  Yet, we must take into consideration the difficulties in understanding infectious disease; examples of the osteological paradox are ever present, understanding the aetiology of bone changes, and the context of genetic differences between populations must be noted whilst PCR amplification, aDNA detection and genome explorations methods must be continually improved for clearer results (Li et al. 2011, Schurch et al. 2011, Spigelman et al. 2012, Tran et al. 2011); this approach must be multidisciplinary in understanding past and present populations (Jurmain et al. 2011, Roberts & Manchester 2010, Waldron 2009).

The modern world has changed, and the boundaries that once protected various human populations has changed dramatically with cheap air travel and vast population movement; this is unprecedented in both history and prehistory, and in population density and scale, but also at the genetic level in human genetic variation (Hawks et al. 2007, Jurmain et al. 2011: 311).  The eradication of smallpox, the Bill and Melinda Gates foundation in fighting malaria, and the ongoing WHO (World Health Organisation) case against polio (Branswell 2012: 50) are strong examples of what can be achieved worldwide.  By building a past population profile of the effects of infectious disease, we are better prepared for the fight tomorrow.


Barnes, I., Duda, A., Pybus, O. G. & Thomas, M. G. 2011. Ancient Urbanization Predicts Genetic Resistance to Tuberculosis. Evolution. 65 (3): 842-848.

Branswell, H. 2012. Polio’s Last Act. Scientific American. 306 (4): 50-55.

Gowland, R. L., & Western, A. G. 2012. Morbidity in the Marshes: Using Spatial Epidemiology to Investigate Skeletal Evidence for Malaria in Anglo-Saxon England (AD 410- 1050). American Journal of Physical Anthropology. 147: 301-311.

Hawks, J., Wang, E. T., Cochran, G. M., Harpending, H. C. & Moyzis, R. K. 2007. Recent Acceleration of Human Adaptive Evolution. Proceedings of the National Academy of Sciences. 104 (52): 20753-20758.

Jurmain, R., Kilgore, L. & Trevathan, W. 2011. The Essentials of Physical Anthropology, International Edition. Belmont: Wadsworth.

Li, Y., Carroll, D. S., Gardner, S. N., Walsh, M. C., Vitalis, E. A. & Damon, I. K. 2007. On the Origin of Smallpox: Correlating Variola Phylogenics with Historical Smallpox Record. Proceedings of the National Academy of Science. 104 (40): 15787-15792.

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

Schurch, A. C., Kremer, K., Kiers, A., Daviena, O., Boeree, M. J., Siezen, R. J., Smith, N. H., & Soolingen, D. V. 2010. The Tempo and Mode of Molecular Evolution of Mycobacterium Tuberculosis at Patient-to-Patient Scale. Infection, Genetics and Evolution. 10 (1): 108-114.

Spigelman, M., Shin, D. H., & Gal, G. K. B. 2012. The Promise, the Problems and the Future of DNA Analysis in Palaeopathology Studies. In Grauer, A. L. (ed). A Companion to Palaeopathology. Chichester: Blackwell Publishing Ltd.  pp.133-151.

Tran, T., Aboudharam, G., Raoult, D., & Drancourt, M. 2011. Beyond Ancient Microbial DNA: Nonnucleotidic Biomolecules for Palaeomicrobiology. BioTechniques. 50: 370-380.

Waldron, T. 2009. Palaeopathology. Cambridge: Cambridge University Press.

Infectious Disease Part 1: Treponemal Disease & Smallpox

5 Oct

The following two posts deal with biomolecular approaches and research studies in detecting the presence of infectious diseases in human bone from archaeological material.  The recent coming of age of biomolecular techniques, as applied to archaeological material, has provided a rich and complex source of information in helping to uncover how infectious diseases spread in the historic and prehistoric past.  Whilst it has help clear some mysteries up, it has unleashed others.  The first post, here, describes recent research focused on Treponemal diseases (including Yaws, Syphilis and Pinta) and Smallpox.  The second post can be found here.


Treponemal Diseases

Roberts & Manchester (2010: 216) note that infectious diseases are ‘not solely microbiological entities but are a composite reflection of individual immunity, social, environmental, and biological interaction’.  The study of treponemal disease, in particular, is fraught with controversy and stigma, both in the modern and historical contexts (Lucas de Melo et al. 2010: 1, Roberts 2000), and in the nature of its spread and transmission.  However the combination of molecular pathology, phylogenetics, and palaeopathological studies, are helping to produce a clearer genetic origin of the disease and the impacts that this disease had, and continues to have, on the world at large (Hunnius et al. 2007: 2092).  Typically the bacterial diseases of the genus Treponema are split into different forms; pinta (T. carateum), yaws (T. pallidum subspecies pertenue), endemic syphilis (T. pallidum subspecies edemicum) and venereal/congenital syphilis (T. pallidum subspecies pallidum) (Table 1; Lucas de Melo et al. 2010: 2).  The four forms were, until recently, indistinguishable in physical and laboratory characteristics (Roberts & Manchester 2010: 207), whilst the pinta strand does not affect bone (Waldron 2009: 103).  DNA analysis of the bacteria of venereal syphilis has shown a difference between it and the non-venereal types; although it is noted that there is no change in the clinical presentation of the disease (Roberts & Manchester 2010: 207).

Table 1. Geographic location, transmission and whether bone is affected for treponemal disease (after Waldron 2009: 103).

Yaws was likely the first disease to emerge, probably from an ape relative in Central Africa, whilst the endemic form of syphilis derived from an ancestral form in the Middle East and the Balkans at a later date, whilst T. pallidum was the last to emerge, probably from a New World progenitor, although the issue is still highly contentious (Roberts & Manchester 2010: 212, Waldron 2009: 105).  Gaining virulence at a dramatic rate in the 15th and 16th centuries AD in Europe, venereal syphilis affected a large section of the population due to its mode of transmission.  It should be noted, however, that bone changes in syphilis are rare in the early stages but common in the tertiary stage of the disease (Roberts & Manchester 2010).  It has also been noted that there could be a back and forth transmission, from one treponemal disease to another, within intra-population groups changing from one environment to another; that ultimately it’s possible that each social group, or population, has its own treponemal disease suited to its ‘geographic and climatic home and its stage of cultural development’ (Roberts & Manchester 2010: 213).

However, this infectious disease, in its venereal form, is particularly hard to locate and identify in archaeological populations; the limitations of biomolecular palaeopathology have become clear (Bouwman & Brown 2005: 711, Hunnius et al. 2007, Lucas de Melo et al. 2010: 10).  Bouwman & Brown’s (2005) experiment, and Hunnius et al. (2007) subsequent paper, have highlighted the difficulties in amplifying T. pallidum subspecies T. pallidum, even in highly suspected bone samples.  Bouwman & Brown (2005: 711) tested 9 treponemal samples using the Polymerase Chain Reaction (PCR) tests, optimized to highlight ancient treponemal DNA.  This resulted in poor amplification of  treponemal ancient DNA (aDNA) from human bone, even with bone of varying origins (geographic, social and climatic samples).  3 outcomes where postulated; the bones were either not suitable for aDNA retrieval, treponemal aDNA was present but the PCR was not sensitive enough to be pick it up, or there was no treponemal DNA in the bones (Bouwman & Brown 2005: 711-712).  Subsequent investigations and phylogenetic approaches have highlighted that the disease invades different parts of the body at impressive rates, but in the later stages of the disease, the organism’s DNA is not present in the actual bone itself, just at the stage when an osteologist can identify it macroscopically (Hunnius et al 2007: 2098).  Phylogenetic evidence supports evidence of variations in the virulence of syphilis, and the support of a more distant origin, possibly around 16,500 to 5000 years ago, but where exactly remains unsolved (Lucas de Melo et al. 2010: 2).  Interestingly, in the early 20th century P. Vivax (the main causer of malaria) was used as a treatment for patients with neurosyphilis in a procedure by the physician Julius Wagner-Jauregg; it was injected as a form of pyrotherapy to introduce high fevers to combat the late stage syphilitic disease by killing the causative bacteria (Wagner-Jauregg 1931).


The Smallpox virus is particularly devastating and disfiguring disease, but thankfully no longer an active infection in the modern world (Manchester & Roberts 2010: 180).  Although kept only in laboratory samples now, there is an ongoing concern regarding whether it could be a danger to modern archaeologists dealing with infected material (Waldron 2009: 110).  The disease, once contracted, either leads to recovery with lifelong immunity or death.  The severe form is called variola major and is documented in the Old World with a 30% death rate once contracted, whilst its less virulent form, named variola or alastrim minor, is found in Central America and has a mortality rate of 1% (Hogan & Harchelroad 2005, Li et al. 2007: 15788).  Smallpox, the strictly human variola virus pathogen, is found in literature and documentary records during the last 2000 years (Larsen 1997), yet an osteological signature is not present or identifiable in infected individuals (Waldron 2009: 110).  Therefore to find out the origins of the disease, Li et al. (2007) used correlated variola phylogenetics with historical smallpox records to map the evolution, origin and transportation of smallpox between human populations.

Li et al. (2007: 15787) state that no credible descriptions of the variola virus have been found on the American continent or sub-Saharan Africa before the advent of westward European exploration in the 15th century AD; suggesting that with European exploration and expansion came the virulent waves of smallpox that helped to decimate the existing Native American populations, who previously had no contact or natural immunization with such a highly virulent disease.  It is worth noting here the disease has been used in warfare as a chemical weapon surprisingly early.  During the 18th century American colonial wars between the French, British and the Native Americans, the British forces stationed in America actively infected items of clothing that were given to the Native population to help aid the spread of the disease among the Native Americans , who at that time were largely allied to the French.  This weakened the Native American population dramatically during the various colonial wars and subsequent colonial expansion westward; it’s estimated nearly half of the American Native population died from smallpox alone and its naturally rapid commutable spread of smallpox through human populations (Hogan & Harchelroad 2005).

Li et al. (2007: 15787) note that there are ambiguous gaps in the evolution of smallpox disease itself however.  Li et al. (2007) initiated a systematic analysis of the concatenated Single Nucleotide Polymorphisms (SNP’s) from the genome sequences of 47 variola major isolates from a broad geographic distribution to investigate its origins.  Variola major has a slowly evolving DNA genome, which means a robust phylogeny of the disease is possible (Hogan & Harchelroad 2005).

Firstly, the results showed that the origin of variola was likely to have diverged from an ancestral African rodent–borne variola like virus, either around 16,000 or 68,000 thousand years ago dependent on which historical records are used to calibrate the molecular clock (East Asian or African) (Li et al. 2007: 15791).  Taterapox virus is associated with terrestrial rodents in West Africa, and provides a close relationship with the variola virus.  It is entirely possible that variola derived from an enzootic pathogen of African rodents, and subsequently spread from Africa outwards (Li et al. 2007: 15792).  Secondly, evidence points towards two primary clades of the variola virus, both from the same source as above, but each represent a different severity and virulence of the variola virus.

The first primary clade is represented by the Asian variola major strains, which are the more clinically severe form of smallpox;  the molecular study of its natural ‘clock’ suggests it spread from Asia either 400 or 1600 years ago (Li et al. 2007: 15788).  Included in this first primary clade is the subclade of the African minor variation of the main Asian variola major disease.  The second primary clade compromises two subclades, of which are the South American alastrim minor and the West African isolates (Li et al. 2007: 15788).  This clade had a remarkably lower fatality rate in comparison to the above clade.  The importance of phylogeny analysis is that it highlights areas of disease prevalence and virulence that can be missed, or indeed entirely absent, from the osteological and archaeological record (Brown & Brown 2011).


Bouwman, A. S. & Brown, T. A. 2005. The Limits of Biomolecular Palaeopathology: Ancient DNA cannot be used to Study Venereal Syphilis. Journal of Archaeological Science. 32: 703-713.

Brown, T. & Brown, K. 2011. Biomolecular Archaeology: An Introduction. Chichester: Blackwell Publishing.

Hogan, C. J. & Harchelroad, F. 2005. Smallpox. Emedicinehealth. Accessed at http://www.emedicinehealth.com/smallpox/page2_em.htm#Smallpox%20Causes on the 29th of April 2012.

Hunnius, T. E., Yang, D., Eng, B., Waye, J. S. & Saunders, S. R. 2007. Digging Deeper into the Limits of Ancient DNA Research on Syphilis. Journal of Archaeological Science 34: 2091-2100.

Larsen, C. S. 1997. Bioarchaeology: Interpreting Behaviour from the Human Skeleton. Cambridge: CambridgeUniversity Press.

Li, Y., Carroll, D. S., Gardner, S. N., Walsh, M. C., Vitalis, E. A. & Damon, I. K. 2007. On the Origin of Smallpox: Correlating Variola Phylogenics with Historical Smallpox Record. Proceedings of the National Academy of Science. 104 (40): 15787-15792.

Lucas de Melo, F., Moreira de Mello, J. C., Fraga, A. M., Nunes, K. & Eggers, S. 2010 Syphilis at the Crossroad of Phylogenetics and Palaeopathology. PLoS Neglected Tropical Diseases.4 (1): 1-11.

Mitchell, P. 2003. The Archaeological Study of Epidemic and Infectious Disease. World Archaeology. 35 (2): 171-179.

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

Wagner-Jouregg, J. 1931. Verhutung und Behandlung der Progressiven Paralyse durch Impfmalaria.  Handbuch der Experimentellen Therapie, Erganzungsband Munchen.

Waldron, T. 2009. Palaeopathology. Cambridge: Cambridge University Press.