In medieval Denmark, burial location often reflected a person’s wealth and status. Christians could pay for prestigious graves, and the closer a grave was to the church, the more expensive it typically was. Researchers used this system of burial placement to explore whether illness affected social status after death. They focused on people who had leprosy, a disease historically linked with stigma and ideas of sin, as well as tuberculosis.
The results were unexpected. Instead of being pushed to less desirable burial spots, individuals with these illnesses were often buried in the same prominent locations as everyone else.
“When we started this work, I was immediately reminded of the film Monty Python and the Holy Grail, specifically the scene with the plague cart,” said Dr. Saige Kelmelis of the University of South Dakota, lead author of the article in Frontiers in Environmental Archaeology. “I think this image depicts our ideas of how people in the past — and in some cases today — respond to debilitating diseases. However, our study reveals that medieval communities were variable in their responses and in their makeup. For several communities, those who were sick were buried alongside their neighbors and given the same treatment as anyone else.”
Studying Medieval Skeletons and Disease
To investigate, Kelmelis worked with Vicki Kristensen and Dr. Dorthe Pedersen of the University of Southern Denmark. The team examined 939 adult skeletons from five medieval cemeteries in Denmark. Three of the burial sites were located in towns, while two were in rural areas, allowing researchers to compare possible differences between urban and countryside populations.
Cities tended to have higher population density, which could increase the spread of diseases such as leprosy and tuberculosis. Conditions often associated with medieval towns also made people more vulnerable to illness.
Still, the two diseases affected people in different ways. Leprosy often caused visible facial lesions that made sufferers stand out, while tuberculosis usually produced less obvious symptoms.
“Tuberculosis is one of those chronic infections that people can live with for a very long time without symptoms,” said Kelmelis. “Also, tuberculosis is not as visibly disabling as leprosy, and in a time when the cause of infection and route of transmission were unknown, tuberculosis patients were likely not met with the same stigmatization as the more obvious leprosy patients. Perhaps medieval folks were so busy dealing with one disease that the other was just the cherry on top of the disease sundae.”
How Researchers Identified Disease in Skeletons
The research team determined whether each skeleton showed signs of disease and also estimated how long each person had lived. Leprosy can leave clear traces on the bones, including facial damage and deterioration of the hands and feet caused by secondary infections. Tuberculosis tends to affect joints and bones near the lungs.
Next, the scientists created detailed maps of each cemetery. They searched for boundaries or features that might signal differences in status, including burials located inside religious buildings. Every skeleton was placed on these maps so the team could compare burial locations between higher status and lower status areas.
“There is documentation of individuals being able to pay a fee to have a more privileged place of burial,” explained Kelmelis. “In life, these folks — benefactors, knights, and clergy — were also likely able to use their wealth to secure closer proximity to divinity, such as having a pew closer to the front of the church.”
Medieval Burial Status and Disease
Overall, the researchers did not find a consistent link between illness and burial status. Only one location, the urban cemetery of Ribe, showed a pattern connected to health. At this site, about one third of individuals buried in lower status areas had tuberculosis, compared with 12% of those buried in the monastery or church.
Because people with leprosy or tuberculosis still appeared in prestigious burial areas, the researchers believe this difference likely reflects varying levels of exposure to tuberculosis rather than social stigma.
Tuberculosis was common across all five cemeteries. The urban burial site at Drotten stood out in particular. Nearly half of the graves there were located in higher status areas, and 51% of the skeletons showed evidence of tuberculosis.
Researchers suggest that wealthier individuals may have had better living conditions, which could have helped them survive tuberculosis longer. Living with the disease for a longer time would increase the chances that the infection left visible marks on their bones.
Rethinking Medieval Attitudes Toward Illness
Taken together, the findings challenge the popular image of medieval societies automatically rejecting people with visible disease. In many cases, individuals with serious illnesses appear to have been buried alongside their neighbors without obvious discrimination.
The researchers note that further excavations will be needed to build a more complete picture of burial practices in some cemeteries. They also point out that their strict diagnostic standards may have missed some infections.
“Individuals may have been carrying the bacteria but died before it could show up in the skeleton,” cautioned Kelmelis. “Unless we can include genomic methods, we may not know the full extent of how these diseases affected past communities.”
