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Care in Ancient Societies

By Michael Cook

Archaeologists are documenting evidence that ancient humans cared for disabled members of their community.

End-of-life care is a phrase associated with gurgling tubes, beeping monitors and flashing lights. But a fledging sub­specialty of archaeology is examining how early humans cared for the disabled in their communities.

A recent paper in the International Journal of Paleopathology has documented the life of a young man who lived in northern Vietnam 3700–4500 years ago. “M9”, as archeologists have named him, was paralysed from the waist down and would have had very limited upper body mobility yet he apparently lived into his early thirties.

How was survival possible in a subsistence Neolithic community? The answer was around-the-clock, high quality personal care according to Lorna Tilley, a PhD student at the Australian National University. This would have included regular bathing, toileting, massaging and turning to avoid pressure sores.

Tilley and her co-author, Marc F. Oxenham, make some interesting observations about the ethics of care. In modern society, people with extreme disability often succumb to depression, sometimes resulting in suicide – and this can occur indirectly by refusing care. In a Neolithic community, depression would have been lethal.

Tilley says that M9’s survival therefore meant that the young man must have lived in “a secure, emotionally-supportive, inclusive environment in which care was provided ungrudgingly, enabling M9 to grow to adulthood, to develop a role for himself within the group, to retain a sense of self-respect, and to interact with others in his community at whatever level was possible. In view of the prolonged and particularly demanding nature of the care provided, it seems justifiable to speculate that the carers’ motivations included compassion, respect and affection.”

As for M9 himself, the “bioarcheologists” suggest that he must have had a remarkable personality. “M9’s prolonged survival with disability suggests an extraordinarily strong will to live; a robust psychological adaptation; a self-esteem capable of overcoming the complete loss of independence; and a personality capable of inspiring others to maintain high quality and costly care over time.”

This is far from the only example of a prehistoric ethic of care. A Neanderthal who lived in Iraq 45,000 years ago survived cranial trauma, amputation of his right arm, other injuries and osteomyelitis thanks to the care of his community.

Likewise a skeleton dating back 10,000 years ago in Calabria exhibited signs of severe dwarfism. Since the young man would not have been able to keep up with other tribesmen in searching for food, his companions must have accommodated his handicaps.

One of the most remarkable stories was published in the Proceedings of the National Academy of Sciences in 2009. It dates back more than 500,000 years ago. Cave dwellers in northern Spain cared for “Cranium 14”, a young girl with cranio­synostosis. This is a birth defect in which the skull segments close too early, producing facial deformities and interfering with the development of the brain.

This deformity is distressing for parents. The head can be large and misshapen, and the eyes can bulge out. The children can be blind and deaf. Their limbs may be deformed. They may have seizures and feed poorly. Many doctors today would advise mothers to terminate the pregnancy.

Here’s the remarkable thing. The hunter-gatherer family of Cranium 14 must have cared for her or she would not have survived for at least 5 years, and perhaps as many as 12 years. In the words of the scientists: “It is obvious that the hominin species did not act against the abnormal/ill individuals during the infancy, as has happened along our own history many times and in many cultures”.

The bioarchaeology of care is a fledgling field that requires subtle analysis of the remains of ancient societies. It is important to avoid reading into the evidence contemporary values and attitudes. But looking after the disabled has always been one of the hallmarks of humanity. It’s inspiring to gaze across the centuries and millennia and see altruistic care for the sick and helpless even among our remote ancestors.

Michael Cook is editor of the bioethics newsletter BioEdge.