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and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe bioarchaeology international copyright © 2021 university of florida press doi: 10.5744/bi.2020.5143 volume 4, numbers 3–4: 151–152 from the foundation to a vision of the future: a note from the founding editors sabrina c. agarwal and brenda j. baker in april 2015, over a rushed lunch in a noisy and packed conference-hotel restaurant, we began to conceptualize a new journal dedicated to the field of bioarchaeology. we excitedly shared our enthusiasm and brimming ideas, and quickly realized we had a common vision: to create a unified place for rigorous peer-reviewed bioarchaeological research that was global in scope, focused on well-contextualized studies, highlighted early career scholarship, and promoted topics of public interest. prior to the publication of bioarchaeology international there was no dedicated journal available to the discipline as a whole, despite the ever-increasing percentage of bioarchaeological research being published in the flagship journals of biological anthropology and archaeology. more importantly, no journal offered researchers an integrated source where osteological, archaeological, funerary, and archival data could be published in one place, with analyses that emphasized both biological and social interpretation. we hope that bioarchaeological international has become a home for that kind of rigorous and transformative work. building a new journal is challenging, particularly with a publisher just starting a journals division from scratch. the nuts and bolts of identifying a manuscript management system and website platform, getting them set up, creating an author/style guide, bringing together a formidable editorial board, garnering interest, soliciting papers, and more, required substantial time and energy. bioarchaeology international was born of this effort, opening for submissions in june 2016. since then, our initial vision of a journal devoted to publication of contextualized bioarchaeological research (see baker and agarwal 2016, vol. 1, nos. 1–2) has developed into four years of published volumes and a growing reputation in bioarchaeology. under our editorship, we have shepherded the publication of four volumes and 16 issues (including the present one), with 59 articles. our initial commentary pieces have addressed timely issues such as collaborative practice and continued conversations around repatriation (boutin et al. 2017, vol. 1, nos. 3–4; kakaliouras 2017, vol. 1, nos. 3–4), highlighted state-of-the-art methods in molecular and chemical analyses (velsko and warriner 2017, vol. 1, nos. 1–2), discussed a way to identify consumption of fermented beverages in the archaeological record (gagnon and juengst 2018, vol. 2, no. 3), and considered biases in facial reconstructions (wilkinson 2020, vol. 4, no. 1). we have been particularly gratified by the range of the research papers published in these first years of the journal. topics include taphonomic processes and mortuary practices, individual and population-level health, growth and activity patterns on the skeleton, and discussions that include famine, stress, disability, euthanasia, mortality, and social complexity from a variety of contexts, including cremation and multiple burials as well as anatomical collections. these first volumes cover an extensive geographic breadth with bioarchaeological studies that span the globe, including australia, austria, canada, belgium, bolivia, brazil, croatia, czech republic, egypt, england, germany, greece, hungary, ireland, italy, japan, nepal, the netherlands, new zealand, palau, peru, romania, spain, sudan, sweden, thailand, turkey, the united states, and vietnam. 156_ufl_j_bi-01-agarwalbaker-intro.indd 151156_ufl_j_bi-01-agarwalbaker-intro.indd 151 15/07/21 2:34 pm15/07/21 2:34 pm note from the founding editors152 during these past years of our editorship, there have been several significant advances and challenges in the field, set in a global landscape of sociopolitical and environmental turmoil and change, including a global pandemic. bioarchaeology, as a maturing field, continues to provide essential insight into issues of current significance in the modern world. bioarchaeology international offers a home for engaging research on issues of current import, including the social responses to and biological consequences of climate change (e.g., williams and larsen 2017, vol. 1, nos. 3–4) and famines (e.g., dewitte and yaussy 2017, vol. 1, nos. 3–4; horocholyn and brickley 2017, vol. 1, nos. 3–4). research on past pandemics and epidemics provides insights into social responses, including stigma and blame, and reveals health disparities, just as we are witnessing today with the covid-19 pandemic. systemic oppression and marginalization of certain groups of people is also evident in the remains and funerary contexts we study from the recent past and long ago, and the bioarchaeological investigations of such health disparities (e.g., gowland et al. 2018, vol. 2, no. 1; olsen et al. 2018, vol. 2, no. 2; redfern et  al. 2018, vol. 2, no. 1; ward et  al. 2020, vol. 3, no. 4), and structural violence (e.g., dabbs 2020, vol. 3, no. 3; dittmar and mitchell 2019, vol. 2, no. 4) continue to provide a critical long view of the toll over multiple generations. bioarchaeologists all over the world have engaged deeply in recent years with issues of racism and racialized violence and have begun to contribute to decolonizing practices in the field, lab, and classroom. the future of our field depends on our contributions to these conversations, and the editorial board of bioarchaeology international remains committed to highlighting such work. finally, we believe the journal can continue its mission to increase the contributions of diverse voices, from the journal’s editorial board members and its authors. this work has only just begun, and we are confident that the new coeditors, gwen robbins schug and siân halcrow, will build on the foundation we have laid. we thank the university press of florida and the provost of the university of florida for their investment in bioarchaeology international and their support through its first years of development. our advisory board, our associate editors, and our editorial assistant have worked hard to make this journal a success. their efforts are greatly appreciated, and we will miss working with them. we will continue to foster the journal in a supporting role and look forward to its further growth. 156_ufl_j_bi-01-agarwalbaker-intro.indd 152156_ufl_j_bi-01-agarwalbaker-intro.indd 152 15/07/21 2:34 pm15/07/21 2:34 pm login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe bioarchaeology international volume 3, number 1: 16–31 doi: 10.5744/bi.2019.1006 copyright © 2019 university of florida press osteobiography: the history of the body as real bottomline history john robb,a* sarah a. inskip,a craig cessford,a jenna dittmar,a toomas kivisild,b piers d. mitchell,a bram mulder,a tamsin c. o’connell,a mary e. price,a alice rose,a and christiana scheibc adepartment of archaeology, university of cambridge, cambridge cb2 3dz, uk bkatholieke universiteit leuven, belgium cestonian bioscience centre, tartu, estonia *correspondence to: john robb, department of archaeology, university of cambridge, downing street, cambridge cb2 3dz, uk email: jer39@cam . ac . uk abstract what is osteobiography good for? the last generation of archaeologists fought to overcome the traditional assumption that archaeology is merely ancillary to history, a substitute to be used when written sources are defective; it is now widely acknowledged that material histories and textual histories tell equally valid and complementary stories about the past. yet the traditional assumption hangs on implicitly in biography: osteobiography is used to fill the gaps in the textual record rather than as a primary source in its own right. in this article we compare the textual biographies and material biographies of two thirteenthcentury townsfolk from medieval england— robert curteis, attested in legal records, and “feature 958,” excavated archaeologically and studied osteobiographically. as the former shows, textual biographies of ordinary people mostly reveal a few traces of financial or legal transactions. interpreting these traces, in fact, implicitly presumes a history of the body. osteobiography reveals a different kind of history, the history of the body as a locus of appearance and social identity, work, health and experience. for all but a few textually rich individuals, osteobiography provides a fuller and more human biography. moreover, textual visibility is deeply biased by class and gender; osteobiography offers particular promise for marxist and feminist understandings of the past. keywords: medieval; experience; osteobiography; ordinary people; biography ¿para qué sirve la osteobiografía? la última generación de arqueólogos luchó para superar la suposición tradicional de que la arqueología es meramente (accesoria) a la historia, una sustituta que se puede utilizar cuando las fuentes escritas son deficientes. ahora es ampliamente reconocido que las historias materiales y las historias textuales igualmente válido y complementario del pasado. sin embargo, la suposición tradicional continúa implícitamente en la biografía: se utiliza la osteobiografía para llenar los vacíos en el historial textual en vez de utilizarla como fuente primaria por derecho propio. en esta investigación comparamos las biografías textuales y biografías materiales de dos ciudadanos de la inglaterra medieval del siglo xiii— robert cuteis, documentado en registros legales, y “feature 958”, excavada arqueologicamente y examinada osteobiograficamente. como demuestra la primera, biografías textuales de la gente común sobre todo revelan algunos rastros de transacciones financieras o legales. la interpretación de estos rastros de hecho presume implícitamente una historia del cuerpo. la osteobiografía revela una clase de historia distinta, la historia del cuerpo como un sitio que contiene información sobre apariencia e identidad social, trabajo, salud y experiencia. para todos aparte de algunos received 29 july 2018 revised 3 january 2019 accepted 5 january 2019 robb et al. 17 biography with and without texts years ago, one of the classic texts of medieval history was eileen power’s (1924) book medieval people. it featured biographies of six medieval men and women. a tradition followed of using the biographies of “typical” people as an entrée into medieval society (e.g., bennett 1955). today, biographies of medieval people still form a staple of popular history. the core of these works was upperclass aristocrats, public men, and merchants, but they made an effort, usually trying to include a token woman and a token poor person. the woman was usually based on some fortuitously well documented gentlewoman such as margery paston or an exceptional case such as margery kempe; the poor person may have been a fictionalized pastiche such as power’s frankish peasant “bodo.” later microhistories (davis 1984; ginzburg 1992; le roy ladurie 1978) expanded the genre, but were possible only when they hit a lucky trove of exceptionally documented material in court or inquisition records. this tradition continues; a recent compilation of medieval biographies (bates et al. 2006) contains only one subject who is not an aristocrat, a highranking religious figure, or a literary figure. the one exception is based not upon textual but upon archaeological and osteological data (fleming 2006). even with texts, sources reveal different things in different abundance. chaucer and shakespeare, the outstanding literary figures of their times, were well known individuals in public life, and each left over a hundred life records. yet virtually all of their life records tell about their business transactions; we know far more of their minor property investments than of whether each really loved his wife or not. as any genealogist will tell you, this bias is true even for surprisingly recent periods. for ordinary people, particularly before parish records began in the sixteenth century and national censuses began in the nineteenth century, it is rare to have even a few life records, and a “biography” almost always consists of just a few incidental transactions and perhaps a will (cf. fleming 2009). such minimal documents form the tough and lasting enamel crowns of the textual record, remaining when the letters, diaries, and conversations, like fragile but informative pelvic bones, vanish in the erosion of time. before the last couple of centuries, no textual record at all attests the very existence of the vast bulk of humanity (fig. 1). this destruction of information filters our historical vision, making an uncritical textual history the preferential history of the rich and noteworthy. if we want to write a genuine “people’s history” (zinn 1980), a history of submerged people and their struggles, we need material evidence, above all the evidence of their own bodies. what role can osteobiography play in balancing this situation? the answer hinges upon the relationship of texts and material remains. traditionally, history has been based upon textual records; material remains have been regarded as ancillary, typically as a supplementary source. in fields such as classical, historical, and early medieval archaeology, the last generation fought to establish archaeology as an equal, complementary source to textual records. biography, however, is among the last holdouts. we still retain the idea that a biography must deal with a named individual and contain specific historical facts and dates. skeletal studies are commonly thought of as providing generic background and color rather than detailed individual stories. this perception partly derives from our idea that imagining an individual requires a name, a face, and a backstory (robb 2009). indeed, with figure 1. medieval england: the inverse relationship between level of historical knowledge and an individual’s social position. pocos individuos que tienen una historia textual abundante, la osteobiografía provee una biografía más amplia y más humana. además, la visibilidad textual está profundamente sesgada por clase y por género; la osteobiografía ofrece un potencial especial para los entendimientos marxistas y feministas del pasado. keywords: medieval; experienca; osteobiographía; gente común; biographía osteobiography as bottom-line history18 highprofile cases such as richard iii (buckley et al. 2013), what makes the osteobiography a “real” biography, rather than just the study of a random skeleton, is the act of identifying the skeleton with a specific historically documented individual. we advocate dethroning the textual individual as the gold standard biography. we define biography as the life story of a specific individual, without presuppositions about what specific information it must contain and what methods are used to achieve it. thus, biographers have the same challenge as any other analysts. different sources, like different scanning technologies, yield different pictures. consider an xray, a genotype, a family story, and a photograph. one is not “truer” than another. instead, they are based on different methods, reveal different aspects of someone, and are useful for different purposes. this point was made graphically by sir john sulston, the nobel laureate who founded the human genome project, when he proposed two autobiographical portraits of himself: a photograph and a genotype. osteobiography has already proved its value in providing “a past with faces,” a past in which all people, rather than just textually privileged ones, have humanity and agency rather than remaining “faceless blobs” (in tringham’s [1991:94] memorable phrase). landmark osteobiographies are reviewed in the introduction above and in the articles in this issue; for medieval england osteobiographical approaches have been advocated by gilchrist (2012:43– 67; see also knüsel et al. 2010, and medieval examples from the netherlands [arts 2003], norway [hamre et  al. 2017], cyprus [baker et al. 2012], and poland [matczak and kozłowski 2017]). our goal in this article is not only to provide another example, useful though that would be. rather, by explicitly comparing skeletal and textual biographies, we wish to explore how they create different kinds of life stories. this article compares two people who lived and died around the same time— the earlier thirteenth century— and in the same place, a neighborhood about 200 meters across in cambridge, england. one is known through historical records, and the other is an excavated skeleton. they spoke the same language, middle english; shared a cosmological frame of reference, medieval christianity; and would have had many of the same thoughts and preoccupations. they may have known each other or jostled in the marketplace. they were buried in the same cemetery. they may have been related. but when we investigate them through textual biography and osteobiography, very different understandings of them emerge. we will argue that, for understanding the lives of the medieval poor, and indeed the vast bulk of humanity in almost any period, osteobiography provides a more detailed, reliable, and insightful life story than textual biography. medieval cambridge by the early twelfth century, cambridge was a medieval town of ca. 90 hectares (fig. 2; bryan 1999; cam 1959; lobel 1975; taylor 1999). records from 1279 show that, by then, it contained around 440 domestic houses, 60 additional houses in outlying suburbs, around 50 vacant properties, and 75 shops or booths. this documentation suggests a population of ca. 2500– 4500. it was a mediumsize market town in which economic life was based upon farming and river trade up and down the cam. it had a castle, and a substantial clerical population based in the benedictine nunnery of st. radegund, the hospital of st. john, and the outlying barnwell priory and leper hospital. more friaries were founded later in the thirteenth century. the university was founded in ca. 1208– 1210, but it did not become a major force in the town until the late thirteenth to early fourteenth centuries. in the period discussed here, its major effect upon the town probably was to add a steady demand for food, drink, and services to support a few hundred clerics and students. burial in medieval cambridge was organized around the religious landscape. in the late twelfth and early thirteenth centuries there were 14 parish churches in cambridge, each anchoring a neighborhood of a few hundred parishioners. both of our subjects were buried at the hospital of st. john, located adjacent to the parish of st. clement in the north end of town where the main northsouth road crossed the river cam. this parish held 35 domestic houses and five shops and booths. its several hundred residents were a broadly representative cross section of society. the parish church cemeteries were the normal place to be buried, but people were also buried in religious houses of various kinds, including the hospital of st. john. from 1144 to 1275, jews were buried in jewish cemeteries. of all these burial options, only a few have been investigated archaeologically. at the parish cemetery of all saints by the castle north of the river, ca. 220 townspeople buried ca. 950– 1365 have been excavated (craddock and gregory n.d.), and nearly 40 skeletons, mostly of friars, recently have been excavated at the augustinian friary south of the marketplace (cessford 2017). the most extensively investigated cemetery is at the hospital of st. john, where approximately 400 burials were excavated (cessford 2012; 2015). st. john’s hospital was a small charitable institution that provided shelter to poor and indigent people. it was founded around 1195 and lasted until 1511 (cessford 2015; rubin 1987; underwood 2008). the hospital itself initially supposedly consisted of the “poorest of shacks” (pauperrium bordam) erected on a valueless piece of waste ground, but it soon acquired a stone chapel, accommodation for the brethren, a dormitory for inmates, robb et al. 19 figure 2. cambridge in the early thirteenth century (map by vicki herring). ancillary structures, and a cemetery (rubin 1987). in the usual medieval pattern, it was supported by income from parish churches and from rentyielding urban properties and agricultural land. these properties were donated to the hospital by the pious in return for prayers and masses. it provided room, board, and clothing for its dozen or so fortunate inmates, who were chosen from the town’s poor and infirm. medieval hospitals provided charitable shelter for many distinct categories of people, including the poor and aged, pilgrims, and the chronically ill (prescott 1992). hospitals also provided the necessary setting to have a “good death,” with ready access to confession and masses around the dying person’s bed (rawcliffe osteobiography as bottom-line history20 figure 3. robert curteis: the principal life record (sjca d18.23). this document in the archives of st. john’s college, cambridge, records, among other transactions, his father’s gift of land to st. john’s hospital in return for the burial of robert’s body there. used by permission of the master and fellows of st. john’s college, cambridge. 1995). although the concept of the “good death” was only fully expressed in the fifteenth century, when the ars moriendi (the art of dying) was published, it is clear that there had been an increasing elaboration around death linked to the developing concept of purgatory, with a distinction between an “idealised and studied good death” and an “unregenerate and impenitent one” (crouch 1997:180). on current bio archae olo gi cal evidence (inskip et al. in prep), cambridge’s hospital of st. john sheltered a combination of older individuals, perhaps unable to work owing to age, weakness, or chronic illness, and younger people with chronic debilitating illnesses. it also housed a few corrodians, older people who had donated property to the hospital in return for guaranteed room and board for the rest of their lives. among the dead buried in the cemetery there were also some townsfolk (such as robert curteis, below) and perhaps some of the hospital lay staff, such as cooks, bakers, and maltsters. robert curteis: a textual biography of the tens of thousands of people who lived and died in cambridge during the thirteenth century, only a minuscule proportion is mentioned in historical records. children, probably about half the population at any time, are almost entirely invisible. adult women appear infrequently, mostly when they owned property in their own right. aside from a few major landowners or civic figures, even adult males emerge only if they were householders subject to taxation, bought or sold property, or fell afoul of the law. anybody actually named in any textual record, therefore, already has faraboveaverage historical visibility. one such person was robert curteis, who lived in st. clement parish in the late twelfth and early thirteenth centuries (faber 2006:321– 322). we have chosen him because his level of historical documentation is typical of the minority of individuals mentioned historically, and his family seems to have been economically representative of the neighborhood. somewhat unusually, he is one of only two townspeople textually documented as being buried in the cemetery of the hospital of st. john (fig. 3), making him a compatriot (at least in death) of feature 958 and others of the skeletal sample under study. table 1 summarizes robert curteis’s available life records, drawing both upon the hospital of st. john’s records (underwood 2008) and upon faber’s (2006) exhaustive familybyfamily study of the parish of st. clement. robert curteis is actually mentioned by name only twice: once as a witness to a neighbor’s minor legal transaction, and once in the document that notes his burial place (fig. 3). we can build something of a family history from references to his paternal grandfather, who was referred to as curteis “at the bridge”; his father, gilbert; and his son, peter. the name “curteis,” or “curtis,” an anglonorman word meaning “a man of good education or manners,” began to be used in england in the twelfth century, becoming widespread by the thirteenth (reaney and wilson 1991:121). gilbert’s, robert’s, and peter’s lives span the transition when ordinary people began to have fixed inherited surnames, often patronymics as in this case. for all of them, their dates of birth can only be estimated by calculating backwards from events such as legal transactions or parentage at which point they must have been adults. except for robert himself, their date of death is also entirely inferential. robert’s grandfather, father, and uncle were townspeople who owned small houses in a crowded neighborhood at the north end of cambridge. they also owned small parcels of land in the town fields that surrounded cambridge. they did not own enough farmland to support a family as fulltime farmers, and we do not know if they cultivated this land themselves or let it out for rent. they did buy other small urban plots, conforming to the medieval pattern in which property was the basic form of wealth and savings were invested in holdings that would yield rent. we do not know where they came from or what their occupations were. a few of their neighbors are identified by placenames or trade names such as “baker” or “fisher,” but most are not. economically, the family seems to have been typical of their neighborhood. st. clement’s parish contained about 100 households paying tax, plus an unknown number of households robb et al. 21 too poor to do so. robert’s father, gilbert, and his uncle, richard, were both among the townspeople who paid taxes, including an amercement in 1211 and tallage in 1219 (maitland 1898:167– 170). in both assessments they were close to the median amount paid in their parish. however, tax was assessed for only 20– 30% of households (149 of about 500 in 1211, 92 of about 500 in 1219). as taxpayers, the curteis males were firmly ensconced in the middle range of the burgess class, the propertyowning freemen of the town, and belonged to the uppermost 10– 20% of adults overall. they were ordinary townsfolk, probably working with their hands in a craft or trade, but certainly not poor. robert’s own life course is even more inferential. robert was almost certainly born between 1180 and 1200. he was not taxed as a head of household in 1211 or 1219, but his father was, implying that robert still lived in his father’s house at that point, perhaps as a young man who was born in the 1190s. he lived long enough to buy or inherit a house plot and to have an acknowledged son or heir, peter, suggesting that he also married. we know when robert died with more precision. between about 1220 and 1230, gilbert is recorded as donating a very small (ca. 3.65 m by 5.50 m) piece of riverside land to the hospital of st. john in return for burying robert there. assuming that robert was born in the 1190s, he would have died around 30 years of age, probably leaving a young son, peter, who inherited both a house plot from him and property from gilbert. the transaction between gilbert and the hospital at robert’s death is interesting in itself. the hospital was permitted to bury its own members, servants, and the inmates in its care. it could also bury others who asked to be interred there in writing, but the hospital then had to pay a fee to the deceased’s parish church (rubin 1987:106). robert would normally have been buried in the graveyard of his local parish church, st.  clement’s. why would robert be buried at the hospital cemetery? while burial in monastic cemeteries was a prestigious act in table 1. robert curteis: the textual record. items in italics are not directly attested by textual records but are inferred from events textually attested, such as transactions implying that the person in question was legally an adult at a given date. sjhc denotes documents listed in the cartulary of the hospital of st. john (underwood 2008). approximate date robert’s approximate age event before 1170 — robert’s grandfather, curteis “at the bridge,” is born. 1160– 1180 — robert’s father, gilbert curteis, and uncle, richard curteis, are born. 1180– 1200 0 robert curteis is born. ca. 1200 curteis “at the bridge” is a bailiff, pays fines, and witnesses various minor legal transactions implying he is a responsible adult (faber 2006:321). ca. 1200– 1211 curteis “at the bridge” dies. early 1200s — robert’s father, gilbert, and uncle, richard, are adults, witnessing a neighbor’s legal transaction (sjhc 5) and owning seven acres of land in fields around the nearby village of maddingley (sjhc 196– 97). 1211 10– 30 along with many neighbors, robert’s father, gilbert, and uncle, richard, are taxed (“amerced”); this implies that their father, curteis, is dead and they are the householders in the family. they pay two marks each, approximately modal for taxpayers in their neighborhood of cambridge and about a third to a half of a laborer’s annual wage (faber 2006:321, 808). early 1200s? 20– 40 robert is an adult, witnessing a neighbor’s land transaction (sjhc 101– 02). 1200– 1220 20– 40 robert’s son peter is born. 1200– 1220 20– 40 later tax lists (the hundred rolls of 1279) imply that robert bought at least one plot of land in st. clement parish; his son, peter, inherited this from him as well as another plot either inherited from robert or directly from gilbert (faber 2006). 1219 20– 40 robert’s father, gilbert, and uncle, richard, are taxed (“tallage”), implying that they are the responsible heads of household (faber 2006:321, 809– 10). richard pays 1£ 4s 8d and gilbert 15s, again approximately modal for their neighborhood. ca. 1220– 1230 25– 45 robert curteis dies. his father, gilbert, still living, gives a piece of riverside land approximately 3.65 by 5.50 m to the hospital of st. john in return for being able to bury robert in the hospital cemetery (faber 2006:321; st john’s college archives d18.1.23). 1246 — robert’s son, peter, gives up rights to seven acres of fields around the nearby village of maddingle (sjhc 200). he owns at least three properties in st. clement’s parish (faber 2006:321– 22). 1260 — robert’s son, peter, owns property at least to 1260, implying he is still living. he does not appear in records after this date and his properties belong to other people, implying that he had no male heirs (faber 2006:321– 22). 1279 no male members of the curteis family are mentioned as owning property in cambridge when the hundred rolls are compiled. osteobiography as bottom-line history22 the later middle ages (and one that was usually paid for with a substantial donation), at this point being buried in the cemetery of a young hospital with its mission of care for the needy was unlikely to be a statusoriented move. rather, in the early to midthirteenth century the townspeople of cambridge considered the hospital an establishment that they had founded and created (known as a hospitale simplex or locus privatus), rather than a more formal religious institution (locus religios; rubin 1987). as robert had lived within 200 m of the hospital for all or most his life, there may have been a close familial attachment. hospitals also provided the necessary setting to have a “good death,” with ready access to confession and masses around the dying person’s bed (rawcliffe 1995). whether this burial location implies that robert was outstandingly pious or an exemplary sinner in need of help is conjectural. the document itself does not specify whether his burial was in the hospital cemetery among the inmates or in a higherstatus position near the chapel. that the piece of donated land was so small probably indicates nothing about the family’s economic status, but simply that it was an infrequent transaction at that point, without an established scale of cost. it seems likely that the land was an adjacent scrap that conveniently filled in a gap in the hospital’s riverside access. as a textual individual, “robert curteis” consists of a name, a sex, a general economic class identification, and a general identification with a place. these provide orientation points for extrapolating much more. while no gender system is entirely binary, for the medieval period, identifying somebody as a social male strongly suggests that this individual was biologically identifiable as male, and it suggests a strongly conventionalized identity and activity regime. we can infer a legal status: a free person not tied to a feudal manor. this information sketches in a series of rights and obligations. for instance, robert would have been free from corvée demands, but owed taxes upon his property. placing robert as an urban man from a moderately prosperous family suggests that he was probably a craftsman or tradesman rather than a general laborer. he and his male line had a fourgeneration run in the ranks of more prosperous townsfolk, buying a handful of small properties that presumably provided rent income from people still less prosperous. this cycle may have ended due to a lack of further heirs, or their property may have ended up among daughters or collateral relatives; it is almost impossible to trace such links in records of this nature. there are also some interesting starting points for further inference. for instance, robert lived long enough to act as a legal witness, buy property, and father a son, all acts of a socially competent adult male, but he was never recorded as a head of household. he may have never left his father’s household. alternatively, perhaps he was adroit at avoiding tax assessments, or perhaps his relatively brief social adulthood simply fell between the infrequent tax exactions that form the available records. this biography has four principal limitations, which can be taken as typical of textual biographies. 1. it relies heavily upon normative generalization to fill in gaps. for instance, we do not really know that, because he was identified as male, robert conformed to “normal” masculinity. we assume that he participated in medieval christianity in a “typical” way rather than being indifferent, skeptical, atheistic, or heretical. similarly, links between people are often more or less inferential. for example, it is sometimes assumed that males with the same surname in successive generations and sometimes holding the same properties are father and son, or at least a straightforward succession of legal heirs. 2. it relies upon an underlying, assumed history of the human body, for instance, in estimating the length of a generation and the level of social activity at different stages of life. 3. it has important social gaps. it really only tells us about heads of households and people engaging in recorded legal transactions. we know almost nothing about women and children, younger sons, servants, and other people (e.g., how large the curteis household actually was, and whether robert had siblings or not). 4. most importantly, even a textual biography much more complete than this one categorically remains silent on many aspects of human experience. it is uncommon to know the occupation or actual daily activities of anyone other than a cleric who is mentioned in textual records of medieval cambridge. similarly, we rarely know of their origin or movements in life, their appearance, or their individual diet or health experience and life risks. it is also worth noting how little relationship this life story bears to any of the dramatic or important regional or national events between 1190 and 1225. nationally, richard i was succeeded by king john (1199), jews were permitted to live freely in england (1201), and a harsh winter created famine (1205). king john was excommunicated by the pope in 1209, involved in the first barons’ war, and forced to sign the magna carta (1215– 1216), and was succeeded by henry iii (1216). locally, cambridge obtained a town charter (1201), a nationally important fair (1211), and royal visits (1215– 1216), and scholars arrived from oxford to begin university teaching (1208– 1210). none of these events are visible in the curteis’ family saga. for ordinary folk, wars and dynastic politics mostly happened robb et al. 23 figure 4. feature 958, excavated (photo: cambridge archaeological unit). somewhere else far away. major famines and local events must have impinged on their lives, but none of these can be readily traced in the individual lives, whether of survivors or casualties. feature 958: an osteobiography feature 958 (f958) is the skeleton of an adult male excavated in the cemetery of the hospital of st. john, cambridge. f958 presented a complete, fully articulated skeleton (fig. 4). he was chosen for osteobiographical reconstruction because he is an older individual with a very well preserved skeleton (figs. 5– 6). moreover, for this article we wanted an adult male to provide a relevant comparison for robert curteis, since our ability to write textual biographies of women from medieval cambridge is almost nil. f958 was male, according to both skeletal criteria (pelvic and cranial indications) and adna evidence. based upon both pelvic traits (following standard protocols in buikstra and ubelaker [1994], as validated in inskip et al. [2018], these included the public symphysis [brooks and suchey 1990] and auricular surface [buckberry and chamberlain 2002]) and advanced dental wear (brothwell 1981), he died between 40 and 60 years of age. f958 is currently modeled as having a 95% probability of having died between 1222 and 1290, based upon bayesian calibration of direct ams dating of his skeleton. as he was between 40 and 60 years old when he died, there is a 95% probability that he was born between 1174 and 1236, and a 68% probability that he was born between 1195 and 1231. if we place him toward the middle of his chronological range and age atdeath distribution, we might imagine him as born around 1200 and dying around 1250. if so, he would have been a child or young man when robert curteis was an adult. he, thus, outlived robert both in lifespan and chronologically. figure 5. feature 958: the principal life record (photo by john robb). osteobiography as bottom-line history24 figure 7. carbon and nitrogen isotopic values for adult saint john’s divinity school samples. feature 958 is marked with a black dot. gray cross indicates median values, and the dark gray area (“bag”) contains 50% of the samples. the outer gray loop is three times the size of the “bag,” and anything outside it is considered an outlier (chart by alice rose produced following rousseuw et al. 1999). figure 6. feature 958: skull (photo by craig cessford). we can summarize the salient facts to be learned from f958’s skeleton succinctly, arranged as far as possible in chronological order. • f958’s genetic heritage is completely unremarkable for the region. while higherresolution scans are ongoing, his mtdna lineage is h2a, which is extremely common for the british isles. • his childhood must be considered a success. linear enamel hypoplasias upon his anterior teeth reveal at least two intervals of interrupted growth between 0 and 6 years of age. it is unknown how serious a stress is needed to produce such lesions, and it may have been quite minor— a short bout of childhood illness, for instance. if he suffered from conditions that result in cribra orbitalia, a very common finding in the st. john’s sample, he lived long enough to remodel all trace of it. he does not show evidence for rickets, which is evident in others in the cemetery. moreover, he survived childhood, unlike perhaps half his birth cohort (based upon general comparison with premodern demographic profiles; see fleming 2006), and he reached an adult stature above the average for males buried in the cemetery. • his adult stature was approximately 177.5 cm, estimated using the trotter and gleser “white” equations (trotter and gleser 1958). his height is well above the average stature of 167– 168 cm for adult males in this sample (dodwell in cessford 2015). with aboveaverage but not extreme height and at least average robustness, he would have fit well into the cohort of adult males. • f958’s collagen carbon isotope value (– 18.7) is typical for the st.  john’s group, and for medieval english samples in general (price 2013). however, his nitrogen isotope value (14.7) is among the highest for both the st. john’s hospital group and for medieval england generally (fig.  7; price 2013). this result suggests that his diet contained a significant proportion of animal protein and/or fish, particularly in the last decade or two of life, the interval presumably represented by the analyzed rib sample. food in medieval england was strongly related to social class, with poorer people subsisting largely on bread, ale, and vegetable pottage. inmates of st. john’s hospital were supposed to receive meat several days a week, and fish at least once a week (rubin 1987). however, f958’s carbon and nitrogen isotope values relative to those of the rest of the hospital skeletal sample suggest perhaps that he had not spent many years within the hospital, but in settings with more privileged access to food. • he displays 12 schmorl’s nodes in thoracic and lumbar vertebrae; these lesions indicate places where bone has resorbed around a herniated intervertebral disk. schmorl’s nodes are common, both in the st. john’s hospital sample and generally in premodern populations. if they do not impinge upon a joint surface or nerve, they do not necessarily indicate any clinical symptoms such as pain or limitation of activity (faccia and williams 2008). unlike osteoarthritis, schmorl’s nodes are often found in younger as well as older adults. however, manifesting them in almost every vertebra in the central and lower back suggests significant accumulated functional stress, perhaps related to work activity. robb et al. 25 figure 8. feature 958’s feet (plantar view); note extensions to the heads of most metatarsals, and flattened facets on the heads of proximal phalanges (photo by sarah inskip). • f958’s bones show entheseal markings typical of a male of advanced age in this group, suggesting that he was physically active without impairment from any longterm chronic illness. the most distinct evidence of activity in his skeleton consists of modifications to his feet (fig. 8). these alterations involve inferior extensions to the distal articular surfaces of almost all metatarsals, reflecting a habitual posture in which the toes were strongly flexed beneath the feet. at the same time, the proximal phalanges display flattened facets on their distal articular surfaces, suggesting that the toes were extended under pressure. the modifications are bilateral. the ankles and hips show no sign of socalled “kneeling facets,” “squatting facets,” or hyperflexion at the hips. this posture is unusual and would not result from habitual kneeling or from riding with the feet held in stirrups, for example. while we do not know what activity would involve this position, it was sustained enough to result in skeletal modifications in a pattern distinct from others in the sample. this observation suggests that f958 may have been a specialized worker of some sort rather than a general laborer. • he suffered from ongoing dental disease, with periodontal disease, five posterior teeth lost before death, and two abscesses. this dental pathology is typical for someone his age in medieval cambridge, and dental problems would have been recognized as part of the normal life course, particularly in older people. no effective therapy was available other than removing the offending tooth. dental disease would not have limited his ability to eat a varied diet, as he would simply have shifted chewing forward to his surviving molars, premolars, and anterior teeth. dental wear on his remaining teeth is very even. however, with untreated dental problems of all kinds, he would certainly have experienced sometimes prolonged episodes of perhaps severe pain. • he suffered two minor traumatic injuries in his lifetime, both of which healed completely without any apparent skeletal complications: a fractured left rib, and a small depressed fracture in the posterior area of his left parietal. both could plausibly have resulted either from accidental causes or violence. traumas from both lesion types were more common in medieval males than females (grauer and miller 2017). both would have caused pain and tenderness for some time but could have healed without medical intervention and without changing his appearance noticeably. • f958’s metatarsals exhibit characteristic lesions of incipient gout, in the form of very small erosive lesions on the medial sides of both mt1 heads. gout was relatively common in medieval cambridge, including in the st.  john’s hospital sample, with multiple individuals showing pathognomic signs of the condition. it may have been caused by a combination of diet, exposure to lead, and genetic background. gout was recognized by medieval people. this condition may have led to episodes of pain, particularly in the feet, and limited mobility. • f958’s leg bones (both femora and tibiae, on both sides) exhibit extensive, fine, active periosteal bone deposition on their midshafts. this pathology is nonspecific. while it seems likely that it originated in some systemic infection, no differential diagnosis is possible. however, it does suggest that he suffered from chronic, lowlevel illness of some kind. its experiential symptoms are unknown. a common feature of conventional biographies is providing images of the biographee to transform him or her from a textual individual to a visual one whom the reader can imagine as a person. being able to provide such an image is a major asset to biographical materials. f958’s skeleton provides us with the necessary material. his facial features were distinguished by a relatively gracile brow but a strong, markedly flared jawline (fig. 6). a facial reconstruction using standard forensic methods (wilkinson 2004), and with a choice of beard and hair aimed at the middle of the range of possibilities, reveals an unremarkable, pleasant, masculine face (fig. 9). going further, how does such an image relate to f958’s everyday appearance? particularly for subjects before recent centuries, almost all available biographical images are formal portraits, normally posed and in full regalia, often made quite late in life. they were not intended to present someone’s osteobiography as bottom-line history26 figure 9. facial reconstruction of feature 958 (image: chris rynn, university of dundee). figure 10. reconstruction of feature 958 in life, some decades prior to his death (picture by mark gridley). appearance in ordinary life and activity, and they normally seem quite distant from it. much the same is true for an expressionless, decontextualized, formal forensic reconstruction. figure 10 presents a complementary approach. as with all forms of biographical interpretation, it helps us think about specific dimensions of the subject’s life. rather than focusing on highlighting individuating physical details (other than a hint of a prominent gonial angle), it focuses upon motion, activity, and social context (the streets of cambridge, some specialized manual work placing stress on the back, a basket potentially of foodstuffs) and is set some time before decline and death. although the hospital of st. john may have housed a few paying inmates (corrodians), and a few non inmates may have been buried in its cemetery, the overwhelming probability is that f958 was an inmate of the hospital. how might he have ended up there? the hospital housed a heterogeneous population, including a mixture of young, chronically ill people and older people who presumably needed shelter due to a combination of age, infirmity, and lack of family support. it may also have contained a few aged and indigent scholars. we have built a picture of f958 as a robust, physically active person who formerly may have pursued a specialized manual craft or trade, and most of his health problems were common in older age. general indicators of decrepitude— particularly tooth loss, back problems evidenced in stooping, and disability— were recognized as signs of advancing age, for instance in visual characterizations of the later “ages of man” (gilchrist 2012). it is possible that he became an inmate of the hospital because of agerelated inability to work, lack of family networks, and the resulting indigence rather than because of any specific medical problem. there is no indication of what caused f958’s death. he lacks any sign of lethal trauma or of tuberculosis or leprosy; preliminary screening has not revealed any pathogen adna. the burial is peculiar in two ways: the grave cut is unusually deep (0.84 m, in contrast to an average of 0.4– 0.6 m). contrary to almost universal practice in medieval england, the body was deposited face down. prone burials are rare, but about a dozen cases are known in medieval england and scotland (gilchrist and sloane 2005:153– 154). there is no consensus about what they may connote, with hypotheses ranging from premature burial of someone still alive to postmortem disturbance or response to an unusual body. it has been suggested that prone burial may represent a penitential gesture. the only evidence of this practice is an account from twelfthcentury france describing a royal burial three centuries earlier, so how widespread a practice this was in thirteenth century england is hard to assess. the most likely robb et al. 27 interpretation here seems “casual or hurried burial” (gilchrist and sloane 2005:154), perhaps related to depositing a body completely wrapped in a shroud within a deep grave. this osteobiography already provides quite a full and varied set of “life records” using these facts to construct a life narrative involves a delicate balance of probability and generalization. some likely inferences include: • what f958 probably looked like. • that he suffered periods of pain from chronic conditions such as dental disease in a world without much effective anesthesia. • that 958 was likely a manual worker rather than a cleric based on the functional stress found in his spine. most clerics who also worked manually (e.g., some monks and friars) had their own institutional burial grounds elsewhere in cambridge. • f958 probably habitually performed some unusual, repetitive gesture or posture, perhaps with functional stress, based on the idiosyncratic functional modifications of his toes. thus, he may have had a craft or trade rather than being a generalized laborer performing the same range of activities that others did. • as a chosen recipient of generous institutional charity in a sea of the urban needy, he must have been seen as deserving and conventionally religious. (this selection, incidentally, gives us some guarantee that his sex and the gender ascribed to him coincided conventionally; it is unlikely that a charitable religious institution would have admitted someone not conforming to gender norms.) bringing these pieces together suggests more complex scenarios. for example, given that the basic way of supporting the old and infirm was within family networks, was f958 the last of his family? given that his isotope values do not converge with those of his fellows, did he live in the hospital for only a few years at most? he appears to have eaten a diet rich in meat or fish in a period during which poor people largely subsisted upon bread, ale, vegetables, and a few dairy products. yet he was buried in a charitable institution that housed people unable to care for themselves. he, thus, appears either to have been eating above his station, or was buried below it. possible backstories for this situation might include the following: • he was previously more prosperous but had come down in the world (illustrating the vicissitudes of “fortune’s wheel,” in medieval parlance). • he previously worked at some manual trade involving access to richerthannormal food (a merchant selling provisions, a butcher, a fisherman). • his need for shelter was not based upon poverty but on other factors such as general decrepitude and a lack of family. in the hyperprecise world of sherlock holmes, in which individuals always substantiate the obvious generalities, every retired sailor conveniently has an anchor tattooed on his arm, and all facts are tightly connected to a single plot, we might imagine f958 as a retired, formerly prosperous fisherman, butcher, or food merchant, a man of conventional and pious disposition, who has become unable to work through age and infirmity and who suffered family losses that left him on his own. thus, he was taken into a poorhouse. but our evidence does not exclude many alternative, if less probable, scenarios, for instance, that he was a lay servant of the hospital who ate at the staff table but was buried in the common cemetery. or he could have been a neighbor who bought his way into the hospital either while living, as a corrodian, or after death through a donation in return for burial there, like robert curteis. in both osteobiography and biography, part of the art is knowing when to stop. the key point, however, is not whether we can reconstruct his biography in every detail; rather, it is understanding what kinds of insights osteobiography affords. unlike the ideal textual biography, we do not have name, precise dates, correlation with historic events, or relatedness to specific other people. but we do have some idea of appearance, diet, the experience of health and illness, habitual activity, social treatment at death, and above all some possible life trajectories— all dimensions of life for which textual biography is normally silent as the grave. discussion: biography, selfknowledge, and bias by now, the takehome message should be obvious. while we are predisposed to regard textual individuals as “real” biographies, the gold standard to which other forms of biography should aspire, this goal really misrepresents the situation. reading the two biographies above, whom do you feel you know more about, robert curteis or f958? clearly, the situation will vary according to the historical context and the available sources. using the two biographies presented here as an example, we might summarize the information available for ordinary medieval people as in table 2. it is obvious that, as with all technologies for scanning and representing people, each method highlights different aspects of an individual’s life; there is no single master method to which others serve merely as handmaidens or substitutes. osteobiography as bottom-line history28 there are important sectors of human life that are far more accessible through skeletal studies than through textual studies, particularly if we want to understand someone’s individuality rather than simply filling in historical generalizations (cf. fleming 2006). comparing the two forms of biography makes an important metapoint about the nature of biography. while a naive view might consider textual biography an arraying of known facts and dates, and osteobiography an interpretive exercise, both are fundamentally interpretive. for traditional textual biographies, this situation is immediately clear not only from comparing competing fulllength biographies of public or literary figures but also from how obituaries or entries in biographical dictionaries select which facts to present and how to marshal them to create a headline or story line. the interpretive element in osteobiography is more obvious at first sight, as the genre implicitly or explicitly is expected to supply elements defined by textual biographies, such as names, faces, occupations, and causes of death. (conversely, and perhaps unfairly, no one considers a textual biography incomplete if it does not report the number of childhood stress episodes as well as the subject’s relationship with her parents, her isotopic values as well as her favorite foods, or her genetic relationships as well as her name!) the point is that neither one is a definitive, universal description of a human life; both are selective interpretive techniques with strengths in highlighting specific aspects of life. it thus follows that there is no single cookbook set of rules; how to interpret a life is relative to why you are doing it. naming a skeleton provides an example. should we have given f958 a name? as discussed above (hosek and robb, this issue), naming humanizes a skeleton and makes it easier to relate to, which is valuable for both public and professionals. however, it also makes a concrete knowledge claim about the skeleton; it can represent a conscious choice about making it familiar or alien; and, as in cases such as “ötzi,” the name can take on a life of its own almost as a quasireal person to whom the skeleton becomes appended. in some cases, naming a skeleton may be table 2. sources of information on an ordinary person in medieval england. textual biography osteobiography name a very small number (some betteroff male heads of households, and a few other people) unavailable without textual aid historical dates (birth, death, etc.) rarely known; sometimes inferable for historically mentioned people to within a generation or so available for dated or archaeologically phased skeletons but usually with a margin of error of one to two generations age rarely known; inferable for historically mentioned people to within ca. 20– 30 years knowable to within 10– 20 years error for adults, more precise for younger individuals gender when somebody is historically attested, gender is generally clear skeletal sex is often available, genetic sex increasingly so, and social gender can often be inferred individual appearance rarely known reconstruction of face and body form sometimes possible religious sentiment rarely known, except through textually attested pious donations rarely known, except through variant burial practices personality rarely known rarely known economic status when somebody is historically attested, approximate economic status may be inferred from tax or property transactions may be inferred approximately from place and manner of burial, and from evidence of food consumption legal status (e.g., serf, free) can sometimes be inferred from legal or financial transactions rarely known activity regime rarely known, except by generalization from job titles specific occupations rarely known, but level of work and idiosyncratic activity patterns may be visible diet, food consumption rarely known some aspects accessible from skeletal and isotopic evidence health experiences rarely known some aspects accessible in some detail from palaeopathology and pathogen adna life risks, contingencies rarely known, except where inferable from legal transactions sometimes inferable from conjunction of disease, trauma, consumption, etc., measured at different points in the lifespan relatedness rarely known, except when legal documents or surnames give clues to parentage or siblinghood rarely known, except if place in general population structure may be reconstructable (adna) mobility rarely known, except when firstgeneration surnames include placenames may be reconstructable through isotopic analysis and/or adna cause of death rarely known, except for unusual cases mentioned in law, medicine, or chronicles rarely, except for severe diseases or traumatic injury leaving skeletal signs robb et al. 29 justified and productive. here, as we undertook this osteobiography as an academic form of exploration to test the limits of the method in generating knowledge, we thought it would prove an impediment. finally, osteobiography offers three specific and valuable advantages that make it a compelling form of biography. one concerns methodology and intersectionality. textual and skeletal biographies are methodologically and epistemologically very similar. each starts with proxy evidence (e.g., isotopic data as a proxy for nutritional status, a tax register as a proxy for household income); each requires a good deal of sifting and construction to build the ensemble of proxies into a life narrative; and each involves constantly tacking back and forth between the specific case and generalities, using generalities to draw out implications but with the risk of normalizing the data and missing individuality. for example, if we know that a given textual or skeletal individual was male, we can infer a great deal about his social identity and activity, but only to the extent that he conformed to conventional norms about maleness. the resulting picture can be complex but always contains an element of probabilistic infilling. generally, in biography, isolated facts lead us to types, and it is the relationship between facts that leads us to nuance these types, depart from them, or develop complex narratives. a major strength of osteobiography is its ability to incorporate multiple strands of evidence to support such narratives. understanding that somebody is both male and upper class tells us far more than each fact does on its own; if you add the fact that he lived to old age, or moved geographically during his lifetime, or plied a specialized trade, it prompts us to develop relations between these facts, to construct a life narrative. this process may be a form of intersectionality, of seeing somebody’s life as structured not by a single dimension but by a conjunction of many dimensions and circumstances. it is obvious that the broader the range of potential information, the more complex or nuanced a portrait may emerge. the textual record tends to give us information on a narrow range of wavelengths, and it is hard to expand beyond what is present on the page. the skeletal record affords a much wider range of potential information, and it is easier to associate different kinds of information. moreover, while (for many areas of history) the textual record tends to be static and closed, the range of information available from skeletal sources is constantly expanding as new methods are developed. for most people in most times, osteobiography affords the basis for more complex and nuanced lives. osteobiography’s second advantage concerns experience and selfunderstanding. osteobiography is not the administrative history of someone being taxed, conscripted, or legally cited by an external authority; it is the history of the body and its experience. humans understand themselves through their bodies. one dimension is selfimage, for example via stature and facial appearance. another is health status, one’s understanding of one’s own body as well or ill, and as well or ill in particular ways (e.g., as subject to common or universal maladies, or as afflicted by unusual or inexplicable conditions). age is also salient. in most premodern societies, what counts is the social age of the body, not chronometric age (cf. sofaer 2011). whether or not most ordinary medieval people had a precise notion of their own age in years, age was typically measured in terms of physical characteristics and capability (gilchrist 2012). age was understood through collectively remembered historical landmarks, social stages such as marriage, and the evidence of people’s own bodies: menstruation, fertility, strength, gray hair, aching joints, and lost teeth en route to finishing up (in shakespeare’s words [as you like it, act ii, scene 7], building upon the medieval trope of the “ages of man”) “sans teeth, sans eyes, sans taste, sans everything.” writing a person’s history through his or her body, rather than through random textual citations, thus gets us much closer to that person’s selfunderstanding; it is history from the inside. finally, osteobiography allows a more democratic history. almost without exception, the textual record is systematically biased toward the more affluent. moreover, it is overwhelmingly male, leaving women less historically visible. it holds other biases too, such as often excluding children, marginalized people, and excluded minorities. the “people without history” (wolf 1982) thus include not only colonized peoples but different or subaltern people of all kinds. the skeletal record certainly is not without bias, starting first and foremost with the question of who is buried within or excluded from a particular site, and moving on to differential visibility of sites, preservation, and excavation. but, by and large, the criteria for osteobiography are less biased and more likely to give a true cross section of human experience; we are far more likely to encounter a woman, a child, or a poor person in the grave than on the page. f958 is an ordinary person; such people, who made up the overwhelming mass of medieval people, offer very little material for the textual biographer to examine, when they can be seen at all. osteobiography affords history for those below the textual threshold. for everyman, and above all for everywoman, whether rural peasants or the urban poor, osteobiography offers allows us to see women, children, and marginalized or excluded people. this makes osteobiography especially valuable for feminist, marxist, and “people’s history” (zinn 1980). it is osteobiography as bottom-line history30 our best chance for understanding the lives of the vast bulk of humanity in the vast majority of the past. acknowledgments we are grateful to many colleagues who have helped in this research. natasha dodwell (cambridge archaeological unit, now of oxford archaeology east) conducted the preliminary assessment of the st.  john’s collection. craig alexander contributed to the bayesian calibration of radiocarbon dates. chris rynn (university of dundee centre for anatomy and human identification) created a facial reconstruction of 958 (fig. 9). mark gridley, archaeological illustrator par excellence, created figure 10. we thank st. john’s college, cambridge, for access to college archives and for permission to publish figure  3. we are grateful to st. john’s college, the mcdonald institute for archaeological research, and the wellcome foundation (collaborative grant 200368/z/15/z “after the plague: health and history in medieval cambridge”) for financial support, and to the mcdonald institute and the cambridge archaeological unit for support of many kinds. finally, we are grateful to three anonymous reviewers whose comments helped to improve the manuscript. references cited arts, nico. 2003. marcus of eindhoven: an archaeological biography of a medieval child. matrijs, utrecht. baker, brenda j., claire e. terhune, and amy papalexandrou. 2012. sew long? the osteobiography of a woman from medieval polis, cyprus. in the bioarchaeology of individuals, edited by ann l. w. stodder and ann m. palkovich. university press of florida, gainesville, pp. 151– 161. bates, david, julia crick, and sarah hamilton. 2006. writing medieval lives: essays in honour of frank barlow. boydell & brewer, woodbridge. bennett, henry s. 1955. six medieval men and women. cambridge university press, cambridge. brooks, sheilagh thompson, and judy myers suchey. 1990. age determination based on the os pubis: a comparison of the acsadinemeskeri and sucheybrooks methods. human evolution 5(3):227– 238. doi: 10 . 1007 / bf02437238. brothwell donald. 1981. digging up bones: the excavation, treatment and study of human skeletal remains. cornell university press, ithaca, ny. bryan, peter. 1999. cambridge: the shaping of the city. privately published, cambridge buckberry, jo, and andrew chamberlain. 2002. age estimation from the auricular surface of the ilium: a revised method. american journal of physical anthropology 119(3):231– 239. doi: 10 . 1002 / ajpa . 10130. buckley, richard, mathew morris, jo appleby, turi king, deirdre o’sullivan, and lin foxhall. 2013. ‘the king in the car park’: new light on the death and burial of richard iii in the grey friars church, leicester, in 1485. antiquity 87(336):519– 38. doi: 10 . 1017 / s0003598x00049103. buikstra, jane e., and douglas h. ubelaker. 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main st, bishop wilton, york yo42 1sr, uk coxford brookes university, school of history, philosophy and culture, faculty of humanities and social sciences, tonge building, oxford ox3 0bp, uk ddepartment of archaeology, university of york, kings manor and principals house, university of york, exhibition square, york yo1 7ep *correspondence to: rebecca gowland, department of archaeology, durham university, south road, durham dh1 3le, uk email: rebecca .gowland@dur .ac .uk abstract during the eighteenth and nineteenth centuries, england underwent a period of rapid urbanization and industrialization. the detrimental effects of urban living conditions and child factory labor on the health of children during this time has been the subject of considerable debate and investigation by historians. it is generally understood that growing up in a rural environment was more conducive to healthy growth and development than within an industrial town. this study presents the first direct comparison of the bio archae ol o gi cal evidence for nonadult health from contemporaneous urban and rural sites from the north of england. rural skeletal assemblages from this period are rare, and most published studies are biased toward urban sites in the south of the country. contrary to expectations, results revealed equal prevalence rates of metabolic and dental disease at both sites, but skeletons from the rural site had greater evidence of growth disruption and respiratory disease. evidence for specific infectious disease and medical care in response to trauma were also identified. our interpretations of rural/urban health during this period must take into account the dire consequences of social inequalities and economic migration. there is a tendency for the latter to be characterized as unidirectional— from country to town— without due consideration of rural industry and child migrant workers. keywords: child labor; growth; metabolic disease resumen durante los siglos xviii y xix inglaterra experimentó un período acelerado de urbanización e industrialización. los efectos perjudiciales de las condiciones de vida urbana y del trabajo infantil obrero en la salud de los niños durante este período han sido objeto de considerables debates e investigación por parte de los historiadores. en general, se entiende que el crecer en un ambiente rural era más propicio para un crecimiento y desarrollo saludables, en comparación con el ambiente al interior de las ciudades industrializadas. este estudio presenta la primera comparación directa de la evidencia bioarqueológica respecto a la salud de individuos noadultos provenientes de sitios urbanos y rurales contemporáneos del norte de inglaterra. las colecciones de restos óseos rurales de este período son escasas, y la mayoría de los estudios publicados están sesgados hacia los sitios urbanos del sur del país. contrario a las expectativas, los resultados revelaron tasas de prevalencia similares en received 10 december 2017 revised 22 february 2018 accepted 03 march 2018 gowland et al. 45 the eighteenth and nineteenth centuries in britain were a period of rapid urbanization and industrialization; from a.d. 1801 to 1901 the proportion of people living in towns increased from onefifth to fourfifths (wohl 1983). by the midnineteenth century almost half of the total population of england was under 20 years of age: “england was awash with children” (humphries 2013:115). traditionally, children from poorer families will always have had to work, either within the domestic context or as apprentices and laborers. what changed with the industrial revolution was the nature of that work, with a dramatic increase in nondomestic labor by women and children (goose and honeyman 2013:4). children of the urban poor in the eighteenth and nineteenth centuries have long been conceptualized as the passive, exploited victims of an insatiable industrial machine, whose wants and needs were overlooked by a laissezfaire society focussed on economy and empire (gowland 2015b). in a speech to the house of lords in 1873, lord shaftesbury famously described children leaving the factory gates during the earlier part of the nineteenth century as “a set of sad, dejected, cadaverous creatures. . . . [t]he sight was most piteous, the deformities incredible. they seemed to me, such were their crooked shapes, like a mass of crooked alphabets” (pinchbeck and hewitt 1973:403). this account is borne out by numerous other descriptions of workingclass urban children at this time (e.g., engels 1950; gaskell 1833). by contrast, the rural environment during this period was conceptualized as much healthier for children, offering fresh, unpolluted air, plenty of sunshine, a more varied diet, less overcrowding, and better sanitation. as gaskell (1833:200) observed: “a child from an agricultural district, eight or nine years old, blooming with rosy health, full of vitality, is transported to a crowded town . . . it is exposed to miasmatic evaporations, shut up in a narrow street, its home is damp and cold, its food poor and badly cooked: in a few months, from the force of these circumstances, the hebelooking child has become pallid.” these sentiments were echoed by the nineteenth century physician francis sharp (in the reports from the commissioners on conditions in factories, 1833, vol xxi, parliamentary papers, pp. 12), who moved from a rural practice near scarborough, north yorkshire, to work in the city of leeds: “the general appearance of the children in leeds immediately struck me as much more pallid, and also the firmness of the fibre as much inferior to what i had seen in scarborough and the adjacent country. . . . if it were not for the individuals who join the mills from the country the factory people would soon be deteriorated.” there was a general anxiety that urban childhoods, particularly when spent undertaking factory labor, would result in the eventual physiological deterioration of the nation. these concerns sparked a number of inquiries into the health of urban and factory children, and a vast amount of qualitative and anthropom etric data was commissioned from across the country. the results of these endeavors indicated that rural children were, as suspected, on average 3 cm taller than their urban counterparts (kirby 2013). it was concluded, however, that factory labor per se was not responsible for the “stinted” growth and low life expectancy, but rather insalubrious urban conditions more generally, combined with the perceived lowly habits and morality of the poor (chadwick 1842). there are numerous descriptions of the filthy, overcrowded, unsanitary, polluted living conditions in many of the poorer slum areas. socalled backto back housing in cities such as bradford and leeds also allowed very little natural light into the rooms, and this combined with severe air pollution meant that exposure to sunshine, vital for proper mineralization of the bones and immune function in growing children, was limited (brimblecombe 1978; hudson 1992). however, some contemporary accounts of rural life also point to inadequate and overcrowded houses, as well as polluted water supplies spreading diseases such as typhus (wilkes 2011). the nineteenthcentury epidemiologist william farr felt that there was an often “fanatical” fixation on the declining conditions of urban centers, stating that “epidemics desolated the country as well as towns, though to less extent” (quoted in young and handcock 1956:771). rural populations ambos sitios en cuanto a desórdenes metabólicos y enfermedades dentales, pero los esqueletos del sitio rural presentaron mayor evidencia de alteraciones del crecimiento, y enfermedades respiratorias. también se encontró evidencia de enfermedades infecciosas específicas y tratamiento médico como respuesta a traumas. nuestras interpretaciones de la salud rural/urbana durante este período deben tener en cuenta las nefastas consecuencias de las desigualdades sociales y la migración económica. existe una tendencia a caracterizar esta última de manera unidireccional— del campo a la ciudad— sin la debida consideración de la industria rural y de los niños trabajadores migrantes. childhood health in the industrial revolution46 were also highly susceptible to periods of food shortages and crop failures, and a series of poor harvests could result in poverty and famine (bogin 1999). alfred ireson, who was born in 1856, described rural life during this period as “a time of trial and difficulty. the agricultural workers had long hours, they pay barely enough to keep body and soul together. the condition of the children in many cases was pitiable. rough food and clothes; everything depended on the skill and character of the mother” (quoted in burnett 1984:83). while protective measures regarding child labor in factories were instigated, those working within agriculture and rural cottage industries were overlooked until the education act of 1876, which decreed that children under 10 years of age could no longer be employed in agricultural work (burnett 1984; pinchbeck and hewitt 1973). the vast majority of research concerning childhood health during this period is derived from historical data and records (kirby 2013). while these are extremely valuable, some of the qualitative reports depict partisan viewpoints and political polemics rather than objective observation (e.g., engels 1950). recent excavations of cemeteries from the eighteenth and nineteenth centuries have highlighted the important contribution of bio archae ol o gi cal evidence for examining the direct physiological impact of these environments on children living at the time (e.g., brickley and miles 1999; dewitte et al. 2015; geber 2016; lewis 2002; mays et al. 2009; newman and gowland 2016; pinhasi et al. 2006). childhood growth and morbidity are multidimensional in etiology but are widely documented as being a sensitive indicator of the socioeconomic environment (lewis 2007). because so few rural sites dating to this period have been excavated, recent bio archae ol o gi cal analyses have been strongly biased toward urban population samples. mays et al. (2008) provide a valuable comparison of urban birmingham with rural wharram percy, but the latter site was in use for a millennium and predominantly medieval, thus lacking chronological resolution. this is important, because rural lifeways were not static and unchanging across the last millennium; rural industry also developed apace during the late eighteenth and early nineteenth centuries. the aim of this study was to compare and contrast rural and urban skeletal evidence for the health and mortality of children from two sites in the north of england in order to assess the historically accepted idea that rural environments were more conducive to better childhood health. this research provides a rare insight into a rural postmedieval assemblage (now reburied) and thus also serves to enrich the existing corpus of bio archae ol o gi cal knowledge for this period, which has so far been largely confined to urban sites. this analysis of sites from the north of england also provides an important comparative data set given the current bias toward sites from the south and midlands. the bioarchae ol o gi cal data will be integrated with existing historical evidence to obtain a richer understanding of living and working conditions in both environments. materials skeletal remains were analyzed from the rural churchyard of st michael and st lawrence, fewston, north yorkshire, and from the urban site of coach lane, north shields, tyneside (fig. 1). fewston, north yorkshire fewston is a small village located in the washburn valley, near harrogate in north yorkshire. the skeletal assemblage was excavated from the parish churchyard in advance of building work by jb archaeology in 2009 and 2010 (buglass 2009; caffell and holst 2017) and was reburied in september 2016. this assemblage is exceptional for several reasons: 1. it is one of only a few predominantly post medieval rural skeletal collections. 2. twentyone of the excavated individuals were confidently identified based on coffin plates and grave monuments. 3. the diaries of john dickinson, a latenineteenth century resident of the adjacent village of greater timble, provide important historical insights into everyday life in the washburn valley. the diaries also refer to a number of the identified individuals within the skeletal assemblage, thus providing unique personal insights. the church of st michael and st lawrence in fewston was rebuilt in a.d. 1697, most of the medieval church having been destroyed in a fire the preceding year (alred 1997:67). the graveyard would have been in use from at least the fourteenth century, and some of the excavated skeletons could date to the medieval period. only a relatively small area (approximately 300 m2), however, was subject to excavation, and coffin plates and headstones indicated that the better surviving burials in this location were predominantly of nineteenthcentury date. the cemetery closed in 1896, although two individuals who died in the early twentieth century did gain permission to be buried there. a total of 154 individuals were excavated, including 50 nonadults, a category defined here as less than 20  years of age. the more usual cutoff age for nonadults in bio archae ol o gi cal studies is either 17 or gowland et al. 47 18 years; however, this was extended for the purposes of this study in recognition that adversity in early life (as evident in many of the skeletons within this sample) is known to cause delays in the chronological age of attainment of skeletal maturation. in the absence of a more reliable age from dental development, therefore, some of the individuals within the sample may have been slightly older than the age that their epiphyseal union suggested. the use of the term nonadult in this context does not, of course, reflect nineteenthcentury social norms regarding the chronological age of attainment of adult status, but denotes the skeletal age only. parish records indicate that the social status of those buried within the cemetery was mixed, including welloff landowners as well as those of lower status, such as laborers. agriculture was the predominant occupation in fewston during this period, but from the late eighteenth century there was also a textile industry, with westhouse mill established at nearby blubberhouses in 1791 (alred 1997:30– 31). coach lane, north shields coach lane was a former society of friends burial ground (c. 1711– 1857) located in north shields, just east of newcastleupontyne. north shields in the late eighteenth and early nineteenth centuries was a heavily populated shipping, fishing, and coalmining community, undergoing rapid development (proctor et al. 2016). the town was heavily industrialized, and in a government report the environmental conditions were considered derisory, with narrow streets described as “more justly compared to wells filled with noxious figure 1. the location of the fewston and coach lane, north shields sites. childhood health in the industrial revolution48 emanations” (second report of the commissioners 1845:19). numerous epidemics, including cholera, occurred during this period, and air and water pollution from the various industries was extensive (proctor et al. 2016). the social status of those buried at the coach lane cemetery was mixed, with quakerism attracting those from different spheres of life. the burial records occasionally document the profession of the deceased, and these included “junior painter,” “grocer,” “shopkeeper,” “master mariner,” and “linen weaver.” there were many prominent, highstatus quakers within the northeast during this period, some of whom were buried at coach lane, along with servants (proctor et al. 2016). the effects of a heavily polluted environment, however, would have been detrimental to all social classes (gowland and newman 2018). there is direct evidence that at least some of the children buried at the site had been engaged in factory labor, with the skeleton of one individual (aged 12– 14 years) possibly exhibiting the notorious occupational condition “phossy jaw”— osteonecrosis of the mandible typically caused by exposure to phosphorus during matchmaking (roberts et  al. 2016). in contrast to fewston, the coach lane cemetery was excavated in its entirety (procter et  al. 2016) and consisted of 236 individuals, 81 of whom were nonadults (under 20 years of age). methods age at death of the nonadults was estimated using dental development and eruption, long bone growth, and epiphyseal fusion (see table 1 for details). following convention, dental age was considered more representative of the chronological age of the child, as tooth development is less affected by environmental adversity than skeletal development (elamin and liversidge 2013; saunders 2008— although see discussion section below). when dental age could not be established due to missing teeth, age was instead estimated from epiphyseal fusion and metric analysis. long bone diaphyseal lengths were measured and compared to age at death estimated from dental age as well as maresh’s (1955) knownage long bone reference data. skeletal growth profiles were constructed from diaphyseal lengths of the major long bones using the midpoint of the dental age range, whereby an individual with a dental age estimate falling between 0.5 to 1.5  years would be categorized as 1 year. this follows the practice of previous growth studies (see mays et al. 2008). these age categories act as a proxy for known age, and it is not intended that the age midpoint should be taken as a genuine reflection of the precise chronological age. recent methods to detect growth disruption were applied, including measurements of vertebral body heights (newman and gowland 2015), and the left femur was selected for cortical thickness (ct) measurements (substituted with the right side when necessary) (mays et al. 2009). radiographs were taken using a mpx 10 portable radiography unit set at 70kvp, 0.500 mas and with a carestream pointofcare digital cr reader. measurements of the total bone width (t) and the medullary width (m) were taken from the midshaft of the femur (mays et al. 2009). cortical thickness was determined as t – m, and plotted against the dental age (see newman and gowland 2016). finally, skeletal indicators of puberty were recorded following shapland and lewis (2013, 2014). the pathological lesions recorded include rickets (vitamin d deficiency), scurvy (vitamin c deficiency), cribra orbitalia, dental enamel hypoplasia, dental caries, nonspecific periosteal reactions on the major long bones, endocranial and ectocranial lesions, maxillary sinusitis, rib lesions and evidence for tuberculosis (table  1). rickets was diagnosed through the presence of bowed long bones, flared and/or porous metaphyses and sternal rib ends, and the presence of medial tilting of the distal tibia, while coxa vara and flattening deformities in the proximal femur were also considered (brickley and ives 2008; mays et al. 2006; ortner and mays 1998). scurvy was diagnosed through the presence of woven bone in the orbits, porosity on the mandible and/or maxilla (especially focused on the internal ramus and coronoid process of the mandible, and around the infraorbital foramen of the table 1. methods of analysis used in this study. method references age at death dental development moorrees et al. 1963a, 1963b; smith 1991 long bone growth maresh 1955; scheuer and black 2000 epiphyseal fusion scheuer and black 2000 growth cortical thickness mays et al. 2009 vertebral body height newman and gowland 2015 pathologies metabolic disease brickley and ives 2006, 2008; mays et al. 2006; ortner 2003; ortner and mays 1998; stark 2014 cribra orbitalia stuartmacadam 1991 dental enamel defects hillson 1996; ogden 2008; ogden et al. 2007 new bone formation ortner 2003; roberts and connell 2004; lewis 2007 gowland et al. 49 maxilla), porosity on the greater wing of the sphenoid, and porosity in the supraspinous fossa of the scapula (ortner 2003; stark 2014). the pathological lesions associated with metabolic disease may be very subtle (brickley and ives 2008), and this is confounded further by the porous appearance of the rapidly growing bones of infants and children. all pathologies were therefore recorded by two bioarchaeologists working side by side (caffell and gowland), and the results were compared with those of an observer working independently (newman). rickets and scurvy were diagnosed as present only when both sets of independent observations were positive. if one independent observer identified indicators of rickets or scurvy but the other did not, then these skeletons were reexamined and agreement reached. due to the multiple skeletal elements that can display signs of vitamin c or vitamin d deficiency, only crude prevalence rates (per individual) for these pathologies were calculated; however, individuals for whom the diagnostic skeletal elements were absent were excluded from the prevalence calculations. all long bones were examined for the presence of nonspecific periosteal new bone growth in the form of woven bone, lamellar bone, and/or abnormal porosity. likewise, the endocranial and ectocranial surfaces and maxillary sinuses were examined for new bone formation (woven and/or lamellar) and porosity. all deciduous and permanent teeth (including unerupted but observable tooth crowns) were examined for defects in enamel formation (lines, grooves or pits), and the prevalence rates for dental enamel defects were expressed as a percentage of all of the teeth present (including observable unerupted teeth). cribra orbitalia was recorded using the stuartmacadam (1991) system, but only presence or absence is reported here, and results are provided as true prevalence rates (percentage of preserved orbits affected). the minimum number of ribs present on the left and right side for each individual was counted, as was the minimum number of ribs showing new bone formation (woven or lamellar). the number of unsided rib fragments was counted, along with those exhibiting pathological lesions. crude prevalence rates were calculated for the minimum number of ribs affected as a proportion of the minimum number of ribs present. results age at death the age distribution of the nonadults from coach lane follows the pattern frequently observed at archaeological cemetery sites, with a high proportion of deaths in those under 6 years of age and relatively few deaths during adolescence (fig. 2). by contrast, fewston presents a more unusual nonadult age distribution, with higher numbers of adolescent deaths. only two individuals at fewston were less than 1 year of age, one of whom was a named individual. the lack of infants is likely to have resulted from the common practice of spatial segregation of this age group within cemeteries and the fact that only a relatively small area was excavated. the difference in age structure between the two sites with respect to the excess of adolescents at fewston is important to consider. is this unusual age profile simply an artifact of the incomplete excavation of fewston, or could it reflect genuine differences figure 2. the ageatdeath distribution of the nonadults from fewston and coach lane. childhood health in the industrial revolution50 in agestructure and mortality risks between the sites? if the latter, then what was the driving force behind this? we hypothesize that this difference reflects genuine mortality risks in this section of the cemetery, which is dominated by nineteenthcentury burials, and that it is driven by the migration of adolescents from poor urban areas seeking employment in rural industry. this will be explored further with reference to the results for the pathological lesions below. comparison of the various pathologies between the two sites will also explicitly consider the different ageatdeath profiles when inferring aspects of the lived experiences of these children. growth diaphyseal lengths, when plotted against dental age, were similar between fewston and coach lane; unfortunately, relatively few measurements were possible from the former site due to poorer preservation (fig. 3). these values aligned with maresh’s (1955) data up until approximately 10 years of age, after which most adolescents drop below the modern values. this could relate to the relatively delayed pubertal growth spurt in these individuals compared to modern children (fig. 4). in keeping with the findings of mays et al. (2009), cortical thickness appears to be a more sensitive indicator of adversity and was compromised in children from both sites. growth retardation was observed particularly in children older than 4 years of age (fig. 3). while only small numbers of femora were available for measurement from fewston, cortical thickness measurements of the humeri and tibiae from these sites were similarly reduced when compared to modern norms. vertebral measurements were taken following the protocol outlined by newman and gowland (2015), which identified measurements from vertebral groupings of c56, t68, and l24 as being reliable indicators of potential population differences in growth patterns. due to the c5– c6 group presenting a more robust sample within this study for both sites, these figure 3. femoral diaphyseal lengths and cortical thickness from fewston and coach lane plotted against dental age as a proxy for known age and modern comparative data. gowland et al. 51 measurements were plotted against dental age (fig. 5). values for several adolescents from fewston were anomalously low, and an ancova test revealed that vertebral body height was statistically different (f[1,35] = 13.551, p = 0.001) between the two sites, while adjusting for dental age. these adolescents also exhibited a range of skeletal indicators of poor health. for example, skeleton 262 had extensive new bone formation and severe enamel hypoplasia; skeleton 338 had severe marrow hyperplasia, woven bone on multiple skeletal elements, and evidence of scurvy; skeleton 208 had sinusitis and cuspal enamel hypoplasia as defined by ogden et al. (2007); and skeleton 331 had evidence of scurvy, rickets, enamel hypoplasia, and new bone formation on the ribs. pathology a wide range of pathological lesions were observed in the nonadult skeletons from both sites. dental enamel defects were common in both the deciduous and permanent dentitions. a greater proportion of nonadults at fewston expressed dental defects than at coach lane (72% compared to 50%), but the true prevalence rate for defects was similar at both sites (table 2), with no statistically significant difference between them (two sample ttest, p > 0.1). there were some differences in the type of the dental enamel defects, however, with planeform and cuspal enamel defects more frequent at fewston (4% of all teeth compared to 0.6% at coach lane). deciduous as well as permanent teeth were affected by enamel hypoplasia at both sites, including pitting defects, but cuspal enamel defects in deciduous teeth were not common (supplementary tables s1– s4). in such instances, the period of stress that produced these lesions would have commenced in utero and occurred during the formation of both the deciduous and permanent dentition. the crude prevalence of rickets was similar between sites and is very high compared to contemporaneous sites in london (lewis 2002). likewise, the prevalence of scurvy was high, and there was no statistically significant difference between coach lane and fewston figure 4. pubertal stages in coach lane (n = 11) and fewston (n = 24) males and females plotted against dental age. childhood health in the industrial revolution52 (table 3). again, this prevalence was higher than at the london sites of chelsea old church, st benet sherehog, and bow baptist (ranging from approximately 4– 10%) but were more comparable with rates seen at cross bones (37%), a site that was located in a particularly impoverished parish of london during this period (newman and gowland 2016). developments in the diagnostic criteria for both rickets and scurvy since some of these reports were published are partly responsible for the disparity, along with the exclusion of poorly preserved skeletons from the prevalence calculations in this study. the north of england, however, was a renowned focal point for rickets in the nineteenth century (owen 1889). the prevalence rate of cribra orbitalia was, again, high at both sites, but fewston exhibited significantly higher frequencies (table 3). nonadults at both sites showed evidence of maxillary sinusitis and rib lesions, but the prevalence of both was significantly higher at fewston (table 4, rib lesions p < 0.05; sinusitis, p < 0.1) and most particularly in children of working age (12– 20  years). by contrast, endocranial and ectocranial new bone was slightly higher at coach lane, although this was not statistically significant (table 4). at coach lane, infants from 1– 12 months were much more likely to exhibit endocranial new bone growth (70%) than other age groups, whereas at fewston higher prevalence rates were observed again among the adolescents. care must be taken when interpreting cranial lesions in such young infants, because rapid bone growth during infancy may be mistaken for pathological lesions (lewis 2007). periosteal new bone formation was recorded for all the major long bones and was much more prevalent among the coach lane population compared to fewston. periosteal new bone formation at this site was most frequently expressed in the tibiae (55%), while at fewston the femur was more frequently affected (22%) (table 5). in terms of specific diseases among the nonadults, there were three individuals of particular note. the figure 5. vertebral body height for c5– c6 plotted against dental age. table 2. dental enamel hypoplasia (deh) at coach lane and fewston. age group deciduous teeth permanent teeth coach lane fewston coach lane fewston no. teeth (no. deh) % deh no. teeth (no. deh) % deh no. teeth (no. deh) % deh no. teeth (no. deh) % deh < 36w 0 0 0 0 0 0 0 0 36w– 1m 34 (0) 0 0 0 0 0 0 0 1– 12m 128 (13) 10 7 (0) 0 3 (1) 33 8 (0) 0 1– 5.9y 382 (66) 17 131 (12) 9 108 (30) 28 202 (28) 14 6– 11.9y 45 (8) 18 67 (7) 10 108 (37) 34 338 (72) 21 12– 19.9y 0 0 3 (0) 0 243 (114) 47 475 (139) 29 total 589 (87) 14 208 (19) 9 462 (182) 39 1023 (239) 23 gowland et al. 53 first was skeleton 69 from coach lane, who had severe osteonecrosis of the mandible accompanied by woven bone formation. this has been interpreted as likely due to phosphorous poisoning, which was a notorious occupational condition associated with the match making industry at this time. a detailed description of this individual was provided by roberts et al. (2016). skeleton 223 (14– 15yearold) from fewston had multiple lytic lesions accompanied by new bone formation in the skull. unfortunately, the skull of this individual was highly fragmented and only parts of the skull, vertebrae, and upper ribs were preserved. both orbital roofs had thick deposits of lamellar bone, with woven bone also present in the left orbit. a circular lytic lesion approximately 14 mm in diameter, with sharp, clear margins, had penetrated the thickness of the right orbital roof (fig. 6). four further lytic lesions were present elsewhere on the cranium. the surrounding external surfaces of these generally had scalloped roughened areas, with deposits of partially remodeled woven bone and lamellar bone (fig. 7). the body of the vomer was enlarged and covered with wellremodeled lamellar bone, with a smooth circular depression in both lateral walls and the perpendicular plate was absent (apparently remodeled). a large, shallow lytic lesion was present on the internal surface of the right mandibular ramus, and the margins were again bounded by thick deposits of partially remodeled woven bone. deposits of lamellar bone extended along the inferior surface of the right mandibular body, and a plaque of lamellar bone was present on the external surface of the right ramus. the axis had a lytic lesion on the external surface of the left lamina surrounded by partially remodeled woven bone. an upper right rib had a deposit of porous lamellar bone on the visceral surface of the neck. none of the other rib fragments had any evidence for lesions, but few of the rib heads and necks survived. table 3. crude prevalence rates (cpr) of rickets and scurvy by age group and true prevalence rates (tpr) of cribra orbitalia (co) at coach lane and fewston. age group coach lane fewston coach lane fewston coach lane fewston rickets cpr rickets cpr scurvy cpr scurvy cpr co tpr co tpr 36w– 1m 0 (9) 0 0 (0) 0 7 (8) 87.5 1 (1) 100 2 (22) 9 0 (1) 0 1– 12m 7 (12) 58.3 1 (1) 100 10 (12) 83.3 1 (1) 100 2 (20) 10 0 (1) 0 1– 5.9y 11 (25) 44.0 2 (4) 50 7 (27) 25.9 3 (8) 37.5 17 (51) 37 3 (6) 50 6– 11.9y 3 (7) 42.8 6 (9) 66.6 0 (6) 0 4 (13) 30.8 6 (10) 66.6 7 (9) 77.8 12– 19.9y 7 (10) 70 4 (15) 26.6 2 (10) 20 6 (16) 37.5 8 (19) 50 9 (14) 64.3 total 28 (63) 44.4 13 (29) 44.8 26 (63) 41.2 15 (39) 38.4 35 (122) 32.8 19 (31) 61.3 table 4. prevalence rates by age and site for maxillary sinusitis (sinus), rib lesions (rib), ectocranial lesions (ecto) and endocranial lesions (endo) at coach lane and fewston. true prevalence is provided for maxillary sinusitis, while only crude prevalence rates are given for the other pathologies. age group coach lane fewston sinus tpr rib cpr ecto cpr endo cpr sinus tpr rib cpr ecto cpr endo cpr < 36w 0 (0) 0 0 (1) 0 0 (1) 0 0 (1) 0 0 (0) 0 0 (0) 0 0 (0) 0 0 (0) 0 36w– 1m 2 (2) 100 1 (11) 9.1 3 (13) 23 4 (13) 30.7 0 (0) 0 0 (1) 0 1 (1) 100 1 (1) 100 1– 12m 1 (2) 50 1 (19) 5.3 12 (20) 60 14 (20) 70 0 (2) 0 0 (1) 0 1 (1) 100 1 (1) 100 1– 5.9y 6 (24) 25 1 (25) 4 5 (28) 17.9 12 (28) 42.9 4 (7) 57.1 0 (5) 0 1 (10) 10 4 (10) 40 6– 11.9y 0 (9) 0 0 (4) 0 3 (6) 50 3 (6) 50 4 (12) 33.3 3 (12) 25 0 (13) 0 4 (12) 33.3 12– 19.9y 6 (19) 31.6 4 (9) 44.4 2 (10) 20 2 (10) 20 17 (26) 65.4 5 (12) 41 5 (16) 31.3 5 (14) 35.7 total 15 (56) 26.8 7 (69) 10.1 25 (78) 32 35 (78) 44.9 25 (47) 53.2 8 (31) 25.8 8 (41) 19.5 15 (38) 39.4 table 5. true prevalence rates of periosteal new bone formation on the major long bones at coach lane and fewston. age group coach lane fewston hum rad ulna fem tib fib hum rad ulna fem tib fib 36w– 1m 10 21 38.9 20 44.4 12.5 0 0 0 0 0 0 1– 12m 32 54.5 50 28 70.8 46.2 20 0 0 0 0 0 1– 5.9y 16 2.4 2.6 38.8 66.7 21 22.2 0 0 20 16.7 33.3 6– 11.9y 11 0 11.1 35.7 8.3 9 6.7 0 0 28.6 25 20 12– 19.9y 27.7 22 27.8 36.8 50 22.2 4 0 16.6 20.8 10.3 15.8 total 20 15 21 32.8 55 21.9 9.8 0 7.9 22 13.6 18.5 childhood health in the industrial revolution54 figure 6. lytic lesions penetrating the right orbit of skeleton 223. figure 7. lytic lesion and new woven and lamellar bone on the left frontal bone of skeleton 223. tuberculosis manifested in the skull, while uncommon in adults, can occur more frequently in children (dawson and robsonbrown 2012; ortner 2003:247– 248). multiple cranial lesions, usually circular, less than 20 mm in size, which penetrate the thickness of the vault, as observed here, are all features of childhood tuberculosis. while bone formation around the lesions is not typical, it can occur (dawson and robson brown 2012; ortner 2003). chaudhary et al. (2004) and sheikh et al. (2012) state that involvement of the jaw is more likely in older individuals (but can occur in children) and typically manifests as destructive lesions in the mandible, with potential involvement of the temporomandibular joint. tuberculosis of the orbit is more common in children and is typically unilateral (dalvin and smith 2016), as expressed here. blindness is a frequent complication of ocular tuberculosis (dalvin and smith 2016; shameem et al. 2009), and, given the severity of the lesions, it seems likely that skeleton 223 experienced a similar outcome. endocranial new bone formation and rib lesions have also both been associated with tuberculosis (lewis 2004, 2007; matos and santos 2006; roberts and manchester 2005:190; santos and roberts 2001, 2006). finally, the skeleton of a 12– 14yearold from coach lane (skeleton 157) exhibited direct evidence of medical care in the form of cranial surgery in association with trauma. the individual had suffered a perimortem bluntforce injury to the left frontal and parietal bones along the coronal suture (fig. 8). two fracture lines radiated anteriorly and posteriorly from the point of impact. two concentric fracture lines extended from the anterior fracture from a point located 44 mm superior to the left orbit rim and 20 mm anterior to the coronal suture. on the ectocranial surface a smoothly curved concentric fracture line extended superiorly and posteriorly, terminating in the coronal suture 45 mm from bregma. the lateral segment was not detached, but displaced internally slightly at the inferior/medial end. at this inferior part the fracture extends at an angle through the bone to the internal surface, where a fracture line extends superiorly for 13.6 mm. a neat circular perimortem trepanation is located in the left frontal squama 11.7 mm medial to the curved fracture line, 5.2 mm from the coronal suture, and 12.8 mm from the metopic suture. the external diameter (16.7 mm) is slightly larger than the internal diameter (14.1 mm) (fig.  8). while the external margins are slightly crushed, the internal margins are sharp and the walls are smooth. this represents an unsuccessful attempt to provide lifesaving medical treatment in response to the perimortem injury. figure 8. frontal and parietal bone of skeleton 157 with perimortem trauma (b), a concentric fracture (a) and evidence for surgical intervention (c). gowland et al. 55 discussion the results initially appeared to contradict the sentiments espoused at the time, namely, that urban environments were much more damaging to childhood health than a rural upbringing. skeletal remains from both places show very high levels of metabolic disease and other nonspecific indicators of physiological disruption. the higher prevalence of many of the pathological conditions, together with poorer growth, among some of the children from fewston compared with coach lane was contrary to expectations and historical records. two questions arise from these results: why did the children at fewston suffer so much chronic health stress, and why were there so many adolescents at this site? usually, the adolescent age category is one of the least well represented within archaeological cemetery populations (as observed at coach lane), a factor lamented in recent studies of puberty in the past (arthur et al. 2016; lewis 2016; shapland and lewis 2013). a direct interpretation of this skeletal evidence would lead to the conclusion that the rural environment was at least as deleterious to health as the urban environment. historical evidence for the washburn valley, in which fewston is located, does in fact point to inadequate, overcrowded, and unsanitary housing for some rural dwellers, along with polluted water supplies. for example, local resident john dickinson noted in his diary entry for 13 october 1881: “there is part [some] talk about the deficient water supply and drainage of the village, and it is thought the sanitary authority will take the matter in hand themselves and compel the proprietors to alter things. the proprietors fear the cost and so it happens that we drink water highly polluted with sewage and our sinks [drains] are simply beastly” (caffell 20151). in 1840, elizabeth and william scaife lost three children (john, aged 2 years, hannah, aged 9  years, and christiana eliza, aged 6 years) within just one week to typhus fever, spread via contaminated water during an epidemic that lasted from 1838 to 1840. while such infectious diseases undoubtedly took a toll on the morbidity and mortality of the fewston population, they would have proven more fatal to younger children, rather than adolescents, as the dreadful suffering of the scaife family attests. these diseases are also acute; they will kill quickly and leave no visible sign on the skeleton. they are not, therefore, responsible for the evidence of chronic disease observed among many of the adolescent skeletons. when interpreting the prevalence of pathological lesions, 1. in addition to the listed reference, an abridged version of this diary was published: harker, r (ed) 1988. timble man: diaries of a dalesman (nelson, lancashire). the younger ageatdeath profile of the children at coach lane should be considered, particularly with regard to the osteological paradox (wood et al. 1992). however, given that many of the lesions recorded and interpreted at both sites were at least initiated during the first few years of life (e.g., enamel hypoplasia, rickets, scurvy, and cribra orbitalia), the comparison of the two different ageatdeath profiles continues to have merit. the presence of documented adults at fewston has made it possible to gather the associated birth and death certificates, together with census records. this provides a known record of individuals who were born, lived, and died in fewston and its environs— that is, the survivors. the skeletons of these adults do not show comparable levels of pathological lesions (e.g., cuspal enamel hypoplasia), and their stature does not appear to have been compromised; indeed, for males it was above the average stature for post medieval england (177.3 cm for fewston males and 160.4 cm for fewston females) (caffell and holst 2017). one could argue that the children in the assemblage were nonsurvivors and that this is why they show a higher prevalence of pathology compared to the adults (wood et al. 1992). another hypothesis (mentioned above) is that these adolescents were not local to the area and instead represent migrants. this interpretation will be explored further after a more detailed comparison with coach lane. north shields was widely known to be a heavily industrialized, polluted, and insalubrious town in the nineteenth century (proctor et al. 2016). the prevalence of metabolic, respiratory, and nonspecific indicators of health stress at this site was high, as expected. in 1889 the british medical association estimated that vitamin d deficiency in the form of rickets in childhood was concentrated in the heavily industrialized areas of the northeast, where coach lane was located (owen 1889). vitamin d deficiency at this site is likely to have been exacerbated by the more northerly latitude, in conjunction with air pollution from the associated industries. the high levels of vitamin d deficiency observed at fewston, however, were not in keeping with historical records. john snow, the famous nineteenthcentury spatial epidemiologist, best known for his work on cholera, began his medical career as a doctor in a north yorkshire village close to fewston. snow (1857) observed that rickets was a relatively rare disease in yorkshire when compared to london. he attributed this to people from yorkshire baking their own bread due to cheaper fuel sources, in contrast to londoners who almost universally ate shopbought bread, heavily adulterated with alum. snow, like his contemporaries, believed that vitamin d deficiency was primarily childhood health in the industrial revolution56 figure 9. cuspal enamel hypoplasia on teeth from fewston. dietary in origin, rather than due to a lack of sunlight, and he thought that alum was responsible for “weakening” the bones. the connection between sunlight and vitamin d deficiency was not made until the late nineteenth century, and diet was still thought to be the predominant cause of the disease even in the 1920s (see findlay and mellanby 1922). the key point here is that the prevalence of rickets at fewston is contrary to snow’s observations in north yorkshire. the prevalence rates of scurvy were also equally high in both the rural and urban sites studied here. it was expected that scurvy would be less prevalent in rural environments due to the increased availability of fruit and vegetables. a regional survey of diet and nutrition highlights that in rural yorkshire the working classes ate largely bread, oatmeal, some sugar, and weak tea, rather than foods rich in vitamin c such as potatoes (horrell and oxley 2012). historical records have also documented that the diet of women and children was more monotonous and less likely to include meat than the diet of men (horrell and oxley 2012; humphries 2010). dental enamel hypoplasia (deh) prevalence was comparable between the sites. deh has multiple etiologies (e.g., infectious disease, trauma, malnutrition) and is generally regarded as a “nonspecific” indicator of disease; however, it is worthwhile focusing on the type of hypoplastic defects present. while linear enamel hypoplasia is by far the most common form exhibited in skeletal samples generally, at fewston there are a number of individuals that have “plane form” and “pitted” defects of the type described by ogden et  al. (2007) as “cuspal enamel hypoplasia” (fig. 9). this term describes the combination of pitted and planeform lesions, together with a disruption in the pattern of the molar cusps, such that multiple small cusps form and develop. ogden et al. (2007:960) noted a relatively high number of individuals with such defects (on deciduous and permanent teeth) from the postmedieval site of broadgate in london and explored a range of reasons for these defects, including vitamin d deficiency. pitting and cuspal enamel hypoplasia is also observed on the deciduous teeth at fewston, indicating an in utero insufficiency. purvis et al.’s (1973) clinical study noted an association between very similar hypoplastic lesions in the deciduous teeth and neonatal tetany, arising from deficiency in vitamin d in the mothers during the third trimester of pregnancy. their sample was from scotland, a northerly latitude, and they observed an increase in frequency during winter and spring when hours of sunshine were lowest. they also noted an association with increased maternal parity and low social status. similar instances of modern cases of enamel hypoplasia associated with nutritional rickets have been reported in the more recent medical literature (e.g., davitbéal et al. 2014). the presentation of these defects is identical to those observed among the fewston skeletons in terms of the teeth affected and location. vitamin d deficiency in pregnant women is known to result in adverse maternal health and birth outcomes affecting the birth weight, bone mass, and immunity of the infant (karras et al. 2016; paterson and ayoub 2015). an earlytwentiethcentury medical book by dick (1922) focusing on the geographical distribution and clinical manifestations of rickets also describes dental lesions, which he argued to be pathognomonic of vitamin d deficiency as follows: “there may be only a pitting, producing a honeycombed appearance of the enamel, or the enamel covering is slight, and the cutting edge of the tooth presents sharp points, giving a characteristic appearance to the tooth” (1922:191– 192). this description is again consistent with the dental lesions observed in some of the fewston individuals. while it is easy to dismiss these early medical texts as outdated, particularly when published during a period in which the etiology of the condition was only poorly understood, it is important to give credit to the fact that these observations were made during a time when the disease was frequently encountered. while enamel hypoplasia is generally considered to be a nonspecific form of stress, in these instances it seems likely to have resulted from an insufficiency of vitamin d and/or calcium, beginning in utero and extending until 2  years of age. vitamin d deficiency contributes to hypocalcaemia and hypophosphatemia, the latter of which is compounded by hyperparathyroidism brought about by hypocalcaemia (foster et al. 2014:6– 7). this lack of calcium and phosphorus results in developmental and mineralization defects in teeth via both direct and indirect mechanisms (foster et al. 2014). it has been observed in clinical studies that gowland et al. 57 vitamin d deficiency can result in interglobular dentine, and this has been identified in archaeological teeth of individuals with residual rickets (d’ortenzio et al. 2016). future analysis of the coach lane site may benefit from a histological analysis of the teeth, but the fewston skeletons have now been reburied. of interest is that none of the adults from coach lane or fewston exhibited evidence of cuspal enamel hypoplasia, indicating a strong association between these lesions and the risk of early mortality. when interpreting the presence of pathological lesions and growth disruption early in the life course, it is important to consider the significance of maternal health for growth and immune status (gowland 2015a). maternal malnutrition, ill health, and exposure to toxins within the living or working environment during pregnancy will adversely affect the developing fetus. intrauterine growth retardation is strongly associated with shorter height in childhood and adolescence (chung and kuzawa 2014). furthermore, a mother who fails to meet her own genetic potential in growth is more likely to have an infant who is small for gestational age. growth deficits early on in life can be difficult to recover from, particularly in adverse biolcultural environments (chung and kuzawa 2014). indeed, the effects of a poor environment on growth could span multiple generations before it is fully reversed despite alleviation of environmental stressors (barker 2012). finally, when interpreting palaeopathological evidence and delayed growth in terms of the local living environments, we must be sure that the pathological conditions observed in the skeletons of the children from fewston and coach lane do in fact relate to the local area. with regard to this period of rapid industrialization and urbanization, migration is often conceptualized as unidirectional— from the countryside to towns. it is important to consider that during this period there was a significant amount of rural industry and that this led in some instances to the apprenticeship of urban children, who were removed to the countryside to work as laborers, as domestic servants, or in textile mills. these individuals were known as pauper apprentices: children taken from workhouses in cities, usually 10– 12 years of age, and indentured to work far from their original home. the children worked long hours, 12 to 14 hours per day, and for no pay, but were instead “taught a trade” and were housed, fed, and given some education (honeyman 2013; levene 2010). there was a flax mill at fewston, known as westhouse mill, and historical sources document the employment of pauper apprentices from the workhouses of lambeth and shoreditch in london, as well as elsewhere in england (honeyman 2007). it therefore seems probable that this excess of adolescents at fewston, with high frequencies of skeletal lesions and stunted growth, reflects a poor and destitute childhood in london rather than one spent at fewston. ives and humphrey’s (2017) study of diaphyseal growth in children from the poor london parish of bethnal green during the nineteenth century also highlights severe growth deficits. social status is one of the strongest determinants of health, and this was particularly evident in postmedieval england (gowland 2018; marmot and wilkinson 2006). as discussed, the evidence for rickets and enamel hypoplasia at fewston is consistent with the pathological evidence from the lowstatus postmedieval cemetery of broadgate in london (ogden et al. 2007; pinhasi et al. 2006). the high prevalence of respiratory disease among these children at fewston is also consistent with mill labor, in which pulmonary complaints, including byssinosis and tuberculosis, were a known occupational hazard (wohl 1983). further isotopic and archival investigation is currently being undertaken in order to verify the nonlocal origins of these adolescents (gowland et al. 2017). conclusion while the children at coach lane undoubtedly showed evidence of adverse living conditions in the form of poor skeletal growth and the presence of physiological insults to the skeleton, it was surprising and contrary to historical evidence that the children from the rural site showed comparable health deficits. one explanation is that we need to reevaluate our ideas of rural life during this time in terms of it providing a more beneficial living environment and diet. alternatively, the health stress observed in some of the fewston children may not relate to the local living environment at all but rather to an impoverished urban childhood in the workhouses of london and elsewhere. childhood mobility during this period as well as urbantorural migration should be factored into our interpretations. industry was not just an urban phenomenon but also a rural endeavor, and we should consider the impact of this on the health and population structure of fewston. finally, poverty has heritable biological consequences via poor maternal health status. this biological disadvantage then becomes exacerbated by poor working and living conditions. the industrial revolution was a period of relative social mobility, with a rise in the middle classes, but for the very poor and disenfranchised the inheritance of biological inequality in terms of morbidity and mortality risks, in addition to social disadvantage, meant that only the very tenacious could survive or thrive. childhood health in the industrial revolution58 acknowledgments the authors would like to acknowledge the british academy (sg132083) for funding this research. we would also like to thank sally and clive robinson and the volunteers from the washburn heritage centre for their contribution and support with the fewston assemblage and jenny proctor at preconstruct archaeology for access to the coach lane collection. i am very grateful to paula monguí for her translation of the abstract. references cited alred, david. 1997. washburn valley yesterday: a pictorial record of life in a dales valley. smith settle, 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.22416. sheikh, soheyl, s. pallagatti, deepak gupta, and amit mittal. 2012. tuberculous osteomyelitis of mandibular condyle: a diagnostic dilemma. dentomaxillofacial radiology 41:169– 174. doi: 10 .1259 /dmfr /56238546. smith, b. holly. 1991. standards of human tooth formation and dental age assessment. in advances in dental anthropology, edited by marc a. kelley and clark spencer larsen. wileyliss, new york, pp. 143– 168. snow, john. 1857. on the adulteration of bread as a cause of rickets. lancet 2, 1766:4– 5. stark, robert j. 2014. a proposed framework for the study of palaeopathological cases of subadult scurvy. international journal of palaeopathology 5:18– 26. doi: 10 .1016 /j .ijpp .2014 .01 .005. stuartmacadam, patricia. 1991. anaemia in roman britain. in health in past societies: biocultural interpretations of human remains in archaeological contexts, edited by helen bush and marek zvelebil. bar international series, 567. tempus reparatum, british archaeological reports, oxford, pp. 101– 113. wilkes, sue. 2011. the children history forgot: young workers of the industrial age. robert hale, london. wohl, anthony s. 1983. endangered lives: public health in victorian england. harvard university press, cambridge. wood, james w., george r. milner, henry c. harpending, and kenneth m. weiss. 1992. the osteological paradox: problems of inferring prehistoric health from skeletal samples. current anthropology 33(4):343– 370. doi: 10 .1086 /204084. young, george malcolm, and w. d. handcock. 1956. english historical documents, vol. 12, pt. 1, 1833– 1874. eyre & spottiswoode, london. table s1. coach lane: dental enamel hypoplasia (deh; pitting, lines, and grooves). age group deciduous permanent all teeth deh total % deh total % deh total % foetus < 36w — 0 — — 0 — — 0 — neonate 36w– 1m 0 34 0.00 — 0 — 0 34 0.0 infant 1– 12m 13 128 10.2 0 3 0.0 13 131 9.9 young juvenile 1– 5.9y 61 382 16.0 27 108 25.0 88 490 18.0 older juvenile 6– 11.9y 8 45 17.8 37 108 34.3 45 153 29.4 adolescent 12– 19.9y — 0 — 114 243 46.9 114 243 46.9 total 82 589 13.9 178 462 38.5 260 1,051 24.7 supplemental tables gowland et al. 61 table s2. coach lane: cuspal enamel hypoplasia (ceh). age group deciduous permanent all teeth ceh total % ceh total % ceh total % foetus < 36w — 0 — — 0 — — 0 — neonate 36w– 1m 0 34 0.0 — 0 — 0 34 0.0 infant 1– 12m 0 128 0.0 1 3 33.3 1 131 0.8 young juvenile 1– 5.9y 2 382 0.5 3 108 2.8 5 490 1.0 older juvenile 6– 11.9y 0 45 0.0 0 108 0.0 0 153 0.0 adolescent 12– 19.9y — 0 — 0 243 0.0 0 243 0.0 total 2 589 0.3 4 462 0.9 6 1,051 0.6 table s3. fewston: dental enamel hypoplasia (deh; pitting, lines, and grooves). age group deciduous permanent all teeth deh total % deh total % deh total % foetus < 36w — 0 — — — — — 0 — neonate 36w– 1m — 0 — — 0 — — 0 — infant 1– 12m 0 7 0.0 0 1 0.0 0 8 0.0 young juvenile 1– 5.9y 12 131 9.2 16 112 14.3 28 243 11.5 older juvenile 6– 11.9y 6 67 9.0 53 247 21.5 59 314 18.8 adolescent 12– 19.9y — 3 — 111 455 24.4 111 458 24.2 total 18 208 8.7 180 815 22.1 198 1023 19.4 table s4. fewston: cuspal enamel hypoplasia (ceh). age group deciduous permanent all teeth ceh total % ceh total % ceh total % foetus < 36w — — — — — — — 0 — neonate 36w– 1m — 0 — — 0 — — 0 — infant 1– 12m 0 7 0.0 0 1 0.0 0 8 0.0 young juvenile 1– 5.9y 0 131 0.0 0 71 0.0 0 202 0.0 older juvenile 6– 11.9y 1 67 1.5 12 271 4.4 13 338 3.8 adolescent 12– 19.9y 0 3 0.0 28 472 5.9 28 475 5.9 total 1 208 0.5 40 815 4.9 41 1,023 4.0 login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines 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current archives submit subscribe bioarchaeology international volume 3, number 1: 1–15 doi: 10.5744/bi.2019.1005 copyright © 2019 university of florida press osteobiography: a platform for bio archae ol o gi cal research lauren hoseka* and john robbb adepartment of anthropology, syracuse university, syracuse, ny 13244, usa bdepartment of archaeology, university of cambridge, downing street, cambridge cb2 3dz, uk *correspondence to: lauren hosek, syracuse university, 209 maxwell hall, syracuse, ny 13244, usa email: lrhosek@syr . edu abstract osteobiography provides a rich basis for understanding the past, but its conceptual framework has not been outlined systematically. it stands in conceptual opposition to a traditional statistical approach to bioarchaeology modeled upon clinical studies in biomedicine, but is interdependent with it. as such, its position mirrors those of clinical case histories as opposed to statistical studies, participantobservation ethnography as opposed to quantitative sociology, and microhistory and biography as opposed to quantitative history. such disciplinary comparisons provide a framework for exploring the strengths and weaknesses of osteobiography. it is not merely a tool for engagingly illustrating the “typical” life history as established statistically. rather, it allows us to understand issues that population studies cannot explore. these include both analytical directions (exploring the complexity of deeply layered data, understanding the role of contingency in human lives, integrating osteological and cultural evidence) and philosophical directions (the interaction of material and conceptual factors in the creation of human bodies, embodiment, the experience of time). keywords: life history; biography; theoretical approaches la osteobiografía ofrece una base rica para comprender el pasado, pero su marco conceptual no se ha delineado de manera sistemática. se encuentra en oposición conceptual a un enfoque estadístico tradicional de la bioarqueología formado sobre estudios clínicos en biomedicina, pero es interdependiente de él. su posición, como tal, refleja aquellos casos de historias clínicas opuestos a los estudios estadísticos, la etnografía de observación participativa opuesta a la sociología cuantitativa, y la microhistoria y la biografía opuestas a la historia cuantitativa. semejantes comparaciones disciplinarias ofrecen un marco para explorar las fortalezas y debilidades de la osteobiografía. no es simplemente una herramienta para ilustrar de manera atractiva la historia “típica” de la vida según lo establecido estadísticamente. más bien, nos permite entender las cuestiones que los estudios de población no pueden explorar. estas incluyen direcciones analíticas (explorando la complejidad de datos en capas profundas, comprendiendo el papel de la contingencia en las vidas humanas, integrando la evidencia osteológica y cultural) y direcciones filosóficas (la interacción de factores materiales y conceptuales en la creación de cuerpos humanos, encarnación, la experiencia del tiempo). la historia de la vida; la biographía; los enfoques teóricos received 30 july 2018 revised 4 january 2019 accepted 5 january 2019 introduction to the special issue: bodies as narratives2 “osteobiography” is a concept that has become popular in recent years, but it remains poorly theorized and has not had systematic methodological exploration. as it is currently used, it remains much as saul (1972) originally formulated it: osteobiography involves assembling all information available from the skeleton to create a life narrative for a single individual. this definition is certainly a stimulating starting point, but it does not do full justice to the concept’s potential. why has the idea not grown and matured in the generation since it was coined? the answer may lie in the dominant biomedical paradigm in which bioarchaeology has grown, which is traceable to its twin roots in skeletal biology and socially oriented processual archaeology. bioarchaeology has broadened greatly in the last decade, exploring new directions such as individual variation, the life course, identity, embodiment, and social theory (see baker and agarwal 2017). examples include theorization of how social relations form the “biological” body (sofaer 2006); discussion not only of how to diagnose pathological lesions and what their medical or epidemiological significance was, but also of what they meant for ancient people’s life experiences (baker and bolhofner 2014; fay 2006; kieffer 2017; marsteller et al. 2011; c. a. roberts et al. 2016) and social relations such as the “bioarchaeology of care” (hawkey 1998; tilley 2015; tilley and oxenham 2011; vlok et al. 2017); problematizing sex and gender as nontrivial theoretical problems in bioarchaeology (geller 2016); problematizing age as a social dimension rather than simply a chronometric indicator (sofaer 2006, 2011); and movements to integrate funerary taphonomy with the question of social agency after death (e.g., cambridge archaeological journal special section 2014). the field is broadening to encompass a new, more humanistic bioarchaeology. yet there remains a methodological and conceptual core that focuses mostly upon establishing significant relationships among variables such as age, sex, disease, activity, and social status. this research is normally done through statistical analyses such as correlation. within this traditional paradigm, the status of osteobiography is unclear. it may be considered a useful scholarly exploration of what statistical relations mean when viewed “on the ground” in an individual life. but it may also be dismissed as simply a tool for engaging the public in a popular book or museum exhibition through human interest stories; the most rigidly quantitative practitioners may see it as unscientific, as a sample size of one cannot “prove” a general point (but see articles in this issue). our core argument here is that osteobiography is not simply an engaging extension tacked on to, and perhaps overstretching, a traditional populationlevel, quantitative bioarchaeology. instead, it forms an indispensable tool within a broader, emerging humanistic bioarchaeology, a tool that poses and responds to different kinds of research questions. these research questions are explored below. moreover, we are at an especially propitious moment to revisit and redevelop the concept of osteobiography. an ensemble of new analytical methods, including isotopic studies of diet and geographical movement during life, adna studies of individuals’ physical characteristics, and adna studies of pathogen exposure and the human microbiome, are adding new layers of depth to our ability to reconstruct humans’ life experiences. with explicit theorization and methodology, we propose that osteobiography has greater potential as a research tool within socially contextualized bioarchaeology. how do osteobiographical and quantitative approaches relate to one another? the answer is straightforward, perhaps obvious. neither approach is adequate on its own. osteobiography allows insight into the structure of individual lives in a way that population level study cannot. yet we can only make sense of an individual life by putting it into its social context. what is exceptional for one group falls squarely within normal variation for another. conversely, relying exclusively upon biomedicalstyle population level statistical studies has limitations, writing off potential information about individual variation as “noise.” such an approach flattens out the complexities and contingencies of individual lives (stodder and palkovich 2012; mays et  al. 2018). moreover, populationlevel statistical studies structure how data are collected and reported. as an example, various landmark skeleton collections have been studied many times to elucidate statistical relations between specific variables, but in a way that makes it impossible to combine data from them into multilayered databases. a focus on individual lives can help population level studies by revealing reasons why data may vary. osteobiography and populationlevel studies are thus interdependent and complementary, and a full exploration of a group and its lives may involve tacking back and forth between them. the osteobiographies in this issue, as well as many of those reviewed below, show how a more theoretically informed osteobiographical approach can address at least three significant research directions: 1. understanding how ancient people perceived, felt, and responded to bodily processes such as appearance, health and illness, violence, aging, and death merits exploration. within a humanistic bioarchaeology, we can, and should, ask how ancient people experienced their lives. we can do so without being naive about either the philosophical issues hosek and robb 3 involved in understanding human experience or the complexity of health and the body as cultural constructs. 2. we do not live within a bivariate world. human lives are structured not only by deterministic, statistical relations between abstract factors but also by chance, historical contingency, and the interaction of complex networks of circumstances. such interactions unfold in a way ordered over time to create important outcomes not simply predictable from generalizations about the variables involved (as in the concept of the “perfect storm”). these contingent outcomes are recognized within biomedicine by the complementary tradition of individual case studies alongside populationbased statistical studies. similarly, most of the social sciences provide methods for statistical studies of underlying regularities (e.g., economic history, quantitative sociology) and for tracing the developmental pathways of individual cases, whether typical or exceptional (e.g., microhistory, biography, ethnographic analysis). understanding how general factors and historical contingencies interact to create specific human lives is an important topic in itself. 3. the shape of human lives may vary socially and undergo historical change. this concept has been suggested both by historians (e.g., in debates about the nature of childhood in ancient society) and by evolutionary biologists (e.g., in studies of life history). it is also important in modern society; one has only to consider how events such as teenage pregnancy act as switches routing people onto different life courses. hypotheses about the multigenerational consequences of maternal health (barker et al. 2002; gowland 2015) provide a current archaeological example. this dimension is potentially very important but relatively unexplored; it requires developing new methods for analyzing osteobiographies not only as individual life histories but also as comparative points of reference that reveal the shape of human lives. this special issue originated as a conference symposium revisiting osteobiography at the 2017 society for american archaeology meetings in vancouver, british columbia, to which many of the participants have contributed. each article builds on the concept of osteobiography and offers novel methodological approaches, theoretical explorations, or the possibility of new frontiers. contributions characterize emerging theoretical directions in osteobiography. these include the intersectionality of identity, the role of narrative in the presentation of data, and the ethics of osteobiography. this introduction provides a systematic overview to the concept of osteobiography and serves as a platform for developing this research agenda further. we outline some key underlying concepts and methods as well as future directions that we hope will push the boundaries of osteobiography and demonstrate its potential as an analytic tool. biographical approaches within bioarchaeology the term “osteobiography” was conceived early in the history of bioarchaeology as part of attempts to bring skeletal data out of the ghetto of appendixes of archaeological reports (baadsgaard et  al. 2012; buikstra 2006; buikstra et al. 2011). the concept was initially developed by frank and julie saul as a methodological framework for reconstructing the lives of maya individuals, developing life histories from human remains (saul and saul 1989). frank saul (1972:8) first coined the term in the early 1970s, explaining that osteobiography “has been used to indicate in a single word that this study is concerned with all of the foregoing aspects of skeletal analysis.” saul applied this approach to skeletal remains from the mayan site altar de sacrificios, intending for these skeletal life histories to encompass contextualized analyses of age, sex, pathology, trauma, and activity. saul and saul (1989) developed osteobiography further by using individual life histories to make projections about the wider skeletal sample. they acknowledged the origins of osteobiography in forensic anthropology and the work of archaeologists including e. a. hooton and biological anthropologists including w. m. krogman and j. l. angel (buikstra 2006). this original conception of osteobiography has been critiqued for lacking serious consideration of the archaeological context of skeletal remains and for approaching populationbased questions with data specific to individuals (buikstra and scott 2009; geller 2014), but it has provided a foundation for bio archae ol o gi cal approaches to individual lives. within theoretical bioarchaeology, two key lines of thought have influenced later manifestations of osteobiography. the first is an acknowledgment of the biosocial nature of the body as a material object influenced by both biological and cultural forces (sofaer 2006). joanna sofaer’s initial call to reevaluate the archaeological body has since been advanced to understand how traces of the life course are embodied in the skeleton itself (e.g., buikstra et al. 2011). bioarchaeologies of childhood (beauchesne and agarwal 2018; lewis 2007; thompson et al. 2014) and old age (appleby 2011; cave and oxenham 2016) have grappled with the material and social outcomes of bodily plasticity in these age spectrums. in her own work, sofaer introduction to the special issue: bodies as narratives4 attempts to reconcile biological age estimations with culturally contextual understandings of age as social process (sofaer 2011; sofaer derevenski 2000) as well as categories of biological sex with the diverse lived experiences of gender (sofaer 2006; sofaer and sørensen 2013). the second theoretical focus within bioarchaeology has been a concern with the life course, typified by sabrina agarwal’s (2012, 2016) exploration of age related biological development sequences occurring within social contexts. an emphasis on social bioarchaeology has emerged from these interests in identity and the life course, prioritizing human social contexts in the study of skeletal remains (agarwal and glencross 2011; gowland and knusel 2006; knudson and stojanowski 2009). as part of these trends in theoretical bioarchaeology, osteobiography gained new attention through robb’s (2002:160) expansion of the concept as “the study through human skeletons of the biography as a cultural narrative” with the intent to discern “cultural understandings of life events and to encompass the history of human remains after death.” in this conception, the life history of an individual is structured by cultural categories including age, gender, and socioeconomic statuses that define various stages of life. an individual life is entangled within social and cosmological temporalities that inform the different paths a life may take. robb’s example of a neolithic female’s life history from the italian catignano site demonstrates how a contextualized skeletal biography can shed light on the embodied experiences of biological processes such as illness, injury, and cultural modification of the body. importantly, robb and others (geller 2012) have added death histories to the osteobiographical project, acknowledging that people often continue to be social actors in some form after biological death. such postmortem agency might be accessed through careful contextualization of skeletal remains within archaeological contexts. alongside the revitalization of osteobiography came a renewed interest in the life experiences of individuals as a counter to epidemiological approaches to past populations. a number of works, including many of those in stodder and palkovich’s (2012) the bioarchaeology of individuals, began to address agency, structure, and the relationships between individuals and populations through a biography of skeletal remains. osteobiography was invoked in some of these projects as a humanistic means of bringing individual people back to life, both for ourselves and as a way of helping nonarchaeologists imagine the past (boutin 2011, 2012, 2016; stojanowski and duncan 2015). these osteobiographies tended to illustrate ordinary lives, acting as case studies introducing an individual to exemplify a site or population. a contrasting theme emerges in other works: the use of osteobiography, or at least the concept of individual life history, to describe distinctive individuals or mortuary contexts. a few notable examples are “skrydstrup woman” from denmark (frei et  al. 2017), the bronze age “egtved girl” (frei et al. 2015) and “gristhorpe man” (melton et  al. 2013), the iron age “princess of vix” (knüsel 2002), the mesolithic shaman burial of bad dürrenberg (porr and alt 2006), and a seventeenth century finnish clergyman (väre 2017). other osteobiographies involve multiple individuals, as in the case of the sailors of the mary rose (stirland 2000), a corded ware burial group (meyer et al. 2009), three medieval individuals from trondheim (hamre et al. 2017), and four individuals from stonehenge (mays et al. 2018). new world examples include buikstra’s hopewell mound burial (1976), elite burial contexts in oaxaca (mayes and barber 2008) and palenque (couoh 2015), a paleoindian individual from brazil (lessa and guidon 2002), and the moatfield ossuary in ontario (williamson and pfeiffer 2003). interestingly, there is at least one osteobiography of a non human animal: tourigny et al. (2016) describe the life history of a nineteenthcentury dog from canada. overall, these osteobiographies show three common features: (a) a principal, though not exclusive, focus on european cases; (b) accelerating tempo in rate of publication, in part related to increasing public engagement and academic publishing pressures, but also to new methods that allow us to reconstruct more complex and interesting life stories; (c) common methods, including osteology, palaeopathology, isotopic analysis, and detailed articulation with archaeological contexts. we have noticed divergences in approach in different areas; for instance, our impression is that osteobiographies of prehistoric people tend to focus more upon lives as expressions of general social conditions, while a strong tradition in textaided osteobiographies has been identification of specific individuals and exploration of social differences within society. there are also common presentational methods, especially facial reconstruction and creation of a name for these unknown individuals. museum exhibitions, in particular, use the latter methods of representation, often based on extensive scientific work but also uniformly involving faces and names. notable examples include vasa museum (stockholm), the mary rose museum (portsmouth), the yorkshire museum (york), and the african burial ground national monument (new york). famous bodies are particularly prone to this kind of reconstructive treatment, in part because of their ability to capture the public’s imagination and further inform on wellknown histories (stojanowski and duncan 2015). these “celebrity bodies” include king hosek and robb 5 tutankhamun (rühli and ikram 2014), “ötzi,” the neolithic alpine iceman (robb 2009), the recently recovered body of richard iii (appleby et al. 2015; toon and stone 2016), the prehistoric paleoamerican known as kennewick man or the ancient one (owsley and jantz 2014), and bog mummies such as lindow man (stead et al. 1986). even as powerful tools for public engagement, these osteobiographies and the bells and whistles of facial reconstruction and documentary reenactments that often accompany them cannot be viewed uncritically. reconstruction of these archaeological bodies in text and media, for both academic and popular audiences, results in an ancient person with a “biography and bodily constitution mirroring those familiar to modern western europeans” (robb 2009:123). while bringing the past “to life,” what narratives are we reinforcing, and what might we lose in (re)constructing these faces and names? and what can we learn that is not already known from their historical biographies? appleby (this issue) provides an exciting example of how richard iii’s osteobiography gives insights not only into richard’s life but into medieval habitus. similar questions arise in the related tradition of biohistory (komar and buikstra 2008; stojanowski and duncan 2017). the intellectual agenda of biohistory is closely linked with forensic anthropology— the identification of unidentified bodies. specifically, biohistorians are concerned with reconstructing life histories of famous individuals or individuals associated with wellknown historical events. for example, the exhumation and analysis of tycho brahe’s remains was at least in part to determine if the sixteenth century astronomer had been murdered (rasmussen et al. 2013). other recent examples include identifying the body of st. paul (mihanović et al. 2017) and examining the life history of famous castrato singer farinelli (belcastro et al. 2011). whether or not all such studies have a scientific rationale, this avenue of inquiry can provide important methods drawn from forensic anthropology as well as powerful examples of life histories reconstructed from physical evidence in skeletal remains. human lives and biographies as a research subject in other fields the narrative study of a life is a qualitative method with many forms, including life writing, biographies, life histories, case studies, autobiographies, and memoirs (harrison 2008; smith 1994). disciplines across the social sciences, humanities, and biomedicine approach individual lives and the lived experience to understand how individuals engage in and perceive their social worlds. disciplinary boundaries are somewhat fuzzy, and definitions of methods and terminology are not always discrete. the fields and research areas that explore narrative and biography are briefly addressed here with an eye to how they approach and represent individual lives. biography as a historical method or research perspective has seen renewed interest in recent decades (renders et al. 2017). in fact, many historians argue that a “biographical turn” commenced in the early 2000s as a reaction to statistical and analytical methods of historiography and as a critique of “grand narratives” (caine 2010; possing 2015, 2017) in a way that parallels transformations within bioarchaeology. importantly, biography plays a significant role in popular history, engaging with the public in an accessible, narrative form. however, the place of biographical studies has long been a debate among historians. critics of historical biography argue that investigating individuals’ lives adds little to understandings of history (kesslerharris 2009; possing 2015). additionally, the textual record is strongly biased toward famous or extraordinary people, making biographies of ordinary people difficult to write (salvatore 2004). historians approach biographies in two main ways: as a lens through which to access larger events and processes, or with a focus on a particular life, with limited larger context. recent proponents of historical biography argue that, in using a critical narrative approach, biographies can move between individual lives and broader historical questions (kesslerharris 2009; meister 2017; renders et al. 2017). the narrative approach of microhistory has offered some insights for historical biographers seeking to bridge these scales of analysis. microhistorians argue that examining objects on a small, intimate scale will reveal previously overlooked phenomena and provide connections to wider historical processes (ginzburg 2014; levi 2001; meister 2017). anthropology has a long history of engaging with life histories and narratives, although with a less explicit reliance on biographical methods. anthropologists have explored the concept of life histories through oral narratives (angrosino 2007; langness and frank 1981) as well as the cultural lives of things (appadurai 1986; hoskins 1996; kopytoff 1986). this tradition also includes the biography of individuals from an anthropological perspective, involving an ethnographic focus on the hyperlocal (herzfeld 1998; kristmundsdottir 2006) as well as the anthropologist as autobiographer (okely and callaway 1992). lifecourse and life history perspectives, emerging from behavioral studies, biology, and evolutionary theory, have also influenced how biological anthropologists approach composite life narratives in terms of the timing of life events, introduction to the special issue: bodies as narratives6 fertility, and mortality (elder et  al. 2003; hill and kaplan 1999). biographical methods have been used more explicitly in archaeology as a way to approach people through their material worlds (gilchrist 2012; meskell and joyce 2003; mytum 2010) and to examine the “life” of artifacts (beaudry 2011; gosden and marshall 1999; joy 2009; meskell 2004). indeed, mytum (2010:242) explains that archaeological biographies are typically “not lifelong biographies of individuals, but insights into particular places, associations and events for which the data is rich enough to allow such a construction.” artifact biographies are necessarily relational, tacking between humans, things, spaces, and technologies to examine uselives or the relationships between people and objects. these smallscale biographies might be contrasted with lifehistory approaches concerned with largerscale and longterm changes in artifacts and technologies (joy 2009). historical archaeologists, in particular, have explored microhistorical representations of site histories, artifact biographies, and individual lives (brooks et al. 2008; huppertz 2010; janowitz and dallal 2013). qualitative inquiries in sociology, in the form of case studies and life histories, underscore the importance of subjective experience and how the life course is shaped by interrelated social factors (heinz and krüger 2001; possing 2015). a lifecourse perspective in sociology refers to changes in human lives across time and through social and institutional structures. this approach emphasizes how conditions of early life affect outcomes later in life and the conjunctions of biological, family, cultural, and institutional factors that shape the life course (gilleard and higgs 2015; harrison 2008; heinz and krüger 2001; mayer 2009). despite a disciplinary emphasis on structures over the individual to form generalizations about society, more recent scholarship has taken seriously how individual cases can be representative and theoretically meaningful (b. roberts 2002; rustin 2008). two currently relevant examples are understanding how men and women follow different career trajectories in spite of attempts to create gender equality and understanding the social consequences of lengthening the human life span. lifecourse studies require longitudinal research establishing social structures integrated with individual life histories based on interviews and case studies (heinz and krüger 2001). this interplay of micro and macroanalyses, using both quantitative and qualitative data, is what gives a lifecourse perspective particular significance across the social sciences. the case study approach in biomedicine is a research method that allows for “an indepth, multi faceted understanding of a complex issue in its reallife context” (crowe et al. 2011:2). a deeply contextualized clinical case provides insights into causality, compounding factors, and the course of intervention. while being criticized for a diminished ability to generalize, case studies are contrasted with (or complement) largescale research designs that may be unfeasible or unable to account for the complexities of a clinical setting (crowe et al. 2011). biography and narrative have been explored in other areas of biomedical research, education, and ethics in the form of illness narratives (bishop and sunderland 2013) and narrative medicine (charon 2001; morris 2008). according to charon (2001), the storytelling inherent in clinical medicine links patients, physicians, and students and requires a narrative competence among medical professionals. narratives of biomedicine can even involve object biographies, as in nunes et al.’s (2013) depiction of the bacterium helicobacter pylori as a biomedical entity with a life history. while we have only touched on the many narrative approaches to individual lives, this summary has shown the efficacy of such a perspective across disciplines. central concepts and methods of osteobiography approaching life histories from skeletal remains requires attention to several key concepts that shape how we “do” osteobiographies. the first is the centrality of the body as the locus of experience and biocultural change. as noted above, the body is constantly in a process of becoming, a “work in progress” of both biological and social origin (ingold 2011; joyce 2005; sofaer 2006). bioarchaeologists rely on the concept of skeletal plasticity to address ways in which social and material worlds shape and inform the biological body (agarwal 2016; sofaer 2006). “plasticity” refers to the capability of the human body to change in response to damage, stress, disease, or degenerative changes. biological processes unfold in a social environment, influenced by learned action, labor, habits, and events throughout the life course. as the focal point of these transformations, the body itself is an intersection of multiple processes, materials, and histories (novak 2017a, 2017b). in fact, one might argue that the body “embodies” history. we see differences in skeletal bodies from different time periods and geographies that reflect how social and environmental histories are enacted on and through the body (robb and harris 2013) characteristics of the body, such as age, sex/gender, and health, are based on a lifetime of culturally negotiated activities. osteobiography must attend to the biosocial changes of the body over time, reconciling biological age estimations with the culturally hosek and robb 7 contextualized understandings of age as social process (agarwal 2016; appleby 2011; gilchrist 2012; sofaer 2011) as well as integrating categories of biological sex with the diverse lived experiences of gender (geller 2016; sofaer 2006; sofaer and sørensen 2013). the intersections between these aspects of identity are particularly rich analytical nodes for bioarchaeology. by “shifting the focus from identity to identities” (byrnes 2017:204), we begin to see how multiple components of social identity become embodied. dynamics of class, power, age, disability, gender, and ancestry gather together at the site of the body, creating particular configurations and possibilities (boutin 2016; byrnes 2017; byrnes and muller 2017; geller 2016). at the heart of osteobiography, as with all forms of narrative, are the concepts of time, scale, and sequence. as bioarchaeologists, we often give primacy to chronometric time in our quest to estimate age at death from skeletal indicators. however, it is arguable that social temporalities are of greater import when considering narrative life histories. the lifecourse model “situates the human life span within social measures of time” (gilchrist 2004:156). such a conceptualization provides the body with a cultural biography of normative (and alternative) stages (robb 2002). this social temporality is entangled with other temporal scales from individual to cosmological measures that link generations and other intersections of identity. thinking about time as multiscalar allows us to move analytically between individuals and populations, building narratives through this dialogue and developing sequences of individual life histories. what ultimately differentiates osteobiography from other ways of interpreting bio archae ol o gi cal data are (a) the focus upon the individual life span as the unit of analysis and (b) arranging data within the life span to form a temporally integrated sequence, in which earlier processes or events cause or form a context for later ones. these factors translate into several specific approaches. some are straightforward and well developed; others are at the frontiers of current methods and need further development. working from samples to individuals and back again bioarchaeology traditionally regards individuals simply as constituents of samples; what matters is the aggregate characteristics of the whole group, often expressed in terms of a graph showing general trends, a correlation coefficient, or summary statistics such as averages and standard deviations. it is assumed that all samples inherently vary, and the variation displayed by a single point will be of minimal analytical purchase or interest. there has been little attention to asking why a specific data point falls where it does, and how this position can be understood in terms of its other characteristics. indeed, given that most studies reduce the available data to only a handful of variables, it is often actually impossible to pose such questions. clearly, we can only understand an individual data point by starting from an understanding of the whole sample and its general characteristics. what is normal or exceptional, local or exotic, coherent or discordant can only be assessed against a wider context. this observation is true not only in terms of biological variation but in social variation as well; individual identities conform to and work against normatively constituted identities such as gender and age, and all societies also understand the life span in terms of a normative biography. such a biography is divided into stages, each of which has its own characteristics. methodologically, this means that osteobiography is interdependent with traditional bioarchaeology: to construct osteobiographies, we have to continually work back and forth from the general characteristics of the whole sample to the individuating variation of a specific person. layering different kinds of data to build an osteobiography, we need to layer as many kinds of data as possible to include a critical density of information about our “person of interest.” this process allows us to juxtapose aspects of someone’s life and ask new questions about them. for instance, did early health episodes have an effect upon their working lives? does their burial treatment relate to their health status or appearance? is an anomalous age estimate related to signs of pathology or intense physical activity? as the osteobiographies to date (see literature review above) and the articles in this collection suggest, there is a core of common elements that often recur. • context: the skeleton’s broader archaeological context, including mortuary environment and other relevant information (as well as historical or textual information, where it is available). • demography: the individual’s age at death, and biological sex. • genetic variation: as available from metric and nonmetric variation, biodistance data, and analysis of adna, providing not only an idea of affinities within a local gene pool but much other information besides (e.g., snps revealing probable eye and hair color). • health: the individual’s health, as inferred from palaeopathology and, increasingly, analysis of pathogen adna. this assessment includes not only the possible health conditions the individual experienced introduction to the special issue: bodies as narratives8 but also their experiential consequences (pain, suffering, disability, changes to appearance or social categorization). • diet: as revealed from skeletal and dental data such as dental disease, and from isotopic (c, n) enrichment ratios. a comparison of isotopes from tissues forming in childhood (particularly teeth), in adulthood (such as slow turnover cortical bone), and relatively soon before death (such as ribs, tissue, or hair) may reveal changes in diet throughout the life span. • mobility: accessible through isotopic ratios (e.g., sr, o and pb) that may reveal the individual’s environmental context at moments when specific tissues were forming. comparison with others in the sample and between samples may suggest how much a person moved during his or her life. • signs of activity, use, and degeneration: an amorphous category of data that always needs careful contextualization within a particular sample, sex, and age range. however, characteristics such as size, body shape and robusticity, laterality, local or general wear and tear, and idiosyncratic development of particular complexes of muscles may reveal habitual activities or socially salient aspects of the individual’s appearance, identity, or life course. • bodily modification: including cranial shaping, trepanation, and dental ablation or modification. • deathways and postmortem history: including how the remains were processed, curated, circulated, and/or deposited. these characteristics may relate not only to the person’s identity or circumstances of death but also to what extent the person was regarded as an active social agent following biological death. this list of data is long. in our experience, for any given individual, most of these data will fall more or less within the “unremarkable” range, and it will only be a few points, or combinations of points, that will highlight the most salient individuating aspects of an osteobiographical life narrative (see robb et al., this issue). one consequence of this array of data is that osteobiography may involve different working practices than standard bioarchaeology (as in the traditional model of a lone researcher collecting one or two kinds of data for a specialized study). there can be no standard “package” of data constituting the raw materials for an osteobiography; the available data depend upon many factors, such as how well preserved the skeletal remains are, the state of documentation (particularly if one is using published “legacy” data or old collections that may lack contextual information), the available expertise and funding, and so on. even so, it is clear that composing an osteobiography requires many different areas of expertise. it may also require considerable funding; while obtaining isotopic data or adna data for one individual may not be too costly, obtaining enough comparative data to put that person in context may cost a lot more. while a lot of the data above could be gathered by an experienced osteologist working alone, the most detailed osteobiographies will typically be generated by a wellfunded, relatively large interdisciplinary team. sequence with the systematic analysis of sequence, we move from things bioarchaeologists largely are doing already to frontiers that need further development. arranging data in temporal sequence is essential to biography. earlier events and conditions channel later ones and influence the possible outcomes the body can take. this configuration has a number of distinct ramifications. bodily processes such as growth, health, and aging create contexts for what happens next. a wellknown example is childhood stress contributing to poorer health later in life. some studies have shown that individuals with enamel defects occurring in early childhood are more likely to die at earlier ages, suggesting that health issues in childhood can affect mortality rates throughout the life course (armelagos et al. 2009; boldsen 2007; miszkiewicz 2015). the best pioneered approach is understanding biological sequence by comparing data from tissues that form at different points in life, typically childhood (from dental data, but also potentially by stature and other evidence of childhood health), adulthood (from slowly replaced bone tissue such as long bone cortical bone) and the last decade or so before death (from quickly replaced bone tissue such as ribs). the same principle can be used to reconstruct microsequences of isotopic data during childhood by microsampling dental enamel formed throughout various moments of growth. such concepts could be developed further. for instance, many pathological lesions, such as trauma and periosteal bone growth, can be classified as active or healed at the time of death, giving information on health changes within an interval of a year or more before death. we can also classify health conditions as having episodic effects, ongoing effects, or permanent effects. for instance, a wellpreserved dentition may show evidence of complex sequences (a set of molars on one side wears and decays within the interval between full eruption and some years before death, their alveoli resorb, and we can see accelerated or idiosyncratic wear on the remaining antimeres). it may be possible to build quite a complex internal chronology from a wellaged and “busy” skeleton. a different aspect of sequence concerns how our “person of interest” relates to historical context. traditionally, archaeologists have been satisfied with hosek and robb 9 relatively loose chronological bracketing; a radiocarbon date with a margin of error of 50– 100 years allows us to place a burial within most archaeological periods, so that we can regard someone as a generic representative of, say, the neolithic, the early mississippian, and so forth. but a combination of careful use of archaeological context and bayesian calibration can get chronological resolution down to the generational level, allowing us to compose nearly realtime “histories” (bayliss and whittle 2007). in some cases, particularly in historical bioarchaeology, we can tease out a community of people who were alive contemporaneously (novak 2017a). knowing a date of death and an approximate life span, can we understand what events someone may have lived through and how they may have affected their life story? sequences can also be extended intergenerationally, highlighting the relational nature of the life course. for example, gowland (2015) points out the heritability of poor health and the impact of the maternal environment on early (and later) life in a bioarchae ol o gi cal context. data analysis perhaps the leastdeveloped methodological aspect of osteobiography concerns how we use data, and here we only mention some possibilities for development. standard statistical methods can be used to establish correlations between different skeletal data, and if these data can also be put into sequence we may be able to build causal narratives. for instance, such a sequence may show how early life experiences relate to a priori social categorizations on one hand and to subsequent life events on the other. techniques such as risk analysis may provide additional ways to express such relationships that focus less upon aggregate samples and more upon the probabilities of individual life contingencies. finally, we need to develop new ways of representing data to help us spot patterns and important variations. sociologists studying variation in the life course use techniques such as network analysis and cluster analysis to show how individual lives conform to or depart from normative patterns and are channeled by important life events. even at the level of simple graphs and diagrams, finding ways to convey information such as how skeletal data relate to how long someone lived would transform our ability to visualize patterns in human lives (see robb, this issue). some frontiers for osteobiography in thinking about new frontiers for osteobiography, we put forward some theoretical issues to consider. for example, what is a life? as the unit of our analysis in an osteobiography, what do we mean by a “life” history? a key consideration is the social agency of the dead. when bioarchaeology is brought into conversation with taphonomy, it is possible to extend biography from (before the) cradle to (after the) grave. additionally, a common assumption in osteobiography is that “individuals” are equated with skeletons. this identification creates an inherent assumption of a bounded entity, rather than one that is relational, material, and contingent. we must ask ourselves, what is the entity? are they living/dead, human/ nonhuman, prehuman, posthuman? bodies can also be subject to fragmentation, made partible or even aggregate. obvious examples emerge from burial taphonomy such as permeable maya bodies (duncan and schwarz 2013; geller 2012) and medieval saints’ relics (robb 2013), as well as modern examples such as organ transplants and body donation systems. another important consideration is the relationship between material things and the body. if we take the body to be material culture, how should osteobiography include things? other materials might come into articulation with the body— many with their own material biographies— such as prosthetic devices, dental fillings, tattoo ink, and so forth. the question of what things is also significant: the fact that skeletal remains are often found in deliberate burial contexts means that we create an implicit hierarchy with grave goods because of their proximity to the skeleton. but what other objects are important in creating an osteobiography, and how do we bring these into a conversation? the materiality of things is particularly emergent when considering weakagency people, such as children and the elderly, leading to a focus on material culture as part of the construction of identity for these individuals as well as the limitations of the body itself. recent bio archae ol o gi cal projects have pushed boundaries of sex and gender and have examined how these aspects of identity develop in the course of social life (geller 2016). how do we relate evidence of biological and social variation, particularly when it is discrepant? when we find a vikingperiod woman buried with weapons (hedenstiernajonson et  al. 2017), do we assume (perhaps influenced by today’s gender attitudes) that binary gender based on biological sex was normal in the past, so that there must be some sexing error and “she” must really be male? or that being a warrior was not a gendered activity? or that vikingperiod gender was not in fact binary? other frontiers include challenging the concept of a skeletal “population” as representing synchronous lives in temporal continuity (novak 2017a). is it possible to identify individuals who were alive at the same time through probabilitybased analysis or through introduction to the special issue: bodies as narratives10 the integration of other types of evidence (including cemetery records and other historical sources)? we may also consider new approaches to data analysis and aggregating lives, such as developing comparative shapes of life courses using multivariate analyses. osteobiography and archaeological ethics osteobiography, like all methods of conceptualization, has an ethical and political dimension rooted in our own situatedness in social relations. geller (this issue) raises some classic ethical dilemmas, particularly in formerly colonial settings and arenas in which knowledge is depersonalized and commercialized. but osteobiography raises much broader ethical dilemmas as well, as it provides a powerful tool for mobilizing the imagination and engaging with our publics. the most obvious ethical dimension concerns the politics of osteobiography. in creating osteobiographies, we may effectively be deputizing a few individuals to stand for an entire place or period in our and the public’s imaginations. as feminist critics since conkey and spector (1984) have noted, peopling the past is a politically loaded act. how do we choose the subjects for osteobiography? do we seek to represent “typical” lives? “interesting” lives (and what makes a life “interesting”)? “invisible” lives? “alternative” lives? do we choose the 99 slaves who conformed and were worked to death, or the one who resisted? the roman “bangle lady” originated in north africa and was buried in york, underlining the multicultural and mobile nature of roman society (leach et al. 2010). but most of her cohort were much more local. should we aim the osteobiographical spotlight at her or at one of them? at an even deeper layer of ontological assumptions, how do our life narratives impose our own concepts of animacy and humanness on past societies? should osteobiographies make the past comprehensibly familiar or challengingly alien? how familiar is too familiar, taking the easy way out? the other ethical dimension concerns the responsibilities of knowledge. take the question of naming anonymous skeletons— something on which there is a surprising level of deeply felt difference of opinion. on one hand, names humanize skeletons; both we and the public understand and relate to “jonathan” or “flavia” differently than to “individual 247” or “context 958.” but in giving people names of our own invention, are we humanizing them in a space all parties understand as imaginatively constituted, or are we claiming knowledge we cannot actually discern? does humanizing concreteness trump literal facticity in some contexts? or can we find ways of finessing the issue— giving people generic names such as “the ship’s carpenter” (as in the mary rose and vasa museums), or using typography to highlight the different bases of imagination and fact? our ethical obligations extend not only toward our professional responsibilities to create knowledge and our duty toward the public who trust our authority, but also to the ancient people we study. conclusions human lives are not disconnected facts and data points; they have a structure, and they also have a cultural interpretation of that structure. bioarchaeology allows us to glimpse the human experience of living in past societies, and osteobiography offers a particularly compelling way to approach the forms these lives can take. the narrative of a life can be understood as a building block of social history, allowing our scales of analysis to shift between big questions of populations and social change, on the one hand, and the events and contingencies at work across a single life, on the other. indeed, osteobiography has raised important questions in some areas of archaeology; for example, it is biographies such as the egtved girl (frei et al. 2015) that have directed attention to the role of highstatus women in bronze age europe. the articles in this issue draw on a range of topics at the forefront of bioarchaeology, bringing new theoretical and methodological approaches to bear on osteobiography. robb et  al. compare the analytical possibilities of textual biography and skeletal biography through two individuals from thirteenthcentury cambridge, england. the archival traces of ordinary people are more biased by socioeconomics and gender than the full suite of osteological, molecular, and reconstructive techniques afforded by osteobiography. appleby incorporates theories of local biologies and relational personhood in forming an osteobiography of richard iii. she argues that richard’s bone chemistry reflects the biosocial consequences of his negotiation of kingship through particular consumption practices. hosek marries osteobiography with a microhistorical approach to address issues of scale and relationality in individual life histories. she presents two osteobiographies from early medieval bohemia and shows how these lives articulate with largescale historical processes. robb uses aggregate osteobiographies to outline the courses an individual life might take. the ensuing lifecourse maps show how pathways might diverge or intertwine based on biological and social differences such as gender and age. boutin and callahan use social psychology to explore how osteobiography might be used in public outreach. they show how different types of osteobiographical narratives play a role in humanizing people from the hosek and robb 11 past and affect how they are viewed by modern audiences. finally, geller proposes a “bioethos” that incorporates ethical questions into osteobiographical research design. through the examples of kennewick man/ancient one and hela/henrietta lacks, she explores how naming, facial reconstruction, and issues of ownership complicate the narratives we develop about human remains. a criticism of osteobiography (and case studies more broadly) that we raised earlier is that one case cannot prove anything. while this statement might be true, both previous osteobiographies and the articles in this issue demonstrate that upholding generalizations is not the real goal of such an approach. osteobiography allows for an understanding of variability in past lives that would otherwise be lost in the search for pvalues. in contrast to the tyranny of the average, but also in conjunction with it, osteobiography can reveal exceptional people or unusual lives that risk being smoothed out in a population analysis. alternatively, in illustrating the life of a typical individual, osteobiography might better humanize population statistics. perhaps even more significantly, osteobiography provides a way to sequence and layer skeletal data into richly contextualized life histories, drawing attention the role of pathway and contingency in the development of a life. we hope that this overview and the following contributions expand the possibilities of osteobiography as a conceptual tool for bioarchaeology, opening new directions for telling stories with skeletal remains. postscript few scholars discuss osteobiography without a nod to frank saul and his foundational work on the concept with his wife, julie mather saul. indeed, when we first conceptualized a conference symposium we asked ourselves, where has osteobiography gone since saul and saul (1989), and where does it go next? the passing of frank saul in june  2018 coincided with the submission of these articles. we would like to acknowledge here his many contributions to maya archaeology, forensic anthropology, and bioarchaeology. we hope that this special issue serves as a recognition of his lasting impact on how we approach life histories through the skeletal body. acknowledgments the authors would like to thank the editors of bioarchaeology international for their guidance and for the opportunity to put together this special issue. we would also like to thank the participants of the bodies as narratives symposium at the 2017 society for american archaeology meeting in vancouver, british columbia, for their lively discussion and insights into the future of osteobiography. we are grateful to brenda baker and to three anonymous reviewers for thoughtful comments that have improved this paper. references cited agarwal, sabrina c. 2012. the past of sex, gender, and health: bioarchaeology of the aging skeleton. american anthropologist 114(2):322– 335. doi: 10 . 1111 / j . 1548 1433 . 2012 . 01428 . x. agarwal, sabrina c. 2016. bone morphologies and histories: life course approaches in bioarchaeology. american journal of physical anthropology supplement: yearbook of physical anthropology 159(s61):130– 149. doi: 10 . 1002 / ajpa . 22905. agarwal, sabrina c., and bonnie a. glencross, eds. 2011. social bioarchaeology. wileyblackwell, london. doi: 10 . 1002 / 9781 444390537. angrosino, michael v. 2007. conducting a life history interview. in doing cultural 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of globalisation. critical social policy 28(3):273– 282. doi: 10 . 1177 / 026101 8308091269. salvatore, nick. 2004. biography and social history: an intimate relationship. labour history 87(2):187– 192. doi: 10 . 2307 / 27516005. saul, frank p. 1972. the human skeletal remains of altar de sacrificios: an osteobiographic analysis. papers of the peabody museum 63(2):3– 123. saul, frank p., and julie mather saul. 1989. osteobiography: a maya example. in reconstruction of life from the skeleton, edited by mehmet y. iscan and kenneth a. r. kennedy. alan r. liss, new york, pp. 287– 301. smith, louis  m. 1994. biographical method. in handbook of qualitative research, edited by norman  k. denzin and yvonna s. lincoln. sage, thousand oaks, ca, pp. 286– 305. sofaer, joanna r. 2006. the body as material culture: a theoretical osteoarchaeology. cambridge university press, cambridge. doi: 10 . 1017 / cbo9780511816666. sofaer, joanna. 2011. towards a social bioarchaeology of age. in social 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florida, gainesville. doi: 10 . 5744 / florida / 9780813038070 . 001 . 0001. stojanowski, christopher, and william n. duncan. 2015. engaging bodies in the public imagination: bioarchaeology as social science, science, and humanities. american journal of human biology 27(1):51– 60. doi: 10 . 1002 / ajhb . 22522. stojanowski, christopher  m., and william  n. duncan. 2017. studies in forensic biohistory: anthropological perspectives. cambridge university press, cambridge. doi: 10 . 1017 / 97811 39683531. hosek and robb 15 thompson, jennifer  l., marta  p. alfonsodurruty, and john  j. crandall, eds. 2014. tracing childhood: bio archae ol o gi cal investigations of early lives in antiquity. university press of florida, gainesville. doi: 10 . 5744 / florida / 9780813049830 . 001 . 0001. tilley, lorna. 2015. theory and practice in the bioarchaeology of care. springer, new york. doi: 10 . 1007 / 978 3 319 18860 7. tilley, lorna, and marc f. oxenham. 2011. survival against the odds: modeling the social implications of care provision to seriously disabled individuals. international journal of palaeopathology 1(2):35– 42. doi: 10 . 1016 / j . ijpp . 2011 . 02 . 003. toon, richard, and laurie stone. 2016. game of thrones: richard iii and the creation of cultural heritage. in studies in forensic biohistory: anthropological perspectives, edited by christopher m. stojanowski and william n. duncan. cambridge university press, cambridge, pp. 43– 66. doi: 10 . 1017 / 9781139683531 . 003. tourigny, eric, richard thomas, eric guiry, richard earp, andrew allen, jamie rothenburger, dennis lawler, and marc nussbaumer. 2016. an osteobiography of a 19thcentury dog from toronto, canada. international journal of osteoarchaeology 26(5):818– 829. doi: 10 . 1002 / oa . 2483. väre, tiina. 2017. osteobiography of vicar rungius: analyses of the bones and tissues of the mummy of an early 17th  century northern finnish clergyman using radiology and stable isotopes. ph.d. dissertation, university of oulu. acta universitatis ouluensis, oulu. vlok, melandri, victor paz, rebecca crozier, and marc oxenham. 2017. a new application of the bioarchaeology of care approach: a case study from the metal period, the philippines. international journal of osteoarchaeology 27(4):662– 671. doi: 10 . 1002 / oa . 2588. williamson, ronald f., and susan pfeiffer. 2003. bones of the ancestors: the archaeology and osteobiography of the moatfield ossuary. canadian museum of civilization, gatineau. doi: 10 . 2307 / j . ctv16q3w. login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics 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england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe preface we are very excited to take on the role of the co-editors-in-chief of bioarchaeology international despite the extremely challenging timing of the transition in july 2020, amid a global pandemic and increasing global awareness of the urgent need to revise ethical standards toward greater representation and equity in our discipline. the founding co-editors-in-chief, sabrina agarwal and brenda baker, have stepped down from their role after roughly four years of dedicated service, although they continue to play an integral advisory role as the founding editors of bioarchaeology international. we want to begin by expressing our deep gratitude to brenda and sabrina. they instigated and led the huge effort to conceptualize the scope of the journal, organize a prestigious advisory and editorial board, and design and implement all the processes and procedures for publishing the journal. as one of the earliest journals in the university of florida press lineup, they also helped lay the processual and procedural foundation for the press to publish nine other journals. for the years 2016–2020, the journal flourished under their extraordinary stewardship, and it brought to fruition their vision for a rigorous future of contextual, theoretically informed, and data driven bioarchaeology (agarwal and baker 2017). we applaud their success in bringing the journal to a point where it has a very strong international reputation in the field due to its high quality, and impactful, relevant articles, and we will endeavor to continue to build on this excellence. despite our trepidation about beginning our term during incredibly challenging circumstances, our fears of the potential impact of the pandemic on submissions, peer review, editorial activities, and most other aspects of the publication process were unfounded. we are pleased to note that the journal currently has three issues in production, and we continue to receive truly excellent papers, which means bioarchaeology international will be able to continue publishing the highest quality work in this vibrant field. we are also extremely pleased that the average time to make a first decision for the journal is only 42 days. that being said, we have also faced challenges moving papers through the later stages of the publication process this year, particularly at the copyediting and proofs stage. covid-19 led to a hiring freeze at the university of florida press, and frankly this is currently our greatest challenge, but it is being alleviated as the press has hired new editing and proofreading staff. therefore, we also want to take this opportunity to express our extreme gratitude to the staff and to all the authors who have stood with us as we work with the press staff to clear the backlog related to the pandemic and we are hopeful for a return to normalcy soon. building on the systems and processes established by brenda and sabrina, we have made a few changes since starting our term. we began with four major goals, three of which are related to ethics and representation, and all of which were intended to expand the relevance and influence of the journal by encouraging the highest quality of submissions. our first priority as new editors was to review the members of the advisory and editorial boards, to relieve members who had completed their terms, and to invite new members who will help us to fulfill our goals of inclusive representation and ethical bioarchaeological practice. we want to take this opportunity to thank the former board members for their years of service and to welcome those who have taken on new roles on the advisory or editorial boards. in revising the board membership, we focused on more representation, including international and bipoc scholars. certainly, this will lead to better anthropology. our new associate editors—alexis boutin, graciela cabana, carlina de la cova, jonny geber, ann m. kakaliouras, tracy prowse, hisashi nakao, liv nilsson stutz, laurie reitsema, dong hoon shin, jorge suby, christina torres-rouff and rachel watkins—are exceptional scholars representing diverse topical areas and we are grateful they were willing to accept our invitation and to commit themselves to serving the field in this way. some of our new advisory board members—d. troy case, pamela geller, rebecca gowland, john krigbaum, judith littleton, and tiffiny a. tung—have moved from the editorial board, and we are so grateful for their willingness to take on this role and provide their expert advice. another new advisory board member—jane buikstra— is a new addition to the board. she is obviously a deeply admired scholar in the field who has already contributed suggestions to help us maintain the excellence of the journal. one of our goals was also to expand our ethical guidelines for publication in the journal to more closely align with current values of our field. we worked with the press and the founding editors to update the research ethics, consent, and integrity bioarchaeology international volume 5, numbers 1–2: iii–iv doi: 10.5744/bi.2021.5000 statement. we hope readers will take a moment to read our expanded statement, which acknowledges the importance in bioarchaeological research of collaboration with and permission from indigenous stakeholders and local communities for research, publication, and to present photographs of human remains. we have also added a new statement on sexual harassment and sexual violence, which demonstrates the commitment of the journal and the press to take sexual and interpersonal misconduct seriously and to provide an inclusive and safe environment for all members of our community. it is now a violation of bioarcheology international’s ethical standards for prospective authors to engage in any conduct prohibited under title ix, including sexual assault, sexual harassment, dating violence, domestic violence, stalking, sexual exploitation, and retaliation. we reserve the right to make editorial decisions based on these ethical standards. finally, we worked with the staff at the press to offer further streamlining of the submissions process, which allows authors to “submit-as-you-like.” we hope this will be attractive to researchers, particularly early career scholars. this new submission system means authors do not have to format submissions specifically for bioarchaeology international until acceptance. we continue to be one of the few journals in biological anthropology to offer professional copy editing upon acceptance and we are interested in expanding our international authorship through these practices and in forthcoming special issues. typically, special issues are proposed to the journal, but in 2020 we as co-editors-in-chief solicited manuscripts for a topical special issue on pandemics in the past and present: contributions from bioarchaeology. bioarchaeology is pertinent to address substantial challenges related to the third epidemiological transition, emerging and re-emerging infections, climate and environmental change, social inequality and building a more equitable, sustainable future. we look forward to contributing to our field’s efforts to provide the long-term perspectives that build understanding and capacity for resilience in the context of current-day global challenges. gwen robbins schug and siân e. halcrow co-editors-in-chief of bioarchaeology international references cited baker, brenda, j., and sabrina c. agarwal. 2017. stronger together: advancing a global bioarchaeology. bioarchaeology international 1 (1–2): 1–18. doi: 10.5744/bi.2017.1005. iv preface login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe bioarchaeology international volume 3, number 1: 58–77 doi: 10.5744/bi.2019.1008 copyright © 2019 university of florida press beyond individual lives: using comparative osteobiography to trace social patterns in classical italy john robba* adepartment of archaeology, university of cambridge, cambridge cb2 3dz uk *correspondence to: john robb, department of archaeology, university of cambridge, downing street, cambridge cb2 3dz, uk email: jer39@cam . ac . uk abstract osteobiographical studies have usually focused upon investigating an individual’s life experience. however, we can also understand variation in the shape of the life course itself as an object of study: are there common patterns for how lives unfold within a society? are there events or experiences that channel life courses? this approach to the life course can be adopted for ancient as well as for modern lives. a key element here is developing new methodologies for characterizing and comparing how lives develop through time, for instance, by ordering biological data in sequence, looking for timestructured patterns in them both by eye and through multivariate statistics. this article presents an initial exploration of this problem, using skeletal and archaeological data on 47 adults from the fifth to third centuries b.c. at pontecagnano, an urban site in campania, italy. the results show both the importance of gender in the life course and the effects of different kinds of physical stress, probably due to specialization in labor. the result is not discrete categories of people but fuzzy envelopes of life possibilities. keywords: biography; gender; work; italy; etruscan; specialization; life course los estudios osteobiográficos se han enfocado generalmente en la investigación de la experiencia vital del individuo. sin embargo, también podemos comprender la variación en la forma del curso mismo de la vida como objeto de estudio: ¿existen patrones comunes (que demuestran) cómo se desarrollan las vidas (individuales) dentro de una sociedad? ¿existen eventos o experiencias que canalizan los cursos de vida? esta aproximación al curso de la vida puede ser adoptada tanto para las vidas ancianas como las modernas. un elemento clave (en esto) es el desarrollo de nuevas metodologías para caracterizar y comparar cómo se desarrollan las vidas a través del tiempo, por ejemplo al ordenar datos biológicos en secuencia y buscar en ellos patrones estructurados en el tiempo tanto (visualmente/por vista) como a través de estadísticas multivariadas. esta investigación presenta una exploración inicial de este problema utilizando los datos esqueléticos y arqueológicos de 47 (cuarenta y siete) adultos del 5o al 3er siglo a.c. en pontecagnano, un sitio urbano en campania, italia. los resultados demuestran tanto la importancia del género en el curso de la vida como los efectos de diferentes tipos de estrés físico, debido con toda probabilidad a la especialización laboral. (esto no resulta) en categorías discretas de personas sino en sobres difusos de posibilidades de la vida. keywords: biografia; género; trabajo; italia; etrusco; especialización; curso de vida received 31 july 2018 revised 28 january 2019 accepted 28 january 2019 robb 59 social process, human life courses, and osteobiography human lives are not mechanical or deterministic, but neither are they simply concatenations of random events. instead, they have a temporal structure; earlier events shape the possibilities of later ones. this is abundantly clear in familiar, everyday examples: an educational opportunity, the death of a parent, a pregnancy, or a serious health episode can shape someone’s entire subsequent life trajectory. moreover, as natives of our own culture we often have a conscious sense of how different kinds of people have distinct events, opportunities, and life tracks. patterning in the actual lives people lead often exists in the context of cultural narratives about how the “normal” human life span is supposed to go, even if many people do not achieve the ideal “good life.” tracking any cohort, whether a formal longterm crosssectional study or your high school graduating class on facebook, shows both how recurrent life patterns emerge from social process and how any individual life has its own trajectory, sometimes taking quite unexpected directions. if we think of lives as vibrant lines extending themselves through time, they do not follow a rigid channel, but nor do they zoom off in random directions. instead, as they wander through the possibility spaces their social and historical setting affords them, they unfold in loose skeins or bundles. the temporal structure of human lives has been studied principally in fields such as public health, sociological lifecourse studies, and biography (see hosek and robb, this issue). these studies bridge the gap between individual lived lives and macropatterns in society as a whole. at the other end of the pole, ethnographers often use narratives of individual lives, taking a single informant’s story as a microhistory exposing social issues (see hosek, this issue). novelists do so as well; for example, thomas hardy’s tess of the d’urbervilles both explores the effect of gendered events upon an individual woman’s life story and shows how tess stands for women as a category within a patriarchal society. in bioarchaeology, osteobiography can accomplish similar goals, letting us assemble facts into life narratives and highlighting the continuity or coherence among all the facts of a human life over time. the key concepts are reviewed above (hosek and robb, this issue) but can be mentioned here (see also boutin et al. 2012; saul and saul 1989; stodder and palkovich 2012). throughout life, the body as a physical structure is constantly changing in response to age and environment (agarwal and beauchesne 2011). thus, as advocated in the lifecourse approach, its history can be read as a record of the stresses and risks experienced at different ages (agarwal 2016; glencross 2012). reciprocally, people interpret changes in their bodies as signifiers of social age, which may be more important than chronological age (appleby 2011; sofaer 2011); indeed, they often go beyond interpreting their bodies, intervening directly and intentionally to modify them or changing their activities in ways that alter their bodies. the body can thus be considered as material culture, as something shaped by the ongoing course of social life (sofaer 2006). this line of thought has been developed archaeologically principally in the idea of childhood, adulthood, and old age as culturally understood stages of life (appleby 2011; halcrow and tayles 2011; lewis 2007; sofaer 2000), but it is also clear that the overall normative biography forms a powerful cultural narrative (robb 2002). but osteobiography has almost always remained at the level of the individual, telling a single life story (with rare exceptions; see barrett and blakey 2011). it has tackled questions of the shape of human lives only by asserting, explicitly or implicitly, that the individuals studied are typical of their time, or group, or class or gender, and thus their life story also tells us something about their social world. this is useful, but we could go much further. some key questions are: • within a human life, are there systematic patterns in how earlier events affect later events? • within a group, are there recurrent patterns in how lives unfold— what events people experience, when they experience them, and what their effects are? • do people in different groups (genders, classes, ethnicities, occupations, religions, etc.) experience different lives? if so, why? to answer these, we need to approach osteobiography differently. osteobiography has typically involved writing individual lives in as much detail as possible. but we can also go “meta,” lining up osteobiographies side by side to examine how individual individual lives are when we aggregate them, how much they really do form tight bundles adhering to narrow life paths or wander loosely through life’s possibilities. intuitively, we might expect to observe people’s lives being played out within fuzzy envelopes, neither tightly deterministic nor unstructured, perhaps with distinct tracks for people differentiated by category and social position or by major life choices such as going to university or experiencing a major illness. but is this really so? although new territory for bioarchaeology, such issues have been explored in fields such as sociological lifecourse studies(heinz and krüger 2001). such studies, however, give us mostly reassurance that the shape of human lives is an intellectually important problem worth studying; bio archae ol o gi cal data are so different from the data sociologists use that by and beyond individual lives60 large we have to devise our own methods rather than borrowing them from other fields. this article is an attempt to do so. interestingly, this requires thinking not only about statistical methods but about pictures as well. osteobiographies involve assembling complex arrays of quite different kinds of data. it is not only the values but the relations between them in multivariate space that are most telling. to make them comprehensible, we need to simplify the data carefully and group them in a way that reveals both patterns and variation. while exploratory multivariate statistics such as clustering or network analysis could be used, we need to integrate categorical, ordinal, and numerical data, and usually any individual is missing at least some data. the alternative approach used here is to accept this as an imaginative challenge and to experiment with new graphs or charts for visualizing human lives. this article argues that individual human lives have shapes or courses and that the shape of human lives in themselves may be important and informative when studied in the aggregate. it presents a first try at exploring the comparative study of the human life course in a past society. using data from 47 adults from the ancient city of pontecagnano (fifth– third centuries b.c.), i try to outline some common life patterns. the analysis is exploratory. it succeeds in outlining some possible variation in how men’s and women’s life courses unfolded, but more importantly, its real goal is to raise the possibility of this kind of approach and to stimulate further work on it. pontecagnano: life and death in an early urban society the town of pontecagnano is located in southern italy, near the tyrrhenian coast south of naples and salerno (fig. 1). it was founded around 800 b.c. and has been continuously occupied since then. its oscan-speaking population was formed of native italic peoples, but with strong influence from both greeks and etruscans. the town’s social structure and culture changed substantially between the eighth and third centuries b.c. as it became increasingly urban, classbased, and integrated with the larger mediterranean world. in the period studied here the town was almost a kilometer square, with a fortification wall, a dense grid street plan, a sacral area, artisan neighborhoods, residential areas, and multiple extramural cemeteries (alfano et  al. 2006). until its takeover by rome in the third century b.c., the town participated fully in the cultural koine of the preroman classical world (d’agostino 1974). over the last 50  years, classical remains from pontecagnano have been extensively excavated, particularly the cemeteries, with substantial bio archae ol o gi cal work done (cencetti 1989; fornaciari et al. 1984, 1986; lombardi pardini et al. 1984, 1992; mallegni et al. 1984; eduardo pardini et al. 1983; elena pardini et al. 1982; petrone 1995; robb et al. 2001; scarsini and bigazzi 1995; serritella 1995; sonego 1991; sonego and scarsini 1994). this study analyzes a homogeneous sample of skeletons from a period of about 10 generations between the fifth and earlier third centuries b.c. in understanding the biographies of these people, two features of social context are critical. first, gender was a key organizing principle of classical culture. classical gender was mostly binary; it was tied closely to biological sex, and it conditioned many aspects of adult life (foxhall 2013; robb and harris 2013:chapter 4 and references therein). in pontecagnano burials, for instance, with a few exceptions there is generally good agreement between skeletal sex and the stereotypical “male” and “female” grave goods (see below). males and females officially became adults between about 15 and 20  years of age, upon marriage for women and when legally recognized as a man around 18 for men (golden 2003); however, they probably began to engage in adult work before this as their capabilities allowed. second, like most or all sizable classical towns, pontecagnano was classstratified; its cemeteries reveal a range of wealth. the samples here comprise mostly the lowermiddle range of society; while they do not contain the wealthiest individuals, they consist of people buried in the normal way with standard rites, which usually consisted of burial in a simple pit or tilecovered grave with a few inexpensive grave goods, mostly ordinary pottery vessels. a sizeble classical town such as pontecagnano had a complex division of labor, with a wide range of specialized workers and craftspeople. many people’s work regimes would have involved generalized or varied tasks, particularly farmworkers and unskilled laborers. but dozens of job specializations were known in both greek and roman society; even in a small city such as pontecagnano, specialized workers would have included porters, stone masons, builders, potters, tile and brick makers, weavers, tailors, shoemakers and other leatherworkers, smiths and metalworkers, carpenters, carters, mule drivers, herders, cooks, and merchants of all sorts of goods. some people buried here may also have engaged in specialized work done elsewhere, for instance, sailors. some of these occupations were engaged in by both free people and enslaved people. women in the classical world often carried out gendered tasks associated with the household, including heavy work such as carrying water; they were normatively associated with spinning and weaving. but they are also known to have carried out activities such as running businesses, and poorer women often did agricultural labor. these two factors suggest that we should expect some differentiation in life courses, both from gender and from the specific activities they robb 61 figure 1. location of pontecagnano within southern italy, ca. 500– 300 b.c. performed. indeed, the two factors intersected; throughout the ancient world, men engaged in a much wider range of specialized jobs than did women (foxhall 2013:96– 101). materials and methods analytical strategy for comparative osteobiography the analytical strategy needed for comparative osteobiography is straightforward, even if some aspects present challenges for skeletal data. a first principle is keeping all data within their context: any individual in our data sets must be seen relative to all the others, leading us to constantly alternate between outlining a general pattern and asking how an individual under study relates to it. a second principle is sequence, arranging events within each life in temporal order. in historical or sociological biographies with welldated life records, this may be done with precision. with skeletal data we normally have to arrange events in bucket categories such as childhood and adulthood, without ordering events within these intervals. in this study, data were assigned to broad stages of the life span (table 1). this included not only biological data but archaeological data as well; funerary treatment beyond individual lives62 reveals a social response following the moment of death. in analyzing the data, two questions are key: 1. at each stage of life, do the data reveal discrete groupings into people whose lives were situated differently? or do they reveal a continuum of variation, or no patterned variation at all? 2. how do events or groupings at earlier life stages influence events or groupings at later life stages? statistically, one could imagine exploring these questions formally using exploratory multivariate analyses (as indeed is sometimes done with sociological data). however, as a preliminary foray it is appropriate here to use a straightforward, more intuitive combination of traditional descriptive statistics, simple inferential statistics such as chisquare and ttest analyses, and visual representations. materials and skeletal methods detailed osteobiographical data on people from pontecagnano were collected by the author in the museo nazionale di antropologia, firenze, in 1991 and 1992. while hundreds of skeletons from the site have been studied (cencetti 1989; fornaciari et al. 1984, 1986; lombardi pardini et  al. 1984, 1992; mallegni et  al. 1984; eduardo pardini et al. 1983; elena pardini et al. 1982; petrone 1995; robb et  al. 2001; scarsini and bigazzi 1995; serritella 1995; sonego 1991; sonego and scarsini 1994), to exclude the effects of historical change, the skeletons chosen for analysis here include a homogeneous sample from the later fifth to early table 1. selected skeletal data for moments in the human life span, listing indicators used in this study. life stage data groupings used in table 2 and figure 7 birth sex (assigning social gender) (buikstra and ubelaker 1994; workshop of european anthropologists 1980) male, female childhood enamel hypoplasia, total number of lesions observed on all teeth in dentition macroscopically using strong oblique light (goodman and rose 1991) 1 lesion, 2– 3 lesions, 4+ lesions cribra orbitalia (buikstra and ubelaker 1994) present / absent stature achieved by adulthood; estimated using all available long bones (trotter and gleser 1958) lower ¼ of male or female range, middle of male or female range, upper ¼ of male or female range adult life traumas as evidence of life risks, identified macroscopically (ortner and aufderheide 1991; ortner and putschar 1981; for more detail on trauma in this collection, see robb 1997) present/ absent dental disease (caries, antemortem tooth loss) presence/absence schmorl’s nodes, number of vertebrae affected (ortner and putschar 1981) 0, 1– 4, 5– 7, 8+ new bone growth (ortner and aufderheide 1991; ortner and putschar 1981; cf. weston 2012) “periostitis”: present/absent anywhere in the skeleton “tibial periostitis”: present/ absent in the tibia(s) arthropathies as evidence of habitual activity (rogers and waldron 1995; rogers et al. 1987; cf. waldron 2012) “osteoarthritis”: presence or absence of marginal bone proliferation, porosity and eburnation “eburnation”: presence or absence of eburnated surfaces entheseal variation as evidence of habitual activity (recorded as grades of expression between 1 and 5, with average entheseal score used to characterize overall skeleton) (hawkey and merbs 1995; robb 1998) (cf. fig. 2) mean entheseal score, grouped into lower ¼ of male or female range, middle of male or female range, upper ¼ of male or female range traits potentially related to specialized activity (see text for explanation) “specialized activity: presence/ absence of several relevant traits” death age at death, representing longevity and mortality as conditioned by social factors (buikstra and ubelaker 1994; workshop of european anthropologists 1980) decade of age at death treatment at death total pottery vessels deposited in the grave (fig. 6, table 2: 0 vessels, 1– 5 vessels, 6+ vessels) 0 vessels, 1– 5 vessels, 6+ vessels grave goods other than pottery presence or absence of grave goods other than pottery presence or absence of specifically “female” ornaments presence or absence of specifically “male” objects (weapons, armour, strigils) presence or absence of other objects robb 63 third centuries b.c. only skeletons well enough preserved to afford mostly complete data were used, and only skeletons with a full range of data collected by a single observer were used. to maximize the biographical information available, only adult skeletons were included in this analysis. a wide range of data were collected: sex, age, stature, and pathologies, non pathological variations, and signs of activities. details of data collected and the relevant standards used are presented in table 1. it is important to realize that, to some extent, this study uses legacy data which reflects the state of the field in the early 1990s. this is evident in what is not included: although most modern osteobiographies would include light stable isotopic and ancient genetic data, these data are not available here. for some other methods, either data collection standards or interpretations have moved on substantially, and consequently these data are omitted here (e.g., studies of biodistance using metrics and nonmetrics; interpretations of activity based upon external bone measurements rather than scan data; pelvic observations once considered related to parturition). many basic standards have changed relatively little (e.g., for aging, sexing, stature estimation, macroscopic recording of linear enamel hypoplasia, presence of activityrelated skeletal variations, and trauma). observation and recording of most paleopathologies remain commensurate, even as interpretations of some have changed. the most rapidly developing methodologies are for entheseal markings (fig.  2), with some researchers using ordinal categories analyzed statistically (hawkey and merbs 1995; weiss 1999, 2007) and others using the “coimbra” system (henderson et al. 2016). even these efforts fail to reflect the biological complexity of muscle attachment sites, and a satisfactory solution has yet to be reached (villotte and knüsel 2013). the data presented here use standards similar to the former, resulting in ordinal grades expressing the full range of morphological variation at an entheseal site (robb 1998). although in some cases one might employ updated standards in a study designed today, the data selected for analysis here are those that are stable and commensurate with standards used today, and they serve effectively to illustrate the approach pioneered here. perhaps the biggest shift in methods and interpretation since 1990 involves issues raised by the “osteological paradox” (wood et al. 1992); the extent to which skeletal phenomena may be agerelated is fundamental to biography and has been taken into consideration throughout the interpretations presented here. analyzing the data collected presents other challenges. some data lack standardized or conventional forms of analysis (e.g., does one tabulate osteoarthritis by joint surface, by bone, or by joint?). in this study, data are analyzed contextually in ways most effective fig. 2. example of standards used to record entheseal marking variation for the common extensors origin, lateral epicondyle of distal humerus. grade 1: no trace of marking visible (not illustrated). left to right: grade 2: small facet is visible; rim of facet is finely rugose and may be indistinct in places, and surface of facet is smooth. grade 3: facet is larger and well bounded on all sides; rim may be slightly raised, and surface is smooth or finely rugose. grade 4: facet is large, covering much of the surface of medial epicondyle; surface may be rugose or rugged, and border is unclear due to rugosity or surface destruction. grade 5: osteophytes; a small protuberance below the edge of the medial epicondyle may be present. beyond individual lives64 for this sample and question. for example, both enamel hypoplasia and schmorl’s nodes were very common in this group, and simply registering them as present or absent does little to highlight variation among individuals; tabulating the number of lesions or using a range of incremental bins proved more revealing. similarly, it seems probable that, in this collection, periosteal deposition on the tibia resulted partly from different causes and had a somewhat different distribution than periosteal deposition elsewhere in the skeleton, and thus the two were analyzed separately. such methodological judgments need to be grounded in the specific nature of each sample analyzed. bodies shaped by work: signs of labor one category of data proved particularly important to this project. work and activity are one fundamental route by which social position and identity intervene in a person’s life story; they also deeply shape the evidence of the body (capasso et al. 1999; jurmain 1998; jurmain et al. 2012; kennedy 1989, 1998; merbs 1983; robb 1994; sofaer 2006; weiss 1999). this is true above all for historical contexts in which there was a highly specialized division of labor but most people still performed strenuous manual work. it is no surprise that it was victorian physicians such as w. a. lane (kennedy 1989) who began to recognize occupationally induced morphologies, fractures, arthropathies, and pathologies. similar conditions characterized life in ancient cities such as pontecagnano. as this insight would suggest, in the skeletons under study it was common to encounter people with highly idiosyncratic patterns of functional modifications, arthropathies, entheseal changes, and gross morphology. these skeletal signs were often markedly different or unique, rather than simply extreme manifestations of conditions common to many people, suggesting that at least in some cases, they must represent some functionally stressful activity that affected a few individuals to a great extent and others little or not at all. to take one example, several individuals in this sample displayed strongly lateralized eburnation and asymmetry in the cervical vertebrae, which suggested that the neck was habitually compressed sideways. this would be compatible with habitually carrying a heavy load such as a block of stone, a bale of goods, or an amphora on one shoulder, with the neck and body bent sideways to stabilize the load and keep the center of gravity over the base of the spine. trying to identify the specific activities that led to such bodily changes is rarely possible, particularly as such skeletal variations almost never respond solely to activity (see recent overview by jurmain et  al. 2012). but, given the range of specialized manual occupations known in ancient cities, we should expect that many people in pontecagnano habitually performed stressful, specialized labor, and this would result in skeletons with marked, idiosyncratic patterns of pathology and functional change. this is a classic example of something osteologists can readily intuit while studying a collection but for which we have no developed methods for analyzing systematically. standard protocols exist for recording data on entheseal markings, osteoarthritis, and some functional variations such as supernumerary facets in joints. but many observable, possibly functional variations have never actually been studied, and those that have been studied respond to multiple causes. to take an example, schmorl’s nodes are small lesions on vertebral bodies where bone has resorbed around a herniated intervertebral disk; they may reflect axial loading or spinal trauma, and they are sometimes but not always associated with lower back pain. some authors consider schmorl’s nodes simply an agerelated degenerative symptom (buikstra and ubelaker 1994:121) even though they are often seen in young adults; others cautiously admit that they may be related to work and activity stress (jurmain 1998:166), while yet others consider them clearly related to mechanical stress (capasso et  al. 1999:38; mann and murphy 1990:52) or to vertebral morphology (plomp et  al. 2012, 2015). clinical reviews suggest that they are multifactorial in origin, but functional loading is one important factor, particularly in younger patients (kyere et al. 2012; mattei and rehman 2014). to add a layer of complexity, information about social process may reside in multivariate patterns, and hence simply tabulating single indicators such as one particular activityrelated trait is usually insufficient. essentially, we need a way to characterize people based upon a close reading of the texture of variation in their overall skeleton, and without regarding any single trait as diagnostic of activity. in this study, however, simply as a proof of concept, a simple, direct approach has been taken. using the general type of evidence considered to be potential signs of activity (capasso et al. 1999; dutour 1986; kennedy 1989; merbs 1983), skeletons were identified as likely to have performed some specialized form of labor, based upon several observations (fig. 3): • idiosyncratic arthropathies, such as localized eburnation: for instance, one skeleton displayed bilateral eburnation on the articular surface of the coronoid process of the ulna, suggesting stressful forces pulling upon the forearms at full extension. similarly, several skeletons displayed ankylosis of the first rib and sternum. robb 65 • functional modifications: besides nonmetric traits such as facets around the joints such as hands, feet, and hips suggesting habitual positions (finnegan 1978; trinkaus 1975), examples include articular facets between the spinous processes on lumbar vertebrae (kacki et al. 2011) and accessory facets within the shoulder capsule. other examples include functional modifications such as interdental grooving probably related to craft activity. • morphological changes such as marked asymmetry in the thorax or vertebrae. • idiosyncratic entheseal changes (e.g., places where specific muscle insertions departed markedly from the general pattern both within the skeleton and for the sample as a whole). in most cases, several of these factors were used together in categorizing somebody as potentially a specialized worker. traumas, pathologies, and variations probably pathological in origin were excluded from use in this categorization; while they are analyzed below, they were not taken into account in assessing (a) figure 3. examples of skeletal features considered potentially related to specialized activity: (a) eburnation, dens, c1 (3805); (b) interdental grooving between multiple upper teeth (3805); (c) spur at insertion of lateral pterygoid muscle, mandible (4065); (d) ankylosis of manubrium and left first rib (4021); (e) osteophyte limiting motion at coronoid process of left ulna (4040); (f) bilateral extension of proximal articular surface onto anterior surface of clavicles (4040); (g) broadened iliac crest with markedly rugose insertion of erector spinae (4040); (h) eburnation, head of first metatarsal (4040). (a) (b) (c) (d) beyond individual lives66 “specialist” status so as to be able to compare them to “specialization” without autocorrelation. schmorl’s nodes were also excluded from this categorization, as they occurred very commonly rather than idiosyncratically throughout the sample, suggesting a different pattern of causation (see below). as a method, this essentially formalizes a close reading of the skeleton, rather than rigorously collecting “hard” data in the traditional way. it does not claim to provide an ironclad diagnostic of specialized forms of labor (since there may be other causes behind the observed variations, and many specialized forms of work may not have left distinctive skeletal signatures); it also will bear some relationship with age, as some of the diagnostic signs of habitual activity patterns develop and become more distinct with age (this is controlled for below). but it is difficult to see any other way of addressing at least semisystematically the patterned variation in activity indicators that the collection displays. at the level of preliminary exploration attempted here, it provides a roughandready first means of characterizing variation in complex traces of habitual activity. if it provides promising results, more sophisticated methods may be developed. figure 3. (continued ) (e) (f) (g) (h) robb 67 the first moment of a social biography: birth, the assignment of gender, and its life consequences most aspects of birth are not accessible to us for these people. we can, however, see one social response to birth: assigning a gender to the newborn. people were ascribed a gender immediately at birth (foxhall 2013:50). bioarchaeologists usually consider sex as a biological given, in contrast to culturally defined gender. we cannot assume a priori that in every society, gender is mapped directly onto biological variation (geller 2017; hollimon 2011; sofaer 2013). however, in classical society, gender was closely aligned with morphological sex; it was considered mostly binary; and it was accompanied by strong expectations about gendered work and comportment. it is specifically for these reasons that i view biological sex here as a reliable proxy for social gender. treating sex in this way allows us to see being born as a biological male or female here as the first moment in an individual’s social biography, a social categorization placing the newborn on a particular social track. this act had profound consequences throughout the life span. women and men had quite different kinds of lives at pontecagnano (tables  2 and 3). among childhood indicators, there is little difference in enamel hypoplasias; while cribra orbitalia is more frequent among women, this may indicate differing metabolic demands rather than social conditions. gender differentiation is most marked in adult indicators of behavior. men systematically had higher levels of schmorl’s nodes, traumatic injuries, periostitis (both generally and in the tibia), osteoarthritis (both generally and in eburnation), and entheseal markings (table 3). some of these differences may be ascribable to age, as there are proportionally more older males in the sample, but the malefemale difference in age at death is not statistically significant (p = 0.342). more importantly, in women, these degenerative and accumulative indicators tend to occur in older individuals, but among men they often occur in men who died in their twenties. this suggests that the rate of wear and tear differed, with men’s bodies exposed to stress and risk earlier and at a faster rate than women. men’s and women’s deaths were also responded to in different ways. women tended to be buried with more grave goods than men. moreover, when women were buried with things other than pottery these tended to be ornaments, while men tended to be buried with weapons, blades, elements of armor (typically a large metal belt), or strigils (a personal bodygrooming accessory used in maleonly world of the gymnasium). these choices of grave goods are virtually stereotypical of gender imagery in the classical world (see vida navarro [1992] for similar patterns in earlier periods at pontecagnano). moreover, women received the most grave goods if they died in young adulthood, while men were more likely to be buried with goods if they died at older ages, perhaps reflecting increasing wealth or authority (gnoli and vernant 1982). this suggests that the narratives used to make sense of lives may have differed for women and men. childhood childhood must have been an important time of life, but in this sample there is little evident association between indicators of childhood health, suggesting that the experience of childhood may not have differed systematically in important ways. nor do we observe a clear relationship between hypoplasia, stature, cribra orbitalia, and biological or social events later in life. there are several obvious reasons for this. first, this sample represents a relatively homogeneous social and economic stratum; classical towns such as pontecagnano had extremes of wealth and poverty, but they are not represented specifically in this sample. second, in an ancient town such as pontecagnano, while betteroff people could shield their children from some risks of harm and malnutrition, the ability to control many health risks such as illness was limited. for example, malaria was endemic in southern italy until recent drainage works, and would have affected all sectors of ancient society. as cribra orbitalia could result from several such conditions, this may be why it does not correlate with social markers. third, some people may have shifted their status over their lifetime (e.g., people who were born enslaved but became free). moreover, this sample includes only people who lived to adulthood. it therefore does not contain primary evidence for one role childhood played in shaping the biography— the people dying as children who never made it to adulthood. becoming impaired did physical impairment play a role in channeling people’s lives? the sample includes three male individuals with conditions that might have affected their social presence or ability to work. the most marked case (3720) had a congenital deformity (humerus varus) that made his right arm 50 mm shorter than his left; he died in his twenties, with severe eburnation in his right shoulder joint, implying some longstanding beyond individual lives68 table 2. biographical data on 47 adults from pontecagnano (fifth to third centuries b.c.), colored according to categories used in analysis, and sorted by sex, life span, and schmorl’s nodes. data are sorted by sex, then age, then schmorl’s nodes. childhood adult experience life span treatment at death n um be r se x h yp op la si a c ri br a st at ur e sc hm or l’n od es tr au m a pe ri os tit is ti bi al p er io st iti s o a eb ur na tio n en th es ea l s co re sp ec ifi c l ab or 20 –3 0 30 –4 0 40 –5 0 50 – to ta l p ot s to ta l g oo ds to ta l n on -p ot s n on -p ot s (c at eg or y) 3838 f 6 y 170.6 0 n n n n n 1.75 n y n n n 0 0 0 none 4094 f 3 1 152.7 0 n n n n n 2.23 n y n n n 1 1 0 none 3748 f 3 155.3 0 n n n 2.38   y n n n 0 3 3 ornaments 4017 f 2 n   0 n n n n n 2.18 n y n n n 6 11 5 ornaments 4019 f 2 n 154.6 0 n n n n n 2.18 n y n n n 14 21 7 ornaments 4059 f 4 y 157.6 5 n n n n n 2.36 n y n n n 0 0 0 none 4105 f 4 n 148.8   n n n n n 1.97 n y n n n 1 1 0 none 4106 f 3 y 160.9   n y y n n 2.08 n y n n n 3 3 0 none 4083 f 1 n     n n n n n 2.06 n y n n n 5 5 0 none 3499 f 3 y 158.5 0 y y y n n 2.79 n y y n n 7 11 4 ornaments 4013 f   n 160.8 0 n n n n n 2.65 n y y n n 2 3 1 ornaments 4045 f 1 n 151.5 1 n y y n n 2.28 n y y n n 0 1 1 ornaments 4020 f   153.0   n y y n n 2.57 n y y n n 1 1 0 none 4065 f 3 n 152.7 0 n n n y y 3.26 y y y y n 0 0 0 none 4035 f   157.4 0 n n n n n 2.82 n y y y n 0 0 0 none 4026 f 1 y 158.3 1 n y n y n 2.92 n y y y n 0 0 0 none 4034 f 1 y 154.7 5 y y n n n 2.51 n y y y n 1 2 1 ornaments 4084 f 2 144.3   n y n y n 3.27 n y y y n 0 0 0 none 4033 m 3 n   1 n y y n n 1.87 n y n n n 0 1 1 other 4085 m 3 n 166.8 2 y y y n n 2.52 y y n n n 0 0 0 none 3720 m 1 n 157.2 5 n n n y y 2.16 n y n n n 2 3 1 other 4093 m 3 y 169.8 8 y y y n n 2.39 n y n n n 0 0 0 none 4040 m 0 n 168.1 10 n n n y y 3.32 y y n n n 0 4 4 weapon 4029 m 3 y 165.0 11 y y y n n 2.47 n y n n n 0 0 0 none 4027 m 1 n 167.0 11 y y y y n 3.12 n y n n n 0 0 0 none 4016 m 4 n 170.2   y n n n n 2.54 n y n n n 1 1 0 none 3801 m 2 n 155.6   n n n y n 2.11 y y n n n 10 10 0 none 4037 m 2 n 172.7 0 n n n y n 3.33 n y y n n 1 1 0 none 4038 m 0 n 162.7 0 y y y n n 2.4 y y y n n 3 4 1 weapon 4051 m 3 n 163.0 0 y y n y y 2.7 y y y n n 0 2 2 armour 4025 m 3 n 169.9 1 y y y y y 2.61 n y y n n 0 0 0 none 3805 m 2 n 168.7 4 n y n y y 3.59 y y y n n 3 3 0 none 4028 m   168.2 0 n y y y n 3.14 n y y y n 0 0 0 none 4046 m 3 y 167.2 0 y y y n n 2.92 y y y y n 0 2 2 weapon 4021 m 2 170.8 0 n y y y y 3.14 y y y y n 0 1 1 strigil 4058 m 2 n 164.2 2 n y y y n 3.6 y y y y n 0 0 0 none 4043 m 1 n 166.5 3 y y n y n 3.09 y y y y n 0 0 0 none 4015 m 4 164.6 3 y n n n n 2.82 n y y y n 1 3 2 armour, strigil 4039 m 4 n 167.1 7 n y y y y 3.07 n y y y n 1 3 2 weapon robb 69 shoulder dysfunction (fig. 4). he had schmorl’s nodes in five vertebrae, implying an active physical regime, and was buried with normal rites, including for some reason an iron nail in his burial. a second individual (4025) had a probable subluxation of the right hip, which may have affected his gait. he also suffered traumas to the left ulna and radius and to his eighth thoracic vertebra, all healed; he died in his thirties and was buried without goods. the third (4029) suffered a fractured right femur midshaft that healed well but left his right leg angulated medially by about 15 degrees and 24 mm shorter than his left, probably affecting his childhood adult experience life span treatment at death n um be r se x h yp op la si a c ri br a st at ur e sc hm or l’n od es tr au m a pe ri os tit is ti bi al p er io st iti s o a eb ur na tio n en th es ea l s co re sp ec ifi c l ab or 20 –3 0 30 –4 0 40 –5 0 50 – to ta l p ot s to ta l g oo ds to ta l n on -p ot s n on -p ot s (c at eg or y) 4012 m 2 y 160.3 7 n n n y n 2.82 n y y y n 5 5 0 none 4100 m 3 n 162.4 7 n y y y y 3.23 y y y y n 0 0 0 none 3733 m 1 n 175.6 10 n n y y 2.99 y y y y n 2 2 0 none 4018 m 2 n 166.6   y y y y y 2.82 y y y y n 0 0 0 none 4047 m 1 n 169.8 0 y y y y y 3.13 y y y y y 0 1 1 weapon 3533 m 0 n 166.6 0 y y y y y 2.83 y y y y y 1 2 1 armour 4042 m   165.2 10 n y n n n 2.99 n y y y y 0 1 1 other 4102 m 3 n 168.6 11 n y y y n 3.04 n y n n n 4 4 0 none table 3. gendered differences in skeletal markers. stage of life biographical marker females males childhood enamel hypoplasia 0– 1 lesions: 4 2– 3 lesions: 8 4+ lesions: 4 0– 1 lesions: 8 2– 3 lesions: 16 4+ lesions: 3 cribra orbitalia 7/14 (50%) 4/25 (16%) stature mean 155.7 mean 166.4 adult experience schmorl’s nodes 4/13 individuals (31%) 18/26 individuals (69%) mean vertebrae affected per person: 0.92 mean vertebrae affected per person: 4.35 trauma 2/18 (11%) 14/29 (48%) periostitis 7/18 (39%) 21/29 (72%) tibial periostitis 4/18 (22%) 17/28 (61%) oa 3/17 (18%) 20/29 (69%) eburnation 1/17 (6%) 12/29 (41%) entheseal score mean: 2.46 mean: 2.85 specialized labor 1/17 (6%) 15/29 (52%) life span life span 20– 30: 9 (50%) 20– 30: 9 (32%) 30– 40: 4 (22%) 30– 40: 5 (18%) 40– 50: 5 (28%) 40– 50: 11 (39%) 50+: 0 (0%) 50+: 3 (11%) response to death total pots mean: 2.28 mean: 1.17 total other goods mean: 1.22 mean: 0.66 total goods mean: 3.50 mean: 1.83 kinds of other goods ornaments weapons, armor, strigils, a few miscellaneous objects beyond individual lives70 gait. he also had cribra orbitalia (unusually for a male in this sample), strong entheseal markings for his age, 11 vertebrae with schmorl’s nodes, and a healed blade cut to his right orbit. he died in his twenties. all three men clearly had a high risk of injury and physical stress, and none survived beyond his thirties, placing them at one end of the spectrum of adult male experience (see below) and suggesting perhaps that ordinary social life did not treat them kindly. on the other hand, all three men were buried in a more or less “normal” way, and the life risks they ran were not unique to them but shared with other men. this suggests that they were not categorically excluded or stigmatized; as laes (2018) comments for the roman period, people with such impairments may have experienced pain and been socially marked or disadvantaged, but they would also have been integrated into everyday social life. adulthood: women’s life paths the pontecagnano women in this sample seem a homogeneous group, at least skeletally (table 2; fig. 7). they display relatively few pathologies, traumas, or adaptations to marked physical stress. they clearly experienced serious life risks, as many of them died relatively early in adulthood. it is possible that some died in childbirth, but we cannot prove this. their burials, however, give us some idea of the normative biography for women. many women dying young had simple burials. for example, 4094 stands for many of them; a small, gracile woman, she died between 18 and 22 years of age and was buried with a single pot. but while 4019 had a similar life trajectory, her burial reveals both more wealth in life (if the gold and silver ornaments she wore in death belonged to her) and a more ostentatious expression of grief in the willingness to sacrifice such wealth permanently. the three women who had relatively lavish grave goods all died relatively young (4017 and 4019 in their twenties, 3499 between 30 and 35). classical sources suggest that motherhood was an important component of women’s identity, and it may be that such ceremonial expressions react to a “bad death” (gnoli and vernant 1982), a sense of losing this opportunity; perhaps they mark a woman dying without children (daughters, or sons who might marry) to whom she could pass on her personal gendered wealth. in contrast, older women generally received relatively simple burials. classical women are often shown in art as authoritative matriarchs at the center of a family (leader 1997); it seems likely that women’s age was valued, but it was expressed in ways other than burial. figure 4. congenital “humerus varus” condition, 3720: (a) right and left humeri; (b) proximal epiphysis, left humerus. (a) (b) robb 71 fig. 5. relationship between average entheseal scores and age at death. top chart: women. bottom chart: men. there were also variations from this common pathway. some may reflect individual variation. individual 4084 was a very small woman (144.3 cm) with enamel hypoplasias reflecting two severe episodes of stress in childhood. she survived until her forties; when she died, she had osteoarthritis in her cervical vertebrae, a healed periosteal lesion on her left femur, an enthesopathy on her right bicipital tuberosity, and hyperostosis frontalis interna. none of these necessarily speak of a life of poverty or marginality. other variations probably reflect work patterns. while classical women, particularly among the poor, routinely did physical work including farm and industrial work, they performed specialized jobs less often than did men. three women in this group (3838, 4059, 4015) display a pattern of early death with many hypoplasias, cribra orbitalia, and/or reduced stature, perhaps suggesting particular poverty. given how rare it is for women in this group to display schmorl’s nodes, it is striking that 4059 had five vertebrae affected by them before she died between 18 and 22; this may mark her as performing especially heavy work. in contrast, 4065 appears the best candidate for a woman undertaking specialized work. she displays osteoarthritis in her hands, feet, and neck (the latter with eburnation), but not her back, suggesting that it is not simply due to agerelated degeneration. her entheseal markings are idiosyncratically varied, with particularly marked common extensors and flexors bilaterally, and, interestingly, marked insertions for the lateral pterygoid muscles. her left first metacarpal displays a 10 mm palmar outgrowth at its base which may be due to a functional extension or a poorly healed avulsion fracture. these may suggest that she habitually engaged in some specialized activity before she died in her forties, perhaps some craft production. interestingly, neither she nor 4059 were accorded particular burial treatment. this may suggest that, while particular forms of women’s work may have been valued, physical work per se did not form part of a woman’s identity in the same way it did men’s. adulthood: men’s divergent life paths the pontecagnano male skeletons seem both “busier” and more varied, in complicated ways. the effect of age is surprisingly minimal. we might expect both agerelated phenomena such as osteoarthritis and lesions such as traumas and periosteal deposition (which accumulate in the skeleton over time) to show a clear relationship with age at death— a version of the “osteological paradox” (wood et al. 1992). indeed, this is the case with dental disease (caries and antemortem loss) in this sample, which clearly progresses with age. but systematic screening shows no significant relationship between most of the skeletal features considered here and age in males. the only exception is the average entheseal score, and even this is much less closely associated with age in men (r2 = 0.264) than it is in women, among whom it shows a quite close relationship (r2 = 0.723) (fig. 5). while entheseal marking increased with age in all men, in some men this happened gradually, while others began experiencing noticeable entheseal changes as soon as they achieved adulthood, if not before; the age at onset is confirmed by men dying in their twenties with high entheseal markings (fig. 5). the same thing can be seen with schmorl’s nodes. interestingly, there seems to have been a difference between males with five or fewer schmorl’s nodes (principally involving lumbar vertebrae, perhaps for biomechanical causes [plomp et al. 2012, 2015]) and those with more than five which implies substantial thoracic involvement (fig. 6). overall, beyond individual lives72 table 4. schmorl’s nodes in men from pontecagnano. gray = skeletal evidence of possible specialized labor. black = none. * = buried with grave goods other than pottery. number of thoracic and lumbar vertebrae with schmorl’s nodes dying 20– 30 dying 30– 40 dying 40– 50 dying 50+ 0 4037 4038* 4051* 4021* 4028 4046* 3533* 4047* 1 4033* 4025 2 4085 4058 3 4015* 4043 4 3805 5 3720* 6 7 4012 4039* 4100 8 4093 9 10 4040* 3733 4042* 11 4027 4029 4102 fig. 6. the number of vertebrae affected by schmorl’s nodes in males; red shows individuals flagged as possibly performing specialized labor, blue shows individuals not flagged as such. asterisks mark individuals buried with grave goods other than pottery vessels. in the pontecagnano sample, while some men dying older may have accumulated these lesions with age, others clearly experienced extensive spinal damage before dying in their twenties (table 4). skeletal degeneration, thus, did not simply mirror age. some men may have followed highimpact lifestyles that placed heavy general stress upon the skeleton from the very beginning of adulthood, while others followed lowerimpact lifestyles in which wear and tear accumulated more gradually. but who were these men? which pathway they traveled may have had some relation to their occupation. ancient cities such as pontecagnano had complex divisions of labor, with a wide range of recognized, full time occupations for males, most involving physical labor. here, about half (15/29) of the male skeletons were identified as potentially having performed specialized work using the criteria described above. as noted above, this is merely an approximate, suggestive categorization, but it helps to identify those skeletons with unusual, potentially activityrelated features. “specialization” has a complex relationship with schmorl’s nodes (recall that the two were separated analytically here as variables independent from each other). the distribution of schmorl’s nodes in men is clearly bimodal (fig. 6): 16 men had 0– 5 lesions, while 10 had 6– 11 lesions. men with no or few schmorl’s nodes were more likely to be “specialists”; men with many schmorl’s nodes were more likely not to be “specialists” (fig. 6). this suggest that some men habitually performed activities placing generalized stress upon the back, while others performed physically forceful but much more specific activities. a few examples can give a human sense of such patterns. at one pole are individuals such as 4027, 4029, 4093, and 4102, who died young showing signs of hard physical labor. for example, by the time he died between 20 and 25 years of age, 4027 already had strong entheseal markings for his age (particularly torso musculature such as the erector spinae), 11 vertebrae marked by schmorl’s nodes, and osteoarthritis in his spine, neck, and acromia, not to mention having broken five right ribs which were probably fractured in a single episode and subsequently healed. in such cases, ongoing entheseal damage, joint degeneration, and minor back injuries were unlikely to have caused their deaths directly, almost all traumas observed were healed, and their early age at death probably bespeaks other life risks in addition to these stresses, suggesting hard or hazardous lives. men such as these, dying in their twenties with heavily stressed skeletons, were often buried without grave goods. at the other pole are individuals such as 3533, 4021, 4028, and 4047. these men show signs of specialized work regimes, lived relatively longer lives, and were buried with prestigious objects. for example, 4021 died in his forties with no schmorl’s nodes or trauma, but he displays highly varied and idiosyncratic enthesopathies, unilateral eburnation marking lateral compression of the neck, asymmetry of the thorax with slight, hardly noticeable scoliosis, strongly asymmetrical robb 73 arms, and ankyloses of the first ribs and sternum. he also had time to develop generalized periostitis and moderate osteoarthritis in the spine and shoulders. he was buried with a strigil, a reference to the urban, socially aspirational masculine culture of the gymnasium (robb and harris 2013:chapter  4). five or six other men in the sample display similar patterns. we must be cautious about interpreting relations between possible work specialization and age at death, as some of the evidence for work patterns (entheseal markings and arthropathies) becomes more distinct and legible with advancing age. but at least some younger men’s skeletons show that differentiated activities could leave traces in the skeleton already from early adulthood. at death, men identified as possibly performing specialized work may have been buried more often with weapons, armor, or strigils (table 2). one might expect athletic equipment such as strigils to be associated with younger men rather than with men in their thirties, forties, and fifties, and there is no clear association between being buried with weapons or armor and skeletal evidence of actual violence (table 5). instead, these grave goods probably refer to ideals of masculinity and to social identity or community position. but before we simply divide pontecagnano males into laborers crushed by toil and upwardly mobile craft specialists, it is worth looking at variations too. we may perhaps identify generalized workers living to old age; for instance, 4042 lived into his fifties with no particular signs of activity beyond 10 schmorl’s nodes. conversely, some men with “specialized” skeletons died in early or middle adulthood. individual 4051 died in his thirties with no schmorl’s nodes but with an unusual pattern of activity markers. he habitually flexed his head, creating an articular facet for the occipital on c2; this was accompanied by a button like callosity on the back of the sacrum, hyperflexion in his hips (with extension of the articular surface on to the anterior neck of the femurs) and ankles (with wellexpressed hyperflexion facets on both distal tibiae), alteration of the shape of the left patella, and strongly lateralized arms with eburnation at the right acromion. his three broken ribs may not have been related to whatever activities created this suite of skeletal changes. he was buried with a large metal belt (a highstatus male object related to armor) and some hooks. the body of 3085 was marked above all by activity in the mouth and head region, shown by dental grooving between many teeth (something almost unique in this group), the development of two separate wear planes on his anterior teeth, strong development of the temporal muscles, and osteoarthritis evidencing downward pressure on the left side of the neck. this was accompanied by eburnation in the manual phalanges, general osteoarthritis in the neck, thoracic spine, and elbows, and periostitis in the right fibula and right olecranon fossa. when he died in his thirties he was buried with three pottery vessels. such variations suggest that men’s life paths were not rigid or categorical tracks but fuzzy envelopes of possibilities. how far can we go in interpreting life paths among these men? some skeletons offer few hooks on which to hang a biographical narrative. individual 4028, who died in his forties with active periostitis in his lower legs and enthesopathies at the insertions of his left gluteus maximum and adductor magnus, was buried without grave goods. such men either followed other patterns of activity or did not trigger the biological processes creating clear skeletal data. others offer, if anything, too much information. individual 4038 is not particularly large (162 cm), and his skeleton is not marked by schmorl’s nodes or by particularly developed entheseal markings. it is not clear why both his humeral shafts are bent outward by 5– 10 degrees. but he shows old fractures of his lower right third molar and left clavicle, and his skull shows a clear perimortem trauma from a strong blow to the left parietal with some blunt instrument, creating a blownout circular perforation with internal beveling, radiating fractures, and no signs of healing (robb 1997: fig. 5.3). when he died in his thirties, 4038 he was buried with three pots and an iron blade. perhaps the most dramatic skeleton is 4040 (see robb 1994). he was a young man who lived until 25– 30. even in his short adult life, he had table 5. grave goods and trauma in pontecagnano males trauma related to violence none possible probable grave goods related to violence or masculinity none 16 individuals 4027 (ribs) 4016 (cranial) 4029 (cranial) possible 4021 (strigil) 4047 (knife) 3533 (boxer’s fracture; metal sheet) probable 4015 (metal belt, strigil) 4021 (strigil) 4039 (blade) 4040 (point) 4051 (ribs; metal belt) 4038 (cranial, perimortem; blade) 4046 (cranial; point) beyond individual lives74 acquired a long suite of skeletal changes. these included strongly marked entheses for his age and vertebrae with 10 schmorl’s nodes, but also many more specific markers: severely worn anterior teeth, entheses showing very strong flexion and abduction of both arms, an osteophyte on the coronoid process limiting flexion of his left ulna, strong flexion of the fingers, enthesopathies at the insertion of erector spinae, ankylosis of the third and fourth thoracic vertebrae, a buttonlike callosity on the posterior sacrum, eburnation of the head of right first metatarsal, and flattened heads of the metatarsals. these do not all have to refer to a single activity or occupation, but they form a unique set in this group, and they also show that specialized activity may have involved very forceful physical stress and may be evident already in early adulthood. when he died, 4040 was buried with an iron lance point, a fibula, and a pendant made from a boar tooth. imagining ancient lives this article is experimental; it will have succeeded if it gives the reader the sense of having encountered the people of pontecagnano as people rather than as skeletons and if it gives a sense of both the common patterns and the different tracks their lives followed as they unfolded. i have intentionally tried to write in terms a historian or anthropologist might use to talk about people rather than terms an osteologist would use to talk about skeletons. much as barrett and blakey (2011) have done with enslaved africans in early new york, i have also tried to juxtapose multiple osteobiographies to give a sense of the major issues, challenges, or range of life experience people had. in interpreting these people’s lives, i have tried to walk carefully between two extremes. one is over formalizing— for instance, by trying to rigidly typologize skeletons into formally defined groups. biological data always have variation due to multiple causes, and assigning individuals to categories automatically moves everything else we know about them into the background, simplifying our understanding of them. the other extreme is overconcretizing. osteobiography traditionally focuses upon adding as much detail as possible about individual subjects. it is tempting to imagine 4016 as a welloff and attractive young woman dying before her marriage or in childbirth, or 4065 as an older woman sitting at a loom. individual 4059 could be a dependent or a slave, hauling heavy jugs of water for a large household all day, with 4027 her male equivalent, toiling at backbreaking unskilled labor. individual 4051 squats, head bent intently and legs akimbo, over his workbench or potter’s wheel, while 4040 hauls at the oars of a galley. all of these are entirely plausible for the historical context and skeletal data; none of them are the only possible pictures the data allow. but beyond the risk of drawing unwarranted conclusions, focusing upon single individuals and their individual stories loses the sense of how human lives unfolded generally within this community. when we juxtapose many biographies, what really emerges is the texture of social process. at pontecagnano, children were placed on gendered tracks at birth, giving them different life chances and risks. these gendered pathways were conditioned not merely by biological difference but above all by social differences regarding ideas of the life trajectory and activities appropriate to male and female lives. childhood seems not to have had a strong influence on adult trajectory, provided one survived it. physical limitations did not place individuals outside the range of ordinary activity and burial. once they reached adulthood, women had more homogeneous life paths. there is some differentiation both in terms of evident wealth and physical stress, but there are not marked discontinuities among the women in this sample. their deaths were most marked in terms of gender and wealth in early adulthood; physical work seems not to have been a strongly salient part of their identity as it was among men. men’s lives were more differentiated, and they seem to have become so immediately from the onset of adulthood, if not before. if there were strong or rigid categories, they may have been legal or political (e.g., servitude or economic dependency) rather than simply mapped on to activity regime, and are invisible to us now. what we see, instead, is a spectrum. some men performed stressful general labor, and many of them died young. some men probably performed specialized labors, and they may have had a greater chance of living longer and being buried with markers of masculinity, social aspiration, or position. but it would be misleading here to speak of rigid social differences, for example between artisans and laborers; even within this small sample from a limited segment of the social spectrum whose lives were far more similar than they were different, we see men exemplifying all variants on these possible tracks. life tracks provide fuzzy, nondeterministic envelopes rather than narrow pathways. they should leave statistical patterns in large samples. in small samples, as we lose the ability to nail down correlations statistically, we gain the ability to think about the people we study as individuals. hence a map of our subjects’ life courses shows tendencies, bundles of trajectories, but also a tangle of interweaving lives (fig. 7). these represent the result of not only social position but also biological variation, contingency, and social movement. and there is no reason to suppose that these histories would not have been discursively available to people robb 75 in ancient societies, at least as ideals of normative lives and the situated histories of how far individuals were able to negotiate the challenges they faced. acknowledgments i am grateful to the museo nazionale di antropologia, firenze, for permission to study the skeletons from pontecagnano, and to colleagues who helped with that research: vitaliano rossi, caterina scarsini, renzo bigazzi, fiorenza sonego, and luca lazzarini. sarah inskip and piers mitchell provided helpful advice on this manuscript. nick zair provided linguistic advice. all errors and misinterpretations remain my own. funding for data collection was provided by the wennergren foundation for anthropological research; theoretical concepts involved were partly developed under the aegis of wellcome trust collaborative grant (collaborative grant 200368/z/15/a). i am very grateful to several anonymous reviewers whose thoughtful and detailed comments have substantially improved the manuscript. references cited agarwal, sabrina c. 2016. bone morphologies and histories: life course approaches in bioarchaeology. american journal of physical anthropology supplement: yearbook of physical anthropology 159(s61):130– 149. doi: 10 . 1002 / ajpa . 22905. agarwal, sabrina c., and patrick beauchesne. 2011. it is not carved in bone: development and plasticity of the aged skeleton. in social bioarchaeology, edited by sabrina c. agarwal and bonnie a. glencross. blackwell, chichester, pp. 312– 331. alfano, donatella, paola aurino, francesco basile, elena caracciolo, maria d’andrea, carmine pellegrino, amadeo rossi, 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required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe bioarchaeology international bioarchaeology international volume 6, numbers 1–2: 133–148 doi: 10.5744/bi.2021.0002 received 17 january 2021 revised 31 march 2021 accepted 10 april 2021 human-animal interactions and infectious disease: a view for bioarchaeology judith littletona*, sarah karstensa, mark bussea, and nicholas malonea abstract   zoonoses are significant in human histories, and in histories of other species and the environment. diseases have been an important evolutionary force, not just the major epidemics but the quieter endemic diseases. these infectious diseases comprise complex events and cycles involving multiple actors (humans, animals, and microorganisms). despite difficulties of preservation, identification, and interpretation, bioarchaeologists have often analyzed zoonotic diseases. however, these studies have tended to focus on an individual disease and its emergence as opposed to the human-animal interactions and complex environmental cycles that underlie zoonotic disease more broadly. in this paper, after a brief review of zoonotic disease and bioarchaeological studies of it, we provide three contemporary case studies that point to the complexity of human-animal interaction and the socioecological circumstances involved in disease. we argue that adopting a one health framework, which is based on rudolf virchow’s insight as well as approaches that emphasize time depth, multiple analytical scales, evolutionary understandings, and a consideration of human ideas and not just practices, would contribute to making bioarchaeology relevant to contemporary and future issues beyond the epidemiological transition model as modified by barrett and armelagos (barrett et al. 1998; barrett and armelagos 2013). keywords: zoonosis; one health; zooarchaeology; pandemics les zoonoses sont importantes dans l’histoire humaine, et en gros dans l’histoire d’autres espèces et de l’environnement. les maladies ont été une force évolutive importante, non seulement les épidémies majeures, mais aussi les maladies endémiques les plus calmes. ces maladies infectieuses comprennent des événements et des cycles complexes impliquant de multiples acteurs (humains, animaux et micro-organismes). malgré les difficultés de préservation, d’identification et d’interprétation, les bioarchéologues ont souvent analysé les zoonoses. cependant, ces études ont eu tendance à se concentrer sur la maladie individuelle et son émergence par opposition aux interactions homme-animal et aux cycles environnementaux complexes qui sous-tendent la maladie zoonotique de manière plus générale. dans cet article, après un bref examen de la maladie zoonotique et des études bioarchéologiques de celle-ci, nous fournissons trois études de cas contemporaines qui soulignent la complexité de l’interaction homme-animal et les circonstances socio-écologiques impliquées dans la maladie. nous soutenons que l’adoption d’un cadre one health basé sur la vision de rudolf virchow ainsi que sur des approches mettant l’accent sur la profondeur temps, les échelles analytiques multiples, les compréhensions évolutives et la prise en compte des idées humaines et non seulement des pratiques, contribuera à rendre la bioarchéologie pertinente pour les problèmes contemporains et futurs au-delà le modèle de transition épidémiologique tel que modifié par barrett et armelagos (barrett et al. 1998; barrett et armelagos 2013). vocabulaire: zoonosis; one health; zooarchéologie between animal and human medicine there is no dividing line—nor should there be. the object is different, but the experience obtained constitutes the basis of all medicine. (rudolf virchow [1821–1902], cited in klauder [1958:170].) it is commonly reported that around 60% of infectious diseases experienced by humans are zoonoses (i.e., pathogens shared with wild or domestic vertebrate animal populations) (taylor et al. 2001). worldwide attention in 2020 has been sharply focused on the possibility of new pathogens such as sars-cov-2. while covid-19 is a zoonotic infection with high lethality for humans, the importance of zoonoses in human history is not only a result of a capacity to cause major mortality or morbidity in human populations. some of the major infections of humans began as a zoonosis before evolving to be a primarily anthroponotic disease (e.g., hiv/aids), raising the question of what conditions promote such transitions (wolfe et al. 2007). other zoonoses (e.g., brucellosis), while causing low mortality in humans, have significant biological and social impacts, affecting livestock survival or meat and milk production (bendrey and fournié 2020). what can bioarchaeology add to our understanding of disease emergence, but also, what can the recognition of disease in the past add to our understanding of the past? the epidemiological transition model, particularly as reworked by armelagos and colleagues (barrett et al. 1998; barrett and armelagos 2013), explicitly identifies the relationship between the emergence of zoonotic infectious disease and human history, postulating that the transition to agricultural practices and domestication increased opportunities for contact between humans and other animals, leading to a rise in infectious disease as a major cause of mortality and morbidity. a similar focus on sedentary habitation and close proximity was proposed by mcneill (1976). these models remain implicit or explicit in many treatments of zoonotic disease. can bioarchaeological perspectives contribute more to this endeavor than what has become a truism? understanding zoonotic diseases, their emergence, evolution, and impact on human and animal populations is important in plotting long-term trajectories of disease, identifying drivers of disease emergence and persistence, and appreciating the interaction between human, animal, and environmental health, particularly drivers of resilience and buffers to exposure (larsen 2018). we argue that integrative approaches (such as a one health perspective that explicitly views environment, human, and animal health as linked [e.g., waltner-toews 2017]) and a more explicitly anthropological consideration of human-animal interactions (taking into account their biocultural complexity) may move us beyond the association of infectious disease with the agricultural transition and contribute to the place-specific deep time histories argued to be essential to understanding disease emergence (wallace et al. 2015). in this paper, we briefly review zoonotic transmission, survey recent bioarchaeological work (primarily zooarchaeological) on zoonoses, which is often very focused on a specific disease, and provide three case studies that demonstrate the complexity of human-animal–disease interactions and why an anthropological understanding of human practices and beliefs is a crucial part of unravelling history. types of interactions between humans, animals, and zoonoses the multiple classifications of zoonoses highlight the complexity of these infections as a class. the term zoonosis itself was first coined by rudolf virchow in the latter part of the nineteenth century and includes anthropozoonosis (nonhuman animals to humans), zooanthroponosis (humans to nonhuman animals), and amphixenosis (nonhuman animals and humans are both reservoirs). a more meaningful classification is the maintenance cycle of the pathogen, which highlights the importance of the triad between host, pathogen, and environment (chomel 2014). the maintenance cycles (shown in fig. 1) are: 1.   direct zoonoses (orthozoonoses) (e.g., rabies); 2.   cyclozoonoses, which require for the developmental cycle of the agent more than one vertebrate species but no invertebrate host (e.g., human taeniasis or tapeworm infections where humans are the definitive hosts); 3.   pherozoonoses (or metazoonoses), which require both vertebrates and invertebrates for completion of the infectious cycle (e.g., plague, rickettsial infections, lyme borreliosis); and 4.   saprozoonoses, which have a vertebrate host and an inanimate developmental site or reservoir (e.g., histoplasmosis). even in a direct zoonosis, the broader ecology of potential reservoirs and their relationships is crucial in disease transmission. however, there are significant problems with analyzing past zoonotic infections, particularly when relying upon skeletal evidence. not only is there the complex ecology of diseases at the human-animal interface but the reality of exploring those relationships from the evidence available in archaeological settings. even in contemporary societies, many zoonoses are unrecognized or underdiagnosed: their symptoms in animals are nonspecific, they are often chronic, developing over several years, and they can co-occur. many zoonoses are today classified as “neglected tropical diseases” (maudlin et al. 2009) and a review of the bioarchaeological literature reflects the way in which some diseases are much more amenable to archaeological study than others. figure 1. the four types of zoonotic maintenance cycles: a. direct transmission (e.g., rabies); b. cyclozoonosis (e.g., taeniasis in humans or cysticercosis in pigs and humans); c. pherozoonosis (e.g., plague); d. saprozoonosis (e.g., ersipelothirx). adapted from chomel (2014:figures 1–4). zoonotic disease in bioarchaeology bioarchaeological analyses of zoonotic diseases were traditionally limited to the study of those diseases that leave visible traces in the archaeological record, such as skeletal lesions or parasitic cysts. only a small handful of zoonotic infections result in skeletal lesions that can be subject to traditional paleopathological analysis and those lesions are often nonspecific (e.g., cribra orbitalia as potentially indicative of malaria) or common to more than one infection (e.g., lesions on the spine resulting from mycobacterium tuberculosis, m. bovis, or brucellosis). while these issues are common to osteological analyses of both human and nonhuman remains, taphonomic processes and biases in the archaeological record impact interpretation of disease in human and nonhuman species differently. those zoonoses that result in skeletal lesions tend to be chronic conditions. in both humans and animals, this limits the number of identifiable diseases and leads to issues associated with the osteological paradox (see wood et al. 1992). in addition, the variable lifespans, economic value, cultural significance, and levels of human investment in veterinary care across nonhuman species create additional biases because some animals (e.g., dogs, horses) tend to live to older ages and are therefore more likely to display skeletal pathologies associated with infectious disease (mackinnon 2010). unlike humans, the remains of animals in the archaeological record are rarely in the form of in situ burials; instead, assemblages of disarticulated, isolated bone fragments associated with food preparation create bias in the species and elements recovered and often make assessment of the distribution of pathological lesions within an individual animal impossible (bartosiewicz 2013; thomas 2017; upex and dobney 2011). it is, therefore, insufficient to look at indicators of disease in past human and animal remains in parallel as they find their way into the archaeological record for different reasons and have different life and depositional histories within particular, but only partially identifiable, social contexts. these additional taphonomic issues of animal remains and a lack of comparative veterinary data for many conditions mean that bioarchaeological studies of zoonoses have primarily relied on analysis of human remains and, therefore, the impacts of such diseases on human populations. many of the infections that result in skeletal lesions have been linked with the domestication of cattle, sheep, and goats. given hypotheses of epidemiological transitions accompanying the adoption of agriculture (see barrett et al. 1998; d’anastasio et al. 2011; fournié et al. 2017; hershkovitz et al. 2008), many studies of the timing of the introduction and transmission pathways of zoonoses into human populations focus on domestication and the neolithic transition. this is particularly true for the mycobacterium tuberculosis complex and brucellosis. brucellosis and infection with m. bovis are typically associated with the consumption of unpasteurized dairy products or prolonged contact with infected sheep, goats, or cattle and their bodily fluids (d’anastasio et al. 2011; moreno 2014; murphy et al. 2009; taylor et al. 2007; wooding et al. 2019). m. tuberculosis was thought to have evolved from the m. bovis strain and then spread and been maintained in the denser sedentary populations of agricultural societies (hershkovitz et al. 2008; stead 1997; stead et al. 1995). this hypothesis was supported by the identification of brucellosis and tuberculosis (tb) in human remains from sites with ethnohistoric and/or archaeological evidence for domestication of sheep, goats, and cattle and the consumption of dairy products (e.g., brothwell 1965; capasso 1999, 2002; merrett 2004; mutolo et al. 2012; ortner and frohlich 2007; rashidi 2011). tb and brucellosis have, however, also been identified through paleopathological and molecular analyses in the remains of hunter-gatherers in the americas (bos et al. 2014; jones 2019), possibly in the pacific (see mcdonald et al. 2020), in predomestication settlements in syria (baker et al. 2015), and even in a late pliocene specimen of australopithecus africanus (d’anastasio et al. 2009). the studies of bos et al. (2014), jones (2019), and mcdonald et al. (2020) dispute suggestions that the origin of tb in the americas and pacific was commensurate with european contact. one of the only examples of direct evidence from faunal remains of zoonoses or anthropozoonoses resulting from human-animal interactions is that of a case of tb in an iroquoian dog from a sixteenth-century iroquoian site in ontario (bathurst and barta 2004). archaeological and ethnohistoric evidence suggests that the role of dogs in iroquoian society was a mixed one, with dogs being used in hunting and guardianship, as companion animals, and as food (bathurst and barta 2004). the consumption of dog meat, the scavenging and coprophagic habits of dogs probably in village middens, as well as the sharing of beds, food, and eating vessels with dogs would have created multiple potential pathways for the transmission of infection between humans and dogs (bathurst and barta 2004). this case demonstrates a range of potential transmission pathways for tb resulting from nonagricultural human-animal interactions. as well as confirming the presence of tb infections in nonagricultural settings, in the past two decades, ancient dna analysis and the sequencing of whole m. tuberculosis complex genomes have also forced a reconsideration of the evolutionary history of tb. studies have suggested that m. tuberculosis likely existed and may well have been pathogenic to humans prior to the separation of the m. bovis lineage (brosch et al. 2002; zink et al. 2007). ancient dna analysis allows for the identification of zoonotic infections that do not result in diagnostic skeletal lesions. chagas disease (trypanosoma cruzi) is one such infection, identified in the tissues of mummies from south and central america dating back as far as 9000 b.p. (aufderheide et al. 2004; fernandes et al. 2008; solari 2011). the date of this disease and its distribution demonstrates how by encroaching and creating novel environments, humans altered the sylvatic life cycle of a disease, potentially promoting a switch from wild animals to humans as vectors (aufderheide et al. 2004; reinhard and araújo 2015). over 100 species of wild mammals act as reservoirs for chagas disease, which is transmitted through several dozen insect species hiding in animals’ nests and lairs. human residence in bat inhabited caves and the predation of wood rats may have brought humans into contact with the disease. however, a number of the insect vectors of the disease appear to have adapted to human dwellings, particularly the wattle and thatch huts built by early settlers, which provided ideal habitats for the nesting insects. the rearing of guinea pigs may also have provided a reservoir for the disease inside homes (aufderheide et al. 2004; coimbra 1988; reinhard and araújo 2015). the examples of chagas disease and the iroquoian dog highlight the problematic nature of a dichotomous domesticate/wild classification for zoonotic vectors. many species fall somewhere on a spectrum between these two extremes and their position within that spectrum and the nature of their interactions with humans varies across time and space. modeling using a wider variety of both direct and indirect evidence can assist in better understanding the nuances of these human-animal–environment interactions that give rise to zoonotic infections and the responses to and outcomes of epidemics, particularly those that leave little or no visible trace in the archaeological record. the most common example of such modeling in bioarchaeology is the use of data from cemeteries associated with known historical epidemics to model the mortality and morbidity profiles of past epidemics and how people might have responded to such diseases. for example, dewitte and wood (2008) compared the age, sex, and morbidity profile of the east smithfield cemetery in london, a cemetery used exclusively during the black death of 1349–1350, to other non-epidemic cemeteries and found that elderly people and those who had experienced physiological stress prior to the epidemic were at a greater risk of dying during the black death. these models, however, focus primarily on the impact of disease on human populations. while an important contribution to our understanding of past and future epidemics, this is only one aspect of the story of any zoonotic epidemic. while still relatively few in number, examples of modeling incorporating zooarchaeological, geospatial, climate, ethnographic, and historical data alongside traditional bioarchaeological analyses offer an opportunity to create a fuller picture of the circumstances leading to and results of zoonotic outbreaks (e.g., bendrey et al. 2019; fournié et al. 2017; gowland and western 2012; marciniak et al. 2018; seetah et al. 2020; smith-guzmán et al. 2016). gowland and western (2012) provide an example of how modeling using multiple lines of evidence can overcome some of the limitations of traditional bioarchaeological analyses in their analysis of malaria in anglo-saxon england. malaria is notoriously difficult to positively diagnose on the basis of skeletal lesions alone. while recent studies using clinical reference samples have attempted to associate a range of skeletal lesions with malarial infection (e.g., smith-guzmán 2015), cribra orbitalia remains the most commonly cited indicator of malaria in the bioarchaeological literature. yet, malaria is only one of a number of possible underlying causes for cribra orbitalia. to determine the likely relationship between the presence of cribra orbitalia and malaria, gowland and western (2012) analyzed the distribution of cribra orbitalia and enamel hypoplasia in anglo-saxon burials in relation to geographic variables and historically recorded distribution patterns of indigenous malaria and the habitat of its mosquito vector anopheles atroparvus. their modeling showed a correlation between cribra orbitalia and geography, as well as a spatial correlation between cribra orbitalia and historically recorded evidence for malaria and its mosquito vector (gowland and western 2012). they also found no such correlations with enamel hypoplasia, indicating a specific cause for acquired anemia rather than generalized poor health (gowland and western 2012). this study demonstrates how incorporating multiple lines of evidence (both direct and indirect) from a range of disciplines can help to elucidate the etiological causes of nonspecific indicators of infection and, therefore, understand the prevalence, distribution, and transmission pathways of diseases. what these examples demonstrate is that the story of zoonotic infections in human populations is long and complex. as pearce-duvet (2007) points out, ecological change and anthropogenic modification of the environment are likely key factors behind disease transmission, with agriculture being just one (although important) instance that changed the transmission ecology and increased the success of preexisting pathogens (see also vlok et al. 2021). bioarchaeology can contribute to a more nuanced understanding of past, contemporary, and future epidemics by providing time depth to the understanding of disease dynamics and the social, biological, and environmental circumstances that give rise to epidemics (dewitte 2016:71; larsen 2018). to do so, however, biases and limitations in research focus and sampling need to be recognized and, where possible, overcome. in particular, presumptions of the types of human-animal interactions that may have resulted in disease transmission need to continue to be superseded by more nuanced interrogation of context-specific relationships between animals (including humans), pathogens, and the environment. complexity and human-animal interactions: three case studies to emphasize that point, we have identified three contemporary case studies based on our own experiences that demonstrate the complex social, economic, and ecological relationships that can exist between humans and animals. pigs and ancestors in papua new guinea anyone who has done research in new guinea will agree on the central importance of pigs in indigenous cosmologies, social relations, and diets. at the same time, anyone who has done research in new guinea will also agree on the difficulty of generalizing across the societies in the most culturally diverse area of the world. the approximately 8 million people of papua new guinea (png), the independent country consisting of the eastern half of the island and nearby offshore islands, speak more than 700 distinct, mutually unintelligible languages, and there is a similar degree of cultural diversity. in west papua, approximately 2 million people speak in excess of 200 distinct languages (foley 2000). this cultural diversity is also reflected in the large variety of kinds of relationships between people and pigs, as well as between humans and other kinds of animals. according to steensberg (1980:111), pigs may have been in new guinea for 10,000 years and were almost certainly introduced by humans. as steensberg notes, “it is tempting to suggest that in this part of the world the breeding of pigs and the cultivation of plants were mutually related from the very beginning, because man [sic] and pigs, have similar systems of digestion, and shared the same kind of food.” in terms of diet, the relationship between pigs and humans depended on pigs’ interest in human food and people’s interest in having a source of meat. more recently, o’connor et al. (2011) have argued for a much more recent introduction of pigs to new guinea, perhaps as recently as 3,000 years ago. their argument that labels, such as “neolithic” as a shorthand for a package of traits, should be abandoned in favor of “understanding and describing the development of local economic practices and their relationships, innovations and transformations they entail” (2011:21) is consistent with the general argument of this paper. the importance of the relationship between pigs and humans can be seen in the amount of food grown to support pig herds, especially in the highlands of new guinea. bourke and vlassak (2004:vi) estimated that food production in the highland provinces of papua new guinea is 47% greater than what would be required to support the human population and they estimate that one-third of all sweet potato tubers grown in those provinces are fed to pigs (cf. hide 2003). in other words, agricultural systems in new guinea (which has some of the oldest agricultural systems in the world) are complex ecosystems that support more than human populations. the two new guinea societies with which one of the authors (busse) is most familiar—boazi-speaking peoples who live along the fly river and the shores of lake murray in papua new guinea’s western province (busse 1987, 1991, 2005), and alekano-speaking people in and around the town of goroka in eastern highlands province (busse 2019)—demonstrate the difficulty of generalizing in a region of such cultural diversity. approximately 2,500 boazi speakers live in small villages and scattered homesteads in the swamps and savannahs on either side of the fly river and along the northern shores of lake murray. they are primarily hunters, fisher folk, sago makers, and gatherers, and do not keep domesticated pigs. however, they do hunt wild pigs, along with cassowary, deer, and wallabies, primarily with bows and arrows, but also with shotguns, on the open savannahs and in the swamp forests in the fly river floodplain. these statements suggest another difficulty with generalization. categories such as “hunters and gatherers,” and “wild” and “domesticated” pigs, reflect the categories and concerns of euro-americans rather than those of boazi speakers. this is true of cultivation practices as well; for example, while boazi only very rarely plant sago palms, they manage their extensive sago swamps by chopping down some juvenile sago palms so that other sago palms can grow better. similarly, while they do not keep domesticated pigs, there are wild pigs that live around the edges of some sago swamps that women feed when they go to make sago. boazi speakers do not distinguish linguistically between pigs that are and are not fed in this way, although they do say that pigs that are not fed by humans taste better than pigs that are fed. while, at least at the time that busse did his main field research, boazi speakers did not talk about the transmission of diseases from pigs to humans, the possibility of disease transfer is affected by the population density and degree of feeding and also gendered patterns of behavior rather than a domestic/wild distinction. pigs are totem animals for members of the basikwin clan among boazi speakers. basikwin is a compound word consisting of basik, meaning “pig,” and the suffix -kwin, meaning “clan.” while there are no prohibitions on killing or eating one’s own totem animal or the totems of other people, busse was told that a widow who really loved her husband would refrain from eating his totem animal. a few people also told him that the members of a totemic group are descended from their group’s totem animal, but this is not a universally held belief. the members of a totemic group are, however, symbolically associated with their totem animals, and disrespect shown to a totem animal can be taken as disrespect toward the people for whom the animal is their totem. such disrespect can result in violence against the person showing disrespect. these symbolic relationships help shape human-animal interactions. throughout the highlands of papua new guinea, pigs were, and to a large degree are, the most significant form of wealth. even today, cash has not completely replaced pigs as a necessary form of wealth in significant public exchanges such as bridewealth and compensation. among alekano speakers in and around goroka, pigs continue to be a significant form of wealth, and they are raised with an eye toward future exchanges. in communities close to goroka town, raising pigs has become a business, and when pigs are needed for public exchanges they are often bought from commercial piggeries. nonetheless, the symbolic importance of pigs continues. at a bridewealth presentation on the northern edge of goroka town in which busse participated in 2015, pigs that had been raised in pens by the groom’s extended family were presented at the end of an elaborate presentation of garden food and money to the bride’s kin, who were from a much more rural area in eastern highlands province (fig. 2). in addition to representing considerable wealth, the way in which the pigs were presented was intended to overwhelm the recipients with the power and wealth of the groom’s family. the value of pigs in these exchanges shapes husbandry practices as well as the potential movement of diseased animal.1 these and other examples provide insights into the complex and diverse ways people conceptualize their relationships with pigs (see also sillitoe 2003).2 understanding the multiple and complex relationships between humans and pigs—ecological, economic, social, and symbolic—in new guinea is critical for understanding the role of pigs in the spread of zoonotic diseases, a point also made by dwyer (2006). simple exogenous categories (e.g., wild and domesticated) are inadequate and potentially misleading in trying to understand the role of pigs (and other animals) in disease transmission. what matters are the social relationships between pigs, between humans, and between pigs and humans. those relationships are complex, multiple, and vary both cross-culturally and through time. how pigs are raised, managed, understood, and used by humans is not the same in different parts of new guinea or in the same community in different historical periods. the movement of pigs, through exchange, between different groups varies considerably in different parts of new guinea. as dwyer (2006:s172) has written, “it is neither the pigs as such, nor people as such, that provide the context within which certain parasites may flourish. to the extent that the relationship varies … so too the expression of those diseases, in either pigs or in people, will itself vary.” he goes on to conclude that, although the tremendous environmental and cultural diversity found on the island of new guinea makes this point particularly salient there, the fine-grained details of relationships among animals, people, and disease (what he calls “the relational context”) is critical everywhere. this includes a long-term evolutionary perspective, since, despite the close relationship between humans and pigs, health in papua new guinea surveys suggests relatively few species of zoonotic parasites (e.g., taenia, trichonellosis) affecting humans, although important bacterial zoonoses (pigbel, japanese encephalitis) are shared with pigs (barnish and ashford 1989). the reason seems to be evolutionary—both the long history of pig-human interaction and the lack of local “wild” reservoirs (owen 2005). in a modern context, this has not protected papua new guinea from african swine fever and other introduced zoonoses (the pig site 2020). in understanding zoonotic disease and its transfer, time, space, and cultural diversity are key aspects. figure 2. a pig feast near goroka in 2014. (photo by m. busse.) the feral and the national herd: bovine tb in new zealand in a contemporary agricultural setting, these same complexities appear although in a very different guise. every year in new zealand (nz) a small number of people (three in 2016) contract m. bovis. in 2016, this comprised 1.3% of all laboratory confirmed cases of tuberculosis among humans in nz, reflecting drops in the overall tb rate in humans and cattle (the institute of environmental science and research 2019). yet there are three points of interest about this figure: bovine tb features largely in newspaper coverage of tuberculosis, m. bovis is still present in new zealand when australia (its nearest neighbor), with a similar history of compulsory herd testing, is heading to tb-free status, and the diseased animals are very differently categorized. this is a case study of the complexity of zoonotic disease ecology, the impact of history, and the way in which those histories come up against human classifications of particular animal species. it demonstrates that it is not just the actions of people and animals but the human perceptions of those animals that frame understandings of disease and ultimately transmission dynamics. the dynamics of transmission and infection of m. bovis in animals is remarkably similar to m. tuberculosis in humans. the same pattern of infection, latency, and active disease occurs in cattle (hancox 2003). the disease is primarily respiratory, so managed herds in close contact are an effective environment for m. bovis transmission. while in contemporary management, animals with active disease are slaughtered, tb-free herds can be subject to “breakdowns” (an episode of disease through the herd) due to an older animal developing active disease from a latent state. transmission to humans traditionally occurred through the drinking of contaminated milk or in abattoirs (through contact with infected carcasses). so why does it persist? bovine tb has been controlled effectively in many countries around the world but the problem in nz (a problem it shares with the uk and ireland) is the existence of significant wild reservoirs of infection. in new zealand, the major vector identified is the brushtail possum (trichosurus vulpecula). possums were identified as a vector in 1971/1972. tb rates among possums are between 1% and 10%, with disease often in highly spatially aggregated areas (ryan et al. 2006). tb is extremely effective among possums, causing death within an average of 4.7 months. sick animals become debilitated, unable to climb, wander around in daylight, and hence are accessible to curious cattle who have been seen to mouth and sniff at the diseased animals. however, this picture is incomplete. possums are an import from australia. the first successful introduction was in 1858 at the behest of acclimatization societies who saw new zealand’s own native fauna as largely doomed and who were interested for a range of sentimental and economic interests in the importation of exotic species (clout and ericksen 2000). it was hoped that possums would form the basis of a successful fur trading industry. up until 1926, there were 127 recorded liberations of possums by acclimatization societies and government agencies (most of nz bred possums). the damage that possums were doing to nz’s native forests was not formally taken into account until 1947 when all they were recognized as pests and poisoning was legalized. possums were unlikely invaders; they have a low intrinsic rate of increase but they do have broad environmental tolerance and are opportunistic feeders. the lack of competitors and parasites in nz lead to their success, although the multiple introductions and releases were probably some of the most important factors since the chance of demographic collapse was overwhelmed and they served to ensure the genetic diversity of the species (clout and ericksen 2000). yet possums do not naturally carry tb. nz possums caught bovine tb from those other great imported animals—cattle and deer and most probably from their carrion (price-carter et al. 2018). from this perspective, possums are the victim rather than the vector. what is also missing from the picture is all the other vectors of bovine tb: ferrets, feral pigs, cats, stoats, and deer. deer in particular can be true maintenance hosts when there is sufficient contact between infected and noninfected animals. while possums may be important in the maintenance and expansion of areas known to be infected, the establishment of completely new areas of infection may be the result of other factors such as the movement of infected deer (ryan and livingstone 2000). the final missing piece of the puzzle lies with the farming industry itself. changes in agricultural practices have made the spread of tb more likely. first is the movement of cattle (price-carter et al. 2018; ryan and livingstone 2000). for example, in the waikato region of the north island, one study demonstrates that only 10% of dairy herds were closed; most farmers move cattle between properties, particularly when young (ryan and livingstone 2000). second is the change in herd size and expansion into new areas. the average dairy herd size in 2017 was 431 but in some areas, average herd size was as high as 800 animals (dairynz 2018). tb outbreaks are more likely in such large groupings both because of the movement of animals between herds but also potentially because of stress. furthermore, farming on pasture forest margins as dairying expands allows cattle and possums to mix most freely (coleman 1988). the ecological picture is complex. there are multiple species involved in the disease cycle and transmission itself is along multiple routes (respiratory and oral), involving the actions of animals (diseased possums coming down to the ground during the day, curious cattle nosing sick or dead possums) and the way in which humans interact with species (not just through infected food products but close handling of animals through milking or in abattoirs), and all in a context created by human translocation of animal species and the intensification of agriculture. however, in coverage of bovine tb, all of these translocated species are labelled: possums as feral, deer as somewhat ambivalent, and cattle as the “national herd,” an integral part of new zealand’s economy (littleton and park 2009). these symbolic categories influence what attention is paid in terms of prevention (possums are frequently exterminated but deer are less subject to culls, while the expansion of dairy herds and cattle movement is part of acceptable agricultural practice). the persistence of bovine tb in new zealand reveals how disease travels along particular lines not simply because particular animals are present, but because of the actions of those animals and the niches constructed by humans that place animals into contact with each other. it is not enough to have the host, pathogen, and environment—it is the nature of the linkages that determines whether disease eventuates and how severe that disease will be. the new zealand case study is also a reminder of animal translocation and its significance in many historical societies. however, there are also the less dramatic movements of animals due to trade, the movement of breeding stock, and transhumance (mashkour et al. 2005). new animals introduce new pathogens, and they can encounter new pathogens. but how much any of this is recognized and acted upon is affected by how humans perceive and categorize the animals with which they interact. the human and nonhuman primate interface: dynamics of disease transmission while the two case studies so far presented demonstrate how “domestic” and “wild” might not be closed categories and how humans manipulate and create conditions for disease transmission, the time depth of human-animal connections is often tied to the notion of domestication. yet, across cultural, historical, and ecological contexts, primates and humans share an extended coexistence. evidence of such coexistence is temporally deep and geographically broad. in gabon, west africa, three ape genera (homo, pan, and gorilla) shared niche space and have likely competed for plant foods for approximately 60,000 years (tutin and oslisly 1995). findings from niah cave, sarawak (in northwest borneo), demonstrate the robust hunting behavior of humans upon an array of nonhuman primate species (a mere subset of the overall bone assemblage) during the terminal pleistocene (25,000–40,000 years ago) (harrison 1966; piper and rabett 2009; sponsel et al. 2002). more recently, human predation likely contributed to the extinction of madagascar’s giant, subfossil lemur species (paleopropithecus spp.) (perez et al. 2005). in contemporary brazil, the indigenous awá-guajá maintain a complicated set of relationships with the endemic red-handed howler monkeys (alouatta belzebul) whereby the primates are integral to both the awá-guajá’s kinship system and diet (cormier 2002). from past to present, the trajectories of most nonhuman primate populations are determined, either directly or indirectly, by humankind’s alterations and actions (behie et al. 2019). contemporary humans construct and occupy increasingly interconnected landscapes that include cities, farms, and forests. our primate kin are routinely displaced from their habitats, hunted for meat, captured for trade, and enlisted as unwitting participants in our research and conservation interventions. habituated animals are vulnerable to human hunting (in the absence of sustained researcher presence), and the cutting of trails and other research activities can alter delicate ecological systems (malone et al. 2010). at the same time, the presence of researchers and/or ecotourists can expose nonhuman primates to human diseases. in fact, multiple disease outbreaks in ape populations have been linked to interactions with humans (köndgen et al. 2008; travis et al. 2008). of course, given our biological similarity, pathogen transmission is bidirectional. that is, humans are susceptible to contracting diseases from nonhuman primates (anthropozoonotic transmission). immeasurable human suffering stems from the ebolaviruses (filoviridae), pathogens which can cause severe hemorrhagic fever and high mortality (40%–90%) in humans and other animals, including decimating outbreaks in chimpanzee and gorilla populations (walsh et al. 2003). additionally, the form of human immunodeficiency virus-1, the virus that caused the aids pandemic, resulted from the “spillover” (nonhuman animal to human transmission via contact with the reservoir host) and mutation of a chimpanzee immunodeficiency virus to humans (gao et al. 1999; gilardi et al. 2015). beyond these highly publicized examples, anthropozoonoses also include retroviruses, intestinal parasites, polio, tb, and anthrax. indeed, the current pandemic and outbreak of covid-19 as well as sars, mers, and nipah virus are also examples of anthropozoonotic spillover events (nieuwland et al. 2022). microbial emergence events and the concomitant risk that infectious agents pose for human populations is related to both the level of microbial diversity (e.g., high in lowland tropical forests) and behaviors that facilitate contact between novel microbes and their prospective hosts (wolfe et al. 2000). incursions into, and modifications of, tropical forests as well as hunting, butchering, and pet keeping of nonhuman primates are among the riskier of such behaviors. however, comprehensive analyses of human and nonhuman primate interfaces reveal their complexity, particularly with respect to emergent diseases (knauf and jones-engel 2020). a prominent example can be found in bali, indonesia. balinese people and long-tailed macaques (macaca fascicularis) live in sympatry, and have done so for over a thousand years. in this time, macaques and balinese people have together developed a mutual ecology where lives and livelihoods are deeply entwined (fuentes 2010; wheatley 1999). the more recent surge of tourism in bali provides an additional layer of relationships. the balinese people/macaque/tourist interface incorporates dietary, economic, parasitological, religious, behavioral, political, and geographical elements (fuentes 2006; jones-engel et al. 2005). the human-macaque interface in bali is characterized by behavioral and ecological interactions embedded in a cocreated history, including: a) macaque populations that congregate at hindu temple sites where they achieve a sacred, protected status, which partially underpins population growth; b) a tourism industry that facilitates the existences of the politically and economically driven tourist-macaque interface; c) the livelihoods of balinese people that are financially supported by tourist-macaque interactions; d) macaque diets being modified by tourist provisioning; and e) belief systems that influence the mutual ecologies of the various actants at these sites (fuentes 2010). additionally, crop-raiding macaques are frequently targeted and killed by farmers outside of temple complexes. moreover, macaques are the most frequently observed nonhuman primate species in the longstanding live animal trade, and their relative abundance has increased over time (malone et al. 2003; nijman et al. 2017) (fig. 3). given the complexity of this interface, and the associated risk of novel microbial emergence and transmission (lane-degraaf et al. 2014), a holistic lens that illuminates the interplay between biophysical and social elements is required (malone and ovenden 2017). figure 3. macaques crated as part of the pet trade in indonesia (2001). (photo by n. malone.) over the course of human evolution, our lineage has navigated new ecologies and niches, including a diverse array of plants and animals. these interactions produce reciprocal effects on bodies and behavior that are at once biological, cultural, and political (fuentes 2020). as demonstrated here in this brief overview of human–nonhuman primate interactions, a strict emphasis on human manipulation and control of other species (formal domestication) is an inadequate lens through which to view the contexts that characterize many organisms that occupy human niche space. fuentes (2007:124) sees human actions that alter species’ ecologies (with impacts on physiology and behavior) as resulting not in “domestic species” per se, “but species that are being directly shaped by processes (domesticatory practices) resulting from human action.” this reframing enables the effective analysis of particular contexts of contact (e.g., trade networks’ live animals or wild game from source to sale; human and macaque coexistence in asian temple sites), and facilitates mitigation strategies accordingly. through this more holistic, anthropological framing of the human and nonhuman primate interface, pathways of pathogen transmission, and their respective risks, are identified as components of broader ecological and sociopolitical systems. adopting a one health perspective to understand and analyze the history of zoonotic disease and its past impacts then relies upon understanding animal and human disease in the context of social and ecological systems as well as evolutionary perspectives (fig. 4). in contemporary health research, such work increasingly engages with a one health perspective—an integrative approach to animal-human health (waltner-toews 2017) that conceptualizes the health of humans, the environment, and nonhuman animals as linked (lebov et al. 2017). there is nothing new in the recognition of human and animal health as linked. day (2011) identifies instances of formal linkages between human and animal disease back to early mesopotamia. but a one health approach adopts a holistic understanding of health beyond the purely biomedical (zinsstag 2012), focusing on relationships between disease dynamics, environmental drivers, livelihood systems, and veterinary and public health responses (scoones et al. 2017). traditionally, one health efforts have focused on surveillance and containment, particularly of zoonotic disease, but as ecosystem approaches to health have developed, researchers have urged for greater consideration of the structural drivers behind disease in linked animal and human populations (wallace et al. 2015), as well as for attention at the local level (rock et al. 2009). as expressed by hinchliffe (2015:31): “there is more than one world, and likewise more than one health … it is crucial that we demonstrate how health is patched together in practices that take account of local conditions …” in many respects, a one health perspective articulates with other frameworks used in the analysis of disease in archaeological settings (e.g., biocultural perspectives, multispecies approaches, agency approaches). different research approaches and research questions emphasize particular aspects but all (to some extent): 1.   problematize the relationship between biology and culture, understanding that disease is not a natural fact but created and recognized within particular settings; 2.   assert that understanding those settings depends upon working with different temporal scales from long-term evolutionary to the short-term life cycle of organisms; 3.   recognize human and animal environments as created not just through human histories but the interaction of species with climate and physical geography which in itself can create new selective pressures (niche construction) and that beyond the creation and modification of environments, it is important to remember that such settings are partial in that different aspects of an environment are salient to humans and animal species; 4.   identify social and economic arrangements as important to understanding disease or other aspects of human-animal relationships; and 5.   acknowledge that in the complex relationships between humans, animals, and microbes, all species are actors in that through their life cycles and actions, they make a discernible difference (law and mol 2008), while not necessarily having the capacity of intention. figure 4. a model of a one health perspective to examine zoonotic disease, adapted from woldehanna and zimicki (2015:figure 1). so what does that suggest—an agenda for bioarchaeology? the relationship between time since domestication and the number of shared pathogens between humans and domesticates has been demonstrated (morand et al. 2014). however, as the case studies above show, that relationship is dependent on much more than just economic relationships or extractive activities. recent outbreaks demonstrate the importance of spillover from enzootic reservoirs into other animal and ultimately human reservoirs. bioarchaeology has also demonstrated that complexity. for example, the complex phylogenetic relationships of the mycobacterium tuberculosis complex (e.g., bos et al. 2014) and the range of potential reservoirs for plague (green 2020) point to how the emergence, spread, and impact of zoonotic infections (and ultimately the evolution of human infections) are more complex and diverse than initially suspected. while specific disease identification in humans or animal skeletal remains is difficult and fraught with problems of specificity and preservation, an integrated perspective opens up a range of potential evidence beyond the identification of diseased individuals (bendrey et al. 2019; one health archaeology research group 2020). the value of such interdisciplinary studies is being recognized in modeling approaches that bring together a range of specialities. such models allow analysis of diseases often considered invisible in the archaeological record and embracing a one health approach can help to untangle the complex set of human-animal–environment relationships that lead to the emergence, spread, and maintenance of zoonotic infections. the use of bioarchaeological data in modeling of disease dynamics is currently somewhat limited, but combining bioarchaeological evidence (including paleogenetics and paleoproteomics) with ecological, climate, geospatial, clinical, zooarchaeological, ethnographic, and historical data among others shows great potential for contributing to our understanding of past, present, and emerging zoonotic diseases. as argued by bendrey et al. (2019), there are multiple sources of data. these can be used as proxies for aspects of the model shown in figure 4. while identification of disease is a first step, it is not the last. if we think about the human aspect, consideration of demography, evidence of work patterns, diet, and movement are all possible. from the animal aspect, while identifiable lesions may not be readily available, the recognizable biodiversity at a site, the demography of animals, evidence of their diet, movement, symbolic value (burial, material culture), and, at times, health, provide indications of the animal niche. aspects of contact are visible within settlement structures and layouts, animal and human demography, evidence of work patterns for both humans and animals, and how that is structured along age and sex/gender. these data can then be analyzed within a careful consideration of climatic and environmental change over time. using the example of tracing the impact of malaria in bahrain (an emergent piece of research), evidence of comorbidity over time is established (e.g., littleton 1998, 2011), but that needs to be tied to stronger evidence for malaria (including the type of malaria from paleogenomics) and human and animal migration. stable isotopes are providing much of the evidence for husbandry and how that varies over time and by place (smith and littleton 2019, 2021) as well as revealing the complexity of human migration in bahrain. those two long-term records can then be tied to archaeological and paleoenvironmental evidence, such as settlement distribution (larsen 1983; olijdam 2000), ecology (tengberg and lombard 2001), and water levels (sanlaville 1992), to develop a dynamic model of disease and human-animal interaction. we are not arguing that all of those aspects of human-animal interactions will always be available (and thinking about the bahrain example, they are certainly not), but a greater emphasis going forward on interdisciplinary research using multiple forms of evidence and developing testable models has great potential. these sorts of analyses can provide the “place-specific deep time histories, cultural infrastructure, and economic geographies” that underlie disease emergence (wallace et al. 2015:68). by centering and exploring the complexity of human-animal interactions within a broader ecological and evolutionary history, bioarchaeologists and their collaborators can offer theoretically informed and historically contextualized studies of humans and other species. such local ecologies inform how human societies have shaped and been shaped by the animals and world around them (akin to niche construction). they have the potential to challenge narratives of imminent risk, of defensive responses (bendrey and fournié 2020), and contribute to burning contemporary questions of disease persistence and emergence. adopting approaches that emphasize time depth, multiple scales of activity, evolutionary understandings, and a consideration of human 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humans. aanthropology, the university of auckland, auckland 1010, new zealand *correspondence to: judith littleton, anthropology, the university of auckland, private mail bag 92019, auckland city, new zealand. e-mail: j.littleton@auckland.ac.nz login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of 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contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe bioarchaeology international (volume 1) bioarchaeology international volume 1, numbers 1–2: 1–18 doi: 10.5744/bi.2017.1005 copyright © 2017 university of florida press bioarchaeology is a burgeoning, integrative field that spans the globe. bioarchaeology is often thought to encompass the study of only the human remains found within archaeological sites, frequently divorced from the contexts in which they were found. the physical remains of people store a record of their biological attributes, providing information on illnesses or trauma they survived or that may have contributed to their deaths, their daily activities, biological affinities, and more. equally informative are the different ways that people were treated in death by those who survived them. rather than investigating only the biological remains or studying material culture alone, integrating these components permits a more complete understanding of how people experienced an array of circumstances over the course of their own lives and through multiple generations. differing subsistence practices, access to resources, exposure to hazards, and changes in economic, political, religious, or environmental factors over time and across vast areas of the world are topics explored by bioarchaeologists. learning how past peoples were affected by pathogens, climate change, and immigration, for example, provides insight into contemporary issues and stronger together: advancing a global bioarchaeology brenda j. bakera* and sabrina c. agarwalb acenter for bio archae ol o gi cal research, school of human evolution & social change, arizona state university, tempe, az, usa bdepartment of anthropology, university of california berkeley, 232 kroeber hall, berkeley, ca, usa *correspondence to: brenda baker, center for bio archae ol o gi cal research, school of human evolution & social change, arizona state university, tempe, az 85287-2402 e-mail: bjbaker@asu .edu abstract bioarchaeology is a relatively young field that aims to improve our understanding of life, death, and interrelationships among past humans around the globe. the discipline grew out of 1960s american processual archaeology and biological anthropology and emerged as human osteoarchaeology in the uk. today, bioarchaeology is a vibrant, interdisciplinary field of study that cross-cuts biological anthropology, archaeology, and social theory to situate past peoples within their biological, cultural, and environmental circumstances. the field emphasizes not only the study of human remains but the integrative analysis and interpretation of their context, including the archaeological, sociocultural, and political milieu and the environmental setting in which people lived. the growing interest in bio archae ol o gi cal research has created the need for a new peer-reviewed journal to help unify and advance this discipline around the globe. in this introduction to bioarchaeology international, we trace the origins of the field and the different “schools” of bioarchaeology that have developed and are now merging as the discipline has matured. we then delineate the purpose and goals of the journal, highlighting how the articles in the first issue contribute to those goals. finally, as co–editors in chief, we describe our vision for contemporary and future directions in bioarchaeology. with this overview of the field and journal, we wish to stimulate discussion and promote international submissions. we intend for bioarchaeology international to strengthen this growing field and help promote scholarly and public interest in our collective research. keywords: archaeology; biological anthropology; biocultural; funerary archaeology; mortuary behavior; osteology; osteoarchaeology; paleopathology stronger together: advancing a global bioarchaeology2 problems. such studies demonstrate how bioarchaeology is relevant to multiple stakeholders and can inform the general public. the development of bioarchaeology bioarchaeology as a field of research has had different trajectories related to variability in academic traditions between north america and those in britain, france, and other countries (for detailed reviews, see buikstra et al. 2011; knüsel 2010; o’donnabhain and lozada 2014; sheridan 2017). in north america, bioarchaeology grew out of processual archaeology and the “new physical anthropology” in the 1950s and 1960s, which began a shift from typological and descriptive studies to problem-oriented investigations of populations embedded within a biocultural paradigm (armelagos 2003; armelagos and van gerven 2003; zuckerman and armelagos 2011; zuckerman and martin 2016a). this “bio-cultural” perspective, which considers biological, cultural, and environmental factors in the study of past human populations, was promulgated by don brothwell (1967) of the uk (see also roberts 2006). incorporation of human osteologists and biological anthropologists, including george armelagos, in large-scale rescue excavations of mortuary sites in southern egypt and northern sudan in the 1960s accelerated this paradigm shift (baker 2016:183– 184; see martin and zuckerman 2016 for a review of armelagos’s influence on biocultural research). while the term “bioarchaeology” initially appeared in the late 1950s (sheridan 2017:112) and was applied by grahame clark (1972) to the study of faunal remains from a mesolithic site in yorkshire (northern england), it was later used by jane buikstra (1977:69) to describe a regionally based, interdisciplinary research program in the lower illinois river valley that integrated archaeology and human osteology to investigate “biocultural change within the woodland period.” in north america, the merging of archaeological and biological anthropological perspectives in the investigation of human remains on a regional scale over time has led to an integrative biocultural approach and promoted population-level analyses that marked a shift from the mostly descriptive studies that focused on measurement and classification of people and their diseases. within american bioarchaeology, however, different schools of thought developed within the nascent discipline (buikstra and beck 2006; rakita 2014; stojanowski and duncan 2014). the biocultural approach was championed by george armelagos, his colleagues, and their students, who acquired broad training across the subfields of anthropology (zuckerman and martin 2016b). jane buikstra’s bioarchaeology emphasizes contextualization and integration of social theory with biological data from human remains (buikstra et al. 2011; buikstra and beck 2006). clark larsen’s definition of bioarchaeology focuses primarily on the interpretation of behavior from the human skeleton (as per the subtitle of his book; larsen 1997, 2015). this perspective separated bioarchaeology from wider aspects of archaeological and social theory. larsen’s form of bioarchaeology has begun to recognize the linkage of archaeology and biological anthropology, acknowledging new developments that situate human biology within “the social past” (larsen and walker 2010:380) and relate to aspects of identity, gender, and other “social and cultural forces that leave their impression on the skeletal body” (larsen 2015:xi). clearly, the lines among these different perspectives both within and beyond north america are blurring as the field has matured. the term “bioarchaeology,” however, is not universally understood or applied globally. in the united states, “bioarchaeology” pertains to both mortuary site archaeology and human osteology, though these components frequently have been treated separately (see goldstein 2006) and often continue to be separate purviews of archaeologists and “anthropologists” in many parts of the world, particularly where archaeologists are trained in classical or near eastern studies (see, e.g., sheridan 2017). in france, different terminology is used for investigation of ritual surrounding death (les gestes funéraires), the study of field anthropology (anthropologie de terrain), or ancient burial (archéothanatologie) as it is now more commonly known (knüsel 2010:68–69). henri duday’s work, commencing in the 1970s (e.g., duday 1978), has become widely influential, particularly since its more recent dissemination in english (e.g., duday 2006, 2009), and is informing studies of body treatment, taphonomy, and commingling (e.g., geber et al. and haddow and knüsel in this issue). although the biocultural paradigm links both british and american perspectives, “bioarchaeology” in the uk refers to the study of all ancient biological remains, including those of humans, animals, and plants, and more generally to environmental archaeology and paleoecology (knüsel 2010:62–63). the study of faunal and human skeletal remains came to be known as “osteoarchaeology” (roberts 2006:418). in the uk, osteoarchaeologists are found in departments of archaeology, whereas north american bioarchaeologists are typically housed in anthropology programs. in both the uk and north america, this field grew rapidly in the 1980s and 1990s. training programs at the master’s degree level were developed at multiple universities in the uk (roberts 2006:430– 431), but only one specific master of arts graduate baker and agarwal 3 curriculum in bioarchaeology developed in the united states. designed in the mid-1980s by a group of arizona state university archaeologists and biological anthropologists led by christopher carr, charles merbs, and christy turner ii, this curriculum required coursework in both archaeology and biological anthropology, producing bioarchaeologists trained in both these subfields of anthropology. the field of bioarchaeology matured in the 1980s and 1990s, largely in response to major criticisms of methods and interpretations. the first potential death knell emerged with post-processual reevaluations of mortuary behavior (e.g., chapman et al. 1981; pader 1982; parker pearson 1982; shanks and tilley 1982) that challenged inferences about socioeconomic status based on grave attributes and inclusions as a straightforward reflection of social status (e.g., binford 1971; saxe 1972). another serious challenge arose when the use of life tables in paleodemography was questioned and, at a more fundamental level, methods of estimating age from the skeleton were criticized for reflecting the structure of the sample on which they were based (bocquet-appel and masset 1982). these criticisms met with numerous rebuttals (e.g., buikstra and konigsberg 1985; van gerven and armelagos 1983) but spurred efforts to address the concerns in both archaeology (see parker pearson 1999) and biological anthropology. improvements to existing techniques of age estimation (e.g., brooks and suchey 1990), development of new techniques (e.g., using the auricular surface [lovejoy et al. 1985] and sternal ends of ribs [i̇şcan et al. 1984a, 1984b]), and new statistical approaches (e.g., transition analysis [boldsen et al. 2002]) have helped allay these concerns. additionally, more sophisticated and critically applied paleodemographic analyses have arisen that incorporate bayesian statistics and hazards analysis (for more information concerning these developments see chamberlain 2000; hoppa and vaupel 2002; and milner et al. 2008) as well as fertility centered models (jackes 2011). issues concerning demography and pathology subsequently were addressed in “the osteological paradox,” an influential paper by wood et al. (1992) that brought the issues of demographic nonstationarity, selective mortality, and heterogeneous frailty to the forefront 25 years ago. this work began perhaps an even more important critical examination of our approach to analyzing the skeletal samples that comprise much of bio archae ol o gi cal research. like the critique of assumptions concerning mortuary practices and the “farewell to paleodemography,” publication of “the osteological paradox” also met with substantial debate and discussion (e.g., wright and yoder 2003), yet the issues raised continue to be deliberated and new analytical approaches are being developed to address them in contemporary bioarchae ol o gi cal research (dewitte and stojanowski 2015; see the section “contemporary directions” below for further discussion). an additional obstacle in the field was spurred principally by repatriation legislation in the early 1990s, as it had already been recognized that data sets generated by different researchers frequently could not be compared due to a lack of standardized scoring criteria and publication of only summary statistics rather than raw data. efforts were made by various organizations and groups of scholars to formulate standards for recording data that are widely used today (brickley and mckinley 2004; buikstra and ubelaker 1994) and are being supplemented with new electronic database applications (e.g., osteoware, the free database software for human skeletal remains [smithsonian institution, https: //osteoware .i .edu]). with the self-reflection on the development of the field in the early 2000s and recognition of continuing challenges (e.g., agarwal and glencross 2011; buikstra et al. 2011; buikstra and beck 2006; knüsel 2010), bioarchaeology is emerging as a more robust field of inquiry that engages social theory more fully and frequently to contextualize biological information gleaned from human remains. bioarchaeologists regularly address questions of both cultural and biological significance through integration of research involving human remains, their burial sites, and their curation. recent work, as outlined below, is contextualizing our understanding of humanity through the lens of the life course, from fetus to death, and over generations, recognizing that rituals surrounding death and body treatment as a form of material culture involve the interaction of both the living and dead. such research serves to bridge the gap that has previously existed between archaeologists and bioarchaeologists and help unify the different research trajectories that developed in the early decades of bio archae ol o gical inquiry. contemporary directions contemporary bioarchaeology continues to emphasize both contextual and multi-scalar approaches. while there remains a focus on population-level trends in the field, there has been a shift to consider and integrate a focus on the individual life course in bio archaeol o gi cal research. at the same time, the field has continued to embrace the use of innovative methods in geospatial analysis, (micro)imaging, and molecular and chemical analysis, coupled with ecological, ethnographic, and historical approaches. recent research in bioarchaeology allows the exploration of https://osteoware.i.edu stronger together: advancing a global bioarchaeology4 broad issues that encompass growth, health, demography, human ecology, sociopolitical and subsistence transitions, epigenetics and developmental biology, and social theoretical approaches to understanding the conceptualization of mortuary landscapes, spatial organization of cemeteries, embodiment of social identity, and more. bioarchaeologists are addressing questions of great relevance to modern issues, including the effects of climate change, demographic and epidemiological transitions, inequality, and migration. we outline here some of the major directions in the contemporary field, although it is certainly not exhaustive. our aim is to showcase many of these current directions of research in the coming issues of bioarchaeology international. although researchers have slowly addressed the complex issues raised by the osteological paradox, its use as a worthy research endeavor in itself has emerged only recently (dewitte and stojanowski 2015). several innovative studies have embraced the investigation of selective mortality and heterogeneous frailty through an examination of specific mortality risks associated with factors such as age, sex, and non-specific indicators of stress (e.g., boldsen 2007; dewitte 2009; dewitte and bekvalac 2010; dewitte and hughes-morey 2012; dewitte and wood 2008; marklein et al. 2016; wilson 2014). differential frailty and risk of death for subgroups that are identified through archaeological evidence or mortuary context now are more frequently investigated (e.g., dewitte 2010; stojanowksi 2013; storey et al. 2012; sullivan 2005). contemporary studies continue to clarify the interpretation of skeletal stress indicators in relation to risk of death in distinct age cohorts, such as preadults versus surviving adolescent or adult cohorts. while early studies such as that by saunders and hoppa (1993) suggested there was no association with indicators of stress (specifically, stunted growth) and risk of death, more recent research supports the relationship of stress indicators and increased risk of death, and demonstrates high frequencies of stress lesions in the very youngest age groups and recovery from stress in older cohorts (littleton 2011; perry 2014; robbins schug 2011). in particular, new studies highlight relationships between stress indicators and mortality, with influences from factors such as gender or status (vercellotti et al. 2014) or early diet (weaning) patterns (for a recent review see tsutaya and yoneda 2015). interest in assessing the consequences of childhood stress for later risk of death and morbidity also has prompted bioarchaeologists to engage more directly with concepts of epigenetics and, particularly, what has been termed the barker hypothesis or, more recently, the developmental origins of health and disease (dohad) hypothesis (agarwal 2016; gowland 2015b; klaus 2014). following an early study by armelagos et al. (2009), researchers have tested the dohad hypothesis using bio archae ol o gi cal data on dental defects (enamel hypoplasias) and adult health and mortality (e.g., amoroso et al. 2014; temple 2014; weisensee 2013). this research is enhanced by analysis of stable isotopes from different parts of bones and teeth and among teeth that form at different times to reveal diet change over the life course and gain a better understanding of individual life histories, even in commingled deposits (e.g., gregoricka 2014; gregoricka et al. 2017). new techniques that examine serial (incremental) sections of tooth dentine (e.g., beaumont et al. 2013; burt and garvie-lok 2013; eerkens et al. 2011), along with analyses of bone collagen and apatite, are advancing our understanding of the weaning process and the identification of a weaning diet, a post-weaning diet, and the age at which an adult diet is adopted (e.g., dupras and tocheri 2007; eerkens and bartelink 2013; richards et al. 2002; waters-rist et al. 2011). these methodological advances have led to a proliferation of research that has begun to tease out biocultural and environmental influences on past communities and contribute to the elucidation of relationships among diet, morbidity, and mortality in various subgroups (e.g., bourbou et al. 2013; gregoricka and sheridan 2012; henderson et al. 2014; kaupová et al. 2014; prowse 2011; reitsema and vercelloti 2012; reitsema et al. 2016; sandberg et al. 2014). additional tests of hypotheses concerning developmental pathways of health in the past and potential multigenerational effects (see, e.g., beaumont et al. 2015) will require multifaceted approaches to investigating the linkage between morbidity and mortality and address the osteological paradox. such research clearly illustrates the maturation and breadth of contemporary bioarchaeology. diet in the past also is being investigated through a life-course approach. when combined with archaeobotanical and zooarchaeological information, stable isotope analysis is the gold standard method for reconstructing diet, subsistence, and even for examining land-use strategies and environments of past populations (e.g., fraser et al. 2013; iacumin et al. 2016). biogeochemical research once provided only an average of what a person consumed over many years based on bulk bone collagen values, although tissue and hair samples in well-preserved assemblages permitted a window into diet during shorter intervals much closer to the person’s death (e.g., white and schwarcz 1994). stable isotopes of strontium and oxygen now go well beyond diet reconstruction and are used regularly to trace residential mobility and identify immigrants within a cemetery, providing further insight into life histories of individuals and social networks baker and agarwal 5 and population movements in the past (e.g., bentley et al. 2009; gregoricka and sheridan 2017; killgrove and montgomery 2016; neil et al. 2016; parker pearson et al. 2016; shaw et al. 2015; valentine 2016; wright 2012). stable isotope research is illuminating new aspects of urbanization, immigration, colonization, interaction, and identity (e.g., buzon and simonetti 2013; knudson 2011; knudson et al. 2014). in fact, more holistic and multidisciplinary approaches to the investigation of migration, culture contact, and colonization have been revitalized in bioarchaeology (baker and tsuda 2015; cabana and clark 2011; murphy and klaus 2017). recent studies of bone mass and biomechanics also have begun to consider life-course approaches and the role of growth on bone remodeling (agarwal 2016). for example, changes in cross-sectional bone geometry along with indicators of stress during growth explore trade-offs between bone development and morphology over the life course (robbins schug and goldman 2014; temple et al. 2013). the critical evaluation of skeletal alterations at sites of tendon and ligament attachments, their etiology, and their relationship to pathological processes as well as habitual activities (henderson and alves cardoso 2012; jurmain et al. 2012) also has led to new investigations of entheseal changes and their development over the life course (villotte and knüsel 2012). while primate functional adaptation in bone morphology is well studied in paleoanthropology and primatology, bioarchaeologists are uniquely positioned to investigate the larger synergistic relationships between social behavior, context, and bone adaptation in the human skeleton across different human communities through time. along with continued attention in bioarchaeology to health and frailty in the past, significant effort has been directed toward refining our methods for diagnosing skeletal indicators of disease and clarifying our interpretation of lesions in ancient bones. for example, new research is challenging our traditional interpretation of non-specific indicators of stress as measures of health status (reitsema and mcilvaine 2014), including dental enamel defects (hassett 2014; hubbard et al. 2009), periosteal reaction (e.g., dewitte 2014a, 2014b; dewitte and wood 2008; weston, 2008, 2009, 2012), and porotic hyperostosis (mcilvaine 2013; piperata et al. 2014), as well as specific patterns of pathology that are diagnostic of metabolic conditions such as scurvy (crandall and klaus 2014) and anemia (smith-guzman 2015), and infections such as leishmaniasis (marsteller et al. 2011). the study of disease progression over the life course also is being examined more broadly in contemporary studies of paleopathology that also draw upon medical sources (e.g., baker and bolhofner 2013). data from both clinical and medical anthropological sources are used increasingly, and we expect work to continue in these areas in both living populations and skeletal assemblages to improve the understanding of pathological lesions in bio archae ol o gi cal research. contemporary bio archae ol o gi cal analyses of health also use state-of-the-art technology. imaging technology such as computed tomography (ct) scanning (o’brien et al. 2009) and x-ray microtomography (micro-ct) analysis (booth et al. 2016), histology (crowder and stout 2011), stable isotope analyses, ancient dna analysis (adna), immunology, and parasitology (reinhard and araújo 2012) are now at the forefront of paleopathological diagnosis. the fastpaced advances in biogeochemical analyses and molecular biology have pushed bio archae ol o gi cal studies in new directions. stable isotope analyses, for example, increasingly are being used to investigate malnutrition and disease (beaumont and montgomery 2016; d’ortenzio et al. 2015; katzenberg 2012; olsen et al. 2014) as well as disease transmission in the past (kendall et al. 2013; roberts et al. 2013). similarly, analysis of adna has gone well beyond confirming the presence of particular conditions in pathological skeletons, revolutionizing our understanding of the origins and evolution of disease (anastasiou and mitchell 2013; harkins and stone 2014; wilbur and stone 2012). research has emphasized the co-evolution of humans and pathogens, including the causative organisms of tuberculosis, leprosy, and plague (e.g., bos et al. 2011, 2014; müller et al. 2014; stone et al. 2009) and investigated the spread of various pathogens both temporally and geographically (e.g., de melo et al. 2010; schuenemann et al. 2013). anthropological geneticists are also analyzing adna to investigate disease susceptibility, for example, examining how north american indigenous populations responded and adapted to new diseases and epidemics such as smallpox upon contact (lindo et al. 2016). evidence of cytosine methylation also is being recovered from ancient bone (gokhman et al. 2014; smith et al. 2015), shedding light on how epigenetic changes could have related to physiological stress in the past and how these changes could alter bone plasticity and growth. past immunological studies using elisa to investigate antigens or antibodies of parasites that cause malaria and schistosomiasis, for example, have been critiqued (e.g., sallares and gomzi 2001), but biomolecular investigations have progressed to encompass analysis of cortisol levels in ancient hair samples that demonstrate individual experiences of physiological stress (webb et al. 2009) and experimental work that will aid our understanding of inflammatory responses in past populations stronger together: advancing a global bioarchaeology6 (crespo et al. 2016). finally, advances in paleomicrobiology are providing insight into the human microbiome and enhancing dietary reconstruction thorough extraction of chemical compounds, adna, and microfossils from ancient dental calculus and archaeological coprolites (buckley et al. 2014; radini et al. 2017; schnorr et al. 2016; warinner and lewis 2015; see also velsko and warriner in this issue), applications that will surely continue to expand in the coming several years. along with the concerns about demography and differential frailty in archaeological samples, there has been a new critical examination of the representativeness of institutionally housed skeletal samples. for example, bioarchaeologists are looking more closely at issues of racism, violence, and health disparities in documented and cadaveric skeletal samples (de la cova 2010; nystrom 2014, 2017). this recent research has revealed aspects of institutionalization and social marginalization historically and has triggered a renewed dialogue on the ethics and scientific use of anatomical collections both in the past and the present. this deep concern for how we study and represent the dead in bio archae ol o gi cal research is certainly part of the contemporary landscape of the field well beyond the passage of the native american graves protection and repatriation act (nagpra) in the united states in 1990, and it forms a new “ethos” of bioarchaeology (martin et al. 2013:23). both in north america and globally (márquez-grant and fibiger 2011), bioarchaeology is forging a new commitment to how we engage with repatriation (kakaliouras 2012, 2017; pérez 2010) and ethical practice with community stakeholders and the public (martin et al. 2013:23–55; roberts 2009:17–34; turner and andrushko 2011). while bioarchaeologists still have much work to do to go beyond consent with stakeholders to achieve a truly collaborative practice (atalay 2006), this recent work demonstrates a new direction in the field toward a larger goal of community-engaged scholarship. with its focus on criminal and humanitarian issues, forensic anthropology is deeply engaged with the public and local communities. although forensic anthropology is a methodologically focused and applied specialty, there has been a movement in recent years to ally the practice with bioarchaeology more closely in order to bring a more holistic and anthropological approach to the field (e.g., crossland and joyce 2015). undocumented border crossers, for example, are generally underprivileged people subjected to hardships or maltreatment that may result in death during their journeys (see kuba 2012 for a recent review). forensic anthropologists have begun applying bioarcheological tools such as stable isotope analyses to determine area of origin or evaluate the frequency of skeletal stress indicators to identify undocumented migrants (beatrice and soler 2016; see also review by kuba 2012). forensic anthropologists are particularly interested in the study of violence in the recent past and the present day. because violence afflicts contemporary society, and the human capability for violence continues to capture public attention, a large amount of bio archae ol o gi cal research has been devoted to understanding violence in the past. current bio archae ol o gi cal approaches to the study of interpersonal and structural violence (e.g., harrod and martin 2014; knüsel and smith 2014; kurin 2016:127– 153; martin et al. 2012; martin and tegtmeyer 2017; nystrom 2014, 2017; redfern 2017) thus are a vital contribution to our understanding of violence throughout human history and in today’s world. another trajectory that has driven contemporary research in bioarchaeology is a concern with the reconstruction of social identity in the past. many contemporary bioarchaeologists have keenly engaged with social theory in their approach to identities based on gender, age, or health (knudson and stojanowski 2008, 2009). theoretically groundbreaking work is grappling with the limitations of the binary nature of biological sex and the traditional use of heteronormative interpretations of gender roles from skeletal remains (agarwal 2012; geller 2005, 2009, 2017; hollimon 2011; sofaer 2006a). similarly, life-course and embodiment perspectives continue to push our study of age and growing old in the past (appleby 2010; gowland 2009, 2015a). this type of research is part of the rapidly developing theoretical approach to viewing the skeleton as a form of material culture crafted through lived experience, which blurs the division of the biological and social body (sofaer 2006b). similar approaches are being taken with the interpretation of skeletal data from preadult skeletons in an attempt to understand the lives of children in the past (e.g., halcrow and tayles 2011; littleton 2011; thompson et al. 2014; wheeler 2010; wheeler et al. 2013). the effort to illuminate group and individual identity is also seen in the recent interest in the bioarchaeology of care (tilley 2015; tilley and schrenk 2017), which considers aspects of illness and caregiving in the past. a resurgence of research focused on individual identity and the lived experience through osteobiographic approaches pioneered by frank saul (1972; saul and saul 1989) has also occurred (baadsgaard et al. 2011; stodder and palkovich 2012). this approach is not a move away from population-focused research, which is still very much the basis of contemporary bioarchaeology research. instead, it is related to the increasing desire for more humanistic approaches in the field and the appreciation of what the lived experiences of individuals within a group can reveal to contextualize our understanding of the populationlevel responses to biological, cultural, and environmental baker and agarwal 7 factors. a related approach is biohistory (e.g., stojanowski and duncan 2016), which involves the investigation of identified historical figures who are often well known, such as richard iii (buckley et al. 2013; the greyfriars research team with maev kennedy and lin foxhall 2015) or king tutankhamun (e.g., rühli and ikram 2013). individual-level research represented by osteobiography and biohistory often is best suited to engagement with students and the public so they can relate to these past people through their own experiences. bioarchaeology must incorporate the archaeological contextual analysis of sites and skeletal remains by integrating them within the landscape and through analysis of the spatial organization, grave styles, body position and orientation, grave inclusions, and the relationships to other sites and landmarks. more bioarchaeologists who focus on skeletal remains have begun to recognize that questions concerning identity, for instance, can only be answered fully by considering both archaeological and biological data. for example, intrasite biodistance studies that estimate the degree of relatedness among those interred have embraced spatial analysis to reconstruct cemetery structure and formation and to discern its underlying organizing principles that relate to grave placement, particularly in regard to biological relationships among the deceased. such research may demonstrate kin-structured organization (e.g., paul et al. 2013; pilloud and larsen 2011; sciulli and cook 2016) and permit insight into variation in health and diet within a community and even among families (e.g., stojanowski 2013). spatial analysis technology such as geographic information systems (gis) is now commonly used in archaeological projects, including those focusing on sites containing human remains (e.g., herrmann 2002; wilhelmson and dell’unto 2015). recent applications of gis compare pathology and status within an analytic framework to investigate health and disease patterns in the past (herrmann et al. 2014; stojanowski 2013). consideration of taphonomic site formation processes and the effects of corpse treatment on the production of archaeological skeletal assemblages is becoming more common and provides new insights into mortuary behaviors in past communities, thereby enhancing our understanding of a community’s perceptions of death, transformation, and memory (e.g., geber et al. in this issue; robb et al. 2015; smith and pérez arias 2015; weiss-krejci 2011). gis and three dimensional photogrammetry are proving particularly useful in understanding how site formation factors and body processing (e.g., defleshing, cremation), curation of elements, the reuse of graves, and patterns of purposeful disturbance are linked to ongoing relationships between the living and the dead (e.g., haddow and knüsel in this issue). the lived experiences of individuals embodied in their remains and the performed identities and experiences evidenced in mortuary contexts are instrumental in new approaches to investigating social inequality in the past. quinn and beck (2016), for example, propose that the degree of coherence or dissonance found across multiple social dimensions is indicative of social organization, and they present three cases studies that examine institutionalized inequality in prehistoric europe. while the preceding types of research are more integrative, much more multidisciplinary collaborative work, particularly research including archaeologists, bioarchaeologists, and others with differing areas of expertise, is needed to advance our understanding of the human experience. there are still too many situations in which the human remains are a low priority, even for projects involving excavation of ancient cemeteries (see sheridan 2017), and many collections of human remains for which archaeological documentation is lacking for a variety of reasons, thus limiting research potential beyond the bones. over the last several years, however, many projects have become increasingly collaborative endeavors. projects may be directed by a bioarchaeologist overseeing a team with differing areas of expertise, have co-directorships of an archaeologist and a bioarchaeologist, integrate bioarchaeologists into both field and lab components of a project, or are partnerships on broad research projects involving previously excavated material that are enriched by cooperation (examples include, among many others, baker 2016:191–193; binder and spencer 2014; buzon et al. 2016; carr and case 2005; and case and carr 2008). recent works on the archaeology of death and burial reflect such collaboration and are more inclusive of archaeological, biological, and cultural perspectives (see, e.g., the representation among chapters in tarlow and nilsson stutz 2013 and wrobel 2014). these trends are encouraging and point to more cooperative engagement in the future. the need for bioarchaeology international the field of bioarchaeology has flourished in the early twenty-first century, accounting for a significant proportion of recent tenure-track academic positions in anthropology in north america (stojanowski and duncan 2014:56) and in archaeology departments globally. numerous graduate and senior researcher grants for bio archae ol o gi cal projects are awarded by the national science foundation and the wenner gren foundation for anthropological research in the united states, the social science and humanities research council in canada, the wellcome trust and the leverhulme trust in the uk, and many other stronger together: advancing a global bioarchaeology8 agencies around the world. in north america, bioarchaeologists constitute a substantial portion of the american association of physical anthropologists (aapa), the canadian association of physical anthropologists (capa), and the society for american archaeology (saa). bioarchaeology podium sessions have comprised a significant number of the biological anthropology section sessions at the american anthropological association annual meetings in the past several years. meetings of regional bio archae ol o gi cal associations in the united states, including the midwest bioarcheology and forensic anthropology association (barfaa), the western bioarchaeology group (webig), and the bioarchaeologists' northeast regional dialogue (bnrd), are well attended. organizations with a substantial focus on bioarchaeology also are prominent in other countries, such as the british association for biological anthropology and osteoarchaeology (babao). despite maturation of bioarchaeology as a field of inquiry and its tremendous growth, there is no dedicated, integrative peer-reviewed journal for this field as a whole. established journals tend to focus on skeletal remains (e.g., american journal of physical anthropology, international journal of osteoarchaeology, international journal of paleopathology), are archaeology outlets appropriate for articles emphasizing the mortuary context or ritual behavior (e.g., american antiquity, antiquity), or are more methodologically (e.g., journal of archaeological science) or theoretically (e.g., journal of archaeological research) oriented. because these traditional divisions between biological and archaeological emphases and even between more theoretical and empirical research persist in our principal journals, integrative work often does not fit well within the scope of one type of journal or the other. regional journals form another outlet for bioarchae ol o gi cal research, yet these publications may not be consulted regularly by those working outside that area, hindering the exchange of ideas among scholars investigating related research questions or working in similar environmental or social contexts. although edited volumes have been a major publication venue for bioarchaeologists since the 1990s, with bioarchaeology book series promulgated by the university press of florida, cambridge university press, and springer (see sheridan 2017 for a valuable summary table), current tenure and promotion criteria in north american and british institutions frequently devalue book chapters in comparison to peer-reviewed journal articles. bioarchaeology international provides a new outlet for rigorous peer-reviewed publication of substantive articles that will help unify this growing field and provide a global perspective. the overarching goal is to publish studies that are contextually and theoretically informed and that explore the human condition and ways in which human remains and their funerary contexts can provide unique insight on variation, behavior, and lifestyle of past people and communities. original research articles, brief reports, and invited commentary essays related to the study of archaeological human remains and mortuary sites will be published quarterly. occasionally, bioarchaeology international will publish thematic issues. thematic issues may build upon conference symposia or arise anew. our well-respected advisory and editorial board members work in seven different countries, helping recruit manuscripts and reviewers because the journal is intended to be global in both content and readership. to facilitate this international perspective, authors are asked to supply their abstracts in a language other than english. this requirement will improve the visibility of the published article, particularly in situations where the alternate-language abstract is that of the country where the author conducted the research or is employed. publication of theoretical, topical, and data-oriented research spanning different regions and temporal periods will appeal to a broad range of scholars, students, and professionals in the fields of bioarchaeology, archaeology, biological/physical anthropology, anthropology, paleopathology, human biology, history, medicine, geography, and other related fields. commentary pieces are intended to promote discussion among readers on current issues and themes in the field or to discuss new research directions that may advance the field. letters to the editors in chief may be submitted to facilitate discussion or alert colleagues to new information concerning collections, methods, projects, and so forth. a feature that sets bioarchaeology international apart is the professional copyediting of accepted manuscripts provided by the university of florida press. our first issue exemplifies the international reach of the journal. authors are affiliated with institutions in six countries. the collected research articles include work in sudan, turkey, the uk, and ireland, and our alternate-language abstracts in this issue are in four different languages—arabic, french, german, and spanish. the concern with archaeological context pervades the research articles in this issue and illustrates recent developments in bioarchaeology that integrate trends highlighted above in american, british, and french perspectives. for example, sarah schrader and michele buzon examine entheseal changes and accidental trauma in concert to help understand changes in activities and risk that may have occurred during the period of egyptian colonization in the new kingdom to the postcolonial era during which a new state developed in ancient nubia. while at first glance this article may appear to be a typically skeletally focused contribution, the authors stress the baker and agarwal 9 investigation of lived experiences of groups of people and the insight such studies provide into understanding population resilience during the imposition and subsequent collapse of a colonial empire. two articles in this issue explore burial treatment and taphonomy. jonny geber and colleagues and scott haddow and christopher knüsel discuss treatment of the dead by the living and the careful recording during excavation that allows the reconstruction of processes that resulted in the mixing of individuals, reuse of skeletal elements or graves, and the social meaning of these manipulations in very different contexts in neolithic ireland and turkey. the juxtaposition of these articles raises points about information gained through restudy of assemblages excavated long ago (geber et al.) and through careful stratigraphic analysis of skull retrieval and secondary burial afforded by thorough excavation records, 3d modeling of graves, and gis spatial analysis (haddow and knüsel). these articles should be of interest to scholars investigating body treatment, secondary burial, and retention or reuse of skeletal elements from sites in different regions or periods. additional discussion of the importance of site stratigraphy in bio archae ol o gical research is provided by bennjamin penny-mason in his study of use of the harris matrix and phasing of burials within cemeteries. he indicates the difficulty of reconstructing site stratigraphy from field records but provides evidence to show that it is preferable to undertake such time-consuming work than to group the burials together in one, often long, temporal span. his examples show the impact that lumping and splitting individuals from different phases of cemeteries excavated in the uk has on the interpretation of pathology within that skeletal assemblage. although penny-mason’s examples are specific to the uk, his findings are of interest to anyone investigating assemblages from cemetery sites, whether focusing on skeletons or grave architecture and artifacts. understanding phases of use within a cemetery is integral to any investigation of ritual, identity, pathology, or change through time. finally, commentary on bioarchaeology of the oral microbiome transcends geography. this issue’s invited essay by irina velsko and christina warinner highlights new advances in investigating the dna and proteins of microbes found in dental calculus to gain information on human health and biology, human and pathogen co-evolution, and diet in past peoples. recommendations for handling and sampling dental calculus from the field to lab will promote future studies. we hope that the utility of investigations on the oral microbiome will spread by word of mouth! conclusion contemporary bioarchaeology is a field with many arms—some focus their research on methodological and technical specialties of bony analysis, or carefully trace mortuary and burial context, while others interpret data with an infusion of social theory and narrative. these branches of the field are no longer disparate. many of today’s scholars are more at ease with, and seek to engage in, multiple modalities of inquiry. the current field is united in its commitment to understand the human experience within a contextual and ethical framework. we are pleased for bioarchaeology international to represent this vision of the field and present a new forum to encompass this expanding and exciting field. acknowledgments we wish to thank meredith morris-babb, director of university press of florida, for her interest in creating a new journal in bioarchaeology and support of this endeavor. lauren phillips, journals manager at the press, has provided endless help in setting up our manuscript submission site, web page, and myriad mechanics needed to bring the journal to fruition. katherine kinkopf (university of california, berkeley), our editorial assistant, has also managed our system adeptly, and her help in keeping the workflow with manuscripts going smoothly is appreciated. jonathan lawrence has done excellent work as the journal’s copy editor. we are grateful to our advisory and editorial board members for their enthusiasm and encouragement. comments on an earlier draft of this paper were graciously provided by troy case, tina jakob, katie kinkopf, judith littleton, and gwen robbins schug. abstracts were translated into arabic by mohamed faroug ali, chinese by shih-shun lee and mei-chih lee, french by isabelle crevecoeur, german by tina jakob, and spanish by tiffiny tung. we also thank christine lee for facilitating the chinese translation. la bioarchéologie est une discipline relativement jeune qui a pour objectif d’améliorer notre compréhension de la vie, de la mort et des interrelations entre les populations humaines passées à l’échelle du monde entier. cette discipline est née de l'archéologie processuelle américaine et de l'anthropologie biologique dans les années 1960, et a émergé en tant qu’ostéo-archéologie humaine au royaume-uni. aujourd'hui, la bioarchéologie est un champ d'étude dynamique et interdisciplinaire au croisement de l'anthropologie biologique, de l'archéologie et des stronger together: advancing a global bioarchaeology10 théories sociales. elle cherche à appréhender les populations humaines passées en tenant compte du contexte biologique, culturel et environnemental. cette discipline met l'accent non seulement sur l'étude des restes humains, mais également sur l'analyse et l'interprétation intégratives de ces données dans leur cadre archéologique, socioculturel, politique, et environnemental. l'intérêt croissant pour les recherches en bioarchéologie est à l’origine de la nécessité de créer un nouveau journal évalué par les pairs afin d’unifier et de faire progresser cette discipline dans le monde entier. dans cette introduction à bioarchaeology international, nous retraçons les origines de la discipline et les différentes “écoles” de bioarchéologie qui se sont développées et qui tendent maintenant à fusionner à mesure que la discipline mûrit. nous décrivons ensuite l’ambition et les intentions de la revue, en soulignant l’adéquation des articles du premier numéro avec ces objectifs. enfin, en tant que co-rédactrices en chef, nous décrivons notre vision des orientations actuelles et futures de la bioarchéologie. avec cet aperçu de la discipline et du journal, nous souhaitons encourager la discussion et promouvoir les soumissions internationales. nous espérons que bioarchaeology international viendra renforcer cette discipline en plein essor et aidera à promouvoir l'intérêt scientifique et public pour notre recherche collective. ملخص: علم اآلثار البايولوجي )علم آثار العظام البشرية القديمة( هو مجال في مهده نسبياً و يهدف الي تحسين مفهوم الحياة و الموت باإلضافة الي العالقات الداخلية ما بين قدماء البشر حول العالم. نشأ العلم في ستينيات علم اآلثار الحديث األمريكي و علم دراسة االنسان البايولوجي كما ظهر في المملكة المتحدة بإسم علم آثار العظام. يعتبر حالياً علم اآلثار البايولوجي علم متجدد و مجال تداخله مع علوم اآلثار، علم دراسة االنسان البايولوجي و النظرية اإلجتماعية يهدف الي إظهار الشعوب القديمة في ظل ظروفهم البايولوجيه و الثقافية و البيئية. ال يركز هذا العلم فقط علي دراسة البقايا البشرية بل التحاليل المتكاملة و تفسير سياقاتها متضمنةً الظروف األثرية، الوسط اإلجتماعي الثقافي و السياسي باألضافة الي المحيط البيئي لهذه الجماعات. أّدت الرغبة المتزايدة في بحوث علم اآلثار البايولوجي الي ضرورة أيجاد مجلة جديدة تستند علي تقييم علمي للمساعدة في توحيد و تطور هذا العلم حول العالم. في هذه المقدمة لعلم اآلثار البايولوجي العالمي نقتفي أصول ميادين علم اآلثار البايولوجي و تطور المدارس المختلفة التي ظهرت حالياً مع نضوج العلم. بعد ذلك نقوم بتوضيح الغرض و األهداف من المجلة و تسليط بعض الضوء في المقام األول علي كيفية مساهمة المقاالت لتحقيق هذه االهداف. و آخيراً نوضح رؤيتنا كمحررون للتوجهات الحالية و المستقبلية لعلم اآلثار البايلوجي. و نرجوا بهذه النظرة العامة للعلم و المجلة إثراء النقاش و شجيع المشاركات العالمية. و نسعي هنا الي تعزيز مجال علم اآلثار البايولوجي العالمي المتطور كما نأمل أن نساعد في التطور البحثي و الفائدة العامة من خالل أبحاثنا الجماعية. la bioarqueología es un campo de estudio relativamente joven que tiene como objetivo mejorar nuestra comprensión de la vida, la muerte y las interrelaciones entre los humanos del pasado en todo el mundo. la disciplina surgió de la arqueología “procesual” y de la antropología biológica en los ee uu de los años 60, y surgió como osteoarqueología humana en el reino unido. hoy en día, la bioarqueología es un campo de estudio vibrante e interdisciplinario que integra la antropología biológica, la arqueología y la teoría social para situar a las comunidades del pasado en sus contextos biológicos, culturales y ambientales. el campo enfatiza no sólo el estudio de los restos humanos, sino también la integración del análisis e interpretación de sus contextos, incluyendo el arqueológico, sociocultural y político, así como el ambiente en el que vivió la gente. el creciente interés en la investigación ha creado la necesidad de una nueva revista revisada por pares para ayudar a unificar y avanzar esta disciplina en todo el mundo. en esta introducción a bioarchaeology international, trazamos los orígenes del campo y las diferentes “escuelas” de bioarqueología que se han desarrollado y ahora se están fusionando a medida que la disciplina ha madurado. luego delineamos el propósito y objetivos de la revista, destacando cómo los artículos en la primera edición contribuyen a esos objetivos. finalmente, como co-editores, describimos nuestra visión para las direcciones contemporáneas y futuras en la bioarqueología. con esta visión general del campo y la revista, deseamos estimular el debate y promover las presentaciones de manuscritos internacionales. nuestra intención es que bioarchaeology international fortalezca este campo creciente y ayudar a promover el interés académico y público en nuestras investigaciones colectivas. bioarchäologie ist ein reltiv junges forschungsgebiet, das die verbesserung unserer verständnisse von leben, tod und den verbindungen archäologischer bevölkerungsgruppen weltweit miteinander zum ziel hat. die disziplin erwuchs aus der nordamerikanischen prozessualen archäologie und physischen anthropologie der 1960er jahre und enstand als human-osteoarchäologie in grossbritannien. heutzutage ist die bioarchäologie ein lebendiges, interdisziplinäres gebiet, das übergreifend die biologische anthropologie, archäologie und sozialtheorie umfasst, um archäologische bevölkerungen in ihren biologischen, kulturellen und ökologischen rahmen zu stellen. die bioarchäologie beinhaltet nicht nur das studium menschlicher überreste, sondern auch die integrative analyse und interpretation der lebensumstände, insbesondere des archäologischen, soziokulturellen und politischen milieus und der umwelt, in der die menschen lebten. dieses wachsende interesse an der bioarchäologischen forschung hat es notwendig gemacht eine neue peer-review-fachzeitschrift zu erschaffen, die helfen soll die disziplin weltweit zu vereinen und voranzutreiben. in diesem einführungsartikel zu bioarchaeology international verfolgen wir die ursprünge und die verschiedenen „schulen“ der bioarchäologie, die sich entwickelt haben und die im zuge der weiterentwicklung der disziplin verschmelzen. desweiteren werden die zwecke und ziele der fachzeitschrift definiert und es wird dargelegt, wie die beiträge in dieser ersten baker and agarwal 11 ausgabe zu diesen zielen beitragen. abschliessend beschreiben wir als cefredakteurinnen unsere vision für zeitgenössische und zukünftige forschungrichtungen der bioarchäologie. mit diesem überblick über die disziplin und die fachzeitschrift wollen wir diskussionen anregen und internationale beiträge fördern. es ist unsere absicht für bioarchaeology international dieses wachsende forschungsgebiet zu stärken und zu helfen, das wissenschaftliche und öffentliche interesse in unsere gemeinschaftliche forschung zu unterstützen. 生物考古學是一個比較年輕的領域，其目的是在改善我們對過去地球上人類的生活，死亡及相互間的関係作 進一步的瞭解，這個學科是從1960年代美國流程考古學及生物考古學在英國演變而成的人類骨頭考古學。生 物考古學現在是一個很活躍跨領域的學科，它蓋括生物考古人類學，考古學，以及社會理論，把過去人類在生 物，文化，生活環境的種種情況放在應有的階位上，這個領域不僅僅強調研究人體的遺留物，並且對他們所 存在的一切作整體的分析及解釋，這包括考古學上，社會文化上及政治情景上以及人類生活環境上的擺置。 因為対生物考古學的研究，有愈來愈多的人有興趣。因此有必要發行一份新的期刊來刊登經過專家審核合格 的文章，能這樣的話，對這個學科在全球性的融合及發展會有幫助。在介紹生物考古學這一期，我們追朔到這 個領域的源頭以及不同生物考古學派的發展，現在這些學派，己融合成爲一個成熟的學科。然後我們把辦這 個刊物的宗旨及目標描述出來並強調刊在這一期的每篇文章都符合我們刊物的目標。最後作為刊物的共同總 編輯，我們對現代及未來生物考古學發展的方向也陳述了我們的視野。為這個領域及這刊物的總體觀，我們 希望能鼓舞討論及促進國際間投稿。我們有意使國際生物考古學這刊物能加強這個領域的發展以及促進學 者及大衆對我們共同研究產生興趣。 references cited agarwal, sabrina c. 2012. the past of sex, gender, and health: bioarchaeology of the aging skeleton. american anthropologist 114(2):322–335. doi: 10 .1111 /j .1548 -1433 .2012 .01428 .x. agarwal, sabrina c. 2016. bone morphologies and histories: life course approaches in bioarchaeology. american journal of physical anthropology supplement: yearbook of physical anthropology 159(s61):130–149. doi: 10 .1002 /ajpa .22905. agarwal, sabrina c., and bonnie a. glencross. 2011. building a social bioarchaeology. in social bioarchaeology, edited by sabrina c. agarwal and bonnie a. 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temporal trends in stable isotopes for nubian mummy tissues. american journal of physical anthropology 93(2):165–187. doi: 10 .1002 /ajpa.1330930203. stronger together: advancing a global bioarchaeology18 wilbur, alicia k., and anne c. stone. 2012. using ancient dna techniques to study human disease. in the global history of paleopathology: pioneers and prospects, edited by jane e. buikstra and charlotte a. roberts. oxford university press, new york, pp. 703–717. wilhelmson, helene, and nicoló dell’unto. 2015. virtual taphonomy: a new method integrating excavation and postprocessing in an archaeological context. american journal of physical anthropology 157:305–321. doi: 10 .1002 /ajpa .22715. wilson, jeremy j. 2014. paradox and promise: research on the role of recent advances in paleodemography and paleoepidemiology to the study of “health” in precolumbian societies. american journal of physical anthropology 155:268–280. doi: 10 .1002 /ajpa .22601. wood, james w., george r. milner, henry c. harpending, and kenneth m. weiss. 1992. the osteological paradox: problems of inferring prehistoric health from skeletal samples. current anthropology 33(4): 343–370. wright, lori e. 2012. immigration to tikal, guatemala: evidence from stable strontium and oxygen isotopes. journal of anthropological archaeology 31:334–352. doi: 10 .1016 /j .jaa .2012 .02 .001. wright, lori e., and cassady j. yoder. 2003. recent progress in bioarchaeology: approaches to the osteological paradox. journal of archaeological research 11(1):43–70. doi: 10 .1023 /a:1021200925063. wrobel, gabriel d., ed. 2014. the bioarchaeology of space and place: ideology, power, and meaning in maya mortuary contexts. springer, new york. doi: 10 .1007 /978 -1 -4939 -0479 -2. zuckerman, molly k., and george j. armelagos. 2011. the origins of biocultural dimensions in bioarchaeology. in social bioarchaeology, edited by sabrina c. agarwal and bonnie a. glencross. blackwell, malden, ma, pp. 15–43. zuckerman, molly k., and debra l. martin. 2016a. introduction: the development of biocultural perspectives in anthropology. in new directions in biocultural anthropology, edited by molly k. zuckerman and debra l. martin. wiley, hoboken, nj, pp. 7–26. zuckerman, molly k., and debra l. martin, eds. 2016b. new directions in biocultural anthropology. wiley, hoboken, nj. bioarchaeology international bioarchaeology international volume 8, numbers 1–2: 1–3 doi: 10.5744/bi.2023.7101 © 2024 university of florida press the journal, bioarchaeology international, was founded to provide the field with an avenue to publish research that takes a humanistic approach to the study of people within a deeply and thoroughly contextualized past (agarwal and baker 2020). the papers published in this journal explore pressing issues of contemporary relevance including health disparities, marginalization, structural violence, climate change and sustainability, the disproportionate impact of epidemics and pandemics on social groups, and social stigma related to disease. the editorial team comprises bioarchaeologists who focus on social justice, human diversity, equity, inclusion, and ethical principles in our research (e.g., agarwal 2022, in press; baker et al. 2001; de la cova 2012, 2019; halcrow et al. 2019, 2021; robbins schug et  al. 2021; watkins 2018). the exploration of ethics is also reflected in the papers published in the journal (e.g., kakaliouras 2017) and in our profession more broadly (e.g., de la cova et al. 2022). we continue to seek and encourage diverse voices in authorship, including representation of scholars from the global south and traditionally underrepresented groups. bio archae ol o gi cal ethics is a complex and challenging topic that is constantly developing. in the 1990s with nagpra, in 2016 with the metoo movement, and in 2020 with covid19 lockdown, we have experienced events that have opened a space for culture change. in 2020, we saw heightened awareness in the us of serious issues spotlighted in the black lives matter movement. although some scholars have been describing alternative antiracist forms of bioarchaeology for decades (e.g., blakey 2008, 2022), many other scholars were more recently moved to think more deeply about ethical issues in the field (geller 2020, 2022; ruckstuhl et al. 2016; soluri and agarwal 2022, squires et al. 2022). numerous ethical statements have been recently developed for associations in the field of bioarchaeology and closely aligned disciplines (e.g., american anthropological association; paleopathology association; and society for american anthropology [saa], where the bioarchaeology interest group were consulted in the 2021 revision of saa’s statement on the treatment of human remains). ethical guidelines in research and reporting have become more sophisticated as academic disciplines evolve and adapt to the sociocultural circumstances in which scholars operate. anthropological ethics are context specific. we seek to uphold integrity, minimize any potential harm, and work with and for communities in their best interests. ethics, policy, and legislation will vary crossculturally and over time. there are many contextspecific considerations, e.g., if human remains are held in a country outside their origin, a layer of complexity is added to bio archae olo gi cal projects. typically, projects require permissions from authorities, but ethical practice should also prioritize consultation, partnership, and/or collaboration with descendant communities and/or local communities and researchers. much of this work is unseen in the publication process and it is an integral part of the bio archae ol o gi cal collaborative research approach and the outreach that many conduct. there is also work on the editorial process not visible to the readership, which is the focus of this editorial. since the inception of bioarchaeology international in 2016, the co– editorsinchief and associate editors have conducted internal checks on research integrity and ethics (including collaboration, consultation, legislation, permissions, plagiarism, etc.). at submission, authors must complete a checklist that includes adherence to ethical practice in the conduct of the research and writing of the article. our policy editorial: ethical guidelines and policies of bioarchaeology international editorial2 on research with native american ancestral remains has become more stringent since 2020. for example, while we initially considered manuscripts with historical (nontribal) permission for data collection, we no longer do so. we do not accept or publish any research on native american, first nations, and/or indigenous communities without recent tribal permissions. in instances where manuscripts are submitted without a permission statement, they are sent back to the authors to confirm permissions prior to going to review and, if no permissions are forthcoming, these manuscripts are not considered for review. photos of human remains from any context are only published when essential to the research questions and aims of the paper and with permissions to use such images. bioarchaeology international was the first international journal with bio archae ol o gi cal content to develop explicit ethical guidelines of consent. this requirement is in addition to the existing ethical standards for journal publications for the university press of florida, which includes responsibilities for editors, authors, reviewers, and the publisher in general publication ethics. in 2020, during covid19 lockdown, the current co– editorsinchief and founding co– editorsinchief worked to expand our statements of research ethics and consent. these revised statements were adopted in april 2021. the expanded ethics statement acknowledges required permissions, specifically from native american, first nations, and/or indigenous communities and other local communities for research, publication, and the presentation of photographs of human remains. when the statement was put online in april 2021, we moved to encourage the publication of an ethics statement in every article, so that most papers published from 2022 forward include information on the consultation and permissions relevant to the specific work. an ethics statement is now required for all papers. manuscripts submitted to bioarchaeology international will not be considered without provision of such a statement. moving forward, the field of bioarchaeology and the journal will continue to consider our ethical obligations in new ways, as social consciousness and best professional practice develop further. the journal maintains a goal of meeting ethical obligations and adapting to changing circumstances over time. for example, there is currently an increased interest in the ethics of using historical anatomical skeletal collections within biological anthropology and anatomy teaching and research. changes in legislation, such as recent amendments of nagpra concerning the repatriation of “culturally unidentifiable” or unprovenienced human remains will also influence the approaches that bioarchaeologists use. due to the nature of the changing landscape of our field, our ethical guidelines at bioarchaeology international are a living document. we will continue to reflect upon our practices. the editorial board welcomes constructive debate and dialogue with bioarchaeologists and other anthropologists in these endeavours, including consideration of manuscripts that engage with these issues. coeditorsinchief siân halcrow and gwen robbins schug founding coeditorsinchief sabrina agarwal and brenda baker works cited agarwal, sabrina c. 2022. the legacy and disposability of brown bodies: the bioethics of skeletal anatomy collections from india. american journal of biological anthropology 177(s73):2. doi: 10.1002/ajpa.24514. agarwal, sabrina  c. in press. the ethics of anatomical collections from india. nature communications. agarwal, sabrina  c., and brenda  j. baker. 2020. from the foundation to a vision of the future: a note from the founding editors. bioarchaeology international 4(3– 4):151– 152. doi: 10.5744/bi.2020.5143. baker, brenda j., tamara l. varney, richard g. wilkinson, lisa m. anderson, and maria  a. liston. 2001. repatriation and the study of human remains. in the future of the past: archaeologists, native americans, and repatriation, edited by tamara bray. garland, new york, pp. 69– 89. doi: 10.4324/9780203056004. blakey, michael  l. 2008. an ethical epistemology of publicly engaged biocultural research. in evaluating multiple narratives, edited by junko habu, clare fawcett, and john m. matsunaga. springer, new york, pp. 17– 28. doi: 10.1007/978038771825 5_2. blakey, michael  l. 2022. walking the ancestors home: on the road to an ethical human biology. anthropology now 14(1– 2):1– 20. doi: 10.1080/19428200.2022.2117976. de la cova, carlina. 2012. patterns of trauma and violence in 19thcenturyborn african american and euroamerican females. international journal of paleopathology 2(2– 3):61– 68. doi: 10.1016/j.ijpp.2012.09.009. de la cova, carlina. 2019. marginalized bodies and the construction of the robert j. terry anatomical skeletal collection: a promised land lost. in bioarchaeology of marginalized people, edited by madeleine l. mant and alyson jaagumägi holland. elsevier, cambridge, ma, pp. 133– 155. doi: 10.1016/ c20170023005. de la cova, carlina, siân halcrow, and gwen robbins schug. 2022. aaba/ppa symposium on ethics in the curation and use of human skeletal remains. presidential choice invited symposium presented at the 91st  annual meeting of the american association of biological anthropologists, denver, co. geller, pamela  l. 2020. building nation, becoming object: the biopolitics of the samuel g. morton crania collection. historical archaeology 54(1):52– 70. doi: 10.1007/s41636019002183. geller, pamela l. 2022. without their consent: handling legacy collections and anatomy teaching specimens acquired without informed consent. the faseb journal 36(s1). doi: 10.1096/fasebj.2022.36.s1.0i623. halcrow, siân, amber aranui, stephanie halmhofer, annalisa heppner, norma johnson, kristina killgrove, and gwen robbins schug. 2021. moving beyond weiss and springer’s repatriation and erasing the past: indigenous values, relationships, https://­upf.­com/­ethics.­asp https://­upf.­com/­ethics.­asp https://­upf.­com/­ethics.­asp https://journals.upress.ufl.edu/bioarchaeology/ethics https://journals.upress.ufl.edu/bioarchaeology/ethics editorial 3 and research. international journal of cultural property 28(2):211– 220. doi: 10.1017/s0940739121000229. halcrow, siân e., rebecca crozier, kate m. domett, thanik lertcharnrit, jennifer s. newton, louise g. shewan, and stacey m. ward. 2019. ethical issues of bioarchaeology in southeast asia. in ethical approaches to human remains, edited by kirsty squires, david errickson, and nicholas márquezgrant. springer international publishing, cham, pp. 465– 484. doi: 10.1007/9783030329266_21. kakaliouras, ann  m. 2017. nagpra and repatriation in the twentyfirst century: shifting the discourse from benefits to responsibilities. bioarchaeology international 1(3– 4):183– 190. doi: 10.5744/bi.2017.1007. robbins schug, gwen, and siân halcrow. 2021. preface. bioarchaeology international 5(1):1– 2. doi: 10.5744/bi.2021.5000. robbins schug, gwen, kristina killgrove, alison atkin, and krista baron. 2021. 3d dead: ethical considerations in digital human osteology. bioarchaeology international 4(3– 4):217– 230. doi: 10.5744/bi.2020.3008. ruckstuhl, katerina, nancy tayles, hallie buckley, richard bradley, roger fyfe, and mark ellison. 2016. the ancestors speak: kōiwi tangata, mātauranga māori and the development of biological anthropology in new zealand. in the routledge handbook of bioarchaeology in southeast asia and the pacific islands, edited by marc oxenham and hallie buckley. routledge, london, new york, pp.  637– 654. doi: 10.4324/9781315725444.ch28. soluri, k. elizabeth, and sabrina c. agarwal. 2022. laboratory manual and workbook for biological anthropology. 2nd  ed. w. w. norton & company. squires, kirsty, charlotte  a. roberts, and nicholas márquez‐ grant. 2022. ethical considerations and publishing in human bioarcheology. american journal of biological anthropology 177(4):615– 619. doi: 10.1002/ajpa.24467. watkins, rachel. 2018. anatomical collections as the anthropological other: some considerations. in bio archae ol o gi cal analyses and bodies, edited by pamela k. stone. springer international publishing, cham, pp. 27– 47. doi: 10.1007/9783319711140_3. login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to 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bioarchaeology international volume 6, number 3: 161–174 doi: 10.5744/bi.2021.0010 received 03 march 2021 revised 07 october 2021 accepted 15 december 2021 bone remodeling changes in an individual with tuberculosis-induced, left-sided femoroacetabular joint destruction, from nineteenth-century milton, new zealand anne marie e. snoddy,a*^ justyna j. miszkiewicz,b,c*^ karen m. cooke,b peter petchey,d and hallie r. buckleya abstract    bone is dynamic, undergoing metabolic changes in response to behavioral and pathological stimuli. this information can be reconstructed in bioarchaeology using histological methods, providing another avenue to explore the experiences of past peoples. we report histological findings from midshaft femoral cortical bone of an identified individual from nineteenth-century new zealand, who suffered from tuberculosis and had a historically documented period of invalidism. materials: burial 21 (b21) is a middle-aged male excavated from the nineteenth-century site of st. john’s burial ground, milton. b21’s left proximal femur and acetabulum exhibited lytic lesions associated with tuberculosis-induced destruction of bone. documentation, including a cause of death of “pneumonic phthisis haemorrhage,” and various biographic details exist for this burial. these suggest that b21’s left and right midshaft femur were under asymmetric biomechanical and pathological conditions and should show differences in the underlying bone remodeling. methods: we collected data on haversian bone microstructure geometric properties and densities from a total of 148 secondary osteons and 481 haversian canals. results: the left femur, from the tuberculosis-inflicted hip joint, had fewer, larger, and more irregularly shaped canals and osteons than the right femur. discussion and conclusion: these findings may indicate the left femur received less biomechanical stimulation than the right femur due to decreased weightbearing. it is also possible that the tuberculosis infection in this individual impacted his bone metabolic activity, leading to increased experiences of bone loss. the presented histological approach may enhance interpretations in bioarchaeology by identifying whether bone remodeling changes occur as a result of longor short-term disuse. keywords:  histology; biomechanics; limb immobilization tkanka kostna jest dynamiczna i ulega przemianom metabolicznym w odpowiedzi na bodźce patologiczne i wynikające z aktywności fizycznej. tę informacje można odtworzyć w bioarcheologii metodami histologicznymi, które otwierają kolejną drogę do rekonstruowania życia przeszłych ludów. raportujemy tutaj histologiczne wyniki z badan środkowej części kości udowej zidentyfikowanego osobnika z xix wieku z nowej zelandii. ten osobnik cierpiał na gruźlicę, która miała historycznie udokumentowane inwalidztwo. materiał: z miejsca pochówku 21 (b21) na cmentarzu św. jana w milton wydobyty został szkielet mężczyzny w średnim wieku. lewa bliższa kość udowa i kawałek kości miednicy wykazywały zmiany związane z destrukcją kości wywołaną efektem gruźlicy. istnieje dokumentacja odnośnie tego osobnika, w tym przyczyna śmierci jako „krwotok płucny” oraz różne szczegóły biograficzne. sugerują one, że lewa i prawa kość udowa w b21 były asymetryczne z perspektywy biomechanicznej i patologicznej. te różnice powinny być odzwierciedlone w przebudowanej mikrostrukturze kości. metody: zebraliśmy dane dotyczące geometrii systemów haversa badając właściwości i gęstości z łącznie 148 osteonów i 481 kanałów haversa. wyniki: lewa kość udowa z dotkniętego gruźlicą stawu biodrowego miała mniej i większe kanały i osteony o nieregularnych kształtach niż prawa kość udowa. dyskusja i wnioski: te wyniki mogą wskazywać, że lewa kość udowa otrzymała mniejszą stymulację biomechaniczną niż prawa kość udowa z powodu zmniejszonego obciążenia. możliwe jest również, że zakażenie gruźlicą w tym osobniku wpłynęło na jego aktywność metaboliczną kości, prowadząc do nasilenia doświadczeń związanych z utratą masy kostnej. nasze wnioski mają implikacje metodologiczne i interpretacyjne dla prowadzenia ‘osteobiografii’ i wzmacniania modeli opieki w bioarcheologii. keywords:  histologia; biomechanika; unieruchomienie kończyn introduction the reconstruction of human lives and lifestyles in bioarchaeology is traditionally achieved using macroscopic methods of skeletal examination, because they allow evaluation of anatomical variation in the light of behavioral and disease variables (larsen 2015) and are noninvasive (meyer 2011). however, bioarchaeologists increasingly recognize that using histological methods as a complementary tool of examination can yield microscopic data that offer insights into the underlying bone growth and change stimulated by various pathologies (crowder and stout 2011; de boer and van der merwe 2011) and biomechanical load (miszkiewicz and mahoney 2017; stout et al. 2019), among other factors. in cases where permissions for destructive sampling of skeletal remains are in place, it is possible to extract small pieces of adult bone for examination under the microscope and measure geometric properties and densities of haversian bone structures (secondary osteons, hereafter “osteons,” and haversian canals) to reconstruct remodeling activity executed by bone multicellular units (bmus) (miszkiewicz and mahoney 2017; stout et al. 2019). one application of such methodology in bioarchaeology can be seen in case studies that compare left and right limb bones’ microscopic changes in individuals afflicted with some form of unilateral condition, such as below-knee amputation (lazenby and pfeiffer 1993), hip joint ankylosis (miszkiewicz et al. 2020), or acute poliomyelitis-related lower limb atrophy (kozłowski and piontek 2000). using archaeological and/or historical documentation evidence, the bone data can be contextualized to shed light on aspects of healing, care in the community, and experiences of short-term or long-term bone changes in past individuals. cortical bone remodeling and unilateral limb pathology bone remodeling changes in cases of unilateral abnormalities can result from either biomechanical or pathological processes or their combined effect (laroche et al. 2003; ramírez et al. 2011). although extrapolating one specific factor is difficult in nonexperimental (i.e., bioarchaeological) settings, broader interpretations within documented case studies can be conducted. adult human cortical bone undergoes remodeling shifts with changes in biomechanical load (augat and schorlemmer 2006; christen et al. 2014; robling et al. 2006). mechanical stimulation of bone tissue resulting in bone remodeling and modeling changes is described under wolff’s law and the mechanostat theory (frost 1998). theoretical and experimental evidence indicates that bone tissue “rearrangement” occurs so that old bone is replaced with more structurally competent bone, or new bone is added at sites of high mechanical strain (christen et al. 2014). equally, limited or absent mechanical stimulus as a result of muscle disuse can lead to bone loss through an uncoupling of otherwise balanced remodeling activity of bone resorption and deposition (alexandre and vico 2011). the remodeling processes of secondary cortical bone can be reconstructed using geometric parameters of haversian tissue seen in two-dimensional (2d) histology sections visualized using light microscopy (stout et al. 2019). the shape and size of osteons, cortical bone remodeling products, reflect the stage and/or frequency of remodeling events (hennig et al. 2015; martin 2007). diseases that disrupt physiological homeostasis also systemically have the potential to disrupt an otherwise balanced bone remodeling, leading to bone loss dominating bone gain (e.g., boyce et al. 2012; walsh and gravallese 2010). this can be best illustrated through osteopenia and osteoporosis, which are bone metabolic conditions characterized by increased bone fragility. while their etiology is complex, it also includes lack of biomechanical stimulation, as bone remodeling is disrupted for prolonged periods of time, such as in cases of bedrest or immobilization (e.g., minaire et al. 1974; schlecht et al. 2012). infectious bacterial diseases, such as tuberculosis, which result in bone lesions including tuberculosis-induced hypertrophic osteopathy (von hunnius 2009) or local deposition of woven bone in response to the infection (kuhn et al. 2007), can be examined alongside bone remodeling changes (nair et al. 1996). one common manifestation of untreated tuberculosis infections is hip joint destruction (babhulkar and pande 2002), which is often one-sided and characterized by unilateral sclerotic lesions or acetabular migration (vogelpoel et al. 2009). one-sided, tuberculosis-induced joint pathology will likely impact bone remodeling from both the disease and biomechanical viewpoint, as the afflicted individual does not have complete mobility of one leg (babhulkar and pande 2002). the knowledge of modern-day presentation of remodeling changes in biomechanical and pathological contexts, combined with histology, offers a powerful means with which to test the extent that localized, cortical-bone mechanical adaptation occurs in archaeological cases of limb immobilization and disuse (e.g., minaire et al. 1974; schlecht et al. 2012). this histological approach may also enhance interpretations in bioarchaeology by identifying whether bone remodeling changes occurred as a result of longor short-term disuse (miszkiewicz et al. 2020). for example, bone histomorphometry has been employed successfully in at least three previous bioarchaeological and paleopathological studies that address these sorts of questions (e.g., kozłowski and piontek 2000; lazenby and pfeiffer 1993; miszkiewicz et al. 2020). lazenby and pfeiffer (1993) reported histologically informed endosteal expansion and increased cortical remodeling, along with macroscopic reduction in size of the left femur in a nineteenth-century canadian (middlesex county, ontario) amputee. the individual had survived amputation approximately five years prior to death and was active following the application of the prosthesis. kozłowski and piontek (2000) used histology to show reduced bone density and osteocyte lacunae counts in the right metatarsal from a severely atrophic leg in a medieval (twelfth to fourteenth century a.d.) male from gruczno, poland. the authors suggest that this individual lived with a long-term, one-sided muscle paralysis caused by acute poliomyelitis. most recently, miszkiewicz et al. (2020) used bone histology to report slight, midshaft femur remodeling asymmetry in a middle-aged male from metal period nagsabaran (philippines) who had suffered from left hip joint ankylosis. the bone remodeling changes were concluded to have been short term due to no severe (e.g., cortical trabecularization) bone resorption changes observed histologically. in all cases, the examined individuals would have experienced a form of biomechanical loading change to one side of their lower limbs. burial 21, saint johns, milton following captain james cook’s visits in the late eighteenth century, aotearoa/new zealand experienced several successive periods of immigration during the nineteenth century. one of the most significant agents of this migration was the new zealand company (nzc), which was formed in 1837 with the intention of profiting from the sale of land. the otago settlement was a joint venture between the lay association of the free church of scotland and the new zealand company, which purchased 144,600 acres of land in coastal otago from ngai tahu (the local maori tribe) in 1844. the intention was to establish a wakefield class settlement, where the community would have two main social classes: a landowning capitalist class and a wage-earning working class (hocken 1898:3; olssen 1984:31–35; schrader 2016:34–36). the head of otago harbour was selected as the site for the town, which was named “dunedin,” the gaelic form of edinburgh, and the first two immigrant ships arrived in 1848 (hocken 1898:48, 57, 77–78, 81, 94; mcdonald 1965:1–4). growth of the new settlement was initially slow, but in 1861, the first of the major otago gold rushes occurred inland at gabriel’s gully, followed by the larger dunstan rush in 1862 (olssen 1984; salmon 1963). these events brought a massive influx of people and capital to dunedin and otago, and the population of the town rose from 2,262 in 1859 to 15,790 in 1864 (mcdonald 1965:44, 51). the rural village of milton, located approximately 50 km southwest of dunedin, was established in 1850 and functioned as an agricultural satellite community (sumpter and lewis 1949:5–10). being approximately equidistant between dunedin and the lawrence goldfields, milton was well placed to service both locations with goods. when the gold rush subsided, it also presented an attractive option for former miners to settle, and it remains the service center for the predominantly agricultural tokomairiro area. in 2016, an excavation of st. john’s anglican burial ground (sjm), milton, was conducted at the request of the local community. this work had the joint objectives of identifying “lost” graves and exploring the lives of colonial new zealanders through bioarchaeological analysis of their remains (petchey et al. 2017). following public consultation, an archaeological authority (no. 2017/171) was granted for excavation by heritage new zealand, and a disinterment license (no. 2016/17) was obtained from the ministry of health. the remains recovered from this excavation are curated at the university of otago, department of anatomy and will be repatriated to sjm once analyses are completed. recently, an integrated case study of disseminated, tuberculosis (tb)–induced, femoroacetabular joint changes in skeletal remains belonging to a middle-aged male (b21) from sjm was reported. this was a unique case study where access to death records, obituaries, and coffin plate information was possible, and archival research identified a period of invalidism impacting b21 for about a year prior to his death. historical documentation shows that the remains of b21 belong to a 42-year-old man who was born in mitcham, london, and immigrated to new zealand via hobart, australia, following the discovery of gold in central otago in 1861. after the rush subsided, he settled in rural community of milton, supporting his wife and 11 children as a laborer. sometime in 1872, he became too ill to work, and his family was supported by a charitable society to which he belonged (the ancient order of foresters [aof]). he died on july 5, 1873, and his cause of death is listed as “pneumonic phthisis haemorrhage.” it was found that b21 exhibited lesions that, along with his documented cause of death, strongly support a diagnosis of disseminated tuberculosis (snoddy et al. 2020). these include extensive destruction of the trabecular bone in the proximal femur (fig. 1) and remodeled destruction of the margins of the left acetabulum, as well as lytic endocranial cranial lesions. on the basis of the lesions of the hip, it was speculated that the one-sided hip joint pathology would have had an adverse effect on b21’s lower limb function (snoddy et al. 2020:234); however, no direct data to test this assumption were available. these data would help validate the corroboration between the surviving bone and documented evidence and provide a methodological avenue for future bioarchaeological research examining cases of one-sided hip joint pathologies. figure 1.  computed tomography scan (posterior view) of the left femur of b21 showing extensive destruction of the trabeculae in the head and trochanters (arrows)(reproduced with permission from snoddy et al. 2020:228). assuming that b21 did not have full ambulatory use of his left leg, we hypothesize here that b21’s left and right midshaft femur will display localized asymmetry in biomechanically stimulated bone remodeling. building upon the prior research (e.g., kozłowski and piontek 2000; lazenby and pfeiffer 1993; miszkiewicz et al. 2020) and principles of bone functional adaptation and disease processes discussed above, we considered a series of bone remodeling scenarios in key types of lower limb (dis)use: •  functional and complete use of both lower limbs: we expect no, comparable, or similar differences in the micro-characteristics (e.g., densities, shape, and size of osteons) of remodeled bone in a symmetrically sampled location on the left and right femur. these might simply reflect natural variation and bilateral asymmetry (we use a 10% threshold—see materials and methods). as such, one can infer that no long-term (several years) or short-term (several months) bone remodeling change had occurred prior to death. •  long-term immobilization of both lower limbs: we would also expect no, comparable, or similar differences in the micro-characteristics (e.g., densities, shape, and size of osteons) of remodeled bone in a symmetrically sampled location on the left and right femur. however, we should see evidence for osteopenia or osteoporosis-like changes in bone microstructure (“disuse osteoporosis”; rolvien and amling 2021), with extensive cortical bone porosity characterized with “giant” neighboring pores coalescing one into another, and enlarged osteon areas (schlecht et al. 2012). in extreme cases, these can lead to a trabecularization effect where cortical bone resembles trabeculae compromising bone tissue (see miszkiewicz et al. 2021). •  long-term immobilization of one lower limb: we would expect to see substantial differences in osteon densities, shape, and size, in addition to one leg bone showing evidence of osteoporosis-like or trabecularization effect (as per above point). •  short-term immobilization of one lower limb: we expect bone histomorphometric differences to exist when comparing the left and the right side, but no abnormal porosity (osteoporosis or trabecularization) would be detected. bone remodeling changes would have only been short term and/or active at the time of death. this is because cortical bone remodeling activity takes several months (robling et al. 2006), but much longer is required for ongoing resorption resulting in micro-porosity coalescing into trabecularization (andreasen et al. 2020). given the documented short-term changes to b21’s behavior prior to death, we predict the left femur from the pathological joint will show histological indicators of prolonged bone resorption. materials and methods standard demographic methods indicate that b21 was a middle-aged (35–49 years old) male of 163.9 ± 3.87 cm stature, which is consistent with documentary evidence (snoddy et al. 2020:223). the skeletal remains were well preserved overall, although all long bones exhibited some fragmentation. this meant maximum length could not be measured in either femur. only the left femur of b21 had been measured in situ using sliding calipers, and this field measurement was used in the aforementioned stature estimation. the postcranial skeleton was disarticulated due to displacement by water entering the coffin at some point after decomposition and prior to coffin collapse (fig. 2a). figure 2.  b21’s midshaft femur bone histology examined in the present study. the left (l) and right (r) femur are shown in (a) where the b21 burial is exposed (reproduced with permission from snoddy et al. 2020). panel (b) shows the femur samples postextraction where the red dashed line marks the cutting location for histology. panel (c) shows overview bone histology for both the left and right femur samples, indicating (black dashed rectangles) regions of interest shown magnified in figure 3 and the separated parts of the right sample (a and b). our sampling conduct followed ethical guidelines stipulated by mays and colleagues (2013). histology samples were extracted at the university of otago anatomy laboratories, where the human remains are curated until the completion of the wider project this study is part of (marsden grant 18-uoo-028) and the repatriation of the remains. the histology samples were transferred to the hard tissue histology laboratory in the school of archaeology and anthropology at the australian national university, canberra for histological expertise. the thin sections produced have been returned to new zealand. small (approximately 1 × 2 cm), cube-like cortical bone samples were extracted from the posterior midshaft of b21’s left and right femur. the extraction occurred along the midpoint of the femoral midshaft overlapping the linea aspera, a muscularly important anatomical landmark (goldman et al. 2009; mittlmeier et al. 1994; polguj et al. 2013), which captures localized bone remodeling in relation to mechanical stimulation (miszkiewicz 2016). the midpoint of the linea aspera was identified following standard anatomical visual examination methods (e.g., polguj et al. 2013). as the linea aspera extends over about a third of the total femur length, its proximal onset and distal ending along the femoral shaft can be easily determined visually. its midpoint can then be estimated by subdividing the entire linea aspera length into equal segments (polguj et al. 2013). a horizontal line measuring 2 cm and a vertical line measuring 1 cm were then marked with a pencil in preparation for extraction of cortical bone samples. samples were cut using a standard dremel 3000 130w tool equipped with a flex shaft direct-drive attachment and a 545 diamond-cutting wheel. parallel transverse and longitudinal cuts were made following the pencil-marked lines so that each sample detached loosely (see technique described in miszkiewicz and mahoney 2016). the preparation of thin sections followed standard methods (miszkiewicz and mahoney 2016, 2017) that involve embedding the samples epoxy resin (buehler), cutting on a low-speed saw (kemet micracut 151 precision cutter), mounting on glass slides (using stuk epoxy glue), grinding and polishing (on a buehler ecomet 300/automet 300 pro touchscreen grinder-polisher), clearing in xylene, dehydrating in ethanol baths, and cover-slipping with dpx. each section was approximately 100 μm thick. the sample from the right femur broke into two smaller portions following the extraction. this happened while sectioning in a transverse plane, whereby the most posterior layer of bone separated from the more cortical portion. this was likely due to bone fragility underlined by the activity of postmortem taphonomic agents, which made the samples structurally brittle (fig. 2b). however, the impregnation with epoxy resin allowed us to contain both pieces for examination under the microscope. this meant we could not meaningfully measure the cortical width (in an anteroposterior plane) of each sample macroscopically (e.g., using digital calipers), so we had to use image analysis tools instead (see further below). the sections were imaged using an olympus bx53 microscope equipped with a dp74 camera at a total magnification ×100. the entirety of each section was imaged first using the olympus cellsens automatic stitching function (fig. 2c). qualitative analyses examining the section for presence of tissue abnormalities, such as trabecularization, were undertaken first. quantitative analyses were then conducted. to ensure we examined “identical,” in terms of size and relative position, regions of interest (rois) within each section, we captured a 9.02-mm2 roi intracortically by identifying a midpoint where arbitrary x and y axes cross when placed over each image (figs. 2c and 3a,b). each of these rois showed well-preserved secondary osteons from which we could calculate standard bone histomorphometry variables that provide information about bone remodeling (miszkiewicz and mahoney 2016). these included osteon population density (opd), which is a function of the number of intact and fragmentary secondary osteons divided by image area (in this case by 9.02 mm2), haversian canal (h.ar), osteon area (on.ar) (in μm2), and osteon circularity (h.cr, on.cr) (keenan et al. 2017; miszkiewicz et al. 2020). circularity is unitless and assessed on the scale of 0 to 1, with values of 1 indicating a “perfect circle” (cr = 4π[area/perimeter2]; keenan et al. 2017). in addition, we recorded a rectangular “strip” through the middle of each section so that subperiosteal bone was contained in each image (left strip area = 11.56 mm2, right strip area = 12.14 mm2 excluding empty space). from this strip, we only measured h.ar and h.cr as cement lines of all osteons could not be consistently seen. however, we ensured we targeted the same number of canals in each sample, which was 143 (286 in total). additionally, we note that localized postmortem changes were apparent in the bone strips. for example, a distinct brown band of discoloration obscuring the periosteal and endosteal borders in each strip was visible (figs. 2 and 3). this is in addition to orange staining along the entire length of the periosteal and endosteal borders and localized cracking when considering the full section. while histo-taphonomy is not the focus of our study, we note these changes are consistent with water damage (pfretzschner 2004) and thus match the waterlogged environment of the b21 burial. hollund et al. (2012) observed similar patterns in archaeological samples impacted by water damage, where staining occurred along bone surfaces but deep cortical bone was protected, citing formation and oxidation of framboidal pyrite. similarly, the intracortical bone in our samples is of almost pristine condition. the quality of archaeological bone histology preservation is traditionally assessed a 0 to 5 scale of the oxford histological index (ohi; hedges et al. 1995:203), where 5 indicates almost modern-like bone (>95% of bone being intact). we assign 4 (>85%) to the full section, and 5 (>95%) to the intracortical roi (see figs. 2 and 3). to that end, we ensured that histology measurements were only collected from intact canals in the longitudinal strip (given inconsistent preservation of cement lines). figure 3.  regions of interest (rois) captured from each left and right femur cortical bone sample. the 9.02-mm2 rois captured intracortically using linearly polarized light are shown in (a) and (b). “longitudinal” strips of bone covering endosteal, intracortical, and periosteal bone regions are seen in (c) and (d). please refer to figure 2 to view the location of rois within their respective full scans of the samples. all the bone histology measurements were collected using the open access imagej/fiji software (doube et al. 2010) using the “freehand” tool for area measurements and the “multi point” tool for counts/density measurements. a minimum of 70 secondary osteons per section were examined, meeting recommended standards (25–50 osteons as per stout and crowder 2011). cortical width of each sample measured from the most outer point on the endosteal to periosteal border was taken using the “straight line” function in imagej/fiji, but it had to be combined from the two portions of the right sample. this introduces some error, but we will treat this measurement cautiously in our interpretations, as it is the only insight into size differences between the left and right femur midshaft in b21. we report this value as an average of three repeated measurements. comparisons of data between the left and right femur were undertaken on a descriptive basis, looking at measures of central tendency, given this is a case study. we report minimum, maximum, mean, and standard deviation (sd) data. raw data generated in this study can be accessed from open access figshare (snoddy et al. 2021). results in terms of qualitative differences, when contrasting the left and right histology from each sample, there were no obvious abnormal or pathological malformations noted (see table 1 for summary, figs. 2 and 3). no significantly advanced bone resorption (e.g., evidence of cortical bone trabecularization) was observed in either of the samples. all bone present throughout the sections was densely remodeled haversian tissue with several generations of osteons as inferred from fragmentary osteons widespread throughout each histology image (figs. 2 and 3). no evidence of primary bone or simple primary vascularization of the cortex was observed either. no noticeable changes on the endosteal surfaces that would have been a result of non-taphonomic/diagenetic processes were apparent. collagen fiber orientation throughout each sample showed no unusual patterning or clustering with a typical combination of light, dark, and alternating osteon morphotypes (skedros et al. 2006). this suggests no specifically different localized mechanical changes in tension or compression (van oers et al. 2015). in the left sample, there were somewhat more instances (at least 14) of active resorption cavities (evidence of osteoclast resorption with no refilling by osteoblasts in live bone; goldman et al. 2009) within localized haversian bone, but this was not substantially different from the right sample (at least 10). because of the broken right sample, however, we cannot account for resorption cavities that might have been present in some of the missing cortical bone. table 1.  summary of qualitative cortical bone histology observations in samples from b21. characteristic   significance   b21 cortical bone trabecularization effect originating on the endocortical bone and extending to the intracortical space.   evidence for osteoporosis-like advanced bone resorption where pores coalesce into “giant” pores, which ultimately weaken bone quality and increase fragility (chen et al. 2013).   no evidence for significantly advanced bone resorption noted, with all haversian canals and osteons falling within typical parameters for humans. this confirms no long-term osteoporosis-like changes in bone quality. cortical bone tissue matrix presentation—primary and/or secondary haversian tissue; woven and/or lamellar bone.   primary bone indicates younger tissue (goldman et al. 2009). secondary bone indicates more mature tissue, which, if heavily remodeled, suggests older bone age (jowsey 1960). presence of woven bone would suggest active and rapid bone formation or healing, whereas lamellar bone lays down over longer periods of time (shapiro and wu 2019).   no woven and primary bone seen. tissue is haversian with multiple generations of secondary osteons, which confirms b21’s bone is well remodeled. histovariability in collagen fiber orientation osteon morphotypes.   collagen fiber orientation can range from transverse (“light”) to longitudinal (“dark”) or be combined (“alternating”) (bromage et al. 2003). predominance of each type can suggest increased localized biomechanical loads of tension (longitudinal collagen—dark osteons) or compression (transverse collagen—light osteons) and/or a combination of loads (alternating osteons) (van oers 2015).   mostly alternating osteon morphotypes were observed reflecting a combination of collagen fiber orientation, which indicates no load-specific localized bone remodeling changes. multiple resorption bays spread throughout the bone cortex.   the presence of resorption cavities seen in cortical bone indicates bone resorption activated at the time of/just before death as an osteon formation had not had enough time to form (i.e., fill the cavity with new bone) (goldman et al. 2009).   left sample shows somewhat more resorption bays than the right, but it is difficult to account for histology “lost” to histo-diagenesis. assuming left femur does have more bays, this could indicate more active resorption of bone when the left leg was not habitually loaded. however, the quantitative analysis showed differences in histology between the left and right sample. given the small sample size and data-violating assumptions for meaningful inferential statistical comparisons, our descriptive evaluations are based on prior studies comparing bilateral human femur anatomical, densitometric, and structural rigidity parameters using adult femora from cadavers (pierre et al. 2010) and amputee patients (åström and stenström 2004; finco and menegaz 2021; gholizadeh et al. 2019; sherk et al. 2008). while pierre et al. (2010) did not specifically use histology to assess bone remodeling, they did report bone mineral density, which is a function of bone remodeling processes executed by osteoblasts and osteoclasts (seibel 2002). pierre et al. (2010) found that femoral side differences in macroscopic and densitometric parameters of less than 10% indicate natural asymmetry (e.g., pierre et al. 2010), which corroborated prior findings in amputees (åström and stenström 2004; finco and menegaz 2021; gholizadeh et al. 2019; sherk et al. 2008). in the handful of prior studies implementing a similar research design to ours, bilateral bone histology differences to have arisen as a result of one-sided limb abnormalities either exceeded 10% (lazenby and pfeiffer 1993; miszkiewicz et al. 2020) or were quantified but not reported (kozłowski and piontek 2000). these studies used a range of cortical bone histology parameters to evaluate these changes, including percent remodeled bone (54% difference between left and right femur in lazenby and pfeiffer 1993), bone vascularity (31% difference between left and right femur in miszkiewicz et al. 2020), and osteocyte lacunae and trabecular bone density (“much lower” in an atrophied right metatarsal compared to a “healthy” metatarsal from the left side in kozłowski and piontek 2000:14). as such, we extrapolate the 10% figure to our study but acknowledge future bone histology research should attempt to validate this on larger archaeological samples. in our study, all of the histomorphometric data measuring osteon densities and osteon and haversian canal size had lower mean values in the left sample when compared to the right (table 2). this was the case using data both from the isolated intracortical roi and the rectangular strips that overlapped endocortical and subperiosteal bone. however, using the aforementioned 10% difference as a threshold signifying normal versus abnormal bilateral difference, only the densities and area measurements of secondary osteons and haversian canals, not the circularity values, were ≥10% different between the left and right sample (fig. 4, table 2), with the haversian canal area showing the largest difference (32%). this means fewer osteons of larger size had accumulated in the left femur compared to the right. standard deviation data were also greater for the left h.ar and on.ar variables showing larger variability of osteon and canal size in the left sample. the circularity measurements of osteons and haversian canals were descriptively higher in the right sample compared to the left, but they remained within a 10% difference (table 2), with the highest difference of 4% recorded for circularity of haversian canals. this does mean the left femur had more irregularly shaped osteons and canals, but it is possible this is due to normal variation or both femora having circularity measures impacted by bone remodeling processes in a similar manner. the cortical bone width measured anteroposteriorly was slightly lower in the left sample (7.055 mm) when compared to the right (7.136 mm), but we need to treat this result cautiously given the fragmentation of the right sample. table 2.  descriptive data for all the bone histology variables. from 9.02 mm2 intracortical roi variable   n r   n l   min r   min l   max r   max l   mean r   mean l   %   sd r   sd l opd   120   107   n/a   n/a   n/a   n/a   52.426   37.650   28   n/a   n/a on.ar   70   78   10,670.485   7,915.970   115,781.647   155,948.723   36,446.247   40,446.481   10   20,009.108   27,973.641 h.ar   100   95   598.924   1,122.056   46,574.946   87,017.520   7,020.628   8,692.155   19   7,416.530   13,464.385 h.cr   100   95   0.403   0.250   0.982   0.987   0.894   0.873   2   0.103   0.131 on.cr   70   78   0.758   0.598   0.983   0.980   0.934   0.920   1   0.042   0.062 from full midsection roi strip h.ar   143   143   314.050   185.968   45,249.587   88,627.186   4,887.476   7,192.130   32   6,721.660   12,036.053 h.cr   143   143   0.465   0.353   0.986   0.976   0.870   0.833   4   0.106   0.137 n, number of units; r, right; l, left; min, minimum data; max, maximum data; sd, standard deviation; roi, region of interest; n/a, not applicable; opd, osteon population density (number/roi area in mm2); on.ar, osteon area (μm²); h.ar, haversian canal area (μm²); h.cr, haversian canal circularity (unitless). percent (%) values interpreted as abnormal difference are in bold. figure 4.  a simple plot illustrating where percent side difference in b21’s proxy histology data for bone remodeling sits in comparison to percent side difference in bone mineral density (bmd, obtained via dual-energy x-ray absorptiometry) published data in naturally asymmetric femora from cadavers and amputee patients. r, right; l, left; a, amputated limb; i, intact limb; opd, osteon population density (number/roi area in mm2); on.ar, osteon area (μm²); h.ar, haversian canal area (μm²); h.cr, haversian canal circularity (unitless). aaveraged data from n = 20 cadavers in pierre et al. (2010). baveraged data from n = 4 donors in finco and menegaz (2021). caveraged data from n = 14 amputees in sherk et al. (2009). daveraged data from n = 99 amputees in leclercq et al. (2003). eb21 data also reported in table 2. discussion and conclusion in this study, we used histology to test whether localized bone remodeling differences between the left and right midshaft femur could be detected in an individual who had suffered from tb-induced, left-sided, femoroacetabular joint pathology. our data for b21 suggest that his left midshaft femur had experienced short-term remodeling modifications likely lasting several months in the leadup to his death. the implications of these findings are discussed below. burial 21’s final illness: the histomorphometric evidence the most plausible interpretation for the observed differences in midshaft femoral cortical microstructure is that the left femur experienced less mechanical load due to the macroscopically observed tuberculous destruction of the hip. this is because we did not observe any other microscopic changes (e.g., woven bone, trabecularized intracortex) in the left sample, except for the reported histomorphometric unilateral differences. however, we cannot exclude the possibility that a more generic/systemic disruption to the bone remodeling balance, resulting from the bacterial infection of b21, underlies the inferred increased bone resorption activity (oliveira et al. 2020). it is known that lower limb mechanical load results in strain, which suppresses prolonged formation of larger secondary osteons (van oers et al. 2008). given the larger canals and osteons in b21’s left femur, it is possible the increased load of the right leg was taken on by b21’s right femur, where we see smaller, strain-suppressed, histo-structures. furthermore, because no “abnormal” bone porosity (i.e., where pores coalesce into larger pores and compromise cortical bone micro-architecture) was observed when comparing the left and right sample, a long-term bone remodeling change cannot be ascertained. shorter-term bone remodeling alteration is more likely. our finding matches the historical documentation that b21 was “invalid” for 11 months. however, we should note that the destruction to this individual’s left hip might have predated this, given that osseous tb is a chronic and slow progressing disease (storm and vlok 2009:495). as such, it is possible the individual’s left leg might have been partially immobile before b21 stopped working. while some bacterial infections can have a localized effect on the skeleton, such as in the case of a tuberculosis-induced joint destruction, they can also dysregulate bone remodeling more systematically such that mineral deposition and bone resorption are out of balance (oliviera et al. 2020). this could explain, alongside our biomechanical interpretation, why we see multiple bmus created resorption cavities in both the left and right femur. without experimental evidence, our discussion remains interpretative in nature. together, the findings align with the documented information about b21’s inability to work for a year prior to his death (bruce herald, 11 february 1873). the ways in which this formed part of this individual’s life experience remains unknown, but we show one biological aspect of his inability to work. the macroscopic lesions exhibited indicate the proximal portion of left femur was structurally compromised. however, the degree to which this affected his mobility is unclear. it would be inappropriate to attempt to reconstruct this individual’s experience of impairment (see battles 2009). the only documented information we have on this final period of b21’s life is that he could no longer support his family through physical work and relied on the charity of the aofs. indeed, even the nature of his employment as a laborer is ambiguous, and we do not know what his work required other than that he be “able-bodied.” at this time and place, he is most likely to have been employed either in building or farm work (possibly both), although milton did also have a number of industries, including a flour mill and a brick and pipe works (the well-known local woolen mills and pottery works were both established after b21 died) (sumpter and lewis 1949:93–94). whatever the exact nature of the laboring work, it would certainly been highly physical in this period. histomorphometry: implications for the construction of osteobiographies our findings address the original speculation in snoddy et al. (2020) that the limb function of b21 was restricted to some degree by the one-sided hip pathology. we add further to the biochemical and paleopathological analyses, combined with documented life history, by offering a more direct histological method of testing for individual-level localized bone functional adaptation in contexts of immobilization. this expands the bioarchaeology of care (tilley 2015) methodological toolkit, allowing bioarchaeologists to seek additional lines of data for inferences about instances of bedrest. the integrated case study for b21 included information on the lightness of his bones possibly indicating osteopenia (snoddy et al. 2020:227). while our femoral histology data cannot diagnose this condition, they can clarify that b21’s behavior and health were likely impacted prior to his death, which can be linked to poor systemic bone metabolism impacting calcium homeostasis. in their model of care, snoddy et al. (2020) discuss how b21 would have required assistance with walking and mobility, which is supported by our histology data. as inferred from clinical literature (babhulkar and pande 2002), the tuberculous joint destruction in b21 would have likely caused significant pain and had a debilitating effect on his daily life, so we can also speculate periods of bedrest, impacting both femora. this could be tied to our histology data for the circularity measurements of osteons and haversian canals, which did not differ substantially when compared between the left and right sample. b21 provides another example of unilateral limb pathologies and associated bone histological changes reported in the paleopathological and bioarchaeological literature (e.g., kozłowski and piontek 2000; lazenby and pfeiffer 1993; miszkiewicz et al. 2020). as outlined in our introduction, these prior studies all reported such microscopic changes using skeletal remains from a range of time periods and geographical regions (medieval poland, metal period philippines, nineteenth-century canada). all successfully determined asymmetric leg bone changes in remodeling reconstructed using the same histological measures of osteon densities (e.g., in lazenby and pfeiffer 1993) and circularity of haversian canals (e.g., in miszkiewicz et al. 2020) as ours or similar measures of bone loss and gain, such as osteocyte densities approximating osteoblastic proliferation (kozłowski and piontek 2000). while lazenby and pfeiffer (1993) sampled the anterior femur, kozłowski and piontek (2000) examined the metatarsals, and miszkiewicz et al. (2020) sampled the posterior femur, as was the case in our study design, all found differences in bone histology. this suggests that histological methods are powerful enough to detect microscopic adaptation to load and pathological changes at the individual level. because the recovery of human skeletal remains displaying such pathologies is rare, we believe that there is potential in ethical (e.g., removing small amounts of bone) histological sampling of limb bones to address questions that cannot be tackled using macroscopic methodologies alone. it is worth noting that bone biology research using experimentally (un)loaded animal models (e.g., jaworski et al. 1980; young et al. 1986), living humans (e.g., sibonga 2013), and postmortem human samples (michael 2018; schlecht et al. 2012; stout 1982) has long provided evidence for limb disuse osteoporosis. specifically, astronauts suspended in weightless environments are notorious for returning to earth with severely advanced bone loss (sibonga 2013), and immobilized southern pig-tailed macaques (macaca nemestrina) develop prolonged bone resorption over the initial seven months of mechanical unloading (young et al. 1980). in light of the modern bone biology research, bioarchaeological and paleopathological cases studies, such as ours, can contribute historical data that conform to mechanical and bone physiological paradigms—forming a truly interdisciplinary approach to understanding the nature of bone tissue. limitations and future research directions because ours is a case study, there are a series of limitations that have hindered a more in-depth exploration of histology in b21. given the poor preservation of long bones in this previously waterlogged burial, we could not obtain femur maximum lengths or robusticity measures from the femora to assess whether b21’s left femur experienced modification (modeling) to its shape and size. we did, cautiously, note a slightly lower cortical width of the left sample when compared to the right. however, the magnitude of this (0.081 mm) difference is extremely unlikely to indicate modeling changes between the two femora. comparisons of data in previous studies of similar research design noted differences on a much larger scale. for example, lazenby and pfeiffer (1993) reported a 13.8% difference in the midshaft anteroposterior diameter in the femora of the nineteenth-century canadian amputee. kozłowski and piontek (2000) reported atrophied cortical width to measure 5 mm compared to 11 mm in a functional limb bone. the difference in b21 is only approximately 1.14%, which is very close to the 1.33% reported by miszkiewicz et al. (2020) for the same variable measured in the metal period filipino individual’s femora, where short-term remodeling changes were inferred. furthermore, given the documented short-term invalidism in the year before b21’s death, this would have not been enough time for macroscopic adaptation to develop in an adult femur. cortical bone samples from the tibia would have allowed us to assess the distribution of histological features along with mechanical signal impacting the lower leg bones, but we did not have access to such samples. we did not have access to bone mineral density data either. these would have helped us confirm the suspected osteopenia and/or localized changes in calcium exchange at the midshaft femur. finally, we have identified that a large archaeological sample study is necessary in the future to validate how much of bone histology bilateral differences are due to natural asymmetry. nevertheless, we have shown that bone histological analyses can complement multi-methodological examinations as part of osteobiographies conducted in bioarchaeology and bioarchaeology of care models. it is clear that histological analysis of bone has a place in the study of disability and care in the past and, acknowledging that destructive analysis is not always possible, should be considered an integral part of the bioarchaeology tool kit. nondestructive microscopic methods, including micro–computed tomography, should also be considered where possible. future work accessing burials similar to ours might shed more light on the length of time impacting bone remodeling prior to death, in relation to specific disease conditions. for example, it would be worth assessing differences in localized femur bone remodeling changes across categories of arthritic, bacterial infection, metabolic, and developmental diseases manifesting in joints. these all have different spectra of pathogenesis that determine the extent of impact on bone remodeling. once contextualized with documented or archaeological evidence, a series of examples can be created for bioarchaeologists to consult when hypothesizing about lifestyle and disease using fragmentarily documented or preserved human remains. acknowledgments we thank the descendants of b21 for allowing us to conduct this study and the members of tp 60 project for preserving the history of tokomairiro/milton. this work was funded by a marsden fund grant awarded to hb and pp (18-uoo028). funding contributions toward technical work at the anu histology laboratory were from the australian research council discovery early career research award (de190100068 to jjm), the anu college of arts and social sciences, and the australian government research training program (rtp) scholarship (to kmc). we are grateful to the anonymous reviewers for their feedback on the earlier versions of this manuscript. references cited åström, ingrid, and anders stenström. 2004. effect on gait and socket comfort in unilateral 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10.1016/b978-0-12-809738-0.00006-5. sumpter, d. j., and j. j. lewis. 1949. faith and toil, the story of tokomairiro (otago centennial historical publications). whitcombe, clutha district. tilley, lorna. 2015. theory and practice in the bioarchaeology of care. springer, heidelberg. van oers, rené f. m., ronald ruimerman, bert van rietbergen, peter a. j. hilbers, and rik huiskes. 2008. relating osteon diameter to strain. bone 43(3):476–482. van oers, rené f. m., hong wang, and rommel g. bacabac. 2015. osteocyte shape and mechanical loading. current osteoporosis reports 13(2):61–66. vogelpoel, els e., jurjen j. been, and arthur a. de gast. 2009. two-stage treatment of acetabular bone defect in tuberculosis of the hip by intended ankylosis followed by total hip arthroplasty: a case report. cases journal 2(1):1–5. von hunnius, tonya. 2009. using microscopy to improve a diagnosis: an isolated case of tuberculosis‐induced hypertrophic osteopathy in archaeological dog remains. international journal of osteoarchaeology 19(3):397–405. walsh, nicole c., and ellen m. gravallese. 2010. bone remodeling in rheumatic disease: a question of balance. immunological reviews 233(1):301–312. doi: 10.1111/j.0105-2896.2009.00857.x. young, d. r., w. j. niklowitz, raymond j. brown, webster s. s. jee. 1986. immobilization-associated osteoporosis in primates. bone 7(2):109–117. doi: 10.1016/8756-3282(86)90682-4. adepartment of anatomy, university of otago, dunedin, otago, new zealand bschool of archaeology and anthropology, australian national university, canberra, australian capital territory, australia cschool of social science, university of queensland, st lucia, queensland, australia darchaeology programme, school of social sciences, university of otago, otago, new zealand *joint first authors ^correspondence to: anne marie e. snoddy, university of otago, department of anatomy, 270 great king street, dunedin, otago 9018, new zealand; and justyna j. miszkiewicz, 44 linnaeus way, canberra, act 0200, australia e-mail: annie.sohler@otago.ac.nz; justyna.miszkiewicz@anu.edu.au login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe bioarchaeology international volume 4, number 1: 15–36 doi: 10.5744/bi.2020.1000 copyright © 2020 university of florida press two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000– 1500 b.c.) melandri vlok,a* marc fredrick oxenham,b,c kate domett,d tran thi minh,e nguyen thi mai huong,e hirofumi matsumura,f hiep hoang trinh,e thomas higham,g charles higham,h nghia truong huu,e and hallie ruth buckleya adepartment of anatomy, university of otago, dunedin, new zealand bschool of archaeology and anthropology, the australian national university, canberra, australia cschool of archaeology, university of aberdeen, scotland, uk dcollege of medicine and dentistry, james cook university, townsville, australia einstitute of archaeology, hanoi, vietnam fschool of health sciences, sapporo medical university, sapporo, japan goxford radiocarbon accelerator unit, university of oxford, oxford ox1 3qy, uk hschool of social sciences, university of otago, dunedin, new zealand *correspondence to: melandri vlok, department of anatomy, university of otago, 270 great king street, dunedin 9016, new zealand email: melandri . vlok@postgrad . otago . ac . nz this research was supported by a national geographic early career grant (ec54332r18), a royal society of new zealand skinner fund grant, and a university of otago doctoral scholarship. abstract skeletal evidence of two probable cases of treponematosis, caused by infection with the bacterium treponema pallidum, from the northern vietnamese early neolithic site of man bac (1906– 1523 cal b.c.) is described. the presence of nodes of subperiosteal new bone directly associated with superficial focal cavitations in a young adult male and a sevenyearold child are strongly diagnostic for treponemal disease. climatic and epidemiological contexts suggest yaws (treponema pallidum pertenue) as the most likely causative treponeme. this evidence is the oldest discovered in the asiapacific region and is the first wellestablished pre columbian example in this region in terms of diagnosis and secure dating. the coastal ecology, sedentary settlement, and high fertility at the site of man bac all provided a biosocial context conducive to the spread of treponemal disease among inhabitants of the site. comorbidity with scurvy in both individuals demonstrates that malnutrition during the agricultural transition may have exacerbated the expression of treponematosis in this community. man bac is a site of great regional importance owing to its role during the neolithic transition of mainland southeast asia. during this transition, approximately 4,000 years ago, farmers migrating from southern china into southeast asia influenced a number of changes in subsistence and demography and potentially introduced new infectious diseases such as treponematosis to indigenous forager communities. the findings presented here may encourage reevaluation of existing southeast asian skeletal samples and demonstrate the importance of using weighted diagnostic criteria for future reporting of treponematosis cases. keywords: agricultural transition; southeast asia; yaws received 8 august 2019 revised 24 february 2020 accepted 24 february 2020 two probable cases of treponema pallidum16 hai trường hợp nhiều khả năng mắc bệnh ghẻ cóc do nhiễm vi khuẩn treponema pallidum, thuộc di chỉ mán bạc sơ kì đá mới việt nam (cal 1906– 1523 b.c.) được mô tả trên bằng chứng di cốt. sự có mặt của các hạt xương mới dưới màng xương trực tiếp liên quan đến các lỗ ổ bề mặt ở một nam trẻ tuổi trưởng thành và một trẻ em 7 tuổi là chẩn đoán nhiều khả năng cho bệnh này. bối cảnh khí hậu và dịch tễ học cho thấy bệnh ghẻ cóc do nhiễm xoắn khuẩn treponema pallidum pertenue là nguyên nhân phổ biến nhất. bằng chứng trên được phát hiện muộn nhất ở khu vực châu áthái bình dương và là một ví dụ điển hình đầu tiên giai đoạn tiền columbia trong khu vực này dựa vào chẩn đoán và định niên đại chính xác. sinh thái biển, lối sống ít di động, và tỷ lệ sinh sản cao ở di chỉ mán bạc, tất cả đã tạo ra sự tương tác giữa các yếu tố sinh học và xã hội thuận lợi cho việc lây lan bệnh ghẻ cóc giữa các cư dân thuộc di chỉ này. cùng với đó là sự mắc bệnh thiếu vitamin c (scurvy) ở cả hai cá thể trên chỉ ra rằng sự suy dinh dưỡng trong suốt quá trình chuyển tiếp nông nghiệp có thể trầm trọng hơn và biểu hiện bệnh ghẻ cóc ở cộng đồng này. mán bạc là một di chỉ vùng quan trọng bởi vì nó nằm trong ranh giới giai đoạn chuyển tiếp đá mới của đông nam á lục địa. trong suốt bước chuyển này, khoảng 4000 năm cách đây, các cư dân nông nghiệp di cư từ miền nam trung quốc vào đông nam á đã ảnh hưởng nhiều thay đổi trong phương thức sinh kế, dân số, và mang theo bệnh nhiễm trùng mới tiềm ẩn như là bệnh ghẻ cóc vào các cộng đồng nông nghiệp bản địa . các phát hiện trình bày trên đây hi vọng sẽ là khởi đầu đánh giá lại về sự tồn tại các di cốt đông nam á và minh họa tầm quan trọng của việc sử dụng tiêu chí chẩn đoán tin cậy về các trường hợp bệnh ghẻ cóc cho nghiên cứu tiếp theo. in recent years, intensive archaeological and bioarchae ol o gi cal research in mainland southeast asia (msea) has described a unique agricultural transition that had a significant impact on the region’s genetics, demographics, social organization, and subsistence base (lipson et al. 2018; matsumura and oxenham 2014; oxenham and buckley 2016). strong morphological evidence for the admixture of local indigenous populations and migrants from southern china (matsumura and oxenham 2013a, 2013b, 2014; matsumura et al. 2008, 2019) has been supported by recent genome wide ancient dna analyses (lipson et al. 2018; mccoll et al. 2018). the evidence indicates that cohabitation and genetic admixture of agriculturalists and local foragers resulted in considerable social and demographic change at this time in msea (lipson et al. 2018; mccoll et al. 2018; oxenham et al. 2011). while there remains a considerable focus on subsistence transitions and its impact on general health worldwide (armelagos and cohen 1984; cohen and cranekramer 2007; snoddy et al. 2017; temple 2010), less attention has been given to the mechanisms of infectious disease transmission from one population to another where substantial levels of mobility (including migration) have been demonstrated. in these circumstances, interaction between two or more populations in socalled friction zones transpires (bellwood and oxenham 2008). here genetic admixture and social transition occurs between foragers and farmers. epidemiological transitions may follow population interactions, as subsistence transitions can cause micronutrient deficiencies, and contact between populations (as evidenced in msea) encourages the spread of infectious disease from one group to another. the identification of specific infectious diseases (such as leprosy, tuberculosis [tb], and treponemal disease) and the consequent epidemiological impact within the chronological, social, and environmental context of friction zones offers important information on human and pathogen coevolution in the changing biosocial contexts of southeast asia over time. an example of the possible introduction of infectious disease with increased population interaction has been suggested in the case of leprosy and tb at a late iron age site in northeast thailand (tayles and buckley 2004) but has not been explored in other regions or during periods of agricultural transitions in this region. this article describes two cases of specific infectious and nutritional disease from the site of man bac in northern vietnam and explores the social, biological, and ecological contexts that may have encouraged the spread of infectious disease during the neolithic demographic transition in msea. materials and methods the site man bac is a phung nguyen period early neolithic habitation site with an associated cemetery located in ninh binh province in northern vietnam, known for complex incised designs on pottery vessels, intricate stone craftwork, and interaction with chinese neolithic farming societies (oxenham et  al. 2011). cultural material reflects both foraging and agricultural subsistence (oxenham et al. 2011). excavated in 1999, 2001, 2004/5, and 2007, the cemetery component of the vlok et al. 17 site consists of 101 individuals of exceptional skeletal preservation. rib samples from four individuals from man bac have been dated to 1906– 1523 cal b.c. (intcal13, 95% ci, with marine reservoir effect applied; online supplement). while insufficient collagen yield meant direct dates could not be derived from the two individuals of focus in this paper, all burials were found within a secure single stratigraphic layer (oxenham et al. 2011). the burial layer was found below two occupation layers. cultural material from all layers are contemporaneous, suggesting an association between the three layers. charcoal from the occupation layers dates to 2016– 1524 cal b.c. (95% ci; oxenham et al. 2011). as such, man bac is the only welldocumented example of an early neolithic settlement in southeast asia where local indigenous people coexisted with migrants from southern china who introduced agricultural practices to the region approximately 4,500 to 3,500 years ago (bellwood and oxenham 2008; matsumura 2011a, 2011b). it is not possible to estimate the population density of the man bac community, because the number of burials is not likely representative of the numbers in the living population and the full extent of the site has not been excavated. however, the man bac cemetery sample is characterized by a high fertility ratio and high rate of natural population growth, with 47.5% of individuals under the age of five years (mcfadden et al. 2018). all burials, with the exception of three flexed inhumations, were in a supine extended position (fig. 1), which is the normative pattern of burial at this time throughout southeast asia (higham et al. 2011). grave goods and ritual tooth removal (ablation) suggest agebased social hierarchy and affinal relationships figure 1. the burial position and associated artifacts of m20 (left) and m29 (right). both individuals were buried extended and supine. the burials are in excellent skeletal condition with the exception of the cranium of m29, which was not present during excavation. (image: m. oxenham) two probable cases of treponema pallidum18 that may have affected the distribution of resources within the community (tilley and oxenham 2016). archaeological remains reveal a mixed or transitional subsistence based on foraging and agricultural practices, similar to other phung ngyuen period settlements. a diet of both terrestrial and aquatic protein resources is indicated by stable isotope collagen values, with more than 50% from aquatic resources (oxenham et al. 2011). the presence of domesticated pig (sus scrofa) dominates the zooarchaeological assemblage (r. k. jones et al. 2019; oxenham et al. 2011). today, man bac is situated approximately 25 km from the coast (oxenham et al. 2011). however, given high sea levels in the midholocene, man bac was likely much closer to the coast within an estuarine zone (tanabe et al. 2006). the variety of faunal sources indicate that the inhabitants of man bac were exploiting a number of ecological zones, including forests, grasslands, lowlands, and marine and estuarine environments (sawada et al. 2011; toizumi et al. 2011). the site forms part of the phung nguyen complex, a series of sites found within the ninh binh region along the red river delta. the presence of contemporaneous pottery suggests extensive interaction between the sites farther inland along the river, as well as shared archaeological material with agricultural sites in southern china (bellwood 2005; nguyen 2008). the type site of phung nguyen is approximately 160 km from today’s coastline, which represents the possible extent of interaction of farming settlements within northern vietnam, although this site is dated to slightly later at around 1500 b.c. (khoach 1980). evidence of housing styles was not excavated at man bac. however, they may have been similar to other phung nguyen habitation sites where large houses on stilts (see oxenham et al. [2015] for a discussion of built structures in the slightly later site of rach nui in southern vietnam) appear to have been built, possibly for similar reasons as constructed in mountainous regions of vietnam today, to keep out snakes and small animals (khoach 1980). concerning the general health of people buried at man bac, previous research has demonstrated high levels of nonspecific stress; 92.3% of males and 53.8% of females presented with cribra orbitalia, and 64.9% of the total assemblage presented with linear enamel hypoplasia of the incisors or canines (oxenham et al. 2011). fortytwo percent of individuals had localized primary canine hypoplasia, which may be related to deficiencies of calcium, vitamin a, or vitamin d during gestation (mcdonell and oxenham 2014). therefore, stress from parasitic, dietary, or infectious origin was commonplace during childhood for many of the individuals from man bac. the detailed paleopathology analysis of the total sample will be presented in forthcoming publications. methods for age and sex estimation the age and sex of individuals from man bac were previously reported by domett and oxenham (2011). adult sex estimations were based on standard methods for qualitative morphological estimates from the skull and pelvis (acsádi et  al. 1970; buikstra and ubelaker 1994; phenice 1969). nonadult age estimates were based on standards for the timing of dental calcification and eruption (moorrees et al. 1963; ubelaker 1999). where teeth were not available for age assessment in nonadults, long bone lengths were compared to nonadults with dental estimates available, as well as to standards for long bone estimates in nonadults by scheuer and black (2000). adult age estimation followed sucheybrooks standards for the pubic symphysis (brooks and suchey 1990). recording methods for abnormal variation (pathological changes) proliferative (lamellar and woven bone) and lytic lesions as well as bone deformities were recorded in the entire preserved skeleton. lesions with the potential to contribute to diagnosis were also radiographed. a differential diagnosis was performed with the basis drawn from seminal literature in paleopathology (brickley and ives 2008; lewis 2017; ortner 2003; snoddy et al. 2018; weston 2012) as well as clinical literature concerning specific diseases (hackett 1976; jaffe 1972; resnick 1995a). lesions were characterized as diagnostic and suggestive of specific disease based on recommendations by snoddy et al. (2018). a clinical basis for diagnosis of specific disease has also been championed by mays (2012), ortner (2011), snoddy et al. (2020), zuckerman et al. (2016), and others (for treponemal disease, powell and cook advocated such criteria in their 2005 book, as do baker et al. [2020]). in the snoddy et al. (2018) criteria, lesions are only considered to be diagnostic (d) if there is strong clinical basis or considerable body of paleopathological work supporting the diagnostic weight of the lesion. lesions where there is no consensus in the clinical or paleopathological literature, but remain anatomically intuitive, were designated a suggestive (s) value. in addition, lesions that have been considered elsewhere as pathognomonic for disease are here scored as strongly diagnostic (sd) (after brickley and ives 2008). for a probable case of disease at least one strongly diagnostic and/or two diagnostic lesions are required (brickley and ives 2008; snoddy et al. 2018). a possible case of disease requires a minimum of one diagnostic lesion and/or two suggestive lesions (snoddy et al. 2018). clinically documented associated pathology was also considered in discussion of the disease expression, but it was not a primary deciding factor in the vlok et al. 19 differential diagnosis due to their poor diagnostic strength in dry bone. these included generalized proliferative bone changes which can be caused by multiple diseases. (see online table s5 for summary of diagnostic strength of lesions.) results the lesions at man bac were predominantly bilateral, symmetrical, and discrete and affected both the postcranial and cranial remains. as the focus of this paper is the identification of specific infectious disease at man bac, the causes of the more generalized pattern of proliferative lesions at mac bac will be reported at a later date but are likely a result of a number of etiologies. a total of seven individuals (10%, 7/70) from man bac— two adults, two adolescents, and three children— share a similar skeletal pattern of diffuse proliferative new bone lesions consistent with systemic disease. two of these seven individuals presented with widespread subperiosteal new bone, endosteal enlargements in the long bone shafts, and focal superficial lytic lesions within nodes of subperiosteal new bone (localized enlargements of subperiosteal new bone). these two individuals are the focus here due to the diagnostic potential of their lesions, with a brief discussion of a further five cases with lower diagnostic strength. a differential diagnosis was conducted on mb05 m20 and mb07 h2 m29, which includes systemic conditions known to produce lesions similar to those observed here: osteomyelitis (nonspecific bone infection), leprosy, tuberculosis, brucellosis, mycosis, treponematosis, rickets/osteomalacia, and scurvy. a description of the bone pathology in these two individuals and a full differential diagnosis are presented. detailed descriptions of lesions in all seven individuals are found in online table s5. descriptions of skeletal lesions consistent with possible and probable treponemal disease in all affected man bac individuals can be found in online table s6. m20 mb05 m20 (herein called m20) is a young adult male (15– 29 years old). the individual was buried east to west in a supine position with three ceramic pots characteristic of the phung ngyuen period (fig.  1). the skeleton is excellently represented, with all limbs, skull (and teeth), hands, and feet complete and 60% representation of the ribs and vertebrae. the surfaces of the bones are in excellent condition. m20 presented with diffuse thick and remodeled new bone with endosteal enlargement of the entire shafts of the right humerus, tibiae, and fibulae (fig. 2). discrete nodes of new bone are present on the medial midshaft of the right tibia and on the distal third of both fibulae symmetrically. the new bone is present on the metaphyses and shafts of the tibiae and fibulae and the distal metaphysis of the right humerus. there are pathological pseudo bowing deformities in the tibiae similar to bowing in a saber shin. while new bone is macroscopically only visible on the distal metaphysis of the right humerus, radiographs reveal endosteal enlargement of the entire shaft, suggesting prior osteoblastic activity that has since remodeled. further discrete deposits of new bone can also be observed on the medial proximal left femur and medial and lateral proximal tibiae. multiple superficial focal lytic lesions are present on the distal fibulae shafts, proximal right fibula, lateral metaphysis of the left humerus, and the lateral aspect of the left calcaneus. the focal lytic lesions of the fibulae are associated with discrete nodes of new bone and active new bone is observed around the margins of the lytic lesions. two focal lesions of the right distal fibula have been damaged postmortem, so it is not possible to determine whether the lesions are superficial or extend into the medulla. however, a small focal superficial lesion is present adjacent to the larger two lesions (fig. 2f), supporting the interpretation that the lesions with postmortem damage do not extend beyond the external cortical bone surface. the two focal lesions of the left distal fibula are clearly superficial, within a node of new bone and with smooth sclerotic margins (fig. 2g). no lytic or diffuse proliferative lesions were present on the cranial vault. bilateral and symmetrical discrete deposits of remodeled new bone and abnormal cortical porosity are present on the external greater wings of the sphenoid bones, temporal bone squama, and posterior and anterior zygomatic bones. the lesions are clearly discrete and do not represent diffuse inflammatory changes in the skull. there are also porotic lesions across the ectocranium (frontal bone, occipital bone, and parietal bones medial to the temporal lines) consistent with porotic hyperostosis, although the diploe is not exposed so this cannot be confirmed. mediumgrade cribra orbitalia was also observed (after stuart‐macadam 1985:392). m29 mb07 h2 m29 (herein called m29) is a nonadult approximately seven years of age at death (oxenham et al. 2011). m29 was buried supine; no clear grave goods were identified, but pottery sherds were present around the region of the sacrum (fig. 1). the cranium was not present, and only the right side of the mandible (including teeth), remained. the individual’s postcranial axial skeleton is very well preserved, but the hands and feet were virtually absent (with the exception of a single preserved metacarpal). there were some hardened soil concretions on the surfaces of the two probable cases of treponema pallidum20 figure 2. expression of lesions related to infectious disease in m20. preserved bones are outlined in black, with absent bones outlined in light gray. the skeletal extent of osteoblastic lesions is indicated by dark gray fill. (a) and (b) superficial focal cavitations with smooth sclerotic margins not within distinct nodes of new bone on the anterior and posterior lateral epicondyle of the right humerus. (c) remodeled cortical enlargements throughout the shafts of the tibiae with striated nodes of new bone on the distal fibulae. (d) radiographs of the tibiae and fibulae: a distinct node of new bone with medullary intrusion is present on the medial middle shaft of the right tibia. the nodes of new bone of the distal fibulae are radiolucent due to the extent of pathological change to the internal cortex of the bone. (e) superficial focal cavitation not within a distinct node of new bone on the proximal right fibula. (f) two focal superficial cavitations on the lateral aspect of the right distal fibula within a distinct node of striated new bone. (g) focal superficial cavitation on the medial aspect of the right distal fibula within a distinct node of striated new bone. (h) focal superficial cavitation on the medial left calcaneal body, not within a distinct node of new bone. (image: m. vlok) vlok et al. 21 long bones and vertebrae, but this was minimal. animal gnaw and puncture marks were observed on some of the lower limb bones. m29 presents with diffuse multilayered new bone across the diaphyses of all limb bones bilaterally, and on the single preserved metacarpal (fig. 3). nodes of subperiosteal new bone are present at the midshafts of the right radius and ulna, proximal left ulna, entire shafts of tibiae, and distal fibulae. multiple lytic lesions with sclerotic margins, observed radiographically, are present on the proximal left ulna, midshafts of the right radius and ulna, and inferior medial left clavicle. the lytic lesions of the midshaft of the right ulna and radius have some postmortem damage to the floor and margins. however, the preserved margins of the lesions indicate they did not penetrate the cortex. the lytic lesions on the distal fibulae do penetrate the cortex to the medullary canal. radiographs also show wellremodeled proliferative new bone on the anterior crest of the tibiae, indicating socalled saber shin. a unilateral enlargement of the sternal end of the left clavicle without any macroscopic presence of thick subperiosteal new bone deposit is evident, and a thin cortex is appreciated from the radiograph. symmetrical mixed active and remodeled new bone and abnormal cortical porosity is present in the supraspinous fossae of the scapulae. although the cranium is absent, remodeled abnormal cortical porosity of the right coronoid process of the mandible is observed. radiographically, all the long bones present with radiodense metaphyseal plates in association with zones of radiolucency in the metaphyseal region. deformity of some long bones is also present in m29. symmetrical swellings of the distal metaphyses and slight cupping of the femora occur (fig. 4c). there is slight bilateral medial “true” bowing of both tibiae confirmed by radiographs with slight posterior protrusion of proximal metaphyseal plates, suggesting depression and deformity (fig. 4g). further, there is lateral bowing of the proximal third of the humeral shafts, and depression and deformity of the metaphyses of the humeral heads (fig. 4d). discussion differential diagnosis the differential diagnosis of the types and skeletal pattern of the lesions in these man bac individuals included bone cancers, osteomyelitis, tuberculosis, brucellosis, mycosis, leprosy, and treponematosis. these diseases are included in the differential diagnosis due to the combination of proliferative and destructive lesions in the disease pathophysiology. the bone response to metastatic cancers may produce a combination of extensive subperiosteal and lytic response. however, these conditions are less likely to cause such widespread involvement of the skeleton as that observed here and are not known to cause multiple and widespread superficial cavitations (ortner 2003:363– 382, 503– 544). cancers such as multiple myeloma or langerhan’s cell histiocytosis (lch), which can result in systemic multifocal destruction of the skeleton, most often appear as punchedout lytic lesions without sclerosis and can be ruled out (ortner 2003:362, 377). m20 and m29 do not appear similar to a possible case of multiple myeloma or lch identified by domett and buckley (2012) in preangkorian cambodia, and marginal sclerosis of the lytic lesions are rare and subperiosteal new bone deposits are not characteristic of these diseases (ortner 2003:363, 377). because bone cancer in archaeological contexts is extremely rare (ortner 2003:363– 382, 503– 544), the presence of two individuals in the collection with similar bone lesions (m20 and m29) further demonstrates that cancer can be ruled out as a possible cause. while subperiosteal and endosteal enlargement are nonspecific inflammatory responses to various diseases and trauma (weston 2012), the widespread and nonuniform nature of the enlargements in the man bac cases are more consistent with that of a systemic infection than metabolic or traumatic etiologies. the subperiosteal new bone lesions of metabolic disease tend to be uniform and symmetrical, unlike the majority of the lesions of m20 and m29 (brickley and ives 2008; pitt 1995; resnick 1995b; snoddy et al. 2018). furthermore, subperiosteal new bone from trauma is most often localized, also unlike that observed in m20 and m29 (rana et al. 2009). however, some of the subperiosteal lesions in both m20 and m29 are symmetrical, and a metabolic etiology contributing to the overall expression of subperiosteal lesions in both individuals is not ruled out and is discussed further below. pyogenic osteomyelitis is a nonspecific infection of the bone producing a characteristic suite of lesions of bone death from loss of blood supply (sequestrum), combining a lytic lesion (circular pusdraining cloaca) and a proliferative healing response (involucrum) (ikpeme et al. 2010). the major causative agents are staphylococcus or streptococcus bacterial species, although other pathogens can infect bone (acosta et al. 2004; ikpeme et al. 2010). initial transmission generally occurs through soft tissue infection of open wounds and, less frequently, secondary to respiratory, food borne or waterborne diseases (giaccai and idriss 1952; honda and mcdonald 2009; jaffe 1972:1015– 1046; miller et al. 1963; vohra et al. 1997). the pathogenic agent enters the bone through the bloodstream and figure 3. expression of lesions related to infectious disease in m29. preserved bones are outlined in black, with absent bones outlined in light gray. an undetermined metacarpal is also present but not demonstrated in the figure, as its skeletal position is unknown. the skeletal extent of osteoblastic lesions is indicated by dark gray fill. (a) subperiosteal new bone deposit on the distal shafts and metaphyses of the humeri. (b) there are slight cortical enlargements visible on radiographs throughout the humeral shafts. (c) remodeled enlargement of the medial left clavicle. the metaphyseal plate is bulging. (d) radiographs do not demonstrate a distinct cortical enlargement of the left medial clavicle. the internal trabeculae appear radiolucent, and a distinct oval lytic lesion with a radiodense sclerotic margin is present on the inferior margin of the medial metaphysis. some increased calcification is present on the medial metaphyseal plate. (e) diffuse subperiosteal new bone deposit across the radii and ulnae. (f) two oval cavitations within nodes of new bone on the midshafts of the right radius and ulna. while significant damage has occurred to the lesion floor, the margins of the lesion are preserved and indicate superficial cavitation. (g) large node of new bone on the proximal left ulna. radiographs demonstrate a small oval lytic lesion with sclerotic margins within the node. (h) prolific subperiosteal new bone across the tibiae and fibulae. fibular cortical enlargements are thickest toward the distal shaft. note the rounded margins of the anterior shaft of the tibiae indicating saber shin deformity. (i) radiograph of the right tibia demonstrating cortical enlargement of the anterior crest indicating saber shin. (j) an unknown metacarpal with significant postmortem damage. however, it is clear that the entire shaft of the metacarpal has undergone prolific pathological change indicative of dactylitis. the internal margins of the cortex are porous. (k) and (l) focal cavitations of the right and left distal fibulae. margins of the lesions are smooth and within nodes of new bone. the surrounding bone has undergone complete prolific pathological change with the internal cortex appearing porous. osteoblastic lesions considered in the diagnosis of nutritional disease are presented in figure 4. (image: m. vlok) vlok et al. 23 figure 4. expressions of lesions related to nutritional disease in m29. preserved bones are outlined in black, with absent bones outlined in light gray. an undetermined metacarpal is also present but not demonstrated in the figure, as its skeletal position is unknown. the skeletal extent of osteoblastic lesions possibly related to nutritional disease is indicated by dark gray fill. (a) mixed active and remodeled discrete deposit of subperiosteal new bone and abnormal cortical porosity medial to the coronoid process of the mandible. (b) symmetrical mixed active and remodeled discrete deposit of subperiosteal new bone in the supraspinous fossa of the scapulae. (c) bilateral swelling and slight cupping of the distal femur. (d) depression of the humeral heads which are reminiscent of coxa vara deformities of the femoral heads (see brickley and ives 2008:102). (e) trummerfeld (scurvy) line and white line of frankle on the distal radius and ulna. these radiographic changes were identified in all metaphyses of long bones. (f) slight medial bending deformities of the tibial shafts. (g) posterior bending of the proximal metaphyseal plate of the tibia. (image: m. vlok) two probable cases of treponema pallidum24 infiltrates through nutrient arteries (jaffe 1972:1015– 1020). proliferation within bone generally begins in the metaphyseal region, eventually spreading to the cortex through the haversian canals (ikpeme et al. 2010; jaffe 1972:1020). osteomyelitis can result in nodes of new bone only, like treponemal disease (hackett 1976:424). however, it is particularly diagnostic in its pyogenic form. substantial deposits of subperiosteal new bone occur particularly in the long bones, resulting in a shell of new bone termed the involucrum (ikpeme et al. 2010; kharbanda and dhir 1991). disruption to blood supply by the involucrum results in bone death (sequestrum) (ikpeme et  al. 2010; kharbanda and dhir 1991). finally, cloacae develop within the involucrum in order to drain pus that has accumulated within the medullary canal (ikpeme et al. 2010; kharbanda and dhir 1991). dactylitis, as observed in m29, is known to occur in osteomyelitis, but it is frequently associated with direct infection to the surrounding soft tissue due to trauma or localized infection (jaffe 1972:1018). osteomyelitis is rare in adults but can result from reoccurrence of infection from adolescence (ortner 2003:187; resnick and niwayama 1995). however, the superficial focal cavitations on the external cortex as observed in the left fibula of m20 are unknown to occur in osteomyelitis and are incompatible with the pathophysiology of cloacae in pyogenic bone infection. while necrotic abscesses have been observed in osteomyelitis, they occur within the medullary canal and not the external cortex (jaffe 1972:1020). although two lesions in the distal fibulae of m29 penetrate to the medullary canal and are reminiscent of cloacae, such lesions have also been observed in cases of treponemal disease where gummatous lesions are associated with advanced endosteal enlargement (hackett 1975). it is clear the entire bone of the fibulae shafts has been involved in this child with the inner cortex appearing porous. there is a lack of association of involucrum or sequestrae with the lytic lesions in m29, as would be expected with osteomyelitis, and more extensive proliferative new bone response also would be expected (hackett 1976:92). furthermore, it would be unusual for cloacae to occur symmetrically, such as observed in m29, as formation of cloacae is determined by the nature of the involucrum development and therefore they do not appear in predictable patterns (jaffe 1972:1018; roberts 2019:298). systemic nonlocalized skeletal expression of both the lytic and proliferative lesions in m20 and m29 without focus of the infection in the metaphyseal regions of bone make osteomyelitis as the underlying cause extremely unlikely. however, given the nonspecificity of osteomyelitis, particularly the nonpyogenic form, a secondary bacterial, viral, or fungal infection cannot be ruled out. the mycobacterium tuberculosis complex (mtbc) is a group of infectious slowgrowing grampositive bacteria that can cause granulomatous necrotizing abscesses throughout the entire body, including bone (flynn and chan 2001; haque 1990; knechel 2009). the mtbc consists of mycobacterium strains that infect a number of mammalian primary hosts but can all cause infection of humans. these include: m. tuberculosis (humans), m. bovis (domestic livestock), m. canetti (humans), m. microti (voles, hyrax, llama, rarely humans), m. caprae (goats), m. pinnipedii (seals and sea lions, rarely humans), and m. africanum (humans) (roberts 2012). the most common form is m. tuberculosis, which is primarily a respiratory disease affecting the lungs (de la ruadomenech 2006; world health organization 2013). m. tuberculosis is most often spread through air droplets from coughing, sneezing, and talking (knechel 2009; world health organization 2013), whereas zoonotic forms such as m. bovis tend to spread to humans through ingestion of meat or dairy (de la ruadomenech 2006). in its chronic form, tuberculosis can cause systemic granulomatous skeletal destruction with minimal new bone response, predominantly in regions of trabecular bone and articular surfaces, such as the vertebral bodies (jaffe 1972:956; key 1940; lafond 1958; ortner 2003:228). therefore, bone destruction in tuberculosis most commonly affects the spine above all other skeletal elements, followed in frequency by involvement of the hip and knee joints (jaffe 1972:956; lafond 1958; ortner 2003:228). in the most advanced form, destruction of the vertebral bodies results in collapse referred to as gibbus formation (or structural kyphosis) seen in pott’s disease, which has been considered pathognomonic for tuberculosis (davidson and horowitz 1970; jaffe 1972:958– 961; turgut 2001). while circumferential deep focal destruction can occur in the long bones in tuberculosis, it is more characteristic of childhood tuberculosis, and even then it is focused in long bone ends rather than shafts (lewis 2017:161; ortner 2003:245; teo and peh 2004). sclerotic margins of the superficial focal lesions on the external shafts of the long bones of m20 and m29 accompanied by cortical enlargement is not reminiscent of the destruction of tuberculosis, which, while chronic, elicits minimal remodeling of the lesion margins (jaffe 1972:976). proliferative new bone response is known to occur, particularly in the early stages of disease, as a systemic inflammatory response to the pathogen or due to psoas abscess formation adjacent to the lumbar spine, but is infrequently found in direct association with the destructive lesions in adults (davidson and horowitz 1970; ortner 2003:232; ridley et al. 1998). in the case of tuberculosis, dactylitis is rare but can occur in juveniles such as that observed in the single vlok et al. 25 metacarpal of m29 (teo and peh 2004). however, in m29 the degree of expression is not severe and lacks the cystic destructive form more common to childhood tuberculosis (lewis 2017:162; teo and peh 2004). as there is no evidence of spinal, trabecular, or joint involvement of which pathogens in the mtbc complex are selective for, tuberculosis is ruled out as a possible cause for the lesions in m20 and m29. brucellosis is a bacterial zoonotic disease commonly associated with animal husbandry. human disease is mainly caused by four species of brucella: b. abortus, b. suis, b. canis, and b. melitensis (alshahed et al. 1994; franco et al. 2007). the bacteria are transmitted mostly through consumption of animal products such as dairy, but they can be transmitted through skin lesions in circumstances of close contact with animals (d’anastasio et al. 2011; franco et al. 2007; mehmet et al. 2002). the brucella bacteria bind to cells of the mononuclear phagocyte system, a group of cells that includes bone marrow progenitors, blood monocytes, and macrophages found in hematopoietic regions of the body including in bone (campbell et  al. 1994; hume 2006). once chronic, brucellosis can affect the skeleton in focal or diffuse forms (alshahed et al. 1994). less has been described about the skeletal pathology of brucellosis than of tuberculosis, and questions remain about how to differentiate definitively between the two, and whether this is even possible in many cases (alshahed et al. 1994). as is the case in tuberculosis, focal destruction of the spine is a primary characteristic of this disease (alshahed et al. 1994). brucellosis can cause widespread destruction of the skeleton, and skeletal involvement is common (alshahed et al. 1994; mehmet et al. 2002). destructive lesions are often but not always accompanied by sclerotic reaction due to their slow development, which is not characteristic of tuberculosis (roberts and buikstra 2019: 421). remodeling can result in the presence of parrot’s beak osteophytes on the superior margin of the anterior vertebral bodies (alshahed et al. 1994). while collapse of the spine can occur, it is unusual for the destruction to advance to the severity seen in tuberculosis (roberts and buikstra 2019). similar to tuberculosis, osteolytic lesions develop in regions of hematopoiesis, including the hip, knee, and ankle joints (alshahed et al. 1994; mehmet et al. 2002). unlike in tuberculosis, following the spine, the sacroiliac joint and knee are most commonly affected (alshahed et al. 1994). for reasons similar to those stated in the consideration of tuberculosis, it is unlikely that brucellosis is responsible for the skeletal appearance of disease observed in m20 and m29. although brucellosis is known to result in focal lesions with sclerotic response, superficial lesions of the external cortex, particularly in relation to cortical enlargements of long bone shafts, have not been observed in the pathophysiology of this disease. various fungal infections are known to result in skeletal involvement. diseases including coccidioidomycosis, blastomycosis, histoplasmosis, aspergillosis, and cryptococcosis rarely infect the musculoskeletal system but are more common in immunocompromised individuals (corr 2011). transmission often occurs through open wounds or through the respiratory tract whereby hematogenous spread occurs (corr 2011). infection is more common in the spine, but it can occur in any region of the skeleton, particularly in regions of hematopoiesis (corr 2011; toone and kelly 1956). for this reason there is a predilection for axial skeletal involvement (taljanovic and adam 2011). when long bones are involved the metaphyses are more commonly affected, with joints affected if destruction is extensive, at times resulting in septic arthritis (taljanovic and adam 2011). the pathological response is primarily in the form of focal punchedout or deep granulomatous osteolytic lesions with or without sclerotic margins (corr 2011; r. c. jones and goodwin 1981; taljanovic and adam 2011; toone and kelly 1956). proliferative new bone response to the extent observed in m20 and m29 has not been reported for mycotic infections. however, given the systemic inflammatory response observed in fungal infections such as coccidioidomycosis, the potential for subperiosteal involvement in mycotic infections cannot be ruled out (corr 2011; taljanovic and adam 2011). finally, clinical reports of skeletal mycotic infections describe lesions that tend to be unilateral and asymmetrical throughout the skeleton (r. c. jones and goodwin 1981; taljanovic and adam 2011; toone and kelly 1956). given the predilection for the axial skeleton such as in the case of tuberculosis and brucellosis, destruction is associated with hematopoiesis in the skeleton, whereby deep osteolysis is more consistent with the pathophysiology of this disease group rather than superficial lytic lesions in the appendicular skeleton as observed in m20 and m29. the symmetrical lytic lesion pattern in the man bac individuals is also not consistent with clinical reports of mycosis. mycosis is therefore ruled out as a possible cause. leprosy is a bacterial infection caused by mycobacterium leprae or m. lepromatosis that affects the skin, nasal mucosa, and peripheral nerves (eichelmann et al. 2013; saonere 2011). the symptoms of the disease vary along a spectrum and are highly dependent on individual immune response (eichelmann et al. 2013). tuberculoid leprosy is a milder form that is often non contagious, whereas lepromatous leprosy is more systemic, infectious, and results in more severe symptoms (eichelmann et al. 2013; saonere 2011). major skeletal changes in leprosy involve nasofacial destruction two probable cases of treponema pallidum26 with inflammatory pitting, and resorption of the terminal phalanges of the hands and feet secondary to loss of sensation from peripheral nerve or circulatory degeneration caused by the pathogen (møller christensen 1961, 1978; ortner 2003:264– 265). slow progression of resorption of the nasopalatal margins, including the anterior nasal spine, and alveolar process of the maxillary incisor area, with associated proliferative subperiosteal new bone and cortical pitting, are considered strongly diagnostic features of this disease (møllerchristensen 1961, 1978; møller christensen et al. 1952). while new bone can occur in leprosy, particularly in the lower legs, and skin granulomas can also occur, leprosy is not known to cause focal granulomatouslike lytic lesions of the long bones such as that observed in m20 and m29 (faget and mayoral 1944). osteomyelitis secondary to peripheral nerve destruction in advanced stages of the disease is well documented, but as described above, the superficial lytic lesions of m20 and m29 are not characteristic of osteomyelitis (faget and mayoral 1944; maas et al. 2002). the suite of cranial lesions observed in m20 is not characteristic of leprosy, as neither destructive lesions of the cranium nor proliferative or cortical pitting lesions of the nasal region were observed. furthermore, no destructive changes to the preserved tubular hand and feet bones of m20 and m29 were observed. the absence of the cranium and the presence of only one metacarpal means leprosy cannot be ruled out as a comorbidity in the case of the child. however, it is improbable that leprosy is responsible for lesions observed in both m20 and m29. treponematosis treponemal disease is a group of infections caused by a spirochete bacterium that primarily affects the skin but can also affect bones and other organs (hook and marra 1992). four diseases, including yaws (treponema pallidum pertenue), pinta (t. carateum), venereal syphilis (t. pallidum pallidum), and endemic syphilis (t. pallidum endemicum), have similar bacterium morphology and share similar pathogenesis (hook and marra 1992; marks et  al. 2014; willcox 1974). pinta is the only treponemal disease that does not affect bone (willcox 1974). each treponeme occupies a different ecological niche (marks et al. 2014). for example, endemic syphilis is restricted to warm, arid regions of the world, whereas yaws thrives in subtropical and tropical regions (willcox 1974). yaws, pinta, and endemic syphilis are nonvenereal treponemal diseases that are transmitted primarily by skin contact, whereas venereal syphilis has evolved to be spread primarily through sexual contact (willcox 1974). a primary skin lesion forms at the site of inoculation within a few weeks of initial infection and subsequently resolves itself (peeling and hook 2006). if left untreated, the disease almost always progresses to a secondary phase. in the secondary phase, the skin rash reappears, becoming more diffuse and is associated with swelling of lymph nodes (lymphadenopathy) (peeling and hook 2006). the secondary phase is then followed by an asymptomatic latent phase, where the infection is contained within granulomas by the immune system (hackett 1953b). latency can last from three to 10 years beyond the initial infection (hackett 1953b). following the period of latency, except in the case of pinta, a tertiary stage begins, where necrosis of the granulomas occurs, resulting in gummatous lesions of skin, internal organs, and bones (hackett 1953b; powell and cook 2005:15– 51). formation of the tertiary stage has been historically documented to occur in one in three untreated cases (hackett 1953b). the tertiary stage is distinctive for its gross destruction of the face, skull, limbs, and, in the case of venereal syphilis, arterial vessels and organs (hackett 1951; peeling and hook 2006). during the tertiary stage, secondary lesions stop forming (hackett 1953b). while early treponemal lesions can heal within a few months, the late (tertiary stage) lesions can last for more than a year and leave permanent changes in bone (hackett 1978). these granulomatous, gummatous lesions are distinctive and specific to all treponemal diseases, and are universally accepted as strongly diagnostic in paleopathology (harper et al. 2011; ortner 2003:286). the socalled caries sicca lesions on the skull are the most well recognized lesions of the disease and are clinically and paleopathologically documented in all skeletal forms of treponemal disease (hackett 1951:159– 165, 1974; sandison 1980). gumma outside of the cranium can develop as focal lesions termed “superficial cavitations” within proliferative new bone on outer surfaces of long bones (hackett 1976:362– 396, 429– 433). all tertiary lesions of treponemal disease are also associated with a sclerotic smoothing of the margins and base of the lesion (hackett 1976:362– 396, 429– 433). gross destruction of the palate and the nasal aperture can also occur (hackett 1946). in the case of venereal syphilis, transplacental transmission, congenital syphilis, causes distinctive bone and dental deformations in infants and young children up until puberty (jaffe 1972:908– 910; lewis 2017:176– 177). congenital forms are rarer in the endemic treponemes but have been reported in endemic syphilis from the ramadi district of iraq, and in yaws in central java, indonesia (akrawi 1949; csonka 1953; engelhardt 1959). the three treponemes that affect bone cannot be distinguished by their skeletal expression (harper et al. 2011). as the above diseases are unlikely causes of the lesions, the presence of superficial cavitations within vlok et al. 27 nodes of new bone in m20 and m29 strongly suggests that the etiology of the lesions expressed is treponematosis (fig. 5). the presence of saber shin and dactylitis supports this diagnosis. we also note here that the lytic lesions and distinct nodes of new bone in m20 and m29 correspond with dissemination through lymph nodes argued by buckley and dias (2002) to be the primary form of noncranial dissemination of the treponema pallidum spirochete into bone. unilateral enlargement of the sternal end of the clavicle, as observed in m29, has been noted in cases of lateonset congenital syphilis (dax and stewart 1939; frangos et  al. 2011; harper et  al. 2011; lewis 2017:179; yang 1940). this socalled higoumenakis sign presents as layers of proliferative new bone on the sternal end of the clavicle unilaterally (frangos et al. 2011). the lack of macroscopic or radiographic trace of proliferative subperiosteal new bone or cortical enlargement on the sternal end of m29’s left clavicle makes the identification of this pathology as a clear higoumenakis sign difficult. however, a rationale for this is explained below in consideration of comorbidity with nutritional stress. to allow for standardization of diagnosis of treponemal diseases, we here present threshold criteria for the designation of possible and probable cases (table 1). standard criteria have been presented previously by harper et al. (2011) using a fivepoint system for inclusion or exclusion of cases. this system attributes a score between 1 and 5, dependent on the specificity of the lesion to treponemal disease. nonspecific lesions such as subperiosteal new bone deposit are classified as a score of 1, and lesions specific to treponemal disease, such as gummatous lesions and late stage caries sicca of multiple skeletal elements, are provided a score of 5. however, the authors do not give a minimum point score required for a sufficient diagnosis of treponemal disease in dry bone. the standardization presented here builds upon work by harper et al. (2011) by introducing a “threshold approach” to diagnosis as recommended by brickley and ives (2008) for their criteria for diagnosis of scurvy, rickets, and osteomalacia and by snoddy et al. (2018) for their criteria for scurvy diagnosis. as described above, we have employed the minimum criteria of one strongly diagnostic or two diagnostic lesions for a probable diagnosis of treponemal disease, which both of these cases demonstrate. a recent review of global evidence for treponemal disease by baker et al. (2020) includes a diagnostic protocol similar to the one presented here. the baker et al. (2020) protocol divides lesions into three diagnostic strengths, consistent with treponemal infection but not diagnostic (c), strongly suggestive (st), and pathognomonic (p). the criteria presented by baker et al. (2020) illustrate the consensus among paleopathologists to work toward standards of diagnosis of treponemal disease. each of the two cases presented here would score 5 out of 5 using the harper et al. (2011) criteria for diagnosis and would be scored as having pathognomonic lesions using the baker et al. (2020) criteria, all consistent with probable diagnoses using the threshold criteria presented here. nutritional disease not all lesions of m20 and m29 are consistent with infectious disease only (online table s5). the discrete deposits of new bone and cortical porosity on the posterior and anterior aspects of the zygomatic bones, and the external greater wings of the sphenoid bones and the temporal bone squama in m20 are more consistent with repeated microtrauma and hematoma formation characteristic of scurvy and not of treponemal infection, where diffuse subperiosteal new bone across the face and cranium would be expected (samarkos et al. 2011; snoddy et al. 2018). this individual also has evidence of anemia in the form of cribra orbitalia and porotic hyperostosis of the ectocranial vault, which may be a consequence of parasitic, infectious, and/or nutritional stress in childhood. a synergistic relationship between infectious and nutritional diseases is well documented (chan 2000; larsen 1995; mata 1975; nussenblatt and semba 2002; pelletier et al. 1995; roberts 2000; roberts and brickley 2018; ruiz et al. 1994), and comorbidity between these would not be unexpected at man bac given the biosocial context of subsistence transition occurring at the site (larsen 1995; oxenham et al. 2011). similar to m20, there are lesions present in m29 that are more likely to result from metabolic or developmental defects than infection (fig. 4). as outlined above, various deformities are present in the long bones of m29. while it is possible that the swelling of the distal femora is a result of the infection, the combination of bending deformities, cupping, and swelling of distal ends of multiple long bones suggests alternative etiologies for these pathologies and is particularly indicative of a demineralization disorder, such as rickets (brickley and ives 2008:103– 107). interactions between infectious and nutritional diseases during childhood growth is an area of ongoing study in paleopathology, and it is possible that a combination of these factors caused the long bone bowing identified in m29. the described porotic and new bone lesions of the mandible and scapulae are all diagnostic macroscopic signs of scurvy (snoddy et al. 2018). the radiographs also revealed groundglass osteopenia, and trummerfeld zones (radiolucent bands within the metaphyses) in association with white lines of frankel two probable cases of treponema pallidum28 figure 5. strongly diagnostic and diagnostic macroscopic lesions for treponemal disease in m20 and m29. (a) superficial focal cavitation of the medial left calcaneus (m20, diagnostic). (b) superficial focal cavitation of the anterior lateral epicondyle of the right humerus (m20, diagnostic). (c) superficial focal cavitation of the posterior lateral epicondyle of the right humerus (m20, diagnostic). (d) superficial focal cavitations within a distinct node of new bone of the right distal fibular shaft (m20, strongly diagnostic). (e) superficial focal cavitations within a distinct node of new bone of the right distal fibular shaft (m20, strongly diagnostic). (f) focal cavitation of the right distal fibular shaft with sclerotic margins within a distinct node of new bone (m29, strongly diagnostic). (g) superficial focal cavitation of the proximal right fibula (m20, diagnostic). (h) focal cavitation of the right distal fibular shaft with sclerotic margins within a distinct node of new bone, same lesion as 5f. (m29, strongly diagnostic). (i) focal cavitations of the right midulnar and radial shafts with sclerotic margins within a distinct node of new bone (m29, strongly diagnostic). (image: m. vlok) vlok et al. 29 table 1. diagnostic criteria for identification of treponematosis (sd = strongly diagnostic, d = diagnostic, and s = suggestive). one sd lesion or two d lesions are required for diagnosis consistent with a probable case. one d lesion or two s lesions are required for diagnosis consistent with a possible case. some lesions are provided for congenital cases and have been observed only in infants and children. the final column indicates which lesions were present in m20 and m29. lesion diagnostic strength differential diagnosis clinical reference paleopathological reference lesion present caries sicca sequence stages 4– 8: circumvallate cavitation, radial scars, serpiginous cavitation, nodular cavitation, and caries sicca of the ectocranium sd hackett 1975, 1976:362– 396 harper et al. 2011 – gummatous lesions on any skeletal element: focal superficial cavitations in direct relation with nodes or expansions (enlargements) of new bone sd hackett 1975, 1976:429– 433 harper et al. 2011 m20 m29 hutchinson’s incisors (congenital) sd normal morphology hackett 1976:441; pessoa and galvão 2011; stokes and gardner 1923 harper et al. 2011; hillson et al. 1998; lewis 2017:179 – moon’s molars (congenital) sd growth disruption hackett 1976:441 harper et al. 2011; hillson et al. 1998; lewis 2017:179 – congenital syphilis (caffey’s) triad: osteochondritis, bilateral thick periosteal reaction of the long bones, and osteomyelitis of metaphyseal ends (early congenital) d nonspecific osteomyelitis, infantile cortical hyperostosis, paget’s disease caffey 1939; jaffe 1972:910 lewis 2017:178 – caries sicca sequence stages 1– 3: clustered pits, confluent clustered pits, focal superficial cavitation of the ectocranium or focal superficial cavitation of the cortex of long bones not within a distinct node or expansion (enlargement) d mycosis, tuberculosis, langerhans’s cell histiocytosis, multiple myeloma, and other metastatic neoplasms hackett 1975, 1976:362– 396 m20 gross rhinomaxillary and palatal destruction (gangosa) d leprosy, tuberculosis, mycosis, destructive neoplasms, trauma, leishmaniasis fiumara and lessell 1970; hackett 1951:164– 168, 1975, 1976:399– 401 lewis 2017:175 – wimberger’s corner sign (congenital): bilateral widening band of decreased calcification of the metaphyses leading to destruction d nonspecific osteomyelitis, trauma, scurvy brackett and standley 2019; rasool and govender 1989 harper et al. 2011; lewis 2017:178 – mulberry (fournier’s) molars d mercury use, growth disruption harper et al. 2011; hillson et al. 1998; lewis 2017:179 – thick periosteal new bone deposition and exostoses on the maxillae (goundou) s scurvy, osteomyelitis, leprosy, infantile cortical hyperostosis, paget’s disease, genetic anemias buckley 2016:30; harper et al. 2011; lewis 2017:175 – higoumenakis sign: unilateral enlargement of the sternal end of the clavicle (congenital) s trauma, nonspecific osteomyelitis, normal variant dax and stewart 1939; yang 1940 frangos et al. 2011; harper et al. 2011; lewis 2017:179 m29 saber shin (pseudobowing of the tibia without bowing of the medullary canal) s leprosy, osteomyelitis, various benign and malignant bone tumors, paget’s disease, hyperflourosis hackett 1951:28 harper et al. 2011 m20 m29 boomerang leg: true tibial bowing with bowing of medullary canal (until adolescence) s rickets, skeletal dysplasias, osteogenesis imperfecta, fracture harper et al. 2011; lewis 2017:175 – dactylitis (subperiosteal new bone enlargement of the hand and feet bones) s tuberculosis, nonspecific osteomyelitis, genetic anemias hackett 1951:30; rasool and govender 1989 harper et al. 2011; lewis 2017:178– 179 m20 m29 charcot’s joint (resorption of weight bearing joints) s septic arthritis, diabetes, osteoarthritis, syringomyelia, tuberculosis hackett 1976; johns 1970; sequeira 1994 harper et al. 2011; lewis 2017:179 – (continued) two probable cases of treponema pallidum30 (radiodense lines on the metaphyseal plates of the long bones) (fig. 4), which are further diagnostic signs of vitamin c deficiency (brickley and ives 2008; snoddy et al. 2017, 2018). the likelihood of comorbidity of treponemal disease with nutritional deficiency in m29, including scurvy as well as deficiency of hormones, minerals, and/or vitamins related to the mineralization process (vitamin d, calcium, phosphorus, and/or parathyroid hormones), may be causing the concurrent thinning of cortices impacting the visibility of a clear higoumenakis sign of congenital syphilis. as gummatous lesions usually form within localized nodes of new bone, the presence of a small lytic process on the medial end of m29’s left clavicle may suggest a wellremodeled new bone deposit in a child with a high bone turnover rate also undergoing nutritional stress. the presence of a congenital expression of treponemal disease at man bac is then possible. in summary, m29 probably suffered from tertiary treponemal disease in association with multiple nutrient deficiencies affecting both osteoid formation and mineralization at various points in the child’s lifetime. in light of more definitive evidence of nutritional stress in m29, an argument could be made for a comorbidity of treponemal disease and vitamin c deficiency in m20 as well. possible treponemal disease? lesions in five other individuals are also consistent with treponemal disease. however, the skeletal expression of their lesions does not provide enough diagnostic strength to allow a probable diagnosis. mb05 m5 is an infant approximately 18 months of age with endosteal enlargement of the long bones associated with superficial lytic lesions. while the radiographs demonstrate a superficial focal sclerotic response in the distal metaphysis of the left humerus and superior acromial end of the clavicle, these lesions are small (lesion is 3.9 × 1.7 mm on humerus and 3 × 3 mm on clavicle), impeding confidence that these lesions are superficial focal cavitations as described by hackett (1976:429– 433). mb05 m29 is a middleaged adult male with dactylitis and diffuse new bone in the forearms and legs associated with endosteal enlargements. two focal superficial lesions with sclerotic response are present on the medial distal right fibula. however, these lesions are not within a distinct node of new bone and therefore do not strictly fit the definition of superficial cavitation by hackett. a further three individuals present with endosteal nodes/enlargements, and/or dactylitis, which are also consistent with treponemal disease (see online table s6). all lesions follow a postcranial pattern of lymphatic dissemination consistent with treponemal disease (buckley and dias 2002). pathophysiology of treponemal disease in m20 and m29 the presence of gummatous lesions in m20 and m29 is strongly diagnostic for treponemal disease in this early neolithic community and, therefore, is sufficient evidence for precolumbian treponemal disease outside of the americas, and represent the oldest cases in lesion diagnostic strength differential diagnosis clinical reference paleopathological reference lesion present opera glass fingers: diaphyseal tapering of the bone s leprosy, rheumatoid arthritis, syringomyelia, diabetes, osteomyelitis, erosive osteoarthritis hackett 1951:153– 154; b. s. jones 1972; swezey et al. 1972 ortner 2003:277 – radiographic: saw tooth appearance of metaphyseal ends or macroscopic symmetrical destruction of metaphyses attributed to osteochondritis (early congenital) s rickets, scurvy, trauma, tuberculosis jaffe 1972:910– 912; rasool and govender 1989 harper et al. 2011; lewis 2017:178 – thick deposit of mixed active and remodeled new bone on the long bones, thickest at the midshaft (congenital), or long bone endosteal nodes or expansions (enlargements) with medullary canal intrusion s paget’s disease, nonspecific osteomyelitis, metastatic bone tumors, tuberculosis hackett 1951, 1975, 1976:411– 433 harper et al. 2011; lewis 2017:178– 180 m20 m29 saddle nose (congenital) s leprosy, trauma, nonspecific osteomyelitis fiumara and lessell 1970; pavithran 1987 harper et al. 2011; lewis 2017:177 – high palatal arch (congenital) s various congenital deformities, including turner’s syndrome and klippelfeil syndrome pavithran 1987 lewis 2017:177 – table 1. (continued). vlok et al. 31 the asiapacific region. the presence of a possible higoumenakis sign in m29 attributed to the lateonset congenital form of treponemal disease does suggest the possibility of transplacental transmission in this case. transplacental transmission of yaws has been known to occur, albeit rarely (engelhardt 1959). children infrequently develop gummatous lesions, but they also have been documented to occur in yaws (hackett 1951). given the age of m20 it is possible that initial infection occurred in late childhood to adolescence, which is epidemiologically consistent with all treponemal diseases. which treponemal disease was present in neolithic man bac? we offer no attempt to diagnose which treponemal disease is responsible based solely on skeletal expression. discussion on the uniformity of skeletal lesions of different treponemes has been dealt with elsewhere (buckley and dias 2002). however, the epidemiological, social, and environmental contexts of the disease do allow some discussion on the treponeme responsible. climatically, vietnam is within latitudinal boundaries where yaws has been historically documented (mitjà et al. 2013). prior to the eradication attempts of yaws by the world health organization in the 1950s, yaws was endemic to vietnam, and reports as late as the 1990s demonstrate a recent history of the disease in the region (meheus and antal 1992). with consideration of all possible and probable cases at man bac, it is clear the lesions are predominantly in nonadults, with only two adults presenting lesions consistent with treponematosis and only one of these with strongly diagnostic lesions (online table s6). the epidemiological distribution in terms of age does suggest a nonvenereal form such as yaws, where initial infection most often occurs between the ages of two and 15 years (mitjà et al. 2013). therefore, yaws is a possible candidate for the treponemal disease present at man bac. however, the climate of this region is marginal for the successful maintenance of yaws in a community. yaws thrives in regions with average yearly temperatures of 27°c but can persist in areas of, at minimum, 21°c yearly average temperature (hill 1953). while northern vietnam fits into this range, in regions where temperatures are not consistent year round, yaws is even less likely to thrive (hill 1953). in january the minimum average temperature in northern vietnam is 12°c, and 14.3°c specifically for ninh binh province where man bac is situated (oxenham et al. 2011). the temperature during the early neolithic of vietnam may have been slightly elevated compared to the present day due to the termination of the mid holocene thermal maximum at around 3000 b.c., which was marked by higher temperatures and rainfall (oxenham et al. 2018). while there are no historic reports of endemic syphilis in the region, northern vietnam becomes cold and dry during the winter months, which is more suitable for the endemic form. in summary, the ecological and climatic context of man bac allowed for the presence of all of the treponemal conditions. however, given the age of the site and epidemiology in regard to the ages of affected individuals, it is more likely a nonvenereal rather than venereal form. social and biological conditions promoting treponemal disease at man bac the ecological and social contexts of man bac fostered an environment that was advantageous to the spread of nonvenereal treponemal disease in the community. agricultural transitions such as that which occurred at man bac have been universally documented to have resulted in epidemiological transitions as farming practices encouraged sedentism, population growth, and increased susceptibility to infection due to nutritional stress (armelagos and cohen 1984; cohen and cranekramer 2007; larsen 2006). in northern vietnam this subsistence change may have led to different epidemiological pressures in the communities with no distinct decline in health, as preneolithic sedentary foragers also had high disease burdens (oxenham et al. 2018). signs of multinutrient deficiency throughout the life of m20 and m29 is further supported by considerably high levels of stress identified in other dental and skeletal evidence from the site (mcdonell and oxenham 2014; oxenham and domett 2011). coastal habitations such as prehistoric man bac have been associated with higher yaws incidence in historical contexts due to the abundance of water and vegetation, increasing population density (hackett 1953a:135; kazadi et al. 2014). furthermore, pre industrialized agricultural communities have also been associated with increased incidence of yaws (guimarães 1953; hackett 1953a:135). the coastal region is also slightly warmer and more humid than inland northern vietnam and therefore more conducive to the spread of yaws (hill 1953). the increase in fertility and population growth at man bac was likely associated with an increase in the number of infants and children within the community, who are known to be the primary transmitters of yaws (mcfadden et al. 2018; mitjà et al. 2013). given the agebased hierarchy, possible relocation of resources to older individuals in the community may have promoted malnutrition in younger individuals, further encouraging disease transmission in children (hill 1953; oxenham et al. 2011). a degree of social two probable cases of treponema pallidum32 group cohesiveness may have further encouraged the transmission of a nonvenereal form of treponematosis spread through close skin contact. the presence of a profoundly disabled individual with quadriparesis following klippelfeil syndrome, who required continuous and intensive care, highlights that the community was one in which individuals were highly cooperative (oxenham et al. 2009; tilley and oxenham 2011). origins of treponemal disease at man bac it is not possible at this point to determine confidently whether treponemal disease was introduced by the farmers from southern china. however, the spread of treponemal disease into msea with migrant farmers during the neolithic is plausible when considering the extent of the migration and the sedentary agricultural contexts they brought with them (bellwood and oxenham 2008). there is no archaeological evidence for contact with other groups apart from southern chinese farmers outside of msea at this time. admixture with indigenous foragers in northern vietnam may have enabled further transmission of treponemal disease throughout msea, although currently no further evidence for prehistoric treponemal disease exists in southeast asian skeletal collections. while we recognize that absence of evidence is not evidence of absence, and a deep antiquity of treponemal disease in msea is possible prior to the agricultural transition, there is no identification of humantohuman transmissive diseases (such as tuberculosis, treponematosis, or leprosy) prior to this time in msea despite intensive bio archae ol o gi cal research in the region (buckley and oxenham 2016). the evidence of infectious disease in msea considerably increases from the bronze and iron ages (oxenham et al. 2005; tayles and buckley 2004). if the treponemal disease at man bac is in fact yaws, the route of transmission throughout the continent would be restricted to tropical and subtropical zones. although man bac is positioned at the presentday upper geographical limit of the survival of yaws, documented cases of yaws existed in southern china and taiwan prior to worldwide eradication attempts where the climate is similar to northern vietnam’s (hill 1953). in light of preeradication, clinical evidence of yaws in this region, a possible origin for the spread of treponemal disease into msea from farmers originating in southern china from approximately 4,000 years ago is plausible. given the presence of treponemal disease at man bac, regional interactions throughout the red river delta also present possible routes of transmission to and from other phung nguyen sites where archaeological material indicates contact with agricultural groups of southern china (khoach 1980; nguyen 2008). the implications of migration and human population interaction on the potential spread of treponemal disease into northern vietnam is an area for further research, particularly with regard to the broader context of the timing of the introduction of treponemal disease into msea. further investigation of existing and newly excavated skeletal assemblages in southern china and msea may provide further insight into the origins and antiquity of this disease within the region. it can be hypothesized that, with the demographic and subsistence transition resulting in nutritional instability, and possibly the introduction of new infectious diseases with migration, the social and environmental contexts of man bac were suitable for the spread of treponematosis. the high rate of natural population increase at man bac was likely fueled by the supplementation of agricultural foods, enabling larger groups to thrive, increasing the number of individuals in the community, and further encouraging the spread of treponematosis (mcfadden et al. 2018). the identification of two cases of probable tertiary treponemal disease in a northern vietnamese neolithic community further supports the contextual evidence for a population undergoing accelerated growth, significant social change, necessitating the navigation of interaction between two populations and one of a unified and close community wherein a treponeme could spread with relative ease. acknowledgments we would like to thank dr. ngo anh son, mr. bui van khanh, and ms. nellissa ling for their assistance with the radiographs, and dr. anne marie e. snoddy for input on the application of a standardized approach to treponemal disease. we thank the associate editor of bioarchaeology international and three anonymous reviewers for their comments and advice in revising the manuscript. author contributions mv wrote majority of the manuscript and performed data collection and processing. hrb contributed to research design, assisted in data processing, and contributed substantially to the manuscript. mfo and kd contributed to research design, provided preliminary data, and contributed to the manuscript. ttm facilitated access to collections, assisted with the data collection, and provided vietnamese translation of the abstract. ntm, hm, hht, and nth facilitated access to collections and provided essential background vlok et al. 33 knowledge for the production of this publication. th and ch contributed radiocarbon dates for the publication and produced the supplementary information on the radiocarbon dates. all authors critically reviewed, revised, and edited the content of the manuscript. references acosta, frank l., cynthia t. chin, alfredo quiñoneshinojosa, christopher p. ames, philip r. weinstein, and dean chou. 2004. diagnosis and management of adult 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bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe bioarchaeology international volume 5, numbers 1–2: 78–95 doi: doi: 10.5744/bi.2021.1004 copyright © 2020 university of florida press patterns of disease and culture in ancient panama: a bioarchaeological analysis of the early graves at cerro juan díaz nicole e. smith-guzmán,a,b* luis a. sánchez herrera,c and richard g. cookea,b asmithsonian tropical research institute, panama, republic of panama bsistema nacional de investigación, secretaría nacional de ciencias y tecnología, panama, republic of panama cdepartamento de antropología e historia, museo nacional de costa rica, san josé, costa rica *correspondence to: nicole smith-guzmán, smithsonian tropical research institute, ancon, panama city, a.p. 0843-03092, republic of panama. e-mail: smithn@si.edu abstract: cerro juan díaz (ls-3) is a large archaeological site located in the coastal lowlands of central pacific panama that comprised a pre-columbian village (200 b.c.–a.d. 1520). a multiyear field campaign (1992–2001) uncovered numerous human burials of diverse antiquity, integrity, complexity, and mortuary goods. this paper considers several aspects of the demography, diet, health, and cultural practices of the earliest mortuary population yet found at ls-3 (a.d. 30–650) through the analysis of human skeletal remains found in the excavation of operation 3, features 1, 2, 16, and 94. this research has led to revised interpretations of these important mortuary contexts. many of the personal adornments traditionally placed at the apex of regional value systems were found with the remains of children, giving support to the notion that, during this time period, age was the primary determinant of the kinds of ornaments that accompanied the dead. oral pathologies present signal the importance of cariogenic foods, such as maize, in the diet, while lingual surface attrition of the maxillary anterior teeth points to a habitual cultural practice of using the teeth as tools—perhaps to peel manioc tubers prior to cooking. head shaping appears to have been an important identity marker in the population, with high frequencies of obelionic-type artificial cranial modification. participation in a male-dominated habitual aquatic activity is revealed by external auditory exostoses in several individuals. finally, a systemic infection consistent with treponema pallidum was prevalent in the population, as evidenced by characteristic osseous lesions. keywords: paleopathology; central america; isthmo-colombian area cerro juan díaz (ls-3) es un sitio arqueológico en la llanura costera del pacífico central de panamá que fungió como aldea precolombina desde 200 a.c. hasta 1520 d.c. durante campañas de campo que se extendieron por diez años (1992–2001), se descubrió numerosos entierros humanos cuya antigüedad, integridad y complejidad, así como sus ajuares mortuorios, eran disimiles entre sí. el presente artículo adopta un enfoque bioarqueológico con el fin de dilucidar varios aspectos de la demografía, la dieta, la salud y las prácticas culturales de la población mortuoria más antigua que se haya encontrado hasta la fecha en el asentamiento (30–650 d.c.). nos concentramos en el análisis de los restos humanos correspondientes a las sepulturas más antiguas excavadas en el sitio: rasgos 1, 2, 16 y 94 de la operación 3. dicho estudio conllevó a revisar interpretaciones anteriores de estos importantes contextos mortuorios. algunos adornos personales que suelen colocarse en el ápice del sistema de valores a nivel regional se encuentran con niños y dan apoyo a propuestas anteriores de que, en esta received 13 august 2020 revised 19 february 2021 accepted 7 march 2021 smith-guzmán et al. 79 cerro juan díaz (ls-3) comprises a multicomponent pre-columbian village site straddling the la villa river, which separates the los santos and herrera provinces in central pacific panama (fig. 1). excavations supervised by richard cooke and led by various archaeologists took place at the site between 1992 and 2001 and sought to stem looting activities at the site and understand the chronology, subsistence economy, and cultural aspects of its ancient occupation (cooke and sánchez herrera 1997; cooke et al. 1998). this paper concentrates on operation 3, a 12 × 20 m excavated area of the site located on an anthropogenic platform on the southern slope of the 42-m high eponymous hill and excavated during the 1992– 1995 field seasons (sánchez herrera 1995; fig. 2). here, a unique circular arrangement of 12 oval stonelined pits was uncovered (cooke and sánchez herrera 1997; cooke et  al. 1998; cooke et  al. 2000; sánchez herrera 1995). these pit features average 3 m in length and 2–2.5 m in depth and were constructed about a.d. 580–6471 (cooke and sánchez herrera 1997; sánchez herrera 1995). nearly all of the pits were vandalized at some time. in the space within the circle of pits, two smaller circular features (features 7 and 8) were placed, which could correspond to burial features, but were also looted in their entirety prior to excavation. local people who visited the site during the excavations claimed that goldwork was taken from the vandalized features and sold. the proximity of the stone-lined pits to the central burial features with which they are coeval (i.e., features 7 and 8), as well as the copious wood charcoal and ash they contained, led cooke and colleagues 1 this estimated date range is based on the combination of the 2σ intcal20 recalibrated ranges of the earliest (i-18672, 1560 ± 80 b.p., cal a.d. 265–647) and latest (i-18671, 1330 ± 80 b.p., cal a.d. 580–885) radiometric dates of charcoal samples taken from the compact clay interspersed in the stone-lined profiles from these features (cooke and sánchez herrera 1997; sánchez herrera 1995). further support for this estimated range comes from the absence of conte style pottery (ca. a.d. 700–1000) within these features (cooke 2011; cooke and sánchez herrera 1997:73). (1998) to surmise that their function may correspond to a mortuary activity similar to smoke embalming reported on the eve of conquest further east in darién. according to spanish chroniclers, the corpses of high-ranked ancestors were suspended over a low flame until dried, and were later displayed in mortuary houses (espinosa 1994:63–64; martyr d’anghera 1912:219–220). as far as the authors are aware, no similar stone-lined pits have been found within the isthmo-colombian area. a total of eight features demonstrated or inferred to have been used for human burials were recorded under the stone-lined pits, thus predating them: features 1, 2, 16, 17, 21, 26, and 94, as well as a feature completely disturbed by “looter’s pit 94.” these burial features comprise some of the earliest intact contexts at the site (ca. 200 b.c.–a.d. 700). four of these pertain to complex and often commingled burials that contained preserved human remains: features 1, 2, 16, and 94. although previous studies have analyzed época, la edad de un difunto era el principal determinante de los bienes que lo acompañaban en la muerte. las patologías orales presentes incluso en niños pequeños en el sitio señalan la importancia de alimentos cariogénicos como el maíz en la dieta, mientras que el desgaste de la superficie lingual de los dientes anteriores superiores (“lsamat,” por sus siglas en inglés) en muchos individuos apunta a la práctica cultural habitual de utilizar los dientes como herramienta, tal vez para pelar tubérculos como la yuca antes de cocinarlos. en esta población, la forma de la cabeza parece haber sido un importante marcador de identidad, de acuerdo con las altas frecuencias de modificación craneal artificial de tipo obeliónico, las que se observaron entre los cráneos hallados en estos entierros. por otro lado, una consuetudinaria actividad acuática es indicada por la presencia de exostosis auditiva externa en varios individuos, mayormente masculinos. finalmente, destaca en esta población una infección sistémica compatible con treponema pallidum, tal y como lo evidencian las características lesiones óseas. figure 1. maps of cerro juan diaz showing the geographic location of the site (a) within panama, (b) in relation to the la villa river and the pacific coast, and (c) the location of the operation 3 excavation on the southern slope of the hill. maps by nicole smith-guzmán, modified from smith-guzmán and cooke 2018a: fig. 1 (inset a); cooke et al. 1998: fig. 1 (inset b); and sánchez herrera 1995: fig. 3 (inset c). patterns of disease and culture in ancient panama80 these features by focusing on the unique material culture items within these burial contexts (cooke et al. 1998; cooke et al. 2000; cooke et al. 2003), the results of the recently completed full analysis of the human remains reveal that individuals of all ages and sexes were buried at this location, and that specialty grave goods may relate to age rather than occupation. evidence of perimortem trauma consistent with the interpersonal violence documented in spanish chronicles was notably absent, but dental and skeletal pathology indicate that oral health problems and physiological stress were common. finally, activities such as diving, craft production, and cranial modification provide insight into the lives of the ancient isthmians. the present study reports these new data and their significance from a biocultural perspective, which have revised certain previous interpretations of these important burial features. the archaeological context the ls-3 site was occupied continuously from about 200 b.c. to the time of spanish contact in the early sixteenth century (isaza aizpurúa 2007). the site is centered on a prominent hill along the south bank of the la villa river, approximately 5 km from the current position of the active shoreline of parita bay in the pacific ocean. extensive archaeological surveys suggest that at its apogee, ls-3 encompassed an estimated area of 150 ha, extending to the north bank of the la villa river and including two additional hills: cerro juan gómez and cerro tello (isaza aizpurúa 2007, 2013). in addition to its prominent funerary components, burnt clay floors with postholes and several shell-bearing middens containing faunal remains are interpreted as dwellings and domestic refuse used from about a.d. 400 to 800 (isaza aizpurúa 2007; sánchez herrera 1995). the contents of the middens suggest residents were consuming mollusks, mostly marine and occasional freshwater fish, maize, and diverse terrestrial fauna, including iguanas, birds, deer, and small mammals (cooke and jiménez 2008; cooke et al. 2007; isaza aizpurúa 2007; jiménez and cooke 2001). specific structures and features at the site have also provided evidence of craft production during the cubitá phase (mayo and cooke 2005) and the conspicuous manipulation of human remains after death (interpreted as “ritual activities”) during the later phases of the site’s use (carvajal et al. 2006). it is uncertain exactly how many people lived at cerro juan díaz at any one time during its long occupation, but the population size likely waxed and waned, with population estimates for the la villa river valley reaching a maximum of 6,500 individuals during the conte ceramic phase (a.d. 700–1000) (isaza aizpurúa 2007). cerro juan díaz began to be used as a mortuary center at the end of the la mula ceramic phase (200 b.c.–a.d. 250), as shown by the earliest radiocarbon date yielded from human dentin collagen (cal a.d. 33–244; table  1). the early burials discussed herein figure 2. plans of the operation 3 excavation at cerro juan díaz showing (a) widespread disturbance of the excavated area by looters’ pits of varying depths, and (b) archaeological features, including those mentioned in the present paper as well as later features which often overlap these. modified from cooke and sánchez herrera 1997: fig. 2. smith-guzmán et al. 81 date between a.d. 30 and 650 and all follow a common pattern of burial context reuse (cooke et al. 2000). old burials were repeatedly disturbed in antiquity and their contents rearranged to accommodate new occupants. primary burials are rare while secondary bundle burials and commingled deposits abound. features 1 and 2 features 1 and 2 at ls-3, operation 3, were excavated in 1992 by luis sánchez herrera and adrián badilla cambronero. feature 1 was a rectangular or ovalshaped pit cut into the bedrock (measuring 1.5 × 2 m, and reaching a maximum depth of 1.1 m) that was used for the burial of human remains (sánchez herrera 1995). this feature had been disturbed, both in pre-columbian times by the placement of feature 2, and more recently by two looters’ pits. feature 1, interpreted as the first burial, contained a cluster of disarticulated human skeletal remains that extended uninterrupted to the base of the intrusive feature 2. human collagen samples from this disarticulated cluster provided radiocarbon dates averaging over 150 years earlier than samples from intact bundle burials in feature 2 (see table 1). commingled remains recovered from feature 1 most likely belong to original occupants of this grave that were disturbed during the burial of individuals in feature 2; however, this could not be confirmed. thus, both features are regarded as a single context for osteological analysis and minimum number of individuals (mni) calculation, which was estimated at 29 individuals (table  2). special cultural objects found dispersed with the human remains in feature 1 table 2. age distribution of individuals from the early burial features at cerro juan díaz non-adults adults feature 0–2 years 3–12 years 13–19 years 20–34 years 35–49 years 50+ years adulta total 1 & 2 3 4 4 2 3 5 8 29 16 2 10 1 0 3 2 1 19 94 0 1 0 0 1 0 2 4 total 5 15 5 2 7 7 11 52 a adult of indeterminate age. table 1. ams radiocarbon dates of human remains from the oldest burial horizon at cerro juan díaz lab no. sample context element sampled conventional radiocarbon age calibrated date (95.4% ci) ceramic phase β-224778 f. 16 cranium 1 tooth (ulp1) 1880 ± 40 b.p. a.d. 33–244 la mula β-224781 f. 2 bundle 2-a tooth (ulm1) 1800 ± 40 b.p. a.d. 129–352 la mula β-147880 f. 16 cranium 14 tooth (lrm1) 1780 ± 40 b.p. a.d. 175–404 tonosí β-224779 f. 16 cranium 11 tooth (um2, l&r) 1700 ± 40 b.p. a.d. 247–425 tonosí β-224780 f. 2 bundle 1 tooth (llm1) 1690 ± 40 b.p. a.d. 247–529 tonosí β-552727 f. 2 bundle 4 cranium 1 bone (r. femur) 1680 ± 30 b.p. a.d. 255–433 tonosí β-147876 f. 2 bundle 2 tooth (ulm3) 1640 ± 40 b.p. a.d. 263–543 tonosí β-224783 f. 2 bundle 4 cranium 2 tooth (ulm3) 1620 ± 40 b.p. a.d. 365–553 tonosí β-224784 f. 2 bundle 5 tooth (urm2) 1600 ± 40 b.p. a.d. 406–565 tonosí β-224785 f. 2 bundle 6 tooth (ulm1) 1570 ± 40 b.p. a.d. 418–577 tonosí β-224788 f. 2 bundle 13 tooth (lrm2) 1560 ± 40 b.p. a.d. 421–588 tonosí β-147878 f. 94 individual 36 tooth (urp2) 1500 ± 40 b.p. a.d. 436–648 cubitá note: all dates were run by beta analytic, inc. and calibrated with oxcal 4.4 using intcal20. patterns of disease and culture in ancient panama82 comprised the following: two incense burners with strap handles (espavé rojo type), two hammered gold-copper plaques with convergent raised spirals belonging to bray’s initial group (a.d. 1–500) of isthmian goldwork (bray 1992), over 300 complete tubular thorny oyster (spondylus spp.) shell beads ca. 4 cm long, and 24 complete jaguar (panthera onca) and puma (puma concolor) canine teeth with one or two holes drilled through the root for suspension (sánchez herrera 1995). feature 2 was a 2 m deep cylindrical pit with a bulbous base (1.3 m maximum diameter), containing human remains of varied burial modes and states of preservation. several clearly defined bundle burials were placed along the west and south quadrants of the shaft. in most cases, these contained the remains of a single individual (i.e., bundles 4, 5, 6, 8, 9, 10, and 13); the exception was a single primary, flexed burial of a 5–6-year-old child, which was placed directly above bundle 4 (fig. 3). this articulated child was denominated “bundle 4 cranium 1,” while the adult individual in the bundle below it was labeled “bundle 4 cranium 2.” based on its articulated nature, this child must have been placed in the burial context soon after death, and thus, the maximum 2σ calibrated date range associated with this individual should, in turn, represent a maximum date for this intrusive burial event in general: cal a.d. 433 (table 1). the remaining human remains in feature 2 pertained to the aforementioned commingled cluster extending from feature 1 through all strata of the north and east quadrants of feature 2: bundles 1, 2, 3, 7, 11, and 12. based on the contextual information from the field notebook of sánchez herrera (1992) at the time of excavation, as well as photographs and documentation from the excavation stored in the archaeology laboratories of the smithsonian tropical research institute, it appears that the following sequence of events occurred. the individuals originally buried in feature 1 were laid to rest in the rectangular or oval-shaped burial cut, which was likely covered by a roof or awning based on the presence of posthole molds in the floor of this burial feature (sánchez herrera 1995). it is unknown if this original interment contained primary or secondary burials, nor how many individuals it contained. these original grave occupants were then disturbed when the burial cut for feature 2 was made. seven bundle burials were carefully arranged in feature 2, and a recently deceased child placed on top of bundle 4 (based on the articulated nature of bundle 4 cranium 1). subsequently, the fill of the original burial was replaced in the grave, including the jumbled remains of the original occupants of feature 1. sánchez herrera recorded the following artifacts from within feature 2: five polished circular agate beads (associated with bundles 2, 7, 8, and 11) and one calliostoma top snail shell with a perforation at its apex (with bundle 1) (sánchez herrera 1995). excavation photographs, field drawings, and lab-based inventories, as well as a subsequent publication, also report the presence of five perforated jaguar (panthera onca) canines and one perforated puma (puma concolor) canine associated with bundle 2. in addition, 41 tubular and elongated spondylus shell beads (ca. 4 cm long) were found associated with bundles 1, 2, 4, 5, 6, 7, 9, and 10, as well as another initial style hammered gold-copper plaque with raised spirals between bundle 2 and the northern wall of the burial cut (cooke et al. 1998). feature 16 located just a few meters north of features 1 and 2, feature 16 was excavated in 1993 by luis sánchez herrera and aguilardo pérez yancky. this feature constituted a similar secondary burial context that disturbed an earlier grave, and consequently led to the commingling of the newly placed remains with the original occupants of the earlier burial context (feature 26). in this case, however, all of the skeletal elements were characterized by disarticulated and commingled remains in a dense cluster (ca. 1 m3; fig. 4), leading sánchez herrera and pérez yancky to enumerate individuals by cranium rather than bundle or skeleton. nonetheless, a pattern similar to that of features 1 and 2 emerged, with more figure 3. field photograph of the excavation of feature 2, showing several bundle burials in situ. note the primary burial of the non-adult skeleton “bundle 4 cranium 1” (a 5–6-year-old child) that was placed over the secondary burial of the adult skeleton “bundle 4 cranium 2” (a 35–45-year-old male), visible at the top of the photo. smith-guzmán et al. 83 commingling and disorder of the remains recovered from the superficial aspect of the cluster, and more organized bundles found at its base. radiocarbon dates also followed this pattern, with an early date for cranium 1 at the top of the cluster, and a date nearly 200 years later in time for cranium 14, found in an organized bundle burial in the lower layer. at least 19 individuals appear to be represented in this burial feature. many shell ornaments were found with the human remains in feature 16. these include 33 spondylus pendants associated with cranium 4, five tear-shaped spondylus beads placed near cranium 12, 87 tubular beads and 30 zoomorphic beads made of spondylus associated with cranium 8, 120 thin tubular beads, one “medallion” bead, three rectangular beads, and 10 zoomorphic beads made of spondylus near cranium 7, and 15 pearls found near cranium 11. yet, the most spectacular artifacts, which have been featured in several publications over the last two decades, were found at the bottom of the grave in association with cranium 14 (cooke 2004; cooke and sánchez herrera 1997; cooke et al. 1998; cooke et al. 2003). these included a copper ring tied with cotton string, 31 dog-shaped spondylus pendants, two polished stone bars, perforated longitudinally (one is agate and the other an unidentified blue stone), and 74 perforated mammal—primarily puma, ocelot (leopardus pardalis), and raccoon (procyon lotor)—teeth (cooke et al. 1998). feature 94 feature 94 was excavated in 1995 by ilean isaza aizpurúa and aguilardo pérez yancky. the main occupant of this feature (individual 36, a 40–55-year-old probable male) was found in a primary, supine position with the legs and arms flexed along the right side of the body (fig. 5). this primary burial was interpreted to have disturbed the original burial, denominated “individual 38,” whose elements appear to represent at least three individuals and were found disturbed and dispersed after removal of individual 36. thus, following the pattern of the previous two burial contexts, feature 94 seems to represent another burial that was reutilized in antiquity. individual 36 was associated with a shell ornament shaped like long-tailed frog, three broken ceramic vessels, and a broken legged metate that contained maize starch grains imbedded on its work surface (cooke and sánchez herrera 1997; cooke et  al. 1998; cooke et  al. 2000; piperno and holst 1998). a radiocarbon date from the dental collagen of individual 36 places this individual at cal a.d. 436–648. materials and methods the human remains from each of these four burial features were reassembled from fragments and analyzed according to the north american standards for osteological assessment (buikstra and ubelaker 1994). in an effort to reassociate the remains of individual skeletons from the highly commingled multiple burials of features 2 and 16, cranial elements were matched with their postcranial counterparts by multiple means. during the excavation of both of these features, many of the bones were numbered and drawn prior to removal; however, this was done somewhat sporadically for features 1 and 2, where many bones figure 5. field photograph of individual 36 (a 40–55-year-old probable male) within feature 94 from above. figure 4. field photograph of the excavation of feature 16 as viewed from the south, showing the depth and volume of the commingled human remains. patterns of disease and culture in ancient panama84 from the uppermost and lowermost phases were not numbered, nor their specific locations plotted. the adult bone matching was based on pelvic sex and age, bone number proximity (i.e., how close one element was placed relative to another), and morphological and metric characteristics of the long bones. the nonadult bone matching was done similarly based on morphology and metric age of long bones, as well as catalog number proximity. most of the bones of the thorax, as well as hand and foot bones, could not be reliably matched to individuals in these commingled contexts and, thus, were analyzed in isolation. the mni for each context was estimated based on a tally of the presence and completeness of each skeletal element per individual, and combined with separate tallies for commingled elements separated by non-adult and adult age categories. completeness was coded as follows: 1 > 75% complete, 2 25%– 75% complete, and 3 < 25% complete. for long bones, presence and completeness were recorded for both proximal and distal epiphyses, as well as proximal, middle, and distal thirds of the diaphyses. these inventory data on presence and completeness of skeletal elements were recorded initially in the smithsonian institution’s osteoware software (osteoware. si.edu), and subsequently organized in a microsoft excel workbook for mni calculation (table s1). preliminary age and sex estimations of the human remains from the early burials at cerro juan díaz published in earlier works were made either by archaeologists in the field or during preliminary cleaning and organizing of the bones in the laboratory by claudia díaz. the present osteological analysis utilized this previous information as a starting point, but did not always agree with these earlier estimations. in the present study, non-adult age estimations were made based primarily on dental development (alqahtani et al. 2010), but long bone lengths (maresh 1970) and epiphyseal fusion (schaefer et  al. 2009) were utilized in cases lacking observable dentition. adult age estimations were based primarily on pelvic morphological changes (brooks and suchey 1990; lovejoy et al. 1985) and occasionally based on cranial suture closure (meindl and lovejoy 1985) in the absence of observable pelves. sex was estimated in older adolescents (aged 15–19 years at death) and adults based primarily on pelvic morphology (buikstra and ubelaker 1994; phenice 1969), and secondarily on cranial morphology (acsádi and nemeskéri 1970). each individual was assessed macroscopically for the presence of dental and osseous pathologies following the standards recommended by buikstra and ubelaker (1994) to provide comprehensive descriptions of lesions from which specific differential diagnoses could be made. the following dental pathologies were recorded: carious lesions, dental abscesses, enamel hypoplasias, and dental anomalies. carious lesions were recorded for any area of decayed tooth enamel resulting in the complete perforation of enamel to the underlying dentin or pulp chamber. aspect and surface location affected by each lesion and its degree of severity were recorded following the numerical coding system outlined in the above referenced standards. abscesses perforating the alveolar bone adjacent to a tooth root were recorded by tooth affected and location of pus drainage. enamel hypoplasias were recorded for each tooth based on the type of defect, including pits, grooves, and opacities, but were only noted to affect deciduous teeth in the present sample. often, heavy dental calculus obscured the labial surfaces of the anterior teeth in the permanent dentition and limited the observability of these teeth for the presence of enamel hypoplasias. dental anomalies were not surveyed in a systematic manner, but were noted during dental inventory on a case-by-case basis. thus, these anomalies are likely underreported in the sample studied (see smith-guzmán 2021 for a multisite survey of dental and skeletal anomalies regionally). osseous pathologies were assessed by side, aspect, and section of the skeletal element affected according to five basic categories: abnormal bone formation, bone loss, porous lesions, trauma, and arthritis. arthritis is not discussed in the present manuscript due to its association with the age of the individual (i.e., degenerative joint disease) in this population. the only form of abnormal bone formation found on the skeletal elements studied comprised periosteal reaction of the long bones, which was recorded based on reaction type, surface appearance, active or healing state, and any endosteal tissue involvement. instances of bone loss, or lytic lesions, were recorded by location in terms of the number of foci, their dimensions, localized bony response, and the presence or absence of associated cortical thinning. porous lesions appearing in the cranium were recorded separately, noting aspects of location affected, pore size, density of porosity, activity, and the presence of diploic expansion. finally, instances of trauma represented by antemortem or perimortem fractures were assessed based on fracture type and characteristics, as well as the extent of callus formation. specific osseous and dental indications of cultural activities were assessed for those biocultural markers known to affect pre-columbian populations in central panama. these included artificial cranial modifications (stewart 1958), for which the category (i.e., tabular or circumferential), degree of modification, center of pressure and its angle to the frankfurt plane, and the presence of pad impressions were recorded. the presence of external auditory exostoses smith-guzmán et al. 85 was assessed separately for each intact auditory canal, and the degree of stenosis recorded in the case of exostosis presence (smith-guzmán and cooke 2018a). finally, the maxillary anterior teeth were assessed for lingual surface attrition of the maxillary anterior teeth (lsamat; irish and turner 1987), the presence of which was defined by wear facets of varied severity that appeared on the lingual surface of the maxillary incisors and canine teeth that were worn to a greater degree than the occlusal attrition seen on the other teeth within the same individual’s dentition (turner and machado 1983). results and discussion paleodemography the proportions of the different age and sex groups present from the individuals buried in the earliest contexts at cerro juan díaz generally follow an expected mortality curve for a preindustrial society, with higher numbers of young children and older adults represented in the graves than adolescents and young adults (lewis 2006). of the 52 individuals recovered from these burial contexts, 10% were infants aged 0–2 years, 29% children aged 3–12 years, 10% adolescents aged 13–19 years, 4% young adults aged 20–34 years, 13% middle adults aged 35–49 years, and 13% older adults aged 50 years or older, with the remaining 21% pertaining to adults of indeterminate age (table 2). that nearly half of the individuals buried in the early contexts at cerro juan díaz correspond to infants, children, and adolescents follows closely the distribution of non-adults and adults seen in later contexts at the site (díaz 1999). the older adolescent (15–19 years) and adult sample contained slightly more males (39%) than females (32%), and 29% of indeterminate sex (table  3). interestingly, the adult female individuals present in the early burial contexts all pertained to the older (50+ years) age category, while there were three female adolescents present and two female individuals of indeterminate age. in contrast, males present included individuals in all age categories, but most corresponded to middle adults. data on exact age and sex estimations made for each individual are accessible in table s2. the difference in age distribution by sex was significant when excluding individuals of indeterminate sex (χ2 = 13.21, df = 4, p = 0.010). caution must be taken in interpreting this result based on the small sample size of female and male individuals of estimated sex (n = 22), and considering that the nine adult individuals of indeterminate sex could potentially fill in the gaps to make this sex-based age distribution more homogeneous. nevertheless, this distribution suggests that females had a significantly lower risk of death between the ages of 20 and 50 years than males. one possible interpretation of this difference is that males were engaging in riskier activities during young and middle adulthood, such as participating in warfare. alternatively, male members of society may have simply been more likely to come into contact with dangerous wildlife (i.e., venomous snakes, crocodiles, felines, sharks, and stingrays) while hunting or foraging for resources. that ancient peoples of panama often came into contact with and revered these dangerous animals is apparent by their frequent detailed depiction on painted ceramics and ornaments of various media and the use of their teeth and barbs as adornments (linares 1977). in terms of the older adolescent sex ratio seen in the early cerro juan díaz burials, this follows the pattern reported at the nearby site of playa venado, where the elevated frequency of adolescent female deaths was hypothesized to relate to obstetrical causes (smith-guzmán and cooke 2018b). table 3. sex distribution of older adolescents and adults from the early burial features at cerro juan díaza 15–19 years 20–34 years 35–49 years 50+ years adultb total feature f m i f m i f m i f m i f m i f m i 1 & 2 3 0 0 0 2 0 0 3 0 3 2 0 1 0 7 7 7 7 16 0 1 0 0 0 0 0 3 0 2 0 0 0 0 1 2 4 1 94 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 1 1 1 total 3 1 0 0 2 0 0 7 0 5 2 0 2 0 9 10 12 9 a f, female; m, male; i, adult of indeterminate sex. b adult of indeterminate age. patterns of disease and culture in ancient panama86 changing interpretations new age and sex estimations allow for different interpretations of several burials, including those of individuals previously interpreted as ritual practitioners. these instances signal that caution must be taken when making interpretations regarding occupation or biological sex of individuals on the basis of grave goods, particularly when made in the field or prior to osteological analysis. two individuals in feature 16 were found associated with a copper ornament, and were originally interpreted as the remains of one adult and one infant (cooke et al. 1998), or alternatively as one adult and one adolescent (cooke 2004). the present study interprets the principal individual (cranium 14) as a 6–7-year-old child whose direct association with the copper ornament found in this bundle context is made clear by the green-colored cupric staining visible on the right maxillary deciduous canine, left mandibular permanent lateral incisor, and the anterior bodies of several cervical vertebrae. the second individual (cranium 11) is consistent with a 5–6-yearold child. in the published literature, the diverse artifact assemblage found in association with these two individuals is interpreted as the belongings of a ritual specialist (i.e., a shaman or healer) and his apprentice (cooke 1998a; cooke 2004; cooke et al. 2003; cooke et al. 2007). however, this interpretation must be revised in light of the osteological analysis of these skeletons. rather than a shaman and his apprentice, the accumulation of specialty or sumptuary goods with these two children more likely reflects a common trend in the mortuary archaeology of the region, in which precious goods are placed in funerary contexts with regard to age rather than social status (briggs 1989, 1993). although the social impetus behind this behavior is unclear, it is likely tied to a spiritual belief in an afterlife in which these mortuary offerings might be required especially for these immature members of society. zoomorphic pendants and ornaments made from the teeth of animals may have represented the animal identifier of the individual’s specific clan (cooke 2004:281), or, alternatively, a mythical figure of regional religious significance (stone 1963). similarly, the specialty items in features 1 and 2 (including the three initial style gold ornaments) are reported in the published literature as belonging to an adult male individual considered to be the “principal occupant” of feature 1 (cooke et al. 2003), buried in a primary “flexed” (cooke et al. 1998), or, alternatively, “extended” position (cooke and jiménez 2004). however, neither of these purported burial modes are supported by the primary archaeological documentation nor can the demographical assessment be confirmed based on the osteological analysis reported herein. based on the present analysis, the partial and commingled remains of at least three disarticulated individuals were present among the material excavated from feature 1: a 16–21-year-old individual of probable male sex, a 5–6-year-old child, and an infant under one year of age. due to the intrusion of feature 2 upon feature 1, the human remains and mortuary goods originally contained in feature 1 were found jumbled and clustered together, extending from the limits of feature 1 all the way to the base of feature 2. while the notion that the artifacts found in association with this mass of commingled remains in feature 1 represent the accoutrements of a ritual specialist (cooke 2004) seems plausible, a clear association of these items with any one individual contained within this disturbed and commingled context is not possible. the reassessment of the association of sumptuary items with children in feature 16 detailed above further signals that caution must be taken in assuming these items necessarily reveal the occupational status of individuals they were buried with, or indeed that they were placed with adults rather than immature individuals. another important demographical reinterpretation must be made regarding individual 36, buried in feature 94. this individual was originally thought to be a 20–25-year-old adult woman based on field observations (cooke et al. 1998; cooke et al. 2000); however, the present osteological assessment found that this individual is biologically consistent with a 40–55-year-old male individual. this change underlines the importance of careful osteological analysis even when associated artifacts are assumed “feminine” in nature (in this case, a metate used for grinding maize). during excavation, quick estimation of the biological sex of human remains is often made based primarily on the most visible morphological trait (i.e., the bony projection at the superciliary arches and glabella of the frontal bone). however, in the first author’s experience, these cranial features are often misleadingly gracile in pre-columbian panamanian remains, particularly in individuals whose crania were artificially modified during life. a more holistic view, taking into account cranial features less affected by cranial modification (i.e., mastoid process size) and placing greater weight on pelvic morphology, provides a more accurate sex estimate. accordingly, the phenice traits of the pubis in individual 36 of feature 94 are overwhelmingly masculine, as is the size of the mastoid processes (see fig. 10 below), while smith-guzmán et al. 87 other sexually dimorphic traits in this individual are more ambiguous. importantly, the in-depth osteological assessment of the human remains from cerro juan díaz highlights some common issues in the excavation of mortuary contexts regionally. when possible, archaeologists should include specialists in bioarchaeology during the excavation of mortuary contexts for multiple reasons. interpretations of these contexts are often formed during excavation and necessitate the participation of experts in human skeletal analysis. likewise, many features of these mortuary contexts and skeletal elements visible in the field may be damaged or lost post-excavation, limiting the feasibility of retrospective analysis. destructive sampling of human remains prior to osteological analysis should be avoided. in turn, bioarchaeologists should be aware of cultural and biological variants in the population, such as cranial modification, which may not be initially apparent in highly fragmented skeletal material, but which can affect morphological characteristics used in age and sex estimation. dental pathology a total of 575 permanent teeth from 41 individuals and 229 deciduous teeth from 19 non-adult individuals were observable (table  4; raw data accessible in table s3). dental decay, including carious lesions and one dental abscess clearly associated with a large carious lesion, affected nine individuals (22%), including the deciduous teeth of three non-adult individuals. ten individuals showed antemortem tooth loss (24%), including nine adults and one non-adult. four individuals (10%) showed signs of dental crowding, as evidenced by the overlap of two or more teeth within the dental arch. dental crowding was rare in premodern times, but is thought to have been more prevalent in populations consuming a diet of soft or processed foods that do not produce the biomechanical masticatory stress necessary for the jaw bones to reach their full biological potential size (corruccini 1990, 1991; cramon-taubadel 2011; rose and roblee 2009). numerous multidisciplinary studies over the last decades have identified key dietary staples in central pacific panama over 8,000 years prior to spanish contact, including primarily marine and freshwater fish, white-tailed deer, and maize (cooke 1998b; cooke et al. 1996; cooke et al. 2007; cooke et al. 2008; cooke et  al. 2013; dickau 2010; jiménez and cooke 2001; piperno 2011). no known ageor sex-based dietary differences exist for cerro juan díaz’s population; nevertheless, norr (1991) observed a significant sex-based difference in stable isotope values of bone collagen from individuals buried at the nearby sites of cerro mangote and sitio sierra wherein females tended to have lower δ15n and δ13c values. a more recent study, which included six individuals from cerro juan díaz, did not report a similar sex-based difference in dietary isotope values, but did find evidence for substantial fish and maize consumption at the site (sharpe et al. 2021). the dental pathologies and crowding in the early burials at cerro juan díaz may reflect a diet high in soft, cariogenic foodstuffs. while maize is a common cariogenic cultigen, it is important to consider the cariogenic potential of other cultigens consumed table 4. dental pathologies and cultural dental wear noted among the human remains from the early burials at operation 3 of cerro juan díaz primary dentition secondary dentition dental pathology teeth affected (n/n) individuals affected (n/n) teeth affected (n/n) individuals affected (n/n) antemortem tooth loss 1/229 1/19 72/575 9/41 caries 14/229 3/19 15/575 5/41 abscess – 1/19 – 1/41 crowding – – – 4/13 enamel hypoplasia a 13/229 6/19 – – lsamat b – – – 6/10 aenamel hypoplasia included only defects to deciduous tooth enamel. blingual surface attrition of the maxillary anterior teeth. patterns of disease and culture in ancient panama88 widely in the lowlands of pacific panama in pre-columbian times, including manioc (manihot esculenta), squash (cucurbita moschata), sweet potato (ipomoea batatas), and several native tree fruits, like palms (bactris spp., attalea butyracea, and acrocomia aculeata), nance (byrsonima crassifolia), and zapote (family sapotaceae) (dickau 2010; piperno 2011; piperno and holst 1998; piperno et  al. 2000). comparatively, zapote (e.g., mamey) and nance contain more total sugars per 100 g serving (20.14 g and 8.31 g, respectively) than does corn (6.26 g) (us department of agriculture 2019). notably, 32% of non-adult individuals from the cerro juan díaz early burials showed signs of developmental defects in the deciduous dental enamel, likely contributing to the proliferation of cariogenic pathogens (duray 1990). this defective enamel manifested as dark, opaque discoloration (i.e., hypocalcification) or non-carious pitting of the labial enamel surfaces of the anterior deciduous teeth, tending to affect multiple teeth per individual. the maxillary deciduous central incisor was most commonly affected (7/16; 44%), followed by the maxillary deciduous lateral incisor (4/15; 27%) and the mandibular deciduous canine (2/23; 9%). these tooth crowns form and mineralize in utero or in early infancy; thus, these hypoplastic defects likely represent a response to nonspecific systemic physiological stress of the mother during gestation or of the infant in the early postnatal period, such as that caused by infectious disease or severe malnutrition (blakey and armelagos 1985; goodman and rose 1990; ortner 2003:300–303). that the teeth affected tended to include both antimeres and often more than one tooth class per individual reduces the likelihood that these defects were caused by localized trauma to the tooth during development (goodman and rose 1990:64). three individuals recovered from bundle burials in feature 2 had dental anomalies of permanent teeth (fig. 6). a 35–45-year-old male individual (cranium 2 from bundle 4) displayed a supernumerary tooth socket just posterior to that of the maxillary left central incisor. both the supernumerary tooth and the maxillary left central incisor were lost postmortem, and thus, the specific morphological characteristics of these teeth could not be observed. the maxillary left lateral incisor of the 15–17-year-old female individual recovered from nearby bundle 5 showed a mild flexion of the long axis of the tooth root relative to that of the crown (cf. “mesial bending”; edgar 2017; edgar et al. 2016) accompanied by prominent interruption grooves along both mesial and distal marginal ridges, with the mesial groove extending halfway down the root. this individual’s maxillary left third premolar was rotated 90° toward the mesial aspect, such that the buccal surface faces mesially. the 50+-year-old female from bundle 13 had an embedded mandibular left third molar that was inverted, with the occlusal surface of the crown facing inferiorly. finally, an isolated molar recovered from the bottom of feature 2 that could not be associated confidently with any one individual shows an anomalous crown morphology characterized by a restricted occlusal aspect containing approximately 10 cusps surrounding a central cusp, which is separated by deep sulcus punctated by non-carious pits and minute enamel projections. a cautious differential diagnosis of this molar is underway, which considers both infectious and genetic factors as potential causative agents (smith-guzmán and berger n.d.). osseous pathology many of the individuals buried in the oldest cerro juan díaz graves showed skeletal signs of nonspecific physiological stress (table 5). systemic inflammation evidenced by periosteal reactions was present in 26% of individuals with observable postcranial elements, appearing bilaterally on the tibiae of four of the eight total individuals affected. the bilateral tibial figure 6. examples of the dental anomalies present in the dentition of individuals from cerro juan díaz operation 3, feature 2, including as follows: a) occlusal view of the maxillary dentition from bundle 4 cranium 2 (35–45-year-old male) showing a supernumerary tooth socket posterior to the socket for the left central incisor, b) labial, lingual, and mesial views of the maxillary left lateral incisor from bundle 5 (15–17-year-old female) showing mesial bending and interruption grooves, c) lingual view of the left side of the mandible from bundle 13 (50+-year-old female) showing an embedded third molar facing inferiorly within the alveolar bone, d) occlusal oblique view of an isolated molar found at the bottom of feature 2 characterized by supernumerary cusps including a central cusp, as well as non-carious pitting and cuspules. smith-guzmán et al. 89 periosteal reactions suggest a systemic physiological stressor, and have been considered by other authors among paleopathological indicators consistent with either yaws (treponema pallidum pertenue) or syphilis (treponema pallidum pallidum) in the population (baker et  al. 2020; buikstra 2019; hackett 1976; harper et al. 2011). other indicators compatible with treponemal disease in the population include anterior bowing (“sabre shin”), which was present in one isolated left tibia from the commingled remains in feature 2, bundle 2 (fig. 7), as well as bilaterally in the tibiae from the 50+-year-old male from feature 2, bundle 10 (fig. 8). the latter individual also showed enlarged diaphyses of the long bones affected and a circular superficial depressed lesion on the right ulna (fig. 8, insert). this small superficial lesion (5.02 × 4.49 mm) perforated only the outer layers of the thickened cortex and was circumscribed with somewhat smooth, regular margins. no similar lesions were noted on this individual and the unifocal and small size of this lesion does not directly correspond to the larger or multifocal lytic postcranial lesions caused by the gumma of treponemal disease (ortner 2003:286). whatever the cause, it does appear likely that this lesion contained a nodular soft tissue component during life. cranial porosity indicative of a specific nutrient deficiency (e.g., scurvy) or anemia of infectious or noninfectious origin was present in 19% of observable crania, co-occurring significantly in many of the same individuals with periosteal reactions (fisher’s exact, p = 0.046). the majority of this cranial porosity consisted of cribra orbitalia (five of the seven individuals), as well as porosity observed on the hard palate in two individuals whose cranial bones were unobservable (see table s2 for details). none of the porosity observed could be categorized as porotic hyperostosis. the only adult with cranial porosity manifested in this case by cribra orbitalia corresponded to the 50+-year-old male individual whose postcranial skeleton was severely affected by figure 7. medial view of a left tibia (h.200) from the disarticulated and commingled cluster of human remains in feature 2, bundle 2, showing anterior bowing. this tibia could not be associated with a specific individual; thus, the age and sex are unknown. table 5. osseous pathologies and cultural modifications noted among the human remains from the early burials at operation 3 of cerro juan díaz non-adults (< 15 years) adolescents and adults (15+ years) total female male indeterminate periosteal reactions 4/10 1/8 1/10 2/3 8/31 cranial porosity 6/14 0/9 1/12 0/1 7/36 external auditory exostosis – 1/8 3/10 0/0 4/18 artificial cranial modification 5/7 1/1 6/10 1/1 13/19 patterns of disease and culture in ancient panama90 periosteal reactions (feature 2, bundle 10; fig. 8). the co-occurrence of these nonspecific stress markers suggests that the same systemic stressor may have been responsible for both pathologies in many of the individuals studied. this in turn supports the notion of cranial porosity due to infectious disease rather than from a dietary nutritional deficiency in these individuals (fig. 9). the patterning of porous and periosteal lesions on the individuals studied was not diagnostic of scurvy specifically; nevertheless, the potential for malnutrition to have provoked porous cranial lesions cannot be ruled out. evidence of cultural activities osteological evidence of cultural activities includes obelionic-type artificial cranial modification, which was present in 68% of observable crania (table 5 and fig. 10). obelionic modification is characterized by superior flattening focused on the obelion, which in turn creates a broadened cranial shape with accentuated curvature of the occipital and frontal bones (tiesler 2014). crania modified in this form are distinguished from other tabular erect modifications by having an acute angle (typically < 50°) between the occipital squama and the frankfurt horizontal plane when viewed from the lateral aspect (nelson and madimenos 2010). this cultural head-shaping activity was practiced widely in the greater coclé cultural region of central panama, likely as an embodied form of group identity (díaz 1999; stewart 1958). unlike in other geographical regions of the figure 9. inferior oblique view of cranium (h.24) from feature 2, bundle 2-f (an 8–9-year-old child), showing severe porosity of the orbits, sphenoid, and left temporal bone. figure 8 photographs of periosteal reactions on the ulnae (anterior view), tibiae (lateral view), and fibulae (medial view) from feature 2, bundle 10 (50+-year-old male), with inset showing a close-up view of the circular depressed lesion present on the anterior aspect of the distal third of the right ulna. note the enlarged diaphysis of all bones affected (excluding the comparatively milder reactions on the right fibula), with slight anterior bowing and vascular impressions present on the tibiae. smith-guzmán et al. 91 precontact americas (tiesler 2014), no other forms of cranial modification appear to have been practiced by the inhabitants of greater coclé. the method for achieving this distinct head shape has been debated in the literature. some maintain that the absence of clear frontal or mandibular deformation excludes the possibility of a counter pressure point, instead suggesting a single focal point of applied pressure to the crown of the head. they suggest a cradleboard with an inclined endpiece as the most likely implement leading to the modification unintentionally (stewart 1958; tiesler 2014). however, others hold that such a cradleboard method would also flatten the occipital region, suggesting a method of flattening with head splints (martínez de león mármol 2009; nelson and madimenos 2010). the absence of any artifact or iconographic representations of the implement used to achieve obelionic modification leaves this debate unresolved for the time being. obelionic modification seldom appears at other sites in north and central america, and in less than 30% of the population, postdating a.d. 500 where it does appear (nelson and madimenos 2010; stewart 1939; tiesler 2014). in mexico, it is especially common at the site of el zapotal in veracruz (a.d. 600– 900), being referred to as “zapotal-type head shapes” (romano 1974). tiesler (2014) notes “superior flattening” has also been reported at frequencies up to 20% at mayan gulf coast sites occupied during the second half of the first millennium a.d., and 29% in skulls at chichén itzá (ca. a.d. 900). in the southwest united states, this cranial modification was present in pueblo populations (a.d. 900–1400), but in only 5% of crania studied (nelson and madimenos 2010). the early burials at cerro juan díaz (all predating a.d. 650) may represent the earliest widespread evidence of obelionic modification. the question of whether obelionic cranial modification was a practice more common and more ancient than in other parts of the new world awaits confirmation as this type of head shaping is often more subtle and may have been missed by bioarchaeologists working in regions with more extravagant head forms. potential social status or kinship associations with cranial modification trends is a future avenue of research in panamanian bioarchaeology to be accomplished through more in-depth studies focused on stable isotopes and biodistance analyses. three male individuals from feature 2 and one female from feature 16 showed external auditory exostoses, culminating in 21% of individuals with at least one auditory canal intact. the overall frequencies of external auditory exostoses by individual (only those with both auditory canals observable) among the early burials at cerro juan díaz were found to be the highest (23.1%) when compared with four other sites along the gulf of panama (which ranged from 0%– 12.5%), highlighting the importance of aquatic activities like diving for precious shells (smith-guzmán and cooke 2018a). the fervent practice of shell diving during the oldest burial horizon at cerro juan díaz is attested by the abundance of spondylus and other marine shell ornaments within the early burials, whereas auditory exostoses were absent in individuals from burials at the site postdating a.d. 800 when gold likely took the place of marine shell as the most important commercial commodity (cooke and bray 1985; martín-rincón and sánchez herrera 2007; sánchez aguilarte 2020). all three of the males affected also had obelionic-type modified crania while the female individual’s cranium was fragmented and unobservable for modification. sixty percent of individuals with observable anterior dentition showed signs of lingual surface attrition of the maxillary anterior teeth (lsamat; table 4 and fig. 11). lsamat was fairly evenly distributed across the different ages and sexes, affecting three of four observable adolescents (two females and one male), one older adult female (the only adult female with observable anterior teeth), and two of the four observable adult male individuals (both middle adults). this distinctive dental wear pattern has been noted among other pre-columbian human remains from panama and is thought to be evidence of the use of the upper front teeth as tools, perhaps in food preparation (e.g., peeling manioc) or in figure 10. right lateral aspect of the cranium from feature 94, individual 36 (a 40–55-year-old probable male), showing superior flattening characteristic of obelionic-type artificial cranial modification. patterns of disease and culture in ancient panama92 basket-making activities (irish and turner 1987; smith-guzmán et al. 2018). this activity appears to have intensified over time at cerro juan díaz, as lsamat was reported at a frequency of 80% of human remains from the later operation 4 (ca. a.d. 800–1000) contexts at the site (díaz 1999:65). in only one case (feature 94, individual 36) was related wear also present on the labial aspect of the anterior mandibular teeth. finally, it should be noted that none of the human skeletal remains showed signs of perimortem trauma, and there was only one instance of antemortem trauma. the latter comprised a healed compression fracture to the base of a first metatarsal from feature 1, likely resulting from an accident. the absence of traumatic lesions in individuals from these early burials concords with that seen in the later contexts of operation 4 at ls-3 (cooke et  al. 2003:137; díaz 1999) and stands in apparent discord with contact period ethnohistorical and archaeological portrayals of panama as rife with “endemic” warfare and with periodic mass human sacrifice events (helms 1979; ibarra rojas 2012; linares 1977; lothrop 1954). bioarchaeological evidence of these violent acts is likewise absent from nearby sites occupied around the same time period (smith-guzmán and cooke 2018b). conclusions the osteological analysis of the human remains recovered from the oldest burial horizon at cerro juan díaz has shifted the interpretations of these important features in several ways and has provided new insights into the health and cultural activities of the earliest inhabitants of the site. specialty objects of metal and shell—frequently interpreted as symbols of rank and wealth alone—were more often associated with the remains of non-adults rather than adults (following assertions by briggs [1989]). conceivably, this age-based association could signify that these valuable objects played a role in religious beliefs about life stages. clearly, the complex relationship of specialty mortuary goods with interred individuals in central pacific panama extends beyond conventional interpretations of social status during life and merits future in-depth studies. high rates of dental pathologies (relative to data from other pre-columbian sites; pezo lanfranco and eggers 2012) and dental crowding follow previous suggestions of high dietary maize content, and perhaps also reflect the consumption of sugary tree fruits. the skeletal evidence of an infectious disease consistent with treponematosis in this population, when taken with similar evidence from other nearby sites (díaz 1999; huard 2013; mcgimsey et al. 1986–1987; norr 1991; smith-guzmán and cooke 2018b), suggests this disease was widespread in the region 1,000 years before spanish arrival. finally, biocultural stress markers present include high rates of head shaping and using teeth as tools that appear to be evenly distributed between the sexes. in contrast, aquatic activities causing external auditory exostoses are restricted to a small group of mostly men, suggesting that diving for marine shells used as ornaments was a male-dominated activity. no perimortem trauma was found on the bones, and the demography follows normal preindustrial patterns of life expectancy, suggesting normal attrition rather than mass casualty events. future directions include the further study of human remains from the early burials through stable isotopes and biodistance analyses. changes in health and cultural activities over time at the site will be assessed through the continued analysis of human remains from the later burial horizons at cerro juan díaz. acknowledgments the authors would like to recognize the efforts of the excavation crews who helped luis sánchez herrera and adrián badilla cambronero clean and excavate these complex features at ls-3 between 1992 and 1995: aguilardo pérez (in guna: bailiver sulup), ilean isaza aizpurúa, olman solís, javier rodríguez, luis barría (father and son), píndaro mitre, melquiades moreno, yanilka díaz, juana sánchez, and gustavo nelson tapia. we owe special thanks to claudia díaz for initially preparing the human remains for study, as well as to laura schell, vanessa sánchez, and leslie naranjo for their assistance with the human remains analysis. the laboratory photographs of the human remains were taken by raiza segundo. the excavations at cerro juan díaz were conducted with figure 11. occlusal view of the anterior maxillary dentition from feature 16, h.20 (a 30–45-year-old male), showing lingual surface attrition (lsamat). note the flattened cingulum with associated wear facets on both central incisors. smith-guzmán et al. 93 the permission of the dirección nacional del patrimonio histórico of panama with funding support from the national geographic society and the smithsonian institution (scholarly studies and latino initiatives grants). the human remains analysis by the first author was made possible through a postdoctoral fellowship funded by the smithsonian tropical research institute and additional research funding from the sistema nacional de investigación (sni) of the secretaría nacional de ciencia y tecnología (senacyt) in panama. finally, we are grateful for the helpful comments and suggestions provided by two reviewers and an associate editor on an earlier version of this manuscript. references acsádi, györgy, and jános nemeskéri. 1970. history of human life span and mortality. akadémiai kiadó, budapest-szeged. alqahtani, sakher j., mark p. hector, and helen m. liversidge. 2010. brief communication: the london atlas of human tooth development and eruption. american journal of physical anthropology 142(3):481–490. doi: 10.1002/ajpa.21258. baker, brenda j., gillian crane-kramer, michael w. dee, lesley a. gregoricka, maciej henneberg, christine lee, sheila a. lukehart, david c. mabey, charlotte a. roberts, ann l. w. stodder, anne c. stone, and stevie winingear. 2020. advancing the understanding of 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american antiquity 28(3):339–359. doi: 10.2307/278277. tiesler, vera. 2014. the bioarchaeology of artificial cranial modifications: new approaches to head shaping and its meanings in pre-columbian mesoamerica and beyond. springer, new york. turner, christy g., ii, and lilia m. cheuiche machado. 1983. a new dental wear pattern and evidence for high carbohydrate consumption in a brazilian archaic skeletal population. american journal of physical anthropology 61(1):125–130. doi: 10.1002/ajpa.1330610113. us department of agriculture, agricultural research service. 2019. fooddata central. https://fdc.nal.usda.gov. accessed april 14, 2020. login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search 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eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe bioarchaeology international copyright © 2021 university of florida press doi: 10.5744/bi.2021.1001 volume 5, numbers 1–2: 47–67 classic maya dental interventions: evidence for tooth extractions at piedras negras, guatemala joshua t. schnella* and andrew k. scherera adepartment of anthropology, brown university, providence, ri 02912, usa *correspondence to: joshua t. schnell, department of anthropology, brown university, box 1921, providence, ri 02912, usa e-mail: joshua_schnell@brown.edu abstract: tooth extractions are among the most common dental procedures performed globally today; however, archaeological evidence for such procedures in the past is relatively scant and largely limited to the classical world. we present a case of therapeutic dental extractions of pathological teeth at the ancient maya site of piedras negras, guatemala, during the late classic period (a.d. 600–800). the evidence comes from an assemblage of fractured, pathological teeth (n = 127) recovered from the marketplace at piedras negras during excavations in 2016 and 2017. we compare the piedras negras marketplace teeth to the broader late classic period mortuary population at the site along three lines of analysis: (1) distribution of teeth by type (incisors, canines, premolars, and molars), (2) pathologies, including dental caries and calculus, and (3) dental wear. we also explore in detail the fracture patterns apparent in the marketplace assemblage. our results indicate that the marketplace teeth display a significantly greater caries rate than the broader mortuary population and that posterior teeth (premolars and molars) are overrepresented in the marketplace sample. these findings point toward therapeutic extractions intended to ameliorate pain associated with oral pathologies. this article presents one of the few case studies of ancient health care in the americas and situates these practices within the market, an important, urban space across much of precolonial mesoamerica. keywords: maya; dentistry; tooth extraction; paleopathology las extracciones dentales se encuentran entre los procedimientos dentales más comunes realizados a nivel mundial en la actualidad. sin embargo, la evidencia arqueológica para tales procedimientos es relativamente escasa en el pasado y se limita en gran medida al mundo clásico. en este artículo, se presenta un caso de extracciones dentales terapéuticas de dientes patológicos en el antiguo sitio maya de piedras negras, guatemala, durante el periodo clásico tardío (600-800 d.c.). la evidencia de este caso proviene de una colección de dientes patológicos y fracturados (n = 127) recolectados en el mercado de piedras negras durante las excavaciones realizadas en los años de 2016 y 2017. estos dientes fueron comparados con otros dientes recolectados alrededor del sitio en contextos mortuorios del periodo clásico tardío a lo largo de tres líneas de análisis: (1) la distribución de los dientes por tipo (incisivos, caninos, premolares y molares), (2) las patologías, incluyendo caries dentales y cálculo y (3) el desgaste dental. asimismo, se exploró en detalle los patrones de fractura aparentes en la colección del mercado. los resultados de este análisis indican que los dientes del mercado muestran una tasa de caries significativamente mayor que los dientes recolectados en contextos mortuorios y que los dientes posteriores (premolares y molares) se encuentran sobrerrepresentados en la muestra proveniente del mercado. estos hallazgos demuestran el uso de extracciones terapéuticas designadas a aliviar el dolor asociado a las patologías bucales. este artículo presenta uno de los pocos estudios de caso de atención médica en el pasado en las américas y sitúa estas prácticas dentro del mercado, un importante espacio urbano que se encuentra a través de la mesoamérica precolombina. received 27 july 2020 revised 16 december 2020 accepted 28 december 2020 evidence for tooth extractions at piedras negras, guatemala 48 excavations in the maya area (and elsewhere in the world) frequently produce isolated human teeth. conventional wisdom is that these teeth come from disturbed burials and little further thought is given to their occurrence. in other instances, loose teeth have been found in classic maya ritual deposits and one interpretation holds that these were extracted from mourners as part of a royal mortuary rite (scherer 2015a:154, 2015b). when we consider the loss of permanent teeth across human societies, both traumatic injury and extraction of carious and abscessed teeth are common occurrences (cahen et al. 1985; morita et al. 1994; reich and hiller 1993; richards et al. 2005). and yet, archaeologically recovered isolated teeth are rarely understood within this framework, owing to the difficulty of reconstructing both the methods and contexts of ancient tooth extraction. in this article, we provide evidence for tooth extractions at the classic period (a.d. 350–900) maya site of piedras negras, guatemala (fig. 1). evidence for tooth extraction comes from a sample of 127 fractured and pathological teeth recovered in approximately 74 m3 of excavated stratigraphy within the marketplace of piedras negras (see below), dating largely to the late classic period (a.d. 600–800). we compare the piedras negras marketplace tooth sample to that of the broader piedras negras mortuary sample along three lines of evidence: (1) distribution of tooth type, (2) pathology (caries and calculus), and (3) wear to determine whether the marketplace teeth, as a group, were markedly different from the general mortuary population. if the marketplace sample represents the remains of extraction, we expect a different composition in terms of tooth type (incisor, canine, premolar, molar) than that derived from the mortuary population where teeth should be represented in close to the same proportions as they are in living individuals. this is because oral pathologies that require extraction disproportionately affect the posterior teeth: premolars and molars (demirci et al. 2010; whittington 1999). further, a greater incidence of pathology should be present in the marketplace sample if they were extracted for palliative reasons. finally, less wear may be present in a sample of extracted teeth relative to the overall mortuary population, given that they were used for a shorter period of time than those teeth that followed their owners to the grave. in addition to these comparisons, we also consider the anteand perimortem fracture patterns in the marketplace sample. we hope our results inspire scholars working elsewhere in the maya area, especially those excavating public quotidian spaces such as marketplaces, to look for similar patterns in their assemblage of human remains from non-mortuary contexts. moreover, these data provide an important window into ancient health care practices in the americas. finally, the approaches taken here may prove useful for scholars interested in the study of ancient dentistry elsewhere in the world. teeth in the archaeological record of the maya region in the maya area, aside from mortuary contexts, human teeth are found as part of isolated skulls in cases of decapitation (barrett and scherer 2005; duncan 2011; massey and steele 1997; whittington 2003) or pectorals and other objects manufactured from skulls (scherer 2015a:100–102; wrobel et  al. 2019). teeth also are found isolated from skulls, most often as a single tooth encountered in construction fill. there are examples, however, of intentional deposits of teeth that warrant further consideration. in belize as well as the central and eastern petén of guatemala, loose human teeth have been found within lip-to-lip cache vessels and have been variously interpreted as offerings, sacrificial victims, and companion burials (chase and chase 1998; pitcavage and braswell 2010; figure 1. regional map depicting location of piedras negras in relation to other archaeological sites mentioned in the text (map by j. schnell). schnell and scherer 49 scherer 2015b). often, these caches are located within or associated with tombs and burials, usually of elite or royal individuals as at el zotz, guatemala (scherer 2015b, 2018), or pusilha and cahal pech, belize (awe et al. 2009; cheetham 2004; pitcavage and braswell 2010). in these contexts, teeth usually occur in small numbers, generally no more than four or five, although a few large deposits of teeth are known (pendergast et al. 1968; saul and hammond 1974). in the case of cache vessels, human teeth are occasionally accompanied by human phalanges (e.g., ricketson and ricketson 1937:55–56). vessels have also been found containing phalanges alone. collectively, these are often referred to as tooth caches and finger bowls (chase 1994; chase and chase 1994, 1998, 2011; cheetham 2004; norton 2016; song et  al. 1994). in other contexts, such deposits exist independent of any sort of vessel. in the cave of actun kabul, belize, for example, several cultural scatters were found within the antechambers that contained isolated human skeletal elements. these were areas of intentional deposition and comprised primarily of human teeth and bones of the hands and feet (shelton et al. 2015:24). there are two prevailing explanations concerning the origins of the teeth, phalanges, and other bones in these cache deposits. considering the small, portable nature of teeth and phalanges, it may be that these elements were collected from extant burials and kept on hand, and later deposited as part of ritual practice, perhaps at stations in established ritual circuits (wrobel et al. 2013:132–133). the second concerns the removability of these elements from living persons. the teeth in these deposits are most often incisors, the teeth that are most easily avulsed from living persons and whose absence will have the least impact on masticatory function (scherer 2015a:154). similarly, the bones present are most often the distal and intermediate phalanges of the hand, both easier and more dramatic to remove than the comparable bones of the foot. archaeologists have recovered a few deposits consisting solely of teeth. at lubaantun, belize, for example, 59 loose teeth were found against the wall of a small structure at the far north end of the site core, dating to the late classic (ca. a.d. 700–800). they appear to have been buried as a single deposit (saul and hammond 1974:124). the lubaantun deposit is unique in that it seems to be the intentional deposition of the complete dentitions of two individuals. the authors argue, based on the completeness of the dentitions and the preservation of the teeth, that they were recovered from a burial long after decomposition had occurred (saul and hammond 1974:124–126). the largest deposit of loose teeth was excavated at the site of yakalche, located just 16 miles northeast of altun ha, belize. during the 1967 season of the royal ontario museum’s project at altun ha (pendergast 1979), preliminary excavations at yakalche yielded a total of 379 human teeth scattered in a single layer dated to the postclassic period along the western face of a platform in the central area of the site (pendergast et al. 1968). unlike the lubaantun cache, the yakalche teeth come from a minimum of 43 individuals. additionally, the majority (60.9%) of these teeth come from individuals aged 6 to 9 based on dental development (pendergast et al. 1968:641). unlike the restricted radius of the lubaantun cache, the yakalche teeth were encountered scattered along the face of a platform, often one at a time or in small groups of no more than five, within fill that overlaid the plaza floor (pendergast et al. 1968:637–638). while the yakalche deposit remains poorly understood, it highlights the range of contexts, quantities, and ages of the individuals represented in individuals represented in deposits of loose teeth in the maya region. piedras negras, guatemala the major maya polity capital of piedras negras is located on the eastern shore of the usumacinta river in the western region of what is now guatemala’s parque nacional sierra del lacandón. piedras negras was the seat of a royal dynasty that governed the community and greater kingdom throughout the classic period (proskouriakoff 1960). its occupational history began ca. 250 b.c. in the late to terminal preclassic period (houston et  al. 2000) and ended around a.d. 930 in the terminal classic period by which point most of the region was largely depopulated (golden et al. 2008:252; golden et al. 2016). the site has been the focus of a number of archaeological projects since it was reported to the international community by teobert maler who visited the site in 1894 (maler 1901). subsequent visits by sylvanus morley in the early twentieth century eventually led to an expedition sponsored by the university of pennsylvania from 1931 to 1939, directed by linton satterthwaite (weeks et  al. 2005:1–2). from 1997 to 2000, and again in 2004, the site was revisited by the proyecto arqueológico piedras negras (papn), directed by stephen houston and héctor escobedo (escobedo and houston 1997, 1998, 1999, 2001, 2005) and, from 2016 to 2017, the proyecto paisaje piedras negras–yaxchilan (pppny) conducted excavations at the site under the direction of andrew scherer, charles golden, griselda pérez robles, and mónica urquizú (pérez robles et al. 2016; urquizú et al. 2017). evidence for tooth extractions at piedras negras, guatemala 50 this paper deals directly with materials recovered during those two most recent field seasons of the pppny and with comparative data from the papn. specifically, it focuses on excavations conducted within a series of three patio groups located in the s quadrant of the site, hereafter referred to as the southeast marketplace (fig. 2). based on a density of materials recovered during early test excavations in the northernmost of these three patios (escobedo 1997; jackson and hruby 2001; urquizú 1998), zachary hruby, richard terry, and mark child of the papn proposed that this area may have functioned as piedras negras’s market. when the pppny returned to the site, they sought to confirm this hypothesis and excavated a total of 29 units across these three patio groups, focusing largely on the open plaza spaces (fig. 3). for detailed information on these excavations, see the original research reports (pérez robles et al 2016; urquizú et al. 2017). these excavations yielded a larger than normal quantity of ceramic sherds, worked and unworked shell, lithic debitage and artifacts, unworked and worked skeletal material from both humans and animals, bone debitage, human teeth, and small quantities of greenstone, quartz, pyrite, and other stones (roche recinos and matsumoto 2016; roche recinos et  al. 2017). as a result of these excavations, these three patio groups have been confirmed as a marketplace, now referred to as the southeast marketplace, with the supposition that the area covered by operation 15i represents the focal point of marketing activities (fig. 3; golden 2017; golden et al. 2020; pérez robles et  al. 2017; roche recinos 2016; roche recinos and matsumoto 2016; roche recinos et al. 2017; scherer et al. 2017; schnell 2017). the identification of piedras negras’s marketplace builds off of prior observations that classic period maya markets are bounded by long-range structures (similar to s-17 and s-18) and may have a pyramidal structure similar to the small s-11 pyramid, as at buenavista del cayo, calakmul, and chunchucmil (cap 2015a; carrasco vargas et al. 2009; dahlin et al. 2007; doyle 2012; roche recinos 2016:42–45; tokovinine and beliaev 2013). pre-columbian mesoamerican markets are known to have been both places of production and healing (cap 2015b; hirth 2009, 2013, 2016; nichols 2013; shaw 2012). these three patio groups, which produced large quantities of lithic and bone debitage indicative of production, are also bounded by three figure 2. map of the marketplace (inset) and its location within the piedras negras site core (digital map by z. nelson, n. curritt, and t. murtha with additions by j. schnell based on original map by f. parris and t. proskouriakoff). figure 3. excavations within the marketplace during the 2016–2017 field seasons (digital map by z. nelson, n. curritt, and t. murtha with additions by j. schnell based on original map by f. parris and t. proskouriakoff). schnell and scherer 51 sweatbaths, used across mesoamerica for birthing and a range of curing activities. the distinctive stratigraphy of the patio floors of the marketplace further distinguishes it from both residential contexts and the civic-ceremonial center of piedras negras. most of the marketplace’s stratigraphy is comprised of a sequence of thin floors laid over the course of the classic period that then give way to a sequence of platforms in the final episodes of construction and occupation (golden 2017:57). missing from the stratigraphic layers of the marketplace excavations is evidence for stucco-finished floors typical of the acropolis of piedras negras and the adjacent ceremonial zone. in contrast, the patio floors of the marketplace vary between packed sediment and sand, suggestive of the regular resurfacing of a heavily trafficked space. the density and distribution of artifacts are interpreted as a mix of debris swept into the floors during relatively frequent resurfacings as well as objects that fell or were dropped during quotidian activities and subsequently trampled into the floor surface. chronology of the marketplace excavations has been derived from a series of radiocarbon dates provided by the university of arizona ams laboratory, combined with analysis of associated ceramic materials, under the direction of mónica urquizú and ana lucia arroyave (urquizú and menéndez 2016; arroyave et al. 2017). both analyses indicate that this area of the site saw initial use and construction during the early classic period with most of the layers dating to either the yaxche (a.d. 620–750) or chacalhaaz phase (a.d. 750–850) of the late classic period (holley 1983; muñoz 2004). no burials have been found within the marketplace despite their ubiquity in other areas of piedras negras where a total of 127 burials have been excavated to date (coe 1959; houston et al. 2003; schnell and scherer 2017; schnell et al. 2017). the lack of burials not only highlights the unlikelihood that this area served a domestic function but also indicates that the teeth were not eroded or exhumed from nearby mortuary deposits, as has been suggested for miscellaneous human remains found at other sites, such as tikal, guatemala (weiss-krejci 2011). classic period mortuary practices at piedras negras generally consisted of the placement of extended supine bodies in primary interments below household or plaza floors. residences elsewhere in the site are so crowded with subfloor burials that some were dug through earlier ones (scherer 2015a:102). isolated elements of human bone were found in the marketplace excavations, including a partial cranial vault, an os coxa, a distal humerus, numerous long bone fragments, and a smaller number of cranial fragments (jackson and hruby 2001:29; schnell et al. 2017). many of these elements bear cutmarks related to the manufacture of bone tools and other objects. from the pppny excavations, bone that could be securely identified as human (including teeth) represents a small portion (n = 290; 6.1%) of a much larger assemblage of bone recovered from the marketplace (n = 4,741). additionally, 1,429 (30.14%) elements could be securely identified as animal, leaving a sizable number as potentially human or animal (n = 3,022; 63.74%). of the unidentified elements, 19.6% (n = 593) were worked, which hindered taxa identification. the worked bone included both production debris and finished products consistent with sites of bone working found elsewhere in the maya area, such as the group l4-3 workshop at dos pilas, identified by kitty emery (2008, 2009, 2010). notably, no children’s bones were found in the southeast marketplace assemblage despite subadults representing roughly one-third of the remains recovered in the mortuary sample at the site (scherer 2015a:41). the dental assemblage among the human remains and other objects recovered from the marketplace of piedras negras were 127 isolated teeth, many of which were fractured and pathological (fig. 4). in no instance were the teeth found clustered together nor were they found within a ceramic vessel. there is little evidence to suggest they were part of a ritual deposit and, in fact, no example of a tooth cache or finger bowl as described earlier in this paper has ever been found at piedras negras. rather, these teeth (and teeth fragments) appear to have been treated similar to the other materials recovered in the marketplace excavations and likely represent debris that was either lost accidentally or intentionally discarded. of the 127 total figure 4. selected teeth and tooth fragments demonstrating the pathological, fragmentary nature of the marketplace assemblage (photo by j. schnell). evidence for tooth extractions at piedras negras, guatemala 52 dental elements, 9.5% (n = 12) were deciduous and 28% (n = 35) were very small enamel or root fragments that could not be further identified and were excluded from this study. only two teeth, both molars, were definitively associated with early classic (a.d. 350–600) strata and were also excluded due to the small sample size from this period. the rest of the identified teeth (n = 78) were recovered from late classic strata and comprise the marketplace sample for this study (table 1). it was not possible to identify discrete individuals in the marketplace assemblage, and thus we could only estimate a minimum number of individuals (mni) based on the most frequently encountered tooth, in this case the right third maxillary premolar (mni = 6). however, if we assume that the dental remains do not represent complete dentitions and that each individual may be represented by only one or a few teeth, the actual number of individuals represented by the dental assemblage is likely much higher. outside of the marketplace, isolated teeth are rare in the piedras negras archaeological record. in the combined 7 years of work by the papn and pppny, only 15 human teeth have been found scattered across 73 operations (not including burials or the marketplace). this is in stark contrast to the 127 human teeth produced in the marketplace alone. observing the unlikelihood that such a large number of teeth in a part of the site void of burials was a product of postdepositional taphonomic processes, we hypothesized that the teeth entered the archaeological record following extractions for palliative care based on the fragmentary and pathological nature of the sample. to test this hypothesis, we completed a series of basic statistical comparisons between the marketplace sample and an aggregated mortuary population. this mortuary population is comprised of all individuals excavated from the burials at piedras negras, previously studied by scherer (houston et  al. 2003; scherer et  al. 1999, 2001; scherer et  al. 2007). since we excluded the two early classic marketplace teeth from the study due to low sample size, all comparisons are made to only the late classic period mortuary sample. we also limited the mortuary population to permanent teeth, as the subsample of deciduous teeth (n = 12) from the marketplace was too small for statistical comparisons. because discrete individuals could not be identified in the marketplace assemblage, we treated the late classic mortuary population as an aggregate collection of teeth, to facilitate comparison. the piedras negras mortuary sample, then, consists of 853 permanent teeth dating to the late classic period. the late classic marketplace sample, on the other hand, consists of 78 permanent teeth and tooth fragments. methods each human tooth from the southeast marketplace was inventoried and scored for dental caries, dental wear, enamel hypoplasia, dental modification, damage, and any other notable features (buikstra and ubelaker 1994; romero 1951; scott 1979; smith 1984). dental modifications were scored but are not considered in this paper. these are the same methods employed by scherer in his analysis of the teeth from the 127 burials that comprise the piedras negras mortuary population, with some minor differences as noted below. the marketplace teeth were compared to those of the broader piedras negras mortuary population along three lines of analysis: (1) the distribution of teeth by type in each sample, (2) pathologies, including caries and calculus, and (3) dental wear. each tooth from the marketplace was scored twice, once by schnell and a second time by scherer. discrepancies between the two scores favored scherer’s interpretation in order to maintain compatibility with his earlier analyses. additionally, the marketplace teeth were examined carefully for damage and fractures. raw counts of tooth types (incisors, canines, premolars, molars) were tabulated for both the marketplace and the piedras negras mortuary samples and used to calculate relative proportions for molars, premolars, canines, and incisors. if the teeth entered the archaeological record randomly, whether taken from graves elsewhere in the site or perhaps from skulls that were worked, carried, or retained at the marketplace, the relative proportion of tooth type (incisor, canine, premolar, molar) should be similar to the proportions of the piedras negras burial assemblage. of course, not all burials will produce teeth in the ratio expected for a typical adult owing to antemortem tooth loss and incomplete recovery by archaeologists. nevertheless, we expect the deviation should be small unless a particular practice targeted the removal of certain teeth across the entire population of piedras negras. moreover, proportions in both should mirror that of a typical adult mouth. third table 1. distribution of teeth in the piedras negras marketplace late classic sample by ceramic phase ceramic phase dates (ce) n yaxche 620–750 20 yaxche-chacalhaaz 620–850 23 chacalhaaz 750–850 35 total 78 schnell and scherer 53 molar agenesis is rare among the maya and so a complete dentition consists of 32 teeth, with eight incisors (25%), four canines (12.5%), eight premolars (25%), and 12 molars (37.5%). if the marketplace dental assemblage was produced from patterned behavior that targeted certain teeth, then we should expect deviations in those anticipated frequencies. for example, as noted earlier, maya tooth caches are significantly comprised of incisors. in regard to pathologies like dental caries and abscesses, the posterior teeth are disproportionately affected, a pattern with significant temporal depth and global scale that still holds true today (cucina et  al. 2011; demirci et  al. 2010; lanfranco and eggers 2012; moore and corbett 1973; whittington 1999). thus, we should expect their overrepresentation in a sample of extracted teeth where the practice was intended to ameliorate pain associated with oral pathology. within the marketplace sample, caries were only recorded when they could be observed as discrete lesions on whole teeth or large fragments of tooth crowns. frequencies of carious versus non-carious teeth were compared between the marketplace and the mortuary sample. dental calculus was scored for both location and severity (buikstra and ubelaker 1994). because of the limits of sample size within the marketplace, dental calculus was compared between the marketplace and the mortuary sample by calculating a general combined average calculus score for all teeth from each sample. dental wear was recorded on all teeth and tooth fragments that had more than half of their occlusal or incisal surfaces present following smith (1984). molar wear was also scored following scott’s (1979) quadrant scoring method. the smith method utilizes an eight-point scale and differentiates scoring guidelines according to tooth type. the scott method records each quadrant of a molar on a 10-point scale, giving each tooth a score ranging between four and 40. wear was compared across the two samples by tooth type (incisors, canines, premolars, molars). with regard to dental wear, the scott (1979) method was not utilized in scherer’s study of the mortuary sample. thus, all comparisons of dental wear focus on scores derived using smith’s (1984) method. all descriptive and univariate statistics were conducted using r statistical software. in the case of damaged teeth from the marketplace, fractures were qualitatively described to distinguish between antemortem, perimortem, and postmortem trauma on the basis of location and quality of the defect. unfortunately, anthropological research on tooth fractures (as opposed to bone fractures) is quite limited in terms of distinguishing between antemortem trauma, perimortem fractures, and postmortem damage. here, we use perimortem to refer to the death of the tooth, whether caused by the death of the person or from its extraction from a living person. by postmortem we mean damage to the tooth long after death, whether caused by taphonomic processes in the archaeological record, excavation, or damage in subsequent handling by researchers (hughes and white 2009; viciano et al. 2012). antemortem fractures are readily distinguished from perimortem fractures or postmortem damage in that the margins of fractures will become rounded and blunted due to continued occlusion (milner and larsen 1991; scott and winn 2011). perimortem tooth fractures are difficult to distinguish from postmortem damage because both are characterized by sharp, angular margins. however, right angles are common in postmortem damage as are fractures that traverse the dentinoenamel junction (dej) (fig. 5a). in vivo, the dej acts as a stabilizing biomechanical structure and plays an important role in arresting crack propagation before it reaches the dentin. without this important structure, postmortem cracks require much less force to bridge enamel and dentin (dong and ruse 2003). when postmortem damage does involve separation of enamel from the dentin, as during excavation or handling of the teeth in the laboratory, a color contrast may result on the newly exposed surfaces (fig. 5b; milner and larsen 1991; scott and winn 2011:724). results the marketplace sample included 78 permanent teeth that could be identified by tooth type (table 2). the figure 5. teeth demonstrating postmortem damage from the brown university osteology teaching laboratory collection: (a) fracture of buccal crown of a mandibular premolar showing a right-angle fracture that bisects the enamel and dentin and exposes the pulp chamber; (b) enamel fragmentation from the buccal aspect of a mandibular molar exposing the underlying dentin (arrow; photos by j. schnell). evidence for tooth extractions at piedras negras, guatemala 54 posterior teeth (77%; premolars and molars) notably outnumber the anterior teeth (23%; incisors, canines, and two supernumerary teeth), deviating from what we would expect if the distribution followed that of a typical maya adult (37.5% anterior; 62.5% posterior). in contrast, the piedras negras mortuary sample more closely matches the expected ratio: 42.1% anterior, 57.9% posterior. the distinctions are even more stark when individual tooth classes are considered. only 10% of the marketplace teeth were identified as incisors, versus 25.6% in the mortuary sample, the latter closely mirroring the expected 25% of incisors in a typical complete adult dentition. premolars are the most overrepresented tooth in the marketplace sample, comprising 37% of the sample, as compared to their 27.8% representation in the mortuary population. again, that latter figure more closely mirrors the 25% we would expect based on premolar distribution in a complete dentition. molar teeth are also more represented in the marketplace sample (40%) than in the mortuary sample (30.1%). the fact that the relative frequency of molars in the mortuary population is below what is expected for a normal dentition points to posterior tooth loss in the piedras negras population, some of which may have been due to extractions. it is noteworthy that premolars are not underrepresented in the mortuary sample as molars are, but it is difficult to point to a specific etiology that may explain this pattern. tooth loss can result from a number of different causes, of which extraction is just one. it may simply be that, all factors considered, molars were more susceptible to tooth loss than premolars in the piedras negras population. overall, though, the distribution of tooth type within the marketplace not only highlights that it is an atypical sample but accords with expectations that premolars and molars should be overrepresented in a sample of tooth extractions aimed at alleviating oral pathologies that disproportionately affect the posterior teeth. the second line of analysis used to evaluate evidence for dental extraction is the pattern of pathologies present in the marketplace sample relative to piedras negras’s mortuary sample. since we eliminated small tooth fragments from the pathological analysis, we were able to score only 53% of the marketplace sample (n = 41) for caries. the calculated caries rate for the marketplace was 59% (n = 24). in contrast, of the 832 teeth (97.5% of total) in the late classic period piedras negras mortuary population sample that were scored for caries, 17.2% (n = 143) demonstrated caries. the marketplace dental sample demonstrated a caries rate more than three times that of the piedras negras burial sample (table  3), a difference that is statistically significant based on chi-square analysis χ2 = 40.6, df = 1, p < .001). nevertheless, the number of carious teeth is likely underestimated within the marketplace since small tooth fragments were not counted despite the fact that some of the fragments from the marketplace are clearly carious (fig. 6). dental calculus was compared between the total marketplace sample and that of a combined sample of teeth from the mortuary population. the combined average calculus score for the marketplace (μ = 0.9) was slightly lower than that of the broader mortuary population (μ = 1.09), but a t-test indicates that this is not a statistically significant difference (t = 1.4, df = 31.58, p = 0.18). table 2. distribution of teeth by type in the late classic period marketplace and the late classic period piedras negras mortuary population as compared to the distribution of teeth within a “typical” late classic period maya adult individual tooth marketplace n (%) piedras negras mortuary population n (%) distribution of teeth in a “typical” adult n (%) incisor 8 (10) 218 (25.6) 8 (25) canine 8 (10) 141 (16.5) 4 (12.5) premolar 29 (37) 237 (27.8) 8 (25) molar 31 (40) 257 (30.1) 12 (37.5) supernumerary 2 (3) 0 (0) 0 (0) total 78 (100) 853 (100) 32 (100) table 3. overall late classic period caries rates of the marketplace assemblage versus the adult mortuary population of piedras negras marketplace n (%) piedras negras mortuary population n (%) total teeth 41 (100) 832 (100) total carious teeth 24 (59) 143 (17.2) total non-carious teeth 17 (41) 689 (82.8) schnell and scherer 55 comparison of the incidence of dental wear focused on the posterior teeth due to the low number of incisors and canines in the marketplace sample that could be scored for wear (n = 1 and n = 4, respectively). of the 29 identified premolars and premolar fragments, 35% (n = 10) could be scored for wear and of the 31 molars, 39% (n = 12) could be scored. in the late classic piedras negras mortuary population, 95.8% (n = 227) of the 237 premolars had been scored for wear, as had 97.3% (n = 250) of the 257 available molars (table  4). the mean premolar wear score for the southeast marketplace sample (μ = 2.0) is roughly equivalent to that of the mortuary sample (μ = 2.044) and a twosided t-test shows the difference is not statistically significant (t = 0.1, df = 9.43, p = 0.93). on the other hand, the mean wear score of the molars in the southeast marketplace sample was lower (μ = 1.58) than that of the mortuary sample (μ = 2.50). a twosided test on the molar values did indicate a statistically significant difference (t = 4.4, df = 14.63, p < .001). the molar wear analyses do support our hypothesis that the marketplace teeth would exhibit less wear than those in the mortuary sample. however, dental wear is multifaceted and although a younger age-at-death profile is a plausible explanation for the discrepancy in mean molar wear between the two samples, we cannot rule out other explanatory factors such as occupational differences and dietary differences. we suggest, though, in light of our other findings, that being extractions, these teeth were in use (and thus subject to attrition) for a shorter period of time than those teeth that followed their owners into the grave. of the 78 teeth in the marketplace sample, 77% (n = 60) are fractured (e.g., missing part of a crown or root) or are themselves fragments of a root or crown. only one of the fractured teeth is consistent with a traumatic blow to the mouth of a living person. however, this tooth is afflicted by extensive caries, which presumably facilitated its fracturing. overall, the fracture patterns observed in the teeth from the marketplace at piedras negras are consistent with either (1) damage from extraction or (2) fragmentation of dental crowns already partially destroyed by dental caries. in one example, a right maxillary molar (pn-15i-1-4) exhibits a perimortem fracture and appears to have fractured due to a twisting motion (fig. 7a). the same tooth also shows apical root resorption that is consistent with root behavior at the site of a pulpal infection (fig. 7a; fuss et  al. 2003:176). observations of modern exodontia indicate that rotation is one of the most common forces applied (ahel et al. 2015:984). this combined presence of root resorption and fracture by axial rotation is consistent with extraction in response to oral pathology. in quite a few other cases, enamel chipping and even crown fractures were observed on or near the cementoenamel junction (cej), particularly on the labial or buccal aspects of teeth (fig. 7b). none of this chipping is consistent with antemortem damage where subsequent use of the tooth would polish the fractured edges. while postmortem damage may also cause separation of the enamel, the focus on the cej and the small figure 6. small dental fragments from the marketplace sample exhibiting carious destruction: (a) unknown crown fragment with destruction of the dentin within the pulp chamber (pn-15h-1-3), (b) maxillary premolar fragment with destruction of the dentin within the pulp chamber (pn-15i-11-8), and (c) left mandibular canine with caries on the distal aspect of the enamel (pn-15i-1-9; photos by a. scherer). evidence for tooth extractions at piedras negras, guatemala 56 surface area affected is more suggestive of damage caused during extraction (compare the slight chipping in fig. 7b with exfoliation of the enamel of the buccal surface of the tooth in fig. 5b). table 4. late classic period premolars and molars distributed by smith dental wear score for the marketplace and piedras negras adult mortuary population with percentages by column marketplace piedras negras mortuary population smith score premolars n (%) molars n (%) premolars n (%) molars n (%) 1 4 (40) 6 (50) 60 (26) 41 (16) 2 4 (40) 5 (42) 112 (49) 109 (44) 3 0 1 (8) 40 (18) 62 (25) 4 2 (20) 0 15 (7) 19 (8) 5 0 0 0 13 (5) 6 0 0 0 3 (1) 7 0 0 0 3 (1) 8 0 0 0 0 total 10 (100) 12 (100) 227 (100) 250 (100) figure 7. fractured teeth from the marketplace sample: (a) right maxillary molar exhibiting external apical root resorption and fractured roots (pn-15i-1-4); (b) left mandibular canine with labial enamel chipping at the cementoenamel junction (pn-15i-1-21; photos by a. scherer). figure 8. prepared jade tooth inlay (pn-15i-1-4; photo by a. roche recinos). figure 9 micro-quartz fragments including a prismatic fragment that may have served as a drill bit (white circle) from piedras negras’s marketplace (pn-15i-1-4; photo by a. roche recinos). schnell and scherer 57 discussion the combination of an atypical distribution of teeth and pathology in the marketplace sample relative to the mortuary sample, coupled with the evidence for fracturing within the marketplace sample, supports our hypothesis that this anomalous assemblage of isolated teeth might be explained by therapeutic tooth extractions. while one could argue that the elevated frequency of caries in the marketplace sample indicates these teeth were drawn from a more caries-prone population than that of their contemporaries in the greater mortuary sample, the more parsimonious explanation is that the higher prevalence of dental caries reflects the extraction of pathological teeth from living individuals. it is also probable that teeth were extracted as a result of abscesses and other infections of both teeth and the associated alveolar region, including nonspecific disorders, such as nonodontogenic tooth pain (mattscheck et  al. 2016) or persistent dentoalveolar pain (nixdorf and moana-filho 2011). without the aid of radiography, the source of oral pain is often difficult to isolate and tooth extraction—even when not needed—provides one of the few options available to alleviate suffering. interpretation of the calculus data is less straightforward, in part because the presence of calculus reflects a broader range of factors, including diet, hygiene, and other individual differences (hanihara et al. 1994; kinaston et al. 2019; lieverse 1999; white 1997). calculus, like all dental pathologies, is also age related—the longer a person lives, the more time is available for calculus to build up. the slightly lower levels of calculus in the marketplace sample may reflect loss of calculus postmortem, with the teeth not protected in a sealed mortuary context. calculus may also have been lost when teeth were extracted. finally, the lower incidence of calculus may be due to the fact that as dental extractions, the teeth have a potentially younger age-at-death profile than the mortuary sample, assuming that at least some of the individuals who had their teeth extracted at the marketplace then went on to continue to live and eventually die at piedras negras. ultimately, it is impossible to explain why the incidence of calculus is lower in the marketplace sample, though a number of potential explanations accord with the hypothesis that these teeth represent the remains of tooth extractions. ancient maya dentistry earlier work on maya dentistry has focused almost exclusively on cosmetic dental modifications at the expense of other dental interventions. much of the earliest work involved classification efforts and the creation of typologies describing the breadth of modifications present in mesoamerica (rubín de la borbolla 1940; dembo and imbelloni 1938; engerrand 1917; hamy 1882; romero 1951, 1970; stewart 1941). since the mid-twentieth century, focus has shifted toward understanding the social significance of these modifications and the technical aspects of their preparation (fastlicht 1951, 1976; fastlicht and romero 1951; gwinnet and gorelick 1979; havill et al. 1997; ramírez-salomón 2016; ramírez-salomón et  al. 2003; tiesler 2001; tiesler et  al. 1999; tiesler et  al. 2002; tiesler et  al. 2017). even archaeological studies that position dentistry as an occupation have historically focused exclusively on cosmetic modification procedures (becker 1973:400–401; romero 1958). only very recently have scholars begun to pay attention to oral care practices (cucina and tiesler 2011; tiesler et al. 2017), despite acknowledgment of these practices in the literature for quite some time. in 1971, samuel fastlicht wrote that maya dentistry “had two aspects; one referred to the diseases of the mouth and their treatments, the other to dental mutilations involving filing and incrustations” (fastlicht 1971:36; authors’ translation from spanish original). at piedras negras, there is circumstantial evidence to indicate that both therapeutic interventions, such as tooth extractions, and cosmetic modifications, such as inlaying, were conducted in the marketplace. at least one finished, prepared jade dental inlay was encountered during excavations in a stratigraphic deposit within which a number of teeth were also found (fig. 8). while it is impossible to know whether inlays were kept on hand or commissioned as bespoke productions, it is probable that the actual drilling of the enamel openings into which the inlays were set did take place in the marketplace. fastlicht was the first to draw a connection between jewelry making and lapidary drilling and drilling dental inlay cavities. he suggested that holes were drilled into the enamel with a tube of hard stone, such as quartz, aided by abrasives, such as sand (fastlicht and romero 1951:70–71). similar methods are proposed for the drilling and polishing of jade by maya lapidarists (kidder et al. 1946; kovacevich 2007, 2011). a number of prismatic quartz pieces and chert drill bits (fig. 9) were found during the marketplace excavations that could have been used to drill both teeth and precious stones (roche recinos, personal communication, 2020). while ethnohistoric sources shed light on precolonial therapeutic dental interventions, the subject has not been a central focus for scholars interested in indigenous medicine in mesoamerica (andrews heath evidence for tooth extractions at piedras negras, guatemala 58 de zapata 1979; bricker and miram 2002; gates 2000; gubler and bolles 2000; hernández 1959; roys 1965, 1976; sahagún 2012). much of what we know comes from early colonial-era documents, such as sahagún’s florentine codex, an expansive chronicle of mexica life at the time of the conquest. in addition to providing instructions for cleaning and extracting teeth, the florentine codex also presents 27 images of patients and doctors, one of which shows an individual suffering from toothache alongside a glyph representing teeth affixed with the sign for water (fig. 10). the central mexican badianus manuscript, as well as several maya texts such as the chilam balam books and the libro del judío, describe a number of remedies for cleaning the teeth, dealing with dental pain, and even extracting teeth. additionally, alonso de molina’s (1571) nahuatl dictionary defines a number of terms related to dental specialists, oral diseases, and dental anatomy that suggests a robust, complex dental tradition in mesoamerica. our identification of isolated teeth with fractured roots aligns well with a hypothesis posed by fastlicht who, speaking of mesoamerican sites, observed that “[it is] with great curiosity we hope to find fractured roots, since one would imagine primitive dentists would have left roots in the alveolus during unpleasant extractions, as is encountered in modern ones” (fastlicht 1947:12; authors’ translation from spanish original). the fracturing of roots remains a problem in contemporary clinical extractions. for example, a recent report suggests that anywhere from 15% to 37% of edentulous dental patients have at least one retained root fragment (nayyar et  al. 2015:table  1). this was clearly a problem for maya extractions as well as evident in a recently reported case of an embedded root fragment in a mandible at xcambó, yucatán (cucina and tiesler 2011). similar instances may be overlooked in other maya skeletal samples since radiography is often necessary to identify retained rood tips. while the maxillae and mandibles of the piedras negras mortuary sample have not been subject to radiography, 81 cases of antemortem tooth loss were observed out of a total sample of 301 observable alveolar canals, providing at least circumstantial evidence for tooth extraction at the site. even more dramatic are two edentulous mandibles, one of which belongs to the occupant of an early classic period royal tomb (fig. 11). contemporary clinical data indicate that anywhere from 9% to 20% of simple extractions result in fracture to the tooth (baniwal et al. 2007; macgregor 1969; venkateshwar et al. 2011), making it the “most common intraoperative complication during tooth extraction” (ahel et al. 2015:984). the risk of complication is due to a variety of factors, including the skill and expertise of the practitioner, the technique and instrument used, and the integrity of both the tooth and surrounding alveolar bone. clinical studies show that during in vivo tooth interventions (e.g., caries drilling or extraction) teeth are more likely to fracture if the structural integrity of the enamel or dentin has already been weakened by caries or some other pathology and fracture lines may run along those points of weakness (kishen 2015). in contrast, teeth that are fractured in vivo as a result of violent injury (e.g., a heavy blow to the mouth) tend to result in root fractures, or fracturing along horizontal planes, usually at the alveolar margin, typically involving complete separation of the crown from the roots (fig. 12; andreasen et al. 2018:377; lukacs 2007:150). only one such case was observed in the marketplace sample, figure 10. folio 160 from book 10 of the florentine codex, depicting an individual suffering from a toothache; the symbol at left is a nahuatl glyph that includes a water sign and may somehow relate to toothache (drawing by j. schnell after the original, sahagún 2012). figure 11. superior view of an edentulous mandible from piedras negras burial 110, an old adult probable male, from an early classic royal tomb (photo by a. scherer). schnell and scherer 59 with fractures to individual root radicals more common, as described in the results. while studies concerning antemortem and perimortem dental fractures and trauma in archaeological populations are scant (alvrus 1997; gibbon and grimoud 2014; lukacs 2007; lukacs and hemphill 1990; merbs 1968; viciano et al. 2012), clinical literature in modern populations suggests that dental fractures primarily affect the anterior dentition (bastone et al. 2000; brunner et al. 2009). severe fractures such as crown-root fractures that involve the enamel, dentin, and cementum are quite rare (andreasen et  al. 2018:355). in the posterior teeth, these fractures are typically caused by indirect trauma (usually the result of the lower jaw coming into forceful contact with the upper through a fall or collision; andreasen et  al. 2018:274). further, these fractures are almost always “uncomplicated,” that is, they do not involve the pulp (andreasen et al. 2018:355). in the marketplace sample, however, complicated crown-root fractures of the posterior teeth are quite common, many of which display fracture planes indicative of the forces typically involved in exodontia. a left mandibular third molar from pn-15g-25-2 exhibits this pattern, with half of the root complex fractured from the tooth, as well as a significant portion of the coronal dentin and surrounding enamel, exposing the pulp chamber (fig. 13a). this particular tooth also exhibits a large cervical caries on the aspect of the tooth opposite the fracture. although traumatic fractures of the posterior teeth are exceptionally rare (bastone et  al. 2000:6), fractures affecting these teeth, especially the molars, are common during extraction (macgregor 1969:table iii). here, the presence of a large caries as well as the tooth’s position in the dental arcade relative to the fracture planes both point toward a therapeutic extraction. some of the enamel chipping around the cej observed in the marketplace sample (fig. 7b) may be explained by extraction methods. for example, if a gripping instrument or percussive force was used, damage to the enamel and/ or fractures to the tooth at the gum line would be expected. in other cases, such as a buccal cusp fragment of a maxillary premolar from pn-15i-12-4, similar fracture patterns to those described in the molar above are directly associated with carious dentin (fig. 13b). moreover, many of the dental fragments recovered within the marketplace exhibit carious dentin (fig. 6) and are thus consistent with the pattern of expected fragmentation during exodontia of crowns weakened by caries. importantly, there were no obvious refits in the assemblage, indicating that crown fragmentation was not due to postmortem taphonomic damage once the teeth had entered the stratigraphy. health care in the marketplace these findings suggest that the marketplace at piedras negras was not only a destination for economic exchange but was also an important center for healing along the usumacinta river. skilled tooth extractors in antiquity were likely sought out by individuals with oral pathologies who were suffering immense pain. it was, however, not a procedure without risk and the process itself could also be a source of pain. as an analogy from contemporary times, figure 12. left mandible from plaza 1, oztoyahualco, teotihuacán, showing horizontal perimortem fracturing of the canine and molars consistent with a traumatic blow (photo by a. scherer). the lateral aspect of the ascending ramus shows extensive cutmarks (not visible in the photo) consistent with defleshing and extraction from a fleshed body. figure 13. complicated dental fractures in the marketplace sample: (a) left third mandibular molar with fractured root and enamel (pn15g-25-2); (b) maxillary premolar buccal cusp (pn-15i-12-4; photos by a. scherer). evidence for tooth extractions at piedras negras, guatemala 60 one k’iche’ woman from guatemala with no fewer than 22 tooth extractions observed: “it hurts and sometimes it bleeds a lot. sometimes the dentista does not have much experience and leaves the root. that really hurts!” (lee 2007:186). we do not know precisely how the ancient maya extracted teeth. in some cases, it may have been done with simple manipulation by hand. in other instances, it may have involved cutting the surrounding gingival tissue or the use of tools made of bone, wood, or stone to leverage the tooth within and ultimately out of the alveolus. tweezers like those found at tikal (moholy-nagy and coe 2008:fig. 209) were perhaps used, though no such implements have been found at piedras negras. ethnographic and ethnohistoric evidence suggests that plants may also have been used to aid in tooth extraction (atran et  al. 2004; balick and arvigo 2015; breedlove and laughlin 2000; hunter and arbona 1995; mendieta and del amo 1981; roys 1976). ongoing paleoethnobotanical analyses in the marketplace have confirmed the presence of a variety of plants with known medicinal uses, including some associated with the management of dental pain (watson et al. 2019). the identification of dental extractions at piedras negras presents one of the few case studies of ancient health care in the americas and emphasizes the close relationship between medicine and markets across much of mesoamerica (kashanipour 2012:132; sahagún 2012). the market has long played a central role in indigenous medical systems in the region, particularly due to its tendency to draw visitors from relatively large catchment areas into a single, often urban setting. early colonial writers noted the presence of apothecaries and physicians in these markets as well (cortés 1962:87–88; sahagún 1961:30, 53). the provision of medical services as an economic exchange is also prevalent in the maya region. in the eighteenth century popol vuh, a quasi–mythical-historical account of creation and the history of the k’iche’ nation, the pair of primordial grandparents describe how they provide for their family by offering a variety of medical services, such as curing the eyes, setting broken bones, and removing worms from teeth (christenson 2003:99). this last service is a metaphor for tooth extractions, as belief in the “tooth worm” as a cause of toothache and dental disease is widespread in the maya region (augusto ávila 1977:26–27; breedlove and laughlin 2000:234, 243; casagrande 2002:77; lee 2007:187; roys 1965:55–57). in recent times in mesoamerica, itinerant healers, including dental specialists, travel to regional markets in order to offer their services on major market days. gordon schendel (1968:51) reports on an indigenous dental practitioner who visited querétaro, a city in central mexico, on market days. he would set up an old kitchen chair in a street behind the market and pull teeth using ancestral medicine. in the guatemalan town of nahualá, patients line up outside of dental offices on market days, many “clutching their cheek, sometimes with a towel draped over the shoulder to catch the blood when they get their turn” (lee 2007:186). at antigua santa catarina ixtahuacán, another town in guatemala, an itinerant dentista comes to town on market days, rents out a small adobe room, and charges just 10 quetzales (~ us$1.30) for dental extractions (lee 2007:188). archaeologically, sweatbaths provide the most salient evidence for loci of ancient maya healing due to their association with midwifery, ritual, and healing as commonly noted by colonial writers (coto 1983:61; durán 1971) and ethnographers (berlin and berlin 1966; cosminsky 1972; katz 1993; maffi 1994; moedano 1977; virkki 1962; wagley 1949; wauchope 1938). ethnohistoric evidence also associates sweatbaths with marketplaces. for example, in the mid-sixteenth century, francisco lópez de gómara noted the presence of a public bath in the marketplace at ocotelulco (1966:120). the traditional maya sweatbath is a vapor bath in which steam is produced through water applied to a bed of heated rocks in a central chamber (groark 2005:786). ancient monumental sweatbaths have a distinct architectural signature, including a firebox in the central chamber. eight sweatbaths have been identified at piedras negras: seven monumental baths and one associated with a rural house group, the largest number in the maya area (child 2006; houston 1996). three of piedras negras’s eight sweatbaths are found at the southeast marketplace (fig. 3): s-2 and s-4 are located along the western edge of the market and s-19 is located on the opposite end of the market, adjacent to the two principal range structures (s-17 and s-18). these three sweatbaths are in the most accessible part of the site and were the ones presumably available to the general populace as well as visitors to the site, many of whom would have arrived from the south, either by the pathway that enters the site or via canoe at piedras negras’s nearby beach. conclusions in this article, we provide bioarchaeological evidence for tooth extractions conducted at the maya site of piedras negras, guatemala, during the late classic period. we suggest that these extractions were conducted to alleviate pain and other ill consequences associated with dental caries. this research presents one of the few case studies of schnell and scherer 61 ancient health care in the americas and provides a complement to prior scholarship on ancient maya dentistry. similar therapeutic dental extractions were presumably practiced across much of the maya region and may explain some of the loose, isolated teeth found archaeologically. this study also supplements an emerging body of literature concerning indigenous therapeutic dentistry in the americas (goguitchaichvili et al. 2017; ortiz et al. 2016; schwartz et al. 1995; seidel et al. 2005; turner 2004) and ancient dental traditions elsewhere in the world (becker 2014; bennike 1985; bernardini et  al. 2012; coppa et  al. 2006; forrai 2009; oxilia et  al. 2015; oxilia et  al. 2017). we hope that this study broadens the scope of scholarship on ancient maya dentistry, beyond cosmetic modifications. it is clear that the indigenous peoples of mesoamerica, the maya included, had a deep understanding of human anatomy and a complex medical tradition that surprised the spanish upon their arrival and that most certainly existed long before then as well. although we cannot draw a direct historical connection between the piedras negras marketplace assemblage and the dental treatments prescribed in the colonial and ethnomedical literature, this evidence for dental extractions during the classic period does provide significant temporal depth for therapeutic dentistry in the region more generally. acknowledgments the authors would like to thank the entire proyecto paisaje piedras negras–yaxchilan research team and all of its collaborators, as well as the proyecto arqueológico piedras negras, without whom this work would not have been possible. 2016 and 2017 excavations in the marketplace were conducted by charles golden, andrew scherer, shanti morell-hart, alejandra roche recinos, mallory matsumoto, and joshua schnell. we offer a special thanks to our colleagues for all of their efforts. funding for the pppny was generously provided by the national science foundation (bcs-1505483/1505399) as well as the alphawood foundation. funding for this particular research, which was part of schnell’s master’s thesis, was provided by the brown university graduate school, department of anthropology, and center for latin american and caribbean studies, as well as the tinker foundation. we also thank stephen houston and charles golden for comments and suggestions on a previous version of this paper. finally, we would like to thank the four anonymous reviewers for their helpful comments on this work. references cited ahel, v., t. ćabov, s. špalj, b. perić, d. jelušić, and m. dmitrašinović. 2015. forces that fracture teeth during extraction with mandibular premolar and maxillary incisor forceps. british journal of oral and maxillofacial surgery 53(10): 982–987. doi: 10.1016/j.bjoms.2015.08.007. alvrus, a. 1997. trauma to the teeth and jaws: three nubian 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studies 75(2):126–135. doi: 10.4311/2011an0233. login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in 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structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register 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https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe bioarchaeology international bioarchaeology international volume 6, numbers 1–2: 58–76 doi: 10.5744/bi.2020.0028 received 29 december 2020 revised 21 may 2021 accepted 20 june 2021 intersectionality and the interpretation of past pandemics samantha l. yaussya abstract   intersectionality refers to the potential for multiple axes of identity to overlap and interact within a single individual, whose lived experiences are further affected by structural forms of oppression that are perpetuated within their society. intersectionality has been adapted by a variety of social science disciplines exploring the negative effects of multiple marginalization and systemic inequality in living populations, but remarkably few intersectional studies of health or pandemics in the past have been produced in bioarchaeology. bioarchaeologists, specifically, are uniquely positioned to contribute to interdisciplinary discourse by expanding the contextual and temporal purviews of intersectionality scholarship, which currently focuses primarily on living populations from western, industrialized contexts. the purpose of this review is to encourage and facilitate intersectionality research within bioarchaeology. to accomplish this goal, the article is divided into three sections: the first section provides a general overview of intersectionality, the second section discusses examples of intersectional scholarship from related disciplines that address health disparities and modern pandemics, and the third section considers the ways in which bioarchaeologists might integrate intersectionality in our empirical research on health and disease in the past. given the potentially daunting task of using bioarchaeological data to investigate intersectionality and health in the past, the third section also highlights three quantitative methodologies that intersectionality scholars have used to investigate the independent, additive effects of individual social identities as well as the multiplicative effects of those same identities as they operate in conjunction with each other to produce patterns of health outcomes in living populations. keywords: bioarchaeology; paleoepidemiology; quantitative methods la interseccionalidad se refiere a los múltiples ejes posibles de la identidad que se intercalan e interactúan en el individuo, cuya experiencia vivida es afectada por las formas estructuradas de opresión que se perpetúan en su sociedad. la interseccionalidad ha sido adoptada por distintas disciplinas en las ciencias sociales para explorar los varios efectos negativos de las marginaciones y desigualdades sistémicas en la población existente, sin embargo, hay pocos estudios publicados enfocados en la salud o las pandemias del pasado dentro del campo de la bioarqueología. los bioarqueólogos, en particular, se encuentran en una posición única para contribuir a la conversación interdisciplinaria, expandiendo el alcance contextual y temporal del estudio de la interseccionalidad, que en la actualidad se concentra principalmente en poblaciones vivientes en contextos occidentales industrializados. el propósito de esta reseña es motivar y facilitar el estudio de la interseccionalidad en la bioarqueología. para cumplir este objetivo, este artículo cuenta con tres partes: la primera sección proporciona un resumen general de la interseccionalidad; la segunda sección utiliza ejemplos de interseccionalidad de estudios en disciplinas adyacentes que explican las desigualdades de salubridad en las pandemias modernas; y la tercera sección considera las diferentes maneras en que los bioarqueólogos podrían integrar la teoría de interseccionalidad en los trabajos de investigación empíricos sobre la salud y enfermedad en el pasado. dada la abrumadora tarea de utilizar los datos bioarqueológicos para investigar la interseccionalidad y la salud en el pasado, esta sección también resalta tres metodologías cuantitativas utilizadas por los investigadores interseccionalistas para estudiar los efectos independientes y acumulativos de las identidades sociales del individuo y los efectos proliferantes de esas mismas identidades que operan en conjunción para producir los patrones de estado de salud en la población existente. keywords: bioarqueología; paleoepidemiología; metodologías cuantitativas intersectionality—a concept developed to address the multiple, interacting identities that exist within a single individual and the systems of power and inequality that influence those identities—developed within black feminist scholarship and has since been adapted by a variety of scholarly disciplines. within the past two decades, the disciplines of sociology, public health, and epidemiology have incorporated intersectionality into their frameworks and methodologies to investigate how multiple social categories intersect and interact with structural factors and processes to produce disparities in health within and between human populations. in contrast, anthropological studies of health—particularly bioarchaeological studies of health in the past—have only recently begun explicitly referencing intersectionality and exploring how it can be leveraged to better understand the experiences and health outcomes of people in a variety of cultural contexts. the purpose of this review is to contribute to future paleopathological and paleoepidemiological research by presenting a basic overview of the aims and concerns of intersectionality, its use in the social sciences by researchers studying health disparities in modern populations, and its potential as a theoretical framework or methodological approach in bioarchaeological studies of pandemics in the past. consequently, this article is divided into three broad sections corresponding to those goals. the first section addresses the origins and development of intersectionality within black feminist scholarship and activism, as well as how the concept of intersectionality has been critiqued and revised within the social sciences. the second section examines examples of intersectional research produced in social science disciplines adjacent to bioarchaeology, including sociology, public health, and epidemiology. particularly, the second section aims to provide models of how other scholars have incorporated the concept of intersectionality into their research frameworks to better understand the production and maintenance of health disparities in modern populations. finally, the third section addresses the potential for bioarchaeological studies to contribute to the growing body of literature addressing questions about intersectionality, identity, structural inequality, and the generation and perpetuation of health disparities across time, space, and cultural contexts. to that end, the third section also introduces analytical methodologies employed in quantitative studies of health produced by other social science disciplines, and it considers the applicability of those quantitative methodologies to the bioarchaeological study of health disparities and pandemics in the past. the origins and development of intersectionality the term intersectionality references the critical insight that categories of social difference and identity (such as race, class, and gender) operate not as mutually exclusive entities but as reciprocally constructed phenomena that interact with forms of systemic oppression (such as racism, classism, and sexism) (collins 2015). as a result, individuals simultaneously experience multiple overlapping identities and social statuses that contribute to their lived experiences. this acknowledgment of social categories as mutually constitutive and interdependent contrasts sharply with conventional studies of social inequality and marginalization that treat categories of social difference and identity as unidimensional, mutually exclusive, and independent of overarching power structures (bowleg 2012; cole 2009). legal scholar and critical race theorist kimberlé crenshaw (1989, 1991) is credited with coining the term intersectionality to describe the lived experiences of black women who disproportionately bear the negative effects of their individual identities and the macro-level processes of racism, sexism, and classism relative to other social groups. particularly, crenshaw examined how antidiscrimination law, feminist theory, and antiracist politics have disregarded the distinctive experiences of women of color, thereby further marginalizing them in settings traditionally understood to be liberating and progressive. in court cases involving discrimination on the basis of race, the focus is on sexor class-privileged black people (i.e., wealthy black men). likewise, in sex discrimination cases, discrimination is viewed in terms of raceand class-privileged women (i.e., wealthy white women). as a result, disadvantage is conceptualized as occurring along a single categorical axis, limiting the investigation of race and sex discrimination to otherwise privileged members of the relevant group. similarly, feminist and antiracist discourses fixate on the experiences of white women and black men, respectively, and fail to consider the unique subjugation faced by women of color (crenshaw 1989). although crenshaw’s use of the term was new, the concept of multiple, intersecting axes of inequality was articulated decades earlier by black scholar-activists. crenshaw herself cites sojourner truth as an early proponent of intersectionality in her 1851 speech “ain’t i a woman?” which exposed the contradiction between stereotypical images of “womanhood” and the experiences of black women. in the late twentieth century, the combahee river collective, a black feminist lesbian group, would echo truth’s frustrations about feminist assessments of subordination and discrimination that ignored the interrelated axes of gender, race, class, and sexuality (combahee river collective 1977). throughout the 1980s, latina and african american women in academia (e.g., anzaldúa 1987; davis 1983; hooks 1981; king 1988; lorde 1984) further problematized unilateral conceptions of race, class, gender, and sexuality and contributed an element of activism to intellectual discourse that is prevalent in modern intersectional scholarship (collins 2015). since its development by black feminist scholars and activists, intersectionality has influenced scholarship in a variety of fields and challenged the idea of a single, fixed social hierarchy. whereas previous investigations of social inequality treated identity categories (such as race, class, or gender) as independent and mutually exclusive entities, intersectionality references the critical insight that those categories of social difference and sameness are “reciprocally constructing phenomena that in turn shape complex social inequalities” (collins 2015:2). one area of tension regarding intersectionality is its variable and inconsistent conceptualization in the fields in which it is applied. intersectionality has been conceived of as a perspective, a concept, an idea, a theory, a nodal point for feminist theoretical engagement, a theoretical framework, a heuristic device, a knowledge project, a methodological approach or type of analysis, a research paradigm, an analytical framework, and even a type of data (collins 2015). the confusion and frustration generated by the definitional ambiguity of intersectionality has led some scholars to call for a more clearly defined and universally applicable definition (verloo 2006). still others have argued that intersectionality could be better employed by scholars across disciplinary boundaries if it were accompanied by clear-cut methodological guidelines for its application (mccall 2005). naturally, these arguments reflect a broad concern on the part of scholars who are interested in intersectionality but are unsure how to productively apply it in their own research. however, other scholars contend that the value of intersectionality lies not in its narrow conceptualization or clearly outlined strategies for operationalization but in its breadth, its lack of precision, and its lack of analytical or theoretical specifications (collins 2015). in this view, intersectionality’s worth as a theory or framework is the fact that it “initiates a process of discovery” and “stimulates our creativity in looking for new and often unorthodox ways of doing feminist analysis” (davis 2009:79). despite being criticized for lacking clearly demarcated analytical strategies or explicitly defined theoretical objectives, intersectionality has been adapted, engaged, and applied in a number of disciplines exploring a great variety of subject areas. the array of identity categories and axes of inequality examined by intersectionality scholars include race, gender, class, educational attainment, relationship status, religion, migrant status, parenthood, sexuality, gender identity, nationality, ability status, indigeneity, and disease status, to name a few (springer et al. 2012). in the face of such wide-ranging topical applicability, many scholars are overwhelmed by the methodological complexity of investigating an endless list of potentially significant identity categories and structural inequalities. however, intersectionality explicitly recognizes that the importance of a given identity or systemic force is grounded in the historical and contextual conditions of the population being studied (christensen and jensen 2012; hancock 2007). as a result, which categories are selected and how many categories and intersections are examined are strategic choices made by the investigators. in other words, intersectionality scholars are not obligated to study every category or capture the full extent of the diversity that exists in a given population. instead, researchers—both qualitative and quantitative—should consider which intersections matter the most for the research question being asked and the populations or contexts being studied, then focus on the categories or intersections that will likely be most salient given the focus of the research project. no one project can expose every outcome of every intersection. rather, intersectional scholars seek to creatively design their research in such a way that they explicitly consider how simple additive categories may not fully uncover the consequences of the categories and processes of interest (misra et al. 2020). importantly, the question of which categories should be prioritized by intersectionality research is not solely a methodological concern but a theoretical one as well. given its roots in activism and social justice movements, intersectionality understandably operates as a form of critical praxis aimed at challenging existing dynamics of power, privilege, and oppression (collins 2015; moradi and grzanka 2017). as such, intersectionality research has often prioritized the study of the perspectives and experiences of historically oppressed and multiply marginalized subjects. however, as other scholars have argued, a full engagement of intersectionality necessitates a critical analysis of privilege as well as marginalization, as it is often through structures of power and privilege that hegemonic systems of oppression are maintained (cole 2009; moradi and grzanka 2017). furthermore, studies that investigate the causes and consequences of multiple identities negotiated within a particular cultural and historical context have the opportunity to foreground the positive, resilient, and empowering aspects of heterogenous identities (werbner 2013), as well as consider the ways in which some identities may exist in conflict and thus be differentially expressed or experienced in a given sociocultural context (sengupta 2006). in this view, intersectionality research should endeavor to avoid narrowly fixating on a subset of intersections (i.e., the multiply disadvantaged) or implying that intersectionality only applies to some people, subjects, or intersections at the expense of others, because such a decision could limit the breadth and productivity of intersectional feminist scholarship (bauer 2014; hancock 2007; moradi 2017; moradi and grzanka 2017). intersectional approaches and applications intersectionality has been effectively employed in studies of living populations in a variety of disciplines, including education (bhopal 2020; tefera et al. 2018), psychology (cole 2009; mitchell et al. 2014; purdie-vaughns and eibach 2008), philosophy (walby 2007), political science (hancock 2007), criminology (paik 2017), sociology (di stasio and larsen 2020; watkins-hayes 2014), anthropology (jackson-best 2016; jackson-best and edwards 2018), and medicine (baig et al. 2016; tan et al. 2016). the breadth of research questions and objectives pursued in intersectionality scholarship lends support to its value within the social sciences and encourages other scholars to consider its applicability in their own research projects. the sections below specifically focus on intersectional approaches employed by scholars tackling research questions tangential to those in paleopathology, paleoepidemiology, and bioarchaeology more generally. importantly, the overview of intersectional research presented below is far from comprehensive. rather, it provides a limited set of examples of successful intersectional studies of health in living populations with the goal of elucidating how an intersectional investigation of past pandemics is readily achievable with the data and expertise already leveraged in our field. sociology and anthropology intersectional research in sociology has contributed at least two vantage points from which social science researchers can investigate the relationships among individual identities and systemic forms of advantage and oppression and measure the outcomes of those interactions (choo and ferree 2010; jones et al. 2013; mccall 2005). at the “intracategorical” level of analysis, researchers focus solely on the experiences and perspectives of a single marginalized group within a particular context (mccall 2005). for example, wingfield’s (2009) study of minority men in the culturally feminized field of nursing reveals variation in the experiences of black men nurses. although previous research identified a “glass escalator” effect that disproportionately benefited men in historically gender-segregated occupations like nursing (williams 1995), wingfield (2009) detects a racialization of the “glass escalator” concept that negatively influences the advancement of minority men in their nursing careers. by focusing on a single disadvantaged group within a specific social setting, sociologists employing the “intracategorical” approach are able to highlight the experiences of individuals at a neglected or understudied intersection. this emphasis on a particular social group underscores the heterogeneity that exists within a given group or context and stresses the concurrent constitution of multiple statuses in any intersectional domain. in contrast, an “intercategorical” approach examines the transformations and consequences that occur when multiple statuses or identity categories meet (choo and ferree 2010; mccall 2005). in this approach to intersectionality, the goal is to examine patterns of interactions between two or more social categories, rather than the outcomes produced at a single intersection of interest. for instance, research by pager (2003) suggests that the employment opportunities in entry-level jobs for black men with a felony record differ dramatically from those of white men in similar circumstances. in this case, the identity category of race is capable of exerting its own effect on employment chances while simultaneously producing a separate interaction effect with felony status that can differentially influence employment chances for white and black men. given its focus on the complex relationships that exist within and across social categories—rather than on the outcomes and experiences associated with a particular social group—the intercategorical approach to intersectionality is analytically more complex compared to the intracategorical approach. for example, a study of gender and class necessitates the assumption of distinct gender categories (e.g., men and women) that can then be compared systematically to class categories (e.g., lower, middle, and upper), thus generating six intersectional categories of analysis. a third axis of identity, such as race (e.g., black and white), would further expand the list of categories being analyzed, such that a consideration of the relationships among three axes of identity becomes a comparative study of 12 separate domains. however, as sociological research demonstrates (e.g., mccall 2001), the analytical complexity of the intercategorical approach need not be daunting to anthropologists and other social scientists interested in employing a quantitative intersectional framework. as discussed below, hierarchical models can evaluate both independent associations between two variables and higher-order interactions among three or more variables, allowing investigators to assess the effects of a single social or biological category as well as the more complex, intersectional domains of interest. anthropological methodologies and perspectives emphasize a holistic understanding of human diversity and have a great deal to contribute to intersectional scholarship. particularly, the understandings that inequalities and power structures are “historically contingent and cross-culturally specific” (gkiouleka et al. 2018:93) and that identities and their meanings vary across space and time (bowleg 2012; chan and howard 2018; collins and bilge 2016; giritli nygren and olofsson 2014; iyer et al. 2008) seem to invite anthropological investigation and interpretation. in terms of potential contributions to intersectional studies of health, anthropologists are ideally situated to investigate the historical production and maintenance of structural inequalities, the variable consequences of and responses to marginalization cross-culturally, and the temporal variation in outcomes associated with intersecting social identities. however, despite this opportunity to engage in transdisciplinary conversations about the generation and outcomes of intersectional domains, anthropologists interested in studying health are disproportionately underrepresented in the intersectionality literature. excepting the notable contributions of anthropologists like khiara bridges (2011) and fatimah jackson-best (2016), intersectional research on health and health outcomes—especially research of the quantitative variety—has been largely produced by other social science disciplines and has remained focused on high-income, industrialized populations like the united states and united kingdom. anthropological research could provide key insights regarding the variation that exists (and has existed) in identity categories and the experiences and health outcomes of the marginalized throughout human history and thus contribute to intersectional scholarship by expanding its contextual and temporal purviews. the relative dearth of intersectional research on health within anthropology may be explained by inconsistent use of the term intersectional or intersectionality in the discipline. that is, anthropologists are producing research on health in the past and present that can be considered intersectional and are engaging with intersectionality; they are simply not explicitly using the term. for example, in her pioneering work on “ethnogenetic layering”, jackson (2003, 2004, 2008) describes the importance of recognizing genetic and nongenetic factors that interact in complex ways within populations to produce the variable health and disease outcomes observed in human groups. ethnogenetic layering acknowledges the cultural and historical elements specific to microethnic groups, which may be overlooked by studies of health and disease that focus solely on macroethnic (or racial) groups (jackson 2004). thus, ethnogenetic layering exposes the unique domains that exist within larger, less homogeneous analytical categories, and it exemplifies the implicitly intersectional research questions being pursued by anthropologists studying health in human populations. as in other disciplines grappling with the complexities of theoretical perspectives and frameworks that critically examine the intersecting axes of power that influence patterns of privilege and marginalization, indoctrination in terms of language, methods, or conventions need not be a precondition to produce meaningful intersectional research (cho et al. 2013). however, if anthropologists studying health disparities are interested in engaging intersectionality in their research and contributing to interdisciplinary intersectional discourse, explicit use of the term will be necessary to integrate anthropological studies of health with the work of social scientists from other disciplines. citing the relevant intersectional literature (e.g., crenshaw 1989, 1991) and unambiguously connecting anthropological data to previous intersectionality research will make the nuanced perspectives and findings of anthropological studies accessible for scholars in other disciplines. introducing new iterations of intersectionality, such as intersectional studies of health in non-western, nonindustrialized contexts or intersectional studies of health in past populations, will require anthropologists to enter the discussion in a visible, purposeful manner. however, as has already been recognized by scholars in other fields, the expansion of intersectional analysis across multiple sites, contexts, and time periods is a worthy endeavor that will fruitfully broaden intersectionality’s discursive terrain (patil 2013). alternatively, some anthropologists who might otherwise engage with intersectionality may be mystified by the methodological demands of applying intersectional analyses in quantitative studies. indeed, many scholars associate intersectionality with qualitative research approaches, because ethnographic approaches, interviews, and participatory action research methods appear to be intrinsically aligned with complex and dynamic understandings of socially constructed dimensions of difference (hunting 2014; misra et al. 2020). understandably, potential practitioners of intersectionality may balk at the idea of integrating relational thinking into empirical research studies. in this respect, anthropologists are not alone (collins 2015; mccall 2005), and intersectional scholarship has been criticized for lacking a definitive and diverse methodological approach (nash 2008). however, in response to these methodological critiques and concerns, there has been an outpouring of support from quantitative scholars in a number of disciplines who have employed intersectionality-informed empirical analyses of health outcomes and disparities (e.g., bowleg 2008; covarrubias 2011; dubrow 2008; hancock 2007, 2019; hargrove 2018; jang 2018; merlo 2018; veenstra 2011). further, as spierings (2012:337) notes, “existing (basic) methods and models are already sufficient for tackling many empirical questions,” including intersectional questions. as the “quantitative intersectional methods” section below demonstrates, an empirical, intersectional anthropology of health in the past is achievable with bioarchaeological and paleopathological data and with statistical methodologies already in use in the field. public health and epidemiology in recent years, intersectionality has been adapted by epidemiologists and public health scholars in studies of living people in a number of contexts. these research projects offer examples of research questions and topics of interest that could foster similar research in paleoepidemiology and paleopathology. for example, some of the first publications leveraging intersectionality in studies of health focused on the hiv/aids epidemic, particularly in nations like the united states, canada, and the united kingdom (collins et al. 2008; dworkin 2005; watkins-hayes 2014). a study by doyal (2009) of hiv-positive black african migrants in london underscores the importance of considering intersectional domains or positions, rather than a single axis of inequality (e.g., gender), when conducting health research (especially if it informs policy). for instance, the hiv/aids-related stigmatization and discrimination experienced by gay and bisexual men were primarily linked to societal ideas of sexual deviance, whereas the stigmatization experienced by heterosexual men was predominantly associated with their lack of financial resources, limited employment opportunities, or perceived loss of social power. similar variations in the lived experiences of different intersectional positions were found in the availability and inclusivity of sources of social support (e.g., religion or spirituality) and organized support groups available to heterosexual and gay or bisexual african migrants in the united kingdom (doyal 2009). other studies have emphasized how intersecting axes of social inequality are causing the hiv/aids epidemic to disproportionately affect black men who have sex with other men (millett et al. 2012). for example, in their study on the experiences of young black gay men in california, arnold and colleagues (2014) noted that stigma, homophobia, and racism intersected to influence patterns of sexual risk behavior, willingness to seek out hiv testing or care, treatment adherence, and willingness to disclose hiv status to sexual partners. typical sources of support in black communities facing racism on a societal level—such as the support offered by an individual’s family or church—are often rescinded in the face of homophobia and stigma related to hiv status. these intersecting axes of stigmatization and marginalization alter the experiences, decisions, and health outcomes of young black gay men who are hiv positive relative to their counterparts occupying other intersectional positions, such as white men who do not self-identify as gay (the experiences of transgender people with hiv/aids, black or white, were not explicitly addressed in the above studies). another growing area of research in intersectional studies of health focuses on the intersecting axes of social inequality that are generating disparities in infection risk, disease burden, and outcomes among racial and ethnic minorities, women, and undocumented workers in the covid-19 pandemic (bowleg 2020; laster pirtle 2020). in the united states, structural and institutional racism are increasing risk of covid-19 exposure and reducing protective barriers to exposure among african american, latina, and native american women, increasing infection risk and risks of mortality among these groups (ryan and el ayadi 2020). an intersectional perspective enables social epidemiologists to consider how intersecting identity categories and systemic inequalities are affecting sexual and gender minorities to increase the risks associated with covid-19, including preexisting health conditions (e.g., higher asthma prevalence), economic inequity (e.g., more likely to have experienced loss of income or employment), occupation, and stigmatization (gibb et al. 2020; wenham et al. 2020). a third developing area of research in public health involves investigating the effects of intersecting social and demographic factors on health outcomes associated with tuberculosis. epidemiologists have long realized that tuberculosis transmission, treatment initiation, treatment adherence, and disease outcomes are associated with class, race/ethnicity, age, and sex (de seixas maciel et al. 2018; muture et al. 2011; kigozi et al. 2017; liew et al. 2015; tola et al. 2015), but they have only recently begun investigating the intersections of these factors in living populations. a study of tuberculosis patients in mamelodi, south africa, found that patients were less likely to continue treatment for the disease if they were “physically, socially, and institutionally ‘out of place’” (ilunga et al. 2020:5). specifically, patients were more likely to stop seeking treatment if they were older (i.e., >60 years of age), at risk of poverty (i.e., on the threshold of being “poor”), and had no south african identification documents (i.e., migrants) (ilunga et al. 2020). these factors, when viewed through an intersectional lens, generate a much richer picture of the social and structural factors that influence tuberculosis outcomes. although each factor exerts an independent effect on health outcomes, it is only from an intersectional perspective that the patterns of morbidity and mortality observed by public health scholars can be fully understood. intersectionality-informed research on health inequalities has most frequently investigated the dimensions of race, gender, and sexuality; the intersections of those identities; and how institutions shape individuals’ positioning and experiences, including their health outcomes (gkiouleka et al. 2018). however, newer studies are expanding the identity categories and institutional factors considered pertinent to health outcomes and therefore broadening the set of intersections deemed relevant in studies of health in living populations. for example, following a call for more intersectional studies of immigrant health (viruell-fuentes et al. 2012), freedman (2016) explored the risks of sexual and gender-based violence against refugees attempting to reach destinations in the european union. the findings of the study indicated vulnerabilities specific to women refugees, such as sexual coercion from smugglers in exchange for safe passage, that were not observed among men refugees (freedman 2016). importantly, studies of migrant or immigrant status and health outcomes like sex-based violence are not only accessible to social science researchers exploring these contexts in living populations. using isotopic and ancient dna evidence, bioarchaeological studies are also capable of examining how migrant status intersected with other social categories to influence lived experiences and health outcomes in the past, thus engaging in a dialogue with scholars performing studies on living populations to understand variation in these processes and outcomes in the past and present. for example, data on strontium, oxygen, and lead isotopes have been used to track mobility and identify migrants in roman britain over the past two decades (e.g., chenery et al. 2010; leach et al. 2009; montgomery 2002; müldner et al. 2011; shaw et al. 2016). when thoughtfully combined with sex estimates, assessments of trauma (to access patterns of interpersonal violence or accidental injury), or disease status, bioarchaeological data on mobility and migration could be integrated into an intersectional framework to study complex patterns of health outcomes in the past. bioarchaeology and intersectionality the discipline of bioarchaeology is uniquely positioned to provide temporal depth to intersectionality research on health and disease through the analysis of human skeletal remains and their mortuary contexts. as mentioned above, anthropologists, in general, are capable of providing key insights about cross-cultural and temporal variation in the types and numbers of individual-level categories of social difference, the effects or consequences of various combinations of advantage and disadvantage, and how different aspects of identity may be leveraged in diverse contexts to engender resilience. bioarchaeologists, in particular, can contribute to understandings about the production and maintenance of oppressive forces and processes at the structural level and challenge the narrative of universal identity categories and outcomes through the material evidence and diverse contextual information contained in the bioarchaeological record (geller 2017). by using information that is inaccessible through any means other than the analysis of human skeletal remains, bioarchaeologists can shed light on how historically generated patterns of inequality and systems of oppression can be dismantled to the benefit of living populations. despite having a unique perspective on the existence of multiple, co-occurring identities and the impacts of those intersecting identities on lived experiences and health outcomes in a variety of contexts, few bioarchaeological studies have explicitly engaged with the concept of intersectionality, and to date, none have attempted an intersectional analysis of one or more pandemics in the past. in some cases, substantive application of intersectionality in bioarchaeology has been hindered by the diminutive sample sizes typical of bioarchaeological studies. for example, in her study examining the paleopathological and isotopic evidence for variation in the lived experience of enslavement in antebellum north carolina, dent (2017) recognizes that the interindividual variation in health outcomes identified by her analyses would be further elucidated by intersectional approaches. however, as is true of many bioarchaeological studies, the cemetery population analyzed in dent’s study consisted of fewer than 20 individuals, making intersectional analyses of multiple biosocial categories difficult. although other disciplines grapple with the limitations of small sample sizes when conducting statistical analyses meant to identify interaction terms as measurable products of intersecting variables (scott and siltanen 2017), large sample sizes are particularly rare in bioarchaeological studies. archaeological sites rarely produce sufficiently sized skeletal samples that can be divided into meaningful categories of identity and subsequently scrutinized for patterns. instead, many bioarchaeological studies pool data across sites or temporal periods to assemble a large enough sample to detect patterns and make meaningful interpretations. for instance, geller (2017) acknowledges the value of intersectional analyses and interpretations in bioarchaeological studies but does not apply intersectionality to her own data on classic period (ca. 250 b.c. to 900 a.d.) maya burials given that her samples were drawn from multiple different sites in northwestern belize. although the limitations of bioarchaeological data pose challenges to intersectional studies that undoubtedly require creative solutions in terms of research design and analysis, this constraint should not thwart potential practitioners in our field from employing an intersectional approach to the fullest extent possible. in the past several years, scholars have increasingly recognized intersectionality as a viable approach in bioarchaeological studies of health and identity in the past. in bioarchaeology, intersectionality and other relational approaches promote the examination of pervasive systems of social stratification (such as gender) and the effects these systems of inequality have in terms of access to resources, which ultimately affects patterns of health and disease (zuckerman and crandall 2019). one bioarchaeological study that incorporates intersectionality into its study design is a study by byrnes (2017) of the interactions among various social categories and impairment and disability. byrnes examines a skeletal sample excavated from the site of the erie county poorhouse in buffalo, new york, which includes 207 adult individuals who exhibit osteological evidence of physically impairing injuries. evidence of hard tissue traumas (such as fractures) and some soft tissue traumas (such as dislocations) was used to estimate the degree of impairment of each individual, and the resultant impairment classes (from “none” to “very severe”) were then compared to sex and age at death categories in an analytical framework that is remarkably similar to the intercategorical approach used by sociologists. generally, results indicated that males of low socioeconomic status were more likely to exhibit a greater number and greater severity of traumatic injuries, which is likely related to the hazards posed by the occupations available to the unskilled laborers residing in the poorhouse. by combining evidence gathered from the skeletal data with evidence from documentary sources on the demographics of the inmates of the poorhouse, byrnes (2017) concludes that ethnicity also contributed to the lived experiences and health outcomes endured by the inhabitants of the poorhouse. specifically, the intersection of gender, ethnicity, socioeconomic status, and age likely influenced employment opportunities, access to resources, social mobility, and degree of impairment experienced by the poor in late eighteenthand early nineteenth-century new york. two additional intersectional studies in bioarchaeology were contributed by torres-rouff and knudson (2017) and knudson and colleagues (2020). in their first publication, torres-rouff and knudson (2017) employ an integrated, multiscalar approach to examine the immutable and mutable aspects of social identity in the san pedro de atacama region of northern chile. the data assessed by torres-rouff and knudson include cranial metric and nonmetric traits (to access biological relationships or patterns of genetic relatedness at the population level), radiogenic strontium and stable oxygen isotope data (to infer geographic origins and residential mobility at the individual level), estimates of physiological age and biological sex (to access social age and gender at the individual level), type and degree of cranial vault modification (to infer social identity at the community level), and the composition and context of graves and grave goods (to access interindividual social identity relationships) during the middle horizon to late intermediate period transition. their findings indicate that biological diversity diminished (i.e., genetic homogeneity increased), isotopic diversity decreased (i.e., migration and paleomobility decreased), cranial modification homogenized, and there was a reduction in the range of individual markers of identity in mortuary contexts from the middle horizon to late intermediate period. torres-rouff and knudson note that their analyses allow them to identify broad changes in identity formation and presentation at the community level while also better understanding the complex intersections of identity that occur at the level of the individual. in constructing their analyses to incorporate evidence for identity at multiple scales, torres-rouff and knudson (2017) provide a powerful example of an effective intersectional model—they are able to explore broad, systemic patterns occurring at the regional and community levels while also considering the multiplicity of identities that exist in a single individual and affect their experiences. likewise, the knudson and colleagues (2020) chapter provides examples of how bioarchaeologists might approach the issue of detecting systems of power in past populations using multiple lines of evidence from the archaeological record. for instance, the authors argue that variation in mortuary artifacts, strontium isotope values, and cranial trauma between the solcor plaza and solcor-3 cemeteries reveals how structural-level inequalities manifested in the daily experiences and differential access to trade and exchange networks available to certain groups during the middle horizon (500–1100 a.d.) in san pedro de atacama. third, a study by yaussy (2019) applies intersectionality in her study of health outcomes in four skeletal samples from industrial-era england. yaussy investigates how sex and socioeconomic status affect patterns of frailty (i.e., differential susceptibility to disease and death among members of a population; vaupel et al. 1979) and mortality at the population level. physiological indicators of stress differentially affected individuals occupying different intersectional positions or domains, underscoring the value of analyses that capture interactions among identity categories. for example, in her analyses of cribra orbitalia presence, yaussy found that cribrotic lesions were associated with the intersection of socioeconomic status and sex, such that females of high socioeconomic status, specifically, were protected from the physiological insults responsible for the lesions (e.g., dietary deficiencies and parasitic infections during childhood). yaussy explains that individual-level marginalizations (such as those associated with age, sex, and socioeconomic status) were coupled with systemic inequalities (such as the classist disparities in urban living conditions and sexist patterns of food distribution among low-status families) that compounded to produce patterns of frailty and mortality that may be obscured by traditional approaches. in the cribra orbitalia results, for instance, a conventional approach to the study of patterns of skeletal stress indicators would have recognized the significant association between cribra orbitalia and sex (i.e., cribrotic lesions were more common in male individuals) but would have missed the three-way relationship between cribra orbitalia presence, socioeconomic status, and sex. consequently, the study by yaussy demonstrates the potential for bioarchaeological studies to expose patterns of health and mortality and, perhaps more important, intersectional patterns of marginalization that existed in the past that were overlooked in previous historical and bioarchaeological studies. additionally, given the close relationship between industrial-era england and the concentration of intersectionality studies of living populations in western, industrialized contexts (including the united kingdom), the study by yaussy (2019) also demonstrates the potential for bioarchaeological studies to meaningfully enter into interdisciplinary discussions of intersectionality and health by providing temporal depth and contextual details concerning the initial production and subsequent maintenance of systemic forms of oppression that are studied by social scientists in the present day. finally, a recent publication by mant and colleagues (2021) has illustrated the wealth of biological, histomorphological, and sociocultural information that bioarchaeologists can pull from to examine the health consequences of intersectional identities in the past. the authors identify two case studies that exemplify an intersectional approach, even when the data were not originally collected with the goal of employing the concept of intersectionality in a study of health in the past. in the first case study, individualized historical records and patterns of trauma expose a complex history of addiction and abuse that ultimately produced the health outcomes observed in the examined individual’s skeletal remains, including his many traumatic injuries and his unclaimed status in the robert j. terry skeletal anatomical collection. in the second case study, the sociocultural context surrounding impoverished older women living in nineteenth-century london is considered in conjunction with trauma patterns on the skeleton of a female who was determined to be at least 46 years of age when she died while in the care of the royal london hospital. in both cases, trauma is considered a health outcome produced by the complex interaction of behavioral, biological, and sociocultural factors and processes operating at the individual and structural levels. the authors argue that “bone health and identity are inextricably linked” (mant et al. 2021:590), and their work highlights the opportunities available to bioarchaeologists to perform intracategorical analyses and use multiple lines of evidence to examine how multiple, intersecting identities affected lived experiences and health outcomes in the past. as recognized above, however, not all intersectional studies of health in anthropology (and, more specifically, in bioarchaeology) have explicitly used the term intersectionality. in its simplest form, intersectionality is a recognition of patterns of difference manifested at the individual level; the relationship of those patterns to multiple, coexisting axes of power and inequality; and how that relationship shapes the privilege and marginalization experienced by individuals and groups. as such, intersectionality has been leveraged by bioarchaeologists studying the outcomes of micro-level identities and macro-level inequalities for decades, despite not being explicitly named. for example, torres-rouff (2002) demonstrates the interrelated aspects of sex and ethnic identity in her study of cranial vault modification in the pre-columbian atacama. specifically, torres-rouff argues that evidence from at least two archaeological sites suggests that the cultural practice of female exogamy influenced patterns of cranial modification in the atacama, providing enduring evidence of the ways in which ethnic boundaries were maintained in individuals occupying particular intersectional positions (i.e., foreign women). similarly, research conducted by de la cova (2010, 2011, 2012) examines disparities in skeletal indicators of disease and trauma between specific intersectional domains and connects these patterns of health and disease to structural violence and systemic inequities that were pervasive in nineteenth-century america. for instance, african american males born during the reconstruction era exhibited higher frequencies of tuberculosis and treponematoses compared to their euro-american counterparts, and this pattern is related to race-based discrimination and class-based differences in living conditions experienced by african american individuals who migrated to the north during the reconstruction period (de la cova 2011). other studies, such as the study of developmental stress in skeletal samples from industrial london conducted by hughes-morey (2016), examine the intersections between sex and status in different settings, thus illustrating the context-dependent nature of identities, systemic oppression, and their effects on a variety of outcomes. in her study, hughes-morey argues that structural inequalities generated sex and class disparities in the early life experiences of the inhabitants of industrializing london. particularly, the intersection of male sex and high socioeconomic status enabled wealthy males to survive to adulthood, despite relatively high frailty (evinced by relatively short tibiae and femora). in contrast, the intersection of low socioeconomic status and female sex had negative effects on both long bone length and risks of mortality, indicating the disparity between the health outcomes and lived experiences of multiply privileged and multiply marginalized individuals. it also bears mentioning that the study by hughes-morey (2016) recognizes the potential ramifications of intersecting identities in “middle groups” (i.e., individuals exhibiting combinations of advantaged and disadvantaged identities, such as high-status females or low-status males). the unique health outcomes of “middle groups” relative to multiply marginalized and multiply privileged individuals have been the subject of previous studies of intersectionality and health in living populations (joe 2015; sen and iyer 2012). the focus of such studies is on the complex interaction between axes of advantage and disadvantage and the potential for such groups to leverage different aspects of their identities in different settings in unique ways that are not captured by analyses of multiply marginalized individuals. importantly, these approaches to studying multiply marginalized groups, multiply privileged groups, and “middle groups” can be applied in bioarchaeological studies of pandemics in the past. the analytical methods used and interpretations produced by hughes-morey (2016) could feasibly be applied in a similarly designed study of the intersections of sex and socioeconomic status and their effects on the patterns of mortality associated with any number of pandemics in the past (e.g., tuberculosis, bubonic plague, leprosy). the studies mentioned above, as well as other studies conducted in recent years (e.g., agarwal 2012; gowland 2017; martin et al. 2010), illustrate a general inclination on behalf of bioarchaeologists to incorporate nuanced understandings of the intersections of social identities and forms of systemic oppression into our studies of lived experience, health, and disease in the past. although many of the bioarchaeological studies cited above do not explicitly apply intersectionality theory, their research designs, findings, and interpretations demonstrate a vested interest in better understanding how multiple, intersecting identities—rather than distinct, independently operating identities—affect and are affected by the lived experiences of individuals and groups in the past. as described below, future work in paleopathology and paleoepidemiology might build upon such foundations by explicitly incorporating intersectionality into their research designs and analyses, which will generate novel, otherwise inaccessible insights into the effects of multiple, overlapping identities on patterns of disease in the past. intersectionality and past pandemics previous bioarchaeological studies of past pandemics an examination of previous bioarchaeological studies of past pandemics reveals the outstanding work that has been done thus far in terms of investigating the impact of identity and inequality on health outcomes in the past, but it also illustrates the need for an intersectional perspective to understand unexplored and unexpected patterns of risk and health in the past. one of the best-known pandemics of the past was the black death (c. 1347–1351 a.d.), which killed 30% to 60% of people in europe and prompted widespread economic, political, and demographic change in european populations (dewitte 2016). much of the bioarchaeological work on the black death has relied on skeletal samples from cemeteries known to have accepted plague victims for burial, such as the east smithfield cemetery in london (e.g., dewitte 2010a, 2010b, 2012; godde et al. 2020; grainger et al. 2008). as the studies of east smithfield illustrate, bioarchaeological studies of epidemic and pandemic burials have the potential to reveal the social responses to pandemic mortality, which could clarify not only how people responded to elevated mortality levels in the past (castex 2008) but also how pandemics in the past exacerbated patterns of marginalization and inequality to disproportionately increase risk among the individuals at particular intersectional domains. for instance, previous bioarchaeological research on black death victims from london shows that older adults and people of all ages who were already in poor health before the epidemic were more likely to die than their younger or healthier peers (dewitte and wood 2008; godde et al. 2020). a bioarchaeological study informed by an intersectional theoretical and analytical framework could further explore these patterns and determine if individuals at the intersections of particular axes of identity were at greater risk of negative health outcomes (such as earlier age at death) compared to other members of the same population. for example, although advanced age and compromised health status (frailty) have been implicated as significant factors influencing the risks of death during the black death in medieval london, an intersectional, intercategorical analysis of age, frailty, and other social or biological aspects of identity may expose unanticipated patterns of mortality risk previously overlooked by researchers employing traditional theoretical and analytical approaches. bioarchaeological studies of tuberculosis also exhibit the potential to reveal new or unexpected patterns of how privilege and marginalization affected health outcomes during epidemics in the past. in living populations, tuberculosis is associated with poverty and social stigmatization, and these associations likely existed in the past as well (roberts 2011). given the fact that it is capable of producing diagnostic bony lesions (roberts and buikstra 2003), tuberculosis is an example of a disease that can be included in bioarchaeological studies of intersectional health outcomes, even in the absence of supporting documentary or mortuary evidence. one paleoepidemiological study of tuberculosis has already revealed, for example, that survivorship for people with tuberculosis lesions varied by sex in early france (ca. 200–1500 a.d.) (blondiaux et al. 2015). future studies of tuberculosis in skeletal samples could employ an intersectional perspective to further clarify how different aspects of identity, marginalization, and health (e.g., sex or gender, socioeconomic status, migrant status, coinfection with leprosy) interacted to influence health outcomes associated with tuberculosis in the past. in these studies, researchers could pinpoint which social and biological categories individually affected the survivorship of individuals afflicted with tuberculosis in the past, yet also identify intersectional domains that experienced increased or decreased risks of mortality as a consequence of their position at the intersection of multiple marginalized or privileged identities within larger systems of power and oppression. quantitative intersectional methods as intersectional approaches gain traction in anthropology and other social science disciplines—particularly in disciplines that study health and disease—it becomes increasingly apparent that bioarchaeologists may have avoided relational approaches for methodological reasons. the history of the field of paleopathology, specifically, is steeped in the interpretation of lesion or pathology frequencies, occasionally divided by social or biological categories (such as sex or socioeconomic status) that are relevant to the research question of the given project or study. however, these categories are almost always examined in isolation, rather than in conjunction. as bioarchaeology tentatively engages with intersectional approaches and research frameworks, it is important to consider the suitability of analytical methods that are used to explore the intersections of dimensions of social difference and identity in modern or past populations. for instance, public health studies on modern populations have revealed that approaches that focus on a single category of difference (such as gender) will inevitably overlook or obfuscate the effects of multiple marginalizations (bauer 2014; bowleg 2012). intersectional analyses of health and disease frequently examine the nonadditive effects of social and biological factors or categories (such as age, gender, race, and class) to evaluate the potential for factors to interact multiplicatively and thus synergistically enhance the negative effects that are produced by any of the factors or categories in isolation. likewise, bioarchaeological analyses have already yielded (perhaps surprising) results regarding the existence of multiple mutually constitutive identities and oppressive structural processes and their effects on health and disease in the past (e.g., yaussy 2019). to encourage and facilitate the use of intersectionality in empirical studies of health and disease in the past, a series of statistical approaches and mathematical models are provided below, with examples from recent social science scholarship that have successfully employed each method. factorial analysis of variance a twoor three-way analysis of variance (anova), also known as a factorial anova, is one way to acknowledge the effects of independent variables on a continuous dependent variable while simultaneously considering the emergent effects that occur when two or more of those variables interact. in studies of health in past or present populations, such an analysis could elucidate how multiple social or biological aspects of identity influence the health outcome of interest, whatever it may be. the main requirements of a factorial anova include one dependent variable that is measured at the continuous level (e.g., stature, age) and two or more independent variables that are divided into two or more categorical groups (e.g., gender, sex, ethnicity, occupation). one drawback of the factorial anova in an intersectional study is the fact that the independent variables—also known as “factors,” hence the name of the model—must be categorical, meaning the groups being included in the analysis must be discrete and independent. as such, a twoor three-way anova would be unsuitable in intersectional analyses that aim to investigate the effects of fluid variables that resist classification into discrete categories. however, current methods in bioarchaeology often (arguably problematically) assign categorical labels to various aspects of identity (e.g., sex, status, age), meaning this issue only pertains to those studies attempting to avoid the limitations of categorical data. a second noteworthy limitation of factorial designs involves the number of categorical factors—in this case, identities—that can be included in a given analysis, since statistical power (i.e., the probability of a test of finding an effect if there is an effect to be found) decreases as the number of factors increases. this limitation can be particularly problematic in bioarchaeological studies, given the small sample sizes typically involved when working with skeletal data. bioarchaeological studies of health and disease in the past can use factorial anova to measure a number of health outcomes (e.g., long bone length or stature, age at death) and compare those to identity categories accessible via skeletal or archaeological evidence (e.g., sex, socioeconomic status, frailty level or disease status, ability or impairment status). for instance, in a study of scalping victims from the site of the crow creek massacre in south dakota (ca. 1325 a.d.), kendell (2011) found that the interaction between the age and sex categories of the victims had an effect on the breadth of cuts made to the frontal bone during the scalping process. in this analysis, the dependent variable was cut breadth, whereas the independent variables were age (divided into categories of young, middle-aged, and older adults) and sex (divided into categories of male and female). subsequent tests to determine the nature of the relationship among cut breadth, age, and sex revealed a significant negative relationship between cut breadth and age in male scalping victims but not female scalping victims. these results indicate that slightly different approaches to scalp removal were used for young and middle-aged males compared to older males and females of all ages. the author posited that this relationship was related to the prestige gained by an attacker who obtained the scalp of a “warrior” (i.e., a young, healthy male) versus the scalp of an older male or female individual. although not explicitly intersectional, the research conducted by kendell exemplifies a bioarchaeological application of factorial anova to examine how intersecting identities—particularly age and sex—influenced a health outcome that could be observed and measured in human skeletal remains. logistic regression a second analytical method frequently used in intersectional studies of health is logistic regression. logistic regression attempts to predict a dependent variable (e.g., the odds of one outcome or another outcome) based on one or more independent predictor variables that are included in the model. these predictor variables can be categorical (e.g., sex) or continuous (e.g., long bone lengths), meaning that a wide variety of biological and social factors can be included in the analysis. logistic regression differs slightly from linear regression in that linear regression uses a continuous dependent variable rather than the dichotomous or polytomous (i.e., a categorical variable with more than two categories) dependent variables used in binomial and multinomial logistic regression, respectively. linear regression models have also been used in intersectional studies of health in conjunction with other analytical techniques (e.g., seng et al. 2012), but logistic regression is typically favored in studies of health when the dependent variable can be conveniently parsed into discrete categories (e.g., fair or poor health). for example, one bioarchaeological study of a past pandemic that uses binomial logistic regression includes godde and colleagues’ (2020) analysis of whether predictor variables like frailty, sex, or age at death affected the odds of dying of the black death (i.e., the dependent variable) in medieval london. in their analysis of frailty, for instance, the authors found that individuals with one or more skeletal indicators of frailty had a 3.7-fold increase in the odds of dying of the black death, suggesting that mortality during the black death was selective with respect to frailty. importantly, intersectional studies of health in modern populations have begun incorporating both additive (or unitary) and multiplicative approaches to better understand both the individual effects of factors of interest on the outcome of interest and the intersecting effects of the factors on the outcome of interest (bauer 2014). in other words, combining the additive and multiplicative regression models allows researchers to establish whether statistical interactions (i.e., intersections) contribute to explanations of variability in health beyond that of the main effects (i.e., individual factors) alone. as a result, biological and social factors of interest can be considered separately (e.g., how age affects the odds of being obese) or in conjunction (e.g., how age and sex interact to affect the odds of being obese). a study by veenstra (2011) uses this two-stage analytical strategy to investigate health outcomes associated with the intersections among race, gender, class, and sexual orientation. first, veenstra uses additive regression models to assess how the independent identity variables affected self-rated health (fair vs. poor) in a canadian sample. second, veenstra introduces cross-product terms (i.e., twoand three-way interaction terms) to the additive model to assess the effects of intersecting identities on self-rated health (i.e., multiplicative models). his findings—that several identity categories exhibited main effects; that gender, race, and sexual orientation each exhibit significant two-way interactions with class; and that gender exhibited a two-way interaction with race—indicate that poor self-rated health outcomes are associated with both independent identity categories (such as indigeneity and bisexual sexual orientation) and intersectional domains (such as poor homosexuals). in sum, the two-stage approach combining additive and multiplicative modeling employed by veenstra (2011) supports the use of logistic regression as an analytical strategy capable of exposing the independent and intersecting effects of identity categories on health. additional examples of how logistic regression analysis can be used in conjunction with an intersectional perspective to investigate complex patterns in health include studies by hinze and colleagues (2012) and marcellin and colleagues (2013). although bioarchaeological studies cannot access some of the self-rated or self-reported health outcomes addressed in studies of living populations, the quantitative methods employed by scholars in public health and epidemiology are still applicable to the social and biological categories accessible to paleopathologists and paleoepidemiologists. the multilevel models described by veenstra (2011) and others offer bioarchaeologists the opportunity to expand upon the binomial logistic regression analyses conducted by scholars like godde and colleagues (2020) to explicitly investigate the potential for intersectional domains to exert a significant effect on measured health outcomes in the past. hierarchical log-linear analysis a third analytical technique that poses promise for intersectional studies of past pandemics is hierarchical log-linear analysis. most generally, log-linear analysis is used to understand associations between two or more categorical variables. however, given that a chi-square test for association is more commonly performed to determine if there is a relationship between two categorical variables, log-linear analysis is typically only employed when three or more categorical variables are being included in the model. thus, the value of a log-linear model is the opportunity to understand if a third categorical variable affects a two-way association previously exposed by cross-tabulation (i.e., understand if an association exists among all three variables) (sloane and morgan 1996). as seen in factorial anova and logistic regression, log-linear analysis is capable of examining the main effects of the variables independent of each other, as well as higher-order interactions (e.g., two-way interactions, three-way interactions). hierarchical log-linear analysis, specifically, assists the researcher in identifying the most parsimonious, unsaturated model (i.e., the model that combines the fewest main effects and interaction terms yet best accounts for most of the variance in the data). in terms of intersectional studies of health, hierarchical log-linear analysis identifies the intersections of two or more identities or health outcomes, which can then be further scrutinized to determine the intersectional domains or groups most affected by the association. therein, however, lies the greatest shortcoming of hierarchical log-linear analysis: determining the direction of any intersectional associations. hierarchical log-linear analysis is, in its simplest form, a model selection procedure. as such, it can identify significant associations, but it cannot determine the nature of the association. for example, hierarchical log-linear analysis could identify an association between gender and heart disease, yet it would not clarify whether men or women are at greater risk of heart disease. thus, for hierarchical log-linear analysis to be incorporated into studies of health and the intersectional associations among identity variables, it must be paired with appropriate cross-tabulation tables to investigate the nature of the associations identified by the log-linear model. examples of studies using hierarchical log-linear analysis to identify associations among health and other contextual factors exist within bioarchaeology (yaussy 2019; yaussy and dewitte 2018; yaussy et al. 2016). although only one study explicitly addresses the implications of the results in light of intersectionality (yaussy 2019), the findings of the other two studies still lend themselves to intersectional interpretations. for example, in their study of adult famine victims from medieval london, yaussy and colleagues (2016) used hierarchical log-linear analysis to evaluate the associations among age at death, burial type (famine vs. attritional), sex (male vs. female), and frailty (evinced by the presence or absence of three skeletal indicators of stress). among other twoand three-way associations, the hierarchical log-linear results indicated a significant four-way association among burial type, sex, age at death, and periosteal new bone formation. subsequent chi-square tests indicated that periosteal lesions were more common in individuals interred in attritional burials (i.e., under normal mortality conditions, rather than the conditions that exist in the context of a famine), males, and middle-aged individuals (i.e., individuals who died between 26 and 45 years of age). although not originally interpreted in light of intersectionality theory, the results of the study indicate the existence of intersections among identity categories (e.g., adult males) and health variables (e.g., risk of death during a famine, chances of surviving trauma or infection capable of eliciting an osteogenic response) that would not have been detected by conventional statistical approaches. conclusions and future directions despite—or perhaps because of—its “definitional dilemmas” (collins 2015), intersectionality has become a widely applied theoretical and analytical framework within the social sciences and particularly in studies of health and disease. as discussed in the first section of this article, intersectionality recognizes “the interaction of multiple identities and experiences of exclusion and subordination” (davis 2009:68), and studies of intersectionality seek to understand the production and maintenance of these systems of oppression and inequality, as well as the measurable positive and negative outcomes that they generate (e.g., physical and mental health, resource access, employment opportunities). in the examples of research studies provided in the second section of this article, intersectionality studies of health in living populations investigate the nonadditive nature of factors like age, gender, race, and class to expose how various aspects of identity and inequality can multiplicatively affect negative health outcomes in marginalized individuals and groups. similarly, bioarchaeology is uniquely situated to contribute to discussions of how intersectionality affects health in a variety of settings and circumstances across time and space, illustrating the contextual nature of intersectional relationships and outcomes. to promote the application of intersectional techniques and interpretations in bioarchaeological studies of past pandemics, the second section of this article reviewed examples of successful intersectionality research projects in sociology, public health, and epidemiology, and the third section offered examples of intersectional research in bioarchaeology and presented potential quantitative methodologies that may be applicable to the study of disease in the past. bioarchaeological studies interested in producing nuanced understandings of health and disease in the past must acknowledge the potential for multiple aspects of identity to intersect and interact with systems of oppression to produce complex patterns of disease risk unexplored by unidimensional analyses utilized in the field thus far. with the incorporation of quantitative methodologies oriented at exposing interactions and the effects of intersectional domains, studies of past pandemics can begin to identify and assess the patterns of health outcomes produced by the complex relationships among categories of identity and structural inequalities in the past. it should be noted that the list of quantitative methods provided in the third section of this article is far from exhaustive (see, for example, the suggestions regarding intersectional approaches to the study of population health made by bauer and scheim 2019a, 2019b; scheim and bauer 2019). the statistical methods and mathematical models provided are a subset of those employed by scholars studying health and disease in living populations and were selected for further consideration as analytical techniques that could relatively painlessly be incorporated into bioarchaeological studies, particularly those of past pandemics. however, it is important to recognize that analytical approaches must arise from the research questions being asked (rather than vice versa) and the above list need not limit the methods of analysis adopted by bioarchaeologists engaging with intersectionality. on the contrary, the bioarchaeological studies of intersectionality discussed in this article are tremendous examples of the diversity of approaches that can be used to explore intersectionality in the past. torres-rouff and knudson (2017), in particular, describe a multiscalar approach to individual, community, and regional identities that tracks change over time in the systemic processes and individual identities that produce variation in lived experiences of individuals and groups. a similar multiscalar approach could feasibly be applied to bioarchaeological studies of pandemics in the past and would broaden the methodological scope of paleoepidemiological studies in the future. in addition to expanding the use of underutilized quantitative approaches, future intersectional studies in bioarchaeology may consider incorporating other recent methodological innovations into their research designs as well. as illustrated by the torres-rouff and knudson (2017) example provided above, isotopic analyses could allow paleopathologists to examine aspects of identity that are typically inaccessible via conventional methods, including paleomobility (migration) and geographic region of origin. likewise, recent advances in the estimation of age at death (boldsen et al. 2002) enable bioarchaeologists to capture patterns of health at late adult ages (beyond the open-ended terminal age categories produced by conventional methods), facilitating the study of age-related experiences across the life course. finally, there is untapped potential in paleoepidemiological studies of disease ecology, which could use a combination of ancient dna analyses and paleoproteomics to assess aspects of identity associated with disease susceptibility, health status, pathogen and host coevolution, and pathogen load. for example, it is now possible to examine coinfection with two or more pathogens in the past (devault et al. 2014; warinner et al. 2014), which could allow researchers to examine the intersection of multiple social identity categories, structural inequality, and the risk of coinfection during past epidemics and pandemics. importantly, a major critique of intersectional approaches in bioarchaeology stems from the foundational goals of intersectionality itself. as initially articulated by black scholar-activists, intersectionality fundamentally explores the causes and effects of race/racism and sex/sexism at the individual and societal levels. although it is possible to explore ascribed or self-identified axes of inequality like race through qualitative and quantitative analyses of living populations, this line of inquiry is largely unavailable to biological anthropologists who work with skeletal remains. indeed, this review emphasizes the limitations of intersectional investigations in bioarchaeology, given that some individual identity categories and larger structural forces (like race and racism) may be inaccessible or inapplicable in many of our studies. however, as mentioned previously, the concept of multiple, interlocking oppressions affecting patterns of frailty and mortality in past populations remains pertinent to bioarchaeological research and is worth consideration in the future. last, in accordance with the overarching goals of intersectionality scholarship, future bioarchaeological studies of intersectionality have the potential to contribute to social justice projects by producing scholarship that leads to social change. intersectionality and feminist theorizing in general are closely linked with social activism and social justice movements (franklin 2001). bioarchaeological studies, in particular, have the capacity to confront the normalization of structural inequality by adding contextual and temporal depth to intersectionality research conducted on living populations. the interpretations of bioarchaeological data and analyses can clarify how systemic forms of oppression were initially constructed and perpetuated in the past and thus can be challenged and dismantled in the present. acknowledgments i extend my sincere appreciation to gwen robbins schug and siân halcrow for inviting me to contribute to this special issue. i also thank sharon dewitte for her encouragement and thoughtful suggestions on previous drafts of this article. finally, and perhaps most important, my sincere thanks goes to three anonymous reviewers for their comments and suggestions, which dramatically improved the quality of this manuscript. further reading dewitte, sharon n., and samantha l. yaussy. 2020. bioarchaeological applications of intersectionality. in theoretical approaches in bioarchaeology, edited by colleen m. cheverko, julia r. prince-buitenhuys, and mark hubbe. routledge, london, pp. 45–58. hankivsky, olena. 2014. intersectionality 101. institute for intersectionality research and policy, simon fraser 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molly k., and john crandall. 2019. reconsidering sex and gender in relation to health and disease in bioarchaeology. journal of anthropological archaeology 54:161–171. doi: 10.1016/j.jaa.2019.04.001. adepartment of sociology and anthropology, utah state university, logan, ut correspondence to: samantha l. yaussy, department of sociology, social work, and anthropology, utah state university, 0730 old main hill, utah state university, logan, utah 84322-0730 e-mail: slyaussy@gmail.com login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access 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together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe bioarchaeology international volume 9, number 3: 199–200 doi: 10.5744/bi.2024.0032x © 2025 university of florida press in table 4, the map id 2 site is listed incorrectly as “huaca colorado/tecape” and the source cited as “alaica 2013.” the correct site name is “huaca colorado/tecapa,” and the source is “alaica 2022.” a revised table 4 is below. correction reference: gagnon, celeste, bethany l. turner, branden cesare rizzuto, and scott e. burnett. 2025. foreigner(?) in a foreign land: multimethod exploration of the first decorative dental inlay identified in a prehispanic peruvian context. bioarchaeology international 9(1):27– 51. doi: 10.5744/bi.2024.0032. table 4. map identifications, regions, and sites discussed. mean values presented here were calculated from published values. δ18o values are expressed permil (‰) relative to standard mean ocean water (vsmow). 206,7,8pb/204pb values were derived from enamel carbonate with the exception of estuquiña values,* which were derived from hair samples. map id region site δ18o 87sr/86sr 206pb/204pb 207pb/204pb 208pb/204pb 3 north coast huacas de moche p12630 28.7 0.70534 18.44 15.66 38.25 n mean δ18o mean 87sr/86sr mean 206pb/204pb mean 207pb/204pb mean 208pb/204pb source ecuador unprovenienced 4 27.8 0.70655 18.60 15.63 38.25 juengst et al. 2021 1 north coast túcame 30 25.4 0.70813 hewitt 2013 2 north coast huaca colorado/tecapa 26 24.8 0.70793 18.87 15.64 38.71 alaica 2022 3 north coast cerro oreja 38 23.9 0.70690 18.74 15.68 38.75 3 north coast huacas de moche 11 25.8 toyne et al. 2014 4 north coast huaca gallinazo 2 0.70687 hyland et al. 2020 4 north coast huaca santa clara 9 0.70679 hyland et al. 2020 5 north highlands lot pinchudos 10 24.4 toyne et al. 2017 6 central highlands ushcugaga 10 0.71052 washburn et al. 2022 6 central highlands marcajirca 36 0.71126 washburn et al. 2022 6 central highlands jato viejo 7 0.71011 washburn et al. 2022 7 central highlands chavín de huántar 5 0.70957 slovak et al. 2016 8 central coast rinconada alta 20 21.0 0.70731 marsteller et al. 2017 8 central coast armatambo 39 21.6 0.70743 marsteller et al. 2017 9 central coast pampa de los gentiles 8 0.70704 knudson et al. 2016 10 south highlands machu picchu 74 22.5 0.71067 18.73 15.64 38.47 turner et al. 2009 (continued) correction200 the reference list incorrectly cites the author’s first name as “aleska” and the publication year as 2013. the correct reference is as follows: alaica, aleksa. 2022. nonhuman social actors in daily and ritual activities in the andes: humananimal interactions among the moche in the middle horizon, jequetepeque valley, peru (ce 600– 1000). ph.d. dissertation, university of toronto. proquest, ann arbor, mi. map id region site δ18o 87sr/86sr 206pb/204pb 207pb/204pb 208pb/204pb 3 north coast huacas de moche p12630 28.7 0.70534 18.44 15.66 38.25 n mean δ18o mean 87sr/86sr mean 206pb/204pb mean 207pb/204pb mean 208pb/204pb source 10 south highlands patallaqta 82 21.4 0.71682 18.99 15.73 38.88 turner 2021 11 south highlands ranracancha 10 0.70793 lofaro et al. 2018 11 south highlands pucullu 10 0.70805 lofaro et al. 2018 11 south highlands cachi 14 0.70714 lofaro et al. 2018 11 south highlands turpo 9 0.70727 lofaro et al. 2018 12 south highlands cuncaicha 4 21.2 0.70648 chalaaldana et al. 2018 13 south coast la tiza 7 23.7 0.70668 buzon et al. 2011 14 south coast uraca 37 0.70826 18.39 15.63 38.58 scaffidi et al. 2021 15 south coast estuquiña 10 .070768 18.48* 15.66* 38.70* carmody 2019 table 4. map identifications, regions, and sites discussed. mean values presented here were calculated from published values. δ18o values are expressed permil (‰) relative to standard mean ocean water (vsmow). 206,7,8pb/204pb values were derived from enamel carbonate with the exception of estuquiña values,* which were derived from hair samples. (continued) login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial 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journals@upress.ufl.edu navigation home search current archives submit subscribe bioarchaeology international copyright © 2021 university of florida press doi: 10.5744/bi.2021.1010 volume 5, numbers 1–2: 1–20 two (missing) left feet: caring for foot amputees in late pre-hispanic túcume, lambayeque peru megann phillips,a vanessa cruz,a erin k. martin,a dylan r. smith,a bernarda delgado elias,b josé manuel escudero villalta,b and j. marla toynea* adepartment of anthropology, university of central florida, orlando, fl 32816, usa bmuseo de sitio de túcume, lima, peru *correspondence to: j. marla toyne, department of anthropology, university of central florida, 4000 central florida blvd., howard phillips hall rm. 309, orlando, fl 32816, usa e-mail: j.marla.toyne@ucf.edu abstract understanding pre-hispanic andean medical practices through skeletal evidence of surgery has been the focus of a number of bioarchaeological investigations in recent years. amputation is an especially interesting topic of research due to the variety of social contexts in which it might have occurred. interpretations for amputation found on the north coast of peru have included therapeutic intervention, punitive measures, and ritualistic dismemberment. here, we present two new cases of successful left foot amputation in young adult females excavated from huaca las balsas (late intermediate period, a.d. 1100–1470) and huaca las abejas (late horizon, a.d. 1470–1535) at the ancient religious and administrative center of túcume. chronologically, they are the latest cases of pre-hispanic amputation published to date. contextual evidence supports a therapeutic motivation for the procedure, as individualized burial treatment and placement within a cemetery group of social elites is not consistent with punitive or ritualistic action. modification of the malleoli, extensive bone proliferation covering the talar articulations, and asymmetrical cortical bone thickness of the tibiae and fibulae (revealed radiographically) suggest the return of some functional mobility using the affected limb after healing. this long-term recovery is evidence of access to quality medical care and accommodation of functional impairment within the amputees’ communities. the presented research uses the bioarchaeology of care approach to explore the lived experiences of these amputees and their social identities, making an important contribution to the anthropology of disability across cultures and time periods. keywords: amputation; ancient medical practice; bioarchaeology of care; disability; skeletal trauma; surgery comprender las prácticas médicas andinas prehispánicas a través de evidencia esquelética de cirugía ha sido el foco de una serie de investigaciones bioarqueológicas en los últimos años. la amputación es un tema de investigación especialmente interesante debido a la variedad de contextos sociales en los que podría haber ocurrido. las interpretaciones para la amputación que se encuentran en la costa norte del perú han incluido la intervención terapéutica, las medidas punitivas y el desmembramiento ritual. aquí, presentamos dos nuevos casos de amputación exitosa del pie izquierdo en hembras adultas jóvenes excavadas desde huaca las balsas (período intermedio tardío, a.d. 1100–1470) y huaca las abejas (horizonte tardío, d.c. 1470–1535) en el antiguo centro religioso y administrativo de túcume. cronológicamente, son los últimos casos de amputación prehispánica publicados hasta la fecha. la evidencia contextual apoya una motivación terapéutica para el procedimiento, ya que el tratamiento y la colocación individualizados del entierro dentro de un grupo cementerio de élites sociales received 30 june 2020; revised 5 october 2020; accepted 30 october 2020 caring for foot amputees in late pre-hispanic túcume2 limb amputation is one of the oldest known surgical procedures (markatos et  al. 2019; sachs et  al. 1999), documented by both historical and archaeological record. it is defined as the intentional removal of a limb, either partially or completely (marcovitch 2009:28). the earliest possible evidence of this practice dates to the neandertals buried in shanidar cave, iraq, over 40,000 years ago (stewart 1977), and archaeological evidence of both successful and unsuccessful ancient amputations has been found globally. examples exist in england (mays 1996), portugal (fernandes et  al. 2017), france (buquet-marcon et al. 2007), bulgaria (zäuner et al. 2013), south africa (van der merwe et al. 2010), and egypt (dupras et al. 2010; nerlich et al. 2000). moreover, amputation remains as medically relevant today as it was in the past. although surgical practices have evolved significantly, with advances in anesthetic, imaging, and operative technologies, the removal of an appendage is a life-altering procedure that continues to be used in the treatment of trauma (ahmad et  al. 2019; barla et  al. 2017; moini et  al. 2009), circulatory and neuropathic issues (nanwani et  al. 2019), localized infections (boffeli 2015), and other conditions (zhao et al. 2020). this article expands current understandings of the history and social implications of amputation by presenting two new cases from túcume, peru, dated to the late intermediate period (a.d. 1100–1470) and late horizon (a.d. 1470–1532). these cases evidence a regional continuity of surgical practices that endured for hundreds of years between the moche culture (a.d. 100–700) and the inca empire (a.d. 1470–1532). additionally, utilization of the bioarchaeology of care approach (tilley 2015; tilley and cameron 2014) allows these cases to be framed as reflections of community care practices and lived experiences of amputees in north coastal peru. the bioarchaeology of care is essential to understanding the nuances of chronic functional impairment in the past—an important contribution to modern disability studies. although functional impairment, healthcare, and disability are separate concepts that should not be conflated, they are often intertwined. this analysis of amputation at túcume explores the possibility that the survival of andean amputees in the distant past was aided by community members and urban infrastructure. however, it simultaneously acknowledges the position of amputees as agentive community members that might or might not have actually been considered disabled. in contrast to previously discovered cases of pre-hispanic amputation in the region, skeletal and mortuary evidence from túcume suggests that amputation occurred as a form of medical intervention, and accommodation of resulting physical limitations fell within contemporary cultural norms. bioarchaeology of care the bioarchaeology of care (tilley 2015; tilley and cameron 2014) is an emerging interpretive framework in bioarchaeology that emphasizes the role of community in the lives of impaired or disabled individuals. this can involve the provision of medical care for acute or chronic ailments, general task assistance, and emotional support offered to a person with a limiting condition either directly (often by kin) or indirectly within an accommodating sociopolitical structure. the identities of impaired or disabled individuals are highly dependent on cultural context and are situationally malleable, and not all functionally no es consistente con la acción punitiva o ritualista. la modificación de los maléolos, la extensa proliferación ósea que cubre las articulaciones talares y el grosor óseo cortical asimétrico de las tibias y los peronés (revelados radiográficamente) sugieren el regreso de cierta movilidad funcional utilizando la extremidad afectada después de la curación. esta recuperación a largo plazo es evidencia del acceso a atención médica de calidad y alojamiento de deterioro funcional dentro de las comunidades de amputados. la investigación presentada utiliza la “bioarqueología de la caridad” para explorar las experiencias vividas de estos amputados y sus identidades sociales, haciendo una contribución importante a la antropología de la discapacidad a través de las culturas y períodos de tiempo. two huacas, both alike in dignity, (in fair túcume, where we lay our scene), from ancient ground break new amputees, where literal dirt made our hands unclean. —modified for contextual purposes from shakespeare (1597:1) caring for foot amputees in late pre-hispanic túcume 3 impaired people identify as disabled or require significant structural accommodation to complete essential tasks (byrnes and muller 2017; kasnitz and shuttleworth 2001; reid-cunningham 2009). however, survival and quality of life of a person with impaired functional abilities often rely on interpersonal and structural accommodation. this includes healthcare access, which is often dependent on socioeconomic status (becker and newsom 2003; kristiansson et al. 2009; walters and suhrcke 2005), and cultural perceptions of impairment (rösing 1999). the bioarchaeology of care has become an invaluable framework to guide paleopathological analysis because of its ability to integrate social theory related to identity and compassion (tilley 2015; tilley and schrenk 2017). due to the intangibility of emotions such as compassion (dettwyler 1991), some bioarchaeologists shy away from the more ephemeral aspects of the approach. however, regardless of emotional consideration, the bioarchaeology of care has proven its utility in a wide variety of social contexts that range from hunter-gatherer groups (tilley and oxenham 2011; tilley 2015) to recent historical institutions (tremblay critcher 2017; wesp 2017). previous examples of the bioarchaeology of care in peru include publications that address trepanation (jolly and kurin 2017), crippling thoracic outlet syndrome (palma málaga and makowski 2019), and chronic post-injury osteomyelitis (sutherland 2019) as conditions that affected individuals and their caretakers in late pre-inca cultures of central and south-central parts of the country. amputation in pre-hispanic peru the history of the bioarchaeology of care in peru is currently limited, considering the relatively table 1. presently published examples of pedal amputation from pre-hispanic north coast peru. site time period and culture individual age and sex side suggested motivation túcume1 late horizon, h. las abejas, unit xa, ent. 1 young adult female left medical/therapeutic amputation chimú-inca túcume1 late intermediate h. las balsas, unit ib, ent. 1 young adult female left medical/therapeutic amputation period, lambayeque castillo de huarmey2 middle horizon, imperial tomb, individual xy young adult male left ritual amputation wari castillo de huarmey2 middle horizon, imperial tomb, individual xx middle adult female left ritual amputation wari el brujo3 early intermediate west sector, tomb 4 middle adult male both intentional amputation period, moche el brujo3 early intermediate huaca cao, bru m98-4 adult male left intentional amputation period, moche mocollope3 early intermediate moc98-1 young adult female right intentional amputation period, moche mocollope4 early intermediate — unknown adult both punitive amputation period, moche huacas de moche5 early intermediate plataforma uhle, tomb 48 young adult male left not considered period, moche 1present study 2więckowski (2016) 3verano et al. (2000) 4vélez lópez (1913) 5chauchat et al. (2009) caring for foot amputees in late pre-hispanic túcume4 figure 1. map of north coast of peru showing locations of sites mentioned in the text. map created by toyne. caring for foot amputees in late pre-hispanic túcume 5 recent definition of this theoretical paradigm, and there is much room for expansion. this article seeks to continue the regional application of the bioarchaeology of care with the analysis of amputees from peru’s north coast. the cases presented provide an important extension of previous discussions of pre-hispanic peruvian amputation practices by providing fresh evidence for surgical practices, motivations, and effects on long-term identity and social integration. previously identified cases of pre-hispanic pedal amputation include those published by vélez lópez (1913), alva and donnan (1993), verano (1997), verano et al. (2000), chauchat et al. (2009), and więckowski (2016) (table 1). some of these examples of foot removal, all of which were found on the north coast of peru, are presumed to have been well-healed antemortem amputations due to bony remodeling of the affected area. however, other examples of missing feet in the bioarchaeological record are less easily interpretable. although verano (1997) and alva and donnan (1993) note that a footless “guard” was placed at the entrance to tomb i and at the entrance to tomb ii at sipán (an elite moche burial site), the poor preservation of these skeletons inhibited observation of their distal lower leg bones. it is therefore unclear whether the missing feet of these tomb guardians reflect antemortem amputation or postmortem removal. of the individuals who do provide evidence for antemortem foot amputation, the earliest were found at the site of mocollope, the el brujo complex, and the huacas de moche complex (fig. 1). all of these early cases are associated with the moche culture (a.d. 100–700) (chauchat et  al. 2009; vélez lópez 1913; verano et  al. 2000). the contextual evidence does not suggest that these individuals were intentionally amputated to serve as tomb guardians. while the motivation is unknown, it is evident that each individual survived long enough to support substantial remodeling of the ankle joint after removal of the foot. the amputees found at the castillo de huarmey (więckowski 2016) (fig. 1), associated with the wari culture (a.d. 600–1100), also seem to have been longterm survivors of amputation. however, they ultimately served as tomb guardians. they were buried in a distinct location in the floor of the antechamber to the wari imperial mausoleum of elite women. the placement of footless individuals as apparent guardians at the entrance to elite tombs suggests a symbolic or spiritual importance of feet and foot amputation among the moche as well as the wari. this possibility is supported by the frequent depiction of isolated feet and foot amputees in moche ceramics (paico vílchez and paico zumaeta 2020; vélez lópez 1913) and the appearance of isolated feet in wari ceramics (trigo rodríguez and hidalgo rocabado 2012; więckowski 2016). however, although a general cultural fascination with feet and foot removal is suggested by this type of artistic expression, ceramics might also lend evidence to punitive or therapeutic theories regarding the motivations underlying amputation. for example, amputees depicted by the moche sometimes have a mutilated nose and lips, which could be interpreted either as punitive maiming or as a symptom of a pathological condition such as nasal leishmaniasis (verano et al. 2000). amputation of the foot (or feet) could have been an additional punitive measure or intended as a treatment for a pathological condition that affected hands and feet. as it is depicted in ceramics, amputation motivated by advanced leishmaniasis, or a similar condition, is considered unlikely due to the unaffected appearance of non-amputated extremities. nonetheless, this does not rule out other medical reasons for amputation in the ceramic or bioarchaeological record. non-punitive amputation that is not ideologically motivated is suggested by the burial of some individuals in traditional, non-guardian burial contexts. this includes the burial contexts of amputees found at el brujo and mocollope (verano et al. 2000), huacas de moche (chauchat et  al. 2009), and túcume (this publication). archaeological context túcume is an extensive archaeological complex located within the la leche river valley, approximately 30 kilometers north of the modern lambayeque regional capital of chiclayo. initially associated with the lambayeque culture (a.d. 900– 1350), the history of túcume covers more than 400 years of occupation and three major shifts in political control (heyerdahl et al. 1995; shimada 1981, 2009). monumental construction at túcume commenced during the late intermediate period at the site (a.d. 1050), and it continued for roughly three centuries until the region was incorporated into the north coastal chimú empire around a.d. 1350 (heyerdahl et al. 1995). around a.d. 1470, the inca empire that was rapidly expanding from peru’s southern highlands conquered the lambayeque valley region. the inca appear to have used túcume as their primary regional administrative center until the arrival of the spanish in a.d. 1532, when the site was burned and ultimately abandoned (covey 2008; narváez vargas 1995b; sandweiss 1995). the administrative and religious core of the complex consists of 26 truncated adobe pyramids caring for foot amputees in late pre-hispanic túcume6 (fig. 2)—called huacas due to their status as sacred pre-hispanic monuments. these huacas were built during the lambayeque occupation around a steep rocky outcropping named cerro la raya (delgado elías and narváez vargas 2016; narváez vargas 1995b; narváez vargas and delgado elías 2011; sandweiss 1995). they vary greatly in size and structural complexity due to their differential uses for administrative, ceremonial, and elite residential purposes. huaca las balsas and huaca las abejas are among those found in the southwestern sector of the archaeological complex. they appear to have functioned as residences and mortuary monuments for associated cemeteries containing social elites (delgado elías and narváez vargas 2016; narváez vargas 1995a; narváez vargas and delgado elías 2011). huaca las balsas is a moderately sized platform mound, measuring approximately 35 × 25 m, with a height of approximately 4.5 m (narváez vargas and delgado elías 2011). despite its smaller size, huaca las balsas has been the subject of much archaeological inquiry due to the presence of intricate carved murals on its walls. the murals depict maritime scenes, including divers collecting spondylus and anthropomorphic bird figures sailing on wooden rafts (balsas). along with these murals, which inspired the huaca’s modern name, the main features of the construction include superficial residential structures, cooking areas, two descending ritual platform areas, and a small platform containing eight burials. these lambayeque burials (approximately a.d. 1240–1300) include adult males and females as well as juvenile individuals, and grave associations indicate middle elite social status (delgado elías and narváez vargas 2016; narváez vargas and delgado elías 2011). huaca las abejas measures approximately 57 meters in length and width and 8 meters in height. the initial architectural survey revealed three construction phases of ritual platforms and a ramp, likely from the late intermediate period (a.d. 900–1470) (escudero villalta 2018). unlike huaca las balsas, excavations have yet to identify residential structures or burials on top of huaca las abejas. however, a small cemetery to the north of the huaca contained figure 2. (a) burial of case 1 (las balsas, unit ib, entierro 1) shown in situ with extended body position. (b) burial of case 2 (las abejas, unit xa, entierro 1) shown in situ, seated and flexed with a few grave goods. (c) map of the túcume archaeological complex, with huaca las abejas and huaca las balsas circled. figure created by toyne. caring for foot amputees in late pre-hispanic túcume 7 28 well-preserved human burials that are of a similar demographic profile to the burials excavated from huaca las balsas. the interred individuals were of middle elite status, although they have been dated to the late horizon (approximately a.d. 1470–1532) based on associated ceramic materials and the seated, flexed burial positioning that are characteristic of chimú-inca occupation (escudero villalta 2018). materials and methods toyne conducted osteological analysis of the skeletons in the field in 2009 and 2014, including metric and morphological observations, following the standards established by buikstra and ubelaker (1994) and ubelaker (1999). biological assessment of age at death and sex were estimated based on morphological characteristics of the os coxae and crania. stature was estimated using tibial condylomalleolar length (clt) using the regression equation proposed by pomeroy and stock (2012) (stature = 57.748 + 2.800clt), which was recommended for regional accuracy by anzellini and toyne (2020). macroscopic observations of pathological bone modification were recorded based on visual examinations, including evidence for traumatic damage, bone remodeling, and inflammatory response (ortner 2012). other pathological changes observed include cranial modification, dental pathology, and osteoarthritic joint changes. finally, key skeletal elements (right and left humeri, femora, and tibiae) were transported to the econor diagnostic imaging clinic in lambayeque, peru, where standard film, single-plane radiographs were taken. analysis of these individuals was conducted according to standard bioarchaeology of care guidelines (tilley 2015; tilley and cameron 2014). the following sections of this report document the process of bioarchaeology of care analysis through four prescribed steps. these steps ensure appropriate consideration of functional impairment and the healthcare that might have been necessary for an impaired person’s survival. they include: (1) description, diagnosis, and documentation of the pathological condition from skeletal and other bioarchaeological evidence; (2) determination of whether or not an individual would have received medical and/or other care from their community; (3) construction of a model of care that might have been necessary for an impaired individual’s survival; and (4) interpretation of the model of care in a broader social context. description, diagnosis, and documentation description of case 1: las balsas, unit ib, entierro 1 this individual (female, between 30 and 40 years) was buried atop huaca las balsas in a simple pit. the skeleton was in an extended position with slight flexing of the legs, positioned with the head to the south (fig. 2). this burial was part of the group of eight burials, including a camelid. radiocarbon dates from nearby entierro 5 produced a date between cal a.d. 1240 and 1300 (720 +/– 40 b.p.), figure 3. the almost-complete skeleton of case 1 (las balsas, unit ib, entierro 1). photo by toyne. caring for foot amputees in late pre-hispanic túcume8 which corresponds to the lambayeque occupation of the late intermediate period. grave position and associations of the individual from huaca las balsas are similar to materials recovered from other lambayeque-style burials at the site (narváez vargas 1995a). for individuals identified as female based on skeletal indicators, burial treatment generally consisted of interment in the extended or slightly flexed position and accompaniment by a variety of functional vessels and weaving-related items. in this particular grave, there were four gourd bowls, one small ceramic cooking pot, two small copper beads near the cranium, and 68 spondylus shell beads near the right and left wrists. the weaving-related items found in the grave include three decorated wooden weaving loom pieces, a gourd needle container, three copper needles, various balls of threads, and chalk. the body was wrapped in a poorly preserved, simple, brown cotton textile. this individual was represented by an almost complete, well-preserved skeleton with minor taphonomic breakage and surface erosion (fig. 3). missing skeletal elements included the left calcaneus, talus, tarsal bones, metatarsal bones, and pedal phalanges (although these elements are thought to be missing due to pathological rather than taphonomic reasons). using the non-pathological right tibia, stature was estimated to be 144.6 cm. this is slightly shorter than the average height of 147.9 cm (σ = 3.08 cm) that was calculated for the seven other adult females interred within similar burial contexts at túcume. the cranium is intact and exhibits a moderate degree of cranial modification, showing flattening across the frontal and occipital bones that resulted in bilateral bulging of the parietal bones. remodeled macroporosity on the posterior bones of the cranial vault is consistent with healed porotic hyperostosis. observations of the dentition revealed a moderate degree of dental attrition that resulted in flat occlusal surfaces of all teeth, four well-healed alveolar sockets indicative of antemortem tooth loss, some hypoplastic defects of the anterior dentition, and four alveolar abscesses that caused resorption of the maxilla. there was also a large carious lesion of the mandibular second molar and minimal dental calculus on the labial surfaces of most teeth. in the postcranial skeleton, two small schmorl’s nodes were observed on the superior bodies of the ninth and twelfth thoracic vertebrae. minor osteophytic lipping affected the anterior body margins of the sixth through twelfth thoracic vertebrae. the key pathological feature on the skeleton was the osteological (morphological and radiographic) modification of the distal portions of the left tibia and fibula (fig. 4). although fragility of the affected bone seems to have contributed to some postmortem fragmentation of relevant pathological features, visual observations of the medial malleolus of the tibia figure 4. (a) detailed anterior oblique view of the left distal tibia and fibula of case 1 (las balsas, unit ib, entierro 1). (b) fragments of the distal articular surface of the tibia showing bone proliferation. photos/figure by toyne. caring for foot amputees in late pre-hispanic túcume 9 showed that it was not consistent with normal morphology. the recovered fragments of the articular region demonstrate active bone proliferation. there was evidence of healed periosteal reaction along the posterior aspect of the midshaft of the tibia and an area of raised sclerotic bone at the attachment site of the flexor digitorum longus. on the fibula, irregular thickening of the distal metaphysis was present. there was also mild medial displacement of the lateral malleolus, possibly the result of a healed fracture. the distal tibio-fibular and talar articular surfaces were completely remodeled so that no facet remained, and the fibular summit was rounded rather than pyramidal in shape. the attachments for the flexor hallucus longus and soleus muscles along the left fibular midshaft also showed pronounced rugosity compared to the right side. radiographs of both tibiae and fibulae (fig. 5a) illustrate the difference in cortical thickness and bone density between the right and left sides of the body. the cortical bone of the right tibial and fibular diaphyses are denser and thicker than the left tibial and figure 5. (a) anterior-view plain film radiograph of the tibiae and fibulae of case 1 (las balsas, unit ib, entierro 1). (b) anterior-view plain film radiographs of the femora of case 1. (c) anterior-view plain film radiographs of the humeri of case 1. figure created by toyne. caring for foot amputees in late pre-hispanic túcume10 fibular diaphyses. this suggests use-related atrophy and reduced biomechanical forces applied to the left lower leg. additional radiographs of the femora (fig. 5b) and humeri (fig. 5c) also demonstrate asymmetrical bone thickness and density that is consistent with reduced limb use on the left side of the body. the appearance of reduced cortical density in the left humerus is what might be expected if this individual were using a crutch or cane, as one-sided crutch and cane use typically occurs contralaterally to the affected lower limb (edelstein 2019). description of case 2: las abejas, unit xa, entierro 1 the second individual (female, approximately 30 to 34 years) was buried in a circular pit in front of the huaca las abejas platform. stratigraphic registration and grave associations confirm that this burial, as well as the other 27 burials recovered together, date to the later fifteenth-century chimú-inca occupation. burial position also supports this cultural affiliation, as the interred was situated in a seated and flexed body position, with the face collapsed downward over crossed arms and legs (fig. 2). typical chimú-inca burial practices for middle elite people at túcume consisted of wrapping bodies in layers textiles and then interring them in a seated, flexed position. grave accoutrements for middle elite women typically included functional vessels and weaving tools as well as decorative accessories such as beaded jewelry. as with other, better-preserved burials from huacas las abejas, the individual described in case 2 was likely wrapped in several layers of woven cloth textiles to create an egg-like bundle. however, only a few remnants of the burial fabrics remained at the time of excavation. the grave goods associated with this individual include a small ceramic bowl, two intentionally damaged copper sewing needles, a weaving loom end bar, 25 wooden spindles and threads of various colors within a gourd bowl, and a small ball of dark brown wool. copper and shell beads were found near the wrists. the grave context also included a small, simply decorated jar that contained the seeds of the bichayo (capparis crotonoides) shrub, a plant indigenous to the north coastal region of peru and commonly used for firewood and animal fodder. the flower and leaves of this plant also have medicinal properties for treating skin rashes and other conditions. when boiled, it can be drunk in a tea to treat bronchitis or inhaled under sauna-like conditions as a remedy for arthritis and bone aches (bussmann and sharon 2015). the adult female skeleton was almost complete and generally well preserved (fig. 6), although the left calcaneus, talus, tarsal bones, metatarsal bones, and pedal phalanges were absent. termites caused extensive taphonomic damage by burrowing into the midshaft of the right femur and the distal portion of the left femur, possibly due to the presence of wooden materials within the grave (huchet et al. 2011). there was also postmortem fragmentation of the left os figure 6. the almost-complete skeleton of case 2 (las abejas, unit xa, entierro 1) from an anterior oblique view, showing termite damage to right femur. photo by toyne. caring for foot amputees in late pre-hispanic túcume 11 coxa, ribs, and scapula. bone brittleness might have contributed to this postmortem fracturing, but osteoporosis was not observed. using the right tibia, her stature was estimated to be approximately 144.6 cm, similar to the estimated stature of the lambayeque individual from huaca las balsas. observations of the dentition found moderate-to-pronounced dental wear that resulted in flattened cusps, as well as a thin layer of dental calculus covering almost all lingual and buccal tooth surfaces. the right maxillary first molar was lost antemortem, as indicated by a well-healed alveolus. interproximal caries developed between the upper left premolars, and it appears that the third molars of the maxilla and mandible were congenitally absent. observations of osteopathology revealed no porotic hyperostosis or cribra orbitalia on the bones of the cranium, but the cranial vault did demonstrate a moderate degree of fronto-occipital modification. there were also osteoarthritic changes to some joint surfaces, including those of the shoulders, hips, and right knee. these osteoarthritic changes included minor osteophytic lipping and cortical thinning. the individual demonstrated significant modification to the distal articular surface of the left tibia and the distal epiphysis of the left fibula. the side-by-side comparison of the right and left lower leg bones is illustrated in figure 7. in addition to healed periosteal reaction along the medial aspect of the tibia’s distal shaft, extensive bony proliferation densely filled the tibio-talar articulation, and the collicular features of the medial malleolus were remodeled. only a small area of the original joint surface could be observed to indicate that there had been a normal facet prior to bony remodeling. although the distal fibula presented with a fairly normal tibio-fibular articulation, there was alteration of the talar articulation. bone proliferation filled the malleolar fossa and the apex was flattened. there also appeared to be a sharply defined oval void between the two bones at their distalmost point of adjacency, perhaps encapsulating a pocket of soft tissue or a cyst-like feature that provided a barrier to bony proliferation in that specific area. radiographs of both tibiae (fig. 8a) illustrate structural changes to cortical thickness and density in the bones of the left limbs. the midshaft of the left tibia demonstrated thin cortical bone and irregular distal cortical density, and radiographic translucence of the distal periarticular area is indicative of atrophy due to reduced weight-bearing. the left fibula demonstrated similar characteristics. radiography also revealed possible tendinopathy of the greater trochanter (fig. 8b) and some minor decreases in cortical bone thickness of the right humerus relative to figure 7. detailed anterior oblique view of the distal tibia and fibula of case 2 (las abejas, unit xa, entierro 1). photo by toyne. caring for foot amputees in late pre-hispanic túcume12 what is observable in the left humerus (fig. 8c). this observation is complemented by what appears to be localized demineralization of the subchondral region of the right humeral head. the osteochrondritic radiodensity of the left humeral head may be an artifact of imaging or perhaps some evidence of avascular necrosis suggesting damage to the shoulder joint. differential diagnosis the individuals found at huaca las balsas (case 1) and huaca las abejas (case 2) likely had their left feet removed via disarticulation of the ankle joint several or many years before their deaths. the nature of the bone response at the distal ends of the left tibiae and fibulae is indicative of survival after surgical amputation, as opposed to congenital absence or incomplete archaeological recovery of foot bones. unaffected diaphyseal morphology indicates maturation was not disrupted by unbalanced limb functionality, and thus the talus and other foot bones were likely removed after the individuals reached adulthood. diaphyseal and distal metaphyseal morphology of the tibiae are normal, and abnormal bony proliferation within the talar articular cavity seems to have occurred over a previously functional joint surface in both cases. although the distal left fibula of the individual from huaca las balsas shows significant metaphyseal remodeling due to an apparent fracture, the distal left fibula of the individual from huaca las abejas is of normal morphology, except for the development of a more bulbous epiphysis. figure 8. (a) anterior-view plain film radiograph of the tibiae and fibulae of case 2 (las abejas, unit xa, entierro 1), picturing a right tibial midshaft cut for sampling and a left fibula with postmortem fragmentation. (b) anterior-view plain film radiographs of the humeri of case 2. figure created by toyne. caring for foot amputees in late pre-hispanic túcume 13 this amputation procedure seems to have been intentional and methodical. accidental or traumatic amputation is unlikely as there is no evidence of severe trauma in either case 1 or case 2 to the malleoli of the tibia and fibula, which constitute part of the ankle joint adjacent to the normal position of the talus. although no cut marks are present on the distal lower leg bones to evidence surgical removal of the foot in either case, it is possible for a welltrained healer to disarticulate the ankle joint by cutting only the soft tissue between the articular surfaces (kirkup 2007; markatos et  al. 2019). this would not leave cut marks on the bone surfaces. additionally, if cut marks on the bone were made, it is very likely that bone remodeling would have obscured them over time. in modern and historic contexts, intentional amputation has been performed as punishment or as a ritual practice (adejumo and olabisi adejumo 2005; bosmia et  al. 2014; kirkup 2007; mavroforou et  al. 2014). some have suggested these potential motivations for pre-hispanic north coast peruvian amputations (kirkup 2007; verano et al. 2000; więckowski 2016). however, the contexts in which the amputees from túcume were buried does not indicate that their amputations were performed for a punitive or ideological purpose, as they were not interred in a deviant fashion (murphy 2008; shay 1985). their burial location, body positioning, and grave accoutrements are typical of middle elite women’s burials during their respective time periods. evidence seems to suggest that the amputations were performed for therapeutic purposes. this conclusion is supported by the fact that, to date, no individuals with severe pathological conditions of the foot have been discovered at túcume. absence of evidence for foot trauma, disease, or malformation in unamputated feet suggests that such conditions might have typically been treated with amputation. although trauma, disease, or malformation can be causes for amputation, none of these conditions is strongly evidenced in the amputees from túcume. the possible healed fracture identified on the distal fibula of the amputee from huaca las balsas (case 1) could indicate trauma that preceded, succeeded, or was associated with the amputation of the foot. alternatively, a localized infection or a chronic disease that leaves few or no skeletal indicators could be to blame. for example, diabetes might have led to ulcer development that necessitated pedal amputation. although there is no skeletal evidence for this condition (biehler-gomez et al. 2019; dupras et al. 2010) in either case 1 or case 2, diabetes mellitus is the leading cause of non-traumatic lower limb and foot amputations in the modern world and in peru specifically (biehler-gomez et  al. 2019; villena 2015). approximately 50% of foot amputations are attributed to the disease (moulik et al. 2003), and it is known to have existed in antiquity (dupras et al. 2010; sanders 2002) outside of peru. aside from diabetes, there are a number of other medical conditions that might have resulted in the removal of a foot. as noted in the introduction to this article, amputation is used in modern times as a treatment for trauma (ahmad et al. 2019; barla et al. 2017; moini et al. 2009), circulatory and neuropathic issues (nanwani et  al. 2019), localized infections (boffeli 2015), and necroses that result from frostbite or other factors (zhao et al. 2020). any of these conditions might be considered a potential precursor to amputation in the young adult women buried at túcume, although necrosis that is specifically related to figure 9. oblique medial posterior view of the right femur of case 1 (las balsas, unit ib, entierro 1) illustrating musculoskeletal bone modification. photo by toyne. caring for foot amputees in late pre-hispanic túcume14 frostbite should be considered extremely unlikely in the relatively warm coastal desert environment of túcume. congenital defects of the foot, such as clubfoot, might also have been a reason for amputation (wright 2011). however, unilateral congenital malformations of the foot would have likely caused developmental consequences for the lower limbs due to asymmetrical weightbearing during development. in both case 1 and case 2, aside from reduced cortical density of the bones of the left leg, the morphology of the right and left lower limbs is symmetrical. this would seem to indicate that differential use of the lower limbs did not occur until skeletal maturity. the case for care regardless of the reason, or reasons, for amputation, changes to the distal tibiae and fibulae suggest that the individuals were still probably capable of locomotion (although locomotion might have been altered or required assistance). in both individuals, the slight loss of bone density in the affected left leg, as compared to the right leg, suggests a shift to preferred use of the right leg for supporting body weight. however, remodeling seems to have occurred in response to some force applied to the end of the left lower leg bones. this would appear to suggest that, while they were not using their left legs in a normal ambulatory fashion, the amputated limb might have contributed limited weight-bearing while standing, walking, or performing other activities. it is worth noting that the individual from huaca las balsas (case 1) additionally demonstrates remodeling and pronounced thickening of the muscular attachment sites for the adductor magnus and biceps femoris muscles on the right femur (fig. 9), possibly suggesting increased or irregular usage of the right leg. however, it is not clear if this change occurred as a result of biomechanical modification of the use of the lower limbs due to the amputation of the left foot. it could have also occurred separately due to another musculoskeletal injury. continued mobility after the amputation of the left foot could have involved the use of a crutch or prosthesis, which would have improved the efficiency of modified ambulation. earlier moche ceramic vessels depicting amputees often include crutches and cuplike coverings for amputated feet (checa 2010; paico vílchez and paico zumaeta 2020; urteaga-ballon 1991; vélez lópez 1913). vélez lópez (1913) and chauchat et  al. (2009) describe prosthetics made of wood found in a moche archaeological context. the fact that no such materials were recovered from the graves of the amputees at túcume does not rule out the possibility that they were used by these individuals during life. in fact, the asymmetrical cortical bone density of the humeri of both individuals could be a product of crutch use. additionally, a wooden crutch or prosthetic might help to explain the termite activity in case 2. the unilateral amputation of a foot does not seem to have caused total immobility in the young adult females excavated from huaca las balsas and huaca las abejas (case 1 and case 2, respectively). however, it is important to acknowledge the longterm consequences of amputation-related physical limitations that affected the lives of those with missing body parts. in these cases, amputation would have affected gait efficiency and left the individuals relatively less mobile than unamputated community members. it is possible that they walked with an uneven gait and likely could not participate in fast-paced or physically strenuous ambulatory activities. with or without the use of a crutch or prosthesis, ambulation would have required greater-than-average energy expenditure, leaving them unable to easily transverse túcume’s urban core. amputees might have relied on assistance and accommodation from community members for essential chores like food acquisition and other locationally tied economic exchanges. they also might have required assistance with pain management after the amputation procedure, which in itself would have required the attention of a person who had some level of practical anatomical knowledge and skill. unilateral amputation of the foot would not have prohibited these individuals from participating in typical gender-specific craft production activities, such as weaving, that do not involve strain on legs and feet. cloth production would have probably afforded them some level of economic independence, in addition to their limited ambulatory independence with the use of a weight-bearing device. however, evidence of an amputation that was probably therapeutic in nature suggests that these individuals did, in fact, receive dedicated medical care at least once in their lives. amputees likely relied on care and attention from kin, neighbors, and medical specialists during and after the surgery. modeling care medical and emotional care for amputees the lack of evidence for reduced social standing or greatly reduced quality of life after amputation in the two young adult females from túcume suggests caring for foot amputees in late pre-hispanic túcume 15 availability of surgical care, societal accommodation of physical impairment, and possible involvement of kin-based support systems in physical and emotional post-operative care. these amputees were evidently able to access the expert medical care needed to perform amputation by disarticulation, possibly due to their elite social status or wealth. additionally, skeletal remodeling suggests that they were provided with appropriate medical and general care after the surgical procedure (buquet-marcon et  al. 2007; van der merwe et al. 2010; zäuner et al. 2013). the procedure itself would have required anatomical familiarity and skill in execution, suggesting that practitioners of amputation operated as knowledgeable medical specialists and probably held unique positions in society, such as healers or shamans (mendoza 2003). the apparent disarticulation procedure that was performed at least twice during different time periods at túcume would have likely been executed similarly to a modern-day syme amputation, which involves cutting a fish-mouth incision around the ankle joint so that the tarsal bones can be easily accessed and pulled apart (yu and hudson 2001). the fatty flesh of the heel pad is later used to cover the end of the newly footless ankle. in addition to the disarticulation of the ankle joint, the syme procedure typically also involves the resection of the malleoli of the tibia and fibula (yu and hudson 2001), creating a more solid weight-bearing surface. neither of the cases discussed here show intentional removal of the malleolar portions, and clefted stubs depicted in moche representations of amputees suggests this was not common practice on the peruvian north coast in preceding centuries (verano et al. 2000). despite this inconsistency, the syme procedure provides what is probably the best baseline for estimating pre-hispanic amputation methodology. a healer or shaman performing an amputation would have needed at least a basic understanding of how to stop bleeding during and immediately after the procedure. this might have been achieved through tourniquets, limb elevation, and/or bandaging, as has been done historically in other parts of the world (kirkup 2007). blood loss could also have been reduced with the use of local plant-based remedies for bleeding and hemorrhaging (bussmann and sharon 2006, 2015). finally, cauterization or suturing might have been used to close the wound. precedent for such practices exists elsewhere in the pre-hispanic andes (cabieses molina 2007; mendoza 2003; moodie 1929; toyne 2015b). appropriate administration of naturopathic anesthetic and pain-relieving drugs (bussman and sharon 2006, 2015; martin 1970) would have greatly benefitted patient comfort during and after the surgical process. other necessary short-term post-operative care would have included wound hygiene and provision of food and water when the physical exertion required for self-care would have resulted in excessive pain or disruption to healing tissues. it would have likely involved changing bandages and administering anti-inflammatory and/or infection-combatting drugs as well (kirkup 2007; pullen 2010). some endemic plant species are used by local people in the modern day to ward off bacterial, viral, and parasitic infection, and these plants were likely used for the same or similar purposes in the distant past (bussmann and sharon 2006, 2015). another probable responsibility of ancient amputees’ caretakers was to aid in their efforts to relearn basic skills, such as walking (kirkup 2007). although rehabilitation after a unilateral syme amputation is less challenging than doing so after an amputation procedure that more dramatically alters the limb, the amputees from ancient túcume likely felt imbalanced and required interpersonal assistance while they adjusted to their new reality (finkler et al. 2017). assistance could have been given by people of close relation to the amputees, such as members of their immediate family. however, this is speculative. short-term post-operative care might have also been performed by medical practitioners or other community members. naturopathic treatments for pain and discomfort also probably played a role in amputees’ long-term care routines. the bichayo plant, for example, whose seeds were found in the burial context of the amputee from huaca las abejas (case 2), can serve as a remedy for arthritis, bone aches, and skin irritations (bussmann and sharon 2015:127). its presence in the grave of this individual could suggest that the plant became associated with her identity after frequent use, possibly as a solution to joint pain caused or exacerbated by habitual compensatory movements after loss of the left foot. use-related migration of the heel pad and subsequent ulceration (bibbo 2013) or the cyst-like structure present at the amputated ankle joint might also have been a cause of discomfort that the amputee and her caretakers attempted to treat through the use of bichayo. heel pad migration and ulceration are common in modern amputees whose feet were removed via the syme procedure, in which the fatty heel pad is used to cover the newly footless ankle stub (bibbo 2013), but it is unclear whether or not the surgeons of pre-hispanic túcume used the heel pad to cover the amputation wound. ultimately, it is important to note that the care necessary during post-amputation life includes physical as well as emotional support. studies of caring for foot amputees in late pre-hispanic túcume16 contemporary amputees show that amputation of lower extremities not only causes physical trauma, but also emotional and psychological damages. patients often suffer from anxiety, depression, grief, and social discomfort associated with changes to body image (liu et  al. 2010; madsen et  al. 2016). historically, these same post-amputation physical and psychological struggles were documented in civil war soldiers recovering from amputation as they attempted to come to terms with new limitations in functionality and shifts in their social identities (bonnan-white et al. 2016; miller 2015). it is impossible to know the emotional struggles of individuals who lived in the distant past, especially in societies not represented by written histories, but it is important to recognize that lived experiences encompass more than solely physical events. the social circles of the amputees from huaca las balsas and huaca las abejas likely provided important emotional support. implications of care social integration of amputees despite physical impairment and its emotional consequences, it is important to consider the fact that individuals affected by unilateral foot amputation might not have been classified as disabled within the societal norms of late intermediate period and late horizon túcume. some modern scholars studying the anthropology of disability choose to make a clear distinction between impairment and disability, with disability being defined as the social stigma that is associated with psychological or physiological impairment or malformation (kasnitz and shuttleworth 2001). ethnographic research on disability in a number of modern cultures has revealed that impairment-related stigma is not applied according to universal standards. atypical functional phenotypes are sometimes even seen as supernatural or sacred. rösing (1999), for example, relates several anecdotes of physical impairments in the modern andes that suggest recognition of disability is dependent on an impaired individual’s community contribution, and in some cases (such as those involving medicine men with crippled hands) impairment might actually be viewed as sacred. she presents the hypothesis that: “in the andes having more disablement often means being less disabled. the reasons are, amongst others, the broader space allowed for compensation within the framework of the norms of reciprocity and representation, as well as the sacred legitimization resource” (rösing 1999:40). the distinction between impairment and stigmatized disability provides some interpretive implications related to burial practice and social identity. social exclusion based on physical impairment could result in deviant burial—a burial style that deviates from the typical model (murphy 2008; shay 1985). in the andes, deviancy is often argued through atypical body treatment, separate burial location, lack of associated burial goods, or some combination of these characteristics. most examples of deviant burial in peru have been associated with sacrifice and warfare (eeckhout and owens 2008; verano 1995). although deviant burials of human sacrifices are found near the temple of the sacred stone at túcume (toyne 2015a, 2016), burials of this character have not been found elsewhere at the site. the amputees at huaca las balsas and huaca las abejas were seemingly not stigmatized for their lost left feet. all indications in the mortuary record point toward a conclusion of social normativity rather than social deviancy for these young female amputees. in fact, it is possible that they might not even have been considered disabled. the apparently high level of social integration experienced by these individuals suggests that they were not outcasts or criminals whose left feet were removed for punitive purposes, despite the depictions of amputees in moche ceramics that seem to suggest punishment as one potential motivation of amputation (vélez lópez 1913; verano et  al. 2000). instead, they were probably individuals with unexceptional social positions and reputations whose feet were amputated as treatment for a medical condition. pre-hispanic amputation as social practice the amputations discussed in this paper might have had a ritual or sacred significance due to earlier depictions of feet and individuals with amputated feet by moche and wari ceramic vessels, which suggest symbolic importance of the lower extremities. such a conclusion could also be supported by the presence of footless guardians in grand moche (alva and donnan 1993; verano 1997) and wari (więckowski 2016) tombs. however, while valid parallels can be drawn between pre-lambayeque art, pre-lambayeque mortuary symbolism, and the chronologically later amputation cases at túcume, there is not a consistent pattern for ritually motivated amputation in these cases. andean gendered cosmologies could also be used to construct an argument for ritually or symbolically motivated foot amputation at túcume, although this is not strongly supported by contextual evidence. the dualistic gendered symbolism caring for foot amputees in late pre-hispanic túcume 17 of andean cosmology denotes parallelism and complementarity that is ref lected in religious and political practices (silverblatt 1987; vogel 2018). therefore, pre-hispanic andean religious rituals often involved separate but parallel spatial organization within sacred spaces (silverblatt 1987). this included the body. in pre-hispanic andean cosmology, the left side of the body and the feet were often characterized as feminine, while the right side and head were characterized as masculine (baumann 1996). the appearance of two young adult women of similar social standing with leftside foot amputations at túcume could potentially indicate a gendered ritualistic practice. however, other known cases of pre-hispanic pedal amputation on the peruvian north coast are inconsistent with this pattern (table 1). at other sites, male individuals are found with bilaterally or unilaterally amputated right and left feet, as are females (chauchat et  al. 2009; vélez lópez 1913; verano et al. 2000; więckowski 2016). this research, in concert with the amputation cases published by verano et al. (2000) and chauchat et  al. (2009), show that non-symbolic amputations occurred in pre-hispanic north coast peru. motivations for foot removal were likely diverse, and medicine might not have been the only reason that these surgeries were performed. nonetheless, there do appear to be some shared characteristics between amputees. all presently known cases of amputation in the ancient andes have been identified on the north coast of peru, all have occurred in individuals who survived the procedure to die as adults, and all seem to have been buried as relatively high-status people (or were buried alongside them). this evidence suggests that amputation-related medical knowledge has deep roots in earlier cultures. also, access to medical care such as amputation might have been an elite privilege that was not accessible to people of lower status. conclusion the medical history and post-amputation care practices of the young adult females with amputated left feet found at huaca las balsas and huaca las abejas provide new evidence for medical knowledge, societal conceptions of functional impairment and disability, and broader patterns in amputation in pre-hispanic north coastal peru. this research demonstrates that pedal amputation via disarticulation at the ankle joint has an even longer and more dynamic regional history than has been previously published. the lambayeque and chimú-inca amputees from túcume illustrate a regional continuity of medical knowledge that transcends major sociopolitical disruptions and power transitions over hundreds of years between moche regional dominance and the arrival of the spanish. additionally, the evidence shows that amputation had a multidimensional and perhaps contextually specific social significance in lambayeque and later cultures of the peruvian north coast. while past bioarchaeological and ceramic evidence has suggested that amputation was used for punitive and symbolic reasons, amputation at túcume seems to have been a primarily therapeutic practice. these female foot amputees appear to have been integrated members of society who were able to access advanced surgical care and then survive for years afterward—through care and accommodation by community members—without severe social stigmatization despite newly limited physical functionality. this research sheds new light on amputation as a community practice in pre-hispanic north coast peru. however, perhaps more importantly, it lends new temporal and cultural depth to broader anthropological understandings of functional impairment and healthcare. the experiences of elite-status amputees at túcume should fuel further thought about the ways in which class status, community support, and other variables affect medical care and social accommodation for functionally impaired people. acknowledgements we thank alfredo narváez vargas for his long-term commitment to archaeological explorations at túcume. daniel sandweiss has also been a great colleague. excavations at huaca las balsas were completed under the authorization of the national directorial resolution no 812/inc, 2009, and at huaca las abejas, the national directorial resolution no 288-2017/cgpa/vmpcic/mc. we also are extremely grateful for the decades-long support and friendship of oswaldo chozo capuñay, manager of the archaeological collections at the museo túcume, and the many archaeologists, staff, and workers. we would like to specifically thank mila cancino and felix angel gutierrez. for contributions in the lab, toyne thanks stefani wai, paige douglas, taylor remley, and wesley garrett. radiographic assistance came from dr. mislav čavka, dr. fabio cavelli, and dr. fabrice dedouit, zagreb. finally, we are grateful for the valuable feedback from reviewers. caring for foot amputees in late pre-hispanic túcume18 references cited adejumo, adebayo, and prisca olabisi adejumo. 2005. time to act against medical collusion in punitive amputations. british medical journal 330(7502):1277. doi: 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bioarchaeology international volume 6, numbers 1–2: 1–22 doi: 10.5744/bi.2022.6000 building a bioarchaeology of pandemic, epidemic, and syndemic diseases: lessons for understanding covid-19 gwen robbins schuga,b* and siân e. halcrowc abstract   as we enter the third year of the covid-19 pandemic, the scientific community has met the sars-cov-2 virus with efficient and effective responses in epidemiology, molecular biology, genetics, vaccine development, and new treatment options. yet the toll of the virus on public health has been uneven globally and within nations to an extent that has led stem professionals to inevitably conclude that a truly effective response requires insights and mobilization from across the social sciences and humanities. it is hard to express how much the pandemic has impacted almost every aspect of life in human communities and how it has laid bare longstanding social problems, like social inequalities. the pandemic has also illuminated the extent of more recent pernicious social forces, such as disaster capitalism, and provides an ominous window into how some governments and societies will meet challenges such as climate change. this introduction presents six commissioned articles that demonstrate the power of an anthropological approach to the biocultural and evolutionary aspects of pandemic and epidemic diseases in the past. in this article, we also frame a path for bioarchaeologists to contribute to incredibly important questions and debates about the global pandemic by situating the articles into holistic theoretical approaches. keywords: bioarchaeology; pandemics; covid-19; sars-cov-2; zoonoses; social inequity the recent outbreak of covid-19, a disease caused by infection with a novel coronavirus sars-cov-2, began as an epidemic in wuhan, china. covid-19 was first recognized as a new infectious disease in december 2019 (petersen et al. 2020; zheng 2020), and the chinese government rapidly moved to put wuhan under a strict lockdown to try and confine the outbreak. later that month, the disease was recognized in the state of washington, in the united states, in an individual who had recently traveled to wuhan. cases multiplied in outbreaks around the globe through the months following and countries began instituting travel bans to try to control the spread of what was quickly becoming an epidemic disease. covid-19 was declared a pandemic by the world health organization (who) on 11 march 2020, when cases of covid-19 in china had increased 13-fold and the disease had been found in 114 countries with more than 118,000 cases, and people fighting to save lives in many hospitals. at this time, there were 9,000 cases in iran and more than 7,700 in south korea (who 2020; chappell 2020). in the majority of european countries, hospitals were overwhelmed with cases; in italy, more than 630 people had died of covid-19 at that time. the country had 10,000 cases, second only to china, and the world soon watched as italians sang to one another from their balconies while in quarantine (rudan 2020). the recent and ongoing global pandemic shut down societies around the globe as cases multiplied exponentially, and it became clear the toll covid-19 would have in terms of morbidity and mortality. the covid-19 pandemic has illuminated social forces that affect the transmissibility, susceptibility, and outcomes of infection with this virus, including syndemic effects with degenerative diseases, obesity, diabetes, hypercholesterolemia, and coinfection with other coronaviruses, influencing susceptibility and outcomes for covid-19 patients; social determinants of health, creating deep disparities in access to vaccines as well as in the risk of serious disease; significant physical impairment for people with “long covid”; and coevolutionary processes creating more endemic and more infective strains of the virus. the impacts of this pandemic extend far beyond the risk for infected individuals and have resulted in financial and economic repercussions rippling through global economies, widespread mental health challenges in adults accompanied by developmental and learning deficits for children, and extreme social divisions, distrust for authority, “othering,” and targeting of already vulnerable groups, even escalating to physical violence. we have yet to fully grasp the demographic and evolutionary consequences of the pandemic, although it is becoming clear that genetic, social, and environmental factors play a role in susceptibility to severe disease (see, e.g., anastassapoulou et al. 2020; godri pollitt et al. 2020; sironi et al. 2020), and there may also be impacts on pregnant women and infants that will be felt in the coming generations (wastnedge at al. 2021). covid-19 has highlighted the role of caregiving in disease susceptibility (connor et al. 2020; gausman and langer 2020; wade et al. 2021) and gender inequality in this labor (fortier 2020). the pandemic has put a spotlight on enduring racism and discrimination (khazanchi et al. 2020), the health impacts of racism (devakumar et al. 2020), and other forms of structural violence (nandagiri et al. 2020; samra et al. 2020; singer and rylko-bauer 2021). it is also challenging our conception of disability (banks et al. 2021; mckinney et al. 2020) as those known as the “long-haulers,” in particular, face substantial hurdles to their physical and cognitive ability that will necessitate new systems of care for these individuals and their families (baig 2021; dorfman 2021; rubin 2020; smith 2022). the covid-19 pandemic has also had consequences for how we view our relationship with the so-called natural world, with debates, for example, about the importance of regulating human–animal interaction and wet markets (aguirre et al. 2020; fine and love-nichols 2021; mizumoto et al. 2020). there have been developments too that might be considered positive, which have resulted from the pandemic, with scientific breakthroughs in rna research and vaccine development that will certainly bring a renaissance in the treatment of a large number of diseases and conditions (pardi et al. 2018). the vaccine development and rollout were only made possible through the collaboration between governments and scientists across the globe, although there is more work to be done in ensuring equitable rollout among countries. as noted, covid-19 has revealed the harsh realities of significant structural inequalities and barriers to health care, the vaccine rollout, education, housing, and food, and we see some positive reactions from some organizations and governments to addressing these structural inequalities. the unfortunate spread of disinformation on covid-19 vaccinations has led to support on various social media platforms for science and public health informed perspectives (e.g., twitter’s covid-19 misleading information policy). with zoom becoming a common venue for academic and other meetings during covid-19 travel restrictions, longstanding concerns are finally being acknowledged about accessibility for people with young children or other care responsibilities, underlying health conditions, disabilities, or who cannot afford to travel for conferences. the current global covid-19 pandemic presents an opportunity for bioarchaeologists to contribute long-term perspectives toward understanding and responding to the current-day global crisis in health. bioarchaeology is uniquely poised to give insights to each of the aforementioned aspects of research on the covid-19 pandemic because of our focus on the history and evolution of infectious diseases in the past and our recognition of humans as biocultural organisms embedded within larger historical-environmental-social-cultural (hesc) contexts. we have at our disposal evidence from mortuary, skeletal, molecular, and isotopic sources that can provide a direct source of evidence about past epidemic diseases (dewitte 2016). the articles in this special issue of bioarchaeology international create sophisticated histories of epidemics, pandemics, and syndemics, which inform larger questions about human health in medical, epidemiological, evolutionary, biological, sociological, historical, policy, planning, and human security discourse. in this introduction to the special issue, we summarize some of the lessons learned from bioarchaeological research on the pandemic, epidemic, and syndemic diseases of the past and how our research informs an anthropological perspective on covid-19. the articles in this special issue are instructive as to how bioarchaeologists and paleopathologists approach epidemic, endemic, and pandemic diseases from a variety of social and cultural theories, and evolutionary and demographic perspectives. when an infectious disease affects a wide swath of a population, we call it an epidemic. epidemic diseases have become an increasingly important evolutionary pressure on modern humans over the course of the holocene as we settled in villages and developed socio-sanitation problems, began to closely associate with animals, and relied more heavily on a few staple cereal crops for our principal source of calories (armelagos et al. 2005). a pandemic is an epidemic infectious disease that has spread across a larger region, affecting multiple countries and continents. it differs from an endemic disease in that a pandemic is an acute event, rather than a longstanding event/disease burden. for instance, malaria is widespread around regions of the world, but it is a disease that has lingered, affecting a large proportion of many human populations for an extended duration, a period of time that exists on an evolutionary timescale. this special issue brings anthropological and bioarchaeological perspectives to bear on pressing social science and biological questions that are currently relevant in the context of the covid-19 global pandemic. here we provide a brief review of theoretical concepts that are at work in the different articles in this issue, explicitly in some (e.g., social determinants of health and critical medical anthropology concepts, such as structural violence) and implicitly in other cases (e.g., the concept of syndemics, not explicitly used much in bioarchaeology to date). these theoretical approaches can be usefully incorporated into more traditionally applied evolutionary and demographic approaches to past epidemics and pandemics as bioarchaeologists turn our data toward addressing problems of contemporary relevance, such as the consequences of hesc forces and human behavior in a pandemic. the articles in this special issue offer holistic models for understanding the evolution and demographic consequences of pandemics, including sophisticated models for assessing the role of human mobility processes and animal–human–environment interactions. a syndemics approach to infectious diseases syndemics theory focuses on synergisms within the biosocial complex that perpetuate and exacerbate negative health outcomes by promoting co-morbidity, altering disease ecology, and contravening healthy epidemiological landscapes, often across the life span and intergenerationally (singer 1994, 2009). stemming from her work on multigenerational impacts of substance abuse during pregnancy (singer and snipes 1992), anthropologist merrill singer developed the concept of syndemics to describe the multitude of factors driving the aids epidemic, focusing specifically on the co-occurrence of substance abuse and violence in communities most susceptible to hiv and aids (singer 1994). this model is widely used in global health research (mendenhall 2017) and medical anthropology (see singer and erickson 2015 for a review), and the notion of syndemics powerfully encapsulates the role of vulnerability and socioeconomic inequality in shaping the disease experience for covid-19 patients (caul 2020; horton 2020; singh et al. 2020). this concept has only occasionally been invoked in paleopathology as a useful interpretive framework to explain evidence for co-morbidity, for example. the concept of syndemics has been explicitly promoted as an interpretive path to explore when we encounter evidence for disease in human skeletal remains (crespo 2020); it has been applied to bioarchaeological research on a suite of epidemic diseases in post-columbian north america (jones et al. 2021) and to the connection between tuberculosis (tb) and diabetes in present-day communities in new zealand (littleton et al. 2014). in a recent review article about the concept of syndemics and its use in research on the history of disease, newfield (2021) makes an important observation that “most of the ever-growing body of historical epidemiological scholarship misses the syndemic mark in that it quarantines the history of one disease, or disease event, from all other diseases. few historians of disease or medicine interrogate co-morbidities or multi-morbidities, or, therefore, seek to identify the factors that cause diseases to cluster in the first place.” this criticism also applies to bioarchaeology. in part, this is a weakness of skeletal data; bone can only respond to disruptions in homeostasis in a few limited ways because of the structural-functional qualities of the tissue. this makes it difficult to disentangle co-morbidities in an individual, and there are also interpretive issues due to the so-called osteological paradox—in which chronic conditions are more likely to be expressed and heterogeneous frailty biases our interpretation (dewitte and stojanowski 2015; wood et al. 1992). in part, it is also a limitation of the archaeological samples, or populations, we work with, which are not representative of a living whole but of the preserved and recovered non-survivors. while a syndemics perspective has not frequently been explicitly applied in many bioarchaeological studies, this special issue demonstrates how syndemic thinking is already at work in our understanding of epidemic and pandemic diseases of the past and their lessons for research on covid-19. the syndemic concept or “syndemic thinking” (newfield 2021) has been implicitly used in some bioarchaeological research to examine a wide variety of factors that have promoted or constrained the spread of disease in the past, including the influence of perception and cultural beliefs about sickness (marstellar et al. 2011) and disability (byrnes and muller 2017), gender ideology (zuckerman 2017), social determinants of health across the life course (gowland 2015), social marginalization (mant and holland 2019), climate and environmental conditions (robbins schug 2020), and human–environmental interactions (aufderheide et al. 2004). it is important when considering syndemics to view disease from a holistic perspective, reconstructing life span epidemiology, focusing on the likelihood of concurrent conditions, the influence of entangled hesc forces, perceptual and semiotic aspects of health, the embodiment of mental and emotional states, and personal agency as a force for specific disease ecologies in past populations. the articles mentioned above and by those in this special issue consider a holistic perspective of disease in our understanding of epidemic and pandemic diseases of the past and their lessons for research on covid-19, whereby endemic, epidemic, and pandemic diseases are socially and culturally contextualized, particularly using theoretical frameworks of disability studies, social determinants of health, intersectionality, critical medical anthropology, epidemiology, and evolutionary biology. bioarchaeology, disability studies, and “long covid” as byrnes and muller (2017:1) point out in their volume devoted to a bioarchaeology of disability and impairment, disability has received little attention in bioarchaeology until recently because the concept has conflicting definitions. disability is often imagined to exist at an intersection between functional (or “biological”) impairment, the culturally influenced meaning and perception of impairment or impaired people, and social forces such as political economy, medicalization, and discrimination. however, contemporary debate in the wider field of disability studies centers on ability as a discursive field within the civil rights movement (owens 2015). ability is also one aspect of our intersectional identity (crenshaw 1989, 2017); it is defined by habitus and enacted through our thoughts, perceptions, and actions (bourdieu 1977:179). ability can also be perceived as a form of diversity (ginsburg and rapp 2020), a subjective lived experience (cascio 2015), or as “otherness” and “difference” that is a social fact with material consequences. ability is also a category that is situated within a nexus of power relations (kasnitz and shuttleworth 2001; owens 2015). anthropological engagement with disability studies is “focused on all stakeholders in local contexts and committed to an ethic of social justice” (kasnitz and shuttleworth 2001:27). this focus on ethics and critical medical anthropology situates the concept of disability in the wider phenomenon of medicalization, a process through which, beginning in the eighteenth century, health and disease became recognized and difference became signified and imbued with meaning (foucault 1961, 1963). medicalization is an idea derived from and something that cannot be distinguished from a discourse about power relations, and this too is true for the concept of disability, which invites an analysis of social structures and power relations in a variety of contexts, including medicine, law, government, and religious institutions. heather battles and rebecca gilmour’s (2022) work informs the question of how disability intersects with infectious disease epidemics in the past. in “beyond mortality: survivors of epidemic infections and the bioarchaeology of impairment and disability,” they engage with disability theory to discuss the long-term impacts and chronic health problems associated with the poliomyelitis (polio) epidemics of the mid-twentieth century. polio, like many infectious diseases, is only symptomatic in a small percentage of cases, and the form most recognizable in human skeletal remains, the paralytic form, only affects 2% of cases. the disease may be recognized by alterations to morphology associated with disuse—limb shortening, atypical torsion or curvature of limb bones, or bone atrophy, a set of skeletal changes that have a very broad-ranging set of conditions making differential diagnosis difficult. however, battles and gilmour point out the high likelihood that this disease was endemic in large urban populations of the past and how it would likely have taken on epidemic proportions each time it was introduced to a new population. battles and gilmour powerfully combine three “bioarchaeologies”—the bioarchaeology of care (tilley 2015), personhood (boutin 2016), and disability and impairment (byrnes and muller 2017)—to create what they deem the survivor-lens approach. using the sequelae associated with polio as their example, they demonstrate a new way to conceptualize the long-term impacts of epidemic and pandemic diseases in the past. battles and gilmour offer a way for bioarchaeologists to engage with the long-term consequences of infectious epidemics in the past, including a consideration of how these outbreaks can shape individual embodied experiences, how they constrain or challenge barriers and abilities, and how they may open a door to sociocultural change in past societies. using the survivor-lens approach, bioarchaeologists can go beyond the evidence of a physical difference or functional impairment, to seek evidence for distorted power relations and their embodiment in the skeleton. we are confident that, in the coming years, battles and gilmour’s model will be useful for other diseases in bioarchaeology. for example, leprosy is a disease that can leave significant physical disability, leaving sufferers missing fingers and toes or lacking sensory abilities (blind, unable to smell or taste). the stigma of this disease, beyond the physical manifestations, limits the potential for many of its sufferers while simultaneously opening a path to an unprecedented degree of freedom for others (roberts 2020a; staples 2005). this disease was recognized and was signified as a mark of “spiritual corruption” by at least the second millennium bc (robbins schug 2016). battles and gilmour also demonstrate how the polio epidemic offers important insights into the current pandemic. polio, like a wide range of other past epidemics, offers a long-term perspective on public health given these sequelae and their impacts on health throughout the life span. the major focus of research on covid-19 so far has understandably been on morbidity and mortality in the short term, but we already know that “long covid” or “covid long-haulers” are suffering and will continue to suffer debilitating symptoms into the future, including loss of taste and smell, neurological problems, extreme shortness of breath upon exertion, and other potential sequelae (mendelson et al. 2021; nikhra 2021; sudre et al. 2021). the survivor-lens approach offers a conceptual framework for studying those potential impacts and their meaning. who suffers? social determinants of health, intersectionality, and structural violence the social determinants of health framework demonstrates how personal and social identity intersects with socioeconomic inequality, marginalization, and structural or institutional violence to create inequities in health outcomes and access to care. vulnerability to epidemic and pandemic disease is strongly determined by hesc processes that increase the likelihood of exposure to pathogens, decrease access to treatment and care options, and undermine the trust necessary for successful public health interventions. in the covid-19 pandemic, we have seen black, hispanic, and indigenous people at greatest risk for morbidity and mortality, in part due to preexisting health disparities resulting from marginalization and also due to economic inequalities in who becomes an “essential worker” versus who has the luxury of staying home (abrams and szefler 2020; alcendor 2020; ataguba and ataguba 2020; dalsania et al. 2022; de souza santos et al. 2021; debopadhaya et al. 2021; fathi et al. 2021; hasan bhuiyan 2021; mcneely et al. 2020; singu and acharya 2020; tai et al. 2021). people in underrepresented communities in the united states have been denied access to medical care (egede et al. 2021), cannot always logistically or financially access necessary care (tai et al. 2021; vargas and sanchez 2020), and have directly suffered from mistrust of medical and government institutions that creates attitudes and behaviors that contravene preventative measures (kricorian and turner 2021; malik et al. 2020; scharff et al. 2010). the lack of representation of black, hispanic, and indigenous providers in the national health care and scientific infrastructure in the united states not only creates opportunities for discrimination (daley et al. 2021; james 2017) but also suggests significant lost opportunities for innovative solutions to the crisis (e.g., ramirez 2021; sweeney 2021). the social determinants of health framework is used to demonstrate how social, economic, and political processes give rise to stratification by income, education, occupation, gender, race, ethnicity, and other factors. these socioeconomic positions, in turn, shape specific determinants of health status where certain epidemic diseases can “feedback” to affect the functioning of those social, economic, and political institutions. covid-19 research has been shaped by these perspectives (e.g., abrams and szefler 2020; ataguba and ataguba 2020; bambra et al. 2020; singu et al. 2020). this is true not only for the impact of the pandemic on people of diverse racial or ethnic identities but also based on disparities in class, gender, mental health status, ability, and rurality (e.g., mcquaid et al. 2021; paul et al. 2021; shakespeare et al. 2021; sharma et al. 2020; turner-musa et al. 2020). one highly stigmatized and marginalized group that has received less attention in covid-19 research today includes people who are institutionalized—in prisons, group homes, and other such settings (e.g., hege et al. 2021; upshaw et al. 2021). this has been previously pointed out in historical research on pandemics, such as the 1918 influenza pandemic (mamelund and dimka 2021). this issue is critically important as we know the largest single-site outbreaks of covid-19 in the united states were in prison populations (https://covidprisonproject.com/), yet stigma prevents substantial research focus on these populations. the effects of institutionalization and pandemics are explored from a bioarchaeological perspective in this special issue. molly zuckerman’s (2022) article, “institutionalization within the context of pandemic infectious disease: examining social vulnerability to the 1918 influenza pandemic amongst individuals institutionalized in the mississippi state asylum,” uses historical demography to explore disability. she demonstrates how individuals within congregate settings who have been deemed inconvenient or unfit are most vulnerable to the impacts of pandemic disease, and they are most likely to be forgotten in pandemic preparedness planning. this article combines concepts from intersectionality, structural violence, and social determinants of health frameworks to demonstrate how social forces created elevated risks for mortality from influenza for young adults, particularly black residents, who were overrepresented in the institutional population compared with the demography of mississippi at that time. although higher mortality rates for black adults were consistent with a nationwide trend, zuckerman’s article demonstrates how black patients were more likely to become institutionalized, and thus at greater risk for influenza in the first place, through a confluence of discriminatory, structurally violent, racist, and ableist forces in mississippi and throughout the south of the united states. zuckerman presents an analysis of data from the mississippi state asylum, which has housed more than 30,000 residents and for whom detailed records were kept. of these, more than 2,200 death records are available for the period circumscribed by the pandemic. this type of detailed, longitudinal data is one of the principal advantages of taking a historical bioarchaeology approach to social determinants of health in pandemic diseases. respiratory-related deaths—tuberculosis, asthma, pneumonia, and influenza—represent a typical syndemic of health issues frequently seen today in institutionalized people worldwide (basu et al. 2011; gostin 2006; licata et al. 2021; simpson et al. 2019). disability, poverty, racism, and insufficient care work in synergy to increase the risk of mortality. although detailed descriptions of the life and death of black mississippians are unavailable in such a large number for the nonresident population, this article does explore how the greater risk of exposure in the first wave of the pandemic led to co-immunity in subsequent waves, which buffered black communities despite malnutrition, co-morbidities, and health consequences of structural violence and racism. zuckerman’s approach focusing on disabilities and institutionalized populations will be valuable to epidemiological research on covid-19 and is an important contribution for bioarchaeologists interested in syndemics, even though this concept was only implicitly used. the article demonstrates that as we assess identity and social categories of difference, it is critical that we acknowledge the multiplicity of identity that is described by the concept of intersectionality (crenshaw 2017). intersecting identities work together in a reciprocal fashion to form systems of oppression (collins 2015). “intersectionality and the interpretation of past pandemics” by samantha yaussy (2022) operationalizes this concept for the study of pandemics in past populations in an attempt to encourage additional research in this area within the field of bioarchaeology. she begins with a review of the development of the field of intersectionality and some of the issues with the adoption of this approach in bioarchaeology. she explains the significant number of identity categories and relationships of inequality among these social divisions, which include race, gender, class, education, relationship status, parenthood, sexuality, gender identity, indigeneity, and disease (springer et al. 2012; yaussy 2022), that may exist in conflict and be differentially expressed cross-culturally and through time. yaussy also explores how intersectionality is employed in sociology, anthropology, and public health, again using approaches that are implicitly but deeply informed by the concept of syndemics. the incredibly valuable contribution of this article is that yaussy developed three quantitative methodologies for bioarchaeologists to explore and understand the multiplicative effects of intersecting identities, particularly within the context of paleopathology. she describes specifically how statistical methods already widely used in the field can be adapted to elucidate the intersecting, overlapping, and accumulating impacts of identity in shaping susceptibility, risk, and impacts of pandemics in the past. prior to this special issue, yaussy could identify no published works in the bioarchaeological literature that explicitly combined the concept of syndemics, intersectionality, and the social determinants of health framework to explore past pandemics, although there have been allusions to such an approach, and certainly scholars have used these frameworks individually (e.g., byrnes and muller 2017; geller 2017; gowland 2017; mant et al. 2021; torres-rouff and knudson 2017; yaussy 2019). yaussy directs bioarchaeologists to the potential for this type of research on the black death and tuberculosis, in particular. these three articles by battles and gilmour, zuckerman, and yaussy demonstrate that the root of theoretical frameworks like social determinants of health, intersectionality, disability, and syndemics is the critical medical anthropology concept of structural violence. structural violence describes how social relations, structures, and institutions constrain human agency and work to impinge upon human potential, denying some people or groups access to basic resources and contributing to increased susceptibility to disease. structural violence is arguably the leading cause of human suffering, morbidity, and disability today (farmer 2004), and this social suffering is exacerbated in situations of increased social stress, including warfare, climate change, and epidemics and pandemics, including covid-19 (barrientos et al. 2021; cabatbat 2021; kabel and phillipson 2021; morgan and rose 2020; nandagiri et al. 2021; saldino et al. 2020; samra et al. 2020; singer and rylko-bauer 2021; singh and singh 2020). as we mentioned above, there is important research already being done on how structural violence and syndemics inform our understanding of covid-19, and that work has already been synthesized in an excellent comprehensive review by singer and rylko-bauer (2021). in bioarchaeology, structural violence as a framework has been explicitly employed since carlina de la cova articulated how gender, race, and class formed the basis for physical violence against certain bodies as opposed to others (de la cova 2008, 2011, 2012, 2020). since that groundbreaking work, structural violence has been applied to other documented skeletal collections derived from marginalized communities (watkins 2012, 2018a, 2018b; watkins and muller 2015), often assembled despite a lack of consent (dunnavant et al. 2021). over the past decade, structural violence has been used as a guiding framework for bioarchaeological research in undocumented archaeological assemblages of human remains from a variety of cultural and social contexts, both historic and ancient (ellis 2020; filipek et al. 2021; geber 2015; klaus 2012; martin and harrod 2020; martin et al. 2010, 2012; nystrom 2014, 2017; nystrom and robbins schug 2020; robbins schug 2017; robbins schug et al. 2012; sheridan and gregoricka 2020; stone 2012; tegtmeyer and martin 2017; torres rouff 2020). unfortunately, social suffering is embodied most frequently by mothers and infants in the modern context and probably in the past as well (ellis 2014; filipek et al. 2021; geber 2015; halcrow and robbins schug in press). in bioarchaeology, skeletons of infants and children are regularly used as a proxy for social determinants of health (halcrow and tayles 2008; halcrow et al. 2017; robbins schug 2011; robbins schug and blevins 2016; robbins schug and goldman 2014; snoddy et al. 2017; for a review, see mays et al. 2017; halcrow and ward 2017). the conceptualization of health and care for mothers and babies in the past draws on anthropology as a holistic field, not a set of subdisciplines, to advance a more holistic understanding of the evolutionary, social, and health significance of inequality (halcrow et al. 2020). a model of health care for mothers and babies in the past has recently been proposed, drawing on different anthropological subdisciplines to advance a more holistic understanding of the evolutionary, social, and health significance of this practice (halcrow 2020; halcrow et al. 2020). this model considers a number of social facets of care and methods from a range of disciplines, including the archaeology of grief and emotion; aspects of identity, including social inequality, gender, community support and alloparenting, infant feeding, and maternal and infant health; environmental factors such as pathogen load; and life history theory. unequal access to health, safety, and medical care during early life also has effects across the life course and intergenerationally (agarwal 2016; dewitte and yaussy 2017; gowland and halcrow 2020). thus, research on social determinants of health in bioarchaeology can be informed on a conceptual level by the developmental origins of health and disease (dohad) hypothesis and life history theory. the dohad hypothesis describes how environmentally induced physiological changes during fetal development and infancy can have long-term consequences on morbidity and mortality later in life (cheverko 2020:66). early life adversity is embodied in the skeleton through pathophysiological markers commonly referred to as “biocultural stress markers” (klaus 2014). although molecular epigenetics is not well understood to a degree we can employ these concepts in bioarchaeology, on a conceptual level, we can use skeletal populations to examine the intersection of evidence for early life stressors, disease susceptibility, and the potential for intergenerational effects on plasticity and morphology (gowland 2015). it is unclear to a large extent what the risks are for the maternal–fetal nexus from covid-19. there is evidence that pregnancy influences immune response to sars-cov-2 infection (ovies et al. 2021), and pregnant women also mount a robust reaction to the mrna vaccines (atyeo et al. 2021; bordt et al. 2021). the possibilities for and the likelihood of vertical transmission are still unclear (ashraf et al. 2020). premature birth has not been decisively demonstrated as a likely outcome in cases of gestational covid-19 (pirjani et al. 2020; takemoto et al. 2020), nor has increased risk for cesarean section or elevated chance of fetal mortality been conclusively linked to covid-19 (mullins et al. 2020); however, these results do not necessarily hold true across all cultural contexts (vizheh et al. 2021). there is some clinical evidence for placental injury and neurological damage in children (lin et al. 2021; wong et al. 2021). although pregnancy outcomes appear good in many cases, available data are primarily on pregnant women infected in their third trimester (yang et al. 2020). studies indicate that newborns from covid-19–infected mothers have a significantly higher risk of morbidity and mortality, and pregnant women themselves can suffer serious and debilitating symptoms and sequelae (villar et al. 2021). these issues have yet to be resolved as it will take time to see these effects. although few specific direct impacts from the sars-cov-2 pathogen have been demonstrated thus far, what has become very clear is that social determinants of health led to an increased risk of death for some pregnant women who had co-morbidities that are all strongly tied as well to social inequality (dongarwar et al. 2020; fathi et al. 2021; siqueira et al. 2021). other than elevated risks related to advanced age, in the majority of cases, elevated risk for pregnant women with covid-19 is due to preexisting conditions—obesity, diabetes, and asthma—which are exacerbated by social conditions of poverty and marginalization due to race or ethnicity, which are also responsible for higher rates of prematurity even in the absence of a global pandemic (hessami et al. 2020). there are many other ways in which the pandemic shapes risk for people who identify as women in regard to violence, immigration, access to health care, and reproductive justice (e.g., chandrasekaran et al. 2020; hernández 2020; moreau et al. 2021; pandya and redcay 2021; todd-gher and shah 2020). the pandemic, stay-at-home orders, and threats to reproductive justice harm people who already live at risk from domestic violence, unequal access to health care and other resources, or mother–infant and family separation (alemi et al. 2020; anarudran et al. 2020; blue et al. 2021; busch-hallen et al. 2020; piquero et al. 2021). psychosocial effects on mothers in the covid-19 environment are also becoming apparent, including significant negative associations resulting from separation/isolation and infant developmental factors (wang et al. 2020). there have been calls for a nuanced biosocial anthropological approach to covid-19 with a number of recent publications focusing on the maternal–infant nexus, maternal–child health, and the potential for transgenerational effects (leonard 2020). for example, a 2020 special volume in the american journal of human biology emphasized deleterious effects on maternal stress; immune function; low birth weights; psychosocial stress; infant feeding, growth, and development; and potentially later-life health outcomes (bogin and varea 2020; gildner and thayer 2020; palmquist et al. 2020). anthropologists too have explored the impacts of unpredictability and insecurity on the social networks that allow humans to successfully care for our offspring (nelson 2021). these impacts are vastly different for women and children depending on their social position. this work underscores the importance of the comparative, anthropological, and evolutionary perspectives in providing the necessary context for understanding how covid-19 is shaping maternal–child health over the long term. evolution, demography, mobility, and animal–human interactions in paleoepidemiological models the final three articles in this special issue tackle paleoepidemiology of infectious diseases, human–pathogen co-evolutionary processes, and the role of cross-cultural differences in human–animal interactions as they shape the risk for zoonotic disease transmission. paleoepidemiology is by definition an interdisciplinary area that examines the incidence, distribution, and spread of communicable diseases in past populations, when medical interventions were limited in effectiveness and variation in the natural history of different diseases is thus more visible (waldron 2007). paleoepidemiology is at the root of bioarchaeological research on infectious disease (zuckerman and armelagos 2014), but it is complicated by a large number of factors (e.g., population interaction, residential mobility, population density, climate change, and subsistence) that play into the population-level experience of a disease. bioarchaeological research on this topic has the potential to inform present-day questions about biosocial and cultural factors that shape disease transmission and who is more or less at risk, particularly because of our focus on social determinants of health and structural barriers to health. access to resources within society will shape possible responses to pandemic disease, including opportunities for migration or the ability to limit interactions with the “outside world,” which then become intrinsically interlinked with disease transmission and the risk for morbidity and mortality (singu et al. 2020; thakur et al. 2020; varkey et al. 2020). what has become clear with the current covid-19 pandemic is that human mobility and interaction are at the core of its transmission, which is typically the case with globalization and infectious diseases (saker et al. 2004). migration due to climate, environmental, or social crisis creates elevated risks for communicable disease and is often responsible for altering disease ecology in ways that will enhance transmission; this is particularly true in cases of labor migration, forced displacement, and resettlement or in situations where rural people resettle in urban slums (mcmichael 2015). mobility that does not involve relocation (travel) was the principal driver of the global pandemic spread (choi et al. 2020; furukawa et al. 2020; ng et al. 2020). the link between human mobility and epidemic outbreaks is a longstanding one, which is explored in melandri vlok and hallie buckley’s (2022) article “paleoepidemiological considerations of mobility and population interaction in the spread of infectious diseases in the prehistoric past.” these authors provide a critical new tool for understanding the anthropological dimensions of disease transmission over the long term through a novel theoretical model that considers the interplay of climate suitability, population density, residential mobility, and human interaction levels using paleoepidemiological data from prehistoric samples from japan, northern viet nam, and mongolia (n = 343). these sites offer a range of different settlement types and mobility processes, and their analyses showed that higher levels of population interaction between sedentary populations in the past are associated with greater frequency of skeletons that demonstrate evidence of infectious disease. highly mobile populations in the past demonstrate higher levels of pathogen diversity. this article illustrates a powerful approach to assessing the co-evolution of disease and interaction of people, provides an essential theoretical review of definitions of human mobility processes (relocation/migration, trade, intermarriage, warfare, religious pilgrimage or diplomatic mission, exploration, and resource procurement), and considers different parameters and levels of human interaction in the assessment of the epidemiological impact on different populations in the past. although their article focuses on the biological and health impacts of human mobility, importantly, they note that social and environmental contexts have impacts on these health outcomes, particularly migrant health and agency. as the authors allude to, this model of mobility and interaction could be strengthened in the future through the analyses of social determinants of health and structural violence, especially as it is so integral to health experiences and outcomes in the context of migration. sharon dewitte and amanda wissler’s article in this special issue, “demographic and evolutionary consequences of pandemic diseases,” reviews the literature on the second pandemic of plague (fourteenth to nineteenth centuries c.e.) and the 1918 influenza pandemic, two of the most significant pandemics in global history. through their detailed examples of the demographic and evolutionary consequences of these two pandemics, dewitte and visser provide important examples of how bioarchaeologists can examine our data within the wider context of larger structural barriers of poverty, structural racism, and past social interventions. they show how selective mortality acts along the axes of age; socially defined race, ethnicity, and indigeneity; socioeconomic status; rural and urban areas; and pregnancy. they also illustrate that selective mortality is associated with tb (again implicitly invoking and illustrating the importance of syndemics theory). selective frailty has been illuminated in dewitte and wood’s (2008) exploration of the black death of 1347–1351, which was the deadliest known epidemic in human history. they found through analyses of victims from the east smithfield black death cemetery in london compared with normal, nonepidemic cemetery samples from two medieval danish towns that the black death was selective with respect to frailty (dewitte and wood 2008). dewitte and wissler (2022) insightfully note that the current range of exposure risks, symptoms, and mortality in the current covid-19 pandemic is not surprising from what anthropologists and historians have learned from past pandemics. they show this with case studies that illustrate the way sociocultural and environmental contexts shape human experiences of disease during pandemics. based on these selective evolutionary findings from the pandemic examples in their article in this special issue, they stress the responsibility we have to relay these findings and predictable effects to the public response to the pandemic: as important as further study on past pandemics is for clarifying their effects at the individual and population level, it is also crucial for the general public, scholars, and policy makers today to gain and sustain awareness of what we already know about our previous experiences of diseases, attend to those factors that affected morbidity and mortality in the past and that persist today, and devote resources toward maintaining and building pandemic responses in the future. for example, previous research has revealed the possible effects of poverty on risks of death during the second pandemic and the 1918 flu, and we are witnessing the ways in which poverty, structural racism, and social marginalization are increasing susceptibility to and risks of death from covid-19 (laster pirtle 2020; patel et al. 2020; rodriguez-lonebear et al. 2020). these effects are both predictable and theoretically preventable. the positive impact of non-pharmaceutical interventions such as mask wearing, social distancing, and banning large gatherings is evident from studying the course of the 1918 pandemic. the public is now more aware of the importance of zoonotic diseases with the covid-19 pandemic as an emerging infectious disease of probable animal origin (haider et al. 2020; zhang and holmes 2020). some estimates suggest that 75% of new or emerging infections derive from our interactions with other species of animals (ogden et al. 2017). although not yet conclusively demonstrated, the sars-cov-2 virus closely resembles a virus that infects bats (zhang and holmes 2020), and it has been suggested that the spillover event occurred at a wet market in wuhan, china, in late 2019 (henley 2020). anthropogenic climate and environmental changes—including global warming, deforestation, habitat destruction, road-building activity, poaching, and population growth—are not only impacting biodiversity and driving the sixth mass extinction event but also altering patterns of human–animal interaction, which creates new threats for disease transmission (henley 2020). this is such a critical juncture that it is leading to new paradigms for understanding public health, including the one health framework, which seeks transdisciplinary collaboration to attain optimal health conditions for humans, other animals, and the environment (e.g., bonilla-aldana et al. 2020; henley 2020; schmeige et al. 2020). interactions between humans and other animals are not only the most likely source of coronavirus infections (salata et al. 2019; ye et al. 2020); other animals also play a role in viral evolution (e.g., el-sayed et al. 2021; lundstrom et al. 2020), the development of medical coping strategies (e.g., christie et al. 2021; dua et al. 2020; luo et al. 2021), and the human coping mechanism for mental health during quarantine (e.g., nagendrappa et al. 2020; ng et al., 2021; ratschen et al. 2020). unfortunately, the threat of future zoonotic spillover is also creating challenges for animal and habitat conservation (e.g., lu et al. 2021; macfarlane and rocha 2020; zhao 2020). many of these same issues will be identified in paleopathological research that focuses on humans and our interactions with other species in the past (e.g., littleton et al. 2015, 2021). the one health framework is beginning to be more recognized as an attractive approach to bioarchaeology. the university of edinburgh one health archaeology research group, for example, combines a wide range of disciplinary approaches to investigate human, animal, and ecosystem health through time (https://www.ed.ac.uk/history-classics-archaeology/research/research-groups/one-health-archaeology). recently, bioarchaeologists bendrey and martin (2021) edited a special volume of seven articles on one health approaches to bioarchaeology in the international journal of osteoarchaeology. these articles cover bacterial, viral, and parasitic pathogens from global case studies spanning the holocene and its epidemiological transitions related to farming, industrialization, and modernity. in their outline of a research agenda for a one health framework for bioarchaeology, bendrey and martin (2021) call for a greater focus on wildlife and domestic animal sources of infection and human health risks in the past using zooarchaeology, ancient dna, and paleoepidemiological approaches to paleopathology. similarly, agarwal (2022) has discussed an anthropological-adapted one health approach in an invited symposium piece for economic anthropology responding to the question, “how can economic anthropologists contribute to our understanding of pandemic responses and recovery?” population increases and urbanization have led to a “livestock revolution” with intensive livestock production and the large-scale trade of live animals, and the clearance and destruction of land for agricultural crops have had devastating impacts on the environment. through the lens of anthropogenic violence and inequality, agarwal reviews the significant social inequality in global food production having significant health and ecological impacts on the countries and specific communities within countries that are producing for the more affluent countries and communities. at the heart of the problem of the environmental and health impacts for disadvantaged countries and populations is intensive livestock consumption. as such, agarwal calls for an ecojustice approach to curb the consumption of meat in the global north. judith littleton and colleagues (2022) make an important contribution to the consideration of zoonotic endemic, epidemic, and pandemic diseases in the past in this special issue with their article entitled “human–animal interactions and infectious disease: a view for bioarchaeology.” they argue that it is important in bioarchaeology to understand the emergence, evolution, and persistence of zoonotic diseases and to appreciate the interaction between human, animal, and environmental health, particularly drivers of resilience and buffers to exposure (larsen 2018; roberts 2020b). they point to the critical need for a focus on human–animal interactions in paleopathology and also to some challenges of the paleopathological study of zoonotic infections. they recognize the complex ecology of diseases at the human–animal interface, and the issues of interpreting these interactions in archeological settings are problematic. they argue that many zoonoses today are unrecognized or underdiagnosed, with sufferers often having chronic nonspecific symptoms and can also co-occur in individuals with other diseases (maudlin et al. 2009). these zoonoses are often neglected tropical diseases that mostly affect communities that live in poverty and unfortunately disproportionately affect women, infants, and children (who 2010). these diseases cause devastating health, social and economic consequences to more than one billion people and a high rate of mortality, with affected people suffering in silence with little political voice (who 2010). littleton and colleagues (2022) argue for integrative and collaborative, transdisciplinary approaches offered by a one health perspective (centers for disease control and prevention 2018), which acknowledges the complex interactions between social and ecological systems (waltner-toews 2017), and an anthropological consideration of human–animal interactions (taking into account their biocultural complexity) moving beyond purely biomedical approaches (zinsstag 2012). as mentioned briefly above, the one health perspective is a transdisciplinary and collaborative approach that explicitly “recognizes the connection between people, animals, plants and their shared environment” and calls on a diverse array of experts in human, animal, and environmental health to work together. although this is not a new approach, it is increasingly becoming recognized as being important for today’s human society. human populations are growing and expanding into new geographic areas with more people living in close contact with wild and domestic animals, providing more opportunities for diseases to pass between animals and people with major social and environmental changes experienced worldwide, including changes in climate and land use, such as deforestation and intensive farming practices, also providing new opportunities for disease transmission. increases and changes in human mobility and the movement of animals and animal products also result in diseases that can spread quickly around the world. similarly, these social contexts and changes can be assessed in the past. the one health approach acts to move theoretical considerations beyond a simplified paleoepidemiological association of infectious zoonotic disease with the agricultural transition and domestication of animals (barrett et al. 1998; d’anastasio et al. 2011; fournié et al. 2017; hershkovitz et al. 2008, larsen 2018; mcmichael 2004; mitchell 2003) and contribute to the context-specific deep time histories argued to be essential to understanding disease emergence (wallace et al. 2015). a recently published example that illustrates the importance of considering zoonoses in the specific social and ecological system, moving beyond this simplified paleoepidemiological transition (agricultural) model, is the research by vlok et al. (2022) of hydatid disease (echinococcus granulosus) in individuals from the pre-agricultural site of con co nga in northern viet nam dated to 7,000 years b.p. the authors suggest that the presence of wild canids and the management of wild buffalo and deer increased the risk of disease transmission to humans and revealed subsistence complexity among hunter-gatherers living millennia prior to the adoption of farming in southeast asia (vlok et al. 2022). similarly, littleton and colleagues acknowledge that tb and brucellosis have been identified through paleopathological and molecular analyses of hunter-gatherers in the americas (bos et al. 2014; jones 2019), in pre-neolithic settlements in syria (baker et al. 2015), and even in a late pliocene specimen of australopithecus africanus (d’anastasio et al. 2009). littleton and colleagues review modeling of outbreaks and advocate for studies that incorporate zooarchaeological, geospatial, climate, ethnographic, and historical data alongside traditional paleoepidemiological analyses of mortality and morbidity to provide a fuller picture of the circumstances leading to epidemics and pandemics (e.g., fournié et al. 2017; gowland and western 2012; marciniak et al. 2018; smith-guzmán et al. 2016). the authors eloquently describe three examples of animal–human–disease interactions: pigs in papua new guinea, tb and possums–bovine–humans in new zealand, and the balinese people and long-tailed macaques (macaca fascicularis). these examples demonstrate the complex sociocultural, political, economic, and ecological relationships that can exist between humans and animals. littleton et al. (2022) acknowledge that the one health perspective fits well with other approaches used in bioarchaeology and paleopathology (e.g., biocultural perspectives including socioeconomic relationships and human agency approaches). this perspective could, therefore, be incorporated with syndemics and social determinants of health frameworks. the burden of zoonotic diseases is higher for populations living in poverty (molyneux 2011). in addition, poorer populations are also marginalized within health systems, and often the impact of endemic animal diseases is mainly felt at the farm level, in terms of disease but also economic impact (seimenis 2012). indigenous populations are also disproportionately affected by diseases associated with the environment and animals (riley et al. 2021). there has been a recent call for the incorporation of indigenous values and leadership into one health research for more effective results (riley et al. 2021). conclusion as we have all come to understand very well, a pandemic is a disease outbreak leading to a sudden and extreme increase in the number of cases that spreads across a large region, including multiple countries, and rapidly affects a large proportion of the population. a crisis of this magnitude can lead to a variety of different responses in human populations, depending upon their hesc circumstances. it is social scientists, and anthropologists in particular, who can offer perspectives that have increasingly been recognized as extremely critical, especially given the chaotic, inefficient, and unhelpful social responses to covid-19, particularly in the united states and, to a lesser extent, in the united kingdom and europe. as remarked by francis collins, the outgoing director of the national institutes of health (nih) in a recent interview, the politicization of science in the united states has recently grown: … much worse. and it’s a reflection of the fact that polarization is much worse—and tribalism is much worse. we’re in a really bad place. if science happens to produce a result that a political perspective doesn’t like, then science has to be attacked. that’s exactly what we see now happening, to the detriment of getting the facts out there. this has turned out to be a much more severe situation than i would have imagined a year ago. i wish we had more insights from behavioural social science research into how this has come to pass, and why it could have gotten so completely widespread. i want to call this out as one of my most major concerns as i stepped down from the nih, of looking at the situation in our nation. somewhere along the way, our political hyperpolarization began having a lot of really dangerous consequences, where in many instances we seem to have lost a sense of how to tell the difference between a fact and an opinion—or some facebook post that’s, frankly, a lie. that’s truly dangerous. that’s another epidemic that is not going to go away even if we triumph over covid-19. we need to figure out what happened here, and how to bring ourselves back to a place where our nation has a more stable future. (subbaraman 2021:373) the articles in this special issue present novel, sophisticated, and holistic approaches to the study of epidemics and pandemics in the past, which demonstrate the powerful ways in which bioarchaeology is positioned to address current-day issues, including disparities in infection rates and health outcomes of covid-19. these authors demonstrate how knowledge of the past provides opportunities for developing a more nuanced and rich understanding of modern epidemiological factors. these articles demonstrate that research on the biology and epidemiology of human diseases requires a biocultural perspective. medical solutions, such as vaccines, will never be enough to end a global pandemic. we must attend to the hesc context, which deeply shapes the complex manner in which individuals, groups, and populations experience the impacts of and respond to infectious diseases. pandemics are crises that lay plain the contours of social inequality and have an especially acute power to create profound suffering for already marginalized groups and, over time, to shape the course of our evolution. however, these conditions create social suffering and shape our evolution even in the absence of pandemics, just more quietly. social inequality is the variable of interest (graeber and wengrow 2021). in a capitalist society, it is not surprising that infectious diseases will be allowed to kill “essential workers” to save the economy (harvey 2020); this is a normal state of affairs, prior to the pandemic (e.g., whyte 2020), and it has been for thousands of years (graeber 2012). it is hardly news that people with disabilities are treated as expendable (e.g., through widespread beliefs that the omicron variant of covid-19 is “mild” unless you have preexisting conditions); this ideology has a long history (mant and holland 2019). the preexisting conditions that make some of us more vulnerable to covid-19 are also exacerbated and made more common by capitalism itself (braveman and gottlieb 2014; who 2013; wilkinson and marmot 2008). capitalism and related phenomena of imperialism, colonialism, slavery, and social inequality have been causing social suffering for centuries, and bioarchaeology demonstrates this history (e.g., barrett and blakey 2011; blakey 1998, 2001, 2020; de la cova 2008, 2010, 2011, 2012, 2014, 2019, 2021; dent 2017; geber 2015; geller 2015, 2021; geller and stojanowski 2017; godde et al. 2020; gowland et al. 2018; hutchinson 2016; hutchinson and mitchem 2001; larsen and milner 1994; larsen et al. 2001; mant et al. 2021; miller et al. 2020; murphy and klaus 2017; newman and gowland 2017; nystrom 2017; tremblay and reedy 2020; watkins 2012, 2018a, 2018b; wesp 2020). values of individualism and social isolation in some societies have deeply limited the range of possible coping mechanisms (nelson 2020; van bavel et al. 2020), which bioarchaeology too would predict (e.g., schrenk and tremblay 2022; tilley 2015; tilley and schrenk 2017). social scientists are not surprised when—in societies founded upon inequality, capitalism, genocide, and slavery—science and medicine will only receive respect and trust when they serve the interests of capital. that has been true in regard to the climate crisis for decades. the question is not when or how this inequality emerged but rather why we feel stuck in our current socioeconomic and political configurations (graeber and wengrow 2021). we end this introduction with a call for bioarchaeologists and paleopathologists to consider the importance of their work to modern-day, pressing human health issues and disparities in health outcomes by making explicit links from their work to public health concerns and to social science discourses more broadly (e.g., bendrey and martin 2021; buikstra 2018). our past and present are thoroughly intertwined, and the lessons from the past are particularly relevant to creating solutions rooted in social justice today (buikstra 2018), in what is arguably the worst health crisis of the twenty-first century, in terms of the immediate mortality rate, morbidity, ongoing health and socioeconomic effects, and for exacerbating inequalities within and among populations (the lancet 2020). although we can never incorporate every theoretical model into our work in paleopathology, this set of articles offers a comprehensive set of approaches to choose from and potentially refine to meet the goals of research in specific contexts. it is this type of research on past epidemics and pandemics that will make a real contribution to understanding and perhaps controlling present-day emerging diseases, such as covid-19, which will become more common in the context of global warming and climate change. an understanding of epidemiology and anthropological contextualization of epidemic and pandemic disease through the exploration of the origins, evolution, the relationships of disease with social factors, and effects of interventions during past outbreaks can be used in a predictive manner to investigate the factors promoting emerging diseases (bendry and martin 2021; dewitte and wissler 2022). acknowledgments we thank all of the authors who contributed to the special issue for their time and effort amid a global pandemic and anna-claire barker for her comments on a draft of this article and editorial assistance. bibliography abrams, elissa m., and stanley j. szefler. 2020. covid-19 and the impact of social determinants of health. the lancet respiratory medicine 8(7):659–661. doi: 10.1016/s2213-2600(20)30234-4. agarwal, sabrina c. 2016. bone morphologies and histories: life course approaches in bioarchaeology. american journal of physical anthropology 159(s61):130–149. doi: 10.1002/ajpa.22905. agarwal, sabrina c. 2022. what does pandemic response and recovery look like through the lens of anthropogenic violence and inequality? economic anthropology 9:158–162. doi: 10.1002/sea2.12238. aguirre, a. alonso, richard catherina, 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https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe copyright © 2021 university of florida press exploring the efficacy of comparative bioarchaeological approaches in providing answers on marginality and networking: the example of late bronze age achlada in florina, northern greece dimitra ermioni michael,a* linda fibiger,a,b christina ziota,c liana gkelou,c and barry molloya** aschool of archaeology, college of social sciences and law, university college dublin, belfield, dublin 4, ireland bschool of history, classics & archaeology, the university of edinburgh, edinburgh eh8 9ag, united kingdom cephorate of antiquities of florina, 53100 florina, greece *correspondence to: dimitra ermioni michael, university college dublin, school of archaeology, john henry newman building, stillorgan rd., belfield, dublin 4, ireland email: e-mail: dimitra.michail@ucd.ie abstract: this paper investigates the efficacy of comparative bioarchaeological approaches in exploring the impact of economic marginality on human lifeways. skeletal remains from the late bronze age cemetery of achlada in northern greece were chosen to address this, as this specific community was probably less well networked, evident in its location away from major communication routes and the paucity of grave goods at the site. a biocultural methodology combining comparative data on funerary practices and lifestyle was implemented. sex differences were found within the community and seem to agree with the differential burial placement of the sexes possibly representing the different roles that society symbolically attributed to men and women in deathways. comparative intercemetery data did not reveal poorer health and diet, or more intense physical activity, compared to well-networked sites. nonetheless, achlada, as well as numerous, mostly north communities of the wider context, probably faced more physiological challenges during growth, at least of a mild to moderate level, compared to a number of populations connected by major communication routes. the current study highlights the importance of implementing comparative bioarchaeological approaches as a means of identifying the impact of marginality on human lifeways, particularly in settings with limited material culture information. limitations linked to preservation issues and the multifactorial nature of lifestyle indicators could be dealt with by future biomolecular and isotopic analyses. keywords: lifeways; palaeopathology; prehistory η παρούσα εργασία έχει στόχο να διερευνήσει το κατά πόσο οι συγκριτικές βιοαρχαιολογικές προσεγγίσεις είναι εφικτό να δώσουν απαντήσεις ως προς την επίδραση της οικονομικής περιθωριοποίησης στον ανθρώπινο τρόπο διαβίωσης. επιλέχθηκαν σκελετικά κατάλοιπα της ύστερης εποχής χαλκού από το νεκροταφείο της received 1 july 2020 revised 9 december 2020 accepted 23 december 2020 **principal investigator bioarchaeology international volume 5, numbers 1–2: 21–46 doi: 10.5744/bi.2021.1005 comparative bioarchaeological approaches on marginality22 the late bronze age (lba) of the eastern mediterranean was a highly networked hub of intercultural interaction. reaching a zenith in the fourteenth to thirteenth centuries b.c., social upheavals in the decades around 1200 b.c. led to a collapse of elite political and economic networks (cline 2014; middleton 2010, 2017, 2020). since the time of shaft graves at mycenae in the seventeenth to fifteenth centuries b.c., strong links to the north and west in the form of imported amber, wellenband ornamentation, chariot styles, and horse trappings demonstrate that modern bias plays a role in how we contextualize mycenaean networks (blake 2008; bouzek 1994, 1985; harding 1984, 2007; iacono 2019; jung and mehofer 2013; maran 2013; molloy 2016). in reality, manifestations of pottery, burial monuments, placement of the body, use of grave goods, and size of cemeteries display a certain fluidity, indicating that communities of the wider context were choosing from a “menu” of practices and material culture, based on their own perspectives. fundamentally, if we seek to better understand the cultural context of mycenaean societies within the landmass they occupy and comprehend the complex cultural interactions between communities of the north, west, and south, improving our knowledge of societies at the margin of mycenaean influence is essential (andreou 2001, 2010; gimatzidis and pieniążek 2018). therefore, bioarchaeological comparative analyses of cemeteries that lie within the wider geographical and cultural context of the lba eastern mediterranean have the potential to provide enlightening information on cultural exchange and mobility. the cemetery of achlada lies south of the historic region called the pelagonia valley, a region of ca. 2,000 km2. this was a region which at once provided good alluvial land for settling and an opportune place to trade both north and south. finds of amber from the achlada cemetery (ziota 2019) suggest that the community of this valley participated to some extent in the morava-vardar/axios routeway trade network. to best explore the context of achlada, we evaluate data from the balkans and greece together. looking initially to the north, at the site of dubac in central serbia, we find well-furnished burials in a mound which is located toward the southern limit of the tumulus culture tradition. the distribution of ceramics common to the vardar/axios region, and found at achlada, finds its northernmost limit around this cemetery (bulatović 2011; dmitrović 2016). following the pottery traditions south, there is a distinct concentration along the morava-vardar/axios corridor, which demonstrates the importance of this north–south routeway. achlada lies to the west of this route, possibly placing the community at the margins of a prosperous zone (fig.  1). well-furnished burials with bronze finds and abundant ceramics have been found along the vardar river in the cemeteries at ulanci and mali dol (e.g., mitrevski 1997; papazovska sanev 2014) where the ceramic forms demonstrate close links with the achlada community (ziota 2019). moving southeast to macedonian pieria, a number of well-studied cemeteries present features of vardar-style pottery, as well as moderate to intense use of mycenaean imports and imitations, while the use of tumuli burials is also practiced (e.g., koulidou et  al. 2017; triantaphyllou 2001; triantaphyllou and andreou 2020). achlada was connected to pieria and material culture parallels were found at trimbina (ziota, 2020, personal communication), but without displaying key cultural features of this region. moving southwest to epirus, connections with the mycenaean world through ceramic imports are evident and the metalwork demonstrates some shared practices with other parts of greece. epirus’s communities also shared ceramic styles with albania and displayed similarities in the interpretation and use of mycenaean influences and objects (papadopoulos et  al. 2014; tartaron 2004). therefore, achlada could also be considered marginal to epirus. αχλάδας στη βόρεια ελλάδα ώστε να απαντηθεί το εν λόγω ερώτημα, καθώς η συγκεκριμένη κοινωνία -βάσει της θέσης της μακριά από τα μεγάλα δίκτυα επικοινωνίας και της παρουσίας πολύ λίγων ταφικών ευρημάτων ήταν πιθανώς λιγότερο καλά δικτυωμένη. ακολουθήθηκε μια συνδυαστική βιοπολιτισμική προσέγγιση συγκριτικών ταφικών δεδομένων και συγκριτικών αποτελεσμάτων δεικτών τρόπου διαβίωσης. βρέθηκαν διαφορές μεταξύ των δύο φύλων στον εν λόγω πληθυσμό οι οποίες φαίνεται να συμφωνούν με την διαφορετική πλευρά κατάκλισής τους, η οποία πιθανώς να συμβόλιζε τη διαφορετικότητα των ρόλων που η κοινωνία απέδιδε σε άντρες και γυναίκες στο ταφικό περιβάλλον. συγκριτικά αποτελέσματα μεταξύ νεκροταφείων δεν φανέρωσαν χαμηλότερο επίπεδο υγείας και διατροφής, ούτε πιο έντονη εργασιακή καταπόνηση, σε σχέση με καλά δικτυωμένες θέσεις. παρόλα αυτά, η αχλάδα, όπως και μια σειρά –κυρίως βόρειωνκοινωνιών του ευρύτερου πλαισίου, πιθανότητα αντιμετώπισαν περισσότερα φαινόμενα καταπόνησης (στρες) κατά τη διάρκεια της ανάπτυξης, τουλάχιστον ήπιου και μετρίου επιπέδου, συγκριτικά με καλύτερα δικτυωμένους πληθυσμούς. η παρούσα εργασία τονίζει τη σημασία της εφαρμογής συγκριτικών βιοαρχαιολογικών προσεγγίσεων ως μέσο μελέτης της επίδρασης της περιθωριοποίησης στους ανθρώπινους πληθυσμούς, ιδιαιτέρως σε θέσεις με περιορισμένες πληροφορίες υλικού πολιτισμού. μεθοδολογικοί περιορισμοί οι οποίοι συνδέονται με ζητήματα διατήρησης αλλά και με τον πολυπαραγοντικό χαρακτήρα των δεικτών τρόπου διαβίωσης, ενδεχομένως να αντιμετωπιστούν μέσω των επερχόμενων βιομοριακών και ισοτοπικών αναλύσεων. λέξεις κλειδιά: τρόποι διαβίωσης; παλαιοπαθολογία; προϊστορία michael et al. 23 even though social differentiation through the character and disposition of grave goods was commonly practiced in communities of the wider study context, in achlada it was not deployed to a significant degree to differentiate the interred in a highly structured manner (ziota 2019: table  1). there are fall-off zones of the major cultural ambits and these overlap with the fall-off zone of the minor vardar tradition. these groups in the pelagonia valley are arguably benefitting from some limited, and as yet poorly defined, trade or communication link. it could be argued that the dearth of prestige goods is indicative of a community not engaging strongly with major networks, either on the basis of the dearth of material from the networks or their lack of intense participation in using metal and other traded materials to construct identity, indicating local practices are dominant. so our questions arise. how marginal may we predict achlada to be? what does it mean to be marginal in this world? when material culture evidence is limited, are comparative bioarchaeological approaches able to provide answers on marginality? if a given community is poorly networked and thus poorly buffered in times of hardship through reciprocal intercommunity exchange networks (halstead and o’shea 1989:4), poorer health and diet might be expected. if people were more dependent on their land to survive and prosper, as a result of reduced trading actions and their associated wealth, higher levels of physical activity might also be expected. if, finally, we consider the lack of grave goods in the mortuary environment to indicate that they were not used as a means of expressing social differentiation in death, a lack of intra-cemetery lifestyle differentiations would be expected. the limited archaeological information and lack of settlement data restricts what can be suggested for the relative prosperity of this lba community. it is therefore imperative to use comparative and contextualized bioarchaeological data to explore marginality and its potential impact on lifeways. the main objective of this study is to examine the efficacy of comparative bioarchaeological approaches in providing answers on marginality and networking, particularly in cases of limited material culture information. the following specific hypotheses are formed: 1) if the lack of material culture differentiation displayed in the mortuary practices of the current community reflects lack of social differentiations in lived reality, significant age or gender differences within the community—not related to biological factors—should be absent. 2) if the achlada community was economically marginal and poorly networked, higher levels of physiological stress and poorer diet compared to well-networked populations would be expected as a consequence of poor economic buffering. similarly, as a result of reduced trading activities and associated wealth, individuals at achlada would probably be involved in more strenuous physical activities when compared to populations connected to major routes. figure 1. the site of achlada in relation to florina, bitola, thessaloniki, pieria, and axios river. comparative bioarchaeological approaches on marginality24 table 1. archaeological and anthropological information for achlada prehistoric assemblage (car: dental caries, leh: linear enamel hypoplasia, amtl: antemortem tooth loss, cal: calculus, s.djd: spinal degenerative joint disease (djd), p.djd: postcranial degenerative joint disease (djd), pf: postcranial fracture, sf: skull fracture, co: cribra orbitalia, ph: porotic hyperostosis, id: infectious disease). n.burial sex age placement of the body (slightly contracted) artifacts pathologies t.466 m 25–45 right  kantharos-shaped amphora car, amtl, cal, s.djd, p.djd, pf, id t.393 f? adult left  one-handled cup pf t.617 ?/f? 25–35 left — car, leh, cal t.329 ? 25–35? left  one-handled cup car, amtl, cal t.302 m adult right  — car, leh, cal t.479 m 25–35 right  kantharos-shaped amphora, bronze dagger and knife car, leh, amtl, cal t.476 m 17–25? right  kantharos car, leh, cal t.346 ? adolescent/adult right  — none  t.344 ? 17–25 right  — leh, cal t.654 ?/m? 25–45 left  bowl car, cal t.469 f? 25–35 left  — car, leh, cal t.336 ? adult right  one-handled cup none  t.510 ? adult left?  ? leh t.337 m 20–25? ?  ? car, leh, amtl, cal t.379 ? 2–3 left  — car t.405 ?/f? 25–35 left  — leh t.364 m adult ?  — cal t.388 f? 25–34? ?  ? none  t.391 ? adult left  ? none   t.394 ? 20–35 left  — car, leh, amtl, cal t.432 ?/f? 25–34 left one-handled cup none  t.365 f? 17–25 right kantharos leh, cal t.360 f? 33–45 left  — car, leh, amtl, cal, s.djd t.384 ? 5–6.5 ?  ? leh t.324 ?/f? 25–45 left  — cal, co t.303 m? 25–30 ? ? leh, cal t.387 m 25–44 right  — car, leh, amtl, cal, s.djd, p.djd t.338 m 33–45/45+ right handleless p.djd t.390 m adult left  — pf t.389 f 30–45 supine  one-handled cup leh, cal, ph (continued) michael et al. 25 human remains from achlada will be analyzed following a biocultural methodology, combining funerary practices with indicators of health and lifestyle. in order to understand the manner in which the communities in pelagonia (fig. 1) were connected to major cultural constellations to the north and/or south, comparative data on type of tombs/burials, placement of the dead, grave goods, and demography will be presented. lifeways will be investigated through dental diseases (caries, antemortem tooth loss (amtl), and calculus), stress and lifestyle indicators (stature, trauma, cribra orbitalia, porotic hyperostosis, and enamel hypoplasia), and degenerative joint diseases (djd, including schmorl’s nodes). table 1. (continued) n.burial sex age placement of the body (slightly contracted) artifacts pathologies t.316 f? 17–25 left  kantharos car, leh, cal, ph t.345 m 33–45/45+ right  — leh, s.djd t.308 ?/f? adult ? ? ph t.352 m 25–35 right  “mycenaeanizing” matt-painted vessel car, leh, cal t.351 ?/f? 17–25? left  bowl car, leh, cal t.415 ? 12–15  right one-handled cup car, leh, cal t.414 ?/m? adult right kantharos-shaped amphora p.djd, sf t.340 m 25–35 right  — car, leh t.342 ? 8–12 ? ? car, leh t.350 ? 5–6.5 right  — none   t.465 ?/m? adult right  — none  t.457 ?/f? adult ? kantharos-shaped amphora none  t.487 ? 3–4 left  beads of amber and glass, stone tool car, leh, co t.472 ? adult left  one-handled cup none   t.356 m? 20–29 right kantharos-shaped amphora, bronze pin car, leh, amtl t.374 m 25–35 right kantharos-shaped amphora car, leh, cal, s.djd t.367 m 25–35 right  — car, leh, pf t.444 f 17–25 left  “mycenaeanizing” painted vessel leh, cal t.378 ?/m? 30–35 right — car, leh, cal, s.djd t.362 ?/m? 25–35? right  — car t.326 f? 25–35 right kantharos-shaped amphora, bronze dagger and pin leh, amtl, cal t.553 ? 17–25 left  two-handled cup car t.370 ? adolescent/adult left? one-handled cup car, pf t.371 ? 12 ± 30 months left  — car, leh t.458 f? 17–25 left  kantharos car comparative bioarchaeological approaches on marginality26 materials and methods the cemetery of achlada since 2014 the ephorate of antiquities of florina has been conducting rescue excavations at a lignite mine in the region of achlada, where a 20-acre archaeological site has been defined. the excavation, which is still in progress, has revealed a cemetery dating from the lba to byzantine times (ziota 2019). this study focuses on the prehistoric cemetery of achlada near to the modern town of florina in macedonia in the north of greece (fig. 1). the prehistoric cemetery (fig. 2) consists of 74 pit burials and according to initial radiocarbon results it was used between 1400 and 1100 b.c. (ziota 2019). artifacts recovered from 32 tombs consisted primarily of pottery. apart from ceramic vessels, the remaining finds include jewelry, weapons, and tools (table 1). despite this limited number of prestige objects, the general pattern in the mortuary assemblage is for few objects to have been used in the final burial rites (ziota 2019). out of the 74 prehistoric burials, 17 are partially or completely disturbed by later burials or foundations of roman buildings. the cemetery consists of single burials with the exception of a couple of cases. there is no indication of a tumulus, nor could this be supported based on the inclination of the ground. tombs in achlada are usually oriented along the southwest– northeast axis. the burials are contained and the deceased were placed with their bodies lying on their side, their lower limbs slightly contracted and their upper limbs flexed in front of the torso (ziota 2019). a total of 54 adult/possible adult individuals, five juveniles, and three adolescents were identified. no infants (up to 1 year) were found. sex estimation was conducted only in adult cases and 22 males/possible males and 17 females/possible females were recognized, as well as 32 individuals that could not be confidently sexed. the demographic information of achlada prehistoric cemetery is presented in fig.  3 (the 55 better preserved individuals). interestingly, males are buried on their right side, whereas females are buried on their left. there are few exceptions to this, indicating a clear distinction between the sexes in terms of their placement (ziota 2019; see table 1). adult burials are found with artifacts with a frequency of 46%, while non-adult ones include artifacts at a much lower percentage (i.e., 25% or 2 out of 8). all burials that were recovered with artifacts include at least one vessel, with the exception of one juvenile inhumation found solely with beads and a stone tool (t.487). all ceramic vessels, which were usually placed close to the lower limbs, were handmade and belonged to specific types, intended for transport, offering, and consumption of liquids. out of the 32 vessels only two were found with matt-painted decoration. apart from pottery, the 13 remaining associated finds recovered in six tombs include three bronze fibulae, one glass and three amber beads (juvenile burial stated above), two bronze daggers, as well as one knife. a unique phallic object, most likely from sandstone, was also recovered (ziota 2019). the ceramic vessels suggest a dynamic local production, without excluding foreign cultural characteristics that have been adapted to the local social and symbolic environment. no mycenaean imports were recovered, even though pottery influenced by or imitating mycenaean patterns was found (ziota 2019). methods biological profiling. sex and age determination of the skeletons was conducted using the morphological criteria of the skull, pelvis, and ribs (bass 1987; brooks and suchey 1990; brothwell 1981; buikstra and ubelaker 1994; i̇şcan et al. 1984, 1985). measurements were also used for sex estimation. adults were categorized as females/possible females, males/possible males, or indeterminate. age determination in juveniles/adolescents was conducted following the criteria outlined in moorrees et  al. (1963), scheuer and black (2000), and ubelaker (1989). the age categories used in this study are: 1) infant (< 1 year); 2) juvenile (1–12 years); 3) adolescent (12–17 years); 4) young adult (18–25 years); 5) young middle adult (26–35 years); 6) old middle adult (36–45 years); 7) mature adult (45+ years); 8) adult; 9) adolescent/adult.figure 2. topographic plan of the prehistoric burials of achlada. michael et al. 27 stature is considered a marker of physical well-being, resource availability, economic and nutritional improvement, as well as social context (tritsaroli and michael 2020). stature estimation was based on femoral length, as it is the largest element in the human skeleton and correlates best with human stature (hauser et  al. 2005). all measurements were performed using an osteometric board, and they were taken on the left side where possible, and on the right when the left side was not available (buikstra and ubelaker 1994; martin 1914). the equations of trotter for whites (1970) were used. paleopathological diagnosis and recording. degenerative joint diseases (djd) are linked, among other factors (such as age), to strenuous physical activities. djd was observed on all the joints of the human body, including the entire spine, according to the criteria of rogers et al. (1987) (fig. 4). in addition, a three-stage recording system for osteophytes and porosity (i.e., mild/moderate/severe) was implemented. eburnation and schmorl’s nodes were recorded as present or absent. schmorl’s nodes mainly refer to the end result of the prolapsed disc, or the lesion that eventually is formed on the surface of the affected vertebral body (faccia and williams 2008:29). even though congenital defects of the spine, age, and trauma are considered to be causative factors (resnick and niwayama 1978), a number of studies have tested schmorl’s nodes as markers of demanding physical activity (i.e., angel et  al. 1987; baker 1997; coughlan and holst 2000; manzon and gualdi-russo 2015). trauma frequencies are highly affected by lifestyle factors such as economy, living environment, occupation, and interpersonal violence (roberts and manchester 2005:84). traumatic lesions were recorded on the entire skeleton, including healed fractures (antemortem trauma), unhealed fractures (perimortem trauma), sharp-force lesions, and projectile lesions. porotic hyperostosis (ph) and cribra orbitalia (co) result from marrow hyperplasia. the etiology of their development has been highly debated and attributed to iron-deficiency anemia, inherited hemolytic anemias, acquired megaloblastic anemia due to b12 and/ or folate deficiency, infectious disease, chronic scalp infections, respiratory infections, scurvy, and rickets (e.g., camaschella 2015; larsen 2015:31–32, 39; o’donnell et  al. 2020; ortner 2003; oxenham and cavill 2010; schultz 2002; walker et al. 2009). when human remains are macroscopically analyzed, ph and co are probably best regarded as stress indicators rather than markers of specific diseases (steckel et  al. 2005:13). ph and co were recorded on four surfaces; orbits (co) and parietal, frontal, and occipital bones (ph), according to a three-stage severity system: 1) porosity, 2) coalesce, 3) diploë expansion (steckel et al. 2005). the stage of healing was also recorded (healed closed lesions or unremodeled lesions). figure 3. demographic composition of achlada’s prehistoric assemblage. (ya: young adults, ym: young middle adults, om: old middle adult, ind. adults: indeterminate adults.) comparative bioarchaeological approaches on marginality28 enamel hypoplasia can occur only while the teeth are developing, thus remaining as a permanent record into adulthood. many factors are relevant to enamel defect etiology but they can be categorized broadly into hereditary anomalies, localized trauma, and systemic metabolic stress such as a nutritional deficiency or childhood illness (goodman and rose 1991:279–294). nevertheless, this condition is usually linked to systematic physiological stress in modern and archaeological skeletal human remains. enamel hypoplasia was recorded on the buccal surface according to its morphology pit, line, or groove (fig. 4). caries and calculus are considered to be mutually exclusive in terms of etiology, as the mechanisms that produce them are different. comparing their frequencies in a population can give valuable information related to dietary patterns (hillson 1979). caries is a disease process characterized by the focal demineralization of dental hard tissues by organic acids produced by bacterial fermentation of dietary carbohydrates (larsen et al. 1991). apart from a cariogenic diet (i.e., sucrose), the etiology of dental caries is also related to poor dental hygiene, which leads to bacterial overgrowth, composition of the saliva, and susceptible tooth structure (bourbou 2013:219). dental calculus is mineralized bacterial plaque (lukacs 1989:283) which consists of microorganisms that accumulate in the mouth, embedded in a matrix partly composed by the organisms themselves and partly derived from proteins in the saliva (i.e., hillson 2005:289). it accumulates on the teeth faster when there is a high protein diet favoring an alkaline oral environment (i.e., lukacs 1989:283), although the role of other factors such as individual variation, cultural practices, and the process of mineralization should not be overlooked (lieverse 1999). dental caries was recorded on the occlusal, mesial, distal, lingual, buccal, cemento-enamel junction (cej), and root, according to a four-stage system: 1) pinpoint, 2) small/< 1/2 crown, 3) medium/< 1/2 crown, and 4) large. calculus was recorded according to brothwell (1981) (fig. 4). teeth were recorded according to the fdi tooth numbering system. statistical analysis as the data did not follow a normal distribution (kolmogorov-smirnov test), two nonparametric tests were performed: the mann-whitney u test (p < 0.05) and the kruskal-wallis test (p < 0.05). spearman’s rank correlation coefficient (p < 0.05, or p < 0.01) was also used in order to test how strongly the variables were associated with each other. the chi-square test was also used for comparative statistical analyses. all the analyses were carried out using spss (statistical package for the social sciences) version 21. results a) intra-cemetery variation out of the 74 prehistoric burials, the systematic study was applied on 55 of them as the poor skeletal representation of the remaining burials did not allow for a detailed osteological analysis and paleopathological investigation. overall percentages of pathological conditions, nonspecific stress indicators, and fractures for the population of achlada are presented in table 2. the overall frequency of djd in the current sample is quite limited. all four cases of postcranial djd were noted in males, three old middle adults and one adult. overall, spinal djd was observed on 25 vertebrae and 11 individuals. apart from spinal djd observed in one female old middle adult, all remaining cases (including schmorl’s nodes) involve males. as expected, djd is mostly observed in older individuals. in cervical and thoracic vertebrae, age shows a positive correlation with osteophytes, although this is not statistically significant (spearman’s rho [age-cervical osteophytes]: 0.108, p = 0.752; spearman’s rho [age-thoracic osteophytes]: 0.230, p = 0.495). traumatic lesions were noted in five individuals (tables 1 and 2 ; also see supplemental information), affecting seven postcranial elements and one cranium. with the exception of one possible adult figure 4. examples of indicators recorded in lba achlada assemblage. a) t.374, male young middle adult, mild osteophytes on the superior body of 5th lumbar vertebra; b) t.340, male young middle adult, caries (medium expression) on the mesial/cemento-enamel junction surface on the 2nd lower left molar; c) t.326, female young middle adult, enamel hypoplasia (grooves) on the upper left canine; d) t.444, female young adult, slight and moderate calculus on right maxilla. courtesy of the hellenic ministry of culture and sports. michael et al. 29 female, the remaining cases were noted in males/possible male individuals. cribra orbitalia and porotic hyperostosis were observed in five cases overall (tables 1 and 2). interestingly, with the exception of one juvenile presenting with porosity on the orbital roof, all remaining four cases were recorded in females. in the adult cases, the lesions were mostly healed. one young child, between three and four years old, presented with both active and healed lesions. prevalences of caries, calculus, amtl, and enamel hypoplasia in relation to sex are presented in table 3. when all age categories are combined, statistically significant differences were found between the sexes for enamel hypoplasia and calculus. more specifically, males and females do present statistically significant differences for the former indicator but not for the latter (mann-whitney u, z = –0.216, p = 0.829). statistical comparisons between males and females while controlling for age are also presented in table 4. no statistically significant differences regarding caries and calculus location and severity were noted. in contrast, the sexes do present statistically significant differences in terms of hypoplasia type (mann-whitney u, z = –4.538, p < 0.001). the stated dental indicators were also examined in relation to age, regardless of sex (table 5). no age differences were noted for enamel hypoplasia, contrary to the remaining indicators. amtl and calculus present their highest rates in the old middle adult category. both conditions present positive and significant correlations with age (spearman’s rho [age-calculus]: 0.193, p = 0.000; spearman’s rho [ageamtl]: 0.137, p = 0.000). dental caries on the other hand are presenting a negative correlation with age (spearman’s rho: –0.038, p = 0.310), although not significant. caries were mostly noted in young adults (table  5) and the difference between the adult age categories is significant (kruskal-wallis, chi-square: 10.221, df = 2, p = 0.06). table 2. percentages of pathological conditions and fractures for the population of achlada (florina). (true prevalence rates for dental diseases and enamel hypoplasia are the number of teeth/alveoli exhibiting the condition divided by the number of teeth/alveoli examined; crude prevalence rates for the remaining conditions and fracture cases are defined as the number of individuals exhibiting the condition/fracture divided by the number of individuals examined.) pathologies individuals affected crude prevalence rate % teeth/alveoli affected true prevalance rate % amtl 9/55 16.4 26/816 3.2 caries 29/55 52.7 70/709 9.9 enamel hypoplasia 31/55 56.4 150/709 21.2 calculus 26/55 47.3 159/709 22.4 cribra orbitalia 2/55 3.6 porotic hyperostosis 3/55 5.5 spinal djd 6/55 10.9 postcranial djd 4/55 7.3 skull fractures* 1/55 1.8 postcranial fractures* 4/55  7.3 *probable cases table 3. dental diseases and enamel hypoplasia in relation to sex (for all age categories combined). f/f? m/m? ? kruskall-wallis test dental caries 21/70 30% 34/70 48.6% 15/70 21.4% chi-square = 2.371 df = 2 p = 0.306 amtl 5/26 19.2% 16/26 61.5% 5/26 19.2% chi-square = 0.000 df = 2 p = 1.000 enamel hypoplasia 30/150 20% 84/150 56% 36/150 24% chi-square = 27.418 df = 2 p = 0.000 calculus 65/159 40.9% 75/159 47.2% 19/159 11.9% chi-square = 16.612 df = 2 p = 0.000 comparative bioarchaeological approaches on marginality30 b) intercemetery comparisons comparative mortuary data. comparative funerary information on the lba sites of the wider archaeological and geographical context is presented in table 6. single burial inhumations are mostly observed in populations north of thessaly, while multiple burials are mostly noted in southern mycenaean populations. the pattern of males being placed on their right side, with females on their left, is noted in the current sample as well as at jančići dubac (with a few exceptions) and at pigi artemidos. artifacts, such as pottery and numerous bronze items (e.g., jewelry, weapons), are common among all sites of the wider study context. elaborate burials are noted in the grave circle/tholos tombs of pylos and kazanaki tholos tomb in thessaly. at numerous sites (e.g., lofkënd tumuli, spathes, korinos, trimbina, athens), prestigious objects were also found, with a proportion of the buried population (table 6). table 4. statistical comparisons of dental diseases and enamel hypoplasia between sexes while controlling for age young adults young middle old middle (f/f? vs. m/m?) (f/f? vs. m/m?) (f/f? vs. m/m?) dental caries 85.7% (18/21); 29.4% (10/34) 9.5% (2/21); 38.2% (13/34) 4.8% (1/21); 29.4% (10/34) mann-whitney: 4397.0 mann-whitney: 6031.5 mann-whitney: 3641.0 z = –0.082 z = –1.857 z = –2.093 p = 0.934 p = 0.063 p = 0.036 amtl 0; 18.8% (3/16) 40% (2/5); 6.3% (1/16) 60% (3/5); 75% (12/16) mann-whitney: 4224.0 mann-whitney: 6321.0 mann-whitney: 3681.0 z = –2.371 z = –1.211 z = –1.571 p = 0.018 p = 0.226 p = 0.116 enamel hypoplasia 43.3% (13/30); 20.2% (17/84) 46.7% (14/30); 56% (47/84) 10% (3/30); 22.6% (19/84) mann-whitney: 3776.5 mann-whitney: 3554.0 mann-whitney: 3432.5 z = –2.692 z = –2.281 z = –2.595 p = 0.007 p = 0.023 p = 0.009 calculus 36.9% (24/65); 21.3% (16/75) 33.8% (22/65); 41.3% (31/75) 29.2% (19/65); 29.3% (22/75) mann-whitney: 4220.0 mann-whitney: 6025.5 mann-whitney: 3667.0 z = –0.737 z = –1.141 z = –1.090 p = 0.461 p= 0.254 p = 0.276 table 5. prevalence of dental diseases and enamel hypoplasia by age groups age groups dental caries amtl calculus enamel hypoplasia juvenile (1–12 years) 5.8% (5/86) absent absent 20.9% (18/86) adolescent (12–18 years) 10% (2/20) absent 10% (2/20) 40% (8/20) yound adult (18–25 years) 16.3% (30/184) 1.4% (3/207) 22.8% (42/184) 19.6% (36/184) young middle (25–35 years) 7.3% (20/273) 2.6% (8/302) 24.5% (67/273) 23.1% (63/273) old middle (36–45 years) 8.4% (11/131) 8.2% (15/182) 31.3% (41/131) 16.8% (22/131) kruskal-wallis test chi-square = 12.519 df = 4 p = 0.014 chi-square = 20.598 df = 4 p = 0.00 chi-square = 33.691 df = 4 p = 0.00 chi-square = 7.134 df = 4 p = 0.129 michael et al. 31 table 6. archaeological information of lba sites of the wider study region sites of the wider context absolute chronology relative chronology type of tombs/burials grave orientation burial placement brief information on grave goods achlada, macedonia, greece 1400–1100 b.c. pit graves, single burials, all inhumations sw–ne; males/right; females/left one ceramic vessel per tomb (32 overall); 13 objects (e.g., amber beads, bronze fibulae, one knife) jančići dubac, serbia1 lba tumuli, inhumations and cremations multiple orientation (w–e and e–w), slightly crouched position observed in some cases, males/right; females/left jewelry, numerous bronze items, ceramic vessels, in general well furnished manastir, čaška–veles, north macedonia2 eba–eia necropolis of the settlement, 12 skeletons, of which 10 with traces of burning-cremation not completed part of the ulanci group lba tradition, north balkan objects (e.g., battle axes— celts, spears) kamenica tumuli, albania3 13th–12th c. b.c. tumuli, great circle, simple pits flexed position pottery, jewelery, weapons apollonia tumulus 10, albania4 lba/eia tumuli, simple pits, single burials multiple orientation nw most prevalent sleeping/fetal position most prevalent 32% of burials with grave goods, remarkable variety of types (e.g., bronze pins, bronze knife, necklace of faience beads) lofkënd tumuli, albania5 lba/eia tumuli, pit burials, single and commingled burials (simultaneous and primary-secondary inhumations), two cremations present multiple orientation (predominant orientation northeast and southeast), mostly supine position with legs flexed less than half of 85 burials with goods, grave goods found more in female burials, mostly one artifact per person, six “wealthier” burials up to 11 items each, in general: pottery, bronze and iron ornaments (including weapons), beads of various materials (iron and glass), electrum objects epirus’s sites, greece (elaphotopos, konitsa, skamneli)6 lba cist graves, inhumations local pottery, bronze weapons and implements, bronze jewelry, lithics; significant number of beads and one matt-painted jug (skamneli burials) p. athinas, macedonia, greece7 1650–1500 b.c. 5 tumuli—16 single-pit graves—the 5 central of them deeper—possible examples of elaborate construction sw–ne males/ right; females/left one ceramic vessel per burial—very few other findings (e.g., jewelry)—most usual ceramic type “thessaly kantharos” with central channel decoration p. artemidos, macedonia, greece8 1600–1400 b.c. tumulus, 6 pit graves & 3 stone & 1 deposit of bones, all single burials variously oriented males on both sides clay vessels and bronze items (one bracelet, one spiral earring, two pins, and three knives); one vase of mycenaean type valtos, macedonia, greece9 mba–lba tumulus—3 pit graves bronze jewelry in one burial korinos, macedonia, greece10 eba–lba tumuli, pit graves, mainly single burials contracted position, no specific orientation large quantity of pottery (local and mycenaean), clay, lithic and stone objects, numerous jewelry (bronze, silver, some gold beads) (continued) comparative bioarchaeological approaches on marginality32 table 6. (continued) sites of the wider context absolute chronology relative chronology type of tombs/burials grave orientation burial placement brief information on grave goods spathes, macedonia, greece11 1400–1200 b.c. cist graves, 2–5 individuals per burial sealstones (17), jewelry weaponry (e.g., sword type g of sandars, c3 dagger) and mycenaean or “mycenaeanising” pottery treis elies, macedonia, greece12 lba/eia cist and pit graves single burials handmade macedonian pottery and ceramics influenced by mycenaean patterns, numerous metalwork findings, simple and “poor” necklaces trimbina, macedonia, greece 13 1420–1150 b.c. 17 cist and pit burials (including one animal burial), single burials ne–sw all human burials with artifacts (pottery and metalwork)—intense mycenaean presence, one “warrior” burial rema xydias, macedonia, greece 14 1390–1200 b.c. mostly cist graves—multiple/ collective inhumations in most cases local production and mycenaean-type artifacts faia petra, macedonia, greece 15 13th c. b.c. five groups of single and multiple burials and a single grave, inhumations and one cremation, elaborate and time-consuming construction of burial enclosures contracted and supine positions plain clay pots (mainly incised decoration filled with white paste— typical of eastern and central macedonia); two mycenaean-type stirrup jars, several bronze items, amber beads, and two gold discs, funerary meals (remains of unburnt animal bones) velestino, thessaly, greece16 lhiiia–b five chamber tombs, one primary, and two to six secondary burials per tomb contracted position not very “rich” artifacts kazanaki, thessaly, greece17 14th c. b.c. one tholos tomb, commingled, evidence of incomplete cremation prestige items (e.g., golden jewelry, 1000 necklace tiles, glass beads), 42 pots (18 matt painted) east lokris, phiotida, greece18 1325–1100 b.c. chamber tombs commingled burials non-elite socioeconomic stratum athens, attiki, greece19 lba chamber tombs, pit graves, cist graves weapons (swords, spears, knives), painted pottery, beads (e.g., gold, amber) pylos, peloponnese, greece20 middle helladic to lhiiic population from the palace of nestor and neighboring area, grave circle, elaborate tholos tombs, chamber tombs and pit (cist) grave, primary and secondary burials in all cases extended and contracted grave circle: multiple artifacts (e.g., bronze cauldrons, daggers, rapiers, boars’ tusks, ornaments of gold, ivory, and silver); tholos tombs: beads of amethyst, pottery, gold leaf; chambers: pottery, beads, bronze and stone artifacts; pit grave: four pots ayia sotira, peloponnese, greece21 lhiiia1– iiib2 chamber cemetery, primary and secondary burials, 24 out of 34 burials showed evidence for secondary treatment pottery, plant, and food remains (meals for living or dead), residues of fatty lipids and wood, hundreds of miniature beads (continued) michael et al. 33 the number of adults vs. non-adults found in cemeteries of the wider region is presented in table 7. the highest adult–non-adult ratios are noted in lba/eia treis elies in pieria (11:1 ratio), mycenaean pylos (8:1 ratio), the current sample (7:1 ratio), and mycenaean voudeni (6:1 ratio). a number of sites, (e.g., kamenica tumuli, apollonia tumulus 10, lofkënd tumuli, spathes, korinos, east lokris, athens, ayia sotira) present ratios between 4:1 and 2:1. in pigi athinas tumuli no non-adults were found, whereas čaška–veles and faia petra present almost an equal number of adults and non-adults. lba jančići dubac is an exception, as the number of non-adults is slightly higher compared to adults. comparative data of lifestyle indicators. comparative djd data of lba sites of the wider study context are presented in table 8. the highest number of postcranial djd cases is noted at rema xydias and pigi athinas in macedonian olympus. the spine is more affected than the rest of the skeleton in achlada and lofkënd tumuli, while in velestino and jančići dubac djd is absent from the postcranial elements. in lba spathes and lba/eia treis elies, the upper part of the body (upper limbs, cervical and thoracic segments, and thorax) is more affected than the lower one (lower limbs, lumbar, and sacral segments) (table 8). comparative data on stature, trauma, co, and ph are presented in table 9. the highest adult stature is observed at jančići dubac and it is much higher compared to all the remaining sites of the wider study context. the two sites in thessaly (kazanaki and velestino), sykia in the peloponnese, and čaška–veles in north macedonia gave stature averages of around 165 cm, while the remaining samples have a stature range of between 158 cm and 162 cm. apart from rema xydias in macedonian olympus exhibiting a very high number of trauma cases (per bone), the majority of the remaining sites present few trauma cases (below five), while achlada cemetery and lofkënd tumuli present six and nine cases of traumatic lesions, respectively. likewise, the majority of sites present limited numbers of co and ph cases, with the exception of pigi athinas and rema xydias (table 9). finally, comparative results of enamel hypoplasia and dental diseases rates are presented in table  10. achlada has a statistically significantly higher rate of enamel hypoplasia than all the sites of central and southern greece, as well all of epirus’s sites (elaphotopos, konitsa, and skamneli). the only sites that present significantly higher rates of enamel hypoplasia than achlada are pigi artemidos and trimbina in macedonian olympus. dental caries frequencies table 6. (continued) sites of the wider context absolute chronology relative chronology type of tombs/burials grave orientation burial placement brief information on grave goods achaea clauss, peloponnese, greece22 lhiiia1–iiic chamber tombs, primary and secondary burials, inhumations, only one cremation clauss warrior 2: left placement, legs in contracted position pottery, sealstones, impressive jewelry, toilet equipment, metal objects, weapons (e.g., naue ii long sword), two warrior burials, exotic knife of north italian origin at clauss warrior 2 voudeni, peloponnese, greece23 1400–1050 b.c. chamber tombs, collective burials numerous findings: pottery, weapons, tools, jewelry; connections with messene, laconia, argolid/corinth, crete, italy, anatolia spaliareika achaea, peloponnese, greece24 lhiiia–c four chamber tombs, primary and secondary inhumations supine position (“local ruler” burial) two bronze swords (burial of local ruler—most elaborate burial), pottery, bronze items, glass and stone beads sykia, peloponnese, greece25 lhiiia–c three chamber tombs weapons (e.g., swords, knives, daggers), pottery 1 dmitrović 2016; 2 veljanovska 2008; 3 kline 2015:69; 4 grazia amore 2010; 5 papadopoulos et al. 2014; stapleton 2014; 6 tartaron 2004; vasileiou et al. 2018; vokotopoulou 1967; 7 poulaki-pantermali 2008; poulaki-pantermali et al. 2010; tritsaroli 2017; 8 tritsaroli and koulidou 2018; 9 poulaki-pantermali et al. 2010; 10 bessios 1997; 11 poulaki-pantermali 1986a, 1986b, 1987a, 1987b, 1990, 1991; 12 poulaki-pantermali 1988, 1989, 1992; 13 koulidou et al. 2017; 14 koulidou 2005, 2009, 2020; tritsaroli, 2020; 15 valla et al. 2010; 16 arachoviti 1994; doulgeri-intzesiloglou 1994; papathanasiou et al. 2012a; 17 adrimi-sismani and alexandrou 2008; 18 iezzi 2005, 2009; 19 camp 2003; smith 2009; 20 blegen et al. 1973; 21 smith et al. 2017; 22 paschalidis 2020; paschalidis and mcgeorge 2009; 23 kolonas 1998, 2009a; moutafi 2015; 24 petropoulos 2000; 25 eustathiou 1997, 1998. comparative bioarchaeological approaches on marginality34 range from 0% to 24.2%, placing achlada’s rate (9.9%) in the middle of this range (table 10). in contrast, the observed calculus rate of the current sample is significantly higher than most other compared collections (mostly in macedonia) with the exception of valtos and pigi artemidos. regarding amtl, achlada’s rate is one of the lowest compared to the sites of the wider study region (table 10). discussion a) intra-cemetery variation in terms of djd, male individuals were more affected than females. osteoarthritis, especially of the spine, is strongly linked to genetics and some studies have documented that this hereditary effect table 7. number of adults and non-adults in lba sites of the wider context adults non-adults (< 18 years) achlada 48 7 jančići dubac1 8 10 manastir, čaška–veles2 7 4 kamenica tumuli3 10 4 apollonia tumulus 104 46 14 lofkënd tumuli5 86 43 p. athinas6 17 0 p. artemidos7 8 2 valtos8 7 3 korinos9 20 4 spathes9 21 6 treis elies9 32 3 trimbina10 18 8 rema xydias10 32 13 faia petra11 7 5 velestino12 20 11 kazanaki13 6 3 east lokris14 142 43 athens15 79 38 pylos16 160 19 ayia sotira17 26 8 achaea clauss18 55 18 voudeni, achaea19 175 31 spaliareika achaea20 21 4 sykia21 28 8 1 radović 2016:272–282; 2 veljanovska 2008:431–438; 3 kline 2015:69; 4 schepartz 2010:52; 5 schepartz 2014:140–141; 6 tritsaroli 2017:238; 7 tritsaroli and koulidou 2018:table 1, 12; 8 tritsaroli 2007:table 1, 192; 9 triantaphyllou 2001:36; 10 tritsaroli 2020:table 2, 262; 11 valla et al. 2010:fig. 6, 236; 12 papathanasiou et al. 2012a:215; 13 papathanasiou 2009:153; 14 iezzi 2005:219, 2009:table 11.1; 15 smith 1998; 16 schepartz et al, 2009:table 10.2, 2011; papathanasiou et al., 2012b; 17 triantaphyllou 2017:132; 18 paschalidis and mcgeorge 2009:102; 19 moutafi 2015:428–429; 20 papathanasiou 2005:table 1, 192; 21 papathanasiou 1999:1009–1101. michael et al. 35 is stronger in females than in males (bergink et al. 2003; sambrook et al. 1999; spector and macgregor 2004; wilson et  al. 1990). therefore, even though the number of affected cases is very limited, it could be cautiously suggested that activity patterns differed between men and women. regarding trauma, the pattern observed in the current sample follows the expected conventional model of males suffering more accidental injuries than females as a possible consequence of a greater exposure to trauma triggered by heavier workload (angel 1974; grauer and roberts 1996; merbs 1989). in particular, traumatic lesions of the foot observed mostly in male individuals of the wider context (figs. s1 and s4) (e.g., papathanasiou et  al. 2012a:218–219; triantaphyllou 2001:83; tritsaroli and koulidou 2018:16) may suggest activities such as farming (e.g., constructing and clearing fields, tilling, planting, and harvesting) and walking long distances (triantaphyllou 2001:83). in achlada cemetery, with the exception of one juvenile, all cases of ph and co were recorded on females. a number of studies have pointed out that females show higher frequencies of acquired anemia than men due to stresses and iron loss related to pregnancy, lactation, and menstruation (larsen 1997; miller 2016; stuart-macadam 1998). on the other hand, as lesions observed on females were mostly healed, it is most likely that they had been formed during childhood/adolescence (stuart-macadam 1985; walker et al. 2009). walker et al. (2009) have challenged the association of iron loss with such porosities, linking them instead to megaloblastic and hemolytic anemias. in any case, due to the limited number of observed cranial elements and the obscure etiology of these lesions, more detailed conclusions could not be drawn. regarding enamel hypoplasia, males overall present higher frequencies of enamel hypoplasia than females and this difference is statistically significant. it seems possible that males could have been more exposed to stress episodes during their developmental years than females. on the other hand, it is quite possible that females experienced the same stress but were physiologically more buffered and did not develop the same amount of defects (e.g., trigunaite et  al. 2015). nevertheless, younger females present significantly higher rates than younger males (table  4), possibly suggesting that females experiencing stress episodes during childhood underwent a significant risk of death in early adulthood (triantaphyllou 2001:114). as a high prevalence of table 8. djd in late bronze age sites of the wider context sites (overall number of individuals) overall djd postcranial djd spinal djd achlada (n = 55) 10 cases (per indiv.) 31 cases (per bone) 4 cases (per indiv.) 6 cases (per bone) 6 cases (per indiv.) 25 cases (per bone) jančići dubac (n = 18)1 not available  not available 4 cases (per indiv.) lofkënd tumulus (n = 136)2 not available 8 cases (per bone) 45 cases (per indiv.) p. athinas (n = 17)3 not available  46 cases (per bone) 18 cases (per bone) p. artemidos (n = 10)4 not available  2 cases per hip, knee, ankle; 1 case per foot (per indiv.) 4 cases (per indiv.) spathes (n = 27)5 11 cases (per bone) upper body: 9 cases lower body: 2 cases (per bone) treis elies (n = 35)5 21 cases (per bone) upper body: 13 cases lower body: 8 cases (per bone) trimbina (n = 26)6 not available  shoulder (13.6%–37.5%) elbow (4.3%– 23.5%) hands (2%–33.3%) hip (18.4%– 23.8%) knee (15.9%–22.2%) ankle (7.9%–25%) foot (3.6%–7.3%)(per bone) cervical: 30.4%, thoracic & lumbar: 33.3% (per bone) kazanaki (n = 9)7 9 cases (per bone) not available  not available  velestino (n = 31)8 not available  not available  12 cases (per bone) spaliareika (n = 25)9 10 cases (per bone) not available not available  sykia (n = 36)10 8 cases (per bone) not available  not available  upper body: upper limbs, cervical and thoracic vertebrae, thorax; lower body: lower limbs, lumbar, and sacral vertebrae. for trimbina and rema xydias djd is presented for both sites combined. 1 radović 2016:272–282; 2 schepartz 2014:148–149; 3 tritsaroli 2017:table 9.6, table 9.7, 243–244; 4 tritsaroli and koulidou 2018:17; 5 triantaphyllou 2001:table 6.1, table 6.4, 70, 74; 6 tritsaroli 2020:258; 7 papathanasiou 2009:154; 8 papathanasiou et al. 2012a:218; 9 papathanasiou 2005:195–196; 10 papathanasiou 1999:1011. comparative bioarchaeological approaches on marginality36 physiological stress indicators in mature and old adults may indicate that affected individuals coped successfully with stress episodes during growth (dewitte and stojanowski 2015:407; wood et  al. 1992:352) current results could indicate that males coped more successfully with stress episodes during childhood compared to females, as defects are much more evident in the middle and old middle aged men than women. could it be suggested then that males received better care, such as a better nutrition, during growth that helped them to cope with stresses more successfully? a dentine isotopic reconstruction could potentially shed light on sex dietary differences during childhood. on the other hand, it cannot be safely assumed that males and females buried in achlada all grew up together under the same conditions. the challenges  both sexes faced in their childhood do not of necessity reflect challenges faced in the same landscape or community setting. osteological and isotopic data from mainland southern greece (papathanasiou et al. 2012b; schepartz et al. 2009; triantaphyllou et al. 2019) have indicated dietary differentiations related to sex, with females having poorer dental health than males, and the latter incorporating more animal protein in their diet. the concept of females consuming cariogenic foodstuffs and males more meat could be suggested for sites in pieria such as pigi athinas (tritsaroli 2017:250), korinos, and spathes (triantaphyllou 2001:120–126), based on caries and calculus rates. the pattern observed at achlada though is not that clear. males present higher rates of caries and calculus than females; however, the differences are not statistically significant. dental caries differences are significant between old middle adult males and females (table  4). amtl, which is associated with caries among other factors (hillson 1996), is also more frequent in males than females and this difference is statable 9. comparative data of stature, trauma, cribra orbitalia, and porotic hyperostosis sites (overall number of individuals) stature trauma cribra orbitalia porotic hyperostosis achlada (n = 55) 162.5 cm 6 cases (per indiv.) 2 cases (per indiv.) 3 cases (per indiv.)8 cases (per bone) jančići dubac (n = 18)1 172.09 cm absent absent absent manastir, čaška–veles (n = 12)2 165.3 cm not available not available not available apollonia tumulus 10 (n = 60)3 not available not available 5 cases (per indiv.) lofkënd tumulus (n = 136)4 161.5 cm 9 cases (per indiv.) 5 cases (per indiv.) 1 case (per indiv.) p. athinas (n = 17)5 162 cm 2 cases (per bone) none 17 cases (per bone) p. artemidos (n = 10)6 not available 2 cases (per indiv.) 3 cases (per indiv.) 1 case (per indiv.) valtos (n = 3)7 not available 2 cases (per bone) absent 1 case (per indiv.) spathes (n = 27)8 157 cm 2 cases (per bone) 3 cases (per bone) 1 case (per bone) treis elies (n = 35)8 not available 2 cases (per bone) 1 case (per bone) absent trimbina (n = 26)9 160 cm 1 case (per bone) 2 cases (per indiv.) 5 cases (per indiv.) rema xydias (n = 45)9 158 cm 15 cases (per bone) 7 cases (per indiv.) 17 cases (per indiv.) kazanaki (n = 9)10 165.5 cm 1 case (per bone) 2 cases (per indiv.) absent velestino (n = 31)11 164.4 cm 2 cases (per indiv.) absent absent spaliareika (n = 25)12 158 cm 1 case (per indiv.) 1 case (per indiv.) 4 cases (per indiv.) achaea clauss (n = 73)13 162.2 cm not available  not available  not available  sykia (n = 36)14 165.9 cm 4 cases (per indiv.) absent 1 case (per indiv.) ayia sotira (n = 34)15 not available 1 case (per indiv.) not available not available 1 radović 2016:272–282; 2 veljanovska 2008:431–438; 3 schepartz 2010:fig. 3.20, 61; 4 schepartz 2014:139–150; 5 tritsaroli 2017:238, 246; 6 tritsaroli and koulidou 2018:15–16; 7 tritsaroli 2007:192–193; 8 triantaphyllou 2001:table 6.5, table 6.15, 79, 106; 9 tritsaroli 2020:table 4, 263; 10 papathanasiou 2009:153–154; 11 papathanasiou et al. 2012a:217–219; 12 papathanasiou 2005:194–195; 13 paschalidis and mcgeorge 2009:103; 14 papathanasiou 1999:1010–1011; 15 triantaphyllou 2017:13. michael et al. 37 tistically significant (mann-whitney u: z = –1.961, p = 0.05). females tend to present higher frequencies of dental caries in both modern and archaeological samples (hillson 2001; walker and hewlett 1990) due to biological, behavioral, and cultural factors (laine 2002; larsen 1997; larsen et  al. 1991; walker and hewlett 1990). nevertheless, this is not a universal pattern. for example, in lofkënd tumuli, mycenaean athens, and mycenaean ayia sotira, males present much higher carious lesions than females (schepartz 2014:149–150; smith 1998; triantaphyllou 2017:136). various cultural and behavioral factors have been proposed to explain this reverse pattern (i.e., more males than females affected), including the type and consistency of food preparation and cooking methods, gendered division of labor, and subsistence activity patterns that could potentially result in differential access to cariogenic food for men and women (lukacs 1989:151–152; walker and erlandson 1986:380). what is even more interesting and not associated with biological factors is the negative association of dental caries with age in the current sample. even though the progressive nature of this condition leads to a developmental pattern that is strongly related to age (manji et al. 1991; thylstrup and fejerskov 1994), the highest percentage of caries was noted in young adults (table  5). both sexes presented negative correlations with age, although the observed correlation was only statistically significant for females. it could be suggested that younger females might have been mostly responsible for specific tasks, such as food preparation, that could have possibly exposed them to a higher intake of cariogenic foodstuffs. these results could also represent selective mortality. it could be proposed that frailty was higher in younger females and thus they were more likely to die and be selected out of the population (dewitte and stojanowski 2015:407; wood et al. 1992). complications during pregnancy and childbirth could be possibly linked to female ill health and mortality. selective mortality could also be proposed for juveniles exhibiting dental caries, even though their number is very limited and far-reaching interpretations should not be made. b) intercemetery comparisons comparative data on funerary practices. comparative mortuary information is presented to better comprehend the different ways in which the communities in pelagonia were connected to major cultural constellations to the north and/or south (table 6). starting from the northern part of the wider context, jančići dubac, in the čačak region, is under the influence of the tumulus tradition and belongs to the western serbian variant of the vatin group (dmitrović 2016:214). it is a very well-furnished mortuary assemblage (with widespread presence of vessels from morava valley) (dmitrović 2016:218) and certain characteristics, such as differential burial treatment between the sexes and type of burials, are also evident in the albanian and ulanci mortuary tradition (papadopoulos et al. 2014; papazovska sanev 2014). a significant difference between achlada and dubac is the prominent presence of cremations (common from 1350 b.c. onward) along with inhumation burials. even though cremations are not absent in the remaining study region, they are much less frequent (table 6). general features of the tumuli ulanci necropolises include inhumations in crouched positions and the body placed in cist/pit graves, while matt-painted pottery and local copies of mycenaean vessels are also present (papazovska sanev 2014:9). such features are very much evident in macedonia, northern greece (e.g., pigi athinas, pigi artemidos, valtos), while cist tombs and single inhumation burials are also the “rule” in lba epirus (e.g., tartaron 2004). tumuli, a tradition that appears on the greek mainland in the early helladic ii period probably as a consequence of influences from the north (tritsaroli 2017:228), is much more evident in pieria, especially before the “mycenaeanization” of the area. moving from the middle helladic period to the late helladic, especially in central and southern greece, the reuse of graves and multiple inhumations appear. these multiple shaft graves are covered by chamber and tholos tombs (stapleton, 2014:205; tritsaroli 2017:227–228) (table  6). the occurrence of multiple and/or secondary burials also appears in macedonia, northern greece, during the developed lba (lhiiia–lhiiib) (e.g., spathes, rema xydias) (koulidou 2020; triantaphyllou 2001:64–65; triantaphyllou and andreou 2020:183), and mostly during the advanced lba (lhiiic) (e.g., faia petra, methoni and kastri in thasos) (triantaphyllou and andreou 2020:183). another important characteristic appearing in the mortuary environment during the lba is the deposition of material wealth in burials (tritsaroli 2017:228). the accumulation of distinct artifacts as manifestations of social identity is evident in numerous northern assemblages, such as spathes and lofkënd tumuli (table  6) (stapleton 2014; triantaphyllou and andreou 2020), as well as at aeani and rymnio in western macedonia (karametrou-mentesidi 1990:355; poulaki-pantermali 2013:45–62). even in cases where prestige items were not found (e.g., pigi athinas) social intra-cemetery differentiation was attempted through differential investment in grave construction (tritsaroli 2017:228–233: table 6). comparative bioarchaeological approaches on marginality38 it is therefore characteristic that in achlada there is no such differential investment in grave construction, while accumulation of distinct artifacts was very relatively modest (just 13 associated finds recovered in six tombs) (ziota 2019). in terms of demographic characteristics, the overall number of juveniles is very small in the community under study while no infants were found. the 7:1 ratio of adults vs. non-adults is similar to that found in mycenaean assemblages, such as voudeni and pylos (table 7). the pattern of a limited number of non-adults is also in agreement with neighboring sites in southern albania, such as the lba kamenica tumulus (kline 2015:69) and lofkënd tumuli (schepartz 2014:144), but not at čaška–veles in north macedonia (veljanovska 2008:431–438) or jančići dubac (radović 2016: 272–282). normally, for preindustrial societies the expected percentage of juveniles and infants ranges between 30% and 50% (coale and demeney 1983; weiss 1973). non-adults were treated in a different way in the mycenaean sphere and there is a significant variation in differential treatment of juvenile individuals in lba greece, not just in relation to their arithmetic presence, but also regarding the presence/absence of artifacts found in their tombs (cavanagh and mee 1998; schepartz et  al. 2009). nevertheless, we cannot be certain of the limited non-adult presence in the achlada community, as it is possible that a higher number of non-adults were buried in a part of the cemetery that was not preserved (due to disruptions by later burials or foundations of roman buildings) (ziota 2019). additionally, it could also be hypothesized that if juvenile burials were shallower than adult ones, it would be more likely for them to get disrupted through later activity during the roman period (ziota 2019). based on the information presented above, it seems that features from different traditions were combined in the current mortuary environment. differential burial treatment between sexes and burial types reflects traditions visible at ulanci and central macedonia cemeteries. material culture evidence reveals relations with sites of central macedonia and southeastern albania (ziota 2019). mycenaean influence is also present, manifested by two “mycenaeanizing” painted vessels (ziota 2019:table 1) and possibly also based on the adult:non-adult ratio. the comparative funerary analysis showed that achlada was connected with minor and major cultural ambits, but in a limited way, as suggested by the lack of significant material culture differentiation within the community. comparative lifestyle data. in terms of djd, the assemblage seems to be moderately affected when compared to other sites of the wider context (table 8), even though spinal djd is prominent. it is obvious that the current assemblage is more intensely affected compared to the well-networked sites at spathes and treis elies, but less so compared to the pigi athinas assemblage (1650–1500 b.c.), with the latter predating achlada as well as the extensive mycenaean influence in the region around mount olympus (tritsaroli 2017:225). rema xydias population in pieria, a modestly furnished assemblage, is also a severely affected community with regard to djd (tritsaroli 2020:258). the cervical segment of the vertebra seems to be more affected in achlada and this pattern is also noted at pigi athinas (tritsaroli 2017:251) and lofkënd tumuli (schepartz 2014). the upper part of the body is also mostly affected in spathes and treis elies (triantaphyllou 2001) (table 8), confirming that food acquisition, processing, preparation, and craft production, which have been linked to degenerative changes predominantly in the upper body (triantaphyllou 2001:75), probably were important labor activities at these sites. different methodologies and recording protocols make it difficult to directly compare djd frequencies between sites, while at the same time age and weight have also been considered to be important causative factors leading to djd (sofaer-derevenski 2000; solano 2002; waldron 1998; weiss 2004, 2006). therefore, interpretations should be treated with caution. injuries in the current sample and wider context are mostly of an accidental nature/origin. cases of possible interpersonal violence are also present, although limited (e.g., scapular fracture [the severity of the lesion suggested a violent episode] at pigi artemidos [tritsaroli and koulidou 2018:20], one healed cranial trauma at lofkënd tumuli [schepartz 2014], and three male individuals in the mycenaean athenian agora found with wounds consistent with combat and interpersonal violence [smith 2009]). in the current sample there is a possible case of a healed cranial depression that could be associated either with a violent attack or an accidental injury (fig. s5); however, the poor preservation of the specific sample does not allow for a secure diagnosis. it is attractive to hypothesize that the dearth of violent cases could be associated with possible advantages related to marginality. if for example we think of competition and raiding, being marginal could have its advantages as there would be little to claim/steal. nevertheless, the paucity of violent trauma cases in the vast majority of well-networked sites does not favor such bold assumptions. michael et al. 39 stature estimates from achlada seem to fall within the range of well-networked lba sites situated to the south, north, and east (table 9). even though stature is mainly affected by genetic factors (lango et  al. 2010; wood et al. 2014), evidence from a wide range of osteological investigations (steckel 1995, 2009) has demonstrated that adult height and environmental stress, usually nutritionally induced, are closely related. stature estimates should be treated with caution though, as results from most of the sites in the comparative list (table 9) are based on very few femoral bones. regarding nonspecific stress indicators, ph and co cases in achlada are quite few, but this is similar to most other sites (see table  9 for references). the enamel hypoplasia rate at achlada is significantly higher than at all the sites of southern and central greece, as well as numerous northern assemblages (table 10). interestingly, with a few exceptions, there is a clear tendency of northern communities to display elevated frequencies of enamel defects, compared to those of central and southern greece. this observation is statistically significant (mann-whitney u: p = 0.008). according to papathanasiou (2005:196), the declining rates of enamel hypoplasia noted in mycenaean populations may reflect an improvement in health status and living conditions, especially for children. when comparing these results with northern sites of the wider context, the current community presents significantly higher rates of table 10. dental diseases and enamel hypoplasia in late bronze age sites of the wider study region dental caries calculus amtl enamel hypoplasia achlada 9.9% 22.4% 3.2% 21.2% jančići dubac1 0%* 16.6%* 11.1% 11.1%* apollonia tumulus 102 17%* not available  4.2% not available  lofkënd tumulus3 9.8% not available  5.3%* 56.6% epirus’s sites4 18.3%* 12.2%* 7.9%* 6.1%* pigi athinas5 10% 14%* 3% 23% pigi artemidos 6 17.8%* 28.2% 3.1% 32%* valtos7 8% 53%* 4% 9%* spathes8 11.23% 7.86%* 26.14%* 14.04%* treis elies8 13.88% 2.08%* 37.66%* 6.9%* korinos8 3.15%* 9.47%* 0%* 4.2%* trimbina9 24.2%* 15.8%* 10.4%* 36.1%* rema xydias9 19%* 25.7%* 26% velestino10 5.1%* 6%* 64.3%* 6%* kazanaki11 0%* not available 0% 8%* pylos (grave circle/tholos iii)12 3.7%* not available 4.8% 4.4%* pylos (chambers)12 12% not available 14.5%* 10.6%* spaliareika13 3.3%* not available 26.1%* 10.8%* sykia14 7% not available 7.3%* 6.1%* ayia sotira15 9.91% not available 7.29%* 1.22%* *statistically significant differences compared to achlada (pearson chi-square test [p < 0.05], df = 1 for all cases). enamel hypoplasia for lofkënd tumuli is given per number of dentitions and statistical comparison with achlada was made based on crude prevalence; amtl for velestino is given per number of individuals and statistical comparison with achlada was made based on crude prevalence; amtl is given combined for trimbina and rema xydias. 1 radović 2016:272–282; 2 schepartz 2010:table 3.2, table 3.3, 62; 3 schepartz 2014:139–150; 4 michael, personal observations; 5 tritsaroli 2017:239; 6 tritsaroli and koulidou 2018:14–15; 7 tritsaroli 2007:193; 8 triantaphyllou 2001:109, 120, 124, 128; 9 tritsaroli 2020:table 4, 263; 10 papathanasiou et al. 2012a:227; 11 papathanasiou 2009:154; 12 schepartz et al. 2009:table 10.5, 167 (retrieved from individual teeth); 13 papathanasiou 2005:35–38, 191–198; 14 papathanasiou 1999: 1009–1101; 15 triantaphyllou 2017:135. comparative bioarchaeological approaches on marginality40 enamel hypoplasia compared to treis elies, spathes, korinos, and jančići dubac sites that were extensively connected to major routes. this is not an absolute pattern, though (e.g., trimbina, tables 6 and 10). it could, however, be suggested that enamel hypoplasia rates in achlada suggest a poor growth environment, leading to multiple episodes of stress and growth arrest during the early years of these individuals. on the other hand, significantly higher enamel hypoplasia rates may not necessarily indicate poorer health (wood et al. 1992), as individuals who do not survive stressful events would not have had the chance to develop such hypoplastic defects. ameloblasts are particularly sensitive to even minor physiological disruptions (larsen 2015:44). in her attempt to interpret the elevated enamel hypoplasia rates in lofkënd tumuli contrary to the limited ph and co cases (tables 9 and 10), schepartz (2014) suggested the possibility of stresses leading to enamel hypoplasia to be of a lower magnitude than those resulting in ph and co, as the former indicator is much more sensitive to metabolic stresses. preservation challenges affecting cranial segments, also noted in the current assemblage, should also be considered. consequently, it could be cautiously suggested that the current sample, as well as a number of mostly northern communities of the wider context, faced more physiological challenges during growth, at least of a mild and moderate level, compared to a number of sites connected to major routes. this could be a result of participation in less extensive trading networks, and/or harsher environmental conditions (e.g., lower temperatures). in terms of diet, the lba in northern greece was marked by a specialized and extensive system of agriculture and stock raising. high juvenile mortality curves have been observed among sheep, goat, and cattle, suggesting a strategy of animal husbandry primarily targeted at meat consumption (triantaphyllou 2015:58). isotopic dietary reconstructions from several aegean bronze age skeletal collections have revealed predominantly terrestrial subsistence strategies involving the intake of both plant and animal products (e.g., dairy products, eggs) without significant contributions of meat or marine protein (i.e., lagia and cavanagh 2010; lagia et al. 2007; papathanasiou 2015; papathanasiou et  al. 2012b; petroutsa et al. 2009; triantaphyllou et al. 2019). heavy reliance on terrestrial food items was also found in lba kamenica tumulus (kline 2015:133). combining dental with isotopic data, spathes and treis elies displayed a low animal intake (triantaphyllou 2015) (table  10). the analogous relation of calculus and protein consumption was also found based on isotopic data, in eba koilada in kozani, western macedonia (triantaphyllou 2001; triantaphyllou 2015; ziota 2007), where the calculus rate was at 22.22% (almost identical to the achlada sample— true prevalence). on the other hand, isotopic results also showed a heavy reliance on animal protein for korinos (triantaphyllou 2015:67), where calculus rates are less than 10%, reminding us that simplistic correlations should be avoided, as oral hygiene, water, and soil quality should also be taken into account when considering dental pathologies (tritsaroli 2017:251). nonetheless, based on the caries/amtl-calculus pattern (table 10), a reliance on animal proteins and thus pastoralism could be cautiously suggested for the current sample. hunting could also be proposed as its practice was renewed by the end of the lba in macedonia (triantaphyllou and andreou 2020:174). achlada’s specific location on a fertile plateau, though, supports cultivating practice. what is certain is that dental diseases do not suggest a poorer diet in the achlada community compared to other well-networked populations (table  10). on the contrary, it could be suggested that the stated community had a good diet with adequate intake of animal proteins. could we assume then that marginality for the specific community meant they had modest access to prestige goods, but adequate access to food sources? even if reciprocal intercommunity exchange networks were less extensive, physical storage and/or diversification (halstead and o’shea 1989:4) could be the primary cultural practices of the achlada community as a response to times of hardship, thus securing adequate food sources. therefore, the dearth of material in graves could suggest a greater focus on basic subsistence or nominal surplus farming organization. it is obvious that the matter of marginality and its impact on human lifeways is highly complex. conclusions in conclusion, it seems that a “menu” of practices was articulated by lba populations presented in the current study. no specific formula existed and communities had the choice of following different funerary practices based on their perspectives. different cultural nodes were being accessed, they were inspired by groups to the north and to the south, but this was selective, and local conventions also emerged, as seen at achlada. scarce deposition of precious materials in the achlada burials (e.g., rare amber finds, occasional metal findings) points to a clear connection—probably not an extensive one, though—with cultural ambits. michael et al. 41 intra-cemetery lifestyle investigation revealed differentiations between the sexes. males possibly managed to cope more successfully with stressful events during growth, possibly indicating better care during childhood. the analysis revealed that men were possibly more engaged in challenging physical activities than women. in addition, dental results suggest that young females were either a group of higher frailty and/or were more exposed to carbohydrates, perhaps as a consequence of their part in the community. the differential burial placement of the sexes in the preserved portion of the cemetery possibly represents symbolically the different roles that society attributed to men and women in deathways (ziota 2019). it is possible that those different roles were associated with actual lifestyle differences. whether these intracommunity differentiations were associated with possible marginality remains unclear. the comparative bioarchaeological analysis did not reveal significantly poorer health compared to well-networked populations. it is true, though, that the current community, as well as a number of mostly northern populations surrounding achlada in the wider region, probably faced more physiological challenges during growth, at least of a mild and moderate level, compared to communities connected to major cultural ambits. in terms of diet and physical activity the analysis did not indicate an unprivileged marginal environment. in fact, dietary dental analysis revealed that the current community had potential access to animal protein. combining mortuary and lifestyle data we find achlada being closer to pigi athinas and lofkënd tumuli, but displaying more modest material culture in the mortuary environment. therefore, it is possible that marginality in the current sample could mean modestly resourced in prestige finished goods rather than less access to food sources. the main challenge at the achlada lba site was the dearth of material culture evidence related to networking and subsistence. for this reason a thorough contextualized and comparative bioarchaeological analysis was implemented. even though preservation challenges and the multifactorial nature of lifestyle indicators hindered firm answers, bioarchaeological comparative approaches were able to offer insights into the priorities and lifeways of this community. dietary isotopic reconstruction, biomolecular analysis, and mobility investigation will hopefully help us to form a more integrated picture. the quest of exploring the impact of marginality on human lifeways has just begun. acknowledgments this research has been funded as part of the european research grant project “the fall of 1200 bc” (grant number 772753). we would like to thank the general hospital of florina for allowing us to use its infrastructure. we would also like to thank dr. panagiotis karkanas, director of the malcolm h. wiener laboratory, for allowing us to use the lab’s infrastructure and especially dr. dimitris michailidis, for his valuable help in processing the x-ray pictures. we finally thank the associate editor and anonymous reviewers for their constructive comments. references 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adepartment of anthropology, the university of western ontario, london, ontario, canada buniversity of wrocław, wrocław, poland cdepartment of anthropology, trent university, peterborough, ontario, canada dlaboratoire pacea, université de bordeaux, pessac, france emuséum national d’histoire naturelle, paris, france fdepartment of anthropology, santa monica college, santa monica, ca, usa gobrascon huarte lain— sucursal del perú, lima, perú hmuseo pachacamac, lurín, perú *correspondence to: andrew nelson, department of anthropology, the university of western ontario, london, ontario, canada, n6a 5c2 email: anelson@uwo . ca abstract a paleoradiographic survey of funerary bundles (fardos) from a late intermediate period (1000 a.d.– 1472 a.d.) cemetery in sector 3 of the site of pachacamac, peru, demonstrated that 15 out of 61 individuals had had their head removed when the body was in an advanced state of skeletonization/mummification. detailed analysis of the field report, the fardos themselves, and xrays and computed tomography scans of the fardos suggested that nine of these individuals were potential candidates for head removal in antiquity. of those nine, six appeared to be clear examples of this practice. the analysis of multiple lines of evidence suggests that the use of this cemetery was complex, as part of a dynamic mortuary program that involved exposing the body for varying lengths of time and repeated excavations for new interments when earlier burials were encountered. we conclude that these heads were removed from funerary bundles when graves were being dug for subsequent burials and the specific identity of the bundled individual had been lost. when considered within the abundant archaeological record of decapitation in the prehispanic andes, as well as ethnohistoric accounts, this pattern is consistent with reported retrieval of heads as material manifestations of ancestors. however, when placed within the broader context of contemporary sites from the central and southern coast, it is clear that specific cultural motivations may have varied through space and time. keywords: peru; pachacamac; headless burial; mortuary archaeology; prehispanic l’étude paléoradiographique de paquets funéraires (fardos) provenant d’un cimetière de la période intermédiaire tardive (1000 a.d.– 1472 a.d.) dans le secteur 3 du site de pachacamac, pérou, a démontré que 15 des 61 individus avaient subi une ablation de la tête lorsque que le corps était dans un état avancé de squelettisation/ momification. l’analyse détaillée du rapport de fouille, des fardos euxmêmes, ainsi que les résultats des received 26 july 2023 revised 25 september 2023 accepted 12 october 2023 bi_xx_xx_05_nelson_4p.indd 1bi_xx_xx_05_nelson_4p.indd 1 14-03-2024 13:50:4814-03-2024 13:50:48 headless burials from pachacamac, peru2 pachacamac is a monumental administrative and pilgrimage center that was occupied from the early intermediate period (0 a.d. to ca. 600 a.d.) through the spanish colonial period (post 1532 a.d.) on the central coast of peru. located just south of the modern city of lima, it served as the capital of the ychsma culture from ca. 1100 a.d. to ca. 1470 a.d. (pozziescott 2010 [the chronology used here follows pozziescot (2017)]; see table 1), when it was conquered by the inca, and the eponymous deity, pachacamac, was incorporated into the inca pantheon. the site’s role as a pilgrimage center was probably locally focused until the inca conquest, after which its importance as a destination for the faithful greatly increased (owens and eeckhout 2022). the focus of this article is a sample of headless individuals from one of the cemeteries at pachacamac. decapitation, in both iconographic and physical forms, played a central role in ritual practice in the prehispanic andes. reviews of the practice have documented cases of decapitation in the cupisnique and moche societies of the north coast (cordy collins 2001), carmichael (1988, 1994, 1995) has written extensively on the practice in the nasca society on the south coast, tung (2008) and tung and knudson (2008, 2010) have documented the practice at the wari site of conchopata, and ogburn (2007) and several spanish chroniclers (e.g., betanzos 1996 [1576]:41) have described the display of defeated leaders’ heads by túpac inca yupanqui. verano (2015) has offered a table 1. chronological sequence of pachacamac (after pozziescott et al. 2017:figure 6) chronology period culture constructions in the sanctuary 1470 a.d.– 1532 a.d. late horizon inca occupation temple of the sun/acllawasi 1000 a.d.– 1470 a.d. late intermediate period ychsma pyramids with ramps 600 a.d.– 1000 a.d. middle horizon pachacamac/neveria painted temple/temple of pachacamac 0 a.d.– 600 a.d. early intermediate period old temple radiographies et des tomodensitogrammes des fardos suggèrent que neuf de ces individus figuraient comme des candidats potentiels à la décollation sur la période considérée. sur ces neuf individus, six d’entre eux semblent être des exemples clairs de cette pratique. l’analyse de plusieurs sources de données suggère que l’utilisation de ce cimetière était complexe et s’inscrivait dans le cadre d’un système mortuaire dynamique qui impliquait l’exposition du corps pour des durées variées ainsi que l’exhumation d’anciennes tombes pour procéder à de nouveaux ensevelissements. nous concluons que ces têtes ont été soustraites des paquets funéraires lors du creusement de nouvelles tombes lorsque l’identité spécifique de l’individu anciennement inhumé avait été perdue. si l’on tient compte de l’abondante documentation archéologique sur la décapitation dans les andes préhispaniques, ainsi que les récits ethnohistoriques, ce schéma est cohérent avec la récupération des têtes en tant que manifestations matérielles des ancêtres. cependant, en se plaçant dans le contexte plus large des sites contemporains de la côte centrale et méridionale, il n’est pas à écarter que les motivations culturelles spécifiques aient pu varier dans l’espace et dans le temps. mots clés: pérou; sépulture sans tête; archéologie mortuaire; préhispanique un estudio paleoradiográfico de fardos funerarios del período intermedio tardío (1000 d.c.– 1472 d.c.) del cementerio en el sector 3 del sitio de pachacamac, perú, demostró que 15 individuos de un total de 61 personas les habían extraído la cabeza cuando el cuerpo se encontraba en un estado avanzado de esqueletización/momificación. análisis detallado del informe de campo, los fardos mismos, como también las radiografías y las tomografías computarizadas de los fardos sugirieron que nueve de estos individuos eran potenciales candidatos para la remoción de cabezas en la antigüedad. de esos nueve, seis parecen ser claros ejemplos de esta práctica. el análisis de múltiples líneas de evidencia sugiere que el uso de este cementerio fue complejo, como parte de un programa mortuorio dinámico que implicó la exposición del cuerpo durante períodos de tiempo variables y excavaciones repetidas para nuevas inhumaciones cuando se encontraron entierros anteriores. concluimos que estas cabezas fueron retiradas de los fardos funerarios cuando se cavaban las tumbas para entierros posteriores y se había perdido la identidad específica del individuo envuelto. cuando se considera dentro del abundante registro arqueológico de decapitaciones en los andes prehispanos, así como los relatos etnohistóricos, este patrón es consistente con la recuperación de cabezas reportada como manifestación material de los antepasados. sin embargo, cuando se les sitúa dentro del contexto más amplio de los sitios contemporáneos de la costa central y sur, queda claro que las motivaciones culturales específicas pueden haber variado a través del espacio y el tiempo. palabras claves: perú; pachacamac; entierro sin cabeza; arqueología mortuoria; prehispánico bi_xx_xx_05_nelson_4p.indd 2bi_xx_xx_05_nelson_4p.indd 2 14-03-2024 13:50:4914-03-2024 13:50:49 nelson et al. 3 comprehensive treatment of the subject, focusing on nonstandard mortuary treatments in the andes. many discussions of decapitation make a distinction between taking the head of an enemy and taking the head of an ancestor (cf. arnold and hasdorf 2008). the former was a punitive political act, while the latter was a powerful link to ancestral vitality and fertility (arnold and hasdorf 2008; carmichael 1994; toyne 2015). thus, this article seeks to place the sample of headless burials from pachacamac within the larger context of the decapitation tradition in the andes to shed new light on this practice and on funerary activities at pachacamac. context the site of pachacamac was first systematically excavated by max uhle (1903), who estimated that there were 80,000 individuals buried at the site. uhle (1903) identified six cemeteries at the site, and additional burials have been found in many other contexts across the site, including areas excavated in the past 25 years by proyecto ychsma in 1999– 2003 (eeckhout 2004; owens and eeckhout 2015), the pachacamac archaeological project directed by izumi shimada starting in 2003 (takigami et al. 2014), the ongoing proyecto arqueológico de valle de pachacamac (palma and makowski 2019), and several conservation and excavation projects of museo pachacamac undertaken since 2008 (e.g., pozziescot et al. 2018). this history was recently reviewed by fuentes et al. (2022). a prehispanic cemetery was encountered during landscaping work as part of the construction of a new national archaeology museum dubbed muna (museo nacional de arqueología del perú). the cemetery was located outside of the main sanctuary in an area designated as sector 3 (see fig. 1). it was excavated in 2015 by jhon baldeos (2015) and again in 2016 and 2019 by baldeos and sara garcía (garcía and baldeos 2020). in 2015, 138 funerary contexts were identified (baldeos 2015:8), including 78 more or less intact fardos (baldeos 2015: 50) (a “fardo” is a structured bundle of textiles that contains an individual and associated grave goods), skeletonized individuals, and secondary burial deposits and other offerings (baldeos 2015). the uppermost layer of the cemetery included many disturbed deposits of human remains. in the later campaigns, rescue excavations were undertaken in areas of a recent chicken farm, aquifer, and sand mining operations. this muchdisturbed context yielded 31 “fortuitous findings,” including many deposits of disturbed human bones and other archaeological material, including 15 fardos (garcía and baldeos 2020). the sector 3 figure 1. map of the site of pachacamac showing the location of sector 3 and the muna cemetery in relation to the main part of the sanctuary. source: museo pachacamac. bi_xx_xx_05_nelson_4p.indd 3bi_xx_xx_05_nelson_4p.indd 3 14-03-2024 13:50:4914-03-2024 13:50:49 headless burials from pachacamac, peru4 cemetery was believed to date from the late middle horizon (600 a.d. to 1000 a.d.) to the early late horizon (1470 a.d. to 1532 a.d.) (baldeos 2015). the cemetery is described as being in a sandy matrix with no evidence for individual tomb cuts or tomb architecture. the uppermost layers had been disturbed by sand mining in the 1960s. the burials were encountered between a few centimeters and 140 cm below the surface. baldeos (2015) excavated in a series of arbitrary levels (see below for a discussion of chronology). in 2019, the mummies as microcosms project (mam) (nelson et al. 2021) began working in collaboration with museo pachacamac to undertake a paleoradiographic, bio archae ol o gi cal survey of the fardos from the sector 3 cemetery. this undertaking is part of a broader research program that seeks to shed light on the biological and cultural characteristics of the occupants of the central coast of peru from the middle horizon through the late horizon. fardos were given an initial visual inspection to assess overall preservation. then, wellpreserved fardos were imaged using plane radiography to assess internal preservation and suitability for computed tomography. finally, a select sample was subjected to computed tomography (ct). minimally invasive samples of textile were taken for 14c analysis and, where accessible, through preexisting openings in the wrappings, and hair samples were obtained for carbon and nitrogen isotopic analysis. in 2022, the project was joined by coauthor pk, and archaeoentomological samples were taken from the fardos. at the time of writing, we have examined 70+ fardos, xrayed 61, and collected ct scans of 48. we have additional xrays and ct scans of fardos from other contexts at pachacamac as well as other sites on the central coast for regional comparisons. the paleoradiographic approach emphasizes the use of nondestructive imaging to visualize the contents of the fardo (nelson et al. 2021). fardos are traditionally studied by unwrapping them (e.g., diaz 2015; frame et al. 2004, 2012; frame and falcón 2014). this process yields important information about body modification (e.g., tattoos), textiles, and wrapping details, but it destroys the context of the fardo, and once the fardo is separated into its components (metals, textiles, bones, etc.), the components are typically curated in different parts of a museum, making it difficult to reconstruct that context (cf. ordoñez 2019). while paleoradiography will never recover the full range of information available from an unwrapping (cf. sutherland 2019), it does not destroy the context, and the bundle can be revisited subsequently with different analyses/techniques. the plane xray survey provides a low cost means of rapidly and nondestructively surveying a large number of bundles. in the course of this survey, it became clear that several of the individuals inside the fardos did not have heads. given the importance of decapitation in andean ritual practice discussed above, this article focuses on these individuals to better understand this element of the mortuary ritual at pachacamac. for the purposes of clarity, in the following descriptions, the term “head” will refer to the cranium and mandible, with variably adhering cervical vertebrae and associated desiccated soft tissues. methods the mam project takes a multimodal approach to the study of prehispanic fardos, emphasizing nondestructive/ minimally invasive methods to maximize the recovery of data. we start with visual inspection of the fardos to assess their state of preservation, and then we record them using photography and drawing, and we make observations about their method of wrapping, any visible artifacts, bones, or mummified body parts. several fardos were found to have been exposed to water and were referred for conservation (shigwekawa 2021). fardos deemed to be stable were then subjected to plane radiography. we used a portable xray source together with a digital xray receptor. we used two receptors: in 2019, the size was 30 × 30 cm, and in 2022, we had a 14 × 17 in. (35.6 × 43.2 cm) plate. fardos for adult individuals can be quite large, so we created a mosaic of individual images using the stitching function in photoshop (v. 13 and 16). for details of the principle of mosaic imaging of large objects, see conlogue (2020), and for the specific application to fardos and details of image stitching, see motley (2022:appendix b). note that the size of the panel makes a critical difference when stitching the images. a large fardo would need as many as 24 individual exposures with the small panel, while it would only need six with the larger panel. the smaller number of larger images greatly reduces registration errors (see motley 2022). we took ct scans in july and august 2019, december 2021, and june 2022 using siemens scanners (somatom definition as and somatom go.up) at the resocentro clinic in miraflores. the scanner settings were as follows: minimum available slice thickness (0.5 mm and 0.6 mm), 110 or 120 kvp, 160 mas, pitch factor of 1.2, and an abdomen protocol. scans were visualized using orssi and dragonfly v. 2022.2 (https:// www . theobjects . com / dragonfly / index . html). the individuals in these fardos are considered type ii mummies following the typology proposed by vreeland (1998). that means that cultural practices, such as wrapping the bodies in absorbent textiles and burying bi_xx_xx_05_nelson_4p.indd 4bi_xx_xx_05_nelson_4p.indd 4 14-03-2024 13:50:5014-03-2024 13:50:50 nelson et al. 5 them in an environment conducive to desiccation, enhance the natural processes of mummification (see motley 2022). this leads to quite variable preservation of soft tissues. bio archae ol o gi cal analysis includes the determination of age, sex, pathological conditions (both soft tissue and osteological), trauma, dental health, and cranial modification. standard osteological techniques are used to determine sex (cranial and pelvic characteristics) and age (dental wear, spinal degeneration, cranial suture closure) following buikstra and ubelaker (1994), with methods modified for use on xray or ct data (e.g., using wink [2014] to assess the pubic symphysis on ct scans). age ranges for adults (young: 21– 35; middle: 35– 50; old: 51+) followed buikstra and ubelaker (1994). we took 14c samples opportunistically through preexisting openings in the fardos’ wrappings. the innermost accessible textile was sampled to avoid potential confusion arising from any rewrapping of the bundles that might have taken place. the radiochronology laboratory at université laval in laval, quebec (https:// www . cen . ulaval . ca / en / infrastructures / radio carbon/), prepared the samples using chemical pretreatment (hcl– naoh– hcl), combustion, extraction, and purification of the co2. the co2 was then graphitized and pressed into a target. the graphite targets were shipped to the keck carbon cycle ams facility at the university of california, irvine (https:// sites . ps . uci . edu / kccams/), for accelerator mass spectrometry counting. calibration of the 14c dates was done using the shcal20 curve (http:// calib . org / calib / calib . html), following the recommendations of marsh et al. (2018: 932) and hogg et al. (2020:774) as the central coast of peru is south and west of the intertropical convergence zone. archaeoentomological analysis follows the principles and methods of forensic entomology, adjusted for the bio archae ol o gi cal context (see huchet 2014) in order to understand the depositional history of a burial. this analysis yields important information about the elaboration of the funerary ritual, particularly with regard to the length of time between death and burial. pk collected more than 450 insect fragments (diptera, coleoptera, phthiraptera, and other arthropoda) from the fardos featured in this article. identifications were made under a stereo microscope at family, subfamily, genus, and, where possible, species level. this primordial sorting allowed us to familiarize ourselves with the material. most specimens were represented by fragmentary remains. diptera fragments were identified using dichotomous keys and reference collections (giordani et al. 2018; greenberg and szyska 1984; huchet and greenberg 2010; lowenbergneto and carvalho 2013; inter alia). details of the calliphoridae table 2. the key stages of the life cycle of peruvian calliphoridae (the blow fly) and the colonization of a corpse. after greenberg & szyska (1984). event duration* colonization of the corpse— eggs laid within minutes (pioneering flies) eggs hatch to become larvae (maggots) ca. 24 hours (1 day) larvae pass through stages ca. 50 hours (2 days) larvae develop into pupae ca 130 hours (5.4 days) pupae develop and hatch to become adults ca. 140 hours (5.8 days) adults leave the corpse after 10 to 15 days of eggs being laid the key stages of the life cycle of peruvian calliphoridae (blow flies) and the colonization of a corpse. after greenberg & szyska (1984) * insects, like all arthropods, are poikilothermic (coldblooded) and their timetable is primarily temperature driven and varies substantially depending on the species. rate of development may be species specific and is influenced by biotic factors, e.g. maggot mass that can significantly accelerate rate of development; and state of the body (clothed or naked, mutilated, etc.). (blow flies) are presented here. see table 2 for the life cycle of the peruvian blow fly. the funerary taphonomic approach (cf. knüsel and robb 2016) is used in the analysis of these fardos. taphonomy is the study of the processes that alter or create a particular context in the archaeological or paleontological record (cf. efremov 1940), and funerary taphonomy uses this method to interpret data in the mortuary context (knüsel and robb 2016). see motley (2022) for a detailed discussion of this approach as applied to the analysis of fardos. results fifteen fardos were identified as being of interest for this study as the xrays clearly demonstrated that they were missing the head. detailed examination of the xrays, ct scans, and the wrappings themselves yielded five potential scenarios to explain the lack of the heads: 1. the fardo was a secondary burial that only included part (not including the head or skull) of the original skeleton; 2. there were inconsistencies between the field report and what we were able to observe, making it impossible to make an unambiguous interpretation; 3. heads that had become separated from the fardo since excavation; 4. heads that were removed, but no attempt had been made to restore the resulting hole in the wrappings; and 5. heads that were removed with some attempt to replace/restore the wrappings. bi_xx_xx_05_nelson_4p.indd 5bi_xx_xx_05_nelson_4p.indd 5 14-03-2024 13:50:5014-03-2024 13:50:50 headless burials from pachacamac, peru6 fardos assigned to categories 1 to 3 (n = 6) were removed from subsequent analysis. the distinction between categories 4 and 5 was maintained because it was impossible to know if a head that had been extracted with no attempt to restore the wrappings (category 4) was removed in antiquity or by looters in more recent times. it was deemed unlikely that a modern looter would attempt to restore or rewrap a bundle after they had removed the head (category 5), so these heads were deemed to have been removed in antiquity. category 4 included three fardos and category 5 included six. detailed analysis of the bones and desiccated skin (when visible) and the ct scans suggests that the individuals were in an advanced state of skeletonization/ mummification when the heads were removed. there are no cut marks on any of the visible bones, and there is generally a clean break at the articular facets at some point along the cervical spine such that several cervical vertebrae were removed with the skull while the remaining vertebrae were left behind. in the case of e82u, the skin of the neck broke at the level of c3– c4, while the cervical spine separated between c1 and the occiput. the hair mass was frequently left behind, indicating that decomposition had proceeded far enough that the scalp was no longer tightly bound to the cranium. the hair was apparently not of interest to the person who extracted the rest of the head. category 4 individuals e68 is a nonadult burial, ca. seven to eight years of age, buried in an extended position, with a cream and browncolored cotton wrap, buried at a depth of 40 cm (fig. 2). this is one of the fardos that had been exposed to water, so the bundle was conserved between our 2019 and 2022 seasons. as we could not visualize this individual directly, this description incorporates observations from the ct scan and notes by shigwekawa (2021). e68 is part of a group burial including e69 to e74, all buried in an extended, supine position. there are no artifacts visible on the ct scan. this individual’s calibrated median probability 14c date is 1448 a.d. (2 sigma [σ] range = 1435 a.d. to 1460 a.d.), which places them in the late intermediate period/ychsma cultural phase. this individual is one of only two nonadult burials older than the age of three years to be positioned in the extended position in the sector 3 sample. the other is e70, part of this group burial along with the extended adult e69 (see below). jijon y caamaño (1949) first noted that the youngest individuals (age less than three to five years) on the peruvian coast tended to be buried in the extended position from the early figure 2. e68— average intensity projection showing the extended position and lack of head. intermediate period to the late horizon, while from the middle horizon (600 a.d. to 1000 a.d.), older nonadults and adults were generally buried in the seated flexed position. this change in position may reflect a change in social identity, possibly the attainment of personhood (poeta and nelson 2021). baldeos (2015) believed that the burial pattern and textiles of this burial group did not correspond with typical ychsma burials and suggested that they may be inca in date. however, burial position is not the focus of this study and will be discussed elsewhere. baldeos (2015) described the head as being removed through a cut in the textiles. the cranium, mandible, and all cervical vertebrae are missing. the thoracic vertebrae, clavicles, and right scapula are displaced laterally. the left scapula and humerus are missing, and the right arm is displaced distally. the packing that bi_xx_xx_05_nelson_4p.indd 6bi_xx_xx_05_nelson_4p.indd 6 14-03-2024 13:50:5114-03-2024 13:50:51 nelson et al. 7 typically lies on top of the head in these fardos is intact and the opening in the wrappings for the removal of the head is where the face would have been, which is in keeping with the extended supine position. the damage to the thorax was quite extensive in comparison to the other fardos. no attempt was made to replace the wrappings. entomological analysis did not yield any information relevant to the mortuary treatment of this individual. e69 is part of the same burial group as e68 (described above) and is a young adult male, buried at a depth of 30 cm (fig. 3). this individual is the only adult in this cemetery to be buried in an extended position. this fardo was also exposed to moisture and was conserved in 2021, so as above, we are relying on notes from shigwekawa (2021) and the ct scan. this individual had a half spondylus shell and a cluster of small metal circular artifacts located in the area of the chest. the calibrated median probability 14c date is 1455 a.d. (2σ range = 1441 a.d. to 1485 a.d.). this date places this individual in the late intermediate period/ ychsma cultural phase or possibly the late horizon/ inca cultural phase. baldeos (2015) suggested that the textiles used to wrap this individual did not follow a typical ychsma style, leading him to suggest that this individual might date to the inca period. like e68, the removal of the head was accompanied by considerable disturbance of the thorax, including the removal of all cervical vertebrae, the right humerus, clavicle and scapula, and inferior displacement of the left arm. the bulk of the original wrapping around the head has been displaced, and the head was removed through an opening in the wrappings where the face would have been. the displaced wrappings were folded back to roughly close the opening, but no attempt was made to hold them in place or to cover the opening. this is visible in the photographs taken at excavation (baldeos 2015:226). baldeos (2015) believed that this burial had been disturbed by sand mining or other modern activities. entomological analysis did not yield any information relevant to the mortuary treatment of this individual. the fact that this individual had a spondylus shell and metal artifacts in the region of the chest/head suggests that this interference was unlikely to have been from a modern looter, who would likely have been more interested in the artifacts than the skull. however, in keeping with the category 4/5 distinction, we will be conservative in our interpretation. e76a is a young adult male, buried at a depth of 120 cm, in a seated and flexed position (fig. 4). the fardo contains numerous metal foil fragments (at least two of copper), and the bundle is wrapped in a cotton cream and brown textile. this individual is one of a group of burials (e76a to e76h). the calibrated median probability 14c date is 1433 a.d. (2σ range = 1417 a.d. to 1449 a.d.). this date places this individual in the late intermediate period/ychsma cultural phase. the skull and first four cervical vertebrae were removed. the textiles around the head end of the fardo included a textile wrapping the neck, one over the body of the fardo, and one over the head end that overlays the body shroud over the shoulders. all three textiles were damaged in order to access the head. no attempt was made to repair or reorganize the textiles. entomological analysis demonstrates that the life cycle of synthesiomyia nudiseta (muscidae) was complete, suggesting that the individual was exposed for an extended period of time, possibly three to four weeks, figure 3. e69— coronal ct slice showing the extended position and lack of head. the rightpointing arrow is highlighting the spondylus shell and the leftpointing arrow is highlighting the round metal artifacts. bi_xx_xx_05_nelson_4p.indd 7bi_xx_xx_05_nelson_4p.indd 7 14-03-2024 13:50:5114-03-2024 13:50:51 headless burials from pachacamac, peru8 between death and burial. given the skeletonized/ mummified state that the neck must have been in at the time of removal, three to four weeks is not likely enough time for soft tissue desiccation to proceed far enough to allow the head to be removed before it was buried. the coastal desert can be quite hot during the summer months of february and march, with very little precipitation but with high humidity (aliaga nestares et al. 2023). galloway (1997) has reported that a corpse may become mummified in as few as 11 days in the sonoran desert, but humidity in arizona is much lower than it is on the central coast. once buried, it is not clear how long it would take for a human body to attain the state of skeletonization/mummification observed here. janaway et al. (2009) used pigs as body analogs to suggest that a body buried in an open tomb on the peruvian coast can retain a moist core for up to two years, although the extremities were desiccated by then. this individual was a deep burial and is therefore less likely to have been encountered by modern figure 5. e76d— coronal ct slice. note the channel (arrow) left by the removal of the head and neck. figure 4. e76a— coronal ct slice. note the channel (arrow) left by the removal of the head and neck. looters. however, in keeping with the category 4/5 distinction, we will be conservative in our interpretation. category 5 individuals e76d is part of the same group of burials as e76a, discussed above. this individual is a young to middle adult female, buried in a seated, flexed position at a depth of 120 cm (fig. 5). the bundle contained numerous spindles (fig. 6), spindle whorls (not seen in the figures), and associated threads, and was wrapped by a beige plainweave textile. there is no 14c date for this individual. a coronal ct slice through the fardo (fig. 5) shows quite a broad area of disturbance that includes the displacement of ribs and removal of all cervical and many thoracic vertebrae. after removal, textiles were used to pack the void, and a red tight weave textile was placed over the opening and a large beige plain textile was used to rewrap the whole bundle. this textile was kept in place by belts wrapped around the middle of the fardo (fig. 6). bi_xx_xx_05_nelson_4p.indd 8bi_xx_xx_05_nelson_4p.indd 8 14-03-2024 13:50:5114-03-2024 13:50:51 nelson et al. 9 the entomological analysis suggests that this individual was likely buried quickly after their death, based on the absence of the remains of pioneer fly species (calliphoridae). e82a is a young adult male, buried in a seated, flexed position at a depth of 75 cm (fig. 7). e82a is part of an extensive deposit of 24 fardos, buried in close association. there are a number of metal artifacts (mostly small foils and two large objects) inside the fardo. abundant raw cotton without seeds was used to stuff the fardo. the calibrated median probability 14c date is 1342 a.d. (2σ range = 1315 a.d. to 1360 a.d.). this date places this individual in the late intermediate period/ychsma cultural phase. the removal of the head appears to have taken most of the cervical vertebrae and displaced several thoracic vertebrae and the scapulae. the displaced textiles were folded back to close the opening. the bundle appears to be intact in the excavation photo (baldeos 2015:293), enough so that baldeos commented on cotton being placed “sobre la cabeza” (2015:293) (“over the head”). the entomological analysis suggests that this individual was likely buried quickly after death, based on the absence of pioneer fly species. e82h is a young adult female, buried in a seated flexed position at a depth of 120 cm, and it is part of the e82 group burial. abundant raw cotton with seeds was used to stuff the fardo and there are nectandra seeds, several small metal foils, and a large unidentified metal artifact in the fardo (a square metal foil ca. 10 × 6.5cm) (fig. 8). the calibrated median probability 14c date is 1394 a.d. (2σ range = 1389 a.d. to 1413 a.d.). this date places this individual in the late intermediate period/ychsma cultural phase. this individual’s head was removed, taking all cervical and possibly the top thoracic vertebrae. the surrounding textiles were carefully rearranged after removal, including placing a light brown, bluestriped ychsma textile over the opening where the head had been. it is unclear whether this textile is an original element of the fardo used to cover the opening or whether it was added for the purpose of recovering the opening, but it covers most of the fardo. the entomological analysis identified 28 hatched puparia and two complete puparia of calliphoridae in various parts of the fardo. this suggests that the fardo was exposed for 10 to 15 days, corresponding to the early part of the immature life cycle of these flies (depending on local temperatures). e82t is an old adult male, buried in a seated flexed position at a depth of 110 cm as part of the e82 group burial. there are several metal foils visible on the xray (fig. 9). the fardo also contains a bundle of cane tubes (fig. 9), a sling, and several corncobs (not visible in fig. 9). the calibrated median probability 14c date is 1342 a.d. (2σ range = 1315 a.d. to 1360 a.d.). this date places this individual in the late intermediate period/ychsma cultural phase. the removal of the head of this individual caused considerable disturbance of the thorax. it displaced the ribs and right humerus laterally and removed all figure 6. e76d— photo of the fardo (photo: andrew nelson). note the intact outer wrapping and the belt around the middle of the fardo. the head end of the fardo is to the left side of the image. a single spindle (one of several) can be seen as indicated by the arrow. figure 7. e82a— coronal ct slice. note the presence of the metal foils. the arrow indicates the position of loose vertebrae and the break in the textile through which the head was removed. bi_xx_xx_05_nelson_4p.indd 9bi_xx_xx_05_nelson_4p.indd 9 14-03-2024 13:50:5114-03-2024 13:50:51 headless burials from pachacamac, peru10 the cervical and most of the thoracic vertebrae and the right scapula and clavicle. after removal of the head, the opening was covered by a brown gauze textile decorated with beige circles. this was likely the original outermost shroud, displaced for the removal of the head and then returned to its position. the shroud was held in place by a coarse weave textile belt around the middle of the fardo. entomological analysis suggests that burial of this individual took place rapidly after death on the basis of a lack of remains of pioneer flies. e82u is a middle to old adult female, buried in a seated, flexed position at a depth of 110 cm, buried adjacent to e82w (below) as part of the e82 group burial. openings in the wrappings show both hands, which figure 8. e82h— coronal ct slice. note the channel (arrow) left by the removal of the head and neck. the circle indicates the location of the unidentified metal artifact. figure 9. e82t— coronal ct slice. note the presence of the metal foils and the cane tubes (circled). the channel left by the removal of the head and neck is indicated by the arrow. display geometric tattoos. the bundle contains abundant raw cotton with seeds, a nectandra seed necklace, spinning spindles near the hands, small feathers, and a silver foil near the neck and another foil by the left elbow (fig. 10). the calibrated median probability 14c date is 1346 a.d. (2σ range = 1301 a.d. to 1363 a.d.). this date places this individual in the late intermediate period/ychsma cultural phase. the outermost wrapping is a creamcolored plain weave textile that appears to have been cut for the removal of the head. a block of cervical vertebrae with accompanying skin and connective tissue was broken away from c1 to c5 but remained in the fardo. the break in the skin of the neck appears at about c3– c4, while the c1 and occipital condyles separated at the point of articulation. this highlights the brittle nature of the desiccated tissue at the time of head removal. an internal textile was folded into the opening left from the removal of the head and a few stitches were used to hold it in place. a small textile, described by bi_xx_xx_05_nelson_4p.indd 10bi_xx_xx_05_nelson_4p.indd 10 14-03-2024 13:50:5114-03-2024 13:50:51 nelson et al. 11 baldeos (2015) as a rectangular tapestry measuring 40 × 45 cm, was used to cover where the head had been. a few calliphoridae puparia were noted, but all had hatched and no adult remains were encountered. this suggests that the body was exposed for less than 10 to 15 days before burial. the presence of latearriving muscidae flies, who feed on decomposition products, suggests that the burial was reopened and the head removed before the body was completely desiccated. e82w is a young adult female, buried in a seated, flexed position at a depth of 75 cm, buried next to e82u (above) as part of the e82 group burial. the bundle was stuffed with abundant raw cotton with seeds and has a single wooden support pole (fig. 11). no artifacts were visible on direct observation or on the xray. the calibrated median probability 14c date is 1420 a.d. (2σ range = 1404 a.d. to 1439 a.d.). this date places this individual in the late intermediate period/ychsma cultural phase. figure 10. e82u— coronal ct slice. note the channel (arrow) left by the removal of the head and neck. figure 11. e82w— composite xray. the support pole is indicated by the arrow. the beige textile originally covering the head had been displaced sideways to the individual’s left to create the opening to access the head. the head was then removed, taking the cervical vertebrae and disturbing the thorax and both shoulder girdles. the hair mass was left behind. the textile was then folded back into place and fixed by a few stitches (fig. 12a and 12b). a few calliphoridae puparia were noted in the outer folds of the bundle’s textiles, but they had hatched and no adult remains were encountered. this suggests that the body was exposed for up to 10 to 15 days before burial. discussion the practice of repairing the opening and/or rewrapping the fardo strongly suggests that the removal of the head in these cases was not an act of violence or looting. this conclusion is consistent with the practice of head recovery reflecting the reverence for the ancestors discussed by carmichael (1994), arnold and bi_xx_xx_05_nelson_4p.indd 11bi_xx_xx_05_nelson_4p.indd 11 14-03-2024 13:50:5214-03-2024 13:50:52 headless burials from pachacamac, peru12 hasdorf (2008), and toyne (2015). however, the degree of damage to the upper half of the spine and thorax in several cases suggests that it was not a delicate process. the process of preparing these individuals for wrapping and burial was not necessarily delicate either (e.g., the positioning of the legs was often accompanied by the dislocation of the hip). the process of decomposition often led to bones moving out of position (particularly of the trunk, where decomposition would begin), but the frequent removal of cervical and thoracic vertebrae and often other elements of the shoulder girdle suggests that this particular pattern is associated with the deliberate removal of the head rather than postmortem decomposition. the sample of six category 5 individuals includes four females and two males, and they range in age from young adults to old adults. the general lack of burial goods and the simple nature of the burial goods that did accompany some of these individuals suggest that they were of modest status. thus, apart from them being adults, there does not appear to be a specific identity (age, sex, status) that the individuals gathering figure 12. e82w— figure 12a is the general view of the textile covering the opening through which the head had been removed. figure 12b shows the stitching of that textile to surrounding wrappings (the wrappings were folded back to allow this view). an arrow indicates the location of the stitches. photos: andrew nelson. the heads had in mind when they chose a fardo to sample. the 14c dates (all dates in text are calibrated) shown in table 3 demonstrate that the cemetery was in use for ca. 200 years (e64 to e71), with most burials taking place in the late intermediate period and three (e69, e71, and e76c) bridging (with their 2σ ranges) the end of the late intermediate period and the early years of the late horizon. these dates correspond to the middle and late ychsma and/or inca cultural periods. a burial’s depth in the cemetery is not correlated with the date of burial, particularly in the case of e64, the highest fardo in the cemetery, who has the earliest date (1295 a.d.). the five category 5 individuals for whom we have 14c dates date to 1420 a.d. or earlier, and the three category 4 individuals date between 1433 a.d. and 1455 a.d. however, overlapping 2σ ranges of e82w and e76a preclude making a clear temporal distinction between the two groups. the fact that e69 has a spondylus shell and metal artifacts suggests that it is unlikely that a modern looter, who would probably have been more interested in the artifacts than the head, defiled this individual. however, for the sake of maintaining a conservative approach, we can conclude that the practice of retrieving heads and repairing the bundles took place in the first two thirds of the use of the cemetery. the dates for the group burials also shed important light on how the cemetery was used. the individuals who comprise the group burials do not appear to have been deposited at the same time. e88 and e88b were uncovered immediately adjacent to each other (e88a was on the other side of e88), and this group burial is the deepest in the cemetery. however, e88a yielded a date of 1397 a.d. (2σ 1390– 1415 a.d.) while e88 was dated to 1448 a.d. (2σ 1435– 1460 a.d.). similarly, e76a dates to 1433 a.d. (2σ 1417– 1449 a.d.) while e76c dates to 1475 a.d. (2σ 1452– 1501 a.d.). in both cases, the 2σ values do not overlap, suggesting the burial events took place at different times. the larger group burials e82 and the extended group (e68 to e73) show lengthy deposition sequences of 84 and 54 years, respectively, with no overlap between the earliest and latest 2σ ranges. thus, it is quite likely that these are not group burials in the sense of a single burial event. rather, either purposefully or accidentally, serial burial events happened to place new individuals in close proximity to individuals who had previously been interred. the lack of bleaching and overall preservation of the fardos suggest that they must have been covered over by sand in the intervening years. several of the burials described here have entomological evidence suggesting that they were buried between a few days and a few weeks after death. motley’s (2022) taphonomic analysis of the completeness and bi_xx_xx_05_nelson_4p.indd 12bi_xx_xx_05_nelson_4p.indd 12 14-03-2024 13:50:5214-03-2024 13:50:52 nelson et al. 13 ta bl e  3. c 1 4 da te s f or th e se ct or 3 c em et er y sh ad ed ro w s r ep re se nt h ea dl es s i nd iv id ua ls k ec k la b # u ni ve rs ité la va l # f14 c ± d 14 c (‰ ) ± c on te xt se x a ge de pt h 14 c a ge (b p) ± ca lib ra te d m ed ia n pr ob ab ili ty da te (a d ) − 2 si gm a (a d ) +2 si gm a (a d ) o th er c om m en t u c ia m s 27 75 04 u la 1 10 76 0. 91 2 0. 00 15 − 8 8 1.5 e6 4 un de te rm in ed no n ad ul t 20 74 0 15 12 95 12 78 13 13 hi gh es t i n ce m et er y u c ia m s 27 75 34 u la 1 10 99 0. 94 22 0. 00 16 −5 7.8 1.6 e6 8 un de te rm in ed no n ad ul t 40 48 0 15 14 48 14 35 14 60 e6 8 74 g ro up b ur ia l u c ia m s 27 75 35 u la 1 11 00 0. 94 45 0. 00 15 −5 5. 5 1.6 e6 9 m al e yo un g ad ul t 40 46 0 15 14 55 14 41 14 85 e6 8 74 g ro up b ur ia l u c ia m s 27 75 36 u la 1 11 01 0. 94 29 0. 00 15 −5 7.1 1.5 e7 0 un de te rm in ed no n ad ul t 40 47 0 15 14 51 14 38 14 62 e6 8 74 g ro up b ur ia l u c ia m s 27 75 05 u la 1 10 77 0. 95 02 0. 00 16 −4 9. 8 1.6 e7 1 un de te rm in ed no n ad ul t 40 41 0 15 14 93 14 56 15 08 e6 8 74 g ro up b ur ia l u c ia m s 27 75 07 u la 1 10 78 0. 93 84 0. 00 16 −6 1.6 1.7 e7 2 un de te rm in ed no n ad ul t 40 51 0 15 14 39 14 24 14 53 e6 8 74 g ro up b ur ia l u c ia m s 27 75 08 u la 1 10 79 0. 93 91 0. 00 15 −6 0. 9 1.5 e7 3 un de te rm in ed in fa nt 40 50 5 15 14 41 14 27 14 53 e6 8 74 g ro up b ur ia l u c ia m s 27 75 09 u la 1 10 80 0. 93 69 0. 00 15 −6 3. 1 1.5 e7 6a m al e ol d ad ul t 12 0 52 5 15 14 33 14 17 14 49 e7 6 gr ou p bu ri al u c ia m s 27 75 10 u la 1 10 81 0. 94 72 0. 00 14 −5 2. 8 1.4 e7 6c un de te rm in ed in fa nt 12 0 43 5 15 14 75 14 52 15 01 e7 6 gr ou p bu ri al u c ia m s 27 75 11 u la 1 10 82 0. 94 3 0. 00 14 −5 7 1.4 e7 8 un de te rm in ed yo un g to m id dl e ad ul t 12 0 47 0 15 14 51 14 38 14 62 e6 8 74 g ro up b ur ia l u c ia m s 27 75 12 u la 1 10 83 0. 92 24 0. 00 15 −7 7.6 1.5 e8 2a un de te rm in ed ad ul t 70 65 0 15 13 42 13 15 13 60 e8 2 gr ou p bu ri al u c ia m s 27 75 20 u la 1 10 86 0. 93 48 0. 00 14 −6 5. 2 1.4 e8 2c m al e m id to o ld a du lt 12 0 54 0 15 14 26 13 89 14 43 e8 2 gr ou p bu ri al u c ia m s 27 75 22 u la 1 10 87 0. 92 66 0. 00 15 −7 3.4 1.5 e8 2h fe m al e yo un g ad ul t 12 0 61 0 15 13 94 13 89 14 13 e8 2 gr ou p bu ri al u c ia m s 27 75 23 u la 1 10 88 0. 93 44 0. 00 15 −6 5. 6 1.5 e8 2l un de te rm in ed no n ad ul t 75 54 5 15 14 24 14 08 14 42 e8 2 gr ou p bu ri al u c ia m s 27 75 24 u la 1 10 89 0. 92 2 0. 00 15 −7 8 1.5 e8 2t m al e ol d ad ul t 75 65 0 15 13 42 13 01 13 63 e8 2 gr ou p bu ri al u c ia m s 27 75 25 u la 1 10 90 0. 92 03 0. 00 15 −7 9. 7 1.5 e8 2u fe m al e m id o ld a du lt 75 66 5 15 13 46 13 01 13 63 ta tto os ; e 82 g ro up bu ri al u c ia m s 27 75 26 u la 1 10 91 0. 93 34 0. 00 15 − 6 6. 6 1.5 e8 2w fe m al e yo un g to m id dl e ad ul t 75 55 5 15 14 20 14 04 14 39 e8 2 gr ou p bu ri al u c ia m s 27 75 27 u la 1 10 92 0. 93 98 0. 00 15 − 6 0. 2 1.5 e8 4 m al e ad ol es ce nt 10 0 50 0 15 14 43 14 29 14 54 at yp ic al b ur ia l u c ia m s 27 75 28 u la 1 10 93 0. 94 18 0. 00 15 − 5 8. 2 1.5 e8 8 un de te rm in ed no n ad ul t 14 0 48 0 15 14 48 14 35 14 60 de ep es t i n ce m et er y; e8 8 gr ou p bu ri al u c ia m s 27 75 29 u la 1 10 94 0. 92 72 0. 00 13 − 7 2. 8 1.3 e8 8b un de te rm in ed no n ad ul t 14 0 60 5 15 13 97 13 90 14 15 de ep es t i n ce m et er y; e8 8 gr ou p bu ri al u c ia m s 27 75 30 u la 1 10 95 0. 93 57 0. 00 14 − 6 4. 3 1.4 fa rd o 1 (fe m al e) m id o ld a du lt 20 53 5 15 14 29 14 12 14 45 as so ci at ed w ith a n ar ry ba lo id u c ia m s 27 75 31 u la 1 10 96 0. 93 56 0. 00 15 − 6 4. 4 1.5 fa rd o 9 m al e ad ul t 20 53 5 15 14 29 14 12 14 45 di st in ct iv e m et al ar tif ac t bi_xx_xx_05_nelson_4p.indd 13bi_xx_xx_05_nelson_4p.indd 13 14-03-2024 13:50:5214-03-2024 13:50:52 headless burials from pachacamac, peru14 articulation of the skeletons is consistent with this model. most of these burials display hyperflexed limbs. recent experimental research by schotsman et  al. (2022) demonstrates that hyperflexion can be achieved after the cessation of rigor mortis. estimates for the duration of rigor mortis vary between 24 and 84 hours after death (goff 2009) and 44 and 76 hours after death (krompecher 2015). goff (2009) notes that low temperatures can prolong rigor while higher temperatures can reduce its length. a delay between death and burial is also consistent with various spanish chronicles, which describe a delayed mortuary ritual of approximately five to 10 days (depending on the source: e.g., cieza de leon [1553] 1922:220; the huarochiri manuscript avila [1573– 1647] 1991:129; and guaman poma [1615] 2009:226– 228). however, given the prevailing environmental conditions on the central coast of peru, particularly in terms of temperature and humidity, it is unlikely that this period was long enough for mummification/skeletonization to proceed to the state where the skin and intervertebral (and other) joints were brittle enough to break cleanly and for the hair mass to be separated from the cranium. it is therefore likely that the individuals were buried after an initial delay but then revisited at a later date to retrieve the head. other examples of head removal are known from the central coast. these include three fardos from a large chamber tomb associated with the painted temple at pachacamac (takigami et al. 2014). this chamber was in use from ca. 1000 a.d. to 1500 a.d. during this time, the tomb was revisited regularly to inter new individuals. takigami et al. (2014) suggest that it was likely that these heads were removed some time after burial, but no attempt was made to sew the wrappings back together. we scanned one of these fardos (along with four others from the chamber tomb) in 2021. the scan demonstrates a similar pattern of disturbance to the cervical vertebrae as the examples discussed here, but the wrappings around where the head would have been are largely missing and do not appear to have been repaired. this would correspond to a category 4 fardo as defined here. beyond the site of pachacamac, jijón y caamaño (1949) described several headless individuals from the nearby site of maranga. several of these date to the early intermediate period. one headless fardo was recovered from huaca ii, cemetery 4, dating to the late intermediate period and so is contemporary with the material described here. one headless individual from the jijón y caamaño collection at the pontificia universidad católica del ecuador (jcap2068) was examined and xrayed by the project described in ordoñez et al. (2015) (an was a member of this project). the xrays show that this individual is an extended infant, less than one year old with no head, but with complete, intact wrappings around the head region of the fardo. unfortunately, the concordance from the museum catalog numbers to the descriptions in jijón y caamaño’s (1949) monograph has been lost, so we cannot be sure of its original context, but this infant likely dates to the late intermediate period or late horizon. watson (2019) has described two headless chancay individuals from the site of ancón, located in the northern part of the lima province. the first individual, 2.5– 165– ivciaa– 94, an adult female, lacks the cranium and mandible but retains the atlas and axis. watson (2019) suggested that if the head was removed intentionally, it would have been done when the body was skeletonized. other postcranial elements were missing as well. the second individual, 2.5.197– icciaa– 94, an adult male individual, is also missing the cranium, mandible, and other skeletal elements. the fardo contains elements from additional adult and nonadult individuals. this individual is exceptional, as they are associated with an elaborate late horizon poncho that contains chimú– lambayeque iconography and inca design elements. one panel of the poncho shows a figure featured elsewhere on the poncho, but in this instance, they are shown without a head. the narrative on the poncho appears to be the funeral of the headless individual, a noble ancestor from the north coast. watson (2019:112) allowed that the exact relationship between the textile and the deceased individual is not clear, although she noted that the association is unlikely to be accidental. slightly further afield, carmichael (1988, 1994) described several instances of head removal from early intermediate period nazca burials, including one currently in the field museum whose head had been removed after the body was mummified (without cutting) (carmichael 1988). he suggested that the heads were collected as a reference to collective ancestors who had “life giving powers of rejuvenation” (carmichael 1994:84). conlee (2007) presented a middle nazca headless burial from the site of la tiza who did demonstrate cut marks on the third cervical vertebra. the photo of the burial (conlee 2007:441) shows a skeleton in a good state of articulation, so it  was possible that this individual’s head was removed at the time of burial, representing a different pattern than that described here. deleonardis (2000) also described a nasca headless burial from the site designated as pv62d13, and like the conlee (2007) case, she concluded that the head was removed at the time of burial. thus, it is possible that there might be at least two patterns of head retrieval in the nasca culture, perhaps representing different processes and motivations. bi_xx_xx_05_nelson_4p.indd 14bi_xx_xx_05_nelson_4p.indd 14 14-03-2024 13:50:5214-03-2024 13:50:52 nelson et al. 15 conclusions the conclusions reached here emphasize the value of nondestructive paleoradiographic imaging done in conjunction with careful direct observations and minimally invasive archaeometric methods to survey large numbers of fardos. if these fardos had been unwrapped before xraying, it is quite likely that subtle details of the wrapping and stitching would have been missed, making it difficult to reconstruct the full sequence of events. individuals buried in the sector 3 cemetery demonstrate varying degrees of delayed mortuary ritual, followed by burial at varying depths in the sandy matrix. at least six, and possibly more, individuals from this sample demonstrate the removal of the head from a fardo after it had been buried, and decomposition had proceeded far enough for the head to come away from the spine and hair mass, with some effort made to repair or restore the wrappings after they had been opened. this would be consistent with the removal of the head for the purposes of ancestor veneration as described by carmichael (1988, 1994), rather than decapitating an enemy or looting the burial. the sector 3 cemetery was in use from the late thirteenth century a.d. to the latter half of the fifteenth century a.d., during which a minimum of 88 funerary bundles and many other funerary contexts (poorly preserved fardos, secondary burials, or bone offerings) were buried. the deceased individuals were being exposed for various lengths of time from a few days to a few weeks. this suggests a dynamic cycle of mortuary activity, with this sandy matrix cemetery being in a constant state of flux. during this time, new individuals were interred alongside earlier burials, creating what now appear to be groups of burials and allowing access to earlier bundles for the retrieval of heads. the headless fardos do not fit any kind of demographic profile, beyond being adults, that suggests that the “decapitators” had a particular identity or phenotype (e.g., age or sex profile) in mind when they harvested a skull (cf. toyne 2015). this model could also explain why the preponderance of the headless fardos are early in the cemetery’s use, as they would have been encountered during later burial events. ultimately, we do not know for sure why these heads were removed. verano (1994) and tung (2007) (inter alia) have described isolated deposits of human head in many prehispanic cultures, and the practice of trophy head collection among the nasca, so while the practice was certainly common, its motivations differed. further work on this topic will require detailed analysis of isolated deposits of human bone at pachacamac and other sites on the central coast. the overall picture outlined here suggests that the complex mortuary ritual that was practiced among individuals of modest status on the fringes of an important pilgrimage and administrative center was not markedly different from what was going on in the large chamber tomb located in the center of the sanctuary, in terms of revisiting the tomb or cemetery and manipulating the earlier fardos (takigami et al. 2014). furthermore, this practice of head removal is in keeping with what is observed at earlier and contemporary sites on the central coast (maranga [jijón y caamaño 1949]; ancón [watson 2019]) and in the nearby nasca valley (e.g., carmichael 1988, 1994), and it differs from the more violent decapitation of the enemy practiced frequently elsewhere in the central andes (e.g., north coast [cordy collins 2001] and wari [e.g., tung 2008]). further work by the mummies as microcosms project will seek to see how widespread this practice was on peru’s central coast. acknowledgments the mummies as microcosms project is funded by an insight grant (435– 2019– 1023) from the social sciences and humanities research council of canada to an and jw. the samples were exported under the resoluciónes viceministerial n° 000222– 2022–vmpcic/mc y n° 000224– 2022– vmpcic/mc, dated october 17, 2022, from peru’s ministry of culture. graduate and undergraduate student support includes a josepharmand bombardier cgs doctoral award, ontario graduate scholarship award, and western’s graduate research scholarship support to jm; wiikwemkoong board of education, sshrc canada graduate scholarship– master’s, and western’s graduate research scholarship support to lp; ontario graduate scholarship and western’s graduate research scholarship support to kw; western’s graduate research scholarship (international) support to tnn; a sshrc canada graduate scholarship– master’s and western’s graduate research scholarship support to aw; a mitacs globalink research award, graduate funding from the pacea laboratory, university of bordeaux, france, and an international mobility scholarship from the école doctorale 304 sciences et environnements, university of bordeaux, france to pk; and university summer research internship support to sr, ha, and rs. we thank david seston (university of western ontario) and elizabeth gómez (universidad nacional mayor de san marcos) for their assistance in the field and jennifer willoughby for her work on the scans. andres shiguekawa and his assistants sharon ñahui and elizabeth gómez worked with museum bi_xx_xx_05_nelson_4p.indd 15bi_xx_xx_05_nelson_4p.indd 15 14-03-2024 13:50:5214-03-2024 13:50:52 headless burials from pachacamac, peru16 personnel to conserve the fardos that had been exposed to moisture and to ct scan them once stabilized. the following individuals provided access to equipment: dr.  rabanilla, osteoray, provided the xray source; michael noël, scil animal care company, provided access to the digital xray panels; and dr. rodrigo escalante, fiorella puccio vega, lic. edith jube fuentes, and lic. mayra fiorella carrillo carranza provided the ct scans at the resocentro clinic in miraflores. pk thanks jeremy mcneil (biology, western university) for providing the field microscope and juan carlos rodríguez (director of the center for heritage research and conservation) for providing us with the necessary digital equipment at the universidad de ingeniería y tecnología. finally, we would like to acknowledge colleagues and staff at the museo pachacamac, perú, and the department of anthropology, university of western ontario. ethics statement the project has received ethics approval from the university of western ontario’s human subjects research ethics board, project id: 114146, granted june 10, 2019, and renewed annually. this is a collaborative effort between the mummies as microcosms project and museo pachacamac and the samples were exported under permit from the ministry of culture. the fundamental approach of the project is to use nondestructive methods to image the contents of these funerary bundles, and to use minimally invasive sampling techniques to obtain samples for 14c and isotopic analysis. we recognize that these funerary bundles contain the remains of people who once lived, loved, and died, and as such they demand our 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rest? the treatment of human offerings and trophies in ancient peru. in tombs for the living: andean mortuary practices, edited by tom dillehay. dumbarton oaks, washington, d.c., pp. 189– 227. vreeland, jamie m. jr. 1998. mummies of peru. in mummies, disease and ancient cultures, edited by aiden e. cockburn, eve cockburn, and theodore a. reyman. cambridge university press, new york, pp. 154– 189. watson jiménez, lucía c. 2019. los fardos de ancónperú (800d.c 1532d.c). una perspectiva bioarqueológica de los cambios sociales en la costa central del perú. bar publishing, oxford. wink, alexandra  e. 2014. pubic symphyseal age estimation from threedimensional reconstructions of pelvic ct scans of live individuals. journal of forensic sciences 59:696– 702. bi_xx_xx_05_nelson_4p.indd 18bi_xx_xx_05_nelson_4p.indd 18 14-03-2024 13:50:5314-03-2024 13:50:53 bioarchaeology international volume 9, number 2: 87–105 doi: 10.5744/bi. 2024. 0010 © 2025 university of florida press using content and bibliometric network analysis to understand the development and study of “violence” in bioarchaeology constanze schattke,a,b,c sabine eggers,a,b and harald wilfingc,d adepartment of anthropology, natural history museum vienna, vienna, austria bvienna doctoral school of ecology and evolution (vdsee), university of vienna, vienna, austria chuman evolution and archaeological sciences (heas) network, university of vienna, vienna, austria dhuman ecology research group, department of evolutionary anthropology, university of vienna, vienna, austria *correspondence to: constanze schattke, natural history museum vienna, department of anthropology, burgring 1, 1010 vienna, austria email: constanze . schattke@nhm wien . ac . at abstract violence is an interdisciplinary concept subjected to the fluctuations of social and personal perceptions of morality, ethics, and justice. while its definition therefore proves to be elusive, it may serve as a way to research and reconstruct human behavior. this also applies to bioarchaeology, which is dedicated to the study of past societies through the analysis of human remains. the aim of this article is to analyze the general development, methodological key concepts, studied markers, and potential paradigm changes in the study of violence in bioarchaeology. this is done by applying bibliometric tools to selected scientific publications and building on previous research analyzing paleopathological literature. the results are then compared to qualitative reviews on violence in bioarchaeology to draw conclusions about significance and applicability of bibliometric network analysis in the light of the expanding scientific literature. finally, a future trajectory of the concept of “violence” in bioarchaeology is presented. keywords: bibliometric analysis; field development; violence gewalt ist ein interdisziplinär konzeptualisiertes phänomen, das soziokulturellen schwankungen bezüglich zur auffassung von moral, ethik und gerechtigkeit stark unterworfen ist. auch wenn sich eine präzise definition daher als herausfordernd erweist, ist gewalt zentraler untersuchungsgegenstand für die rekonstruktion menschlicher verhaltensweisen. dies gilt auch für die bioarchäologie, die sich der systematischen erforschung vergangener gesellschaften anhand menschlicher skelettüberreste widmet. ziel dieses beitrags ist es, die allgemeine entwicklung, die methodologischen schlüsselkonzepte sowie die potenziellen paradigmatischen transformationen bei der untersuchung von gewaltphänomenen in der bioarchäologischen forschungspraxis zu analysieren. hierzu werden bibliometrische analysen auf basis ausgewählter wissenschaftlicher publikationen angewandt, auch aufbauend auf früheren untersuchungen zur analyse paläopathologischer literatur. die hier erzielten ergebnisse werden mit denen qualitativer arbeiten über gewalt in der bioarchäologie verglichen, um schlussfolgerungen über die bedeutung und anwendbarkeit der bibliometrischen netzwerkanalyse im hinblick auf die wachsende wissenschaftliche literatur zu ziehen. abschließend wird ein ausblick auf die entwicklung des gewaltbegriffs in der bioarchäologie gegeben. keywords: gewalt; trauma; bioarchäologie; netzwerkanalyse; bibliometrie received 29 may 2024 revised 28 april 2025 accepted 5 june 2025 violence in bioarchaeological literature: a bibliometric analysis88 bioarchaeology primarily focuses on human skeletal material and mortuary contexts, as well as other biological remains in archaeological contexts to address questions such as health, lifestyle, diet, and mortality of past populations (buikstra 1977). through classifications like age at death and sex estimation, conclusions can be drawn about the demography of a population (berryman et  al. 2013; roberts 2019). other information open for study and interpretation that can be derived from the skeletal record includes taphonomic influences, pathological conditions, and trauma. the term “trauma” may be considered too unspecific, and phrases like “traumatic injuries” are preferred in bioarchaeology or when referring to skeletal contexts. for the scope of this article, we deliberately use a broader term as we intend to cover a wider range of types of trauma. the study of trauma and violence is a major focus in bioarchaeology (pérezflórez and harrod 2021; walker 2001). through the nature of injury patterns observed on the bone, conclusions may be drawn about the causes of injuries related to weapons, and hypotheses regarding victimhood or perpetrator behavior may be tested. in contrast to the social sciences, violence in bioarchaeology is primarily understood as a physical force leaving traces on the human body itself (redfern 2014), although it is accepted that interpersonal violence “does not occur in isolation from social and cultural forces” (lee 2016:158). however, there are also understandings that focus on the body and its necropolitical agency. bioarchaeology is able to explore the environment of the politically sensitive human body through time, interpreting changes and responses to it through cultural and political shifts (geller and suri 2014). skeletal evidence, including burial contexts, provides clues for interpretation in terms of reconstructing behavior and possible motivations behind it. particularly in violent contexts, this shows how the human body can be affected on a deeply personal and individual level (harrod, martin, et al. 2012). many humanities and other scientific disciplines seek to understand and categorize violence, mainly due to its frequency in the human experience. examples are the behavioral sciences, sociology, politics, psychology, philosophy, and archaeology, to name a few (silverberg and gray 1992; wahl 2013; whitehead 2007). therefore, different and fielddependent definitions exist in varying detail (mbembe and corcoran 2019; reemtsma 2010; whitehead 2007). philosophy is particularly well suited to the analysis of this topic, as it offers an objective approach to understanding and examining the overarching structures of society and objectively deals with analyzing and understanding societal encompassing structures. thomas hobbes (1588– 1679), for example, approached violent behavior such as warfare as an integral part of human nature, present since prehistory, positioning him contrary to jean jacques rousseau (1712– 1778), who attributed it to the emergence of sovereign states (bachofen 2015). in the 1960s, the why and how behind what is perceived as violence and violent behavior gained new traction in the political postwar contexts, with scholars like hannah arendt (1906– 1975) (arendt 1970), and on postcoloniality by frantz fanon (1925– 1961) (fanon 2013). today, philosophers like jan philipp reemtsma (1952) even argue that violence is being overanalyzed and has become something that has to be understood, prevented, and fought rather than just being accepted by society as a part of human nature (reemtsma 2010). while there seems to be no universal agreement on how or even if violence can be defined and analyzed, it is therefore a concept that is best studied using an interdisciplinary approach. the study of violence not only encompasses its physical aspects but also includes less tangible effects that may impact the human body, such as structural and epistemic violence (galtung 1969). the disparities resulting in structural violence stem from medical, cultural, and economic factors, with capitalist structures often exacerbating social and political instabilities, leading to disadvantages for outgroups (farmer 2004; springer 2011; whitehead 2007). this has led to “social bioarchaeology” considering archival and historical sources to explain and contextualize human remains, focusing on health markers (agarwal and glencross 2011; klaus 2012). this does not imply the absence of structural violence in the bio archae ol o gical record; rather, it requires the consideration of multiple lines of evidence, introducing greater complexity into the analysis. as scholars creating knowledge, it is important to consider the epistemic implications of our research. when generally dealing with theoretical concepts of violence, we would therefore also like to briefly consider epistemic violence. it arises from the creation and interpretation of knowledge, granting power to those who assert the primacy and universality of their knowledge over the knowledge systems of marginalized others. prevalent in scientific culture, epistemic violence dismisses but also silences alternative perspectives through assumptions and exclusions (spivak 1988; teo 2010). it ultimately culminates in the control and interpretation of knowledge, reflecting a nontangible power dynamic in the realm of information. teo (2010) illustrates this by showing how a randomly chosen anatomical characteristic, such as ear size, can lead to a claim of population superiority. the scientific literature is growing exponentially, with a doubling of literature currently set at every schattke et al. 89 15 years (fortunato et al. 2018). this development has created a new field of study that analyzes the information of this output. bibliometrics refers to the data scientific publications create through their metadata, such as citation scores, (co)authorships, affiliation data, and abstract keywords (donthu et  al. 2021). these huge data sets can then be analyzed using network analysis to relate these metrics to each other and to get a deeper understanding of the past, current, and potential future developments of the respective field. this can include the detection of the currently most cited documents, coauthorship networks, as well as research subfields. bibliometric network analysis can therefore help not only to identify key concepts and research trends in science in general, but has especially shown what research incentives influence interdisciplinary fields in detail (donthu et  al. 2021; gonzálezalcaide et  al. 2015; leng and leng 2021). this offers the chance to quantitatively and qualitatively explore the development of the study of violence in bioarchaeology using large amounts of selected publications. this article analyzes how violence is studied with and through human remains from archaeological contexts to understand the current and past research approaches to violence in the bio archae ol o gi cal field using content and quantitative bibliographical analysis of relevant scientific publications. the documents are analyzed using their bibliographical data to map the development of study regarding methods, quantitative output, and key concepts. this is followed by a focus on their content and a manual analysis of previously identified key concepts. based on previous research and review, it is hypothesized that the bio archae ol o gi cal interest in violence will continue to grow, sparking research around terms such as interpersonal, systemic, and epistemic violence (agarwal and glencross 2011; walker 2001). it is also hypothesized that there has been a shift toward a more interdisciplinary approach of contextualizing human remains within the framework of “violence,” resulting from a general increased influx of theoretical concepts and approaches from the social sciences and humanities into biological anthropology (accomazzo 2012). previous bibliometric analysis on paleopathological literature has found a quantitative dominance of the publication of case studies as publication type (boutin et al. 2022). this study picks up from there to apply a similar methodology to a body of literature concerned with the study of violence in the osteological record. because there is no previous research and data on this type of study, it is for now hypothesized that case studies are also the focus of research regarding violence, in contrast to population analyses. in the end, the results from the quantitative review were compared to those of qualitative reviews that have been conducted in the past, to draw conclusions on their results and similarity. this is done to gain a better understanding of the possibilities offered by bibliometric approaches to reviews in bioarchaeology, especially for junior scholars and outsiders who are new to the field. this novel approach is also necessary in light of the exponential growth of scientific literature (donthu et  al. 2021; fortunato et al. 2018). material and methods this study did not involve the analysis of human remains; instead, it focused on examining publications containing bio archae ol o gi cal content related to violence. the initial research phase involved acquiring scientific articles (fig. 1). the aim was to use citation analysis to identify key documents in the field of bioarchaeology and the skeletal markers studied here. in addition, bibliographic coupling and cooccurrence analysis of keywords were applied to identify potential subfields of research. this will help reconstruct the development of the field on a quantitative and qualitative basis. data collection and search strategies the data used in this study were extracted from scopus (https:// www . elsevier . com / solutions / scopus) on march  11, 2024. scopus is a large citation database containing 93 million records from more than 25,000 scientific outlets and publishers.1 the first step of data retrieval was to identify relevant scientific outlets that would cover the study of human bones in an archaeological context. these were identified based on keywords in their source title (table  1). this means that no bias was created in the selection of publication outlets, but also that popular scientific outlets not specializing in archaeological sciences and with broader scopes, such as journals like nature, science, and plos one, were not included in the search. then, documents were selected based on the occurrence of “violence” in the document’s title, abstract, and keywords and the concluding search results saved as lists in scopus. lastly, the document lists were manually cleaned by scanning their content to exclude research on other homo species, exclusively recent medicolegal contexts and material culture including weapons and fortifications. an exception for this was the “forensic” list containing information 1 https:// www . elsevier . com / products / scopus / content, accessed november 27, 2023. https://www.elsevier.com/solutions/scopus https://www.elsevier.com/products/scopus/content violence in bioarchaeological literature: a bibliometric analysis90 from publication outlets with “forensic” in their title. here, the number of selected documents was not only higher compared to the other outlets but was also mostly focusing on present crime or accident cases. therefore, only documents also containing “archaeology” and “archaeological” were automatically selected from this list and then manually cleaned using the same procedure as explained above. retrieved bibliographic information per publication for this study included author(s), title, abstract, keywords, and additional geographic and affiliatory data. this way, a total of 434 documents relevant for the analysis could be exported as a .csv file from scopus for further data analysis after merging all lists from manual content cleaning. classification of publications all publications included in this database were also classified according to their publication type. here, figure 1. workflow for the data selection process and network analysis conducted in this research. table 1. steps in retrieving relevant literature for this study using the scopus database. the data query consisted of requesting source titles through relevant bio archae ol o gi cal keywords and then identifying relevant documents by searching for “violence” in document title, abstract, and keywords. source title: word document title, abstract, keywords: word amount of retrieved publications amount of retrieved publications after manual content cleaning total amount of retrieved publications, with duplicates total amount of retrieved publications, without duplicates “anthropology” and “violence” 1,149 84 n = 473 n = 434 “anthropological” 342 37 “archaeology” 280 92 “archaeological” 90 52 “bioarchaeology” 75 70 “bio archae ol o gi cal” 5 4 “forensic” 2,760 14 “osteoarchaeology” 84 82 “osteoarchaeological” 0 0 “paleopathology” 36 33 “paleopathological” 3 0 “pathology” 232 3 “pathological” 3 2 schattke et al. 91 the categorization approach presented by boutin et al. (2022) in their quantitative analysis of paleopathological literature was followed. they examined the relevancy of case studies in the paleopathological literature by coding publications into types and consequently analyzing their citation frequency. because scopus does return numerous scientific types of publications, including whole books, errata, and conference posters, categories for “book” and “other” were added to the analysis. the categories were as follows: case studies: the analysis was conducted, and results and discussion were presented on an individual level, with multiple case studies being possible within one publication. population analysis: the focus of this analysis was the quantitative analysis of a whole population, including sex or ethnic affiliation. methods: the development of diagnostic and innovative approaches was in focus. review/comments: the general development of the field and/or its parts was reviewed, discussed, and put in context to other concepts. book: the entry was referring to a whole book or volume with multiple chapters. other: no other category applied. conclusions will be drawn based on the proposed hypothesis that different types of violence are studied either on a population level or through an individual case report. all publications were classified independently by two bio archae ol o gi cal scholars to achieve greater consistency in data collection. network analysis all network analyses herein have been conducted using vosviewer (version 1.6.19) with standard algorithm settings for analysis, if not stated otherwise. vosviewer is a software application used to study bibliometric data sets, providing visual representations of bibliometric data as networks (van eck and waltman 2010). generally speaking, network analysis connects items in a data set through links created by different types of analyses. these links can represent bibliographic coupling links between publications, coauthorship links between researchers, and cooccurrence links between keywords. each link is characterized by a strength, denoted by a positive numerical value, indicating the intensity of its connection. this can signify, for example, the number of shared references between two publications, the number of coauthored publications by two researchers, or the frequency of cooccurrence of two keywords. these networks can then be visualized as a map, where items are organized within clusters. items can only appear in one cluster but can also be unclustered or excluded in the visualization process for an improved visualization. items can also have two numerical attributes: weight and score. weight is a nonnegative value and indicates the “importance” of an item; higher weight implies greater importance, resulting in a more prominent visualization within the map. scores can represent various numerical properties of an item, for example, publication year. in vos viewer, clusters are sequentially visualized through a distinctive color (red, green, blue, yellow, purple, light blue, orange, brown). relevant types of analysis for this study are as follows (van eck and waltman 2018): citation analysis: citation analysis is a way to understand if and how often documents in a data set cite each other. a relationship analysis like this can also be done based not only on citation but also on the number of occurrences of a selected item within a document, for example, a keyword. coauthorship analysis: here, we analyzed which authors tend to publish together by clustering previous publications together by authorship. it can help identify collaboration dynamics in the field. cooccurrence analysis: this analysis counts how often items like keywords appear together in one document. it can help identify important “miniconcepts” and research interests within the documents analyzed. bibliographic coupling analysis: here we analyzed how similar documents are based on the references cited in their bibliographic body, placing similar research topics and approaches together. at first, a general citation analysis of the documents of this data set was created to identify current key concepts and the general consensus among bioarcheologists who research violence in the past, as well as to see which documents are cited the most. based on the similarity of the cited literature in the bibliography of the publications, the publications were visualized in a network. this means that publications presenting similar research approaches or themes are clustering together more closely. ideally, these clusters appear without a lot of overlapping of items to allow for the detection of distinct research fields. regarding the potential paradigm shifts in the study of violence, the documents were evaluated using co occurrence analysis of keywords. when a change violence in bioarchaeological literature: a bibliometric analysis92 could be observed in the distribution of keywords over time, instead of a continuous occurrence, it was assumed that a shift in research trends had occurred in the study of violence within bioarchaeology. a quantitative analysis of author keywords also revealed the current most prevalent research approaches. a demographic analysis of authors and institutions was performed to highlight the most productive scholars and their affiliations. for all network analyses, including names and keywords, appropriate thesauri were applied to account for name duplicates, and minimum thresholds for keyword occurrences were set for their later display in the network maps. finally, the results from the quantitative bibliometric analysis were also compared with those from the previously categorized qualitative, mostly cited reviews from within the analyzed data set. this is done to see where the strengths, weaknesses, and limitations of this quantitative analysis lie. results the purpose of this article is to identify, analyze, and report the concepts and methodologies used to investigate the patterns of violence that have been and are being studied through human remains in archaeological contexts. as table 1 shows, a total of n = 434 documents containing the term “violence” in their document title, abstract, or keywords published in peerreviewed, englishspeaking journals from the fields of anthropology, archaeology, bioarchaeology, palaeopathology, and forensic journals were identified. the first publication was published in 1987; the last ones were published in 2024 (fig. 2). the maximum number of publications occurred in 2012, with a publication of n = 42 documents. a total of n = 94 publication outlets were identified; the one cited the most was the international journal of osteoarchaeology (n = 82). before a demographic author and coauthor analysis, a thesaurus— a text file grouping synonyms together— was applied to account for duplicates, abbreviations, and differences in spellings in country and author names, resulting in a total of n = 897 authors with affiliations from n = 57 countries (table 2). coauthorship analysis was able to connect n = 235 of these authors together in 22 clusters, reflecting their collaboration dynamics (fig. 3). between the first 10 authors, the most cited document in the data set is from an author who did not publish the most documents. this deviation in the number of documents and citations is also the case for other authors. there is a clear dominance of scientific output from u.s.based affiliations, followed by affiliations from canada and europe and only a little from australia or south america, where there is a dominance from chile. figure 2. distribution of publication years for documents relevant for this study. the maximum number of n = 42 retrieved documents occurred in 2012. the first publications for this data set occurred in 1987. status: march 11, 2024. schattke et al. 93 classification of publication the documents were classified according to their publication type (fig.  4). because scopus does also include references for nonclassical entries such as errata and conference abstracts, some entries could not figure 3. coauthorship analysis clustering n = 235 out of n = 897 authors together in 22 clusters, visualizing who collaborated and published together on the topic of “violence” in the data set. table 2. listing the 10 most prevalent authors in the data set studying violence in bioarchaeology through the number of documents and the total number of their citations within the data set. listed are also the top 10 countries mentioned in the affiliations. total number of authors n = 897, of countries n = 57. author documents citations country affiliations mentioned tung t. a. 13 596 united states 202 harrod r. p. 12 348 united kingdom 76 martin d. l. 11 334 spain 29 redfern r. c. 9 127 canada 26 knüsel c. j. 8 103 germany/ italy 18 schulting r. j. 7 127 france 15 novak m. 6 116 chile 13 fibiger l. 6 107 australia 10 walker p. l. 5 792 russia 10 pérez v. r. 5 147 portugal 9 be classified into classical means of publications (“other”). the most prevalent type of publication was population studies (n = 234). second in frequency were reviews and comments (n = 93), followed by case studies (n = 62). a focus of the discussion is on the reviews and their impact on the field (table 3). the seven documents listed as “other” were errata and introductory chapters to books and journal special issues, which did not contain any research information. citation analysis: author interactions and studied subfields to identify key documents in the data set, a citation analysis was conducted. the citation analysis connected and clustered n = 347 of 434 documents together. this is because not all documents are linked to each other through citations. the threshold of a minimum number of citations of a document was set to 0 before the analysis to ensure the best coverage. the cluster presents which of the retrieved documents are currently most cited within the data set in 2024 (fig. 5). proximity and clustering are influenced by citation frequencies within the data set. the color violence in bioarchaeological literature: a bibliometric analysis94 gradient indicates the publication year of the document, from oldest (purple) to latest (yellow). bibliographic analysis: identifying research fields using bibliographic coupling analysis, the documents were then analyzed based on similarities in their cited references in their bibliographic body (fig. 6). this refers to citing the same or similar documents. to account for the development of the field of violence research in bioarchaeology through time, the analysis was conducted in 10year research brackets based on the year of publication, starting with the first publication in 1987 (supplemental figs. s1– s4). in the first two decades, because of the small amount of research present at the time, all table 3. ten most cited articles with review and comment characteristics identified and their number of citations within this data set. note that multiple citations of one reference are possible within a document. author(s)/editor(s) year of publication title number of citations lovell, n. c. 1997 trauma analysis in paleopathology 474 walker, p. l. 2001 a bio archae ol o gi cal perspective on the history of violence 415 lambert, p. m. 2002 the archaeology of war: a north american perspective 155 larsen, c. s. 2002 bioarchaeology: the lives and lifestyles of past people 132 martin, d. l., harrod, r. p. 2015 bio archae ol o gi cal contributions to the study of violence 121 larsen, c. s. 1994 in the wake of columbus: native population biology in the postcontact americas 70 gat, a. 2015 proving communal warfare among huntergatherers: the quasirousseauan error 59 rodríguezmartín, c. 2006 identification and differential diagnosis of traumatic lesions of the skeleton 49 kissel, m., kim, n. c. 2019 the emergence of human warfare: current perspectives 41 muller, j. l., pearlstein, k. e., de la cova, c. 2017 dissection and documented skeletal collections: embodiments of legalized inequality 30stone, p. k. 2012 binding women: ethnology, skeletal deformations, and violence against women figure 4. distribution of publications included in this bibliometric study according to their classification into study type. a total of n = 434 publications was manually classified, following a twoeye approach. schattke et al. 95 documents were included in cluster visualization, even if they did not cite each other and thus did not produce any links. for all decades, the threshold of a minimum number of citations of a document was set to zero before the analysis to ensure the best coverage. mapping was visualized using a clustersensitive color gradient indicating the belonging to a cluster as well as representing the citation quantity of a document by size. note that the cluster color is always newly calculated based on the additional references and does not continuously represent the same clusters throughout the temporal analysis. cooccurrence analysis: framing and labeling through keywords in addition to the keywords used to retrieve relevant documents for this study, keywords within the data were also analyzed (fig.  7). all author keywords appearing at least three times in the data set were included in the cooccurrence analysis. before the analysis, a thesaurus was applied to account for duplicates. keywords referring to plurals were counted as singulars (e.g., “humans” as “human”), and other semantic peculiarities and spellings were standardized (e.g., “anthropology, physical” was counted as “physical anthropology,” “archeology” as “archaeology”). additionally, countries were excluded because the region of study was not of interest here but rather how violence is studied. for a summary of geographic author affiliations, see table 2 instead. keywords hinting at different ethnicities and regions were, however, kept in the analysis (e.g., “kerma,” “black”). this resulted in clustering n = 85 of 980 author keywords together when a keyword appeared at least three times in the data set (table 4). the map is presented using an overlay network with a timesensitive color gradient indicating the average publication year. in addition, a network density visualization was conducted to account for quantity and thus the topical density of these keywords in the field on a scale from blue to yellow. discussion the bibliometric analysis of the topic of violence in bioarcheology on the basis of author and keyword analyses yields noteworthy results, which will be discussed below. figure 5. visualizing an almost fourdecadelong network of publications associated with bioarchaeology and violence and their authors citing each other in the data set (n = 347), spanning from the first publication in 1987 to the latest in 2024. proximity of and clustering of nodes are influenced by citation frequencies within the data set, while the color gradient denotes the publication year of each document from oldest (purple) to latest (yellow). violence in bioarchaeological literature: a bibliometric analysis96 structuring the field– key concepts and subfields there is a clear dominance of documents affiliated with institutions in the united states, with nearly three times as many affiliations as in the second highest, the united kingdom. author analysis has shown that the quantity of published documents in the data set studied does not necessarily correspond to the authors of the relevant key concepts identified in the field (see discussion below). the most cited authors did not write the most documents in this data set. citation analysis: highly relevant documents. today’s representation of violence in bioarchaeology has revealed several important key documents (fig. 5) that continue to be relevant since their publication. central to this map are the works of lovell, walker, and dietler (dietler 2010; lovell 1997; walker 2001). lovell and walker represent standards in the development of methods and are also reviewing the interpretation of violence in the bio archae ol o gi cal record. no less quantitatively relevant, however, are also other publications generating clusters around them (lambert 2002; larsen 2002; martin and harrod 2015; müldner and richards 2007; torresrouff 2008; tung 2012). bibliographic coupling: subfields of research. when the documents were clustered based on the similarities in their references, documents similar to the citation analysis were centralized. a total of eight clusters, connecting n = 411 of 434 items to each other, suggest the development of eight large and small subfields that are partly overlapping and interacting with each other (fig. 6). in the beginning decade of the selected documents between 1987 and 1996, very little exchange between research documented in these publications happened (supplemental fig. s1). only between 1997 and 2006 did the first real cluster emerge (supplemental fig. s2), showcasing once again in its biggest accumulation mainly case studies but also reference works that have impacted the field until today (e.g., lambert 2002; larsen 2002; lovell 1997; walker 2001). the other documents are mostly grouped together based on type of trauma and circumstances (e.g., head trauma in the pacific region figure 6. cumulative visualization of documents in the bibliographic coupling analysis. here, the documents are placed based on the similarity of references cited in their bibliography bodies. clusters are indicated by color. schattke et al. 97 possibly associated with cannibalism, trauma in neolithic europe; degusta 1999; orschiedt et  al. 2003), but also already slowly hinting at studying structural violence associated with shifts in societal structures and climate change in the next decades (gronenborn 2006c; hutchinson 1996; lessa and mendonça de souza 2004). additionally, collaborative projects and student– mentor relationships might have influenced how papers were cited. this development of slowly establishing numerous bio archae ol o gi cal subfields studying violence continued between 2007 and 2016, where the field differentiated into seven clusters (depicted as seven different colors in supplemental fig. s3) that are contentwise already closely related to the clusters presented in the last evaluated decade. several centered key concepts identified in the citation analysis, such as tung and dietler, are also emerging as relevant for the field for the first time (dietler 2010; tung 2012), while others are cementing their status as key concepts in this continuous representation through time, as already indicated by the citation analysis (lambert 2002; lovell 1997; tung 2012; walker 2001). however, this is not always the case, as one of the first documents studying structural violence in general, and the first one in this data set, was not clustered and thus represented in both the third and fourth final cluster visualization at all (angel et  al. 1987). instead, it disappears during the development of the field, suggesting a differentiating establishment of new, different methods studying structural violence from the late eighties until today. figure 7. keyword analysis results of n = 85 author keywords used in publications between 1987 and 2024, showcasing the average publication year of the respective keyword on a scale from oldest (purple) to latest (yellow). to see how frequently the most common 30 keywords occur, please refer to table 4. violence in bioarchaeological literature: a bibliometric analysis98 in the most recent decade (fig.  6), the first appearing and three largest clusters evolve around topics on how to study violence. within the first red cluster, the document with the highest link strength is larsen (2002). generally, the documents in this cluster focus on contextspecific studies of violence, meaning the “classical” research on how and where violence is observed (e.g., jordana et al. 2009; kanz and grossschmidt 2006; müldner and richards 2007). this is followed by the green cluster grouping around walker (2001), which also incorporates social theory (e.g., dietler 2010; gat 2015) and studies within these theoretical frameworks (e.g., andrushko and verano 2008; hurlbut 2000). a seemingly exclusive focus on structural violence is the third blue cluster grouping around klaus (2012), surrounded by research about social inequality and gender differences (e.g., cheung et al. 2017; harrod, thompson, et  al. 2012; muñozencinar 2019). the fourth and yellow cluster around lovell (1997) shows similar documents grouped together as in the red cluster, but an influx of paleopathological analysis is visible (e.g., judd 2002; jurmain 2001; van der merwe et al. 2010). looking at the content of the following clusters, they are then grouped together based on their geographical research focus and are located throughout the other clusters, suggesting a high topical overlap with them. this is not surprising, as a local research focus requires a contextualization within the local archaeological record, which would also be reflected in the reference body. keyword cooccurrence: markers and fields. the content analysis through author keywords revealed four methodological subfields that support the study of violence in the archaeological record. these are “bioarchaeology,” “palaeopathology,” “forensic anthropology,” and analysis through “taphonomy” (fig. 7). there are no time period constrictions, although most research was linked to the “neolithic” and “medieval” times (table 4). the average publication years are more oriented toward the 2010s, hinting at a continuous use of these keywords since they are calculated as an average. an exception is the pre2000 keywords “fracture,” “urban,” and the oldest clustered keyword “pathology,” which not only denotes its own research field but also represents one of the oldest subfields in bioarchaeology (aufderheide and rodriguezmartin 1998). most importantly, however, the analysis revealed that bioarchaeology, since its beginning, seems to focus on the study of two types of violence: interpersonal and structural violence. closely associated with structural violence are “women,” “institutionalization,” “inequality,” and “osteobiography,” whereas interpersonal violence unsurprisingly heavily associates with the field of forensic anthropology, “interpersonal violence,” “trauma,” and “male”. bioarchaeology’s lens on traumatic and stressful contexts trauma. physical violence leaving evidence on the skeleton may be the most obvious because of its table 4. keyword analysis results, listing the quantitative representation of n = 980 keywords in the documents that appeared at least three times. place keyword appearances place keyword appearances 1 violence 79 16 medieval 9 2 trauma 57 17 sharp force trauma 9 3 bioarchaeology 53 18 cranial trauma 9 4 interpersonal violence 45 19 decapitation 8 5 fracture 25 20 gender 7 6 paleopathology 24 21 blunt force trauma 7 7 warfare 22 22 identity 7 8 structural violence 20 23 health 6 9 perimortem trauma 15 24 strontium isotopes 6 10 injury 14 25 weapon 6 11 conflict 12 26 prehistory 6 12 neolithic 11 27 bronze age 6 13 taphonomy 10 28 migration 5 14 skeletal trauma 10 29 scalping 5 15 forensic anthropology 9 30 embodiment 5 schattke et al. 99 inherent bodily and visible nature. the keyword analysis showed that the most often researched marker was “trauma,” mostly studied through “fracture” and “injury,” just a few ranks below them in terms of frequency. other words that may refer to this include (traumatic) lesions, wounds, and injuries. as explained before, however, trauma does not necessarily have to manifest itself physically. the more direct and detailed keywords studying interpersonal violence (e.g., “decapitating,” “scalping”) are becoming gradually more abstract when trying to cover the topics of structural violence. here, the surroundings and circumstances of potential contexts of structural violence are the focus (e.g., “migration,” “health”) and studied through contextdependent proxies rather than fractures (“strontium isotopes,” “gender”). what markers exactly are being used to study structural violence does not become ultimately clear through keyword analysis. rather, an idea is given of what concepts are being included in the study (e.g., “migration,” “health,” but also “gender” and “identity”), but no ultimate bioarchae ol o gi cal markers stand out in the analysis. past research on a seemingly clear bio archae ol o gi cal term like “bone remodeling” has already highlighted the subjective differences in the reception and meaning of scientific terms in bioarchaeology and paleopathology (wei and cooper 2023). stress. as indicated in the temporal and topical implications of the cocitation and cooccurrence analysis, bioarchaeology focuses on the study of interpersonal and structural violence. notably, within this data set, structural violence is even the study focus of the first two publications (fig. 5; angel et al. 1987; kelley and angel 1987). because of the clear focus on interpersonal violence in this data set and a lack of data on the markers of structural violence, it was zoomed in to the cluster from the citation analysis, focusing on angel et al. (1987) and subjected to further manual content analysis. in it, the health, lifestyle, and occupation of a nineteenthcentury free black community in philadelphia, united states, are analyzed. black people, enslaved people, and contextualization around hospitals continue to be the research focus in this cluster (atwell 2022; de la cova 2012; halling and seidemann 2017), but it is also studied how other marginalized groups like women (stone 2012) and migrants (harrod, thompson, et al. 2012) were affected by structural violence in the past. documents in this cluster offering general background and methodology in what markers can be studied (klaus 2012), as well as a more generalized conceptual approach (zuckerman and crandall 2019), were published way later than the works by angel et al. in 1987, suggesting a development without referencing these works. zuckerman and crandall, in particular, offer a thorough background review of the influences social theory has had on bioarchaeology and consequently stress the implementation of additional models and theories in what has previously been labeled “social bioarchaeology” (agarwal and glencross 2011; zuckerman and crandall 2019). their analysis greatly reflects which skeletal markers are associated with health, disease, and trauma, but also sex and gender can be studied, as well as the social impact(s) they themselves may have had on past populations. the manual cluster content analysis could show that structural violence is mostly studied through what can best be described as stressors, acting as “proxies for resource inequity” (blevins et al. 2023). these are inevitably more complicated than studying the mere absence or presence of healed and unhealed trauma, and have therefore been represented diversely, mainly by lesions associated with certain diseases. more common markers researched were inflammation, porotic hyperostosis, dental caries, and dental enamel defects (klaus 2012; zoëga and murphy 2015). however, these markers are nonspecific, appearing as osseous or dental manifestations in different conditions. this includes, for example, metabolic diseases like vitamin c deficiency and tuberculosis (atwell 2022; blevins et  al. 2023). the presence of syphilis— more diagnostic— was investigated through a combination of bio archae ol o gi cal and historical analysis (atwell 2022). the keyword analysis already suggested that the use of osteobiographies, a (detailed) life history reconstruction based on various individual aspects, as reflected mainly by bone morphology, but also molecular analyses, synthesizes these interdisciplinary data at least on an individual level. structural violence in bioarchaeology is, therefore, as the keyword occurrence had already indicated, also considering “social injustices” (galtung 1969) in its approaches when studying human remains. these structural disadvantages can result from medical, cultural, and economic perspectives, where capitalist structures and practices are currently the most prevalent, promoting political as well as societal instabilities (farmer 2004; springer 2011; whitehead 2007). stressors or markers of stress take time (months to years) to manifest in the skeleton. physical trauma is an indicator of personally experienced violence, and stress markers are represented throughout the continuously present societal marginalization caused by structural violence. these markers do not have to be necessarily indicative of one specific disease but can be general symptoms, as is the case for inflammatory reactions. in the herein reviewed documents, some diseases and their markers stood out (e.g., syphilis in violence in bioarchaeological literature: a bibliometric analysis100 women), in their implications on both health and society. additionally, compared to the study of interpersonal violence, there was an even higher degree of interdisciplinarity visible through the implementation of ideas and concepts, especially from social theory and intersectional feminist studies (atwell 2022; zuckerman and crandall 2019). this reveals the prevalence of a threesided approach to study structural violence affecting past populations, happening through bio archae ol o gi cal analysis, provenance research approaches, and historical contextualization of the researched human remains. prevalent study type of violence in bioarchaeology the most prevalent study type in violence is population studies, meaning a focus on quantitative distribution of fracture patterns— or other indicators of violence— in the osteological record. this is in strong contrast to paleopathology, a neighboring field of bioarchaeology that studies pathological changes in bones, teeth, and, in special cases, soft tissues and hair when dealing with mummies or bog bodies. here, a review of publication types of documents published in one journal yielded the prevalent type as case studies, highlighting the diagnostic nature of paleopathology over its demographic analysis (boutin et  al. 2022). for this study, it was hypothesized that this must be the same case in the study of “violence” markers, such as fracture patterns or stressors, and that the diagnostic distinguishment of perimortem versus postmortem fractures might have yielded similar scholarly discourse in the past. instead, the results present an alternative perspective. this might be because fracture and injury patterns, the most studied markers concerning violence, as revealed in this study, can be interpreted with fewer contextual data than compared to paleopathological cases. here, the observed pathological markers are mostly disease unspecific and gain their diagnostic meaning through contextualization with factors such as the presence of other pathological markers, malnutrition, or sex. therefore, especially datadriven case studies with a focus on paleopathological method development and the identification of diagnostic markers have a significant impact on academic research (boutin et al. 2022). comparison of aspects of qualitative versus quantitative literature reviews the advantage of conducting a network analysis of scientific literature lies in its quantitative approach, replicability, and comparatively faster speed compared to qualitative literature. it is easily conducted after setting the search parameters, and the development of a field can be repeatedly studied through different periods of time, taking various formal aspects into account, including relevant keywords, authorship, and demographic author information. this can be best described as research metadata, which give information about the anchors and geographical placements of the field itself. quantitative research is, therefore, especially useful to track interdisciplinary fields that draw from different subfields, subsequently developing its methodology. research patterns and clusters can be detected and analyzed quantitatively, without bias, and are thus reproducible. although this is lacking in the qualitative approach, this can be bypassed by subjecting identified key concepts to a manual analysis to answer more specific research questions, as done for this study. however, the bibliometric analysis does not indicate whether a document was cited frequently due to agreement, disagreement or other controversies surrounding its theme. this interpretation needs to be done by contextualizing it into the past and present scientific discussion. selecting keywords for document retrieval introduces bias, especially toward scientific outlets. non subjectspecific documents and potentially revealing innovative data patterns were thus potentially excluded— however, “violence,” studied across disciplines, yielded n = 250,247 entries in scopus in march 2024 when globally searched for in the “document title, abstract, keywords” field. our criteria also excluded socalled highimpact journals such as nature, science, and plos one. however, previous research (boutin et al., 2022) employed a comparable approach, focusing solely on one specialized paleopathological journal. we also wanted to target a range of archaeological journals to gain a deeper understanding of violence in bioarchaeology. additionally, while the authors’ presumed awareness was based on the keyword’s presence, it cannot be ruled out that relevant documents were not included because the corresponding indexing is missing. this is also the case even if all search criteria apply, but it may still yield documents that ultimately are studying violence “more” compared to other topics. even though michael dietler’s (2010) volume, consumption, entanglement, and violence in ancient mediterranean france, hit all criteria for search and inclusion, it must be considered that its content mainly deviates from the scope of this study as it focuses on materialistic rather than osteological studies. and while it shows up with high citation scores in the analysis, its position in the clusters also indicates a small relatedness to the other documents within the data set. schattke et al. 101 two major reviews identified in the bibliometric analysis were conducted by nancy lovell (1997) and philip walker (2001), cited a total of n = 474 and n = 415 times, respectively, as multiple citations of one reference are counted within a document. these are qualitative reviews by skilled and senior scholars revisiting the study of violence on human remains. lovell (1997) reviews the methodological concepts necessary to diagnose skeletal fractures for each bone in detail. the fracture types, as well as proximate and ultimate causes of injury, she argues, help in the paleopathological analysis and interpretation of trauma– connected paleopathology with violence. lovell also focuses on bone development, mechanical properties, and the cause and effect of forces that could potentially cause fractures. the presentation of this information for each skeletal element is what makes lovell’s review so impactful, demonstrated through its central placement in all bibliometric analyses conducted herein. in total, she cited 108 documents stemming from as early as 1910. four years later, walker (2001) provided an extensive review of not only the history but also the development of how human remains are studied in the context of violence. directly asking what bioarchaeology has contributed to the understanding of violent behavior in the past, he illuminates the potential of bio archae ol o gi cal research, also drawing on the influences and methodologies from other fields like history and the social sciences. by proposing ways to connect bio archae ol o gi cal methodology and highlighting caveats for research, his review gains its main strength. in total, walker references 110 further documents in his bibliography, providing insights into scientific literature published between 1906 and 2001, the year he published his review, although his first reference for an osteological reference was angel’s comparative work on fractures from the neolithic to modern times from 1974 (angel 1974). patricia lambert’s review, cited n = 155 times, and clark spencer larsen’s work (n = 132 times) address similar opportunities and challenges in the study of violence compared to walker’s, although lambert puts her scope on north america only (lambert 2002; larsen 2002). one major point of critique for qualitative reviews is that they might be biased through the authors’ preferences for picking their own case references (e.g., walker 2001). one advance, however, is their focus on the contents. both walker and lovell provide suggestions for markers to study violence, while the author keyword cooccurrence in this study only provided directional hints. additionally, offering a huge citation database, the indexed contents on scopus are not complete, as the outlets need to fulfill certain criteria to be indexed.2 this can also lead to the presence of duplicates. in the data set evaluated, three documents appear through eight entries. in the first case, two documents with the same digital object identifiers (dois) appear as a journal article as well as a book chapter (frazer 2007a, 2007b). this is similar to the second case, where three entries of the same publication, indexed through different dois, appear in different outlets (gronenborn 2006a, 2006b, 2006c). in the third case, an introductory book chapter was indexed three times in scopus because of similar reasons (armit et al. 2006a, 2006b, 2006c). because all entries appeared independently and already showed different numbers of citations, it was decided to consider all of these publications as independent of each other. it is not likely to be a mistake by the authors but rather an indexing mistake by scopus wrongly classifying the entries multiple times under different publication types. that scopus is not a complete database also becomes apparent, for at least three documents could be identified that, while following the requirement for data selection, are not indexed in scopus (e.g., buckley 2000; smith 1996; williamson et al. 2003). additionally, martin and frayer’s volume troubled times from 1997 did not hit any search criteria and was therefore not included in the data set, although it is a common reference (martin and frayer 1997). these are all consistent challenges in bibliometric network analysis, which are not exclusive to bioarchaeology. otherwise, it could be shown that the quantitative literature review approach through bibliometric analysis is at least equal to the qualitative approach in terms of speed, reproducibility, and range of topics covered, and it even offers advantages. this includes providing visually appealing networks of quantitative data through a clear visualization of complex bibliometric data, including more documents than the qualitative reviews observed here. this allows for a clear understanding of the influences of different fields and neighboring disciplines in interdisciplinary fields such as violence in bioarchaeology, especially through the analysis of cluster contents. by referencing databases like scopus, future researchers can reproduce the analysis, thereby eliminating the possibility of reviewer bias, such as familiarity with the already known literature and specific approaches and methods. last but not least, bibliometric analysis tools make scientific fields more accessible to outsiders and young scientists, helping them understand current and past concepts and providing more experienced scholars with an overview of their development, including potential input from previously unknown literature. to avoid the pitfalls mentioned above in the 2 https:// www . elsevier . com / products / scopus / content # 3 selection standards, accessed november 7, 2024. https://www.elsevier.com/products/scopus/content#3-selection-standards https://www.elsevier.com/products/scopus/content#3-selection-standards violence in bioarchaeological literature: a bibliometric analysis102 retrieval of literature, it is recommended to define the search criteria precisely but with a certain openness. initially, a selection of publication outlets and types should be made. subsequently, a search for keywords may be conducted, with a certain degree of flexibility in terms of precision advised to aim for potentially previously unknown topics. the results can then be reflected upon with the help of a qualitative addition of further publications, such as previous reviews, as done here. this is the optimal way to provide a multifaceted picture of the current state of debate in scientific fields. violence in bioarchaeology— changes and challenges the historical analysis of violence, briefly mentioned in the introduction, has shown that what is considered violence is constantly changing and evolving, depending on societal, cultural, and personal influences. contemporary attitudes therefore also affect how violence is studied. in this data set, we found a high prevalence of author affiliations to the united states, suggesting not only a research focus from north american universities but also a dominance in the methodological development of the field. the number of publications studying violence has increased in the past decade, with a focus on analysis at the population level (fig. 2; fig. 4). while the fundamental cornerstones for studying structural violence have been set since at least the 1980s, and the first two publications in this data set even directly refer to studying structural violence (angel et al. 1987; kelley and angel 1987), the keyword analysis suggests an increase in this subfield only in the 2010s. this is also supported by the bibliographic analysis, which indicates that no cluster specific to the study of structural violence has been identified in the past decade. after a differentiation between interpersonal violence in bioarchaeology and structural violence in the social sciences (accomazzo 2012), the question also remains if and how epistemic violence, a violence inherent in knowledge and power and proposed by postcolonial researchers such as spivak (1988), will become a future bio archae ol o gi cal research subfield. even more abstract than structural violence, it acts through the creation and transport of violence through knowledge (e.g., racial categorization promoted by science and followed by social discrimination). it is expected that in the future, with the rising selfawareness of bioarchaeology and especially its contribution to racist ideologies and the treatment of minorities (buikstra et  al. 2022; roberts 2019), it will also look more closely at what bioarchaeology contributed to the creation and establishment of epistemic oppression. the collection practices and often colonial contexts involved in the provenance of human remains collections (pollock 2023), the centerpiece of many bio archae ol o gi cal works, can already be interpreted and labeled as epistemic violence. analyzing how epistemic violence is investigated in the bio archae olo gi cal context was only indirectly possible in this analysis. it can, however, be thematically situated closely to clusters and keywords that deal with or link to structural violence. for the future, a continuation of the increase in publications regarding the general study of violence in the skeletal record is predicted. the current global geopolitical tensions are perpetuating, especially the less tangible types of structural and likely also epistemic violence. conclusion this work has analyzed how violence has been studied in bioarchaeology using content and quantitative bibliometric network analysis. for one, it accounted for how the increasingly growing and fastpaced body of scientific literature can be used to quantitatively study an interdisciplinary field in a fast and easy way. it also showed how bibliometric metadata can be used to understand scholarly collaboration and publication dynamics. the analyses presented here also, not surprisingly, showed that studies of violence have become interdisciplinary in bioarchaeology. only a broad treatment of this topic can lead to an account that is capable of depicting the highly contextualized physical, social, and cultural factors and consequences of violence in the bio archae ol o gi cal record. in the past, this happened through consistent bioarchae ol o gi cal methods and without many changes in its paradigms. therefore, the most unforeseen aspect to be considered when studying violence in the future is the necessity to take the present societal and scientific challenges and changes into account while adapting them into the bio archae ol o gi cal research repertoire. a change of perspective on how and what we perceive as violence in our everyday lives could thus lead to research on how epistemic violence has affected human remains. this is particularly necessary when considering the origins of many osteological collections of human remains. acknowledgments c. s. thanks leo capari for his support and introduction to the topic of bibliographic network analysis, as well as paul klostermann and sheridan strang for assisting in the manual classification of schattke et al. 103 documents. this article was published open access with the financial support of the natural history museum vienna. supplemental information supplemental figures s1–s4 can be found online. references cited accomazzo, sarah. 2012. anthropology of violence: historical and current theories, concepts, and debates in physical and sociocultural anthropology. journal of human behavior in the social environment 22(5):535– 552. doi: 10 . 1080 / 10911359 . 2011 . 598727. agarwal, sabrina c., and bonnie a. glencross, eds. 2011. social bioarchaeology. blackwell studies in global archaeology 14. wileyblackwell, chichester. andrushko, valeria a., and john w. verano. 2008. prehistoric trepanation in the cuzco region of peru: a view into an ancient andean practice. 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current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe bioarchaeology international bioarchaeology international volume 8, numbers 1–2: 63–84 doi: 10.5744/bi.2022.0030 © 2024 university of florida press gender across generations: childhood food practices as socialization processes in ancient china melanie j. miller,a,b,c* siân e. halcrow,a bowen yang,d yu dong,d kate pechenkina,e and wenquan fanf adepartment of anatomy, university of otago, dunedin, new zealand barchaeological research facility, university of california, berkeley, berkeley, ca, usa cnorthern california institute for research and education, san francisco, ca, usa dinstitute of cultural heritage, shandong university, qingdao, china edepartment of anthropology, queens college, city university of new york, new york, ny, usa fhenan provincial institute of cultural heritage and archaeology, zhengzhou, china *correspondence to: melanie j. miller, department of anatomy, university of otago, 270 great king street, dunedin 9016, new zealand e-mail: millermj@berkeley.edu abstract food is a biological imperative as well as a core material that humans use in socializing ourselves, and the things we choose to consume are infused with cultural meanings. children, especially very young children, have little agency in subsistence decisions, and therefore the foods that caretakers feed to children may hold profound information about cultural value systems and reveal social processes and idealized identities. here we focus on relationships between food, sex, and gender in early life by studying the childhood diets of 57 eastern zhou period individuals from the central plains region of china (771– 221 bce). using stable isotope analysis of incremental dentin samples, we create detailed dietary histories of childhood years. from very early in life, the average δ15n value for boys is notably higher than the average for girls, indicating slightly more protein consumption for most males, and this continues across childhood. foods such as meat and millet were highly valued in ancient china and, whether intentional or not, become associated with aspects of sex and gender through preferential feeding to male children. these isotopic data reveal a key aspect of the socializing processes of children across generational interactions with caretakers, with food communicating information about social worth and gender, which becomes embodied in the developing child. keywords: stable isotope; childhood; china 摘要：食物是生物生存必需品，也是人类社会化过程中的的重要材料，人们选择消费的食物常常富含文化意 义。儿童，特别是年幼的儿童，不具备自主选择食物的能力，照顾者给儿童的饮食可能包含大量关于社会文 化体系的信息，因此可以揭示当时的社会进程和理想化的身份。在本文中，我们通过研究东周时期（公元前 771-221年）中国中原地区57名儿童的饮食，以探索早期饮食与生物性别、社会性别之间的关系。通过对序列 采样的牙本质样本进行稳定同位素分析，我们重建了详细的儿童期饮食史。结果表明，从幼儿时期开始，男 孩饮食的δ15n平均值就明显高于女孩，这表明大多数男孩的饮食中消耗了更多动物蛋白，这种饮食习惯贯 穿于整个童年时期。在中国古代，肉类和粟黍等食物被高度重视，无论是有意还是无意，这些食物被更多的 喂给男性子嗣从而变得与性别相关。稳定同位素数据揭示了儿童与照顾者之间跨代互动的社会化过程，饮 食表达了当时的社会价值和社会性别，并通过发育中的儿童体现出来。 keywords: 稳定同位素; 童年; 中国 received 29 october 2022 revised 05 april 2023 accepted 10 may 2023 childhood food practices as socialization processes in ancient china64 diet and nutrition are key components to health experiences over the lifetime and have significant effects on growth and development during early life and continued effects into adulthood (gamble and bentley 2022; gluckman et  al. 2007; lewis 2018). beginning from birth, nutritious and safe food is critical for all organisms (including liquids/drinks as “food”). however, humans approach food not only as a biological imperative but also as a medium that conveys sociocultural information (appadurai 1981). the choices caretakers make about the foods given to infants and children are implicitly biocultural as they have significant biological and social meanings and effects. for example, infant feeding strategies (milk feeding vs. formula feeding, weaning timing, complementary food choices, etc.) are all culturally mediated practices that can have biological consequences for the developing infant (miller 2018; palmquist 2017). consequently, anthropologists and health scientists have a longstanding interest in studying human diets and nutrition, both to improve health conditions in living populations as well as to understand the cultural values we attach to cuisines. here we utilize stable isotope analysis of tooth dentin and bone collagen samples to study diets of ancient eastern zhou individuals from the central plains of china (fig. 1) over their lifetimes, with particular attention to childhood diets and the roles specific foods may have played in gendering individuals in early life. food and gender food is a primary substance used in the socialization and enculturation of individuals and communities, as food practices are intertwined with culturally specific understandings of age, gender, wealth, religion, figure 1. maps showing locations of eastern zhou archeological sites. lower right map shows the archaeological sites of changxinyuan, gaolou, tiancheng, and xiyasi (part of the ancient zhenghan city). lower left map shows relative location of archaeological site guomianyichang, approximately 26 km north of xinzheng/ancient zhenghan city sites. miller et al. 65 politics, and more (appadurai 1981; douglas 2008; hastorf 2017; meigs 1987; sterckx 2005, 2011; weismantel 1988). cultural identities are inextricably tied to foodways; indeed, a common way communities identify “us versus them” is through comparisons of subsistence and cuisine (appadurai 1981; douglas 1984; franklin 2001; gaytán 2008; harris 1985; hesse 1990). food practices and beliefs about what is or is not edible, who consumes particular foods (when, how much, how often, in what context), and other values that foods are imbued with (such as what qualifies as “healthful” foods) are all learned behaviors that are routinely practiced and embedded in our social interactions (bourdieu 1977; lévistrauss 1966; meigs 1987; rozin et  al. 1997; sterckx 2011). caretaker/familial relationships are foundational to that socialization process via food; caretakers are responsible for ensuring adequate food intake for the young, and what qualifies as adequate/ proper meals for young people is culturally defined. from how infants are fed (breastfeeding, animalmilk feeding, formula feeding, etc.), to who makes the choices about weaning foods and what those are (and why), to later childhood diets and beyond, these are all small acts that normalize and idealize particular ways of being and convey significant amounts of social cultural knowledge through their action and embodiment (bourdieu 1977; butler 1999; farnell 2000; mauss 1973; meigs 1987; mennell 1985; taylor 1999). within the field of bioarchaeology, “sex” is often a key variable in research design and is usually presented as a binary expression (male/female) of biological factors (such as chromosomes, genes, gonads, hormones, etc.), with skeletal morphology being the primary lens of analysis, and this is not without problems or critique of assigning a binary gender construction to estimated biological sex (agarwal and wesp 2017; faustosterling 1993, 2012; geller 2017; richardson 2013; sofaer 2006; zuckerman and crandall 2019; zuckerman et al. 2023). bioarchaeologists typically disambiguate “sex” from “gender” through the framework of viewing gender as a cultural construction; gender encapsulates socialized (learned) ways of being, embodied and performed (how to behave, speak, carry one’s self, emote, etc.), which includes culturally specific understandings of characteristics and behaviors that make one socially appropriate and identifiable according to shared understandings of gender norms (butler 1999; geller 2017). one’s gender may or may not correspond to notions of an individual’s sex, though historians have noted that a sexgender conflation existed in ancient china (hinsch 2013, 2018; nyitray 2021). both external and internal conditions shape understandings of gender, and these are historically contingent and change over time and space (bourdieu 1977; butler 1999; farnell 2000; taylor 1999). gender/ gendering (gender expression, gendered embodiment) is a continuous process of both external (communal/ societal/institutional) as well as internal (personal/ psychological) interpretation and performance of normative behaviors, expectations, beliefs, actions, and so on, such that society genders us and we are gendering ourselves through countless thoughts and acts (butler 1999; joyce 2000). scholars have noted the insidious nature of gendering processes, which are often implicit, are nondiscursive, and normalize particular ways of being in the world as completely “natural,” which is achieved through countless choices and acts, usually without reflexive critical thought (bourdieu 1977; bouveresse 1999; butler 1999; farnell 2000; mauss 1973). gender in particular is communicated through embodied performance (hexis; bourdieu 1977), which makes studying these parts of humanity particularly challenging for scholars of the past. however, there are material things that are central to our socialization, and in this case, we investigate food as a primary medium for the communication of cultural values (see geller 2017 on gender and the materially discursive). food is embodied material culture, “that is, a special kind of material culture created specifically for immediate destruction, but destruction through the transformative process of ingestion into the human body . . . hence, it has an unusually close relationship to the person and to both the inculcation and the symbolization of concepts of identity” (dietler 2007:222). while numerous materials reveal and communicate aspects of personal and shared identities and ideologies (clothing, for example), food is one of the few things humans imbibe and whose components, both chemical elements and symbolic meanings, can become a part of the person. people have long looked to food, drinks, and other substances we consume as constructive, neutral, or destructive elements in creating particular types of people (healthy, sickly, strong, weak, virtuous, corrupt, moral, pious, deviant, etc.), and this was certainly part of belief systems in ancient china (sterckx 2011). these food valuations are learned and passed across generations, which is not to say they remain static but in fact can be places where culture is demonstrably changing over time and can be studied through material traces in the archaeological record (dietler and hayden 2001; hastorf 2017). food can symbolize normative, aspirational, and inimical values, which in turn can be incorporated and embodied by the consumer. childhood is a critical period where one is figuring out how to be in the world (lancy et  al. 2010), and learning gendered behavior is certainly a large part of this social developmental process (montgomery 2010). it is through inter and intragenerational interactions that particular ways of being are normalized over time. this socializing/learning of gender norms occurs both externally (through dialogue, through material culture) but also internally (psychologically/personally), childhood food practices as socialization processes in ancient china66 recursively functioning as “boying the boy and girling the girl” (butler 1999; joyce 2000). it is these processes that begin in life as external that individuals then take up and carry on, or modify or reject over the course of their lifetime (butler 1999). food can act as a medium imbued with values related to gender, where cultural ideas about what a particular gender eats (or should eat) is passed on, reenacted over time, normalized, and embodied. children often lack the agency of choice when it comes to subsistence, with families typically exerting this power over young individuals (lancy 2012). therefore, through these acts of caretakers choosing food for infants and children, they are also implicitly communicating ideals and values through meals, which in turn create the literal body of the child. one of the earliest adult interventions in childhood feeding is the process of weaning a child off of (breast) milk using supplementary foods. this process is highly variable in its timing and tempo (macadam and dettwyler 1995; tomori et al. 2018). the weaning process has long interested anthropologists and health scientists due to the complex biosocial relationship formed between a mother/allomother and an infant, as well as the potential short and longterm consequences for the health of the pair, particularly the developing child (lewis 2007; macadam and dettwyler 1995; tomori et al. 2018; tomori et al. 2022). beliefs and behaviors about when to begin weaning a child, how long that process should last, what supplementary foods should be given to an infant, or what foods should be actively avoided are primarily culturally dictated practices. although infants typically need dietary supplementation beginning around age six months as metabolic needs outpace milk’s nutritional content, the addition of new foods into a child’s diet around this period are primarily cultural/personal choices (dettwyler 1987; fouts 2004; halcrow et  al. 2018; macadam and dettwyler 1995). it is assumed that over the course of human history, mothers (embedded in their larger social spheres) have primarily been making these decisions about when to wean their baby and the appropriate ways to do so. the length of time a child is weaned has often been related to ideas of parental investment, and the foods that children begin eating as they transition to a nonmilk diet may be especially revealing about deeply held cultural valuations ascribed to specific foodstuffs. while much of the anthropological work to understand human food practices in relation to culture and social identities is on living populations, we have historical and archaeological evidence for gendered diets in the past, including revelations made through the use of stable isotope analysis (miller 2016; miller et al. 2018; reitsema and vercellotti 2012; soncin et al. 2021; white 2005). our bodies reflect the chemistry of the foods we eat and the water we drink, with some caveats (leethorp 2008). stable isotope analysis of bodily tissues is one technique bioarchaeologists frequently use for dietary reconstructions and can inform us of the plants and animals consumed during specific periods of life, depending on the tissue studied (miller et al. 2018; sealy et al. 1995). carbon stable isotope data (δ13c) primarily tell us about the plant foods people ate as well as animal sources (deniro and epstein 1978; schoeninger and deniro 1982). carbon isotope data are particularly useful in places where diets can include both c3 and c4 plants, such as central china, where the traditional domesticated crop millet is a c4 plant, while primary c3 crops include rice, wheat, soy, and more (farquhar et al. 1989). nitrogen stable isotope data (δ15n) can be used to understand food webs and trophic positions, with increasing nitrogen values as one rises through the food chain (i.e., δ15n values can aid in distinguishing vegans from carnivores) (deniro and epstein 1981; minagawa and wada 1984). analyzing different tissues from the same individual (i.e., bone and tooth) allows us to study dietary patterns from different periods of life, as well as different time scales of dietary averaging (beaumont et al. 2018; reynard and tuross 2015; tsutaya and yoneda 2015). bone is constantly remodeled over the lifetime while teeth are formed during youth and do not remodel. we can now subsample the dentin of a single tooth using an incremental/serial approach to create a detailed chronology of isotopic signatures across the developmental window of that tooth (burt and garvie lok 2013; eerkens et al. 2011). for this study, targeted sampling of a permanent first molar provides dietary evidence spanning from around birth to 10 years of age, while sampling a permanent canine informs us of dietary patterns roughly from the ages of one to 14 years (alqahtani et al. 2010; hillson 2005). in contrast, bone chemistry reflects the average diet from at least the final decade before death (ambrose and norr 1993; fahy et al. 2017). by studying a bone and tooth sample from individuals who died as adults, we can examine dietary patterns over the life course in conjunction with various biosocial variables such as sex and age (miller et al. 2018). therefore, we approach the body as a material record of dietary practices during life and use the chemical signatures locked in bodily tissues to try and understand the biosocial roles that foods played in animating that life (sofaer 2006; white 2005). life in eastern zhou period china the eastern zhou period (spring and autumn period 771– 476 bce and warring states period 475– 221 bce) is a pivotal era of chinese history as numerous political, technological, and ideological changes were miller et al. 67 under way. this is a time of political instability, with many states frequently in conflict and at war, terminating with the final zhou ruler deposed and the unification of early china by qin shihuang (feng 2013; liu and chen 2012; von falkenhausen 2006). philosophers such as confucius, mencius, and mozi lived during the eastern zhou period, and their ideologies were recorded and canonized over time, cementing cultural philosophies, including idealized behaviors and normative social roles, which in turn were being shaped in response to earlier chinese history, as well as becoming archetypes for future generations to model/modify (feng 2013; hinsch 2003; liu and chen 2012; sterckx 2005; von falkenhausen 2006). texts that relate to this period of chinese history are themselves revised products. for example, many of the writings attributed to confucius were assembled by disciples in the han dynasty period (206 bce– 220 ce). consequently, these texts reflect later compilers selecting particular rules, lessons, and fables that uphold the highest standards of moral order to inspire people to live up to, as well as reflecting aspects of class, gender, clan, and so on (hinsch 2013). by the han dynasty period, society was patriarchal, and these texts are primarily devoted to the experiences of men, and elite men at that, with far fewer passages dedicated to women’s experiences, which in and of itself suggests a lower value afforded to women and their diminished power within these societies (hinsch 2013, 2018). gender roles appear to be increasingly codified during this time, with most political and publicfacing power concentrated in the hands of men, including control of wealth, land, inheritance, and so on. in contrast, women’s roles emphasized the family and domestic sphere, with great weight placed upon women for producing children, particularly a male heir (hinsch 2013, 2018; nyitray 2021). the wellknown phrase “men plow, women weave” (nangeng nüzhi) is thought to have its roots in even earlier times in china and articulates a gendered division of labor while also symbolizing the larger culturally sanctioned gendered separations that existed along many axes of daily life (hinsch 2013). historians have argued that these bifurcations between men and women’s roles evolved over time and that earlier generations (such as the shang and western zhou dynasties) laid the foundation for an ideological shift to occur during the eastern zhou period, one that created a more stark contrast in idealized gender relations and whose philosophies related male– female duality of perceived biological sex to individual and familial morality and virtue, as well as good governance and political stability (hinsch 2013, 2018). while women are underrepresented in ancient texts, the passages that do relate to women often focus on the domestic sphere and filial piety, as hinsch (2013) summarizes: “(a) woman should ideally hide herself within the recesses of the home, sacrifice her desires so she could cater to her husband and his kin, and obey her spouse and senior inlaws. conversely, a man was free to leave the home and enter the wider world, pursue personal interests apart from his family, and exercise authority over his wife. separation of the sexes had become a justification for wideranging masculine privilege” (hinsch 2013:25). wealthy families had the economic means to segregate parts of their daily lives and socialize primarily in homosocial spheres (men out in the world with men, women cloistered at home with other women and children), but this was certainly not the case for most common people whose daily interactions would have likely been structured but potentially less genderdivided out of practical necessity (hinsch 2013). though much more is known about life during these times for the ruling and elite classes, certain aspects of gender roles, particularly related to the roles of girls as daughters, and women as wives and mothers responsible for producing and caring for children, were likely shared across many social dimensions, including class and clan groups (hinsch 2018). the liji, also known as the book of rites, provides further insights into the eastern zhou sex– gender binary, which clearly began in childhood with children treated differently based on their perceived sex (external genitalia and associated reproductive capabilities) and gendered accordingly: 子能食食，教以右手。能言，男唯女俞。男鞶革，女 鞶絲. when the child was able to take their own food, they were taught to use the right hand. when they were able to speak, a boy (was taught to) respond with respect; a girl, submissively and gentle. the former was fitted with a handbag of leather; the latter, with one of silk. 六年教之數與 方名。七年男女不同席，不共食。八年出入門戶及即 席飲食，必後長者，始教之讓。九年教之數日。 at six years, they were taught the numbers and the names of the cardinal points; at the age of seven, boys and girls did not occupy the same mat nor eat together; at eight, when going out or coming in at a gate or door, and going to their mats to eat and drink, they were required to follow their elders: the teaching of yielding to others now begun; at nine, they were taught how to number the days. 十年出就外傅，居宿於外，學書計，衣不帛襦 褲，禮帥初，朝夕學幼儀，請肄簡諒。at ten, (the boy) went to a master outside, and stayed with him (even) over the night. he learned the classical books and calculation; he did not wear his jacket or trousers of silk; in the courteous manners he followed his early lessons; morning and evening he followed the etiquette of respecting childhood food practices as socialization processes in ancient china68 the elders; he would ask to be exercised in (reading) the tablets, and learn to be honest. 女子十年 不出，姆教婉娩聽從，執麻枲，治絲繭，織紝組紃， 學女事以共衣服，觀於祭祀，納酒漿、籩豆、菹醢， 禮相助奠。a girl at the age of ten ceased to go out (from the women’s apartments). her governess taught her the arts of pleasing speech and manners, to be docile and obedient, to handle the flax fibers, to deal with the cocoons, to weave silks and to learn (all) woman’s work, how to furnish garments, to watch the sacrifices, to supply the liquors and sauces, to fill the various stands and dishes with pickles and brine, and to assist in setting forth the appurtenances for the ceremonies. 十有五年而笄，二十而嫁；有故，二十三年而嫁。聘 則為妻，奔則為妾。凡女拜尚右手。at fifteen, she assumed the hairpin; at twenty, she was married, or, if there were occasion (for the delay), at twentythree. if there were the betrothal rites, she became a wife; and if she went without these, a concubine. in all salutations of females, the upper place was given to the right hand. (liji, nei ze, 76– 82; translation by authors) here we see a clear sex– gender binary from a young age with a number of specific ages called out as chronological markers of particular life events depending on the gender of the individual, and clear demarcation of gendered work begins from a young age. all of this points to deeply embedded notions of a gender binary and an implicit hierarchy where males are given greater power in the public domain, while female power is limited to the domestic sphere (hinsch 2013, 2018). we acknowledge that the layering and intersections of various experiential variables (age, gender, social status, ethnicity, etc.) means that while we may focus on one of these, in this case gender, we recognize these axes rarely operate independently and singularly; therefore, our interpretations may be clouded by individual factors we cannot comprehend, qualify, or quantify at this time. recently, feminist and queer critiques of understandings of gender in china’s history have pushed researchers not only to expand studies to include women in the past but also to study masculinity, as well as to view gender beyond a dichotomous perspective (chiang 2012; hinsch 2013, 2018; louie 2002; nyitray 2021). it is certain that different ideas and norms for gendered behavior existed for individuals of different social classes, ethnic groups, and so on in ancient china (hinsch 2013, 2018; ko 2007; nyitray 2021). this research starts to touch upon those intersections of gender with other experiential identities through the presentation of selective individual case studies. evidence of eastern zhou cuisines archaeological and historical evidence indicate the importance of particular plants and animals in the diets of eastern zhou peoples (dong et  al. 2017; lee et al. 2007). millet is the locally domesticated crop and dominated diets for millennia (cohen 2011; lee et al. 2007; liu et al. 2009; zhao 2011), while grains such as rice (domesticated from the south) and wheat (introduced from the west) appear less frequently in archaeological assemblages in this region during this time (chen 2016; deng et al. 2019; fuller et al. 2009; guo and jin 2019; jiang and liu 2006; zhou and garvie lok 2015). historical texts reference specific foods, and the contexts of these references can provide hints as to the valuation and cultural meanings ascribed to some of these foodstuffs. for example, in many historical texts such as the analects of confucius, the liji, and the huang di nei jing, millet is repeatedly mentioned and is qualified as the traditional, highly desired grain. in contrast, wheat and soybean were considered “coarse” foods and therefore less valued, both symbolically as well as monetarily, with higher prices recorded for millet during the later han dynasty. soybean and wheat were also known as reliable foodstuffs for feeding the poor and were even used to feed soldiers during military campaigns (yu 2016). grains such as millet, rice, and wheat were also turned into alcoholic beverages, and these wines are often mentioned in historical texts in relation to elite men’s sociopolitical interactions, as well as rituals honoring ancestors (chang 1977; liu and reid 2020; liu et al. 2020; sterckx 2005, 2011; yu 2016). importantly, millet is isotopically distinct from most other plants that humans consume because it is a c4 plant, with δ13c values ranging from − 14‰ to − 8‰. in contrast, c3 plants, such as rice, wheat, barley, and soybeans, have δ13c values around − 23‰ (an et al. 2015; deniro and epstein 1978; farquhar et al. 1989; kohn 2010; o’leary 1988; wang et al. 2018). meat was also given high value both economically and socially, particularly holding significant power for honoring ancestors and performing rites (see knapp 2019; liji wang zhi 31; sterckx 2019). meat was also thought to have been infrequently consumed by the majority of people, particularly beef and lamb, which were highly prized and very expensive. rather, these were meats of the upper classes, while pork and chicken, in particular, were more likely the occasional meat protein sources for commoners and poorer folks (chang 1977; yu 2016). nitrogen isotope values can provide information about protein consumption, with stepwise enrichment of +3– 5‰ in δ15n as one rises through the food chain (deniro and schoeninger 1983; minagawa and wada 1984; schoeninger and miller et al. 69 deniro 1984). isotopic analysis of a small number of zooarchaeological samples (pig, dog, cattle, sheep) from two eastern zhou sites in ancient zhenghan city (changxinyuan and tianli) indicate animals raised on diverse resources (dong et  al. 2017; miller et  al. 2020). the δ13c values ranged from − 18.6‰ to − 6.8‰, and δ15n values ranging from 2.4‰ to 10.7‰. recent bio archae ol o gi cal research using stable isotope analysis has documented dietary differences between nobles and commoners, with nobles/highstatus individuals having the highest nitrogen values, indicating greater meat consumption and often consuming greater amounts of millet (or rice), which were also highly valued (wei et al. 2021; zhou 2020; zhou et al. 2021). previous bio archae ol o gi cal research on life for people living during the eastern zhou period has shown links between diet, sex, gender, and increasing social inequalities (dong et al. 2017; miller et al. 2020). specifically, bio archae ol o gi cal evidence has shown dietary differences between males and females during adulthood, with males consuming more of the traditional and highly valued grain of millet, as well as more meat, while females consumed more of the relatively newly introduced cereals, wheat and soy (dong et al. 2017; miller et al. 2020). a recent study of 23 individuals from ancient urban zhenghan city (xiyasi, 西亚斯, and chanxingyuan, 畅馨苑; fig. 1) using incremental dentin samples suggested that aspects of these dietary patterns began during childhood, with boys consuming more c4 foods (millets) than girls, starting in youth, but overall, individuals consumed more c3 foods (wheat, soy, rice, etc.) during childhood in comparison to their later adulthood diets (miller et  al. 2020). here we focus on the stable isotopic data from 34 newly studied eastern zhou individuals in addition to drawing on the previously published data from 23 other urban zhenghan eastern zhou people (miller et al. 2020) in order to illuminate childhood dietary patterns with particular attention to understanding dynamic relationships between food, sex, and gender. these dietary data from eastern zhou period individuals are from three newly studied archaeological sites from henan province on the central plains of china (fig. 1): gaolou (郜楼), tiancheng (天成), and guomianyichang (国棉一厂). two of the sites, tiancheng and gaolou, are from ancient urban zhenghan city, located under presentday xinzheng. the third site, guomianyichang, is located about 26 km to the north of ancient zhenghan city, in the modern longhu town, near zhengzhou. guomianyichang is located near the ancient city of huayang, which was a military outpost, though the relationship between those two sites is still unclear. archaeological research on these sites and associated excavated materials is ongoing (see supplemental information for more information). materials and methods skeletal samples (both a tooth and a bone sample) from 34 eastern zhou period individuals from three archaeological sites (gaolou, tiancheng, and guomianyichang) were analyzed using isotopic methods. we studied nine individuals from gaolou (five females, four males) and nine individuals from tiancheng (five females, four males). due to preservation issues, we are missing bone collagen isotopic data for three individuals from tiancheng. from guomianyichang, 16 individuals were studied (six females, seven males, three unknown skeletal sex). ongoing analyses of archaeological materials, including further human osteological analyses, prevent complete assessment of the nature of these cemeteries. no radiocarbon dates have been analyzed from these locales, but artifacts and stratigraphy indicate all burials presented here are from the eastern zhou era, and in some cases, this can be refined further to either the spring and autumn period or the warring states period (see supplemental information). some burials are believed to have been disturbed and looted in the past and therefore we are cautious in the use of mortuary treatment and associated grave goods, as these may not accurately reflect the original burial treatment and are also known to reflect the actions of the living and not necessarily the status of the deceased. individuals were selected for isotopic analysis based on preservation of skeletal elements to estimate sex and age, as well as presence of a permanent canine or first molar with minimal wear. skeletal sex and age were estimated using standard osteological observations of the pelvis and skull (brooks and suchey 1990; buikstra and ubelaker 1994). almost all were adults at the time of death, so these individuals are survivors, in that most did not die as youths. individuals were grouped in broad age categories of “juvenile” (estimated age of death as less than 18 years; n = 2), “young” (estimated age at death from 18 to 29  years; n = 10), “middle” (estimated age at death between 30 and 49; n = 8), or “older” (estimated age at death 50+; n = 8). six individuals were more challenging to narrow their estimated age at death, so five are listed with two potential age categories, and one is noted as an adult (over 18 years at age of death). of the 34 new individuals studied, 16 were estimated to be females, 15 were estimated to be males, and three were of unknown skeletal sex. a permanent first molar or canine tooth was preferentially selected to capture the early years of diet (however, one individual’s childhood diet is childhood food practices as socialization processes in ancient china70 represented by a second molar, guomianyichang m109). teeth were gently cleaned and silicone molds were created prior to destructive analysis. bone samples were preferentially taken from elements that were already broken. tooth dentin segments were prepared for isotopic analysis following previously published protocols (beaumont and montgomery 2015; king et al. 2018; sealy et al. 1995; sealy et al. 2014). for dental samples, enamel was removed using a handheld rotary tool and preserved for future analyses. the remaining dentin tissue was placed in labeled beakers with dilute hcl (0.5 m) until the tissue demineralized sufficiently to be sliced with a scalpel. any adhering cementum and/or secondary or tertiary dentin was removed when noted. tooth samples were carefully sliced into ~1 mm increments beginning from the occlusal surface of the crown and proceeding to the root tip, using a clean scalpel and metric ruler. individual dentin slices were placed into labeled microcentrifuge tubes with 0.5 m hcl until further demineralized. samples were rinsed repeatedly with pure water to neutrality, and then dilute hcl of 0.001 m (ph 3 solution) was added to samples before gelatinizing them for 24 hours in a 75°c oven. samples were then agitated to mix and frozen prior to freezedrying. bone samples followed a similar protocol. cortical surfaces were first cleaned and then bone was crushed and sieved, with the 0.25 mm to 1 mm fraction used for collagen extraction. bone samples were demineralized in 0.2 m hcl (replaced as needed until demineralization was complete) and then rinsed with purified water to neutrality. samples were then treated with 0.125 m naoh for 20 hours and then rinsed to neutrality. dilute 0.001 m hcl was added to each sample before placing them in a 70°c oven for 48 hours. samples were then frozen and freeze dried. freezedried collagen samples were weighed into tin capsules for isotopic analysis at the joint international research laboratory for environmental and social archaeology at shandong university, qingdao, china, using a flash 2000 hy elemental analyzer coupled to a delta v advantage irms. samples were analyzed in conjunction with calibration standards, including usgs40 (lglutamic acid, δ13c = − 26.39‰ ± 0.04‰, δ15n = − 4.52‰ ± 0.06‰), usgs62 (caffeine, δ13c = − 14.79‰ ± 0.04‰, δ15n = +20.17‰ ± 0.06‰), usgs41a (lglutamic acid, δ13c = +36.55‰ ± 0.08‰, δ15n = +47.55‰ ± 0.15‰), and internal standard of ema b2155 (casein). the lab reports precision of ± 0.1‰ for δ13c and ± 0.2‰ for δ15n. collagen quality was assessed by %c, %n, and atomic c:n, with all samples reported here having c:n values between 3.1 and 3.6 (deniro 1985; guiry and szpak 2021; schwarcz and nahal 2021). a general developmental timeline for each tooth was used to facilitate interindividual comparisons as well as allowing for comparisons of dentin isotopic data across studies. with m1, we assumed the developmental range began at birth (0 years) and completed at 10 years, while for canines, we placed the maximums at six months (0.5 years) to 14 years. age estimations of each segment were calculated using the beaumont and montgomery (2015) method, which relies on a simple, linear relationship between the total time a tooth was growing (for example, 10 years for a first molar) and the number of segmented samples extracted by a researcher. the result is an estimated median age point for each incremental sample and which provides a standardized approach that allows comparison to previous studies (miller et al. 2020). however, dentin is not deposited in horizontal layers throughout the tooth structure, meaning that the slices created through the protocol will inevitably capture overlapping periods of dentin development, and therefore, associated time frames for each segment should be considered an estimated average with potentially fuzzy boundaries rather than absolutes (beaumont et  al. 2013; tsutaya 2020). results the incremental dentin samples from eastern zhou individuals from gaolou, tiancheng, and guomianyichang (n = 34 individuals with n = 393 paired δ13c and δ15n values, supplemental tables 1 and 2) show a wide range of δ13c values, from − 19.8‰ to − 7.6‰, and δ15n values range from 6.2‰ to 14.3‰. examining the individual dietary profiles (figs. 2– 4), many individuals show characteristic declines in δ15n in the first years of life, indicating the process of removing breast milk from the diet (weaning), as well as changes to δ13c values across childhood years related to differential consumption of c3 and c4 plants. these same individuals (n = 34) have bone collagen values that range from − 15.7‰ to − 8.8‰ and δ15n values from 6.1‰ to 10.5‰ (figs. 2– 4, supplemental table 1). the dentin profiles of individuals from the eastern zhou ancient zhenghan city archaeological sites of xiyasi and changxinyuan are replotted in supplemental figures 1 and 2, and their data are included in subsequent analyses of eastern zhou dietary patterns (for all original xiasyi and changxinyuan data, see miller et al. 2020). figures 5 and 6 plot the incremental dentin isotopic profiles from all of the eastern zhou individuals we have studied to date (gaolou, tiancheng, and guomianyichang in this study and xiyasi and changxinyuan data from miller et al. 2020) and use a loess curve to show the moving average for δ15n and δ13c miller et al. 71 across the childhood years in conjunction with estimated skeletal sex (n = 54; 27 females, 27 males). overall, we see a high degree of isotopic heterogeneity, with large ranges observed in nitrogen, but especially in carbon isotope values, suggestive of differential dietary practices between children, as well as revealing an expansive diversity in the foods that were considered acceptable to feed growing children. a patterned difference is observed across childhood in the dentin δ15n values (fig. 5), where the male average is consistently slightly higher than the female average, indicating slightly more protein consumption (or proteins from a higher trophic position). the offset suggests a meaningful difference in dietary practices. additionally, for most of childhood, females have slightly lower average dentin δ13c values, indicating more c3 foods in their diets compared to their male peers (fig. 6). we estimated the weaning ages for a total of 47 eastern zhou individuals (28 individuals from this study plus data from 19 individuals studied in miller et al. 2020) who have the earliest dentin segments present in their profiles (table  1; supplemental table  1). to estimate weaning ages, we looked for declines in δ15n by 1‰ to 4‰, with potential concurrent changes to δ13c values across the earliest forming dentin, and that are associated with the removal of milk from the diet (burt and amin 2014; eerkens et al. 2011). individuals (n = 10) who are missing the early forming dentin tissue or those with isotopic data that do not fit the expected drop in δ15n were excluded from weaning age estimations. across the 47 individuals examined, the average weaning age is estimated at 2.9 years of age, with no statistically significant difference (wilcoxon rank sum test p = 0.759) in weaning age figure 2. isotopic profiles for individuals from gaolou (n = 9; n = 5 females; n = 4 males). δ15n values (solid plotted line with circles shows dentin collagen values and horizontal line is bone collagen value) and δ13c values (dashed plotted line with circles shows dentin collagen values and dashed horizontal line is bone collagen value) are presented. childhood food practices as socialization processes in ancient china72 estimates between females (n = 20, average = 3.0 years) and males (n = 24, average = 2.9 years). these ages are estimates in that the dentin samples capture overlapping periods of development due to the way dentin tissue grows as well as the sampling procedure, and coupled with the fact that every individual’s developmental timeline will vary (i.e., timing of tooth growth). therefore, these estimates should be treated as fuzzy averages rather than absolutes. diets in the first few years of life are a complex combination of a mother’s (or allomother’s) diet (via milk) and the weaning foods consumed. since the isotopic data indicate the average age of weaning was three years, we used the age of five years as the cutoff for comparing means (δ15n; δ13c) between females and males, which should represent diets that do not include the influence of milk (mother’s diet) and only reflect the diet of the individual (tables 2 and 3; supplemental table 1). there is a statistically significant difference in childhood diets post five years between males (mean δ15n = 8.5‰; mean δ13c = − 13.3‰) and females (mean δ15n = 7.8‰; mean δ13c = − 14.0‰) for both elements. all δ15n values were pooled (not averaged by individual) and appear bimodally distributed for both males and females, with males’ distribution shifted slightly higher on δ15n values (wilcoxon rank sum test, p = 1.21e07). all δ13c values post age five years were compared between males and females (values pooled, not averaged by individual), and males were normally distributed but females were not (wilcoxon rank sum test, p = 0.0018). we further compared the means of dentin samples of females and males between ages five and 10 years, which is the overlapping developmental period first molars and canines capture. the 27 males (represented by 139 dentin samples) had a mean δ15n = 8.5‰, which is statistically significantly different from the 27 females (represented by 144 dentin samples) who had a mean δ15n = 7.8‰ (wilcoxon rank sum test, p = 3.086e5). the female mean δ13c (27 females, n = 144 samples) of − 13.9‰ is statistically significantly different from the male mean δ13c (27 males, n = 139 samples) of − 13.2‰ (wilcoxon rank sum test, p = 0.006). this suggests there are meaningful differences in diets between boys and girls. on average, females have lower average δ15n and δ13c values than males during childhood (postweaning). bone collagen values are compared for these same eastern zhou individuals to examine possible dietary figure 3. isotopic profiles for individuals from tiancheng (n = 9; n = 5 females; n = 4 males). δ15n values (solid plotted line with circles shows dentin collagen values and horizontal line is bone collagen value) and δ13c values (dashed plotted line with circles shows dentin collagen values and dashed horizontal line is bone collagen value) are presented. miller et al. 73 figure 4. isotopic profiles for individuals from guomianyichang (n = 16; n = 6 females; n = 7 males; n = 3 unknown skeletal sex). δ15n values (solid plotted line with circles shows dentin collagen values and horizontal line is bone collagen value) and δ13c values (dashed plotted line with circles shows dentin collagen values and dashed horizontal line is bone collagen value) are presented. figure 5. δ15n dentin profiles for each eastern zhou individual studied across the gaolou, tiancheng, and guomianyichang sites as well as the δ15n dentin profiles of individuals from xiyasi and changxinyuan (miller et al. 2020). female and male dentin profiles are plotted. a loess curve was plotted for males and females, and it shows that on average, male children had slightly higher δ15n values than their female peers across infancy and childhood. figure 6. δ13c dentin profiles for each eastern zhou period individual studied across the gaolou, tiancheng, and guomianyichang sites as well as the δ13c dentin profiles of individuals from xiyasi and changxinyuan (miller et al. 2020). female and male dentin profiles are plotted. a loess curve was plotted for males and females, and for much of the childhood period, females had slightly lower δ13c values compared to their male peers. childhood food practices as socialization processes in ancient china74 differences in later life (tables 4 and 5; supplemental table 1). there are no statistically significant differences between the average δ15n (wilcoxon rank sum test, p = 0.762) and δ13c (wilcoxon rank sum test, p = 0.079) bone collagen values of females and males. interestingly, the degree of difference between the childhood dentin and later life bone collagen δ15n values decreases between females and males, while the average δ13c values become more divergent in adulthood. table 1. eastern zhou estimated age of weaning eastern zhou count (n) median (years) mean (years) sd (years) overall 47 2.8 2.9 0.6 males 24 2.7 2.9 0.7 females 20 3 3 0.7 unknown 3 2.8 2.9 0.5 table 2. summary of δ15n dentin values post age five years sex number of dentin samples median δ15n (‰) mean δ15n (‰) sd (‰) female (n = 27) 168 7.9 7.8 1.2 male (n = 27) 159 8.6 8.5 1.3 table 3. summary of δ13c dentin values post age five years sex number of dentin samples median δ13c (‰) mean δ13c (‰) sd (‰) female (n = 27) 168 – 14.5 – 14 2.8 male (n = 27) 159 – 13.2 – 13.3 2.5 table 4. summary of bone collagen δ15n for these eastern zhou individuals sex number of dentin samples median δ15n (‰) mean δ15n (‰) sd (‰) female 27 8 8.1 1.1 male 27 7.9 8.2 1.1 unknown 3 6.9 table 5. summary of bone collagen δ13c for these eastern zhou individuals sex number of dentin samples median δ13c (‰) mean δ13c (‰) sd (‰) female 27 – 11.4 – 12 2 male 27 – 10.9 – 11 1.8 unknown 3 – 13.8 discussion feeding children as gendering practices: childhood diets overall, the dentin isotopic values for gaolou, tiancheng, and guomianyichang individuals show a very wide range, from diets composed primarily of c3 plants to diets heavily reliant on c4 plants, and numerous mixtures between these extremes. there was also differential consumption of proteins (relatively more or less and/or proteins from different trophic positions) (figs. 2– 4). we see that dietary variation occurs both within the same person’s diet over the course of childhood, in comparison with their later bone collagen values, and between individuals. this high degree of diversity in the isotopic values during childhood indicates that people living in this region had access to many different kinds of plant and animal resources and that a large spectrum of items were considered foods that were appropriate to feed growing children. surprisingly, when we aggregate all of the incremental dentin values for eastern zhou individuals we have studied from this region so far (fig. 5), we observe a small but consistent offset in the average δ15n values between males and females across infancy and childhood. in general, females have lower δ15n values when compared with males. stable nitrogen isotope values primarily reflect the proteinaceous foods of the diet, and differences between individuals may be evidence of more or less protein consumed or different types of proteins consumed (i.e., plant proteins vs. animal derived proteins). that individuals we assessed as biologically male show, on average, higher δ15n values across their childhood years compared with the individuals assessed as biologically female reveals that males were fed a bit more meat, or proteins from higher trophic levels, when they were children. in contrast, the females we studied generally received a bit less meat in their diets or instead consumed lower trophic proteins (potentially more plantderived proteins) as youths. patriarchal eastern zhou society valued males more than females, and meat was also highly prized. we propose that caretakers fed male children more meat than female children, and whether intentionally or not, meat became tied to the creation of male bodies and embodiment of male gender roles, including conveying notions of social worth. furthermore, the δ15n offset occurs across the entire period of dentin development represented, beginning in the very earliest period of life. across childhood but especially during the first years of life, it was likely mothers who were the primary caretakers making choices about the feeding habits of their miller et al. 75 children and setting their dietary trajectories (though certainly mothers’ beliefs were embedded within culturally learned, normative frameworks). the earliest dentin segments capture the first couple years of life, when most infants were still consuming significant amounts of breast milk (see discussion of weaning, below). the fact that an offset between males and females begins so early in life presents the possibility that the diets of lactating women may have even altered based on perceptions of their child. if male children were preferred, women who produced male heirs may have themselves benefited by being able to consume more meat in their own meals. this temporary access to a more coveted food item, meat, could cause a slight increase in the δ15n of their breast milk, which in turn would be consumed by their developing infant and resulted in the downstream effect, separating the δ15n dentin values observed between females and males during the earliest period of infancy. the persistence of the offset across all of the childhood years represented (and statistically significant difference in δ15n between boys and girls after age five years) indicates that, in general, male children were likely fed a little bit more meat than their sisters and other girls throughout this developmental period and that this was an ongoing embodied gendering practice across childhood. we also considered if there may have been any differences in childhood nitrogen isotope patterning within and between sites; perhaps meat consumption was related to factors such as geography (urban vs. nonurban communities), economic power, or access to particular foodstuffs. comparing within and between sites, we see that the higher male offset in δ15n persists (fig. 7). this suggests that notions that children deemed to be “boys” (highly desired male offspring) should be fed more meat in their diets because of their higher social value may have been widespread within central plains eastern zhou culture. there are a few individuals who do not follow these patterns (a few females with high δ15n values, a few males with low δ15n values) who likely indicate how diet is also entangled in aspects of wealth, status, access, and other factors. it is in these dietary isotopic data sets that we can begin to access personalized and lived aspects of gender for eastern zhou people, discerning how food practices were entangled in gender norms and embodied gender expression, with specific foods fed to certain individuals, which, over time, shapes that person into the embodiment of those cultural ideals. figure 7. δ15n isotopic data profiles by site and by skeletal sex showing the same patterning of a higher average δ15n value for males than for females across all sites. childhood food practices as socialization processes in ancient china76 although we believe this patterned offset in δ15n values for the dentin collagen samples was driven by cultural forces, we cannot rule out the possibility of a sexbased biological explanation. physiological stress can change how the body utilizes energetic resources, which can alter tissue nitrogen stable isotope values (d’ortenzio et al. 2015; fuller et al. 2003; fuller et al. 2006; katzenberg and lovell 1999; williams et  al. 2011). elevated δ15n values observed in hair or dentition samples have been interpreted as potential evidence for stress in past populations (d’ortenzio et al. 2015; king et al. 2018; miller et al. 2020), but these are usually shortterm changes to a few individuals, and protracted stress across an entire group has (to our knowledge) only been observed by beaumont and montgomery (2016) in their study of victims of the great irish famine. we believe it is unlikely that as a group, male children are experiencing heightened stress relative to their female peers, particularly in the patriarchal eastern zhou society with known male– female hierarchies. if not related to stress, perhaps boys metabolize and incorporate dietary protein differently during childhood compared to females? however, most research using this isotopic methodology to study childhood diets from other regions of the world finds little difference in isotope results used for assessing diets between males and females during childhood. further, when dietary differences between females and males have been found, they have been explained as evidence for cultural behaviors, such as social differentiation via food practices, not as a biological phenomenon (eerkens and bartelink 2013; ganiatsou et al. 2022). a few individuals we studied exhibit opposing covariance in nitrogen and carbon values (such as nitrogen declining but carbon values increasing; for example, see guomianyichang m068). these patterns have been considered potential evidence of physiological stress (beaumont and montgomery 2016; garland et al. 2018; king et al. 2018) but can also occur when a child is weaned onto a diet that is different from the milk they were previously consuming (i.e., mother’s diet). if an infant was weaned using foods that have more positive δ13c values (such a millets) than what the lactating female had been consuming (captured in the milk), we would see nitrogen values continuing to decline (removal of milk from diet) while carbon values increased (consumption of foods like millets with higher δ13c values). both of these hypotheses should be considered in individuals whose values exhibit covariance, and other stress indicators (via paleopathological analyses) may also assist in these interpretations. future studies may help to clarify if there are any underlying physiological reasons that might cause such noted differences in nitrogen isotope values between growing children. when we aggregate the dentin δ13c isotope profiles for all eastern zhou individuals, we find that the average is slightly lower for females than it is for males across most of childhood, and the means between the sexes are statistically different when we look at the values after age five years (see loess curves in fig. 6). this indicates that overall, female children were consuming a bit more c3type foods while males were consuming a bit more c4type foods. if c4 foods, such as millets, were afforded a higher value (as indicated in historical texts), then the difference in childhood carbon isotope values may demonstrate the preferential feeding of millets to boys and with slightly less of these foods (or drinks) given to girls. however, the patterns in these data appear more complex when we examine the values within and between archaeological sites (fig. 8). we previously found (miller et al. 2020) that during childhood, females from xiyasi and changxinyuan generally consumed more c3 foods than males, who consumed more c4 foods (millets), and this pattern is also seen in the newly examined individuals from tiancheng. however, the opposite pattern is found for those buried at the sites of gaolou and guomianyichang; the average δ13c value for males is lower than females, indicating females buried at those sites ate more millets during childhood than the males. the few individuals with the very highest δ13c values across childhood and the very lowest δ13c values across childhood also all come from gaolou and guomianyichang (with one exception of a male from changxinyuan who also has quite high δ13c values in childhood), and therefore the individuals who were interred in these cemeteries encompass the largest δ13c range in childhood diets. when we examine the evidence at the individual level, we see indications of relationships between isotope values, markers of grave wealth/ status/class, and life histories (see “dietary patterns over the lifetime: individual examples”). here we may be seeing interacting effects of regional food practices and access to specific resources, in conjunction with experiences such as gender and class. weaning patterns all gaolou, tiancheng, and guomianyichang individuals studied with early life dentin segments show evidence for breastfeeding and weaning in their isotopic values. our weaning age estimations for 47 of the eastern zhou individuals show that by around age three years of age, milk is no longer a detectable dietary component for most, and there is no significant difference in the estimated weaning ages between females and males. the earliest age we detected weaning termination was around 1.6 years (gaolou, m100, miller et al. 77 female; supplemental tables 1 and 2) while the latest age we estimated weaning completion was around 4.3 years (guomianyichang, m090, female; supplemental tables 1 and 2). therefore, there is variability in the length of the weaning process, with most children completing weaning between ages 2.5 and 3.5 years. historical texts provide information about the relationship between specific chronological and social ages, and they suggest that the age of three years was an important marker in a child’s life. for example, in the liji, a warring states and han period document advising of social norms and ceremonial rituals, we learn, “食子者，三年而出，見於公宮則劬。大夫之子有食 母，士之妻自養其子. the nurse of the ruler’s boy quit the palace after three years, and the ruler meets her, and rewarded her for her toilsome work. the son of a great officer had a nurse. the wife of an ordinary officer nourished her child herself” (liji, nei ze, 74). this passage tells us a few very important things: (1) children were nursed (breastfed), (2) in almost all cases a baby’s mother was the one nursing the infant but ruling and upperclass elite families had access to wet nurses, and (3) children were nursed and closely cared for in this way for the first three years of life. further evidence of the importance of the age of three is found in the analects of confucius through a discussion of proper mourning rites, where it is said deceased parents should be mourned for three years as that is the same amount of time that they intensely cared for their child at the beginning of their life (chen [confucius] 2017:215; see also miller et al. 2020). these isotopic findings, in conjunction with historical references, support the importance of the social age of three years in ancient eastern zhou culture. there is a large amount of variation in childhood diets (between individuals and within the same individual’s childhood years), revealed through the wide spread of nitrogen and carbon isotope values observed across the dentin data sets. this shows there was a high degree of variability in supplemental foods during weaning and the diets subsequently consumed across childhood. when we look more closely at the carbon isotopic profiles from the earliest years of life, we see that during the first two to three years of life, the male δ13c values are actually lower than the females. however, the loess curve representing the male average δ13c values over time (average is the solid blue line and blue shaded band is the confidence interval of the mean; see fig. 6) is almost flat across all of childhood, suggesting little change overall in the average male consumption of c3 and c4 plantbased foods (and animals consuming those resources). in contrast, the female figure 8. δ13c isotopic data profiles by site do not show a standardized pattern between the sexes, suggesting this aspect of diet is not driven by gender alone but likely has many complicating factors such as location/region, class/wealth, and more. childhood food practices as socialization processes in ancient china78 δ13c average line shows a drop of about 2‰ across the first few years of life before leveling out slightly below the male line. this is the same period of time we believe most individuals were still consuming some breast milk as they were slowly being weaned. consequently, these data from the earliest years of life partially reflect a mother’s diet while she was breastfeeding as well as revealing the isotopic values of the dominant weaning foods. we suggest that the patterns in the δ13c averages indicate that infant girls’ diets were supplemented with more c3 foods (daughters given more meals with wheat, soy, rice, barley, etc.), while infant boys were generally weaned onto diets with slightly more c4 foods (millets). mothers’ diets likely contained more c4 foods than the diets that they weaned their daughters onto, hence the ~2‰ decline as they were weaned off of milletenriched milk and onto diets with more c3 solid foods. sons were weaned onto diets that more closely resemble their mother’s diets (a bit more millet), hence the relatively flat loess curve for male δ13c across childhood. dietary patterns over the lifetime: gender and age for the eastern zhou people studied (n = 56), we calculated that on average, dietary δ13c increased by 1.9‰ between childhood and adulthood (comparing average δ13c post age five to bone collagen δ13c; tables 2– 5; supplemental table 1), meaning most individuals consumed slightly more c3 resources in childhood and then more c4 resources in adulthood. when divided by skeletal sex, we see that on average, female values (n = 27) increased between childhood and adulthood by 1.7‰, while male values (n = 27) increased by 2.1‰. of 27 females, only seven had values in adulthood that were lower than their childhood values (i.e., their diets included more c3 foods as they aged), and further three of those individuals had change of less than 1‰ (so a relatively insignificant dietary change for those women). of the 27 males, five had values in adulthood that were meaningfully lower than their childhood values (change was greater than 1‰), suggesting a shift to more c3 foods as they aged. these patterns show that most people’s diets changed slightly over their life course, and for the majority, that meant consuming a greater amount of c4type foods, presumably millets, in adulthood compared to during their childhood years. this dietary influx of millet during adulthood may relate to better access to preferred foods for older individuals, as well as the consumption of milletbased alcoholic beverages (liu 2021). the liji provides multiple narratives on agerelated dietary habits, such as passage 11 of the nei ze, which discusses the proper conduct for a recently married young couple who live with the husband’s parents: “ 父母在，朝夕恒食，子婦佐餕，既食恒餕，父沒母存，冢 子御食，群子婦佐餕如初，旨甘柔滑，孺子餕. while the parents are both alive, at their regular meals, morning and evening the sons and their wives will serve them, and what is left after they will themselves eat. when the father is dead, and the mother still alive, the eldest son should accompany her at meals, and other sons and the wives will serve, and do with what is left as in the former case. the children should have the sweet, soft, and unctuous things that are left” (liji, nei ze, 11). this passage reveals information about the familial structure as well as how food is distributed within a household. the parents of the eldest son (parentsinlaw from the wife’s perspective) hold the highest regard in the family, they are fed first, and what they do not eat is then left to the married couple, and after that children (those of the younger married couple) are fed the remaining foods. the liji text can be interpreted as a guide for how people (of particular classes and means) should ideally comport themselves, and it presented guiding structures and principles for proper cultural behavior to maintain order in the family, clan, and state. here we see how foodrelated behaviors are part of upholding the social power structure. if as one ages, they get to select the better (preferred/more valued/tastier) portions of a meal, then we could see how consumption of particular foods such as millet could be mediated by multiple aspects of life experience, including sex/gender, age, and status. interestingly, within the 56 individuals we can calculate dietary change between their dentin and bone collagen samples, we find almost no change observed for δ15n. when we divide the sampled individuals by sex, we see that female δ15n values generally increase between childhood and adulthood, by an average of 0.3‰, while male values actually decrease by an average of 0.2‰. neither of these shifts are considered isotopically meaningful, in that they are not indicative of a major dietary change (pestle et al. 2014), though the slightly higher rate of change for females may indicate some benefit for particular women who had better access to meat in adulthood compared with childhood, while boys and men already generally had better access to meat compared with females and maintained that over their lifetime. interestingly, the liji again points to the intersections of multiple life variables and highlights how aging adults should be given privileged access to certain food if they are elderly: “王制: 五十異粻，六十宿肉，七十貳膳，八十常珍； 九十，飲食不離寢、膳飲從於游可也. for those of fifty, the grain was (fine and) different (from that used by younger men). for those of sixty, flesh was kept in store. for those of seventy, there were two fine dishes miller et al. 79 every meal. for those of eighty, there was a constant supply of delicacies. for those of ninety, food and drink were never out of their chambers. wherever they wandered (to another place), it was required that savory meat and drink should follow them” (liji, wang zhi, 56). here we see how nicer grain and meat were considered particularly important foods for people as they aged, with the elderly ideally always having easy access to a tasty meal, especially meat; this hypothesis could be tested in future bio archae ol o gical research focused on agerelated dietary changes in adulthood. dietary patterns over the lifetime: individual examples two of the females we studied from gaolou have exceptionally high δ13c values in childhood and that are retained into adulthood based on their bone collagen values, and both of these women also had markers of wealth in their burials. individual m089 had both an inner and outer coffin (considered a more expensive grave), while m145 was buried with many pieces of pottery and a coffin decorated with cinnabar, and perhaps their (interpreted) higher status may have given them greater access to the desirable grain, millet, across their lifetimes. however, the relationships between gender and wealth likely have interacting effects over the life course. for example, m082 was a female from gaolou who also had a wealthier burial featuring inner and outer coffins, pottery, cowry shell, and cinnabar, but she has much lower δ13c values across childhood showing significant c3 food consumption. her bone collagen value is over 3‰ higher than her final dentin sample, indicating she experienced a dietary change to consuming more c4 foods in adulthood, which may have been tied to a change in wealth/ status later in life. similarly, gaolou m115, a male, had the lowest δ13c values across his early childhood years within the whole gaolou sample: the average δ13c across all his dentin samples = − 16‰, with the very final dentin segment δ13c = − 14.1‰, but his later life bone collagen δ13c = − 9.1‰, shows a very dramatic dietary shift between childhood and adulthood. perhaps his social standing and wealth improved as an adult, he was buried with shell and cinnabar, and the later life shift to a diet rich in the desired grain, millet, could have also been a benefit if his social status improved. it is certain that gender was only one of many potential axes that diet was interacting with, and wealth and status would have played a major role in the foods people could afford to eat as well as what was considered appropriate and desirable cuisine. unfortunately, assessing largescale relationships between mortuary treatment and diet over the lifetime is challenging due to grave disturbances and plundering in earlier times, limiting our ability to accurately assess all individuals’ treatment at death (see materials section). the same patterning of average δ13c for males being lower than females during childhood is also seen in the guomianyichang sample. guomianyichang may have been affiliated with a nearby military site and may not have had consistent access to the same food resources as zhenghan city (yang et al. in press). for example, individual m124 from guomianyichang was an older aged male from the spring and autumn period, and his childhood carbon isotope values are the lowest of any eastern zhou male we have studied to date: average δ13c across all his dentin samples = − 19.1‰, with the very final dentin segment δ13c = − 18.3‰, but his later life bone collagen δ13c = − 11‰, showing a significant dietary shift between childhood and adulthood. he appeared to be buried without a tomb structure but had five pottery items interred with him. perhaps m124’s social status increased over his lifetime and in his older age he was able to dine on more millet? interestingly, another male from guomianyichang, m068, also had very low δ13c values across most of his dentin samples, with an average δ13c = − 18‰ between birth and around age nine years. his final dentin sample, aged around nine to 10  years, shows a large change in δ13c to − 11.6‰, and this dietary shift may have held through his later life as his bone collagen δ13c value is − 11.4‰. in contrast, m146 was a young adult woman who lived during the warring states period and upon death was buried in a single coffin, with one piece of pottery. her childhood dentin δ13c values were very high (average = − 8.2‰), indicating a diet dominated by millets, but her final bone collagen value, − 14.2‰, shows a significant dietary shift occurred for her and that she consumed much more c3type foods as an adult. it might be possible that some of the individuals who were buried at guomianyichang were not born and raised in this area but instead moved here in association with the military post, and therefore their diets may have shifted if there were regional differences in the cuisines or access to particular ingredients. therefore, gender may be an important factor in childhood dietary practices, but additional variables such as wealth or region/location may have played a larger role or dictated different dietary customs for individuals or specific communities. conclusions the unique relationships that humans have with the things that we eat make foodrelated data sets (botanical and faunal remains, stable isotope data, dental childhood food practices as socialization processes in ancient china80 calculus data, iconographic representations, etc.) a rich medium to explore layers of the human experience that are inaccessible from other material remains in archaeological contexts. technological advances are allowing for finer resolution of information that was previously out of reach, and attention to particular materials, such as dietary evidence from food studies, which is known to be laden with meaning (including environmental information, economic values, ideological uses, understandings of sex, gender, age, health, wellness, etc.), offers us a window to aspects of humanity that are personal, are relatable, and can deepen our understanding of the shared and divergent parts of what it has meant to be human in particular times and places. isotopic analysis of skeletal tissues provides a rare opportunity to get to know the life history of a specific person from the past, and advances such as incremental segmentation of tooth dentin provide detailed pictures of specific periods of ancient lives. here we have shown that dentin samples can reveal information about particular foods fed to children and the ways that communities thought about and imbued those foods with values. the observed patterning in the isotopic data reported here is pointing to something that goes beyond the simplistic act of eating; repeated processes of feeding children slightly different meals, such as differing amounts of meat or other proteinrich foods, appears to reflect socially constructed foodvalue systems intersecting with gender roles, which are enacted by caretakers using food (intentionally or not) as a material medium that both symbolically conveys gendered meaning as well as literally creating a gendered body that is chemically differentiated through consumption of these meals over time. all humans become part of their culture and communities through socialization into myriad roles and shared understandings of normalized/naturalized ways of being. the warring states period philosopher, xunzi, related learning to be a cultured gentleman to the processes acting on individuals during key periods of life through a simple analogy: “through steaming and bending, you can make wood as straight as an inkline into a wheel. and after its curve conforms to the compass, even when parched under the sun it will not become straight again, because the steaming and bending have made it a certain way” (xunzi, transcribed by hutton 2014:1). gendered ways of being are historically contingent and learned (habitus) through observation, mimesis, modification, and reiteration over generations (hexis), with individuals and social groups constantly making and remaking the boundaries and, in a sense, rules of how differently gendered groups should behave and exist in the world (bourdieu 1977; butler 1999). some of these social processes are created through dialogue and may even be embedded within linguistic structures (such as gendered language), others are materially communicated (such as clothing) or enacted (such as the activities/ labor/products one can produce), and others, such as food, can operate along multiple dimensions, including uniquely being a material that becomes a part of the person’s body itself (dietler 2007). dietary practices and the specific foods a person eats can be a part of gender identity and the gendering process. childhood is a critical period of dynamic biological changes and complex social learning, and gender identities are one of many human experiences that may be catalyzed beginning in early life. the fact that children lack the ability to feed themselves for the first years of life makes studying early childhood foodways an exceptionally revealing space for illuminating social processes and the cultural values of specific foods, particularly as it speaks to the transgenerational aspects of social reproduction. through highresolution dietary reconstructions of early life using an incremental dentin sampling approach, we have seen how for eastern zhou peoples living on the central plains of china, one food type in particular, meat, reveals social values and gender inequalities, while also becoming part of the gendering process and gender embodiment itself. caretakers, primarily mothers, were responsible for feeding their children, and therefore in studying early life diets, we are observing intergenerational interactions materialized through food choice. maleness becomes embodied through enacting particular characteristics that make up the category itself, and here we see mothers and other caretakers marking the maleness of specific children through the consumption of meat, and potentially millet to a minor extent, which in turn also marks female children in contrast to this (i.e., less meat consumption, less millet consumption). these gendered roles are relational and, in some ways, oppositional to one another, fitting within the dyadic frameworks of ancient chinese philosophies, thought to create balance and harmony through their coexistence (louie 2002). these dietary practices worked to create gendered bodies that were sensible in accordance with cultural norms and values, which followed particular ways of being in the world, including intersections with other aspects of identity, and reinforced gendered notions through their existence and repetition across generations. ethics statement 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malis, daniel d. dillon, kerri j. widrick, elise j. adams, mary e. hill, et al. 2023. sex, gender, and sexuality in paleopathology: select current developments and pathways forward. international journal of paleopathology 41:8– 21. bioarchaeology international volume 7, number 1: 1–31 doi: 10.5744/bi.2022.0011 copyright © 2023 university of florida press structural violence and physical death at tlatelolco: selecting the chronically malnourished for sacrifice at a late postclassic mesoamerican city (1300– 1521 ce) kelly e. blevins,a,b* madeline mcgrane,b josefina mansilla lory,c salvador guilliem arroyo,d and jane e. buikstrab adepartment of archaeology, durham university, durham, uk bcenter for bio archae ol o gi cal research, school of human evolution and social change, arizona state university, tempe, az, usa cdirección de antropología física, instituto nacional de antropología e historia, mexico city, mexico dzona arqueológica tlatelolco, instituto nacional de antropología e historia, mexico city, mexico *correspondence to: kelly e. blevins, department of archaeology, durham university, lower mount joy south rd, durham dh1 3le, united kingdom. email: blevinske1@gmail . com abstract human sacrifice in mesoamerican cities was diverse and highly ritualized, and it remains incompletely understood. knowing who was selected for ritual violence is essential for interpreting specialized mortuary deposits and furthering research on mexica society. to understand the structure and variability of sacrificial and mortuary practices, we examine here three burial contexts from tlatelolco, a densely populated city in the heart of the triple alliance. the interment contexts of grupo norte (n = 52) and paso a desnivel (n = 45) had been excavated from within the ceremonial center near the tlatelolco templo mayor, and atenantitech (n = 40) from a bordering calpulli or neighborhood. to establish which contexts are likely sacrificial deposits, we compare the ageatdeath distributions, biological sex, and perimortem ritual trauma across these sites. we seek to understand if social status determined sacrificial inclusion by using metabolic and infectious disease as proxies for resource inequality. we find that the residential deposit approximates an attritional mortality distribution and that ceremonial center deposits primarily comprised nonadults, who also presented with significantly higher rates of metabolic and infectious disease than the nonadults from the residential site. informed by previous studies and the ethnohistorical literature, we propose that impoverished individuals living on the margins of mexica society were chosen as sacrificial victims. high prevalence of metabolic and infectious disease comorbidity indicates that these individuals endured longterm nutritional deficiency, apparently vitamin c. further, variation in age, pathology, and perimortem treatment among ceremonial center deposits reveals the striking diversity of ritualized killings in a prominent mexica city. keywords: human sacrifice; structural violence; tlatelolco; mesoamerica; mexica; scurvy el sacrificio en mesoamérica fue en extremo diverso, con muy diferentes y complejos rituales, saber quién y porqué fue seleccionado, para ser consagrados en un lugar específico es fundamental para interpretar los depósitos mortuorios y avanzar en la investigación sobre la sociedad mexica. para comprender la estructura y variabilidad de las prácticas mortuorias, examinamos tres contextos de entierros de tlatelolco, una ciudad densamente poblada localizada en el corazón de la triple alianza. los contextos de entierro de grupo norte received 22 february 2022 revised 27 june 2022 accepted 27 june 2022 structural violence and physical death at tlatelolco2 mexica sacrificial rites were complex, distinctive, and predictable; human sacrifice was methodically practiced throughout an annual cycle of ceremonies and festivals. human remains were offered to the gods as intricate ofrendas from contexts as grand as templos mayores to commonplace residential courtyards, bodies were butchered for ceremonial consumption, and skulls were organized into racks and columns called tzompantli as dramatic displays of authority (chávez balderas 2017; horcasitas and heyden 1971; lópez luján and olivier 2010; núñez enríquez 2006). there are rich bio archae ol o gi cal records of human sacrifice from the mexica cities tenochtitlantlatelolco that corroborate these detailed ethnohistorical depictions, such as displays of severed heads on tzompantli skull racks (chávez balderas 2017; gonzález rul 1963; pijoan aguadé et al. 1989), caches of dismembered and sorted human bones (pijoan aguadé 1997; pijoan aguadé et al. 1995), and ribcages and sternums with evidence of heart extraction (chávez balderas 2017). pennock (2012) estimates that 87 human sacrificial rites occurred during an annual ceremonial cycle from sahagún’s florentine codex— the ceremonies, each a purposeful transaction between the worldly and otherworldly. how people were chosen for sacrificial rites, however, remains unclear, despite their identities being central for understanding mexica social hierarchy and societal organization. ethnohistoric sources suggest that elements of social identity or perhaps intersecting identities, such as age, gender, health, or ethnic affiliation; status as a slave or war captive; or emulation of the deity being worshipped determined who was selected for ritual sacrifice (summarized in graulich 2016:221– 267; iguaz 1993; ingham 1984; paulinyi 2013; román berrelleza and chávez balderas 2006; román berrelleza and rodríguez 1997). some mexica scholars identify the flowery wars (statesanctioned warfare) as the primary method for capturing sacrificial victims (davies 1977; ingham 1984; read 1998). the social identities of sacrificial victims were likely as diverse as the ceremonies themselves. bio archae ol o gi cal analysis of sacrificial deposits is key to clarifying how social identities predisposed individuals to specialized forms of ritual killings and sacrificial inclusion overall. the skeleton serves as a record of lived experience, simultaneously documenting an individual’s age and sex and showing how these persona intersected with risk of chronic malnutrition, disease, and traumatic injury (de la cova 2011, 2012, 2014; null et al. 2004; watkins 2012). skeletal analyses of human sacrifices from mexica cities tenochtitlantlatelolco have revealed that primary interments largely comprised nonadults (de la cruz et al. 2008; guilliem arroyo 1999; lópez luján 1993; román berrelleza 1990, 2010; román berrelleza and chávez balderas 2006), underscoring the importance of age for sacrificial inclusion. templo de ehécatl quetzalcóatl, subsequently referred to as templo r, and ofrenda 48 are examples of such sacrificial deposits comprising mostly nonadults. in the ceremonial center of tlatelolco, guilliem arroyo (1999) and his team excavated 43 human burials from the base of templo r (guilliem arroyo 1999); approximately 70  percent of the individuals were younger than 10 years (de la cruz et al. 2008; guilliem arroyo 1999). de la cruz and colleagues (2008) used ancient dna (adna) methods to assess sex of the templo r nonadult remains and found that nearly all the individuals were male. excavated from the base of tenochtitlan’s templo mayor, ofrenda 48 contained 42 flexed interments of nonadults between two and seven years old inside a rectangular tomb with white (n = 52) y paso a desnivel (n = 45) habían sido excavados dentro del centro ceremonial cerca del templo mayor de tlatelolco, y atenantitech (n = 40) de un barrio o calpulli limítrofe. para confirmar y explicar qué contextos son depósitos de sacrificio, comparamos las distribuciones de edad biológica al morir, el sexo y el trauma ritual perimortem en estos restos humanos. buscamos esclarecer si el estatus social determina la inclusión sacrificatoria mediante el análisis de enfermedades metabólicas e infecciosas como parámetros de una desigualdad de recursos. encontramos que los individuos del sitio de enterramientos residencial se aproxima a una distribución de mortalidad por deterioro físico y que los depósitos de restos humanos del centro ceremonial estaban compuestos principalmente por sujetos no adultos que a su vez presentan tasas significativamente más altas de enfermedades metabólicas e infecciosas que los no adultos del sitio residencial. con base en estudios previos y la literatura etnohistórica, proponemos que algunos individuos con una calidad de vida menoscabada que vivían en los márgenes de la sociedad mexica, fueron elegidos como víctimas de sacrificio. la alta prevalencia de comorbilidad de enfermedades metabólicas e infecciosas indica que estas personas soportaron durante un largo plazo deficiencias nutricionales, aparentemente de vitamina c. además, la variación entre la edad, la patología y el tratamiento perimortem entre los individuos de los depósitos mortuorios del centro ceremonial revela una sorprendente diversidad de rituales sacrificiales en una ciudad mexica prominente. palabras claves: sacrificio humano; violencia estructural; tlatelolco; mesoamerica; mexica; escorbuto blevins et al. 3 stucco walls (lópez luján 1993; román berrelleza 1990). the young ages of the individuals and the abundance of blue pigments, jugs sculpted with the face of tlaloc, and offerings of aquatic nature, such as marine shells, suggest that this was a sacrificial offering to tlaloc, the deity of the aquatic realm and bringer of rains (lópez luján 1993). templo r and ofrenda 48 sacrificial deposits have been linked to periods of drought and famine reported in mexica codices throughout the fourteenth and fifteenth centuries (de la cruz et al. 2008; guilliem arroyo 1999; read 1998:183; román berrelleza 1999; román berrelleza and chávez balderas 2006; therrell et al. 2004). in the mexica worldview, childhood was a liminal phase between the otherworldly and the worldly (lópez austin 2004:324; román berrelleza 2010). children possessed a purity that, combined with their lingering connection to the otherworldly, made them particularly valuable to the gods. as such, infants and children were ritually killed and offered as blood sacrifice to appease deities responsible for preventing droughts, ensuring bountiful crop yields, and infusing energy into each new year (anderson and dibble 1981; read 1998). ethnohistoric accounts describe “little noble children” being sacrificed as a smallscale but annual occurrence (arnold 1999). annually, as payment for rains, and therefore fertile land and plentiful harvests, children were ritually killed not inside city centers but within lake texcoco or near bodies of water in the mountains surrounding the basin of mexico, as recounted by durán and others (broda de casas 1971; horcasitas and heyden 1971:157; paulinyi 2013). chroniclers of nueva españa, durán, motolinía, pomar, and sahagún report variable numbers of children sacrificed during these annual or special occasions, from one to four (benavente 2014:50; horcasitas and heyden 1971:157), 10 to 15 (pomar 1989:168– 169), or “many” (anderson and dibble 1981:1). further, an important aspect of mexica child sacrifice was ixiptla, or living representations of the gods and their assistants (lópez luján and olivier 2010; román berrelleza 2010; román berrelleza and chávez balderas 2006). this concept has been invoked to explain the male sex bias of the templo r nonadults, as ehécatlquetzalcóatl is a male deity (román berrelleza and chávez balderas 2006). the exclusively young ages of the ofrenda 48 nonadults have been interpreted as the embodiment of the tlaloques, tlaloc’s childsized assistants (román berrelleza 1990). additionally, román berrelleza (1990, 1999, 2010) has reported that more than 50 percent of the nonadults from templo r and ofrenda 48 have skeletal pathologies, namely cribra orbitalia, porotic hyperostosis, and severe carious lesions. de la cruz et  al. (2008) and paulinyi (2013) interpret the high pathology prevalence as further support for the centrality of ixiptla in child sacrifice, as some deities were patrons of specific disorders and diseases (de la cruz et al. 2008; paulinyi 2013). pathology prevalence figures, however, have not been published, nor do we know whether these pathologies occurred at similar frequencies in individuals who were not sacrificed (i.e., those who died natural deaths). if nonadults were indeed selected for sacrifice based on the diseases that marked them as embodied deities, then we must specify those disease etiologies to understand if and how living circumstances predisposed nonadults to sickness and therefore sacrifice. chronic malnutrition and infection offer clear insight concerning these children’s living environment and socioeconomic status and, intrinsically related, their ability to access adequate nutrition (farmer 1996a, 1996b; fotso 2006; harpham 2009). here we investigate how the mechanisms for selecting nonadults for human sacrifice reflect social hierarchy and inequity in a densely populated late postclassic mesoamerican city, tlatelolco, by using infection and vitamin c deficiency as proxies for resource inequity. by the arrival of the spanish in 1519 ce, tlatelolco housed the largest marketplace in the mesoamerica; tens of thousands of visitors purportedly attended the city center daily (pagden 1986:103). tlatelolco was located approximately three kilometers north of the triple alliance imperial capital, tenochtitlan, and was connected to it by a causeway. tenochtitlan tlatelolco were contiguous humanmodified islands in the basin of mexico that were rapidly settled and developed by the mexica people within the 200 to 300 years prior to european contact (davies 1980; sanders et al. 1979; solis and morales 1990). when the spanish arrived, tlatelolco had been annexed by tenochtitlan and continued to serve as the ceremonial and commercial heart of the city (anderson and schroeder 1997:49– 51); tens of thousands individuals were thought to have lived in the contiguous islands (jiménez martínez 2021). as a ceremonial center and densely populated metropolis, tlatelolco is an ideal place to investigate the intersection of mexica religious ideology and urban inequality. while it is clear that the tlatelolco skeletal collections include definitive evidence of ritualized sacrifice and dismemberment (guilliem arroyo 2008; pijoan aguadé et al. 1989, 1995; pijoan aguadé and mansilla lory 2010), the lack of archaeological contextual information, including maps and grave goods, has thus far impeded formal investigation, with the exception of templo r. there are hundreds of individual burials from multiple contexts that remain unanalyzed. structural violence and physical death at tlatelolco4 individual burials from different areas of the site remain difficult to interpret, given the paucity of comparative data from late postclassic ceremonial centers (see appendix s1 archaeological context). to expand our understanding of ritual sacrifice and specialized mortuary practices and how individuals were chosen for inclusion in such contexts at tlatelolco, we compared osteobiographical profiles of two uncharacterized mortuary deposits (grupo norte and paso a desnivel) excavated from the ceremonial center to a mortuary deposit excavated from atenantitech, a neighborhood adjacent to the ceremonial center. we aim to (1) determine if individuals interred in the ceremonial center were sacrificed, (2) reveal the variability of specialized mortuary and sacrificial treatment between the tlatelolco ceremonial center and a residential site, and (3) identify whether aspects of social status as reflected by malnutrition and infection determined sacrificial inclusion. materials skeletal assemblages analyzed in this study: grupo norte, paso a desnivel, and atenantitech for this study, we analyzed skeletons that were excavated from the tlatelolco ceremonial center during a period of intense urban development and salvage archaeology in 1961 and 1962. the northwestern area of the site was excavated then, and of particular interest are the areas that presently house the eje central lázaro cárdenas avenue. a group of structures, templo i norte, templo ii norte, and templo redondo, subsequently referred to as grupo norte (fig. 1), had associated burials, previously reported as including primary inhumations, cremations, and mixed burials (gonzález rul and garcía mejía 1962). hundreds of burials were excavated from grupo norte. the iconic ossuary 14 of figure 1. map of the basin of mexico during the late postclassic period showing the location of tenochtitlantlatelolco. expanded area shows the approximate boundaries of the tlatelolco ceremonial precinct (teal) and atenantitech barrio (yellow) overlaid on modernday mexico city. approximate excavation locations of the skeletons considered in this study are marked in red. basin of mexico map by yavidaxiu, public domain, via wikimedia commons. map of tlatelolco modified from google, imagery 2021 cnes/airbus, maxar technologies, following work by hjpd cc bysa 3.0. blevins et al. 5 more than 150 dismembered, defleshed, and commingled individuals was excavated from this area (pijoan aguadé 1997; pijoan aguadé et al. 1995), but many single burials were recovered as well. skeletons were also recovered from the context paso a desnivel, which translates to “overpass.” this collection of burials is thought to have been excavated from an area just northwest of grupo norte where there now exists a highway overpass on eje central lázaro cárdenas (fig. 1). the primary burials from grupo norte (n = 52) and paso a desnivel (n = 45) remain unpublished, likely in part due to the aforementioned difficulties delineating mortuary contexts, lack of documented grave goods, and absence of maps, drawings, and levels. as archaeologist francisco gonzález rul explained in an interview, the salvage nature of the grupo norte and paso a desnivel excavations meant that the areas were excavated simultaneously and burials were given numbers as they were excavated, regardless of context (guilliem arroyo, personal communication, 2016). for example, entierros 7– 20 and 89– 124 were excavated from the grupo norte complex, and entierros 21– 71 were excavated from paso a desnivel. thanks to the decades of archival work by salvador guilliem arroyo and the proyecto tlatelolco team, it was possible to match the burial numbers and contexts recorded in francisco gonzález rul’s field notebook with the burial numbers of the skeletons stored in the instituto nacional de antropología e historia (inah) dirección de antropología física (daf) tlatelolco collection, stored in the museo nacional de antropología (mna) in mexico city, mexico. beginning in 1988, archaeologist maria de jesus sanchez vazquez led the salvage excavation of a residential area in the neighborhood of atenantitech, a barrio of tlatelolco (caso 1956) (fig. 1). an area of approximately 5,500 m2 was sampled, and 56 burials were excavated by 1990; 45 of those burials were moved to inahdaf for curation, and 40 were available for analysis here (calderon 2009). burials were excavated from multiple stratigraphic levels spanning the late postclassic occupation of tlatelolco. although the foundations of residential buildings were found in several levels, all skeletons were excavated from an open area delimited by buildings, further supporting its longterm use as a centro funerario (jesús sánchez vázquez, personal communication). both adults and nonadults were recovered from the site. most of the nonadults were buried in a cluster separate from the adults, providing some evidence of agebased mortuary behavior (calderon 2009). cremations were apparently excavated from the site as well, but there is no indication of how many. the skeletal assemblage excavated from atenantitech serves as a normal mortality comparison for the ceremonial center contexts. methods data collection the first author collected all the raw age, sex, and pathology data macroscopically from the inahdaf tlatelolco skeletal collections at the mna in mexico city, mexico. sex recording details sex was primarily assessed using pelvic morphology. when necessary due to incomplete preservation, however, cranial morphology and scapula glenoid, humeral head, and/or femoral head width measurements were used to assign sex. no attempt was made to assess the sex of nonadult skeletal morphology (appendix s1 methodology: sex assessment). while reconciling context and burial numbers as recorded in the original field notebook with burial numbers on the storage boxes, however, it was possible to match skeleton ids to those published as part of adna studies. therefore, genetic sex assignments were included for the grupo norte and paso a desnivel individuals analyzed by moralesarce et al. (2019) and for individuals in the comparative templo r sample analyzed by de la cruz et al. (2008) (table a1). age recording details nonadults. when teeth were available, age range estimates were generated using the london atlas of tooth development and eruption (alqahtani et al. 2010). otherwise, age was estimated using skeletal element measurements (maresh 1970) and/or epiphyseal union stages as collated by schaefer et al. (2009) (see appendix s1 methodology: nonadult age assessment). for statistical treatment, the average value of each nonadult’s age range was selected as a point estimate for all summary statistics and analyses. adults. age ranges were generated using transition analysis adbou age estimation v2.1.046 (available at http:// statsmachine . net / software / adbou2/) for individuals whose epiphyses were obliterated and dental development was complete (boldsen et  al. 2002). the corrected point estimate was rounded to the nearest whole number and used as the age estimate for all summary statistics and analyses. age ranges and point estimates for all individuals can be found in table a1. paleopathological recording details differential diagnosis a differential diagnosis was designed using published criteria for scurvy, rickets, porotic lesions caused by http://statsmachine.net/software/adbou2/ structural violence and physical death at tlatelolco6 acquired anemia, and infectious disease (klaus and lynnerup 2019; ortner and mays 1998; ragsdale et al. 1981; schattmann et al. 2016; snoddy et al. 2018; stuart‐macadam 1991; weston 2012). each individual was assigned present, absent, or unobservable for each pathological indicator. see appendix s2 (a, b, and c): “pathology distribution figures” for intra skeleton preservation and pathological distributions. diagnostic pathological changes caused by rickets were not observed in any individuals, so the final pathological categories for the analysis were scurvy, anemia, and infectious disease (table a2). see appendix s1 table s1 missing data assessment for a  summary of how unobservable/missing values affected sample sizes for each analysis. scurvy. individuals were diagnosed with scurvy if they had at least one diagnostic indicator or at least two suggestive indicators as defined in table a2. the differential diagnosis was designed using criteria published by snoddy et al. (2018) and schattmann et al. (2016), and photographic examples of indicators can be seen in figure 2. individuals were determined to be scurvy free if they had cranial and postcranial elements preserved and no diagnostic lesions or only one suggestive lesion. in this study, most scorbutic changes were isolated to cranial and mandibular elements. therefore, if an individual did not have a preserved skull or cranial fragments and had no postcranial pathological changes diagnostic or suggestive of scurvy, they were identified as unobservable (na) for scurvy. anemia. penetrating porotic lesions accompanied by expansive diploë and thinning of the outer table on the orbits and cranial vault were considered indicative of anemia (types 3, 4, and 5 from stuartmacadam 1991). if an individual did not have a preserved skull or cranial fragments, they were identified as unobservable (na) for anemia. infectious disease. an individual was identified as having infectious disease if they had subperiosteal new bone formation (spnbf), osteolytic changes, or osteoblastic changes suggestive of infection. in this study, diffuse spnbf was recorded as infection due to its documented and hypothesized associations with systemic bacterial and viral infections (burrows 1971; csonka and pace 1985; haygood and williamson 1994; lakey et  al. 2008; rasool 2001; teo and peh 2004). spnbf was identified as an indicator of infection when the lesion patterning suggested a systemic stimulus (ragsdale et al. 1981; weston 2012). specifically, the spnbf must have been (1) present on at least a third of the diaphysis of long bones and (2) bilaterally distributed or present across multiple skeletal elements. additionally, individuals with spnbf along the visceral surface of the vertebral portion of the ribs were identified as having an infection (cheng pau et al. 2009; collier et al. 1967; daviesbarrett et al. 2019; roberts et al. 1994). spnbf lesions formed in response to the pooling of blood and subsequent inflammation on the distal aspects of long bones, thought to be caused by scorbutic hemorrhaging (choi et al. 2007; gulko et al. 2015), were not considered as indicators of infection. in several cases, osteolytic and osteoblastic changes could be reliably attributed to a more specific disease process, such as treponemal disease and tuberculosis (baker et al. 2020; klaus and lynnerup 2019; pálfi et al. 2012). those data will be analyzed in subsequent publications, but in this analysis, those individuals were recorded as having infectious disease. therefore, “infectious disease,” as recorded here, refers to unspecified and specific infections. only individuals with more than half of their appendicular and axial skeletons preserved were recorded as observable for infectious disease. comparative age and sex data. the welldocumented sacrificial assemblage from templo r was used as a comparative sample for paleodemographic analyses. these skeletons are curated in the tenochtitlan templo mayor museum and were not analyzed as part of this study, so they are not included in the pathology analyses. we used age estimates previously published by moreiras reynaga et al. (2021), de la cruz et al. (2008), and guilliem arroyo (1999), as indicated in table a1. cut marks. the first author documented perimortem cut marks typical of those previously identified at tlatelolco by pijoan aguadé (1995, 1997). all skeletal elements were macroscopically examined for perimortem trauma. perimortem trauma related to ritual treatment was classified as dismemberment, scalping, cut marks from defleshing and/or disarticulation, heart extraction, or decapitation (following hamilton 2016; jelíneck 1993; pijoan aguadé 1997; pijoan aguadé and mansilla lory 2010; pijoan aguadé et  al. 1995; tiesler and olivier 2020). dismemberment was identified as percussive impacts near ligament attachments or joints (fig. 3a). scalping was identified as cut marks on the calvarium (fig. 3b). defleshing/disarticulation was identified as clusters of cut marks around tendon or muscle attachment sites, including the vertebral rib  ends (fig. 3c). heart extraction was identified as cut marks on the sternal ends of the ribs, multiple perimortem fractures on sternal rib ends (fig.  4a, b), and/or bisected sterna and/or manubriam (fig. 4c). decapitation was identified as cut marks on the basicranium, cervical vertebrae, and/or first rib. using written descriptions and photos, composite distributions of perimortem trauma were created in pixelmator pro v2.0.5 junipero. figure 2. examples of pathological indicators used in the differential diagnosis (skeleton id). (a) ectocranial temporal and greater sphenoid wing porosity and new bone formation (nbf) (196_116). (b) endocranial occipital nbf (128_40). (c) endocranial sphenoid foramen rotundum nbf (128_40). (d) endocranial sphenoid lesser wing nbf (121_24). (e) orbit nbf and porosity (118_19). (f) posterior zygomatic and posterior maxilla nbf (195_114). (g) anterior maxilla and infraorbital foramen porosity (195_114). (h) medial mandible coronoid process porosity (118_19). (i) inferior pars basilaris porosity (56_14d). (j) scapula supraspinous fossa nbf and porosity (121_24). (k) visceral surface ilium nbf, vascular impressions, and porosity (195_114). (l) distal anterolateral humerus metaphysis nbf and porosity (121_24). (m) anterolateral rib shaft nbf and porosity (182_94). (n) rib sternal end porosity (183_95b). (o) anterior distal femur metaphysis porosity (56_14d). (p) orbit penetrating and expansive porosity (atn_22_28). (q) anterior ulnae diffuse nbf (121_24). (r) anterolateral tibia diaphysis nbf (129_43). photos taken by first author or juan salvador rivera sánchez inahdaf (h). structural violence and physical death at tlatelolco8 radiocarbon dating to understand better the chronology of the mortuary deposits, seven individuals were chosen for radiocarbon dating: three from grupo norte, three from paso a desnivel, and one from atenantitech. samples of six vertebral elements and one ilium weighing between 344 and 693 mg were processed by the university of arizona ams laboratory. comparative analyses paleodemographic comparisons to differentiate between special mortuary and normal mortality deposits, we compared the ageatdeath distributions of the three ceremonial center contexts, grupo norte, paso a desnivel, and templo r, and one residential context, atenantitech. the distributions were visualized by binned age categories as well as by  kaplan– meier survival curves. to determine if there are significant differences among the mortuary contexts, two multiway (1: all contexts; 2: ceremonial center contexts) and one pairwise (residential context and ceremonial center context) logrank tests were performed on the survival times (i.e., ageatdeath distributions). logrank test was chosen because we are only interested in differences in overall survival curve distribution and not controlling for any confounding factors. to correct for the familywise error rate that results from performing multiple statistical tests, the figure 3. (a) right femur distal epiphyseal surface, three angles; impact from dismemberment; grupo norte 182_94. (b) posterior parietals and occipital; scalping with inset; paso a desnivel 135_55. (c) right proximal humerus; cut marks (defleshing and/or disarticulation) on crest of greater tubercle with inset; paso a desnivel 137_59. blevins et al. 9 bonferroni adjustment was made by dividing the original alpha value by the number of logrank tests, for a corrected alpha value of α = 0.05/3 = 0.016. in addition to ageatdeath distributions, we compared sex ratios across all contexts. sex of individuals younger than 16 years was previously assessed using amplicon (de la cruz et al. 2008) and wholegenome sequencing (moralesarce et al. 2019). metabolic and infectious disease distributions chisquare analysis. first, we performed a chisquare test on a 3 × 4 contingency table to identify differences  in metabolic disease, infectious disease, and comorbidity of infectious and metabolic disease distributions between the ceremonial center contexts (grupo norte and paso a desnivel) and residential context (atenantitech). scurvy and anemia were collapsed into a metabolic disease category to avoid uncertainty in the etiology of orbital lesions. to ensure comparable results across contexts, analyses were limited to individuals with age estimates younger than 20  years because (1) the ratio of nonadults to adults is higher in the ceremonial center contexts, and (2) skeletal manifestations of pathologies differ between nonadults and adults. the cutoff of 20 years was chosen to include adolescent individuals with nonobliterated epiphyses who had age ranges spanning 16 to 22 years. although it is recommended to use a fisher’s exact test for contingency tables when >20 percent of the cells have values fewer than five, a chisquare test was chosen because it is better suited for the interpretation and visualization of multiway contingency tables (si methodology: chisquare visualizations). to be conservative, we performed fisher’s exact tests and found similar pvalues for both tests. figure 4. paso a desnivel 140_65. (a) left rib #4 visceral surface showing perimortem break on sternal end (left) and same rib with view of external surface showing perimortem break (right) with black circle showing plastic deformation. (b) right rib #2 showing perimortem break at the sternal end from the visceral (left) and external (right) surfaces. (c) perimortem bisection of sternum. white arrows showing lack of color differential and/or plastic deformation. structural violence and physical death at tlatelolco10 all statistical tests and plotting were done in rstudio (r version 4.1.2) using base r and the ggplot2, ggridges, bchron, tidyr, dplyr, tibble, survminer, survival, and corrplot packages (haslett and parnell 2008; kassambara et  al. 2019; müller and wickham 2020; therneau 2015; wei and simko 2017; wickham 2016, 2020; wickham et al. 2020; wilke 2017). all of the r code can be found at https:// github . com / kelzor / human sacrifice and malnutrition at tlatelolco. cut marks. the perimortem trauma distributions  were visually compared using the composite distributions and a bar chart of counts. results paleodemographic comparisons there are clear differences in ageatdeath distributions between ceremonial and residential contexts (fig.  5). the residential context, atenantitech, approximates a normalmortality distribution as a u shaped curve with peaks in the first five years of life and during adulthood. there were no perinates or infants recovered from the atenantitech cemetery, suggesting perinates and infants had distinct mortuary treatment. in contrast to the ushaped distribution of atenantitech, the grupo norte and paso a desnivel distributions are dominated by peaks in the 1 to 5year and 10 to 20year age categories and have few adult individuals. the templo r distribution differs from all other contexts with the largest peaks in the youngest age categories, 0– 1 and 1– 5. kaplan– meier survival curves illustrate the probability of individuals remaining in the sample as age increases (fig. 6). the logrank test result for all contexts indicates that there is a significant difference among survival curves (p < 0.001) (fig.  6a, table  1). there are significant differences among survival curves of the ceremonial center contexts (p = 0.007) (fig. 6b) and between the residential context, atenantitech, and the ceremonial center context with the most figure 5. ageatdeath distribution by context. for the age ranges, the lower value is exclusive, and the higher value is inclusive. for example, age group 1– 5 contains individuals more than one year of age at death up to and including five years of age at death, whereas individuals one year or less of age at death are in age group 0– 1. https://github.com/kelzor/human-sacrifice-and-malnutrition-at-tlatelolco https://github.com/kelzor/human-sacrifice-and-malnutrition-at-tlatelolco blevins et al. 11 similar survival curve, paso a desnivel (p  =  0.004) (fig. 6c, table 1). the ageatdeath distributions of atenantitech and templo r are significantly different from one another and the other two ceremonial center contexts, grupo norte and paso a desnivel. there is a marked sex skew in nonadults from the ceremonial center (fig. 7). the templo r nonadults are almost entirely male, and the paso a desnivel and grupo norte nonadults are almost entirely female. the individuals aged 16+ yearsatdeath from templo r are all male. the 16+ individuals from paso a desnivel and grupo norte show less sex bias than in the younger individuals, but the older individuals are predominantly female. no individuals younger than 16 years from atenantitech have sex assessments because biomolecular work has not been performed on these remains. the 16+ individuals from atenantitech approximate an even female to male ratio at 56:44. metabolic and infectious disease distributions the comparison of infection, metabolic disease, and comorbidity distributions across the three contexts was limited to individuals younger than 20, because pathology frequencies are similar within contexts and age groups before 20+ years (fig. 8). there are clear visual differences in pathology prevalence among table 1. logrank test results by context comparison. comparison χ2 df p all contexts 32.4 3 <0.001* ceremonial contexts 9.8 2 0.007* residential and most similar ceremonial 8.1 1 0.004* *significant at α = .05/3 = .016. figure 6. survival curves of (a) all contexts, (b) ceremonial center contexts, and (c) residential and most closely related ceremonial center context. structural violence and physical death at tlatelolco12 contexts (fig.  9). the distributions of pathology across all contexts are significantly different, χ2(6, n  = 85) = 25.812, p < 0.001. the distributions of pathology between the two ceremonial center contexts are significantly different as well, χ2(3, n = 71) = 11.441, p = 0.009. the pathology distributions between atenantitech and grupo norte do not significantly differ, χ2(3, n = 51) = 7.427, p = 0.059 (table 2) (see appendix s1 figure s1 chisquare visualizations). the pathology distribution by age category and context reveals that the percentage of unaffected individuals from atenantitech remains similar across all age categories, despite small sample sizes per age category (fig.  8). individuals from the ceremonial center deposits show evidence of infection co occurring consistently with metabolic disease in nonadults 0– 10 years of ageatdeath. infectious and metabolic comorbidity, however, does not occur in the youngest individuals from atenantitech. all the individuals aged 20+ from the ceremonial center deposits are affected. among the atenantitech age groups, the individuals aged 20+ have the highest prevalence of infection without cooccurrence of metabolic disease. cut marks paso a desnivel has five to six times as many occurrences of perimortem trauma as the other two contexts (n = 21), and it is the only context with evidence of heart extraction (fig.  10, table  3). grupo norte (n = 4) and atenantitech (n = 3) have similar amounts of perimortem trauma, but the types of ritualized traumas differ between the two sites (figs. 10 and 11, table 3). the only forms of ceremonial perimortem trauma identified at atenantitech are defleshing/disarticulation and scalping, whereas dismemberment is also present at grupo norte. all types of perimortem trauma were observed across all age groups, except for heart extraction, which was only observed in two adults, a female and male. there are no apparent sex based differences among perimortem traumas, but only 60 percent of individuals have sex assignments (table 3). radiocarbon dating all seven bone samples yielded sufficient collagen for analysis, and the atomic c/n ratios range from 3.2 to 3.4, which is considered to be of sufficient quality figure 7. sex prevalence by context and age category. sample sizes indicate the number of individuals for which sex assessments were possible. genetic sex determination of individuals in the 0– 16 age category was performed by de la cruz et al. (2008) (templo r) and moralesarce et al. (2019) (grupo norte and paso a desnivel). blevins et al. 13 (deniro 1985). the intcal20 (reimer et al. 2020) calibrated dates from the grupo norte samples, two paso a desnivel samples and the sample from atenantitech, were dated between 1332 and 1445 ce (95  percent probability interval) (fig. 12, raw data in appendix s1 table s2). one sample from paso a desnivel was dated to 897– 1025 ce (95 percent probability interval). were the individuals from the ceremonial center sacrificed? despite the limitations of analyzing skeletons with incomplete provenience information, we were able to identify meaningful trends within and among contexts that strongly suggest at least some, if not all, of the ceremonial center individuals were ritually killed; individuals buried in the ceremonial center deposits are significantly younger with skewed sex ratios, have  significantly more evidence of metabolic and infectious disease, and were ritually processed with greater variability than those buried in the residential context of atenantitech. given that the ethnohistorical and (bio)archaeological records indicate that the ritual killing of children was an integral part of mexica religion and enabled dialogue between the earthly and supernatural realms, it is unsurprising that there would be many nonadult sacrificial deposits at tlatelolco. while the residential  context of atenantitech approximates a normal mortality distribution, the age distributions of grupo norte, paso a desnivel, and templo r are significantly younger (fig. 3), with high frequencies occurring in the 15– 20 age group, when individuals should be at their most resilient (weiss 1973). the grupo norte and paso a desnivel age distributions deviate from that of templo r (fig. 5), with higher frequencies of older children (5– 10 and 10– 15) and figure 8. prevalence of pathology by context across age groups. sample size is indicated for each context for each age category. note that there is only one observable individual from atenantitech for the 10– 15 year age category. figure 9. prevalence of pathology in individuals younger than 20 years by context. table 2. contingency tables and chisquare test results for each combination of contexts. comorbidity infection metabolic unaffected paso a desnivel 22 4 8 0 grupo norte 16 1 12 8 atenantitech 2 1 3 8 χ2 df n p 25.81 6 85 <0.001* comorbidity infection metabolic unaffected paso a desnivel 22 4 8 0 grupo norte 16 1 12 8 χ2 df n p 11.44 3 71 0.009* comorbidity infection metabolic unaffected grupo norte 16 1 12 8 atenantitech 2 1 3 8 χ2 df n p 7.42 3 51 0.059 *significant at α = .05/3 = .016. blevins et al. 15 adolescents (15– 20) (fig.  3). moreover, the grupo norte and paso a desnivel nonadults who have genetic sex assessments are predominantly female, the opposite of what is observed at templo r (fig. 7). the skew toward female inclusion is also present in the adult individuals, but it is less pronounced. it is  possible that these deposits are combinations of sacrificial victims, war captives, slaves, and children, which has been described by colonialperiod chroniclers (horcasitas and heyden 1971:256), chosen for their embodiment of a female deity. compared to templo r, grupo norte and paso a desnivel have a marked absence of infants (defined here as 0– 1 year), which could reflect the different roles played by these table 3. perimortem trauma occurrence by context, age, and sex. sex assignments of nonadults were made from genetic x and y chromosome data by morales arce et al. (2019). context perimortem trauma number of individuals ageatdeath point estimate in years (sex where applicable) paso a desnivel defleshing/disarticulation 8 4, 5, 5, 6 (f), 9, 15 (f), 15, 20 (f) defleshing/disarticulation and scalping 1 18 (m) defleshing/disarticulation and dismemberment 3 18.5 (m), 19.5 (f), 20.25 (m) defleshing/disarticulation and heart extraction 1 24.5 (f) scalping 1 11.5 (m) scalping and heart extraction 1 30 (m) grupo norte defleshing/disarticulation 1 0.75 scalping 1 2.5 dismemberment 2 4.75 (f), 11.5 atenantitech defleshing/disarticulation 2 17 (f), 25 (m) scalping 1 3.5 figure 10. count of each type of perimortem trauma by context. some individuals are represented more than once because they had more than one type of peripostmortem trauma. fi gu re 11 . c om po sit e pe ri m or te m tr au m a di st ri bu tio n fo r ( a) p as o a d es ni ve l, (b ) g ru po n or te , a nd (c ) a te na nt ite ch . r ed in di ca te s s ha llo w c ut m ar ks . b la ck in di ca te s p er cu ss iv e im pa ct s a nd p er im or te m fr ac tu re s. a d ot te d lin e in di ca te s t he p er im or te m tr au m a is o n an a sp ec t o f t he sk el et on n ot v is ib le (e .g . p os te ri or , i nf er io r, or su pe ri or ). blevins et al. 17 figure 12. ridgeline plot of radiocarbon dating probability distributions colored by context. victims of ritual killings. similar to observations by  román berrelleza (1990, 1999, and 2010), the individuals from the ceremonial center contexts are characterized by a high frequency of porotic cranial and orbital lesions. in the case of paso a desnivel, all individuals have evidence of metabolic disease, infection, or both. although the difference in pathology distribution between grupo norte and atenantitech is not statistically significant, atenantitech has the highest frequency of unaffected nonadults and the lowest frequency of comorbidities overall (fig. 9). given that evidence for some perimortem trauma was identified in all contexts analyzed here, it is surprising that no such evidence has been reported from templo r or ofrenda 48, aside from a single bisected femur (román berrelleza 1990). the reported method of child sacrifice involved throat cutting, which would not necessarily leave skeletal evidence. indeed, medrano enríquez (2021) also remarks on the lack of perimortem trauma from throat cutting, cut marks on the cervical vertebrae or basicranium, in sacrificed nonadults from tula (1000– 1200 ce). except for the two cases of heart extraction from paso a desnivel, the perimortem trauma likely reflects distinctive ritualized treatment for the bones and flesh after death. ethnohistoric accounts describe an intimate relationship between sacrifice and ceremonial consumption by nobles, priests, and warriors (anderson and dibble 1981:24, 29; carrasco 1999:84, 174– 176; heyden 1994:192– 193; horcasitas and heyden 1971:191). this ceremonial consumption of sacrificed flesh, along with the ritualized flaying and repurposing of skins (carrasco 1999:145; heyden 1994:485), could explain the evidence for soft tissue removal. further, dismembered body parts were deposited in funerary spaces as a way to consecrate the ground (núñez enríquez 2006:149), but it is possible that other sacrificial and ceremonial acts could have been performed to sanctify burials. this could explain the evidence for soft tissue removal at atenantitech. interestingly, the context with the highest frequency of pathology is also the context with the most counts of perimortem trauma (paso a desnivel). together, the demographic homogeneity, high pathology prevalence, and perimortem trauma strongly suggest that grupo norte and paso a desivel, like templo r and ofrenda 48, were sacrificial deposits. further, interpreted within the osteological paradox, the trend of high comorbidity and low unaffected prevalence within these contexts suggests that these individuals were not dying natural deaths (wood et al. 1992). that so many of these individuals have skeletal indicators of infectious and metabolic disease suggests that they were robust to have survived until the point of sacrifice. some of these individuals likely could have survived into adulthood. there are few comparative data for sacrificial deposits of single burials from mexica sites, as much of the mortuary research has focused on ossuary deposits with clear evidence of sacrifice, elite burials, or caches of decapitated crania (chávez balderas 2017; gonzález rul 1997; pijoan aguadé 1997;pijoan aguadé et  al. 1989; pijoan aguadé and mansilla lory 1997, 2010). there are, however, some comparable examples from central mexico. within central mexico, there is only one example of a middlelate postclassic non adult mass burial, to the authors’ knowledge. at structural violence and physical death at tlatelolco18 teopanzolco, morelos, approximately 100 km south of tenochtitlantlatelolco, a cache of at least 92 individuals was dated to the middlelate postclassic period using ceramic burial goods (lagunas rodríguez and serrano sanchez 1972; smith 2010). over half of the individuals were nonadults, and most individuals had skeletal evidence of disarticulation or limb, hand, or foot removal. of the adults, males and females were represented equally (lagunas rodríguez and serrano sanchez 1972). two postclassic burials from cholula, puebla, demonstrate smallscale child sacrifice, more like accounts by spanish chroniclers  than the larger deposits at teopanzolco and tenochtitlantlatelolco. two children were excavated from a central altar within the ceremonial plaza; their skulls were found disarticulated and arranged away from the postcranial elements (lagunas rodríguez et al. 1976:74). gabriel de rojas (a colonial mayor of cholula) reported in 1581 that human sacrifices were performed in cholula during times of drought. he described the sacrifice of children captured or bought of ages 6– 10 (rojas 1927). due to the absence of maps, levels, drawings, and original burial photos, we assessed burial chronology through radiocarbon dating. six out of seven date estimates fall between 1332 and 1445 ce (95  percent probability interval), in agreement with the generally accepted timeframe for the founding of tenochtitlan and tlatelolco and the subsequent growth in size and influence of the connected cities. interestingly, one individual from paso a desnivel, 13453, was dated to 897– 1025 ce (95 percent probability interval), approximately 300– 400  years before the supposed founding of the cities. the earlier date from paso a desnivel suggests that at least this area of the site and probably others were recurrently used for sacrificial deposits for centuries. it is notable that the individual dated 300– 400 years earlier than the others, paso a desnivel 13453, is not an outlier in pathology or perimortem trauma; paso a desnivel 13453 has metabolic and infectious disease and perimortem cut marks consistent with defleshing and/or disarticulation, strikingly similar distributions as observed among the other nonadults from paso a desnivel. although this is an unexpected finding, it underscores the continuity of mesoamerican religious and ceremonial practices. the islands of lake texcoco may have been occupied or used for specialized ceremonial activities during the postclassic (900– 1200 ce) period; many communities existed along the shores of lake texcoco during this time (gorenflo 2015). the continuity of religious ideology and sacrificial practices in the basin of mexico in the early to late postclassic periods is supported further by medrano enríquez’s (2021) analysis of sacrificed nonadults from tula (1000– 1200 ce). of the 49 individuals recovered from a sacrificial deposit, 45 are nonadults. of the 27 nonadults with sufficient preservation for analysis, 23 (85.2 percent) exhibit signs of scurvy. the prevalence figures for periosteal new bone formation  (91.3 percent), cribra orbitalia (78.6 percent), and porotic hyperostosis (95.7  percent) are similarly high. additionally, the individuals have similar distributions of perimortem trauma consistent with scalping and defleshing: scrapes across cranial bones and cut marks on proximal and distal long bones. the age, pathology, and ritualized perimortem trauma similarities between sacrificial victims from tula and tlatelolco observed here are in line with the many other forms of evidence linking tula and the toltecs to tenochtitlantlatelolco and the mexica (anawalt 1990; iverson 2018; leonardo lópez luján and lópez austin 2009). physical, cultural, and structural violence at tlatelolco human sacrifice was performed in mesoamerica across millennia, balancing relationships with the gods to ensure the continuation of the universe (boone 1984; gonzález torres 1994, 2010; pijoan aguadé and mansilla lory 1997). during the late postclassic period in tenochtitlantlatelolco, sacrifice functioned as statesanctioned cosmological currency for life and fertility (ingham 1984; read 1998). within the mexica cosmology, human sacrifice was an obligatory act to ensure the continual renewal of the world and the nourishment of all those who live in it (lópez austin 2004:392– 393). it was a calculated, highly contextualized, and often consensual act between religious priests and human bodies: the ultimate currency to the gods. human sacrifice required fastidious preparation and mental and emotional focus and was not the bloodthirsty, vengeful act frequently portrayed by colonial elites and in more recent popular culture. the mexica calendar consisted of 18 months, and during each month, multiple sacrifices were orchestrated with specific goals, requirements, and treatments of the sacrificial victim(s) (see anderson and dibble 1981). alfredo lópez austin identifies four types of human sacrifice and their goals: physical manifestations of the gods (ixiptla) to complete and renew their worldly life cycle, tributes/payments to the gods to sustain and placate them, companions for  the gods (and lords) to accompany them, and those sacrificed for the purposes of their skin to imbue the wearer with the power of xipe tótec (lópez austin 200:433– 435). accordingly, some sacrificed individuals were chosen for their physical prowess and blevins et al. 19 honorable representation of a deity; some were lauded and idolized for the days, months, or years preceding their death; and many were of the honorable noble, merchant, and warrior classes (anderson and dibble 1981:9– 10; lópez austin 200:409). bio archae ol o gical  evidence from tenochtitlan’s templo mayor shows that the decorative processing of skulls from sacrificed adults was determined by the high or low social status of the individual, further highlighting the socioeconomic diversity of ritually killed individuals in tenochtitlantlatelolco (ragsdale et al. 2016). most scholars have interpreted mexica child sacrifice as a combination of tribute and ixiptla. the high pathology prevalence observed in nonadult remains from templo r and ofrenda 48 has been interpreted to mean that children of “precarious health” were selected for sacrifice, as regular payment to the gods was required and the child would likely die anyway or because the child exhibited the disease of a patron deity (román berrelleza 1990, 1999, 2010). indeed, durán reports that sick children were dressed as the god tezcatlipoca and sacrificed as his ixiptla (horcasitas and  heyden 1971:110). the individuals analyzed in this study, however, were not only sick with infectious  disease but also were suffering from chronic malnutrition. this distinction between disease etiologies indicates that tribute played a role in the sacrifice of these individuals in addition to ixiptla, as specified diseases of patron deities are infectious or congenital. we propose that children of “precarious health” were sacrificed not only because of their living representations of patron deities but also because of low socioeconomic status. sahagún and dúran describe how during times of famine and financial hardship in tenochtitlantlatelolco, destitute parents sold their children as sacrificial tribute to survive (anderson and dibble 1950:39; anderson and dibble 1981:8; horcasitas and heyden 1971:281– 282). situated within what is known of mexica lifeways, the sacrifice of the non adults from grupo norte and paso a desnivel resulted from difficult decisions by parents in a plea to the gods to end a period of hardship, possibly famine, for all of those in the city. that these nonadults were likely selected from lowerclass families who were already disproportionately affected by economic hardship, however, reveals how cosmological obligations were not evenly distributed across mexica social hierarchies. although human sacrifice was a cosmological necessity and act of divine reverence, it also functioned as a statesanctioned tool of political power in the mexica empire. human sacrifice enabled targeted control of tributary provinces and the lower classes of what was known to be a highly stratified and hierarchical society (broda de casas 1972; dibble and anderson 2012). the state dictated who would die so that the rest could prosper. foucault (1978) provides a framework for recognizing the unequal effects of power structures on bodies and lives, biopolitics. mbembé (2003, 2008) extends this framework explicitly to include the control of death: necropolitics. necropolitics can be distilled as the state’s “power and capacity to dictate who may live and who must die” (mbembé 2008:152). the high prevalence of metabolic and infectious disease among those who had to die in the tlatelolco ceremonial center exposes concurrent forms of violence operating within the city. galtung (1969, 1990) proposes three selfreinforcing forms of violence: cultural, physical, and structural. here, the credence that human sacrifice begets life and prosperity could be interpreted as cultural violence: the religious rite of human sacrifice legitimized physical violence as a necessity and thus required there be a reliable source of human capital to expend. ethnohistoric records describe slave markets at which adults and children were sold explicitly for sacrificial purposes (anderson and dibble 1950:19; graulich 2016:241– 246; horcasitas and heyden 1971:133, 279– 280). so that the mexica could continually repay cosmological debts with human sacrifice, mechanisms of structural violence could have maintained socioeconomic stratification, detected here as unequal access to resources between those who were ritually killed and those who died natural deaths. like klaus (2012), we acknowledge that a structural violence framework was developed in response to western capitalist power structures, colonization and imperialism, the transatlantic slave trade, and twentieth to twentyfirstcentury warfare and therefore is not directly applicable to a society that was largely eliminated through conquest and colonialism. additionally, we acknowledge that the meaning and experience of death for the mexica are unknowable and that the available accounts of mexica lifeways were recorded through the lens of colonial ideology and assimilative motives. a bio/necropolitics framework, however, allows us to explore the disproportionate metabolic and infectious disease prevalence among these sacrificed nonadults as interlocked processes of social stratification and dictated death; citywide hardships disproportionately affected lower social status households, as we see in modern cities. although mexica society was highly stratified (smith and hicks 2017), there are few direct accounts of poverty and the impoverished within tenochtitlan tlatelolco. aztec scholar inga clendinnen offers an explanation as to why: “the poor are given scant attention in the sources as we have them: as so often, they press silently beyond the rim of the described” (clendinnen 2014:147). some glimpses into the experiences of  the poorest inhabitants of tenochtitlantlatelolco structural violence and physical death at tlatelolco20 come from ethnohistorical accounts. sahagún describes how those too poor to participate would hover at the margins of ceremonial feasts, begging for just a mouthful of leftovers (dibble and anderson 1979:124, 129). resource inequity in the city was acknowledged by the state through huey tecuilhuitl, during which the ruler provided food in the style of a soup kitchen. maize gruel was piled into canoes and distributed through the city; the poor arrived at dawn to collect as much as they could carry (anderson and dibble 1981:13; tezozómoc 1943:35– 36). sahagún states that individuals without bowls would heap maize gruel into their clothing. people would then wait for a single handful of tamales at midday (anderson and dibble 1981:96). not all who queued would receive food, as “at this time, ordinarily, there is a want of the necessities of life” (anderson and dibble 1981:14). sahagún describes violent scenes of those scrambling for food and those who were fortunate enough to be ahead in line. “what can we do, we who are poor? in misfortune hath the feast day come! to what avail is our misery? miserable are our small children!” (anderson and dibble 1981:98). durán describes further evidence of institutionalized poverty that occurred during the feast of tlacaxipehualiztli; during the forty days of this rite, noblemen allowed poor men to don the skins of their sacrificed slaves, enabling the poor men to go door to door and beg simultaneously for themselves and for the noblemen whose skins they had borrowed (anderson and dibble 1981:54; horcasitas and heyden 1971:182– 183). these descriptions suggest that people surviving on the margins of society in tenochtitlantlatelolco faced food insecurity, undoubtedly resulting in malnutrition. scurvy results from insufficient vitamin c intake. in adults, signs and symptoms can appear as early as 29 days after complete vitamin c depletion, with signs possibly observable on skeletal remains (ecchymosis and swollen, bleeding gums) occurring as early as 36 to 42 days after depletion (hodges et al. 1971). when the diet was limited to an insufficient amount of vitamin c (1 mg daily), however, scurvy signs occurred after 82 days, with swollen, bleeding gums and hemorrhaging occurring as early as 163 to 182 days (krebs 1953). when sufficient vitamin c is reintroduced into the diet, scurvyrelated spnbf is resorbed in as few as four weeks (polat et al. 2015). in adults, around 10 mg of vitamin c daily is enough to prevent clinical scurvy (hodges et al. 1971; krebs 1953). it is recommended that nonadults (1– 19 years) consume at least 20 mg of vitamin c daily (fao/who group 1970), but it is likely that 5– 10 mg of daily vitamin c would be sufficient to prevent clinical scurvy, especially in infants and children (1– 12 years) (fao/who group, 1970). outside of controlled experimental conditions, it is rare that an individual’s diet is completely depleted of vitamin c; therefore, skeletal evidence of scurvy could suggest at least five months of deficient dietary intake, possibly more. porotic, hypertrophic lesions of the cranial vault and orbits are associated with acquired anemia and may form in response to iron, folate, or b12 deficiency (walker et  al. 2009). acquired anemia and scurvy commonly cooccur (khalife et  al. 2019; pan et al. 2021), not only because vitamin c deficiency leads to decreased ability to metabolize iron and folate, but also because malnourished individuals are typically deficient in multiple nutrients (cox 1969; fain 2005). overall, the prevalence of metabolic disease in the ceremonial center contexts is exceptionally high. for comparison, the prevalence of scurvy in the non adults from the ceremonial center contexts is much higher in the case of paso a desnivel (85.3 percent) and slightly higher in the case of grupo norte (68.41 percent) than a mass burial from the great irish famine (62.8 percent) (geber and murphy 2012). for the ceremonial center contexts, comorbidity was more prevalent than either metabolic or infectious disease alone. vitamin c plays an important role in the innate and adaptive immune responses. ascorbic acid is essential for ensuring the integrity of epithelial cells and wound healing, mitigating the oxidative stress caused by active phagocytes, and maintaining adequate antibody levels (see carr and maggini 2017). vitamin c deficiency, porotic hyperostosis, and cribra orbitalia have all been linked to respiratory infection (bakaev and duntau 2004; hemilä 2017; o’donnell et al. 2020). the recurrent cycles of nutrient deficiency likely led to increased vulnerability to infection in these individuals. the pathologies observed in the ceremonial center contexts are indicative of longterm dietary deficiency, as evidenced by skeletal manifestations of scurvy and acquired anemia and their frequent comorbidity with infection. the variety of grains, legumes, vegetables, insects, and small game available in the basin of mexico is thought to have led to nutritionally complete diets (ortiz de montellano 1978), although maize was heavily cultivated and formed much of the diet (moreiras reynaga et  al. 2020). maize, beans, amaranth, chia, squash, chilies, and various fruits and vegetables were grown within the city through the chinampa (raised field) agricultural system (ortiz de montellano 1990:94– 97; read 1998:7). these crops were grown simultaneously for efficient and abundant agricultural production. by the late postclassic, however, it is estimated that there were over one million inhabitants in the basin of mexico, and possibly 200,000 within tenochtitlantlatelolco (ortiz de montellano 1978; ortiz de montellano 1990:106; santley and rose 1979; smith 2008). the population density likely surged blevins et al. 21 alongside societal stratification and food security disparities among social classes during periods of food scarcity and famine (hassig 1981). today, vitamin c deficiency is observed in refugee camps where relief food is predominantly cereals without supplements (desenclos et al. 1989), lowincome populations within highincome countries with limited access to non processed foods (mosdøl et al. 2008), and lowincome countries (rowe and carr 2020). similarly, tortillas, gruel, and tamales, which contain no vitamin c, were dietary staples for commoners, slaves, and the poor and were purportedly the main sources of calories during periods of food scarcity and famine (anderson and dibble 1981:14; hassig 1981). what does atenantitech as a normal mortality sample tell us about tlatelolco city life? atenantitech is characterized by a lower pathology prevalence and proportionally less comorbidity than the ceremonial center contexts. although lower than  the ceremonial center contexts, the prevalence of scurvy in the atenantitech nonadults was also relatively high (35.68 percent), suggesting that resource inequity may have transected multiple social classes in tlatelolco and malnutrition may have been common. the prevalence of scurvy at atenantitech is comparable to that identified in nonadults from rural and urban mixedstatus northern england cemeteries (20.93– 35.13 percent), dating to the eighteenth to nineteenth centuries (gowland et al. 2018). despite being from drastically different contexts, these data show that ~30 percent prevalence of scurvy is not abnormal for a community cemetery, especially from disadvantaged populations. conclusions by delineating the etiologies of skeletal pathologies on sacrificial victims, we exposed how social hierarchies impacted those living and dying in a mexica city. we compared three ceremonial contexts and one residential mortuary context from the tlatelolco ceremonial center and determined that these ceremonial center deposits are sacrificial in nature and comprise mostly nonadults. variability in age, sex, pathology, and perimortem trauma distributions among the ceremonial center contexts shows that ritual immolations in the tlatelolco ceremonial center were diverse, representing different ceremonies dedicated to varied deities. the high prevalence of metabolic and infectious disease and comorbidity in the ceremonial center contexts studied suggests that individuals who were chosen for sacrifice suffered from longterm malnutrition. we interpret this to mean that resource inequality and food insecurity were commonplace, within the city center and possibly across basin of mexico communities. although we cannot be certain that the non adult sacrificial victims lived in tenochtitlantlatelolco or the larger lake texcoco area, isotopic profiles from templo r nonadults indicate that they grew up in the basin of mexico (moreiras reynaga et al. 2021). therefore, it seems that migrant status may not have determined risk of sacrificial inclusion. the recovery and analysis of postclassic basin of mexico mortuary assemblages, especially those from normal mortality contexts, will certainly improve our understanding of how mexica cosmology and socioeconomic hierarchy maintained and exploited social difference. future work comparing the ancestry of these sacrificed individuals to natural mortality assemblages from communities subjugated by the mexica will reveal further how social identities dictated death at tlatelolco. acknowledgments we sincerely thank the three anonymous reviewers and bi editors, whose feedback greatly improved this manuscript. data collection and radiocarbon dating was performed with permission from inahdaf and the inah consejo de arqueología. samples for radiocarbon dating were removed from the mna as allowed by orden de salida 12645 and exported to arizona with permission as outlined by inah oficio 40134718. all photos are shared with permission from inahdaf. keb worked with undergraduate student samantha vargas to produce the first digital inventories for all analyzed skeletons for the inah daf permanent collections record, registro único. in addition, keb generated the only known inventory, preservation, and pathology summary by box and burial id of the tlatelolco d.f. skeletal collection and shared it with inahdaf. this research was funded by a fulbrightgarcía robles fellowship awarded to keb and a national science foundation doctoral dissertation research improvement grant (bcs1945812) awarded to keb and anne c. stone. this article is open access thanks to funding awarded to keb from the school of human evolution and social change, arizona state university. we are grateful for all the help and support provided by david volcanes vidal, juan manuel argüelles, irma martínez chavez, juan salvador rivera sánchez, samantha vargas, alejandro alvarado gonzález, and all other inahdaf staff during data collection at mna. we are indebted to maria de jesus sanchez structural violence and physical death at tlatelolco22 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instituto nacional de antropología e historia (inah) dirección de antropología física (daf). over 1,000 individuals have been recovered from multiple contexts within the ceremonial center and surrounding neighborhoods: iztatlan, nonoalco, and atenantitech (caso 1956; gonzález rul 1961, 1994; gonzález rul and garcía mejía 1962; martínez del río 1945). although recovery of human remains and artifacts from the site dates to the nineteenth century (hamy 1884; herrera and cicero 1895), the first rigorous excavations at tlatelolco were executed between 1944 and 1948 by robert barlow, pablo martínez del río, and antonieta espejo (angulo v 1991; espejo 2018; martínez del río 1945). this project is notable for uncovering tlatelolco’s templo mayor and delineating its construction phases and the unprecedented magnitude of techniques used to preserve organic remains (angulo v 1991; matos moctezuma 2008). some human remains were excavated during this time, including isolated skulls with the first cervical vertebra (espejo 1945). the excavation summaries allude to five offerings and thousands of human skeletal remains that were excavated from the walls and recesses of the templo mayor, but unfortunately their location is currently unknown (noguera 1966). archaeological excavations at tlatelolco expanded during the 1960s, mostly as salvage projects stimulated by urban development. urban architect and city planner, mario pani, began improving the infrastructure of mexico city; this involved building a major road and the nonoalcotlatelolco housing complex northwest of the zona arqueológica de tlatelolco (angulo v 1991). nonoalcotlatelolco refers to the area bordered to the west by the avenida de los insurgentes and the puente de nonoalco, to the north by the street of manuel gonzalez, to the south by ricardo flores magón, and to the east by paseo de la reforma. francisco gonzález rul led the salvage archaeology project with inah between 1960 and 1964, and eduardo contreras sánchez continued between 1965 and 1968 (gonzález rul 1961, 1963; gonzález rul and garcía mejía 1962; guilliem arroyo 1999). between 1960 and 1966, the area south of the templo mayor was excavated (angulo v 1991). approximately 1,050 burials were identified south of the templo mayor during the 1960s excavations (guilliem arroyo 1999:66). only approximately 350 individuals, including primary and comingled burials as well as caches of skeletal elements, from the 1965– 1966 excavations, however, have been curated and stored in the museo nacional de antropología (mna). angulo v (1991:114– 115) suggests that at least one context in the southern area resulted from “una muerte masiva y colectiva,” because many burials were superimposed and a homogeneous layer of zacatapalloli, agave spines used for autosacrifice rolled in balls of grass, covering “many” of the burials. he suggests these burials could have been either the result of the massacre that occurred during the annexation of tlatelolco by tenochtitlan, a fifteenthcentury epidemic, or a sacrifice of war prisoners. in addition to inhumations, special deposits of human remains were recovered, such as a cache of mandibles (serrano sánchez and lópez alfonso 1972), a cache of isolated human teeth (romano 1963), and a tzompantli (gonzález rul 1963). the tlatelolco skeletal collection is curated by inah dirección de antropología física (daf), and it is stored in the mna. the collection includes human burials excavated since the 1960s from the ceremonial center as well as tlatelolco barrios, such as iztatlan and nonoalco. most skeletons have separate box and burial numbers with no further contextual information. the  boxes are numbered “tlatelolco  d.f. 1” through “tlatelolco d.f. 633,” but the burial numbering restarts at 1 several times, such that there are multiple skeletons labeled entierro 1, entierro 2, entierro 3, and so on. in some cases, the reinitiation of a burial numbering cycle signals the start of a new excavation project, as is the case with the 1965– 1966 southern patio excavations. there are not, however, enough “entierro 1” entries for every mortuary context to have its own numbering system. therefore, for example, entierros 1 through 50 could span many specialized mortuary deposits from different areas of the ceremonial center. serrano sánchez and lópez alonso acknowledge the lack of published information on prehispanic tlatelolco burials, despite being the largest skeletal collection stored in mnadaf (serrano sánchez and lópez alfonso 1972). the authors analyzed a subset (n = 57) of these individuals from the southern patio, ostensibly from the same burial context. the authors argue that although these burials were deposited blevins et al. 27 within a short period of time because they were all excavated from a similar level, between 2 and 2.5 meters, the burials do not appear to be simultaneous. all but three of the burials in feature 9 were direct, flexed inhumations, 70  percent oriented with cranium to the east and feet to the west. one infant was buried in a large pot, and two young adults show evidence of dismemberment before burial, such that all skeletal elements were present, but the torso, limbs, and cranium were not in anatomical position. serrano and lópez examined the skeletons in situ, so it was not possible to observe cut marks on the burials with evidence of dismemberment. dismemberment cut marks, however, have been documented from other areas of the site (pijoan aguadé et al. 1995), and sahagún chronicled that dismemberment and cannibalism were practiced during ceremonial sacrifices (anderson and dibble 1981). no seated burials or bound mortuary bundles were identified in the southern patio mortuary assemblage, despite being typical of other contemporaneous ceremonial complexes and frequently depicted in codices as normal mortuary treatment in the basin of mexico during the postclassic (anderson and dibble 1978:44– 45; berdan and anawalt 1997:205; iguaz 1993). seated and bound burials, however, were purportedly found elsewhere at tlatelolco (gonzález rul and garcía mejía 1962). the burial goods are diverse without any apparent trends, except distinctions between adult and juvenile burial assemblages. plates, pots, bowls, and figurines were found in adult burials, and juvenile burials were associated with small vessels, small figurines, and clay marbles. additionally, the placement of a round dish over the skull typified juvenile burials. in three cases, a human radius thought to be an offering was found in a juvenile and two adult burials. the majority (63.16 percent) of the individuals in feature 9 were classified as infantiles, but the chronological age is not specified (serrano sánchez and lópez alfonso 1972). given the high percentage of juveniles, the authors suggest that this burial complex was a selective burial site, resulted from a high infant mortality event, or reflects a ceremonial sacrifice. of the individuals for which skeletal sex estimation was possible (n = 13), five are female and six are male. given the young ages of these individuals, the number of males may be overestimated, as sexual dimorphism may not yet be expressed in youthful skeletal structures. unfortunately, it is not possible to identify which skeletons were examined by serrano sánchez and lópez alonso (1972) from feature 9. the current catalog of skeletons only provides excavation date, box number, and burial number, with no reference to feature or trench location. many of the burials were excavated from an open area circumscribed by various temples and structures, but there must have been some that were associated with these structures. it will be impossible to delimit the undoubtedly temporally and contextually different mortuary assemblages without better models for mortuary behavior and burial structure. although the morphologic variation of tlatelolco skeletons and isolated skeletal elements has been studied extensively (see lópez alonso and jiménez lópez 2016), the lack of contextual data has prevented hypothesisdriven research on these collections for over a century. upon accessing the catalog at the mna (herrera and cicero, 1895), eusebio dávalos hurtado reports, “nos encontramos con un verdadero caos que sólo nos permitió aclarar una parte ínfima del problema” (davalos hurtado 1951:24). in 1987, archaeologist salvador guilliem arroyo led the best documented mortuary excavation from the tlatelolco ceremonial center (guilliem arroyo 1999). within the first year, the team began excavating an elaborate ceremonial complex at the base of templo de ehécatlquetzalcóatl, subsequently referred to as templo r. the ceremonial complex took three seasons to excavate and comprised 43 human burials: 37 non adults and six adults (de la cruz et al. 2008; guilliem arroyo 1999). the nonadults were buried in pots or inhumed. at least 19 individuals showed evidence of sacrifice, such as dismemberment, mutilation, and decapitation in situ (guilliem arroyo 1999). of 43 individuals excavated from the base of templo r, ~70 percent were younger than 10 years (de la cruz et al. 2008; guilliem arroyo 1999). over 2,000 objects were recovered from the complex. the mass of offerings and the young ages of the individuals led to the interpretation that the ceremonial complex was a sacrificial appeasement to the deity ehécatlquetzalcóatl (de la cruz et al. 2008; guilliem arroyo 1999). methodology sex assessment the greater sciatic notch and preauricular sulcus were recorded and interpreted as in buikstra and ubelaker (1994). character states of the ischium and pubic bone were recorded following gómezvaldés et  al. (2017) and klales et al. (2012). the composite arc and subpubic angle were recorded following bruzek (2002), and assessment of sexually dimorphic cranial features followed standards published by buikstra and ubelaker (1994). individuals were assigned a sex of f, f?, m?, m, or na after considering the gestalt of the aforementioned assessments. for the purposes of the following analyses, the nonambiguous and ambiguous categories for each sex were collapsed, such that all individuals included in the analyses are either f, m, or na. structural violence and physical death at tlatelolco28 nonadult age assessment an age or age range based on developmental stage was assigned to each preserved and visible tooth; in some individuals, teeth had been glued into the sockets, and root development was not observable. of all an individual’s observable teeth, the minimum and maximum ages were used to create an age range. when teeth were unobservable or not present, long bone length was used to estimate age. humeral, radial, ulnar, femoral, tibial, fibular, iliac, ischial, and pubic lengths were recorded to the nearest millimeter using a standard osteometric board. depending on which elements were preserved, a minimum and maximum age was determined using both male and female 10th– 90th percentile ranges as published by maresh (1970). for nonadults with fully formed permanent dentition or unobservable third molars, epiphyseal union stage was recorded as open, fusing, fused, or obliterated. the ages corresponding to epiphyseal union stages of all available skeletal elements were used to generate a range of minimum to maximum age. since there is not a comprehensive mexican reference sample for epiphyseal union stages, the first author generated conservative age ranges by using the summary tables for epiphyseal union stages presented by schaefer et al. (2009), which represent an amalgam of several skeletal aging studies (albert and maples 1995; cardoso 2008; coqueugniot and weaver 2007; mckern and stewart 1957; sahni et  al. 1995; m. c. schaefer 2008; webb and suchey 1985). pathology recording each skeleton was arranged in anatomical position, and each element was macroscopically inspected for pathological porosity, osteoblastic changes, osteoclastic changes, and perimortem trauma. a light source such as a headlamp or desk lamp and a 30× jeweler’s loupe were used to identify these pathological changes. all pathological changes were described in freeform format, documenting lesion location and distribution, dimensions, and status (active, healing, healed, mixed). each pathology was photographed with an iphone 8 camera during the descriptive process so that timestamps could be referenced within the description. this resulted in a descriptive and photographic pathology narrative for each individual that could be used for digital intercountry consultation and referenced throughout the differential diagnosis process. chisquare visualizations to visualize the pearson residuals from the multiway the chisquare test, we used the corrplot r package (wei and simko 2017). based on the proportional contribution of each cell, we reduced the overall contingency table into two 2 × 3 contingency tables and performed two more chisquare tests to assess further which associations contribute to statistical significance. we used the bonferroni correction to adjust the pvalues of the post hoc chisquare tests, for a corrected alpha value of α = .05/3 = 0.016. in the overall comparison, comorbidity and unaffected status contribute the most to the observed chi square score (fig. s1d). atenantitech is characterized by a low comorbidity prevalence and high unaffected prevalence, whereas the opposite is true for paso a desnivel (fig. s1a). the comparison between the ceremonial center sites shows that the difference in distribution is driven by the low prevalence of unaffected individuals in paso a desnivel (figs. s1b and s1e). the difference, although not statistically significant, between atenantitech and grupo norte contexts is caused by lower comorbidity and higher unaffected in atenantitech (figs. s1c and s1f). missing data assessment for paleodemographic analyses, all individuals with age estimates were included. for pathology comparisons across contexts and age ranges, only individuals who were observable for metabolic and infectious disease were included (table s1). this resulted in a 11.11– 21.15 percent loss of individuals and a mean age change of 2.66– 7.28 percent across contexts. similarly, for the dataset of individuals younger than 20, the subset of individuals who were observable for metabolic and infectious disease comprised 5.56– 22.22 percent fewer individuals with mean age changes 0.4– 3.4 percent across contexts. limitations clearly, the results of this study are tempered by the lack of contextual and spatial data, along with archaeological site reports. we believe, however, that by attempting to delineate mortuary contexts and interpreting the data within the rich archaeological and ethnohistoric record of tenochtitlantlatelolco, we have drawn meaningful conclusions from skeletons previously without provenience. the dental and skeletal age ranges for nonadults were generated from nonmexican reference samples, which may mean individuals are systematically over or underaged. since we do not make any claims about specific chronological ages, these biases should not affect the main conclusions of this study. there are several caveats to consider regarding the metabolic and infectious disease differential diagnoses. without radiographs, it is impossible to be certain if individuals with penetrating porotic cranial lesions resulted from marrow hypertrophy or were caused by blevins et al. 29 figure s1. (a– c) the circles are plotted proportionally in size to the chisquare residual values; blue and red indicate a positive or negative association between the row and column variables, respectively. (d– f) the circles are plotted proportionally to the relative contribution of each cell to the chisquare statistic, calculated as the r2/chi2. table s1. ageatdeath summary statistics by context for each analysis dataset. context n median mean sd min max all individuals atenantitech 40 20.15 22.95 19.77 1.2 83 grupo norte 52 7.25 11.25 12.07 0.5 67 paso a desnivel 45 12 13.85 12.41 2 76 individuals with observable pathology atenantitech 32 20.15 24.05 21.24 1.2 83 grupo norte 41 7 10.43 11.41 0.5 67 paso a desnivel 40 11.75 13.48 12.62 2 76 % change in sample size, median, and mean atenantitech − 20.00 0.00 4.78 grupo norte − 21.15 − 3.45 − 7.28 paso a desnivel − 11.11 − 2.08 − 2.66 individuals younger than 20 atenantitech 18 5.5 7.48 5.81 1.2 19.5 grupo norte 45 5.5 7.93 6.11 0.5 19.5 paso a desnivel 36 8 9.65 5.83 2 19.5 individuals younger than 20 with observable pathology atenantitech 14 5.5 7.23 5.55 1.2 17 grupo_norte 37 6 7.96 6.14 0.5 19.5 paso a desnivel 34 9 9.96 5.85 2 19.5 % change in sample size, median, and mean atenantitech − 22.22 0.00 − 3.40 grupo norte − 17.78 8.33 − 0.40 paso a desnivel − 5.56 11.11 − 3.14 structural violence and physical death at tlatelolco30 the hemorrhaging → inflammation → capillary formation cascade caused by vitamin c deficiency. to mitigate this limitation, we chose to limit a diagnosis of anemia to cranial lesions appearing to penetrate the cortical bone and expose the trabeculae. additionally, we chose to integrate scurvy and anemia assignments into a single “metabolic” category. further, we are aware that vitamin c deficiency may cause subperiosteal new bone formation (spnbf) on the diaphyses of long bones, not just around the metaphyses. in this study, diaphyseal scurvyrelated spnbf may have been misclassified as evidence of infection. even if our estimates of comorbidity are inflated, it does not affect the fact that the ceremonial center deposits have an exceptionally high prevalence of metabolic disease. lastly, the authors are aware that systemic spnbf has  many known etiologies in nonadults, namely, congenital and metabolic disorders and neoplasms (bisseret et al. 2015; chen et al. 2012). given the rarity of these conditions, however, we believe that even if we have misdiagnosed some noninfectious cases of spnbf as infectious, it would not affect the overall results. while the activity status of all pathological changes was recorded (active, healing, healed), the introduction of this variable into analyses would have limited statistical power by further decreasing sample sizes. we believe this is not an essential distinction to make for the purposes of this paper and that the absence of this distinction does not detract from the overall conclusions. references cited albert, a. m., and w. r. maples. 1995. stages of epiphyseal union for thoracic and lumbar vertebral centra as a method of age determination for teenage and young adult skeletons. journal of forensic sciences 40(4):13838j. https:// doi . org / 10 . 1520 / jfs13838j anderson, a. j. o., and c. e. dibble, trans. 1978. book 3: the origins of the gods. in florentine codex: the general history of the things in new spain. the school of american research and the university of utah, santa fe, new mexico, pp. 1– 70. anderson, a. j. o., and dibble, c. e. 1981, trans. book 2: the ceremonies. in florentine codex: general history of the things of new spain. the school of american research and the university of utah, santa fe, new mexico, pp. 1– 247. angulo v, j. 1991. trabajos de exploración y conservación en tlatelolco: notas antiguas y comentarios recientes temporada 1965– 1966. arqueologia 6:101– 116. berdan, f. f., and p. r. anawalt. 1997. the essential codex mendoza. university of california press, berkeley. https:// doi . org / 10 . 2307 / 3034523 bisseret, d., r. kaci, m. h. lafageproust, m. alison, c. parlier cuau, j. d. laredo, and v. bousson. 2015. periosteum: characteristic imaging findings with emphasis on radiologic-pathologic comparisons. skeletal radiology 44(3): 321– 338. https:// doi . org / 10 . 1007 / s00256 014 1976 5 bruzek, j. 2002. a method for visual determination of sex, using the human hip bone. american journal of physical anthropology 117(2):157– 168. https:// doi . org / 10 . 1002 / ajpa . 10012 buikstra, j. e., and d. h. ubelaker. 1994. standards for data collection from human skeletal remains. arkansas archaeological survey, fayetteville. cardoso, h. f. v. 2008. age estimation of adolescent and young adult male and female skeletons ii, epiphyseal union at the upper limb and scapular girdle in a modern portuguese skeletal sample. american journal of physical anthropology 137(1): 97– 105. https:// doi . org / 10 . 1002 / ajpa . 20850 caso, a. 1956. los barrios antiguos de tenochtitlan y tlatelolco. memorias de la academia mexicana de la historia, 15, mexico city. chen, e., s. masih, k. chow, g. matcuk, and d. patel. 2012. periosteal reaction: review of various patterns associated with specific pathology. contemporary diagnostic radiology 35(17):1– 5. https:// doi . org / 10 . 1097 / 01 . cdr . 0000418464 . 79923 . 5c coqueugniot, h., and t. d. weaver. 2007. brief communication:  infracranial maturation in the skeletal collection from coimbra, portugal: new aging standards for epiphyseal union. american journal of physical anthropology 134(3): 424– 437. https:// doi . org / 10 . 1002 / ajpa . 20683 davalos hurtado, e. 1951. la deformación craneana entre los  tlatelolcas. escuela nacional de antropología e historia, mexico city. de la cruz, i., a. gonzález oliver, b. m. kemp, j. a. román, d. g. smith, and a. torre blanco. 2008. sex identification of children sacrificed to the ancient aztec rain gods in tlatelolco. current anthropology 49(3):519– 526. espejo, a. 2018. las ofrendas encontradas en tlatelolco. in tlatelolco a través de los tiempos edited by andrés lira gonzález. el colegio de méxico, el colegio nacional, academia mexicana de la historia, mexico city, pp. 295– 316. gómezvaldés, j. a., a. menéndez garmendia, l. garcíabarzola, g. sánchezmejorada, c. karam, j. p. baraybar, and a. klales. 2017. recalibration of the klales et al. (2012) method of sexing the human innominate for mexican populations. american journal of physical anthropology 162(3):600– 604. table s2. radiocarbon dating raw data. skeleton id context uncalibrated age standard deviation calibration curve age at death (years) tlt_3_56_14d templo norte 555 21 intcal20 3 tlt_11_134_53 paso a desnivel 1066 21 intcal20 6 tlt_13_137_58 paso a desnivel 528 21 intcal20 9 tlt_15_143_70 paso a desnivel 514 21 intcal20 4 tlt_17_189_107 templo norte 493 21 intcal20 26 tlt_19_193_112 templo norte 560 21 intcal20 13.5 atn_2_22_28 atenantitech 527 22 intcal20 20.5 https://doi.org/10.1520/jfs13838j https://doi.org/10.2307/3034523 https://doi.org/10.2307/3034523 https://doi.org/10.1007/s00256-014-1976-5 https://doi.org/10.1007/s00256-014-1976-5 https://doi.org/10.1002/ajpa.10012 https://doi.org/10.1002/ajpa.20850 https://doi.org/10.1097/01.cdr.0000418464.79923.5c https://doi.org/10.1002/ajpa.20683 blevins et al. 31 gonzález rul, f. 1961. trabajos de xploración 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institute of archaeology 4:63– 76. klales, a. r., s. d. ousley, and j. m. vollner. 2012. a revised method of sexing the human innominate using phenice’s nonmetric traits and statistical methods. american journal of physical anthropology 149(1):104– 114. https:// doi . org / 10 . 1002 / ajpa . 22102 lópez alonso, s., and j. c. jiménez lópez. 2016. la colección osteológica de tlatelolco. diario de campo: la antropología física ayer y hoy— enfoques 10– 11:19– 27. maresh, m. m. 1970. measurements from roentgenograms. in human growth and development, edited by r. w. mccammon. c. c. thomas, springfield, illinois, pp. 157– 200. martínez del río, p. 1945. resumen de los trabajos arqueológicos. in tlatelolco a través de los tiempos v, edited by f. gonzález rul. instituto nacional de antropología e historia, mexico city, pp. 145– 146. matos moctezuma, e. 2008. la arqueología de tlatelolco: de la colonia a los sesenta del siglo. arqueología 15(89):37– 45. mckern, t. w., and t. d. stewart. 1957. skeletal age changes in young american males, analysed from the standpoint of age identification. headquarters quartermaster research and development command, technical report ep45, environmental protection research division, natick, massachusetts. noguera, e. 1966. historia de las exploraciones en tlatelolco. in summa anthropologica en homenaje a roberto j. weitlaner). instituto de antropología e historia, mexico city, pp. 71– 78. pijoan aguadé, c. m., j. mansilla lory, and a. pastrana. 1995. un caso de desmembramiento. tlatelolco, d.f. in estudios de antropologia biologica v, edited by r. m. ramos rodríguez. instituto nacional de antropología e historia, mexico city, pp. 81– 90. romano, a. 1963. ofrenda de dientes humanos. boletín del inah 12:8. sahni, d., i. jit, and sanjeev. 1995. time of fusion of epiphyses at the elbow and wrist joints in girls of northwest india. forensic science international 74(1– 2):47– 55. https:// doi . org / 10 . 1016 / 0379 0738(95)017363 schaefer, m., s. black, and l. scheuer. 2009. juvenile osteology: a laboratory and field manual. academic press, new york. schaefer, m. c. 2008. a summary of epiphyseal union timings in bosnian males. international journal of osteoarchaeology 18(5):536– 545. https:// doi . org / 10 . 1002 / oa . 959 serrano sánchez, c., and s. lópez alfonso. 1972. algunos datos sobre la funeraria entre los tlatelolcas prehispánicos. boletin bibliografico de antropologia americana 35:47– 60. webb, p. a. o., and j. m. suchey. 1985. epiphyseal union of the anterior iliac crest and medial clavicle in a modern multiracial sample of american males and females. american journal of physical anthropology 68(4):457– 466. https:// doi . org / 10 . 1002 / ajpa . 1330680402 https://doi.org/10.1002/ajpa.22102 https://doi.org/10.1002/ajpa.22102 https://doi.org/10.1016/0379-0738(95)01736-3 https://doi.org/10.1016/0379-0738(95)01736-3 https://doi.org/10.1002/oa.959 https://doi.org/10.1002/ajpa.1330680402 https://doi.org/10.1002/ajpa.1330680402 idstacks 2 idstacks 3 idstacks 4 idstacks 5 idstacks 7 idstacks 8 idstacks 11 idstacks 12 idstacks 13 idstacks 17 idstacks 18 idstacks 19 idstacks 20 idstacks 21 idstacks 22 idstacks 23 idstacks 24 idstacks 25 idstacks 26 idstacks 27 idstacks 28 idstacks 30 login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe bioarchaeology international copyright © 2021 university of florida press doi: 10.5744/bi.2020.2001 volume 4, number 2: 75–88 living and dying in mountain landscapes: an introduction jess becka* and colin p. quinnb auniversity of cambridge, mcdonald institute for archaeological research, cambridge cb2 3er, uk, and anthropology department, vassar college, poughkeepsie, ny 12604, usa banthropology department, hamilton college, clinton, ny 13323, usa *correspondence to: jess beck, anthropology department, vassar college, 124 raymond avenue, poughkeepsie, ny 12604, usa e-mail: jessicabeck@vassar.edu abstract in this introduction to the thematic issue living and dying in mountain landscapes, we develop an analytical framework for the bioarchaeology and mortuary archaeology of highland landscapes. we highlight new theoretical, methodological, and comparative contributions to the anthropological study of upland spaces. theoretical contributions include examining identity, connectivity, and adaptation from an explicitly biocultural perspective. by bridging the biological anthropological focus on the somatic with an archaeological focus on the long term, bioarchaeology allows for the development of an embodied understanding of “marginal” highland environments, investigating how such landscapes shape and are shaped by human action over time. recent advances in bioarchaeological methods, including isotopic analyses of mobility and diet and ancient dna studies of kinship and relatedness, are combined with traditional osteological examinations of age, sex, ancestry, and disease to reconstruct the lifeways of mountain communities. these methodological advances take advantage of the topographical, geological, and ecological diversity of mountain landscapes. finally, a comparative bioarchaeology of upland and lowland communities across space and time provides a deeper understanding of highland adaptations and identities. the papers share a number of unifying themes, including the impact of mountain landscapes on channeling resource control, creating or mediating diverse identities, and the importance of interdisciplinary investigations for developing an understanding of the relationship between people and place. as this issue demonstrates, the study of human remains must be situated within a holistic bioarchaeological approach to life and death in order to understand the dynamic relationships between people and the highland environments they occupy. keywords: mountains; marginality; identity en esta introducción a la cuestión temática 'vivir y morir en paisajes de montaña’ desarrollamos un marco analítico para la bioarqueología y la arqueología mortuoria de los paisajes serranos. destacamos un conjunto de nuevas contribuciones teóricas, metodológicas, y comparativas al estudio antropológico de estos paisajes. entre ellas destacan los análisis de la identidad, la conectividad y la adaptación, todos aproximados desde una perspectiva explícitamente biocultural. al unir el énfasis bioantropológico en lo somático con el interés arqueológico en la larga duración, la bioarqueología favorece una aproximación corporizada a los ambientes “marginales” de las tierras altas, investigando cómo estos paisajes moldean y son moldeados por la acción humana a lo largo del tiempo. los recientes avances en métodos bioarqueológicos, como los análisis isotópicos de movilidad y dieta o los estudios de adn antiguo sobre parentesco y otros principios de existencia compartida, se combinan con los tradicionales exámenes osteológicos de edad, sexo, ascendencia y enfermedad para reconstruir las formas de vida de las comunidades de montaña. estos avances metodológicos aprovechan la received 14 december 2019 revised 29 may 2020 accepted 1 june 2020 introduction76 in his exploration of the paradoxes characterizing “remote areas,” social anthropologist edwin ardener (1987:41) underscores the importance of topography: “mountains conventionally add to the ‘remoteness’ experience, but so very frequently do plains, forests, and rivers—so much so that the inhabitants of ‘unremote’ places sometimes say that they do not have ‘real’ mountains, plains, forests, or rivers—only something else, hills (say), woods, or streams.” however, ardener (1987:49) also cautions that “‘remoteness’ is a specification, and a perception, from elsewhere, from an outside standpoint; but from inside the people have their own perceptions.” the tension between the perceived marginality of mountain landscapes and the realities of their human occupation is one that has infused much of the recent literature on this topic in anthropology, human geography, and cultural ecology. mountain landscapes are apparently still deeply paradoxical spaces for anthropologists and other social scientists. bates and lozny (2013:2), in their edited volume on cultural adaptations to mountain environments around the world, emphasize that despite their perceived status as “pristine” or “primeval” refugia, highland landscapes are historically contingent spaces, shaped by management practices ranging from road construction to mineral extraction. similarly, kuklina and holland (2018) stress that the perception of particular mountainous areas as remote or inaccessible can be a relatively recent historical phenomenon, rooted in the organization of state-imposed infrastructure (e.g., “distance demolishing technologies” [scott 2009:xii]) rather than inherent or long-standing inaccessibility. instead of being ecologically marginal spaces, mountains are important reservoirs of biocultural diversity (stepp et  al. 2005), and even harsh climatic conditions do not always prove a deterrent to upland occupations by local human groups (walsh 2005). depending on the topographic criteria used to define mountains, geographers estimate that between 12% and 24% of all terrestrial land area outside antarctica is composed of mountains (kapos et al. 2000; körner et  al. 2011; meybeck et  al. 2001). given the prevalence of mountain landscapes and the frequency with which humans interact with mountains across the globe, anthropologists are increasingly aware of the need to better understand these landscapes. the primacy of upland landscapes for structuring and mediating social relationships has led increasing anthropological attention to be paid to these environments, as evidenced by the popularity of scott’s (2009) volume on the deliberate statelessness of highland communities in southeast asia, or the recent institute for european and mediterranean archaeology (iema) conference at the university of buffalo on the topic of the “archaeology of mountain landscapes” (iema 2017). while bioarchaeologists have grown more invested in elucidating the relationships between people and the social and environmental landscapes they inhabit (austin 2017; becker 2019; berger and juengst 2017; white et  al. 2009), there has not been an edited volume or journal issue devoted to the bioarchaeology of mountain landscapes. this absence has contributed to an incomplete understanding of human-environment interaction at a time when such approaches are growing in importance within the field (see robbins schug 2020). for example, mountains are among the regions most susceptible to climate change (adler et al. 2019; kohler et al. 2014). understanding how people in the past navigated mountain landscapes can provide critical insights into the role of landscapes in affecting human behavior, add to emerging scholarship on migration and human mobility, and contribute to broader examinations of human responses to environmental change in the past and present. the scholarship in this issue addresses three overarching themes in order to work toward building a new theoretical, methodological, and comparative framework to deepen our understanding of the biocultural context of mountain communities. first, mountain landscapes have been approached from a variety of theoretical perspectives. what are the most diversidad topográfica, geológica y ecológica de los entornos serranos. finalmente, una comprensión más profunda de las adaptaciones e identidades de las serranías requiere de una aproximación bioarqueológica comparativa de las comunidades serranas y de las que habitan las tierras bajas a través del tiempo y del espacio. todos estos trabajos comparten una serie de temas comunes: la manera en la que los paisajes de montaña canalizan las formas de control de los recursos, la creación o mediación de distintas identidades y la importancia de las investigaciones interdisciplinares para desarrollar una comprensión de la relación entre personas y lugares. como se demuestra a lo largo de este número, el estudio de los restos humanos requiere de un enfoque bioarqueológico holístico de la vida y la muerte que permita comprender las relaciones dinámicas que se desarrollaron entre las personas y sus respectivos entornos serranos. palabras clave: montañas; marginalidad; identidad beck and quinn 77 promising existing approaches and future developments in theorizing a bioarchaeology of mountain landscapes? for example, archaeological approaches to upland landscapes often focus on issues of mobility and marginality. in what ways do upland communities use and manipulate their local topographies, and in what ways are such groups constricted by mountain landscapes? mountains can be arenas in which people contest and assert claims to territory, resources, and power. visibility and accessibility within such landscapes affect communication, interaction, and engagement with other features of local social topographies. second, what are the methodological opportunities and challenges for a bioarchaeology and mortuary archaeology of mountain landscapes? for example, the geological diversity of mountain landscapes can be an asset to isotopic studies of mobility, but limitations on sampling and accessibility may inhibit our ability to construct adequate base maps. how do new methods elucidate the lives and funerary practices of people buried in mountain landscapes? finally, how do mountain communities compare with contemporaneous groups in the lowlands? isolation must be demonstrated, rather than assumed. to understand highland adaptations, lifeways, and ideologies, mountain communities must be situated within a larger macroregion to identify the extent to which the landscape uniquely structured the social lives of upland communities. this issue presents a novel approach to these questions by bringing together nuanced case studies from eastern europe (beck, ciugudean, and quinn), southeastern europe (zavodny), and central asia (eng and aldenderfer) (fig. 1, table  1). in this introduction we contextualize these case studies within broader archaeological approaches to mountainous landscapes across the globe. recurring themes include the biocultural implications of mountains as channels of resource control, the use of mortuary ideology to unify or distinguish upland identities through mediating relationships between the living and the dead, and the importance of multiple lines of evidence—from paleoclimatic to textual to skeletal—for understanding the complex relationships between upland peoples and the landscapes they inhabit. 1. approaching mountain landscapes from a biocultural perspective there is no simple way to define mountains. researchers in the natural sciences have relied upon ruggedness, the maximal elevation differences within a specified distance, to characterize mountains by their one common feature: steepness (körner et  al. 2011). other factors, such as elevation, climate, and biodiversity, are unable to fully encapsulate the variability in mountain landscapes (körner et  al. 2011). while some researchers have tried to quantitatively classify landscapes based on elevation and ruggedness (e.g., kapos et  al. 2000), others have used ruggedness alone (e.g., meybeck et  al. 2001). such parameters, however, may lead portions of foothills or less rugged mountain chains, such as the older apuseni mountain range (beck et al. 2020), to be excluded from this kind of classification. as a result, no globally accepted definition of mountains exists figure 1. map of mountainous landscapes across the globe (black). examples of bioarchaeological research in mountain landscapes are marked on the map with numbers that correspond to the entries in table 1. case studies from this special issue are surrounded by gray circles: (6) beck et al., (8) eng and aldenderfer, (9) zavodny (based on körner et al. 2011:figure 1). introduction78 (gerrard 1990; körner et  al. 2011; smith and mark 2003). as anthropologists, we argue that mountains are not only defined by their physical characteristics; they are also understood as socially mediated cultural landscapes. consequently, it is not possible to draw strict definitional boundaries between mountainous and non-mountainous landscapes. we acknowledge that complex ontologies within past societies could have defined such landscapes in myriad ways (smith and mark 2003). here, we employ a more holistic conceptualization of mountain landscapes as spaces with topographic ruggedness where human behavior and interaction are shaped by the physiological and environmental complexity the landscapes encompass. the common conceptualization of mountains as marginal areas is partially related to the very real physiological constraints on human high-altitude occupation. high-altitude (> 2,500 m above sea level) mountainous landscapes present significant obstacles to human habitation, ranging from decreased levels of oxygen (hypoxia) to weather extremes, high levels of solar radiation, and the low primary productivity of local ecologies (rademaker et al. 2014; aldenderfer 2019). such harsh environments require major genetic, physiological, and cultural adaptations in the human groups occupying these landscapes. research focused on the populations of three areas—the tibetan plateau, the ethiopian plateau, and the andean altiplano—has revealed measurable differences in the hematological, circulatory, and respiratory features of high-altitude groups (beall 2001, 2006; beall et al. 2001; bigham et al. 2013). cultural adaptations include the use of particular kinds of technology and material culture, as well as residential, resource, and subsistence strategies that allow human groups to overcome the problems of hypoxia, seasonality, and cold stress with which they are confronted within high-altitude environments (aldenderfer 2006). despite the undisputed harshness of life at high altitudes, archaeological research demonstrates that humans have deliberately exploited mountainous landscapes for thousands of years. the foothills of the north caucasus have been occupied since the middle paleolithic, between 70,000 and 30,000 years b.p. (skinner et al. 2005), while the foothills of the south caucasus have been inhabited since the upper paleolithic, some 33,000 to 27,000 years bp (bar-yosef et al. 2011), with occasional evidence of higher-altitude occupations, as at the site of hovk 1 cave in armenia (pinhasi et  al. 2008; sagona 2017). recent research has extended the human occupation of the tibetan plateau, one of the highest human-occupied environments on earth, from ~12,700 years b.p. (meyer et al. 2017) to at least 30,000 to 40,000 years b.p. (zhang et al. 2018). the earliest archaeological sites in the high andes of peru and bolivia have been dated to over 12,000 years b.p., though widespread and table 1. mountainous landscapes referenced in bioarchaeological case studies discussed in text. bolded numbers and asterisked references denote case studies introduced in this thematic issue. number mountainous landscape region research topics references 1 acacus mountains north africa isotopic analysis of mobility tafuri et al. 2006 2 alps (central) western europe isotopic analysis of mobility holden 2003; müller et al. 2003 3 andes (central) south america isotopic analysis of mobility tung and knudson 2011; 4 andes (south central) south america analyses of osteoarthritis; isotopic analysis of mobility; analyses of artificial cranial deformation, nonmetric traits, and demographic profiles becker 2019; blom et al. 1998; knudson et al. 2005 5 cardamom mountains southeast asia mortuary archaeology, radiocarbon dating beavan et al. 2012 6 carpathians (western) eastern europe mortuary archaeology, bioarchaeological analysis of mortuary treatment beck et al. 2020* 7 caucasus (greater) eurasia isotopic analysis of diet knipper et al. 2018 8 himalayan arc central asia genomic, isotopic, bioarchaeological, anthropological, and archaeological analyses eng and aldenderfer 2017, 2020* 9 lika region of croatia southeastern europe mortuary archaeology zavodny 2020* 10 sierra madre (south) mesoamerica isotopic analysis of mobility price et al. 2015 11 vosges mountains western europe isotopic analysis of mobility bentley et al. 2003 beck and quinn 79 year-round occupations did not occur until several thousand years later (capriles et al. 2016; rademaker et al. 2014). bioarchaeology has the potential to make major contributions to debates about mountain communities through the use of a biocultural and embodied perspective. by combining skeletal evidence with mortuary archaeology, bioarchaeology allows us to embed our understandings of mountain communities within explicit discussions of human choice and agency in order to explore how, when, and why human groups occupy highland areas. 2. theorizing a bioarchaeology of mountain landscapes through interrogating marginality mountain landscapes are commonly framed as socially and environmentally marginal spaces, as evidenced through the vocabulary used to describe them: upland regions are “remote” (kuklina and holland 2018), “inaccessible” (hammond 1976), “low-yielding” (guillet 1983), “risky” (walsh 2005), “on the fringe” (walsh 2005), “rugged” (salomon 2018), and “forbidding” (cole and wolf 1974) areas characterized by extreme “isolation” (galaty 2013). this reputation often has long-lasting effects; as drummond (2018) notes, the economic and historical marginality of highland areas often has led to delays in toponymic recording, so that in addition to being viewed as inaccessible, many of these areas remained officially nameless until relatively recently. as a result of the presumed marginality of upland environments, archaeological approaches to “peripheral” landscapes are particularly helpful for guiding the development of bioarchaeological understandings of mountain communities. much of the vocabulary used to describe peripheral regions is rooted in disciplinary adaptations of world systems theory (wallerstein 1974), which have applied various iterations of core-periphery frameworks to the prehistoric past (kardulias and hall 2008; peregrine 2000; sherratt 1993a, 1993b). the overarching goal of such analyses entails situating social and economic networks within a broader regional or extra-regional core-periphery framework that structures interactions at a variety of scales. many of these core-periphery relationships are at least partially defined by environmental factors. in his discussion of the intersection between physical and social geographies, hall (2000:251) specifies that “the interaction between valley people and hill people is perhaps the earliest form of world-system formation,” emphasizing that ecological borders, such as those between the steppe and arable lands or between plains and mountains, are key areas for studying the social tensions and transformations precipitated by intergroup interactions. such approaches are not without their detractors (e.g., harding 2013; stein 2002). however, what is most relevant for our purposes is that mountains are often assumed to be marginal areas, and useful archaeological interrogations of the concepts of “margins” and “peripheries” have been developed in response to early applications of world systems theory. such interventions began during the 1990s, with sherratt (1993b:250) pointing to marginal regions in bronze age europe as areas that were “culturally transformed, but structurally independent” of near eastern urban centers and their peripheries. he highlights the independence and agency of marginal communities in picking and choosing elements of urban society—be they technological, political, or ideological—to reinterpret in new social contexts. this foregrounding of choice and agency on part of actors on the margins is also encapsulated by the notion of “negotiated peripherality” (kardulias 2007; morris 1996), whereby actors in peripheral zones are not passive recipients in thrall to external forces but rather “active players” (kardulias 2007:76) in intergroup interactions. these framings are echoed by other work that highlights the status of “peripheries” (stein 2002) and “frontiers” (k. g. lightfoot and martinez 1995) as productive areas of cross-cultural contact, where microscalar analyses of human agency and macroscalar understandings of broader socioeconomic systems both affect the outcome of interactions and events. just as mountains are assumed to be politically marginal spaces, they are also assumed to be environmentally hazardous. as walsh (2005:298–299) argues, “there is little doubt that mountain environments are risky . . . and many of these risks increase with altitude.” researchers working with contemporary mountain communities emphasize that life in such landscapes is difficult due to the demands of making a living in a harsh and unpredictable environment, though it is worth noting that these characterizations are based on high altitudes in temperate zones where climate and ecology are subject to largescale seasonal changes (cole and wolf 1974; schon and galaty 2006). mountain communities cope with environmental challenges through a variety of cultural adaptations ranging from seasonal migration, to the development of a range of agropastoral strategies, to the diversification of productive activities and their scheduling (lozny 2013:396). as halstead (1990) demonstrates in his study of transhumant pastoralism in the pindhus mountains of northern greece, introduction80 such strategies are often dependent on complex interconnections that link those living at high altitudes to other communities. in the pindhus, transhumant pastoralism was underlain by a variety of overlapping strategies, including access to both extensive summer and winter pasture, reliable means of converting animals into agricultural staples, participation in overland trade networks allowing for a degree of economic specialization, and irrigated summer crops that could be used to buffer risks in the winter months. halstead’s work reveals that pastoralists in the pindhus were not relics of a stubborn prehistoric self-sufficiency but were instead deeply connected to modern economic systems of land management and exchange. archaeological work in alpine france likewise highlights the importance of historical context for understanding how environmental risk was perceived in mountain landscapes in the past. through a program of combined survey and test excavations, walsh (2005:289) demonstrates that human occupations of the faravel plateau “waxed and waned” in patterns that did not correspond predictably to regional climatic shifts. during the roman period, when climatic conditions were optimal, the highlands were relatively empty. during the medieval and post-medieval periods, which coincided with the climatic deterioration wrought by the little ice age, these alpine environments were at their busiest. such patterns are the result of culturally and historically mediated perceptions of risk, folded into larger social, economic, and political frameworks. walsh argues that people did not avoid the highlands during the roman period because the mountains were viewed as economically or ecologically marginal spaces, but instead because patterns of land occupation were shaped by roman policies and attitudes toward land management, territorial boundaries, and population control. while the romans provide one example of a larger imperial power acting to keep people out of the mountains, there are many documented upland communities whose presence within mountain landscapes is rooted in resistance to larger systems of control. scott (2009), in particular, reads the continued occupation of the zomia—the massive expanse of the southeast asian massif which spans ten countries— as an explicit response to the expanding power of lowland states and empires: “virtually everything about these people’s livelihood, social organization, ideologies, and (more controversially) even their largely oral cultures, can be read as strategic positionings designed to keep the state at arm’s length” (2009:x). schon and galaty (2006) highlight the deployment of similar strategies in the shala valley of northern albania, one of the last refugia of tribal societies in twentieth-century europe. shala valley communities have occupied this upland region since the fifteenth century in response to both internal and external factors, including changes in settlement patterns and land use within albania and the ever-encroaching influence of the ottoman empire. galaty (2013) argues that occupants of the shala valley took advantage of the opportunity for autonomy afforded by the relative isolation and inaccessibility of the mountain landscape, maintaining their negotiated peripherality through a program of violence, feuding, and warfare, supplemented by intermittent political interaction with the larger powers that surrounded them. in this case, while politics were local, decisions and alliances were still embedded within an understanding of external political frameworks: here, “‘isolation’ was not so much a condition to be endured, but was rather a strategy engaged, one used to fend off conquest and incorporation by external powers and preserve a degree of autonomy” (galaty 2013:145). even a cursory survey of the existing literature devoted to mountain communities thus demonstrates that marginality is relative, and careful consideration of cultural and historical context is necessary before characterizing highland spaces as the wastelands of “freezing privation” often imagined by outsiders, as is the case in the andes (salomon 2018:24). importantly, bioarchaeology can make key contributions to theorizing marginality, whether social or environmental, in mountain landscapes. many of the critiques of world systems theory hinge on problems of scale and focus (i.e., harding 2013:385), with archaeologists resisting sweeping, top-down economic explanations of cultural transformations that treat peripheral communities as passive recipients of change fomented by external systems. such critiques call for more fine-grained, microscale examinations of how outside influences are received, reconfigured, or resisted at the level of individuals and communities. as k. g. lightfoot and martinez (1995:483–485) emphasize in their research on fur-trading in western north america, the “backgrounds, interests and motivations” of individuals inhabiting frontier zones vary as a result of ethnic, socioeconomic, and gendered identities, creating a rich potential for individuals and factions to participate in intercultural interactions to further their own agendas. tica (2019) likewise highlights the dynamic fluidity of social relations at borders and frontiers, while tica and martin’s (2019) geographically and chronologically wide-ranging edited volume provides a demonstration of the ways in which bioarchaeology can investigate areas that are either spatially or symbolically beck and quinn 81 liminal. bioarchaeology is well positioned to explore these marginal dynamics through investigating how dimensions of social identity (e.g., age, gender, class) and lived experience (e.g., disease, violence, stress) affect how intergroup interactions are received at the level of individuals (quinn and beck 2016). in addition to providing a more fine-grained understanding of the social dynamics of the “periphery,” bioarchaeology can also make unique contributions to theories of marginality through the investi gation of social connectivity and environmental risk from an embodied perspective. lived experiences of travel, intercommunity relationships, resource consumption, and physiological stress can become “literally incorporated” into human skeletal remains (sensu krieger 2005). all of these experiences and the individual and/or communal choices that they entail—deciding where to move, what to eat and drink, what kinds of labor to undertake, and whom to interact with—are important considerations for comprehending the biosocial context of marginal landscapes. as we outline in the next section, recent techniques in archaeological science, ranging from isotopic analyses of mobility and diet to ancient dna (adna) studies of kinship and relatedness, can be combined with traditional osteological examinations of age, sex, ancestry, disease, and stress to deepen our understanding of the ways in which marginality is incarnated or resisted in mountain communities. finally, the mortuary practices of mountain communities have the potential to illuminate the ways in which distinct upland identities are maintained, negotiated, and communicated to others (parker pearson 1995). all contributions to this issue highlight the ways in which the treatment and placement of the dead can convey particular messages about resource ownership (beck, ciugudean, and quinn), territorial control (zavodny), or regional cultural identity (eng and aldenderfer). beavan et al. (2012) report similar practices for the cardamom mountains of cambodia in the fourteenth through sixteenth centuries a.d. archaeological research in this region has documented multiple mortuary sites on mountain cliffs and ledges, where the bones of the dead were deposited in imported ceramic vessels that were then placed in coffins carved out of local wood. these animistic upland funerary practices were distinct from the predominant mortuary rituals of the lowland khmer empire and highlight the strategies by which people “whose lives were contemporary with, yet a world apart, from angkor” maintained distinct identities in both life and death (beavan et  al. 2012:20). theoretical attention to the ways in which upland mortuary practices act as forums in which community identities are affirmed or contested provides greater anthropological insight into the ways in which mountain communities distinguished themselves from, or incorporated themselves into, wider social networks. 3. methodological opportunities and challenges of mountain landscapes while bioarchaeology has the ability to contribute to the development of new theoretical approaches to mountain landscapes through a focus on the embodied dimensions of marginality and identity, expanding methodological toolkits have also increased the scope of osteoarchaeological research. new developments in bioarchaeological and archaeological science make it possible to investigate multiple aspects of lived experience from a biocultural perspective, including mobility, diet, disease, stress, and kinship. the geological and topographical complexity of mountains makes them ideal contexts in which to use isotopic analyses of strontium and oxygen to examine patterns of individual and regional mobility. these techniques have been profitably employed in a series of studies comparing upland and lowland landscapes in south america (knudson et al. 2005; toyne et  al. 2014; tung and knudson 2011; white et  al. 2009), north america (price et  al. 2015), europe (bentley et al. 2003), and north africa (tafuri et al. 2006). there is also a rich and expanding literature that uses such techniques to document animal mobility, particularly in areas where questions persist about the origins and organization of pastoral practices (chazin 2018; chazin et  al. 2019; see ventresca miller and makarewicz 2018 for a summary of recent research). because oxygen isotope ratios are influenced by many environmental factors—including latitude, altitude, climate, precipitation levels, and seasonality (knudson 2009; e. lightfoot and o’connell 2016)—many of the most promising new studies combine oxygen isotope analysis with a reliance on geological distinctions between mountains and lowlands, as materialized in different ranges of strontium isotope ratios, in order to identify migrants and locals. indeed, bentley’s (2006) foundational and highly cited overview of strontium applications in archaeology itself uses a case study from a mountainous region, the upper rhine valley of germany, to illuminate the potential of the strontium isotopic approach for identifying migrants in geologically and topographically variable landscapes. introduction82 strategies that sample multiple teeth from a single skeleton to reconstruct patterns of mobility over the course of individual life histories (hrnčíř and laffoon 2019) have particular potential for deepening our understanding of lived experience in mountain environments. these methods take advantage of the developmentally staggered formation times of the permanent teeth in order to compare strontium isotope ratios that were taken up at different times during an individual’s life. one well-publicized demonstration of the utility of these fine-grained strategies is the interdisciplinary approach to tracing the lifetime mobility of “ötzi,” or the “iceman,” the famously well preserved late neolithic individual found in the ötztal alps along the border of italy and austria. in this case, researchers used a multidisciplinary toolkit including strontium and oxygen isotopes sampled from a variety of tissues to demonstrate that this individual’s lifetime movements were likely restricted to a 60 km radius of where his body was found (holden 2003; müller et al. 2003). importantly, stojanowski and duncan (2015) suggest that these kinds of deeply textured reconstructions of individual life histories are one way to attract public attention to archaeological research, an observation that has been echoed by other scholars focused on osteobiographical approaches to the human past (e.g., boutin and callahan 2019; hosek and robb 2019; robb 2009; robb et al. 2019). recent advances in adna research provide another avenue for understanding migration and interaction in mountain landscapes. for example, paleogenetic studies have documented large-scale patterns of prehistoric migration in the study of european prehistory (e.g., haak et al. 2015; kristiansen et al. 2017). at the same time, research in late prehistoric central europe has demonstrated the value of archaeogenetic studies for understanding patterning in kinship, mobility, and social relations at a more localized scale. mittnik et  al. (2019) examine bronze age inheritance and inequality in southern germany, bringing together adna, mortuary archaeology, and isotopic analysis to elucidate the links between kinship and control over metal resources over the course of the neolithic to bronze age transition. knipper et al. (2017) employ similar methods— embedding local paleogenetic and isotopic analyses within a well-established regional archaeology—to explore patterning in patrilocality and exogamy in bell beaker complex and early bronze age southern bavaria. such interdisciplinary initiatives highlight the potential of adna approaches for informing biocultural research design in mountain landscapes. as walsh (2005:300) indicates, the presence of larger numbers of people is one strategy that can be used to reduce risk in mountain environments. relationships between individuals and communities that occupied mountain landscapes and new migrant communities are one kind of interaction that could be identified through adna research. in addition to providing a deeper understanding of mobility at the individual and community level, isotopic approaches are also useful for understanding other distinctions in lived experience between highland and lowland groups, particularly when it comes to subsistence. knipper et al. (2018), for example, explicitly compare the diets of groups exploiting the caucasus uplands and groups exploiting the adjacent humid steppe in their diachronic exploration of the russian north caucasus region. here, isotopic analysis of carbon (δ13c) and nitrogen (δ15n) isotopes preserved in the human bone collagen of “mountain dwellers and valley residents” (135), combined with gis analyses of land type and use, revealed dietary shifts that appear to have been linked to changes in settlement patterns and subsistence practices. in this case, the explicit collection and comparison of samples from a variety of habitats and time periods (knipper et al. 2018:table 9.1) helped to provide a detailed cultural and ecological framework within which to examine the diet of upland communities. as the aforementioned studies demonstrate, biomolecular analyses can provide insight into differences in diet, mobility, and connectivity between upland and lowland communities. however, standard skeletal indicators of dietary or physiological stress are also important for reconstructing mountain lifeways. eng and aldenderfer’s bioarchaeological research in the himalayas of nepal offers a useful template for exploring multiple aspects of lived experience in the highlands. through examining patterns of dental disease and childhood stress markers in a sample of three sites in the mustang district of nepal, the authors outline evidence for intersite differences in oral health in tandem with low frequencies of stress markers across all samples, identifying a “complex picture of adaptive responses among high altitude communities” (2017:11) whose lifeways are adapted to, but not determined by, their environment. traditional forms of skeletal analysis can be embedded within an understanding of archaeological context to provide deep insights into patterns of disease, labor, ritual practices, and ethnicity in mountain communities. for example, in their diachronic study of influence and colonization within the tiwanaku polity, blom et  al. (1998) assess the frequency of nonmetric cranial, dental, and skeletal traits, as well as patterning in demographic profiles and artificial cranial deformation styles to provide a beck and quinn 83 bioarchaeological test of archaeological models of interaction between the highland tiwanku heartland and local groups from the lowlands of the moquegua valley. as torres-rouff (2002) emphasizes, practices such as artificial cranial deformation can be used as a form of physical and symbolic demarcation or as a means of signaling and materializing social ties to other communities. such somatic manifestations of social practice could be used to denote various social identities—whether religious, ethnic, or status-related—within mountain groups. while multiple social identities can thus be read through treating the body as a form of material culture (sofaer 2006), human skeletal remains also encode unconscious information about the daily practices of past societies. in her investigation of labor practices in the tiwanaku state, becker (2019) profitably borrows from ingold’s notion of “taskscapes” to explore the ways in which human skeletal remains preserve a record of habitual activities in the past. through comparing the frequency and anatomical patterning of osteoarthritis in a large sample of individuals from the highland tiwanaku state core and a lower-elevation colony, this research identifies regional differences in activity patterns between the core and colony, as well as gendered and occupational differences in labor practices at varying scales. such studies provide valuable models for bioarchaeologists tasked with understanding the social lives of mountain communities. while methodological developments in bioarchaeology thus demonstrate the novel insights and rich detail that analyses of human remains can provide into the experiences of individuals living in mountain landscapes, significant challenges remain. as beavan et al. (2012:1) indicate, archaeological research focused on upland cultures is faced with particular obstacles, including issues of archaeological preservation, accessibility of samples, and researcher access to sites. in their paper in this issue, eng and aldenderfer likewise point to the potential need for lowland-adapted researchers to acclimate physically to high-altitude study sites and the limited laboratory infrastructure available in many highland regions. also problematic is the concentration of salvage archaeological work in lowlands due to the predominance of infrastructural projects in these areas; the highlands often lack the rich cultural and historical backdrop such an existing record can provide (see beck, ciugudean, and quinn’s paper in this issue). research-focused excavations are thus often a prerequisite for understanding mountain communities from a biocultural perspective, but such research programs come with a particular set of financial constraints and ethical considerations, including questions about when and why it is appropriate to embark on new excavation campaigns. however, without targeted programs of upland bioarchaeological research, the spatial distribution of archaeological research will produce biased samples which exclude mountain communities as a result of their remoteness in modern infrastructural contexts. the geological and topographic complexity of mountains also requires that we increase the quantity of samples used to create baseline maps of bioavailable strontium when compared with less geologically complex landscapes. such challenges require careful consideration moving forward and underscore the importance of this special issue for developing clear and effective strategies for mountain bioarchaeological research. 4. a global bioarchaeology of mountain landscapes the contributions to this thematic issue highlight the emerging potential for a global bioarchaeology of mountain landscapes. zavodny’s investigation of mortuary practices in bronze and iron age lika, croatia, demonstrates the utility of incorporating previously excavated data into new theoretical frameworks. her research uses a novel and systematic examination of mortuary evidence—including grave goods, body treatment, and cemetery type—to counter culture-historical narratives that portray the iapodian culture as appearing fully formed in the region during the late bronze age. her work shows that the emergence of a coherent iapodian identity was a complex process that played out differently in different valleys, relative to localized distinctions in geography that may have been linked to the ability to control and channel exchange networks. zavodny highlights the ways in which treating mortuary components as a “discrete comparative package” can assist archaeologists and bioarchaeologists untangling the complex patterns of interaction and integration that permeate the social geography of mountain regions. similarly, eng and aldenderfer use genetic analyses to unpack the “mosaic” population history of highland nepal, arguing that this region has been a nexus for intergroup interaction and movement for long periods of time. their archaeogenetic evidence provides new data against which to evaluate long-standing historical and archaeological claims about the human inhabitation of the area, leading them to forcefully underscore that “a modern perception of the ‘remoteness’ of these valleys should not be projected uncritically into the past” (eng and aldenderfer 2020:143). introduction84 importantly, eng and aldenderfer emphasize that different lines of evidence tell different, and incomplete, stories about the human past. it is only through bringing together archaeological, bioarchaeological, genomic, ethnohistoric, and paleo-environmental evidence in a comparative framework that a holistic and detailed picture of migration and biocultural adaptation begins to materialize for himalayan prehistory. our own research in transylvania, presented in this issue, has begun to explore the degree to which upland mortuary practices during the early bronze age—which incorporated different forms of mortuary treatment and structural elements than lowland tombs—may have been one way local communities signaled a distinct cultural and ethnic identity (beck, ciugudean, and quinn). here, our explicitly biocultural approach will provide a fine-grained anthropological framework for understanding the local impact of the “massive migrations” that have been argued to characterize european late prehistory (haak et  al. 2015). in this region, evaluating how lowland and upland communities maintained or negotiated distinct identities through mortuary practice has important implications for examining how “peripheral” regions responded to the larger-scale social transformations that characterized the european third millennium b.c. (harris et al. 2013). the papers in this issue also demonstrate the multi scalar potential of bioarchaeological approaches to mountain landscapes. our case study in transylvania is locally focused, comparing the bioarchaeological and mortuary evidence from two sites that could have been accessed in a day’s journey on foot in prehistory. this local scale allows us to examine the ways in which mortuary practices may have acted as a venue for signaling differences in community identity, even between groups located in close geographic proximity to one another. zavodny tacks back and forth between the local scale and the regional scale, situating her analysis of the important center of gacka within an examination of other late bronze age sites in the caput adriae, assessing how patterning in the material culture incorporated into mortuary practices can provide new information about patterns of exchange and resource control. eng and aldenderfer pursue a regional approach, drawing upon biocultural evidence from six sites in the mustang and manang districts of nepal to explore variation in migration, adaptation, and lived experience over space, time, and altitude. finally, all of the studies included in this issue emphasize the utility of interdisciplinary approaches that incorporate multiple lines of evidence and compare bioarchaeological data from the human skeleton to data drawn from archaeological, historical, and paleoclimatic records. whether examining resource access and control (beck, ciugudean, and quinn), channels of exchange (zavodny), or high-altitude adaptation (eng and aldenderfer), the research presented in this issue is careful to compare not only lowland and highland communities but also the results from a range of studies and specialities. that diverse lines of evidence are consistently incorporated into mountain bioarchaeological research from a wide variety of regions and time periods suggests that collaborative, interdisciplinary projects that involve multiple anthropological subfields and academic disciplines will provide key insights into the lives of mountain communities moving forward. 5. conclusions as lozny (2013:395) emphasizes, social scientists have taken two essential approaches to mountain landscapes: “(1) the comparison of the adaptation of similar cultures or similar technological systems to different environments, and (2) the comparison of the adaptations of different cultures to similar ecosystems.” the tension between seeking human universals and highlighting cultural particularity is not new within anthropology, but bioarchaeology is capable of contributing to both dimensions in an anthropological study of mountain communities through framing new theoretical and methodo log ical insights within an explicitly comparative approach. bioarchaeology and mortuary archaeology offer unique theoretical contributions to an anthropological understanding of mountain communities. first, both specializations provide an opportunity to assess marginality from an explicitly biocultural perspective. by combining isotopic, adna, and morphometric approaches to the analysis of human skeletal remains, while embedding such investigations in a nuanced understanding of archaeological and cultural context, bioarchaeologists can examine connectivity and adaptation through a biosocial lens. second, bioarchaeology bridges biological anthropology’s emphasis on the somatic with an archaeological focus on the long term. this dual approach allows for the development of an embodied understanding of “risky” or “remote” environments and allows anthropologists to explore how such landscapes shape and are shaped by human action over time. as the articles in this issue demonstrate, such examinations can be undertaken at a variety of scales, ranging from the local (beck, ciugudean, and quinn) to the regional (eng and aldenderfer; zavodny). finally, the unique beck and quinn 85 relationship between skeletal and mortuary evidence (quinn and beck 2016) permits a focus on community identity as communicated through mortuary practice. examining how the “lived” identities and experiences materialized in human remains intersect with the “performed” identities reified through funerary treatment allows for a holistic understanding of life and death in mountain landscapes. the methodological strategies and considerations outlined in this issue highlight the new opportunities afforded by recent developments in archaeological science and the necessity of framing such approaches within an appropriate research design. insights into the lives and deaths of individuals in mountain communities are generated both through the use of multiple lines of evidence and through bioarchaeological participation in truly interdisciplinary projects that incorporate the perspectives of multiple disciplines. the research described here includes work from bioarchaeologists, archaeologists, biomolecular anthropologists, ethnographers, cultural ecologists, and climate scientists, and the knowledge and contributions of each discipline cannot be siloed. multidisciplinary collaborations like the high himalayas archaeological research project (eng and aldenderfer) provide a model for this kind of research moving forward. finally, the research undertaken in this issue underscores that mountain communities cannot be considered in isolation. both ethnographic (cole and wolf 1974; galaty 2013; schon and galaty 2006) and archaeological research (beavan et  al. 2012; walsh 2005) reveal the extent to which the dynamics of upland living are affected and structured by events in the lowlands. that highland and lowland communities are often tightly socially and politically interlinked, however does not mean that mountain communities are merely “passive object[s] to be manipulated by outside forces” (harding 2013:385). instead, a recurring motif in anthropological examinations of these landscapes is the extent to which upland occupations balance participation in larger systems with human agency in response to economic (halstead 1990), political (scott 2009), or social (walsh 2005) factors. it is therefore important that bioarchaeological investigations of these communities are attentive to patterns of both reciprocity with and resistance to lowland agendas. although mountain communities may be conceived of as socially and environmentally peripheral, we must remember that this peripherality is often intentional and negotiated (kardulias 2007; morris 1996). understanding the interplay between social practice and the environment is a critical avenue for bioarchaeological research. the risks and opportunities provided by the topographic, geological, and ecological characteristics of mountain landscapes are part of the daily lives and ideological systems of communities that inhabit them. the articles in this issue demonstrate that through examining how identity and lived experience shape social dynamics in “remote” regions and investigating marginality from an embodied perspective, bioarchaeology can provide unparalleled insight into living and dying in mountain landscapes. acknowledgments this thematic issue is based on the 2019 society for american archaeology podium session “living and dying in mountain and highland landscapes,” and all participants in this session offered valuable insight into the challenges and potential of developing a bioarchaeology of mountain landscapes. the two session discussants, michael galaty (university of michigan) and douglas k. charles (wesleyan university), also provided thoughtful and valuable summary comments on this topic. hannah chazin (columbia university), sara juengst (unc charlotte) and alicia ventresca miller (university of michigan) provided advice and assistance regarding current research and resources for their respective regions of speciality. pedro díaz-del-río (cchs, csic madrid) assisted with the translation of the abstract into 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in addition, the bioarchaeology of impairment/disability is an emerging area of research that can contribute insight into experiences of disease consequences. in this article, we give an overview of published work on survivors of infectious disease using both bioarchaeology and disability history. using the example of post-polio paralysis, we propose a theoretical approach to the bioarchaeological study of infectious disease that is inclusive of the history of impairment and disability, which we refer to as a survivor lens. we structure this discussion through scaffolded questions that move through multiple levels of analysis: from the individual and relational to the drivers of cultural change. we argue that bioarchaeological research on past epidemics and pandemics that attends to morbidity, lasting impairment, and disability can contribute to wider conversations about infectious disease and disability in the past and present. keywords: sequelae; poliomyelitis; palaeopathology en général, les épidémies et les pandémies sont considérées en termes de morbidité et de mortalité, de susceptibilité et d’immunité, et de réponses sociales et d’impacts immédiats de l’événement épidémique. moins d’attention est accordée aux conséquences à long terme pour les individus et les populations en termes de séquelles d’infections, telles que la cécité après la variole, la surdité due à la rubéole congénitale et la paralysie après la polio. cette même tendance est observée lors de la pandémie de covid-19. il y a moins d’attention accordée au nombre de cas et de décès, aux questions d’immunité et d’impacts économiques au premier plan, et aux problèmes de santé à long terme ou chroniques des survivants de covid-19 reçoivent. une grande partie de la recherche existante sur les effets de ces séquelles de la maladie provient de la recherche sur les déficiences/handicaps. de plus, la bioarchéologie de la déficience/handicap est un domaine de recherche émergent qui peut contribuer à mieux comprendre les expériences des conséquences de maladie. dans cet article, nous donnons un aperçu des travaux publiés sur les survivants de maladies infectieuses en utilisant à la fois la bioarchéologie et l’histoire du handicap. en utilisant l’exemple de la paralysie post-polio, nous proposons une approche théorique de l’étude bioarchéologique des maladies infectieuses qui inclut l’histoire de la déficience/handicap, que nous appelons une lentille de survivant. nous structurons cette discussion à travers des questions échafaudées qui traversent de multiples niveaux d’analyse: de l’individu au relationnel, jusqu’au aux changements culturels. nous soutenons que la recherche bioarchéologique sur les épidémies et pandémies historiques qui examine la morbidité et le handicap peut contribuer à des conversations plus larges sur les maladies infectieuses et le handicap au passé ainsi qu’au présent. mots clés: séquelles; poliomyélite; paléopathologie bioarchaeologists have undertaken considerable study on past epidemics, including, most frequently, plagues caused by the bacterium yersinia pestis (e.g., dewitte 2014; spyrou et al. 2019). many of these studies have contributed extremely valuable insight into the vulnerability and risk of different demographic groups in societies, primarily in europe (e.g., castex and kacki 2016; dewitte 2009, 2010; dewitte and wood 2008; godde et al. 2020; kacki and castex 2014; rigeade et al. 2009; signoli et al. 2007; see also critical review by bramanti et al. 2018). due to the nature of the y. pestis pathogen, these investigations looked at people who succumbed relatively quickly. accordingly, bioarchaeologists often focus their studies on larger cemetery/burial deposits associated with mass deaths from epidemics of this and other infectious diseases. but in addition to the individuals who died of these diseases, there was also a portion of individuals who survived them. for example, while smallpox is notoriously deadly, 65% to 80% of infected people would have actually survived this condition, albeit frequently with long-term sequelae (long-term biological consequences of infection) (semba 2003). up to 9% of smallpox cases developed ocular complications (e.g., corneal ulcers) or severe scarring around the eye, making that disease the leading cause of blindness in europe in the centuries preceding inoculation (semba 2003). while some consequences of epidemic disease that survivors experienced may be visible archaeologically, much of the evidence may be too nonspecific to identify a clear “survivor cohort” (i.e., those who contracted but did not die of the disease). however, we argue that simply remembering that these survivors exist can provide bioarchaeologists with new approaches and lenses through which to understand the lasting repercussions of epidemics, some of which we discuss here. additionally, such an approach could potentially assist in the (re)interpretation of palaeopathological features in well-dated assemblages. in this article, we define a survivor as someone who has lived through the acute stage of an epidemic infection, whether or not the pathogen is cleared from the body (e.g., measles) or persists in a latent form (e.g., varicella-zoster or tuberculosis) with potential for later reactivation. these survivors might or might not experience lasting effects of that infection, but they are nevertheless part of a larger group of people who contracted an epidemic disease but did not die of it. recognizing that the observation of skeletal changes associated with disease is something palaeopathologists already do, what we are proposing is a particular theoretical (rather than methodological) perspective that, when integrated in study designs and interpretations, can not only add to our understanding of the past but also contribute to bringing bioarchaeological work into wider conversations about the impacts of epidemics and pandemics in the present and future. amid the current covid-19 pandemic (2019–present), much focus has been placed on 1) deaths and counts of deaths (the death toll), 2) risk factors for disease-associated mortality at the personal level (e.g., obesity, asthma), and 3) disparities in covid-19 mortality among racialized and marginalized groups. however, long covid also emerged early on as a concern, as covid-19 survivors suffering from lasting effects of the disease (aka “long-haulers”) sought to raise awareness (see perego et al. 2020), in the hopes of ending stigma and prompting more medical research toward possible treatments. long covid has brought to mind the sequelae of other diseases, such as neurological disorders following influenza (honigsbaum and krishnan 2020), cognitive impairment following cerebral malaria (john et al. 2008), and eyesight and hearing loss consequent to infection with ebola virus (clark et al. 2015). furthermore, new research around post–covid-19 sequelae has highlighted how medical interventions such as mechanical ventilation and life support have their own associated potential sequelae (torres-casto et al. 2021; for physical impairments associated with post–intensive care syndrome, see ohtake et al. 2018). despite neurological involvement and potential resulting sequelae, for example, being common in epidemics and pandemics, these complications and chronic illnesses are underrecognized and understudied—with even less attention paid to their personal, social, and economic consequences (valerio et al. 2020). poliomyelitis (polio for short), however, is an example of a disease better known for its long-term impact on survivors (hence its older name, “infantile paralysis”) than for its mortality rate. polio in the twentieth century was also deeply connected to the disability rights movement, through polio survivors. in this article, we use polio to illustrate post-epidemic survivorship and ground our discussion regarding this theoretical approach. we argue that although great focus has been placed on epidemic mortality due to its implications for demography and host–pathogen evolution (among other major topics in biological anthropology), the epidemic survivor cohort should not be forgotten in bioarchaeological contexts. in our infectious disease examples, it is clear that disease sequelae encountered by survivors may considerably affect their post-epidemic experiences through physical impairments as well as social stigma. while skeletal evidence for infectious disease sequelae is regularly described in the form of bioarchaeological case studies, we suggest that, when appropriate, these individuals should also be seen as part of a larger, “long-hauler” group affected by epidemic infectious disease. adopting this “survivor lens,” which integrates epidemic and disability research, can allow researchers to consider impacts on individuals, their relations (e.g., their families/households), and societies. through the use of a survivor lens, we argue that bioarchaeologists can ask appropriate questions about individuals and their bodies, place those bodies within social landscapes, and consider the larger cultural changes that may be linked to survivor cohorts following epidemics. accordingly, it can contribute to efforts to grow bioarchaeological approaches from traditional case studies to group-level investigations of social experience (for discussion of progress in this area, see buikstra and roberts 2012). infectious disease survivors in disability history while it is true that disability can exist without disease, and vice versa, the two have had an intimate relationship for centuries, and in some cases they are inextricably linked. linker (2013:505) disability history emerged out of the civil rights struggles that, by the 1980s, launched the field of disability studies. disability activists wanted to shift the focus from physical impairment to social disablement in order to direct attention to the political, rather than the personal and the medical (oliver 1996; see upias and the disability alliance 1975; disabled peoples’ international 1981; for a discussion of this history, see also hurst 2005). out of this came the medical (or individual) and social models of disability, which distinguish the medicalization of disability from the activists’ perspective of disability as a social situation arising from discrimination and prejudice, and not from the impairment itself. the medical model defines disability based on biological dysfunction (i.e., impairment), with a focus on treatment and “cure,” relegating issues to hospitals, clinics, and individual health interactions under the medical gaze, with medical solutions. as such, those operating according to the medical model tend to use the term “disability” interchangeably with “impairment” to describe compromised physical and/or cognitive function (rothman 2010; shakespeare 2012). in contrast, the social model holds that disability is caused solely by exclusionary social and physical structures; individuals with impairments are not “disabled” by their biology, but rather by the discriminatory, oppressive, and stigmatizing behaviors and environments within society (llewellyn and hogan 2000). under the social model, “impairment” and “disability” are distinct and separate concepts. in the first decades of the twenty-first century, critiques of the social model emerged that called for complicating the strict binary of impairment versus disability (for a review and discussion, see rembis 2019). under proposed alternative approaches, the medical and social models are still important and useful—but not mutually exclusive. snyder and mitchell’s (2010) “cultural” model, for example, accounts for both the lived reality of a compromised biological state as well as the disabling impacts of marginalizing social and physical environments. this approach recognizes the constructed nature of the body and identity, preserving the role of biological impairment in contrast to its rejection under the social model (snyder and mitchell 2010). physiological impairments experienced by disabled people (the term according to identity-first language, increasingly preferred by many disability communities, as opposed to “people with disabilities,” the term according to people-first language) likely comprise an important aspect of their embodied identities, which play a role in the disadvantages they encounter and contribute to how they experience their world (shakespeare 2012). as biosocial/biocultural anthropologists readily recognize, the biological and the social/cultural are deeply intertwined (fuentes 2020; shakespeare 2014). we cannot deny the role that the body and physical experiences play in an individual’s lived experience and sociocultural context; impairments may indeed shape how social and cultural situations are experienced. furthermore, impairment and disability are dynamic, situated, and intersectional with age, gender, race, religion, class, and other markers of identity (rembis 2019). accepting impairment/disability as overlapping and interrelated categories allows for more complexity and nuance in considering pain and suffering, as well as more critical engagement—but not rejection—of concepts such as diagnosis, treatment, recovery, cure, and care (rembis 2019). the emergence of these alternative approaches and their associated critiques of the social model should not be perceived as a rejection of the social model per se but rather as a sign of its extraordinary influence and usefulness in moving understandings of disability forward. by breaking the assumed link between physical impairment and social disability, the social model de-naturalized disability and opened up space for not only changing policy and professional practice but “transform[ing] consciousness” more broadly (oliver 1996:42). this reconceptualization of impairment/disability primarily looked ahead—to changing material circumstances for disabled people in the present and future. however, in recognition that perceptions of the past shape present action, it also influenced historical work. besides war (which often goes hand-in-hand with epidemic disease) and work, diseases have been the primary producers of disabled people (kudlick 2014; rembis 2019). yet, disability history and the history of infectious disease and epidemics are typically siloed in separate fields. historians catherine kudlick (2013, 2018) and beth linker (2013) have called for disability to be used not only as a topic for study but as a tool of analysis. rather than epidemic mortality, kudlick has argued for a focus on survivors of infectious diseases, such as smallpox, as a way not only to expand understandings of epidemics in history but also to bring disability history and medical history together. survivors, rather than death tolls, are placed at the center of analysis. epidemics have “a hidden history” of disability and survival, and examining this hidden history provokes questions about taken-for-granted ideas regarding personal, social, and political reactions and responses to both epidemic disease and disability (kudlick 2014:197). kudlick (2013) points to polio as the best example of existing work that brings together medical and disability history—though still with much scope for more. taking inspiration from and building on this work by historians, we envision similar developments in bioarchaeology, bringing together the paleopathology of infectious disease and the emerging (bio)archaeology of disability to better understand the impact of epidemics. bioarchaeology can play an important role in locating impairment and interpreting societal reactions to such bodily differences and, as far as possible, the lived experience of disabled people (rembis 2019). authors such as buckingham (2011) and southwell-wright (2013) have made the point that much of historical research relies upon, or predominantly represents, elite views and not the full spectrum of society. additionally, marginalized groups are often underrepresented in quantitative historical data. bioarchaeologists work with samples that often reach beyond the elite and therefore may better characterize the experiences of average and marginalized bodies. in the following section, we discuss the current state of bioarchaeological research on impairment and disability, with attention to its relationship with infectious disease. disability in bioarchaeology early palaeopathological and bioarchaeological contributions in this area often showed interest in understanding an individual’s suffering or experience of disability (e.g., brothwell 1961). in some of these early cases, authors were quite creative in presenting interpretations of skeletal material that today might seem baseless (e.g., some narrative work by calvin wells, as described by waldron 2014). tendencies to allude to the past feelings of individuals with impairments, and sometimes their caregivers, eventually inspired dettwyler’s (1991) critique, “can palaeopathology provide evidence for ‘compassion’?” while this work does articulate with concepts of impairment and disability, dettwyler’s (1991) primary argument is against the unjustified interpretations of community motivations and compassion, as well as of the quality of life of impaired individuals in the past. this stern warning was likely warranted but unfortunately impeded much of the bioarchaeological commentary on disability for many years. it took some time following dettwyler’s (1991) publication, but near the end of the decade, volumes began to emerge that tackled themes related to identity, disability, and archaeology in new ways (finlay 1999; hubert 2000). these volumes integrated contributions from scholars and disability specialists in diverse fields, from anthropology to law to psychiatry. in one of these archaeologically focused collections, cross (1999:24), a disability scholar, explains disability politics and adopts a social model perspective to remind readers of terminological differences and, very importantly, that “archaeologists dig up impairment, not disability.” roberts (1999, 2000) also argues the importance of contextualizing disability, reminding readers that disability is something social and that its meaning and experience may differ. these socially informed perspectives were often published alongside medically oriented contributions that focused on interpreting “disadvantage” from skeletal evidence for disease and deformity and served to remind readers of the archaeological invisibility of people with impairments (waldron 2000). a dichotomy in approaches did not go unnoticed at this stage, and prominent disability studies scholar tom shakespeare (1999:100) warned (bio)archaeologists to not be reductionists who confuse “the biological evidence with the social experience.” shakespeare (1999) also observed a lack of consistency with our terminology at this stage, placing bioarchaeologists out of step with the broader disability studies context. discussion surrounding the interpretation of disability from skeletal and archaeological data slowed again at this point. some publications in the 1990s investigated impairment, such as knüsel et al. (1992) and hawkey (1998). however, for the most part, these publications examined physical function as it is preserved in the skeleton, rather than engaging directly with disability studies literature, theories, and terminology. in the later 2000s and early 2010s, we saw bioarchaeologists revive this discourse, alongside advancements in how we conceptualize bodies (e.g., sofaer 2006). knudson and stojanowski (2008), for example, engaged with the social model of disability and reflected on disability as an aspect of individual social identity that might be elucidated from funerary contexts and skeletal remains. we then saw inquiry into disability in archaeology pickup, with contributions critiquing the under-theorization of this area of study within anthropology and reinvigorating dialogue with a greater connection with the disability studies literature (e.g., battles 2011; southwell-wright 2013). in the mid-2010s, a new angle to looking at human experiences of impairments and possible disabilities was introduced by lorna tilley (2012) in the form of the bioarchaeology of care. the bioarchaeology of care model has since been thoroughly explored in various volumes and studies (e.g., tilley 2015; tilley and cameron 2014; tilley and schrenk 2017). despite earlier calls for more direct engagement with disability studies literature when looking at difference in the past, tilley’s work continues to take a more medicalized approach, adopting definitions and conceptualizations of disability as outlined by the world health organization (tilley and schrenk 2017:16). the research rigor that is encouraged by the use of the bioarchaeology of care framework is admirable and has resulted in many published case studies by researchers wishing to better understand the experiences of past people (e.g., málaga and makowski 2019; solari et al. 2020; tornberg and jacobsson 2018; and many more). for example, tilley and nystrom (2019) applied this model in their analysis of the mummified remains of a nasca child from peru (ca. 700 a.d.) with evidence for tuberculosis. the insights drawn from this case allow researchers to interpret that the nasca people “cherished their children,” giving greater insight into this culture’s daily life (tilley and nystrom 2019:79). while some of this wealth of care-related literature reaches into individual, social, and cultural perceptions of impairment as it relates to care provision, it does not explicitly engage with the realm of critical disability studies as advocated in the 1990s. alongside the bioarchaeology of care, we have seen the emergence of additional discussions of diverse human experiences and frameworks for the bioarchaeology of personhood (boutin 2016) and the bioarchaeology of impairment and disability (byrnes and muller 2017; matczak et al. 2019). while some volumes (e.g., byrnes and muller 2017) integrate voices from critical disability studies such as shuttleworth and meekosha (2017), in practice, much of the bioarchaeological work remains grounded in more medically oriented models of disability. like the bioarchaeology of care, this developing bioarchaeology of impairment and disability predominantly relies on the frameworks and definitions by the world health organization that are familiar to modern clinicians. alternatives, such as the bioarchaeology of personhood proposed by boutin (2016), have more social-model foundations; they argue once again that disability has been under-theorized by bioarchaeologists and indicate that possibilities to better interact with diverse public audiences must be promoted. approaches that engage more with embodiment and intersectional identities (gowland 2017; schrader and torres-rouff 2020) also have considerable potential in their recognition and engagement with critical and social disability theories. although more socially informed models exist in bioarchaeology, they have not gained as much traction as the medically driven frameworks. it is difficult to explain why this might be, as the critical disability engagement with bioarchaeology has been calling out for more theoretical nuance for the past 25 years. perhaps our persistent adoption of the medical approach is a tactic that permits bioarchaeologists to still firmly situate their evidence for disability within the analysis of the human body itself, through the skeletal remains. however, if we continue to choose this route, we must remember shakespeare’s (1999:100) critique and be absolutely certain we are not confusing “the biological evidence with the social experience.” bioarchaeology has the potential to greatly broaden the scope of what we can learn about experiences of epidemic survivorship and disability in the past. by continuing to develop our discipline, as well as how we view and interpret past lives and experiences, we can work to better represent the diversity in humans as well as the repercussions of epidemic disease. envisioning a survivor lens approach in this section, we explore how approaching archaeological assemblages using a survivor lens will improve our understanding of the consequences and human experiences of infectious disease. it is important to note that this new theoretical nuance in epidemic interpretations must be adapted and flexibly applied depending on the context; different diseases will require their own unique methodological techniques and contextualized interpretations using this approach. due to considerable variation in diseases, contexts, and possible methods of investigation, we are not able to prescribe a specific “how-to” for identifying and interpreting survivors in bioarchaeology; there are simply too many factors that are unique in each situation. instead, to demonstrate the importance of our aims, we use poliomyelitis and other infectious disease examples to discuss how a survivor lens can illuminate survivors’ individual, social, and cultural experiences and contributions and therefore extend bioarchaeological interpretations. poliomyelitis is a disease caused by infection with one of the smallest known viruses, an enterovirus in the picornaviridae family of rna viruses, with three serotypes that vary in neurovirulence. it is an enteric infection spread through the fecal–oral route (contaminated water or food or person-to-person via contaminated hands) or by droplets or aerosols (person-to-person). the poliovirus spreads from the throat or intestines to the lymph nodes and then to the bloodstream. from there, it may enter the central nervous system, where it damages motor neurons, causing paralysis and other complications (smallman-raynor et al. 2006). symptoms of polio infection can vary from sore throat, headache, and other signs of influenza-like illness to severe and potentially fatal paralysis and encephalitis. polio likely affected some individuals in the past. however, reported cases are relatively rare in the archaeological literature and in all instances represent case studies of individuals with some degree of paralysis (possible archaeological cases of polio are summarized by novak et al. 2014 and berner et al. 2021). poliomyelitis can be remarkably debilitating but results in relatively low mortality in the regions where it is endemic. with the wealth of modern clinical and archival literature available on polio and survivors’ experiences, as well as its propensity to leave identifiable skeletal indicators in some infected individuals, there is significant scope for investigating polio’s past epidemic legacies. moreover, poliomyelitis serves as a perfect example to demonstrate the importance of looking beyond epidemic-related deaths and pivoting our perspectives to more fully consider an epidemic’s survivors while keeping a familiar touchstone of identifiable skeletal lesions upon which palaeopathologists typically ground their interpretations. in the following sections, we consider three questions: if epidemics were as common in the more distant past as they were in recent history, where are all the survivors in archaeological contexts? what can infectious disease survivors tell us? and how does taking a survivor lens to view the (pre)history of epidemic disease change our perspective? these scaffolded questions move through multiple levels of analysis: from the individual body, to the social and interpersonal, to the drivers of cultural change. where are all the survivors? individuals and bodies traditional palaeopathology often relies on the observation of skeletal lesions (e.g., lytic and blastic bone responses). however, individual infections and their sequelae may not result in osteological changes or be identifiable via biochemical techniques. bioarchaeologists are accustomed to working within these limitations to investigate conditions that only manifest skeletally in a subset of all those infected. for example, tuberculosis affects the skeleton in only 3% to 5% of cases (roberts and buikstra 2019). table 1 provides examples of a variety of infectious diseases that are often associated with long-term sequelae; some leave skeletally observable indicators, but many may leave no trace (see also valerio et al. 2020:table 2 for examples of epidemic diseases with known neurological complications). because there will almost always be a subset of individuals who live through an infectious disease but do not manifest skeletal lesions, bioarchaeologists must still remember that these “invisibly” impaired individuals exist within the assemblages we are investigating. palaeopathologists and bioarchaeologists are already experienced with considering such cases as a subsample of a wider survivor population and should therefore be well positioned to take on a survivor lens that relies on careful extrapolation of diseases and their sequelae from the individual to group levels. by considering the long-term consequences of polio more closely, we can explore the challenges associated with accounting for survivors in archaeological contexts. there are three clinically recognized forms of poliomyelitis: abortive (minor illness only), nonparalytic (major illness without paralysis), and paralytic (major illness with subsequent paralysis). paralytic polio is one of the most recognizable expressions of this disease and typically results in acute flaccid paralysis (i.e., muscle weakness or paralysis with sudden onset) of one or more limbs (smallman-raynor et al. 2006). however, the vast majority of infections are asymptomatic or with such mild symptoms that the infection goes unnoticed; between 4% and 8% are the abortive form and only 1% to 2% become major illnesses (e.g., paralytic) (smallman-raynor et al. 2006). table 1. selected infectious diseases and associated sequelae. disease   pathogen   potential for reactivation?1   sequelae (general synopsis with selected examples)2   sources chickenpox   varicella-zoster virus (vzv)   yes; reactivation may be acute second episode or become chronic   reactivation of vzv as shingles can lead to a chronic syndrome called postherpetic neuralgia and can include encephalitis, vision loss, facial palsy (ramsay-hunt syndrome), and chronic paralysis of an extremity.   hayashi et al. (2009) poliomyelitis   poliovirus   no   the main characteristic of polio is acute flaccid paralysis affecting one or more limbs. limb shortening may occur if the infection occurs before skeletal maturity, and muscle impairment or paralysis and compensatory biomechanical use may cause other osseous changes. for example, scoliosis may develop due to asymmetrical trunk paralysis. post-polio syndrome occurs in a large proportion of paralytic polio survivors and is characterized by renewed, progressive muscle weakness; muscle and joint pain; and fatigue decades after original recovery.   grauer and roberts (2019); smallmanraynor et al. (2006) smallpox   orthopoxvirus variola, aka variola virus. two variants (major and minor)   no   smallpox infection often leads to scarring, sometimes severe enough to prevent eyes from opening, resulting in impaired vision or blindness. ocular complications are another potential cause of blindness. infection of the bones and joints (osteomyelitis variolosa) can cause bone lesions, deformity, joint fusion, and lasting joint pain. the elbows are particularly likely to be affected.   darton et al. (2013); grauer and roberts (2019) syphilis   treponema pallidum pallidum   yes   while this disease may not initially easily fit the “survivor” model proposed in this article, syphilis is argued to have appeared in a more virulent epidemic form in certain times and contexts, such as in late fifteenth/early sixteenth-century europe and in nineteenth-century australia as the disease was introduced to the aboriginal population by european colonists. as such, in some contexts, syphilis can be viewed as an epidemic condition using a survivor lens. t. pallidum bacteria infect the skin and mucous membranes, with progressive stages of the disease divided into primary, secondary, and tertiary forms (with latent asymptomatic periods). long-term infection can lead to lesions and changes in various bodily systems, particularly the skin and the cardiovascular and musculoskeletal systems, including aortitis (the most common cause of death from syphilis), gummatous osteomyelitis, periostitis of the long bones and cranium, and pseudo-rheumatism. early congenital syphilis (birth–2 years) can include hydrocephalus and osteochondritis with pseudoparalysis of the limbs. late congenital syphilis (>2 years of age) can include gummatous lesions (leading to saber shins and bossing of the frontal and parietal bones) and maldevelopment of the maxilla and dentition. deafness and blindness are also potential sequelae.   de melo et al. (2010); dowling (1997); fratamico et al. (2009); klausner and freeman (2009); tesini (2020) tuberculosis (tb)   mycobacterium tuberculosis   yes   tuberculosis infection is divided into three stages: primary infection, latent tb, and chronic active tb. if the initial primary infection becomes disseminated throughout the body, complications such as tuberculous meningitis (which occurs most often in young children or immunosuppressed individuals) may develop. in chronic active tb, as the disease progresses, symptoms such as fevers and anorexia develop, and in terms of extrapulmonary tb, lesions and abscesses can occur in multiple sites or tissues. tb can affect bone in approximately 3% to 5% of cases. foci are most commonly found in the vertebrae (known as pott’s disease, with potential for spinal cord compression; pott’s paraplegia; and kyphosis due to vertebral collapse) and joints, such as the hip and knee, which can lead to dislocation, ankylosis, and/or arthritis.   roberts and buikstra (2019); greenstein et al. (2009) 1the diseases and pathogens listed are those with an initial acute infection phase after exposure, after which the pathogen may be either cleared from the body or persist in a latent phase with the potential for later reactivation. in this article, a “survivor” refers to someone who did not die in the acute infection phase. 2we have included a selection of sequelae with an emphasis on those potentially observable bioachaeologically, particularly on skeletal remains. we have also included some conditions less likely to be visible bioarchaeologically to give a broader representation of the possible impairments. the sequelae listed here do not represent all potential sequelae of each disease. modern bioarchaeological studies have discussed possible cases of the paralytic form of poliomyelitis in archaeological skeletons based on the observation of skeletal traits indicative of the associated disuse and altered function. the most commonly reported skeletal changes include shortened limbs, bone atrophy, and torsion and abnormal curvature of long bones (castells navarro et al. 2017; ciesielska and stark 2020; gładykowska‐rzeczycka and śmiszkiewicz‐skwarska 1998; kozlowski and piontek 2000; lászló 2017; novak et al. 2014; thompson 2014). scoliosis and skeletal evidence of clubfoot are also regularly mentioned (e.g., castells navarro et al. 2017; winkler and grosschmidt 1988). although there are some distinguishing features of paralytic polio, poliomyelitis has only rarely been diagnosed in archaeological human remains despite being potentially common in the past. the apparent “rarity” of polio is perhaps not surprising given that only a small minority of poliovirus infections tend to develop into major illnesses with long-term sequelae. however, even one or two in 100 infections developing into paralytic cases adds up to a large number of potentially visible polio survivors. this prevailing perception of polio as a “rare” disease is addressed by berner et al. (2021), who argue for the use of a number of specific geographic, environmental, demographic, and cultural variables in the systematic analysis of ancient cemeteries. they offer a specific methodological approach to the diagnosis of paralytic poliomyelitis in survivors and suggest development of a measure of this “rarity” for this and other diseases yielding a ratio of prevalence with a community (berner et al. 2021). we encourage readers interested in exploring specific methods for investigating survivors to consider berner et al.’s (2021) suggested approaches. recognizing polio as a “common” rather than a “rare” disease does not mean assuming it was evenly distributed across populations. urban, rural, and remote contexts would be differentially affected; the virus could only be established (endemic) in large urban settlements of 250,000 people or more (the critical community size for poliovirus; eichner et al. 1994). smallman-raynor et al. (2006) classify polio as being in this endemic phase in large populations prior to (ca.) 1880 a.d. in endemic polio contexts, most manifestations of the disease would be abortive (i.e., minor) and occur in infants—who, once they had contracted polio once in their life, would develop immunity and be unlikely to contract a more severe form later. in contrast, populations who had never before encountered polio would be more likely to have higher mortality and larger groups of people affected with more severe disease sequelae (paul 1971). in any population where the poliovirus was new—and people had no immunity from prior exposures—it is a logical possibility that a substantial outbreak would have occurred upon that population encountering the virus for the first time. for example, the 1947–1948 polio epidemic in the nicobar islands appears to have been largely a “virgin soil” epidemic, with approximately 10% of the population developing symptoms of paralytic polio and causing 280 deaths; in one village, 15.8% developed paralytic polio, and 3.9% of the population died (moses 1948; smallman-raynor et al. 2006:422–424). a 1949 outbreak in chesterfield inlet, nunavut, canada, left over 14% of its inuit population of 275 people with paralysis and caused 14 deaths—a mortality rate of over 5% (adamson et al. 1949). total morbidity for the outbreak (those showing any symptoms of the infection) was estimated at 50% or more (adamson et al. 1949). polio here nicely demonstrates the “iceberg concept of infection,” described by evans (1984) as referring to a biological gradient of host response to a pathogen. some pathogens, such as the viruses that cause rabies and measles, cause clinically apparent illness in all or nearly all infections of human hosts. in others (such as poliovirus), clinical illness comprises only a small proportion of the host response pattern, with asymptomatic or unrecognized infections making up a larger share (evans 1984). we have adapted evans’s original analogy and diagram to represent the implications of this gradient for the visibility of sequelae in the archaeological record, visually indicating relative proportions of individuals who may show disease sequelae in osteological contexts versus those who likely will not (fig. 1). figure 1. diagram illustrating the “iceberg concept of infection” and its implications for visibility of sequelae in the archaeological record. adapted from evans (1984:figure 2, 20). bioarchaeology (in terms of analysis of skeletal remains in their archaeological context) may be one of the few options available for learning more about the history and origins of polio. genomic investigations are not promising options to advance our ability to identify polio survivors; as a tiny rna virus that rapidly accumulates nucleotide substitutions, poliovirus does not survive for ancient genomics analysis and also does not lend itself to phylogenetic reconstruction beyond only the very recent past (i.e., past several decades) (jorba et al. 2008; kuge et al. 1989; rico-hesse et al. 1987). in summary, it is nearly impossible to see polio epidemic deaths that happen in the acute stage bioarchaeologically—no ancient rna, no signs on the body/skeleton, and unlikely mass mortality. this leaves the bodies of the survivors (i.e., those with the longer-lasting sequelae such as paralysis) as the only bioarchaeological evidence—a small but visible portion of the “infection iceberg” in which deaths represent only the very tip (see fig. 1). polio, therefore, forces us to look at the survivors, not the fatalities—an important lesson that can be extended to other infectious diseases regardless of how they manifest skeletally. based on the iceberg model of infection, as long as even one skeletal case of paralytic polio is identified, it can be inferred that other instances of the disease were also present in the population, albeit perhaps in other forms (e.g., abortive, nonparalytic). although the exact infection rates may remain unknown, the link between skeletally visible and invisible cases is clear. blanket interpretations, however, about survivors and rates of survivors are typically not possible due to contextual variability in infection rates (e.g., urban versus rural) and differences in the rate that sequelae manifest. as such, it continues to be vital that bioarchaeologists and palaeopathologists situate their interpretations carefully within each context and remember that the individuals with lesions represent only a subset of the whole survivor cohort. what can survivors tell us? social landscapes and behaviors building on an understanding of the presence of visible and invisible survivors in the archaeological record (see previous section and fig. 1), it is next necessary to explore how individuals and their bodies interact with the existing social landscape. this section explores the “social” impacts on and experiences of survivors through health care practices, treatments, and functional outcomes, as well as stigma enacted by other members of their communities. while discussing the social impacts on individuals, we also revisit (social model) distinctions between impairment and disability and consider the role these perceptions of difference may play in survivors’ experiences. by applying a survivor lens while considering the aftermath of epidemics, this section shows how we might move beyond individual bodies to better understand the social circumstances within which they lived and how these circumstances may have shaped survivors’ lives. treatment is often a necessary intervention to ensure survival and achieve outcomes that are perceived as optimal. although lives, functional abilities, and/or appearances may have been preserved, these same treatment interventions can also sometimes cause poor long-term outcomes in survivors. immobilization and bedrest are examples of treatments that may help individual health and mobility outcomes but come with potential detrimental trade-offs. immobilization was a common practice in twentieth-century polio epidemics, with the goal of preventing skeletal deformities (ross 1993); however, it also contributed to muscle atrophy and reduced joint flexibility (altenbaugh 2015). in tuberculosis sanitoria, bedrest was a common treatment in order to “immobilize the lungs” (coryllos 1933). in both these cases, extended periods of immobility would affect all bodily systems and could contribute to an individual’s overall “frailty,” leading to increased fracture risks due to reduced bone mass and central nervous system changes creating reductions in balance, as well as respiratory and cardiac complications (dittmer and teasell 1993; teasell and dittmer 1993). bioarchaeological studies such as those by sparacello et al. (2016) and mansukoski and sparacello (2018) underscore these periods of reduced mobility in the past and report skeletal evidence for growth interruptions and increased gracility in individuals associated with responses to or risks for chronic tuberculosis infection. thus, the skeletal material (and the impairment experienced in life) reflects not only disease processes but also ideas about proper treatment and intervention as well as ideal outcomes in terms of function and aesthetics. in terms of their experiences as survivors, people who have had polio, especially those with severe paralysis, are also subject to increased mortality in the long term (nielsen et al. 2003). among other risks, potentially fatal complications such as pneumonia may develop over time. furthermore, decades after recovery from the initial infection, polio survivors can develop “post-polio syndrome,” characterized by symptoms including muscle weakness and fatigue. the cause is believed to be a failure of the motor neurons that compensated for the damage from the original infection (jubelt and agre 2000). thus, even after a period of recovery and stability, polio survivors can still experience increasing impairment and disability. estimates of the proportion of survivors who go on to develop post-polio syndrome range from 28.5% to 64%, with those who had more severe acute infections followed by greater functional recovery apparently at higher risk (jubelt and agre 2000; ramlow et al. 1992; windebank et al. 1991). bioarchaeologists who have considered polio as a possible cause for the skeletal changes they observed have focused on a range of interpretive outcomes. early work by mitchell (1900) was concerned with morphology and patterning of the asymmetry but still considered the ways that the affected individual may have compensated for their different leg lengths through the use of high-soled sandals and balancing staves. this interest in individuals’ mobility carries on in modern studies, where researchers use similar observations and measurements to comment on the functional consequences of paralytic polio (novak et al. 2014). other scholars strive to interpret the experiences of individuals with neuromuscular conditions using frameworks such as the bioarchaeology of care. although polio was listed as just one of many possibilities, schrenk and martin (2017) adopt this approach with the case of an 18-year-old female from the bronze age united arab emirates in order to understand her experience of care as well as social and community relationships. they suggest that this individual likely needed some care provision that was provided predominantly by her close contacts but was also able to be somewhat self-sufficient with her upper body as long as materials were within reach (schrenk and martin 2017). a more quantitative approach is proposed by stodder (2017), who adopts the world health organization’s global burden of disease (gbd) project model (and its associated metrics of disability weights and years lived with disability) to focus on morbidity over mortality and better deal with conditions that do not fit easily into specific etiological frameworks. one of the categories in the gbd model, “impairment (hip, leg, foot),” was originally designed for polio sequelae but later expanded to include non-polio causation (stodder 2017:note on table 10.1, 188). the advantage of the gbd approach, she says, is that it can reveal things about a population’s health that are masked in demographic statistics, such as in life tables (stodder 2017). we have established that following epidemics, there is often a subset of the population that experiences long-term and potentially impairing consequences. these impairments can be invisible and private, but they can also be recognized within communities and among individuals. in some cases, this visibility results in judgment and prejudice against those individuals because they have been (or continue to be) affected by a disease, which may carry a stigma. this stigmatization has the potential to alienate individuals and groups of individuals in a society and fuel health inequalities (hatzenbuehler et al. 2013; james et al. 2020). it can also result in additional (negative) outcomes related to the embodied experiences of stigma. for example, stress is one pathway through which stigma can become embodied. the physiological stress response elicited by exposure to stigma can slow recovery and increase a person’s chances of developing complications such as secondary or additional infections, while psychosocial stress can have serious mental health impacts (brewis et al. 2020). stigma associated with an infectious disease and/or its sequelae can also reinforce existing stereotypes and heighten discrimination when concentrated in already marginalized groups; such intersectional stigma can lead to the compounding of suffering (brewis et al. 2020; for discussion of intersectional analysis in bioarchaeology, see mant et al. 2021 and yaussy 2019). furthermore, visible and impairing sequelae following infection with a contagious disease can also increase suffering by bringing discrimination and the stigma of disability and difference into the mix. stigma around polio in the twentieth century could manifest in different ways, such as the perception of polio survivors as dangerous spreaders of contagion even long after recovery. for example, one polio survivor recalls, “years after i had polio, when adults saw me coming they would say out loud to their children to stay away from me because they could ‘catch it’” (bruno 2002:83). polio survivors were also subject to overt and more generalized prejudice associated with their new disability status. bruno remembers another incident in which a stranger on the street one day stopped him and declared, “you cripples shouldn’t be allowed in public!” (bruno 2002:83). it is clear that polio survivors experienced stigma and social exclusion in the historical past. these examples, combined with other historic and archaeological examples of stigma associated with infectious diseases (e.g., leprosy), support the idea that people with infectious disease sequelae in other contexts may have been treated differently following infection. investigations of archaeological difference have the potential to yield enormous insight into the social circumstances existing after an epidemic disease (e.g., hubert 2000). by using existing bioarchaeological theories and methods (embodiment, bioarchaeology of personhood, bioarchaeology of care) strongly grounded in a contextual understanding of the region and time, survivors can be remembered and situated in their social landscapes to better infer their specific experiences and how they were shaped by community attitudes. work on leprosy and leprosaria already deals with many of these questions (e.g., roberts 2011, 2020; robbins schug 2016), and these approaches may be useful as we continue to consider survivors of other epidemic infectious diseases and the social and embodied repercussions they encountered. while stigma is frequently associated with infectious diseases and their sequelae, it is imperative that bioarchaeologists always ground interpretations of stigma experienced by survivors in appropriate contextual data. we must not apply our modern understanding of disease perceptions to the past, as they very well may have differed. this is nicely demonstrated by robbins schug’s (2016) investigation of the evolution of stigma against people with leprosy in south asia. using both mortuary evidence and textual analysis, robbins schug situates shifts in the disease experience of leprosy within changes in climate, politics, economy, and society, particularly major fluctuations in urbanism over millennia. she finds that at some points in time, leprosy was much less stigmatized by community members than at other times. her findings demonstrate a clear destabilization of the assumption that stigmatization and othering of people with leprosy is natural and universal (robbins schug 2016). in other words, the presence of disease or related sequelae alone does not predict the occurrence of stigma or preface the development of changes in social behaviors associated with treatment of individuals with disease repercussions. robbins schug’s (2016) research provides a valuable example of bioarchaeological work that de-naturalizes the link between the medical (disease, impairment) and the social (disability). the primary point of the social model is not that there is no relationship at all between the two but rather that impairment does not have to lead to disability. taking a survivor lens approach, embedded with understanding of the socially nuanced differences between impairment and disability, will tell us much about survivor experiences of not only their bodies but also the broader social landscape in which they lived, including the nature and impacts of treatment and stigmatization. how does taking a survivor lens change our perspective? cultural insights and developments this focus on survivors—not those that simply made it through the epidemic event, but those whose bodies were permanently marked by the disease (visibly or not)—gives us a different perspective on the disease and its impact, on both the pathogen as it moved through human populations and on how populations and societies were changed by its effects. people with bodies sharing the same “designations of deviance” can find themselves clustered together in certain settings (e.g., institutions) and/or discover that their critical mass allows for effective collective social and political action (snyder and mitchell 2006:185). we know, for example, from histories of the past century that the emergence of large cohorts of wounded soldiers and polio survivors led to major medical, political, and social changes, from advances in orthopedics to the disability rights and disabled consumer movements and their wide impact (see, for example, kaufert and kaufert 1984; liebenberg 1994). despite such progress, many of our assumptions and interpretations, driven by modern cultural perspectives, are still ableist in nature. ableism is a set of ideas, values, and practices that hold able-bodiedness as the standard of normalcy, desirability, and productivity and accordingly marginalize, oppress, and render “invisible” those who deviate from that standard (chouinard 1997; wolbring 2008). particular configurations of ableism today can shape our approach to the past. in order to challenge culturally ingrained preconceptions, this section works to illuminate how contributions and innovations led by survivors helped to drive meaningful cultural changes in the perception of, and attitudes about and toward, disabled people. the large and recurring polio epidemics of the early twentieth century, combined with standard immobilization treatments, resulted in an increasing need for polio aftercare. at the same time, the first world war also created a similar demand for treatment of wounded, disabled soldiers. both of these events, and particularly their historical confluence, are credited with laying the groundwork for modern physical therapy (altenbaugh 2015) as well as modern orthopedics (see battles 2019; ross 1993). orthopedic surgeons and rehabilitative therapists often took treatment techniques originally developed with one group and applied them for the other. for example, once the influx of wounded troops to new zealand’s military hospitals waned, the hospitals transitioned to civilian use, and the orthopedic expertise of military medical staff was applied to the treatment of polio survivors (battles 2019). in the same vein, physical therapy techniques developed in the care of polio survivors after the 1916 epidemic in new zealand were seen as potentially useful for the care of the war-wounded (see battles 2019). perhaps unsurprisingly, these two groups (polio survivors and wounded soldiers) sometimes found themselves co-resident in the same facilities, with significant impact on their experiences of rehabilitation (see, for example, battles 2019 and ross 1993 in new zealand and koven 1994 in great britain). while these rehabilitative institutions and their associated treatments typically operated with the goal of shaping bodies to fit back into an able-bodied normative world, at the same time, there is an extensive literature on how polio survivors shaped their societies and cultures in the twentieth century. the impact of polio on culture is particularly evident in countries where waves of polio epidemics led to the emergence of institutional patient cultures and community formation among disabled polio survivors (see altenbaugh 2015; gallagher 1998). the form these communities and impacts took depended on local and, particularly in the twentieth century, national contexts. in cold war hungary, for example, the ideas and values of modernity, industry, and production shaped the rehabilitative treatment of polio survivors, with training for specific trades (vargha 2018b). similar to work offered in other institutional rehabilitative settings, these trades consisted of watch repair and shoemaking for boys and men, and work in the prosthetics factory for girls and women (vargha 2018b). furthermore, vargha (2018a) describes the formation of a civil society in the late 1970s by hungarian polio survivors who drew on their institutional networks developed during their long periods in the hospital. their aim was to achieve disabled people’s full participation in society and as such organized themselves to provide for each other and to call upon the state to fulfill its responsibilities toward them (vargha 2018a). finding their institutional occupational training restricted their options for education and work, hungary’s national association of disabled societies established a packaging company that provided its members with work options (vargha 2018a). to organize such a society that was neither directly opposed to the government nor co-opted by it was a remarkable thing in the midst of a communist state (vargha 2018a). while their placement within institutions and the emphasis on normative bodies are less than ideal, these social circumstances within which survivors lived provided an opportunity for cultural reformations found through the development of disability-led communities. one of the most famous polio survivors was former u.s. president franklin d. roosevelt (fdr). fdr contracted polio in 1921 when he was 39 years old, which developed into the paralytic form. although he made efforts to downplay any disability during his time in office, he was instrumental in establishing the warm springs institute, a comprehensive rehabilitation center initially focused on post-polio recovery in all its physical, psychological, and social dimensions (holland 2006) but which today includes rehabilitation for other spinal cord and stroke-related conditions. although fdr was just one survivor, the innovative nature of the warm springs institute created an important community for many disease (polio) survivors; a number of future disability rights activists (e.g., hugh gallagher, discussed further below) spent time there (see patterson 2012). holland (2006) describes warm springs in the 1920s to 1940s as an enclave where the stigma of disability was not only transcended but the medical model of disability itself was challenged. quality of life, rather than a “cure,” was the focus (holland 2006). furthermore, the physical environment of warm springs was designed to be fully accessible—one of the few outdoor facilities to do so at the time (holland 2006). this rehabilitation center, initiated by a disabled infectious disease survivor and hosting a similar survivor community, with disabled people in leadership positions as staff and board members, is argued to be the precursor to the disability rights, universal design, and independent living movements (holland 2006). warm springs not only foreshadowed these later movements but directly influenced them; for example, fred fay, who spent two years at warm springs, established the boston center for independent living in 1974 (holland 2006). the independent living movement argues for reinvention of medical model–style rehabilitation and education programs (holland 2006), with disabled people, rather than medical professionals, in control. it drew inspiration from other movements, including the civil rights movement of the 1950s to 1960s, and has been instrumental in changing the way that disabled people live day-to-day. at the same time, the operation of warm springs as a white-only facility in the american south fostering white leadership also influenced the shape of the american disability rights movement (i.e., problematically, as a predominantly white-led initiative) (patterson 2012). due to these facilities established by a survivor who created communities for survivors, we can clearly see cultural changes in ways of living and social perception that affected not only the survivors, but also their families, community members, and broader society. as with the first world war, the aftermath of the second world war combined with polio epidemics amid the postwar baby boom spurred political and public support in the united states to fund rehabilitation and develop new mobility aids (altenbaugh 2015). this increase in warand disease-related impairments also led to changes in architecture and design (e.g., single-level homes) and adapted vehicles (e.g., introduction of hand controls) (altenbaugh 2015:191 citing gallagher 1998; buick motor division 1946). in the united states, activists such as edward roberts, judy heumann, mary lou breslin, and hugh gregory gallagher—all polio survivors who used wheelchairs—had substantial impacts on changing policies and regulations for accessibility, some of which led to major changes in built environments. for example, roberts and other members of an activist group of disabled students at the university of california at berkeley, known as the “rolling quads,” campaigned for better physical community access (e.g., curb cuts in sidewalks to facilitate wheelchair mobility) and lobbied the university to establish a physically disabled students program, for which they obtained a federal grant to fund staffing, wheelchair repairs, and other access needs (danforth 2018; patterson 2012). the rolling quads emerged from a community of students who lived on the third floor of a campus hospital, which, unlike the dormitories, was wheelchair accessible and had room for roberts’s “iron lung” respirator (patterson 2012). from this beginning, in 1972, two of the rolling quads established the first center for independent living, which became a model for hundreds of similar centers around the united states (danforth 2018; patterson 2012). these actions at berkeley launched the independent living movement (see above) and attracted disability activists from across the country, including judy heumann (patterson 2012), while influencing others such as mary lou breslin (already at berkeley) to become active in disability rights activism (wolfe 2012). while at university in new york, heumann had advocated for ramp access to her classroom; in 1970, along with others (some of whom she had met as a child at camp jened, a camp for disabled children), she founded the civil rights organization disabled in action. breslin cofounded the disability rights education and defense fund, a leading national civil rights law and policy center, in 1979 (wolfe 2012). among gallagher’s extensive contributions to disability rights in the united states (see his autobiography [gallagher 1998], as well as discussion in altenbaugh 2015), as a senate staffer, he drafted the federal architectural barriers act of 1968, which required that all public buildings, or those in which physically impaired individuals might reside or work, financed with federal funds be designed and constructed in accordance with prescribed accessibility standards (architectural barriers act 1968). similarly in hungary, polio survivors were instrumental in the establishment of the national federation of disabled persons’ associations (meosz), the country’s largest nongovernmental organization for representing and advocating disability rights (vargha 2018b). polio survivors were thus at the center of twentieth-century changes to the built environment for physical accessibility and increased representation of disabled people during decision-making affecting them. the previous examples provide valuable context to indicate that disabled people have been active in designing and driving changes in built environments; there is no reason to believe that their input and innovation were excluded in the past. early on in archaeological investigations of disability, cross (1999) proposed that archaeologists should be considering the landscapes and built environments in which individuals lived. sneed (2020) approaches these questions through her investigation of ramps used in ancient greek architecture, arguing for the potential influence of the presence of people with mobility impairments on architectural choices for public spaces (healing sanctuaries). there is still much room to investigate relationships between bodies and space in archaeological contexts, and as the historic examples demonstrate, we should remember that some design elements may indeed have been driven by the survivors themselves. to operationalize the survivor lens, we must continue to practice good palaeopathology and bioarchaeology through multiple levels. rather than prescribing a specific method or radically new approach that will necessarily differ based on context (see “where are all the survivors? individuals and bodies” section), the survivor lens represents a subtle theoretical shift that allows us to envision group-level experiences, such as the impact of a sudden cohort of disabled people in a community or society. as demonstrated here, the history of polio in the twentieth century demonstrates how diseases can become “imprinted on the bodies of survivors, societies and cultures” (vargha 2018a:181). the ways polio survivors and others dealt with the consequences of polio infection brought about diverse impacts on society and culture, from changes in medical treatment and built environments to community formation spurring advocacy and activism that led to yet bigger changes on the national and international scale. this is a clear difference in focus from approaches such as the bioarchaeology of care. not only is there an explicit emphasis on the group-level impact of the presence of a survivor cohort, but the survivor lens considers survivors to be potential drivers of innovation and change—including as active agents of that change. a survivor lens can thus help bioarchaeologists consider both the long-term impacts that epidemic survival has on individuals and their immediate relations, as well as in shaping societies. conclusion and future directions in the covid-19 pandemic thus far, as in the bioarchaeology of past pandemics, the focus of concern has largely been on deaths. covid’s “long-haulers” remind us, however, that the effects of such outbreaks include long-term morbidity and disability for the survivors of infection—often in proportionately larger numbers than the death toll. polio is an example of such a disease with sequelae that are potentially visible in the archaeological record, and it prompts us to think of the possibilities of approaching the study of past epidemics a bit differently. one potential source of guidance or inspiration we can look to is developments in the field of disability history, particularly kudlick (2013, 2018) and linker’s (2013) calls for bringing together usually “siloed” fields in considering the survivors of epidemic infections. similarly, bioarchaeology of infectious disease and epidemics might be brought together with the emerging research area of bioarchaeology of impairment/disability to better understand the impact of epidemics and pandemics in the past. considering individuals with evidence for infectious disease as “survivors” is not new in palaeopathology. for any evidence of disease to manifest in the skeleton, the individual must have had that condition for a relatively prolonged time, long enough for skeletal changes to develop. so by definition, by the time paleopathologists can observe evidence for skeletal disease, they are also observing a “survivor.” moving forward, we should also remember that some of these individuals are survivors of larger epidemics and therefore part of larger survivor cohorts. this expanded understanding of epidemic repercussions will allow survivor experiences and stories to be better contextualized within larger social health scenarios. by incorporating work from disability studies with our bioarchaeological understandings, we have the potential to conceptualize our interpretations a little differently—perhaps providing fuller interpretations of individual and group experiences of disease events, moving beyond individual-level experiences to see individuals as part of larger groups impaired by waves of epidemic disease. a “survivor lens” thus not only moves us from mortality to morbidity, impairment, and disability but also aids in making the leap from physical impairment to social disability—and exploring the relationship between them. it redirects our focus from definitive diagnosis to possibilities and beyond individuals (osteobiography, bioarchaeology of personhood) and relations (bioarchaeology of care) to specific groups and structure. a survivor lens on epidemics and pandemics, therefore, is a shift in perspective. we cannot prescribe a specific method or detailed approach here, because this will necessarily depend on the relevant biological and social context: the pathogen and its associated disease(s), the time and place, and so on. moving forward with this research, the next steps will include applying this theory using various methodological approaches. this operationalization might require the development of new techniques, creative applications of old approaches, and/or the continued integration of interdisciplinary methods. regardless of the methods used, the point is that we must first work to think differently about the impact of epidemics. specifically, we argue for a focus not only on the lasting impacts of deaths (e.g., on the economy or ecology), but also on the lasting impacts of sickness and impairment/disability at the group level as well as on the individual in context. while this is certainly not entirely new in bioarchaeology, there is ample room for further development—particularly with a multior transdisciplinary approach informed by 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e-mail: h.battles@auckland.ac.nz login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe bioarchaeology international volume 9, number 2: 106–122 doi: 10.5744/bi.2025.0006 © 2025 university of florida press social determinants of head trauma? skull fractures in nineteenthcentury male prisoners in graz, austriahungary jonny gebera* and niels hammerb aschool of history, classics and archaeology, university of edinburgh, edinburgh, united kingdom bdivision of macroscopic and clinical anatomy, medical university of graz, austria *correspondence to jonny geber, school of history, classics and archaeology, university of edinburgh, william robertson wing, old medical school, teviot place, edinburgh eh8 9ag, united kingdom e-mail: jonny . geber@ed . ac . uk abstract this study investigates whether social factors influence patterns of head trauma in a bio archae ol o gi cal population sample of known identity. by examining the relationship between individuallevel social variables and head trauma, it is hypothesized that social determinants shape behaviors leading to injury. skulls and crania of 135 males who died in karlau prison, graz, austriahungary, between 1858 and 1908 were analyzed. head trauma was quantified statistically by region (cranial base, vault, and face) and type. social variables were defined from historical records and included age, legitimacy status at birth, language, and occupation. head trauma was present in 23.0% of all individuals, with 2.2% to cranial bases, 20.5% to vaults, and 5.9% to faces. the social variables considered have a limited impact on the occurrence and patterns of head injuries in this group. the only significant patterns observed related to legitimacy status in individuals older than 40 years. individuals born to married parents displayed a higher trauma rate, as well as slovenian speakers classified as unskilled laborers. a logistic regression analysis revealed that social variables poorly predicted trauma outcomes, despite the wellcontextualized sample. the random pattern of head trauma could possibly be linked to the social dynamics within the prison system, rather than life outside the institution that the variables considered in this study reflect. this study highlights how social complexity, which is evident from the historical records pertaining to these individuals, does not necessarily manifest as patterns of health and injury in bio archae ol o gi cal population samples. keywords: anatomical collection; criminology; habsburg; sdoh; violence die vorliegende studie untersucht anhand in einer bioarchäologischen stichprobe bekannter identität, ob soziale faktoren das auftreten von schädeltraumata beeinflussen. nach betrachtung der beziehung individueller sozialer variablen mit schädeltraumata wurde die hypothese aufgestellt, dass soziale determinanten verhaltensweisen beinflussen können, die zu letztlich verletzungen führten. analysiert wurden schädel von 135 männern, die zwischen 1858 und 1908 im karlau strafhaus, graz, österreichungarn, verstorben waren. schädeltraumata wurden statistisch nach region (schädelbasis, kalotte und gesicht) und art quantifiziert. soziale variablen wurden auf grundlage historischer aufzeichnungen definiert, beinhalteten alter, legitimitätsstatus bei geburt, sprache und beruf. nachweisbare schädeltraumata existierten bei 23,0% aller individuen; 2,2% an der schädelbasis, 20,5% kalottennah und 5,9% am viszerocranium. die vorliegenden sozialen variablen hatten begrenzten einfluss auf das auftreten und die muster von kopfverletzungen dieser gruppe. ein signifikantes muster waren der legitimitätsstatus bei individuen älter als 40 jahre. nachkommen verheirateter eltern wiesen höhere traumataraten, ebenso ungelernte, slowenischsprachige arbeiter. logistische regressionsanalysen ergaben, dass sich trotz der gut kontextualisierten stichprobe aus sozialen variablen schädeltraumata kaum vorhersagen lassen. das eher zufällige muster von schädeltraumata könnte daher eher mit sozialen dynamiken innerhalb des gefängnissystems in verbindung gebracht stehen; weniger mit dem received 26 february 2025 revised 22 april 2025 accepted 14 june 2025 geber and hammer 107 introduction the intersection of social history and bioarchaeology provides a potent framework for investigating the influence of societal structures on health and injury in past populations (geber 2015; klaus et al. 2017; mays 2023; murphy and klaus 2017). consequently, the relationship between social complexity and head trauma rates has been explored in various studies, often linked to community interactions (baustian 2018) and broader dimensions such as population dynamics, environmental stability, subsistence strategies, social hierarchies, and cultural norms (de la cova 2010; fibiger et  al. 2023; geber and o’donnabhain 2020; scaffidi and tung 2020; walker 1989). however, these investigations are generally relying on broad inferences about social living conditions and environments derived from burial contexts, which may not accurately represent the individual’s true experiences. while studies of individuals with known identities and detailed biographies offer a more nuanced approach, these are often limited to those of high social status (e.g., kacki et  al. 2018; karsten and manhag 2017). named or identified individuals in historical anatomical collections, primarily composed of individuals from lower social strata, provide a notable exception. the significance of these collections— and the ethics pertaining to them— has often been argued from a scientific point of view (campanacho and cardoso 2018; marinho et  al. 2018), which reflects how they were collected in the first place. in more recent years, however, the importance of these collections for gaining a better understanding of how social and cultural environments shape and impact human health and development have gained momentum (zuckerman 2018), as well as insights into attitudes and “othering” in social power relations in the past (robbins schug et al. 2025; zuckerman et al. 2021). this research explores patterns of head trauma on the skulls of male prisoners who died in karlau prison (provinzialstrafanstalt grazkarlau) in the city of graz in styria, austriahungary, between november 1858 and december 1908. during this period, the bodies of unclaimed deceased prisoners were anatomized at the institute of anatomy of karlfranzens university, and some skeletal remains were included in its anatomical collection. as the identities of these individuals are known, it has been possible to obtain detailed biographical information through church records, dissection protocols, collection catalogues, newspaper articles, published literature, and more. these sources give an unprecedented insight into the social environment during the lives of these individuals, and this information enables a critical assessment of the biocultural linkages between social factors and head trauma patterns (cf. mant et  al. 2020; martin and harrod 2015; perry and gowland 2022). building upon findings from studies of contemporary prison populations (davies et al. 2012; mcmillan et al. 2021; mcmillan et al. 2022; williams et al. 2010), it is hypothesized that social circumstances, as well as the behaviors associated with these, influence the risk of head injuries. the aim of the study is to investigate whether specific social factors may explain patterns of head trauma within karlau prison during the latter half of the nineteenth century. the research question is underpinned by the social determinants of health (sdoh) framework, which highlights the impact of sociopolitical context (e.g., labor market access and education), structural factors (e.g., socioeconomic status and class), and intermediate determinants (e.g., work/living conditions, and lifestyle factors) on health outcomes (braveman 2023:5– 15; solar and irwin 2010). while biocultural in its application to bioarchaeology, the sdoh approach specifically aims to elucidate the sociocultural determinants of health outcomes. this represents a more precise focus compared to the traditionally broader, holistic, and contextual examination of the interplay between biology, society, and culture in bioarchaeology but generally requires wellcontextualized and detailed life history accounts or data that are not always readily available (see cherverko 2021:67 ff.). karlau prison, anatomization of prisoners’ bodies at karlfranzensuniversity, and rehumanizing the anatomical collection karlau prison (fig. 1) is located west of the river mur, on what in the nineteenth century was the southwestern outskirts of the city of graz, and was first established as a provincial prison in 1809. the building itself was originally a late sixteenthcentury leben außerhalb dieser institutionen, das die in dieser studie berücksichtigten variablen widerspiegelten. diese studie verdeutlicht, dass sich soziale komplexität, wie sie in den historischen aufzeichnungen über diese individuen erkennbar ist, nicht zwangsläufig in mustern von gesundheit und verletzungen in bioarchäologischen stichproben widerspiegelt. stickwörter: anatomische sammlung; gewalt; kriminologie; habsburg; sdoh (soziale determinanten der gesundheit) social patterns of head trauma108 royal hunting lodge/castle (hammerluza 2017). during a few months in 1859, it was used as a penal institution for political prisoners from the crownland kingdom of lombardyvenetia. from september 1859, karlau prison functioned as a forced labor institution for prisoners from lower austria, until it was officially reverted to its function as a provincial male prison in 1863 (hammerluza 2019:71– 74). between 1869 and 1872, the prison underwent significant reconstruction to facilitate the solitary confinement of prisoners in accordance with the so called pennsylvania system prison reform, which argued that separating prisoners from each other within the institution would prevent them from further “moral corruption” (see vaux 1884). by 1888, the institution, which, other than the prison and associated buildings, included a garden and farmlands, covered over five hectares enclosed within 3.2meterhigh walls. in december that year, the karlau prison held 745 prisoners, of whom 24 were sentenced to life and 85 served sentences of between 10 and 20 years (leitmaier 1890:340– 350). the prison was one of several public institutions (such as hospitals and asylums) in graz that supplied postmortem human bodies for anatomical study at the anatomical institute at karlfranzens university. the anatomical institute, first established when the (new) university was founded in 1848, was located in a purposebuilt and stateof theart facility on harrachgasse 21 in the center of graz. it housed its own anatomical collection and museum, which was considered an essential component of any anatomical institution at the time. in austria, there was a seemingly tolerant attitude toward human dissection, at least among those who partook in the public debate. this perspective likely reflected both the roman catholic (the dominant religion of the habsburg monarchy) theological focus on the immortality of the soul relative to the mortality of the body, and the broader context of political liberalism, modernity, and the societal benefits gained through the advance of anatomical knowledge overall during the nineteenth century (buklijas 2008, 2018). in graz, mirroring the practice in vienna, the anatomical institute interred dissected bodies in coffins within a designated cemetery plot. this practice suggests that the deceased were not merely treated as “cadavers” but afforded a degree of dignity, being buried in consecrated ground in accordance with societal norms (buklijas 2008). this respect is further evidenced by the recording and maintenance of the individuals’ names in institutional records and the anatomical collection. integrating these documentary sources with osteobiographies of human remains, through osteological and palaeopathological analysis, allows for efforts toward rehumanizing the collection (zuckerman et al. 2024). this rehumanization is crucial not only to avoid further “othering” of the remains but also to potentially illuminate subaltern voices from the past, often silenced in historical records and whose stories have largely been forgotten. or as franz rabl (no. 651, b. 5 january 1856), whose convictions included four murders, five robberies, eight arsons, and 12 counts of theft and fraud, uttered shortly before his execution on 11 november  1890 (grazer volksblatt 1890): forgive me, and remember me. . . . [verzeiht mir, und seid meiner eingedenk. . . . ] figure 1. a postcard photograph of karlau prison from 1911, by anton schlauer (graz, verlag). source: university of graz (https:// gams . uni graz . at / o:gm . 6237). cc bysa 3.0 at. https://gams.uni-graz.at/o:gm.6237 geber and hammer 109 material and methods the sample comprised 135 identified individuals: 127 skulls (seven missing the calotte), two crania (one missing the calotte), and six complete skeletons. two of these individuals did not die in karlau prison but were included in the study on the basis of context as they had been imprisoned in life: one individual, who was convicted of murder, died from stroke (gehirnlähmung) in the city’s lunatic asylum (feldhof irrenanstalt) in 1873, and another convicted murderer (franz rabl, see above) died by public execution in the courtyard of the state courthouse (landes gerichtsgebäude) at the old jail (kriminalgebäude/inquisitions und arresthaus) (see hammerluza 2008) in the city. the main cause of death in the total population sample, however, was respiratory disease (65.9%; 89/135), most commonly due to tuberculosis. all individuals were male, which was confirmed through macroscopic analysis following a standard osteological protocol (buikstra and ubelaker 1994; sjøvold 1988). most of the human remains included in this study (78.5%; 106/135) were anatomized during the tenure of professor emil zuckerkandl (1849– 1910), who joined graz in 1882 (höflechner 2006:357– 387). the expansion of the collection that occurred during this time appears to be part of an intent to establish a research theme on anatomical variation and morphology, as well as bring the anatomical collections to equal standing with other institutions, such as vienna, where zuckerkandl had come from (hyrtl 1869). the remains are curated by the division of macroscopic and clinical anatomy at the medical university of graz, which is the successor institution to the former anatomical institute. the remains are exceptionally wellpreserved, with the exception of the dentitions, which are very fragile and frequently damaged. this might be attributable to the maceration process (described in detail in an article published in the archiv für anatomie und entwickelungsgeschichte), which involved soaking in warm water (up to 50°c) and degreasing in a gasoline solution, followed by cleaning with soap and water and sunbleaching (planer 1877). the skulls are marked with a number (typically a paper label affixed to the glabella) that corresponds to the register of the inventory of the former anatomical museum (when located at harrachgasse 21). in some instances, the catalogue number (in addition to the paper label) was written in pencil on the skulls, primarily on an occipital condyle or on one of the mandibular ramii. originally, the names of the individuals, their age at death, provenance (location of birth and death), and crime conviction were written in ink on the squama of the temporal bones, mostly on the left bone or on both. this writing was, for various undisclosed reasons, deliberately erased in the early 2000s from most of the skulls but could be partly or completely discerned in this study with the aid of an ultraviolet led light torch (luxnovac, 30 w at 365 nm). through this method, it was possible to read partial or complete writings on 103 skulls. given that the sample comprised named individuals, the study first sought to validate or refute the recorded identities by crossreferencing all the available sources in conjunction with the results of the osteological analysis. these written sources included, in addition to the inventory catalogues, primarily dissection registers and church records. all these sources give, to varying degrees, the same information relating to name, sex, age and date of death, place of birth, “ethnicity” (see below), profession, and criminal convictions. occasionally, notes about observed anatomical anomalies and variations are also included in the museum catalogue descriptions, which could be used to confirm that the register entry is linked to the correct skull. of the total sample, mismatched identities were noted in only two cases. in these, the number label attached to the glabella did not match the description of the skull in the catalogue inventory, but the correct numbers could be discerned from vague pencil or ink writings on the bones. age at death the age at death was calculated from birth and death dates recorded in the relevant church records, as only stated known ages at death are valid if they can be confirmed from primary sources. while it was possible to locate the death dates for all individuals, birth records could not be found for 13 individuals. there was, however, a strong correlation between recorded (x = 38.9, sd = 14.8) and actual (x = 38.5 years, sd = 14.8) age at death (rs = .996, p < 0.001, n = 122). to ensure consistency in the data, however, only actual ages at death were used for analysis. recorded ages at death were, however, used for missing cases when assigning individuals to age groups. the age group classifications used are those employed in nineteenthcentury austrian crime statistics (k. k. justizministerium 1852): 14– 20  years, 20– 30  years, 30– 40  years, and 40+ years. recording, classification, and quantification of head trauma head trauma (involving the whole skull) was recorded by location and type (dedouit et al. 2024) and social patterns of head trauma110 included both antemortem and perimortem injuries. healed bony calluses on skulls in general tend to be small and are often difficult to discern, in contrast to postcranial elements (cunha and pinheiro 2009), and can easily be misdiagnosed from normal anatomical variation and potential alternative causes like dermoid cysts and infectious lesions (e.g., tuberculosis, treponemal disease). to avoid overdiagnosis, botham (2019) proposed a more strict and standardized descriptive diagnostic protocol considering lesion margins, shape, size, location, and endocranial table involvement. bone remodeling in wellhealed lesions, however, often obscures these features, making descriptions difficult. in the current study, clear cases of depression fractures were only evident in lesions measuring more than 3 × 3 mm in size. as virtually all lesions were healed (see below), diagnosing and describing trauma was aided through computed tomography scans (siemens somatom definition as+, axial slice orientation, slice thickness 0.6 mm, no slice increment), which were processed and analyzed using amira 3d (thermo fisher scientific, v. 2024.1). definition of social variables this study defines a social variable as an attribute or characteristic that influences interactions and behaviors in individuals, as well as within and between groups. in archaeology, social dimensions are generally only informed and contextualized by mortuary contexts. while this approach is appropriate (baker and agarwal 2017), it is fundamentally imperfect in the sense that it is built on general understandings of how past communities and societies were structured (i.e., gender roles, how social stratifications were manifested, etc.) that do not necessarily always apply on an individual level. in contrast, identified human remains, for which individual social circumstances can be determined, offer significant advantages for understanding how social complexities manifest in human skeletal biology and, consequently, how this biology responds and adapts to social environments. the details of biographical information pertaining to named individuals can vary greatly, however (see cardoso 2018), and the choice of social variables to include in the study is limited by the information available in archival sources. the evident bias in these archival sources leans toward demographic data (birth and death records), social conditions (such as societal position, family structure, and committed crimes), and health variables (specifically the cause of death), reflecting what was deemed important to wider society. (social) age: social dimensions in relation to age are multifaceted and theoretically complex. for example, johfre and saperstein (2023) discuss social age within a multilevel system where age can determine behavioral expectations in new interactions, such as dominance, submission, violence, or respect. thus, age in this sample may be considered a social factor influencing behavior and trauma outcomes, even though it is not possible to determine at what age episodes of head trauma occurred. bio archae ol o gi cal assessments of social age generally rely on biologically estimated chronological age, informed by stages of dental development and mineralization, as well as bone degeneration (mays 2021:55– 97). despite the aim of these osteological techniques to approximate chronological age at death within a certain range, their inherent methodological limitations prevent the determination of specific ages. the present study overcomes this limitation by utilizing the known chronological age at death of the individuals, thus permitting a more direct examination of age as a social variable. legitimacy status at birth: church records generally record the legitimacy status of newborn children, thereby providing potential insight into early childhood social conditions. for most of the nineteenth century, legal restrictions, socalled politischer ehekonsens (“political marriage consent”), were in place in austria and across the habsburg monarchy that restricted the ability of those with lesser or no resources to marry (kytir and münz 1986), meaning that illegitimacy came to be linked with poverty and social position. when a child’s legitimacy is not explicitly stated in church records, it can be inferred indirectly. if no father is listed, illegitimacy is assumed. similarly, if the individual’s surname in adulthood matches the mother’s maiden name, an illegitimate status at birth can be assumed. language: in the multiethnic austrianhungarian state, ethnocultural affiliations were complex and officially defined through linguistic classification (see stergar and scheer 2018). from 1880 onward, the census in the austrian half of the double monarchy specified the mandatory recording of one of nine languages (umgangssprache, the “everyday language” used): german, bohemianmoravianslovak, polish, ruthenian, slovenian, serbiancroatian, italianladino, romanian, and hungarian. the archival records for individuals in this study largely adhere to these categories, with the exception of two individuals identified as french and seven others with unclear or unknown classifications. due to ethnopolitical complexities embedded within the habsburg monarchy, where ethnocultural affiliations were linked to not only tradition and identity but also societal influence, geber and hammer 111 tensions became increasingly marked throughout the nineteenth century (hubbard 1970; wingfield 2004). these tensions frequently found expression in stereotypes contrasting “civilized” peoples with naturmensch; for example, german speakers were viewed as economic, industrious, and diligent, hungarians as vain and hottempered, and romanians and croats as hardened, lazy, wild, and drunken (see vári 2004). it is reasonable to assume that these stereotypes and attitudes also affected the lives of the individuals considered in this study. social class (by occupation): social mobility in graz during most of the nineteenth century was generally stagnant, and with increasing industrialization during the latter half of the nineteenth century, society became more and more characterized by socioeconomic stratifications linked to professions, even among the working classes (e.g., skilled versus unskilled laborers) (hubbard 1984). these social categorizations, based on occupation, are also evident in the census and reflected in the archives pertaining to the individuals considered in this study. these occupations, which can be viewed as an indicator of the social position held in later life, were categorized as selfemployed/independent (e.g., master tradesmen, merchants, and privatiers), skilled laborers (craft workers, including apprentices), unskilled laborers (including servants and day laborers), and unemployed (including beggars and vagrants) (hubbard 1984; kořalka 2010). for five younger individuals (less than 30  years), the recorded occupation of their fathers was used. classification of criminal offenses following the definitions used at the time (oberster gerichts und cassationshof 1884:49– 51), the individuals studied were convicted of 13 different categories of crimes (including attempts), which were classified into the three broad categories used by the habsburg judicial system (k. k. justizministerium 1852:section xx): violent offenses (gewaltthätige handlungsweisse, e.g., murder, manslaughter, sexual crimes, arson), property/economic offenses (gewinnsucht, e.g., theft, robbery, and fraud), and political crimes (verbrechen politischer natur, e.g., lèse majesté, counterfeiting, and forgery). it was possible to assign a criminal offense category to 133 individuals in the present study. the convictions only refer to the last judicial sentence given to the individuals, however. from notes in the archival sources, it is evident that some prisoners were repeat offenders, but it has not been possible to trace the full criminal records for all individuals. statistical analysis data analyses were conducted using spss (ibm, version 29.0.1.0). a spearman’s rho correlation test was employed when investigating the relationship between ranked variables and chisquare tests for categorical variables. a fisher’s exact test was used in sparse data sets (five or fewer cell counts). a logistic regression model was applied to investigate the probability of head trauma (dependent variable) when linked to age, legitimacy status at birth, language, and social class (independent variables). results age at death averaged at 38.5  years, ranging from 15.9  years to 73.1  years (sd = 14.8, n = 122), which gives a good reflection of the mortality pattern of the prison at the time but not the age structure of the living prison population. the majority of the individuals were german speakers from the styria region (including lower styria, now part of slovenia). in december 1888, the prison population (n = 745) consisted of 66.8% german speakers, 30.2% slovenian speakers, 0.1% hungarian speakers, and 2.8% other language groups (leitmaier 1890:349). in the study sample (n = 128), 60.9% spoke german as their everyday language, 31.3% slovenian, 0.8% hungarian, and 7.0% other languages, which suggests that the collection is a close representation of the ethnocultural composition of the prison inmates at the time. most individuals (51.1%; 69/135) were unskilled laborers belonging to lower social classes (table 1). fracture frequencies the overall prevalence of head trauma in the karlau prison population sample was 23.0% (31/135), affecting the posterior cranial base in three individuals, the cranial vault in 26 individuals, and the face in eight individuals (table 2). a wilcoxon signedrank test indicated no apparent side dominance to where fractures most commonly occurred on the skulls (t = 25.50, z = − 1.112, p = 0.266). weak correlations were observed between facial fractures and injuries to the cranial base (rs = 0.18, p = 0.042, n = 135) and cranial vault (rs = 0.27, p = 0.002, n = 127), suggesting that trauma affecting different regions of the head in an individual had generally occurred on separate occasions. of those affected (n = 31), the number of diagnosed fractures ranged from 1 to 5 (x = 1.7, sd = 1.1). cranial base fractures are typically classified by region: anterior (frontobasal) fractures often result social patterns of head trauma112 from direct frontal impact, central skull base fractures commonly extend from frontobasal fractures, and posterior skull base fractures usually occur due to direct occipital impact and may extend into the petrous part of the temporal bone (baugnon and hudgins 2014). only posterior skull base fractures, affecting three individuals, were observed in the karlau prison population sample. one of these cases comprised two perimortem fractures in an individual (no.  137) who died by judicial hanging. these fractures included a unilateral (right) occipitomastoid diastasis and a hole fracture (approximately 8 × 6 mm in size) posterior to the right occipital condyle and extending to the lateral margin of the foramen magnum (fig. 2). the fractures are likely directly related to the cause of death rather than damage caused table 1. baseline characteristics of the prevalence of head trauma by social variable categories in the karlau prison population sample. variable statistic total head trauma χ2 (df) pvaluepresent not present age at death [years] nobs (nmiss) 122 (13) 30 (1) 92 (12) 110.3 (105) 0.342 x (sd) 38.5 (14.8) 38.7 (15.7) 38.5 (14.6) range 15.9– 73.1 15.9– 73.1 17.4– 70.7 age group [years] nobs (nmiss) 135 (0) 31 (0) 104 (0) 1.5 (3) 0.702 14– 20 n (%) 6 (4.4) 1 (3.2) 5 (4.8) 20– 30 n (%) 43 (31.9) 9 (29.0) 34 (32.7) 30– 40 n (%) 25 (18.5) 8 (25.8) 17 (16.3) 40+ n (%) 61 (45.2) 13 (41.9) 48 (46.2) legitimacy status at birth nobs (nmiss) 119 (16) 28 (3) 91 (13) 0.4 (1) 0.545 legitimate n (%) 75 (63.0) 19 (67.9) 56 (61.5) illegitimate n (%) 44 (37.0) 9 (32.1) 35 (38.5) language nobs (nmiss) 128 (7) 29 (2) 99 (5) 3.6 (6) 0.742 german n (%) 78 (60.9) 17 (58.6) 61 (61.6) bohemianmoravianslovak n (%) 2 (1.6) 1 (3.4) 1 (1.0) slovenian n (%) 40 (31.3) 10 (34.5) 30 (30.3) serbiancroatian n (%) 1 (0.8) 0 (0.0) 1 (1.0) italianladino n (%) 4 (3.1) 0 (0.0) 4 (4.0) hungarian n (%) 1 (0.8) 0 (0.0) 1 (1.0) other (foreign) n (%) 2 (1.6) 1 (3.2) 1 (1.0) social category (by profession) nobs (nmiss) 135 (0) 31 (0) 104 (0) 2.3 (3) 0.516 selfemployed/independent n (%) 7 (5.2) 1 (3.2) 6 (5.8) skilled laborer n (%) 47 (34.8) 13 (41.9) 34 (32.7) unskilled laborer n (%) 69 (51.1) 16 (51.6) 53 (51.0) unemployed/destitute n (%) 12 (8.9) 1 (3.2) 11 (10.6) table 2. quantification of skull fractures, by region and fracture type. region/fracture type n (%) [individuals affected] side [number of fractures] left right cranial base (posterior) (n = 135) 3 (2.2) 3 2 linear 2 (1.5) 2 0 diastatic 2 (1.5) 1 1 hole 1 (0.7) 0 1 cranial vault (n = 127) 26 (20.5) 21 15 depression 13 (10.2) 12 6 linear 10 (7.9) 4 6 multiple linear 3 (2.4) 2 1 diastatic 1 (0.8) 1 0 ?gutter 1 (0.8) 1 0 stellate 1 (0.8) 0 1 hole 2 (1.6) 1 1 facial (n = 135) 8 (5.9) 7 5 frontal sinus 2 (1.5) 1 1 infraorbital rim 1 (0.7) 0 1 mandible 1 (0.7) 1 0 nasoorbitoethmoid 1 (0.7) 1 0 nose 5 (3.7) 3 3 zygomaticomaxillary complex 1 (0.7) 1 0 figure 2. perimortem fractures observed in the posterior cranial base of a 26.4yearold (no. 137), who died by judicial hanging. a hole fracture is noted immediately posterior to the right occipital condyle, as well as an occipitomastoid diastasis on the right side of the skull base. photo: jonny geber. geber and hammer 113 during the anatomical dissection. occipitomastoid diastatic fractures have been reported in other cases of judicial hangingrelated skeletal trauma (campanacho and garcia 2021; waldron 1996; woodjones 1913). the additional two individuals with injuries to the cranial base displayed antemortem fractures (fig. 3). these included a linear fracture in the process of healing on the left aspect of the occipital bone of a 44.0yearold individual (no.  78), where a fracture line extended onto the temporoparietal suture where it is diastatic. the second skull belonged to a 57.0yearold individual (no. 124), which displayed a healed linear fracture running diagonally across the left aspect from the jugular junction to the external protuberance. linear fractures affecting the neurocranium generally originate distant from the in bending impact area of the bone and radiate both toward and away from where the impact occurred (galloway 1999). the linear fractures in these individuals were both confined to the occipital bone, and both on the same side, likely as a consequence of being struck from the front or left while moving the face away from an aggressor. overall, the majority (72.2%; 13/18) of cranial vault lesions affected the frontal bone, with the remaining fractures present on parietal bones (27.8%; 5/18). most of the cranial vault injuries were depression fractures (fig.  4a), with approximate surface areas (length × width) ranging from 0.1 to 14.8 cm2, with a median of 0.6 cm2 (sd = 3.6 cm2, n = 18). the morphology of cranial vault depressions depends on the size and shape of the object that causes the injuries, and is generally the result of objects that are of “moderate” size not exceeding the cranial vault dimensions at the site of impact (galloway 1999). linear fractures (fig.  4b) on skulls tend to occur when the head is struck by larger surface objects, and these fracture types were present in 12 individuals. in addition, there was also a case of a stellate fracture (fig. 4c) observed on the right parietal bone of a 15.9yearold (no.  1414), who was also the youngest individual in the population sample. stellate fractures originate at the point of impact and sometimes result in a depression at the point of impact (galloway 1999), which was also observed in this case. less common cranial vault injuries in the population sample included hole fractures and a potential gutter fracture that may be indicative of healed gunshot trauma (fig. 5) in three individuals. these males had been convicted of violent (public violence and rape) and property (robbery) crimes. the hole fractures, similar in size and shape, exhibit smooth margins with pitted reactive bone on the ectocranial surface and smaller healed fragments on the endocranial surface. it was not possible to identify any radiating fracture lines originating from the perforations, which, however, may have become indiscernible through the healing process (cunha and pinheiro 2009). the potential gutter fracture (fig. 5c), located on the left parietal bone of a prisoner convicted of robbery, is less definitive due to the bone remodeling process of the margins. it presents as a shallow depression with two parallel linear leveled bases on the ectocranial surface, possibly indicative of a grazing bullet wound (berryman 2019). facial fractures predominately affected the nose and midface in the population sample. healed figure 3. fractures of the posterior cranial base in two individuals, affecting the skulls of a 44.0yearold (no. 78), where a diastatic and linear fracture (in the process of healing) are present on the left aspect (a), and a 57.0yearold (no. 124) with a healed linear fracture on the posteriorleft part of the head (b). images generated from ct scans through amira 3d (thermo fisher scientific, v. 2024.2), by jonny geber. social patterns of head trauma114 complex fracture patterns, which are the result of highforce trauma, were present in three individuals. these exhibited fractures involving the nasoorbitoethmoid (fig.  6a) and zygomaticomaxillary complex (see fig. 6c) on the left side of the face. in one of these cases, a skull (no. 178) belonging to a convicted assassin also involved a fracture of the left coronoid process of the mandible (see figure 6d), which is reportedly rare in the clinical literature and today most commonly the result of falls and road traffic accidents (diab et al. 2022; galloway 1999). other facial fractures observed involved the infraorbital rim and the frontal sinus (fig. 6a) in two individuals. nasal fractures (fig. 6b) were the most commonly observed facial trauma in the group. these are, as with cranial vault trauma, most commonly attributed to interpersonal violence (magalhães et al. 2020). associations between criminal offense and head trauma within the group, there was a relatively even distribution of individuals convicted of violent (51.9%; 69/133) and property/economic crimes (43.6%; 58/133), while political crimes were the least common conviction at only 4.5% (6/133). there was only a weak correlation between crime offense convictions and age (rs = − 0.208, p = 0.022, n = 121), which indicates that these social variables did not influence the criminal offense data within this sample. no statistically significant associations between criminal offense category and head trauma were observed in the sample on an overall level (χ2(2) = 0.171, p = 1.000), but when investigating the association by age group, a chi square test identified a difference in fracture rates of figure 4. examples of healed cranial vault fractures, which include a depression fracture (a) on the frontal bone (no. 145) of a 31.3yearold, a linear fracture (b) running from the right midcoronal suture to the midsquama of the temporal bone in the skull (no. 180) of a 30.9yearold, and a stellate fracture (c) on the superior portion of the right parietal bone in a skull belonging to a 15.9yearold (no. 1414). photo: jonny geber. geber and hammer 115 cranial vaults in the 20 to 30year age group (χ2(2) = 7.151, p = 0.035), where prisoners who had committed property/economic crimes were more than twice as likely to display fractures compared to prisoners with violent and political crime convictions (fig. 7). relationship between social variables and head trauma patterns while the age of injury cannot be established for these individuals, age may serve as a useful interpretive variable under the hypothesis that the risk of certain trauma types was linked to age, potentially evident as cumulative rates or an increased number of fractures in older versus younger individuals. the data, however, show no association between the prevalence of head trauma (rs = − .004, p = 0.915, n = 122) and the number of fractures (rs = 0.062, p = 0.062, n = 122) with age at death, which suggests that there is no relationship between age as a social variable and head trauma patterns in this population sample. the only pattern relating to age noted appears to be random. when the data were analyzed by age group, it was found that among 40+yearolds, there was a significantly higher rate of cranial vault trauma in those born as legitimate children: 27.3% (9/33) were affected, compared to none (0.0%; 0/15) among those born illegitimate (χ²(1) = 5.035, p = 0.041, n = 48). another observation is that there was a statistically significantly higher rate of cranial vault trauma in individuals aged 20– 30  years convicted of property offenses within the germanspeaking group (χ²(2) = 8.404, p = 0.010, n = 35). legitimacy status at birth also stands out as the only variable associated with facial trauma in the overall sample, where it was observed only in individuals (8.0%; 6/69) born to parents who were married (χ²(2) = 3.707, p = 0.054, n = 119). if it is accepted that legitimacy status can be used as a proxy for social status in early childhood, then this would suggest that poverty or a lower family social position at the beginning of life had no influence on later life outcomes in terms of exposure to trauma. austrian crime statistics from the late nineteenth century recorded the legitimacy status of offenders (e.g., k. k. statistischen centralcommission 1896), and it is noteworthy that from these data, the prevailing perception linking illegitimate birth to increased adult criminality was increasingly being questioned, albeit figure 5. healed hole fracture fractures on right aspect of the frontal bone (a) of a 30.8yearold (no. 106) and on the right parietal bone (b), adjacent to the coronal suture, belonging to a 73.1yearold (no. 215), and a potential gutter fracture (c) on the superolateral aspect of the left parietal bone of a 42.3yearold (no. 166). photo: jonny geber. social patterns of head trauma116 figure 6. examples of healed facial fractures, affecting the frontal sinus and nasoorbitoethmoid complex (a) on the right side of the face of a 57.0yearold (no. 124), the left side of the nose (b) in a 64.2yearold (no. 216), and the zygomaticomaxillary complex (c) and coronoid process of the mandible (d) on the left side of the face of a 22.7yearold (no. 178). photo: jonny geber. figure 7. bar chart displaying prevalence of head trauma by age group, region of head (cb = cranial base, cv = cranial vault, fa = face), and criminal offence category. geber and hammer 117 with some reluctance (see morrison 1897:121ff.). by the early twentieth century, reports indicated that 13.8% of male prisoners in austria were born illegitimate, only marginally higher than the 13.7% recorded for the general population (von borosini 1913). no direct associations between language, as a proxy for ethnocultural identity, and head trauma patterns were observed in the population sample. as german speakers dominate the overall sample, however, any potentially cultural patterns of trauma (see brickley and smith 2006; de la cova 2010; geber and o’donnabhain 2020) may be obscured in the data. when considering social groups by profession, it was noted, however, that a higher rate of facial fractures was present among unskilled laborers (χ²(2) = 14.139, p = 0.015, n = 65) who spoke slovenian. as with the observation noted among germanspeaking property offenders (see above), this difference appears to be random. on the overall level, no relationship between head trauma frequencies (χ²(3) = 2.338, p = 0.505, n = 135) and social group was observed in the sample. logistic regression analysis when considering all the data together, a logistic regression analysis revealed that the tested social variables were not significant predictors of head trauma (χ²(11) = 8.018, p = 0.712). the model explained a relatively small proportion of the variance (cox & snell r² = 7.0%; nagelkerke r² = 10.4%), with 76.8% correctly predicted. these findings suggest that social factors, as measured and analyzed in this study, have a limited impact on the occurrence of skull fractures in the karlau prison population sample. discussion the austrohungarian monarchy was a geopolitically complex state characterized by underlying ethnic, political, and cultural tensions— a europe en miniature (weinmann 1867:97)— that would influence the industrial, scientific, and social development that characterized much of the nineteenth century (beller 2018; middleton 2020). throughout the lifetime of many of the individuals included in this study, much of habsburg society was locked in political and social turmoil (sperber 2005). these conflicts led to the formation of the austrohungarian compromise in 1867 and eventually collapse through the catastrophe of world war i from 1914 to 1918 (beller 2018). in terms of the sdoh framework, these political tensions form the backdrop of the social conditions the individuals from karlau prison lived in prior to and during imprisonment. this includes their socioeconomic positions within society, which in this study can be partly denoted by the recorded professions they held in life. while the professions are a valid reflection of social structure and position within society (hubbard 1984), it should be noted that social stratification is not always expressed equally within the same cohort. for instance, sociologist max weber included power as a determining factor in hierarchical relations, meaning that the “standing” of individuals could very much have depended on specific contexts (hurst 2016:213– 221). this is exemplified by one of the individuals in the present study, a man called leopold kendler (b. 19 october  1833). according to the records, he was a road sweeper from sankt leonard am forst in lower austria. he died in karlau prison on the morning of 7 november 1882 due to pulmonary tuberculosis. his skull (no. 225) showed no evidence of trauma. while his occupation would indicate that he held a low social position, the archives noted that he was the leader of a band of thieves, which would have ranked him high within his own social context, from which he would have benefited in terms of access to resources and other means. leopold was born as an illegitimate child to katharina kendler, an unmarried maid. while legitimacy status reflects an intersection between both the religious (in the christian faith, a family founding sacrament) and the secular (as a legal contract) domains, it was grounded in morals within the community. illegitimacy was much more common in austria than in many other european countries, varied by region, but did not necessarily have exclusively negative connotations (shorter et  al. 1971; sumnall 2009, 2020). the politischer ehekonsens system, intended to prevent pauperism within the population, was disbanded in the late 1860s mostly for administrative reasons (lanzinger 2003). what followed was a drastic decline in illegitimate births across austria, which suggests that common law practices had been solidly in place and that the status of illegitimacy probably had few social consequences on a broader scale (shorter et al. 1971; von borosini 1913). only five individuals in this study were born in the years after politischer ehekonsens was disbanded, and four of them were illegitimate at birth. it is therefore not possible to estimate whether the reform had any impact on social patterns related to head trauma. the third element of the sdoh framework discusses intermediary determinants through which structural determinants, such as social status and class, operate (solar and irwin 2010:36– 43). this relates to both working and living conditions, as well as social patterns of head trauma118 lifestyle choices, which in this context can be denoted by the crimes committed by the individuals considered in this study. as previously stated, no correlation or association between crime convictions and head trauma patterns was observed in this study. it should be noted, however, that the classification of crimes into broad categories may hide nuances in the type and severity of the crimes committed. head trauma related to imprisonment? in comparison with other nineteenthcentury populations, the prevalence rate of head trauma in the karlau prison group is high (table 3) and statistically significant (χ²(5) = 25.291, p < 0.001, n = 1,402). however, rates of head fractures in bio archae ol o gi cal samples vary significantly due to how trauma rates are quantified and reported, and they may also be populationspecific. for instance, in de la cova’s study of the terry, hamanntodd, and cobb anatomical collections, nasal fracture rates were exceptionally high (de la cova 2008:253– 264) and hence skew the overall prevalence of head trauma if not differentiated from other regions of the skull in that study. the seemingly random pattern of head trauma observed in karlau prisoners may be better explained by considering the unique social dynamics within the prison environment. the prison system likely fostered distinct social hierarchies and relationships, both between prisoners and guards and among the prisoners themselves. these dynamics may have differed significantly from the social structures experienced by these individuals outside of the prison, potentially contributing to the observed (nonevident) patterns of head trauma. the aforementioned case of a male that displayed a cranial base fracture in the process of healing (fig. 3a), might, for instance, be a reflection of trauma that occurred in the prison. this skull (no.  78) belonged to ferdinand wick (b. 11 april  1845), a day laborer from upper austria who was convicted of theft and died in karlau prison on 27 april  1889 due to pulmonary tuberculosis. he is listed as a wanted criminal, for having stolen clothes, in the central police gazette (centralpolizeiblatt) from 21 september  1887 (k. k. polizeidirection zu wien 1888:200). this is likely the specific offense he was convicted of, and he must therefore have been imprisoned for up to one and a half years prior to his death. as mentioned previously, between 1869 and 1872, the karlau prison was rebuilt in order to adhere to the pennsylvania system (leitmaier 1890:340– 350). this prison reform, which was the first of its kind in austria, advocated for solitary confinement as a means for prisoners’ moral and social reform, and part of their rehabilitation (sellin 1970). it is, however, unclear to what extent solitary confinement was upheld within the institution in practice. a report published in the laibacher tagblatt in february 1872 described the newly rebuilt prison with narrow corridors and 260 bright cells closed off with thick wooden doors through which prisoners were fed via a hatch. largebarred windows could be opened with a bar to provide ventilation, and the cells were furnished with a single bed, a table, a stool, and a rake and a rack to keep the space clean (laibacher tagblatt 1872). ten years later, it was reported that the prison in karlau (and ljubljana) was overcrowded by 480 prisoners (haus der abgeordneten des österreichischen reichsrathes 1882:xiii. ministerium der justiz), which may mean that some cells were used for more than one prisoner. while solitary confinement was argued to be beneficial to prisoners, by means of protecting them from bad influence by other incarcerated criminals, more recent debates on prison reform would suggest that it is likely to have had a drastic effect on both mental and physical health and wellbeing instead. table 3. frequencies of head trauma in nineteenthcentury population samples (males only). population social strata head trauma source% no./total karlau prison, graz, austria, 1858– 1908 lower/middle 19.7 25/127 this study kilkenny union workhouse, ireland, 1847– 1851 lower 6.3 12/190 geber and o’donnabhain (2020) terry/hamanntodd/cobb, united states, 1812– 1870 lower 9.4 57/605 de la cova (2008) freedman’s cemetery, texas, united states, c. 1869– 1907 lower 5.6 13/231 davidson et al. (2002) st marylebone, london, england, c. 1700– 1859 middle/upper 4.7 5/106 miles et al. (2008) st mary and st michael, london, england, 1843– 1854 lower 9.1 13/143 henderson et al. (2013) due to differences in how rates of head trauma have been defined and quantified in various studies, the highest rate by region was selected from studies that differentiated between trauma to different regions of the skull. for de la cova’s study of the terry, hamanntodd, and cobb anatomical collections (de la cova 2008), however, only cranial vault rates were considered, as the exceptionally high rate of nasal fractures in these samples (43.5%; 263/605) distorted the data. geber and hammer 119 this, in turn, could have aggravated violence within the prison population, including selfharm (see kaba et  al. 2014). this is exemplified by the case of matthäus ulbl (b. 4 february 1825), whose story was published in the swedish newspaper westernorrlands allehanda in january 1876. matthäus had worked as a painter’s assistant but followed a criminal career path from a young age. in 1868, after 20 years in prison, he was pardoned, but upon his release, he took out immediate vengeance on the person who had reported him to the police. he was convicted of murder to life in prison (for a second time) and made an attempt on his own life by hitting his head violently against a wall (westernorrlands allehanda 1876). no skeletal evidence of head trauma was noted on his skull (no.  662), which is consistent with biomechanical studies of “headbutting” injuries, which have noted that the risk of bone fractures is relatively low (adamec et  al. 2013). in december  1875, ulbl managed to escape but was quickly caught and returned to karlau prison. he would live for an additional six years until he died of a stroke (apoplexia cerebri) on 11 december 1881. conclusions the study of remains of individuals of known identity is a rare occurrence in bio archae ol o gi cal studies. they often derive from nineteenthcentury anatomical collections, which have been a valuable resource for developing and refining methods such as sex and ageatdeath estimations (e.g., marinho et  al. 2018). this study has shown that integrating osteological analysis with historical and archival records with skeletal remains from these collections also significantly helps to improve the theoretical and analytical approach to understanding social complexities in bio archae ol o gi cal research. it is evident, from the historical records, that the life experiences of the males incarcerated within karlau prison were diverse. these differences in life experiences are not reflected in the skeletal trauma record, which, however, may relate to the prison environment, which may have resulted in additional head trauma or injuries that obscure any patterns that may have been evident prior to incarceration. the lack of evident direct links between the social variables selected and skeletal morphology (in this case, the evidence of trauma) on an individual level shows that the biocultural approach may not always capture social complexities when interpreting pathological changes in human skeletal remains, especially when historical biographical information is not available. yet, this lack of social patterns within the prison population— but high rates of head fractures compared to nonprison population groups— is telling in its own right. it may suggest that an assigned “othering” of people as criminals had more influence on the risk of exposure to head trauma than social conditions relating to age, ethnocultural identity, poverty, and socioeconomic status. acknowledgments the authors thank the reviewers and the editor for their helpful comments and suggestions; alfred stelzl and ao.prof. reinhold reimann, division of macroscopic and clinical anatomy, medical university of graz, for providing contextual information about the anatomical collection; and priv.doz. mag. dr.  elke hammerluza, styrian provincial archives, for help when accessing archives and recommendations of additional sources. finally, a big thanks to the team at the medical university of graz for helping to facilitate this research. this research was funded by the leverhulme trust (rf2023114\2), awarded to jonny geber. ethics statement the authors recognize the multilayered and culturally complex ethical circumstances relating to human remains, both historically and in the present time. research ethics was assessed and approved by the school of history, classics, and archaeology research ethics board (13 april 2021) and the medical university of graz ethics commission (36241 ex 23/24). author contributions j. g. designed research, analyzed the data, and wrote the paper with input from the coauthor; n. h. provided analytical support and provided material resources and acquisition of data. references cited adamec, jiri, vera mai, matthias graw, klaus schneider, john martin hempel, and jutta schöpfer. 2013. biomechanics and injury risk of a headbutt. international journal of legal medicine 127:103– 110. doi: 10 . 1007 / s00414 011 0617 y. baker, brenda  j., and sabrina  c. agarwal. 2017. stronger together: 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211008815. zuckerman, molly k., kathryn e. marklein, rita m. austin, and courtney  a. hofman. 2024. exercises in ethically engaged work in biological anthropology. american journal of biological anthropology 186(1):e25015. doi: 10 . 1002 / ajpa . 25015. login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe bioarchaeology international volume 8, numbers 3–4: 182–215 doi: 10.5744/bi.2023.0004 copyright © 2024 university of florida press forgotten children: the fetal and infant skeletal remains of the w. d. trotter anatomy museum, new zealand megan southorn,#,a siân e. halcrow,#,*,a stephie r. lončar,a emma l. sudron,a,b chris smith,a and d. gareth jonesa #these authors contributed equally to this work. adepartment of anatomy, university of otago, dunedin, new zealand baustralian research centre for human evolution, griffith university, gold coast, australia *correspondence to: siân e. halcrow, university of otago, anatomy, great king street, dunedin 9054, new zealand email: sian . halcrow@otago . ac . nz abstract fetal and infant skeletal remains in anatomical collections remain an underutilized yet important source of information on the interactions of gender, class, and religion during pregnancy and infant loss. the w. d. trotter anatomy museum at the university of otago in new zealand, founded in the nineteenth century, houses more than 2,000 models and anatomical “specimens,” with many of the skeletal remains lacking provenience information. this research aimed to both provide an inventory of the fetal and infant skeletal remains and identify through archival analysis the social context of those whose remains were obtained by the museum. an osteological analysis was carried out to assess the minimum number of individuals (mni), estimate ageatdeath, and provide evidence for pathology and dissection. the results are interpreted in the context of the archival accession data and historical information at the time to provide the social context in which these people lived and therefore information that may be related to their deaths and acquisition of their bodies by the university. most of the infants within the collection died around the time of fullterm birth, and some individuals have evidence for developmental pathology, birth trauma, and/or postmortem dissection. the historical context and legislation around body donation suggests structural inequality played a role in the acquisition of these infants’ remains from mothers (primarily poor and/or unmarried women) and that these remains went through a process of commodification and objectification and were retained as developmental teaching “specimens” and examples of pathology. keywords: anatomy museum; infant osteology; structural violence german skelettüberreste von föten und säuglingen in anatomischen sammlungen sind nach wie vor eine wenig genutzte, aber wichtige informationsquelle über die wechselwirkungen von geschlecht, soziale schicht und religion während der schwangerschaft und beim verlust des kindes. das im 19. jahrhundert gegründete w. d. trotter anatomy museum an der university of otago in neuseeland beherbergt mehr als 2000 exponate und anatomische „präparate“, wobei es bei vielen skelettüberresten keine angaben zur herkunft gibt. ziel dieser forschung war es, sowohl eine bestandsaufnahme der skelettüberreste von föten und säuglingen zu erstellen als auch durch eine archivanalyse den sozialen kontext derjenigen zu identifizieren, deren überreste vom museum erhalten wurden. es wurde eine osteologische analyse durchgeführt, um die mindestanzahl der personen (mni) zu ermitteln, das sterbealter abzuschätzen und hinweise auf pathologie und sektion/obduktion zu geben. die ergebnisse werden im kontext der archivierten zugangsdaten und historischen informationen zu der zeit interpretiert, um den sozialen kontext zu ermitteln, in dem diese menschen lebten, und damit informationen, die mit ihrem tod und dem erwerb ihrer körper durch die universität in zusammenhang stehen received 25 january 2023 revised 23 september 2023 accepted 7 december 2023 southorn et al. 183 dedicated to the babies lost and subsequently kept in the w. d. trotter museum, whose life stories (albeit short) we hope to give a voice at least partially to here. the study of historic human remains themselves provides vital information on the life experiences of past individuals and populations (larsen 2015). although the lives of individuals in more recent history are better documented than the lives of earlier populations, specific subgroups of society are often forgotten in these narratives (i.e., women, children, the poor, disabled or mentally ill) (clarke 2012; helleiner et  al. 2001; riley 1988). historical anatomical human remains are a unique source of information to assess the life experiences of individuals and communities in the past, and the study of infant remains from these contexts may give us an understanding of the development of medicalization of the body during pregnancy and childbirth (dittmar and mitchell 2016, 2018; muller and butler 2018). due to the close physiological relationship between mothers and infants during pregnancy and breastfeeding, pathology that exists in fetal and infant skeletal remains can be evidence for nutritional deficiencies and infectious disease in mothers (gowland and halcrow 2020). with the shift toward anatomy becoming a more humanistic field, ignoring the social power structures and sociocultural context that led to these individuals being anatomized and held in collections is no longer acceptable (de la cova 2019; muller et al. 2017; muller and butler 2018). such studies may lend insight into the influences that led to them being anatomized, such as disparities in access to health care historically and the inequitable treatment of the dead. perspectives on the acquisition and use of human remains, their contribution to anatomy and biological anthropology, and acknowledgment of their history of acquisition have changed over time within the museum and anthropological contexts (alberti 2011; claes and deblon 2018; wilson 2015). the use and display of these remains can be conceptualized through the lens of the commodification of bodies for their continued use in medical teaching and as objects of curiosity, including for the display and voyeurism of individuals with pathology (claes and deblon 2018; hodge 2013; ion 2022; macdonald 2012). galtung (1969), who was the primary proponent of the theoretical model of structural violence, defined this as a way in which social structures, laws, and other social institutions cause harm to individuals and prevent groups of people from meeting their full potential könnten. die meisten säuglinge in der sammlung starben etwa zum zeitpunkt der geburtsreife, und bei einigen personen liegen hinweise auf entwicklungsstörungen, geburtstrauma und/oder eine postmortale obduktion vor. der historische kontext und die gesetzgebung zur körperspende legen nahe, dass strukturelle ungleichheit beim erwerb der überreste dieser säuglinge von müttern (hauptsächlich arme und/oder unverheiratete frauen) eine rolle gespielt hat und dass diese überreste einen prozess der kommerzialisierung und objektivierung durchlaufen haben und als solche aufbewahrt wurden entwicklungslehre„präparate“ und exponate der pathologie. translation by: stephie lončar and sara otto scot tish tha fuighill cnàimhneach leatrom anabaich is leanaban ann an cruinneachaidhean anatomach fhathast nan stòras fiosrachaidh nach eilear a’ cleachdadh gu leòr ach a tha cudromach a thaobh fiosrachaidh air eadar obrachadh gnè, clas, agus creideamh tro leatromachd agus call leanaban. ann an taightasgaidh anatomy wd trotter aig oilthigh otago ann an sealan nuadh, a chaidh a stèidheachadh san naoidheamh linn deug, tha còrr air 2000 modal agus ‘sampaill’ anatomach, le mòran de na fuighill cnàimhneach gun fhiosrachadh air tùs. bha an rannsachadh seo ag amas air an dà chuid cunntas a thoirt air na fuighill cnàimhneach leatrom anabaich is pàiste a bh’ aig an oilthigh agus sealltainn, tro sgrùdadh tasglainn, an cotheacsa sòisealta. chaidh mion sgrùdadh osteologach a dhèanamh gus measadh a dhèanamh air an àireamh as lugha de leanabain faleth (mni), tuairmse air aoisaigbàis, agus fianais airson eòlasghlar agus gearradh na mhìrean. tha na toraidhean air am mìneachadh ann an cotheacsa dàta sealbhachaidh tasglainn agus fiosrachadh eachdraidheil aig an àm gus an cotheacsa sòisealta anns an robh na leanabain beò a thoirt seachad, agus, mar sin, fiosrachadh a dh’ fhaodadh a bhith cocheangailte ri am bàs agus mar a fhuaireadh na cuirp aca leis an oilthigh. bhàsaich a’ mhòrchuid de na naoidheanan taobh astaigh a’ chochruinneachaidh aig àm breith lànùine, agus tha fianais aig cuid aca air eòlasghalair leasachaidh, trauma breith agus / no gearradh postmortem. tha an cotheacsa eachdraidheil agus an reachdas mu thabhartas bodhaig a’ nochdadh gun robh pàirt aig neoionannachd structarail ann a bhith a’ faighinn fuighill nan leanaban bho mhàthraichean (boireannaich a bha bochd agus/no gun phòsadh sa mhòrchuid), agus gun deach na fuighill sin tro phròiseas bathair agus dìmeas agus gun deach an cumail mar ‘sampaill’ leasachadh teagasg agus eisimpleirean de eòlasghalar. translation by: annella macarthur gaelic forgotten children184 through the deprivation of basic needs through social forces of power. the amassing of anatomical skeletal collections has been understood through this theoretical model, with many works evoking this lens in the context of the treatment of the african american bodies in anatomical and anthropological contexts (e.g., de la cova 2019; lans 2020; nystrom 2014; watkins 2018; watkins and muller 2015). like the united states and united kingdom, in new zealand, the change of legislation in the nineteenth century to reduce the incentive for graverobbing led to the legal right for the acquisition of bodies from public institutions by physicians (anatomy act 1875). research on these historical anatomical collections highlights social deprivation related to factors such as race and poverty that were central to the formation of these collections (de la cova 2011; jones and whitaker 2012; lans 2021; richardson 1987; sappol 2002). the very presence of vulnerable or marginalized individuals such as infants within an anatomical collection can be indicative of the structural violence they (and their parent/s) experienced during their short lives and after death (zuckerman 2021). it has been suggested that most of the cadavers of adults received by the university of otago medical school historically were likely unclaimed bodies from hospitals, societies for the poor, and an asylum, all of whom cared for or housed society’s most vulnerable, those who faced societal structures that harmed them throughout their lives and after death (jones and fennell 1991). we acknowledge the sensitive nature of this study of these fetal and infant remains (beiter et  al. 2019; biers 2020; bonney et al. 2020; fourniquet et al. 2019; squires and piombinomascali 2022; wilson 2015), both from the perspective of how they may have been acquired in the past and our reflections on the ethics of those practices today, and the potential to continue and compound this injustice through the osteological investigation and objectification of these infants. part of our intention here is to study the osteology and pathology of these infants to start to tell the stories of their (albeit) short lives and the experiences of their parents and to attempt to understand something about how they came to be in these collections. this analysis helps with elucidating the context of provenience, which is important when considering their use in teaching, research, and display and informing students and researchers (cormer 2022; hildebrandt 2019). from a scientific paleopathological point of view, images are expected for verification of the observations. however, we are cognizant that these photographs could be disturbing for some and may be seen as objectification and continuation of this structural violence and inequitable treatment of these remains. we also recognize the personal sensitive nature of fetal and infant loss for some and the social taboo surrounding discussing and engaging with pregnancy loss (cox 2019). therefore, we include the images of the infants as supplementary information, so if readers wish to refer to these, they have agency in their decision. infants in anatomical education literature on the role of the fetus and infant in anatomical education is sparse (e.g., armüller and lenk 2022; dittmar and mitchell 2016; wilson 2015). the nineteenth and twentieth centuries were a formative time for anatomy and the collection of humans for their dissection and curation. in the united kingdom, adult males were the preferred body for most dissections during the nineteenth century (dittmar and mitchell 2016), and for that reason, literature that focuses on the use of the human body in medical education largely ignores women, infants, and children. the primary reason male cadavers were preferred in medical education in the united kingdom and other countries was their availability. under the act for regulating schools of anatomy 1832 (united kingdom), bodies legally available for dissection were either executed felons or those who had died in workhouses, hospitals, or other charitable institutions who had no family to claim their body for burial or cremation. although this law meant that the bodies of women and children’s bodies were legally available for dissection, their availability was restricted by the wardens of such charitable institutions. these wardens were known to refuse to hand over custody of women’s bodies to anatomists after death (dittmar and mitchell 2018) or would refuse to admit pregnant people into their care entirely (clarke 2012; dittmar and mitchell 2018). pregnant bodies from executions were also largely unavailable as their execution was incredibly rare: all pregnant people destined for the gallows were given a stay of execution until after the birth of their child (dittmar and mitchell 2018), thus rendering the bodies nearly completely unavailable to anatomists through that means. evidence from other skeletal collections around the globe suggests that the rarity and importance of these bodies in obstetric education has been a major incentive for the continued holding of the remains in museums for future generations (dittmar and mitchell 2016; kosenko et  al. 2022). interestingly, in the new zealand context, the bodies of (likely not pregnant) women were readily made available for use in anatomy education at the university of otago from institutions such as seacliff lunatic asylum (jones 2012) and in at least one case from the “gaol” (jail) (sudron 2021). southorn et al. 185 as discussed, historical legislation in great britain meant that dissection was largely limited to criminals and impoverished adults (mostly men), making the presence of infants and perinates in a museum even more unusual (dittmar and mitchell 2016; jones and fennell 1991; richardson 1987). dissection or dismemberment of the body after death went against the christian beliefs of the time, where in order to be resurrected when christ returned to earth, the physical body needed to remain intact (knight 2018; zuckerman et al. 2021). therefore, the donation of remains of a newborn or an infant to a museum is an unusual and unexpected choice for victorian and edwardian era parents in a predominantly christian society such as historic dunedin. more pragmatic justifications as to why these infant remains may have ended up in the care of the university, such as avoiding the cost of burial or religious doctrine preventing the burial of unbaptized infants in consecrated ground (dine 2019; murphy 2011), are also problematic. across dunedin, there are many historic stillbirths and infants buried in cemetery plots of all classes. for instance, the northern cemetery, one of dunedin’s largest cemeteries, was secular and contained a large number of council owned “third class” plots open for the burial of those who could not afford to purchase a plot themselves (lane 2018). the university of otago medical school likely acquired the remains of fetuses and infants as the only reliable way of studying early human development at the time. what is not clear, however, is the social context that led to the donation or forced acquisition of the infant remains for retention in the museum. the main aim of this research is to both provide an inventory of the fetal and infant skeletal remains and identify through archival analysis the social context of those whose remains were obtained and held in the w. d. trotter anatomy museum. to do this, we completed an osteological analysis of the remains and undertook archival research to investigate the social and historical circumstances for the inclusion of fetal and infant remains in this anatomical collection, including medical approaches to childbirth and consent to dissection for the purposes of medical education. there has been a growing awareness of the continuing impact of the profound lack of ethical standards in the collection, curation, and use of human skeletal remains for research and teaching purposes. an investigation of the rich social and historical context and ethics of past acquisition practices of historical anatomical collections in institutions is integral to starting this process of ethically engaging with these collections (adams 2009). the historical collecting practices define, in most part, what remains are held within museums today as guided by what was seen as acceptable in their social and historic context. fetal, infant, and child remains in these collections pose several ethical issues, and it is important to understand the historical acquisition and provenance for the consideration of their use in teaching, research, and display today (wilson 2015). the w. d. trotter anatomy museum, university of otago in dunedin this museum was founded in the late 1870s as part of the medical school and houses more than 2,000 human and model anatomical "specimens" used in education and research. in the museum is a collection of fetal and infant skeletal remains. no prior osteological or historical archival analyses had been completed on these infant remains. the city of dunedin was founded in 1848 by scottish colonial settlers, and the university was established less than 30 years later, in 1869. the land for the dunedin settlement had been purchased from the local iwi (tribe) of kāi tahu (carmalt jones 1945), and the subsequent discovery of gold inland from dunedin in 1861 made the city the industrial, financial, and commercial center of new zealand, a fine city to found new zealand’s first university (carmalt jones 1945; hercus and bell 1964; trapeznik 2011). methods age definitions all skeletonized infants (ageatdeath of less than one year) in the w. d. trotter museum collection were analyzed, and all historical information pertaining to infants acquired by the university of otago medical school for dissection was included in this project. we refer to these individuals collectively as “infants,” in line with the world health organization definition of the first year of life. other definitions used in this research are “fetus”, aged up to 37 weeks gestation; “perinate,” from birth to the seventh day of life; “neonate,” from the eighth to twentyeighth day of life; and “postneonate,” from the twentyninth day of life to the end of the first year. the term “fetus” is used in bioarchaeology to refer to an individual older than eight weeks gestation but not yet born (lewis 2007). we have used the term “fetus” in this research to refer to an individual aged prior to when a pregnancy reaches “term” at the end of the thirtyseventh week of gestation, because any individual older than 37 weeks of gestation may well have been born before their death and therefore cross the line of live birth forgotten children186 that marks the transition from “fetus” to “perinate.” all other definitions are concurrent with bioarcheological and clinical literature (halcrow 2017; halcrow and tayles 2008; lewis 2007). historical archival analysis available diaries, letters, and other forms of communication between undertakers, hospitals, medical practitioners, and university were investigated via an extensive search of materials associated with the anatomy department within the hākena database. no mention of procurement of infant remains for use in anatomy was found from those sources. the primary archival text for this study was the register of anatomical material, which was supplemented with historic undertaker records from hugh gourley ltd. (now gillions funeral services). we obtained the historical death certificates from the new zealand department of internal affairs. the information obtained from these resources is described in table 1 and below. a review of relevant historical literature and primary historical (archival) sources was used to identify any information available on when and why these remains may have been acquired, why they died, and to assess how aspects of gender, class, religion, and the concept of personhood may have interacted to result in the curation of these within the w. d. trotter anatomy museum. the university of otago register of anatomical material this archival book documents the acquisition of bodies by the department of anatomy from the period of 1876– 1941 and is held in the hocken collection | uare taoka o hākena in dunedin (fig. 1). it is assumed that all bodies used in anatomy education at the university of otago in this period were listed in this register. the register listed the name of the deceased, their age atdeath, the date the university received their body, the date any dissection commenced, the institution it was received from, the cause of death, the undertaker, the date of burial (if this occurred), any injections they received (e.g., to help with preservation), and any extra notes. interestingly, in the case of infants, instead of indicating the same undertaker was used for burial “do,” often a dash was written instead. the entire register was read systematically, taking photographs of each entry for an infant. this information was then digitally transcribed into a microsoft excel spreadsheet. at gillions funeral services, which recorded many of the early body donations to the university of otago (see supplementary file 1), we assessed the ledgers from 1876– 1941 (as this was the period documented in the university of otago register of anatomical material), using the index to find all cases of bodies that were sent to the university of otago by hugh gourley ltd. we then cross referenced the data from the hocken collection | uare taoka o hākena, recording any instances of infants being sent to the medical school and recording any extra information about the infants noted in the register of anatomical material. examples of this included costs associated with “supplying” the body of these individuals to the university and the date when dissection was commenced. hugh gourley ltd. funeral services ledgers the ledgers date from 1875, when the business was known as hugh gourley ltd., to the present day (now table 1. historical archival accession sources archival sources source information included the register of anatomical material hocken collection | uare taoka o hākena in dunedin acquisitions of human remains from 1876– 1941 includes name of the deceased, their age at death, the date the university received their body, the date any dissection commenced, the institution from which it was received, the cause of death, the undertaker, the date of burial (if this occurred), any injections they received (e.g., to help with preservation), and any extra notes. hugh gourley ltd. gillions funeral home, private collection, dunedin name of the individual being buried (or the person footing the bill in some cases), if the person was being buried by a trust, what funeral services they requested, place of death, sometimes date of death or burial, and any costs incurred (for example, for transport of the body). historical death certificates new zealand department of internal affairs | te tari taiwhenua (nzdia) the online historical search (https:// www . bdmhistoricalrecords . dia . govt . nz/) was used to find the registration number for historical records to be ordered from nzdia. cause of death, date of death, ageatdeath, parental marital status, father’s occupation, burial location, date of burial, and name of medical professional who attended illness and death. southorn et al. 187 gillions funeral services). as gourley was one of the two primary undertakers in the dunedin region, it provides a representative insight into the context of individuals who were sent to the university. the earlier ledgers were up to 500 pages long, with each book covering up to five years of finances for the funeral home. the books recorded the name of the individual being buried (or the person footing the bill in some cases), if the person was being buried by a trust, what funeral services they requested, place of death, sometimes date of death or burial, and any costs incurred. each ledger had an index book of surnames or company names that indicated the page in which their transactions with gourley ltd. were listed. an example of this is provided in supplementary figure 1. institutions such as the dunedin public hospital and the university of otago regularly had complete pages devoted to the bodies gourley was involved with undertaking, as shown in supplementary figure 2. the earlier historic entries were typically more detailed regarding place and context of death. death certificates historical death certificates are held by the new zealand department of internal affairs. we investigated the death certificates of the infants noted in the university of otago register of anatomical material. the death certificates provide further detail in addition to the registers such as parental marital status, father’s occupation, burial location, and date of burial. they were used to provide information on the social status of the parent/s of these infants as well as confirm ageatdeath and cause of death (see figure 2 as an example). skeletal analysis all fetal and infant remains were analyzed from the skeletal collection. the osteological analysis focused on estimating the minimum number of individuals (mni) within the collection, estimating the ageatdeath from each individual skeletal element (where possible), and macroscopic identification, description, and differential figure 1. university of otago register of anatomical material (with permission from the hocken collections | uare taoka o hākena). figure 2. example of a death certificate from the nzdia. name of the infant and their parent/s have been redacted. forgotten children188 diagnosis of any pathology. no destructive analyses were undertaken on the remains. mni was important to estimate as most of the skeletal remains have been curated by skeletal elements (e.g., all loose infant and fetal frontal bones were curated together under one accession number), rather than by individual. there are some remains presented as complete individuals, either as articulated skeletons in anatomical position or laid out in glass cases, also in anatomical position. mni can be calculated using the bone that is most frequently represented within the collection and the siding of these bones if they are paired. the most numerous bone within the infant and fetal skeletal remains of the w. d. trotter anatomy museum collection was the squamous part of the occipital bone. as this is an unpaired bone, more than one in the collection represents more than one individual, regardless of age or sex. an age estimation was obtained for each bone element where possible. all measurements of long bone length and cranial size were assessed using the standards from fazekas and kòsa (1978). fazekas and kòsa (1978) is the most complete standard available for age estimation of perinatal remains. although other standards may be considered more methodologically sound due to being developed from individuals with a known ageatdeath, fazekas and kòsa (1978) is the most widely accepted standard for estimating age from single skeletal elements (cunningham et al. 2016; lewis 2017; michel and charlier 2011; pap and pálfi 2011; weidig et  al. 2011). poor maternal health and physiological stress can cause growth disruption and, in extreme cases, intrauterine growth restriction (iugr), which may lead to underestimation of the age of these skeletal remains (hendrix and berghella 2008; hoppa 2000; merwin and harris 1998; perkins et. al. 2016). as growth disruption in fetal and infant skeletal remains is identified by comparing the age estimation from long bone length with age estimation from the dentition (hodson and gowland 2020), iugr is unable to be conclusively diagnosed in this collection (or differentiated from younger fetuses who are a normal size) because the dental and remains are generally not curated together as individuals. age estimation based on dental development mitigates some of the limitations of skeletal aging methods as it is argued to be more tightly controlled by genetics and is therefore less susceptible to physiological stress (bolaños et  al. 2000; liversidge and molleson 2004; thesleff 2000). for this research, estimating age from dental development is more appropriate than dental eruption methods as dental development methods can be used for perinatal individuals whose teeth have not yet erupted. radiographs were taken to assess development of all dental remains. the standard used for this research was the london atlas of tooth development and eruption (alqahtani et  al. 2010; alqahtani et  al. 2014). although this standard may not be considered the most accurate in estimating age from dental development in a modern new zealand population (baylis and bassed 2017), the reference population of historic british and european juveniles reflects the predominantly european origin population of nineteenth century dunedin. the inclusion of fetal standards and clear differentiation of stages in perinatal development made the london atlas of tooth development and eruption the most suitable standard to use in this research. sex estimation was not attempted as sexually dimorphic morphological characteristics are not sufficiently developed for conclusive sex estimation in preadolescent individuals (white and folkens 2005). results analysis of the register of anatomical materials showed 24 infants were acquired by the university of otago from 1876– 1941. twenty perinates, one neonate, and three postneonates were recorded as “supplied” to the university between 1876 and 1941 (supplementary table  1). there were six females, 12 males, and six individuals who did not have their sex recorded. the individuals are listed as year of death to protect their identity. only four individuals from the register of anatomical materials appeared in gourley’s ledgers, also listed with the cost of “supplying” each individual to the university. of the total number of infants, eight had prematurity or “immaturity” listed as cause of death. one who passed away from “prematurity” had a twin who survived (listed as “one breathes”). two of the individuals died from trauma or birth complications, including hemorrhage. two infants died of “inanition” and one of pyloric stenosis malnutrition. six had congenital or birth defects, which may have made their bodies particularly interesting for use in anatomy education. two died from infectious diseases: tuberculous enteritis and congenital syphilis. two individuals had no cause of death listed. source of fetal and infant bodies the infants supplied to the university of otago from 1876 to 1941 were typically acquired from public institutions such as batchelor maternity hospital (n = 11) and dunedin public hospital (n = 9). three individuals were supplied by the “redroofs” salvation army maternity home, one from cook maternity home in southorn et al. 189 gisborne, and one individual from an unnamed maternity hospital (supplementary table  1). the most common source of infant bodies changes over time. bodies predominately came from dunedin public hospital in 1885– 1920, whereas from 1921– 1934, they were provided almost exclusively by batchelor hospital. of the 24 infants in the university of otago register, there were 18 who had death records available. seven of the 18 infants have father “not recorded” on the birth certificate, indicating they were “illegitimate” children to unmarried mothers (all those historical records with “illegitimate” were typed out with that information retracted). those with a father recorded and their father’s profession recorded were mostly working class (e.g., laborers, bricklayers). four have “university” noted in their “burial details” section in the death certificate (e.g., fig. 2). although many of the infants in the university register note that they have been buried at various dates, with crossreferenced entries in gourley’s registers reporting the location as anderson bay cemetery, we find no evidence of burials of these individuals through the digitized burial records at the anderson bay cemetery. although we have data on the acquisition of infants from the archival research, the skeletal remains in the museum are no longer linked to this information, and thus we cannot match the remains to any specific individual identity. osteological results based on the skeletal analysis, the minimum number of individuals within the fetal and infant collection is 32. the collection comprises different curation techniques (table 2). most of the nonarticulated skeletal elements are from the cranium. ribs, vertebrae, and pelvic bones were only found in the articulated or mounted individuals. the general preservation of the skeletal tissue is excellent. the delicate skeletal elements of the crania, including the cranial vault bones and bones of the face, have been subject to some postmortem damage. damage to the parietal bones is most common, as well as unilateral or bilateral damage to the zygomatic processes of the temporal bones. ageatdeath the age of the fetuses and infants ranges from 15 weeks gestation to 3 months postnatal (fig. 3). most of the skeletal elements are aged to be within the final month of pregnancy to full term (36– 40 weeks gestation). aging for individual skeletal elements is shown in figure 4. some individual skeletal elements (n = 51/296) were unable to be aged for one of three reasons: inability to access the element (some were encased in perspex or resin); postmortem damage to the element, making accurate measurement impossible (i.e., ethmoid); or lack of an aging standard for the skeletal element. these age estimations are presented below as both the age of the identified individuals within the collection (mni = 32), as well as the age estimations for every individual skeletal element that was able to be analyzed. the skeletal element age distribution (fig. 4) is included as it is more representative of the age distribution of the entire infant skeletal collection in the w. d. trotter anatomy museum. pathology six of the 19 articulated individuals (five represented by articulated crania and one articulated skeleton) exhibited some form of visible skeletal pathology. two of the five individuals represented by crania that exhibited pathology had trauma possibly related to delivery (o3.d15 and o3.d6), and four individuals exhibited pathology consistent with congenital developmental abnormalities (o3.d7, o3.d14, o3.d180, and o5.d1). one of these individuals with evidence for developmental pathology (o5.d1) is a complete articulated skeleton. detailed descriptions of the pathological observations, photos, and differential diagnosis for each individual are included in supplementary file 2. discussion the main aim of this research was to provide an inventory of the fetal and infant skeletal remains of the w. d. trotter anatomy museum and understand the social context in which these remains were acquired by the museum. to achieve this aim, the osteological evidence needs to be interpreted within the maternal and infant health context, in concert with archival data on their provenance and the social context of class, gender, and religion at the time that may have led to their acquisition and use in the museum context. although our data do not allow for us to identify the infant skeletal remains to any specific individual, the general age distribution as well as the causes of death and evidence of pathology on the bones of the table 2. the number of articulated skeletons, articulated crania or skulls, and nonarticulated skeletal elements in the w. d. trotter anatomy museum curation type number mounted or articulated skeleton, >90% complete 6 articulated cranium or skull 13 nonarticulated skeletal element 267 forgotten children190 fetuses and infants are similar between the skeletal remains and the available archival data. for example, we have two infants with skeletal evidence for cerebral trauma, and there are two infants who are noted in both their death certificates and university register that they died from birth trauma. similarly, we have evidence for individuals with developmental skeletal defects and many who are premature, and these etiologies are also documented in the historical archival research. we believe that the individuals may have been collected due to their pathologies and as examples of development (e.g., the premature infants). however, this is obviously a biased sample whereby infants who are born prematurely and those with developmental disorders are more likely to pass away. infant and maternal mortality in new zealand assessing the osteological evidence of ageatdeath and pathology, using knowledge of historical causes figure 3. age-at-death distribution of the fetal and infant individuals of the w. d. trotter anatomy museum collection. those individuals older than 43 weeks gestational age are assumed to have been born alive and their death occurred within the neonatal or post-neonatal period. figure 4. age-at-death distribution for individual fetal and infant skeletal elements of the w. d. trotter anatomy museum collection. those individuals older than 43 weeks gestational age are assumed to have been born alive and their death occurred within the neonatal or post-neonatal period. southorn et al. 191 of fetal and infant death in new zealand is important in considering the possible causes of death for these infants in the w. d. trotter museum. common causes of maternal death are important to explore also, as maternal and fetal health are inextricably linked (lassi et al. 2013) and infants who lost their mother at birth tended to have poorer health outcomes (atrash 2011; clarke 2012; loudon 1991; pavard et al. 2005; sadetskaya and oxley 2012). in new zealand, infant mortality peaked in 1875 at 130 deaths per 1,000 live births and then began to decline thereafter (fraser 1928), similarly to other developed countries at this time (loudon 1991; sadetskaya 2015; sadetskaya and oxley 2012). by 1920, this mortality rate had more than halved due to the improvements in maternal and infant care. it is argued, however, that this decline in infant mortality was only experienced by the pākehā (white new zealander) population (pool et al. 2007; sadetskaya 2015), with the māori mortality rates excluded in published data until 1920 (sheehan 1878; waldegrave 1901; ward 1905). once introduced, māori registration data continued to be of poor quality (pool 1973), and therefore the true māori infant mortality rate during the nineteenth and early twentieth centuries remains unknown, with modern estimations placing it much higher than the pākehā recorded infant mortality rate (statistics new zealand 2006). despite improvements in public health and medical treatment during the early twentieth century, the major causes of infant death have not changed significantly since the nineteenth century, with the main causes being prematurity and respiratory and diarrheal diseases (clarke 2012; fraser 1928; loudon 1991). there was no formal requirement to register stillbirth in new zealand until 1919, but some earlier parents chose to register their stillborn child. poor obstetric technique contributed to both infant and maternal mortality, with some of the methods developed for dealing with maternal health conditions such as eclampsia causing trauma for both mother and child (bryder 1986; drife 2002; loudon 1986; sheikh et al. 2013). the use of accouchement forcé, high forceps early in labor, and nonsterile techniques posed significant risk to both mother and child and were at times used without clinical need (bryder 1986; drife 2002; loudon 1986; sheikh et al. 2013). this risk is seen in the individuals who have evidence for forceps trauma from the skeletal evidence. societal reactions to infant and fetal loss assessing prenatal loss is especially important because the societal response to an individual who died before birth may have impacted the decisions made by parents after death regarding burial or donation of the remains of their baby, including dissection or donation to a museum. the infants in the w. d. trotter anatomy museum were not treated in the normative way in terms of religious and spiritual needs of burial on consecrated ground. this indicates that despite going against social norms, it was seen as imperative (by the medical community at least) for these bodies to be used in teaching and research context at the time and that their educational value overrode the need for normative burial. most of the infants in the collection are aged around full term (40 weeks) or younger. defining stillbirth in a historic osteological context is difficult; in this research, any individual with an estimated ageatdeath between 20 and 40 weeks gestation is considered a possible stillbirth. the role of religion in society can impact on the choices available for burial of stillborn children (murphy 2011). in some religions, receiving god’s forgiveness before death (through baptism or other penitential rites) was a way to ease the road of the departed to heaven (murphy 2011). baptism was also often a criterion for burial in a religious burial ground but could only be performed on live children (cootes 2021; murphy 2011; perry 1983). if a child looked to be in distress after birth, emergency baptism could be performed by a layperson to ensure the safe passage of their soul to heaven (code of canon law 1983; clarke 2012). under the cemeteries bill (new zealand) 1880, the consecrated areas of cemeteries were exclusively under the authority of the church that consecrated them. this meant that children who were not baptized may not have been able to be buried in consecrated ground, depending on the doctrine of the controlling church (murphy 2011). this could be a source of pain for a deeply religious family and potentially impact the decisions they would make regarding the care of their child after death. while the burial of stillborn children in consecrated ground may have been prevented, public cemeteries and some denominations did allow for the burial of stillborn children (ockwell 1978, 1982), as was the case in dunedin. archaeological evidence from canada and the united kingdom also indicates that burial of stillborns was not uncommon (davis 2009; herring et  al. 1991). in new zealand, there was no framework for registering stillbirths until 1913 and no requirement to register stillbirths until 1919 (birth and deaths registration amendment act 1912); consequently, nineteenth century stillbirth rates are unknown. experienced new zealand physicians ernest rawson and william sealy estimated that stillbirths made up 3% to 5% of the births they attended between 1859 and 1895 (clarke 2012). forgotten children192 infant loss and family grief she has no baby now to call her mother. (eliza white diary 1830, cited in clarke 2012:223) to understand the significance of the accession of the infants in the museum, a consideration of emotional responses to infant death and normative funerary ritual is important. since the 1960s, some anthropological and archaeological literature has suggested that in times of high infant mortality, parents would restrain themselves from emotionally investing in their infants to prevent overwhelming grief if the child was to die and can be used to explain infant atypical burial (ariès 1962; cannon and cook 2015; jalland 1996; parkes 1986; pollock 1983; stone 1977). the theory of withholding of grief does not fit with evidence for attitudes toward infant loss in historic new zealand. unfortunately, the relatively high infant mortality rates of the late nineteenth century meant that the reality of infant death was something many families faced (clarke 2012; jalland 1996). during victorian and edwardian times, there are obvious signs of public displays of grief, which can be contrasted to today’s stigma and silence surrounding pregnancy loss or the loss of an infant (gowland 2020). for instance, there are primary accounts from new zealand that show that miscarriage, stillbirth, and the death of a child were all discussed in personal letters between friends and family and even announced in the newspapers (clarke 2012; clutha leader 1894; mount ida chronicle 1881; porter and macdonald 1996) (e.g., fig. 5). pākehā funerary practices in nineteenthcentury new zealand followed those of victorian england and were involved and elaborate (bedikian 2008; schafer 2007). family involvement with the body of the deceased was common in the united kingdom, with relatives often congregating in one room with the body for several days (murdoch 2015). postmortem photography and large funeral processions would precede interment within the week after death (murdoch 2015). children’s deaths were seen as particularly tragic for the family (jalland 1996) and were mourned accordingly, with the same funerary practices and interment rights afforded to children as to adults. one exception to this may have been interment rights for stillborn children, who were possibly restricted from burial in denominational areas of cemeteries, as discussed previously. although it is highly unlikely the infant and fetal remains of the w. d. trotter anatomy museum are of māori ancestry, discussion of infant death and mortuary treatment within māori culture is relevant, even if to rule out this possibility. in māori culture, the correct treatment of a stillborn child after death was imperative, as the souls of stillborn children were believed to become malignant spirits (kehua) after death. kehua could cause severe illness among members of the iwi (tribe) and so the burial rites were particularly important to ensure the passage of the soul to rangi (heaven) or te po (the underworld) and prevent the soul staying on earth, where it could cause harm (goldie 1904). the community would come together at the marae (meeting house) for days of whaikōrero (speeches), waiata (songs), karakia (prayer), poroporoaki (speeches of farewell), and tangi (mourning) (jacob et al. 2011). the entire community (including children) would take part in this process, and burial would only occur after all the marae rituals were completed (jacob et al. 2011). acquisition of human remains for education in new zealand in many modern “western” cultures, an individual is often imbued with personhood throughout gestation, and identity acquisition begins in the womb (gowland 2020; gowland et al. 2014). this concept of personhood in infants is enshrined in new zealand legislation that governs modern collections such as the w. d. trotter anatomy museum. since 2008, in new zealand, fetal and infant tissue has been unable to be acquired (human tissue act 2008, section 8(b)). if modern legislation effectively bans the collection of fetal and infant tissue under the guise of the individual being unable to consent, why was the acquisition, preservation, and storage of infant and fetal tissue considered appropriate in nineteenthcentury new zealand? this can be understood within the different social context from when the remains were acquired. the fetal and infant skeletal remains were collected when the anatomy act 1875 was the governing legislation for schools of anatomy. this act, modeled on the 1832 uk anatomy act, allowed for the dissection of human remains by the schools of anatomy if permission for dissection was given by the individual with legal custody of the body after death (anatomy act 1875). this law theoretically allowed for any individual to undergo dissection, including women and figure 5. an example of an announcement of stillbirth; mataura ensign, 12 july 1887. courtesy of the national library of new zealand | te puna mātauranga o aotearoa. southorn et al. 193 children, unless they had explicitly stated they did not want to undergo dissection (anatomy act 1875). in line with evidence from skeletal collections from other parts of the world, it is likely these remains were collected to study development and pathology (dittmar and mitchell 2016), and the continued preferential holding of these remains over (anatomically normal) males dissected over the past 150 years at the otago medical school suggests they were valued for their rarity and role in education. the purchase of skeletal remains was a fast and straightforward way to build a collection from the midnineteenth to late twentieth centuries during the formative period for anatomization of human material (hefner et al. 2016). india was the primary source of (adult) skeletal remains, which were unfortunately often robbed from graves, coerced from families, or taken under false pretenses such as for postmortem examinations and then processed for medical use (hefner et al. 2016). however, acquisition records indicate the primary sources of infant remains for the medical school include being donated or acquired from the local community immediately after their deaths. it may be that the infants that were acquired for cadaveric dissection remain in the w. d. trotter anatomy museum today. of the four individuals also found in gourley’s ledgers, three were listed as having a cost for the “university” as a part of the entry, for “supplying” the body. the typical cost for supplying a body to the institution was £5 (which translates to roughly $1,151 nzd in 2023), but the cost associated with one infant, who died in dunedin from a cerebral hemorrhage, cost £31, which amounts to a modern $7,137 nzd. the willingness to pay the relatively high cost associated with obtaining these remains for anatomy education suggests the high demand for cadavers in dunedin. there is no evidence from any historical sources for widespread graverobbing of bodies for use in anatomical education within the new zealand context. body donation of infants, medical authority, and the intersection of class, stigma, and structural violence body donation in nineteenthcentury new zealand was almost unrecognizable from the modern body bequest program in place at the university of otago. the current body bequest program at the university of otago, in line with the new zealand human tissue act 2008, requires informed, clear, written consent from the individual and the individual’s family. one of the desired outcomes of the anatomy act 1875 was to increase the availability of cadavers for medical education (jones and whitaker 2012). this was to prevent graverobbing, which had been a major problem in the united kingdom (dittmar and mitchell 2016; jones and whitaker 2012). the supply of cadavers for education was increased by the law allowing the use of unclaimed bodies for dissection (anatomy act 1875). once again, this law disproportionately affected the poor and mentally ill (jones and whitaker 2012). those who had sought help during their lifetime (including poor pregnant women) and died while in care were now available for dissection at the discretion of the warden or surgeon, who were afforded a large amount of authority in this context. our historical analysis focusing on the accession registers and sources of bodies proves that this was indeed the case. dunedin public hospital, the otago benevolent institution, “redroofs” salvation army house, the batchelor maternity hospital, and cook maternity home in gisborne were the places of death on the records for these infants. these hospitals provided care beyond the immediate pre and postnatal period for poor women and their children (clarke 2012). “redroofs,” alongside other salvation army houses across the country, specifically aided single or unwed mothers for a brief period before and after birth. the marital status and socio-economic status information that we have for these mothers is discussed below. the anatomy act 1875 required consent only from the person who had legal custody of the body after death unless the prospective donor had objected to dissection either verbally or in writing during their lifetime. in most situations, the family would have legal custody of an individual’s body after death and therefore familial consent would be required for the donation of the body to the university. if an individual died in hospital, prison, or an asylum, the surgeon or warden in charge of the institution had legal custody of the body. the university of otago sought out these bodies; the first cadaver dissected at the university of otago was that of a man who had died in dunedin public hospital (carmalt jones 1945). dunedin public hospital and the university of otago were closely linked; many of the lecturers at the medical school also worked in the hospital (carmalt jones 1945; hercus and bell 1964), and it remains a teaching hospital to this day. it is likely that many of the remains of the fetal and infant individuals within the collection were donated by the hospital physicians because the records show that all the infants accessioned listed in the register of anatomical material died while in a hospital. in this case, the anatomy act 1875 disproportionately affected poor families. in nineteenthcentury new zealand, hospital birth was seen as a last resort. many towns refused to open a maternity ward at all, believing they were vectors for infection (clarke forgotten children194 2012). middleclass and wealthy women gave birth at home, attended by midwives or a doctor (clarke 2012), in which case, the family would maintain legal custody of the child should it pass away or be stillborn. the majority of women giving birth in hospitals in the nineteenth century were poor or without familial support; therefore, the legal chain of custody meant that poor women were the most likely to be left without a choice in regard to the resting place of their children if they were stillborn or died soon after birth, which may have led to the acquisition of their infants for use in the medical school and museum context. the presence of individuals with developmental anomalies within the collection also suggests that hospital care may have been required for these individuals in their short life and they may have died in hospital. some may also have been selectively curated within the collection as examples of pathology, a way to demonstrate abnormalities in development to medical students. no further record of burial could be identified for any of the infants detailed in the register of anatomical material. while the register denotes a date of burial (for some, but not all the infants), there are no dunedin city council records of burial for these infants. if in fact these infants were not buried, this is a major indication that they were treated differently in death than many of the adult cadavers who were buried. the collection and anatomization of fetuses was highly valued in the advancement of scientific careers and social prestige (franzén 2022; wilkie 2003), where curators and anatomists went through a phase of amassing “material” in the nineteenth century (teather 1990). in the nineteenth and twentieth century united states, women were given little to no agency in this process of the acquisition of their infants in the anatomical context, and most were not aware that their baby had been taken away (dubow 2011; noe 2004. morgan (2002, 2004, 2009) has explored from a medical anthropological point of view the place anatomical collectors and preparers play in the transformation of embryos and fetuses in the social context of turning something that is mostly socially unrecognizable (e.g., early pregnancy) into an object of cultural and social importance (morgan 2009:5). franzén (2022) found in the context of acquisition of fetal bodies by uppsala university from ca. 1890– 1930 that mothers had different understandings of fetal bodies and notions of their care than the physicians and anatomists. although the infant and fetal remains in the w. d. trotter anatomy museum may have been donated by the surgeon of the hospital they died in, it is also possible that some of the families may have chosen to donate the bodies of their children to support medical education or for other unspecified reasons, but this is unknown. the individual reasons behind body donation are varied and complex, and parents may have chosen body donation or to leave the remains of their child unclaimed for social, religious, or more pragmatic reasons (fennell and jones 1992). structural violence toward women was a factor contributing to the acquisition of infant bodies for education. as stated, structural violence is harm perpetuated against individuals or groups through the normalization of inequalities embedded within social structures and institutions (galtung 1969; rylko bauer and farmer 2016), and this can be extended to the acquisition of human remains and dissection of these remains in anatomy (nystrom 2014). a significant proportion of the infants who were used in the w. d. trotter anatomy museum were born to unmarried mothers, and those who were married were mostly from lowclass families, as evidenced by the occupations of their husbands. there were many mechanisms through which structural violence impacted women. the patriarchal society of colonial new zealand placed blame for rape and coercive sexual encounters on women (nz truth 1908). social stigma surrounding pregnancy out of wedlock painted women as “shiftless and immoral” or “sinners” (garlick 2012; nz truth 1908) and forced women out of jobs, therefore making them reliant on social institutions (such as parishes and benevolent institutions, which often had discriminatory policies toward pregnant women) or family for material assistance (clarke 2012; destitute persons act 1846; garlick 2012; hospital and charitable institutions act 1885). poor pregnant women, if not already institutionalized, were forced to give birth without medical care or attend hospital (o’donnell 1991). mothers with financial means in nineteenth and early twentiethcentury new zealand would typically avoid giving birth in public hospitals, instead seeking maternity care in their own home from a private doctor, midwife, or nurse (clarke 2012). some mothers had no choice but to give birth in the public hospital, either due to financial constraints or perceived social deviance (i.e., being a single mother) (o’donnell 1991). hospital births could violate women’s autonomy, leaving them alone at the hands of male doctors, with no choice in their own birth experience, and legally no custody of the body of their child should they die in hospital (the mother’s body would also remain in the custody of the surgeon, should she die while admitted) (anatomy act 1875). the social circumstances of a woman affected the health care she was able to access, the care she was entitled to, and the choices she was able to make for her own body and the body of her child. southorn et al. 195 there is evidence for the abandonment of infants and infanticide at the end of the nineteenth century and early twentieth century in dunedin, with many of these infants remaining unidentified (e.g., fig. 6). clarke (2012) reviewed several cases, many of whom were from dunedin, which was the biggest center in new zealand at the time. these infants would have been likely candidates for medical dissection and curation in the museum. many of the infants who were identified in these circumstances were “illegitimate” (clarke 2012) and therefore victims of structural violence through lack of social support for women within a patriarchal society where being an unmarried mother meant you could be shamed and unsupported at various levels in society. conclusion little research has focused on the fetal and infant remains of anatomy museums around the globe (dittmar and mitchell 2016; muller and butler 2018). in the museum and education environment, bodies have, especially in the past, been objectified as anatomical specimens rather than the individuals these remains belong to, nor has the social context been assessed that culminated in their curation in these institutions’ collections. fetal and infant remains from historical anatomical collections can provide important insight into the lives of mothers and infants during the time the remains were acquired and their social context. the osteological analyses found that there is a range of bones from individuals of different ages and the presence of developmental pathology, emphasizing their value as developmental resources at the time of acquisition and the authority afforded to the physicians in collecting them. most individuals were aged at around fullterm, mimicking the normal ageatdeath distribution of infants. there is osteological evidence for two individuals dying around the time of death from birth trauma, one including the possible use of forceps during birth, and there is evidence for dissection on some individuals. there is also osteological evidence for four individuals with skeletal developmental anomalies whose skeletal remains may have been kept for dissection and education as examples of anatomical “oddities.” the archival evidence on ageatdeath and cause of death is similar to the osteological evidence. however, because of the loss of provenience information for individuals still housed in the collection, we are unable to identify the human remains to specific individuals. the archival evidence and social historical context give us insight into their acquisition through the consideration of structural violence at the nexus of factors including class and social stigma of unwed pregnant people, affecting the treatment of parents and the treatment of their deceased infants, with marginalization in death as they had during their short life. these factors should be addressed in the retention of these remains and in their use in education and research. ethics statement we approached the university of otago ethics committee and the new zealand department of internal affairs | te tari taiwhenua for our archival research using the publicly available ledgers and death certificates and were advised that no ethical review was required so long as our data collection and publications of this information comply with all relevant legislation (i.e., privacy act 2020, births, deaths, marriages and relationships registration act 2021, health information privacy code 2020, human tissue act 2008, etc.). permission from the hocken library | figure 6. newspaper article on verdict of infanticide by abandonment, with mother unknown. source: greymouth evening star, 18 june 1904, p. 4. forgotten children196 uare taoka o hākena was obtained for the use of figure  1. ethics approval for the osteological research was gained from the university of otago department of anatomy body ethics committee. acknowledgments thank you to gillions funeral services ltd. for access to the archives and to the hocken librarians for their help with access to the collection and their copying of figure 1. part of the archival work was funded by the department of anatomy summer scholarship from the university of otago awarded to es and funding from the performance based research fund awarded to sh. we also thank annella macarthur, sara otto and stephie lončar for their language expertise in translating the abstract. we are especially grateful to annella macarthur for her expertise in translating the abstract into scottish gaelic, a language with a rich cultural heritage that remains a vital part of our history. we thank the associate editor, coeditorin chief (gwen robbins schug), and reviewers for their constructive comments challenging us to reflect on how to appropriately present these infants housed within the w. d. trotter museum, which is not an easy story to tell. references cited adams, m. 2009. both sides of the collecting encounter: 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govt . nz / newspapers / gest19040618 . 2 . 29. accessed 27 may 2023. thesleff, irma. 2000. genetic basis of tooth development and dental defects. acta odontologica scandinavica 58(5):191– 194. doi: 10 . 1080 / 000163500750051728. trapeznik, alex. 2011. on the waterfront: the historic waterfront precinct, dunedin, new zealand. public history review 18: 65– 82. twice a father: increasing the illegitimate birth rate. 1908. nz truth, may  23. https:// paperspast . natlib . govt . nz / newspapers / nztr19080523 . 2 . 26 . 4. accessed 10 december 2021. ubelaker, d. h. 1991. perimortem and postmortem modification of human bone: lessons from forensic anthropology. anthropologie 29(3):171– 174. university of otago register of anatomical material (1876– 1941). department of anatomy records (8311503). hocken collections, dunedin. van vliet, g., b. larroque, l. bubuteishvili, k. supernant, and j. legér. 2003. sexspecific impact of congenital hypothyroidism due to thyroid dysgenesis on skeletal maturation in term newborns. the journal of clinical endocrinology & metabolism 88(5):2009– 2013. doi:10 . 1210 / jc . 2002 021735. vertinksy, a. t., and p. d. barnes. 2007. macrocephaly, increased intracranial pressure, and hydrocephalus in the infant and young child. topics in magnetic resonance imaging 18:35– 51. doi: 10 . 1097 / rmr . 0b013e3180d0a753. waldegrave, f. 1901. census of the māori population (papers relating to). appendix to the journal of the house of representatives. https:// paperspast . natlib . govt . nz / parliamentary / ajhr19 01 i . 2 . 4 . 2 . 43. accessed 11 january 2023. ward, j. g. 1905. public health statement by the minister of public health, the hon. sir j.g. ward, k.c.m.g. appendix to the journal of the house of representatives. https:// paperspast . natlib . govt . nz / parliamentary / ajhr1905 i . 2 . 4 . 2 . 53. accessed 11 january 2023. watkins, r. j. 2018. the fate of anatomical collections in the us: bioanthropological investigations of structural 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of racial violence. the annals of the american academy of political and social science 694(1):39– 47. doi: 10 . 1177 / 00027162211008815. southorn et al. 201 supplementary file 1 images of the records of hugh gourley (undertaker) figure s1. example of index of gourley’s 1925–1927 ledger. name has been redacted. figure s2. example of page of transactions with the university from gourley’s 1908–1910 ledger. names have been redacted. forgotten children202 supplementary file 2 details of postmortem modifications, pathological descriptions, images, and differential diagnoses postmortem modifications pathological descriptions individual o3.d15 an articulated crania of an individual with an estimated age of 38 to 40 weeks gestation (accession identification o3.d15) had an 11mm overlap of the parietal bones at the sagittal suture (supplementary figure 5). overlap of the parietal and occipital bones at the lambdoid suture was also visible, but the amount of overlap was unable to be measured due to the articulation of the cranial bones (supplementary figure 6). this overlap was likely the result of head molding during delivery. if an infant is in the correct position for delivery (head down), a large amount of pressure is distributed across the cranial vault as the fetus passes through the pelvis (chasler 1967; sorbe and dahlgren 1983). the flexible cranial sutures and open fontanelles of the fetal skull allow the bones of the cranial vault to shift and overlap as the fetus moves through the pelvis during delivery (molding) and reduces the circumference of the skull, allowing for an easier passage through the birth canal (ami 2019; chasler 1967; sorbe and dahlgren 1983). trauma to the brain from head molding can occur even in a “normal” delivery with no visible head molding from the birth process (ami et  al. 2019; rooks et  al. 2008). severe cases of head molding can lead to intrapartum or neonatal death (sorbe and dahlgren 1983). significant head molding during delivery may indicate cephalopelvic disproportion, when the size of the head of the infant and the size of the pelvic outlet are incompatible for birth (buchmann and libhaber 2008; iversen et  al. 2020; munabi et al. 2016; stewart and philpott 1980). without treatment, cephalopelvic disproportion may result in an obstructed labor and could be a death sentence for both the mother and child (dolea and abouzahr 2000; shirley et  al. 2020). treatments such as symphysiotomy and craniotomy were available but either required long convalescence postprocedure or resulted in the death of the infant (jardine 1904). caesarean sections were not commonly performed in nineteenthcentury new zealand (clarke 2012), and so an obstructed labor may have meant death or life changing disability for both mother and child (drife 2002; jardine 1904). it is possible that cephalopelvic disproportion and the resulting obstructed labor was the cause of the molding observed in individual o3.d15 and may have been the primary trauma resulting in their death. individual o3.d6 another individual (o3.d6) with an estimated age of 40 weeks has perimortem trauma to the right parietal bone (supplementary figure 7). the trauma site measures 40.4 mm from anterior to posterior and lies immediately superior to the right parietal eminence. this bone fracture displays a stellate pattern, with multiple fractures radiating from a middle area of wastage 22.3 mm in width (anterior to posterior). there is some plastic deformation of the remaining bone around this area of wastage and one fracture extending to but not crossing the coronal suture anteriorly to the trauma. superiorly, there is another smaller area of wastage (11.6 mm from anterior to posterior). the plastic deformation of bone around an area of fracture indicates that the trauma occurred before the organic collagen component of the bone had degraded and so could have occurred around the time of death (kemp 2016; ubelaker 1991). plastic deformation is the permanent bending of bonds between atoms in bone, caused by slow loading stress (love and wiersema 2016). a lack of remodeling or new bone growth around the fracture also supports the argument that this is perimortem trauma. given this infant’s age and the nature of the bluntforce trauma, one possible cause of this trauma is from the use of forceps during delivery (chasler 1967; dupuis et al. 2005; kendall and woloshin 1952). instrumental forceps deliveries were common at the time for both prophylaxis and intervention in obstructed labor (delee 1920). individual o3.d7 this individual is represented by an articulated crania with an estimated ageatdeath of younger than one month postbirth. age estimation from the dentition and the cranial size were consistent. this individual is well preserved except for postmortem damage to the maxilla and mandible, exposing the dentition. individual o3.d7 exhibits bilateral fusion of the coronal and squamous sutures (supplementary figure 4). the coronal suture had also begun to obliterate. fusion of these cranial sutures normally begins in adulthood (cunningham et al. 2016). southorn et al. 203 individual o3.d14 individual o3.d14 is represented by an articulated crania with an estimated ageatdeath of one to three months postbirth. estimations of age from the dentition and the cranial bone size were consistent. individual o3.d14 exhibits significant postmortem damage to the left and right parietal bones, exposing the dura mater that has been preserved inside the cranium. this damage has likely occurred to the thin bones during the use of the individual in medical and anatomical education at the university of otago. this individual has evidence for developmental pathology in the form of bilateral fusion of the squamous and coronal sutures without total obliteration and abnormal frontal bossing (supplementary figure  8). in addition, approximately midway down, and either side of the metopic suture, there is an area of irregularity. at this level, on the right frontal bone, there is a small area of exposed dura; to the left in the same location appears to be an area of thinning bone (supplementary figure 9). individual o3.d180 the third individual represented by an articulated skull displaying pathology, individual o3.d180, was 38 to 40 weeks gestation with evidence for developmental abnormalities. this individual has an abnormally large anterior fontanelle (supplementary figure 10), one large intrasutural bone in the medial part of the lambdoid suture (supplementary figure 11), an underdeveloped face, and many very small intrasutural bones (supplementary figures 11 and 12). individual o5.d1 individual o5.d1 is an articulated full skeleton. age estimation from the dentition was not possible due to the remains being encased but is likely a neonate based on the individual’s size. analysis found the frontal bone sits significantly inferior (~1 cm) to the parietals at the level of the anterior fontanelle, and the occipital contained three extra bone ossicles (intrasutural bones) in the superior portion around the level of lambda extending right and inferiorly (supplementary figure  13). as well as this, the anterior fontanelle appeared unusually large. postcranially, the axial skeleton exhibited an anteriorly protruding sternum and ribcage. the pelvis is narrow and internally rotated on the left with the developing sacrum and coccyx curving around through and above the pelvis inlet. on the appendicular skeleton, the humerus is angled medially bilaterally, creating a high carrying angle at the elbow, and there is a left deviation of both femora in the acetabulum. there is bilateral medial deviation of the feet from the metatarsals to phalanges. the left first metatarsal sits slightly under the second metatarsal. the right foot exhibited postaxial polydactyly type a (benjamin et al. 2022) with a broad fifth metatarsal bone and no shaft duplication, but with duplication at the phalangeal level, creating six phalanges. differential diagnosis individuals o3.d7 and o3.d14 premature fusion of the cranial sutures or craniosynostosis is a relatively common developmental anomaly, affecting around 1/2,500 children (aleck 2004; di rocco et  al. 2009). untreated craniosynostosis can lead to abnormal growth of the cranium and increased intracranial pressure (governale 2015). most cases of craniosynostosis are isolated and are not usually inherited. these cases are known as primary nonsyndromic craniosynostosis and typically affect one cranial suture only, most commonly the sagittal suture (aleck 2004; governale 2015; ranger et  al. 2010). due to the number of sutures involved in the cases of craniosynostosis in individuals o3.d7 and o3.d14, primary nonsyndromic craniosynostosis is an unlikely diagnosis (aleck 2004; governale 2015). syndromic craniosynostosis results from genetic mutations, most commonly in the fibroblast growth factor receptor (fgfr) genes (aleck 2004; governale 2015). although syndromic genes can mutate spontaneously, most cases of syndromic craniosynostosis have a familial component (governale 2015). the most common conditions that cause syndromic craniosynostosis are crouzon syndrome, jackson– weiss syndrome, apert syndrome, and pfeiffer syndrome (aufderheide and rodríguezmartin 1998). all these conditions present with craniosynostosis, along with variable cranial and midface deformities, and usually with specific diagnostic features in the postcranial skeleton. as o3.d7 and o3.d14 are only represented by skulls, any postcranial skeletal pathology is unable to be assessed, leaving the diagnosis inconclusive for these two individuals (supplementary tables  2 and 3, respectively). individual o3.d180 the differential diagnosis for this individual focused on conditions that result in abnormally large fontanelles and an underdeveloped face, as well as disorders of bone development and ossification, including achondroplasia, increased intracranial pressure, rickets, congenital hypothyroidism, down syndrome (trisomy 21), forgotten children204 edwards syndrome (trisomy 18), and intrauterine growth restriction (supplementary table  4). as with the previous individuals discussed, the absence of post cranial remains means a more conclusive diagnosis of congenital disorders is not possible. the congenital conditions consistent with most of the pathology present of this individual are edwards syndrome (trisomy 18) or congenital hypothyroidism. edwards syndrome is a rare genetic condition caused by the presence of one extra partial or full chromosome 18 and occurs in approximately 1 in 8,000 live births (cereda and carey 2012). individuals with trisomy 18 have low birth weight, growth restriction, an underdeveloped face, a wide anterior fontanelle, and a narrow forehead with a “strawberryshaped” skull that is brachiocephalic with a flattened occipital bone and pointed frontal bones, all consistent with o3.d180’s morphology (supplementary figure 10). edwards syndrome is associated with a very high fetal and infant mortality rate, where almost 40% of affected individuals who make it to term die during labor (cereda and carey 2012). congenital hypothyroidism (ch) occurs when there is a lack of the hormones triiodothyronine and thyroxine, which stimulate metabolism and are important in the formation and maturation of bone (rastogi and lafranchi 2010). congenital hypothyroidism can be permanent or transient. permanent ch is the result of thyroid abnormalities or errors of thyroid hormone biosynthesis, while transient ch can occur due to thyroidstimulating hormone deficiency or congenital hypopituitarism. maternal iodine deficiency can also cause transient ch (rastogi and lafranchi 2010), which is important within the new zealand context as the soil is naturally low in iodine, and goiter was common in the population prior to the introduction of iodized salt in the 1920s (hercus et al. 1925). signs of ch typically arise in the soft tissue, but ch can also cause abnormal development in skeletal tissue, resulting in wide anterior and posterior fontanelles, open sutures, and epiphyseal dysgenesis (rastogi and lafranchi 2010; van vliet et al. 2003). there is a discrepancy of estimated skeletal age of this individual (34– 36 weeks gestation) compared with a dental age estimation of 38 to 40 weeks gestation. it is possible that this individual suffered intrauterine growth restriction as the result of a genetic condition or concurrently with a genetic condition as a result of maternal health and placental conditions (hendrix and berghella 2008; sharma et al. 2016). individual o5.d1 when considering individual o5.d1, there are clear developmental anomalies, and diagnoses considered focused on the postaxial polydactyly, including trisomies 13 and 18, ellis– van creveld syndrome, and greig cephalopolysyndactyly syndrome. while no diagnosis was definitive, o5.d1 has features suggestive of trisomy 13 (also known as patau syndrome), chondroectodermal dysplasia (ellis– van creveld syndrome), and hydrolethalus syndrome (supplementary table 5). trisomy 13 presents as a multiple congenital anomaly pattern and occurs in approximately 1 in 10,000 live births (carey 2022). first described in 1960, trisomy 13 is caused by the translocation of all or part of chromosome 13, resulting in an individual with 47 chromosomes. the cardinal signs of trisomy 13 are orofacial clefts, microphthalmia/anophthalmia, and postaxial polydactyly of the hands and feet, but these features only have 60% to 70% occurrence in the syndrome, making diagnosis challenging (carey 2022). soft tissue defects and organ malformations can add weight to the diagnosis, but obviously not in skeletal material such as o5.d1. the lethality of trisomy 13 depends on the degree of malformation and can vary between individuals. chondroectodermal dysplasia, also known as ellis– van creveld syndrome, was first reported in 1940, with more than 200 cases now identified. o5.d1 shares some features with chondroectodermal dysplasia, such as polydactyly of the feet, short middle phalanges, and abnormal rib development (jones et  al. 2021), but once again, diagnosis is limited as clinical diagnoses make use of abnormalities in the soft tissue. approximately half of children born with chondroectodermal dysplasia die in early infancy, usually as a result of cardiorespiratory malformations (jones et al. 2021). two disorders of primary cilium structure were also considered: meckel– gruber and hydrolethalus syndrome. both syndromes are the result of genetic mutations in the genes encoding the primary cilium, and a common feature is postaxial polydactyly (carey 2022; hartill et  al. 2017; salonen and herva 1990). meckel– gruber and hydrolethalus are considered lethal, with most infants with the disorders stillborn or dying within a few days of birth (carey 2022; hartill et al. 2017; salonen and herva 1990). meckel– gruber and hydrolethalus syndromes primarily manifest in the organs, with some skeletal features present. southorn et al. 205 figure s3. view of the left side of the skull of individual o3.d6. the cranial vault has been opened using a postmortem transverse cut. (a) arrow indicating an example of the postmortem shallow demarcation kerf mark on the left lateral frontal bone. (b) arrow indicating the kerf marks crossing the left squamosal suture. figure s4. view of the left side of the skull of individual o3.d7 showing fusion and partial obliteration of the coronal and squamous sutures. arrow indicating an example of the shallow demarcation kerf marks on the left parietal bone. forgotten children206 figure s5. the overlap of the left parietal bone over the right parietal bone at the sagittal suture in individual o3.d15. figure s6. the overlap of the parietal bones over the occipital bone at the lambdoid suture in individual o3.d15. southorn et al. 207 figure s7. trauma to the right parietal bone of individual o3.d6. figure s8. view of the right side of the cranium of individual o3.d14 showing fusion of the squamous suture and frontal bossing. bone fracturing is postmortem. forgotten children208 figure s9. anterior view of individual o3.d14 showing abnormal parietal bossing due to the premature fusion of the squamous and coronal sutures. arrow indicating the area of irregularity in the region of the metopic suture. southorn et al. 209 figure s10. the extremely wide anterior fontanelle of o3.d180. figure s11. the lambdoid suture of individual o3.d180, with one large and many small intrasutural bones. figure s12. the left side of the cranium of individual o3.d180, showing the open lambdoid, sphenoparietal and occipitomastoid sutures, and intrasutural bones. the small midface is also visible. forgotten children210 figure s13. posterior view of the cranium of individual o5.d1, showing the three wormian bones at the level of lambda. figure s14. left lateral view of individual o5.d1, showing the frontal bone sitting inferiorly to the parietal bone, as well as the abnormally protruding ribs and sternum. southorn et al. 211 figure s15. posterior view of individual o5.d1, showing the high carrying angles in the upper limb, internal rotation of the pelvis, and left deviation of the femur. figure s16. the feet of individual o5.d1, with post-axial polydactyly type a (benjamin et al. 2022) of the right foot. forgotten children212 supplementary table s1. death information for the babies listed in the university of otago register for anatomical material, supplemented with information from official death certificates. age at death year official death certificate father recorded father occupation place of death* cause of death (death certificate) cause of death (register of human material) record of burial 3 days 1885 no — — hospital (register) — — not found 15 days 1903 yes recorded groom nelson st, south dunedin (dunedin hospital) malformation, inanition heart not found 6 hours 1913 yes not recorded — maternity hospital forth street (later renamed batchelor hospital) prematurity premature not found 6 days 1915 no recorded — hospital (register) — spina bifida not found (found birth certificate, not death certificate) 14 days 1916 yes not recorded — salvation army home, dunblane st, roslyn ("redroofs") congenital heart disease — not found 3 days 1916 no — — dunedin hospital (register) — syphilis not found 10 hours 1917 yes not recorded — salvation army home, dunblane st, roslyn ("redroofs") cerebral compression during delivery cerebral hemorrhage not found 6 weeks 1918 no — — "redroofs" (register) — tb enteritis not found 1.5 hours 1919 no — — dunedin hospital (register) — prematurity not found 5 weeks 1920 yes not recorded — dunedin hospital pyloric stenosis pyloric stenosis malnutrition not found 2 days 1921 yes recorded bricklayer batchelor hospital congenital defect in heart congenital defect in heart not found 2 days 1921 yes not recorded maternity hospital forth st (batchelor hospital) immaturity prematurity not found 2 days 1925 yes recorded carpenter batchelor hospital immaturity prematurity not found 1 days 1926 yes recorded — batchelor hospital tracheal obstruction large thyroid gland, tracheal obstruction not found 20 minutes 1926 no — — — — prematurity not found 6 days 1926 yes recorded clerk batchelor hospital hemorrhage neonatorum hemorrhage not found 32 hours 1928 yes recorded blacksmith batchelor hospital anencephalous malformation not found 2 days 1928 yes recorded driver batchelor hospital immaturity prematurity (?), debility, etc. not found 2 day 1929 yes not recorded — batchelor hospital prematurity prematurity, debility, cardiac condition not found 28 hours  1930 yes recorded laborer batchelor hospital immaturity immaturity not found 6 day 1931 yes not recorded — public hospital dunedin inanition inanition not found 4 hours 1934 yes recorded laborer batchelor hospital neonatal asphyxia congenital defects not found 6 hours 1934 yes recorded laborer maternity home, gisborne imperfect development monster imperfect development. anencephaly. monster — 9 days 1936 no — — dunedin hospital (register) — inanition not found *register in parentheses is denoted if there was no information on the death certificate and information was obtained from the university of otago register of human material. southorn et al. 213 supplementary table s2. features considered in the differential diagnosis for individual o3.d7. possible diagnosis skeletal features present (✔), absent (x), or unobservable (– ) in o3.d7 source primary nonsyndromic craniosynostosis single suture synostosis (normally sagittal) x aleck 2004 aufderheide and rodríguezmartin 1998 crouzon syndrome (not typically recognizable until end of the first year) craniosynostosis underdeveloped midface prominent forehead shallow orbits receding maxilla c2/c3 or c5/c6 fusion sacrococcygeal tail ✔ x x x x – – aleck 2004 alnamnam et al. 2019 aufderheide and rodríguezmartin 1998 jackson– weiss syndrome craniosynostosis shallow orbits midfacial retrusion foot abnormalities ✔ x x – tartaglia et al. 1997 apert syndrome craniosynostosis acrocephaly underdeveloped midface shallow orbits symmetrical syndactyly ✔ x x x – liu et al. 2013 aufderheide and rodríguezmartin 1998 pfeiffer syndrome craniosynostosis (coronal and sagittal) shallow orbits underdeveloped midface syndactyly ✔ (coronal only) x x – giancotti et al. 2017 supplementary table s3. features considered in the differential diagnosis for individual o3.d14. possible diagnosis skeletal features present (✔), absent (x), or unobservable (– ) in o3.d14 source primary nonsyndromic craniosynostosis single suture synostosis (normally sagittal) x aleck 2004 aufderheide and rodríguezmartin 1998 crouzon syndrome (not typically recognizable until end of the first year) craniosynostosis underdeveloped midface prominent forehead shallow orbits receding maxilla c2/c3 or c5/c6 fusion sacrococcygeal tail ✔ x ✔ x – damaged postmortem – – aleck 2004 alnamnam et al. 2019 aufderheide and rodríguezmartin 1998 jackson– weiss syndrome craniosynostosis shallow orbits midfacial retrusion foot abnormalities ✔ x x – tartaglia et al. 1997 apert syndrome craniosynostosis acrocephaly underdeveloped midface shallow orbits symmetrical syndactyly ✔ x x x – liu et al. 2013 aufderheide and rodríguezmartin 1998 pfeiffer syndrome craniosynostosis (coronal and sagittal) shallow orbits underdeveloped midface syndactyly ✔ (coronal only) x x – giancotti et al. 2017 forgotten children214 supplementary table s4. features used in the differential diagnosis of individual o3.d180. possible diagnosis skeletal features present (✔), absent (x), or unobservable (– ) in 03.d180 source achondroplasia macrocephaly wide anterior fontanelle midfacial retrusion prominent forehead short limbs x ✔ x x – pauli 2019 lewis 2019 increased intracranial pressure macrocephaly wide fontanelles x ✔ vertinsky and barnes 2007 rickets (features usually visible after four months of age) thin bone posterior flattening of the cranial vault subperiosteal bone deposition delayed fontanelle closure bending of long bones thickening of long bone shafts x x x ✔ – – brickley and ives 2008 ortner 2003 congenital hypothyroidism wide anterior fontanelle wide posterior fontanelle open sutures flat nasal bridge macrocephaly femoral epiphyseal dysgenesis ✔ ✔ ✔ x x – rastogi and lafranchi 2010 aufderheide and rodríguezmartin 1998 trisomy 21 (down’s syndrome) delayed ossification wide anterior fontanelle brachycephaly bulging forehead small nose flat nasal bridge short lower limb bones x ✔ x x x x – barden 1983 aufderheide and rodríguezmartin 1998 trisomy 18 (edwards’ syndrome) prominent occiput narrow bifrontal diameter wide anterior fontanelle cleft palate lowset, malformed auricles short hallux, frequently dorsiflexed small oral opening narrow palatal arch micrognathia small pelvis overlap of second and third fingers “rocker bottom” feet ✔ ✔ ✔ x – – x x x – – – cereda and carey 2012 jones et al. 2021 intrauterine growth restriction (iugr) macrocephaly (not in symmetrical iugr) poor formation of bone wide anterior fontanelle x ✔ ✔ sharma et al. 2016 southorn et al. 215 supplementary table s5. features used in the differential diagnosis of o5.d1. possible diagnosis skeletal features present (✔), absent (x), or unobservable (– ) in o5.d1 source trisomy 13 (patau syndrome) sloping forehead spinal malformations wide anterior fontanelle presence of a cervical rib absence of the 12th rib anomalies in rib morphology low acetabular angles long distal phalanges malformation of fifth finger and toe polydactyly prominence of the nasal bridge and tip orofacial clefts microphthalmia/anophthalmia x x ✔ x x ✔ – x ✔ toe ✔ ✔ x x kjaer et al. 1997 jones, jones and del campo 2021 carey 2022 trisomy 18 (edwards’ syndrome) prominent occiput narrow bifrontal diameter wide anterior fontanelle cleft palate lowset, malformed auricles short hallux, frequently dorsiflexed small oral opening narrow palatal arch micrognathia small pelvis overlap of second and third fingers “rocker bottom” feet x x ✔ x x x dorsiflexion x x x ✔ x x cereda and carey 2012 jones et al. 2021 chondroectodermal dysplasia (ellis– van creveld syndrome) small stature of prenatal onset disproportionate extremities polydactyly short, broad middle phalanges and hypoplastic distal phalanges malformed carpals fusion of capitate and hamate, and extra carpal bone narrow thorax with short, poorly developed ribs hypoplasia of upper lateral tibia pelvic dysplasia neonatal teeth – x ✔ ✔ broad middle on hand – ✔ abnormal ribcage development x – x jones et al. 2021 greig cephalopolysyndactyly syndrome high forehead frontal bossing macrocephaly broad nasal root postaxial polydactyly (hands only) broad thumbs syndactyly preaxial polydactyly (feet only) broad halluces syndactyly broad, late closing cranial sutures trigonocephaly x x x x x (feet only) x – not complex x (postaxial polydactyly) x – not complex x x jones et al. 2021 malik 2012 *simple syndactyly cannot be observed without soft tissue, and therefore cannot be excluded. complex syndactyly can be excluded due to the normal bone formation of the hands and feet with the exception of the polydactyly* meckel– gruber syndrome postaxial polydactyly of hands and feet bowing and shortening of the long bones cleft lip and palate ✔ x x hartill et al. 2017 hydrolethalus syndrome occipital bone defect micrognathia polydactyly club feet short limbs x x ✔ ✔ x salonen and herva 1990 login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with 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guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe bioarchaeology international volume 7, number 4: 307–327 doi: 10.5744/bi.2022.0034 copyright © 2023 university of florida press race, population affinity, and mortality risk during the second plague pandemic in fourteenthcentury london, england rebecca redfern,a,b* sharon n. dewitte,c joseph t. hefner,d and dorothy kime amuseum of london, london, united kingdom of great britain and northern ireland bschool of history, classics, and archaeology, newcastle university, newcastle upon tyne, united kingdom of great britain and northern ireland cinstitute of behavioral science and department of anthropology, university of colorado, boulder, boulder, co, usa ddepartment of anthropology, michigan state university, east lansing, mi, usa eenglish, brandeis university, waltham, ma, usa * correspondence to: rebecca redfern, museum of london, centre for human bioarchaeology, 150 london wall, london ec2y 5hn, united kingdom of great britain and northern ireland. email: rredfern@museumoflondon . org . uk abstract we investigate whether hazards of death from plague and physiological stress at a fourteenthcentury plague cemetery (royal mint, london) differed between populations using n = 49 adults whose affiliation was established using macromorphoscopic traits. compared to a nonplague cemetery (n = 96), there was a greater proportion of people of estimated african affiliation in the plague burials. cox proportional hazards analysis revealed higher hazards of death from plague for those with estimated african affiliation. there were higher rates of linear enamel hypoplasia in those with estimated african affiliation, but this finding is not statistically significant. these results provide the first evidence that hazards of plague death were higher for people of estimated african affiliation compared to other affiliations, possibly because of existing inequalities, in addition to migration (free or forced) outcomes. these findings may reflect premodern structural racism’s devastating effects. keywords: second plague pandemic; mortality risk; population affiliation investigamos si los riesgos de la muerte resultando de la peste y estrés fisiológico en un cementerio de la peste del siglo xiv (royal mint, londres) son diferente entre poblaciones de adultos (n = 49) quienes afiliación estuvieron establecido utilizando rasgos macromorfoscópicos. en comparación con un cementerio no asociado con la peste (n = 96), había una proporción más grande de gente estimado tener afiliación africana en los entierros asociados con la peste. análisis de riesgos proporcional de cox indicaron que había un riesgo de muerte de la plaga más alto por individuos estimados tener afiliación africana. había índices más grandes de hipoplasia de esmalte dental en individuos de afiliación africana, pero el nivel estadístico no fue significativo. los resultados demuestran la primera evidencia que los riesgos de la muerte de la peste fueron más altos por gente de afiliación africana en comparación a otras afinidades, posiblemente como resultado de disparidades sociales en combinación con los efectos de migración (libre o forzada). los resultados se pueden reflejar las consecuencias devastadoras del racismo estructural premoderno. palabras claves: segunda pandemia de la plaga; riesgo de mortalidad; affiliacion poblacional received 19 november 2022 revised 29 april 2023 accepted 19 august 2023 population affinity and plague in fourteenth-century london308 the second plague pandemic’s (spp) first outbreak in the midfourteenth century a.d., commonly referred to as the black death, killed many millions of people across eurasia and africa and was one of the most catastrophic disease events the world has ever experienced (ziegler 2016). the spp continued in the form of outbreaks and isolated cases of plague for centuries afterward. paleogenetic analysis of human remains from across europe and asia has established that the spp was caused by yersina pestis, the bacterium that continues to cause plague globally (bos et  al. 2011, 2012; gourvennec 2019; haensch et  al. 2010; kacki et al. 2011; keller et al. 2019; schuenemann et al. 2011; spyrou et al. 2016, 2019, 2022; willmott et al. 2020). extensive land and sea trade networks promoted the rapid spread of the initial wave of the spp (byrne 2012; ziegler 2016); some modeling suggests the disease traveled between 1.5 and 6 km a day (christakos et al. 2005). through dramatic depopulation, the fourteenth century plague also wrought significant political and economic changes across europe (horrox 1994), and it resulted in many violent acts against minority groups, including the racialreligious cleansing of jewish communities (colet et al. 2016; nirenberg 2015; rambaran olm 2020). the pandemic led to increased tensions between different communities, status groups, and religions, although these detrimental divisions and structural inequalities (i.e., racism) already existed and had been rising for many years, in part due to the little ice age’s (1300– 1870 a.d.) successive waves of famine and climatic instability (fagan 2000; hahn 2001; heng 2018a; ziegler 2016). consequently, the pandemic affected countries whose populations were already compromised, as evidenced by the study of medieval human remains from across europe (dewitte 2015; gamble et al. 2017; scott and hoppa 2019; yaussy et al. 2016, 2018). despite some medieval primary sources suggesting the first wave of the spp killed almost everyone it infected (cohn 2008), bio archae ol o gi cal research has provided evidence that, in at least some contexts, it was not an indiscriminate killer. for example, in london, individuals with evidence of physiological stressors experienced prior to the epidemic, including those associated with developmental disruption during childhood, were more likely to die during the 1348– 1350 a.d. outbreak compared to agepeers without evidence of such previous exposure to stress (dewitte 2009, 2010a, 2010b, 2014a, 2014b, 2014c, 2014d; dewitte and hughesmorey 2012; dewitte and wood 2008; godde et  al. 2020). analysis of individuals who died in a plague in the latter half of the fourteenth century, likely the 1361 a.d. plague, which killed an estimated 10% to 30% of the english population, indicates a relatively high hazard of dying for individuals who were frail because of previous exposure to physiological stressors and those who were nutritionally compromised (dewitte and kowaleski 2017; dewitte and wissler 2022). bio archae ol o gi cal research on the spp has not yielded evidence of sex difference in plague mortality (castex and kacki 2016; dewitte 2009). however, evidence from historical documents indicates a sexselective effect (i.e., higher numbers of female deaths compared to nonplague years) during spp outbreaks up through 1450 a.d. in the netherlands (curtis and roosen 2017). historical documents also yield evidence that mortality during the spp was worse for poorer people than for the wealthy in some contexts (alfani and bonetti 2019; cummins et al. 2016; dewitte and kowaleski 2017; galanaud et al. 2020). in this way, the spp documentary evidence reveals how gender and class categories (structural inequality) compound harm in populations. research on premodern spp in subsaharan africa has also revealed a substantial effect on populations and communities, especially in late medieval west africa (chouin 2018a, 2018b; green 2018; see also gomez 2020). there is thus existing evidence that medieval plague mortality risks varied along both biopolitical and sociocultural dimensions. however, to date, no bio archae ol o gi cal research has addressed the potential effects of structural racism, despite primary source evidence showing that northern europe had a diverse and racialized population during this period (heng 2018a; ray 2007; williamson 2014). to further clarify the ways in which biosocial factors affected risks of mortality during the spp, our study is the first to combine osteological evidence for population affiliation with skeletal data on sex, ageatdeath, and physiological stress in human remains excavated from a london, fourteenthcentury, spp burial ground. we test the hypothesis that people who would have been identified as belonging to population affiliations other than white european and specifically connected to an african geographical affiliation, and who were therefore potentially racialized as black in life or suffered the stressors associated with antiblackness, migration (forced or otherwise), and unfreedoms (at demise or over a lifetime), faced higher risks of death compared to white europeans during the spp. this is a premodern example of current discussions concerning race and covid– 19 (columbia university 2020; ogedegbe et al. 2020). there were other groups in premodern england’s racialized landscape, including the welsh, irish, jews, and muslims. in future population discussions, we can examine the compounded harm via intersectionality of black jews and black muslims— although this cannot be confirmed for medieval redfern et al. 309 english jewish cemeteries, because those human remains are reburied, often immediately after excavation (e.g., historic england 2020; the jewish chronicle 2019; see also belcastro and mariotti 2021; colomer 2014; gleize et al. 2016). currently, because our sites were christian burial grounds, they do not yield any evidence for black muslims, although their presence may have been erased through being given a christian burial treatment. nevertheless, one can consider the further compounded harm of intersectionality in relation to antiblackness and racioreligious structural racism in these cases in future examinations of muslim grave sites. our article focuses on antiblack structural racism within christian cemeteries, racial capitalism’s earlier genealogies, and medieval london as a location to highlight how a substantial community can be erased from history. autoethnography and our situatedness an article about medieval bioarchaeology that discusses race, racism, pre1500 a.d. medieval england, an earlier genealogy related to transatlantic chattel slavery, the archive of slavery, and a global pandemic’s effect on racialized populations of varied states of unfreedom requires a selfreflexive, critical analysis of its methodologies and commitments, especially as the concurrent pandemics of covid19 and global antiblackness devastate racialized communities in the 2020s. black lives matter. black methodologies matter. a discussion of decolonization and black feminist theoretical praxis often begins with an autoethnography (brownvincent 2019; franklin 2001; tuhiwai smith 2022). this has been advocated as a necessary component in an antiracist, black feminist, and decolonized approach to historical bioarchaeology (see watkins 2020:19). we are keenly aware of the twinned whiteness of both anthropology and medieval studies. this double whiteness has also meant a lack of black researchers and “knowledge producers” in our fields. we hope to prioritize the methodologies of black feminist archaeology and the interdisciplinary work we bring to bear on this archive (watkins 2020:14). in addition, following “archaeologies of the heart,” we emphasize our commitment “to position . . . work consciously and to practice a rigorous selfreflexivity in its conduct” (supernant et al. 2021:6). we believe that our work is about “generating multiple perspectives on truth” (supernant et  al. 2021:7), especially how our interdisciplinary work crosses academic silos, enabling a “pluralistic approach” to a myriad of historical truths and methodological discoveries (supernant et al. 2021:7). materials and methods medieval london: people and plague london provides an ideal context to examine structural racism’s possible effects on risk of death during the spp for two reasons: it contained a heterogenous population mix, and archaeological excavations have yielded skeletal samples with incredible chronological control, enabling a study of a relatively large sample of people known to have died during spp (grainger et al. 2008; pfizenmaier 2016). london, medieval england’s most important urban center, was home to the country’s most powerful political, economic, and religious institutions. connected to the world by its river port, which brought goods and people directly into fourteenthcentury london, it was home to an estimated 80,000 people (barron et  al. 2017; thrupp 1989). primary source examination, from 1336– 1584 a.d., reveal nearly 18,000 “foreigners” had come to london from india, greece, iceland, and mainland europe (i.e., italy) (lutkin 2016); note that information about appearance (i.e., skin color) was not recorded in the source material. the majority were temporary residents, but mercantile and richer migrants stayed for several years and sometimes were accompanied by their entire households, which included free and enslaved servants and illegitimate children (laufenberg 2016; lutkin 2016; thrupp 1957, 1989). many enslaved people were forced into bondage in italian and southern spanish markets and originated from subsaharan and northern africa or eastern europe (guidibruscoli 2016; hernæs and iversen 2002; miller 2002; phillips 1985, 2013). the primary source and bio archae ol o gi cal evidence reveal that several population affiliation groups and mixedrace people lived in london, some of whom who had spent their early childhood in britain, suggesting that they were (at least) secondgeneration migrants (kendall et  al. 2013; redfern and hefner 2019; richard of devizes 1192). before the plague reached england in 1348 a.d., extensive preparations had been made to cope with the epidemic. this included the creation of two emergency burial grounds— east smithfield (close to the tower of london) and west smithfield, positioned further north in the city (grainger et al. 2008; pfizenmaier 2016). the plague reached london in fall 1348, resulting in 60% of the city’s population dying, until it waned in 1351 a.d. (byrne 2012; horrox 1994; sloane 2011). sloane (2011) has shown that the city’s parish population affinity and plague in fourteenth-century london310 cemeteries (numbering over 100) buried the majority of plague victims. however, these cemeteries mostly have not been divided into pre or postplague phases, meaning that the emergency burial ground populations remain unique. medieval london: race, antiblackness, and medieval england this article includes data and tools that have been rightly critiqued for their role in perpetuating systemic racism, specifically the use of macromorphoscopic traits (bethard and digangi 2020; contra. stull et  al. 2021). we acknowledge that any methodological overhaul and/or new theorized praxis is a process and that whiteness must be decentered to achieve this. as two white anthropologists, a white bioarchaeologist, and one woman of color medievalist, we must decenter our work. we choose to foreground contexts and complexities, as well as white supremacist genealogies in forensic anthropology and medieval studies, as a form of methodological praxis as process. in light of critique, we used five traits with known heritability: anterior nasal spine, interorbital breadth, nasal aperture width, inferior nasal aperture, and nasal bone contour (plemons 2022). black feminist praxis and recent antiracist work that utilizes historical context to analyze a site informs our research (barnes 2021). as cho and colleagues (2021) advocate, we use the terms population affinity and mixed race, mindful that “racism is a social reality that can affect biology” (cho et al. 2021). we also acknowledge the contextual nuances and specific details that must be discussed when working in race and science. as presented in kim and coles (2021:4– 12), we understand that structural racism is built into science and agree that studies of the past must be specific to their temporality and location. in this section, we contextualize the distinct specificities of time, geography, and conditions in relation to medieval england and race that is different from other european geographies. despite scholars documenting the multiracial scene in early modern london (habib 2008; hall 1995) or more recently on an early modern english ship (scorrer et al. 2021), the image of a white medieval england persists. this white nostalgia is rooted in the same white supremacist ideology that has fed contemporary violence. likewise, medieval studies scholarship has boosted this “preracial” version of the premodern past that has allowed medieval cultures, societies, writers, and powerbrokers to hide behind “white innocence,” when the truth is that race (structural racism) was invented, refined, and rehearsed in medieval england (kim 2021). heng (2018a:3) explains that medieval race is “a structural relationship for the articulation and management of human differences, rather than substantive content . . . [with] religion— the paramount source of authority in the medieval period— could . . . for instance, [subject ‘detested’ people] to a political theology that could biologize, define, and essentialize an entire community as fundamentally and absolutely different.” our definition of race centers the black feminist material turn (biopolitical and sociocultural)— dependent on location and temporality (spillers 1987, 2003; weheliye 2014). although many historians have argued that using “race” to describe the medieval phenomena of structural racism is anachronistic, others in premodern critical race studies, as well as critical race theorists, have in the past several decades made it emphatically clear that the term to use is race rather than anything else (heng 2021; kim 2021; mills 2020; among others). later medieval england (c. 1100– 1500 a.d.) inherited, through its written and spoken culture, narratives of a racialized hierarchy connected to geographic space and climate, ideas that can be traced back to hippocrates (kennedy et al. 2013:35– 41). although hippocratic work was not in circulation, its vision of a geographic/climatological organization of racial hierarchy is present in cartography (e.g., the hereford map, 1300 a.d.), which centers and gives more room to european places and territories. medieval english white christianity based its racialization on “population affinity” connected to organizing people by climatological/geographic racial difference, meaning that medieval english antiblackness included epidermal racialization (heng 2018a:180– 256; whitaker 2019). england had already begun practicing how to organize, categorize, and hierarchize nonhegemonic white christian groups because it was an early racial state (heng 2018a, 2018b). the english state, as part of a larger colonial project in the twelfth and thirteenth centuries, also racialized the welsh and irish in the british isles, and muslims in its eastern mediterranean crusader colony (acre, lost in 1291 a.d.), using many of the same orientalist tropes flung at both real and imagined islamic foes (heng 2018a; lumbley 2019; rajabzadeh 2019). structural racism had different terrains and archives for different groups. in the case of the english racioreligious jewish and islamic difference, we can identify their populations by how they were buried in grave sites and, for the pre1290 jewish community in england, a small anglohebrew documentary archive (olszowyschlanger 2015). for the welsh and irish who the english colonized in the twelfth and thirteenth centuries, we have substantial documentary archives of how the subaltern racialized populations spoke back to english colonial hegemony. redfern et al. 311 in contrast, black people did not have emic documentation or viewpoints from which we hear directly about their lives or racial formations, or else the documentation has been completely whitewashed, because the white imaginary defined medieval england as a white population space. concomitantly, hundreds of archives were destroyed during the dissolution (1536– 1540 a.d.) (kim 2022), and medieval scholarship has deliberately whitewashed the presence of black people in archives. we have two examples: one methodological and one documentary (from the medieval english literary canon) that demonstrate the consequences for the documentary and archaeological record. across britain and europe, the majority of osteoarchaeological professional recording standards do not record population affiliation or ancestry (e.g., rose et  al. 1991), due to a combination of factors: it was only recently being introduced in british standards (created 2004) in 2017 (mitchell and brickley 2017), not all bioarchaeology/human osteology/paleopathology courses teach these methods, and many archaeological contractors have not revised their standards for over a decade. consequently, the white imaginary, which assumes a de facto white population, is used as the “empirical” evidence for a population discussion of all medieval european human remains, especially burial grounds (contra. redfern and hefner 2019, 2021; our migration story n.d.; york archaeology 2019). therefore, the paucity of population affiliation data means that there is no “empirical” evidence for a whiteonly population in medieval england. instead, immense work must be done to debunk the white supremacist scholarly and methodological structures that have upheld and kept the white racial imaginary in place for centuries and is central to white medieval “heritage politics” in contemporary farright politics (christmas 2019). this has affected our analysis of the english documentary record. it is also a record in white scholarly methodologies, ontologies, and whitewashing. the white imaginary has trained scholars to skip over what is so plain to see. the work of fourteenthcentury london poet geoffrey chaucer has been the subject of scholarship for centuries, and his canterbury tales has been a british colonial school text (viswanathan 2014). yet, only recently has race been discussed with respect to chaucer’s cook’s tale. this tale, which describes an apprentice cook’s (named perkyn revelour) london life, involves gambling, sex workers, and occasional prison stints. revelour is physically described as: “broun as a berye, a propre short felwe/ with lokkes blake ykembd ful fetisly” (brown as a berry, a proper short fellow/ with black locks combed elegantly) (san marino, huntington library ms ellesmere 26 c9, f. 46v– 47v). hsy (2021:380) is the first to discuss revelour in relation to race— “a racialized brownness”— using the potential of “racial speculation.” the white gaze is so embedded that scholars see the darker skin in the ellesmere manuscript’s cook’s portrait as evidence of disease or low social class (sweany 2018). there are over three dozen medieval english manuscripts that attest to the black cook. this is an example of a specific documentary archive in which all scholarship has skipped over the cook as a black servant in fourteenthcentury london. earlier chaucer and race scholars had to temper their arguments, because the “empirical” population evidence upheld the white racial imaginary of a white medieval england (hsy 2021; whitaker 2019). recording population affiliation would have a cascading and seismic effect in scholarship, prompting a reassessment of medieval european primary sources. osteological data will allow medieval scholars to say that these black men, women, and children, who have been recorded, are not a fantasy or just possibilities. such data also would reveal an earlier start to england’s adoption and practice of racialized unfreedoms (fuentes and rouse 2016; morgan 2021; otelle 2021). although medieval england’s race technology was mutable, biopolitical, and sociocultural, english white christian hegemony saw racial difference as immutable and in the blood. anyone who was marked visually or embodied as originating outside of europe, particularly if they fitted a “black ethiopian” description, would have been racialized. we identify “mixed race” people as racialized based on what critical race legal theorists would identify as miscegenation laws appearing in the fourth lateran council’s canon 68 (1215 a.d.). this ruling specifically forbade christians from forming sexual relationships with jews or muslims due to concerns about mixedrace/religious children (harris 1993:1739– 1740; heng 2018a:76– 77). black feminist methodology the royal mint site, in relation to the effects of pandemic disease and population affiliations, offers us an insight into medieval racial necropolitics and structural violence. as can be seen in covid19 pandemic data, there is a clear correlation between structural violence, particularly as it pertains to race, and disproportionately higher rates of mortality among global majority communities (flagg et al. 2020). the effects of structural racism can be found in archaeological data and health disparities observed in human remains (nystrom 2014:756– 766). to do justice to the human remains in our study, we foreground the work of black feminist archaeology. battlebaptiste (2016:70) suggests this “takes into account the disadvantage of how these aspects of identity (primarily population affinity and plague in fourteenth-century london312 race and gender) act as a doubled (and with class a triple) form of oppression” (see franklin 2001:115– 116). this sits alongside the work of hill collins (2019), crenshaw (1991, 1989), and the combahee river collective (taylor 2017) about intersectionality. we follow hartman’s (1997, 2007) work on the archive of slavery and mckittrick (2006, 2014, 2015) on black geography to center black feminist archive and data methodologies. although much work done in black feminist archaeology focuses on north american post1492 a.d. sites, we apply these methods to london’s fourteenthcentury cityscape. the royal mint site also reorients our understanding of the transatlantic chattel slavery archive’s beginnings. likewise, the discussion of structural racism and pandemic necropolitics (mbembé and meintjes 2003) remains an ongoing lens of analysis. we bring these multidisciplinary strands together in order to, in battlebaptiste’s (2016:67) words, “create a purposefully coarse and textured analytical framework.” our framework pulls from black feminist work in the humanities, social sciences, and sciences. we contextualize the royal mint site as part of the archive of slavery, as well as what wynter (1990) and mckittrick (2006) theorize as “demonic grounds,” and to see medieval london as a black diaspora geography: “demonic grounds . . . are not simply identifying categories of difference, absence, and the places and voices of black women and/or black feminism; they also outline the ways in which this place is an unfinished and therefore transformative human geography story” (mckittrick 2006:xxvi). hartman (2008:2) remarks upon the “act of chance or disaster” that allowed us to even have a sentence, a phrase to mark black women’s presence in the archival records, when the standard encounter with the archive is silence, erasure, and “invisibility.” given that a percentage of those killed by london plague epidemics were enslaved or formerly enslaved people, our black feminist archaeology must first address the archive of slavery. our archive, their remains, are precisely what hartman (2008:2) characterizes as a “death sentence, a tomb, a display of the violated body, an inventory of property.” we are reckoning with the impossibility of discussing premodern black lives in any way that is not about pain and death. their remains, “the violence that deposited these traces in the archive” (hartman 2008:2), are our evidence and data points. this is why we must think through black feminist archaeology to consider other ways to tell these narratives. mckittrick (2014:17) addresses the archive of slavery, black men and women as data, by calling attention to “the mathematics of the unliving.” what mckittrick (2014:16) underlines is that these bodies (our osteological data) become an “objectcommodity” in which there is no way to give life or to tell these stories. “if the source of blackness is death and violence,” they argue, “the citation of blackness— the scholarly stories we tell— calls for the repetition of death and violence. . . . put differently, historically present anti black violence is repaired by reproducing knowledge about the black subjects that renders them less than human” (mckittrick 2014:17– 18). this is the methodological knot we must unravel. hartman (2008:11) argues for a methodological shift to address this issue: what they call “critical fabulation.” the purpose here is not “to give voice to the slave, but rather to imagine what cannot be verified, a realm of experience which is situated between two zones of death— social and corporeal” (hartman 2008:12, 2019). mckittrick (2014:25) argues that black studies is the method to work successfully on demonic grounds precisely “because the mathematics of blackness and white supremacy are seemingly knowable (because accountable and counted) and always laden with a chaotic uncertainty.” developing that concept, flewellen (2017:73) proposes that “demonic grounds then become spaces that literally create new conceptualizations of being, a possessed form of being that cannot be knowable, yet act as a fruitful space for exploration and knowledge production, there by representing human geography.” designating fourteenthcentury london as a demonic ground allows us to reexamine our data to address these different possibilities. the pandemic burial grounds are a form of black spatial geography and especially a matter of black diaspora. as watkins (2020:20) explains, the works of black feminist biopolitics and race “discuss racializing assemblages as key vehicles through which biocentricity is reinforced” and “involve[s] sociopolitical processes that discipline humanity into categories, such as human, not quite human, and nonhuman.” our approach aligns with this critical race genealogy: the biopolitical that thinks through racialized assemblages. lastly, black feminist methodology asks that this work be a collaboration with a community of stakeholders as a form of social justice and an extension of black feminist autoethnography. watkins (2020:23) builds on the threepillar structure advocated by blakey (1991): (1) that “scientific investigation is not an objective or passive practice”; (2) that “decolonized study of human biology should readily contribute to broader, interdisciplinary investigations of human conditions and disparities”; and (3) “the explicit recognition of human responsibility in the production of scientific knowledge.” we plan to bring these methods into our future work. there are no uk projects similar to blakey’s (2020) work at the new york african burial ground, as medieval and later burial grounds were not separated by race but rather by religious tradition, and redfern et al. 313 archaeological contractors do not consistently record or report population affiliation data (see redfern and hefner 2019). but we agree with franklin et al. (2020) that related communities must be collaborators and partners in archaeological practice. we intend to keep accountable to these larger methodological goals— we believe the recent work of finding ceremony (https:// www . findingceremony . com/) is an excellent example of descendant community-centered work. skeletal samples the individuals in this study are curated by the museum of london. the plague victims (n = 49) included in this study were excavated from the royal mint site (london) (min86) in the 1980s and derive from two phases of burial at the site (figs. 1– 2). the first phase is the east smithfield cemetery (1348– 1350 a.d.), a planned emergency burial ground whose creation and use is recorded in a number of primary sources, with dates supported by coins from a purse found during excavation of the inhumations (grainger et al. 2008). plague victims from the city were buried there with care and respect in grave rows or previously prepared mass burial trenches. although the names of some people buried at the cemetery are known from their wills, which stipulated their place of internment, none can be associated with an individual skeleton (grainger et al. 2008). in 1350 a.d., the royal household purchased adjacent land, enabling king edward iii to found a cistercian abbey. this served the plague burial ground but also established its own cemetery, which was in use from 1350 to 1538 a.d.; again, although the names of some people buried there are documented, figure 1. map showing the location of london within the united kingdom, scale 1:5,000,000 (os opendata downloads). https://www.findingceremony.com/ https://www.findingceremony.com/ population affinity and plague in fourteenth-century london314 none of the human remains in our study could be associated with a particular individual (grainger and phillpotts 2011). archaeological and primary source evidence has established three burial phases at st.  mary graces, but only individuals from the first phase are included in our study, as they date from 1350– 1400 a.d., when the plague was still present in london, including during the second major outbreak of plague in 1361 a.d. (grainger and phillpotts 2011). ancient dna analysis of skeletons excavated from the emergency burial ground and the first burial phase of st. mary graces has identified y. pestis at both sites (bos et al. 2011; klunk et al. 2019; schuenemann et al. 2011). individuals who died from causes other than plague (the nonplague individuals, n = 96) included in this study were excavated from areas of st. mary graces not associated with plague outbreaks (n = 7) and from the st. mary spital cemetery (srp98, n = 89) (fig. 3) (connell et al. 2012). the srp98 cemetery was used over four distinct phases (as determined by archaeological and radiometric evidence): 1100– 1200, 1200– 1250, 1250– 1400, and 1400– 1540 a.d. to ensure as best as possible that our analyses compared hazard rates (see below) for population affiliations during the spp relative to nonplague mortality, we did not include individuals buried in srp98 between 1250 and 1400 a.d. the human remains from min86 and srp98 were recorded using the wellcome osteological research database (word) using published standard methods (powers 2007, 2012): a total of 636 individuals from east smithfield and 199 from the first burial phase at st. mary graces were recorded (centre for human bioarchaeology 2007a, 2007b). of these, 49 adult (> 18 years old) individuals were included in our study: 40 from east smithfield and nine from st.  mary graces. they had previously been selected for population affiliation analysis (redfern and hefner 2019, 2021) because they had the cranial vault and facial bones present that are used in the macromorphoscopic method (mms) (hefner and linde 2018). the modern constructed identities often associated with race, such as “white” or “black,” are not biological realities and the continuous and overlapping nature of human variation does not permit a rigid determination. instead, any method only calculates probabilities of membership into some a priori established reference samples. to detach our estimates from the typological underpinnings of forensic anthropology, we utilized cranial data to estimate affinity, which spradley and figure 2. map showing the location of the east smithfield (min86) burial ground in london, england. © museum of london archaeology. redfern et al. 315 the white european sample. of the nine plague individuals from st. mary graces, two were most similar to the white european sample, three to the asian sample, and four to the african sample. nonplague individuals from st. mary graces and srp98 included 87 individuals similar to the white european sample, one individual to the asian sample, and eight individuals similar to the african sample. tables 1 and 2 summarize these data for each site. redfern and hefner (2019, 2021) provide additional details on this approach and our decision to pool those with white european and asian population affinity estimates. using site archive information and the ancient dna (adna) evidence for y. pestis, it was possible to establish that they were from the emergency burial ground or first phase of burial at st. mary graces and, therefore, were plague victims (table 2). previous research by dewitte (2010a, 2014a, 2018) used transition analysis to estimate ageatdeath for individuals from min86 and srp98. this method of adult age estimation uses bayesian statistics to avoid the problem of agemimicry (i.e., estimates biased toward the known age reference sample used to derive age estimation methods) that limits conventional methods of age estimation (boldsen et  al. 2002). importantly, it also yields point estimates of age for all possible adult ages, rather than broad interval estimates with an open ended terminal category (e.g., > 45 years old), as is the case with conventional methods, thereby allowing for analysis of mortality patterns at advanced ages. our previous research on selective mortality during the spp used transition analysis age estimates. therefore, for consistency, we used these age estimates because transition analysis estimates are less prone to age mimicry and potentially more informative about mortality patterns at advanced adult ages. although like most skeletal age estimation methods, the accuracy of this approach is not ideal (see milner and boldsen 2012), we have used the same method across all individuals in this study and are less concerned with individual estimates than with the aggregate pattern. transition analysis age estimates were generated using the anthropological database, odense university (adbou) age estimation software and selecting the informative “archaeological” prior distribution of ages at death. the archaeological prior, which is based on data from seventeenthcentury danish rural parish records, represents a generalized preindustrial mortality curve and is thus suited to medieval samples (bullock et al. 2013). we assess variation in risk of mortality, survivorship, and evidence of exposure to physiological stress across population affinity groups within these cemetery samples. with respect to skeletal markers of physiological stress, we are mindful of the potential jantz (2021) and ross and pilloud (2021) suggest is not attached to definitions of race and ethnicity, and does provide useful data for identification efforts and biodistance analysis. therefore, we selected global reference samples from the mms databank, representing populations from europe, north and south africa, north and southeast asia, the americas, south pacific islands, and the middle east (hefner and linde 2018). five mms traits with demonstrable heritability estimates were selected to capture cranial morphological variability and ecogeographical patterns of human variation. these data were passed through a classification model to produce a probabilistic estimate of population affiliation for each. two associated statistics inform our analysis: (1) the accuracy of the models and (2) the probability estimates of each classification. each model used leaveoneout crossvalidation and had accuracies around 75% to 80% (95% ci: 70.1% to 90%) for up to seven reference groups. in general, posterior probability values closer to 1.0 represent more similarity to the reference sample, while lower values suggest less likelihood of a correct classification. at east smithfield, three individuals had cranial morphologies most similar to the asian sample, five to the african sample, and 32 to figure 3. location of st. mary spital (srp98) within london. © museum of london archaeology. population affinity and plague in fourteenth-century london316 effects of the osteological paradox (wood et al. 1992), that is, that the presence of stress markers may not be a clear reflection of poor health in this context. specifically, it is possible that the presence of stress markers may reflect resilience in some people, and the absence of them might reflect low frailty (or “good health”), contrary to conventional interpretations. previous work on these populations has demonstrated that all of the nonspecific skeletal markers of physiological stress used in this study were related to higher mortality risk during the spp (dewitte 2010b, 2014b, 2014c, 2015, 2018; dewitte and wood 2008; godde et  al. 2020). previous work in this context has also demonstrated that although the presence of periosteal new bone formation (pnbf) in general is associated with elevated risks of mortality (dewitte and wood 2008), healed pnbf is associated with higher survivorship and thus may reflect resilience (dewitte 2014). that is, by leveraging agestructured data to overcome some of the potential limitations posed by heterogeneous frailty and selective mortality (dewitte and stojanowski 2015; wood et al. 1992), our previous research has established that these skeletal stress markers are, at least in this context, useful markers of frailty or resilience. therefore, we used data collected by the second author for presence/absence of linear enamel hypoplasia (leh) on the left mandibular canine, cribra orbitalia (co) on the left orbit, and pnbf table 1. list of individuals from st. mary spital (srp98), context (skeleton number), date, burial type, sex, and population affiliation group (ppg). m (male), p.m (probable male), f (female), i (intermediate); srp98 burial types: a/b/c (attritional cemetery), d (multilayered, horizontal stacked rows within a single grave cut) (connell et al. 2012:13). context date burial type sex ppg age (years) 1334 1200– 1250 a m white european 20.62 1716 1100– 1200 b f white european 2344 1400– 1539 a f white european 28.94 2487 1400– 1539 d f white european 51 2646 1400– 1539 a pm white european 33.74 2657 1400– 1539 a pm white european 39.01 2679 1400– 1539 a m african 65.44 2907 1400– 1539 a pm white european 40.93 3037 1400– 1539 a pm african 35.71 3172 1200– 1250 a m white european 22.46 3515 1400– 1539 a m african 24.19 3533 1100– 1200 a f white european 3538 1200– 1250 b f white european 30.6 3775 1400– 1539 a f white european 47.01 3934 1200– 1250 d f white european 59.8 5275 1200– 1250 a m white european 35.31 5510 1100– 1200 a f white european 42.4 5561 1100– 1200 c f white european 5677 1100– 1200 a f white european 34.4 5794 1100– 1200 a f white european 5869 1100– 1200 a f white european 6427 1400– 1539 a m white european 34.39 6571 1100– 1200 a m white european 7127 1400– 1539 a f white european 19.05 7266 1400– 1539 a f white european 29.36 7383 1200– 1250 a m white european 32.79 7616 1400– 1539 a pm white european 48.59 7701 1400– 1539 a m white european 23.56 7796 1400– 1539 a f white european 32.44 7915 1400– 1539 a m white european 34.17 8264 1400– 1539 a f white european 30.74 9260 1400– 1539 a m white european 21.94 9420 1100– 1200 a f white european 9632 1100– 1200 d m white european 21.5 9789 1100– 1200 d m white european 34.8 10124 1400– 1539 a i white european 24.99 10765 1400– 1539 a f white european 34.15 10794 1400– 1539 a pm white european 76.39 11050 1400– 1539 a m white european 15.49 11136 1400– 1539 a m white european 26.1 11221 1400– 1539 a f white european 30.18 11428 1400– 1539 a f white european 19.71 12238 1400– 1539 a m white european 18.5 12714 1200– 1250 a m white european 29 12923 1200– 1250 a i white european 30.77 context date burial type sex ppg age (years) 14307 1200– 1250 a pm white european 34.3 14493 1400– 1539 a f white european 27.19 14868 1200– 1250 a m white european 31.46 15030 1200– 1250 a f white european 19.33 15339 1200– 1250 a m white european 18.5 17496 1200– 1250 a f white european 30.09 19503 1400– 1539 d f white european 19 19618 1400– 1539 a m white european 35.74 19950 1200– 1250 d f white european 49.9 20082 1200– 1250 a f african 19.35 20184 1400– 1539 a pm white european 36.47 20255 1400– 1539 a f white european 36.32 20360 1200– 1250 a pm white european 21 20462 1400– 1539 a m white european 24.88 20682 1200– 1250 d m white european 30.5 21011 1400– 1539 a m white european 33.33 21099 1400– 1539 a m african 19.51 21273 1100– 1200 a m white european 21371 1400– 1539 a m white european 30.28 21569 1400– 1539 a m white european 17.5 22105 1400– 1539 a m white european 26.14 22640 1200– 1250 d f white european 18 22648 1200– 1250 a i white european 23.71 23103 1200– 1250 a f white european 26.6 23441 1400– 1539 a m white european 25.8 23448 1400– 1539 a p.f african 18 23514 1200– 1250 d m white european 26 24010 1100– 1200 d f white european 30.3 24185 1100– 1200 d f white european 50 25492 1200– 1250 a pm white european 25.44 25737 1200– 1250 a m white european 18.5 25832 1200– 1250 a i white european 18.71 27177 1400– 1539 a f white european 18.5 27476 1100– 1200 a m african 29462 1400– 1539 a f white european 15 29698 1200– 1250 a f white european 31.8 30039 1200– 1250 a p.f white european 16.56 30212 1200– 1250 d m white european 74.7 30448 1200– 1250 a m white european 20.5 30939 1200– 1250 a pm white european 15 31245 1200– 1250 a pm white european 24.25 32091 1200– 1250 a f white european 44.5 32302 1200– 1250 d m white european 18.5 33167 1200– 1250 a f white european 31.6 redfern et al. 317 table 2. list of individuals from the royal mint site (min86) organized by burial ground: east smithfield (plague burials) and st. mary graces (potential plague and nonplague burials), plague score, context (skeleton number), sex (m male, f female) and population affiliation group (ppg) and code, and transition analysis age estimate. site code site name plague context sex ppg ppg code 3 (0: white european, 1: african, 2: asian) ppg code 2 (0: white european/ asian, 1: african) plague code (0: nonplague, 1: plague) age (years) min86 east smithfield plague 5272 m white european 0 0 1 57.45 min86 east smithfield plague 5281 m african 1 1 1 20.19 min86 east smithfield plague 5283 f white european 0 0 1 17.63 min86 east smithfield plague 5285 m white european 0 0 1 33.28 min86 east smithfield plague 5741 f african 1 1 1 31.16 min86 east smithfield plague 5902 f african 1 1 1 15 min86 east smithfield plague 5960 m white european 0 0 1 31.74 min86 east smithfield plague 6428 f white european 0 0 1 17.9 min86 east smithfield plague 6467 f white european 0 0 1 18.72 min86 east smithfield plague 6532 f white european 0 0 1 38.82 min86 east smithfield plague 7065 m white european 0 0 1 24.05 min86 east smithfield plague 7094 m white european 0 0 1 15 min86 east smithfield plague 7163 f white european 0 0 1 30.69 min86 east smithfield plague 7381 f asian 2 0 1 15 min86 east smithfield plague 8277 m white european 0 0 1 26.41 min86 east smithfield plague 8343 m white european 0 0 1 32.25 min86 east smithfield plague 8427 f white european 0 0 1 29.01 min86 east smithfield plague 9540 m african 1 1 1 19.8 min86 east smithfield plague 9807 f white european 0 0 1 19.45 min86 east smithfield plague 11108 f asian 2 0 1 43.1 min86 east smithfield plague 11109 f white european 0 0 1 20.34 min86 east smithfield plague 11115 m white european 0 0 1 28.21 min86 east smithfield plague 11118 m white european 0 0 1 33.52 min86 east smithfield plague 11193 m white european 0 0 1 43.01 min86 east smithfield plague 11244 f african 1 1 1 20.77 min86 east smithfield plague 11430 f white european 0 0 1 28.19 min86 east smithfield plague 11625 m asian 2 0 1 18.88 min86 east smithfield plague 11627 m white european 0 0 1 18.67 min86 east smithfield plague 11857 m white european 0 0 1 78.13 min86 east smithfield plague 11914 m white european 0 0 1 15 min86 east smithfield plague 11944 m white european 0 0 1 48.5 min86 east smithfield plague 12566 m white european 0 0 1 23.89 min86 east smithfield plague 12567 m white european 0 0 1 39.3 min86 east smithfield plague 12643 f white european 0 0 1 22.66 min86 east smithfield plague 12700 f white european 0 0 1 35.21 min86 east smithfield plague 12790 f white european 0 0 1 45.87 min86 east smithfield plague 12813 m white european 0 0 1 57.18 min86 east smithfield plague 12814 f white european 0 0 1 34.19 min86 east smithfield plague 12815 m white european 0 0 1 15 min86 east smithfield plague 20003 f white european 0 0 1 min86 st. mary graces potential plague 6272 f asian 2 0 1 18.73 min86 st. mary graces potential plague 6371 m african 1 1 1 17.5 min86 st. mary graces potential plague 6565 f white european 0 0 1 33.61 min86 st. mary graces potential plague 8015 f african 1 1 1 21.04 min86 st. mary graces potential plague 8108 m african 1 1 1 min86 st. mary graces potential plague 9519 f african 1 1 1 19.5 min86 st. mary graces potential plague 9901 m asian 2 0 1 17.01 min86 st. mary graces potential plague 11030 m asian 2 0 1 72.3 min86 st. mary graces potential plague 12664 f white european 0 0 1 24.47 min86 st. mary graces nonplague 9395 m white european 0 0 0 min86 st. mary graces nonplague 9417 m asian 2 0 0 75.22 min86 st. mary graces nonplague 9425 m african 1 1 0 68.21 min86 st. mary graces nonplague 10170 m white european 0 0 0 17.5 min86 st. mary graces nonplague 12297 f white european 0 0 0 30.73 min86 st. mary graces nonplague 12339 f white european 0 0 0 72.24 min86 st. mary graces nonplague 13935 m white european 0 0 0 35.26 population affinity and plague in fourteenth-century london318 on the left tibia. the first two can only occur during childhood and have multifactorial origins, with leh reflecting disruptions of ameloblast activity during enamel development (towle and irish 2020) and co often in response to anemia (brickley 2018). pnbf also has multifactorial origins, such as infection or trauma, but can form at any point during life (weston 2012). although these signs of physiological stress have multifactorial origins, making diagnosis of specific etiologies difficult or impossible, bio archae ol o gi cal research has demonstrated that they provide crucial insights into stress and, by careful inference, health in past populations (larsen 2015). comparison of these skeletal markers across the groups in this study thus has the potential to reveal differences in exposures to physiological stressors or frailty/health based on population affinity. statistical analyses we initially performed analyses comparing all three population affinity groups. we also pooled samples estimated as white european and asian for all analyses. we did so for a number of supportable reasons, including the weak likelihood estimates among the asianestimated sample and preliminary analysis revealing no significant differences in hazards of dying between those with estimated white european and asian population affiliation (indicating pooling would not result in loss of resolution or reduced power for the overall hazard model). differences in hazards of dying among the population affinity were assessed using the cox proportional hazards model. the cox proportional hazards model evaluates the hazard of an event (in this case, death from plague) and is thus also reflective of survival, with estimated hazard ratios above 1 indicating decreased survival times associated with the variable of interest, and hazard ratios below 1 indicating greater survival times. this semiparametric model allows for the estimation of differences in hazards of dying (or survival) within a sample based on variables of interest but does not require the specification of a parametric baseline hazard function and is thus suited to the relatively small sample sizes available for this study. for analyses of all three population affinity groups, individuals estimated to be white european were assigned a score of 0, those with estimated african population affiliation were assigned a score of 1, and those with estimated asian population affiliation were assigned a score of 2. for analysis using pooled data from those with estimated white european and asian population affiliations, individuals estimated to be white european or asian were assigned a score of 0 and those with estimated african population affiliation were assigned a score of 1. following godde et  al. (2020), we applied the cox model to data from both plague and nonplague burials, using a binary outcome variable of “death from plague” (coded as 1 for individuals buried in east smithfield or the plague area of st. mary graces) or “other cause of death” (coded as 0 for individuals buried in st. mary graces >c. 1400, srp98, c. 1100– 1250, and srp98 c. 1400– 1540), with ageatdeath as the time scale (tables 1 and 2). we take an intersectional approach and avoid the assumption that the experiences of people of different population affinities would have been uniform across sex within each population affinity group. to determine whether the intersection of sex and population affinity amplified poor outcomes, we compare survivorship and hazards of mortality separately by estimated sex. due to limited sample sizes, differences in numbers of males and females, proportions of individuals of estimated population affiliations, and the presence/absence of skeletal physiological stress indicators among the groups were evaluated using fisher’s exact tests. in some contexts, skeletal indicators of physiological stress have been shown to be associated with age, and previous research has demonstrated that the frequency of pnbf increases with age (dewitte 2014c; grauer 1993). it is therefore possible that observed differences between groups in the frequencies of skeletal indicators of physiological stress might be an artifact of the interaction between ageassociated skeletal indicators of stress and differences between the ageatdeath distributions of those groups, rather than reflecting true differences in exposure to physiological stress. for example, one group might have a higher frequency of pnbf compared to another simply because it has a greater proportion of older adults. to determine whether this might have an effect on our findings, binary logistic regression was used to evaluate the relationship between age and each skeletal indicator of stress used in our study. all analyses were performed in spss. we selected a priori a pvalue of less than 0.1 as indicative of a trend worthy of consideration. as in previous work, we chose this alpha level in light of the fact that, as is typical in bioarchaeology, we are working with small sample sizes, and adherence to a conventional alpha level of 0.05 could hinder dissemination of results that might reflect larger population patterns and stimulate additional study. results analysis of adults from the population affiliation groups (tables 1 and 2) did not reveal any significant differences among the groups with respect to sex redfern et al. 319 affiliation groups and of the pooled white european/ asian vs. african population affiliation groups are shown in table 5. these results indicate that for the femaleonly sample, individuals of estimated african population affinity have a significantly higher estimated hazard of dying of plague compared to those with estimated white european affinity. there are no significant associations for any of the other comparisons. when we pool people with estimated white european and asian population affinity, using the pooledsex sample and the male only sample, these analyses did not reveal evidence of significant differences in hazard rates between population affiliation groups. however, using the femaleonly sample, the results indicate that individuals with estimated african affiliation have a significantly higher estimated hazard of dying of plague compared to those with estimated white european/asian affiliation. this result suggests how intersectionality— the compounded harm of race and gender and misogynoir (bailey 2021; crenshaw 1989, 1991)— may have impacted mortality during medieval pandemic disease. the results of binary logistic regression to evaluate the association between age and each physiological stress indicator for the plague burials are shown in table 6. as has been shown previously (dewitte 2014b, 2014c, 2018), there is a significant positive association between age and pnbf. however, neither leh nor co are significantly associated with age. comparison of frequencies of physiological stress between the affiliation groups (table 7) revealed higher rates of leh but lower rates of co and pnbf in individuals with estimated african affiliation and compared to those with white european/asian affiliation. none of these differences were statistically significant. ratios for either the plague or the nonplague samples. using data from all three population affiliation groups, there are significantly higher proportions of people of estimated african and asian affiliation in the plague burials compared to the nonplague burials, as shown in table 3. similarly, when using data from the pooled white european/asian vs. african population affiliation groups, there is a significantly higher proportion of people of estimated african affiliation in the plague burials compared to the nonplague burials (18.4% vs. 8.3%, fisher’s exact p = 0.076). the mean ages at death and the corresponding 95% confidence intervals for each group among the plague burials are shown in table 4. the results of cox proportional hazards analyses of all three population table 3. frequencies of individuals of each estimated population affiliation group in the plague vs. nonplague burials. population affiliation plague nonplague pvalue african 9 (18.4%) 8 (8.33%) 0.002 asian 6 (12.2%) 1 (1.04%) white european 34 (69.4%) 87 (90.63%) african 9 (18.4%) 8 (8.3%) 0.076 white european/asian 40 (81.6%) 88 (91.7%) table 4. mean ages at death in years (and corresponding 95% confidence intervals) for each population affiliation among plague burials. population affiliation mean age at death 95% ci white european (n = 33) 31.435 26.621– 36.249 african (n = 8) 20.620 17.362– 23.878 asian (n = 6) 30.837 12.586– 49.087 white european/asian (n = 39) 31.34 26.52– 36.17 african (n = 8) 20.62 17.36– 23.88 table 5. cox proportional hazards analysis results comparing (a) all three population affiliation groups and (b) white european/asian and african: hazard ratios, exp(β), with corresponding 95% confidence intervals. the asterisk indicates, for each comparison, which population affiliation is the reference group; significant results are indicated in bold. a population affiliation exp(β) 95% ci pvalue pooled sexes white european* (n = 111) and african (n = 15) 1.323 0.765– 2.288 0.317 white european* (n = 111) and asian (n = 7) 0.699 0.319– 1.529 0.37 african* (n = 15) and asian (n = 7) 0.613 0.215– 1.747 0.36 female white european* (n = 47) and african (n = 7) 3.21 1.373– 7.506 0.007 white european* (n = 47) and asian (n = 3) 1.532 0.470– 4.997 0.479 african* (n = 7) and asian (n = 3) 0.699 0.141– 3.464 0.661 male white european* (n = 60) and african (n = 8) 0.932 0.439– 1.977 0.854 white european* (n = 60) and asian (n = 4) 0.598 0.211– 1.692 0.332 african* (n = 8) and asian (n = 4) 0.426 0.086– 2.110 0.296 b pooled sexes white european/asian* and african 1.374 0.798– 2.366 0.252 female white european/asian* and african 2.995 1.290– 6.950 0.011 male white european/asian* and african 1.029 0.488– 2.167 0.941 population affinity and plague in fourteenth-century london320 would have primarily been in the working class, especially domestic labor. the use of a black feminist methodology has meant that we can now analyze these data specifically with a “multiissue” lens. we point to crenshaw’s discussion of how intersectionality works in relation to discrimination and compounded harm as a way to consider why black women would have been at higher risk: the point is that black women can experience discrimination in any number of ways and that the contradiction arises from our assumptions that their claims of exclusion must be unidirectional. consider an analogy to traffic in an intersection, coming and going in all four directions. discrimination, like traffic through an intersection, may flow in one direction, and it may flow in another. if an accident happens in an intersection, it can be caused by cars traveling from any number of directions and, sometimes, from all of them. similarly, if a black woman is harmed because she is in the intersection, her injury could result from sex discrimination or race discrimination. (crenshaw 1989:149) however, in our case with our data, we would like to add to the sentence “if a black woman is harmed because she is in the intersection, her injury could result from sex discrimination or race discrimination,” the issue of class discrimination and disability discrimination. because of the white imaginary in relation to the black population’s erasure in medieval england, there is little scholarship that discusses the contours of the labor of black women. however, if we look at the scholarship in early modern england, the discussion is more robust and has pointed to black women primarily being working class, especially as domestic labor (akhimie 2018; brown 2021). a black woman’s situation in domestic service also brings up the specter of  labor theft, hard manual labor, as well as sexual harassment, coercion, if not assault because of her status as household servant. harris (2022) speaks of this most in relation to chaucer and the recent reassessment happening in regards to his “rape/raptus” case that involves cecily chaumpaigne. as she discusses “the numerous female servants” in chaucer’s oeuvre, she explains that “we must think about how these figures are subject to assumptions about women’s labor and who owns it, how they embody gendered vulnerability, and how they are expected to subordinate their wills to those of others” (harris 2022:477). harris (2022:477) further points to phipps’s (2020:141– 142) work on “raptus” (the very wide term for rape that included abduction to physical assault in discussion these results suggest that, at least for females, individuals with estimated african affiliation faced higher hazards of dying of plague compared to individuals of estimated white european affiliations of similar ages. the higher observed rates of leh in individuals in the plague burials with estimated african (100%) compared to those with white european/asian population affiliation (71%) might be an artifact of small sample sizes. alternatively, this might reflect differences in either exposure to stressors or survival of acute physiological stress during childhood, potentially reflecting enslavement/unfreedom. for past populations, just as much as for living populations, it is essential that we are careful to avoid the incorrect and harmful implication that there is a biological basis of race, and we actively oppose the incorrect inference that there is something inherent to people assigned to a certain racial category that makes them more vulnerable to disease. instead, we emphasize here that variation by race in susceptibility to and hazard of dying from disease reflects the biological and psychosocial effects of racism, which was present in the medieval world (heng 2018a); race is a social classification and is not based in biological reality, but it does have biological consequences (american association of biological anthropologists 2019; fuentes and rouse 2016; gravlee 2009; lans 2020; mclean 2019; weheliye 2014). the data that we have analyzed here reveal that black women, because of the structural harm of misogynoir, had a higher risk of spp death. but what are the potential contexts of this higher risk? along with antiblackness and misogyny, these women would have dealt with issues around class because they table 6. results of binary logistic regression of age and each physiological stress indicator among plague burials. leh (linear enamel hypoplasia), pnbf (periosteal new bone formation). pathology exp(β) 95% ci pvalue leh (n = 39) 1.004 0.95– 1.07 0.88 pnbf (n = 28) 1.13 1.02– 1.26 0.018 cribra orbitalia (n = 35) 0.974 0.91– 1.04 0.45 table 7. frequencies of physiological stress indicators and pvalues from fisher’s exact tests of differences among population affiliations (plague burials). leh (linear enamel hypoplasia), pnbf (periosteal new bone formation). pathology white european asian african pvalue leh 21/26 (80.8%) 1/4 (20%) 8/8 (100%) 0.005 pnbf 6/20 (30%) 0 (0%) 1/5 (20%) 0.803 cribra orbitalia 8/26 (30.8%) 0 (0%) 1/7 (14.3%) 0.804 redfern et al. 321 the middle ages) occurring in court cases “involving servant women in late medieval town courts” (phipps 2020:141– 142). she also examines lewis’s (2016) work on the osteology of medieval “urban servant women” to discuss how the gender and class discrimination manifested in these women’s remains. she quotes lewis’s conclusion: “there are suggestions that domestic service caused strain on the legs and backs of the urban females. . . . overall it was the urban females that carried the burden of respiratory and infectious diseases, suggesting they may have been the most vulnerable group in medieval society” (harris 2022:478; lewis 2016:138– 171). the osteological discussion aligns with what our data show in relation to infectious pandemic disease. the osteological information also reveals the ways in which urban servant women would have been prone to physical disability because of their manual labor work and exposure to disease. harris (2022) finishes this section of her article to point to the many scholars who have discussed the sexual vulnerability of domestic women servants in the late middle ages (see kettle 1995; mcintosh 1984; werner 2016). we can further speculate about the lives that these women may have lived and even their potential literacy if we consider phillips’s recent work (2022, 2023) on black servants and their consumption of conduct books in early modern europe. all these contextual considerations and speculations would not have been possible without a black feminist bio archae ol o gi cal methodology. for example, if we were to revisit lewis’s (2016) group of women’s remains analyzed as part of “work and the adolescent in medieval england (ad 900– 1550): the osteological evidence,” and we used a black feminist methodology that included race as an analytic category, what further nuance in the bio archae ol o gi cal analysis could we find? what could align with our current discussions about misgnoir and intersectionality? conclusions we are currently witnessing, on a horrifying scale, the biological effects of racism in the covid19 pandemic. evidence is emerging that black communities across the global north comprise an alarmingly disproportionate number of cases and deaths (fuentes 2020; paton et al. 2020; rossen et al. 2020). pirtle (2020) compellingly argues that this demonstrates the effects of racial capitalism increase the risk of comorbid conditions in black americans (see african american policy forum 2020). clearly, medieval england, and the embodied experiences of london’s racialized black population, as attested in the primary sources (adi 2019), and based on preliminary data from a sample of 89 individuals from two cemeteries, who appear to make up 20% to 30% of the population (redfern and hefner 2021), are not directly comparable to modern populations. however, this study’s results suggest that the health outcomes of structural and anti-black racism we see today might have had parallels during the spp. this study’s findings, in addition to improving how we understand the history of racialized marginalization’s effects on human health and mortality, highlight the heterogeneity that exists within the human remains that we rely on to reconstruct premodern life. much of the variation in frailty and embodied experiences present in archaeological human remains is largely hidden from our view (dewitte and stojanowski 2015; wood et al. 1992). our previous work focused on those variables most often utilized in bioarchaeology: age, sex, and pathological conditions. but the patterns revealed by analyzing just those data mask a tremendous amount of underlying variation and the outcomes of intersections across varied biosocial dimensions. by applying multiple analytical approaches to and lines of evidence from these skeletal samples, we have the potential to uncover some of that once hidden heterogeneity to better understand the forces that shaped past lives. we also argue that the way forward in medieval bioarchaeology is with a black feminist methodology, which we believe has revealed an example of how intersectionality works in relation to pandemic disease. we recommend that intersectionality and critical race theories become integrated into medieval bio archae ol o gi cal studies, as well as the pandemic necropolitics seen in certain premodern racialized communities. although not without issue, we hope that geographically, temporally, and local, condition specific mms can make a contribution to reassessing the medieval european archive of remains, documentary, and visual evidence. we believe black feminist methodology is foundational to narrate the lived experience of black people, whose substantial premodern english community has been elided and erased. we conclude here by taking a small step and cue from hartman’s (2019) “wayward lives” to methodologically reimagine one black woman from our study here and resituate her in the space of medieval london. this is just a sketch of possibilities and the strands that can be pulled to begin piecing a counternarrative of a medieval black london. in chaucer’s cook’s tale, perkyn revelour plans to move in with his gambling friend and his sexworker wife— the living situation suggests a potential polyamorous relationship. he is described earlier as carousing with a “wench,” gambling, and playing music. in these short lines, we get a picture of medieval london’s urban population affinity and plague in fourteenth-century london322 street culture, where perkyn watches the parades in cheapside and gets himself locked up in newgate prison on occasion. harris (2019) has written and discussed the contours of racialized and gendered terminology around the word wench in relation to transatlantic chattel slavery in the british and american context. wench was a reference to black women servants (i.e., ones who were enslaved) who were seen as “sexually available” in nineteenthcentury american media. harris (2019) does a philological deepdive into the development of wench in late medieval english. specifically in chaucer, they reveals how its use always references the social hierarchy of servant, below a lady (merchant’s tale), and consistently is coupled with sexual availability (merchant’s tale), including that of toxic rape culture and genderbased sexual violence (reeve’s tale). can perkyn revelour’s “wench” be another black woman servant also working and living in the london streets but finding time to dance, play dice, and drink with a medieval black cook? can we imagine her in hartman’s (2019) opening to wayward lives but in london’s fourteenthcentury urban streets filled with brothels, shops, outdoor dice games, and taverns selling beer: you can find her in the group of beautiful thugs and too fast girls congregating on the corner and humming the latest rag, . . . watch her in the alley passing a pitcher of beer back and forth with her friends. . . . step onto any of the paths that cross the sprawling city and you’ll encounter her as she roams. (hartman 2019:3) acknowledgments rr is forever indebted to stuart wyatt (mol) for managing to combine his one hour’s exercise during lockdown 2020 with retrieving the min86 site report from the archaeological archive. funding to snd from the nsf (bcs0406252, bcs1261682) and the wennergren foundation (#7142, #8247) supported data collection from east smithfield and st.  mary graces. permission to sample the human remains from min86 and srp98 was given by the museum of london in accordance with their ethical policies (https:// www . museumoflondon . org . uk / about us / corporate information / policies). we are grateful to dr.  kelly kamnikar at university of new mexico who provided the spanish translation of our abstract. references adi, hakim. 2019. black british history: new perspectives. bloomsbury academic, london. african american policy forum. 2020. under the blacklight. https:// aapf . org / all episodes utb. accessed 11 june 2020. akhimie, patricia. 2018. shakespeare and the 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http://decodedpast.com/evidence-medieval-black-history-england/5433 https://www.journals.uchicago.edu/doi/10.1086/204084 https://www.journals.uchicago.edu/doi/10.1086/204084 https://www.yorkarchaeology.co.uk/new-blog/2019/6/14/st-stephens-church https://www.yorkarchaeology.co.uk/new-blog/2019/6/14/st-stephens-church idstacks 2 idstacks 4 idstacks 5 idstacks 6 idstacks 7 idstacks 9 idstacks 12 idstacks 13 idstacks 14 idstacks 15 idstacks 16 idstacks 17 idstacks 18 idstacks 19 login | bioarchaeology international main navigation main content sidebar current archives search announcements subscribe early view toggle search register login search toggle navigation home login subscription or article purchase required to access item. to verify subscription, access previous purchase, or purchase article, log in to journal. username password forgot your password? keep me logged in login register sidebar-links about overview editorial board publication ethics contact contributors author guidelines thematic issue proposals open access policy submit an article subscribers subscribe/renew recommend to your librarian news sign-upnews sign-up   most read structural violence and physical death at tlatelolco two probable cases of infection with treponema pallidum during the neolithic period in northern vietnam (ca. 2000–1500 b.c.) race, population affinity, and mortality risk during the second plague pandemic in fourteenth-century london, england stronger together: advancing a global bioarchaeology osteobiography: a platform for bioarchaeology research issn: 2472-8349 eissn: 2472-8357   university of florida press https://floridapress.org email: journals@upress.ufl.edu navigation home search current archives submit subscribe bioarchaeology international doi: 10.5744/bi.2024.0027 copyright © 2025 university of florida press —-1 —0 —+1 detailed recovery methods show the complexity of ancient mortuary practices in later stone age huntergatherers of southerncentral africa jessica i. cerezoromán,a,* elizabeth a. sawchuk,b,c,d alex bertacchi,e,f annalys hanson,g megan walsh,a e. grace veatch,h potiphar kaliba,i and jessica c. thompsone,j,k adepartment of anthropology, university of oklahoma, norman, ok, usa bcleveland museum of natural history, cleveland, oh, usa cdepartment of anthropology, university of alberta, edmonton, ab, canada ddepartment of anthropology, stony brook university, stony brook, ny, usa edepartment of anthropology, yale university, new haven, ct, usa fdepartment of earth and planetary sciences, yale university, new haven, ct, usa gsol solutions, llc, paradise valley, az, usa hhuman origins program, department of anthropology, national museum of natural history, smithsonian institution, washington, d.c., usa iresearch division, department of museums and monuments, lilongwe, malawi jyale peabody museum of natural history, new haven, ct, usa kinstitute of human origins, arizona state university, tempe, az, usa * correspondence to: jessica i. cerezoromán, university of oklahoma– anthropology, 455 w. lindsey st. dale hall tower, room 509, norman, ok 730190390, usa email: jessica . cerezoroman@ou . edu abstract this article examines mortuary practices by terminal pleistocene and holocene huntergatherers from malawi and eastern zambia in southerncentral africa, with a focus on the evidence for secondary burial and postmortem body manipulation over the past ~16,000 years. published regional archaeological literature documents widespread but variable reports of incomplete or isolated remains from these contexts. while preburial body exposure, postburial manipulation, and/or secondary burial with selective removal or interment of certain body parts are possible explanations, inconsistent recovery and reporting of archaeological contexts and bone modifications makes it challenging to fully exclude taphonomic processes. the social significance of such practices in regional huntergatherer lifeways is also undertheorized because most remains were reported in appendices as element lists that focus on population characteristics. here, we report human remains recovered between 2016 and 2019 through detailed archaeological excavations from five rock shelters in malawi, which provide a way to investigate burial practices with highresolution data sets. we recovered remains from 19 individuals, 16 of whom are represented only by isolated elements. individuals found in primary burials have evidence for preburial loss or postburial removal of elements that are not readily explained by nonanthropogenic processes. we interpret some of these patterns as likely evidence of mortuary treatments involving posthumous exposure, manipulation, and/or curation of body parts. keywords: mortuary practices; hunter-gatherers; africa en este artículo se examinan las prácticas mortuorias de los cazadoresrecolectores de malawi y el este de zambia en el centrosur de áfrica durante el pleistoceno terminal y el holoceno. particularmente nos concentramos received 3 october 2024 revised 21 december 2024 accepted 31 january 2025 published online 13 june 2025 bi_0-0_08_cerezo-román_3pp.indd 1bi_0-0_08_cerezo-román_3pp.indd 1 27-05-2025 15:37:3627-05-2025 15:37:36 https://orcid.org/0000-0002-7752-8079 https://orcid.org/0000-0003-4398-2174 https://orcid.org/0000-0002-6952-7666 https://orcid.org/0000-0003-1627-4949 mortuary practices in hunter-gatherers of southern-central africa2 -1— 0— +1— introduction mortuary archaeology allows us to look at how people in the past handled and disposed of the bodies of their dead in a ritualized fashion (nilsson stutz 2016). the practices related to the treatment and burial of the deceased can be viewed as deeply entangled, with a wide range of emotional responses to death, including love, anxiety, fear, grief, loss, and standardized behaviors directed by cultural norms and traditions. the nature and materiality of the corpse may also play a significant role in thinking about the responses of the living. the cadaver, ambiguous by its very nature, located between subject and object, is often described as an object with different degrees of personhood depending on the culture, time period, and the identity of the dead itself (cerezoromán 2015; kristeva 1980; mcclelland and cerezoromán 2016; nilsson stutz 2003, 2016). what people do with the human remains as part of mortuary rituals varies depending on the culture and time period. while some people decide to cremate their loved ones, other groups bury their dead, then reopen the graves for a variety of reasons, and perform secondary mortuary treatments. the use of relics, token burials, and curation of human remains as part of secondary mortuary rituals in past societies has been well documented in many cultures around the world and throughout time (e.g., chapman et  al. 2017; chávez 2018; edlichmuth 2020; kjellström 2020; loston 2007; stratouli et  al. 2010). while finding isolated bones in secondary deposits of human remains in archaeological sites is not unusual, such finds are not typically at the center of the research. furthermore, archaeological identification of secondary mortuary practices is challenging because not all the behaviors associated with their creation and performance leave archaeological traces, osteobiographies are not easily reconstructed from isolated elements, and generally, the archaeological visibility of these practices is low. in some cases, the traces that remain may resemble unintentional or nonanthropogenic disturbance. while understandable from the perspective of prioritizing datarich features, the bias in mortuary archaeology toward primary burials inhibits understanding of the full repertoire of past behaviors. secondary deposits of human remains in the form of isolated findings are often not analyzed, quickly ignored, and discarded as disturbances without further exploration. in many cases, isolated findings of human remains and human remains in secondary deposits are a product of bioturbation and taphonomic processes, but in other instances, they could be the product of human behavior, secondary mortuary burial deposit, and part of the archaeological record that should not be ignored. in this article, we explore how mortuary rituals and the social significance of diverse practices were incorporated into the lifeways of later stone age (lsa) foragers of malawi and eastern zambia. this region and time period have long been described as containing human remains in both primary inhumations and secondary deposits from archaeological rock shelters but with little bio archae ol o gi cal attention dedicated to why this may be. this is a missed opportunity to understand the underlying diversity and complexity of the forager social and ritual world across africa and beyond. unlike with earlier work, most of the remains described in this study were en la evidencia de entierro secundario y manipulación de cuerpos postmortem durante los últimos ~16,000 años. la literatura arqueológica regional publicada documenta muchos entierros incompletos o aislados de diversas formas en estos contextos. la exposición del cuerpo antes del entierro, manipulación del cuerpo después del entierro, entierro secundario con remoción selectiva de restos óseos y/o entierro de ciertos partes del cuerpo son explicaciones posibles. sin embargo, la recuperación y las modificaciones de los huesos en los informes de hallazgos arqueológicos son inconsistentes y eso dificulta la exclusión total de los procesos tafonómicos de los contextos de restos humanos. la importancia social de tales prácticas en los modos de vida regionales de los cazadoresrecolectores también es poco teorizado, ya que la mayoría de los restos y hallazgos se describen en apéndices que se centran en las características de la población y solo hay listas de los elementos óseos. aquí informamos sobre los restos humanos recuperados entre 2016 y 2019 a través de excavaciones arqueológicas detalladas de cinco refugios rocosos en malawi, que proporcionan una manera de investigar las prácticas funerarias usando un conjunto de datos de alta resolución. recuperamos restos de diecinueve individuos, dieciséis de los cuales están representados sólo por elementos aislados. individuos encontrados en entierros primarios tienen evidencia de remoción de elementos óseos antes de ser enterrados o después del entierro que no se explican fácilmente a través de procesos no antropogénicos. interpretamos que algunos de estos patrones son posibles evidencias de tratamientos mortuorios que involucran exposición póstuma, manipulación y/o curación de partes del cuerpo. keywords: prá cticas mortuorias; cazadoresrecolectores; áfrica bi_0-0_08_cerezo-román_3pp.indd 2bi_0-0_08_cerezo-román_3pp.indd 2 27-05-2025 15:37:3627-05-2025 15:37:36 cerezoromán et al. 3 —-1 —0 —+1 recovered using highresolution excavation techniques and documentation. this enables the first assessment of the diversity of mortuary practice in the region, including the potential role of secondary mortuary treatment. between the 1950s and 1970s, lsa human remains were recovered from nine rock shelter sites in eastern zambia and malawi (fig. 1) and published as site reports or dissertations (clark 1956, 1973; mgomezulu 1978; phillipson 1976; sandelowsky 1972; also see supplementary materials). these include general descriptions of recovery methods, preliminary counts of elements, and a small number of conventional radiocarbon ages. as was commonplace at the time, bio archae ol o gi cal research was limited to basic osteological reporting and largely confined to appendices (buikstra 1991). excavations at five rock shelters in the kasitu valley of the mzimba district of northern malawi between 2016 and 2019 by the malawi ancient lifeways and peoples project (malapp) have been finer in detail and offer new information that we articulate with older records to reveal considerable variation in regional lsa mortuary practice and a far more extensive bio archae ol o gi cal record than was previously known. our two research questions are as follows: (1) what are the different ways of treating the bodies at each site? (2) what do these mortuary rituals suggest about social memory and the use of space across the landscape, as well as the role of human remains in these processes? we first examine the immediate questions of where remains were deposited (which sites contain them), how they manifest in the archaeological record (from isolated elements in secondary deposits to primary inhumations), and the quality of the evidence for deliberate association with other objects within or as part of the grave feature. we also consolidate information about the minimum number of individuals, the evidence for variation in how they were treated in the perimortem period, and how these variables may relate to other factors such as the ontogenetic ages and biological sexes of the deceased. drawing from published literature and analyses of newly recovered remains, we use spatial analysis together with taphonomic indicators, such as element part representation, fragmentation, and modification, to explore the evidence for how human remains arrived at these sites and what happened to them during and after deposition. by comparing the quality of evidence from recently excavated sites and “legacy” collections (i.e., those excavated decades ago prior to contemporary documentation methods and often with incomplete contextual information; king 2016), we are able to assess the relationship between recovery practices, data quality, and ability of the bioarchaeologists to “see” diverse ancient mortuary practices. background the bio archae ol o gi cal record prior to recent study recent analyses of ancient dna (adna) from 11 ancient individuals from malawi and eastern zambia figure 1. locations of sites mentioned in the text. (a) boxed area on the small map of africa. (b) detail of the kasitu valley. african countries and water bodies shapefiles from natural earth. ecoregions from the nature conservancy. topography from srtm, a product of nasa. circles with crosses or dots of different colors represent locations of rock shelters with remains of human foragers. bi_0-0_08_cerezo-román_3pp.indd 3bi_0-0_08_cerezo-román_3pp.indd 3 27-05-2025 15:37:3827-05-2025 15:37:38 https://journals.upress.ufl.edu/bioarchaeology/article/view/3077/3628 mortuary practices in hunter-gatherers of southern-central africa4 -1— 0— +1— show that terminal pleistocene and holocene forgers in the region were genetically distinct from bantu speaking people who occupy the region today (lipson et al. 2022; skoglund et al. 2017). the ancestry of these ancient foragers forms a threeway cline between both ancient and living foragers in eastern, central, and southern africa. this cline was established after ~50,000 years ago, but by ~20,000 years ago, populations in the region had become more regionally differentiated. this emphasizes the significance of malawi and eastern zambia as ancient crossroads for population interactions and their subsequent role as loci for population differentiation. because mortuary practice is heavily embedded in cultural norms and traditions, understanding variation in the treatment of the dead may offer unique insight into the emergence of different cultural identities in tandem with biological divergence. however, although malawi and eastern zambia have a substantial bio archae ol o gi cal record of lsa foragers, there has been little investigation into spatiotemporal variation in mortuary treatment (supplementary materials). in this article, we define primary inhumation as a feature where the individual was deposited as a complete body and the body decomposed in situ (duday 2009; knüsel and schotsmans 2022). secondary inhumation deposits refer to those with human remains that are isolated, incomplete, and/or unarticulated, indicating relocation to a secondary location after initial decomposition or disarticulation elsewhere. surveyed reports include variable descriptions of both types, including at least 45 individuals from nine sites (17 children, 24 adults, and four with unreported ageatdeath). eighteen individuals from seven of these sites have enough contextual evidence to suggest skeletal elements were part of burial features comprising multiple elements from the same individual, although the degree of completeness and commingling is highly variable. for the other individuals, either context was not described or described as isolated remains. we also note that associated worked bone objects and parts of faunal remains for five individuals from four sites were reported as potential burial objects, which may offer additional insight into variation in mortuary practice (table 1). we discuss all radiocarbon dates in this article in calibrated years b.p., calibrated in oxcal 4.4 using the sh20 calibration curve (hogg et  al. 2020). date ranges for human remains recovered prior to 2016 were based on conventional radiocarbon dating of associated charcoal and only reported for chencherere ii (clark 1972), fingira (sandelowsky 1972), mtuzi (mgomezulu 1978), and kalemba, makwe, and thandwe (all in phillipson 1976). these placed all remains in the middle to late holocene, except for one individual from the terminal pleistocene at kalemba. although recent adna work (lipson et al. 2022; skoglund et al. 2017) has largely corroborated this general age division through direct ages on individuals from fingira (~6,000– 2,500 years cal. b.p.), chencherere ii (~5,000  years cal. b.p.), and kalemba (~5,000  years cal. b.p.), only three individuals reported in earlier literature from the region have been directly dated: sk 5, an adult female from kalemba (5,285– 4,975 years cal. b.p.); hora 1, an adult male from the hora 1 site (hor1 site, 9,090– 8,770 years cal. b.p.); and hora 2, an adult female from the hor1 site (8,175– 7,944 years cal. b.p.)(clark 1956). all other direct dates on human remains are from individuals who were more recently recovered or cannot be identified as the same individuals from earlier reports. in total, 10 ancient foragers from malawi (four from fingira, four from hor1, and two from chencherere ii) and one from kalemba in zambia have published adna results (lipson et al. 2022; skoglund et al. 2017). patterns in mortuary practice based on early research initial excavation reports emphasized complete burials and/or clusters of human remains. however, many more individuals are represented by isolated remains. at chencherere ii, careful study of the faunal remains by crader (1984a) revealed 21 additional fragmentary human elements from at least seven more individuals than reported by clark (1973), raising the minimum number of individuals (mni) from one to eight. of the entire sample of 47 lsa individuals from the region published to date (the 45 reported prior to malapp, plus the two infants recovered by malapp in 2019), it is notable that only six (four from hor1, one from fingira, and one from chencherere ii) were represented by any remains in clear articulation in a primary inhumation burial. all other individuals were represented by commingled, isolated, and/or fragmentary elements, with the mni calculated in the original reports on the basis of repeated elements, spatial location within the site, and/or ontogenetic ages (table 2). this total record comprising mainly fragmentary and/or isolated remains (table 2) could be a consequence of preservation or recovery bias, including postdepositional taphonomic disturbance unrelated to mortuary behavior. however, early excavation reports do describe original observations that some sets of remains appeared intentionally clustered or patterned by element in ways suggesting some degree of postmortem body exposure, secondary burial, and/or manipulation of primary burials (table 1). for bi_0-0_08_cerezo-román_3pp.indd 4bi_0-0_08_cerezo-román_3pp.indd 4 27-05-2025 15:37:3827-05-2025 15:37:38 https://journals.upress.ufl.edu/bioarchaeology/article/view/3077/3628 https://journals.upress.ufl.edu/bioarchaeology/article/view/3077/3628 cerezoromán et al. 5 —-1 —0 —+1 ta b le 1. a ge a nd se x di st ri bu tio n, b ur ia l t yp e an d su pp or tin g ev id en ce , a ss oc ia te d ob je ct s, an d cu rr en t r ep os ito ri es o f a nc ie nt h un te r ga th er er in di vi du al s b as ed o n hu m an re m ai ns fr om m al aw i a nd ea st er n za m bi a ba se d on re m ai ns re co ve re d an d re po rt ed p ri or to 2 01 6. s ite s l is te d no rt h (to p) to so ut h (b ot to m ) f or m al aw i a nd z am bi a, re sp ec tiv el y. n r = no t r ep or te d. si te c ou nt ry ye ar o f re co ve ry in fa nt < 1 y ea r yo un g c hi ld 1– 5 ye ar s o ld er c hi ld 6– 19 ye ar s yo un g a du lt 17 – 3 0 ye ar s a du lt 30 + ye ar s in de t. n r se x* bu ri al ty pe c on te xt ua l e vi de nc e fo r se co nd ar y/ m an ip ul at ed bu ri al o bj ec ts re po sit or y re fe re nc e fi ng ir a ro ck sh el te r m al aw i 19 66 0 5 3 0 2 6 0 in de t. (1 4) m (2 ) p (1) f/ u (1 5) n /a n on e n at ur al h is to ry m us eu m , lo nd on , u ni te d k in gd om sa nd el ow sk y 19 72 h or a 1 m al aw i 19 50 0 0 0 1 1 0 0 m (1 ) f (1) p (1) ps (1 ) “. . . w ith th e e xc ep tio n of h ee l bo ne s a nd th re e o th er b on es of th e a nk le o f t he ri gh t f oo t, al l t he o th er b on es o f t he fe et w er e m iss in g. th e l eft fi bu la w as m iss in g an d on ly th e br ok en sh aft o f t he ri gh t o ne w as p re se nt . a n um be r o f t he bo ne s o f t he h an ds w er e a lso m iss in g. th e h ee lb on e o f t he ri gh t f oo t w as fo un d w he re th e k ne e c ap sh ou ld h av e be en — th us su gg es tin g th at it ha d be en p la ce d th er e in te nt io na lly . i t w ou ld ap pe ar , t he re fo re , t ha t t he bo dy h ad b ee n su bj ec te d to so m e e xp os ur e b ef or e b ur ia l to ok p la ce . . .” (1 07 ) “. . . u pp er ja w (p al at e) o f a sm al l an te lo pe , pr ob ab ly a b us h bu ck , w hi ch h ad be en p la ce d un de r th e ri gh t s ho ul de r bl ad e. . . . t w o of th e lu m ba r ve rt eb ra e of bu ri al n o.  1 re st ed on a p er cu ss io n fla ke d st on e ax e, bu t w he th er th is ca n be ta ke n to b e a tr ue a ss oc ia tio n or n ot is un ce rt ai n. ” ( 10 7) u ni ve rs ity of c ap e to w n, so ut h a fr ic a; n at ur al h is to ry m us eu m , lo nd on , u ni te d k in gd om c la rk 19 56 c bt s (d z4 0) m al aw i 19 76 1 0 0 0 0 0 0 in de t. (1) p (1) n /a n on e n at io na l re po sit or y, n gu lu di , m al aw i m go m ez ul u 19 78 m tu zi (d z1 26 ) m al aw i 19 76 0 0 0 4 1 0 1 m (6 ) s (3 ) “s ku lls 1 an d 3b w er e co m pl et el y se pa ra te d fr om th e r es t o f t he ir p os tc ra ni al [s ic ] a nd w er e f ou nd fa ci ng do w n . . . sk ul ls 2 an d 3a , al th ou gh e ac h w ith a sp in al co lu m n le ad in g to it , a lso fa ce d do w n w hi le th ei r id en tifi ab le p os tc ra ni al fa ce d up . th e r ib c ag e o f ‘b ur ia l 2 ’ w as sq ua sh ed o ve r th e p el vi s. ‘b ur ia l 1 ’ h ad a ll th e l on g lim b bo ne s p ut to ge th er li ke p ie ce s o f w oo d in a p ile , 3 0 cm . f ro m th e [s] ku ll. ” ( 10 3) “. . . b on e po in t, pr ob ab ly u se d as an a rr ow o r l in k sh aft . . .” (2 34 ) n at io na l re po sit or y, n gu lu di , m al aw i m go m ez ul u 19 78 (c on tin ue d) bi_0-0_08_cerezo-román_3pp.indd 5bi_0-0_08_cerezo-román_3pp.indd 5 27-05-2025 15:37:3827-05-2025 15:37:38 mortuary practices in hunter-gatherers of southern-central africa6 -1— 0— +1— si te c ou nt ry ye ar o f re co ve ry in fa nt < 1 y ea r yo un g c hi ld 1– 5 ye ar s o ld er c hi ld 6– 19 ye ar s yo un g a du lt 17 – 3 0 ye ar s a du lt 30 + ye ar s in de t. n r se x* bu ri al ty pe c on te xt ua l e vi de nc e fo r se co nd ar y/ m an ip ul at ed bu ri al o bj ec ts re po sit or y re fe re nc e c he nc he re re ii m al aw i 19 72 0 1 4 1 0 2 0 in de t. (7 ) m (1 ) p (1) f/ u (7 ) n /a “. . . sm al l, fin el y po in te d bo ne a w l ne ar th e ri gh t ar m . . .” (c la rk :9 ) n at io na l h is to ry m us eu m , lo nd on , u ni te d k in gd om c la rk 19 72 ; c ra de r 1 98 4 n ac hi ku fu c av es za m bi a 19 48 0 0 0 0 0 0 1 in de t. (1) u (1 ) n /a n on e u nk no w n c la rk 19 50 th an dw e za m bi a 19 70 0 1 0 0 2 0 0 in de t. (1) m (1 ) f (1) p (1) s (1) f/ u (1 ) “i t a pp ea rs th at th e s ke le to n w as p ar tly d is ar tic ul at ed o r di sm em be re d be fo re b ur ia l. o ne fe m ur w as b ro ke n an d th e t w o ha lv es w id el y se pa ra te d. th e f ac ia l r eg io n of th e s ku ll, to ge th er w ith th e m ax ill a, w as m is si ng , b ut th e m an di bl e w as p re se nt . th e at la s a nd a xi s v er te br ae w er e fo un d ar tic ul at ed w ith th e sk ul l b ut se pa ra te d fr om th e re st o f t he v er te br al co lu m n. ” (5 0) “o ve r t he fe et o f th is [e ld er ly in di vi du al ] sk el et on w er e pl ac ed tw o fr ag m en ts o f w ar th og sk ul ls, ea ch re ta in in g a pa ir o f t us ks . o ve r th e t ib ia e w as se t an ot he r s uc h fr ag m en t w ith a si ng le m as siv e tu sk .” (5 0) li vi ng st on e m us eu m , li vi ng st on e, za m bi a ph ill ip so n 19 76 k al em ba za m bi a 19 71 1 0 1 2 0 1 0 in de t. (3 ) f (2 ) p (1) s (3 ) f/ u (1 ) sk 2 (a du lt f) : o nl y a sk ul l an d ce rv ic al v er te br ae pr es en t; sk 4 (c hi ld 7– 8  ye ar s) : “ th e s ku ll ha d ev id en tly b ee n br ok en b ef or e bu ri al a nd th e p ie ce s w er e se pa ra te d. ”; sk 5 (a du lt f) : “th e p it w as li ne d w ith th re e pi ec es o f a h um an p el vi s a nd on e s ku ll fr ag m en t. in th e ar ea th us d em ar ca te d w er e pl ac ed , o ne a t e ac h en d, th e tw o ha lv es o f a m an di bl e. be tw ee n th es e w as a p ile o f ve rt eb ra a nd ri b fr ag m en ts , a fe w b its o f s ha tte re d lo ng b on e, a nd tw o pi ec es o f th e t em po ra l.” (1 25 ) n on e li vi ng st on e m us eu m , li vi ng st on e, za m bi a ph ill ip so n 19 76 m ak w e za m bi a 19 66 0 0 0 0 0 0 3 in de t. (3 ) f/ u (3 ) n /a n on e li vi ng st on e m us eu m , li vi ng st on e, za m bi a ph ill ip so n 19 76 *s ex e st im at es a re re po rt ed o nl y fo r a du lt in di vi du al s w ith su ffi ci en tly c om pl et e m or ph ol og y; la te r c or ro bo ra te d w ith a d n a o n th e tw o ad ul ts fr om h or a 1 ( sk og lu nd e t a l. 20 17 ) a nd o ne a du lt fr om k al em ba (l ip so n et  a l. 20 22 ) ** bu ri al ty pe is a s p er o ri gi na l e xc av at or in te rp re ta tio n. p = p ri m ar y; p /s = p ri m ar y w ith p os td ep os iti on al m an ip ul at io n; s = se co nd ar y; f /u = fr ag m en ta ry b ut u ns pe ci fie d; u = u ns pe ci fie d ta b le 1. (c on tin ue d) bi_0-0_08_cerezo-román_3pp.indd 6bi_0-0_08_cerezo-román_3pp.indd 6 27-05-2025 15:37:3827-05-2025 15:37:38 cerezoromán et al. 7 —-1 —0 —+1 table 2. minimum number of elements from 43 (minimum) individuals from seven sites excavated prior to 2016. individual element data were not reported from the changoni bible training school or for the nachikufu caves, so they are not included here, but individuals from these sites do appear as part of a total mni of 45 in table 1. eastern zambia central malawi northern malawi body region kalemba makwe thandwe mtuzi chencherere ii hora 1 fingira rock shelter total head cranium 29 0 13 14 1 2 30 89 maxilla 0 0 3 0 0 0 0 3 mandible 2 0 2 4 0 1 4 13 hyoid 0 0 0 0 0 0 3 3 tooth 32 4 25 84 39 48 74 306 shoulder scapula 0 0 3 1 2 4 9 19 clavicle 0 0 2 2 3 3 3 13 neck/chest/back sternum 0 0 1 0 1 1 2 5 manubrium 0 0 0 0 0 0 1 1 vertebra 8 0 4 2 27 39 97 177 rib 2 0 3 2 27 25 3 62 pelvis pelvis 1 0 5 2 7 3 8 26 sacrum 0 0 1 0 0 0 0 1 arm humerus 0 0 4 2 2 4 6 18 radius 0 1 5 2 2 3 3 16 ulna 1 0 4 1 5 4 2 17 wrist carpal 0 0 3 9 16 8 15 51 hand metacarpal 0 0 7 11 10 4 18 50 manual element 0 0 0 0 0 1 0 1 leg femur 1 0 5 3 3 4 5 21 patella 0 0 2 1 0 0 4 7 tibia 1 0 4 3 2 4 5 19 fibula 1 0 3 2 3 3 2 14 ankle tarsal 0 0 6 8 10 11 40 75 foot metatarsal 0 0 2 1 10 2 28 43 metatarsal or philangeal 0 0 0 0 0 0 28 28 pedal element 0 0 0 0 0 3 0 3 wrist/ankle unspecified carpal/tarsal 0 0 0 6 0 0 0 6 hand/foot unspecified phalanx 1 0 11 15 57 5 92 181 total 79 5 118 175 227 182 482 1,268 example, at hor1, in northern malawi, clark (1956:107) describes the conditions of recovery of the adult female skeleton: “with the exception of the heel bones and three other bones of the ankle of the right foot, all the other bones of the feet were missing. the left fibula was missing and only the broken shaft of the right one was present. a number of the bones of the hands were also missing. the heelbone of the right foot was found where the knee cap should have beenthus suggesting that it had been placed there intentionally” (fig. 2). at mtuzi, in the central part of malawi, six individuals are represented by fragmentary crania with a small quantity of fragmented postcranial elements but considered by mgomezulu (1978) to have been clustered within three graves. mgomezulu (1978:103) writes that “‘burial 1’ had all the long limb bones put together like pieces of wood in a pile, 30 cm. from the [sic] skull.” at kalemba in eastern zambia, phillipson (1976:125) indicates there are “four separate human burials” and specifies three as secondary burials (table  1). at thandwe, phillipson (1976:50) describes evidence based on the arrangement and fragmentation of elements that “the skeleton was partly disarticulated or dismembered before burial” (table 1). bi_0-0_08_cerezo-román_3pp.indd 7bi_0-0_08_cerezo-román_3pp.indd 7 27-05-2025 15:37:3827-05-2025 15:37:38 mortuary practices in hunter-gatherers of southern-central africa8 -1— 0— +1— the use of stones as part of mortuary practice adds additional information about regional variation and may also have facilitated identifying the locations of existing burials as foragers reoccupied the same sites. at thandwe, an elderly female was interred with a large triangular rock that phillipson (1976:50) interprets as a marker stone. overlying this burial were the commingled remains of an elderly male and a child aged two to three years at death, both of which were also subsequently covered by a stone slab. clark (1973:9) also describes a “pile of stones resting in a shallow depression dug into the rotten granite” floor of chencherere ii, into which the body of an adult male was interred. sandelowsky (1972:120– 122) reports that for the adult male burial from fingira, “stones lay above the fractures of the right shoulder, arm and leg as well as above two breaks in the bones of the left leg.” combining previous and new research taken together, these observations open the possibility of broader variation in mortuary treatment than previously considered, including primary and secondary inhumations. furthermore, osteological analysis (table  1) revealed individuals in inferred secondary inhumations span all age and both sex categories. they also show that for some individuals, there was community investment in these interments, including the use of stones that could have deterred scavengers but also may have served as markers. the welldescribed and disproportionate representation of cranial elements inside commingled burial features at kalemba and mtuzi (table  2) is consistent with original excavator interpretations that there was some degree of body manipulation (mgomezulu 1978; phillipson 1976). recovery of remains from different layers (e.g., kalemba) or with thousands of years of separation between directly dated individuals (e.g., fingira) also shows that the same places were used for mortuary practice over periods of time that far exceed individual living memory. at this time, the associated archaeological record is too coarsely resolved to know if this represents local continuity in cultural practice or simply convergence on the solution of rock shelters as receptacles for the dead. understanding ancient mortuary practices in lsa foraging communities requires shifting attention away from clear primary inhumations to a more balanced approach where secondary burial deposits of human remains, as well as isolated bones, are also analyzed and considered important aspects of the bioarchae ol o gi cal record. this is important for our area of study and any site that presents secondary deposits of human remains. at any rock shelter site with complex formation history, fragmentation and commingling of remains may be the result of unrelated human activities at the site such as pitdigging, trampling, or campfires. nonanthropogenic taphonomic processes may have also played a role (e.g., sediment compaction, bone dissolution, and/or bioturbation) (haglund and sorg 2002; pokines et al. 2022). it is also possible that secondary burial deposits and body manipulation may have been an important aspect of postmortem treatment in late pleistocene and holocene foragers of southerncentral africa prior to ~2,000  years ago that has largely gone undescribed. with the exception of crader’s (1984a) work at chencherere ii and possibly the lists of elements from finigra in the appendix of sandelowsky’s (1972) dissertation, most collections have not undergone careful study of faunal assemblages to identify isolated human elements. human remains may therefore be present, in isolated and/or highly fragmented form, at sites that do not report them— or they may be more numerous than realized at sites where clear primary inhumations have also been recovered. if so, then this would change the archaeological conceptualization of the mortuary landscape as it was experienced by lsa foragers by increasing the number of localities ancient foragers used as repositories for their dead and adding nuance about specific kinds of treatments. figure 2. hora 2 adult female in situ prior to removal, reproduced from clark (1956:figure vi) and enhanced for clarity using photoshop version 24.1.1. (a) missing left fibula. (b) right calcaneus displaced to the position of the left knee. photo credit: society of malawi. bi_0-0_08_cerezo-román_3pp.indd 8bi_0-0_08_cerezo-román_3pp.indd 8 27-05-2025 15:37:3827-05-2025 15:37:38 cerezoromán et al. 9 —-1 —0 —+1 although foragers may well have used other localities outside of shelters as mortuary places, these places were not preserved or have not yet been located. therefore, here we focus on rock shelter deposits by providing new data about element representation, mni, spatial relationships, and taphonomic variables from five recently excavated rock shelter sites in the kasitu valley of the mzimba district of malawi. study area, sites, and methods the kasitu valley of malawi separates the eastern highlands of the viphya plateau from plains that grade west into the luangwa valley of zambia (fig. 1). it is characterized by zambezian miombo open woodland interspersed with edaphic grasslands known as dambos (debusk 1998; wright et al. 2024). prominent local landmarks are the kasitu river, a perennial water source at the foothills of the highlands, and mount hora, a granitegneiss inselberg that rises 110 m from the plain to 1,716 m above sea level (amsl). two of the excavated rock shelters (hor1 and hor5) are located near the base of the inselberg, at 1,470 m and 1,503 m amsl, respectively. hor1 was first excavated by clark in 1950 (clark 1956) and again by malapp in 2016, 2017, 2018, and 2019. hor5 was excavated by sandelowsky in 1966 (sandelowsky 1972) and again by malapp in 2018. a third site, mazinga 1, or maz1 (1,401 m amsl), was excavated by malapp in 2017, 2018, 2019, 2022, and 2023 and is located at the foothills of the highlands, where the luwelezi stream flows into the kasitu river. the kadawonda 1 and 2 (kad1 and kad2) sites, excavated by malapp in 2017, are part of a complex of rock shelters formed in a small outcrop in the upper luwelezi catchment, at 1,709 m amsl. full descriptions of cultural sequences, stratigraphy, and chronology are presently underway, so for the purposes of this analysis, we used broad age categories such as “holocene” and “pleistocene” and refer to published ages for the sites for more specific information. as analysis is ongoing, only remains recovered through the 2019 excavation seasons are reported here. excavation strategies, site recording, and processing of recovered materials were the same across all sites and included recovery and analysis of all finds larger than 3 mm and, in the case of hor1, larger than 1 mm (supplementary methods). the data generated in our examination of the human remains were analyzed using spss 24 and microsoft office excel 2016. the variables recorded during the study of the deposits consisted of three main types: biological data, posthumous treatment of the body, and archaeological context. j.cr. recorded biological data that includes estimations of sex, ageatdeath, pathological conditions, and trauma. j.c.t. recorded further taphonomic attributes such as degree of matrix coverage, fossilization, and microscopic bone surface modifications. the variables documented for the posthumous treatment of the body and archaeological context include (a) body manipulation and treatment; (b) spatial analysis, deposit type, and context; and (c) associated objects. the human skeletal remains consisted of primary inhumations, bones found in a burned charcoal and ash feature, and isolated remains. the degree of fragmentation and fossilization of the remains limited analytical observations, particularly clinical diagnoses of pathological conditions and the frequency and etiology of traumas and cut marks. the protocols for osteological data collection were based primarily on those of buikstra and ubelaker (1994) and subsequent revisions (arizona state museum 2018; cunningham et al. 2016). skeletal data collection consisted of documenting metric and morphological observations of remains. for each individual and isolated remains, a detailed skeletal inventory was generated, which included recording the presence of elements and their conditions. these analyses allow for interpretations of body completeness at the moment of burial and the number of individuals represented in each deposit (refer to supplement for details on the methods that were used to estimate the ageatdeath, sex, trauma, and pathologies). after bio archae ol o gical identification, the spatial positions of all elements were plotted in arcgis versions 8+ in plan and three dimensional view. methods for obtaining mni estimates based on spatial and ontogenetic data are provided in the supplement. we analyzed the posthumous treatment of the bodies using primary and secondary data. the primary data were generated by analyzing the practices performed directly or indirectly on the body as evidenced in the human skeletal remains (e.g., burning, cut marks, grave items). secondary data were collected from basic contextual information (e.g., spatial associations, orientations and positions of the remains, chronologies, field observations about sedimentary context) and publications. body manipulations were analyzed to reconstruct the ritual practices done to the deceased individuals. the intentional deposits that contain human bone were classified as either burials or nonburials, as well as whether they were in burned features or in secondary or mixed contexts (knüsel 2014; knüsel and schotsmans 2022; roksandic 2001). results human remains recovered by malapp across the five sites represent a minimum number of 19 bi_0-0_08_cerezo-román_3pp.indd 9bi_0-0_08_cerezo-román_3pp.indd 9 27-05-2025 15:37:3827-05-2025 15:37:38 https://journals.upress.ufl.edu/bioarchaeology/article/view/3077/3628 mortuary practices in hunter-gatherers of southern-central africa10 -1— 0— +1— individuals, which together with the two adults reported by clark (1956) total 21 individuals from the kasitu valley sites (table  3; supplementary data set). here, we detail new results from hor1, hor5, and maz1 and in the discussion combine them with results reported prior to initiation of malapp. table 3 also includes isolated elements from two additional sites for which there is currently insufficient context to reconstruct mortuary practices in spatial detail because there is only one from each site: the crown of an upper right maxillary molar from a child aged ≥2.5 to ≤4.5  years from kad1 and a manual distal phalanx from a child ≤5  years from kad2 (fig. 1). hor1 is to date the only reported site in the kasitu valley containing primary inhumations (table  3). the first two individuals are the adults recovered by clark in 1950, which he designated as “hora burial 1” (directly dated to ~9,200  years ago) and “hora burial 2” (directly dated to ~8,100  years ago); both were found to preserve ancient dna (lipson et al. 2022; skoglund et al. 2017a). bio archae ol o gical and contextual details of hora 1 and hora 2 from published literature are provided in the supplement. malapp excavations between 2016 and 2019 resulted in the recovery of three additional inhumations. one was represented by a concentration of burned adult human bone, here designated “hora 3,” that may represent a primary deposit within an ash feature. the feature, but not the remains within them, dates to ~9,500 years ago, as reported by lipson et al. (2022), and will be described in detail together in a separate publication. the other two inhumations were primary burials of infants (“kahora 1” and “kahora 2”), table 3. minimum number of individuals identified from five sites in the kasitu valley. site individual age at death sex sex determination adna individual context chronological age reference hor1 hora 1 30– 50 yrs m morph, adna i2966 burial (primary) 9, 124– 8, 972 cal bp (direct enamel) clark 1956; lipson et al. 2022; skoglund et al. 2017 hor1 hora 2 20– 30 yrs f morth, adna i2967 burial (primary with missing major elements) 7, 960– 8, 170 cal bp (direct collagen) clark 1956; skoglund et al. 2017 hor1 hora 3 18– 50 yrs f n/a n/a burial (primary in a burned feature) ~9500 cal bp (indirect, charcoal) lipson et al. 2022 hor1 hora 4 ≥14 yrs indet n/a n/a isolated element pleistocene this paper hor1 hora 5 ≥14 yrs indet n/a n/a isolated element pleistocene this paper hor1 horal 6 ≥14 yrs indet n/a n/a isolated element (potential disturbed burial) pleistocene (intrusive into) this paper hor1 hora 7 ≥14 yrs indet n/a n/a isolated element holocene this paper hor1 kahora 1 0– 3 mths m adna i19528 burial (primary with missing major elements) ~14,000 cal bp (indirect, charcoal) lipson et al. 2022 hor1 kahora 2 7.5±3 mths m adna i19529 burial (primary with missing major elements) ~16,000 cal bp (indirect, charcoal and snail shell) lipson et al. 2022 hor1 kahora 3 2– 7.5 yrs indet n/a n/a isolated element pleistocene this paper hor1 kahora 4 0– 6 mths indet n/a n/a isolated element pleistocene this paper hor1 kahora 5 2– 7.5 yrs indet n/a n/a isolated element pleistocene this paper hor1 kahora 6 infant/child indet n/a n/a isolated element holocene this paper hor1 kahora 7 0– 6 mths indet n/a n/a isolated element holocene this paper hor5 hor5 individual 1 ≥4.5 and ≤7.5±3 mths indet n/a n/a isolated element holocene this paper hor5 hor5 individual 2 0– 6 mths indet n/a n/a isolated element holocene this paper hor5 hor5 individual 3 ≥12 yrs indet n/a n/a isolated element holocene this paper kad1 kad1 individual 1 ≥2.5 yrs and ≤4,5 yrs indet n/a n/a isolated element holocene this paper kad2 kad2 individual 1 ≤5 yrs indet n/a n/a isolated element holocene this paper maz1 maz1 individual 1 >14 yrs indet n/a n/a isolated element holocene this paper maz1 maz1 individual 2 0– 6 mths indet n/a n/a element cluster (potential disturbed or secondary burial) pleistocene (intrusive into?) this paper bi_0-0_08_cerezo-román_3pp.indd 10bi_0-0_08_cerezo-román_3pp.indd 10 27-05-2025 15:37:3827-05-2025 15:37:38 https://journals.upress.ufl.edu/bioarchaeology/article/view/3077/3630 https://journals.upress.ufl.edu/bioarchaeology/article/view/3077/3630 cerezoromán et al. 11 —-1 —0 —+1 previously only reported in terms of their chronology and adna (lipson et al. 2022). here, we describe the bio archae ol o gi cal details of kahora 1 and kahora 2 for the first time (table 3, fig. 3, supplementary data set). kahora 1 infant burial this individual was recovered near the start of the 2019 malapp excavation season and was first reported by lipson et al. (2022). the only remains from this individual exported from malawi were the right petrous for adna and 14c analysis (no collagen was recovered). we estimated the ageatdeath for this individual to be birth ± three months (omnibus skeletal estimate) based on the degree of epiphyseal fusion and dental development (a crown had formed on the mandibular left second deciduous incisor but the root had not developed) (alqahtani et al. 2010; buikstra and ubelaker 1994). pathologies or trauma were not possible to document. genetic sex was determined as male (lipson et al. 2022). the individual is nearly complete except for the missing lower right tibia and fibula, as well as most of the manual and pedal elements. the spatial distribution of elements indicates a tightly flexed position with the head to the south and potentially slightly raised above the body based on the distribution of crushed cranial fragments on top of the left shoulder and thorax region (fig. 4). most elements were in anatomical position, but the right arm had experienced greater postmortem movement at the joints and was located to the west of the thorax in association with a series of right ribs in anatomical position. our interpretation is that the individual was initially placed on the left side and decomposed in situ. then, through the process of decomposition, the right side of the body collapsed to bring the right arm elements and right ribcage over to the left side of the body as the soft tissue and ligaments decomposed and the skeletal elements were displaced (knüsel and schotsmans 2022). this is further supported by the fact that the figure 3. plan view of the hor1 site showing locations of the hora 1 and hora 2 skeletons recovered by clark, reconstructed location of his excavation grid relative to the malapp grid, positions of the kahora 1 and kahora 2 infant burials, and positions of all other human remains (white dots). deeper excavations are darker in shading. the cluster in the deepest part is the concentration of burned bone designated as hora 3. figure 4. plan view of the kahora 1 and 2 primary inhumations (a), noting that kahora 2 is nearly 70 cm lower in the sediments than kahora 1. (b) a closeup of the distribution of body regions for kahora 1 and (c) the same for kahora 2. gray outlines in (c) are rocks found in the region ~10 cm below the remains. bi_0-0_08_cerezo-román_3pp.indd 11bi_0-0_08_cerezo-román_3pp.indd 11 27-05-2025 15:37:4127-05-2025 15:37:41 https://journals.upress.ufl.edu/bioarchaeology/article/view/3077/3630 mortuary practices in hunter-gatherers of southern-central africa12 -1— 0— +1— right humerus was slightly elevated above the other remains and was therefore the first major element to be discovered after the hemimandibles. the individual was discovered in situ and located adjacent to the eroding edge of the previous year’s excavation in 2018. we considered if it might be possible that the right tibia, fibula, and most pedal elements could have been lost to disturbance or erosion between excavation seasons or during section cleanings. however, all section cleanings and disturbed/ collapsed profile materials were also sieved and completely sorted for both the 3mm and 1mm sieve and did not result in the recovery of these elements. this attention to detailed excavation, sieving, and sorting resulted in the recovery of some ray elements, which were difficult to identify more specifically because those in the sieve were out of anatomical context, and the morphology was less clearly defined because of the very young ageat death of the individual. those we did find were well preserved and unfragmented, raising the possibility of other explanations for missing elements beyond taphonomy. we did not identify any objects that appeared to be intentionally placed within the burial or as a part of the feature. no burial pit outline or coloration was apparent, although the individual must represent a primary burial to be so complete and well articulated. while there was insufficient collagen to provide a direct 14c date, antiquity was estimated to be ~14,000 years cal. b.p. based on associated radiocarbon dating of charcoal and giant land snail shell from within the burial fill (lipson et al. 2022: table s4). although the burial may therefore be younger than ~14,000  years old, it cannot be younger than ~9,500  years old, as it lay entirely below an intact cemented ash feature (lipson et  al. 2022:supplementary data). kahora 2 infant burial this individual was fairly complete in terms of skeletal representation but fragmentary. ageatdeath was estimated to be 7.5 ± 3 months (omnibus skeletal age estimate) based on bone growth, development, and dental eruption patterns. the maxillary right and left first incisors and maxillary second right incisors have developed crowns, but the roots have not started to develop. the maxillary canines and molars also are present, but it was challenging to evaluate their exact degree of development because of poor preservation (alqahtani et  al. 2010; buikstra and ubelaker 1994). while teeth were observed in the mandible, the degree of development cannot be identified with precision because of obscuring bone. genetic sex was determined to be male (lipson et al. 2022). no trauma or pathological changes were observed based on the initial field review. the spatial distribution of elements indicates a primary inhumation on the right side with the head to the south, in a flexed and potentially slightly upright position, which then experienced postmortem disturbance (fig.  4). paired elements (radius and ulna and tibia and fibula) were tightly associated, and it is possible that the knees were touching the elbows and the individual was in a curled position. the forearms were directly under the collapsed vault of the cranium, with the cervical vertebrae and broken clavicle fragments extending to the west. however, most of the ribs and vertebrae were missing, with only some fragments of the left scapula and mostly left ribs recovered. the left lower limb was bent at an angle, and the right femur was not in anatomical position with the right tibia and fibula, while both innominates and the right scapula were missing entirely. although the elements were fragmentary, the spatial distribution suggests postmortem disturbances resulting in loss of elements from the back and pelvic region of the skeleton. three possibilities could be explored that can contribute to the lack of thoracic and pelvic elements from an infant of this ageatdeath in all the surrounding sediments: (1) poor preservation due to enhanced microbial decomposition within the abdomen and/or soil ph; (2) absence through natural disturbances such as moving water, stratigraphic sloping, insect activity, or carnivore activity; or (3) intentional or unintentional disturbance and removal by humans. the first option is unlikely because bones of similar size and density (ribs from the left side, vertebral arches, and centra from other parts of the vertebral column) from this individual were preserved and recovered in situ. therefore, preservation was unlikely to be affected by soil ph, microbial decomposition, or exposure to water, including through wetsieving, especially for larger elements like the ilia. thoracic elements that are present were recovered 10 to 30 cm away from the parts of the skeleton that were in general articulation, and no other remains from the wide excavated area around and below these could be attributed to this individual. the alternative hypotheses are that the removal of elements more likely occurred instead through carnivore scavenging or other natural factors that mechanically displaced parts of the skeleton or postmortem manipulation by humans. this burial deposit was dated by association to a minimum of ~16,000  years cal. b.p. using giant land snail shell bi_0-0_08_cerezo-román_3pp.indd 12bi_0-0_08_cerezo-román_3pp.indd 12 27-05-2025 15:37:4127-05-2025 15:37:41 cerezoromán et al. 13 —-1 —0 —+1 fragments from the feature fill (lipson et  al. 2022: table s4). as with kahora 1, the minimum stratigraphic age is ~9,500 years cal. b.p. hor1 isolated remains we identified 55 additional fragments of human bone and 12 fragments of potential human bone from hor1 in addition to elements assigned to inhumations (table 4). most of these were isolated elements, with only minimal clustering apparent (fig.  5). among the isolated fragments, the most common represented elements were the cranial vault, fingers, and unspecific long bone fragments. conservatively, the mni is nine individuals with developmental ages of ≥14 years (4), 2– 7.5 years (2), 0 to 6 months (2), and ≤14 years (1) (table 1, table 4). these were calculated on the basis of repeating elements, ontogeny, their occurrence in either area i or area ii of the excavation (fig. 3, fig. 5), spatial distance from articulated individuals of the same developmental age, and/or broad chronological associations (e.g., holocene vs. pleistocene). intriguingly, one of the isolated unidentified fragments bears a cut mark (fig. 7a), although the fragment is not morphologically diagnostic beyond being part of a long bone. while most faunal specimens in the assemblage are from ungulates, which have distinctive cortical and trabecular bone qualities, body size and morphology make it likely, but not certain, that this cutmarked fragment was human. hor5 bio archae ol o gi cal summary we identified 12 isolated human elements from the site of hora 5 (hor5). this site was first excavated by sandelowsky in 1967 and did not report any human remains from an estimated sediment volume of ~1.4 m3 (sandelowsky 1972:239). sandelowsky (1972) described all bones from the site as “only minute pieces and splinters,” none of which could be identified. in 2018, malapp excavated ~1.0 m3 of sediment and recovered numerous faunal remains that are currently under analysis. the human remains consist of two fragments of a deciduous incisor, an indeterminate molar crown, a rib fragment, and eight phalanges (table 5). together, these newly reported remains indicate the presence of at least one adult and two nonadults. individual 1 is represented by a wellpreserved incisor (root ¼ developed) and is estimated to have been an individual older than ≥4.5 and ≤7.5 ± 3 months at death (alqahtani et  al. 2010). the molar crown, located just over a meter to the north and closer to the surface, is also tentatively assigned to individual 1 because it has the same ontogenetic age and stratigraphic provenience in the upper layer dated to the late holocene based on charcoal fragments (2,946– 2,777 cal. b.p., 2,800 ± 20, ugams37844; 2,840– 2,720 cal. b.p., 2,660±20, ugams37846; fig. 6b). the incisor was located ~70 cm away horizontally and ~20 cm above a cluster of infant manual and pedal phalanges representing individual 2, which, together with the rib fragment, have an ontogenetic age of zero to six months at death and are in a layer with an associated charcoal age of 4,950 ± 20 (5,718– 5,588 cal. b.p., ugams37845), in the middle holocene. the overlap in the ranges of ageatdeath and the possibility of bioturbation between layers makes it possible that all the infant remains belong to a single individual, but the spatial and chronological differences suggest that at least two are present. the adult remains (individual 3) consist of two intermediate manual phalanges and a proximal manual phalanx recovered from the upper layer (fig. 6). a site plan and profile showing locations of the human remains in situ at hor5 is shown in figure 6. all elements except one part of the incisor were recovered from the sieve, so all spatial locations can only be ascertained to within a 0.5m × 0.5m × 0.05m volume of sediment. a notable aspect of the hor5 assemblage is the presence of anthropogenic modifications to all the nondental remains. both the infant and the adult remains were carbonized, and all three adult phalanges also exhibit marks consistent with stone tool modification (fig. 7). j.c.t. examined all modifications under a 10– 40× binocular zoom microscope and applied criteria from published literature and experience with experimental taphonomic assemblages to assess if marks might be recent (postexcavation) modifications, natural bone features such as vascular grooves, if they may have occurred postdepositionally within the sediments, or if they were more likely by agent(s) that modify bone in the perimortem period (fernándezjalvo and andrews 2016; supplementary materials). although all three elements have marks with some attributes suggestive of cut mark morphology (e.g., vshaped, subparallel grooves with microstriations), their spatial associations with fracture propagation, together with discrete patches of microstriations, make them more consistent with percussion marks from a directed impact to the bone (blumenschine et al. 1996). maz1 bio archae ol o gi cal summary mazinga 1 (maz1) was first excavated in 2017 by malapp. thirtythree isolated human elements and four potential human elements were recovered from 4 m3 of sediment excavated between 2017 and 2019 bi_0-0_08_cerezo-román_3pp.indd 13bi_0-0_08_cerezo-román_3pp.indd 13 27-05-2025 15:37:4127-05-2025 15:37:41 https://journals.upress.ufl.edu/bioarchaeology/article/view/3077/3628 https://journals.upress.ufl.edu/bioarchaeology/article/view/3077/3628 mortuary practices in hunter-gatherers of southern-central africa14 -1— 0— +1— ta b le 4 . su m m ar y of is ol at ed e le m en ts fr om h o r 1 ( th e sit e) , o rg an iz ed b y in di vi du al (h or a 4, k ah or a 3, e tc .). in d iv id u a l r eg io n — b on e h or a 4 h or a 5 h or a 6 h or a 7 k ah or a 3 k ah or a 4 k ah or a 5 k ah or a 6 k ah or a 7 u na ss ig ne d to ta l h ea d c ra ni al 0 1 0 0 0 0 0 0 0 0 1 c ra ni al — f ro nt al 0 0 0 0 5 0 0 0 0 0 5 c ra ni al — t em po ra l — m as to id 0 1 0 0 0 0 0 0 0 0 1 c ra ni al — p ar ie ta l 0 0 0 0 1 0 0 0 1 0 2 h em im an di bl e 0 0 0 0 1 0 0 0 1 0 2 to ot h — in ci so r — m ax ill ar y 0 0 0 0 0 0 1 0 0 0 1 to ot h — c an in e — m ax ill ar y 0 1 0 0 1 0 0 0 0 0 2 to ot h — in ci so r — m an di bu la r 0 0 0 0 0 0 0 0 1 0 1 to ot h — m ol ar — m an di bu la r — d ec id uo us 0 0 0 0 1 0 0 0 0 0 1 to ot h — m ol ar 0 1 0 0 0 0 0 0 0 0 1 n ec k ve rt eb ra — c er vi ca l 0 0 0 0 0 0 0 0 1 0 1 c h es t/ u pp er b a c k r ib 0 1 0 0 1 0 0 0 0 0 2 ve rt eb ra — th or ac ic 0 0 0 0 0 0 0 0 2 0 2 a r m h um er us 0 1 0 0 1 0 0 0 0 0 2 ra di us 0 0 0 0 0 0 0 0 2 0 2 h a n d m et ac ar pa l 0 0 0 0 1 0 0 0 0 0 1 ph al an x — m an ua l — p ro xi m al 0 0 0 0 1 0 0 0 0 4 5 ph al an x — m an ua l — in te rm ed ia te 0 0 0 0 2 0 0 0 1 1 4 ph al an x — m an ua l d is ta l 0 1 0 0 0 0 0 0 0 0 1 le g s fe m ur 0 0 0 0 0 0 0 0 1 0 1 ti bi a 1 0 0 0 0 0 0 0 0 0 1 fo o t m et at ar sa l 0 0 1 0 0 1 0 0 1 0 3 ph al an x — p ed al — p ro xi m al 0 0 0 0 0 0 0 0 1 0 1 ph al an x — p ed al — d is ta l 0 1 0 0 0 0 0 0 0 1 2 r eg io n n o n sp ec if ic ve rt eb ra 0 0 0 0 0 0 0 0 1 0 1 lo ng b on e fr ag m en t 2 1 0 0 0 0 0 0 0 2 5 ph al an x 0 0 0 0 0 0 0 0 0 1 1 ph al an x — in de te rm in at e — in te rm ed ia te 0 0 0 0 0 0 0 0 0 1 1 ph al an x — in de te rm in at e — d is ta l 0 0 0 0 0 0 0 0 1 0 1 to ta l 3 8 1 1 14 2 1 1 12 12 55 bi_0-0_08_cerezo-román_3pp.indd 14bi_0-0_08_cerezo-román_3pp.indd 14 27-05-2025 15:37:4127-05-2025 15:37:41 cerezoromán et al. 15 —-1 —0 —+1 figure 5. plan (top) and profile (bottom) views of the locations of adult (a = area i; b = area ii) and nonadult (c = area i; d = area ii) remains at hor1. profiles are viewed to the west; scales same as plan view. p = pleistocene; h = holocene. dark/larger and light/small dots are fragments definitely/probably from that individual (e.g., large, dark aqua dots in panel a are adult remains assigned to individual hora 5 and small, light aqua dots in panel a are probable in assignment to that same individual). light gray stippled background indicates all finds plotted in the excavation as nonhuman remains (e.g., lithics, shells, faunal remains, bone not identifiable to taxon). the tops of the profiles of areas i and ii are of similar absolute elevation. refer to figure 3 for their true relative horizontal relationship. table 5. summary of isolated elements from hor5 organized by individual. only fragments with a definite (rather than probable) assignment as human are included. individual region— bone hor5 indiv. 1 hor5 indiv. 2 hor5 indiv. 3 total head tooth — incisor — maxillary — deciduous 2 0 0 2 tooth — molar 1 0 0 1 chest/upper back rib 0 1 0 1 hand phalanx — manual — proximal 0 2 1 3 phalanx — manual — intermediate 0 0 2 2 phalanx — manual — distal 0 1 0 1 foot phalanx — pedal — distal 0 2 0 2 total 3 6 3 12 (table 6); sorting of materials excavated in 2022 and 2023 is still underway. a site plan and profile showing locations of the human remains we report here in situ is shown in figure 8. remains from at least one individual older than 14  years (individual 1) and one infant between zero and six months (individual 2) are present (table  5). individual 1 is represented by a charred and fragmented distal humerus with a curved and oblique angled break on the shaft that is typical of bones broken while they were in a fresh state (villa and mahieu 1991). only 20% of the bone surface was free from adhering matrix and therefore available for examination of modifications, but none were identified. bi_0-0_08_cerezo-román_3pp.indd 15bi_0-0_08_cerezo-román_3pp.indd 15 27-05-2025 15:37:4227-05-2025 15:37:42 mortuary practices in hunter-gatherers of southern-central africa16 -1— 0— +1— attempts to obtain a direct 14c age were unsuccessful given insufficient collagen. a land snail shell found in situ within 10 cm of the humerus and at the same depth returned an age of 9,010 ± 30 (10,234– 9,916 cal. b.p.; ugams39314). if the humerus represents a disturbed burial, then additional dates are required to more precisely ascertain the chronological age of deposition. all other adult remains from the holocene layers of this excavation are designated provisionally as “individual 1— possible” because of their adult status, but there is no clear spatial clustering or clear pattern by anatomical region (fig. 8). in the pleistocene layers, there is a cluster of vertebral fragments together with a single manual intermediate phalanx from an infant aged zero to six months at death. unlike the faunal remains from this depth, the human remains are not fossilized and their surfaces are not heavily encrusted. this taphonomic difference in the condition of bone surfaces between human and faunal remains suggests that the human remains are part of an intrusive holocene burial. another manual intermediate phalanx found approximately 1 m away and at a similar depth may be from the same individual. at maz1, holocene human elements tend to be more common toward the eastern margin of the excavation, which also is where the humerus was found. this may be further evidence of a disturbed burial outside the excavation margin. an alternative explanation is that these elements were part of a secondary burial, which may also explain the fragmentation and burning treatments. discussion by combining burial information from older publications with more recent excavations using finedetailed recovery methods, we show that mortuary practices among lsa communities in malawi and eastern zambia may be more complex than previously reported and that secondary burial and postmortem manipulation should not be ignored as a possible explanation for fragmentary and isolated remains. this seems figure 6. plan (a) and (b) profile views of malapp excavations and recovered remains by individual, relative to a digitized plan of the hor5 site from sandelowsky (1972:224). individuals are different colors. dark colors represent elements used to generate the mni and/or other elements known from articulation and/or refitting to be from the same individual. light colors represent elements potentially from the same individual on the basis of ontogenetic age and stratigraphic location only (e.g., red dots identify the presence of the hor5 individual 1 and pink dots are only potentially from the hor5 individual 1). the profile view in (b) uses small black dots to represent plotted finds that are not human remains. these define the shape of the excavation and the overall density of finds. bi_0-0_08_cerezo-román_3pp.indd 16bi_0-0_08_cerezo-román_3pp.indd 16 27-05-2025 15:37:4327-05-2025 15:37:43 cerezoromán et al. 17 —-1 —0 —+1 figure 7. stone tool– marked elements from hor1 and hor5. (a) 60086 long bone fragment from hor1 pleistocene layers. (b) 54639 intermediate manual phalanx from hor5. (c) 53693 proximal manual phalanx from hor5. (d) 54638 intermediate manual phalanx from hor5. macro images are taken at 20 and closeup images are at 50 unless otherwise specified. table 6. summary of isolated elements from maz1 organized by individual. only fragments with a definite (rather than probable) assignment as human are included. individual region — bone maz1 indiv. 1 maz1 indiv. 2 unassigned total head cranial — occipital 1 0 0 1 tooth — molar — maxillary 1 0 0 1 tooth — premolar/molar 1 0 0 1 neck vertebra — cervical 0 2 0 2 chest/upper back rib 1 0 0 2 vertebra — thoracic 1 1 0 1 lower back vertebra — lumbar 0 8 0 8 arm humerus 1 0 0 1 ulna 1 0 0 1 hand phalanx — manual — proximal 0 0 1 1 phalanx — manual — intermediate 1 2 0 3 phalanx — manual — distal 3 0 0 3 foot metatarsal 2 0 0 2 phalanx — pedal — proximal 1 0 0 1 region nonspecific vertebra 0 3 0 3 longbone fragment 2 0 0 2 total 16 16 1 33 bi_0-0_08_cerezo-román_3pp.indd 17bi_0-0_08_cerezo-román_3pp.indd 17 27-05-2025 15:37:4527-05-2025 15:37:45 mortuary practices in hunter-gatherers of southern-central africa18 -1— 0— +1— especially plausible (but not excluding other lines of evidence) if the skeletal elements present displacement of possible anthropogenic origin (e.g., bone piles, calcaneus placed on the area of the patella) and cut marks and breaks suggest some sort of body manipulation. here, we center on the decedents, the deposits, how the individuals were treated, and the social significance of the place. based on some ethnographic records (woodburn 1982) and previously known practices of primary inhumation during the lsa in southcentral africa, burials were a regular part of the bio archae ol o gi cal record of the broader region. even more broadly, archaeologists working at many sites in south africa have found primary inhumations in rock shelters (hall 2000; parkington et  al. 1980; pearce 2008). here, we add to the discourse by presenting new bio archae ol o gi cal evidence from the kasitu valley documenting the occurrence of (1) possible intentional removal/displacement of remains via exposure prior to burial and/or reopening of primary burials; (2) overrepresentation of certain skeletal elements among the isolated remains, suggesting possible intentional figure 8. plan (a) and (b) profile views of malapp excavations and recovered remains by individual. dark colors represent elements used to generate the mni and/or other elements known from articulation and/or refitting to be from the same individual. light colors represent elements potentially from the same individual on the basis of ontogenetic age and stratigraphic location only (e.g., red dots identify the presence of the maz1 individual 1 and pink dots are only potentially from the hor5 individual 1). the profile view in (b) uses small black dots to represent plotted finds that are not human remains. these define the shape of the excavation and the overall density of finds. bi_0-0_08_cerezo-román_3pp.indd 18bi_0-0_08_cerezo-román_3pp.indd 18 27-05-2025 15:37:4627-05-2025 15:37:46 cerezoromán et al. 19 —-1 —0 —+1 curation and inclusion in the sites; and (3) clear modification of some remains in the form of cut marks. removal/displacement of remains at hor1, the primary adult burials (hora 1 and hora 2) and the infant burials (kahora 1 and kahora 2) were placed in the grave as complete bodies and decomposed in situ based on the osteological and archaeological evidence. however, at least three of the four primary inhumations also show evidence of body manipulation. for example, the missing lower right tibia and fibula of kahora 1 do not appear to be the result of taphonomy or postdepositional processes because a thorough excavation of the surrounding area combined with highly precise recovery methods failed to recover any evidence of these remains while other elements were relatively well preserved, even for infant remains. in the kahora 2 infant burial, partially articulated limbs were not in anatomical position, there was displacement of shoulder and vertebral elements many tens of centimeters away from their original points of articulation with the other remains, and most of the lumbar and pelvic elements were missing. as with kahora 1, the surrounding excavation encompassed an area large enough and deep enough (at least 50 cm horizontally in all directions and 15 cm vertically below the remains) to indicate that the missing elements were not simply displaced slightly away from the main mortuary feature. in the case of the hora 2 adult female burial, clark (1956:107) makes a strong case for postmortem manipulation by documenting the numerous missing hand bones, the absence of the left fibula (which should have been protected as the individual was lying flexed on their left side), and the nearcomplete absence of the feet with the exception of the calcaneus and three other ankle bones of the right foot. furthermore, the right calcaneus was moved to the left patella position, as documented in the in situ photograph published by clark and reproduced in figure  2. while clark (1956:107) interpreted this as evidence that the body had been subjected to “some exposure before burial took place,” the corollary is that the individual’s bones were manipulated after the body decomposed by reopening the grave. the adult male hora 1 was also missing hand bones, although there is no known surviving photograph of the individual in situ to assess if element loss was potentially attributable to nonmortuary practices such as fragmentation in the ground, coarse recovery methods, transport, or curation. while small hand bones and foot bones are more easily displaced by rodents and/or affected by formation processes (haglund and sorg 2002; pokines et al. 2022), this would not be the case with entire elements and major long bones such as hora 2’s missing feet and fibula. if a carnivore had accessed this element and removed it while the body was in situ, there would not be undisturbed long bones in articulation on top. considering formation processes, taphonomy, and placement of all primary burials at hor1, a plausible explanation is that body manipulation regularly occurred at the site through repositioning and removal of skeletal elements. at minimum, we must consider whether the missing elements (particularly of the long bones) from the hora 2 and kahora 1 primary inhumations result from intentional anthropogenic disturbance and removal. although the sample size is small, there is consistency in the missing elements in that they are from the lower limb bones, hands, and feet. this suggests a common set of processes were in operation, with four possible hypotheses. first, elements may have never been recovered, or they may not have been recognized by the analysts. we reject these hypotheses for hora 2 because unlike with hora 1, details of missing elements were reported by the excavator and documented with a photograph of the remains in situ (clark 1956; fig. 2). we also reject the possibility of lack of recovery for kahora 1, because all sediments from malapp excavations at hor1 were water sieved through nested 3 mm and 1mm sieves and sorted, without exception. similar preservation of infant remains, including bones of similar size, thickness, and density, found in situ and in the sieve suggests no destruction occurred through wetsieving or that elements were not preserved due to the ph of the soil. tiny wellpreserved elements such as distal phalanges were identified during sorting, which makes it unlikely that large elements such as a tibia and fibula would be missed. taphonomic factors such as scavenging, sediment compaction, and/or selective dissolution are not satisfactory explanations for some of the missing elements. hora 2’s missing left fibula would have been lying underneath the other lower limb elements based on body position, and moving water or rodent burrows would not selectively move only a few bones while keeping the remainder in articulation or relocating only the calcaneus to the patellar position. for kahora 1, the missing elements are on the right side and would have been lying on top, so a scavenger may have been more able to access them from above the burial pit. however, if this happened, then it did not disturb the anatomical position of the other elements, including the femur. instead, both individuals appear to have decomposed in situ and then been slightly disturbed or partially disarticulated, with elements removed and others repositioned at some point after burial. for other sites, nonanthropogenic explanations are more plausible. for example, the infant remains from bi_0-0_08_cerezo-román_3pp.indd 19bi_0-0_08_cerezo-román_3pp.indd 19 27-05-2025 15:37:4627-05-2025 15:37:46 mortuary practices in hunter-gatherers of southern-central africa20 -1— 0— +1— maz1 are more suggestive of either a previous inhumation that was removed or heavily disturbed while in a partially decomposed state or a secondary deposition of elements. vertebral elements from the cervical, thoracic, and lumbar regions are all present, but these fragments only represent a small part of the total vertebrae in a complete individual. other elements from the skeleton are either missing or spatially displaced by more than 1 m in any horizontal direction. this is because only one other element (a phalanx) was found in the rest of the excavated area. unlike the adult remains from the holocene layers, the infant remains are clustered and represent the tiniest ossified elements from an individual this young. because vertebrae are among the elements least resistant to densitymediated attrition (lam et  al. 2003), we do not consider sediment compaction or dissolution of the more robust limb bones to be a likely explanation for this pattern. access to a partially or completely decomposed body, which was then removed from the site by either carnivores or people, could account for the disappearance of these elements. deviations from expected representation of certain elements another line of evidence that may suggest some skeletal elements were deliberately removed is the overrepresentation of teeth and phalanges relative to other skeletal parts among isolated elements from all of the sites (tables  4, 5, 6, and supplementary data). while this could be explained by their highly identifiable morphology leading to collection bias, this is unlikely based on site recovery methods that employed consistent wetsieving and considered less diagnostic elements such as fragmented long bone shafts. although we also searched for these during sorting, we found only a very small number that could be tentatively identified as human. moreover, our excavations at hor1, hor5, and maz1 were extended laterally enough to be confident that most remains not assigned to a primary inhumation truly were isolated and not part of a disturbed feature with elements displaced to fall outside the excavation area. we must then consider how the isolated remains entered the archaeological records at this site (i.e., through intentional collection and mortuary deposition or through more quotidian means). across all remains recently excavated from all five sites (i.e., not including the hora 1 and hora 2 adult burials, because we cannot quantitatively assess element representation for them based on published reports or discount the possibility of element loss after recovery), we found a total of 20 teeth and 58 phalanges. three of the phalanges present anthropogenic modifications (see below). while deciduous teeth are naturally shed and teeth in general are commonly lost through disease and trauma, this is less so the case with fingers and toes. forensic literature and experimental studies also show that fingers and toes are lost late in the sequence of decomposition and/or carnivore scavenging (darwent and lyman 2002; pickering 2001; pokines and kerbis peterhans 2007; pokines et al. 2022). the fact that so many more phalanges were found relative to teeth, which tend to be the most identifiable and wellpreserved human remains in the archaeological record, raises the possibility that phalanges, particularly the ones with anthropogenic modifications, were intentionally brought to and interred at the site as part of mortuary practices. anthropogenic modifications to elements detailed microscopic study of the bone surfaces of the primary inhumations at hor1 is still underway; these represent 885 of the 1,006 elements listed in the supplementary data set. the balance of the sample (n = 121) is from the isolated remains, which we have examined for bone surface modifications. of these, only 67 (55%) have at least half the surface unencrusted by sandy matrix and visible for observation. three of these are phalanges from hor5 that retain stone tool marks from defleshing, disarticulation, percussion, or a combination of these based on the direction of the marks and their characteristics (fig. 7). these are not fleshbearing bones that would be useful for nutritive cannibalism, which indicates to us that the purpose was likely related to mortuary practice or other symbolic behaviors. we suggest that these actions, combined with the other lines of evidence presented here, are most consistent with behaviors associated with curating and subsequently transporting the remains for the purpose of secondary mortuary deposits. contextualizing mortuary practices in the regional lsa record consistent with our reporting here, archaeological human remains from southerncentral africa have been historically reported as complete but disturbed primary burials or unassociated (isolated) fragments (clark 1973; fagan and van noten, 1971; phillipson 1976; sandelowsky and robinson 1968). at fingira, the northernmost site in our literature review, sandelowsky (1972; sandelowsky and robinson 1968) found only one individual with any evidence of articulation, while remains of at least 15 others were scattered near the shelter wall and represented by a few elements. bi_0-0_08_cerezo-román_3pp.indd 20bi_0-0_08_cerezo-román_3pp.indd 20 27-05-2025 15:37:4627-05-2025 15:37:46 https://journals.upress.ufl.edu/bioarchaeology/article/view/3077/3630 https://journals.upress.ufl.edu/bioarchaeology/article/view/3077/3630 cerezoromán et al. 21 —-1 —0 —+1 sandelowsky (1972:121) describes the state of the partially articulated skeleton as follows: “many of the bones had been broken, in some cases shattered. stones lay above the fractures of the right shoulder, arm, and leg, and two breaks in the bones of the left leg. all these fractures must have occurred while the flesh still held the bones together, and the body must have been covered by earth before the decaying bones could scatter.” the image published in the dissertation does not show any hand or foot elements (sandelowsky 1972:121, plate 8), and a memoir later published by sandelowsky (2004:16) states that “there was no trace of hand or foot bones.” the missing elements cannot be explained through rough recovery methods because the memoir further describes “a great deal of blowing and very light brushing” during excavation of the remains (sandelowsky 2004:14). targeted dissolution or fragmentation of only hands and feet is further unlikely because the bones “were so hard that we thought they could well be semifossilised” (sandelowsky 2004:16), and brothwell and molleson’s report in the dissertation (sandelowsky 1972:405) confirms that “cleaning off hard calcareous matrix” was necessary prior to analysis. postdepositional disturbance therefore appears to be the most likely explanation. original excavations at fingira measured ~10 m2 and reached a maximum depth of 1.5 m, which is not a large space to contain the remains of at least 16 individuals. therefore, the fragmented and isolated state of other remains may be attributable to anthropogenic disturbance from later burials. this appears less likely for the fingira 1 individual, who was missing both hand and foot elements while retaining most other bones in articulation (sandelowsky 1972, 2004). rock collapse and sediment movement could explain displacement, but not complete removal, of only these body parts. the two remaining possibilities are partial access to the cadaver by scavenging animals or intentional mortuary behavior. brothwell and molleson (in sandelowsky 1972:429) offer evidence for the scavenging possibility by describing the left tibia as “gnawed by animals” and only describing the presence of a few distal limb elements (left radius, proximal right ulna, distal left ulna, and complete right tibia). however, the report does not provide a complete element inventory for this individual, and further inconsistencies make it difficult to evaluate if this is the only explanation. for example, the image in sandelowsky (1972:121, plate 8) shows the right tibia and fibula in articulation, but no fibulae are mentioned in the report. the report attributes a measurement on a left calcaneus to this individual, although the original excavator states that feet were not present. transfer of the remains to london occurred in three batches, providing ample opportunity for element loss or mixup. approximately 300 km to the south in central malawi and eastern zambia, there is more evidence for intentional commingling of individuals in the same primary or secondary inhumation (mtuzi, thandwe) and instances of interments consisting primarily of cranial elements (mtuzi, kalemba). only isolated elements were recovered at makwe: one incisor, three molars, and one radius fragment (phillipson 1976). thandwe contained a primary burial of a female and a second individual that phillipson (1976) suggests was partially disarticulated or dismembered because the pelvis and lumbar vertebrae were not recovered (phillipson 1976:50). the remains were associated with stone “slabs,” with a second burial of a male individual on top of the slab covering the remains of the female. next to the male burial were the crushed skull bones and very fragmentary postcranial remains from a child (phillipson 1976). at kalemba rock shelter, phillipson (1976:168– 169) reports a total of five individuals mainly represented by parts of the skull and cervical vertebrae. only in one case were significant postcranial remains preserved, but they were fragmentary and incomplete (table 2). phillipson (1976:168– 169) also suggests that in each case, there were signs that the skull had been broken before burial and the pieces separated. the only deposit of postcranial remains consisted of fragmented, burned bones, potentially evidence for a secondary cremation deposit. phillipson (1976:168– 169) suggests that the dismemberment and burial of heads was a ritual process; he also proposes that the contexts may be indicators of cannibalism. at mtuzi, in the central region of malawi ~175 km east of kalemba, thandwe, and makwe, mgomezulu (1978) reports that at least six sets of adult male remains were recovered in three separate burials. mgomezulu (1978) suggests that the “bodies were left in the shelter. later the remains of the bodies in various stages of preservation were found by relatives, and it is possible that this could explain why several body parts are missing . . . the pile of long limb bones was made from bare bones which, when buried, received little or no disturbance from the revisits of animals. it is easier to make such a pile from bare and partly disconnected bones than from connected bone surrounded by the flesh” (mgomezulu 1978:106– 107). similar deposits of human remains with missing elements and fragmented burials were found in the thandwe rock shelter (mgomezulu 1978; phillipson 1976). mgomezulu (1978) mentions that individuals may have died close to rock shelters under various circumstances, such as warfare between groups or attacks by wild animals. wild animals such as hyenas bi_0-0_08_cerezo-román_3pp.indd 21bi_0-0_08_cerezo-román_3pp.indd 21 27-05-2025 15:37:4627-05-2025 15:37:46 mortuary practices in hunter-gatherers of southern-central africa22 -1— 0— +1— and vultures may prey on the bodies after death, but no mention of animal puncture marks or animal damage is described in the publications. animal puncture marks and damage are common in individuals who die in open areas when their bodies are not recovered immediately (beck et al. 2015; roberts and ingham 2008; suckling et al. 2016), and future work that involves microscopic examination of the surfaces of the mtuzi bones may provide more information. archaeological research on early holocene huntergatherer sites in somalia also found similar patterns of missing hands and feet and isolated clusters of teeth (brant 1988), suggesting a potential archaeological case of intentional removal of these elements in a different african forager context. death and meaning in the lsa of malawi and zambia we can see that mortuary practices in the lsa of southerncentral africa had some commonalities, such as placing the dead in rock shelters. individuals undertaking residential or other activities in those spaces may have encountered remains and removed bones and repositioned them, potentially even thousands of years after initial inhumation. archaeological studies have suggested that the interments of a sedentary group tend to symbolize corporate membership and rights to land and inheritance (mcanany 1995). parker pearson (2008:141) suggests that “fixing the dead in the land is a social and political act which ensures access and rights over natural resources.” these ideas highlight a crosscultural pattern previously proposed by arthur saxe (1970) and reformulated by lynne goldstein (1976), in which formal disposal areas such as cemeteries are used by corporate groups to claim ancestral ties to the ancestors and control access to crucial but restricted resources and territories. while this crosscultural pattern usually applies to agricultural groups, charles and buikstra (1983) applied these ideas of territoriality to huntergatherer groups in an interesting way. they proposed and tested that formal corpsedisposal areas can reflect a corporate unit reflecting corporate behavior, and this corporate behavior can be tied to territorial behavior. we suggest that these ideas can be used for lsa groups in africa, which are generally inferred to have been residentially mobile hunters and gatherers (kusimba 2005; lipson et  al. 2022; pfeiffer and harrington 2018). it is highly plausible that forager groups considered the shelters to be important landmarks and part of the territory they used. the small amount of archaeological research in the region overall makes it difficult to tie these patterns to other aspects of forager lifeways, although new zooarchaeological data from hor1 suggest small hunting ranges (bertacchi et al. 2025). ancient dna from individuals at fingira and hor1 provide some effective population size estimates between ~300 and 1,000 individuals (lipson et  al. 2022: extended data figure  9). together with data from other ancient foragers in malawi, zambia, tanzania, and kenya, these ancient genetic data sets show that in the terminal pleistocene to holocene, groups of foragers across southerncentral africa exchanged genes mainly within geographic scales of 100 to 300 km, consistent with the ethnolinguistic territory sizes of modern nonequestrian warm climate huntergatherers (marlowe 2005). the implication is that at the time hor1 was occupied, genetically and potentially also culturally differentiated groups of huntergatherers lived in the region. because treatment of the dead is deeply culturally embedded, variation in mortuary practice may offer unique insight into a period of time when ethnolinguistic identities among central african foragers were becoming more strongly expressed. while there might be other areas in the landscape to deposit the dead, we center the discussion on the rock shelters as these types of places are where human remains have been more often found and excavated. they occur because of rocky outcrops on inselbergs, which are largely unvegetated stone escarpments that rise abruptly from the surrounding landscape and can be seen in distinctive profile from many tens of kilometers away (fig. 9). in addition to their practical uses (e.g., shelter, vantage points), multiple lines of evidence point to their social significance. their deposits often contain hundreds of personal ornaments, including debris from ornament manufacture on site (miller et  al. 2021). malawi’s extensive rock art record always occurs in shelters (malijani 2019; smith 1995). foodproducing societies that now live in malawi also associate earlier populations of foragers with mountains and caves in their oral histories (rangely 1952, 1963; zubieta 2016). through careful excavation and documentation, we are now able to add the mortuary record to an emerging understanding of these places as part of the sociosymbolic landscape, highlighting their importance through time and among diverse groups. there is considerable time depth (sometimes on the order of thousands of years), over which these places were repeatedly used for burial. direct dating of remains we recovered at fingira showed that the site was used for mortuary purposes minimally at ~6,100 and ~2,500 cal. b.p. (skoglund et al. 2017). these remains lacked the hard matrix on bones recovered by earlier excavations, suggesting some may be even bi_0-0_08_cerezo-román_3pp.indd 22bi_0-0_08_cerezo-román_3pp.indd 22 27-05-2025 15:37:4627-05-2025 15:37:46 cerezoromán et al. 23 —-1 —0 —+1 older (brothwell and molleson, in sandelowsky 1972:405). in addition to stratigraphic placement at multiple sites that suggests longterm use, remains from hor1 have been directly dated to ~8,200 and ~9,000 cal. b.p. and through close association with dated materials to ~14,000 and ~16,000 (lipson et al. 2022; skoglund et  al. 2017). our finding that many more individuals are represented by isolated remains than by primary inhumations reveals these sites as greater loci of mortuary behavior than previously recognized. people from across the entire community structure appear to have been included, as shown by the variable developmental age and biological sex distributions, and the apparent paucity of specific grave objects. at the same time, there is subregional variability that may yet be revealed through detailed excavation, fine sieving, and careful sorting of all osteological materials. figure 9. location of fingira rock (top) and hora mountain (bottom) relative to landscape features. insets show their unique local prominence as steeply rising inselbergs (~90 m and ~250 m, respectively). there are no similarly large landmarks in the local viewsheds. image credits: google earth, jacob davis, and chelsea smith. bi_0-0_08_cerezo-román_3pp.indd 23bi_0-0_08_cerezo-román_3pp.indd 23 27-05-2025 15:37:4727-05-2025 15:37:47 mortuary practices in hunter-gatherers of southern-central africa24 -1— 0— +1— we are not necessarily suggesting that observed patterns correlate to territoriality or control of these areas on the landscape. however, it is possible that in using these locations as homes, shelters, and places to bury their dead, lsa foragers created memories and established connections to the sites in various ways that could be related to family histories and ancestral places. the space was used and revisited, creating individual and collective memories through time. creating “persistent places” over time through burial practices has been suggested for mobile early food producers elsewhere in africa, notably across the sahara and eastern africa (di lernia 2013; di lernia and tafuri 2013; hildebrand et  al. 2018; sawchuk et al. 2018). among megalithic “pillar sites” associated with early herders in kenya’s turkana basin, secondary burial and the inclusion of isolated remains (especially fingers and teeth) in anthropogenic mortuary cavities is commonplace (sawchuk et al. 2018; sawchuk et al. 2019; sawchuk et al. 2022). there is no reason to assume, a priori, that such complex mortuary behaviors would not have deeper roots among lsa foragers and predate food production. interpreting this evidence, we infer that variation in lsa mortuary rituals in southcentral africa focused on the body itself. while people inhabiting these rock shelters may have regularly encountered remains and even repositioned them, this did not result in indiscriminate scattering of elements. furthermore, it is possible that additional isolated remains were brought to these places, potentially as part of secondary burial deposits. we are not claiming or even suggesting that this is the case for every isolated human element found in these sites; postdepositional disturbances and taphonomic issues were surely important factors. rather, we are opening the possibility that evidence of postmortem manipulation in the form of intentional removal of skeletal elements, the selection of particular skeletal elements for burials, and even the cutting and burning of the remains as part of funeral ceremonies must also be considered when reconstructing site histories. our findings are consistent with reports of previously excavated sites in the study region, which also show highly variable evidence of body manipulation and/or secondary treatment. it is possible that variation in body treatment could be used to display and distinguish the identity of each deceased individual, as well as the mourners. particular body treatments could show the social relations of these individuals or be associated with belonging, whereby returning with a piece of human remains the mourners claim a connection to the specific community and their ancestors (cerezoromán 2014; chapman and gaydarska 2007; geller 2012; liston 2007; mcanany 1995; rakita 2009). chapman and gaydarska (2007) suggest that through the fragmentation process and secondary treatment, a connection between the objects, the living community, and the ancestors can be created and maintained. secondary treatment in the form of exhumation, grave reuse and reopening, skeletal relics of the decedent, or skull removal had been documented in different groups through time in africa related to ancestral veneration (e.g., chilver 1965; david 1992; fagan 1969; insoll 2016; madden 1940; muller 1976; siiriäinen 1977; volavka 1998). variation among mortuary behaviors suggests a lack of a unifying way of treating the dead across the spans of space and time represented in our study. this implies freedom by the mourner to follow their family or group preferences but within a more widespread tradition of posthumous body manipulation. although time depth likely accounts for some of this variation, examination of the published record together with our new data from the kasitu valley offers hints of geographic patterning. complete primary inhumations with missing and likely removal hand and foot skeletal elements are more common in the northern part of the study, while the southern part features more secondary and/or commingled burials that include crania. this may indicate some degree of regional cultural continuity in mortuary practice, which is consistent with genetic evidence for lsa groups choosing partners within their immediate geographic region during the terminal pleistocene and holocene (lipson et al. 2022). the use of sites over thousands of years as living areas (territories/investment in “places”) and the deposition of “tokens” or parts of people from elsewhere seems relevant. there are many reasons why groups practice secondary burials of a few or one skeletal elements related to different ideas of personhood, ancestral veneration, symbolic representation of the decedent, acts of purification, and acts of desecration, among others (cerezoromán 2015; cerezo román et al. 2017; graham 2009; graham et al. 2018; liston 2007). we suggest that perhaps in the instances that we found, “token” or secondary burials could have had symbolic power as a source of remembrance of the deceased and the connections and networks that previously existed between the deceased and mourners. they may also connect with specific places on the landscape that are both prominent visual landmarks and specific points of social memory. conclusions here, we show with careful recovery and complete sorting of osteological remains from new excavations bi_0-0_08_cerezo-román_3pp.indd 24bi_0-0_08_cerezo-román_3pp.indd 24 27-05-2025 15:37:4727-05-2025 15:37:47 cerezoromán et al. 25 —-1 —0 —+1 in the mzimba district of malawi that there are ancient human remains in every excavated rock shelter, reiterating the important role of these places as repositories for the dead among ancient african foragers. we also show that there is biased skeletal part representation that is, in some cases, best explained through anthropogenic removal and deposition of remains, and for at least some of these, there is evidence of defleshing and/or fragmentation using stone tools. this supports a conclusion that intentional postmortem body manipulation was practiced in the area and sets the scene for broader interpretations of mortuary ritual and the embodiment of memory. we caution, however, that it is necessary to go back and reanalyze other human remains from sites in the region that reported intentional and extensive postmortem treatment and evaluate the presence or absence of nonanthropogenic damage alongside new analyses of anthropogenic modifications. there is good archaeological evidence of non anthropogenic factors that contribute to the finding of human remains in rock shelters, such as redeposited human bones, disturbance, and reasons not associated with secondary burials in rock shelters at several lsa sites in south africa (hall 2000; parkington et al. 1980; pearce 2008). although the south african record is relatively geographically distant from malawi, it offers the closest available data set for comparison. this approach may also be a fruitful avenue of research for ancient forager remains from northern africa, which also show substantial evidence for intentional disturbance of burials and movement of bodies or body parts into specific sheltered locations with long records of human occupation (haverkort and lubell 1999). some patterns, however, may only be possible to understand with new excavations that maintain careful spatial control and documentation. our work shows that an excavation, recovery, and analytical focus on more obvious mortuary features, such as burials, may have rendered invisible other important and meaningful cultural practices. evidence of selective removal and transport of elements requires careful consideration and analysis of the data and can reveal a tradition of embodied memory making that carries the relationship between community members and the bodies of their dead beyond the brief moment of interment. it draws out the duration of the relationship between the body of the deceased and the people tending to their remains, effectively extending the mortuary ritual over time. it also extends the ritual spatially, across the broader cultural landscape (watts et al. 2020). this interpretive approach offers a richer view of the complexity of ancient forager social and symbolic worlds than simply analyzing more complete burial features as the physical traces of singular, unassociated events and isolated remains as random collections of elements. our findings illustrate a need for more in depth discussions about mortuary complexity about ancient foragers in southcentral africa and beyond. acknowledgments we thank the malawi department of museums and monuments for their longterm collaboration and permission to do this work. we are especially grateful to inkosi ya makhosi m’mbelwa v, inkosi chindi, inkosi kampingo sibande, inkosana thomas nkosi, the mzimba heritage association, and the communities around the sites for welcoming the research for so many years. we also thank our representatives from the department of museums and monuments, the community field and field lab crew, and student participants for their careful eyes and many hours spent processing finds. particular thanks are owed to fredrick mapemba and raphael mwafulirwa for their operation of the field lab. menno welling and jacob davis were of invaluable logistical and intellectual support. inset images in figure  9 are by jacob davis and chelsea smith. fieldwork was funded by wennergren foundation grant 9432, national geographic society award ngs53412r18, emory university, yale university, and hyde family foundations. financial support was provided by the university of oklahoma libraries’ open access fund and the department of anthropology. the society of malawi gave permission to reproduce the original image of the hora 2 burial from clark (1956). three anonymous reviewers and an associate editor provided constructive feedback on an initial submission. ethics statement the two hor1 nonadult burials (kahora 1 and kahora 2) were recovered in 2019 and are curated by the malawi department of museums and monuments (formerly department of antiquities). additional remains from hor1, hor5, and maz1 were recovered in 2017, 2018, and 2019. permission for the research was provided under permits a/iii/3.3/70, a/iii/3.3/71, ad/23/56, and ncst/rtt/2/6. export was provided under a/1/1/1/3.6/50, a/1/1/1/3.6/44, a/ii/1.5/33, and mhq/cul/1/04/2. spatial coordinates in the supplementary data set have been modified from the original utm to obscure exact site locations. they are correct relative to one another within each site but do not tie to realworld locations. bi_0-0_08_cerezo-román_3pp.indd 25bi_0-0_08_cerezo-román_3pp.indd 25 27-05-2025 15:37:4727-05-2025 15:37:47 mortuary practices in hunter-gatherers of southern-central africa26 -1— 0— +1— references alqahtani, s. j., m. p. hector, and h. m. liversidge. 2010. brief communication: the london atlas of human tooth development and eruption. american journal of physical anthropology 142:481– 490. arizona state museum, university of arizona. 2018. asm osteology recording packet. arizona state museum, university of arizona, tucson. https:// statemuseum . arizona . edu / file / 712 [accessed 1 january 2018]. 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