On some paleopathological examples of amputation and the implications for healthcare in 13th-17th century Lithuania.

OBJECTIVE: To explore care that was likely provided to an adult male amputee from medieval Lithuania, positioning analysis within what is known of contemporary amputation practices. MATERIALS: Three sets of skeletal remains with evidence for amputation, dating to between the 13th-17th centuries AD and recovered during different archaeological excavations in Vilnius, Lithuania. METHODS: Macroscopic inspection of lesions, with additional X-ray analysis of the main subject. The Index of Care was used to investigate possible caregiving. RESULTS: Two individuals experienced amputation of a single element, and the third experienced bilateral hand amputation. Only one individual displayed healing. Historic sources suggest use of amputation for punitive purposes during this period, and judicial punishment is proposed as the most likely reason for amputation in at least two cases. CONCLUSIONS: Evidence of long-term healing in one individual suggests receipt of care. This individual likely relied on family and/or community members for survival immediately following amputation, and subsequently for support in managing disability. SIGNIFICANCE: Successfully combining osteology with history in a framework for analyzing care provision in past Eastern European society, this study underlines the critical importance of context in undertaking bioarchaeology of care analyses. It also adds two examples of perimortem abscissions in this region to the paleopathological record. LIMITATIONS: Our approach relied on skeletal interpretation. Soft tissue was lost to decomposition and no relevant archaeological evidence was found in association with the remains. SUGGESTIONS FOR FURTHER RESEARCH: A review of skeletal collections may allow identification of overlooked cases of amputation (and care).

A possible case of paralysis in early modern Vilnius and the implications for social care.

OBJECTIVE: To present a case of possible paralysis from early modern Vilnius and to discuss the potential level of care that was provided in the society of that time. MATERIALS: A partially disturbed skeleton of a young female from a 16th-17th century Orthodox Christian cemetery. METHODS: Macroscopic, osteometric and X-ray examinations coupled with a literature review aimed at providing a differential diagnosis. RESULTS: The skeletal remains showed signs of disuse atrophy most probably due to a neurological disorder acquired in the woman's late teens. Differentials suggest that the observed limb atrophy was most likely a consequence of poliomyelitis. CONCLUSIONS: The case of a young female with paralysis presented in this paper could serve as an example of care provided by her household. SIGNIFICANCE: This study substantially contributes to further understanding of the nature and quality of care provided to disabled individuals in their households even in the absence of written sources. LIMITATIONS: There is a degree of diagnostic ambiguity due to the application of routine clinical criteria to paleopathological cases. SUGGESTIONS FOR FURTHER RESEARCH: The article makes several recommendations for future research, e.g., systematic investigation of possible cases of bone atrophy in a broader sociocultural context, as well as searching for evidence of gastrointestinal infections, especially poliomyelitis, supplemented by the application of biomolecular technologies.