Bioarchaeological Analysis of Disability and Caregiving from a Nineteenth-Century Institution in Central Kentucky

This article presents a case of disability and care provision from a mid-nineteenth-century psychiatric institutional care facility (Eastern State Hospital) in central Kentucky. The study focuses on a late teen or early young adult (15–19 years old) displaying bilateral limb length asymmetry and skeletal atrophy, suggesting neurogenic paralysis of the left arm and leg. Conditions considered in the differential diagnosis include traumatic injury and neuromuscular disorders such as Duchenne muscular dystrophy, paralytic poliomyelitis, and cerebral palsy. Based on the pathological conditions observed and careful consideration of the biosocial context, the individual in the current case most likely suffered from spastic hemiplegic cerebral palsy. This investigation utilizes the bioarchaeology of care methodology developed by Tilley and Oxenham (2011) to explore the relationships between biological and sociocultural dimensions of disability and the provision of care. The individual’s physical impairments are assessed to identify the possible clinical significance and functional limitations on the ability to perform daily activities within the specific biocultural context, as well as what that care may have comprised. The differential diagnosis and bioarchaeology of care analysis presented provides insight into the experience of disability and care provision for patients of the hospital, while highlighting some of the challenges introduced with historical institutionalized individuals.