A recent article in the International Journal of Palaeopathology, ‘survival against the odds: modelling the social implications of care provision to seriously disabled individuals’ by Tilley & Oxenham (2011), has proposed a new methodology (the ‘bioarchaeology of care’) highlighting the functional impacts of pathologies, possible and probable health challenges encountered, and the nature of support required to sustain life for disabled individuals in the archaeological record. Make no mistake- this is a bold, interesting and arresting improvement in the field of palaeopathological studies.
The focus of the investigation is the individual called Man Bac burial 9 (hereafter referred to as M9), from a Neolithic cemetery site (1700-2000BC) located in Ninh Binh province of northern Vietnam, 100km north of Hanoi (Tilley & Oxenham 2011: 36). Excavations between 1999 & 2007 uncovered 95 individuals, with the site occupying a mouth of an estuary of the Red River Delta. The archaeological evidence suggests a ‘hunter gather economy’, with a focus on aquatic and terrestrial vertebrate fauna (Tilley & Oxenham 2011: 36).
The individual under study was a male between 20-30 years old, buried in a north to south flexed position on his right side, in contrast to the normal mortuary practice of extended supine east-west orientation. The skeleton of M9 exhibits extreme disuse atrophy of the lower and upper limbs (as evidenced by the gracile bones), alongside full ankylosis of all cervical and first three thoracic vertebrae, permanent torticollis, and bilateral temporomandibular joint degeneration; a ‘diagnosis of Klippel Feil Syndrome type III has been proposed’ (Tilley & Oxenham 2011: 36). It is thought that M9 survived for approximately 10 years with disabilities (minimally paraplegia/maximally quadriplegia) so severe that he relied on assistance for nearly ever aspect of his life.
The methodology identified the context of care for M9, (as above), included reviewing the socio-cultural context, general health, and the Man Bac physical environment. Next, Tilley & Oxenham (2011: 37) reviewed current clinical literature and split the care needed by M9 into a) basic and b) advanced care. Basic care consists of the daily necessities of life- dressing, food, water, transport & dressing, whilst advanced care includes maintenance of personal hygiene, managing long term environmental and physical concerns, general health maintenance, dedicated nursing, medical intervention as needed and continued well-being.
Tilley & Oxenham (2011: 40) are right in assessing that it can never be known how the Man Bac society identified and understood illness, but assume that the same basic physiological responses were the same. The methodology is still under development, and I look forward to it being applied to further archaeological individuals and cultures (Larsen 1997, Roberts & Manchester 2010).
My only reservation regarding the methodology and approach of the researchers & archaeologists are the dangers inherent in applying a care scheme (or ‘retrospective attribution of motive’) onto a culture from which we are substantially removed from, both in space and time. Regarding what is, and what can be classed as a disability, together with differing cultural and world views, means that disability can never be classed easily (Roberts & Manchester 2010). The ever resourceful IFA have produced a recent paper on employing disabled people, and it helps to highlight how Britain’s own views on disabilities have, and continue, to change (see this post for the social, medical and charitable models of disability).
Regardless, this is an interesting and much-needed review of how disabled individuals are examined in a cultural context. The use of modern clinical data alongside the environmental, archaeological and palaeopathological evidence is well presented, and produces interesting results whilst making the best use out of available evidence. On the last note, it is noted that the cultural values exhibited & recorded are key in giving a partial insight into the life and care of M9; hopefully this methodology will be developed further and used again, however it should not be used carte blanche without the full context of evidence available.
Larsen, C. 1997. Bioarchaeology: Interpreting Behaviour From The Human Skeleton. Cambridge: Cambridge University Press.
Tilley, L. & Oxenham, M. F. 2011. Survival Against the Odds: Modelling the Social Implications of Care Provision to Seriously Disabled Individuals. International Journal of Palaeopathology. Vol 1 (2) pp.35-42. (Access required).
Waldron, T. 2009. Palaeopathology: Cambridge Manuals in Archaeology. Cambridge: Cambridge University Press.
Whittington, K. 2011. Employing People with Disabilities- IFA Practise Paper. Reading: IFA.