Rich medieval Danes bought graves ‘closer to God’ despite leprosy stigma, archaeologists find

(Press-News.org) Medieval Christians in Denmark showed off their wealth in death by buying prestigious graves: the closer to the church, the higher the price. Researchers used these gravesites to investigate social exclusion based on illness, by studying whether people with leprosy — a highly stigmatized disease culturally associated with sin — or tuberculosis were kept out of the higher-status areas. Unexpectedly, they found that people who were ill with stigmatized diseases were buried just as prominently as their peers. 

“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.” 

Beyond the graves 

The lead researchers, Kelmelis and Vicki Kristensen and Dr Dorthe Pedersen of the University of Southern Denmark, examined 939 adult skeletons from five Danish medieval cemeteries: three urban and two rural, to capture possible differences between towns and the countryside. Higher population density makes it easier for both leprosy and tuberculosis to be transmitted, and unhealthy conditions traditionally associated with medieval towns increase vulnerability to both diseases. 

However, the two diseases impacted patients’ lives differently. Leprosy patients’ facial lesions would have marked them out as different, unlike the less-specific symptoms of tuberculosis.  

“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.” 

The scientists assessed disease status for each skeleton, as well as how long each person had lived. Leprosy leaves behind evidence of facial lesions and damage to the hands and feet caused by secondary infections, while tuberculosis affects the joints and bones near the lungs.  

Scientists then mapped out the cemeteries, looking for any demarcations that would indicate status differences, like burials within religious buildings. They plotted each skeleton on these maps, looking for differences between higher- 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.” 

Bring out your dead 

The scientists found no overall link between disease and burial status. Only at the urban cemetery of Ribe were there any differences that correlated with health: roughly a third of people buried in the lower-status cemetery had tuberculosis, compared to 12% of the people buried in the monastery or the church. As people with leprosy or tuberculosis were not excluded from higher-status areas, the researchers think this reflected different levels of exposure to tuberculosis, not stigma.  

However, all cemeteries contained many tuberculosis patients — especially the urban cemetery of Drotten, where nearly half the burials were in high-status areas and 51% had tuberculosis. People who could afford prestigious graves could also have paid for better living conditions, which helped them survive tuberculosis long enough for the disease to mark their bones.  

These results suggest that medieval people were less likely to exclude the visibly sick from society than stereotypes indicate. However, the researchers caution that more excavations are needed to get a more complete picture of some cemeteries, and that their stringent diagnostic criteria may not have identified every patient.  

“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.” 

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