Title: Diseased cities: An examination of tuberculosis and other chronic respiratory diseases surrounding the time of the Black Death in Cambridge, England

Authors: Jenna M. Dittmar^1,2, Piers D. Mitchell¹, Sarah A. Inskip^1,3, Craig Cessford⁴, John E. Robb⁵

Affiliations: ¹McDonald Institute for Archaeological Research, University of Cambridge, Cambridge, UK; ²Department of Archaeology, University of Aberdeen, Aberdeen, UK; ³School of Archaeology and Ancient History, University of Leicester, Leicester, UK; ⁴Cambridge Archaeological Unit, Department of Archaeology, University of Cambridge, Cambridge, UK; ⁵Department of Archaeology, University of Cambridge, Cambridge, UK

Abstract: The presence of disease in past populations was affected by numerous factors, many of which were not uniformly experienced by members of society. By considering the heterogeneous nature of the inhabitants of Medieval towns, a more nuanced picture of how diseases affected societies can be seen. This paper aims to examine the factors that influenced the presence of tuberculosis and other respiratory diseases and the resulting lived experience of individuals in an English market town before and after the Black Death plague pandemic. Human skeletal remains (n=268) from three burial grounds in Cambridge, UK that date to c. 950-1538 were macroscopically assessed, including; the Hospital of St John the Evangelist (n=169), the rurban parish of All Saints by the Castle (n=91), and an Augustinian Friary (n=26). 23.3% (n=64/286) of individuals had skeletal lesions suggestive of a chronic respiratory disease. Of these, 12.2% (n=35/286) had evidence of tuberculosis and 10.8% (n=29/268) of individuals with well-preserved ribs had periosteal new bone formation on the visceral surfaces. When analysed by site, no significant difference in prevalence rate was identified between the hospital, parish and friary. Individuals that could be accurately dated to either pre- or post-1348 (n=184) were then analysed to determine if there was a difference in the prevalence of these diseases surrounding the Black Death, and no significant difference in prevalence was found before (n=25/126) or after (n=16/58). This suggests that the inhabitants of medieval Cambridge were uniformly affected by tuberculosis and other chronic respiratory conditions and were a consistent threat both before and after the Black Death.