Episode 2: Down Syndrome and Researching Disability

In this episode, the Accessible Medievalist takes a look at medieval evidence for Down Syndrome as well as issues with diagnosing historical disability and what burial practices can tell us.

Check out more on the Accessible Medievalist web site! 

Bibliography:

Centers for Disease Control and Prevention. “Living with Down Syndrome.” November 22, 2024. https://www.cdc.gov/birth-defects/living-with-down-syndrome/?CDC_AAref_Val=https://www.cdc.gov/ncbddd/birthdefects/downsyndrome/data.html, accessed January 3, 2026.

Holst, Malin. “Osteological Analysis Coppergate York.” York Archaeological Trust For Excavation & Research. York Osteoarchaeology, 2010. https://research.yorkarchaeology.co.uk/wp-content/uploads/2023/08/CoppergateOsteologicalAnalysis.pdf.  

JORVIK Viking Centre. “The People of JORVIK.” https://www.jorvikvikingcentre.co.uk/the-vikings/the-people-of-jorvik/, accessed January 4, 2026.

Martinez-Frias, Maria Luisa. “The real earliest historical evidence of Down syndrome." American Journal of  Medical Genetics 132A, no. 2 (2005): 231.

Nolan, Blair, et. al. “Disability and Care in Late Medieval Lund, Sweden: An Analysis of Trauma and Intersecting Identities, Aided by Photogrammetric Digitization and Visualization.” Open Archaeology 11, no. 1 (2025): 1-18.

Rivollat, Maïté, et. al. “Ancient Down syndrome: An osteological case from Saint-Jean-des-Vignes, northeastern France, from the 5–6th century.” International Journal of Paleopathology 7 (2014): 8-14.

Starbuck, John M. “On the Antiquity of Trisomy 21: Moving Towards a Quantitative Diagnosis of Down Syndrome in Historic Material Culture.” Journal of Contemporary Anthropology 2, no. 1 (2011): 19-44.

Mentioned in Episode: Lectures on Tap

Credits: 

Music - Medieval Theme 01 by Strobotone is licensed under a Attribution-NoDerivatives 4.0 International License

Clip - Mulan from MovieSounds

Transcript

Episode 5: Down Syndrome and Researching Disability

Welcome to the Accessible Medievalist! I am Dr. Kisha Tracy, your host. 

A few weeks ago, I gave a talk on medieval mental health for the awesome organization Lectures on Tap. Afterwards, a couple in the audience came up to chat, and they told me that one of them had a sister with Down syndrome, and so they were very interested in disability. As luck would have it, I had just happened to be doing some research on what historical evidence we have about individuals with Down syndrome that I was able to share, absolutely delighting them. One laughed and said, “You may have just converted another medievalist!” Music to my ears! That conversation made me want to share this information on the Accessible Medievalist.

Down syndrome is a genetic condition that happens when a person has a full or partial extra copy of chromosome 21. Characteristics can include a slant to the eyes, smaller stature, and potentially mild to moderate cognitive impairment. As with most disabilities, the experience of different individuals with the same condition can be vastly different. Down syndrome is no exception. Different people could have a unique set of characteristics or some not at all. There can also be a difference between those with full and those with partial extra copies of the chromosome. According to the Centers for Disease Control and Prevention, in the United States, Down syndrome occurs in about one in every 640 babies. 

While Down syndrome was named in 1866 after the English physician John Langdon Down and then it wasn’t until 1959 that French physician Jérôme Lejeune discovered the chromosomal connection, we know that wasn’t the beginning of its story. John M. Starbuck, in the article “On the Antiquity of Trisomy 21,” says something that I have to chuckle at. He says, “On the basis of both material culture and skeletal remains exhibiting Down syndrome like phenotypes, and basic logic, it is likely that Down syndrome has been present in mankind for as long as chromosome 21 has existed.” It’s the insert of “basic logic” that I find amusing. 

There tends to be an illogical trend in preconceptions about disability that somehow people with disabilities just appeared one day in the modern era. In presentations, to illustrate this, I usually use the screenshot from the animated film Mulan, in which the dragon Mushu talks about how the Hun army survived the avalanche. (Clip from film: “They popped up out of the snow! Like daisies!”) I always think of this line in this context. That people with disabilities somehow suddenly appeared one day is something that doesn’t make any sense, and, while entertaining in  a grimly amusing sort of way, it has a negative impact on representation, implying that people with disabilities do not have a long history and place in the human story. For the record, disabilities have existed as long as people have had bodies. Starbuck emphasizes that when he says that “basic logic” would indicate Down syndrome has also always existed.

But he does also use other evidence to make his case, including material culture and skeletal remains. His article is very interesting, and I recommend it, because he looks at different pieces of this evidence that other scholars have put forward and rates how strong of the likelihood there is that they are evidence of Down syndrome. Much of the material culture is artistic representations - paintings, statues, and the like. What fascinates me is the range of cultures and geographies that have such representations. It’s truly amazing! They range from North, Central, and South American to European and beyond. I will discuss two of the medieval ones here. 

The first is one that Starbuck calls “arguably one of the highest quality depictions of Down syndrome in material culture.” It is a Toltec terracotta figurine head from approximately 500CE. The Toltecs existed in Mexico. Maria Luisa Martinez-Frias attributed Down syndrome characteristics to this head, including short palpebral fissures, which make the eyes appear smaller or slit-like, oblique eyes, midfacial hypoplasia, which causes a flatter appearance, an open mouth, and a protruding tongue. 

The second artistic representation I will mention is the early sixteenth-century Flemish painting The Adoration of the Christ Child. Andrew S. Levitas and Cheryl S. Reid have argued that the angel on the Virgin Mary’s left and a shepherd both exhibit Down syndrome characteristics, many of the same as the Toltec figure. What seems important is that there is another nearly identical version of The Adoration of the Christ Child painted around the same time, which does not give these features to these individuals, suggesting such representation is deliberate. The couple I met at my Lectures on Tap event commented on the perception of people with Down syndrome as having “cherubic faces,” which here we have in literal form. Starbuck comments that the other angels at the top of the painting also have similar features. It’s an interesting connection to contemplate.

So we have these artistic representations (again, these two are just examples - there are more, from before and after the Middle Ages as well). We also have skeletal remains. This discovery I’m going to talk about was actually one of the first mentions that I really took notice of concerning medieval Down syndrome. A group of researchers took a closer look at a skeleton, dating to the fifth or sixth century CE, of a five to seven-year-old child found at an abbey in northeastern France. They noted a large cephalic index, which means the head's width is greater relative to its length; a flat occipital bone; and thinness of the cranial vault, among other characteristics, which led them to identify the child as having Down syndrome. Potentially, this child is the earliest and youngest case to be identified. 

I do want to take a minute to talk a bit about diagnosis. Diagnosing individuals in the past can be tricky. Something like disability requires interdisciplinary study, bringing together various disciplines to understand the experience of historical disability. Fortunately, my background in medieval studies prepared me in how to do interdisciplinary work. Despite that, we have to be very careful with diagnosis. I am not trained as a medical professional, and that’s certainly something I keep in mind. But, more importantly, I think, the difficulty with diagnosis is that it can mean that we place modern definitions on certain experiences, rather than viewing them as medieval people would. That includes using terminology or language that medieval people did not use. In a future episode, I’ll talk more about language and terms for medieval disability and the complexities of interpreting them. But while we certainly have to be careful with diagnosis, I often say that I feel like there is a freedom in this need to interpret the evidence we have rather than be influenced by, for example, the baggage that comes with modern diagnoses. Naming a certain condition or saying that an individual has a certain diagnosis may come with a set of expectations. Without a diagnosis, we look at the evidence that we are given and see the experience, physical, social, and otherwise. On the other hand, we do need to be aware that, while certain conditions were present, they might not have been named until more recently in history. So all of this has to be weighed when we are studying and then talking about them.

With a disability such as Down syndrome that is more difficult to identify, it is significant when different types of sources are examined together, so, just like the examples I’ve talked about here, artistic representations and archaeological evidence can corroborate each other.

Another aspect of the archaeological evidence in the case of the child in France that we can discuss is the circumstances of burial. Burial practices are incredibly important in so many cultures, and they often indicate how a person was perceived in life. We can think of this in terms of the size of mausoleums - generally, a larger mausoleum in a cemetery indicates high status, usually tied to having a lot of money or influence. It can also indicate a famous or, in some cases, infamous person. In some Christian communities, where a person is buried is just as important - those outside of the protection of the church might not be allowed to be buried inside church grounds. 

So there is a lot we can at least speculate about concerning where and how people with disabilities are buried. The 2014 researchers of the child with Down syndrome observed that they were “not treated differently at death than others in the community. We interpret this as meaning that the child was maybe not stigmatized during life, the first time a Down syndrome individual has been so viewed in the context of the ancient community.” To translate, this child does not seem to have been treated any differently. Neutral treatment is actually very illuminating; it means that the individual was simply viewed as any other member of the community. 

To contrast, an example of potential negative treatment is the late ninth-century CE Coppergate Woman from York, England. I want to note here that the sex of an individual from a burial is biological - we don’t know the gender experience of those individuals unless we have further evidence. In this case, the woman’s remains indicate hip dysplasia, osteoarthritis, and joint disease. She likely used crutches or some other mobility device. Her body, however, was found quite a ways away from the others in the area, which could indicate possible ostracism. I want to emphasize “possible” here. Without further corroboration or evidence, it is difficult to be certain.

We also have examples of people with disabilities being buried in places of honor. A body, male approximately thirty years old, found in a cemetery in Lund in southern Sweden has severe fractures of the left knee, which healed and fused at a 45-degree angle. This body was buried in a place of high status, close to the church. 

So what does this tell us? It is important not to generalize about all people with disabilities. Just as various people with the same disability can have very different experiences, so can all people with disabilities in a 1000 year time span all over the world. There are so many variables that can effect the experience of a person with disability. 

But we can say that the evidence about medieval people with Down syndrome reinforces what Starbuck calls “basic logic,” that they existed and lived and left their own marks on the human story.