The study of disability in Iceland has recently ventured into
accessing experiences of disability in the past in interdisciplinary
perspective and produced compelling contributions.
Archaeological evidence contributes to these endeavours by
offering broad contextual clues as well as toolkits for extrapolating details
about both individual and community-level experiences of disability in the past.
For example, considering factors such as building materials and design, space
and settlements, we can learn more about the risks to human health posed by
dwellings (Roberts 2012). Drawing on concerted enquiries regarding the
potential place of archaeology within disability studies and how care might
have been evidenced in the past, palaeopathology has offered new insights into
these questions for disability in an Icelandic context (cf. Tilley; Southwell-Wright). Using understanding gleaned from archaeological contexts of social
conditions, dwellings, and the indoor and outdoor environments to build a
context for the data acquired, this study in particular will unpack population-level data about possible cases of hearing loss in medieval Icelandic
communities.
In bioarchaeology, individuals are regarded as keepers of biological and
social data, accessible primarily through the skeleton, enabling us to explore
community dynamics, health, and vulnerabilities using identified patterns
(Hodson; Tilley; Perry and Gowland). The human remains found in
archaeological excavations in Iceland have indeed kept such data, giving
researchers invaluable insights into household and community dynamics, and
the impact of diet and environment on health throughout the life course (Zoëga
and Murphy; Walser III et al.; Sayle et al.). In particular, the data in this study
present an opportunity to advance child-conscious perspectives in our lens on
the past, to interpolate elements of household and family dynamics. In this vein,
this work is grounded in the anthropological framework of situated biologies,
which is essential to exploring the dynamic interactions of the human body
with its socio-cultural and ecological context. This framework can bring nuance
to the perspectives—that is, as perspectives and not necessarily statements of
fact—enshrined in inherited historical accounts (Niewöhner; Southwell-Wright).
Studying hearing loss as both an individual and broader societal experience
can allow for comparison of health within and between populations and may
also offer insights into speech and language acquisition in the past in this
context. This study aims to describe the potential for hearing loss using skeletal
remains from four medieval Icelandic assemblages: Hofstaðir, Keldudalur,
Skeljastaðir, and Skriðuklaustur (as reported in Collins 2019). In these
assemblages, the prevalence of pathological hearing loss appears to be
contingent with evidence for chronic respiratory infection, especially endemic
tuberculosis (TB). This study also explores the experiences of children in the
past, and especially how children in an assemblage may not only represent
evidence for continuous transmission of TB but might also be used to form
criteria to determine TB endemicity, or hyperendemicity in past populations.
The results of this study uniquely allow us to shape a narrative about hearing
loss at a populational level, using the skeletal remains as a primary biological
resource situated in interacting and overlapping contexts.
The study of disability in palaeopathology has been characterized largely
by identifying visible markers of trauma, joint disease or obvious deformity,
especially changes which have resulted in reduced mobility and likely pain
during an individual’s lifetime; effectively, the focus has been on hyper visible
manifestations of disease and difference, and deviance from burial norms, with
extrapolations made largely from case studies (Stodder and Byrnes).
Palaeopathology and bioarchaeology are grappling with precisely how to frame
disability but perhaps it suffices to draw on this partial definition: disability
comprises biological, psychological, and social elements, and is produced
through interaction between physical and/or cognitive impairment and the
cultural and physical environment (Tilley; Stodder and Byrnes). Our ongoing
experiences with pandemic and endemic diseases have, to some degree, forced
society to examine the overlapping and convergent nature of experiences of
chronic illness and disability, including exploring the care-related implications
for the larger community (Dimka, van Doren, and Battles; Tilley; Bohling,
Croucher, and Buckberry; Stodder and Byrnes). The work presented here draws
on current research paradigms in archaeology and palaeopathology, shaped by
the lens of situated biologies. This study is a product also of the study of
disability in the past, the bioarchaeology of care and the archaeology of
childhood, all of which share overlapping methods and aims to access the
tangibilities of life in the past. Additionally, this work ventures into territory
once thought unattainable: to depict the prevalence of a form of sensory
impairment in an archaeological population. In utilizing these frameworks,
these ventures must thereby acknowledge that disability cannot be directly
observed based on skeletal evidence for impairment (Kristjánsdóttir and
Walser) but rather can be approached by suggesting reasonable inferences
based on identified overlapping and contingent contexts. Evidence from
palaeopathology can better inform the narratives we shape about many aspects
of life in the past and help us to understand the lived experiences of the people
in those communities we aim to depict in archaeological research.
Whom the house holds
Recent research has fostered closer examination of Icelandic households
and intergenerational dynamics (Lewis-Simpson; McCooey; Zoëga) as well as
insights into disability in the Icelandic past (Sigurjónsdóttir and Rice). The
Icelandic model of farmsteading and property ownership demarcated social
status, with the property owner at the top of the hierarchy. All individuals
belonged to a household and resided on a farmstead, and the household urged
the participation of all capable in economic and social life (Bolender; McCooey;
Zoëga and Murphy). These households, primarily based on farms, were integral
social units with a stratified structure that signified land ownership, farmstead
production, and social identity, demarcating property and status (Bolender).
Despite these stratifications, all shared most and usually all of the living space
available, making the experience and impact of the indoor environment a
collective and general one.
Household was not necessarily synonymous with family or kinship but
rather defined as a group of co-dependent people, some of whom may have been
biologically related. Household and family are terms which may be overlapping
but not synonymous. For this context, household is preferred. This may
encompass multi-generational kinship and non-kinship households, and even
some seasonally or otherwise temporally dependent members (Bolender; Zoëga;
Crawford, Hadley, and Shepherd). Children within a household might include
biological descendants of members of the household or may have joined the
household under the fosterage or guardianship of others; the system of
fosterage and guardianship was widely practiced, regulated by law and most
possible eventualities and outcomes were considered in the law in case of
changes in circumstance (Lewis-Simpson). Most of the body of literature
concerning childhood in the past in Iceland delves into questions of
chronological and social age using written sources, and perspectives from
archaeology can augment current insights (Zoëga; Callow). Children may be
portrayed as not entirely passive subjects, and while we encounter some
ambiguities in the texts about how chronological or categorical ages correlate
to social ages, there are some accepted general social boundaries (Callow; cf.
Baxter).
The burial mounds of the pagan period often disproportionately
represented (male) heads of households (Friðriksson and Vésteinsson). The
latter communal churchyard burials which came to replace home fields, in
contrast to the pre-Christian period, were generally inclusive of all household
members and reflect these household demographics (Bolender; Zoëga). This
shift towards household cemeteries subsequently paved the way for the
adoption of communal burials in churchyards, reflecting the deep-rooted multi-generational kinship and non-kinship households (Zoëga). This departure from
pre-Christian era practices, whereby household cemeteries incorporated
individuals of all ages and genders, offers a more comprehensive representation
of past society than pagan period burials, in a sense making them research-desirable as data that offer the most accessible total picture available to us.
The longhouse itself was built of commonly available building materials
which were suitable for the cold and wet climate: turf walls and turf roof
encasing a wooden frame (van Hoof and van Dijken; Zoëga, Sigurðardóttir, and
Zoëga). The skills needed to construct and maintain these structures, from turf
cutting to drying, storage, building, and repair, would have been fairly common
knowledge, an essential seasonal chore for every household. By the eighteenth
century and through to the twentieth, authorities expressed concern about
improving the quality of life in the home and noted the health risks associated
with turf structures, though these would have been naturally insulating and an
essential building material in a landscape lacking replenishable timber (Zoëga,
Sigurðardóttir, and Zoëga).
At the heart of the turf structure, the hearth figured large in the life of the
household, providing a central source of light and warmth to the interior space
as well as a cooking fire. However, an open fire comes with health risks which
are compounded by prolonged exposure. It is known from modern contexts that
the use of biomass fuels such as wood and peat produces particulates and
volatile organic compounds (VOCs), which are associated with an increased risk
of chronic obstructive pulmonary disease and markedly increased risks of lung
cancer in women and acute respiratory infections in young children (Torres-Duque et al.; Aftab, Noor, and Aslam). Moreover, prolonged exposure to solid
and biomass fuels increases the risk of pulmonary infections, especially TB,
according to evidence amassed from various global locales (Fullerton, Bruce,
and Gordon; Pokhrel et al.; Sahito et al.; Sumpter and Chandramohan; Haque et
al.). These risks have also been measured in archaeological populations,
especially in research which focused on lesions indicative of chronic sinusitis,
again from varied global regions (Sundman and Kjellström; Boocock, Roberts,
and Manchester; Merrett and Pfeiffer; Panhuysen, Coened, and Bruintjes;
Roberts 2007; Lewis, Roberts, and Manchester; Davies-Barrett, Roberts, and
Antoine).
Experimental archaeology measuring firewood consumption and exposure
to particulate matter and VOCs in reconstructed longhouses and turfhouses of
the early modern period found that participants were exposed to harmful levels
of such substances, and it is highly likely that these health risks were also faced
by people in the past (Beck et al.; Christensen and Ryhl‐Svendsen; Trbojevic,
Mooney, and Bell). Most such experiments were conducted in thatched-roof
dwellings primarily using firewood, so results may not translate perfectly to
turf structures. Since the turf in Icelandic houses was often used in the walls
and roof, ventilation was likely poorer than in structures which used thatch;
turf walls could be as much as 1.5 metres thick (Milek). Inhabitants would have
lived with high pollution levels and low air exchange rates, which were
recognized as a major health concern beginning at least in the early modern
period (van Hoof and van Dijken; Zoëga, Sigurðardóttir, and Zoëga). Exposure
to particulate pollution and smoke would have held serious consequences for
the health of the population, as households shared common living spaces in all
seasons. Air-quality appraisal in some experimental structures has indicated
that smoke tends to draft above wall height towards the roof, but particulate
matter tends to remain closer to its point of origin (Beck et al.; Christensen and
Ryhl‐Svendsen; Roberts and Cox). Christensen and Ryhl-Svendsen note that
measurements were taken at the standard height of 110 cm, approximating the
breathing zone of a person seated, resting, or bent over while cooking—and
more or less the height of a young child.
The association between TB prevalence and indoor air pollution has grown
steadily from global data. Smoke exposure in the home from biomass fuels and
spending prolonged periods of time in poorly ventilated structures are
especially conducive to transmission of TB (Fullerton, Bruce, and Gordon;
Pokhrel et al.; Sahito et al; Sumpter and Chandramohan; Uys et al 2011).
Globally, TB is also known to be more prevalent among males than females, yet
women have been marked as experiencing particular risks when in constant
proximity to biomass fuel use (Pokhrel et al.; Sharma, Kumar, and Singh; Horton
et al.). The implications, therefore, of identifying TB in these past populations,
interlinked with environmental and social conditions, are an increased
likelihood for disease endemicity and many contingent health risks. The
narrative in Iceland in particular has shifted to connote an experience of a
chronic and debilitating infectious disease which likely persisted across
centuries and throughout different regions of the country, until its near
eradication with twentieth-century antibiotic treatment (Sigurðsson). The
specific case descriptions of pathological lesions which have strong or definite
associations with a TB diagnosis have indicated that TB was endemic in Iceland
likely from the settlement period (Collins 2020).
The presence of respiratory infection is not only a measure of the burden
of disease but also, in a sense, a proxy measure of household intimacy. The
setting of the home, both the physical structure and the household and its
members, are measures of familial and interpersonal intimacy, which, among
other things, may drive endemic disease. Parents and caregivers determine how
children spend a significant portion of their time, for example, engaging in
tasks, and in proximity to whom (Baxter; Crawford, Hadley, and Shepherd). A
child’s risk of acquiring TB from a mother increased the risk of mortality eight-fold in high-burden endemic areas (Hamzaoui et al.). Hyperendemic refers to
persistent, continuously high levels of disease, and the evidence from at least
four medieval sites fits a number of criteria for identified hyperendemic TB
(Collins 2019). Namely, cases are heavily clustered and individuals may be
infectious simultaneously, and in all likelihood the medieval Icelandic cohorts
regularly spent prolonged periods of time with a group in an enclosed space
with inadequate ventilation (Uys et al. 2011; 2015; Hamzaoui et al.). Children
and adolescents usually acquire TB from infected adults, and those with latent
TB are often the source of future epidemics, as they are reservoirs for future
transmission with disease reactivation; this can even be many years after
primary infection has occurred (Tsai et al.; Hamzaoui et al.). Without
vaccination, 30–40% of infected infants are estimated to progress to
intrathoracic TB, with 10–20% developing disseminated disease (Marais et al.;
Perez-Velez, Roya-Pabon and Marais). Patients aged three to four years have
the highest lymph node involvement, but the least number of lung tissue lesions
compared with older children (Graham, Marais, and Amanullah; Delacourt). At
five to ten years of age, the risk of active disease declines, but the risk of
developing adult-type TB increases. With this age-related shift, a phenotypic
shift also occurs, from a disease of primarily lymph node involvement and
disseminated disease to cavitary lung-disease (adult-type), often coinciding
with puberty (Graham, Marais, and Amanullah; Delacourt). Observation and
differential diagnosis in skeletal remains must also consider these phenomena
specific to young children (Lewis).
In modern studies, contact scores consider child-specific risk factors which
include maternal TB status and sleep proximity, duration of exposure, exposure
to multiple index cases, and index case infectivity (Mandalakas et al.). These
factors demonstrably increased the odds of contracting TB in children aged
three months to six years in a Cape Town study (Uys et al. 2011). Of course, the
last component (index case infectivity) is unlikely to be ascertainable in an
archaeological population, but all of the former components can be reasonably
inferred from the archaeological context. Not only were children most likely to
bear the brunt of the exposure to VOCs and particulate matter simply because
of their proximity to the open hearth and environmental conditions, but they
were also susceptible to contracting infectious respiratory disease because of
unavoidable, prolonged contact with infected adults (inferred index cases).
Hearing loss, a hidden disability
The study of disability in the Nordic past has relied heavily on textual
witnesses (Crocker, Tirosh, and Jakobsson; Sigurjónsdóttir, Jakobsson, and
Björnsdóttir; Lewis-Simpson). The rich corpus of saga literature and medieval
miracle collections have little to say about hearing loss in particular (Smith;
Samúelsson; Þorvaldsson; Michelson-Ambelang; Jónsson). Hearing loss is
seldom mentioned in the sagas, and in only one of three instances could a
possible pathological instance be read from the text (Michelson-Ambelang). Of
the 104 healing miracles identified in the hagiographies of the saints Þorlákur,
Jón, and Guðmundur inn góði [the Good], only two refer to deaf persons
(Whaley). Some readings of later material have led scholars to believe that
hearing loss was not prevalent in pre-modern society. Alternatively, drawing
on later eighteenth and nineteenth century sources, Smith has posited that
marginalization of non-speaking individuals was a remnant of earlier social
attitudes which may have denied them confirmation into the church, and
hospital admission and care. In contrast, recent work has affirmed that close
readings of the material available do indicate that deaf and non-speaking people
maintained varying degrees of agency, not least through non-verbal
communication and gestural systems practiced across multiple periods, as well
as the use of wax tablets (Tirosh). However, not all could afford to invest in the
technology or training needed to realize these forms of communication
(Tirosh). To better elucidate the extent of hearing loss in the past and reduce
bias in our narratives, other avenues are required, especially those which bring
us nearer to assessing whole populations.
Hearing loss is sometimes recognized as a hidden or invisible disability
(Mackenzie and Smith). Hearing impairment or loss can refer to any level of
severity. However, deafness refers strictly to profound hearing loss. Otitis
media, or middle ear infection, is responsible for 60% of hearing loss cases in
children aged under 15 years, and chronic cases of otitis media are responsible
for hearing loss in 31% of cases worldwide (World Health Organization). In
children today almost 60% of hearing loss is due to preventable causes such as
ear infections and birth complications (Bluestone and Klein). Most episodes of
middle ear infection occur between the ages of 0–2 years, but otitis media with
effusion (discharge) may peak between two and six years of age, and generally
episodes of middle ear infection decrease by about age seven when the mastoid
air cells are developed and help to pressurize the middle ear (Bluestone and
Klein; Bluestone and Doyle; Cinamon). The complications of otitis media can
include hearing loss, vestibular, balance and motor dysfunctions, perforation of
the tympanic membrane, petrositis, labrynthitis, facial paralysis, and otitis
externa. Nearly all children who have discharge from the ears have some degree
of hearing loss. Children face particular vulnerabilities with even short periods
of hearing loss, in loss of consonant sounds for example, and detrimental effects
on language acquisition (Bluestone and Klein). Consonant hearing loss and
consonant confusion is, of course, also recognized among hearing-impaired
adults (Phatak et al.). Hearing loss may be conductive, in which the sound
conduction of the middle ear ossicles is in some way impaired. In sensori-neural
hearing loss the labyrinth and nerves of the inner ear are involved; mixed
hearing loss describes a combination of the above. Only conductive hearing loss
can be identified with any certainty in skeletal remains.
Otitis media and TB in medieval Iceland
The study of otitis media in the skeletal assemblages from Hofstaðir,
Keldudalur, Skeljastaðir, and Skriðuklaustur relied on general osteological and
palaeopathological analysis coupled with the specific aims to investigate
chronic upper respiratory tract infection (Collins 2019). In palaeopathology,
interpretation and reporting of lesions of TB in skeletal assemblages has
perhaps been somewhat dichotomized as either gastrointestinal or respiratory
infection. However, the clinical evidence indicates that these systems are
linked, and function or dysfunction in one system affects the function of
neighbouring systems, as the mucosal barriers may be permeated in cases of
inflammation, infection or even gastrointestinal reflux. Otitis media as a
sequela of TB is known to occur without indications of pulmonary infection,
although it remains notoriously difficult in clinical settings to identify TB as the
culprit in cases of chronic otitis media (cf. Sens et al.). Generally tuberculous
otitis has been discovered after patients have failed to respond to traditional
treatments and often present false-negative cultures (Sebastian et al.). It should
be noted that it is impossible to exclude other pathogens completely, but TB,
according to abundant clinical evidence, is a most likely candidate for effecting
such severe cases of otitis media, as seen in the ancient Icelandic population.
For specialists working with human remains, it should become common
practice to investigate the sinuses and ears, using a simple endoscope, to
identify respiratory infection in the material under investigation and perhaps
especially if there are suspected cases of TB. Uniquely, assessing lesions of the
middle ear presents us with a key to real insights into the tangible experience
of a hearing loss at population level (cf. Sigurjónsdóttir and Rice).
The results of the study, highlighting chronic infection of the middle ears,
included a total of 303 individuals who had at least one temporal bone preserved
from Hofstaðir, Keldudalur, Skeljastaðir, and Skriðuklaustur (Collins 2019). Of a
total of 303, 210 were affected by chronic otitis media in either one or both ears
(69%). Among all of the non-adult skeletal remains across all four sites, 62 of 108
(57%) had evidence of some form of chronic otitis media (Table 1), and among
the adults, 145 of 196 individuals (74%) were affected (Table 2). Although there
is no particular lesion which can be pathognomonic for TB in the ears, it is clear
that among the individuals with diagnostic or a very likely diagnosis of TB,
based on the post-cranial skeleton, there is a strong association, as 30 of the 38
identified individuals (79%) with definite or very likely TB diagnosis had otitis
media.
Table 1. The crude prevalence of otitis media among non-adults at the four sites, including individuals aged 14–16.9 years, where (n) is the number affected of those with the bone preserved (temporal bone) (N).| Age (years) | Hofstaðir | Keldudalur | Skeljastaðir | Skriðuklaustur | Total | |
|---|
| Age (years) | n | N | n | N | n | N | n | N | n | N |
|---|
| 0-1.0 | 30 | 59 | 10 | 12 | | | 2 | 4 | 42 | 75 |
| 1-3.9 | 1 | 3 | 5 | 5 | | | 1 | 3 | 7 | 11 |
| 4-6.9 | | | | | | 1 | 1 | 1 | 1 | 2 |
| 7-10.9 | 2 | 2 | 2 | 3 | | | | 2 | 4 | 7 |
| 11-13.9 | 1 | 1 | | | 1 | 1 | 1 | 2 | 3 | 4 |
| 14-16.9 | 3 | 3 | | 2 | | | 2 | 4 | 5 | 9 |
| Male | 1 | 1 | | | | | 1 | 1 | 2 | 2 |
| Female | 1 | 1 | | | | | | 1 | 1 | 2 |
| Unknown | 1 | 1 | | 2 | | | 1 | 2 | 2 | 5 |
| Total | 37 | 68 | 17 | 22 | 1 | 2 | 7 | 16 | 62 | 108 |
Table 2. Bilateral otitis media prevalence among adults, depicted by age and sex, where (n) is the number affected of those with a preserved temporal (N). | Hofstaðir | Keldudalur | Skeljastaðir | Skriðuklaustur | Total |
|---|
| Age (years) | n | N | n | N | n | N | n | N | n | N |
|---|
| 17-25 | 6 | 6 | 1 | 3 | 4 | 4 | 12 | 18 | 23 | 31 |
| Male | 1 | 1 | | 1 | 1 | 1 | 5 | 7 | 7 | 10 |
| Female | 5 | 5 | 1 | 2 | 3 | 3 | 7 | 10 | 16 | 20 |
| Unknown | | | | | | | | 1 | 0 | 1 |
| 26-34 | 7 | 10 | | | 2 | 5 | 12 | 13 | 21 | 28 |
| Male | 2 | 4 | | | 2 | 4 | 6 | 6 | 10 | 14 |
| Female | 4 | 5 | | | | 1 | 5 | 6 | 9 | 12 |
| Unknown | 1 | 1 | | | | | 1 | 1 | 2 | 2 |
| 35-44 | 20 | 26 | 6 | 7 | 8 | 10 | 9 | 11 | 43 | 54 |
| Male | 10 | 13 | 3 | 3 | 5 | 6 | 6 | 8 | 24 | 30 |
| Female | 10 | 13 | 3 | 4 | 3 | 3 | 3 | 3 | 19 | 23 |
| Unknown | | | | | | 1 | | | | 1 |
| 45+ | 21 | 26 | 7 | 9 | 20 | 27 | 10 | 18 | 58 | 80 |
| Male | 10 | 12 | 2 | 4 | 11 | 13 | 3 | 7 | 26 | 36 |
| Female | 11 | 14 | 5 | 5 | 9 | 14 | 6 | 10 | 31 | 43 |
| Unknown | | | | | | | 1 | 1 | 1 | 1 |
| Adult | 1 | 1 | 1 | 1 | | | 1 | 1 | | 3 |
| Male | | | | | | | | | | |
| Female | 1 | 1 | | | | | | | | |
| Unknown | | | 1 | 1 | | | 1 | 1 | | |
| Total | 55 | 69 | 15 | 20 | 34 | 46 | 44 | 61 | 145 | 196 |
| Male | 23 | 30 | 5 | 8 | 19 | 24 | 20 | 28 | 67 | 90 |
| Female | 31 | 38 | 9 | 11 | 12 | 21 | 21 | 29 | 73 | 99 |
| Unknown | 1 | 1 | 1 | 1 | | 1 | 3 | 4 | 5 | 7 |
In this sample, 59 of 303 (19.5%) individuals were observed with the highest
grades of change, including total destruction or obfuscation of the middle ear
cavity. These are the individuals who are suspected to have suffered from
profound conductive hearing loss, and some of these cases may have been
mixed hearing loss because of the severity of disease and location of the lesions.
There were no significant differences detected between the rate of
infection for skeletons sexed as male or female at any of the four sites. However,
a caveat should be noted pertaining to the rates of ear infection among infants.
The appearance of otitis media in infants, those aged under 12 months, is
notable, because young infants are more susceptible to gastro-oesophageal
reflux, which, in turn, predisposes them to an increased risk of sinusitis and
otitis media. Reflux disrupts the protective system of mucociliary transport and
other physical barriers between the digestive and respiratory systems
(Openshaw; Tasker et al.; Phipps et al.). The immature barriers of an infant or
young child would not have been very effective at protecting the sinuses and
ears from regurgitated food, particles, pathogens, or other debris, and
therefore, gastrointestinal reflux must be considered as a potential contributor
to respiratory disease in the sample. However, it is unclear to what degree. This
may offer an explanation for the presence of otitis media in this cohort, as it is
not possible to identify or definitively account for this using the skeletal
remains.
Conclusions
The evidence from the human remains indicates that hearing loss in
varying degrees was likely more prevalent in the past than previously known,
even considering very conservative interpretations of the results. These
biological data dovetail with evidence from social contexts, e.g., that deaf and
non-speaking people did indeed utilize means to articulate their needs and
desires in interpersonal relationships (Tirosh), and environmental contexts,
long recognized from archaeological data. This research further underlines the
importance of not only including non-adult remains in future studies in order
to depict the impact of disease on children in the past, but also taking care to
understand particular disease aetiologies and how they may affect sensitive
cohorts differently. The settings and surroundings of the indoor and outdoor
environment, its social capacities and functions, and even the state of childhood
itself all come to bear on the mechanisms for disease acquisition and the
experience of disease.
The consequences of climate change will invoke fresh challenges for society
in the near future, especially for its most vulnerable members, facing critical
events such as migration and unrest (Crawford, Hadley, and Shepherd).
Understanding respiratory infection in the past remains relevant in that latent
TB and transmission mechanisms persist as a global health concern. The
discourse in archaeology has focused on differences in rates of TB and disease
transmission in dense vs. less densely populated areas, i.e., urban vs. rural
settlements. While this is entirely valid, it may also be useful to pan our lens to
understand the parameters of endemic and even hyperendemic settings and
adopt this terminology. These terms offer the means to acknowledge
appropriately the biological situatedness (as understood by Niewöhner and
Lock) of individuals and communities and the acutely human experiences of life
and health.
Generally, researchers should refrain from diagnosing profound deafness,
particularly as it is impossible to ascertain this condition with absolute
certainty. However, it is reasonable to hypothesize that severe conductive
hearing loss was probable in certain circumstances, notably with evidence of
disruption in the ossicular chain. Nonetheless, pinpointing sensorineural or
mixed hearing loss presents an appreciable challenge. Here the evidence speaks
to hearing loss (in varying degree) as a piece of the fabric of life in the past.
Chronic respiratory infection and chronic conductive hearing loss (and perhaps
also sensorineural hearing loss) seem to have been common enough according
to the skeletal evidence that most Icelanders in the past must have come into
regular contact with individuals who were experiencing hearing loss.