Disability and care in Western Europe during Medieval times: A bioarchaeological perspective.

This Special Issue has its foundation in presentations delivered in the symposium Disability and Care in Medieval Times: a Bioarchaeological Perspective into Health-related Practices held at the 2019 European Association of Archaeologists conference in Switzerland. It comprises 12 papers, all relevant to aspects of pathology experience and/or care provision in Western Europe during the Early to Late Middle Ages (500 - 1500 CE). Reflecting the 1000 year timespan involved, these papers are characterised by diversity in subject matter and in the lifeways in which they are located, but all contribute to the symposium's primary aim: to demonstrate that our understanding of the Medieval period is enhanced by cross-disciplinary, bioarchaeological research into individual and collective experiences of disability and care. This Introduction provides the background to the 2019 symposium, and briefly discusses the papers contained in the Special Issue which emerged from this.

Helping to shine light on the Dark Ages: Applying the bioarchaeology of care approach to remains from the early Anglo-Saxon cemetery at Worthy Park.

OBJECTIVE: To test the hypothesis that a bioarchaeological focus on health-related care provision can contribute to the currently limited understanding of social practice in Early Anglo-Saxon England (mid5th-early7th centuries AD). MATERIALS: Published descriptions of pathology in 69 adult remains from the Early Anglo-Saxon cemetery of Worthy Park, southern England. METHODS: Three case studies (one examining likely need for care at an individual level and two at a population level) were undertaken using the bioarchaeology of care approach. RESULTS: Analyses indicate likely care provision ('direct support' and/or 'accommodation of difference') to Worthy Park individuals experiencing temporary or permanent disability. Interpretation suggests community interdependence, cooperation, flexibility and tolerance of difference, as well as cultural and socioeconomic mechanisms for managing physical and social challenges of ageing. CONCLUSIONS: This study provides proof of concept that bioarchaeology of care analysis can offer new insights into social practice in this period. SIGNIFICANCE: This study demonstrates that a bioarchaeological focus on caregiving behaviours in an Early Anglo-Saxon community extends modern thinking about social relations in post-Roman Britain, offering a model for future investigations into social practice in this, and potentially other, periods. More generally, it illustrates the richness of results achievable when combining bioarchaeological and historical research. LIMITATIONS: Reliance on secondary sources limited detail (and potentially accuracy) of interpretation possible. SUGGESTIONS FOR FURTHER RESEARCH: This study's approach should be further tested and refined, either through application to different Anglo-Saxon (or other historic) populations or in a more thorough analysis of the Worthy Park sample itself.

Mummy studies and the bioarchaeology of care.

The bioarchaeology of care is a framework through which researchers can begin to infer the level of care an individual may have required based on the presence of paleopathological evidence. To date, all of the research that has employed the framework has been based on evidence derived from skeletal material. This special issue was organized in order to highlight how the analysis of mummified soft tissue, as well as other sources of data commonly associated with mummified remains, such as coprolites and intestinal contents, has the potential to provide valuable insight into the reconstruction of care in the past.

A 'cold case' of care: Looking at old data from a new perspective in mummy research.

In 1973, analysis of the mummified remains of a young boy dated to 700AD and from the Late Nasca period (Peru) identified (i) chronic Pott's disease, leading to loss of lower body mobility, and (ii) acute miliary tuberculosis, affecting most organs and the immediate cause of death (Allison et al., 1973). This report was the first to establish, beyond dispute, the presence of tuberculosis in the Americas before the arrival of Europeans. Here, we revisit the 'Nasca Boy' from a bioarchaeology of care perspective. Contextualising the original study's results within what is known of contemporary lifeways, we apply the bioarchaeology of care methodology in considering the Nasca Boy's experience of living with tuberculosis; the type of care he required and how this may have evolved over a period of deteriorating health; and what such caregiving may suggest both about social organisation within his community and some of the more everyday aspects of Nasca existence. Up to now, the bioarchaeology of care approach has been employed almost exclusively with skeletal evidence; in this analysis of the Nasca Boy's remains, and in the accompanying wider-ranging discussion, we illustrate the potential of preserved soft tissue evidence to contribute to research into disability and care in the past. Although this report functions as a stand-alone case study, to obtain maximum benefit it should be read in conjunction with the Introduction to the special International Journal of Paleopathology issue on 'mummy studies and the bioarchaeology of care' (Nystrom and Tilley, 2018).

Accommodating difference in the prehistoric past: Revisiting the case of Romito 2 from a bioarchaeology of care perspective.

The remains of Romito 2 (probable male, 17-20 years) date to around 11,000 BP and represent the earliest known case of chondrodystrophic dwarfism (acromesomelic dysplasia). From a hunter-gatherer community in a mountainous region of southern Italy, Romito 2's skeletal dysplasia limited his participation in typical economic and other cultural activities undertaken by his cohort, and anomalies in appearance distinguished him from his peers from infancy onwards. Frayer et al. (1987) were first to describe Romito 2 in detail, suggesting survival to age-at-death indicates group support. Four years later Dettwyler (1991) challenged this conclusion and, a decade after this, Frayer retracted the original claim for care (Bower, 2002). Using the Index of Care (Tilley and Cameron, 2014), this study revisits Romito 2 from a bioarchaeology of care perspective to ascertain whether a valid basis for inferring caregiving exists. Concluding Frayer et al. (1987) were right the first time - that Romito 2's survival reflects caregiving in the form of 'accommodation of difference' - this contribution argues that focus on contemporary context is the key to estimating functional impact of pathology and related need for care. This paper also briefly considers ethical concerns raised by archaeology's treatment of Romito 2's remains.

Introducing the Index of Care: A web-based application supporting archaeological research into health-related care.

The Index of Care is a web-based application designed to support the recently proposed four-stage 'bioarchaeology of care' methodology for identifying and interpreting health-related care provision in prehistory. The Index offers a framework for guiding researchers in 'thinking through' the steps of a bioarchaeology of care analysis; it continuously prompts consideration of biological and archaeological evidence relevant to care provision; it operationalises key concepts such as 'disability' and 'care'; and it encourages transparency in the reasoning underlying conclusions, facilitating review. This paper describes the aims, structure and content of the Index, and provides an example of its use. The Index of Care is freely available on-line; it is currently in active development, and feedback is sought to improve its utility and usability. This is the first time in bioarchaeology that an instrument for examining behaviour as complex as caregiving has been proposed.

Survival against the odds: Modeling the social implications of care provision to seriously disabled individuals.

Survival of an adult male (M9) with juvenile-onset quadriplegia in Neolithic Vietnam indicates provision of continuous care from his community, and adds to the growing literature documenting survival of disabled individuals in prehistory. Although the role of care-giving in achieving survival is occasionally acknowledged it is rarely elaborated, and a bioarchaeological model of care is missing. Contextualized analysis of specific instances of care can offer unique insights into contemporary culture, as the case of M9 illustrates. The 'bioarchaeology of care' identifies likely functional impacts of the pathology; possible and probable health challenges encountered; and nature of the support required to sustain life. Consideration of these factors in relation to lifeways practices and behaviours extends and enriches archaeological observations of M9's community. Additionally, M9's survival of extreme disability suggests certain personality traits touching on aspects of identity. Still under development, this new methodology promises to be a valuable heuristic tool.