Plan of the book

To give both depth and breadth on health in ancient America, the chapters that follow provide a general arc of lives and bodies from pregnancy and birth, through early and late childhood, to adolescence, and into the young, full, and mature adult years followed by the elderly (Roksandic and Armstrong 2011: 341). We emphatically stress that this book is not a synthesis of all available data on health and disease from all archaeological sites in the U.S.; rather it is a sampling of core areas within the U.S. that provide particularly rich and detailed evidence for allowing interpretive meaning and broader implications about that evidence. Ancient cultures in the U.S. have complex, rich, and long histories that predate the written records of the colonial invaders in the 1500s. American history texts often start at this point as if there were no history for Native Americans prior to the 1500s. As Lambert writes, “assumptions of the preeminence of Western contact in the formulation of New

World social process minimizes the importance of its unique landscapes, events, trajectories, and solutions” (2002: 208). This text works against that minimization of indigenous history by providing snapshots of life prior to contact.

There is extensive variability across the U.S. in terms of environments, cultures, languages, customs, subsistence activities, and political-economic structures. Thus, it is safe to say that one narrative could not capture what life was life for the hundreds of different Native American groups living in the U.S. prior to contact. This book draws heavily from data produced over many years of study by numerous bioarchaeologists from four core regions (discussed earlier) to demonstrate some of that variability and cultural complexity. These core areas provide highlights of what is known about health and disease but are not by any means representative of the whole of the U.S. bioarchaeological findings. The period focused on is generally from around ad 900 to 1400. These four core areas are complemented and expanded on by presenting data from earlier periods and other regions when necessary to show what is similar or unique about the patterns within the core areas.

As emphasized already, disease is hardly ever a random occurrence. That is why in the U.S. so much faith is placed in the Centers for Disease Control in Atlanta, Georgia. Every major endemic and epidemic disease to have been studied is patterned. People become vulnerable to particular diseases or trauma and injury at particular times in their life because a suite of factors such as biology, behavior, location, overall health status, age, and sex place them in harm’s way. Tracking these patterns in the ancient world is challenging but it can be done as Chapters 3 through 6 demonstrate.

A life-history approach is utilized to examine more closely the important stages within a human lifetime including birth, infancy, childhood, adolescence, adulthood, and the elderly years. This approach aided in organizing the information about important biocultural factors that come into play for different groups during these stages, such as diet, nutrition, living conditions, and things that could harm people at different stages of life. Life-history theory is used to help explain the traits for each group that govern these life events and highlights various adaptations that are made with each stage. Providing only information on disease is not as useful as providing information on the rich context within which disease is buffered or experienced due to various behaviors. Hill summarizes this well when she states that “[i]dentifying health hazards alone, without studying the priorities that govern human decisions, will not affect the mortality rate of individuals who willingly and knowingly incur such risks” (1993: 78).

Before starting in on the core area studies, Chapter 2 focuses on how bioarchaeologists make sense and meaning out of “reading” the changes and abnormalities they see on the bones. A selective overview of the most common skeletal and dental diseases and trauma are provided.

Basic techniques for the analysis of human remains are provided and act as a backdrop to the chapters that follow. Specific diseases and injuries are introduced in this chapter and how to scientifically quantify and analyze them are reviewed.

Although not every disease or medical event that threatens health can be gleaned from the bones, many of the more common diseases and ailments do, such as staph and strep infections, nutritional inadequacies and anemia, and degenerative diseases and osteoarthritis. This chapter emphasizes that disease is rarely static, and often people do recover or they adjust and adapt to living with a disease. In some cases they die. Health over the course of a lifetime can improve or stabilize or deteriorate. Common ailments such as a staph infection can run their course in predictable ways. Chapter 2 provides the way these kinds of dynamic events around disease may have played out for ancient people based on the kinds of evidence obtained from bones and teeth.

Chapter 3 provides a broad overview of pregnancy, maternal health, and infant mortality for the core areas to understand the kinds of things that may have made some pregnant women and some mothers more at risk for dying young than others. Maternal morbidity and mortality have been assumed to be related to the stresses of pregnancy during the peak reproductive years. More recent evidence, however, points more to other kinds of factors that can place women at risk for illness and death that are not solely about pregnancy and birth but that have to do with cultural practices such as sexual division of labor, gender inequality, and lack of access to adequate resources (Stone In Press). Maternal health and neonates/infants (aged from birth to about 2 years) are the focus of this chapter.

Children and adolescents are examined in Chapter 4 to clarify trends in disease and trauma during the years preceding adulthood, generally divided into early and late childhood and adolescence (Roksandic and Armstrong 2011: 341). Many studies focused on children have shown that the process of weaning makes children more vulnerable to a host of pathologies. In general, ancient children who survive the peak weaning years during early childhood (ages 2—6) tend to do quite well and survive the late childhood (ages 6—10) and adolescent years (ages 10—18) and move into young adulthood. Data from the core regions explored in this chapter show that childhood health is also linked to subsistence activities, diet, environment, resources, and cultural practices that sometimes protect children and at other times link them to illness.

Chapter 5 takes an extended look at adult health profiles for the core areas. Patterns in disease and early death are strongly linked with a range of cultural factors such as religion, diet, culturally sanctioned violence, warfare, and political- economic processes that make resources differentially available to community members. Immigrant status, ethnicity, and gender all are connected in causal ways with either better or worse health, depending on the power structure and the nature of resource distribution. For adults both disease and violence within the cultures and periods tend to overshadow their lives, and for this reason these two categories are focused on.

The elderly adults, which in ancient America would be persons older than 50, are examined in Chapter 6. While some archaeological sites produce an abundance of individuals in the older age categories, others have hardly any. Growing old in ancient America was a risky business, and in general, the elderly represent a small proportion of the overall cemetery or burial collections. It must be remembered that the average age at death in the 1800s was around 40 years and that it was not until the early 1900s that life expectancy doubled to about 80 years where it has stayed up until the present (with some variations in the U.S. by region, ethnicity, socioeconomic status, age, and other factors) (Finch 2010).

Chapter 7 starts with a series of questions about the importance and relevance of knowing more about health in the ancient new world. The past can be used as a guide to the future and in terms of human health, longevity, and the ability to adapt to dynamic changes, it is of interest to know how to best avoid diseases that kill and injuries that maim. The big questions of our time can actually be partially answered by some of the data presented in this text. Will increasing climate change and hotter temperatures make people more violent? (Not necessarily.) Do diverse diets lead to better health? (Yes, if accessible.) Are there ways to prevent maternal mortality and infant mortality? (Yes.) These and other timely questions are juxtaposed with information from the text as a way to invite broader engagement with finding the solutions to many of the problems plaguing the U.S. today.

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