What was a hospital like in medieval times? Researchers analyzed 400 skeletons to find out

An illustration of project number 92 (‘Wat’) based on the osteobiography generated through analyses of remains excavated from the main cemetery of the hospital of St. John the Evangelist in Cambridge. (Credit: Mark Gridley/After the Plague)

After surviving a horrific pandemic, an elderly man named Wat ended up spending his final days in a hospital, eventually passing away from cancer.

It's a story that wouldn't be out of place in 2023 — except that it occurred more than 600 years ago in medieval England, and the pandemic in question was the bubonic plague, not COVID-19.

"Wat" is the name researchers have given to one of 400 skeletal remains found in an excavation of a medieval hospital in Cambridge.

The remains were found when the hospital was first excavated in 2010, but who exactly these 400 people were, and how they came to be included among the hospital's inhabitants, was a mystery — until now.

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A new analysis published Friday in the peer-reviewed journal Antiquity has provided not only a glimpse into their individual lives hundreds of years ago, but is shedding light on who used hospitals at a time when they largely acted as live-in charities for the poor rather than a place to provide medical care.

"Like all medieval towns, Cambridge was a sea of need," John Robb, a professor at the University of Cambridge and one of the authors of the new research, said in a press release.

"A few of the luckier poor people got bed and board in the hospital for life. Selection criteria would have been a mix of material want, local politics, and spiritual merit."

Researchers combined skeletal, isotopic and genetic data collected from the remains in order to build detailed portraits of the medieval lives of several people who were laid to rest in the hospital cemetery.

They include a hard-working peasant woman, a four-year-old boy who didn't make it past childhood and a young woman who spent most of her short life fighting tuberculosis in a hospital bed.

Their stories were compiled as part of the "After the Plague" project at the University of Cambridge, which includes a website detailing the lives of 16 people whose remains were found in different medieval excavation sites across Cambridge, including the hospital's cemetery.

Researchers found that the "medieval benefits system" allowed for the care of a diverse range of people from various backgrounds, showing that the face of medieval poverty was far from one note.

But with resources scarce, getting a spot in the hospital was far from a given.

 

POVERTY, PRAYER AND PUBLIC SHAME: HOW TO GET ACCEPTED INTO A MEDIEVAL HOSPITAL

 

In modern times, a hospital has a flow of patients seeking emergency services or seeing specialists.

But in the year 1195, when the hospital of St. John the Evangelist was founded, its purpose was to help the "poor and infirm," a broad category that would only include more people a century and a half later after the bubonic plague, known as the Black Death, swept through Europe in 1347-51.

So who got into this exclusive charitable establishment?

The process of choosing who would be housed in the hospital involved a complicated balancing act between human need versus the religious and cultural goals of those who ran the hospital.

"We know that lepers, pregnant women and the insane were prohibited, while piety was a must," Robb said.

Hospital patients were required to pray for those who donated to the institution, he added, so their souls would move faster through purgatory on the way to heaven when they died.

This made donating to the hospital a spiritual choice for donors as much as a humanitarian one.

"A hospital was a prayer factory," Robb said.

Familial connections between the hospital inhabitants were rare, researchers found, indicating that people were admitted based on individual need.

Compared to the townsfolk, those in the hospital were on average an inch shorter and had worse health, but tended to have less bodily trauma, suggesting they were well-cared for and safe from injury.

Those who received a spot almost always suffered from poverty.

But while some skeletons bore the signs of tough, physical work or the stunted growth of a childhood filled with hunger, others told a different story.

Some male skeletons showed a life of good nutrition and a lack of rough work. Although most at this time had uneven arms due to performing manual labour in late adolescence, with the right arm more strongly built, these male skeletons had perfectly symmetrical arms.

These could be the "early scholars of the University of Cambridge," Robb believes. Part of the hospital's charter was to provide support for scholars without funds of their own.

There were also up to eight people who showed evidence that they once were well off before falling on hard times.

 

'WAT'

 

Wat, who lived until at least the age of 60 and died sometime between 1375 and 1427, wasn't always poor, researchers believe.

Although it's unclear what he did for a living, it wasn't manual labour as that wear and tear would've shown in his skeleton. But it was his isotopic readings that sparked interest for researchers.

Isotopes are atoms with the same number of protons, but different numbers of neutrons — essentially different versions of the same chemical element.

The ratios of isotopes contained in the food we eat are left like a mark on the body, a trace that researchers can look for in bones or teeth in order to understand a person's diet, even centuries after their death.

Wat's isotopic readings, along with up to seven other skeletons, showed that he consumed much less animal protein in the last 10 years of his life than he did when he was younger.

Almost everyone else at the hospital saw their diet improve or stay the same over their stay.

However, a sudden decline in their diet could suggest that a person once was relatively wealthy, but suddenly lost their wealth and needed the aid of the hospital, the study says.

"Theological doctrines encouraged aid for the shame-faced poor, who threatened the moral order by showing that you could live virtuously and prosperously but still fall victim to twists of fortune," Robb said.

There were a few children's skeletons found in the cemetery, small by their age by around five years of growth. These were believed to be orphan children.

 

THE 16 FACES

 

Those who were chosen to have their life stories featured as part of the 16 faces of medieval Cambridge offer a more specific look at the people who spent their last days in the hospital.

Thomas is an example of one scholar who likely moved to Cambridge after growing up in a different region of the country and died of an infectious disease between the age of 26 and 35 years old.

At four foot eight, Alice was one of the shortest women in town and had strongly built arms from years of hard work.

Anne suffered several injuries over her life, which gave her a strong limp exacerbated by severe arthritis, but still lived to somewhere between 45 and 60 years old – lives not so different from our own, lived hundreds of years ago.

Researchers believe the diverse population of those who spent time at the hospital shows why it was in operation for 300 years, surviving through the Black Death and beyond.

"They chose to help a range of people. This not only fulfilled their statutory mission but also provided cases to appeal to a range of donors and their emotions: pity aroused by poor and sick orphans, the spiritual benefit to benefactors of supporting pious scholars, reassurance that there was restorative help when prosperous, upstanding individuals, similar to the donor, suffered misfortune," the authors wrote in the study.