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The Black Death and medieval health change

Did the Black Death transform medieval society?

Or was there more continuity than change?


The Black Death epidemic of bubonic plague swept through Europe in 1347-50; in some places, such as England (1348-9), it killed up to half the population. How did such a health catastrophe change medieval society?

Using textual and archaeological evidence, historians have shown that some important things changed in the decades after the huge epidemic:

  • Demographic collapse: population stagnated and it took 2-3 centuries before population levels reached what they had been before the plague.

  • Wages often rose as the demand for labour outstripped the number of people available to work after the huge number of deaths during the epidemic.

  • Labourers were less tied to places and freer to move around in search of work.

  • Settlements shrank as there were fewer people, and cultivated fields were often converted to pasture, which took less labour and supplied wool for the thriving cloth trade.

A reconstruction image of a Black Death patient

A patient dying of Black Death; Reconstruction image: Mark Gridley

These changes have been linked to knock-on changes such as the ongoing freeing of serfs from being tied to specific manors, people moving around more between employments and between countryside and towns, and increased activism by poor people (for instance, in the Peasants' Revolt of 1380).

However, there were many things that apparently didn't change much. The basic structure of medieval society and politics remained remarkably stable, and changes in literature, art, architecture and religion are subtle at best. It is possible that the plague killed huge numbers of people, but didn't change structural elements of medieval society dramatically. Another approach sees the Black Death not as an isolated event, but as part of a general fourteenth century crisis. Some historians argue that by the 1200s, Europe was overpopulated to the limit of what the productive economy of the time could support, and the climate was beginning to get cooler and wetter, making crop failures and famine more common. For example, the fourteenth century in England began disastrously with the Great Famine (1315-20) triggered by several years of crop failure in a row, in which 10-15% of the population died. In this view, the Black Death is what happens when a new disease meets a population which is already stressed, hungry and vulnerable.

Skeletal evidence can add to this debate in new ways. For example, historical records can tell us that wages rose, but they don't tell us whether people's diet actually improved. Were people taller after the Black Death (if they were eating better, or less disease-prone)? If there was less crowding of dense populations, was there less infectious disease? Did epidemics form a selection pressure which might have changed the genetic composition of medieval


A graph showing a population pyramid

Tuberculosis in people dying at different points throughout the medieval period

Chart: After the Plague project

A graph showing median death date

Did the age people died at change during the Middle Ages?

Chart: After the Plague project

Testing models of change


Tracing the health and lifestyle effects of the Black Death was a major focus of our project. For about 30 skeletal, chemical and genetic indicators, we compared people before and after the plague to see what changed. Of course, some important changes took a generation or two after the plague to kick in, and we also didn't want to assume that any change happening in medieval times must have been due to the Black Death. So we also compared people living in each century, made models of continuous change, and compared people before and after a range of dates (e.g. before and after 1200, 1250, 1300).

The upshot: most things didn't change after the Black Death. This included:

  • age at death (and diseases of age such as osteoarthritis)

  • stature

  • trauma

  • indicators of childhood stress (enamel hypoplasia, cribra orbitalia)

  • diseases such as tuberculosis

  • the overall genetic composition of the town, and the specific gene locations related to response to infectious disease and other things

We did find a few things that changed in later medieval times, but most of these changes did not coincide with the Black Death, reminding us that many things were changing throughout the medieval period. Overall, our results suggest that there was much more continuity than change in medieval Cambridge -- at least, in the living conditions that affected people's health and their skeletons. This agrees well with models that see the Black Death not as a single catastrophic event in isolation, but as part of an ongoing, general fourtteenth to fifteenth century crisis related to climatic worsening, overpopulation, new diseases, and other causes -- a long-term process whose effects may be subtle, highly variable and sometimes quite local.

It's important to remember that Cambridge may not be typical. Most medieval people lived rurally. Our study focuses upon the minority of people living in a town – Cambridge. And Cambridge was an unusual town; the University and its large religious community may have given it an economic stability many towns lacked, particularly since the University grew substantially in the fifteenth century, bringing money from rich patrons into the city. We do not claim that our findings would be the same anywhere in medieval England or Europe!

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