Medieval Danish communities did not shun individuals afflicted with leprosy or tuberculosis, burying them with the same status and proximity to religious sites as their healthier neighbors, according to a new study examining skeletal remains from the period.
Researchers from the University of South Dakota, the University of Southern Denmark, and several Danish museums analyzed the remains of 939 adults from five medieval cemeteries – three urban and two rural – dating from approximately 1050 to 1536 AD. The study, published in Frontiers in Environmental Archaeology on February 12, 2026, challenges long-held assumptions about social ostracism of the sick in medieval Europe.
The team assessed skeletal indicators of both leprosy and tuberculosis, diseases that were prevalent during the medieval period. Leprosy, characterized by visible skin lesions and nerve damage, carried a particularly strong social stigma, often associated with sin and impurity. Tuberculosis, while also widespread, presented with less immediately obvious symptoms.
“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, the lead author of the study. “I think this image depicts our ideas of how people in the past – and in some cases today – respond to debilitating diseases. Though, 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.”
The researchers mapped the cemeteries, looking for patterns in burial location that might indicate social stratification. They found evidence that individuals could pay for more prestigious burial plots, typically closer to churches or within religious buildings. However, the presence of leprosy or tuberculosis did not consistently correlate with lower burial status.
The urban cemetery of Ribe showed the most pronounced difference. Roughly one-third of individuals buried in the lower-status section of the cemetery had evidence of tuberculosis, compared to 12% of those buried in the monastery or church. Researchers suggest this difference may reflect varying levels of exposure to the disease rather than social exclusion.
Conversely, the urban cemetery of Drotten showed a high prevalence of tuberculosis – 51% – among those buried in high-status areas. Nearly half of the burials in this cemetery were considered high status. This suggests that individuals who could afford better living conditions, and therefore potentially more protection from disease, were also more likely to survive with tuberculosis long enough for the disease to leave detectable traces on their bones.
According to a 2019 study published in PubMed, urbanization during the Danish medieval period (AD 1200-1400) likely increased exposure to pathogens. The study analyzed skeletal remains from both urban and rural sites, finding varying frequencies of leprosy and tuberculosis, but no significant differences in survival rates between urban and rural populations with the diseases.
“Tuberculosis is one of those chronic infections that people can live with for a very long time without symptoms,” Kelmelis explained. “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 researchers caution that their findings may not represent a complete picture, as not all individuals with these diseases would necessarily leave detectable traces on their skeletons. Further research, including genomic analysis, is needed to fully understand the impact of these diseases on past communities. A 2017 study cited in ScienceDirect highlights the potential of ancient DNA and lipid biomarkers in diagnosing ancient leprosy and tuberculosis.
The study team is continuing to analyze data from additional Danish cemeteries, seeking to refine their understanding of medieval health and social practices.
