Physical Impairment and Care Estimation in Medieval Estremoz (Portugal): A Bioarchaeological Perspective

Abstract

This study aims to compare diet and skeletal health indicators between individuals with varying degrees of physical impairment and the general adult population from medieval Estremoz, Portugal, to assess their health status and their survival outcomes. Skeletal remains from 41 male adult individuals, including 8 with physical impairments and 33 from the general population, were analyzed. The impairment of these individuals was described, and their need for care was inferred considering the guidelines of the Index of Care and the Bioarchaeology of Disability approach. Skeletal lesions, physiological stress indicators, and estimated diet (using stable isotope analysis of bone collagen) were compared between individuals with and without signs of physical impairment. Individuals with physical impairments did not exhibit more frequent or more severe skeletal indicators of physiological stress or trauma than the general population. The survival into adulthood with good health of individuals with physical abnormalities or limiting conditions suggests consistent care, particularly in childhood and as needed throughout life. This study provides evidence that individuals with disabilities in medieval Estremoz do not seem to have been excluded from the community. These findings contribute to broader discussions on social support, resilience, and caregiving in historical populations. The sample size of impaired individuals is small, and osteological preservation may limit the identification of subtle stress indicators. Future work should explore disabilities and caregiving practices in other medieval populations, incorporating stable isotopic analysis to compare their adult and childhood diet with the general population.