Men and women in the Middle Ages suffered from the same diseases and risk of dying

Women in modern societies live about five years longer than men. Even in extreme conditions, girls outlast boys. The so-called gender survival paradox is completed when statistics show that women tend to have more illnesses than men, but a longer life expectancy. Although the paradox has not been resolved, science is beginning to point to genetics and biology. It has not always been like this. The study of the bones of hundreds of people who lived in medieval London, published in the scientific journal Science Advances, shows that, in those times, amid famines and several plague epidemics, both women and men had a similar morbidity and mortality risk. The authors of this work suggest only one possible explanation: in a patriarchal society, cultural factors that favored the men of London society won out over biology.

Bones and teeth bear traces of the illnesses and hardships that the body has endured, including mental ones. A study published a few years ago showed how the brains of children who had the misfortune of spending time in the orphanages of the Romanian regime under the dictator Ceaucescu were forever shrunken. The malnutrition, abandonment, and mistreatment suffered by children exploited during the Industrial Revolution can also be detected in the grooves that open in the teeth due to poor enamel formation (hypoplasia). Marks on the skull tell stories of oncological operations thousands of years ago or, from the earliest wars, in traumas to the bones caused by arrows or spears. But interpreting these bone scars is not always easy. The deterioration of the head of the bones of the extremities can be a sign of fragility. However, osteoporosis is a pathology that usually appears at more advanced ages, so it could also indicate greater resilience.

Based on this complexity, a group of bioarchaeologists has analyzed the remains of 1,658 people buried in London cemeteries between the 11th and 15th centuries. They looked for the presence of up to ten biomarkers, from hypoplasia to abnormal femur length, to the formation of new bone tissue (indicator of a traumatic injury, but also of its healing) or the presence of cavities. As University of Colorado Boulder anthropologist and co-author of the research, Sharon DeWitte, recalls, dental caries are connected to general health status: “They can reflect an inadequate immune response and are associated with malnutrition; cavities can also be a factor contributing to poor health; for example, by producing a systemic inflammatory response that can have negative effects, and infection by caries can spread from the mouth to other parts of the body.”

Using the results of these biomarkers, the researchers created fragility and resilience indices, looking at which side the bones fell depending on whether they belonged to a woman or a man. The conclusions of their work read: “Our comparison of frailty and resilience indices between males and females does not reveal any significant differences between estimated males and females. These findings suggest the male-female morbidity-mortality paradox that is observed in some present-day populations may not have existed in medieval London.”

Although the paper does not detail the results for specific biomarkers by using indexes that aggregate them, DeWitte relates what they detected (in a previous paper) with the specific case of the differential impact of the plague. “Our main conclusion was that men experienced significantly lower mortality risks compared to women after the Black Death (14th-16th centuries) under normal mortality conditions and during famines,” she explains in an email. “This suggests that the female survival advantage (due to their greater reserves of body fat and the protective effects of estrogen) that has been observed in more recent famines did not exist in the medieval period,” she adds. The reason, although they cannot state it with certainty, must have been social: “Perhaps because the cultural practices that benefited men in a society that valued them more outweighed any inherent biological advantage for women.”

The study’s primary author, James Madison University researcher Samantha Yaussy, gives another example: femur length. “Short femoral lengths are often associated with resource deprivation during growth and development, for example, food shortages or poor living conditions,” she says. When they looked at differences in the femur between men and women, they saw that “femoral length was more variable and contributed to fragility to a greater degree in women compared to men.” The bones studied were all from adults, suggesting that “the most fragile men, i.e. those with short femurs, died in childhood, resulting in the surviving cohort of adult men analyzed in our study exhibiting less variation in femoral length compared to women,” Yaussy adds.

For the authors of the paper, their results would demonstrate that the longer life expectancy of women observed today is a relatively recent phenomenon, probably due to less cultural marginalization today. “Longer female survival (i.e. the paradox of morbidity and mortality) did not appear until quite recently,” Yaussy argues. Throughout much of history, she adds, “women were culturally marginalized, which affected their survival.”

This would have caused societies such as medieval London to “minimise or eliminate any biological advantage they had through some cultural artefact, resulting in a woman’s risk of death being approximately the same as a man’s,” the researcher explains. However, there is another possibility that Yaussy does not rule out: that the most fragile men died in childhood and the adult sample has a bias in favour of those who survived, with a lower rate of fragility and a higher rate of resilience.

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