Palaeopathology in Egypt and Nubia A century in review Edited by Ryan Metcalfe, Jenefer Cockitt and Rosalie David Archaeopress Egyptology 6 Archaeopress Gordon House 276 Banbury Road Oxford OX2 7ED www.archaeopress.com ISBN 978 1 78491 026 6 ISBN 978 1 78491 027 3 (e-Pdf) © Archaeopress and the individual authors 2014 All rights reserved. No part of this book may be reproduced, stored in retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying or otherwise, without the prior written permission of the copyright owners. Printed in England by CMP (UK) Ltd This book is available direct from Archaeopress or from our website www.archaeopress.com Contents Preface ���������������������������������������������������������������������������������������������������������������������� ii Acknowledgements �������������������������������������������������������������������������������������������������� iii Chapter 1: History of bioarchaeology Sir Grafton Elliot Smith: Palaeopathology and the Archaeological Survey of Nubia ���� 1 Rosalie David Whose body? The human remains from the 1908-1909 season of the Archaeological Survey of Nubia ��������������������������������������������������������������������������������������������������������� 9 Jenefer A. Cockitt The more things change? The archaeological work of Alfred Lucas �������������������������� 23 Ryan Metcalfe Chapter 2: Palaeopathology Harris lines, ill health during childhood, poor diet, emotional stress or normal growth patterns? ����������������������������������������������������������������������������������������������������������������� 31 Abeer Eladany An interesting example of a condylar fracture from ancient Nubia suggesting the possibility of early surgical intervention ������������������������������������������������������������������ 41 Mervyn Harris, Tristan Lowe and Farah Ahmed An overview of the evidence for tuberculosis from ancient Egypt ���������������������������� 51 Lisa Sabbahy Palaeopathology, disability and bodily impairments ������������������������������������������������ 57 Sonia Zakrzewski Chapter 3: Dental palaeopathology Dental infections in ancient Nubia ��������������������������������������������������������������������������� 69 Roger J. Forshaw iv A case of severe ankylosis of temporomandibular joint from New Kingdom necropolis (Saqqara, Egypt) ������������������������������������������������������������������������������������������������������ 83 Ladislava Horáčková and Frank Rühli Occlusal macrowear, antemortem tooth loss, and temporomandibular joint arthritis at Predynastic Naqada��������������������������������������������������������������������������������������������� 95 Nancy C. Lovell Chapter 4: Mummification How to make a mummy: A late hieratic guide from Abusir �������������������������������������107 Jiří Janák and Renata Landgráfová Studying mummies: Giving life to a dry subject ������������������������������������������������������119 Michael R. Zimmerman Chapter 5: Imaging in bioarchaeology Microstructural analysis of a Predynastic iron meteorite bead ��������������������������������129 Diane Johnson, Monica M. Grady, Tristan Lowe and Joyce Tyldesley Imaging and analysis of skeletal morphology: New tools and techniques����������������141 Norman MacLeod Chapter 6: Digital resources Mummies on rails ���������������������������������������������������������������������������������������������������157 Ahmad Alam, Ian Dunlop, Robert Stevens, Andrew Brass, Jenefer Cockitt, Rosalie David and Ryan Metcalfe Mummy website and database �������������������������������������������������������������������������������167 Barbara Zimmerman, Sukeerthi Shaga, Pavitra Kaveri Ramnath, and Sai Phaneendra Vadapalli v Palaeopathology, disability and bodily impairments Sonia Zakrzewski Archaeology, University of Southampton, Southampton, UK Abstract In archaeology, disabled people and disability have often been overlooked or considered ‘hidden from view’ (see Waldron, 2000). Yet disease and disability are present in all societies, and any person may become disabled at some point in their life. This disability may be permanent or temporary, and may contribute to social exclusion and the concept of ‘difference’. ‘What is perceived as a ‘disability’ or as ‘madness’ in one society, in another may be considered as just one attribute among many which make up an individual, or may not be perceived as part of the individual at all’ (Waldron, 2000, p.7). Although Egypt seems to have been relatively accepting towards individuals considered as ‘different’ or ‘other’ (Jeffreys and Tait, 2000), Egyptian attitudes towards minorities (of any form, be they physical or ethnic) are varied. Theories of disability According to the World Health Organisation (WHO), disability is an umbrella term, covering impairment, activity limitation, and restriction on participation (WHO, no date). An impairment is a problem in body function or structure. An activity limitation is a difficulty encountered by an individual in executing or undertaking a task or action. A participation restriction is a problem experienced by a person in their involvement in life situations. Disability is therefore a complex phenomenon, reflecting an interaction between the features of a person’s body and the features of the society in which they live. Disability, however, is constructed in different ways by different academic disciplines. Whereas the medical community have generally considered disability in terms of medical reductionism, social scientists have, more commonly, followed a social model of disability (Thomas, 2007). Oliver (1983) argued that disability is not caused by impairment, but rather from social restrictions placed upon individuals with bodily impairment. Resultingly, medical sociologists theorise chronic illness and disability through a lens of social deviance (Thomas, 2007). This focus comprises both aspects of the impaired body and the lived experience. In this sense, a disability is simply a form of limited activity, and hence a disabled person is one who has a medically certifiable condition preventing them from carrying out the full ‘normal’ range of age-related activities (Thomas, 2007). Following this argument, disability is an age-related and universal phenomenon, with the importance being placed upon living with ‘illness’ and hence the focus not being constrained to the individual, but also to the changed circumstances of significant others. In contrast, Murphy (1990), despite rejecting the social deviance model, views disability as a state of social liminality, whereby the individual is in a state of exclusion from ordinary 57 58 Palaeopathology in Egypt and Nubia life and is denied the full expression of ‘being human’. As such, the disabled person is outside the formal social system. This construction of disability is built upon human perception and ‘being’ as embodied phenomena, with meaning residing in the body and the body itself residing in the world (Merleau-Ponty, 1962). Consequently, there is a fluid boundary between disabled and able-bodied, with identity (and particularly self-identity and ascribed identity) being of significance. Negative views of disability, or disabilism, develop this viewpoint and stress that the relative degrees of need, care or dependency, may lead to individuals being ascribed a childlike status. The varying configurations of needs are thus given primacy at the expense of the social individual, thereby revolving back to the social model of disability (Thomas, 2007). Medical sociologists appear to congregate around the view that disability and impairment should not be viewed in terms of biological reductionism, but rather that disability and being disabled are not all about the body, but rather comprise impairment effects and hence are subjective experiences with many differences (Thomas, 2007). Tremain (2002) develops this argument further to consider impairment and disability to be viewed as sex is to gender. Thus the impaired body is socially constructed, and the embodied ‘difference’ is the so-called impairment and external reaction to this is the so-called disability. This permits ‘disabled’ to be viewed as a point upon a continuum rather than as a binary opposition to ‘able-bodied’. Consequently, focus is placed upon the body in pain, chronic illness such as rheumatoid arthritis, and other forms of illness, including mental illness (Thomas, 2007). This paper follows all these arguments to explore what is meant by disability within an explicitly Egyptian context. Furthermore, it evaluates the impact that impairment or difference, relative to the Egyptian norm, might have had upon lived social experience. It is clear from texts, such as the ‘Instruction of Amenemope’ (which includes phrases such as “Do not laugh at a blind man, Nor tease a dwarf, Nor cause hardship for the lame”), that tolerance towards people with disabilities was recommended. This has been described as ‘a more generous attitude towards some disabilities’ (Quarmby, 2011, p.25). The above concepts of disease and disability link in to constructions of ‘otherness’ (Hubert, 2000) and identity within bioarchaeology (Knudson and Stojanowski, 2008; Perry, 2007). However, distinctions remain in terms of which disabilities or ‘others’ are deemed respectable or viewed as ‘Egyptian people’. Representations of disablement and malformation Within Egyptian artistic representation, the body is viewed as an entity, but with each portion having an idealised or typical form which are then combined to form a composite body (Robins, 1994). Despite this leading to a human figure that plainly does not correspond directly with reality, some representations do show the body in meticulous anatomical detail (Weeks, 1970). As a result, most individuals are depicted in an idealised form. However, some specific individuals were depicted differently from other ‘normal’ individuals, for example dwarves (Dasen, 1993; Iversen, 1975; Robins, 1994; Weeks, 1970), but physical irregularities or impairments were primarily shown for minor figures (Dasen, 1993). Palaeopathology, disability and bodily impairments Probably the most common representation of disability is of dwarfing. This phrasing could be construed as an oxymoron, as small stature and dwarfing need not lead to any reduction in ability to undertake activities. Indeed, there were even three distinct Egyptian words for abnormally short people (dng, nmw, and Hwa), and use of these words was usually accompanied by a determinative depicting a disproportionate dwarf with a long trunk and short limbs (Dasen, 1993). Several dwarves are well known and were of high social ranking. During the Fourth Dynasty (although previously dated as Fifth or Sixth Dynasty (e.g. Filer, 1995; Kozma, 2006)), the dwarf Perniankhu, a court entertainer, was buried in the great western cemetery at Giza (Wilkinson, 2007). In statues he is depicted with short bowed legs, thick ankles and flat feet. However, he is also depicted with symbols of authority, such as a sceptre and long staff (Hawass, 1991; Wilkinson, 2007). Also during the Old Kingdom, the dwarf Seneb achieved the rank of court official, as priest for Khufu and Djedefra and ‘Director of Dwarfs in Charge of Dressing’ [the sovereign], and tutor to the king’s son (Wilkinson, 2007). Seneb was buried with his wife in a mastaba at Giza, and is well known from statuary, such as the sculptural group with his family housed in the Cairo Museum [Cairo Museum JE 51280]. These relatively anatomically accurate depictions of achondroplastic dwarfism continue through to the Late Period, as evidenced by illustration of the naked figure of Djeho on his sarcophagus [Cairo Museum CG 29307 (his patron was Tjaiharpta CG 29306)] (Baines, 1992; Kozma, 2006). The ‘physical anomaly [of dwarfing] was not only tolerated, but accepted and valued as a divine mark for its religious associations’ (Dasen, 1993, p.156), as not only do dwarves appear to have a special affinity with solar deities, but their use in cult dances is referred to in the Pyramid Texts (Baines, 1992). Dwarves are thus depicted in an essentially positive manner (Sullivan, 2001), and their biological disorder appears not to have been viewed within artistic representation as a handicap or disability. It has been argued, however, that they may have been considered as liminal, due to their frequent association with other malformed people (such hunchbacks) and exotic people (such as from Nubia or Punt) (Dasen, 1993). In this sense, physical attributes might be considered of importance in depiction of personhood. Although individual and personal traits were generally avoided (Iversen, 1975), and bodies were depicted in significant meaningful detail, such as legs with muscles flexed (Weeks, 1970), representations exist that might show some form of disease process or disability. Depictions of individuals with hunched or humped backs are relatively common. Examples include the gardener from the tomb of Ipuy at Beni Hasan [Metropolitan Museum of Art, New York 30.4.115], two Predynastic wooden figurines curated in Brussels [Musées Royaux d’Art et d’Histoire de Bruxelles], or the well-known Predynastic red clay statuette from Aswan [Private collection, Paris]. The deformities illustrated by these examples are commonly thought to be representations of kyphosis resulting from Pott’s disease (Filer, 1995; Halioua and Ziskind, 2005; Reeves, 1992; Ziskind and Halioua, 2007), although other putative causes have been suggested (Nunn, 1996). Both congenital deformity (talipes equinus) and bodily change as a result of infection (poliomyelitis) have been suggested for the withered right leg depicted on the New Kingdom funerary stela of Roma [Ny Carlsberg Glyptotek, Copenhagen AIN 134] (Filer, 1995; Halioua and Ziskind, 2005; Nunn, 1996). This stela is of particular note as the 59 60 Palaeopathology in Egypt and Nubia deceased is shown using his staff as a crutch rather than as a symbol of status and rank (Jeffreys and Tait, 2000). Focus has heretofore concentrated upon representations of skeletal manifestations of disability. It should be remembered, however, there are many other forms of disablement, such as reductions or impairments in hearing and vision. The blind appear most commonly depicted in specific roles, such as harpists or singers, although in some iconographic representations blindness has been suggested to represent piety (Dasen, 1993). Examples include the blind harpist from the New Kingdom tomb of Nakht at Thebes [Tomb TT52, Metropolitan Museum, New York 15.5.19d ], the blind harpist from the New Kingdom tomb of Patenemheb at Saqqara [Rijksmuseum van Oudheden, Leiden AMT 1-35], and Raia. The latter was Chief of Singers in the temple of Ptah at Memphis during the Ramesside period (Wilkinson, 2007), and, in his tomb at Saqqara, was depicted as blind when playing music for his patron deities, Ptah and Hathor, but as sighted in other scenes (Dasen, 1993). In addition to these examples of disability, note must be made of iconographic representations of disease, such as the genital hypertrophy suggestive of schistosomiasis or the distended abdomens suggestive of umbilical hernias (Jeffreys and Tait, 2000), such as in the Old Kingdom tomb of Ptah-Hetep at Saqqara (Thompson Rowling, 1967a). Furthermore the medical papyri provide evidence of treatment of these conditions, such as the twenty treatments given in the Ebers papyrus for haematuria (Thompson Rowling, 1967b). In modern Egyptian medicine, this is commonly associated with schistosomiasis or neoplasia of the renal tract (Thompson Rowling, 1967b). Although these disorders are not commonly considered as disabilities, these can be disabling to the individuals and society concerned as they can to reductions in fitness, activity or participation, hence falling under the WHO classification for disability. Palaeopathologies of Egyptian disablement and impairment Given the skeletal and mummified preservation of bodies from Egyptian contexts, there are relatively large numbers of individuals who might be considered, in palaeopathological terms, to have experienced potential disablement or impairment. Only a few examples can be included here, and hence should be considered as case studies for discussion. As noted earlier, the most commonly depicted congenital skeletal anomaly is that of dwarfing. Skeletal examples of putative achondroplasia include the two dwarfs found in chambers M and L of the Early Dynastic tomb of Semerkhet [Natural History Museum, London AF11.4/427 & AF 11.4.462] (Dasen, 1993; Ortner and Putschar, 1981) and Predynastic long bones that may derive from El-Mostagedda (Brothwell, 1967; Dasen, 1993). The latter are potentially Badarian in date and may be curated in the Duckworth Collection, Cambridge. More recently, the skeleton of Perniankhu was excavated from tomb G1700 at Giza (Hawass, 1991). Brief descriptions are to be found in Filer (1995) and Kozma (2006), although a full palaeopathological description of the skeleton has yet to be published. All skeletal remains of dwarfs recorded in the literature (including those Palaeopathology, disability and bodily impairments whose whereabouts are now unknown) appear to have been relatively ‘healthy’ and may have been considered ‘other’ rather than ‘disabled’. Of particular note among other congenital disorders, diseases and/or malformations, described from Egyptian skeletal and mummified remains, is the suggestion of cerebral palsy for a mature 13th Dynasty female from Thebes (Nerlich et al., 2010). The authors note strong flexion in the radio-carpal joint and hyperextension in the metacarpophalangeal joints of the left hand, associated with greater dental wear & abrasion of the temporo-mandibular joint on the left side. They argue that this could arise from compensatory use of the left side of jaw as, in addition, they note some evidence of reduced functionality of the right side masticatory musculature. People with cerebral palsy may also suffer from dyskinesia and ataxia, and hence can experience the side effect of drooling and difficulty with speech associated with ‘strange’ facial expressions (Nerlich et al., 2010). The most common skeletal malformation is likely spina bifida occulta. Although usually asymptomatic, spina bifida occulta may cause pain and neuralgia. One Nubian individual [RCS Nubian 178A, Natural History Museum, London] has even been argued to have been paraplegic, associated with spina bifida (Thompson Rowling, 1967c). Most ‘disabilities’ arise during the lifetime of the individual concerned, but may not be permanent effects. For example, limitations upon participation may occur either permanently or temporarily as a result of bodily trauma. Post-traumatic ankylosis of bones, such as the talocrural joint of male E12 from the Memphite tomb of Horemheb IV (Strouhal, 2008), might affect mobility. As a result of a femoral fracture, one Egyptian has been described as ‘[having] had one leg slightly shorter than the other and walked with a limp’ (Filer, 1995, pp. 87-88). Given the illustrations, Filer is most likely referring to individual EA 37340 at the British Museum, London. Filer (1995, p.88) continues, ‘the long period of immobility whilst the leg set would have made the person dependant [sic] upon his community’. The most problematic issue with trauma is the mal-alignment of fractures. The medical papyri, including the Edwin Smith papyrus, indicate that the fractures were reduced through manipulation and the use of splints. Archaeological evidence of the latter are known, such as the palm tree splints supporting two Christian period Nubian arms which are curated at the Hunterian Museum in London. Poorly aligned ulnae have been argued to be the most common of poorly aligned fractures (Hussien et al., 2010), and thus would have affected productivity and activity. Iconographic evidence for Pott’s disease has been summarised earlier. Tuberculosis has been recognised palaeopathologically on the basis of both skeletal kyphosis and iliopsoas abscesses, such as in the 21st Dynasty Theban mummy Nespaheran (Filer, 1995; Nunn, 1996; Ruffer, 1921; Ziskind and Halioua, 2007). For reviews of such cases see Buikstra et al. (1993) and Morse et al. (1964). Mycobacterial DNA has been recovered from a variety of Egyptian contexts (such as from Dr Granville’s mummy, a 26th Dynasty female named Irtyersenu (Donoghue et al., 2010)), although not all DNA fragments have been sufficiently well preserved to distinguish between M. bovis, M. africanum and M. tuberculosis, such as from an Adaïma child (Crubézy et al., 1998). Given the successful amplification of M. tuberculosis from individuals not exhibiting skeletal changes 61 62 Palaeopathology in Egypt and Nubia associated with tuberculosis (such as Dr Granville’s mummy mentioned above), it has been argued that infection with M. tuberculosis was common (Zink et al., 2001; 2003) or even endemic (Donoghue et al., 2010). Acquired infections and parasitic conditions such as schistosomiasis are also recognisable, e.g. Schistosoma ova found in the intestinal tract of Nakht (an unembalmed New Kingdom mummy, sometimes denoted as Royal Ontario Museum I or ROM I) (Millet et al., 1980). Schistosome circulating anodic antigen has been identified in X-group mummies from Wadi Halfa (Miller et al., 1992) and in Predynastic and New Kingdom mummies (Deelder et al 1990). Other parasites such as Ascaris (Cockburn et al., 1980) [as in PUM II, belonging to Philadelphia Art Museum, but curated at Philadelphia University Museum], filarial worms [as in the Leeds mummy Natsef Amun] (Sandison and Tapp, 1980) or guinea worms [as in Manchester mummy 1770] (Sandison and Tapp, 1980) have been described. Lymphatic filariasis, as occurs when filarial worms block lymphatic channels, has been proposed as the cause of elephantiasis noted in some iconographic representations (Sandison and Tapp, 1980; Weeks, 1970). Such infections could cause declines in health and sense of wellbeing, and potentially in activity levels. Some idiopathic disorders, such as scoliosis, are relatively easily identified palaeopathologically, such as burial 11 from Quesna (Rowland, 2008). Mild forms are unlikely to have any major effect upon the person affected, but more severe forms are associated with thoracic insufficiency and hence difficulties in breathing (Campbell et al., 2003). Although no examples of congenital deafness have been found, hearing loss or impairment has been argued for a mature male individual from Giza who suffered from a slice injury to the left temporal and into the auditory meatus (Filer, 1992). This can be compared with congenital deafness resulting from bone growth over the external auditory meatus described in a Roman child [Poundbury 1114] in the UK (Molleson, 1993). Finally, although sight is difficult to assess palaeopathologically, a possible case of blindness deriving from carcinoma has been noted from Naga-ed-Dêr (Podzorski, 1990). For a review of eye diseases in Egypt, see Andersen (1997). Integration of dis/ability within palaeopathology Roberts (1999) enumerates difficulties in considering disability within a palaeopathological framework. These issues include aspects such as modern concepts of disability differing from ancient views, difficulties in assessing what abnormalities in skeletal record may have been disabling to the individual concerned, difficulties in assessing the impact upon the society in which that individual lived, problems in interpreting evidence from artistic or documentary sources to get a degree of prevalence within the population, and issues with the archaeological record for caring and compassion. Dettwyler (1991) argued that conclusions cannot be drawn about the quality of life for the disabled from skeletal evidence of impairment, but if bioarchaeologists move beyond implicit (and often tacitly negative) assumptions about disability, focus can be placed upon both the individuals as people and upon ‘ability’. This argument develops from Dettwyler’s demonstration that ‘survival’ of individuals with disabilities or impairments cannot be directly assumed to result from compassion. Here I am arguing that disabilities or impairments should Palaeopathology, disability and bodily impairments be viewed, following Tremain (2002), as simply points upon a continuum of ability, and that the recognition of these positions may be elucidated by other aspects of Egyptian archaeology. In this sense, bioarchaeologists need to remember that it is bodily impairments, such as joint disease or arthritis, rather than disability, that are excavated and studied (Cross, 1999), and subsequently a concept of disability, based upon a more explicitly social model, must be developed. Using skeletal manifestations of potentially disabling conditions permits a baseline model of physical ability to be developed. It is important to note that this is only a baseline, as both bodily and social adaptation may have been used by the individual and their society to develop their abilities (or specialisations, for example, as musicians). In the past, pain and dependency too frequently have been assumed to have been experienced by the individuals concerned (see discussion in Roberts, 2000). There are, however, no standards of osseous or other bodily change that can be demonstrated to cause pain, or indeed the degree of pain experienced. Relatively minor bone damage resulting from osteoarthritis may produce severe pain (Roberts, 1999), and yet greater skeletal changes may be asymptomatic. Furthermore, it is well-known that bodily deformity, such as resulting from leprosy, need not necessarily be disabling (Roberts, 1999). These aspects demonstrate the importance of developing a social model of ability from the palaeopathological record for impairment. Using this framework, the degree of disablement can be considered. Health problems such as anaemia, although not particularly ‘disabling’, also affect the individual’s life, such as through increased fatigue, loss of body weight and effects upon their sense of health. These in turn may affect productivity and thus their ‘ability’. Such individuals might not be disabled under the common usage of the term, but would experience ‘restriction upon participation’ and thus might be considered as being in some group of ‘others’ by the surrounding society. It has already been noted that iconographic representation of some ‘disabled’ groups within Egypt indicates that such people ‘were not regarded as subnormal or in any way socially diminished’ (Jeffreys and Tait, 2000, p.91). As these authors argue, the medical conditions included, e.g. dwarfing, blindness, those with clubfeet etc., are those that are incurable and are primarily congenital. By contrast, they argue that conditions developing during life, e.g. spinal kyphosis resulting from tuberculosis, were depicted in much more negative tones or were considered ‘emblematic of non-elite rank and activities’ (Jeffreys and Tait, 2000, p.92). Consequently, using the term disability in ancient Egypt is almost meaningless unless the medical conditions being considered are suitably quantified. Furthermore, palaeopathologists and bioarchaeologists also need to consider that conditions not deemed disabling in modern conditions, such as myopia, may have had a much greater impact upon both the individual and the society. Developing an Egyptian social model of disability and impairment The arguments above demonstrate that disability should be considered as a normal part of life, and that all individuals can be placed upon a fluid continuum of ability. During certain periods of life, an individual might be less physically ‘able’ or be 63 64 Palaeopathology in Egypt and Nubia restricted in their participation, such as during pregnancy or when recuperating following skeletal trauma or fracture. For example, during the healing of a bone following fracture, it must be immobilised, thereby reducing mobility and the use of that bone or an affected limb. It is possible that the Egyptians recognised this as Sullivan (2001, p.262) argues that ‘[the Egyptian] artist does not attempt to ‘beautify’ deformity which suggests that there was a prevailing attitude of cultural acceptance over deformity’. She links this to physical deformities of certain Egyptian deities, such as Bes and Hapi, and suggests that ‘physical deformity may have been received as a positive mark of divinity’ (Sullivan, 2001, p.262). There is little evidence of prejudice, at least for disorders that might be considered ‘noble’ (Jeffreys and Tait, 2000, p.91), and hence temporal duration, context and social rank must be incorporated into all Egyptian models of disability and impairment. Furthermore, although chronic illnesses and impairments appear in all sectors of modern society, certain groups, such as the lower ranking or poorer, are more vulnerable (Bartley, 2004). Following this hypothesis for past Egyptian populations, it is imperative that focus is placed upon the labourers, farmers and lower ranking individuals in order to develop a model of Egyptian health and ability. An ‘anthropologie de terrain’ approach (Duday, 2009) might permit small-scale differences in funerary practice or relative liminality (cf Knüsel, 1999), as might happen within primarily lower ranking groups, to be identified (such as the prone burial of congenitally deaf child at Poundbury (Molleson, 1999)). Furthermore, given that ‘the personal responses of disabled individuals to their impairments … have to be located within a contextual framework that takes account of both history and ideology’ (Oliver and Barnes, 2012, p.98), the ability continuum must be viewed through the lens of the individual agent and the moment in their life course. Ancient Egyptians may have viewed individuals along some form of ability continuum, with people acting differently in differing situations and in different periods of their lives. As archaeologists and palaeopathologists, we need to move beyond a negative framework for impairment, but rather view all people in terms of varying abilities, some of which may have potential for exploitation. In addition to the blind harpists discussed above, Nunn (1996) has suggested that individuals with myopia (who might be considered blind or partially sighted in some contexts) might have been employed to undertake miniature engravings. Indeed, in modern western society, some people born deaf have argued that, due to use of sign language, they should not be considered disabled, but rather a cultural minority (Oliver and Barnes, 2012). A social model of Egyptian ‘disability’ would argue that all people have varying abilities, rather than disabilities and impairments. Dis/ ability therefore acts as one dimension within Egyptian identity. Thus to access detailed aspects of the past Egyptian attitudes to dis/ability, all cadavers need to be remembered to have been people, rather than categorised as disabled or ‘other’, and importance placed upon the timing and duration of all bodily effects. Acknowledgments The author would like to thank Stephanie Wright (for discussions regarding disability in ancient Rome), Joanne Rowland, Sarah Inskip, Scott Haddow and all the others in the Minufiyeh (Quesna) team, and the organisers of the Palaeopathology in Egypt and Nubia Palaeopathology, disability and bodily impairments workshop, and most especially Ryan Metcalfe. Partially funded by the Egypt Exploration Society and the Arts & Humanities Research Council. References Andersen, S.R., 1997. The eye and its diseases in ancient Egypt. Acta Ophthalmologica Scandinavica 75, pp.338-344. Baines, J., 1992. Merit by Proxy: The Biographies of the Dwarf Djeho and his patron Tjaiharpta. Journal of Egyptian Archaeology 78, pp.241-257. Brothwell, D., 1967. Major congenital anomalies of the skeleton: Evidence from earlier populations. In: D. Brothwell and A.T. Sandison, eds. Diseases in Antiquity. Springfield: Charles C Thomas. pp.423-443. Buikstra, J.E., Baker, B.J. and Cook, D.C. 1993. 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