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‘City dwellers in Middle Ages no worse off than village dwellers’

City dwellers in the Middle Ages were probably no worse off than people living in villages. Both groups had very different health risks, is Rachel Schats' conclusion from her research on bone material. PhD defence 3 November.

We often assume that cities in the Middle Ages with their poor hygiene and higher population density had a negative effect on the physical wellbeing of city dwellers. And at the same time a kind of idyllic purity is attributed to the lifestyle of country farming communities.  New research by osteoarchaeologist Rachel Schats undermines these assumptions. 'My research shows that rural areas and cities didn't differ very much from one another as far as disease is concerned,' Schats commented. 

Bone material

For her dissertation Schats examined the bones of city dwellers from Alkmaar (1448 – 1572 AD) and rural inhabitants in the West-Frisian community of Blokhuizen (1000 – 1200 AD) and the flooded village of Klaaskinderkerke (1286 – 1570 AD) in Zeeland. From the bone material she was able to detect which diseases or shortcomings these people had, what their physical condition had been and what they ate. 


From Schats’ research it became clear that the risks of the city were very different from those of the countryside. She discovered, for example, that at least two of the 189 Alkmaar skeletons had damaged ribs and vertebrae, which could indicate tuberculosis. None of the 173 inhabitants of the country areas suffered from this particular disease. Schats explained, 'As only 10 per cent of TBC patients develop bone damage, you can assume that a lot more of the Alkmaar people suffered from TBC. Presumably the difference with the country was much greater.' 

Stress markers

But if you look at the number of stress markers in the bones, you notice how little difference there is between city and country dewllers. Stress remarked, 'These stress markers indicate the degree of malnutrition or disease. Although it is not immediately clear what the diseases are, we do see that these stress markers are equally distributed among the city and country dwellers.' 

Tooth decay

The Alkmaar people also had more tooth decay than the villagers in Blokhuizen and Klaaskinderkerke. Schats thinks this has to do with the greater availability of food on the Alkmaar markets. 'Thanks to national and international trade, people who lived in  cities had access to more and more carbohydrate products such as fruit, sugar and honey. They may well also have drunk more beer because the city's water was so dirty. All that sugar was bad for their teeth.' 


At the same time, urbanisation probably had a positive effect on the number of typical 'country ailments'. Schats found signs of arthrosis on the upper part of the skeletons of women from country areas, probably caused by the heavy farm work such as milking and churning that they did. The skeletons of city women had fewer signs of arthrosis, probably because they no longer did such heavy annual work. 

Isotope research

Finally, Schas was able to deduce from isotope research that the people from Alkmaar ate a lot more marine fish than the villagers from West Friesland. 'The amount of fish available was increasing at the time, and salted herring was particularly popular. A lot of the fish was sold on markets and so was more accessible to the city dwellers.' 

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