Applying the Index of Care to the Mississippian Period: A Case Study of Treponematosis, Physical Impairment, and Probable Health-Related Caregiving From the Holliston Mills Site, TN

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Bioarchaeologists and palaeopathologists have recently turned their attention towards one critical aspect of the study of the history of disease: health-related caregiving. In response, an approach, the bioarchaeology of care, and, within it, the web-based Index of Care (IoC) have been developed to enable the identification and interpretation of past caregiving. Here, we apply the IoC to Burial 86, a young adult (18–25 years) female from the late Mississippian period, Dallas cultural phase Holliston Mills site (40HW11; ca. ad 1348–1535), TN. Burial 86 exhibits pathologies specific to treponematosis. They also exhibit a suite of pathologies indicative of physical impairment, including a varus angular deformity in the right tibia that is potentially the result of a malaligned pathological fracture. Following the IoC, we determine that Burial 86 probably experienced moderate clinical impacts on several domains (e.g., musculoskeletal system) with various functional impacts on essential activities of daily living. This means that Burial 86 likely had a disability and likely received caregiving, though it is impossible to determine if the care was efficacious. That care was provided likely reflected the community of Holliston Mills' more egalitarian socio-political structure, which was unusual for the late Mississippian. It may also reflect Burial 86's agency, the presence of adequate resources at the site, as indicated by high frequencies of high status mortuary artifacts, or a combination of these factors. The mortuary program for Burial 86 does not indicate that they were marked as being different—in status or other social categories—than other community members. This study highlights how bioarchaeological evidence can be used to explore the downstream effects of chronic infections, such as treponematosis, throughout the body and across the life course, and the opportunities for health-related caregiving in past societies that these processes can potentially create.