Unfolding like a true detective story, this edited volume by P. Willey and colleagues sets out to contextualise a series of comingled artefacts, faunal and human remains that were recovered from an atypical burial location associated with the nineteenth-century Army hospital at Point San Jose in the Fort Mason complex, San Francisco, California, USA. The partial remains of several individuals were identified in a pit near two historic structures during renovations in 2010 and date to sometime between 1864 and 1891: but what explains their interment there? It is from this position of puzzlement that the posited pieces presented in this publication proceed.

To address the mysterious burial context, the authors apply a mixture of historical documentary, archival, medical anthropological, zooarchaeological, artefactual and human osteological analyses. The combination of these approaches creates a full picture of the situation, both in terms of deep contextualisation of the era of deposition at Point San Jose as well as a detailed documentary analysis which sheds light on aspects of the lives lived by the interred individuals as ascertained through age, sex, stature, isotopic assessments of diet and mobility and palaeopathological analyses.

Given the incomplete nature of the remains recovered, the size of the burial pit and its location in relation to the hospital, it was quickly inferred that the remains identified probably reflect deposits of hospital-related activities, likely associated with amputation, autopsy, and dissection. Upon the recovery of a sacrum (a bone of the lower back), it became clear that the mixed remains are more than simply amputated body parts, bringing forth additional questions. A mixture of adult male and female and subadult remains are represented in the analysed assemblage, which further indicated that these are not exclusively the remains of soldiers from the fort.

Part I provides the historical perspective. With a focus on San Francisco, Lisa Bright (Chapter 1) contextualises the history of westward expansion in the USA and the history of California. Following the gold rush of 1848 in California, San Francisco in particular developed quickly but remained comparatively isolated before the expansion of steamboat routes and completion of the railroad in 1869. By the 1870s San Francisco had a population of about 100 000, which boomed to around 274 000 by the 1880s.

The contributions of Coleen Milligan (Chapter 2) and Brian Spatola and Kristen Pearlstein (Chapter 3) nicely address the historical context around medical uses of human bodies in the nineteenth century. Steady growth in medical training following the American Civil War (1861–1865) resulted in increasing demand for human cadavers. Following initial prohibitions on using human remains—a period that was fraught with grave robbing and other unsavoury manners of acquisition—legal provisions for using human remains were enacted. Legal routes were also often problematic, primarily deeming the bodies of criminals and those who died in state-run institutions or without next of kin the most suitable for use in medical labs. Such acquisition practices, which disproportionately impacted minority and socio-economically vulnerable groups, are widely recognised today as unjust. This is a larger legacy issue within biology, anatomy, medicine, and anthropology. As Anne Grauer points out in The Routledge handbook of paleopathology (Reference Grauer2023), hundreds of thousands of historically acquired human skeletons remain curated in countless global institutions. Among those, as Sabrina Agarwal noted in a Reference Agarwal2022 presentation to the American Association of Biological Anthropologists, there is a particularly prominent legacy of Indian skeletons in educational institutions, with tens of thousands of skeletons exported each year from India over a 150-year period.

Peter Gavette (Chapter 4) examines who may have been responsible for the interment of the identified human remains. Ultimately, the most likely is Dr Edwin Bentley, Point San Jose surgeon from 1869–1876 having been in the right place during the appropriate time. He was also the first to successfully undertake a human-to-human blood transfusion in the USA. Beyond a simple ‘whodunnit’, the discussion around Dr Bentley is used as a fillip for digging deeper into the history of medical practices in America during this time.

Part II shifts the focus to excavation and post-excavation analyses. Focusing on the series of medicinal bottles recovered, Angela Locke Barton (Chapter 6) provides nuanced insights to the nature of the pharmaceutical industry and medical practices at Point San Jose as well as a further refinement to the temporality of the deposits in the pit through relative dating of artefact-production periods. This approach provides a bridge between sections, drawing in equal terms on historical context and bottle-production characteristics to create a balanced complementary source of data contextualisation. The same can also be said of the faunal analyses presented by Kasey Cole and colleagues in Chapter 7, which address numerous aspects of the social environment and dietary practices at Point San Jose and provide an interpretive basis upon which subsequent dietary reconstruction through isotope analyses builds.

Part III presents the deepest problematisation of the human remains recovered. Chapter 9 asks: how many individuals are represented in the burial? As is often the case, simple questions do not always have simple answers, with a range of 25–40 individuals being possible. Chapters 8–11 leverage multiple lines of evidence, from morphometric to XRF and others, to further substantiate the demographic dynamics of the interred individuals, demonstrating the benefits of mixed-method maximised interpretations. Chapters 12–14 address questions of diet and mobility using isotope analyses and paleopathology. Furthermore, Sarah Hall considers structural violence (Chapter 15) in Part IV, to develop broader socially informed perspectives on the lives of the individuals interred at Point San Jose, to help contextualise their experiences beyond the metrics of their osteobiographies.

The comingled medical-waste deposit identified in association with the historic Point San Jose hospital probably reflects remains resulting from anatomical dissections, although autopsy and amputation cannot be ruled out entirely. This still leaves the question of who exactly these people were. The osteobiographies of the individuals clearly demonstrate that they were not all soldiers, while several inferences derived from the skeletal materials suggest the assemblage may include individuals of lower socio-economic status. Perhaps additional future research through forensic genealogy and DNA will address this mystery.

Grounding (bio)archaeological findings within broader discussions of life in nineteenth-century San Francisco, this volume is most directly targeted at (bio)archaeologists and medical historians. Having said that, this volume is also accessible and will be of interest to a broader readership, particularly those interested in medical, military and Californian history. This volume will make a welcome addition to research and public libraries alike.