In medieval Denmark, the place of burial often reflected a person’s wealth and status. Christians could pay for famous tombs, and the closer the tomb was to the church, the more expensive it usually was. Researchers used this burial system to investigate whether disease affects social status after death. They focused on people who had not only tuberculosis but also leprosy, which has historically been associated with prejudice and ideas of sin.
The results were unexpected. Those suffering from these diseases were often buried in the same prominent location as others, rather than being pushed to less desirable burial locations.
“When I started this job, I immediately thought of this movie. Monty Python and the Holy Grailespecially the plague cart scene,” said the study’s lead author, Dr. Saige Kelmeris of the University of South Dakota. Frontiers of environmental archeology. “We think this image represents our idea of ​​how people in the past, and in some cases today, responded to debilitating illnesses. However, our research reveals that the responses of medieval communities and their composition were diverse. In some communities, sick people were buried with their neighbors and received the same treatment as everyone else.”
Study of medieval skeletons and diseases
Kermeris collaborated with Vicki Christensen and Dr. Dothe Pedersen from the University of Southern Denmark on the research. The research team examined 939 adult human remains from five medieval cemeteries in Denmark. Three of the burial sites were in urban areas and two in rural areas, allowing researchers to compare possible differences between urban and rural populations.
Cities tend to have higher population densities, which can increase the prevalence of diseases such as leprosy and tuberculosis. Conditions common in medieval towns made people susceptible to disease.
Still, the two diseases affected people in different ways. Whereas leprosy often caused visible lesions on the face that made patients stand out, tuberculosis usually had less obvious symptoms.
“Tuberculosis is one of those chronic infections that can coexist for a very long time without symptoms,” Kermeris said. “Also, tuberculosis is not as visibly disabling as leprosy. At a time when the cause and route of infection were unknown, tuberculosis patients would not have been subject to the same stigma as the more obvious leprosy patients. Perhaps people in the Middle Ages were busy dealing with one disease, and the other was just the icing on top of a sick sundae.”
How researchers identified skeletal disease
The researchers determined whether each skeleton showed signs of disease and also estimated how long each person lived. Leprosy can leave visible marks on bones, including facial damage and deterioration of limbs due to secondary infections. Tuberculosis tends to affect the joints and bones near the lungs.
The scientists then created detailed maps of each cemetery. They looked for boundaries and features that might indicate status differences, such as burial grounds within religious buildings. All human remains were placed on these maps, allowing the team to compare burial locations in higher-status and lower-status areas.
“There is documentation that individuals were able to pay a fee to obtain a more privileged burial location,” Kermeris explained. “It is likely that these people (patrons, knights, clergy) were also able to use their wealth to draw closer to God during their lifetime, such as by having pews closer to the front of the church.”
Burial conditions and diseases in the Middle Ages
Overall, the researchers found no consistent association between disease and burial conditions. Only one location, the urban cemetery of Ribe, showed a health-related pattern. At this site, about a third of those buried in low-status areas had tuberculosis, compared to 12 percent of those buried in monasteries and churches.
Because people with leprosy and tuberculosis still appear in prestigious burial grounds, researchers believe this difference likely reflects different levels of exposure to tuberculosis rather than social prejudice.
Tuberculosis was common in all five cemeteries. The urban burial ground of Drotten was particularly outstanding. Almost half of the graves there were in high-status areas, and 51 percent of the remains had evidence of tuberculosis.
Researchers suggest that wealthy people may have had better living conditions, which may have helped them survive tuberculosis longer. If you live with this disease for a long time, the infection is likely to leave visible marks on your bones.
Rethinking medieval attitudes towards disease
Taken together, the findings challenge the common image of medieval societies automatically rejecting people with visible illnesses. In many cases, people with serious illnesses appear to be buried with their neighbors without apparent discrimination.
Researchers note that further excavations are needed to build a more complete picture of burial practices at some cemeteries. They also point out that strict diagnostic criteria may have led to some infections being missed.
“The individual may have carried the bacteria but died before it appeared on the skeleton,” Kermeris warned. “Unless we can include genomic methods, we may never fully know how these diseases affected communities in the past.”
