What was the biggest health problem of the Middle Ages?

The bubonic plague is often considered the greatest threat to human health during the Middle Ages. But a new study suggests that medieval people had several bigger health problems, ones that caused far more deaths than the plague.

A team of British researchers wanted to better understand the health and medical challenges that medieval people faced. They note how many histories of the Middle Ages present plague – namely the Black Death that struck in the mid-14th century – as the greatest threat (and sometimes the only one worth mentioning), but is this accurate? The team wanted to do a more systematic analysis, using a range of written, archaeological, and palaeopathological evidence. Their research has been published in the International Journal of Paleopathology.


Their research focused on England between the years 1200 and 1500, but adapted modern methods for understanding the health issues of society. They looked at a variety of diseases and conditions, and then considered several key factors:

a) Its overall prevalence in the population
b) What proportion of cases result in the sufferer’s death? What proportion of cases result in disability?
c) How much disability does it impose upon the sufferer? Is this lifelong or for a limited duration?
d) How does it affect people of different ages?

A physician and a patient in bed. – British Library MS Harley 3140 fol. 2

The team created a model that looked at a medieval population of 100,000 and how much various medical issues would cause ‘Years of Life Lost’ and ‘Years Lived with Disability’. Based on this they came up with a list of the most severe health-related problems. They write:

So what was the biggest health problem of the Middle Ages? The answer is straightforward: infant and child death, followed by various infectious diseases, of which the most significant single one was probably tuberculosis.

Here are their top 15 health-related problems:

  1. Infant and child death (varied causes)
  2. Tuberculosis
  3. Fevers
  4. Viral pulmonary infections
  5. Diarrheal and GI infections
  6. Leprosy
  7. Social inequality
  8. Strokes
  9. Fractures
  10. Malaria
  11. Yersinia pestis (plague)
  12. Childbirth
  13. Rickets
  14. Cancers
  15. Mental illness

Many of the problems named here are now almost unknown issues in the modern western world. By way of comparison, the five largest causes of mortality in present-day England are: Ischemic heart disease, Lung cancer,
Stroke, Alzheimer disease and COPD.

The results also show that events like the Black Death should not be the focus of researchers when trying to understand medieval health. The researchers explain:


We need to dethrone plague as the poster child for medieval health problems. Plague is visible, dramatic and famous; but it is merely the tip of the iceberg. Across the later Middle Ages as a whole, your risk of dying from infant and childhood diseases was probably 15− 20 times higher than your risk of dying from plague, and your risk of dying from any of half a dozen endemic bacterial and viral infections was 4–8 times higher.

The article also points out how infectious diseases were the true threat in the Middle Ages, especially in childhood. They write that:

Medieval people lived in a sea of pathogens which assailed them continually. Particularly when their immune systems were compromised by hunger, poverty, or other illnesses, they died in droves. Cumulatively, infectious diseases formed a force as omnipresent, powerful and invisible as gravity, causing grief, moulding settlement patterns, deciding the fate of enterprises such as campaigns of warfare, and shaping demographic regimes.


The team hopes that their research and methods will be useful for other studies that look at health in past societies. Perhaps they too can better understand not only what were the different kinds of medical challenges people faced, but also how they responded to them.

The article, “The greatest health problem of the Middle Ages? Estimating the burden of disease in medieval England,” by John Robb, Craig Cessford, Jenna Dittmar, Sarah A. Inskip and Piers D. Mitchell, appears in the International Journal of Paleopathology. Click here to access the article.

Click here to read more about health and medicine in the Middle Ages

Top Image: Medical consultations as shown in British Library MS Sloane 1977  fol. 50r