Medieval Cambridge: the social healthscape

Imagine it is 1347 and you are trying to learn about health in medieval Cambridge. Standing in the bustling marketplace beside Great St. Mary's church, you stop 20 people and (in your best Middle English), you ask them about their health. The results would be very different depending on which 20 people you stopped. Trying to understand medieval health from the archaeology can be somewhat similar. Different kinds of people were buried in different places; to get a cross-section of the health of the whole city, we always have to remember what sector of the town each skeletal sample represents.

Our biographies give a sense of different people's lives as individuals, but we can also see how each group had its own health issues.

Many aspects of health didn't differ much among people living in medieval Cambridge. Rich people and poor people lived in close proximity and there was little effective medical care for either. There were also certain risks that they couldn't insulate themselves from. For example, there was little understanding of what caused infectious diseases such as malaria and tuberculosis, and both prosperous and poor people lived in conditions that favoured disease – crowded lodgings, exposure to vectors such as parasites, and unclean water sources. They shared many of the general health conditions of a crowded, polluted medieval town.

But we also found that there was some important variation in how different groups lived. Although good skeletal samples don't exist to study some sectors of medieval Cambridge – the University population, travellers from elsewhere, Jews (until they were expelled in 1275), and soldiers stationed at the Castle – we can compare some important groups: ordinary townsfolk, religious professionals, and people living on charity.

Reconstruction image: Mark Gridley

Ordinary Townsfolk

Of the ordinary townspeople, some would have worked in the town, and some in the fields around Cambridge. Almost all did some form of manual labour, whether skilled or unskilled, working for themselves or receiving wages working for others. Several dozen specialised trades were practiced in Cambridge, but many men would have been general labourers – some regularly employed, some picking up short term jobs from day to day. Women worked in the fields, as market traders, brewers and sellers of ale, and laundresses, among other jobs and sometimes doing general labour. The town also contained some very poor people, living in what we would consider severe deprivation.

In our skeletal samples, ordinary townsfolk were represented by people from All Saints by the Castle, the parish cemetery for an outlying neighbourhood of medieval Cambridge. There were also a few townspeople from other city-centre sites. While most townspeople had adequate food, its basic staples were grain (in the form of bread, porridge and ale), vegetables and a little dairy foods; for most, their diet (both as children and adults) was not very enriched with fish and animal protein. Probably about half of the people in this group would not have survived their childhood, as infant and child death was common (particularly from infectious diseases), but if they did then the often lived a surprisingly long time.

Of the people who made it to adulthood, at least half of them lived beyond 45 years.The ordinary townspeople were of medium height by modern standard: women grew to around 163 cm (5ft 4 in) and men to around 171 cm (5ft 7in). Both men and women were often quite robust, suggesting that they did strenuous physical work. Of all the people in medieval Cambridge, it was this group that had the highest rate of traumatic injury, which probably reflects the risks of labouring hard for a living.

The skeletons we studied for the After the Plague project included a few more prosperous townsfolk, who had enough money to pay to be buried at the Augustinian Friary. They had more enriched nutrition, which suggests that the amount of meat and fish you ate was indeed a marker of your status for medieval people. But they were about the same size, suffered from similar health conditions and died at the same ages as other townspeople. Money couldn't buy you health in all respects.

Religious professionals

The Augustinian Friars were religious professionals who lived according to the rules of their order. Their isotopes show that, for the ones buried here, the friars were almost all recruited in East Anglia. We know historically that some friars travelled to Cambridge to study, sometimes from as far as France and Italy, but presumably most of those from overseas didn’t die during their time in Cambridge. The Friars' family backgrounds were mixed, but judging by markers of childhood development, they didn’t seem to come from the poorest backgrounds.

In some ways, the friars resemble the townspeople of Cambridge. They suffered from the same range of ailments and injuries (for instance, several of them died of plague, leaving plague bacteria DNA in their bones, though from later outbreaks rather than from the 1348-9 Black Death epidemic). They died at the same ages as townspeople. Some of them clearly did stressful physical work. The friars are often quite robust and seem to have pursued very varied activities, including specialised manual labour. Unsurprisingly, they often had foot modifications which may be related to habitual kneeling. Perhaps more curious is that they had the highest level of bunions. This may have been related to wearing constricting shoes. Tight pointy-toed shoes became fashionable for men in the fourteenth to fifteenth centuries; friars weren’t supposed to wear fashionable attire, but they did anyway.

The Augustinian Friars' skeletons differed from townsmen in two ways. First, on average the friars were taller than other men by about 2 cm (1 inch). Boys were admitted to the order in their early to mid-teens, when they were still growing. When novices joined the friary, their nutrition changed. The evidence for this can be seen when we compare the composition of their teeth (which formed during childhood), with that of their bone (which reflects the last decade or so of their lives); the isotopic composition of their adult years often shows a jump in how much animal and fish protein they ate. Secondly, according to their bone chemistry, of the people living in medieval Cambridge, the friars had the most enriched adult diet. Monks and friars were often caricatured for eating well; in spite of the frequent fast days they were supposed to observe, if they belonged to a prosperous order; they ate a standardised institutional diet with regular meat and fish.

Reconstruction image: Mark Gridley

A reconstruction image of a medieval hospital

Reconstruction image: Mark Gridley

People that received charity

Many people in medieval towns would have been poor, living precarious lives, but there was little safety net to help them. In Cambridge, as in many towns, a charitable 'hospital' offered food, a place to live, and clothing for a fortunate small fraction of the needy. The Hospital of St. John had a staff of perhaps half a dozen clerics and lay helpers, and it provided food, shelter and clothing for about a dozen live-in inmates, including men and women, mostly adults.

This group turned out to be surprisingly mixed. Some were undoubtedly extremely poor and needy. Compared to other medieval people in Cambridge, many of them show poor childhood environments – very low stature, very low food-related isotopes, and childhood growth interruptions. On average, the Hospital inmates were 1-2 cm shorter than townspeople in general, perhaps from growth interruptions in childhood. Some of these have robust, well-muscled skeletons, but many of them show little sign of having laboured hard, perhaps because they were chronically ill. These individuals often died relatively young; they often had chronic diseases such as tuberculosis. Some had had poor childhoods, but survived until older ages; since care in old age depended entirely upon one’s savings and family/ social networks, it is possible that their families were too poor to care for them. Such skeletons show the Hospital's role as a benefits system for a small number of the desperately poor.

However, the Hospital burials also included other kinds of people. Many people buried there do not look very different skeletally from ordinary townsfolk of medieval Cambridge, and it is quite likely that they lived like everyone else until some particular combination of circumstances – old age, a health crisis, outliving all their relatives and having no savings – made them needy. A few had probably been more prosperous and descended into poverty later in life, presumably as their fortunes changed. A few people buried at the Hospital may have been paying 'corrodians' who donated their worldly goods to the Hospital in return for room and board for the remainder of their lives, or they may have been neighbours of the Hospital who simply wanted to be buried there. Particularly in the later Middle Ages, the Hospital also provided shelter for some scholars of Cambridge University who had become too old or ill to work as scholars. It also seems to have provided burial in consecrated ground for a few strangers who died while visiting Cambridge.

This heterogeneity is reflected in the skeletons from the Hospital. To take an example, the isotopic data from most of the other groups from medieval Cambridge group tightly together, suggesting that townspeople and religious professionals ate a consistent diet typical of their group. In contrast, because they include such varied people, the Hospital people varied more than anybody else nutritionally. They also often show an improved diet once they joined the Hospital (we can see this by comparing the isotopic values from their childhood with those from late in their lives); people in the Hospital lived in a way modelled on monasteries and friaries, with a diet regularly including meat and fish, and their diet was probably considerably better than that of most townspeople.