Leprosy carried powerful stigma in medieval Europe, but new skeletal evidence from Danish cemeteries suggests the sick were not always pushed aside in death.
In medieval Denmark, burial location reflected social standing. Families who could afford it paid for graves closer to the church, where plots were considered more prestigious and therefore more expensive. Researchers turned to these cemeteries to explore whether illness influenced who received these prime burial spots. They specifically examined whether people with leprosy — a highly stigmatized disease culturally associated with sin — or tuberculosis were excluded from high-status areas.
Contrary to expectations, the evidence showed that individuals with these diseases were buried in prominent locations just as often as others in their communities.
“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, lead author of the article in Frontiers in Environmental Archaeology. “I think this image depicts our ideas of how people in the past — and in some cases today — respond to debilitating diseases. However, 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.”
Beyond the graves
Kelmelis, Vicki Kristensen, and Dr. Dorthe Pedersen of the University of Southern Denmark analyzed 939 adult skeletons recovered from five medieval cemeteries in Denmark. Three sites were located in towns and two in rural areas, allowing the team to compare patterns between urban and countryside populations. Because infectious diseases spread more easily in crowded environments, medieval towns likely experienced higher transmission rates of both leprosy and tuberculosis. Poor sanitation and other unhealthy living conditions common in urban centers may also have increased susceptibility.
Although both illnesses were widespread, they shaped daily life in different ways. Leprosy often produced visible facial damage that clearly signaled disease. Tuberculosis, by contrast, usually caused symptoms that were less specific and less outwardly noticeable.
“Tuberculosis is one of those chronic infections that people can live with for a very long time without symptoms,” said Kelmelis. “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.”
To determine who had been affected, the researchers examined each skeleton for telltale signs of disease and estimated age at death. Leprosy can leave characteristic facial lesions along with damage to the hands and feet caused by secondary infections. Tuberculosis typically affects bones associated with the lungs, including nearby joints.
The team also created detailed maps of the cemeteries to identify potential status divisions, such as burials located inside churches or other religious structures. Each individual was plotted according to burial location, enabling the researchers to compare patterns between higher- and lower-status areas.
“There is documentation of individuals being able to pay a fee to have a more privileged place of burial,” explained Kelmelis. “In life, these folks — benefactors, knights, and clergy — were also likely able to use their wealth to secure closer proximity to divinity, such as having a pew closer to the front of the church.”
Bring out your dead
The scientists found no overall link between disease and burial status. Only at the urban cemetery of Ribe were there any differences that correlated with health: roughly a third of people buried in the lower-status cemetery had tuberculosis, compared to 12% of the people buried in the monastery or the church. As people with leprosy or tuberculosis were not excluded from higher-status areas, the researchers think this reflected different levels of exposure to tuberculosis, not stigma.
However, all cemeteries contained many tuberculosis patients — especially the urban cemetery of Drotten, where nearly half the burials were in high-status areas and 51% had tuberculosis. People who could afford prestigious graves could also have paid for better living conditions, which helped them survive tuberculosis long enough for the disease to mark their bones.
These results suggest that medieval people were less likely to exclude the visibly sick from society than stereotypes indicate. However, the researchers caution that more excavations are needed to get a more complete picture of some cemeteries, and that their stringent diagnostic criteria may not have identified every patient.
“Individuals may have been carrying the bacteria but died before it could show up in the skeleton,” cautioned Kelmelis. “Unless we can include genomic methods, we may not know the full extent of how these diseases affected past communities.”
Reference: “Closer to godliness: a contextual study of osteoarchaeological and spatial patterns of diseased individuals in medieval Danish cemeteries” by Saige Kelmelis, Vicki Rytoft Kristensen, Lars Agersnap Larsen, Maria Knudsen, Lene Mollerup, Lone Seeberg and Dorthe Dangvard Pedersen, 26 November 2025, Frontiers in Environmental Archaeology.
DOI: 10.3389/fearc.2025.1699370
Funding: National Science Foundation, Wenner-Gren Foundation, American-Scandinavian Foundation, Velux
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3 Comments
So Monty Python and the holy grail isn’t a an accurate document of medieval Britain ? I’m shocked.
Monty Python aren’t a team of scientists. Rather, they’re a comedy troupe.
During major historical plague outbreaks, carts (or wagons) were indeed used to collect bodies, though the exact practice varied by place and period. The scene in Monty Python and the Holy Grail is comedic exaggeration, but it’s rooted in real historical behavior.
How it worked historically
1. Black Death (14th century Europe)
During the Black Death (1347–1351), mortality was so high that normal burial systems collapsed in many cities.
Authorities organized body collection teams.
Carts or wagons moved through streets to pick up corpses from homes.
Bodies were taken to mass graves or plague pits.
In some cities, church bells or public calls signaled collection times.
However, documentation suggests the famous cry “Bring out your dead!” is more mythologized than literally recorded.
2. London plague of 1665
During the Great Plague of London, there is strong documentation:
Nighttime “dead carts” operated under parish authority.
Collectors were sometimes called “searchers” or “bearers.”
Bodies were transported to large burial pits.
Contemporary diaries describe the process vividly, especially that of Samuel Pepys.
Pepys wrote about hearing the bell and seeing carts carrying multiple corpses through the streets.