Bioarchaeology of Care

The bioarchaeology of care is an archaeological approach that endeavors to use physical evidence of care-giving to explore and interpret the details of past behavior, some of which may be unreachable by other means (Tilley 2011). The term was popularized in the research of Lorna Tilley and Marc Oxenham, in which they use a case study to construct an analytical framework to approach the evidence, cognizant of its social context and implications. For the most part, this care-giving is associated with individuals that are disabled or otherwise impaired; this entails limitations to activity and participation in some – or all – of their culture and lifestyle. 

One particular case, that of Man Bac Burial 9, demonstrates this phenomenon thoroughly. The remains of M9 were discovered in a Neolithic cemetery site in northern Vietnam, dating back to roughly 4,000 years ago (Gorman 2012). The physical evidence reveals that M9 was paralyzed from the waist down in adolescence; his restricted upper body movement and immobilized lower body would have required extensive care in all aspects of life, and yet, M9 survived for approximately 10 more years. His survival to that point implies certain things about his community and about prehistoric society as a whole. Firstly, it implies altruism. The care-giving M9 received despite his reduced contributions to the Neolithic subsistence economy indicate that not only was there a surplus of labor and resources that would allow for his care, but also that there was compassion and a willingness in the community to do so. Additionally, there must have been a diverse range of food that would accommodate M9’s unique dietary needs emerging from immobility-associated gastrointestinal issues. M9 is one of the first prehistoric examples of long-term care-giving and survival with total disability (Tilley 2011).

Figure 1: Location of excavation site Man Bac 9. (Photograph provided by James Gorman of The New York Times, 2012).

Figure 2: Modern day Man Bac, cemetery excavation site visible on the middle right. (Photograph provided by Lorna Tilley, 2011).

Alongside with the growth of the bioarchaeology of care is the corresponding debate over its viability. The archaeological evidence under discussion indicates that ancient Neolithic communities cared for their disabled members. The two responses to this are (1) the compassion argument or (2) the null hypothesis. The former believes that the care-giving was motivated by altruism and a commitment to their community members. The latter disagrees, arguing that there is not enough concrete evidence to draw conclusions about community care-giving, rather, the impaired individual must have managed on their own (Thorpe 2016, 93). The two main complications in interpreting bioarchaeology originate in our modern biases. Firstly, it may be irresponsible to retroactively attribute a motive, in this case compassion, to a culture we are completely removed from (Tilley 2011). Second, our medical understanding of particular disabilities is situated within the modern, mostly Western world, which may be completely incomparable to that of the Vietnamese Neolithic (Tilley 2011).

While archaeologists recognize these limitations, they must also acknowledge how the societal implications of care-giving enhance and add to general cultural analysis. The rejection of compassion is unproductive; instead, a more fruitful conversation could be the change of care-giving throughout the archaeological record (Thorpe 2016, 105). Overall, bioarchaeology of care can provide insights on the culture and community of an individual, while also contributing to our understanding of prehistoric society.


Further Readings:

  1. Oxenham, Marc F., Hirofumi Matsumura, and Nguyen Kim Dung, eds. Man Bac: The Excavation of a Neolithic Site in Northern Vietnam. Vol. 33. ANU Press, 2010.
  2. Halcrow, Siân E. “New Bioarchaeological Approaches to Care in the Past.” Antiquity 91, no. 358 (2017): 1101–3. doi:10.15184/aqy.2017.99.



Gorman, James. “Ancient Bones That Tell a Story of Compassion.” The New York Times, December 2012.

Thorpe, Nick. “The Palaeolithic Compassion Debate – Alternative Projections of Modern-Day Disability into the Distant Past,” in Care in the Past: Archaeological and Interdisciplinary Perspectives, edited by Lindsay Powell, et al., Oxbow Books, Limited, 2016. ProQuest Ebook Central,

Tilley, Lorna and Marc F. Oxenham. “Survival against the odds: Modeling the social implications of care provision to seriously disabled individuals.” International Journal of Paleopathology, Volume 1, Issue 1, 2011, pp. 35-42,

Off With Their…Limbs! : Exploring Amputations Of Days Gone By

Amputations date back to ancient times and were as life-changing as they
are today. Performing something as complicated as amputation a thousand years ago meant that humans had to have a decent understanding of the body. The evolution of medicine suggests that agricultural societies were settled at least ten thousand years ago and stimulated major innovations surrounding medical practices. The invention and development of advanced surgical procedures were one of them. Before 2022, the oldest discovery of such an operation was found in the skeletal remains of a European Neolithic farmer. This discovery was made in Buthiers-Boulancourt of France (Maloney et al. 2022). The archeologists found that the farmer’s left forearm was surgically removed and had partially healed before death. The estimated time that this might have taken place was seven thousand years ago. The study revealed that the remains showed a medical procedure that is considered to be complicated even today, known as amputation. Amputation is the surgical removal of a body part like an arm or leg. So, the case that took place 7,000 years ago would have required a comprehensive knowledge of human anatomy and appropriate technical skills that would successfully remove a part of the body without causing more damage. Three cases of perimortem limb amputations that consisted of the severing of both hands and feet of three adult males were also reported in the archaeological literature some years back (Fernandes et al. 2017). The skeletons were from the medieval Portuguese necropolis. After studying the lesions, patterns, and location, it was concluded that the amputations were likely a result of judicial punishment during the medieval times in Estremoz city. Another case of a male with trans metatarsal amputation of both forefeet was found in England. However, this case does not infer a deliberate surgical amputation. A recent study shows amputation performed on a child that is believed to have taken place almost 31,000 years ago. The skeletal remains were found in Borneo, Papua New Guinea. This individual had their left lower leg and left foot amputated. The individual underwent amputation at a very young age and is believed to have survived the surgery and lived for around another nine years. Navigating veins, arteries, and tissues to make sure the wound was clean and had no other complications meant the people had knowledge, experience, and materials for performing the procedure (Blake 2022). This discovery suggests that amputations were performed far earlier than originally believed, and further archaeological surveys may lead to many other similar discoveries in the future. Overall, these findings help us better understand the archaeology of seemingly undocumented times.

Figure 1: Archaeological discovery in Borneo showing left and right legs, with an absent lower part of the left leg along with the left foot. (NPR 2022)

Figure 2: Tim Maloney (a professor) taking a closer look at the bones during excavation at the Liang Tebo cave located in Borneo. (NPR 2022)










For more information surrounding amputations and anthropology, please visit:

  • (A case of bilateral forefoot amputation from the Romano-British cemetery of Lankhills, Winchester, UK)
  • (The oldest amputation on a Neolithic human skeleton in France)




  1. Blake, Elissa. 2022. “Stone Age Surgery: Earliest Evidence Of Amputation Found”. The University Of Sydney.
  2. Fernandes, Teresa, Marco Liberato, Carina Marques, and Eugénia Cunha. 2017. “Three Cases Of Feet And Hand Amputation From Medieval Estremoz, Portugal”. International Journal Of Paleopathology 18: 63-68. doi:10.1016/j.ijpp.2017.05.007.
  3. Maloney, Tim Ryan, India Ella Dilkes-Hall, Melandri Vlok, Adhi Agus Oktaviana, Pindi Setiawan, Andika Arief Drajat Priyatno, and Marlon Ririmasse et al. 2022. “Surgical Amputation Of A Limb 31,000 Years Ago In Borneo”. Nature, no. 609: 547-551. doi:10.1038/s41586-022-05160-8.
  4. NPR. 2022. “Amputation in a 31,000-Year-Old Skeleton May Be a Sign of Prehistoric Medical Advances.” NPR, September 7, 2022, sec. Science.