 Oh, hello everybody. I'm not actually going to give a background into bioarchaeology because there are several people here who know far more about it than I do, but I am going to give bioarchaeology of care. So, beginning. Caring for those who are disabled by disease or injury is one of the most common, complex and demanding of behaviors. And if we can untangle the components of this care can tell us a lot about the people who are giving it and about the society in which it was given. So, where there's evidence in human remains indicating that a person lived with a disabling pathology suggests that they were probably cared for by those around them. And if we can tease out that experience of disability and care can provide us with new perspectives on the past. And the bioarchaeology of care is an approach that attempts to do just this. And while it was developed with prehistoric populations, because I'm a prehistorian, okay, that forgives me everything, there have been a few stunning applications of this approach to historic populations and you're going to be hearing some of these in this session. For those who haven't come across it, I'm going to introduce the bioarchaeology of care methodology illustrated with a case study from prehistoric Peru. Then I'm going to discuss what the presence of text might offer bioarchaeology of care analysis. You might well ask why use the prehistoric example in a medieval care session. Well, the absence of documentary evidence lets me show what can be achieved with archaeology alone with material evidence alone. And this provides the baseline for considering what text might add. And this is going to be a very fast and furious presentation and I apologize in advance because there's a lot of material to cover. The bioarchaeology of care is case study based, it's cross-disciplinary. It consists of four stages which progress through description, inference to interpretation with each stage building on the last to encourage a systematic and rigorous approach. I'm going to go through each stage in detail, don't worry. This approach is fundamentally bioarchaeological. I want to emphasize that context is as important as diagnosis for understanding what was necessary and what was possible in giving care. And analysis is supported by the index of care, an online application with four steps corresponding to the four stages containing linked worksheets to help organize evidence and observation and I have a handout available. Stage one of the bioarchaeology of care describes diagnosis and documents. It brings together all personal and life ways, information available for the subject and it provides the context for all subsequent analysis and interpretation. And the subject today is a young boy from the Nazca culture aged eight at death. He dates to 700 A.D. which is the late Nazca period and was recovered from a grave in Hacienda Agua Salada, Nazca province Peru. His remains were wrapped in textiles forming a money bundle. Within this bundle he was positioned on an adobe stool with lower legs drawn back beside him. Spinal deformities visible suggested that he might have been suffering from spots disease or spinal tuberculosis. Now in 1973 Allison and colleagues identified evidence for pulmonary and extra pulmonary tuberculosis, POTS disease and a psoas abscess as well as multiple Harris lines acquired from early childhood onwards indicators of arrested growth which suggested chronic poor health. Allison and Co suggested the timeline for disease that's shown here, initial infection around age two, TB of the spine leading to lower body paralysis around age six or seven and death within weeks from blood-borne spread of TB to various organs happening into round age eight. And I'm happy to share my slides with anybody so don't bother taking photographs unless you really want to. There are two special features of the boy's mortuary treatment. The most significant is the position, his position on the stool. It was shaped to his body and this suggests that he used it during life and this fits in with ethnic historic reports that such stools were used to transport people unable to walk. In typical Nazca burials, bodies of flex needs to chest and position sitting just straightforwardly or on their side. There's no other interment with this feature recorded making this burial unique. Among the standard range of grave goods the second unusual feature is inclusion of pan pipes. Now pan pipes were associated with shamans with ceremonies with rituals. There's no other known case of their inclusion in a child's burial. General background. Okay the Nazca boy came from a small farming settlement on the Nazca river in the desert foothills of the Andes. Asyandawa Salada likely consisted of a few families defined by a common ancestor with everyone sharing economic, social and cultural responsibilities. The late Nazca period was defined by environmental and social pressures. General health stress and frequencies of disease and injury were on the increase. The rich Nazca iconography reflects cosmology, culture, it suggests animus beliefs with emphasis on fertility, death and regeneration. Increasing scenes of conflict in the late Nazca probably reflects social breakdown. But what's most interesting is what is not depicted in the art. So no domestic scenes, few representations of women and no representations of children. In fact there's very little in the archaeology to suggest just how Nazca children were regarded and we're going to come back to this later. Stage two establishes whether on balance of probability the subject had a disability requiring care. With disability defined in terms of functioning capability within the subject's social and physical context. Part one looks at the clinical impacts of the subject's pathology then part two identifies the possible effects of these impacts on the subject's ability to function independently. If care was likely required to manage the pathology impacts then the case study continues. If the subject could well have managed without care it stops. So symptoms of untreated spinal TB include fever, anorexia, weight loss, failure to grow, exhaustion and pain. Over time mechanical restrictions from the virtual damage reduced respiratory function. As neurological impacts of Pott's disease reduced his mobility the Nazca boy faced the range of well known immobility related problems. Challenges to cardiovascular, endocrine, digestive functions and of course the potentially lethal pressure source that accrue when people are bedridden. The symptoms of active blood-borne TB are listed here and they are pretty much the same as those of Pott's disease but on steroids. Part two of stage two considers the likely effects of identified clinical impacts on functional capability in terms of essential and instrumental activities of daily living. So the essential activities of daily living on the left are tasks fundamental to a basic level of independence. If they can't be performed then regardless of time place the person will need care to survive. Instrumental activities of daily living on the other hand refer to everyday actions and interactions considered normal for a community member. So pathology impact on instrumental activities is largely context dependent. For most of the Nazca boy's life up to his loss of mobility disease impacts probably have come under the heading of instrumental activities. He lived with poor health from early childhood delaying development of motor skills in turn probably affecting cognitive, social and emotional development. Unable to keep up with his peers he'd miss out on most of the informal activities where children learn social and applied skills. Find it impossible to carry out the small jobs that are typical for children in pre-industrial agricultural societies feeding animals bringing in firewood fetching water. With loss of mobility would come the impacts that fall under the essential activities of daily living heading. He'd be increasingly reliant on others for meeting basic needs for bathing and toileting for movement over distance for access to food and water for social participation and following the onset of milliery TB well he'd be incapable of any independent function. So to the final question of stage two on the balance of probability did the Nazca boy require care? Well while all children require care at some stage the Nazca boy required special time consuming health related care over most of his lifetime so the answer to that is yes. Stage three identifies the components of care provided in response to stage two impacts considered within the constraints of the stage one lifeways context. It proposes a model of basic care the duration of care what resources were required and what costs might have been incurred. Caregiving is conceptualized along a continuum extending from direct support through to accommodation of difference where direct support really refers to hands-on more intensive care more resource using care and accommodation of difference refers to adjustments made to include the subject within the community when their disability makes participation difficult or perhaps impossible. In the bioarchaeology of care certain basic components of caregiving is viewed as constant over time and place because they derive from what we could think of as constant human physiological and psychological needs so constants of care listed on the left mostly correspond to direct support where evidence of disease permits we can infer some of these constants with a fair amount of confidence on the other hand accommodation of difference covers measures to adapt the environment to the individual and a largely context determined so against the backdrop of the subjects lifeways we can ask what activities were standard what level of participation was expected was the physical environment an obstacle to participation and we can identify where adjustments may have been required and even in very broad terms what that those adjustments might have been. So the Nazca boy would need accommodation throughout his life acceptance of his difficulties then just acting as an ordinary child would call for special efforts to include him in activities as disease progressed he'd need a mounting level of direct support every form of care that's listed there on the bottom left would be needed and nursing an increasingly fragile child and he'd also need social and psychological support to comfort him to entertain to distract him and above all to give him that motivation to keep struggling with his disease all this increasingly demanding care would come with practical and emotional costs for his immediate carers of course but in a small subsistence stressed community there are also economic and social costs involved in supporting the caregivers themselves and these costs are borne by the small group as a whole. Stage four unpacks the implications of both provision and receipt of care in terms of understanding aspects of community social relations practice and organization and subject identity so caregiving always always involves agencies both agency sorry should really stress that caregiving always involves agency both carers and carer recipients choose how they respond to the challenges of disability which is why care offers such a valuable picture into the past part one focuses on caregivers and it proposes a generic decision path considers what underlies choices made at each step from identifying the need for care through to the end of care and includes mortuary treatment as care after death it asks what any particular decision made might suggest but aims motivation skills resources of those involved part two focuses on the subject what the experience of disability and to care may suggest about them as an individual the nasca boy case study allows us to consider aspects of cultural practice and his community including nasca attitudes towards children it's clear that there was a substantial emotional and economic investment in caring for a youngster who had little chance of long-term survival suggesting that even in the pressured environment of the late nasca the nasca put a high value on preserving life the boy's unique burial treatment seems an extension of this care the presence of the adobe stool might be explained in various ways as a mobility aid perhaps to help transition to the afterlife maybe to help functioning in the afterlife or maybe the stool was just such a part of his identity that including it was a mark of respect of love why the panpipes maybe they represent shamanic healing possibly needed in the afterlife or maybe the boy just liked panpipe music and the pipes celebrate the presence the pipes celebrate this but whatever the reason their inclusion is intentional it has a meaning that marks the boy as an individual both in life and in death together these aspects the burial treatment may tell us something of nasca beliefs about what happens after death for example maybe they reflect the belief that an individual retains their corporeal form it's just simply translated to another realm returning to the earlier observation that there's no evidence of how children were regarded in nasca culture the nasca boy's care during life and after death shows that at least one child was valued and if one child was valued perhaps it was nasca cultural practice to value all children perceiving each child as having their own personality their own needs and finally no one receiving care is passive they choose to cooperate with care and the shapes its process and its outcomes the osteobiography developed over stages one to three is the basis for speculating about the subject as a person the nasca boy had a very different childhood to his healthy appears outside the main action yes but also the focus of special attention you can't know how he responded to this maybe he felt special maybe he felt frustrated maybe angry maybe depressed maybe all of these but the length of his survival suggests the coping personality tenacious adaptable huh now to the meat based on archaeological evidence alone we get a very rich picture of the nasca boy's lived experience in his life ways but how might this study had been different if it had been located in historic times if he'd been a peasant child from early medieval rural europe of 700 ad when tb or the wasting disease was well established well we probably wouldn't have any additional information on what his personal experience of disability or care involved from contemporary texts there's little in medieval documents that deals directly with the detail of day to day caregiving maybe this is because caregiving was such a commonplace activity that there was no need to record it having said that actually a few of the medieval miracle narratives the counts of disabled pilgrims seeking cures at holy shrines do provide a glimpse into what was involved in caring for some pilgrims before they were healed but these narratives of course were written to promote belief in divine healing not to document how people lived with disability nor the nature of their care although texts on the practice of caregiving are lacking as in the anna pointed out there's a wealth of medieval documents on the philosophy and teaching of medicine on symptoms etiologies diagnosis prognosis of a vast range of pathologies and the recommended treatments for these which span prayer medicine surgery all the way to medical to magical incantations healthcare practitioners are described so we have physicians leeches midwives barbers astrologers wise women members of religious orders course was central entrusted with the health of body and soul which were understood as inseparable and texts reveal the presence of diseases largely invisible to archaeology for example mental illness which is a huge issue today also major concern in medieval times even though it was differently conceptualized texts can also shed light on how people with disabilities were perceived while there may have been no specific category of the disabled in medieval times disabilities existed and there was sometimes stigmatized so in some periods people with leprosy were unclean those born with deformities with a product of unnatural sexual practice such conception and those crippled or blinded in later life displayed punishment for sins against God until quite recently it was believed that where disability was considered the fault somehow of the sufferer they received little sympathy although most historians now believe that even when notions of fault pertained those in need did receive care back to the Nazca boy what could text add to his case study as things now stand we'll never know how the Nazca boys community understood what was happening to him did they recognize tv as one disease with a range of symptoms or did they explain his condition as a selection collection of unrelated pathologies was it a disease at all in the sense of an unnatural state to be reversed was it the result of rational forces or bad magic with the will of the gods was k contingent on the cause of illness or was k given regardless of course what medical interventions what healers would have been available for a peasant child as a child would he have been treated differently to an adult as a boy differently to a girl without direct evidence we never know what exact treatment was given to somebody like the Nazca boy but where contemporary documents exist we can build a more complete picture of the environment in which his disability and care were experienced so our analysis will be richer for this and what we draw from a bio archaeological analysis in context such as these in relation to the lived experience of disability and care in turn enriches the historical record so in looking at these sorts of questions bio archaeology of care can make a significant contribution to medieval social history so in reading this presentation my general lack of ignorance so it was very eclectic choice I was struck by the general lack of cross fertilization between the work of bio archaeologists and the work of historians and I think this results in a diminished capacity for us to understand the past for bio archaeology of care case studies situated in historic times there's huge potential for embracing both the contents of primary sources and contributions of historians skilled in interpreting these and interestingly the past decades have seen some historians adopting what's called a material turn focusing on objects made or modified by humans and recasting text as material culture and analyzing it as such on the other hand the bio archaeology of care takes human remains modified by the actions of caregiving approaching these in part as material culture and then tries to read these remains as if they were text telling the story of an individual and their community so for bio archaeology of care at least close collaboration between bio archaeologists and historians could be a marriage of minds and it could produce amazing results thank you