Care in the Past: Archaeological and Interdisciplinary Perspectives

By Lindsay Powell and Rebecca Gowland

Care-giving is an activity that has been practiced by all human societies. From the earliest societies through to the present, all humans have faced choices regarding how people in positions of dependency are to be treated. As such, care-giving, and the form it takes, is a central experience of being a human and one that is culturally mediated. Archaeology has tended to marginalise the study of care, and debates surrounding our ability to recognise it within the archaeological record have often remained implicit rather than a focus of discussion. These 12 papers examine the topic of care in past societies and specifically how we might recognise the provision of care in archaeological contexts and to open up an inter-disciplinary conversation, including historical, bioarchaeological, faunal and philosophical perspectives. The topic of ‘care’ is examined through three different strands: the provision of care throughout the life course, namely that provided to the youngest and oldest members of a society; care-giving and attitudes towards impairment and disability in prehistoric and historic contexts, and the role of animals as both recipients of care and as tools for its provision.

• Language: English
• Publisher: Oxbow Books
• Release date: Nov 30, 2016
• ISBN: 9781785703362

Book preview

Published in the United Kingdom in 2017 by

OXBOW BOOKS

The Old Music Hall, 106–108 Cowley Road, Oxford OX4 1JE

and in the United States by

OXBOW BOOKS

1950 Lawrence Road, Havertown, PA 19083

© Oxbow Books and the individual contributors 2017

Paperback Edition: ISBN 978-1-78570-335-5

Digital Edition: ISBN 978-1-78570-336-2 (epub)

Digital Edition: ISBN 978-1-78570-337-9 (kindle)

Digital Edition: ISBN 978-1-78570-338-6 (pdf)

A CIP record for this book is available from the British Library

Library of Congress Cataloging-in-Publication Data

Names: Powell, Lindsay, editor of compilation. | Southwell-Wright, William, editor of compilation. | Gowland, Rebecca, editor of compilation.

Title: Care in the past: archaeological and interdisciplinary perspectives / edited by Lindsay Powell, William Southwell-Wright, and Rebecca Gowland.

Description: Oxford; Philadelphia: Oxbow Books, 2016. | Includes bibliographical references.

Identifiers: LCCN 2016044905 (print) | LCCN 2016045533 (ebook) | ISBN 9781785703355 (paperback) | ISBN 9781785703362 (epub) | ISBN 9781785703379 (mobi) | ISBN 9781785703386 (pdf)

Subjects: LCSH: Social archaeology. | Archaeology and history. | Caregivers--History. | Caring--Social aspects--History. | Child care--History. | Older people--Care--History. | People with disabilities--Care--History. | Animal welfare--History.

Classification: LCC CC72.4.C367 2016 (print) | LCC CC72.4 (ebook) | DDC 930.1--dc23

LC record available at https://lccn.loc.gov/2016044905

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical including photocopying, recording or by any information storage and retrieval system, without permission from the publisher in writing.

Printed in the United Kingdom by Hobbs the Printers Ltd.

For a complete list of Oxbow titles, please contact:

Oxbow Books is part of the Casemate Group

Front cover: Concerned parents trying to coax a sick child to take some liquid while a dog waits patiently. Watercolour by W.H. Margetson, 1901. Image courtesy of Wellcome Library, London under a Creative Commons licence.

Lindsay Powell

To Nathan, my mom and family

William Southwell-Wright

I would like to dedicate this book to my parents for their love and support

Rebecca Gowland

For my boys, Tim, Theo and Milo, for all of your care and love

Contents

Acknowledgements

List of Contributors

Preface

  1.  Foundations and Approaches to the Study of Care in the Past

William Southwell-Wright, Rebecca Gowland, and Lindsay Powell

Section 1 Care and the Life Course

  2.  Childcare in the Past: The Contribution of Palaeopathology

Mary Lewis

  3.  The Terrible Tyranny of the Majority: Recognising Population Variability and Individual Agency in Past Infant Feeding Practices

Ellen Kendall

  4.  Precious Things: Examining the Status and Care of Children in Late Medieval England through the Analysis of Cultural and Biological Markers

Heidi Dawson

  5.  That Tattered Coat Upon a Stick the Ageing Body: Evidence for Elder Marginalisation and Abuse in Roman Britain

Rebecca L. Gowland

Section 2 Care, Impairment and Disability

  6.  The Palaeolithic Compassion Debate – Alternative Projections of Modern-Day Disability into the Distant Past

Nick Thorpe

  7.  Setting the Scene for an Evolutionary Approach to Care in Prehistory: A Historical and Philosophical Journey

David Doat

  8.  A Long Waiting for Death: Dependency and the Care of the Disabled in a 19th Century Asylum

Shawn M. Phillips

  9.  Prayers and Poultices: Medieval Health Care at the Isle of May, Scotland, c. 430–1580 AD

Marlo Willows

Section 3 Care and Non-Human Animals

10.  Towards a Zooarchaeology of Animal Care

Richard Thomas

11.  Rare Secrets of Physicke: Insect Medicaments in Historical Western Society

Gary King

12.  Concluding Thoughts and Future Directions

Rebecca Gowland, Lindsay Powell, and William Southwell-Wright

Acknowledgements

The editors would like to express their gratitude to the following people and organisations for their support and contributions to this volume. First, we would like to thank the Department of Archaeology, Durham University for the initial grant of a Research Dialogues Fund and the Institute of Medieval and Early Modern Studies, Durham University for contributing funding for the conference that provided the initial impetus for this volume – Care in the Past: Archaeological and Interdisciplinary Perspectives. We would also like to thank the College of St. Hild and St. Bede for allowing us to stage the conference, Sophie Newman for her assistance on the day, and all those individuals who gave talks: Jessica Cooney, Heidi Dawson, Katherine Huntley, Bryn James, Gary King, Mary Lewis, Dawn McLaren, Irina Metzler, Hannah Newton, Nick Thorpe, Veronique Thouroude, and Marlo Willows. Secondly, thanks are given to Emma-Jayne Graham and Julie Peacock for giving talks as part of the Care in the Past Research Dialogues talks given at the Department of Archaeology, Durham University. Thirdly, we would like to thank the Theoretical Archaeology Group (TAG) and the University of Liverpool for allowing our participation in their annual conference, and those who contributed to our session Disability and Archaeology: Critical Perspectives and Inclusive Practices: Victoria Beauchamp, Emma-Jayne Graham, Shawn Phillips, Dario Scarpati, Nicola Thorpe, Lisa Trentin, Johannes Verstraete, Julie Walker, and Stephanie Wright. Finally, we would like to thank Julie Gardner at Oxbow, Charlotte Roberts, the chapter authors, and all those individuals who assisted in the production of the volume: Patricia Baker, David Bolt, Kathy Dettwyler, Mandy Jay, Andrew Millard, Piers Mitchell, Rebecca Redfern, Sarah Semple, Nivien Speith, Nathan Thomas, Tim Thompson, Beth Upex, and Mark White.

List of Contributors

DR. HEIDI DAWSON

Department of Archaeology and Anthropology

University of Bristol

43 Woodland Road

Bristol

BS8 1UU

[e-mail]

DR. DAVID DOAT

Ethics (EA 7446)

Catholic University of Lille

60, Boulevard Vauban

F-59800 Lille

France

[e-mail]

DR. REBECCA GOWLAND

Durham University

Department of Archaeology

South Road

Durham

DH1 3LE

[e-mail]

ELLEN KENDALL

Durham University

Department of Archaeology

South Road

Durham

DH1 3LE

[e-mail]

DR. GARY KING

Independent Researcher

[e-mail]

DR. MARY LEWIS

Department of Archaeology

University of Reading

Whiteknights

PO Box 227

Reading

RG6 6AB

[e-mail]

DR. SHAWN PHILLIPS

Indiana State University

College of Arts and Sciences

Department of Earth and Environmental Systems

200 North Seventh Street

Terre Haute

Indiana 47802

USA

[e-mail]

DR. LINDSAY POWELL

Independent Researcher

[e-mail]

DR. CHARLOTTE ROBERTS

Durham University

Department of Archaeology

South Road

Durham

DH1 3LE

[e-mail]

WILLIAM SOUTHWELL-WRIGHT

Independent Researcher

[e-mail]

DR. RICHARD THOMAS

School of Archaeology and Ancient History

University of Leicester

University Road

Leicester

LE1 7RH

[e-mail]

DR. NICK THORPE

University of Winchester

Sparkford Road

Winchester

SO22 4NR

[e-mail]

DR. MARLO WILLOWS

University of Edinburgh

School of History, Classics and Archaeology

Teviot Place, Edinburgh, EH8 9AG

[e-mail]

Preface

Navigating Approaches to Impairment, Disability and Care in the Past: The Need for Reflection

Charlotte Roberts

Introduction

It is a pleasure to write this preface to a volume that will become essential reading for those working in this field. The health and general well-being of any society, past or present, can be argued as key features that underpin its very function. An ill and disabled society can affect that very function, as can poor access to health or related care. This is why health care is such an important component of any country’s infrastructure, albeit varying in availability and quality over time and space. While accepting that the experience of living with health problems and accessing care and treatment today are vastly different to living in the Palaeolithic, for example, there are some parts of the world today that have health care systems that function relatively effectively. They may variously provide efficient diagnosis and treatment at the point of need, help on prevention and healthy living, and access to general advice (including social care options). While recognizing that health care can be varied in availability and quality today, the experience of disease varies too across the world, and is very much driven by where people live and in which sociocultural milieu they reside.

How can the here and now help us understand the past?

It is perhaps worth dwelling momentarily on one health care system, albeit in a developed country, to show that it is worth considering the here and now against exploring the longue durée of mental and physical impairments, disability, and care. The National Health Service in Britain was launched on July 5th in 1948 under a Labour government, with Aneurin Bevan as Health Minister. It functions across the United Kingdom (England, Scotland, Wales and Northern Ireland), and was based on three core principles: that it met the needs of everyone, that it was free at the point of delivery, and that it was based on clinical need, and not the ability to pay (http://www.nhs.uk/pages/home.aspx, accessed 4/3/2016). However, as populations grow older and population numbers and composition change, pressures on this service are increasingly being seen, and there are disparities in care even across the four regions of the NHS in the UK. In a 2012 audit of health care across the UK significant differences in health outcomes were found (National Audit Office 2012, 4). For example, in 2008–2010, average life expectancy at birth varied for men from 75.9 in Scotland to 78.6 in England, and for women from 80.4 in Scotland to 82.6 in England. Similar disparities were also evident in healthy life expectancy and in standardised mortality ratios, which take account of the make-up of each nation’s population in terms of age and gender. However, such measures of outcomes largely reflect general standards of public health – and therefore the need for healthcare – rather than the performance and effectiveness of the health services. There are also media reports to indicate that even within the same country of the UK, care varies (http://www.rightcare.nhs.uk/index.php/atlas/nhs-atlas-of-variation-in-healthcare-2015/, accessed 4/3/2016). One headline here was that older people in some parts of England are much more likely to be admitted to hospital because of the unavailability of the right care in their community.

Imagine now how varied care for individuals and communities was likely to have been in the past. This is notwithstanding the wide variation in how the same diseases would have affected different people in varying ways along a spectrum, how those people may or may not have developed impairments and whether those impairments affected their overall mental and/or physical well-being. This is in addition to thinking about if our ancestors had access to health care, with the quality and quantity of said health care likely to have been very varied. As the papers in this volume show, the subjects of impairment, disability and care are usually intertwined both in the past and the present and are, overall, extremely complex to navigate; this is particularly so when using bioarchaeological data. I believe that having an underpinning awareness of the here and now is essential to be able to appreciate the potential underlying nuances that bioarchaeological and other types of data present to us.

Understanding the nuances of people’s experiences of illness, impairment, disability and recovery

This volume has a focus on the treatment of people with impairments and disabilities in the past and their care (e.g. in the Palaeolithic – Thorpe; 19th century USA - Phillips), including animals (e.g. Thomas), and specific therapeutic agents (e.g. Willows, and King), alongside the ways in which people at different points in the life course received care (e.g. Lewis, Kendall, and Dawson on children, Gowland on the older generation), or indeed neglect. The volume also includes a very welcome consideration of the evolution of care (i.e. Doat). While exploring how care systems have evolved is imperative to understand the long view, it is also important to remember that the need for and quality of care through the life course will vary (from cradle to grave; see Public Health England 2014), as will the type and quality of care through the course of a disease affecting any one person (e.g. see Roberts 2016).

In providing this preface, I come from a background of nursing prior to entering academia and (unintentionally) staying with the latter. It was therefore a revelation to me as my career progressed that I could increasingly use what I learned in nursing to understand care in the past in its broadest sense, including inferring disability (Roberts 1988; 1991; 2000; 2014). Training in the 1970s and spending most of the three years on the wards, and learning on the job, unlike nurse training today, I learnt very quickly to think holistically, and consider the care of the whole. It was not just a matter of medical or surgical treatment of a person for an illness or injury, but a consideration of the whole person, physically, mentally and socially. As Hippocrates indicated in the 5th to 4th century BC, it is more important to know what sort of person has a disease than know what sort of disease a person has. I particularly learnt about people from a huge cross section of society. While there is a move in medicine to a more personalized approach, albeit today focused on using a person’s genetic profile to make decisions on prevention, diagnosis, and treatment of a disease (Muir Gray 2013), nursing care in the 1970s in particular was personalized. This likely reflected perhaps more time and money available to address personal circumstances, and how each person’s needs varied, even with the same illness or surgical intervention. Even at discharge, personal needs were accommodated and community care rapidly put into place to allow patients to go home to their community. While care in a hospital therefore could be personalized then, and people had time and energy, we had the capacity as nurses to provide added value, for example by talking to patients, providing a helping hand to get them better, and to engage with them as people, i.e. individuals in their own right.

However, the most important thing I learnt in nursing, and particularly relevant to this volume, was about disease and injury related disability. In my work as a nurse I appreciated that each and every person is an individual who will react to and express the same disease in their bodies in many different ways, along a broad spectrum, will have similar and different signs and symptoms, and recover at different rates. This set me up well for understanding and interpreting bioarchaeological data for disease and injury. It is also important to consider that people’s immune system strength will affect whether they experience illness and how severe that disease may be manifest. This has for me become extremely relevant as I study the evidence for leprosy in skeletal remains where different types of leprosy can be experienced along an immune spectrum (Ridley and Jopling 1966). I also quickly appreciated that as a bioarchaeologist it is impossible to talk to the patient and learn about their personality and emotions. This led me to the conclusion that we must respect these limitations when trying to understand the past and not over interpret the data. Indeed, even the personality characteristics of a well person can predispose them to later illness (e.g. see Smith and MacKenzie 2006), the persona of an ill person (and their care-giver) may affect the progress of their illness and recovery (e.g. see Fredrickson and Levenson 1998, Peterson et al. 2006; Reich and Schatzburg 2010, and many others), and even having a view from your hospital bed can aid recovery (Ulrich 1984)!

Impairment, disability and care in the past

Disability

The World Health Organization (http://www.who.int/topics/disabilities/en/, accessed 4/3/2016) defines disability as an umbrella term that covers impairments, activity limitations, and participation restrictions. Impairment is defined as a problem in body function or structure, an activity limitation, a difficulty that has an impact on performing a task, and a participation restriction is something a person experiences. As it says, it is a complex phenomenon, reflecting the interaction between features of a person’s body and features of the society in which he or she lives. The International Classification of Functioning, Disability and Health, a classification of health and health-related domains, being the WHO framework for measuring health and ‘disability’ at both individual and population levels, is particularly relevant here (http://www.who.int/classifications/icf/icf_more/en/, accessed 4/3/2016). Overcoming the difficulties faced by people with disabilities requires interventions to remove environmental and social barriers. This is the social model of disability, or the way society is organized that prevents a person with disability functioning normally. On the contrary, the medical model focuses on the illness as being the problem, and something that must be fixed. It is also clear that impairment may be something people are born with (congenital) or developed later in life. This has implications for their experience and how communities might treat them. If we consider that over a billion people today have some form of disability, this is 15% of the global population (http://www.who.int/mediacentre/factsheets/fs352/en/, accessed 4/3/2016), and that there are also up to two million adults who have significant problems in functioning; this is a global challenge that continually needs addressing.

We do know, nevertheless, that people (and animals) can adapt to having an impairment, but that this depends much on the person themselves and the characteristics of the disease and related impairment (e.g. see Farzad et al. 2015 on the little correlation of impairment with disability following a hand injury). We can also see adaptation at its extreme, for example at the London 2012 Paralympics; such impressive athleticism was apparent often with what appeared to be considerable impairment. However, we should also realise that impairments can be temporary or permanent, major or minor, and visible and invisible, the latter particularly having implications for treatment by communities. All these factors affect a person’s experience of their impairment. Impairment has of course been documented by many in bioarchaeology, as seen mainly in evidence in skeletal remains. Having just a skeleton and appreciating that impairment may affect only the soft tissues, or both bones and soft tissues, makes for a challenge in interpretation, alongside trying to consider related symptoms. For example, how much pain was experienced? In clinical literature it is clear that there are differences in perceptions of pain, pain thresholds in men and women, and whether pain is even experienced (e.g. Faccia and Williams 2008; Tschugg et al. 2015), and there are differences between the sexes in functional limitations (e.g. see Faccia and Williams 2008; Young and Lemaire 2014). Therefore, we might see a disease affecting the skeleton and know from the clinical literature that it can cause pain, but how can we actually know if the person experienced this symptom (e.g. see Roberts et al. 2016)? While impairment was likely present in the past, as seen through the lens of skeletal evidence for disease, interpreted using a clinical base, even if this was the case, A disability is only one aspect of an individual. In history, people have often forgotten that the individual is more than the sum of their disabilities (Covey 1998, 42).

Care

Care is defined as the provision of what is necessary for the health, welfare, maintenance, and protection of someone or something. Any person past or present has varied and different needs, whether they are old, young, male or female, and according to their individual illness. Associated with disability or indeed any illness accompanied or not by disability, there may be social stigma, which could have affected how a person was treated within their community and even cared for (e.g. see Roberts 2011 on a comparative study of leprosy and tuberculosis). However, as Dettwyler (1991, 382) usefully highlights, There is a wide gap between survival and being treated nicely.

It can be very challenging indeed to infer care in the past using any form of evidence. Some of the questions that need to be addressed might be: who received care, was it just physical care or was the person’s mental well-being also considered, did care changed throughout the time a person experienced a disease, and was it effective? In bioarchaeology, evidence of care may be directly visualized (e.g. trepanation, amputation, dentistry, or even wound care), or indirectly gleaned through interrogating historical documents or reading artworks. For example, a wealth of historical documents tells us that disability and care was a part of the experiences of past societies, but it is not always clear who was cared for and how. Likewise, bioarchaeologists who have documented disease and injury in skeletal remains may also have inferred disability and the provision of care. For example, in Frayer et al.’s (1987, 62) study of a late Palaeolithic skeleton representing an adolescent from Italy an assumption was made that he must have been supported by members of his social group despite his severe handicap and limited ability to contribute to subsistence and other economic activities. Speculation is fine of course, if the evidence is supportive.

There have also been assumptions about how a person was treated with specific diseases, for example that all people with leprosy were ostracized (but see Roberts 2002), and that communities built institutions into which ill people were incarcerated, for better or worse. While these institutions were opened, for example leprosy hospitals (e.g. see Magilton et al. 2008) and sanatoria (for people with tuberculosis – e.g. see Roberts and Bernard 2015), it cannot be assumed that each and every person with leprosy or tuberculosis was admitted nor, if they were, that they received decent care. Care itself in an institution may be available along a broad spectrum of quality and quantity from none, through abusive to excellent. It could however be argued that structural violence (Farmer 1996) could be inherent as a result of the founding of institutions, which might encourage stigma and imprison patients. As noted in this volume, a recent development in exploring personalized care has come from Tilley and Cameron (2014). This web-based method allows a much more nuanced and detailed understanding of the possibility that, firstly impairment was present as evidenced in the skeleton, and secondly that care may have been provided. Using a clinical base for understanding, and contextualizing the skeletal data, we are beginning to see a more objective, rather than subjective, approach to disability and care. Nevertheless, it does inherently make scholars focus on the individual (osteobiography) rather than the population at large, and therefore while a detailed understanding of that person’s experience is achieved, this cannot be applied more widely to the rest of their community.

Final thoughts

Exploring impairment, disability, and care in the past is, without doubt challenging and complex, as this volume highlights, but it should take a multidisciplinary, holistic approach, including the consideration of ethnographic data. However, the provision of care is and has been an inherent aspect of human behaviour, and its observation provides a window on compassion. We also have to appreciate that the consideration of disability and care must take an evolutionary approach, not only at the individual level, but from a life course perspective, and over time and space. Such studies must also consider views of the body, concepts of disease and treatment, levels of anatomical knowledge, and knowledge of care and treatment, which of course were likely passed down through the generations. Varied community responses to impairment and disability may also have led to changes in the built environment, and treatment of people at death (funerary context). Studies must also show clinical understanding of specific diseases and associated impairments affecting people in the past, as Tilley and Cameron (2014) have emphasized. A person’s age, sex, gender, social status, ethnicity, and religion also have important parts to play in interpretation. It may also be instructive to use documented skeletal collections with individual life histories. Integrating data on contemporary socio-cultural and political/economic context with that from skeletal remains is of course essential. Finally, we should remember that humans and other animals can, very effectively, adapt to circumstances in which they find themselves. We should not make assumptions necessarily that a person with X disease or injury was impaired or disabled. I encourage scholars working in this field of study from all disciplines to engage with the papers in this volume, and to embrace their recommendations. It is particularly pleasing to see younger scholars producing important contributions. This subject matter will undoubtedly be developed and continue to contribute towards debates surrounding care-giving in the past, utilizing a range of archaeological and historical evidence.

References

Covey, H. (1998) Social Perceptions of People With Disabilities in History. Springfield, Illinois, Charles C Thomas.

Dettwyler, K. A. (1991) Can palaeopathology provide evidence for compassion? American Journal of Physical Anthropology 84, 375–384.

Faccia K. J. and Williams, R. C. (2008) Schmorl’s Nodes: clinical significance and implications for the bioarchaeological record. International Journal of Osteoarchaeology 18, 28–44.

Farmer, P. (1996) On suffering and structural violence: a view from below. Daedalus 125, 261–283.

Farzad, M., Asgari, A., Dashab, F., Layeghi, F., Karimlou, M., Hosseini, S. A. and Rassafiani, M. (2015) Does disability correlate with impairment after hand injury? Clinical Orthopaedics and Related Research 473, 3470–3476.

Frayer, D. W., Horton, W. A., Macchiarelli, R. and Mussi, M. (1987) Dwarfism in an adolescent from the Italian late Upper Palaeolithic. Nature 330, 60–62.

Fredrickson, B. L. and Levenson, R. W. (1998) Positive emotions speed recovery from the cardiovascular sequelae of negative emotions. Cognition and Emotion 12, 191–220.

Magilton, J., Lee, F. and Boylston, A. (eds.) (2008) Lepers Outside the Gate. Excavations at the cemetery of the Hospital of St James and St Mary Magdalene, Chichester, 1986–1987 and 1993. Council for British Archaeology Research Report 158/Chichester Excavations 10. York, Council for British Archaeology.

Muir Gray, J. A. (2013) The shift to personalised and population medicine. The Lancet 382, 200–201.

National Audit Office (2012) Healthcare across the UK: A comparison of the NHS in England, Scotland, Wales and Northern Ireland. London, National Audit Office.

Peterson, C., Park, N. and Seligman, M. E. P. (2006) Greater strengths of character and recovery from illness. The Journal of Positive Psychology 1, 17–26.

Public Health England (2014) Framework for Personalised Care and Population Health for Nurses, Midwives, Health Visitors and Allied Health Professionals. Caring for Populations Across the Lifecourse. London, Public Health England.

Reich, J. and Schatzburg, A. (2010) Personality traits and medical outcome of cardiac illness. Journal of Psychiatric Research 44, 1017–1020.

Ridley, D. S. and Jopling, W. H. (1966) Classification of leprosy according to immunity: a five-group system. International Journal of Leprosy 34, 255–273.

Roberts, C. A. (1988) Trauma and its Treatment in British Antiquity. An Osteoarchaeological Study of Macroscopic and Radiological Features of Long Bone Fractures from the Historic Period with a Comparative Study of Clinical Radiographs, Supplemented with Contemporary Documentary, Iconographical and Archaeological Evidence. Unpublished PhD, University of Bradford.

Roberts, C. A. (1991) Trauma and treatment in the British Isles in the Historic period: a design for multidisciplinary research. In D. Ortner and A. C. Aufderheide (eds.) Human Palaeopathology: Current Syntheses and Future Options, 225–240. Washington, Smithsonian Institution Press.

Roberts, C. A. (2000) Did they take sugar? The use of skeletal evidence in the study of disability in past populations. In J Hubert (ed.) Madness, Disability and Social exclusion. The Archaeology and Anthropology of Difference, 46–59. London, Routledge.

Roberts, C. A. (2002) The antiquity of leprosy in Britain. The skeletal evidence. In C. A. Roberts, M. E. Lewis and K. Manchester (eds.) The Past and Present of Leprosy. Archaeological, Historical, Palaeopathological and Clinical Approaches. Proceedings of the International Congress on the Evolution and palaeoepidemiology of the infectious diseases 3 (ICEPID), University of Bradford, 26th–31st July 1999, 213–222. British Archaeological Reports. International Series 1054. Oxford, Archaeopress.

Roberts, C. A. (2011) The bioarchaeology of leprosy and tuberculosis in late Medieval England: a comparative study of perceptions, stigma, diagnosis and treatment. In B. Glencross and S. Agarwal (eds.) Handbook of Social Archaeology, 252–281. Chichester, Wiley Blackwell.

Roberts, C. A. (2014) Conference Paper on Bioarchaeology and disability: using the present to inform interpretations of past impairment. Dis/ability: Archaeologie und Anthropologie – Funde und Befunde, Bremen, Germany.

Roberts, C. A. (2016) Applying the index of care to a person who suffered leprosy in late Medieval England. In L. Tilley and A. Schrenk (eds.) Building a Bioarchaeology of Care. Springer, 101–124.

Roberts, C. A. and Bernard, M.-C. (2015) Tuberculosis: a demographic analysis and social study of admissions to a children’s sanatorium (1936–1954) in Stannington, Northumberland, England. Tuberculosis Special Issue 95, S105–S108.

Roberts, C. A., Caffell, A., Filipek-Ogden, K. L., Jakob, T. and Gowland, R. (2016) Til Poison Phosphorous brought them Death: An occupationally-related disease in a post-Medieval skeleton from Coach Lane, North Shields, North-East England. International Journal of Paleopathology 13, 39–48.

Smith, T. W. and MacKenzie, J. (2006) Personality and risk of physical illness. Annual Review of Clinical Psychology 2, 435–467.

Tilley, L. and Cameron, T. (2014) Introducing the Index of Care: A web-based application supporting archaeological research into health-related care. International Journal of Paleopathology 6, 5–9.

Tschugg, A., Löscher, W. N., Hartmann, S., Neururer, S., Wildauer, M. and Thomé, C. (2015) Gender influences radicular pain perception in patients with lumbar disc herniation. Journal of Women’s Health (Larchmt) 24, 771–776.

Ulrich, R. S. (1984) View through a window may influence recovery from surgery. Science 224, 420–421.

Young, J. L. and Lemaire, E. D. (2014) Linking bone changes in the distal femur to functional deficits. International Journal of Osteoarchaeology 24, 709–721.

Chapter 1

Foundations and Approaches to the Study of Care in the Past

William Southwell-Wright, Rebecca Gowland, and Lindsay Powell

Introduction

Care may be broadly defined as the provision of what is necessary in order to maintain another person’s state of health and welfare. Care provision for infants and children is regarded as normative and universal; care for the elderly is culturally more variable, though still an expected part of the dynamics of care across the life course. Care for those who are dependent as a consequence of physical and/or mental impairments arguably presents a more exceptional social challenge and has been highly historically variable. From the earliest humans to the present day, all groups have faced choices regarding the care, inclusion, or marginalisation of impaired individuals. Decisions regarding care-giving within any one society are contingent on a range of factors, such as environment, culture, and social structure, in addition to the nature of the impairment and the pre-existing identity of the sufferer. The question of care, both as an activity and as a social attitude towards those who require it (the emotional side of care), are of inherent interest to all people in all times. It is worth noting, that in this broad definition of care, it is important that we do not confine it to humans alone, but also encompass the care of animals. This book therefore aims to address a variety of these aspects of care in the past, through the adoption of a range of perspectives furnished from evidence that includes bioarchaeological, isotopic, faunal, philosophical and historical analyses.

In the developed world, questions surrounding care for the disabled, the elderly, their place in society, and social stigma and approbation surrounding people’s choices of child-rearing practices are matters of constant discussion and controversy, both within the media