The bones of the victims of the Black Death from 14th century London have some poignant tales to tell, of people who lived and died during a calamitous time in history. AAAS Member Sharon DeWitte, Ph.D., a biological anthropologist, and professor of anthropology at the University of South Carolina in Columbia, has studied those bones and has concluded that poverty might well have worsened the death toll during that medieval pandemic.
When the coronavirus blazed into the public consciousness last spring, the Black Death was a common touchstone for commentators and even the general public, even though the two diseases don't have that much in common.
There is one valid parallel, though, which is that social inequality can worsen outcomes, according to DeWitte. As many as 70% of the English may have been living at or below the poverty level when the Black Death arrived in London in 1348, compared with about 10.5% of Americans who lived in poverty in 2019, according to the United States Census. Studies have already shown that poor people are getting sicker, and are hospitalized and die from COVID-19 more often, than people who are not poor — and that racial inequality compounds the vulnerability.
“COVID-19 has shone a light on how devastating the effects of being impoverished are on health and well-being on a larger scale,” DeWitte says.
To study the link in medieval times, DeWitte has studied skeletons exhumed from the East Smithfield graveyard, which was dedicated to an estimated 2,400 people who died during the Black Death. Many of the skeletons are now curated at the Museum of London. DeWitte has been to London four times to work with them. She has also looked at the skeletons of hundreds of people who died of other causes before the Black Death, for comparison. This work is part of a project that examines the plague as an emerging (and re-emerging) disease over time in medieval London, using skeletal samples that date from 1000 to 1739. Next, DeWitte will study mechanisms that might have affected health in this period, including diet, gender, migration patterns, and genetic changes.
“I am very interested in the effects of poverty and inequality in a variety of contexts,” she says.
Bones are all that remain of ordinary people
Ordinary people are not mentioned in any of the historical documents that survive from the 14th century, DeWitte says. Their bones are all we have.
“When I lay a skull on a padded table facing me, it’s hard to resist imagining what that person looked like in life,” DeWitte says. “I often think about the fact that few, if any, of the people I study would ever have imagined that I and others would one day look at their bones to try to understand their lives. I feel really privileged to have the opportunity to reconstruct medieval life using their remains.”
Some of the people in the East Smithfield cemetery, located near the Tower of London, may have been notable citizens of London, but it’s impossible to tell now. While they were given Christian burials and treated with remarkable respect, given the public-health emergency underway, “they didn't have grave goods or anything else to denote their status,” DeWitte says.
She believes the pervasive poverty of the time meant that more Londoners met the plague with compromised immune systems and other depleted physical resources and that the carnage was much worse than it would have been had the population been healthier.
The plague has not marked the bones DeWitte worked with — for one thing, people died within days of showing symptoms — but she can sometimes tell if people had suffered from other diseases that may have contributed to their demise. DeWitte found that shorter adults and those with defective enamel formation in their teeth, two indicators of malnutrition in early childhood, were more likely to die during the Black Death than people of the same age without such developmental stress markers.
Lessons from the Black Death for our time
COVID-19 has made the ancient pandemics relevant to our time, but we need to learn their lessons, DeWitte says.
“We are increasingly aware of how devastating the effects of being impoverished are on full health and well-being,” she says. “We can see with plagues of the past — the medieval period and the flu of 1918 — and now with COVID-19, death is not the necessary outcome of being infected with this particular pathogen. The mortality levels we are seeing are preventable.”
For her part, DeWitte says she has always been “a little weirdly comfortable with death.” As a teenager, she had surgery to correct scoliosis, and says she imagined archeologists in the future “digging up my weird skeleton, maybe making mistakes about my life based on my skeleton.” Now, she says, she wants to be cremated or returned to the soil. “I don’t want to have a lot of stuff done to my body,” she says.
Her legacy, she hopes, will be to help people understand, by humanizing the past and sharing empirical data, that the phenomenon of emerging infectious disease is here to stay.
“These are things that have happened in the past and we will deal with them in the future,” she says. “How can we be better prepared to avoid the worst outcomes?”