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BIOARCHAEOLOGICAL CONTEXT
The site of Tell Abraq is located on the Persian Gulf
coast of the Arabian Peninsula in present-day United
Arab Emirates (UAE). It was excavated between 1989
and 1998 by Drs. Daniel Potts of the University of Sydney and Debra Martin of the University of Nevada, Las
Vegas and their team. The earliest archaeological material from Tell Abraq dates to the Arabian Bronze Age or
Umm an-Nar period from 2600 to 2000 B.C. (Potts
2000b). The people of Tell Abraq enjoyed a rich diet
from marine, agricultural, and terrestrial sources such
fish, shellfish, camel, goat, dates, barley, and wheat
(Gutierrez 1994, Potts 2000a). Exotic artifacts such as
linen, hair combs, and ivory items suggest the site also
played a significant role in a trade network involving
areas such as Dilmun, Harappa, and Mesopotamia (Potts
2000a). The only human remains at the site were excavated from a sealed, circular-styled mudbrick tomb dated
from 2200 to 2000 B.C. (Potts 2000a). The tomb is
unique in that it is the only contemporaneous burial site
that was not looted and was otherwise relatively undisturbed. Over time as the tomb was used, a commingled
burial formed as new individuals were interred atop the
old, creating a bed of bone, soil, and artifacts 1.4 meters
thick (Potts 2000a). The commingled nature of the remains creates a unique challenge for analysis because
matching bones to any one individual to examine a complete skeleton is nearly impossible. Of the 286 adults in
the population, we highlight two case studies of individuals who suffered and survived a severe pathology and
would have required aid from other individuals in the
community.
CASE STUDY #1
Fractures are the most common traumatic injury, occurring across time, species, age, sex and activity
(Zimmerman and Kelley 1982). While some fractures
attributed to violent trauma can be lethal, this naturally
depends on the location and severity of the break and the
damage to bone and soft tissues. This case study focuses
on an individual who likely endured the significant pain
of a broken arm and dealt with the resulting complications as it healed out of alignment.
Implications
While the human body is incredibly resilient and
most fracture cases are nonlethal, this does not diminish
the effects of caretaking efforts of those who assisted
trauma patients in ancient times, such as at Tell Abraq.
Waldron writes, What is particularly noticeable about
fractures that are found in skeletal assemblages is that the
majority are well healed and in good alignment and few
are found with signs of infection. This must indicate that
there were in the general community, a number of individuals who had the knowledge and the skill to treat and
set broken bones, and that the community was able to
care for the injured individuals during their period of
recovery and recuperation (2009:143). In this case, the
pain at the time of the bone break would have been excruciating. Bruising, broken blood vessels, and soft tissue
damage are just a few of the immediate consequences
(Waldron 2009, LeMone and Burke 2004). The muscles
surrounding the break can naturally spasm, which may
cause greater displacement of the broken ends of bone.
Treatment for a fracture at Tell Abraq would have been
much like todays practices (Swearingen 2007). The bone
must first be reduced or reset into anatomical position,
which was likely to be very painful without surgery or
analgesics. Then the bone is immobilized or restricted
from movement to allow for healing, such as in a splint
(Waldron 2009). The mal-union is a complication as a
result of three possible scenarios where treatment was
ineffective: First, the bone was broken and was never
reduced; second, the break caused a greater dislodging of
the bone and was improperly reduced; third, it was improperly immobilized, and the ends shifted out of position. Based on the callus size, at least six weeks of heal-
CASE STUDY #2
This next case study investigates an individual who suffered a possible knee dislocation. With this type of injury, this adult would have been dependent on other
members of the community, but it is apparent that this
individual continued to work out of necessity despite any
discomfort that may have been experienced. The evidence lies in the extensive shiny and polished area of
bone on the articular surface of a femur. This condition is
called eburnation, and it is a diagnostic sign of advanced
osteoarthritis, which is known to occur as a consequence
of a poorly healed fracture or a dislocation over time
(Aufderheide and Rodriguez-Martin 1998, Ortner 2003,
Waldron 2009). Although dislocation of the knee is rare,
complications from ligament, tendon, or muscle tears can
place this joint at risk. Once a dislocation occurs and is
left untreated, pain from the injured joint often ensues.
Implications
This individual would have experienced a great
deal of pain at the event of the ligament tear. Symptoms
of tears are much like a broken bone, with swelling,
bruising, and tenderness at the site (Swearingen 2007).
Particularly with the ACL, there is even a reported popping sound at the time of the tear. Modern treatment of a
ligament tear, besides surgery, is the RICE method,
short for rest, ice, compression, and elevation. It is unknown, however, what ancient treatment would have
been employed outside of rest. As the soft tissues healed,
this individual would have been limited in mobility. The
joint would have been affected by limited range of motion and ambulatory difficulty (Swearingen 2007). Certainly, this individual was not completely disabled and
continued to function after the incident, as eburnation
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Escamilla, Rafael F.
2001
Knee biomechanics of the dynamic squat exercise. Medicine and Science in Sports and Exercise 33(1):127-141.
CONCLUSION
Care of disabled individuals in ancient populations is an
emerging topic that merits a closer look. The fact that
severely infected and healed broken bones at Tell Abraq
exist gives testament to an individuals survival with an
ailment, something that would not have been possible
without outside aid. This aid may have consisted of general support such as provisions of food and shelter as well
as possible specialized nursing care as in treatment of a
broken limb. These case studies reveal the nature of care
and compassion of those who helped their sick and injured. This speaks to the character and culture of the
community at Tell Abraq. They valued members who
were limited in their ability to contribute or were otherwise placing a burden on the groups resources. Although
these individuals were dependent on others for support,
their periods of limited activity should not be thought of
in terms of impairment. Their diminished capacity to
contribute to the community may have been offset by
taking on other tasks or roles that were within their abilities. But in doing so, what is less clear is how their social
status may have been impacted. In addition, the roles of
caretakers may have also been socially defined. These
lines of thought are useful queries to gain a better understanding of care and compassion in the community, but
without artifacts or historical evidence, there is only so
much that can be inferred. This research provides a nuanced view of ancient care through a biocultural lens, and
future applications of the bioarchaeology of care approach would prove valuable.
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