The study of the material remains of pre-modern health culture – of ‘sewers and skeletons’ – has occasionally been treated with ambivalence by medical historians. For their part, osteoarchaeologists and palaeopathologists seek to explain (amongst other things) the functional consequences for an individual of a range of particular congenital and acquired disorders; the socio-economic determinants of health within a population; cultural and social responses to disease; pre-modern surgical and remedial treatments; and the origins and epidemiology of infectious diseases. Historians of medicine, whilst embracing aspects of the spatial and material culture of pre-modern health care, have on occasion defined their agenda against that of historical epidemiologists and palaeopathologists, largely as a consequence of reacting against anachronistic forms of ‘retrospective diagnosis’ in their own field. They particularly seek to avoid any suggestion that concepts or diagnoses of diseases transcend time and place, or that they are somehow static, common or innate, or that they are independent of the interpretations offered by the individuals who experience, witness or define them. For example, in a witty and textured article, the historian Peregrine Horden argued that ‘in the history of … pre-nineteenth-century … public health measures, sewers and skeletons are not quite enough’. Horden admitted that what he calls the ‘materialist-biological’ account can ‘capture some of the story’ but, he contended, ‘it will do that only in the narrow terms of biomedicine and demography’. Religious and moral philosophies and concepts of pollution comprised the principal explanation for disease in the medieval Christian West. These might too easily be eclipsed, Horden implied, by a methodology that utilizes modern concepts of hygiene or pathogens at the expense of such culturally specific categories as space, ritual, symbolism and concerns about communal purity.

In addition to the underlying theoretical concerns, other factors have also discouraged a fuller integration of historical and material evidence.