Caring in Ancient Times

A new bioarchaeological approach suggests health care has a long human history.

Over 4,000 years ago, in a small hunter-gatherer settlement in northern Vietnam, a young man survived for around a decade while paralyzed from the waist down and with extremely limited use of his upper limbs. This degree of pathology would pose a challenge to living at any time in human history; in the Neolithic community of Man Bac it would have been completely disabling.

Archaeologists record the remains of Man Bac Burial 9 before removal. Lorna Tilley

We can’t know exactly how Man Bac Burial 9 experienced his quadriplegia, but like anyone managing long-term immobility he would have faced serious and potentially life-threatening health challenges, including pressure sores and dysfunction of the major organ systems. Yet Man Bac Burial 9 lived with severe disability from early adolescence into his mid-twenties. The immediate cause of his death is not clear, but what certain is that he could not have survived 10 days, let alone 10 years, without continual, comprehensive, and labor-intensive care from members of his community.

The case of Man Bac Burial 9 was the first to use a new methodology in the archaeological sciences—the bioarchaeology of care—developed to examine the way in which people in the past responded to the demands of severe disease and disability. Skeletal evidence suggests that contrary to a commonly held view of prehistoric life as a relentlessly competitive and self-serving enterprise, some past peoples cared for vulnerable members of their societies. A growing number of studies using the bioarchaeology of care approach propose that far from abandoning those with disease or disability because to support them would be too costly for the group, past people were willing to use scarce resources to accommodate and care for those in need. The bones of those who lived with the impacts of serious pathology can speak to us of complex cultural and biological aspects of health care provisioning in the past, and suggest that health care may be as old as humanity.

The bioarchaeology of care

The bioarchaeology of care offers a framework for helping archaeologists to identify and interpret likely cases of health care provision in the past. The researcher initiates analysis when evidence in human remains suggests an individual survived despite a disease or injury that most likely resulted in a disability—and a need for care in the form of direct support and/or accommodation. The approach provides a systematic, four-stage procedure for describing pathology; assessing clinical and functional impacts and associated disability; constructing a basic model of care possibly given in response; and investigating the implications of caregiving at both the individual and the community level. This last stage may be the most important one of all.

Bioarchaeological analysis of health-related care can provide unique insights into past human behaviour and, more particularly, past human agency. Caregivers and care recipients must navigate a range of choices in deciding whether care is necessary, what care is possible, whether to commit to providing and/or cooperating in this care, and perhaps when care should end. The decisions reached allow us to reflect on the values, beliefs, and abilities in play, and through these to enrich our understanding of history.

The four stages of the bioarchaeology of care are operationalized in an open-access, online application—the Index of Care—designed to walk researchers through the process of analysis.

Lorna Tilley

Caring for Lesley

A young woman migrated to the trading village of Tell Abraq, south of present-day Dubai, during the Bronze Age (2,200 BC–300 AD), and contracted a debilitating disease which resulted in the permanent paralysis of her legs. Named “Lesley” by the archaeologists who excavated her, she was the only fully articulated individual in a communal tomb of commingled remains. Using the bioarchaeology of care approach we can explore the implications of health care provisioning in this community.

Differential diagnosis of Lesley’s skeletal remains indicates that she suffered from paralytic poliomyelitis. The poliomyelitis virus is highly contagious, entering the body through the fecal-oral route, often through contaminated water or person-to-person contact. Isotopic analysis indicates that Lesley moved to Tell Abraq when she was around 18 years old, placing her at increased risk for contracting the paralytic form of the disease. During the initial stages of the virus Lesley would have suffered high fevers, stiffness in neck and limbs, headaches, vomiting, and muscle fatigue. Within the first few days, she would have begun to lose mobility in her legs followed by the loss of use of her arms. While it is impossible to know exactly for how long Lesley experienced poliomyelitis, patients today usually recover from the acute phase of the virus within 3–12 months.

The severity of disease required two phases of health care: intense short-term care for the duration of the virus, and long-term accommodation for the subsequent permanent paralysis. During the acute phase of her illness, she would have required close monitoring and someone to provide her with food and water. She may well have needed throat massages while eating and drinking to assist swallowing and prevent choking. Her temperature would have needed regular monitoring and measures taken to reduce high fevers (such as the application of a wet cloth to the head and/or body). She would most likely have needed assistance with bathing and toileting, and frequent postural adjustments would have been necessary to prevent the development of bedsores and infection.

Lesley in situ. Left: Uncovered, fully articulated, and flexed on her left side. Right: Surrounded by commingled remains of the tomb’s other occupants.Nassir H. Al Abboudi, Director, Government of Sharjah, Department of Culture and Information, Directorate of Antiquities and Heritage

The thin and elongated nature of Lesley’s femora and tibia (upper and lower leg bones) indicate that the virus left her paralyzed from the waist down. While she may have required continual help with hygiene and prevention of bedsores, most care would have been in the form of accommodating her disability. If food and fluids were kept close, Lesley would have been able to manage her diet independently, although it is unlikely she would have been able to gather produce from the agricultural fields surrounding the area. So, we can infer that others must have offered her some form of basic food provisioning. Muscle markers on her radii, ulnae, and clavicles (upper and lower arm and shoulder bones) suggest that Lesley was using her arms extensively, and she may have been dragging herself around her domestic setting and immediate village confines.

The amount of care required during the acute, possibly year-long, phase of disease would have placed considerable strain on members of Lesley’s community, particularly her immediate family. All the time spent monitoring and caring for Lesley was time not spent on other essential tasks, such as working in the fields or herding animals. Lesley’s survival indicates that her community was willing (and able) to expend the time and resources necessary to look after her while she suffered the serious effects of this stage of her illness.

Community members’ management of the long-term impacts of Lesley’s paralysis would have included the adoption of strategies to accommodate her daily wants and needs. People would have recognized that she was unable to participate in normal agricultural tasks and likely accepted her taking on additional responsibilities in other areas such as household chores or weaving, by way of compensation. It is unlikely that Lesley did nothing at all, as most members of pre-industrial societies were required to contribute to the group economy where possible. Such adjustments indicate a collective readiness to modify social roles within the community to accommodate difference. While this might seem a slight concession, it reflects a willingness to value a person’s ability to contribute in non-standard ways, and acceptance of the need to be flexible in the way society is run.

Learning from ancient care

So what can the bioarchaeology of care approach tell us? In the cases of both Man Bac Burial 9 and Lesley, provision of health-related care entailed intensive and time-consuming efforts on the part of caregivers. In both cases, those providing care in response to acute distress would more than likely have anticipated that, were initial health care measures successful, some level of long-term support for the recipient might be needed. Conscious choices were required: To give or to withhold care? To assign scarce resources to caring for one individual or to assign priority elsewhere? In both instances, group members chose to allocate their time and energies to caring for the vulnerable in their community.

Our past contains important lessons for the present, if we are willing to pay attention. As we write this article, uncertainty reigns over the fate of the millions who will lose health care coverage if the Affordable Care Act is repealed. Is this really the best “art of the deal” that we can manage? An archaeological focus on health-related care completely overturns the notion that society has evolved by embracing a winner-takes-all “survival of the fittest” approach to health and welfare policy. On the contrary, research demonstrates the cooperation, flexibility, and ingenuity shown by past peoples in caring for one another. The bioarchaeology of care approach highlights a defining hallmark of the human species: our capacity to support each other in times of need.

Alecia Schrenk is a PhD student at the University of Nevada, Las Vegas. She is first author on two publications exploring migration, disability, and health care at Tell Abraq. In 2015, she organized a session at the Society for American Archaeology’s Annual Meeting, resulting in the volume New Developments in the Bioarchaeology of Care (2016) with Lorna Tilley.

Lorna Tilley is a visiting fellow at the Australian National University, Canberra. She is sole or primary author of several articles on the bioarchaeology of care approach; the first (Tilley and Oxenham 2011) was awarded Most Influential Paper (2011–2015) by the International Journal of Paleopathology. She is author of Theory and Practice in the Bioarchaeology of Care (2015), and co-editor of New Developments in the Bioarchaeology of Care (2016).

Cite as: Schrenk, Alecia, and Lorna Tilley. 2018. “Caring in Ancient Times.” Anthropology News website, January 24, 2018. DOI: 10.111/AN.743


Fascinating and glad of this approach. Back when–I was doing my dissertation research–I contemplated this issue but did not develop it. One male in the skeletal group had a congenial malformation of his humerus and yet–the arm must have worked/been braced because the lower arm was normal and he lived an ordinary lifespan. Fieldwork subsequently with living people one case of spina bifida in a child of 6–paralyzed and mentally deficient, but completely integrated into community and no infections despite dirt floors no running water, etc. Another fieldwork: child of 8 polio paralysis waist down, crawling in desert dirt, healthy and needed to be removed from village to polio hospital before she reached adolescence (self-awareness), and in same tiny village, infant 13 months old, ‘floppy baby syndrome’ = complete helplessness, no sucking reflex, looked 3 months, mother dropped milk drop by drop into his throat…and…his smile lit up the entire village! Still, he was close to death, after a vast effort on his mother’s part. People do, and people did, care for each other. I am certain of that.

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