Understanding how care was provided in the past is essential to gaining knowledge about how communities were socially organized to confront disease and disability. New Developments in the Bioarchaeology of Care presents how the Bioarchaeology of Care theory is applied, through several case studies focusing on past care provision within a philosophical framework linked to ethical approaches in bioarchaeology. This edited collection is the result of a symposium of the Society for American Archaeology (SAA) held in 2015 in San Francisco, USA, entitled ‘Building a Bioarchaeology of Care’. This also represents a follow-up of the volume edited by Tilley in 2015 (Reference Tilley2015a).
The book is divided into three parts that follow an Introduction by Tilley & Schrenk (Chapter 1) which reviews the developments of past caregiving and summarizes the structure of the book. The following chapter (2), by Tilley, emphasizes the theoretical aspects of the Bioarchaeology of Care with its ‘caveats and constraints’ on implementing the Index of Care to archaeological cases studies (individuals M9 from Neolithic Vietnam and Romito 2 from the Epi-Gravettian Riparo del Romito in Calabria), which represents an expanded and updated paper by Tilley (Reference Tilley2015b).
Part 1 is a compendium of ‘Cases Studies: Applying and Adapting the Bioarchaeology of Care Methodology’ (Chapters 3–9). The first case study is a bioarchaeological analysis by Schrenk & Martin of a Bronze Age skeleton from Tell Abraq (UAE). The application of Tilley and Cameron's (Reference Tilley and Cameron2014) Index of Care leads the authors to propose two alternatives, based on the differential diagnosis offered by two care models. Chapter 4 (by Willet & Harrod) offers an interesting case study, in which the application of the Index showed that the Aztect Burial 88 from the West Ruin in northern New Mexico with several traumatic injuries suggested reduced mobility and active care provision among the Pueblo community. In the following chapter (5), Worne focuses on a late prehistoric case in Averbuch, Tennessee, where an individual suffered traumatic injuries and multiple fractures and received care to survive. As the author states, this is an interesting case since, in an agricultural society, not contributing to daily activities meant that the social organisation was still able to care for such individuals. In Chapter 6, Roberts applies the Index of Care to an individual with leprosy in late medieval Chichester, England. Although the model could not prove whether care was given in this case, this study shows that every individual is unique and past caregiving could only reflect individual needs and cultural traditions. In Chapter 7, two medieval cases from Poland involving leprosy and gigantism are presented by Matczak & Kozlowski. Although the two cases showed different models of care and disability, this study combined data from the analysis of the burial, thus demonstrating that such an approach should be considered in bioarchaeological research to provide a spectrum of past historical cases. In the next chapter (8), Conlogue et al. focus their research on an eighteenth-century skeleton of a male individual with severely reduced mobility from London, England. The disability known as kyphoscoliosis, along with the associated impairments, implies that care had to be given to this individual for him to survive. In this case study too, the analysis of burial data was essential since the social condition and status of this individual meant that the provision of care was guaranteed. In Chapter 9, Jolly & Kurin examine a case of trepanation with survival from prehistoric Chanka (Peru). This is of special interest because trepanation is not only a surgical operation but also provides evidence of care for trauma suffered in relation to violent episodes.
Part II, ‘New Directions for Bioarchaeology of Care Research’, contains seven chapters (10–16). Chapter 10, by Nystrom & Piombino-Mascali, is the only chapter that evidences care on the basis of mummified soft tissue. It mainly deals with the eighteenth- to mid-nineteenth-century ad remains from the Mother Church at Piraino (Sicily). Given the limitations of observing disability on skeletal remains, mummified remains and other associated data show great potential for understanding care in the past. Nystrom and Piombino-Mascali review three main topics, i.e. surgical intervention, therapeutic tattooing, and medicinal plants. They emphasize that Bioarchaeology of Care studies of mummified remains must include contextual data and archaeological theory.
The next chapter (11), by Oxenham & Willis, focuses on the bioarchaeology of care of children that lived in prehistoric Man Bac (Vietnam). This study shows that, in addition to health and disease, understanding mortuary behaviour is essential to make inferences about children. Although the authors used the stages designed by Tilley to produce a model of care, they conclude that each stage of the model depends on several factors, including social context, age, disease, and disability. Gowland (Chapter 12) reviews individuals of advanced age and deals with aspects such as the perception of old age and disability in the past and how care could have been provided. In addition, she lists a series of factors that should be considered when analysing bioarchaeological data to interpret disability in older individuals; these relate mainly to identity and the construction of self, but also to relations within a social context. Chapter 13, by Wesp, concerns a historical case in Central Mexico, where institutional care was established in the form of hospitals. This specific case of care, through the creation of a hospital established to look after the Indigenous population, included not only medical care, but also psychological, spiritual, and religious support since it was linked to the Christian charitable missions established in the Americas. This is another example of how the Bioarchaeology of Care could be approached through multiple strands of evidence.
In the following Chapter (14), Tremblay Critcher reviews the role of hospitals and other care institutions during the nineteenth and early twentieth century. The author developed a method to examine how such institutions worked at two different levels: the individual and the population level. Although she acknowledges the limitations of the method, combining the bioarchaeological evidence (with their own inherent limitations) with additional documentary sources offers new possibilities to investigate the impact of care provision or ‘ lack of caregiving’ (p. 287). In Chapter 15, Milella aims to reconstruct care during prehistory, using a dataset (by Binford) derived from 390 hunter-gatherer societies. The author concludes that care was a complex issue among hunter-gatherers, where biological and cultural aspects should be treated in combination and analysed at a population level and not at an individual level. Wilson and others present in Chapter 16 the Digitised Diseases web-based 3D resource as a complementary tool for the Bioarchaeology of Care. While this tool is useful for comparative analysis of palaeopathological cases, the resource is a way of moving from individual cases to understanding social contexts and combining archaeological, historical, and bioarchaeological data to develop a model of care.
The last three chapters of the book (17–19) constitute Part III, entitled ‘Ethics and Accountability in the Bioarchaeology of Care’. Chapter 17, by Doat, brings together the ethical and philosophical issues arising in bioarchaeology. He agrees with the framework designed by Tilley and Cameron (Reference Tilley and Cameron2014) since this respects moral economy of contemporary archaeological practice, and this field is developing towards building a methodology designed to understand how care was given in the past. In Chapter 18, Mennear explains the importance of public engagement in the Bioarchaeology of Care. While the discipline seemingly has a strong impact and there is great public interest in archaeology, he argues for the establishment of guidelines for best practice in bioarchaeology to deliver and communicate academic research. The last chapter (19) contains Buikstra's conclusions. Based on her extensive expertise in bioarchaeology, and looking back to the publication of the first paper about the Bioarchaeology of Care (Tilley & Oxenham, Reference Tilley and Oxenham2011), Buikstra assesses the achievements and evolution of the discipline since then. Her analysis is positive overall: she agrees that the methodology of the Bioarchaeolgy of Care works for all the case studies presented in the book and looks forward to the development of more application and extensions in the future.
The book is well structured and there is a good balance of case studies applying the approaches developed within the Bioarchaeology of Care. The selection of case studies illustrates perfectly the provision of care in the past and the process of caregiving at different times and in different places worldwide, and give new insights into care not only in the past but also in contemporary societies. The use of skeletal remains as the basis for research is usefully complemented by the examination of mummified remains and associated data, including documentary, clinical, ethnological, and web-based approaches.
The book presents new research in the Bioarchaeology of Care within the debate around the application of the Index of Care and the production of different models of care. Within bioarchaeological research, this is an innovative approach and it offers the possibility of re-analysing old and new cases. Within the range of expertise presented here, the authors appear to agree that the standardization of the method shows that the methodology works for different periods and geographical locations.
Not only does this book serve as a reference for the application of the Bioarchaeology of Care methodology but it also demonstrates that the discipline is in good shape. Future developments might include a holistic approach integrating details of the archaeological context, the historical data, all kinds of bioarchaeological research, and ethical considerations.
